Jim Moriarty - Hiiiiii!

 (Sherlock Meta by wellingtongoose)

What exactly is wrong with Mr Moriarty?

I’ve always thought of him as evil but for the first time I look at Mr Moriarty from a medical perspective.

Is he mentally ill?

And if so, what does he have and how did he become this way?



Assumptions to Begin

As with all my metas, I assume that the Sherlock “universe” functions exactly the same as “real life”. If you believe that in the Sherlock “universe”, Jim Moriarty is pure evil and rose fully formed from the fires of hell that is your prerogative and this meta is not going to be of any interest to you.

If you disagree with what I’ve said, don’t torch my message box like its Bonfire Night – have a reasonable discussion with me.

This was written very quickly and skips over many details, may be technically inaccurate, uses terrible abbreviations and makes generalisations,  - so do message me if you need clarifications and explanations.

Sherlock must be really jealous…

If there was any character that actually does fit the profile of a “high-functioning sociopath” it would be Jim Moriarty not Sherlock Holmes.

However this term doesn’t exist (and never did). Moriarty’s condition would be described in modern psychiatric terms as: psychopathic/severe personality disorder (more on this later).

What exactly is a personality disorder and how does this explain Jim Moriarty?

“Personality disorders are enduring (starting in childhood or adolescence and continuing to adulthood), persistent and pervasive disorders of inner experience and behaviour that cause distress or significant impairment in social functioning. Personality problems manifest as problems in cognition (ways of perceiving and thinking about self and others), affect (range, intensity and appropriateness of emotional response) and behaviour (interpersonal functioning, occupational and social functioning, and impulse control). “ – Oxford Handbook of Psychiatry.

A really bad, scientifically and technically inaccurate, analogy involving computers…

 

This is best I can do to explain just how personality disorders work.  I don’t know much about computers, though so bear with me.

When we are born our minds are like a brand new computer off the production line. The hard disks are empty and unformatted; there is a basic operating system, which can be modified later.

The operating system is our “personality”. It dictates how we perceive and react to external stimuli. Some components of personality are genetic but the environment also plays a large role in the development of our personalities. At the current moment scientist are not sure exactly how genes and environment interact to produce distinct personality disorders.

Going back to the computer, as we interact with our environment we received inputs. We build up a hard disk full of data (memory) and software (skills). The content of each individual computer is different and depends on the environmental inputs. Although the basic operating system gives everyone similar potentials and constraints, the exact programs on individual computers mean that there is great variety in what tasks can be accomplished on each computer. Hence people have different skills, talents and gifts depending on their environment.

What happens in a personality disorder is that (and this is a terrible analogy) a virus infects the computer and corrupts the operating system. Please do not go away thinking personality disorders are infective, they are not!

On the surface it may appear that this computer is functioning normally but when you go to do certain tasks, you discover that it does not function in the same way a non-infected computer would.

The virus is a “bad” combination of external/environmental inputs that the patient is exposed to very early in life.

Because “infection” happens so early the virus becomes an integral part of the operating system and user does not realise that this computer should behave differently. In the same way patients with personality disorders tend to think they are perfectly fine and it is psychiatrists who are “nuts”.

Inputs into this computer are processed differently and do not produce the same output as other machines. In the same way stimuli that usually produced one emotional response in the “normal” population may produce a completely different emotional response in patients with personality disorders.

 This probably explains why Jim Moriarty’s response to “people have died” is “that’s what people do!”

(I originally thought this emotional response filled with frustration and anger was due to Jim loosing someone early in life and is still not past the anger stage of grief but it seems less likely.)

Personality disorders fundamentally distort the patients’ way of thinking and thus their way of functioning. They cannot understand why “normal” people think the way they do, in the same way that “normal” people cannot understand them (and label them insane or criminal).

Full Marks Mr Moriarty and that is not a Compliment

 

What is Psychopathy?

Psychopathic personality disorder (PPD) is considered a separate but related diagnosis to Dissocial personality disorder (DPD), which is characterised by a pervasive pattern of disregard for, and violation of, the rights of others. DPD is considered the most common personality disorder with a prevalence of between 1%-5% of the general population in the UK. Compare this with schizophrenia which has a prevalence of between 0.5%-1% in the UK.

For more on DPD read this meta.

However, most psychiatrists regard psychopathic personality disorder as a more severe manifestation of DPD. We must remember that, like any psychiatric illness, DPD exists on a spectrum and PPD is at one extreme end. Psychopaths have all the characteristics of DPD but to a more severe degree. In a highly unscientific way, I would describe them as just more “insane”. The same veneer of normality exists in PPD; they may even be better at disguising their abnormalities. However when the mask slips, it becomes obvious that these people are “psychologically disturbed”. Patients who are on the opposite end of the DPD spectrum will often be described as “nasty” and “criminal” rather than “insane”.

Psychopathic personality disorder is diagnosed most commonly using the Hare Checklist, a 20 point long list of characteristic psychopathic traits. These 20 traits are further categorised into three subgroups.

 Factor 1 traits are all to do with narcissism.

A high score in this category correlates with high social potency (ability to function well in society at least on the surface) and high achievement but does not correlate with high suicide risk. In fact these people who score highly in factor 1 are deemed very unlikely to commit suicide and are never put on “suicide watch” in hospital unless they have another psychiatric problem.

Factor 2 traits are all about antisocial behaviour patterns.

Most of the listed criteria are identical to the checklist for diagnosing DPD. People who score more highly in this section than Factor 1, usually have low socio-economic status and a high risk of suicide.

Therefore psychopathy itself has a spectrum of manifestations from narcissistic, charismatic and high achieving psychopaths at one end to poverty stricken, repeat offending criminals at the other.

I am quite convinced that Jim Moriarty firmly falls into the narcissistic end of the spectrum.

If we look at the checklist, we can see that he scores very highly over all, but better in Factor 1 than Factor 2.

The factors in italics are the ones that I do not feel Moriarty consistently demonstrates from what we can see on screen. I am not going to a great deal about each trait because this meta would be very very long.

Factor 1: Personality “Aggressive narcissism”

* Glibness/superficial charm (superb acting skills, charmed Kitty Riley very quickly)
* Grandiose sense of self-worth
* Pathological lying
* Cunning/manipulative
* Lack of remorse or guilt
* Shallow affect (his genuine emotion is short-lived)
* Callousness; lack of empathy
* Failure to accept responsibility for own actions (“That’s what people do!”)

Factor 2: Case history “Socially deviant lifestyle”.

* Need for stimulation/proneness to boredom (committing heinously clever crimes, getting Sherlock to come out and play)
* Parasitic lifestyle (unknown)
* Poor behavioural control (screaming in the middle of a conversation…)
* Lack of realistic long-term goals (no, definitely plans well into the future)
* Impulsivity (“I’m so changeable”)
* Irresponsibility (this is not failure to accept responsibility for crimes but rather unable to carry through with commitments)
* Juvenile delinquency (Carl Powers )
* Early behaviour problems (unknown)
* Revocation of conditional release (unknown)

Traits not correlated with either factor

Promiscuous sexual behaviour (unknown – we are really looking for multiple examples of cheating behaviour or several sexual partners in one night)

Many short-term relationships (unknown)

Criminal versatility (Jim in a nut shell)

Jim scores a solid 13 out of 20 which is enough to get him diagnosed.

In reality, if we had more information about Jim he could probably score much higher, perhaps even 18 or 19/20, which would make him a highly psychopathic individual – enough to get him sectioned and committed to a high security psychiatric unit.

In some cases their extreme traits make psychopaths diagnoses much easier if you know exactly what to look for. The average DPD suffer is more likely end up in prison than a psychiatric unit but people with PPD (at least the ones who get caught) are more likely to be sent to high security mental hospitals.

I don’t doubt that any qualified psychiatrist would be able to do a spot diagnosis on Jim Moriarty if they could see the scenes that we did.

However I am convinced that Jim has more than just psychopathic personality disorder. His intense obsession with Sherlock, emotional instability and the fact that his ended up committing suicide are good indicators of another personality disorder:

The Borderline between Psychotic and Neurotic



Borderline personality disorder is so called because it was considered that suffers are on the borderline between psychosis and neurosis.

A very bad, non-PC joke:

What is the difference between psychosis and neurosis?

Answer: the psychotic patient believes 2+2=5 and thinks you should too; the neurotic patient knows that 2+2=4 and is disturbed by this.

In effect, psychosis is characterised by delusions (belief held with strong conviction despite superior evidence to the contrary), and neurosis is characterised by an inability to cope with reality.

Walking on the Tightrope

 

In the UK we use a different diagnostic manual to the DSM-IV (used in America), called the ICD-10. The psychiatric diseases listed are mostly the same but under different names, and the diagnostic criteria are subtly different.  The ICD-10 equivalent of Borderline personality disorder is Emotional Unstable Personality Disorder (EUD).

Moriarty may not fulfil the diagnostic criteria (depends on the psychiatrist diagnosing him) but he definitely possesses certain unique traits of emotional unstable personality disorder that cannot be explained by any other diagnosis.

F60.30 Impulsive type

At least three of the following must be present, one of which must be (2):

1.     marked tendency to act unexpectedly and without consideration of the consequences

2.    marked tendency to engage in quarrelsome behaviour and to have conflicts with others, especially when impulsive acts are thwarted or criticized; (The patient does not need be in a lot of quarrels per se, psychiatrists look for people who have instigate or escalate conflicts with others to an unnecessary degree that cannot be explain simply by anger or humiliation. I think Jim Moriarty’s intent need to destroy Sherlock in Season 2 demonstrates the qualities we are looking for)

3.     liability to outbursts of anger or violence, with inability to control the resulting behavioural explosions

4.     difficulty in maintaining any course of action that offers no immediate reward

5.     unstable and capricious (impulsive, whimsical) mood

F60.31 Borderline type

At least three of the symptoms mentioned in F60.30 Impulsive type must be present (above), with at least two of the following in addition:

1.     disturbances in and uncertainty about self-image, aims, and internal preferences

2.     liability to become involved in intense and unstable relationships, often leading to emotional crisis

3.     excessive efforts to avoid abandonment (possibly? He did kill himself because he didn’t want to continue living in a world without Sherlock to “play” with).

4.     recurrent threats or acts of self-harm

5.     chronic feelings of emptiness.

6.     demonstrates impulsive behaviour

From a semi-professional view of point, I think Jim Moriarty’s obsession with Sherlock throughout the show is pathological. It is beyond the realm of what psychiatrists would regard as “normal” or “acceptable” obsession. He forms an intense interest in Sherlock despite not meeting the man and sacrifices his own gain in order to entice the object of his obsession through a maze of challenges that culminates in an audience with Jim.

It may just be because he sees in Sherlock a kindred spirit. In the psychiatrically well population, people do not normally attempt to destroy others they feel are similar to themselves nor do relationships usually end in suicide.

We do not have a good solid foundation for this diagnosis as there is reasonable doubt whether he may have EUD because there is much more room for different professional interpretations with regards to whether Moriarty clearly demonstrates enough of the criteria.

However having two personality disorders can alter the presentation of one or both of the disorders. Jim’s primary psychiatric disease has to be Psychopathic Personality Disorder and the development of this disorder may have contributed to an atypical presentation of EUD.

A psychiatrist would not disregard the EUD traits, whether or not he is diagnosed. From a practical point of view, these traits change his behaviour pattern so that it would deviate from what psychiatrists expect of “psychopaths”. EUD traits also influence assessment of suicide risk – with EUD traits Jim has just gone from a very low suicide risk to a high suicide risk.

A common observation that is not included in the diagnostic criteria is that people with EUD do not have a coherent solid sense of self. In other words they “do not really know who they are”. For most suffers this leads to uncertainly, low self-esteem and being easily influenced by others. For other suffers this produces the phenomenon we seen in Kitty Riley’s flat. Moriarty is incredibly convincing when he turns into Rich Brook - it is also as if he turns into a completely different person.

Creating a mask is a key symptom of psychopathic personality disorder but becoming an entirely different person is a feature we see in people with one kind of EUD. It is quite easy for such individuals to simply take on the role of another because they completely believe that they have become fundamentally different. They do not “perform a role”, they “live the life”.

In conclusion - if Moriarty were to walk into a psychiatric clinic he would most likely to be labelled as psychopathic personality disorder (narcissism predominate) with an emotionally unstable component.

Two is Good Company

 

Can you actually have two personality disorders?

Yes, and it’s incredibly common. Most psychiatric illnesses have co-morbidities. This means that there are often one or more accompanying disorders in addition to the main psychiatric disorder.

EUD and DPD as separate conditions give psychiatrists more grief than any other disease. These patients require very intensive management and never get better. There is no medically recognised effective treatment for personality disorders; most of what we do revolves around keeping the public and the patient safe. For EUD suffers we can give all manner of support and occasionally mood stabilisers like anti-depressants to reduce suicide risk. For DPD patients we either commit them to a secure psychiatric unit or if we cannot, we like to keep an eye on them until they inevitably end up in jail, again.

How did Jim become the Person he is?

 

There is no consensus on the actual agent that causes EUD or DPD. However there has been one very consistent finding in many large scale retrospective (examining past history) studies done people with personality disorders:

Child Abuse

As I’ve said previous the “seed” for personality disorders is sown very early in life. We do not know exactly how the different personality disorders arise from abuse but there is no denying the strong correlation. Correlation does not equate to causation and there are many flaws to retrospectice studies. Thus child abuse is considered a “risk factor” for developing personality disorders rather than the actual cause.

Emotionally Unstable Personality Disorder has the strongest correlation with childhood abuse, in particular sexual abuse. There haven’t been any large scale studies of the effect of genetics on EUD. It is know that first degree relatives of some with EUD have a higher risk of developing it than the normal population but this can be due to sharing the same environment.

Dissocial personality disorder/Psychopathic personality disorder appears to have a larger genetic component than EUD. We know this because when we study sets of identical twins raise in separate households and different environments, we find a significant percentage (~30%) of twins both develop DPD. Studies have also shown that physical child abuse and severe neglect correlate with the development of this disorder.

We must remember that is both genes and the environment in tandem that leads to the development of personality disorders. The identical twin concordance rate for DPD is only ~30% which means the ~70% of the factors the lead to this personality disorder are environmental.

It is important to remember that only a small minority of child abuse victims go onto the develop personality disorders, but nearly all patients with severe personality disorders have been abused as children.

Where Headcanon meets Statistics. 

In order for Jim Moriarty to end up the way he did, statistically he is very likely to have been abused as child. It is also likely that one or both of his parents had personality disorders as well. If I had to make an educated guess, I would say his father had DPD (as it is more common in men than women) and his mother had EUD (as it is more common in women than men).

Alternatively, his parents may have simply suffered from a myriad of social problems. The most common cause of parenting which results in children with personality disorders is drug addiction. It may not actually be the drug addiction that leads to abuse and neglect (though most psychiatrists think it is), it may be the entire socio-economic environment that these families inhabit. Poverty and all the associated problems increase the risk of child abuse, which increases the risk (how ever minute) of developing personality disorders.

Side note - Jim Moriarty may have been born with a genetic predisposition to DPD into a middle class family. His father might have also suffered from DPD, which may explain why Jim developed a more severe form. A significant minority of business leaders, politicians and dictators do have DPD. However the vast majority of people who develop psychopathic personality disorder/DPD are born into socio-economically deprived families.

Most commonly psychiatrists see:drug addiction, violent crime, domestic abuse, parents/siblings with psychiatric illnesses in the social/family history of patients who have developed DPD. To reiterate, we usually see all of these risk factors in the patient’s home environment not just one or two. 

I doubt both his parents stayed in his life for very long. EUD traits often manifest themselves in children who have suffered a string of abandonments – and they are relatively more common in children who have been spent a long time in social care. On the other hand, one or both of Jim Moriarty’s parents might have raised him to adulthood, which would only exacerbate the severity of his personality disorder.

From group studies of adopted children we have discovered that just exposing a baby to 12-18 months of abuse and neglect is enough to make a permanent alteration in some that will eventually lead them to develop a personality disorder. Most of this data actually comes from studies of Eastern European babies adopted by Western parents from the former soviet bloc. These babies arrive looking psychologically normal (because you can’t really do psychiatric tests on a baby). However many of them developed personality disorders (mainly DPD) despite living nearly all their lives in home environments that did not expose them to any of the risk factors for developing DPD e.g. abuse, neglect, poverty etc. Upon further investigation into the backgrounds of these children from their respective orphanages, researchers have discovered that they were almost all subjected to horrifying abuse as infants.

Jim Moriarty might have been adopted by a perfectly nice middle class couple, who absolutely adored him but he would still have turned into a psychopath.

Jim’s life has been anything but good but it is also, in my eyes, a tragedy. Statistical - it is more likely that his parents would have suffered from a whole host of social and psychiatric problems then it is for his parents to be responsible citizens or well off/middle-class.

Their household would probably have made “dysfunctional” sound like a compliment. They were obviously not fit to have a child, let alone raise one but the social services didn’t do the best thing which is to remove the baby immediately. Jim might have suffered through long months of abuse before he was eventually removed by which time the damage was already done.

Life in the care system in the UK is pretty dire. I doubt it is any better in Ireland. Statistics show children are less likely to leave school with any qualifications, much more likely to be addicted to drugs, and chillingly must more likely to die before they reach adulthood.  Moriarty survived but the time in care must have simply exacerbated his personality disorders.

Is Jim Moriarty to blame for the fact that he commits such heinous crimes? A significant proportion of psychiatrists argue that people with personality disorders should not be regarded as criminals – they should be seen as very ill people.

This meta is not entirely speculation. I’ve laid out the psychiatric reasoning for Jim’s diagnoses. There is scientific evidence to support the various risk factors that are involved in the development of personality disorders. This certainly isn’t an academic paper, heavens it would be laughed out of the face of the earth if it was (no references see) but there are facts to support my conclusions, which are more deductions I think than imaginations.