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Book Review: The Psychopath Test – A Journey Through the Madness Industry

A few years ago, several dozen prominent neurologists and academics began receiving a similar package in the mail: a beautifully printed book with a note. The message to the recipients advised them that they’d been selected to crack a mysterious code, but no one knew where the packages had originated from. “The Psychopath Test” is the story of the journey to crack that code and how it informs the diagnosis and treatment of psychopaths. What do we know about the industry of diagnosing madness?

Immerse yourself in the stories of those who are labeled insane and the dubious practices of those who diagnose them.


  • Wonder how mental illness is diagnosed — and if there might be mistakes in the process
  • Want to go behind-the-scenes of mental health facilities
  • Are interested in how the mentally ill are treated

Book Review: The Psychopath Test - A Journey Through the Madness Industry


The curious case of a strange book, with its exquisite illustrations, fine paper, missing words, and elliptical aphorisms, baffled all those who received it. Some pages had been left blank; others had shapes carefully cut out. One of the recipients, a London neurologist named Deborah, called author Jon Ronson to put his investigative skills to work and figure out the source of the books, along with why the book urged its recipients to crack a special code. Ronson’s journey took him to several countries in Europe and North America, chasing down scant leads and looking into Facebook accounts that, upon examination, were carefully crafted fakes with names that created anagrams corresponding to the strange book.

Undeterred, Ronson’s research eventually led him to the home of a Swedish psychiatrist and translator, and after questioning the man carefully, Ronson believed that he’d found the elusive sender of the mysterious book. When he reported his findings back to Deborah, the two discussed the absurdity and intrigue the book had provided to the community of dozens of elite scholars who were drawn into the mystery when they had each received the book. Each scholar had reached out to other colleagues across various fields to try to solve the strange riddles, aphorisms, and codes that appeared in the book. Over the course of several years, this one mysterious book generated its own little economy: an exchange of theories and ideas that crossed oceans.

Like a stone thrown in a pond, the ripple effects of one crackpot’s odd project had spurred a wealth of fascinating ideas. Ronson wonders if this experience with the book mirrors how madness changes the way people encounter the world. Perhaps, he thinks, madness serves a role in how societies are organized; maybe society itself is an expression of a kind of madness. Thus, Ronson begins to consider madness in a new light.

In Ronson’s book The Psychopath Test, he asks: What if madness is part of what makes the world go around? What if society is not built on rationality but on insanity? What do we know about the industry built around diagnosing and treating madness, and what kind of irrationality is built into the system itself?

The Man Who Faked Madness

The American Psychiatric Association currently recognizes 374 known mental disorders, but the term psychopath is not listed among them. But the traits we tend to associate with psychopaths can be found in two well-defined disorders: narcissistic personality disorder and antisocial personality disorder. Those who embody these disorders are often manipulative, deceitful, obsessed with power, and preoccupied with grandiose, entitled fantasies about their success.

Given that many powerful business tycoons and politicians exhibit these traits, Ronson decides to find out if many of them could be considered psychopaths. He also wonders if it’s possible that psychiatrists have misdiagnosed or mislabeled psychopaths. If so, what would be the consequences of those mistakes?

To find out, Ronson seeks out a man named Tony, reputed to have faked his own madness to get out of a minor legal infraction, resulting in the disastrous consequence of him being indefinitely committed to Broadmoor psychiatric hospital. The more he tries to convince the doctors of his sanity, the more psychopathic they believe him to be. As Ronson digs into Tony’s story and medical records, he speaks with some of the psychiatric team members who agree that Tony faked insanity to avoid a prison sentence. The key difference in their opinion and Tony’s story is that they believe he faked mental illness because he’s a deceitful and manipulative psychopath trying to avoid the consequences of his crime at any cost.

The term psychopath came from a German doctor, J. L. A. Koch, who published a book on the condition in 1891. Since then, Ronson argues, the field of psychiatry has been fascinated with diagnosing psychopaths and experimenting with ways to treat them. Is there something innately broken in these alleged psychopaths — something in their genetic code that can never be reformed? Or is their behavior the result of neglectful parents and traumatic childhoods? While most of the field continues to debate the sources of psychopathology, doctors tend to agree on one thing: Once a psychopath, always a psychopath. That certainly seems to be the case with Tony, whose medical records continue to bear the label.

The Psychopath Test

One specific test is commonly used to determine whether someone should be classified as a psychopath: the HARE PCL-R Checklist. The 20-point HARE Checklist includes assessments related to grandiosity, need for excitement, lying, manipulation, lack of empathy, impulsivity, irresponsibility, promiscuity, and more. Early behavior problems also play an important role in diagnosis — things like cruelty to animals, persistent bullying, vandalism, and arson.

Most importantly, a key aspect of the diagnostic process is taking note of the person’s affect as they describe some of the things they’ve done. Thus, the HARE Checklist is not only made up of a standardized list of questions, it also requires the assessor to read between the lines of a person’s appearance, speech, and body language. This is problematic because it leaves much open to the doctor’s subjective interpretation of nonstandardized details.

Ronson theorizes that if the doctors think their subject is probably a psychopath, they’re more likely to attribute psychopathic tendencies to this person, which could result in an incorrect label being applied to that person for life. And unlike other mental disorders like depression, which mental health professionals understand comes and goes, the term psychopath is thought to be something intransitory: It’s a core part of who a person is.

The more psychologists Ronson interviews, the more he hears that many of them believe that a disproportionate number of diagnosable psychopaths could be found on Wall Street or as captains of industry. They tell Ronson that the higher you go up the corporate ladder, the more psychopaths you’re likely to find. So, Ronson heads to New York to discover if this is true, having first trained himself in the HARE Checklist so that he’ll be able to spot any psychopaths he might encounter.

Once there, he hears a lot of stories about CEOs and executives exhibiting psychopathic behavior: intimidating employees, staging unnecessary scenes of humiliation and cruelty, frightening their underlings, and being violent with their wives. Often, these men were also defrauding and stealing from their companies and ruining innocent people’s life savings.

A common theme among the men was an obsession with predators and prey. They believed themselves to be predators and thought it was only natural to take advantage of weakness in others. Ronson calls this corporate psychopathy.

After interviewing several “corporate psychopaths,” Ronson begins to wonder if the HARE Checklist is truly a foolproof method for identifying psychopaths. When talking to a fellow journalist and friend, he confesses his preoccupation with the Checklist and how he now finds himself diagnosing people he meets. There’s something terrifying and strange about the idea of meeting a true psychopath, and as a writer, he’s drawn to a good story. Ronson begins to wonder if psychiatrists have also been diagnosing too many people as psychopaths out of mere (if wellintentioned) fascination. What if there’s something psychopathic about spotting madness in others?

He continues his examination of this relationship between madness, fascination, and diagnosis when meeting with a British man named David Shayler. Shayler had been recruited as a spy for MI5 (so he says) and began popularizing theories in Britain that most of the terror attacks there were elaborate hoaxes staged to frame Muslims. From spy to conspiracy theorist, Shayler made his rounds in the media, until one day, he announced something truly unbelievable: He said he is the Messiah, and MI5 will help him save the world.

What Ronson realizes is that Shayler exemplifies being the right sort of mad — the sort of crazy that captivates public interest with his loopy conspiracy theories, commanding presence, and MI5 background. News media and entertainment outlets could immediately identify his persona as exhibiting the kind of madness that draws in viewers and creates just the right mix of interest and controversy. It’s not just journalists and psychiatrists who are beguiled by a good story; it’s the public at large. People might be suspicious, but they’re not as conspiracy-obsessed as David Shayler, so they enjoy watching him spew theories. A little of just the right sort of madness creates profits.

Good Luck

Ronson meets with an elderly psychiatrist to discuss his suspicions about the potential misdiagnosis and profiteering going on in the “madness industry,” as he calls it. The psychiatrist tells him about a 1973 experiment in which eight healthy doctors committed themselves to separate mental health facilities. They were all diagnosed with insanity, committed against their will for up to two months, and given powerful anti-psychotic drugs. The more they tried to convince the staff that they were sane, the more drugs they were given. All found that the only way out was to admit that they were insane and follow the staff’s plan to get better.

Due in part to the national fallout from this experiment, the Diagnostic and Statistical Manual, known as the DSM, was created to classify and categorize mental illnesses in a more recognizable, concrete way. As modified versions of the manual grew thicker — from 64 pages to 434 pages — with new diagnoses every few years, so did the public’s interest in using the book to diagnose mental illnesses. Millions of copies were sold to the general public, far outnumbering the mental health professionals for whom the book was designed.

The checklists in the DSM, combined with overzealous pharmaceutical companies and curious amateurs, was a worrisome combination. For example, a rise in autism diagnoses, which in fact was caused by criteria changes in the DSM instead of an actual rise in the number of cases, led to the anti-vaccination movement.

It seems to Ronson that the trouble with the checklists, HARE, and the DSM is that they all created a world in which ordinary behaviors can be misdiagnosed and misunderstood, even by well-trained professionals. There’s too much room for subjective analysis.

With these thoughts in mind, Ronson returns to visit Tony, the man who had gotten himself locked up in Broadmoor hospital to avoid a prison sentence and had been labeled a psychopath. Amazingly, the hospital had called in a tribunal of outside experts who decided that Tony should be freed, after more than 12 years of institutionalization. The doctor overseeing his treatment, who previously stated that psychopaths could not be cured, told Ronson he believed Tony had been reformed by the system.


After meeting many mentally ill patients and mental health practitioners, Ronson seeks to find out how and why people are diagnosed as psychopaths. He becomes caught up in the fascination of secretly submitting everyone he meets to the psychopath test — the HARE Checklist — with inconclusive results. It turns out that very different kinds of people can score highly on the HARE Checklist, and very few of them are psychopaths.

Ronson notes that in addition to the very disturbed people who these diagnostic tools catch, there are many who slip through undetected. And unfortunately, many who are mostly ordinary are wrongly diagnosed and mistakenly treated.

Ronson concludes that the madness industry is just that: a business that sells products. Its diagnostic manuals, training conferences, and extensive treatments are just the tip of the iceberg because now, Big Pharma is pushing more and more ordinary people to diagnose themselves and their children to “treat” them with drugs.

Reducing people to diagnostic labels creates healthy profits.

About the author

Jon Ronson is the author of The Psychopath Test, The Men Who Stare at Goats, and Them. He is also a documentary filmmaker and lives in London.

Jon Ronson’s works include New York Times bestseller So You’ve Been Publicly Shamed, Lost at Sea, The Amazing Adventures of Phoenix Jones, and international bestsellers: Them: Adventures with Extremists and The Men Who Stare at Goats. Ronson lives in New York.


Science, Mental Health, Sociology, Journalism, Mental Illness, True Crime, Humor, Criminal Psychology, Psychopaths, Biographies and Memoirs, Professionals and Academics, Medical Psychology Pathologies, Popular Culture in Social Sciences, Popular Psychology Pathologies

Table of Contents

1 The Missing Part of the Puzzle Revealed 1
2 The Man Who Faked Madness 33
3 Psychopaths Dream in Black-and-White 65
4 The Psychopath Test 89
5 Toto 119
6 Night of the Living Dead 139
7 The Right Sort of Madness 169
8 The Madness of David Shayler 179
9 Aiming a Bit High 212
10 The Avoidable Death of Rebecca Riley 230
11 Good Luck 253
Notes/Sources/Bibliography/Acknowledgments 273


In this madcap journey, a bestselling journalist investigates psychopaths and the industry of doctors, scientists, and everyone else who studies them.

The Psychopath Test is a fascinating journey through the minds of madness. Jon Ronson’s exploration of a potential hoax being played on the world’s top neurologists takes him, unexpectedly, into the heart of the madness industry. An influential psychologist who is convinced that many important CEOs and politicians are, in fact, psychopaths teaches Ronson how to spot these high-flying individuals by looking out for little telltale verbal and nonverbal clues. And so Ronson, armed with his new psychopath-spotting abilities, enters the corridors of power. He spends time with a death-squad leader institutionalized for mortgage fraud in Coxsackie, New York; a legendary CEO whose psychopathy has been speculated about in the press; and a patient in an asylum for the criminally insane who insists he’s sane and certainly not a psychopath.

Ronson not only solves the mystery of the hoax but also discovers, disturbingly, that sometimes the personalities at the helm of the madness industry are, with their drives and obsessions, as mad in their own way as those they study. And that relatively ordinary people are, more and more, defined by their maddest edges.


“Because of Ronson’s relentless self-deprecation and goofy, British humor, it’s easy to tag along without fully realizing the rigor of his reporting, which is itself frenzied with compulsive questioning and obsessive research.” — The Boston Globe

“A rollicking, page-turner of a book… no ordinary piece of investigative journalism… Ronson’s storytelling skills are strong enough to enliven even the necessary reflections that would be one yawn after another if entrusted to a lesser writer.” — San Francisco Chronicle

“…A book that manages to be as cheerily kooky as it is well-researched.” — Los Angeles Times

“Engagingly irreverent…” — New York Times

“[A] fascinating and humane book…” — Washington Post Book World

“…Both terrifying and hilarious.” — O, The Oprah Magazine

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