 I'm Sam Wagner and I'm the author of Malignant Self-Love, Narcissism Revisited. How would a therapist describe a first encounter with a psychopathic patient? Let us imagine precisely such a session. The therapist writes, notes of a first therapy session with John Mayl, 46, diagnosed with antisocial personality disorder, or psychopathy and sociopathy. John was referred to therapy by the court, notes the therapist. This was part of a rehabilitation program. John is serving time in prison, having been convicted of ground fraud. The scam perpetrated by him involved hundreds of retired men and women in a dozen states over a period of three years. All his victims lost their life savings and suffered grievous and life-threatening stress symptoms. John seems rather peeved at having to attend the sessions, but tries to hide his displeasure by claiming to be eager to heal, reform himself and get reintegrated into normative society. When I ask him how does he feel about the fact that three of his victims died of heart attacks as a direct result of his misconduct, he barely suppresses an urge to laugh out loud and then denies any responsibility. His clients, he says, were adults, they knew what they were doing, and had the deal he was working on done well, they would have all become filthy rich. John then goes on the attack. Aren't psychiatrists supposed to be impartial? He complains that I sound exactly like the vicious and self-promoting low-brobe prosecutor at his trial. The therapist continues his notes. John looks completely puzzled and disdainful when I ask him why he did what he did. For the money, of course, he blurs out impatiently and then recomposes himself. Had this panned out, these guys would have had a great retirement far better than their meager and laughable pensions could provide. Can he describe his typical customer? Of course he can. He is nothing if not for him. John provides me with a litany of detailed demographics. No, I say, I am interested to know about their wishes, hopes, needs, fears, backgrounds, families, emotions, not the demographics. John is stumped for a moment. Why would I want to know these data? Not like I was their bloody grandson or something. John is contemptuous toward the meek and the weak. Life is hostile. It is one long, cruel battle, no holds barring. Life is a jungle. Only the fittest survive. Is he one of the fittest, I ask? He shows signs of unease and contrition, but soon I find out that he merely regrets having been caught. He depresses him to face incontrovertible proof that he is not as intellectually superior to others as he had always believed himself to be. Fact is, he was caught. Is he a man of his word, I ask? Yes, but sometimes circumstances conspire to prevent one from fulfilling one's obligations, he explains. Is he referring to moral or to contractual obligations? Yes, John believes him, because they represent a confluence of the self-interest of the contracting parties. Morality is another thing altogether, he says. Morality, John says, was invented by the strong to emasculate and enslave the masses. So is he immoral by choice, not immoral, he grins, and just amoral? How does John choose his business partners, I inquire? He settles down, back at the armchair, closes his eyes, and enumerates. They have to be alert, super-intelligent, willing to take risks, inventive, and well-connected. John says, under different circumstances, you and I would have been a great team. He promises me that as his psychiatrist, I would fit the bill. I am definitely one of the most astute and erudite persons he has ever met, I thank him, and he immediately asks for a favor. Could I recommend to the prison authorities to allow him to have free access to the public pay form? He can't run his businesses with a single daily time limited call, and this is adversely affecting the lives and investments of many poor people. When I decline to do his bidding, he sulks, clearly consumed by barely suppressed rage. I look at John and I say, how are you adopting to being incarcerated? John admits that he is not, because there is no need to. He is going to win his appeal. The case against him was flimsy, tainted, and dubious. And what if he fails, I ask? He doesn't believe in premature planning, he retorts. One day at a time is my motto, he says smugly. The world is so unpredictable that it is by far better to improvise. John seems disappointed with our first session. When I ask him what his expectations were, he shrugs, frankly doctor, talking about scams, I don't believe in this psychobabble of yours, but I was hoping to be able to finally communicate my needs and wishes to someone who would appreciate them and lend me a hand here. His greatest need, I suggest, is to accept and admit that he erred, that he made a mistake, and to feel remorse. This strikes him as very funny, and the encounter ends as it had begun, with John deriding his victims and laughing out loud. End of the notes of the first therapy session with John, a psychobabble.