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During a lecture to medical students, psychiatrist Dr Colin Bouwer noted that administering insulin would be the perfect murder. The victim would suffer hypoglycaemia, which could be attributed to a pancreatic tumour; coma and death would follow.
In the course of his murder trial the prosecution produced evidence that Bouwer had forged 11 prescriptions using patient’s names – for sulphonylureas, metformin and insulin. He had asked the National Poisons Centre if these drugs would show up in tests. Purporting to be a forensic psychiatrist he had asked experts for their views on blood tests. Shoved to the back of his pantry was a mortar and pestle with traces of insulin.
Dr Bouwer arrived in Dunedin with his third wife Annette in 1997. His New Zealand career led from clinical work to Head of Psychiatry at the University of Otago. Colin and Annette appeared to be an affectionate couple. However, at an overseas conference in 1999, Bouwer began a relationship with a colleague also attending the conference.
Soon after this Annette began experiencing dizziness and feeling unwell, she was admitted to hospital twice and had exploratory surgery to locate the non-existent insulin-producing pancreatic tumour. Despite improving during her hospital stays Annette deteriorated after returning home. She died on the 5 January 2000.
Dr Andrew Bowers of the Dunedin hospital insisted on a post-mortem despite Bouwer’s objections. Bouwer claimed that Annette (a devout Christian) was Jewish and should be cremated the next morning.
The trial and subsequent research uncovered dark details of Bouwer’s history. Between 1981 and 1992 he had been categorised as an “Impaired Doctor” by the South African Health Professionals Council because of his addiction to the opioid pethidine. South African journalist Megan Power uncovered that Bouwer had seduced woman patients. His claims that he had been a member of the African National Council and that he had been imprisoned and tortured, were revealed to be untrue.
Bouwer lied often. He told a friend that an earlier wife had killed herself and their children. He told Annette’s South African family that he had not contacted the hospital as Annette’s health declined because New Zealand health services closed over Christmas and New Year. He shaved his head to simulate the consequences of (non-existent) chemotherapy for (non-existent) cancer.
Bouwer was found guilty of murdering his wife. How could the exponent of the “perfect murder” have been caught? This was a carefully planned murder. Not a reactive, spontaneous violent attack.
Verdict and diagnosis
Credit for picking up on suspicious aspects of the case must go to Dr Bowers. The post-mortem he ordered revealed high levels of sedatives and insulin in Annette’s blood.
Bouwer’s sloppiness provided the prosecution with clues. The email trail. The forged prescriptions. The residue of insulin in the mortar and pestle. Even leaving the mortar and pestle in the pantry. These slip-ups provide evidence of another kind - the categorisation of Bouwer as a psychopath.
The trouble with defining a person as a psychopath, or any of the “Dark Tetrad” traits (as well as psychopathy, these are Sadism, Machiavellianism and Narcissism), is that these concepts overlap.
As Mary Trump, clinical psychologist and niece of Donald Trump notes in Too Much and Never Enough, ex-president Trump could be diagnosed as Narcissistic, or as Psychopathic, according to the criteria of the DSM5 (Diagnostic and Statistical Manual of Mental Disorders, Volume 5).
Below I attempt a distinction between these traits in terms of the Big Five personality profile.
Another question – do we gain anything by fixing a label to a murderer, or ex-president, or a boss? Bad behaviour is bad behaviour after all.
An answer to this challenge is the emerging research that different flavours of Dark-side personality perpetrate different sorts of bad behaviour. Diagnosis can help with assessing risk, and potentially, treatment.
Colin Bouwer seems to tick the boxes in terms of recent formulations of Narcissism (the Grandiose version that is – these items are from the Narcissism Personality Inventory 13). Would Bouwer describe himself as “A born leader”? Given his leadership roles – possibly. How about “I will usually show off if I get the chance”? Possibly that was the motivation of his lies, and his boast to the medical students. Or “I will never be satisfied unless I get all that I deserve”? His philandering behaviour indicates this could have been part of his mindset.
Bouwer also looks to fit to some extent with the three dimensions of Machiavellianism. He certainly attempted some manipulative tactics – going to South Africa when charged with murder to steal letterhead to “authenticate” his claim to be depressed and collecting drugs for his suicide. His sense of morality seems as pragmatic as the original Machiavelli – if it works it must be good, even if only for him. Machiavellians have cynical views of others motives – it is difficult to assess this in Bouwer’s case.
There are four aspects to psychopathy. On one of them Bouwer gets home free – he did not have a criminal record – until convicted of murder. There is of course his anti-social behaviour such as drug abuse and the exploitation of vulnerable patients.
There is clear evidence of manipulating others – the women he seduced, his wife, his mistress.
Was his lifestyle erratic? As well as his promiscuity the evidence is his impulsiveness in perpetrating Annette’s murder (the email queries, the forged prescriptions, the traces of insulin on the pestle and mortar), then attempting to cover his tracks (attempting to subvert the post-mortem).
Was he callous – emotionally shallow and cold? The slow poisoning of Annette is clear evidence.
Finally the fourth horseman of the Dark Tetrad – Sadism. Both sadists and psychopaths are impetuous and disagreeable. The distinction is that the psychopath inflicts suffering and the sadist watches. The psychopath attacks the victim. The sadist avoids involvement. The distinction can be understood in terms of the poles of extraversion – the psychopath is more socially proactive, and the sadist appears introverted, even socially withdrawn.
Do Dark Tetrad inclinations predict violence, particularly extreme even lethal violence?
The stand-out predictor of aggression and violence is psychopathy. Delroy Paulhus and his collaborators suggest that this is an extension of the short-term mating strategy that is a part of the syndrome of psychopathy. Sexual violence and competitive violence are an aspect of the psychopath’s manipulation of others, erratic lifestyle and limited emotionality, along with anti-social behaviour (which might not always result in conviction).
Janko Mededovic and Nicola Vujicic investigated the relationship between dark traits and violence by asking Serbian prisoners to report to rate these traits (using self-reports on standardised assessments). Some of these inmates were convicted of murder, some of other violent crimes, and others were non-violent offenders — all completed dark trait surveys of their personality.
Were the more psychopathic more likely to be violent, and lethally violent at that? There was no such pattern of any dark trait being associated with different offending.
Just because psychopaths are more likely to be violent does not mean that all violent offenders are psychopathic. A large proportion of violent offenders demonstrate “reactive” violence. Usually, they attack in response to a threat to their vulnerable status (see Margot Wilson and Martin Daly’s analysis of Chicago murders) – what used to be termed a “crime of passion.” Such violent offenders might not match any dark triad profile, their violence being the culmination of a range of experiences leaving them with a limited hold on status opportunities.
Using the Big Five to clarify the Dark Tetrad traits
Returning to the issue of distinguishing these dark traits – is there any indication of the difference in these individuals’ variation on the universal Big Five of personality (the OCEAN model – for openness, conscientiousness, extraversion, agreeableness and neuroticism, or “nervousness”)?
All of the Dark Tetrad traits share an antagonistic, ruthless, “disagreeable” inclination (the low pole of agreeableness). The “vulnerable narcissist” is low on agreeableness and highly “neurotic” (or emotionally unstable). Or if a grandiose narcissist is very “extroverted” along with disagreeableness – the more visible flavour of narcissism.
Two recent studies suggest that psychopaths are impulsive (low conscientiousness) along with their ruthlessness (Kevin Williams, Delroy Paulhus and Robert Hare, 2007; and Janko Mededovic and Boban Petrovick, 2015). There are less consistent suggestions of emotionality (which would match descriptions of low anxiety and fearlessness). Also, as noted above, there are indications that the psychopath is extraverted – so attracted to the prospect of rewards – potentially contributing to an “erratic lifestyle” (Williams).
The Big Five profile of the Machiavellian seems pretty much pure darkness – disagreeable and immoral to the core - as Martina Bader and others reported in a study of the “D” factor – the antagonistic core of disagreeableness.
Sadism is remarkable for “introversion” and social withdrawal on top of profound disagreeableness.
Colin Bouwer died in 2018. He had corresponded with Carl Elliot who wrote about the case in The New Yorker. Bouwer diagnosed himself as a psychopath, and complained of the impossibility of change. While treatment of psychopathy is still a contentious area a recent review identified “promising” angles. Not in time for Bouwer or for Annette Bouwer.