From the point of view of a psychiatrist, Michael Swango's story could serve as a textbook illustration of a psychopath or sociopath, in current terminology (The Diagnostic and Statistic Manual of Mental Disorders of the American Psychiatric Association), Antisocial Personality Disorder, or ASPD. Such individuals are characterized by displaying a pervasive pattern of disregard for and violation of the rights of others, failing to conform to social norms, deceitfulness, reckless disregard for safety of self or others, consistent irresponsibility, and lack of remorse. Often their own self appraisal is arrogant and inflated. Yet, most amazingly, despite this list of unlikeable character traits, individuals with ASPD may be charming (if glib). It is remarkably easy to be seduced by the seeming sincerity and engaging charm of the sociopath.

Speaking as a training director who screens applications and interviews applicants, I fervently hope that I would have spotted the holes in such a young man's resume, looked beyond his charm and the superficial plausibility of his explanations, investigated thoroughly to get the entire and true picture of his convictions, heard directly from colleagues at his various institutions of the "between-the-lines" suspicions that they might not dare commit to writing, and had the correct instinct to refuse him. Yet I cannot help but be sobered by learning that Dr. Alan Miller, the psychiatry department's residency training director who hired him at Stonybrook, was a former New York State mental-hygiene commissioner who is still described by the dean who reluctantly accepted his resignation over this affair as "experienced and highly respected...a trainer of young people." Dr. Miller acknowledges responsibility for having apparently succumbed to Swango's "singularly persuasive [manner] at his personal interview." Yet, says Dean Cohen: "There would have been no way a skillful psychiatrist would detect any deviant behavior or lack of truthfulness. Any of us would be taken in, given how charming and bright and effective he was."

I do not agree that this complicated story supports the conclusion that "some physicians seem willing to take the word of almost any doctor rather than accept the rulings of the courts." Rather the problem seems to be one of getting the "ruling of the court" into the public record in such a form as to be unalterable by the smooth explanations, forgeries, or obscurations that a Swango can introduce.

Certainly a national data bank that tracks convictions, together with appropriate incentives to check it, will help. So too would providing state licensing boards with greater license to refuse credentials when the record is troubled to the extent that Swango's was. Perhaps the lesson for those who must screen applications is that no document submitted by any applicant can be fully trusted. In a world where anyone has access to xerox, laser printer, and fine paper, the most convincing forgeries can be easily generated. And one's own instincts for sizing up another and detecting honesty, one's own sense of fair play, can fall victim to psychopathy.