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Articles:  Charles Manson's psychopathology complicated and fascinating & 
What You Need To Know About DSM-5-TR {Below}

Charles Manson’s psychopathology 

complicated and fascinating


By Alan F. Friedman, Ph.D., et al

     A recently published journal article examines the last psychological evaluation of Charles Manson and includes a contemporary analysis of his psychological test findings along with clinical observations of his personality, both from the original testing and past interviews from video recordings.  

     Tod Roy, Ph.D., the clinical psychologist now retired from Pelican Bay State Prison in California, conducted an extensive assessment on Manson in 1997. He obtained permission to publish test findings after Manson’s death in 2017. Roy invited Joni Mihura. Ph.D., David Nichols, Ph.D., Reid Meloy, Ph.D., and me to participate in reexamining Manson’s data in order to potentially cast new light on his enigmatic personality.


     Manson was convicted on seven counts of murder. Among the victims were actress Sharon Tate, the wife of Roman Polanski, and her friend, coffee heiress Abigail Folger. The killings and legal case captured international attention and raised questions about Manson’s personality, diagnoses, ideology and motives for masterminding these horrific murders. The public has continued to be fascinated by the gruesome nature of the crimes, and a recent (2019) film by Quentin Tarantino (Once Upon a Time in Hollywood) has drawn wide audiences and rekindled interest in the “Manson family” crimes.

     The death penalty Manson received in 1969 was invalidated in 1972 by the U.S. Supreme Court. He instead served out a life sentence in the California Department of Corrections until his death at the age of 83.

     Over the course of his nearly half-century of confinement, Manson received multiple evaluations, resulting in diagnoses ranging from severe character disorder to schizoaffective disorder to schizophrenia. The recent study of the data collected by Roy allowed experts in the fields of psychopathy (Meloy), the Rorschach (Mihura), and the MMPI-2 (Friedman and Nichols) to reassess the original findings with contemporary scoring measures.

     Mihura, a co-developer of the Rorschach Performance Assessment System (R-PAS) published in 2011, reinterpreted Manson’s 1997 Rorschach results using R-PAS to expand the original interpretation based on the 1995 version of Exner’s Comprehensive System (CS). The original Rorschach findings concluded that there were signs of psychoticism and other indicia of disturbance.

     Mihura asked three people with R-PAS coding proficiency to re-code Manson’s Rorschach responses, blind to the original scoring as well as to the identity of the case. A major focus of her analysis was using the Rorschach data in a contemporary manner to help answer the decades-old controversy as to whether Charles Manson qualified for a diagnosis of schizophrenia. Roy’s conclusions from the Rorschach CS did not conclude that he had schizophrenia but, instead, Psychotic Disorder NOS.

     At the same time, his Rorschach CS results were used to conclude he had loose associations and tangentiality. These interpretations were based on the CS WSum6 index. That same R-PAS index (renamed WSumCog) was also elevated. However, R-PAS has more nuanced interpretations of that scale based on which of its components are elevated. Specifically, Manson was not elevated on the linguistic codes in that index that Mihura’s recent research shows targets disorganized thinking.

Instead, Manson had unrealistic and odd visual combinations (e.g., “2 KKK men with wings”), which is not empirically associated with disorganized thinking.

     Mihura was curious, after reexamining Manson’s Rorschach data, what the report referred to as his “metaphorical and disjointed way of communicating” that led many to conclude he had disorganized thinking, which had led to a schizophrenia diagnosis. Lacking access to the 1997 clinical interview by Roy, she reviewed video clips freely available online from 1970, around the time of his trial, plus an interview with Diane Sawyer in 1993 that occurred closer in time to his 1997 examination.

     Manson did not display anything close to disorganized thinking in the 1970 video clip. But in the Sawyer interview, as lucidly detailed in their journal article, Mihura concluded that what appeared to be disorganized speech was actually a highly skilled psychopathic attempt to control the interview – specifically, to avoid answering Sawyer’s pointed and persistent questions as to whether he instructed the members of the family to kill.

     In addition, consistent with his complex Rorschach responses and the behavioral observations

in the report, she also ruled out the negative psychotic symptoms of asociality and inexpressivity,

which contemporary research shows are the two other major components of schizophrenia. In contrast,

Manson was highly social and talkative as well as verbally, emotionally and behaviorally expressive.

     Friedman and Nichols rescored the 1997 MMPI-2 data and examined various items,

indices, scale components and scales to expand upon an earlier automated clinical

interpretation by the Caldwell Report. Using the Structural Summary of Nichols and

Greene (1995) the MMPI-2 data were organized into categories to re-interpret and expand upon the original MMPI-2 analysis. Validity scale interpretation revealed that Manson’s response style reflected specific areas of symptomatic disturbance rather than an effort to malinger or exaggerate psychiatric disability.

     Manson’s responses were deemed valid for interpretation. He produced a two-point code pattern of 6-8/8-6 with secondary elevations on Scales 1 (hypochondriasis) and 9 (hypomania).

     Manson’s MMPI-2 test results strongly suggested areas of psychotic ideation, although not necessarily to a level of manifest decompensation. Not surprisingly, he endorsed items reflective of delusions of control and persecutory ideas, along with other endorsements referring to spotty sensory oddities. Additionally, multiple cognitive complaints emphasizing memory, concentration and initiative were admitted.

     Manson’s mood at the time of testing appeared euphoric and grandiose, but also irritable. His profile pattern and multiple responses suggested mania, consistent with his reactivity and his animated and intense style as an imposing and flamboyant figure, with over-talkativeness and episodes of intense excitement and impulse pressures leading to actions without sufficient deliberation or restraint.

     The MMPI-2 reanalysis notably reveals a mixed diagnostic picture, including a primary diagnosis among the mood disorders. He tested as being vulnerable to a psychotic decompensation with one or more concurrent personality disorders based upon his strong psychopathic, antisocial, schizotypal and narcissistic trends.

     Meloy examined Manson’s Psychopathy Checklist-Revised (PCL-R; Hare, 1991) and concurred with Roy’s interpretation that Manson’s score of 36 reflected markedly severe psychopathic personality traits. Meloy expanded the interpretation of psychopathy by describing how Manson used psychological manipulation and physical aggression to achieve his goals. He points out that Manson manifested the “dark tetrad” of psychopathy, narcissism, Machiavellianism and sadism in his interpersonal and criminal history.

     Meloy draws connections between the PCL-R and the MMPI-2 data in a way that displays their convergent validity. The authors further present a comprehensive discussion of the DSM systems used over the years to diagnose Manson and describe a hybrid model of personality assessment, using both a categorical and dimensional approach.

     Meloy describes Manson and his “family” as a terrorist cell which was politically motivated to target non-combatants. This is especially interesting as it addresses the concept of accelerationism through his “helter-skelter” fantasy. Manson is currently a hero for neo-Nazis worldwide, wherein acceleration is understood as a violent means to advance the collapse of existing social and economic order. Meloy delineates the nexus between Manson’s severe psychopathology and ideology, which helps explain the motivational context for the Manson family killings.

     Readers interested in the psychological functioning and motives of Charles Manson will also find Roy’s historical review of Manson’s adverse upbringing important and can read about how the original assessment of this high-profile mastermind criminal/terrorist occurred within a prison setting. This article should help clinicians understand the psychopathology of one of the most notorious criminals of the Twentieth Century.

The abstract may be found at:

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 Tod A. Roy, Ph.D., is a clinical and forensic psychologist who practiced in California and Arizona. He has been retired since 2016.

 Joni L. Mihura, Ph.D., ABPP, is a professor at the University of Toledo. She specializes in assessment, psychosis and test validity meta-analyses. She co-developed the new Rorschach system (R-PAS) for which she presents lectures and training internationally.

Alan Friedman, Ph.D., is a faculty member at Northwestern University Medical School. He is the senior author of three MMPI textbooks. He specializes in risk and hiring assessments for public safety agencies and is a litigation expert/consultant in civil and criminal cases.

David S. Nichols, Ph.D., is a retired clinical psychologist whose career has focused on personality assessment, both in psychiatric hospital and graduate education settings. He has published extensively on the MMPI and MMPI-2.

Reid Meloy, Ph.D., ABPP, is a board-certified forensic psychologist and consults on criminal and civil cases. He has been a consultant to the Behavioral Analysis Unit, FBI, for the past two decades. His email address is


What you need to know about DSM-5-TR

By Megan Wrona, Ph.D.


and Brian Burke, Ph.D.

The Diagnostic and Statistical Manual of Mental Disorders (DSM) provides classifications for the range of human mental health disorders. The DSM outlines specific symptoms that must be exhibited for a person to receive a particular diagnosis and is used to communicate within the profession. 

     Since the publication of DSM-I in 1952, it has been revised roughly every decade or so. Across the revisions, diagnoses have been expanded, removed, clarified and updated as our culture shifted and our understanding of disorders grew.

     The most recent substantial changes to the DSM were published in the DSM-5 in 2013. Some diagnostic categories were modified (e.g., separation of Mood Disorders into Depressive Disorders and Bipolar Disorders) and some disorders were changed and/or removed (e.g., elimination of Asperger’s Disorder in favor of Autism Spectrum Disorder). The multiaxial system was eliminated, diagnoses were streamlined and disorders were more closely aligned with the International Classification of Disease (ICD), according to the ICD-9 and the then soon-to-be-released ICD-10 (2015).

     In March of 2022, a text revision TR) was published. The DSM-5-TR had multiple goals, but the modifications and updates were not substantial enough to warrant a DSM-6. Although the revisions in the DSM-5-TR do not significantly change clinical practice or diagnoses, clinicians should be familiar with their implications.

     Most changes in the DSM-5-TR are minor updates related to clarity in the wording. For example, in Autism Spectrum Disorder, “as manifested by the following symptoms” was changed to “as manifested by all of the following symptoms” in order to highlight that someone must exhibit each of the symptoms in criterion A (Deficits in Social Communication and Social Interaction) rather than merely one or two.

     Those interested in the wording changes for specific diagnoses should review the Fact Sheets provided online at the American Psychiatric Association’s website.  Although most changes are small, the more substantial changes include:” Increased Attention to Culture, Racism, and Discrimination.” Revising the DSM to be more inclusive and aware of the role of culture, racism and discrimination was a priority of the TR.  Two working groups reviewed details throughout the DSM-5. The first group, the Cross-Cutting Review Committee on Cultural Issues, updated diagnoses to include potential cultural influences on the diagnoses. As you review the TR, you will notice that sections on Culture-Related Diagnostic Issues are expanded for many disorders.

     For example, discrimination and other cultural factors are now explicitly named as potential

contributors to the onset and severity of PTSD.  Additionally, the section acknowledges that certain

communities may be exposed to ongoing trauma, which can impact individual symptom presentation.

The second group, the Ethnoracial Equity and Inclusion Work Group, identified language that may

be discriminatory or perpetuate stereotypes. Their recommendations led to updated terms in the

DSM-5-TR. For instance, racialized replaced race/racial, experienced gender replaced desired gender

and terms such as minority and non-White were removed.

Coding Updates

     The DSM-5-TR now aligns with the ICD-10 revision, Clinical Modification (ICD-10-CM). ICD-9 is no longer included. Clinicians should be aware that ICD-11 was published in January 2022 and thus coding will likely be updated in the next version of the DSM.

     Prolonged Grief Disorder is the only new diagnosis in the DSM-5-TR. This disorder acknowledges complex, persistent grief and its impact on functioning. It can be diagnosed if someone exhibits a persistent grief response that extends beyond 12 months for adults (6 months for children). Prolonged Grief Disorder is classified with the Trauma and Stressor-Related Disorders category.

Codes for Suicidal Behavior/Ideation. Suicidal Behavior and Nonsuicidal Self-Injury were added as additional codes under the classification of Other Conditions that May Be a Clinical Focus. These were added to better assess the prevalence of these behaviors, improve treatment and identify potential risk factors for suicide.

     Other miscellaneous updates: The names of two disorders were changed to match ICD coding: Intellectual Disability was replaced with Intellectual Developmental Disorder and Conversion Disorder was replaced with Functional Neurological Symptom Disorder. Unspecified Mood Disorder and Stimulant-Induced Mild Neurocognitive Disorder were added after inadvertently being left out of the DSM-5. Specifiers for Adjustment Disorder were clarified and include “Persistent (chronic)” as a specifier when a stressor is ongoing or if it has enduring consequences (e.g., a drawn-out, contentious divorce or COVID-19).

     For more detailed information, please review the American Psychiatric Association’s website, which provides various Fact Sheets related to specific disorders and general changes.

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References available from authors

Megan Wrona, Ph.D., is an associate professor of psychology at Fort Lewis College. Her research

interests center around how culture integrates with clinical practice as well as teaching. She is a licensed psychologist in Colorado and Utah. Her email address is

Brian Burke, Ph.D., is a clinical psychologist and professor of psychology at Fort Lewis College whose research interests include motivational interviewing, terror management theory and college teaching. He has published numerous articles and is the co-author (with Wrona) of Abnormal Psychology: A Modern Approach, Third Edition, an undergraduate textbook.

His email address is

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