Janet came to her family physician with acute symptoms of anxiety and teariness. She told a complex story of having met a handsome young man at a business conference 2 years ago. At the time, she was a single woman with her own successful business, and Matt was a consultant who was smart and confident. The two hit it off and embarked on a passionate and exciting relationship. Soon he suggested a professional partnership to expand her business. She was impressed by his clear vision and committed money from her inheritance to the project.

At the time, she felt seduced. He told her that they were special, smarter than the competition, and it seemed to be true for a while. Then she became aware that he was bending the regulations in their industry. When she asked about this, he became shockingly cold to her. He got into a rage and didn’t come home that night. He was there, though, when she woke up the next morning — as if nothing had happened — observing her. Eventually, regulators began to question their business practices. The excitement and closeness suddenly stopped and he disappeared with a substantial sum of money. She was left with debts and thorny legal problems.

Strong mother, absent father

Matt is a fine example of what’s known as a perverse character. The term doesn’t refer to sexual behaviour but rather to the structure of a person’s internal experience. Perverse characters usually had an ambivalent relationship with their mothers in which they intermittently felt special and protected, always with the possibility of replacing the father as the primary male in the household. The father was often absent or degraded in these families — in Matt’s case, he was a struggling musician whom his mother had discarded early in his life. These are the mothers who will bail out their offspring, no matter how much trouble they get into. As a result, the child grows up with a distorted sense of power that gives them a peculiar sense of confidence and self-possession.

Flouting the social norms

Such people appear to have a different worldview and to live by their own set of rules. The more psychopathic they are, the more they flout social norms and laws. They feel neither guilt nor empathy — for them, empathy gets in the way of reaching their goal. They appear very smart, and they’re expert at managing people emotionally — all in the service of getting what they want. If you get too close to them, they will likely do something a bit shocking, to push you back, and they will calmly wait to observe what you will do — just as Matt did when Janet began to ask questions. Perverse characters can be very changeable and may even appear to have multiple personalities because they can shift quickly. Unlike dissociative characters, though, they do this in order to satisfy a personal agenda.

Physicians may see perverse characters when they need something, often regarding legal problems. They rarely present with feelings of anxiety, depression or anger. More often, it’s their families and partners we see — those injured by these people as they make their way through life.