Synopsis

Following The Texas Chainsaw Massacre (1974), we go back-to-back with Silence of the Lambs, the screen adaptation of the Thomas Harris novel by the same name and sequel to the 1986 film, Manhunter (itself an adaptation of the Harris novel Red Dragon). Both films (as well as the trilogy-completing novel/film, Hannibal) feature Dr. Hannibal Lecter, a brilliant and cultured psychiatrist turned man-eating serial murderer. Silence of the Lambs begins with FBI trainee, Clarice Starling, assigned to interview Lecter in the hope of providing information on a serial killer at large known as “Buffalo Bill” who has murdered 5 women and is believed to be holding a Senator’s daughter. Lecter, who is imprisoned in a “hospital for the criminally insane,” agrees to assist Starling, provided she acts to facilitate his transfer from the facility and discloses details of her troubled childhood. Although Lecter’s assistance proves invaluable in Starling’s search for Buffalo Bill, his ulterior motives eventually become clear.

At Rutgers Robert Wood Johnson Medical School, a triple feature of Psycho (1960), The Texas Chainsaw Massacre (1974), and The Silence of the Lambs is required viewing given that Ed Gein inspired the creation of all 3 films. Ed Gein, the Wisconsin Butcher, was a serial killer and body snatcher who fashioned trophies and keepsakes from the bones and skin of his victims.

THE PSYCHIATRY OF SILENCE OF THE LAMBS

Throughout the series, Thomas Harris repeatedly uses early childhood trauma as a catalytic event in producing personality and psychopathology (presented in greater detail in the novels). Notably, Hannibal Lecter, Jame “Buffalo Bill” Gumb, and Clarice Starling have all suffered abandonment by their parents and subsequent trauma.

Lecter was born to a wealthy family in Lithuania where his parents were killed by a Nazi air raid at age 11. He and his sister, Mischa, survived, only to be captured by Nazi sympathizers who murdered Mischa, cooked her remains, and fed them to Lecter.
Buffalo Bill is revealed as having been orphaned by his mother, an alcoholic prostitute, and was in foster care for 10 years before being adopted by his grandparents, whom he later murders. Following the killing of his grandparents, he is sent to an inpatient psychiatric facility where he learns to be a tailor and discovers his issues with gender identity.

Around the age of 10, Starling’s father, a town sheriff, was shot and killed after responding to a robbery. Her distraught mother was unable to provide for her and sent Clarice to Montana to live on the family farm. However, the sound of sheep being slaughtered was too much for her to bear, haunting her dreams into adulthood.

At the outset of the film, Gumb has murdered 5 women, removing swaths of flesh from each of his victims in order to create a patchwork bodysuit made of women’s skin. While Gumb is a crossdresser who has previously been denied gender reaffirming surgery due to psychiatric instability, the vast majority of sufferers of gender dysphoria are not violent toward others, though there is increased risk of self-destructive behaviors, substance abuse, mood disorder and suicide. Gender dysphoria is a new diagnosis to the DSM-5, with distinct differences from its DSM-IV precursor, Gender Identity Disorder. [Notably, the DSM-III (published in 1980 and in use at the time of the book and film) was the first edition to address incongruence between anatomic sex and gender identity specifically denoting a difference between gender identity (self-image) and gender role (outward portrayal of gender).] In DSM-IV, Gender Identity Disorder is classified as a sexual disorder, with diagnosis based on incongruence in identity. The DSM-5 takes a more progressive stance, accepting that gender identity incongruence in and of itself may not be pathological, but that distress arising from such circumstance is a specific diagnostic entity that may necessitate specific treatment goals and therapeutic strategies and social support.

Both Hannibal Lecter and Jame Gumb demonstrate behavior and attitudes consistent with Antisocial Personality Disorder (APD). This personality disorder is characterized by violent tendencies, disregard for laws and social norms, and a failure to feel guilt or remorse. While not all persons with APD demonstrate a propensity for violence, they frequently show blatant disregard for the rights and feelings of others, often acting to exploit others for their own personal gain. While the terms “sociopath’ and “psychopath’ have no consensus definition, they are often used interchangeably in the context of APD. The disorder is often seen with comorbid substance abuse and is common among incarcerated persons, with some estimates nearing 80% of all male prison inmates and 25% of female inmates.