The Spool / Movies
“Crazy, Not Insane” is a flawed, fascinating portrait of criminal psychology

Alex Gibney’s latest dives into the work of criminal psychologist Dr. Dorothy Otnow Lewis, but can leave you with more questions than answers.


Prolific documentarian Alex Gibney spent much of 2020 working on Totally Under Control, a film about the Trump administration’s dangerous, immoral dereliction of duty in the face of the COVID-19 pandemic that still rages across the country. However, the world shut down just as Gibney’s previous film, Crazy, Not Insane, was due to premiere at the South By Southwest film festival. Instead, it debuted at the Copenhagen International Documentary Festival and then sat on the shelf for most of the year, ultimately showing at Venice this fall before premiering for North American audiences November 18th on HBO and HBO Max.

Crazy, Not Insane is adapted from the writings of psychiatrist Dorothy Otnow Lewis, a woman who worked for decades with serial killers and multiple murderers. Through a collage of video footage of her career interviews, animated crime recreations, interviews with Dr. Lewis talking to Gibney, and memories delivered via voiceover narration by Laura Dern, Crazy, Not Insane revisits some of her more memorable cases. 

Dr. Lewis was a pioneer in court psychiatry, visiting with criminal patients to determine whether they were mentally competent… either to stand trial in the first place, or face execution for their crimes. More specifically, she was a pioneer in diagnosing cases of Multiple Personality Disorder (aka Dissociative Identity Disorder) as the result of childhood trauma and brain injury, working throughout her career at a theory that many people who kill do because of neuropathological illness.

Crazy, Not Insane
Photo: HBO

Crazy, Not Insane is a compelling watch. Dr. Lewis was at the forefront of a number of significant cases involving complex legal questions, and save for a few shocking photos of victims, Gibney mostly follows her lead of looking not at the what and how of the crime, but the why. 

True-crime documentaries occasionally focus far too much on the former, titillating viewers with salacious details about bodily mutilation while leaving killers’ interiority as something simply “evil” and unknowable; instead, here, Dr. Lewis cautions that “evil” is a religious concept. The patchwork approach to narrativizing her career works well, too; Dern’s narration is a great choice. Hers is a familiar, trustworthy voice, easing us in and out of some fantastical situations.

Because, while Dr. Lewis seems to believe wholeheartedly in what she does — and appears an empathetic, incredibly smart, infinitely-curious individual — she admits several times that her training says that “multiples did not exist.” 

Save for a few shocking photos of victims, Gibney mostly follows [Lewis’] lead of looking not at the what and how of the crime, but the why. 

Indeed, as the “Multiple Personality Disorder” episode of podcast phenom You’re Wrong About helpfully elucidates, Dissociative Identity Disorder has fallen significantly out of fashion in the last few decades, as “repressed memory” diagnoses faded at the close of the Satanic Panic. But you wouldn’t know it from Crazy, Not Insane, a film that treats people who question Dr. Lewis’s work as heretics who simply don’t believe in the humanity of killers.

Crazy, Not Insane is far too credulous of Dr. Lewis’s stories. Or, to put it differently: Dr. Lewis seems far too credulous of her interview subjects. As You’re Wrong About hosts Sarah Marshall and Michael Hobbes discuss in that episode, it’s incredibly easy for psychiatrists, interviewers, etc. to subconsciously guide their subjects to specific, predetermined, favorable outcomes. 

This is not at all to say that she’s a fraud or that she set out to lie, but Dr. Lewis evidently expects from the outset to find evidence that her patients are victims of childhood abuse, developing other identities to shield them from trauma. She fully admits to having been invited on to several cases “to confirm [a Multiple Personality Disorder] diagnosis,” often not diagnosing the patients herself, but confirming that they do have MPD. She seems disappointed when evidence is lacking; miraculously, her subjects then seem to come out with exactly what she was looking for.

Crazy, Not Insane
Nov 8, 1990; Rochester, NY, USA; Defense lawyer Thomas Cocuzzi questions Dr. Dorothy Otnow Lewis, a psychiatrist about her interviews with Arthur Shawcross. Mandatory Credit: Kevin Higley/Democrat and Chronicle via USA TODAY NETWORK

The documentary culminates with Dr. Lewis’ work with the Holy Grail of serial-killer interview subjects, Ted Bundy. Bundy famously denied having committed any of his crimes up until just before his execution, whereupon he admitted everything. For a while, in an OJ Simpson If I Did It-esque narrativizing of his murders, he described the killings as though they had been committed by something he named “The Entity,” before ultimately admitting to having done it all himself later on. 

This, along with the fact that Bundy occasionally signed letters from “Sam” — the name of his abusive grandfather — leads Dr. Lewis to wonder if perhaps Bundy too suffered from Multiple Personality Disorder. I’ve watched an unfortunate amount of Bundy media and have heard him be diagnosed with any number of afflictions, from “pure evil” to rampant narcissism; this one’s new.

Overall, Crazy, Not Insane is at its best when Dr. Lewis focuses instead on the ethics of the death penalty. Whatever her other shortcomings may be (depending on if you believe Multiple Personality Disorder is as common as she does), she is a fiercely empathetic woman, her pain and sadness at state-sanctioned murder written all over her expressive face. 

She describes one story of a man who, she says, saved the pecan pie from his last meal “for after the execution.” She looks horrified. “I would say he didn’t know what it meant to be executed, but my colleagues found him perfectly competent to be executed. And I don’t know who ate the pie.”

Crazy, Not Insane is currently playing on HBO and streaming on HBO Max.

Crazy, Not Insane Trailer: