The persons examined in this study were males committed to St. Elizabeth's Hospital (Washington, D.C.) after having been declared not guilty of a crime by reason of insanity or having been referred to the researcher (a psychiatrist) by the courts of community agencies. The subjects represented a cross section of socioeconomic, racial, family, education, and criminal backgrounds. Hundreds of hours were spent probing the subjects' early experiences, fantasies, psychosexual development, and conflicts. Although the subjects developed insight, their criminal behavior did not change, since they continued to violate hospital rules, steal hospital supplies, use drugs and alcohol, and commit a variety of other offenses. All of the subjects displayed common patterns of thinking about themselves, about others, and about approaches to life. From an early age they reacted violently to all efforts to control them by setting limits and applying discipline. All perceived themselves as superior to others while others were viewed as pawns to be manipulated and used even against their wills. All were riddled with fear, primarily the fear of being 'put down' or losing control of the circumstances and people in their environment. This hypersensitivity to psychological threats created constant anger and thoughts, if not overt expressions of violence, to deal with these constant threats. Efforts to counter violent and criminal thinking patterns met with mixed success. Those highly motivated to change could be reeducated and through the exercise of their wills reprogram their basis approaches to people and circumstances.