When police raided suspected murderer Ed Gein’s house in Plainfield, Wis., in November 1957, they found a chair upholstered in human skin, a skull used as a soup bowl, a belt decorated with carved-off nipples and a table propped up by human shinbones, among other gruesome items. The ghoulish “memorabilia” was discovered to be from at least two murdered women and dozens of exhumed bodies, which Gein obtained during up to 40 nocturnal visits to local graveyards.

After being diagnosed with schizophrenia and pronounced insane, Gein—whose mother Augusta was domineering and told him that women and sex were evil—was committed to a mental hospital. But after 10 years, he was declared fit to stand trial, which he did in November 1968. He was found “not guilty by reason of insanity” and sentenced to life imprisonment in psychiatric institutions.

While at the Mendota Mental Health Institute in Wisconsin, where he would spend the rest of his life, Gein had most of the medical staff praise his amiable disposition and cooperative nature And surprisingly for such a gruesome killer, he had an unblemished incarceration record.

A&E Crime + Investigation spoke with Dr. Gail Saltz, clinical associate professor of psychiatry at the New York Presbyterian Hospital Weill-Cornell School of Medicine and author of Anatomy of a Secret Life: The Psychology of Living a Lie about Gein’s unusual behavior as a  “model patient” after he was incarcerated for his crimes.

According to Harold Schechter, who wrote Deviant, a biography on Gein, the murderer was a perfect patient: blissful, calm, never requiring tranquilizers to keep under control—and he got along really well with other patients. Why do you think he felt “at home” while in confinement?

Somebody who was a child in an authoritarian home may feel familiarity or even compelled to repeat what was essentially a trauma for them.

Living under very stringent rules, without freedoms, and being told what to think and do is very difficult for children. [Some] assimilate to the conditions—even though they may be angry [about] them—and experience it as an ongoing chronic trauma. They then replay that childhood trauma as adults and reparticipate in the conditions as a way of managing and processing the trauma. Essentially, they are drawn to it.

In Gein’s mind, had Augusta been replaced by his incarcerators?

His incarcerators were the people that kept him under control. In being authoritarian, they may—you wouldn’t know for sure without talking to him—have been reminiscent of his mother.

It’s been reported the only thing that troubled medical staff about Gein was the disconcerting way he stared at nurses and other female staff. How did he feel at the sight of women?

It is hard to tell whether he was consumed by fantasy or obsessional thoughts or whether he eroticized their bodies. We also don’t know whether he suffered from depersonalization—a highly aroused and traumatized state where you are almost outside yourself, observing—which [sometimes happens to] people who have been abused. “A person who looks like nobody is home,” is how people describe depersonalization. Or maybe it was rage, or a combination of rage and eroticism—the possibilities are many.