There are loads of people who are scammers, and they're aware they are scammers. And then there's the true believers who scam people, but it's driven by delusion. I often wonder about the motivations of various high profile individuals such as faith healers. Benny Hinn randomly comes to mind. We rarely get to know for sure; we're left to speculate. (Although now and then, the truth is revealed with clarity. My favorite example is James Randi's legendary take down of televangalist Peter Popoff.)
Most of the ex-pats I talk to think that Bob is self-aware when he abuses patients for financial gain. I beg to differ. When Bob assumed control over businesses started by his patients, I believe he genuinely thought it was in their best interest therapeutically. And that it's rooted in narcissism on steroids.
(The other ex-pats think I let Bob off too easy. I beg to differ here too, because if I'm right, then Bob is profoundly delusional. That's not exactly letting him off the hook. But again I digress.)
In any event, it's a false dilemma. The human mind is complex. I think it's possible to be a true believer and a self-aware scammer. L. Ron Hubbard comes to mind.
As for Bob, we're left to speculate.
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