TVScope: Psycho - The Man Who Faked His Life Channel 4, September 13th, 10pm

If you watched The Man Who Faked His Life last week, you were probably perturbed by it. Presented in the opening narration as "the story of how one trivial lie led to the murder of a man's entire family", the programme brings one into the images and emotions on discovery by firemen in January 1993 of two children and their mother dead in a blazing house.

Their father was also found in the blaze, mute, traumatised but alive. His parents, it emerges, have also been murdered in their home some distance away.

Who would want to hurt this man, who was without an enemy in the world? This was the perfect family: the father, Jean-Claude Ramond, was a respected medical doctor and researcher for the World Health Organization in Geneva. The mother was a pharmacist who devoted most of her time to her family. The children, seven-year-old Caroline, and five-year-old Antoine, were beautiful, able and sociable children who enjoyed the rewards of their father's successful medical career.

What initially appears to be a murder crime mystery unfolds as a human tragedy of mammoth proportions. It began, 18 years before the murders when Jean-Claude Ramond felt unable to take his first medical exam, pretended to his family that he had passed and began a life of increasingly complex deceit to maintain the pretence of a successful medical career. When the truth was about to be revealed he killed his entire family rather than kill their belief in him.

What kind of person does this? What kind of son kills his parents, what husband kills his wife, what father kills his children? Most of the interviews in the programme were with friends or crime writers, whose acquaintance with the fictional world of crime could hardly have outdone the illusory world Ramond created for himself.

The programme suggests that this typifies the condition of narcissistic personality disorder, with its grandiosity, self-importance, need for admiration, lack of empathy, exploitative, arrogant, haughty and envious behaviour that derives from too little or too much emotional support.

But anyone watching the programme must have felt that this story was much more complex than a simple collection of symptoms. For example, what are the boundaries between reality and fiction particularly in this world of "hyper-reality"?

What is "self" if a man can in his lifetime play so many parts? What is love if the approbation of the loved ones supersedes their right to know truly with whom they are in love, in all his human vulnerability? How can one know anyone, if one man could deceive so many? What lies behind the ideal family? What dark secrets do images of "perfection" contain?

• Marie Murray is director of psychology at St Vincent's Hospital, Fairview.