Well adjusted individuals are less likely to build a murderous drug empire. I think organized crime is a little bit like politics. If you’ve made it to the top you’ve been through so much shit that you have nerves of steel and a Teflon soul. You will have found a way to deal with it or you already went swimming with the fish.

They can probably afford a real therapist out of pocket but my guess is that’s the exception rather than the rule. The inevitable influx of millennials and gen-z into crime may have driven those numbers up since Tony Soprano but still.