He shows no regret for the suffering he has 'inflicted on'/'upon' these innocent people.
His problems are mainly 'self-inflicted'.
a 'self-inflicted' wound
(..) Yes, why? Why wasn't killing the boy enough? Why must you send a letter, as well? I want to inflict pain, and I won't be satisfied unless I can see the suffering that I'm causing. He was watching the Santorellis. (..)2018 TvShow: The Alienist Title: These Bloody Thoughts Season: 1 Episode 4
(..) You see these butterflies? Beneath their beautiful wings is a whole array of instruments used to inflict agony during coitus. The connection between pain and pleasure is far more common than you think. The person I'm speaking of (..)2018 TvShow: The Alienist Title: These Bloody Thoughts Season: 1 Episode 4