This looks like one of the climactic scenes from an Imaginary Character movie (Drop Dead Fred, Donnie Darko, etc.). The "psychologist" represents Ziggy's repression, his desire for sanity and stability, but the trail of bodies in his gruesome wake* show that an attempt at murder-free living is merely a temporary state, a brief pause before the continuing slide to moral and psychological oblivion.
Ziggy has finally stopped yelling "Shut up shut up SHUT UP!" in public while debating this mental construct, and has finally decided to take his frightening advice. "But if I take responsibility for my actions. . ." he thinks aloud, finally realizing that an attempt at requital, however impossible for such great crimes, would leave his illusory bearded, flamboyantly disco Willy Wonka of a doctor no further function to fulfill. By becoming "whole" he will lose his greatest and only friend, will look at his hands and, for the first time, see the blood thereupon.
Will weep but feel free.
* But far be it from me to suggest that Ziggy is a killer:
"I wanna stwangle wu!"
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