Activate Altar of Dementia by sacrificing Ruthless Ripper.
When Ruthless Ripper dies, Missy's first ability triggers, returning Ruthless Ripper from your graveyard to the battlefield face down as a 2/2 Cyberman artifact creature.
Resolve the Altar of Dementia ability, causing target player to mill cards equal to Ruthless Ripper's power.
Activate Ruthless Ripper's morph ability by revealing a black card from your hand, turning it face up.
Ruthless Ripper triggers, causing target player to lose 2 life.
Repeat.
This cunning loop relies on Missy to constantly intercept your sacrifices, turning the graveyard into a revolving door where the dead refuse to stay down. By feeding Ruthless Ripper into Altar of Dementia, you mill your opponents while Missy immediately resurrects that very same creature face down as a 2/2 Cyberman artifact creature. From there, you simply turn Ruthless Ripper face up using its morph ability, draining your target's life with its trigger before sending it right back to the altar.