In a news item from Seattle in March of 2007: "a mentally troubled woman accused of drowning her six-year-old daughter, cutting off her head and throwing the remains off a bridge, has pleaded guilty to firstdegree murder."34
A schizophrenic man in his forties, with a long record of being abusive toward his mother-physically attacking her on a number of occasions-had been in and out of mental institutions many times. In a similar pattern to Andrew Goldstein's case, above, he would be released, would stop taking his medications, and would then experience a relapse. In his psychotic state, he imagined the FBI was following him and that he could save the world by getting people to give up their money and credit cards, since without them, "there would be no war or crime." He would walk around the city looking for the rainbow or else feeling he had turned into a bear. Finally, he began to believe his mother was "Satan," and in that state of mind, he attacked her with a knife, stabbing her many times and cutting out both her eyes-with the rationale that "now the World could see again." He felt compelled to attack his mother in this way so as to satisfy terrifying hallucinatory voices, as if from God, commanding that he "kill Satan." Shortly before the fatal attack he had complained in a hospital emergency room that radioactive emissions from a satellite were entering his brain and bothering him, making him feel that his own life was in danger. The murder was characterized as an evil act by the media immediately thereafter, but public reaction softened when it became apparent that the man was severely psychotic. Neighbors testified that when he was taking his medication, he was polite and friendly and helpful toward his mother, with whom he lived during his adult years when not in hospital.
A man in his late twenties had recently become a father. The burdens of the new responsibilities and demands that accompany fatherhoodbeing able to relate lovingly to the infant, working consistently so as to support the growing family, accepting the necessary shift of attention on the part of his wife toward the new baby-pushed this fragile man beyond his coping capacity. Already struggling with depression before he married, he now fell into a psychotic depression. Hearing God's voice urging him to destroy both himself and the infant so as to save the world from even bigger destruction, he jumped out the window, clutching his six-month-old son. He survived; the infant did not. The man was then sent by the courts to a forensic hospital.
Though marijuana is not often implicated in crimes of the "heinous" or "depraved" sort that would place them in the realm of "evil," heavy use in vulnerable persons may result in violent acts. A gifted young artist, for example, began to abuse marijuana several times a day every day in a deteriorating family context, one aspect of which was his mother having become extremely seductive toward him after the death of his father. As his tension mounted and his self-control weakened under the influence of the cannabis, he one day "lost it," and on impulse bludgeoned his mother to death. While smoking the marijuana so heavily, he began to show psychotic symptoms: delusions that his mother was the devil and that it was his mission to kill her. He has now spent many years off marijuana and on appropriate medication in a forensic hospital, where he has made an excellent adjustment. He has had one-man shows of his paintings in various galleries. In this case, what made for such a favorable recovery was the absence of psychopathic traits, along with the freedom from psychotic thinking, once he stopped the marijuana.
Heavy marijuana abuse in a psychopathic person can lead to a quite different result, and to the kinds of violent crimes that in the public eye smack of evil. This was the case with what the papers described as the "grisly slaying of dancer, Monica Berle" in 1989.35 Her killer, who had met the dancer through a friend and who had begun to live with her, both used and dealt marijuana heavily. He had developed grandiose delusions, imagining he was "the Lord," whose mission he felt was to "take leadership of the satanic cultists to make sure they do everything that has to be done to destroy all those people who disagree with my church ... those who call me evil, who say I am not the New Lord." He called himself "966" because he said that three lords came floating out of a wall to appear to him in 1966. After killing the dancer, he dismembered her body, boiled her head in a kitchen pot, and placed bits of her flesh in buckets he then kept in storage facilities. Having cooked her flesh, he then, in an act of grotesque generosity, dispensed some to the homeless in his neighborhood as "meat." As an earlier indication of his contempt for the suffering of living creatures, throughout his adolescent and adult years he had tortured cats and dogs. This may have served as a prelude to the manner in which he murdered and desecrated his victim. Because this man was psychopathic, but had been psychotic only temporarily owing to the effects of drug abuse, he should be placed in Category 16: multiple vicious acts that may include murder. Curiously, he did not, to the best of our knowledge, indulge in cannibalism himself. Instead, he dismembered his victim's body to destroy evidence. That he gave some of her flesh to strangers as though it were properly edible meat created a kind of cannibalism-by-proxy. This, of course, also contributed to the disappearance of her body, so as to thwart the authorities in their prosecution of the case.
Sometimes chronic abuse of powerful illicit drugs such as "crack" cocaine can lead to a psychotic state resembling paranoid schizophrenia: delusions of persecution are prominent, as are hallucinations commanding one to commit violent acts. Whether Lom Luong was hearing such voices is not known, but he was a heavy crack user. He had gotten into an argument with his wife (both were immigrants from Vietnam) and one day threw all four children off a bridge in Mobile, Alabama. Their ages ranged from three to just four months. He initially confessed, then retracted, claiming a certain woman had taken the children to feed and clothe them. But then over a period of several days, the bodies of the four children were found. Luong was called a "monster" in the press, and people who were against the death penalty wrote letters stating that they were still basically against it but wanted to make an exception in Luong's case.36 Luong's murder of his children, shocking because he killed all four at once, made headlines-but only briefly, because of his humble socioeconomic position. The situation was quite different when Andrea Yates drowned all five of her children in Texas in June of 2001. She had been valedictorian of her high school class and had worked as a nurse until she married Russell Yates in 1993. Her husband persuaded her to remain at home caring for the children, even home-schooling and homechurching them. Russell was a computer specialist at NASA earning what was then an upper-middle-class income. For a time, however, he insisted they all live in a Greyhound bus that he had converted into a mobile home. There was a family history of depression on Andrea's side; she'd had postpartum depression (leading to a suicide attempt) after the birth of her fourth child, and a more severe depression after the last child, who was only six months old. It couldn't have been easy to live-almost imprisoned-in such cramped quarters.
This may have contributed to her final depression, which reached psychotic proportions. She heard voices and had felt for some time like killing her children, which was most inconsistent with her otherwise unusually caring nature. The psychiatric care she received toward the end was not of the best quality: she was given two different antidepressants and an antipsychotic drug, but the latter was dropped, unwisely as it turned out, shortly before the murders. By that time, the family had moved to a house-where she drowned her children one by one in the bathtub.37 Granted that killing four or five of one's children makes a bigger impact on the public than killing only one, the publicity in the Yates case, in contrast to the Luong case, was a function of the higher social position of Andrea and her family. Described as a "shy woman, bereft of self-esteem, overwhelmed by raising her five children with little help, yet unable to admit her frustration,"38 she, as a person, hardly met any of our criteria for "evil." Once the matter came to trial, the shocking nature of the act, however, coupled with the publicity, led to an initial rejection of the insanity defense and to a sentence of life imprisonment. This was eventually overturned, and Andrea was sent to a forensic hos
pital, where she should have been sent in the first place.
There is something about cannibalism in the course of a crime that many of us react to with a revulsion more intense even than our reaction to incest, and not matched by any other act of violence, with the exception possibly of castration or other types of mutilation. Perhaps this has to do with the primitive nature of cannibalism, as though it represents our earliest, yet socially taboo, longing. In my psychoanalytic training, I was taught the developmental stages through which, in Freud's understanding, the infant passed on the way to psychological maturity. The first stage was called oral cannibalism, based on the assumption that the newborn wanted not merely to suckle at its mother's breast but to devour all of her. But newborns can't talk; they can only give us hints about what they're longing for. I think the jury is still out on this one. But I understand how predictable it is that we shudder when we hear about cannibalism: the crime involves, after all, the total annihilation of a human being-someone just like ourselves-not by an alligator or a tiger (which we don't hold to the same standard) but by another human being who was willing to trample on this most sacred prohibition in the social code. This is what underlies, I believe, the universal reaction of horror, and of evil, when we hear of a cannibal murder-especially when committed by a "crazy" person acting on impulse. He could, to our way of thinking, attack anyone at any time in a totally unpredictable fashion. When twenty-one-year-old Mark Sappington began killing on impulse and then cannibalizing four people in Kansas City, Kansas, and drinking their blood as well, he quickly earned the soubriquet "the Kansas City Vam- pire."39 Sappington was schizophrenic: someone whom most people knew as a charming young man with a ready wit. But under the influence of his psychosis, he heard voices commanding him to drink the blood and devour the flesh of whichever stranger he might meet next on the street. Some of the victims, however, were people he knew. As with many highprofile and particularly horrific crimes by mentally ill persons, the disposition in court is a mixed one: he will be held in a forensic hospitalbut for the rest of his life.
Despite improvements in the care of the severely mentally ill over the past twenty years, imperfections in psychiatry and the law still allow some dangerous persons to slip through the cracks. We are, however, much more aware of risk factors in mentally ill people that either lower or heighten the likelihood of a violent outbreak. Many of these factors have been worked out by law enforcement personnel40 and by mental health professionals.41 Some of the risk factors one watches for in trying to predict violence in the mentally ill include command hallucinations (in which a person hears a "voice" urging him to do a certain act, often enough a violent act); delusions of persecution (the belief that people are out to do you harm, for example); recent purchase of a weapon or camouflage gear; fantasies of revenge; abuse of alcohol or drugs; a criminal history-especially if marked by previous episodes of violence; head trauma; being male; and conditions such as schizophrenia or manicdepression. Other risk factors include personality abnormalities where certain traits are in abundance, such as paranoia, antisocial behavior, or psychopathic behavior. Mentally ill people showing only a few of these factors may be no more at risk for violence-much less for murder-than any average person. Others, showing many such factors, especially if previous violence and recent drug abuse are in the picture, are at far higher risk. In some tragic cases, however, our awareness of just how many of these red flags were present is raised only after a violent or lethal act has occurred. The next example shows how a tragedy could have been averted, had we known beforehand what we knew only in retrospect.
A thirty-nine-year-old man had first been diagnosed as schizophrenic when he was twenty-two. He had been in and out of hospitals numerous times in the interval, sometimes because of outbursts of anger and violence toward his parents. He had never worked and lived at home all during this period. It was his refusal to keep taking the medications he had been given that led to his becoming actively psychotic again and again, ending up for brief stays in the hospital on each such occasion. He would often hear accusatory voices and felt people were "after him." He had peculiar habits, such as wandering the streets at all hours, picking up cigarette butts, or taking twenty showers a day. His parents divorced during his adolescence, after which he lived alone with his mother. It was when she had to be placed in a nursing home that his life unraveled once again. By this stage, his mother had grown afraid of him and insisted he not visit her. When he attempted to do so, he was restrained by the staff, toward whom he then lashed out, necessitating police intervention. This happened twice, and both times he was taken to an emergency room to have his mental state evaluated. He was then admitted for observation and given appropriate medications, but was released after two days. Little inquiry was made into his lengthy psychiatric history. Nursing a grudge against the first psychiatrist who had examined him years before-and who had recommended he be hospitalized involuntarilyhe now decided to rob that doctor and use the money to spirit his mother and himself far away where they could continue to live together. To that end, just two weeks after the episodes of violence at the nursing home, he gained entrance to the doctor's office, carrying a suitcase filled with knives, duct tape, and other paraphernalia related to a crime and to escape. Whether his initial intention was to harm or kill the doctor was unclear, but he did begin to attack the doctor with knives. Hearing the commotion, a doctor who shared the office suite ran to the rescue of her partner-only to be attacked by the man with a meat cleaver and knives, and with greater force than had been used against the first doctor. The first doctor survived. The second died. Whereas a good deal of planning went into the attempted robbery of the first doctor, the murder of the woman was done on impulse. The attacker escaped from the building and was at large for several days before he was captured. Given that the victim was a well-known and highly respected psychologist, her murder instantly became headline news.42 The first headlines were all the more glaring because the "madman was still on the loose," a phrase that maximized the element of fear in the public.
As for the killer, the thorough examination he underwent after the murder showed that he had-with the exception of drug abuse-almost every known risk factor for predicting violence (including those specific for the mentally ill). There was a fantasized rehearsal of the crime, acquisition of weapons, lowered inhibition (thanks to his having stopped taking his medication), obsessional preoccupation with the doctor from the past, recent and past violence, involuntary hospitalizations on many occasions, a perception of injustice, active delusions, and command-type hallucinations. These were all within the context of chronic paranoid schizophrenia, in a male, where the risk is greater than it would be for a female. Unfortunately, the emergency room doctors who saw this man in the days before the murder had neither the time nor perhaps the intuitive sense to know that this man was at high risk for imminent violence. He belonged to a small group of mentally ill persons whose risk for violence in the near future was perhaps 90 percent, though their risk for actual murder would be much lower. He did not belong to the vastly larger group of mentally ill people for whom the violence risk was 1 or 2 percent, and for murder risk-negligible. Doctors in private practice don't have metal detectors as you enter their offices, nor would they always be of help. Dr. Wayne Fenton, associate director of the National Institute of Mental Health in Maryland, was killed by a schizophrenic patient he saw in his private office in 2006; the patient had used only his fists.43
What is hard for the public to understand is that for any given individual, going about the business of ordinary life, the risk of being harmed seriously, let alone killed, by a mentally ill person who has gone berserk is of about the same order as being killed by lightning. Yet the first seems evil and disproportionately high; the lightning strike we regard (more accurately) as bad luck and exceedingly rare. This has much to do, I believe, with the fact that within the animal kingdom, the animal of greatest danger to a human being is of course another human being. And since we are
the only animal capable of evil, death-especially a brutal one born of impulsive rage at the hands of our fellow man-is often interpreted as ... evil.
To put this point in clearer perspective, the public's emotional reaction to a shocking murder, especially to one that involves mutilation, extreme suffering, and degradation of the victim(s), torture, and the like, is altogether understandable. Accompanying this emotional reaction is, often enough, the word evil. Evil, when we say the word, is the verbal counterpart of the horror certain acts elicit. The public needs no education about this: the reaction is part of our culture, part of our nature. I say "our" here, referring to the fact that the vast majority of people, whatever murderous thoughts they may have from time to time when angered or grievously disappointed, do not lose control and do something evil. People have less reason to be afraid of the mentally ill person who kills a family member, however gruesomely, than of a psychopathic serial killer or a recidivist rapist-whose danger to the public is far greater. In between the once-in-a-lifetime act of the psychotic person who kills a parent and the psychopathic killer is the mentally ill person who is violence-prone and resistant to treatment. He, like the schizophrenic man who bludgeoned the psychologist, lives in a chaotic manner, does not comply with his treatment regimen, and is at great risk of harming others in the future. The mentally ill person committing an act of the sort we call evil is responsible for that act-but is considered to show "diminished responsibility" because of the illness. A good deal of the responsibility in a case such as that of the man who killed the psychologist rests on the shoulders of the "system" that was imprudent in releasing him from residential care in the first place. He had a long track record of defying medical advice and of menacing others. The medical system had a long track record of failing to ensure that he was kept within the four walls of a hospital setting-that protected him from his tendency to become ill and violent again, and that protected the public from what he was likely to do if prematurely released into the community.
The Anatomy of Evil Page 9