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PERSPECTIVE ON MENTAL ILLNESS

The Stigma Is Always on Trial

January 25, 1998|PARK DIETZ

Park Dietz was a consultant for the prosecution in the Theodore Kaczynski trial. He is a forensic psychiatrist and clinical professor of psychiatry and bio-behavioral sciences at the UCLA School of Medicine. He testified in the trials of John Hinckley, Jeffrey Dahmer, Erik Menendez and John duPont.

Schizophrenia is a terrible disease that can profoundly alter a person's perception of reality. In the paranoid form of the illness, the patient may experience frightening hallucinations or delusions. A family member, a neighbor or a passing stranger may be perceived as a malevolent impostor, a threatening robot or an attacking demon. Some patients believe that their thoughts are being broadcast to others, that transmitters have been placed in their bodies or that they are under electronic surveillence wherever they go. A burnt slice of toast, an unlucky number on the license plate of a passing car or a frown from the boss are not only taken as intentional harassment, but are cited as clues to the identity of a persecutor and evidence of the conspirator's omnipotence.

For many patients, it is like living in a horror film. Although most manage to avoid lethal violence, as many as 10% ultimately kill themselves, often to escape an intolerable existence, and a smaller percentage kill others, often to protect themselves from a perceived attack.

A young security guard baby-sitting his 3-year-old nephew hallucinated that the boy had transformed into a red-eyed vampire. Terrified by what he saw and believing he was killing a vampire, he killed his sleeping nephew, then tried to protect himself from continued attack by cutting the heart from the body and burning the remains in the fireplace.

I found him to suffer from paranoid schizophrenia and to be insane--not responsible for the crime. He was insane not because he was schizophrenic or because his crime was bizarre, but because his illness caused him to believe at that time that he was killing a vampire. Thus, he did not know he was killing a human and did not know that what he was doing was wrong.

In contrast, consider the case of John E. duPont, who held delusional beliefs that there were hidden tunnels in his estate, that his mansion moved mechanically and that people were hiding in the walls and the trees to spy on him. He acted on these delusions by excavating the grounds in search of tunnels, insisting that his employees spend countless hours observing videotapes of the mansion that allegedly showed movement of the building, placing barbed wire into the spaces in the walls and shooting into the trees. Although there was some debate as to his diagnosis, paranoid schizophrenia was the most popular finding among the experts at his trial.

DuPont never said why he shot and killed Olympic wrestler David Schultz, claiming he had not been there or done that, despite two witnesses. The defense contended that DuPont must have thought Schultz was a Russian terrorist who was about to kill him and was therefore not responsible because he thought he was doing the right thing in defending himself in an act of war.

The prosecution contended that the murder was motivated by DuPont's envy of the high esteem in which Schultz was held by the wrestling community and by anger toward Schultz for befriending another wrestler who was harming DuPont's reputation in the highest ranks of Olympic wrestling by disclosing DuPont's instability. I testified that DuPont's actions in threatening the witnesses, fleeing the scene and telling his staff, "If the police come, don't let them in," all showed that he knew what he had done and knew that it was wrong. Thus, despite his illness, he was responsible for the crime.

Having schizophrenia does not eliminate responsibility for criminal actions unless, at the very moment of the crime, symptoms of the illness cause the person to meet the legal test of insanity. In most jurisdictions, only a killer who does not know what he is doing, who did not know it was wrong or who couldn't control his actions is insane under the law. Even people with untreated schizophrenia usually know what they are doing and whether it is wrong. And while the person with schizophrenia may have little control over his symptoms, he has considerable control over his actions. Thus, with rare exceptions, even people with schizophrenia are responsible for their bad acts.

Despite great advances in the medical treatment of schizophrenia in the second half of this century, we remain woefully deficient in our ability to deliver that treatment to patients in need. The stigma associated with mental illness is at the root of this failure and contributes to inadequacies of health insurance coverage for mental illness, lack of information and resources among the families of patients, and the difficulties many patients have in accepting their own illnesses.

Each time a notorious criminal claims schizophrenia, a public debate erupts around the issues of responsibility and punishment. I admit these are fascinating issues, but these controversies have a tragic side effect: They associate the schizophrenia label with notorious criminals, which adds to the stigma of mental illness, making it even more difficult to get patients the help they need. Whether Ted Kaczynski was correctly diagnosed as suffering schizophrenia is now less important than the resolve not to punish sufferers for the crimes of one extremist.

Every time a notorious criminal claims to have schizophrenia, it hurts the law-abiding majority of sufferers.

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