Wednesday, January 21, 2009

It Doesn't Get Crazier Than This

by Lucy Puryear, M.D.

In 2004 Andre Thomas killed his wife and children, cut their hearts out, put the hearts in his pocket, and walked outside. He then went home, put them in a plastic bag and threw them out. He stabbed himself three times in the chest and then walked into a police station to report his crime. What a horrible, heinous crime. He was understandably tried for capital murder. On the surface this looks easy--he turned himself in to the police and confessed his crime. He only needed to plead guilty and await his sentence. But while awaiting his trial in his solitary cell, he pulled his own eye out and ate it. Yes it's true, he plucked his own eye out and ate it, right there in his cell.

I have never evaluated Mr. Thomas, but according to newspaper reports he has a diagnosis of schizophrenia. His behavior now at least starts to make some sense. He suffers from delusions and altered reality. Maybe he hears voices. He reportedly believed that his family was possessed by the devil. Killing them was saving the world from evil. I couldn't find any report as to why he plucked his eye out. The prosecution suggested it was a ploy to appear insane. You've got to be kidding me.

I agree people try to fake mental illness to escape some form of punishment. I personally was duped by a fellow who showed up in the psych ward claiming to be a wolf. It took me about 30 minutes to figure out that his story was bogus and he was trying to find a warm place to stay for the night. He laughed when I told him that his diagnosis was that he was full of "s--t." He was quickly discharged.

Non-mentally ill people do not pluck their own eyes out for some secondary gain. People with
schizophrenia, when seriously ill, have been known to mutilate themselves in an attempt to cut off offending body parts, or kill themselves. I have personally witnessed one case of a man who cut off his own penis (fairly rare, but does happen), a man who cut off his arm with a circular saw, and a woman who slit her own throat. These persons had delusional "reasons" for doing these things and were "crazy" enough to be able to carry it out. I would propose that it would be close to impossible for any of us to pull out our eye voluntarily unless we were hallucinating on LSD or mushrooms. We would be temporarily "crazy."

In 2004 a judge declared Mr. Thomas competent to stand trial. He was found guilty and sentenced to death. While awaiting his sentence to be carried out, Andre Thomas last month plucked out his other eye and ate it. Yes really, he ate his other eye and is now blind.

The terrific blog,
Grits For Breakfast, posted on this story on January 9, 2009. The comments were amazing. Although there were several who were sympathetic with Mr. Thomas's mental health issues, many more suggested that he should be executed to put him out of his misery. Well that's one way to deal with the mentally ill in prison-- kill them.

To those of you who would suggest that I am soft on crime, consider this novel idea. How about we make mental health treatment available in the community to those who need it. Had Mr. Thomas been adequately treated and monitored he never would have killed his family or plucked out his eye. Three people would be alive today and an enormous amount of money would be saved keeping him out of the prison system. That's not soft on crime, that's preventing crime.

There are so many problems here. How do you find someone
competent to stand trial who is so severely mentally ill? The standard for competency is not very stringent. You have to understand the charges against you and be able to participate in your own defense. Those are easily met standards. How do lawyers and judges who may know next to nothing about mental illness evaluate the mental state of a defendant? By the time a defendant appears in court they have usually been medicated and no longer display obviously bizarre and crazy behavior. Someone who is no longer psychotic will often try to make logical sense out of the crime they committed and will say that they knew at the time that what they were doing was wrong.

There may be one way to make some sense out of the issue of the mentally ill who commit crimes. Several communities have
Mental Health Courts. These courts are in place for those defendants who have histories of mental illness before committing a crime, or committed a crime while mentally ill. The lawyers, judges, and others assigned to these courts have special training in mental illness and are equipped to knowledgeably handle these defendants. Instead of the revolving door from prison to back on the streets where psychiatric care is lacking, then back in prison when another crime is committed, these persons can be put into a system where follow-up is mandatory and resources are available. Another example of not being soft on crime, but preventing crime.

Harris County, Texas will soon have it's own mental health court.
Judge Jan Krocker's 184th District Court will hear felony cases of defendants diagnosed with schizophrenia, bipolar disorder and severe depression on a full-time basis. What a great idea: stop crime by making sure the revolving door is closed for those with mental illness. The perfect liberal and conservative agenda all rolled into one. Unfortunately for Mr. Andre Thomas and for his family it's too late in coming.


Anonymous said...

"Well that's one way to deal with the mentally ill in prison-- kill them."

I'm guessing that society as a whole probably doesn't want to kill every mentally ill person in jail.Bbut I bet society as a whole would probably have less qualms with mentally ill people in prison that killed more than one person in a truly gory fashion receiving the death penalty. And I'm not sure I believe that all mentally ill people don't know right from wrong.

I have no idea if this man knew right from wrong, or if he was completely delusional at the time he killed his family, then cut out their hearts. Maybe he was delusional, and didn't know right from wrong. But are all mentally ill people delusional, and not able to tell right from wrong, when they commit a violent crime?

"To those of you who would suggest that I am soft on crime, consider this novel idea. How about we make mental health treatment available in the community to those who need it. Had Mr. Thomas been adequately treated and monitored he never would have killed his family or plucked out his eye. Three people would be alive today and an enormous amount of money would be saved keeping him out of the prison system."

Are you alluding that no violent crimes have occurred while a mentally ill person was on medication?

I think you are too soft on crime when it comes to the mentally ill, and because of others that feel the same, attorneys have been able to take advantage of the system easier and easier.

Perhaps I wouldn't feel this strongly about it if mentally unstable people that committed horrendous violent crimes wouldn't be released from institutions. They've already proven how easily they can snap.

~Tulula Boolah

A Voice of Sanity said...

See Toronto: Canada's First Mental Health Court :
In August 1997 a significant increase in the number of mentally disordered accused coming through the courthouse was brought to the attention of the Chief Justice and Senior Regional Justice (Toronto Region).
It was proposed that a court specifically designed to accommodate mentally disordered accused be established as the amount of cases of this nature were clogging the justice system, causing unacceptable delays and inefficiencies.
The plan was endorsed by the Chief Justice and "Mental Health Court" opened in courtroom 102 in May 1998The Mental Health Court in Toronto was the first of its kind in Canada and one of the first in the world.
Mental health court a success

JUSTICE: Mentally ill offenders are getting the help they need instead of simply being put in jail.


The London Free Press

jigmeister said...

As long as treatment centers are established so that the special courts have some referral options, this plan has some merit. In the past, county and state institutions were the only options.

Jan has some special qualifications. She has suffered through personal trauma involving, I believe, depression that has been managed with medication and has a great deal of empathy that few other judges possess.

Anonymous said...

Making mental health available in the community to those who need it is not exactly a novel idea. There is already a lot of free mental health care available. Sadly, a lot, if not most seriously mentally ill individuals don't get it. And we already know that a large percentage of mentally ill individuals on meds quit taking them. We also already know how terrible our mental health and judicial system are at "monitoring" people. A mental health court may very help a select few like drug addicts and alcoholics, but I don't see how it will help individuals like Andre Thomas.

I agree that many of the mentally ill do not belong prison, nor do most drug addicts. But it is grossly irresponsible to let any person who commits such a heinous act back out in society just because a pill can [temporarily] restore their sanity. It just isn't fair to put society at risk. Society's safely should always come first. Sending this man, and others like him to a mental institution for the rest of their lives is their "get out of jail free" card. Just because they don't deserve to go to prison doesn't mean they deserve to be free.

Lucy Puryear MD said...

Great comments. No, not all mentally ill people who commit crimes are delusional. People with mental illness do commit crimes while on medication and should be punished for their crimes. I am not suggesting that being mentally ill is a get out of jail free card.

I am saying that the system is broken. That people with severe mentall illnesses often do not receive adequate care in the community. It can take three months or longer to get an outpatient appointment in our "free" (paid for by taxpayers)mental health system in Harris County. While waiting for these appointments people go off of their medications, become ill, and SOME commit crimes.

I believe in the 60's when the mental health care moved from long term institutional care to community centered care we went too far in the other direction. Yes there were those who spent way too long in hospitals who shouldn't have been there. But there are others who are ill enough, and incapacitated enough that they can't live safely in the community. They need a place to live, available food, and someone to hand out their medication.

To commit someone to from Houston to Rusk State Hospital used to be an option for long term care. You were able to have someone stay for months at at time with the hope that long term care would more permanently stabilize their illness. Now stays at Rusk are more short term and seriously ill patients are back out on the streets.

Primary prevention is always a preferable way to deal with a problem. Instead of trying to figure out how to deal with a mentally ill man who commits a horrible crime, let's figure out a way to prevent the crime in the first place. Mental health courts are a step in the right direction.

Unknown said...

I hadn't heard about Harris' County's plans for Mental Health Court. That is good news indeed.
As a whole, our society has a poor understanding of mental health issues and many are misguided enough to believe that some of these people just need a little self-control or self-discipline.
We need more compassion for the mentally ill, more access to mental health care--including better insurance coverage--and more tolerance for those who seek psychological or psychiatric care. I'd venture to say that every dollar our society would spend in preventative health care, would reap hundreds of dollars in the lowered cost of crime and imprisonment.

Anonymous said...

I keep forgetting to ask this one question....why is there the common thread of evil that spawns these delusional individuals to kill? Andre, Andrea Yates, the woman just released who severed her baby daughters arms, and more have claimed to have killed in the name of evil.

jigmeister said...


Perhaps the biggest concern prosecutors had in the past with state facilities was the tendency to medicate and release or medicate and return to the court jurisdiction with a finding that competence now exists, without any real indication that the underlying problem was gone. Is this still happening at Rusk and Austin?

Lucy Puryear MD said...

I don't have direct knowledge of Austin, but I do know it has been a problem at Rusk. Additionally, at this point in time we have no cure for mental illness. Some, occasionally go away on their own and co not come back, but this is rare. Most people will need medication for a lifetime; similar to someone with diabetes. When I worked briefly in Ohio we could get outpatient commitments that meant that a patient was mandated to attend outpatient appointments. If they did not show they could be picked up and returned to an inpatient facility.

The chronically mentally ill person is a huge problem in society. It is estimated that 50%of the homeless in Houston are suffering from mental illness. The vast majority of those are not dangerous to others, only to themselves due to lack of self-care.

A Voice of Sanity said...

Many have commented that America's prisons are now used as its criminal mental asylums, a task for which they have neither the facilities nor the staff. This is as clear a case of penny wise and pound foolish as one could find.

Jan C said...

The victim is just as dead whether they were killed by a sane person or an insane person.

Do we jail the sane killer as a deterrent to future crimes or as a function of rehabilitation? If the killer is judged insane, is he treated and then freed to kill again when he fails to take his meds or otherwise fails to follow clinical treatment?

No one in their "right" mind commits a crime like murder. Maybe the entire justice system needs overhauling.

But if and until that is done, we can't take the chance of releasing mentally unstable and dangerous people back into society in the hopes that therapeutic treatment will render them harmless.

Gritsforbreakfast said...

Jan writes, "No one in their "right" mind commits a crime like murder."

That's not true at all!! I don't think it helps matters to conflate the mental culpability of a diagnosed, untreated schizophrenic to workaday murderers.

In fact, quite frequently Texas juries decide that not only was a killer in their right mind when they murdered someone, but that the victim needed killin'!

The vast majority of murderers sent to prison will ultimately get out again. Jan says "we can't take the chance" of letting them out, but actually murderers have among the lowest recidivism rates of all offenders. High profile recidivists like McDuff get all the attention, but it's false and wrong IMO to generalize broadly from such cases and ignore the more commonplace reality.

For anyone interested, I offered my own reaction to Lucy's excellent post here.

Jan C said...

A murderer takes a life. Permanently. He can't give it back like he can a stolen car or filched credit card.

But because there may be a lower recidivist rate for killers than other types of criminals, we do what? Let them go? If the punishment truly fit the crime, a killer would never be free again.

There are many reasons why murderers do what they do. Whether they are flat out crazy nutcases eating their own eyeballs, or cold, calculating killers who rationalize their actions, or people overcome with a frenzy of emotion, NONE of them are in their right minds when they take a life.

We all have dark impulses. But most of us don't act on those thoughts and impulses. The people who cross that line have something wrong, something that makes them different. Something society needs protection from.

A Voice of Sanity said...

Jan said: We all have dark impulses. But most of us don't act on those thoughts and impulses. The people who cross that line have something wrong, something that makes them different. Something society needs protection from.

What about the vice president of a corporation who is told that it will cost $25 per unit to make the product safer, but decides to save the millions it will cost and instead just compensate the victims, a cheaper option and thus enhancing his annual bonus. Why does he get to go to church with his family every Sunday? Is this his dark impulse?

Anonymous said...

Thank you for writing this post. I have a mental illness & consider myself fortunate, so far I'm not one of those falling through the cracks.

I'm not surprised, but continue to be disheartened by the lack of public empathy towards the mentally ill. It seems the mentally ill are 1 of the few disabilities it's still okay to joke about & discriminate against, or just hope we're all put our of our misery.

You are so right, our system is broken. This family may have been spared ALL of this tragedy if proper care was available. As for Andrea Yates, I recommend reading "Are you there alone?" Yes, someone should be held accountable in her situation, her husband, and many, many doctors.

I am encouraged by people such as yourself that see the problem for what it really is & that also see those of us with mental illnesses not as broken beyond repair, but with true compassion. You are actually helping by providing solutions... what a novel concept.

Yes, I have a mental illness. No, I'm not a criminal.

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