It's An Outrage

by Lucy Puryear, M.D.

"Woman Who Cut Off Baby's Arms to be Released," Houston Chronicle, November 7, 2008. Dee Schlosser was arrested in Dallas, in November of 2004 for cutting off her daughter Maggie's arms, resulting in her death. In the aftermath of the Andrea Yates case in Texas, several women have been found not guilty by reason of insanity after killing their children. All of these women, including Schlosser, were psychotic at the time of the killings. Schlosser believed that by cutting off her daughter's arms she was making a more perfect offering to God. The police came to her home and found her soaked in blood humming along to a hymn.

Schlosser was sent to a state mental hospital where she received treatment and continued to be under the jurisdiction of the court. According to law, persons found NGRI (not guilty by reason of insanity) must remain in a state mental hospital indefinitely until it is determined by their psychiatrist that they are no longer a danger to themselves or others and can be maintained in outpatient treatment. Schlosser will be released into the community where she will be mandated to meet with a psychiatrist weekly. She will no longer be allowed to have contact with her other two children, and may not be in close proximity to any other children. It is unknown where she will live when released. She will remain under the jurisdiction of the court permanently and will be forced to return to the hospital if she again becomes dangerous.

Understandably the prosecutors of Collin County are unhappy with her release and wish the laws were different. Understandably the citizens of Dallas are unhappy that she may released into their community. Understandably there may be some renewed talk about having the laws changed. Maybe Dee Schlosser should have been committed to a state psychiatric facility for the rest of her life? It is an outrage that a mother who killed her children is free to walk the streets.

I am going to ask you to believe that Dee Schlosser should be released and be free to live what ever kind of life she is able to piece together for herself. She is no longer psychotic, she is on medication, she will be monitored by a psychiatrist to make sure that she remains well. So why should she remain in the hospital; just so our sensibilities are appeased? That's a waste of money. Her being in the hospital does not protect you or your children. Dee Schlosser has no intention of coming to your house to cut off the arms of your child.

Many of you would say she should be in jail, or even executed for what she did. That would solve the problem. She did something bad and she should be punished. Does it matter that her brain was malfunctioning? That the blood flow to certain areas of the brain were increased where they shouldn't have been and decreased to other parts? Was this happening to her because she chose to be crazy or decided that hearing voices and was a good idea?

Let me ask you to fantasize for a moment. What if you had a hundred and four degree fever and you became delirious. You were hearing someone walking into your room in the middle of the night and when you looked up you saw a masked man carrying a gun. You reached for your gun on the bedside table and shot. Only later when your illness was treated were you aware that you had shot your husband. Death penalty? Think that's not possible? Hallucinations happen all the time with high fevers and brain infections. Your brain is malfunctioning.

Let's speculate again. You are driving in your car and have a heart attack. You swerve off the road and plow into a group of people standing on the corner of the street. A mother and her young child are killed. Death penalty? Clearly you didn't do this on purpose. Your heart was malfunctioning and caused behavior that was out of your control. Let me go a little further. What if you knew you were at risk for heart disease but declined diet and exercise and didn't take your heart medication because you didn't like the side effects. Death penalty? Surely you knew you were at risk for a heart attack. In fact you doctor warned you on numerous occasions. The fact that you had a heart attack isn't all that surprising. Are you responsible for those deaths?

Mental illness is a brain disorder. The symptoms are behavioral, and often the symptoms are horrific. No one wishes to be mentally ill, anymore than someone asks to have diabetes or heart disease or meningitis. And untreated the symptoms of mental illness can be deadly, just like any other medical illness. Not just for yourself, but as I described above, for others. Why do we treat the mentally ill as criminals?

Dee Schlosser will never live a care free life. She must live with the knowledge and memory of killing her child. She will no longer be able to care for or have contact with her other children, and her marriage ended in divorce. What kind of life will she have? Can you imagine waking up every day to that horror? As a matter of fact, most mothers who have killed their children eventually end up killing themselves.

Let me let you in on a secret. Every single one of you reading this has a mental illness, has a family member with a mental illness, or knows someone who has one. And if you don't know someone who does that's simply because they don't talk about it. The stigma of mental illness is so great that we can't face admitting that we are all affected. This is not unlike epilepsy in earlier times. Until the cause of and treatment for epilepsy was discovered family members were hidden in asylums, attics, and weren't allowed to marry into good families. That is where mental illness is today.

Dee Schlosser deserves to be released if she is no longer suffering from her symptoms. She is medicated and no longer poses any danger to anyone. Don't worry, if you feel the need for her to be punished she already has been. She will continue to suffer every day of her life no matter where she is living. She needs our prayers. And we need to pray that some day we can find the cause of and a cure for mental illness so that no one kills their child because they're sick.

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What Does it Mean to be Crazy?

by Lucy Puryear, M.D.

You may be surprised by my title and use of the work "crazy." That's not exactly a politically correct medical term, but when you listen to a psychiatrist's private conversations it's one that's used frequently. It's shorthand for, "Boy, did I just see someone who was really sick." What is meant by that is that the person in front of us is either acting bizarrely (standing in the middle of the street gesticulating wildly and talking to the sky) . . . listening to voices in his head or responding to visions you and I can't see (if you've ever had a really high fever you might have experienced this; it's called delirium) . . . believes something entirely off the wall (the CIA has planted a bug in my head--remember you have to be careful with delusions, one day the CIA may indeed be capable of that!) . . . or his speech is so unintelligible he doesn't make sense to anyone (the technical term is "word salad," a little of this, a little of that . . .) .

So when I'm speaking with a group of psychiatrists I'm pretty sure we all know the shorthand. But when you are trying to translate "crazy" to a courtroom it becomes much more complicated. The medical and legal definitions are entirely different.

In the Andrea Yates trial I was asked to determine if Yates (pictured above) was legally insane at the moment she drowned her children. So I had to put my medical definition through the lens of a legal one: Was Andrea Yates legally insane at the time she killed her children?

There is no standard psychiatric definition of the word insane and it's not one we use in regular conversation. In a courtroom in Texas insane means the following: does the person know at the time the crime was committed the difference between right and wrong? From a medical understanding of psychotic illness (crazy) that definition is hard to interpret. Obviously the jury found it difficult as well. In the first trial she was found guilty, in the second trial, not guilty by reason of insanity.

To make matters more confusing, the legal definition of insanity changes depending on which state you live in. You can commit the same heinous crime and be insane in Texas, but by definition not insane in Connecticut. Excuse me for saying so, but that's CRAZY. Whereas Texas uses a much older and more constricted definition of insanity (McNaughton Rule), Connecticut uses a more modern definition (American Law Institute). The advocates who worked so tirelessly for the defense in the Andrea Yates trial have been working to have the legal definition of insanity changed in Texas to a more modern standard. Good luck getting that passed in a state that still struggles over the execution of those with mental retardation.

There's a new case getting the attention of the media here in Houston that will test the stomachs of those chosen to sit on the jury. Joshua Royce Mauldin (pictured left) is currently on trial for putting his two-month-old baby daughter in a microwave for ten seconds. She suffered second- and third-degree burns over parts of her body and currently is living with relatives. Mr. Mauldin has pled not guilty by reason of insanity. According to the Houston Chronicle, he has a history of mental illness and claims to have heard voices. He felt a "weird sensation" come over him right before he put her in the oven.

I have not interviewed Mr. Mauldin or consulted with any of the psychiatrists who have. Is he legally insane? I don't know. That's going to be for the jury to decide. The jury will have to make sense of a complicated psychiatric history and conflicting testimony from mental health professionals. Is he crazy? No doubt. Is he sick? Absolutely. There's something seriously wrong with someone who can do that to another human being. But in the state of Texas the defense will have to prove that at the time of the crime he didn't know what he was doing was wrong. In this instance, I bet that will be a hard case to make.

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