Louis Theroux s01e24 Episode Script
By Reason of Insanity: Part 2
1 For the first time in 60 years, Ohio State psychiatric hospitals had allowed cameras in to film with patients.
Most of the men and women I'd be meeting have committed serious crimes, but been found NGRI - Not Guilty by Reason of Insanity and detained - not for punishment but for treatment.
Hey, how are you? Regards, dude.
Can we come in? Sure, why not.
Thank you.
This week I'd be going deeper inside the forensic world, getting to know patients whose personalities are so intertwined with their illness - it makes them more difficult to treat.
I have narcissistic, attention-seeking and a little bit antisocial.
I'd be meeting clinicians grappling with the grey area between criminal actions and medical symptoms.
What did the voices say, do you remember? They told me to kill, kill - kill everybody cos they out to get you.
And I'd be exploring the blurred line that defines what we consider insanity.
You OK over there, Charles? Yeah, I'm just playing crazy.
I'm not really ill - I'm just playing, yeah.
Hey, Brian.
Hiya, how ya doin'? Good.
How are you? All right.
I was at Summit Behavioural Healthcare, a mental hospital in Cincinnati.
A patient named Brian was having his monthly meeting with his treatment team.
Next problem is mental health - you know your diagnosis.
Yeah, er, schizoaffective.
Schizoaffective bipolar type.
Yeah, bipolar type.
OK.
The objective for this problem is to engage in conversations with others about subjects other than religion.
So, occasionally your mental illness has come in the form of religious distortions, would that be right? Yeah.
I mean certain things about my spirituality are good, but my illness is, kind of, coincided with some of the spiritual aspect.
When Brian is not doing well he gets preoccupied with religion - there is nothing else in his life.
You don't sleep, you are not eating well - the only thing that you do is pray.
Brian had first been admitted to hospital 20 years earlier after killing his mother.
Here we go.
OK.
Like all NGRI patients, he'd been judged incapable of telling right from wrong.
How are you doing? Good, how are you doing? Before the incident he'd had a conversion experience at a Pentecostal church.
Can you describe the events leading up to the incident? Yeah, erso Sunday before the incident happened, God spoke to me he said, "Are you willing to give up your worldly music for me?" "Your worldly music"? Yeah.
Which was what? Like country, some rock and roll, stuff like that.
I remember I took it all and just threw it in the trash.
CDs? Yeah.
And how old were you at this time, by the way? Erm, I was going on 21.
About 21.
So, then what happened? Tuesday night and God told me to go home.
I had this paper in my hand that said, "I fear for your souls.
" And my parents got up out of bed - my mum basically backed me into a corner and the first time in my life I ever heard, like, cuss words come out of her and my dad came to my bedroom and almost attacked me.
Do you think maybe you were getting into a manic state and perhaps they were trying to control you? It's a possible explanation.
And my mum commanded my dad to leave with all the car keys and the spirit in her said, "So, tell me about the Bible" like that.
And then it began a process of me trying to cast Satan out of her in the name of Jesus.
Eventually the spirit took her out to the garage and her face was all distorted - at least my perception of her face was distorted - I heard a voice say, "Kill it.
" And what God shared with me years later was that Satan was still in the garage at this time and he's the one that said, "Kill it.
" and I thought it was God telling me to kill the devil, so I saw it was bad at the time and I just I freaked out.
You used the bat and you beat your mum to death? Do you remember doing that? Yeah.
What was that like at the time? I was so scared that, er it was, like I didn't comprehend what I was doing and I mean it's, er it's been 20 years ago, over 20 years and, er sometimes I relive it in my mind, you know.
And, er How is it when you do that? What does that feel like? Er lot of pain.
What's striking is that you still hold on to the idea that she was possessed demonically.
Yeah.
I mean, what makes you so sure of that? ErmI think because Fact is she went from someone who never cursed, not once - to all of a sudden she was cursing like crazy.
And the fact that the voice in the garage said, "Kill it.
" I know that was, I know it was Satan that said that, you know.
This terrible, terrible thing happened at a time when you were under the influence of this Church, that doesn't, erm make you question that Church and its beliefs? I don't question that at all.
No.
Treatment in the Ohio Forensic System involves a combination of medication and classes.
So, we want to know - where do you find peace? Er, I find peace meditating in my room.
For those patients with the most serious crimes, the road to recovery begins in the State's maximum security area - the Timothy B Moritz Unit - or Moritz for short.
So, we'll go this way and where we're headed is across this central courtyard.
The Director, Lynn Dickerson, had offered to show me around.
We have a fitness room here.
No free weights, no bulking up.
This is our art room, another one of the very popular areas.
This is one of our seclusion and restraint rooms - there's one on each unit.
When would you need to use one of these? Last resort.
Absolutely last resort.
There are around 50 patients at Moritz, many are profoundly mentally ill and heavily medicated, but there are some who appear well.
Louis, this is Thomas.
Hi.
Hi, Louis.
A patient named Thomas had agreed to speak with me.
I'll just turn on the light.
This is where you stay? Yeah.
This is my junk.
I'm going to give you, like, a seven out of ten on tidiness.
See, those shoes are together, but those one's aren't.
Tell me about you, how did you come to be here? Well, erm, I was out on the streets, erm, I stopped taking my medicine and then while off my medicine, I committed a crime and killed a man.
Did you know that you'd killed someone? No, I didn't know I did it.
What did you think you'd done? I didn't know what itthey, er, they kept saying I did - I didn't believe that I did - I still didn'tdon't believe it to this day, but I must-I must have.
And what's your diagnosis? Er, paranoid schizophrenic.
Mm-hm.
And you're medicated for it? Yeah.
It make me feel n-normal.
May I say, you seem very normal.
Yeah.
You have very good, erm, good interpersonal communication.
Yeah.
Is it nice to hear that? Yeah, it does.
So, this is Thomas' chart.
This is the page where your various diagnoses are.
Is it OK with you if I read some of these out? Yeah, go ahead.
So, it says antisocial personality disorder.
Is that is that something that you allegedly have? According to them, I do.
Is that right, Lynn? He seems very pro-social! But, no, I don't think I'm antisocial.
I like people.
I'm outgoing - when I'm on my medicine.
But it also means that, erm, that you engage in behaviours that society wouldn't like.
Well, yeah.
Might be notmight be criminal behaviours Yeah.
might be things that would be upsetting to other people.
Yeah.
Then it says "malingering" which, doesn't that mean faking symptoms? That doesn't sound right either, does it? I never heard of that one.
That's a new one on me.
This is interesting - "What types of things trigger you to feel "uncomfortable, anxious, frustrated? Patient states - nothing.
" Nothing frustrates me.
Is that right? I was all frustrated when I was in county jail, that frustrated me.
When I got here, I was relieved from the frustration.
Really? Yeah, nothing frustrate me.
Interesting.
What's a lesser charge of taking someone's life than murder? Manslaughter.
Manslaughter.
Alongside the hospital's NGRI patients, there is a subgroup of those found incompetent to stand trial.
They'll face their charges if they become well enough to understand the legal process.
Number four - one cannot be tried unless physically present in the court room.
Is that a true statement or a false statement? Good morning.
How ya feeling? 'One of these is Charles.
'Having made progress at Moritz, 'he was graduating to a less restrictive civil hospital.
' When you make your show, this what we're going to name this segment of the show, right here.
"The big pack up"! You're going from forensic mental to civil mental? Civil mental, yeah.
Because you've done so well, here.
Is that right? Done well.
You got to do well, here.
Would you agree with that, erm, Doctor Soehner? Yes.
He has done very well, here.
Charles has been a model patient? Well, you know, he is not an angel but he has been making efforts to stay out of trouble.
What was your original case that brought you to the attention of the courts? I had four counts of aggravated robbery of a Credit Union.
Is it that a bank? Yeah, a bank.
It's basically a bank.
Same thing, yeah.
You went in there to rob it? Yeah, I did rob it three times.
We got caught time the fourth time.
It's, er, four days in a row.
I was really out there.
You would think they'd catch you the second time? Or the first time! Right? You did well to you did well to do it three times successfully.
Oh, no! We wouldn't use them words with crime - "Did well".
So, have you not gone to trial yet, Charles? No trial yet.
This happened how long ago? December, 2007.
Do you feel you're competent to stand trial? Erm, I got a few personal problems and things that occurred with lawyers - I can't deal with lawyers.
You're angry with lawyers as a group? Very angry, yeah.
Why? So, as far as being Lawyers got something to do with some baby rape and shout stuff, which I don't appreciate that they did and I don't trust lawyers.
It's interesting because, you know, there are good and bad people in all walks of life.
Would you agree? Yeah.
Even among lawyers - there's good ones and bad ones? There's probably good ones there, yeah.
But I don't know which ones is the good ones, so I'm going to say sorry and I hate 'em all.
I can see that would be an obstacle to getting a good trial.
Doctor Soehner, have you talked to Charles about his issues with lawyers? Yes, he's had difficulties with lawyers.
In my opinion, he could work with an attorney if he chose to, but other evaluators disagree with my opinion.
How are you getting on with your packing? I'm done.
I just got to get my, erm my personal electronics, er, razors OK.
and snacks out of the pantry there.
We'll just hang here.
So, Doctor Soehner, you're feeling really is that Charles, um should be declared competent to stand trial? Yes.
You think at some level maybe Charles is worried that he would be found, umguilty and sent to a prison? Yes.
So, maybe he's playing the system a little bit? Yes.
You think so? Yes.
Is Charles definitely mentally ill? Yes, Charles does have a mental illness.
But he has enough sense to know how to work the system a little bit? Absolutely.
Do you think you are mentally ill? Seriously mentally ill.
You are? I don't even let them know how mentally ill I was, or they probably would never let me out.
I'm seriously mentally ill.
Some things in my mind I don't even bring out - never.
Is that everything? That's everything, yeah.
All right, Charles.
Good luck! Most people, you say, "Are you mentally ill?" and they say, "No" or they say, "Yes, I guess I am.
" But he said, "Oh, yes.
I'm very, very mentally ill".
I'd never heard someone say that before.
Well, generally those that have incentives to be labelled mentally ill and to remain incompetent and unrestorable, certainly would want to keep that label.
Later, Miss Angie.
It's funny that you can be mentally ill and malingering.
Yes, those are the most difficult types because they know what the symptoms of mental illness truly are.
Charles was moving to Kosar - a civil mental hospital that has a number of forensic units for patients with criminal cases.
So, you've been here before, Charles? Er, maybe about 50 or 60 times.
What's it like to be back? It's like, erm, coming home.
Nicky! Hi, Charles.
How are you? Depending on their progress in treatment, patients are assigned a movement level.
322.
For Charles, arriving back was a familiar routine.
Clean, everything's clean.
Have you ate? No, I ain't ate? Do you want something to eat? I would love something to eat.
I ain't ate in two days, I've been fasting.
Would you like a cup of coffee? I'd love a drink, I drink tea.
OK.
Help me out with getting food.
I got ya.
Help me out deep, man, cos I'm hungry.
OK.
The idea I have for today's group is a bit of a challenge, but to maybe think - if you have the opportunity to talk to yourself the day you went to jail, the day you were arrested - what would you say? At Summit, and along with Brian, I was attending a group called Recovery From Loss for patients who have killed family members.
I would tell myself that I need to seek out help when when I get too excited about something.
Or if I start hearing voices - go for help right away.
What are you thinking about when you pray? Erm, I think about drawing close to God, like the Bible says, "Draw nigh unto God, or draw nigh unto you.
" "Draw nigh unto you"? Yeah.
You're, like, with your heart, you're drawn close to God and he draws close to you.
Is there a voice? Erm, usually, usually not.
Erm, the Bible says, "In the presence of God, there's fullness of joy.
" And sometimes, sometimes God speaks to me but it's not, like, it's not an audible voice - it's, like, in my spirit.
Do you remember what they said at your treatment team? One of your things was to have conversations with people.
Do you remember? Yeah.
Er, something other than religion, yeah.
I just realised we were, kind of, breaking that rule.
Maybe that's OK? What do you think? Well, I'm-I'm trying to be more well-rounded.
It's-it's hard because, you know, being locked up so long in these places, only thing I really have had to turn to is my faith to get me through.
Would you like to play ping pong? Sure.
Well played - nice shot! Thanks.
So, right now - are you experiencing any symptoms like hearing voices, or having any, er, suspicious Charles was meeting his new treatment team to discuss his movement level and check in with his psychiatrist, Doctor Singh.
Doctor Singh, you know Charles? Have you worked with Charles before? Many years.
Probably forgot about it 2007 and 2009.
I came from Moritz and came here in 2009 and you let me go in 2011.
April, 2011.
Oh, OK.
Well, you know.
It's, kind of, faintly remember your face, but I don't really remember.
But tell us about what, er, what's happening and how you're feeling today.
What's going on? I'm feeling, ermbetter than I ever felt in my life.
At the moment Charles' level - as far as where he can go in the hospital and outside - is level what? One? Er, by default anybody that comes here onto the unit is on level one.
I don't think that's going to be a long thing, you know.
A week, two weeks? Generally about two weeks, yeah.
You have positive memories of Doctor Singh? Erm, all I'll say is, let me answer it this way - do I have any negative memories of him? No, all positive.
All positive of her.
She was on the unit.
Cos every time I see her, she always had a bright, happy face.
So, you know.
Everybody's cool, I guess.
Keep thinking about it, you come with some positives, at least on me! That's it, you don't think they're evaluating you, but you're really evaluating them, right? OK, thanks a lot.
Elsewhere on Charles' unit, I'd heard about another patient whose crime was said to be unusual - even by the standards of the hospital.
Hey, Dean.
We coming.
You ready? It involved a serious sexual assault on a close family member.
Hi, Dean.
How ya doing? His name was Dean.
I wasn't sure how much he was willing to say about the incident.
Is there any of your stuff here that you'd like to show me? Yeah, the books and then the posters I got.
This is my gratitude list.
I did it one time when I was really feeling bad.
And then this is my family.
My dad, my mum and me when I was 16.
That's before you came in here.
That's before I came in here.
How often do they come and visit you? My mum's expected to come today, actually - hopefully.
And then my dad - they switch up the visiting days because that way I can spend more time with each of them.
What's your diagnosis? I actually have a little bit of confusion about that.
Because I waswhen I was first in here, I was bipolar.
Now, I have mental disorder NOS on the Axis I.
Not otherwise specified? Right.
Which means I have a lot of different things, but no one diagnosis.
I have borderline personality disorder and I don't Which means? I don't actually know a lot about that.
But I know, it's basically, it's not a People argue that it's not a mental illness, but then other people say it is a mental illness.
So, there is some debate about that from what I heard on NPR.
You were found not guilty by reason of insanity, is that right? Yes.
What can you tell me about your offence? Er, my offence was against a family member.
It hurt them horribly, actually.
Erm because of me that person has PTSD.
But that person still comes to visit me every week.
That person forgives me for what I did.
I don't deserve that forgiveness.
How old were you? I was three months after my 18th birthday or four.
I forget which.
About one month after I'd celebrated a graduation party from school.
What was it that made you commit the act that you did? The delusion I was having was that the person would enjoy it and respond.
And, I mean, I was told Why are you looking like that? Me? Yeah.
I'm just lis Sorry, I'm just listening.
Oh, OK.
They told me that, er, that was a delusion.
I mean, I know where I got that delusion.
There was a style of underground comics that I was reading on the internet and it kinda just warped my mind.
Cos I was reading them for years, you know, years and years.
On the day of the incident, was there anything different that happened? No, and I'll tell you that - this is the mystery in my family.
It was the best day.
I mean, it was a happy day.
There was nothing that made you snap? No, I just No.
I just remember I went and got a knife and then I walked in to her room.
I mean, that person's room.
What time of day? I remember looking at the clock, it was like nine in the morning, 9:13.
How long did it last - the whole interlude? Oh, God.
Less-less than 20 minutes.
I mean Yeah.
But I had a For her - it was probably for a very long time.
How did the police get involved? I called them.
You called them? I called them.
I called on the phone to the police and I said, "I want to commit suicide.
" You know? Meanwhile, what was going on with the victim? Erm, I have no idea.
I wasn't there.
My dad won't talk about it - what happened.
He tells me occasionally, but he says, "Son, it was either forgive you or kill you.
" And I understand that.
I understand why he said that.
Do you think? Yeah, I'm just thinking about it.
It's a it's an unbelievable story.
Yeah.
That's the problem.
How do you mean? Well, I thought you meant "unbelievable", like it sounds like farce, you know.
Not farce but, erm, it's almost like a Greek tragedy.
Oedipus? Yeah.
Oedipus would be correct, probably.
I'm good to keep talking.
Do you feel they've been able to help you here? They help me if I let them and they've helped me a lot lately.
There's very good doctors here.
Thanks, Dean.
Yep.
OK, see you later.
Yep, see ya.
If you'd like to sign here.
Yes, I would.
How are you doing, today? I was back at Moritz in a therapy group with Thomas - the patient whose diagnoses included antisocial personality disorder.
Since our last meeting, I'd read about his case.
Early one morning, he'd stabbed and killed a man at random in the street.
A 42-year-old dishwasher on his way to work.
I was still struggling to connect to the gruesomeness of the crime with the Thomas I'd met.
I'd arranged for another interview - this time with his psychiatrist, Doctor Soehner.
We didn't talk a great deal about your offence last time.
Not much.
Are you comfortable talking about it? Yeah, I'm OK with it.
What can you say about it? That, er, I committed it.
Erm I admit that I was on drugs and I was using a lot of drugs.
And I was off my medicine and I'm unpredictable when I'm off my medicine.
When you come off of your medications, what kind of symptoms do you experience? Er, hallucinations and erm I'm hearing voices.
What did the voices say? Do you remember? They told me to kill, kill, kill anybody.
I mean, justit wasn't no particular person, it just at random and to kill everybody cos they out to get you.
Mm-hm.
Do you remember when you first saw the victim? Er, I think so.
I was walking down the street, it was dark - it was at night-time - and er he was walking in front of me and seemed like he had changed into a skeleton with, erm a cloak over his head and the voices told me to kill him now.
They'd say, "Do it now, do it now.
" They kept getting on my nerves, so I just did it.
Had you had any other violent incidents before that? Erno.
First time.
We talked about your diagnosis, didn't we? Right, paranoid schizophrenia.
There's paranoid schizophrenia and then there's also an Axis II disorder, which is, erm Er, what is that? Bipolar? Antisocial personality disorder.
Oh, yeah, yeah.
That one, yeah.
I remember that one.
Can you talk about that a little bit? Because as I understand it, that's hard to medicate? Yes.
Antisocial personality disorder is, erm, basically someone who, er from their earlier days - even before the age of 12- begin to, erbehave in a manner that is against the usual norms of society.
Running away from home, getting in trouble with the law - and in very severe cases - it can include abuse of animals.
Do you know how Thomas came by that diagnosis? Well, younger years involved running away from home, some defiance with authority, erm and even cruelty to animals, at one point.
Is that right, Thomas? Yeah, that's right.
What was it? A cat.
What did you do? Tied it to the railroad tracks.
Why? I don't know.
Just something to do.
And did a long prison sentence for 16 years.
Yeah.
For what? Attempted murder.
During a mental illness episode? Yeah, it was, it was I think I was on the medicine then, but it's not what you think.
What it was - my girlfriend said that I hurt assaulted her little daughter.
Said you had assaulted her physically or sexually? Physically.
That, that wasn't true.
She was just getting back at me for, er having an affair with another woman.
So, the conviction was for, for what? Assault on a five-year-old, which I really didn't do.
So you deny doing that? Right.
Can someone be not guilty by reason of insanity on the basis of a diagnosis of antisocial personality disorder? No.
Why not? It's not considered a legal mental illness.
And thankfully the courts do not consider antisocial personality disorder to be a mental illness, otherwise everybody would be found not guilty by reason of insanity.
Thanks, Doctor Soehner.
OK.
It was good to see you, Thomas.
Let me know if you have any questions.
OK.
Thanks, brother.
Thanks so much, Thomas.
All right.
Thank you.
You dropped your keys.
Oh, thank you.
All right.
You know, I've got to know Thomas a tiny bit and found him pleasant to be around and then when you read out the list of things that had happened in his past, I was, I was quite shocked.
And, ermit made me think It would be a scary thought to think of him at large in the community.
Absolutely.
Particularly if he's not taking his medications and is using substances - very scary.
I was back at Kosar for breakfast with a patient named Christian.
He was in for assaulting a police officer.
What's your story? How long have you been here? This my second stint here on this charge.
I've been here about, er, four months.
What's your diagnosis? Paranoid Schizophrenia.
I've got audio and visual hallucinations, like, I'll get the sky talking to me, er The sky? The sky, sky, big The clouds, er Saying? Well, I remember one time I was trying to go to college and, er, I looked up and the sky was like, "Go away!" I'm like, "Huh?" "You don't belong here.
" I was like, "Oh, man.
" I gave up going to college that day.
How are you doing in here? How's it going? Pretty smooth, erm, I'm recovering.
Yeah, I get a kick out of this place, I enjoy it a lot.
Really? Yeah.
I didn't think you were going to say that.
Sorry about that! Do you know Dean? Dean, yeah, Dean, yeah, I hang out with Dean.
Do you talk about each other's cases? Not all that often, that doesn't come up.
Dean doesn't talk about his case at all.
Dean will not tell you what he has done.
He's really ashamed.
What's up? HOW you doing? Man, I woke up five minutes ago, I'm surprised I'm standing.
So, what you been up to, Christian? Oh, nothing, bro, I've just woken up myself.
Do you two ever talk about your diagnoses? I ask him some days how the voices are going because I know he has that sometimes, you know.
They're not voices In a way, what Christian's dealing with is fairly, erm, common as far as mental illness goes, which is auditory and visual hallucinations related to schizophrenia, is that right? Yeah.
But you've got something a little more, erm Complex.
Yeah, I have narcissistic attention-seeking and a little bit of antisocial.
So, I was speaking with the, er, treatment team.
I would like to meet with you tomorrow afternoon to do your risk assessment and Oh, yeah.
Come by my office at three if you can.
Dean is seeing his treatment team.
Though patients generally see their teams once a month, due to his special needs, Dean gets meetings every Wednesday.
Yeah, I have a question.
Erm, can I get a CD player because I've been wanting to get, you never hear the great choruses Are we talking about a personal CD player? Yeah, for me, you know or can you have them for everybody? No.
Oh.
I just want to make sure we were on the same page.
Yeah, it would cut down on my cost.
You can give me one of yours.
No.
Oh.
Yeah.
I still can't get an MP3 player.
No.
OK.
Or a DVD player? No.
OK, I didn't think so.
I mean I had them both.
Never mind forget about it.
Any more questions? Nope, not really.
All right.
OK, thanks.
Yeah.
OK.
See you later.
Thank you, Dean.
Bye! Fucking waste of time.
That's something he gets on this unit, right? A weekly check in meeting, but that's not typical, is that right? No, it's not typical but if somebody needs that, that's what we'll give em.
It keeps him from a patient being able to split staff and coming to whoever's door, several times a day, if this person says no, then I'll maybe go ask this person, where then you just jot it down and come and ask us every week.
Playing mum off against dad? Exactly, yeah.
He requires a little more attention, maybe, than some of the other patients? Yes, yes.
In the past, let's just say his behaviour was very, very different, especially if someone said, "No.
" Disruptive? Yeah.
But not assaultive? Well, there was assaultive behaviour in the past.
On patients? On patients.
And staff? I don't recall about that, I'd have to look at his old risk assessment, so I'd prefer not to say.
Erm, but, yeah, assaultive behaviour was an issue.
It sounds like he is making progress in his recovery, in his treatment.
I think so.
I've known Dean for several years, you know, nobody's perfect, I get that, but the difference is, to me, pretty striking, from where he was before.
It was lunchtime and a chance to catch up with Charles.
What you been up to, man? What's going on over there in England, man? Well, erm Fast cars and what? Just the usual.
You seem very well.
I'm very well.
Like, erm And mentally - you feel well? I feel very well.
Better than I ever felt in my life.
Would you like to stand trial if you're competent to stand trial? You know, they're kind of like baby rapists in the courtroom and the judge, OK, the lawyers lead the baby-raping organisation.
But do you really believe that? The lawyers, man, they I hate baby-rapers, man, I can't stand 'em.
What makes you think that lawyers are baby-rapers? I'm going to tell you why.
It's the hi O-B-A, yeah, it's the Ohio Bar Association, but it's concealed in this secret society.
The OBA really stands for Ohio Baby Abusers, that's their secret society, lawyers.
Would you like to be found competent to stand trial? That it still leads back to baby-rapers, it leads right back to 'em.
You know what? If all of a sudden God would say, "Yes, please," so I can get in that courtroom, ooh, just, hmm, all I want is one of 'em.
I said if I wasn't serving God, I would think all kind of stupid things, I wouldn't want to go back to court and I'd be thinking stupid things, but I don't think it, because I try to push it out.
Charles.
What? Stay with me.
How long before you get your conditional release, do you think? Erm, I got to make level four and it shouldn't take me long to make a level four, cos I ain't going to be clowning - I go along with the rules always, I don't cause no trouble.
But then if you got to court to get your level four, won't there be lawyers there for that? Erm, I don't have to, erm, work with them, I stay away from them.
I get away from them, I tell them to get away from me and just do what ya'll going to do.
I ain't got to talk to 'em or I don't have to work with 'em.
I don't have to work with them I got one way or the other, I got to do something.
Back at Summit and Brian was in the running for a possible change in his movement level.
He'd been scheduled to be evaluated by a forensic review team or FRT, but there were still concerns that some of his religious beliefs might be a problem.
I caught up with Doctor Rukseniene.
How is everything going here? Erm, things are stable.
Erm, I mean, unfortunately, Brian is not getting FRT this week.
OK, cos he was expecting to.
He was expecting.
I have the feeling that maybe with Brian, it's more complicated.
Well, yes, it is, erm I mean, his behaviour is perfect, however, he still has the same beliefs that from clinical perspective, would consider to be psychosis.
Really.
He has psychosis? That's the main symptom of his illness.
He was hearing voices, so he believes that was the enemy speaking to him, erm, we call that a hallucination.
Are you choosing your words carefully? Yes, because, erm, there is a large group of people who have the same beliefs.
Who are not considered to be mentally ill? Absolutely, yes.
Here's a good one.
It says, "When at night you cannot sleep, "talk to the shepherd and stop counting sheep.
" "When there is too much bad news, catch up on the good news, don't "tell God how big your storm is, tell the storm how big your God is.
" Tell the storm how big God is? Yeah.
Nice out here, isn't it? Yeah.
You loved your mum.
There was no reason for you to be angry with her? There was no reason for you to be angry with her? No.
She never did anything to me.
Had you ever fallen out with her in some way? No, no.
How old was she, when you killed her? I think she was 48.
I think s-somewhere around 48.
I mean it's just a terrible tragedy that, er really wrecked the whole family, you know.
When I think about my brother, you know, his loss, you know, cos he was only 17 at the time.
I wish I could contact my brother, write him a letter and just tell him how sorry I am.
Why can't you? Well, through the courts my dad and brother have a restraining order which says I can't contact them ever.
Ever? Even after 20 years? So If a condition of you getting back in touch with your brother and father again was that you that you accepted that your mother was not possessed, if that was the condition, would you be able to do that? No.
I wish I could turn back the time, you know.
I can't.
I was heading out of the hospital.
I'd made an arrangement to meet the victim of Dean's sexual assault - his mother, Cathy.
Hi, Cathy? Hi! Hi, Louis.
Can we come in? Come on in.
How do you do? Nice to meet you.
Dean was our Christmas card every year.
Just Dean? You wouldn't put yourself or your husband on there? No, just the baby.
Cute kid.
Darling little boy.
And he's quite a ham, I mean he'd let us take picture after picture.
Did he? He enjoyed the attention.
Yes.
Was he well behaved as a small boy? As a small child, yes.
Most of our difficulties started when he went to school.
Right.
Yeah.
His behaviour in school was just bad.
Attention seeking? Oh, yeah, very much so, and very manipulative.
Of who? Everybody.
Then, when he got, I would say middle school, he did start becoming more physical, like he would get angry and throw a desk, or hit a wall.
Um He sat in the principal's office once with a pencil to his neck, you know, and was going to threaten to hurt himself.
This was, I'm thinking, tenth grade.
Tenth grade is around 15, 16, so that was before the incident.
Something's really changed there, hasn't it? Mm-hm.
It's not just that he's become much heavier, there's a little bit of a darkness around the eyes.
I know.
Had he changed personality-wise there? He started getting more moody, yeah.
Moreangry.
Was Dean picking up new diagnoses as he went along? Yes.
Like what? What were they? Well, it all started out with attention deficit disorder, and then oppositional defiant disorder.
He mentioned borderline personality disorder.
Well, and that's been since he's been at At the hospital.
At the hospital.
Kosar.
Which was kind of a whole new thing for me.
I mean, it's like that's who he is, as opposed to having a condition.
He was 18 when the incident occurred.
Yeah.
You were at home.
Mm.
Your husband was somewhere else.
My husband was at work.
And Dean was at home.
I mean, how much are you able to talk about what happened? Um We'll give it a go.
He came in? I was getting ready.
I was upstairs getting ready to take him for his appointment at the social security, and he come in the room and he had a knife.
He threw me down and um He assaulted me.
Was he naked when he came in? No.
He was clothed? No, he was clothed the whole time.
The whole time.
So, he didn't actually The It It was a sexual assault.
There was no penile penetration.
He ripped my top, ripped my bra, my pants were around my ankles Um So Were you fighting him? No, not really.
Just saying, "Dean, don't do this, stop this".
He had that knife.
Was he holding the knife? Uh-huh, yeah.
I was so worried that he would realise what he was doing and hurt himself, I mean, more than thinking about Yeah, I know it's crazy.
In a way, it's not a million miles from holding his pencil at his neck when he's at the principal's office.
I mean, I've been told, you know, I've been in counselling, of course, that he knowsknew how to do me, how to He knew how to manipulate you? Yeah.
What do you think he was trying to achieve? I'm not sure.
I have My latest theory is it was something he wanted to do, and he did it.
He said that he called the police, but you didn't.
He did.
Do you think in some way he wanted to be hospitalised? You know, I've thought that, you know, I've thought that through the years.
You know, was he scared of being out of school? You know, the routine being changed.
What's he going to do? Was it, "Am I going to have to get a job?" He's 25 now, is that right? You still have what you consider to be a good relationship? Yeah, we do.
And his dad does too? Yes.
Yeah, remarkably.
You know, my husband doesn't talk a lot.
I do wonder sometimes how he has managed to cope with it all.
How has Dean changed since then? Has he changed? I've seen more change in Dean in the last, just the last year.
He does seem to care more about other people, you know.
I mean, he'll send a card home, which doesn't sound like much, but for him, it kinda is.
Do you ever think he could do something like that again to you? I would like to think not.
I don't think he'll ever have the opportunity.
I don't think we'll ever be alone together.
And, I mean, who knows, maybe that'll change some day, but right now I don't think so.
I think we should always have somebody with us.
I was struck by Dean's mother's courage and her dignity, and puzzled by the strangeness of Dean's case.
A young man seemingly victimised by his condition, who, in turn, victimised the person who cared most for him.
At Kosar, patients and staff were getting ready for Christmas.
For all the flaws in our understanding of mental illness, I'd come to see the hospitals as deeply humane places, attempting to provide care, even in the most ambiguous and confusing cases.
On Dean's unit, I had an appointment with another patient called Paul.
Hi, Paul.
How are you doing? Louis.
Doing good, glad to meet you.
Nice to meet you.
Have you got a few minutes? Yes, I do.
How long have you been at the hospital? I've been here about two months, since the middle of July, I believe.
And you missed a court date? Yep, February is when they arrested me, and I've been in jail up until two months ago for missing that court date, without actually being convicted of anything.
So you haven't gone to trial yet? No, I've been waiting.
What are they accusing you of? The court part of it is what they accusedwhat I was arrested for, it was erchild pornography on my computer.
I was trying for legal X-rated files.
Pornography? I didn't double check what was coming down over the internet.
I was waiting until I would get like 180 gigabytes, that was what I was shooting for, and I was just short of that when they caught my channel, what do you call it? Internet connection had some illegal files on.
They have an electronic way of doing that.
Do you have an interest in child pornography? No, I don't, not a bit.
I hate that stuff, I really do.
But the child part is what surprised me, when I found out that was going on my computer.
They thought I deliberately did it in order to distribute it.
Just by sharing files on the internet, that's considered distribution.
You're kidding! Well, see, I don't know where anyone that was getting those files, you mean that's what they were talking about? Probably.
Oh, boy! Are you OK over there, Charles? Yeah, I'm OK, and, you know, thinking about some things, and, you've been asking me about some things, and umabout some malingering stuff.
You know, you've been asking about it and er I ain't saying I'm malingering, let's put that on record.
I ain't saying I'm not malingering, let's put that on record.
They want to play games and not care about my health You know, this right here, they want to take the tea from the unit, the whole hospital, they didn't do it in the whole hospital, only this unit took the tea You like to drink tea, don't you? No, no, I hate tea, it's nasty.
I thought you liked tea.
No, I hate it.
I hate tea until I seen this on the box, "Regular tea drinking will help maintain healthy vascular function", which means that it'll help my blood clots and my bad circulation.
They say they don't care if I get my legs cut-off.
They don't care about my health, so I don't care nothing about malingering, how about that one? Why are you bringing malingering into it? You was always talking about me going back to court, getting competent.
I'll never be competent to stand trial.
If I did, I'd do the rest of my life in a penitentiary.
I got murders, kidnappings, everything from 1978.
I got other cases too, this ain't the first one.
I've been doing this all my life, before you was born.
I'm unrestorable incompetent that's never been to trial.
How about that one? I got kidnappingsâ I got a whole bunch of kidnappings.
Do you think you are malingering? Do I think I'm malingering? Er Let me see, I can say this illegally where they won't say, "Ah, you just said malingering" Oh, I know a way I can do it.
Mental patients One way you can know a mental patient, they'll say they're not crazy, they're just playing crazy, so, yeah, I'm just playing crazy, I'm not really ill, I'm just playing, yeah.
How about that one? That's like a triple bluff, isn't it? Do you know what I mean? They want to play and that's not playing, I understand playing.
Let me tell you, I don't want to use the word "work the system", but I just I get what I can get.
I got $1,200 orthopaedic shoes.
I just picked them up the other day.
I got designer glasses.
They're going to give me $3,000 partials, yeah.
Your teeth? Yeah, so they want to play with me, and I care about my health, I'm going to get what I can get.
Do you don't mind being called a malingerer? I love it.
Charles, I really believe you because I know how the system works and you aren't a liar, all right? You know what I'm saying? OK.
So they want malingering, OK, we'll malinger.
Catch you later.
With my time at Kosar nearly at a close, I've arranged for one last chat with Dean and his psychiatrist, Doctor Singh.
Can I join you? Yeah, sure, come on in.
You've been working with Dean, how long, a couple of years now, is it? Like seven.
Seven years.
Seven years, really? Since he moved to here.
You've seen him make good progress? Yeah, definitely.
You know, I've met your mum, she seemed really nice, and obviously you're intelligent, and it would seem, you know, in those two respects, you have two big advantages in life, and yet this horrendous crime took place.
How do you make sense of that? I think of it privately like this, my soul was sick.
Your soul was sick.
Yeah.
Not in the sense of a delusionary way, but more what I chose to put into my body was pretty much like really underground stuff, you know? You mean in terms of what you were reading? Internet, what I was reading, what I was watching, what I was choosing to believe.
I mean, I had no friends whatsoever.
My parents helped me as much as they could, but I just felt helpless.
Would you say you were not in your right mind when the offence happened, Dean? I've actually questioned that myself because I've had psychologists tell me I didn't have a mental illness and I shouldn't be here.
I don't want to believe I did what I did on my own, if I did, because that would make me a monster.
It would make me someone who deserves to be put down.
I think you do have a psychiatric illness, Dean, so you don't have to really think what happened was not because of the psychiatric problem.
I think you have the guilt and the remorse, which is a good thing.
So it's good that you feel guilty, Dean.
Yeah.
I know.
It doesn't make it easier some days.
See you later, Dean.
Thank you.
See ya.
It may be that there are as many kinds of mental illness as there are patients.
In my time at the hospital, what had struck me was the difficulty of dealing with the outer edges of the disease.
The place where a person's symptoms and the self are inextricably intertwined.
The distinction was, at times, unclear, but it could also be very real, and so too the feelings of remorse and the possibility of a new start.
Most of the men and women I'd be meeting have committed serious crimes, but been found NGRI - Not Guilty by Reason of Insanity and detained - not for punishment but for treatment.
Hey, how are you? Regards, dude.
Can we come in? Sure, why not.
Thank you.
This week I'd be going deeper inside the forensic world, getting to know patients whose personalities are so intertwined with their illness - it makes them more difficult to treat.
I have narcissistic, attention-seeking and a little bit antisocial.
I'd be meeting clinicians grappling with the grey area between criminal actions and medical symptoms.
What did the voices say, do you remember? They told me to kill, kill - kill everybody cos they out to get you.
And I'd be exploring the blurred line that defines what we consider insanity.
You OK over there, Charles? Yeah, I'm just playing crazy.
I'm not really ill - I'm just playing, yeah.
Hey, Brian.
Hiya, how ya doin'? Good.
How are you? All right.
I was at Summit Behavioural Healthcare, a mental hospital in Cincinnati.
A patient named Brian was having his monthly meeting with his treatment team.
Next problem is mental health - you know your diagnosis.
Yeah, er, schizoaffective.
Schizoaffective bipolar type.
Yeah, bipolar type.
OK.
The objective for this problem is to engage in conversations with others about subjects other than religion.
So, occasionally your mental illness has come in the form of religious distortions, would that be right? Yeah.
I mean certain things about my spirituality are good, but my illness is, kind of, coincided with some of the spiritual aspect.
When Brian is not doing well he gets preoccupied with religion - there is nothing else in his life.
You don't sleep, you are not eating well - the only thing that you do is pray.
Brian had first been admitted to hospital 20 years earlier after killing his mother.
Here we go.
OK.
Like all NGRI patients, he'd been judged incapable of telling right from wrong.
How are you doing? Good, how are you doing? Before the incident he'd had a conversion experience at a Pentecostal church.
Can you describe the events leading up to the incident? Yeah, erso Sunday before the incident happened, God spoke to me he said, "Are you willing to give up your worldly music for me?" "Your worldly music"? Yeah.
Which was what? Like country, some rock and roll, stuff like that.
I remember I took it all and just threw it in the trash.
CDs? Yeah.
And how old were you at this time, by the way? Erm, I was going on 21.
About 21.
So, then what happened? Tuesday night and God told me to go home.
I had this paper in my hand that said, "I fear for your souls.
" And my parents got up out of bed - my mum basically backed me into a corner and the first time in my life I ever heard, like, cuss words come out of her and my dad came to my bedroom and almost attacked me.
Do you think maybe you were getting into a manic state and perhaps they were trying to control you? It's a possible explanation.
And my mum commanded my dad to leave with all the car keys and the spirit in her said, "So, tell me about the Bible" like that.
And then it began a process of me trying to cast Satan out of her in the name of Jesus.
Eventually the spirit took her out to the garage and her face was all distorted - at least my perception of her face was distorted - I heard a voice say, "Kill it.
" And what God shared with me years later was that Satan was still in the garage at this time and he's the one that said, "Kill it.
" and I thought it was God telling me to kill the devil, so I saw it was bad at the time and I just I freaked out.
You used the bat and you beat your mum to death? Do you remember doing that? Yeah.
What was that like at the time? I was so scared that, er it was, like I didn't comprehend what I was doing and I mean it's, er it's been 20 years ago, over 20 years and, er sometimes I relive it in my mind, you know.
And, er How is it when you do that? What does that feel like? Er lot of pain.
What's striking is that you still hold on to the idea that she was possessed demonically.
Yeah.
I mean, what makes you so sure of that? ErmI think because Fact is she went from someone who never cursed, not once - to all of a sudden she was cursing like crazy.
And the fact that the voice in the garage said, "Kill it.
" I know that was, I know it was Satan that said that, you know.
This terrible, terrible thing happened at a time when you were under the influence of this Church, that doesn't, erm make you question that Church and its beliefs? I don't question that at all.
No.
Treatment in the Ohio Forensic System involves a combination of medication and classes.
So, we want to know - where do you find peace? Er, I find peace meditating in my room.
For those patients with the most serious crimes, the road to recovery begins in the State's maximum security area - the Timothy B Moritz Unit - or Moritz for short.
So, we'll go this way and where we're headed is across this central courtyard.
The Director, Lynn Dickerson, had offered to show me around.
We have a fitness room here.
No free weights, no bulking up.
This is our art room, another one of the very popular areas.
This is one of our seclusion and restraint rooms - there's one on each unit.
When would you need to use one of these? Last resort.
Absolutely last resort.
There are around 50 patients at Moritz, many are profoundly mentally ill and heavily medicated, but there are some who appear well.
Louis, this is Thomas.
Hi.
Hi, Louis.
A patient named Thomas had agreed to speak with me.
I'll just turn on the light.
This is where you stay? Yeah.
This is my junk.
I'm going to give you, like, a seven out of ten on tidiness.
See, those shoes are together, but those one's aren't.
Tell me about you, how did you come to be here? Well, erm, I was out on the streets, erm, I stopped taking my medicine and then while off my medicine, I committed a crime and killed a man.
Did you know that you'd killed someone? No, I didn't know I did it.
What did you think you'd done? I didn't know what itthey, er, they kept saying I did - I didn't believe that I did - I still didn'tdon't believe it to this day, but I must-I must have.
And what's your diagnosis? Er, paranoid schizophrenic.
Mm-hm.
And you're medicated for it? Yeah.
It make me feel n-normal.
May I say, you seem very normal.
Yeah.
You have very good, erm, good interpersonal communication.
Yeah.
Is it nice to hear that? Yeah, it does.
So, this is Thomas' chart.
This is the page where your various diagnoses are.
Is it OK with you if I read some of these out? Yeah, go ahead.
So, it says antisocial personality disorder.
Is that is that something that you allegedly have? According to them, I do.
Is that right, Lynn? He seems very pro-social! But, no, I don't think I'm antisocial.
I like people.
I'm outgoing - when I'm on my medicine.
But it also means that, erm, that you engage in behaviours that society wouldn't like.
Well, yeah.
Might be notmight be criminal behaviours Yeah.
might be things that would be upsetting to other people.
Yeah.
Then it says "malingering" which, doesn't that mean faking symptoms? That doesn't sound right either, does it? I never heard of that one.
That's a new one on me.
This is interesting - "What types of things trigger you to feel "uncomfortable, anxious, frustrated? Patient states - nothing.
" Nothing frustrates me.
Is that right? I was all frustrated when I was in county jail, that frustrated me.
When I got here, I was relieved from the frustration.
Really? Yeah, nothing frustrate me.
Interesting.
What's a lesser charge of taking someone's life than murder? Manslaughter.
Manslaughter.
Alongside the hospital's NGRI patients, there is a subgroup of those found incompetent to stand trial.
They'll face their charges if they become well enough to understand the legal process.
Number four - one cannot be tried unless physically present in the court room.
Is that a true statement or a false statement? Good morning.
How ya feeling? 'One of these is Charles.
'Having made progress at Moritz, 'he was graduating to a less restrictive civil hospital.
' When you make your show, this what we're going to name this segment of the show, right here.
"The big pack up"! You're going from forensic mental to civil mental? Civil mental, yeah.
Because you've done so well, here.
Is that right? Done well.
You got to do well, here.
Would you agree with that, erm, Doctor Soehner? Yes.
He has done very well, here.
Charles has been a model patient? Well, you know, he is not an angel but he has been making efforts to stay out of trouble.
What was your original case that brought you to the attention of the courts? I had four counts of aggravated robbery of a Credit Union.
Is it that a bank? Yeah, a bank.
It's basically a bank.
Same thing, yeah.
You went in there to rob it? Yeah, I did rob it three times.
We got caught time the fourth time.
It's, er, four days in a row.
I was really out there.
You would think they'd catch you the second time? Or the first time! Right? You did well to you did well to do it three times successfully.
Oh, no! We wouldn't use them words with crime - "Did well".
So, have you not gone to trial yet, Charles? No trial yet.
This happened how long ago? December, 2007.
Do you feel you're competent to stand trial? Erm, I got a few personal problems and things that occurred with lawyers - I can't deal with lawyers.
You're angry with lawyers as a group? Very angry, yeah.
Why? So, as far as being Lawyers got something to do with some baby rape and shout stuff, which I don't appreciate that they did and I don't trust lawyers.
It's interesting because, you know, there are good and bad people in all walks of life.
Would you agree? Yeah.
Even among lawyers - there's good ones and bad ones? There's probably good ones there, yeah.
But I don't know which ones is the good ones, so I'm going to say sorry and I hate 'em all.
I can see that would be an obstacle to getting a good trial.
Doctor Soehner, have you talked to Charles about his issues with lawyers? Yes, he's had difficulties with lawyers.
In my opinion, he could work with an attorney if he chose to, but other evaluators disagree with my opinion.
How are you getting on with your packing? I'm done.
I just got to get my, erm my personal electronics, er, razors OK.
and snacks out of the pantry there.
We'll just hang here.
So, Doctor Soehner, you're feeling really is that Charles, um should be declared competent to stand trial? Yes.
You think at some level maybe Charles is worried that he would be found, umguilty and sent to a prison? Yes.
So, maybe he's playing the system a little bit? Yes.
You think so? Yes.
Is Charles definitely mentally ill? Yes, Charles does have a mental illness.
But he has enough sense to know how to work the system a little bit? Absolutely.
Do you think you are mentally ill? Seriously mentally ill.
You are? I don't even let them know how mentally ill I was, or they probably would never let me out.
I'm seriously mentally ill.
Some things in my mind I don't even bring out - never.
Is that everything? That's everything, yeah.
All right, Charles.
Good luck! Most people, you say, "Are you mentally ill?" and they say, "No" or they say, "Yes, I guess I am.
" But he said, "Oh, yes.
I'm very, very mentally ill".
I'd never heard someone say that before.
Well, generally those that have incentives to be labelled mentally ill and to remain incompetent and unrestorable, certainly would want to keep that label.
Later, Miss Angie.
It's funny that you can be mentally ill and malingering.
Yes, those are the most difficult types because they know what the symptoms of mental illness truly are.
Charles was moving to Kosar - a civil mental hospital that has a number of forensic units for patients with criminal cases.
So, you've been here before, Charles? Er, maybe about 50 or 60 times.
What's it like to be back? It's like, erm, coming home.
Nicky! Hi, Charles.
How are you? Depending on their progress in treatment, patients are assigned a movement level.
322.
For Charles, arriving back was a familiar routine.
Clean, everything's clean.
Have you ate? No, I ain't ate? Do you want something to eat? I would love something to eat.
I ain't ate in two days, I've been fasting.
Would you like a cup of coffee? I'd love a drink, I drink tea.
OK.
Help me out with getting food.
I got ya.
Help me out deep, man, cos I'm hungry.
OK.
The idea I have for today's group is a bit of a challenge, but to maybe think - if you have the opportunity to talk to yourself the day you went to jail, the day you were arrested - what would you say? At Summit, and along with Brian, I was attending a group called Recovery From Loss for patients who have killed family members.
I would tell myself that I need to seek out help when when I get too excited about something.
Or if I start hearing voices - go for help right away.
What are you thinking about when you pray? Erm, I think about drawing close to God, like the Bible says, "Draw nigh unto God, or draw nigh unto you.
" "Draw nigh unto you"? Yeah.
You're, like, with your heart, you're drawn close to God and he draws close to you.
Is there a voice? Erm, usually, usually not.
Erm, the Bible says, "In the presence of God, there's fullness of joy.
" And sometimes, sometimes God speaks to me but it's not, like, it's not an audible voice - it's, like, in my spirit.
Do you remember what they said at your treatment team? One of your things was to have conversations with people.
Do you remember? Yeah.
Er, something other than religion, yeah.
I just realised we were, kind of, breaking that rule.
Maybe that's OK? What do you think? Well, I'm-I'm trying to be more well-rounded.
It's-it's hard because, you know, being locked up so long in these places, only thing I really have had to turn to is my faith to get me through.
Would you like to play ping pong? Sure.
Well played - nice shot! Thanks.
So, right now - are you experiencing any symptoms like hearing voices, or having any, er, suspicious Charles was meeting his new treatment team to discuss his movement level and check in with his psychiatrist, Doctor Singh.
Doctor Singh, you know Charles? Have you worked with Charles before? Many years.
Probably forgot about it 2007 and 2009.
I came from Moritz and came here in 2009 and you let me go in 2011.
April, 2011.
Oh, OK.
Well, you know.
It's, kind of, faintly remember your face, but I don't really remember.
But tell us about what, er, what's happening and how you're feeling today.
What's going on? I'm feeling, ermbetter than I ever felt in my life.
At the moment Charles' level - as far as where he can go in the hospital and outside - is level what? One? Er, by default anybody that comes here onto the unit is on level one.
I don't think that's going to be a long thing, you know.
A week, two weeks? Generally about two weeks, yeah.
You have positive memories of Doctor Singh? Erm, all I'll say is, let me answer it this way - do I have any negative memories of him? No, all positive.
All positive of her.
She was on the unit.
Cos every time I see her, she always had a bright, happy face.
So, you know.
Everybody's cool, I guess.
Keep thinking about it, you come with some positives, at least on me! That's it, you don't think they're evaluating you, but you're really evaluating them, right? OK, thanks a lot.
Elsewhere on Charles' unit, I'd heard about another patient whose crime was said to be unusual - even by the standards of the hospital.
Hey, Dean.
We coming.
You ready? It involved a serious sexual assault on a close family member.
Hi, Dean.
How ya doing? His name was Dean.
I wasn't sure how much he was willing to say about the incident.
Is there any of your stuff here that you'd like to show me? Yeah, the books and then the posters I got.
This is my gratitude list.
I did it one time when I was really feeling bad.
And then this is my family.
My dad, my mum and me when I was 16.
That's before you came in here.
That's before I came in here.
How often do they come and visit you? My mum's expected to come today, actually - hopefully.
And then my dad - they switch up the visiting days because that way I can spend more time with each of them.
What's your diagnosis? I actually have a little bit of confusion about that.
Because I waswhen I was first in here, I was bipolar.
Now, I have mental disorder NOS on the Axis I.
Not otherwise specified? Right.
Which means I have a lot of different things, but no one diagnosis.
I have borderline personality disorder and I don't Which means? I don't actually know a lot about that.
But I know, it's basically, it's not a People argue that it's not a mental illness, but then other people say it is a mental illness.
So, there is some debate about that from what I heard on NPR.
You were found not guilty by reason of insanity, is that right? Yes.
What can you tell me about your offence? Er, my offence was against a family member.
It hurt them horribly, actually.
Erm because of me that person has PTSD.
But that person still comes to visit me every week.
That person forgives me for what I did.
I don't deserve that forgiveness.
How old were you? I was three months after my 18th birthday or four.
I forget which.
About one month after I'd celebrated a graduation party from school.
What was it that made you commit the act that you did? The delusion I was having was that the person would enjoy it and respond.
And, I mean, I was told Why are you looking like that? Me? Yeah.
I'm just lis Sorry, I'm just listening.
Oh, OK.
They told me that, er, that was a delusion.
I mean, I know where I got that delusion.
There was a style of underground comics that I was reading on the internet and it kinda just warped my mind.
Cos I was reading them for years, you know, years and years.
On the day of the incident, was there anything different that happened? No, and I'll tell you that - this is the mystery in my family.
It was the best day.
I mean, it was a happy day.
There was nothing that made you snap? No, I just No.
I just remember I went and got a knife and then I walked in to her room.
I mean, that person's room.
What time of day? I remember looking at the clock, it was like nine in the morning, 9:13.
How long did it last - the whole interlude? Oh, God.
Less-less than 20 minutes.
I mean Yeah.
But I had a For her - it was probably for a very long time.
How did the police get involved? I called them.
You called them? I called them.
I called on the phone to the police and I said, "I want to commit suicide.
" You know? Meanwhile, what was going on with the victim? Erm, I have no idea.
I wasn't there.
My dad won't talk about it - what happened.
He tells me occasionally, but he says, "Son, it was either forgive you or kill you.
" And I understand that.
I understand why he said that.
Do you think? Yeah, I'm just thinking about it.
It's a it's an unbelievable story.
Yeah.
That's the problem.
How do you mean? Well, I thought you meant "unbelievable", like it sounds like farce, you know.
Not farce but, erm, it's almost like a Greek tragedy.
Oedipus? Yeah.
Oedipus would be correct, probably.
I'm good to keep talking.
Do you feel they've been able to help you here? They help me if I let them and they've helped me a lot lately.
There's very good doctors here.
Thanks, Dean.
Yep.
OK, see you later.
Yep, see ya.
If you'd like to sign here.
Yes, I would.
How are you doing, today? I was back at Moritz in a therapy group with Thomas - the patient whose diagnoses included antisocial personality disorder.
Since our last meeting, I'd read about his case.
Early one morning, he'd stabbed and killed a man at random in the street.
A 42-year-old dishwasher on his way to work.
I was still struggling to connect to the gruesomeness of the crime with the Thomas I'd met.
I'd arranged for another interview - this time with his psychiatrist, Doctor Soehner.
We didn't talk a great deal about your offence last time.
Not much.
Are you comfortable talking about it? Yeah, I'm OK with it.
What can you say about it? That, er, I committed it.
Erm I admit that I was on drugs and I was using a lot of drugs.
And I was off my medicine and I'm unpredictable when I'm off my medicine.
When you come off of your medications, what kind of symptoms do you experience? Er, hallucinations and erm I'm hearing voices.
What did the voices say? Do you remember? They told me to kill, kill, kill anybody.
I mean, justit wasn't no particular person, it just at random and to kill everybody cos they out to get you.
Mm-hm.
Do you remember when you first saw the victim? Er, I think so.
I was walking down the street, it was dark - it was at night-time - and er he was walking in front of me and seemed like he had changed into a skeleton with, erm a cloak over his head and the voices told me to kill him now.
They'd say, "Do it now, do it now.
" They kept getting on my nerves, so I just did it.
Had you had any other violent incidents before that? Erno.
First time.
We talked about your diagnosis, didn't we? Right, paranoid schizophrenia.
There's paranoid schizophrenia and then there's also an Axis II disorder, which is, erm Er, what is that? Bipolar? Antisocial personality disorder.
Oh, yeah, yeah.
That one, yeah.
I remember that one.
Can you talk about that a little bit? Because as I understand it, that's hard to medicate? Yes.
Antisocial personality disorder is, erm, basically someone who, er from their earlier days - even before the age of 12- begin to, erbehave in a manner that is against the usual norms of society.
Running away from home, getting in trouble with the law - and in very severe cases - it can include abuse of animals.
Do you know how Thomas came by that diagnosis? Well, younger years involved running away from home, some defiance with authority, erm and even cruelty to animals, at one point.
Is that right, Thomas? Yeah, that's right.
What was it? A cat.
What did you do? Tied it to the railroad tracks.
Why? I don't know.
Just something to do.
And did a long prison sentence for 16 years.
Yeah.
For what? Attempted murder.
During a mental illness episode? Yeah, it was, it was I think I was on the medicine then, but it's not what you think.
What it was - my girlfriend said that I hurt assaulted her little daughter.
Said you had assaulted her physically or sexually? Physically.
That, that wasn't true.
She was just getting back at me for, er having an affair with another woman.
So, the conviction was for, for what? Assault on a five-year-old, which I really didn't do.
So you deny doing that? Right.
Can someone be not guilty by reason of insanity on the basis of a diagnosis of antisocial personality disorder? No.
Why not? It's not considered a legal mental illness.
And thankfully the courts do not consider antisocial personality disorder to be a mental illness, otherwise everybody would be found not guilty by reason of insanity.
Thanks, Doctor Soehner.
OK.
It was good to see you, Thomas.
Let me know if you have any questions.
OK.
Thanks, brother.
Thanks so much, Thomas.
All right.
Thank you.
You dropped your keys.
Oh, thank you.
All right.
You know, I've got to know Thomas a tiny bit and found him pleasant to be around and then when you read out the list of things that had happened in his past, I was, I was quite shocked.
And, ermit made me think It would be a scary thought to think of him at large in the community.
Absolutely.
Particularly if he's not taking his medications and is using substances - very scary.
I was back at Kosar for breakfast with a patient named Christian.
He was in for assaulting a police officer.
What's your story? How long have you been here? This my second stint here on this charge.
I've been here about, er, four months.
What's your diagnosis? Paranoid Schizophrenia.
I've got audio and visual hallucinations, like, I'll get the sky talking to me, er The sky? The sky, sky, big The clouds, er Saying? Well, I remember one time I was trying to go to college and, er, I looked up and the sky was like, "Go away!" I'm like, "Huh?" "You don't belong here.
" I was like, "Oh, man.
" I gave up going to college that day.
How are you doing in here? How's it going? Pretty smooth, erm, I'm recovering.
Yeah, I get a kick out of this place, I enjoy it a lot.
Really? Yeah.
I didn't think you were going to say that.
Sorry about that! Do you know Dean? Dean, yeah, Dean, yeah, I hang out with Dean.
Do you talk about each other's cases? Not all that often, that doesn't come up.
Dean doesn't talk about his case at all.
Dean will not tell you what he has done.
He's really ashamed.
What's up? HOW you doing? Man, I woke up five minutes ago, I'm surprised I'm standing.
So, what you been up to, Christian? Oh, nothing, bro, I've just woken up myself.
Do you two ever talk about your diagnoses? I ask him some days how the voices are going because I know he has that sometimes, you know.
They're not voices In a way, what Christian's dealing with is fairly, erm, common as far as mental illness goes, which is auditory and visual hallucinations related to schizophrenia, is that right? Yeah.
But you've got something a little more, erm Complex.
Yeah, I have narcissistic attention-seeking and a little bit of antisocial.
So, I was speaking with the, er, treatment team.
I would like to meet with you tomorrow afternoon to do your risk assessment and Oh, yeah.
Come by my office at three if you can.
Dean is seeing his treatment team.
Though patients generally see their teams once a month, due to his special needs, Dean gets meetings every Wednesday.
Yeah, I have a question.
Erm, can I get a CD player because I've been wanting to get, you never hear the great choruses Are we talking about a personal CD player? Yeah, for me, you know or can you have them for everybody? No.
Oh.
I just want to make sure we were on the same page.
Yeah, it would cut down on my cost.
You can give me one of yours.
No.
Oh.
Yeah.
I still can't get an MP3 player.
No.
OK.
Or a DVD player? No.
OK, I didn't think so.
I mean I had them both.
Never mind forget about it.
Any more questions? Nope, not really.
All right.
OK, thanks.
Yeah.
OK.
See you later.
Thank you, Dean.
Bye! Fucking waste of time.
That's something he gets on this unit, right? A weekly check in meeting, but that's not typical, is that right? No, it's not typical but if somebody needs that, that's what we'll give em.
It keeps him from a patient being able to split staff and coming to whoever's door, several times a day, if this person says no, then I'll maybe go ask this person, where then you just jot it down and come and ask us every week.
Playing mum off against dad? Exactly, yeah.
He requires a little more attention, maybe, than some of the other patients? Yes, yes.
In the past, let's just say his behaviour was very, very different, especially if someone said, "No.
" Disruptive? Yeah.
But not assaultive? Well, there was assaultive behaviour in the past.
On patients? On patients.
And staff? I don't recall about that, I'd have to look at his old risk assessment, so I'd prefer not to say.
Erm, but, yeah, assaultive behaviour was an issue.
It sounds like he is making progress in his recovery, in his treatment.
I think so.
I've known Dean for several years, you know, nobody's perfect, I get that, but the difference is, to me, pretty striking, from where he was before.
It was lunchtime and a chance to catch up with Charles.
What you been up to, man? What's going on over there in England, man? Well, erm Fast cars and what? Just the usual.
You seem very well.
I'm very well.
Like, erm And mentally - you feel well? I feel very well.
Better than I ever felt in my life.
Would you like to stand trial if you're competent to stand trial? You know, they're kind of like baby rapists in the courtroom and the judge, OK, the lawyers lead the baby-raping organisation.
But do you really believe that? The lawyers, man, they I hate baby-rapers, man, I can't stand 'em.
What makes you think that lawyers are baby-rapers? I'm going to tell you why.
It's the hi O-B-A, yeah, it's the Ohio Bar Association, but it's concealed in this secret society.
The OBA really stands for Ohio Baby Abusers, that's their secret society, lawyers.
Would you like to be found competent to stand trial? That it still leads back to baby-rapers, it leads right back to 'em.
You know what? If all of a sudden God would say, "Yes, please," so I can get in that courtroom, ooh, just, hmm, all I want is one of 'em.
I said if I wasn't serving God, I would think all kind of stupid things, I wouldn't want to go back to court and I'd be thinking stupid things, but I don't think it, because I try to push it out.
Charles.
What? Stay with me.
How long before you get your conditional release, do you think? Erm, I got to make level four and it shouldn't take me long to make a level four, cos I ain't going to be clowning - I go along with the rules always, I don't cause no trouble.
But then if you got to court to get your level four, won't there be lawyers there for that? Erm, I don't have to, erm, work with them, I stay away from them.
I get away from them, I tell them to get away from me and just do what ya'll going to do.
I ain't got to talk to 'em or I don't have to work with 'em.
I don't have to work with them I got one way or the other, I got to do something.
Back at Summit and Brian was in the running for a possible change in his movement level.
He'd been scheduled to be evaluated by a forensic review team or FRT, but there were still concerns that some of his religious beliefs might be a problem.
I caught up with Doctor Rukseniene.
How is everything going here? Erm, things are stable.
Erm, I mean, unfortunately, Brian is not getting FRT this week.
OK, cos he was expecting to.
He was expecting.
I have the feeling that maybe with Brian, it's more complicated.
Well, yes, it is, erm I mean, his behaviour is perfect, however, he still has the same beliefs that from clinical perspective, would consider to be psychosis.
Really.
He has psychosis? That's the main symptom of his illness.
He was hearing voices, so he believes that was the enemy speaking to him, erm, we call that a hallucination.
Are you choosing your words carefully? Yes, because, erm, there is a large group of people who have the same beliefs.
Who are not considered to be mentally ill? Absolutely, yes.
Here's a good one.
It says, "When at night you cannot sleep, "talk to the shepherd and stop counting sheep.
" "When there is too much bad news, catch up on the good news, don't "tell God how big your storm is, tell the storm how big your God is.
" Tell the storm how big God is? Yeah.
Nice out here, isn't it? Yeah.
You loved your mum.
There was no reason for you to be angry with her? There was no reason for you to be angry with her? No.
She never did anything to me.
Had you ever fallen out with her in some way? No, no.
How old was she, when you killed her? I think she was 48.
I think s-somewhere around 48.
I mean it's just a terrible tragedy that, er really wrecked the whole family, you know.
When I think about my brother, you know, his loss, you know, cos he was only 17 at the time.
I wish I could contact my brother, write him a letter and just tell him how sorry I am.
Why can't you? Well, through the courts my dad and brother have a restraining order which says I can't contact them ever.
Ever? Even after 20 years? So If a condition of you getting back in touch with your brother and father again was that you that you accepted that your mother was not possessed, if that was the condition, would you be able to do that? No.
I wish I could turn back the time, you know.
I can't.
I was heading out of the hospital.
I'd made an arrangement to meet the victim of Dean's sexual assault - his mother, Cathy.
Hi, Cathy? Hi! Hi, Louis.
Can we come in? Come on in.
How do you do? Nice to meet you.
Dean was our Christmas card every year.
Just Dean? You wouldn't put yourself or your husband on there? No, just the baby.
Cute kid.
Darling little boy.
And he's quite a ham, I mean he'd let us take picture after picture.
Did he? He enjoyed the attention.
Yes.
Was he well behaved as a small boy? As a small child, yes.
Most of our difficulties started when he went to school.
Right.
Yeah.
His behaviour in school was just bad.
Attention seeking? Oh, yeah, very much so, and very manipulative.
Of who? Everybody.
Then, when he got, I would say middle school, he did start becoming more physical, like he would get angry and throw a desk, or hit a wall.
Um He sat in the principal's office once with a pencil to his neck, you know, and was going to threaten to hurt himself.
This was, I'm thinking, tenth grade.
Tenth grade is around 15, 16, so that was before the incident.
Something's really changed there, hasn't it? Mm-hm.
It's not just that he's become much heavier, there's a little bit of a darkness around the eyes.
I know.
Had he changed personality-wise there? He started getting more moody, yeah.
Moreangry.
Was Dean picking up new diagnoses as he went along? Yes.
Like what? What were they? Well, it all started out with attention deficit disorder, and then oppositional defiant disorder.
He mentioned borderline personality disorder.
Well, and that's been since he's been at At the hospital.
At the hospital.
Kosar.
Which was kind of a whole new thing for me.
I mean, it's like that's who he is, as opposed to having a condition.
He was 18 when the incident occurred.
Yeah.
You were at home.
Mm.
Your husband was somewhere else.
My husband was at work.
And Dean was at home.
I mean, how much are you able to talk about what happened? Um We'll give it a go.
He came in? I was getting ready.
I was upstairs getting ready to take him for his appointment at the social security, and he come in the room and he had a knife.
He threw me down and um He assaulted me.
Was he naked when he came in? No.
He was clothed? No, he was clothed the whole time.
The whole time.
So, he didn't actually The It It was a sexual assault.
There was no penile penetration.
He ripped my top, ripped my bra, my pants were around my ankles Um So Were you fighting him? No, not really.
Just saying, "Dean, don't do this, stop this".
He had that knife.
Was he holding the knife? Uh-huh, yeah.
I was so worried that he would realise what he was doing and hurt himself, I mean, more than thinking about Yeah, I know it's crazy.
In a way, it's not a million miles from holding his pencil at his neck when he's at the principal's office.
I mean, I've been told, you know, I've been in counselling, of course, that he knowsknew how to do me, how to He knew how to manipulate you? Yeah.
What do you think he was trying to achieve? I'm not sure.
I have My latest theory is it was something he wanted to do, and he did it.
He said that he called the police, but you didn't.
He did.
Do you think in some way he wanted to be hospitalised? You know, I've thought that, you know, I've thought that through the years.
You know, was he scared of being out of school? You know, the routine being changed.
What's he going to do? Was it, "Am I going to have to get a job?" He's 25 now, is that right? You still have what you consider to be a good relationship? Yeah, we do.
And his dad does too? Yes.
Yeah, remarkably.
You know, my husband doesn't talk a lot.
I do wonder sometimes how he has managed to cope with it all.
How has Dean changed since then? Has he changed? I've seen more change in Dean in the last, just the last year.
He does seem to care more about other people, you know.
I mean, he'll send a card home, which doesn't sound like much, but for him, it kinda is.
Do you ever think he could do something like that again to you? I would like to think not.
I don't think he'll ever have the opportunity.
I don't think we'll ever be alone together.
And, I mean, who knows, maybe that'll change some day, but right now I don't think so.
I think we should always have somebody with us.
I was struck by Dean's mother's courage and her dignity, and puzzled by the strangeness of Dean's case.
A young man seemingly victimised by his condition, who, in turn, victimised the person who cared most for him.
At Kosar, patients and staff were getting ready for Christmas.
For all the flaws in our understanding of mental illness, I'd come to see the hospitals as deeply humane places, attempting to provide care, even in the most ambiguous and confusing cases.
On Dean's unit, I had an appointment with another patient called Paul.
Hi, Paul.
How are you doing? Louis.
Doing good, glad to meet you.
Nice to meet you.
Have you got a few minutes? Yes, I do.
How long have you been at the hospital? I've been here about two months, since the middle of July, I believe.
And you missed a court date? Yep, February is when they arrested me, and I've been in jail up until two months ago for missing that court date, without actually being convicted of anything.
So you haven't gone to trial yet? No, I've been waiting.
What are they accusing you of? The court part of it is what they accusedwhat I was arrested for, it was erchild pornography on my computer.
I was trying for legal X-rated files.
Pornography? I didn't double check what was coming down over the internet.
I was waiting until I would get like 180 gigabytes, that was what I was shooting for, and I was just short of that when they caught my channel, what do you call it? Internet connection had some illegal files on.
They have an electronic way of doing that.
Do you have an interest in child pornography? No, I don't, not a bit.
I hate that stuff, I really do.
But the child part is what surprised me, when I found out that was going on my computer.
They thought I deliberately did it in order to distribute it.
Just by sharing files on the internet, that's considered distribution.
You're kidding! Well, see, I don't know where anyone that was getting those files, you mean that's what they were talking about? Probably.
Oh, boy! Are you OK over there, Charles? Yeah, I'm OK, and, you know, thinking about some things, and, you've been asking me about some things, and umabout some malingering stuff.
You know, you've been asking about it and er I ain't saying I'm malingering, let's put that on record.
I ain't saying I'm not malingering, let's put that on record.
They want to play games and not care about my health You know, this right here, they want to take the tea from the unit, the whole hospital, they didn't do it in the whole hospital, only this unit took the tea You like to drink tea, don't you? No, no, I hate tea, it's nasty.
I thought you liked tea.
No, I hate it.
I hate tea until I seen this on the box, "Regular tea drinking will help maintain healthy vascular function", which means that it'll help my blood clots and my bad circulation.
They say they don't care if I get my legs cut-off.
They don't care about my health, so I don't care nothing about malingering, how about that one? Why are you bringing malingering into it? You was always talking about me going back to court, getting competent.
I'll never be competent to stand trial.
If I did, I'd do the rest of my life in a penitentiary.
I got murders, kidnappings, everything from 1978.
I got other cases too, this ain't the first one.
I've been doing this all my life, before you was born.
I'm unrestorable incompetent that's never been to trial.
How about that one? I got kidnappingsâ I got a whole bunch of kidnappings.
Do you think you are malingering? Do I think I'm malingering? Er Let me see, I can say this illegally where they won't say, "Ah, you just said malingering" Oh, I know a way I can do it.
Mental patients One way you can know a mental patient, they'll say they're not crazy, they're just playing crazy, so, yeah, I'm just playing crazy, I'm not really ill, I'm just playing, yeah.
How about that one? That's like a triple bluff, isn't it? Do you know what I mean? They want to play and that's not playing, I understand playing.
Let me tell you, I don't want to use the word "work the system", but I just I get what I can get.
I got $1,200 orthopaedic shoes.
I just picked them up the other day.
I got designer glasses.
They're going to give me $3,000 partials, yeah.
Your teeth? Yeah, so they want to play with me, and I care about my health, I'm going to get what I can get.
Do you don't mind being called a malingerer? I love it.
Charles, I really believe you because I know how the system works and you aren't a liar, all right? You know what I'm saying? OK.
So they want malingering, OK, we'll malinger.
Catch you later.
With my time at Kosar nearly at a close, I've arranged for one last chat with Dean and his psychiatrist, Doctor Singh.
Can I join you? Yeah, sure, come on in.
You've been working with Dean, how long, a couple of years now, is it? Like seven.
Seven years.
Seven years, really? Since he moved to here.
You've seen him make good progress? Yeah, definitely.
You know, I've met your mum, she seemed really nice, and obviously you're intelligent, and it would seem, you know, in those two respects, you have two big advantages in life, and yet this horrendous crime took place.
How do you make sense of that? I think of it privately like this, my soul was sick.
Your soul was sick.
Yeah.
Not in the sense of a delusionary way, but more what I chose to put into my body was pretty much like really underground stuff, you know? You mean in terms of what you were reading? Internet, what I was reading, what I was watching, what I was choosing to believe.
I mean, I had no friends whatsoever.
My parents helped me as much as they could, but I just felt helpless.
Would you say you were not in your right mind when the offence happened, Dean? I've actually questioned that myself because I've had psychologists tell me I didn't have a mental illness and I shouldn't be here.
I don't want to believe I did what I did on my own, if I did, because that would make me a monster.
It would make me someone who deserves to be put down.
I think you do have a psychiatric illness, Dean, so you don't have to really think what happened was not because of the psychiatric problem.
I think you have the guilt and the remorse, which is a good thing.
So it's good that you feel guilty, Dean.
Yeah.
I know.
It doesn't make it easier some days.
See you later, Dean.
Thank you.
See ya.
It may be that there are as many kinds of mental illness as there are patients.
In my time at the hospital, what had struck me was the difficulty of dealing with the outer edges of the disease.
The place where a person's symptoms and the self are inextricably intertwined.
The distinction was, at times, unclear, but it could also be very real, and so too the feelings of remorse and the possibility of a new start.