Wednesday, April 25, 2007


by Tory Butterworth

I don't know about you, but I'm not a big believer in the, "Not Guilty by reason of insanity," plea. I've worked with many clients from dysfunctional families, including sadistic and/or abusive parents. Some of these clients are the nicest people you'll ever meet, with a great capacity for empathy with others' pain. Of course, some sadistic and/or abusive people also come from such backgrounds. Still, it proves to me that there can be many different responses to the same dysfunctional environment.

I was reminded of why we need the insanity defense when I met a patient I'll call Joe (not his real name.)

Joe believed the FBI was chasing him. He got on a bus and rode across the country, exiting somewhere in Utah. Scared he was being followed, he stole the nearest car, and in due time was caught and arrested.

Now, I don't know about you, but if I thought the FBI was chasing me, I might well have done the same thing. The problem, of course, was that the FBI didn't have anything to do with it. It was all in Joe's head.

Joe complained that the people next door where listening in on his thoughts. He said he wanted to move to Minnesota to get away from it. I asked him how it would be different for him in Minnesota. He said, "In Minnesota, if they're listening, they don't talk about it!"

This is what clinicians call, "psychotic," being out of touch with reality. A number of conditions can cause psychotic symptoms, including dehydration, severe lack of sleep, and abuse of certain substances. Several different psychiatric disorders, including bipolar disorder and depression with psychotic features, can also cause psychosis.

The most common cause of psychosis, however, is schizophrenia. Epidemiologists estimate one in 100 people in this country are schizophrenic. Average people sometimes use "schizophrenic," to mean having a split personality. The mental health diagnosis, however, is part of a much broader disease that can lead to progressive mental disorganization.

To follow up on the, "Creating Believable Villains," theme of my last few blogs, I believe that psychotic people can make sympathetic villains, if the author can show how their actions arise from their distorted thoughts. However, it is usually difficult to disguise psychosis (most people can tell that someone who's psychotic is acting weird, even if they don't understand why) and so it may be difficult to make it a surprise that this type of villain committed a crime.

Any of you crime writers out there considering making your villain guilty by reason of insanity?


lisa curry said...

Tory, most interesting. Being psychotic must be sort of like being stuck in a bizarre nightmare, even when you're awake. That thought occurred to me because I woke up from a bizarre nightmare this morning and was relieved to be out of it, and then I read your blog and thought about what it would be like if your nightmares followed you into waking consciousness. My dream was not unlike your client's delusions about the FBI, except mine involved torture, which suggests to me that maybe it's not a good idea to read historical novels about the Spanish Inquisition before going to bed!

Joyce said...

Very interesting, Tory! I don't believe in the insanity defense either. I think it's abused too often and even if the actor gets treatment while he's locked up, when he gets out, chances are he stops taking his meds and he's back to where he started.

We've had calls at work where the person thinks there are listening devices in their house, aliens are watching them, someone keeps breaking in (no evidence of this), etc. The guys are pretty good at appeasing them--they just tell them what they want to hear, then call county mental health, who usually doesn't do anything anyway.

Tory said...

Lisa: Exactly! That's my guess what it's like, too. And yes, I couldn't stand to read novels about the Spanish Inquisition at any time of the day or night.

Joyce: In terms of county mental health, if the client doesn't think they are crazy they aren't usually willing to show up for appointments or take their medications, and there's not a lot mental health people can do for them. Ironically, the sicker they are, the less they realize they're sick.

With the far-out psychotics I just try to, as you say, "Tell them what they want to hear," and generally engage them enough to keep them coming. And I try to be flexible enough that they can drop in at a moment's notice. Most importantly, I try to explain what's going on to their family and get them involved. Unfortunately, the burden of care almost always falls on the the family members.

Joyce said...

And I forgot to say that aluminum foil works really well to block the alien transmissions. :-)

Tory said...

Joyce: not to mention making a great fashion statement!

Nancy said...

Tory, I'm feeling very mentally disorganized right now. I call it deadline madness---maybe a form of psychosis??

When I was taking antidepressants for several months, I woke from vivid dreams one morning and couldn't distinguish what was real and what was dream. At least I was together enough to know it was time to get off the drugs, but it was a frightening peek into what a delusional person might suffer.

Nancy, again said...

PS. I'm really looking forward to your workshop at the Pennwriter conference, Tory!

Tory said...

Nancy: Thanks for the vote of confidence!

Distinguishing that you're unclear about what is real and what is a dream is a sign of health. As psychotics get sicker, they believe their own hallucinations more, and so are harder to treat.

Pretty scary that antidepressants can do that!

Judith said...

My favorite psychotic villian is Hannibal Lechter. Of course part of why I love his character is because of the actor who so brilliantly brought him to the screen. Reading the book scared the of me!!!!

Anonymous said...

Very interesting post, Tory. I always learn so much from you.

Joyce: I'll have to remember that about the aluminum foil. LOL!

Cathy said...

Quite a challenge to deal with the mentally ill, and I'm sure you're doing a great job, Tory.

My parents tell me about a neighbor lady who is sure she's being watched and has a gun in her house. She was taken away and came back without her two children, but still acts psychotic. We're hoping the gun was taken away, too.

Joyce said...

Cathy, if the police were aware she had a gun, it would have been confiscated. She'd need a court order to get it back.

Tory said...

Judith: I think Hannibal Lechter is the most wonderful character, too. I wasn't willing to read the book, but in the movie I was really impressed how they portrayed his pathology as a twisted desire for contact.

I wouldn't call him psychotic, however. My impression is he was more the psychopath, with no moral conscience, that I wrote about in my March 14th Blog called, "Why People Do Bad Things." I think he was in touch with reality, just didn't care how anyone else felt.

That's a sign of a great character: you can diagnose them!