June 18, 2007
Science: Insane or Merely Psychotic?
David B. Sullivan walked into a McDonald's restaurant last year and did what most people would think of as "insane": He went up to a teenage employee, witnesses said, and knifed her for no apparent reason. The victim, Anna Svidersky, died.
But keep one thing in mind when Sullivan, 29, and two other Vancouver residents go on trial this year for equally chilling crimes: A defendant can be insane in the colloquial sense but not the legal one.Despite advances in brain research that have shed light on how we learn, why we have cravings and where we store memory, what provokes violent behavior can be answered only with an educated guess.
"You can't look (at a brain scan or any other test) and say, 'Aha!'" said Dr. Bruce Gage, a psychiatrist at Western State Hospital near Tacoma.
When a defendant pleads insanity, doctors for the defense and the prosecution will often give differing opinions on the severity of his psychosis.
That's the word they'll use: "psychosis." The word "insanity" is left to the court.
Many people who commit crimes have psychosis, a syndrome marked by delusional thoughts, hallucinations or disorganized thinking.
"Just because you're psychotic doesn't mean you will be found insane," Gage said.
The state's bar for insanity is high, said Clark County Senior Deputy Prosecutor John Fairgrieve. The presumption is that a defendant is responsible for his actions and, if they include crimes, should be punished with a prison term.
Statewide, fewer than 20 criminal defendants are found insane every year, Gage said.
In Clark County, only one murder defendant has been acquitted by reason of insanity in the past decade. Ryan Galvin remains under the state mental hospital's supervision, but has been judged well enough to live off campus.
Cause, effect of psychosis
Doctors know the causes of psychosis. They include mental illnesses such as paranoid schizophrenia and bipolar disorder or structural problems such as tumors. General medical illnesses, such as infections and electrolyte imbalances, can change brain chemistry to the point it triggers bizarre behavior.
Doctors also know psychosis lurks in the frontal and temporal lobes of the brain, the centers that control reason and emotion.
A frontal-lobe problem can also hamper impulse control, Gage said.
It's normal, for example, to have a fleeting thought about how gratifying it would be to punch an obnoxious co-worker. But a healthy brain runs through the consequences -- you'd lose your job, be charged with a crime, possibly face time in jail -- and the thought evaporates. People with damaged frontal lobes, on the other hand, can act out urges without thinking about what will happen next.
A temporal-lobe problem can lead to severe emotional disturbances, delusions and hallucinations. Galvin, for example, thought he was doing a good thing when he stabbed his mother with a butcher knife while she slept in her Vancouver home. Portland police officers found him naked and bloody, lapping up water in a public fountain. Galvin told Vancouver detectives he'd "killed the beast" and the fountain was the entrance to heaven.
Galvin had not been taking his medication for bipolar disorder and schizophrenia.
Studies have shown that schizophrenics have enlarged ventricles in the temporal lobes, due to the loss of brain tissue in the surrounding areas, but the abnormalities aren't always readily apparent in individual brain scans, Gage said .
State of mind
What doctors can't do is definitively answer the key question about mentally ill defendants: What was their state of mind?
Gage, who has been at Western State since 1990, runs the University of Washington forensic psychiatry fellowship program at the hospital. He tells medical students that the interview remains the most important diagnostic tool.
He asks patients what they were thinking before, during and after the act.
"You can see the lines in the letter 'A' and yet not know that it is a letter 'A,' " he said. "A higher level of processing ideas requires a more globally intact brain. The impulse to strike out may be a very primitive impulse, but the ability to recognize that it's a bad idea, to think morally, requires much more of your brain," he said.
He also assesses whether the patient has an accurate perception of what's going on in the world. Are they seeing things? Are they hearing voices? Are they smelling scents no one else can smell? Delusions are not just fantasies, Gage said. It's virtually impossible to persuade someone out of a delusion.
When the patient talks, Gage also considers whether they are organizing their thoughts and stringing sentences together in a way that makes sense.
As part of pre-trial evaluations, Gage also talks to the patient's family and friends to see what they've observed.
He said he knows the public views the insanity defense with skepticism, and said it's easy to detect defendants who are exaggerating or making up symptoms because their stories aren't consistent with what science does know about mental illness.
"When they are acutely crazy, they don't come in and say, 'I'm crazy.' They say, 'They were aliens and I had to do them in.' "
Did you know?
Psychosis is a medical syndrome whose symptoms can include disordered thinking and speech, delusions and hallucinations.
Insanity is a legal standard. To be found not guilty by reason of insanity, a defendant must prove he was so psychotic he could not distinguish right from wrong or appreciate the nature and quality of the criminal act.
Defendants who claim insanity often have damage in the sections of the brain that control reason and emotion.
Shane A. Cole, 32 In 2004, Cole fatally stabbed Hazel "Sis" Stephens, a neighbor in his downtown Vancouver apartment complex. Mentally retarded and a paranoid schizophrenic with a criminal history, Cole was ruled mentally unfit to stand trial. Cole is at Western State Hospital, where he'll stay until a judge rules he no longer presents a danger to society.
Charlene A. Dorcy, 41 The former Hazel Dell resident shot and killed her daughters, Jessica, 4, and Brittany, 2, in a Skamania County gravel pit in 2004. A paranoid schizophrenic who didn't take medication and said her affliction was a "curse" she had to live under, Dorcy pleaded guilty to first-degree murder. Dorcy is serving her 63-year sentence at the Washington Corrections Center for Women in Gig Harbor.
Eric S. Foster, 38 The Vancouver man bludgeoned his father to death last year, a few days after his father took him to a hospital over concern about his increasingly erratic behavior. The paranoid schizophrenic signed himself out of the hospital before he was evaluated. Foster is awaiting trial; a judge will rule after an Aug. 20 hearing whether Foster can use an insanity defense.
Ryan M. Galvin, 37 In 1999, Galvin stabbed his mother, Charlotte, in their McLoughlin Heights home. Galvin had been off his medication for paranoid schizophrenia and bipolar disorder and said he was only killing "the evil" inside of his mother; a judge found Galvin not guilty by reason of insanity. Galvin remains under the supervision of Western State Hospital but lives in an off-campus apartment.
Christafer McBain, 21 McBain fatally stabbed his father, David A. Clark, in his apartment near Evergreen High School in 2004. The drug addict pleaded guilty this year to second-degree murder after a judge rejected his insanity claim. He's serving a 20-year sentence at Washington State Penitentiary in Walla Walla.
Kelly N. Meining, 32 The Sifton mother fatally stabbed her 20-month-old son, Bryce, in 2006. Meining, who has two other children and bipolar disorder, allegedly believed other people were going to harm or kill her son. She has not decided whether to use an insanity defense at her Aug. 6 trial.
David B. Sullivan, 29 Sullivan walked into a McDonald's near Fort Vancouver High School last year and fatally stabbed Anna Svidersky, a teenage employee. The paranoid schizophrenic was not taking his medication. A hearing begins Tuesday on whether Sullivan can use an insanity defense at his Aug. 20 trial.
Stephanie Rice covers the courts. She can be contacted at