Paranoid Disorders and Homicide

The entire array of paranoid disorders has a much more complex relationship to violence and homicide than the organic and toxic conditions. The various paranoid illnesses can be viewed on a spectrum. On one end are cases of pure paranoia which blends almost imperceptibly into normal personality; on the opposite end of the scale are the more disorganized forms of paranoid schizophrenia. The conclusion of Swanson, Bohnert, and Smith (1970) that paranoid delusions, as well as delusional jealousy, are major causes of homicide still holds true (Palermo et al., 1997; Silva, Harry, Leong, and Weinstock, 1996). Lanzkron (1963) studied 150 mental patients charged with murder. He found that 37.3% had paranoid delusions and 20% displayed delusional jealousy and delusions of infidelity. The prevalence of paranoia among homicidal offenders has held up not only over time (Wilcox, 1985) but cross-culturally as well (Benezech, 1984). Revitch (1979) found that most patients who kill their physicians (often urologists because of the sexual aspects of urological disorders) are paranoiacs. In addition, many mass murderers (Hempel, Meloy, and Richards, 1999) have strong paranoid proclivities, as do many political assassins (Lewis, 1987).

The classic example of a homicidal act motivated directly by delusions of persecution was the murder committed by Daniel M’Naghten, from which the legal test of insanity, the M’Naghten Rule, arose. M’Naghten, a Scotsman, believed that he was being persecuted and followed by members of the ruling political party in England, and he requested protection from the provost of Glasgow. In an attempt to assassinate his persecutor (the prime minister of England), M’Naghten accidentally killed the press secretary. As a result of this 1843 case, the English Court established the M’Naghten Rule (having to do with a defendant’s ability to know the nature and quality of his acts and to distinguish between right and wrong), which has since served as the standard for insanity in most of the English- speaking countries of the world.

The following case typifies a homicide that was a direct result of paranoid delusions.

Case 3.1: Disorganized Paranoid Psychosis and Matricide

A 22-year-old male was evaluated to determine his state of mind at the time of the homicide. He was charged with murdering his 50-year-old mother by bludgeoning her with his fists and a door. The victim, who had been repeatedly struck in the head and neck area, died of multiple skull fractures.

For 6 years prior to the murder, AA had had numerous consultations with psychiatrists and was hospitalized several times; there were four separate hospitalizations during the year immediately preceding the homicide. On one occasion, AA’s father pleaded with the judge to keep his son in an institution, since the father recognized—as did most of the neighbors—the potential for severe violence. Unfortunately, the court-appointed psychiatrist who evaluated AA believed that he could be easily managed on an outpatient basis.

AA slowly developed paranoid delusions where he believed that his mother was a Communist who was plotting to kill him and also was plotting with other Communists to take over the world. He became convinced that the “real purpose” of his mother’s European trip was to attend secret meetings to put her plan into action. In order to protect the world, he decided that the only course of action was to kill his mother. According to police reports, the victim was found dead at home. The crime scene was described as follows: “There was blood on the walls ... broken furniture ... broken windows ... blood in the bathroom. A broken and bent door of the medicine cabinet was also noted.” When AA was arrested that evening while riding his bicycle a few blocks away from the scene of the murder, he was “soaked with blood.” He stated, “I hit her with anything I could get my hands on. I hit her with furniture. I wanted to kill her as fast as I could. I am glad she is dead.”

When evaluated in the county jail, AA was extremely agitated and questioned the examiner in great detail about his credentials and identity and the purpose of his visit. He inspected all notes and refused to sit down, pacing in the examination room. After about 20 minutes, AA made a fist and refused to continue the examination because “I am as sane as you are. They’re trying to make me a mental case and I am not.”

About 1 month later, AA was much more cooperative but still paranoid. He was unable to concentrate and stated that noises and telephones bothered him. His conversation was bizarre. He stared into space for long periods of time, repeating one or two words. He said,

I can’t think. How can a dead man think? I am dead. People are conspiring. I am the center of everyone’s conversation. I am the nucleus. They say things like “It’s only a disease.” And they talk about me. People don’t act the way they should. Everyone’s out to make a buck and they want to destroy me. The secret society is doing it. They want to get rich and start a world war.

He explained that he heard voices telling him that he should kill her, and so he did.

This as is an excellent example of a homicide that was a direct result of a paranoid psychosis. Unlike Daniel M’Naghten, whose overall personality seemed intact (except for his delusions), AA appeared bizarre, decompensated, and disorganized. The murder and the crime scene itself reflected the extent of his disorganization. Although family members, neighbors, and friends recognized the potential for extreme violence, the court, following the advice of the court-appointed psychiatrist, did not listen. AA was found not guilty by reason of insanity (in accordance with the M’Naghten Rule) and placed in a psychiatric facility.

In the following case, a 19-year-old man killed a child, also as a direct result of paranoid delusions. However, in this case, the offender was not as overtly disorganized as in Case 3.1. Family members, friends, and schoolmates viewed him as very odd, but they had no idea of the extent of his bizarre delusions which led to the act.

Case 3.2: Encapsulated Delusions and Murder of a Young Girl

A 19-year-old male killed an 11-year-old girl by throwing her in the back of a garbage truck when the garbage men were not looking. The motivation for the homicide was revealed in a letter that he wrote 2 days after the murder.

The haircut I got changed me completely. It gave me a new personality. Then the devil possessed me. I went to Toronto to see my cousins. I was so attractive that they got mad if I didn’t look at my girl cousin. I was like a prince. I started to communicate by looking straight at people’s eyes, which took a lot out of me. It made me more feminine. I was free so I wanted to set people free. They had a record player so I communicated with music, which took a lot out of me again. My cousin said that he would like to show me Toronto. While riding in his car, I told him that I never had sex with a girl. That took a lot out of me, also. I was feminine because I gave too much too fast. I was becoming a homosexual. I was becoming very blind because of a need for sex.

I came home. My father noticed I was becoming gay. I went back home to my mother. There were ESP people downstairs. While I drew pictures, I played the radio to communicate with the people downstairs. They got angry because I was communicating by sound waves like the serpent. The whole town didn’t like me. The ESP people told my father to bring me to New York City to the Hare Krishna place to cure me. It did not work. I went to live with my father.

Everyone was out one day when I started to communicate with car sounds. Then that night I made my heart to physically drop from sound waves. In the morning, my homosexuality was gone and I was like a dead man because in the daytime I thought that whatever I ate would not come out; instead it would stay in me and the poison would kill me.

The next morning I started following garbage trucks because I knew that the more the heart beats, the smaller it gets and it would get smaller and smaller until infinitely small and I could physically live forever. The pain I would bear would be outstanding. I thought I would freeze a thousand times more than I can and boil like the latter. I went to my mother’s house the next morning.

I thought if I threw someone in a garbage truck I could be saved. I saw a little girl just standing in front of her house. I got to talk to her, grabbed her, and threw her in the garbage truck when the guys weren’t looking. Then I got caught and was sent to the hospital. I thought worms and insects would eat me. I also thought I would be the devil himself and I would be locked up in a room forever. I thought I was going to be a suffering thing. I thought if electricity was in me, I wouldn’t be hurting people. If I did not kill the girl, my mother would have been killed. Everyone in the world was quarantined and they used to say the devil may care. I hope I didn’t lose my soul. Everything was made for me. Once the sun obeyed me. I thought I was here to be blessed on. Thank God everything is all right now, Thank God.

This individual was viewed by others as withdrawn and strange, but no one recognized the depth and complexity of his delusions or the potential violence that could flow directly from them. His thinking did not appear especially disorganized when he discussed topics unrelated to his delusional ideas. He was found not guilty by reason of insanity.

In many instances the relationship between paranoia and homicide is indirect and more complex than in the preceding cases. Such an indirect relationship often exists in cases of delusional jealousy, a condition first described by Revitch (1954) under the name “conjugal paranoia.” The symptomatology in delusional jealousy consists basically of accusations of infidelity; destructive, hostile, and aggressive attitudes toward the partner; and feelings of insecurity and dependency. These accusations reflect a break with reality so that there is actually an encapsulated psychosis. Thus, delusional jealousy is far more extreme than pathological jealousy (Morenz and Lane, 2007), which is a more common condition. At times, the paranoid accusations may have some basis in reality, but the truth is distorted and “evidence” is frequently fabricated. It is sometimes difficult to diagnose delusional jealousy because the subject’s personality appears to be intact, he is able to work, and his performance during the examination is convincing. He is able to mislead not only his own family members and friends but also many mental health professionals as well. Thus, his (or her) partner often is incorrectly considered mentally disturbed as the partner appears agitated, whereas the paranoiac maintains a cool and calm demeanor and is viewed as normal.

The following case exemplifies a homicide associated with delusional jealousy.

Case 3.3: Delusional Jealousy and Homicide

A 73-year-old male killed his wife under these circumstances: a year prior to the homicide, while attending a church picnic, BB observed a young man, who looked about 35 years old, kissing his 68-year-old wife.

I said, “Hey, what’s going on.” My wife told me, “Be quiet, he is a priest.” I said, “You better go to confession.” My wife said, “He is a priest, you can’t talk to him like that.” I told him he needs absolution before he says mass. Word, thought, and deed. If the thought is there, that’s evil. It’s the same as the act. He turned around and gave me a dirty look. He walked away with another male friend. They both had sports shirts on.

After this incident, BB slowly developed an idea that his wife was having a sexual relationship with the parish priest.

She was always going to church and she was so clever on hiding it. I asked her what was going on, and she said that I was crazy. She refused to talk to me, so I let it go. I felt I had to really start to understand this. I hid all of this from our children. I tried to present a good marital image.

As time went on, the delusion became fixed when BB found “incontrovertible evidence” to support his belief.

She’d go out at 8:30 p.m. and come home at 12:30 in the morning. She said she went to play bingo at the church, but I could smell cigarettes and cigars on her. She’d come home with a certain cigar odor.

Finally, the children, all of whom were adults and well situated with their own families, became aware of BB’s ideation. They spoke to their father many times, but he remained unconvinced. He spent hours in the basement of his home crying, “How could she do this after almost 50 years of marriage?”

On one occasion, BB confronted his wife before they went to church.

I asked her what was in the bag that she was carrying. She wouldn’t show me. I said to her, "It is probably a present for the con artist you are going to. A whoremaster.” I broke down and cried like a baby.

The following day, BB went to the parish monsignor in order to explain the situation and enlist his help. The monsignor said that he would look into the matter and that BB should come back the following week. When BB returned, the monsignor said that there was no substance to BB’s allegations. He explained that Mrs. В attended church functions regularly along with her daughters. He described the parish priest as friendly, well liked, and not involved with his wife as BB had thought. This did not satisfy BB, because a delusion—which does not stem from reality—cannot be dissipated by facts of reality. Thus, BB incorporated the monsignor into his delusional ideas and concluded that he was covering up the affair to avoid embarrassment to the church. In addition, BB reasoned that his wife’s 83-year-old lady friend was also “in on it,” covering up the affair as well.

After several more weeks of brooding and thinking about his wife’s behavior, BB attempted to contact the bishop, as he had had no success at the parish level. He made numerous phone calls but was unable to arrange a meeting with the bishop. He therefore became very despondent. “Through my whole life I did everything right. I followed the Church to the letter, and this is how I’m treated. The priest has an affair with my wife, and the monsignor and the bishop won’t help me.” That afternoon, while watching a TV talk show whose topic was infidelity, BB called the show’s producer. The show’s representatives were very interested in this case, as it involved themes of older woman, younger man, sex, and the clergy. BB became agitated following the conversation. His wife returned home at around 6 o’clock and went into the bathroom. From the closet, BB took the gun he had for many years and shot his wife in the stomach when she came out. He then called the police and explained what happened.

When interviewed in the county jail 1 month later, BB was adamant that his wife was having an affair. He spoke about “clues” that supported his assertions of his wife’s unfaithfulness. For example, he stated that his wife “used to wear cotton underwear. She changed her underwear to pink silk or satin underwear. What did it mean? I saw this on TV.” He also had found a box of candy that he believed was a gift from the priest. “Also there was a pillow and blanket in the back of her car. I think it was there for a quickie in the back seat. That’s what I presume. I checked the car for other tell-tale signs.”

A thorough investigation by the prosecutor’s office, as well as his defense attorney’s investigator, revealed that there was absolutely no evidence that Mrs. В was unfaithful. When she went to the church functions, she was always accompanied by one of her daughters. One daughter said,

My father had a one-track mind that my mother was running around. He went crazy. My mother was calling me up crying, stating “He accuses me of having a boyfriend.” She said, “He is sobbing like a baby in the basement.” She was crying several times to me on the phone. “He is accusing me of having a boyfriend, the priest.” She was so upset about all of these accusations.

Both prosecution and defense experts agreed that BB suffered from a delusional disorder (jealous type). In addition, the defendant had no insight into his delusional beliefs. He continued to remain adamant that his wife was unfaithful and involved with the priest or another “high church official.” When gently challenged that he might have misinterpreted or imagined his wife’s actions, BB became irritated, animated, and excited, emotions typical of a paranoiac and atypical of someone who simply has significant jealousy.

Although BB was psychotic, this case is different from the M’Naghten case, and from Cases 3.1 and 3.2, since here the homicide was not a direct result of his delusions. BB did not believe that his wife was going to harm him, nor did he believe that killing her was a command from God or a way to save himself from dying. BB killed his wife out of anger and humiliation, emotions that were a result of his psychosis. Accordingly, he was not totally absolved of criminal responsibility. However, the degree of intent was reduced, as a result of his illness, from first degree murder to manslaughter.

Case 3.4: Delusional Jealousy vs. Persecutory Delusions

A 47-year-old female, married to a physician, had a long history of multiple contacts with the police as a direct result of her disturbed behavior, specifically leaving her home because she did not feel it was safe. D.T. was hospitalized multiple times, and some admissions were for several months. Typically, D.T. would leave her home and sleep in her car in various parking lots, dressed inappropriately in cold weather. She stayed away for extended periods of time, hiding, because “she did not feel safe at home.” Once, she lived in her car for 7 days during February. Questioned by the police when they made several welfare checks, D.T. told them there were no arguments between her and her husband and no domestic violence, but she thought that in some way being at home was unsafe. At one point, she went to a police station to see if they could help her with housing because she no longer wanted to live at home. In fact, she inquired about homeless shelters in the area. During this period of time, she was under the care of a local psychiatrist.

About 7 weeks before the homicide, D.T. went to the police station and told an officer that something could happen to her in the future, that her husband “could do something” to her, and she was concerned. About 10 days or so before the homicide, she went to an Army Navy store and purchased a can of pepper spray. Three days later, D.T. came back to the same store and bought a large hunting knife, which she kept in a satchel in her closet during the day and under her bed at night.

On the day of the homicide, her delusional belief that her husband and her husband’s family were plotting to harm her “in some way” intensified. She took a marble vase and hit her mother-in-law on the head multiple times, killing her as a result of massive blunt-force trauma. D.T. fled the crime scene, gave a false name at a hotel where she stayed for several days, and was found wandering at a bus terminal. She told the authorities she had lost her wallet and had no credentials. When interviewed by the police, she said,

I can’t stay in that house anymore, the marriage is over, I don’t trust my husband. He can do anything to me. I didn’t want anyone to find me. She [the mother-in-law] was up to something. I had a feeling, it’s hard to explain.

A defense expert evaluated D.T. and believed she had a delusional disorder, jealous type. Upon further analysis, it became obvious that delusional jealousy was not the underlying problem, but rather delusions of persecution. D.T. did not leave her home and live in her car multiple times prior to the homicide, and buy pepper spray and a large hunting knife because she was jealous, she did it because she felt unsafe and believed her husband’s family was going to harm her. Any jealous thoughts and beliefs, while present, were secondary to a more basic persecutory delusion. It was not that her husband was going to divorce her, the delusional belief that ultimately led to the homicide was that her husband and mother- in-law were going to get rid of her, and she believed she was not safe. D.T.’s delusional belief fluctuated—as do all symptoms—in intensity and became stronger and more intolerable just before the homicide. “I was really scared. It is possible they [her husband and mother- in-law] were in it together .... [The mother-in-law] perhaps was planning to kill me.” D.T. was found legally insane, and even while at the hospital, she still felt unsafe. She believed that her husband could poison her hospital food in some way and that “he could get to me.”

This case presents a problem not only in diagnosis but in clinical management as well. Individuals who have encapsulated delusions—particularly delusional jealousy as well as a persecutory type of delusion—are extremely difficult to treat. The delusions are so encapsulated that they are often intractable, even with medication (which, however, can possibly reduce the intensity of the delusion). Psychotherapy is of minimal value because a delusion does not stem from facts of reality; therefore, it cannot be dissipated by facts of reality. Moreover, these types of delusions are often missed diagnostically in both their incipient and residual stages. And such delusions are extremely dangerous—especially a delusion of persecution—because individuals act out in self-protective ways which can easily result in violence.

Although it is not uncommon for individuals with a psychotic disorder to commit homicide, in some cases, such as the following, the killing is not at all directly connected to the psychosis.

Case 3.5: Paranoid Psychosis, Arson, and Murder of Four Women

A 27-year-old male (CC) with a well-documented history of paranoid schizophrenia gave a detailed statement to the police explaining how and why he had set fire to his mother’s home and therefore caused the deaths of four women. He explained that he had set his alarm for 3 o’clock in the morning, so that “while everyone was asleep I could do what I planned.” He poured gasoline into two bottles, placed both bottles in the oven, turned on the broiler, and set the temperature to 550 degrees. “I knew the broiler was on because of the pilot light. I knew when the oven heated up, the bottles would melt, and the gasoline would start a fire.” He was aware that four relatives besides his mother were sleeping in the house, but “I didn’t care, I just wanted to hurt my mother.” He hoped that eventually everyone would get out all right, “but I was so mad at my mother [that] I just didn’t care.” CC admitted that in his initial statement he had lied to the police about various details of the offense and the reason he had gasoline on his clothes when arrested. “I lied because I was scared and wanted to cover my tracks. I’m sorry for what happened and knew what I did was wrong. I was angry and I didn’t care. I wasn’t thinking about anything else.”

The argument with his mother that precipitated the arson occurred about 1 week before the offense. CC felt that his mother made fun of him because of his inability to hold a job or keep a girlfriend. His mother (the only survivor) explained her comments in a much different light, stating that she was trying to offer counsel and guidance in order to prevent him from making irrational decisions.

CC stated that he had intended to burn down the house so that

my mother would lose the house. She made fun of me, so I wanted to take away from her something that she was proud of. I didn’t want to hurt or kill anybody. I was so angry. She worked hard for the house. She told me I was nothing. I felt real bad, and I had an idea to burn down her house. My mother teased me and said I was garbage.

When he was asked whether he had heard voices directing him to set the fire (as he had told a previous examiner), CC stated,

I didn’t hear voices. I am sorry I lied part of the way, but I’ve been covering my tracks. A guy in the jail told me, “Whatever you do, lie.” I am gonna be honest with you; I was hurt and destroyed. She said I was nothing and I’d never make nothing of myself. Every car I got always broke down. She wants me to better myself, but every time I try to better myself nothing would satisfy her. To be truthful, it was anger. Voices may have played a part in it, but it was really anger.

This offender had a clear history of paranoid schizophrenia with auditory hallucinations and delusions. When he was initially arrested, he gave a very clear statement explaining his motivation for the arson: anger at his mother. He never mentioned anything remotely connected to hearing voices. He denied, upon careful questioning, that voices played a direct role in the arson and subsequent homicides.

His primary motivation, then, was anger toward his mother; his mental illness played a secondary, and important, role since it was largely responsible for the extreme level of anger that he displayed. If he did hear command hallucinations (as he told a defense psychiatrist, but later recanted), they were consistent with his intentions and may simply have given a concrete utterance to his own wishes. The defendant pleaded guilty to aggravated manslaughter and was sentenced to a correctional facility, where he will likely be treated within the structure of the prison system.