A Case of the Body Snatchers

As I began my interview with Andrew, his bizarre thinking herniated forth. His speech rapid and tense, he shouted, “They’re forcing me to take them,” his antipsychotic medication. “It’s taken away the good voices. They tell me I’m going to heaven.” He then veered into the supernatural. He rambled about angels, sinfulness, and angels informing him of his eventual ascension to heaven. “My parents, they’re evil demons. The one who died, he’s a fallen angel. Technically, I acted in self-defense.”

Andrew was referring to his victim—stepbrother Peter. One autumn after, moments after returning from his college classes, Andrew drove a knife into Peter's abdomen, ending his life. And it wasn’t in self-defense: the killing was prompted by a combination of delusions about the divine and all-too-human reactions expressed in a most ungodly fashion.

Andrew’s lawyer retained me to confirm his client’s diagnosis of schizophrenia and to opine whether Andrew’s mental disorder compromised his ability to know right from wrong, that is, if he’s insane. Diagnosing Andrew was the easy part. He had a long history of mental illness and psychiatric hospitalization, and had been decidedly diagnosed with the illness. More difficult was the ladder question: Did Andrew’s mental illness distort his ability to know the killing was legally or morally wrong?

The psychiatric records documented Andrew’s psychosis. His thinking fulminated with delusions about God and was distorted and disrupted by auditory hallucinations, with him believing he heard the words of the divine. I experienced the force of his disorder with my own eyes and senses, in vivo. Religious delusions were key elements to Andrew’s inner world.

As we talked, it became clear that Andrew’s spiritual madness was indivisible from his bizarre beliefs about his family. As his psychotic rambling picked up speed, his kin became implicated. “My family, God took them away from me.” I was puzzled and asked what he meant. Again, he said, “God took them away from me. They were raptured.” He explained how hitherto, his family’s “good spirits” were taken into heaven, their bodies appropriated by demons. Since then, “They’ve been plotting against me. You don’t know the extremes that I’ve gone through, my parents plotting against me. They wanted me to go to hell. I couldn’t take it. I don’t know why I didn’t take their lives.”

At this point, I told Andrew I wanted to talk with him about the morning Peter died. In a matter-of-fact fashion, Andrew described how he took a kitchen knife and stabbed his stepbrother twice. He watched Peter stagger and fall. There was no exchange of words before the stabbing, no strident exchange or emotive altercation leading to the deadly assault. He called his family “extremely wicked people. He wanted to kill them all. I asked why he didn’t try do so. His father, Andrew said, is a strong man.

Andrew complained that his father “kicked me out.” He was referencing the fact that, not long before the killing, his parents had told him they decided he could no longer live home, due to the impact his mental illness is having on them and Peter. They had scheduled a time for him to visit a board and care home for individuals with mental illness.

Glaring at me, he growled that Peter was to get the bedroom (i.e., the bedroom where they both slept). “That led to the killing too.” He then regressed back into incoherence and religiosity. “God was putting a lot of guilt on me for everything, I don’t know. I was supposed to do something for God. I don’t know what. I was angry at my brother…he wanted to send me to hell…”

Andrew had already been diagnosed with paranoid schizophrenia. I concluded that he also suffered from Capgras syndrome, characterized by a fixed delusion that identical-looking imposters have replaced others, usually family members. It’s frequently co-morbid with schizophrenic illness. This added a wrinkle in Andrew’s psychiatric illness and further complicated my understanding of his psyche, which could influence my medical-legal decision-making.

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Over the course of my interviews with Andrew, I listened carefully to his assertions of putative deific communication. He regularly contradicted himself. He spoke of his family as doppelgangers, demons living in his parents’ and brother’s bodies, and with a deific command to kill them. He said, for instance, “I can hear God direct me…it happened because of the will of God.” On the other hand, he told me, “God doesn’t want me to murder anybody.” And, “God chastised me” for the killing. At another point, I asked if he felt it was wrong to kill his stepbrother. “I always knew it was,” he said. “I did it. I acted foolish. Besides, I’m going to heaven.”

Andrew’s psychological testing results reflected the complexity of his psyche: the finding clearly revealed his mentally disordered, paranoid state of mind, with a distorted self-image. He may have been exaggerating his symptoms somewhat, no clear dissimulation was evident.

I pondered the implications of Andrew’s mental state when he stabbed Peter. He had a long history of mental illness, common with those adjudicated to be insane. But did his illness interfere with his ability to know it was wrong to kill? Was he mostly driven to murder Peter out of rage over having to go to a board and care facility? After all, he’d been psychotic for years and never attempted to kill anyone. Most people with mental illness aren’t violent, and certainty don’t kill. He didn’t attempt to attack his father because of his father’s physical prowess, a subtle indicator of some rational decision-making. And he told me that he always knew it was wrong to kill his stepbrother.

I concluded that Andrew had at least a rudimentary understanding of the wrongfulness of his action. His was driven by deranged deific motivations, but also by some all-to-natural worldly and violent urges. I opined that, although very mentally ill, Andrew was sane.

All insanity evaluations are difficult and complex. Andrew’s case was especially so.

If you're interested in a more comprehensive description and understanding of this complex case, please take a look at the chapter of my book, Decoding Madness, referenced below.