The case for insanity

by David Lomas / 26 March, 2011
Psychology professor Xavier Amador states the case for some high-profile killers not even recognising their own illness.

His clients are the infamous: Unabomber Ted Kaczynski, al Qaeda 9/11 planner Ramzi bin al-Shibh, the Fort Hood massacre's Major Nidal Malik Hasan and al Qaeda's 20th 9/11 terrorist Zacarias Moussaoui.

Add in Arizona gunman Jared Lee Loughner, who shot six people dead and injured 14 while attempting to assassinate United States Senator Gabrielle Giffords, and even by US standards, celebrity defence psychologist Dr Xavier Amador has analysed some intriguing characters.

Amador, who is an internationally recognised clinical psychologist, author and professor at Columbia University, is in New Zealand for two weeks to speak to health professionals on new methods for helping schizophrenics and bipolar sufferers, of whom there are about 80,000 here.

There is much to be learnt, says the Cuban American, from the highest profile "insane" killers or wannabe killers. "Most are just ill," says Amador, "but they do not know it."

Take Kaczynski - the Unabomber (University and Airline Bomber) who terrorised the US for 18 years - from 1978-96. He was a child genius who became a brilliant mathematician and University of California associate professor by 25. But then Kaczynski threw in the academic world, taught himself survival skills and moved to a remote Montana cabin without electricity or running water.

Six years later, enraged by the destruction of wilderness around his cabin, he turned anarchist and started a mail-bombing spree that left three people dead and 23 others injured.

When arrested in 1996, following a tip-off from his estranged brother, Kaczynski was dressed in ragged clothing and sporting an unkempt beard. His cabin was fouled with his own faeces.

In court, Kaczynski was, according to Amador, on a "fast track to a death sentence" because he refused to use a mental-­health defence. Amador read of Kaczynski's intransigence in the New York Times and approached the trial judge and the defence and prosecution, asking whether they were aware Kaczynski's refusal to be considered mentally ill was a symptom of schizophrenia.

Amador is among the wave of psychologists who embraced "20 years of research and more than 300 studies" and accepted that a symptom of schizophrenia is a condition called anosognosia, which essentially means a person is unaware of or unwilling to accept their illness.

In Kaczynski's case the anosognosia led him to say, "I am not sick and I will be damned if I will allow you to say I am sick." When the psychologist appointed to give her opinion of Kaczynski reported he was schizophrenic, it changed the whole case. Kaczynski pleaded guilty and avoided the death penalty - but still refuses to accept he is mentally ill.

For Amador that case illustrated how little understanding there was of schizophrenia and the anosognosia symptom.

"If in arguably the biggest case in the US at the time we had people in the field [the defence psychologists in the ­Kaczynski case] who didn't know this was a phobia, a symptom of schizophrenia, then clearly there was a lot of educating to do," he says.

His visit to New Zealand, his third, is part of an education campaign that has taken him around the world. His evangelism is partly inspired by his brother Henry, a schizophrenic who would not accept he was ill.

According to Amador, families involved with New Zealand's schizophrenics and bipolar sufferers have to adapt how they deal with the mentally ill.

"Most people think it is denial - that is what we [psychologists] used to think - but when a patient says 'I am not sick', we now know that that is actually a symptom of the brain disorder," says Amador.

The denial of illness means many with mental illness do not take their medication. International studies suggest at any given moment half of all sufferers will not be taking prescribed medication.

Caregivers need to "stop playing on the field of schizophrenia" and start becoming teammates and coaches who help a person rather than challenging them. Amador says in his brother's case he talked to him about achieving goals such as finding ways he could stay out of hospital and how he could ensure he had money - "and we became a team on that playing field".

Amador, who is co-chair for schizophrenia on the writing committee for the international psychiatrist's bible, The Diagnostic and Statistical Manual, says he is pleased to see the New Zealand Law Commission has recently recommended no changes be made to the insanity defence in the Crimes Act.

The commission found that despite its being "quite old-fashioned", the defence is generally thought to be working as well as could any of the available reform options. One of the most publicised cases where insanity has been used was in 2001 when recently released psychiatric patient Mark Burton stabbed his mother to death in Queenstown.

After John Hinckley's acquittal on the grounds of insanity for his attempted assassination of President Ronald Reagan in 1981, a slew of changes were made to the insanity defence in the United States. Hinckley was obsessed with actress Jodie Foster and believed assassinating the president would bring him fame, and recognition from Foster.

Amador says the insanity defence is rarely used in the US (in almost 50 death penalty cases in which he has given evidence the insanity defence has been used only once). Instead, mental illness is raised during sentencing deliberations.

That was the case with Zacarias Moussaoui, the so-called 20th terrorist in the September 11, 2001, suicide attacks on the US. Moussaoui, who pleaded guilty to a conspiracy to crash aircraft into key US buildings (but said he was not part of the 9/11 attacks), faced death by lethal injection. However, at his sentencing hearing Amador and other psychologists argued he was a paranoid schizophrenic.

Amador says Moussaoui, now 42, did not accept his actions were a result of his schizophrenia. He wanted to be a martyr for Islam.

Moussaoui only wanted to be interviewed by prosecution psychologists, believing they had a vested interest in finding him sane. Amador's interview with Moussaoui was conducted in a prison cell with Moussaoui refusing to talk for a long period - "he would just take a sip from his water bottle and spit it at me", recalls Amador. "I was holding up a piece of cardboard blocking him."

Moussaoui eventually started talking. "He told me, speaking softly, that 'Bush will release me.' And he really believed that."

The al Qaeda terrorist talked about an electric fan he'd found on top of his car that he claimed contained an FBI bug. "Where is 'my' fan, it must be forensically examine [sic] before they kill me," Moussaoui wrote. Amador says that this classic delusion pointed to paranoid schizophrenia.

Amador went to France to research Moussaoui's background (Moussaoui was born in Morocco, raised in France and later studied in England) and says his chances of being schizophrenic were "through the roof". His father was mentally ill and two of his sisters were schizophrenic.

When sentenced to life imprisonment, Moussaoui called out, "America, you lost ... I won."

Amador is not yet able to speak about other high-profile cases.

US Army major Nidal Malik Hasan, who went on a rampage at Fort Hood, Texas, killing 13 and wounding 32, is yet to go to military trial, while Jared Lee Loughner also awaits trial. In the case of Ramzi bin al-Shibh there is a major secrecy issue.

"It is extraordinary. Even if he says hello to me it is top secret. Every word these guys utter is top secret," says Amador, of his meeting with bin al-Shibh at Guantanamo Bay. It took Amador six months to get approval to tell bin al-Shibh's lawyer the results of his interview.

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