Читать книгу The Measure of Madness: - Katherine Ramsland - Страница 11

Her body landed on the sidewalk. Did she jump or was she pushed? None of those crowded around could be sure. The police identified her as a resident of the apartment building. Minutes later, a man exited the building and began to stroll nonchalantly down the block. The neighbors identified him as the victim’s husband, Mr. Paulson. The police asked him to take them up to his apartment. Signs of his futile attempts to clean up the apartment were more than enough to raise their suspicions. Within a few hours he confessed—he had strangled his wife, then thrown her body out the window to fake a suicide.

Mr. Paulson’s attorney quickly realized that all the evidence pointed toward his client’s guilt but that the act itself made no sense. How could Mr. Paulson kill his wife when he professed to love her? His client could not adequately explain his motive. All he said was that there had been an “argument.”

Typically, when one spouse kills the other, there is a long history of severe marital difficulties, and substance abuse, or mental illness, or both. But Mr. Paulson had no history of emotional problems. He had never been arrested or behaved violently. Everyone involved in the case was confused.

It was necessary to bring in experts to search for psychiatric issues that could be raised as a defense to save Mr. Paulson from spending the rest of his life behind bars. His attorney called Dr. Daniel Schwartz who had years of experience as an expert witness. Dr. Schwartz, the director of Forensic Psychiatric Services at Kings County Hospital, was well known for his work on numerous high profile cases, including the Son of Sam, the Amityville Horror killer, and John Chapman, the man who shot John Lennon.

I was a newly licensed clinical psychologist and excited to be working on a forensic inpatient psychiatric unit. I had only been there a year when Dr. Schwartz asked for my help on this high profile case. I was surprised to learn that Dr. Schwartz had been unable to uncover any evidence of mental illness in Mr. Paulson.

“Cheryl, I examined him,” Dr. Schwartz said, “I felt I was missing something. I don’t know what was wrong with him.”

“What do you mean?” I asked.

“He wasn’t a violent man,” Dr. Schwartz replied. “And the police knew it. When they took him to the precinct for questioning, they didn’t handcuff him. In all my years in this field, I’ve never seen the police do that. They always handcuff suspects.”

Dr. Schwartz asked me to administer some psychological tests. He was puzzled by the defendant’s flat emotional state and hoped that the tests would help explain his uncharacteristic homicidal rage. Dr. Schwartz also asked me to conduct a neuropsychological evaluation of Mr. Paulson’s perceptual motor skills, language functioning, problem solving, and complex reasoning abilities. There were much more experienced psychologists working on the forensic unit, but I was the only one trained to administer these specialized tests of brain function.

Before leaving for my appointment with Mr. Paulson, I asked for advice from a senior level neuropsychologist, Lucille Horn, Ph.D. We sat in her office and I told her what I knew about the case.

“And here’s the strangest part,” I said. “Dr. Schwartz told me the defendant had a ‘neurological event’ about forty years ago, but was never diagnosed with anything. He was hospitalized twice after he suddenly developed speech difficulties and weakness on the right side of his body. The symptoms resolved after a few months and he never relapsed.”

As we talked, I began packing, doing my best to take only those tests I would need. The tests were heavy and I was taking the subway.

“Well, you have to take the Purdue Pegboard,” Dr. Horn said, gesturing at the large wooden board.¹

“That?” I stared at it in dismay. It was 3-feet by 2-feet, easily the bulkiest of the tests in the room. But looking at her face, I knew better than to ignore her suggestion. She was the expert; I had to bring it. The Purdue Pegboard measures fine motor coordination and speed, and could reveal whether or not Mr. Paulson still suffered from brain dysfunction.

An hour later I arrived at my office. Usually the defendants I interview are incarcerated and too poor to make bail. I interview them in the forensic hospital, court holding areas, or at Riker’s Island jail. I was meeting Mr. Paulson in my outpatient office, since he was out on bail.

I was somewhat taken aback when the elegantly dressed, 70-year-old man arrived at my office. While I knew the general facts about the case, I was unprepared for such a soft-spoken, polite defendant. With his gray hair, courtly manner, and easy smile, he actually reminded me of a favorite uncle. It was hard to remember that this reserved old man had strangled his wife and thrown her body out their twelfth floor apartment window.

I felt a rush of discomfort when Mr. Paulson walked into the room. He reached out to shake my hand and I experienced a sense of role reversal. His age and expensive suit made me feel like I was the one about to be evaluated. I wondered if he noticed the shabbiness of my office furniture.

Typically, I might be apprehensive to stay alone with a defendant charged with murder. However, Mr. Paulson’s composure put me at ease. Later, I became more aware of how peculiar his equanimity was in such a situation. His calmness was out of place. Most individuals faced with such serious charges and the distinct possibility of spending the rest of their lives incarcerated would be extremely anxious or depressed. He denied any symptoms of mental illness and I observed none.

We took our seats. At least I was able to maintain enough equilibrium to sit on my side of the desk. I started the interview with the Mini Mental Status Exam (MMSE), a brief screening test of cognitive functioning that takes approximately ten minutes to administer.² It is widely used in medical and psychiatric settings to test for dementia. The test is composed of a series of questions to assess language skills, memory, and attention. Mr. Paulson passed easily.

Then I asked, as politely as possible, what had led to the killing. There are two big sources of conflict in any marriage: money and sex. Had Mr. Paulson or his wife been spending too much or hiding assets? Was one of them having an affair? He denied any serious financial or marital problems.

“What happened before you attacked her?” I asked.

“We had been arguing,” Mr. Paulson readily admitted.

He then continued to explain dispassionately how, as with so many marital conflicts, theirs had begun as an argument about bills. He was an independent businessman, an importer, and business had been slow recently. While there was no objective reason to fear bankruptcy, he was feeling stressed. Mr. Paulson insisted that they cut their spending but his wife was resistant. They started to argue about a few recent purchases of hers that he considered excessive and unnecessary and then began to argue about the children.

I realized by this point that Mr. Paulson’s typical pattern during their quarrels was to retreat and give in, saying, “O.K. honey, whatever you want.” But this argument was different in important aspects. It escalated and became personal and bitter. He recalled how he tried to end the conflict by retreating; however, his wife blocked his exit, would not let him leave, and, as he pushed to get past her, she attacked him physically, scratching him on the face.

Although Mr. Paulson claimed that he could not recall everything that happened after she scratched him, he did admit that he had became enraged, angrier than he had ever been in his life. He remembered slapping her and, when she continued to scratch him, strangling her to death. He admitted feeling overwhelmed with panic afterwards and throwing her body out the window in a desperate attempt to stage a suicide.

After listening to his story about the argument and how he had strangled his wife, I refocused back to a less emotional part of the evaluation—the psychological testing. I continued with a typical battery of psychological tests, including the Wechsler Adult Intelligence Scale, the Rorschach or “inkblot test,” and the House-Tree-Person drawings.³

In the Rorschach, an individual views ten inkblots and provides responses to the query “What might this be?” The individual’s responses are thought to be important clues to underlying, unconscious thoughts and feelings. Frequently, psychotic individuals can respond with images which do not even conform to the blots. The House-Tree-Person drawings require a person to draw four pictures, one each of a house, a tree, a man, and a woman. Psychologists analyze both the content and the process—how the person completes the drawings, what the person includes (and leaves out), and what parts the person emphasizes. All provide important clues as to a person’s mental state, feelings, and concerns.

Mr. Paulson’s personality testing indicated that, while he had an extremely limited emotional range and a rigid, over-controlled manner, he was not depressed or psychotic. My jaw almost dropped, however, as I watched him draw the female—she was nude! What was even more unexpected was that this nude woman was wearing high-heeled boots.

While artists frequently draw nudes, it was a strange and puzzling drawing for someone of his background. While I did initially consider whether his drawing reflected some unconscious feelings about women, I instead concluded that he, at least during this task, showed poor judgment and self awareness—most intelligent defendants charged with murder would be careful to try to look as normal as possible and draw the female clothed.

Next, I administered the Wechsler Adult Intelligence Test.⁴ Overall, Mr. Paulson had superior intellectual skills, but the tests revealed some subtle cognitive decline. He had trouble repeating back strings of numbers that I recited to him—a sign of attention problems. The more neuropsychological tests I administered, the more odd discrepancies I found. When I measured his verbal and visual memory skills, his verbal score was in the 45th percentile, but his visual score was in the 99th.

The Purdue Pegboard yielded the most striking results. I instructed Mr. Paulson to place pegs in the holes on the board as quickly as possible, first with his right hand and then with his left. He was right-handed, yet his left, nondominant hand was faster at placing the pegs. This was extremely unusual.

As I watched his right hand fumbling to insert the pegs, I remembered what Dr. Schwartz had said about the symptoms Mr. Paulson had exhibited decades earlier—weakness in the right side of his body and speech difficulties. The left cerebral cortex controls sensations and movement of the right side of the body and vice versa. His slower right hand indicated some dysfunction in the left hemisphere. The speech center is also located in the left hemisphere in most individuals. His history was more evidence of something wrong in his left cerebral hemisphere.

“Mr. Paulson, tell me about your hospitalizations forty years ago,” I said. “What symptoms did you have?”

“It happened when I was twenty-four years old,” he answered. “I started to have terrible headaches and trouble speaking.” He told me he was admitted to a hospital twice but discharged each time after a few days when his symptoms disappeared. His hospitalizations occurred so long ago that sophisticated neurological tests were not yet in existence. There were no MRI (Magnetic Resonance Imagery) or PET (Positron Emission Tomography) scans to take.

Mr. Paulson recalled that the doctors performed a spinal tap. During a spinal tap a needle is placed into the spinal cavity to remove cerebral spinal fluid. The tap can find elevated protein levels, indicating an intracranial (within the brain) bleed. He recalled the doctors telling him he may have suffered some bleeding in his brain.

Mr. Paulson told me that he recovered within a few months with no lingering symptoms. Since he never experienced a recurrence, he paid little attention to what caused the two hospitalizations. Even when new, sophisticated brain scanning tests became available, he never considered going to a physician to investigate.

Looking at Mr. Paulson, I took a deep breath and folded my hands on the table. “Well, we’re all done,” I said. “The good news is you’re not mentally ill. But I do want you to see a neurologist.”

He accepted these results with the same bland expression he had been wearing all day. He shook my hand, thanked me for my time, and walked out. I never saw him again.

I called the defendant’s attorney right away. “There’s definitely something wrong in Mr. Paulson’s brain. I think it’s in his left cerebral hemisphere.”

“What’s the next step?”

“You should get him to a neurologist right away. He needs an MRI,” I said.

After that, Mr. Paulson was referred to a prestigious hospital and evaluated by a team of the most well-respected neurologists and neuropsychologists in New York City. The attorney sent me a copy of their reports and the MRI scan. As I suspected, the MRI revealed an abnormality in his left cerebral cortex.

Mr. Paulson’s MRI showed that an arachnoid cyst (a sack of fluid-filled tissue) had formed inside his skull but outside his brain. It developed in the protective lining, the arachnoid membrane, surrounding his brain, displacing his left temporal lobe, part of the frontal lobe, and the left middle cerebral artery. The cyst was huge, bigger than I had ever seen. I could not believe that he had lived all these years with the cyst slowly growing inside his skull without any obvious symptoms.

This kind of cyst is found in approximately 5 out of every 1,000 people. It can be present at birth or acquired later in life from an injury, and is usually asymptomatic. If the cyst grows large enough, however, it can cause a range of symptoms including cognitive problems, mood swings, headaches, dizziness, seizures, and psychosis, depending on the size and area of the brain affected.

Mr. Paulson was given an EEG (Electroencephalogram). Electrodes were placed on his scalp to measure brain electrical activity. He had a mild reduction of activity in the left hemisphere.

He was given a PET (Positron Emission Tomography) scan which produces a three-dimensional image of the brain. To create the image, the patient is given an intravenous injection of molecules such as glucose, to which small amounts of a radioactive material have been attached. The PET scanner detects the radioactive signal and generates an image of the tissues, possibly revealing abnormalities.

Mr. Paulson’s PET scan showed that the cyst impaired function primarily in the regions in the left frontal lobe next to the cyst. The results were consistent with those of other tests. All the brain tests showed abnormal function in this brain area.

Dr. Schwartz and I discussed the significance of the medical tests. He would have to decide whether the results proved anything definitive about the defendant’s mental state at the time of the offense. That was the million dollar question: was Mr. Paulson legally insane when he killed his wife?

“Have you ever heard of a psychiatric defense based on a brain cyst?” I asked.

“No, but clearly Mr. Paulson’s cyst was affecting the functioning of the brain tissue around it,” Dr. Schwartz said. “I’m convinced that his cyst played an important role in his impulsive attack.”

We were silent for a moment. “I just wish someone had written down Mr. Paulson’s statements when he was questioned by the police,” Dr. Schwartz exclaimed suddenly. “It’s strange that there are no police records of what he said when he was arrested.” Typically detectives prepare reports of comments made by the defendant at the crime scene and during police interrogation. None seemed to exist in this case.

“What are you going to write in your report?” I asked.

“That Mr. Paulson was not responsible for the killing of his wife,” he said.

I was not surprised by Dr. Schwartz’s certainty. I believe he was as impressed as I was by the size of the defendant’s cyst. A few days later, he gave me his report. It was short and to the point.

“It is this combination at the time of the present offense of dysfunctional frontal lobe pathways (due to the arachnoid cyst) and his wife’s unusual, provocative behavior which in my professional opinion made it impossible for Mr. Paulson to appreciate the nature and consequences of his conduct or that it was wrong.”⁵

Almost six months went by, and I got caught up in other cases. Dr. Schwartz called me one day to update me on a new turn of events. It turned out that Mr. Paulson’s fate was riding on the admissibility of the PET scan at trial. The defense attorney was eager to use the PET scan results at the trial to convince the jury that his client’s brain was so abnormal that he was not responsible for killing his wife.

The PET scan was a relatively new technology and the prosecution sought to exclude it from the trial, arguing that it was still an experimental test. The criteria for accepting scientific testimony is outlined by the 1923 Frye decision.⁶ Scientific testimony is permitted if it is “generally accepted” in the scientific community.

Mr. Paulson’s pretrial hearing, also known as a Frye Hearing, lasted several weeks. The presiding judge weighed testimony from many psychiatrists, neurologists, and experts in nuclear medicine. After hearing the scientific testimony, the judge ruled that the PET scan was widely accepted in the scientific community and could be presented during the trial itself.

I knew the prosecutor had offered Mr. Paulson a plea of murder in the second degree before the Frye hearing. On the day of jury selection, eleven days after the judge ruled that the PET scans were admissible, the prosecutor offered a much better plea—manslaughter. Mr. Paulson accepted and was sentenced to prison for seven to twenty-one years.

When I heard about Mr. Paulson’s decision, I wondered what would have happened if he had gone to trial. Would the jury have believed that his cyst made him kill his wife? It would have been interesting to see how a jury would react to the psychiatric, neurological, and psychological testimony, but I understood his decision not to risk it. Perhaps he was afraid he would be convicted. Or he wanted to spare his children the trauma of a trial. Or he had run out of money to pay for his already quite expensive defense.

Years later, when Dr. Schwartz and I were discussing Mr. Paulson’s case, he told me about a dramatic event that occurred the day before the trial was scheduled to begin. The prosecution “found” reports of Mr. Paulson’s statements that he made to the police shortly after he killed his wife. For months before the trial, the defense attorney had been requesting all relevant records and had not been told of the existence of these transcripts.

Dr. Schwartz’s usual cheerful and humorous tone of voice changed dramatically when he told me about the sudden appearance of these critical records.

“I read through those police notes for the first time right before the trial date,” Dr. Schwartz said. “Mr. Paulson was incoherent at first. Only after hours of questioning did he start to make sense.”

“What did you make of this?” I asked.

“Clearly, there was something wrong with him. If the prosecutor had turned over the statements when he should have, I would have realized immediately that Mr. Paulson had some kind of brain damage.”

Dr. Schwartz’s tone spoke volumes about his distaste for the prosecutor’s tactics.

“I remember like it was yesterday when the police began videotaping defendants’ interrogations,” he said. “At the time I wondered why didn’t they tape Mr. Paulson’s confession?”

“What do you make of the whole thing?” I asked.

“I think they knew he wasn’t in his right mind and they didn’t want this captured on video!”

I am not sure what angered Dr. Schwartz more: the possibility that evidence had been unethically withheld, or that he had been unable to recognize Mr. Paulson’s brain abnormality without the crucial police reports. I, on the other hand, was pleased that my neuropsychological testing detected the brain cyst. And, as a newcomer to the field, I was grateful to be given the extraordinary opportunity to play a part in a landmark case.

Not only was it the first case in which PET scan results were ruled admissible, it also became well-known by lawyers and forensic experts in the growing field of what is now called neurolaw. Neuroscience was beginning to transform the American legal system, and my Purdue Pegboard and I had been there at the beginning of it all. I can not thank Dr. Horn enough.