Guilty By Reason of Insanity by Dorothy O. Lewis, M.D. 1998, Balantine Publishing Group, $7.99, pps. 338

Reviewed by John A. Speyrer

"Long before these men wound up on death row, their similarly limited, primitive, impulsive parents had raised them in the only fashion they knew. They battered them. They used them sexually. They sold their child's bodies to buddies in exchange for drugs or food or money. They neglected them. Sometimes they even tried to kill them. These brutish parents had set the stage on which our condemned subjects now found themselves playing out the final act. It was a drama generations in the making. . . .They had lived to perpetrate on others the violence that had been visited upon them."

-- Dorothy O. Lewis, M.D.

For the past twenty-five years, the author, a psychiatrist, has been studying death-row inmates in this country. She recounts interesting facts about her own early life. She had a premature birth and writes that she was held "prisoner" in an incubator as a new-born. Probably, that is the reason why loneliness has always been one of her major negative feelings (Editor's note: That's just my primal speculation!). As a child she felt she did not fit in with her classmates. She felt she was different and she was! From early childhood the question of why people are so different has continued to interest her. She was to base her career on finding the answer to the question: What makes people tick?

Dr. Lewis writes that during her psychiatric residency she was taught that some persons become criminals because they could not obtain the material things they wanted, and therefore, had to resort to violence. When she began her practice, the contemporary books about violent children held the view that they had irresponsible parents who did not know how to apply discipline. The kids were not sick; they were just bad!

In juvenile court, what she witnessed about the truth of the origins of violence differed radically from her medical school teachings. But, she did arrive at definite conclusions about the families of juveniles who were condemned to death. She learned that the closed doors of childhood was where early abuse took place and soon discovered that families of the violent children would rather have their children go to their death than reveal their ugly family secrets. She writes that, at that time, she accepted inadequate explanations for the multiplicity of scars which the children bore which were the direct result of batterings and torture. Like the rest of us, Dr. Lewis believes that she could not see what she could not bear to see.

After joining the N.Y.U. faculty, she was able to secure a small grant to study the prisoners on Bellevue Hospital's forensic ward. Her findings were published in a leading psychiatric journal and, as a result, she was invited to be interviewed on CBS Morning News. Her ninety-second interview was viewed by an attorney in Florida and she was asked to evaluate his death row clients. Her second career had begun.

The author believes that there may be genetic predipositions to some of the more severe mental illnesses, but none have been proven to exist. In violent offenders neurological changes in the brain do exist, but, she asks: Are they the result or the cause? Dr. Lewis decides it is difficult to "tease out" the psychological consequences of being grossly mistreated from the physical consequences. Stress produces cortisol which has shown to damage the hippocamus. Most of the death row inmates she interviewed with both severely physically and psychologically damaged. A large portion of the book deals with material unearthed during the death-row inmate interviews.

She believes, as do others, that the type of crime as well as its modus operandi leads an astute investigator to determine the type of pathology involved. Perhaps, even the trauma suffered by the perpetrator decades earler can be learned. Many murderers are psychotic. She writes: "Sometimes they mistake victims for other individuals in their lives -- incestuous mothers, violent fathers, or taunting siblings." One mother taught her son the art of cunnilingus at age six. Neurological deficits can also sometimes be a cause of the violent and anti-social behavior. One case recounted traumatic forceps delivery and others brain damage because of oxygen deprivation at birth. Psychological results of birth trauma are not discussed. In many of her investigations she was accompanied by neurologist, Jonathan Picus.

Lewis writes that whenever she reads about the claims of the False Memory Syndrome advocates that repressed memories do not exist, she thinks back to the numerous cases which furnished overwhelmingly proof to her that traumatic memories can be repressed. Being a psychiatrist, she naturally understood and believed the concept of repressed memory, but ". . . had no idea of the extent to which memories like these could be submerged, hidden from conscious awareness, and still influence behavior." Denial runs rampant among the murderers. Many have physical scars to prove their many accidents and willful beatings, but some don't even know that their scars exist - having been completely disowned.

A surprisingly large percentage of the stories of inmates recounted in Guility by Reason of Insanity were found to have multiple personality disorders (another belief rejected by the FMS proponents). During her residency training at Yale, no mention of MPD was made. It was as though the disorder did not exist. No reputable doctor in the 1960s and 1970s admitted having seen such cases. Furthermore, in those days, anyone with delusions and/or hallucinations was diagnosed as schizophrenic.

She marvels how the people who were abused tend to draw into their fold those who wish to abuse. Working with such a group who lived together in one house, Dr. Lewis remarks, "Long before any of them had met each other, torture and humiliation had become a way of life; for all of them pain and degradation were an old pair of curiously attractive but excruciatingly uncomfortable shoes. Whenever they slipped into them, they hurt, and yet they could not bring themselves to get rid of them." Freud, Lewis writes, called this urge the "repetition compulsion" syndrome. But Freud had never explained its origin. There are a number of theories to explain the operation of the compulsion. One is that it is an attempt to heal. The author believes it is based on an unconscious attraction to what is familiar. [Being treated with love and respect is so alien to some that discomfort may arise. This happens since love in the present brings up into their repressed need for love in infancy and early childhood. -- The Editor]

Dr. Lewis believes that knowing the actual origins of violence makes it difficult to determine whether someone is guilty, sane or insane. This is because issues of protecting the innocent arise as well as a ever-present need by the court system for revenge against the perpetrator. When the perpetrator exercises his free will, it is not something static but, like violence, also has its origins in particular repressed pains. One's ability to exercise free will fluctuates, as do defenses and insights.

Killers are not born that way; they are made. How much responsibility do they have for deciding which way they will act out? Perhaps, no more so than a person suffering from a psychosomatic condition can choose his ailment. Lewis takes issue with the penal and judicial system which she believes is more interested in punishing offenders than understanding them. Huge amounts of government money is spent on biological psychiatry but very little on studying the ultimate causes of violent sociopathic criminality.

The author recounts her attempt to locate a sociopath who was born that way. After all leads resulted in failure, she was finally directed to a seemingly bona fide person with no conscience. He was an executioner. He did his job, he said, with "no feelings." The book recounts her interview with him. As expected, there were no surprises. The executioner had birth trauma and he mentioned how everyone had thought he would not live long after birth. It was uncovered in the interview that this supposed "natural" sociopath had been in jail for assault and battery, had many beatings as a child, and was paranoid.

Disturbing to read but highly recommended.

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