Wednesday, June 6, 2012

Psychiatrists Weigh In on Hernandez and Patz Case Confession - NYTimes.com

Psychiatrists Weigh In on Hernandez and Patz Case Confession - NYTimes.com

June 1, 2012

Psychiatrists Offer Theories About Suspect in Patz Case

His confession came more than three decades after the fact. He had no apparent motive or criminal record. And his mental struggles — he had diagnoses of schizophrenia and bipolar disorder — were reportedly being treated.
Details about the life of Pedro Hernandez, who confessed last week to killing Etan Patz, a 6-year-old who disappeared while walking to a bus stop in SoHo in 1979, are still far too scarce to make any authoritative judgments, psychiatrists say.
But if Mr. Hernandez’s trajectory from obscure family man to prime suspect appears highly unusual, so, too, is the 33-year-old case, and perhaps also its solution. Some experts offered possible explanations for how he could have strangled the boy and lived with the secret all these years, while others wondered if he confessed to a crime he did not commit, a common phenomenon in notorious crimes.
All agreed that there were huge gaps in Mr. Hernandez’s life story. Did he have a history of erratic or violent behavior? When was he found to have a mental disorder? When did he begin treatment? If he killed Etan, could he have killed other people and never gotten caught?
“Absolutely everything’s strange about this case, and the chain of facts is simply not clear, whatever your theory is,” said Dr. Angela Hegarty, a forensic psychiatrist at Creedmoor Psychiatric Center in Queens, who also teaches at Columbia University.
If Mr. Hernandez was in fact the killer, his story is plausible, but only by making several assumptions, experts say.
It is known that he worked at a bodega on the corner where Etan was supposed to catch his bus. He had started there roughly a month before the boy’s disappearance and left soon after. In his confession, he said he had lured the boy into the basement with the promise of a soda and strangled him as soon as they got downstairs. Details of his confession have not been confirmed by the authorities.
Mr. Hernandez was 18 at the time of Etan’s disappearance, an age when psychiatric conditions like schizophrenia and bipolar disorder typically first strike.
The initial symptoms, whether mania or strange voices, are often so frightening that people withdraw or act out. Physical violence is rare, but studies suggest that when it happens, it is often during this initial period — before the disorder is disabling, or treated.
“You could make the case that he committed this one act, then went back home and got treatment,” said Dr. E. Fuller Torrey, founder of the Treatment Advocacy Center in Arlington, Va., which advocates for stronger laws to treat people with severe mental disorders.
“If he got started on medication, that could have controlled his symptoms,” Dr. Torrey said. “And we know, too, that people with schizophrenia do better in structured situations — and if his family provided it, that could have helped, too.”
It could also be that Mr. Hernandez’s schizophrenia — if that is indeed what he had — resolved on its own. About a quarter of people given the diagnosis recover, without the help of medication; and others “age out,” in medical parlance, improving incrementally over time and needing less treatment.
People close to Mr. Hernandez have said that he is taking Zyprexa, a drug often prescribed for schizophrenia and bipolar disorder. “It could be that the family became concerned about him back then, and essentially he’s been on a low dose of antipsychotic medication these intervening years,” Dr. Torrey said.
Yet in the 1970s, psychiatric treatment was still largely the province of the affluent, and its stigma loomed larger than it does today.
It is also hardly a given that a confused teenager from a large working-class family like Mr. Hernandez’s would have found good treatment at all, much less so quickly, or that he would have followed doctors’ orders even if he had. Patients often take their medication intermittently, going on it for periods and then quitting, either because of the drugs’ unpleasant side effects or their failure to relieve symptoms. And many patients take years to admit that they have a disorder and need treatment.
So Mr. Hernandez would have had to turn himself around, to some extent, despite his mental struggles and a guilty conscience.
The overall case just does not fit any known pattern, said Dr. Michael H. Stone, a New York psychiatrist who wrote the book “The Anatomy of Evil.”
According to the police, Mr. Hernandez said he killed the child because “something came over me”; he did not admit to any sexual motives. But adult men who kill school-age strangers almost always do so for sexual reasons, forensic psychiatrists say.
Dr. Stone, who keeps a database of some 1,500 news clippings about serial killers and murderers, said he found among them 50 cases of an adult male killing a child who was a stranger. In all but three of them, there was evidence of a sexual motive. And the killers in all three of those cases were widely recognized as dangerous before the crimes.
Mr. Hernandez comes across as nothing of the kind, at least in the sketchy portrait gathered so far from family members and neighbors. He was married, and helped raise two children.
“Someone who at age 18 kills a child in a psychotic rage is generally going to be already pretty crazy by age 16 or 17 and often not a lot better by age 42,” Dr. Stone said.
In 1999, in another famous New York case, Andrew Goldstein, a man with schizophrenia, pushed a woman to her death on the subway tracks. In 2008, a man with that disorder, David Tarloff, stabbed to death a therapist on the Upper East Side. Both men were known to be erratic and dangerous well before the attacks, and neither was receiving proper treatment, doctors said.
Thus far, there is no evidence that Mr. Hernandez was anywhere near as threatening as Mr. Goldstein or Mr. Tarloff were.
And if he was a sexual predator who had already committed a murder, it would have been very difficult to silence those urges for a lifetime, Dr. Stone said. “For him to go from being that person to a marriageable, somewhat pleasant guy with his own children — that’s a very unlikely scenario,” he said.
Dr. Stone speculated that the more likely killer was Jose A. Ramos, a former mental patient against whom the Patz family won a wrongful-death suit in 2004. Mr. Ramos, who said he believed he had molested Etan but denied killing him, is in prison in Pennsylvania following a conviction on charges of child molesting in a different case.
If Mr. Ramos is the killer, then Mr. Hernandez is making it all up. People with schizophrenia can at times have delusions that they are responsible for crimes they did not commit. Is he one of those people whose mental problems are rooted in a feeling of deep moral inadequacy, and a drive to confess is a way to relieve anxiety rather than tell the truth? Working at a bodega close to the crime, could he have felt somehow responsible?
More than 100 people reportedly “confessed” to killing President John F. Kennedy after his shooting, including some in a hospital where Dr. Stone worked.
Given how little is known of Mr. Hernandez, this is all guesswork built on hunches. But in cases like this one, with the physical evidence long gone, that may be all that investigators, the public — and the Patz family — ever gets.

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