Crazed and Confused

Health and medicine explained.
Aug. 30 2001 3:00 AM

Crazed and Confused

A murder defendant is forced to choose between the death penalty and permanent madness. 

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Russell Weston Jr. gunned his way into the U.S. Capitol in the summer of 1998, allegedly killing two guards. Later he told psychiatrists that his intended destination was the "Ruby Satellite System," a time-reversal machine housed on the Capitol's first floor, which he hoped activate in order to save the world from cannibals and the coming "black heva" plague. Today, the 44-year-old Weston is confined to a cell in a North Carolina federal prison, sunk in madness, awaiting trial.

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Weston has refused, however, to voluntarily take the psychotropic medications that could lift his delusions and render him legally competent to stand trial—that is, put him in a frame of mind to understand the charges against him and cooperate with his lawyers. So prosecutors obtained a court order to force him to take those drugs against his will, an order that the U.S. Court of Appeals for the D.C. Circuit upheld last month.

Citing their client's limited constitutional right to refuse medication, Weston's lawyers have threatened to appeal again to the Supreme Court. It could be that Weston's lawyers believe that forced medication under any circumstances is wrong, but it's equally likely that their appeal is strategic. If Weston can't be judged competent to stand trial, there is no chance that their client will face the death penalty, a real possibility in this case. But by putting their client's legal best interest ahead of his optimal medical interest, the lawyers are effectively sacrificing Weston's sanity to save his life.

The U.S. Supreme Court dealt with a defendant's right refuse medication in 1992 in Riggins v. Nevada. David Riggins, charged with murder, complained of hearing voices, so his jailers gave him high-dose Mellaril (thioridazine, an anti-psychotic similar to Thorazine). After being found competent to stand trial, Riggins wanted off the drug, arguing that he had a right to demonstrate to jurors his "true mental state" at the time of the crime. He also claimed that the drug's sedating and dulling effect would impair his functioning on the stand. Riggins prevailed, though the court indicated that the right to refuse medication could be overridden under certain circumstances.

But what separates Weston's case from Riggins' was that Riggins was neither incoherent nor delusional and could weigh the consequences of not taking medication. Weston does not acknowledge he is ill. He cannot even assess the trade-off inherent in deciding to reject treatment.

Because today's anti-psychotic drugs have fewer bad side effects, dosed defendants need to worry much less about their courtroom demeanors. But the point about a defendant wanting jurors to see him as he was at the time of the alleged crime has merit. What juror wouldn't be more sympathetic to Weston if they heard him expound on his theory of "time washing"? About how the ripening of corn causes time to flow backward? And about how he needed to come to the Capitol that July day in 1998 to save the world from cannibals and black heva?

Would Weston respond to medication? Two years before the shootings, he was hospitalized in Montana and treated with anti-psychotics, at first against his will. After a while, the nurses noted he was "pleasant and cooperative ... takes meds willingly ... voices no threats toward anyone." There is a good chance medications could work once again to soothe his agitation and dispel his fears. But because Weston has been so ill for so long, his case might defy our best pharmacology, and a judge may decide that he could never be restored to competency. At that point, Weston's criminal case could become a civil matter resulting in Weston's commitment to a psychiatric facility for an indefinite period.

If the medications worked well, Weston could stand trial. Diagnosed as a schizophrenic, he'd be a good candidate for an insanity defense that could send him to an institution for decades. But insanity defenses have become increasingly difficult to mount since John Hinckley's successful plea in the Ronald Reagan shooting. Many states changed their insanity defense laws to shift the burden of proof: In the old regime, the prosecution had to prove the defendant was sane beyond a reasonable doubt. Now in many states and in the District of Columbia, the defense must establish the defendant's insanity with a standard of clear and convincing evidence. Another change was narrowing the definition of insanity to refer only to whether the defendant knew the difference between right and wrong; prior to Hinckley, many state laws said that a person was legally insane if he couldn't conform his behavior to do what was right even when he did in fact know that what he was doing (e.g., shooting Reagan) was wrong. An insanity plea is used in less than 1 percent of all felony cases and succeeds in only about one quarter of contested cases. In high-profile cases, such as Weston's, the success rate is even lower.

Weston faces a classic Catch-22: If he takes the drugs and gets better, he could be tried and executed. If he wins his legal appeal and avoids medication, he escapes a deadly prosecution but is sentenced to years of psychic torment—perhaps a lifetime of torment. The humane thing to do is to force Weston to take medication—and to convince Attorney General John Ashcroft to instruct his prosecutors not to seek the death penalty. Perhaps then Weston's lawyers would drop their appeal and their client could get the drugs he so obviously needs, even if that means a life sentence in prison.

Given the enormity of his act, Weston doesn't deserve freedom. But he does deserve his sanity.

Sally Satel is a psychiatrist and resident scholar at the American Enterprise Institute.

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