CRITICA

The findings and conclusions in this article are those of the authors and do not necessarily represent the views or opinions of the California Department of State Hospitals or the California Health and Human Services Agency, or any federal, state, county government entity, university, or private affiliation.

The confinement, in hospitals, of psychotic persons who have committed violent crimes serves defensive functions for our society and for our collective and individual psyches. Under the banner of public safety and under the statutes related to Not Guilty by Reason of Insanity, such people are sequestered in institutions, ostensibly defending the average person from the danger posed by those few people with serious mental illnesses who also engage in overt violence. The systems that operate to house, manage, and treat these seriously ill people are perhaps less visible and less prominent in public consciousness than our prison systems, though they are similar to our prisons in some of their functions. 

In isolating psychotic and otherwise mentally ill individuals judged as Not Guilty by Reason of Insanity, certain institutions hide from public view the people deemed, at some level, most different, not only in their behavior, but also in the degree of their participation in shared, ‘consensual’ reality. For many such people, cast as ‘crazy,’ ‘sick,’ or radically Other, their court-mandated hospitalization is not the beginning of their isolation but its culmination, the endpoint (or is it a midpoint?) of a long journey of having been cast aside, ostracized, traumatized, rejected, misunderstood, and failed by our systems of care.

There are standards and procedures for the evaluation and treatment of people with mental illness who commit crimes; these are not my focus here. My attempt is rather to capture something of the moral and spiritual difficulty that arises when I confront this aspect of reality, and to feel into an often-forgotten corner of our world, in hopes that doing so will help me to understand something new about what it is to be alive today. The opinions and ideas expressed here are solely my own.

Suppose a murder is committed by a person ultimately judged as being unable, due to mental illness, to comprehend their acts or their rightness and wrongness, and suppose this person is eventually adjudicated Not Guilty by Reason of Insanity and hospitalized. The illness remains. The murder remains. It might seem to live on and call out for seeing. Our society shuts this person and their illness behind walls and fences. We shut our eyes to the crime, and what is psychosis but a kind of not-seeing? A collective schizophrenic ptosis, is this a side-effect of murder? What might we offer the killer if he is to continue to live, what is our treatment for the patient who kills? To listen to and for the parts of him that are dead, that died that day, that he must kill again and again. To listen for life struggling against death.

A man who kills and remains alive must live out a strange tension, an acrimony between hatred of the Other and hatred of himself. To continue to live, he (and we) must accept his hate, and remain alive to it. Who wouldn’t prefer to shut their eyes to murder? Who wouldn’t be driven to the edge of sanity by a world that constantly asks us how much wrongdoing we can stomach? We must try not to look away; to remain alive to the rightness and wrongness of the world keeps us in touch with at least I know which way is up.

And yet the question remains, which way is up? In our institutions of confinement and in a society beset by so much willful, lawful, political destruction, we are wracked with diffusion and confusion. Who has really done the killing here? When we face our senseless and psychotic violence we face a collective psyche where there are no clear lines separating the Self from the Other from the Act, where we each might have only the most tenuous grasp on This is who I am, this is what I have done, this is what has happened to me, I must take this medication for the rest of my life. When we have killed, to remain alive means the risk is never wholly resolved that We might kill again. Becoming alive is so dangerous that it must be approached with a certain degree of deadness. 

Supportive or exploratory? I could speak of technique, of paranoia progressing to guilt, of splitting and gradual integration, but these are spiritual matters as much as they are anything else. They are matters of the heart and they pale in the face of the task, which is to remain alive and dead together alongside those we hide behind the walls of our prisons and hospitals. There is no shortage of reality-orientation being enacted upon them by the facts of their confinement; their meals are taken at specific times, their clothing is the property of the state. And in the face of the horror and the indignity and the love, I have nothing to say on what we ought to do with our psychotic murderers. Our task is sometimes to forget which way is up. 

The burning bush answered Moses’s question, “What are you?” with, I am that I am, and this is no more comprehensible than Abraham’s raising of the knife against Isaac, not relieved of his own grief until the moment his murderous intent could be seen and felt; only after the knife was lifted could it be cast aside. What can a man make of himself when he comes so close to murder?  What could it be to choose life before a force of such overwhelming power and perplexity that to choose life means to choose death? What more could be said than I am that I am? 

To be met with such a force requires us to invert what we think we know about what is right and what is wrong. There is so much wrongness in the world, there is so much death and murder, and with the person who kills in the midst of psychosis, to focus on the wrongness of what has been done is to put ourselves to sleep. This is who I am, this is what I have done, this is what has happened to me, I must take this medication for the rest of my life.

The murderous patient may make no more sense of himself and his act than any of us may make of Abraham’s near-crime. And what sense is there to be made of it, anyway, when the victim is dead and the murderer himself Not Guilty because he is Insane? Perhaps not making sense, but making willingness, submitting to movement among life and death and life. One illustrates and illuminates and defends against the other; if we are lucky, we trip and fall into something poorly described as insight. Or perhaps we simply continue to trip and fall and stand and trip again. We must see ourselves lift the knife. We tremble before the burning bush, and become alive just at the moment when we know what we might have done. And for he who has actually done it, who must resist life to remain alive, to open his eyes each day is a kind of prayer–either that the psychosis will be lifted, or that it won’t. 

That it was someone else and not me; that Abraham, in the end, killed the ram instead; that the killing continues; these reflections are a challenge to all of us, to me, an invitation to behold unspeakable grief and choose life. To see the knife in my own hand is to become alive to the possibility that I, too, might be so confused by my pain that I would raise a hand against my own. And isn’t that what we must do if we are to remain alive in the company of so much death? That, at least, is what I must do. Abraham proved his faith, rightly or wrongly, by submitting to a force he could not comprehend. Were his eyes open or shut?