Badness or Madness?

When neo-Nazi sympathizer Buford O. Furrow Jr. opened fire on a Jewish day school last Tuesday it seemed fairly straightforward: He had committed a hate crime. But when we learned that Furrow had tried to get psychiatric help, he--and his crime--suddenly became more complicated.

He seemed less like Timothy McVeigh--a sane but hate-filled, violent man--and more like Colin Ferguson, the paranoid schizophrenic black man who gunned down white passengers on the Long Island Railroad in 1994.

At first, much of the media assumed Furrow was mentally ill. As a psychiatrist, I received many requests to explain how yet another mentally ill person could “fall between the cracks.� Clearly, he was a profoundly disturbed man. In the fall of 1998, he was in a psychiatric hospital for a month and shortly after being released sought help at another hospital, the Fairfax Psychiatric Hospital near Seattle. After he pulled a knife on a nurse at Fairfax, he was taken into police custody. What Furrow told police shows how tortured he was and how he realized that he needed to be protected from himself and others from him.

Furrow said he had wounded himself several times with a knife, almost severing a finger; perhaps he was intoxicated at the time. He talked about suicide and about fantasies of a killing spree. He said he had many knives and a semi-automatic handgun.

But right now, we don’t know the extent of Furrow’s mental illness. He hasn’t been formally examined or diagnosed. Here is how I will be thinking about Furrow’s case as more information is learned:

I want to understand whether his murderous behavior was a product of an odious belief system (e.g., Nazism) or whether he was out of touch with reality on many fronts and his hatred of Jews and minorities was just an expression of one of several delusions he harbored. The dynamics of psychosis are that the sufferer is delusional about something. Maybe he thinks the FBI is following him; that the television announcer is talking directly to him; that his family members are really aliens.

When John Hinckley tried to kill a president to impress an actress, people could easily see his logic was the product of insanity. When the Son of Sam thought a dog was commanding him to kill and he shot that tormenting dog, no one thought of him as a dog-hater. Yet when delusions happen to be politically charged, murderous acts take on new, but clinically misinformed, meaning.

For example, Ferguson was assailed as a racist. That made no sense to me: He killed white people because he was delusional about white people.

Was Furrow delusional about Jews? I don’t know.

On the other end of the motivational spectrum is badness. While not a formal diagnostic term, most of us know it when we see it. McVeigh’s blowing up an occupied building in Oklahoma City fits that description. While some people consider it axiomatic that anyone who sets out to kill scores of people is crazy, technically it is a matter of diagnosis. McVeigh was not psychotic. He wasn’t normal, but he was criminally responsible.

There is virtually no medication that could change the thought processes of someone like McVeigh. Is it possible that some form of psychotherapy could help, or even a religious conversion? Maybe. Some death row conversions, like the recent one of Karla Faye Tucker, seem quite authentic. But while these people are hellbent on destroying others, for personal or political reasons, and feel no remorse afterward, there is very little psychiatry can do. We call these feelings and behaviors “ego-syntonic,� in other words, they are comfortable for the person.

Ted Bundy is a classic example of someone whose actions (which he knew perfectly well were wrong) caused no friction in his soul. Figures like Hitler, Pol Pot and Idi Amin are able to rationalize genocide on philosophical grounds. One of the hallmarks of badness (or evil, as some might call it) is the lack of ambivalence that the perpetrators feel toward their actions. In this regard, Furrow is different. He sought psychiatric help, presumably, because he knew, on some level, that his impulses were unhealthy. But did these impulses spring from psychosis?

When they do, society knows what’s needed. The Colin Fergusons and John Hinckleys must be treated for a severe mental illness and society needs to be kept safe from them. When we know ahead of time that individuals with schizophrenia have a pattern of becoming dangerous, homeless or physically deteriorated when off their medication, we need mechanisms to compel them to take those medications or to hospitalize them when we see them spiraling into an abyss.

Our profession has a moral obligation to help anyone who comes to us. The doctors and nurses at Fairfax had intended to treat Furrow but he made that impossible at the time by threatening the staff.

We don’t know yet where Buford Furrow lies on the continuum between badness and madness. My suspicion is that his form of pathology is not amenable to treatment through medication. But even in the face of such a horrifying crime, this is a distinction we need to remember.