Madness on Death Row

© Tony Recena

The Eighth Amendment to the United States Constitution forbids cruel and unusual punishments. And in 1986, the Supreme Court ruled that the execution of an insane convict is unconstitutional. It’s utter madness that the State of Virginia is scheduled to execute William Morva tomorrow, when it is crystal clear from the descriptions of his history that he has long suffered from one of the most severe brain disorders, schizophrenia. There is no doubt that his actions were horrific just as there is also no doubt, based on a detailed report first in the Washington Post on June 24 and subsequently in additional news reports, about his medical diagnosis. While I have not examined him, the notion expressed at his sentencing hearing that he suffered from a delusional disorder is blatantly wrong. As one of the world’s leading experts on the science of schizophrenia, I am struck by the fact that the descriptions of him read like a page right out a psychiatry textbook. Mr. Morva displays the classic symptoms of schizophrenia, plain and simple. How is Virginia on the verge of executing such a blatantly sick person in defiance of the Supreme Court?

Schizophrenia is a brain disorder that affects approximately 1% of the worldwide population imposing a substantial global burden of disease that sometimes leads to death. As in Mr. Morva’s case, the devastation often becomes apparent in late adolescence as affected individuals begin to show remarkable changes in personality and role performance — typically falling behind in school, becoming socially isolated, and manifesting strange and bizarre behaviors. Confused and Idiosyncratic ideas, often with religious and grandiose themes with no foundation in reality, are hallmarks of the change in mental state. These delusions indicate difficulty in separating reality from fantasy.

As made clear in the Post article, Mr. Morva epitomized all of these characteristics. Schizophrenia is not something that shows up out of the blue and it is not diagnosed because of a single abnormal behavior or delusion, no matter how dramatic. Medical diagnosis requires a pattern of deteriorating and strange behavior that occurs over a protracted period of time, usually several years. The description of William Morva’s slide into dysfunctional behavior and strange ideas beginning in his senior year of high school and progressing over the next six years is the typical pattern. How was this information not front and center at his sentencing?

It is not rare for patients with schizophrenia to engage in criminal behavior, but the vast majority of patients are non-violent. In fact, they are much more likely to become victims than perpetrators of violence. In most cases, the criminal behavior is consistent with delusional beliefs that have gone untreated. As an expert witness in the trial of John Hinckley, who shot President Reagan because he thought this would make Jodie Foster fall in love with him, I see many parallels. John Hinckley, who also suffered from schizophrenia, did not engage in this horrific act out of the blue. He had been manifesting a deteriorating level of function for years before he finally got treatment in prison, regrettably only after his notorious action.

The Post article suggests that William Morva murdered law enforcement officials while attempting a prison escape because distorted and paranoid ideas made him fearful of plots to kill him. It is impossible to know whether these beliefs explain his actions, but the brains of patients with schizophrenia do not function like yours or mine. Illogical fears and behavior driven by confusion and delusional ideas are expected. Sadly, his mother also seems to have recognized that prison might have been the only way for her son to get treatment. Prisons today represent the primary treatment facilities for a large fraction of America’s mentally ill individuals, though they are poorly suited to this purpose.

After centuries of viewing “madness” as a behavioral problem, scientific research has established that schizophrenia is a brain disorder and that it is heavily influenced by genes and biological processes that begin in early brain development. These new insights have invigorated research efforts to find new approaches to treatment and prevention, but much more research is needed. Instead of spending upwards of $60,000 a year housing death row inmates with schizophrenia, that money could be put to more effective use for supporting treatment and research, possibly heading off acts of violence that result in tragedies like those in this instance. Mr. Morva’s case for clemency is in now in the hands of Governor McAuliffe. His profound illness and the ruling of the Supreme Court should make the decision a “no-brainer.”


Originally published at www.huffingtonpost.com on July 5, 2017.