Psychiatrist appointed by Court to evaluate the 6-year-old

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Q: Doctor, how did you first hear about this case and what was your immediate reaction?

Blinder: I first heard about this case as I hear about so many cases during the course of the year. I get an appointment from the court asking me to examine someone accused of a heinous crime, to determine whether or not he is even competent to stand trial. There was some issue in the judge's mind or the attorney's mind that this particular defendant might not be able to go through with the court proceeding in a meaningful way. Then, and only afterwards, did I learn that this particular defendant was 6 years old, and I was shocked. He was charged with attempted murder.

Q: You were shocked by...?

Blinder: It's not the usual thing even in my practice, where I think I've seen everything, that you find a 6-year-old charged with deliberately attempting to kill someone.

Q: How did you feel about participating in a case like this?

Blinder: My approach was professional. This was the assignment and, I suppose after 30 years of doing these kinds of cases, they become somewhat mundane, so the opportunity to look at a case that's a little different, perks up your interest again.

Q: Was this 6-year-old the youngest client that you had examined prior to this?

Blinder: I have seen youngsters as young as 6, but never one charged with this kind of crime. I have seen 9-year-old, 10-year-old shoplifters and 11-year-old fire setters, but here we have a 6-year-old charged with attempted murder. That was outside my experience.

Q: Prior to meeting with the 6-year-old, you reviewed police reports, reports from other psychiatrists and psychologists, as well as a videotape of the 6-year-old being interviewed by the police. What were your impressions of the 6-year-old at this point?

Blinder: The information that I received was that there was no apparent motive for this crime, if indeed he did do it, and apparently he did it. He got into this home, ostensibly to steal a bicycle, and then while he was there, took a stick or some hard object and almost mashed in the brains of a 2 or 3-month-old infant. He at first denied it, then talked about it being an accident. Finally he acknowledged that he did it, but showed no remorse. There was an allegation that he had threatened a little girl that knew he was in there and he told her, "Don't tell anybody that I was here, and if you tell the police, I'm going to come and get you." When being interviewed by the police, again he seemed not to have any motive or any remorse for what he had done. It just seemed like the thing to do at the time. He certainly didn't exhibit any obvious evidence of a mental disability. He seemed like a very handsome, even charming--a reasonably bright young man, who did a terrible thing, that didn't seem to bother him that awfully much.

Q: So what kind of strategy did you develop, given what you had learned, and what you had seen of this boy, what kind of strategy did you develop for your meeting with him?

Blinder: The purpose of my examination was not just to form a psychiatric diagnosis and let it hang there in the ether and the air. The courts are not that much interested in my clinical findings. The court has a very narrow interest in what I have to say. It wants to know whether or not this young man has some sort of disability, and if so, is it serious enough to prevent him going forward with the court proceedings?

So I had two tests. One was to arrive at a clinical diagnosis and then to determine whether or not, if he had a diagnosis, if that was sufficient to bar him from going forward with the trial. To do that, I had to approach him as I would any other diagnostic case outside of a forensic setting. I take a bit of a past history, get a sense of what he was doing at the time of the crime, what was going on in his mind, how he feels about it now. And as he tells me about those things, I listen to the way his mind works, to see whether or not, aside from the content of his words, there was something in the process of this mentation that would suggest we have a mentally disabled individual, one so disabled he would not grasp that he was charged with a crime, that he faced certain penalties, that the judge's job was to make a decision about his freedom, that the prosecutor was to present the damning evidence, that his attorney was there to help him and so on and so forth.

So I went through this clinical procedure, got a sense of what the appropriate diagnosis would be, what his state of mind was at the time of his offense, his comprehension, not only of the offense but of the forthcoming judicial proceedings, and then tried to arrive at some advice to the court as to whether or not I felt he was psychologically equal to his day in court.

Q: And where and when did the examination take place with the juvenile, and what were your first impressions of the boy, and how long did the examination take?

Blinder: I performed the examination in June of '96, in juvenile hall. It was fairly shortly after the offense. I'm a little fuzzy now, almost a year later, as to how much of the time I devoted to this case was in the review of the records and the videotape, and how much time I spent with him. It was probably close to an hour with the young boy himself, and that examination took place in an examination room at the juvenile hall in Contra Costa County.

Q: And what were your first impressions of him?

Blinder: My first impression was a perfectly ordinary, smiling, outgoing young man. There was nothing about his demeanor or his appearance to suggest that we were dealing with either a dangerous fellow, or one who was wrestling with mental retardation or some obviously disabling psychiatric disorder.

Q: Just another 6-year-old?

Blinder: Just another 6-year-old. Although this one had a certain charm to him, a wonderful smile, a good-looking kid, and engaging. But with the restlessness that you would expect from a 6-year-old who doesn't want to sit there and talk to a shrink for an hour in a little tiny room,

Q: Did you like him?

Blinder: He was very likable. Very likable.

Q: And following your examination, what diagnosis did you arrive at?

Blinder: I felt that he was a psychopath in the making. We tend to reserve such a label for adults and we talk about juveniles who act out in violent ways as suffering a conduct disorder. The use of the term psychopath or antisocial personality is perhaps prematurely pejorative and we don't ordinarily see the necessary signs and symptoms in one so young and someone so small. So we don't use that terms ... when we talk about juveniles. I certainly have never used that term before. But this young man was so evidently suffused with all of the findings, that, when they fully blossomed later in life, will call for this diagnosis, that I was comfortable in talking about him having a nascent sociopathic personality. Or a psychopath in the making.

Q: And what were the symptoms that he displayed during that examination that led you to that conclusion?

Blinder: The diagnosis is made, generally, and certainly I made it in this case, because I was faced with a subject who, first of all, had committed a gratuitous act of violence. An act of violence for which he had absolutely no motive. I asked him why he did it. He said, "Well, I was there. It was interesting. It seemed like the thing to do." He had no remorse for what he did. He knew that what he did was bad because people had told him he was bad, and he was being confined to juvenile hall because of what he had done. So he knew it was bad, but that it was evil did not seem to register particularly with him. It had no resonance within him, so there was no remorse. He clearly knew how to lie, because initially he said he didn't do it. Then he told me it was an accident, and then he finally admitted doing it. So he sort of eased up to the truth. He knew the virtue of threat, because he told this little girl on the day of the offense, "You better not tell anybody what I did."

He had a somewhat ominous track record even before he committed this. He was something of a bully back at school. Fascinated with guns. He drowned the family cat, set some fires, had some bed wetting problems. All characteristics of individuals who later on, at the age of 18, 19, 20, commit a series of crimes, finally get to the scrutiny of folks like me and then are definitively diagnosed anti-social personality. We retrace back to their childhood and reel off the diagnosis. With this young fellow, I didn't have to go back to his childhood, I had the condition already almost fully formed, although it had only blossomed into one overt criminal act.

Q: Is he dangerous?

Blinder: Well, he's only 6 years old and he weighs 60 pounds. But what happens when he's six feet tall and weighs 200 pounds. He could do society a lot of damage, and he took a good shot at that when he encountered this 3-month-old infant, so he's dangerous now and I guess we may hear from him again down the road as well.

Q: Will he kill again? When will he kill?

Blinder: I cannot predict the complexion or the nature of his subsequent anti-social acts, and just before this interview I dropped my crystal ball on the steps and it shattered into a million pieces, so I can't even predict whether or not he will necessarily break the law or come to the attention of the authorities. But I can say that the personality characteristics that I found in this young boy, that seemed to drive him, and the absence of any inhibiting factors, the absence of empathy for his fellow kid and some of the other diagnostic features are so common in individuals who do go forward in a life of violence and a life of crime, that I think we should have a great concern that we will indeed be faced with what to do with this fellow on down the road... When he has his freedom and he has a bit of heft to him, I think statistically there is some likelihood that he will act in a criminal fashion. Whether or not ... this young man will definitively grow up to be John Dillinger, I can't say. But I think had I examined John Dillinger when he was 6 years old, I would have seen qualities very much like what I saw in this young man.

Q: Okay. But what can be done with a 6-year-old like this?

Blinder: What do you do with a 6-year-old like this? One thing that works is you sequester them. So that they no longer have the society to attack. There are obviously a variety of ethical, moral and psychological reasons why this may not be a good or a permanent solution. But it's very tempting. To make sure that they don't have the opportunity to do the kind of damage that we know they are capable of. They are, at least theoretically, responsive to long-term psychotherapeutic intervention. And it is possible to make little tiny corrections, day by day, in how they experience their world and how to react to it ... to give them a set of internal controls so they don't need the external controls of sequestration and bars on the windows to get them to mind their p's and q's. You can, almost retrain people, and change their character for the better. It's difficult but ... and there are no guarantees, of course. The problem, to me, stems from my conviction that in this sort of character disorder--and certainly a character disorder of this early severity--it is probably largely genetic. Yes, certainly, being raised in a violent neighborhood and in a violent or less than optimum home with father absent, mother an alcoholic--these things are not therapeutic. And doubtless these are the kinds of things that will illuminate or enhance an individual's genetic endowment. But if it brings to the table, if you will, a certain genetic structure, it's very difficult to modify that through behavioral or psychotherapeutic techniques.

Q: So there's a heavy genetic loading for this condition. What did you mean, exactly, by that?

Blinder: When you see this degree of characterologic pathology fully formed, all of the signs and symptoms right out of the textbook. Even in the presence of a particularly pernicious and malignant environment, it's hard to imagine it can do this much damage to a kid, that at the age of 6, he could exhibit so much psychiatric disorder. It has to come in utero. It has to be part of his genetic endowment, and this explains why, though granted, you do see sociopaths coming from bad neighborhoods and less than optimum family situations and home life, you find them popping up all the time in the best of families. One brother is a cop, another brother is a priest and the third brother is John Dillinger. And the brother who became John Dillinger had the same home, the same nanny, the same mother and father, the same nice neighborhood. But he becomes John Dillinger because he was genetically predisposed to become John Dillinger. And maybe there were certain things that you could have done to advance or inhibit his going down that particular road. But I think it's pretty well set in cement by the time his mother and his father's sperm and egg meet and form his particular genetic endowment.

Q: So it's truly natural born killer then, really?

Blinder: There is something to be said for the phrase "natural born killer."

Q: And is this what we're looking at with this boy?

Blinder: It's my view that most of what I found was predestined by his genetic endowment.

Q: He was born that way.

Blinder: I believe he was born that way, yes. This is not to say that things happened in his life... This is not to say that there weren't things in his life that made it worse. His father left the scene by the time he was four. And there is some statistical evidence that father absent homes tend to generate more anti-social behavior in sons and maybe daughters than homes where father is present. Mother had a drinking problem, so she may not have always been available to him, and indeed her drinking problem may have contributed in some arcane way to his genetic endowment. But, as I say, it's hard to imagine that you would get this comprehensive a characterologic disorder without his genes playing a substantial part in who he is.

Q: So, is there any form of treatment available in America today that would be useful in changing this boy and turning him into a law abiding, nonviolent, peaceful citizen of our society?

Blinder: The most impressive results I have seen in treating sociopaths, or sociopaths in the making, was the approach they take in Denmark, where rather than simply locking them up, they put them in a controlled setting. And every time there's an infraction of the rules, however slight, they lose a privilege, a small privilege. And every time they do something right, they are rewarded with a chip that they can trade in for things that they want--more television time, cigarettes, whatever the case may be, maybe an extra half hour out on the basketball court. And by doing this round the clock, all the time, reinforcing their minding their p's and q's, punishing those times where they slip, you begin to re-alter their makeup. Now whether or not it actually impacts upon their genetic structure, I can't say, but at least, if you can't alter the genotype, you may be able to alter the phenotype so their behavior changes. And they have an excellent record in individuals who, heretofore, were constantly getting into trouble with the law. And after they graduate, their incidence of recidivism and further criminal behavior drops. I am not aware of any formal setting that we have in this country, but certainly we have many places where disturbed youngsters can be treated, and they have people who are experienced in youngsters whose disturbance takes the form of conduct disorders. And they can get good results.

Q: And what would you think the chances for this boy would be, given the treatment program that he's presently in now?

Blinder: I don't know enough about the treatment program in which he is involved to pass judgment. So I will just answer you in general terms, that given what I believe to be the severity of his character disorder, and it would have to be severe for me to be able to confidently make an adult diagnosis on someone who's merely 6 years old. So, given the severity of his disorder, I tend to be pessimistic that we're going to make enough of a change to substantially improve his chances of leading a productive life. The other thing that makes me worried is that these individuals not only enact and commit violence, but they are often recipients of violence. They are provocative, and sometimes they mess around with people who give as good as they get, so that their life expectancy isn't terribly long. So there may not be enough time to make the changes that we need. On the other hand, this will be one of our few opportunities to tackle this problem in its formative stages, [because] the kid is only 6 years old, and such resources as society has will be brought to bear on this young boy. We're not waiting until he's 20 years old and he's killed three people. We're getting him now while he's 6 and he has a lot of developmental processes to complete. And maybe we can get our two cents in and maybe our five cents, and our nickels and our quarters and our dollars over the next ten years, to ensure a happier outcome than if he was simply left to his own devices.

Q: At an age where there's diminishing resources available for children, why should we spend the money?

Blinder: The question, of course, is whether or not this is the most cost-effective allocation of our resources. Should we spend $100,000 to try and straighten out one 6-year-old or break that $100,000 into $10,000 pieces, and devote $10,000 to special kids? Ten of them, that are nearly as deep water as this boy is, they're just having some earlier signs, or lesser signs of problems. But because they're less severe, they're more amenable to treatment. Maybe just giving them a dynamite education might make all the difference in the world. So should we take this $100,000 and instead of giving it to this tough case, and instead spread it out over ten easier cases? That's obviously not for me to say, but that, to me is a very timely question.

Q: And what would your own preference be, personally? What would you do?

Blinder: Well, if it were up to me, I would take two-thirds of the money that we spend building weapons that probably don't work, and which would be useless even if they did work, and devote them to all of our children. So that we not only take care of this particular 6-year-old but we have the ten $10,000 parcels to give to the others. I would not, if it were up to me, be in an either/or situation. I think there are lots of things we can do. Think of the cost to society of our promiscuous availability of guns. If we eliminated all these guns, all the money that goes into repairing holes in the heads and all the violence that occurs, we wouldn't have to spend that money. We would have more funds available again, for education, and for psychotherapy of kids that run into trouble. I've long felt that the NRA has injured and killed more people than cancer. You know, if we can save at that expense, then we would have money available to treat troubled youngsters.

Q: Why did you feel this 6-year-old was competent to stand trial?

Blinder: The issue of competency is separate from youth, from juvenility. It is, in fact, separate from psychiatric disorder. An individual can have a severe psychiatric disorder--he's hallucinating, he thinks that he's Napoleon and he regularly hears the voice of the Virgin Mary, and he's had these problems for some years. But, if nonetheless he knows that he's been charged with attempted murder, that he knows that this particular court is qualified to judge even Napoleon. That it has jurisdiction over the emperor. If the voices that he hears are not so loud that he can't hear the voice of his attorney, telling him, "I don't want you to take the stand," and, "Just kind of keep quiet and sit there." If he understands that, if convicted, he's going to spend maybe the rest of his life in prison. If he understands the role of the jury. If he understands that whatever was in his mind, society, at least, believes that what he did was wrong. And if he can sit through six, seven hours every day in a courtroom and not jump up and urinate on the judge or the bailiff, despite his obvious psychosis, he may very well be competent to stand trial.

There was certainly no evidence of psychosis in this young boy. The question in my mind was: Was he simply too young and thus not have the sophistication to understand good from evil, truth from lying, right from wrong? Not really understand what a judge is. Not really understand that the lawyer is his friend and so on.

But I determined that he knew truth from falsehood. I asked him whether or not my telling him that birds fly ... is that right or wrong? Is that true or false? And he said, "Oh, no. That birds fly. That's true." I said, "Well how about if I told you that dogs fly?" He said, "Oh, no. That's false." He obviously knew the virtue of lying because at first he denied what he had done and said it was an accident. He understood that society considered what he had done wrong, which is why he was being locked up at juvenile hall. He knew the judge's task. He knew his lawyer was there to help him. He knew the prosecutor was going to gather the evidence against him and he understood that if things didn't go his way, he might not go home to see his mommy for a long, long time. So despite his juvenility, I felt that he grasped the essentials of what a trial proceeding was, why he was going to be tried and what the penalties might be. I certainly don't think he had the level of sophistication of Justice Cardoza, but you don't need that. You just need to have a fingernail grip on what's going on in order to pass this particular test.

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