New Documentary “Crazy, Not Insane” Premieres Tonight

Forensic psychiatrist Dorothy Otnow Lewis on the stand during the Arthur Shawcross trial

Source: Courtesy of HBO

With today’s renewed interest in Ted Bundy, I’ve always wondered what happened to the notes that forensic psychiatrist Dorothy Otnow Lewis made during her time with him. HBO’s new documentary, Crazy, Not Insane, answers this question. It also features her work with other killers. Using photos and videos from throughout Lewis’ professional life, along with quotes from her published work, the production spotlights her concerns with how our society treats its most extreme killers.

Lewis has a keen interest in the factors that cause or influence people to become violent. At 82, she’s still exploring what distinguishes them from the rest of us. She offers a remarkable body of work, including evaluations of 22 serial killers. Formerly a psychiatric expert on organic disorders and violence at New York City’s Bellevue Hospital, she'd found that abuse, brain damage, and some types of organic conditions play a clear role.

Alex Gibney, who brought us The Inventor: Out for Blood in Silicon Valley, directed and co-produced this documentary. Using a fragmented series of images and drawings, he hopes to convey the bizarre world of violent madness that’s often not considered legally insane. “In making the film,” Gibney says, “we found a crazy-quilt style — using cinema verité, archive, animation, home movies – that playfully mirrors the magnificent complexity of the human mind.” The shifting animations are effective, even mesmerizing.

Lewis hadn’t planned to work with killers, but her encounter with juvenile delinquents changed her mind. She observed how often certain problems within their families had made them act out. So, she got curious about the variables that set aggressive kids apart. She organized research projects that helped her to identify the key influences. Again and again, she found abuse mingling with neurological and psychiatric disorders.

Take Johnny Frank Garrett. At 17, he stood convicted and sentenced to death for the rape and murder of an elderly Catholic nun. Lewis evaluated him for the Texas Board of Pardons and Paroles’ sentencing review and found that he hallucinated voices. She diagnosed him with schizophrenia and brain damage. Then she added multiple personality disorder, or MPD. Her effort didn’t help. Garrett was executed in 1992.

Lewis has become a controversial figure for her diagnosis of MPD (now called dissociative identity disorder, or DID). In the documentary, she admits she’s been professionally ridiculed. She’d once been skeptical of this condition, too, but then she interviewed Marie Moore. The 36-year-old woman had helped to torture and kill a teenage girl. Moore told police she had a personality named Billy.

To Lewis, Moore described memory lapses, blackouts, confusion, suicide attempts, and a background of sadistic childhood sexual abuse. Her neurological testing showed damage in the frontal lobe, an area of her brain responsible for judgment and impulse control. Lewis thought Marie’s symptoms were due to schizophrenia or epileptic seizures. But then “Billy” emerged. In a gruff voice, he claimed to be Marie’s protector. Lewis explored further and found what she thought was evidence of MPD in Moore’s childhood, during abuse. Her opinion about this diagnosis shifted, opening her eyes to its markers in others.

Many mental health experts lobby for the court to accept extreme childhood abuse as a mitigating factor. Lewis has made this issue a calling. She finds that juries resist weighing mental illness in their evaluation of horrendous crimes. They prefer the emotional appeal of the religious label, evil, to scientific analysis.

Still, a DID diagnosis is more clinical interpretation than scientific fact. We see how slippery it is when Lewis tries to show media journalist Diane Sawyer evidence of a killer’s “alters.” David Wilson, a convicted murderer, closes his eyes, shakes his head, and changes his voice. Sawyer thinks he could be faking to gain transfer to a hospital and lose his death sentence. Lewis responds, “I had a different impression from yours.”

And that’s the crux: A predisposition to interpret certain behavior as a symptom of DID is likely to result in the diagnosis, while an inclination to dismiss it supports viewing it as fake. That’s the trouble with “soft science.” It's also why Lewis prefers to use neurological results.

In 1990, she became part of the defense team for Arthur Shawcross. Accused of the murders of 11 women in Rochester, New York, Shawcross pleaded not guilty by reason of insanity. Thus, he’d have to show that at the time of each offense, he suffered from a mental defect that prevented him from knowing what he was doing or understanding that it was wrong.

Through hypnosis, Lewis found that Shawcross had been severely traumatized as a child. He used a high voice to adopt the persona of his mother, the one who'd wanted these women dead. Shawcross said he was fighting himself: “It’s like I’m two different people doing something bad.” This looked very much like MPD. Then a brain scan showed damage. Lewis thought Shawcross might have had incomplete temporal lobe seizures that produced blackouts. Psychological tests from his childhood confirmed he’d been a seriously disturbed boy.

Lewis expected the attorney to use the brain scan images and the testimony of a neurologist as solid evidence of an aberrant organic condition. Instead, the attorney focused on the hypnosis sessions, which jurors could easily view as feigned (especially after the prosecutor’s expert did so). They found Shawcross to be sane and guilty. Although Lewis acknowledges that this trial had been a professional and emotional setback, she continued her campaign to get the courts to accept brain damage as the basis for diminished capacity.

Threaded throughout the film is the notion that legal definitions of competence and insanity make little sense in the psychiatric context. Legal precedent and a lack of appreciation for psychiatric research impede the contribution of updated ideas about mental illness. Thus, it thwarts true justice.

The last part of the documentary takes up Lewis’s work with Ted Bundy — what I'd been waiting for. She'd examined him for Polly Nelson, one of his defense attorneys. According to Nelson’s account, Lewis quickly diagnosed Bundy as bipolar. Although Bundy had always said his home life was normal, Lewis doubted this. She characterized Bundy’s relationship with his mother as superficial and cold. She also believed that his grandfather, who’d had considerable influence during Bundy’s earliest years, had been a violent man. In addition, Lewis interviewed Bundy’s Aunt Julia, who described 3-year-old Ted placing knives around her in her bed. Lewis thinks these narratives support evidence of his early antisocial tendencies.

At this point, I found the documentary a bit misleading. Lewis sounds definitive, but years ago Julia told a Vanity Fair writer that the knife incident had been exaggerated. It had been a prank and she hadn’t been frightened. Nor did she think her nephew was troubled. In addition, author Christian Barth has interviewed relatives and acquaintances of Bundy’s grandfather, presenting a much less malevolent portrait. And during Bundy’s numerous evaluations in Utah and Florida, no other mental health expert diagnosed a bipolar disorder. Lewis’s opinion needs context.

More controversial was her attempt to get Bundy to accept that his self-named “entity” was an alter personality. He did describe how it took over his conscious mechanism to dictate what he’d do — and viewers can hear him say this. But he resisted an MPD diagnosis. Years later, Lewis received a packet of love letters from Bundy’s wife that bore a variety of signatures. She thinks this could indicate different personalities.

There are many worthwhile nuggets in Crazy, Not Insane, especially those that advance our knowledge about violent disorders. The program serves as a needed balance to the current trendy fascination with what serial killers have done. In Lewis, we see a person trying to calculate how they became so violent and hoping to inject more awareness and compassion into the legal system. Maybe she’ll educate some future participants.

No matter where you might stand on her diagnostic approach, these cases should make us review the court’s current control over the concept of insanity.

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The documentary debuts November 18 on HBO.