The Measure of Madness:. Katherine Ramsland
scan. As I suspected, the MRI revealed an abnormality in his left cerebral cortex.
Mr. Paulson’s MRI showed that an arachnoid cyst (a sack of fluid-filled tissue) had formed inside his skull but outside his brain. It developed in the protective lining, the arachnoid membrane, surrounding his brain, displacing his left temporal lobe, part of the frontal lobe, and the left middle cerebral artery. The cyst was huge, bigger than I had ever seen. I could not believe that he had lived all these years with the cyst slowly growing inside his skull without any obvious symptoms.
This kind of cyst is found in approximately 5 out of every 1,000 people. It can be present at birth or acquired later in life from an injury, and is usually asymptomatic. If the cyst grows large enough, however, it can cause a range of symptoms including cognitive problems, mood swings, headaches, dizziness, seizures, and psychosis, depending on the size and area of the brain affected.
Mr. Paulson was given an EEG (Electroencephalogram). Electrodes were placed on his scalp to measure brain electrical activity. He had a mild reduction of activity in the left hemisphere.
He was given a PET (Positron Emission Tomography) scan which produces a three-dimensional image of the brain. To create the image, the patient is given an intravenous injection of molecules such as glucose, to which small amounts of a radioactive material have been attached. The PET scanner detects the radioactive signal and generates an image of the tissues, possibly revealing abnormalities.
Mr. Paulson’s PET scan showed that the cyst impaired function primarily in the regions in the left frontal lobe next to the cyst. The results were consistent with those of other tests. All the brain tests showed abnormal function in this brain area.
Dr. Schwartz and I discussed the significance of the medical tests. He would have to decide whether the results proved anything definitive about the defendant’s mental state at the time of the offense. That was the million dollar question: was Mr. Paulson legally insane when he killed his wife?
“Have you ever heard of a psychiatric defense based on a brain cyst?” I asked.
“No, but clearly Mr. Paulson’s cyst was affecting the functioning of the brain tissue around it,” Dr. Schwartz said. “I’m convinced that his cyst played an important role in his impulsive attack.”
We were silent for a moment. “I just wish someone had written down Mr. Paulson’s statements when he was questioned by the police,” Dr. Schwartz exclaimed suddenly. “It’s strange that there are no police records of what he said when he was arrested.” Typically detectives prepare reports of comments made by the defendant at the crime scene and during police interrogation. None seemed to exist in this case.
“What are you going to write in your report?” I asked.
“That Mr. Paulson was not responsible for the killing of his wife,” he said.
I was not surprised by Dr. Schwartz’s certainty. I believe he was as impressed as I was by the size of the defendant’s cyst. A few days later, he gave me his report. It was short and to the point.
“It is this combination at the time of the present offense of dysfunctional frontal lobe pathways (due to the arachnoid cyst) and his wife’s unusual, provocative behavior which in my professional opinion made it impossible for Mr. Paulson to appreciate the nature and consequences of his conduct or that it was wrong.”5
Almost six months went by, and I got caught up in other cases. Dr. Schwartz called me one day to update me on a new turn of events. It turned out that Mr. Paulson’s fate was riding on the admissibility of the PET scan at trial. The defense attorney was eager to use the PET scan results at the trial to convince the jury that his client’s brain was so abnormal that he was not responsible for killing his wife.
The PET scan was a relatively new technology and the prosecution sought to exclude it from the trial, arguing that it was still an experimental test. The criteria for accepting scientific testimony is outlined by the 1923 Frye decision.6 Scientific testimony is permitted if it is “generally accepted” in the scientific community.
Mr. Paulson’s pretrial hearing, also known as a Frye Hearing, lasted several weeks. The presiding judge weighed testimony from many psychiatrists, neurologists, and experts in nuclear medicine. After hearing the scientific testimony, the judge ruled that the PET scan was widely accepted in the scientific community and could be presented during the trial itself.
I knew the prosecutor had offered Mr. Paulson a plea of murder in the second degree before the Frye hearing. On the day of jury selection, eleven days after the judge ruled that the PET scans were admissible, the prosecutor offered a much better plea—manslaughter. Mr. Paulson accepted and was sentenced to prison for seven to twenty-one years.
When I heard about Mr. Paulson’s decision, I wondered what would have happened if he had gone to trial. Would the jury have believed that his cyst made him kill his wife? It would have been interesting to see how a jury would react to the psychiatric, neurological, and psychological testimony, but I understood his decision not to risk it. Perhaps he was afraid he would be convicted. Or he wanted to spare his children the trauma of a trial. Or he had run out of money to pay for his already quite expensive defense.
Years later, when Dr. Schwartz and I were discussing Mr. Paulson’s case, he told me about a dramatic event that occurred the day before the trial was scheduled to begin. The prosecution “found” reports of Mr. Paulson’s statements that he made to the police shortly after he killed his wife. For months before the trial, the defense attorney had been requesting all relevant records and had not been told of the existence of these transcripts.
Dr. Schwartz’s usual cheerful and humorous tone of voice changed dramatically when he told me about the sudden appearance of these critical records.
“I read through those police notes for the first time right before the trial date,” Dr. Schwartz said. “Mr. Paulson was incoherent at first. Only after hours of questioning did he start to make sense.”
“What did you make of this?” I asked.
“Clearly, there was something wrong with him. If the prosecutor had turned over the statements when he should have, I would have realized immediately that Mr. Paulson had some kind of brain damage.”
Dr. Schwartz’s tone spoke volumes about his distaste for the prosecutor’s tactics.
“I remember like it was yesterday when the police began videotaping defendants’ interrogations,” he said. “At the time I wondered why didn’t they tape Mr. Paulson’s confession?”
“What do you make of the whole thing?” I asked.
“I think they knew he wasn’t in his right mind and they didn’t want this captured on video!”
I am not sure what angered Dr. Schwartz more: the possibility that evidence had been unethically withheld, or that he had been unable to recognize Mr. Paulson’s brain abnormality without the crucial police reports. I, on the other hand, was pleased that my neuropsychological testing detected the brain cyst. And, as a newcomer to the field, I was grateful to be given the extraordinary opportunity to play a part in a landmark case.
Not only was it the first case in which PET scan results were ruled admissible, it also became well-known by lawyers and forensic experts in the growing field of what is now called neurolaw. Neuroscience was beginning to transform the American legal system, and my Purdue Pegboard and I had been there at the beginning of it all. I can not thank Dr. Horn enough.
Chapter 2
A BOTCHED SUICIDE
It was 8:00 a.m. when the police officer finished his shift and signed out to go home. On his way out, he passed a thin, young man wearing a sweatshirt and sneakers. Something told him to look back. He turned around to get a better look, and at that moment the young man pulled out a gun. “I want to kill a cop,” he said, and aimed at two other officers standing in front of the precinct. He pulled the trigger twice, and the gun misfired. The officers pulled out their guns and started shooting. The man fell to