Fatal Delusions Tragedy: Betty Keat's descent into mental illness, her refusal of treatment and her harassment of her neighbors, and her death by police bullets raise questions about how society responds to people with severe psychiatric problems.

"Many of her neighbors are extremely concerned that she is acting quite strangely and that this may signal another relapse of her psychiatric condition," he wrote. "We strongly urge you to quickly take whatever action you think is appropriate to ensure the safety of both Mrs. Keat and the neighborhood. In the long run, some type of supervised living situation is necessary to avoid this chronic pattern of relapse and rehospitalization."

Schuberth faxed the letter in 1993, more than two years before the crisis that would end with Keat's death.

He received no response.

The first suspicion

It was nearly 30 years ago, but Jim Keat remembers the moment he first suspected his wife might be mentally ill.

He was the New Delhi correspondent for The Baltimore Sun; his brilliant, strong-willed wife was riding horses, learning polo and pursuing research in Asian studies. He had heard mutterings about Betty's odd behavior, but he had dismissed them.

Now, as he drove across the teeming Indian capital, he looked at his wife in the passenger seat. She was waving to the crowds in a slow, stylized manner, "like Queen Elizabeth," Jim Keat recalls.

The daughter of Slovak immigrants, she had won a scholarship to Hunter College, where she was president of the history club. She and Jim met as graduate students, drawn together by their mutual interest in India. They had married in 1955 on their first stay in New Delhi.

Now she deteriorated quickly. In 1967, she was sedated and brought home to New York, where psychiatrists first offered a diagnosis: paranoid schizophrenia. Later, as Betty Keat gyrated between hospitals and home in a dispiriting cycle, the doctors would explain her wild mood swings with a second diagnosis: bipolar disorder -- or manic depression.

To control her paranoid delusions, she took antipsychotic medications; for the manic depression, she took lithium. These were the miracle drugs of the 1950s and '60s that had made conceivable the deinstitutionalization of the mentally ill. From a peak of 9,530 people in Maryland's state mental hospitals in 1956, the hospitalized population has declined by more than 80 percent to 1,600 today.

When medication stabilized her illness, what people saw in Betty Keat was an impressive breadth of knowledge, a quick wit and real affection for those she felt close to.

She pushed her niece and nephew in New York to pursue their educations. She took them to museums, sent them tender notes and surprising gifts -- once, an enormous bag of popcorn, delivered by UPS with a note saying, "Have a party."

For 15 years, she taught sociology and anthropology at Morgan State University, where students and professors recall her, when stable, as an engaging, no-nonsense instructor. Stefan Goodwin, colleague, recalls her as "very decent and dedicated," a gourmet cook, an avid reader, an athletic woman who liked to skate, swim, bicycle and hike.

Feeling like a zombie

But like many patients, Keat didn't like the side-effects of her medications, including muscle twitches and flattened emotions. "She said the medication made her feel like a zombie," says her sister, Janet Beyer.

After a year or two -- sometimes just a few months -- of relative stability, Keat would stop taking her medication. And gradually, her symptoms would reappear.

When her illness flared, Morgan State students complained of insulting or racist remarks. Once she wrote to the FBI on Morgan stationery, signing herself "the Whore of God Almighty." In the early 1980s, she was banned from teaching; in 1986, she was dismissed in a budget-cutting move.

By then, her marriage had dissolved.

In every crisis, it had fallen to Jim Keat to cope. Betty's only close relative, her seven-year-younger sister, Beyer, was a widowed mother of two who lived in New York.

So it was Jim Keat who coaxed his wife to take her medication and who, when she didn't, had her committed to the hospital. He bore the brunt of her paranoid imaginings. Once she leveled an air rifle at him. From Springfield Hospital Center she ordered for delivery to her husband 200 elegant invitations to a "wedding reception" for her and an acquaintance. Another time, she placed an "In Memoriam" notice in the newspaper for her very alive husband.

Finally Jim Keat, too, wanted to escape her ranting accusations. He moved out in 1980; they were divorced in 1983; he remarried in 1986. But for some years he remained on call in crisis; as late as May, 1994, he took her home from Springfield Hospital Center.

Like Betty's sister and several of her therapists, her husband had long urged her to sell the house on Taplow Road. Having lost her marriage and profession, she clung to the house as "an emotional anchor," a palpable symbol of respectability, says Jim Keat, who retired last year as an editor of The Sun.

But taxes, maintenance and heat were too much for her disability checks and modest pension. There was no one to look after her, monitor her condition, encourage her to take medication.