A difficult, elusive diagnosis

Evaluation varied: severe mental illness to plain 'meanness'

March 24, 2000|By Scott Shane | Scott Shane,Sun Staff

Joseph C. Palczynski's first trip to a psychiatric hospital came at the age of 14, and it set the pattern for a life in which a violent personality and mental illness made a volatile combination.

After allegedly telling his stepfather, "I'm the devil and I'm going to kill you," the teen-ager was hospitalized at Taylor Manor in Ellicott City. The grab-bag of diagnoses he received in a brief stay there suggests a complicated and confusing case: mild depression; attention deficit disorder; "schizoid disorder," an extreme emotional detachment; and a vague fourth label called "specific developmental disorder, mixed."

He would compile a long record of threatening and attacking a series of girlfriends. And this month, at the age of 31, he erupted in a final spree of violence, killing four people and holding three others hostage for four days before police shot him to death Tuesday night.

Over the years, many psychologists and other professionals evaluated Palczynski, usually at the request of the criminal justice system. Rarely did they reach the same conclusion.

Sometimes they concluded that he suffered from bipolar disorder, an illness characterized by swings of mood from depression to mania and back.

At other times the diagnosis was paranoid schizophrenia, a brain disease in which the patient hears voices or has bizarre delusions of persecution.

And at still other times, psychologists concluded that he suffered not from either of those psychotic illnesses, but rather from a severely flawed personality.

Psychiatrists and advocates for the mentally ill said yesterday that the varying diagnoses are not unusual, particularly in a patient who, like Palczynski, was rarely examined twice by the same professional.

"People drift in and out of the mental health system, and no one sees them consistently," said Dr. Paul M. Appelbaum, chairman of psychiatry at the University of Massachusetts and vice president of the American Psychiatric Association. He said bipolar disorder can be very difficult to distinguish from schizophrenia if a patient is not followed over several months.

"It's not the kind of thing where they can take an X-ray and say, 'Yes, it's broken and here's where it's broken,'" said Janet Edelman, an activist with the Maryland chapter of the National Alliance for the Mentally Ill. "They go to different doctors. Their behavior changes. They get on or off medication."

Her organization, which represents families of the mentally ill, said this week that Palczynski's case showed the need for a stronger system of care for mental patients outside the hospital and changes in state law to make it easier to force a patient to take medication.

Dr. E. Fuller Torrey, a Washington-area psychiatrist and writer who has long campaigned for such legal changes, agreed. "I think this guy's Exhibit A on why the law needs to be changed. Assuming the diagnosis of psychosis is correct, he should not have been wandering around in the community without taking his medication," Torrey said.

But a state task force that spent last a year studying the issue recently rejected the idea of "outpatient commitment," under which a patient who refuses to take medication could be forcibly hospitalized. State law permits forced hospitalization only when a patient is judged dangerous to himself or others.

The task force decided that a stronger commitment law would cause patients to avoid voluntary treatment and divert attention and money from the need to strengthen the mental health system. Some of its members also say Palczynski's long history of violence, and murky diagnosis, makes his case a poor guide to how the system should be changed.

"I wish to heck everybody wouldn't use Palczynski to debate these issues," said Herbert S. Cromwell, director of the Maryland Association of Psychiatric Support Services.

The shifting, confusing nature of Palczynski's state of mind is illustrated by several court-ordered evaluations from the past decade.

In March 1992, a psychologist at the federal prison in Petersburg, Va., examined Palczynski after an episode in which he bought a rifle "to kill the ninjas" he was convinced were trying to murder him -- and then used the rifle to threaten his girlfriend. Palczynski claimed to have bought 200 rounds of ammunition: "Fifty were for her [his girlfriend] and 150 were for the cops," and said "the rifle makes me feel like I can do anything."

Describing a man who was dangerously out of touch with reality and suicidal, the psychologist, Michael W. Morrison, diagnosed paranoid schizophrenia. He concluded that Palczynski was legally insane when he bought the gun and not competent to stand trial on federal weapons charges.

Morrison offered a dismal prognosis, saying Palczynski probably would have to be forced to take his medication and that his psychotic illness might well be a "lifelong condition."

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