ELIZABETH FARNSWORTH: Friends and family members of Russell Eugene Weston, Jr. have known for years that he was mentally unstable.
RUSSELL EUGENE WESTON SR.: It just escalated, you know, slowly at times over time and things were-you know--get a little bit bigger and a little bit bigger, but we were never concerned, you know, that much because he had a big imagination, and we thought that there wasn't any problem with that. But as time went on, then they got a little worse and a little worse until finally we were walking a very fine line to not make him mad at us but still keep some kind of control over him.
ELIZABETH FARNSWORTH: The forty-one year old man charged today with the murder was diagnosed in the mid 1980's with paranoid schizophrenia. He was a loner who lived in rural Montana and sometimes at his parents' home in Valmeyer, Illinois. In 1996, the Secret Service interviewed him in Valmeyer, after the county sheriff reported Weston had complained he was being pursued by federal assassins.
RUSSELL EUGENE WESTON SR.: There was an incident where he thought there was someone from the Navy Seals was down the back road and that President Clinton had hired him to have him executed. And I will tell them--I said, you know, Rusty, this is not true, Bill Clinton wouldn't know you from Adam.
ELIZABETH FARNSWORTH: A few months later, Weston was involuntarily committed to Warm Springs State Mental Hospital in Montana for 53 days. His doctors decided he was at low risk for harming himself or others. The Secret Service had reportedly come to the same conclusion. But in recent years, his family said he hasn't taken his medicines regularly and had grown steadily more delusional.
ARBAH JO WESTON: He was always from one thing to the other. He was a member-wanted to join-at one time he was-belonged to the FBI, the CIA, or he wanted to join them. He was a general or something in the Army, people had planted, a dentist had put something in his teeth that he received, that they could send down--they were watching him with a satellites. The TV, when it was on, they could talk to him through the TV, and they would watch him with through the TV.
ELIZABETH FARNSWORTH: Today, doctors at DC General Hospital discussed Weston's current mental state.
DR. NORMA SMALLS: He's aware that he's a prisoner. We are able to speak to him, and-but there is some confusion on his part, and-
REPORTER: Is he aware of the charges?
DR. NORMA SMALLS: I haven't spoken to him in details about that.
REPORTER: Is he aware of the trouble?
DR. NORMA SMALLS: Well, he's awake, and he's talking. And we still do have to give him some medications to calm him down somewhat.
ELIZABETH FARNSWORTH: Weston had his first meeting with a court-appointed attorney at the hospital today.
ELIZABETH FARNSWORTH: And for more we're joined by two psychiatrists with expertise in schizophrenia: Dr. David Pickar, chief of the experimental therapeutics branch of the National Institute of Mental Health; and Dr. Nancy Andreasen, director of the Mental Health Clinical Research center at the University of Iowa and editor at the American Journal of Psychiatry. Dr. Andreasen, Russell Weston was diagnosed as a paranoid schizophrenic. What is paranoid schizophrenia?
DR. NANCY ANDREASEN, University of Iowa: Paranoid schizophrenia is a type of schizophrenia where the person is particularly troubled by delusions. Delusions are fixed false beliefs and are frequently similar to his beliefs that people are trying to harm the person or conspire against them, although most of the time these don't elaborate into, you know, dangerous behavior, as they did in his case.
ELIZABETH FARNSWORTH: So, Dr. Andreasen, the stories we just heard from his family are somewhat familiar to you. This is not an unusual case?
NANCY ANDREASEN: Not really, no.
ELIZABETH FARNSWORTH: What causes the disease?
NANCY ANDREASEN: Schizophrenia-we think those of us who do research on it--as a disease that has multiple hits, much like cancer. You know, when we think of cancer, we think of an insult to the immune system, perhaps due to the exposure to radiation, perhaps suppression of steroids and so on. In the case of schizophrenia it's probably also multiple things-perhaps a genetic predisposition, nutritional factors early in life, viral infections, head injuries, exposure to toxin, exposure to drugs of various kinds, illicit drugs. All these various things can add up to produce a brain injury that then we recognize as schizophrenia.
ELIZABETH FARNSWORTH: So, Dr. Pickar, essentially, it is a disease of the brain.
DR. DAVID PICKAR, National Institute of Mental Health: There's no question. This is a brain disorder. It's a tragic disorder. It's a disorder that begins in late adolescence, early adulthood, and, as Dr. Andreasen says, paranoid schizophrenia has a sort of specific clinical constellation of signs and symptoms. But this is a brain disorder that deteriorates people's ability to tell truth from non-truth in terms of reality and interferes with their ability to function on a day-to-day basis and, unfortunately, as we've seen in this tragedy, sometimes it can involve violent behavior.
ELIZABETH FARNSWORTH: Dr. Pickar, is Weston's story of being committed involuntarily, then being released with medication and then not taking the medication, is that fairly typical?
DR. DAVID PICKAR: Unfortunately, it's quite typical. And the medications we have to treat schizophrenia are pretty good. They're not great, but they're pretty good.
ELIZABETH FARNSWORTH: Excuse me for interrupting but before you go on, just tell us briefly what they are.
DR. DAVID PICKAR: Resparidone, Izitrexia or Lanzopine are two new medications that really made a difference for thousands and thousands of people. Many patients do well on these medications. That is to say, they're less delusional, they may hear voices. They tend to go away, and they function better. But, many, many people stop their medications, and when you stop these medications, and the relapse can be very severe. In terms of danger and assessing dangers in this somebody off medication, it's a whole different bet than when you're seeing somebody who's probably medicated.
ELIZABETH FARNSWORTH: And, Dr. Andreasen, why do so many patients stop taking medication?
DR. NANCY ANDREASEN: Well, as Dr. Pickar said, we have these newer medications that are really very efficacious, but the older medications, which were used for fully 50 years, up until these new medications were developed about three years ago, the older medications had a lot of side effects, and patients often felt very uncomfortable on them. They felt stiff, they felt restless, just very unpleasant, and so sometimes the treatment-at least from the point of view of the patient-was almost as bad as the disease, itself. The old medications and the new medications work really well on these key symptoms of delusions and hearing voices, but the new medications have very few or minimal side effects, and it's really much easier for people to stay on those medications than on the older ones. I don't think we know at this point what medications Mr. Weston had been treated with.
ELIZABETH FARNSWORTH: But is it especially hard to get people to take them, because if you feel somebody's after you, you might think the medication is part of that syndrome.
DR. NANCY ANDREASEN: Sometimes, sometimes, but what usually happens is that with proper care a person is usually in a hospital when he's in that state, you slowly increase the medication, he begins to feel better, the delusions diminish, and those symptoms go away and you have an establishment more of trust, insight about the nature of what he's been through, and so on. And if you can continue to work with the person, at that point and at that point forward, with regular contacts, then usually patients will be compliant or will stay on their medications. In this case we had a loner who apparently got lost to the health care system.
ELIZABETH FARNSWORTH: And Dr. Pickar, is that fairly common? Apparently he was sent back to his home in Illinois and then no longer saw a doctor, no longer took medication.
DR. DAVID PICKAR: Elizabeth, unfortunately, it's very, very common. It is relatively rare for someone to do or to act in a violent way, but it was a very common course of this illness, particularly in our country in terms of the health care system. And once you stop medication, this is a very, very serious illness. You know, Elizabeth, 10 percent of the patients who have schizophrenia die from suicide. They're often dangerous to themselves, as well as to other people. This is a very serious public health problem.
ELIZABETH FARNSWORTH: But, Dr. Pickar, you say it's not that common to have violence against somebody else.
DR. DAVID PICKAR: I think certainly from my perspective it's important not to stigmatize people who suffer from this illness. And, believe me, this is a suffering for the families and for the patient. But there are some individuals who begin to act on their delusions, Elizabeth, very much like we heard in this particular case, to have a false belief, which may feel dangerous to them, and when an individual begins to act on it, threatening a president, for example, were behaving in a variety of ways that may cause attention to potential danger. Then a light bulb should go off. You're dealing with a different set of circumstances. Fortunately, that's the minority of cases. But when it occurs, it's real and it's serious, and it's important.
ELIZABETH FARNSWORTH: And Dr. Andreasen, what are the options in that case for a family?
DR. NANCY ANDREASEN: Well, there is a procedure known as commitment, and the first step of course is to just see a doctor, but if-as David and I know each other-so as David says, if the person has chosen not to take medications, then the first step is to see if he's willing to go back on them under medical supervision. If the person is not willing-and David is exactly right-the situation where somebody is making threatening statements is a genuine emergency and everybody takes that very seriously-and if that sort of thing is happening, then what usually is done is that a commitment is filed, the laws governing that vary from state to state and region to region but the typical grounds for committing a person are that the person is dangerous to himself or to other people.
And when that occurs, usually a lawyer or a group of lawyers from the hearing determined whether the person is dangerous and then declare that the person take medication. And after that, you can have a couple of situations. You can have in-patient treatment for a period of time, or you can have-and it's not uncommon-out-patient commitment where the person is required to be on medications but as an outpatient. And if he does not come in for his regular appointments, then somebody goes out and checks up on him.
ELIZABETH FARNSWORTH: And Dr. Pickar, what about in this case? I don't believe that there were threats against other people from Russell Weston. What are the family's options in that case, where they recognize that he's very, very sick, and he perhaps could be a danger, but he hasn't threatened anybody?
DR. DAVID PICKAR: I certainly know all the details about Mr. Weston, but the point is exactly on target, Elizabeth. What about-what do they do? You know, I believe that many families are waiting for that phone call, are very concerned that something terrible is happening to their child or brother, whatever it happens to be, or, in fact, that person has done something that may cause a problem. Our society is very generous around civil liberties, and well it should be.
And taking away someone's civil liberties, hospitalizing them against their will is something that can't be taken lightly. But the families sometimes have to make those calls, and deal with-it's just what Nancy was talking about in terms of initiating the legal system to restricting civil liberties for a period of time until somebody's well enough to be able to handle it. But it is tough on families, tough on siblings, tough on parents.
ELIZABETH FARNSWORTH: Dr. Andreasen, I've really been struck by this in doing this research. Just about everybody that I've talked to today has some story like this one, although not ending up this tragically. This is really a common problem, isn't it?
DR. NANCY ANDREASEN: It's an extremely common problem. As David was saying, it affects a large number of people. In fact, the prevalence of schizophrenia is 1 percent of the population. That's 2 and a half million Americans at a minimum, and that makes it one of the most important public health problems in our society, important because it produces what we call morbidity or a lot of suffering for patients and for their families.
It produces a huge economic burden on society because most people with schizophrenia are not able to work and to lead productive lives because their symptoms are so severe-and then it's a big burden on the health care system because, you know, these patients are ill; they need to be followed; they need to be treated, so it's very important and unfortunately, it's very misunderstood. Public education about schizophrenia is not adequate; they don't even know what the illness is; and health care providers of various sorts and to stigmatize patients with mental illness, despite the fact that it's now just about universally recognized that it's a brain disease like every-like all other brain diseases, Alzheimer's, Parkinson's Disease, and so on.
ELIZABETH FARNSWORTH: And, Dr. David Pickar, in the very brief time we have left, what's the most other common perception people should get rid of about this disease?
DR. DAVID PICKAR: Split personality. And it's an equal opportunity disease. It afflicts African-Americans, Asian-Americans, and it's found around the world, and roughly that same prevalence, as Nancy said, 1 percent. This is a real thing; it's not gone away; and I think, Elizabeth, it's going to be one of the great brass rings of medical research to really uncover the etiology or etiologies of this disorder.
ELIZABETH FARNSWORTH: Okay. Thank you both very much.
DR. DAVID PICKAR: Thank you.