When does “Not guilty by reason of insanity” apply? — (The Virginian-Pilot)

SSRI Ed note: Woman with new baby is prescribed Zoloft, becomes psychotic, "hormones" get the blame

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The Virginian-Pilot

By Scott Daugherty, The Virginian-Pilot

CHESAPEAKE – Brandi Pryor doesn’t know why she bit off part of her 10-month-old son’s ear.

And the 27-year-old nurse doesn’t remember blaming a devil for the boy’s injuries.

But Dr. Thomas Sugden said there is a reason for that: Postpartum depression made her legally insane.

“In my professional clinical opinion, Ms. Pryor did not understand the nature, character and consequences of her behavior,” said Sugden, a clinical psychologist who interviewed her. “It appears likely that her psychotic illness was triggered by hormones after the birth of her child.”

Based largely on Sugden’s recommendation, Chesapeake Circuit Judge Bruce Kushner found Pryor not guilty by reason of insanity last month of one count of malicious wounding.

It was a rare finding in South Hampton Roads. Statistics were not available, but prosecutors and defense attorneys said few defendants claim they were legally insane at the time of an offense, and even fewer such pleas succeed.

“We certainly don’t see them a lot,” said Virginia Beach Commonwealth’s Attorney Colin Stolle, estimating that he might have three so-called NGRI findings a year.

Attorneys stressed that it takes much more than a history of mental illness for someone to be ruled legally insane. In Virginia, a judge must believe that the defendant was unable to distinguish between right and wrong at the time of the offense or otherwise unable to control his or her impulses. The defendant also cannot be willfully intoxicated at the time of the offense.

“It’s a pretty high bar,” said Suffolk Commonwealth’s Attorney C. Phillips Ferguson.

Stolle noted a case his office handled in 2009 in which a man cut off the head of his 5-year-old son. Joseph Henry Hagerman III thought that the world was ending and that demons were infecting everyone around them, Stolle said. Hagerman believed the only way he could ensure his son’s soul went to heaven was to kill him.

“That’s the level we are talking about,” Stolle said.

The determination usually hangs on the recommendation of a clinical psychologist like Sugden. If a prosecutor or defense attorney disagrees with the initial report, he or she can seek a second opinion. And if the two doctors disagree, the attorneys can take the case to trial and let a judge or jury decide.

“It’s very rare for us to have a battle of experts,” Stolle said.

Annette Miller – an assistant public defender in Virginia Beach who has handled at least 30 cases in which the defendant was deemed legally insane – said many NGRI pleas fail because the defendant was “self-medicating” with drugs or alcohol.  “A lot of them are addicts,” she said.

Attorneys said it’s possible that a person could trick doctors into thinking he or she is insane, but it’s very difficult. The doctors are on the lookout for malingering, they said.

Pryor bit her baby Oct. 4, 2013, outside Sentara Village, a 103-bed assisted living facility at 778 Oak Grove Road.

Her mental problems, however, started much earlier. She told Sugden she did not feel right after the birth of her child. She said she went to her primary care physician, who prescribed her the antidepressant Zoloft.

Pryor described her symptoms as “hearing screaming.” When she asked who it was, the voice in her head responded “Satan,” documents said.

Stolle said Pryor’s case was emblematic of many involving NGRI defenses. He noted that she had sought medical help before attacking her son.

“Usually, there is a well-documented history of mental problems,” he said.

Pryor’s mental state was especially bad the day of the incident. She told Sugden she woke up at her parent’s place that morning with a sudden need to leave the house. She took her son outside, got in her car and drove away. She said she heard gunshots while driving on the highway.

Pryor eventually found her way to Sentara Village, where one of her patients from All Heart Home Health and Hospice lived. She took the man – whom Pryor referred to that day as her grandfather – outside in a wheelchair in an inexplicable attempt to protect him.

“I don’t know why I was thinking they were trying to hurt him,” Pryor told Sugden.

Sentara Village staff came out and took the man back inside. Then Pryor got into her car and locked the doors.

Police arrived, along with a couple of Pryor’s co-workers and her father and sister.

No one could talk Pryor into unlocking the car, though. She believed that her son was Jesus and that the police would take him from her.

Officer Nathaniel Lake eventually broke one of the car’s rear windows with a baton. He said Pryor was holding the boy so tight she risked suffocating him.

Before Lake could get inside the vehicle, Pryor leaned down and bit the boy’s ear.

“That devil bit my child,” Pryor yelled while police were taking her into custody, according to a statement of facts.

Chesapeake Commonwealth’s Attorney Nancy Parr said doctors couldn’t reattach the missing earlobe.

Pryor told Sugden she doesn’t remember saying anything about a devil.

“I don’t know why I bit my son’s ear. I love that boy to death,” she said, claiming it was an accident.

Sugden said Pryor appears to have been suffering from either postpartum depression with psychotic features or possibly the more severe postpartum psychosis.

Dr. James Paulson, an associate professor of psychology at Old Dominion University, said postpartum depression affects about 13 percent of women who have children and is “actually pretty common.” He said it manifests itself like most other forms of depression, with the person feeling detached and unable to experience joy.

Postpartum psychosis is much more rare and serious. Paulson said the mother can hear voices, suffer delusions or experience other symptoms of psychosis, most of which involve the child.

“Whenever we see postpartum psychosis, it is always a medical emergency,” Paulson said. “The child is in danger.”

Andrew K. James, Pryor’s defense attorney, did not return two calls seeking comment.

Last month, Judge Kushner ordered Pryor placed in the custody of the Department of Mental Health, Mental Retardation and Substance Abuse Services for further evaluation. A follow-up hearing is set for Dec. 2.

Miller, the public defender, said it isn’t always a good thing for a defendant to enter a plea of not guilty by reason of insanity. She said she’s had several cases over the years in which mentally ill clients ended up spending more time in state hospitals than they would have spent in state prisons if convicted.

Before a defendant can be released, Miller noted, the doctors, judge, prosecutor and defense attorney usually have to reach a consensus.

“People think that you get found NGRI and you get off,” she said. “That’s not the case.”

Doctors will interview Pryor over the next couple of months and develop a treatment plan. After that, she could spend months or even years in a state hospital receiving help.

“There is no way to estimate how long Ms. Pryor will be a patient,” Parr said.

Scott Daugherty, 757-222-5221 scott.daugherty@pilotonline.com