1. I am a physician licensed to practice in California, with a specialty in clinical and forensic psychiatry. I am a licensed physician specializing in psychiatry and europsychiatry. I am in private practice focusing on forensic consultations. My business address is P.O. Box 11708, Berkeley, California, 94712-2708.
2.I am a member of the American Psychiatric Association, the California Medical Association, the Northern California Psychiatric Association, and the Board of Medical Examiners for the Superior Court of San Francisco, California. I am also a member of the American Academy of Psychiatry and the Law, the International Academy of Law and Mental Health, as well as a member of the American College of Forensic Psychiatrists.
3.I received my bachelor’s degree from Westminster College in Salt Lake City,Utah, in 1969. I received my medical degree at the University of Utah in 1977. I completed my residency at the Pacific Medical Center in San Francisco, California, in 1981, and participated in a National Institute of Mental Health/American Psychiatric Association Fellowship in 1982. I received my board certification in psychiatry and neurology in 1992. I became a diplomate in the American College of Forensic Examiners in 1998. I was the Clinical Director of the New Beginnings Program at Doctors Hospital in Pinole, California, from 1989 to 1994 and Senior Consulting Addictionologist to the New Beginnings Programs at Doctors Hospital, Pinole, California, and San Ramon Regional Medical Center, San Ramon, California, from 1994 to 1996.
4.I am currently Affiliate Professor at the University of Washington, Bothell Campus. I was Adjunct Professor at the University of California, Davis, Medical School, Department of Psychiatry, in the postgraduate Forensic Psychiatry Fellowship. In that position I taught courses on criminal responsibility and the trial process. I have lectured both nationally and internationally on issues of criminal responsibility and competency. I am also in private practice in Oakland, California. I have been a forensic consultant in civil, capital, and appellate proceedings since 1984. I have been qualified and testified as an expert in a number of civil and criminal cases.
Referral Questions
5.Counsel for Damien Echols requested my assistance in the following capacities:
a. Conduct a comprehensive mental health examination of Mr. Echols to determine whether Mr. Echols suffered from a mental disease and, if so, whether that disease affected his competency to stand trial during 1993 - 1994;
b. Identify environmental, genetic, and neuropsychiatric factors that may have adversely affected Mr. Echols’ early childhood and adolescent development;
c. Determine the appropriateness and standard of care of medical and Psychiatric treatment received by Mr. Echols at the Monroe County Jail;
d. Determine whether or not Mr. Echols was able to provide knowing and rational consent to treatment provided by the Monroe County Jail;
and
e. Determine the effects of treatment administered by the Monroe County Jail on Mr. Echols mental status, including whether the type and amount of medication Mr. Echols received was appropriate.
Information Relied Upon
6. My medical opinions are based on the following information:
a. Clinical interviews of Mr. Echols I conducted in December, 2000;
b. Social Security Administration documentation of Mr. Echols’ mental disability;
c. Transcripts of Mr. Echols’ trial;
d. Collateral reports of lay witnesses who observed Mr. Echols’ behavior throughout his trial;
e. Medical records of Mr. Echols’ three psychiatric hospitalizations in the year preceding his arrest;
f. Mr. Echols’ writings and correspondence;
g. Mr. Echols’ Arkansas Child Protective Services records;
h. Mr. Echols’ 1992-1994 East Arkansas Regional Mental Health Center Records;
i. Monroe County jail records of Mr. Echols’ suicide attempt;
j. Mr. Echols’ prescription medication records;
k. Results of psychological and neuropsychological tests administered to Mr. Echols; and
l. Other life history documents, including educational and medical records.
7. The data I reviewed, though by no means inclusive, are clinically significant and are required in order to provide valid and reliable medical and psychiatric opinions.
Findings
8. My findings include the following:
a. Mr. Echols has a serious mental illness characterized by grandiose and persecutory delusions, auditory and visual hallucinations, disordered thought processes, substantial lack of insight, and chronic, incapacitating mood swings;
b. Mr. Echols’ mental illness was established before the offense and subsequent legal proceedings. The Social Security Administration determined that Mr. Echols was 100% disabled due to mental impairment and granted him full disability benefits;
c.Mr. Echols’ mental illness made him incompetent to stand trial. The stress, complexity, and adversarial nature of the trial compounded the effects of his mental illness. He was not able to understand rationally and respond appropriately to the many demands of the prolonged legal proceedings. He could not adequately appreciate or consistently articulate the nature and gravity of the charges against him. He did not understand the role of his counsel and could not assist his counsel or investigators in identifying critical evidence or a viable theory of defense. His grandiose and paranoid delusions left him unable to make rational decisions and grossly distorted his perception of the purpose and possible outcomes of the trial.
d. Mr. Echols’ mental status worsened with time. He developed a psychotic euphoria that caused him to believe he would evolve into a superior entity, would be assisted by similar deities, and eventually would be transported to a different world. His psychosis dominated his perceptions of all aspects of the court proceedings. He developed delusions of reference in which he believed every event or movement, regardless how insignificant, was a potential “sign” that the deities were attempting to show him the pathway to the other world where he would join other entities like himself. As a result Mr. Echols was extremely hyper vigilant and anxious but at the same time completely unable to attend to the critical aspects of his death penalty trial.
e. Mr. Echols had no control over his mental illness, nor did he possess the skills or insight to militate his psychosis or delusions prior to or during his trial. His mental illness, combined with his immaturity and the enormous stress of his charges, incarceration and trial substantially impaired his perception of reality. Lack of insight, low tolerance for stress and immaturity are strong characteristic features of chronic mental illness.
Mental Status Examination
9.Mr. Echols presented as a neatly groomed, adequately nourished, healthy man of his stated age. He was oriented to person, place, date, and context of interview. After his confinement on death row at the age of 19 he converted to Buddhism. His appearance was consistent with the traditions of some Buddhist sects. His head was shaved and he wore a necklace made of wooden beads. Mr. Echols was soft spoken, polite and cooperative throughout the interview. He consistently appeared to be sincere and to put forth his best effort in all domains of the evaluation. His responses reflected average intelligence. His ability to assimilate new information and his short term memory were within normal limits, however there are significant gaps in his long term memory.
10.Mr. Echols’ showed signs of a mood disorder. His affect was generally flat and constricted, although he became animated and more expressive on several occasions. In some instances his affect did not match his thought content or the content of the interview, but on the whole these domains were consistent. Mr. Echols denied persistent hallucinations but did acknowledge hearing intermittent “noises or voices.” Mr. Echols’ insight, judgment and thought content appeared to be adequate, although his responses suggested both his insight and judgment continue to be compromised by his mood disorder. He denied fixed delusions and homicidal or suicidal thoughts.
11.During the second day of interviewing, Mr. Echols had difficulty concentrating, which is consistent with dissociation; he lost his train of thought and there was marked delay in his responses. When asked what he was experiencing, he said certain questions caused him to relive the experiences being discussed.
12.Mr. Echols’ accounts of his social and medical history were consistent with documentation and collateral interviews. There is a long standing history of an extremely chaotic and impoverished childhood that thwarted the trajectory of his development and left Mr. Echols with very low self esteem and poor coping skills. He lacked adequate nurturing, guidance, and supervision. He was exposed to chronic psychological maltreatment and was unable to retreat from or interpret his experiences. He developed symptoms of extreme anxiety at a very young age and had virtually no compensatory influences to counteract the damage to his social and emotional development. He was isolated from peers and caring adults who could help him find internal and external resources to restore.
13. Mr. Echols’ accounts of his symptoms since childhood are consistent with severe traumatic stress disorders and mood disorders. He reported periods of dissociation in which he “lost” long spans of time. He also endorsed numerous physical problems, including frequent severe headaches (for which he was treated with prescription medications as a child), heart palpitations, difficulty breathing (he was diagnosed with and treated for asthma), and chronic sleeping problems. He reported having nightmares from which he awakened in a terrified state as often as twice a night. These symptoms persisted throughout his childhood and adolescence and grew to include periods of psychosis.
14. Mr. Echols’ became so debilitated by his escalating mental illness that he was hospitalized three times during the year prior to his arrest for the current offense. His diagnoses included mood disorder, psychosis not otherwise specified, and severe depression. He was evaluated by the Social Security Administration and given full disability benefits on the basis of his mental illness.
15. Mr. Echols vividly described a course of mood-incongruent psychotic features that reached their apex during the stress of his trial and pressure of constant media attention, and did not abate until after his confinement on death row.
16. Although he has received no psychiatric treatment on death row Mr. Echols stated his mental illness has improved significantly since his incarceration. He attributes this improvement to his structured environment, the enduring support of his wife, who is a touchstone to reality and is unflaggingly devoted to his best interest, and his devout study of Buddhism.
Hallucinations
17. Prior to and during his trial, Mr. Echols heard “voices that were not really voices” and he “was not sure if it was a voice inside” his head or “somebody else’s voice.” He thought it “was nearly impossible” to tell if it was his voice or somebody/something else. He experienced visual hallucinations that “were personifications of others. They were like smoke, changing shape but present and constant.” The personifications had specific names and activities. One was “Morpheus Sandman” who was a hybrid of a human being and a god. Another example was “Washington crossing the Delaware.” Mr. Echols saw Washington cross the Delaware with “Hermes on the boat.” Hermes was able to cross with Washington because “Hermes was moving backwards through time.” Mr. Echols came to believe that he was the same as these personifications, “made of the same material and from the same place.”
Delusions
18. Mr. Echols stated that at some point in his adolescence he came to believe he was “something that was almost a supreme being that came from a place other people didn’t come from.” This transformation caused him to change physically, the pertinent changes appearing in his “appendages, hands, feet, hair.” He acquired “an entirely different bone structure that was not human.” He developed “stronger senses.” His eyesight was better and his “ability to smell and taste changed.” He had a different stance, moved his eyes and held his head differently. He grew his nails so that they would be a “perfect 1 ½ inches long.” When he looked at his hands, he could see his bones. His weight dropped to 116 pounds, consistent with neurovegetative signs seen in mood disorders. This period of physical change began the year before his arrest and lasted for about two years after he was on death row.
Family History
19. Despite its many problems and limitations, Mr. Echols’ family has remained supportive and concerned for his well being. They visited him in jail prior to his trial, attended the trial, and have maintained contact with him since his confinement on death row. They work and live in eastern Arkansas in the community where Mr. Echols spent the majority of his childhood.
20. The Echols family appears to have done the best it could in the face of enormous adversity. There is evidence of generational poverty, mental illness, low education and employability, limited problem solving skills, medical problems, and social alienation.
21. Mr. Echols’ mother, Pamela, was adopted under mysterious circumstances and reared as the only child of her adoptive mother, who was trained as a practical nurse, and her adoptive father, who was an illiterate blue collar worker. When Mr. Echols’ mother began junior high school, she developed bizarre behavior that intensified as she grew older. She stopped attending high school because, in her words, it made her “crazy.” She was unable to cope with the stress of school, stopped leaving her home entirely, and received psychiatric treatment. Her adoptive mother was forced to quit work in order to stay home and care for her. Mr. Echols’ mother, Pamela, married Mr. Echols’ father, Joe Hutchison, when she was only 15.
22. Mr. Echols’ mother became pregnant with Mr. Echols during the first year of her marriage. Due to her age and mental condition the pregnancy was high risk and marked by numerous complications. According to her, the pregnancy “almost killed me.” She remained so nauseated and ill that she lost 50 pounds over the course of nine months. Her diet was very poor;she was not well nourished. Her long, high risk labor necessitated a caesarean section from which she recuperated slowly.
23. Not surprisingly, Mr. Echols had many problems as an infant and young child. He was “fretful and nervous and cried all of the time.” His mother could not soothe him, and he slept fitfully for only three or four hours a night. At a very young age he began to demonstrate
troubling behaviors. He repetitively banged his head against the wall and floor until he was three. He was “withdrawn as a small child” and delayed in meeting his developmental milestones. He “did not walk until approximately 13 months of age” and “his speech development was slowed.”
24. Following Mr. Echols’ birth his mother suffered a miscarriage and soon after became pregnant with his younger sister. This, his mother’s third pregnancy, was also complicated. Mr. Echols’ mother was not able to care for her two small children, so she sent Mr.Echols to live with his maternal grandmother. Although Mr. Echols returned to live with hismother and father, his mother was very dependent on her mother for assistance in caring for Mr. Echols and, later, his sister. Pamela Echols was never able to live on her own or care for her children without a great deal of support. She remained dependent on others for guidance and assistance with child rearing.
Childhood
25. Like Mr. Echols’ mother, his father, Joe Hutchison, also appears to have suffered from mental instability. Joe Hutchison is uniformly described as immature, self absorbed, cruel and capricious. He chronically neglected and abused his family. He berated his wife and son, set unrealistic expectations, called them degrading names, destroyed their most cherished possessions, terrorized them by threatening to break their bones and hurt them in other ways, and isolated them from community and family support by moving frequently -- sometimes impulsively leaving a residence only days or weeks after moving in. On one occasion, he forced his wife to leave her hospital bed to move with him to another city. He found sadistic pleasure in donning horrifying rubber masks of hideous monsters and appearing at his son’s bedroom window where he terrified Mr. Echols by making gruesome noises. In addition, Mr. Hutchison kept his family anxious with his fixation on the notion that others were trying to hurt him. For example, he was convinced “people were trying to run him down” and constantly harangued his wife and son about the individuals who were trying to kill him.
26. The constant anticipation of psychological and physical violence left Mr. Echols and his mother chronically aroused and upset. There was no respite from the oppressive environment and neither mother nor child was equipped to deal with Joe Hutchison’s increasingly disturbed behavior. Fearing for her life and those of her children Pamela Echols finally found the courage to divorce Joe Hutchison in 1986. By that time most of the damage was done.
27. Mr. Echols first recalls being overwhelmed by distressing and terrifying emotions in the second grade when he was positive there was going to be a nuclear war. He believed he “had to get back to where something told him he came from before the war started.” As he grew older this obsession evolved into a driving force that consumed him and “took up every bit of brain space and brain power.” He became convinced that he was “an alien, from another world, not like any human on earth.”
Adolescence
28. In adolescence Mr. Echols became frankly suicidal. Unable to find a way out of his depression and hopelessness, he thought the only escape from his constant mental, physical and emotional pain was to kill himself. Still, he persevered as best he could until, at about the age of 16, his mental illness took a sudden turn for the worst. Mr. Echols describes feeling disorganized and out of control of his racing thoughts and emotions. He began to “laugh hysterically and make other people think I was crazy.” For Mr. Echols “manic-ness” meant “everything sped up and became frantic. Others called it hysterical,” but Mr. Echols described it as “...being driven.” When he “...went crazy, everything sped up.” He “...had no thought process.” He could not remember “...all of the weird things I did,” but people would tell him about them later and he was surprised by his actions. For example, he recalled a time when “some kids threw a hamburger up on the ceiling” and he reached up, grabbed it, and ate it.
29. His mania was interspersed with periods of “waiting” interminably for “an abstract thing that might come in the blink of an eye.” He was mentally confused and “did not know what he was waiting for.” Mr. Echols “tried cutting” himself to “feel different somehow” and “to see if it would let some of the pain out.” He felt “worn-out.” During the one year of high school he attended in the ninth grade, he kept a journal at the instruction of his English teacher. It became more and more abstract -- when I wrote about one thing it came out as something else. If I wrote about the moon, I was actually describing the grocery store.
30. Mr. Echols reported that the intense shift between depression and mania “literally drove me crazy.” He remembered that “everything hurt, from the smell of water to green grass, brown grass.” He was exquisitely sensitive to “the way people smelled” and “the smell of water.” He described manic episodes when his “brain rolled, like a TV that is not adjusted.” He believed his brain rolled when it rained or when he was near a large body of water. The change of seasons had a strong effect on him also, especially fall and winter, and made “his brain roll constantly.”
31. Mr. Echols’ overwhelming depression and other problems with mood during childhood and adolescence caused disabling disturbances in his emotions, thoughts, behavior and physical health. His sleep was irregular; he often had no energy to perform the simplest tasks; his thoughts were paralyzingly sluggish or racing at speeds he could not control. He felt caught in time, and thought it was hopeless even to think about feeling better or gaining control over his life. He ruminated about painful memories and insignificant events. He could not concentrate and became easily confused; it was impossible to make even simple decisions. He cried and “sobbed all the time without any understanding of what made...” him so sad. He had no ability to feel joy or pleasure. He became completely inconsolable and isolated, unable to relate to others in any meaningful way. He was inexplicably sensitive to physical sensations and reacted to the slightest changes in his environment. His body “hurt when the sun went up or when the sun went down, when it rained or when it did not rain.” He could not stop or escape from the pain; it became “a throb that never went away.” He despised himself and felt worthless; he was consumed with shame and despair.
32. Mr. Echols’ mental deterioration spiraled against the backdrop of his unpredictable and troubled home life. His mother’s confusion and dependence continued. Within days of divorcing Joe Hutchison she married Andy Jack Echols, an illiterate laborer who worked intermittently as a roofer. The family was extremely poor. They found a shack set in the middle of crop fields that were doused with pesticides at regular intervals. The crude dwelling -- which had not been used as a residential structure in years -- had no plumbing or running water. There was little insulation, poor ventilation and virtually no privacy. The abject conditions intensified the financial and emotional burdens of the struggling family, but the rent was only $35.00 per month so they stayed. Despite the extremely unhealthy conditions, the Echols remained in the shack for five years. During this time Mr. Echols received no mental health treatment or other interventions that would improve his increasing mental disorders.
33. Going from Joe Hutchison to Andy Echols was like going from the frying pan into the fire. In addition to increased isolation and poverty and being exposed to toxic pesticides, the Department of Human Services (DHS) records show that Andy Echols sexually abused Mr. Echols’ younger sister repeatedly until she mustered the courage to report him to her school counselor. DHS intervened and Pamela moved her children out of the shack. Yet, that was as much as Pamela Hutchison Echols was able to do to protect her children from the ravages of poverty, domestic violence, mental illness and sexual abuse. For, no sooner had she separated from Andy Echols than she, Damien and his sister moved in with Joe Hutchison, along with Joe Hutchison’s own mentally impaired son. The return of Joe Hutchison, whom Mr. Echols had not seen for years, coincided with Mr. Echols’ first psychiatric hospitalization.
34. Mr. Echols’s mental illness did not improve after his hospitalization. He remained in excruciating emotional pain, betrayed by his mind and body. The world was an unsafe, unpredictable maze from which he desperately looked for an escape. He finally found relief in his own form of medication. He instinctively turned to inhalants and began “huffing” gasoline; he thought he “invented it.” Later he tried marijuana a few times before his arrest, but it did not become a habit. He also used the medication prescribed for his migraine headaches -- Midrin -- as a means of tolerating stress and fear of attending school. Mr. Echols’ primitive efforts to cope in an internal and external climate of terror ultimately failed. Unable to outrun his terror, he withdrew from school in the ninth grade and tried to insulate himself from the external pressures that contributed to his mental illness.
35. Despite his often bizarre and disorganized behavior, Mr. Echols has no history of childhood violence or aggression. To the contrary, he was ostracized by other children and made the butt of jokes. His pronounced apathy and passivity made him a routine target for cruel jokes. He never resisted these humiliating gestures. On one occasion several children told him to suck a rock; he responded without question. Another time he was told to walk down a school hallway without shoes; he did so. He was considered odd, different, separate from his cohort. Instead of gaining a sense of efficacy and esteem through interaction with his peers, Mr. Echols’ social experiences reinforced his sense of being damaged and useless. The lack of connection with caring peers and adults who could see and intervene in his many problems likely contributed to his mounting mental illness.
36. The only law enforcement record concerning Mr. Echols involves minor incidents with his girlfriend’s parents. By the age of sixteen Mr. Echols’ depression and hopelessness was written all over his body. He wore black clothes, hair and nails. His strange, often flat affect kept him out of step with mainstream life in a small Arkansas town. Yet he found one person, a young girl with problems of her own, whom he felt could understand him. They developed a relationship and became inseparable. Her parents strongly opposed their dating and tried to keep them apart. Desperate to stay together they planned to go to California. Mr. Echols’ mother, overtaxed with her own problems, did not intervene to keep the troubled teenagers near their parents. Instead, she gave them no more than $10.00 to $15.00 - the only money she had - as a contribution toward expenses. No one - not Mr. Echols, his girlfriend or Mr. Echols’ mother - could foresee the dangers of two teenagers traveling halfway across the country with no money and no where to live in California. The ill-fated plan lasted less than 24-hours. The couple went to an abandoned trailer where they planned to spend the night and leave for California the next day. Not long after they arrived, the police arrived and they were arrested. Mr. Echols was taken to a juvenile facility where he attempted to hang himself. Following their arrests and initial evaluations both youths were placed in psychiatric hospitals. Psychiatric Treatment East Arkansas Regional Mental Health Center, May, 1992
37. The Arkansas Department of Human Services (DHS) referred Mr. Echols for diagnosis and evaluation May 5, 1992, when Mr. Echols was 17 years old, following substantiated reports his step father was sexually assaulting his sister. After determining Mr. Echols was a seriously mentally ill teenager, DHS sent him to East Arkansas Regional Mental Health Center, where he was treated until his arrest for the current offense in June, 1993.
38. Personnel at East Arkansas Regional Mental Health Center described Mr. Echols as very disturbed. He was withdrawn, spoke little, and rarely had eye contact with anyone: “he stared at the wall or cast his eyes downward.” He appeared “confused,” and dressed strangely -- “all in black.” He was preoccupied with his fingernails, which he “filed to points.” Concerned about the nature and complexity of his problems Mental Health Center staff recommended that Mr. Echols immediately be involuntarily committed to Charter Hospital in Little Rock for more extensive evaluation and treatment. He was transferred on June 1, 1992, where he remained until June 28, 1992, when his parents removed him from the hospital.
Charter Hospital, June 1 - 25, 1992
39. Mr. Echols was provisionally diagnosed with Major Depressive Disorder, single episode and medicated with Imipramine, an anti depressant drug. Admission notes recorded that Mr. Echols was “a very confused child” who felt as if there was “no one he can trust.” The staff psychiatrist who conducted a mental status exam upon admission described the 17-year old as “cooperative and polite” with “an odd stare,” and flat affect. The psychiatrist also noted Mr. Echols was “quiet, hesitant when answering some questions [and] appeared as though some of the questions were somewhat difficult or bothered him to answer.” Additionally, Mr. Echols demonstrated “lack of concentration,” “poor judgment,” and “absolutely no insight into his illness...or ability to effectively problem solve.” The psychiatrist had “major concerns that this young man was exhibiting disturbed, bizarre and unusual thinking.”
40. Mr. Echols’ delusional thinking was evident throughout his hospitalization. He explained that he had “no feelings about suicide” because he thought he could “be reincarnated.” He indicated to others he thought he possessed special powers. A social worker reported Mr. Echols “appeared to be sniffing the air around him as if he were responding to an external stimulus.” He smiled inappropriately and “cut his eyes in one direction or the other, as if he were hearing or thinking of something before he spoke.” The social worker concluded he was “responding to an outside stimulation” and “may have been experiencing auditory hallucinations.” Visual hallucinations also may have been present. Mr. Echols said he thought the furniture in the psychiatric unit “was causing blurred vision.”
41. Mr. Echols exhibited “a bizarre and unusual manner” of adjustment to the psychiatric unit that was also reflected in his “bizarre and unusual thinking pattern.” He was “preoccupied with witchcraft” but consistently denied any involvement with satanic worship. He was observed “meditating in his room in a bizarre and unusual fashion,” “wrote some very unusual poems,” and remained on “the peripheral of the group throughout” his hospitalization. He made unusual and bizarre sounds “with his mouth that sound[ed] like a cat purr.” He had “trouble making eye contact” and was “quite paranoid.” He told staff there were “survelance [sic] cameras behind his mirror and under his desk” and cautioned other adolescent patients that staff were “constantly watching them.” Staff observed him sitting and “rocking methodically back and forth,” daydreaming, and staring into space. When interrupted, he appeared startled. He wanted to “calm down” and said he “was feeling ‘jittery’ internally.” Hospital staff noted he showed “no aggressive behavior” in the hospital.
42. Mr. Echols’ behavior demonstrated “a pervasively depressed mood throughout most of his hospitalization.” He withdrew from family and friends, had a “sad facial expression” and “spent long intervals alone.” He lost interest in eating, had difficulty going to sleep, and planned ways to commit suicide. He repeatedly thought “about wrapping the sheet from his bed around his neck and ‘trying to hang’” himself.
43. Mr. Echols’ psychiatric care was interrupted by his parents who removed him from the hospital June 25, 1992, and moved to Oregon. His discharge diagnosis was major depression, single episode, dysthymia and rule out psychotic disorder not otherwise specified. He was instructed to continue taking 150 mg. of Imipramine daily.
St. Vincent Hospital, Oregon, September 2 - 4, 1992
44. Mr. Echols’ mental illness worsened after his release from Charter Hospital. Within two weeks of moving to Oregon with his family he was voluntarily admitted to St. Vincent Hospital in Portland after his parents observed extremely bizarre behavior that was unresponsive to outside influence. Mr. Echols and his family have different memories of the events surrounding Mr. Echols’ admission to St. Vincent’s Hospital. Mr. Echols recalled being very depressed and unable to stop crying “for quite some time.” He was disoriented from the move and homesick for Arkansas. He had no recollection of threatening to harm himself or others. His father, however, informed staff that Mr. Echols had “been sniffing gasoline and that at [the] dinner table” he had talked about “drinking a bottle of bleach.”
45. As had staff members at Charter Hospital, those at St. Vincent consistently described Mr. Echols as quiet, compliant and noncombative. The admitting diagnoses were psychotic disorder, not otherwise specified, dysthymia, depression, and suicidal ideation. However, within 48 hours these diagnoses were changed to adjustment disorder of adolescence with disturbance of conduct, whereupon Mr. Echols was discharged to his parents with instructions to continue taking daily doses of 150 mg. of Imipramine. Despite two psychiatric hospitalizations within six weeks, Mr. Echols’ parents allowed the disturbed 17-year-old to return to Arkansas. The family met him at the hospital upon his discharge and gave him cash for a taxi to take directly to the bus station. He traveled alone by bus to West Memphis.
Charter Hospital, Little Rock, September 14 - 28, 1992
46. Mr. Echols was completely incapable of caring for himself when he returned to Arkansas. He had no money and his mental illness and lack of skills and experience prevented him from working. He lived on the streets and even stayed at the home of his abusive step-father, Andy Echols, a few nights. Within days he was identified by his probation officer who believed that Mr. Echols should be treated in a long-term residential psychiatric facility. The probation officer had Mr. Echols detained in the juvenile facility for violating his parole by returning to Arkansas. Staff and residents at the facility describe Mr. Echols as losing touch with reality. His behavior deteriorated drastically. One resident reported he observed Mr. Echols “. . .sucking the blood off the scratch that. . .” another inmate “. . .had on his arm.” Mr. Echols was placed in isolation and on suicide watch. The juvenile facility quickly obtained a court order and sent Mr. Echols to Charter Hospital for the purpose of “determining the appropriate method of referral to a residential treatment facility.” Mr. Echols was readmitted to Charter Hospital in Little Rock, Arkansas, on September 14, 1992, where he remained until his discharge on September 22, 1992.
47. The provisional diagnoses at Charter Hospital were psychotic disorder, not otherwise specified, and dysthymia. Staff members immediately noticed Mr. Echols’ bizarre behavior, including his “growling” and making other strange sounds. A social worker described Mr. Echols’ behavior as “odd” and reported that he “smiled at inappropriate times,” “cut his eyes back and forth,” and “seemed to be giggling at something that he was saying.”
48. Mr. Echols also had noticeable problems with attention and concentration. He “stared off into space” and daydreamed in class and group activities. When staff members attempted to bring him back to the task at hand he “would then act like he was very startled, as if ‘jolted’ back into the group process.”
49. Other serious problems noted by staff members include “[a]lteration in thought processes evidenced by delusional thinking and inappropriate social behavior.” His appearance was “disheveled” and “unkempt,” and he had consistently “poor” eye contact. He dressed “in entirely black clothing, frequently [wrote] poems and [drew] pictures of symbols” which one staff member erroneously interpreted as “closely associated with devil worship.” Mr. Echols stated that he was “a witch” not a vampire or devil worshiper.
50. Mr. Echols’ mood disturbances continued unabated. His affect “was extremely flat,” he showed “absolutely no observable evidence of emotion” and he appeared anxious and uncomfortable. Charter Hospital records reflect that Mr. Echols had almost no insight into the nature or severity of his problems.
51. Like all other staff who observed Mr. Echols over time, he was described by Charter mental health staff as “calm,” “compliant and cooperative.” A psychiatrist noted that even though Mr. Echols had “difficulty with reality testing” he related in “a very quiet and withdrawn fashion” and “was actually quite pleasant.”
52. Mr. Echols was discharged from Charter Hospital on September 28,1992, with diagnoses of psychotic disorder not otherwise specified, and dysthymia. He was released to the care of his step father, Andy Echols, who lived in West Memphis, Arkansas. Mr. Echols was instructed to continue taking his daily dose of 150 mg. of Imipramine and report to the local mental health center for follow-up care. Return to East Arkansas Mental Health Center, January 1993
53. There is an abundance of evidence to show that Mr. Echols’ serious mental illness required long term hospitalization and more aggressive treatment than he received in prior hospitalizations. In January of 1993 Mr. Echols again sought help at East Arkansas Mental Health Center where mental health professionals described Mr. Echols’ elaborate history of delusions, psychosis, and severe problems with mood and memory. His delusions often were grandiose. He told staff he was “going to influence the world.” He also reported he obtained power by “drinking blood.” His mood oscillated between euphoria and severe depression. Most of the time his affect was flat and his face “expressionless.” Other times he reported he could “do anything.” During his worst periods Mr. Echols became psychotic. He felt a “spirit [was] living within him” that was “put inside him last year.” The spirit “decided to become part of him” and was the spirit of a woman who was killed by her husband. Despite his pronounced history of multiple forms of trauma, there is only one reference in the records about how traumatic experiences affected Mr. Echols. The symptoms associated with trauma are described as substantial periods of impaired memory consistent with “a dissociative response to trauma.” Though profoundly mental ill, Mr. Echols has always responded well to the structure of a therapeutic setting. He has never been a management problem and staff members uniformly describe him as passive, compliant and likeable.
Social Security Administration, January 1993 - August 1994
54. Though he was only 18 years old, mental health professionals at East Arkansas Regional Mental Health Center concurred that Mr. Echols’ severe and enduring mental illness made him unable to function without substantial assistance from mental health and other agencies. Staff members assisted Mr. Echols in applying for Social Security Disability Benefits through the Social Security Administration (SSA). After conducting an independent evaluation, the SSA determined that Mr. Echols was 100% disabled and was awarded full disability benefits on the basis of his mental illness. The finding by the Social Security Administration of a mental disability is a significant factor that any competent mental health professional would consider in an objective determination of Mr. Echols’ mental state. At the time of arrest and trial, Mr. Echols was still considered severely mentally impaired by the SSA and was receiving full SSA disability benefits.
Arrest and Trial
55. Mr. Echols’ abject mental illness, which began in late childhood and early adolescence, is abundantly documented in mental health and state agency records, evaluations and collateral accounts that well precede the offense. The many diagnoses and unsuccessful treatment efforts indicate a virulent disease that required long term intervention, and careful follow-up care, which Mr. Echols did not receive. As a result, Mr. Echols remained mentally ill at the time of his arrest in June of 1993 and throughout the time he was awaiting trial. His perception, judgment and behavior were grossly distorted by paranoid and grandiose delusions, delusions of reference, and hallucinations. He believed his arrest was an omen that supernatural entities would soon arrive to transport him to another world where he could live among beings like himself, who could understand and accept him. Far from being able to appreciate the grave charges against him, Mr. Echols believed his arrest signified his imminent metamorphosis and ultimate liberation. He described visual and auditory hallucinations: the beings “communicated” with him -- often through the words and actions of others -- and revealed themselves to him through a series of elaborate scenes that included a host of eerie and dour characters. Mr. Echols’ thought disorder prevented him from making sense of and meaningfully participating in the complex tasks involved in preparing his murder trial: he had no understanding of the complex and painstaking process involved in identifying and developing a viable theory of defense or defeating the prosecution’s case. He was not able to assist his attorneys in developing a comprehensive investigative plan, and could not assess strategies of jury selection, opening statements, direct and cross examination, and closing arguments. His problems with memory and concentration, and his preoccupation with being transported to another world, prevented him from providing critical life history information that was essential for the penalty phase of his trial. Rather than assisting in his defense, Mr. Echols spent his time touching each brick in his cell to find the “secret passage” to the other world.
56. It is undisputed that unmanageable stress exacerbates psychosis. Mr. Echols’ behavior during trial is completely consistent with the course of psychosis in the presence of constant stress. Cameras in the courtroom, reporters, the constant flurry of activity, lack of predictability and general hostility directed toward him all contributed to Mr. Echols’ tenuous contact with reality. He was confused and hyper vigilant. He saw every stimulus as a potential vehicle to the other world. For example, he believed the courtroom itself, and any person - regardless how superfluous their role in the legal process - or event as a possible sign of his impending journey to the “other world.” He was inundated with overwhelming sights, sounds, smells and behaviors, but lacked any ability to discern accurately the meaning of the events around him. As the trial wore on and pressure mounted Mr. Echols became increasingly despondent that he had not been transported to the world his “entities” had promised him. He blamed himself and desperately increased his efforts to find the key that would allow him to be with those like himself. His magical obsession with finding a passage to the other world kept him constantly aroused and alert, but with a distorted and myopic view of the activities around him.
57. As Mr. Echols’ anxiety and delusions increased, he became less and less able to attend to or accurately understand the legal process that held his life in the balance. He reported that his mind was “always in that place - the place that was the gateway.” His delusions were most pervasive and virulent when he testified; he believed his testimony was the portal to the other world. He reported, “It was worse on the stand; I thought this must be the summit, the culmination. Somehow this was the moment when whatever it is happens.” His attention was consumed by the notion of his transition; he searched in vain for a divine sign, that “it” was happening. Every nerve cell was poised for this cataclysmic event. Nearly everything he saw or heard was incorporated into his delusion. For example, he perceived the cameras used by the media and HBO film crew as a sign of his imminent transition. All his judgments and decisions were “based 100% on being ready for the Others,” - the entities to whom he belonged and would soon join.
Birth of his Son
58. Mr. Echols’ thinking at the time of his trial appears to have been disorganized and delusional in all domains. Despite his entrenched belief he would be transported to another world, he married his pregnant girlfriend, who subsequently gave birth to a son. This usually joyous event instead became another vehicle for Mr. Echols’ complex delusions. His reaction to his son’s birth reflects psychotic thinking and lack of contact with reality. Notes Mr. Echols wrote about his son are consistent with psychosis:
I found out my son was born. The Spirits wont leave me alone. They surround me constantly. I think the baby stole my soul. . . .I saw my son for the First time yesturday [sic] something happened when I looked at him. I don’t think I was supposed to see him.
Medication During Trial
59. Jail records reflect that Mr. Echols was administered 150 mg. of Imipramine daily by non-medically trained jail personnel during the nine months of his pre-trial incarceration and throughout his trial. However, the records do not include a consent form for medication signed by Mr. Echols and a witness. Medical standards of care set forth by the American Medical Association require that all patients be fully informed about the possible risks and benefits of recommended medical treatments, as well as alternative treatments available to the patient, and of their right to decline medical treatment altogether. Informed consent requires the capacity to weigh options rationally about the risks and the benefits of various treatments. There is no indication in Mr. Echols’ jail records that he was provided pertinent information regarding the medications he was taking or whether he was evaluated to determine if he possessed the requisite mental faculties to make a reasoned decision regarding his treatment.
60. Moreover, there is no documentation that Mr. Echols received any medical supervision or periodic evaluations while he was taking Imipramine during his pre-trial incarceration and trial. The administration of a prescription drug without medical supervision is a serious breach of national standards of care set forth by the American Medical Association. Psychiatrists and other physicians licensed to practice medicine and prescribe medications are required to monitor their patients regularly to evaluate the clinical and side effects of medications, determine whether a change of medication is indicated, and assess other medical problems that could influence the efficacy of previously prescribed drugs.
61. Neither do jail records document within a reasonable degree of medical certainty that the medication Mr. Echols received prior to and during his trial was appropriate for the nature and severity of his psychiatric disorders. Indeed, Imipramine - the antidepressant Mr. Echols was given daily for at least a year prior to and during his trial - is contra-indicated for the signs and symptoms of his mental illness. Imipramine is a tricyclic antidepressant used primarily for the treatment of depression, but has been shown to significantly increase the risk of mania and hypomania. In other words, Imipramine can expand the symptoms of depression to include manic episodes. Manic episodes, like severe depression, can include psychotic features in which the patient develops delusions, and intermittently or completely loses contact with reality. Adolescents who suffer from depression are especially vulnerable to negative side effects of Imipramine, including confusion, anxiety, drowsiness, dizziness, sedation, excitation, headaches, nervousness, and weakness. Mr. Echols reported several of these symptoms, including confusion, drowsiness, dizziness and weakness, during a clinical interview. In addition, he described in writing feeling weak and drowsy, suffering from headaches, and having vivid and disturbing dreams during his trial.
62. Mr. Echols’ thought processes and behavior prior to and during trial are consistent with mania (see Diagnostic and Statistical Manual, 4th Edition, 1995). An investigator who interviewed Mr. Echols weekly observed unpredictable mood swings, ranging from abysmal depression and hopelessness to rapturous feelings of omnipotence. These intense changes in mood and affect appeared unrelated to external influences and were far out of proportion to environmental events. Equally significant, Mr. Echols seemed to have no insight into the cause of his emotional storms, and was unresponsive to support, reassurances, or efforts to place the experiences in an understandable context.
63. The increase in Mr. Echols’ psychiatric symptoms before and during trial may in large part be attributable to the combination of the inadequate diagnosis of his condition, combined with lack of psychiatric monitoring by qualified mental health professionals and improper medication. Had Mr. Echols been evaluated, diagnosed and treated within the guidelines outlined by the American Medical Association, and had he received the correct combination of medications, he likely would have been far more capable of acting in his own best interest, which in turn could have had a positive influence on the outcome of his trial.
Suicide Attempt Pre Trial
64. Mr. Echols’ mental health was in a precipitous state of decline well before his trial began. His mood swings intensified and his mania and depression became life threatening. On June 9, 1993, he tried to kill himself by taking an overdose of Imipramine because he believed this would allow him to be transported to “the other place.” He was taken from the jail to a local hospital where he remained less than 24 hours. When he was returned to the jail Mr. Echols did not receive follow up care from a psychiatrist or other licensed physician, nor was he placed on suicide precaution or in a special housing unit for mentally ill inmates.
Contemporaneous Writings
65a Mr. Echols’ significant history of mental illness and hospitalizations are supported by contemporaneous journals and missives he wrote before and during his trial. These documents memorialize in vivid detail disabling delusions, hallucinations and gross distortions of reality. The structure and quality of his writing provide insight into the nature and depth of his paranoia. His experience of himself and others is replete with irrational fear, distrust, confusion and a pronounced lack of insight regarding his mental illness. For example, he believed someone was “. . .doing something to the food and putting some kind of gas in the vents” and thought someone was “. . .doing something to [his] medicine.”
66a Signs and symptoms of Mr. Echols’ mental illness also include depersonalization and derealizion (consistent with dissociative experiences). He did not recognize his physical appearance; he hallucinated that his “hands and feet are changing” and believed his body was being transformed from a human being to a superior being - Christ. He saw these changes as signs of his inevitable metamorphosis and followed command hallucinations to ready himself for this life changing event. He expressed frustration at having to take his medication because he believed it was preventing his transition:
I can see physical changes happening in my body. I can tell it’s getting ready. The abonations [sic] have already begun to be spit Forth from the Earth. I have seen some of them. I will become one soon. . . .My body is changing but that medicine is making it happen a lot more slowly than normal I am outgrowing my skin. I am eating packs of sugar and Kool-Aid to give my body the extra energy it needs to make its change. Soon People will be able to Know I am the Christ Just by looking at me.
67a Mood swings are also evident in Mr. Echols’ writing. He described long standing depression beginning in early childhood that alternated with manic episodes accompanied by grandiose delusions. He writes:
I had a very sad and Deppresing [sic] child hood. I was always sad for no apparent reason. I cried constantly. . . [Once I] “cried for about 3 hours” when everything hit me all at once and made me so sad that I knew I would ever reach one of those high spots again. I always knew I was different from all other children. I could always tell that my thought process was different. I always thought other children were crazy or stupid. . . .I knew ever since I was Really young that I was Destined for Greatness. At first I thought maybe I was an alien. I don’t Know why it Just seemed natural.
68a Mr. Echols oscillated between grandiose, paranoid and persecutory delusions of such proportion and duration that he was unable to understand consistently or meaningfully participate in the proceedings against him:
[I believe] I was the God of the New Eon and that no one could never touch me. ..[I believed I had to] slay myself. But I will be back, I will rise again in three Days. Just like the first God. [The trial against me] is the beginning of an apocalypse and The war will start in 94 - the world ends in 96. [I am] the new Messiaha. [sic]
69a Mr. Echols became obsessed with his grandiose and persecutory delusions, and began to began to demonstrate delusions of reference as well.
[E]very one stared at me like I was some kind of freak. . .Everyone knew I didn’t belong there. . . .[T]hey hate me because God hates me. Because he knows I can beat him so he tries to kill me Every chance he Gets. . . .They don’t understand they can’t beat me and God still tries everything he can to kill me but he cant. Death cant stop me. I would be only the third person in history to raise from the Dead. Lazarus, Jesus Christ, Damien. I will prove it very soon. . . .[T]hey think I don’t know they’re watching me. They think I don’t know about the spies and bugs. I do. . . .I’ve got spies too.
70a Mr. Echols wrote about the visual and auditory hallucinations dating to childhood and continuing throughout the trial:
I remember when I was very young. One night I woke up and there was some one in my bed. It scared me so bad I couldn’t even move. When I snapped out of it I Jumped out of Bed and Ran to my mothers room. I told her and she went to my Room and looked. She said there was nobody there. She said there was no way someone could have gotten in without her knowing it. . . .I can Remember one Night, when I was a little older and I woke up to see a man, standing in my room. It paralyzed me. I wouldn’t even blink because I knew as soon as I opened my eyes he would Be right in my face. I guess later I must have passed out because the next thing I knew it was the next morning. . . .no one believed me. . . .I thought people may be right. But I changed my mind one night when there was an old man in my room. I thought If I just ignored him he would go away. But when I looked again he was right in front of me. He licked my hand and said, “Does that feel like a Dream to you.” He talked for awhile of things that arn’t [sic] important yet.
71a The hallucination of the old man was a recurring theme in Mr. Echols’ writings. Mr. Echols saw and heard the old man and believed him to be an integral part of Mr. Echols’ transformation:
This morning when I woke up my eyes wher [sic] stuck open. I must have slept that way. My heart was beating so hard it was vibrating my head. I went to Hell. It was not a dream. I was really there. It wasn’t that bad. The old man took me there. He is my constant companion now. My new name is baalbasath. We are leaving soon now.
72a Another apparition Mr. Echols wrote about was “Rosey,” a superior being who took Mr. Echols “some where every night Now.” Rosey put Mr. Echols . . .in a horse. It felt so good to just run and run. I never wanted to stop. He said we’ll do lots of fun things from now on. He says he has to show me a lot of stuff before October. . .[He told me not] to worry about anything any body says to me or does. . .
73a Mr. Echols was so plagued with hallucinations, delusions and dissociative symptoms that his health suffered during the trial.
[s]omething is very wrong here!. . .[I think I am] having a nervous breakdown. . ..Today I have a splitting headache. I feel like I got a hangover.
It’s cause Rosey won’t let me sleep that much. . . .I don’t feel very well today. I’m getting sick. Every time me and Rosey do something it makes me Really Sleepy and hungry. Once I even got a Nose bleed.
74a The combination of these factors prevented Mr. Echols from assisting his attorneys with even the simplest tasks. He could not comprehend or evaluate the quickly unfolding events or make rational decisions in his own best interest. The burden was overwhelming and the results disastrous.
Contemporaneous Lay Witness Descriptions
75a Mr. Echols’ mental health history, behavior before and during trial and contemporaneous writings are completely consistent with collateral descriptions of his mental status before and during the trial. Numerous lay witnesses who knew Mr. Echols over time observed that he was not in touch with reality frequently during their visits with him at the jail and in the courtroom. They gave several examples of Mr. Echols’ disturbed mental state. Mr. Echols’ stepfather, Andy Echols, reported that when Mr. Echols was asked questions, “his answers did not make any sense.” His biological father found Mr. Echols so “upset and depressed” that Mr. Echols “did not seem to know what was going on.” All family members noted that Mr. Echols “was losing a lot of weight,” a common symptom of both major depression and mania.
76a Glori Shettles, an investigator, had the most contact with Mr. Echols before and during Mr. Echols’ trial. She described Mr. Echols’ episodic loss of contact with reality, his pervasive problems with attention and concentration, his inability to discern the significance of the events, his lack of insight into the nature of his mental illness, his unpredictable and rapid mood swings, his paranoid beliefs, and general mental decline. Ms. Shettles met with Mr. Echols at least once a week during his pretrial incarceration and numerous times during pre trial and trial proceedings. Mrs. Shettles witnessed Mr. Echols’ dramatic “mood swings from deep sobbing to laughing hysterically and giggling without any cause for the change.” She reported that he cried during “. . .almost every meeting, sometimes collapsing onto. . .” her shoulders “. . .in utter despair that was beyond the legal situation. His depression had been with him a long time and it affected everything he thought and did.”
77a According to Ms. Shettles, Mr. Echols “was not able to maintain an active interest in legal developments and was so crippled by depression that he could not be motivated to help in his own defense.” He discussed suicide repeatedly as a means of relief, but at the same time believed he “could overcome death because he was different from people.”
78a Ms. Shettles corroborated the grandiose and persecutory delusions described in Mr. Echols’ writings and medical records. [He believed he was] an outsider to whom no one could relate. He believed he was an alien and discussed it with his mother from the time when he was a small child of only three or four. It was not an analogy; it was a concrete belief that he was from another world, another planet. He was consumed with the belief that he was not of this world and talked about it at every opportunity. The paranoid and persecutory delusions extended to his trial counsel and almost anyone with whom he had contact. Any activity, regardless how innocuous, was imbued with significant and usually sinister meaning. [He believed people]. . .always thought he was strange [and that] his peers, teachers, and strangers were against him. He analyzed everything that was said to him and attributed special meaning to their words. [He was] suspicious of his trial counsel and sensed they did not like him, were afraid of him, and believed he worshiped the devils.” [He used] his special powers to determine that his counsel were in on a conspiracy with the judge and prosecution. . .[Mr. Echols was] preoccupied with his paranoia to the exclusion of knowing what was actually happening in the courtroom. He constantly scanned the audience, the cameras, witnesses, and attorneys and believed that they were looking at him in a special way, but they were not even looking at him.
79a Ms. Shettles described much of Mr. Echols’ behavior as unpredictable and bizarre. He had “bizarre topics of conversation” that made him laugh inappropriately. At many other times, he lost contact with reality and acted “as if he were in a trance, staring but not seeing.” He had difficulty sleeping, looked “haggard and exhausted,” and felt physically ill frequently. He “rocked, pulled his hair, bit his fingers and nails, and bit his lower lip.”
Psychological Testing
80a Mr. Echols has been evaluated on three separate occasions by three different psychologists, each of whom administered a battery of tests. A prominent feature of each evaluation was the Minnesota Multiphasic Personality Inventory (MMPI), which was administered on June 8, 1992; September 2, 1992; and February 20, 1994. The independent test results were quite consistent; all revealed valid profiles and strong indications of depression, mania, severe anxiety, delusions and psychosis.
81a Test results for the June 8, 1992, MMPI reflected elevations on scores of psychotic thinking, including hallucinations, paranoid ideation, and delusions, as well as severe anxiety and other related emotional disturbances. The suggested diagnoses were schizophrenia, disorganized type; and bipolar disorder, manic. Individual responses on this test revealed that Mr. Echols was afraid of losing his mind, had bizarre thoughts, and had very peculiar experiences. Three months later, on September 2, 1992, a second MMPI was administered. The test results very closely paralleled the findings of the earlier MMPI. Shortly before Mr. Echols’ trial began in 1994, he was administered the MMPI a third time for the purpose of identifying mitigating evidence. Like the other two, this MMPI revealed psychotic thought processes consistent with schizophrenia. Specific indicators of a thought disorder included mental confusion, persecutory ideas, acute anxiety, and depressed suicidal ideation.
Neuropsychological Testing
82a I have also consulted with Karen B. Froming, Ph.D., a board certified neuropsychologist who administered a battery of neuropsychological tests to Mr. Echols to determine whether Mr. Echols suffers from brain damage or deficits that would affect his medical or psychological status. The results of this battery - which are consistent with all three MMPI’s - suggest that Mr. Echols suffers from a severe long term mood disorder that affects his perception, judgment and behavior. The battery also revealed Mr. Echols’ I.Q. score to be substantially higher than his score on tests administered immediately prior to trial. Given Mr. Echols’ history of mental illness beginning in childhood, and the enormous stress he bore as a result of his arrest and trial, the best explanation for the difference in I.Q. scores is the effects of delusions, hallucinations, psychotic depression, lack of sleep and mania. These factors compromised his actual intellectual abilities by interfering with his attention, concentration, memory and problem solving skills.
Post Trial Competency Hearing
83a I also reviewed the 13-page transcript of a post trial competency hearing held March 11, 1996. It appears from the transcript that no mental health professional examined Mr. Echols for competency prior to the post trial competency hearing, nor testified about Mr. Echols’ substantial
history of psychiatric illness. It also appears that neither counsel nor the court was aware of three significant factors that were relevant to determining Mr. Echols’ competency:
1. Mr. Echols’ well established history of major mental illness, including the determination by the Social Security Administration that he was mentally disabled;
2. the psychiatric symptoms he manifested during trial proceedings; and
3. the deleterious effects of the psychiatric symptoms, especially his delusional beliefs and hallucinations, on his ability to understand legal proceedings and to aid and assist counsel.
84a The hearing is bereft of any testimony or evidence by any mental health professional about Mr. Echols’ mental functioning. No mental health professional examined Mr. Echols, administered appropriate diagnostic tests, or reviewed his symptom complex to determine if he were competent. At a minimum, any competency evaluation must be conducted by a mental health professional with experience and training in forensic evaluations. The evaluating mental health professional must first determine if Mr. Echols suffers from a mental disease or defect, well-documented in Mr. Echols’ history. The evaluating mental health professional must then take into account whether and how symptoms, such as those manifested by Mr. Echols, impair specific competence-related abilities.
85a The transcript of the hearing makes no reference to any information from sources traditionally relied upon to address mental state at the time of trial. No mention is made of numerous documents and records that establish Mr. Echols’ considerable psychiatric history, including the following:
1. determination by Social Security Administration that Mr. Echols was disabled due to mental impairments;
2. records of three psychiatric hospitalizations within the year prior to Mr. Echols’ arrest, outpatient treatment at the area mental health center, and social service agency investigation into Mr. Echols’ family;
3. jail records documenting Mr. Echols’ suicide attempt; and
4. unsupervised administration of psychotropic medication during trial. These medical records detail Mr. Echols’ delusions, hallucinations, mood disorder, traumatic history, and paranoia. These records serve to alert a competent mental health examiner to symptomatology that adversely affected Mr. Echols’ competency-related abilities.
86a No testimony was introduced from lay or expert witnesses about their observations of Mr. Echols’ bizarre behavior during his trial. At the time of Mr. Echols’ trial, he was visited by members of his family frequently and a defense investigator weekly. Their observations, reported above, demonstrate the manner in which Mr. Echols’ psychiatric symptoms interfered with his rational and logical thought processes. His contemporaneous writings, some of which were provided to a defense investigator, also offer evidence of how his grandiose and paranoid delusions and elaborate auditory and visual hallucinations distorted his understanding of legal proceedings against him. These observations and writings are relevant to any determination about Mr. Echols’ competency.
87a Mr. Echols testified briefly during the hearing and answered questions by his counsel and the court. None of the questions and answers was sufficient to establish a basis for concluding that Mr. Echols was competent or incompetent at the time of trial or at the time of the post trial hearing. Many of the questions, particularly those asking Mr. Echols about trial and appeal materials, were not followed to demonstrate that he had read the materials. None of the questions asked of Mr. Echols can approximate a mental status examination by an appropriately trained and experienced mental health professional. A critical part of any competency evaluation is the mental status examination. The mental status examination is a systematic inquiry into current mental functioning. It is a standard interview technique that probes specifically for signs and symptoms of mental illness. Mental status examinations commonly involve brief tests and queries about orientation and reports of recent subjective symptoms. Responses in a mental status examination are used to assess current cognitive and emotional functioning. None of the questions put to Mr. Echols by counsel and the court probed for signs and symptoms of Mr. Echols’ mental illness, or even asked about symptoms. The questions and answers did not offer adequate data to support inferences about Mr. Echols’ mental status. The questions offered no psychiatric utility and should not be relied upon to assess Mr. Echols’ competency-related abilities. The questions also did not attempt to manifest any understanding Mr. Echols might have had of the proceedings.
88a The information contained in the transcript of the hearing is insufficient to support a finding concerning Mr. Echols’ competency at the time of his trial. It failed to take into account how Mr. Echols’ severe psychiatric symptoms affected his competency.
Conclusions
89a Prior to and during his murder trial, Damien Echols suffered from a severe psychiatric disorder characterized by enduring delusions, auditory and visual hallucinations and severe mood swings ranging from suicidal depression to extreme mania. Ample evidence documents the catastrophic impact of these distressing symptoms on Mr. Echols’s grasp of reality and his perception of events around him. His pervasive delusions and psychosis undermined his understanding the implications of the charges against him, grossly distorted his perception of events in and out of the courtroom, and compromised his relationship with his lawyers. At the time of his trial, the nature and severity of Mr. Echols’ multiple psychiatric illnesses left him unable to rationally understand rationally the nature of the legal proceedings against him and to aid and assist counsel in a rational and factual manner.
I declare under penalty of perjury, under the laws of the United States of America and the State of California, that the foregoing is true and correct.
Executed this day of February, 2001, at Pinole, California.
