http://www.buffalonews.com/editorial/20041017/1019302.asp

FOCUS: MENTAL HEALTH No perfect prescription

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A study of three killings by schizophrenics reveals no fool-proof system exists to prevent such tragedies

By STEPHEN WATSON and GENE WARNER News Staff Reporters 10/17/2004

Dennis C. Enser/Buffalo News

Jeremy M. Perkins, whose mother fed him vitamins to deal with his mental illness, stabbed her 77 times in their Amherst home because he thought she had an evil eye.

Kirsten M. Vanderlinde, left, and Falisha M. Madera both killed their daughters.

First of two parts

All three suffered from powerful delusions, bizarre beliefs that dominated their thoughts. Kirsten M. Vanderlinde, by all accounts an attentive mother, was convinced she couldn't care for her 7-month-old daughter, Melissa.

Jeremy M. Perkins, whose mother gave him vitamins to deal with his mental illness, believed she had an evil eye.

And Falisha M. Madera felt that her own schizophrenia was torturing her daughter, that she had to save her 9-year-old from that suffering.

All three acted on their delusions.

Vanderlinde repeatedly smashed her daughter's head on a North Buffalo sidewalk - the only way she thought she could protect a baby she knew was doomed.

Perkins stabbed his mother 77 times in their Amherst home, later telling authorities he had put out her evil eye.

And Madera listened to her voices, stabbing her daughter five times in their Niagara Falls apartment to send her to heaven and end her suffering.

All three had much in common:

They all suffered from schizophrenia and its delusions.

None had ever had lashed out in violence previously.

All three had concerned family members who tried to help.

Yet none was taking anti-psychotic drugs in the days before the attacks.

The three killings - and other recent local attacks - suggest a major failure in the local mental-health system.

But a Buffalo News investigation into these cases, culled from interviews with family friends, defense attorneys, mental-health professionals and advocates, shows that no fail-proof system exists to prevent these tragedies.

What happens

So who is to blame when diagnosed schizophrenics fail to take their medication and strike out in anger?

"The crux of the problem, the big lie in the system, is that you can predict dangerousness," said Lynne M. Shuster, coordinator of the local Alliance for the Mentally Ill. "The truth is, you can't predict dangerousness."

Especially when these patients stop taking their medication - often the key ingredient in taming their inner demons.

The stresses of everyday life, their often volatile personal relationships and the side effects of some anti-psychotic drugs often drive these patients away from taking their medication.

Without them, mentally ill people often lose insight into their illness and plunge into a cycle of getting sicker and denying they need help. In extreme cases, that cycle can lead to violence.

"Part of the illness is that people don't understand they're ill," said Mary T. Zdanowicz, executive director of the Treatment Advocacy Center in Arlington, Va. "They can't distinguish between reality and what their brain is telling them."

When mentally ill people fail to take their drugs, the existing system relies almost entirely on their loved ones to make sure they receive treatment.

Vanderlinde has a concerned father, but he lives in Ithaca and takes care of his wife, who also suffers from schizophrenia. And her longtime boyfriend, whom she met in treatment, couldn't help her cope with her disease.

Perkins' parents, for religious reasons, chose to treat their son with vitamins.

And Madera's mother, after encouraging her to move to Niagara Falls to be closer to her, was unable to help her daughter get her needed medication.

The public tends to dwell on random violent acts of mentally ill people, such as the killing of Fredonia native Kendra Webdale. In 1999, she was thrown in front of a subway train in New York City by a schizophrenic man she never had met, the last of his many violent acts.

But Vanderlinde, Perkins and Madera all lashed out at loved ones, apparently the first time each turned violent. All three have been charged with murder, and an insanity defense is expected in any of the cases that go to trial.

"The majority of those people tend to be very quiet, withdrawn," said Michael White, Niagara County's deputy mental health director. "They don't have a great deal of social interaction. They're nonviolent. Probably nine times out of 10, the anger and hostility they would have is self-directed. It's far more likely for someone to commit suicide than homicide."

These three cases show, in painful detail, that the system for preventing dangerous acts by seriously mentally ill people is a fragile one.

Kirsten's downfall

Peter Vanderlinde, Kirsten's father, is described as a saint.

He has lived with schizophrenia every day of his married life, dealing with the illness that long ago struck his wife. They decided not to have children. But when his wife became pregnant, he prayed every day that his child would not be afflicted.

Kirsten Vanderlinde grew up in a traditional, loving home in Ithaca, earning grades in the high 90s and admission to the University at Buffalo. But as an exchange student in Germany, when she called home once a week, her father noticed problems with her speech.

He flew to Germany, where she pleaded for help.

"Daddy, my brain doesn't work," she told him. "Please help me."

Thus began Kirsten's battle with schizophrenia.

She understood her illness. More than a dozen times, she checked into area hospitals, from Buffalo and Jamestown to Elmira and Ithaca.

Yet her delusion, that she couldn't care for her daughter, dominated her thoughts.

"She is thinking all along, even when she's on her meds, that she's not a good mother," said her attorney, John R. Nuchereno. "That's the delusion."

Vanderlinde stopped taking her medication a few weeks before the May 28 killing.

Her boyfriend had moved out. She wandered the streets, babbling almost incoherently, unsuccessfully trying to give her baby away to a neighbor and later to police.

Nuchereno believes the way the baby was killed proves how ill the mother was.

"If you wanted to terminate the life of your child, you would do it in any other way than this," he said. "This was horrific."

Vanderlinde recently sent a letter to her good friend, Shirley Ford, saying how sorry she feels about what happened.

"(Melissa) was such a sweet little girl," she wrote. "I miss her so much. I know we will be reunited in heaven."

Madera had been ill for years.

She had a tough childhood, sexually abused by people close to her, according to her attorney, James P. Harrington.

In recent years, she developed obsessive-compulsive behavior. She constantly rechecked her stove to make sure it was off.

For at least six months, Madera, 25, was on Zyprexa, with Medicaid paying for the anti-psychotic drug used to treat schizophrenia. In the spring, she tried to kill herself by slashing her wrists.

When her mother asked Madera to move from Buffalo to Niagara County to be closer to her, she had difficulty switching her coverage from Erie County to Niagara County.

Madera's prescription ran out at least several weeks before she killed her daughter on July 17, Harrington said.

There shouldn't be a penalty for switching prescription drug coverage across county lines, said a family friend, the Rev. Hylda Bevans of First Assembly Church of God in Niagara Falls.

"It's really a tragic thing to see," she said. "The whole family is totally devastated. . . . The mother loved her little girl."

Madera stabbed 9-year-old Kayla five times, later saying voices told her to kill the girl, according to police. Madera's mother, who talked to her every day, was out of town the weekend of the killing.

Madera has had problems coping with Kayla's death.

"She now is saying that she doesn't believe that it happened," Harrington said of Madera recently.

The evil eye

Months before he stabbed his mother to death, Jeremy Perkins was arrested at UB's North Campus, where he fought with campus police while searching for a woman his internal voices told him to find.

The woman was Diana - goddess of the hunt in Greek mythology.

Perkins' parents, who are members of the Church of Scientology, treated him with large vitamin pills. But he gagged on them, feeding his delusion that his mother had an "evil eye," his attorney said.

"I cut out her evil eye," Perkins told police, after killing his mother, Ellie, in March 2003.

But he didn't.

"He didn't touch her eye, but his delusion was that when she was giving him the pills, she was evil," said Nuchereno, who represents Perkins and Vanderlinde.

But why stab her 77 times?

"To a normal person, it would suggest a lot of anger," Nuchereno said. "To me, it doesn't suggest anything. He had no idea what he was doing."

Nuchereno insists there was no failure of the system in Perkins' case.

"What system?" he asked. "Jeremy lived at home with his parents."

Several other mentally ill people stand accused of particularly violent crimes. They include Norris E. Wells, 59, accused of stabbing his wife, Lynn, five times in the chest and arms May 6 in their Clarence home.

Wells told police he killed her to protect her from the Mafia, police have said.

Stopping the cycle

By all accounts, the community-based system for treating patients works well - as long as they take their medication.

But when they don't, it can set off a cycle of deteriorating behavior. How can that cycle be stopped?

The answer may be in educating people close to them - and the public. In Vanderlinde's case, for example, friends and police saw signs she was deteriorating. But no one realized how close to the edge she was.

Michael Weiner, Erie County mental health commissioner, cited the missed opportunities in the Vanderlinde case and wonders whether any of these killings could have been prevented.

"Quite frankly, I don't see as much of a system failure in these cases as a civic failure to respond," he said.

Weiner suggested that mental-health professionals teach the lay community more about how the system works and what services are available.

The system has a relatively new weapon in Kendra's Law, designed to provide better treatment for those who won't - or can't - help themselves.

But often that's not enough, a lesson learned by those who mourn Melissa Vanderlinde, Ellie Perkins and Kayla Madera.

Monday: How Kendra's law works, or doesn't

e-mail: swatson@buffnews.com e-mail: gwarner@buffnews.com

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