Ever since 2012, when Marci Webber was found not guilty by reason of insanity for having killed her four-year-old daughter, she has been detained in Illinois mental hospitals. Mad in America has run several posts by Cindi Perlin about Marci, for she committed the homicide while deep in a psychotic episode that erupted while she was on a cocktail of psychiatric drugs.
On September 18, an Illinois county judge ruled that Marci Webber no longer meets the legal criteria for being kept locked up in a mental hospital, and that the Illinois Department of Human Services must develop a plan for her conditional discharge.
Judge George Bakalis did not rule this way because he agreed that Webber’s homicidal act was due to the drugs. However, the proceedings do tell of a case history that lends reason to believe that is so, and they also provide confirmation for her complaints that she was punished and abused at Elgin Mental Health Center because of her refusal to take psychiatric drugs there.
Psychiatric Drugs, and the Long Path to Homicide
In 2010, Webber was 43 years old and had no prior history of psychosis. However, she did have a longtime history of use of psychiatric drugs, and struggles with depression, anxiety and insomnia—struggles that she sees today as due in large part to drug-induced akathisia.
Born in 1967, Webber entered the Army in 1987, serving on a Pershing Missile crew headquartered in Germany. After an honorable discharge in 1989, she earned a bachelor’s degree in communications from the University of Illinois. Her first daughter, Mallory, was born in 1992, and not long after that, she was in a custody battle with the father of her child. Her physician prescribed her Paxil in order to “take the edge off her stress,” she told MIA.
Webber worked at various advertising jobs during the next several years, and, while on the Paxil, she continually suffered from anxiety and insomnia. In 2000, she gave birth to a second daughter, Madison, and as she was struggling with the stress of taking care of a newborn, her physician prescribed her a higher dosage of Paxil. In 2001, she entered Albany Law School, and with her mood and sleep issues growing increasingly worse, a psychiatrist added Zyprexa to the Paxil, as this was supposed to dampen mood and help her sleep. At some point, Wellbutrin was also added to her cocktail.
In January of 2002, she was unable to refill her prescriptions because of a problem with her insurance coverage, and the abrupt withdrawal from her cocktail sent her into a tailspin. After she held a knife to her arm in front of her husband, she was committed to a hospital.
The rest of that year unspooled in an ever more chaotic way. Her husband left her, and her drug cocktail grew to include Zoloft, Neurontin and Seroquel, with this latter drug a replacement for the Zyprexa. This cocktail often induced excruciating akathisia, and she now began drinking alcohol to temper that pain. Twice more that year she voluntarily went to the hospital in the hope of getting relief from all of these stresses.
In the years that followed, she took a medical leave from Albany Law School, having finished five of the eight semesters. She took care of her two daughters, living on social security disability, and in 2006 had a third daughter, Maggie. During the next years, she stayed on a cocktail of Zoloft, Wellbutrin and Seroquel, with other drugs thrown in now and then. The dosages of the three main drugs were often pushed higher.
At the end of May in 2010, she traveled to Illinois to attend the high school graduation of her oldest daughter, Mallory, who by that time was living with her father. However, she had forgotten her psychiatric pillbox, and soon she was in the grip of severe withdrawal symptoms, and her thoughts took a decided paranoid turn.
In the previous 12 months, there had been several incidents at the Catholic Church she attended, one of which involved a seminarian improperly touching her four-year-old daughter. Now she became more obsessed with that risk to her daughter, and then, in late October, she abruptly went back on a newly prescribed combination of psychiatric drugs. She resumed taking Zoloft, at a high dose, and a psychiatrist replaced the Seroquel prescription with one for Ambien. This last drug is known for the “weird” side effects it can cause, including “hypnosis, amnesia, and hallucinations.”
“Ambien was the kicker,” Webber recalled. “It was that and the akathisia. The pain just went through the roof. You will do anything to end it.”
Webber’s thoughts now ran wild. She became convinced that an Internet sex ring was going to kidnap her four-year-old daughter and make her a sex slave. The kidnappers would then kill her in a Satanic ritual, which, Webber believed, would doom her to eternal Hell. In November of that year, while visiting her mother in Illinois, Webber killed her daughter to save her from that fate. She then tried to killed herself.
“I thought I was sending her to heaven,” she said.
Cindi Perlin, who had been Marci’s psychotherapist for years, immediately had one thought when she learned what had happened: It had to be the drugs that triggered her homicidal act. “At that point I had known Marci intimately for 8 years and had known her to be a concerned and loving parent to her children,” she wrote, in one of her MIA posts. “Marci had never been violent or psychotic before.”
Not Guilty by Reason of Insanity
Webber spent two years in jail, and then, at a short bench trial in 2012, she was found not guilty by reason of insanity. After a short time at Chicago-Read Mental Health Center, she was transferred to a mental hospital in Elgin, Illinois, and it was there she decided to take a stand and refuse to take any more psychiatric medication.
Her noncompliance led to years of mistreatment and harassment, with staff at one point encouraging her to kill herself. She was assaulted more than a dozen times by other patients.
However, once off psychiatric drugs, Webber’s psychotic symptoms abated, which provided her with legal cause to petition for her release. Under Illinois law, a person found not guilty by reason of insanity may continue to be detained only as long as that person is a danger to self or others, and is in need of inpatient care. Webber first petitioned for discharge in 2014, but after a series of delays, the court denied her request in 2017.
In June of 2018, she filed a new petition for discharge, and hearings commenced in May of 2019.
Webber presented testimony from two psychologists, Toby Watson and Dathan Paterno, and one psychiatrist, Gail Tasch. Collectively, they administered a battery of tests, and they all concluded that Webber suffered from no major mental disorder, and was not a danger to self or others. Although she may have suffered from depression, anxiety and symptoms of post-traumatic stress disorder in the past, they concluded that any ongoing symptoms of this type could be attributed to her confinement and hostile treatment at the Elgin facility.
The state, which was seeking to continue her confinement, presented testimony from a psychologist, Lesley Kane, whom the court had appointed to interview Webber, and from psychiatrist Richard Malis, who works for the Illinois Department of Human Services. While both argued Webber’s petition for discharge should be denied, they did so for different reasons.
Kane told the judge that although Webber had not displayed any psychotic symptoms for some time, she had “traits” that supported a diagnosis of borderline personality disorder. People with this disorder, she told the court, often had “marked mood swings,” were “frequently agitated,” and prone to “extreme sarcasm” and “enduring bitterness.” If Webber were released, she would be at risk “for developing more symptomatology in a community setting,” Kane said, and thus should remain a hospital inpatient.
Videotape of Leslie Kane’s interview of Marci Webber, Nov. 20, 2018
Malis gave Webber a different diagnosis. He testified that Webber suffered from “hallucinations and delusions and schizoaffective bipolar disorder,” and that she continued to be “a threat to herself or others.” Yet he did acknowledge that even though Webber had not taken medication in many years, she did not show any signs of psychosis.
The head “night-shift” nurse at Elgin Mental Health Center, Terry Nicholas, also testified to an incident that told of a type of institutional lying by Elgin Mental Health Center about Webber’s behavior. At one point, after Nicholas had written in Webber’s chart that she was “pleasant and cooperative,” his superiors, upon reviewing the chart, told him that this had upset Dr. Malis. In his decision, Judge Bakalis detailed the sequence of events:
Mr. Nicholas was informed that Dr. Malis was not pleased with this charting and did not want pleasant things regarding petitioner reported as it would harm his intent to petition the court to obtain an order for forced medication on the petitioner. Nicholas testified that Dr. Malis himself expressed his displeasure directly to him stating that he could not obtain the court order with those types of comments in the petitioner’s chart. This testimony was unrebutted by the state.
Judge Bakalis noted that something similar had come up during Webber’s first petition for discharge. During the earlier proceedings, two Chicago-Read staff had testified that they did not think Webber was mentally ill and that she should be discharged. Yet, both had previously signed “treatment letters” that were sent to the court stating that, in fact, she needed to be kept in a confined environment. This seemed to be another instance of medical staff presenting a false account of Webber’s behavior to the court, the judge noted.
This prior testimony and the present testimony of Mr. Nicholas seems to indicate to the court that employees of the Illinois Department of Human Services (IDHS) are directed by their superiors to endorse their superior’s diagnoses even if they disagree with it. Although the testimony at the prior hearing was not while petitioner was under the care of Dr. Malis, it calls into question the manner of which IDHS makes reports and what pressure is placed on employees to conform to what supervising doctors feel should be done even if they disagree. This causes the court pause to consider whether the ninety-day reports which have been submitted to the court are completely accurate regarding the petitioner.
The Judge’s Decision
This was the mix of testimony that Judge Bakalis needed to sort through to make his decision. He had heard three professionals testify that Marci Webber did not have a mental illness, a fourth testify that she had borderline personality disorder, and a fifth that she had schizoaffective bipolar disorder. However, everyone seemed to agree that she had not shown symptoms of psychosis since stopping her meds six years earlier, and there was also testimony that Webber’s noncompliance so irritated Malis that he had scolded a facility nurse for writing in a chart that she was “pleasant and cooperative” off meds.
First, in his written decision, Judge Bakalis dismissed the testimony of Webber’s three expert witnesses as of no account. The court, he wrote, “cannot agree with petitioner’s experts that she does not suffer from mental illness, clearly, she does.”
Second, he stated that it was Kane’s testimony that he found convincing. “The court finds that the analysis of Dr. Kane is closest to what currently afflicts the petitioner, basically borderline personality disorder. The petitioner clearly needs to have good mental health treatment and therapy.”
Third, he concluded that Webber “will never receive that [good] treatment while in the custody of the IDHS,” and under the care of Dr. Malis. Judge Bakalis wrote:
The court specifically asked Dr. Malis if rapport was necessary between a psychiatrist and a patient in order for treatment to be effective; Dr. Malis acknowledged this was necessary. He further acknowledged that no such rapport exists between himself and the petitioner because of petitioner’s distrust of him and his position that she cannot improve without psychiatric medications. When asked by the court whether a different psychiatrist could be assigned to petitioner in light of this lack of rapport, Dr. Malis stated this was not possible.
The court has concerns about the treatment relationship between petitioner and Dr. Malis. Clearly, petitioner is uncooperative with Dr. Malis and Dr. Malis sees no hope for petitioner improving without her taking medications even though petitioner has been in remission of psychosis for a number of years without medication.
Having assessed the testimony in this way, Judge Bakalis concluded that while the traits associated with borderline personality disorder, such as “being a difficult, disagreeable and narcissistic” person, may “make a person unlikeable” it “does not establish a person to be a danger to herself or other.” As such, it does not, “in the court’s opinion, require inpatient attention. Many persons with the same attributes are found throughout society.”
However, while Judge Bakalis attributed those traits to Webber, he noted that she had “not shown physically violent behavior toward staff or other patients. In fact, the petitioner has been the subject of abuse by other patients without retaliating.”
In sum, Judge Bakalis found that the state had not shown that Webber was “in need of mental health services on an inpatient basis.” He ordered the Illinois Department of Human Services to develop a plan for her “conditional release,” which will require her to get mental health treatment in the community and avoid all use of non-prescribed drugs, cannabis and alcohol. The conditional release will be for five years, and if Webber complies with all of the conditions during that time, she will be “fully discharged” from the custody of the Illinois Department of Human Services.
A Chronology of Psychiatric Drugs
While there is a well-established link between drug-induced akathisia and violence, and also a risk that SSRIs can trigger such behavior, the possible cause-and-effect link in Marci Webber’s case is clouded by her long use of psychiatric drugs without ever becoming violent or psychotic before 2010.
But the chronology is certainly suggestive of that link. Abrupt withdrawal from a cocktail of drugs that includes an antipsychotic is known to put one at risk of experiencing a psychotic episode, and it is notable that she killed her daughter shortly after going back on a cocktail that included Ambien, with all of its possible weird mental effects. And as she remembers it today, the pain from the akathisia became intolerable.
Then, once she withdrew from the medications in 2013, her mind cleared and she has not shown signs of psychosis since.
In his decision, Judge Bakalis revealed his own ambivalence on this point, which can be seen in his use of the word “merely”:
The court continues to have some concerns as to whether petitioner completely understands that her prior conduct was caused by her developing mental illness and not merely caused by the medications she was taking at the time of the offense.
Although her discharge is conditional, with a plan yet to be set, Webber is is now looking forward to the possibility of a new future. “I did this for every chemically sensitive patient forced to endure horrible or dangerous side effects like akathisia,” she said in a telephone call to MIA. “I am grateful that I am leaving the hell I have spent years in, and for the support of [all those) who faithfully contributed to my cause.”
Mad in America hosts blogs by a diverse group of writers. These posts are designed to serve as a public forum for a discussion—broadly speaking—of psychiatry and its treatments. The opinions expressed are the writers’ own.