Opinion ID: 78555
Heading Depth: 2
Heading Rank: 1

Heading: Cunningham's Psychiatric History

Text: In 1983, when he was thirteen, Cunningham was hospitalized for two months in Mesa Vista Hospital, a mental health institution in San Diego, after he had, according to a later report, exposed himself, and was talking about cutting off his penis. (R2:210). While there, he was diagnosed as having chronic undifferentiated schizophrenia ( id. ), which involved significant episodes of a breakdown in his thinking processes and which prevented think[ing] in a logical rational manner. (R12:752). An individual with that diagnosis has a thinking and emotional state [that] does not correspond to reality, and he often does not react to various life circumstances as a normal person would react. ( Id. ) After Cunningham was discharged from Mesa Vista Hospital, he was transferred to MacLaren Hall, another facility, to await placement. (R2:211). While there Cunningham engaged in some bizarre behavior, described in the records as follows: [H]e removed his clothing, urinated on the floor, put his finger which was contaminated with urine into his mouth. He inserted the same finger into his anus, then took it out and put it in his mouth. ( Id. ). Dr. Terence W. Campbell, a forensic psychologist who testified on Cunningham's behalf at the trial, later noted in his report that someone who engages in that sort of behavior quite obviously is a very disturbed individual. ( Id. ) Dr. Campbell testified that bizarre behavior of that type is very rare and that he could remember having observed only three or four episodes like it in his entire career and those were by exceedingly disturbed, very psychotic inmates, most of whom were in a penitentiary. (R12:754). During the same month as that bizarre incident, hospital personnel at MacLaren Hall also had to restrain Cunningham because of his loss of behavioral control. (R2:211). Cunningham made it so difficult for staff to apply the restraints, however, that his arm was broken in the struggle. ( Id. ) Later that same year, Cunningham was admitted to Camarillo State Hospital in California at the age of fourteen, [1] and he remained there until he was eighteen or nineteen years old. [2] ( See id. at 211-13). Records from that institution indicate that by age fourteen Cunningham had suffered a grand mal seizure and had been diagnosed as having an idiopathic seizure disorder. ( Id. at 211). A year later, in September 1984, one doctor at Camarillo State Hospital diagnosed Cunningham, who was then fifteen years old, with Schizophrenia, Undifferentiated. ( Id. at 212). According to that doctor's psychiatric evaluation, Cunningham had a history of short periods of psychotic decompensation in which he hears voices and behaves in an irrational manner. This is interspersed with episodes of very good behavior and a high level of performance. ( Id. at 211-12). The report further noted that Cunningham seemed to do well while medicated but that he reported hearing voices at night when he was not taking his medication. ( Id. at 212). Dr. Campbell testified that these reports from Cunningham's early hospitalizations establish that he experienced auditory hallucinations provoking irrational behavior. ( Id. ) Although Cunningham's psychotic behavior could be effectively controlled with medication at that time, Dr. Campbell noted that without institutional influences, mentally ill people can indulge their own impulsiveness and poor judgment in the community in a manner that leads to serious problems. ( Id. ) According to him, Cunningham responded in just this manner. ( Id. ) Another psychiatrist who evaluated Cunningham during his lengthy stay at Camarillo State Hospital disagreed with the earlier schizophrenia diagnosis for a number of reasons, one of which was that he found Cunningham's story about hallucinations not very convincing. ( Id. ) That psychiatrist nonetheless diagnosed Cunningham as psychotic (Atypical Psychosis) and as having a Conduct Disorder, Undersocialized, Aggressive. ( Id. ) Cunningham was just under sixteen years old at the time of that evaluation. As Dr. Campbell later noted at trial, all of the psychiatrists who treated Cunningham at this stage of his life agreed that he was psychotic, although there was some disagreement on the specific type of psychosis. (R12:765-66). In 1986, when Cunningham was seventeen years old and still institutionalized at Camarillo State Hospital, he sexually assaulted a female music therapist who was interning at the institution. (R2:213). He physically attacked the intern, forced her to the ground, and ripped open the front of her blouse so he could fondle her breasts. ( Id. ) During the struggle, Cunningham told the intern that he had a knife in his back pocket and would kill her if she did not submit to him. ( Id. ) The intern escaped only after her screams brought another man to the area, causing Cunningham to run away. ( Id. ) Although Cunningham eventually acknowledged his involvement in the attack, he explained his behavior by claiming that he and a friend had taken some acid earlier, which caused him to hallucinate that voices were telling him that the intern was a mannequin that had stolen his mother's clothing. ( Id. ) The struggle, Cunningham explained, was merely his attempt to get the clothing back. ( Id. ) Cunningham's story did not explain why he had felt it necessary to fondle the breasts of the mannequin, or to threaten it with a knife. Dr. Robert Defrancisco, the State's clinical psychologist, noted at trial that the fact that Cunningham ran when he heard someone coming indicated he had some consciousness of what he was doing when he assaulted the intern. (R13:847-48). Dr. Campbell's report concluded that this incident establishes that Mr. Cunningham has a history of sexual assaultiveness that involves psychotic decompensation. (R2:213). In his words, [t]o belabor the obvious, [this] is indicative of a seriously disturbed individual. ( Id. ) Dr. Campbell further noted that using later diagnostic criteria, Cunningham's condition at the time he sexually assaulted the young intern would have been diagnosed as a Substance-Induced Psychotic Disorder. ( Id. ) When he was seventeen or eighteen years old, Cunningham was declared a conservator of the State of California through the diagnosis of being gravely mentally ill or disabled. ( Id. at 221). By the time he was nineteen years old, Cunningham had been admitted to Foothill Hospital, another California mental health institution. ( See id. at 213). Two psychiatrists at that facility evaluated Cunningham's legal competency and responsibility. ( Id. ) They diagnosed him with chronic schizophrenia that was controlled at the time by an ample dose of psychotropic medication, but until recently [he] was agitated, violent and unpredictable. ( Id. at 213-14). Those two psychiatrists concluded that Cunningham was not competent to care for his own basic needs, and he was incapable or unwilling to accept voluntary treatment because of his chronic psychosis, poor judgment, and lack of understanding as well as his belief that nothing [was] wrong with himself. ( Id. at 214). Some months after being admitted to Foothill Hospital, Cunningham was discharged from that institution. He was prescribed medications including Dilantin for seizure disorders and Haldol and Lithium to prevent him from going back into a psychotic condition. ( Id.; R12:773-74). After being discharged from Foothill Hospital at the age of nineteen, Cunningham lived on the streets and hopped freight trains from state to state and place to place. (R2:214, 222). He drew Supplemental Security Income benefits of about $720 per month, which were apparently sent to a mailing address he maintained in California. ( Id. ) While on the road (or rails) Cunningham stayed at various crisis centers in Utah, Wyoming, and Florida. ( Id. ) His criminal history during that period includes an arson charge and a possession of cocaine for sale charge in Miami, as well as numerous misdemeanors including indecent exposure. ( Id. ) Between the ages of nineteen and twenty-one, Cunningham was hospitalized in an Oklahoma psychiatric facility and possibly other facilities. ( Id. at 214). At age twenty-one, he was admitted to Jackson Memorial Hospital in Miami after threatening to harm himself and overdosing on Dilantin, an anti-seizure medication, that he had hoarded until he amassed a dose that was large enough to be potentially fatal. ( Id.; R12:775). At age twenty-two Cunningham was again admitted to Jackson Memorial Hospital as a result of a social worker's report that Cunningham was depressed and had been cutting his wrists with an aluminum can, in his words, to take the pain away from [his] heart. (R2:214). The hospital records from that admission note that Cunningham had a history of four previous suicide attempts and was [p]ositive for persecutory delusions. [3] ( Id. at 214-15). The records also indicate that he was positive for marijuana use since age fourteen; last used three days ago. (R12:776-77). On August 21, 1992, Cunningham was admitted to the Miami hospital a third time because he had intentionally cut his wrist with a piece of broken glass. (R2:215). He was put into four-point restraints for protection of self and others. ( Id. ) During this third stay at Jackson Memorial Hospital, Cunningham was spitting, banging his head with the wrist restraints, and was verbally abusive, hostile, [and] uncooperative, stating `I want you to hurt me.' ( Id. )