Fatal Delusions Tragedy: Betty Keat's descent into mental illness, her refusal of treatment and her harassment of her neighbors, and her death by police bullets raise questions about how society responds to people with severe psychiatric problems.

THE BALTIMORE SUN

The people on Taplow Road were accustomed to the eccentricities of their neighbor.

In her own wild imaginings, Betty Keat was by turns a CIA agent, a samurai warrior, the owner of Maryland psychiatric hospitals, headmistress of a girl's school. She called her house "the North Command Post"; she was its "commander-in-chief" and had sole responsibility for the security of Baltimore and Washington.

In the grip of her mental illness, Keat had hosed down the neighbors' houses, thrown rocks at their cars, stolen their newspapers. She had berated them with obscenities, appeared half-dressed in her windows. On occasion, she had threatened their lives.

So when she charged down the street in quiet, elegant Homeland on the fourth day after the blizzard of 1996, eyes blazing, carrying a sickle and a string bag loaded with would-be firebombs, perhaps the most surprising thing was that the neighbors were not surprised.

From the bag, she pulled glass bottles containing lighter fluid, insecticide and wooden matches and hurled them at the two houses on each side of her own hulking, gray-stucco house. Two fell into the snowdrifts; a third shattered against a neighbor's garage.

Then she climbed back in her living-room window -- she had not used the front door for months -- and retreated to the attic bedroom, her last redoubt in the dark, frigid house.

As they had many times before in the long, dreary history of Betty Keat's mental illness, the neighbors called the police. And as they had many times before, the police came to take her to the hospital.

But on the evening of Jan. 12, Keat advanced on one officer with a kitchen knife, crying out, "There's no such thing as police in Baltimore City!" Twice she was sprayed with pepper spray, police say, but she kept coming at the officer. From the opposite corner of her living room, two other officers shot her dead.

Last week, Assistant State's Attorney Timothy J. Doory and homicide detectives met with Keat's relatives to explain why they believe the shooting was necessary to protect an officer's life. The relatives argued that the shooting was avoidable and that the subsequent police investigation was botched.

At the meeting, the relatives turned over a third bullet and shell casing they found while cleaning up Keat's house. They say their discovery disproves the official police version that only two shots were fired. The state's attorney's office agreed to examine the new evidence before deciding whether any charges should be pursued against the officers. Whatever the outcome of the prosecutors' inquiry, it is clear that what happened the night of Jan. 12 was only the culmination of Betty Keat's tragedy. A review of Keat's mental health records, made available to The Sun at the request of her family, and interviews with relatives, neighbors and therapists, suggests that her violent death was a foreseeable end for a woman abandoned to her illness.

Keat's life dramatized society's struggle to cope with the 40-year exodus of the severely mentally ill from state institutions to the community and to balance patients' need for treatment with their right to refuse it.

"We've done a very good job of emptying the hospitals," says E. Fuller Torrey, a psychiatrist with the National Institute of Mental Health and author of several books on mental illness. "We've done an abysmal job of providing care in the community."

The spectacle of homeless people holding animated conversations with the air is one visible consequence of the mental health system's failings. Betty Keat's sometimes pathetic, sometimes terrifying war on the neighbors she saw as a menace was another consequence, a reminder of the burden "community mental health care" can impose on a community. She was not homeless, but her house became a prison where she was left alone with her poisonous delusions.

For seven months before her death, Keat had received no therapy and no medication. One day in May, she had announced that she didn't want any more treatment. And though her mental health center still rated her as "severely dysfunctional," it closed her case.

That decision virtually guaranteed that she would descend again into madness, as she had each time she stopped taking medication since she first grew ill in the late 1960s. She had been hospitalized at least a dozen times, usually forcibly committed when she became erratic and threatening.

For more than a decade, Keat's illness transformed a corner of her upscale neighborhood, where an unapproved house paint can prompt a scolding letter from the Homeland Association, into a virtual extension of the mental health system. But neighbors who were the first to spot signs of relapse were frustrated in their attempts to get her help.

Kenneth C. Schuberth, the pediatrician who lives next door, once got the name of one therapist who had treated Keat and faxed her a letter that would seem prescient in retrospect.

"Many of her neighbors are extremely concerned that she is acting quite strangely and that this may signal another relapse of her psychiatric condition," he wrote. "We strongly urge you to quickly take whatever action you think is appropriate to ensure the safety of both Mrs. Keat and the neighborhood. In the long run, some type of supervised living situation is necessary to avoid this chronic pattern of relapse and rehospitalization."

Schuberth faxed the letter in 1993, more than two years before the crisis that would end with Keat's death.

He received no response.

The first suspicion

It was nearly 30 years ago, but Jim Keat remembers the moment he first suspected his wife might be mentally ill.

He was the New Delhi correspondent for The Baltimore Sun; his brilliant, strong-willed wife was riding horses, learning polo and pursuing research in Asian studies. He had heard mutterings about Betty's odd behavior, but he had dismissed them.

Now, as he drove across the teeming Indian capital, he looked at his wife in the passenger seat. She was waving to the crowds in a slow, stylized manner, "like Queen Elizabeth," Jim Keat recalls.

The daughter of Slovak immigrants, she had won a scholarship to Hunter College, where she was president of the history club. She and Jim met as graduate students, drawn together by their mutual interest in India. They had married in 1955 on their first stay in New Delhi.

Now she deteriorated quickly. In 1967, she was sedated and brought home to New York, where psychiatrists first offered a diagnosis: paranoid schizophrenia. Later, as Betty Keat gyrated between hospitals and home in a dispiriting cycle, the doctors would explain her wild mood swings with a second diagnosis: bipolar disorder -- or manic depression.

To control her paranoid delusions, she took antipsychotic medications; for the manic depression, she took lithium. These were the miracle drugs of the 1950s and '60s that had made conceivable the deinstitutionalization of the mentally ill. From a peak of 9,530 people in Maryland's state mental hospitals in 1956, the hospitalized population has declined by more than 80 percent to 1,600 today.

When medication stabilized her illness, what people saw in Betty Keat was an impressive breadth of knowledge, a quick wit and real affection for those she felt close to.

She pushed her niece and nephew in New York to pursue their educations. She took them to museums, sent them tender notes and surprising gifts -- once, an enormous bag of popcorn, delivered by UPS with a note saying, "Have a party."

For 15 years, she taught sociology and anthropology at Morgan State University, where students and professors recall her, when stable, as an engaging, no-nonsense instructor. Stefan Goodwin, colleague, recalls her as "very decent and dedicated," a gourmet cook, an avid reader, an athletic woman who liked to skate, swim, bicycle and hike.

Feeling like a zombie

But like many patients, Keat didn't like the side-effects of her medications, including muscle twitches and flattened emotions. "She said the medication made her feel like a zombie," says her sister, Janet Beyer.

After a year or two -- sometimes just a few months -- of relative stability, Keat would stop taking her medication. And gradually, her symptoms would reappear.

When her illness flared, Morgan State students complained of insulting or racist remarks. Once she wrote to the FBI on Morgan stationery, signing herself "the Whore of God Almighty." In the early 1980s, she was banned from teaching; in 1986, she was dismissed in a budget-cutting move.

By then, her marriage had dissolved.

In every crisis, it had fallen to Jim Keat to cope. Betty's only close relative, her seven-year-younger sister, Beyer, was a widowed mother of two who lived in New York.

So it was Jim Keat who coaxed his wife to take her medication and who, when she didn't, had her committed to the hospital. He bore the brunt of her paranoid imaginings. Once she leveled an air rifle at him. From Springfield Hospital Center she ordered for delivery to her husband 200 elegant invitations to a "wedding reception" for her and an acquaintance. Another time, she placed an "In Memoriam" notice in the newspaper for her very alive husband.

Finally Jim Keat, too, wanted to escape her ranting accusations. He moved out in 1980; they were divorced in 1983; he remarried in 1986. But for some years he remained on call in crisis; as late as May, 1994, he took her home from Springfield Hospital Center.

Like Betty's sister and several of her therapists, her husband had long urged her to sell the house on Taplow Road. Having lost her marriage and profession, she clung to the house as "an emotional anchor," a palpable symbol of respectability, says Jim Keat, who retired last year as an editor of The Sun.

But taxes, maintenance and heat were too much for her disability checks and modest pension. There was no one to look after her, monitor her condition, encourage her to take medication.

And there were the neighbors, who had paid the considerable price of admission to this orderly suburb, never imagining what the lady next door might be like.

The lady next door

When Bill and Terry McDaniel bought 328 Taplow Road in the summer of 1985 and began remodeling, it wasn't long before Keat made her presence known.

When the McDaniels were out, she ordered workmen to leave, threatening to kill them for allegedly stealing her radio's batteries. When they were home, she raved at them for murdering the previous owners and burying them in the back yard. She declared loudly and often that their house "smelled like syphilis."

When Bill McDaniel cut the grass, she turned her hose on him. She tried to seal their doors and gates with duct tape and bicycle locks. Once she doused their yard with lighter fluid and ignited it, singeing the grass.

McDaniel, a lawyer, was quicker to go on the offensive than his wife, an art teacher. Early on, Terry McDaniel attended five therapy sessions with Keat, trying fruitlessly to win her trust. But in the years to come, Keat would report Terry McDaniel for child abuse, bash at her side door at dawn with a fence post, threaten her with a brick.

Eventually, Terry McDaniel confesses, "I didn't want to help her anymore. I just wanted the problem solved." The McDaniels, who have an 8-year-old daughter, documented Keat's transgressions, swore out complaints against her and summoned police. They pressured Springfield to keep her hospitalized longer. They videotaped her antics in the yard and, last year, filed a lawsuit against her.

On the other side of Keat's house, Richard and Theresa Toohey experienced the same spooky harassment, the same notes rambling about firearms and declaring, "I have permission from the police to kill you." In 1987, Keat told Theresa Toohey that if her husband kept spitting in Keat's windows late at night -- her latest delusion -- "he will be killed." In the Tooheys' bushes, Keat left a piece of paper chalked with an obscene threat, a razor blade taped below the scrawl.

The neighbors knew her patterns better than any therapist. For months after a hospitalization, she'd be stable, withdrawn. Then unusual statuary or plants would appear on the uncut lawn -- once it was unplanted rose bushes, arrayed to spell her initials. Sometimes a sign saying "The Cloisters" would appear on the front door. Lights would blaze in the middle of the night.

She was off her medication again.

A sad ritual

"There got to be almost a ritual, an annual cycle," Richard Toohey recalls. "I don't think there was ever a year when there wasn't a Betty something-or-other."

Once she was arrested near the White House in Washington, a shotgun in her car. Another time she led police on a high-speed chase down York Road; an officer had to break her window to get her out. One hapless officer who encountered her in her front yard was thrown to the ground with a judo-style flip. She confided to bewildered police officers that many of her problems resulted from her role as commander-in-chief of the North Command Post, a title she often put in the return address of her rambling letters.

"People were terrified of her," says Rebecca L. Johnson, a clinical psychologist who lived across the street for 11 years. "People didn't want their children in the yard if there was any chance that she'd be outside."

Johnson said she understood Keat's illness and tried to befriend her. But her attentions, she discovered, soon made her a target for her ailing neighbor's paranoid fantasies. She concluded it was best simply to avoid Keat.

When the Tooheys sold the house and moved to Baltimore County in 1990, Keat's behavior was a major reason, Richard Toohey says. "She was a fierce, imposing woman when she was at her craziest," he says.

Schuberth, the pediatrician who bought the Tooheys' house, quickly became a target for shouted abuse and threatening letters. One discussed her shotgun and said she hoped to

acquire a "bazooka or Tommy gun."

On several occasions when Keat relapsed, Schuberth and his wife, Linda, an occupational therapist, tried to alert officials at the institutions they knew had cared for her: Springfield Hospital Center, Sheppard and Enoch Pratt Hospital and the North Baltimore Center, an outpatient clinic on Charles Street.

Despite their knowledge of the health system, they failed. The therapists did not respond to phone calls or faxes, presumably because to discuss Keat's condition would violate confidentiality guidelines. Though the neighbors saw more of Keat than anyone, and though they carried some of the burden of her illness, they could play no role in her care.

"The mental health people made it clear to us," Linda Schuberth says, "that our only recourse was to call the police."

Conditions of commitment

Had Betty Keat lived in North Carolina, or one of 34 other states, she might have been placed on "outpatient commitment." Rather than commit her to a hospital, a court could have ordered her to attend therapy or take her medication as a condition of staying in the community.

Had she lived in New Hampshire or one of several other states, she might have been granted "conditional release" from a mental hospital, whose director would have the right to order her rehospitalized if she refused treatment.

Maryland law permits neither of these options, which are often opposed by advocates for patients' rights because of the potential for abuse. Instead, the mental health system in Baltimore generally relies on coaxing patients to accept voluntary treatment. How assertive a clinic is in pursuing fearful or delusional patients -- whether therapists make repeated visits, try persistently to establish trust, seek the intervention of friends and relatives -- often determines whether treatment can be given.

Whatever the approach, the challenge is the same: how to keep patients on the medications many need as surely as a diabetic needs insulin.

That was Stephanie Jamieson's job when she took on the care of Betty Keat upon her release from Springfield in May 1994. Jamieson is a psychiatric nurse with the North Baltimore Center on Charles Street, one of seven mental health agencies that serve different areas of the city under the coordination of Baltimore Mental Health Systems Inc.

For a year, Jamieson provided what medical records suggest was attentive care, visiting Keat at home about once a week. She not only administered injections of an anti-psychotic drug but took her lonely client to lunch and on shopping trips, providing a sympathetic ear.

Improvement

Keat showed modest improvement. She swam, bicycled, cleaned house, even attended a few lectures sponsored by the Baltimore Council on Foreign Affairs. She appreciated being out of the hospital and so feared going back that once, in September 1994, she told a social worker she would prefer to be forcibly medicated.

"Client expressed that she would like to have something in place where if client gets so sick and refuses medication that NBC [North Baltimore Center] could give it to her anyway," the social worker wrote.

But last May 16, after returning from shopping for birdseed and houseplants, Keat abruptly told Jamieson she wanted no more visits and no more medication. "When therapist tried to discuss it," Jamieson wrote, "client said she had nothing to talk about and walked away."

Six days later, Jamieson sent a brief letter to Keat. "I was surprised and dismayed by your decision to dismiss me and to discontinue treatment by the North Baltimore Center," she wrote. "Although I am aware that you see no need for continuing mental health services, I am concerned that you will relapse and end up back in the hospital. That would be a shame, considering how much time and energy you have devoted to putting your house and life back together."

She urged her to call or write, and on "two or three occasions" drove by Keat's house and "saw no evidence of problems," according to a written statement provided to The Sun by the North Baltimore Center. Then, after consulting with superiors, she closed the case on July 21.

North Baltimore Center's decision to close the case was not based on a belief that Keat had recovered. Discharge papers ranked her as "severely dysfunctional" in nearly every area. But the center failed to notify Jim Keat or Janet Beyer, and took no steps to monitor her condition or to seek her hospitalization.

The right to refuse

In their written statement, North Baltimore Center officials said they believed they had done the right thing. "We have evaluated the case and have determined that, in addition to the drive bys, the letter was sufficient," the statement said. It also pointed out that the center is "required to respect an individual's right to refuse treatment."

Betty Keat's decline took its familiar course. By fall, she was regularly clashing with the neighbors: spraying her hose on the McDaniels' house, throwing stones at Linda Schuberth, slipping out her living-room window at dawn to steal the neighbors' newspapers.

Jamshed Ghandhi, an old friend whom Mrs. Keat had befriended when she was a graduate student and he was a 15-year-old undergraduate from India, visited her in early November. A professor of finance at the Wharton School, Ghandhi caught a train from Philadelphia and spent a few hours at the Taplow Road house, which he found cluttered and cold.

"She was very bad, really bad," says Ghandhi. "Talking about everything -- 50 items at the same time, ranging from the political scene to the Vermeer exhibition."

When January's blizzard buried Baltimore, the next-door neighbors found themselves wondering about Keat. They had not seen her for days and were not sure her home had heat.

Linda Schuberth saw a light on at 4 a.m. one morning and was reassured. Terry McDaniel checked with Jim Taylor, who lived across the street; he pointed out a certain curtain that Keat opened each morning and drew each evening.

It was Taylor, 77, who spotted her at 4: 30 p.m. the Friday after the blizzard, marching down Taplow with the bottles of lighter fluid. He whispered to his companions, who were helping him shovel snow, "Just don't say anything."

"She had a wild look in her eyes," Taylor says.

The neighbors watched as Keat threw the bottles and disappeared. Taylor rang Terry McDaniel's doorbell and told her what had happened. Two more of the would-be firebombs clattered from Keat's small, third-floor window, landing in the snow between the houses.

Terry McDaniel called the police.

A young, female officer arrived first. Catherine Taylor, Jim's wife, spoke with her and realized she knew nothing about Keat.

"I told her, 'Don't you try to do this yourself,' " Catherine Taylor says.

Soon several more officers arrived, knocked at Keat's door and shouted.

As four officers climbed in through the window, the Schuberths joined the McDaniels on the McDaniels' staircase, peering into the darkness and following the officers' progress through the house as their flashlights illuminated windows on the first and second floors.

A third-floor room was locked; later, officers would find a wedge of brie cheese in a small box on the floor, and some walnuts and a nutcracker on the neatly made bed. On the desk, they would find a pile of books reflecting Keat's scholarly passions, India and Islam. In the closet, they would find a shotgun and ammunition.

There was a sound of a scuffle, then muffled gunshots, then voices calling "10-38! 10-38!" It was the code for an ambulance.

Final attentions

In death, Betty Keat drew more attention than she ever had in life.

Her sister, niece and nephew visited Baltimore for the first time in many months, demanding explanations from the police and hiring an attorney to investigate the shooting. Top mental health officials met police Commissioner Thomas Frazier to discuss how such tragedies might be averted, and the department agreed to beef up its training on mental illness. Baltimore Mental Health Systems Inc. asked North Baltimore Center and its other six component agencies to review their policies on what steps to take when a delusional patient refuses treatment.

Keat's death became a symbol -- but what it symbolized depended on who was talking. Her relatives spoke of intolerant neighbors; neighbors muttered about the failure of relatives to care for their own. Mental health workers questioned whether the police really had to shoot her; police asked why no mental health worker was in touch with a lonely and psychotic woman.

Jamshed Ghandhi, the old friend who was perhaps Betty Keat's last visitor, discovered that she had left him in her will an antique ivory crucifix she had purchased in India long ago.

"I suppose I brought back fond memories of her graduate school days," he says. "She was a woman of many passions then. It was heart-rendingly sad to see what became of her."

Betty Keat's life and death, he said, illustrated how inadequate the system was for supporting patients as disturbed and as demanding as she could be.

"It's easy to say, 'You're completely free.' And it's easy to say, 'You're locked up,' " Ghandhi said. "To manage someone in between is far more difficult and more complex."

Pub Date: 5/07/96

Baltimore Crisis Response Inc.

Started in 1993, Baltimore Crisis Response runs a hot line and dispatches teams of professionals -- psychiatrist, psychiatric nurse and counselor -- to defuse crises involving the mentally ill. Supported with state and federal money through Baltimore Mental Health Systems Inc., the service currently operates only in East Baltimore, though it is seeking funding to expand to citywide operation.

The service appears to be exactly what Betty Keat's neighbors wished for: someone to call to engage the mental health system. The teams are trained to go to great lengths to reach mentally ill people who are fearful, hostile and inclined to refuse treatment.

The 24-hour hot line number, which is expected to receive 10,000

calls this year, is (410) 752-2272.

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