Personality disorders best explain the Capital Gazette gunman’s symptoms, not the more serious mental illnesses with which defense experts diagnosed him, psychologists testifying for the prosecution said Monday.
Dr. Marshall Cowan, of the Maryland Department of Health, said the mass shooter has narcissistic personality disorder and suffered from “narcissistic injuries,” or slights he couldn’t overcome, prompting him to become angry and spiteful. Cowan dismissed that the three major mental disorders diagnosed by defense experts accounted for the gunman’s symptoms.
Meanwhile, Dr. Scott Bender, of the University of Virginia, raised doubts about the psychological tests utilized by the defense experts to arrive at their diagnoses of delusional disorder, obsessive compulsive disorder and autism spectrum disorder.
He said some of the tests lacked reliability checks, failed to differentiate between similar diagnoses or neglected to take into account the context of his pending trial.
Neither doctor offered an opinion about the sanity of the man who killed Gerald Fischman, Rob Hiaasen, John McNamara, Rebecca Smith and Wendi Winters. But the two psychologists were the first mental health experts to refute testimony from experts hired by Jarrod Ramos’ attorneys who supported his insanity defense.
The defense experts testified Ramos long suffered from delusions, or fixed false beliefs rooted in mental disorder, that caused him to believe he was being persecuted.
Cowan, who met with Ramos for a total of eight hours as part of a sanity evaluation ordered by the judge, testified Ramos’ strange and spiteful thinking was reality-based. He said all of Ramos’ anger traced to his anger over the newspaper writing about his harassment conviction, something that really happened.
What may have seemed like delusions were actually just real ideas overblown in Ramos’ mind because of his personality disorders, said Cowan, referring to Ramos’ losing court battles with the newspaper that ended with rejection by a Maryland appeals court.
Cowan also diagnosed Ramos with schizotypal personality disorder. Personality disorders typically aren’t enough to support insanity defenses.
“(Ramos) collected narcissistic injuries since 2011 and has continued to gather people and resentments and anger related to an ever-growing group,” Cowan said. “When he failed in the Court of Special Appeals he had nowhere else to go.”
That’s evidence of Ramos’ narcissistic personality disorder, which also was supported by Ramos’ seemingly isolated existence, Cowan said. He highlighted some of the diagnostic criteria for the condition in the Diagnostic and Statistical Manual of Mental Disorders, 5th Edition, a guide to help mental health professionals diagnose patients.
“Vulnerability in self-esteem makes individuals with narcissistic personality disorder very sensitive to ‘injury’ from criticism or defeat,” the description reads. “Although they may not show it outwardly, criticism may haunt these individuals and may leave them feeling humiliated, degraded, hollow and empty. They may react with disdain, rage or defiant counterattack.”
Cowan said he dismissed the possibility of developmental disorders, such as autism, and that he ruled out obsessive compulsive disorder because Ramos denied the obsessive rituals often associated with that condition. Defense experts said Ramos’ OCD led to his life becoming consumed by one line in the newspaper column that he believed tarnished his reputation.
During the first weeks of trial, Dr. Catherine Yeager, a psychologist, and Dr. Thomas Hyde, a neurologist, testified that Ramos suffered from severe mental conditions. Dr. Dorothy Otnow Lewis agreed and said she believes the 41-year-old is not criminally responsible because his conditions prevented him from understanding what he did was wrong and from being able to stop himself from doing it.
Bender, a neuropsychologist hired by the State’s Attorney’s Office to examine psychological testing used in Ramos’ case, also disputed how the defense experts arrived at the OCD diagnosis, saying the test that Yeager used to support her diagnosis doesn’t sufficiently differentiate between OCD and the less serious obsessive compulsive personality disorder.
He said a test used by defense experts to assist in their OCD diagnosis and another that’s a screener for autism are easily researchable online to the point a person taking it “could pretty much nail it.”
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The diagnosis of autism spectrum disorder by the defense, Bender said, was troubling because it lacked information from Ramos’ key developmental years.
Autism usually is diagnosed in children because parents or teachers notice a child isn’t developing appropriately, he said. It can be diagnosed in adults, but, when it is, it’s suggestive of a milder form of the spectrum disorder, which ranges dramatically in severity.
“Any evidence of autism spectrum disorder seems to come from Mr. Ramos himself, many, many years later,” Bender said.
Lewis and Yeager testified autism prevented Ramos from understanding the magnitude of damage and trauma he caused the families of the people he killed and the victims who survived his attack on the Capital Gazette, part of Baltimore Sun Media.
Bender also said Ramos barely reached the threshold for a test tailored for detecting delusional disorder and similar conditions, and that Yeager didn’t evaluate his results based on a different grading scale developed for incarcerated people awaiting trial, who naturally score higher on parts of the test that scan for paranoid thoughts.
Applying that context, Bender said, Ramos results’ appear to be much more normal.
Capital Gazette reporter Lilly Price contributed to this article.