Jason’s Story Jason is a twenty-year-old patient who is accused of second-degree murder for killing a twenty-one-year-old female (Yvonne) one year ago, and was subsequently certified into a state forensic hospital for further evaluation and treatment while awaiting trial. His counsel intends to allege that he was in a dissociative state, due to possible drug use, when he stabbed the victim to death. Childhood Jason is an only child . From the age of five, his teachers and parents noted undue aggression, distractibility, and a lack of concentration. By his own admission, he was impulsive, acted out, and experienced temper tantrums three to four times per week. At school and at home his temper problems continued and he was described at school as "a bully with no friends" His parents noted that around the age of nine, they began to see a cycle developing. In the first stage of the cycle, he would start school, a project, or a new routine motivated and positive. His positive beginnings were short-lived however, and he would become frustrated, blow up, and get angry, followed by a calm period. His parents noted that his ability to cope with feelings such as frustration related to the phase of the cycle. At the age of thirteen, his maternal grandfather, with whom he was very close, died. This was devastating to him. He took this quite badly as his grandfather was a significant person in his life. In grade seven (age thirteen), he attended a new school, and although he was very anxious about starting there, the year began well. However, within six months his parents reported that he had poor peer relationships and was bullying other children. He was suspended for stealing items from other student's lockers. During this period, he reports that he frequently lied and stole from his parents. Jason admitted, in the intake interview, that he started using marijuana when he was thirteen. After Christmas that year, his parents sent him to live with his aunt, uncle, and cousins. He got along well with his relatives for most of the spring and few problems were noted with his temper. His mood stabilized. In May, however, he threatened his Aunt with a knife when she tried to stop him from taking his Uncle's motorcycle. He dropped the bike on the ground and ran into the house. He proceeded to start destroying his possessions. When confronted by his aunt he broke down and started to cry. He was remorseful about the incident but was returned home to his parents. Home Life His parents state that there was a great deal of emotional tension in the house. He was referred to the Nelson Treatment Centre for assessment, but Jason refused to see the therapist. During the summer months in subsequent years, he spent a lot of time at the family cottage and seemed to benefit greatly from his relationship with Yvonne (the murder victim). The relationship was described by his parents as a "brothersister" relationship. He returned to school in September each year, but was suspended often for infrequent attendance. His mother reports that he was difficult to tolerate because of his drug use and his refusal to do any chores around the house. His mother reported that she was afraid of him because his outbursts were so unpredictable. An unchaperoned house party led to substantial damage to Jason's house and this resulted in a significant confrontation with his parents. His parents asked him to leave (He just turned eighteen) and he spent several weeks living in Yvonne's apartment. He reports that his status at her apartment was one of a friend who was staying with her temporarily. During this period he had a girlfriend who broke up with him. His parents reported that he was quite upset by this. He stole Yvonne's car, drove to his grandmother's summer cottage, and broke in. He vandalized several cottages. After spending two days at the cottage, he decided to return the car to Yvonne. However, he panicked when he saw the police at the roadblock (checking for drunk drivers). The police chased him but he managed to lose them. He hid for an hour and started driving again but fell asleep while driving and the car ended up in the ditch. He walked to the nearest town, went to the police department, and told them what happened. He was arrested and sent to the Mental Health Center for a court-ordered assessment. He was given a one-year probation (convicted of six counts of Breaking and Entering, taking an automobile without consent, and careless driving). His conditions of treatment included seeing a doctor and attending group therapy. Pre-Murder About six weeks prior to the homicide, Jason reports that he started having what he called "rushes" in which he would feel very strange, tense and agitated. The acute stage would last for about five minutes but he would continue to feel strange for a few hours. His parents had left town on a two-week holiday and he was staying at home alone. He sought help from his uncle who took him to the emergency room at the hospital. The doctor described Jason as being "very anxious, continually clenching his fists" and gave him a prescription for diazepam. The night prior to the homicide he stayed at a friend's house partying (doing acid and drinking vodka). The next evening around 9 pm, he went to stay with Yvonne. He reports waking up at 3:00 am trying to control his feelings of panic and his need to run away. He was having suicidal thoughts and felt that he needed to take Yvonne's car and get away. At some point he remembers the knife being in his hand and that he was stabbing Yvonne in a state of extreme emotional rage (victim was stabbed approximately sixteen times). He claims he did not remember the actual attack, but he remembers feeling a sense of relief some time afterward. He remembers covering the body with a sheet. He says he took a shower, changed clothes, took her car keys and left. He went to work and told them he did not feel well. When asked about cuts on his hands he claimed he had cut his hand when changing a tire. He returned to Yvonne's apartment and took her car and left the city heading towards his grandmother's cottage. The car broke down several miles outside the city. When the police stopped to ask him if he needed help he acted very confused and could not identify himself. The police arrested him. Post-Murder Jason has not been able to explain adequately the motivation behind his actions. He reports he does not understand why he would have killed his "best friend." During the interview, he talked at length about his friendship with Yvonne, described her as like a big sister to him, and expressed remorse for what he had done. He stated that he felt she was the only person in the world that he could turn to and that he valued her friendship and support. When he first arrived at this hospital, Jason reported that he wanted to gain insight into his behavior. More recent reports, however, indicate that he blames the homicide on his mental illness and is refusing to take part in psychotherapy. In the last four months, he seems to have gained a measure of control over his impulses and has not been a management problem on the unit. According to nursing reports, Jason tends to have somewhat condescending attitude towards the other patients and can be sarcastic to staff when denied a request. It has also been noted that Jason will "go shopping from staff to staff when he does not receive the answer he wants."
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