John Hinckley, from St. Elizabeth's hospital to Williamsburg, VA

There's a difference between being disturbed and being dangerous. Let's hope the docs at St. E's aren't proven wrong in their assessment. 

NY Magazine

"In his fantasy pursuit of Jodie Foster, [President Reagan's would-be assassin John] Hinckley cast himself as a chivalric knight, but in life, he had never had a girlfriend. In the hospital, that changed. Hinckley became a promiscuous lover of real women, some of whom seemed to love him back — and others who did not. Leslie deVeau was already a patient at St. Elizabeths when Hinckley arrived, having murdered her 10-year-old daughter in her sleep. (She had then turned the shotgun on herself, but missed her heart and blew off her left arm.) She also was white, and from an upper-middle-class family. Hinckley approached her at a Halloween mixer. “I’d ask you to dance if I danced,” he said.

Their courtship blossomed slowly, over 20 years, constrained by stringent rules and schedules. When they could not see each other, they would exchange letters, taping them beneath the dining tables in the cafeteria. But the romance intensified when deVeau was released (in 1990) and began coming to see him during visiting hours. They would hold hands across a large table and talk, under the watchfulness of the hospital guards. deVeau needed someone to mother, she told The New Yorker in 1999. Hinckley, whom others found distant and defensive, was revealing and loquacious with her, she said. When they first started having sex, outdoors, nearly ten years after they met, it wasn’t awkward, despite Hinckley’s inexperience. “It was as if we’d both had this core of loneliness for a hundred years,” said deVeau.

...

With Cynthia Bruce, another patient at St. Elizabeths, Hinckley cast himself in a savior role. Bruce, several years younger, has severe schizophrenia and has spent her life in and out of hospitals, according to court documents. By 2009, when they became close, the judge had already approved a series of furloughs home for Hinckley — 12-hour day trips in 2003 and then three-day overnights in 2006 — and his focus was on getting released. In the hospital, he and Bruce were inseparable. And when Hinckley was in Williamsburg, to the annoyance of his mother, they talked incessantly on the phone.

But Hinckley had mixed feelings about Bruce. On the one hand, he loved her. The relationship was “pretty intense,” he told a psychiatrist, and he gave her several rings, including one that was “like the one William gave Kate,” he said. Hinckley even told his family they intended to marry, and said he was considering conversion to Catholicism because Bruce was so devout. On the other hand, he hoped to be out of the hospital soon, so “what’s the point of being engaged to her?” (“It’s very confusing, because they are either engaged or not engaged,” his psychiatrist said.) Another doctor expressed concern that Hinckley was being deceitful, leading Bruce on in order to ameliorate his loneliness. Certain people saw the relationship as evidence of his increased empathy; others saw a mind almost weaponized by selfishness. At a hospital Christmas party, Hinckley was gentlemanly when Bruce had an anxiety attack, escorting her to the front gate so she could get home. But when she’d stood outside the hospital, in full-blown psychosis, holding a sign on a pole and screaming religious terms and his name, Hinckley told his doctors he didn’t hear her.

How do doctors decide when a person’s fantasies are dangerous? In assessing patients for release, psychiatrists talk about “state or trait.” Did a person commit murder because of his “state” — hallucinations or delusions or drunkenness? Or was it depression or a mania that is a part of an underlying disorder — a “trait”? How good is the patient at understanding himself, managing his illness, and acting responsibly in his own interest?

Within three years of hospitalization, John Hinckley’s most dangerous symptoms — his obsessive, fantastical, suicidal-homicidal-romantic thoughts — had abated and, his lawyer says, without the help of psychotropic drugs. But whatever mental illness Hinckley had, it was atypical. “For some people, their symptomology doesn’t fit neatly into a category, or even two or three,” says Paul Appelbaum, the Columbia psychiatrist. “The field doesn’t have it all figured out yet. It’s not unusual to see people who have had multiple diagnoses, incompatible diagnoses, and now have a new set of diagnoses.” Eventually, the hospital settled on a durable clinical label for Hinckley’s illness: major depression and nonspecific psychosis, both of which had been in remission since at least 1990. And over time, Hinckley remained symptom-free. Generally speaking, age modulates psychosis and diminishes violent impulses."