Crime Library: Criminal Minds and Methods

Rampage in Camden

Unruh in Retrospect

The more random the killings, says sociologist Jack Levin, and the more it occurs in public places among absolute strangers, the more likely it is that the killer is psychotic, or insane.

That was not the case with Howard Unruh.  He knew most of the people he had killed, hed placed them on a list, it was his neighborhood, and the spate of killings was the result of what he called a preconceived plan.  He even believed he was not crazy.  When he heard sirens, he rushed home.  Thus he knew that what he had done was illegal or wrong.  He was aware and he had made a plan.  That frame of mind generally does not pass in todays courts as insane.

The Encyclopedia of Schizophrenia and the Psychotic Disorders, by Dr. Richard Noll

Dr. Richard Noll, professor of psychology at DeSales University and author of The Encyclopedia of Schizophrenia and the Psychotic Disorders, now in its second edition, offers a perspective on the manner in which Unruh may have been diagnosed in 1949.

It sounds more like schizoid personality disorder or paranoid personality disorder, in modern DSM-IV parlance.  When someone was violent back then, they always invoked the diagnosis of paranoid schizophrenia.  If someone was distraught (from emotional trauma, for example), that might be called pseudo-neurotic schizophrenia. 

Paranoid schizophrenia is traditionally one of the most misused diagnostic labels in both clinical and forensic contexts.  Schizophrenia is an insidious, chronic brain disease that takes many forms, the paranoid subtype being one of them. The age of onset for this subtype tends to be slightly older than for other subtypes, has a better prognosis, and is most likely to be helped by treatment.  The hallmark of the paranoid subtype is delusions, usually of a persecutory or grandiose nature.  For the individual in Trenton Psychiatric Hospital since 1949 who killed 13 people because he believed his neighbors were slandering him, you would have to place that explosive event in the context of prior mental status and subsequent clinical observations.  Anyone -- especially a male under great stress due to a divorce, job loss, death of a loved one, etc. -- could become paranoid and violent under conditions of extreme and prolonged stress.

In a clinical contest, it is really quite difficult to distinguish between paranoid schizophrenia, an agitated manic episode of bipolar disorder, delusional disorder, a brief psychotic reaction, or someone with a paranoid personality disorder (a character disorder, not a psychotic disorder), who simply loses it.    Without a detailed clinical history, it is hard to assess whether the diagnosis was a correct one.  However, it is true that the diagnostic criteria for paranoid schizophrenia have tightened up considerably since the 1940s when this incident took place, and back then the term paranoid schizophrenia was liberally dispensed in a forensic context as almost a euphemism for raving madman. Anytime violence entered the case history, the paranoid schizophrenia diagnostic label was almost automatically applied, even if someone was bipolar and violent, or under stress and violent.

In other words, had he gone on his rampage today, his paranoia would have been acknowledged but unless psychosis actually affected his ability to appreciate that what he was doing was wrong or made him unable to comply with what he knew, then he would have been declared legally sane.

Howard Unruh remained at Trenton Psychiatric Hospital and as of this writing, is still there, according to Ramsey, mopping floors.  Now in his 80s, he reportedly has spoken to no one since his mother died some years ago.  He has ground privileges now and just keeps to himself.