By Kathleen Brady Shea, Managing Editor, The Times

A psychiatrist for the Chester County District Attorney’s Office testified on Thursday, April 10, that a former county resident acquitted of heinous crimes in 1980 by reason of insanity remains a danger to himself and others and needs to stay institutionalized – an opinion three other doctors disputed.

The conflicting testimony in Chester County Court has occurred for at least a decade at the annual commitment hearing for Richard Greist, who has resided at Norristown State Hospital for most of the past 35 years. In 1978, during an apparent psychotic rampage, Greist fatally stabbed his pregnant wife at their East Coventry home, ripping his unborn son from her womb with a screwdriver and mutilating the fetus. He also gouged his 6-year-old daughter’s eye, slashed his grandmother’s throat, and butchered the family cat.

Because a judge ruled that Greist could not be held responsible for his crimes, he can never be incarcerated for them; however, the court holds an annual commitment hearing to review Greist’s record and hear what are generally dueling recommendations for his future. The hospital’s doctors have been working to transition Greist into a group home while the commonwealth’s doctor  has maintained that until Greist understands and accepts responsibility for his actions,  he poses a risk to the public.

Like the previous several hearings before Chester County Court Judge Edward Griffith, three psychiatrists testifying in Greist’s behalf, two of whom interact with him regularly at Norristown State, believe that he is making progress and deserves more frequent privileges to leave the hospital grounds on day and weekend passes.

In countering that view, Dr. Barbara Ziv, a psychiatrist who has been evaluating Greist for a decade, testified that substantial literature supports the belief that treating psychiatrists can often lose their objectivity. She said she believes that Greist’s grip on reality has declined in the past year. She said her opinion was based in part on an unsettling interview she had with him earlier this week, during which he presented her with a threatening letter.

In it, he accused her of telling his attorney, Marita Malloy Hutchinson, in 2006 that nothing Greist could ever do would make Ziv change her mind, a statement that Ziv disputed and is not contained in the court record. As a result, Greist suggested that Ziv read a passage from Deuteronomy that he included in the letter.

The passage focuses on retribution for those deemed to be a “false witness,” recommending that such a person would deserve to have done to them “as he had schemed to do to his brother.” The passage goes on to espouse “eye for eye” justice.  Greist ended by saying: “Under current mental health laws, it is your obligation as a reviewer to recommend to the court, my discharge.”

Ziv testified that “no matter how you look at it, it’s a threat. …If you bear false witness, this is what’s going to happen to you.” She said the fact that Greist would present her with such a letter before a court hearing, knowing that it would become part of the record demonstrates “extremely poor insight, extremely poor judgement.”

In addition, it underscores Greist’s tenuous grasp of reality and the danger he poses, she testified, adding that Greist has relentlessly pursued his goal of getting “out of the hospital” for decades without attempting to understand what got him there. Instead, he suggests that “it was mostly sleep deprivation” that led to his rampage, a meritless contention, Ziv said.

Without the structure of a contained institution, Greist “has the capacity to become violent, aggressive and flagrantly psychotic,” Ziv testified. She added that Greist could be very charming so she is not surprised that others have a different opinion.

Although Hutchinson did not have questions for Ziv, Greist did, and he began his cross-examination by asking the psychiatrist if she remembered “when the U.S. landed on the moon.” The judge cut him off, stating that it was not relevant. Greist countered that it would be but moved on when he saw that Griffith was not going to change his mind.

Greist and Ziv disagreed over what she viewed as examples of his psychosis, such as the time he incorrectly insisted that he was discharged from the hospital with a cerebral hemorrhage.

Dr. Ira Brenner, who conducts weekly psychotherapy sessions with Greist, testified that he is familiar with literature that suggests treating doctors can  be biased but felt that he had maintained an objective analysis. He described Greist as an “exquisitely sensitive and remorseful individual” who showed no signs of psychosis.

In fact, Greist’s ability to survive – “and in some ways thrive” – in the state hospital setting showed that he deserved increased privileges, Brenner said. He also testified that he found Ziv “extremely courageous” for continuing with Greist’s interview if she had felt so threatened by his letter.

Greist took a couple of minutes toward the end of the hearing to apologize to Ziv, who had already left the courtroom. He said he now realized that the letter represented “a terrible mistake.”

Hutchinson said she believed the judge should increase Greist’s unsupervised time off the hospital grounds in accord with his doctors’ recommendations; however, Assistant District Attorney Peter Hobart urged Griffith to consider the reverse. Hobart pointed out that the judge increased Greist’s privileges last year, prompting Ziv to conclude that if Greist “gets an inch, he takes a mile.” Calling Ziv an advocate for the public’s safety, Hobart suggested that the fact that Ziv is concerned about Greist’s behavior should inform the court’s decision to reduce his privileges, not expand them.

“I will tell you that I am troubled by this letter,” said the judge, who is expected to issue a decision after reviewing all of the materials.