State of Mind

When the Death Penalty and Serious Mental Illness Collide

An Arizona case tests the question of when the government can execute someone with serious mental illness.

Open door revealing an empty execution chamber, with a cot.
Photo illustration by Slate. Photo by Paul Buck/AFP via Getty Images.

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On Tuesday, an Arizona judge declared Clarence Dixon competent for execution, allowing the state to take another step toward what is scheduled to be its first execution since 2014. The ruling—which will be appealed and comes despite the fact that Dixon’s lawyers argue his “mental illness thwarts his ability to form a rational understanding of the State’s reasons for his execution”—provides a widow into the question of when the government can execute someone with serious mental illness.

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In 1978, two days before he committed the murder for which he would later be sentenced to death, Dixon sat before then-Maricopa County Superior Court Judge Sandra Day O’Connor, facing assault charges. Dixon had approached a stranger on the street and hit her over the head with a metal pipe, according to court records. Following his indictment, Dixon was diagnosed with severe depression and schizophrenia, determined incompetent to stand trial, and referred to the state hospital for treatment. “I have a strong feeling that without presence of the mental disturbance, the act of violence would not have taken place,” wrote one of the doctors who evaluated Dixon.

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After Dixon spent a few months in treatment, O’Connor found him not guilty by reason of insanity and ordered he be referred to civil commitment proceedings within the next 10 days. Dixon was then released.

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Fewer than 48 hours later, on Jan 7, 1978, 21-year-old Deana Lynne Bowdoin was raped and murdered in her apartment. Bowdoin was in her final semester of a marketing degree at Arizona State University and planned to work in international business after graduating, the Arizona Republic reported at the time. Her case went cold.

Two decades later, in 2001, DNA testing linked Dixon, who was serving a life sentence in state prison for an unrelated sexual assault conviction, to Bowdoin’s murder. During his trial for Bowdoin’s murder, Dixon fired his court-appointed lawyers and represented himself. He was convicted and sentenced to death in 2008. After a lengthy appeals process, on April 5, the Arizona Supreme Court set Dixon’s execution date for May 11.

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“I will never stop thinking of Deana, but I look forward to resolution of Dixon’s criminal matter through the imposition of punishment,” Leslie James, Bowdoin’s sister, wrote in a statement after the Arizona Supreme Court’s ruling. “Deana’s brutal murder, the 23 years of wondering who was responsible, and the 21 years of our involvement in the criminal justice process has been a long road that none of us asked for and none of us deserved.”

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Over the past month, Dixon’s lawyers have mounted last-ditch legal battles on several fronts—arguing, for example, that law enforcement officials are overrepresented on Arizona’s clemency board; that Arizona has not shared enough information about the drugs that will be used in the execution and that those drugs are likely to cause “undue suffering” due to Dixon’s underlying health issues (particularly relevant given the state’s botched execution of Joseph Wood in 2014, which took nearly two hours and 15 injections, the Guardian reported); and most prominently, that Dixon has no rational understanding of the reason for his execution, making the same unconstitutional.

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According to psychological assessments presented by his attorneys, Dixon—a member of the Navajo Nation, which opposes the death penalty—has often suffered auditory, tactile, and visual hallucinations, and is under the delusion that his execution is the result of a wrongful arrest in 1985. What’s more, a neuropsychological evaluator noted in 2012 that Dixon had potential brain damage, which was confirmed by a second doctor.

In a report from March, which Dixon’s attorneys used in Tuesday’s competency hearing, a psychiatrist diagnosed Dixon with schizophrenia and found him “disconnected with reality, especially as it relates to his legal case” and “fixate[d] on an issue that is unrelated to his execution, limiting his ability to abstractly consider why he is to be executed.”

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Maricopa County Assistant Attorney General Jeff Sparks, on the other hand, argued Tuesday that “nothing prevents [Dixon] from rationally understanding” the reasons for his execution. The state’s psychological evaluator diagnosed Dixon primarily with an antisocial personality disorder and opined he understood the connection between the 1978 murder he was convicted of and his upcoming execution. (The state’s evaluator spent 70 minutes with Dixon via video conference, whereas the defense evaluator visited with Dixon five times in person.)

Dixon’s lawyers also argue that Arizona’s definition of competency for execution is narrower than the standard established by the Supreme Court, and thus unconstitutional. Under Arizona law, someone is incompetent when they are “presently unaware” that they are to be punished for murder and that the “impending punishment for that crime is death.”

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The Supreme Court has addressed the standard for competency for execution in cases including Ford v. Wainwright, Panetti v. Quarterman, and Madison v. Alabama. Put together, the cases establish that it is unconstitutional to execute someone who is legally insane and that the person put to death needs to understand the “meaning and purpose” behind the execution, and the “link between … crime and punishment.” In Panetti, which both parties agreed to use as the standard for Tuesday’s hearing, the majority wrote,  “A prisoner’s awareness of the State’s rationale for an execution is not the same as a rational understanding of it.”

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Not everyone with a serious mental illness and/or delusions is incompetent to be executed. According to Robert Dunham, executive director of the Death Penalty Information Center, the question is, “What does the delusion go to?”

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Pointing to the way delusional thinking influenced the lead-up to Dixon’s crime, the crime itself, and his resulting interactions with the court system, Dunham described Dixon’s case as “one of the strongest” mental health defenses he’d ever seen.

On Tuesday evening, however, Judge Robert Olson determined that Dixon did not prove that “his mental state is so distorted by a mental illness that he lacks a rational understanding of the State’s rationale for his execution.”

Individuals with mental illness are overrepresented on death rows across the country. According to an analysis by Frank Baumgartner and Betsy Neill published in the Washington Post in 2017, “43 percent of inmates executed between 2000 and 2015 had received a mental illness diagnosis at some point in their lives,” compared with 18 percent of the general population being diagnosed with any mental illness, and 4 percent being diagnosed with serious mental illness. Four percent of people executed had been diagnosed with schizophrenia, compared to 1 percent of the general population. States including Kentucky and Ohio have passed laws to prohibit the execution of people diagnosed with a serious mental illness. Since 2017, similar initiatives have been introduced in 10 other states, according to the Death Penalty Information Center. (Here, it’s important to make clear the vast majority of people diagnosed with mental illness never commit a crime, nevertheless, those who do get caught in the criminal justice system face significant barriers to treatment and justice, and are more likely to make false confessions, to appear “off” to juries, and to be unable to assist their attorneys.)

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In a clemency hearing on April 28, Dixon’s lawyers focused on his serious mental illness at the time of the crime and since, as well as what they identified as significant flaws in his trial process, largely due to the fact that he represented himself. Lawyers for the state, on the other hand, argued that there was no proof that Dixon was legally insane at the time of the murder, because O’Connor’s insanity finding was related to his state of mind at the time of a different crime, the assault, and Dixon had received treatment in the lapse between the assault and O’Connor’s ruling. They argued Dixon was a “predator,” a threat to the community, and without remorse. Citing their psychological evaluator, state attorneys said there is no reason to believe Dixon is currently delusional or incompetent. The four-person board did not grant clemency.

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Dixon’s crime is a horrific one—neither that nor his guilt are in question. Bowdoin was not his only victim, either. He sexually assaulted other women and is currently serving a life sentence for one such conviction. There is no evidence he has shown remorse. Even if he had, the harm of his actions is irreversible.

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But we are left, ultimately, with what-ifs. What would have happened if, upon his first interaction with the criminal justice system, Dixon would have gotten the treatment, and follow-up, he needed? If he hadn’t been released without treatment and supervision? If there were a more robust public mental health system for people diagnosed with serious mental illness and charged with a crime?

“I was found incompetent in court in the past,” Dixon reportedly said in a psychiatric interview in August 2021, referring to the court proceedings two days before Bowdoin’s death. “I was ordered to the Arizona State Hospital, and someone dropped the ball.”

State of Mind is a partnership of Slate and Arizona State University that offers a practical look at our mental health system—and how to make it better.

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