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Review Report—Department of Clinical Psychology
Name of Patient: Robert Daniel Keane (DOB 03/31/1986, age 18)
Robert (preferred name: Robbie) has been seen on a monthly outpatient basis since his arrival at Northbrooke Children’s Home in February 1996.
History
Robert was originally admitted following the fatal stabbing of his uncle and father. The police investigation at this time concluded that Robert had committed the murders. However, as Robert was below the age of criminal responsibility when the crimes were carried out, the judge recommended placement in Northbrooke rather than a juvenile detention facility. This has clearly benefitted Robert and has enabled him to get the increased help and support that he needed.
Current Situation
Robert has been diagnosed with depression, post-traumatic stress disorder (PTSD), obsessive-compulsive disorder (OCD), and generalized anxiety disorder, conditions resulting from the severe sexual abuse he received at an early age at the hands of his caregivers.
In addition, given the relationship between personality disorders and childhood sexual abuse, a diagnosis of antisocial personality disorder has been suggested. Concern about Robert’s ability to empathize with others remains, although his scores on psychopathy have been inconclusive.
A diagnosis of dissociative identity disorder was originally given but withdrawn in 2001 after it was concluded the alternative personality states shown by the patient were voluntary role-playing, used as a tool for Robert to escape everyday life. Robert has been observed mimicking other individuals (usually well-known people in the media), but we conclude this is not an unusual coping mechanism and has no risk attached.
Following neuropsychological testing, Robert’s full-scale IQ was found to fall in the very superior range (around 145). He has diligently applied himself to his studies, gaining twelve GCSEs at grades A and A*, and four A levels.
Risks
Robert has tried to commit suicide with an overdose on two separate occasions, the last instance of this occurring in 2002 (see below). We believe the suicide attempts to be related to Robert’s depression: this continues to be a focus of Robert’s psychotherapy, carried out with a cognitive behavioral approach.
Some incidents of arson were reported throughout 1999 and 2000, the final one resulting in the almost complete destruction of the art therapy wing. While these were strongly suggested to have been the result of Keane’s actions, no concrete evidence was found, and all charges were dropped. However, Keane was closely supervised in the year following these instances: no suspicious behavior was observed.
Clinical Formulation
The extreme sexualized behavior Robert demonstrated at the time of his uncle and father’s murders was unusual in a child of that age (nine), although it can be explained through learned behavior via the troubled family environment he was accustomed to.
Robert has difficulty building relationships, particularly with women. I believe this is due to Robert attributing blame for his abuse to his absent mother (she left the family home when he was three) and projecting this onto other females.
However, Robert did manage to forge one friendship during his time at Northbrooke. The departure of this boy two years ago (in 2002) did cause some initial withdrawal and a suicide attempt. Robert responded well to therapy, and no attempts have been made since.
Proposed Future Interventions
It is my belief that Robert has grown into a capable young man and, with continued therapy, will be able to make a success of his adult life.
Because of the improvement shown during Robert’s rehabilitation, and the notorious circumstances of his uncle and father’s murders, it is my recommendation that Robert be given a new identity and that all linked records and biological samples associated with his crimes in 1996 be expunged. This privacy is essential to ensure that he may lead a normal life without fear of prejudice or reprisals.
Dictated, not checked or signed, to avoid delay.
Dr. Mark Singleton
Consultant Clinical Neuropsychologist
08/03/04
CHAPTER
38
THE ECHO MAN wanted them to find apartment 214—Cara knows that now. The name on the lease, the fact that it was next door—right fucking next door—to the staged Dahmer scene. And he’d left that pint glass there to taunt them.
She doesn’t know how he got Libby’s fingerprints. He could have swiped it from a pub years ago, and in a way, it doesn’t matter. What does matter is she’s dead, and Cara can’t help but look over to where her friend lies, under a white tent preserving the evidence on her body.
She’s been through the whole range of emotions in the last hour. Pure red-hot anger, forcing her to march off down the track, tears blinding her. She’d crouched, her hands resting on her knees, out of sight of the team as the rain soaked her to the skin. She’d ignored her phone ringing until, realizing it would never stop, she’d been forced to answer it, and cold and drained, she’d walked back to the crime scene.
The show must go on.
