The Q&A: Laura Tillman

With each issue, Trib+Health brings you an interview with experts on issues related to health care. Here is this week's subject:

Laura Tillman is a freelance journalist and writer who published her first book, The Long Shadow of Small Ghosts: Murder and Memory in an American City, this year. The book explores the lasting effects of a horrible crime in Brownsville, Texas. John Allen Rubio murdered his three children when he believed they were possessed by an evil spirit, the result of his mental illness.

Tillman discussed her book this weekend at a panel on reporting from the border at the Texas Book Festival in Austin.

Editor's note: This interview has been edited for length and clarity.

Trib+Health: Do you think the lack of accessibility to mental health care in Brownsville was one of the causes of the crime?

Laura Tillman: I think it’s one of the significant factors, in part because there is both a stigma around mental illness and a lack of familiarity with the symptoms of mental illness, in John's case, paranoid schizophrenia. There are few mental health professionals in the region. Because of that, people don’t necessarily have the information to recognize symptoms when they see them in others or to help them get treatment. 

Trib+Health: In your book, you mention certain ancestral practices, such as the curanderia and the use of the huevo, that Rubio’s family used to explain psychosis. How does culture play a role in this crime?

Tillman: In John’s case, there was definitely a strain of these beliefs in curanderia and using some of those measures, like the huevo, to help them diagnose whether their children were possessed or not.

In this culture, there is a belief that you can be cursed, for example by the mal de ojo, and John's grandmother was believed by some members in her family to be a bruja, or witch, practicing the inverse of curanderia, which is really a healing practice. When John said he saw or heard certain things or believed his children were being cursed, some of these beliefs lined up with spiritual possibilities, and may have been viewed as real as opposed to symptoms of a paranoid mind.  

Trib+Health: Do you think it may be equally dangerous for other families to use these beliefs as a way to explain mental illnesses?

Tillman: These beliefs cannot be held responsible for what happened — it's common for people with paranoid schizophrenia to involve religion in their delusions, but many healthy people have the same religious beliefs and they never manifest in a violent act. I don’t think the beliefs in and of themselves are dangerous, and one of the things I took away from the process of learning about curanderia is the healing and positive nature of many of these beliefs. 

Trib+Health: What about Rubio's use of marijuana and spray paint before the crime? Is there a chance that other psychedelic drugs might have played a part in this tragedy?

Tillman: It makes sense that the excessive amount of spray John was using could have contributed to his actions. Huffing those quantities can sometimes mimic the symptoms of schizophrenia or psychosis, according to experts. John says he wasn't using drugs in the days immediately leading up to the crime, so there is a debate about whether those drugs could have a long-term impact on his mental state, or whether he was technically sober when the events occurred and his mental illness is entirely to blame.

The trouble is, John's confession immediately after the crime is not reliable, so the information we have available is flawed. I think what we can see is a kind of perfect storm — a man with a mental illness who is self-medicating with drugs, a family with a lot of external pressures, a lack of people around him to recognize the dangerous symptoms that were manifesting and escalating. 

Trib+Health: You mention how Rubio was enrolled in a special education program in school. Is there anything that the institution could have done to address his mental illness from an early age?

Tillman: He did have some different instructors who were monitoring his case over the years and trying to get him help. In retrospect, it's evident that he needed not just help with his learning disabilities, but what was then called his emotional disturbance. Partly, it appears that his parents were not advocating to get him the kind of help he needed, because his father was absent and his mother was using drugs and was not emotionally present for him either.

Now, we can say that John would have benefitted from intensive therapy or perhaps medication, but in many ways he was high functioning compared to other students in special education, and was seen to be doing well at times.  

Trib+Health: How did Rubio's troubled upbringing and childhood developmental delay affect his psychotic episodes?

Tillman: John had an extremely difficult childhood. Not only were his parents either abusive and absent but his mother was using drugs since he was very young. She was at one point encouraging him to work as a prostitute. His other siblings had to help him get ready for school, feed him.

But he also loved his mother very much. As a young child, it makes sense that he would seek out that closeness with his mother, until a point when her drug use became more extreme, and he said her personality really changed. He was surrounded by chaos and didn't really have someone in his home life that he could depend on.

Some experts say this caused John to have a superhero complex — he amplified his own power internally because he was actually powerless. It was a way of tricking himself into feeling better. But it's something that seems to also have eventually become part of his illusions of grandeur.

He believed he was sent on some kind of divine mission, or that he could see what actions needed to be taken when no one else could. This behavior seems to have taken a more extreme turn when he reached early adulthood, which is also the age when people typically begin to show the first signs of schizophrenia. It's also when John became a more heavy drug user, a way of self-medicating depression. 

Trib+Health: Why was it important to look for the story behind John Allen Rubio and humanize a horrible murder case in Brownsville? 

Tillman: I first started getting interested in this story because of the local debate about whether the apartment building where the crime occurred should be torn down or not. I wanted to understand why this solution was being proposed, why erase the memory of the crime? Did that mean there was nothing to learn from it?

In the same sense, I wanted to understand who was this man, what his life was like before this happened, and what there might be to learn from that life instead of just erasing or forgetting it. I found that there was a more complicated person than the words that are usually used to describe him, like "monster" and "evil" would suggest.