A Criminal Mind For 40 years, Joel Dreyer was a respected psychiatrist who oversaw a clinic for troubled children, belonged to an exclusive country club, and doted on his four daughters and nine grandchildren. Then, suddenly, he became a major drug dealer. Why?

In the 1980s, psychiatrist Joel Dreyer was a fixture on Detroit’s WXYZ Channel 7. His commercials promoting his treatment center, InnerVisions, which he named after the Stevie Wonder album, sometimes ran up to five times a day. In one ad, Dreyer blocks a bartender from serving a mug of beer to a patron and says, “Don’t let your marriage or your job suffer from alcohol or drugs.” In another, Dreyer, in a navy pinstriped suit with a white pocket square, looks into the camera, his expression concerned and sympathetic. “Don’t you want to talk to someone who will listen?” he asks. “Someone who won’t pass judgment? Someone who cares? Come talk to me.” InnerVisions, which was based in Southfield, a suburb northwest of Detroit, had a staff of 80 physicians, psychologists, and therapists and took up two floors of a high-rise. It had made Dreyer not only a public figure but also wealthy. He maintained a side career as an expert witness. Attorneys called on him because he was smart, charming, and persuasive. Dreyer mostly testified for the defense, and with each high-profile case, his celebrity grew. Between the clinic, trial work, and his private practice, he was earning as much as $450,000 a year. Dreyer loved to be the center of attention. He would sometimes ride to work on a motorcycle in a bejeweled Elvis outfit to entertain his colleagues. Other days he would wear purple cowboy boots, cowboy hats, wild colored sweaters, platform shoes, or a fake fox head and tail draped around his neck like a scarf. He tended to speak loudly. He kept courtroom illustrations of himself testifying on his office wall. He drove a red Ferrari and once had a picture of himself taken in front of it holding an AK-47. Yet Dreyer also relished helping people, particularly those who were abused and depressed. Many thought of him as an unusually generous therapist. Steven Lupiloff, who has known him since the 1970s, says that Dreyer led charity drives and went out of his way to treat patients who could not afford to pay him — including Lupiloff’s sister, who was suicidal. After she died from cancer, Dreyer treated Lupiloff for depression. One day, in 1986, Kathy Cuneo felt someone’s foot thump the back of her legs flirtatiously as she drank from a water fountain at her gym. She recognized Dreyer from his TV ads. Tall with a broad chest, he had dark hair, a prominent nose, and nearly perfect white teeth. Dreyer was 49 and single, his marriage of 29 years having recently dissolved. His two eldest daughters were on their own; the youngest, still in high school, lived with him. Kathy was 28, blond and slender, a golf instructor. “I was at a point in my life where I wanted to get married and have kids,” she says. “I was star-struck. He was a gentleman.” Within a year, the two married. “I truly, truly loved him.” At the time, Dreyer’s name kept popping up in the papers and TV news. Several years earlier, he had testified on behalf of Ronald Lloyd Bailey, a 27-year-old from nearby Livonia who had been charged with abducting and strangling a 14-year-old boy. Bailey’s attorneys argued that he was insane, and Dreyer was their key expert witness. Dreyer, in his usual bold manner, acted out a mental examination before the court, testifying that Bailey had been sexually abused as a child and thought he was someone else when he killed the boy. In reading the guilty verdict, the judge said he found Dreyer’s testimony to be “more theater than substance.” The case was appealed, and Dreyer increasingly became the object of vilification. Kathy couldn’t ignore the cold stares. “People thought he was representing a child killer,” she says. Colleagues turned on Dreyer. Harvey Ager, a forensic psychiatrist who had worked at InnerVisions, called his former boss the kind of shrink lawyers wanted to “buy an opinion from.” In 1988, the newlyweds decided to leave Michigan. It took them a few years to decide where to live. They eventually settled on Murrieta, California, where Dreyer was named medical director of the Oak Grove Institute, which served children with social and behavioral challenges. Just off Interstate 15 in Riverside County, southeast of Los Angeles, Murrieta, a former ranch town, was in the midst of a real estate boom. Dreyer and Kathy bought a five-bedroom home with a pool on 5 1/2 acres of land — enough room for their 5-year-old daughter, Jade, and a menagerie that included horses, llamas, pigs, chickens, rabbits, 15 dogs, and 20 cats. Dreyer wasn’t making the kind of money he had made in Michigan, but the couple lived more lavishly than most of their neighbors. They vacationed in Las Vegas and Palm Springs. They joined the area’s most exclusive country club, where they golfed together. Dreyer drove a yellow Corvette. According to Kathy, he was loving and devoted and made her laugh. She and Jade never saw him touch a glass of alcohol or take drugs. Not even wine. By their count, he took maybe four aspirin in ten years. Then, around 2000, Kathy began to notice changes in her husband. Dreyer, who had turned 63, no longer seemed the man she had married. He was becoming embarrassing, reckless. He stopped obeying traffic signals, particularly stop signs. He began cheating, often blatantly, in golf matches with other club members. He started watching a lot of internet porn, so much that Kathy cut the cable on the back of his computer. Kathy had never questioned his fidelity, but now she began to suspect he was having affairs. At first, Kathy chalked it up to aging. “There is an expression, that as you get older you just become more of what you are,” she says. “If you are generous, you get more generous. If you are really loud, you get more loud.” Dreyer’s grown daughters, who lived in Michigan and Israel, also noticed a change. He had been a doting father who encouraged them to discuss politics and to debate the Torah. His youngest child from the first marriage, Darra, had felt especially close to him. “When I was 15, my parents divorced,” she later wrote, “and I chose to live with my dad.… He was more balanced and in general always more consistent. Even upon remarrying, my dad was completely committed to me.” But now, Darra thought, “He seemed emotionally detached and cold.” It was teenage Jade who saw Dreyer’s metamorphosis up close. She idolized her father. He picked her up from school every day, the two of them often belting out Motown songs together in the car. “He was always a character. Fun, and loud, and outgoing,” she says. “All my friends wanted him to be their dad.” But he began acting in ways that confused and scared her. He stole things that he could easily afford: a shot glass from a shop in Las Vegas, pens from convenience stores, groceries from Target. Jade told her mom that a friend who worked security at Target had warned her that her dad’s photo was on the store’s wall: “The next time he comes in, they’ll arrest him.” After 17 years of marriage, Kathy filed for divorce. Dreyer remarried soon after. His new wife, a woman named Independence Treen, was 37 years his junior and on probation after serving time for grand theft auto. Five foot five with blond hair and hazel eyes, she looked like a younger version of Kathy. Dreyer’s daughters were horrified. “She looks, acts, and sounds like a drug addict,” one told him. “What is wrong with you? Are you out of your mind?” But Dreyer never explained himself. He just introduced her to his family and friends as if everything was normal. As Darra had done years earlier, Jade chose to stay with her dad. She was still close to him and wanted to remain in the house where she’d grown up. But that didn’t last long. Independence’s friends hung around like it was a summer beach home, many of them drugged out. Independence liked to sunbathe topless. One day Kathy dropped off Jade and spotted Independence coming outside bare-breasted to mow the lawn. Kathy insisted that Jade move in with her. Dreyer’s behavior was becoming harder to explain. At a grandson’s bar mitzvah, he pulled out a newspaper to read in the middle of the boy’s speech. He showed up late to the lobby of a hotel with Independence to meet one of his daughters and her friend, wearing a pair of expensive slacks and nothing from the waist up. Whatever sense of shame he’d had no longer existed. Embarrassed and angry, Kathy had come to despise her former husband. He didn’t have any concern for what he was putting Jade through, for how much he was hurting his family. “I wanted him dead,” she says. “He ruined my life, my daughter’s life. He ruined a lot of lives.”

On Christmas Day 2005, Newport Beach police received a call from Brett Siciliano. He was worried about his 35-year-old twin sister. She had not shown up for family festivities, no one had heard from her for two days, and he was now standing outside her condo where he could hear her Maltese whimpering inside. Police found her facedown on the bed, dead from an overdose. Near her body were 20 prescription medications, two of which, Oxycontin and Ambien, had been issued by Joel Dreyer 23 days earlier. Siciliano decided to conduct his own investigation. A few months later, he made an appointment to see Dreyer, complaining of back and knee pain and sleep problems. Dreyer, who wore a sweater with a Playboy bunny insignia and a lanyard chain linking his front and back pockets, did not inquire about his medical history, did not ask for X-rays or scans, and did not examine his knees or back. Siciliano walked out with prescriptions for 120 Norco and 10 Vicodin tablets for pain, and 30 Ambien pills for insomnia. For the five-minute exam, Dreyer charged $100. Siciliano went straight to the Murrieta police. As a physician, Dreyer had the authority to write prescriptions, but now he was handing them out to seemingly anyone who asked. In parking lots. In Chinese restaurants. Out of his home. Still the medical director at Oak Grove, Dreyer was also seeing private patients at an office in nearby Temecula — a cramped 8-foot-by-8-foot room with a desk, three chairs, and a bookcase. “It looked like a janitor’s closet,” Siciliano says. The Murrieta Police Department had already received numerous complaints about Dreyer, and they would continue. Three pharmacists informed the department that they had stopped filling Dreyer’s prescriptions because too many of his patients were asking for highly addictive drugs like Oxycodone, Hydrocodone, and Alprazolam. An employee at LA Fitness reported that Dreyer was writing prescriptions in the lobby to members and employees. By early 2007, the Drug Enforcement Administration had begun an investigation, sending an undercover female officer wearing a wire into Dreyer’s office. “Why are you here to see a shrink?” he asked. She explained that she needed prescriptions for her boyfriend, who’d hurt his foot. Dreyer asked if she was having pain, too. She shook her head no. “Cramps?” Dreyer asked. “I mean that makes sense, cramps.” “Well, we’ll get you covered,” Dreyer said. “And you know it’s a hundred-dollar charge.” After she paid him, he told her, “And that, my love, is the game.” He gave her prescriptions for Vicodin and Xanax. The agent asked how soon she could come back, and Dreyer said in a month. “There is no option,” he said, “unless you want to go out with me every night.” He also told her not to fill the prescriptions at Costco’s pharmacy: “Costco’s been assholes.” The agent returned two months later, this time asking for Percocet, which Dreyer wrote a prescription for, referring to her as “cutie” and “baby” throughout the visit. In March, an undercover agent from the California Medical Board came to Dreyer, saying she had a sore throat and cramps. He told her she was “very pretty” and inquired if she was single. She asked for Xanax, and Dreyer said he worried about her “getting all these crazy meds,” adding, “I don’t want to hook you, baby.” He prescribed 30 doses of Xanax and 60 doses of Vicodin. Fourteen days later, an undercover detective from the Murrieta Police Department paid Dreyer a call, complaining of stress as well as knee and back pain. He, too, received a perfunctory exam and walked out with prescriptions. The police department, DEA, and California Medical Board obtained warrants to search Dreyer’s office and home in late July. Investigators found that between 2004 and 2007 Dreyer had written prescriptions for 800 doses of Actiq, which contains Fentanyl, an opioid used to manage pain for cancer patients that is up to 100 times stronger than morphine; 37,000 doses of Xanax, which is a benzodiazepine, an anti-anxiety drug; 7,000 Concerta, 18,000 Ritalin, and 12,000 Adderall pills, all amphetamine-based psychostimulants used to treat attention-deficit hyperactivity disorder and popular on the black market; and 68,000 Norco, 17,746 Oxycodone, and 78,923 Hydrocodone pills, all pain narcotics and lethal when abused. Early on the morning of July 24, 2007, a joint task force arrested Dreyer at his home. Dressed in a black T-shirt, gray stonewashed jeans, and black pointed boots, he seemed to have an amused grimace as an officer gripped his left arm and led him out the front doors. Jade, who was at a friend’s, did not find out about her father’s arrest until the next morning, when she saw a photograph of her father in handcuffs on the front page of the Riverside Press-Enterprise. She called her mom, who also didn’t know, begging her to post bail, which had been set at $50,000. To Dreyer’s daughters and to Kathy, the drug charges seemed out of character. “I never thought Joel would do anything illegal,” Kathy says. “He bent rules. He never broke them.” Jade had noticed he was writing prescriptions haphazardly. “He’s always been kind of out there a little bit,” she says. “But he never got involved in criminal activity.” By now, however, the family realized that the man they had known all their lives had become unrecognizable. “It’s like he died,” Darra later wrote. “He is with us, but not the same.” Friends and former colleagues were stunned. “It was a big shock,” says Suki Gill, clinical director at the Homes of Hope Foster Family Agency, who had worked with Dreyer when he first moved to California. “He would give the shirt off his back for you. The children loved him, and the staff loved him as well.” According to Stuart Bloom, then the director at Oak Grove, the clinic never received any complaints during Dreyer’s tenure. He had “sound medical judgment with personal conviction.” For all the questions swirling around the case, one continued to perplex his family. Dreyer could have made millions with the amount of drugs he sold. Instead he appeared to have made a fraction of that. A single Oxycontin pill goes for as much as $80 on the street. Dreyer’s prescriptions were usually for a bottle containing 90 pills. His patients paid him $100 for the consultation and prescription. He wrote 2,000 prescriptions for 500 patients over two years, which would have earned him around $200,000. At the height of his drug dealing, Dreyer stopped paying the mortgage on the home he had once shared with Kathy. It ended up going into foreclosure. He also owed her hundreds of thousands of dollars in spousal support. His family had to pool together money to cover his bail and tens of thousands more in legal fees. To the DEA, the California Medical Board, and the prosecutor, though, it was an open-and-shut case. Dreyer was one of the biggest prescription drug dealers in Riverside County. Their investigation traced Dreyer’s activities to Mexico, where he traveled regularly and wrote illegal prescriptions out of a pain clinic. The Medical Board revoked his license immediately. A year later, Independence divorced him. On September 21, 2009, two and a half years after his arrest, Dreyer pleaded guilty to the charges of conspiracy to possess with the intent to distribute controlled substances. The only question that remained was how much time he would serve.

Seven months before Dreyer pleaded guilty to his charges, he went to see Daniel Amen, a psychiatrist in Newport Beach who had become well-known and controversial for using single-photon emission computed tomography, or SPECT, scans, which track blood flow in areas of the brain, showing high and low activity. The technology has helped diagnose dementia, strokes, and epilepsy as well as brain injuries in football players. Long before Dreyer was arrested, some members of his family had suspected that something was not right in his brain. Kathy thought he might be showing signs of early onset Alzheimer’s, though that wouldn’t explain his criminal behavior. During a visit, one of his daughters, a psychologist in Michigan, found that her dad had urinated in his bed. He was sitting in it like nothing had happened. She wrote a letter describing some of her father’s personality changes to Amen, who had known Dreyer over the years: “When we would speak on the phone he would barely ask questions about me or my family. He also had very little to say in general. He seemed detached and disinterested. This was in complete contrast to our prior relationship.” The SPECT scans revealed dark regions in Dreyer’s prefrontal cortex, indicating deterioration in areas associated with feelings of shame, empathy, or embarrassment as well as impulse control and insight. According to Amen, Dreyer suffered from a neurological condition called frontotemporal dementia. An estimated 50,000 to 60,000 people in the United States have the disease, though the number is probably higher, since many doctors are unfamiliar with the progressive neurodegenerative brain disorder, which has no identifiable cause. People who have the illness can develop sociopathic and disinhibited behavior. The dementia sometimes manifests in sexual compulsions. Unlike most Alzheimer’s patients, who develop symptoms later in life, individuals with frontotemporal dementia begin to decline as early as their 50s. Most do not lose their memories or cognition in the initial stages of the disease. Instead they lose key parts of their ethical and social personalities. Lesions in the brain’s right ventromedial-anterior temporal network can make them unconcerned with other people’s distress, and the symptoms often begin with indifference. “This explains everything,” Jade said to her mother after she heard Amen’s diagnosis. His odd third marriage. His hypersexuality at age 70. All of those reckless prescriptions. “This is why he’s been like this.” There were holes in his prefrontal cortex. For Kathy, the news was baffling. How much of her former husband’s personality was the disease? How much was the true him? She found herself crying at times, grieving the life they had once shared. She still held on to so much anger, but the diagnosis also made her feel sorry for him. “If I would have known he was sick,” she says, “maybe I wouldn’t have left. But now I know it wasn’t a choice for him.” Scientists have long known how frontal-lobe damage can alter a personality, at least since the case of Phineas Gage, one of the most famous neurology patients of all time. In 1848, he was working on a railroad construction site in Vermont when an explosion sent a 3 1/2-foot-long iron rod through his brain. After his accident, he appeared fine, but those close to him realized he wasn’t. He became inappropriate, talking openly about sex and swearing profusely in public. Gage’s brain offered neurologists one of the first clues that brain trauma could affect a person’s moral compass. A 2013 paper published in Cognitive & Behavioral Neurology found that more than half of the 32 frontotemporal dementia patients studied broke the law. Some stole food, clothes, cosmetics, or money. Some trespassed into homes. Others physically assaulted people or groped them. The finding was supported in a study published this year in JAMA Neurology; it showed that 37 percent of 64 patients with frontotemporal dementia at the University of California, San Francisco, Memory and Aging Center had committed crimes, including shoplifting, sexual harassment, and urinating in public. At the request of Dreyer’s lawyers, Amen’s report was admitted as evidence during sentencing proceedings. In 2010, Dreyer obtained a second neuropsychological evaluation. He appeared at the offices of David Rudnick, a neuropsychiatrist, in Santa Monica, wearing a rumpled blue pinstriped suit and bright-gold cowboy boots with a cutout in the left one to accommodate his house-arrest monitor. He announced that Independence “was gorgeous, a 10, and a great fuck who gave great head” and detailed how he went to Mexico to write prescriptions and have sex with two prostitutes. Rudnick noted that Dreyer erupted into uproarious laughter over his own comments and was “inappropriately inquisitive.” At times, Dreyer reached out to touch Rudnick and roamed through his office and its contents. Rudnick’s diagnosis confirmed Amen’s. Dreyer’s condition appeared to be “literally a textbook description” of frontotemporal dementia. This put him at risk for being deceived, manipulated, and injured, Rudnick wrote. Dreyer’s lawyers filed the report with the court. For his family, Rudnick’s conclusion was further assurance that Dreyer was suffering from an illness and was not a terrible person. But for his lawyers, Amen’s and now Rudnick’s findings posed a perplexing challenge. The American justice system divides the criminal mind into two categories: guilty and insane. The first is aware of its own criminal intent, which is determined by premeditation, reckless knowing, and purposeful actions. An insane mind shows severe mental impairment, specifically the inability to know right from wrong. Those deemed insane might receive a lesser sentence or, in the case of John Hinckley Jr., President Ronald Reagan’s failed assassin, might not be found guilty at all. Individuals with frontotemporal dementia, though, do not fit neatly into either category. They can still distinguish right from wrong and may even be aware that they are breaking laws. But the disorder may lead them to not care if they cross the line into pathological, unlawful, or unacceptable behavior. It may even encourage them to do so. Such individuals are able to carry on intelligent conversations, remember stories, write, read, and maybe even work — at least in the early stages. It’s their moral judgment that becomes skewed. Frontotemporal dementia is just one of many brain conditions confounding the criminal justice system. Between 2005 and 2012, more than 1,500 judicial opinions involving defendants cited the use of neuroscience. But there is no guiding framework for how the courts should handle such cases. How do you ensure the process is fair? What science is legitimate, and what’s speculative? Allowing someone with brain damage or dementia off the hook for purposeful or reckless criminal behavior could capsize the judicial system, but ignoring emerging science is untenable. In March, for example, researchers from the University of Denver found that 96 percent of all inmates screened at the Downtown Detention Center in Colorado had brain trauma, mostly from blunt-force injuries to the head — much higher than the estimated 6 to 8.5 percent of the general population. The Supreme Court has made three major decisions drawing on neuroscience. In 2002, it ruled that executing an intellectually disabled or legally insane person is a violation of the Eighth Amendment’s ban on cruel and unusual punishments. Three years later, the Court cited neuroscience, which had established that the prefrontal cortexes of juveniles are not fully developed, when it declared that those under 18 cannot receive the death penalty. And in 2012 it applied the same reasoning when it decided that juveniles could not receive life imprisonment without the possibility of parole. “Where we are is an interesting moment in history,” said Nita Farahany, a professor of law and philosophy at Duke University and a member of President Obama’s bioethics committee. “Are we going to have to reimagine or reconceive a criminal justice system that better reflects what we’re finding out about the brain?”

The judge in Dreyer’s case, Virginia Phillips, wasn’t persuaded that dementia led to his crimes and refused to hold an evidentiary hearing to determine his mental competence. On December 13, 2010, she sentenced Dreyer to ten years. He was 73 years old, and his family worried he would die in prison. While in the Metropolitan Detention Center in Los Angeles, Dreyer obtained new attorneys who appealed the decision, claiming that the dementia had left him incompetent to plead guilty. Dreyer’s lawyers and the U.S. Attorney’s Office agreed to call upon forensic psychologist Daniel Martell to conduct another evaluation of his mental state for the court. Martell affirmed that the brain scans and neuropsychological tests established “a classic presentation of frontotemporal dementia,” but that the condition had not rendered Dreyer incompetent to plead guilty. However, he warned, Dreyer’s inability to filter himself — he “tossed around racial epithets and religious slurs indiscriminately” during the exam — could be dangerous to him in prison. He suggested protective custody. In August 2012, the U.S. Ninth Circuit Court of Appeals reversed Phillips’s decision, vacating Dreyer’s sentence. The three-judge panel, with one member dissenting, criticized Phillips for not ordering a competency hearing, claiming she inappropriately substituted her own opinions about Dreyer’s behavior for those of medical experts. In an unusual move, the court ordered that Phillips be removed from the case. Within the Ninth Circuit, which has 29 judges, the opinion divided and outraged. Some worried it would allow any defendant claiming a brain disorder or mental illness to seek an appeal for a competency hearing. With 21,000 sentences handed down in the Ninth Circuit in 2011 alone, the judicial system could become inundated with mental evaluations, resentencings, and remands if the opinion stood. It was a matter of such concern that eight of the Ninth Circuit judges voted to have the Dreyer case reheard, this time before a panel representing the entire court. But they failed to get a majority 15 votes. On January 7, 2013, the original three-judge panel withdrew its opinion, issuing a new one that upheld the original decision to vacate Dreyer’s sentence but allowing Judge Phillips to keep the case. The eight judges who voted to have the case reheard scolded the outcome in a statement written by Judge Richard Tallman, which was included in the final opinion: The repercussions of the Dreyer case, Tallman wrote, “will wreak havoc on sentencing proceedings.” By extending legal protection to the mentally ill, the Ninth Circuit decision was seminal. Judges would have to take into greater account the mental state of defendants and would no longer be able to deny competency hearings as subjectively as they had in the past. “This changes the judge’s role,” says law professor Francis X. Shen, executive director of education and outreach for the MacArthur Foundation Research Network on Law and Neuroscience. “Typically defense counsel would request a competency hearing if they thought it was in the best interest of their client. Here the appeals court is putting judges on notice.” For Dreyer and his family, the decision gave them renewed optimism that he would be released, though they worried about Judge Phillips. His daughters spoke to him about how it was just a matter of weeks before he would be free. “I did my 1000 sit-ups for my 164th consecutive day in prison,” he wrote to one. “I hate being here, & my hopes are probably way too sky high for [the] court to set me free!” All of his emails and calls were recorded, copied, and studied by a prison psychia­trist assigned to conduct his mental-competency evaluation. On April 19, 2014, Dreyer again went before Judge Phillips. The prison psychiatrist did not dispute that Dreyer had frontotemporal dementia but declared nonetheless that he was competent. Judge Phillips upheld her original sentence. Dreyer would serve his full ten years.