Dementia May Have Turned Doctor Into a Predator

The story of an Indiana small-town doctor who went from medical missionary and Sunday school teacher to convicted predator gets a far stranger second act in the New Yorker. Adeline Goss revisits the case of Ray Howell, a beloved evangelical family physician who opened a rural clinic in Roachdale in 1983. Nearly three decades later, he pleaded guilty to felony charges tied to overprescribing opioids, often in exchange for sex—conduct linked by investigators to multiple overdose deaths. What distinguishes Howell from other "pill mill" doctors is what turned up after the collapse of his practice: a rare brain mutation associated with a form of dementia that can warp behavior long before obvious cognitive decline sets in. Roughly half of people with this mutation in the gene C9orf72 exhibit dementia symptoms by their late 50s.

Howell died in 2018 at age 64. His brain "is so abnormal that it's stored under neon lights in a refrigerated room at the University of California, San Francisco, and neurologists who have studied it are uncertain about who was responsible for these crimes: Ray Howell, or his disease," writes Goss. "I know, because I'm one of them." Goss walks through the uneasy clash between medical evidence and criminal law. Prosecutors argued Howell's misconduct long predated signs of disease, while his family sees the diagnosis as retroactive absolution. The piece digs into how much responsibility we can assign when a degenerating brain is involved—and how little neuroscience can currently say about the question. Read the full story.