The legal profession is bound by its ethics to offer the best defense for a defendant charged with mayhem, yet it is a perversion of forensic physicians' and psychiatrists' mission to focus on the patient only, especially when that patient threatens society through wanton destructiveness and violence. There are persons beyond the scope and reach of modern behavioral sciences' ability to rehabilitate, persons of twisted minds and deranged habits of gratification. Three Suffolk Court cases depict such individuals. Fred, convicted on two counts of rape and first degree murder, was put on work release and escaped from prison, committing a similar rape and murder within 1 year from his escape. Tests revealed him capable of responding without signs of schizophrenia and put to question why he was permitted to go on work release. Gunner, after spending 16 and 18 years, respectively, in prison for two grotesque murders, was charged with a similar murder 18 months after his second release. Finally, Buck committed a murder after a history of violent behavior. This case illustrates how determinants of mayhem can be in evidence through observable repeated acts and that a permissive approach can lead to homicidal acting out. Seven references are cited.