Prior to the period of the hospital's remodeling, Amadeus Arkham treated patients at the State Psychiatric Hospital in Metropolis, where he, his wife Constance and his daughter Harriet had been living for quite some time. Upon his telling his family of his plans, they moved back to his family home to oversee the remodeling. While there, Amadeus Arkham received a call from the police notifying him that Martin "Mad Dog" Hawkins, a serial killer, referred to Amadeus Arkham by Metropolis Penitentiary while at State Psychiatric Hospital, had escaped from prison and sought his considered opinion on the murderer's state of mind. Shortly afterward, Amadeus Arkham returned to his home to find his front door wide open. Inside, he discovered the raped and mutilated corpses of his wife and daughter in an upstairs room, with Mad Dog's alias carved on Harriet's body. Despite this family tragedy, the Elizabeth Arkham Asylum for the Criminally Insane officially opened that November.