1. That his choking her provides proof that he wasn't as sedated as they kept saying he was, and therefore a big clue that he had premeditated it and his whole scheme to be held not responsible was therefore compromised?
2. That even if they held him not-responsible because he was crazy, his choking her would set back his therapy considerably and his expectation to get out in "a year" was probably a bit optimistic.
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The movie explains both points.
Ray is not actually a violent person (as we know) and we see him giving away his pills to other inmates. In the final scenes, he pretends to be more sedated than he is on purpose. It's part of his plan.
I agree that his killing Lena would set him back on all fronts as far as therapy, but it's still far better than the life sentence Lena had set him up for. Even if he got out in a year or two (as implied), that was nothing compared to watching her use him, abandon her kids, screw his best friend, and walk off with his life's work and fortune.
I don't like what he does in the end, but I also don't see any other way around it. Lena was already willing to completely destroy him to get at his money so he had to be willing to do the same.
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I keep thinking I'm a grownup, but I'm not.
What bothered me is how fast she apparently died. I know every human is different but every time I choked someone to death the least amount of time it took was at least 30 seconds longer than it took Lena to die at Ray's hands.
sharewomen have a lower lung capacity, so i'm not sure if your victims were all men or perhaps if they were women, maybe they had been collegiate-level swimmers or experienced cave divers