The mental illness problem

Imperfect understanding of mental illness is but one of systemic faults in justice system that requires an overhaul

Schizophrenia, as with the majority of other forms of mental illness, has been present in mankind since early in the evolutionary cycle. It was only formally classified by Kraepelin as a distinct mental disorder in 1887 and in 1911 the Swiss psychiatrist Eugen Bleuler coined the word ‘schizophrenia’. It is an incurable condition though modern treatment regimes and medications may alleviate or moderate the symptoms. It is a common illness with a prevalence rate of 1.1 per cent of the population (source NIMH) globally. There is robust evidence of differences in clinical characteristics and outcomes between the developed and the developing world. (Naqvi, Naqvi, Murtaza and Nazir — AKU, 2010) Patients do better in the developed world. Estimates vary but there are approximately 420 psychiatrists nationally. We have been unable to find any record of any member of any judicial bench being a psychiatrist or having any experience or training in the understanding of mental illness.

Mental illness is poorly understood in Pakistan generally and the resources to treat it are thinly spread. Inevitably a percentage of people with all forms of mental illness commit crimes as do those who are not mentally ill, and they end up in the judicial system. The judicial system is no better prepared to address their illness than are the medical professions, and the judiciary as a whole are not necessarily better prepared to understand mental illness than any other member of society.

Occasionally a mental health-related topic makes headlines and the Supreme Court ruling reported on October 21, 2016 that a psychiatric disorder such as schizophrenia does not subjugate the death sentence is one such. The SC opined that rules relating to mental sickness were not ‘subjugative’ to the delay in the implementation of a death sentence such as that awarded to Imdad Ali who was sentenced in 2002 when he was convicted of murder. All subsequent appeals up the judicial system have failed since and his conviction stands, his execution potentially imminent. The wife of Imdad Ali had approached the Supreme Court pleading that her husband was not of sound mind and that the death sentence should be delayed until he gets treatment and recovers to the point at which he is competent to make his will. He is diagnosed as a paranoid schizophrenic as per medical records placed before the courts.

At issue is whether a mental illness should be a mitigating factor in the carrying out of a death sentence. Practice varies widely around the world, with developed nations tending towards a more lenient interpretation. In one respect at least the findings of the learned justices is inaccurate. “Schizophrenia is not a permanent mental disorder” — but it is. The justices acknowledged that the ‘prognosis had been improved by drugs’ and went on to say that the condition is also improved by ‘vigorous psychological and social managements, and rehabilitation.’ Their further comment reveals the fundamental flaw not only in their judgment but in the system that underpins it. The honourable justices deemed that as ‘a recoverable illness (schizophrenia) does not fall within the definition of a mental disorder as defined by the Mental Health Ordinance 2001’ it does not subjugate the death sentence. The honourable justices were therefore reliant in their judgment as to what does or does not constitute a mental illness by a definition that is itself flawed. From flawed advice flows flawed judgments.

The case is emblematic of a justice system that is flawed from top to bottom and not only in the delivery of justice to the mentally ill. In the same week a man — not mentally ill — was acquitted of a crime by the Supreme Court only for the bench to find he had been dead for two years. An imperfect understanding of mental illness is but one of the systemic faults in a justice system that requires a root and branch overhaul, perhaps as radical as ‘back to basics’ — and a mental health component to the future training of all judges.

Published in The Express Tribune, October 23^rd, 2016.

Like Opinion & Editorial on Facebook, follow @ETOpEd on Twitter to receive all updates on all our daily pieces.