Schizophrenia: a mental disorder

Making sense of the law shouldn’t be this hard

Alan Alda (best known as ‘Hawkeye’ in the television series M.A.S.H) published his autobiography in 2005. At the beginning of the book he notes, ‘’my mother didn’t try to stab my father until I was six.’’ Alda’s father, an actor, was a positive influence on his son, as was his mother, a source of great encouragement despite her unfortunate habit of trying to stab her husband. That occurred because of a mental illness.

John Nash was a mathematician who received the Nobel Prize for a mathematical theory which became the cornerstone of modern economics. He became known to non-academic circles because of the film ‘A Beautiful Mind’ that portrayed his life and achievements – achievements that took place in spite of a debilitating mental illness.

There were also Mary Lincoln – Abraham Lincoln’s wife; James Beck – a drummer who played with the Beatles and Eric Clapton, Peter Green – guitarist for Fleetwood Mac; and Eduard Einstein – Albert Einstein’s son. All people on the world stage diagnosed with schizophrenia.

Schizophrenia is defined by the National Institute of Mental Health in the US as: ‘a chronic and severe mental disorder that affects how a person thinks, feels, and behaves. People with schizophrenia may seem like they have lost touch with reality. Although schizophrenia is not as common as other mental disorders, the symptoms can be very disabling.’

Schizophrenia is also prevalent in Pakistan.

According to Shakila Akhtar in a paper cited by the International Society for Psychological and Social Approaches to Psychosis:

‘In Pakistan about 1.5% of the population suffers from schizophrenia. It occurs among both males and females, paranoid schizophrenia being the most common.’

The report says that investigators find that sexual abuse may trigger schizophrenia amongst women because of the mental stress it causes. They cite several factors such as social stigma, insulting treatment by the police and defense attorneys during court proceedings, as well as that the perpetrator is often a powerful person able to distort facts in court. All these factors prevent victims from taking steps against the abuse, and very often these victims are themselves accused of this, or other crimes.

This column protests against a recent ruling by the Supreme Court of Pakistan which says that ‘schizophrenia does not fall within its legal definition of mental disorders’ and the consequent permission to execute a man suffering from this mental disorder.

We have already seen that schizophrenia is defined as a mental disorder by professionals. It is questioned why, in spite of modern medical knowledge of this mental disorder, the Supreme Court is bound by previous definitions, and appears unable to amend those definitions?

In a document the Federal Judicial Academy speaks of the roles of the various judicial courts in Pakistan under the constitution. About the Supreme Court it says: ‘The Supreme Court is the apex Court of the land, exercising original, appellate and advisory jurisdiction. It is the Court of ultimate appeal and final arbiter of law and the Constitution. Its decisions are binding on all other courts. The Court exercises original jurisdiction in settling inter-governmental disputes, be that dispute between the Federal Government and a provincial government or among provincial governments. The Court also exercises original jurisdiction concurrently with High Courts for the enforcement of Fundamental Rights, where a question of ‘public importance’ is involved. The Court has appellate jurisdiction in civil and criminal matters. The jurisdiction of the Supreme Court, original as well as appellate, is fairly wide. Besides entertaining civil and criminal appeals from the High Courts, the Court also hears appeals from judgments against the Federal Shariat Court, Federal/provincial service tribunals and some special courts. The Court also entertains cases of violation of Fundamental Rights.’

The above makes it clear that whatever the existing legal definition of mental disorders, the Supreme Court of Pakistan does possess power to amend that definition and is in fact expected to do so by bringing its supposed superior wisdom to bear on the matter, power that it signally failed to exercise recently. Repercussions of this failure are likely to be immediate, most imminently in the case of Imdad Ali, a fifty year old man who suffers from severe delusions and ‘hears voices’. Imdad has been on death row for the past many years for the murder of a Muslim cleric. By the time this column goes to print Imdad may have been executed, an act that is little short of murder.

While in prison Imdad Ali was certified as suffering from schizophrenia by a qualified psychiatrist. Yet, Imdad’s appeal was rejected. Reuters reports that in its rejection of an appeal, the Supreme Court ruled that ‘Schizophrenia is not a permanent mental disorder; rather it is an imbalance which can increase or decrease depending on the level of stress. In recent years, the prognosis has been improved with drugs, by vigorous psychological and social managements, and rehabilitation.’ Dismissing professional diagnosis, the Supreme Court based this judgement instead on a dictionary definition of schizophrenia and on a judgement made almost thirty years ago by the Indian Supreme Court.

Arguing against the Supreme Courts claim that schizophrenia is necessarily treatable and is not grounds for clemency, one can again cite Shakila Akhtar’s report quoted at the beginning of this column which goes on to say that data for this report was based only on cases known to hospitals and clinics, that the great majority of patients never come in contact with psychiatric services, since about 70% of Pakistan’s population lives in rural areas where, and generally in Pakistan, the literacy rate is low and there is no knowledge regarding schizophrenia. Symptoms of schizophrenia are generally attributed to magic or possession by spirits and demons. Instead of consulting psychologists or psychiatrists patients of schizophrenia are taken to faith healers and religious quacks, or to visit holy shrines where they are treated with holy water or sanctified ointment, in the belief that this will help. Sometimes patients are punished brutally by these so called therapists with the notion that this torture hurts the possessing spirit and not the patient and will therefore cause the spirit or demon to leave. Some even believe that marriage is a good remedy for schizophrenia. Such practices are also prevalent in developed countries but the ratio of such practices there is much lower as compared to Pakistan.

Following an attack on an Army Public School by the TTP in Peshawar in 2014, in which almost 150 people most of them children were killed, the death penalty was re-introduced in Pakistan. That should have served as a red flag to the judiciary, that now more than ever their judgements must be informed, well considered and just, because in addition to the power to bring change and improvement, they now possess the power to save lives. They have failed signally in this respect. Imdad Ali, who belongs to a poor family and was himself an impoverished electrician, received the first medical diagnosis for his mental disorder when he was in prison. Since he was accused of the murder of a cleric, perhaps it was the prospect of backlash from religious zealots that proved daunting for the judge, in which case Pakistan, with its superabundance of zealots is lost indeed if even the Supreme court of the land cannot assert itself in the face of that threat. Or perhaps it is not just the uneducated segment of Pakistan that is uneducated and ill informed. Either way, Imdad or others like him are now in danger of their lives. Miscarriage of justice in the case of civil rights is the fastest route to destruction, and we appear to be on that road.