From the Times’ science correspondent Anjana Ahuja:
Wayne Fenton, an expert on schizophrenia and an associate director of the National Institute for Mental Health in Washington, was found beaten to death in his office in September. A 19-year-old patient who was booked to see Dr Fenton that afternoon has confessed to the killing.
Dr Fenton, 53, clearly had not foreseen that he was at serious risk. And if he couldn’t predict it, who can? That question is posed by Richard Friedman, a clinical psychiatrist at Weill Cornell Medical College in New York. In the New England Journal of Medicine, Professor Friedman questions the policy — common in America and Britain — that the mentally ill can be forcibly medicated or restrained only if they are a danger to themselves or others. It may, he says, be time to “reset the threshold” so that action is taken before threats are made.
The question answers itself: these experts on schizophrenia are unable to predict which patients are prone to violence, yet it’s being suggested that they should be given the power to imprison individuals before any actual violence is committed. Clearly, they don’t have the competence. And that’s quite apart from the fundamental breach of the foundations of any liberal legal system: that people are answerable only for what they’ve done, not for the type of person they are or the opinions they may hold. It’s unfortunate, then, that the government is now proposing changes to the Mental Health Act to allow for precisely this: the detention of people deemed to have a personality disorder. Theodore Dalrymple sounded off on this last week.
Anjana Ahuja goes on to say that this is a timely debate in the light of the inquiry last week into the case of John Barrett, the paranoid schizophrenic who stabbed a man to death in Richmond Park. But in fact Barrett’s case is about the failure of the staff at Springfield Hospital to follow established guidelines. Barrett already had a history of violence, having stabbed three people at random in a hospital outpatients unit, one of whom almost died, back in 2002. He was granted a conditional discharge by a mental health review tribunal in 2003, just one year later. Prior to the murder in Richmond Park he’d been readmiitted, having “failed to adhere to the conditions laid down for his release, including taking his antipsychotic drugs and staying off recreational drugs”. He would have done what he did whatever changes were made to the Mental Health Act.
I realise this is largely academic, in that Barrett’s been charged with manslaughter and will spend most of the rest of his life in confinement, but I wonder how much responsibility he should be assigned for the killing of Denis Finnegan. Yes, the acceptance of his plea of diminished responsibility was correct in the light of his hearing voices and so on. Could he have told the voices to bugger off? From what I understand these schizophrenic voices have a religious intensity, making them more than simply annoying noises in the head. Then again we don’t excuse religious maniacs for their terrorist excesses (well, most of us don’t).
But no, I was thinking more of his refusal to take his drugs, and to (presumably) smoke dope. If you knowingly took a drug which turned you into a zombified killer, would you then be guilty of manslaughter, or murder, even if the act of killing was not one that you had control over at the time? And if you knowingly didn’t take drugs which stopped you turning into a potential killer, is that much different?