Angry Doctor

Thursday, September 21, 2006

Madness

Madness.

Where to begin?

Perhaps from this news article then.

(excerpt)


CONVICTED wife-killer Mohamad Zam Abdul Rashid has been sentenced to life in prison.

The penalty meted out to Mohamad Zam, who did not show any emotions during sentencing but will be appealing, came nearly two months after he was found guilty of battering his wife Ramona Johari, to death.

He escaped the gallows after he was found to be suffering from frontal lobe syndrome, a personality disorder that is said to cause emotional liability with associated irritability and outbursts of anger.

But Mohamad Zam apparently didn't know about his mental condition and the need to be on medication for life.


angry doc didn't really pay any attention to the news then. A 'mad' guy kills his wife, he is put away in some place for the rest of his life where he cannot kill another person again. Case closed.

But then along came this letter, which argued for a more compassionate approach towards people with mental illness.

I reproduce passages from the letter:


"I am disturbed by the harsh sentence meted out to 44-year-old Mohammad Zam Abdul Rashid, whom psychiatrist Stephen Phang testified had a mental illness that was not detected until his arrest.

Rather than put him behind bars, couldn't the court make it compulsory for Mohammad Zam to seek treatment at the Institute of Mental Health (IMH), where, with medication, counselling, love and the much-needed support of a good team of nursing staff, he can recover and go on to lead a normal life?"

"Reports of the mentally ill being put in jail add to the stigmatisation of mental illness because people will believe that all mental patients are violent and troublemakers.

When you lock a person up, the damage can be extensive. During the Sars period when the Ministry of Health closed the door to all hospital visits, my wife, who was confined in IMH for a month, became very fearful. She took almost a year to recover from a relapse of schizophrenia."

"Clearly, there is a lack of understanding of mental illness in Singapore. The structural support for caregivers is also very weak and that is why many of them give up and abandon loved ones who are stricken with mental illness.

In its review, the National Mental Health Committee should look at laws to protect the mentally ill, structural support for caregivers and public- education programmes that will help to better manage mental illness."


Frontal lobe syndrome is not schizophrenia, but nevertheless the author made some valid points. Perhaps only a very small percentage of metally-ill persons are violent, but while it may be too extreme to not take the presence of mental illness into account in sentencing, it is perhaps irresponsible to the rest of society to be too lenient when the person in question has actually killed someone.

But others do not share his view, as apparent from three letter to the ST Forum today.

This one in particular was... interesting.


Compassion for mentally ill offenders? Law must run its course

I refer to the letter 'Treat mentally ill offenders, not jail them' (ST, Sept 16) by Raymond Anthony Fernando.

I must disagree with his call for compassion for offenders who have mental disease. A crime is a crime, and a person has to pay for his offence, whether he is mentally stable or unstable.

A mentally unstable person can prove he is schizophrenic or mad (if he prefers the term) and then claim insanity as his defence in our law courts. But his lawyers have to prove that he was actually legally or medically insane at the time of the crime. It's as simple as that.

To allow mentally unsound people to go around killing, murdering, raping normal citizens and then plead for compassion for their crimes is very unfair to normal people like me. It will encourage anarchy and lawlessness in our society.

It is the duty of the family of the mentally unsound to ensure that they receive adequate treatment and hence remain in a stable condition, with proper medication, which needs daily supervision.

But we have to ask a simple question: What is mental instability? What is insanity? Is a hot-tempered person who suffers from so-called bipolar disorder mad or mentally unsound? Can he or she claim "insanity" as a defence too? It seems ambiguous to me.

In a recent Oprah Winfrey episode, Linda Hamilton, the famous Hollywood actress, stunned the audience by admitting that she suffered from bipolar disorder. However, she still managed to work throughout her life and in fact acted exceedingly well in The Incredible Hulk. She did not consider herself "mentally unsound" in any way. It was to her an inherent genetic condition which she accepted as part of her character. She did not consider herself "insane" or mentally incompetent.

The great poet T.S. Eliot also suffered from bipolar disorder, characterised by mood swings. But he never considered himself "mentally unsound". He in fact won the Nobel Prize for Literature.

I think Singapore society still has difficulty accepting schizophrenics or those suffering from other mental diseases. But the truth is: Nobody is born mad. Anybody can get depression, and if not controlled, this can lead to manic depression, and if not controlled, could lead to schizophrenia or some other forms of mental instability.

It is the duty of the patient to take care of himself and not commit crimes and use mental disease as an excuse. And it is the duty of his or her family to help the patient to keep his disease in check.

But we all have to pay the price for our crimes, be it murder, rape, assault or any acts of violence.

The negligence of the family of the mentally unsound normally results in these acts. Stress
triggers off a final onslaught and an "act of momentary madness" which results in a crime. It's up to the courts to then decide what is the best punishment.

For me, it's very simple. If a person can prove his madness at the time of committing his crime, he is legally insane and should not be executed or hanged by virtue of "insanity" but he should be confined to an asylum thereafter and receive adequate medical care for life.

If he cannot prove his offence was caused by mental disease, he should hang. If not, we can all go out and murder one another and then claim "insanity" as a defence, even if we are totally sane and had reacted more in a fit of passion or anger. Is this fair? I think not.

Basil Pereira


angry doc was brought up with the understanding that mentally-ill patients who have killed are locked up in a special ward in the mental hospital. They don't get executed, but neither can they cause harm to others again; so in a way he doesn't disagree with the author's argument that:

"If a person can prove his madness at the time of committing his crime, he is legally insane and should not be executed or hanged by virtue of "insanity" but he should be confined to an asylum thereafter and receive adequate medical care for life.

If he cannot prove his offence was caused by mental disease, he should hang."

But angry doc is disturbed by the way the author argued for his case.

Frontal lobe syndrome is not bipolar disorder or schizophrenia.

'Nobody is born mad', but there are strong genetic and prenatal factors involved in the development of schizophrenia. And while there is a correlation between depression, manic-depression, and schizophrenia, it is inaccurate to say that one leads to another. More importantly, nobody *wants* to become mad.

One of the characteristics of being 'of unsound mind' is being unable to take care of oneself. To say that it is 'the duty of the patient to take care of himself and not commit crimes and use mental disease as an excuse' is like saying it's an immunocompromised-patient's fault that he can't fight off infections.

But what is most disturbing to angry doc is the sentiment revealed in the following paragraphs:


"To allow mentally unsound people to go around killing, murdering, raping normal citizens and then plead for compassion for their crimes is very unfair to normal people like me. It will encourage anarchy and lawlessness in our society."

"If he cannot prove his offence was caused by mental disease, he should hang. If not, we can all go out and murder one another and then claim "insanity" as a defence, even if we are totally sane and had reacted more in a fit of passion or anger. Is this fair? I think not."


It sounds as if the author feels that 'killing, murdering, raping' are activities that are unfairly denied to 'normal people', who undoubtedly would go forth and commit these crimes aplenty if they knew all they faced in punishment was a lifetime of imprisonment instead of death by hanging.

What a frightening world Mr Pereira lives in.

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1 Comments:

  • I am rather bewildered by 'angry doctor' and others who read what I thought was a very simple honest letter to the ST online forum with regards those suffering from mental disease, crime and punishment.

    I know of persons who suffered from depression, who because of neglect from family members became worse - and suffered from bipolar disorder - and eventually schizophrenia - but in stages - due to neglect. So it is not true to say I know nothing of mental disease and those suffering from it.

    Whilst I believe those who suffer from schizophrenia should be dealt with compassion and be confined in an asylum [or sanatorium] for life if they commit murder, it is very important that they have proof of schizophrenia prior to the crime and not come out tra-la-la with a defence of insanity because of schizophrenia a day after the crime after paying a psychiatrist as advised by a lawyer that a plea of insanity is the only defence against hanging ...

    Got it? have a good new year - angry doctor. I still think based on what I know of from real life cases that the level of psychiatric care in Singapore is really backward - and the attitude of Singaporeans to those with mental disease is appalling. I believe that the level of a civilized society can be measured by the love and compassion we show those who suffer from this sad disease ... i dont think we can call ourselves very civilized from the appalling lack of concern or understanding that those with mental disease suffer from - and especially by the callous way psychiatrists seem to be more concerned with charging sky high rates for these patients .... Greed rather than compassion seems to dominate the psychiatrist profession today unfortunately.

    By Anonymous Basil Pereira, At January 04, 2007 3:06 pm  

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