The Sunday Times, Uncategorized

April 22nd, 2007

Sorry, but we can’t just lock up pyschos

It takes a strange kind of mother to force her tiny children to hit and punch each other, to goad them with insults to fight harder and to film them as they weep, laughing all the while. That is what Zara Care did to her two-year-old boy and her three-year-old girl, egged on by her own mother and two of her sisters.

Quite rightly, her children were taken away from her for ever at Plymouth crown court last week and given into the custody of their paternal grandparents. The unfortunately named Ms Care also pleaded guilty to other offences of child cruelty, including ill treatment, neglect and abandonment.

In such circumstances it is usual to point an accusing finger at social services. Why did they not prevent this happening in the first place? Wasn’t it obvious that Care’s family was extremely dysfunctional?

However — and without knowing all the facts — I doubt that would be fair. There are countless young mothers (and fathers) who come from horribly dysfunctional families, who may suffer from personality disorders or low intelligence, not to mention poverty, illiteracy and drink or drug abuse. It must be difficult for social workers, doctors, nurses or teachers to predict that, of all these inadequate mothers, this particular one will do her children serious harm.

Even if, most improbably, one could make such a prediction with any confidence, what should one then do? Lock the woman up, or take away her babies before she has done anything wrong, just in case?

Zara Care’s story made me think again of the Virginia Tech mass murderer Cho Seung-hui. There were many indications that he was disturbed. Several times his teachers warned the university’s counselling services, the police and the dean of studies about his frightening behaviour. It emerged that nearly 18 months ago Cho was declared mentally ill and “an imminent danger to others” by a judge, and was admitted to a mental health unit. But before long he was released for outpatient treatment after a doctor certified that although Cho was mentally ill, “he does not present an imminent danger to himself or others”.

I mention this not to point blame at Virginia Tech or those responsible for Cho and for the safety of all students. It must be obvious to any fair-minded person that it is extremely difficult to determine whether a disturbed person is dangerous and, having done so, what to do about him.

Does he suffer from a mental illness that can be treated? Does he suffer from a personality disorder that cannot? These diagnoses are hard to make. What’s more, the fashions in diagnosis change. So, too, do ideas of what can and cannot be treated. It is still not legal in this country to detain someone without being able to treat him.

Professional judgment is very erratic — Cho’s doctors disagreed, for example, and scientific understanding of the human psyche is still primitive. In America, the FBI and secret services have considered profiling school shooters like Cho, to stop them before they start, but have concluded that it is not possible at present.

By coincidence, these questions were well debated in the House of Commons last week. For nearly 10 years the government has being trying to change the law on mental illness, or what we now have to call mental health. Last Monday its controversial mental health bill received a second reading. The bill’s main purpose is to lay down the circumstances in which a mentally ill person can be compulsorily detained or treated without consent.

The government is partly responding to outrage at the terrifying murders committed by mentally ill people who have been released from mental hospitals or were supposedly being treated in the community. It’s not possible to be sure how many people are killed this way each year, but the number for the past eight years in England and Wales seems to be about 50.

True to form, the government and Patricia Hewitt, the health secretary, incline in the direction of compulsion and control. Their many critics on all political and medical sides, especially in the Lords, have tried with some success to soften the terms of the bill in the direction of freedom and civil rights.

Professor Sheila Hollins, the mother of Abigail Witchalls who was paralysed in an attack by a disturbed young man, is also president of the Royal College of Psychiatrists. She argues in support of the Lords amendments in the interests of patients’ rights. So does Iain Duncan Smith, the former Tory leader, and an alliance of medical professionals and civil libertarians. My heart and instincts are with them — for now.

In future, I suspect, their convictions and my inclinations will change. In future it will become easier and easier to recognise from their earliest years, with proper scientific predictors, the men and women who will almost certainly do harm to others. Then, I suspect, the balance between personal freedom and security will change dramatically.

It is already happening. A few years ago American studies of children with severe attention deficit hyperactivity disorder argued that they were much more likely than others to commit violent crimes later and that this could be identified by brain scans. The scans could even suggest the degree of probability.

Dutch studies of a family of highly aggressive and impulsive (but mentally healthy) men claim to have found clear genetic markers for their condition. What’s more, it will probably become easier to treat or to control such people by new scientific means — one of the objections to locking up psychopaths is that they cannot be treated. Then the question of their civil liberties will fade and with it our objections.

Meanwhile, in America there is a voluntary gated community of convicted paedophiles, who have come together for protection from themselves and others. Outside their ghetto they know they will almost certainly attack again and be attacked in turn. Perhaps this solution could be offered to others with dangerous and untreatable problems — shooters, sadists and psychopaths.

It is a miserable image, but perhaps it’s better than the alternative — being locked up, being given compulsory community treatment orders or being lynched.