The Madhouse: social alienation of patients in a mental asylum as depicted by Francisco de Goya Photograph: (Others)
Mental health issues should be part of public health goals within the prison system all over the world.
Every year 10th of October is observed as the World Mental Health day with the objective to understand and support mental health. According to World Health Organization (WHO), 'mental health can be affected by a range of socio-economic factors'. Prisoners are known to be very vulnerable to mental health problems. Mental health issues and crime are highly publicised by media houses. John Schrank who shot Teddy Roosevelt was declared insane by doctors. Schrank revealed, 'President William Mc Kinley appeared in his dream and said he was assassinated by Roosevelt'. The Judge sentenced Schrank to life in an asylum. Another sensational case that grabbed headline was when President Ronald Reagan was shot by John Hinckley Jr. who claimed he tried to impress Jodie Foster. He was acquitted of 13 charges and declared legally insane.
Dr Amlan Basu - the then clinical director of Broadmoor - pointed out, 'perpetrators often commit horrendous crimes but they are also victims and it’s very easy to see somebody as either the perpetrator or the victim. It’s much more difficult to understand that somebody might be both.' This observation is apt. Often in mental health cases, we do fail to see a perpetrator as a victim. The life of a prisoner in the prison environment can be daunting and can cause adverse health issues. As a result, the prisoners with mental health can act violent and cause harm; this is one of the major challenges of prison authorities.
Understanding a criminal mind
It is understood that ‘criminal behaviour’ and ‘violence’ are a global public health concern. To protect the society at large, it is our fundamental duty to analyse the anatomy of a prisoner who suffers from mental health issues. It is crucial to explore if there are (if any) concrete evidence to identify the nexus between human deformities, environmental factors and genetics.
Lombroso, a psychiatrist and a prison doctor at an asylum introduced the controversial concept of 'born criminals'. He believed that criminality was inherited. To identify a criminal, certain physical attributes should be considered, such as ‘enormous jaws’, ‘high cheek bones’, ‘solitary lines in the palms’, ‘handle-shaped ears’, ‘insensibility to pain’, ‘acute eye sight’, ‘fuller lips’, ‘abnormal teeth’, ’too long arms’. Any person who matches up with five or more of these biological traits is considered to be a born criminal. As per his study, he identified few other traits too, for e.g. ‘hypersensitivity to pain or touch’, ‘tattoos’, ‘use of criminal slangs’ and ‘unemployment’.
Once his researched advanced, he classified criminals in three broad categories, ‘born criminals’, ‘abnormal criminals’ and ‘occasional criminals’. Lombroso’s study was highly criticised and considered dangerous as well as inaccurate.
Neurocriminology probably could be the game-changer in the field dealing with prediction and prevention of crimes. It focuses on the ‘brains of criminals’ and further studies the ‘genetic’, ‘environmental’ and ‘neurological’ predispositions. Dr. Adrian Raine, in his book, The Anatomy of Violence, conducted extensive research on biological factors that could lead to violent behaviour. According to him, psychopaths have 18 per cent reduction in the volume of the ‘amygdala’. Thus, the seed of emotion, ‘amygdala’ is not receptive and fails to make moral decisions like a normal person.
Raine studied 41 convicted killers and conducted Positron Emission Tomography (PET); the brain imaging scans revealed significant reduction in the development of prefrontal cortex. As a result of this deficiency, he argued, the brain poorly responds and has less control over ‘anger and rage’. Any person afflicted with it suffers a ‘greater addiction risk’ and lacks in ‘problem-solving skills’. Thus, due to the deficiency in the ‘executive function’ of the brain, they are poor in crucial decision making as well as vulnerable to violent activities.
The study on brain imaging evidently can help analyse the ‘physical deformities’ and ‘functional abnormalities’. Arguably, this can help in the treatment of prisoners and prevent further crime. If biological causes of violence are detected earlier, the offenders can be rehabilitated at the earliest.
Rehabilitation of perpetrators
Daniel Reisel raised the question if crime can be tackled by training the brain of a perpetrator?
Reisel extensively studied inmates’ brains to understand the core cause of their violent behaviour. His findings show, psychopaths have different physiological response to emotions. The MRI scans of the prisoners in Wormwood Scrubs showed interesting results. The inmates had ‘deficient amygdala’, therefore, they lacked empathy and felt attracted to immoral behaviour. According to Reisel, the deficiency in amygdale can be corrected by ‘birth of new neurons’ in an adult brain. To achieve the same, prisoners with dysfunctional amygdala should be placed in an improved environment. Steps were taken to help rehabilitate them through restorative justice program. Perpetrators should take responsibility for their own action.
On New Year’s eve in 1997, Katy Hutchinson’s husband was murdered by Ryan Aldridge in a small town of Squamish in British Columbia. Katy who is an advocate of restorative justice care program decided to meet her husband’s murderer. Ryan was convicted of manslaughter and five years imprisonment. Katy believed in ‘changing lives’ and ‘building community’ through restorative justice. Katy forgave Aldridge as she believed, 'being human is rolling up our sleeves and taking active part in repairing harm.'
Though she was criticised for forgiving Ryan, she believed an opportunity should to be created for ‘a new and hopeful beginning’. Restorative justice and forgiveness helped Ryan become a changed man. He is now married with a child. The power of restorative justice care helped him understand his wrongdoing. He apologised to Katy and her children.
Thus, restorative care emphasises on providing opportunities for victims and offenders, facilitating discussion on the crime that has been committed, and stresses the importance of taking charge and repairing the harm. This helps in developing empathy and respond better in mayhem situation.
The Notion of punishment
In India, as per the National Crime Records Bureau (NCRB), the inmates suffering from mental illness at the end of the year 2014 was found to be 2527 convicts, 2823 under-trials and 9 detenus. This is, undoubtedly, an impressive figure and to fix the issue of mental health new holistic methods are to be adopted to treat the inmates. The law makers should think of alternative methods to cure and treat mental health patients.
The notion of punishment needs to go through a paradigm shift. A punishment focusing on retribution has ‘less room for repentance and forgiveness’, it is purely concerned with attaching ‘stigma' to the offenders. On the other hand, restorative justice develops the character and emotional quotient of an offender; it is structured to ‘solve problems’ and involves the parties help understand the harm on four parameters ‘moral, economic, social and political’. Mere deterrence is not effective, prisons will be over crowded and it will not provide an opportunity to the offender to reform.
The main cause of morbidity in prisoners is due to mental health problems. Mental health institutions need to be revolutionised towards hosting prisoners suffering from mental health issues. The idea of punishment should shift from managing criminals to rehabilitation. Prisons should not be a ‘dumping ground,’ rather state should adopt effective measures to create a holistic environment for prisoners suffering from mental health issues.
Environmental factors regulate behaviour; it can be accomplished if mental health institutions are well equipped with medical and technical assistance to treat the prisoners. How we treat mental health of prisoners will go a long way in keeping society safe and will definitely prevent perpetrators from committing repeated offences. Thus, mental health issues should be part of public health goals within the prison system all over the world.