6.2 A Hypothetical Mental Patient

Let us try to get a feeling for the human side of this problem by sketching the profile of a hypothetical mental patient. We’ll call the patient Kerry. Kerry is a young person who has always felt a little bit different from other people, perhaps because of a heightened feeling of vulnerability or self-consciousness. Kerry has long held a passion for poetry and eastern religions, and recently he/she began to find new meaning in favourite writings. After sitting up all one night reading, he/she slipped into an altered state of consciousness involving visions and voices. When Kerry began to express unusual beliefs to the family over the next few days, together with fragmented quotations of poetry referring to ‘slings and arrows of outrageous fortune’ and taking ‘arms against a sea of troubles’, the family doctor was called in to make an examination. The doctor identified delusions, and thought Kerry was in need of care, treatment, and control. This led to Kerry’s involuntary admission into a mental hospital.

DSM-IV defines delusions as false beliefs that are not ‘ordinarily accepted by other members of the person’s culture or subculture’.[18] This means that Kerry’s family doctor, by virtue of being a medical practitioner, is presumed under the sanctions of typical mental health legislation to be a competent judge of ordinarily accepted beliefs and is empowered to certify anyone who appears to hold beliefs that he/she thinks are culturally unacceptable.

It should be remembered that after Kerry’s incarceration in a hospital there are still no laboratory tests available to confirm an underlying cause for the delusions identified by the family doctor. The hospital psychiatrists would therefore have to rely on monitoring Kerry’s thoughts and beliefs, and their outward manifestations, to know whether his/her condition was improving or deteriorating. This means that treatment that is intended to ‘improve’ Kerry’s condition will also be intended to coerce him/her to give up or change the ‘false’ beliefs that were the original symptoms of the illness. So long as Kerry’s delusions remain in an unremitted state it is likely that the treatment/coercion will continue.

This deduction allows us to establish a prima facie case that any involuntary psychiatric treatment given to a person alleged to have schizophrenia would violate Article 18 by subjecting the person ‘to coercion which would impair his freedom to have or to adopt a religion or belief of his choice’.[19] A further case can be made that the standard neuroleptic drug treatment given to people who are alleged to have schizophrenia does not merely select delusions for modification but also interferes with the person’s freedom of thought by blocking the higher thinking centres of the brain.

[18] International Commission of Jurists, Siracusa Principles on the Limitations and Derogation Provisions in the International Covenant on Civil and Political Rights., p. 765.

[19] United Nations, ‘International Covenant on Civil and Political Rights’, Article 18.2, reproduced in Satish Chandra, ed., p. 32.