It was December of 2015 when a well dressed businesswoman stabbed another woman, a complete stranger, repeatedly with a small knife in the Shoppers Drug Mart located in the underground PATH network near Bloor and Yonge. One of the thrusts had penetrated the woman’s heart and she later died in hospital. Video footage led to her identification and arrest at her home and she spent two years in prison awaiting trial. During the pretrial period she was diagnosed with acute schizophrenia and was found NCR – not criminally responsible. She spent the next eight years in confined treatment, transitioning to a halfway house. Earlier this month the Ontario Review Board gave the woman an absolute discharge meaning she will no longer be supervised and is also no longer deemed dangerous to the public.
Predictably the online response was furious. Ranging from calling for her death, informing the victim’s family of her present address to continued prison sentencing. The popular sentiment was that justice had not been served, certainly as pertains to the victim, and what if she decides to stop taking her medication by which her condition could return.
A similar homicide occurred in 2008 on a Winnipeg bound Greyhound Bus west of Portage La Prairie. A man stabbed his seat mate to death while he slept, decapitated him and began eating parts of his body. The perpetrator was also found NCR because of extreme schizophrenia. He underwent successful treatment and was given an absolute discharge in 2017. He has not reoffended since.
I have never had a mental illness. I have never had schizophrenia. But I can speak with authority on the condition because my wife has and continues to have schizophrenia. Like both preceeding examples, my wife had the very uncommon late onset schizophrenia. Like my wife, both perpetrators enjoyed successful adult careers until being afflicted in their late 30s. They however lacked a network of close friends and family perhaps because of their immigrant and nonmarital status. This allowed their disease to progress to an unusually advanced stage without medical intervention.
Mental illness is like any other illness of the body, except it affects the brain. And this distinction makes it a socially stigmatized disease. You lose even your friends and family because the perception is that you should be able to will yourself to recovery. In the manner that drug and alcohol addicts and people with weight control problems overcome their personal struggles. The intelligent and the disciplined are immune. But they’re not.
Advocacy on behalf of the mentally ill is paramount, more so than for other diseases. Every single homeless person is likely mentally ill but they have been abandoned by their friends and family and no longer have the conscious ability to seek medical help. My wife had the same psychiatrist for a decade who tried medication after medication to no avail. He was fixated on the idea that the latest developed drugs must be the most efficacious. In reality, pharmaceutical companies make moderate alterations in the chemical structures of their current drugs to allow them to patent a brand new drug with no real improvement in performance. I had to advocate for a change in clinician by seeking the resources of Toronto’s famed CAMH (Center for Addiction and Mental Health) where it was quickly decided to try an old legacy antipsychotic drug. This was the drug therapy that finally restore life to her.
Schizophrenia is an illness that does not respond well to psychotherapy. It is a poorly understood condition that seems to reflect a chemical imbalance in the brain. Friends and families can still do their part to mitigate the symptoms by providing a safe environment that the patient can clearly identify as one rooted in reality. A schizophrenic is bombarded with unceasing hallucinations and voices that make it impossible to determine reality from fantasy. Both perpetrators report hearing and following the directives of some divine entity to the point of committing murder, although they did not perceive it as an act of murder – the man believed he was killing a malevolent alien.
That is the basis for the NCR verdict. In the same way that we have a separate system for adjudicating juvenile felons who are too immature to fully comprehend the repercussions of their crimes, a person who can no longer perceive reality surely cannot be responsible for their actions. If we truly endorse a justice system that upholds rehabilitation over retribution there is simply no justification for a prison sentence after the NCR individual has recovered their mental health. The system has returned a law abiding and productive citizen back to society.
But without a lifetime of supervision, will NCR culprits reoffend? A study of 1800 NCR cases showed a two year recidivism of 17% and those associated with violent crime even lower. Both rates are also much lower than the recidivism rate of those that were found guilty of a crime. But what if our schizophrenics decide to stop take their meds, which is a decision that is many levels of magnitude below the decision to commit a felony. The dosing scheme involves daily oral meds and a once monthly long acting slow release injection. To be sure, most antipsychotics have a variety of unpleasant side effects including weight gain, tardive dyskinesia (involuntary movements), and brain fog. But before granting an absolute discharge, the candidate has to demonstrate unbroken years of absent psychosis which also implies strict drug compliance. After an initial period of denial where drug compliance may be spotty, once an individual experiences sanity they will do everything to maintain that status.
In 2001, Russell Crowe stared in the film “A Beautiful Mind” which told the real life story of Nobel laureate mathematician John Nash. Nash also developed late onset schizophrenia but he found taking the antipsychotic meds prevented his mind from working clearly. He decided to forgo the drugs and actively deny all his hallucinations and what they spoke to him. The university provided a work environment that allow his interaction with students and his ex wife kept him safe at home. Beginning in his 50s, the hormonal changes of aging actually caused all his hallucinations to diminish until they disappeared completely. He was disease free in 1994 when awarded the Nobel Prize in Economics.
But what of justice? Marco Muzzo was the scion son who made news in the Toronto region in 2015 by driving drunk and killing 3 children and their grandfather. He was granted a full parole in 2021. He had spent approximately four years in jail before being granted day parole. Nobody denies he did not serve his time. Our schizophrenics spent a decade in confinement for one homicide. People are so much more forgiving of an alcoholic than a schizophrenic.
Jim Chung's Ramblings 