Cynics Unlimited

Exactly a year and six days after the shooting death of Jane Creba on Boxing Day 2005, Toronto witnessed the murder of another woman, Jean Springer. On January 1 2007, Ms. Springer, a sixty-year-old accountant originally from Trinidad and Tobago, responded to a knock on her door from Altaf Ibrahim, a former classmate of her son Anton. Ibrahim asked to talk to Anton. When Springer replied that Anton no longer lived with her, Ibrahim took a gun and fired at her, killing her instantly.

The incident was covered extensively by Toronto’s newspapers and television stations. Ms. Springer was an active member of her Methodist church and affectionately known as “Auntie Jean” in her neighbourhood. Commentators spoke of the loss her death represented not only for her family but for her entire community.

Details were meanwhile emerging about her assailant, Altaf Ibrahim. According to acquaintances of his, he was a schizophrenic who had stopped taking his medication. He also had a history of contact with the police, stays in psychiatric facilities, and involvement in a knife-wielding attack. At some point he became convinced that Anton Springer was trying to rape his (Ibrahim’s) mother. Police speculated that Anton, rather than Jean Springer herself, may have been Ibrahim’s intended target. At the end of October this year, Ibrahim was found to be not criminally responsible for Springer’s death because his mental condition prevented him from recognizing the wrongfulness of his act. The Ontario Review Board has yet to decide his fate.

The Springer case raises a thorny question: should people with mental illness be made to take medication against their will to stop them from harming others (or themselves for that matter)? If Altaf Ibrahim had been forced to do so, would Jean Springer still be alive today? Of course not all mentally disturbed individuals are violent. However, in the last year or so Canada has seen a spate of violent crimes committed by people with psychiatric problems. In May, a man in Calgary who had earlier complained of being “possessed” fatally stabbed his wife, two of his three daughters, a tenant in his home, and finally himself. Two months later a man believed to have paranoid schizophrenia attacked and killed a fellow passenger on a Greyhound bus. This man, like Ibrahim, had refused to seek treatment for his condition.

In a way, coerced medical treatment goes against the freedoms that we in Western society hold dear. Adults are generally permitted to decline medical care even if doing so costs them their lives or if the reasons for their refusal appear irrational. For example, Jehovah’s Witnesses reject blood transfusions on the grounds that several Biblical verses forbid the consumption of blood – an interpretation incomprehensible to most other Christian denominations. One argument for mandating psychiatric treatment versus, say, a blood transfusion or kidney donation is that mental illness affects the brain and by definition renders those affected by it irrational. Just as Altaf Ibrahim was unable to make a choice of whether or not to shoot Jean Springer, he was incapable of deciding whether or not to take his “meds.”

One concern about forced psychiatric treatment stems from the fact that throughout history people with no real mental conditions have been deemed insane and subjected to inhumane procedures in an attempt to “cure” them. Dissidents in the former Soviet Union, for instance, were sometimes confined to psychiatric institutions for questioning Communist doctrine. In one case described by Russian journalist Cathy Young, a man in this position was drugged to the point of being unable to form a complete sentence. Nor have the West’s actions towards individuals considered mentally ill always been sterling. Homosexuality, for example, was viewed as a psychological disorder until 1974, and many gay youths were sent to mental hospitals where they forcibly underwent “treatments” ranging from castration to electroconvulsive shock to aversion therapy. One difference between homosexuality and schizophrenia, though, is that while attitudes towards the former have varied across time and place, in almost all cultures individuals with symptoms suggestive of schizophrenia are recognized as not being normal.

While I myself am in favour of individual liberty and the right to reject medical care, in the case of the mentally ill I believe forced treatment has a place at times. In a sense it even seems inhumane to deny such patients treatment that might alleviate their suffering but that they lack the ability to consent to (I know this from personal experience; an aunt of mine committed suicide after a long struggle with what was probably bipolar disorder). More importantly, there is the principle of “Your right to swing your fist ends where my nose begins.” From that perspective, Ms. Springer’s right to safety and ultimately life itself should have taken precedence over Altaf Ibrahim’s right to refuse his medication.

This does not necessarily mean that all individuals with mental problems should be locked up in institutions permanently (in Ibrahim’s case I think he should be, not to make him “pay” for his crime but to protect others from his actions). Regular visits from a nurse or social worker might be the most cost-effective means of ensuring that some mentally ill patients can function in society without hurting themselves or others. But if coerced medical treatment can prevent tragedies like the Springer murder, it should not be ruled out entirely.