A MAN WAS RECENTLY sentenced to life imprisonment for an arson attack in which he killed four people, including his 16-year-old former girlfriend, who no longer wanted to have anything to do with him.

Eight months before the arson attack, he had been released after serving only three and a half years for having killed a woman who refused to leave her husband for him. He repeatedly smashed her over the head with a mallet, fracturing her skull in seven places: not something easily done in a fit of absentmindedness.

The case is emblematic of the stubborn refusal of the British State to carry out its first and most indispensable duty, to protect the lives of its citizens. The case is at the extreme end of the spectrum of seriousness, of course; but the fact remains that hundreds of thousands, and possibly even millions, of crimes are committed annually by convicted criminals who are on probation, creating a vast sum of misery.

Now the Government wants to distract us from its stubborn and deliberate failure (and that of all governments over the past century) by trying to revive an old proposal. The Mental Health Bill. which was dropped in March after a successful campaign by mental health and civil liberties campaigners, is being resurrected this week in Parliament. The Government hopes with this Bill to give the impression that the insecurity that we all justifiably feel is the consequence of untreated psychiatric disorder. Once again it wants to give doctors the responsibility for doing what the legislators and courts have failed consistently to do.

The case of John Barrett, a schizophrenic who killed a banker in Richmond Park while on short-term leave from his secure hospital, is grist to the Government’s mill. It is true, as in the Barrett case, that psychiatric services often fail to carry out their duties properly, and indeed seem to make the same mistakes over and over again; but it is also true that, since human beings are inherently unpredictable, a certain number of terrible cases will always occur each year. Most people would agree that schizophrenics who have displayed a propensity to aggression or violence ought to be treated vigorously, irrespective of their wish of the moment.

What is not true is that if all psychiatric patients were treated optimally, we should all be very much safer than we are. Schizophrenics are more likely than others to be violent; but that does not mean that most violence is committed by schizophrenics. In fact, schizophrenics have become more violent in proportion as society itself in general has become more violent. Most violence, in fact, is committed by people who are not mentally ill.

It is worth mentioning at this point the difficulties that have been caused by the lack of beds in psychiatric hospitals, a shortage resulting from the policy of successive governments. Schizophrenics who have committed acts of violence are remanded to prison because there are no hospital places for them; and under current legislation they cannot be treated against their will in prison. This means that the conditions of 18th-century Bedlam are being re- created in our prisons, an interesting if not very edifying experiment. The simplest solution to this small but distressing problem would be to allow for the treatment of schizophrenics in prison.

The Government wants to go much further, however, by making it easier to detain people with personality disorders. Most crimes are not committed by schizophrenics or by people with other treatable psychiatric disorders. A large number of crimes, many of them of the most serious kind, are committed by people with strange and difficult characters. They are the kind of crimes of which people say that the perpetrator must have been mad, because only a madman would have committed such a crime.

However, the circularity of this argument will not explain the madness. We know that a man is mad only because he has committed a certain kind of crime, and then we say that he committed it because he was mad.

There are very large numbers of people walking about who have very strange personalities, whom it is easy to imagine committing dangerous acts. But it is a very old adage in psychiatry that the best predictor of future behaviour is past behaviour; when psychiatrists are asked to predict which of their patients without a history of violence will commit it in the future, they not only tend to overestimate, but to be no better at it than anyone else.

Unfortunately, the Government wants to impose upon doctors the duty to speculate on the dangerousness of their patients who have as yet committed no offence but who have very strange personalities, with a view to their indefinite preventive detention. It would, of course, be completely unethical for doctors to do this. If the proposed law is passed, it will place them in a dilemma: either to break the law or to act unethically.

What lies behind this authoritarian proposal? Is it not curious that the State should refuse to take seriously what people have already done, and at the same time ask doctors to speculate what people who have done nothing may do? Is it not strange that we should release, after three and half years, a man who smashed a woman’s skull in because he loved her and she did not love him, and yet be proposing to detain people because they have odd and difficult personalities?

The capacity of British governments to get everything exactly the wrong way round is almost infinite. But perhaps there is method in their “madness”. When people complain of the criminal mayhem around them, the Government will soon be able to blame the doctors for it.

Theodore Dalrymple is a psychiatrist and former prison doctor

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