Mental Illness and Justice: The Need for a New Paradigm

Last fall, I received a call from a distressed father asking me to review his son’s case. His son had been diagnosed with bipolar disorder (manic depression). The son was on parole for a crime that he had committed when he was in a manic stage. He quit taking his medication again, went manic, and committed another series of crimes. The son was eventually sentenced to seventy years in prison with twenty suspended.

I talked with the son’s attorney before sentencing and expressed my sorrow that the parole officer, family, or someone else hadn’t been able to force the son into treatment when it became clear that he was off his medication and headed for serious trouble. In many cases, a couple of days or a few weeks with the proper medical care would be all that it takes to stabilize a patient’s brain chemistry so they can return to their normal life.

The attorney looked at me in disgust and responded “but that would have violated his civil rights.”

I can’t think of a clearer depiction of our profession’s inability to grasp the realities of mental illness. The system that we’ve established and operate helped this young man avoid a short involuntary stay in favor of a lifetime in prison. It’s not surprising that under this system our State Prison houses several times more people with serious mental illness than the State Hospital.

Last month, our office worked with the family of a Helena man who suffered from a mental illness-induced psychosis that involved a major battle between angels and demons. According to his delusions, the battle would end on a specific day in early March when the man must kill the Antichrist. The family was terrified that the delusion of the Antichrist would be projected on an innocent victim on the street. The legal and medical communities felt legally blocked from averting potential tragedy.

While I understand that there is a real need to revise some of Montana’s laws pertaining to mental illnesses, I can’t help but think that part of the problem is our profession’s failure to understand the role of brain chemistry in mental illnesses and crises. Would we be this paralyzed if the dangerous delusions had been caused by someone slipping him LSD? I have to believe that we would have done more to keep this poor man’s path from intersecting with the SWAT Team or the coroner.

The man was arrested before the delusional apocalypse and sent into treatment. While we can all be happy that broad tragedy has been averted, it is shameful that he had to become a criminal in order to be freed from his debilitating hallucinations.

We can and must do better than that.

The legal system flounders when faced with someone whose biological brain disorder affects how they think, feel, and act. People who live with serious mental illnesses and their families expect us to do better than seizing someone who acts irrationally because of a medical condition and punishing them for acting irrationally. Our profession must update our conception of mental illness to reflect society’s new understanding of the effects of mental illnesses on the functioning of the brain.

The realities of the challenges presented by mental illness mirror the plight of a person who is “involuntarily intoxicated.” For instance, bipolar disorder drastically alters the release of the brain chemicals dopamine, serotonin and norepinephrine. The different levels and timing of these chemicals affect mood regulation, stress responses, pleasure, reward, and cognitive functions to cause mania, depression, or even a mix of both. A man or woman in the grips of a manic or depressive episode has effectively been drugged by their illness.

While not a silver bullet, the involuntary intoxication paradigm can be can be a valuable tool to help attorneys navigate through the complex civil rights, neglect, and public safety issues presented by someone in a mental illness crisis. It offers a major step forward in adapting our legal system to reflect the medical realities presented by these devastating illnesses.