In a detailed verdict issued on Thursday, the Supreme Court of Pakistan has paved way for the execution of Imdad Ali, a patient diagnosed with paranoid schizophrenia. Ali was convicted of killing his religious mentor in 2001 before he accused him of plotting against him and standing in the way of his spiritual knowledge immediately prior to the murder.
The detailed judgment issued on Thursday observed: “Schizophrenia is not a permanent mental disorder; rather it is an imbalance that can increase or decrease depending on the level of stress. In recent years, the prognosis has been improved with drugs, by vigorous psychological and social managements, and rehabilitation. It is, therefore, a recoverable disease, which in all cases does not fall within the definition of ‘mental disorder’ as defined in the Mental Health Ordinance, 2001.”
However, the Supreme Court’s observation that schizophrenia is a “recoverable disease and which in all cases does not fall under the definition of “mental disorder” is glaringly erroneous. As the World Health Organisation (WHO) fact sheet on schizophrenia clearly states it is a “severe mental disorder” affecting more than 21 million people worldwide.
Moreover, the argument made by the esteemed judges regarding the improvement of prognosis with administration of drugs coupled with physiological and social managements is also contradictory as Imdad Ali who has been kept under solitary confinement for the last three years clearly does not have access to counselling services that were determined essential for a patient that has been diagnosed with paranoid schizophrenia.
In his report the Head of Department of Psychiatry, Nishter Hospital, Dr Naeemullah Leghari, states: “There was history of self-talk, gesturing, posturing, odd ideas and beliefs, bizarre ideations and lack of concern for his death sentence. During his stay in the ward, he was found to be a totally withdrawn person, preoccupied within himself and showed lack of interest in the people and activities around him. He was often found engaged in self-talk and also passing smiles on his own. His mental state exam was significant for: lack of self care, incoherent speak (lacking clarity), which was difficult to understand, and [an] irritable mood.”
The medical report further makes a note that Ali has paranoid schizophrenia, which is a “chronic and disabling psychiatric illness. This illness significantly impairs the person’s rational thinking and decision-making capabilities. Hence, in my opinion he is an insane person.”
When reached for a comment, a renowned psychiatrist based in Islamabad, Dr Ambreen Ahmed noted that while schizophrenia is treatable and can be managed, but for a majority of patients it is a life-long ailment that is followed by medication and psychological support. Hence, in her expert opinion while schizophrenia can be controlled, it cannot be cured and is thus, not a recoverable disease. She further reaffirmed that schizophrenia is among the most serious prevalent mental disorders and that “… if it does not fall under the definition of mental disorders…” under the Mental Health Ordinance, she is “… not sure what does.”
International rights based organisations such as the Amnesty International and Human Rights Watch have expressed grave concerns on Ali’s impending execution. The Amnesty International in a statement noted: “Pakistan is clearly in breach of international human rights standards that protect people with mental illnesses and ensure that they are never subject to this cruel and irreversible punishment.”
Now putting all legal and medical arguments aside, let us look at this case solely from a humanitarian perspective: Ali is now nearly 50 years old having been on the death row for the last 16 years. He has a wife and no children to support him, and he comes from a marginalized family that was not able to afford the opinions of private medical consultants, which would have provided sufficient grounds to justify his illness.
Moreover, for the last three years Ali has been kept in solitary confinement, which is absolutely bizarre given the fact that multiple scientific studies have found correlations between solitary confinement and hallucinations. For instance, in 1951, researchers at the McGill University paid a group of male graduate students to stay in a simulative setting of solitary confinement. The plan was to observe students for six weeks, but not even one student lasted more than seven days. Nearly every student lost the ability “to think clearly about anything for any length of time,” while several others began to suffer from hallucinations.
Let us not make a travesty of our judicial system; the appeal of Imdad Ali’s wife must be reconsidered on compassionate, humanitarian grounds, as killing a mentally ill prisoner who has already languished behind bars for the last 16 years will bring justice to no one.