In the wake of violence, sexual assaults, mob aggression, etc., in various parts of the country in the recent past along with an increase in intimate partner violence, child and elder abuse during the ongoing pandemic, words like ‘pagal aadmi’, ‘psycho’, ‘mass hysteria’ or ‘crackpot’ keep circling among the public. Many are convinced that such inhumane acts can only be caused by people with ‘unsound’ minds. This notion is not right, considering a riot or mob violence takes years of nurturing and the involvement of multiple hierarchies.
Recently one of my journalist friends asked me, “Psychiatrists say mental disorders are not linked to violence. Don’t you think mass killings in the West and the endless violence here are all some signs of impending mental illness?” I have faced similar questions in the past. Being a physician, especially a psychiatrist, this triggered a thought. I took this opportunity to guide the readers through three basic facets: 1. What constitutes mental disorders and what do not? 2. How might people with and without mental disorders be capable of cruel and immoral behavior? and 3. Understanding the differences between the two.
We understand where this comes from. Through media portrayal, it has been popularised that any asocial, bizarre, inhumane or sadistic act can be considered to be a ‘disease of the mind’, with the perpetrator getting the label of ‘delusional’ or ‘psychotic’ or the generic term of ‘deranged’, much to his/her comfort. This gives a potential defence against the legal outlook, as it happened with one of the accused in the Nirbhaya case. It evokes our empathy related to the perpetrator and we find solace in accepting ‘mental disorder’ as a reason for the crime, which is a more plausible and pragmatic explanation for us. Why? The mentally ill have traditionally been marginalised and segregated from society, wrongly viewed as dangerous. We believe this keeps us safe and in denial of the brooding evil in our inner selves.
We, the psychiatrists, are partially at fault here, having not done enough to clarify the boundaries of mental illness. Section 84 of the IPC (traditionally derived from the M’Naghten rule of the UK) details the criminal responsibility of the insane. It uses terms like ‘unsoundness of mind’ as a reason for commission of an act contrary to the law. Now, in a country where feeling sad is equated to depression and taking pride in one’s actions is deemed to be narcissism, it is difficult to bring forward the true definitions of mental illness. The concept of a mental disorder lacks a consistent operational definition. Added to that is the prevalent stigma, lack of awareness and reductionist approach towards mental health in our country, which makes the situation more complex.
So what constitutes a mental disorder? To answer my journalist friend: There are standard diagnostic systems like ICD-10 and DSM-5 based on which we diagnose mental disorders, just like diabetes or hypertension. Simply put, shocking acts of violence, revenge, sexual assault, hate crimes, etc., alone do not constitute mental illness by formal scientific standards. Forensic psychiatrists clearly state that it is a grave mistake to consider a criminal act to be the result of a mental illness simply because it was horrific or grave.
The heinousness of an act has nothing to do with a diagnosis. It obviously can be correlated to the state of mind as psychopathy is common in the perpetrators of these crimes. It is also vital to understand that completely sane individuals are equally capable of committing such severe crimes and do not necessarily need to be mentally troubled. In fact, psychotic individuals rarely turn aggressive and that too, only when provoked in relation to their symptoms (for example, a person with a delusion that someone is spying on them might get agitated to see a stranger near his house). However, the actual incidence of physical violence and aggression by mentally ill individuals is very low (less than 1%).
Ironically, the need to be selfish, oppositional, violent and self-servingly sadistic has always been there in the human race. It just needs the correct triggers to surface. We have evolved and segregated ourselves into caste, race, religion, and political and socio-ethnic based groups. The diversity of individual or collectivistic interests and disrespect to varying opinions are often the potential triggers for this innate violence to resurface. We cannot diagnose any individual involved in mob violence, not even the person who first started the aggression.
Unfortunately, our psychiatric diagnostic system is not equipped to make collective diagnoses, else the entire district, state or country would probably have been labelled as deranged simply because we ourselves have ingrained this group-based hate in our mind for years, be it for a particular community or religion, and have only waited for the right channels to vent it out.
A certain ideology or a certain speech might have provided that. In that case, the very system is of unsound mind, not a particular individual. And this is exactly where this differs from the mass shootings in the West, where a single person with a sociopathic or delusional ideology attempts to cleanse the world off its impurities in a much more impulsive and crude way than the Nazis thought about eugenics. Do we call them as suffering from mental illness then? It can be debated, but it’s a collective issue building up for generations altogether.
Once again, does immoral, callous, cruel and supremely selfish behavior exclusively constitute mental illness? The answer is no. These socially deviant traits are widely prevalent, irrespective of a diagnosed mental disorder. Some of the perpetrators might be gullible, neurotic, easily brainwashed into mass violence; however, these personality traits do not make someone mentally ill.
No country or state is inherently violent. Misinformation has kept us in popular denial for long. It’s high time we realise that the ‘mass’ in mass hysteria is composed of each one of us. Hence, preventing aggression and hatred is a collective responsibility. Reflecting on our collective thinking, tolerance and empathy towards others might be more helpful in averting crises like the Nirbhaya or Hathras case rather than blaming them solely on isolated sociopaths or people suffering from mental illnesses.
Dr Debanjan Banerjee
Psychiatrist, National Institute of Mental Health and Neuro-Sciences, Bengaluru
(dr.djan88@gmail.com)