Psycho Killer

Last week a mentally ill man shot one policeman to death and hurt three other people when they came to apprehend him in his home in the Swedish town of Nyköping. This is a very rare and shocking occurrence in Sweden, where gun control is such that most people have never seen a handgun. Wednesday, an opinion piece about the case appeared in the main Swedish newspaper Dagens Nyheter. It was written by two senior psychiatrists, Henrik Belfrage and Göran Fransson, both of whom have examined the killer in the past. What they had to say is quite remarkable, and so I decided to translate a few bits.

"Dedicated forensic-psychiatric clinics should be given the overarching responsibility for evaluating threatening people with paranoid symptoms. The level of expertise and security in the public mental healthcare system is insufficient. Many psychiatrists simply do not dare to write a certificate of insanity for these people because they risk facing threats and violence.

As a consequence, there is currently hardly anyone even within the judicial system who dares report threats from mentally ill paranoiacs, because it is impossible to trust psychiatric forced care to act and accept its responsibility. The tragic police murder in Nyköping should never have had to happen. The killer's paranoid and dangerous state had long been amply documented, and the question was no longer if something might happen, but simply when.

[...]

As early as in 1999 we reported the [...] man as exceptionally dangerous. At that time, he suffered from a pronounced delusional syndrom, so-called kverulansparanoia, and several persons were receiving serious threats from him. Unfortunately he was in jail at the time, not a hospital, serving time. After he had knifed three unknown people, killing one, a psychiatric evaluation had classified his paranoia as a personality disorder (that is, not a mental illness), and this was not enough to sentence him to indefinite mental care. [...]

Someone who is severely mentally ill should of course be certified as insane and entered into forced psychiatric care, particularly if they are dangerous to others. This is in our view where things are not working, and the fault is mainly with the forced psychiatric care system.

If a psychiatrist for some reason -- insufficient expertise, or, which is unfortunately more likely, fear -- cannot accept the responsibility of such an assessment, then the forced care system breaks down. Anyone who has previously been involved in a court case or a forced care evaluation regarding the patient ends up in a very precarious situation. To wit, the paranoiac suddenly receives a "certificate" that he is in fact not ill at all, which becomes proof to him that all previous assessments of him as mentally ill were erroneous and possibly motivated by spite. This calls for revenge. [...]

It appears that most people within and without the judicial system are fully aware of the weaknesses in the courts and forced care system in cases like these. The threats we have received from the man in question included various affidavits from lawyers, doctors and others who certify that he did not receive a fair trial the last time, that he displays no psychiatric symptoms, that he has the signatories' full support in his struggle against the authorities etc. Did these people write those documents because they really believed what they said?

No, of course not. They wrote them out of fear for themselves. Everyone knows that unless you play along with the paranoiac you risk becoming the victim of threats and violence. In this case it is also amply documented that a great number of authority representatives, doctors, district attorneys and others have been receiving serious threats from the man for years. How many police reports? None. No-one dares.

[...]

Anyone who had been in contact with this man in recent years knew that he would in all likelihood break out in homicidal violence one day. This was obvious. Nevertheless, in the eight years since we filed our assessment, he has never received forced care. A young policeman with his entire life in front of him became the man's victim. Him, instead of one of us who are on the man's hate-and-death list. It feels terrible to us, and it is a great defeat for the judicial system and the forced mental care system.

[...] the professionals in question should not have to live under constant threat because the forced care system is not acting against severely ill and dangerous people. Nor should these ill people be left without the care they so clearly need."

Update 1 July: Here's another opinion piece by the husband of a Swedish psychologist who was stalked and threatened by a former patient. She repeatedly reported the man to the police, but he finally murdered her in 2006 on the stairs to her office. The killer has since been deemed too insane to deserve a lifetime in prison, but too sane to receive indefinite forced psychiatric treatment. Instead, he serves a ten-year prison sentence, which in Swedish practice means five years.

[More blog entries about psychiatry, mentalillness, murder, Sweden, crime; mord, brott, psykiatri, mentalsjukdom, Nyköping]