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Ian Brady: mad or bad?

'I am not mentally ill I just have a severe personality disorder'

On Friday 28th June 2013 Ian Brady, the notorious serial killer jailed for life in 1966 for the murder of three children and responsible for the deaths of a number of others, lost his bid to be transferred from Ashworth high security psychiatric hospital to prison.  He argued in a week long tribunal, which was filmed and broadcast to the public, that he should not be held in a psychiatric unit because he is not mentally ill.  He claims instead that he has severe personality disorders.

Brady says he wants to go to prison where he would be allowed to die by refusing to eat.  At Ashworth, where Brady is detained under the Mental Health Act, he is fed through a tube since he went on hunger strike in 1999, (although he has some soup and toast most days).  Ian Brady, who is now 75 years old and is Britain’s longest-serving prisoner, has developed long-standing, well-known and extremely bitter feelings about the regime at Ashworth where he was transferred when  he was diagnosed as a paranoid schizophrenic in 1985.  He now claims that he deliberately feigned symptoms of mental illness to get a transfer but the tribunal concluded that,
"Mr Ian Stewart Brady continues to suffer from a mental disorder which is of a nature and degree which makes it appropriate for him to continue to receive medical treatment, and that it is necessary for his health and safety and for the protection of other persons that he should receive such treatment in hospital, and that appropriate medical treatment is available for him."
But, why would Brady claim not to be ill and what is the distinction between mental illness and personality disorder?  Put simply if Brady is not ill and can’t be treated he does not need to be detained in a hospital.

Schizophrenia is a mental illness that affects the way someone thinks that can be treated with medication and therapy.  Unlike common stereotypes sufferers are not generally violent but can become very scared and upset during episodes.  Symptoms include psychosis which means experiencing things that are not real (hallucinations) and having unusual beliefs (delusions).  Psychosis can come and go.  Other symptoms include lack of motivation and becoming withdrawn, these symptoms are generally more long-lasting and persistent.  It is believed to be the result of a combination of both genetic and environmental causes.  Both sides agree that Brady has narcissistic, paranoid and antisocial personality disorder, but his defence team claimed he no longer shows signs of being schizophrenic or psychotic.

A personality disorder describes a long-term pattern of behaviour, mood and style of coping that creates severe difficulties at home, at work and in personal relationships.  Someone with a personality disorder typically has extreme beliefs and behaviours that are quite rigid and differ from their cultural norms and has difficulty maintaining close relationships.  Environment, rather than genetics, is thought to lead the development of a personality disorder.  There are a number of different types of personality disorders. The DSM V classification divides them into groups A ‘odd and eccentric’, B ‘dramatic or flamboyant’ and C ‘anxious and fearful’.   Brady is said to have a number of disorders, characteristics of which include exaggerated self-importance, craving attention and admiration, intolerance of others(narcissistic), impulsive, reckless and aggressive behaviour, no thought for others (anti-social) suspicious, unable to trust others (paranoid).

Personality disorder itself is not generally treated with drugs, although it can lead to other mental health difficulties like depression that may be treated with medication, and does not usually require hospitalisation.  It used to be thought that a personality disorder could not be treated and so was not considered an illness but more recently ideas about this are changing and long-term psychological therapy have been found to be helpful.  Part of Brady’s defence was that he has been very resistant to treatment.  If he can’t be treated there is an argument that he does not need to be in hospital.  Schizophrenia is treatable with medication but not curable; however Brady has refused medication and therapy since 2000.  Ashworth claims that if he leaves hospital his condition, which cannot be cured and does not go away, will deteriorate and he will become more psychotic.

Interestingly, Brady claims that he faked psychosis in order to get a transfer to hospital.  If this were true it would be elaborate and extremely manipulative behaviour typical of a personality disorder but he has been unable to manipulate the authorities into placing him back in prison now that he has changed his mind.  It can be argued that the tribunal process itself was an expression of narcissism.  A typical mental health tribunal would take a few hours at most.  This tribunal took a full week.  Brady insisted on a public forum where he spoke at length and in detail in his first public appearance since 1987.

Around one in four people in Britain will experience mental illness each year and one in three over their life time.  Schizophrenia is thought to affect about one in a hundred people, most of whom pose no threat to others and whose symptoms can be managed with the right treatment.   Around one in ten people in the general population may have some form of personality disorder but in prison it may be as many as nine in ten.  Brady’s condition is considered to be very extreme and uncommon.  He is one of only around 700 people being held in Britain under the Mental Health Act in high security hospitals and it is estimated of these between only 50-100 individuals have a similarly extreme pathology.  Marjorie Wallace, chief executive of the mental health charity Sane said: “The spotlight on high-profile cases where society has to judge whether someone is mad or bad can only further the stigma for people struggling with the daily reality of mental illness and disorder.'’ 

The tribunal, which is estimated to have cost the taxpayer around £250,000, raises many uncomfortable issues for example; in what kind of legal process does a man say in his defence that he only killed for ‘recreation’ and the ‘existential experience’? Does Brady really wish to kill himself or has he resorted to hunger strike in a desperate attempt to control others?  By refusing food the authorities are compelled to respond to his manipulation.  Why is this prisoner given such a public forum when the voices of so many innocent and well behaved people suffering with mental health issues are not heard?  Brady’s condition means he has an inflated opinion of his own self-importance and this extended process confirms his beliefs.  It can be argued that the public do have a fascination with Brady and his crimes and this public process serves to satisfy curiosity about him while confirming his own self-importance.  Throughout the tribunal he has demonstrated his need to control and while he may have had some success in controlling the process, he has not had any in influencing their conclusion.  It is rare for the workings of the mental health system to be shown publicly and what could have been an opportunity to demystify and educate about mental health care was instead perhaps the final showcase for a publicity seeking narcissist.

For an interesting insight into how one psychiatric hospital cares for more ‘normal’ mentally ill teenagers watch BBC Three’s ‘Don’t Call Me Crazy’ on Monday from 9-10pm

For more information on different types of mental disorder and illness visit the Rethink Mental Illness web page, detailed below.


 

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