I write this piece today because, as a nurse, I feel it’s my professional obligation to educate and advocate. I only learned about the Scott Panetti case last weekend and was thoroughly disturbed, like many others, upon hearing media reports of the impending ethical disaster scheduled for this Wednesday, December 3rd. To understand my heavy-hearted and conflicted feelings, I read as many articles, research studies, and legal documents as I could up until writing this. I am a nursing student and am by no means a neurolaw or neuropsychiatric expert. Mental health professionals have indeed weighed in on the hearings, confirming symptoms and presence of disability; however, I did notice what seemed to be a lack of discussion revolving around the bias of stigma and societal misrepresentation of mental illness that undoubtedly influenced to the Court’s decision. To negate bias and bolster the past psychiatric testimonies confirming mental incompetence, the basic pathophysiology of the disease must be presented to the Court and should be supported by neuropsychiatric evidence to emphasize the true, organic, and degenerative nature of schizophrenia. I have presented my thoughts below in two related sections: The Ethical Dilemma and Much Needed Neuroscience and Education for Justice.
The Ethical Dilemma:
In less than two days, Texas will execute Scott Panetti, a severely mentally ill man who was convicted of murder in 1995 after representing himself in court dressed in a purple cowboy costume. Panetti, who had been hospitalized for acute exacerbations of schizophrenia several times throughout his life, was not taking his medications and was floridly psychotic, yet the court somehow deemed him competent enough to insist on representing himself. During the trial, he presented his medical records, which were covered in drawings and scripture, and he called upon over 200 witnesses including Jesus, Pope John Paul II, and John F. Kennedy. When he testified in court he appeared agitated and spoke of delusions in disorganized, tangential phrases. At some point, he spoke to the jury as his alter-ego “Sarge” whom he says committed the murders of his mother-in-law and father-in-law in 1992. Panetti has been on Death Row ever since.
Over the past several years, Panetti’s execution has been stayed many times, largely on the grounds of the 8th Amendment, which bans states from “inflicting the death penalty upon a prisoner who is insane”. Texas continued to battle with attorneys, essentially saying Panetti is sane enough to be executed. This prompted the US Supreme Court decision in 2007’s Panetti v. Quarterman, 551 U.S. 930 stating “A prisoner’s awareness of the State’s rationale for an execution is not the same as a rational understanding of it.”
Scott Panetti may be aware of his impending execution, however he clearly cannot rationally comprehend the reason: Panetti currently believes Satan, working through the State of Texas, wants to kill him this week to prevent him from preaching scripture to fellow inmates. Despite the above stated legislature designed to protect the mentally ill; despite extensive evidence of mental disability; and despite numerous international petitions for clemency, the Texas Court of Criminal Appeals continues to uphold its decision to execute Scott Panetti on December 3, 2014. As Ron S. Honberg, J.D., National Director of Policy and Legal Affairs at NAMI, the National Alliance on Mental Illness, writes in his recent Los Angeles Times Op-Ed piece, if the State of Texas carries out Panetti’s death sentence, it will be one of the “most outrageous executions of our time” demonstrating the United States’ failure “to protect the inherent dignity and civil rights of Americans with mental illness when they come into the criminal justice system.”
Much Needed Neuroscience and Education for Justice:
The media too often represents sufferers of schizophrenia as scary, erratic, crazy people who hear voices and see things that don’t exist. It’s important to correct this inaccurate portrayal and educate the public about the lesser-appreciated trademarks of the disease, such as progressive cognitive deterioration and delusions.
Perhaps the most striking and telling form of evidence that could be easily appreciated by the untrained layperson is a set of MRIs, or magnetic resonance images, comparing a healthy brain image with a schizophrenic brain. With a bit of basic background information about the pathophysiological process, the layperson could be guided in analyzing the basic differences between the images.
Challenging jurors to learn and to replace stigma with unbiased pathophysiology could possibly lead to better-informed decisions and a more just justice system.
We as mental health professionals can and should cite every bit of current research that could allow us to correct media misrepresentations and stress the true gravity of a schizophrenia diagnosis. In this case, neuroscientific evidence could have helped influenced a life or death decision and thwarted a civil rights disaster.
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