Over the years I have always had a creepy feeling about watching the Libyan tyrant in action as he frequently strutted around the global political scene consorting with other brutal dictators and pariahs from Hugo Chavez in Venezuela and Fidel Castro in Cuba to Alexander Lukashenko in Belarus.More recently his comic operetta costumes, bizarre use of heavy sunglasses indoors and rambling incoherent speeches have made me realise that actually he strongly reminded me of some of my former more disturbed schizophrenic patients.
I declare a professional and not just a political curiosity, having previously beena consultant psychiatrist at a London teaching hospital prior to being electedas MEP for London. I was also in charge of a low secure mental health unitdealing with the more disturbed end of the psychiatric spectrum, with some of my patients being deemed by the courts as criminally insane and sectionedunder the forensic sections of the Mental Health Act.
I was further moved to think a little more of Gaddafi’s mental state and psychiatric diagnosis when the Foreign Secretary, William Hague, very recently described him as making “delusional statements”. Hague as a layman was presumably using this figuratively in the same way as the late President Reagan described Gaddafi as the “mad dog of the Middle East”.
In fact Gaddafi does, in my view from observing his behaviour through the media and listening to his rambling speeches, appear to demonstrate many of the classical symptoms of schizophrenia including a flattened affect, paranoid (often grandiose and sometimes persecutory) delusions, lack of insight and losing touch with reality and a disintegration of personality. A quick search of the internet revealed to me that there have been occasional reports over the years that Gaddafi has received psychiatric treatment and there has been much speculation in the press about his exact medical diagnosis.
As a psychiatrist I can state professionally that of course you can never make a formal accurate diagnosis without first in person fully examining the patientmentally in a detailed clinical interview. You should also carry out a fullphysical medical examination, including laboratory tests, to exclude organicbrain disorder. Ideally you should also observe the patient closely over a periodof time.
All I can do, therefore, is speculate on his mental state and diagnosis based onmy lengthy experience as a former clinician and using my clinical intuitionlooking at his face when he speaks. Furthermore, I am clinically restricted in
not being an Arabic speaker so cannot listen to his speeches in the originaltongue. This would obviously make it easier to detect one of the hallmarks of schizophrenia called “formal thought disorder”, although there are many Arabic-speaking psychiatrists in Britain so their professional opinion would be very valuable here.
The other missing link is whether he has ever admitted to have hallucinated or heard voices within his head, which only an in-depth interview can reveal normally. There can also be no doubt that as well as possible major psychosishe demonstrates many of the signs of anti-social personality and possibly narcissistic disorder judging by his remorseless cruelty over many years inordering countless public executions of political dissidents, some of which heis alleged to have personally supervised. However, personality disorder is very hard to diagnose in a psychotic individual and untangle his true personality from the underlying mental illness.
Some psychiatrists might also argue he had elements of manic depression, judging by some of his bizarre, grandiose and wasteful spending schemes. Yet others might argue that Gaddafi has a borderline personality, thus explaining his unstable behaviour with temporary psychotic episodes. Interestingly, some psychiatric schools believe in the concept of “schizophrenic spectrum disorder” which suggests higher rates of personality disorder in first degree relatives of the schizophrenic patient. This would be consistent with the sociopathic behaviour of some of Gaddafi’s cruel sons!
Given that the tyrant is on the run you may ask why this matters. If my diagnosis is correct it raises a number of difficult ethical medico-legal questions in terms of how to deal with him by way of criminal justice. The Arab world does not have a strong tradition of mitigation of criminal behaviour as a result of mental illness, and I recall for instance the case of former King Faisal of Saudi Arabia. Faisal was assassinated by his nephew who, in spite of being declared insane, was still publicly beheaded for regicide.
Thus Gaddafi’s medical diagnosis is highly relevant because if hopefully he is shortly apprehended and sent to the International Criminal Court to be tried for crimes against humanity he will be presumably be automatically subjected to a lengthy pre-trial medical psychiatric examination. Although I have no experience in the area of forensic psychiatry when applied in the area of crimes against humanity under the Rome Statute, I presume the same rules apply as for domestic criminal trials.
Thus the ICC might conceivably find him unfit to plead if it draws upon US jurisprudence, where this is commonly applied to psychotics in order to avoid the death sentence. Even if he was fit to plead (i.e. he understands the nature of the charges and can follow proceedings) under the English tradition his
defence lawyers could still plead insanity (the McNaughton rules) and he would then, if convicted, be found not guilty by virtue of insanity. If he were to plead diminished responsibility, under English legal rules Gaddafi could be found guilty but he would not be sentenced criminally to a prison but detained in a special hospital at Her Majesty’s pleasure.
So does this mean the allies and the ICC should now be making discrete enquiries whether any such secure psychiatric facilities would have him if my scenario ensues? Broadmoor has a long tradition of harbouring the most dangerous of Britain’s criminally insane with even space to erect a secure Bedouin tent in its spacious grounds for such a high-profile inmate.
But on further reflection maybe the National Transitional Council will decide not to hand him over to the ICC if it means that he would not only avoid execution or life imprisonment but would actually end up being well cared for in a special hospital for the criminally insane.