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Peter Sutcliffe cannot have been ‘cured’ of schizophrenia

In 1981, Peter Sutcliffe was given a whole-life tariff for the murders of 13 women. Sutcliffe, dubbed the Yorkshire Ripper by the press, initially spent three years in prison before being moved to Broadmoor Hospital, a high-security psychiatric facility, where he has been held since 1984. Now, psychiatrists at Broadmoor say that Sutcliffe is fit to return to prison.

At the time of his trial, Sutcliffe was diagnosed with paranoid schizophrenia and three psychiatrists who assessed him said that he was driven to kill because of this and a belief that he was on a “divine mission”. Despite this, the judge refused to accept a plea of diminished responsibility and, although the exact reasons are unclear, Sutcliffe’s subsequent transfer to Broadmoor is reported to have been because of this paranoid schizophrenia.

Sutcliffe may have been transferred because he became more unwell in prison or it may be that a prison psychiatrist considered Sutcliffe’s schizophrenia to be central to his serial killing. Again the exact reasons are unclear, however, regardless of the reasoning, in order to make a transfer to hospital from prison, the law requires that two psychiatrists have to recommend that a transfer is required.

So if Sutcliffe is seen by some as fit to return to prison, does this mean he is no longer suffering from paranoid schizophrenia?

Long-term illness

Schizophrenia (including paranoid schizophrenia) is a long-term illness that cannot be cured. Symptoms can include hallucinations, delusions and confused thinking. The person’s behaviour changes because of their illness and they often cannot tell the difference between their own thoughts and reality. This not being able to tell the difference between false beliefs or delusions and reality is a defining feature of schizophrenia.

Paranoid schizophrenia is a sub-type of schizophrenia, where the symptoms experienced are very suspicious beliefs. The person may believe that they are being persecuted. It can also include grandiose symptoms alongside suspicion and Sutcliffe is reported to have said that he heard the voice of God telling him to kill. This is an example of an auditory hallucination.

In some people, their responses to what can be very distressing hallucinations can be withdrawal into their own world.
Although it is reported that under 10% of violence can be attributed in some way to schizophrenia, for people like Sutcliffe, their response to symptoms can be extreme violence. It is accepted that schizophrenia has a strong link to violence and while some studies have found that up to 10% of people awaiting trial for murder have schizophrenia – highlighting the seriousness of the issue – it is important to point out that not all people with schizophrenia become violent. Indeed, the overall proportion of violence in society that can be attributable to schizophrenia is small.

Research shows that those with schizophrenia who act violently have a heightened sensitivity to negative emotional cues in the environment and are slower at processing responses, which may be one of the reasons these people act violently, compared to them socially withdrawing. However, research is still emerging in this area and is not clear.

Violence is also much more complex than being the result of a mental health problem. Researchers are trying to distinguish why some people with schizophrenia become violent, and some do not, and there are emerging findings that substance misuse is a factor that increases the risk of a person with schizophrenia becoming violent. Further to this it is clear that people without severe mental illness also become violent, and so consideration needs to be given to a person’s risk once they are well or when their mental illness is deemed to be stable, because the risk that they could become violent remains. There will be risks relating to Sutcliffe’s unusual and extreme case that remain unknown.

Broadmoor Hospital. Andrew Smith/Wikimedia, CC BY

No cure

Nobody knows what causes schizophrenia and there are no cures. However, it can be managed and symptoms treated using drugs and talking therapies, such as cognitive behavioural therapy. Some people with schizophrenia respond better to treatment than others though there is little evidence as to why this is. In practice in secure hospitals, treatment often involves trialling medication to see what works best, and this can take some time, even years, to assess.

Sutcliffe has been in Broadmoor for many years, suggesting that his schizophrenia has been difficult to treat. In cases where the person is considered to be a danger to others, drugs, such as antipsychotic medication, can be administered without the patient’s consent under the Mental Health Act.

Medication and talking therapy is likely to have been provided to Sutcliffe, as it is commonplace in forensic psychiatric units, and his apparent stabilisation may be a result of not only willingness to engage in such treatment, but also his illness responding well to it.

Ongoing monitoring

Many may be surprised that it is being suggested that Sutcliffe return to prison due to the length of time that he has been in Broadmoor, and the fact that his schizophrenia, which probably contributed to the murders, cannot be cured. However, it is more likely that doctors are suggesting that Sutcliffe’s symptoms have now stabilised and that he is manageable under the less intensive healthcare service provided within a prison.

But this is no guarantee that Sutcliffe, who has been housed in a hospital environment that has been a protective factor in his stabilisation, wouldn’t become unwell again. There is also a danger that in a busy prison, prison officers might not notice subtle changes in his behaviour – changes that could signify a worsening of his mental state. If he transfers back to prison he would need to be closely monitored by mental health professionals during this transition stage.

Despite prison-based mental health service provision being clearly defined, some argue that prisons do not provide adequate treatment for those with schizophrenia. Prison is a far more cost effective placement compared to a psychiatric unit, however what is important in this – and any – case is that if a transfer takes place, it is carefully managed. Meanwhile, the debate regarding prison versus hospital for those with schizophrenia remains.

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