Re: ‘Vincent Li is not a monster,' June 9 Gazette:
With all due respect, your editorial on Mr. Li fails to take account of the clinical reality of schizophrenia. You state that he is schizophrenic and he was not taking his medication. Hence, he was delusional and was hallucinating when he killed a man on a bus. You could say exactly the same about the Yorkshire Ripper, who is in Parkhurst Prison on the Isle of Wight for life after killing 13 women. A colleague of mine worked with him and reported to me that he continued for many years to be very delusional and to have hallucinations.
I have worked with schizophrenic patients since I was 16 and I am now 59 years old. I am a clinical neuropsychologist in private practice but I worked for more than 15 years in psychiatric hospitals here and in the United Kingdom. I have published much original research on schizophrenia in international journals. Your argument falls down because schizophrenia is not a curable condition. It is a permanent defect state of the human brain caused by a terrible disease and it is only partially alleviated by drugs. The disease involves lack of insight. In fact, delusional beliefs are an integral part of the disorder because the person does not realize that the voices they hear telling them to do things are not real, even after medication.
Your assurance that he has "made consistent progress" in the short term on medication is not reassuring. If Mr. Li is released, there is a high risk that he will not take his medication and that he will once again act on the instructions of his voices. Even if he takes the medication, there is absolutely no assurance that he will not hear voices or have delusions. It is expected that a man who is in a constrained environment and on antipsychotic medication will have fewer hallucinations. However, a perennial problem with schizophrenic patients is that, once exposed to real-world stress, they stop taking their medication when free to do so because they have no insight into their illness. That is one reason why the average schizophrenic patient in the admissions unit at Alberta Hospital Edmonton has a mean of 12 previous admissions.
I worked at Alberta Hospital Edmonton when one man with frontal lobe damage was released after killing his girlfriend. He was released three times. Each time, he killed another woman. Three innocent women are dead because of the medical error of releasing a patient who could not be expected to control his own behaviour. The same mistake must be avoided when dealing with people like Mr. Li. The risk of releasing him into the general public is too high, just as it is too risky to let the Yorkshire Ripper out of prison.
In general, schizophrenic patients pose less harm to the general public than those not suffering any illness. They are an underserved part of our health care system and I have been an active supporter of keeping Alberta Hospital Edmonton open. I encourage others to join the party at www.savealbertahospital.com. However, in the very rare case in which hallucinations and delusions lead to the beheading of an innocent man, it is not realistic to expect that a full remission will take place.
Dr. Paul Green, Clinical neuropsychologist, Fellow, National Academy of Neuropsychology, St. Albert
