“In order to be able to achieve real success among patients treated with forced medication, complex psycho-rehabilitation would be necessary”

How does a criminologist-sociologist become a judicial observer?

I was employed as a so-called reintegration counselor after I spent a few years at the psychiatric institute in Szentgotthárd. The latter is home to, among others, psychiatric patients who have nowhere to be released after their medical treatment. I was able to utilize the knowledge and experience I gained at the psychiatry in Szentgotthárd in the reintegration of patients treated with compulsory medical treatment.

During your stay, how many people were you able to reintegrate, so to speak, among the residents of IMEI?

Not many. I would like to ask you back: in your opinion, how is it possible to rehabilitate a mentally disturbed person in an institution operating under prison conditions, equipped with all means of coercion and cut off from the world? The question is, what actually led him to commit his act? These people do not become criminals simply because of their psychiatric illness. If that were the case, they would only have to be given the right medicine and the danger would be gone. But in addition, many questions such as why did you stop taking your medication should be investigated? Did something happen at work, if at all, where did his friends go, why did his relationship with his family deteriorate? Is there alcohol or drugs in the picture?

According to this, they could become free again in a short time…

Not exactly. Based on the opinions of the experts and the treating doctor, the court reviews every six months whether the treatment was effective enough, but there is no upper limit to its duration. The experts and the doctor must declare that if the “patient” is released from the walls of the IMEI, does he pose a danger to anyone, can he become a repeat offender. Since we cannot be sure how we ourselves would react in an unexpected situation, we cannot guarantee the future actions of IMEI patients either. Although, according to IMEI statistics, a patient spends an average of 4-6 years within the institution’s walls, the time spent in forced medical treatment is often several decades. While complex psycho-rehabilitation provided in a civilian hospital involves hospitalization for a few months at most. Another obstacle to leaving is that they don’t let anyone out of IMEI until they have somewhere to go. But where could he go? In the majority of cases, what happened in the family is what led someone to come here. In other words, those whose support is most needed lose their trust in the patient. Forensic psychiatry in Hungary today does not deal with the restoration of relationships, it follows the simpler way: it gives medicine and hermetically seals off the “criminal” from his relatives and the outside world.

Not just nurses and psychiatrists – although there aren’t enough of them in such a closed institution – but all kinds of other helpers: for example, social workers, caregivers, psychologists, special education teachers, developers, criminologists. However, IMEI is part of the penal system, it operates in an absolutely centralized system, which means that it can decide very few things independently about the fate of its patients.

Can he escape punishment if he is referred to compulsory medical treatment due to his state of mind?

On the one hand, there is an acquittal, the second part of which is that forced medical treatment is ordered. Which, by the way, as I already mentioned, takes place in the territory of a prison. If we start from the text of the legislation, then the goal is primarily the protection of society, and only secondarily medical treatment. By the way, I think that it is not even necessary to make it the task of forensic psychiatry to treat effectively. The realistic goal could be for the workers there to assess what led to the crime and what of it can be dealt with within the possibilities of a closed institution. But it’s also worth looking at who usually gets into the IMEI. According to the law, “perpetrators of acts of violence against a person or causing public danger” who cannot be punished due to their pathological state of mind. It is important to clearly see what an act of violence against a person or causing public danger can mean in practice. Undoubtedly, it happens that someone ends up here after a brutal crime, this is the rarest case. The IMEI also treats people who may have pushed a BKV inspector, who is a person performing a public duty, or threatened the ambulances when they wanted to take him to the hospital against his will. If someone is suffering from a serious mental disorder, such as schizophrenia, and a psychotic episode is about to occur, family members, acquaintances, or neighbors often call the ambulance. The ambulance has the option to transport you and also to ask for the help of the police. If in such a situation the person concerned throws, say, a bottle at the police officer – and this is a specific case, then this is considered violence against an official person, even if no one is otherwise injured. And it is the decision of the acting police officer whether to file a report or just take the patient to the hospital. If you file a complaint, your path may lead straight to IMEI. For example, I met a woman over 80 years old who set her own nightgowns on fire in her own barn. No one was injured, and there was no significant material damage, but her act was classified as causing public danger and it was established that the lady also has dementia. I mentioned these examples only so that we know that people are not necessarily sentenced to forced medical treatment for brutal acts. However, those who come here and the life stories behind them are actually invisible.

The general public can only follow the story until the court decision is reached. What happens to them after the door closes on them?

I have no personal experience of the first weeks of admission, because I did not work in that department. In this case, the exact mapping of the referred patient’s condition and the adjustment of his medications begin. Forensic psychiatric experts must declare whether the person had mental capacity at the time of the commission of the crime. This is important because mental disorder alone is not sufficient for compulsory medical treatment. That is, if someone has, say, a diagnosed schizophrenia and commits something, it does not automatically mean that they will not be considered to be counted. The most common case is that the patient is admitted for an episode of the disease, a symptom. In such cases, there are previous medical histories, health documents, and they can listen to the relatives and the patient. A problem can arise when the act itself is actually the very first or last symptom. Or, for example, in the case of mixed diagnoses, when someone is diagnosed with schizophrenia, but they also have some kind of personality disorder, which in itself does not limit or exclude the ability to be counted. When the diagnoses are mixed like this, it is difficult to disentangle afterwards which one was decisive at the time of the commission of the crime. This is also clarified in the IMEI. If it is already apparent that the process will start in the direction of compulsory medical treatment, the so-called preliminary compulsory medical treatment is ordered. The “accused” is already placed in a patient ward where forced medical treatment is also carried out. And even though this is not yet his legal status, as he is only in pre-trial detention, from that point on, the same thing happens to him as to the other people undergoing compulsory medical treatment. Finally, he should even give the experts an answer as to whether there is a chance that the patient would commit a similar act if he stayed outside. István Benedek wrote in Aranyketrec that it is impossible to say what a healthy person will do in the future, let alone a sick one. In other words, there will be no one who will say: he certainly won’t hurt anyone anymore. Such a procedure can drag on for years before the court gets around to acquitting the accused and ordering medical treatment of the coercion.

Specifically, what does medical treatment involve? Are you given medication, forced to attend therapy sessions, or do you sit in a room all day and grind?

Actually, all of these, and a little bit of none of them. The vast majority of psychiatric patients, and here we should say 99 percent, are not dangerous to their environment. And this is also true for people suffering from severe mental disorders, such as schizophrenia. It is very rare that one of them becomes a criminal. It may happen that during a psychotic episode his behavior becomes bizarre, he says strange things, he can create fear in those around him, but he rarely gets to the point of committing something. Even in those cases where they do commit something, the background is usually that they stopped taking the medication for some reason. Medicines play a very important role in psychiatry. Of course, it also depends on the mental disorder, but with a diagnosis of, say, schizophrenia, proper medication is very important to maintain a symptom-free state. However, in the case of these diseases, they often lack disease insight, i.e. they do not feel sick, which can lead to the abandonment of medications that otherwise cause very unpleasant side effects. This may result in another psychotic event during which he will not be in control of his actions. In the vast majority of cases, the crime is often the result of the patient stopping the medication.

I myself visited the walls of the institute quite a few years ago. That’s when I met a patient there who made a paper airplane with a special edge drive called the Snowflake Catcher. He had already lived in IMEI for the second decade. After his parents struggled with his sometimes “strange” behavior, his grandmother took him in. The old woman took him to the doctor, they went for treatment, but when the boy was supposed to go to the hospital for a few weeks, upon hearing the news, she tied him up and brutally killed his grandmother. After that it was entered in the IMEI. According to his doctors, even after several decades of treatment, his remaining “tevil” is sometimes prone to impulsive and aggressive behavior. What should happen to him? His parents couldn’t handle him even when he was a teenager, he destroyed his grandmother who loved him…

Presumably it was still in there because there is nowhere to let it out. His family cannot take him back for understandable reasons, the waiting list for places in social homes that accept such patients is several years old. He is probably one of those patients who will never start a family, will never have a well-paying job, and will spend their days in a residential institution like the one in Szentgotthárd. Maybe, if you’re lucky, you can move to a smaller home.