As Dr Das himself summarised, Forensic Psychiatry “is the intersection between mental illness and offending," which can include confused acts of extreme violence such as murder.
A notable Consultant Forensic Psychiatrist, Das works within the criminal justice system, assessing the mental health of persons undergoing trial to diagnose mental illness, comment on defendants’ mental state at the time of their offence, recommend appropriate treatments, provide psychiatric defences and sometimes testifying on mentally ill subjects of legal investigation himself. As well as criminal courts, his role has also included working behind the scenes as part of the prison rehabilitation service where he has worked closely with afflicted inmates to aid their recovery and consequent reintegration into society. This job includes prescribing medication, referring for extensive psychological work, and prioritising the extremely unwell cases to transfer them to specialist secure hospitals. Das has dealt with violence, even being punched in the face at work. However, despite the gritty reality, Das believes in constructively and openly discussing the topic of serious mental illness. He has written a series of short stories which have been published in acclaimed online and print magazines such as Chantwood Magazine, The Fiction Pool, Literally Stories and Dark Fire Magazine, using creativity as a counterbalance to the otherwise clinical dimension of his profession. He also writes a progressive blog for The Huffington Post, which aims to reduce the stigma around mental health, records his personal experiences and combats the sensationalising of criminality by those with extreme mental health problems. “Ironically,” he stated, “though my particular area of work deals with aggressive patients, only a small percentage of those with severe mental health disorders such as Schizophrenia actually commit violent crimes.”
Nevertheless, this small number of high-risk potentially dangerous mentally unwell patients require the most support and supervision. “Such patients require a lot of time and resources,” Das asserted. “Unfortunately, this is not readily available.” On the question of straddling the fine line between protecting the public and sensitively rehabilitating legally confined patients, Das elaborated: “It is a balancing act. On the one hand, it is necessary to detain people who are capable of violence against their will, but then they will be locked up for months or even years in an environment that, quite frankly, is often hostile. It can be painful to my patients struggling, often through no fault of their own. However, there are some real breakthrough moments too. I remember continuing to try to reach women in prison, who were too paranoid to disclose that they were hearing voices. With some persistence, I finally earned their trust and convinced them to take medication and eventually recover.”
Indeed, Das will be publishing his debut fictional novel, Reason of Insanity, later this year, loosely based on a real-life ex-patient which presents offending in the context of mental illness through a more objective, sympathetic light. The narrative follows a young woman who has murdered her sister during a psychotic episode and finds herself slowly recovering within a secure rehabilitation facility after being sectioned. She must come to terms with the shockingly terrible act she has committed. “The story takes place over a period of three and a half years in a psychiatric unit for offenders. It follows the emotive arc from the time of the protagonist’s arrival to hospital, through her rehabilitation and finally acceptance of what she’s done. It’s an ethical trajectory too. I wanted to create a realistic portrayal, capturing the horror of the violence as well as the hard truth that this person did not realise what she was doing in the moment. She is as devastated by her own atrocity as much as those around her. She must also then make amends with her family. Additionally, I explore the new environment of a medium-secure facility into which she is suddenly thrust. It is challenging. The character is bullied by other patients who have anti-social personalities yet manages to forge close relationships with others.”
Das elaborated on some of the authentic psychiatric insights, “which are peppered through my novel…. The vast majority of my patients have suffered some form of abuse when they were younger, whether it was sexual, emotional or physical. Not having love and support certainly predisposes you to both mental illnesses, and offending. Poverty, drugs and lack of education are other big factors.”
A need for compassion extends to the entire world of disability and the vulnerable spectrum of humanity with which mental health is inherently interlinked. Das explores this intricacy in his creative writing, where his prior pieces have been more surreal, humorous, bizarre and even playful. All his published work can be found on his author website. “I tend to use storytelling as an escape. It’s important to see the positivity and humour or the unique perspective of a situation. Anybody can make a story depressing. I think it takes more skill and imagination to make it funny too.”
One short story entitled My Previous Face, begins ‘I simply look ahead today’. It is about a facially disfigured man who faces judgement and fear daily, but has beautifully learned to accept the experience as part of strange, unwieldly life. Delving into the reason he is maimed, Das finally shows that the protagonist has gained as much as he has lost. Much like the doctor’s attitude to his day job then, his stories reflect a grounded empathy which humanises his protagonists, shifting the issue from the idea of a besieged individual to the limits of society’s own thinking.
“We have come a long way in terms of opening up about mental health problems, but we still need to accept more serious, long-term illnesses. People might be readier to talk about more common and more relatable issues such as anxiety and depression, but we don’t see enough about the more extreme cases such as Schizophrenia.” Indeed, Mariah Carey might have admitted she has Bipolar Disorder, but where are the high-profile celebrities with psychosis? Here, Das made sure to add: “one of the biggest misconceptions about extreme mental illness is that sufferers cannot be high functioning. In fact, many lead rich and fulfilling lives with the right treatment and encouraging environment.”
Das also interestingly commented on the generally detrimental effect of the current divisive socio-political climate on the public psyche: “this is definitely causing increased levels of baseline anxiety and depression, which also sadly detracts from the attention given to more extreme mental health disorders at the stage of primary care. These services are overwhelmed, redirecting many cases to psychiatrists in secondary care, meaning there is often a delay in treatment. Fake news, Brexit, and the inflammatory actions of Trump are interlocking to really unnerve people, and create great insecurity and stress. In terms of government funding, psychiatric services have been severely cut over the years, so more and more sufferers of mental illness are treated in the community, instead of hospital. This might afford more freedom for some patients, but it also results in many conditions not being adequately medically treated too – it’s a stunt to save money.” As a result, many patients who should be in hospital are not are not adequately supported and monitored. Many tend to deteriorate, which makes then makes them more likely to end up in the criminal justice system. “The number of people we see in the courts within the Forensic Psychiatry service and the seriousness of their offending has swelled since I started working in this field in 2011,” says Das. As well as the conflicted zeitgeist, this inflated figure is also due to the increasing acknowledgement of mental health issues which would have previously gone undiagnosed, which Das hastens to add is a plus. “We just have more of a way to go.
”Finally, Das also cautioned on reducing the time and emotion invested in social media, and actively managing the stress of a busy life to enhance mental well-being. Going into the very depth of unseated consciousness then, the candid Dr Das shows that aside from the internal chemical imbalances or one’s upbringing, stable social circumstance is as much an important emotional foundation.