Medical Test for Justice Karnan: No Lab Can Prove Mental Illness

There are no established ways to detect mental illness. Is the medical examination of Justice Karnan then justified?

The recent order by a bench of seven senior-most judges of the Supreme Court and its context unmistakably shows that the apex court wanted a ‘mental illness’ test of Justice Karnan. This ‘mental illness’ test is supposed to determine if he is capable of defending himself in the ongoing contempt case before that bench.

The problem, however, is that there is no laboratory test in existence to detect if a person is ‘mentally ill’, and therefore, not much clinical guidance is available to decide if such a person can defend himself in a particular judicial proceeding.

I am an advocate; I am not a medical professional. However, I take a keen interest in the medical sciences, and have studied it over the past decade-and-a-half, out of personal interest.

Also read: Justice Karnan Calls Medical Order “Mad”, Accuses SC of Caste Bias

Diagnosing Mental Illness

Can you see the mind under a microscope? You know the answer: NO. Therefore, there is no laboratory test to discover ‘mental illness’. The general public is mostly misinformed about mental illnesses, and mistakenly assumes that there is a definitive laboratory test to detect it. There is none.

Let’s first hear from a few authorities:

The Diagnostic and Statistical Manual of Mental Disorders (DSM) of the United States is a leading medical manual that psychiatrists around the world look up for clinical reference and guidance. It is now in its fifth edition.

Allen Frances was the chairman of the task force for a previous edition and according to him, there are no objective tests in psychiatry, no X-ray, laboratory, or exam finding that concludes definitively if someone does or does not have a mental disorder.

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Mental Illness and its Symptoms

Let’s look at a few more authorities:

Unlike diabetes or cancer, there is no medical test that can provide a diagnosis of mental illness.

National Association of Mental Illness, the largest public mental health organisation in the United States.

While there has been no shortage of alleged biochemical explanations for psychiatric conditions…not one has been proven. On the contrary, in every instance where such an imbalance was thought to have been found, it was later proven false.

Dr Joseph Glenmullen, Medical Board certified psychiatrist at the Harvard Medical School and celebrated author.

There is no blood or other biological test to ascertain the presence or absence of a mental illness, as there is for most bodily diseases. If such a test were developed… then the condition would cease to be a mental illness and would be classified, instead, as a symptom of a bodily disease.

Dr Thomas Szasz, Professor Emeritus of Psychiatry, New York University Medical School, Syracuse.

Why then, did the Supreme Court direct such a test in the first place? My guess is that the judges of the Supreme Court did not know more, and have shown the same ignorance leading the general populace to believe about the existence of a laboratory test to discover mental illness.

However, neither the public nor the courts could be blamed for such ignorance. The medical authorities in this country are grossly negligent for not doing enough to dispel such pervasive ignorance.

Pitfalls of Medical Science

Also, the complexity of defining a ‘mental illness’ has always bedevilled the medical sciences. In the late 1960’s, homosexuality was considered to be a mental illness in the United States and most parts of the world; doctors were paid to brainwash, drug and purge patients of homosexuality.

In 1973, the second edition of the DSM reluctantly, and conditionally, dropped homosexuality from the list of mental disorders (5,850 votes for removal and 3,810 votes for retention). It was only in 1987 that homosexuality was completely removed from the DSM.

Five years later, the World Health Organisation followed suit and removed homosexuality as a mental disorder in 1992. This twist and turn will tell us about the complexity of defining a mental illness or disorder for clinical purposes.

Sustained Medical Approach

The medical diagnosis for a mental illness involves a sustained and prolonged interaction with the patient and his family members or caregivers.

Based on such an interaction, if the doctor opines that the patient has been exhibiting disturbing, self-destructive or compulsive behaviour over a prolonged period, he may recommend a few laboratory tests to determine if any physical illness might be aiding such a disturbing behaviour.

This complexity distinguishes a mental illness from other types of illnesses and diseases. The doctor may then administer certain drugs and monitor the response of the patient to such drugs, while also monitoring the patient’s behaviour. Given the fact that there is no urine test, blood test, brain scan or other laboratory finding that could allow a doctor to track such a patient's progress definitively, the doctor may try different drugs or combination thereof to improve the results.

None of this complexity or the prolonged and sustained medical approach to deal with mental illnesses is reflected in the order of the Supreme Court directing a medical test for Justice Karnan.

As the public assumes that some or the other such test exists and that doctors possess definitive methods to treat mental illnesses, there is a general propensity to delay such diagnosis, hampering medical attention and intervention; the public suffers greater misinformation from such orders.

Difference between Science and Reality

Whether Justice Karnan is in a position to defend himself in the ongoing contempt proceeding is a determination that is best left to the Supreme Court bench itself, in the circumstances of this case.

Delegating it to a team of government doctors, with their frustration and failure at it, is bound to add on to the mistaken public perception about the availability of a laboratory diagnosis and standard treatment for mental illnesses. The science and reality, however, is something else.

Also Read: SC Ordering Medical Test Of Justice Karnan Is Unwarranted

(The writer is a Supreme Court lawyer and can be reached @dhananjaylegal. This is a personal blog and the views expressed above are the author’s own. The Quint neither endorses nor is responsible for the same.)