The door to the psychiatric ward of a large hospital in Islamabad opens. A young woman is sitting cross-legged on the bed. One hand is handcuffed, one end of handcuff is tied to the bed, and the fingers of the other hand were holding a half-burnt cigarette, the smoke of which was making the atmosphere heavy. Two male policemen were also enjoying tea and cigarettes at the same time and there was a funny conversation going on between the two parties. Both the purpose of coming to the room and the atmosphere inside were a strange experience for a budding psychiatrist like me. My purpose was to examine the mental health of the woman who had been released from court after slaughtering her two children. She was sent for psychiatric evaluation.

Human behavior and actions can stun even the jurists and when they are unable to understand the motivations, it comes to the dark corners of the mind and the accused appears before us as an alleged patient. As mental health professionals, our job is to check what was the state of mind of the patient at the time of the relevant action and whether he is suffering from any major mental illness which may be directly or indirectly related to this action. It is a very complicated process. From the symptoms and recent mental state of the patient’s, you can never accurately know the mental state at the time of the action two weeks ago. Even the years of austerity seem to water down the complexity of the problems on many occasions.

Repeated mental state examination of the alleged accused as a patient reduces the complexity of these problems. Being non-judgmental and empathic can also help. A distinction must be made between the examination of a physician and a policeman. While entering the room for the first time, I thought that the woman would be psychotic and disconnected from reality and in that state she would have committed this act. After several mental state examinations, it was suspected that the woman was angry with her husband because he was allegedly interested in other women. Even that day, after the fight with her husband, the thought was constantly circulating in her mind that there is nothing left in life for her and her children. The emotional instability of the personality and the habit of doing things without thinking worked here as well and she picked up a knife from the kitchen and turned it on the neck of the four-year-old child. Even the screams and blood of the innocent soul could not cool the fire of revenge and the next turn was that of a seven-year-old child.

Woman suffered from depression for a long time. She was treated in several hospitals. Also had ECT five years ago. She tried to take her own life three times and her mother’s life once before. A few months ago, she jumped from the roof and underwent a spinal surgery. A minor argument turned into a rebuke and she tried to kill his mother by putting a pillow over her face.

During her admission in the ward, the process of disease and personality assessment was repeated several times and more than one physician participated in the process. In the ward, her appetite, sleep pattern and relationship with family members were all normal. There was no regret or remorse for her action. What was important to us as clinicians was that there was no sign of psychosis during all this time. The woman was in the world of reality and was well aware of all the facts and their consequences. Emotional instability and Impulsivity were significant on the personality test. In developed countries, psychiatric evaluation is mandatory in such unusual alleged crimes. If severe depression, psychosis, mental retardation or any other cause of disconnection from reality is the cause of such crime, the law and mental health institutions work together to find a solution. Risks can be better managed with colaboration. Personality disorders and psychopathy are generally kept below the level of illness in these matters and are not covered under the umbrella of mental illness.

This woman was admitted to the ward for almost a month. A typical mother struggling with depression, who is disappointed with the world, has done this in the hope of the children’s improvement in the other world. This woman was not suffering from psychosis, but the severity of the disease like depression became such that it forced her to do such a dangerous act. Personality dirorder, traumatic childhood events, and cigarette or drug use increase the risk factor in disease or non-disease risky actions. There is a need to address your personality and emotional health if itis negatively affecting you and others, before any major damage is done. Depression is a treatable disease. Medications, psychotherapy, magnetic resonance therapy (TMS) and many other methods can save lives and improve quality of life.