When Psychosis Ends In A Jail Cell

Recovering from psychosis is challenging enough in itself. When you have a court case hanging over you, the stakes are even higher.  

Maria Penaranda // Arts & Culture Editor

“That first time…was the most purest, beautiful-est experience I’ve ever had.” *Ruby’s blue eyes trace the cup of tea in her hands as she describes her first encounter with mania. At nineteen, Ruby was diagnosed with Bipolar Disorder after experiencing the first of multiple manic-turned-psychotic episodes requiring hospitalization—six, to be exact.

It’s been over a decade since her initial Bipolar Disorder diagnosis. In the summer of 2019, after five years free of manic-psychotic episodes, she had another. Now, Ruby is facing prosecution in court after committing a criminal offence while psychotic. 

“This is the worst it’s ever been by far, the absolute biggest shit-show. The worst for my mother, for my friends—you know, the fact that it’s the court system, the law that I’m dealing with, it’s scary,” she shared.  

Mood flows in a natural rhythm like oceanic tides, there’s a manageable ebb and flow between joyous highs and devastating lows. The cycle of bipolar mania and depression closely resembles hurricanes of religious ecstasy and crushing despair. Mania is an intense, elevated state that lasts for at least one week, with symptoms like excessive energy, reduced sleep, hyper-talkativeness, disjointed ideas, risky behaviour, and an increased sense of self-worth or grandiosity. Depressive episodes are characterized by profound feelings of sadness, low-energy, poor appetite, poor concentration, and suicidal thoughts.  

For Ruby, the onset of her mania and psychotic symptoms is insidious. “Like if you’ve ever seen those really creepy tsunami videos where the water, instead of coming at you in one big wave, it creeps in really, really slowly— that’s how I feel about it. It’s like this energy and this build-up is creeping into my body, and creeping into my mind and creeping in just ever-so-slightly,” she said. 

“I get these feelings of acceptance for myself, and self-love and self-worth, and I’m flooded with these feelings; I just don’t ever want it to go away… but then you totally have this like—it’s not always nasty—but a nasty ego that wants to, like, live forever, that knows that it won’t, and wants to hold onto anything to survive and to be the best,” she continued. “And I think when you get this influx of beautiful energy, and that part of you is able to grab onto it, of course it’s just going to blow the fuck up and, at least for my experience, grab onto that energy and spin out of control, and have these delusions of grandeur.” 

After Ruby was arrested, she spent about a week in jail while still severely psychotic before being sent to a hospital where she could recover enough to be deemed fit to stand trial. Neither her family nor friends knew where she was. “No one was telling them anything. They had me in jail but they couldn’t get to me,” she said. After three weeks at the hospital, she was sent back to jail. 

In jail, Ruby worked serving meals to other inmates for $2 a day. Using the jail’s fixed schedule as a guide, she created a routine for herself that incorporated meal times, meditations, reading, and using the jail’s workout room. “I thrived in jail,” she joked. 

Then, Ruby was transported to a city cell, where she stayed for about two days awaiting her hearing. “It’s like the size of my kitchen, white walls with a fluorescent light, and maybe a blanket and… a small cushion, and you’re in there for like 12 hours and that’s it,” she recalled. “So I felt like I was going fucking crazy, and that’s when it really sunk in, what was happening.” 

People like Ruby who end up committing criminal offences due to severe mental illness can rely on a defence of mental disorder and be found “Not Criminally Responsible on Account of Mental Disorder” (NCRMD). Section 16 of the criminal code states: “No person is criminally responsible for an act committed or an omission made while suffering from a mental disorder that rendered the person incapable of appreciating the nature and quality of the act or omission, or of knowing that it was wrong.” 

“Wrongfulness is a test of legal and moral wrongfulness,” said Dr. Sumeeta Chatterjee, the medical head of inpatient and outpatient forensic services at the Center For Addiction and Mental Health in Toronto, as well as the program director of the Forensic Psychiatry specialty residency training program at the University of Toronto. “The person can know that technically what they’re doing is legally wrong because they shouldn’t hurt that person, but they felt morally compelled, or [felt] what they were doing was morally right, in order to [for example], what they believe at the time, defend themselves against someone intending to cause harm to them.” 

Ruby says she faced this very situation. “I was 100 per cent in my mind doing the right thing, not just for myself, but what I thought was good for everybody else.” 

When someone is found NCRMD, they are sent to a provincial review board within 45 days. Upon hearing from a psychiatrist who has been observing the person, the crown, and the defence, the tribunal of lawyers and psychiatrists can either discharge the person unconditionally, discharge the person under certain conditions, or keep them in custody at a forensic hospital.  

Cases like R. V Swain challenged previous common law as a violation of the Charter. As a result, review boards were implemented to protect the rights of those found NCRMD, and the rights of the public. Those conditionally discharged or kept in custody are entitled to a yearly review of their case by the board, who evaluate the treatment and recovery of the individual and adjust conditions accordingly. 

“Before Swain and before [1992], there was no review board,” said Robert Diab, a criminal lawyer and law professor at Thompson Rivers University. “Whether you committed murder or whether you committed theft by stealing chips at Safeway, if you did it because you were suffering from—well the language before [1992] was insanity…you weren’t acquitted, you were kept in custody.” The verdict of not guilty by reason of “insanity” meant no right to a hearing, and the possibly of being held in custody indefinitely. The only way to be released was through the Lieutenant Governor.  

It’s jarring to think that less than 30 years ago it was legal to force people with mental illness to forfeit their own freedom for acts they had no control over. Considering the stigma against severe mental health disorders and the NCRMD defence that continues to prevail today, perhaps it’s not so surprising.  

The “insanity” defence is generally regarded as unfavorable in North America according to Susan Yamamoto, a research associate at the University of Carleton’s Legal Decision Making Lab who specializes in studying attitudes towards the NCRMD defense. “Studies indicate that this is likely owing to some combination of misconceptions surrounding the defence (e.g., the idea that dangerous offenders are often quickly returned to the street with no treatment), stigma toward persons with mental disorders, and moral objections to the defence,” she said. 

Yamamoto noted that people tend to significantly overestimate the frequency of “insanity” pleas. Statistics Canada reports that NCRMD rulings represent about one per cent of all criminal cases. According to the Mental Health Commission of Canada in 2013, among NCRMD cases, eight per cent involved serious violence, and less than three per cent of violent offence cases involve an offender with a mental disorder.  

When we think of the NCRMD defence, cases like those of Vincent Li or Allan Schoenborn may come to mind, where the acts committed are so horrifying it becomes difficult to distinguish the person from the act, and the illness that drove them to do it. Stereotypes and stigma are prominent. “The media likely plays a significant role in perpetuating these damaging narratives,” Yamamoto explained. 

For Dr. Chatterjee, stigma is one of the most challenging aspects of forensic psychiatry. “The level of stigma that they face can be barriers to accessing the support, the resources, and the treatment they need to move forward with their lives,” she said.  

Ruby, eyes glistening like the ocean after a storm, says she’s doing alright. With a half-smile, she tells me she’s trying to not beat herself up for a situation that’s out of her control. “I’m trying to really, for myself, for my mind, make myself believe that this happened for a reason, for whatever reason,” she said. “I wanna be like standing somewhere, looking someone in the eye and say: ‘I wouldn’t be here doing this if that shit didn’t happen’ you know?” 

Maybe more than others, I can grasp how remarkable Ruby’s outlook is because I’ve experienced manic psychosis. My own manic-turned-psychotic episodes required hospitalization each time and completely disrupted my life. Twice, I had to move cities, leave my friends and life behind, quit my job and drop out of school.  

If you’ve been hospitalized for a manic-psychotic episode, you probably understand. You understand the electricity of euphoria, of feeling connected to the earth and believing your existence is special and chosen. You know the look on someone’s face when it melts from awe to fear as you worsen. You may know what it’s like to walk for hours on end, finding beauty at every turn and never tiring, or what it’s like to hear or see things through your senses that just aren’t there for everybody else. You understand the horror and humiliation that sinks in after you find your way back to consciousness and realize how permanently damaged your reputation may be. You may have lost friends who can’t or won’t understand. You know how frustrating it is to have your thinking and performance blunted because of your foggy, drained and recovering brain. You understand what it’s like to be completely thrown off-course from your life, how piecing things back together can take years. You may know the confusion and guilt that comes from contemplating if there’s a grain of truth to the experience, to the spiritual energy you felt that can’t be medically validated and will therefore always be untrue, lumped into the ‘crazy’.   

In preparation for her case, Ruby’s lawyer gave her a 14-page document of all her psychiatric notes—from her first episode to her most recent.  

“It just was horrifying to me to walk out into this like trial knowing that these specific people read this specific report on me—and this is me at my worst possible moments in life, my most vulnerable, and it doesn’t say anything in-between about the person that I actually am and the things that I have accomplished despite having this, you know? It doesn’t mention anything of that.” 

*Name has been changed to protect the identity of the interviewee