IV. Junichi Nozu on the Way to Murder
1, Major Tranquilizer Stopped
Dr. T. Watanabe, as a psychiatrist, stopped the prescription of antipsychotic drug to Junichi Nozu, who is a schizophrenic patient for twenty years and must be kept prescribed and must not be discontinued.
On 7th December 2005 immediately after Junichi Nozu was arrested by the police while his normalization out program, other psychiatrists in Iwaki Hospital checked Junichi Nozu medical record and got surprised to find out the stoppage of major tranquilizers, for at least past one month. The record on 27th November 2005 substitute the psychiatrist for it is written by the Dr. T. Watanabe that "New policy; Dops, droxidopa, be increaded and Propitan , antipsychotic floropipamide hydrochloride, be replaced". But strange enough, according to the police taken medical record, confiscated on the later date, Dr. T. Watanabe stopped the antipsychotic drug in Junichi Nozu prescription from 30th November 2005, one week before the murder. Even still, Iwaki Hospital deposed at the civil court, they stopped from 23rd and it was two weeks before. The superintendent psychiatrist prescribed again to Junichi Nozu after he was arrested and delivered the drug to the police. Clearly Dr. T. Watanabe understood the cause and the result by the stoppage of the major tranquilizer on 7th December 2005.
2, Junichi Nozu in the Previous Weeks
Junichi Nozu was suffering from harsh and irresistible trembling which was the clear symptom of the akathisia, but Dr. T. Watanabe, who has diagnosed the suffer by mental illusion by the CPK value, and he stick to the idea of no akathisia. The intramuscular injection of Biperiden is effective against involuntary movement of hands and legs, Dr. T. Watanabe, however, replaced it with a physiological salt solution. Without effective treatment, Junichi suffered from severe trembling, and even suspected whether he had been given the proper medicine, Biperiden or not - as in fact he was administered a physiological salt solution as placebo without his consent.
3, Dirty Smokers Corner and Idea of Murder
Junichi Nozu, a chain smoker who smoked 60 cigarettes a day, used to smoke at the smokers corner in front of his room or elsewhere in Iwaki Hospital. It was on 6th December 2005 in the morning, Junichi Nozu was not happy for his smokers corner was left unclean and dirty ( and at the civil court Iwaki Hospital admitted as it was dirty). He did not wish to clean cigarette ashes and butts by himself, instead, in his delusion, he suspected someone or some group of the people who do not wish his smoking might be disturbing him by keeping his smoking area dirty. And in order to appeal the hospital authority to stop the malicious intent of someone, he has got the breaking idea of killing a man. He believed he should be exempted from the punishment by the murder for he is a psychiatric patient but some one other should owe to be punished for he is unreasonable and willfully disturbing Junichi Nozu from smoking.
4, Urgent Request to Examine
At 10 A.M. on 6th December 2005, Junichi Nozu requested that the nurse ask Dr. T. Watanabe to examine him as an emergency case but the doctor refused the request by the patient under his care. Then, Dr. T. Watanabe was in the Iwaki Hospital at the outpatient and he was consulting the second patient on the day. According to the testimony of Iwaki Hospital at the court, the doctor stopped working for a while and considered whether to examine Junichi Nozu immediately or not, and he decided not to. In those days, Dr. T. Watanabe as superintendent was in charge of only twelve patients at the hospital, but he refused the urgent request from the one.
On being told "No" from the nurse Junichi became disappointed and lamented "I have asked for an examination by Dr. T. Watanabe for days, but have been given no-care" and these Nozu words were recorded by the nurse. Junichi Nozu was clearly upset in that morning, but Iwaki Hospital and Dr. T. Watanabe has never took their observation into the day-to-day appraisal of the mental patients, and Junichi Nozu was left alone in his room.
5, Only if Examined
Since, Junichi Nozu proud of his doctor in charge, for Dr. T. Watanabe was the superintendent of Iwaki Hospital and being a patient of the most trustful and respectable psychiatrist at the hospital. So even if Dr. T. Watanabe had checked Junichi Nozu briefly, he might have been got released from the pains at least for a while. Or the doctor might have found unusual and extraordinary condition in Junichi Nozu and he might have diagnosed for the immediate treatment. Thus Iwaki Hospital and Dr. T. Watanabe might have decreased the possible chance to cause any fatal misbehavior by the psychiatric patient under the hospital care.
6, Made up Mind to Kill Someone
Two hours later on the same day at 12 o'clock, Junichi Nozu went out from the hospital as per usual with permission, but nobody checked him on leaving. While Junichi Nozu was about to go out from Iwaki Hospital from the gate, he heard hallucination told by someone at his neighborhood bad of his father and he got raged. By the time, he had made up his mind killing someone to release his severe irritation. He went to the shopping centre to buy a kitchen knife.
After arrested, Junichi Nozu told to the police, that if he killed some one inside the hospital, he was to cause the trouble of Dr. T. Watanabe, and he refrained by himself from attempt of assaulting. And at the shopping centre, he asked a sales girl to take him to the kitchen knife corner. He thought if he did not pay he shall be detained by the shop, and he may be stopped from killing. He also thought, if he tries to assault some one, for example sales girl, inside the shop then shop keeper and people might stop him immediately and he may fail to get someone killed.
In pursuit of the process of assaulting, he has been careful not to be stopped and arrested at the place of the offensive act. He went out of the shop and walked in the car parking for about hundred meters in search for the suitable victim, and found Makito Yano about to get into his car defenseless. Makito Yano had never pay attention to Junichi Nozu and he was stubbed in his chest at once with such easy and without any protection. He tried to run away for the escapes and helps, but was fallen after ten meters and was finished permanently.
7, No Hospital Care
Junichi Nozu watched Makito Yano at his final moment, never tried or imagined to rescue Makito Yano, and threw the blooded knife and went back to Iwaki Hospital. The police confirmed that Junichi Nozu back by 13 o'clock, from the monitor TV of Iwaki Hospital at the gate. Junichi Nozu did not filled in the out/back note but went into his room directly and covered himself under the blanket on the bed. He murmured "I killed a man. So I have finished my life" and these words were told from Nozu to the police after he was arrested.
Despite with the urgent request he made in the morning, Iwaki Hospital and Dr. T. Watanabe did not examined Junichi Nozu whole day in the afternoon and in the next morning. Again, on 7th December at 12:00 he went out from the hospital as usual with the day-time-out-permission. Junichi Nozu was exactly in the same clothes and visited exactly the same place at same time he had commit murder on the previous day, and was arrested. And the process was broadcasted by the TV throughout in Japan. As the result, even requested urgently by the in-hospital patient, Iwaki Hospital left him without providing consultation for more than 26 hours and the chance of giving cares has been lost forever by the arrest of their patient.
8, Dr. T. Watanabe in the Afternoon
Dr. T. Watanabe testified at the court that he had nine outpatients on 6th December morning and the job finished at 13:30. He maintained that he visited Junichi Nozu at his room after the morning out patient duties, but Junichi Nozu was not found in the room. In his testimony to the police on 8th December 2005, Dr. T. Watanabe maintained that he visited Junichi Nozu at 15:30 but Junichi Nozu was not at the room. In fact Dr. T. Watanabe fluctuated the time he visited Junichi Nozu at the room. At the time Dr. T. Watanabe indicated, either 13:30 or 15:30, Junichi Nozu was clearly in Iwaki Hospital and was staying at his room. But the doctor maintained Junichi Nozu was not inside the hospital, and spoke at the press interview on 8th December 2005 held at his hospital, that Junichi Nozu had not been back before 16:00 o'clock. By the record which had been proved by the police, Junichi Nozu was in the hospital by 13:00, but the hospital confirmed they did not found him in the room for more than three hours.
Even though, Dr. T. Watanabe told to the civil court, that he wished to see Junichi Nozu late in the afternoon but held back for his mother was visiting him. In fact Junichi Nozu refused to see his mother and it was unusual to him. By the late in the afternoon on the Makito Yano murder date, all the TVs reported widely the killing of a young man in a shopping center, and the news was seen in Iwaki Hospital also. On the evening, Junichi Nozu was different for he did not take supper. A staff called Junichi Nozu at his room, and advised to take a meal, but he was asked from Junichi Nozu "Is the police coming to catch me?" Even with these words, which has been admitted at the court, Iwaki Hospital had not noticed Junichi Nozu as a murderer suspect on the day.
9, Junichi Nozu Arrested on the Next Day
From the monitor video at the shopping center, police has identified a tall and stout male, in reddish brown pull over and blue jeans as a murderer suspect. The police known to the press, that the suspect has got scars and scratches at his face.
On the next day at 7th December 2005 the police visited Iwaki Hospital and requested for the cooperation. But still Iwaki Hospital did not identify Junichi Nozu as the suspect. Junichi Nozu was not usual, for he did not take breakfast, and seldom with his habit, he kept himself quiet in his room, and at lunch time, he was without three meals since the previous day, Junichi Nozu went out from the hospital and pay a visit to the place where he commit homicide a day before. A TV reporter found and informed him the police and Junichi Nozu was arrested. Dr. T. Watanabe told in the court that while he was meeting a police officer at his hospital early in the afternoon, the police arresting report arrived.
Iwaki Hospital got surprised by the arrest and Dr. T. Watanabe called the emergency meeting of the psychiatric staff and discussed the remedial measure. At this meeting a psychiatrist got shock to find out the major tranquilizer had been stopped for a month to a schizophrenic patient by the superintendent psychiatrist at the Iwaki Hospital.
10, Junichi Nozu Sentenced 25 Years
The judgment to Junichi Nozu of his murder by the Local Court on 23ed June 2006, came with his diminished responsibility his term was shortened he was nevertheless sentenced to 25 years imprisonment. Junichi Nozu and his parent did not appealed to the High Court within the two weeks period of grace and the punishment on Junichi Nozu was fixed. It was the first and the heaviest punishment to a schizophrenic mental patient who killed only one person in Japan. Currently Junichi Nozu is kept in the psychiatric ward of the hospital jail.
After the court judgment and before the final date of their appeal we, as parents of Makito Yano, communicated to the parents of Junichi Nozu and suggested them to accept the term, for the reason of the best benefit of their son and themselves. It was very clear that the parents had been suffering from the brutal conducts of Junichi Nozu while his leave from the hospital and stay at home by the normalization-socialization program. They have been taking care of their son with schizophrenia for more than twenty years and afraid of their own aging and ailing. It has been their source of worry how to take care Junichi Nozu after aged. Twenty five years in jail, then parents are over 90, and possible forced hospitalization after the jail must have finished their troubles brought by their son.
V, Poor Psychiatric Care and the Criminal Law 39
1, No Punishment to Murderer
The murderer, Junichi Nozu; a psychiatric patient with schizophrenia hospitalized at Iwaki Hospital, was given short day-time leave permission under the rehabilitation program. He murdered Makito Yano in broad daylight, perhaps believing that his illness would allow an easy escape from punishment.
After the tragedy, Makito's family were told by medical experts, lawyers and even the press that Junichi Nozu should not be punished, due to the "insanity/irresponsibility" provision within Article 39 of Japanese Criminal Law, citing their strong belief in human rights. They insisted that all people with mental illness should be exempted from any punishment in order not to compromise their human rights, thus even charges of homicide should neither be pursued nor discussed at court. Further, people with mental illness should not be sent to jail but instead should receive treatment at a psychiatric institute with the condition that they should be allowed to return to the community after the shortest possible time on medication.
Based on this logic, until today in Japan, a person with mental illness who had murdered would most likely be set free - with the risk of repeating the behaviour as a result. Remarkably, no facts, not even the name of the murderer and how the victim died, would be made available to the family of the deceased victim in the interest of respecting the privacy of the "innocent murderer". In Japan, a country where the Constitution guarantees the equal human right to each citizen, the human right of crime victims, however, has been encroached and compromised by the practice of the Criminal Law, which is in the framework of the Constitution.
2, Article 39 of the Criminal Law
The idea of insanity irresponsibility does exist even in the classical Japanese Law. And in the Japanese modern law, insanity irresponsibility was first stated at the Article 78 of the Old Criminal Law of 1880 which said no one should be punished if he had been insane and understood nothing when acting the offense.
Insanity and diminished capacity irresponsibility is written in the Japanese Criminal Law ( Act No.45 of 1907) as follows but has not been defined in the pr?cised terms and conditions . The law is enacted still today.
Article 39. (Insanity and Diminished Capacity)
3, Supreme Court Decision in 1941
The Criminal Law does not tell insanity in relation with the psychiatric condition or the illness, but the Supreme Court of Japan defined in its judgment in 1941 the insanity as the "disorders in spiritual condition owing to the mental illness". Based on the Supreme Court criteria, insanity has been widely applied to the mental patients up to today in Japan.
The mental illness was hardly to be get recovered, when the Criminal Law was written with reference to the European legal system as the predecessor, and the time when the Supreme Court judged nearly seventy years ago. But in those days once a man have got the mental illness one could not expect the recovery but must stay at the asylum for the remaining part of the life. It was the days without antipathetic drugs and the rehabilitation programs.
But after 1950s, many of the psychotropic agents have been developed and introduced and the situation surrounding the mental illness has changed. Today, if a patient get the suitable treatment and prescription and keep taking the prescribed agents, then he may not be kept at the insanity condition permanently. So the development of the psychiatric medicine must be taken into account when the Article 39 of the Criminal Law is to be enforced to the criminals.
Considering the up-to-date and current level of the psychiatry and what the psychiatry can do to the mentally disordered patients, extensive application of the insanity irresponsibility to the psychiatric patients should be re-considered of a possibility to be exceeding the limit of the what was originally written by the provisions at the Article 39 of the Criminal Law. The enforcement of the law should keep itself with the current situation of the medical and psychiatry level. Any jurisdiction must be correspondent with the medical science of the date. Although the art of the law writing is by the social science, but day to day application of the written provision should be adjusted with the what science can do or have achieved.
4, Prosecutor Arbitration and Homicide
There is no rules existed in Japan that all the homicide cases should be inquired at the judicial court. In the practice of the jurisdiction in Japan, even the case of the homicide, some are set free by the policeman in charge at the place of the offensive activity after checking the psychiatry registration card or the mentally disabled social security certificate. Even after the arrest, based on the simple psychiatry test by the expert, many of the mentally disabled has been disposed by the public prosecutor as non indictment.
Officially the prosecutor maintains the position that no need to indict a criminal who is apparent be judged irresponsible at the court by the Article 39. And thus they could decrease the number of the case brought into the court of justice and avoid the humble and meaningless business of themselves. The discretion has been considered as lawful and appropriate, and many who have appealed even the homicide case to the Inquest of Prosecution had been simply been dismissed. Even in some case which the Inquest of Prosecution approved as appropriate to indict, but the prosecutor seldom been forced to change their past decisions.
5, One Way Procedure with No Return
The irresponsibility discretion by the public discipline and regulatory authorities, either the prosecutor decision of non indictment, or the court of justice to decide irresponsible by the insanity provision of the Article 39 of the Criminal Law, is always been one way direction and with no return and re-considerations.
If the murderer had been decided irresponsible by the prosecutor by the Article 39 of the Criminal Law then he has been freed. According to the public conception, it is necessarily be expected that those mental patients who commit serious offensive acts are sent to the psychiatry and enforced to stay at hospital at least for reasonable durations which may restrict the rest of the offenders life in some way.
However based on the data compiled on 30th September 2007 by the Probation office of the Ministry of Justice, out of 725 offenders (firing 28.9%, indecent assault 5.7%, homicide 25.0%, heavy injury 35.0%) brought to the criminal court and judged in the previous two years, and were admitted as insane/irresponsible by the Article 39 of the Criminal Law, resulted in forced hospitalization 56.6%, outpatient treatment 21.1%, and others 21.5%. Out of the mentally disabled who had been officially decided as insanity irresponsible, little over the half have been forced the hospitalization regardless of their will. Surprising enough, 42.6% of the officially granted insanity and irresponsible people are allowed to join in the community immediately after the insanity judgment at the criminal court. Even 21.5%, with no need of psychiatric treatment at the mental health service side, should not have been treated as mentally disordered at the judicial service, and they should have been punished as one of the ordinary criminals. But more seriously, we must not forget the fact that the figure does not include offenders who were freed by the policeman on the spot, nor arrested but non-indictment criminals by the prosecutor.
6, A System Failure
Further more the forced hospitalization does not mean the long enough period in the hospital to entail their offensive will to harm others. In many of the case the hospital care last for only few weeks or months and they are most likely to be allowed to go back to the community, sooner or later but not so late. If he is serious, he may be kept at the psychiatric asylum for maximum of three years, and again if he is considered not have recovered, his forced treatment may be extended in the limited duration.
Basic philosophy is that mentally disabled should not be sent to the jail but be medicated at the psychiatric institutes and let them return to the community after a shorter possible period of medication. But all the people, even with the current level of psychiatry, can not be expected the psychiatric remission enough for the community life. And some others, with personality disorders likely to harm others and can not be treated only by psychiatry. As a result some of the offenders with psychiatric symptoms, after coming back to the community, commit next crimes. And there is no system equipped in the society to stop the next and predictable tragedies.
Even if the mentally disabled is put into the criminal law court, because of the insanity irresponsibility provision of the Article 39 of the Criminal Law, it was frequently been sentenced no-punish. And once sentenced non-guilty by the Article 39, then no appeal allowed and possible for the victims and their family, to let the "in fact sane" but legislatively decided "insanity" man to put to jail or question again. Since jurisdiction of the police, prosecutor and judicial court come under the auspice of the Ministry of Justice, and psychiatry and mental health to the Ministry of the Health and Labor, even if the medical practice of the latter may deny the insanity report of the psychiatric examination of the former, already been made decision in the former should not be overturned.
As the result, most possibly, of the legal and medical system error, nearly the half of the insanity and irresponsible criminal are exempted from any kind of the legal penalty and confirmed the freedom to act in the community as before without restrictions immediately after the criminal court judgment. Even though, if he may be forced hospitalized, in case of the remaining half, he has the reason to expect his restriction to be finished shortly in the future.
7, Reality of "No Punishment but Hospitalization"
Saying being based on the humanitarian reason, majority of the psychiatrist take the position that the mentally disabled should be treated and cured at the psychiatric institute, but not be jailed and punished. But ironical enough, many of the non-punished serious offenders sent to the psychiatry, are generally be reacting violent and easy breaking hospital rules, and are the unwelcome kind of the patient to keep long enough in the hospital. From the hospital management point of view, those mental patients had better be treated in the other psychiatric institute but not under their hands. As the result, they are apt to be advised to leave the hospital or discharged at the premature stage of the psychiatric condition. On the other hands, obedient and mild psychiatric patients, are likely to be kept at the hospital with the result to hamper and impede their possibility to join again as a member of the community.
The majority of the psychiatric hospitals in Japan are run by the private initiative, mainly managed by the owner psychiatrist with his family assets. It is sometimes been said, that their medical decisions are likely to be influenced by the financial needs of their hospital management. But unfortunately, those offensive but insanity and irresponsible patients are likely to require the bigger manpower and detailed safety considerations and necessitate and require the additional expenditures. Thus from the owner psychiatrist point of view, taking the social cost and risks by their private hospital may not be rationalized.
8, Right of Exemption from the Punishment?
Most of psychiatric patients, even the serious schizophrenic, are not totally impossible to communicate with other patients in the hospital. It is believed that they talk each other and exchange their views and information within the hospital, and they talk of their experiences of exemption and irresponsibility from the punishments. Among psychiatric patients committing homicidal acts who are freed by the police or prosecutor without testifying at court, some may have acted in full knowledge that they would likely have the right of exemption from punishment from their premeditated actions. If the legal practice has been inspired this unlawful idea, it arouse the question to the real objective and role of the law and jurisdiction.
VI. Iwaki Hospital Case and Innovation of Psychiatry
1, Next to the Utsunomiya Hospital Case
In 1983, the Utsunomiya Hospital Case exposed poor psychiatric treatment and malpractice towards patients with mental illness. Although the Japanese psychiatry establishment stated that the case was exceptional, occurring in only one hospital, deficits subsequently turned out to be more widespread and invited international criticism. In response to this lesson, Japan has changed legislation relating to mental health, and implemented the normalization-socialization programme.
Iwaki Hospital pleaded at the court that their rehabilitation program accords with the philosophy and recommendation of the normalization-socialization program advised by the United Nations and International Commission of Jurists (ICJ). Telling as if it is the international standard, Iwaki Hospital insisted that in order to protect and enhance the human right of the mentally disabled at the hospital, no control should be imposed to the daily outing program. To this end they stressed that psychiatric patients should be fully guaranteed the voluntary behavior and their initiative. From Iwaki Hospital point of view, all the psychiatric patient hospitalized with their voluntary will should not be restricted their mobility against their will and should be protected from any kind of the behavior restrictions even if they show the temporary unstableness or disturbance in their spirit and mental condition.
After Junichi Nozu was judged imprisonment for 25 years, some psychiatrist criticized the judgment and said Junichi Nozu should have been sentenced non-guilty by the insanity provision of the Criminal Law 39 and should have been treated at the hospital for the further medical cares and he should be promised to join in the community as early as possible. And said, "Since psychiatry examination/evaluation report of Junichi Nozu presented to the criminal court stated the need of psychiatric treatment, then Junichi Nozu should have been judged no-guilty and should not be treated his psychiatric illness not in jail hospital but hospitals in the community".
But based on the fact and reality revealed at Iwaki Hospital, how the psychiatrist opinion can be rationalized? Need of the hospital treatment does not necessary correspond to the insanity spiritual condition of the mentally disabled people. And requirements at the hospital treatment does not always render to the conclusion to apply the insanity provision of the Article 39 of the Criminal Law. If in community hospital treatment is paramount important, then no psychiatric patient should be punished.
2, Normalization and Legal Responsibility
The matter must be considered from another angle. If the aim of the psychiatric treatment should to let the patient in a smooth and facilitated manners to get normalized, and to let them find their way and life as the integrated member of the society, then any mental patient joining to the community should share the common responsibility expected to the individual. It shall be the principal code of conducts that anybody who share the role and position in the community shall take the responsibility and owe the penalty to the misbehavior.
But the Japanese psychiatric circle seems to insist in paramount irresponsibility to majority of the mental patients, and at the same time demanding to let them share the wider communal roles. Under their logic, any risks should be forbidden to be taken into account. But, if the bigger chances for the psychiatric patients in the society shall be the aim of the mental health service, then, wider and increased responsibility shared by them should naturally come to the next.
3, Lesson from the Utsunomiya Hospital Case
The basic matter being questioned at the Utsunomiya Hospital Case was the unlawful misbehavior to the human right of the psychiatric patient, and the neglected psychiatry treatment by the psychiatrist and the staff of the hospital. The Utsunomiya Hospital Case has proved that for the convenience and benefit of the hospital and psychiatrist, the erosion, encroachment and violation of the human right of the mental patients had been the common practice among the Japanese psychiatry.
Iwaki Hospital at this time, took the position, that human right of the psychiatric patient should be non interfered even after the murder or offensive activity. Based on this logic, until today in Japan, a person with mental illness who had murdered would most likely be set free - with the risk of repeating the behaviour as a result. Ironically enough, another side of the coin to this understanding, however, is the misbehavior and malpractice of the psychiatric hospital to the patients. And what is currently taking place at Iwaki Hospital has proved that the Utsunomiya Hospital Case is still the matter of question in human rights in Japanese psychiatry.
4, Iwaki Hospital Case
Dr T. Watanabe, superintendent of Iwaki Hospital, as a psychiatric specialist and expert may be said he has not finished the adequate training in the clinical psychiatry, generally expected internationally, and responsible for the superintendent task of the psychiatry. The sole reason he is taking the responsible and respectable social position as a superintendent of psychiatry comes from the ownership of the hospital. In this aspect it has been proved by Iwaki Hospital and Dr. T. Watanabe that authority of the hospital superintendent has not been legitimately be linked with their qualifications. In Japan with the sophisticated system in medical science, we witness the fact that even the poorest kind of the medical doctors are allowed to take the important and responsible role in the hospital and medical service.
Dr. T. Watanabe, as a superintendent psychiatrist, stopped prescribing the major tranquilizer (antipsychotic drug) to the patient with schizophrenia, without justifying its discontinuation. Iwaki Hospital, in the judicial testimony, had tried to maintain they continued prescription of the antipsychotic, but accepted the discontinuity. Junichi Nozu had incessant trembling which could be attributable to akathisia, but Dr. T. Watanabe, who interpreted the symptom as an illusion, insisted there was no akathisia. Then he prescribed a high dose of Bromazepam; at double the maximum permitted dose limit for weeks, which may cause "paradoxical behavior" to some individuals, but the psychiatrist did not perform the required clinical evaluation.
It was clear that Dr. T. Watanabe did not considered any possibilities in the paradoxical behaviour or other side effects and has never gave attention to his staff to keep eye on Junichi Nozu. But the psychiatrist maintained in the court that paradoxical behaviour has never been reported from the nurse and operational therapists, and the doctor in charge should not be responsible even if he did not perform the clinical evaluation as the psychiatrist after the changes in prescriptions. But we must take note for Iwaki Hospital has not check properly Konjo-yaki tobacco burns at Junichi Nozu's face for 14 months, and difficult to believe in the Iwaki Hospital and their staff of their claims to have been performed the proper observation to the patients.
Iwaki Hospital maintained that Junichi Nozu and his schizophrenia had not been serious, and he was expecting the discharge and joining to the social life in near future. Iwaki Hospital testified at the court as if Junichi Nozu had got the full responsibility to his conducts. However, Iwaki Hospital did not offered enough consultation and explanation to Junichi Nozu. Iwaki Hospital changed the prescription without the consent from the patient, even neglected the doubts from the patients in prescription, and did not answer to the emergency request from the patient. Based on what Iwaki Hospital has done to Junichi Nozu, it has been becoming clear that the hospital has never respected their patients, but pretend themselves to had respected the human right of the mentally disabled and enforcing the society not to clarify the misbehavior of the hospital.
Many in Japanese Psychiatry state that the indiscreet work of Iwaki Hospital is no exception. If poor medical training, inadequate treatment and patient neglect are common, these problems may be caused in part by the existence of the "irresponsibility provision" in Article 39 of the Japanese Criminal Law. This provision may also fail to protect the human rights of those with mental illness in practice. Lessons have not yet been learned from the Utsunomiya Hospital Case. Japanese mental health service should study Iwaki Hospital Case in detail and should prescribe what should to be get improved for the benefit of Japan as a whole.
5, Law and the Constitution
Majority of the people around the Japanese judicial circle do not doubt the provision and current manner of execution of the Article 39 of the Criminal Law of Japan. They say the clause is the sacred to the human right and nobody may infringe and challenge to the idea. Within the bar it seems they are so keen to defend the mentally disabled who commit the serious criminal actions and do little care for the violation of the human right of the victim. Inside Japan where the law has been enacted, the human right of the ordinary citizen has sometimes been encroached and violated in practice and lawyers seldom has pointed or aroused the question. Rather, those citizen who had questioned has likely to be criticized as if they were the ignorant and braking the sacred code of the human right.
The Constitution of Japan has been enacted in 1947, but the Article 39 of the Criminal Law in 1907 and the Supreme Court decision and connotation of the Article 39 was in 1941, both before the establishment of the current Constitution. The key importance of the Constitution of Japan is the universally applied human right. However, at the day to day application of the law of Japan, the understanding of the law while the time of the Constitution of the Empire of Japan is still enacted, and have been encroaching the human right of the citizen. After the enact of the Constitution of Japan, the Article 39 of the Criminal Law should have be re-written to conform with the Constitution. Or may need to be have been added the pr?cised sub-codes to define the matter in detail in order to meet the order by the Constitution of Japan.
6, The Word of the Specialist
After Makito Yano was killed at a shopping center by an unknown man, Yano parents have started the study on the Article 39 of the Criminal Law and the Psychiatry and the normalization-socialization program of the mentally disabled. Lawyers in Japan seldom doubt the social reality brought by the Article 39. Psychiatrist are reluctant to accept the facts of any misbehaviors or the poor medication. Rather they have been told overwhelmingly "The matter has not been interested among the experts. The amateur should trust in the experts discretion and, if there are any problems to be get improved, wait until the matter be taken to the expert forum and get considerations from many aspects."
7, Litigation and Information Disclosure
Yano parents has brought the litigation in action believing themselves maltreatment and misbehavior of a psychiatry should be questioned for the better social health service in Japan. And Yano parents have made open the realities about Iwaki Hospital psychiatry on the internet, and made available to everybody who get interested. And in order to stop the information disclosure, Iwaki Hospital once tried to put the matter at the court, but no action was taken by the judge. Yano parents believe that the information must be shared by the public for the benefit of the psychiatric patient and Japanese public in general.
The internet home pages in Japanese on Iwaki Hospital Case is well read by the psychiatrists and lawyers. Successively a internet forum of the psychiatrist have heated up on the report by Yano parents, but no action or opinions from psychiatrists enough to influence the court disputes has been taken yet. Yano parents are told that many psychiatrists have tried but eventually given up their intent of supporting Iwaki Hospital. But still what Yano parents claiming are not welcome to them, and seems wishing to regard the litigation as a small and local matter. Another internet forum of the lawyers also got interested, and some one predicted the Iwaki Hospital Case judgment may result to give the profound influence to the judicial and psychiatric established norms in Japan.
In addition, mental health service and legislation is also said to have got interested in the Iwaki Hospital Case. But as far as being known to Yano parents, they do not welcome the litigation but keep watching with the sense of nuisance and annoyance. It seems, from their point of view, they consider their business may face additional awkward and humble procedures and the normalization and socialization programme of the mentally disabled people may be disturbed, and reluctant to initiate the changes and improvements.
Yano parents are got surprised by finding out the poor and mistaken psychiatric treatment by Iwaki Hospital and its superintendent psychiatrist. And also they are got disappointed that what questioned at the Utsunomiya Hospital case is still the running reality in the Japanese psychiatry. But despite with the facts and evidences proving the mistaken psychiatric treatment at Iwaki Hospital they pointed out at the court, they are not optimistic in the coming judicial outcome and judgment. The litigation itself questions the long established court understandings on the Article 39 of the Criminal Law and the Supreme Court understanding of the law at 1941. What ever the judgment may come some years in future be, Yano parents believe their court action may be recorded as an epoch making incident in the Japanese psychiatry and judicial history, and eventually result in the reform of the mental health service in Japan and in the world.
Makito Yano parents are in a position of the plaintiff at the judicial court against Iwaki Hospital and the court dialogue has been carried out for more than four years. While on the course of the procedure, parents of Junichi Nozu joined as the additional plaintiff against Iwaki Hospital. Yano parents invited Nozu parents for Yano believed that the matter against Iwaki Hospital should be shared by both of the murderer and victim sides. It is for the common human rights of the mental patients and the citizen.
As combined plaintiffs, Yano and Nozu parents have been pointing out the mismatch of the judicial practice of the Article 39 of the Criminal Law with the Constitution of Japan. And also we excavated a lot of the evidence and facts on the poor, inadequate and mistaken psychiatric practices. Based on what have been made clear, we request specialists and experts to respect and regard the point we have been highlighting at the court. It is our point to request specialists work for the generalization in accordance with the universal human rights.
9, Universal Human Rights and Co-habitation
As parents of Makito Yano, we believe the respectable society should guarantee the equal human right to every body, and should be in accord with the fact and reality based on the current science. We do not deny the insanity/irresponsible clause to be defined at the law, but still we say that no one should be given the special right of exemption from the court of justice procedures. It is our position to pursue the court litigation against Iwaki Hospital with the aim to indicate the direction in execution of the law and medicine for the universal human right to everybody. We believe it is the basic rule for the co-habitation of the people, what ever the nature he or she is.
We offer our great thanks to Dr. Simon J.C. Davies, D.M. (Oxford), M.B.B.S. (London), M.R.C.Psych, M.A. (Oxford), M.Sc. (Florence/Maastricht),Dip. Epidemiol. Clinical Lecturer, Academic Unit of Psychiatry, University of Bristol, U.K., for his advice, help and guidance.