Iwaki Hospital Case

Insanity Irresponsibility and Responsibility of the Clinical Psychiatry
Victim and Murderer Co-operate Against Poor Psychiatric Care & Criminal Law 39

26th June,2010
Chie Yano and Keiji Yano

  The murder of Makito Yano by a psychiatric patient Junichi Nozu in broad daylight brought the value of the psychiatric treatment and normalization-socialization program of Iwaki Hospital into question. In addition the human rights both of psychiatric patients and the Japanese population in general, under Article 39 of Japanese Criminal Law and the Constitution has been put under the spotlight. At the criminal court the murderer was sentenced to 25 years of imprisonment. However, the parents of both the victim and the perpetrator have co-operated as plaintiffs and have been taking action at the judicial court with regard to malpractice and poor psychiatric treatment by Iwaki Hospital. This action is in the spirit of universal human rights.

I. Combined Plaintiffs

1, Makito Yano a Japanese and British Citizen

  Makito Yano, male and born in Liverpool U.K. on 20th August 1977 and both citizen of Japan and the United Kingdom, died on 6th December 2005 aged 28, being murdered by Junichi Nozu 36, who had a diagnosis of schizophrenia. Their encounter took place at a shopping centre in Takamatsu City in Shikoku Island Japan, when Makito Yano was about to get into his car after having lunch. He was stabbed in the chest with a kitchen knife which Junichi Nozu bought for the petty amount of only 105 yen (about one U.S. dollar or 70 British pence). In a few seconds Makito Yano died from massive bleeding as his aorta was severed from the heart. The murderer, Junichi Nozu, a schizophrenic patient at Iwaki Hospital, had been given permission for short day-time leave under the rehabilitation programme.

2, Escaped Murderer

  If Junichi Nozu had been caught immediately after the act of committing the homicide, then, he would likely not have been arrested. In Japan, if a person committing an offence is carrying an admission card of a psychiatric institute or a certificate of mental disability, then police may not always arrest them there but instead may simply return them to the psychiatric institute or even set them free with the matter considered to be finished.

  It is widely argued by those in medical and legal circles, as well as by the press, that people with mental illness should not be punished for any offence. Hence, in most cases, legal procedures normally invoked may not be completed due to the "insanity provision" of Article 39 of Japanese Criminal Law. Even if the suspect has committed a homicidal act, the public disposition may be taken that in view of an irresponsible nature through the mental illness, he may not be subjected to scrutiny at a court of justice, but instead given shelter and treatment at a psychiatric institute.

3, Schizophrenic Arrested on Next Day

  As Junichi Nozu was not detained at the site of the assault, he walked back to the hospital. This strange and sudden bloodshed, resulting in the death of a young man, was widely reported by the TV and newspapers provoking a surge of public anxiety. Local people were subjected to considerable worry about public safety, especially for the children. Soon after, using information from a security camera picture from the shop where the suspect bought a knife, the police identified a large man with scars on his face, and made the connection to a patient at Iwaki Hospital. On the next day, while a police officer was meeting with the superintendent of Iwaki Hospital, Dr. T. Watanabe, other policemen detained Junichi Nozu, visiting the site of murder, and who remained under the rehabilitation programme outside the hospital.

  Since the case was now already well known to the public, Junichi Nozu was subjected to the normal legal procedure and his mental condition was examined on the initiative of the prosecutor. Based on the psychiatric report which suggested he had sanity of mind, but with diminished responsibility, Junichi Nozu was found guilty of deliberate homicide. He was sentenced to 25 years imprisonment, this being a shortened term.

  Based on this experience, the parents of Makito Yano consider that all serious offences such as homicide should always be scrutinized at the judicial court irrespective of who is thought to have committed the crime. If the case had not been reviewed at the court, then no information such as name of the murderer and how the victim died may have been made available to the victim's family. And unless the case was taken to the judicial court, then the social justice from the victim side can not be achieved in practice.

4, Challenge for Makito Yano

  The parents of Makito Yano take the position, that certain established ideas and practices within Japanese judicial circles should not be accepted and could not be respected in the global community. As Japan is a trusted member of the world community, all practices occurring in Japan, should meet internationally accepted standards.

  Keeping their grief concealed, they have made every effort to make the Makito case known to the public. They wrote a book entitled "Kyojin : insanity sword", covering as much of the known facts and evidence as possible. They asserted that all murderers, even a person with schizophrenia, should be made to testify at a judicial court and must be examined in the spirit of pursuing a charge of homicide. The book was published while Juichi Nozu was detained for psychiatric examination prior to the announcement of the prosecution. Assisted by the impetus of public attention, Junichi Nozu's case was taken to the judicial court and he was prosecuted for his murderous intent and found guilty. Although with his diminished responsibility his term was shortened he was nevertheless sentenced to 25 years imprisonment.

5, Murderer Parents

  Based on their difficult and harrowing experiences, the parents of Makito Yano have established the impression that there is already some flexibility in the interpretation of and execution of Article 39 of Japanese Criminal Law. They have subsequently prepared to take action in the civil courts by questioning the defensibility of the psychiatric care at Iwaki Hospital.

  While the criminal court examination was underway, they suggested to the parents of Junichi Nozu that their son who committed murder could also be considered a victim of inadequate and questionable hospital treatment. They advised Junichi Nozu's parents that they had good reason to take action against Iwaki Hospital. Subsequently, they told the Nozu family, that they would not accept the 11.4 million yen offered by them in compensation, but instead requested Nozu's parents to utilize the money in the upcoming litigation on behalf of their son; Junichi Nozu. The idea was a surprise to Nozu's parents, but they were willing to consider this new proposal. Thus, the idea of having combined plaintiffs in the litigation against Iwaki Hospital took shape.

  On the judgment day at the criminal court of Takamatsu Local Court on 23ed June 2006, the civil litigation against Iwaki Hospital was put forward by parents of Makito Yano. By this date, they had received a letter from the parents of Junichi Nozu recording their willingness to join the litigation, although their entry was to be delayed to 19th October 2008 until they had marshalled their ideas and information.

6, Responsibility of the Psychiatry Hospital

  Since Iwaki Hospital had not been examined at the criminal court, Makito Yano parents brought the case at the civil court, seeking that the hospital and the doctor in charge be held responsible for failing to administer appropriate and legitimate treatment to Junichi Nozu. The court discussions have been continuing for more than four years, and are still underway.

  It is the position of Makito Yano parents to let the unsatisfactory treatment given by Iwaki Hospital to Junichi Nozu be made known to the public, in the hope that Japanese psychiatry treatment may be improved in cases of this kind, and that the "irresponsibility provision" of Japanese Criminal Law be reformed so that people in Junichi Nozu's circumstances are made to face up to their responsibilities. It is the opinion of the Makito Yano's parents that the day to day practice of the law has led to encroachment on universal human rights which are guaranteed to the people under the Constitution of Japan.

  In pursuing the allegations against Iwaki Hospital many hidden facts have been revealed, which have surprised the families of both the victim and the murderer. In the view of Makito Yano's parents, Junichi Nozu was poorly cared for at the hospital and many of Iwaki Hospital's prescriptions were questionable. In order to make available best and good psychiatric care to psychiatric patients and to protect the human rights of people who are affected by the accidents or assault generated by psychiatric patients, the information must be made available for the improvement of clinical psychiatry in Japan.

7, Combined Plaintiffs by the Victim and Murderer

  While the civil court litigation on Iwaki Hospital psychiatric activity was on the way, Makito Yano's parents kept in communication with Junichi Nozu's parents through their legal representative, and for waited them to join the litigation as additional plaintiffs against Iwaki Hospital and Dr. T. Watanabe. There appeared to be many reasons for the parents of Junichi Nozu to demand that the hospital and the doctor in charge take some of the responsibility and bear some of the penalty based on the facts revealed at the criminal and civil court.

  The parents of Makito Yano added that, "As the parents of the victim, welcome Junichi Nozu's parents to join, and believe that Makito Yano would also welcome the joint action against the hospital. Junichi Nozu's parents should take action not only for their regret that Junichi Nozu was not given sufficient care and treatment, but also for psychiatric patients in general in respect of their right to receive the appropriate psychiatric treatment. With the co-operated action by both of the parents as plaintiffs, it can be hoped that there will be a better prospect of improvement both in Japanese psychiatry and in the application of the law. If the current circumstances continue, then the human rights of the mentally ill and their families may remain unnoticed raising the prospect of further injustice and sadness. In order to create the better system in mental health care in Japan, Junichi Nozu's parents are better to work together with the family of the victim Makito Yano".

  For the initial two and half years the Iwaki Hospital Case was examined with the single plaintiff - the parents of Makito Yano. Junichi Nozu's parents kept to their words to the Yano family as regards their will to participate in the litigation, subsequently joining the action as an additional plaintiff. It was the position of Yano parents that Junichi Nozu should own his responsibility of killing Makito Yano and he should serve out all of his officially fixed and imposed penalties. Nevertheless, Nozu's parents had good reason to take action against Iwaki Hospital together with Yano's parents, for the lack of adequate treatment administered to their son.

8, Psychiatrists and Lawyers get Surprised

  The news the murderer's family joining the victim's family as combined plaintiffs against the hospital created a great surprise among psychiatrists and lawyers in Japan. The conventional belief was that the offender's family and victim's family would naturally quarrel and argue between each other and could not share and target common benefits against psychiatrists, lawyers and legislative decisions. The psychiatrist and the hospital had perhaps considered themselves to be standing in a neutral position with an impartial role and defensible stance allied to the respect normally afforded to their profession. It was thus a matter of considerable surprise that a coalition representing both victim and offender would pointed out responsibility of the psychiatric hospital in the matter in relation to Article 39 of the Criminal Law.

II. Junichi Nozu and Offensive Nature

1, Shopping Centre Murder

  Makito Yano, male aged 28, was stabbed to death at a car parking of a shopping center in Takamatsu City, on 6th December 2005. After taking lunch, he was about to open door at his car and was stabbed at his chest and died from the massive bleeding. For Makito Yano it was his first contact with Junichi Nozu, male murderer aged 36, and he has never took caution against Junichi Nozu then approaching towards him with murderous intent. It was nothing more than another contact with unknown men at the shopping center. He has never expected the sudden and forced change in his fate and the finish of his life. After a thrust, he tried to escape from the attack for ten meters and fell down.

  Although Makito Yano was deprived of the right to live, his parents were told that the perpetrator should not be punished and the hospital should be exempted from taking any responsibility. The idea raised questions around the universal application of human rights. 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.

2, Offensive Nature and Schizophrenia

  Junichi Nozu was first examined at a mental clinic at 14 years old and the psychiatrist diagnosed him with personality disorder and indicated schizophrenia. He hardly finished the compulsory junior high school education, and thereafter could not perform even easy jobs and did not accept any educations or trainings. He had been idle at home but filed in his medical records putting fire, frequent domestic violence and neighborhood troubles caused by Junichi Nozu. For about twenty years, Junichi Nozu has been treated of his schizophrenia without brakes either outpatient or in many hospitals.

  It seemed Junichi Nozu father did not wished his son diagnosed schizophrenia and his such request had been recorded at the Kagawa Medical School Hospital. The official psychiatric examiner who examined and evaluated Junichi Nozu after the homicide wrote in her report, his father used to ask doctors to write in his medical records to diagnose OCD; obsessive compulsory disorder, and not schizophrenia. Many psychiatrists has written in the records, in Japanese "強迫神経症(=OCD)", and added "Sc"in English to the next for the purpose to write the exact record secretly to the father.

3, Chances to Learn Punishment Free

  When he was at the first year at junior high school, Junichi Nozu gave up his schooling and haven't fulfilled the even minimum requirement in basic education. He has been a patient of the psychiatry ever since. He put fire at 17 but he was not arrested nor punished for he was not an adult and was a mental patient. He has been treated by many psychiatry and been in hospital many times, and he could have many chances to learn a told idea of exemption from the punishment.

  Immediately after he was arrested, he spoke to the prosecutor, that he killed a man with an easy spirit and expect, even if he is to be punished, it should be short and comfortable enough as if to stay at the vacation leave. He did not considered any chances of the long period of restriction for example without tobacco in the jail, instead, he expected the punishment as something the different kind of the experience from the dull and boredom hospital life which he had been accustomed to.

4, Assault Experiences

  One Saturday close to the noon, being idle at home alone, 17 years old Junichi Nozu, having been playing with organic solvent and put fire at his house and burnt down three, but he run away only for his safety. While Junichi Nozu, 187cm height and 90Kg weight, was a patient at the Kagawa Medical School from 1987, and at 25 years old Junichi Nozu tried to attack a female doctor with the knife and was stopped.

  When Junichi Nozu was a out patient to Y. Psychiatric Clinic he in a sudden assaulted a young man on the street outside of the clinic. The victim fled into the clinic and the circumstances have been witnessed by Dr. Y.. At the time, Junichi Nozu father apologized to the man, accepted all the responsibility, begged a pardon, and has pay the compensation. Dr. Y. said to Yano parents, after the news on Junichi Nozu shopping center murder, that he supposed the victim might share the personality with the assaulted man; who is younger to Junichi Nozu, built slender and enjoy healthy social life which should not be available to Junichi Nozu himself.

  Soon after the assault, Junichi Nozu father visited Iwaki Hospital on 20th September 2004, and met Dr. H. and explained the condition and situation of Junichi Nozu. He stated, firing, domestic violence, assault cases in other hospitals, street attack of a young man and payment of compensation. He also stated that Junichi was OCD and schizophrenia. (This part of the medical record evidence was not included in the file which Iwaki Hospital presented voluntary to the civil court, but was found in the file which police confiscated and forwarded to the criminal court.)

5, Iwaki Hospital Deny Offensive Nature

  Junichi Nozu was accepted to Iwaki Hospital on 1st October 2004. He was given a private room in the Annexed ward of the Ward Two. In admission, Junichi Nozu was given the day-time leave permission daily for two hours. It was for the purpose of the rehabilitation in the psychiatric normalization-socialization program. After the hospitalization, on 20th October morning, Junichi Nozu assaulted a young male nurse in the morning while the nurse washing and brushing the teeth. It is said, that the nurse has got the similarity in personality appearance with Makito Yano. Iwaki Hospital put Junichi Nozu to the closed ward at the time, but returned him to the open ward a week later, and Junichi Nozu was again given the day time out permission as before.

  At the civil court examination, Iwaki Hospital and Dr. T. Watanabe have denied in Junichi Nozu the need to diagnose the personality disorders and temptation to injure other persons. As the psychiatrist and the psychiatric institute, they stick to the idea not to diagnose assaulting possibilities in any mental patient in obsessive compulsory disorder (OCD) and schizophrenia. Further they insisted saying to diagnose may enhance the public sentiment of the discrimination and spoil the human right of the mentally disabled. Even with schizophrenic symptoms and past records in assaults, they maintained no need of diagnose the assaulting nature in Junichi Nozu.

6, Day -Time Leave Permission

  From the first day Junichi Nozu was admitted at Iwaki Hospital, he was given permission for short day-time leave under the rehabilitation programme. Iwaki Hospital accepted Junichi Nozu in the Ward Two, and primary objective of which was the cognitive impairment and senile dementia. Junichi Nozu, at aged 36, was given his private room in the Annex to the Ward Two and which was given another function to cure adolescence crises by the pamphlet of Iwaki Hospital. He is neither elderly nor teenage but was given his room in the ward with such specialized objectives.

  When Junichi Nozu to go out from the ward and the hospital, under the rehabilitation program, he was told to write in an note book placed in front of the nurse station of the Ward Two; what o'clock out and back. And it was the gentleman agreement between the hospital and the psychiatric patient. Corresponding to his out of the hospital permission, Junichi Nozu was given the inside hospital mobility freedom. Under the rule, Junichi Nozu is not required to report his whereabouts to the ward nurse station as far as he is inside the hospital compound. The ward was composed of the two buildings, the main building and the Annex building. The nurse station was located at the main building and Junichi Nozu private room was located at the Annex. The elevator was located in front of nurse station, but one more at the Annex building next to Junichi Nozu private room. And Junichi Nozu was known the key code to operate elevator at the Annex, and ended up frequently with no reports to the nurse station even to go out from the hospital compound.

  The day-time-leave permission, which Junichi Nozu was given at admission on 1st October 2005, was temporary lifted while Junichi Nozu was in custody at the closed ward by his attack against nurse on 20th October. But, after one week and back to the Annex, he was again given freedom of movement in the hospital and allowed the daily out from the hospital compounds. Iwaki Hospital has never checked the day to day changes of the psychiatric conditions and symptoms in Junichi Nozu. And our question about the daily observation, turned out a new idea to Iwaki Hospital and the staffs. The daily practice is concerned, Junichi Nozu was all free to go out from the ward, and the ward staffs could not and did not check all the in and out of the patient. Also, Iwaki Hospital has not deployed the gate man, but out and back of Junichi Nozu on the murder day was confirmed by the police from the video tape of the monitor TV fixed at the gate.

III. Iwaki Hospital Care to Junichi Nozu

1, Dr T. Watanabe and Career Background

  Dr. T. Watanabe was born to a physician who run a hospital in the geriatric medicine. After some years from high school, he passed entrance examination to the newly established medical school by the private initiative. And after licensed, Dr. T. Watanabe took the brief psychiatric training and worked short period at a private psychiatry hospital. There is no evidence that he has completed the highly expertise and specialized trainings in the current psychiatry and enough to take the responsibility of the superintendent role of a psychiatry with 248 beds. But as the owner of the hospital, he was the superintendent psychiatrist from the start of his career. He extended Iwaki Hospital from the geriatric medicine and added the psychiatry. He increased the bed to 248 and established additional rehabilitation facilities in mental health and in elderly. Currently he is the owner and management responsible for medical complex of psychiatric hospital and two rehabilitation facilities.

2, Diagnose after Staff Advice

  Dr. T. Watanabe is a registered psychiatrist but while in the local court discussion, he testified the geriatric medicine is no different from the psychiatry for both are the mental illness. He also once denied schizophrenia diagnose to Junichi Nozu but finally deposed his schizophrenia at the court. And such unstableness of the diagnose correspond to have stopped the major tranquilizers to Junichi Nozu who must be prescribed the antipathetic drug for the rest of his life. Dr. T. Watanabe refused to diagnose the personality disorders and any possibility of offensive action to Junichi Nozu. He said, he could not foresee the dangers of assault in Junichi Nozu for he has not been told from the nurse and other hospital staffs of their findings and possibilities of assaulting and offensive conducts. He confirmed and testified at the court by himself, that he used to diagnose his patients not by his own observation and consultation but by the words of the nurse and other subordinate staffs or even by the words from another hospitals.

3, Akathisia and CPK

  On 14th February 2005, doctor in charge of Junichi Nozu was changed to Dr. T. Watanabe. At first, Junichi Nozu looked to the new psychiatrist not serious in the schizophrenic symptoms, and he questioned the diagnose by the previous psychiatrist Dr. N.. Clearly the newly substituted doctor has not enough checked the past medical records and examination reports. Thanks to the new and up-to-date type antipathetic drug, atypical type, prescribed to Junichi Nozu by the former doctor in charge, Junichi Nozu in front of Dr. T. Watanabe looked in a good condition.

  Dr. T. Watanabe, the new doctor in charge mistook Junichi Nozu and doubted his schizophrenia and diagnosed strongly in the obsessive compulsory disorder (OCD). Junichi Nozu persistently told Dr T. Watanabe of his annoyance and involuntary movements of his hands and legs. On 23ed February, Dr. S, a proxy psychiatric doctor of the day, diagnosed him akathisia (+), however, two days later on 25th February, Dr. T. Watanabe again examined Junichi Nozu, and wrote in the medical record "CPK value is too low to diagnose as the akathisia." Even with the suggestion by other psychiatric staff of the hospital, the superintendent of Iwaki Hospital himself neglected and diagnosed with his confidence akathisia. as illusion by the CPK value; which was the fatal misunderstanding. The CPK, creatine-phospho-kinase, value come from the muscle texture damages but not related to the nerve control system resulting to the akathisia.

4, Dr T. Watanabe Diagnose on Schizophrenia

  Dr. T. Watanabe has been prescribing only the conventional type, typical, major tranquilizers (antipathetic drug) to Junichi Nozu with his schizophrenia. But he was wondering Junichi Nozu, who has been a schizophrenic for more than twenty years, as the obsessive compulsory disorder (OCD), and has stopped prescription of major tranquilizer in November; prior to the Makito Yano murder on 6th December 2005. To this end, Dr. T. Watanabe explained at the court that "Since Junichi Nozu was sentenced for 25 years, it has proved by the judicial court that Junichi Nozu was not a schizophrenic." After the series of the exchanged disputes, in the end Dr. T. Watanabe admitted the diagnose of Junichi Nozu as the schizophrenia.

  But while in the local court discussion, Dr. T. Watanabe tried to maintain the position that Junichi Nozu was the OCD but not schizophrenia. Dr. T. Watanabe eventually and at last admitted Junichi Nozu diagnosed as a schizophrenic after the persistent question from the plaintiff. And Dr. T. Watanabe said, the OCD patient should not be considered the personality disorders, and not any possibility of the aggressiveness and assaulting. Even with the Junichi Nozu father preliminary explanation and the assault case within Iwaki Hospital after the admission, the superintendent doctor stressed that they should not foresee in Junichi Nozu of his aggressiveness and assaulting personalities. 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.

5, Konjyo-yaki : Tobacco Burns

  When Junichi Nozu became very irritated, he would inflict tobacco burns on his left cheek, thereby performing "Konjo-yaki" on himself, to ease his mind. Since Konjo-yaki was noted from the start of Iwaki Hospital admission, Junichi Nozu was continuously creating fresh scars and scratches on his face over 14-months in hospital, by releasing his frustrations and itchy and creepy feelings by the Konjyo-yaki tobacco burns. Because of his schizophrenia he may not have felt the terrible pain from the burns, but he could manage to kill uncomfortable senses from his irresistible trembling and could feel the better. However, medical staff, (psychiatrists and physicians), nurses and others at Iwaki Hospital took no action in relation to the changes on his face. Dr. T. Watanabe had prescribed only the conventional type of major tranquilizers, but if he had changed to the newer, atypical type, then it is possible the situation might have been changed or improved.

  Konjo-yaki, in Junichi Nozu's terms, is the intentional inflicting of tobacco burns on the cheek, involving creating scars and scratches. Iwaki Hospital admitted finding evidence of this at the time of hospitalization (1st October 2004), but they tried to say it was acne. Labored and forced logic as it was by the psychiatry, but strange enough, the scars were found only left cheek at the face to a man aged 36. Nevertheless, Junichi Nozu kept burning his face in Iwaki Hospital, the scars ever present, but the spots erupting then disappearing over the 14 months.

  Konjo-yaki was a marker for the police when arresting the murderer suspect, and was shown on Television. Yet Iwaki Hospital strongly denied there were any Konjo-yaki scars on Junichi Nozu's face. The hospital even testified at the civil court that Konjo-yaki was a story created by the plaintiff and had never existed. Photos taken from the television footage were submitted by the plaintiff, so Iwaki Hospital stopped insisting that Konjo-yaki was a fake. Has Iwaki Hospital as a psychiatric care-giver been treating their patients without looking at their face?

  After five months under custody, and strictly controlled from smoking, Junichi Nozu was taken to the criminal court in April 2006, and at his left cheek, traces of scars and scratches are found. But at the date of verdict, after seven months, his Konjyo-yaki has almost been disappearing. On 25th January 2010 Junichi Nozu was testified under the civil court procedure at the Jail Hospital and none of the scars found at his face. And Junichi Nozu stated better in his psychiatric symptoms than what he was when he commit the murder for his akathisia has gone. So, if Iwaki Hospital took proper attention to Konjyo-yaki with Junichi Nozu, then Konjyo-yaki must have been cured and disappeared from Junichi Nozu at the face while in Iwaki Hospital for 14 months. The psychiatrist who was appointed by the prosecutor for the official forensic psychiatric examination to the judicial court, questioned in her report why Junichi Nozu psychiatric condition got worse in Iwaki Hospital. It suggest that Junichi Nozu has not been given a proper treatment even though he was hospitalized as a patient.

【Photo 1】Konjo-yaki scars
【Photo 2】forehead, right & left cheeks
(▲Junichi Nozu and Konjo-yaki, broadcast by TV Asahi)

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)
(1) An act of insanity is not punishable.
(2) An act of diminished capacity shall lead to the punishment being reduced.

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.

8, Plaintiffs

  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.