‘The only reason they would not be fatal,’ said the barrister Sara Mansoori KC, ‘is because the claimant would be locked up and prevented from his desire to end his life.’ She was speaking of allegations of sexual misconduct, which her client denies and which The Guardian and ITN wish to publish. The client is a celebrity identified in court proceedings only as PPT.
On Tuesday, after hearing of PPT’s declared intention to kill himself should the allegations against him be published, Mr Justice Nicklin dismissed his application for an injunction. The judge made no finding about the truth of the allegations but did find that the state’s duty to protect the celebrity lay with NHS psychiatric services, not with a requirement on the courts to prevent publication. PPT has been granted permission to appeal.
Having spent thirty years working in hospitals, often with patients who are suicidal or recovering from suicide attempts, I am aware of the limits of our powers as doctors. We are reasonably good at keeping people alive. Making them glad of it is another matter.
In any life, a sense of shame is an essential corrective
I vividly remember a patient who seemed to me to be utterly intent on ending their life. What was unusual was that they were not in the grip of depression or of what could be called mental illness. Instead, they had been caught acting in a shameful way. They did not wish to live because they were so ashamed and felt with total conviction that life was unbearable and that they did not deserve to survive.
Their disgrace was real, and there was nothing delusional about their sense that they had acted appallingly. Their judgement of what they had done was correct, but it did not follow that this was also true of their judgement of what the future held. My psychiatric colleagues and I were in the position of attempting to treat the results of disgrace. None of us felt we had the professional power to treat the disgrace itself. I do not believe Mr Justice Nicklin has devolved to medicine what does not belong to it. He has said, rightly, that medicine is doing what it can, and that this discharges the state’s duty.
When a man suffers under the torture of false allegations, there is only so much doctors can do to help. When allegations are true, the shame they inspire can be a moral and not a medical problem. In any life, a sense of shame is an essential corrective. Without it, every one of us would be worse. Shame can be evidence our conscience is working, not malfunctioning.
A friend once said of the Victorian poet and politician Richard Monckton Milnes, Lord Houghton, that he was someone you could go to when you were in trouble. Another replied that he was more than that – he was a man you could go to when you were in disgrace.
Many years ago I was involved in a catastrophe. Pulling a small building down with a friend, I tugged on a piece of timber when he was inside, and it came down on him. He survived, narrowly, but has been in a wheelchair ever since. Another friend spent some time with me going over what had happened, wanting me to see my guilt clearly. ‘But this does not mean you are worthless,’ he added, at one point: a statement as much about duty as forgiveness. Guilt does not efface our duty.
Shame punishes, and most of us think it should. There is a harder position, which demands we own our shame, while not allowing us to believe that it is all we are. ‘All sins shall be forgiven unto the sons of men,’ said Christ.
There is no sin for which a man cannot repent. How hard it is to live by that belief, and be willing to forgive those in the world whose guilt is obvious and whose crimes are awful. How much harder to forgive oneself, should the guilt be one’s own.
We all need friends we can go to when we are in trouble, and when we are in disgrace. Seeking forgiveness for our sins requires us to recognise them as our own. Houghton stood by his friends who were disgraced not because he felt their disgrace was undeserved but because he believed disgrace was not all there was.
I don’t know what happened to my patient after they left my care. The last I said to them was that they had a family, and that guilt, however awful, does not wipe out what we owe to others. I don’t know whether they believed me.
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