Discretionary Care

Following changes in law and court practices in Pakistan, individuals who have been incarcerated and have mental illnesses in Pakistan experience changing forms of bureaucratic violence as they undergo psychiatric screening. This happens in the context of a move by the Supreme Court of Pakistan to treat mental illness as a mitigating factor in crimes such as blasphemy or murder. The article explores the ways in which ‘patient-prisoners’ are over and under-psychiatrized given the discretionary ways in which psychiatric evidence is used to judge criminality. In some cases, prisoners wait to be labelled ‘mentally sound’ to stand trial and to defend themselves, experiencing pressure to obey discipline in prison despite their severe mental illnesses, representing a modality of under-psychiatrization. In other cases, bureaucratic violence inflicted on patient-prisoners includes over-psychiatrization when state officials seek psychiatric causes for crimes even when they are absent, resulting in delays in court proceedings.