M ental I llness C oncerns A ll	This man is deaf. His second wife is not as fluent in the sign language they use. He is from egypt; a muslim, inactively so. A brother and he shared a modified local language betwen them, but the brother lives in egypt, as do the rest of the family. This marriage is breaking up, explicitly because Assaf has accumulated very high debts through recent gambling, and this has gone as far as to threaten possession of the home, where they have a five year old daughter. The marriage breakdown is escalating as the wife seeks separation arrangements and a divorce. There is no clear break, and the wife remains somewhat in touch and involved as Assaf mounts distress, cutting himself, and dissociating from responsibility. Assaf has nowhere else to go which might reduce anxiety and give him time to see to a future for him. He attends a deaf centre but it seems without a meaningful contact there where he might relate and get company in his troubles. There is a local interpreting service, not engaged at any time, that might have taken him to a level of social service support. Interpretation is required on important assessment contacts but is taken up mostly by what and who is immediately available at crisis times, very often it being his wife who is called upon, who is in a difficult role as supporter here, and yet as opponent to him, in what she wants. At any rate he is increasingly isolated. His brother visits to settle some of the debt problems and intercede about future arrangenents about the daughter and family connections. One junior doctor which sees him in an a&e crisis, is from the neighbouring Sudan and gets an inkling that there might be something further in the back of the distress which Assaf shows. This comment is not really taken into account. He feels there may be an potential adultery accusation between them, which back in egypt/sudan rural area can lead to murder - that is an errant wife might be 'acceptably ' killed. Earlier Assaf had given a hard to follow description to his wife of being egged on in gambling by 'the voice' in his head of a work colleague, although not any acquaintance of Assaf, also a gambler. This is not thought to be an indication of schizophrenia, nor borne in mind. The psychiatric assessment of Assaf is that he is undergoing stress reactions through an adjustment strain to social disruption - the marriage breakdown being initiated by his wife, leaving him, already isolated by deaness, with no sort of social network to support him. Assaf kills the friend of his wife, stabbing him, and not saying anything about it to his liaison psychiatric interpreter nurse the next day, The police find he has previously acquired the driving licence of the victim, photocopied the address in it, and placed it in a dustbin. The wife and her friend knew it had gone missing, but did not see howthat was connected with the husband. Many reports for the Court ruled out significant mental illness. back to Inquiry List back to Home page.   <       E-mail reaction is welcome mica@didgy.freeserve.co.uk