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Schizophrenia strikes without warning, destroying typical families, yet the horror endured is anything but typical.  Days are filled with frightening hallucinations and paranoia.  If diagnosed it can be managed with medications, but often the disease goes untreated with dire consequences.  Deinstitutionalization has lead to an untreated mentally ill homeless population.  Beneath the city streets, the homeless find refuge but they can’t escape their own nightmarish delusions. Many resist offers of help or shelter. Over 150,000 schizophrenics are held in jails as the last resort to get these individuals off the street. 

Patients are responsible for taking their medications but often refuse to believe they are sick. Michael Lauder sold his story of his battle with schizophrenia two months before he stabbed his pregnant girlfriend.  Certainly he was aware of his illness, but he was unaware of the symptoms of his illness.  Unable to distinguish real experiences from imagined, those who fall into delusion are out of control. It is estimated that nearly half of those treated for schizophrenia are off their medications.   New York City has passed Kendra’s Law, ordering mentally ill to take their medications and receive treatment and if they failed to do so, they could be held against their will.  Patient advocates argue this infringes on civil liberties and is unconstitutional.

There is still debate among mental health professionals as to the cause and appropriate treatments for schizophrenia.  Most believe schizophrenia is a result of disruptive signals being sent to the neuron transmitters in the brain and the only successful treatment calms these transmitters.  A minority of psychologist believe schizophrenia is a disorder caused from abuse or stress and is best treated with therapy. 

It is a misconception that Schizophrenics are violent and always dangerous.  When violence does occur, it is usually directed at oneself or family members and friends and is a result of paranoid and psychotic symptoms.  

If a crime is committed, there are degrees of sanity defined and used to ensure justice is served.  It is possible that both the victim and perpetrator are innocent of wrong doing. The perpetrator may not be able to discern right from wrong, or they may be so out of touch with reality; they have no control over their actions.  

A defendant is deemed competent to stand trial if they are able to assist in their own defense, make decisions and enter a plea.  If a defendant is incompetent, they are held and treated, with the trial postponed until they can stand trial.  The criminal charges are not dismissed and the defendant isn’t released.  However, if a defendant is found not guilty by reason of insanity which “requires a diagnosis of active psychosis, schizophrenia, schizoaffective disorder, or bipolar disorder, with active psychotic features are present during the crime” (1) , the court may sentence defendants to institutions until they are no longer a danger.  

Sometimes the verdict is Guilty and Mentally Ill, which results in a lesser conviction, but defendants are held accountable for their acts, either incarcerated or institutionalized  Temporary Insanity is a plea entered if defendant is considered sane, hasn’t been diagnosed with any psychosis or disorder, but at time of the crime, they were unable to control their actions.  This is similar to the Irresistible Impulse Defense, “the inability of people to control their actions; concluding crimes during a fit of passion were insane, not guilty because irresistible impulse driven by mental disease causes one to act against their will.”  If substances play a part in someone’s ability to control their actions, they may use The Substantial Capacity Test to prove lack of mental capacity required to determine right from wrong and abide the law.  

 (1) Criminal Insanity,  www.karisable.com, November, 17 2007