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GAZETTE
SEPTEMBER 1990
S c h i z o p h r e n ia a n d t h e L aw
Part 2
Medico-legal aspects
Having endeavoured to give some
idea of the disorder, I will nowdeal
with some medico-legal problems
that arise in relation to patients
suffering from schizophrenia.
Criminal Law
In criminal law, patients suffering
from schizophrenia may come to
the attention of the courts through
offences, such as vagrancy or re-
lated petty crime, associated with
chronic schizophrenia, where the
main problem is the lack of drive
and affective blunting. Such pati-
ents tend to drift down the social
scale and present serious social
problems.
The more dramatic cases, how-
ever, are those involving violence,
which are usually associated with
the paranoid form of schizophrenia.
Taylor & Gunn, in a recent paper,
showed that among both seriously
and trivially violent offenders the
prevalence of schizophrenia was
much higher than in the general
population. Two other workers,
Walker and McCabe, studied all
patients subject to Hospital and
Guardianship Orders under Part 5 of
the British Mental Health Act and
to compulsory detention under the
Criminal Procedures (Insanity) Act
1964. They found that amongst
males, schizophrenics were dispro-
portionately more likely to have
committed violent offences. 50%
of the female violent offenders and
59% of the males were schizo-
phrenic. No study of comparable
samples in the Western World has
found a lower proportion. Interest-
ingly, violence to property was
more common than personal
violence.
Another report from West
Germany, inwhich the records of all
mentally abnormal offenders con-
victed of homocide or potentially
lethal attacks over a ten year period
were studied, found that 53%were
schizophrenic. Despite this they
calculated that the risk of such
offences in a schizophrenic popula-
tion was only about 0.05%, in
other words, although amongst the
crimes of violence committed by
mentally disturbed people, the
proportion of schizophrenics is very
high, the incidence of violence
amongst schizophrenic patients is
low. Violence against the self is
more common. In one 30 year
follow up study, just over 4% of
schizophrenic patients had died by
suicide, accounting for 10% of all
schizophrenic deaths. It must be
emphasised, therefore, that the risk
of a schizophrenic harming himself
ismuch greater than the risk of him
harming someone else.
By
S. Desmond McGrath
FRCPI., FRC. Psych.,
DPM.
Diminished responsibility
In this country the method of
dealing with a person who has
committed a murder but is insane
is still not satisfactory. For well over
acentury the law was based on the
McNaughten rules which were de-
rived not from a legal decision but
from the answers given by judges
to a series of questions put to them
in 1843 by the House of Lords.
Their most relevant answers were
to questions 2 and 3, which were
in part as follows "The jurors ought
to be told in all cases that every
man is to be presumed sane and to
possess a sufficient degree of rea-
son to be responsible for his crimes
until the contrary be proved to their
satisfaction: and that to establish
a defence on the grounds of
insanity it must be clearly proved
that at the time of the commiting
of the act the party accused was
labouring under such a defect of
reason from disease of the mind as
" In this country the method of
dealing with a person who has
committed a murder but is
insane is still not satisfactory."
not to know the nature and quality
of the act hewas doing; or if he did
know it that he did not know he
was doing what was wrong".
These guidelines are most unsatis-
factory and if they were literally
interpreted nobody would be found
legally insane. Fortunately, follow-
ing some excellent judgments the
position in Irish courts has changed
to a considerable extent, although
the situation is still not satisfactory
in that illogically a person is found
guilty but insane instead of not
guilty by reason of insanity.
The
Hayes
case which came to
trial in 1968 before Mr. Justice
Henchy showed the gross limita-
tions of the McNaughten rules.
Hayes was accused of murdering
his wife in October, 1965. Hewas
a fourty eight year old farmer from
Des McGrath.
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