The Gazette 1990

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

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.

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

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

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

Des McGrath.

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