Hi. I'm Jeannie Tse, and I'm here to answer the question, "Are people with schizophrenia responsible for their actions?" This is a complicated question and, truthfully, whether people can be held responsible for their actions varies within people, depending on what symptoms they're experiencing at the moment of the alleged crime. And among people, there's definitely a wide variation among people with schizophrenia regarding the types of symptoms they have and their insight into their actions and their illness and how they behave.
So, first of all, there's that wide variation. When we look at capacity, as doctors, the capacity to make decisions, the capacity to be responsible for actions, there are four sets of areas that we examine.
One is, do they understand the nature and impact of their actions? Do they understand, for instance, if they're being accused of stealing something, what it is that they've done, why it's against the law, that it's against the law, and what the consequences of their action are?
Being able to appreciate the consequences of their actions is an important second feature of the examination capacity.
Being able to reason about the information provided, to say, "Okay. I stole something from this person, and that affects them because they then lose money, it will make them angry, this will happen." Being able to reason about it is an important factor as well.
And then the fourth is to be able to make an expressive choice. So, can the person say, "I choose to steal something." Or, was it that they felt it was totally out of their control?
In schizophrenia, the things that would put that out of their control are really delusions and hallucinations, disorganization of thinking and behavior. And so, if you have a paranoid delusion and you believe that the KGB has put you up to stealing whatever it is you stole, then that distorts your thinking. And, for that person, a judge who is the person who, based on the evidence, determines whether someone is criminally responsible, might say, "No that person thought that the KGB was forcing them." They're not criminally responsible for that action.
And so delusions can play into it. Hallucinations, if somebody has a voice but keeps telling them, "You need to steal that item," then, again, are they responsible? Were they able to make that choice freely or was the voice impacting them? Those are important questions.
If their thinking and behavior is totally disorganized, if they can't plan from A to B and see that my action is going to have this consequence, well then that also affects their ability to make a clear choice and to understand the impact of their actions. And so, for that person, they may be held not criminally responsible for an action.
But each person with schizophrenia, and each crime, must be tried separately with separate expertise to determine criminal responsibility.