Characteristics
Schizophrenia is just one of several similar mental illnesses in a
larger class called psychotic disorders, which are broadly characterized
by delusions and hallucinations. According to the American Psychological
Association (as cited by Schug and Fradella, 2015), the diagnostic
criteria for schizophrenia are delusions, hallucinations, disorganized
speech, grossly disorganized or catatonic behavior, and negative
symptoms (diminished emotional expression or avolition). In order for
someone to be diagnosed with schizophrenia, two or more of these
symptoms must be present for a significant portion of a 1-month period,
one of the first three symptoms must be present.
Symptoms are categorized into positive and negative symptoms. Positive
and negative are used in a numerical sense here, rather than in a
connotational good and bad sense. Positive symptoms are
thoughts, feelings, or behaviors that seem to be added to the way a
normal person would think, feel, or behave. These positive symptoms
include delusions, hallucinations, catatonic behavior, and disorganized
speech. Negative symptoms are thoughts, feelings, or behaviors that seem
to indicate that something is lacking compared to a normal person’s
thinking, feeling, behaviors. These negative symptoms include diminished
emotional expression and avolition (Schug & Fradella, 2015). Now that
the basic characteristics of schizophrenia are understood, an
examination of theoretical explanations and etiology is required
Theoretical Explanations and Etiology
Neurobiological and psychosocial factors are two of many theoretical
explanations for schizophrenia. The overarching thought that those with
schizophrenia may be biologically distinct is indicated by brain
imaging. Walsh & Yum (2013) discuss a “neurodevelopmental model that
incorporates genetics, neurological functioning, and immunological
factors” (para. 1), highlighting that multiple factors must be assessed
when examining this theoretical explanation. Various research over the
years has looked at the neurobiological factors that may lead a
diagnosed schizophrenic to become violent and criminal. Similarly, links
with violent schizophrenia have been made between a person’s upbringing,
parents, early childhood deprivation, previous abuse or trauma,
religiosity, and current or prior homelessness. Schug & Fradella (2015)
conclude their thoughts on these points by saying that finding from
multiple studies “may suggest that biological, psychosocial, or
interactional trajectories may lead to homicidal violence in
schizophrenia” (p. 211) and “potential pathways to crime and violence
among those with schizophrenia may not necessarily be illness related
(p. 213).
Schizophrenia rarely occurs along as a diagnosis and is usually
accompanied by comorbid substance abuse. Substance use, and abuse, is
high among those diagnosed with schizophrenia. This is likely due to an
attempt to self-medicate and reduce psychotic symptoms (Schug &
Fradella, 2015). It is a generally accepted fact that people diagnosed
with schizophrenia are much more likely to abuse substances which leads
to higher crime and violence rates. “Much of the increased risk for
criminality and violence among persons with major psychotic disorders
(e.g., schizophrenia) can be attributed to co-occurring substance
abuse” (McCabe et al., 2012, p. 272). This fact adds to the complexity
of this disorder’s effect on the general public, and more specifically,
it’s link to the criminal justice and the criminal justice system.
Connections with Crime
Schizophrenia is one of the most interesting disorders due to it’s
perception by entertainment media and it’s common association with crime
and violence. While not among the most prevalent of mental illnesses, it
is one of the most well-known by name, though not by definition, and it
captures the intrigue of more people than most any other mental illness
due to it’s apparent link to crime. “It must be remembered… that
most individuals with schizophrenia are not violent” (Schug &
Fradella, 2015, p. 169-170). Statistically speaking, 80% of people
diagnosed with schizophrenia have been found to not be violent, however
multiple studies of criminal populations have found higher rates of
schizophrenia compared to the general public. Interestingly, there are
also studies that show an increased rate of criminal schizophrenia over
the years.
The crime rate of schizophrenia patients was lower than that of the
general population until the 1960s (Rabkin 1979); however,
population-based studies (Swanson et al. 1990; Stueve and Link 1997) and
birth cohort studies (Brennan et al. 2000; Hodgins 1992; Arseneault et
al. 2000; Räsänen et al. 1998) convincingly show that criminality is now
more prevalent among people with schizophrenia than in the general
population. (Munkner, Haastrup, Joergensen, & Kramp, 2003, p. 1).
Nonetheless, “the joint prevalence of schizophrenia and offending is
rare” (Morgan et al., 2008, p. 5).
Schizophrenia has a concrete link to violence. The National Institute of
Mental Health (as cited by Schug & Fradella, 2015) shows over a 15%
prevalence of minor violence and just nder 4% prevalence of serious
violence. Kinworthy (2016) concurs by saying that “only a small
minority of patients with Schizophrenia commit violent crimes” (p. 54).
While this shows that the vast majority of those with schizophrenia are
not violent, no one should doubt it’s connections to violence and
violent crimes. However, a 2009 meta-analysis concluded that the
majority of violence (both criminal and non-criminal) among individuals
with schizophrenia was due to substance use disorders (McCabe et al.,
2012, p. 272), which shows a more significant correlation between
substance abuse and violence rather than schizophrenia and violence. The
comorbidity of these two mental illnesses blurs the lines when thinking
about correlation.
As previously mentioned, the vast majority of those diagnosed with
schizophrenia have been found to be not violent. The connection between
schizophrenia and nonviolent or property crimes has not been studied
significantly. Interestingly, Kinworthy (2016) asserts that non-violence
is linked to higher cognitive functioning in those with schizophrenia.
Moreover, it is believed that individuals with Schizophrenia that are
prone to violence can be distinguished from both those with
Schizophrenia who are non-violent as well as controls based upon
performance on neuropsychological tasks (Naudts and Hodgins, 2006; Schug
and Raine, 2009), thus suggesting that cognitive impairment in
individuals with Schizophrenia may contribute to violent behaviors and
the presence of cognitive impairment can be utilized in determination of
risk of future violence. (p. 20-21)
Additionally, McCabe and colleagues (2012) found that “individuals with
serious mental illness are more likely to commit and be prosecuted for
minor nuisances than for serious crimes as compared to those without
mental illness” (p. 281).
Schizophrenia’s link to sexual crimes is one fraught with dramatization.
“Despite sensationalized media accounts of violent schizophrenic sexual
attackers… and reports of the bizarre and terrifying nature of
these attacks…, sexual crimes appear to be comparatively rare
among schizophrenic persons” (Schug & Fradella, 2015, p. 201). Studies
by Alish and colleagues (as cited by Schug & Fradella, 2015) show that
only a very small percentage - between 2-5% - of sexual offenders are
diagnosed with schizophrenia. Additionally, psychotic offenders
comprised a significantly lower percentage of sexual offenders than
their nonpsychotic counterparts, according to Nijman and colleagues (as
cited by Shug & Fradella, 2015). “Ultimately, however, schizophrenic
sex offenders comprise a small subgroup of schizophrenic criminals
requiring highly specializezd treatment” (Schug & Fradella, 2015, p.
205).
Interactions with the Criminal Justice System
With the obvious connects between schizophrenia and crime, it logically
follows that schizophrenia regularly comes into contact with the
criminal justice system. People with schizophrenia, like people with
other mental illnesses, pose specific challenges to each level of the
criminal justice system: law enforcement, the courts, and corrections.
Law enforcement is the first line in the criminal justice system, and
serve as the boots on the ground for much of what enters the criminal
justice system. Law enforcement are often in contact with
schizophrenics, who are either the perpetrator of a crime or the victim
of one. Calls involving the mentally ill have increased potential to be
unpredictable and possibly violent. Most law enforcement departments
have a Psychiatric Emergency Response Team (PERT), or an equivalently
designated team, for incidents regarding someone with a known mentally
illness such as schizophrenia. For example, the Escondido Police
Department (n.d.) has a dedicated police officer partnered with a
licensed medical health clinician that work together to assess mentally
ill individuals and determine the next steps to take. However, these
kinds of specially trained teams are not always available, and officers
rarely knows the mental condition of suspects prior to their first
engagement and are typically undertreated prior to contact with law
enforcement (McCabe et al., 2012). As such, it is important for those on
the front line of the criminal justice system to be given adequate
training to understand and handle situations with the mentally ill.
“Officers must possess an understanding of schizophrenia so that they
realize that individuals suffering from schizophrenia may not readily
understand or comply with police commands, or be able to communicate
details of an offense where they are victims rather than perpetrators”
(Walsh & Yun, 2013, p. 9).
The courts are given the challenge of determining the culpability of
those with mental illness. Additionally, they are responsible for
determining if punishment or rehabilitation is the proper course of
action for those with schizophrenia. Unfortunately, many schizophrenics
go undiagnosed or untreated and end up getting sent to prison or jail
for their criminal offenses, which according to schizophrenia.com
(n.d.), are mostly minor offenses such as trespassing. According to
McCabe and colleagues (2012), “the fact that the majority of mentally
ill detainees do not receive adequate treatment before arrest, while
incarcerated, or upon reentry makes successful transition into the
community all the more challenging” (p. 281). In order to best serve
this challenging population group, the courts must prioritize treatment
at mental health facilities over incarceration in jails or prisons.
Statistically, “at least 10% of jail populations, 18% of state prison
populations, and 16% of federal prison populations have severe mental
illness” (McCabe et al., 2012, p. 272). Schizophrenia is a major mental
illness that is well represented in correctional facilities across the
country. According to schizophrenia.com (n.d.), “the vast majority of
people with schizophrenia who are in jail have been charged with
misdemeanors.” Prison life is not easy for any inmate, but it is
especially poor for those with schizophrenia and can even lead to
worsened symptoms. According to Blitz, Wolff, & Shi (2008), “Overall,
both males and females with mental disorder are disproportionately
represented among victims of physical violence inside prison.” In
addition a well representation within jails and prisons, a significant
number of people with schizophrenia exist within this country’s
probation/parole system. Walsh & Yun (2013) postulate that proper
mental health training is even more necessary for probation and parole
officers than for law enforcement officers, due to their more frequent
contact with the mentally ill. They note that supervising people with
schizophrenia is disconcerting and a large task given the mandatory
treatment orders, a medical concern that must be enforced by the
officer, who has no medical training.