Schizophrenia - crime and punishment

April 22, 2007 8:23 AM

Is it possible to fake schizophrenia? I had a discussion the other days and the other person claimed that it can be done to avoid legal recourse. Never thought about it much, but it could be true. Please understand that I am sensitive to people suffering from any illness, be it mental or otherwise. I ask this question with respect and sensitivity.
posted by bright77blue to health & fitness (33 comments total)

Well there isn't a blood test or any physical test to be taken to determine if you have it. I suppose if you study the symptoms enough and know what to say and do, it could be possible. I have bipolar disorder, so my answer is based on my personal experiences with psychiatrists (though I don't know if court-appointed psychiatrists are trained differently to look for fakers).

I have/had friends who are schizophrenic. Schizophrenia is a serious illness, so I don't mean to downplay their disorder in any way. It would be one of the more difficult ones to pull off if you faked it, but some people are good actors.

I don't think you'd avoid much though. It's still your responsibility, you just might get sent to a psychiatric facility instead of jail. And from what I've heard, often those are worse than prison.
posted by veronitron at 8:40 AM on April 22, 2007

My understanding is that it is very very hard to avoid legal responsibility for a crime through the "insanity defense," even for people who really are totally cracked. It sounds like your friend has been listening to too much right-wing radio.
posted by alms at 8:44 AM on April 22, 2007

Two layers of difficulty make this well-nigh impossible. First off, a court-appointed forensic psychologist (or psychiatrist) would evaluate you - someone who would put you through a battery of tests and knows his or her stuff well enough to be called an expert witness. Then, you have to mount that as a legal defense, which is rarely successful, but could be useful during sentencing.

Just hearing voices is not enough. The forensic psychologist with whom I worked had spotted several fakers, caught them up on little (but important) things.
posted by adipocere at 8:58 AM on April 22, 2007

Thanks for the answers. I assume that if you really make a study of it, and spend time reading through medical journals and perhaps interview or know others with the same illness?

It does sound right wing. I am left wing Canadian, so that is why I need a good answer to make a good counter point.
posted by bright77blue at 9:07 AM on April 22, 2007

I don't know about schizophrenia specifically, but I know that other mental illnesses have precursors as far back as childhood. If your lawyers can't dig up teachers that could remember you humming and rocking or animal bones in your old bedroom, good luck with that.
posted by DU at 9:20 AM on April 22, 2007

Damn. I wish I could remember the source, but years ago (early 80s?), I saw a documentary about a guy who faked Multiple Personality Disorder (not Schizophrenia) in an attempt to get away with murder. And it worked for a long time. He fooled a large number of psychologists. Then this one doctor cleverly unraveled the plot. He did so by making off-handed remarks about the way real MPD-sufferers behave, noting that most of them have more than one extra personality. Low-and-behold, the murderer suddenly developed more personalities.

Eventually, the discovered that the guy had been studying psychology books for years. He knew what psychologists looked for and knew how to fake it. The psychologist who debunked him went beyond doing the normal tests and actually tried playing "cat and mouse" games with him.
posted by grumblebee at 9:23 AM on April 22, 2007

One notable case is mobster Vincent Gigante.
posted by sexymofo at 9:34 AM on April 22, 2007

I believe that Primal Fear deals with something like this. (At least from what I can recall from watching the ending in my Abnormal Psych class.)
posted by sperose at 10:26 AM on April 22, 2007

The legal system has different standards for 'insanity' than exist for meeting the criteria for psychiatric disorders. One can be accurately diagnosed as schizophrenic in a psychiatric sense but not deemed 'legally insane.'

On the psychiatric aspect, in a classic article (PDF), David Rosenhahn had a bunch of (non-schizophrenic) people gain admission to psychiatric hospitals by briefly saying that they were experiencing auditory hallucinations. Once admitted, these pseudo-patients stopped reporting the symptoms and acted as they normally would. It took an average of nearly 3 weeks for the pseudo-patients to be released from the mental hospitals, each with a diagnosis of 'schizophrenia in remission.' This has been taken to demonstrate flaws in the psychiatric diagnosis process, although others disagreed, pointing out that an individual faking physical symptoms could get diagnosed with a 'classic' physical disorder. More details on this and a clever follow-up study can be found at Wikipedia.
posted by i love cheese at 10:33 AM on April 22, 2007

Lots of illnesses can be faked. More often than not the goal is to obtain disability insurance payments. Docs are wise to it and we have our ways of rooting out the fakers, whom we term "malingerers."

Faking schizophrenia for a legal defense isn't a very good idea. You're basically trading a defined sentence of incarceration for an open-ended sentence of incarceration plus some meds, and the meds are very unpleasant to take for people who don't actually have schizophrenia.
posted by ikkyu2 at 10:35 AM on April 22, 2007

Here's an article on how they detect malingering and some of the tests used to detect feigning.

grumblebee, are you thinking of Kenneth Bianchi?
posted by squeak at 10:55 AM on April 22, 2007

Ted Bundy tried to fake multiple-personality disorder, and managed to convince one psychiatrist. Another one saw through him, however, and was able to convince a court that Bundy was putting it on.
posted by Steven C. Den Beste at 11:05 AM on April 22, 2007

The counterpoint is that an insanity defense would be insanely against your interests if you're sane - you don't "get off" by pleading insanity, instead of a prison sentance of a mere x years, you get sentanced to a secure facility for an open-ended number of years - possibly until the day you die, and where you will enjoy perhaps even less freedom than prison.
I'm not an expert, just heard some expert talking about it a long time ago. Apparently getting off by pleading insanity is a myth, because people don't understand what awaits the insane criminal. Finding out more about that side of things would probably get you your counterpoint.
posted by -harlequin- at 11:06 AM on April 22, 2007

grumblebee, are you thinking of Kenneth Bianchi?

YES!
posted by grumblebee at 11:13 AM on April 22, 2007

I am given to understand that when an insane individual "recovers," they may still be tried for the original crime, depending on circumstance.

Things like being too psychotic or irrational to understand the court proceedings will therefore only postpone the trial. Rather than exhanging a criminal sentence for psychiatric treatment, the defendant may get both.

And I'll make the obligatory reference to One Flew Over the Cuckoo's Nest as a cautionary tale about the hazards of successfully faking insanity, since no one else has done it yet. :-)
posted by Crosius at 11:22 AM on April 22, 2007

Rats. I was thinking of Bianchi, too. I was wrong about it being Ted Bundy. (Bummer.)
posted by Steven C. Den Beste at 11:26 AM on April 22, 2007

Googling Insanity Defense turns up lots of interesting and relevant stuff.

For example, there's this from the Washington Post:

Are insanity defenses often successful?
No, despite public perceptions to the contrary. One eight-state study of criminal cases in the early 1990s concluded that less than one percent of defendants pleaded insanity and, of them, only a quarter won aquittals.

"In the real world, it just doesn't happen," said Maryland Attorney General Joseph Curran, who as lieutenant governor in 1983 chaired a task force that helped tighten that state's insanity defense.

posted by alms at 12:03 PM on April 22, 2007

Clinicians who work with schizophrenics and people with other mental illnesses are usually experienced enough to detect bullshit immediately. There are usually clustered symptoms, an extensive history, etc. and inconsistencies in behavior while under observation would definitely stand out. I've seen people have very convincing-looking seizures only to be rushed to the ER and told within fifteen seconds by the ER doctor "Nah, she's faking it." There's certainly something to be said for experience. Also because of the suspicion of a schizophrenia's genetic root (around gene FXYD6), there may be tests developed in the future which can, along with PET scans, confirm a predisposition.

So the short answer is "You might be able to fake it, but not for very long."
posted by inoculatedcities at 12:11 PM on April 22, 2007

There are usually clustered symptoms, an extensive history...

This is spot-on. I was going to suggest something similar, that a good psych evaluation is not going to happen in a vacuum -- the evaluator will be talking to friends, family, co-workers, etc, to gather additional perspectives and historical information. You'll have difficulty getting people to buy it if it's coming out of the clear blue sky with zero past examples of odd behavior.
posted by Cool Papa Bell at 1:02 PM on April 22, 2007

In my Psych 101 textbook there was a discussion of one of the major quandaries related to schizophrenia diagnosis. Everyone agreed that the major symptom was "disorganized thinking." But how did one determine that the patients thoughts were disorganized? Why, by talking to them, of course. If they their speech was incoherent, then their thoughts were as well.

But, the authors pointed out, the fact that the patient's speech was incoherent was proof of nothing except that the patient's speech was incoherent. Indeed, some researchers were arguing that schizophrenia might actually be nothing more than a form of aphasia (a communication disorder).

Obviously, the subject is vastly more complex than this. But the text book writers were making the point that, when it comes to schizophrenia, we have, at best, only indirect evidence as to what's taking place inside that person's head.

So if someone were attempting to fake schizophrenia, they would, in theory, only have to learn to mimic the speech patterns and behavior of a schizophrenic. My personal opinion is that this would be incredibly difficult to do. But then, I've never tried it or known anyone who has.

Something else you may want to consider...

I should preface this by saying that most schizophrenics don't go around killing people. But of those who do, I strongly suspect that their murders tend to be random, unplanned, and pointless. These are, after all, people who can't think coherently. So you might have a guy flying into a rage and bludgeoning someone who's sitting next to him on the bus, but you wouldn't see a schizophrenic getting mad that his neighbor is sleeping with his wife and pumping six bullets in the man's skull.

So if the murder you wanted to get away with involved trying to hasten your inheritance by killing your parents or getting revenge on the guy who got you fired, the simple fact that you had a reason for killing the person would be a pretty big clue that you weren't incoherent when you did it. At the very least, it's going to make prosecuting attorneys and police extremely suspicious. Doubly so if you did it in the middle of the night when no one else was around, tried to dispose of the gun afterwards, lied about the crime, etc.

So in order to convince people that you're really a schizophrenic, you'd have to kill someone against whom you have no known grudge, in front of witnesses, in an obviously unplanned manner, and then make no intelligent, effective effort to cover up your crime. This would require (a) a desire to kill someone, as Johnny Cash put it, "just to watch him die" and (b) a enormous set of balls.

Finally, I should point out that if the state wants you in prison (and it'd be surprising if they didn't), they'll do whatever they can to produce experts who will say that you knew what you were doing when you killed the guy. So even if your performance is Oscar caliber, they're still going to do whatever they can to nail you.
posted by Clay201 at 1:07 PM on April 22, 2007

You might also want to read up on and follow the case of Scott Panetti, currently before the Supreme Court:

"...Panetti's case is complicated because everyone agrees he is mentally ill. Where the state and Panetti's lawyers differ...is that the state believes the inmate is exaggerating his illness to escape punishment."
posted by Robert Angelo at 1:47 PM on April 22, 2007

Even if one did manage to somehow fool a professional (which is doubtful), I'm guessing a brain scan would clear things up pretty quickly.
posted by puritycontrol at 3:07 PM on April 22, 2007

Interesting, puritycontrol. I wonder when this discovery was made? The text book I mentioned above was circa 1990.
posted by Clay201 at 3:18 PM on April 22, 2007

Clay201: I should preface this by saying that most schizophrenics don't go around killing people. But of those who do, I strongly suspect that their murders tend to be random, unplanned, and pointless.

I have to disagree with this. A good friend of mine was almost killed by a mutual friend of ours, who is schizophrenic. The schizophrenic friend had become paranoid specifically about my friend, and decided killing him was the best course of action. Good thing my friend had taken martial arts for probably 15 years at that time.

I have been paranoid as a result of withdrawal from schizophrenic (anti-psychotic) meds that I took for my bipolar mania. The paranoia I experienced was also very specific in nature.
posted by veronitron at 3:38 PM on April 22, 2007

veronitron,

Thanks for the information. That's very interesting.

This would argue against my assertion that schizophrenics tend not to be violent.

On the other hand, it would tend to support my argument that, when they are violent, the target of their violence is chosen for an irrational reason (i.e. paranoia) and not for a rational reason (i.e. a standing grudge or monetary gain). For the invididual trying to fake schizoprhenia in order to get away with murder, it suggests that he'd need to lay some groundwork before the act, convincing people he'd been having paranoid delusions centered on his intended victim.
posted by Clay201 at 4:56 PM on April 22, 2007

Thank you everyone. I have much more insight into the topic. My understanding is that mentally ill people commit about the same number of crimes as the general population.

Thanks again,

BB
posted by bright77blue at 5:48 PM on April 22, 2007

On the basis of reportage from one of my former housemates, I can assure you that the meds are unpleasant even if you do have schizophrenia.
posted by flabdablet at 5:54 PM on April 22, 2007

This would argue against my assertion that schizophrenics tend not to be violent.

I have a schizophrenic cousin that would also be a data point against your assertion, BUT the Naitonal Alliance for the Mentally Ill are strong advocates that the mentally ill are generally no more likely to be violent than the general population. I would suggest contacting them, they are a huge great resource on exactly this topic. among others.
posted by jessamyn at 6:50 PM on April 22, 2007

As just a last note about my friend who attempted murder: he was completely unmedicated at the time, as far as I know.

I have had other friends who are schizophrenic, and they are not violent at all. I don't know if the paranoia I felt was at all similar to what a schizophrenic feels, but it made me want to withdraw, not act out.
posted by veronitron at 7:32 PM on April 22, 2007

The mentally ill are no more likely to be violent than the general population, but they are more likely to be victims of violence - both random (beat up the homeless guy for fun) and institutional (we needed to beat him black and blue before we could get him to psych ward).

Pretending to have schizophrenia when you don't is a really bad idea.
posted by flabdablet at 8:32 PM on April 22, 2007

A lot of positive symptoms of schizophrenia can be faked. However... there are cognitive deficites, usually mild, that can be used to detect schizophrenia by a number of tests that are fairly reliable. I can get back to you with specifics if you really want.

Also, if one was to be really hardcore about proving it - one way or another - schizophrenics have higher dopamine release in response to amphetamine and patients with acute schizophrenia have even higher levels. This can be done by injecting isotope-tagged DOPA (a dopamine precursor) and putting the subject in a PET scanner, then inject sub-recreational (very sub) doses of amphetamine and then assess dopamine release.

So I'd be in the camp that, no, schizophrenia couldn't be faked with absolute fidelity
posted by porpoise at 8:36 PM on April 22, 2007

Brain scans are not useful in making or ruling out a diagnosis of schizophrenia. Once you've been diagnosed, you can be thrown into a pool along with 1000 other diagnosed people; statistical analysis will show that the average schizophrenic brain has more atrophy than the average healthy brain. But the presence of that atrophy isn't specific or diagnostic of anything at all.

The amphetamine PET scan proposed isn't something that I've ever heard of in clinical use. I'd want to know how many false positives and false negatives it was going to produce before I used it for forensic purposes. Wouldn't you? Tests like these are used to investigate biochemical models of disease, not to diagnose living persons.

The textbook says that people with schizophrenia are no more or less likely to commit murder than other people, but when they do commit murder or other violent crimes, it's likely to be for incomprehensible reasons. That's certainly born out by my experience. Often the mentally ill person doesn't even recall exactly what their reasoning was when they did the violent act.
posted by ikkyu2 at 8:44 PM on April 22, 2007

For those who might still be interested, I broached this topic with three different neurologists at a convention and the consensus seems to be "Sure you can fake it," because it's a clinical diagnosis, not an objective finding from an instrument. A neurologist can certainly give information (such as PET findings or others that have been mentioned) but it can be taken either way in court where juries know very little about neuroscience and much more weight is given to the credentials of the testifying expert. In the end, it's a matter of a psychiatrist determining for him or herself that the individual is schizophrenic, or so I'm told.
posted by inoculatedcities at 12:13 PM on May 17, 2007