Restoration of Competency, Schizophrenia, and Anti-Psychotic Medications

Applying Neuroscience and [Forensic] Psychology to the Law

Competency to Stand Trial and Restoration of Competency

A Basic Look into Complicated Legal Issues

Before we get into restoration let’s being with outlining what competency means in the legal sense, “The legal definition of competence refers to whether an individual has sufficient present ability to perform necessary personal or legal functions” (Costanzo et al, 2015). Awesome so we got that down… Now breaking it down further, when an individual commits a crime such as murder, said person is taken to trial… where he or she will be found guilty or innocent… but mind you it’s not quite so cut and dry as there may be extenuating factors that further complicate matters.

The Case of the Capitol Shooter

Let’s look at example where certain matters, such as mental illness, affect courtroom proceedings… In the case of the ‘Capitol Shooter’ Russell Weston, regardless that he committed several crimes including murder in the first-degree and was facing the federal death penalty for the crimes charged against him, he has yet to stand trial. You might be wondering how on earth can someone not stand trail when said person clearly shot multiple officers of the law and killed an officer [Officer Jacob Chestnut] and a detective [Detective John Gibson] at the United States Capitol Building… Well that’s because the defendant was found to be incompetent to stand trail due to his severe mental illness.

Looking back into the Russell Weston’s medical history you’ll find that he was diagnosed with schizophrenia and has suffered from auditory hallucinations and paranoid delusions. His hallucinations and delusions manifested into his falsely believing in the government conspiring with communists and cannibals… due to his mental illness he was neither able to work with his attorney nor held a reasonable awareness of the roles played by courtroom officials. Since being found incompetent to stand trial the courts mandated that he be treated until such a time that his competence is restored, but much to their dismay the defendant has yet to be restored to competence and it is unlikely that said competence will ever be restored.

A Just Legal System

In order for our legal system to be just and hold the esteem of the public it must conduct fair trials. Therefore the level of functioning exhibited by the defendant- including the defendant’s ability to work with their attorney, understanding of the court proceedings, and understanding of the roles of the judge, jury, and sides [prosecution and defense]- is greatly important when conduction a trial. Sometimes defendants’ must be given competency to stand trial evaluations to ensure that the defendant is in an able state of mind to proceed through the court process [this is typically done if requested by the defense and/or prosecution]. If a defendant is found to be incompetent to stand trial the courts will hold off the criminal trials until the defendant is restored.

Restoration of Competence

Restoration of competence is tricky, defendants have a right to due process so forcing treatment might infringe on these rights. But in 2003 the Supreme Court ‘worked to clarify the type of proceedings deemed necessary before an incompetent defendant could be medicated against their will’

“The Supreme Court ruled that a criminal defendant who was not a danger to himself, herself, or others could be forcibly medicated if and only if: (1) such treatment was medically appropriate; (2) the treatment was unlikely to have side effects that would undermine the trail fairness; and (3) such treatment was necessary to further a significant government interest, such as the prosecution of a serious crime” (Costanzo et al, 2015)

Treatment to Restore Competence

Treatment of incompetence usually coincides with hospitalization [civil commitment], therapy, training of courtroom rules and procedures, and/or [involuntary] administration of anti-psychotic medications.

While anti-psychotic medications can greatly improve the patients mental state by reduction in delusions and hallucinations, it is estimated that a fourth of mentally ill patients do not show any improvement. Additionally the side effects to these drugs are often physically debilitating as the can often produce afflictions of musculature such as tremors, rigidity, a postural dysfunction… and even after these drugs are discontinued there is still a possibility that these unsavory side effects will persist. Newer generations of anti-psychotic drugs are a great improvement as they do not seem to have the negative motor problem side effects, but with that said it is unlikely that these medications will be used since they are considerably more costly, “difficult to administer to involuntary patients, and have potentially lethal side effects if not monitored closely” (Costanzo et al, 2015).

A Closer Look at Schizophrenia

Schizophrenia is a serious mental illness that is estimated to afflict a large portion of inmates currently incarcerated. But does that mean that people with this disease should be feared and considered violent? HECK NO!

Do not let simple estimates skew your perception and bias you to have negative stereotypes! Schizophrenia is a horrible disease; it is “a chronic, debilitating psychiatric illness characterized by positive, negative, and cognitive symptoms” (Girgis et al, 2008).

Schizophrenia not only affects the structure of the brain, widened sulci and frontal lobe dysfunction, it has also been found to causally afflict signaling pathways in the brain, including insulin signaling pathways.

Anti-Psychotic Medications

There is no denying that these medications greatly help the vast majority of individuals suffering from schizophrenia, but it is important to remember that what is right for one person is not necessarily right for another. Physiological reactions can vary greatly from person to person so it’s important to take time to find what medication is right for each unique individual. Another important part of determining what medication is right for a patient is taking into account the side effects and if they out weigh the possible benefits of taking the anti-psychotic medication.

Costanzo, M. & Krauss, D. (2015). Forensic and legal psychology: Psychological science applied to the law. 2nd edition, New York: Worth Publishers.

Girgis, R. R., J. A. Javitch, and J. A. Lieberman. “Antipsychotic drug mechanisms: links between therapeutic effects, metabolic side effects and the insulin signaling pathway.” Molecular psychiatry 13.10 (2008): 918–929.