Aspectos penales y características clínicas de la criminalidad en la esquizofrenia
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Ana Fresán Orellana [1] ; Josune Tejero ; Rogelio Apiquian ; Cristina Lóyzaga Mendoza ; María García Anaya ; Humberto Nicolini Sánchez
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[1] Instituto Nacional de Psiquiatría
Instituto Nacional de Psiquiatría
México
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- Localización: Salud mental, ISSN 0185-3325, Vol. 25, Nº. 5, 2002, págs. 72-78
- Idioma: español
- Enlaces
- Dialnet Métricas: 2 Citas
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Resumen
- español
El presente escrito plantea el hacer una revisión del marco penal para aquellos enfermos mentales que cometen algún delito, y señalar la relación existente entre esquizofrenia, agresividad y criminalidad.
En México, el Código Penal establece que un sujeto que comete un delito es sancionado o castigado por el Estado y para ello se requiere la comprobación de su culpabilidad.
Si un sujeto carece de la madurez y las facultades psíquicas necesarias para el reconocimiento del delito, no se le considerará culpable, y, por ende, será declarado inimputable. Esto es una excluyente de responsabilidad del delito, como ocurre en el caso de algunos trastornos mentales.
Se ha considerado que el diagnóstico de esquizofrenia tiene un papel sustancial en la historia del criminal con trastorno mental. Existen abundantes pruebas que sugieren que la comisión de crímenes observada en los pacientes con esquizofrenia no es un fenómeno originado por el diagnóstico, sino por un incremento en la agresividad secundario a la presencia de síntomas psicóticos específicos, principalmente alucinaciones y delirios de contenido persecutorio o de comando.
El abuso de sustancias se ha considerado como un factor de riesgo para la conducta agresiva, que conduce a la criminalidad en los pacientes con esquizofrenia. En diversos estudios se ha observado que el abuso de sustancias, principalmente de alcohol y cocaína, es una variable que permite diferenciar a los esquizofrénicos con antecedentes criminales de aquéllos sin antecedentes de esta índole.
En nuestro medio, es necesaria una mejor descripción legal de los trastornos mentales enumerados dentro del concepto de inimputabilidad, en específico, de la esquizofrenia y de otros trastornos psicóticos. Lo anterior se debe a que los resultados obtenidos en diversas investigaciones en el área de la psiquiatría han sido contradictorios en cuanto a la asociación de esquizofrenia y criminalidad.
Algunos autores consideran que la esquizofrenia es uno de los principales diagnósticos asociados con la criminalidad, mientras que otros indican que esta asociación se halla limitada a diversos factores de riesgo que se presentan en determinadas etapas del padecimiento de estos pacientes; factores tales como la severidad de los síntomas psicóticos y el abuso de sustancias.
Por lo tanto, no sólo hace falta realizar estudios que asocien la esquizofrenia con la criminalidad en nuestro medio, sino que indiquen también, la presencia y severidad de la agresividad, ya que esta variable es la que conduce a la comisión de actos violentos o criminales.
El estudio de la agresividad y de los factores asociados con su manifestación, tales como la severidad de la sintomatología psicótica, la vulnerabilidad genética, la personalidad y el ajuste premórbido, permitirá tener un mayor conocimiento de la representatividad de los trastornos mentales, en especial de la esquizofrenia, en los índices de criminalidad en nuestro medio.
- English
As a general rule, people are held responsible for their behavior.
Nevertheless, some are not judged as criminals by justice, on behalf of their mental condition.
The present work offers a review of the penitentiary frame for people with mental illness who have commited a crime, and points out the relationship between schizophrenia, aggression and criminality.
In Mexico, a person who commits a crime is sanctioned or punished by the State and to do that, it is necessary to prove the subject’s guilt.
If a person lacks the maturity and necessary mental faculties to recognize the crime committed, culpability isn’t present and the subject is considered inimputable. This is a cause for crime responsibility exclusion, and a most important feature regarding people with mental disorders.
In spite that criminal responsibility is associated with concepts such as free will or free choice, in practice it is related to imputability or inimputability.
One of the major problems for psychiatry, is that, at times, legal concepts differ from the psychiatry’s concept of responsability.
This problem becomes more complicated due to the lack of a clear legal definition of mental disorders that could be accepted in general situations.
The interaction between psychiatry and law is complex. Legal system resorts to psychiatry for mental disorder identification, in order to explain the way in which disorder obstructs the capacities of the accused and also to evaluate the mental state of the subject at the moment that the crime occurred.
Violent and aggressive acts committed by patients with a mental disorder have attracted psychiatric, criminological and general population’s attention.
The evidence of an increased rate of crimes among individuals with a mental disorder, in comparison to general population, is based on researches that have studied people who reside in prisons or who have committed major crimes, specially when violence is evident.
Nevertheless, it is important to keep in mind that this selection excludes the majority of people with mental disorders and also the majority of those considered as criminals.
It has been considered that the diagnosis of schizophrenia has a substantial role in the history of criminals with a severe mental disorder.
Until now, a causal relation between schizophrenia and homicide hasn’t been established. It has been reported an increased homicide rate among schizophrenics in a 10 time proportion higher than the general population.
There is considerable evidence suggesting that aggressive behaviors and the subsequent crimes committed by schizophrenic patients aren’t a phenomena pertaining to diagnosis but, rather, a consequence of specific psychotic symptoms, specially persecutory and command hallucinations, and delusions.
It has been proposed that the existence of criminal behaviors in schizophrenic patients is a rational response to irrational beliefs (delusions) and, in a similar way, command hallucinations can order the patient what to do, and as a consequence, indicate the course that violent behavior will take.
Substance abuse has been considered as a risk factor for aggressive behaviors and criminality in patients with schizophrenia. Several studies have documented that substance abuse, specially alcohol and cocaine, is a variable that discriminates schizophrenics having criminal records from those who don’t have any.
In our society, it is necessary to have a better legal description of the mental disorders attached to the concept of inimputability, specifically for schizophrenia and other psychotic disorders. This is needed due to the contradictory results obtained in several psychiatric researches, regarding the association between schizophrenia and criminality.
Some authors have considered that schizophrenia is one of the most important psychiatric diagnosis associated to criminality, while other authors have reported that this association is limited to several risk factors that these patients present, such as the psychotic symptoms’ severity, and substance abuse.
On the other hand, it is important to mention that crimes committed by schizophrenic patients, are mostly directed towards a member of the family environment. This could be one of the reasons for which these behaviors do not appear in legal records, and a reason why patients are not imprissoned.
On behalf of this, it is necessary not only to study the association between schizophrenia and criminality in our society, but also the presence and severity of aggressiveness, because aggressiveness is the variable that leads to the perpetration of criminal behaviors.
Future research on aggressiveness and associated factors, such as psychotic symptomatology´s severity, genetic vulnerability, personality traits and premorbid adjustment, will allow to have a better knowledge of the representative role of mental disorders specially schizophrenia in criminality rates in our society
- español
