COMPETENCE AND RESPONSIBILITY IN SCHIZOPHRENIA

In a survey of the historical background it is shown that the classica l doctrine on responsibility in schizophrenia has left its mark on the wordings of the psychiatric textbooks of the different countries. Clo sely combined with the imputation of enduring irresponsibility in schi zophrenia was the opinion that civil rights are largely suspended if a person is given the diagnosis of schizophrenia. By the more recent re search results of the studies of course and long-term outcome of schiz ophrenia and related psychoses and the development of the basic sympto m concept has shown that it is not justified on principle to summarily deprive a person, diagnosed as schizophrenia, of civil rights as well as of criminal responsibility. New directions and some guidelines for an adequate assessment of competence and responsibility in schizophre nia are described. The knowledge of the newer findings and the applica tion and utilization of the concept of basic symptoms and non-psychoti c basic stages enable to overcome the doctrines of incurability, princ iple heterogeneity and numinous singularity and may lead to a rather a ppropriate and adequate social appreciation of the disease. Insight, f reedom, responsibility, and competence of a person diagnosed as schizo phrenia are in the postpsychotic pure residues and basic stages much m ore frequently preserved and available than hitherto assumed. After re mission of the florid schizophrenic phase in the postpsychotic basic s tages which are psychopathologically not schizophrenic competence as f ar as civil rights are concerned is usually not yet lost and criminal irresponsibility cannot be assumed immediately without a careful exami nation of the defendant: Not only the deed and the diagnosis, but also the psychopathological type and stage of the disorder and the individ ual behind the act including the psychological and social circumstance s of the crime have to be taken into consideration. A dogmatizing eith er-or-principle: Irresponsibility of organic and endogenous psychoses, responsibility of psychic-reactive, neurotic and psychopathic develop ments would be a formalism and show a lack of discrimination that coul d not do justice to the reality and the very different psychopathologi cal and social types and stages in schizophrenia.