Hearing Voices and Determining Criminal Responsibility

During decades of conducting evaluations in criminal cases, I have encountered defendants who have asserted that voices directed them to engage in the behavior at issue. They maintained that they were powerless to resist the commands. Their version of what transpired suggested the presence of a psychotic condition with auditory hallucinations.

Rafael* was charged with malicious wounding of his wife. He stated that he had been directed by a “spirit” to kill her. Not only did he attribute his alleged crime to the spirit, but he also said that the spirit inhabited his body as part of a reincarnation from an earlier life.

Because he spoke English hesitatingly, a Spanish interpreter participated during the evaluation. Rafael emphasized that he did not fully understand questions unless they were asked in his native language. He noted that his command of English was inadequate to express himself fully and precisely. As I was to discover, this was only partially true.

Rafael contended that he had been hearing this spirit’s voice since childhood and it had considerable influence. In fact, he attributed all malevolent thoughts and behavior to the spirit. However, midway through our clinical interviews, he acknowledged that he had become acquainted with the spirit only during the past year. During a visit to his native country, a psychiatrist told him that he was possessed by a “bad spirit” and referred him to a spiritual center in the United States close to where he was living. From a counselor at that center, he learned about the spirit. Rafael bathed daily in a potion consisting of rum, holy water, honey, coffee, lime juice, and rice. He burned incense in his apartment regularly. Rafael said that this was all because of instruction by Angelina, a counselor. He strongly advised that I speak to Angelina. He insisted that it was the spirit that sent him “to hell” and forced him to do bad things.

It is critically important to consult collateral sources when conducting a sanity evaluation, not simply to determine truthfulness but to better understand the defendant and how he was functioning earlier in life. In Rafael’s case, I interviewed the counselor Angelina, his wife Lucia, and his teenage son Jose.

Puzzled as to why Rafael provided her name and contact information, Angelina had nothing positive to say. “He fooled me with his personality,” she stated and commented, “I don’t think he’s such a wonderful person. Don’t let him fool you. He knows exactly what he’s doing. He’s not a man of his word. I don’t want anything to do with him.” Angelina affirmed that Rafael appeared to believe in spirits, but she did not. She encouraged him to go to church. Her opinion of Rafael’s wife was that she was “a nice, sweet person.”

Already Rafael had been untruthful about two important matters. Initially, he Indicated that, from childhood, he believed he was possessed, but later said that only recently did the spirit become a force in his life. He then invoked the influence of a spirit only with respect to the matter before the court. Rafael completely misrepresented the role his so-called spiritual advisor had played and her attitude toward him.

As we continued to talk, Rafael disclosed that, as a child, he did things that he characterized as “not normal,” that he was violent many years before attempting to kill Lucia. As a teenager, he shot a horse with a rifle, hurled stones at people, threw animals into a river, and became embroiled in fights at school. It was not difficult for him to reveal this behavior early in the evaluation because he attributed nearly everything to the “spirit.” He also said the spirit caused him to molest his daughter and prodded him to drink large quantities of alcohol.

When it came to discussing attacking his wife, Rafael became intensely animated. Launching into a lengthy monologue in English, he recounted lies that his wife allegedly told in the courtroom. While recounting his version of the alleged crime (not for the first time), Rafael was in familiar territory, and his spoken English improved notably. Rafael became so animated that he rose from his chair and partially re-enacted what had transpired. His emphasis was on what his wife did, claiming that she attacked him.

At first, Rafael claimed that he did not remember what happened, that he saw only a devil, not his wife. He emphasized that, as he held a knife in his hand, he saw Lucia bleeding and surrendered the knife to his son. Jose volunteered that, on the very day of the offense, his father had tried to strangle his mother, then grew angrier throughout the day.

Psychosis Essential Reads

Navigating Mental Crises

Using Metaphors to Deal With Psychosis

Rafael wanted to have it both ways with respect to the spirit. On the one hand, he claimed to be at its mercy. On the other, he said that he could put off what the spirit told him to do. He spent considerable time portraying himself as a man very much in control of his life while working at two jobs and raising a family. Asked again if the spirit instructed him what to do on the day of the alleged offense, he hesitated and vaguely stated that something came over him.

Rafael may have entertained superstitions about a spirit. However, it seemed as though he recently had arrived at his belief and used it conveniently when explaining any wrongdoing. There is a difference between a superstition and a psychotic condition in which a person is not in contact with reality. Throughout this evaluation, Rafael was clear and coherent. The interpreter had no difficulty following him.

I administered items from standardized tests to assess attention, concentration, and orientation to reality. From these tests as well as from my overall assessment, it was apparent that Rafael could pay attention, concentrate, and understand what was transpiring not only during this evaluation but more generally in his environment before the alleged offense occurred.

The information I gathered from collateral sources confirmed that Rafael’s functioning was not impaired by psychosis nor did he, until this evaluation, attribute his behavior to a spirit or commanding voice.

In conducting evaluations with people who present themselves as directed by voices or “command hallucinations” (as they are sometimes called), it is important to question in detail the nature of the voice or spirit. Is the person consistent in referring to one voice or is there more than one? What is the nature of the voice (one defendant described a voice he heard as soft and smooth but later said it was scratchy and harsh)? Under what circumstances does he hear it? Does he always feel compelled to obey it or has he at times completely disregarded what it was telling him?

It is essential to interview collateral sources who know the person well and have observed him over time. This is particularly useful in determining whether the current alleged offense is a continuation of a pattern that has preceded it.

The evaluator must try to differentiate between a superstition or idiosyncratic belief and a psychotic condition in which the person loses contact with reality, is not oriented as to person, place or time, and loses the capacity to make independent choices. In short, a determination must be made as to whether he understood the nature, character, and consequences of his actions. Rafael did not meet the standard for insanity in the Commonwealth of Virginia.

*Names have been changed to preserve confidentiality