MEMORANDUM OF LAW CONCERNING PSYCHIATRIC AND LEGAL TERMS AND CASE LAW RELATING TO

BEHAVIOR AND MENTAL ILLNESS (Note these are two separate documents)

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Please NOTE: that there is great confusion among judges and attorneys concerning the following terms,
which are clarified here, so that there is no confusion concerning such issues.

The following is a summary of terms found in American case law concerning fitness, insanity, mental
illness, and PTSD, as well as abstracted, and annotated with comments by Shelton, from a well-
respected psychiatric learned treatise - Mental Disorder and Criminal Responsibility by Stephen J.
Hucker, Christopher D. Webster, Mark H. Ben-Aron, Butterworths, 1981.

Stephen J. Hucker, MB, BS, FRCP(C), FRCPsych, in 1981 was a Consultant Psychiatrist, Professor, Division
of Forensic Psychiatry at the University of Toronto. [FRCP = Fellow of the Royal Canadian College of
Physicians; NCR = Not Criminally Responsible under Canadian Law]

A. Post-Traumatic Stress Disorder (“PTSD”) = an altered state of consciousness, dissociative

phenomena, or dream-like state during wakefulness, where a person relives in his/her mind as
if real, a previous life-threatening or thought to be life-threatening, or very traumatic event,
which is not a delusion, hallucination, or psychotic episode, often resulting in an inability to
perceive accurately ongoing events;

B. Disorder versus symptom, state, or phenomena = a disorder is a permanent condition or

illness, where symptoms may come or go depending upon if they are acute, chronic, in
remission, or temporarily activated by triggers such as flashbacks in PTSD;

C. Dissociative disorders versus temporary dissociative symptoms, phenomena or state = are

conditions in which there is loss of the usual integration of personal identity and memories,
sensory and motor functions. There is a splitting off of specific mental activities from the rest of
conscious awareness (eg. A commonplace example would be driving to work while focusing on
the day in court and arriving with no memory of the actual drive).

Dissociative Disorders are severe diagnosable illnesses; result in diverse and significant impairment of
functioning fairly common. They are often associated with childhood physical or sexual abuse.

Dissociative symptoms may occur in a number of other psychiatric disorders (e.g. conversion disorder,
acute and chronic PTSD, borderline personality disorder, major depression, acute schizophrenia, etc.)

Several major subtypes exist:

- Dissociative amnesia – inability to remember an event, which was often traumatic (occurs in PTSD
flashbacks)

- Dissociative fugue – state of wandering often with confusion about one’s personal identity or even
adoption of a new identity
- Dissociative Identity Disorder (“Multiple Personality Disorder”)

- Depersonalization Disorder

- Dissociative Disorder, not otherwise specified

D. Delusion = delusions are false or erroneous beliefs that a person holds on to, without adequate
evidence - beliefs that usually involve a misinterpretation of real perceptions or experiences,
such as believing that the television is talking about the person viewing it or that an officer is
the devil; Paranoid Delusions

E. Hallucinations = erroneous beliefs that usually involve fictitious perceptions or experiences,

such as seeing visions or hearing voices; this includes command hallucinations, instructing
someone to do something like take a child to heaven for its protection – common thought in
post-partum psychosis. A hallucination is defined as sensory perception in the absence of
external stimuli. Hallucinations are different from illusions, or perceptual distortions, which are
the misperception of external stimuli. Hallucinations may occur in any of the senses and take
on almost any form, which may include simple sensations (such as lights, colors, tastes, and
smells) to experiences such as seeing and interacting with fully formed animals and people,
hearing voices, and having complex tactile sensations.

F. Psychotic episode = THE TERM PSYCHOSIS is NOT A DIAGNOSIS, but is a term describing
symptoms.

IT IS VERY BROAD AND IS OFTEN MISUSED BY LAYMEN. It is an abnormal condition of the mind
that involves a loss of contact with reality. It can mean anything from relatively normal
aberrant experiences to the complex and catatonic expressions of schizophrenia and bipolar
type 1 disorder, in properly diagnosed psychiatric disorders (where other causes have been
excluded by extensive medical and biological laboratory tests). People experiencing psychosis
may exhibit personality changes and thought disorder. Depending on its severity, this may be
accompanied by unusual or bizarre behavior, as well as difficulty with social interaction and
impairment in carrying out daily life activities.

[A PTSD flashback is not a psychotic episode – it is based in reality, not a loss of contact with
real memories, but the mind is in an altered state of consciousness so that it is relived in the
mind as a dream-like state. It is not a thought disorder, but is a dissociation of memory with
time and place, which impairs the mind from normal perception of ongoing activities when the
PTSD flashback is present.]

Generally, psychosis involves noticeable deficits in normal behavior (negative signs) and more
commonly to diverse types of hallucinations or delusional beliefs, particularly with regard to the relation
between self and others as in grandiosity and pronoia or paranoia. Psychosis is manifested by positive &
negative signs and symptoms: loose associations [of ideas and concepts], poverty of speech [lack of
detailed expressive speech], suspiciousness, guardedness, auditory hallucinations, paranoid delusions,
aggression and blunted affect, lack of motivation, asociality, disorganized/slowed/concrete thinking [lack
of abstract thought], bizarre logic/associations, thought broadcasting [“the TV is putting words into my
mind” or “I can make the person on the TV think things”], possible auditory hallucinations and paranoia,
poor insight [into a situation or predicament], and impaired judgment. Psychosis characterized by
illogical and grandiose thinking is also diagnosed as a major mental illness.

G. Catatonia = again not a diagnosis by itself, but a symptom that describes a profoundly agitated
state in which the experience of reality is generally considered impaired. There are two primary
manifestations of catatonic behavior. The classic presentation is a person who does not move
or interact with the world in any way while awake. This type of catatonia presents with waxy
flexibility. Waxy flexibility is when someone physically moves part of a catatonic person's body
and the person stays in the position even if it is bizarre and otherwise nonfunctional (such as
moving a person's arm straight up in the air and the arm staying there). [The mind in its agitated
state is so dissociated from the body’s muscles that there is no volitional movement]

The other type of catatonia is more of an outward presentation of the profoundly agitated state
described above. It involves excessive and purposeless motor behavior, as well as extreme mental
preoccupation that prevents an intact experience of reality. An example is someone walking very fast in
circles to the exclusion of anything else with a level of mental preoccupation (meaning not focused on
anything relevant to the situation) that was not typical of the person prior to the symptom onset. In both
types of catatonia there is generally no reaction to anything that happens outside of them. It is
important to distinguish catatonic agitation from severe bipolar mania, although someone could have
both.

H. Thought disorders = describes an underlying disturbance to conscious thought and is classified

largely by its effects on speech and writing. Affected persons show loosening of associations,
that is, a disconnection and disorganization of the semantic content of speech and writing. In
the severe form speech becomes incomprehensible and it is known as "word salad".

I. Fitness = a legal not medical term, which means that: “To be considered competent to stand
trial, an individual must possess sufficient capacity to comprehend the nature and quality
of the proceedings against him and his own position in relation to these proceedings. Further,
he must be able to adequately advise counsel rationally in the preparation and
implementation of his own defense.” Heller MS, Traylor WH, Ehrlich SM, et al: Intelligence,
psychosis and competency to stand trial. Bull Am Acad Psychiatry Law 9:267–74, 1981

A defendant is entitled to a fitness hearing only when a bona fide doubt of his fitness is raised. Easley,
192 Ill. 2d at 318. Once a bona fide doubt of fitness is raised, the State bears the burden of establishing
defendant's fitness by a preponderance of the evidence. People v. Griffin, 178 Ill. 2d 65, 79 (1997).
(People v. Kalwa, 1999 Ill App (1st) 1971671)

"A defendant may not be put to trial unless he ' "has sufficient present ability to consult with his lawyer
with a reasonable degree of rational understanding . . . [and] a rational as well as factual understanding
of the proceedings against him." ' " Cooper, 517 U.S. at 354, 134 L. Ed. 2d at 506, 116 S. Ct. at 1377,
quoting Dusky v. United States, 362 U.S. 402, 402, 4 L. Ed. 2d 824, 825, 80 S. Ct. 788, 789 (1960). "A
defendant is presumed to be fit to stand trial or to plead ***. A defendant is unfit if, because of his
mental or physical condition, he is unable to understand the nature and purpose of the proceedings
against him or to assist in his defense." 725 ILCS 5/104-10 (West 2000). In order to conduct a defense in
a rational and reasonable manner, a defendant should be capable of cooperating with his counsel to the
end that any available defenses may be interposed"), and United States v. O'Kennard, No. 02 CR 481
(N.D. Ill. 2004) ("Cooperation with counsel has been described as 'the capacity to provide whatever
assistance counsel requires in order to explore and present an adequate defense' "), quoting R. Bonnie,
The Competence of Criminal Defendants: Beyond Dusky and Drope, 47 Miami L. Rev. 539, 552-53 (1993).
The Illinois fitness statute is specific. It provides that a trial court may consider the following factors
during a fitness hearing in determining both the defendant's understanding of the nature of and purpose
of the proceedings and his ability to assist counsel:

"(1) The defendant's knowledge and understanding of the charge, the proceedings, the consequences of
a plea, judgment or sentence, and the functions of the participants in the trial process;

(2) The defendant's ability to observe, recollect and relate occurrences, especially those concerning the
incidents alleged, and to communicate with counsel;

(3) The defendant's social behavior and abilities; orientation as to time and place; recognition of persons,
places and things; and performance of motor processes." 725 ILCS 5/104-16(b) (West 2000).

Ultimately, fitness must be judged based on the totality of the circumstances. See People v. Kinkead, 182
Ill. 2d 316, 340, 695 N.E.2d 1255, 1266 (1998); State v. Forsyth, 547 N.W.2d 833, 838 (Iowa App. 1996).
(People v. Kalwa, 1999 Ill App (1st) 1971671)

J. Temporary insanity = a legal term defined by each state

States have right to define insanity and elements needed to prove insanity. Four states have no insanity
defense but allow use of mental illness as factor in proving mens rea. Other states use combination of
evidence about cognitive, moral, or volitional incapacity, and product of mental illness, or M'Naghten
test (cognitive & moral incapacity), to determine proof of lack of culpability. Clark v. Arizona, 2006 U.S.
05-5966

One can be unfit but not insane, if one has no knowledge of the event and therefore cannot admit to
having committed the offense, yet on exam by experts is found sane. The court in People v. Stahl, 2013
Ill. App. LEXIS 71 (5 Dist. 2013) held that the defendant was unfit for trial as he could not assist defense
counsel due to the results of a gunshot wound to the head, but he was not insane, as physicians found
him sane at the time of trial. A classic insanity defense requires knowledge of and admission of acts
charged. The Illinois Supreme Court upheld that ruling. "Accordingly, under article 104 of the Code,
amnesia as to the events surrounding the crime does not per se render a defendant unfit to stand trial.
Rather, the fact that a defendant cannot recollect the incident at issue is just one of the circumstances
that may be considered in determining a defendant’s fitness. See 725 ILCS 5/104-16(b)(2) (West 2010).
We therefore hold that a court must consider the totality of the circumstances to determine whether a
defendant is fit to stand trial." People v. Stahl, 2014 IL 115804 [The lack of memory due to gunshot
wound for the event prohibited the defendant from assisting his attorney, therefore, the Supreme Court
affirmed that Stahl was unfit for trial and denied State’s appeal.]

K. Insanity = a legal term meaning that the defendant at time of trial does not understand the
nature or consequences of the alleged criminal act

States have right to define insanity and elements needed to prove insanity. Four states have no insanity
defense but allow use of mental illness as factor in proving mens rea [a state of mind where the person
understands what they are doing]. Other states use combination of evidence about cognitive, moral, or
volitional incapacity, and product of mental illness, or M'Naghten test (cognitive & moral incapacity), to
determine proof of lack of culpability. Clark v. Arizona, 2006 U.S. 05-5966

A mental state problem at the time of the offense does not equate to an insanity defense. People v. Lee,
128 Ill. App. 3d 774 (1 Dist. 1984) Fitness is a legal term and not a psychiatric opinion. If there is no
memory of events at the time of the offense, or no knowledge by the defendant of the event, then
there is no general insanity defense. People v. Kashney, 129 Ill. App. 3d 218 (1 Dist. 1984).

L. Medical or clinical conditions may cause Non-Mental Disorder Automatism:

 Cerebral concussion

 Hypoglycemia (low blood sugar) or other metabolic disturbances found in starvation,

dehydration, diabetes and other disorders. Drugs (medically administered)

 Alcohol – idiosyncratic or pathological intoxication

 Dissociative state – see above

 Sleepwalking – Parks case

 Parasomnias – behavioral phenomena inappropriate to the sleeping state, Commoner in

childhood but can occur for the first time in adults,

 Violence can occur in various sleep disorders:

 associated with sudden wakening

– sleep drunkenness
– confusion, disorientation, misinterpretation of reality on sudden arousal from deep
(stage 3 or 4) sleep
– may act as if defending against imagined attack (PTSD nightmare)
– no subsequent recall

 associated with sleepwalking

– complex coordinated actions
– includes destruction of surrounding objects, self injury or injury to others
 – victim usually a spouse
– repeat actions actually common and repeated
– genetic predisposition
– may be precipitated by external factors

 night terrors
– probably commonest parasomnia
– may have some recall of a frightening dream
– behaviour suggestive of night terror witnessed by others
- REM sleep behaviour disorder
– mainly elderly men
– 50% neurological disorder – none with psychiatric abnormality
– dream enactment during REM

Canadian References & Further Reading:

Supreme Court Cases:
R v. Oomen, (1994) SCC (CB 671)
R.v. Cooper (1980) 1 S.C.R. 1149
R.v Simpson (1977), 35 CCC (2d) 337
R.v Barnier (1980), 51 CCC (2d) 193, 109 DLR (3d) 257
R.v Abbey, (1982) 68 CCC (2d) 394 (SCC)
R. v. Chaulk, (1990) 3 S.C.R. 1303
R.v. Stone, (1999) 2 S.C.R. 290
Rabey v. The Queen, [1980] 2 S.C.R. 513, aff'g (1977), 17 O.R. (2d) 1

Further Reading:
MacDonald, N., Hucker, S.J., Hébert, P.C. (2010) “The crime of mental illness.” Editorial, Canadian Medical
Association Journal,182(13):1399.

Desmarais, S.L., Hucker, S.J., Brink, J., and DeFreitas, K. (2008) “A Canadian Example of Insanity Defence
Reform: Accused Found Not Criminally Responsible Before and After the Winko Decision.” International
Journal of Forensic Mental Health, 7 (1), 1-14 .

Desmarais, S.L. & Hucker, S.J. Multi-site Follow-up Study of Mentally Disordered Accused: An
Examination of Individuals Found Not Criminally Responsible & Unfit To Stand Trial. Research & Statistics
Division, Department of Justice, Canada. June 2005.

Hucker, S.J . & DeFreitas, K. (2005) “Criminal responsibility”. In Encyclopedia of Forensic & Legal
Medicine.Payne-Jones, J., Byard, R., Cory, T. & Henderson, C. (eds). Elsevier: Oxford.
Livingston, James, D., Wilson, Derek, Tien George, Bond, Lynda. (2003). "A Follow-Up Study of Persons
Found Not Criminally Responsible on Account of Mental Disorder in British Columbia". Canadian Journal
of Psychiatry. July.

Bloom, H. "Psychiatric Issues in the Criminal Process". in A Practical Guide to Mental Health Law,
Capacity and Consent Law of Ontario. Hy Bloom and Michael Bay (eds). Carswell. 1996. pp 255-292.

Hucker, S. J. , Webster, C. D., & Ben-Aron, M. H. (Eds.). (1981). Mental Disorder and Criminal
Responsibility. Toronto: Butterworths.

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MEMORANDUM OF LAW - FITNESS EXAMS

(SUGGESTED FOR USE IN EDUCATING JUDGES AND COURT ATTORNEYS)

1. NOW COMES, Plaintiff Linda Shelton (“Shelton”), pro se, who presents this 
Memorandum of Law for the benefit of all parties in this case, with a suggestion that it 
should be disseminated to all judges in Cook County Courts:

2. MEMORANDUM OF LAW ­ FITNESS EXAMS The due process clause of the 
fourteenth amendment prohibits the conviction and sentencing of a defendant who is not fit
to stand trial. U.S. Const., amend. XIV; People v. Johnson, 206 Ill. 2d 348, 361, 794 N.E.2d 
294, 303 (2002). In Illinois, a defendant is presumed fit to stand trial and is considered 
unfit only if his mental or physical condition prevents him from understanding 
the nature and purpose of the proceedings against him or assisting in his own 
defense. 725 ILCS 5/104­10 (West 2000); People v. Shum, 207 Ill. 2d 47, 57, 797 N.E.2d 
609, 615­16 (2003). When a bona fide doubt as to defendant's fitness to stand trial exists, 
the court must order a fitness hearing to resolve the question of fitness before the case 
proceeds any further. 725 ILCS 5/104­11(a) (West 2000); Johnson, 206 Ill. 2d at 361, 794 
N.E.2d at 303; People v. Griffin, 178 Ill.2d 65, 79 227 Ill.Dec. 338, 687 N.E.2d 820 (1997).  

3. A professional forensic psychiatric exam is not really necessary to 
determine fitness, but is necessary to determine if the defendant suffers from 
mental illness. Fitness and mental illness are two different issues and determination of 
such is not equivalent.  Fitness is determined by a judge; mental illness is diagnosed by a 
licensed physician or psychologist. A forensic exam is evidence that may be used in the 
fitness hearing to determine fitness by the trier of the facts, along with any other evidence 
produced by the defense, the state, or the court.

4. There is no fixed sign, symptom, or behavior that mandates a 
determination of fitness. “The question is often a difficult one in which a wide range of 
manifestations and subtle nuances are implicated.” People v. Eddmonds, 143 Ill. 2d 501, 
518 (1991) (quoting Drope v. Missouri, 420 U.S. 162, 180 (1975)). Some doubt of a 
defendant’s fitness is not enough. People v. Walker, 262 Ill.App.3d 796, 803, 200 Ill.Dec 345,
635 N.E.2d 684 (1994). No single factor in itself raises a bono fide doubt of a defendant’s 
fitness to stand trial; the fact that a defendant suffers a mental disturbance or 
disability or requires psychiatric treatment such as psychotropic drugs does not 
 necessarily raise a  bona fide
    doubt. Walker, 262 Ill.App3d at 803, 200 Ill.Dec. 345, 635 
N.E.2d 684; People v. Shum, 207 Ill. 2d 47, 59, 797 N.E.2d 609, 615­16 (2003); People v. 
Easley, 192 Ill. 2d 307, 322, 736 N.E.2d 975, 986 (2000); Eddmonds, 143 Ill. 2d at 519; 
People v. Stephens, 2012 IL App (1st) 110296 Even evidence of extreme disruptive 
behavior and a sociopathic personality does not compel the conclusion that a 
   bona 
 fide  doubt exists as to a defendant’s fitness to stand trial. People v. Smith, 253 
Ill.App.3d 948, 953, 192 Ill.Dec. 742, 625 N.E.2d 897 (1993) "Fitness speaks only to a 
person's ability to function within the context of a trial. It does not refer to sanity or 
competence in other areas. A defendant can be fit for trial although his or her mind may be 
otherwise unsound." People v. Easley, 192 Ill. 2d 307, 320 (2000) (citing People v. Murphy, 
72 Ill. 2d 421, 432­33 (1978)); see also Eddmonds, 143 Ill. 2d at 519­20. Moreover, “[t]he 
question of fitness may be fluid. Someone who appeared to have difficulty understanding 
his plight in 2007 may be rational in 2008.” People v. Weeks, 393 Ill. App. 3d 1004, 1010 
(2009). 

5. The question of whether a defendant is fit to stand trial is a different 
inquiry than whether the defendant is able to waive his or her Miranda rights. 
See People v. Rockamann, 79 Ill. App. 3d 575, 580­81 (1979). For instance, in Rockamann, 
the appellate court rejected a defendant’s argument that it was an “unexplainable 
inconsistency” that he was found competent to stand trial but his confession was 
suppressed because he did not knowingly understand and waive his Miranda rights. 
Rockamann, 79 Ill. App. 3d at 580. The court stated that the question in determining 
fitness to stand trial was whether the defendant was able to understand the nature and 
purpose of the proceedings and assist in his own defense (Rockamann, 79 Ill. App. 3d at 
579), but the standard for determining whether a confession was admissible is “whether or 
not the statement has been made ‘freely, voluntarily and without compulsion or inducement
of any sort,’ or whether the defendant’s will was overborne at the time he confessed,” which 
required consideration of the totality of the circumstances, including details of the 
interrogation as well as the characteristics of the accused (internal quotation marks 
omitted) (Rockamman, 79 Ill. App. 3d at 581 (quoting People v. Hester, 39 Ill. 2d 489, 497 
(1968))). The court noted that “these two criteria contrast strikingly” and that “[a] finding of
unfitness under one test does not mandate such a conclusion under the other.” Rockamann, 
79 Ill. App. 3d at 581. People v. Stephens, 2012 IL App (1st) 110296 at ¶95

6. Court determinations of fitness are made by a court hearing (bench or jury 
trial) and not by the forensic examiner. 
 The ultimate decision as to a defendant’s fitness must be made by the trial court, not
the experts. People v. Bilyew, 73 Ill.2d 294, 302 (1978) 

The examiner’s report is merely evidence. The trier of fact at the fitness hearing 
decides its weight. Fitness by statute and case law is determined by the judge, if 
jury is waved or the jury in a fitness hearing per 725 ILCS 5/104­11(c): 

725 ILCS 5/104­11 (c) When a bona fide doubt of the defendant’s fitness has been 
raised, the burden of proving that the defendant is fit by a preponderance of the 
evidence and the burden of going forward with the evidence are on the State. 
However, the court may call its own witnesses and conduct its own inquiry. 
[emphasis added]

7. A fitness order is NOT evidence of a bona fide doubt per the First District 
Illinois Appellate Court in People v. Hill, 345 Ill.App.3d 620, 803 N.E. 2d 138 (2003); People
v Hanson, 2012 IL App (3d) 110210­U (2004)
 . 
[W]e find that the trial court’s decision to appoint an expert to examine a defendant 
has no bearing on the court’s ultimate conclusion as to whether a bona fide doubt as 
to the defendant’ fitness to stand trial has been raised. (Hill Id)

This overturned People v. Cleer, 328 Ill. App. 3d 428 (2002), where the court determined 
that the grant of a fitness examination implicitly demonstrated the trial judge's bona fide 
doubt concerning defendant's fitness for trial.

8. [O]nce facts are brought to the attention of the trial court, either from 
observation of the defendant or the suggestion of counsel, that raise a bona fide 
doubt of the defendant’s fitness to stand trial, the trial court has a duty to hold a 
fitness hearing. People v. Brandon, 162 Ill.2d 450, 456, 205 Ill.Dec. 421, 643 N.E.2d 712, 
(1994); see 725 ILCS 5/104­11() (West 1996). 

9. It is basic that an insane person cannot lawfully be tried for a crime and that to place such
a person on trial is a denial of due process. ( People v. Bender, 20 Ill.2d 45; People v. Burson, 11
Ill.2d 360; People v. Reeves, 412 Ill. 555.) It is also generally true that it is the responsibility of
the accused or his attorney to raise the question of the accused's competency to stand trial.
( People v. Maynard, 347 Ill. 422; People ex rel. Wiesman v. Nierstheimer, 401 Ill. 260.)
However, the failure of a defendant to raise this issue will not always preclude him from later
having the question considered. As we said in People v. Burson, 11 Ill.2d 360 at 370, "this is a
rule of administration and not of jurisdiction or power, and it will not operate to deprive an
accused of his constitutional rights of due process."
 10. Whether a bona fide doubt as to a defendant’s fitness has arisen is 
generally a matter within the discretion of the trial court. People v. Sandham, 174 
Ill.2d 379, 382, 220 Ill.Dec. 611, 673 N.E.2d 1032 (1996). “[W]hether the doubt is ‘bona fide’ 
is relevant only to the initial determination to hold a fitness hearing.” (Emphasis in 
original.) People v Murphy 160 Ill.App.3d 781 at 783, 112 Ill.Dec. 295, 513 N.E.2d 904 
(1987)” Brown, 252 Ill.App.3d at 383. “Whether a bona fide doubt of a defendant’s 
fitness exists involves a fact­specific inquiry” (emphasis added). See Eddmonds, 143 
Ill.2d at 518, 161 Ill.Dec. 306, 578 N.E.2d at 959 (1991), quoting Drope, 420 U.S. at 180, 95 
S.Ct at 908, 43 L.Ed.2d at 118 (“there are no fixed or immutable signs which invariably 
indicate the need for further inquiry to determine fitness to proceed; the question is often a 
difficult one in which a wide range of manifestations and subtle nuances are implicated’”)” 
People v. M. Tapscott, 386 Ill.App.3d 1064, 899 N.E.2d 597, 326 Ill.Dec. 380 (2008). 

11. The Illinois Supreme Court has repeatedly held that when determining 
whether a bona fide doubt of defendant’s fitness exists, courts should consider 
the following factors: the defendant’s irrational behavior, the defendant’s 
demeanor at trial and any prior medical opinion on the defendant’s competence 
to stand trial. People v. Harris, 206 Ill.2d 293, 304, 276 Ill.Dec. 286, 794 N.E.2d 181, 190 
(2002). 

12. Once a bona fide doubt of defendant’s fitness to stand trial is raised, there 
is no longer a presumption of fitness. Murphy, 160 Ill.App.3d 781. “Only if, from an 
objective point of view, the circumstances raise a “bona fide doubt” – that is, “a real, 
substantial[,] and legitimate doubt” (People v. Eddmonds, 143 Ill.2d 501, 518, 161 Ill.Dec. 
306, 578 N.E.2d 952, 959 (1991) – of the defendant’s fitness does the defendant have a right
to a fitness hearing. 725 ILCS 5/104­11(a) (West 2002).”

13. A Court may order a fitness exam (In Cook County Courts this is referred to 
as a behavioral clinical exam = BCX) at the request of the state or the defense or if 
the court expresses a bona fide doubt of defendant’s fitness per 725 ILCS 5/104-11. 
This bona fide doubt must be specific and not a general statement and must
 be expressed in open court on the record . It is not sufficient for a judge to state 
that a defendant’s behavior or writings suggest a fitness exam is needed. The 
defense attorney, prosecuting attorney, or judge must specify, in their 
pleading or on the record, the nature of the behavior or the details in the 
writings that SUGGEST fitness is absent. General or conclusory statements
are not sufficient. If the defense attorney or prosecuting attorney moves for a 
fitness exam, then appointment of an expert under this provision cannot be 
considered a conclusion concerning a bona fide doubt of defendant's fitness but, 
 
rather, merely allows an expert to examine the defendant to determine   if
    a 
   bona 
 fide  doubt may be raised. (Hill, supra) If a defense attorney opines that the 
defendant is unfit, this opinion must be affirmed by affidavit, otherwise 
this is not a bona fide doubt of fitness. People v. Stephens, 2012 IL App (1st) 
110296 at ¶97­98 “The representations of defendant’s counsel concerning the 
competence of his client, while not conclusive, are another important factor to 
consider.” Eddmonds, 143 Ill. 2d at 518 (quoting Drope v. Missouri, 420 U.S. 162, 
180 (1975)). 

14. Regarding disability with a low IQ: A finding several years prior that a 
person is mentally disabled [with IQ of 64 = mild mental disability] and had trouble 
communicating and understanding his Miranda rights, without any other evidence 
of unfitness at trial, is not an arguable basis that there was a bona fide doubt of 
defendant’s fitness such that the trial court would have been required to order a 
fitness hearing sua sponte. People v. Stephens, 2012 IL App (1st) 110296 at ¶98 In 
People v. Shanklin, 351 Ill. App. 3d 303 (4th Dist. 2004):

 [T]the defendant pled guilty to attempted murder in the middle of a bench 
trial. Included in his presentence investigation report was information that 
the defendant had been hospitalized three times for mental health problems 
and that tests completed during his hospital stays indicated that the 
defendant was mildly mentally retarded and had significant problems 
retaining and receiving verbal information. Shanklin, 351 Ill. App. 3d at 304. 
Later, the defendant filed a postconviction petition alleging that he was unfit 
when he entered his guilty plea; the defendant also alleged that his trial 
counsel was ineffective for failing to raise the issue of the defendant’s fitness 
before the trial court despite the fact that the defendant had informed trial 
counsel of his mental health history. Shanklin, 351 Ill. App. 3d at 304­05. 
The defendant attached copies of his psychological evaluation from Hartgrove
Hospital to the petition. The evaluation included the facts that the defendant 
was admitted to Hartgrove Hospital on three separate occasions when he was
15 and 16 years old for “violent and disruptive behavior” and was assessed by
psychiatric and social work staff, who concluded that the defendant had a low
IQ in the mildly mentally retarded range, had a history of mental health 
treatment, and had difficulty receiving and retaining verbal information. 
Shanklin, 351 Ill. App. 3d at 306. The defendant’s postconviction petition was
dismissed at the first stage. Shanklin, 351 Ill. App. 3d at 305.

On appeal, the appellate court reversed, finding that the defendant had 
stated the gist of a constitutional claim that he was unable to understand the
nature of the proceedings and his trial counsel was ineffective in failing to 
request a fitness hearing. Shanklin, 351 Ill. App. 3d at 308. The court noted 
that “[g]enerally, limited intellectual ability, without more, does not render a 
defendant unfit [for] trial,” but “[t]his case, however, involved more than just 
low mental capacity.” Shanklin, 351 Ill. App. 3d at 306. The court pointed to 
the defendant’s mental health history and the report indicating that the 
defendant had problems with verbal communication. Shanklin, 351 Ill. App. 
3d at 306. The court stated, “[t]he report indicates defendant may not have 
been able to fully comprehend what was being verbally communicated to him 
either by counsel or the trial court as to the consequences of a guilty plea in 
this case” and noted that the defendant’s hospital record suggested that he 
“was likely to avoid academic situations that would cause him shame or 
embarrassment. It is not idle speculation to consider whether defendant may 
have answered questions from the court in a way that would avoid exposing 
his intellectual deficit.” Shanklin, 351 Ill. App. 3d at 307. Consequently, the 
court found that a fitness hearing should have been held. Shanklin, 351 Ill. 
App. 3d at 308.

We do not agree with defendant that the Fourth District’s decision in 
Shanklin compels the same result in the case at bar. …. [In Stevens], there 
was no guilty plea and defendant’s sole basis for claiming unfitness was the 
opinions of the three experts who testified at his suppression hearing and 
who did not discuss or opine to his fitness. …[T]he experts’ opinions alone do 
not provide an arguable basis for finding a bona fide doubt of defendant’s 
fitness. …[U]like in Shanklin, defendant [in Stevens] was not hospitalized for
mental health problems and was only evaluated in the context of his ability 
to waive his Miranda rights. …[T]here is no indication that defendant 
exhibited any conduct to his trial counsel that would have supported a 
request for a fitness evaluation; instead, defendant again focuses solely on 
the experts’ opinions. We cannot find that the failure of trial counsel to 
request a fitness hearing based on these [stale] opinions arguably fell below 
an objective standard of reasonableness….

Moreover, we cannot find that defendant was arguably prejudiced by trial 
counsel’s failure to request a fitness hearing. Our supreme court has 
discussed the standard to be applied in determining whether the failure to 
request a fitness hearing is prejudicial:
“[T]o establish that his trial counsel’s alleged incompetency prejudiced
him within the meaning of Strickland, defendant must show that facts
existed at the time of his trial that would have raised a bona fide 
doubt of his ability to understand the nature and purpose of the 
proceeding and to assist in his defense. Defendant is entitled to relief 
on this postconviction claim only if he shows that the trial court would
have found a bona fide doubt of his fitness and ordered a fitness 
hearing if it had been appraised of the evidence now offered.” Easley, 
192 Ill. 2d at 318­19.
In [Stevens], defendant’s ineffectiveness argument depends solely on the 
experts’ opinions. The same evidence was relied upon in defendant’s 
 argument that the trial court should have sua sponte ordered a fitness 
hearing. There, we concluded that the experts’ opinions, alone, were not 
sufficient to arguably raise a bona fide doubt of defendant’s fitness because 
the opinions did not consider his fitness to stand trial. Thus, there is no 
arguable basis for concluding that the trial court would have ordered a 
fitness hearing if trial counsel had requested one, and defendant’s 
ineffectiveness claim fails on the prejudice prong as well. 

People v. Stephens, 2012 IL App (1st) 110296 at ¶104­107

15. No fitness exams may be ordered to be held at a facility run by the 
Department of Human Services. 725 ILCS 5/104­13

725 ILCS 5/104­13. Fitness Examination. 

    (c) An examination ordered under this Section shall be given at the place 
designated by the person who will conduct the examination, except that if the
defendant is being held in custody, the examination shall take place at such 
location as the court directs. No examinations under this Section shall be 
ordered to take place at mental health or developmental disabilities facilities 
operated by the Department of Human Services.

16. Even if there is no request for a fitness exam and no bona fide doubt of 
fitness, a defendant may still use the defense of not sane at time of the offense 
(temporary insanity or lack of intent due to an altered state of consciousness, not caused by 
defendant – i.e. not drunk and not under influence of self­ingested illicit drugs. A post­
traumatic­stress­disorder (PTSD) flashback would theoretically fit in this category.). People
v. Lowe, 109 Ill. App. 2d 236 (4 Dist. 1969). 

17. Insanity is a legal, not medical term. A mental state problem at the time of the 
offense does not equate to an insanity defense. People v. Lee, 128 Ill. App. 3d 774 (1 Dist. 
1984) Fitness is a legal term and not a psychiatric opinion. If there is no memory of
 events at the time of the offense , or no knowledge by the defendant of the event, then 
there is no insanity defense. People v. Kashney, 129 Ill. App. 3d 218 (1 Dist. 1984). 

18.  One can be unfit but not insane, if one has no knowledge of the event and 
therefore cannot admit to having committed the offense, yet on exam by experts is found 
sane. The court in People v. Stahl, 2013 Ill. App. LEXIS 71 (5 Dist. 2013) held that the 
defendant was unfit for trial as he could not assist defense counsel due to the 
results of a gunshot wound to the head, but he was not insane, as physicians found him 
sane at the time of trial. A classic insanity defense requires knowledge of and 
admission of acts charged. The Illinois Supreme Court upheld that ruling. "Accordingly, 
under article 104 of the Code, amnesia as to the events surrounding the crime does 
not per se render a defendant unfit to stand trial. Rather, the fact that a defendant
cannot recollect the incident at issue is just one of the circumstances that may be 
considered in determining a defendant’s fitness. See 725 ILCS 5/104­16(b)(2) (West 
2010). We therefore hold that a court must consider the totality of the 
circumstances to determine whether a defendant is fit to stand trial." People v. 
Stahl, 2014 IL 115804 

19. Lack of memory for the event is not proof of general incompetence to take 
care of self or represent self but may prove no intent, which is an affirmative 
defense, as an element of many crimes is intent, (Stahl, (supra)) as with, for example, 
those charged with aggravated battery of a peace officer, without knowledge that the person
was a peace officer, at the time of the offense, or without intent to harm them as they were 
delusional or in an altered mental state at the time (such as a PTSD flashback) then there 
is no probable cause under the Illinois battery statute1.  Probable cause exists “if ‘the facts 
and circumstances within [the officer’s] knowledge and of which they had reasonably 
reliable information’ would suffice to ‘warrant a prudent person believing’ that a person has
committed a crime.”   Burke v. Town of Walpole, 405 F.3d 66, 80 (1st Cir.2005) (quoting 
Roche v. John Hancock Mut. Life Ins. Co., 81 F.3d 249, 254 (1st Cir.1996). 

20. If defendant’s experts opine he is not sane at the time of the offense, then 
the state is not authorized to request a general fitness exam. The state holds no 
legal right under the statutes to plead insanity for the defense, when the defense is only 
pleading that the insanity was limited to the time of the offense. However, the defendant is 
unfit for trial as he cannot provide assistance to the defense attorney. A discharge hearing 
must occur at this point. People v. Sedlacek, 2013 Ill. App. LEXIS 172 (5 Dist. March 2013). 
The Department of Mental Health is not required to house defendants who are 
unfit for trial but not in need of mental health treatment and not committable. 
People v. Lang, 62 Ill. App. 3d 688, 378 N.E.2d 1106 (1 Dist. 1978). Least restrictive 
environment is required by law, unless the defendant is proven in an evidentiary hearing to
be too dangerous to release or under civil commitment proceedings he is found to be a 
1
720 ILCS 5/12-3
Sec. 12-3. Battery.
(a) A person commits battery if he or she knowingly without legal justification by any means (1) causes bodily
harm to an individual or (2) makes physical contact of an insulting or provoking nature with an individual.
720 ILCS 5/12-3.05
Sec. 12-3.05. Aggravated battery.
(d) Offense based on status of victim. A person commits aggravated battery when, in committing a battery, other
than by discharge of a firearm, he or she knows the individual battered to be any of the following:
(4) A peace officer:
(i) performing his or her official duties;
(h) Sentence. Unless otherwise provided, aggravated battery is a Class 3 felony.
Aggravated battery as defined in subdivision . . . (d)(4) . . . is a Class 2 felony.
danger to himself or others. Treatment may still be mandated, whether as an inpatient in a
secure facility or as an outpatient, for a period of time to be determined by statute, by the 
court, and by the treating physician. 

21. As the IL fitness statute, 725 ILCS 5/104 does not differentiate between 
someone who is unfit or insane and someone who is temporarily insane or has a 
temporary altered mental status, there is a large hole in the law that leaves the 
latter subject to inappropriate and perhaps overly harsh and burdensome denial 
of their liberty rights. It would be appropriate for a court to certify a question to 
the IL Supreme Court as to whether this law is unconstitutional concerning those
who have temporary insanity or an altered mental state that causes them to 
commit an offense. In addition, this would be an appropriate issue of first impression to 
be addressed by direct appeal if the fitness statute dispositions are used for a person with 
temporary insanity or an altered mental state at time of offense that is fit and sane at other
times.

22. However, the IL statutes for fitness do NOT differentiate between how a person 
found insane versus one found temporarily insane should be handled. There is a total 
absence of law pertaining to the disposition of persons found temporarily insane, 
with lack of intent, and therefore not guilty by reason of temporary insanity. It is 
fundamentally unfair to confine them to a mental institution if they are unlikely 
to be in that temporarily insane state again, or if they are not dangerous while in 
that state.
 
23. 725 ILCS 5/104-14(c) mandates that the Court inform the Defendant that he 
has a statutory right to refuse to answer questions at the BCX exam:
 
Use of Statements Made During Examination or Treatment. 
725 ILCS 5/104-14 (c) The court shall advise the defendant of the limitations on the 
use of any statements made or information gathered in the course of the fitness 
examination or subsequent treatment as provided in this Section. It shall also 
advise him that he may refuse to cooperate with the person conducting the 
examination, but that his refusal may be admissible into evidence on the 
issue of his mental or physical condition. [emphasis added]
  
24. 725 ILCS 5/104-13(d) mandates that the Court MAY not revoke bail if the 
Defendant is ordered to undergo a BCX exam in order to accomplish the exam:
 
Fitness Examination.
725 ILCS 5/104-13 (d) Release on bail or on recognizance shall not be revoked and 
an application therefor shall not be denied on the grounds that an examination has 
been ordered. 
 25. Therefore, defendants have a statutory right to refuse to answer questions 
at a BCX exam and this act does not permit the Court to revoke or alter bail for 
violation of the condition of bail to appear at a BCX exam and answer questions. 
The Court may hold the defendant in contempt only if they refuse to show up for the exam.
 
26. The report of the fitness examination ordered from Forensic Clinical Services is due 
within 30 days of the date of the order per 725 ILCS 5/104-15.
 
27. If the court has expressed a bona fide doubt of fitness or if the evaluators 
report opines that the defendant is unfit, then the court must order a due process
fitness hearing; but if a report says a defendant is fit and the judge agrees after a 
request for an exam by the defense or prosecutor, then the court is NOT obligated
to hold a fitness hearing. People v. Hill, 345 Ill.App.3d 620, 803 N.E. 2d 138 (2003); 
People v Hanson, 2012 IL App (3d) 110210­U (2004) “To hold a fitness hearing, the court 
must first hear evidence raising a bona fide doubt of the defendant’s fitness. Eddmonds, 
143 Ill.2d at 518, 161 Ill.Dec. 306, 578 N.E.2d at 959.

28. The fitness hearing must be held within 45 days of receiving the report of 
the fitness exam, regardless of the results of the report per 725 ILCS 5/104-16.:
 
725 ILCS 5/104-16 (a) The court shall conduct a hearing to determine the issue of 
the defendant’s fitness within 45 days of receipt of the final written report of the 
person or persons conducting the examination or upon conclusion of the matter then 
pending before it 

However, there is no legal penalty to the court or state if they refuse to hold the hearing 
within 45 days. This is often abused and the courts may grant continuance after 
continuance, or keep reordering the fitness exam. The law allows this to toll speedy trial.

29. A judge is required to empanel a jury if there are no opinions by expert 
who have examined defendant according to ethical standards of their professions. 
People v. Bickham, 13 Ill.App.3d 857, 301 N.E.2d 172 (5 Dist. 1973). This is because if a 
judge is the party claiming unfitness then the judge is clearly biased and a jury must be the
impartial judge of fitness.

30. Other opinions upholding right to a jury in a fitness trial/hearing include: People v. 
McLain, 37 Ill.2d 173, 226 N.E.2d 21 (1967). [A judge’s observations during hearings cannot
over­rule opinions by defense witnesses that defendant is unfit [or fit]. The Illinois Supreme
Court has held that if facts existed at the time of defendant's trial which, if presented to the
trial court, would have raised a bona fide doubt as to his sanity, the accused would have 
had a right to have a jury impaneled to try the question of his sanity. 
 We further do not believe that the defendant's constitutional rights could be 
satisfied here by remanding the case to the circuit court for a limited hearing 
to determine the defendant's sanity as of the time of his trial. In the recent 
case of People v. Thompson, 36 Ill.2d 332, we held that a limited hearing on 
the question of the defendant's sanity as of the time of his plea would not be 
sufficient and that due process required a full new trial.

Our ruling in the Thompson case was grounded on the authority 
of Pate v. Robinson, 383 U.S. 375, 15 L.Ed.2d 815, where the United States 
Supreme Court considered this question. The Supreme Court held that such 
a limited hearing would not satisfy constitutional requirements of due 
process because of the inherent difficulties there of retrospectively 
determining the defendant's sanity. In that case any hearing would have 
been held six years after the defendant's trial.

 In People v. McLain, 37 Ill.2d 173, 226 N.E.2d 21 (1967)

A jury must be empaneled for a fitness hearing unless waived. People v. James, 130 Ill. 
App.2d 532, 263, N.E.2d 705 (2 Dist. 1970). Defendant has right to waive jury and defense 
counsel cannot take away this right and waive it for defendant. People v. Haynes, 174 Ill.2d 
204, 673 N.E.2d 318 (1996); People v. Smith, 10 Ill.App.3d 61, 293 N.E.2d 465 (1 Dist. 
1973).

31. McDowell v. People, 33 Ill. 121; People v. Anderson, 31 Ill.2d 262; People v. De 
Simone, 28 Ill.2d 72; People v. Richeson, 24 Ill.2d 182; People v. Robinson, 22 Ill.2d 
162; People v. Burson, 11 Ill.2d 360.) An appropriate means for raising the issue of 
defendant's sanity when such facts existed at the time of trial but were unknown to the 
court is a petition in the nature of a writ of error coram nobis, which has been abolished 
and is now replaced by 1301 motions to reconsider if up to 30 days post decision and 1401 
petitions to reinstate case and reconsider more than 30 days after trial decision. 
McDowell v. People, 33 Ill.2d 121; People v. Anderson, 31 Ill.2d 262;  735 ILCS 5/2­1401 If 
the defendant is in custody, then an appeal or a petition for writ of habeas  corpus would be 
more appropriate than a 1401 petition. A formal petition for writ of error has been replaced 
by appeal.

32. Defendant, unless physically too ill, must be allowed to attend fitness 
hearing and cannot be barred, even if they are making outbursts or are verbally 
aggressive. People v. Lawrence, 123 Ill App 2d 513, 270 N.E.2d 510 (1 Dist. 1971), 725 ILCS
5/104­16(c).

33. It is well settled in Illinois that where no bona fide doubt as to a defendant's 
competency to stand trial exists, a psychiatric report shows defendant fit and the defendant
moves for or acquiesces in the withdrawal of a petition requesting a fitness hearing, there is
no abuse of discretion where the court fails to hold a fitness hearing sua sponte. Hill 
(Supra); People v. Hicks, 35 Ill. 2d 390, 394, 220 N.E.2d 461 (1966); People v. Mayhew, 18 
Ill. App. 3d 483, 488, 309 N.E.2d 672 (1974).

34. The details of the forensic examiner’s report have no bearing on scheduling the 
fitness hearing. A judge may not continue to re­order the BCX until he obtains a 
report of fitness or no fitness even if the defendant refuses to cooperate and the 
examiner reports he is unable to determine fitness, in order to delay a hearing. 
The hearing is a statutory right and delaying the hearing because the report says 
that the examiner cannot determine fitness due to failure to cooperate does NOT 
toll this statutory time period of 45 days after the report is received. A judge has 
no legal authority to mandate that the defendant must answer questions. [no case 
law available on this, but this is writer’s opinion based on case law as to plain language 
interpretation of a statute ­ Case law concerning plain language interpretation of law: The 
fundamental rule of statutory construction is to ascertain and give effect to the legislature's
intent.  People v. Pack, 224 Ill.2d 144, 147, 308 Ill.Dec. 735, 862 N.E.2d 938 (2007).   The 
language of the statute is the best indication of legislative intent, and we give that 
language its plain and ordinary meaning.  Pack, 224 Ill.2d at 147, 308 Ill.Dec. 735, 862 
N.E.2d 938.   We construe the statute as a whole and cannot view words or phrases in 
isolation but, rather, must consider them in light of other relevant provisions of the statute.
 People v. Beachem, 229 Ill.2d 237, 243, 321 Ill.Dec. 793, 890 N.E.2d 515 (2008).]

35. A defendant has a statutory right to continue to refuse to answer 
questions. 725 ILCS 5/104-14(c)  In general if a defendant refuses to answer questions, it 
is futile to re­order the fitness exam. The result is that there will be no forensic examiner’s 
recommendation as to whether or not the defendant is fit. The fitness hearing will have 
to proceed without professional opinion based solely on other witnesses called by
the court, which may include the transcript of statements made by the defendant and 
pleadings written by the defendant. 

[T]he trial court’s decision to appoint an expert to examine a defendant 
has no bearing on the court’s ultimate conclusion as to whether a bona fide
doubt as to the defendant’s fitness to stand trial has been raised. Hill 803 
N.E. 2d 138, at 145.
 
36. Courts may still determine fitness even though the forensic psychiatry 
examiner is unable to determine fitness based on defendant’s unwillingness to 
cooperate: 

COURTS DETERMINE FITNESS BASED ON THREE FACTORS: the 
defendant’s irrational behavior, the defendant’s demeanor at trial, and any 
 prior medical opinion on the defendant’s competence to stand trial.  Hill 
803 N.E. 2d 138, at 145. [emphasis added]
 
Although the . . . [the expert] was not able to “come to [a] definitive opinion in 
regards to defendant’s fitness to stand trial,” this failure was due to defendant’s lack
of cooperation. Hill 803 N.E. 2d 138, at 145.
 
In Hill case the court concluded that the defendant was fit to stand trial. A previous, 
though not contemporaneously timely exam had determined defendant was mentally ill but
fit to stand trial and the judge’s observations in court led him to conclude the defendant 
understood the players in the court and the charges against him.
 
While these reports provide some evidence of mental illness, they are insufficient to 
counter the several indications in the record that defendant understood and 
participated at trial . . . . [and] exhibited no irrational behavior.  Hill 803 N.E. 2d 
138, at 146
 
37. Evidence presented at the fitness hearing may include a report from 
forensic clinical services, or from private psychiatrists and psychologists 
retained by either side. The report may state that the defendant is fit or unfit for trial 
and the examiners detailed reasoning and clinical judgment as to why he came to that 
conclusion, or may simply be a statement that the examiner was unable to make 
this determination at the exam because the defendant was unable or unwilling to 
cooperate with questions.

38. In People v. Williams, 87 Ill. App.3d 860 (1980), the Illinois Supreme Court held 
that a judge may not substitute his observations of a defendant’s sanity at the 
time of trial for the unrefuted opinions of expert witnesses. [[A]lthough courts have 
properly rejected psychiatric testimony as to a defendant's unfitness, and have found a 
defendant fit to stand trial, such determinations of fitness were made after a court has 
heard conflicting testimony; we have found no cases in which a trial court has been 
permitted to reject conclusions of experts who agreed that a defendant was unfit to stand 
trial.] In People v. Bilyew(1978), 73 Ill.2d 294, 383 N.E.2d 212, the supreme court pointed 
out that the credibility and weight to be given psychiatric testimony is for the trier of fact; 
the trial judge is to analyze and evaluate the factual bases for experts' opinions rather than
to rely on the ultimate opinions themselves. Indeed, it is clear that the trial judge is not 
obliged as a matter of law to accept opinions of psychiatrists. (People v. Deizman (1976), 44 
Ill.App.3d 829, 358 N.E.2d 1208.) Further, the conclusions of experts are only as valid as 
the bases or reasons for them. (People v. Walker (1979), 77 Ill.App.3d 227, 395 N.E.2d 
1087.) 

39. A finding of unfitness is a final appealable order. 725 ILCS 5/104­16(e)
 
 40. I recommend that during fitness exams that the defendant should have a 
right set in the statutes to have a tape recording, video recording, or silent 
witness present (especially if they are mentally incompetent, youthful, or have been 
abused by police or medical staff in the  past and need someone’s presence to keep them 
calm and cooperative).

There is NOTHING in the American Psychiatric Association’s ethical standards or the 
Association of Psychiatry and the Law ethical standards that suggest universally that a 
silent witness or recording would interfere with the examiner’s ability to obtain an accurate
examination.  Of course, in some situations a witness could be intimidating and that would 
interfere with the exam, but there are also instances, such as with a child, with a person 
with PTSD or who is claustrophobic, or the mentally ill or mentally challenged that a 
person would be comforted and more likely to give accurate answers to the examiner if they
were present. The stated policy of the Cook County Circuit Court Forensic Examiner that 
witnesses universally interfere with exams has not basis in fact.

Unless this is done, the defendant will have no due process means of having the medical 
examiner’s interview reviewed by other professionals for standard of care and accuracy.  
The defendant would have no way of refuting a false mental health diagnosis made by an 
incompetent examiner outside the standard of care of the profession.  This would deny due 
process.

41. The United States Supreme Court in Indiana v. Edwards (2008) went 
beyond Faretta and stated that even if a defendant is mentally fit to stand trial, 
the State may deny the defendant the right to self­representation on grounds that
he is mentally not competent to represent himself IF HE WOULD BE DENIED A 
FAIR TRIAL. They stated that mental illness is not a unitary or static concept and that 
the trial judge must carefully consider this issue. Yet they set NO guidelines as to the 
definition of mental competency to self­representation and specifically rejected 
Indiana’s blanket bar on self­representation if the court finds the defendant cannot 
“communicate coherently.”
 
42. This poses a dilemma for the court as the court must itself determine 
mental competency for self­representation without any guidelines at present.
 
43. Regardless of the result of the forensic clinical exam and the examiner’s report, I 
recommend that the judge should question the defendant and have this on the record. 
Particularly with very intelligent and legally savvy defendants who refuse to answer 
questions at a fitness exam because they feel the fitness order was illegal and unjustified or
because they disagree with the court’s dicta [U.S. Supreme Court dicta in Estelle v. Smith, 
451 U.S. 454 (1981) that the defendant has no constitutional fifth amendment right to have 
a witness present during a fitness exam or a recording of the fitness exam], it is important 
for the judge to question the defendant on the record to verify fitness and competence for 
self­representation. The answers to these questions can then be utilized by the court in lieu 
of a professional’s fitness exam report to determine the issue of fitness, but not the issue of 
mental illness. A professional forensic psychiatric exam is not really necessary to determine
fitness, but is necessary to determine if the defendant suffers from mental illness.

The questions should include the following: 

1) if the defendant is able to formulate questions logically that address specific issues 
related to his case (the judge could ask the defendant a hypothetical case about a 
crime and what a witness saw, asking the defendant to take notes, and then ask him
what they would ask the witness on the stand), 
2) if the defendant understands the role of the players in the court, 
3) if the defendant understands the charges against him or what he is accused of, 
4) if the defendant understands the possible sentence and what the word sentence 
means,
5) if the defendant understands the meaning or actual consequences of being sentenced
(jail, loss of liberty, parole, not able to make phone calls or visit persons whenever 
they want) as well as what these consequences entail, 
6) if the defendant is oriented as to time, place, and situation (that he is in custody, on 
bail, in a certain place, city, and on a certain date and what that means), 
7) if the defendant expresses basic understanding of the concept of legal research and 
the significance of statutes, codes, and case law, as well as how to accomplish this 
while in custody or on bail (go to law library, use legal resources, talk with an 
attorney) and 
8) if the defendant is able to control his behavior and emotions so that he can 
effectively listen, take notes, and formulate questions including questions to a stand­
by counsel regarding courtroom procedure.

 If all of these issues are answered in the affirmative then the defendant should be 
considered fit for purposes of trial and competent for purposes of self­representation. If the 
defendant meets all these criteria but due to PTSD may have a flashback 
triggered with the questioning of a particular witness due to the topic discussed, 
the court has plenary power to allow a stand­by counsel to question that witness. 
There is to date no case barring this type of order.
 
44. Unfortunately, courts are left to formulate criteria for mental competence 
for self­representation with the United States Supreme Court holding in 
abeyance further decisions upon the criteria for mental competence for self­
representation until further cases reach the Court.

Linda Lorincz Shelton © 2018