Abstract
The view that mental disorders can excuse a person for a particular action is widespread. It is supported by psychiatrists, ethicists and lawyers and is reflected in criminal law, via the insanity defence. It remains a matter of debate, however, exactly how mental disorders affect a person’s moral responsibility. The purpose of this paper is to develop a conceptual framework that can help explicate and straightforwardly communicate our intuitions on mental disorder and diminished responsibility. Four factors are identified which contribute to the explanation of why mental disorders excuse. The first concerns the cluster of ‘free will’ or agency-related phenomena (like having alternative possibilities, or being the genuine source of the action); the second factor concerns extreme urges; the third factor concerns false beliefs; the fourth factor is moral sensitivity. Referring to one or more of these factors should enable us to explain the various instances in which we either partially or completely excuse a person because of a mental disorder.
This is a preview of subscription content, log in via an institution to check access.
Access this chapter
Tax calculation will be finalised at checkout
Purchases are for personal use only
Notes
- 1.
In this chapter, I will not address the question whether or why, in general, it is justified to hold people responsible for their actions; I will assume that human beings are generally responsible for their actions, and that at least in some cases mental disorders can undermine such responsibility.
- 2.
Given this approach, in this paper I am not committed to a particular account of moral responsibility, like the one suggested by Fischer and Ravizza (1998). Such commitment would render the model only applicable to those supportive of – and familiar with – this view.
- 3.
Morse (2007) for instance, criticizes this view.
- 4.
- 5.
Whereas the focus of the paper is to explain our moral responses, the analysis is informed by discussions on moral responsibility as well as legal responsibility. This is in line with, e.g., the accounts by Pouncey and Lukens (2010) and Elliott (1996) who do not make a strict distinction between the moral and legal domain as far as relationship between responsibility and mental disorder is concerned. Notably though, jurisdictions vary considerably worldwide in the exact way they approach ‘criminal responsibility’. Still, there appears to be a profound and shared view reflected by these different legal systems: that somehow mental disorders can excuse. The present paper tries to build a framework from an ethical perspective that could also inform the legal/forensic debate.
- 6.
They feature in various forms in legal and ethical debates on criminal and moral responsibility of people suffering from a mental disorder (see the next sections for references). Often an attempt has been made to understand exculpation using (only) one overarching concept, like free will, or irresistible impulse. For an overview within the context of the insanity defence, see Elliott (1996).
- 7.
Such as compatibilism and (hard) incompatibilism, and the specific notions of free will that have been developed within the context of these positions (Kane 2002).
- 8.
It is virtually impossible to talk about free will in a way that would not conflict with any of the many metaphysical positions on free will (Kane 2002). Since free will is central to many ethical as well as forensic psychiatric considerations of moral responsibility and to the effects of mental disorder on responsibility, I take the concept of free will – in spite of the many metaphysical complexities – as the first factor to examine in order to find out why mental disorders sometimes excuse.
- 9.
- 10.
I do not take these reasons to be, for instance, ‘reasonable’, or ‘rational’, or ‘the right reasons’, or the result of a perfect reflective process or of an infallible perception apparatus. Of course, the reasons may be the result of such perfect processes, and the reasons may be ‘reasonable’, or ‘rational/right’, but the aspect of free will that is considered here merely brings forward that the action was responsive to or based on reasons (no matter their specific nature).
- 11.
Surely, the tic may be influenced by – or a response to – another person’s behaviour or certain features of the situation. But the tic itself is not generated ‘for a reason’ in the sense our behaviour usually is. Meanwhile, not all tics are performed involuntarily according to patients themselves, see Lang (1991), Verdellen et al. (2008).
- 12.
Note that in the Tourette case, people might also want to refer to the lack of alternative options with respect to tics in order to explain why they excuse a Tourette patient for a particular action.
- 13.
Irresistible impulses have been considered relevant for the insanity defence, see Elliott (1996), the Irresistible impulse test in criminal law.
- 14.
DSM-IV criteria for kleptomania are: A. Recurrent failure to resist impulses to steal objects that are not needed for personal use or for their monetary value. B. Increasing sense of tension immediately before committing the theft. C. Pleasure, gratification, or relief at the time of committing the theft. D. The stealing is not committed to express anger or vengeance and is not in response to a delusion or a hallucination. E. The stealing is not better accounted for by Conduct Disorder, a Manic Episode, or Antisocial Personality Disorder (American Psychiatric Association 1994). Notably, these criteria do not state that the impulses are irresistible; they merely state that there is recurrent failure to resist.
- 15.
Within the context of mental disorder, however, it is not primarily the absence of correct knowledge but the presence of false belief that appears to be most relevant with respect to diminished responsibility.
- 16.
Notably, a person is not responsible for this delusional belief; it is the result of a mental disorder he could not have avoided, and for which he is not held responsible (Edwards 2009).
- 17.
However, as indicated at the beginning of this section, mental disorders are more likely to lead to distorted knowledge than to a mere lack of knowledge (like in amnesia).
- 18.
Of course, more information about the case would be necessary in order to reach a final decision on these matters. Meanwhile, we might still think that M’Naghten’s response was blameworthy: one should not kill the prime minister, even not in case one is convinced that he causes one nothing but trouble.
- 19.
Still, a vivid debate is going on about how to understand the specific capacity that is lacking in psychopaths. According to some, the problem psychopaths face has to do with certain ‘moral beliefs’ (Maibom 2008). Then, this fourth element of the proposed framework may in fact merge into the third element: (false) beliefs.
- 20.
Christian Perring has provided an insightful account of the concept of mental disorder in which the idea of ‘involuntariness’ is central. He writes (Perring 2004, p. 489): ‘I will propose and test the thesis … that all behavioral symptoms of mental disorders must be involuntary.’ He understands involuntariness to come in three different forms (Perring 2004, p. 496): ‘To summarize, I have found three ways in which we can count a form of behavior as involuntary: (a) It is the result of an irresistible craving or overpowering fear. (b) It is the result of an aberrant and temporary desire external to a person’s true personality. (c) It is the result of a delusion. I am proposing involuntariness of all symptoms as a necessary condition of mental disorder, not a sufficient one.’ Although there are several significant differences between his approach/proposal and mine, there are similarities as well, mainly with respect to distinguishing between delusions (although I prefer false beliefs, which includes false beliefs arising from hallucinations as well as delusions) and not being the source (b) of the action. The proposed model also contains more (and different) elements than the one proposed by Steve Matthews (2004), who basically addresses the legal insanity defence. He proposes to leave out any reference to mental disorders, ‘referring instead to a defence of failed agency’. According to Matthews (2004, p. 452), ‘the test of responsible agency … is failed if any one of the following three conditions is satisfied: (a) the person lacked the capacity to understand the nature of what he or she was doing; or (b) the person lacked the capacity to understand that what he or she was doing was wrong (that is, the person’s conduct was insufficiently reasons-responsive, constitutively speaking, to conventional, moral or legal codes of behaviour); or (c) the person was unable to control his or her conduct.’ As is clear from this quotation, Matthews conceives of the insanity defence in terms of circumscribed incapacities.
- 21.
One can argue that it is relevant these that false delusional beliefs were acquired ‘unfreely’. For if the person had freely chosen to believe the contents of the delusion then the person would be considered responsible. Yet, my response to this objection is that the fact that the delusional false belief has been acquired involuntarily is already entailed by the fact that we say that it was due to a mental disorder, because, as Edwards points out, people are not considered responsible for the disorder (Edwards 2009).
References
American Psychiatric Association. 1994. Diagnostic and statistical manual of mental disorders-IV. Washington, DC: American Psychiatric Association.
Bentall, R.P., G. Rowse, N. Shryane, P. Kinderman, R. Howard, N. Blackwood, R. Moore, and R. Corcoran. 2009. The cognitive and affective structure of paranoid delusions: A transdiagnostic investigation of patients with schizophrenia spectrum disorders and depression. Archives of General Psychiatry 66: 236–247.
Bortolotti, L. 2010. Delusions and other irrational beliefs. Oxford: Oxford University Press.
Braham, L.G., P. Trower, and M. Birchwood. 2004. Acting on command hallucinations and dangerous behavior: A critique of the major findings in the last decade. Clinical Psychology Review 24: 513–528.
Edwards, C. 2009. Ethical decisions in the classification of mental conditions as mental illness. Philosophy, Psychiatry, and Psychology 16: 73–90.
Elliott, C. 1996. The rules of insanity. Moral responsibility and the mentally ill offender. Albany: State University of New York.
Fields, L. 1987. Exoneration of the mentally ill. Journal of Medical Ethics 13: 201–205.
Fine, C., and J. Kennett. 2004. Mental impairment, moral understanding and criminal responsibility: Psychopathy and the purposes of punishment. International Journal of Law and Psychiatry 27: 425–443.
Fischer, J.M., and M. Ravizza. 1998. Responsibility and control. A theory of moral responsibility. Cambridge: Cambridge University Press.
Haji, I. 2010. Psychopathy, ethical perception, and moral culpability. Neuroethics 3: 135–150.
Juth, N., and F. Lorentzon. 2010. The concept of free will and forensic psychiatry. International Journal of Law and Psychiatry 33: 1–6.
Kane, R. 2002. The Oxford handbook of free will. Oxford: Oxford University Press.
Kinscherff, R. 2010. Proposition: A personality disorder may nullify responsibility for a criminal act. The Journal of Law, Medicine & Ethics 38: 745–759.
Lang, A. 1991. Patient perception of tics and other movement disorders. Neurology 41: 223–228.
Litton, P. 2010. Psychopathy and responsibility theory. Philosophy Compass 5: 676–688.
Maibom, H.L. 2008. The mad, the bad, and the psychopath. Neuroethics 1: 167–184.
Malatesti, L., and J. McMillan (eds.). 2010. Responsibility and psychopathy. Interfacing law, psychiatry, and philosophy. Oxford: Oxford University Press.
Matthews, S. 2004. Failed agency and the insanity defence. International Journal of Law and Psychiatry 27: 413–424.
McKenna, M. 2009. Compatibilism. Retrieved March 23, 2011, from http://plato.stanford.edu/entries/compatibilism.
Mele, A. 1995. Autonomous agents. From self-control to autonomy. New York: Oxford University Press.
Meynen, G. 2010. Free will and mental disorder: Exploring the relationship. Theoretical Medicine and Bioethics 31: 429–443.
Morse, S.J. 2007. The non-problem of free will in forensic psychiatry and psychology. Behavioral Sciences & the Law 25: 203–220.
Muller, S., and H. Walter. 2010. Reviewing autonomy: Implications of the neurosciences and the free will debate for the principle of respect for the patient’s autonomy. Cambridge Quarterly of Healthcare Ethics 19: 205–217.
O’Connor, T. 2010. Free will. Retrieved February 2, 2011, from http://plato.stanford.edu/entries/freewill/.
Olatunji, B.O., J.M. Cisler, and B.J. Deacon. 2010. Efficacy of cognitive behavioral therapy for anxiety disorders: A review of meta-analytic findings. The Psychiatric Clinics of North America 33: 557–577.
Perring, C. 2004. Conceptual issues in assessing responsibility for actions symptomatic of mental illness. International Journal of Law and Psychiatry 27: 489–503.
Perring, C. 2010. Mental illness. Retrieved September 21, 2011, from http://plato.stanford.edu/entries/mental-illness/.
Pouncey, C.L., and J.M. Lukens. 2010. Madness versus badness: The ethical tension between the recovery movement and forensic psychiatry. Theoretical Medicine and Bioethics 31: 93–105.
Reich, W. 2005. Psychiatric diagnosis as an ethical problem. In Psychiatric ethics, 3rd ed, ed. S. Bloch, P. Chodoff, and S. Green, 193–224. Oxford: Oxford University Press.
Sadock, B.J., and V.A. Sadock (eds.). 2005. Kaplan & Sadock’s comprehensive textbook of psychiatry, 8th ed. Philadelphia: Lippincott Williams & Wilkins.
Stone, A.A. 2008. The ethical boundaries of forensic psychiatry: A view from the ivory tower. The Journal of the American Academy of Psychiatry and the Law 36: 167–174.
Strawson, P.F. 2003. Freedom and resentment. In Free will, ed. G. Watson, 72–93. Oxford: Oxford University Press.
Verdellen, C.W., C.A. Hoogduin, B.S. Kato, G.P. Keijsers, D.C. Cath, and H.B. Hoijtink. 2008. Habituation of premonitory sensations during exposure and response prevention treatment in Tourette’s syndrome. Behavior Modification 32: 215–227.
Walter, H. 2001. Neurophilosophy of free will. From libertarian illusions to a concept of natural autonomy. Cambridge, MA: MIT Press.
Widerker, D., and M. McKenna (eds.). 2003. Moral responsibility and alternative possibilities: Essays on the importance of alternative possibilities. Aldershot: Ashgate.
Acknowledgment
I thank Alan Ralston, MD, for his helpful comments.
Author information
Authors and Affiliations
Corresponding author
Editor information
Editors and Affiliations
Rights and permissions
Copyright information
© 2013 Springer Science+Business Media Dordrecht
About this chapter
Cite this chapter
Meynen, G. (2013). Why Mental Disorders Can Diminish Responsibility: Proposing a Theoretical Framework. In: Musschenga, B., van Harskamp, A. (eds) What Makes Us Moral? On the capacities and conditions for being moral. Library of Ethics and Applied Philosophy, vol 31. Springer, Dordrecht. https://doi.org/10.1007/978-94-007-6343-2_13
Download citation
DOI: https://doi.org/10.1007/978-94-007-6343-2_13
Published:
Publisher Name: Springer, Dordrecht
Print ISBN: 978-94-007-6342-5
Online ISBN: 978-94-007-6343-2
eBook Packages: Humanities, Social Sciences and LawPhilosophy and Religion (R0)