The Rules of Insanity: Moral Responsibility and the Mentally Ill

by Carl Elliott

Addresses the Can we apply ordinary standards of responsibility to the mentally disordered offender?

In The Rules of Insanity, Carl Elliott draws on philosophy and psychiatry to develop a conceptual framework for judging the moral responsibility of mentally ill offenders. Arguing that there is little useful that can be said about the responsibility of mentally ill offenders in general, Elliott looks at specific mental illnesses in detail; among them schizophrenia, manic-depressive disorders, psychosexual disorders such as exhibitionism and voyeurism, personality disorders, and impulse control disorders such as kleptomania and pyromania. He takes a particularly hard look at the psychopath or sociopath, who many have argued is incapable of understanding morality. Making extensive use of psychiatric case histories, Elliott explores the various ways in which mental illness can affect a person’s intentions and thus excuse him or her from moral responsibility.

"This is the best discussion of the insanity defense and diminished capacity that I have seen from an ethics point of view. Other treatments tend to be more legally oriented and to make light of the more fundamental philosophical and ethical issues. What is special is the author's easy familiarity with the clinical problems (he is a physician), his well reasoned, well written, jargon free argument, and his capacity to go back and forth from general principles to particular cases and disorders. This book has a unique niche--its conclusions are responsible--it teaches a lot." -- Michael Schwartz, M.D., Case Western Reserve University

143 pages, Paperback

First published January 1, 1996

About the author

Carl Elliott is a professor of philosophy at the University of Minnesota. Trained in medicine as well as philosophy, Elliott is the recipient of a Guggenheim Fellowship, a National Endowment for the Humanities Public Scholar Award, the Cary and Ann Maguire Chair in Ethics and American History at the Library of Congress, a resident fellowship at the Rockefeller Center in Bellagio, and the Weatherhead Fellowship at the School for Advanced Research in Santa Fe. His writing has appeared in The New Yorker, The Atlantic, The New York Review of Books, The New York Times, Mother Jones and The American Scholar. He has been a visiting faculty member at the Institute for Advanced Study in Princeton, the University of Sydney, and the University of Otago in New Zealand, where he is an affiliate of the Bioethics Centre.

Reviews

[Michael · Rating 5 out of 5]

When it comes to the literature of moral responsibility, I much prefer philosophers to psychologists and psychiatrists. The latter two professions tend to take a hard deterministic view of human behavior, according to which a person's decisions are wholly determined by heredity and environment with no room for free will. That leaves no room for nuance--no one could be morally responsible for anything.

Philosophers can be hard determinists, although most are either soft determinists (compatibalists) or libertarians on the will. All would agree that someone who is severely mentally ill to the point of not recognizing reality or not understanding right and wrong is not morally responsible for his actions. Where Eliot goes against the current psychological and psychiatric zeitgeist is in his view that a person with a personality disorder is morally responsible for his acts despite having a somewhat distorted view of reality due to his disorder. His one exception is the psychopath; when this book was written it was thought that a true psychopath has no conscience. Later research has suggested that psychopaths have a conscience but are able to turn it off or on at will.

The current trend is to deny moral responsibility or at least hold that it is greatly mitigated in people with personality disorders. Elliot is willing to admit this in extreme situations such as a person with borderline personality disorder who acts while in a fugue state. In general, however, Elliott considers personality disorders to be character flaws. This is, I think, correct, and is obscured by the social sciences' attempt to remain "non-judgmental." Yet people with personality disorders are not causally determined by their disorder to do act A instead of acts B or C. Rather, they are able to choose which action to perform, though their disorder makes it difficult at times to do the right thing. They remain morally responsible for the bad actions they perform.

Elliot does a service not only to the public at large, but also to sufferers of personality disorders. Many times the refusal of people with personality disorders (especially the Cluster B disorders--narcissistic, histrionic, borderline, and antisocial personality disorders) is due to their failure to take responsibility for their bad actions. Instead, they blame others. If they realize they do have moral responsibility for their actions, that is wrong to say, "I can't help who I am," then effective treatment is possible. Elliott's approach offers a better way of appraising personality disorders and a way out of the suffering by holding people with personality disorders accountable for their actions.