The Rules of Insanity: Moral Responsibility and the Mentally Ill Offender by Carl Elliott

by Carl Elliott

A particularly lucid look at the philosophical and psychiatrical framework for judging moral responsibility with mentally ill offenders. Elliott (McGill Centre for Medicine, Ethics, and Law) sets the standard for his discussion by detailing the insanity plea within its legal context, and attending t

Paperback Bunko

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.