Psychiatric Disorder and the Reactive Attitudes
There are some notoriously difficult questions about when, and how far, people with psychiatric disorders are responsible for their actions. One reason for these questions being so difficult is our limited understanding of these disorders. Another is that some conditions, such as compulsions and addictions, have blurred boundaries. So such questions as “was he responsible?” and “could she help doing it?” do not always admit of “yes” or “no” answers. These complications make matters difficult enough. But there is a further set of problems, to be the focus of attention here, raised by the fact that some psychiatric and neurological conditions cause long term changes in character and personality. How should the legal system respond to antisocial actions flowing from these changes? And, at least as important, how should those who know such people respond to these deep changes in them?
1. Excuses as a defence of character.
It is worth for a moment leaving aside psychiatric disorder, and looking at responsibility and excuses in general. It is widely agreed that Aristotle was right in seeing ignorance and compulsion as the two central classes of excuses. That ignorance and compulsion have this dominant position reflects the way our judgements of responsibility are guided by an interest in the person’s motives, values and character. If a man knowingly steals money, this reflects on his honesty in a way that being oblivious of a banknote among a loose pile of papers he is picking up does not. If a woman hands over the key to the safe because the robber is armed and dangerous, this reflects fear rather than any desire to help with the robbery. What matters is the motivation behind the action, and understanding the motivation contributes to our picture of the person’s values and character. Pleas of ignorance (“He did not notice the banknote”) and of compulsion (“She was forced to hand over the key”) defend a person’s character. If accepted, they defeat the claim that he is a thief or that she was complicit with the robber.
When mental disorder counts as an excuse, it is often because it supports a claim of ignorance or compulsion. Often the psychiatric versions of these two pleas raise special problems of their own. Someone may be ignorant of what he is doing because of his deluded state, but there are often difficulties for an observer, whether a psychiatrist or anyone else, in deciding how far he was in fact deluded. And the particular cognitive distortions that are characteristic of delusions often seem strange enough to raise difficult questions of interpretation. Psychiatric states may involve a degree of compulsion, but again the “inner” compulsion of addiction or of obsessive-compulsive disorder is often much harder to establish than the external and visible compulsion when the robber brandishes a gun.
There are well-known philosophical models for thinking about cases of conflict, such as unwilling addiction. One is Harry Frankfurt’s use of second-order desires. (1.) His “wanton” is someone with only first-order desires: someone who only wants to have things, do things, etc., but does not have any preference for having some desires over others or about which desires win out over others. Most of us are not wantons, but have second-order desires and preferences, being glad not to have the desires of a paedophile, or wishing our desire to exercise was stronger than our desire to sit talking over coffee. The unwilling addict is characterized by having a second-order desire to escape the dependence, which conflicts with a first-order desire to take the drug. Where the first-order desire wins out, the addict is unfree, because the real self, identified with the higher-order desire, is defeated.
One problem for this view is why a person’s real self should be identified with higher-order desires rather than with first-order desires. This has led to an alternative strategy. One version is Frankfurt’s own: sometimes a person just does “decisively identify” with one set of desires rather 