hief 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 than another. Another version is shared by Gary Watson and Charles Taylor: what matters is not different orders of desires, but the contrast between desires and values. I am free when the desires that win out are in harmony with my deepest values, and I am unfree when dominant desires and deepest values are in conflict. There is considerable plausibility to this approach, although it leaves open difficult questions about how the distinction between desires and values is to be drawn and about how, when values are in conflict, we are to decide which are deepest. (2.)
2. “It wasn't the real me": character-distorting conditions.
In these cases of conflict, a “psychiatric” condition seems to have taken over part of a person. Even more difficult are the issues raised when a psychiatric disorder seems to take over and distort someone’s whole personality and character. How should we think about such cases?
On the one hand, accepting or rejecting an excuse is largely about how far an apparently bad action does or does not reflect the person’s character. Excuses protect character by disconnecting it from objectionable actions. So it seems strange to allow as an excuse the claim that psychiatric disorder has changed a person’s character for the worse. Does not such a plea mean that the person’s present character is open to precisely the sort of criticism that the objectionable action suggests?
On the other hand, where a medical condition brings about a radical transformation of character, we are inclined to say that “it is not him but his illness”. The easygoing, friendly man we all knew for many years becomes unrecognizably difficult, stubborn, and bad-tempered as his dementia progresses. Or a woman’s whole personality is changed for the worse when she gets a brain tumour. We may feel that blaming them for what they now do shows a lack of understanding. The behaviour is surely down to changes in the brain over which they have no control. The same psychological changes may lie in wait for any of us, if our brains start to g