Arpalyclaimsthatthefactthatanydisorderisamentaldisorderdoesnotitselfprovide judgement-thatistosay,thefactthatamentaldisorderismedicallyclassifiedassuchdoesnot itselfprovidelegaljudgementonthebehavioursofthepersonwiththedisorder Hermain argumentisthatthesituationiscomplicated.Shegivestheexampleofaschizophrenicwho, believingsomeonetobethedevil,murdersthem-andarguesthatthisactionisunintentional,and thereforetheschizophrenicisnotblameworthy.Asacontrast,sheofferstheexampleofthose withantisocialpersonalitydisorder,orotherdisorderswithanunusuallyhighdegreeof amorality,committingacrime,andsaysthattheperson’samoralitymakesthecriminalact intentionalandthereforethepersonblameworthy.Shealsocitescomplicatedcases,suchasthose ofLisathekleptomaniac,whostolemoneyfromheremployer,butalsohasaremarkably complicatedmedicalandpsychiatrichistory,aswellasfamilysituation.Forthiscasein particular,Arpalynotes“thereisafeelingthatwedonotknowenough—bothaboutthenatureof kleptomaniaingeneralandaboutthisparticularunreliableyoungwoman—tohaveafirm convictiononthematter…thefactthatkleptomaniacountsasamentaldisorderdoesnotbyitself providethejudgement”(Arpaly2005,pp.294).Thus,shesaysthatthesubjectivenatureof diagnosesandmentaldisordersmakesjudgementinsomecasesimpossible-andthatthefactthat adisorderisclassifiedasadisorderdoesnot,initself,levyjudgementonaperson’sactions.
However,Arpaly’sargumentistooambiguous.Itmustbeasked-atwhatpointdowe drawtheline?Atwhatpointaresomeone’sactionsconsideredontheirown,independentofthe individual’smentalillness,asopposedtojustasymptomorafunctionofthedisorder?
Whatfactorsmustbeconsideredtodeterminewhereornotitmattersifanactionisa symptom?Ifittrulyisamatterofintention,asArpalyargues,thenwhatdetermines intentionality?Isittheseverityandsymptomsoftheillness?Thewarrantoftheindividual’s
mentalstate?Theseverityoftheaction?Evenunintentionallywrongactionscanhavesevere negativeconsequences.Howcanweexplainandreconcilethisharm,ifnotbyassigningblame insomecapacity?
Arpalyverydecisivelystatesthataschizophrenicthatcommitsmurderwhileina delusionalepisodeisnotresponsiblefortheiractions.However,diagnosesforseveral“severe” mentalillnesseshavemorethandoubledinthelasttwentyyears(Frances2013),whiletheDSM andconventionalcriteriafordiagnosishaveloosened(Fabiano2020).Isitpossible,then,that someindividualswillbeincorrectlydiagnosedwithamentalillnessthatexcusestheirsevere misbehaviors?Willitalsobepossible,fromapurelylegalstandpoint,thatindividualsguiltyof seriouscrimeswillbeabletogetdiagnosesthatexcusethemfromrepercussions?
Furthermore,inmanycases,offenderswhoclaimmentalillnessasalegaldefenceoften carrydiagnosesalready.Consideringthepriorknowledgepresentinthesesituations,howdowe judgeresponsibility?Forexample,imagineyouhaveafriendwithapeanutallergy.Ifthisfriend goestoarestauranttoeat,itistheirresponsibilitytochooseitemsoffthemenuthatdonot containpeanuts,andaskthekitchenstafftoensurethereisnocross-contamination.Ifyourfriend ordersadishwithpeanuts,ordoesnotmentiontheirallergytothestaffatall,andthenhasan allergicreaction,youwouldnotsaythattheirallergicreactionisnot,tosomeextent,theirfault. Instead,youwouldadmonishthemfornottakingthenecessaryprecautions.Inasimilarthread, taketheearliercaseofLisa.Asadiagnosedkleptomaniac,sheshouldhavebeenableto accuratelyascertainherhabits,andconcludethatshecannotbetrustedinajobthatinvolves handlingmoneyorothervaluables.Lisamaynothavecontroloverheractions,butshe knows hertendencies,andtheyarethereforeherresponsibilities.
Thisisnotunreasonable-anarticleaboutDissociativeIdentityDisorderin The Cut mentionsthat theinterviewedindividualdisclosedherconditiontoherworkplacemanagerandfellow employees(Feidelson2021).
Allofthesequestionsareworthaskingandconsidering,asambiguityandlackof distinctionsinArpaly’sclaimcanhavefar-reachingconsequences.Wemustbeabletojudge, withsomecertaintyatleast,howresponsibleanindividualisforhisorheractions,whetheror nottheyoccurinconjunctionwithamentalillness.
References
Arpaly,N.(2005).Howitisnot“Justlikediabetes”:Mentaldisordersandthemoral psychologist. Philosophical Issues, 15(1),282–298.
https://doi.org/10.1111/j.1533-6077.2005.00067.x
Fabiano,F.,&Haslam,N.(2020).DiagnosticinflationintheDSM:Ameta-analysisof changesinthestringencyofpsychiatricdiagnosisfromDSM-IIItoDSM-5. Clinical Psychology Review, 80,101889.https://doi.org/10.1016/j.cpr.2020.101889
Feidelson,L.(2021,August10). Meet my multiple mes.TheCut.
https://www.thecut.com/2021/08/dissociative-identity-disorder-youtube.html
Frances,A.(2013).Thepast,presentandfutureofpsychiatricdiagnosis. World Psychiatry, 12(2),111–112.https://doi.org/10.1002/wps.20027