Mental Illness and Moral Discernment: A Clinical Psychiatric Perspective
Keywords:free will, psychiatry, mental illness, theological anthropology, determinism, moral responsibility, neuropsychology
As a contribution to a wider discussion on moral discernment in theological anthropology, this paper seeks to answer the question “What is the impact of mental illness on an individual’s ability to make moral decisions?” Written from a clinical psychiatric perspective, it considers recent contributions from psychology, neuropsychology and imaging technology. It notes that the popular conception that mental illness necessarily robs an individual of moral responsibility is largely unfounded. Most people who suffer from mental health problems do not lose the capacity to make moral decisions, and mental illness on its own rarely explains anti-social or criminal behaviour. Moreover, the assumptions of some scientists, that recent developments in neuropsychology and brain imaging suggest biological determinism, must be treated with caution.
American Psychiatric Association. 2013. Diagnostic and Statistical Manual of Mental Disorders. Washington, D.C.: American Psychiatric Association Publishing.
Appelbaum, Paul S. 2020. “Violent Acts and Being the Target of Violence Among People With Mental Illness-The Data and Their Limits”. JAMA psychiatry 77, no. 4: 345–46. doi:10.1001/jamapsychiatry.2019.4266.
Cáceda, Ricardo, Charles B. Nemeroff, and Philip D. Harvey. 2014. “Toward an Understanding of Decision Making in Severe Mental Illness”. The Journal of Neuropsychiatry and Clinical Neuroscienes”. 26, no. 3: 196–213. doi:10.1176/appi.neuropsych.12110268.
Cortez, Marc. 2010. Theological Anthropology: A Guide for the Perplexed. London: Bloomsbury T&T Clark.
Cortez, Marc, and Michael P. Jensen, eds. 2018. T&T Clark Reader in Theological Anthropology. London: Bloomsbury T&T Clark.
Gazzinga, Michael. 2011. Who’s in Charge? Free Will and the Science of the Brain. New York, NY: Harper Collins.
Gilligan, Carol. 1982. In a Different Voice: Psychological Theory and Women’s Development. Cambridge, MA: Harvard Univ. Press.
Goldberg, Carey. “Psychopaths: Cold Blood or Broken Circuit? Inmate Brain Scans Find New Flaws”. Accessed March 26, 2020. https://www.wbur.org/commonhealth/2017/07/07/psychopaths-brain-scans-neuron.
Griffith, Meghan. 2013. Free Will: The Basics. London: Routledge.
Hosking, Jay G., Erik K. Kastman, Hayley M. Dorfman, Gregory R. Samanez-Larkin, Arielle Baskin-Sommers, Kent A. Kiehl, Joseph P. Newman, and Joshua W. Buckholtz. 2017. “Disrupted Prefrontal Regulation of Striatal Subjective Value Signals in Psychopathy”. Neuron 95, no. 1: 221-231.e4. doi:10.1016/j.neuron.2017.06.030.
Keyes, Corey L. M. 2002. “The Mental Health Continuum: From Languishing to Flourishing in Life”. Journal of Health and Social Behavior 43, no. 2: 207–22. doi:10.2307/3090197.
Kohlberg, Lawrence. 1981. Essays on Moral Development Vol 1: The Philosophy of Moral Development. San Francisco, CA: Harper & Row.
Meloy, J. R., Anthony G. Hempel, B. T. Gray, Kris Mohandie, Andrew Shiva, and Thomas C. Richards. 2004. “A Comparative Analysis of North American Adolescent and Adult Mass Murderers”. Behavioral Sciences & the Law 22, no. 3: 291–309. doi:10.1002/bsl.586.
Messer, Neil. 2015. “Determinism, Freedom and Sin: Reformed Theological Resources for a Conversation with Neuroscience and Philosophy”. Studies in Christian Ethics 28, no. 2: 163–74. doi:10.1177/0953946815570591.
Meynen, Gerben. 2015. “How Mental Disorders Can Compromise the Will”. In Free Will and The Brain: Neuroscientific, Philosophical and Legal Perspectives, edited by Walter Glannon, 125–45. Cambridge: Cambridge Univ. Press.
Milgram, Stanley. 1963. “Behavioral Study of Obedience”. The Journal of Abnormal and Social Psychology 67, no. 4: 371–78. doi:10.1037/h0040525.
—. 1965. “Some Conditions of Obedience and Disobedience to Authority”. Human Relations 18, no. 1: 57–76. doi:10.1177/001872676501800105.
Murphy, Nancey C., and Warren S. Brown. 2007. Did My Neurons Make Me Do It? Philosophical and Neurobiological Perspectives on Moral Responsibility and Free Will. Oxford: Oxford Univ. Press.
National Health Service. 2019. “Mental Health Act Statistics, Annual Figures 2018-19”. Accessed 24th September 2020. https://digital.nhs.uk/data-and-information/publications/statistical/mental-health-act-statistics-annual-figures/2018-19-annual-figures.
Nielssen, Olav, Dominique Bourget, Taina Laajasalo, Marieke Liem, Alain Labelle, Helina Häkkänen-Nyholm, Frans Koenraadt, and Matthew M. Large. 2011. “Homicide of Strangers by People with a Psychotic Illness”. Schizophrenia Bulletin 37, no. 3: 572–79. doi:10.1093/schbul/sbp112.
Perry, Gina. 2013. Behind the Shock Machine: The Untold Story of the Notorious Milgram Psychology Experiments. New York, NY: The New Press.
Pink, Thomas. 2004. Free Will: A Very Short Introduction. Oxford: Oxford Univ. Press.
Powell, Andrew. 2002. “Good and Evil — a psychiatrist’s perspective” Paper given to 3rd Mental Anguish and Religion Conference on 1st July 2002 at the Institute for Arts, London. https://citeseerx.ist.psu.edu/viewdoc/download?doi=10.1.1.564.6642&rep=rep1&type=pdf.
Ramplin, Steve, and Gloria Ayob. 2017. “Moral Responsibility in Psychopathy: A Clinicophilosphical Case Discussion”. BJPsych Advances 23, no. 3: 187–95. doi:10.1192/apt.bp.115.015321.
Robson, David. 2019. “How to Upgrade Your Thinking and Avoid Traps that Make you look Stupid”. New Scientist, February 20, 2019. https://www.newscientist.com/article/mg24132180-100-how-to-upgrade-your-thinking-and-avoid-traps-that-make-you-look-stupid/
Steadman, H. J., E. P. Mulvey, J. Monahan, P. C. Robbins, P. S. Appelbaum, T. Grisso, L. H. Roth, and E. Silver. 1998. “Violence by People Discharged From Acute Psychiatric Inpatient Facilities and by Others in the Same Neighborhoods”. Archives of General Psychiatry 55, no. 5: 393–401. doi:10.1001/archpsyc.55.5.393.
Swanson, Jeffrey W., E. E. McGinty, Seena Fazel, and Vickie M. Mays. 2015. “Mental Illness and the Reduction of Gun Violence and Suicide: Bringing Epidemiologic Research to Policy”. Annals of Epidemiology 25, no. 5: 366–76. doi:10.1016/j.annepidem.2014.03.004.
Taylor, Steve. 2013. “The Real Meaning of ‘Good’ and ‘Evil’”. Psychology Today. 26th August 2013. https://www.psychologytoday.com/gb/blog/out-the-darkness/201308/the-real-meaning-good-and-evil.
Timpe, Kevin. 2014. Free Will in Philosophical Theology. London: Bloomsbury Academic.
Torrance, Alan. 2004. “Developments in Neuroscience and Human Freedom: Some Theological and Philosophical Questions”. Science and Christian Belief 16, no. 2: 123–37.
Watson, Gary. 2003. “Introduction”. In Free Will, edited by Gary Watson, 1–25. Oxford: Oxford Univ. Press.
World Health Organisation. 2001. “Mental Disorders Affect One in Four People”. Accessed March 31, 2020. https://www.who.int/news/item/28-09-2001-the-world-health-report-2001-mental-disorders-affect-one-in-four-people.
—. 2012. International Classification of Diseases 11th Revision. Geneva: World Health Organisation.
—. 2018. “Mental Health: Strengthening our Response”. Accessed April 1, 2020. https://www.who.int/news-room/fact-sheets/detail/mental-health-strengthening-our-response.