The traditional legal verdict of not guilty by reason of insanity as well as the more recent verdict of guilty but mentally ill rest on often unquestioned epistemological assumptions about human behavior and its causes, unjustified reliance on forensic psychiatrists, and questionable, if not deplorable ethical standards. This paper offers a critique of legal perspectives on insanity, historical and current, based on the altermative epistemological and ethical assumptions of Thomas S. Szasz. In addition, we examine Szasz''s unique rhetorical analysis of (...) mental illness and its implications for forensic psychiatry. (shrink)

This article offers a critique and reconstruction of the concept of medicalization. Most researchers describe medicalization as the redefinition of social problems as medical concerns, and track its spread by the proliferation of disease language and diagnostic categories. Forensic psychiatry and disorders like psychopathy are often cited in these debates. I argue that focusing on discourse overlooks how medical language can justify or mask non-medical practices and outcomes, and lead researchers to identify medicalization where it has not occurred. Building on (...) other critiques of medicalization and recent studies of medical and legal expertise, I propose an alternative conception based on conditions for the performance of medical practice and other forms of expert labor. I distinguish the participation or intervention of medical practitioners from the medicalization of expert practice and identify several institutional factors that facilitate the latter. I illustrate this approach using a critical historical case: the first adult penal psychiatric clinic in the United States, founded by the eminent psychopathologist Bernard Glueck at New York’s Sing Sing Prison in 1916. Glueck’s extensive writings reveal little evidence of medicalization: psychopaths were largely defined and diagnosed according to penal rather than medical criteria, and they received additional punishment rather than treatment. A review of recent research confirms that psychopathy remains primarily a penal rather than medical condition. I conclude that focusing studies of medicalization on practice rather than discourse clarifies the concept and avoids reifying the notion of a medicalized society. (shrink)

At the one extreme, social service provision by government may be seen as the work of benevolent professionals, and at the other as that of tyrannical social engineers. This paper examines the views of the libertarian economist, F.A. Hayek, and the British sociologist and philosopher, T.H. Marshall, on such provision. Marshall takes an optimistic view of the development of the professional classes in Britain and elsewhere; he sees social welfare specialists as essential to the preservation of social rights and argues (...) they should be given powers that sometimes supersede democratic preferences. Hayek, however, sees these professionals, in their drive to promote social equality, as a danger to liberty in Western democracies; he thus opposes a democratic system in which such people are allowed to attain influence. Both Hayek and Marshall raise questions about welfare and inequality and about the degree of authority social welfare professionals should be given. However, they take opposing views on the proper role of what Burke called ?natural aristocracy? (shrink)

This article introduces the concept of economic medicalization where non-medical problems are transformed into medical problems in order to achieve the objective of corporate shareholder wealth maximization. Following an overview of the differences in ethical norms applicable to medical ethics and business ethics, the economic medicalization of medical research practice and publication is examined in some detail. This motivates a general discussion of the problems involved in the ethical approval process for medical research that balances the interests of both business (...) and government in the market for medical products and services. (shrink)

ArgumentResearch into the biological markers of pathology has long been a feature of British psychiatry. Such somatic indicators and associated features of mental disorder often intertwine with discourse on psychological and behavioral correlates and causes of mental ill-health. Disorders of sociality – particularly psychopathy and antisocial personality disorder – are important instances where the search for markers of pathology has a long history; research in this area has played an important role in shaping how mental health professionals understand the conditions. (...) Here, I characterize the multiplicity of psychiatric praxis that has sought to define the mark of antisociality as a form of “ontological anarchy.” I regard this as an essential feature of the search for biological and other markers of an unstable referent, positing that uncertainties endure – in part – precisely because of attempts to build consensus regarding the ontology of antisociality through biomedical means. Such an account is suggestive of the co-production of biomarkers, mental disorder, and psychiatric institutions. (shrink)

Ideologies of progress sprout from an inextinguishable hope that one day things will be better. Somewhere ahead life will be more abundant and there will be less pain and fear. Somewhere ahead there will be more rationality, objectivity, and truth. Somewhere ahead there will always be more love and compassion for others. Any combination of these and of other values could easily be extracted from the literature of progress. When writers begin with the thesis, ‘there is progress in the realisation (...) of values’, they assume two things. Firstly , they put forward a sociological-historical hypothesis according to which social changes proceed in a set direction and fall into some sort of sequential pattern, and secondly , they contrive to find that, on the whole, in this sequence, there is a linear increase in the realisation of some values which they regard as essential to humanity. A careful inspection of the second of these two assumptions discloses the belief that not only things will be getting better and better but people too. Those, then, who are ideologists of progress are committed to a coherent directionality not only in the betterment of circumstances but also in the betterment of people; in brief, social changes will be accompanied by changes in the ‘modal’ personality as well. (shrink)

ABSTRACT The purpose of this article is to supply a justification in moral philosophy for considering the grossly depraved criminal to be less than a normally responsible agent. Decisions concerning the responsibility of a person depend upon our ability to act and react morally with that person. The argument is that when we reflect on the implications of (1) the moral role that desires play in excusing or condemning actions and (2) the minimum moral requirements of punishment, we realise that (...) a moral community does not exist between us and the grossly depraved. That is, we cannot apply key moral categories simpliciter, including the notion of guilt. (shrink)

T he Question of punishment and its justification has been a major preoccupation in recent philosophy of law. The reasons for this growing concern are not difficult to discover. Both philosophers and jurists have become increasingly sceptical of traditional theories of legal punishment. Each of these inherited theories was designed to establish criteria for the recognition and appraisal of punishment as a legal institution. However, alternative theories emphasised different and often conflicting criteria. Some theories emphasised moral desert and retribution, while (...) others appealed to the social utilities of punishment. Failure to reconcile these diverse philosophical viewpoints, through sustained debate over two centuries, has been a major source of intellectual dissatisfaction. (shrink)

This paper examines the challenge that psychoanalytic theory cannot be refuted. It does so by considering the theory in its orthodox Freudian form, and in the main branches into which it can be divided ? the theory of Instincts, of Development, of Psychic Structure, of Mental Economics or Defence, and of Symptom Formation. The essential character of the generalizations and concepts of these branches will just be indicated; and we shall ask of each branch whether it is possible to refute (...) it. A considerable amount of scientific enquiry has been done into the concepts and generalizations of psychoanalysis. Relevant examples of these enquiries will be noted; and the question asked whether these scientific studies have in fact done anything to refute or support the various branches of psychoanalytic theory. The general upshot will be that the challenge is both important and a mistake. (shrink)

The growth of self-tracking and personal surveillance has given rise to the Quantified Self movement. Members of this movement seek to enhance their personal well-being, productivity, and self-actualization through the tracking and gamification of personal data. The technologies that make this possible can also track and gamify aspects of our interpersonal, romantic relationships. Several authors have begun to challenge the ethical and normative implications of this development. In this article, we build upon this work to provide a detailed ethical analysis (...) of the Quantified Relationship. We identify eight core objections to the QR and subject them to critical scrutiny. We argue that although critics raise legitimate concerns, there are ways in which tracking technologies can be used to support and facilitate good relationships. We thus adopt a stance of cautious openness toward this technology and advocate the development of a research agenda for the positive use of QR technologies. (shrink)

The demands of morality ought to be intelligible. However they are not alwaysreadilyintelligible. Thus it is easy to see why we need good sense and courage, and why we should seek to live at peace with our neighbours. But moral necessity is not always that transparent. Furthermore the intelligibility we seek is perhaps not always of this kind. This paper illustrates these difficulties by considering certain basic and unshakable convictions we share about homicide and sexuality, two topics we tend to (...) think badly about. And it explores a significant similarity in the moral philosophies of Anscombe and Kant. (shrink)

In Chapter VI of his powerful study God and Other Minds Dr Alvin Plantinga deploys what—following a suggestion of mine—he calls ‘The Free Will Defence’. He presents his case there as a reaction to two earlier attempts to overcome that defence. I propose to take this chapter in Plantinga as my starting point here; and, as far as can be, to ignore, though not by that token to repudiate, those by now rather ancient earlier essays.

One of the philosophical discussions stimulated by the recent scientific study of psychopathy concerns the mental illness status of this construct. This paper contributes to this debate by recommending a way of approaching the problem at issue. By relying on and integrating the seminal work of the philosopher of psychiatry Bill Fulford, I argue that a mental illness is a harmful unified construct that involves failures of ordinary doing. Central to the present proposal is the idea that the notion of (...) failure of ordinary doing, besides the first personal experience of the patient, has to be spelled out also by referring to a normative account of idealised conditions of agency. This account would have to state in particular the conditions which are required for moral responsibility. I maintain that psychopathy is a unified enough construct that involves some harms. The question whether the condition involves also a failure of ordinary doing, as this notion is understood in this paper, is not investigated here. (shrink)