This article investigates “impaired insight,” a controversial psychiatric category describing a mad person unable to know his or her madness. Like “moral insanity” and other concepts before it, impaired insight offers a way to link the disparate logics of human responsibility in psychiatry and the law. I attribute its development to changes wrought by deinstitutionalization, the rise of antipsychotic medication, and patient incarceration in penal settings. In a system that aims to govern psychiatric patients through their freedom, the logic of (...) impaired insight introduces a wrinkle: can a person make an informed choice to refuse treatment if madness itself impairs awareness of illness? Drawing on tools from the sociology of science, I trace the process by which researchers recast psychodynamic “denial” as a neurological and therefore non-volitional “impairment” in the 1990s. I then show how social movement actors mobilized the materialized form in the legal and policy fields in the 2000s, bringing insight science to bear upon the very questions of custodial management and patient rights that gave birth to it. At stake is this dilemma: how can societies that simultaneously privilege individual responsibility and somatic accounts of behavior govern those at the border of legal capacity, and with what justification? (shrink)

In this remarkable book Michel Foucault, one of the most influential thinkers of recent times, calls us to look critically at specific historical events in order to uncover new layers of significance.

We have argued here that to attribute criminal responsibility to psychopathic individuals is to ignore substantial and growing evidence that psychopathic individuals are significantly impaired in moral understanding. They do not appear to know why moral transgressions are wrong in the full sense required by the law. As morally blameless offenders, punishment as a basis for detention cannot be justified. Moreover, as there are currently no successful treatment programs for psychopathy, nor can detention be justified on grounds of treatment. Instead, (...) we argue detention on the grounds of self- defence, due to the severe and continuing threat posed by the psychopathic criminal. (shrink)

The term “psychopath” has enjoyed wide currency both in popular culture and among specialists in forensic psychiatry. Historians, however, have generally neglected the subject. This essay examines the history of psychopathy in the country that first coined the term, developed the concept, and debated its treatment: Germany. While the notion can be traced to nineteenth-century psychiatric ideas about abnormal, yet not completely pathological, character traits, the figure of the psychopath emerged out of distinctly twentieth-century preoccupations and institutions. The vagueness and (...) plasticity of the diagnosis of psychopathy proved to be one of the keys to its success, as it was embraced and employed by clinicians, researchers, and the mass media, despite attempts by some to curb its use. Within the span of a few decades, the image of the psychopath became one of a perpetual troublemaker, an individual who could not be managed within any institutional setting. By midcentury, psychopaths were no longer seen as simply nosological curiosities; rather, they were spatial problems, individuals whose defiance of institutional routine and attempts at social redemption stood in for an attributed mental status. The history of psychopathy therefore reveals how public dangers and risks can be shaped and defined by institutional limitations. (shrink)

I argue for two propositions. First, contrary to the common wisdom, we may justly punish individuals who are not morally responsible for their crimes. Psychopaths – individuals who lack the capacity to feel sympathy – help to prove this point. Scholars are increasingly arguing that psychopaths are not morally responsible for their behavior because they suffer from a neurological disorder that makes it impossible for them to understand, and therefore be motivated by, moral reasons. These same scholars then infer from (...) this conclusion that they must also lack criminal responsibility and therefore that our continuing to punish psychopaths for their crimes is unjust. My response is that this inference is entirely fallacious. -/- Criminal responsibility turns out to be quite distinct from moral responsibility. The two kinds of responsibility require very different conditions to be satisfied. In particular, criminal responsibility, unlike moral responsibility, does not require an agent be able to grasp and follow moral reasons; it requires only that the individual be able to grasp and follow criminal laws. Once this point is recognized, it becomes much easier to accept my thesis: while the subset of psychopaths who commit crimes are not morally responsible for their criminal behavior because they cannot understand moral reasons, they are still criminally responsible because they can understand what the consequences will be if they get caught. For this reason, even though I concede that psychopaths are not morally responsible for the crimes that they commit, our practice of punishing them for these crimes is still just. -/- Second, I argue that psychopathy is a mental illness and should be recognized as such. One reason that it should be recognized as a mental illness is simply because it is; it satisfies the main criteria for inclusion in the DSM-IV, the “bible” of mental disorders. The other reason is more practical than conceptual. It starts with two facts: the U.S. Supreme Court has decided that the preventive detention of any individual who is not a criminal suspect is not constitutional unless the individual is not only dangerous but also mentally ill; and psychopathy is not currently considered to be a mental illness. So, as things now stand, we cannot preventively commit dangerous psychopaths – that is, psychopaths who have clearly indicated that they will be committing serious crimes. Instead, we must wait for them to commit the crimes before we can lock them up. Unfortunately, this incarceration always comes too late for the victims. It would therefore be better if we could lock them up before they actually inflict any harm. Once again, then, I propose that the legal and psychological communities classify psychopathy as a mental illness. (shrink)

Whether psychopathy is a mental disease or illness can affect whether psychiatrists should treat it and whether it could serve as the basis for an insanity defense in criminal trials. Our understanding of psychopathy has been greatly improved in recent years by new research in psychology and neuroscience. This illuminating research enables us to argue that psychopathy counts as a mental disease on any plausible account of mental disease. In particular, Szasz's and Pickard's eliminativist views and Sedgwick's social constructivist account (...) of mental illness that might exclude psychopathy are not plausible, and there is no reason to exclude psychopathy under Boorse's and Scadding's biomedical accounts, Wakefield's harmful dysfunction account, and the DSM-IV-TR objective harm account of mental disease. The basic reason is that psychopathy involve neural dysfunction that increases risk of serious harm and loss to people with psychopathy. (shrink)

Although diagnosis is integral to the theory and practice of psychiatry, social scientists have not developed a comprehensive approach to diagnosis. This paper presents a preliminary outline of the issues which a sociology of diagnosis should integrate. These include bias and social control in psychiatric diagnosis, diagnosis as part of a new extension of the biopsychiatric medical model, and flaws in contemporary diagnostic categorization. These issues are then viewed in terms of professional practice styles, diagnostic biases, psychiatry's professional dominance over (...) the mental health field, and psychiatric hegemony over the clinical interaction with patients. (shrink)

Some evil actions are public. Maybe genocide is the most awful. Other evil actions are private, a matter of one person harming another or of self-inflicted injury. Child abuse, in our current reckoning, is the worst of private evils. We want to put a stop to it. We know we can’t do that, not entirely. Human wickedness won’t go away. But we must protect as many children as we can. We want also to discover and help those who have already (...) been hurt. Anyone who feels differently is already something of a monster.We are so sure of these moral truths that we seldom pause to wonder what child abuse is. We know we don’t understand it. We have little idea of what prompts people to harm children. But we do have the sense that what we mean by child abuse is something perfectly definite. So it comes as a surprise that the very idea of child abuse has been in constant flux the past thirty years. Previously our present conception of abusing a child did not even exist. People do many of the same vile things to children, for sure, that they did a century ago. But we’ve been almost unwittingly changing the very definitions of abuse and revising our values and our moral codes accordingly. Ian Hacking, a philosopher, teaches at the Institute for the History and Philosophy of Science and Technology in the University of Toronto. His latest book is entitled The Taming of Chance. (shrink)

Now available in a Harper Colophon edition, this classic book has revolutionized thinking throughout the Western world about the nature of the psychiatric profession and the moral implications of its practices. Book jacket.

"The medical establishment has become a major threat to health. The disabling impact of professional control over medicine has reached the proportions of an epidemic. Iatrogenesis, the name for this new epidemic, comes from iatros, the Greek word for physician, and genesis, meaning origin. Discussion of the disease of medical progress has moved up on the agendas of medical conferences, researchers concentrate on the sick-making powers of diagnosis and therapy, and reports on paradoxical damage caused by cures for sickness take (...) up increasing space in medical dope-sheets [...] The public has been alerted to the perplexity and uncertainty of the best among its hygienic caretakers [...] This book argues that panic is out of place. Thoughtful public discussion of the iatrogenic pandemic, beginning with an insistence upon demystification of all medical matters, will not be dangerous to the commonweal."-- from Introduction. (shrink)

In this incisive book, Michel de Certeau considers the uses to which social representation and modes of social behavior are put by individuals and groups, describing the tactics available to the common man for reclaiming his own autonomy from the all-pervasive forces of commerce, politics, and culture. In exploring the public meaning of ingeniously defended private meanings, de Certeau draws brilliantly on an immense theoretical literature to speak of an apposite use of imaginative literature.

This book brings together, in systematic and generalized form, the main outlines of a conceptual scheme for the analysis of the structure and processes of social systems. It carries out Pareto's intention by using the "structural-functional" level of analysis.

The focus of this volume, which collects both recent and now-classic essays, is the historical emergence of concepts and objects, through new uses of words and ...

True to his longstanding bias against grand unifying theories, Hacking chooses to pursue these questions by focusing on a specific case of memory-thinking: the history of multiple personality. His excavation of the contemporary terrain leads him, however, to the surprisingly grand conclusion that the various sciences of memory—including neurological studies of localization, experimental studies of recall, and studies in the psychodynamics of memory—all emerged in connection with attempts to “scientize the soul,” as a result of which spiritual battles have been (...) recast as scientific controversies “where we suppose there is such a thing as knowledge to be had”. (shrink)

Although the concept of psychopathy retains its currency in British psychiatry, apparently being meaningful as well as useful to practitioners (1), it is often taken to refer to a purely legal category with social control functions rather than a medical diagnosis with treatment implications. I wish, in this brief article, to suggest that it is essentially, and most usefully, an ethical category which stands outside the diagnostic framework of present-day psychiatry.

Here the distinguished philosopher Ian Hacking uses the MPD epidemic and its links with the contemporary concept of child abuse to scrutinize today's moral...

There has long been interest in identifying and studying ‘‘successful psychopaths.” This study sampled psychologists with an interest in law, attorneys, and clinical psychology professors to obtain descriptions of individuals considered to be psychopaths who were also successful in their endeavors. The results showed a consistent description across professions and convergence with descriptions of traditional psychopathy, though the successful psychopathy profile had higher scores on conscientiousness, as measured within the five-factor model (FFM). These results are useful in documenting the existence (...) of successful psychopathy, demonstrating the potential benefit of informant methodology, and providing an FFM description that distinguishes successful psychopaths from unsuccessful psychopaths studied more routinely within prison settings. (shrink)

Currently, psychopathy and related terms such as antisocial personality disorder are popular yet problematic constructs within forensic psychology and other disciplines. Psychopathy is traced typically to the works of Pinel and Prichard in the early 19th century, and it has even been linked to biblical passages, although there appears to be little or no support for the latter claim. The first use of the term psychopathy in German psychiatry of the mid-19th century referred only to psychological disturbance in general, or (...) ‘personality diseases’, although German psychiatrists such as Kraepelin did propose more specific definitions of the term related to social deviance. Our modern understanding of psychopathy as a psychiatric disorder of an undetermined genetic origin involving antisocial elements and a lack of feeling or concern for others owes much to the clinical work and writings of Cleckley. Antisocial personality disorder appears similarly to derive from the work of psychiatric nosologists like Kraepelin and Schneider, while sociopathy is due more to the work of Partridge in the 1920s and 1930s. (shrink)

Obsessed with the twin beliefs that misbehavior is a medical disorder and that the duty of the state is to protect adults from themselves, we have replaced criminal-punitive sentences with civil-therapeutic 'programs.' The result is the relentless loss of individual liberty, erosion of personal responsibility, and destruction of the security of persons and property - symptoms of the transformation of a Constitutional Republic into a Therapeutic State, unconstrained by the rule of law.