The concept of responsibility in psychiatric thought

Abstract

Responsibility is a varied concept employed customarily and usefully in thinking in different areas of life. It may be thought of as a concept, a habit, a guide to conduct, evidence of mental health, or social maturity. There is legal, medical or psychiatric, social or ethical, religious, and personal idealistic responsibility. In this latter, one may have a responsi bility to one's self (to thine own self be true) that is greater than the responsibility to a given society, culture, or nationality. This is a respon sibility to a larger society or humanity, to a deeper self or one's con victions, a concept that merges into what ordinarily would be called religious responsibility. Legal responsibility is involved in the making of wills and in the disposition of funds. Here there may be the question of the clarity of understanding as, for example, in the confusions and memory loss with disease of the nervous system in people with old-age changes and arterio sclerosis. Psychiatric responsibilities are involved when there is frank mental disease, when the patient may be so disturbed by the excitations of fear, anger, suspicion, self-depreciation, melancholia, infections, or toxic factors, that he cannot use his customary judgment in the conduct of his affairs and behavior and so is a danger to himself and others. Then there is the concept of criminal responsibility, when the be havior may be motivated by such pathological processes as delusions or hallucinations, or is moved by such unaccustomed compulsive or unpre dictable impulses that one is said not to be responsible, not punishable, but in need of treatment as a sick person. Then the time-tried Mc Naghten Rules as to whether the person who committed a crime knew at the time the difference between right and wrong and the consequences of his actions may hold legally, but not seem appropriate psychiatrically. One sees many criminals mentally ill who knew the difference between