"There but for the grace of God": moral responsibility and mental illness.

Abstract

Setting the terms of praise- and blameworthiness has long dominated philosophers' discussions of responsibility. Analytic philosophy has most often looked to reason and the abstract relations between individual rational judgements and actions to advance the discourse on moral responsibility. Those whose capacity for reasoned judgement is impaired are deeply problematic. Is it proper to morally appraise "the mentally ill"? The philosopher T.M. Scanlon discusses moral responsibility as a precondition of moral appraisal and contends that it is not appropriate to appraise a person as (morally) praise- or blameworthy if that person cannot be held responsible for the action(s) for which he is being praised or blamed. What are the conditions, then, under which one can properly be said to be responsible for one's actions? Can one hold "the mentally ill" responsible for their actions? If not, can it in any way be reasonable to expect them to "take responsibility" for their actions and/or characters? The expectation that "the mentally ill" will attempt to control, i.e. take responsibility for their behaviour despite the fact of their mental illness is a pervasive feature of psychiatric approaches to the care and treatment of "the mentally ill". It would seem that such treatment approaches are coherent only to the degree "the mentally ill" can be considered responsible moral agents. This paper explores these issues with regard to that form of mental illness categorized as the personality disorders. It describes the morally and clinically relevant features of personality disorder, explains how they do not fit traditional analytic paradigms of "mental illness" and elaborates the argument that persons with this category of mental illness are fully moral persons who are rightly subject to praise and blame.