Contextualism as a Solution to Paternalism in Psychiatric Practice

In this paper, I address the problem of paternalism in psychiatry by framing it in terms of anosognosia, the lack of awareness that one is ill. I argue that, in the face of avowals from competent patients that they are not ill, the burden of proof falls on the clinician to show that a diagnosis is justified using some normative theory, and that a theory with properly justified evaluative standards for psychiatric diagnosis must have what is known as normative authority. I then consider what criteria an account of mental disorder must satisfy to have normative authority. I argue that, to solve the problem of paternalism, psychiatry must ground what it means to be mentally ill or mentally healthy in the concerns of individual patients. Finally, I consider some objections to this view.