Since the early 1990s, the philosophical debate over broad accounts of mental illness has stalled. Although there remains unresolved tension between mixed and medical models of mental illness, bioethics seems to be moving from a naturalistic account of mental illness to one in which illness is determined by applying an evaluative notion of function. Nonetheless, existing models often underestimate the role of social norms in defining illness. Most important, such models have paid inadequate attention to the relevance of wider philosophical assumptions about the objectivity of ethics and the concept of personhood to our understanding of illness. I attempt to demonstrate that these concepts are integral for differentiating mental illnesses from the vast array of irrational and pre-rational drives and personality traits for which we usually wish to hold the bearer morally responsible. In emphasizing the normative component in accounts of mental illness, I am not attacking psychiatric expertise, but rather endeavoring to bring philosophical discussion closer to the actual, informal decisions that psychiatrists (in particular forensic psychiatrists) regularly make when asked to determine someone's moral responsibility for a mental condition.


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pp. 73-90
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