Do mental disorders excuse people from responsibility when they harm others? It’s easy to feel trapped between two extremes. Either people with mental disorders aren’t responsible because they lack control, in which case we need to help them, not blame them. Or they are responsible because they do have control, in which case we should blame them, not help them. I think we need to escape this trap and that philosophical reflection on real clinical practice with patients with personality disorder can help us do so.
I began life as an analytic philosopher at the University of Oxford but for the last five years I’ve worked at the Oxfordshire Complex Needs Service, a Therapeutic Community (TC) for people with personality disorder. When I first started working clinically, I was struck by the stance adopted towards TC members who hurt others. I call this stance, ‘Responsibility without Blame’. Both in theory and in practice, this stance requires separating our concepts of responsibility and blame much more sharply than as a society we typically do.
As a philosopher, my research aims to do just this. My view is that responsibility is fundamentally about a person’s own capacity for agency. To be responsible is to have control over your behaviour, in which case you can be held accountable, as well as supported to do things differently. Blame, in contrast, is about how we respond when a person is responsible for harm. We blame someone when, in addition to asking someone to answer for their behaviour and to change, we also do things like retaliate and reject them, judge them or write them off, and feel all sorts of hostile emotions, like hate, anger, disgust, scorn, and contempt. Blame gets in the way of people’s motivation to change. Responsibility and accountability, in contrast, are central to it.
As a society, we should learn from clinical practice. Control comes in degrees, and no doubt all of us, not just people with mental disorders, sometimes don’t have enough control to be responsible for what we do. But when someone is responsible, we can’t help them if we deny their agency. For people can only work to change what they can control. We need to be real about when people have control and so are responsible and accountable for harm. But we can do this with concern and compassion, not with blame.
I’m currently trying to take the clinical stance of Responsibility without Blame into the criminal law. One of my projects is the development of a Responsibility without Blame training for prison officers, in conjunction with the KUF programme at the Institute of Mental Health, as part of a joint Department of Health and Ministry of Justice initiative to increase awareness of personality disorder and create a more psychologically informed environment within prisons. If you want to read more about this and other aspects of my research, you can access information and articles on my webpage http://www.philosophy.ox.ac.uk/members/research_staff/hanna_pickard as well as listening to the podcast above.
To hear a Philosophy Bites [http://www.philosophybites.com/] podcast with Hanna on this topic, click here [http://llnw.libsyn.com/p/9/1/1/9117f1dac5d99c98/Hanna_Pickard_on_Responsibility_and_Personality_Disorder.mp3?s=1342277553&e=1342279353&c_id=4681789&h=4fda6a9e4646a75c85d044dfaa967ddd].
All comments very welcome!