Also Thomas Szasz in The Myth of Mental Illness (1981) and perhaps R. D. Laing in The Politics of Experience and other works.

As Hendrika I warmly recommend The Myth of Mental Illness and espcially the sections that discuss behaviour which isn´t accepted in our society and in all of a sudden are defined as a disease - mental illness.

I strongly believe that social factors and circumstances like poverty and the way a Child is raised and met in general will affect ones accountability and/ability to conduct responsible actions. These circumstances don´t have to be labelled ILLNESS in order to be valid when deciding on for exeamlpe ones criminal responsibility.

When I have interviewed Swdish forensic psychiatric patients on what they believed to be the causators of their crime(s) very few Point to the severe mental illness as the main cause. Instead they put forward factors lika anger or rage towards a certain person, living for a long time in social misery and substance abuse.

I´m quite aware that this opensa another angle to your question BUT my point is that no matter if you suffer from mental illness and not, the qualityy of your social context is utterly significance to your well-being.

Best regards, Pontus

Thesis Madness as the Foundation of Non-Culpability

Psychiatry is assumed to have a double function and is also obligated to third parties and to society in general. Acceptance of such a kind of double obligation carries the risk of double moral standards, placing the psychiatrist ethically outside the community of physicians and questioning the unrestricted obligation towards the patient. The recommended article formulates a moral position, which places the psychiatrist, like all other physicians, exclusively on the side of the patient in terms of professional ethics and discusses the practical problems arising from this moral position.

http://download.springer.com/static/pdf/430/art%253A10.1007%252Fs00115-015-4303-z.pdf?originUrl=http%3A%2F%2Flink.springer.com%2Farticle%2F10.1007%2Fs00115-015-4303-z&token2=exp=1459844281~acl=%2Fstatic%2Fpdf%2F430%2Fart%25253A10.1007%25252Fs00115-015-4303-z.pdf%3ForiginUrl%3Dhttp%253A%252F%252Flink.springer.com%252Farticle%252F10.1007%252Fs00115-015-4303-z*~hmac=97544ce53bdc1bb124f5446e1f4e794952b2ae86904486366f9d1968690e136a

Article Moral oder Doppelmoral?

Best Mario

You make an excellent Point of the psychiatrist´s `double Agency` and indeed a quite peculiar one. Coercive psychiatric care is, at least to me, easier to accept when it is based on the patient-psychiatrist relationship, i.e. when the life, health and function of the patient is at risk. The minute coercive psychiatric care is based on assessment of the patient being potential risk to society, I find it more or less outrageous.

Especially considering all research that show that severe mental disorder (e.g. psychosis) is small potato in comparison to substance abuse etc. The fact that a severe mental illness is a necessary condition to be locked up TO PREVENT bad things (e.g. violent crime) is in my opinion nothing but wrong (morally, legally, scientificallly).

Nevertheless this is the case in a majority/all European countries and it leds to stigma of an already vulnerable Group in our society.

Until further notice, Pontus

I strongly disagree that there is qualitative gap between psychiatry and other medical specialities in this respect. There are all kinds of duties that physicians have towards the society and these can conflict with therapeutic relationship with the patient in various places. Examples would be:

• duties of distributive justice (e.g. distribution of scarce resources or efficient use of available resources - sometimes these will be against the interests of a particular patient. Of course this is more pronounced in disaster settings,but different sorts of rationing or triage are present in every medical institution)
• duties of protection of society (there are most well known in the context of prevention of infectious diseases - mandatory reporting, counter to physician confidentiality, participation in enforcing vaccination mandates and other public health measures, but also mandatory reporting of some publicly prosecuted crimes, such as child abuse, family violence and rape in some jurisdictions)
• research contexts (it is well explored in the literature that all medical research has potential to conflict with clinical ethics, regardless of what Declaration of Helsinki says this conflict is unavoidable in some situations)

There are probably others but these three come to mind immediately. I do think there is a quantitative gap - psychiatrists are put into such situations more often, but I do not think this is unique to psychiatry and in fact we have one whole multidisciplinary area of medicine that is full of such ethical minefields - paediatric medicine. 

That being said psychiatry has it's darker legacies to deal with as well as conceptual problems, still much more vague evidence, nosology and standards, plus societal fears and misconceptions. So this remains a significant challenge. 

One thing I am preparing a workshop presentation on is the temptation to use psychiatry to solve problems in other areas, such as problems of criminal law and public safety.