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Mental health professionals prefer to talk about an impairment of a "person's perception or understanding of reality". They hold a "guilty but mentally ill" verdict to be contradiction in terms. All "mentally-ill" people operate within a (usually coherent) worldview, with consistent internal logic, and rules of right and wrong (ethics). Yet, these rarely conform to
way most people perceive world. The mentally-ill, therefore, cannot be guilty because s/he has a tenuous grasp on reality.
Yet, experience teaches us that a criminal maybe mentally ill even as s/he maintains a perfect reality test and thus is held criminally responsible (Jeffrey Dahmer comes to mind). The "perception and understanding of reality", in other words, can and does co-exist even with severest forms of mental illness.
This makes it even more difficult to comprehend what is meant by "mental disease". If some mentally ill maintain a grasp on reality, know right from wrong, can anticipate outcomes of their actions, are not subject to irresistible impulses (the official position of American Psychiatric Association) - in what way do they differ from us, "normal" folks?
This is why insanity defense often sits ill with mental health pathologies deemed socially "acceptable" and "normal" - such as religion or love.
Consider following case:
A mother bashes skulls of her three sons. Two of them die. She claims to have acted on instructions she had received from God. She is found not guilty by reason of insanity. The jury determined that she "did not know right from wrong during killings."
But why exactly was she judged insane?
Her belief in existence of God - a being with inordinate and inhuman attributes - may be irrational.
But it does not constitute insanity in strictest sense because it conforms to social and cultural creeds and codes of conduct in her milieu. Billions of people faithfully subscribe to same ideas, adhere to same transcendental rules, observe same mystical rituals, and claim to go through same experiences. This shared psychosis is so widespread that it can no longer be deemed pathological, statistically speaking.
She claimed that God has spoken to her.
As do numerous other people. Behavior that is considered psychotic (paranoid-schizophrenic) in other contexts is lauded and admired in religious circles. Hearing voices and seeing visions - auditory and visual delusions - are considered rank manifestations of righteousness and sanctity.
Perhaps it was content of her hallucinations that proved her insane?
She claimed that God had instructed her to kill her boys. Surely, God would not ordain such evil?
Alas, Old and New Testaments both contain examples of God's appetite for human sacrifice. Abraham was ordered by God to sacrifice Isaac, his beloved son (though this savage command was rescinded at last moment). Jesus, son of God himself, was crucified to atone for sins of humanity.
A divine injunction to slay one's offspring would sit well with Holy Scriptures and Apocrypha as well as with millennia-old Judeo-Christian traditions of martyrdom and sacrifice.
Her actions were wrong and incommensurate with both human and divine (or natural) laws.
Yes, but they were perfectly in accord with a literal interpretation of certain divinely-inspired texts, millennial scriptures, apocalyptic thought systems, and fundamentalist religious ideologies (such as ones espousing imminence of "rupture"). Unless one declares these doctrines and writings insane, her actions are not.
we are forced to conclusion that murderous mother is perfectly sane. Her frame of reference is different to ours. Hence, her definitions of right and wrong are idiosyncratic. To her, killing her babies was right thing to do and in conformity with valued teachings and her own epiphany. Her grasp of reality - immediate and later consequences of her actions - was never impaired.
It would seem that sanity and insanity are relative terms, dependent on frames of cultural and social reference, and statistically defined. There isn't - and, in principle, can never emerge - an "objective", medical, scientific test to determine mental health or disease unequivocally.
VIII. Adaptation and Insanity - (correspondence with Paul Shirley, MSW)
"Normal" people adapt to their environment - both human and natural.
"Abnormal" ones try to adapt their environment - both human and natural - to their idiosyncratic needs/profile.
If they succeed, their environment, both human (society) and natural is pathologized.
Sam Vaknin is the author of Malignant Self Love - Narcissism Revisited and After the Rain - How the West Lost the East. He is a columnist for Central Europe Review, PopMatters, and eBookWeb , a United Press International (UPI) Senior Business Correspondent, and the editor of mental health and Central East Europe categories in The Open Directory Bellaonline, and Suite101 .
Visit Sam's Web site at http://samvak.tripod.com
