Self-Made Madness

This multi-disciplinary text lies in the general areas of forensic psychiatry, sociology, jurisprudence, criminal law and criminology. It questions traditional assumptions about illness and particularly mental disorder and deals with the controversial notion that they are not at least in part the fault of the "sufferer". It examines how the law can take into account such "culpable" notions of mental disorder in determining criminal responsibility (if a person culpably causes a condition e.g. intoxication s/he cannot rely on that condition as the basis of a defence at trial; hence the law affords different levels of justification/excuse/mitigation to the crimes of those who have got themselves drunk and those who are drunk due to being "slipped a mickey"). This culpability for the defence-causing condition (or "responsibility for level of criminal responsibility") is called "meta-responsibility". The first half of the book is theoretical and discusses the way traditional illness models relate to meta-responsibility; the insanity defence and other mental condition defences; the relationship of clinical issues such as medication non-compliance and insight to meta-responsibility (with reference to critical psychiatric and social constructivist models of mental disorder which cast it not as an affliction but as a sometimes positive experience which may be under control of the "sufferer"); and the counterfactual notion that considers how the possible voluntary origins of mental disorder would benefit the criminal and non-criminal mentally disordered. The second half of the book presents a case vignette experiment of mock jurors, examining the effect of a "meta-responsibility insanity test" (one which allows jurors to reflect their consideration of the defendant's culpability for their disorder in the jurors' verdict). The test made no difference to the number of insanity verdicts rendered (in comparison to a "normal" insanity test); however, the recommended length of detention in hospital for insanity acquittees significantly diminished using the new test. This suggests that the post-trial disposal to hospital, which has long been pointed as "pseudo-therapeutic punishment" by commentators (insanity acquittees are likely to spend twice as long in hospital than if they had simply pled guilty and gone to jail) is in part "revenge" by society and the criminal justice system for "beating the rap" using a condition which they deem to be at least partly the defendant's fault.