Crime, Punishment and Disease in a Relativistic Universe

Antony Flew

• Publisher: Routledge
• Year: 2018
• ISBN:
  9781351525008
• Edition: 1
• Topic: Philosophie
• Subtopic: Philosophie politique

In Crime, Punishment and Disease, Antony Flew makes clear both the meaning and the implications carried by the application of the expression "mental disease." He aims to discourage its use in conditions that provide the victims of such diseases with an excuse for failing to perform what would have been their imperative duties had they enjoyed good mental health. Flew attacks the gross over-extensions of the notion of mental disease on both sides of the Atlantic. He defends human dignity and responsibility against the suggestion that we are all, or most of us, "sick, sick, sick." In particular, he challenges the paternalist pretensions of people who claim a right to control and manipulate others because they are allegedly sick, and consequently not responsible for what they do.In a typical ordinary disease, Flew notes, it is the patient who complains of the disease rather than someone else who complains about the patient. But those who claim that some crime or all crime is symptomatic of mental disease and those who identify disorders such as attention/deficit/hyperactivity disorder (ADHD) as conditions requiring psychiatric attention are taking the disfavored behavior rather than the distress of their patients as the warrant for supposedly medical interventions. They should instead first consider how what they propose to call mental disease does, and does not, resemble syphilis, measles, and other communicable diseases.Flew sees his work as complementary to Thomas Szasz's. He applies a philosophical perspective to problems Szasz discusses as a psychiatrist. This work will be of particular interest to students of philosophy and politics, in that it relates modern discussion of mental illness to the Plato of The Republic. Flew also takes note in this context of Samuel Butler's Erewhon. This work will be of direct relevance to criminologists, as well as those interested in social welfare, philosophy of education, and new developments in psychiatry.

II Disease and Mental Disease

1 One main outcome of Part I should be a realisation of the dependence of the derivative notions of mental health and mental disease upon the prior notions of (physical) health and (physical) disease. If this dependence were merely historical and etymological it would be of little present concern. To urge that the true and proper meaning of all expressions as now employed must be determined by either the ultimate etymology or the original English senses of the words involved is unsound and tiresome. But it is both correct and important to insist that, if a large part of the point of applying the descriptions ‘mental health’ and ‘mental disease‘ is to imply that most if not quite all which is involved in (physical) health and (physical) disease is involved in these further cases also, then any attempt to elucidate the former should begin from some preliminary examination of the latter.

This modest methodological claim may appear trite and obvious. But triteness and obviousness are essentially relative to time and place and person. For it is most remarkable how little attention seems to be paid in the now abundant literature on the nature and criteria of mental health and mental disease to the similarities and dissimilarities between these and their physical analogues. Indeed the present essay will, I believe, be sufficiently justified if it succeeds in persuading some future contributors to this literature to proceed in this now obviously sound way.

Consider as a first example Dr Marie Jahoda‘s Current Concepts of Positive Mental Health, This is an American work. It was sponsored by the ‘Joint Commission on Mental Illness and Health, as part of a national mental health survey that will culminate in a final report containing findings and recommendations for a national mental health program’. This whole enterprise achieved a most authoritative vindication when only five years later on 5 February 1963 President Kennedy issued his Message to the Congress on ‘Mental Health and Menial Retardation’, Dr Jahoda begins: ‘There is hardly a term in current psychological thoughts as vague, elusive and ambiguous as the term “mental health” …. The purpose of this review is to clarify a variety of efforts to give meaning to this vague notion.’ She proceeds to classify and to discuss a great many such efforts, Yet, almost Incredibly, she never once develops any comparisons between mental health as so conceived and physical health; and neither, it seems, did any of the authorities from whom she quotes. What is revealed is, as her introductory remarks suggest, a conceptual shambles. But she herself concludes, quite inappropriately, with the familiar mandatory appeal for more (expensive) empirical research: ‘a slow and costly’ striving ‘for more and better knowledge about the conditions conducive to mental health’.²³

The nearest which anyone in this whole book gets to what should be the fundamental comparison is a hint in a dissenting – perhaps in this context one should say grumbling – Appendix. This nearest is still not very near. But Dr Walter Barton does put as the ‘Viewpolnt of a Clinician‘ what he qualifies, but does not express, as a conceptual insight: ‘Conceptually, it is difficult to see how a national program … can be operated’ except in as much, as ‘illness is the point of departure and health is the goal.‘²⁴ This negatively constructive emphasis contrasts with the hankering felt by Dr Jahoda herself, by the Staff Director of the Joint Commission, and by most of Dr Jahoda‘s quoted authorities, for some robustly North American accentuation of the positive. Thus the Staff Director writes in his prefatory ‘Staff Review‘ of ‘interest in mental health, as a positive force … to be made conceptually clear and practically useful’, He notes that the ‘behavioural scientists who have joined the mental health team and are making increasingly important contributions to the mental health movement have expressed dissatisfaction with a primary focus on “sick behaviour”’.²⁵ Very significantly there is even talk, here and elsewhere, of ‘the mental health ideology’. Dr Jahoda‘s own chosen title Current Concepts of Positive Menial Health is also entirely apt to the contributions she does actually find herself examining.²⁶

★

2 A second illustration, which again has some representative status, is provided by a Report of the Scientific Committee of the World Federation for Mental Health. Entitled ‘Mental Health and Value Systems’, it appeared with another on ‘Identity’ as a pair of Cross-Cultural Studies in Menial Healik, published in a single volume edited by Dr Kenneth Soddy. Dr Soddy is an Englishman, Scientific Director of the Federation, and also Secretary of the Scientific Committee. The volume was issued in 1961 as ‘A World Mental Health Year Publication’.

The Report begins by noticing ‘that mental health is increasingly becoming a value, in a similar sense to the modern concept of bodily health’. It takes this observation as setting its own task: ‘If this be truly an emerging concept, then it is time to consider the relationship between mental health and the established value systems of people.’²⁷ Here the question should arise whether there is or has been a corresponding cross-cultural problem about physical health; and, if not, or even if so, what it is about mental health which makes the difference.

The nearest which the Report comes to recognising and answering this question is in considering ‘the acceptances of mental health concepts’ and ‘the resistances‘ thereto. ‘Here’, it says, ‘an interesting comparison can be made with the acceptance of the notion of physical health.’ Indeed it can be, But it is not made here. Instead the Report continues: ‘The latter has not always been regarded as a “good object” but, although the operative description of physical health may be the world, physical health has become increasingly recognised as important and valuable…. If the concept of physical health as a “good object” has been acceptable only with difficulty, that of mental health is likely to provoke even greater resistances,‘²⁸

No reason whatsoever is offered why we should accept the incredible protasis. No hint is given of any peculiar interpretation in which it might possibly be true. That distinguished signatories could bring themselves to assert, as a fact requiring no evidential support, that physical health has only recently come to be regarded as a good thing, constitutes a noteworthy indication of how some people – and not only rather young people – are able to believe anything about the dark days before they were born. An age which no longer reads the Bible certainly cannot remember its Apocrypha: ‘Health and good estate of body are above all gold.’ (Ecclesiasticus, xxx 15)

Even if we were to accept the bold assertion about struggles for the acceptance of physical health as a good thing we still need, but are not given, a reason why mental health should be expected to encounter not the same but ‘even greater resistances’. The Report thus fails to make anything but a memorable nonsense of its only explicit attempt to compare mental with physical health, Where a crucial difference might have been revealed the opening gap is covered over with an enormous counter-factual assumption.

If you do not start right, with a faithful comparison between proposed notions of mental health and the original physical paradigm, you cannot hope to bring out clearly why these former seem to be beset by ideological disputes and cross-cultural conflicts of a kind which scarcely afflict the latter at all. Certainly ideology is sometimes relevant to the practice of physical medicine. A Jehovah‘s Witness for instance may not accept a blood transfusion. A hard-line Roman Catholic doctor will not in any circumstances perform an abortion, But, if we waive at this stage the question whether the conditions for which a secular doctor would be likely to prescribe these treatments could be called strictly disease, these are disagreements not about diagnoses but about what it is permissible to do about conditions of which the diagnoses may be taken as agreed. Such disagreements are not therefore of the same kind as those with which Dr Jahoda is concerned. For these do not spring, as those do, from differences with regard to the correct criteria for the application of the diagnostic expressions ‘mental health’ and ‘mental disease‘.

To see why mental health as conceived by Dr Jahoda is an inherently disputatious notion, in a way in which physical health is not, consider the first paragraph of her statement of the ‘Purpose and Scope‘ of her study: ‘The purpose of this review is to clarify a variety of efforts to give meaning to this vague notion. In doing so we shall have to examine the assumptions about the nature of man and society underlying such efforts by making explicit some of their implications and con-sequences. This should lead first to a description of various types of human behaviour called mentally healthy and second to a discussion of mental health concepts suggested in the literature.’²⁹

No mere body doctor needs to examine ‘assumptions about the nature of man and society‘ before he can decide whether the man in front of him is or is not physically fit. The crux lies in the emphasis in the following sentence on behaviour. If ‘mental health’ is to be officially defined, as Dr Jahoda here suggests, in terms of what people actually do do, rather than in terms of what they are capable of doing, then the notion as so defined becomes liable to be involved in every dispute about ideals and actions. By the same token it must thereby lose some of its logical connections with the concept of physical health. For it is notorious that a man may be physically fit but a scoundrel, sick yet a saint. So if the analogy between mental and physical health is to be preserved here, then we must provide for the parallel possibility of saying for instance that whereas St Francis of Assisi suffered from various mental diseases ‘Scarface’ Al Capone enjoyed the rudest of rude mental health.

The Report to the World Federation is even more explicit about the ideologically committed character of its concepts of mental health; although, as we have just seen, by making a truly heroic assumption the authors then conceal from themselves the size of the gap which is thus opened between mental and physical health. They start from two principles: ‘That there can be different degrees of mental health; and that mental health is associated with … the prevailing religion or ideology of the community concerned.’ Curiously, they fail to remark the apparent although not perhaps ultimate inconsistency of this sort of cultural relativism with their own absolute insistence later ‘that the members of a group of individuals who remain contented while they are in an inferior position in society fail to satisfy some of the important criteria of mental health. We would like also to question the state of mental health of the “superior” group in that society.‘ The Reporters also display at this point the tendency, common in ‘the mental health movement’ and among ‘the mental health team‘, to pack all possible goods into one single, all-embracing, conflict-concealing ideal; which for them makes ‘mental health’ a revamped and scientistic substitute for the ‘summum bonum‘ of an older generation of philosophers.³⁰

★

3 A third example of failure fully to come to terms with the physical paradigm is provided by two chapters in Lady Wootton‘s Social Science and Social Pathology. These are for two reasons of especial interest to us. First she also is approaching notions of mental disease from a primary concern with delinquency. Second she does turn her eyes to the physical paradigm much more frequently than others do. Thus in the first of these two chapters, ‘Social Pathology and the Concepts of Mental Health and Mental Illness’, she starts by noticing how ‘in the course of a couple of centuries some wheels have come nearly full circle … instead of treating lunatics as criminals, we now regard many criminals as lunatics, or at any rate as mentally disordered‘.³¹

She proceeds to pick out as ‘underlying the prevailing contemporary views … a series of closely related propositions’. The first is that

mental health and its correlative, mental illness, are objective in the sense that they are more than an expression either of the tastes and value-judgements of psychiatrists, or of the cultural norms of a particular society: mental health is to be regarded as closely analogous to, and no less ‘real‘ than, its physical counterpart. Second, it is presumed to be possible … to diagnose these objective conditions … by criteria which are independent of any anti-social behaviour on the part of those who suffer from them; so that anti-social persons can be divided into the two classes of those who are mentally disordered, and those who are not thus handicapped.

The second of these is presumably a consequence of the first, provided only that the necessary possibility is taken to be sometimes theoretical and not always practical. The distinction to which it refers, between criteria which are or are not independent, relates to that developed in Section 3 of Part I, between logically necessary and logically contingent interpretations. But what Lady Wootton presents as a corollary of this second assumption, is not. For, as has surely been made clear by later sections of that part, it is although rash perfectly coherent to maintain a version of the extreme Rees thesis in a contingent and consequently providential interpretation. You could, that is to say, without contradiction assert that all delinquencies, as identified by one set of appropriate criteria, are as a matter of fact expressions of mental diseases, as identified by another and altogether different set of appropriate criteria. In the remainder of this chapter Lady Wootton examines a large number of suggested definitions of ‘mental health’ and ‘mental disease‘. She concludes that these one and all fail to justify the first of the series of closely related assumptions which she distinguished at the beginning.

In the next chapter she considers ‘Mental Disorder and Criminal Responsibility’. It is here that her readiness to pursue analogies with the physical paradigm is most evident and most salutary. She notices for instance that we do not allow without further argument that every disease must fully excuse any conduct whatever in its subject. Indeed that a man is suffering from such and such a physical disease is sometimes irrelevant to, sometimes excuses and sometimes compounds his offence, So in so far as the analogy between the mental and the physical holds we should expect the same to apply with mental disease. For example: the fact that I do suffer terribly from a duodenal ulcer must surely excuse a general shortness of temper; but it can scarcely be allowed to expunge my offence in implementing some elaborately spiteful premeditated scheme. Again the fact that you are afflicted with a disease of the eyes which disables you from judging speeds and distances does nothing to extenuate your guilt in killing a man in a car crash. On the contrary: that you knew of this disability makes it altogether inexcusable to have been driving a car at all. Finally, to quote one of Lady Wootton‘s own happily shrewd questions, ‘Why should we accept a plea of diminished responsibility for the unlawful revenges of the deluded against their imaginary persecutors, but not for similar actions perpetrated against real enemies by rational persons, if both parties alike recognize what they do as wrong?‘³³

We must however challenge the astonishing contention made at the very beginning of this second chapter. She writes: ‘If mental health and ill-health cannot be defined in objective scientific terms that are free of subjective moral judgements, it follows that we have no reliable criterion by which to distin-guish the sick from the healthy mind. The road is then wide open for those who wish to classify all forms of anti-social, or at least criminal, behaviour as symptoms of mental disorder.‘³⁴

What is most immediately astonishing about this is the conclusion that the collapse of all attempts to develop a suitably objective distinction between mental health and mental disease must clear the way for assertions that all behaviour of some particular disfavoured sort is in fact a symptom of mental disorder. For it is clear that all concerned are continuing to assume that the truth of any such assertion would license certain inferences about the behaviour in question, inferences which are only warranted if and in so far as it does in some or indeed in most important respects actually resemble the symptoms of a typical physical disorder. But we certainly are not entitled to claim that something is the case regardless of whether or not there are any good grounds for maintaining that this is in fact so. If all attempts to develop a suitably objective distinction parallel to the distinction between physical health and physical disease have indeed collapsed, then the true moral is not that we are entitled to assert of anything we choose that it is always a symptom of mental disorder, it is rather that it is not legitimate to try to employ the expression ‘mental disease’ in any sense presupposing the subsistence of a strong and extensive analogy between such mental disease and physical disease.

Although, as we have just this moment seen, this is not what Lady Wootton actually says here, it is nevertheless a position which she might be content to hold. For she is going on to urge that we are and, she seems inclined to think, should be moving towards ‘abandoning the co...