Does mental disorder involve loss of personal autonomy?

Derek Bolton and Natalie Banner

in Autonomy and Mental Disorder

Published on behalf of Oxford University Press

Published in print April 2012 | ISBN: 9780199595426
Published online February 2013 | e-ISBN: 9780191754739 | DOI:

Series: International Perspectives in Philosophy & Psychiatry

Does mental disorder involve loss of personal autonomy?

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In the course of the chapter we have considered the nature and variety of the distress and disabilities involved in mental disorder and examined the extent to which these features may be helpfully explicated in terms of the various philosophical, psychological and political meanings of autonomy. Several main points relevant to this question have been identified. First, the notion of illness in general and of mental illness in particular refers to an episode in which normal functioning is disrupted or lost—‘normal’ including ‘normal for the person’—as opposed to some lasting personality trait or character. In the case of mental illness in particular, mental states and the state of the self are disrupted. To the extent that the person speaking and acting identifies with these abnormal states, the person is not being themselves—for reasons of illness. This disruption of the states of the self could be described as a loss of autonomy as authenticity, but in our view this is unhelpful. This is mainly because the idea of autonomy as authenticity is itself problematic, quite possibly irredeemably so. But it is also because this formulation would stretch the meaning of authenticity too far. The central issue in this context is that people in an illness episode are not as they usually are; it is not that they are being inauthentic in any other sense, or that their usual self is authentic is any sense other than: the way they usually are. A second point is that the distress and disabilities fundamental to mental disorder typically involve loss of freedom to act. This idea of freedom to act is central to the political meaning of autonomy. Liberal political philosophy seeks to safeguard freedom of action, presupposing the autonomous, self-determined agent. This presupposition is interrogated by ‘illness’, among other things. When a person is ill, the person is not altogether themselves, and either or both of ‘self’ and ‘determination’ lose clarity. Illness typically involves not being able to do what one normally can, a loss of freedom, not because of any outside interference, but because of one’s inner state.

Chapter.  8475 words. 

Subjects: Psychiatry

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