Mental Illness, Violence & Liberty

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The mass murder that occurred at Sandy Hook Elementary school has created significant interest in both gun control and mental health. In this essay I will focus on the matter of mental health.

When watching the coverage on CNN, I saw a segment in which Dr. Gupta noted that currently people can only be involuntarily detained for mental health issues when they present an imminent danger. He expressed concern about this high threshold, noting that this has the practical impact that authorities generally cannot act until someone has done something harmful and then it can be rather too late. One rather important matter is sorting out what the threshold for official intervention.

On the one hand, it can be argued that the relevant authorities need to be proactive. They should not wait until they learn that someone with a mental issue is plotting to shoot children before acting. They certainly should not wait until after someone with a mental issue has murdered dozens of people. They have to determine whether or not a person with a mental issue (or issues) is likely to engage in such behavior and deal with the person well before people are hurt.  That is, the authorities need to catch and deal with the person while he is still a pre-criminal rather than an actual criminal.

In terms of arguing in favor of this, a plausible line of approach would be a utilitarian argument: dealing with people with mental issues before they commit acts of violence will prevent the harmful consequences that otherwise would have occurred.

On the other hand, there is the obvious moral concern with allowing authorities to detain and deal with people not for something they have done or have even plotted to do but merely might do.  Obviously, there is rather serious practical challenge of sorting out what a person might do when they are not actually conspiring or planning a misdeed. There is also the moral concern of justifying coercing or detaining a person for what they might do. Intuitively, the mere fact that a person could or might do something wrong does not warrant acting against the person. The obvious exception is when there is adequate evidence to establish that a person is plotting or conspiring to commit a crime. However, these sorts of things are already covered by the law, so what would seem to be under consideration would be coercing people without adequate evidence that they are plotting or conspiring to commit crimes. On the face of it, this would seem unacceptable.

One obvious way to justify using the coercive power of the state against those with mental issues before they commit or even plan a crime is to argue that certain mental issues are themselves adequate evidence that a person is reasonably likely to engage in a crime, even though nothing she has done meets the imminent danger threshold.

On an abstract level, this does have a certain appeal. To use an analogy to physical health, if certain factors indicate a high risk of a condition occurring, then it make sense to treat for that condition before it manifests. Likewise, if certain factors indicate a high risk of a person with mental issues engaging in violence against others, then it makes sense to treat for that condition before it manifests.

It might be objected that people can refuse medical treatment for physical conditions and hence they should be able to do the same for dangerous mental issues. The obvious reply is that if a person refuses treatment for a physical ailment, he is only endangering himself. But if someone refuses treatment for a condition that can result in her engaging in violence against others, then she is putting others in danger without their consent and she does not have the liberty or right to do this.

Moving into the realm of the concrete, the matter becomes rather problematic. One rather obvious point of concern is that mental health science is lagging far behind the physical health sciences (I am using the popular rather than philosophical distinction between mental and physical here) and the physical health sciences are still rather limited. As such, using the best mental health science of the day to predict how likely a person is likely to engage in violence (in the absence of evidence of planning and actual past crimes) will typically result in a prediction of dubious accuracy. To use the coercive power of the state against an individual on the basis of such dubious evidence would not be morally acceptable. After all, a person can only be justly denied liberty on adequate grounds and such a prediction does not seem strong enough to warrant such action.

It might be countered that in the light of such events as the shootings at Sandy Hook and Colorado, there are legitimate grounds to use the coercive power of the state against people who might engage in such actions on the grounds that preventing another mass murder is worth the price of denying people their freedom on mere suspicion.

As might be imagined, without very clear guidelines and limitations, this sort of principle could easily be extended to anyone who might commit a crime—thus justifying locking up people for being potential criminals. This would certainly be wrong.

It might be countered that there is no danger of the principle being extended and that such worries are worries based on a slippery slope. After all, one might say, the principle only applies to those deemed to have the right (or rather wrong) sort of mental issues. Normal people, one might say in a calm voice, have nothing to worry about.

However, it seems that normal people might. After all, it is normal for people to have the occasional mental issue (such as depression) and there is the concern that the application of the fuzzy science of mental health might result in incorrect determinations of mental issues.

To close, I am not saying that we should not reconsider the threshold for applying the coercive power of the state to people with mental issues. Rather, my point is that this should be done with due care to avoid creating more harm than it would prevent.

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