18 February 2007



For those who are familiar with trains in England would remember that some trains and the underground use (used) three rails instead of the normal two rails. Not surprisingly, this third rail was called, "the third rail."

Unlike most other trains, this third rail supplied the electricity to the train, instead of the overhead power cables which are more common these days. There is a lot to recommend this third rail system, the most important of which is that the countryside is not defaced with those ridiculously hanging cables, with out of place pylons and other contraptions. The down side is that they are dangerous if one happened to step on these rails. Dangerous in the sense that having lunch with sharks can be dangerous. But why would someone want to have lunch with sharks is too big a question to answer now.

In dealing with madness (and its synonyms) we have adopted the equivalent of a third rail system. On the one hand we have madness as a medical condition and on the other, madness (insanity) is involved in a legal context. However, insanity as a defence in court is not that common. These are the two binary contexts where we commonly find madness as the object of our attention.

Philosophy is the third rail. And as long as medicine or the law don't inadvertently step onto this third rail, everything should be fine. To give you a taste of what I mean I will consider these two questions. For a long time madness in medicine had been the domain of psychiatry and maybe psychology. Always trying to reach that gold standard of normality; in other words, to help troubled patient achieve a normal mind. However, with the advent and progress in neurology, with its tools of MRI, fMRI, genetics and so on the debate has shifting from normal mind to normal brain. In other words, should we be talking about normal minds or normal brains? And although the neurologist is clear about his or her mission statement and the psychiatrist about his or her mission statement, the answer to the question “normal mind or normal brain?” has deep and serious implications.

Take the legal situation. Is the law concerned with administering punishment or social engineering. For example, is the law there to punish people who transgress the law or to remove people who transgress the law from society? In other words, is the law concerned with justice or social engineering?

If we want to punish people, then we have to exclude mitigating circumstances and administer the punishment. Hence, whether someone was abused when they were young or live in poverty it's just immaterial. However, if we want social engineering then it won't be the jury and the courts who decides what happens to people who transgress the law, but maybe a neurologist who is in a much better position to tell us what is a normal brain, and by implication reasonable behaviour.

Of course, when I say normal brain, normal mind or even social engineering I am not necessarily thinking about the state of affairs as it is now. Maybe answering the question what is a normal brain is as difficult to answer as what is a normal mind. But we, as philosophers, are free to look further a field than the here and now. We can, for example, understand the normal brain idea to be analogous to Plato’s forms. Some ideal standard or a gold standard, if you like, of what is a normal brain. Maybe one day neurologists might be able to perform some sort of benchmarking for human brains in the way that companies today do benchmarking for all sorts of gizmos.

My point is that once we touch that third rail of philosophy, most probably, someone is going to get hurt. The question, is it a normal mind or a normal brain?, is a philosophical question (value judgement even about science), But the outcome to this question is very important; for example, if we decide that it's a normal brain then research, maybe drug research, would focus on changing the composition of the brain and not changing the behaviour of the patient. Similarly, for the legal system, the debate between punishment and social engineering Is a philosophical question. And if we opt for social engineering then we can expect to see the law moving towards administering justice through a test tube.

There is a good essay on mental illness on the Stanford encyclopedia of philosophy, written by Christian Perring. I won’t go into too much detail about this article except to identify some interesting philosophical issues, maybe even more philosophy of science and medicine.

An important debate which this essay identifies is whether there is such a thing as mental illness and as a consequence whether psychiatry is a real science (questions asked by Szasz)? Although the essay points out that psychiatry is a respectable science these days, the issue has not gone away. Is disease, by definition, a bodily disease? In which case we lose the mental part of the disease.

But there still remain the issues of what is normal and what is a disease? What is normal is a difficult question to answer for psychiatry, neurology and philosophy. in my opinion the problems lies in the fact that we can easily decide whether someone is behaving normally or abnormally. Evolution has made sure we can answer this question, at least, at face value. But when we come to establish an a priori definition of “normal” we come across all sorts of problems.

Maybe it is relatively easy to establish abnormality if we can establish an abnormal brain or physical damage to the brain. But what about behaviour which is the result of trauma, fear or aggression by others. What is the disease: the irregular patterns in an MRI or the bully who is terrorising the neighbourhood? And what should we treat: the bully or the brain? Maybe this might prove easy to answer?

What about cultural differences? Is it “normal” for a patient to object if their doctor is a male or a female? In our culture a doctor is a doctor, and whether they are male or female is just immaterial. But that’s our culture. So even if there is an electron microscope answer to what is normal, there might not be a similar answer to what is normal with culture playing a relevant role? You would have noticed that we are that close to touching that dangerous third rail. We touch that third rail as soon as we ask the question, whose culture should we follow; ours which says that the sex of the doctor is immaterial or some other culture which says that it does matter? Maybe we haven’t been electrocuted yet, but now consider this question: should female foeticide be allowed simply because in a culture females have no value at all? Is it madness or normal for a mother to abort a foetus simply because females are considered as having no real value?

However, today we know enough that hereditary linage is preserved through the maternal mitochondria. Can we go from here and say that at least from a genetic argument point of view, a female who destroys a female foetus is, in effect, “genetically” mad? She’s destroying her genetic lineage. And can we imply that societies who condone female foeticide (or similar anti-female behaviour) are in effect mad and crazy because they are condoning the destruction of their linage? What we know for sure is that which ever way we answer these questions, we are going to get philosophically electrocuted.

Although in reality medical madness and legal madness are poles apart, they do come together when they consider certain issues, for example, personal responsibility. Excluding addiction and other abuses, how can we hold someone to be responsible for their actions if their brain falls far short of the gold standard? And if responsibility has now become a matter for the electron microscope to establish, have psychiatry and neurology destroyed morality? Maybe not, our evolutionary instinct has no problem deciding what is a normal person and who looks suspicious, even if sometimes we get it wrong. And if we can arrive so far, we can also arrive at having a semblance of a functional moral system; sans electron microscope.

But this dilemma of moral responsibility, is not only a central issue for medicine, but also for the law. The law (Wikipedia: insanity defence) recognises that sometimes the mental state of the person on trial is a relevant issue. And although mental illness and insanity differ from jurisdiction to jurisdiction, the idea is relatively clear, “punishment is only reasonable if the defendant is capable of distinguishing right and wrong.” But using insanity or mental illness as a defence could very well be a double edged sward. In England, for example, if a defence of insanity succeeds, the courts can still issue a hospital order against the defendant which has no limits. Hence, although the defendant might not go to prison, they might still end up in an institution for much longer than had they gone to prison. For this reason, insanity defences are not very common. (The M’Naughton Rules (1843) are the main test for of insanity in most common law jurisdictions).

The legal position on madness (insanity, mental illness) seems to centre on the fact that justice must be seen to be made. Hence, someone might indeed have a mental illness or be insane, but nevertheless they will still go through the trial and punishment process; for example Michigan was the first state to establish the verdict, Guilty but mentally Ill (1975). The legal process takes precedence.

In a short article, “Mad Bad or Ill,” published on the welcome trust website (http://www.wellcome.ac.uk/doc_WTX024068.html), it is reported that the philosopher, Professor Glover (with others), is conducting research amongst inmates from Broadmoor Special Hospital ( a hospital in the UK which houses people who have been institutionalised by the courts) and who suffer from Antisocial Personality Disorder. Glover, is trying to find out what are the moral beliefs and moral reasoning of these patients, who would otherwise be considered criminals. For example, his interviews include such questions as “the only space in the car park is the disabled parking space, do you use it?”

However, in the words of Glover himself, these interviews are proving more difficult because…[the patients] are too demented to take part or put up a front. That this sort of field research should prove difficult does not come as a surprise. The problem, and it is an old problem, is that it is one thing to ask people what they think they would do in a given situation and what they actually do in the event that they do find themselves in such a situation. In reality we don’t know what people will do in real life when faced with a serious moral dilemma. One reason is of course, that most of us do not have to face serious moral dilemmas on a regular basis and hardly the same dilemma, anyway.

Hence, the real problem for Glover, is that he is facing some sort of mirror image of the is/ought problem. You will remember that Hume drew our attention to the incongruity of jumping from is (the past) to what ought to be (the future.) In Glover’s case he is faced with what is in the future (what someone will actually do in a real situation) from what ought to be done (what someone believes they will do). If it does not work from what is to what ought to be, why should the world be more predictable from what ought to be to what is? We can use the same objection to those psychology studies who purport to arrive at moral truths by subjecting a few undergraduates to experiments in the comfort of a university laboratory. Maybe, following combat troops in action with a clip board might produce better and realistic results about what is a moral standard.

I use the Glover research, which no doubt is very useful and probably good things will come out from it, to show that the third rail, philosophy, is just as dangerous to jurisprudence as it is to medicine. That is, trying to find what is morally normal in law. However, although the meaning and the use of madness is very different in the legal context from the medical context, there are parallel similarities especially in issues and consequences. The references I give above discuss these similarities and differences in detail. What I am interested in is that both disciplines are concerned with responsibility. That is, if someone is suffering from mental illness are they responsible for their actions? For the legal profession the objective seems to be to protect the notion that we act with a free will or as if we act with a free will. And in a way, the medical profession aims to restore this idea of free will, or at least as if the patient is restored to acting with a free will.

However, as I pointed out, the future consequences might not turn out to be as clear cut and friendly to all parties. The more we move away from mental illness to brain disease the less scope we give to the legal process. And although the courts might always be involved with punishment they would certainly have to share their powers for social engineering with medial experts. In other words, if the courts tried to investigate the normal brain, they would be acting as neurologists and not lawyers.

Now, whether we use the M'Naghten Rules or MRI or our evolutionary instinct, we all would agree (philosophers ought to be cautious about such agreements) that mad is bad and negative. It is therefore no wonder that both medicine and the law are very much concerned with establishing what is normal by identifying the abnormal. But is this enough?

The reason why we shouldn’t agree to any general statements is because we haven’t yet investigated what “normal” people think about madness. One thing we can do about this is to look at how we use the word mad(crazy) in our everyday language. In everyday language, mad has (mainly) four meanings:

1) unusual, unconventional, risky,

2) anger,

3) hurriedness, fast,

4) a lot, a huge amount.



For example:

1) He must be mad to leave his city job to go and observe fruit flies mate.

2) He was hopping mad when the fruit flies were blown away by the wind.

3) He rushed away in a mad run trying to follow the fruit flies in the wind.

4) Clearly, he is mad about fruit flies.



In our “normal” language “mad” represents common emotion and feelings, but with a high or extreme intensity. And this is an important issue for philosophy. Is an emotional expression the same as a behavioural expression? Maybe the issue for madness is not so much an issue of behaviour, but an issue of how we control our emotions. I submit that a rational and normal agent would have a high degree of ability to control one’s emotions. Of course, there are always limits. Having lunch with sharks is quite unreasonable and irrational, even of one is not afraid, in the same way that it is quite reasonable and rational to be angry if one’s fruit flies are blown away.

Take care


18 February 2007

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