Luca Malatesti

Analytical and conceptual engineering approaches converge in showing that harm should be a necessary component of the general concept of mental disorder, particularly within the Diagnostic and Statistical Manual of Mental Disorders (DSM). Nevertheless, the notion of harm in this and similar manuals remains vague and insufficiently defined. Using conceptual engineering, which refines or constructs concepts to better serve theoretical and practical aims, I develop an explication of psychiatric harm. Psychiatric harm arises when psychological inabilities obstruct the formation or pursuit of admissible conceptions of the good life. I reject definitions grounded in uncritical social consensus, rationalist exclusions, or essentialist ideals of human flourishing, and instead propose standards rooted in normative pluralism and democratic values that respect individual diversity. Finally, I indicate that this framework could be operationalised through methodologies exemplified by the World Health Organization’s International Classification of Functioning, Disability and Health (ICF).

This paper explores the possibility of defining the concept of mental disorder through conceptual engineering. This method proposes shaping a concept ac- cording to the goals it should serve. I argue that mental disorders should be understood as unitary mental conditions involving harm. Such harm should be assessed against justifiable standards and arise from factors beyond an individual’s ordinary control. The paper examines this proposal through five components of the proposed concept of mental disorder: unity, harm, normative standards, factors beyond control, and mental nature. The aim is to provide a framework that could support clearer diagnosis, ethical justification of treat- ment, and improved theoretical understanding.

Should offenders with psychopathy or those exhibiting extreme forms of antisocial behaviour be considered criminally responsible? The current debate seems to have reached a stalemate. Several scholars have argued that neuropsychological data on individuals with psychopathy might be relevant for determining their criminal responsibility. However, relying on such data has not produced a consensus among legal scholars and philosophers on whether individuals with psychopathy should be excused from responsibility. We offer a diagnosis about why this debate has reached a standoff. We argue that part of the problem is that psychopathy, being a syndrome-based category, is too heterogeneous and thus offers low prospects for being integrated with neuropsychological data that might support significant conclusions about the criminal responsibility of individuals with psychopathy. Moreover, the construct of psychopathy was not originally devised to discriminate criminally accountable from unaccountable antisocial individuals. To overcome these difficulties and advance the debate, we extend a currently less discussed theoretical framework for bridging biopsychology and the law that focuses on neuropsychological constructs, domains, and processes that directly measure capacities of offenders that are relevant for criminal responsibility, without necessarily relying on mediating syndrome-based constructs. The novelty of our contribution is that the biopsychological bases of exculpation can be further developed and used for determining more fine-grained categorisations of antisocial personality types. We show how this framework provides guidelines for interdisciplinary research that can significantly advance our understanding of the preconditions for criminal responsibility and help the legal practice of ascribing or withholding it.

This Element offers a framework for exploring the methodological challenges of neuroethics. The aim is to provide a roadmap for the methodological assumptions, and related pitfalls, involved in the interdisciplinary investigation of the ethical and legal implications of neuroscientific research and technology. It illustrates these points via the debate about the ethical and legal responsibility of psychopaths. Argument and the conceptual analysis of normative concepts such as 'personhood' or 'human agency' is central to neuroethics. This Element discusses different approaches to establishing norms and principles that regulate the practices addressed by neuroethics and that involve the use of such concepts. How to characterize the psychological features central to neuroethics, such as autonomy, consent, moral understanding, moral motivation, and control is a methodological challenge. In addition, there are epistemic challenges when determining the validity of neuroscientific evidence.

Should offenders with psychopathy or those exhibiting extreme forms of antisocial behav- iour be considered criminally responsible? The current debate seems to have reached a stalemate. Several scholars have argued that neuropsychologi- cal data on individuals with psychopathy might be relevant for determining their criminal responsibil- ity. However, relying on such data has not produced a consensus among legal scholars and philosophers on whether individuals with psychopathy should be excused from responsibility. We offer a diagnosis about why this debate has reached a standoff. We argue that part of the problem is that psychopathy, being a syndrome-based category, is too heterogeneous and thus offers low prospects for being integrated with neuropsychological data that might support significant conclusions about the criminal responsibility of individuals with psychopathy. Moreover, the construct of psychopathy was not originally devised to discriminate criminally accountable from unac- countable antisocial individuals. To overcome these difficulties and advance the debate, we extend a currently less discussed theoretical framework for bridging biopsychology and the law that focuses on neuropsychological constructs, domains, and processes that directly measure capacities of offenders that are relevant for criminal responsibility, without necessarily relying on mediating syndrome-based constructs. The novelty of our contribution is that the biopsy- chological bases of exculpation can be further devel- oped and used for determining more fine-grained cat- egorisations of antisocial personality types. We show how this framework provides guidelines for inter- disciplinary research that can significantly advance our understanding of the preconditions for criminal responsibility and help the legal practice of ascribing or withholding it.

Recently, Matt King and Peter Carruthers have argued that the Real Self accounts of moral responsibility or autonomy are under pressure because they rely on a questionable conception of self-knowledge of propositional attitudes, such as beliefs and desires. In fact, they defend, as a plausible assumption, the claim that transparent self-knowledge of propositional attitudes is incompatible with mounting evidence in the cognitive sciences. In this chapter, we respond to this line of argument. We describe the types of self-knowledge that might plausibly be involved, as psychological prerequisites, in the processes of identification and integration that lead to the constitution of the real self of an agent. We argue that these forms of self- knowledge do not require the type of transparent knowledge of propositional attitudes that, according to King and Carruthers, is incompatible with the results of contemporary cognitive science.

Psychopathy is typically characterized as a constellation of deviant personality traits and behavioral tendencies. The link between psychopathic personality traits and pervasive antisocial behavior raises a crucial question concerning the legal accountability of offenders with psychopathy. Some argue that the unique clinical profile and neurobiological peculiarities of individuals with psychopathy mitigate their responsibility, while others maintain that current scientific knowledge does not support the use of psychopathy as an exculpatory condition for criminal offending. Our overview mainly centeres on whether offenders with psychopathy can be considered legally insane. In this regard, our overview suggests that there is still an ongoing debate whether psychopathy should be used as a legally relevant construct for determining criminal responsibility. Moreover, our discussion indicates that careful attention should be put on empirical and conceptual issues surrounding the role of (neuro)scientific data for determining whether individuals with psychopathy should be considered criminally blameworthy for their wrongdoings.

This paper investigates, from a philosophical perspective, whether high functioning autists are legally responsible for the crimes they may commit. We do this from the perspective of the Croatian legal system. According to Croatian Criminal Law, but also criminal laws adopted in many other countries, the legal responsibility of the person is undermined due to insanity when two conditions are satisfied. The first may be called the incapacity requirement. It states that a person, when committing the crime, suffers cognitive or volitional incapacities or limited capacities that are relevant for exculpation. The second, we may call the mental disorder requirement, which states that these exculpatory incapacities are due to the presence of a mental disorder. In this paper we focus on the incapacity requirement. The review of the studies on executive functions deficits associated with high-functioning autism suggests that many autists should not be held categorically responsible for the crimes they may commit. Nonetheless, we argue that these impairments in executive functions generally do not provide an unqualified excuse.

In this chapter, we investigate whether psychopathy is a mental disorder. We argue that addressing this question requires engaging, at least, with three principal issues that have conceptual, empirical, and normative dimensions. First, it must be established whether current measures of psychopathy individuate a unitary class of individuals. By this we mean that persons classifed as psychopaths should share some relevant similarities that support explanation, prediction, and treatment. Second, it must be proven that psychopathy harms the person who has it. Third, it must be established that the harm associated with psychopathy is relevant for the ascription of disorder status. Regarding this latter issue, we argue that psychopathy should be considered a disorder if its harmfulness derives from certain incapacities or limited capacities. These incapacities should affect basic competences that are justifably required for conducting a preferable type of life. Within this framework, we tentatively advance the hypothesis that some normatively justifed conclusions and empirical evidence about psychopathy, that needs nonetheless to be further investigated, might support the claim that people with psychopathy have a mental disorder.

There are some distinct methodological challenges, and possible pitfalls, for neuroethics when it evaluates neuroscientific results and links them to issues such as moral or legal responsibility. Some problems emerge in determining the requirements for responsibility. We will show how philosophical proposals in this area need to interact with legal doctrine and practice. Problems can occur when inferring normative implications from neuroscientific results. Other problems arise when it is not recognized that data about brain anatomy or physiology are relevant to the ascription of responsibility only when they are significantly correlated with the psychological capacities contemplated by the legal formulations of responsibility. We will demonstrate this by considering two significant cases concerning psychopathy. Some paradigms that aim at measuring higher-order capacities, such as moral understanding, have limited validity. More robust paradigms for the study of learning in restricted controlled conditions, on the other hand, have limited ecological validity across individuals and context to be of any use for the law.

This book explains the ethical and conceptual tensions in the use of psychopathy in different countries, including America, Canada, the UK, Croatia, Australia, and New Zealand. It offers an extensive critical analysis of how psychopathy functions within institutional and social contexts. Inside, readers will find innovative interdisciplinary analysis, written by leading international experts. The chapters explore how different countries have used this diagnosis. A central concern is whether psychopathy is a mental disorder, and this has a bearing upon whether it should be used. The book’s case studies will help readers understand the problems associated with psychopathy. Academics and students working in the philosophy of psychiatry, bioethics, and moral psychology will find it a valuable resource. In addition, it will also appeal to mental health professionals working in forensic settings, psychologists with an interest in the ethical implications of the use of psychopathy as a construct and particularly those with a research interest in it.

The recurring claim that the construct of psychopathy is value laden often is not qualified in enough detail. The chapters in this part of the volume, instead, investigate in depth the role and significance of values in different aspects of the construct of psychopathy. Following these chapters, but also by offering a background to them, we show how certain values are involved in the characterisation of psychopathy, inform societal needs satisfied by this construct, and have a central role in determining whether psychopathy is a mental disorder. Moreover, we relate this description to our criticism of the view that the entrenchment of the notion of psychopathy with values in principle renders it irreconcilable with sound psychiatric theory and practice. However, we also recognize that the value-ladenness of psychopathy leaves open other important challenges. Meeting them needs addressing interdisciplinary interrelated issues that have empirical, normative, and theoretical dimensions.

The harm usually associated with psychopathy requires therapeutically, legally, and ethically satisfactory solutions. Scholars from different fields have, thus, examined whether empirical evidence shows that individuals with psychopathic traits satisfy concepts, such as responsibility, mental disorder, or disability, that have specific legal or ethical implications. The present paper considers the less discussed issue of whether psychopathy is a disability. As it has been shown for the cases of the responsibility and mental disorder status of psychopathic individuals, we argue that it is undecided whether psychopathy is a disability. Nonetheless, based on insights from disability studies and legislations, we propose that interventions to directly modify the propensities of individuals with psychopathic tendencies should be balanced with modifications of the social and physical environments to accommodate their peculiarities. We also suggest how this social approach in some practical contexts that involve non-offender populations might be effective in addressing some of the negative effects of psychopathy.

Recently there has been a trend of moving towards biological and neurocognitive based classifications of mental disorders that is motivated by a dissatisfaction with the syndrome-based classifications of mental disorders. The Research Domain Criteria (indicated with the acronym RDoC) represents a bold and systematic attempt to foster this advancement. However, RDoC faces theoretical and conceptual issues that need to be addressed. Some of these difficulties emerge when we reflect on the plausible reading of the slogan “mental disorders are brain disorders”, that according to proponents of RDoC constitutes one of its main presuppositions. Some authors think that endorsing this idea commits RDoC to a form of biological reductionism. We offer empirical and theoretical considerations for concluding that the slogan above should not be read as a reductionist thesis. We argue, instead, that the slogan has a pragmatic function whose aim is to direct research in psychopathology. We show how this function might be captured in the framework of a Carnapian explication as a methodological tool for conceptual engineering. Thus, we argue that a charitable interpretation of the aims of the proponents of RDoC should be understood as an attempt at providing an explication of the concept of mental disorder in terms of brain disorder whose main goal is to provide a more precise and fruitful notion that is expected to have a beneficial impact on classification, research, and treatment of psychiatric conditions.

In this paper we aim to offer a balanced argument to motivate (re)thinking about the mental illness clause within the insanity defence. This is the clause that states that mental illness should have a relevant causal or explanatory role for the presence of the incapacities or limited capacities that are covered by this defence. We offer three main considerations showing the important legal and epistemological roles that the mental illness clause plays in the evaluation of legal responsibility. Although we acknowledge that these advantages could be preserved without having this clause explicitly stated in the law, we resist proposals that deny the importance of mental illness in exculpation. We argue, thus, that any attempt at removing the mental illness clause from legal formulations of the insanity defence should offer alternative ways of keeping in place these advantages.

Effective and specifically targeted social and therapeutic responses for antisocial personality disorders and psychopathy are scarce. Some authors maintain that this scarcity should be overcome by revising current syndrome - based classifications of these conditions and devising better biocognitive classifications of antisocial individuals. The inspiration for the latter classifications has been embedded in the Research domain criteria approach (RDoC). RDoC - type approaches to psychiatric research aim at transforming diagnosis, provide valid measures of disorders, aid clinical practice, and improve health outcomes by integrating the data on the genetic, neural, cognitive, and affective systems underlying psychiatric conditions. In the first part of the paper, we discuss the benefits of such approaches in comparison to the dominant syndrome-based ones and review recent attempts at building biocognitive classifications of antisocial individuals. Other researchers, how ever, have objected that biocognitive approaches in psychiatry are committed to an untenable form of explanatory.

Psychopaths have emotional and rational impairments that can be expressed in persistent criminal behaviour. UK and US law has not traditionally excused disordered individuals for their crimes citing these impairments as a cause for their criminal behaviour. Until now, the discussion of whether psychopaths are morally responsible for their behaviour has usually taken place in the realm of philosophy. However, in recent years, this debate has been informed by scientific and psychiatric advancements, fundamentally so with the development of Robert Hare's diagnostic tool, the Psychopathy Checklist. Responsibility and Psychopathy explores the moral responsibility of psychopaths. It engages with problems at the interface between law, psychiatry, and philosophy, and is divided into three parts offering relevant interdisciplinary background information to address this main problem. The first part discusses the public policy and legal responses to psychopathy. It offers an introduction to the central practical issue of how public policy should respond to psychopathy, providing insights for those arguing about the responsibility of psychopaths. The second part introduces recent scientific advancements in the classification, description, explanation, and treatment of psychopathy. The third part of the volume includes chapters covering the most significant dimensions of philosophical debate on the moral and criminal responsibility of psychopaths.