Chapter 6 identifies the doctrine of diminished responsibility as the closest antecedent of the Universal Partial Defence (UPD), and a suitable template from which to forge the proposal. Taking a particularised theoretical approach, the chapter draws on case law and empirical studies to arrive at a more fine-grained account of the operation of the defence. It reveals a penumbral approach to its interpretation in the courts, through the subtle inclusion of factors that sit at the edge of what might be considered a recognised medical condition or mental disorder. The chapter maintains that this flexibility suggests a stomach for moral complexity on the part of fact-finders, arguing for a broader, normative test that can include consideration of circumstance, as the basis of the UPD. The analysis considers the role of key decision-makers, and it serves to inform the development of a bounded causal theory of partial excuse in Chapter 7.

This chapter explores legislative time limits on the prosecution of crime in civil and common law jurisdictions. It addresses the rationales for barring the prosecution of old crimes and undertakes a comparative analysis of three jurisdictional groupings: Continental Europe (with a focus on Germany and France), the Commonwealth (with a focus on England and Wales) and the United States (with a focus on federal law). The analysis identifies comparable features in limitation doctrine across jurisdictions while revealing how the theory and practice of statutes of limitation differs markedly in different legal systems. In broad terms, Continental systems codify general and categorical time limits on the prosecution of offences; Commonwealth systems tend not to have any statutory time bars on the prosecution of offences other than minor offences; and in the United States, most offences, other than the most serious, are subject to statutory limitation periods. The chapter concludes by drawing together the points of comparison between the three jurisdictional groupings, commenting on their distinctions and similarities.

There are no such things as “personality disorders” distinct from other mental disorders. Distinct personality disorders cannot be identified based on their developmental course or their symptoms. The new ICD and DSM concept of personality disorder as self and interpersonal dysfunction identifies important forms of psychopathology but is not more (or less) related to personality than are other disorders. Rather, personality traits contribute to risk for all forms of mental disorder, and most symptom dimensions are coextensive with dimensions of normal personality, such that persistent symptoms of psychopathology are typically extreme or maladaptive variants of normal personality traits. However, symptoms are merely indicators of risk rather than necessary and sufficient indicators of psychopathology. We draw on our cybernetic dysfunction theory of psychopathology to clarify the role of personality in mental disorder. Psychopathology is defined as “persistent failure to move toward one’s goals, due to failure to generate effective new goals, interpretations, or strategies when existing ones prove unsuccessful.” Personality is exhaustively described by personality traits and characteristic adaptations, the latter being relatively stable goals, interpretations, and strategies that are specified relative to an individual’s particular life circumstances. Psychopathology always involves failure of characteristic adaptations and thus breakdown in personality functioning.

Madness, as a form of suffering, has existed as long as humankind. Only in the nineteenth century did it come under the aegis of medicine, giving rise to the birth of psychiatry/alienism as a discipline. Prior to this, madness had attracted the attention of many agents, including the Church, medics, philosophers, and others. During the seventeenth century in the context of secularization, the scientific revolution, and other factors, it began to be viewed as a natural kind and thereby a medical object. In the nineteenth century, the medicalization of madness was further associated with a growth of mental asylums, enabling alienists to observe patients longitudinally, to classify their complaints, and to construct the language for the description/construction/capture of mental symptoms, namely, descriptive psychopathology. In contrast to the signs available to medical doctors, alienists had to develop different clinical criteria, and the emerging social sciences became the natural source for these. Thus, from the beginning, descriptive psychopathology was a hybrid construct, incorporating the frameworks of both the natural sciences and the social sciences. The tension resulting from this incongruent union has persisted ever since and contributed to the polarities in current conceptions of mental disorders as well as the challenges facing psychiatry today.

The Introduction summarises the core themes of the book and outlines how the argument will proceed over the course of its chapters. It explains why the issue it centres around – namely, how the law grapples with the impact of mental disorder on decision-making – is so important, and why successfully navigating the tension between respect for (and deference to) idiosyncratic values, and protection from disorder or impairment, must be a precondition of England and Wales adopting ‘fused’ mental capacity and health legislation, or a more CRPD-compliant statutory framework. It also explains how the book relates to the existing literature in this area, which has focused in recent years on concerns about the binary nature of the capacity framework, and on the individualistic and rational ‘liberal subject’ on which this framework rests. Finally, it elaborates briefly on some of the concepts which the book will draw upon, in particular what is meant by ‘values’ and ‘beliefs’.

Where the real basis for finding someone to lack capacity is that you consider the beliefs or values that motivate their decision to be distorted by a mental illness, such that the decision is not authentically desired and so is unworthy of respect, this entails a number of empirical and normative claims. This chapter will interrogate these claims by reference to the wide-ranging literature on the nature of mental disorder, and on differing conceptions of autonomy and authenticity (as a component of autonomous decision-making). It will be concluded that while an agent acting on the basis of disordered beliefs or values will often be acting inauthentically (and thus non-autonomously), this will not always be the case, and situations could arise in which there is reason to believe that the agent would endorse or sanction their belief, even knowing it is derived from illness. Moreover, once the shaky conceptual ground on which such judgements must be made is acknowledged, it becomes essential that these judgements are brought out into the open, where they can be subject to appropriate scrutiny.

This chapter will explore a key problem with the current law’s approach – namely, that it is impossible to assess a person’s capacity to ‘use or weigh’ the information relevant to a decision without engaging with the values that underpin their decision. It will suggest that while some recourse to the person’s values is unavoidable, the current approach gives assessors ample room to invoke other values when assessing the person’s capacity, thus creating space for paternalistic judgments to go unchecked. Despite this risk, it will be claimed that in many of the cases in which this occurs, underpinning the assessment is in fact a concern that the values or beliefs that motivate a person’s decision have been affected by an illness or impairment, such that the decision reached is not one that the agent would have made, but for that disorder or impairment. The current law cannot account for this, and so assessors are forced to manipulate the test for capacity instead. While this prevents unnecessary harm, it has the effect of obscuring the value-laden and highly controversial claims that may underpin such decisions, which remain insulated from scrutiny or challenge.

Violence is common and is a public health issue. Forensic psychiatrists offer treatment for the small amount of violence that is due to mental disorder. It is essential to distinguish between meaningful explanations and causes. Violence is not a unitary concept. Evidence for the specific causal associations between mental illness and violence is reviewed. Anger, anxiety, moral and amoral actions are reviewed including intoxication and withdrawal, deception, antisocial personality and psychopathy, and a range of mental illnesses and developmental disorders. Social and developmental factors are also important. Memes, media and social contagion influence the forms of violence. Court reports and treatments are considered critically in relation to violence.

This chapter describes some commonly used nonhuman paradigms for assessing animal behavior and the figures that are used to present those data. The chapter opens with an overview of some animal species used in neuroscience research, a discussion about nonhuman housing, and a description of types of validity that behavioral neuroscientists concern themselves with. The behavioral tests described here are divided into five major categories: motor behaviors; pain; learning and memory; mental disorders such as anxiety, depression, and substance use disorder; and social behaviors. Included is a description of a survival analysis and an explanation of interpreting Kaplan–Meier curves.

This chapter seeks to provide clinicians with a better understanding of prisons and overcome many of the myths and misconceptions, with the objective of making the environment more attractive and interesting for future psychiatrists. In addition to a wide need and a rich variety of conditions, the psychiatrist in prison must contend with barriers to care such as working without a mental health act and, when a patient needs to be transferred and treated outside of prison, navigating complicated pathways to care. Mental disorder is prevalent in all prison systems. Pathways into prison may be related to general factors, specific factors such as delusions and comorbidities and complications of mental illness such as homelessness and breakdown of relationships, as well as service provision issues. The prevailing policy has been to divert prisoners in need of hospital care out of prisons. Court diversion models can focus on any point in the pathway from community to the criminal justice system. In prison, specialist mental health services are needed to address the high levels of morbidity due to self-harm, drug use, suicide and self-harm, hunger strikes and many other manifestations of developmental problems and traumatic experiences.

This chapter reviews decision-making in insanity defense trials. The chapter begins with an overview of the variety of legal definitions of insanity in the United States, discussing how these rules provide parameters and shape (or fail to shape) insanity decisions. Various factors related to decision-making in insanity defense cases are discussed, including attitudes toward the insanity defense itself (and how these reflect myths about the insanity defense and its implications), prototypes of insanity, and individual differences of both jurors and defendants. The chapter examines misconceptions of mental disorder and how these might relate to decision-making in these cases and considers the role of decision-makers’ perceptions of punishment in this context. The chapter also reflects on the role of intersecting identities in insanity judgments, provides an overview and synthesis of the current body of research on legal decision-making in insanity cases, discusses limitations to the current literature, provides future directions, and considers legal and policy implications.