Rationality, Diagnosis, and Patient Autonomy in Psychiatry

Abstract

and Keywords In this chapter, our focus is the role played by notions of rationality in the diagnosis of mental disorders, and in the practice of overriding patient autonomy in psychiatry. We describe and evaluate different hypotheses concerning the relationship between rationality and diagnosis, raising questions about what features underpin psychiatric categories. These questions reinforce widely held concerns about the use of diagnosis as a justification for overriding autonomy, which have motivated a shift to mental incapacity as an alternative justification. However, this approach too has recently been criticized from a mental disability rights perspective. Our analysis of the relationship between mental capacity and rationality is used to illuminate these concerns, and to investigate further the relationship between rationality and psychiatric diagnosis.

Querying the Call to Introduce Mental Capacity Testing to Mental Health Law: Does the Doctrine of Necessity Provide an Alternative?

“…Whatever the underlying assumptions, law that bases interference on the presence of mental disorder-the so-called "status" approach-holds that a psychiatric diagnosis eliminates the need to assess the person's decision-making ability. The diagnosis alone is taken to mean that the person is not in a position to decide for themselves, at least in relation to psychiatric treatment... [19].…”

“…potentially severe (see [45]). However, there is some evidence to show that courts in the UK and Australia are permitting greater scope for risk than was previously the case (see [19,33]).…”

“…In addressing these two major concerns about mental health law, mental capacity assessments are advanced as a more ethical basis for involuntary psychiatric intervention (see [9][10][11]19]). Arguably, assessors would no longer rely on diagnosis and could largely transcend the subjective judgment of the outcome of a person's choice; instead judging whether a person comprehends a decision that needs to be made at a particular time.…”

“…This article will examine the call to replace psychiatric diagnosis with mental (in)capacity as a basis for involuntary intervention under mental health law. Similar analyses have examined this call from the perspective of psychiatric ethics [19], while other prominent studies have focused on "fusing" mental health law and guardianship (adult capacity) law to create an overarching substituted decision-making framework for law and policy [13]. Instead, this article will assess and critique the proposal to introduce mental capacity assessments as grounds for involuntary intervention within mental health law.…”

Taking the long view: an emerging framework for translational psychiatric science

“…Anxiety and mood disorders , for example, have been linked with creativity; and people with autism are beginning to be recruited by some high‐tech industries for their particular cognitive skills . There is compelling evidence, furthermore, suggesting that people with certain psychiatric disorders may actually be more rational in certain tasks than the non‐clinical population . For instance, people with schizophrenia are less vulnerable to a statistically normal but irrational tendency to gamble when faced with a certain loss ; and people with autism are more logically consistent than controls when making decisions involving possible financial gain, because they are not distracted by emotional contextual cues in the same way as controls .…”