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'That proves you mad, because you know it not': impaired insight and the dilemma of governing psychiatric patients as legal subjects
- Source :
- Theory and Society. 46:201-228
- Publication Year :
- 2017
- Publisher :
- Springer Science and Business Media LLC, 2017.
-
Abstract
- This article investigates “impaired insight,” a controversial psychiatric category describing a mad person unable to know his or her madness. Like “moral insanity” and other concepts before it, impaired insight offers a way to link the disparate logics of human responsibility in psychiatry and the law. I attribute its development to changes wrought by deinstitutionalization, the rise of antipsychotic medication, and patient incarceration in penal settings. In a system that aims to govern psychiatric patients through their freedom, the logic of impaired insight introduces a wrinkle: can a person make an informed choice to refuse treatment if madness itself impairs awareness of illness? Drawing on tools from the sociology of science, I trace the process by which researchers recast psychodynamic “denial” as a neurological and therefore non-volitional “impairment” in the 1990s. I then show how social movement actors mobilized the materialized form in the legal and policy fields in the 2000s, bringing insight science to bear upon the very questions of custodial management and patient rights that gave birth to it. At stake is this dilemma: how can societies that simultaneously privilege individual responsibility and somatic accounts of behavior govern those at the border of legal capacity, and with what justification?
- Subjects :
- History
Sociology of scientific knowledge
medicine.medical_specialty
050402 sociology
Sociology and Political Science
media_common.quotation_subject
05 social sciences
Psychodynamics
humanities
030227 psychiatry
Dilemma
03 medical and health sciences
0302 clinical medicine
Denial
0504 sociology
Moral insanity
medicine
Moral responsibility
Sociology
Psychiatry
Social psychology
Privilege (social inequality)
media_common
Social movement
Subjects
Details
- ISSN :
- 15737853 and 03042421
- Volume :
- 46
- Database :
- OpenAIRE
- Journal :
- Theory and Society
- Accession number :
- edsair.doi...........94998fee6ed513d71e9822857d489612