Commentary on 'Competence in chronic mental illness: The relevance of practical wisdom'

As this interesting paper well brings out, the assessment of competence to make decisions can be especially difficult in cases of adult mental illness. The paper revolves around two such cases, both involving OCD. Jack realises his symptoms are peculiar, but resists admission to a psychiatric unit because he prefers not changing his way of life. Later, deep brain stimulation is of some therapeutic benefit, but he is now considering discontinuing treatment. Mary decides to stop treatment based on anti-depressants and CBT, and later, on the advice of her psychiatrist, becomes involved in childcare, which provides some health benefits. Ruissen et al describe three approaches to competence—the cognitive approach (C), the emotions approach (E), and the values approach (V), and suggest that weaknesses in each can best be dealt with by combining all three in a fourth, the practical wisdom approach (P). I shall raise some questions internal to Ruissen et al 's critique of the three rejected approaches, and express some doubts about the appropriateness of an Aristotelian model of competence. I shall conclude that the preferable model is a version of C. According to C, a person is …