Philosophy, Psychiatry, & Psychology

We are grateful for the opportunity to respond to the two kind and thoughtful commentaries on our paper. Sadler suggests irrationality may be the key to distinguishing psychiatric from nonpsychiatric violence. We are not so sure that this is necessarily as helpful as it might at first seem. Who gets to decide what is rational? Much “normal” violence, committed in the heat of the moment, impulsively, and drunkenly, may not appear that rational, even to the perpetrator, in the cold light of day. We are not sure one would wish to bring this sort of violence within the province of psychiatric explanations. Likewise, a point we made in our paper: Even delusionally driven violence often has its own internal coherence and rationality within an irrational framework.

We found much to agree with in McCallum’s commentary, and perhaps his alternative approach is more helpful. He proposes a more sociological model of understanding what is going on in these complex cases, one that starts with societal dividing practices. Our present times have been described as the tyranny of the bureaucrats. Professional approaches are devalued. Diagnosis is only relevant in terms of its bureaucratic utility in moving people from one category to another. Since the writing of our paper, the criminal law has changed further in England and Wales. The Criminal Justice Act 2003 brought with it new sentences of indeterminate detention for public protection for those offenders categorized as “dangerous.” The presence or absence of psychiatric disorder being largely irrelevant for these purposes. This would seem to fit nicely with McCallum’s analysis, and in principle rather takes the wind out of our sails when we argued about the discrimination against psychiatric violence—now a diagnosis is not necessary for the state to intervene in a probabilistic fashion to prevent future violence. Deciding between what sort of violence counts as psychiatric and what does not, does not have quite the same drastic differential effect on the individual as perhaps it did. Its importance is now, as predicted by McCallum’s model, more to do with bureaucracy: Which government department will be paying for the individual’s preventive detention (Department of Health or Ministry of Justice)? [End Page 75]