Madness versus badness: the ethical tension between the recovery movement and forensic psychiatry

Theor Med Bioeth. 2010 Feb;31(1):93-105. doi: 10.1007/s11017-010-9138-9.


The mental health recovery movement promotes patient self-determination and opposes coercive psychiatric treatment. While it has made great strides towards these ends, its rhetoric impairs its political efficacy. We illustrate how psychiatry can share recovery values and yet appear to violate them. In certain criminal proceedings, for example, forensic psychiatrists routinely argue that persons with mental illness who have committed crimes are not full moral agents. Such arguments align with the recovery movement's aim of providing appropriate treatment and services for people with severe mental illness, but contradict its fundamental principle of self-determination. We suggest that this contradiction should be addressed with some urgency, and we recommend a multidisciplinary collaborative effort involving ethics, law, psychiatry, and social policy to address this and other ethical questions that arise as the United States strives to implement recovery-oriented programs.

MeSH terms

  • Beneficence
  • Bioethics*
  • Character*
  • Commitment of Mentally Ill / legislation & jurisprudence
  • Commitment of Mentally Ill / standards
  • Commitment of Mentally Ill / trends
  • Community Mental Health Services
  • Community Psychiatry* / standards
  • Community Psychiatry* / trends
  • Criminals / psychology*
  • Dangerous Behavior*
  • Decision Making
  • Forensic Psychiatry* / standards
  • Forensic Psychiatry* / trends
  • Humans
  • Interdisciplinary Communication
  • Jurisprudence
  • Knowledge
  • Mental Competency
  • Mental Disorders / psychology*
  • Mental Disorders / rehabilitation*
  • Morals*
  • Patient Advocacy
  • Personal Autonomy*
  • Physician-Patient Relations / ethics
  • Public Policy / legislation & jurisprudence
  • Public Policy / trends
  • Punishment
  • Recovery of Function
  • Self-Help Groups
  • Social Values
  • Terminology as Topic
  • United States