Ten years ago the Royal Institute of Philosophy marked the establishment of the Society for Applied Philosophy with a series of public lectures, published in an earlier book in this series, under the title Philosophy and Practice (Griffiths, 1985). Looking back it i s hard to believe this was only ten years ago. Applied philosophy still has its critics. But it is now so pervasive, so much the norm, that it seems to have been with us always. Law, medicine, education, nursing, the environment, politics, economics … almost it seems, no subject is quite respectable nowadays without its philosophy and its philosophical exponents.

These are exciting times for philosophy and psychiatry. After drifting apart for most of this century, the two disciplines, if not yet fully reconciled, are suddenly at least on speaking terms. With hindsight we may wonder why they should have ignored each other for so long. As Anthony Quinton pointed out in a lecture to the Royal Institute of Philosophy a few years ago, it is remarkable that philosophers, in a sense the experts on rationality, should have had so little to say about the phenomena of irrationality (Quinton, 1985, ch. 2). There have been partial exceptions, of course. Descartes and Kant both touched on madness; and there were, notably, important philosophical influences on the development of modern psychiatry in the late nineteenth and early twentieth centuries (Zilboorg and Henry, 1941). Yet even John Locke, who was a doctor as well as philosopher, confined himself to a fair-l y superficial distinction between what we should now call mental illness and mental defect—those with, in Locke's view, respectively too many ideas and too few (Locke, 1960).

During the last fifty years three major ways of defining a science of psychology have been proposed and tried out.

On New year's Eve 1992 a man suffering from schizophrenia climbed into a lions' cage at the London Zoo and was badly mauled. This event provoked a full-scale moral panic among the media and government, the tragedy seeming to violate many of the comfortable myths about progress in psychiatry, echoing the impact of the civil war in former Yugoslavia which had shattered the hope of an era of unbroken European peace following the end of the cold war. Whatever we may wish in reality the lion does not lie down with the lamb. Daniel the visionary, the interpreter of dreams, the one who asserted that his God, the God of angels and saints with power over man and beasts would eventually endure, while all earthly kings were found wanting, emerged from the lions’ den unscathed—but secular, psychiatric, suffering, decarcer-ated, visionless, late-twentieth-century man does not.

The philosopher is the man who has to cure himself of many sicknesses of the understanding before he can arrive at the notions of the sound human understanding. (Wittgenstein, 1967, no. 302)

This paper will be about the relationship between mental disorder and physical disorder. I shall also be concerned with the connection between these notions and the notion of ‘illness’.

I shall be employing a number of terms that have a variety of usages as in other contexts. The definitions I shall be using in this article are given below.

Some readers may have seen the re-runs, on BBC-TV recently, of the ‘Face to Face’ interviews done by John Freeman in the 1960s. One of these was with the singer Adam Faith, then a startlingly beautiful young man with the grace to be amazed at being chosen to be sandwiched between Martin Luther King and (if I remember aright) J. K. Galbraith. The re-runs were accompanied, where possible, with a further interview with the same person. What I found almost as startling as his lost beauty was Faith's referring to himself-when-young in the third person. After watching the rerun interview, the now middle-aged man commented to Freeman, on several occasions, that ‘He said such-and-such’, ‘He told you so-and-so’, and the like.

Can deception be a model for self-deception? There are familiar problems with saying that it can be. At the heart of all these problems, in the long run and despite the complexities and sophistications of the various theories, is this one evident point: all deception of another requires at least two choosing and believing agents, and such a duality is not—is it?—a model which we can tolerate for understanding a single person. Yet on the other hand we seem to have no other way of describing self-deception; most attempts to do so, even if they begin by criticising the ‘deception’ model, prove, in the long run, to come down to it.

This article centres around two somewhat contrasting case histories: one involving a person with dementia; the other a person with mild mania.

I am interested in those vices which appear on lists of ‘deadly sins’, not from any theological point of view but because of the insight revealed in their selection as being ‘death to the soul’, which I understand as ‘corruptive of the self’. ‘Corruption’ is here to be taken in a literal sense as ‘destruction or dissolution of the constitution of a thing which makes that thing what it is’ (OED). Such corruption is to be found in the structure of the will. Aquinas thought that vice consists in desire gone wrong because uncontrolled by reason. Perhaps what follows can be seen as an interpretation and filling out of this view.

So fearfully and wonderfully are we made, so infinitely subtle is the spiritual part of our being, so difficult is it to trace with accuracy the effect of diseased intellect upon human action, that I may appeal to all who hear me, whether there are any causes more difficult, or which, indeed, so often confound the learning of the judges themselves, as when insanity, or the the effects and consequences of insanity, become the subjects of legal consideration and judgment. (From Thomas Erskine's address to the jury in Rex v. Hadfield)

Unlike topics such as criminal responsibility, dangerousness has only recently begun to interest philosophically minded penologists. The most likely explanation is that until the middle of this century the periods for which people who had done serious harm to others were incarcerated in the UK so long that when they were released their age or condition or circumstances made them unlikely to repeat their crimes. It was only when pressure of resources—in plain terms overcrowded prisons and mental hospitals—forced the shortening of these periods that it became politically necessary to worry about the possible dangerousness of really substantial numbers of prisoners and patients who became eligible for release. The problem was not entirely new. A few lifers, for example, had been set free each year, under licences which lasted for the rest of their lives; and the Special Hospitals which housed the violent insane had discharged carefully selected inmates, also under supervision. But by the late 1960s the introduction of parole, the Mental Health Act and the abolition of capital punishment had greatly increased the number of cases in which the problem of dangerousness had to be faced, and difficult decisions had to be taken.

‘Law’ said Mr Justice Windeyer of the High Court of Australia, ‘marches with science, but to the rear, and limping a little’. Nowhere is this limping more apparent than in respect of the attempts to keep up with medical science. The media is full of reports of the use of fetal ova to create new life, of the transplant of animal parts into human bodies, of tests involving the consumption of radioactive materials by human subjects. The law's response to these problems has been notable most often by its absence. To some extent, the failure of the law to come to grips with developments is not entirely its own fault. Sometimes the advances made possible by science can only be forseen by those with a scientific background. At other times, however, the law fails by not being flexible enough to be able to create new categories of legal obligations. It tries instead to pigeon-hole radically new ideas within centuries-old categorisations. As anyone who has had experience with packing a large number of outsized objects into a too small suitcase will tell you, squeezing things into inappropriately shaped containers takes time. This is one of the problems apparent in the doctrine of consent; the area of law which attempts to regulate the provision of medical services by a practitioner to a patient.

I am going to consider some common and, for the most part, fairly unreflective reasons for thinking that homosexuality is a bad thing and, therefore, something that should be extirpated, if that is possible, or suppressed, by, most obviously, legal prohibition or, falling short of that, by moral or social pressure. These reasons are five in number: homosexuality is held to be unnatural, abnormal, a perversion, morally wrong or sinful and aesthetically repellent or disgusting. The first three of these unfavourable characterisations of homosexuality apply to it primarily as an orientation, a disposition to engage in homosexual activity, whether the disposition is manifested or not. The other two, the moral and aesthetic ones so far as most of their proponents are concerned, apply only to homosexuality, as manifested in actual conduct. The desire to sin, after all, is a necessary condition of virtue. There is no merit in not doing things one has no desire to do. Similarly the desire to do something disgusting is hardly, in itself, disgusting.

Friedrich Wilhelm Nietzsche was born on 5 October 1844 and died on 25 August, 1900. From 1889 until his death eleven years later he was physically and mentally ill and incapable of work. It is almost certain that he died of the brain disease known as G.P.I., General Paralysis of the Insane, or general paresis. In the nineteenth century and well into our own era, this was a not uncommon tertiary manifestation of a syphilitic infection which might originally have been contracted many years before. Because the initial stages of syphilis can now be treated with antibiotics, general paresis is rarely seen today.