I just read Jeanette Kennett's paper "Mental Disorder, Moral Agency, and the Self" in the Oxford Handbook of Bioethics, edited by Bonnie Steinbock, Oxford University Press, 2007. (Incidentally, it is the first time I've read a whole article through Google books -- it saved me a few weeks, since I didn't have to get a copy through Inter Library Loan. Very useful.)
Kennett (pictured) here is discussing an issue I have been thinking about myself recently -- the apparent dilemma that one either treats mentally ill people as autonomous and thus subject to blame for when they are hurful and inconsiderate, or else treats them as nonautonomous, than thus as objects rather than ends-in-themselves. Either way, mentally ill people are in a bad position.
Her approach is rich, even if seems a little rambling. Her main example is Anne Deveson's son Jonathan, who she describes in her memoir Tell Me I'm Here. Jonathan had schizophrenia. Kennett says, using R. Jay Wallace, that on the standard account of moral agency, which requires that an agent be able to step back from his or her desires and examine them in the light of moral principles. She argues that Jonathan did not have that capacity. However, she gives contradictory evidence, since she points out that Deveson found notes written by Jonathan to himself saying "Don't hurt Anne," suggesting that he did regret his actions. It seems that Jonathan was able to assess his own actions at other times, but he was far less able to stop doing them. It is not so clear why Jonathan got so angry with Anne, but it does seem that he at least sometimes regretted his harmful actions. Kennett says that on standard accounts Jonathan cannout count as a responsible moral agent, but it's not so clear to me that this is true.
Kennett also talks about the visibility of the self. At first I thought this was a weak and unnecessary part of the paper, but on reflection it seems the richest part, because it is a new attempt to voice the difficult of people with mental disorders becoming objectified and invisible. She discusses Strawson's idea of participant attitudes, and the difficulties that people with serious mental illness have at being participants, as well as in planning for the future, and forming friendships. In these says, mentally ill people can become invisible. Kennett, quite rightly I think, argues that there is no neat seperation between the mentally ill person and their illness, when their illness has come to shape their identity. Obviously, she is concerned that mentally ill people can retain visibility.
The most philosophically interesting claim of the paper is that Strawson is wrong that we must take an objective stance towards people with chronic and severe mental illnesses. She says that it is not clear that there is a strong conceptual connection between occupying the participant stance and attributing responsible agency to people like Jonathan. She also points out that the participant stance is elastic. It might be available to some degree.
Kennett also focuses on the question whether a participant stance requires attributions of responsibility. She points out that one can have rich participant relationships with children -- not taking the objective stance towards them -- without holding them responsible for their actions. Using these sorts of analogies, she argues that we are not forced toward an objective stance toward the mentally ill. So the bottom line is that even if we do not hold mentally ill pepole responsible, we can still have rich interpersonal relationships with them, even if they are not a rich as with mentally well people.
The view taken by Kennett here is very appealing, and she makes a reasonable case for it. Maybe the conclusion is not very surprising to people who spend a great deal of time with mentally ill people, and Strawson's rather black and white position is quite an oversimplification. But I also think that Kennett's position is a little simplistic. Even with people with chronic severe mental illness, it may be possible for some people to have relationships with them where some mutual attitudes of holding each other responsible is possible. We can also hold people responsible for some things but not others. This is pretty clear with children and teens: they gradually grow into full responsibility. So we need to revise, or at least use with greater flexibility, the standard criterion of moral responsibility to take into account the complexities of life.