Mental Illness or Moral Illness?

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This past week two events, both involving victims, created headlines: the massacre in Aurora, Colorado, and the judgment against Penn State for their leadership’s failure to report sexual predator Jerry Sandusky to the police.

As I read the news about last week’s horrific shooting, I wondered how suspect James Holmes would be portrayed in the media. The media are prone to jump to conclusions about a suspect’s mental health, as if reporters are expects on criminal motivation and mental health. I’ve written about this tendency twice before: A Second Arizona Tragedy and Sadly, Here We Go Again.

Surprisingly, I have seen very little speculation about shooting suspect James Holmes’ mental health. Instead of speculating whether or not Holmes was mentally ill, it would be more fitting to have a national discussion about moral illness. We talk about “physical illness” and “mental illness”, but not “moral illness”. A quick search on Google yielded 1.7 million hits for “physical illness” and over 31 million hits for “mental illness” but less than 15,000 for “moral illness”, and many of these were references to one book which has that term in its title.

My friend Herm Keizer has been doing good work on the moral challenges that military personnel face in the line of duty which he calls “moral injury.” If people can be injured morally, and I believe we can, why can we not also become ill morally?

Health and illness are not distinct categories but are part of a continuum. No one has perfect physical or mental health. But somewhere on that continuum, professionals need to make a judgment call whether a condition someone lives with needs to be treated as an illness or not. Medical doctors have specific criteria to use to determine whether to begin treating a physical illness. Similarly, psychiatrists and psychologists have specific criteria spelled out in the DSM-IV to determine whether someone has mental illness.

However, determining the criteria for labeling someone “mentally ill” or whether or not to label some set of symptoms as “mental illness” is highly controversial, as the raging debate about the upcoming DSM-V shows. If this is true about mental illness, it would be much more true if we began talking about moral illness.

Here are two challenges in talking about moral illnesses. First, determining criteria for moral illness assumes that some standard exists for moral health. Although nearly all people have codes of conduct, those codes are idiosyncratic. It would be impossible for a society to agree upon a set of criteria that would establish that someone is, beyond reasonable doubt, morally ill. Second, to modify the word “illness” with the word “moral” stretches the definition of both. Usually, we think of “illness” as a condition that comes upon a person over which he had little choice. In contrast, we talk about “moral” as having to do with one’s volition. “Moral illness” implies both volition and the lack of it, and therefore it implies that one is both responsible for his actions and not responsible.

Still, I wonder if “moral illness” is a term and concept that needs to become part of our dialog about human depravity. I think of moral illness as a condition of the soul in which one has so abused his concept of right and wrong for so long, that his choices descend further and further from common mores into a dark world where people can commit mass murder or sexually abuse young boys.

Did a sexual predator like Jerry Sandusky begin his career at Penn State with the hope that he would be able to uses the perks of his position to sexually abuse boys? Maybe. But maybe through the series of little rationalizations over a long period of time he move from brief fantasies into out and out abuse. Did Joe Paterno and the other leadership at Penn State decide one day, “Let’s engage in a systematic cover up to protect our friend and assistant coach, even though he will likely harm more young victims in years to come”? Maybe. More likely, little decisions and small rationalizations grew a morally ill culture among the Penn State leadership so that Sandusky could continue in his predatory ways for years.

Murder suspect, James Holmes, is described by the people who grew up with him as quiet, withdrawn, and very smart. One of his high school classmates describe Holmes as “a little nerdy. He was really shy, really quiet, but really nice and sweet.” Did this “really nice and sweet” young man decide one day to become a mass murderer? Maybe. Did a mental illness so consume him the he did not know that killing people is wrong (the heart of an insanity defense)? Maybe. Or maybe little decisions along the way, little rationalizations, allowed him to drift so far from societal mores that he booby-trapped his apartment then headed to a movie theater and opened fire on a crowd?

What do you think? Should we talk more about moral illness? How would you define it? How does one become morally ill?

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Wow, Mark, thanks for this.  It is provocative!  How easily in recent decades we have slipped into seeing sin as mental or emotional problems.   Surely this is one dimension, but it's not the whole story, and I wonder if we've come to act as though mental or emotional illness explains everything, and then we design our prescriptions accordingly...  I want to wonder here whether Holmes and I are alike in experiencing temptations in our early years - temptations to harbor anger, or pride, or hate, or some craving for power....   Were we alike in our longing to find significance, meaning, love?   And then by God's grace, and the presence of the Christian community, and a loving family, I began to learn NOT to indulge those thoughts, but to look in other directions to fulfill my cravings.    Holmes on the other hand, and here I'm speculating wildly, might have spent more and more time and energy fueling the thoughts that lead to idolatry, destruction, delusion, and sin.     Some of us nurture our worst inclinations; others of us by God's grace starve them.  This I think is an important part of having Christ be formed in us.   Was Holmes ill?   I think so.  Was he evil?   I think so.  And by the time he had entered the theater he had submitted himself virtually totally to the patterns and the beliefs and the behaviors that he had been practicing for years.  I'm very interested in hearing others comment on my thoughts.   Am I making bibical and common sense?   

Guide

For more information about moral injury, Herm Keizer collaborated on an insightful piece about moral injury and military suicide that appeared yesterday in the Huffington Post: Moral Injury: The Crucial Missing Piece in Understanding Soldier Suicides.

Mark, very stretching and helpful piece.  Now I'd like to see you or someone who knows the Batman mistique do an analysis of where those - and especially this latest "Dark Knight" - movies are on the "morally ill/healthy" scale.  The "media" doesn't like to talk much about that either; they label - and dismiss - as "conservatives" those who might want to attribute some of the problem to the "dark" stuff in today's (well, last 25 years) movies.

Guide

Others would be much more qualified to comment on the topic than I. Anyone?

I'd recommend reading an editorial by Ross Doutha of the New York Times entitled, "Ross Douthat: The Way we fear now."  

He links Holmes and "Tthe Dark Knight Rises" in his reflection.  He uses adjectives like "lunatic moralists" and "Lunatic  nihilists" to describe the characters in the Trilogy.  They are different from previous  villains who sought to bring things down to erect an alternative order.  For these villains their main objective is destruction for destruction's sake.  These villains are "... inscrutable,  protean, appearing from nowhere to terrorize, seeking no higher end than chaos,  no higher  thrill than fear."  All they want from us is death.    He doesn't use the term "morally ill" but suggests strongly similarities between the motivations of Holmes and the progressively depraved villains portrayed in our media entertainment.   Henry G. world-burners, meticulous madmen, terrorists without a cause.  world-burners, meticulous madmen, terrorists without a cause. all they want from us is death. 

It is provocative.  I find it difficult, however, to square with the doctrine of total depravity.  If everyone is morally ill - and it would seem that the Bible does teach just that - defining a category of moral illness (or injury) becomes highly problematic.

If we are going to say, for instance, that some people are morally ill, we must allow that others are morally healthy.  Does someone morally healthy still need a savior?  Why, if he's healthy?  Doesn't Jesus even say that he came for the sick - the healthy don't need a physician?  But if we are going to say everyone is morally ill (total depravity), then this ceases to be a useful category in determining a way forward when confronted by events such as Aurora or Columbine.  Or rather, it supplants the biblical language of sin, grace, redemption, and forgiveness with the clinical language of illness, treatment, and cure.  I'm not so sure that's a good trade.

Guide

Eric, thanks for this opportunity to clarify. I affirm the doctrine of total depravity wholeheartedly. "There is no one on earth who is righteous." (Ecc. 7:20) However, although the confession of sin in the Book of Common Prayer says, "There is no health in us," I would disagree with that. I don't think of moral health and moral illness as distinct categories into which we can divide all humans. Instead these are endpoints on a continuum in which we all find ourselves. Every one of us has elements of moral health and moral illness. Like someone said, the line between good and evil cuts down the middle of every human heart. Just as we want (and sometimes work at) developing physical hygiene, so it would be wise for all of us to work at good moral hygiene and to avoid actions and thoughts that lead toward increasing moral illness.

Concerning my original point, namely, fingering mental illness as the reason why mass murderers commit their atrocities, I'm thankful that I have seen very little of that sort of speculation with regard to James Holmes. This is good for everyone affected by mental illness. I would submit that speculation about mental illness in days following a tragedy like the one in Aurora not only stigmatizes people with mental illness, but also is useless except for increasing advertising revenue. It would make much more sense to talk instead about moral illness. I suppose the media are doing that in a way with much of their reporting about the alleged murderer: a member of a sex hook-up website, amassing weaponry in the months preceding the incident, isolating himself from other people. He was morally adrift, or in my terminology, he was very ill morally, and over 70 victims paid the price.

I wonder how the demonic is involved...

Karl and Mark,

Thanks.  Your reflections on 'moral illness' reminded me of listening to the 1O commandments every Sunday morning.  They were always read before the prayer of confession - as a 'teacher of sin.'  I remember, and have often pondered the phrases following the second commandment -  "for I, the Lord your God, am a jealous God, punishing the children for the sin of the parents to the third and fourth generation of those who hate me, but showing love to a thousand generations of those who love me and keep my commandments."  

I've wondered about the various ways 'media' - in all its various forms - has become a 'parent' for some - a parent with limited - and in some cases no - moral boundaries.  Media often reminds me of the phrase the writer of the book of Judges aptly uses for a 'morally ill' society; "There was no king in Israel.  Everyone did what was right in their own eyes."

Much to ponder - and then translate - and then proclaim in light of the Good News.

Thanks for prompting this kind of reflection.

John

Mark, Random thoughts in response:

I wonder how this is different between Aristotle's spectrum of vice and virtue?

Certainly as Christians we recognize the downward spiral that indulging temptations takes us to (James 1:14).

I appreciate the implications of an "illness" that there is the ability for healing. And the distinction between this and mental illness that may unfairly stigmatize the mentally ill. (I would assume that a person, then, could be both morally and mentallly ill? Or would you make the case that a socio/psychopath could not be morally ill because they can no longer distinguish morality? )

What wold you suggest are the practical implications ramifications of such a diagnosis? And who would be qualified to treat it?

Lots of interesting fodder for thought and discussion!

Guide

Julia, you ask four good questions. First, I'm not going to touch your question about Aristotle because I'm not qualified to answer.

Second, you ask, "I would assume that a person, then, could be both morally and mentallly ill? Or would you make the case that a socio/psychopath could not be morally ill because they can no longer distinguish morality?" I agree that one can be both mentally and morally ill. I have a friend who lives with chronic, severe mental illness who has robust moral health. So I would assume the opposite could be true too. Could someone be so morally ill that he can no longer know that what he is doing is wrong? Perhaps, but I would want to proceed carefully with this. If we say "yes," then it may be true not only for people who commit crimes and use an insanity defense, but also for drug traffikers in who leave headless bodies in the streets, and for terrorists who bomb large numbers of victims. These too, it would seem, do not know or believe that what they are doing is wrong. Then we would need to ask is someone culpable for actions that violate commonly held human mores, such as killing innocent people, if they do not consider their actions to be wrong? And should they be "punished" or should they be "treated"?

That's a segue into your last two questions: "What wold you suggest are the practical implications ramifications of such a diagnosis? And who would be qualified to treat it?" To avoid rambling, anyone else have thoughts about these good questions?

Hi Mark,

Interesting reflections on Morality. 

As is true in all human action, there is a mix of nature and nurture involved.  I recently watched a series on the Science channel in which a neurologist examined the brain patterns of psycyopaths.  He found that they did have a unique set of physical characteristics that occured mentally.  He then had his own brain scanned, and found he exhibited the same characteristics.  When he asked his friends if they thought he was like a psychopath, they said yes, "you're controlling, arrogant, can't be corrected, etc."  The scientist credited his parents with raising him in such a way that the tendencies of his genetic/neurological problem did not arise to the level of action.  I think it is much the same way with all of us.  We have inherent tendencies that can develop in the direction of either virtue or vice. 

There is quite a lot of work being done in this area between mind and morality.  One good title on the subject is simply, "The Moral Mind." 

Each person is morally responsible, but if we let a vice grow, it eventually takes over, in the form of some kind of addiction.  I suspect that is the process that someone like Jerry Sandusky experienced.

(I can get references on both the documentary and the book but don't have them here at my fingertips)

Kent: is the Book Moral Minds... by Marc Hauser ?

Yes, Hauser is the author.  There is a growing list of books on this.

Julia, interesting comment on Aristotle's moral compass.   It seems that in general, he equates virtue with moderation.  Eg.  Don't be too courageous, but don't be too afraid.   or... don't be too stingy, but not too generous either.   While this often seems to be common sense, it is not the kind of standard we want to apply to Christian living, it seems to me.  It is a bit arbitrary... and ends up saying something like, have faith, but not too much faith.  Pray some, but don't pray too much. 

I believe that common sense and balance does play a role, but that doesn't mean that somehow using common sense is more virtuous than stepping out in faith.   Jesus command to the rich man to sell all he had and follow HIm might seem to lead to the vice of carelessness by worldly and aristotelian standards, but Jesus' standards are different.  For Jesus, fishing for men instead of for fish, is not as extreme as many might think.  Caring for and sharing with the poor is okay, no matter how extreme.  Claiming all the world (not just Sundays) for Christ is the right kind of extreme. 

I wonder if the first type of illness we ought to be thinking of is spiritual illness.  Spiritual illness  would be a misunderstanding of who God is, or a denial of God, or lack of a confident relationship with God.  It is this type of illness that often leads to a moral quagmire, sometimes moral illness, since there is no real reference point for truth and behaviour outside of oneself and thus might lead to all kinds of immoral behaviour.   This is a situation where there is no immunity or resistance anymore to the immoral behaviour which is displayed by others on tv or internet or magazines or conversation. 

 I would think spiritual illness can also lead to some types of mental illness, once that realization of a lack of reference point, and a lack of purpose, a lack of real relationship sinks in.   This can be a common cause of depression and anger and unhappiness, both for non-christians, but also sometimes for christians. 

Moral illness leads directly to sin, and because we cannot always read the heart, we must deal with the sin more than with the moral illness that might cause us to sin.  But moral illness can be catching, even for Christians.  It helps if we put a quarantine on ourselves or on those who are morally ill, so that it will not infect us.   On the other hand, spiritual health can heal the heart, will help us to resist, and our relationship with God will have an impact on how we live. 

Great to see reflection out there on the web on this important subject.  The concept of "moral illnesses" I believe needs to replace much of the discussion we see in the popular media about "mental illness."  Many psychologists, psychiatrists, and other MH professionals have questioned the whole concept of "mental illness" itself.  And so while people may differ over what constitutes "moral illness," that question has also pervaded some aspects of the mental illness community.  When one suffers a debilitating condition (a safer word), such as depression or anxiety, and cannot perform routine ADL (activities of daily living), that I believe is in a different category than a condition wherein one seeks to do harm to another human being.  It occurs to me that psychology and the criminal justice system have done some work here already in talking about sociopaths and psychopaths.  One of the great  minds of the MH community, Dr. Karl Meninger, has dealt with this in his book Whatever Became of Sin. I confess I have not read it, but this blog has challenged me anew to seek it out and take a gander. Quite a while back I saved an article from Newsweek, I believe it was, on the "Psychologizing of Sin."   I firmly and fully believe this topic needs to come out of the shadows and be addressed more in the mainstream press.  Much of the problem has been the atheistic and agnostic and postmodernist bias of the whole higher education system.  And we in the church have avoided apologetic confrontation of secular culture, confining our salt to our church saltshakers.  We need to engage the secular, godless mindset effectively at every level, including academia and the popular press.  I hope to hear more on this topic and benefit from the various contributions. The problem of universal definitions amidst so much multiculturalism was mentioned.  I think few would take issue with murder or rape or child abuse as problematic in a definition of criminal evil, even in a culture committed to moral relativism.  Thanks Mark for putting this out there on the table. 

Guide

Mark, thanks for sharing your thoughts. One of the great challenges with identifying "moral illness" in a pluralistic society will be identifying specific behaviors that we can all agree are wrong. If you do have opporutnity read Dr. Meninger's book, it would be great if you would share a few applicable insights here.

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