Mental sanity

Frem asks:

What do you call ‘mental sanity’? Would anyone dare to answer?

Answer by Craig Skinner

Here’s an answer, although I dont feel daring.

“Sanity” means “health” (Latin sanus=healthy) so that “mental sanity” means “mental health”. However,the term is rarely used when speaking of physical health, so that “sanity”/”insanity” refer to mental health/disease (and some physical diseases eg syphilis, can also produce mental disease).

The notion of “insanity” is narrower than “mentally ill” Most mentally ill people are not insane. “Insanity” implies that the disease is bad enough to cause loss of reason, inability to tell right from wrong, and is a term used by lawyers rather than doctors these days, as “not guilty by reason of insanity” is a common defence to a murder charge. Among doctors and nurses, the terms “delirium” and “psychosis” are respectively used for fleeting and persistent loss of reason. Delirium can be due to feverish illness, drugs or alcohol, and psychosis is usually due to schizophrenia or severe bipolar disorder.

In short, sanity implies mental health, or mental illness insufficient to cause loss of reason. The term is often used loosely to express praise in other contexts (eg sane policies).

There is a tendency for lawyers to extend the insanity defence beyond the conditions I have mentioned, to include, for example, genetic variants known to be associated with aggression, or people with damage to the amygdala causing lack of emotional response to another’s suffering, the “my brain made me do it” defence. One difficulty for the defendant here is that if the defence be accepted, and nothing can be done to change the brain, he is liable to be locked up for at least as long as if he plead guilty.

I wonder if your mention of anyone “daring” to answer, reflects the view that there is no real sanity/insanity distinction, just labelling by the regime in power of their views and those expressed by opponents. It is true that some regimes have labelled troublesome “dissidents” insane and locked them up, and this still goes on. But this is abuse of psychiatry, and shameful activity by doctors involved. It doesnt mean that mental illness is an arbitrary social construct. Tell that to my sister with schizophrenia or my cousin with bipolar disorder whose lives were ruined by their illness, although greatly helped by medication and ECT.


4 thoughts on “Mental sanity

  1. And one more note added to Craig:

    In your first answer, you wrote: “Roll on the day when we understand mental illness better, and diagnosis will be no more controversial than that of, say, tuberculosis”. NO!

    I think this to be the core of our difference: Mental illness is fundamentally a metaphysical problem in view of mental sanity and not a clinical problem. Or, to be more precise: The clinical aspects and the metaphysical aspects should clearly be kept apart in the same way as the “bigness” and the “greatness” of a painting are kept apart. A small and humble work of art (Duerer’s “Hare”) may be great, while a pompous work of art like f.i. this one of Makart >, while technically impressive, is already irrelevant. Why?

    Thus once more: My concept of mental sanity has (almost) nothing to do with clinical evaluations according to “DSM-5”.

    I am thinking along the lines of Freud and Jung and Adler and Frankl and their followers, and along the lines of all religious people. What does it mean to live in delusions not about the door knob but about your life? The religious concept of insanity has nothing to do with the clinical concept.

    In German, the word for saint is “Heiliger”, which is derived from “heil”, which means “heal, intact, complete, not broken”. “Healing a broken heart” is a spiritual act, not a matter for the apothecary or the neurologist. “Giving sense to one’s life” is a philosophical or a religious task, not a clinical one.

    No neurologist will ever be able to tell you about the meaning of your life! It would come to what is called “mixing up the categories” as in the example of “bigness” and “greatness” or in mixing up “heaven” and “sky”.

    Science does not know of “meaning”, it does not understand the concepts of “goal” and “value” in any ethical sense. Science knows of cause and effect. Science knows of sexuality, but it does not understand the concept of love — not even neuroscience does. To call the “love of God” a sign of mental insanity would indicate a complete misunderstanding. The realm of meaning is completely separated from the realm of facts. Meaning is a relation. Would you call the love of the child to its teddy a sign of “mental insanity”? Should a neurologist of the future “remove that insanity”? If he does he would redefine the meaning of humanity — and he wouldn’t even be aware of it! To put it differently: To be well behaved and to get children you need no love! You could deliver all love-novels and love-poems to the bin. Love is not a scientific concept. I would never leave the final verdict on humanity to the scientists.

  2. Hubertus

    It’s a pleasure to receive comment and constructive criticism of my views.

    I think it vital for clarity to distinguish insanity (serious mental illness) from evil (Hitler, Himmler), from hard-line political views (Trump), from extreme religious views (Jesus, St Francis) and from views just different from our own (atheists v theists).

    Hitler was perfectly sane. Had he survived to face a war crimes tribunal, I wouldnt have accepted a plea of not guilty by reason of insanity. Nor would he have offered one. He would have been proud of his success in killing so many Jews, disappointed that he had been unable to finish the job. Likewise family-man Himmler, although he might have tried the coward’s “only following orders” defence.

    Yes, Nurse Ratched in “One Flew Over The Cuckoo’s Nest” (an Oscar-winning turn) is sane. She deliberately abuses her power and is an evil woman. Mc Murphy (another Oscar-winning turn in a role turned down by Gene Hackman) is also sane but thinks that by feigning mental illness, he will have an easier ride in hospital than in prison, and tragically ends up getting the ultimate tranquilizer, lobotomy.

    The real horror of evil is not that perpetrators are insane or monsters (subhuman, inhuman, “animals” etc), but that they can go home after an evil deed, read a bed time story to their children, and have a laugh and chat with friends over a few beers. Dont tell me all those people involved in genocide in Rwanda, Bosnia or Nazi Germany were insane, monsters or psychopaths. We all struggle to make sense of it, trying to avoid the uncomfortable conclusion that, in the right circumstances, most of us would be capable, maybe not of orchestrating such horrors, but at least of playing our part.

    As regards anti-psychiatry, I have said a fair bit on this in a previous posting (Philosophy, psychiatry and anti-psychiatry, 23 September 2015). I acknowledge abuse, both historical and current. But we should be anti-abuse, not anti-psychiatry. We should be pro-psychiatry, in favour of mentally ill people getting best care. To be anti-psychiatry is like being anti-surgery because surgery was abused in sterilizing the “unfit” in eugenics programmes, or anti-dermatology because skin scientists go along with misleading talk about skin ageing to boost cosmetics profits.

    Of course there are borderline cases. Brain tumour is usually taken as a bone fide cause of insanity, when a previously law abiding citizen acts totally out of character and murders somebody. But should lesser brain anomalies, such as many psychopaths have, exculpate a person?
    Why do most people who sincerely believe they are the Son of God and act on voices telling them to kill family members possessed by the Devil, get labelled insane, whilst Jesus’s proclamation of his Sonship is taken as true by believers and merely incorrect by unbelievers.

    Roll on the day when we understand mental illness better, and diagnosis will be no more controversial than that of, say, tuberculosis, once thought to be commoner in the poor because of their congenital deficiency and lack of moral fibre, rather than because of overcrowding and malnutrition favouring development and spread of infection.

    In conclusion, I agree that these are deep philosophical waters. But I do feel that my view at least slightly clears them, whereas a view that conflates insanity, evil, minority views and outsider views, helps keep them muddy.

  3. Dear Craig, perhaps you should have felt the challenge. Would you call Jesus or St.Francis “mentally sane”? By what argument? Would you call Hitler “mentally insane”? By what argument? Think of “One Flew Over The Cuckoos Nest”. Would you call the nurse “mentally sane”? If not — why not? Would you call Trump mentally sane? Himmler, the manager of the Holocaust, was a loving father and husband. What was wrong with Dr.Mengele? What about “Discipline and Punish” by Foucault (

    I am not speaking of clinical cases “according to DSM-5” ( My question is more related to “antipsychiatry” (Szasz, Laing, Cooper ea.) and to cultural standards. In some cultures, LGBTQ cases are seen as normal, in other cultures they are seen as illnesses or unnatural. What decides? And there is anomy and “ethno-psycho-analysis” or ethnopsychiatry (see

    From a philosophical point of view, it is a terribly hard question. For the atheists, all religious people are “mildly insane”, because they believe in non-existent beings, while from a religious point of view, those atheists are, because they lack “spiritual senses”.

    So once more: What do you call “mental sanity”? Dare you?

    1. Hubertus

      Thanks for further comment.

      Oh, the semantic confusion.

      I dealt with insanity in the clinical/legal sense, and stand by my answers. I dont think you have much quarrel with me, although I am surprized you dont favour understanding mental illness better and diagnosing it without stigma. Does your view extend to all illnesses with serious mental effects like Alzheimer’s, neurosyphilis, Parkinson’s disease for examples?

      You are concerned with “sanity” as spiritual wholeness or moral integrity, and of course doctors/scientists qua doctors/scientists have nothing to say about this.

      It might be best if we both avoid the terms “sane/insane”. No problem for me. I have never used them in the clinical sense. They was already unfashionable when I started as a medical student 60 years ago. I am, content with “seriously mentally ill”, “psychotic” and “delirious”, and lawyers could get by with “not guilty by reason of the balance of the mind being disturbed”

      Equally, you can get by with, say, “spiritual wholeness” or “moral integrity”. These can be cashed out in terms of Plato’s harmony of the soul, Aristotle’s eudaimonia, Kant’s Kingdom of Ends, your own “constructive and supportive”, or some combination; they probably all come to much the same thing, and theists will wish above all that our actions be in accordance with God’s will.

      How to achieve such a blessed condition?. The ancient Greeks were keen on the state promoting virtue in the citizenry. These days most prefer the state to simply enable personal autonomy and growth, so that the individual makes her own spiritual journey. I rather like John Macurray’s comment (Gifford Lectures 1953), after concluding that Descartes set us all off on the wrong foot by positing us as isolated thinkers rather than social doers, that “all thought is for the sake of action, all action for the sake of love”.

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