During this winter semester (2025/2026) I started attending the course Philosophy of Psychiatry at the Faculty of Arts of Charles University. My motivation is to gain a deeper insight into the philosophical problems in the field of psychiatry. For we live at a time when psychiatry has become a needed and therefore influential field. From a marginal field within medicine, psychiatry has grown into an independent discipline, because the times demanded it. Psychological problems and a general focus on mental health are part of the lifestyle of the 21st century – whether we like it or not. We can debate how and why the “psychiatrisation” of everyday life began, and whether the normalisation of talking about one’s mental health in a café or over dinner is, on the whole, a “net benefit” for the individual and for society. The fact remains that psychiatric problems are on the rise. And by that I do not mean “only” those that call for psychotherapy, but also the medically serious and debilitating cases of depression, borderline personality disorder, schizophrenia, sexual deviations and other disorders, which are often accompanied by violence and danger for the sick and for those around them. Is it the fault of an over-technologised society, of the complexity of everyday problems, of the constant emphasis on performance at work and in private life, of the lack of room to be oneself – an authentic Self? Or were there perhaps genetic predispositions dormant in us that began to be triggered with the arrival of the hypermodern world, or by globally stressful situations such as the one we went through in recent years during COVID-19, in the wake of which the number of psychiatrically ill people rose drastically?

The importance of fields comes and goes with demand. Let us recall those very covid years, when obscure specialists in epidemiology became overnight star prophetic voices whose words we devoured in a manner of truly biblical proportions. What an epidemiologist said was the truth. Perhaps I am exaggerating, but who, during the first years of covid, dared to criticise epidemiologists? Perhaps a few youtubers and influencers, but most clever, educated and rationally minded people knew that we had to follow the science, wherever it might lead us. Only in hindsight – and everyone is a general after the battle – can we say what we gained and what we lost during covid, as far as health is concerned, but also freedom.

Psychiatry today is the epidemiology of the human soul. It tries not only to treat existing problems but also to reduce the risk of potential problems that have not yet manifested themselves in a person. Psychiatry has thereby become a preventive hygiene, that is, a mechanism against dangerous individuals in society who must be kept under surveillance – and this not because of what they have done, but because of who and what they are.

Or at least that is what Michel Foucault thinks in his article “On the Concept of the Dangerous Individual in 19th-Century Psychiatry”. The article falls into the category of philosophical and sociological critique of psychiatry and of its relation to criminal law. It tries to show that the role of psychiatrists changed over time from expert testimony in relatively clear cases of mental disorder to that of specialists whose main task is to interpret a person’s personality and issue a statement on criminal responsibility, which depends on how the given abnormal or deviant act fits into the wider framework of the individual’s life. If it fits and expresses some rational continuity, the person can be declared responsible and therefore guilty. Whereas if the monstrous act departs from the individual’s usual patterns of behaviour, it is a mental problem and the individual is declared not responsible and innocent.

The article opens with a description of a trial in which the accused is called upon to defend himself before the judge and the jury. But the accused remains silent. He stays silent for so long that one of the jurors cannot bear it and cries out: “For God’s sake, defend yourself!” This account of a single trial from 1975 points to the important role played by knowledge of the character and life story of the accused, for a trial must to some extent know the accused, since the motivations and intentions hidden behind the crime committed are important facts according to which the degree of guilt and the severity of the sentence are defined.

A significant milestone in the relation between psychiatry and law is the work of the Italian criminologist Raffaele Garofalo from the mid-19th century, who formulated the so-called Garofalo principle. According to it, crimes are divided into those against law and those against nature. While the former denote technical violations of the law, the latter stem from a person’s innate moral or psychological defects. This brings the very personality of the offender into the centre of the court proceedings. Whereas criminal law used to know only the act and the law, after Garofalo the “criminal” enters the process as a third element that the court has to deal with.

Introducing the criminal as an element of the trial was motivated by the effort to make criminal law more rational, able to take into account the criminal’s motivation and intentions. This was nothing new – even before the 19th century, psychiatrists (or the form psychiatrists took at the time) were called in to various cases where mental disorders needed to be identified. These were above all mental weakness (dementia, imbecillitas) or temporary madness and fits of rage (furor). These states had visible and recognisable symptoms of raving, seizures and delirium, so it was not always necessary to request a medical expert opinion – the judges could recognise them themselves.

It was only the monstrous cases of the early 19th century that led to calling in a psychiatrist for consultation, not to confirm an obvious medical defect, but as an interpreter of motivations. The monstrosity of these cases lay in their brutality, their repulsiveness, but above all in the apparent inexplicability of why it had happened. Take, for example, the case of the retired officer Metzger, who lived alone. He begins, however, to look after his landlady’s child, and one day, without any motive, he strikes the child twice with a hammer, but does not kill it. It was an act without anger or gain, entirely without reason. The case of Henriette Cornier of Paris in 1827 tells the story of a servant who borrows a child to look after, insisting on it herself, but murders the child by cutting off its head and throwing it out of the window. The act became the canonical case of “homicidal monomania”, that is, a would-be psychiatric illness that has no other symptom than the one that a person, out of the blue, commits some monstrosity – incomprehensibly and without motive. Last but not least, the case of a woman from Sélestat in 1817: during a famine, a woman kills her daughter by cutting off her leg and cooking it in a soup. This case is important for Foucault’s argument, because the record of the trial shows speculation about the role played by the time of famine. It turned out that precisely because there was a famine, the act was a rational one, so the woman was not mad and was responsible. Which means that had there been no famine, she would most likely have been declared not responsible and would not have been punished with the full force of the law. This case of the woman from Sélestat points to the blurred line between punishment and acquittal, responsibility and non-responsibility.

To explain these monstrous acts that have no explanation, psychiatry developed precisely homicidal monomania – that is, something Foucault considers a pure fiction, for it is a disorder that has no obvious symptoms or signs, only one: the commission of an inexplicable and monstrous crime. Foucault points out that psychiatrists thereby invented a paradoxical entity: it is supposedly a disorder that has no obvious symptoms, never manifests itself – except at the moment of the crime –, and yet psychiatrists considered themselves experts able to recognise the invisible traces of this invisible illness, that is, some kind of warning signs.

For Foucault, homicidal monomania is not only a fiction but also a demonstration that psychiatry has become a form of social surveillance and control. For if any one of us can potentially become a monstrous murderer, and if psychiatry alone can somehow recognise the warning signs, it holds the power of a kind of “public hygiene” in society (p. 6).

From page 8 onwards, Foucault asks how psychiatry managed to get to the very centre of criminal law and to appear side by side with judges as the expert witnesses determining the criminal responsibility of the accused. It was not a revolution from above but rather an evolution from below. The trial required the motive of the offender to be identified. The reason for the crime became the reason for imposing such and such a punishment. But if the judge did not know the reason for the crime, he could not punish it. Judges therefore needed to know the motives in order to decide on the punishment. For the system of punishment to work, one needs to know not only the offender and the act, but also the motive and a psychologically clear relation between the act and the author of the act. Doctors began to be called to court as experts not only to identify clear symptoms of dementia or fits of madness, but also as specialists in motivation (p. 8). A crime began to be judged not only by what had been committed, but also by how the given criminal act can be understood in the wider context of the individual’s behaviour, character and personal psychological history. The more the act can be rationally explained with reference to the person’s previous life, the guiltier he is. The less the act fits into the context of the person’s life, the more it is seen as arbitrary and random, and therefore incomprehensible, which relieves the accused of legal responsibility, for he will be declared not responsible.

On pages 15–18 we read a further hypothesis about how psychiatry made its way into criminal law. It has to do with the introduction of insurance, not in criminal law but in civil law. New social elements – for example employment or mass public transport – meant that companies exposed themselves to legal liability when something happened to employees or passengers while working for them or using their services. When, for example, an employee was injured at work, or knocked down a pedestrian in the street with a company car, the persons concerned were compensated regardless of whether the company proved that it had done everything in its power to limit the probability of risk.

And it was precisely this keeping watch over the probability of risk that led to the idea settling in society that the criminal does not need to explain his motives – he is guilty because some psychiatrist had previously determined that he has a personality or mental disorder and that it is in his nature to be deviant.

Foucault thus shows that psychiatry did not enter the legal system by revolution, but through a gradual transformation of judicial thinking itself. Judges needed to know motives in order to decide on guilt and punishment, and so doctors became interpreters of psychological causalities. From that moment on, the court asks not only what happened, but also why it happened – and in the end, who it is that committed the act. Whereas the act used to be punished, now the personality begins to be judged. Psychiatry thus moves law from the category of guilt to the category of dangerousness. The question, then, is this: is a person judged by their act, or by their identity?

Philosophy of Psychiatry — a three-part series: