Moral Accountability of Crime vs Mental Illness
A crime committed by someone suffering from a psychological illness can only be termed moral or immoral based on the degree of impairment. For instance, depression or bipolar disorder can manifest as mild, where the individual understands reality, or as severe, as seen in the case of Andrea Yates, where depression is combined with psychosis, leading to a distorted perception of reality.
Psychotic Depression: What Happened in the Andrea Yates Case?
Delusions and hallucinations associated with psychotic depression can result in irrational violence. Andrea Yates was diagnosed with severe postpartum depression and psychosis and was convicted of drowning her five children (Carson, 2025). She suffered from a rare but severe mental illness that can cause hallucinations, delusions, and extreme irrational behavior. Yates’ religious beliefs contributed to her delusions; she believed she was saving her children from eternal damnation by killing them. Ultimately, she was found not guilty because of insanity and was committed to a psychiatric facility. Her case remains a devastating example of how untreated mental illness can lead to catastrophic outcomes.
What makes them commit the crime?
In particular, what factors contribute to the tendency toward criminal behavior in people with depression and bipolar disorder? Can such actions be considered fully criminal, given that the perpetrators may also be victims of their mental health conditions? In this context, they face punishment both from the legal system and as a consequence of their mental struggles.
Cognitive and Emotional Impairment
Major Depressive Disorder (MDD) with severe features is characterized by reduced activity in the prefrontal cortex (PFC), leading to impaired decision-making and poor impulse control (Hooley, 2019). Cognitive impairment is a core feature of depression, with studies indicating slower processing speed, attention deficits, and difficulties in planning (Rock et al., 2014). Both low mood and cognitive impairment are associated with poor psychosocial functioning.
Reality Distortion: Negative Views of Self, World, and Future
Beck’s Cognitive Triad suggests that negative perceptions of the self, world, and future distort reality testing (Hooley, 2019). Depressed individuals often systematically and negatively alter their perceptions. Those with dysfunctional attitudes are likely to experience increased depressed mood following negative events. Negative views of the future mediate the relationship between dysfunctional attitudes and subsequent mood changes (Abela, 2002). Consequently, depressed individuals may see no alternative to harmful actions, such as suicide or violence, especially when psychosis leads to a loss of touch with reality, including the belief that they are being controlled by external forces.
Mania and Poor Judgment
Risk-taking, aggression, and impulsivity can occur due to dopamine dysregulation in individuals with bipolar disorder (Strakowski et al., 2005). During manic episodes, hyperactivity, grandiosity, and lack of insight often prevent individuals from recognizing their harmful behavior. Manic individuals may exhibit unrealistic self-beliefs (e.g., “I can’t lose this race”), leading to reckless decisions regarding finances, relationships, or violence. Up to 60% of manic patients deny their illness (Ghaemi et al., 2000), which impedes self-correction of poor judgments.
Lacking a Sense of Control Compared to Healthy Individuals
In bipolar disorder, mania results from excessive dopamine levels, leading to poor risk assessment, while depression is associated with low serotonin levels that foster hopelessness and impulsivity. Research indicates that arrest rates can be three to five times higher during manic episodes (Fazel et al., 2010). Individuals in manic states may lack clarity and understanding of their situations, failing to differentiate between right and wrong or assess the consequences of their actions.
Conclusion
Rational thinking and current legal concepts posit that the responsibility of a person in a crime is determined by the causal processes leading to an outcome, specifically the psychological processes that resulted in particular actions. Certain psychological processes justify ascribing full responsibility, while others warrant a classification of “reduced” responsibility (Broome et al., 2010).
Individuals with non-psychotic depression or bipolar disorder may retain some understanding of their actions but struggle with impulse control and feelings of hopelessness. In extreme cases of depression and bipolar disorder, when a person’s reality is distorted and they lack a sense of control, it becomes morally questionable to hold them accountable for their actions. While not all mentally ill individuals are “innocent” of their actions, extreme cases involving psychosis or severe cognitive impairment challenge traditional notions of moral responsibility. It is crucial to consider treatment, rather than just punishment, in these cases.
References
Carson, S. H. (2025, July 14). Psychopathology [lecture recording], Canvas. https://canvas.harvard.edu/
Hooley, J. M., Butcher, J. N., Nock, M., & Mineka, S. (2019). Abnormal psychology (18th ed.). Pearson.
Rock PL, Roiser JP, Riedel WJ, Blackwell AD. Cognitive impairment in depression: a systematic review and meta-analysis. Psychol Med. 2014 Jul;44(10):2029-40. doi: 10.1017/S0033291713002535. https://pubmed.ncbi.nlm.nih.gov/24168753/
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Strakowski SM, Adler CM, Holland SK, Mills NP, DelBello MP, Eliassen JC. Abnormal FMRI brain activation in euthymic bipolar disorder patients during a counting Stroop interference task. Am J Psychiatry. 2005 Sep;162(9):1697-705. doi: 10.1176/appi.ajp.162.9.1697. https://pubmed.ncbi.nlm.nih.gov/16135630/
Fazel S, Lichtenstein P, Grann M, Goodwin GM, Långström N. Bipolar disorder and violent crime: new evidence from population-based longitudinal studies and systematic review. Arch Gen Psychiatry. 2010 Sep;67(9):931-8. doi: 10.1001/archgenpsychiatry.2010.97. https://pubmed.ncbi.nlm.nih.gov/20819987/
Broome, Matthew & Bortolotti, Lisa & Mameli, Matteo. (2010). Moral Responsibility and Mental Illness: A Case Study. Cambridge quarterly of healthcare ethics: CQ: the international journal of healthcare ethics committees. 19. 179-87. 10.1017/S0963180109990442. https://www.researchgate.net/publication/41941622_Moral_Responsibility_and_Mental_Illness_A_Case_Study
Ghaemi SN, Boiman EE, Goodwin FK. Diagnosing bipolar disorder and the effect of antidepressants: a naturalistic study. J Clin Psychiatry. 2000 Oct;61(10):804-8. doi: 10.4088/jcp.v61n1013. https://pubmed.ncbi.nlm.nih.gov/11078046/