Forum Internum Revisited: Considering the Absolute Core of Freedom of Belief and Opinion in Terms of Negative Liberty, Authenticity, and Capability
Human rights theory generally conceptualizes freedom of thought, conscience, religion, and belief as well as freedom of opinion and expression, as offering absolute protection in what is called the forum internum. At a minimum, this is taken to mean the right to maintain thoughts in one’s own mind, whatever they may be and independently of how others may feel about them. However, if we adopt this stance, it seems to imply that there exists an absolute right to hold psychotic delusions. This article takes the position that this conclusion is ethically problematic from the perspective of psychiatric treatment and the rights of persons with psychosis. The article reflects on this particular challenge and sets forth an understanding of freedom in the forum internum that might apply to situations where for various reasons it is not, necessarily accurate to maintain that persons have an absolute right to their own thoughts. For the purpose of proposing such an understanding, the article engages with current debates within human rights theory and political philosophy and analyzes discussions about psychotic delusions and the way in which involuntary treatment is justified. Based on this analysis, this article in turn conceptualizes freedom in the forum internum as ‘negative liberty’, ‘authenticity’, and ‘capability’. This article suggests that when forum internum is redefined as encompassing a right to certain internal capabilities, the right remains meaningful for persons with psychotic delusions as well.
KeywordsFreedom of belief and opinion Forum internum Delusions Psychosis Involuntary treatment Competence Capabilities approach
We are grateful to Jason Lepojärvi for his comments and suggestions and to Grant S. White for his careful proofreading.
This work was supported by the Church Research Institute, the Finnish Cultural Foundation, and the Academy of Finland.
- Ahdar RJ, Leigh I (2005) Religious Freedom in the Liberal State. Oxford and New York, Oxford University Press.Google Scholar
- Arsheim, H (2014), Lost in Translation? Religion-Making at Four UN Human Rights Committees, 1993–2013. Dissertation, University of Oslo.Google Scholar
- Beauchamp TL, Childress JF (1989) Principles of Biomedical Ethics. New York and Oxford, Oxford University Press.Google Scholar
- Berlin B (2005) Liberty. Hardy H (ed). Oxford, Oxford University Press, pp 169–170.Google Scholar
- Bortolotti L (2010) Delusions and Other Irrational Beliefs. Oxford, Oxford University Press.Google Scholar
- Christman J (2015) Autonomy in Moral and Political Philosophy. Stanford Encyclopedia of Philosophy. https://plato.stanford.edu/entries/autonomy-moral/. Accessed 2 May 2018.
- Council of Europe (2004) Recommendation No. Rec (2004)10 of the Committee of Ministers to Members States Concerning the Protection of the Human Rights and Dignity of Persons with Mental Disorder and its Explanatory Memorandum. https://www.coe.int/t/dg3/healthbioethic/Activities/08_Psychiatry_and_human_rights_en/Rec(2004)10%20EM%20E.pdf. Accessed 2 May 2018.
- Danchin P (2008) Of Prophets and Proselytes: Freedom of Religion and the Conflict of Rights in International Law. Harvard International Law Journal 49(2):250–321.Google Scholar
- DSM-V, Diagnostic and Statistical Manual of Mental Disorders (2013) Fifth edition, Washington D.C. and London, American Psychiatric Publishing.Google Scholar
- Dworkin RA (1985) A Matter of Principle. Cambridge and London, Harvard University Press.Google Scholar
- Feinberg J (1973) Social Philosophy. New Jersey, Prentice Hall.Google Scholar
- Fulford KWM, Thornton T, Graham G (2006) Oxford Textbook of Philosophy and Psychiatry. Oxford, Oxford University Press.Google Scholar
- Glover J (2003) Towards Humanism in Psychiatry. The Tanner Lectures on Human Values (Princeton University, February 12–14, 2003). http://tannerlectures.utah.edu/_documents/a-to-z/g/glover_2003.pdf. Accessed 2 May 2018.
- Guignon C (2004) On Being Authentic. London and New York, Routledge.Google Scholar
- Gøtzsche, PC (2015) Deadly Psychiatry and Organised Denial. København, People’s Press.Google Scholar
- Gunn TJ (2003) The Complexity of Religion and the Definition of ‘Religion’ in International Law. Harvard Human Rights Journal 15:189–215.Google Scholar
- Human Rights Committee, General Comment 22, Article 18 (Forty-eighth session, 1993). Compilation of General Comments and General Recommendations Adopted by Human Rights Treaty Bodies, U.N. Doc. HRI/GEN/1/Rev.1 at 35 (1994).Google Scholar
- International Covenant on Civil and Political Rights (ICCPR) (1966).Google Scholar
- Iso-Koivisto E (2004) “Pois sieltä, ylös, takaisin” – ensimmäinen psykoosi kokemuksena. Dissertation, Turun yliopisto.Google Scholar
- Karapuu H (2011) Perusoikeuksien Käsite ja Luokittelu. In: Hallberg P et al (eds) Perusoikeudet. Helsinki, WSOYpro, pp 63–87.Google Scholar
- Klasson Sundin M (2016) Barnets religionsfrihet - en villkorad frihet? En filosofisk undersökning utifrån FN:s Barnkonvention. Dissertation, Uppsala, Acta Universitatis Upsaliensis.Google Scholar
- Kuosmanen J (2009) Personal Liberty in Psychiatric Care–Towards Service User Involvement. Turun Yliopiston Julkaisuja, Sarja D: 841. Dissertation, Turun yliopisto.Google Scholar
- Lerner N (2006) Religion, Secular Beliefs and Human Rights. 25 Years After the 1981 Declaration. Leiden & Boston, Martinus Nijhoff Publisher.Google Scholar
- Lönnqvist J, Moring J, Henriksson M (2014). Hoitoon Ohjaaminen. In: Lönnqvist J et al (eds) Psykiatria. Helsinki, Duodecim.Google Scholar
- Mielenterveyslaki (Mental Health Act) 2001/1423, Unofficial Translation: www.finlex.fi/en/laki/kaannokset/1990/en19901116.pdf. Accessed 2 May 2018.
- MI Principles (Principles for the Protection of Persons with Mental Illness and the Improvement of Mental Health Care), A/RES/46/119, 75th plenary meeting, 17 December 1991.Google Scholar
- Nowak M (1993) U.N. Covenant on Civil and Political Rights, CCPR Commentary. Kehl and Strasbourg, N.P. Engel Publisher.Google Scholar
- Nussbaum MC (2008) Liberty of Conscience. In Defence of America’s Tradition of Religious Equality. New York, Basic Books.Google Scholar
- Nussbaum MC (2006) Frontiers of Justice. Disability, Nationality, Species Membership. Cambridge, Massachusetts and London, The Belknap Press of Harvard University Press.Google Scholar
- Partch KJ (1981) Freedom of Conscience and Expression, and Political Freedoms. In: Henkin L (ed) The International Bill of Rights. The Covenant on Civil and Political Rights. New York, Columbia University Press, pp 209–245.Google Scholar
- Quinn G, Degener T (2002) The Moral Authority for Change: Human Rights Values and the Worldwide Process of Disability Reform. In: Quinn G and Degener T (eds) Human Rights and Disability. The Current Use and Future Potential of United Nations Human Rights Instruments in the Context of Disability. New York & Geneva, United Nations, pp 13–28. http://www.ohchr.org/Documents/Publications/HRDisabilityen.pdf. Accessed 2 May 2018.Google Scholar
- Radden J (2011) On Delusion. London and New York, Routledge.Google Scholar
- Rainey B, Wicks E, Ovey C (2014) Jacobs, White & Ovey. The European Convention on Human Rights, 6th edn. Oxford, Oxford University Press.Google Scholar
- Rikoslaki 2003/515. http://www.finlex.fi/fi/laki/ajantasa/1889/18890039001. Accessed 21 March 2018.
- Roberts C (2016) Interpreting Freedom from Religion: A Step too far? University of Bristol Law School Blog. Published online 13 June 2016. https://legalresearch.blogs.bris.ac.uk/2016/06/interpreting-freedom-from-religion-a-step-too-far/. Accessed 2 May 2018.
- Sass LA (1994) The Paradoxes of Delusion. Wittgenstein, Schreber, and the Schizoprenic Mind. Ithaca and London, Cornell University Press.Google Scholar
- Scanlon T (1972) A Theory of Freedom of Expression. Philosophy and Public Affairs 1(2):204–226.Google Scholar
- Sen A (2009) The Idea of Justice. London, Allen Lane.Google Scholar
- Sen A (1999) Development as Freedom. Oxford and New York, Oxford University Press.Google Scholar
- Slotte P (2015) International Law and Freedom of Religion and Belief: Origins, Presuppositions and Structure of the Protection Framework. In: Ferrari S (ed), Routledge Handbook of Law and Religion. Abingdon and New York, Routledge, pp 103–117.Google Scholar
- Slotte P (2012) The Religious and the Secular in European Human Rights Discourse. Finnish yearbook of international law 21:231–286.Google Scholar
- Slotte P (2011) What Is a Man if He Has Words But Has No Deeds? Some Remarks on the European Convention of Human Rights. In: Brunsveld N and Trigg R (eds) Religion in the Public Sphere: Proceedings of the 2010 Conference of the European Society for Philosophy of Religion, pp 259–271. (Ars Disputandi Supplement Series, Vol. 5).Google Scholar
- Stenlund M (2017) Promoting the Freedom of Thought of Mental Health Service Users: Nussbaum's Capabilities Approach Meets Values-based Practice. Journal of Medical Ethics. Published online 9 August 2017. http://jme.bmj.com/content/early/2017/08/09/medethics-2016-103637.info. Accessed 2 May 2018.
- Stenlund M (2014) Freedom of Delusion. Interdisciplinary Views of Freedom of Belief and Opinion Meet the Individual with Psychosis. Dissertation, Helsinki, University of Helsinki. http://urn.fi/URN:ISBN:978-952-10-9747-8. Accessed 2 May 2018.
- Stephens GL, Graham G (2007) The Delusional Stance. In: Chung MC, Fulford KWM, Graham G (eds) Reconceiving Schizophrenia. Oxford, Oxford University Press, pp 193–215.Google Scholar
- Szasz T (1990) Law and Psychiatry: The Problems that will not go away. J Mind Behav 11(3–4):557–563.Google Scholar
- Tahzib BG (1996) Freedom of Religion or Belief. Ensuring Effective International Legal Protection. Hague, Martinus Nijhoff Publishers.Google Scholar
- Tiihonen J (2014) Oikeuspsykiatria. In: Lönnqvist J et al (eds) Psykiatria. Helsinki, Duodecim, pp 697–715.Google Scholar
- UN Human Rights Committee (HRC), CCPR General Comment No. 22: Article 18 (Freedom of Thought, Conscience or Religion), 30 July 1993, CCPR/C/21/Rev.1/Add.4, available at: http://www.refworld.org/docid/453883fb22.html [accessed 15 March 2018]
- Whelan D (2010) Indivisible Human Rights. A History. Philadelphia, University of Pennsylvania Press.Google Scholar
- Whitaker R (2016) The Case Against Antipsychotics. A Review of Their Long-term Effects. Mad in America. https://www.madinamerica.com/wp-content/uploads/2016/07/The-Case-Against-Antipsychotics.pdf. Accessed 20 September 2017.
- WHO (2005) WHO Resource Book on Mental Health, Human Rights and Legislation. https://ec.europa.eu/health/sites/health/files/mental_health/docs/who_resource_book_en.pdf. Accessed 2 May 2018.