Human Rights Review

, Volume 19, Issue 4, pp 425–446 | Cite as

Forum Internum Revisited: Considering the Absolute Core of Freedom of Belief and Opinion in Terms of Negative Liberty, Authenticity, and Capability

  • Mari StenlundEmail author
  • Pamela Slotte


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.


Freedom 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.

Funding information

This work was supported by the Church Research Institute, the Finnish Cultural Foundation, and the Academy of Finland.


  1. Ahdar RJ, Leigh I (2005) Religious Freedom in the Liberal State. Oxford and New York, Oxford University Press.Google Scholar
  2. Arsheim, H (2014), Lost in Translation? Religion-Making at Four UN Human Rights Committees, 1993–2013. Dissertation, University of Oslo.Google Scholar
  3. Beauchamp TL, Childress JF (1989) Principles of Biomedical Ethics. New York and Oxford, Oxford University Press.Google Scholar
  4. Beltran S (2005) The International Protection of Human Rights versus Groups Employing Psychological Manipulation. The International Journal of Human Rights 9(3):285–305.CrossRefGoogle Scholar
  5. Berlin B (2005) Liberty. Hardy H (ed). Oxford, Oxford University Press, pp 169–170.Google Scholar
  6. Berrios GE (1991) Delusions as “Wrong Beliefs”: A Conceptual History. Br J Psychiatry 159(14):6–13.CrossRefGoogle Scholar
  7. Bolton D, Banner N (2012) Does Mental Disorder Involve Loss of Personal Autonomy? In: Radoilska L (ed) Autonomy and Mental Disorder. Oxford, Oxford University Press, pp 77–99.CrossRefGoogle Scholar
  8. Bortolotti L (2010) Delusions and Other Irrational Beliefs. Oxford, Oxford University Press.Google Scholar
  9. Bratza N (2012) The ‘Precious Asset’: Freedom of Religion Under the European Convention on Human Rights. Ecclesiastical Law Journal 14(2):256–271.CrossRefGoogle Scholar
  10. Brison SJ (1996) The Autonomy Defence of Free Speech. Ethics 108:312–339.CrossRefGoogle Scholar
  11. Bublitz JC (2013) My Mind is Mine!? Cognitive Liberty as a Legal Concept. In: Hildt E and Franke AG (eds) Cognitive Enhancement: An Interdisciplinary Perspective. Dordrecht, Springer, pp 233–264.CrossRefGoogle Scholar
  12. Christman J (2015) Autonomy in Moral and Political Philosophy. Stanford Encyclopedia of Philosophy. Accessed 2 May 2018.
  13. Currie G, Ravenscroft I (2002) Recreative Minds. Imagination in Philosophy and Psychology. Oxford, Oxford University Press.CrossRefGoogle Scholar
  14. 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. Accessed 2 May 2018.
  15. 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
  16. DSM-V, Diagnostic and Statistical Manual of Mental Disorders (2013) Fifth edition, Washington D.C. and London, American Psychiatric Publishing.Google Scholar
  17. Dworkin RA (1985) A Matter of Principle. Cambridge and London, Harvard University Press.Google Scholar
  18. Erler A, Hope T (2014) Mental Disorder and the Concept of Authenticity. Philosophy, Psychiatry, and Psychology 21(3):219–232.CrossRefGoogle Scholar
  19. Evans C (2001a) Freedom of Religion Under the European Convention of Human Rights. Oxford, Oxford University Press.CrossRefGoogle Scholar
  20. Evans MD (2001b) Human Rights, Religious Liberty, and the Universality Debate. In: O’Dair R and Lewis A (eds) Law and Religion. Oxford, Oxford University Press, pp 205–226.CrossRefGoogle Scholar
  21. Evans MD (1997) Religious Liberty and International Law in Europe. Cambridge, Cambridge University Press.CrossRefGoogle Scholar
  22. Feinberg J (1973) Social Philosophy. New Jersey, Prentice Hall.Google Scholar
  23. Fulford KWM, Radoilska L (2012) Three Challenges from Delusion for Theories of Autonomy. In: Radoilska L (ed) Autonomy and Mental Disorder. Oxford, Oxford University Press, pp 44–74.CrossRefGoogle Scholar
  24. Fulford KWM, Thornton T, Graham G (2006) Oxford Textbook of Philosophy and Psychiatry. Oxford, Oxford University Press.Google Scholar
  25. Glover J (2003) Towards Humanism in Psychiatry. The Tanner Lectures on Human Values (Princeton University, February 12–14, 2003). Accessed 2 May 2018.
  26. Gosden R (1997) Shrinking the Freedom of Thought: How Involuntary Psychiatric Treatment Violates Basic Human Rights. Monitors: Journal of Human Rights and Technology, 1(Feb). Accessed 2 May 2018.
  27. Guignon C (2004) On Being Authentic. London and New York, Routledge.Google Scholar
  28. Gutheil TG (1980) In Search of True Freedom: Drug Refusal, Involuntary Medication, and “Rotting with Your Rights On”. American Journal of Psychiatry 137(3):327–328.CrossRefGoogle Scholar
  29. Gøtzsche, PC (2015) Deadly Psychiatry and Organised Denial. København, People’s Press.Google Scholar
  30. Gunn TJ (2003) The Complexity of Religion and the Definition of ‘Religion’ in International Law. Harvard Human Rights Journal 15:189–215.Google Scholar
  31. Heinimaa, M (2002) Incomprehensibility: The Role of the Concept in DSM-IV Definition of Schizophrenic Delusions. Medicine, Health Care and Philosophy 5(3):291–295.CrossRefGoogle Scholar
  32. 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
  33. International Covenant on Civil and Political Rights (ICCPR) (1966).Google Scholar
  34. Iso-Koivisto E (2004) “Pois sieltä, ylös, takaisin” – ensimmäinen psykoosi kokemuksena. Dissertation, Turun yliopisto.Google Scholar
  35. Kaltiala-Heino RK, Korkeila J, Tuohimäki C, Tuori T, Lehtinen V (2000) Coercion and Restrictions in Psychiatric Inpatient Treatment. European Psychiatry 15(3):213–219.CrossRefGoogle Scholar
  36. Kapur S (2003) Psychosis as a State of Aberrant Salience: A Framework Linking Biology, Phenomenology, and Pharmacology in Schizophrenia. American Journal of Psychiatry 160(1):13–23.CrossRefGoogle Scholar
  37. Karapuu H (2011) Perusoikeuksien Käsite ja Luokittelu. In: Hallberg P et al (eds) Perusoikeudet. Helsinki, WSOYpro, pp 63–87.Google Scholar
  38. Klasson Sundin M (2016) Barnets religionsfrihet - en villkorad frihet? En filosofisk undersökning utifrån FN:s Barnkonvention. Dissertation, Uppsala, Acta Universitatis Upsaliensis.Google Scholar
  39. Kuosmanen J (2009) Personal Liberty in Psychiatric Care–Towards Service User Involvement. Turun Yliopiston Julkaisuja, Sarja D: 841. Dissertation, Turun yliopisto.Google Scholar
  40. Langlaude S (2007) The Right of the Child to Religious Freedom in International Law. Leiden and Boston, Martinus Nijhoff Publishers.CrossRefGoogle Scholar
  41. Lerner N (2006) Religion, Secular Beliefs and Human Rights. 25 Years After the 1981 Declaration. Leiden & Boston, Martinus Nijhoff Publisher.Google Scholar
  42. Lönnqvist J, Moring J, Henriksson M (2014). Hoitoon Ohjaaminen. In: Lönnqvist J et al (eds) Psykiatria. Helsinki, Duodecim.Google Scholar
  43. Meyerson D (1998) On Being One’s Own Person. Ethical Theory and Moral Practice 1(4):447–466.CrossRefGoogle Scholar
  44. Mielenterveyslaki (Mental Health Act) 2001/1423, Unofficial Translation: Accessed 2 May 2018.
  45. 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
  46. Nowak M (1993) U.N. Covenant on Civil and Political Rights, CCPR Commentary. Kehl and Strasbourg, N.P. Engel Publisher.Google Scholar
  47. Nussbaum MC (2011) Creating Capabilities. The Human Development Approach. Cambridge, Massachusetts and London, The Belknap Press of Harvard University Press.CrossRefGoogle Scholar
  48. Nussbaum MC (2008) Liberty of Conscience. In Defence of America’s Tradition of Religious Equality. New York, Basic Books.Google Scholar
  49. Nussbaum MC (2006) Frontiers of Justice. Disability, Nationality, Species Membership. Cambridge, Massachusetts and London, The Belknap Press of Harvard University Press.Google Scholar
  50. Oshana M (2007) Autonomy and the Question of Authenticity. Social Theory & Practice 33(3):411–429.CrossRefGoogle Scholar
  51. 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
  52. Peele R, Chodoff, P (2009) Involuntary Hospitalization and Deinstitutionalization. In: Bloch S and Green SA (eds) Psychiatric Ethics, 4th edn. Oxford, Oxford University Press, pp 211–228.CrossRefGoogle Scholar
  53. Peroni L (2014) Deconstructing ‘Legal’ Religion in Strasbourg. Oxford Journal of Law and Religion 3(2):235–257.CrossRefGoogle Scholar
  54. Petkoff, P (2012) Forum Internum and Forum Externum in Canon Law and Public International Law with a Particular Reference to the Jurisprudence of the European Court of Human Rights. Religion & Human Rights 7(3):183–214CrossRefGoogle Scholar
  55. 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. Accessed 2 May 2018.Google Scholar
  56. Radden J (2011) On Delusion. London and New York, Routledge.Google Scholar
  57. Rainey B, Wicks E, Ovey C (2014) Jacobs, White & Ovey. The European Convention on Human Rights, 6th edn. Oxford, Oxford University Press.Google Scholar
  58. Rikoslaki 2003/515. Accessed 21 March 2018.
  59. Roberts C (2016) Interpreting Freedom from Religion: A Step too far? University of Bristol Law School Blog. Published online 13 June 2016. Accessed 2 May 2018.
  60. Roberts G (1991) Delusional Belief Systems and Meaning in Life: A Preferred Reality? British Journal of Psychiatry 159 suppl.(14):19–28.CrossRefGoogle Scholar
  61. Sass LA (1994) The Paradoxes of Delusion. Wittgenstein, Schreber, and the Schizoprenic Mind. Ithaca and London, Cornell University Press.Google Scholar
  62. Scanlon T (1972) A Theory of Freedom of Expression. Philosophy and Public Affairs 1(2):204–226.Google Scholar
  63. Scheinin M (2000) Freedom of Thought, Conscience and Religion. Studia Theologica 54(1):5–18.CrossRefGoogle Scholar
  64. Sen A (2009) The Idea of Justice. London, Allen Lane.Google Scholar
  65. Sen A (1999) Development as Freedom. Oxford and New York, Oxford University Press.Google Scholar
  66. Sims A (1997) Commentary on “Spiritual Experience and Psychopathology”. Philosophy, Psychiatry, and Psychology 4(1):79–81.CrossRefGoogle Scholar
  67. 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
  68. Slotte P (2012[2010]) The Religious and the Secular in European Human Rights Discourse. Finnish yearbook of international law 21:231–286.Google Scholar
  69. 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
  70. 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. Accessed 2 May 2018.
  71. Stenlund M (2014) Freedom of Delusion. Interdisciplinary Views of Freedom of Belief and Opinion Meet the Individual with Psychosis. Dissertation, Helsinki, University of Helsinki. Accessed 2 May 2018.
  72. Stenlund M (2013) Is There a Right to Hold a Delusion? Delusions as a Challenge for Human Rights Discussion. Ethical Theory and Moral Practice 16(4):829–843.CrossRefGoogle Scholar
  73. 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
  74. Szasz T (1990) Law and Psychiatry: The Problems that will not go away. J Mind Behav 11(3–4):557–563.Google Scholar
  75. Tahzib BG (1996) Freedom of Religion or Belief. Ensuring Effective International Legal Protection. Hague, Martinus Nijhoff Publishers.Google Scholar
  76. Taylor PM (2005) Freedom of Religion. UN and European Human Rights Law and Practice. Cambridge, Cambridge University Press.CrossRefGoogle Scholar
  77. Tiihonen J (2014) Oikeuspsykiatria. In: Lönnqvist J et al (eds) Psykiatria. Helsinki, Duodecim, pp 697–715.Google Scholar
  78. 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: [accessed 15 March 2018]
  79. Wagner LC, King M (2005) Existential Needs of People with Psychotic Disorders in Pôrto Alegre, Brazil. The British Journal of Psychiatry 186:141–145.CrossRefGoogle Scholar
  80. Whelan D (2010) Indivisible Human Rights. A History. Philadelphia, University of Pennsylvania Press.Google Scholar
  81. Whitaker R (2016) The Case Against Antipsychotics. A Review of Their Long-term Effects. Mad in America. Accessed 20 September 2017.
  82. WHO (2005) WHO Resource Book on Mental Health, Human Rights and Legislation. Accessed 2 May 2018.
  83. Widdershoven GAM, Ruissen A, van Balkom A, et al. (2017) Competence in Chronic Mental Illness: The Relevance of Practical Wisdom. J Med Ethics 43:1–5.CrossRefGoogle Scholar

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Authors and Affiliations

  1. 1.Expert at Asiantuntijaosuuskunta Mielekäs, MikkeliMikkeliFinland
  2. 2.Faculty of Arts, Psychology and TheologyÅbo Akademi UniversityTurkuFinland
  3. 3.Centre of Excellence in Law, Identity and the European NarrativesUniversity of HelsinkiHelsinkiFinland

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