Mental disorder as a puzzle for constitutivism.

In the Nicomachean Ethics, Aristotle argues that the performance called for by being human is rational flourishing and a life that falls short of flourishing will fail to constitute a life lived in accordance with the norms governing human kind in virtue of its function. Against this constitutivist story, a puzzle arises: On Aristotle's criteria, it looks impossible for a person with a mental disorder to flourish. I consider whether this puzzle can be satisfactorily addressed without abandoning Aristotelian constitutivism. I regard this as a puzzle worthy of serious engagement because there is a tension between the adoption of Aristotelian virtue ethics as a normative backbone for applied ethics and the possibility that the theory would consign many, many people to being incapable of virtue or flourishing. I first set out the basic commitments of a constitutivist Aristotelian account and show how it generates the hypothesis that a person with mental disorder could never flourish. I then present two contemporary concepts of mental disorder-one from the fifth edition of the American Psychiatric Association's Diagnostic and Statistical Manual of Mental Disorders and one from philosopher George Graham's The Disordered Mind. I show that Graham's treatment of mental disorder supplies the basis for a compelling response to the puzzle for constitutivism. That response is rooted in his conceptualization of disorder as involving truncated rather than absent rationality. I suggest that Aristotle's discussion of death can be construed as supporting a second response. Finally, I discuss possible clinical implications under the auspices of caring constitutivism, which treats Aristotle's account of the human function as a basis from which ideals of rationality and recovery can be empathetically developed.