Most of us think we have free will, and most of us realize that there are limits to free will. If someone has, for example, a lesion in the brain, he or she might behave differently than normal without realizing what is happening. Aristotle discusses the case of a drunk person who commits a crime while drunk without realizing at the time what he was doing. He says that the wrong action itself is not voluntary; however, since the decision to drink too much was voluntary, the drunk person is responsible for his action.

Nature and nurture both cooperate in limiting our practical range of choices. Our heredity can set basic personality traits, environment can modify them, and we have learned that environment can modify a person’s genetics. A person’s own decision can modify his genetics as well–this discovery and others is the reason why epigenetics is a hot field in current biology.

Someone with schizophrenia who behaves in a destructive way due to the disease process in his body is making choices based on the fantasy world view characteristic of schizophrenics. The choice is voluntary in a way, but since it is based on an illusion caused by the illness, the choice is ultimately so constrained as to be involuntary. The same is true of other psychoses as well as most of the Class B personality disorders. Voluntary choice is constrained due to traits that sometimes result in the disintegration of the personality. A person does not have to reach the extreme of dissociative identity disorder to suffer from a fragmented personality. Overwhelming emotions characteristic of the Class Bs can interfere with voluntary action; the impulses can cause an adrenaline rush that can interfere with judgment, and in extreme cases a temporary dissociation can occur. I have struggled with my views on this matter over time. I have met psychologists who say that these persons have free will and have decided to focus on the self, and that such focus is characteristic of egotism and is evil. I once believed this was the case; however, on reading accounts of recovery from some of these conditions, including recovery from the notorious borderline personality disorder, I have reconsidered. J. R. R. Tolkien considered the Rin to be too great a temptation for anyone to bear–a temptation that a person could not resist. Perhaps overwhelming waves of emotion can temporarily limit the scope of voluntary action. The situation would be similar to those who are drunk or on drugs and have impulses they often cannot control. The difference is that in the case of mental illness, environment (and in some cases heredity) have molded a person into unhealthy patterns of behavior that may be too difficult to voluntarily resist. What are the options for such individuals?

It seems to me that the option is to seek treatment, just as alcoholics who are not forced to do so by the criminal justice system must voluntarily decide to be treated if they have any chance to be helped. I am not sure that a schizophrenic recognizes the need for help. If someone with one of the Class B personality disorders avoids denial and seeks treatment, it is possible, with a patient therapist and a long-term therapeutic relationship, for that person to be successfully treated. Dialectical behavior therapy, for example, has been useful in treating borderline personality disorder. The alternative, at least for this condition, is grim. BPD individuals do not intend to hurt others–not for sheer “meanness.” It stems from splitting (which I call “individualized Manicheanism” that puts a person into the “all good” category one moment and the “Satanic evil” category the next moment. Much of the behavior is the attempt of the fragmented personality to survive. Jesus said that “A house divided against itself cannot stand.” Could it be that a personality divided against itself can cause the body to be divided against itself? Some people with various mental conditions are in poor physical health. While that may be due to poor eating and exercise habits, I wonder if a mental disorder can be in a one-to-one correspondence with a physical disorder. Is it possible, for example, for a divided personality to cause the body to be divided against itself? If so, would the physical disease be eased or reversed if the disparate patches of personality could once again join into one? I suppose that is possible. Such a task would involve a skilled therapist with top-notch skills and the wisdom, as well as the knowledge, to help a person become whole again. My hope and prayer is that, with God’s help, all those who suffer from actions that are, at least in part, beyond their control due to illness, physical and/or mental, will heal.