Mad or Bad Psychiatry’s Foundational Divide and the Illusion of Binary Thinking

This paper revisits Philippe Pinel’s (1745-1826) psychiatric legacy, on the occasion of the 200th anniversary of his death, to challenge the enduring dichotomy between madness and criminality. While Pinel is celebrated for separating the insane from the criminal, his deeper insight—that madness is always partial and never fully negates agency—has been largely overlooked. Drawing on this dialectical view, the paper critiques the persistence of rigid classifications in psychiatry and forensic contexts. It argues for a model of mental illness as a dynamic interplay between vulnerability and self-awareness, with profound implications for clinical practice, legal judgment, and public perception. By highlighting psychiatry’s double bind—caught between therapeutic nuance and legal absolutism—the paper calls for a renewed ethical stance that embraces complexity and reclaims psychiatry’s role as a bridge-builder rather than a boundary enforcer.