ABSTRACT
This chapter examines two types of meta-responsibility. The first type, consensual meta-responsibility, arises from the consent to genesis or exacerbation of mental disorder in the pursuit of sensual experiences, e.g. medication non-compliance because of a wish to be free of medication side-effects. The second type, purposive meta-responsibility, arises from a 'wish to be crazy' in which mental disorder is valued as a primary goal and behaviour/cognition is directed toward this goal. The social constructivist and existential phenomenological models are often cast as antithetic to the liberal-scientific model, but this chapter emphasizes their complementary characteristics. Consensual meta-responsibility is relevant to problems of clinical management, e.g. non-compliance with medication or medical instructions, failing to attend outpatient appointments. Medication non-compliance is examined here as an example of consensual meta-responsibility, particularly within the context of the schizophrenias. The social constructivist and existential phenomenological models do therefore indicate the element of voluntarism that is required by the notion of purposive meta-responsibility.
