Happy Birthday Tom, I'm not far behind you. My take on the mad/bad argument is less to do with medication, and more to do with the level of responsibility which can be directly attributable to the individual. It gets a bit grey with personality disorders though. Man stabs wife because she went shopping. BAD. Man stabs wife because the voices told him to. MAD. Man stabs wife because the voices told him to because the man decided he didn't want to take his medication. MAD-BAD? Man stabs himself because his wife has an affair. SAD. Man stabs wife because he saw her look at another male in the street and this is completely unacceptable because he is the only person she can look at. This is because he is a selfish scumbag. BAD. Man stabs wife and male in street because he saw her look at the male and this is completely unacceptable because he is the only person she can look at. This is because he has psychopathic personality disorder. ? I dunno where to draw the line - PDs are untreatable and people with them are most definitely "mad" in the sense that their diagnosis is in various mental health diagnostic manuals - the question is whether or not the individual is capable of not doing those acts. IMHO