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A single IQ point determines whether you are responsible enough for a death sentence, because we have laws. Laws should be legible, consistent, and standardized tests provide both. If it is more cruel to execute a person who scores a 69 IQ person than one who scores a 70 it is because we or [this code] say(s) so. The spectrum of culpability or responsibility is typically done via sentencing, as you note, but if someone clears the bar for insanity we also say it has to be a threshold. It must be, because the judgment is binary. As for your questions on psychosis specifically, as I understand a psychosis diagnosis is not a get out of jail free card. One must suffer the kind of trial going on now where either the state or a defendant proves why a specific instance of psychosis means one should or should not be held accountable for a crime.
My hot take: it means shrinks observed something enough times to give it a name and stuck it in the DSM. These observations, decisions, and writing are all indeed mediated by language.
Allow me to be a punk and consider something really crazy. There is and has been an ongoing epidemic of an unnamed affliction which primarily effects young men. It is an old affliction, possibly as old as time. There are differences in observable rates of this condition demographically speaking, but it's definitely higher in the general population of young men.
The generalized case sees a young man taken in the blink of an eye with blind rage. A man with this condition is overcome and engages in swift, brutal, disproportionate violence against another -- most often another man. Without proper studies early researchers of the condition have informally dubbed it Insulted Shoe Disorder, or ISD. The name stems from one case discovered by researchers in the field which involved a man who upon hearing an insult (made against the shoes he was wearing) flew into a blind rage, beat another man to death, and took the victim's shoes. The police arrived to the scene shortly afterward and immediately arrested the man. In custody, the man repeatedly stated he couldn't say what came over him, he could not say why he flew into a blind rage, and he could not say why he took off the man's shoes. "I don't know," is all the man could say, face in hands. While awaiting trial, the man's lawyer arranged for several psychiatrists to come and see him. Each time he told the same story, "The man insulted my shoes, I saw red. I don't remember much after that. The next thing I know my fists are covered in blood and I'm looking at two cops pointing guns at me, a shoe in each hand."
Sociologists, always ahead of medicine, have visited areas with suspected cases of ISD to draw comparisons between them. They found that even while adjusting for things like culture and race that young men separated by thousands of miles were generally at risk of suffering the affliction. They regarded this as a natural kind of illness, though the sociologists admitted they were unqualified to definitively say. Sometimes they found the young men had a history of violence prior to their first documented ISD episode. In other cases, the sociologists found that the young men had no history of violence at all. Seemingly, they found something just inexplicably snapped within these men at one moment in time which evoked a reaction that could not be undone or considered sane.
What could be more crazy than to kill someone simply because they insulted your shoes, truck, hat, or mother-- is it not a mental illness because it is more common relative to cases of filicidal mothers? But of cognizance and choice, what sane thinking person would choose throw their life away over that? Certainly there are some who exhibit signs of ISD while still being responsible for their irresponsible actions, but there must be those afflicted who had little choice in the matter. The sociologists even tell us this responsibility may be diffuse, perhaps medicine could confirm this. Medicine could recognize few young men want to experience an episode of ISD. Identifying which ISD cases might suggest a temporary insanity and separating them from the hardened thugs is a moral imperative. We are talking a massive scale here. Potentially tens of thousands of young men a year unfairly prosecuted as if they had control of their actions to an extent they should be held criminally liable.
These can be and often are the same thing.
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