Anosognosia[0] is a typical aspect of many mental illnesses. If they knew the delusions weren't real, they wouldn't really be delusions.
There is a fundamental hard problem here that many people who think there are easy solutions ignore: how do we as a society fairly determine who can have their autonomy taken from them? Where do we draw the line between personal responsibility, mental illness, and willful criminal intent?
In the past, the line was drawn too far towards the state and family and there were innumerable horror stories of "difficult" women being lobotomized and locked up in sanitoria for life because their family didn't want to deal with their rebellious ways.
The deinstitutionalization movement swung the pendulum the other way and said, basically, you're completely responsible for yourself all the way up until you commit an actual crime. Because criminality is now the line, it means the police end up dealing with the mentally ill more than they should.
The right point is somewhere between these, but drawing it fairly is hard and we don't have great social structures to support it. (In particular, how does society allow the medical infrastructure decide who should have autonomy in a country that doesn't even provide any right to medical access in the first place?)
There is a fundamental hard problem here that many people who think there are easy solutions ignore: how do we as a society fairly determine who can have their autonomy taken from them? Where do we draw the line between personal responsibility, mental illness, and willful criminal intent?
In the past, the line was drawn too far towards the state and family and there were innumerable horror stories of "difficult" women being lobotomized and locked up in sanitoria for life because their family didn't want to deal with their rebellious ways.
The deinstitutionalization movement swung the pendulum the other way and said, basically, you're completely responsible for yourself all the way up until you commit an actual crime. Because criminality is now the line, it means the police end up dealing with the mentally ill more than they should.
The right point is somewhere between these, but drawing it fairly is hard and we don't have great social structures to support it. (In particular, how does society allow the medical infrastructure decide who should have autonomy in a country that doesn't even provide any right to medical access in the first place?)
[0] https://en.wikipedia.org/wiki/Anosognosia