The debate is on again. Can a person be judged guilty of a crime if he or she cannot tell right from wrong? The last time it was the John Hinckley case. This time it is the Richard Berendzen case.

In a May 4 op-ed column, Dr. Kenneth Grundfast absolved Berendzen of responsibility for making obscene phone calls because, he said, Berendzen's behavior might have resulted from abnormal genes.

Then Charles Krauthammer weighed in on the opposite side of the issue {op-ed, May 11}, stating that blaming aberrant behavior on diseases is becoming popular with "middle-class malefactors whose white-collar crimes cannot plausibly be blamed on a wretched environment." Krauthammer cited as examples Pete Rose's gambling addiction syndrome, Mayor Marion Barry's alleged alcoholism and finally Richard Berendzen's alleged paraphilia, subcategory telephone scatologia.

In discussing Barry, Krauthammer cited the mayor's response to the question as to why he had repeatedly lied about his drug problem: "That was the disease talking ... I was a victim." The implication is that if one has a disease, one is absolved of guilt for crimes resulting from behaviors that are manifestations of that disease. So which view is correct?

The problem is that the dilemma involves law and medicine and their impact on society. Law by and large deals with the utilitarian concept of creating order by striking a balance between the needs of the individual and the needs of society. Medicine on the other hand, particularly psychiatry, deals primarily with the needs of the individual. What I would propose is that although this offers a seeming dichotomy of divergent needs, they are not mutually exclusive if put in the proper context.

Resolving this apparent dichotomy is important because there is a trend toward returning to a moral explanation for aberrant behavior as a result of society's impatience with widespread crime. As an example, the Supreme Court recently ruled (Traynor v. Turnage) that primary alcoholism constitutes "willful misconduct" with regard to a case involving Veterans Administration benefits. This represents a serious threat to the concept that alcoholism is a disease.

The problem most individuals have in dealing with the concept that alcoholism and other illness that manifest in compulsive behavior are diseases is that they lack a personal frame of reference. Another problem with the disease concept is that the treatments have not been entirely worked out. If alcoholism is a disease, where precisely does this disease lie, and how can we fix it? But just because medicine does not have all the answers does not mean that defining a disease is not important in terms of what we do know and its impact on treatment.

The fact that there are medical explanations for human behavior has nothing to do with an individual's acceptance of personal responsibility for that behavior. I work with patients who are alcoholic or chemically dependent. They are taught that they are suffering from a disease. This is important because the chemically dependent individual is riddled with shame and guilt; he thinks that powerlessness over alcohol or drugs is the result of moral weakness. The chemically dependent person thinks exactly what most of society thinks -- that people should be able to stop drinking or using drugs as simply as one turns off hot water when one gets burned. The chemically dependent patient's acceptance of his disease can free him of guilt and allow him to concentrate on his recovery. This has nothing to do with absolution from criminal guilt resulting from behavior that was a product of that patient's addiction.

The recovering alcoholic who was arrested for driving while intoxicated while he was in the active stage of his alcoholism must answer for the crime and must accept personal responsibility for his actions.

In short, defining an aberrant behavioral pattern as a disease allows for treatment; it does not excuse that behavior. In recognizing this, the societal need for protection against aberrant behavior is met while at the same time allowing for treatment of the individual. -- Andrew M. Baer, M.D.