 The present discussion concerns evaluations that are primarily negative, although as we saw earlier, positive evaluations arise in traditions valorizing madness, and many in the neuro-diversity movement insist that autism spectrum and other mental disorders are human variations analogous to differences of gender, which ought to be granted respectful accommodation, not clinical treatment.(See Chapman 2019, Hoffman 2019.) Negative social attitudes towards observable disorder have led to stigma, self-stigma, and discrimination (Hinshaw 2007). The madman and madwoman have been the subject of fear, misunderstanding, disparagement and condemnation, their failings exaggerated and humanity denied (Gilman 1985). With modernity, care and protection apparently replaced earlier, moralistic and neglectful arrangements. (The reforms’ real effects and costs remain an unsettled matter of historical  debate.[7]  ) At the same time formal exceptions and protections, such as the insanity defense, recognized mental disorder as an exculpating excuse for wrongdoing and negligence. Despite such attitudinal change, however, these issues around responsibility remain contentious and unresolved (C. Edwards 2009).