Why is the issue of agency and self-determination of such concern? As a nonpsychiatrist, Luhrmann is as much focused on the society at large as on the realm of psychiatric disorders. She sees a danger of this biological "moral loophole" being expanded: "Psychiatric knowledge seeps into popular culture like the dye from a red shirt in hot water." Also, she has embraced the position of patient (consumer) groups that resent the view that their actions stem from illness rather than from "themselves." In her final chapter, "Madness and Moral Responsibility," Luhrmann states that the different psychiatric approaches to agency have "profound consequences for the way we feel compassion for the person we need to help." The empathy stemming from the biomedical model is "simple empathy," whereas the psychodynamic model, by assuming intentionality in illness, leads to "complex empathy," "empathizing with the patient’s self-destructiveness as well as with his despair." The psychiatrist’s choice between these two views of patients is for Luhrmann a moral decision in itself. At the very end of her book this is stated in stark terms: a choice between understanding patients "only as the detritus of a broken brain" or as "engaged in the struggle to be decent, responsible people." If we choose the former, "the loss of our souls is a high price to pay." In other words, the biologically minded psychiatrist falls into this great moral loophole, even when treating patients humanely, if he or she "constructs" the patient as an incapacitated victim of illness.