The present work presents a critical discussion on the notion of individual autonomy as a spring to think about the situation of justice and the quality of life of those who suffer what is now known as severe mental disabilities. It assumes that issues such as social participation, human rights and citizenship of this social group, historically marginalized and excluded, can not be seriously thought without discussing the hegemonic social representation that visualizes madness or mental illness as the absence of individual autonomy. This situation is observed both at the level of the principles on which our social institutions and public policies are based, and in the daily life of the actors themselves. It is necessary, therefore, to think of new ways to understand the problem of individual autonomy that are inclusive for the case of the mentally impaired or the mentally handicapped. This is necessary, at least for those who believe that categories as an individual or citizen should also include those who belong to this minority. But also because it is necessary to denaturalize a liberal conception of individual autonomy that visualizes it as a functional capacity of self-interested rational individuals and not as a relational capacity, which can never be lost due to illness or disability. The approach to relational autonomy is finally proposed as an approach to inclusive individual autonomy with conditions such as mental disability, but which immediately obliges us to address the question of the relationship with others, probably the essence of the problem of madness, after all.