“A Liberal Account of Addiction‘ is a major contribution to the discussion of addiction, its treatment, and the social and policy issues which arise from it. Questioning as it does many generally accepted assumptions about addictive behavior, particularly the use of hard drugs, it will provoke even those who do not agree with it to rethink their positions. Many of its suggestions are relevant also, in my opinion, to thinking about other areas of psychiatric interest. Nevertheless, I want to argue (...) that its authors have perhaps not freed themselves sufficiently from some common assumptions, in particular about the nature of mental disorder, and that their argument might benefit from such liberation. The central assumption that I have in mind is that understanding human actions is nothing but understanding the brain activity that accompanies them. If so, then a pattern of behavior can count as a ’mental disorder’ in any clinically or legally relevant sense only if it is the result of a brain disease, causing a breakdown in normal brain functioning. Starting from this assumption, the authors seek to show, by means of evidence from neuroscience, that addiction to drugs does not have a unique ’neural substrate,’ distinct from that of any other kind of pleasure-seeking behavior. When we have a pleasurable experience of any kind, as they point out, dopamine is normally released within the brain. This, they say, activates the ’reward’ pathways, making the person more likely to repeat the behavior that gives rise to the pleasurable experience in questionÑwhether it is eating, sex, or injecting heroin. Addiction, they argue, is therefore just a tendency to repeat an intensely pleasurable experience, whatever the nature of that experience might be. The particular chemistry of the substance involved in this particular form of pleasure is, they argue, irrelevantÑall that matters is that the experience it gives someone is pleasant. Addiction, they. (shrink)
How should we deal with mental disorder - as an "illness" like diabetes or bronchitis, as a "problem in living", or what? This book seeks to answer such questions by going to their roots, in philosophical questions about the nature of the human mind, the ways in which it can be understood, and about the nature and aims of scientific medicine. The controversy over the nature of mental disorder and the appropriateness of the "medical model" is not just an abstract (...) theoretical debate: it has a bearing on very practical issues of appropriate treatment, as well as on psychiatric ethics and law. A major contention of this book is that these questions are ultimately philosophical in character: they can be resolved only if we abandon some widespread philosophical assumptions about the "mind" and the "body", and about what it means for medicine to be "scientific". The "phenomenological" approach of the twentieth-century French philosopher, Maurice Merleau-Ponty is used to question these assumptions. His conception of human beings as "body-subjects" is argued to provide a more illuminating way of thinking about mental disorder and the ways in which it can be understood and treated. The conditions we conventionally call "mental disorders" are, it is argued, not a homogeneous group: the standard interpretation of the medical model fits some more readily than others. The core mental disorders, however, are best regarded as disturbed ways of being in the world, which cause unhappiness because of deviation from "human" rather than straightforwardly "biological" norms. That is, they are problems in how we experience the world and especially other people, rather than in physiological functioning - even though the nature of our experience cannot ultimately be separated from the ways in which our bodies function. This analysis is applied within the book both to issues in clinical treatment and to the special ethical and legal questions of psychiatry. Written by a well known philosopher in an accessible and clear style, this book should be of interest to a wide range of readers, from psychiatrists to social workers, lawyers, ethicists, philosophers and anyone with an interest in mental health. (shrink)
This paper aims to provide an argument for saying that a publicly funded health care system, available to all free at the point of delivery, is morally superior to a market system, and to provide a framework for deciding questions about which forms of health care should be included in such a public system. The argument presents health care as a âheadâ, in the sense of something to which human beings are morally entitled as a necessary condition for a life (...) worthy of human dignity. Alternative arguments for similar conclusions, proposed by Daniels and Buchanan, are critically examined and rejected. (shrink)
Philosophy plays an integral role in French society, affecting its art, drama, politics, and culture. In this accessible, chronological survey, Matthews offers some explanations for the enduring popularity of the subject and traces the developments that French philosophy has taken in the twentieth century, from its roots in the thought of Descartes to key figures such as Bergson, Sartre, Marcel, Merleau-Ponty, Foucault, Derrida, and the recent French Feminists.
