Online research in philosophy

Effective treatment of personality disorder (PD) presents a clinical conundrum. Many of the behaviours constitutive of PD cause harm to self and others. Encouraging service users to take responsibility for this behaviour is central to treatment. Blame, in contrast, is detrimental. How is it possible to hold service users responsible for harm to self and others without blaming them? A solution to this problem is part conceptual, part practical. I offer a conceptual framework that clearly distinguishes between ideas of responsibility, (...) blameworthiness, and blame. Within this framework, I distinguish two sorts of blame, which I call ‘detached’ and ‘affective’. Affective, not detached, blame is detrimental to effective treatment. I suggest that the practical demand to avoid affective blame is largely achieved through attention to PD service users’ past history. Past history does not eliminate responsibility and blameworthiness. Instead, it directly evokes compassion and empathy, which compete with affective blame. (shrink)

My first experience as a clinician was in a Therapeutic Community for service users with personality disorder. As well as having personality disorder, many of the Community members also suffered from related conditions, such as addiction and eating disorders. Broadly speaking, these conditions are what we might call ‘disorders of agency’. Core diagnostic symptoms or maintaining factors of disorders of agency are actions and omissions: patterns of behaviour central to the nature or maintenance of the condition. For instance, borderline personality (...) disorder is diagnosed in part via deliberate self-harm and attempted suicide, reckless and impulsive behaviour, substance use, violence, and outbursts of anger; addiction is diagnosed via maladaptive patterns of drug consumption; eating disorders involve eating too much or too little. If a service user is to improve let alone recover from these disorders, they must change the diagnostic or maintaining pattern of behaviour (cf. Pearce and Pickard, 2010). For instance, service users with borderline personality disorder must stop self-harming; addicts need to quit using drugs or alcohol; anorexics must eat. (shrink)

Popular and neurobiological accounts of addiction tend to treat it as a form of compulsion. This contrasts with personality disorder, where most problematic behaviours are treated as voluntary. But high levels of co-morbidity, overlapping diagnostic traits, and the effectiveness of a range of comparable clinical interventions for addiction and personality disorder suggest that this difference in treatment is unjustified. Drawing on this range of clinical interventions, we argue that addiction is not a form of compulsion. Rather, the misuse of drugs (...) and alcohol is like many of the problematic behaviours associated with personality disorder: it is typically a way of coping with psychological distress. We suggest that a satisfying explanation of why many addicts struggle to control their use can be given without departing from concepts employed in our basic folk psychological understanding of agency. In particular, we appeal to five rough-and-ready folk psychological factors to explain addiction: (i) strength of desire and habit; (ii) willpower; (iii) motivation; (iv) functional role; and (v) decision and resolve. (shrink)

When philosophers want an example of a person who lacks the ability to do otherwise, they turn to psychopathology. Addicts, agoraphobics, kleptomaniacs, neurotics, obsessives, and even psychopathic serial murderers, are all purportedly subject to irresistible desires that compel the person to act: no alternative possibility is supposed to exist. I argue that this conception of psychopathology is false and offer an empirically and clinically informed understanding of disorders of agency which preserves the ability to do otherwise. First, I appeal to (...) standard clinical treatment for disorders of agency and argue that it undermines this conception of psychopathology. Second, I offer a detailed discussion of addiction, where our knowledge of the neurobiological mechanisms underpinning the disorder is relatively advanced. I argue that neurobiology notwithstanding, addiction is not a form of compulsion and I explain how addiction can impair behavioural control without extinguishing it. Third, I step back from addiction, and briefly sketch what the philosophical landscape more generally looks like without psychopathological compulsion: we lose our standard purported real-world example of psychologically determined action. I conclude by reflecting on the centrality of choice and free will to our concept of action, and their potency within clinical treatment for disorders of agency. (shrink)

I argue that addiction is not a chronic, relapsing, neurobiological disease characterized by compulsive use of drugs or alcohol. Large-scale national survey data demonstrate that rates of substance dependence peak in adolescence and early adulthood and then decline steeply; addicts tend to “mature out” in their late twenties or early thirties. The exceptions are addicts who suffer from additional psychiatric disorders. I hypothesize that this difference in patterns of use and relapse between the general and psychiatric populations can be explained (...) by the purpose served by drugs and alcohol for patients. Drugs and alcohol alleviate the severe psychological distress typically experienced by patients with comorbid psychiatric disorders and associated problems. On this hypothesis, consumption is a chosen means to ends that are rational to desire: Use is not compulsive. The upshot of this explanation is that the orthodox view of addiction as a chronic, relapsing neurobiological disease is misguided. I delineate five folk psychological factors that together explain addiction as purposive action: strong and habitual desire; willpower; motivation; functional role; and decision and resolve. I conclude by drawing lessons for research and effective treatment. (shrink)

Stigma and prejudice have long affected the science and treatment of personality disorder (PD). It is widely recognized that PD is associated with social exclusion, unemployment, homelessness, and crime, together with addiction, eating disorders, anxiety, depression, and psychoses (National Institute of Mental Health in England 2003). The financial burden placed on psychiatric, medical, social, legal, and forensic services is high. The practical and emotional burden placed on family and friends of those with PD, as well as the clinicians who seek (...) to treat them, is equally real. PD is also associated with deliberate self-harm, suicide, mortality, violence, chaotic lifestyles, emotional instability, and severe and .. (shrink)

The DSM-IV-TR (American Psychiatric Association 1994, 689) defines personality disorder (PD) as: An enduring pattern of experience and behavior that deviates markedly from the expectations of an individual’s culture. This pattern is manifested in two (or more) of the following areas: 1 Cognition (i.e., ways of perceiving and interpreting self, other people, and events); 2 Affectivity (i.e., the range, intensity, lability, and appropriateness of emotional response); 3 Interpersonal functioning; and 4 Impulse control. B The enduring ..

Philosophy of psychiatry is on the rise. The last decade has seen an explosion in philosophical interest in psychiatric disorder, supported by flourishing research in adjacent disciplines, particularly clinical and cognitive psychology, neuroscience, and, of course, psychiatry itself. The publication of the first edition of The Mind and its Discon- tents in 1999 helped spark this explosion. The publication of this second edition is a welcome addition to OUP’s blossoming International Perspectives in Philosophy and Psychiatry Series.

Extant philosophical accounts of schizophrenic alien thought neglect three clinically signifi cant features of the phenomenon. First, not only thoughts, but also impulses and feelings, are experienced as alien. Second, only a select array of thoughts, impulses, and feelings are experienced as alien. Th ird, empathy with experiences of alienation is possible. I provide an account of disownership that does justice to these features by drawing on recent work on delusions and selfknowledge. Th e key idea is that disownership occurs (...) when there is a failure of rational control over one’s mind. Th is produces a clash between the deliverances of introspection and practical enquiry as ways of knowing one’s mind. Th is explanation places disownership on a continuum with more common aspects of our psychological life, such as addiction, akrasia, obsessional thinking, and immoral, selfi sh or shameful thoughts. I conclude by addressing objections, and exploring the relevance of my account to questions in the philosophy of psychiatry concerning the validity of our current taxonomy of symptoms, and the nature of psychiatric classifi cation.. (shrink)

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This chapter offers a novel defence of Szasz’s claim that mental illness is a myth by bringing to bear a standard type of thought experiment used in philosophical discussions of the meaning of natural kind concepts. This makes it possible to accept Szasz’s conclusion that mental illness involves problems of living, some of which may be moral in nature, while bypassing the debate about the meaning of the concept of illness. The chapter then considers the nature of schizophrenia and the (...) personality disorders (PDs) within this framework. It argues that neither is likely to constitute a scientifically valid category, but that nonetheless their symptoms can be scientifically explained. It concludes with a discussion of the way in which Cluster B or ‘bad’ PDs involve failures of virtue or character, and argues that this does not preclude them from being appropriately treated within contemporary, multidisciplinary, mental health services. (shrink)

This paper argues that perception of one's body ‘from the inside’ provides one with an awareness of acting, and that this awareness explains a previously overlooked feature of one's knowledge of one's own actions. Actions are events: they occur during periods of time. Knowledge of such events must be sensitive to their course through time. Perception of one's body ‘from the inside’ allows one to monitor one's actions as they unfold, thereby sustaining one's knowledge of what one is doing over (...) the period of time in which one is doing it. (shrink)

Can consideration of the emotions help to solve the problem of other minds? Intuitively, it should. We often think of emotions as public: as observable in the body, face, and voice of others. Perhaps you can simply see another's disgust or anger, say, in her demeanour and expression; or hear the sadness clearly in his voice. Publicity of..