This is a pre-copyedited, author-produced version of an article accepted for publication in the Journal of Applied Philosophy, following peer review. Please do not cite this version. Clean Hands? Philosophical Lessons from Scrupulosity Jesse S. Summers and Walter Sinnott-Armstrong, 2019 New York: Oxford University Press, xii 202pp, $74 (hb) Reviewed by Pei-hua Huang Jesse Summers and Walter Sinnott-Armstrong's Clean Hands: Philosophical Lessons from Scrupulosity is an intriguing and informative work. The subject matter covered in this monograph is a special type of obsessive-compulsive disorder named Scrupulosity. It is a philosophically interesting psychiatric condition because it is widely characterised by an obsession with morally and religiously relevant affairs. Like other forms of OCD, Scrupulosity also involves pathological obsessions and difficulties in controlling one's thoughts and behaviours. Yet, the content of Scrupulosity brings distinctive moral and philosophical issues which are not necessarily shared with other forms of OCD. When it comes to having an OCD about hand-washing, for instance, we would not feel puzzled about whether the compulsive behaviour is a virtuous action. Yet, we would, when it comes to Scrupulosity - if a person with Scrupulosity spends unusually long hours on checking the receipts of their customers every day to ensure that they didn't accidentally overcharge them, should we view their 'dedication' as a virtuous action, or should we view it as a pathological behaviour which might require psychiatric treatments? It is also unclear that whether it is people with Scrupulosity who need treatment to lower down their atypically high standards, or, that it is we, people without Scrupulosity, who need a strong dose of moral enhancement. In this carefully organised monograph, Summers and Sinnott-Armstrong argue that Scrupulosity is better characterised as a psychiatric condition rather than as moral sainthood. To persuade their readers that Scrupulosity is indeed a psychiatric condition which sometimes might warrant treatment, Summers and SinnottArmstrong offer a very comprehensive introduction to Scrupulosity in the first four chapters, equipping their readers with the necessary knowledge of Scrupulosity to examine the philosophical implications brought about by Scrupulosity. Chapter 1 introduces 14 cases of Scrupulosity to help readers get a sense about what it is like to have Scrupulosity. Chapter 2 delineates the general features of OCD and This is a pre-copyedited, author-produced version of an article accepted for publication in the Journal of Applied Philosophy, following peer review. Please do not cite this version. Chapter 3 explains why Scrupulosity is now understood as a special type of OCD by most psychiatrists and the famous DSM-5. After establishing the link between OCD and Scrupulosity, Summers and Sinnott-Armstrong shift their attention to mental illness in Chapter 4. They argue that while currently many mental illnesses' physical markers remain unknown and the diagnosis of mental illnesses requires the doctors to make certain value-judgements, these concerns nonetheless are not significant enough for one to conclude that mental illness is merely a myth. Chapter 5 addresses questions regarding whether or not people with Scrupulosity are virtuous. Concerning these questions, Summers and Sinnott-Armstrong give a negative answer. Briefly, to qualify as a moral exemplar, one must be able to attend to different moral affairs swiftly based on a couple of moral considerations. For instance, how likely potential harm might be caused by a particular action, and adjust one's moral decisions regarding which action one should take based on this sort of moral calculation. Yet, people with Scrupulosity generally only focus on a narrow scope of morally relevant affairs and often experience difficulties in shifting their attention from the matters they are obsessed with to issues that are more important. The fixation and inflexibility not only distance people with Scrupulosity from moral sainthood but also further indicate that their obsessions result mainly from the desire to soothe their anxiety instead of genuine concerns for morality. Summers and Sinnott-Armstrong therefore conclude that Scrupulosity is not a desirable moral character or virtue but a mental illness. Chapter 6 supports Summers and Sinnott-Armstrong's view from the angle of moral judgement. They point out that compared with moral judgements made by people without Scrupulosity, those made by people with Scrupulosity tend to involve unrealistic high standards of oneself, a conflation of the moral status of thought and action, and/or a conflation of moral ideals and minimal moral requirements. These distinctive features, again, seem to result from their high levels of anxiety. Should it be the case, Summers and Sinnott-Armstrong suggest, it might be better to name these peculiar 'moral judgements' as 'Scrupulous judgements' because the real content of their judgements might not be about morality but again about matters that can soothe their anxiety. This is a pre-copyedited, author-produced version of an article accepted for publication in the Journal of Applied Philosophy, following peer review. Please do not cite this version. Chapter 7 tries to answer whether and when people with Scrupulosity are responsible for the harms they cause to others due to their Scrupulous traits, by testing Scrupulosity against a great variety of theories of responsibility. Since each of the theories differs greatly in its conceptualisation, the answer varies. For instance, under Shoemaker's account of attributability-responsibility, certain cases of Scrupulosity can be held responsible. Yet, if the framework we use to probe this question focuses on reasons-responsiveness, then people with Scrupulosity might be excused because their anxiety might have made them incapable of responding to a wide range of reasons. Chapter 8 focuses on ethical concerns about and justifications for treating Scrupulosity. The moral element in Scrupulosity makes it tricky to distinguish treatment from indoctrination, especially when the person with Scrupulosity objects the treatment and is willing to view their distress or anxiety as a necessary expense for the 'good cause'. Acknowledging concerns like this, Summers and Sinnott-Armstrong thus focus on the arbitrariness and internal incoherence of the patient's beliefs or standards when developing their justification for treatment for Scrupulosity. For instance, when a patient conflates moral ideals and moral requirements and suffers greatly from constant anxiety of failing what they are 'morally required' to do, a therapist may justify the intervention by helping the patient see how they mistake their ideals for requirements without resorting to the therapist's own moral standards or views. I share Summers and Sinnott-Armstrong's commitment to autonomy, yet I hesitate to accept their view that treatment for Scrupulosity is better justified by appealing to the internal incoherence and arbitrariness of the patient's beliefs or standards My concern is twofold. First, justifying treatment for Scrupulosity in this way still requires the therapist to make a certain form of value judgement independent of the patient's beliefs. Second, what truly grounds Summers and Sinnott-Armstrong's view seems to be considerations about pathological anxiety. Briefly, many of us have conflicting moral beliefs. Yet most of us would not think trying to 'treat' people holding conflicting moral beliefs is justifiable, which indicates that when determining the appropriateness of treating people with arbitrary and incoherent beliefs, a therapist still needs to make This is a pre-copyedited, author-produced version of an article accepted for publication in the Journal of Applied Philosophy, following peer review. Please do not cite this version. decisions based on considerations external to the patient's beliefs. In fact, when building up their argument of internal incoherence, Summers and Sinnott-Armstrong do mention more than one time that these rules and standards set by people with Scrupulosity are so arbitrary partly because these rules and standards result primarily from their need for soothing anxiety. This seems to agree with my observation that arbitrariness and internal coherence alone cannot offer sufficient justificatory power for treating Scrupulosity over objection. I enjoyed reading this book very much and found it highly informative. The philosophical investigation Summers and Sinnott-Armstrong carry out here also demonstrates there is a need to dedicate more research into developing 'moral psychiatry' as a field independent of moral psychology and philosophy of psychiatry. Each chapter is more or less self-contained, so readers can freely decide which chapter they'd like to go to first without having any trouble grasping the essence of the arguments.