An important philosophical issue in the study of addiction is what difference the fact that a person is addicted makes to attributions of autonomy (and responsibility) to their drug-oriented behavior. In spite of accumulating evidence suggesting the role of emotional dysregulation in understanding addiction, it has received surprisingly little attention in the debate about this issue. I claim that, as a result, an important aspect of the autonomy impairment of many addicted individuals has been largely overlooked. A widely shared assumption (...) in the philosophical literature is that for addiction to impair a person’s autonomy it has to make them (in some sense) take drugs against their will. So-called “willing addicts” are therefore usually seen as exempted from the autonomy impairment believed to characterize “unwilling addicts”, the latter being those who ‘truly want’ to stop using drugs but find their attempts repeatedly derailed by failures of self-control. In this article, I argue that the association between addiction and emotional dysregulation shows why this assumption is false. Emotional dysregulation is not only consistent with the possibility that many addicts take drugs ‘willingly’, it supports the hypothesis that they use drugs because they truly want to. The article proposes an explanation for why emotional dysregulation should nevertheless be seen as an aspect of their loss of control and an important reason why they have impaired autonomy. I end by exploring some implications of this account for addict’s decision-making capacity when they are prescribed the drugs to which they are addicted. -/- . (shrink)

Addiction is standardly characterized as a neurobiological disease of compulsion. Against this characterization, I argue that many cases of addiction cannot be explained without recognizing the value of drugs to those who are addicted; and I explore in detail an insufficiently recognized source of value, namely, a sense of self and social identity as an addict. For people who lack a genuine alternative sense of self and social identity, recovery represents an existential threat. Given that an addict identification carries expectations (...) of continued consumption despite negative consequences, there is therefore a parsimonious explanation of why people who identify as addicts continue to use drugs despite these consequences: they self‐identify as addicts and that is what addicts are supposed to do. I conclude by considering how it is nonetheless possible to overcome addiction despite this identity, in part by imagining and enacting a new one. Importantly, this possibility requires the availability of social support and material resources that are all too frequently absent in the lives of those who struggle with addiction. (shrink)

There is a debate about the nature of addiction, whether it is a result of brain damage, brain dysfunction, or normal brain changes that result from habit acquisition, and about whether it is a disease. I argue that the debate about whether addiction is a disease is much ado about nothing, since all parties agree it is “unquestionably destructive.” Furthermore, the term ‘addiction’ has disappeared from recent DSM’s in favor of a spectrum of ‘abuse’ disorders. This may be a good (...) thing indicating more nuance in typing the heterogeneous phenomena we used to call ‘addiction’. (shrink)

Various traditions in mental health care, such as phenomenological, and existential and cognitive-behavioral psychotherapy, implicitly or explicitly acknowledge that a disruption of the self, or the person, or the agent is among the common denominators of different mental disorders. They often emphasize the importance of understanding patients as reasonsresponsive, in their full mental health relevant complexity, if their mental disorder is to be treated successfully. The centrality of the concept of the self is not mirrored in the mainstream scientific approaches (...) in psychiatry however; the self has rarely been considered as the object of scientific research, the empirical investigation of which might yield successful explanations of and interventions in mental disorders. Thus, even though self-related phenomena are clinically relevant in so far as they give important information about a mental disorder to the clinician and help the development of effective interventions, they are not considered among the scientifically relevant properties of mental disorders. Leaving the self-related phenomena out of the scientific research on mental disorders can be attributed to the presupposition that the self is not empirically tractable and its use will hinder psychiatry’s goal to be scientific. In this paper, taking issue with this, I argue the self is empirically tractable, and its use as a target of research will not hinder psychiatry’s scientific commitments. (shrink)

The question “What is the relationship between the self and mental disorder?” is especially important for mental health professionals interested in understanding and treating patients, as most mental disorders are intimately tied to self‐related concerns, such as loss of self‐esteem and self‐control, or diminished agency and autonomy. Philosophy, along with the cognitive and behavioral sciences, offers a wealth of conceptual and empirical resources to answer this question, as the concepts of the self and psychopathology have occupied a central place in (...) these fields since their inception. Interestingly, and unfortunately, however, scientific psychiatry, in its approach to mental disorder as primarily a cluster of signs and symptoms has been slow in acknowledging the advances in conceptualizing and investigating mental disorders in relation to the self. The article addresses this problem and offers solutions for better cross‐fertilization between empirical and philosophical inquiry into the self and psychiatric research on mental disorders. The first part evaluates what empirically informed philosophical inquiry and philosophically informed empirical inquiry offer to the examination of the relationship between the self and mental disorders. The second part argues that scientific psychiatry has missed opportunities to find effective treatments for mental disorders because of its insularity from debates in naturalistic philosophy and cognitive and behavioral sciences. Psychiatry has much to gain from the conceptual, scientific, and clinical resourcefulness of philosophy's collaboration with the cognitive and behavioral sciences. (shrink)

In this paper, I examine Reinforcement Learning modelling practice in psychiatry, in the context of alcohol use disorders. I argue that the epistemic roles RL currently plays in the development of psychiatric classification and search for explanations of clinically relevant phenomena are best appreciated in terms of Chang’s account of epistemic iteration, and by distinguishing mechanistic and aetiological modes of computational explanation.