People suffering from Obsessive-Compulsive Disorder (OCD) do things they do not want to do, and/or they think things they do not want to think. In about 10 percent of OCD patients, none of the available treatment options is effective. A small group of these patients is currently being treated with deep brain stimulation (DBS). Deep brain stimulation involves the implantation of electrodes in the brain. These electrodes give a continuous electrical pulse to the brain area in which they are implanted. (...) It turns out that patients may experience profound changes as a result of DBS treatment. It is not just the symptoms that change; patients rather seem to experience a different way of being in the world. These global effects are insufficiently captured by traditional psychiatric scales, which mainly consist of behavioural measures of the severity of the symptoms. In this article we aim to capture the changes in the patients’ phenomenology and make sense of the broad range of changes they report. For that we introduce an enactive, affordance-based model that fleshes out the dynamic interactions between person and world in four aspects. The first aspect is the patients’ experience of the world. We propose to specify the patients’ world in terms of a field of affordances, with the three dimensions of broadness of scope (‘width’ of the field), temporal horizon (‘depth’), and relevance of the perceived affordances (‘height’). The second aspect is the person-side of the interaction, that is, the patients’ self-experience, notably their moods and feelings. Thirdly, we point to the different characteristics of the way in which patients relate to the world. And lastly, the existential stance refers to the stance that patients take towards the changes they experience: the second-order evaluative relation to their interactions and themselves. With our model we intend to specify the notion of being in the world in order to do justice to the phenomenological effects of DBS treatment. (shrink)

Deep Brain Stimulation (DBS) is a relatively new, experimental treatment for patients suffering from treatment-refractory Obsessive Compulsive Disorder (OCD). The effects of treatment are typically assessed with psychopathological scales that measure the amount of symptoms. However, clinical experience indicates that the effects of DBS are not limited to symptoms only: patients for instance report changes in perception, feeling stronger and more confident, and doing things unreflectively. Our aim is to get a better overview of the whole variety of changes that (...) OCD patients experience during DBS treatment. For that purpose we conducted in-depth, semi-structured interviews with 18 OCD patients. In this paper, we present the results from this qualitative study.We list the changes grouped in four domains: with regard to (a) person, (b) (social) world, (c)characteristics of person-world interactions, and (d) existential stance. We subsequently provide an interpretation of these results. In particular, we suggest that many of these changes can be seen as different expressions of the same process; namely that the experience of anxiety and tension gives way to an increased basic trust and increased reliance on one’s abilities. We then discuss the clinical implications of our findings, especially with regard to properly informing patients of what they can expect from treatment, the usefulness of including CBT in treatment, and the limitations of current measures of treatment success. We end by making several concrete suggestions for further research. (shrink)

I argue that culpable ignorance can be irreducibly collective. In some cases, it is not fair to expect any individual to have avoided her ignorance of some fact, but it is fair to expect the agents together to have avoided their ignorance of that fact. Hence, no agent is individually culpable for her ignorance, but they are culpable for their ignorance together. This provides us with good reason to think that any group that is culpably ignorant in this irreducibly collective (...) sense is non-distributively collectively responsible for subsequent unwitting acts and consequences. (shrink)

Does DBS change a patient’s personality? This is one of the central questions in the debate on the ethics of treatment with Deep Brain Stimulation (DBS). At the moment, however, this important debate is hampered by the fact that there is relatively little data available concerning what patients actually experience following DBS treatment. There are a few qualitative studies with patients with Parkinson’s disease and Primary Dystonia and some case reports, but there has been no qualitative study yet with patients (...) suffering from psychiatric disorders. In this paper, we present the experiences of 18 patients with Obsessive-Compulsive Disorder (OCD) who are undergoing treatment with DBS. We will also discuss the inherent difficulties of how to define and assess changes in personality, in particular for patients with psychiatric disorders. We end with a discussion of the data and how these shed new light on the conceptual debate about how to define personality. (shrink)

This paper investigates agents’ blameworthiness when they are part of a group that does harm. We analyse three factors that affect the scope of an agent’s blameworthiness in these cases: shared intentionality, interpersonal influence, and common knowledge. Each factor involves circumstantial luck. The more each factor is present, the greater is the scope of each agent’s vicarious blameworthiness for the other agents’ contributions to the harm. We then consider an agent’s degree of blameworthiness, as distinct from her scope of blameworthiness. (...) We suggest that an agent mostly controls her degree of blameworthiness—but even here, luck constrains what possible degrees of blameworthiness are open to her. (shrink)

According to some collectivists, purposive groups that lack decision-making procedures such as riot mobs, friends walking together, or the pro-life lobby can be morally responsible and have moral duties. I focus on plural subject- and we-mode-collectivism. I argue that purposive groups do not qualify as duty-bearers even if they qualify as agents on either view. To qualify as a duty-bearer, an agent must be morally competent. I develop the Update Argument. An agent is morally competent only if the agent has (...) sufficient positive and negative control over updating their goal-seeking states. Positive control involves the general ability to update one’s goal-seeking states, whereas negative control involves the absence of other agents with the capacity to arbitrarily interfere with updating one’s goal-seeking states. I argue that even if purposive groups qualify as plural subjects or we-mode group agents, these groups necessarily lack negative control over updating their goal-seeking states. This creates a cut-off point for groups as duty-bearers: Organized groups may qualify as duty-bearers, whereas purposive groups cannot qualify as duty-bearers. (shrink)

We propose to understand social affordances in the broader context of responsiveness to a field of relevant affordances in general. This perspective clarifies our everyday ability to unreflectively switch between social and other affordances. Moreover, based on our experience with Deep Brain Stimulation for treating obsessive-compulsive disorder (OCD) patients, we suggest that psychiatric disorders may affect skilled intentionality, including responsiveness to social affordances.

According to the traditional Western concept of freedom, the ability to exercise free will depends on the availability of options and the possibility to consciously decide which one to choose. Since neuroscientific research increasingly shows the limits of what we in fact consciously control, it seems that our belief in free will and hence in personal autonomy is in trouble. -/- A closer look at the phenomenology of Obsessive-Compulsive Disorder (OCD) gives us reason to doubt the traditional concept of freedom (...) in terms of conscious control. Patients suffering from OCD experience themselves as unfree. The question is whether their lack of freedom is due to a lack of will power. Do they have too little conscious control over their thoughts and actions? Or could it be the opposite: are they exerting too much conscious control over their thoughts and actions? -/- In this chapter, we will argue that OCD patients testify to the general condition that exercising an increased conscious control over actions can in fact diminish the sense of agency rather than increase the experience of freedom. The experiences of these patients show that the traditional conception of freedom in terms of ‘free will’ has major shortcomings. There is an alternative, however, to be found in the work of Hannah Arendt. She advocates a conception of freedom as freedom in action. Combined with phenomenological insights on action, Arendt’s account of freedom helps us to get a more adequate understanding of the role of deliberation in the experience of freedom. We argue that the experience of freedom depends on the right balance between deliberate control and unreflective actions. (shrink)

In this chapter we give an overview of current and historical conceptions of the nature of obsessions and compulsions. We discuss some open questions pertaining to the primacy of the affective, volitional or affective nature of obsessive-compulsive disorder (OCD). Furthermore, we add some phenomenological suggestions of our own. In particular, we point to the patients’ need for absolute certainty and the lack of trust underlying this need. Building on insights from Wittgenstein, we argue that the kind of certainty the patients (...) strive for is unattainable in principle via the acquisition of factual knowledge. Moreover, we suggest that the patients’ attempts to attain certainty are counter-productive as their excessive conscious control in fact undermines the trust they need. (shrink)

Although the enactive approach has been very successful in explaining many basic social interactions in terms of embodied practices, there is still much work to be done when it comes to higher forms of social cognition. In this article, we discuss and evaluate two recent proposals by Shaun Gallagher and Daniel Hutto that try to bridge this ‘cognitive gap’ by appealing to the notion of narrative practice. Although we are enthusiastic about these proposals, we argue that (i) it is difficult (...) to see them as continuous with the enactivist notion of direct coupling, and (ii) the failure to account for folk psychological action interpretation suggests that the enactive approach should adopt a broader notion of coupling. (shrink)

In this paper, we focus on the moral responsibility of organized groups in light of historicism. Historicism is the view that any morally responsible agent must satisfy certain historical conditions, such as not having been manipulated. We set out four examples involving morally responsible organized groups that pose problems for existing accounts of historicism. We then pose a trilemma: one can reject group responsibility, reject historicism, or revise historicism. We pursue the third option. We formulate a Manipulation Condition and a (...) Guarding Condition as addendums to historicism that are necessary to accommodate our cases of group responsibility. (shrink)

Many philosophers accept the idea that there are duties to promote or create just institutions. But are the addressees of such duties supposed to be individuals – the members of the citizenry? What does it mean for an individual to promote or create just institutions? According to the ‘Simple View’, the citizenry has a collective duty to create or promote just institutions, and each individual citizen has an individual duty to do their part in this collective project. The simple view (...) appears to work well with regard to – you guessed it – ‘simple’ scenarios but it is riddled with further questions and problems. In this chapter, we raise five problems for the Simple View: (a) We suggest that one cannot develop a view concerning the citizenry’s duty to promote just institutions in isolation from a conception of the ontological relationship between the state and its citizens; (b) We argue that it is not obvious that the citizenry is the right entity to be attributed duties in the first place; (c) We show that a plausible account of collective duties to promote just institutions must not remain silent on the complexities and difficulties amorphous, unorganized group face in vis-à-vis collective action; (d) We contend that without allocation principles for contributory duties amongst the citizenry, or – alternatively – a method for practical deliberation that is action-guiding in collective action contexts, the claim that the citizens have a collective duty to promote just institutions remains moot; and, finally, (e) We demonstrate that the problem of reasonable disagreement is a serious threat to a collective duty to promote or create just institutions – it potentially undermines such a duty altogether and allows for conflicting contributory duties amongst the citizenry. We hope that our discussion will ultimately help improve existing theories and conceptual frameworks with a view to better understanding citizens’ obligations to promote justice under non-ideal conditions. (shrink)

In this essay I explore the resources Thomas Aquinas provides for enquiries concerning the psychological abilities of nonhuman animals. I first look to Aquinas’s account of divine, angelic, human, and nonhuman animal naming, to help us articulate the contours of a ‘critical anthropocentrism’ that aims to steer clear of the mistakes of a na¨ıve anthropocentrism and misconceived avowals to entirely eschew anthropocentrism. I then address the need for our critical anthropocentrism both to reject the mental-physical dichotomy endorsed by ‘folk psychology’ (...) and to articulate a more adequate ‘commonsense psychology’ that acknowledges most embodied animal behavior is observable psychological behavior. Next, I argue that we can develop Aquinas’s doctrine of estimation and conation to formulate an account of nonhuman animal action that more adequately characterizes the purposeful behaviors of nonhuman animals. To do so, we first need to recognize a wider range of nonhuman animal behaviors that are captured by Aquinas’s ‘estimative sense’, and that all of these behaviors are specified by a finite variety of particular goods confined to the animals’ environmental niches. But we also need to supplement Aquinas’s account of human and nonhuman animal agency by exploring the ontogeny and ecology of how humans and other animals become attuned to affordances within these different environmental niches. I argue that we should look to Aquinas’s account of nonhuman animal capacities in ST I-II 6-17 for subtle insights that can expand our understanding of how nonhuman animals engage in purposeful behavior by exercising analogous nonrational and imperfectly voluntary forms of intention, deliberation, choice, execution, and enjoyment. I conclude with an outline for how future enquiry can seek to explain the nonrational purposeful problem-solving competencies of chimps, canines, corvids, cetaceans, cephalopods, and other nonhuman animal species. (shrink)

This article, the second of a two-part essay, outlines a solution to certain tensions in Thomist philosophical anthropology concerning the interaction of the human person’s immaterial intellectual or noetic operations with the psychosomatic sensory operations that are constituted from the formal organization of the nervous system. Continuing with where the first part left off, I argue that Thomists should not be tempted by strong emergentist accounts of mental operations that act directly on the brain, but should maintain, with Aquinas, that (...) noetic operations directly interact with psychosomatic operations. I develop a Thomist account of noetic–psychosomatic interactions that expands upon the first part’s rapprochement between the new mechanist philosophy of neuroscience and psychology and hylomorphic animalism. I argue that noetic–psychosomatic interactions are best understood as analogous to the way diverse higher and lower order psychosomatic powers interact by actualizing, coordinating, and directing the operations of other psychosomatic powers. I draw on James Ross’s arguments for the immateriality of intellectual operations as realizing definite pure functions in order to elucidate the way noetic operations uniquely actualize, coordinate, and direct the psychosomatic operations they interact with. I conclude with a conjectural sketch of how this presentation of Thomist philosophical anthropology understands the noetic and psychosomatic deficits brought about by damage to the nervous system. (shrink)

This paper will argue that the order and the unity of St. Thomas Aquinas’s five ways can be elucidated through a consideration of St. Thomas’s appropriation of an Avicennian insight that he used to order and unify the wisdom of the Aristotelian and Abrahamic philosophical traditions towards the existence of God. I will begin with a central aporia from Aristotle’s Metaphysics. Aristotle says that the science of first philosophy has three different theoretical vectors: ontology, aitiology, and theology. But how can (...) all three be united into a single Aristotelian science? In his Metaphysics of the Healing, Avicenna resolved the impasse by taking the ontological vector as the subject of metaphysics. He then integrated the question of the four first causes into the penultimate stage of his demonstration for the existence of God, thereby placing aitiological and theological questions among the ultimate concerns of a unified Aristotelian metaphysics. In the five ways, St. Thomas integrated Avicenna’s Aristotelian search for the first four causes into the last four of his five ways, by showing that each of the four aitiological orders terminate in an ultimate first cause that we call God. Finally, by appending the proof from the Physics to the beginning of the five ways, St. Thomas was able to show that the ultimate aim of both natural philosophy and metaphysics is the divine first principle, which is the beginning and subject of sacra doctrina. (shrink)

Thomas Aquinas consistently defended the thesis that the separated rational soul that results from a human person’s death is not a person. Nevertheless, what has emerged in recent decades is a sophisticated disputed question between “survivalists” and “corruptionists” concerning the personhood of the separated soul that has left us with intractable disagreements wherein neither side seems able to convince the other. In our contribution to this disputed question, we present a digest of an unconsidered middle way: the separated soul is (...) an incomplete person. (shrink)

Is it necessary for all Christians – including Christians who are metaphysicians with demonstrative knowledge of God’s existence – to hold by faith that God exists? I shall approach this apparently straightforward question by investigating two opposing lines of interpretation of Thomas Aquinas’s own response to this question. I shall begin with two texts from Thomas that motivate two incompatible theses concerning Thomas’s doctrine of the harmony of faith and reason with respect to the existence of God. Next, I shall (...) clarify the salient points of disagreement between these two interpretations of faith and reason in Thomas Aquinas before examining dialectically a number of arguments in favor and against the respective theses of these two interpretations. In the final section I shall argue that the results of our dialectical inquiry reveal that the initial disagreement between the two positions is not irresolvable. Accordingly, I shall conclude by proposing two revised versions of the initial theses that emphasize the compatibility of these two interpretations of Thomas Aquinas’s doctrine of the harmony of faith and reason. (shrink)

I am tasked with addressing philosophical hazards in the neuroscientific study of religion. As a philosopher concerned with the well-being of neuroscientists studying religion, I am inclined to begin with the philosophical hazards of philosophy. I am well aware of the extraordinary difficulties of both tasks, for the hazards are many and it is easy to miss the forest for the trees or the trees for the forest. Instead of focusing on one issue in great detail, I shall hang a (...) number of warning signs around a forest of issues that identify various philosophical hazards which deserve particular caution when it comes to neuroscience and religion. Since I am aiming for breadth over depth, my brief remarks on each issue shall be synoptic, non-exhaustive, contentious and suggestive for additional consideration and reflection. To redress such deficits, I have provided references for further reading. (shrink)

We whole-heartedly agree with Mecacci and Haselager(2014) on the need to investigate the psychosocial effects of deep brain stimulation (DBS), and particularly to find out how to prevent adverse psychosocial effects. We also agree with the authors on the value of an embodied, embedded, enactive approach (EEC) to the self and the mind–brain problem. However, we do not think this value primarily lies in dissolving a so-called “maladaptation” of patients to their DBS device. In this comment, we challenge three central (...) claims of the authors on the basis of our direct experience with psychosocial effects of DBS in 45 obsessive- compulsive disorder (OCD) patients treated at the AMC in Amsterdam, The Netherlands, and our indepth qualitative interviews with 18 of them (de Haan et al. 2013). We end our comment by sketching out our perspective on the practical merits of an EEC approach to DBS. (shrink)