It is widely agreed that obsessive-compulsive disorder involves irrationality. But where in the complex of states and processes that constitutes OCD should this irrationality be located? A pervasive assumption in both the psychiatric and philosophical literature is that the seat of irrationality is located in the obsessive thoughts characteristic of OCD. Building on a puzzle about insight into OCD (Taylor 2022), we challenge this pervasive assumption, and argue instead that the irrationality of OCD is located in (...) the emotions that are characteristic of OCD, such as anxiety or fear. In particular, we propose to understand the irrationality of OCD as a matter of harboring recalcitrant emotions. We argue that this account not only solves the puzzle about insight, but also makes better sense of how OCD sufferers experience and describe their condition and helps explain some otherwise puzzling features of compulsive behavior. (shrink)

In this article we examine obsessive compulsive disorder (OCD). We examine and reject two existing models of this disorder: the Dysfunctional Belief Model and the Inference‐Based Approach. Instead, we propose that the main distinctive characteristic of OCD is a hyperactive sub‐personal signal of being in error, experienced by the individual as uncertainty about his or her intentional actions (including mental actions). This signalling interacts with the anxiety sensitivities of the individual to trigger conscious checking processes, including (...) speculations about possible harms. We examine the implications of this model for the individual's capacity to control his or her thoughts. (shrink)

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)

How does doubt come about? What are the mechanisms responsible for our inclinations to reassess propositions and collect further evidence to support or reject them? In this paper, I approach this question by focusing on what might be considered a distorting mirror of unreasonable doubt, namely the pathological doubt of patients with obsessive–compulsive disorder (OCD). Individuals with OCD exhibit a form of persistent doubting, indecisiveness, and over-cautiousness at pathological levels (Rasmussen and Eisen in Psychiatr Clin 15(4):743–758, 1992; (...) Reed in Obsessional experience and compulsive behaviour: a cognitive-structural approach, Academic Press, Cambridge, 1985; Tolin et al. in Cogn Ther Res 27(6):657–669, 2003). I argue that the failure in OCD is of an affective nature, involving both excessive epistemic anxiety and hyperactive feelings of uncertainty. I further argue that our adaptive disposition to inquire about the right matters—that is, about propositions which are both epistemically risky and imply harmful possibilities—might depend on these affective mechanisms. (shrink)

Emotions might contribute to our being rational cognitive agents. Anxiety – and more specifically epistemic anxiety – provides an especially interesting case study into the role of emotion for adaptive cognition. In this paper, I aim at clarifying the epistemic contribution of anxiety, and the role that ill-calibrated anxiety might play in maladaptive epistemic activities which can be observed in psychopathology. In particular, I argue that this emotion contributes to our ability to adapt our cognitive efforts to how we represent (...) the practical factors relevant to the task at hand, by sig- naling the need for increased cognitive processing and evidence gathering in high- stakes situations. I hypothesize that dysfunctional or ill-calibrated epistemic anxiety might play an important role in the motivation driving persons with obsessive- compulsive disorder (OCD) to invest high amounts of cognitive resources into the resolution of apparently simple and innocuous questions. As I argue, OCD might be conceived as a case in which epistemic anxiety is inappropriately elicited, represent- ing these as high-stakes questions, and inadequately signaling a need for cognition. In this paper, I thus make use of the concept of (epistemic) anxiety as developed in the philosophy of emotion and in epistemology, to propose an account of the role of anxiety in the pathological doubt that is central to obsessive-compulsive disorder. (shrink)

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)

Part (a) -/- 'Obsessive-compulsive disorder (OCD) is a form of anxiety where the person has thoughts, images or ideas which they find hard to ignore (obsessions). This can lead to them feeling that they have a need to perform certain things to feel better (compulsions). -/- Part (b) -/- For two of the perspectives named in Part a, one from either Psychodynamic or cognitive and the other from either Biological or behaviourism using a table like the one (...) below evaluate the evidence which you have used to support each perspective. (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)

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)

It’s a common assumption in psychiatry and psychotherapy that mental health conditions are marked out by some form of epistemic irrationality. With respect to obsessive-compulsive disorder (OCD), the mainstream view is that OCD causes irrational beliefs. Recently, however, this ‘doxastic view’ has been criticized from a theoretical and empirical perspective. Instead a more promising ‘zetetic view’ has been proposed which locates the epistemic irrationality of OCD not in irrational beliefs, but in the senseless inquiries it prompts. Yet, (...) in this paper I present a special class of cases—sexual obsessive-compulsive disorder (S-OCD)—which cannot be explained by existing doxastic and zetetic accounts of the epistemic irrationality of OCD. In addition, some people with S-OCD appear to be adhering too well to a plausible set of norms for inquiry. Their suffering seems to be partially caused by an excess of rationality, and not a lack thereof. They seem, if anything, too rational. This shows firstly that it’s unlikely that there is one form of epistemic irrationality common to all persons living with OCD. Secondly, it should lead us to rethink the epistemic categories we use in classifying mental health conditions such as OCD. (shrink)

In recent years, there has been a trend in psychiatry to try and explain disorders of action in terms of an over-reliance on the habitual mode of action. In particular, it has been hypothesized that compulsions in obsessive-compulsive disorder are driven by maladaptive habits. In this paper, I argue that this view of obsessive-compulsive disorder does not fit the phenomenology of the disorder in many patients and that a more refined conceptualization of habit (...) is likely to be helpful in clarifying the distinctions between disorders of action. There are thus two aims to this paper. The first is to highlight the issues pertaining to the view that compulsions are the result of an over-reliance on the habitual mode of action, leading to a loss of agentive control. The second aim is to examine the view of agentive control implicit in those accounts and see how other conceptions of agentive control might do a better job at accounting for the distinct ways in which persons suffering from pathologies of action may be said to lack control. (shrink)

Pierre-Henri Castel provides a short but richly argued precis of his recently published two-volume 1,000-page masterwork on the history of obsessive-compulsive disorder. Having not read the as-yet-untranslated books, I write this commentary from Plato’s cave, trying to infer the reality of Castel’s analysis from expository shadows. I am unlikely to be more successful than Plato’s poor troglodytes, so I apologize ahead of time for any misunderstandings. Moreover, I cannot assess Castel’s detailed evidential case for his substantive theses.1 (...) I thus focus on some key philosophical issues that impinge on an area of my concern, the concept of mental disorder. Castel is a rare breed of French.. (shrink)

Obsessive-compulsive disorder is a commonly occurring neuropsychiatric condition characterized by bothersome intrusive thoughts and urges that frequently lead to repetitive dysfunctional behaviours such as excessive handwashing. There are well-documented alterations in cerebral function which appear to be closely related to the manifestation of these symptoms. Controlled studies of cognitive-behavioural therapy techniques utilizing the active refocusing of attention away from the intrusive phenomena of OCD and onto adaptive alternative activities have demonstrated both significant improvements in clinical symptoms and (...) systematic changes in the pathological brain circuitry associated with them. Careful investigation of the relationships between the experiential and putative neurophysiological processes involved in these changes can offer useful insights into volitional aspects of cerebral function. (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.

Case reports about patients undergoing Deep Brain Stimulation (DBS) for various motor and psychiatric disorders - including Parkinson’s Disease, Obsessive Compulsive Disorder, and Treatment Resistant Depression - have sparked a vast literature in neuroethics. Questions about whether and how DBS changes the self have been at the fore. The present chapter brings these neuroethical debates into conversation with recent research in moral psychology. We begin in Section 1 by reviewing the recent clinical literature on DBS. In Section (...) 2, we consider whether DBS poses a threat to personal identity. In Section 3 we argue for engagement with recent empirical work examining judgements of when identity changes. We conclude in Section 4 by highlighting a range of ethical issues raised by DBS, including various cross-cultural considerations. (shrink)

“But surely if it's not irrational, it can’t be OCD!” my friend exclaimed, when I told them about the paper Carolina Flores and Brent Kious provided their excellent comments for. In all fairness, my friend is not working in philosophy, or psychiatry, or in psychology. Still, I take their sentiment to be expressive of a widely held view: if you have a certain mental illness, then you must be irrational. Conversely, rationality guarantees mental health; the sane life is the rational (...) life. -/- In my paper, I attempted to complicate this picture. My main line of thought was that if the sane life is the rational life, we do not have a good conception of rationality yet. For, our best theories of rationality fail to capture what is going wrong in some cases of obsessive-compulsive disorder (OCD). Addressing the criticisms raised by my commentators will allow me to clear up some misunderstandings and sketch avenues for further work. (shrink)

In this article, an account of the architecture of the cognitive contamination system is offered, according to which the contamination system can generate contamination represen- tations in circumstances that do not satisfy the norms of contamination, including in cases of mere visual contact with disgusting objects. It is argued that this architecture is important for explaining the content, logic, distribution, and persistence of maternal impression beliefs – according to which fetal defects are caused by the pregnant mother’s experiences and actions (...) – which in turn provide important evidence of the architecture of the cognitive contamination system. (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)

Philosophical lessons come in many different shapes and sizes. Some lessons are big, some are small. Some lessons go deep and have a big impact, some are shallow and have almost none. Some lessons are not really philosophical at all or would not really be lessons for an audience of academic philosophers. I mention these truisms not to disparage this informative book on 'moral OCD' (moral obsessive-compulsive disorder, or 'Scrupulosity') but rather to emphasize how difficult it can (...) be to discern the book's intended audience, given its interdisciplinary aims and structure. That question is never explicitly addressed (it is admittedly a slim book, slimmer than it appears), but the question has consequences for how to think about the book's ultimate value, and for whom. The book might attract two groups in particular: philosophers working on the nature of responsibility (the subject of the book's longest chapter) and psychiatric researchers or mental health professionals interested in moral philosophy and the philosophy of mental illness. I will return to what moral philosophers can learn from moral OCD, but there will be spoilers. (shrink)

Anorexia nervosa is an eating disorder characterized by very restrictive eating or dieting leading to weight loss, a fear of weight gain, and a distorted body image. Several physiological mechanisms and behaviors that maintain and worsen symptoms of anorexia have addictive qualities that parallel that of substance use disorder. Similarities between anorexia nervosa and substance use disorder are explored, including other relevant diagnoses and phenomenons like reward deficiency syndrome. Related mechanisms and behaviors associated with anorexia and substance (...) use disorder include compulsion, the detrimental continuation of maladaptive behaviors, impaired control, and disorder-related changes in neurology. Conceptualizing anorexia nervosa as an addiction could assist in creating effective treatments for this disorder. (shrink)

In this opinion piece we propose the investigation of psychedelic-assisted psychotherapy for the treatment of body dysmorphic disorder (BDD). BDD is a psychiatric disorder characterised by appearance-based preoccupations and accompanying compulsions. While safe and effective treatments for BDD exist, non-response and relapse rates remain high. Therefore, there is a need to investigate promising new treatment options for this highly debilitating condition. Preliminary evidence suggests safety, feasibility, and potential efficacy of psychedelic treatments in disorders that share similar psychopathological mechanisms (...) with BDD. Drawing on this evidence, as well as on relevant qualitative reports and theoretical proposals, we argue that it would be worthwhile to conduct a phase 2a study aimed at assessing the safety and feasibility of psychedelic-assisted psychotherapy in BDD. We also offer some suggestions for how future research ought to proceed. (shrink)

The capacity to act in accordance with one’s morality (broadly construed) is constitutive of moral agency. This capacity can be undermined—in whole or in part—by for instance, hypnosis, addiction, or obsessive-compulsion. Another way this capacity can be undermined is through poor moral reasoning. Moral irrationality can frustrate one’s capacity to act in accordance with one’s morality and in turn, stunt one’s moral agency. In a similar respect, improving moral rationality can strengthen this capacity and enhance moral agency. The empirical (...) research program on (non-moral) cognitive debiasing inspires developing techniques to improve our moral rational capacities—i.e., moral debiasing. Yet, moral debiasing presupposes moral biases—that is, systematic moral errors. So, what are moral errors exactly? The pertinent kind is subjective moral errors. Ultimately, A’s φ-ing is a subjective moral error insofar as φ-ing deviates from A’s genuine morality per instrumental subjective moral rationality (ISMR)—i.e., insofar as φ-ing frustrates A+’s morally-relevant ends, wherein A+ is a counterfactual idealization of A upon whom is bestowed those endowments that A considers authoritative under ordinary optimal conditions. The provision of an in-principle standard of subjective moral error lays important theoretical groundwork for future empirical inquiry into subjective moral debiasing. (shrink)

Volition and Allied Causal Concepts is a work of aetiology and metapsychology. Aetiology is the branch of philosophy and logic devoted to the study of causality (the cause-effect relation) in all its forms; and metapsychology is the study of the basic concepts common to all psychological discourse, most of which are causal. Volition (or free will) is to be distinguished from causation and natural spontaneity. The latter categories, i.e. deterministic causality and its negation, have been treated in a separate work, (...) The Logic of Causation. Volition may be characterized as personal causality, a relation between an agent (the self or soul) and his actions (acts of will). Unlike causation, this relation cannot be entirely defined using conditional (if–then) propositions. Although we can say that the agent is a sine qua non of his actions, we cannot say that the agent is invariably (in all or specific circumstances) followed by his actions. It appears that both an act of will and its negation remain possible to a soul in any given set of circumstances. This defines freedom of the will, and implies the responsibility of the agent for his actions. Introspection provides knowledge of particular acts of will. The existence of freewill implies a distinction between necessary causation (determinism independent of volition) and inertial causation (determinism, except when some contrary will interferes). An act of will occurs on a spiritual plane. It may have natural (mental or physical) consequences; those that inevitably follow it may be regarded as directly willed, whereas those that vary according to circumstances must be considered indirectly willed. Volition presupposes some degree of consciousness. So-called involuntary acts of will involve a minimum of attention, whereas mindful acts are fully conscious. Even pure whim involves intention. Most volitions moreover involve valuation, some sort of projection of goals, deliberation on means, choice and decision. To judge responsibility, various distinctions are called for, like that between intentional, incidental and accidental consequences. Volitional action can be affected through the terms and conditions of the world surrounding its agent, but also more intimately through the influence of concrete or abstract aspects of that world that the subject has cognized. The causal concept of influence, and its implication of cognition (of inner or outer information, including emotions), are crucial to measuring the effort involved in volition. Influences make willing easier or harder, yet do not curtail its essential freedom. All the causal concepts used in psychological explanation – affections, appetites, instincts, habits, obsessions, compulsions, urges and impulses – can be elucidated thanks to this important finding. Much of human (and animal) behavior can thus be both acknowledged as volitional and as variously influenced. Volition and Allied Causal Concepts is a work of ambitious scope, intent on finally resolving philosophical and logical issues that have always impeded progress in psychology. It clarifies the structure and workings of the psyche, facilitating hygienic and therapeutic endeavors. The relation between volition and physical laws is discussed, as is the place of volition in biology. Concepts used in biology, analogous to that of purpose, are incidentally analyzed. Theological issues are also dealt with, as are some topics in ethics and law. (shrink)

This study, by using 142 groups of data from 1990 to 2007 and the method of cross-temporal meta-analysis, researched the changing trend of status of mental health of 108736 members of the Chinese Army along with the change of years. All the data came from 94 related research reports, and all the research reports used SCL-90 (the Symptom Checklist 90) as the testing tool of mental health. The study found that: (1) mental health of members of the Chinese Army steadily (...) improved between 1990 and 2007; (2) during those 18 years, the Interpersonal Sensitivity factor of SCL-90 of Chinese Army members changed most significantly, and the least significantly changed factor was Somatization; (3) Chinese Army members showed evidence of fewest problems on the Photic Anxiety factor, in contrast to the consistent problems indicated by scores on the Obsessive-Compulsive and Interpersonal Sensitivity scales; (4) Chinese Army members from single-child families (N =1,944) showed significant lower evidence of positive mental health than soldiers from multiple child families (N =2,649); (5) The mental health of soldiers from non-agricultural backgrounds (N =7,808) was less positive than that of soldiers from agricultural households(N =11,459); (6) Chinese Army members with senior high school education level (N = 10,189) had less positive mental health than those with junior high school (N = 8,407) or university education (N = 863). (shrink)

Orthorexia is a condition in which the subject becomes obsessed with identifying and maintaining the ideal diet, rigidly avoiding foods perceived as unhealthy or harmful. In this paper, I examine widespread cultural factors that provide particularly fertile ground for the development of orthorexia, drawing out social and historical connections between religion and orthorexia (which literally means “righteous eating”), and also addressing how ambiguities in the concept of “health” make it particularly prone to take on quasi-religious significance. I argue that what (...) makes this sort of disordered eating destructive to both men and women is ultimately a common urge to transcend rather than to embrace the realities of embodiment. In sum, I believe that orthorexia is best understood as a manifestation of age-old anxieties about human nitude and mortality—anxieties which current dominant sociocultural forces prime us to experi- ence and express in unhealthy attitudes toward healthy eating. (shrink)

For many contemporary artists, failure has been an instrument of experimentation and self-expression, of investigation into existential questions and manifestation of utopian tensions. In this paper, I will discuss how some of the well-known strategies of experimental and avant-garde artistic practices with failure involve risky actions, challenging or impossible attempts, loss of control, and compulsive repetition of inconclusive acts. In those experimentations, the ideal model of an effective and successful action performance (in which a goal is defined through a (...) clear intention, a plan and a well-controlled execution) is willfully sabotaged in its stages. In this regard, a distinction between failure and mistake will be highlighted: if failure could be traced back to the tradition of heroic or tragic defeat in front of adverse odds, mistake on the contrary means doing something wrong that one is expected to control. While failure negatively reflects our tension toward autonomy, the focus on mistakes is the expression of rigidity and heightened risk aversion in contexts where maximal efficiency and self-optimization are expected. This paper will argue that equating the category of failure with that of mistake is not faithful to the motives underlying those artistic traditions. In this respect, artistic experimentations in the “aesthetic of failure” can also be viewed as a critical response toward a general mindset defined by the anxiety of control and obsessive mistake avoidance that seems typical of our current times. (shrink)

Body checking, characterized by the repeated visual or physical inspection of particular parts of one’s own body (e.g. thighs, waist, or upper arms) is one of the most prominent behaviors associated with eating disorders, particularly Anorexia Nervosa (AN). In this paper, we explore the explanatory potential of the Recalcitrant Fear Model of AN (RFM) in relation to body checking. We argue that RFM, when combined with certain plausible auxiliary hypotheses about the cognitive and epistemic roles of emotions, is able to (...) explain key characteristics of body checking, including how body checking behavior becomes habitual and compulsive. (shrink)

Despite growing understanding of the addictive qualities of the internet, and rising concerns about the effects of excessive internet use on personal wellbeing and mental health, the corresponding ethical debate is still in its infancy, and many of the relevant philosophical and conceptual frameworks are underdeveloped. Our goal in this chapter is to explore some of this evolving terrain. While there are unique ethical considerations that pertain to the formalisation of a disorder related to excessive internet use, our ethical (...) concerns (and indeed our mental health concerns) about whether certain technologies undermine wellbeing can and should be far broader than the debates about the appropriateness of particular diagnostic categories. In this chapter we introduce some of these wider debates with regards to persuasive digital technologies— particularly those which aim to maximise use, or even to encourage compulsive engagement—as well as the difficulty in articulating the harms involved in excessive internet use, especially where such use has not led to functional impairment. Following these conversations we briefly consider some more practical ethical implications, including regulation of certain design features, concerns about growing socioeconomic inequality in online services, and whether there should be a “right to disconnect.”. (shrink)

The Shadow of God in the Philosopher’s Garden. The Parc de La Villette in Paris in the context of the philosophy of chôra I Bernard Tschumi’s project of the Parc de La Villette could have won the competition and was implemented thanks to the political atmosphere that accompanied the victory of the left-wing candidate in the French presidential elections in 1981. François Mitterand’s revision of the political programme and the replacement of radical reforms with the construction of prestigious architectural objects (...) and urban assumptions in the French capital gave Tschumi a unique opportunity to realise ideas that polemicised with traditional forms of social life, questioned the basic principles of architecture and included architectural work in the philosophical disputes over the issues of metaphysics. Tschumi’s theoretical assumptions put forward during the design of the Parc de La Villette highlighted the questions of conflict between the main components of the project and suggested that the intensification of differences was analogous to Jacques Derrida’s creation of the concept of différance. It was this philosopher who in a special commentary to Derrida’s project also introduced the concept of maintenant, which aimed at demonstrating that the architect’s polemical inclinations remain in a hidden balance with his inclinations to affirmation of architectural principles. During the discussion between Derrida and Peter Eisenman, who was to take part in the design of the Parisian park, the concept of the chôra was also put forward, which in the course of the debate led to an additional confusion of architectural and philosophical problems. II In the period from the Antiquity to the Renaissance, the dialogue Timaeus was the most frequently commented work of Plato. At present, the most frequently discussed is the issue of the chôra included in it, which aroused fascination among philosophers, researchers of rhetoric, religion, feminism, but also architecture. The work on the chôra also influenced the development of the interpretation of the Parc de La Villette, among which the topics related to the beginning and the change were highlighted. In early uses of the word chôra in Greek, as in Homer’s 18th Book of Iliad, it meant both dancing and a place to dance. On this occasion, it can be seen that it is not possible to determine which phenomenon took precedence in the creation of the name. It cannot be denied, however, that the word concerned a specific movement, as if circular and returning to an indefinable beginning. Despite gaining more and more general meanings, the word chôra has retained its connection with the dance of people on the threshing floor, the dance of bees (choros meliton) or the dance of stars (choros astron). In Timaeus, the chôra is a space filled with movement with an effect similar to shaking the sieve to husk the grain: it separates similar elements from the dissimilar ones. The juxtaposition of the Parc de La Villette and the chôra already at this stage leads to the suggestion that the park was treated by the architect as a place of dynamic changes leading to the establishment of new social solutions. In his statements, the architect confirmed that the park was to be a space of new politics and ethics. The book by Julia Kristeva La Révolution du langage poétique contributed to the spread of the belief that works of art can play a role as factors of political revolution. In this work, the author put forward the thesis that the chôra is a kind of space, the character of which has a destructive influence on attempts to conclude language games. The chôra gives beginning to words, but at the same time, by leaving a trace of this beginning it forces us to renew their meanings. The chôra understood in this way, turns out to be an irremovable beginning, to which one has to return all the time. Kristeva found manifestations of the chôra’s activity in avant-garde French poetry, to which she attributed the role of a mediator between criticism of metaphysics and aspirations for social change. The chôra, violating the language, introduces some voids into it, as if traces of the abyss, which direct the consciousness towards understanding the necessity of political changes. The Parc de La Villette was to pursue similar objectives in the city space. In his essays, Tschumi considered the problems of creating spaces that would give rise to a radical democracy. The proposed rebellious spaces should have the characteristics of a void, in which contradictory forces would occur as forms of pure activity. The means of achieving this goal was to concentrate contradictions and make them visible. The Parc de La Villette was supposed to collect differences as indelible and at the same time by showing them it was supposed to raise awareness of the social world as a conglomerate of differences. Saturation of the space of the park with subversive values results from the character of this space suppressed in the consciousness, as well as from the social diversity which has not been taken into account so far. The main contradictions contained in space relate to the division that exists between its presentation as a mental problem and a sensual one. The park was the deliberate creation of a place that transcends such a division and creates a separate space for negotiation between architectural theories and its practical applications. The purpose of the park was to become a place of future events, which would not hide their conflicting character coming from diversity of both space and society. The method of composition usually aimed at achieving a harmonious whole has been replaced by Tschumi with a system of juxtaposition of non-coherent elements or those resulting from variations and transformations. Tschumi did not seek direct influence on politics in the Parc de La Villette, but made room for thinking about the possibilities of the future. He introduced problems rather than showed solutions to them. The task of the park was to put the principles of architecture into a kind of vibration that would inspire users to participate in the new community. III Tschumi believes that the quality of architecture depends on the theoretical factor it contains. Such a view led to the creation of architecture that would achieve visibility and comprehensibility only after its interpretation. On his way to creating such an architecture he took on a purely philosophical reflection on the basic building block of architecture, which is space. In 1975, he wrote an essay entitled Questions of Space, in which he included several dozen questions about the nature of space. The questions he formulated could be regarded as analogous to the situation in the philosophy of the time, in which the interest in questioning the most obvious forms of understanding the world and intellectual categories increased. The research on space is an area common to many fields of natural sciences, humanities and artistic creation, but it also deals with other problems, such as issues of experience. The concept of space-time continuum proposed by Hermann Minkowski drew attention to the identity of time and space with the events taking place. Probably regardless of the postulates of physicists commenting on Albert Einstein’s discoveries, also in philosophy it increased the importance of the concept of the event which became dominant in Martin Heidegger’s latest work Contributions of Philosophy: Of the event. Furthermore, Tschumi’s reflections on space entered into relation with the problem of experience, which aroused the interest of a group of French philosophers trying to assimilate Georges Bataille’s concept of “inner experience”. Both Tschumi and Derrida referred to Bataille because his views could be used not only to modify the concept of the subject, but also to change the understanding of what constitutes the area of architecture. The discussion on experience has led to the recognition that the subject is not sovereign, but actually a form of what is on their outside. Such insights make it possible to treat the area of the Parc de La Villette as existing mainly when it is organised by its users. The decisive features of the park are its assumptions, according to which it is a variety of active void that leads to agreeing new social relations with it. The park does not force to participate in already existing moral or political communities, but tries to move into an unknown future in which the scope of free functioning of individuals will be increased. Doubts about the principles of functioning of the individual self and its discovery as a whole composed of non-coherent parts, as well as its dependence on its own depth full of disordered forces, influenced the understanding of architecture as a set of contradictions whose source is a fundamental void anticipating the empty phenomenal space. The use of this phenomenal void in architecture, as well as the rejection of the whole and unity, had a specific political purpose and drew its inspiration from political analyses. In the Parc de La Villette, metaphysics and politics were brought closer together because the philosophy of void was used to create new conditions for community action. It can be argued that the source of this philosophy was the perception of errors in existing societies dependent on the shortcomings of traditional metaphysics. Spacing (espacement) was one of the key terms in Derrida’s philosophy, which was also combined with the concepts of différance and chôra. The study of the nature of space, especially its transition from the level of pure possibility to the level of sensual phenomenon, also contributes to understanding how well designed space can have an impact on its audience. This explanation is based on Tschumi’s assumption that the space of the Parc de La Villette contradicts the integrating approaches and instead exposes contradictions, but it does so in a way that combines incompatible properties into a single piece of architecture. The specificity of such integration is similar to the invention of a musical phrase, which is an ideological message: moral and political. Such a thesis may raise doubts, however, if both the clearly adopted assumptions and those deduced from the work allow for their logically ordered presentation then to a limited extent it may be assumed that the work has achieved a connection between a specific philosophy of space and its practical application. Derrida combined the problem of spatiality with the problem of transcendental imagination in the philosophy of Immanuel Kant, who in the first version of Critique of Pure Reason assumed that pure imagination precedes the appearance of time and space, even in their transcendental forms. The imagination in such a situation can be described as a factor activating time and space, which indicates what function is played by movement in this activity. This leads us to recognize that the ultra originary source of pure forms of sensual intuition is movement, which in early Greek philosophy was identified with void and its lack of resistance to phenomena occurring in it. Derrida’s philosophy in search of a certain super-transcendental source of time and space pointed to différance which, like void or the chôra, does not have material features or even any other form of being. Différance is the primary cause of the disruption of motionlessness and the introduction of activity into motionless time and space, thus its activity can be described as spacing (espacement). Derrida’s discoveries in this respect are not entirely original, because Georg Wilhelm Friedrich Hegel already pointed out when examining the present that it is primarily a differential relation (differente Beziehung), which, being seemingly neutral, influences the present with supernatural force and makes it unidentifiable with itself. Differente Beziehung must similarly influence the originary space, negating its initial character by multiplying its divisions and expanding its boundaries. Différance acts by revealing contradictions wherever there is apparent undifferentiation. Tschumi, composing the Parc de La Villette as a variety of void and a set of incompatible layers, followed the rules of différance or the chôra: he made void visible together with its saturation with contradictions. If space can be considered to be the result of the activity of difference, such activity has a certain regularity, which influences the behaviour of its observers. Differences or contradictions fall into a certain rhythm, which can be considered a manifestation of transcendent order. The problem is that what can be considered the source of such order, namely the logos or God, is partly disorder and error. According to descriptions contained in Timaeus, the world is a combination of forces that drive to order with forces of erroneous necessity that resounds in every order and forces it to return to disorder. Derrida denied the possibility of understanding différance as a theological value, even if it were a negative or apophatic theology, but no categorical denial could be perfect. The assumption that différance or the chôra are not endowed with any substance properties cannot deny their activity, and thus a certain force. Already since Democritus, philosophy has multiplied the names of such a force and the contradictory variety of its manifestations, never forgetting also the necessity for reason to withdraw from the possibility of giving its correct characteristics. Such a withdrawal may be interpreted as an expression of respect and, in certain situations, as a cult of the force that precedes reasonableness. The Parc de La Villette, which is an artistic divagation about the contradictions and forces behind them, can be considered as a place of their sublimation, and therefore as a variation of the temple of what differs from order and disorder. IV In the texts that presented the theoretical assumptions of the Parc de La Villette, Tschumi used a large number of terms that contradicted not only the traditional principles of composing architecture, but also negated the rules of social order and the foundations of Western metaphysics. Tschumi’s statements, which are a continuation of his leftist political fascinations from the May 1968 revolution, as well as his interest in the philosophy of French poststructuralism and his collaboration with Derrida, prove that terms such as “disruption”, “dissociation”, “disfunction”, “disjunction” and “dispersion” not only referred to architectural problems but also applied to political criticism and the deepest foundations of thinking itself. His collaboration with Derrida manifested itself primarily in the publication La Case Vide: La Villette 1985, in which the architect’s design drawings and texts explaining his concepts related to the Parc de La Villette were accompanied by an extensive essay by Derrida, which included theoretical problems taken up by Tschumi in a philosophical context. Architectural and philosophical issues were also combined during seven discussion meetings organised by Eisenman, invited by Tschumi to collaborate on the design of the Parc de La Villette. Eisenman, who, like Tschumi, invited Derrida to participate in the design of the park and also led to the publication of Chora L Works: Jacques Derrida and Peter Eisenman, in which his ideas were confronted with Derrida’s philosophical text. In this case, Derrida’s essay was not a direct commentary on the architect’s concepts, but rather a reflection on the question of the chôra presented by Plato in Timaeus. During the discussion and in his essay, Derrida pointed out that the chôra is a component of the created world, yet it does not belong to it, but precedes it. The originality of the chôra is so radical that she also precedes all the factors of creating the world, including ideas and the Demiurge. Thus athesis appeared in the metaphysics of the West that the chôra is a form of active abyss, in relation to which all beings are secondary, both those perfect (as ideas or God) and those created, such as the world, things, people or language. This leads to the conclusion that the chôra does not exist, because all existence is a derivative of the chôra. Nor could the chôra be described, since it is a form of developing a space that is preceded by a lack of space characteristic of the chôra. Derrida intended the chôra to be an instance with an exceptional degree of transcendentalism, an anti-metaphysical instance, but also an a-theological one. However, this attempt failed, both in the field of secular philosophy and in the field of theology. Derrida’s characteristics of the chôra to strengthen its transcendentalism and negation of metaphysics had to be expressed in a language that immediately produces new concepts and a new metaphysics that reproduces the categories of the beginning, the origin or the foundation known from earlier philosophical traditions. All forms of criticism of metaphysics are also inspired by negative, apophatic and mystical theology. The undermining of many concepts of permanent meaning and the introduction of new concepts of unstable meaning, characteristic of the philosophy of deconstruction, had many features of originality, but it was directed towards problems whose solutions repeat, with the use of new vocabulary, the findings known in culture since Democritus. Thus, if apophatic philosophy can be regarded as deconstruction avant la lettre, then deconstruction itself in its late versions began to take on the features of a new religion. The exchange of inspiration between theology and deconstruction was manifested in a series of scientific conferences and publications in which Derrida’s philosophical concepts were interpreted within the scope of religious thought. Theological threads began to be found in such concepts of deconstruction as différance or the chôra, while at the same time Derrida himself undertook in his philosophy to study problems such as the Other (L’Autre) or the Impossible (Impossible), which belonged to newer theological traditions. As a consequence of the new problems, the deconstruction became closer to the features of a new religion. Philosophy, at least from Kant’s time, has tried to create a system that would take over from religion the tasks of setting moral and political goals. Similarly, Derrida has directed his interest towards the problems of democracy and ethics, which would enable their renewal. Attempts to create a new religion (cleared of old metaphors), a new community or a new democracy bring problems and threats which may be no less troublesome than the previous systems. All promises of freedom carry with them threats, the greater the more they strive for perfection. The renewal of existential orders, sometimes carried out by means of violent changes, is a certain repetitive feature of human cultures. Deep changes, however, do not protect against the return of both old gods and old demons. Tschumi and Derrida were shaped in their youth by the atmosphere of leftist rebellion against the moral and political limitations of ossified communities and the imperfections of democracy. The ethical theme distinguishes many of their works, including the Parc de La Villette. The opposition to the metaphysical traditions of philosophy and architecture contained in this park was prompted by specific political situations and resulted from bringing political issues to the level of philosophical considerations. Achievements made at the level of pure concepts were then subject to elevation, to a kind of sacralization, which made them religious concepts. The deconstruction reached for the status of the new religion especially when it found its followers and began to generate moral obligations. In the new situation, terms such as the chôra, l’Autre or the Impossible were absolutized and in relation to them a cult and attitude of adoration emerged. The Parc de La Villtette then gained new post-secular meanings, which allow it to be assigned the function of a Temple of Otherness (L’Autre) and Impossible. V In the traditional sense, a work of art creates an illustration of the outside world, or of a certain text or doctrine. Sometimes it is considered that such an illustration is not literal, but is an interpretation of what is visible, or an interpretation of a certain literary or ideological message. It can also be assumed that a work of art creates its own visual world, a separate story or a separate philosophical statement. Parc de La Villette represents the last of these possibilities: it is a philosophical statement that develops the premises derived from poststructuralist philosophies and the philosophy of deconstruction. The uniqueness of its being status, however, is that it does so not only at the level of the theoretical assumptions, but also through its functioning as an active philosophical work. This means that a park is a happening philosophy. Its activity, however, does not refer only to the present tense, but is also an attempt to penetrate the future, all otherness and impossibility. This kind of activity assumes that the work, in a sense, does not yet fully exist, but is also still produced in the processes of its interpretation. The theoretical foundations of the park included texts by Tschumi, in which he questioned traditional ways of creating a work of architecture, postulating in return the use of a long series of negations, which were comparable to the crisis of metaphysics characteristic of contemporary philosophy. It is therefore no coincidence that the publication containing Tschumi’s theoretical text on Parc de La Villette was accompanied by an essay by Derrida developing some of the architect’s concepts. The next step in integrating philosophy into the process of park design was a series of discussions between Eisenman and Derrida, who completely moved the creation of the park into the world of thoughts, without accentuating the need for their realization in the material reality. The main topic of these discussions was the problem of the chôra, which was taken up by later commentators and used to interpret the park as a work in which the philosophy of the beginning is manifested relating to issues of politics, morality and religion. The park was therefore interpreted as a space of invention within the scope of creating new rules of functioning of the community and democracy. Thinking about the political future may, however, exceed the horizon of ordinary expectations. Although philosophical thought is always connected with contemporary problems and metaphysics sometimes intertwines with current politics, yet at the same time the customs of philosophy also include crossing horizons and thinking about absolute otherness and impossibility. Initially, the chôra, différance, absolute otherness (tout autre) and the Impossible were concepts of pure philosophy of atheistic character, but with the further development of the discussion, more and more theological motifs began to emerge. One of the reasons for this phenomenon was the fact that radical negations of all being, which were contemplated in contemporary philosophy (by Heidegger and Derrida, among others), had previously been manifested in negative and apophatic theologies (by Master Eckhart, among others).Also the category of the “Other”, taken from Emmanuel Levinas, was clearly connected with the thought about God. A further reason for connecting the chôra with the theological thought was the interest in the philosophy of deconstruction expressed by some theologians. John Caputo in particular managed to persuade Derrida to participate in discussions on the current status of religion. In the late period of Derrida’s writing, further statements on religious topics appeared. All these reasons led to posing a question about the identity of the chôra and God. Although there were no satisfactory conclusions on this issue, the discussion was also important to create an interpretation of the park as a place of worship. The chôra, representing, according to Plato, the preoriginal emptiness is the place of every beginning, but it turns out that it is not neutral to the being created in it. The chôra deposits itself in every being as an irremovable beginning that interferes with its stability. The chôra, therefore, forces us into a palintropical movement, but it also turns out to be a pure compulsion, an erring necessity and a fundamental force from which, in the human perception, motifs useful to the individual and to the community are extracted. All definitions of this force, including its anthropomorphisation, are formulated in such a way that they allow for building private and collective morality upon them. Such definitions are changed depending on variable political situations. It is difficult to determine whether in the processes of changes in the formulation of “God’s names” any essential value is retained, which is not subject to change. The current definitions of the chôra (God?), which can be found, for example, in the philosophy of Caputo, stress that she is a combination of various and contradictory forces. This characteristic inherits much of Plato’s concept, reminds us of Master Eckhart’s views on Gottheit and, at the same time, is not unfamiliar to Tschumi, whose essays were an apologia of contradictions. The current concept of chôra, transferred into the sphere of politics, is the praise of social diversity and the protection of the difference from the forces of order. In the Parc de La Villette, the future community and democracy were elevated as a system of safe existence of individuals in all their singularity. The park is a temple of a future community in which individual beings have nothing in common. (shrink)

How should addictive behavior be explained? In terms of neurobiological illness and compulsion, or as a choice made freely, even rationally, in the face of harmful social or psychological circumstances? Some of the disagreement between proponents of the prevailing medical models and choice models in the science of addiction centres on the notion of “loss of control” as a normative characterization of addiction. In this article I examine two of the standard interpretations of loss of control in addiction, one according (...) to which addicts have lost free will, the other according to which their will is weak. I argue that both interpretations are mistaken and propose therefore an alternative based on a dual-process approach. This alternative neither rules out a capacity in addicts to rationally choose to engage in drug-oriented behavior, nor the possibility that addictive behavior can be compulsive and depend upon harmful changes in their brains caused by the regular use of drugs. (shrink)

I show that Pickard’s argument against the irresistibility of addiction fails because her proposed dilemma, according to which either drug-seeking does not count as action or addiction is resistible, is flawed; and that is the case whether or not one endorses Pickard’s controversial definition of action. Briefly, we can easily imagine cases in which drug-seeking meets Pickard’s conditions for agency without thereby implying that the addiction was not irresistible, as when the drug addict may take more than one route to (...) go meet her dealer. (shrink)

As it emerged from philosophical analyses and cognitive research, most concepts exhibit typicality effects, and resist to the efforts of defining them in terms of necessary and sufficient conditions. This holds also in the case of many medical concepts. This is a problem for the design of computer science ontologies, since knowledge representation formalisms commonly adopted in this field (such as, in the first place, the Web Ontology Language - OWL) do not allow for the representation of concepts in terms (...) of typical traits. The need of representing concepts in terms of typical traits concerns almost every domain of real world knowledge, including medical domains. In particular, in this article we take into account the domain of mental disorders, starting from the DSM-5 descriptions of some specific disorders. We favour a hybrid approach to concept representation, in which ontology oriented formalisms are combined to a geometric representation of knowledge based on conceptual space. As a preliminary step to apply our proposal to mental disorder concepts, we started to develop an OWL ontology of the schizophrenia spectrum, which is as close as possible to the DSM-5 descriptions. (shrink)

In this chapter I investigate the kinds of changes that psychiatric kinds undergo when they become explanatory targets of areas of sciences that are not “mature” and are in the early stages of discovering mechanisms. The two areas of science that are the targets of my analysis are cognitive neuroscience and cognitive neurobiology.

Normative thinking about addiction has traditionally been divided between, on the one hand, a medical model which sees addiction as a disease characterized by compulsive and relapsing drug use over which the addict has little or no control and, on the other, a moral model which sees addiction as a choice characterized by voluntary behaviour under the control of the addict. Proponents of the former appeal to evidence showing that regular consumption of drugs causes persistent changes in the brain (...) structures and functions known to be involved in the motivation of behavior. On this evidence, it is often concluded that becoming addicted involves a transition from voluntary, chosen drug use to non-voluntary compulsive drug use. Against this view, proponents of the moral model provide ample evidence that addictive drug use involves voluntary chosen behaviour. In this paper we argue that although they are right about something, both views are mistaken. We present a third model that neither rules out the view of addictive drug use as compulsive, nor that it involves voluntary chosen behavior. -/- . (shrink)

This contribution focuses on what type of question “Are mental disorders brain disorders?” is and what task Anneli Jefferson performs in her book with the same title. I distinguish between conceptual engineering and conceptual choice, the former involving the individuation of an adequate concept for a specific goal, and the latter involving the normative problem of whether we should employ the concept at hand. I contend that Anneli Jefferson’s book is a work of conceptual engineering, which is valuable in and (...) of itself, but that this is insufficient to answer an equally essential version of the question, “Are mental disorders brain disorders?”, namely, whether we should adopt the newly engineered concept or not, considering a broader range of goals for mental health research and practice. (shrink)

This paper offers a philosophical analysis of the connection between mental disorder and suicide risk. In contemporary psychiatry, it is commonly suggested that this connection is a causal connection that has been established through empirical discovery. Herein, I examine the extent to which this claim can be sustained. I argue that the connection between mental disorder and increased suicide risk is not wholly causal but is partly conceptual. This in part relates to the way suicidality is built into (...) the definitions of some psychiatric diagnoses. It also relates to the broader normative assumption that suicidal behavior is by definition mentally disordered behavior. The above has significant epistemological implications, which I explore. I propose that the claim that suicide is connected with mental disorder cannot be justified solely by appealing to empirical evidence but also warrants a justification on conceptual and normative grounds. (shrink)

Three problems threaten any account of philosophical rule in the Republic. First, Socrates is supposed to show that acting justly is always beneficial, but instead he extols the benefits of having a just soul. He leaves little reason to believe practical justice and psychic justice are connected and thus to believe that philosophers will act justly. In response to this problem, I show that just acts produce just souls. Since philosophers want to have just souls, they will act justly. Second, (...) Socrates’ alleged aim is to demonstrate that justice is beneficial, but philosophers, who have to give up a life of philosophy to rule, actually appear to be harmed by ruling. I explain that, since the founders of the city justly command them to rule, philosophers cannot, in fact, obtain a better life, and so ruling does not harm them. Third, it seems incongruous that philosophers, who should, as just people, jump at the opportunity to rule Kallipolis, must be compelled to rule. I show that Plato carefully constructs an educational system that produces rulers who do not want to rule, since such rulers alone will rule best. (shrink)

Addicts sometimes engage in such spectacularly self-destructive behavior that they seem to act under compulsion. I briefly review the claim that addiction is not compulsive at all. I then consider recent accounts of addiction by Holton and Schroeder, which characterize addiction in terms of abnormally strong motivations. However, this account can only explain the apparent compulsivity of addiction if we assume—contrary to what we know about addicts—that the desires are so strong as to be irresistible. I then consider accounts (...) that invoke the phenomenon of “ego depletion,” according to which a person can resist temptation for a while, but not indefinitely. Implicit in this account is the assumption that addiction-related desires persist long enough to deplete the addict’s willpower. The balance of the paper argues that the persistence of the desire to consume drugs is a significant form of dysfunction in its own right, and that it makes an important and independent contribution to the compulsivity of addiction. I argue that addiction involves dysfunction in a mechanism that normally prevents a person from being tempted to do something that would invite disaster. (shrink)

Josh is a typical 27-year-old in a career that he enjoys and a successful marriage. Josh begins to exhibit the symptoms of a manic episode. He is soon diagnosed with bipolar disorder. While non-manic, Josh’s preferences are typical. While manic, his preferences change dramatically. He quits his job, cheats on his partner, and squanders his savings. These are behaviors that Josh, when non-manic (euthymic), would never agree to. When Josh returns to a euthymic state, he regrets these decisions. Should (...) those close to Josh have prevented him from making these decisions, or does his competence to decide persist despite his acute mania? In this paper, I examine the connections be-tween bipolar disorder and consent. I defend the view that many (although far from all) individuals with bipolar disorder are competent to consent to a wide variety of things when they are in a manic state. This means that mania should not be presumed to undermine competence in clinical settings. -/- I have several goals in this paper. I want to bring philosophy to bear on the connection between consent and bipolar disorder. Additionally, I intend this paper to contribute to the general debate about the conditions of informed consent. Bipolar disorder presents novel challenges to existing conceptions of competence to consent which require stable core of values for an agent to be competent. For example, Buchanan and Brock endorse such a view. In showing that shifting values do not undermine the competence of a person experiencing acute mania, I show that the aforementioned views of competence are false. Overall, this paper makes substantive contributions to the debate about competence to consent and presents the first sustained philosophical treatment of consent among people with bipolar disorder. (shrink)

Charland's article suggests that we need to think more about whether decision-making capacity is impaired in severe addiction, working from the idea that drug dealers rely on this understanding of addiction to draw in their clients. Charland argues that it is possible to make a choice without being in control (to make decisions without having decision-making capacity). I argue in support of Charland's ideas by examining the reasons supporting a medical model of addiction and its importance. (For Charland's article and (...) the full set of commentaries, please see the Research Gate link). (shrink)

Sufferers of eating disorders often hold false beliefs about their own body size. Such beliefs appear to violate norms of rationality, being neither grounded by nor responsive to appropriate forms of evidence. I defend the rationality of these beliefs. I argue that they are in fact supported by appropriate evidence, emanating from proprioceptive misperception of bodily boundaries. This argument has far‐reaching implications for the explanation and treatment of eating disorders, as well as debates over the relationship between rationality and human (...) psychology. (shrink)

What is an inference? Logicians and philosophers have proposed various conceptions of inference. I shall first highlight seven features that contribute to distinguish these conceptions. I shall then compare three conceptions to see which of them best explains the special force that compels us to accept the conclusion of an inference, if we accept its premises.

First-person reports of Major Depressive Disorder reveal that when an individual becomes depressed a profound change or ‘shift’ to one’s conscious experience occurs. The depressed person reports that something fundamental to their experience has been disturbed or shifted; a change associated with the common but elusive claim that when depressed one finds oneself in a ‘different world’ detached from reality and other people. Existing attempts to utilise these phenomenological observations in a psychiatric context are challenged by the fact that (...) this experiential ‘shift’ characteristic of depression appears mysterious and resists analysis in scientific terms. This paper offers a way out of this predicament. The hypothesis proposed is that when an individual becomes depressed, the individual departs from a state of ordinary wakeful consciousness and enters a distinctive global state of consciousness akin to dreaming and the psychedelic state. After unpacking and motivating this hypothesis in the context of research in consciousness science, I outline two of its important implications for the neurobiology of depression and psychedelic psychiatry. The upshot is a promising and conceptually well-motivated hypothesis about depression which is apt for empirical uptake and development. (shrink)

The diagnostic category of borderline personality disorder (BPD) has come under increasing criticism in recent years. In this paper, we analyze the role and impact of epistemic injustice, specifically testimonial injustice, in relation to the diagnosis of BPD. We first offer a critical sociological and historical account, detailing and expanding a range of arguments that BPD is problematic nosologically. We then turn to explore the epistemic injustices that can result from a BPD diagnosis, showing how they can lead to (...) experiences of testimonial injustice which impede patient engagement in meaning-making activities, thereby undermining standard therapeutic goals. We conclude by showing how our arguments bolster ongoing efforts to replace the diagnostic category of BPD with alternatives such as complex post-traumatic stress disorder. (shrink)

Meaning-making plays a central role in how we deal with experiences of suffering, including those due to mental disorder. And for many, religious beliefs, experiences, and practices (hereafter, religious engagement) play a central role in informing this meaning-making. However, a crucial facet of the relationship between experiences of mental disorder and religious engagement remains underexplored—namely the potentially positive effects of mental disorder on religious engagement (e.g. experiences of bipolar disorder increasing sense of God’s presence). In what (...) follows, I will present empirical findings from two recent studies of mine which shed light on the extent to which participants experienced these positive effects, specific components of these effects, and how they fit into their understanding of their mental disorder and its relationship to their religious identity. In doing so, I will draw on and expand Tasia Scrutton’s Potentially Transformative view (2015a, 2015b, 2020) according to which mental disorders may provide opportunities for spiritual growth. My empirical results align with and help deepen an account according to which mental disorders are potentially spiritually transformative by providing further insight into such instances: specifically, which symptoms and internal and external factors are often involved, as well as which religious beliefs, experiences, and/or practices are often affected. After presenting these results and articulating their relevance for a potentially transformative view of mental disorder, I will then address some potential objections to the theoretical account as well as some limitations of the empirical work, before sketching possible promising directions for future research. (shrink)

Orthodoxy holds that the difference between weakness of will and compulsion is a matter of the resistibility of an agent's effective motivation, which makes control-based views of agency especially well equipped to distinguish blameworthy weak-willed acts from non-blameworthy compulsive acts. I defend an alternative view that the difference between weakness and compulsion instead lies in the fact that agents would upon reflection give some conative weight to acting on their weak-willed desires for some aim other than to extinguish them, (...) but not to their compulsive desires. This view allows identificationist theorists of moral responsibility to explain why weak-willed actions, but not compulsive actions, are attributable to agents such that they can, in theory, be praised or blamed for them. After motivating and presenting the view in detail, I show how it has unique resources for explaining the ethics of managing one's compulsions. (shrink)

The problems of contemporary states are in large part “affective disorders”; they are failures of states to properly understand and coordinate the emotions of the individuals within and in some instances outside the state. By excluding, imprisoning, and marginalizing members of their societies, states create internal enemies who ultimately enervate their own power and the possibility of peace and freedom within the state. Spinoza’s political theory, based on the notion that the best forms of state are those that coordinate the (...) power and emotions of those within a state, offers us both a diagnosis of and a cure for these affective disorders. In this paper I will outline Spinoza’s notion of the power of the state as a function of the power and coordination of the emotions of its citizens, and show that when the state contracts an affective disorder, such as excessive crime, rebellion, terrorism, etc. the state has failed to properly empower, include and coordinate the passions of the multitude of its citizens and subjects. (shrink)

This chapter conceptually analyzes the post-traumatic stress injuries called moral injury, moral fatigue or exhaustion, and broken spirit. It then identifies two puzzles. First, soldiers sometimes sustain moral injury even from doing right actions. Second, they experience moral exhaustion from making decisions even where the morally right choice is so obvious that it shouldn’t be stressful to make it; and even where rightness of decision is so murky that no decision could be morally faulted. The injuries result of mistaken moral (...) self-evaluation. Methods of preventing and treating these injuries are defended, including training in self-forgiveness, moral off-loading of actions and decisions to persons and devices less likely to feel inappropriate guilt, and the use of drugs to prevent such guilt. The foregoing has been about moral injury erroneously resulting from the non-violation of a correct moral code. But the chapter then introduces the concept of moral pseudo-injury—felt moral injury that has in reality resulted from violation of a false moral code, so that no one has really been morally injured. This can be used as a method in warfighting. And since the injuries it produces are illusory, this would be morally superior to physical violence. For it causes less injury to its victims, and should cause less guilt in those who must inflict it. Historical precedents are considered. Finally, our enemies often use moral pseudo-injury against us, in the form of terrorist violence against civilians. Terrorism causes comparatively few harms, yet we mistakenly see it as more morally horrific than conventional combat that causes much worse loss of life among armed forces members. Here we need the nuancing and clarifying power of philosophy to restore a sense of proportion, thence to prevent or therapize the moral pseudo-injury we may experience from these sorts of attacks. (This is a pre-penultimate version of the published version, available from OUP at the external link, which contains minor variances. The paper was earlier known as "PTSD Weaponized: A Theory of Moral Injury"; that now superseded version is archived under "past conferences" on the Center for Ethics and the Rule of Law website.). (shrink)