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 (...) class='Hi'>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)

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)

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)

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)

Anorexia nervosa involves seemingly irrational beliefs about body size and the value of thinness. Historically, researchers and clinicians have avoided referring to such beliefs as delusions, instead opting for the label ‘overvalued ideas’. I discuss the relationship between the beliefs associated with anorexia nervosa and the distinction between delusions and overvalued ideas, as it is conceived in both European and American psychiatric traditions. In doing so, I question the benefit of applying the concepts of delusion and overvalued idea (...) to anorexia nervosa and raise some issues with contemporary use of the Brown Assessment of Beliefs scale for assessing the level of delusionality associated with the disorder. (shrink)

It is largely unethical to sentence individuals who are addicted to drugs to prison. While substance use can be a crime, it must be treated differently from other crimes because addiction is a psychiatric disorder. Prisons are penal institutions. Legitimate goals of penal sanctions include retribution, deterrence, rehabilitation, and incapacitation.[i] Most of these goals do not speak to those with substance use disorder, and incarceration may be counterproductive given the wide availability of drugs and feeble rehabilitation (...) efforts in prison. Further, it may be the case that substance use disorder impairs an addict’s autonomy, calling into question his criminal culpability. Our understanding of substance use disorder has evolved and our prison sentencing practices must do the same. This paper will first provide background on substance use disorder as a psychiatric disorder. Then, the need to focus on rehabilitating rather than punishing those with substance use disorder who commit crimes will be explored. Finally, this paper will address whether an individual with substance use disorder can be considered culpable for any crime—regardless of severity—and whether that individual’s autonomy is impaired due to his addiction. I conclude that culpability should depend on whether the serious crime would have occurred in the absence of the drug addiction. In most cases, it is unethical to sentence an individual with substance use disorder to prison where other options such as home confinement are available. (shrink)

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)

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)

This article investigates the ability of mental incapacity tests to account for problems of control, through a study of the approach to alcohol dependence and a comparison with the approach to anorexia nervosa, in England and Wales. The focus is on two areas of law where questions of legal and mental capacity arise for people who are alcohol dependent: decisions about treatment for alcohol dependence and diminished responsibility for a killing. The mental incapacity tests used in these legal contexts (...) are importantly different—one involves a ‘cognitive’ test, while the other includes an explicit impaired-control limb—and the comparison provides insight into a longstanding debate about the virtues of one type of test over the other. It is shown that both kinds of test can take control problems into account, but also that both can be interpreted in narrow and wide ways that significantly influence the outcome of the assessment. It is therefore argued that to a large extent, it is not the kind of mental incapacity test that matters, but how the test is interpreted. It is further proposed that value judgements are playing an unrecognised and inappropriate role in shaping this interpretation. This raises concerns about the current approach to assessing the impact of alcohol dependency on the capacity to make decisions about alcohol use or treatment, as well as broader concerns about flexibility within incapacity tests. (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)

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)

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)

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)

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)

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)

Since the dawn of the internet, pornography has effectively become ubiquitous, pervasive, and increasingly normalised. Study findings show remarkable similarities in how the brain reacts to pornography, and other known addictive substances, and indicate that consuming pornography is comparable to consuming other known addictive substances. Moreover, two of the biggest risk factors for addiction are the substance’s availability and its easy accessibility, particularly in the case of younger persons. To date, pornography addiction has been conceptualised as a behavioural addiction. (...) However, the body of research data on pornography addiction does not provide conclusive support for behavioural addiction. The aim of this thesis is to put forward the idea that pornography can, and should, be conceptualised as an addictive substance, and, that when pornography is consumed, an addictive substance is consumed. In order to support this claim, there are many factors that must be addressed. I first clarify what pornography entails by exploring how it is conceptualised, what pornography ‘does’, and what it means to be a pornography consumer. Secondly, I examine the conceptualisations of substances, substance consumption and addiction, respectively, as well as the subsequent difference between substance and behavioural addiction. Thirdly, I give an inclusive overview of pornography addiction by not only examining the most recent perspectives of researchers, but also of pornography consumers. I conclude by suggesting how we should go about conceptualising pornography addiction, and then propose how the set of diagnostic criteria for pornography use disorder should be formulated for a future iteration of the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders. I argue that, given the abundance of academic research on substance addiction, compared to the scarcity of research on behavioural addiction, conceptualising pornography as an addictive substance is more likely to create a sense of urgency for the future research of pornography addiction than would be the case if it is considered a potential behavioural addiction. Furthermore, I argue that the classification of pornography as an addictive substance, and the inclusion of pornography use disorder in a future iteration of the DSM, will raise awareness of the potential adverse effects of pornography consumption and, therefore, the harmful consequences of pornography use disorder. (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)

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)

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)

In my presentation I argue for the utility of a philosophical counseling method, called logic-based therapy (LBT), in the treatment of addicted populations. In the context of addiction treatment LBT could be also classified as a philosophical psychotherapy. Philosophical psychotherapy can be understood as an umbrella term for interventions designed to treat mental health disorders, with theoretical foundations that are philosophical. Philosophical psychotherapy would be distinct from philosophical counseling, as the latter does not directly treat mental health disorders. I suggest (...) that LBT has utility beyond philosophical counseling and is a viable intervention in the treatment of certain mental health disorders, like substance use disorders. I provide a brief overview of LBT and then discuss a LBT case study with a client suffering diagnosed with a substance use disorder. In the case study the client was advised to apply the moral philosophy of Friedrich Nietzsche as an uplifting philosophical framework to counteract his unproductive worldview and fallacious thinking. Considering that there is an ostensibly low efficacy rate for the treatment of addiction, articulating the value of philosophical psychotherapies in the context of addiction treatment can assist in the development of novel philosophically-based addiction treatment and recovery-oriented programs––thus expanding the treatment and recovery options available for those seeking recovery from addiction. (shrink)

Anorexia Nervosa (AN) is an eating disorder characterised by self-starvation. Accounts of AN typically frame the disorder in individualistic terms: e.g., genetic predisposition, perceptual disturbances of body size and shape, experiential bodily disturbances. Without disputing the role these factors may play in developing AN, we instead draw attention to the way disordered eating practices in AN are actively supported by others. Specifically, we consider how Pro-Anorexia (ProAna) websites—which provide support and solidarity, tips, motivational content, a sense of community, (...) and understanding to individuals with AN—help drive and maintain AN practices. We use C. Thi Nguyen’s work on epistemic “echo chambers”, along with Maria Lugones’ work on “worlds” and “ease”, to explore the dynamics of these processes. Adopting this broader temporal and intersubjective perspective, we argue, not only helps to further illuminate the experiential character of AN but also has important clinical and therapeutic significance. (shrink)

Abstract This article proposes and outlines an integrally informed 12 Step-based therapy that is adapted for treating addicted populations. Integrated Recovery Therapy (IRT) as a therapeutic orientation is an Integral Methodological Pluralism to therapy for treating addiction. Its two main features are paradigmatic and meta-paradigmatic. The paradigmatic aspect refers to the recognition, compilation and implementation of various methodologies in a comprehensive and inclusive manner. The meta-paradigmatic aspect refers to IRT’s capacity to weave together, relate and integrate the various paradigmatic practices. (...) IRT is a meta-therapy derived from the Integrated Recovery Model, which is a comprehensive, balanced, multi-phased and multi-disciplinary clinical model designed for in-patient addiction treatment. As with the Integrated Recovery Model, IRT’s philosophy is derived from an integration of the 12-step abstinence-based philosophy, mindfulness, positive psychology, and Integral theory. It is suggested here that the application of IRT as a meta-therapy provides a truly comprehensive and integrated therapeutic orientation for therapists who treat addicted populations. -/- Keywords: Integrated Recovery Therapy, Integrated Recovery model; 12 Steps; mindfulness; Integral theory; positive psycholog. (shrink)

Currently there is such a cornucopia of conflicting theories in the field of addiction studies that it has become exceedingly difficult for treatment providers, therapists, and policymakers to integrate this vast field of knowledge into effective treatment. Since such a chaotic overabundance of treatment theories, styles, and definitions cloud the field of addictionology, many therapists claim their field is in need of a paradigm shift. In the last 20 years an integrative and compound model has emerged known as the biopsychosocial (...) model, but without a solid and comprehensive meta-framework, syncretistic confusion can result when therapists pick and choose techniques without direction or an overall rationale. To address this problem, Guy du Plessis applies integral theory as a conceptual framework for understanding addiction, as well as a meta-therapeutic framework for therapists. The integral foundation of addiction outlined in this book provides researchers, academics, treatment providers, policy makers, and therapists with a conceptual architectonic of addiction and its treatment that is integrative, inclusive, and practical. An Integral Foundation for Addiction Treatment belongs on the shelf of every addiction treatment therapist, and anyone else who is impacted or influenced by the topic. (shrink)

Many who suffer from eating disorders claim that they see themselves as “fat”. Despite decades of research into the phenomenon, behavioural evidence has failed to confirm that eating disorders involve visual misperception of own-body size. I illustrate the importance of this phenomenon for our understanding of perceptual processing, outline the challenges involved in experimentally confirming it, and provide solutions to those challenges.

Body dissatisfaction has long been considered an integral component of and driving force behind anorexia nervosa. In this paper, I characterise body dissatisfaction in terms of problematic beliefs about body size and the value of thinness. I suggest two methods for understanding these beliefs. Regarding body size beliefs, I suggest focusing on certain forms of misleading phenomenal evidence that sufferers of anorexia nervosa are exposed to. Regarding beliefs about the value of thinness, I suggest focusing on the benefits (...) of such beliefs. (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.

A distorted representation of one's own body is a diagnostic criterion and core psychopathology of both anorexia nervosa (AN) and bulimia nervosa (BN). Despite recent technical advances in research, it is still unknown whether this body image disturbance is characterized by body dissatisfaction and a low ideal weight and/or includes a distorted perception or processing of body size. In this article, we provide an update and meta-analysis of 42 articles summarizing measures and results for body size estimation (BSE) (...) from 926 individuals with AN, 536 individuals with BN and 1920 controls. We replicate findings that individuals with AN and BN overestimate their body size as compared to controls (ES= 0.63). Our meta-regression shows that metric methods (BSE by direct or indirect spatial measures) yield larger effect sizes than depictive methods (BSE by evaluating distorted pictures), and that effect sizes are larger for patients with BN than for patients with AN. To interpret these results, we suggest a revised theoretical framework for BSE that accounts for differences between depictive and metric BSE methods regarding the underlying body representations (conceptual vs. perceptual, implicit vs. explicit). We also discuss clinical implications and argue for the importance of multimethod approaches to investigate body image disturbance. (shrink)

In this essay I explore the notion of philosophy as a way of life as a recovery pathway for individuals in addiction recovery. My hypothesis is that philosophy as a way of life can be a compelling, and legitimate recovery pathway for individuals in addiction recovery, as one of many recovery pathways. I will focus on logic-based therapy applied in the context of addiction recovery. The aim of presenting a case study is to show how a client receiving LBT is (...) provided with techniques and a worldview that can contribute to a philosophically oriented recovery program. In the case study the client was advised to apply the moral philosophy of Friedrich Nietzsche as an uplifting philosophical framework to counteract his unproductive worldview and fallacious thinking. Considering that there is an ostensibly low efficacy rate for the treatment of addiction, articulating the value of philosophy as a way of life as a recovery pathway provides a conceptual and methodological framework for the development of novel philosophically-based addiction treatment and recovery-oriented programs—thus expanding the treatment and recovery options available for those seeking recovery from addiction. (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)

This article outlines an integrally informed model for addictionon treatment and recover that is being pioneered and developed at Tabankulu Secondary Addiction Recovery Center in Cape Town, South Africa. Tabankulu is the world’s first inpatient Addictionon treatment center to implement an integrally informed treatment model. The Integrated Recovery model is a comprehensive, balanced, multi-phased, and multi-disciplinary approach to the treatment of and recovery from addiction. Its philosophy is derived from integrang a 12 Step abstinence-based methodology, mindfulness-based interventions, positive psychology, and (...) Integral Theory. The case is made that addictionon treatment facilities, therapists working with this population, and recovering addicts will become more proficient, effective, and consequently have higher success rates by becoming integrally informed. (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)

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)

Anorexia Nervosa (AN) is a complex disorder characterised by self-starvation, an act of self-destruction. It is often described as a disorder marked by paradoxes and, despite extensive research attention, is still not well understood. Much AN research focuses upon the distorted body image that individuals with AN supposedly experience. However, based upon reports from individuals describing their own experience of AN, I argue that their bodily experience is much more complex than this focus might lead us to believe. Such (...) research often presents an overly cognitive understanding of bodily experience in AN, underplaying the affective, felt experience of individuals with AN, as well as descriptions of empowerment, strength and control reported in the early stages of AN. This paper seeks to enrich our understanding of bodily experience in AN as it progresses throughout the various stages of the disorder. I show how the classical phenomenological distinction between the body-as-subject and the body-as-object, as well as Leder’s conception of the visceral body, can inform our understanding of bodily experience in AN. I suggest that the project of self-starvation is an attempt to overcome the noisy demands of the visceral body, which are experienced as threatening the body-as-subject, through a process of objectifying the body-as-object. By cashing out AN as a project of radical bodily control that, tragically, comes to control the individual, we can capture important aspects of the bodily experience of AN and the temporal progression of the disorder. -/- . (shrink)

According to a number of influential views in penal theory, 1 one of the primary goals of the criminal justice system is to rehabilitate offenders. Rehabilitativemeasures are commonly included as a part of a criminal sentence. For example, in some jurisdictions judges may order violent offenders to attend anger management classes or to undergo cognitive behavioural therapy as a part of their sentences. In a limited number of cases, neurointerventions — interventions that exert a direct biological effect on the brain (...) — have been used as aids to rehabilitation, typically being imposed as part of criminal sentences, separate treatment orders, or conditions of parole. Examples of such interventions include medications intended to attenuate addictive desires in substance-abusing offenders and agents intended to suppress libido in sex offenders.This chapter reviews some of the ethical issues raised by the use of neurointerventions as aids to rehabilitation. (shrink)

Impairment of self-control is often said to be a defining feature of addiction. Yet many addicts display what appears to be a considerable amount of control over their drug-oriented actions. Not only are their actions clearly intentional and frequently carried out in a conscious and deliberate manner, there is evidence that many addicts are responsive to a wide range of ordinary incentives and counter-incentives. Moreover, addicts have a wide variety of reasons for using drugs, reasons which often seem to go (...) a long way towards explaining their drug-oriented behavior. Many use drugs, for example, to cope with stressful or traumatic experiences. In this article I argue that some standard philosophical explanations of addicts’ impairment of self-control are inadequate, and propose an alternative. (shrink)

Anorexia nervosa patients exhibit distorted body-representations. Specifically, they represent their bodies as larger than reality. Given that this distortion likely exacerbates the condition, there is an obligation to further understand and, if possible, rectify it. In pursuit of this, experimental paradigms are needed which manipulate the spatial content of these representations. In this essay, I discuss how virtual reality technology that implements full-body variants of the rubber-hand illusion may prove useful in this regard, and I discuss some issues related (...) to the clinical application of this method. -/- . (shrink)

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)

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)

Most adult persons with anorexia satisfy the existing criteria widely used to assess decision-making capacity, meaning that incapacity typically cannot be used to justify coercive intervention. After rejecting two other approaches to justification, Professor Radden concludes that it is most likely not possible to justify coercive medical intervention for persons with anorexia in liberal terms, though she leaves it open whether some other framework might succeed. I shall assume here that the standard approach to assessing decisionmaking capacity is (...) adequate.1 The question then is whether we can justify—within a liberal framework—coercive intervention with the decision of a competent... (shrink)

Cases of severe and enduring Anorexia Nervosa (SEAN) rightly raise a great deal of concern around assessing capacity to refuse treatment (including artificial feeding). Commentators worry that the Court of Protection in England & Wales strays perilously close to a presumption of incapacity in such cases (Cave and Tan 2017, 16), with some especially bold (one might even say reckless) observers suggesting that the ordinary presumption in favor of capacity ought to be reversed in such cases (Ip 2019). -/- (...) Those of us who worry that such trends and proposals amount to (or at least pose a serious threat of) wrongful discrimination on the grounds of disability nevertheless feel the pull of judging many SEAN service users to be incapacitous with respect to decisions regarding (perhaps amongst other things) treatments involving feeding, artificial or otherwise. But it is difficult to get to grips with exactly what their incapacity consists in. Many such service users seem able to understand, retain, use and weigh information, and express a decision (i.e. they seem, prima facie, to satisfy the ‘MacArthur’ criteria). At the very least, they do not, generally. (shrink)

Background: Recent literature on addiction and judgments about the characteristics of agents has focused on the implications of adopting a ‘brain disease’ versus ‘moral weakness’ model of addiction. Typically, such judgments have to do with what capacities an agent has (e.g., the ability to abstain from substance use). Much less work, however, has been conducted on the relationship between addiction and judgments about an agent’s identity, including whether or to what extent an individual is seen as the same person (...) after becoming addicted. Methods: We conducted a series of vignette-based experiments (total N = 3,620) to assess lay attitudes concerning addiction and identity persistence, systematically manipulating key characteristics of agents and their drug of addiction. Conclusions: In Study 1, we found that US participants judged an agent who became addicted to drugs as being closer to ‘a completely different person’ than ‘completely the same person’ as the agent who existed prior to the addiction. In Studies 2-6, we investigated the intuitive basis for this result, finding that lay judgments of altered identity as a consequence of drug use and addiction are driven primarily by perceived negative changes in the moral character of drug users, who are seen as having deviated from their good true selves. (shrink)

Research in the philosophy of addiction commonly explores how agency is impacted in addiction by focusing on moments of apparent loss of control over addictive behavior and seeking to explain how such moments result from the effects of psychoactive substance use on cognition and volition. Recently, Glackin et al. (2021) have suggested that agency in addiction can be helpfully analyzed using the concept of affordances. They argue that addicted agents experience addiction-related affordances, such as action possibilities relating to drugs, (...) drug paraphernalia, and drug-related activities, as aberrantly salient motivations for action. Building on this approach, we present a novel two-tiered affordance model of addiction. In doing so, we suggest that what is significant about the addicted person’s world is not simply what affordances are experienced as salient, but also the way in which the addicted person’s world is shaped by a dominant concern. It is not only that addiction-related affordances become more prominent as addiction progresses but that one’s plurality of concerns become monopolized by and funneled through addiction. Our model endorses Glackin et al.’s idea that addiction-related affordances become aberrantly salient, while proposing why they become and remain so. This way of viewing agency in addiction also brings to light important implications for recovery and treatment. For, if an addicted person adopts a new, even “socially approved”, dominant concern, there is a risk that the shape of addiction is preserved, even though the content changes, leaving an individual at the risk of addiction substitution or relapse. (shrink)

Progress in addiction science is hampered by disagreements and ambiguity around its core construct: addiction. Addiction Ontology (AddictO) offers a path to a solution of the kind that has addressed similar problems in other areas of science: a set of clearly and uniquely defined entities to which terms such as ‘addiction’, addictive disorder’ and ‘substance dependence ’can be applied for ease of reference while recognizing that it is the construct definitions and their unique IDs that are central, not the (...) terms. (shrink)

Today’s everyone normal life can include a normal rate of playing computer games or video games; but what about an excessive or compulsive use of video games that impact on our life? Our kids, who usually spend a lot of time in playing video games will likely have a trouble in paying attention to their school lessons. In this paper, we introduce an expert system to help users in getting the correct diagnosis of the health problem of video game (...) addictions that range from (Musculoskeletal issues, Vision problems and Obesity). Moreover, this expert system provides information about the problem and tell us how we can solve it. SL5 Object expert system language was used to design and implement the expert system. (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)

Whether anorexic patients should be able to refuse treatment when this potentially has a fatal outcome is a vexed topic. A recent proposal for a new category of ‘terminal anorexia’ suggests criteria when a move to palliative care or even physician assisted suicide might be justified. I argue that this proposed diagnosis presents a false sense of certainty of the illness trajectory by conceptualizing anorexia in analogy with physical disorders and stressing the effects of starvation. Furthermore, this conceptualization (...) is in conflict with the claim that individuals who meet the diagnostic criteria for terminal anorexia have decision making capacity. It should therefore be rejected. (shrink)