The main message of Neuroethics is that neuroscience forces us to reconceptualize human agency as marvelously diverse and flexible. Free will can arise from unconscious brain processes. Individuals with mental disorders, including addiction and psychopathy, exhibit more agency than is often recognized. Brain interventions should be embraced with cautious optimism. Our moral intuitions, which arise from entangled reason and emotion, can generally be trusted. Nevertheless, we can and should safely enhance our brain chemistry, partly because motivated reasoning crops up in (...) everyday life and in the practice of neuroscience itself. Despite serious limitations, brain science can be useful in the courtroom and marketplace. Recognizing all this nuance leaves little room for anxious alarmism or overhype and urges an emphasis on neurodiversity. The result is a highly opinionated tour of neuroethics as an exciting field full of implications for philosophy, science, medicine, law, and public policy. (shrink)

This volume bridges contemporary philosophical conceptions of risk and responsibility and offers an extensive examination of the topic. It shows that risk and responsibility combine in ways that give rise to new philosophical questions and problems. Philosophical interest in the relationship between risk and responsibility continues to rise, due in no small part due to environmental crises, emerging technologies, legal developments, and new medical advances. Despite such interest, scholars are just now working out how to conceive of the links between (...) risk and responsibility, the implications that risks may have to conceptions of responsibility (and vice versa), as well as how such theorizing might play out in applied cases. With contributions from leading scholars, this volume brings together new work examining the interplay between risk and responsibility, exploring its varied philosophical aspects and applications to contemporary issues in law, bioethics, technology, and environmental ethics. Risk and Responsibility in Context will be of interest to philosophers working in ethics, bioethics, philosophy of law, and philosophy of technology, as well as scholars and practitioners in law, health and science management, public policy, and environmental studies. (shrink)

Reprint of an article that first appeared in Monash Bioethics Review (2018).

BackgroundThe merits and drawbacks of moral relevance models of addiction have predominantly been discussed theoretically, without empirical evidence of these potential effects. This study develops and evaluates a novel survey measure for assessing moral evaluations of patient substance misuse (ME-PSM).MethodsThis measure was tested on 524 health professionals (i.e., physicians, nurses, and other health professionals) in California (n = 173), urban France (n = 102), and urban China (n = 249). Demographic factors associated with ME-PSM were investigated using analyses of variance (...) (ANOVAs) and t-tests, with results suggesting that ME-PSM is higher among younger health professionals, nurses (when compared with physicians and other health professionals), and Chinese health professionals (when compared with French and American health professionals).ResultsResults provide preliminary support for the psychometric quality of the survey measure introduced in this study, including the existence of a single latent structure and partial invariance of collected data across countries.ConclusionThe survey measure for ME-PSM which was developed and tested in the current study appears to hold potential utility for use as a measure of moral views of patient substance misuse. With development, this measure may be used to examine moral evaluations, both as factors of stigma and of other clinical factors associated with the treatment of patients with substance use disorders. (shrink)

In recent years, philosophers have identified a number of moral and psychological harms associated with the attention economy (Alysworth & Castro, 2021; Castro & Pham, 2020; Williams, 2018). Missing from many of these accounts of the attention economy, however, is what exactly attention is. As a result of this neglect of the cognitive science of attention, many of these accounts are not empirically credible. They rely on oversimplified and unsophisticated accounts of not only attention, but self- control, and addiction as (...) well. Of note are accounts of the attention economy that rely on the ‘brain disease’ rhetoric of addiction and subsequent control failures (Aylsworth & Castro, 2021; Bhargava & Velasquez, 2021), accounts that rely on a strict dichotomy of top-down vs. bottom-up attention (Williams, 2018; Aylsworth & Castro, 2021), and accounts that construe attention as a limited resource (Williams, 2018). -/- Drawing on recent work from the neuroscience and psychology of attention, I demonstrate the shortcomings of these accounts and sketch a way forward for an empirically grounded account of the attention economy. These accounts tend to uphold strict dichotomies of voluntary control (e.g., compulsion versus choice, dual-process models of self-control, and top-down versus bottom-up) that cannot account for the complexities of attentional control, mental agency, and decision-making. As such, these empirically and conceptually impoverished accounts cannot adequately address the current so-called crisis of attention. To better understand the harms associated with the attention economy, we need an empirically responsible account of the nature and function of attention and mental agency. (shrink)

Can nonhuman animals and artificial intelligence (AI) entities be attributed moral agency? The general assumption in the philosophical literature is that moral agency applies exclusively to humans since they alone possess free will or capacities required for deliberate reflection. Consequently, only humans have been taken to be eligible for ascriptions of moral responsibility in terms of, for instance, blame or praise, moral criticism, or attributions of vice and virtue. Animals and machines may cause harm, but they cannot be appropriately ascribed (...) moral responsibility for their behavior. This thesis challenges the conventional paradigm by proposing an alternative approach where moral agency is conceived as the competence to participate in moral responsibility practices. By shifting focus from intra-individual to contextual and socially situated features, this practice-focused approach appears to make the attribution of moral agency to nonhuman animals and AI entities more plausible than commonly assumed. Moreover, considering the current and potential future prevalence of nonhuman animals and AI entities in everyday settings and social contexts, a potential extension of moral agency to such entities could very well transform our social, moral, and legal practices. Hence, this thesis proposes that the attribution or withholding of moral agency to different entities should be carefully evaluated, considering the potential normative implications. (shrink)

This paper argues that, although moral agency and moral patiency are distinct concepts, we have pro tanto normative reasons to ascribe some moral agency to all moral patients. Assuming a practice-focused approach, moral agents are beings that participate in moral responsibility practices. When someone is a participant, we are warranted to take a participant stance toward them. Beings who lack moral agency are instead accounted for by an objective stance. As such, they are assumed to be exempted from moral responsibility (...) practices but may still be acknowledged as moral patients. In this paper, I question that a wholly objective stance is, in practice, compatible with proper sensitivity and responsiveness to moral considerations regarding the exempted moral patient. I claim that the participant stance involves a distinct other-regarding perspective, only available from within this stance. Recognizing others specifically as addressor participants induces a readiness for second-person interaction. Instead of merely seeing and treating the moral patient as an object of moral concern, we see them as a source or maker of moral claims and demands. This “you-perspective” appears to be necessary for perceiving a wider range of morally relevant facts and considerations in relation to them. Consequently, taking a wholly objective stance towards a moral patient may impede, or even corrupt, one’s moral sensitivity and responsiveness. Given a commitment to scaffold and cultivate moral agency, there are normative reasons to take an addressor participant stance to all moral patients, and never a wholly objective one. (shrink)

I explore the relationship between psychiatric fictionalism and the attribution of moral responsibility. My central claim is as follows. If one is a psychiatric fictionalist, one should also strongly consider being a fictionalist about responsibility. This results in the ‘intrinsic view’, namely, the view that mental illness does not just happen to interfere with moral responsibility: that interference is an intrinsic part of the narrative. I end by discussing three illustrative examples.

There is a long-standing failure to create an ethical culture around substance use disorders (SUDs) or dependence that actively supports people’s recovery efforts. Issues which impede the development of prorecovery environments are complex, but include the far-reaching effects of the social stigma that surrounds SUDs; and the failure to harness relational and social support that allows debates to transcend blaming individual substance users. As part of efforts to create prorecovery environments, it is important to acknowledge that bioethics debate on SUDs (...) is narrow in scope, prioritising topics related to its traditional interests in individual autonomy and novel technologies. As a result, it has not played a significant role in helping to transform the ethical cultures in which substance use recovery takes place. For example, it largely neglects the ethical challenges of developing an empathic, person-centred approach to substance use problems that listens and responds to the voices of clients. It has also participated little in efforts to develop a positive response to reducing the toxic effects of stigma. Indeed, some contributions from the field fan stigma, rather than alleviate it. The aim of this paper is to seed broader ethical debate, in academic literature and lay/professional communities, on how societies should respond to SUDs: steering a course between the critical, but narrow approach of bioethics and the empowerment discourse of evidence-based treatments. (shrink)

In this introduction we set out some salient themes that will help structure understanding of a complex set of intersecting issues discussed in this special issue on the work of Marc Lewis: conceptual foundations of the disease model, tolerating the disease model given socio-political environments, and A third wave: refining conceptualization of addiction in the light of Lewis’s model.

On the moral model of addiction, addicts are morally responsible and blameworthy for their addictive behaviours. The model is sometimes resisted on the grounds that blaming addicts is incompatible with treating addiction in a compassionate and non-punitive way. I argue the moral model is consistent with addressing addiction compassionately and non-punitively and better accounts for both the role of addicts’ agency in the recovery process. If an addict is responsible for their addictive behaviours, and that behaviour is in some way (...) bad or wrong, then that addict is blameworthy. If not, then they are not. But, if their addictive behaviour or behaviour which contributes to and perpetuates their condition of addiction, is not bad or wrong, then addiction is not an issue of moral concern. Addicts are blameworthy, but attributions of blame need not be followed by harsh treatment or punishment. Because blame and harsh treatment or punishment can be separated, there is no good reason to reject the moral model of addiction. (shrink)

The landscape of addiction is dominated by two rival models: a moral model and a model that characterizes addiction as a neurobiological disease of compulsion. Against both, I offer a scientifically and clinically informed alternative. Addiction is a highly heterogenous condition that is ill‐characterized as involving compulsive use. On the whole, drug consumption in addiction remains goal directed: people take drugs because drugs have tremendous value. This view has potential implications for the claim that addiction is, in all cases, a (...) brain disease. But more importantly, it has implications for clinical and policy interventions. To help someone overcome addiction, you need to understand and address why they persist in using drugs despite negative consequences. If they are not compelled, then the explanation must advert to the value of drugs for them as an individual. What blocks us from acknowledging this reality is not science but fear: that it will ignite moralism about drugs and condemnation of drug users. The solution is not to cleave to the concept of compulsion but to fight moralism directly. (shrink)

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

This article starts from a paradox and aims to solve it. On the one hand, although Drug Courts (DCs) are one of the most interesting penal innovations in recent years, running counter to the dominant retributive approach and the rival approach based on deterrence, they have surprisingly not attracted the attention of philosophers and therefore lack a solid philosophical foundation. On the other hand, although Pickard's ‘responsibility without blame’ approach looks very convincing on paper, its practical applications remain unclear outside (...) the clinical context. I argue that Pickard's approach is the theoretical framework that DCs need and that they are a compelling application of it: DCs do ascribe to participants various forms of responsibility (criminal ‘liability-responsibility’, responsibility of choice, responsibility for progress or failure, responsibility as answerability, tort liability) while striving to keep ‘affective blame’ at bay in order to help them regain their autonomy. However, I argue that some of the limitations of both this approach and DCs become apparent once we consider the ‘outer limits’ of DCs, in other words those who are terminated from DCs and those who refuse to enter DCs in the first place. (shrink)

In this article I address the question of what makes addiction morally problematic, and seek to answer it by drawing on values salient in the sub-Saharan African philosophical tradition. Specifically, I appeal to life-force and communal relationship, each of which African philosophers have at times advanced as a foundational value, and spell out how addiction, or at least salient instances of it, could be viewed as unethical for flouting them. I do not seek to defend either vitality or community as (...) the best explanation of when and why addiction is immoral, instead arguing that each of these characteristically African values grounds an independent and plausible account of that. I conclude that both vitalism and communalism merit consideration as rivals to accounts that Western ethicists would typically make, according to which addiction is immoral insofar as it degrades rationality or autonomy, as per Kantianism, or causes pain or dissatisfaction, à la utilitarianism. (shrink)

ABSTRACT‘Self-ambiguity’, we suggest, is best understood as an uncertainty about how strongly a given feature reflects who one truly is. When this understanding of self-ambiguity is applied to a view of the self as having both essential and shapable components, self-ambiguity can be seen to have two aspects: (1) uncertainty about one's essential or relatively unchangeable characteristics, e.g. one's sexuality, and (2) uncertainty about how to shape oneself, e.g. which values to commit to, actions to pursue, or essential features to (...) identify with. We explain how a narrative account of agency can accommodate these forms of self-ambiguity and argue that such an account also reveals another kind of self-ambiguity, namely, (3) uncertainty about whether one's established self-narrative represents who one really is. We illustrate this third form of self-ambiguity in the context of addiction where people's established addiction self-narratives make it difficult to identify with recovery. We argue that recovery will require embracing, especially, our third form of self-ambiguity as a chance for positive self-transformation. Treatment for addiction should, therefore, support people in going through and ultimately narratively resolving the inevitable self-ambiguities of the recovery process. (shrink)

Psychiatric involvement in patient morality is controversial. If psychiatrists are tasked with shaping patient morality, the coercive potential of psychiatry is increased, treatment may be unfairly administered on the basis of patients’ moral beliefs rather than medical need, moral disputes could damage the therapeutic relationship and, in any case, we are often uncertain or conflicted about what is morally right. Yet, there is also a strong case for the view that psychiatry often works through improving patient morality and, therefore, should (...) aim to do so. Our goal is to offer a practical and ethical path through this conflict. We argue that the default psychiatric approach to patient morality should be procedural, whereby patients are helped to express their own moral beliefs. Such a procedural approach avoids the brunt of objections to psychiatric involvement in patient morality. However, in a small subset of cases where patients’ moral beliefs are sufficiently distorted or underdeveloped, we claim that psychiatrists should move to a substantive approach and shape thecontentof those beliefs when they are relevant to psychiatric outcomes. The substantive approach is prone to the above objections but we argue it is nevertheless justified in this subset of cases. (shrink)

Previous discussions of addiction have often focused on the question of whether addiction is a disease. This discussion distinguishes that question – the disease question – from the question of whether addiction is a disability. I argue that, however one answers the disease question, and indeed on almost any credible account of addiction, addiction is a disability. I then consider the implications of this view, or why it matters that addiction is a disability. The disease model of addiction has led (...) many to see addiction as primarily a medical problem, and to make medical treatment of the addicted person the first priority in addressing addiction. Once addiction is viewed as a disability, different concerns are foregrounded. The problem of addiction resides not only in the addicted person, but also in the social environment in which the addicted person finds herself. The fundamental ethical question about addiction is not how addicted persons can be treated or otherwise changed, but how a just society can make reasonable accommodations for addicted persons. (shrink)

Snoek, like other commentators, conflates some of my neural claims with those of the Brain Disease Model of Addiction. But she sees other details of my modeling with precision and depth. I welcome her emphasis on individual and developmental differences in addicts' capacity to recognize and deploy their personal agency. In fact we agree that belief in personal agency is a critical first step to cultivating it. Yet I wish to steer away from the disease nomenclature, to give that belief (...) its best chance to flourish. (shrink)

Szalavitz’s model and mine share a good many components. Foremost among them is the conviction that addiction is a developmental trajectory, not a disease. Szalavitz is correct that we should consider controlled substance use an acceptable outcome, though I would like her to shift her terminology away from the medical mainstream. Finally, I suggest that Szalavitz's important idea of a "reset" in brain development might best be addressed by the notion of kindling.

Although these authors sometimes resort to medical terminology, we strongly agree that addiction is not a disease and that the Brain Disease Model of Addiction captures only one part of the story and distorts the big picture. Yet Satel and Lilienfeld continue to conflate a neurobiological model with a disease model. They also complain that my modeling of addiction reveals a hidden “neurocentric” bias, despite my integration of multiple levels of analysis, exactly as they recommend.

Pickard’s contribution reminds me that conceptualizing choice is no simple matter. Pickard sees choice as entirely voluntary, while I argue that choice is only partially voluntary. Choices are based on appraisals of situations, which fluctuate due to external circumstances and internal states such as emotion and mood. Habit itself competes with volition, and all these parameters vary with development. Psychological factors such as delay discounting and especially one's belief in one's agency are critical for volitional choice as well.

Frank and Nagel are very interested in the causes and consequences of moralizing about addiction. If addiction is a disease, moralistic concerns are sidelined. If it's a choice, we'd better identify clear reasons to absolve addicts from blame. While these are interesting considerations, they don't have much to do with the model of addiction I put forward in the target article.

I applaud Fenton and Wiers' attempt to find a demarcation point between cases of addiction that fall within the range of normal function and those that may count as disease. However, I argue that continua don't offer demarcation points, the mechanisms involved are not demonstrably different, and trying to pin down subjectivity doesn't help.

There is a lively debate over who is to blame for the harms arising from unhealthy behaviours, like overeating and excessive drinking. In this paper, I argue that given how demanding the conditions required for moral responsibility actually are, we cannot be highly confident that anyone is ever morally responsible. I also adduce evidence that holding people responsible for their unhealthy behaviours has costs: it undermines public support for the measures that are likely to have the most impact on these (...) harms. I claim that these two facts—the fact that we cannot be highly confident that anyone is morally responsible and the fact that holding people responsible for their unhealthy behaviours has costs—interact. Together they give us a powerful reason for believing, or acting as if we believed, that ordinary people are not in fact responsible for their unhealthy behaviours. (shrink)

Clinical psychologists describe decentering as the mental operation in which a subject “moves out” of immersion in a mental state. Such decentering is philosophically puzzling. It involves that a subject attends to her mental state to distance herself from it. That is, she attends to the state to make it less determining of her processing. This paper provides a philosophical explanation of the nature of decentering. It analyses decentering as a complex mental operation composed of two sub-operations: introspection and detachment. (...) Drawing on this analysis, the paper argues that decentering involves certain dynamics of attention and attention control that pose an important challenge to a selection for action theory of attention. This challenge concerns adequately describing the workings of detachment in decentering. The paper discusses how a selection for action theory might reply, yet it argues that all the available replies involve unattractive aspects. The paper closes with broader perspectives, suggesting that decentering might also pose a puzzle for other theories of attention. (shrink)

This paper offers an overview of the philosophical work on epistemic injustices as it relates to psychiatry. After describing the development of epistemic injustice studies, we survey the existing literature on its application to psychiatry. We describe how the concept of epistemic injustice has been taken up into a range of debates in philosophy of psychiatry, including the nature of psychiatric conditions, psychiatric practices and research, and ameliorative projects. The final section of the paper indicates future directions for philosophical research (...) of epistemic injustices and psychiatry, concerning neurocognitive disorders, identity prejudices in psychiatric illness, concepts of epistemic privilege in psychiatry, and the prospects for combining phenomenological psychopathology and epistemic justice. We argue that much remains to be done in the conceptualization of these epistemic injustices and suggest that this future work should be multidisciplinary in character and sensitive to the phenomenology of psychiatric conditions. (shrink)

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

I develop and defend the view that subjects are necessarily psychologically able to revise their beliefs in response to relevant counter-evidence. Specifically, subjects can revise their beliefs in response to relevant counter-evidence, given their current psychological mechanisms and skills. If a subject lacks this ability, then the mental state in question is not a belief, though it may be some other kind of cognitive attitude, such as a supposi-tion, an entertained thought, or a pretense. The result is a moderately revisionary (...) view of belief: while most mental states we thought were beliefs are beliefs, some mental states which we thought were beliefs are not beliefs. The argument for this view draws on two key claims: First, subjects are rationally obligated to revise their beliefs in response to relevant counter-evidence. Second, if some subject is rationally obligated to revise one of her mental states, then that subject can revise that mental state, given her current psychological mechanisms and skills. Along the way to defending these claims, I argue that rational obligations can govern activities which reflect on one’s rational character, whether or not those activities are under one’s voluntary control. I also show how the relevant version of epistemic ‘ought’ implies ‘can’ survives an objection which plagues other variants of the principle. (shrink)

Psychedelic Harm Reduction and Integration is a transtheoretical and transdiagnostic clinical approach to working with patients who are using or considering using psychedelics in any context. The ongoing discussion of psychedelics in academic research and mainstream media, coupled with recent law enforcement deprioritization of psychedelics and compassionate use approvals for psychedelic-assisted therapy, make this model exceedingly timely. Given the prevalence of psychedelic use, the therapeutic potential of psychedelics, and the unique cultural and historical context in which psychedelics are placed, it (...) is important that mental health providers have an understanding of the unique motivations, experiences, and needs of people who use them. PHRI incorporates elements of harm reduction psychotherapy and psychedelic-assisted psychotherapy, and can be applied in both brief and ongoing psychotherapy interactions. PHRI represents a shift away from assessment limited to untoward outcomes of psychedelic use and abstinence-based addiction treatment paradigms and toward a stance of compassionate, destigmatizing acceptance of patients' choices. Considerations for assessment, preparation, and working with difficult experiences are presented. (shrink)

This article advances a new analysis of stupidity as a distinctive form of cognitive failing. Section 1 outlines some problems in explicating this notion and suggests some desiderata. Section 2 sketches an existing model of stupidity, found in Kant and Flaubert, which serves as a foil for my own view. In section 3, I introduce my theory: I analyse stupidity as form of conceptual self-hampering, characterised by a specific aetiology and with a range of deleterious effects. In section 4, I (...) show how this proposal meets the desiderata and I clarify how it diverges from existing accounts. My position is close to a 'public health approach', in contrast to the virtue/vice framework employed by Engel or Mulligan. (shrink)

According to Victoria McGeer’s “scaffolding view” (SV) (McGeer 2019), responsibility is a matter of moral reasons-sensitivity (MRS) which, in turn, requires only a “susceptibility to the scaffolding power of the reactive attitudes, experienced as a form of moral address” (2019: 315). This claim prompts a prima facie challenge: doesn’t this susceptibility lead to doing the right things for the wrong reasons? Although the SV offers a nuanced and sophisticated answer to this challenge, one that moreover respects the social nature of (...) moral knowledge and the fragility of moral motivation, it does not succeed. It redefines MRS to fit our responsibility practices in a way that overlooks our (fragile) capacity for “genuine MRS.” The first and primary objective of this paper is to contrast SV-MRS with genuine MRS. The second objective is to suggest that rather than redefining MRS (which is both unwarranted and costly), we should accept that there is a gap between our practices (and thus responsible agency) and genuine MRS. (shrink)

The brain disease model of addiction is widely endorsed by agencies concerned with treating behavioral disorders and combatting the stigma often associated with addiction. However, both its accuracy and its effectiveness in reducing stigma have been challenged. A proposed alternative, the “choice” model, recognizes the residual rational behavior control capacities of addicted individuals and their ability to make choices, some of which may cause harm. Since harmful choices are ordinarily perceived as blameworthy, the choice model may inadvertently help justify stigma. (...) This paper seeks to fully naturalize the choice model by highlighting the determinants of voluntary action and thus increase its potential for destigmatizing addiction. In light of a deterministic understanding of behavior, it is unreasonable to suppose that addicted individuals could have made different choices in becoming addicted and in subsequent situations. To the extent that stigma is motivated by the supposition that addicted individuals could have chosen otherwise in actual situations, a deterministic understanding of addictive behavior promises to mitigate blame and stigma. (shrink)

I argue that influential recent discussions have whitewashed blame, characterizing it in ways that deemphasize or ignore its morally problematic features. I distinguish “definitional,” “creeping,” and “emphasis” whitewash, and argue that they play a central role in overall endorsements of blame by T.M. Scanlon, George Sher, and Miranda Fricker. In particular, these endorsements treat blame as appropriate by definition (Scanlon), or as little more than a wish (Sher), and infer from blame's having one useful function that it is a good (...) practice overall (Fricker). I use an analogy with revenge to illustrate the mechanisms of whitewashing, including broadening a concept to include available alternatives to it and inference from one feature of a practice to an overall conclusion about that practice. Several features of blame make it particularly prone to whitewashing, including blamers' personal or emotional stake in blaming and widespread disagreement about the nature of blame. I argue that a non‐whitewashing treatment of blame must pay closer attention both to blame's harms, and to comparisons between blame and alternative, non‐blaming reactions. (shrink)

While some form of loss of control is often assumed to be a common feature of the diverse manifestations of addiction, it is far from clear how loss of control should be understood. In this paper, I put forward a concept of decrease in control in addiction that aims to fill this gap and thus provide a general framework for thinking about addictive behavior. The development of this account involves two main steps. First, I present a view of degrees of (...) control as the degree to which an agent would be responsive to potential or counterfactual sufficient reasons to do otherwise. Second, I sketch an account of the relevant control-undermining factors in addiction that is consonant with my proposed view of degrees of control. Being a high-level functional property, reasons-responsiveness is particularly well suited to frame an account of control-undermining factors that is doubly pluralistic: it encompasses the contribution of factors both internal and external to the agent, and it is consistent with various proposals as to the precise nature of the anomaly taking place in the psychology of addiction. (shrink)

This paper assesses two accounts of what it means to have a moral responsibility. According to the desert account, moral responsibility amounts to deserving credit or blame for doing or failing to do things. According to an alternative theory, the demand account, moral responsibility amounts to being subject to a moral requirement, such as an obligation or duty. On this account, moral responsibility identifies the presence of a moral demand that may or may not be accompanied by desert. Experiments are (...) conducted to test these accounts in ordinary moral judgment. Results indicate that moral judgment has both a demand and a desert function, that responsibility can pattern with the demand function, and that responsibilities are attributed without blame, criticism, or punishment when several determinants of moral judgment, such as conscious awareness, intention, belief, and neurodeterminism are manipulated. Results also suggest that having a responsibility is distinguished from being responsible for something, that the latter can pattern with the desert function, and that paradoxically, one can have a responsibility that one is not responsible for. These findings advance our understanding of moral responsibility, the processes underlying moral judgment in moral psychology, and conceptual clarity in moral philosophy. (shrink)

There is a strong presumption that mental disorder injures a person's autonomy, understood as a set of capacities and as an ideal condition of agency which is worth striving for. However, recent multidimensional approaches to autonomy have revealed a greater diversity in ways of being autonomous than has previously been appreciated. This presumption, then, risks wrongly dismissing variant, neuro-atypical sorts of autonomy as non-autonomy. This is both an epistemic error, which impairs our understanding of autonomy as a phenomenon, and a (...) moral error, which withholds recognition and respect that autonomous agents are due. I argue that careful attention to the different 'shapes' of agent's autonomy reveals that there are indeed distinctive kinds of neuro-atypical autonomy that are widely mistaken for non-autonomy. This project argues for two propositions. First, that there is a kind of autonomy, with a distinctive shape and texture, available to bipolar agents. This is a variant sort of autonomy, but not a defective or deficient sort. It is the ideal of autonomy that it is worth bipolar agents striving for, given the range and intensity of experiences that they will have to confront. Whilst bipolar autonomy will look unlike more neurotypical kinds of autonomy, it continues to be owed recognition. The second proposition is that we should understand the ideal of autonomy to be both pluralist and highly context sensitive. Given the range of starting points from which agents will strive to an ideal of autonomy, there will be some variation in the ideals worth striving for. The variation in ideals will reflect the existential realities they are local to. Theory of autonomy must be adapted to recognise bipolar, and other neuro-atypical, kinds of autonomy, and to reflect this wider pluralism. These propositions will be argued for with careful attention to the experiences and agency of people living with bipolar, or related, disorders. Understanding the ways that manic or depressive episodes, and the shifts between them, alter and apply pressure to our agency will inform an account of the distinctively bipolar autonomy that can be built on top of it. (shrink)

The addiction literature is fraught with conceptual confusions, stalled debates, and an unfortunate lack of clear and careful attempts to delineate the phenomenon of addiction in a way that might lead to consensus. My dissertation has two overarching aims, one metaphysical and one practical. -/- The first aim is to defend an account of addiction as the systematic disposition to fail to control one’s desires to engage in certain types of behaviors. I defend the inclusion of desires and impaired control (...) in the definition, and I flesh out the notion of systematicity central to my dispositionalist framework. I engage the so-called ‘disease vs. choice’ debate, criticizing its presupposition that we are dealing here with a dichotomy and arguing that the movement towards a middle ground is the right track to take. I explain how the dispositionalist account can capture this middle ground and how it serves to expand upon existing views, in particular by filling in the metaphysical details. -/- The second aim is to show how the account I defend can help to unify the extant views and disciplinary perspectives in the literature. Both the dispositionalist aspect of my framework and the methodology adopted (applied ontology and systematic metaphysics) can move the literature towards both substantive and methodological unification. This will help to clear up conceptual confusions, resolve (or sometimes dissolve) apparently intractable disputes, situate different research perspectives with respect to each other, facilitate interdisciplinary dialogue, and help to frame important questions about addiction. Finally, I offer the beginnings of an ontology of addiction, which will provide a terminologically well-structured guide to the addiction literature in a way that will facilitate more effective and efficient communication and data management across disciplines. (shrink)

A dominant view of guilt and shame is that they have opposing action tendencies: guilt- prone people are more likely to avoid or overcome dysfunctional patterns of behaviour, making amends for past misdoings, whereas shame-prone people are more likely to persist in dysfunctional patterns of behaviour, avoiding responsibility for past misdoings and/or lashing out in defensive aggression. Some have suggested that addiction treatment should make use of these insights, tailoring therapy according to people’s degree of guilt-proneness versus shame-proneness. In this (...) paper, we challenge this dominant view, reviewing empirical findings from others as well as our own to question (1) whether shame and guilt can be so easily disentangled in the experience of people with addiction, and (2) whether shame and guilt have the opposing action tendencies standardly attributed to them. We recommend a shift in theoretical perspective that explains our main finding that both emotions can be either destructive or constructive for recovery, depending on how these emotions are managed. We argue such management depends in turn on a person’s quality of self-blame (retributive or ‘scaffolding’), impacting upon their attitude towards their own agency as someone with fixed and unchanging dispositions (shame and guilt destructive for recovery) or as someone capable of changing themselves (shame and guilt productive for recovery). With an eye to therapeutic intervention, we then explore how this shift in attitude towards the self can be accomplished. Specifically, we discuss empathy-driven affective and narratively-driven cognitive components of a process that allow individuals to move away from the register of retributive self-blame into a register of scaffolding ‘reproach’, thereby enabling them to manage their experiences of both shame and guilt in a more generative way. (shrink)

In this chapter we focus on the structure of close personal relations and diagnose how these relationships are disrupted by addiction. We draw upon Peter Strawson’s landmark paper ‘Freedom and Resentment’ (2008, first published 1962) to argue that loved ones of those with addiction veer between, (1) reactive attitudes of blame and resentment generated by disappointed expectations of goodwill and reciprocity, and (2) the detached objective stance from which the addicted person is seen as less blameworthy but also as less (...) fit for ordinary interpersonal relationships. We examine how these responses, in turn, shape the addicted person’s view of themselves, their character and their capacities, and provide a negative narrative trajectory that impedes recovery. We close with a consideration of how these effects might be mitigated by adopting less demanding variations of the participant stance. (shrink)