Neil Levy argues that while addicts who believe they are not addicts are self-deceived, addicts who believe they are addicts are just as self-deceived. Such persons accept a false belief that their addictive behaviour involves a loss of control. This paper examines two implications of Levy's discussion: that accurate self-knowledge may be particularly difficult for addicts; and that an addict's self-deceived belief that they cannot control themselves may aid their attempts at self-control. I argue that the self-deceived beliefs of addicts (...) in denial and of self-described addicts differ in kind. Unlike the self-deception of an addict in denial, that of the self-described addict allows them to acknowledge their behaviour. As such, it may aid an addict to develop more self-control. A paradoxical implication is that this self-deception may allow an addict more self-knowledge. (shrink)

Everyone loves a good story. But does everyone live a good story? It has frequently been asserted by philosophers, psychologists and others interested in understanding the distinctive nature of human existence that our lives do, or should, take a narrative form. Over the last few decades there has been a steady and growing focus on this narrative approach within philosophical discussions of personal identity, resulting in a wide range of narrative identity theories. While the narrative approach has shown great promise (...) as a tool for addressing longstanding and intractable problems of personal identity, it has also given rise to much suspicion. Opponents of this approach charge it with overstating or distorting the structure of actual lives. (shrink)

There is evidence to suggest that some patients who undergo Deep Brain Stimulation can experience changes to dispositional, emotional and behavioural states that play a central role in conceptions of personality, identity, autonomy, authenticity, agency and/or self. For example, some patients undergoing DBS for Parkinson’s Disease have developed hypersexuality, and some have reported increased apathy. Moreover, experimental psychiatric applications of DBS may intentionally seek to elicit changes to the patient’s dispositional, emotional and behavioural states, in so far as dysfunctions in (...) these states may undergird the targeted disorder. Such changes following DBS have been of considerable interest to ethicists, but there is a considerable degree of conflict amongst different parties to this debate about whether DBS really does change PIAAAS, and whether this matters. This paper explores these conflicting views and suggests that we may be able to mediate this conflict by attending more closely to what parties to the debate mean when they invoke the concepts lumped together under the acronym PIAAAS. Drawing on empirical work on patient attitudes, this paper outlines how these different understandings of the concepts incorporated into PIAAAS have been understood in this debate, and how they may relate to other fundamental concepts in medical ethics such as well-being and autonomy. The paper clarifies some key areas of disagreement in this context, and develops proposals for how ethicists might fruitfully contribute to future empirical assessments of apparent changes to PIAAAS following DBS treatment. (shrink)

Deep brain stimulation has been of considerable interest to bioethicists, in large part because of the effects that the intervention can occasionally have on central features of the recipient’s personality. These effects raise questions regarding the philosophical concept of authenticity. In this article, we expand on our earlier work on the concept of authenticity in the context of deep brain stimulation by developing a diachronic, value-based account of authenticity. Our account draws on both existentialist and essentialist approaches to authenticity, and (...) Laura Waddell Ekstrom’s coherentist approach to personal autonomy. In developing our account, we respond to Sven Nyholm and Elizabeth O’Neill’s synchronic approach to authenticity, and explain how the diachronic approach we defend can have practical utility, contrary to Alexandre Erler and Tony Hope’s criticism of autonomy-based approaches to authenticity. Having drawn a distinction between the authenticity of an individual’s traits and the authenticity of that person’s values, we consider how our conception of authenticity applies to the context of anorexia nervosa in comparison to other prominent accounts of authenticity. We conclude with some reflections on the prudential value of authenticity, and by highlighting how the language of authenticity can be invoked to justify covert forms of paternalism that run contrary to the value of individuality that seems to be at the heart of authenticity. (shrink)

Drug use and drug addiction are severely stigmatised around the world. Marc Lewis does not frame his learning model of addiction as a choice model out of concern that to do so further encourages stigma and blame. Yet the evidence in support of a choice model is increasingly strong as well as consonant with core elements of his learning model. I offer a responsibility without blame framework that derives from reflection on forms of clinical practice that support change and recovery (...) in patients who cause harm to themselves and others. This framework can be used to interrogate our own attitudes and responses, so that we can better see how to acknowledge the truth about choice and agency in addiction, while avoiding stigma and blame, and instead maintaining care and compassion alongside a commitment to working for social justice and good. (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)

Addiction involves a chronic deficit in self-governance that treatment aims to restore. We draw on our interviews with addicted people to argue that addiction is, in part, a problem of self-narrative change. Over time, agents come to strongly identify with the aspects of their self-narratives that are consistently verified by others. When addiction self-narratives become established, they shape the addicted person’s experience, plans, and expectations so that pathways to recovery appear implausible and feel alien. Therefore, the agent may prefer to (...) enact her disvalued self-narrative because at least it represents who she takes herself to be. To recover, the agent needs to conduct narrative work, adjusting her existing self-narrative so that it better supports recovery-directed narrative projections. Reducing cravings, managing withdrawals, increasing self-control, and developing goals are all important for recovery but those approaches will often be in vain if the influence of self-narrative is ignored. If our analysis is correct, addiction treatment will typically be more effective if it incorporates support for self-narrative change. (shrink)

All people are vulnerable to having their self-concepts shaped by others. This article investigates that vulnerability using a theory of narrative self-constitution. According to narrative self-constitution, people depend on others to develop and maintain skills of self-narration and they are vulnerable to having the content of their self-narratives co-authored by others. This theoretical framework highlights how vulnerability to co-authoring is essential to developing a self-narrative and, thus, the possibility of autonomy. However, this vulnerability equally entails that co-authors can undermine autonomy (...) by contributing disvalued content to the agent’s self-narrative and undermining her authorial skills. I illustrate these processes with the first-hand reports of several women who survived sexual abuse as children. Their narratives of survival and healing reveal the challenges involved in developing the skills required to manage vulnerability to co-authoring and how others can help in this process. Finally, I discuss some of the implications of co-authoring for the healthcare professional and the therapeutic relationship. (shrink)

Recent work on diachronic agency has challenged the predominantly structural or synchronic approach to agency that is characteristic of much of the literature in contemporary philosophical moral psychology. However, the embodied dimensions of diachronic agency continue to be neglected in the literature. This article draws on phenomenological perspectives on embodiment and narrative conceptions of the self to argue that diachronic agency and selfhood are anchored in embodiment. In doing so, the article also responds to Diana Meyers' recent work on corporeal (...) selfhood. (shrink)

Addiction is almost universally held to be characterized by a loss of control over drug-seeking and consuming behavior. But the actions of addicts, even of those who seem to want to abstain from drugs, seem to be guided by reasons. In this paper, I argue that we can explain this fact, consistent with continuing to maintain that addiction involves a loss of control, by understanding addiction as involving an oscillation between conflicting judgments. I argue that the dysfunction of the mesolimbic (...) dopamine system that typifies addictions causes the generation of a mismatch between the top-down model of the world that reflects the judgment that the addict ought to refrain from drugs, and bottom-up input caused by cues predictive of drug availability. This constitutes a powerful pressure toward revising the judgment and thereby attenuating the prediction error. But the new model is not stable, and shifts under the pressure of bottom-up inputs in different contexts; hence the oscillation of all-things-considered judgment. Evidence from social psychology is adduced, to suggest that a similar process may be involved in ordinary cases of weakness of will. (shrink)

If there is one value that seems beyond reproach in modernity, it is that of the self and the terms that cluster around it, such as self-esteem, self-confidence and self-respect. It is not clear, however, that all those who invoke the self really know what they are talking about, or that they are all talking about the same thing. What is this thing called 'self', then, and what is its psychological, philosophical and educational salience? More specifically, what role do emotions (...) play in the creation and constitution of the self? This book proposes a realist, emotion-grounded conception of selfhood. In arguing for a closer link between selfhood and emotion than has been previously suggested, the author critically explores and integrates self research from diverse academic fields. This is a provocative book that should excite anyone interested in cutting-edge research on self-issues and emotions that lies at the intersection of psychology, philosophy of mind, moral philosophy and moral education. (shrink)

Being in Time examines philosophical treatments of time and self-consciousness in relation to concepts of narrative, focusing on the literary aspects of philosophical writing. Lloyd shows how philosophy bears on the human and emotional aspects of the experience of time which are often neglected by the history of philosophy. Starting with Augustine's treatment of the ways in which time makes him a 'problem to himself', the book traces the themes of unity and the experience of fragmentation and loss as expressed (...) by Descartes, Hume and Kant. The idea of the past as 'lost' is explored through Bergson's philosophy of time and Nietzsche's doctrine of eternal return. The book concludes with a discussion of philosophical aspects of themes of self-consciousness, memory and writing in Proust's Remembrance of Things Past and the novels of Virginia Woolf. (shrink)

Why do some addicted people chronically fail in their goal to recover, while others succeed? On one established view, recovery depends, in part, on efforts of intentional planning agency. This seems right, however, firsthand accounts of addiction suggest that the agent’s self-narrative also has an influence. This paper presents arguments for the view that self-narratives have independent, self-fulfilling momentum that can support or undermine self-governance. The self-narrative structures of addicted persons can entrench addiction and alienate the agent from practically feasible (...) recovery plans. Strategic re-narration can redirect narrative momentum and therefore support recovery in ways that intentional planning alone cannot. (shrink)