Many people, at one time or another, struggle with faith issues about sin, guilt, punishment, and hell. But a segment of the population, many of them Catholic, are so afraid of sin that their lives are marked with anxiety and fear. These people suffer from an affliction called scrupulosity. This book provides specific answers to questions and concerns related to sin, confession, self-worth, sexuality, prayer, God's forgiveness, thoughts, dreams, fantasies, and other issues. It offers words of encouragement and helpful (...) suggestions to those who suffer from this affliction and for those who counsel them. (shrink)

Scrupulosity is a form of OCD where patients obsess about morality and sometimes compulsively confess or atone. It involves chronic doubt and anxiety as well as deviant moral judgments. This chapter argues that Scrupulosity is a mental illness and that its distortion of moral judgments undermines, or at least reduces, patients’ moral responsibility. The authors go on to argue that this condition challenges popular deep-self theories of responsibility, which assert that one is only blameworthy or praiseworthy for actions (...) that arise from one’s deep self, from what one truly values. Patients with ego-syntonic Scrupulosity, however, identify with their condition and seem to have cares that reflect their deep selves, yet do not seem fully responsible for their actions or their consequences, such as neglecting the needs of their loved ones. Other theories, particularly reasons-responsiveness theories, better capture the ways in which responsibility in Scrupulosity is reduced. (shrink)

Psychologists and cultural historians typically have argued that early modern theologians such as Martin Luther, John Bunyan, and Ignatius Loyola exhibited behavior that the Diagnostic and Statistical Manual of Mental Disorders (DSM IV) classifies as a subtype of obsessive-compulsive disorder termed “religious scrupulosity.” This essay argues that, although early modern theologians do manifest scrupulosity, such religiosity was a culturally acceptable, even recommended component of spiritual progress, a necessary means of receiving an unmerited bestowal of God’s grace. The larger (...) aim of the essay is to point out some of the limitations of current DSM criteria when attempting retrospectively to diagnose historical figures with mental pathology. (shrink)

People with Scrupulosity have rigorous, obsessive moral beliefs that lead to extreme and compulsive moral acts. These fascinating outliers raise profound questions about human nature, mental illness, moral belief, responsibility, and psychiatric treatment. Clean Hands? Uses a range of case studies to examine this condition and its philosophical implications.

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)

David Shoemaker presents a new pluralistic theory of responsibility, based on the idea of quality of will. His approach is motivated by our ambivalence to real-life cases of marginal agency, such as those caused by clinical depression, dementia, scrupulosity, psychopathy, autism, intellectual disability, and poor formative circumstances. Our ambivalent responses suggest that such agents are responsible in some ways but not others. Shoemaker develops a theory to account for our ambivalence, via close examination of several categories of pancultural emotional (...) responsibility responses and their appropriateness conditions. The result is three distinct types of responsibility, each with its own set of required capacities: attributability, answerability, and accountability. Attributability is about the having and expressing of various traits of character, and it is the target of a range of aretaic sentiments and emotional practices organized around disdain and admiration. Answerability is about one’s capacity to govern one’s actions and attitudes by one’s evaluative judgments about the worth of various practical reasons, and it is the target of a range of sentiments and emotional practices organized around regret and pride. Accountability is about one’s ability to regard others, both evaluatively and emotionally, and it is the target of a range of sentiments and emotional practices organized around anger and gratitude. In Part One of the book, this tripartite theory is developed and defended. In Part Two of the book, the tripartite theory’s predictions about specific marginal cases are tested, once certain empirical details about the nature of those agents have been filled in and discussed. (shrink)

Scrupulosity raises fascinating issues about the nature of moral judgment and about moral responsibility. After defining scrupulosity, describing its common features, and discussing concrete case studies, we discuss three peculiar aspects of moral judgments made by scrupulous patients: perfectionism, intolerance of uncertainty, and moral thought-action fusion. We then consider whether mesh and reasons-responsiveness accounts of responsibility explain whether the scrupulous are morally responsible.

This chapter asks how moral shame and dread in Theravāda Buddhist philosophy compare with their appropriated use in contemporary Thai society. There has been a received view or an appropriated understanding of these concepts, warning against doing bad deeds. Moral shame and dread imply an irrational fear of doing something morally horrible in this contemporary usage. For example, one has an excessive fear of punishments in purgatory and believes it should be the sole morally appropriate reason for not killing. However, (...) how does this appropriated understanding differ from the original Buddhist understanding? This chapter argues that they differ in their philosophical assumptions: causalism and possibilism. Theravāda philosophy espouses causalism, the view that one should avoid bad deeds because of the doctrine of karma. On the other hand, the appropriated understanding implies possibilism, with a scrupulosity-based assumption that avoiding evil behaviors is motivated by the grip of unreasonable fear that doing them could result in irredeemable errors. I offer a new conception of meditative intentionality's power to solve this implied irrational fear problem. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Active Euthanasia and Assisted SuicidePat Milmoe McCarrick (bio)Although the President's Commission for the Study of Ethical Problems in Medicine and Biomedical and Behavioral Research in its 1983 report, Deciding to Forego Life-Sustaining Treatment, described the words and terms "euthanasia," "right to die," and "death with dignity" as slogans or code words—"empty rhetoric," (I, p. 24), the literature reviewed for this Scope Note continues to use these terms. Therefore, to (...) discuss the termination of a patient's life by a physician at the patient's request, the phrase active euthanasia is used, and the supplying of a means by a physician whereby a patient can end his or her life is referred to as assisted suicide.Euthanasia, either as the "good death" from classical Greek or "mercy killing" to end unbearable suffering in the dying, has long been a topic of interest in western civilization (III, Brody 1989). In recent years, public awareness of this discussion about control over the time of one's death has been informed by a series of well-publicized events. They include the November 1991 rejection by a vote of 54 percent to 46 percent of the Washington state Initiative 119, which would have allowed the option of requesting one's physician to "aid-in-dying" for adult patients in a "medically terminal condition" (V, Gross 1991); two medical journal articles describing physician's actions in helping bring death to two patients (V, Anonymous 1988; V, Quill 1991); Dr. Jack Kevorkian's assistance in the suicide of three women (V, Belkin 1990; V, Wilkerson 1991); and the best seller status of a how-to book on committing suicide with opiates obtained from a physician (III, Humphry 1991).For the most part, material included in the annotated bibliography in Scope Note 18 has been chosen from works published in the four years since "It's Over, Debbie" (V, Anonymous 1988) appeared in early January 1988 in the Journal of the American Medical Association.Dr. Edmund D. Pellegrino (V, 1991, pp. 3118-19) presented opposing views about active voluntary euthanasia as follows:Those who favor voluntary euthanasia argue that it is a beneficent and compassionate act; it respects autonomy by preserving the patient's control of the manner, method, [End Page 79] and timing of death; it takes the matter outside the reach of "medical power" (accessed in this Scope Note's bibliography at V, Fletcher 1973; V, Nowell-Smith 1989) and scrupulosity; and it prevents the injustice that allows some patients to choose death by refusal of life-support measures, while denying others the right to do so by active euthanasia....The opponents of active euthanasia argue that it undermines the value of, and respect for, all human life (V, Kass 1989; V, Coyle 1990; V, Singer 1990). They fear that guidelines cannot avoid sliding down the "slippery slope" to involuntary euthanasia and selective devaluation of the lives of the most vulnerable among us.... If euthanasia is legal, it is predicted that patients will feel subtle pressure to conform so as to relieve the economic and emotional burdens they impose on family and friends.Euthanasia, its opponents further argue, is socially destructive: it undermines trust in physicians, desensitizes society to killing, and imperils the ground already gained in legitimating passive euthanasia(IV, Wolf 1989).Physicians were not particularly involved with a patient's death until after World War II when participation grew in proportion to the growth of technology. Since the complex, life-sustaining equipment that could forestall death was located in a hospital, death itself became almost completely medicalized (V, Dagi 1991). For terminally ill persons who would like to die a painless death, either by their own hand or with assistance, physicians have almost a monopoly on obtaining strong drugs for distribution to patients (V, Abrams 1990).Active euthanasia for human beings is not legalized anywhere in the world (V, VonDrehle 1991). It is classified as homicide or murder in all fifty states and in Great Britain, Canada, Australia, and the Phillippines (V, Nerland 1989). Twentysix states in the United States prohibit assisted suicide by statute (V, Rosenblum 1990).In 1969 in the Netherlands, a physician named Jan Hendrik van... (shrink)

Discussions related to the detection of objective reality, the truth and lie are still a heated topic in the domain of philosophical epistemology. While certain philosophical contexts and theories suggest that the notion "reality as an independent category" should not be engaged, instead, interpretations, including reciprocal, should be used, others hold it that philosophical discussion cannot continue without reference to the said notion. Different philosophers and scolars approach this problem from different angles. When discussing these topics, philosophers often resort to (...) certain thought experiments, engaging an important concept, which can broadly be identified as "the global observer." This concept has something in common with such concepts as the God's Eye, Omniscient Interpreter, Ultimate Observer (quantum physics), Agent of Logical omniscience (game theories), Ideal Observer (ethics and meta-ethics), God (analytic theology). Despite the abundance of works on the topic and scrupulosity of arguments, there still remain many uncertainties in such discussions, mostly related to a great number of logical paradoxes, associated with the problem. Therefore, in view of the current situation, the focus of the research paper is on the deliberation of consistency of the notion "global observer" from the standpoint of logic and philosophy. The results of the analysis of the issue at stake are expected to clarify the notion and to enrich current discussions on the topic. I examine certain difficulties in the philosophical assumptions concerning one of the philosophical concepts, which could be collectively named as the "global observer." The article below explores the notion of the global observer as the guarantor of the determinability and configuration of events in the world. There is explained the meaning of this concept and attempt to show that, despite variations in the wording, it is used in many philosophical contexts related to epistemology. The core issue of the present research paper is the analysis of the consistency of the notion "global observer" from the standpoint of logic and philosophy. The paper discusses why application of this notion in some contexts poses challenges and appears to be paradoxical. (shrink)

Journalists say sometimes that the end does not justify the means, but they can act otherwise. Even if there are only rare instances in which the end can justify the means, some guidelines are needed to determine when those situations exist. I propose six questions for application to this thorny issue and for avoiding extremes of moral laxity and false scrupulosity.

Discussions related to the detection of objective reality, the truth and lie are still a heated topic in the domain of philosophical epistemology. While certain philosophical contexts and theories suggest that the notion "reality as an independent category" should not be engaged, instead, interpretations, including reciprocal, should be used, others hold it that philosophical discussion cannot continue without reference to the said notion. Different philosophers and scolars approach this problem from different angles. When discussing these topics, philosophers often resort to (...) certain thought experiments, engaging an important concept, which can broadly be identified as "the global observer." This concept has something in common with such concepts as the God's Eye, Omniscient Interpreter, Ultimate Observer (quantum physics), Agent of Logical omniscience (game theories), Ideal Observer (ethics and meta-ethics), God (analytic theology). Despite the abundance of works on the topic and scrupulosity of arguments, there still remain many uncertainties in such discussions, mostly related to a great number of logical paradoxes, associated with the problem. Therefore, in view of the current situation, the focus of the research paper is on the deliberation of consistency of the notion "global observer" from the standpoint of logic and philosophy. The results of the analysis of the issue at stake are expected to clarify the notion and to enrich current discussions on the topic. I examine certain difficulties in the philosophical assumptions concerning one of the philosophical concepts, which could be collectively named as the "global observer." The article below explores the notion of the global observer as the guarantor of the determinability and configuration of events in the world. There is explained the meaning of this concept and attempt to show that, despite variations in the wording, it is used in many philosophical contexts related to epistemology. The core issue of the present research paper is the analysis of the consistency of the notion "global observer" from the standpoint of logic and philosophy. The paper discusses why application of this notion in some contexts poses challenges and appears to be paradoxical. (shrink)

The Disordered Mind, Third Edition is a wide-ranging introduction to the philosophy of mental disorder or illness. It examines and explains, from a philosophical standpoint, what mental disorder is: its reality, causes, consequences, compassionate treatment, and more. Revised and updated throughout, the third edition includes enhanced discussions of the distinction between mental health and illness, selfhood and delusions about the self, impairments of basic psychological capacities in mental disorder and the distinct roles that mental causation and neural mechanisms play in (...) mental illness. The book is organized around four questions: What is a mental disorder or illness? What makes mental disorder something bad? What are various mental disorders and what do they tell us about the mind? What is mental health and how may it be restored? Numerous disorders are discussed including: addiction, agoraphobia, delusion, depression, dissociative identity disorder, obsession-compulsion, schizophrenia, and religious scrupulosity, among others. Several neurological disorders are examined. Various problems associated with DSM-5 and with psychiatric diagnosis are explored. Including chapter summaries and suggestions for further reading at the end of each chapter, The Disordered Mind presupposes no special background in philosophy, and as such will be of interest to those in related disciplines such as psychology, psychiatry and mental health, and professions such as nursing and social work. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Adolph Meyer’s Psychobiology in Historical Context, and Its Relationship to George Engel’s Biopsychosocial ModelEdwin R. Wallace IV (bio)Keywordspsychobiology, integrative models of psychiatry, biopsychosocial modelBefore addressing the importance of Adolf Meyer and the question of his impact on the biopsychosocial model of the psychoanalytical internist George Engel, let us tersely sketch the history of functionalism in medicine/psychiatry, and of the nineteenth/early twentieth century’s progressive abandonment of it in favor of (...) basic science reductive models of “disease,” not illness.FunctionalismWhereas Hippocratic physicians diagnosed diatheses in terms of humoral excesses or deficiencies, their primary emphasis was on the ill person. They began with careful histories of the patient’s complaints and his or her daily life course, customary activities, typical foods and beverages imbibed, and the exacerbation or relief of symptoms associated with any or all of these. They also asked questions about his physical and social environment. They carefully looked for any clinically pertinent signs, and might physically examine the patient or his excretions. When they arrived at a diagnosis (say, an excess of yellow or black bile, or of blood or phlegm), they would educate the patient about it and discuss possible approaches. Although leeching, emetics, or purgatives might be prescribed, “dietetics” was the core of the treatment. Much more than recommendations about dietary intake, this involved conversations about “lifestyle” management in general: exercise, fresh air, habit changes, and perhaps bathing in mineral waters or spas. If the patient were “melancholic” (which then included what we would now consider a variety of psychiatric disorders), he or she might be prescribed daily swimming and other forms of vigorous exercise, conversations with a philosopher, [End Page 347] attendance at theatrical comedies, or even referral to an Asklepian temple for “incubation sleep” and priestly dream interpretation. Often doctors worked closely with physical trainers, to whom they sent their patients. In short, their orientation was holistic (“mind”/”body” integration), directed first and foremost toward an individual ill person.In the second century, C.E. Galen, despite his humoral and anatomical pathologies, was similarly holistic or functionalist. He resorted to a variety of physical examinational methods while also attending to the patient’s mental/emotional status. He described one case where he was attending a woman for syncopal episodes. His examinations of her included his customary attention to the pulse. During one evening session, a servant entered and happened to mention that he had just seen the handsome Pylades dancing. Suddenly her pulse became irregular and she fainted straight away. This led Galen to consider love sickness, and perhaps not humoral or organ pathology. He tested his hypothesis during subsequent visits. Whenever another dancer or actor was mentioned, her pulse remained regular and her sensorium alert, but when Pylades was mentioned the irregular pulse and fainting recurred. Because she was married, Galen realized her insoluble conflict, and treated her accordingly.From the fall of Rome until the rise of University Medicine in the later Middle Ages, medical lore and doctoring was in monastic hands—each monastery had its clerical medic, who might also attend outsiders. They were attuned to the traditional triad of major mental disorders—mania, melancholia, and phrenitis—which they explained somatically. However, they also encountered lesser mental/emotional disorders for which they developed their own nosology. “Scrupulosity,” for example, characterized a committed monk with an unrealistic sense of sinfulness and guilt—which often drove him to self-mortification such as flagellation, hair shirts with chains underneath, and so forth, for which the remedy was kindly pastoral counseling. “Accedia” was akin to our “dysthymia,” whose sufferer was affected by sadness, lassitude, and impaired capacity to carry out the monastic routine. This was viewed as straddling the boundary between sickness and sin. Routine physical labor (“occupational therapy”) and prayers, confession, penance, and “pep talks” were prescribed.When universities with medical schools arose in the latter Middle Ages, students’ educations were mostly bookish and theoretical. Hippocratic and Galenic somatic orientations were still preeminent. (Vesalius would not publish his illustrated anatomical text until 1543.) Dietetics and purgatives, bloodletting, and so on were still favored treatments. Nevertheless, doctors gave considerable time and attention to their patients as ill... (shrink)

The five factor trait of conscientiousness is a supertrait, denoting on one hand a pattern of excessive labor, rigidity, orderliness and compulsivity, and on the other hand a pattern of strict rectitude, scrupulosity, dutifulness and morality. In both respects the obsessive-compulsive personality is conscientious; indeed, it has been labeled a disorder of extreme conscientiousness. Antisocial personality disorder, in the present paper, is described as occupying the opposite end of the conscientiousness continuum. The antisocial is impulsive rather than compulsive, illicit (...) rather than licit, and furtive rather than forthright.After clinically comparing the obsessive and antisocial personalities, the present paper invokes evolutionary theory to explain their resultant behavioral, ideological, political and demographic differences. (shrink)

The five factor trait of conscientiousnessis a supertrait, denoting on one hand a pattern of excessive labor, rigidity, orderliness and compulsivity,and on the other hand a pattern of strict rectitude, scrupulosity, dutifulness and morality. In both respects the obsessive-compulsive personality is conscientious; indeed, it has been labeled a disorder of extreme conscientiousness. Antisocial personality disorder, in the present paper, is described as occupying the opposite end of the conscientiousness continuum. The antisocial is impulsive rather than compulsive, illicit rather than (...) licit, and furtive rather than forthright.After clinically comparing the obsessive and antisocial personalities, the present paper invokes evolutionary theory to explain their resultant behavioral, ideological, political and demographic differences. (shrink)

By focusing discussion through Søren Kierkegaard's view of Martin Luther's initiation into the monastery , it is suggested that an analogy can be discerned for Kierkegaard's own sense of divine vocation and the ensuing self‐mortification of melancholy and religious scrupulosity which commentators have suspected in both figures. Kierkegaard's often ambivalent critique of Luther's Anfechtung is thus read as bearing ironic significance for his own struggles with ‘spiritual trial’ [Anfægtelse]. In this reading, Luther's Anfechtung is taken to signify for Kierkegaard (...) both the anguish inherent to the authentic God‐relationship and also the dangerous possibility of the individual imagination's [Phantasi] capitulation into the precariously embellished realm of ‘the fantastic’ [Phantastiske]. It is here that Kierkegaard's emphasis upon individual responsibility – contrasted with Luther's concentration upon the role of the devil – demonstrates the fundamental differentiation between Kierkegaard's anatomy of Anfægtelse and Luther's Anfechtung. (shrink)

This groundbreaking volume of original essays presents fresh avenues of inquiry at the intersection of philosophy and psychiatry. Contributors draw from a variety of fields, including evolutionary psychiatry, phenomenology, biopsychosocial models, psychoanalysis, neuroscience, neuroethics, behavioral economics, and virtue theory. Philosophy and Psychiatry’s unique structure consists of two parts: in the first, philosophers write five lead essays with replies from psychiatrists. In the second part, this arrangement is reversed. The result is an interdisciplinary exchange that allows for direct discourse, and a (...) volume at the forefront of defining an emerging discipline. Philosophy and Psychiatry will be of interest to professionals in philosophy and psychiatry, as well as mental health researchers and clinicians. (shrink)

This level-raising contribution to the theory of interpretation is marked by sophistication, soundness, scrupulosity, and good sense.