Psychopathology and Free Will

"... what makes a piece of behaviour an action, as opposed to a mere bodily movement, like an automatic reflex, is that it is voluntary. This means that there is the capacity for genuine choice between possible courses of action."

"How is it possible to hold that a person could be powerless to prevent the complicated, diachronic, planned and executed instrumental actions that comprise drug-seeking and drug-taking behaviour? Is it really credible that at no point is there the possibility of an alternative course of action for an addict, that these desires are irresistible?"

"... there are reasons apart from compulsion for holding that responsibility is diminished or blame inappropriate: powerlessness s not the only possible excuse or mitigating condition, let alone ground for an attitude of compassion and concern ... Indeed, clinical practice with patients with disorders of agency typically distinguishes sharply between the appropriateness of holding a patient responsible for behaviour, and blaming them ... Responsibility is central to effective treatment: agency cannot be denied. But blame is detrimental: sympathy and compassion must nonetheless be maintained."

A three-pronged approach:

  1. The patient is encouraged to go "cold turkey" with respect to the behavior in question.
  2. The patient learns to identify "triggers" for the behavior, and to identify alternative strategies to cope with them.
  3. The patient is offered empathy and understanding in a non-judgmental environment.

Inability to do otherwise is not established by ...

  • The difficulty of withdrawal symptoms
  • The neurobiological effects of addiction
  • The testimony of addicts

Though addicts can do otherwise, they often don't:

  • Because of their strong desires and well-learned habits
  • Because they lack willpower
  • Because giving into their addiction has (at least short-term) benefits
  • Because they lack external motivations and incentives
  • Because they lack resolve due to their belief that they are powerless

Why should philosophers care about "real" addicts as opposed to ones that are just conceptually possible?

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