Steve Matthews

What is the role and value of pleasure in addiction? Foddy and Savulescu have claimed that substance use is just pleasure-oriented behavior. They describe addiction as "strong appetites toward pleasure" and argue that addicts suffer in significant part because of strong social and moral disapproval of lives dominated by pleasure seeking. But such lives, they claim, can be autonomous and rational. The view they offer is largely in line with the choice model and opposed to a disease model of addiction. Foddy and Savulescu are sceptical of self-reports that emphasize the ill effects of addiction such as loss of family and possessions, or that claim an absence of pleasure after tolerance sets in. Such reports they think are shaped by social stigma which makes available a limited set of socially approved addiction narratives. We will not question the claim that a life devoted to pleasure can be autonomously chosen. Nor do we question the claim that the social stigma attached to the use of certain drugs increases the harm suffered by the user. However our interviews with addicts reveal a genuinely ambivalent and complex relationship between addiction, value, and pleasure. Our subjects did not shy away from discussing pleasure and its role in use. But though they usually valued the pleasurable properties of substances, and this played that did not mean that they valued an addictive life. Our interviews distinguished changing attitudes towards drug related pleasures across the course of substance use, including diminishing pleasure from use over time and increasing resentment at the effects of substance use on other valued activities. In this paper we consider the implications of what drug users say about pleasure and value over the course of addiction for models of addiction. Well don't get me wrong, I love using mate. If I could use successfully I would. I'd still be using. I love using. I just don't like the shit that comes with it.

Psychotherapy and counselling services are now available on-line, and expanding rapidly. Yet there appears almost no ethical analysis of this on-line mode of delivery of such professional services. In this paper I present such an analysis by considering the limitations on-line contact imposes on the nature of the professional–client relationship. The analysis proceeds via the contrast between the face-to-face case and the on-line case. At the core of the problem must be the recognition that on-line interaction imposes a physical barrier largely permitting only those disclosures of self we choose to make available, and greatly restricting the range of involuntary features and behaviours. I show why this is problematic, first, for the development of a close professional–client relationship, with particular emphasis on such failures as diagnosis and monitoring of the patient. Second I describe the importance of the development of professional character, and of how the on-line environment fails to provide a context for such character traits to emerge and develop.

In some recent criminal cases in the United States a defense has been mounted based on an affliction known as Dissociative Identity Disorder (DID) (formerly Multiple Personality Disorder). The crux of the defense rests on the proposition that a dominant personality was incapable of appreciating the nature and quality of wrongfulness of conduct caused by an alter personality. This defense has been successful in some cases, but not others, and so philosophers, lawyers, and psychiatrists are now in debate in an attempt to clarify the issues. One of the salient issues involves the question of personal identity between the individual who allegedly committed the offense and the individual who stands accused. Stephen Behnke and Walter Sinnott-Armstrong have recently put forward a test for establishing personal identity in these cases. In this discussion, I present reasons for rejecting their proposal.

The condition known as Multiple Personality Disorder (MPD) or Dissociative Identity Disorder (DID) is metaphysically strange. Can there really be several distinct persons operating in a single body? Our view is that DID sufferers are single persons with a severe mental disorder. In this paper we compare the phenomenology of dissociation between personality states in DID with certain delusional disorders. We argue both that the burden of proof must lie with those who defend the metaphysically extravagant Multiple Persons view and that there is little theoretical motivation to yield to that view in light of the fact that the core symptoms of DID bear remarkable similarity to the symptoms of these other disorders where no such extravagance is ever seriously entertained.

Mary Walker (2012) argues that the narrative form that self-understanding must take is capable of providing a largely truthful picture of who we are, despite neuropsychological evidence suggesting the contrary. Walker describes three approaches to counter the conclusion of falsity in self narratives: that some truths are fully intelligible only within a narrative structure; that narratives contain non-factual content with a significance and meaning otherwise unavailable; thirdly, and importantly for our purposes, she offers a constraint ‘on what can count as a correct or good self-narrative...to point to ways in which the process of self-narration should be connected to the facts’. In this commentary we elaborate and offer further support to Walker’s claim that ‘continual intersubjective checking’ provides a dynamic and corrective social mechanism for ensuring truth in self narratives.

Substance use and misuse occurs at a very high rate among people with mental health problems and the relationship between the two conditions is complex. In this paper we argue that treatment of substance use in dual diagnosis clients must begin from an understanding of the losses suffered by those with mental illness. We outline the fundamental condition of effective agency, unified agency, which is disrupted in mental illness and show how this is needed to secure access to central social and moral goods such as continuing employment and satisfying relationships. We argue that drug use will be disvaluable primarily in so far as it too prevents access to this set of agential goods and focuses the agent on synchronic well-being to the exclusion of diachronic well-being. The goals and methods of treatment for dual diagnosis patients should thus reflect the primary impairment to unified agency.

This entry has two general aims. The first is to profile the practices of neuromarketing (both current and hypothetical), and the second is to identify what is ethically troubling about these practices. It will be claimed that neuromarketing does not really present novel ethical challenges, and that marketers are simply continuing to do what they have always done, only now they have at their disposal the tools of neuroscience which they have duly recruited. What will be presupposed is a principle of proportionality: marketing practices are morally objectionable commensurate with the degree to which they impugn the moral sovereignty of market actors. With this principle in mind, it is important to consider the literature which is sceptical about the potential for neuromarketing to be successful. If its claims are overblown, as will be suggested, then the ethical threat neuromarketing is said to pose, can be viewed also as overblown. An area that has worried many is that neuromarketing poses a threat to brain privacy, and so an analysis will be given of the nature of this threat, given the principle of proportionality. It will be argued that worries about brain privacy seem, prima facie, to be justified, but on closer analysis, fall away. However, a residual threat to privacy does remain: the collection over time, and aggregation of private brain information, where the target loses control over its ownership and distribution.

Marya Schechtman argues that psychological continuity accounts of personal identity, as represented by Derek Parfit's account, fail to escape the circularity objection. She claims that Parfit's deployment of quasi-memory (and other quasi-psychological) states to escape circularity implicitly commit us to an implausible view of human psychology. Schechtman suggests that what is lacking here is a coherence condition, and that this is something essential in any account of personal identity. In response to this I argue first that circularity may be escaped using quasi-psychological states even with the addition of the coherence condition. Second, I argue that there is something right about the coherence condition, and a major task of this paper is to identify its proper theoretical role. I do so by reflection on integration therapies for people with multiple personality disorder (MPD). The familiar distinction between the moral and the metaphysical concept of the person is developed alongside such reflection. Connecting these two issues I argue that coherence acts as a normative constraint on accounts of personal identity, but that the normative dimension of personhood is not essential to our notion of a person tout court

In this article I argue that insanity defences such as M’Nagten should be abolished in favour of a defence of failed agency. It is not insanity per se, or any other empirical condition, which constitutes the moral reason for exculpation. Rather, we should first recognize the conditions for being a responsible moral agent. These include some capacity to direct and control one’s behavior, a non-delusional component, and the capacity to recognize that one’s behavior is expressive of what they have reason to be doing. When either of these fail in a case involving alleged criminal behavior the defence of failed agency may be appealed to. There may be many causes, including and besides insanity, that give rise to use of the defence of failed agency.

We will analyze the concept of anonymity, along with cognate notions, and their relation to privacy, with a view to developing an understanding of how we control our identity in public and why such control is important in developing and maintaining our social selves. We will take anonymity to be representative of a suite of techniques of nonidentifiability that persons use to manage and protect their privacy. At the core of these techniques is the aim of being untrackable; this means that others lack the information they would need either to intrude physically upon me or to discover some private facts about me. Anonymity often enough goes together with privacy, but not always. Consider a person walking down a foreign street. It is not a physically private situation but no one there knows who you are. On the other hand, when I cast a postal vote, this act is both private and anonymous. Privacy and anonymity seem to go together because of the way each protects something importantly personal, but their coming apart suggests a difference both in what they mean and in our purposes for securing them. A lot has been written about privacy, and deservedly so; there is reason to think anonymity, and its cognates, important as well

Dissociative Identity Disorder (DID) (formerly known as Multiple Personality Disorder) is a condition in which a person appears to possess more than one personality, and sometimes very many. Some recent criminal cases involving defendants with DID have resulted in "not guilty" verdicts, though the defense is not always successful in this regard. Walter Sinnott-Armstrong and Stephen Behnke have argued that we should excuse DID sufferers from responsibility, only if at the time of the act the person was insane (typically delusional); otherwise the presumption should be that persons with DID are indeed responsible for their actions. We find their interpretation of DID and of the way in which the requirements for criminal insanity relate to this condition worrying and likely to result in injustice to DID sufferers. Our thesis is that persons with DID cannot be responsible for their actions if the usual features of the condition are present. A person with DID is a single person in the grip of a very serious mental disorder. By focusing on the features of DID which have, as we argue, the effect of deluding the patient, we try to show that such a person is unable to fulfill the ordinary conditions of responsible agency (namely, autonomy and self-control).

The quality of our public discourse – think of the climate change debate for instance – is never very high. A day spent observing it reveals a litany of misrepresentation and error, argumentative fallacy, and a general lack of good will. In this paper I focus on a microcosmic aspect of these practices: the use of two types of argument – the argumentum ad hominem and appeal to authority – and a way in which they are related. Public debate is so contaminated by the misuse of the ad hominem tactic that it is important to have an understanding of one of the ways in which its use may be legitimate. So readers who might have expected an analysis of the ad hominem fallacy will, on the contrary, be presented with an account of one of the places for its potential success. In ad hominem, arguers are viewed as legitimate constitutive targets for their own argument; in authority arguments, arguers provide a legitimate constitutive warrant for an argument they deploy. These types of argument are connected in so far as the identities of persons deploying them carry the cognitive weight of the argument. If authority arguments sometimes deserve to succeed, ad hominem attacks on them are potentially legitimate. An important motivation for this analysis is that in identifying the success conditions for one of the ad hominem types we attain some clarity in the evaluation of their use.

Significant numbers of people believe that victims of violent crime are blameworthy in so far as they imprudently place themselves in dangerous situations. This belief is maintained and fuelled by ongoing social commentary. In this paper I describe a recent violent criminal case, as a foil against which I attempt to extract and refine the argument based on prudence that seems to support this belief. I then offer a moral critique of what goes wrong when this argument, continually repeated as social commentary, is left unchallenged. The effect of failing to challenge this repeated argument is the view, held by many, that the vulnerable are imprudent; indeed, they are believed negatively responsible (partly or wholly) for the violence wrought upon their person. My central claim is that public declarations of blame are morally problematic partly because they focus responsibility away from perpetrators, and partly because they harm vulnerable citizens who, as a result of internalising such public blame, suffer unnecessary constraints on their liberty

Stephen White (1989) suggests that current reductionist orthodoxy has been too restricted in its concern with psychological facts only. But once we widen the range of facts that we allow, including, for example, certain cultural or technological facts (the metapsychological facts), the boundaries we draw around persons will be determined by factors that cannot be fixed absolutely. Whether one survives or not won’t be a matter merely of psychological continuity between one’s different person-stages; inter alia, it will be a matter of what one’s society presupposes about such things as “personal identity, responsibility, and the unity and character of the self”. Such presuppositions differ across cultures and times. So, according to White, there are no universal facts about personal identity and survival; personal identity is a relative notion. In this paper I offer an alternative, and in so doing draw out some important morals for the methodology we apply in investigating questions of personal identity.

Marc Lewis argues that addiction is not a disease, it is instead a dysfunctional outcome of what plastic brains ordinarily do, given the adaptive processes of learning and development within environments where people are seeking happiness, or relief, or escape. They come to obsessively desire substances or activities that they believe will deliver happiness and so on, but this comes to corrupt the normal process of development when it escalates beyond a point of functionality. Such ‘deep learning’ emerges from consumptive habits, or ‘motivated repetition’, and although addiction is bad, it ferments out of the ordinary stuff underpinning any neural habit. Lewis gives us a convincing story about the process that leads from ordinary controlled consumption through to quite heavy addictive consumption, but I claim that in some extreme cases the eventual state of deep learning tips over into clinically significant impairment and disorder. Addiction is an elastic concept, and although it develops through mild and moderate forms, the impairment we see in severe cases needs to be acknowledged. This impairment, I argue, consists in the chronic automatic consumption present in late stage addiction. In this condition, the desiring self largely drops out the picture, as the addicted individual begins to mindlessly consume. This impairment is clinically significant because the machinery of motivated rationality has become corrupted. To bolster this claim I compare what is going on in these extreme cases with what goes on in people who dissociate in cases of depersonalization disorder.

Effective agency, according to contemporary Kantians, requires a unity of purpose both at a time, in order that we may eliminate conflict among our motives, and over time, because many of the things we do form part of longer-term projects and make sense only in the light of these projects and life plans. Call this the unity of agency thesis. This thesis can be regarded as a normative constraint on accounts of personal identity and indeed on accounts of what it is to have the life of a person in the broad, rather than narrowly biological sense. It is also a fundamental condition of social life that persons within society fulfill a range of longitudinal roles: parenthood is one such obvious example, as are teachers, health professionals, engineers, artists, and many others. The fulfillment of these and other valuable social roles requires that agents have the capacity to rationally conceive of themselves as engaged in these roles and subject to the demands of them. To be unable to fulfill any such longitudinal social roles is to have a life deficient in value. The unity of agency is thus, we argue, something we rationally strive for, and something to be morally promoted. Psychiatric states that undermine the unity of agency are morally and rationally disvaluable. Using the example of dissociation, we explain how one such state may have this undermining or disruptive effect on the unity of agency. The therapeutic ends for psychiatry in conditions involving such states are thus seen more globally as the restoration of effective agency, that is, unified agency.

In this essay I want to focus on a quality inherent in that range of feelings we associate with an experience described as ‘flow’. Csíkszentmihályi describes it as a state that arises in people involved in some skilled activity who become fully immersed in it; they reach a state of ‘intrinsic motivation’ and loss of self-awareness; their actions seem to occur spontaneously so that they seem to become simultaneously a passive witness to their own highly skilled agency. There are skilled movements and manoeuvres in sailing in which the equipment becomes, as we say, “an extension of oneself”. Under these conditions the sailor has usually reached such a level of proficiency that the state of flow just described may obtain. Moments of flow are relatively rare, and are highly prized by those who know what to look for. Losing oneself in the activity in this way is one of its highpoints, a point which makes it thereby significant and meaningful. Excellence in sailing confers a kind of fulfilment we rarely attain. It is, for this reason, an ideal worth striving for.

Among theories of personal identity over time the simple view has not been popular among philosophers, but it nevertheless remains the default view among non philosophers. It may be construed either as the view that nothing grounds a claim of personal identity over time, or that something quite simple (a soul perhaps) is the ground. If the former construal is accepted, a conspicuous difficulty is that the condition of causal dependence between person-stages is absent. But this leaves such a view open to an objection from the failure to provide a condition of individuation. If, on the other hand something like a soul is said to ground personal identity over time, such an account turns out to be more suited to a kind of continuity view.

In what sense is a person addicted to drugs or alcohol incompetent, and so a legitimate object of coercive treatment? The standard tests for competence do not pick out the capacity that is lost in addiction: the capacity to properly regulate consumption. This paper is an attempt to sketch a justificatory framework for understanding the conditions under which addicted persons may be treated against their will. These conditions rarely obtain, for they apply only when addiction is extremely severe and great harm threatens. It will be argued also that to widen the measures currently in place in some jurisdictions, though philosophically well-motivated, would require very strong evidence of a set of conditions disposing a person to an addictive future. It is doubtful that any such currently available evidence is strong enough to justify coercive treatment. Nevertheless, coercive treatment of addiction is already a reality, with the potential for more, and so some discussion will be presented regarding the extraordinary safeguards necessary to prevent misapplication of such treatment policies.