Lisa Bortolotti

This paper argues for psychological realism in the conception of psychiatric disorders. We review the following contemporary ways of understanding the future of psychiatry: (1) psychiatric classification cannot be successfully reduced to neurobiology, and thus psychiatric disorders should not be conceived of as biological kinds; (2) psychiatric classification can be successfully reduced to neurobiology, and thus psychiatric disorders should be conceived of as biological kinds. Position (1) can lead either to instrumentalism or to eliminativism about psychiatry, depending on whether psychiatric classification is regarded as useful. Position (2), which is inspired by the growing interest in neuroscience within scientific psychiatry, leads to biological realism or essentialism. In this paper we endorse a different realist position, which we label psychological realism. Psychiatric disorders are identified and addressed on the basis of their psychological manifestations which are often described as violations of epistemic, moral or social norms. A couple of examples are proposed by reference to the pathological aspects of delusions, and the factors contributing to their formation.

Contemporary philosophers and bioethicists argue that life extension is bad for the individual. According to the agency objection to life extension, being constrained as an agent adds to the meaningfulness of human life. Life extension removes constraints, and thus it deprives life of meaning. In the paper, I concede that constrained agency contributes to the meaningfulness of human life, but reject the agency objection to life extension in its current form. Even in an extended life, decision-making remains constrained, and many obstacles to the fulfilment of an agent’s goals are preserved. Agents with longer lives are also presented with new challenges: for instance, it might be harder for them to avoid chronic boredom, and sustain their motivation to act in the pursuit of their goals. Although objections from agency and boredom are often used in combination to support the view that a much longer life is likely to bring misery or become meaningless, I argue that the acceptance of the boredom objection undermines the persuasiveness of the agency objection.

In this chapter, our focus is the role played by notions of rationality in the diagnosis of mental disorders, and in the practice of overriding patient autonomy in psychiatry. We describe and evaluate different hypotheses concerning the relationship between rationality and diagnosis, raising questions about what features underpin psychiatric categories. These questions reinforce widely held concerns about the use of diagnosis as a justification for overriding autonomy, which have motivated a shift to mental incapacity as an alternative justification. However, this approach too has recently been criticized from a mental disability rights perspective. Our analysis of the relationship between mental capacity and rationality is used to illuminate these concerns, and to investigate further the relationship between rationality and psychiatric diagnosis.

We talk about irrationality when behaviour defies explanation or prediction, when decisions are driven by emotions or instinct rather than by reflection, when reasoning fails to conform to basic principles of logic and probability, and when beliefs lack coherence or empirical support. Depending on the context, agents exhibiting irrational behaviour may be described as foolish, ignorant, unwise or even insane. In this clear and engaging introduction to current debates on irrationality, Lisa Bortolotti presents the many facets of the concept and offers an original account of the importance of judgements of irrationality as value judgements. The book examines the standards against which we measure human behaviour, and reviews the often serious implications of judgements of irrationality for ethics and policy. Bortolotti argues that we should adopt a more critical stance towards accepted standards of rationality in the light of the often surprising outcomes of philosophical inquiry and cognitive science research into decision making. Irrationality is an accessible guide to the concept and will be essential reading for students and scholars interested in the limitations of human cognition and human agency.

Does conscious reflection lead to good decision-making? Whereas engaging in reflection is traditionally thought to be the best way to make wise choices, recent psychological evidence undermines the role of reflection in lay and expert judgement. The literature suggests that thinking about reasons does not improve the choices people make, and that experts do not engage in reflection, but base their judgements on intuition, often shaped by extensive previous experience. Can we square the traditional accounts of wisdom with the results of these empirical studies? Should we even attempt to? I shall defend the view that philosophy and cognitive sciences genuinely interact in tackling questions such as whether reflection leads to making wise choices.