Lubomira Radoilska

In this paper, I address two related challenges the phenomenon of depression raises for conceptions according to which autonomy is an agency concept and an independent source of justification. The first challenge is directed at the claim that autonomous agency involves intending under the guise of the good: the robust though not always direct link between evaluation and motivation implied here seems to be severed in some instances of depression; yet, this does not seem to affect the possibility of autonomous action. The second challenge targets the feasibility of a reliable distinction between autonomous and non-autonomous choices in the context of depression: value-neutral and value-laden ways of drawing the distinction seem both open to decisive objections. I develop an account of paradoxical identification which supports a revised value-neutral distinction between autonomous and non-autonomous choices in the context of depression (my response to challenge 2), and shows that depression is inconsistent with autonomy to the extent that it involves an agent’s (paradoxical) identification with projects she implicitly loathes, that is, to the extent that depression thwarts intending under the guise of the good (my response to challenge 1).

Autonomy is a fundamental though contested concept both in philosophy and the broader intellectual culture of today’s liberal societies. For instance, most of us place great value on the opportunity to make our own decisions and to lead a life of our own choosing. Yet, there is stark disagreement on what is involved in being able to decide autonomously, as well as how important this is compared to other commitments. For example, the success of every group project requires that group members make decisions about the project collectively rather than each on their own. This disagreement notwithstanding, mental disorder is routinely assumed to put a strain on autonomy; however, it is unclear whether this is effectively the case and, if so, whether this is due to the nature of mental disorder or the social stigma that often attaches to it. This book is the first exploration of the nature and value of autonomy with reference to mental disorder. By reflecting on instances of mental disorder where autonomy is apparently compromised, it offers a systematic discussion of the underlying presuppositions of the present autonomy debates in philosophy and psychiatry. In so doing, it helps address different kinds of emerging scepticism questioning either the appeal of autonomy as a concept or its relevance to specific areas of normative ethics, including psychiatric ethics.