Jeanette Kennett

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.

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.

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).

Metaethics has recently been confronted by evidence from cognitive neuroscience that tacit emotional processes play an essential causal role in moral judgement. Most neuroscientists, and some metaethicists, take this evidence to vindicate a version of metaethical sentimentalism. In this paper we argue that the ‘dual process’ model of cognition that frames the discussion within and without philosophy does not do justice to an important constraint on any theory of deliberation and judgement. Namely, decision-making is the exercise of a capacity for agency. Agency, in turn, requires a capacity to conceive of oneself as temporally extended: to inhabit, in both memory and imagination, an autobiographical past and future. To plan, to commit to plans, and to act in accordance with previous plans requires a diachronic self, able to transcend the present moment. While this fact about agency is central to much of moral philosophy (e.g. in discussions of autonomy and moral responsibility) it is opaque to the dual process framework and those meta-ethical accounts which situate themselves within this model of cognition. We show how this is the case and argue for an empirically adequate account of moral judgement which gives sufficient role to memory and imagination as cognitive prerequisites of agency. We reconsider the empirical evidence, provide an alternative, agentive, interpretation of key findings, and evaluate the consequences for metaethics.

Undercover marketing targets potential customers by concealing the commercial nature of an apparently social transaction. In a typical case an individual approaches a marketing target apparently to provide some information or advice about a product in a way that makes it seem like they are a fellow consumer. In another kind of case, a friend displays a product to you, and encourages its purchase, but fails to disclose their association with the marketing firm. We focus on this second type of case and argue that the constitutive dispositions of friendship that provide for the development and maintenance of intimacy also render friends especially vulnerable to undercover marketing techniques and so to the exploitation of friendship for commercial ends. We show how this is corrupting both of the friendship and the commercial agent.