Jeanette Kennett

Pickard (2012) claims that the neurobiological or disease model of addiction hinders the recovery of people because it undermines their feeling of self-efficacy and agency. Sub- stance users are “not aided by being treated as victims of a neurobiological disease, as opposed to agents of their own recovery” (40).Although Pickard acknowledges that claims of powerlessness or loss of agency can have a functional role in the self-narratives of substance users in excusing them from blame, she primarily focuses on the negative effects of the diseasemodel on the recovery of substance users. Preliminary evidence from in-depth interviews with heroin-dependent participants in our current cohort study on addiction and moral identity supports Pickard’s claims in part: Substance users describe grades of control, psychological distress, and loss of options, and an ambivalent attitude toward their belief in self-efficacy. However the interviews also provide points of critique. While Pickard is right to dismiss the more extreme claims of proponents of the disease model—namely, that drug use in addicts is literally compelled—user responses suggest that an understanding of the neurobiology of addiction might in some respects support rather than undermine a sense of agency. Moreover, there is reason to suppose that the relation be- tween substance use and psychological distress is not as straightforward as Pickard claims. In this respect we believe the debate must become more nuanced and move beyond a simple opposition between the disease model and the rational choice model endorsed by Pickard.

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.

Kant claimed both that "moral feeling is the capacity to be affected by a moral judgment" and that moral motivation is motivation by principle. What are the psychological mechanism that could enable principles to motivate? This chapter develops in more detail a suggestion made elsewhere by the author that posits a connection between susceptibility to the discomfort of cognitive dissonance and moral motivation of a broadly Kantian kind. The chapter argues that the possession of principles is constitutively connected to one’s status as a diachronic self and to one’s rational agentive capacities. If psychopaths are insensitive to cognitive dissonance, they cannot have or be motivated by principles. This provides an explanation of the failure of moral motivation in psychopaths that differs from the usual focus on lack of empathy.

In a 2004 paper, Greene and Cohen predicted that neuroscience would revolutionise criminal justice by presenting a mechanistic view of human agency that would change people’s intuitions about retributive punishment. According to their theory, this change in intuitions would in turn lead to the demise of retributivism within criminal justice systems. Their influential paper has been challenged, most notably by Morse, who has argued that it is unlikely that there will be major changes to criminal justice systems in response to neuroscience. In this paper we commence a tentative empirical enquiry into the claims of these theorists, focusing on Australian criminal justice. Our analysis of Australian cases is not supportive of claims about the demise of retributive justice, and instead suggests the possibility that neuroscience may be used by the courts to calibrate retributive desert. It is thus more consistent with the predictive claims of Morse than of Greene and Cohen. We also consider evidence derived from interviews with judges, and this leads us to consider the possibility of a backlash against evidence of brain impairment. Finally we note that change in penal aims may be occurring that is unrelated to developments in neuroscience.

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.

In this commentary on Anneli Jefferson’s Are Mental Disorders Brain Disorders? I endorse her capacitarian approach to responsibility but suggest that the effects of at least some mental/brain disorders on the agent’s psychology show that we cannot neatly separate the epistemic condition from the control condition when assessing agential capacity. I then discuss the labeling issue in the context of rival attributionist accounts of responsibility which hold that agents are responsible if their actions are attributable to them. The incorporation of mental disorders into identity through social processes may open agents with mental or brain disorders open to unfair blame. However, we cannot fully understand the effects of the disorders on agential capacity without closely attending to the social environment that shapes the way the disorder is conceived, enacted, perceived, and responded to over time.

The decline in autobiographical memory function in people with Alzheimer’s dementia has been argued to cause a loss of self-identity. Prior research suggests that people perceive changes in moral traits and loss of memories with a “social-moral core” as most impactful to the maintenance of identity. However, such research has so far asked people to rate from a third-person perspective, considering the extent to which hypothetical others maintain their identity in the face of various impairments. In the current study, we examined the impact of perspective, comparing first- and third-person perspectives, as well as memory type. This online study asked 201 participants to consider hypothetical scenarios in which either themselves or another person experienced different types of memory failures associated with a diagnosis of AD. For each scenario, participants rated the degree to which the depicted individual remained the same person, and how impactful the impairment was. Social semantic memory failures – involving failures to recognise a loved one – were rated as most detrimental to self-continuity, and procedural memory failures the least. Averaged across all memory types, people considered their own and their partner’s self-continuity to be more resilient to memory failures than that of a parent or stranger. However, this pattern was reversed for some memory types: forgetting semantic or episodic information about close relationships was rated as more detrimental from a first-person than third-person perspective. Our findings suggest that perspective and type of memory impairment interact to impact judgements about the extent to which people maintain their identity when they experience dementia, and highlight the importance of social relationships to maintaining a sense of self.

In the study reported in their rich article, Brandenburg and Strijbos investigate the attitudes of clinicians, in a facility for adults with autism, to norm transgressions by service users. In doing so they interrogate Hanna Pickard’s responsibility without blame approach to therapy and ask whether it applies across different clinical settings.Pickard draws a distinction between responsibility for an action in the sense of being the agent of the action and so, by definition, having some control over it, and moral responsibility for an action which includes being blameworthy for it. For Pickard, you can be responsible for a harmful action without being morally responsible and therefore blameworthy. You might...

What is required of the interpreter of disordered minds and what can we learn from the process? Jonathan Glover's book focuses on human interpretation and its role in psychiatry. His hope is that a more careful and sensitive exploration of minds that are very different from our own, will assist us to answer a range of important questions about human agency, identity and responsibility. In this commentary I will focus on the process and purpose of interpretation and expand on some of the moral issues that arise out of the interpretive challenges posed by mental disorders.

In her wonderfully rich and insightful article, Sofia Jeppsson argues that, although a person with psychosis may seem to be strange and unintelligible to us, we nevertheless have duties of intelligibility toward them. And she draws upon her own experience to show that psychotic experiences and reasoning are more intelligible than we might have thought.In this brief commentary, I focus on why the assumption of hypothetical intelligibility is a duty of respect owed to those experiencing psychosis. In everyday human interaction we expend significant resources on interpreting other people, largely to be able to predict and explain their behavior and to adjust our own behavior and expectations accordingly in our...

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.

According to a Kantian conception truthfulness is characterised as a requirement of respect for the agency of another. In lying we manipulate the other’s rational capacities to achieve ends we know or fear they may not share. This is paradigmatically a failure of respect. In this paper we argue that the importance of truthfulness also lies in significant part in the ways in which it supports our agential need to make sense of the world, other people, and ourselves. Since sense-making is something we do together, and that we can support or undermine, it generates norms of interaction that constitute a further, distinct, mode of recognition and respect for another’s agency. But the requirements of truthfulness and support for sense-making sometimes conflict. Through a series of cases, we analyze why and when a rigid insistence on truthfulness is disrespectful of the other and undermining of their agency.