Anneli Jefferson

In this chapter, I look at how deep self views assign responsibility and autonomy to individuals suffering from mental ill health. Deep self views say that an agent is only acting autonomously and responsible for their actions if these align with their deep self, if they endorse their desires and motivations. That kind of view of responsible agency seems particularly well suited to give a theoretical grounding to the everyday intuition that sometimes an action is better ascribed to the illness than to the agent and that the agent is therefore not responsible. I show how deep self views differ from reasons responsiveness accounts of responsibility in who they count as responsible. I then discuss cases which deep self views are particularly well placed to deal with, where individuals are alienated from desires and motivations that arise from their mental health condition. Finally, I turn to cases deep self views struggle with, where desires that are symptomatic of the illness are endorsed by the individual but deeply harmful for them. I show that sometimes, these will have to be counted as autonomous desires that express the deep self but also suggest possible ways of avoiding this conclusion.

Whether anorexic patients should be able to refuse treatment when this refusal potentially has a fatal outcome is a vexed topic. A recent proposal for a new category of “terminal anorexia” suggests criteria when a move to palliative care or even physician-assisted suicide might be justified. The author argues that this proposed diagnosis presents a false sense of certainty of the illness trajectory by conceptualizing anorexia in analogy with physical disorders and stressing the effects of starvation. Furthermore, this conceptualization is in conflict with the claim that individuals who meet the diagnostic criteria for terminal anorexia have decision-making capacity. It should therefore be rejected.

Recent work on ecological accounts of moral responsibility and agency have argued for the importance of social environments for moral reasons responsiveness. Moral audiences can scaffold individual agents’ sensitivity to moral reasons and their motivation to act on them, but they can also undermine it. In this paper, we look at two case studies of ‘scaffolding bad’, where moral agency is undermined by social environments: street gangs and online incel communities. In discussing these case studies, we draw both on recent situated cognition literature and on scaffolded responsibility theory. We show that the way individuals are embedded into a specific social environment changes the moral considerations they are sensitive to in systematic ways because of the way these environments scaffold affective and cognitive processes, specifically those that concern the perception and treatment of ingroups and outgroups. We argue that gangs undermine reasons responsiveness to a greater extent than incel communities because gang members are more thoroughly immersed in the gang environment.

Should moral blame stop at the grave? We often blame the dead for the bad things they did while alive. But blaming the dead poses a prima facie challenge to accounts which take our blaming practices to aim at communicating moral disapproval to wrongdoers or at improving their moral agency. If these kinds of aims are made definitional for blame, blaming the dead becomes impossible. But even on accounts which say that paradigmatically, blame is a form of moral engagement which aims to effect changes in the wrongdoer, blaming the dead may seem unjustified, pointless or even irrational. In this paper, I explain how blaming the dead can be made sense of and justified. However, not all cases of blaming the dead fit this explanation, because blaming the dead is not a homogenous practice.

In this paper, I respond to commentaries on my book “Are Mental Disorders Brain Disorders?”. The topics I discuss are: accounts of function and dysfunction, constraints on the relationship between processes at the level of the brain and the mind, externalism in psychiatry, implications for moral responsibility and the question whether my account is a form of conceptual engineering. I defend my account and argue that the key criterion for whether mental disorders are brain disorders is whether we can map dysfunctional psychological processes onto specific differences in brain function. I also acknowledge that my commentators have identified points where my account needs further development.

Ecological accounts of responsible agency claim that moral feedback is essential to the reasons-responsiveness of agents. In this paper, we discuss McGeer’s scaffolded reasons-responsiveness account in the light of two concerns. The first is that some agents may be less attuned to feedback from their social environment but are nevertheless morally responsible agents – for example, autistic people. The second is that moral audiences can actually work to undermine reasons-responsiveness if they espouse the wrong values. We argue that McGeer’s account can be modified to handle both problems. Once we understand the specific roles that moral feedback plays for recognizing and acting on moral reasons, we can see that autistics frequently do rely on such feedback, although it often needs to be more explicit. Furthermore, although McGeer is correct to highlight the importance of moral feedback, audience sensitivity is not all that matters to reasons-responsiveness; it needs to be tempered by a consistent application of moral rules. Agents also need to make sure that they choose their moral audiences carefully, paying special attention to receiving feedback from audiences which may be adversely affected by their actions.

Sometimes persons are legally responsible for reckless behavior that causes criminal harm. This is the case under the newly drafted provisions of the U.S. Model Penal Code (MPC), which holds persons responsible for “simple” rape (nonconsensual sex without proof of force or threats of force), where the offender recklessly disregards the risk that the victim does not consent. In this paper we offer an explanation and corrective critique of the handling of reckless rape cases, with a focus on the U.S. criminal justice system, although our analysis is applicable more broadly. We argue that a wider group of reckless rapists are criminally responsible than is captured by the MPC and claim criminal punishment of reckless rapists must be justified by looking to both moral desert and instrumental aims achieved by criminal punishment. Part of the law’s job is to communicate and enforce society’s expectations regarding unacceptable behavior. In punishing reckless rape, we are not just giving people what they deserve, but also reinforcing and shaping norms regarding sexual behavior.

The question of whether mental disorders are disorders of the brain has led to a long- running and controversial dispute within psychiatry, psychology and philosophy of mind and psychology. While recent work in neuroscience frequently tries to identify underlying brain dysfunction in mental disorders, detractors argue that labelling mental disorders as brain disorders is reductive and can result in harmful social effects. This book brings a much- needed philosophical perspective to bear on this important question.

We often hear that certain mental disorders are disorders of the brain, but it is not clear what this claim amounts to. Does it mean that they are like classic brain diseases such as brain cancer? I argue that this is not the case for most mental disorders. Neither does the claim that all mental disorders are brain disorders follow from a materialist world-view. The only plausible way of understanding mental disorders as brain disorders is a fairly modest one, where we label brain differences we find in mental illness as pathological based on their link to mental dysfunction. How many mental disorders will turn out to be brain disorders on this understanding is an empirical question.

Does a diagnosis of brain dysfunction matter for ascriptions of moral responsibility? This chapter argues that, while knowledge of brain pathology can inform judgments of moral responsibility, its evidential value is currently limited for a number of practical and theoretical reasons. These include the problem of establishing causation from correlational data, drawing inferences about individuals from group data, and the reliance of the interpretation of brain findings on well-established psychological findings. Brain disorders sometimes matter for moral responsibility, however, because they change an individual’s moral psychology in a way that is beyond their control. While control over psychological changes is not an excusing factor, brain disorders can mitigate moral responsibility because they confront individuals with new psychological deficits or urges for which their previous moral education and existing external and internal moral resources have not prepared them.

Autobiographical stories do not merely offer insights into someone’s experience but can constitute evidence or even serve as self-standing arguments for a given viewpoint in the context of public debates. Such stories are likely to exercise considerable influence on debate participants’ views and behaviour due to their being more vivid, engaging, and accessible than other forms of evidence or argument. In this paper we are interested in whether there are epistemic and moral duties associated with the use of autobiographical stories in mental health debates. We argue that debate participants have a responsibility to assess a story as evidence or as an argument when the story is put forward to support a given viewpoint. We also make some preliminary suggestions about what can be done to ensure that the use of stories contributes to the variety of the resources available to debate participants without compromising the quality of the argumentation or increasing polarisation.

I defend an instrumentalist account of moral responsibility and adopt Manuel Vargas’ idea that our responsibility practices are justified by their effects. However, whereas Vargas gives an independent account of morally responsible agency, on my account, responsible agency is defined as the susceptibility to developing and maintaining moral agency through being held responsible. I show that the instrumentalism I propose can avoid some problems more crude forms of instrumentalism encounter by adopting aspects of Strawsonian accounts. I then show the implications for our understanding of responsibility: my account requires us to adopt a graded notion of responsibility and accept the claim that certain individuals may not be responsible because they are not susceptible to being influenced by our moral responsibility practices. Finally, I discuss whether the account is committed to allowing the instrumentalization of non-responsible individuals in cases where blaming them may benefit others’ moral agency.

In everyday confabulation and rationalisation of behaviour, agents provide sincerely believed explanations of behaviour which are ill-grounded and normally inaccurate. In this paper, I look at the commonalities and differences between confabulations and rationalisations and investigate their moral costs and benefits. Following Summers and Velleman, I argue that both can be beneficial because they constrain future behaviour through self-consistency motivations. However, I then show that the same features that make confabulations and rationalisations beneficial in some cases can also make them morally costly, when behaviour is explained and justified through the endorsement of bad moral principles. I show that these effects are most likely to occur where the central element of confabulation, self-explanation, and the central element of rationalisation, self-justification, coincide.

In their fascinating and timely article, Blumenthal-Barbyand Ubel (2018) argue that it is often unclear whether patients exhibit hope, are unrealistically optimistic, or are in denial or self-deceived, as distinctions made on the basis of belief accuracy are problematic. The authors maintain that, in most cases, we should respect patients' decisions, even when they exhibit some optimistic bias. We agree on all key points and intend to provide additional evidence to support the authors’ arguments, drawing attention to the fact that in the health domain, as in other areas of life, being unrealistically optimistic can be an asset, leading to self-fulfilling prophecies and giving people a higher chance of living the life they desire.

The question of whether psychopaths are criminally and morally responsible has generated significant controversy in the literature. In this paper, we discuss what relevance a psychopathy diagnosis has for criminal responsibility. It has been argued that figuring out whether psychopathy is a mental illness is of fundamental importance, because it is a precondition for psychopaths’ eligibility to be excused via the legal insanity defense. But even if psychopathy counts as a mental illness, this alone is not sufficient to show the insanity defense is applicable; it must also be shown that, as a result of the illness, specific deficits in moral understanding or control are present. In this paper, we show that a diagnosis of psychopathy will generally not indicate that a defendant is eligible for an insanity defense. This is because the group of individuals subsumed under the diagnosis is so heterogeneous that while some psychopaths do show significant impairments in affect and control which may impact on their responsibility, many psychopaths are not incapacitated in a way relevant to responsibility.

In this paper, I address the question whether mental disorders should be understood to be brain disorders and what conditions need to be met for a disorder to be rightly described as a brain disorder. I defend the view that mental disorders are autonomous and that a condition can be a mental disorder without at the same time being a brain disorder. I then show the consequences of this view. The most important of these is that brain differences underlying mental disorders derive their status as disordered from the fact that they realize mental dysfunction and are therefore non-autonomous or dependent on the level of the mental. I defend this view of brain disorders against the objection that only conditions whose pathological character can be identified independently of the mental level of description count as brain disorders. The understanding of brain disorders I propose requires a certain amount of conceptual revision and is at odds with approaches which take the notion of brain disorder to be fundamental or look to neuroscience to provide us with a purely physiological understanding of mental illness. It also entails a pluralistic understanding of psychiatric illness, according to which a condition can be both a mental disorder and a brain disorder.

When individuals display cognitive biases, they are prone to developing systematically false beliefs. Evolutionary psychologists have argued that rather than being a flaw in human cognition, biases may actually be design features. In my paper, I assess the claim that unrealistic optimism is such a design feature because it is a form of error management. Proponents of this theory say that when individuals make decisions under uncertainty, it can be advantageous to err on the side of overconfidence if the potential gains through success are high and the costs of failure are low. I argue that there are a number of conceptual problems in matching the theory with the existing data. I also show that there is empirical evidence against the error management hypothesis.

Here we consider the nature of unrealistic optimism and other related positive illusions. We are interested in whether cognitive states that are unrealistically optimistic are belief states, whether they are false, and whether they are epistemically irrational. We also ask to what extent unrealistically optimistic cognitive states are fixed. Based on the classic and recent empirical literature on unrealistic optimism, we offer some preliminary answers to these questions, thereby laying the foundations for answering further questions about unrealistic optimism, such as whether it has biological, psychological, or epistemic benefits.

Current legal practice holds that a diagnosis of psychopathy does not remove criminal responsibility. In contrast, many philosophers and legal experts are increasingly persuaded by evidence from experimental psychology and neuroscience indicating moral and cognitive deficits in psychopaths and have argued that they should be excused from moral responsibility. However, having opposite views concerning psychopaths’ moral responsibility, on the one hand, and criminal responsibility, on the other, seems unfortunate given the assumption that the law should, at least to some extent, react to the same desert-based considerations as do ascriptions of moral responsibility. In response, Stephen Morse has argued that the law should indeed be reformed so as to excuse those with severe psychopathy from blame, but that psychopaths that have committed criminal offences should still be subject to some legal repercussions such as civil commitment. We argue that consequentialist and norm-expressivist considerations analogous to those that support punishing psychopaths or at least retaining some legal liability, might also be drawn on in favour of holding psychopaths morally accountable.