Elliot Porter

Bipolar or related disorders (BoRD) present unique practical and existential problems for people who live with them. All agents experience changes in the things they care about over time. However people living with BoRD face drastic shifts in what seems valuable to them, which upset their longitudinal values (if, indeed, any stable longitudinal values are available in the first place). Navigating these evaluative high seas presents agents living with BoRD with a distinctive existential question, not shared by those on calmer waters. I draw out two contrasting ways in which someone living with BoRD might seek to support their self-determination in these circumstances, by crafting appropriate self care and support regimes. The first strategy involves managing one’s affective episodes so that they do not interrupt one’s plans and long-term agency over time. The second involves a regimen that allows one the greatest degree of freedom in adapting to changes in one’s experiences of value. What distinguishes these sorts of self-determination is the scope at which they are predicated. Although both sorts of self-determination allow an individual to rule themselves, they alter the overall shape of one’s autonomy in quite different ways.

A debate persists over how to distinguish manic states from non-manic ones (such as depressions). A lacuna exists amongst these efforts, where a specifically agentive account of mania would sit. An agentive account centers the manic person’s view of practical reasons, rationalizing their actions in the same way that sympathetic understandings rationalize the actions of more neurotypical agents. In this paper, I argue that mania restructures our agency by creating a pervasive sense of urgency. This urgency changes the kind of handling that our practical reasons seem to call out for. Whilst this can make us less reliable as agents, I argue that this does not undermine the basic capacities on which personal autonomy is founded. The greater threat to manic agents’ autonomy is nonrecognition of this restructured agency, undermining autonomy in its social dimensions. Without an agentive account, we will fail to recognize distinctly manic agency when we see it, limiting our understanding of autonomy, and withholding recognition, fundamental to autonomy in its social dimensions, from manic agents.

Some considerations are urgent and others are not. Sometimes we invite criticism if we neglect the urgency of our situation, even if our action seems adequate to respond to it. Despite this significance, the literature does not offer a satisfactory analysis of the normative structure of urgency. I examine three views of urgency, drawn from philosophical and adjacent literature, which fail to explain the distinctive criticism we face when we neglect the urgency of our reasons. Instead I argue that urgent considerations pre-empt our deliberation about less urgent considerations. Urgency, then, is a meta-normative phenomenon, setting standards for how we handle and respond to first-order considerations, requiring that we close deliberation. In the face of urgency, appropriate action is not enough: commitment is called for. This is how we enact appreciation of our practical reasons, independently of our carrying out the action they call for.

There is a strong presumption that mental disorder injures a person's autonomy, understood as a set of capacities and as an ideal condition of agency which is worth striving for. However, recent multidimensional approaches to autonomy have revealed a greater diversity in ways of being autonomous than has previously been appreciated. This presumption, then, risks wrongly dismissing variant, neuro-atypical sorts of autonomy as non-autonomy. This is both an epistemic error, which impairs our understanding of autonomy as a phenomenon, and a moral error, which withholds recognition and respect that autonomous agents are due. I argue that careful attention to the different 'shapes' of agent's autonomy reveals that there are indeed distinctive kinds of neuro-atypical autonomy that are widely mistaken for non-autonomy. This project argues for two propositions. First, that there is a kind of autonomy, with a distinctive shape and texture, available to bipolar agents. This is a variant sort of autonomy, but not a defective or deficient sort. It is the ideal of autonomy that it is worth bipolar agents striving for, given the range and intensity of experiences that they will have to confront. Whilst bipolar autonomy will look unlike more neurotypical kinds of autonomy, it continues to be owed recognition. The second proposition is that we should understand the ideal of autonomy to be both pluralist and highly context sensitive. Given the range of starting points from which agents will strive to an ideal of autonomy, there will be some variation in the ideals worth striving for. The variation in ideals will reflect the existential realities they are local to. Theory of autonomy must be adapted to recognise bipolar, and other neuro-atypical, kinds of autonomy, and to reflect this wider pluralism. These propositions will be argued for with careful attention to the experiences and agency of people living with bipolar, or related, disorders. Understanding the ways that manic or depressive episodes, and the shifts between them, alter and apply pressure to our agency will inform an account of the distinctively bipolar autonomy that can be built on top of it.

Abstract:Bipolar or related disorders (BoRD) present unique practical and existential problems for people who live with them. All agents experience changes in the things they care about over time. However people living with BoRD face drastic shifts in what seems valuable to them, which upset their longitudinal values (if, indeed, any stable longitudinal values are available in the first place). Navigating these evaluative high seas presents agents living with BoRD with a distinctive existential question, not shared by those on calmer waters. I draw out two contrasting ways in which someone living with BoRD might seek to support their self-determination in these circumstances, by crafting appropriate self care and support regimes. The first strategy involves managing one’s affective episodes so that they do not interrupt one’s plans and long-term agency over time. The second involves a regimen that allows one the greatest degree of freedom in adapting to changes in one’s experiences of value. What distinguishes these sorts of self-determination is the scope at which they are predicated. Although both sorts of self-determination allow an individual to rule themselves, they alter the overall shape of one’s autonomy in quite different ways.