Adam kindly asked me to be a guest on his blog, so in the next month I’ll be writing about the relationship between having a diagnosis of a psychiatric disorder and being autonomous. I believe this is a good topic. It has important practical implications for healthcare, as we want to respect people’s preferences whenever possible but also know when it is acceptable to disregard them. Moreover, it informs decision making in ethical and legal contexts, where the exercise of autonomy is often linked to moral and legal responsibility for action.
I am a Reader in Philosophy at the University of Birmingham and I work in the philosophy of the cognitive sciences and in biomedical ethics. Together with my colleagues Heather Widdows and Iain Law I founded a Research Cluster in the Philosophy of Health and Happiness. We are interested in questions such as: Are good health and happiness related? Can well-being be measured? What does wisdom require? What is the best conception of health? Is it value-free? Does mortality give shape and meaning to human life? We address these issues in collaboration with other philosophers, but also scientists, healthcare professionals, social scientists and policy makers. We offer both an MA in the Philosophy of Health and Happiness and PhD supervision on topics within normative and applied ethics, global bioethics, philosophy of medicine, philosophy of psychology, philosophy of psychiatry, and related areas. (An example of my work with Heather Widdows on the right not to know as it applies to diagnosis and genetic testing for psychiatric disorders is described here). My interest in whether a diagnosis of mental illness has implications for autonomy and moral responsibility falls under this more general interest in the relationship between health and happiness.
In the last five years my research focus has been on the nature of clinical delusions, a common symptom in psychiatric disorders such as schizophrenia, amnesia, dementia, and delusional disorders. I wrote a book, Delusions and Other Irrational Beliefs (OUP 2009), where I argue that delusions are beliefs which violate norms of rationality (e.g. they are resistant to counterevidence and often conflict with other things the person believes). I maintain that the irrationality of delusions doesn’t help us distinguish them from other beliefs, because many of our everyday beliefs are also irrational in the same way as (but maybe to a lesser extent than) delusions. If you are interested in the topic, this paper, where I defend my account of delusions from recent challenges, has just been published in Neuroethics and is open access. If you don’t feel like reading a whole paper, I guest-blogged about delusions in The Splintered Mind some time ago, so you can browse my posts starting here.
Discussing different definitions of delusions may seem irrelevant to the predicament of those who are diagnosed with schizophrenia or dementia. Yet, the nature of delusions matters not just to hair-splitting philosophers of mind, but also to clinical practitioners and service users (given that the range of available treatment options is determined by the nature of the condition being diagnosed). Also, attributions of moral responsibility are sensitive to whether our reports are genuine beliefs as opposed to wishful thinking or acts of imagination. What I do when I believe that aliens are chasing me is different from what I do when I just imagine that they are. For instance, one may understand my desire to isolate myself from family and friends, if I believe that by doing so I protect them from the evil influence of the alien beings that are making my life hell. This social withdrawal is not uncommon in people with delusions of persecution: they modify key aspects of their lives and their everyday behaviour as a result of believing that there is something bad threatening them.
If the relationship between psychopathology and moral responsibility interests you, watch this space! In the next post I'll talk about the recent debate on whether authors of ominous crimes necessarily have mental illness, triggered by the Breivik trial in Norway.