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Philosophy, Psychiatry, & Psychology 7.2 (2000) 121-122

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Guarding Patient Agency

Joseph Loizzo

P. G. Campbell's "Diagnosing Agency" offers a coherent approach to theanguage of human agency that should be both refreshing to the philosopher and inviting to the clinician. The clear and straightforward style of this piece engage the reader in a deceptively simple line of argument: the language of human agency, featuring terms like intentionality and unintentionality, is of such "abiding interest" to us as talking mammals that our understanding of it should be nuanced enough to embrace the full range of its use, from teaching philosophical ideals of agency to teaching therapeutic skills to control compulsions. In explaining to a high-functioning person with chronic dysthymia the available treatment options for depression, for instance, the philosophical idea of rational agency Campbell mentions could help the person relate the options to his worldview and values. Thus, after defining rational agency as the idea that human beings are capable of a high degree of rational self-control of thought, mood, and behavior, one could explain that the reductive mind-brain models of psychopharmacology assume that our rational self-control of these is fixed and low, while the behavioral learning-neural plasticity model of cognitive therapy assumes that we can increase our degree of rational-control of these by unlearning old habits and learning new skills such as cognitive reframing.

Taking as test-case the language of akrasia or weakness of will, Campbell succeeds admirably in elucidating the shades of gray that make the diagnosis of human action and intention in this all too familiar realm of everyday speech far from trivial. In fact, the choice of akrasia is crucial to his argument since it pinpoints the part of this gray zone that is made especially thorny by the intersecting technical discourses of philosophy and psychiatry. For instance, if a person with a history of alcohol dependence is brought to an emergency room after attempting suicide under the influence of alcohol, the philosophical determination of whether his actions were rational and intentional intersects with psychiatric determinations such as whether he was/is intoxicated, drank with suicidal intent, has insight into his alcohol dependence, etc., as well as with the medico-legal determination of whether he is a danger to himself.

Given the incursion of mechanistic language from reductive neurobiology and computational neuroscience, the thrust of Campbell's argument is to make the life-space of action language safe for therapeutic discourse, both in the Greek sense of discourse that schools the passions and in the modern sense of psychotherapy as emotional reeducation. In order to do this, he must clear the field of rationalistic accounts that wall off parts of action language with strict dualistic concepts presupposing a disconnect between will and reason. His case in point is so-called strict akrasia, in which a person chooses out of weakness to do what her heart desires, despite a more or less [End Page 121] rational belief that it will not be good for her overall. For instance, a woman obsessively involved with an evasive or abusive man pursues or stays with him against her better judgment.

Campbell's critiques of Davidson's and Mele's accounts of strict akrasia are cogent, although they condense such complex interchanges that the general reader may grow impatient for a return to the clarity of the author's own voice. Although the exchanges are necessary to his argument and incidentally offer the clinician a frozen section of the current philosophical debate, I for one couldn't help wishing that Campbell had spent less time defending his diagnosis and more outlining his recommendations; for how to treat the idealized language of rational agency, say, or the therapeutic language of dysfunctional agency. To be fair, for him to gratify my wish would probably require another paper; one hopes that such sequels are on the way, or at least on the author's To Do list.

Before I renounce the topic of irrational wishes completely, however, let me confess another desiderata that came while cheering Campbell on: to see him critique...


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