Table Of Content

Autonomy, Enactivism, and Mental Disorder Thisbookbringstogetherinsightsfromtheenactivistapproachinphilosophy of mind and existing work on autonomous agency from both philosophy of action and feminist philosophy. It then utilizes this proposed account of autonomous agency to make sense of the impairments in agency that commonly occur in cases of dissociative identity disorder, mood disorders, and psychopathy. While much of the existing philosophical work on autonomy focuses on threats that come from outside the agent, thisbook addresses how inner con- flict, instability of character, or motivational issues can disrupt agency. In the first half of the book, the author conceptualizes what it means to be self-gov- erningandtoexerciseautonomousagency.Inthesecondhalf,sheinvestigates theextenttowhichagentswithvariousformsofmentaldisorderarecapableof exercisingautonomy.Inherview,manyformsofmentaldisorderinvolvedis- ruptions to self-governance, so that agents lack sufficient control over their intentional behavior or are unable to formulate and execute coherent action plans.However,thisdoesnotmeanthattheyareutterlyincapableofautono- mous agency; rather, their ability to exercise this capacity is compromised in important respects. Understanding these agential impairments can help to deepen our understanding of what it means to exercise autonomy, and also devisemoreeffectivetreatmentsthatrestoresubjects’agency. Autonomy, Enactivism, and Mental Disorder will be of interest to researchers and advanced students working in philosophy of mind, philosophy of action, philosophy of psychiatry, and feminist philosophy. Michelle Maiese is Professor of Philosophy at Emmanuel College, USA. Her research addresses issues in philosophy of mind and philosophy of psychiatry. She has authored or co-authored four books: Embodied Minds in Action (2009), Embodiment, Emotion, and Cognition (2011), Embodied Selves and Divided Minds (2015), and The Mind–Body Politic (2019). Routledge Studies in Contemporary Philosophy Time in Action The Temporal Structure of Rational Agency and Practical Thought Edited by Carla Bagnoli Perspectives on Taste Aesthetics, Language, Metaphysics, and Experimental Philosophy Edited by Jeremy Wyatt, Julia Zakkou, and Dan Zeman A Referential Theory of Truth and Falsity Ilhan Inan Existentialism and the Desirability of Immortality Adam Buben Recognition and the Human Life-Form: Beyond Identity and Difference Heikki Ikäheimo Autonomy, Enactivism, and Mental Disorder A Philosophical Account Michelle Maiese The Philosophy of Fanaticism Epistemic, Affective, and Political Dimensions Edited by Leo Townsend, Ruth Rebecca Tietjen, Hans Bernhard Schmid, and Michael Staudigl Mental Action and the Conscious Mind Edited by Michael Brent and Lisa Miracchi Titus Epistemic Injustice and the Philosophy of Recognition Edited by Paul Giladi and Nicola McMillan For more information about this series, please visit: https://www.routledge. com/Routledge-Studies-in-Contemporary-Philosophy/book-series/SE0720 Autonomy, Enactivism, and Mental Disorder A Philosophical Account Michelle Maiese Firstpublished2022 byRoutledge 605ThirdAvenue,NewYork,NY10158 andbyRoutledge 4ParkSquare,MiltonPark,Abingdon,OxonOX144RN RoutledgeisanimprintoftheTaylor&FrancisGroup,aninforma business ©2022MichelleMaiese TherightofMichelleMaiesetobeidentifiedastheauthorofthiswork hasbeenassertedinaccordancewithsections77and78oftheCopyright, DesignsandPatentsAct1988. Allrightsreserved.Nopartofthisbookmaybereprintedorreproduced orutilisedinanyformorbyanyelectronic,mechanical,orothermeans, nowknownorhereafterinvented,includingphotocopyingandrecording, orinanyinformationstorageorretrievalsystem,withoutpermissionin writingfromthepublishers. Trademarknotice:Productorcorporatenamesmaybetrademarksor registeredtrademarks,andareusedonlyforidentificationand explanationwithoutintenttoinfringe. LibraryofCongressCataloging-in-PublicationData Names:Maiese,Michelle,author. Title:Autonomy,enactivism,andmentaldisorder:aphilosophical account/MichelleMaiese. Description:NewYork,NY:Routledge,2022.| Series:Routledgestudiesincontemporaryphilosophy| Includesbibliographicalreferencesandindex. Identifiers:LCCN2022000892(print)|LCCN2022000893(ebook)| ISBN9781032003160(hbk)|ISBN9781032004235(pbk)| ISBN9781003174103(ebook) Subjects:LCSH:Autonomy(Philosophy)|Agent(Philosophy)| Mentalillness.|Philosophyofmind.|Cognitivescience.| Act(Philosophy) Classification:LCCB105.A84M352022(print)|LCCB105.A84(ebook)| DDC128–dc23/eng/20220225 LCrecordavailableathttps://lccn.loc.gov/2022000892 LCebookrecordavailableathttps://lccn.loc.gov/2022000893 ISBN:978-1-032-00316-0(hbk) ISBN:978-1-032-00423-5(pbk) ISBN:978-1-003-17410-3(ebk) DOI:10.4324/9781003174103 TypesetinSabon byTaylor&FrancisBooks Contents Acknowledgments viii 1 Autonomous Agency: Conditions for an Adequate Account 1 1.1 Introduction 1 1.2 Frankfurt’s Identification Account 4 1.2.1 Second-Order Volitions and Identification 5 1.2.2 Intelligibility and the Problem of External Manipulation 7 1.2.3 The Regress Problem 9 1.3 Pre-reflective Agency and Reasons-Responsiveness 12 1.4 Autonomy as Relational 18 1.5 Summary of Conditions, and a Way Forward 21 2 An Enactivist Conception of Autonomous Agency 27 2.1 Introduction 27 2.2 Agency, Biological Autonomy, and Sensorimotor Autonomy 29 2.2.1 Basic Agency, Trying, and Habits 30 2.2.2 AffectiveFraming,Regional Identities,andtheSelf 34 2.3 The Stability and Plasticity of Habit 40 2.4 The Role of Social Influences 46 2.4.1 Relational Autonomy and the Socially Embedded Self 50 2.4.2 The Mindshaping Thesis 54 2.5 Concluding Remarks 59 3 Enactivism Meets Frankfurt: Embracing, Resisting, and Reconfiguring Habits 65 vi Contents 3.1 Introduction 65 3.2 The Need for Self-Modification 66 3.3 From Sensorimotor Equilibration to Self-Equilibration 70 3.4 Changing What We Care About 75 3.4.1 Virtual Actions and Agentic Skills 83 3.4.2 Equilibration and the Contribution of the Environment 86 3.5 Authenticity, Regress, and Manipulation: Making Sense of Autonomy Deficits 88 3.6 Concluding Remarks 94 4 Ambivalence and Agency in Dissociative Identity Disorder 98 4.1 Introduction: Disruptions toAutonomousAgencyinMental Disorder 98 4.2 DissociativeIdentityDisorderandtheSingleSelfThesis 103 4.3 Extreme Ambivalence in DID 106 4.4 Disruptions to Agency and Instability of the Self 112 4.4.1 Disjointed Affective Framings 114 4.4.2 Is Ambivalence Always a Threat to Autonomy? 117 4.5 Self-Equilibration in Cases of DID 121 4.6 Concluding Remarks 124 5 “Getting Stuck” in Mood Disorders 129 5.1 Introduction 129 5.2 Disruptions to Motivation in Depression 130 5.3 A Depressive Comportment: Inflexible Habits and Constriction of the Affordance Field 135 5.4 Self-Equilibration in Cases of Depression 142 5.5 Disruptions to Agency in Bipolar Disorder 146 5.5.1 Distortion of the Affordance Field in Mania 149 5.5.2 Unstable Agency and Fluctuating Moods 151 5.5.3 Self-Equilibration in Bipolar Disorder 154 5.6 Concluding Remarks 156 6 One-Dimensional Selfhood in Psychopathy 160 6.1 Introduction 160 6.2 Reasons-Responsivity and Ethical Know-How 163 6.3 Inflexible Agency and Affordance Engagement 168 6.4 Instability and Lack of Character 171 6.5 Self-Equilibration and Relational Autonomy 176 Contents vii 6.6 Concluding Remarks 184 7 Further Implications: Responsibility and Treatment 190 7.1 Introduction 190 7.2 Agency and Moral Responsibility 191 7.2.1 Responsibility in Cases of DID 195 7.2.2 Responsible Agency Among Agents with Mood Disorders 197 7.2.3 Responsible Psychopaths? 199 7.3 Legal Responsibility, Relational Autonomy, and Restorative Justice 203 7.4 Promoting Autonomy Via Holistic Treatment 209 7.4.1 Moving Beyond Medication 210 7.4.2 Recovery and Patients as Experts 213 7.5 Concluding Remarks 221 Index 225 Acknowledgments ThismonographexpandsuponideasexploredinEmbodiedSelvesandDivided Minds,TheMind–BodyPolitic(co-authoredwithRobertHanna),severalpast articles,andmyPh.D.dissertation.Itaimstointegrateenactivism,philosophy of action, philosophy of psychiatry, and feminist theorizing about relational autonomy. Common sense tells us that autonomy is lacking in many cases of mentalillness.Gettingclearaboutwhatthisentailsshedslightonthenatureof agencyandself-determinationaswellthedisruptionstoagencythatoccurdue tomentalillness.This,inturn,putsusinabetterpositiontodeveloplegaland treatmentpracticesthatcultivateandrestoreautonomy. However,mydiscus- sion of real-world implications in the concluding chapter only briefly touches upon important topics that need to be explored much more fully. My hope is that this discussion sets the stage for future research. Thanks to Sam Dayson (myundergraduateresearchassistant)forhelpingmefindarticlestoread.Ialso am grateful for the feedback provided by numerous anonymous reviewers, especiallythosewhoprovidedconstructivecriticisminakindmanner. Much of this project was completed during the Covid-19 pandemic, at a time when many of us were struggling with mental health issues. For me, researchandwriting provided amuch-neededbreak from doom-scrolling on social media, television binging, and alcohol consumption. I am grateful for my friends and family who spent time with me on zoom during the early days of the pandemic, as well as those who were willing to hang out in the chilly outdoors in the winter of 2021. I especially want to thank my partner, Nathan, for being my quarantine buddy and building me a patio. There’s nobody else I’d prefer to be safe at home with. 1 Autonomous Agency: Conditions for an Adequate Account 1.1 Introduction While the term “autonomy” generally connotes self-determination, it has taken on many different meanings in the philosophical literature. One approach, which stems from liberal political philosophy, characterizes autonomy as freedom of the individual to carry on with their affairs provided that this does not interfere with the freedom of others. Such freedom of action requires that individuals be free from coercive interference and have a range of reasonable options from which to choose. This notion of choice autonomy signifies a political, pragmatic approach; within the realm of health care provision, for example, it raises questions about whether it is ever justifiable to subject someone to medical treatment without their con- sent (Lillehammer, 2012, p. 197). A second approach, obviously related to thefirst,focusesonwhatit meanstobeaself-governingagent, one whocan reflect on their beliefs, motivations, and actions, formulate goals, and execute action plans. A self-governing individual who is capable of agent autonomy is a paradigm example of someone who can enter into legally binding contracts, participate in market exchanges, engage in democratic processes, and be held responsible for their actions. However, the focus of the present projectislargely theoretical.Inthe first half of the book, I aim to conceptualize what it means to be self-governing and exercise autonomous agency. I begin, in the present chapter, by dis- cussing some of the central questions and puzzles widely discussed in the literature on autonomy, and then presenting some conditions for an adequate account. Then, in the latter half of the book, I investigate the extent to which agents suffering from various forms of mental disorder are capable of exercising autonomy. In my view, many forms of mental disorder involve disruptions to self-governance, so that agents lack sufficient control over their intentional behavior or are unable to formulate and execute coherent action plans. However, this does not mean that they are utterly incapable of autonomousagency;rather,theirabilitytoexercisethiscapacityisdisrupted or compromised in distinctive respects. Understanding these disruptions can both help to deepen our understanding of what it means to exercise DOI: 10.4324/9781003174103-1