Philosophy and Ethics

This blog follows up issues and ideas from my website: Philosophy and Ethics.

Friday, 12 April 2013

Mental illness, determinism and moral responsibility


Sometimes a specific question raises a number of fundamental issues.  Here is a question emailed to me by John Gould, from Australia, who is interested in the implications of mental illness for both the Philosophy of Mind and Ethics:

John Gould’s question…

One thing I have noticed in my general reading to date is how the question of mental illness is often overlooked, (or merely "glossed over" very quickly) in the field of philosophy of mind? Would you agree? If so, I am curious as to why this might be, as it seems to me that certain types of psychiatric disorder raise some very interesting questions about issues like ,( for instance), human freedom/metaphysical freedom and ethics, amongst others?

What do you think about this?

I am thinking, in particular, of certain disorders of the human frontal lobe , neurogenetic psychiatric disorders like ADHD (Attention Deficit Hyperactivity Disorder), for example, where there is currently good empirical evidence (from fMRI and PET neuroimaging studies, etc;) that the condition arrises from deficiencies in the development, structure and function of the prefrontal cortex and its networks with other brain regions (like the striatum and cerebellum).

Briefly, in a frontal lobe syndrome like ADHD, the totality of neurocognitive  deficits (including, in particular, impairments to the functioning of the so-called frontal lobe "Executive Function" of "working memory") serve to cleave: thought from action,  knowledge from performance, past and future from the moment and the sense of time from the rest of behaviour generally. Impairments to "working memory" in ADHD and related types of frontal lobe disorders, disrupt the cross-temporal organization of behaviour, loosen the binding of past and future consequences to the deliberations on current behaviour and lessen the capacity to bridge delays among the elements of a behavioural contingency (events, responses and outcomes).

If I can now "cut to the chase", this would seem to have some obvious moral/ethical implications with respect to the notion of an ADHD adult's  personal accountability and responsibility within society. That is, an argument could be used by some  (rightly, to my mind) to seek a legal finding of "diminished capacity" in the mental status of those with prefrontal cortex pathologies like ADHD, because as that capacity was originally conceived in common law, it was:  the power to consider one's actions in the light of past experience and future consequences as best as one can know them - to deliberate the outcomes of one's actions in relation to time. In ADHD, however, a person who has the disorder is unable to organize their behaviour across time toward the purposeful, meaningful achievement of future goals as effectively as a person who does not have the disorder. They are unable, for example, to use hindsight and foresight as effectively as a normal person is, in contemplating the consequences of the actions that they take. This is largely because impairments to then functioning of  their "working memory" mean that they are afflicted with a kind of "blindness to time" , or rather, a "temporal myopia" (a nearsightedness to the future). The disorder, that is,  greatly restricts the time horizon horizon (or temporal window) over which they are able to rationally ponder the consequences of their actions, thus keeping them from coping with the probable future as well as others do who do not have ADHD.

This is not a choice; in that it is through no fault of their own that they find themselves in this predicament. The neuropsychological mechanisms for doing so (i.e. frontal lobe executive functions like "working memory") are simply not operating as effectively for them as they are for typical individuals. These faulty neuropsychological mechanisms are congenital (inherited at birth by the person with ADHD); they are not "normative"; and given this, how could persons with ADHD ( and other similar types of frontal lobe syndrome) properly be held to be  as "blameworthy" - as a normal adult would be - for the pattern of very substantial chaos and crisis often generated in their lives by their neurological inability to clearly "see", and take meaningful, rational, action toward, the future?

What are your views on this, Mel? Do you see frontal lobe psychiatric disorders like ADHD (and, say, schizophrenia, Bipolar Disorder and Antisocial Personality Disorder and so on) as having a moral/ethical dimension in the sense that I have tried to explain (above)? Would you agree with those neuroscientists who ague that the "Self" is located in, and a function of, the human prefrontal cortex?  Do you think it is correct to argue that congenital (neurogenetic) frontal lobe pathologies, disproportionately diminish the human freedom, and thereby the moral responsibility, of those unfortunate persons who are afflicted with them? 

My response …

Thank you for this email - you raise a fascinating and interlocking set of questions.

From the ethical perspective, almost everyone agrees that moral questions only arise in situations where there is a measure of personal freedom, and the degree of moral (and legal) responsibility is proportionate to that freedom.  If frontal lobe disorders totally incapacitate an individual, in terms of making a rational choices and directing actions accordingly, the individual cannot be considered to be morally responsible.

However, the situation is more problematic, since there are any number of factors (both inherited and socially acquired) that appear to influence personal choice and action. A frontal lobe disorder will be one of these - perhaps the most serious one - but it may be difficult to prove that it is the ONLY factor involved.  Forgive my lack of knowledge of psychiatric disorders, but I assume that none of those you mention is totally binary, but is subject to degrees of severity. Simply being diagnosed with a disorder may not therefore be taken to indicate that a particular behaviour is inevitable in any one individual.

The other question raised on the ethical side is the extent to which an individual suffering from such a disorder is able (perhaps with help from others) to mitigate its effects.  If you know what your limitations are, it can be argued that you have a duty to avoid situations that can aggravate their effects – or perhaps that others have a moral responsibility to ensure that you do not get yourself into such situations.

And then there's the problem of knowing what is the norm against which any form of abnormal behaviour is to be compared.

But that brings me to a Philosophy of Mind question...  Neuroscience tends to identify the self with neural activity. I'm far from sure that is the case.  Of course, particular actions and experiences correspond to specific areas of neural activity, and are impossible without it; but that does not mean that what we experience as the self is therefore identical with that brain activity. The self develops in relation to the environment in which an individual finds himself or herself. I am what I am in large part because of my experience, relationships, family and social background and so on. I am shaped by the culture within which I live, and the language and concepts to which I have been exposed.  Hence, I am not simply my brain, but something which is created in the relationship between my brain and the rest of the world.  Of course, that relationship is itself etched upon our neural pathways (if that's an appropriate way to put it, forgive me if not) and shapes our anticipation of the future and our habitual ways of reacting  - limited, of course, in the case of ADHD.

Hence, although the self cannot be physically located other than within the brain, many elements of the self - in terms of how we self-identify - are social rather than physical; we are influenced both socially and physically.  And what, I feel, is not sufficiently understood is the degree to which those two areas of influence affect one another, or how they balance against one another.  At the extreme, old-style Marxists used to regard any challenge to the social or political order as a sign of mental illness.  At the other extreme, a full analysis of most people would explain much of their behaviour, but would it thereby exonerate them from blame for their actions?

I guess, much of this could be summed up by saying that I would be uneasy if a person suffering from ADHD - or any of the other conditions - was regarded as nothing more than an example of that condition and treated accordingly.  The issue is how a person's psychological functioning is matched to their personal and social situation. The more severe the condition, the more likely it will dominate - to the point at which moral responsibility becomes impossible. But I imagine that in a majority of cases it is a matter of degree.

Touch one issue, and it throws up so many questions!

Further reflections…

If you hold a determinist view, you assume that everything – including every action and thought – can (in theory, if not in practice) be explained in terms of those things that have brought it about. Everything is physical, including the brain, and there is therefore no scope for ‘free will’ or the injection into the closed series of physical causes an extra mental ‘cause’ for which the agent alone is responsible.

This has implications for morality and law, for, if moral and legal responsibility are based on the assumption that an individual is free to choose what he or she will do, and – having chosen – is also free to put that choice into effect, then determinism will appear to undermine both.  In effect, we would be forced to concede that every actions deemed ‘wrong’ is actually a failure of the individual’s physical or social system; either the action is explicable entirely in terms of a physical incapacity of the brain, or a failure of the social system to imprint moral responsibility upon it.

A strict determinist might hold a ‘person’ responsible for an action, but would see no point in any form of retributive punishment, since there is no unique ‘self’ that deserves to be punished. At most, the task of punishment is to protect society for a seriously damaged individual, or to provide an opportunity to re-program that individual in order that he or she will not offend in the future.  If it is argued that punishment will indeed ‘teach the person a lesson’, that is not retribution but re-programming.

But there would seem to be a further problem here. Pushed to its extreme, this line of argument would lead to a Stalinist approach, namely that the very act of questioning the social and political order, let alone acting against it, must be a sign of mental illness. Equally, it assumes that, with no free will to influence behaviour, fundamental change can only come as the result of external stimulus.  There is little scope for the thinking individual to re-view their world and change their behaviour.

Following up on this…

On the website I have some notes for students on Freedom and Ethics, and brief notes from an A level talk on Freedom and Determinism.

In my books, there are chapters entitled ‘Free to choose?’ and ‘The experience of moral choice’ in Understand Ethics, ‘Free will and ethics’ in Understand thePhilosophy of Mind, and ‘Freedom and determinism’ in Religion and Science.

Your comments on this would be most welcome.