Hi, everyone. First of all, thanks for sharing this opportunity with me! As Thomas mentioned, I’ve been thinking about the place of agency in mental health recently, and I’m excited to get to work through some of my most recent questions and conundrums with you. From what I can tell, this topic is a bit peripheral (might we say, ‘refreshing’?) for Flickers, so I hope you’ll have as much fun thinking about it as I plan to.
Let me start with some background. In my work, I’m concerned with the discipline of psychiatry as both a scientific and an evaluative enterprise. Because of this dual nature, it is simultaneously our most critical and most dangerous tool for alleviating the harms caused by mental illness. As I’m sure I don’t have to rehearse here, psychiatry has historically been used as a tool of social oppression. That being said, I find myself principally motivated to address the very real and pernicious effects of mental illness. The goal is to heal or to help people flourish psychologically.
So what, then, of agency? One thing which is frequently remarked upon is the perception that healthy people have a kind of control over their lives which sufferers of mental illness lack. We often say of the compulsive person that ‘she just couldn’t help it’, or of the addict that ‘he slipped’. First person accounts of depression can invoke the complaint from the agent herself that she her behavior is ‘idiotic’ or ‘unreasonable’. Here, then, is a speculation:
A theory of mental health might be cached out in terms of agency. Perhaps, what is significant about mental disorders is the way in which they impair agency.
As philosopher of psychiatry George Graham likes to put it, mental disorders “gum up the works” (2010).
As perhaps no one knows better than readers here, our perceptions of what it means for human beings to exercise agency are changing—and this only makes this issue more complicated. Here then, is my basic question. In light of recent empirical evidence from the sciences of the mind, what is it (if anything) that sufferers of mental illness lack, and what does this imply about the aim of therapeutic intervention? This is a huge subject of course, and over the next few weeks I hope to examine only a few pieces of the puzzle. I hope also that you all will offer more! Until next time, here are a few questions to mull over:
- What does it mean to be a ‘competent’ patient?
- In what sense must we be rational?
- What kind of self-directedness is valuable?
- What is in our best interest?