Autonomy And Mental Disorder

Autonomy is a fundamental though contested concept. For instance, most of us place great value on the opportunity to make our own decisions and to be able to lead a life of our own choosing. Yet there is stark disagreement on what is involved in being able to decide autonomously, as well as how important this is compared with other commitments. For example, the success of every group project requires that group members make decisions about the project collectively rather than each on their own. This disagreement notwithstanding, mental disorder is routinely assumed to put a strain on autonomy. However, it is unclear whether this is effectively the case and, if so, whether this is due to the nature of mental disorder or of the social stigma that is often attached to it. Autonomy and Mental Disorder is the first exploration of the nature and value of autonomy with reference to mental disorder. By reflecting on instances of mental disorder where autonomy is apparently compromised, it offers a systematic discussion of the underlying presuppositions of the present autonomy debates. In so doing, it helps address different kinds of emerging scepticism questioning either the appeal of autonomy as a concept or its relevance to specific areas of normative ethics, including psychiatric ethics. Written by leading figures in philosophy and psychiatry, Autonomy and Mental Disorder will appeal to a wide range of readers in these and related disciplines. Lubomira Radoilska is Affiliated Lecturer in the Faculty of Philosophy at Cambridge University and Research Associate of the Uehiro Centre for Practical Ethics at Oxford University. She is the author of Aristotle and the Moral Philosophy of Today (2007).

Ethics of Psychiatry addresses the key ethical and legal issues in mental health care. With selections by Paul S. Applebaum, Christopher Boorse, Kerry Brace, Peter R. Breggin, Paula J. Caplan, Glen O. Gabbard, Donald H.J. Hermann, Lawrie Reznek, Thomas Szasz, Jerome Wakefield, Bruce J. Winick, and Robert M. Veatch, among others, this sourcebook offers the latest research in psychiatry, psychology, advocacy, mental health law, social services, and medical ethics relevant to the rational autonomy of psychiatric patients.

This book brings together insights from the enactivist approach in philosophy 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, this book addresses how inner conflict, 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-governing and to exercise autonomous agency. In the second half, she investigates the extent to which agents with various forms of mental disorder are capable of exercising autonomy. In her 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 autonomous 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 devise more effective treatments that restore subjects’ 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.

Estimates indicate that as many as 1 in 4 Americans will experience a mental health problem or will misuse alcohol or drugs in their lifetimes. These disorders are among the most highly stigmatized health conditions in the United States, and they remain barriers to full participation in society in areas as basic as education, housing, and employment. Improving the lives of people with mental health and substance abuse disorders has been a priority in the United States for more than 50 years. The Community Mental Health Act of 1963 is considered a major turning point in America's efforts to improve behavioral healthcare. It ushered in an era of optimism and hope and laid the groundwork for the consumer movement and new models of recovery. The consumer movement gave voice to people with mental and substance use disorders and brought their perspectives and experience into national discussions about mental health. However over the same 50-year period, positive change in American public attitudes and beliefs about mental and substance use disorders has lagged behind these advances. Stigma is a complex social phenomenon based on a relationship between an attribute and a stereotype that assigns undesirable labels, qualities, and behaviors to a person with that attribute. Labeled individuals are then socially devalued, which leads to inequality and discrimination. This report contributes to national efforts to understand and change attitudes, beliefs and behaviors that can lead to stigma and discrimination. Changing stigma in a lasting way will require coordinated efforts, which are based on the best possible evidence, supported at the national level with multiyear funding, and planned and implemented by an effective coalition of representative stakeholders. Ending Discrimination Against People with Mental and Substance Use Disorders: The Evidence for Stigma Change explores stigma and discrimination faced by individuals with mental or substance use disorders and recommends effective strategies for reducing stigma and encouraging people to seek treatment and other supportive services. It offers a set of conclusions and recommendations about successful stigma change strategies and the research needed to inform and evaluate these efforts in the United States.

This analysis of the law's approach to healthcare decision-making critiques its liberal foundations in respect of three categories of people: adults with capacity, adults without capacity and adults who are subject to mental health legislation. Focusing primarily on the law in England and Wales, the analysis also draws on the law in the United States, legal positions in Australia, Canada, Ireland, New Zealand and Scotland and on the human rights protections provided by the ECHR and the Convention on the Rights of Persons with Disabilities. Having identified the limitations of a legal view of autonomy as primarily a principle of non-interference, Mary Donnelly questions the effectiveness of capacity as a gatekeeper for the right of autonomy and advocates both an increased role for human rights in developing the conceptual basis for the law and the grounding of future legal developments in a close empirical interrogation of the law in practice.