Agency in the absence of reason-responsiveness: The case of dispositional impulsivity in personality disorders

Abstract

It has been argued recently that persons diagnosed with a personality disorder (PD) ought to be held responsible for their actions because these actions are voluntary. (Pickard 2011, this journal). In what follows, I argue that this claim is grounded in a conception of voluntary action that is too coarse-grained to provide an adequate understanding of the structure of agency in persons diagnosed with PD. When the concept of voluntary action and that of behaviours typical of PD are examined more carefully, the claim that PD behaviours are voluntary turns out to be tenuous in at least two ways. Firstly, it becomes apparent that the grounds provided by Pickard do not conclusively establish that PD behaviours are voluntary. Secondly, a more refined conception of voluntary agency helps us to appreciate that, if indeed PD behaviours are voluntary, such behaviours seem at best to be voluntary in an anaemic and limited sense -a sense that is quite distinct from the ordinary sense in which we speak of actions being voluntary.

When the illness speaks

“…A rich philosophical literature exists on the nature of responsibility and culpability in mental illness. Distinctions are made between types of disorder (such as psychotic illnesses, personality disorders, impulse control disorders and mood disorders) as well as psychiatric symptoms (such as faulty cognitions, impaired insight and impaired impulse control) and their relationships to personal agency (Pickard 2011; Ayob 2016; Szalai 2016). In some instances, these philosophical distinctions may serve as helpful tools for the experienced practitioner in parsing out what behaviours and thoughts fall outside of a person's agency and identity.…”