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post factum
and making later
adjustments. The mere presence of a drug-induced pro-social compulsion does not
abolish that judgement.
Second, the capacity for online moral review might be preserved, even if the action
is automatic, despite the fact that traditionally automatic actions have been
associated with lack of awareness (Norman and Shallice, 1986) and contrasted with
willed action (James, 1891). For James, automatic action happens ‘wherever
movement follows unhesitatingly and immediately the notion of it in the mind …
We are then aware of nothing between the conception and the execution,’ while
46
See: Oxford Dictionary,
http://www.oxforddictionaries.com/definition/english/review
(Accessed: 27.08.2014). Although in some uses of the concept, ‘review’ may include an
intention to make necessary changes, the action guiding aspect is not a necessary
component of the concept and I will use ‘review’ to denote ‘critical assessment’ or
‘evaluation.’
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acts that require exercise of will, include ‘an additional conscious element of a fiat,
mandate, or expressed consent’ (p. 522). While automatic actions may happen
without awareness of the action taking place, we can typically bring our conscious
awareness to observe and monitor those actions. Taking a sip of water, breathing or
blinking might happen without conscious awareness when we are engrossed in a
conversation, but we might chose to direct our attention and examine these
processes and actions more closely. The ability to consciously attend can be further
trained. For example, mindfulness meditation may involve the systematic practice
of attending to actions performed without conscious awareness, such as breathing
and walking, and attending to otherwise unnoticed sensations, emotions and
thought processes. The ability to be aware of automatic actions and processes
suggests that the preservation of review in general and moral review specifically is
at least in principle plausible even when the actions cannot be said to be ‘willed’ in
James’ (1891) sense.
To more closely examine this possibility, let us examine whether conscious review
is preserved in the case of uncontrollable behaviours in OCD. In his article on the
phenomenology of compulsions, Denys (2011) begins with an illustrative case. A
patient is young mother, who is terrified by the thought of killing her daughter:
‘When I’m alone at home and I see my daughter sleeping in her
crib then I can see myself strangling her. I’m terribly shocked by
the thought and I am very frightened by it. If nobody holds me
back, I could murder my daughter. I don’t want to harm her, but
there is no guarantee that I never will. I can’t control myself any
longer. I thought I was a good mother, but the fact that I think
about it says something about who I really am. It shows that
perhaps I don’t love my daughter enough. I don’t want to think
about it but I’m not able to keep the thought out of my mind. The
harder I resist, the stronger the thought is. In the beginning I
occasionally thought about it, but now I think about it all the time.
Though I realize that the thought is absurd, I can’t stop it.’ (in:
Denys, 2011, p.1)
194
In this example, Denys’ (2011) patient takes an active evaluative stance
47
towards
compulsive thoughts and the resulting behaviours.
48
OCD is typically considered to
involve ‘insight’ about the ‘senselessness’ of the behaviours and lack of
endorsement of the intrusive thoughts. Such ‘insight,’ in the language of psychiatry,
is somewhat different from the concept of ‘moral review’ I proposed earlier. It is
usually defined and established on the basis of more than procedural criteria.
Rather, ‘insight’ is understood in content-laden terms, encompasses more than just
moral review specifically and is often established on the basis of the
outcome
of a
review. Despite these dissimilarities between ‘insight’ and ‘moral review,’ the
example serves our discussion well in so far as the presence of ‘insight’ indicates a
preserved ability for epistemic, pragmatic and moral review – even when strong
compulsions are present. As Denys’ (2011) points out,
‘With OCD there is always a moment of subjective
reflection as a result of which a viewpoint will be taken
against the contents and the form of the symptoms. The
patient with OCD is engaged in a dialogue with his or her
disease and constantly reviews his or herself with respect to
the contents and the form of the thoughts and acts. … The
obsessions … will be denied, resisted, avoided, doubted,
smoothed over, compared, balanced.’ (p.5)
The first lesson worth considering in discussing MB is that the presence of strong
compulsions and intrusive thoughts
49
need not abolish moral review.
47
OCD is typically regarded as involving ‘insight’ about the ‘senselessness’ of the
behaviours and thoughts. Such ‘insight’ is usually defined not in procedural terms, such as
an ability for review, but in more content-laden terms. Nevertheless, it demonstrates the
ability.
48
Psychologists and psychiatrists call such thoughts ‘obsessions,’ while they refer to
behaviours that relieve anxiety by obsessions, situational avoidance and covert behaviours
such as thought suppression and prayers as ‘compulsions.’ See for example: Abramowitz
(1998). For the purpose of this work, however, what matters more is the property of
‘compulsiveness’ (uncontrollability leading to some effects) whether as applied to intrusive
thoughts or to uncontrollable behaviours.
49
One could object that intrusive thoughts in OCD thoughts are ‘mere imaginings’ in the
sense that they do not have a motivational component. Analogically, even though I could
visualize shaving off my partner’s hair while he is asleep, I may have little or no motivation
to actually do it. I do not think that such an objection is strong – it does not follow from the
195
A further question that can be raised is whether or not the presence of strong
compulsion allows for the presence of moral review of sufficient quality: whether
such review takes into consideration the right factors in the right way, whether it
relies on well-justified beliefs, and so on. This doubt is
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