Narrative Self-Constitution and Recovery from Addiction

Why do some addicted people chronically fail in their goal to recover, while others succeed? On one established view, recovery depends, in part, on efforts of intentional planning agency. This seems right, however, firsthand accounts of addiction suggest that the agent’s self-narrative also has an influence. This paper presents arguments for the view that self-narratives have independent, self-fulfilling momentum that can support or undermine self-governance. The self-narrative structures of addicted persons can entrench addiction and alienate the agent from practically feasible recovery plans. Strategic re-narration can redirect narrative momentum and therefore support recovery in ways that intentional planning alone cannot

Reasons, reflection, and repugnance

In this chapter we draw comparisons between Kass’ views on the normative authority of repugnance and social intuitionist accounts of moral judgement which are similarly sceptical about the role of reasoned reflection in moral judgement. We survey the empirical claims made in support of giving moral primacy to intuitions generated by emotions such as repugnance, as well as some common objections. We then examine accounts which integrate intuition and reflection, and argue that plausible accounts of wisdom are in tension with Kass’ claim that our inarticulable emotional responses can be the expression of deep wisdom. We conclude that while repugnance and other emotions have a role to play in informing deliberation and judgement, we have reason to be cautious in giving them normative authority. Affective responses alone cannot discharge the burden of justification for moral judgement and are just one tool relied upon by those we consider wise

DBS, Personal Identity, and Diachronic Value

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Reactive attitudes, relationships, and addiction

In this chapter we focus on the structure of close personal relations and diagnose how these relationships are disrupted by addiction. We draw upon Peter Strawson’s landmark paper ‘Freedom and Resentment’ (2008, first published 1962) to argue that loved ones of those with addiction veer between, (1) reactive attitudes of blame and resentment generated by disappointed expectations of goodwill and reciprocity, and (2) the detached objective stance from which the addicted person is seen as less blameworthy but also as less fit for ordinary interpersonal relationships. We examine how these responses, in turn, shape the addicted person’s view of themselves, their character and their capacities, and provide a negative narrative trajectory that impedes recovery. We close with a consideration of how these effects might be mitigated by adopting less demanding variations of the participant stance

Chapter 4 Welfarist Psychiatry Goes Global

We begin by describing welfarist psychiatry before outlining the relevant challenges to improving global mental health and explaining how welfarist psychiatry meets those challenges

Narrating Truths Worth Living: Addiction Narratives

Self-narrative is often, perhaps primarily, a tool of self- constitution, not of truth representation. We explore this theme with reference to our own recent qualitative interviews of substance-dependent agents. Narrative self- constitution, the process of realizing a valued narrative projection of oneself, depends on one’s narrative tracking truth to a certain extent. Therefore, insofar as narratives are successfully realized, they have a claim to being true, although a certain amount of self-deception typically comes along for the ride. We suggest that, because agents typically value certain outcomes more highly than truth for truth’s sake, it makes sense to narrate in ways that aren’t strictly true if that helps ensure highly valued outcomes do come true. Walker (2012) outlines three ways of defending the truth of past-directed narratives, but the role of future-directed narratives in realizing highly valued truths provides her a fourth way

Native and foreign born as predictors of pediatric asthma in an Asian immigrant population: a cross sectional survey

<p>Abstract</p> <p>Background</p> <p>Asthma prevalence is lower in less developed countries and among some recent immigrant populations in the US, but the reasons for this are not clear. One possibility is that early childhood infections are protective against asthma.</p> <p>Methods</p> <p>We surveyed Asian immigrant children (n = 204; age 4–18) to assess the relationship between asthma and native or foreign place of birth. We included questions about environmental exposures, demographic variables and family history of asthma to test whether they might explain effects of place of birth on asthma.</p> <p>Results</p> <p>The native and foreign born groups were similar in most respects. Analysis of association with diagnosed asthma for all ages together resulted in two logistic regression models. Both retained born in the US (ORs were 3.2 and 4.3; p < 0.01) and family history of asthma (ORs were 6.4 and 7.2; p < 0.001). One model retained living near heavy motor traffic (OR = 2.6; p = 0.012). The other retained language (OR = 3.2; p = 0.003). However, for older children (11–18 years of age) being born in the US lost some of its predictive power.</p> <p>Conclusion</p> <p>Our findings are consistent with early childhood infections that are prevalent outside the US protecting against asthma.</p

Narrative self-constitution and vulnerability to co-authoring

All people are vulnerable to having their self-concepts shaped by others. This article investigates that vulnerability using a theory of narrative self-constitution. According to narrative self-constitution, people depend on others to develop and maintain skills of self-narration and they are vulnerable to having the content of their self-narratives co-authored by others. This theoretical framework highlights how vulnerability to co-authoring is essential to developing a self-narrative and, thus, the possibility of autonomy. However, this vulnerability equally entails that co-authors can undermine autonomy by contributing disvalued content to the agent's self-narrative and undermining her authorial skills. I illustrate these processes with the first-hand reports of several women who survived sexual abuse as children. Their narratives of survival and healing reveal the challenges involved in (re)developing the skills required to manage vulnerability to co-authoring and how others can help in this process. Finally, I discuss some of the implications of co-authoring for the healthcare professional and the therapeutic relationship.15 page(s

Narrative, self-governance, and addiction

Theoretical thesis.Bibliography: pages 262-271.Introduction -- Chapter 1. Addiction : a disorder of choice? -- Chapter 2. Diachronic stability in action -- Chapter 3. Normative planning agency and self-governance -- Chapter 4. Narrative agency -- Chapter 5. Choice accounts versus planning accounts -- Chapter 6. Planning accounts versus the narrative account. -- Conclusion.Addiction has long inflicted heavy costs on individuals and society yet we still lack an account of agency that can satisfactorily explain addicted behaviour. This thesis attempts to develop such an account by drawing on theories of narrative self-constitution. I argue that a narrative account improves on the reward maximisation views promoted by Gene Heyman and George Ainslie and the normative planning views promoted by Richard Holton and Michael Bratman.Heyman and Ainslie define all action, including addicted action, as reward maximizing where rewards are fixed by extra-agential forces. This account eliminates both the possibility of a synchronic struggle against addictive desire and the possibility of self-governance in general. Therefore, it clashes with the experience of addicts and clinicians who see recovery as an extended agential struggle. Normative planning theories improve on these accounts by making room for self-governance. According to these views, self-governance varies according to how much effort the agent puts into conforming to norms of practical reason as they form and enact their plans and policies. However, there remain a variety of agential phenomena that are mysterious on normative planning accounts. The most glaring cases are where addicts recover despite there being no improvement in their planning skills or circumstances and where addicts fail to recover despite disvaluing their lifestyle and having the planning skills to pursue available alternatives.The narrative account defended in this thesis builds on normative planning accounts by showing how networks of intentions are nested within more holistic self-narratives that include interpretations of one’s contingent circumstances. The way agents self-narrate, therefore, affects their self-governance in ways that go beyond mere normative organization of intentions. As a consequence, certain styles of self-narration can entrench addiction or facilitate recovery somewhat independently of one’s values, planning skills, and available opportunities.Mode of access: World wide web1 online resource (271 pages

THE IMPORTANCE OF SELF-NARRATION IN RECOVERY FROM ADDICTION

: Addiction involves a chronic deficit in self-governance that treatment aims to restore. We draw on our interviews with addicted people to argue that addiction is, in part, a problem of self-narrative change. Over time, agents come to strongly identify with the aspects of their self-narratives that are consistently verified by others. When addiction self-narratives become established, they shape the addicted person’s experience, plans, and expectations so that pathways to recovery seem to be implausible and feel alien. Therefore, the agent may prefer to enact her disvalued self-narrative because at least it represents who she takes herself to be. To recover, the agent needs to conduct narrative work, adjusting her existing self-narrative so that it better supports recovery-directed narrative projections. Reducing cravings, managing withdrawals, increasing self-control, and developing goals are all important for recovery, but those approaches will often be in vain if the influence of self-narrative is ignored. If our analysis is correct, addiction treatment will typically be more effective if it incorporates support for self-narrative change