We develop the concept of a volitional disability as an aid in understanding those patients who behave in ways that are harmful to themselves in spite of their desire to do otherwise. Using this concept enables us to describe their behavior as intentional but ‘unvoluntary’. We demonstrate the clinical reality of such behavior by giving clinical examples of the behavior of those with phobic, compulsive, and addictive disorders. We then attempt to show how some kinds of self-harming behavior of noncompliant (...) patients are similar to phobic and compulsive behavior. We propose use of the concept of volitional disability to make it easier for physicians to work with these noncompliant patients and thus to improve their ability to provide better care for them. Keywords: alcoholism, volitional disability, physician attitudes, addictive, disorders, compulsions, phobias, noncompliance CiteULike Connotea Del.icio.us What's this? (shrink)

We develop the concept of a volitional disability as an aid in understanding those patients who behave in ways that are harmful to themselves in spite of their desire to do otherwise. Using this concept enables us to describe their behavior as intentional but ‘unvoluntary’. We demonstrate the clinical reality of such behavior by giving clinical examples of the behavior of those with phobic, compulsive, and addictive disorders. We then attempt to show how some kinds of self-harming behavior of noncompliant (...) patients are similar to phobic and compulsive behavior. We propose use of the concept of volitional disability to make it easier for physicians to work with these noncompliant patients and thus to improve their ability to provide better care for them. (shrink)

Augustine’s insights into the will and its free decision have long been a focus of controversy since his lifetime. Nonetheless, in modern scholarship, little effort has been made to clarify the actual function of the will as a psychological force in the life of mind. It has often been taken for granted that the will is an independent faculty which underlies our moral responsibility by its free choice. Accordingly, much ink has been spilled over issues such as necessity and freedom, (...) grace and free will, sin and evil will etc. This philosophical inquiry distinguishes itself from its antecedents by adopting a psychological focus on the function of the will. It attempts to explicate why uoluntas, and not other psychological activities, is the locus of moral responsibility in Augustine’s philosophical psychology. The work is thus split into two parts, each consisting of four chapters: the first part devoted to the will’s operation as a psychological dynamism, and the second to the traditional consideration of the will as a moral faculty. In the first part, the dissertation systematically investigates the psychological phenomenon of the will in its relationship to other psychological activities, from irrational affection to intellectual cognition. This phenomenological approach starts with Augustine’s unusual conception of concupiscentia carnis in his debates with Julian of Eclanum. According to Augustine’s philosophical interpretation of this biblical term, concupiscentia carnis as an uncontrollable tendency defines the essential infirmity of the will and forms the starting-point of further affective expressions of the soul. Then, the analysis advances to the role of the will in the formation of affection. It reveals the implicit approval that is entailed in the unvoluntary pre-volitional movements of the soul. This explains the superficial discrepancy between Augustine’s accounts of affection as can be found in Books IX and XIV of De ciuitate Dei. This general account of Augustine’s theory of emotion is followed by an in-depth examination of the feeling of shame so as to display the will’s actual contribution in a reflective affection. Augustine convincingly proves that shame reflects the powerlessness of the will in confrontation with concupiscentia carnis as well as the will’s effort to regain its dignity. To complete the foray into Augustine’s philosophy of the soul, his reflections on intellect and will in the process of moral decision are called into question. By reconsidering Augustine’s account of his own conversion and his reflections on our journey to the happy life, my analyses show that neither intellectualitic nor voluntaristic interpretations do justice to his understanding of moral decision. The voluntaristic interpretation overlooks the intellectual perspective of happy life and Augustine’s emphasis on the necessity of a knowledge of the good for our moral behaviour. On the other hand, the intellectualistic account unjustly ignores Augustine’s insights into the severe destructiveness of the failure of the will and the dilemma of two wills at war. To summarize, the phenomenological approach in Part I reveals the omnipresent feature of the will in mental life. The implications of this psychological feature of the will are twofold. It indicates the independence of the will as well as the limitations of the will by its actual conditions. The second part of this work investigates the moral significance of Augustine’s psychological insights into the function of the will. What bridges the gap between uoluntas as a psychological power and uoluntas as a moral faculty is Augustine’s most controversial conception of freedom. The dissertation first scrutinizes Augustine’s arguments for the independence of the will as reconstructed and assumed in the first part. By metaphysical arguments, Augustine reveals that nothing external, neither inferior nor superior being, can force the will to attain a particular disposition. For this cannot happen in a world governed by the divine order. In his analyses of the phenomenon of two contradictory wills, Augustine shows that the will is conditioned but not compelled by other internal forces. However, this merely represents the negative aspect of the will’s freedom, or libertas a coactione. At the same time, the positive aspect of Augustinian uoluntas has frequently been misinterpreted as a faculty of choice, or libertas indifferentiae. A careful reading shows that the free decision of the will is essentially a capacity to pursue one’s own happiness. In accord with this eudemonistic emphasis, the genuine freedom is the freedom to will and to accomplish the good, which alone guarantees the happy life. This original interpretation of freedom offers powerful support to Augustine’s account of moral agency. One is not only held responsible for his voluntary evildoings which he could have avoided, but also for the necessary conditions of life, i.e., ignorantia and difficultas as effects of original sin. For as argued earlier, even the presence of concupiscentia carnis as the inherent infirmity of the will contains the least assent of the will. This assent establishes the moral agency in evil willing. To account for our agency in the good will, the dissertation addresses the problem of compatibility between divine grace and freedom of will. My analysis shows that Augustine’s rigid position in the last years of his life is also philosophically defensible. An internal function of the grace upon the faculty of the will will not destroy its freedom to attain its own disposition. This philosophical analysis concludes by highlightling the close affiliation between the will and the self in Augustinian uoluntas. “I know nothing I could call my own if the will by which I’m willing or unwilling is not my own.”. By consent or dissent of the will, we identify ourselves with mental images, affective movements, practical reasoning and other psychological activities, either implicitly or explicitly. Augustine’s realistic conceptions of the will and its conditioned freedom provide a subtle and rich picture of human nature, which is still relevant to our own theoretical reflections on the self. 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Los conceptos de voluntariedad y decisión trabajados en la Ética Nicomaquea de Aristóteles permiten pensar bajo qué condiciones se atribuye la responsabilidad de una acción a una persona. Como primera condición para ello tal acción no se puede efectuar de una manera involuntaria (akô), donde se actúe por ignorancia o coacción. De esta forma se hace evidente que la responsabilidad recae sólo en un caso voluntario (hekôn), donde éste implica un decisión entre dos o más opciones. Así, en el presente (...) texto se avalúa en qué consiste el concepto de decisión, siendo éste una deliberación que lleva a una determinación o juicio (Krisis), en donde solamente se delibera lo que se esté en poder de realizar. Por ello la decisión, que se da bajo una consideración voluntaria, fundamenta la acción y de esta manera ésta última se convierte en responsabilidad de la persona que decide. (shrink)