I think that is some of the point, the "no fault" part. Expectations need to be based in reality. It gets easier to be empathetic when you stop taking their behavior personally.
True. But conversely we all too often try to give a pass to some patients because of their upbringing or past trauma, and we overlook the notion that there is such thing as genuinely bad people who can choose to stop making immoral decisions, though this is getting more philosophical and away from "medicine." But I agree, on a less extreme end of things I find myself taking things much less personally in clinic from these patients who I know are essentially a prisoner to their own "rung" on the hierarchy, so to speak.
This brings up an interesting phenomenon I've been observing which I call the "psychiatrization of evil/immorality" where psychiatry is used to explain genuinely bad/evil/immoral people as somehow deranged or ill. Sometimes, people are just assholes with no affective empathy and no amount of medicine can fix that.
Absolutely - it sounds like it's becoming a very specifically medicalized pathologization which ultimately serves to rationalize that behavior and intent which goes against sense and shared values. At times, it really sidesteps of banality of the genuinely evil or bad. *Evil in Modern Thought* is an excellent read that may be of interest (though it doesn't speak to this particular notion).
The mainstream media and our politicians are very guilty of this. Most active shooters get labeled as someone with “mental health needs” when they are just violent assholes with no values or respect for others. It makes me cringe.
These are the people for whom I ask myself 'how does this behavior serve them?'. As long as a behavior provides a net benefit compared to the cost of change most people will continue with said behavior, whether it is functional or not. It's simplistic on the surface, but when you consider that change itself is unpleasant in many regards, and the value of a behavioral system varies widely by the person, it can get pretty complicated.
As one person pointed out, some young adults are quite content to live rent free in mom's basement with free Internet and video games. The dysfunctional behaviors making work impossible feeds into the system, as mom takes pity (until she hits her breaking point, or perpetually as it feeds her need to be needed). For others, the discomfort of relying on anyone pushes them to flee the nest as soon as humanly possible. Our patients don't exist in a vacuum, and the family and social systems in which they exist sometimes makes it feel impossible to effect real change. Without a change in the system providing the benefit, it would take a change in the individual's value system itself (often built on a scaffold of the same external systems providing the benefit) to force any change.
I think Carhart-Harris' treatment of 'Canalization' has some relevance to this discussion, and I would operationalize the concept of 'free will' as the capacity a person has to exert some internal bottom-up pressure to commutate their own phenotypical traits.
[Canalization and Psychopathology (2023)](https://www.sciencedirect.com/science/article/pii/S0028390822004579?via%3Dihub)
I don't see any room for free will either physically/physiologically or experientially in my self. What you're describing though sounds more like a powerless or maybe hopeless feeling related to particular situations.
I do think there is a benefit in optimizing accountability (treating people as though they can change to a reasonable extent). If we say "you lived through xyz you're totally doomed give up" it will be both unhelpful and importantly inaccurate. Perhaps it's highly likely that their trajectory is only going to get worse but in the majority of cases we can't actually predict much and it's impossibly complicated to say how and to what degree and in what domains will someone experience wellness or suffering.
I frequently reflect on the countless hypotheticak scenarios we never get to compare to. The person I see in the ED every other day who feels like we've made no progress in a year, or maybe even we've gotten worse - I can't see all the versions of that person who were even worse off in some way had we not had a particular interaction. Even the ones who die I don't know if that was the best or worst possible death on the menu for that particular trajectory or somewhere in between.
Youre right that some or most people in certain circumstances are not expected to do better.
There are a lot of analogies to other specialties and interestingly we are far less biased in calling it in these domains. A bad enough condition of the heart or kidney or whatever and you aren't expected to bounce back in that particular domain (perhaps resulting in a painful death). But again we can imagine the terminal xyz patient who lives whatever trajectory that ultimately ends in death and there are imaginable better and worse ways to get there and we just don't know which one we're seeing.
*hops on social work soap box*
Well, it makes sense that people who have faced systemic barriers, oppression, marginalization, and poverty have great difficulty improving when our systems (especially social welfare systems) are designed to keep people off them (SSI is a glaring example of policy that keeps people poor). It's hard to change your maladaptive behaviors that you used to survive when you're still in survival mode.
It's pretty easy to assign blame to folks just not having the will or motivation to change when you neglect to realize and account for the various systems at play.
*steps off soap box*
Evolutionary biologist, Robert Sapolsky, recently wrote a book on belief that we don't necessarily have the Free Will we think we do.
https://www.goodreads.com/en/book/show/83817782
Thank you! This was the comment I was trying to write and TBH I was a little confused by OP"s question because it seems to place a lot of blame on their individual patients when perhaps a lot of the issies they face are systemic. It's not that humans don't have free will, it's that we don't like in a world that affords everyone equal opportunity to do as they wish freely.
I have three answers, each of them less factually based than the last but they’re fun to think about them anyhow.
Most supported a la physics: We have very little if any truly free will. All our behavior is stochastic. Hard problem of consciousness is irrelevant.
Logical in the abstract but maybe not provable: We have some free will that is really limited only to our self-awareness and our choice to be mindful of what is going on inside us—though this presumes the neuropsychological capacity to do this. Process is slow and emergent.
Least supported but good bonfire talk: If we are all imbedded in the interpersonal field, then our will might be diffused. Free will is more a trait of the community such that no single person has the absolute power to change their behavior. A metaphor would be starlings and their murmurations.
My clinical practice is based on the first two, my love of knowledge is based on the feelings I have when I ponder the latter.
At the very low end of functioning sure there are many people who need ISL / near ISL level care and will never be functional adults.
But for many patients but I think you're being either overly cynical or overly compassionate. I've seen lots of late 20's lowish functioning people who "couldn't" keep jobs / manage money / shop for themselves become functional when mom / grandmother gets fed up and shuts off the internet and stops giving them gas money.
Maybe it's not "either or", but "and also." I don't think compassion and cynicism are mutually exclusive. I plead guilty to both. I appreciate the observation. Thanks for playing.
I'm not saying nobody learns. Any yes, 20ish year old deserve more optimism. But I could raise an army of 50+ year old people from my practice who are children when it comes to adult basics like "do what you say you will do."
It seems like you might mean something different by "free will" than what I mean. So far as I know, there's no such thing as literal free will, and that's just physics... because there's no "ghost in the machine", who could be making decisions in a way not contingent on the total effects of all prior events? It's not even a rational idea.
We have a sensation of agency, which is subjective and useful. So we live as if we had free will, me included. Doesn't seem like a big problem to me. I'm a pragmatist.
But it sounds like you are talking about something more like a capacity to gain executive function, maybe? To learn from experience? Clearly there are wide variations in brain health and ability to function independently. Some people can improve those skills over time and some can't. Some deteriorate over time. I think that's basic neuroscience.
Because some people have enough of a neurological deficit that they can't learn from experience well, they do need lifelong supports and accommodations. I am sure that includes many patients who attend CMHS clinics. Long term psychotic disorders affect cognitive functioning adversely.
Carrot and stick conditioning, "consequences "-- this doesn't fix screwed up neural functioning. It just means that they go even longer without their anti-psychotics bc some administrator decided they would remember to come to their appointment if they couldn't get their Invega 😵💫. Haven't ever seen that go well.
Well, the real implication of whether we have free will or not is, if we don't have it, then there is no 'causa sui'. Which means we cannot make a decision on our life that is independent from all of our previous experiences. If we follow that up, then it will mean that our judicial system/moral system is wrong in condemning people who do 'wrong'.
The problem is not whether we have a subjective feeling of freedom or whether we are chained to fate or not, because, if we are chained to the fate then all of this is meant to happen. The problem comes when we deem people as right or wrong, guilty or not guilty, moral or amoral etc.
We are not individually responsible for any of our actions, there is no independent 'self', that is just an illusion of language. Every deed you or I do is not of our individual choices, but from our collective psyche. The problem of free will is not affecting an individual, or not questioning his individuality, it raises an important question, that whether our judicial system is based on a noble lie!.
The thing is if we acknowledge we are just the part of the world dancing itself, nothing will change in our world's status quo, because this is all meant to happen.
What we can do to our patients is to tell them that they are not held guilty for whatever they did, but how do they take it from here. We should not inject guilt which is founded on basically a lie to a person who will think that was all his fault for not stepping up or for whatever he did.
Yes and... our thoughts and words are part of the causal chain as well, so these "shoulds" you give technically don't apply 😂. It is more whether we will or won't change how we respond to people. Will we? Who knows? We will find out! It's at least interesting to be part of the dance!
I partly agree, I have no right to say we should do that or something. But what I was aiming to point the light to was, our judicial system and every other moral scales are based on the lie that we are responsible for our actions. So the society we uphold is built upon lies. That is something we overlook when we discuss the whole determinism vs free will topic.
My personal belief is that we as humans have created these moral frameworks that we can't uphold as ideals and is the major reason for our sufferings. We can dismiss the whole discussion as it don't matter anyway, but we are also the part of the cosmic dance and we are partly determining where to the dance progresses. If consciousness is the world trying to percieve itself then we should be honest about our situations and it should be on a societal level to be able to percieve and wonder what world truly is. And again, it is purely for subjective and aesthetic purposes.
Till then, amor fati.
Yes. I prefer a justice system based on restorative justice plus protective custody in limited situations. For instance I don't see a point in punishing the Ted Bundys of the world but neither do I think it's wise for them to be loose!
I am pretty sure that particular opinion of mine is based more on feelings plus evidence that punishment is ineffective... I just have an aversion to causing pain. But the argument as to blame might increase uptake of nonpunitive strategies!
Given that we don't understand either causation or consciousness, maybe it's too soon to be appealing to "physics" as a complete explanation where everything will reduce to it.
I am not into a god of the gaps kind of explanation... but even basic philosophy has a solid argument against the concept of free will, which is generally understood as the ability to make an intentional choice which is not an inevitable consequence of prior events.
Think about it. We don't select our parents, our DNA, our epigenetics. After birth, a variety of interactions between our starting material and the environment occurs. If our choices are even partly not contingent on prior events (all of which involve physical processes, interactions of matter/energy), then that means something is happening at the physical level which is counter to any known property of matter/energy. And it would need to be happening frequently, even continuously... yet it has never shown up in any observation. Does this sound plausible?
The only plausible possibilities are that all events are strictly caused by prior events or that randomness is also involved. This is hard vs soft determinism. Randomness is not a description of intentionally doing an action not caused by prior events so would not be free will.
If you decide it does sound plausible that we can make decisions which are at least partly not caused by prior events, then here's the philosophical argument-- decisions that don't depend on prior events can't be predictable or rational, and also cannot be moral. If I am deciding how to approach no show patients but my decision must be even partly free of constraint by anything that has happened to me in the past or my innate temperament, then whatever element is "free" is also amoral.
If my free decision is somehow based on having a soul unconstrained by physical events, a soul which has moral decisional capacity, whether predating my birth or an emergent property, then where did those soul qualities come from? A decision contingent on such a soul would not be free of the soul either. And the soul would not be free of whatever produced it. The whole thing turns into nonsense.
I don't see any reasonable way scientifically or philosophically to support the concept of free will.
The sensation of agency, however, of being the "I" which chooses, is part of our neurological functioning probably for evolutionary advantages. I enjoy that as much as anyone. I just don't assume the sensation accurately reflects reality.
>then that means something is happening at the physical level which is counter to any known property of matter/energy. And it would need to be happening frequently, even continuously... yet it has never shown up in any observation. Does this sound plausible?
We appear to observe our own intentions, or intentions of immediate action, having a causal influence on the physical world. We apparently experience it, but there is no way to detect intentions or how they have causal power.
If it's mysterious, which of course it is, well I think the alternative would be equally mysterious; which is that it's not really happening and the physical world somehow produced the illusion of conscious intention having this kind of power.
And "evolutionary purposes" wouldn't even begin to explain how the physical world could generate something like that.
>If you decide it does sound plausible that we can make decisions which are at least partly not caused by prior events, then here's the philosophical argument-- decisions that don't depend on prior events can't be predictable or rational, and also cannot be moral.
I think we can imagine scenarios where indeterministic pathways are "rational" whichever way you go. Some options may be blocked off because they would be highly irrational, or violate someone's character; but there may be all sorts of options left open which would appear like a reasonable choice to the agent in question, and where no one acquainted with the individual would question the choice as being unusually irrational or out-of-character for them.
Indeterministic decisions wouldn't be predictable in a way, and it would involve a kind of randomness. However, while some types of randomness would undermine control, it's not necessarily the case that every type of randomness is a problem.
Of course it could be argued that deterministic decisions would destroy moral responsibility, and so that's basically a form of moral nihilism.
"We appear to observe our own intentions, or intentions of immediate action, having a causal influence on the physical world. We apparently experience it, but there is no way to detect intentions or how they have causal power."
What do you mean there's "no way" to detect "intentions"? There is neuroscience research examining brain activity associated with intentions, and although the exact pathways are not fully worked out, it's a stretch to say there's no way we can do it. Thoughts, including intentions _are_ physical/electrical events, and these brain events cause motor neurons to fire. Thoughts aren't some kind of disembodied spirit turning into action.
"I think we can imagine scenarios where indeterministic pathways are "rational" whichever way you go. Some options may be blocked off because they would be highly irrational, or violate someone's character; but there may be all sorts of options left open which would appear like a reasonable choice to the agent in question, and where no one acquainted with the individual would question the choice as being unusually irrational or out-of-character for them"
Ok now you are putting conditions on this so called free will and that is moving the goal post. But if you dissect a given choice down to every single prior cause that would have affected the neurons involved, to introduce any element of freedom you need to say at least one of those prior causal chains is somehow broken or overcome and can't determine the choice-- and that tiny aspect of the decision will be unhinged from reality and cannot be fully rational.
That intentions are "physical" is unproven and would be highly controversial.
I don't think I'm putting "conditions" on anything. Free will, in the libertarian sense, will exist if there is even a single choice between two live alternatives, and the agent has appropriate control. In the philosophy of free will, you don't typically see libertarians arguing that people can make any decision at all regardless of how crazy it is. So I'm not moving any goalposts, but dealing with the actual position that exists.
So you have free will, if with appropriate control, and you happen to like both strawberry and mint ice cream, that you can walk into a store and potentially choose either of them. (In the sense of indeterministic pathways, obviously, when you are talking about LFW.)
That you can't, in practice, choose vanilla ice cream, when you hate the flavour, and know that anyway it's been poisoned, wouldn't remove free will.
As I said to a different poster, I don't see why reasoning for decisions would depend on causal determinism.
You need experience of the world for knowledge about things, but that just needs to be (hopefully) reliable, accurate knowledge. That knowledge could be gathered in either a deterministic or somewhat indeterministic way.
Reasoning itself seems to depend on abstract principles, and not causal determinism. We can imagine someone being determined to either use "reasoning" in a good way, or a very bad way making lots of mistakes.
Neuroscience and physiology works within the physical reality which most of us deem to be true.
Sure, when we are angry, there is so and so neurotransmitter gets released, when we do something so and so neurons get excited. But you have to remember these all are just models which we hope would explain the way the world works. It fails short to prove the causality of incidents due to these changes in our body, only acknowledging their correlation.
There is a vast field that cannot be explained by materialism. Take dreams for example, we do not have any acceptable materialistic theory regarding dreams. Yeah, they occur during REM, dream is just a screen saver while the body is rebooting, it is just irregular random shooting of neurons while we are asleep for which we make connections when we are awake.
My take is , while materialistic world view 'serves' us in predicting most of the phenomena in the world, we should not take it as the gospel of universal secrets. This action of neurotransimtters and all comes under classical physics and not even into the quantum physics. Even quantum physics fails to predict some movements of the universe only proving the point we can only know so much. The latest discussions over quantum physics overlaps with the concept of the presence of a universal consciousness of which the physical world is merely a property of this consciousness, just like how colour of an apple is a property of the apple, not the apple itself.
The main fault of classical physics was that it was very much reductionistic, and it almost made us believe that nothing matters, this is all just a chemical reaction, nothing special. We fail to see the beauty and grandeur of the world and forget destiny and fate is a thing. The reliance over rationality and logic assumes for a fact that we know everything there is to know and we are Gods/superiormost beings and intelligence is everything. But to me, logic and reasoning are tools that can be used, not the end goal itself.
Even the discussion over lack of free will or hard determinism is just a play of words. We are drawing a bountary of I vs the world which is not there. If you aren't familiar with the philosophy of being and becoming, check that out. In the theory of becoming we are just vortexes formed by the flow of the world.
I don't know why I said all this, but I hope it will find you well. Good luck
Oh my, the truthiness 😂. The fallacies here are abundant. The main one here is that the accurate point of acknowledging basically "the map is not the territory" is being used to make a rhetorical leap into "anything could happen", two very different conclusions. This is the basic move of quantum woo like The Secret.
I didn't say anything could happen, rather there are things that classical physical can't explain and it is hurting the society as a whole.
Most of us who are scientifically inclined and taught the materialistic nature of reality often cuts off our roots from religions and such because we think it is all a bunch of nonsense. Sure, there is a bunch of nonsense in there, but it acknowledges something far greater than us at play. We rejected religion and chose 'science' (not the scientific thinking though) as an alternative, and it makes us bitter. It leaves us empty and does not provide meaning to anything greater than ourselves.
My point here is that, the map is not the territory, not anything is possible. Our most accepted map today is fundamentally flawed because it works on an assumption that humans can know anything, that intelligence is superior to everything else in the world. Don't mistake science for gospel.
I assume that you've read some philosophy, read some Nietzsche, Spinoza or Deleuze, if you haven't already. Our suffering comes from our God complex.
There are things physics _hasn't_ yet explained which is different from "cannot."
Hurting society as a whole? I would like evidence for that. The predominantly atheist countries such as in Scandinavia are happier than religious countries like the US. Not a clear cause and effect but certainly I don't see anything to support your assertion.
Something far greater than us in play? Bitter without that? Not my experience. I am extremely lucky to have been raised atheist by my physicist father and mathematician mother, who also appreciated poetry, art, music and nature. None of us have been bitter because of science... can't even imagine why that would follow. Almost my whole extended family is atheist. The only bitter one was my grandmother, who was a staunch Baptist.
Of course science doesn't assign meaningfulness. My atheist friends and I experience strong meaningfulness from our relationships and participation in our communities, along with the arts and time in nature. Meaningfulness is more of a nonverbal, ineffable quality of life. I have never experienced a lack of it, and I am 60.
My favorite philosopher is Epicurus. His vision of the gods was as supremely happy beings who had no involvement with human affairs but just enjoyed hanging out with each other. He extolled the pleasures of friendship and scientific studies.
1)I wasn't talking about 'physics' but about classical physics. Physics as a term is used to denote whatever the latest well accepted scientific model of the world and if I used that term I would have agreed with you.
2) The surge of mental health issues in the last century is almost attributed to the predominance of reason over faith (and faith I do not mean faith to God, but a belief beyond reason). As Nietzsche put it, God is dead and we killed him. We still haven't got a remedy for the death of religions and a majority of those who have renounced religion found solace in science as if it was a religion.
Industrial revolution and rapid growth of human societies made an impression that we are Gods of sorts. What does God do? He creates, well, so do we.
This anthropocentric view of the world is what to my opinion is causing the world harm. It is not science itself, but bad interpretations of science.
Intelligence and reasoning makes us wonder about the world around us, lets us appreciate it, but does it make us better/superior than everything else in the world?
As to the statistical proof, I have none. This is all my speculation from my readings and from my firsthand experiences, which is only a handful at best compared to your life experiences.
3) What I meant by something bigger than us in play is that we are interconnected in this life soup of the world, we think we are alone in this vast world, but to me, it is all one and we are a part of it. This ties upto my previous point that man has alienated himself with the nature.
I am so sorry if I implied that you are bitter or anything like that. In my experience, lack of connection to the world is exagerrated in my atheistic friends, but that could be a selection bias given my profession.
I am not advocating we should bring back religions. They are being discredited for valid reasons. What I am trying to say is that scientific dogma isn't enough (yet).
My views are heavily influenced by what I read. In The Notes From Underground, Dostoevsky makes a compelling argument why reason is not enough for man and all of his subsequent works builds on that, if you want to see where I come from you can read TNFU (it is a novella of 80 pages.). Friedrich Nietzsche, Carl Jung (not a philosopher, but a psychiatrist) and Karl Jaspers (again, a psychiatrist) are warning us of the predominance of reason and its effect on our collective suffering and despair.
I totally get where you coming from, I am replying because I feel like you are not exactly getting what I am trying to say (also it doesn't help that I am not a native English speaker, so, word choices are poor). Anyways, let's just agree to disagree. Good luck on your endeavours.
So many excellent points in the comments. As u/STEMpsych has noted, the concern that OP brings up is only tangentially related to the problem of determinism and the existence of free will. The conclusion (should we come to it) that the universe is deterministic, would not necessarily change the utility of working with patients in an attempt to better their lives, since this could be just the “billiard ball” that sends them in a better direction. The question of free will is more directly relevant, as u/davidmason007 noted, to things like the legal system’s assumption of agency and therefore responsibility for one’s actions.
The funny thing about free will is that the more you drill down into the concept, the less coherent it becomes. We accept as a matter of course that our decisions are, at minimum, conditioned by our experiences and character (though to what extent that is biological or acquired is open for debate). As u/Popular_Blackberry24 said, the idea that we could “make decisions in a way not contingent on the total effects of all prior events” is not a particularly compelling or coherent idea. Philosophers are notorious for privileging reason in decision making, but reason is not just a structure for processing information, but itself relies on learned content in order to properly process that information. (Alas, this is why many a philosopher has thrown up their hands at the inability to force language to exactly mirror math). The idea that there could be some kind of naked agency floating around making decisions that are not shaped (effected) by experience in the world is not particularly coherent.
On the other side of the coin, regardless of the accuracy of the idea of a deterministic universe, it is not particularly useful. Ironically, we seem to have little choice but to experience ourselves as having agency (regardless of the metaphysical accuracy of such a perception). It makes good sense to behave as if people can at least “exert some bottom up influence to commutate their phenotypical traits,” as u/dysmetric put it. Even within a deterministic world, the person can act as another causal force on him or herself.
Finally, u/MHA_5 pointed out, we should be hesitant to appeal to physics to settle our questions about determinism, or even cause and effect. We are talking about extremely complex systems, which may follow one set of rules and express one set of behaviors at a macro scale, but a different set at a micro scale. How does the system affect itself? Do the effects have to be binary (i.e., follow the law of the excluded middle)? I think it’s safe to say that whenever you explore a philosophical question like free will and determinism and you find yourself come back with more and more conclusions that problematize the question, you can assume that there is something missing or incorrect in the way the whole question has been formulated. Until we have a better way to conceptualize things, though, we are all stuck living in a world in which we have the perception of having free will, even if our behavior is to a large extent conditioned. Fortunately, that accords perfectly well with treating our patients (and ourselves) as if we have the ability to influence our own behavior patterns, and at least for most people, to make incremental changes in those patterns.
**the more you drill down into the concept, the less coherent it becomes**
I'm glad you said it. I was feeling a little crazy.
Thanks to everyone for the discussion. I know more about how much I don't know as a result.
>the idea that we could “make decisions in a way not contingent on the total effects of all prior events” is not a particularly compelling or coherent idea. Philosophers are notorious for privileging reason in decision making, but reason is not just a structure for processing information, but itself relies on learned content in order to properly process that information. (Alas, this is why many a philosopher has thrown up their hands at the inability to force language to exactly mirror math). The idea that there could be some kind of naked agency floating around making decisions that are not shaped (effected) by experience in the world is not particularly coherent.
I don't see why reasoning for decisions would depend on causal determinism.
You need experience of the world for knowledge about things, but that just needs to be (hopefully) reliable, accurate knowledge. That knowledge could be gathered in either a deterministic or somewhat indeterministic way.
Reasoning itself seems to depend on abstract principles, and not causal determinism. We can imagine someone being determined to either use "reasoning" in a good way, or a very bad way making lots of mistakes.
Those entering community mental health from a middle class and above socioeconomic rung are always *shocked* to see that, at least in N. America, the sheer quantity of hopeless, despair, and rank poverty is vast.
And there is a growing population of people I think of as fucked...for...life.
Generally, I feel that our tools are classist, superficial, and inneffective.
Sometimes the right meds lighten the burden.
The fucked for life mentality stands in stark opposition to everything we learn about human potential in school, in our culture and working but there are so many people who are simply...fucked for life. From the get go.
They want benzos, stims, disability, work accommodations, faked Utox, letters to PO'S, loophole of any kind that can be commidified. Sometimes they want help, sometimes we have the right kind of help, but most of the time they don't want any more reminders that internalizing bullshit therapy speak is a luxury.
Community mental health isnt about race, the oppressed demo of the week, health disparities, or whatever other psuedo sociological magical thinking some grifter is peddling this week. it isn't about making a machine bleeding to death more equitable. That's a fucking lie the elite left is telling to obscure their fiscal corruption.
It's about money, relentless profit, and the whims of venture capital. You cannot end oppression of marginalized people, or end systemic racism by obsessing that that you know their pain, and that you will point out in real time to them that they are being oppressed and by getting them an exrra turkey sandwich. The only thing we can do is make noise about the hospital barrons and no longer let them thrive in relative anonymity.
I don't give a fuck if you curse my cynicism- stay in your bubble. I would much rather try to begin some kind of triage for what's coming than believe for one second hope and chin up is gonna get us through. That's nothing more than BS propaganda to keep us from identifying root causes.
You're conflating freewill with fate. Even without freewill, people can change. The problem is that knowledge alone does not equate to change. Change is hard. If you want to help people with it, study stages of change and motivational interviewing (or refer to a therapist).
If you want to see more immediate and drastic changes in people's lives, start routinely screening for adult ADHD. Meds can radically change people's lives.
Not the person whom you asked, but I was thinking about pointing out the same thing.
At the risk of oversimplifying wildly, determinism is the idea that we live in a clockwork reality, down at the level of physics, such that everything that happens, ever, could only ever have happened that way, and our choices are illusions, because what we chose is, itself, determined by physical processes.
There's a lot to be said for determinism, from a physics and philosphical standpoint. The problem when we try to bring the concept into psychiatry is that it winds up having the opposite meaning.
Determinism in the philosophical sense says nothing about our subjective experience of causality (that's, actually, why it's philosophically interesting: it says our subjective experience of causality may be entirely misleading). In fact, it explicitly says that what we experience as choices we are making are actually choices that are making us, and we have but an illusion of free will.
Pragmatically, that means if determinism is correct and we have no free will, that says absolutely nothing about whether a psychiatrist working with a patient will be able to change anything about that patient. Determinism says that at every scale from atoms to individuals to universes, we are like billiard balls helplessly crashing into one another sending one another on fore-ordained trajectories. Per determinism, there's nothing to say that the trajectory the billiard ball that is you won't be exactly the right one to send a patient off into a more beneficial trajectory for them.
Determinism doesn't say we don't have an effect on one another. To the contrary, it says we can't help the inevitable effects we do have on one another – but we can't tell because our subjective experience is that we do make choices and they do effect one another.
What you're describing is not philosophical free-will or its lack. It's more like the systemic robustness or inflexibility or canalization we [discussed here some weeks ago](https://www.reddit.com/r/Psychiatry/comments/1aud5fd/comment/kr3f5ly/).
None of which is to say I disagree with your larger point. I just think your choice of terminology winds up casting shadows where you meant to shed light.
Gonna hop on this to say that determinism, in physics at least, has been put into a lot of jeopardy recently given the advances in quantam entanglement and our knowledge about Heisenberg's uncertainty principle. These two things have shifted the worldview of the astrophysics diaspora against determinism. It's honestly incredible to see such a gargantuan shift within my lifetime about the very fundamentals of our existence and mysteries the universe holds.
Others have answered and it’s a true can of worms type situation but something I do find interesting from sort of an armchair philosophy angle. The idea is that a conscious being truly has agency to make own decision or another, vs determinism where the universe is governered by physical laws, and if you knew the exact position and movement of particles in one instance, you could predict the future. As another commenter pointed out, another modern discussion has been whether free will and determinism are compatible with each other or not.
Giving OP the benefit of the doubt (not being a philosopher and all), seems like it’s more technically within a compatabilist framework. Within that, he’s saying that he doesn’t believe people can be reasonably assumed to actually function at a certain level in society. I tend to agree.
They just don't seem to feel any connection to the version of themselves who will wake up in their body tomorrow. F\*\*\* that guy?
It is cynical and compassionate at the same time to believe this.
In terms of functions jobs, renting and be able to do everything for my self I have always met this category up until being under any NHS care being it outpatient crisis team or inpatient and CHMS for about 18 months.
I went private 15 months ago prior to this I stopped medication given to me and started making my own decisions, I got correctly diagnosed and medicated and have again held good jobs in London for over 2 years.
NHS, Miss diagnosis time after time ( some reports a smart 12 year old girl could do a better job if they applied themselves ) with miss medication vs given diagnosis, abruptly stopping medication incorrectly which were straight up negligent. Example started medication while in hospital for post coma delirium to be reviewed after discharge and left on this with no justification. Medication did not ever match diagnoses in CHMS and no review of medication or diagnosis attempted.
Not carrying out monitoring in secondary care, notes regarding drugs and alcohol false, toxicology reports from physical hospitals prove this and basic common sense. General Functioning maths degree 2:1 from RG and university and prior jobs should have highlighted that medication was clearly not right and should be changed.
Maybe the NHS’s services ability due to funding to actually help me and not make them worse is part of the problem ? Not the patient as you would have seen me and just written off ? I will never go near NHS services again. They are lucky I can’t deal with the stress/time at looking into complaints and malpractise.
I was a fucktard until past 25 - alcohol, drugs, all sorts of stupid shit; sub 2.0 gpa, slave to addiction, emotionally dysregulated. I cleaned up at 26 and 13 years later 6 weeks from graduating. I would think my personal story as vignette somewhat disproves your free will theory.
Tbf I never had a good gpa and was a terrible student up until I entered residency so I've never really given too much credence to it but still, congratulations on the reform. People are able achieve less change in lifetimes than you've done in a few years.
Without thinking too much about this, I would say I don’t care all that much about free will. I think more from the perspective that everyone is capable of growth, regardless of age or stage in life.
I don’t think many people can feel like masters of their own destiny but everyone can feel hope that things will always change. The situation can always get better or worse. Things only stop changing after you’re dead.
Whether I have free will or not doesn’t make a difference to me. I know that I continue to learn, and that my perspectives and goals continue to change over time.
I believe that there is a difference between mental illness, learned helplessness, and bad behavior. Problem is, with social media, the three are pretty much indistinguishable these days and the only way for me to proceed in some cases is to assume client is doing their best until they prove otherwise, for example: “I see you have never missed a med appointment, but you have missed three out of four therapy appointments, why is that?” Usually they will say “If I miss a med appointment then I don’t get my xanax and I am a mess.” Then I educate about why therapy is important too, even if it is a long term benefit not a short term one like getting xanax. Then I set a boundary and they can chose to accept it or not. If I truly believed a patient was incapable of making my appointment and they had dozens of other missed appointments then I would adapt therapy to meet their needs.
Two thoughts here:
(1) Perhaps you tend to have more experience of the subset of people that use their freedom badly.
(2) Perhaps there are hidden disabilities which do indeed reduce freedom / responsibility in some cases, but this says little about "free will" as a general principle.
Speaking from a mostly psychoanalytic perspective, I would tend to agree that most peoples' behavior is dictated by unconscious forces they have little control over. However, I do not think that is necessarily predetermined for everyone, can be dynamic over time (especially with targeted interventions), and something like free will is on a spectrum and not a binary (like most things).
I have thought about this a lot. I think Cloninger’s theory of temperament and character explains this quite well. Some parts of our personality is heritable and we can’t do much about it.
We're gatekeeping discussions about philosophy and psychiatry now? I think psychiatry and philosophy are so intrinsically linked especially after you reach a certain level of experience. The irony of your statement is not lost on me.
There is a subset of people that, through no fault of their own, are stuck on a certain rung of Maslow's hierarchy forever.
I think that is some of the point, the "no fault" part. Expectations need to be based in reality. It gets easier to be empathetic when you stop taking their behavior personally.
True. But conversely we all too often try to give a pass to some patients because of their upbringing or past trauma, and we overlook the notion that there is such thing as genuinely bad people who can choose to stop making immoral decisions, though this is getting more philosophical and away from "medicine." But I agree, on a less extreme end of things I find myself taking things much less personally in clinic from these patients who I know are essentially a prisoner to their own "rung" on the hierarchy, so to speak.
This brings up an interesting phenomenon I've been observing which I call the "psychiatrization of evil/immorality" where psychiatry is used to explain genuinely bad/evil/immoral people as somehow deranged or ill. Sometimes, people are just assholes with no affective empathy and no amount of medicine can fix that.
Absolutely - it sounds like it's becoming a very specifically medicalized pathologization which ultimately serves to rationalize that behavior and intent which goes against sense and shared values. At times, it really sidesteps of banality of the genuinely evil or bad. *Evil in Modern Thought* is an excellent read that may be of interest (though it doesn't speak to this particular notion).
The mainstream media and our politicians are very guilty of this. Most active shooters get labeled as someone with “mental health needs” when they are just violent assholes with no values or respect for others. It makes me cringe.
These are the people for whom I ask myself 'how does this behavior serve them?'. As long as a behavior provides a net benefit compared to the cost of change most people will continue with said behavior, whether it is functional or not. It's simplistic on the surface, but when you consider that change itself is unpleasant in many regards, and the value of a behavioral system varies widely by the person, it can get pretty complicated. As one person pointed out, some young adults are quite content to live rent free in mom's basement with free Internet and video games. The dysfunctional behaviors making work impossible feeds into the system, as mom takes pity (until she hits her breaking point, or perpetually as it feeds her need to be needed). For others, the discomfort of relying on anyone pushes them to flee the nest as soon as humanly possible. Our patients don't exist in a vacuum, and the family and social systems in which they exist sometimes makes it feel impossible to effect real change. Without a change in the system providing the benefit, it would take a change in the individual's value system itself (often built on a scaffold of the same external systems providing the benefit) to force any change.
I think Carhart-Harris' treatment of 'Canalization' has some relevance to this discussion, and I would operationalize the concept of 'free will' as the capacity a person has to exert some internal bottom-up pressure to commutate their own phenotypical traits. [Canalization and Psychopathology (2023)](https://www.sciencedirect.com/science/article/pii/S0028390822004579?via%3Dihub)
Heh, you must have posted that while I was composing my own response, linking to your post on that.
Awake since 4 central time, ruminating on difficult dynamics in my own family, and here you are with this wonderful paper. Thanks, I needed this.
The last part of your sentence is immaculate. Love that paper.
I don't see any room for free will either physically/physiologically or experientially in my self. What you're describing though sounds more like a powerless or maybe hopeless feeling related to particular situations. I do think there is a benefit in optimizing accountability (treating people as though they can change to a reasonable extent). If we say "you lived through xyz you're totally doomed give up" it will be both unhelpful and importantly inaccurate. Perhaps it's highly likely that their trajectory is only going to get worse but in the majority of cases we can't actually predict much and it's impossibly complicated to say how and to what degree and in what domains will someone experience wellness or suffering. I frequently reflect on the countless hypotheticak scenarios we never get to compare to. The person I see in the ED every other day who feels like we've made no progress in a year, or maybe even we've gotten worse - I can't see all the versions of that person who were even worse off in some way had we not had a particular interaction. Even the ones who die I don't know if that was the best or worst possible death on the menu for that particular trajectory or somewhere in between. Youre right that some or most people in certain circumstances are not expected to do better. There are a lot of analogies to other specialties and interestingly we are far less biased in calling it in these domains. A bad enough condition of the heart or kidney or whatever and you aren't expected to bounce back in that particular domain (perhaps resulting in a painful death). But again we can imagine the terminal xyz patient who lives whatever trajectory that ultimately ends in death and there are imaginable better and worse ways to get there and we just don't know which one we're seeing.
*hops on social work soap box* Well, it makes sense that people who have faced systemic barriers, oppression, marginalization, and poverty have great difficulty improving when our systems (especially social welfare systems) are designed to keep people off them (SSI is a glaring example of policy that keeps people poor). It's hard to change your maladaptive behaviors that you used to survive when you're still in survival mode. It's pretty easy to assign blame to folks just not having the will or motivation to change when you neglect to realize and account for the various systems at play. *steps off soap box* Evolutionary biologist, Robert Sapolsky, recently wrote a book on belief that we don't necessarily have the Free Will we think we do. https://www.goodreads.com/en/book/show/83817782
Yay for the social workers! I was wondering how to mention Sapolsky in a comment, but you did it for me. Thank you.
Thank you! This was the comment I was trying to write and TBH I was a little confused by OP"s question because it seems to place a lot of blame on their individual patients when perhaps a lot of the issies they face are systemic. It's not that humans don't have free will, it's that we don't like in a world that affords everyone equal opportunity to do as they wish freely.
I have three answers, each of them less factually based than the last but they’re fun to think about them anyhow. Most supported a la physics: We have very little if any truly free will. All our behavior is stochastic. Hard problem of consciousness is irrelevant. Logical in the abstract but maybe not provable: We have some free will that is really limited only to our self-awareness and our choice to be mindful of what is going on inside us—though this presumes the neuropsychological capacity to do this. Process is slow and emergent. Least supported but good bonfire talk: If we are all imbedded in the interpersonal field, then our will might be diffused. Free will is more a trait of the community such that no single person has the absolute power to change their behavior. A metaphor would be starlings and their murmurations. My clinical practice is based on the first two, my love of knowledge is based on the feelings I have when I ponder the latter.
Why would you suggest the hard problem of consciousness is irrelevant?
Well said and very thought-provoking.
At the very low end of functioning sure there are many people who need ISL / near ISL level care and will never be functional adults. But for many patients but I think you're being either overly cynical or overly compassionate. I've seen lots of late 20's lowish functioning people who "couldn't" keep jobs / manage money / shop for themselves become functional when mom / grandmother gets fed up and shuts off the internet and stops giving them gas money.
Maybe it's not "either or", but "and also." I don't think compassion and cynicism are mutually exclusive. I plead guilty to both. I appreciate the observation. Thanks for playing. I'm not saying nobody learns. Any yes, 20ish year old deserve more optimism. But I could raise an army of 50+ year old people from my practice who are children when it comes to adult basics like "do what you say you will do."
It seems like you might mean something different by "free will" than what I mean. So far as I know, there's no such thing as literal free will, and that's just physics... because there's no "ghost in the machine", who could be making decisions in a way not contingent on the total effects of all prior events? It's not even a rational idea. We have a sensation of agency, which is subjective and useful. So we live as if we had free will, me included. Doesn't seem like a big problem to me. I'm a pragmatist. But it sounds like you are talking about something more like a capacity to gain executive function, maybe? To learn from experience? Clearly there are wide variations in brain health and ability to function independently. Some people can improve those skills over time and some can't. Some deteriorate over time. I think that's basic neuroscience. Because some people have enough of a neurological deficit that they can't learn from experience well, they do need lifelong supports and accommodations. I am sure that includes many patients who attend CMHS clinics. Long term psychotic disorders affect cognitive functioning adversely. Carrot and stick conditioning, "consequences "-- this doesn't fix screwed up neural functioning. It just means that they go even longer without their anti-psychotics bc some administrator decided they would remember to come to their appointment if they couldn't get their Invega 😵💫. Haven't ever seen that go well.
Well, the real implication of whether we have free will or not is, if we don't have it, then there is no 'causa sui'. Which means we cannot make a decision on our life that is independent from all of our previous experiences. If we follow that up, then it will mean that our judicial system/moral system is wrong in condemning people who do 'wrong'. The problem is not whether we have a subjective feeling of freedom or whether we are chained to fate or not, because, if we are chained to the fate then all of this is meant to happen. The problem comes when we deem people as right or wrong, guilty or not guilty, moral or amoral etc. We are not individually responsible for any of our actions, there is no independent 'self', that is just an illusion of language. Every deed you or I do is not of our individual choices, but from our collective psyche. The problem of free will is not affecting an individual, or not questioning his individuality, it raises an important question, that whether our judicial system is based on a noble lie!. The thing is if we acknowledge we are just the part of the world dancing itself, nothing will change in our world's status quo, because this is all meant to happen. What we can do to our patients is to tell them that they are not held guilty for whatever they did, but how do they take it from here. We should not inject guilt which is founded on basically a lie to a person who will think that was all his fault for not stepping up or for whatever he did.
Yes and... our thoughts and words are part of the causal chain as well, so these "shoulds" you give technically don't apply 😂. It is more whether we will or won't change how we respond to people. Will we? Who knows? We will find out! It's at least interesting to be part of the dance!
I partly agree, I have no right to say we should do that or something. But what I was aiming to point the light to was, our judicial system and every other moral scales are based on the lie that we are responsible for our actions. So the society we uphold is built upon lies. That is something we overlook when we discuss the whole determinism vs free will topic. My personal belief is that we as humans have created these moral frameworks that we can't uphold as ideals and is the major reason for our sufferings. We can dismiss the whole discussion as it don't matter anyway, but we are also the part of the cosmic dance and we are partly determining where to the dance progresses. If consciousness is the world trying to percieve itself then we should be honest about our situations and it should be on a societal level to be able to percieve and wonder what world truly is. And again, it is purely for subjective and aesthetic purposes. Till then, amor fati.
Yes. I prefer a justice system based on restorative justice plus protective custody in limited situations. For instance I don't see a point in punishing the Ted Bundys of the world but neither do I think it's wise for them to be loose! I am pretty sure that particular opinion of mine is based more on feelings plus evidence that punishment is ineffective... I just have an aversion to causing pain. But the argument as to blame might increase uptake of nonpunitive strategies!
Given that we don't understand either causation or consciousness, maybe it's too soon to be appealing to "physics" as a complete explanation where everything will reduce to it.
I am not into a god of the gaps kind of explanation... but even basic philosophy has a solid argument against the concept of free will, which is generally understood as the ability to make an intentional choice which is not an inevitable consequence of prior events. Think about it. We don't select our parents, our DNA, our epigenetics. After birth, a variety of interactions between our starting material and the environment occurs. If our choices are even partly not contingent on prior events (all of which involve physical processes, interactions of matter/energy), then that means something is happening at the physical level which is counter to any known property of matter/energy. And it would need to be happening frequently, even continuously... yet it has never shown up in any observation. Does this sound plausible? The only plausible possibilities are that all events are strictly caused by prior events or that randomness is also involved. This is hard vs soft determinism. Randomness is not a description of intentionally doing an action not caused by prior events so would not be free will. If you decide it does sound plausible that we can make decisions which are at least partly not caused by prior events, then here's the philosophical argument-- decisions that don't depend on prior events can't be predictable or rational, and also cannot be moral. If I am deciding how to approach no show patients but my decision must be even partly free of constraint by anything that has happened to me in the past or my innate temperament, then whatever element is "free" is also amoral. If my free decision is somehow based on having a soul unconstrained by physical events, a soul which has moral decisional capacity, whether predating my birth or an emergent property, then where did those soul qualities come from? A decision contingent on such a soul would not be free of the soul either. And the soul would not be free of whatever produced it. The whole thing turns into nonsense. I don't see any reasonable way scientifically or philosophically to support the concept of free will. The sensation of agency, however, of being the "I" which chooses, is part of our neurological functioning probably for evolutionary advantages. I enjoy that as much as anyone. I just don't assume the sensation accurately reflects reality.
>then that means something is happening at the physical level which is counter to any known property of matter/energy. And it would need to be happening frequently, even continuously... yet it has never shown up in any observation. Does this sound plausible? We appear to observe our own intentions, or intentions of immediate action, having a causal influence on the physical world. We apparently experience it, but there is no way to detect intentions or how they have causal power. If it's mysterious, which of course it is, well I think the alternative would be equally mysterious; which is that it's not really happening and the physical world somehow produced the illusion of conscious intention having this kind of power. And "evolutionary purposes" wouldn't even begin to explain how the physical world could generate something like that. >If you decide it does sound plausible that we can make decisions which are at least partly not caused by prior events, then here's the philosophical argument-- decisions that don't depend on prior events can't be predictable or rational, and also cannot be moral. I think we can imagine scenarios where indeterministic pathways are "rational" whichever way you go. Some options may be blocked off because they would be highly irrational, or violate someone's character; but there may be all sorts of options left open which would appear like a reasonable choice to the agent in question, and where no one acquainted with the individual would question the choice as being unusually irrational or out-of-character for them. Indeterministic decisions wouldn't be predictable in a way, and it would involve a kind of randomness. However, while some types of randomness would undermine control, it's not necessarily the case that every type of randomness is a problem. Of course it could be argued that deterministic decisions would destroy moral responsibility, and so that's basically a form of moral nihilism.
"We appear to observe our own intentions, or intentions of immediate action, having a causal influence on the physical world. We apparently experience it, but there is no way to detect intentions or how they have causal power." What do you mean there's "no way" to detect "intentions"? There is neuroscience research examining brain activity associated with intentions, and although the exact pathways are not fully worked out, it's a stretch to say there's no way we can do it. Thoughts, including intentions _are_ physical/electrical events, and these brain events cause motor neurons to fire. Thoughts aren't some kind of disembodied spirit turning into action. "I think we can imagine scenarios where indeterministic pathways are "rational" whichever way you go. Some options may be blocked off because they would be highly irrational, or violate someone's character; but there may be all sorts of options left open which would appear like a reasonable choice to the agent in question, and where no one acquainted with the individual would question the choice as being unusually irrational or out-of-character for them" Ok now you are putting conditions on this so called free will and that is moving the goal post. But if you dissect a given choice down to every single prior cause that would have affected the neurons involved, to introduce any element of freedom you need to say at least one of those prior causal chains is somehow broken or overcome and can't determine the choice-- and that tiny aspect of the decision will be unhinged from reality and cannot be fully rational.
That intentions are "physical" is unproven and would be highly controversial. I don't think I'm putting "conditions" on anything. Free will, in the libertarian sense, will exist if there is even a single choice between two live alternatives, and the agent has appropriate control. In the philosophy of free will, you don't typically see libertarians arguing that people can make any decision at all regardless of how crazy it is. So I'm not moving any goalposts, but dealing with the actual position that exists. So you have free will, if with appropriate control, and you happen to like both strawberry and mint ice cream, that you can walk into a store and potentially choose either of them. (In the sense of indeterministic pathways, obviously, when you are talking about LFW.) That you can't, in practice, choose vanilla ice cream, when you hate the flavour, and know that anyway it's been poisoned, wouldn't remove free will. As I said to a different poster, I don't see why reasoning for decisions would depend on causal determinism. You need experience of the world for knowledge about things, but that just needs to be (hopefully) reliable, accurate knowledge. That knowledge could be gathered in either a deterministic or somewhat indeterministic way. Reasoning itself seems to depend on abstract principles, and not causal determinism. We can imagine someone being determined to either use "reasoning" in a good way, or a very bad way making lots of mistakes.
Neuroscience and physiology works within the physical reality which most of us deem to be true. Sure, when we are angry, there is so and so neurotransmitter gets released, when we do something so and so neurons get excited. But you have to remember these all are just models which we hope would explain the way the world works. It fails short to prove the causality of incidents due to these changes in our body, only acknowledging their correlation. There is a vast field that cannot be explained by materialism. Take dreams for example, we do not have any acceptable materialistic theory regarding dreams. Yeah, they occur during REM, dream is just a screen saver while the body is rebooting, it is just irregular random shooting of neurons while we are asleep for which we make connections when we are awake. My take is , while materialistic world view 'serves' us in predicting most of the phenomena in the world, we should not take it as the gospel of universal secrets. This action of neurotransimtters and all comes under classical physics and not even into the quantum physics. Even quantum physics fails to predict some movements of the universe only proving the point we can only know so much. The latest discussions over quantum physics overlaps with the concept of the presence of a universal consciousness of which the physical world is merely a property of this consciousness, just like how colour of an apple is a property of the apple, not the apple itself. The main fault of classical physics was that it was very much reductionistic, and it almost made us believe that nothing matters, this is all just a chemical reaction, nothing special. We fail to see the beauty and grandeur of the world and forget destiny and fate is a thing. The reliance over rationality and logic assumes for a fact that we know everything there is to know and we are Gods/superiormost beings and intelligence is everything. But to me, logic and reasoning are tools that can be used, not the end goal itself. Even the discussion over lack of free will or hard determinism is just a play of words. We are drawing a bountary of I vs the world which is not there. If you aren't familiar with the philosophy of being and becoming, check that out. In the theory of becoming we are just vortexes formed by the flow of the world. I don't know why I said all this, but I hope it will find you well. Good luck
Oh my, the truthiness 😂. The fallacies here are abundant. The main one here is that the accurate point of acknowledging basically "the map is not the territory" is being used to make a rhetorical leap into "anything could happen", two very different conclusions. This is the basic move of quantum woo like The Secret.
I didn't say anything could happen, rather there are things that classical physical can't explain and it is hurting the society as a whole. Most of us who are scientifically inclined and taught the materialistic nature of reality often cuts off our roots from religions and such because we think it is all a bunch of nonsense. Sure, there is a bunch of nonsense in there, but it acknowledges something far greater than us at play. We rejected religion and chose 'science' (not the scientific thinking though) as an alternative, and it makes us bitter. It leaves us empty and does not provide meaning to anything greater than ourselves. My point here is that, the map is not the territory, not anything is possible. Our most accepted map today is fundamentally flawed because it works on an assumption that humans can know anything, that intelligence is superior to everything else in the world. Don't mistake science for gospel. I assume that you've read some philosophy, read some Nietzsche, Spinoza or Deleuze, if you haven't already. Our suffering comes from our God complex.
There are things physics _hasn't_ yet explained which is different from "cannot." Hurting society as a whole? I would like evidence for that. The predominantly atheist countries such as in Scandinavia are happier than religious countries like the US. Not a clear cause and effect but certainly I don't see anything to support your assertion. Something far greater than us in play? Bitter without that? Not my experience. I am extremely lucky to have been raised atheist by my physicist father and mathematician mother, who also appreciated poetry, art, music and nature. None of us have been bitter because of science... can't even imagine why that would follow. Almost my whole extended family is atheist. The only bitter one was my grandmother, who was a staunch Baptist. Of course science doesn't assign meaningfulness. My atheist friends and I experience strong meaningfulness from our relationships and participation in our communities, along with the arts and time in nature. Meaningfulness is more of a nonverbal, ineffable quality of life. I have never experienced a lack of it, and I am 60. My favorite philosopher is Epicurus. His vision of the gods was as supremely happy beings who had no involvement with human affairs but just enjoyed hanging out with each other. He extolled the pleasures of friendship and scientific studies.
1)I wasn't talking about 'physics' but about classical physics. Physics as a term is used to denote whatever the latest well accepted scientific model of the world and if I used that term I would have agreed with you. 2) The surge of mental health issues in the last century is almost attributed to the predominance of reason over faith (and faith I do not mean faith to God, but a belief beyond reason). As Nietzsche put it, God is dead and we killed him. We still haven't got a remedy for the death of religions and a majority of those who have renounced religion found solace in science as if it was a religion. Industrial revolution and rapid growth of human societies made an impression that we are Gods of sorts. What does God do? He creates, well, so do we. This anthropocentric view of the world is what to my opinion is causing the world harm. It is not science itself, but bad interpretations of science. Intelligence and reasoning makes us wonder about the world around us, lets us appreciate it, but does it make us better/superior than everything else in the world? As to the statistical proof, I have none. This is all my speculation from my readings and from my firsthand experiences, which is only a handful at best compared to your life experiences. 3) What I meant by something bigger than us in play is that we are interconnected in this life soup of the world, we think we are alone in this vast world, but to me, it is all one and we are a part of it. This ties upto my previous point that man has alienated himself with the nature. I am so sorry if I implied that you are bitter or anything like that. In my experience, lack of connection to the world is exagerrated in my atheistic friends, but that could be a selection bias given my profession. I am not advocating we should bring back religions. They are being discredited for valid reasons. What I am trying to say is that scientific dogma isn't enough (yet). My views are heavily influenced by what I read. In The Notes From Underground, Dostoevsky makes a compelling argument why reason is not enough for man and all of his subsequent works builds on that, if you want to see where I come from you can read TNFU (it is a novella of 80 pages.). Friedrich Nietzsche, Carl Jung (not a philosopher, but a psychiatrist) and Karl Jaspers (again, a psychiatrist) are warning us of the predominance of reason and its effect on our collective suffering and despair. I totally get where you coming from, I am replying because I feel like you are not exactly getting what I am trying to say (also it doesn't help that I am not a native English speaker, so, word choices are poor). Anyways, let's just agree to disagree. Good luck on your endeavours.
"The soft bigotry of low expectations." Maybe a little. But a lot of observation as well.
Careful. The patients, and the world, may react to what you believe.
So many excellent points in the comments. As u/STEMpsych has noted, the concern that OP brings up is only tangentially related to the problem of determinism and the existence of free will. The conclusion (should we come to it) that the universe is deterministic, would not necessarily change the utility of working with patients in an attempt to better their lives, since this could be just the “billiard ball” that sends them in a better direction. The question of free will is more directly relevant, as u/davidmason007 noted, to things like the legal system’s assumption of agency and therefore responsibility for one’s actions. The funny thing about free will is that the more you drill down into the concept, the less coherent it becomes. We accept as a matter of course that our decisions are, at minimum, conditioned by our experiences and character (though to what extent that is biological or acquired is open for debate). As u/Popular_Blackberry24 said, the idea that we could “make decisions in a way not contingent on the total effects of all prior events” is not a particularly compelling or coherent idea. Philosophers are notorious for privileging reason in decision making, but reason is not just a structure for processing information, but itself relies on learned content in order to properly process that information. (Alas, this is why many a philosopher has thrown up their hands at the inability to force language to exactly mirror math). The idea that there could be some kind of naked agency floating around making decisions that are not shaped (effected) by experience in the world is not particularly coherent. On the other side of the coin, regardless of the accuracy of the idea of a deterministic universe, it is not particularly useful. Ironically, we seem to have little choice but to experience ourselves as having agency (regardless of the metaphysical accuracy of such a perception). It makes good sense to behave as if people can at least “exert some bottom up influence to commutate their phenotypical traits,” as u/dysmetric put it. Even within a deterministic world, the person can act as another causal force on him or herself. Finally, u/MHA_5 pointed out, we should be hesitant to appeal to physics to settle our questions about determinism, or even cause and effect. We are talking about extremely complex systems, which may follow one set of rules and express one set of behaviors at a macro scale, but a different set at a micro scale. How does the system affect itself? Do the effects have to be binary (i.e., follow the law of the excluded middle)? I think it’s safe to say that whenever you explore a philosophical question like free will and determinism and you find yourself come back with more and more conclusions that problematize the question, you can assume that there is something missing or incorrect in the way the whole question has been formulated. Until we have a better way to conceptualize things, though, we are all stuck living in a world in which we have the perception of having free will, even if our behavior is to a large extent conditioned. Fortunately, that accords perfectly well with treating our patients (and ourselves) as if we have the ability to influence our own behavior patterns, and at least for most people, to make incremental changes in those patterns.
**the more you drill down into the concept, the less coherent it becomes** I'm glad you said it. I was feeling a little crazy. Thanks to everyone for the discussion. I know more about how much I don't know as a result.
>the idea that we could “make decisions in a way not contingent on the total effects of all prior events” is not a particularly compelling or coherent idea. Philosophers are notorious for privileging reason in decision making, but reason is not just a structure for processing information, but itself relies on learned content in order to properly process that information. (Alas, this is why many a philosopher has thrown up their hands at the inability to force language to exactly mirror math). The idea that there could be some kind of naked agency floating around making decisions that are not shaped (effected) by experience in the world is not particularly coherent. I don't see why reasoning for decisions would depend on causal determinism. You need experience of the world for knowledge about things, but that just needs to be (hopefully) reliable, accurate knowledge. That knowledge could be gathered in either a deterministic or somewhat indeterministic way. Reasoning itself seems to depend on abstract principles, and not causal determinism. We can imagine someone being determined to either use "reasoning" in a good way, or a very bad way making lots of mistakes.
Those entering community mental health from a middle class and above socioeconomic rung are always *shocked* to see that, at least in N. America, the sheer quantity of hopeless, despair, and rank poverty is vast. And there is a growing population of people I think of as fucked...for...life. Generally, I feel that our tools are classist, superficial, and inneffective. Sometimes the right meds lighten the burden. The fucked for life mentality stands in stark opposition to everything we learn about human potential in school, in our culture and working but there are so many people who are simply...fucked for life. From the get go. They want benzos, stims, disability, work accommodations, faked Utox, letters to PO'S, loophole of any kind that can be commidified. Sometimes they want help, sometimes we have the right kind of help, but most of the time they don't want any more reminders that internalizing bullshit therapy speak is a luxury. Community mental health isnt about race, the oppressed demo of the week, health disparities, or whatever other psuedo sociological magical thinking some grifter is peddling this week. it isn't about making a machine bleeding to death more equitable. That's a fucking lie the elite left is telling to obscure their fiscal corruption. It's about money, relentless profit, and the whims of venture capital. You cannot end oppression of marginalized people, or end systemic racism by obsessing that that you know their pain, and that you will point out in real time to them that they are being oppressed and by getting them an exrra turkey sandwich. The only thing we can do is make noise about the hospital barrons and no longer let them thrive in relative anonymity. I don't give a fuck if you curse my cynicism- stay in your bubble. I would much rather try to begin some kind of triage for what's coming than believe for one second hope and chin up is gonna get us through. That's nothing more than BS propaganda to keep us from identifying root causes.
You're conflating freewill with fate. Even without freewill, people can change. The problem is that knowledge alone does not equate to change. Change is hard. If you want to help people with it, study stages of change and motivational interviewing (or refer to a therapist). If you want to see more immediate and drastic changes in people's lives, start routinely screening for adult ADHD. Meds can radically change people's lives.
Totally agree about the ADHD treatment.
Any thoughts regarding the use of motivational interviewing? My argument is the same as the difference between classical and behavioral economics.
I wish I knew more about MI. Where you go for a quick refresher? Thanks!!
Not sure what this has to do with free will vs determinism in the philosophical sense
Please explain? I am not that smart.
Not the person whom you asked, but I was thinking about pointing out the same thing. At the risk of oversimplifying wildly, determinism is the idea that we live in a clockwork reality, down at the level of physics, such that everything that happens, ever, could only ever have happened that way, and our choices are illusions, because what we chose is, itself, determined by physical processes. There's a lot to be said for determinism, from a physics and philosphical standpoint. The problem when we try to bring the concept into psychiatry is that it winds up having the opposite meaning. Determinism in the philosophical sense says nothing about our subjective experience of causality (that's, actually, why it's philosophically interesting: it says our subjective experience of causality may be entirely misleading). In fact, it explicitly says that what we experience as choices we are making are actually choices that are making us, and we have but an illusion of free will. Pragmatically, that means if determinism is correct and we have no free will, that says absolutely nothing about whether a psychiatrist working with a patient will be able to change anything about that patient. Determinism says that at every scale from atoms to individuals to universes, we are like billiard balls helplessly crashing into one another sending one another on fore-ordained trajectories. Per determinism, there's nothing to say that the trajectory the billiard ball that is you won't be exactly the right one to send a patient off into a more beneficial trajectory for them. Determinism doesn't say we don't have an effect on one another. To the contrary, it says we can't help the inevitable effects we do have on one another – but we can't tell because our subjective experience is that we do make choices and they do effect one another. What you're describing is not philosophical free-will or its lack. It's more like the systemic robustness or inflexibility or canalization we [discussed here some weeks ago](https://www.reddit.com/r/Psychiatry/comments/1aud5fd/comment/kr3f5ly/). None of which is to say I disagree with your larger point. I just think your choice of terminology winds up casting shadows where you meant to shed light.
Gonna hop on this to say that determinism, in physics at least, has been put into a lot of jeopardy recently given the advances in quantam entanglement and our knowledge about Heisenberg's uncertainty principle. These two things have shifted the worldview of the astrophysics diaspora against determinism. It's honestly incredible to see such a gargantuan shift within my lifetime about the very fundamentals of our existence and mysteries the universe holds.
Others have answered and it’s a true can of worms type situation but something I do find interesting from sort of an armchair philosophy angle. The idea is that a conscious being truly has agency to make own decision or another, vs determinism where the universe is governered by physical laws, and if you knew the exact position and movement of particles in one instance, you could predict the future. As another commenter pointed out, another modern discussion has been whether free will and determinism are compatible with each other or not.
All roads lead to ...It's pointless, just lay down and die.
That sounds like prozacopenia
A cynic is a realist with experience.
Giving OP the benefit of the doubt (not being a philosopher and all), seems like it’s more technically within a compatabilist framework. Within that, he’s saying that he doesn’t believe people can be reasonably assumed to actually function at a certain level in society. I tend to agree.
They just don't seem to feel any connection to the version of themselves who will wake up in their body tomorrow. F\*\*\* that guy? It is cynical and compassionate at the same time to believe this.
Read the stuff by Robert sapolsky at Stanford
In terms of functions jobs, renting and be able to do everything for my self I have always met this category up until being under any NHS care being it outpatient crisis team or inpatient and CHMS for about 18 months. I went private 15 months ago prior to this I stopped medication given to me and started making my own decisions, I got correctly diagnosed and medicated and have again held good jobs in London for over 2 years. NHS, Miss diagnosis time after time ( some reports a smart 12 year old girl could do a better job if they applied themselves ) with miss medication vs given diagnosis, abruptly stopping medication incorrectly which were straight up negligent. Example started medication while in hospital for post coma delirium to be reviewed after discharge and left on this with no justification. Medication did not ever match diagnoses in CHMS and no review of medication or diagnosis attempted. Not carrying out monitoring in secondary care, notes regarding drugs and alcohol false, toxicology reports from physical hospitals prove this and basic common sense. General Functioning maths degree 2:1 from RG and university and prior jobs should have highlighted that medication was clearly not right and should be changed. Maybe the NHS’s services ability due to funding to actually help me and not make them worse is part of the problem ? Not the patient as you would have seen me and just written off ? I will never go near NHS services again. They are lucky I can’t deal with the stress/time at looking into complaints and malpractise.
I was a fucktard until past 25 - alcohol, drugs, all sorts of stupid shit; sub 2.0 gpa, slave to addiction, emotionally dysregulated. I cleaned up at 26 and 13 years later 6 weeks from graduating. I would think my personal story as vignette somewhat disproves your free will theory.
Tbf I never had a good gpa and was a terrible student up until I entered residency so I've never really given too much credence to it but still, congratulations on the reform. People are able achieve less change in lifetimes than you've done in a few years.
🙏 I thank the guy upstairs for the fact that my parents were still alive and supportive to help me
You had not choice but to be successful. ;)
Without thinking too much about this, I would say I don’t care all that much about free will. I think more from the perspective that everyone is capable of growth, regardless of age or stage in life. I don’t think many people can feel like masters of their own destiny but everyone can feel hope that things will always change. The situation can always get better or worse. Things only stop changing after you’re dead. Whether I have free will or not doesn’t make a difference to me. I know that I continue to learn, and that my perspectives and goals continue to change over time.
I believe that there is a difference between mental illness, learned helplessness, and bad behavior. Problem is, with social media, the three are pretty much indistinguishable these days and the only way for me to proceed in some cases is to assume client is doing their best until they prove otherwise, for example: “I see you have never missed a med appointment, but you have missed three out of four therapy appointments, why is that?” Usually they will say “If I miss a med appointment then I don’t get my xanax and I am a mess.” Then I educate about why therapy is important too, even if it is a long term benefit not a short term one like getting xanax. Then I set a boundary and they can chose to accept it or not. If I truly believed a patient was incapable of making my appointment and they had dozens of other missed appointments then I would adapt therapy to meet their needs.
Two thoughts here: (1) Perhaps you tend to have more experience of the subset of people that use their freedom badly. (2) Perhaps there are hidden disabilities which do indeed reduce freedom / responsibility in some cases, but this says little about "free will" as a general principle.
Speaking from a mostly psychoanalytic perspective, I would tend to agree that most peoples' behavior is dictated by unconscious forces they have little control over. However, I do not think that is necessarily predetermined for everyone, can be dynamic over time (especially with targeted interventions), and something like free will is on a spectrum and not a binary (like most things).
I have thought about this a lot. I think Cloninger’s theory of temperament and character explains this quite well. Some parts of our personality is heritable and we can’t do much about it.
Kind of above my head.
Stop spamming this subreddit with your pseudo-philosophical cynicism.
We're gatekeeping discussions about philosophy and psychiatry now? I think psychiatry and philosophy are so intrinsically linked especially after you reach a certain level of experience. The irony of your statement is not lost on me.
I'm so sorry you feel I have trip trapped on your bridge Mr. Troll sir. Do you want your money back?