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Psychiatric Naturalism and the Dimensions of Freedom: Implications for Psychiatry and the Law

Psychiatric Naturalism and the Dimensions of Freedom: Implications for Psychiatry and the Law

By naturalistic, I mean that we need not posit nonmaterial or metaphysical entities—although these might exist—to explain the world or ourselves. As the Center for Naturalism put it: "Nothing about us escapes being included in the physical universe, or escapes being shaped by the various processes—physical, biological, psychological, and social—that science describes. On a scientific understanding of ourselves, there's no evidence for immaterial souls, spirits, mental essences, or disembodied selves which stand apart from the physical world."1

And yet, in the face of all this, I maintain that we do experience and possess a very real kind of freedom. Of what, then, might this freedom consist? And how might such freedom be vitiated in the presence of certain brain conditions? Finally, how does such a view square with our everyday understanding of moral responsibility and societal punishment for "evil-doing"?

First threshold

I believe that the ancient Stoics had it about right when they construed freedom in essentially negative terms; that is, in terms of what is not presentwhen we say that we act "freely." At the very least, the Stoic formulation may help us toward a first approximation of what is meant by freedom.

In the Discourses, Stoic philosopher Epictetus described a free individual as a person who is free fromcertain inhibiting conditions; specifically, he or she is free from distress,free from fear,free from violent emotions,and free from hindrance.2In the ordinary linguistic use of the term "free," I believe these components are usually understood or intended. That is, we say, Jones acted freely if (among other criteria yet to be specified), Jones acted at a time when, with respect to the act in question, he was not under great duress, was not being coerced, was not experiencing some overwhelming emotional turmoil, and was not hindered from pursuing his wishes.I believe that these negative aspects of freedom bring us to what I would call the first threshold of a free act. These nonconstraint features are generally necessary but not sufficient to constitute what, in ordinary language, we mean by a free act. (I am again appealing to what our ordinary languagetells us about words such as free- dom; and, as the philosopher Ludwig Wittgenstein reminded us, "ordinary language is all right."3)

Second threshold

The second threshold involves the presence of intentionality. The philosopher Keith Seddon defined intentionality as follows: "In order for any action to be intentional, we have to understand the background of the situation against which we intend to act; what we hope to accomplish, and why it is reasonable to suppose that this action will produce that result"2 (italics added).

Note that Seddon's concept of intentionality entails more than simply acting consciously or with a purpose in mind—it entails rationality as well. On this admittedly stringent view of intentionality, a person who decided that the KGB had implanted an electrode in his brain and that the only way to correct this situation was to remove the electrode with an ice pick, which could only be accomplished by kidnapping the Russian ambassador, would not be acting intentionally. Nor would that individual be acting freely in the sense I wish to develop. It may also be seen that this unfortunate individual would not meet most ordinary definitions of "sane."

Indeed, Robert Daly has developed the concept of sanity in a way that is readily transferable to the concept of freedomI am developing. Daly wrote: "A person is judged to be 'sane' when the behavioral and experiential foundations of his capacity for action (his personality) are so integrated with his knowledge and capacity to choose that he is... able to secure his prudential interests" (personal communication, March 21, 2007). If we substitute the word "free" for "sane" in the above- noted passage, we will arrive at something similar to what is meant by the second threshold of freedom.

Third threshold

The third threshold for a truly free act is quite straightforward and intuitively obvious: The act must be subjectively experienced as consistent with the individual's wishes. Simply put, we feel free when we think that we are acting in accordance with our own wishes—what Thomas Clark called the authorship criterion of free action. In part 1 of this essay, I described a hypothetical "assault machine" that when strapped to a person's arm and connected to the brain overrides his or her intentions and wishes and causes him to strike the nearest person. Assuming the person does not wish to be assaultive, it is evident that the act of assault cannot be free in this hypothetical scenario.

Note that this third threshold involves an experiential or phenomenological element of freedom: Very simply, we feel freewhile carrying out most of our everyday actions, regardless of how a deterministic science might explain them. (Dr Nassir Ghaemi has pointed to psychiatrist and philosopher Karl Jaspers4 as one who understood the importance of this transcendent "world of personal freedom."5) Some proponents of determinism argue that this feeling of freedom is nothing more than a "trick" played on humans by our brains—a comforting delusion that belies the causal mechanisms that determine our actions. I strongly disagree: Nothing in the nature of determinism or causality vitiates or renders illusory our conscious experience of being free. That feeling is as real as rocks, trees, or atoms. Indeed, none of the 3 main threshold criteria I have described is vitiated by the operation of physical law, neurochemical processes, causality, or determinism.

According to Clark, a free act is unconstrained, rational, and experienced as self-authored (personal communication, April 12, 2007). These criteria do not require us to posit some contra-causal "autonomous self" rising up, sundered from physical laws, magically choosing a course of action.

Indeed, the "capacity to choose," as was cited in Robert Daly's work, need not be understood as a faculty disconnected from determined, causal events. Rather, the individual's capacity to choosemay be understood as the repertoire of contemplated acts and behaviors that the individual perceives, evaluates and, in principle, is capable of performing, immediately prior to acting. This repertoire is akin to what computer scientist Marvin Minsky referred to as the "resources" available to the human brain at the moment an action is contemplated.6 These might include neuronal circuits or brain regions dedicated to aggression, passivity, avoidance, and so on.

In the case of highly creative and abstract actions, such as painting a portrait (as was described in part 1), this repertoire of available acts (resources) might include neuronal pathways representing "impressionist techniques" or "classical style." Note that the individual is capable of performing in principle. There are always sufficient reasons why, at a given moment, the individual does not in fact carry out all potentially available actions. Indeed, that is why determinists argue that for any action performed a person could not have done otherwise at that particular moment. This, however, does not mean that our actions are easily predictable or that we cannot modify our behaviorwhen contemplating similar actions in the future.

On the contrary, the entire foundation of psychotherapy requires the presupposition that we can help many of our patients acquire an ever more flexible, adaptive, and existentially fulfilling repertoire of behaviors.

Thus, psychotherapy is not threatened by determinism; rather, psycho-therapy of any type relies on causality as the underlying basis for favorably modifying thought, emotion, and behavior. It is simply that the causes we ordinarily attend to in psychotherapy are those proximately linked to the patient's behavior: those we ordinarily understand as the patient's enduring wishes, beliefs, impulses, fantasies, and goals.In short, we understand that the proximate cause of the patient's behavior is his personality—essentially what the Stoics called "the ruling principle."

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