Libertarian free will (LFW) refers to the idea that individuals have complete control over their choices, independent of prior causes or constraints. A person is according to LFW the sole originator of their actions and can thus in some sense be held accountable for their actions.
LFW hinges on the assumption that there exists a core, autonomous agent—a “self”—within us that can initiate actions independently of any external influences or internal predispositions. This view implies a persistent, isolated decision-maker that can “rise above” cause and effect, effectively detaching itself from things like genetics, prior experiences, or current mental states to make truly free choices. The self would need to exist as something separate from the causal web of the brain’s functions—something akin to an independent “driver” that controls the body and makes unconditioned choices.
I have in earlier posts argued against the existence of LFW and a self as both concepts are incompatible with a naturalistic world-view and thus our current understanding of physics.
ChatGPT puts the share of people believing in some form of LFW at 50% or more. Some of the believers in LFW are psychiatrists, judges and other professions with substantial impact on the lives of other people.
In this post I explore some consequencies of a belief in LFW in psychiatry where it can have a big (and mostly negative) impact.
Psychiatry doesn’t meet philosophy
If one truly believes in LFW then one must logically believe that a person’s actions can be explained solely by the character of the person, by attributes of the person’s self rather than factors such as the person’s genetic disposition, social situation, sensory input, psychiatric disorder, brain tumor, or childhood abuse. In this moral attribution model the cause of a person’s actions is explained by the person having certain moral attributes such as “virtuous” or “evil”.
A claim of evolutionary biology is that the brain has evolved to regulate the allostasis of the organism. Such regulation is tightly coupled to input from the environment and from within the body. See e.g., this post for a modern theory of how it may work. It seems highly unlikely that the human brain would have evolved a decision making mechanism that has no resemblance to the historical brain’s allostasis regulation system. That seems to be the implication of LFW though.
In the moral attribution model psychiatric interventions would logically shift from therapeutic or medical approaches to moral education, or, if we take the most extreme stance, nothing, since the free will can not be influenced. Such a stance would render diagnoses like those found in DSM (Diagnostic and Statistical Manual of Mental Disorders) nearly irrelevant, replacing them with moral judgments such as “virtuous” or “evil”.
Note on popular culture
Popular culture reinforces the moral attribution model by often explaning criminal behavior in terms of moral attributes. Words such as “psychopath” or “crackpot” are used not as a diagnoses but as a moral attribute. Crime series are full of detectives with an urge to “nail the evil bastard who did this”. Sometimes the word “sick” is added to the characterization but only as an other moral attribute, not as an indication of an actual disease.
Free will in psychiatric care
The geocentric model of the solar system is good enough for predicting celestial events like eclipses and the positions of planets to a useful precision. In terms of designing calendars, the geocentric and heliocentric models are equally effective because the main requirement for a calendar is to track the passage of time based on observable phenomena such as the sun’s movement across the sky, phases of the moon, and the seasons. To use the geocentric model for the planning of interplanetary space travel would lead to a disaster.
Passing moral judgement on a person with a psychiatric disorder like a substance abuse disorder is like predicting the movement of the planets based on a geocentric model. While it may work in specific cases, there are several problems with using it as a guiding principle in psychiatry:
- It points out that a certain behavior is unacceptable but doesn’t by itself suggest other interventions than moral education.
- It implies that the person, using their free will, should be able to get out of their mental disorder by themselves if we point out that it is their own responsibility. This doesn’t often happen without support.
- It may be considered a sufficient pseudo-intervention to the mental disorder. A person’s “poor character” becomes the etiology of the disorder, preventing a search for true causes and treatments.
- As it is often used for virtue signaling and status enhancement of the one passing the moral judgement, it is not always interpreted as sincerely helpful.
Psychiatry without the belief in free will and a self is more likely to look for all causes for a person’s problems including genetics, social situation, substance abuse (as both a cause and an effect), somatic factors, and mental predispositions. Based on the findings, a holistic set of interventions can be undertaken. This naturalistic (“mechanistic”) model is therefore more useful than the moral attribution model.
I don’t claim that many psychiatrists actually limit their set of administered interventions to moral education even if they believe in some form of free will. They seem to be capable of double-think like most other people. The problem is that the belief in free will sneaks consciously or unconsciously into the clinical work from time to time, just like one is consciously or unconsciously guided by one’s prejudices in general.
During the many years that I have been supporting people close to me with neuropsychiatric diagnoses with their care (and lack of care), I have from health care professionals (and others) personally heard many unhelpful statements that can be interpreted as moral judgements. There is a huge power distance between the doctor and the patient in psychiatry to start with. And there is a huge difference between calling the patient a drug addict (a characterization) and stating that the patient is suffering from a substance use disorder (a clinical condition).
One expression I have heard often is “we have given the patient responsibility for X”. X may be administering their medicines as prescribed or to come in time to appointments. The assignment of responsibility has never been preceded by an assessment of the patient’s competence to act according to the assigned responsibility and seldom if ever followed by any additional supporting measures. Predictably enough, the patient has often failed to “take responsibility” and failed, leading to an even lower sense of control and self-esteem.
As a manager I have learnt that giving somebody responsibility is job half-done. The other half consists of ensuring that the person is able and willing to take responsibility. See also this post.
I suspect that the practice of assigning responsibility to patients without ensuring that the patient is ready to take responsibility is informed by a belief in free will, an assumption that the “self” of a patient is a free, undetermined agent capable of making unconditioned choices if only told to do so 1. Or, worse, it may be a way for the clinician to find an excuse for a failing treatment.
An alternative to “giving responsibility”
To cure a mental condition such as a substance use disorder, the patient must be intrinsically motivated to choose an alternative lifestyle. Nobody can control the patients behavior remotely so that control must eventually come from within the patient themself. The question is how to influence the patient to will to do more of the right things and less of the wrong things. Questioning the patient’s character is seldom the best method.
An alternative to passing judgement is motivational interviewing and similar techniques that attempt to help the patient realize that change is possible but that it requires actions taken by the patient themselves. Motivational interviewing is non-judgemental.
Faulty person vs an evil person
If an autonomous vehicle collides with a pedestrian, we don’t call vehicle evil. We call it a faulty vehicle and attempt to repair it if possible. If a wolf kills a lamb, we don’t call it evil. We see to it that it doesn’t get close to the sheep in the future.
We should replace the characterization “person of poor character” with “faulty person”. “Faulty” is here to be understood in a mechanistic sense and doesn’t carry any valence. It just indicates that there is a fault somewhere in the person’s brain or body leading to a failure like drinking too much. Psychiatric care should attempt to repair the fault in whatever way that works. Calling somebody evil is not the best way to repair something.
Seeing the human being as a machine will lead to a more humanistic world.
Links
[1] Free Will, Determinism, and the Criminal Justice System. The law office of John Guidry. Blog post.
- Trying to influence somebody with a free will is logically inconsistent of course. Would the person be swayed by such influence, then the will would not be free. ↩︎