In his target article and recent interesting book about addiction and the brain, Marc Lewis claims that the prevalent medical view of addiction as a brain disease or a disorder, is mistaken. In this commentary we critically examine his arguments for this claim. We find these arguments to rest on some problematical and largely undefended assumptions about notions of disease, disorder and the demarcation between them and good health. Even if addiction does seem to differ from some typical brain diseases, we believe contrary to Lewis, that there are still good reasons to maintain its classification as a mental or behavioral disorder.
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For one very influential version of the dysfunction view, see especially .
It should be noted here that there are different ways of interpreting the normativity of the concept of function, ranging from evolutionary to causal-mechanistic ones. For a recent version of the latter, see e.g., .
Without norms there would be no way to talk about “learning” either, at least not in the ordinary language sense of the term, as learning in this sense presupposes normative notions like knowledge and skill. Consequently, whether something counts as learning (in the ordinary sense) it will not be something that can be determined purely at a descriptive level, whether neural or behavioral. From this perspective, acquiring an addiction, rather than seeming a case of learning, may seem more like a case of unlearning or of losing various skills, abilities and knowledge (e.g., skills, abilities and knowledge associated with self-governance).
How much love really has in common with addiction depends on one’s view of what love is. There has been considerable debate about this question in philosophy, e.g., whether love is a moral emotion . A suspicion one might harbor is that when Lewis and fellow neuroscientists talk about love, what they really have in mind is what many participants in this debate would describe, rather, as infatuation or sexual drive, which they distinguish from love. We put this issue aside here.
For a defense of the view that mental illness involves violations of rationality, see .
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Henden, E., Gjelsvik, O. What Is Wrong with the Brains of Addicts?. Neuroethics 10, 71–78 (2017). https://doi.org/10.1007/s12152-016-9285-4