Advertisement

Medical Irrationality

Chapter
  • 613 Downloads
Part of the Philosophy and Medicine book series (PHME, volume 118)

Abstract

Nonadherent patients are often conscious of their behavior but do not understand it: When asked why they did not stick to their diet, obese persons often do not try to hide their nonadherence but add with a sigh—“I know, I should, but I can’t help myself.’’ This perplexing human behavior has been described under the name of akrasia (literally lack of strength). Other philosophers have used the term incontinence , or weakness of will . In this chapter, I propose to describe nonadherence as a case of incontinent action. The definition of an incontinent action is that the agent intentionally performs an action that she herself does not consider to be the best—not an action that is considered bad by another. In short, the classic view of nonadherence was about disagreement between doctor and patient , whereas considering nonadherence as a case of akrasia places the disagreement between the patient and herself. Davidson suggested that there is a principle of continence : When one abides by this principle, one commits to using all the available information before acting (this is the ‘all things considered ’). Akrasia is the consequence of a failure of this principle . To explain how the exile of the principle of continence is possible, Davidson proposed the hypothesis of a divided mind. This partitioned mind hypothesis is applicable to clinical experience: For instance, there are pipe smokers who take the warning labels out of the tobacco boxes so that they do not have to ‘think’ about it, or perhaps because the labels confront their irrationality .

Keywords

Prima Facie Good Judgment Normal Role Necker Cube Anticipate Regret 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

References

  1. Abelhauser A, Lévy A, Laska F, Weill-Philippe S. Le temps de l’adhésion. In: L’observance aux traitements contre le VIH/SIDA. Agence Nationale de Recherche sur le SIDA; 2001.Google Scholar
  2. Aristotle. Nicomachaen ethics. Book VII, 2, p. 1–2.Google Scholar
  3. Assal JP, Gfeller R, Kreinhofer M. Les stades d’acceptation du diabète. Journ Annu Diabetol Hôtel Dieu. 1981;223–35.Google Scholar
  4. Baudelaire C. Meditation. The flowers of evil (trans: McGowan J). Oxford World’s Classics; 2008.Google Scholar
  5. Cavell M. Reason and the gardener. In: Hahn LE, editor. The philosophy of Donald Davidson. The library of living philosophers. vol. XXVII. Open Court; 1999, p. 407–21, and Davidson’s response, p. 422–23.Google Scholar
  6. Correia V. La Duperie de soi et le problème de l’irrationalité: Des Illusions de l’esprit à la faiblesse de la volonté. Éditions Universitaires Européennes; 2010.Google Scholar
  7. Davidson D. Actions, reasons and causes. J Philos. 1963;60:685–700 (Reprinted in: Essays on actions and events. Oxford: Clarendon Press; 2001).Google Scholar
  8. Davidson D. Two paradoxes of irrationality. In: Wollheim R, Hopkins J, editors. Philosophical essays on Freud. Cambridge: Cambridge University Press; 1982, pp. 289–305 (Reprinted in: Problems of rationality. Oxford: Clarendon Press; 2004).Google Scholar
  9. Davidson D. In: Hahn LE, editor. The philosophy of Donald Davidson. The library of living philosophers. vol. XXVII. Open Court; 1999.Google Scholar
  10. Dostoyevsky F. Notes from the underground (trans: Pevear R, Volokhonsky L). Vintage; 1994.Google Scholar
  11. Gfeller R, Assal JP. Le vécu du malade diabétique. Folia Psychopractica, 10, Hoffmann-Laroche et Cie, SA Bâle; 1979.Google Scholar
  12. Heather N. A conceptual framework for explaining drug addiction. J Psychopharmacol. 1998;12:3–7.CrossRefGoogle Scholar
  13. Livet P. Émotions et rationalité morale, P. U. F., Collection Sociologies; 2002.Google Scholar
  14. Loewenstein G, Read D, Baumeister RF, editors. Time and decision, economic and psychological perspectives on intertemporal choice. New York: Russell Sage Foundation; 2003.Google Scholar
  15. Lopez-Azpiazu I, Martinez-Gonzalez MA, Kearney J, Gibney M, Martinez JA. Perceived barriers of, and benefits to, healthy eating reported by a Spanish national sample. Public Health Nutr. 1999;2:209–15.CrossRefGoogle Scholar
  16. Mele AR. Irrationality, an essay on akrasia, self-deception and self-control. Oxford: Oxford University Press; 1992.Google Scholar
  17. Mele AR. Self-deception unmasked. Princeton: Princeton University Press; 2001.Google Scholar
  18. O’Connell KA. Akrasia, health behavior, relapse and reverse theory. Nurs Outlook. 1996;44:94–8.CrossRefGoogle Scholar
  19. Ogien R. La faiblesse de la volonté, P.U.F.; 1993.Google Scholar
  20. Olmsted MP, McFarlane T. Body weight and body image. BMC Women Health. 2004;4(Suppl 1):S5.CrossRefGoogle Scholar
  21. Pears D. The goals and strategies of self-deception. In: Elster J, editor. The multiple self. Cambridge: Cambridge University Press; 1985.Google Scholar
  22. Plato. Protagoras, 352b–358d.Google Scholar
  23. Reach G. Application de la théorie causale de l’action à l’analyse de la non-observance thérapeutique. Presse Med. 2000;29:1939–46.Google Scholar
  24. Reach G, Zerrouki A, Leclerc D, d’Ivernois JF. Adjustment of insulin doses: from knowledge to decision. Patient Educ Counsel. 2005;56:98–103.Google Scholar
  25. Saint Paul. Romans. 7:15–25.Google Scholar
  26. Smith M. Rational capacities, or: how to distinguish recklessness, weakness and compulsion. In: Stroud S, Tappolet C, editors. Weakness of will and practical irrationality. Oxford: Clarendon Press; 2003.Google Scholar
  27. Spitz E. Les stratégies d’adaptation face à la maladie chronique. In: Fischer GN, editor. Traité de psychologie de la santé. Dunod; 2002.Google Scholar
  28. Stroud S, Tappolet C, editors. Weakness of will and practical irrationality. Oxford: Clarendon Press; 2003.Google Scholar
  29. Tappolet C. Emotions and the intelligibility of akratic actions. In: Stroud S, Tappolet C, editors. Weakness of will and practical irrationality. Oxford: Clarendon Press; 2003.Google Scholar
  30. Tversky A, Kahneman D. Judgment under uncertainty: heuristics and biases. Science. 1974;185:1124–31.CrossRefGoogle Scholar
  31. Watson G. Skepticism about weakness of will. Philos Rev. 1977;86:316–39.CrossRefGoogle Scholar
  32. Ziebland S, Thorogood M, Yudkin P, Jones L, Coulter A. Lack of willpower or lack of wherewithal? ‘Internal’ and ‘external’ barriers to changing diet and exercise in a three year follow-up of participants in a health check. Soc Sci Med. 1998;46:461–5.CrossRefGoogle Scholar

Copyright information

© Springer International Publishing Switzerland 2015

Authors and Affiliations

  1. 1.Avicenne Hospital and Paris 13 UniversitySorbonne Paris CitéBobignyFrance

Personalised recommendations