I sent my sketch of the alcohlics to the young psychiatrist who was treating two of them. This is what he said
I like the way you have sketched out the alcoholics. The main point for me is that when you meet a patient (as a doctor) you have to retain the idea that they are a centre of potential moral agency, an act centre, another person somewhat like yourself underneath, this prevents one slipping into a view more familiar to vetenary science. In addictions it feels as if that this autonomous core is precisely what is progressively undermined. Not surprisingly the most popular evidence based therapy is Motivational Interviewing – to elicit the self motivating thoughts and statements from the patient (no prompting allowed!). So although never stated thus, I think the doctor currently aims therapeutically to rehabilitate what ever human moral agency he feels is left (ie a moral aim) while the patient often resists and demands a medical and hence absolving stamp (ie a medical aim). The paradox! of brain
science is that it reinforces the view that what we think of currently as moral is in fact medical. If the drug therapies we had were highly effective this would be less of a problem (complex issues of reducing moral experience to neurology aside), but of course at the moment most drunks stay drunk and the models that reduce their predicament to a frontal pathway remain just that – a model with little utility beyond making us feel more like real doctors.
Having said that the above will probably change. A series of drugs targeting cannabinoid receptors in the frontal “motivational pathways” have been developed. With this kind of potential utility, the argument shifts obviously towards the medical again. But something moral catches in my mind… perhaps simply a pathway I can block without ceasing to be me.
Then he added the most important point:
What is happening with the addicted high functioning writer?
It seems that while he considers the problem within the more moral domain of his mothers fault he cannot quit even with therapy. Then he decides it is a medical genetic fact and this appears to give him the strength (with the help of his wife) to make the moral decision to give it up…. amazing.
