Medical irrationality

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.