Responsible Agency and Mental Disorder – What Role for the Brain?

It is sometimes assumed that identifying mental health problems as brain diseases has important ramifications for the responsibility of those suffering from mental illness. In this paper, I focus on the supposed benefits and disadvantages of claiming that addiction involves brain dysfunction. Leschner famously argued that to consider addiction a brain disease would lead to move away from the moral model, according to which addicts are to blame for their condition. In a recent backlash, it has been claimed that labeling addiction as a brain disease increases stigma and distracts from societal causes underlying addiction. In my paper, I argue that some of the conclusions people draw on the basis of the observed brain differences in addiction are mistaken. Specifically, the belief that there is a physiological problem is compatible with societal and psychological causes, and brain dysfunction does not in and of itself undermine moral responsibility. The relevant capacities for responsibility are defined on the psychological level. Finally, I discuss ways in which brain science can be integrated into a broader approach to addiction, which allows addicts to take responsibility for their condition and behaviour, while making use of the new information brain science contributes.