Research

“Anorexia Nervosa: Illusion in the Sense of Agency” (Click through to find the article on the Mind & Language website, and click here for preprint)

This paper provides a novel analysis of anorexia nervosa (AN) in the context of the sense of agency literature. I first show that two accounts of anorexia nervosa that we ought to take seriously— i.e., the first personal reports of those who have experienced it firsthand as well as the research that seeks to explain anorexic behavior from an empirical perspective— appear to be thoroughly in tension with one another in their descriptions of anorexic actions. Rather than proceeding at this point by way of disregarding anorexic testimony as meaningless or insincere, I instead offer a positive account of the sense of agency in anorexia nervosa that renders these two depictions compatible. The resultant picture of anorexic behavior is one that accommodates current empirical findings while also providing valuable insight into how it is that anorexics can sincerely report feeling fully in control over their food restriction.

 [A paper about the fundamental nature of pathological loss of control] (Title redacted for blind review)

This paper challenges traditional accounts of pathological agency by arguing that substance use disorder (SUD) and anorexia nervosa (AN)—one defined by impulsive seeking, the other by rigid restriction—are not opposites, but are in fact structurally symmetrical. I argue that this symmetry is revealed by their shared underlying mechanisms (such as attentional biases and dysfunctional cognitive control) and a core behavioral inflexibility. I analyze this inflexibility in terms of a compromised counterfactual capacity for self-control. The resulting “Horseshoe Model” captures this mirror-image relationship. Unlike traditional addiction-centered accounts that require motivational conflict, this model can explain pathological “loss of control” even when agents experience no phenomenological struggle. I thus argue that the core of this phenomenon is behavioral inflexibility itself, thereby expanding our philosophical understanding of pathological agency and its clinical implications.

"Medical Paternalism, Anorexia Nervosa, and the Problem of Pathological Values" (Click through to find the article on the Synthese website, and click here for preprint)

For a public-facing piece based on this paper that includes a bit of further reflection on the way forward, check out my entry in New Work in Philosophy here.

This paper focuses on the problem posed by egosyntonic mental disorders (such as anorexia nervosa and the personality disorders) in the context of medical paternalism and values-based medicine. I argue that the directive to incorporate patient values (as dictated by values-based medicine) cannot do the work of mitigating medical paternalism in the treatment of AN. Rather than chalking this up as a failure due to AN being a particularly challenging case, I instead conclude that the failure of VBM in this context cuts to the heart of the limitations of trying to rectify medical paternalism within psychiatry as it currently exists.

Deep brain stimulation for psychiatric versus neurological disorders: A call for nuance (Click through to the open access article at the Philosophy and the Mind Sciences website, and click here for preprint)

In this (peer-reviewed) contribution to the Book Symposium for Josh May's Neuroethics: Agency in the Age of Brain Science, I critique what I take to be an overly optimistic picture of deep-brain stimulation (DBS) therapy put forward by May. I argue, first, that May does not sufficiently distinguish between disorders that are properly considered neurological and those that are properly considered psychiatric (or psychopathological). After motivating this distinction, I argue that May’s discussion of DBS fails to account for the added complexities and potential ethical harms of DBS for psychiatric conditions.

[A paper about deep brain stimulation and the ethics of mechanistic recovery]

This paper challenges functionalist accounts of neurointerventions (like the ethical parity principle) which suggest that functionally equivalent processes are ethically on par. I argue this view is mistaken in the psychiatric context precisely because it overlooks a crucial distinction: that between agential recovery, guided by the patient’s reasons and values, and mechanistic recovery, which works via a process that bypasses those values. I analyze a spectrum of treatments, using DBS for Parkinson’s disease as a baseline for an agency-restoring intervention, to demonstrate how the ethical stakes shift from case to case. I argue that these stakes become highest in the decision to consent to treatments designed to compel behaviors that bypass the patient’s endorsed values, a choice at the heart of disorders of profound ambivalence such as AN. Drawing on L.A. Paul’s work on transformative experience, I argue this presents a fundamental challenge to our traditional models of informed consent. 

This agential vs. mechanistic framework is presented as a crucial tool for evaluating any neurotechnological intervention, as it allows us to assess the distinct ethical stakes that flow from how an intervention achieves its outcome, rather than merely focusing on the functional outcome itself. The paper’s conclusion extends this analysis to the projected use of “closed-loop” adaptive neurostimulation. This form of neurotechnology would utilize machine learning algorithms to autonomously treat psychiatric symptoms by directly modulating a patient’s subpersonal neural activity. I argue this distinction is essential for determining the extent to which such a system would be capable of restoring patient agency rather than merely mechanistically bypassing it.