The free will vs. determinism debate that exists within psychology has long been a philosophical doctrine that roots back to Descartes (1596-1650), and has had an enormous impact on psychology, all the major theorists ranging from William James (1890) to B.F. Skinner (1971), have concluded empirical theories to help provide validity as to whether behaviour is determined by stimuli or external/internal events; this positivistic, mechanistic view of scientific psychology according to Taylor (1963), states that everything including thought processes and behaviour, is casually determined (Gross, 2003; 2010).
The common sense view that people make their own decisions is a debate upon free will, the fact that we have a mind to be able to agree and disagree, implies we have a freedom of choice in regards to behaviour (Gross, 2003). So what exactly is free will? (Figure 1.1) Through this information, a balanced view upon the free will vs. determinism debate in regards to implications that exist within the treatment of disorders will be researched and presented.
In diagnosing and treating mental disorders, both psychologists and psychiatrists often have to make judgements in regards to free will and determinism, whether that be explicitly or implicitly, this is because mental disorders can often be seen as complete or partial breakdown of the persons control over their emotions, thinking and behaviour. This is evident in patients with (OCD) or obsessive compulsive disorder, in definition this can be described as being compelled against his or her will or a behaviour which cannot be controlled (Gross, 2003).
Developments in neuroscience can provide relevance to the debate in regards to clinical practises which treat mental disorders, clinical psychiatrists accept the view that free will can be impaired in many patients with mental disorders whose capacity to choose may have been compromised, in such cases the individual may then be considered not accountable for their own actions or behaviour. An acknowledgment to determinism is then made, in the way that some of the behaviour of that person is accredited to the mental disorder, advances in neuroscience have increased the understanding of brain functioning and led to the possibility that abnormal behaviour will be less recognized to the patients control of choice in relation to action, and more to brain function abnormalities. Although before the developments the view was questioned through the mind-brain dualism of the reductionists in the 19th century (Scott Henderson, 2005).
Libet (1985) performed a study in relating the brain and our free will to behaviour; he showed that the preliminary brain activity which occurs through free choice is actually a couple hundred milliseconds before the choice reaches the conscious awareness. Basically stating that the brain makes decisions before the individual and that free will is an illusion. Rose et al. (1984) was a socio-biologist who believed in biological determinism, which states it is our biology that is to blame for our behaviour and mental abnormalities, not the individual; this approach seems appealing in regards to treatment of disorders as it removes the guilt and responsibility involved, however the view that our lives are constrained by a genetic predisposition, fails to recognise that as human we are constantly re-creating our own material environment and that it is our biology that makes us free (Gross, 2010).
According to an article in the: Clinical Neuroscience Research Journal (2004;p,113-118), Social turmoil regarding psychosurgery and deep brain stimulation (DBS) was evident throughout the 1960-1970s, DBS being an effective form of diagnosis and treatment for mental disorders, even in our modern day which can be used to treat disorders such as severe OCD and Parkinsonââ‚¬â„¢s disease, however the turmoil regarding the whole treatment was because it was seen as means of controlling or changing behaviour and effecting emotional disturbance against free will, it was also thought that the treatment was used to control social behaviour of violent urban areas in the USA, resulting in mind control and racial repression. However these arguments are now just a by-product of the dualism era, and having a deeper knowledge into neuroscience and mental disorders, has allowed further research into the social stability of DBS, resulting in less speculation on it being a completely controlled deterministic approach to treatments of disorders (Fins, 2004).
In regards to treatment of eating disorders such as anorexia nervosa, according to the; Handbook of treatment for eating disorders (1997) by David M. Garner et al. the philosophical balance is addressed in regards as to whether patients with severe eating disorders should be hospitalised, on one side of the argument patients can be free to preserve their eating disorder even if it involves suboptimal functioning, and on the other it can be argued that the disorder could be so serious that it impairs judgement and restricts the patientââ‚¬â„¢s ability to exercise free choice especially in regards to the appraisal of the medical risks, as it appears both points seem variably valid and yet no possible solution can be found to solve the present dilemma.
In relation to treatment refusal and free will, patients may make poor treatment decisions because of their illness symptoms, and that they would likely make a different choice if symptom free, because of this an important legal rights concept regarding the free will of treatment refusal is based upon determination of competency (Figure 1.2), or the right to refuse treatment with consent. Competence is decision specific, so patients may be competent enough to make a treatment decision at one time and not the other, also a decision made about a precise consequence of treatment might be easy to consent too in relation to a decision made about a more complex consequence of treatment which could result in a set of different outcomes (Masten, A.S., & Curtis, W.J., 2000).
If an individual is overruled as being incompetent i.e. unable to appreciate and understand information given about treatment, then it is possible to force treatment upon a patient against his/her free will, however according to the self-determinism theory, forcing treatment upon patients makes them less likely to experience treatment success if externally exposed (Mary, 2008).
In conclusion a balanced view upon the free wills vs. determinism debate in regards to treatments of disorders seems controversially one sided, a lot of the literature and research into the subject identify the reductionist determinism approach as acceptable in many forms of clinical psychiatry, whether this is in regards to forced treatment or altering the emotional state through deep brain stimulation. However the balance is much more positive in our modern day times then it were 60-70 years ago. This is mainly thanks to advances in neuroscience and our understanding we have gained about the brain through the mental health institutes, the ongoing debate