Abstract: For a range of common medical conditions, including anorexia, depression, addiction, and personality disorders, the core symptoms or maintaining factors include actions and omissions: voluntary behaviours over which the patient has some degree of control. Recovery from these conditions thus requires the patient to have the motivation and will to change their behaviour: the patient must make choices to promote recovery, as opposed to delay or prevent it. In this paper, we explore how some of the assumptions underlying more traditional medical approaches to these conditions are detrimental to recovery. Patients should not be treated as passive victims of disease, but rather as responsible agents. We thus propose that the place of agency in medical care needs to be reconceived. We draw on contemporary empirical research on willpower to suggest an alternative approach.

Dr Steve Pearce is a consultant psychiatrist working in Oxfordshire, specialising in the treatment of complex and hard to help patients and personality disorder. He is the Programme Director of the Oxfordshire Complex Needs Service, a community treatment service for people with personality disorder and related conditions.

Dr Hanna Pickard is a Fellow of All Souls College and a Research Fellow at the Oxford Centre for Neuroethics, and a therapist at the Oxfordshire Complex Needs Service. Her research aims to integrate analytic philosophy of mind with clinical data. She has just won a Wellcome Trust Biomedical Ethics Clinical Research Fellowship for a project on Responsibility and Morality within Personality Disorder.