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description= The crisis consists precisely in the fact that the old is dying and the new cannot be born; in this interregnum a great variety of morbid symptoms appear. - Gramsci;

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ation could there be for such heavy handedness in relation to people with pws my understanding of pws is cursory and second hand so i hesitate to make firm judgements about the condition let alone the lives of people with the syndrome however i think that concentrating on structural features of pws and attendant care settings can be useful in thinking about potential justifications of coercion this is because pws illustrates the relation between some different aspects of human freedom in a particularly perspicuous fashion to return to our question is there a reason why coercive measures like locking away food and restricting access to money might be legitimate in some situations encountered by people with pws one defence could be prior consent i ve only spoken to one staff member in a pws residence so it s not clear whether this is standard practice but where she works residents sign a contract upon entering agreeing to certain rules by which the institution operates since there has been consensus beforehand then agreed upon restrictions on liberty can look to be self authorised but given pressure from families and the cognitive and emotional difficulties people with pws often face it s not clear how meaningful any complex future oriented consent can be in many instances in this respect the coercion of persons with pws in relation to access to food would be different from odysseus s efforts to hear the song of the sirens without harm by commanding his soldiers to tie him to the ship s mast and ignore his pleas to be unbound crudely the ruggedly independent odysseus who hatches the plan himself seems better placed to know and be accountable for what he is getting in for furthermore appeals to tacit consent for coercive care regimes look not to be compelling justifications either for example and again anecdotally the mental capacity act has been used as a lever to persuade people considered seriously at risk to stay in residential care them being told that if they try to leave permanently they will likely be found to lack decision making capacity in relation to their living arrangements and that a best interest decision will be made for them thus even when there is prior or tacit consent it looks to be vitiated in the circumstances under which it would typically be given antiseptic expressions such as restricting a person s liberty can obscure a fraught reality of arguments resentment misery and violence coercion is no small thing yet pws engenders situations in which untrammelled individual liberty destroys rather than sustains autonomy thus i think the idea that coercion of some people with pws in relation to access to food and money can sometimes be justified even in the absence of prior or tacit consent is one we should take seriously my freedom can potentially be deepened by preventing me from acting on my most intense enduring and visceral desires this thought tends to strike people either as soporifically obvious highly paradoxical or both how you respond is likely to be determined by the conceptual framework you bring to the concept of freedom if negative liberty freedom from interference and impediment is foremost in mind then the thought may appear incoherent it looks to be similarly implausible if self governance consists in being recognised to be a self sufficient agent whose actions should never be directed by others even on certain conceptions of freedom as authenticity then given sufficiently insistent and recurrent desires being stopped from pursuing them will only diminish freedom but we ought to reject these understandings of freedom or rather the most fruitful way to approach freedom is to subsume these aspects into a more comprehensive structure such that they are not necessarily decisive factors self determination requires social scaffolding typically this involves others deferring to someone s present wishes or giving them a hand in realising them but at times it is these wishes themselves that warp a person s psyche leaving them unable to think feel or act other than in a deadeningly fixed fashion when agency is highjacked becoming unresponsive to reason its environment and other affects then freedom and free rein no longer coincide pws looks to be a paradigm case of agency being overridden without the structure and resistance provided by appropriate institutions then people are consumed by their appetite to consume when wracked by an insatiable hunger which returns with a similar ferocity shortly after eating then being left to the sisyphean labour of adhering to it physically and mentally enervating oneself in the process amounts to no freedom worth having indeed it is being abandoned to another kind of slavery freedom of whatever kind need not possess lexical priority and the torrent of pain and frustration involved in battles over food may prove so great that it becomes the decisive factor in determining what to do yet the best that can be said for others stepping back in such situations is that it would offer someone momentary satisfactions and spare them the exhausting and fractious wrangling over access to food however the relative success of residential support for people with pws suggests that this would be the exception rather than the rule in a controlled environment where people know that no amount of arguing or emotional pressure will get them extra food then stress and anguish is partly lessened anyway moreover empowerment another of those sterile words becomes a tangible reality the power to act is massively inreased whether that is a capability to do things one enjoys because the distractions of food are less present to work because a carer stops one being waylaid on the journey or to visit places because ill health does not get in the way of travel despite the vexations of the additional constraints involved such an existence looks to be more autonomous than one without them self direction is secured more comprehensively through being subject to extraordinary limits in some specific areas it is difficult to draw general conclusions not least because people with pws live very different lives however i think we should be sensitive to a few basic points i desires can corrode agency as well as express it ii freedom is multifaceted extending beyond negative liberty and including functioning agency and real capabilities to act iii self determination relies on scaffolding that can enjoin others to step in as well as step back and iv it is possible to augment autonomy by curbing liberty the orectic structures fostered by pws help to exemplify all this suggesting that there are strong grounds for limited coercive intervention in at least some lives dominated by pws counterveiling considerations soon crowd in of course such as demands for normalisation of people with disabilities equality of respect for persons and a historically informed revulsion for any psychiatric led coercion thus no decisive justification emerges and h l mencken s maxim holds for every subtle and complicated question there is a perfectly simple and straightforward answer which is wrong yet the overarching thought here that institutions can provide structures in which to realise freedom even or sometime especially if they close down untrammeled choice is one which should be more often borne in mind more information on prader willi syndrome the best book on the subject which i have come across is prader willi syndrome development and manifestations by joyce whittington and tony holland another good introduction is can t stop eating a documentary i remember seeing years ago and which is now available on youtube 7 comments october 26 2011 reassembling autonomy hegel claims that the path of philosophy is not the common way a man can take in his dressing gown instead t rue thoughts and scientific insight can only be won by the labour of the concept arbeit des begriffes concepts so characterised are both material and tools philosophy brings concepts to bear on concepts tracing their logical structure interconnections and development thus philosophy can be depicted as conceptual labour but concepts themselves can also be understood as a kind of labourer arbeiter like other workers concepts do not come ready made they must be reproduced and sustained within a suitable environment and they are only likely to thrive when they stand in fruitful relationships with others in their community so too as with other workers they can become overworked and enervated as a result of the jobs they perform as well as diseased from noxious working conditions or pestilent co workers autonomy is in danger of becoming such a fatigued and sickly concept for one it is required to do work of stakhanovite proportions even when restricted to personal autonomy the term has countless meanings everything from liberty moral responsibility self legislation non fungibility reasons responsiveness and mental capacity to name only a handful this semantic plasticity means that virtually any action thought person or social formation can be lauded as autonomous or condemned as heteronomous thereby making precise analysis very difficult without a continual revalidation or recalibration of the meaning of terms like a precarious worker at a temp agency the concept of autonomy finds itself deployed in all sorts of heterogeneous settings with little ability to shape the jobs it is tasked with performing and the expectation that it will not bring any potentially disruptive history or politics with it from its previous workplaces indeed autonomy as an ideal is so frictionless that whatever your cause radical social justice or tax cuts national liberation struggles or imperialist military intervention survivors of psychiatry and disability movements or conservative social policy then some autonomist justification can be confected for it but if your rallying cry strikes fear in no one s hearts then it s worse than useless the deeper problem however is not merely formal that autonomy can be co opted by almost anyone but that it has been co opted by some pernicious political and philosophical forces in short autonomy s neighbourhood has been gentrified and most of its friends are complacent liberals mired in talk of abstract rights authenticity choice and decision making it is hard to locate any genuine critical or elucidatory potentiality in the concept if anything its predominant philosophical deployments now do little more than reinforce a narcissistic form of individualism you need only look to the soporific preoccupations of its champions the merits of life planning how lowly drug addicts are oppressive communalist tendencies within islam the opprobrium that lack of restraint at the dinner table deserves and so on telegraph fodder basically what then is to be done the concept of autonomy or merely the term autonomy could simply be abandoned similar temptations arise with notions like democracy that have been subject to conceptual capture by forces of reaction despite the latent radicalism and unadorned beauty of the idea autonomy might be jettisoned for being equally tainted and functioning as a dampener rather than a catalyst of thought but that would be to relinquish important logical and linguistic territory losing battles over contested concepts such as freedom is part of the reason why for instance markets that immiserate millions of people in underdeveloped economies can so seamlessly acquire honorifics like free at the very least this ground ought not simply be ceded without a fight moreover concern for autonomy already saturates philosophy medicine psychiatry social care law and political economy and so can be seen a beachhead as much as a quagmire in sum the concept of autonomy ought be revitalised rather than repudiated first and negatively the elements of authenticity and decision making capacity that loom so large in its contemporary usage should be offset the tacit metaethics underlying this usage is one which invariably crowns individual desires and choices as sovereign such that autonomy becomes a psychological capacity to enact plans for preference maximisation which is in turn understood as the only thing we could ever have a reason to do whilst the struggle for human autonomy should ultimately be oriented by the prospect of achieving a non alienated affective and volitional relationship to ourselves establishing this as the primary criterion of autonomy feeds a myopic and conceited individualism which suppresses the possibility that freedom requires a radical change or reassembly of our present self autonomy can be neither an affable psychological equilibrium nor cod existentialist anomic willing nor the pop therapeutic idiocy of a quest for our real selves second and more positively the concept of autonomy needs to be yoked to more apposite kinds of human independence than those that currently trouble most philosophers lawyers and psychologists for kant it was ossified institutions like those of traditional religious life which impeded the kind of self determination that the public use of reason can win for us lacking the courage to use one s own understanding meant relying on a private use of reason one bounded by the parochial assumptions of such an institution however in reanimating a concern with the place of the free rational individual within contemporary social formations we must look to other structural forces most obviously for anyone on the left today there has to be a recognition of those threats to self determination that come from outside of the comfortable circle of bourgeois consensus tyrannous concentrations of capital and the neo liberal states that are subjugated by them which together dominate the economic and social landscape limpened forms of political governance compounded by structurally typhlotic news media which are incapable of drawing out and enacting the popular will and interests and the assault upon the welfare state including education and basic welfare payments alongside psychiatric medical and social care provision that foster the capabilities and opportunities that individual self determination depends upon clearly these are first and foremost political harms which you do not need a philosophical analysis of autonomy to identify yet these threats should orient a conception of autonomy which ultimately may be able to sharpen an understanding of what would concretely be needed for free human agency to be realised if the concept of autonomy is rehabilitated in this fashion then it may once again return to the most useful kind of work leave a comment october 3 2011 paternalism and anti authoritarian authority liberals despise paternalism like nature abhors a vacuum but despite being lodged in the collective political imaginary the metaphor of paternal authority is increasingly anachronistic and obfuscatory in the seventeenth century robert filmer s identification of patriarchal and political power at least capture...