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The role of emotion in ethical decisionmaking.

The Role of Emotion in Ethical Decisionmaking

What is the moral significance of may feelings when I hear that newly dead human bodies are used in car crashes for research on automobile safety? What should I make of the emotions aroused by the news that dying old persons will have their food and water withdrawn, or in other instances, be straitjacketed and forcibly fed? And does my emotional response to the dilemmas presented by AIDS or surrogate motherhood count? Everyone agrees that bioethical decisions, involving as they often do matters of life, death, sex reproduction, and familial and professional loyalties, can arouse emotional responses. What is not agreed upon is whether, or how, one should weigh emotions when trying to resolve an ethical dilemma.

A completely rationalist view dismisses the role of emotions with the assertion that "arguments are one thing, sentiments another, and nothing fogs the mind so thoroughly as emotion." [1] Adherents of this negative estimate of emotion would advise a person confronting an ethical dilemma to arrive at a decision using rational considerations alone. As Tristram Engelhardt, Jr. says in his widely hailed book on bioethics, we should see the affirmations of one's feelings as "irrational, surd," and seek to become impartial reasoners "whose only interests are in the consistency and force of rational argument." [2]

Other philosophers may begrudgingly admit the inevitability of emotive intuitions, to gut feelings in moral argumentation but vigorously resist employing them. As James Rachels puts it, "The idea cannot be to avoid reliance on unsupported 'sentiments' (to use Hume's word) altogether--that is impossible. The idea is always to be suspicious of them, and to rely on as few as possible, only after examining them critically, and only after pushing the arguments and explanations as far as they will go without them." [3]

Joel Feinberg contends that emotions always should be subordinated to reason in the process of decisionmaking. Feinberg is not unappreciative of moral emotions, but they can never serve as an ethical criterion. A sentimental attachment to fetuses, corpses, or body parts should not be allowed to thwart the interests of actual living persons who need abortions, organ transplants, or automobile safety research. For emotions to count in any applied ethical decisions, they must be justified on independent grounds. [4]

I propose a model for the mutual interaction of thinking and feeling in ethical decisionmaking. Certainly, reason should monitor reason as in traditional philosophical critiques, and reason should tutor the emotions as in Feinberg's model. But I would also claim that emotion should tutor reason and that emotion should monitor emotion. The ideal goal is to come to an ethical decision through a personal equilibrium in which emotion and reason are both activated and in accord.

Human Emotions in Psychology

What do we now think we know about the functioning of human beings that should make us take emotions more seriously in ethical enterprises?

The human emotional system is a universal component of human functioning, the primary motivating system of all activity, including of course, thinking about ethical dilemmas. Following Darwin's lead, psychological theorists now see human emotions, like human cognitive capacities, to have been selected through evolution to ensure the survival of individuals and the group. [5] Emotions are energizing and adaptive, and serve communicating, bonding, and motivating functions. They seem to be distinct from either physiological drives or cognitive processes, although complex interactions and learned associations occur. Without emotions or affects to amplify physiological drives and infuse cognitive processing with subjective meaning, human beings would not care enough to stay alive, much less mate, nurture offspring, create kindship bonds, or pursue art, science, literature, or moral philosophy.

Emotions can be loosely defined as distinctly patterned huamn experiences that, when consciously felt, produce, qualitatively distinct sujective feelings and predispositions: "I am angry and want to attack"; "I am afraid and want to flee"; "I love and wish to approach." [6] Theorists argue over the correct boundaries of definition: How long does an emotion last? How intense must it be? Must it always involve awareness? Others focus upon how cognition, learning, and the social environment influence emotional experiences. I take an inclusive approach that sees feelings, sentiments, and moods as forms of emotional experience.

The different emotions appear to be constituted of distinctly patterned responses of the neurobiochemical, facial, and motor systems. [7] Evidence from cross-cultural and infant research points to panhuman constancies in emotional response and expression--fron New York to New Guinea, the same facial expressions communicate the same emotions. [5] A limited set of basic emotions have been described which, like the primary colors, can be blended, differentiated, and elaborated. These primary emotions are usually differentiated as interest-excitement, enjoyment-joy, surprise-startle, distress-anguish, anger-range, disgust-revulsion, contempt-scorn, fear-terror, shame-humiliation, and for many, guilt-remorse, and love.

As human beings we come equipped with evolved emotional and cognitive capacities that operate interactively. While emotions and cognitions are often combined, emotions differ from cognitions in their subjective intensity, specificity, and nonverbal richness. [9] The emotional system also seems to respond to and encode in memory nonverbal, qualitative dimensions of experience. Reason as verbal, symbolic, cognitive processing, is a faculty more detached, mobile, and quick in operation than emotion. But the existence of such complex subsystems in the human organism seems an overall advantage: one system can always serve as a corrective to the others. Emotion and thinking are, in sum, complementary, synergistic, parallel processes, constantly blending and interacting as a person functions.

Thinking and deciding take place in self-conscious, aware, motivated human beings who are constantly experiencing what William James called the stream of consciousness. Thinking will interact with a person's emotive, perceptual, physiological, and motor systems. Emotions also interact in the stream of consciousness in complex ways, especially through memory.

As we think through a problem we call upon our memory. Memory networks may be activated either a feeling or an idea; calling up one part of a scenario may activate the feelings or ideas storeod with it. [10] Thinking about death may activate sad feelings; feeling sad may activate thoughts of death. Emotional states have been shown to affect all sorts of cognitive processes: selective content and efficiency of memory, problem-solving or learning ability, predictions of the future, social evaluation of persons, self-estimates, altruistic decisions, aggressive assessments, and even perception of physical stimuli in the environment.

Researchers on the development of emotion in children present a helpful image of the continual dynamic of thinking and feeling in consciousness. Finding inadequate linear models that posited that cognition causes emotion, or that emotion causes cognition, these researchers "developed a third model based on the metaphor of a musical this model, the cognitive-emotional relationship is depicted as a complex interplay of processes, similar to the themes of a fugue, which are often lost and reappear." [11] The interweaving process goes on in human beings throughout life: emotions induce thoughts that may induce emotion. [12] This interplay between thinking and feeling in personal consciousness can become open to introspection, and long before experimental psychologists began their studies these inner processes were depicted in poetry, drama, fiction, philosophy, and religious writing.

Emotions and Moral Reasoning

Indeed, the emotions are particularly important in moral and ethical functioning. In every culture children develop emotional reactions of guilt and shame at the same age. They seem to have an innately programmed predisposition to be morally socialized and to enter into moral discourse, for which full development of emotional response is necessary. [13] Studies of psychopaths indicate that they are below average or deficient in emotional responsiveness. A lack of anxiety, guilt, empathy, or love devastates moral functioning. Persons may have a high I.Q. and be able to articulate verbally the culture's moral rules, but if they cannot feel the emotional force of inner obligation, they can disregard all moral rules or arguments without a qualm.

Emotions energize the ethical quest. A person must be emotionally interested enough and care enough about discerning the truth to persevere despite distractions. Even more, a person who wrestles with moral questions is usually emotionally committed to doing good and avoiding evil. A good case can be made that waht is specifically moral about moral thinking, what gives it its imperative "oughtness," is personal emotional investment. When emotion infuses an evaluative judgment, it is transformed into a prescriptive moral judgment of what ought to be done.

Moreover, it appears that the building blocks of moral thinking are imbued with emotion. The human mind gives evidence of actively creating units consisting of fused thoughts and emotions and then storing these constructions in long-term memory. These cognitive-affective constructs, the thing and the feeling-about-the-thing, appear to be encoded in complex networks of memory, some of which may be complex or extensive enough to be called narratives, "scripts," "scenes," or "scenarios." [14] Moral sentiments consist of such fusions of things joined with feelings about the thing, as for instance, "torture = wrong, disgusting," or "truthtelling = good." As we think through a moral conflict or question we call up memory stores and inevitably have our thinking shaped by the linked associations.

Personally invested emotional commitments shape selective attention. A person always enters the ethical decision-making process in midstream, influenced by his or her past experiences and the operation of long-term memory. Evidence is accruing that the emotions or thoughts that seem to "pop" spontaneously into our heads are not at all random. Extensive preconscious selection and filtering interact with long-term memory to determine what reaches conscious awareness. [15] The selective filtering activity that brings a thought or feeling to consciousness will have personal significance and may serve adaptive or defensive purposes. [16] High level thinking, much less a creative intellectual solution ("Aha, I've got it!"), can happen only when a person has been prepared through past effort. So too, emotional responses, especially moral sentiments, indicate the achievement of self-development and those "habits of the heart" known as moral character.

As the philosopher Iris Murdoch has expressed this:

"If we consider what the work of attention is like, how continuously it goes on, and how imperceptibly it builds up structures of value round about us, we shall not be surprised that at crucial moments of choice most of the business of choosing is already over. This does not imply that we are not free, certainly not. But it implies that the exercise of our freedom is a small piecemeal business which goes on all the time and not a grandiose leaping about unimpeded at important moments. The moral life, in this view, is something that goes on continually." [17]

Moral lapses, "sudden" betrayals, or acts of heroism are influenced by past choices.

The Tutoring Role of Reason

Methods for the rational assessment of thinking and the rational tutoring of emotions in ethical decisionmaking have been highly developed and elaborated. There have also been many attempts to broaden and deepen the concept of reason--and thereby implicitly recognize and recapture the role of emotion in thinking. Human reasoning is no longer identified solely with the calculating and analytic capacities displayed by computers; human intelligence is more imaginative, holistic, and playful (more emotive?) than narrowly focused logical or critical analysis.

By certain traditional criteria, such as consistency, logic, rules of evidence, appropriateness, coherence, clarity, completeness, and congruence with reality, human thinking can be assessed as ranging from the highly rational to the seriously inadequate. Moral thinking, as a form of structural thought, can be assessed by the traditional canons of rationality, and moral philosophers are adept in this analysis.

We can almost always assess rationally (at least in others) the appearance of childish, immature, emotional responses, fused with childish thinking, that endanger ethical decisions. Humans wish to avoid pain and seek pleasure. Initiated and abetted by psychoanalysis, the psychology of self-deception has made us acutely aware of the emotional and cognitive maneuvers that produce self-protective feats of selective attention, sometimes called "vital lies." [18] All of the "defenses" enumerated in psychoanalytic thinking are activations of cognitive-affective structures to deploy attention away from painful reality, or if that fails, to distort what is perceived and felt. Persons who constantly and rigidly use these strategies to avoid pain finally so cripple their emotional capacities that their cognitive and emotional functioning becomes maladaptive by any standards, whether one talks about neurosis, regression, or moral immaturity.

Psychology now sees the person as constantly acting. The "id" is no longer refied as a force, but is characterized as the regressed, childish way a person feels and thinks:

"It is a way of acting erotically or aggressively that is more or less infantile in its being irrational, unmodulated, unrestrained, heedles of consequences and contradiction, thoroughly egocentric, and more than likely associated with those vivid and diffuse physiological processes that fall under the common heading of excitement or arousal." [19]

The emotions and moral thinking displayed are those of a child, whether the person is a bright young physician under stress, an old person facing death, an adolescent facing life, or even a middle-aged philosopher undergoing a second adolescence. Regression can occur at any time in the life cycle, and can produce irrational emotions entwined with irrational thinking. Other emotional disorders have the same effect, so that "reasoning with a person suffering from mania is like reasoning with a five-year-old." [20] Depressed persons are equally resistant to the rational tutoring of their emotions. When people are in such an excessively stressed or regressed state, they cannot make mature moral or ethical decisions.

Such disturbed states are fairly dramatic and have given rise to the equating of all emotion with those particular infantile passions that are dangerous to moral functioning. Excessive conditions of disordered emotion and thinking result in qualitatively different states of addiction and obsession; feelings and thoughts are flooding, intrusive, inappropriately repeated and recycled, with the felt loss of flexible control of attention.

While the circular interaction of thinking and feeling ensures that they both deteriorate together, it is easier to notice the more dramatic disorders of the emotions. Thus traditional rationalist philosophers and Freudian theorists, and those proposing models of decisionmaking, have stressed the bias involved in emotions.

Regression and Moral Conflict

The working model of moral conflict has been that of emotion warring against reason, with only reason's mastery offering trustworthy guidance. A more careful analysis of the regressed state would see that the moral conflict is usually a case of one immature thinking-emotive moral scenario in conflict with another more wholly owned and appropriately mature moral scenario. Rational tutoring of self or others assesses the inappropriate responses and substitutes others. Reasoning can affect mood and emotions as stoic strategies, psychotherapy, and ordinary self-control regularly prove.

Rational persons may have a more difficult time noticing and assessing those less dramatic but equally disabling disorders consisting of deficits of emotion. In philosophical arguments the problem of such deficits is regularly ignored and that of excessive emotion emphasized. Yet in our technological culture perhaps the greatest moral danger arises not from sentimentality, but from devaluing feeling and not attending to or nurturing moral emotions. Numbeness, apathy, isolated disassociations between thinking and feeling are also moral warning signals. Psychopaths, persons under stress, persons who have coped by ignoring or denying their emotions, suffer from deficit problems in moral emotions.

Some persons are too "burned out" from stress to see or care about moral dilemmas. Others are so accustomed to isolating and not attending to their emotions that when they inadvertently must confront feeling, they are overwhelmed by what seems to them an alien external force. They are all the more susceptible to moral collapse and making poor ethical decisions.

Habits of numbing or suppressing emotion spread to other domains in a personality and impair moral thinking as surely as excessive, infantile emotions do. The human mind for brief periods can go into detached, depersonalized overdrive and function automatically like a computer. We have seen detached analysis destructively employed by the best and the brightest. The maintenance of moral emotions and the care and cultivation of moral sentiment should be seen as all-important; after all, the rational tutoring of emotion depends upon people who already possess a highly developed emotional repertoire. Those concerned with educating health care workers know that the absence of emotional responses of empathy and sympathy become critical bioethical issues. [21]

The Tutoring Role of Emotion

But the more controversial claim being made here is that just as reason tutors and monitors emotion, so too can our emotions tutor reasons. Why so? And how? There are positive and negative ways this can happen as the dynamic interactive stream of human consciousness proceeds. We are sometimes morally restrained, and on the other hand, sometimes activated by our emotions to go beyond our habitual moral framework. Given the knowledge of the preconscious filtering process needed for consciousness, and knowing the innate capacity of the emotional system to respond to reality, even momentary emotions can be seen as a message to myself, from myself and all that has shaped me. We should pay attention, for our emotions constitute reflexive personal signals, or "vital signs" informing us of inner processes or of interactions with the environment. [22]

As we think through moral options or pursue arguments there can arise negative emotional responses ranging from mild feelings of aversion to intense feelings of repugnance. A rational argument without any apparent logical flaws may be presented--in, for instance, proposals for using torture, or harvesting neomorts, or refusing to treat AIDS--but our moral emotions prevent us from giving assent. When we feel strongly and persistently that this is wrong, wrong, wrong, but we can't articulate why, we withhold assent. Our discomfort induces us to continue looking beyond the proposed arguments, to keep searching and broaden the review. Later we may be able to understand the emotional reaction and feel profoundly grateful that we were not carried away by abstractions.

Emotions also tutor moral reasoning in positive ways. Much of our creativity in moral thinking emerges as ideas and emotions are activated in memory and produce new reverberations. Many moral revolutions have been initiated by empathy felt for previously excluded groups: slaves, women, workers, children, the handicapped, experimental subjects, patients in institutions. As I emotionally respond to another person or group, I may be forced to confront a conflicting moral attitude concerning the group. Novel emotional responses of sympathy clash with previously accepted moral principles, an inconsistency and unsettling discrepancy that can then prompt a creative moral readjustment.

The emotion of love, defined minimally as joyful-interest with a predisposition to approach and attachment, most aptly tutors reason. Love engenders attention and concern, and minimizes fear and indifference. It motivates the resistance necessary to withstand automatic dismissals. At the other end of the emotional spectrum, anger, especially vicarious anger, can also tutor moral reasoning. Since the time of the Old Testament prophets, the experience of indignation or anger has moved persons to call for a drastic revision of their moral ideas. Present experiences of anger at what happens to an AIDS patient, a dying old person, or the mentally retarded in institutions, may cause a drastic reappraisal of moral thinking.

In a more subtle process, even more difficult to elucidate or articulate, one emotion can monitor and tutor another. Love and sympathy neutralize many negative emotions, as for instance when in the treatment of the diseased or handicapped, sympathy overcomes disgust. Love can quell anger or mitigate contempt for a person's moral lapse or betrayal. On the other hand, anger can transform sadness, depression, and apathy into active assertion or aspiration. Much of both psychotherapy and moral socialization can be seen not only as teaching rational control, but also as trying to substitute and transform one emotion by including the feeling of another.

As Iris Murdoch has expressed it:

It is also a psychological fact, and one of importance in moral philosophy, that we can all receive moral help by focusing our attnetion upon things which are valuable: virtuous people, great art, perhaps the idea of goodness itself. Human beings are naturally "attached" and when an attachment seems painful or bad it is most readily displaced by another attachment..... [23]

An attachment or emotion can be experienced as painful or bad, both by its intrinsic experience of awfulness, as in envy or jealousy, and/or because our reason has judged it to be bad in this situation.

Loving attachments to virtuous persons influence and tutor my own emotions and moral sentiments. In ethical decisionmaking, I can assess an emotional response by comparing it to the response of those I admire and love. Their moral authority and persuasiveness arise from my emotional response to their goodness. In the same way, my emotional aversion to a person's life and moral being can make me distrust their reactions to a moral dilemma.

Our trust in the moral sentiments of those we hold to be good is not irrational, but neither is it infallible, since they too can be mistaken. Nonetheless, we are drawn even more persuasively to those we think to be rationally acute as well as good. If emotion and reason are inevitably intertwined, then the traditionally acclaimed guidance of persons communally held to be wise and good is most to be trusted. A good person's lifelong cultivation of appropriate emotions will help protect him or her from those deformations of moral reasoning that afflict the immature, regressed, or selfishly willful person undergoing stress or conflict. While a diseased physician can cure a sick patient, it is unlikely that an amoral or evil person can make wise and good ethical judgments solely through logical analysis.

The Art of Ethical Decisionmaking

If one would decide wisely and well, the best strategy would include both trusting and skeptical awareness of all of one's capacities and reactions. An individual is far too complex and personal consciousness (and preconsciousness) operates too instantaneously, for simple linear processing. It is essential to engage in fully extended, fully inclusive, circular, parallel processing of the dynamic interplays of consciousness.

While I am assessing my reasoning and arguments by rational criteria, I should pay attention to emotions, even those fleeting negative feelings that may be most in danger of defensive suppression. In the same process my emotional responses are in turn being rationally and emotionaly assessed for appropriateness, or for their infantile or qualitative characteristics. Deficits and numbness should also be considered. as rational argument proceeds I can seek to enrich the process with emotional intuitions and associations, imagined moral scenarios, and the testimony of the wise and good. Can these emotions become universal, can they produce good consequences, are these feelings consistent with my other best emotions? Communication about my feelings with others would be a further test. Certainly, I should also continually compare my rational of arguments to the critical reasoning of reflective experts, as found, say, in analytic articles or ethical guidelines. New ideas, arguments, or emotions should be continually checked and mutually adjusted.

The philosopher Jonathan Bennett recommends "checking of one's principles in the light of one's sympathies...It can happen that a certain moral principle becomes untenable--meaning one cannot hold it any longer--because it conflicts intolerably with the pity or revulsion or whatever that one feels when one sees what the principle leads to." Even more interestingly, Bennett sees principles themselves "as embodiments of one's best feelings, one's broadest and keenest sympathies. On that view principles can help one across intervals when one's feelings are at less than their best, that is through periods of misanthropy or meanness or self-centeredness or depression or anger." [24]

Philosophers rehabilitating emotions and emotional commitments are recognizing what Mary Midgley has called "the unity of the moral enterprise." In her view, solving moral problems involves "three inseparable aspects--(1) a changing view of 'the facts,' (2) a change of feeling, and (3) a change in action, arising out of a changing sense of what action can decently be contemplated and what cannot." She thinks it has been a "real misfortune" that many philosophers "have tended to concentrate entirely on separating these factors and putting them in competition as if they were alternatives, rather than on investigating the highly complex relation between them and pointing out where it goes wrong." [25] Heart and mind should no longer be seen as antagonistic adversaries in the moral enterprise.

As one wrestles with an ethical decision the goal is an emotively grounded reflective equilibrium in which all systems are integrated, all tests are satisfied, and a wholehearted decision can be made. The person as knower or whole self, has done the best he or she can after a fully personal engagement. But one may still have to deal with further conflict arising from disagreements with others, either as personal individuals or collective professional groups or institutions. What about other persons and their differing moral sentiments? Their lacks of emotion, or different emotions combined with different reasoning may lead to very different resolutions in direct conflict with my own. What then? Must I resign, resist, persuade, sue, or politically organize? Since such social conflicts and challenges present new ethical dilemmas, I may have to repeat my whole decision-making process again to deal with the consequences of an ethical decision.

One conclusion I would have to draw, however, is that I must respect the differing moral sentiments of others. Just as in my reasoning I would be open to correction from better arguments, so I should be open to the possibility that the moral emotions of others may be more valid and morally sound than my own. Unlike Feinberg, I would be especially slow to label the moral sentiments or responses of others as squeamishness, or sentimentality, or irrationality. I would be especially aware that graver moral danger arises from a deficit of moral emotion than from emotional excess.

Even if a person cannot articulate or defend his or her emotions philosophically, that would not necessarily prove them wrong. The requirement that everyone must be able to articulate and defend rationally their moral sentiments seems excessive. This requirement may be hard even for moral philosophers, and might be beyond many people's resources. Since emotions and moral sentiments arise partially from nonverbally encoded interpersonal experiences that a person may not quickly retrieve from memory, persons with developed intuitive emotional responses may still lack the vocabulary or skill to compete in philosophical or political debate. They may need intellectual advocates to articulate and defend their moral sentiments. The newest developments in psychology and philosophy indicate that in the future of bioethics, there will be more analysis and defense of the role of emotions in ethical decisionmaking.


[1] Quoted in Joel Feinberg, "Sentiment and Sentimentality in Practical Ethics," Presidential Address delivered before American Philosophical Association in Sacramento, California, March 26, 1982; see also "The Mistreatment of Dead Bodies: The Moral Trap of Sentimentality," Hastings Center Report 15:1 (February 1985), 31-37.

[2] H. Tristram Engelhardt, Jr., The Foundations of Bioethics (New York: Oxford University Press), 10.

[3] James Rachels, The End of Life: Euthanasia and Morality (Oxford: Oxford University Press, 1986), 149.

[4] Feinberg, "Sentiment and Sentimentality in Practical Ethics."

[5] Robert Plutchik, Emotion: A Psychoevolutionary Synthesis (New York: Harper and Row, 1980).

[6] See Carroll E. Izard, "Emotion-Cognition Relationships and Human Development," in Emotions, Cognition & Behavior, Carroll E. Izard, Jerome Kagan, and Robert B. Zajonic, eds. (Cambridge: Cambridge University Press, 1984), 17-37. A counter view holding that most emotions are cognitive systems or rules of behavior can be found in James R. Averill, "Emotion and Anxiety: Sociocultural, Biological, and Psychological Determinants," in Explaining Emotion, Amelie O. Rorty, ed. (Berkley: University of California Press, 1980), 37-72.

[7] Ross Buck, The Communication of Emotion (New York: The Guilford Press, 1984).

[8] Paul Ekman, "Expression and the Nature of Emotion," in Approaches to Emotion, Klaus R. Scherer and Paul Ekman, eds. (Hillsdale, NJ: Lawrence Erlbaum, 1984), 319-43.

[9] Douglas Derryberry and Mary Klevjord Rothbart, "Emotion, Attention and Temperament," in Emotions, Cognition & Behavior, 132-66; for a philosophical treatment of "magnetizing dispositions" and the tenacity" of emotions, see Amelie O. Rorty, "Explaining Emotions," in Explaining Emotions, 103-26.

[10] Stephen G. Gilligan and Gordon Bower, "Cognitive Consequences of Emotional Arousal," in Emotions, Cognition & Behavior, 547-88.

[11] Michael Lewis and Linda Michalson, Children's Emotions and Moods (New York: Plenum Press, 1983), 88.

[12] Joseph DeRivera, "Development and the Full Range of Emotional Experience," in Emotion in Adult Development, Carol Zander Malatesta and Carroll E. Izard, eds. (Beverly Hills, CA: Sage Publications, 1984), 45-63.

[13] Richard A. Dienstbier, "The Role of Emotion in Moral Socialization," in Emotions, Cognition & Behavior, 484-514; Drew Western, Self & Society: Narcissism, Collectivism, and the Development of Morals (Cambridge: University Press, 1985), especially Chapter 2, "Emotion: A Missing Link Between Psychodynamic and Cognitive-Behavioral Psychology?", 22-96; for a philosophical reappraisal see Roberto Mangabeira Unger, Passion: An Essay an Personality (New York: The Free Press, 1984).

[14] Silvan S. Tomkins, Affect, Imagery and Consciousness, Cognition and Affect, 3 (New York: Springer, 1982).

[15] Daniel Goleman, "Part Two, The Machinery of Mind," in Vital Lies, Simple Truths: The Psychology of Self-Deception (New York: Simon and Schuster, 1985).

[16] Roy Schafter, "The Psychoanalytic Vision of Reality," in A New Language for Psychoanalysis (New Haven: Yale University Press, 1976) 22-56.

[17] Iris Murdoch, The Sovereignty of Good (London: Ark Paperbacks, 1985), 37.

[18] Goleman, "Part Two, the Machinery of Mind," 22.

[19] Schafer, "The Psychoanalytic Vision of Reality," 195.

[20] Silvano Arieti and Jules Bemporad, Severe and Mild Depression: The Psychotherapeutic Approach (New York: Basic Books, 1978), 17.

[21] Mary Howell, "Caretakers' Views on Responsibilities for the Care of the Demented Elderly," Journal of the American Geriatrics Society 32:9 (September 1984), 657-60; Christine K. Cassel, "Ethical Dilemmas in Dementia," Seminars in Neurology 4:1 (March 1984), 92-97; Kathleen Nolan, "In Death's Shadow: The Meanings of Withholding Resuscitation," Hastings Center Report 17:5 (October/November 1987), 9-14.

[22] Willard Gaylin, Feelings: Our Vital Signs (New York: Harper & Row, 1979).

[23] Iris Murdoch, The Sovereignty of Good, 56.

[24] Jonathan Bennett, "The Conscience of Huckleberry Finn," Philosophy 49 (1974), 123-34.

[25] Mary Midgley, "The Flight from Blame," Philosophy 62 (1987), 271-91.

Sidney Callahan is an author and an associate professor of psychology at Mercy College, Dobbs Ferry, NY.
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Author:Callahan, Sidney
Publication:The Hastings Center Report
Date:Jun 1, 1988
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