In this paper, I will present and advocate a view about what we are doing when we attribute delusion, namely, say that someone is delusional. It is an “expressivist” view, roughly analogous to expressivism in meta-ethics. Just as meta-ethical expressivism accounts for certain key features of moral discourse, so does this expressivism account for certain key features of delusion attribution. And just as meta-ethical expressivism undermines factualism about moral properties, so does this expressivism, if correct, show that certain attempts to (...) objectively define delusion are misguided. I proceed as follows. I start by examining different attempts at defining delusion, separating broadly psychiatric attempts from epistemic ones. I then present a change of approach, according to which we question whether the term “delusion” is in the business of (merely) describing reality. I then support this proposal, first, by borrowing standard lines of argument from meta-ethics (including ontological reluctance, intrinsic motivation, and deep disagreement) but also, by inference to the best explanation of some the features we see when we try to theorise about delusion (namely that it is hard to define, and that our delusion attributions are elicited by a plurality of norms). (shrink)

In this paper I discuss Wakefield’s account of mental disorder as applied to the case of gender dysphoria (GD). I argue that despite being a hybrid account which brings together a naturalistic and normative element in order to avoid pathologising normal or expectable states, the theory alone is still not extensive enough to answer the question of whether GD should be classed as a disorder. I suggest that the hybrid account falls short in adequately investigating how the harm and dysfunction (...) in cases of GD relate to each other, and secondly that the question of why some dysfunction is disvalued and experienced as harmful requires further consideration. This masks further analysis of patients’ distress and results in an unhelpful overlap of two types of clinical patients within a diagnosis of GD; those with gender-role dysphoria and those with sex dysphoria. These two conditions can be associated with different harms and dysfunctions but Wakefield’s hybrid account does not have the tools to recognise this. This misunderstanding of the sources of dysfunction and harm in those diagnosed with GD risks ineffective treatment for patients and reinforcing the very same prejudiced norms which were conducive to the state being experienced as harmful in the first place. The theory needs to engage, to a surprising and so far unacknowledged extent, with sociological concepts such as the categorisation and stratification of groups in society and the mechanism of systemic oppression, in order to answer the question of whether GD should be classed as a mental disorder. Only then can it successfully avoid pathologising normal or expectable states, as has been seen in past ‘illnesses’ such as homosexuality and ‘drapetomania’. (shrink)

In this paper I consider the project of offering an evolutionary debunking explanation for transparency in doxastic deliberation. I examine Nicole Dular and Nikki Fortier’s (2021) attempt at such a project. I suggest that their account faces a dilemma. On the one horn, their explanation of transparency involves casting our mechanisms for belief formation as solely concerned with truth. I argue that this is explanatorily inadequate when we take a wider view of our belief formation practices. I show that Dular (...) and Fortier overstate the extent to which adaptive non-evidentially supported beliefs are rare, and the implausibility of disjunctive evolutionary systems. They should allow a role for the non-truth directed behaviour of our mechanisms of belief formation. On the other hand, we might restrict the explanation offered by Dular and Fortier to the deliberative context, that is, we might understand them as allowing for non-evidential belief formation outside of the deliberative context, but as identifying the key to explaining transparency in the truth-directed evolutionary mechanisms as they operate in the deliberative context. However, this would land them on the second horn of the dilemma: we would then have no different an explanation to one I have offered elsewhere (2018), an explanation which Dular and Fortier explicitly put aside as engaged in a project different from their own. I finish by briefly considering some broader implications relating to explaining transparency, the nature of belief, and the prospects for pragmatism. I conclude that Dular and Fortier’s debunking explanation of transparency bestows an implausible role for truth in fixing our beliefs, or, if it doesn’t, then we simply have the restatement of a view explicitly disavowed by the authors. We are left, then, with an explanation we ought not want, or an explanation we already had. (shrink)

In chapter 3 of Delusions and Beliefs, Kengo Miyazono argues that, when delusions are pathological beliefs, they are so due to their being both harmful and malfunctional. In this brief commentary, I put pressure on Miyazono’s account of delusions as harmful malfunctioning beliefs. No delusions might satisfy the malfunction criterion and some delusions might fail to satisfy the harmfulness criterion when such conditions are interpreted as criteria for pathological beliefs. In the end, I raise a general concern about attributing pathological (...) status to single beliefs out of context, and gesture towards the idea of pathology as a failure of agency to which some beliefs can contribute but that can only be identified by considering the person as a whole. (shrink)

The notion of harm has been a recurring and a significant notion in the characterization of mental disorder. It is present in eminent diagnostic manuals such as DSM and ICD, as well as in the discussion on mental disorders in philosophy of psychiatry. Recent demotion of harm in the definition of mental disorders in DSM-5 shows a general trend towards reducing the significance of harm when thinking about the nature of mental disorders. In this paper, we defend the relevance of (...) the notion of harm in the characterization of mental disorder against some of these attacks. We approach this issue by using the method of conceptual explication pioneered by Rudolf Carnap. Within this framework, we argue that keeping the notion of harm not only helps to discriminate what is pathological from the nonpathological but also prevents potential misuses of psychiatric authority. (shrink)

The notion of harm is frequently used in the discussion of the nature of mental disorder. Harm also plays important roles in the prominent diagnostic manuals such as DSM and ICD. Recently, however, Cristina Amoretti and Elisabetta Lalumera have questioned the idea that harm should be a necessary constituent of mental disorders. They argue that the notion of harm is underspecified and potentially leads to false negatives in diagnosing mental disorders. Given that harm plays significant roles in medical diagnosis and (...) treatment indicates that we should be reluctant to remove it as a criterion for deciding whether some condition is a mental disorder. Instead, we argue that harm should be understood in the prudential sense and harm in this sense provides a way of responding to worries raised by Amoretti and Lalumera, while staying true to the conception of harm that is relevant for psychiatric practice. (shrink)