“No One Is Psychotic in My Presence”

Philosophy, Psychiatry, and Psychology 15 (4):315-319 (2008)
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Abstract

In lieu of an abstract, here is a brief excerpt of the content:“No One Is Psychotic in My Presence”S. Nassir Ghaemi (bio)Keywordsexistentialism, Semrad, delusions, psychosis, empathy, HavensWe are all prone to make wrong judgments about others (and ourselves) based on inaccurate (or insufficient) information. I recently had this experience with a relative, who cited a number of behaviors as reasons for him to make a rather harsh judgment about my internal mental states. Before hearing his rationale—and despite my belief that he was wrong—I had to reserve some doubt that I might, unconsciously, have those disagreeable habits that my kind relative ascribed to me. But after I heard his explanation, the only possibility that seemed to fit was psychosis (in him, not me); because I was rather certain that he did not have a psychotic illness, I had to conclude that he had beliefs that served his own purposes in some way, although they were simply wrong.We all do this, all the time (perhaps this is the source of the wisdom behind a peasant woman’s admonition to Maxim Gorky: “Remember, above all, do not judge: that is the Devil’s work” [Gorky 1949]).But we do not all have delusions, at least in the sense that delusions are supposed to mark out psychiatric illnesses. Rhodes and Gipps (2008) make this point in their critique of cognitive theories of delusion: “One (‘rationalist’) line of research has explored to what extent people with psychotic delusions may have a malfunction in their reasoning processes (Garety and Hemsley 1994). Another (‘empiricist’) approach has it that delusions are a product of normal reasoning processes running on data provided by abnormal perceptual experiences (Maher 1988, 1999).” Both approaches identify abnormal kinds of reasoning in persons with psychosis, most of which are shared with the normal population (like my relative). But: “the question needs to be asked as to why, in many cases, clear counter-evidence has no effect in correcting the delusional belief. Confirmation bias after all itself only explains why people may not look for disconfirming evidence (Wason 1968), and does not explain why people may fail to believe it when they happen upon or are presented with it” (Rhodes and Gipps 2008, 306).This gets to the distinction between non-bizarre and bizarre delusions (a distinction that the authors do not make in their paper): Non-bizarre delusions seem completely explainable on cognitive grounds—they are not incredibly irrational (my relative’s perspective is logically plausible), yet they are just wrong (it is empirically false, I think). (Another example: I could plausibly believe that the FBI has me—a Shiite Muslim Middle Eastern male who hails from the Axis of Evil—under surveillance; it would simply be false, or not). On the other hand, the authors’ examples of delusions are both bizarre and wrong at first glance, not because they are illogical (in their conceptual associations), but simply because they just seem wrong without [End Page 315] much need to explain why (unlike my relative’s theories): “What, then, needs accounting for is why deluded persons do not themselves recognize the following: the unlikeliness of their belief, the insufficiency of the grounds they provide, the unlikeliness of their premises when they provide them (as well as their conclusions), the greater likelihood that the evidence they adduce was (for example) hallucinated rather than perceived, and so on” (Rhodes and Gipps 2008, 297).The authors turn first to Ludwig Wittgenstein, then John Searle—the former for the notion that we have “Bedrock certainties” that are founded on having served us in acting in the world (these beliefs do not require rational or empirical justification), the latter for the notion of a Background “defined as those abilities and dispositions which themselves are neither representations nor rules, yet that we need to hypothesize as functioning before we can make sense of everyday perception, thinking and language” (Searle 1995, 129). Go mow the lawn, we say, presuming that scissors will not be used:The capacity to discern what counts as the relevant context is itself a Background capacity that cannot, on pains of an infinite regress of an infinity of disambiguations, be understood as consisting in further propositional knowledge. The cultural ‘common sense...

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