Background Delusions are a significant feature of mental illnesses and can occur in many clinical conditions (Maher, 2001) yet the standard clinical definition (American Psychiatric Association. DSM-5 Task Force, 2013) is highly contentious. Much of the literature holds elements such as bizarreness of content and incorrigibility of belief as defining factors of delusion. However, on closer inspection, delusions are not so easy to pin down. The difficulty in defining delusion is not a new one as “…we are all capable of (...) having convictions and it is a universal human characteristic to hold on to our own mistaken judgements.” (Jaspers, 1963, p.63). Objective I intend to highlight some of the difficulties associated with the definition of delusion and perhaps clarify the phenomenology. Methodology I examine some of the philosophical, psychological and psychiatric literature with regard to the definition of delusion. I also consider my experience of my own mental activity and experiences from my therapeutic work. Results/Conclusion I identify that delusions are a heterogeneous group and that there may be more than one ‘class’ of delusion. I also show that delusions are multi-dimensional with characteristics on a continuum with normal beliefs and that further research is needed to clarify the phenomenology. (shrink)

In this paper I investigate the topic of paranoid atmospheres. This subject is especially of interest with respect to persons who are deluded, and also, I will demonstrate, sheds light upon the psychiatrist's "gaze" and knowledge of delusions. In my argument I will follow a path initially outlined by Karl Jaspers (1883-1969): modern psychiatric diagnosis of delusions is a diagnosis of form and not content. Jaspers' emphasis on the form of delusions enables psychiatrists to be self-critical about their professional knowledge (...) and, consequently, prevent the development of dogmatic attitudes. In accord with Jaspers, my argument will focus on the basic structure of delusions and highlight the difference between delusional realities and non-delusional realities, a difference that follows from the possibility of self-criticism of one's own conscious and explicit convictions. I will demonstrate the importance of self-criticism with regard to paranoid atmospheres and also to psychiatric knowledge. In this manner, an understanding of delusions as lived experience will be developed, which argues that an escalation of the influence of delusional convictions, resulting in a profoundly paranoid atmosphere, is most problematic for the deluded person. To acknowledge this insight mirrors the need for a self-critique of psychiatric discourse, encourages an empathic and respectful relationship between professionals and deluded patients, and enables deluded persons to restrict their paranoid atmosphere. It is the main conclusion of my paper that a deluded person cannot do (with respect to his delusional convictions) what a psychiatrist must do (with respect to his psychiatric knowledge and his own existential convictions) in order to prevent a profoundly paranoid atmosphere in their relationship: be self-critical. (shrink)

In this paper the question of autonomy in delusional disorders is investigated using a phenomenological approach. I refer to the distinction between freedom of intentional action, and freedom of the will, and develop phenomenological descriptions of lived autonomy, taking into account the distinction between a pre-reflective and a reflective type. Drawing on a case report, I deliver finely-grained phenomenological descriptions of lived autonomy and experienced self-determination when acting on delusions. This analysis seeks to demonstrate that a person with delusions (...) can be described as responsible for her behaviour on a ‘framed’ level (level of freedom of intentional action), even though she is not autonomous on a higher (‘framing’) level (level of freedom of the will), if, and only if, the goods of agency for herself and others are respected. In these cases the person with delusions is very nearly comparable to people in love, who are also not free to choose their convictions, and who could also be rightly held responsible for the behaviour flowing from their convictions. (shrink)

Empiricist models explain delusional beliefs by identifying the abnormal experiences which ground them. Recently, this strategy has been adopted to explain the false body size beliefs of anorexia nervosa patients. As such, a number of abnormal experiences of body size which patients suffer from have been identified. These oversized experiences convey false information regarding the patients’ own bodies, indicating that they are larger than reality. However, in addition to these oversized experiences, patients are also exposed to significant evidence suggesting (...) their bodies are in fact thin. This situation poses a conundrum: why do patients appear strongly influenced by the former kinds of evidence while the latter has little effect? To solve this conundrum, I suggest a two-factor account. First, I discuss research on the biases patients exhibit in how they gather, attend to and interpret evidence related to their own body size. Such biases in evidence treatment, I suggest, cause oversized experiences to be sought out, attended to and accepted, while veridical body size experiences are ignored or explained away. These biases constitute the second factor for this empiricist model, accounting for the unwarranted conviction with which these beliefs are held. Finally, in line with recent research into self-deception, I propose that, paradoxically, these biases in evidence treatment arise from patients’ own desires. (shrink)

In this dissertation I advance a Jaspersian account of the formation and possession of irrational attitudes. This account stands in opposition to two competing views – externalism and internalism with respect to rational and irrational attitudes. According to externalism, a subject’s attitudes are irrational when they fail to satisfy standards or criteria independent of the subject, such as laws of logic, methods for evidence acquisition, and rules of decision theory. According to internalism, a subject’s attitudes are irrational when they are (...) not supported by reasons selected by the subject. In this dissertation, I take Donald Davidson’s theory of rational and irrational attitudes to be a case of externalism and John Searle’s theory of rational and irrational attitudes to be a case of internalism. While articulating and identifying the merits of externalism and internalism with respect to rational or irrational attitudes, I argue that each account ends up in difficulties: Davidson’s externalism cannot account for the experience of freedom, an individual’s subjectivity, and is unable to avoid an infinite regress of rules; Searle’s internalism struggles to avoid solipsism and an infinite regress of reasons. Karl Jaspers’ account of rational and irrational attitude formation, I argue, avoids the pitfalls of Davidson’s and Searle’s views while preserving the merits of each. On Jaspers’ account, a subject possesses rational attitudes insofar as that subject holds those attitudes to be always open to revision while, at the same time, using those attitudes to bring unity to all manner of phenomena and other attitudes. Irrationality, by contrast, occurs, on the Jaspersian view, when a subject holds onto attitudes with complete and absolute resolution and interprets all else according to these attitudes. Having defined a Jaspersian account of rational and irrational attitudes, I show how it accounts for the irrationality of delusional beliefs and the irrationality of certain worldviews. On Jaspers’ view, I argue, delusions and worldviews are irrational insofar as they are held with absolute conviction, are unamenable to modification, and are used to understand all available evidence, views, and opinions. (shrink)

This paper explores the phenomenology of the Capgras and Cotard delusions. The former is generally characterised as the belief that relatives or friends have been replaced by impostors, and the latter as the conviction that one is dead or has ceased to exist. A commonly reported feature of these delusions is an experienced ''defamiliarisation'' or even ''derealisation'' of things, which is associated with an absence or distortion of affect. I suggest that the importance attributed to affect by current explanations of (...) delusional experience can serve to make explicit the manner in which we ordinarily experience the world under a taken-for-granted aspect of affective familiarity. This implicit feeling is, I argue, partly constitutive of our sense of reality. However, so-called ''folk psychology,'' which is generally adopted by philosophers as an initial interpretive backdrop for delusional beliefs and for beliefs more generally, fails to accommodate it. As a consequence, some pervasive philosophical assumptions concerning the manner in which we experience and understand the world, ourselves, and each other are called into question. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:The Background Theory of Delusion and Existential PhenomenologyRichard G. T. Gipps (bio) and John Rhodes (bio)KeywordsPhenomenology, psychological explanation, epistemology, schizophreniaSituating and Clarifying the PaperThe commentaries of Nassir Ghaemi and Giovanni Stanghellini help to sketch out the intellectual landscape of philosophical perspectives in psychiatry, and situate our paper within it. A happy convergence between the analytical philosophy perspective from which we were writing, and the existential–phenomenological paradigm described by both (...) authors, is the result. Stanghellini in particular carefully describes three main theories of existential deformations, tracing delusion formation back to either (i) a disturbance of meaning synthesis conceived as a dysfunction of a Husserlian consciousness, (ii) a disturbance of pre-reflective self-consciousness resulting in a kind of paralyzing hyperreflexivity, and (iii) (Stanghellini’s preferred model) a disturbance of embodiment. This final account views delusion as springing from a failure in the subject’s corporeal and praxical being-in-the-world. As the subject’s practical, pre-reflective grip on the world is loosened, so their minds become unconstrained by that understanding and practical rationality immanent within that grip, and thought, now unconstrained, starts to travel through delusional worlds. Stanghellini accordingly views our model as an example of a disembodiment theory, which allows it to overcome the disadvantages of the first two models, which may both, in their own ways, overvalue the rôle of (disturbances of) reflective consciousness in the formation (and delusional deformation) of everyday understanding.Being situated within a preexisting landscape has both its benefits and its disbenefits, the principle example of the latter being the potential assimilation of anything new to what has already been said. Thus, although we are grateful to our commentators for placing us on the larger historical and conceptual map, it may be helpful to briefly rehearse our motivations for drawing on the philosophical ideas of the Bedrock and Background in our theory of delusion. Our paper was primarily motivated by a concern that current, psychologically mainstream, cognitive models of delusion, although helpfully drawing our attention to common reasoning and perceptual deficits in the person with psychosis, fail to adequately account for what is delusional about delusions. It was, in [End Page 321] particular, to account for the certainty with which the deluded person clings to often quite extraordinary beliefs that we drew on the epistemological notion of the background. And although this epistemological notion fits quite neatly with ontological concerns regarding the embodied and praxical character of human existence, it is the particular epistemic rôle that it played in our theory—to do with the extraratiocinative constraint on judgement provided by the Background—that we wish to stress here.We return to this shortly, but first wish to comment briefly on two specific considerations raised by the commentaries. The first concerns Stanghellini’s claim that, for us, “when studying delusions, the focus should be on providing an adequate framework for understanding, rather than providing empirical hypotheses to be tested” (2008, 311–314). It seems to us, however, that both are equally important. What we wished to stress, however, was that empirical hypothesis testing may be led astray if it is not informed by an adequate framework for understanding. For example, most cognitive psychological experiments on delusions concern themselves with the individual’s ability to make appropriate guesses (e.g., regarding the color of beads in a bag), and their tendency to jump to conclusions; they do not concern themselves with the kinds of extraordinary conviction and certainty met with in delusion. The risk run by empirical researchers of cognitive factors in delusion is that a lack of a prior adequate theorization of delusion makes for accounts that are ultimately only of the formation, not of delusion in particular but rather of false or unusual beliefs more generally. An analytical approach, however, can help to explicate the ways in which the psychiatric concept of delusion fails to be adequately characterized by the quite general ‘external criteria’ of delusion (as Jaspers [1963] called them: falsity, stubbornness, uncommon), and aids in the construction of empirical hypotheses this time constrained by an understanding of the true ‘internal criteria’ of psychotic belief. Such an approach helps to spell out the... (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Philosophy, Psychiatry, & Psychology 11.1 (2004) 87-94 [Access article in PDF] Talk and the Nature of Delusions:Defending Sociocultural Perspectives on Mental Illness Eugenie Georgaca Keywords discourse, social constructionism, delusions, psychosis, mental illness, context It is very pleasing to see writers from philosophy, psychiatry and psychology, the three disciplines represented by this journal, debating the issue of delusions. The majority of the papers in this volume set out to determine (...) the underlying mechanisms responsible for delusions. As such, they offer themselves as discussions of the etiological factors of the formation and maintenance of delusions. My paper analyzes the interactional presentation and negotiation of statements that would be considered as delusional. This led some commentators (Ghaemi 2004; Sass 2004) to argue that the analysis of talk about delusions is useful, but cannot be extended to claims about the nature of delusions. In the following section, I discuss the ways in which analyzing interactions can be useful in clinical research and practice. Subsequently, I identify and critically discuss the assumptions about the nature of delusions that underlie these criticisms and the majority of the papers in this volume. The Usefulness of the Study of Interaction My paper can be seen as part of a growing body of studies that attempt to elucidate the role of interactional and discursive processes in the identification and management of disorders (Barrett 1988; Coulter 1975; Hak 1989; Pollner 1975; Smith 1978; Soyland 1994). Microsociological and ethnographic studies look at the properties of client-professional interaction with the aim of clarifying the tacit skills and knowledges used in such encounters. Palmer (2000), for example, argues that the recognition of disorder is a social and interactional issue both in the sense that the judgment of disorder is based on social criteria and in the sense that diagnosis is an interpersonal process with its own inherent social order. The aim, therefore, of analyzing professional-client interactions would be to articulate the properties of this implicit social order. Other researchers argue that diagnosis is not a process of identification or recognition of disorder, but rather a process of active construction of disorder and of transforming the person to a mental patient. Barrett's (1988) analysis of the transformation of a [End Page 87] person to a "person suffering from schizophrenia" and subsequently a "schizophrenic" through interviewing and report writing is an excellent example of this kind of work.The application of this approach to the field of delusions would attempt to address the issue of how delusions are diagnosed and managed through the interactions between the delusional patient and the clinician. In this paper and in previous work (Georgaca 1996, 2000) I showed that statements that have been diagnosed as delusional are presented and argued through using appropriate conversational strategies, drawing on socially meaningful systems of knowledge and applying appropriate rules of evidence. Moreover, I argued that there was no way in which these disagreements over competing versions of reality could be definitely settled conversationally, and that instances of breakdown in communication were due not to the delusional version being proven wrong, but to lack of explanatory frameworks within which the competing versions could be negotiated. At least in the exchanges analyzed, the criteria of implausibility, conviction, and incorrigibility were shown not to apply.Clinicians do not customarily investigate the truth of patient claims against empirical data (Maher 1992), which means that they have to judge claims on the basis of the patient's presentation in the diagnostic interview. Because there are no technical guidelines for the assessment of truth and falsity, plausibility and implausibility, rationality and irrationality, clinicians have to rely on personal judgment. The question then is on what grounds the clinician's personal judgment is granted the status of determining the truth of someone else's claim and in what capacity clinicians are called to make such decisions. I will not pursue this argument any further here. The point I want to make is that the analysis of professional-client interactions foregrounds the active role of professionals in clinical decisions and questions the criteria upon which decisions are... (shrink)

Metacognitive training (MCT) was developed to promote awareness of reasoning biases among patients with schizophrenia. While MCT has been translated into 31 languages, most MCT studies were conducted in Europe, including newer evidence recommending an individualized approach of delivery. As reasoning biases covered in MCT are separable processes and are associated with different symptoms, testing the effect of selected MCT modules would help to develop a targeted and cost-effective intervention for specific symptoms and associated mechanisms. This study tested the efficacy (...) of a 4-session metacognitive training for delusions, MCTd (in Traditional Chinese with cultural adaptations, provided individually), as an adjunct to antipsychotics in reducing severity and conviction of delusions, jumping to conclusions bias and belief inflexibility. Forty-four patients with delusions were randomized into the MCTd or the wait-list control condition. Patients on wait-list received the same MCTd after four weeks of treatment as usual. Assessment interviews took place before and after the treatment, and at 4-week follow-up. There was an additional baseline assessment for the controls. Jumping to conclusions and belief flexibility were measured by the beads tasks and the Maudsley Assessment of Delusions Scale. Attendance rate of the MCTd was satisfactory (84.5%). Compared to treatment as usual, there was a greater reduction in psychotic symptoms, delusional severity and conviction following MCTd. There was a large treatment effect size in improvement in belief flexibility. Improvement in reaction to hypothetical contradiction predicted treatment effect in positive symptoms and delusions. Jumping to conclusions bias was reduced following MCTd, although the treatment effect was not significantly larger than TAU. Our results support the use of process-based interventions that target psychological mechanisms underlying specific psychotic symptoms as adjuncts to more conventional approach. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Philosophy, Psychiatry, & Psychology 11.1 (2004) 55-64 [Access article in PDF] Delusions and Discourse:Moving beyond the Constraints of the Modernist Paradigm David J. Harper This special issue provides a good opportunity to reflect on the range of views about delusions,1 and it is good to see all the authors taking the issue of how to approach this topic seriously. Here I wish to argue that the traditional psychiatric view (...) of delusions is problematic. In the first half of this article I will group my comments on the issues raised by the papers by Klee and Bayne and Pacherie together as I think that, for their differences, they share modernist philosophical assumptions. I will argue that the modernist paradigm runs into considerable problems in considering beliefs felt by some to be unusual and I will go on to argue that we need to move beyond this paradigm and embrace different approaches, of which the work by Georgaca is an exemplar. The Trouble with (traditional Views of) Delusions The traditional psychiatric view of delusion has come under increasing attack over recent years. As Georgaca has noted, a number of problems with the assumptions in definitions of delusion can be identified when they are viewed from a social constructionist perspective (Georgaca 2000, 2004; Harper 1992, 1996; Heise 1988). For convenience I will group these under four main headings. They Are Based on a Naively Realist View of the World The criterion of inaccuracy or falsity implies that deciding on the veracity of a belief is a relatively unproblematic matter. However, the reality of claims does not always seem so important in judgments about whether a belief is delusional or not. For example, there is little evidence that mental health professionals systematically investigate the basis for people's beliefs; rather, they decide whether a belief is plausible. Thus Maher has argued that the assessment of the plausibility of beliefs is "typically made by a clinician on the basis of "common sense," and not on the basis of a systematic evaluation of empirical data" (1992, 261). He notes that it is not "customary to present counterevidence to the patient; it is not even common to present vigorous counterargument" (1992, 261) and there appears to be some empirical evidence of this (McCabe et al. 2002). Here then, we begin to see [End Page 55] how psychiatry, while claiming to have the power to judge the truth of beliefs on the basis of its status as an empirical scientific discipline, can be seen to make judgments on the basis of common sense and taken-for-granted social and cultural assumptions.Some commentators have suggested that delusions should be identified less by whether they seem to accord with reality but more by whether a person gives evidence for their belief (Gillett 1995; Spitzer 1990). However, this seems to be based on an idealized view of how people manage their beliefs in everyday life. For example, I would question how many of us have evidence for many of the beliefs (e.g., political, ethical, religious, etc.) we hold dear; indeed it would be hard to think of what evidence we could have for some of them (e.g., religious and ethical beliefs). Some recent work has suggested that the diagnosis of delusion is made on the basis of how people with delusions talk and interact; for example, some have argued that they do not appear to appreciate the hearer's point of view (Palmer 2000). However, here and in previous work, Georgaca (2000, 2004) has shown that people with delusions are able to talk about and negotiate disagreements about their beliefs and that many disputes of fact cannot be settled in conversation. People Said to Have Delusions Are Seen to Vary in the Conviction With Which Those Beliefs Are Held There is evidence that people considered to be deluded vary in the conviction with which they hold beliefs (Garety 1985) and can also be persuaded to modify their beliefs if this is conducted in a sensitive and collaborative manner (e.g., Chadwick, Birchwood, and Trower 1996). This... (shrink)

Does the formation of delusions involve abnormal reasoning? According to the prominent ‘two-factor’ theory of delusions (e.g. Coltheart, 2007), the answer is yes. The second factor in this theory is supposed to affect a deluded individual's ability to evaluate candidates for belief. However, most published accounts of the two-factor theory have not said much about the nature of this second factor. In an effort to remedy this shortcoming, Coltheart, Menzies and Sutton (2010) recently put forward a Bayesian account of inference (...) in delusions. I outline some criticisms of this important account, and sketch an alternative account of delusional inference that, I argue, avoids these criticisms. Specifically, I argue that the second factor in delusion formation involves a systematic deviation from Bayesian updating, a deviation that may be characterized as a bias towards ‘explanatory adequacy’. I present a numerical model of this idea and show that my alternative account is broadly consistent with prominent prediction error models of delusion formation (e.g. Corlett, Murray et al., 2007). (shrink)

In both cognitive science and philosophy, many theorists have recently appealed to a predictive processing framework to offer explanations of why certain individuals form delusional beliefs. One aim of this essay will be to illustrate how one could plausibly develop a predictive processing account in different ways to account for the onset of different kinds of delusions. However, the second aim of this essay will be to discuss two significant limitations of the predictive processing framework. First, I shall draw (...) on the structure of explanatory why-questions to argue that predictive processing theories can only partially explain the formation of delusional beliefs. Second, I shall argue that predictive processing theories cannot explain how implausible delusional hypotheses are generated. Yet understanding why an agent even generates a delusional hypothesis is a crucial step to understanding why she eventually comes to believe it. The final section of the essay presents three alternative ways the process of hypothesis generation might be functionally divergent in cases of delusional cognition. (shrink)

Delusions are deeply evidence-resistant. Patients with delusions are unmoved by evidence that is in direct conflict with the delusion, often responding to such evidence by offering obvious, and strange, confabulations. As a consequence, the standard view is that delusions are not evidence-responsive. This claim has been used as a key argumentative wedge in debates on the nature of delusions. Some have taken delusions to be beliefs and argued that this implies that belief is not constitutively evidence-responsive. Others hold fixed the (...) evidenceresponsiveness of belief and take this to show that delusions cannot be beliefs. Against this common assumption, I appeal to a large range of empirical evidence to argue that delusions are evidence-responsive in the sense that subjects have the capacity to respond to evidence on their delusion in rationally permissible ways. The extreme evidence-resistance of delusions is a consequence of powerful masking factors on these capacities, such as strange perceptual experiences, motivational factors, and cognitive biases. This view makes room for holding both that belief is constitutively evidence-responsive and that delusions are beliefs, and it has important implications for the study and treatment of delusions. (shrink)

In order to explain delusional beliefs, one must first consider what factors should be included in a theory of delusion. Unlike a one-factor theory, a two-factor theory of delusion argues that not only anomalous experience (the first factor) but also an impairment of the belief-evaluation system (the second factor) is required. Recently, two-factor theorists have adopted various Bayesian approaches in order to give a more accurate description of delusion formation. By reviewing the progression from a one-factor theory to a (...) two-factor theory, I argue that in light of the second factor’s requirements, different proposed impairments can be unified within a consistent belief-evaluation system. Under this interpretation of the second factor, I further argue that the role of a mechanism responsible for detecting bizarreness is wrongly neglected. I conclude that the second factor is a compound system which consists of differing functional parts, one of which functions to detect bizarreness in different stages of delusion; moreover, I hold that the impairment can be one or several of these functional parts. (shrink)

In Paradoxes of Delusion, Sass aims to use passages from Wittgenstein to characterize the feeling of “mute particularity” that forms a part of delusional atmosphere. I argue that Wittgenstein’s discussion provides no helpful positive account. But his remarks on more everyday cases of the uncanny and the feeling of unreality might seem to promise a better approach via the expressive use of words in secondary sense. I argue that this also is a false hope but that, interestingly, there can (...) be no interesting or substantial explanation of this failure. (shrink)

INTRODUCTION: Delusional misidentification syndromes (DMS) are a group of psychopathological experiences occurring in psychosis, involving the misidentification of a person or place. DMS are often accompanied by hostility towards the object of delusional misidentification. This is of a particular concern in perinatal mental illness due to the potential disruption of the mother-infant bond, and risk of neglect, violence, or infanticide towards a misidentified child. This review aimed to collate all published cases of DMS in postpartum psychosis to further (...) understand how these syndromes present in perinatal mental illness. METHODS: In August 2021, an online database search was conducted using PubMed, MEDLINE, PsycINFO, CINAHL, and Embase to identify all publications reporting DMS in the perinatal period. RESULTS: Nine papers were included in the review involving 8 case reports of Capgras syndrome and one case series involving 4 cases of Fregoli syndrome. Three cases identified organic pathology, which may have contributed to the presentation. The most common subject of misidentification was the patient’s husband (n = 7), followed by their baby (n = 6), hospital staff (n = 4), other family members (n = 3), and self (n = 1). Five cases remark on the impact of perinatal illness on the maternal-infant bond, of which four result in the mother being unwilling to care for the infant as the result of their delusional beliefs. CONCLUSION: This is the first systematic review of the literature in this field. Although small in number, these cases reveal several important learning points including that DMS can occur with or without underlying organic disease. Active exploration of the nature of delusions in postpartum psychosis is required to mitigate the risk of harm to the infant and mother-infant bond. It may also uncover that these syndromes are more common in postpartum psychosis than previously realized. (shrink)

Philosophers have been long interested in delusional beliefs and in whether, by reporting and endorsing such beliefs, deluded subjects violate norms of rationality (Campbell 1999; Davies & Coltheart 2002; Gerrans 2001; Stone & Young 1997; Broome 2004; Bortolotti 2005). So far they have focused on identifying the relation between intentionality and rationality in order to gain a better understanding of both ordinary and delusional beliefs. In this paper Matthew Broome and I aim at drawing attention to the extent (...) to which deluded subjects are committed to the content of their delusional beliefs, that is, to whether they can be regarded as authors of their beliefs (Moran 2001). We consider several levels of commitment one can have to a reported belief, delusional or otherwise, and we distinguish between _ownership_ and _authorship_ of beliefs (Gallagher 2000). After examining some examples of belief authoring (or lack thereof) in psychopathology, we argue that there is no straight-forward and unitary answer to the question whether deluded subjects author their beliefs. Nevertheless, introducing the notion of authorship in the debate can significantly contribute to the philosophical literature on the rationality of delusions and can also have important implications for diagnosis and therapy in psychiatry. (shrink)

How is confabulation related to self-deception? Obviously, that depends on what confabulation and self-deception are. In the first main section, I sketch a position that I have developed elsewhere on self-deception. I turn to confabulation in the second main section. Confabulation in general is more than I can take on in this chapter. I focus on confabulations associated with a trio of delusions.

Delusional beliefs have sometimes been considered as rational inferences from abnormal experiences. We explore this idea in more detail, making the following points. Firstly, the abnormalities of cognition which initially prompt the entertaining of a delusional belief are not always conscious and since we prefer to restrict the term “experience” to consciousness we refer to “abnormal data” rather than “abnormal experience”. Secondly, we argue that in relation to many delusions (we consider eight) one can clearly identify what the (...) abnormal cognitive data are which prompted the delusion and what the neuropsychological impairment is which is responsible for the occurrence of these data; but one can equally clearly point to cases where this impairments is present but delusion is not. So the impairment is not sufficient for delusion to occur. A second cognitive impairment, one which impairs the ability to evaluate beliefs, must also be present. Thirdly (and this is the main thrust of our chapter) we consider in detail what the nature of the inference is that leads from the abnormal data to the belief. This is not deductive inference and it is not inference by enumerative induction; it is abductive inference. We offer a Bayesian account of abductive inference and apply it to the explanation of delusional belief. (shrink)

The relationship between dream content and waking life experiences remains difficult to decipher. However, some neurobiological findings suggest that dreaming can, at least in part, be considered epiphenomenal to ongoing memory consolidation processes in sleep. Both abnormalities in sleep architecture and impairment in memory consolidation mechanisms are thought to be involved in the development of psychosis. The objective of this study was to assess the continuity between delusional contents and dreams in acutely psychotic patients. Ten patients with a single (...) fixed and recurring delusional content were asked to report their dreams during an acute psychotic break. Sixteen judges with four different levels of acquaintance to the specific content of the patients’ delusions were asked to group the dreams, expecting that fragments of the delusional thought would guide the task. A mathematical index was developed in order to compare correct groupings between the four groups of judges. Most judges grouped the dreams slightly above chance level and no relevant differences could be found between the four groups [F = 1.297; p = n.s.]. Scoring of dreams for specific delusional themes suggested a continuity in terms of dream and waking mentation for two contents . These findings seem to suggest that at least some delusional contents recur within patients’ dreams. Future studies will need to determine whether such continuity reflects ongoing consolidation processes that are relevant to current theories of delusion formation and stabilization. (shrink)

Even more than for other treatments, great importance must be given to informed consent in the case of electroconvulsive therapy. In a percentage of cases, the symbolic connotation of the treatment, even if mostly and intrinsically negative, may actually be a determining factor in the patient’s motives for giving consent. On an ethical and medicolegal level, the most critical point is that concerning consent to the treatment by a psychotic subject with a severely compromised ability to comprehend the nature and (...) objective of the proposed therapy, but who nonetheless expresses his consent, for reasons derived from delusional thoughts. In fact, this situation necessarily brings to light the contradiction between an explicit expression of consent, a necessary formality for the commencement of therapy, and the validity of this consent, which may be severely compromised due to the patient’s inability to comprehend reality and therefore to accept the proposal of treatment, which is intrinsic to this reality. With the use of an electric current, the symbolic experience associated with anaesthesia, and the connection to convulsions, ECT enters the collective consciousness. In relation to this, ECT is symbolic of these three factors and hooks on to the thoughts, fears, feelings and expectations of delusional patients. These are often exemplified in the violent intervention of the persecutor in the patient with schizophrenia, the expected punishment for the ’error’ committed for which the depressed patient blames himself and the social repression of the maniacal patient’s affirmation of his inflated self-esteem. (shrink)

Jennifer Radden has drawn attention to two features of delusion, ambivalence and subjectivity, which are problematic for theories of delusion that treat delusions as empirical beliefs. She argues for an ‘attitude’ theory of delusion. I argue that once the cognitive architecture of delusion formation is properly described the debate between doxastic and attitude theorists loses its edge. That architecture suggests that delusions are produced by activity in the ‘default mode network’ unsupervised by networks required for decontextualized processing. The cognitive properties (...) of these networks explain the features of delusion which generate the debate between doxastic and attitude theorists. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Philosophy, Psychiatry, & Psychology 11.1 (2004) 95-99 [Access article in PDF] Delusional Content and the Public Nature of Meaning:Reply to the Other Contributors Robert Klee The contribution by professors Bayne and Pacherie (2004) is an earnest attempt to defend a popular model of monothematic delusions against criticisms launched by John Campbell (2001). This model of monothematic delusions holds that such delusions are rational attempts by the sufferer to (...) explain to herself specific kinds of anomalous sensory/affective experiences. Bayne, Pacherie, Campbell, and for that matter Sass, Harper, and Georgaca, write as if semantic meaning accrued to words in a language term by term, as if meaning is "private" to the deluded person, and that she might therefore mean almost anything by her own idiosyncratic use of the public language she otherwise speaks. This is a notorious mistake. As Hilary Putnam famously put it in his classic 1975 paper "The meaning of 'meaning,'" "Cut the pie any way you like, 'meanings' just ain't in the head" (1975, 227). That is, meanings are not ethereal interior mental objects, private to the speaker—they are not private inner episodes that take place in some mental center stage of consciousness. The deluded person does not and cannot succeed in changing the meaning of a term in a public language like English merely by an individual act of imaginative will involving the making of a bizarre assertion—not even if she repeats it a thousand times. The public nature of meaning, if I can coin a phrase for it, is the central theme in the work of the later Wittgenstein. Even before Putnam, Wittgenstein had made the same point in his Philosophical Investigations via a famous footnote in which he writes, Can I say 'bububu' and mean "If it doesn't rain I shall go for a walk"?—it is only in a language that I can mean something by something. This shows clearly that the grammar of 'to mean' is not like that of the expression 'to imagine' and the like." (2001, 18e) Wittgenstein argues that the answer to the rhetorical question in the footnote is an emphatic No. To mean something by the use of words in a public language is not equivalent to an act of individual free imagination. The languages we each speak, including the unfortunately deluded among us, are public not private, and insofar as the notion of meaning has an understandable sense, the meaning of a term is fixed by its actual public use, across large time intervals, in many different contexts, by the many millions of speakers of the language in question. It is time that segments of the intellectual map beyond the borders [End Page 95] of philosophy got the news about this, for I think an appreciation of this point would forestall certain objections and argumentative moves that otherwise take up space in the psychological literature.Bayne and Pacherie (2004) describe Campbell's model of monothematic delusions as proposing that "delusions can be usefully regarded as Wittgensteinian framework propositions" (p. 7). I have discussed this notion in my main paper, although I do not use the terms framework propositions; I stick to Wittgenstein's own words. Wittgenstein called them, literally in the German, propositions that "stand fast for us" (feststehen). This description strikes me as less misleading than calling them framework propositions, for the latter expression suggests that they could in some sense be replaceable by a different framework of framework propositions, something that Wittgenstein in no way ever meant to suggest. Wittgenstein did not think of these propositions as individualized or privately owned—as beliefs that might vary considerably across the population of speakers of the language in which they are expressed. That is why he explicitly wrote that they stand fast for us. Note the plural pronoun. There is something irreducibly collective, something publicly owned, about the epistemology of these propositions. These propositions represent the accumulated certainties that precipitate out of what is commonly shared in human experience over long time intervals. Precisely because what stands fast for us is... (shrink)

The Capgras delusion is a condition in which a person believes that an imposter has replaced some close friend or relative. Recent theorists have appealed to Bayesianism to help explain both why a subject with the Capgras delusion adopts this delusional belief and why it persists despite counter-evidence. The Bayesian approach is useful for addressing these questions; however, the main proposal of this essay is that Capgras subjects also have a delusional conception of epistemic possibility, more specifically, they (...) think more things are possible, given what is known, than non-delusional subjects do. I argue that this is a central way in which their thinking departs from ordinary cognition and that it cannot be characterized in Bayesian terms. Thus, in order to fully understand the cognitive processing involved in the Capgras delusion, we must move beyond Bayesianism. 1 The Simple Bayesian Model2 Anomalous Evidence and the Capgras Delusion3 Impaired Reasoning4 Setting Priors5 Epistemic Modality6 Delusions of Possibility7 Delusions of Possibility in Different Contexts8 How Many Factors? (shrink)

Thanks to Michel Foucault, Jeremy Bentham's panopticon has become the iconic modern prison. But Foucault and most of his readers neglect the fact that a significant proportion of Bentham's panoptical writings were concerned with critically contrasting his ideal prison with the reality of penal transportation to New South Wales. Among his many criticisms, Bentham focussed particular attention on the problem of convict reform, arguing that surveillance was necessary to ensure genuine reformation, and that such surveillance was impossible in the open (...) prison of New South Wales. This connection between reformation and surveillance was a pervasive feature of Bentham's thought, reflected in his ideas for a centralised information state as well as his wider corpus on criminal justice. In this paper, I historicise Bentham's theory of reformative surveillance, and argue that Bentham, writing from London, misunderstood the importance of surveillance to the penal colony. At least in theory, convicts in New South Wales were subject to extensive systems of surveillance, and the failure of these systems in practice point to the limitations of Bentham's own, largely hypothetical, plans. (shrink)

In this paper I consider a theory developed within cognitive neuropsychiatry to explain two delusions of misidentification, the Capgras and the Cotard delusions. These delusions are classified together with others in which the subject misidentifies persons, places or objects, including parts of her own body. Strictly speaking, the Cotard may not, at the level of content, be a delusion of misidentification, but I have described it as such because the theory I discuss treats it as sharing a causal and a (...) conceptual structure with the Capgras delusion. That theory, associated particularly with the work of Andy Young, raises a Wittgensteinian echo in its claim that, at the subpersonal, information-processing, level, perceptual recognition of familiar faces and scenes is laden with affect. Where affect is absent or distorted as a result of neurological damage the subject “feels” strange in the presence of familiar scenes or people. Thus Young and Leafhead in their discussion of the Cotard delusion: “What the patients often give as evidence of their nonexistence or death is that they don’t have proper feeling.”. (shrink)

What role should a citizen's religious convictions play in her political activities? Is she, for example, permitted to decide on the basis of her religious convictions to support laws that criminalize abortion or discourage homosexual relations? Christopher Eberle is deeply at odds with the dominant orthodoxy among political theorists about the relation of religion and politics. His argument is that a citizen may responsibly ground her political commitments on religious beliefs, even if her only reasons for her political (...) commitments are religious in nature. His ideal of citizenship allows citizens to engage in politics without privatizing their religious commitments, and yet does not license mindless and intransigent sectarianism. An inherently controversial book that offers a substantial challenge to political liberalism, it will be read by students and professionals in philosophy, political science, law and religious studies, and general readers seeking insight into the relationship between religious commitments and liberal politics. (shrink)

Folie à deux is the transference of delusional ideas from one 'primary' individual to one or more 'secondary' individuals (Lasègue & Falret, 1877). However, it is difficult to investigate experimentally because often only one patient is identified as delusional. We investigated whether hypnosis could model the experiences of the secondary in this delusion. Our primary was a confederate, who displayed two delusional beliefs and attempted to transmit them to hypnotised subjects. We manipulated the status of the confederate (...) so that they were portrayed as either "credible" or merely "interesting". Many high hypnotisable individuals adopted the confederate's beliefs and confabulated evidence in support of them. Also, subjects who interacted with a credible confederate extended their delusions beyond those displayed by the confederate. We discuss the strengths and limitations of this approach and suggest ways to improve the validity of this model. (shrink)

In this paper I consider a theory developed within cognitive neuropsychiatry to explain two delusions of misidentification, the Capgras and the Cotard delusions. These delusions are classified together with others in which the subject misidentifies persons, places or objects, including parts of her own body. Strictly speaking, the Cotard may not, at the level of content, be a delusion of misidentification, but I have described it as such because the theory I discuss treats it as sharing a causal and a (...) conceptual structure with the Capgras delusion. That theory, associated particularly with the work of Andy Young, raises a Wittgensteinian echo in its claim that, at the subpersonal, information-processing, level, perceptual recognition of familiar faces and scenes is laden with affect. Where affect is absent or distorted as a result of neurological damage the subject “feels” strange in the presence of familiar scenes or people. Thus Young and Leafhead in their discussion of the Cotard delusion: “What the patients often give as evidence of their nonexistence or death is that they don’t have proper feeling.”. (shrink)

A short paper presented before the Fellows of the Center for the Study of Democratic Institutions during the academic year 1969-70, with an Introductory Note written nearly 50 years later. The paper describes the author's enduring personal philosophical precept; it is also an implicit encomium to individuals whose psychology establishes a dependable bridge between their rational convictions and their conduct.

This chapter considers some epistemic aspects of interactions with those who are believed to be delusional. The chapter makes five main claims: first, for the day-to-day purposes of most individuals, it is helpful to understand delusions as extreme epistemic failures, failures that all are guilty of to some degree. Second, one should be cautious when attributing delusions to others because to call someone delusional can act to discredit them, and this can be especially dangerous when applied to members (...) of oppressed groups. Third, delusional individuals can indeed be wronged by epistemic injustice. Fourth, epistemic responsibility for delusions needs to be extended beyond the individual holding delusional beliefs to the conditions that shape those beliefs. Finally, the virtue of epistemic humility offers several important epistemic benefits in interactions with delusional others. (shrink)

Conviction Narrative Theory (CNT) is a theory of choice underradical uncertainty– situations where outcomes cannot be enumerated and probabilities cannot be assigned. Whereas most theories of choice assume that people rely on (potentially biased) probabilistic judgments, such theories cannot account for adaptive decision-making when probabilities cannot be assigned. CNT proposes that people usenarratives– structured representations of causal, temporal, analogical, and valence relationships – rather than probabilities, as the currency of thought that unifies our sense-making and decision-making faculties. According to CNT, (...) narratives arise from the interplay between individual cognition and the social environment, with reasoners adopting a narrative that feels “right” to explain the available data; using that narrative to imagine plausible futures; and affectively evaluating those imagined futures to make a choice. Evidence from many areas of the cognitive, behavioral, and social sciences supports this basic model, including lab experiments, interview studies, and econometric analyses. We identify 12 propositions to explain how the mental representations (narratives) interact with four inter-related processes (explanation, simulation, affective evaluation, and communication), examining the theoretical and empirical basis for each. We conclude by discussing how CNT can provide a common vocabulary for researchers studying everyday choices across areas of the decision sciences. (shrink)

How far may Americans properly rely on their religious beliefs when they make and defend political decisions? For example, are ordinary citizens or legislators doing something wrong when they consciously allow their decisions respecting abortion laws to be determined by their religious views? Despite its intense contemporary relevance, the full dimensions of this issue have until now not been thoroughly examined. Religious Convictions and Political Choice represents the first attempt to fill this gap. Beginning with an account of the (...) basic premises of our liberal democracy, Greenawalt moves to a comparison between rational secular grounds of decision and grounds based on religious convictions. He discusses particular issues such as animal rights and abortion, showing how religious convictions can bear on an individual's decisions about them, and inquires whether reliance on such convictions is compatible with liberal democratic premises. In conclusion, he argues that citizens cannot be expected to rely exclusively on rational, secular grounds. (shrink)

In this paper we address the ethics of adopting delusional beliefs and we apply consequentialist and deontological considerations to the epistemic evaluation of delusions. Delusions are characterised by their epistemic shortcomings and they are often defined as false and irrational beliefs. Despite this, when agents are overwhelmed by negative emotions due to the effects of trauma or previous adversities, or when they are subject to anxiety and stress as a result of hypersalient experience, the adoption of a delusional (...) belief can prevent a serious epistemic harm from occurring. For instance, delusions can allow agents to remain in touch with their environment overcoming the disruptive effect of negative emotions and anxiety. Moreover, agents are not blameworthy for adopting their delusions if their ability to believe otherwise is compromised. There is evidence suggesting that no evidence-related action that would counterfactually lead them to believe otherwise is typically available to them. The lack of ability to believe otherwise, together with some other conditions, implies that the agents are not blameworthy for their delusions. The examination of the epistemic status of delusions prompts us to acknowledge the complexity and contextual nature of epistemic evaluation, establish connections between consequentialist and deontological frameworks in epistemology, and introduce the notion of epistemic innocence into the vocabulary of epistemic evaluation. (shrink)

Psychiatric treatment and diagnosis rests upon a richer conception of normativity than, for example, cognitive neuropsychology. This paper explores the role that considerations of rationality can play in defining this richer conception of normativity. It distinguishes two types of rationality and considers how each type can break down in different ways in delusional psychiatric disorders.

: The notion of a delusion occupies a central place in psychotherapy. The presence of delusional thinking in a patient is often regarded as indicative of psychosis. And yet, the nature of a delusion is still widely disputed. The difficulty of defining a delusion has proved so difficult that some prominent authors have declared the task impossible. The aim of this paper is to offer a characterisation of delusional systems of thought. In this paper is argued that delusions, (...) unlike scientific explanations and the explanations generally offered by common sense, fail to minimise that which requires explanation. In the first part of the paper, difficulties with extant accounts will be discussed. In the following parts, the author’s own account of delusional thoughts will be developed and some difficult cases considered. It will be argued that delusions differ from more typical beliefs in the number of things that they leave unexplained. Delusions, unlike those beliefs we typically see as rational, bring about an increase in the number of things requiring explanation. Keywords: Delusions; Epistemology; Analysis; Explanation; Rationality Aspetti epistemologici del pensiero delirante Riassunto: La nozione di delirio occupa una posizione centrale nell’ambito della psicoterapia. La presenza del pensiero delirante in un paziente è considerata spesso come un indice di psicosi. E, tuttavia, la natura del delirio non è ancora oggetto di ampio accordo tra gli studiosi. La difficoltà nel definire il delirio si è mostrata talmente ostica che diversi importanti studiosi hanno dichiarato questo compito impossibile. Lo scopo di questo lavoro è quello di offrire una caratterizzazione dei sistemi di pensiero delirante. Si sosterrà che i deliri, diversamente dalle spiegazioni scientifiche e da quelle offerte generalmente dal senso comune, non riescono a ridurre quanto necessita di una spiegazione. Nella prima parte del lavoro, saranno discusse le difficoltà degli approcci correnti. Nelle parti seguenti verrà proposto l’approccio dell’autore ai pensieri deliranti e verranno presi in esame alcuni casi complessi. Si sosterrà che i deliri si distinguono dai casi più tipici di credenza per il numero di cose che lasciano senza spiegazione. I deliri, diversamente dalle credenze che tipicamente consideriamo irrazionali, determinano un incremento del numero di cose che richiedono una spiegazione. Parole chiave: Delirio; Epistemologia; Analisi; Spiegazione; Razionalità. (shrink)

Oxford Legal Philosophy publishes the best new work in philosophically-oriented legal theory. It commissions and solicits monographs in all branches of the subject, including works on philosophical issues in all areas of public and private law, and in the national, transnational, and international realms; studies of the nature of law, legal institutions, and legal reasoning; treatments of problems in political morality as they bear on law; and explorations in the nature and development of legal philosophy itself. The series represents diverse (...) traditions of thought but always with an emphasis on rigour and originality. It sets the standard in contemporary jurisprudence.This book shows that civil disobedience is generally more defensible than private conscientious objection.Part I explores the morality of conviction and conscience. Each of these concepts informs a distinct argument for civil disobedience. The conviction argument begins with the communicative principle of conscientiousness. According to the CPC, having a conscientious moral conviction means not just acting consistently with our beliefs and judging ourselves and others by a common moral standard. It also means not seeking to evade the consequences of our beliefs and being willing to communicate them to others. The conviction argument shows that, as a constrained, communicative practice, civil disobedience has a better claim than private objection does to the protections that liberal societies give to conscientious dissent. This view reverses the standard liberal picture which sees private 'conscientious' objection as a modest act of personal belief and civil disobedience as a strategic, undemocratic act whose costs are only sometimes worth bearing.The conscience argument is narrower and shows that genuinely morally responsive civil disobedience honours the best of our moral responsibilities and is protected by a duty-based moral right of conscience.Part II translates the conviction argument and conscience argument into two legal defences. The first is a demands-of-conviction defence. The second is a necessity defence. Both of these defences apply more readily to civil disobedience than to private disobedience. Part II also examines lawful punishment, showing that, even when punishment is justifiable, civil disobedients have a moral right not to be punished. (shrink)

In his overview of recent work on intellectual humility, Nathan Ballantyne (2021) highlights some of the potential ‘dark sides’ of intellectual humility (IH) and calls for a critical study of the ‘value-theory’ of IH. In this article, we sketch out three ways that IH may threaten political conviction. We end our response by arguing that some forms of IH include different kinds of quietism about political convictions, which do not necessarily equate with a lack of conviction.

BACKGROUND: Delusions in schizophrenia are commonly approached as empirical false beliefs about everyday reality. Phenomenological accounts, by contrast, have suggested that delusions are more adequately understood as pertaining to a different kind of reality experience. How this alteration of reality experience should be characterised, which dimensions of experiential life are involved, and whether delusional reality might differ from standard reality in various ways is unclear and little is known about how patients with delusions value and relate to these experiential (...) alterations. This study aimed to investigate the nature of delusional reality experience, and its subjective apprehension, in individuals with lived experience of delusions and a schizophrenia-spectrum diagnosis. METHODS: In this qualitative phenomenological study, we recruited individuals with lived experience of delusions and a schizophrenia-spectrum diagnosis from two psychiatric-hospital services in Belgium using homogenous sampling. Criteria for participation were having undergone at least one psychotic episode with occurring delusional symptoms, present at least 1 year before participation, on the basis of clinical notes assessed by the attending psychiatrist; a schizophrenia-spectrum diagnosis, ascertained through clinical interview by the attending psychiatrist upon admission; being aged between 18 years and 65 years; and having the capacity to give informed consent. Exclusion criteria included worries concerning capacity to consent and risk of distress caused by participation. We did phenomenologically driven semi-structured interviews with the participants to explore the nature of delusional reality experience and their subjective valuation of these experiences. We used interpretative phenomenological analysis, a qualitative method tailored to the in-depth exploration of participants’ first-person perspective, to analyse their accounts. FINDINGS: Between March 2, 2020, and Sept 30, 2020, 18 adults participated in the interview study. The findings suggest that delusions are often embedded in wide-ranging alterations of basic reality experience, involving quasi-ineffable atmospheric and ontological qualities that undermine participants’ sense of the world as unambiguously real, fully present, and shared with others. We also found that delusional reality experience can differ from standard reality in various ways, across multiple dimensions, and that participants are often implicitly or explicitly aware of the distinction between delusional and standard reality. Delusional experience can have an enduring value and meaning that is not fully captured by a strictly medical perspective. INTERPRETATION: Increased awareness and recognition of the distinctive nature of delusional reality experience, in both clinical and research settings, can improve diagnostic accuracy, explanatory models, and therapeutic support for individuals with delusions whose lived realities are not always evident from an everyday perspective. FUNDING: FWO Flanders. TRANSLATION: For the Dutch translation of the abstract see Supplementary Materials section. (shrink)

Epistemic injustice occurs when we fail to appropriately respect others as epistemic agents. Philosophers building on the work of Miranda Fricker, who introduced the concept, have focused on epistemic injustices involving certain social categories, particularly race and gender. Can there be epistemic injustice attached to political conviction and affiliation? I argue yes: politics can be a salient social category that draws epistemic injustice. Epistemic injustices might also be intersectional, based on the overlap of politics and some other identity category like (...) race or sex. Further, and more provocatively, I argue that political minorities in academia, in particular conservatives and libertarians, are most likely the victims of epistemic injustice on the basis of their politics. Such epistemic injustices might even be routine. Although more limited in scope and severity than other forms of epistemic injustice, political epistemic injustices in academia ought to be of special concern from a standpoint of social justice because of the academy’s central role in knowledge production and dissemination. (shrink)