Uno de los principales problemas de la filosofía de la psicopatología contemporánea consiste en definir qué tipo de estados mentales son aquellos que denominamos delirantes. A esto se le ha denominado el “problema tipológico de los delirios”. El principal objetivo de este artículo es examinar las principales alternativas filosóficas contemporáneas a este problema: el doxasticismo—de acuerdo con el cuál los delirios deben ser caracterizados como creencias—y al anti-doxasticismo—el cuál niega el estatuto doxásticos de los delirios y ofrece una caracterización (...) alternativa. Para examinar el debate, el artículo presentará las principales características de ambas posiciones y sus fundamentos. Después, examinaremos los principales argumentos esgrimidos contra el doxasticismo y las respuestas y contraargumentos por parte de las alternativas doxásticas. Finalmente, expondremos algunas cuestiones conceptuales y desafíos abiertos relacionados con el debate y que, a nuestro juicio, deberían de marcar la hoja de ruta de los filósofos de la mente interesados en los delirios en los próximos años. (shrink)

Clinicians and cognitive scientists typically conceive of delusions as doxastic—they view delusions as beliefs. But some philosophers have countered with anti-doxastic objections: delusions cannot be beliefs because they fail the necessary conditions of belief. A common response involves meeting these objections on their own terms by accepting necessary conditions on belief but trying to blunt their force. I take a different approach by invoking a cognitive-phenomenal view of belief and jettisoning the rational/behavioural conditions. On this view, the anti-doxastic (...) claims can be rejected outright, and doxasticism can be defended. I call this the cognitive phenomenological defence of doxasticism. (shrink)

In some ways, someone suffering from the delusion that his or her spouse has been kidnapped and replaced with an imposter appears to believe that he or she eats dinner with an imposter every night. But the imperviousness of delusions to counter-evidence makes it hard to classify them as beliefs, and easier to classify them as imaginings. Bayne and Pacherie want to use Schwitzgebel’s dispositional account of belief to restore confidence in the doxastic character of delusion. While dispositionalism appears to (...) allow us to classify delusions as beliefs, this allowance isn’t a robust vindication of doxasticism. The significance of the allowance can be increased by emphasizing the role of folk-psychological norms in individuating propositional attitudes. But letting those norms play a large role in the individuation of belief makes it hard to count as believers the deluded subjects who violate most such norms. Dispositionalism about belief can’t defend doxasticism about delusion. (shrink)

Clinical delusions are widely characterized as being pathological beliefs in both the clinical literature and in common sense. Recently, a philosophical debate has emerged between defenders of the commonsense position (doxasticists) and their opponents, who have the burden of pointing toward alternative characterizations (anti-doxasticists). In this chapter, I argue that both doxasticism and anti- doxasticism fail to characterize the functional role of delusions while at the same time being unable to play a role in the explanation of these (...) phenomena. I also argue that though a more nuanced view of belief in which mental states are more or less belief-like instills a healthy skepticism towards the precision of folk-psychological concepts, such a stance fails to be of use in building a theory of delusion that will be able to bridge different levels of explanation, such as the phenomenology and neurobiology of delusion. Thus, I advocate moving past the question ‘Are delusions beliefs?’ and their description as propositional attitudes toward the description of the processes that generate delusion, with a view toward explaining, rather than explaining away, the personal-level aspects of the phenomenon that have been made inscrutable by investing in doxastic terminology. (shrink)

This volume brings together recent work on the nature of belief, imagination, and delusion. Whilst philosophers of mind and epistemology employ notions of belief and imagination in their theorizing, parallel work seeking to make these notions more precise continues. Delusions are standardly taken to be bizarre beliefs occurring in the clinical population, which do not respond to evidence. The purpose of this collection of essays is to get clearer on the nature of belief and imagination, the ways in which they (...) relate to one another, and how they might be integrated into accounts of delusional belief formation. The jumping off point is the idea that recent work in philosophy of mind and epistemology which has sought to characterise the nature of belief and imagination allows us to formulate the issues with new precision, by, for example, drawing on work concerning how imagination is involved in delusion formation, or work concerning how to properly distinguish imagination from belief. The volume also considers questions concerning imagination's architecture, the role of metacognitive error in our mental lives, how best to understand delusional experience, and the relationship between delusion and evidence. The contributors are ideally placed to explore these issues, both individually and as a collective. With interests spanning different disciplines (philosophy, psychology, cognitive science), and approaches (theoretical, empirically informed), the result is a rich and varied collection of insights. (shrink)

The imperviousness of delusions to counter-evidence makes it tempting to classify them as imaginings. Bayne and Pacherie argue that adopting a dispositional account of belief can secure the doxastic status of delusions. But dispositionalism can only secure genuinely doxastic status for mental states by giving folk-psychological norms a significant role in the individuation of attitudes. When such norms individuate belief, deluded subjects will not count as believing their delusions. In general, dispositionalism won't confer genuinely doxastic status more often than do (...) competing accounts of belief. (shrink)

Clinical delusions have traditionally been characterized as beliefs in psychiatry. However, philosophers have recently engaged with the empirical literature and produced a number of objections to the so-called doxastic status of delusion, stemming mainly from the mismatch between the functional role of delusions and that expected of beliefs. In response to this, an appeal to dispositionalism about the nature of belief has been proposed to vindicate the doxastic status of delusion. In this paper, I first present the objections to attributing (...) beliefs to delusional patients and the application of dispositionalism in the attempt to vindicate doxasticism. I then assess this application and some responses to the objections to the doxastic characterization. Finally, I offer some conclusions about the limits of folk-psychological concepts in the characterization and explanation of complex psychological phenomena such as delusions. (shrink)

The Spinozan theory of belief fixation holds that mentally representing truth-apt propositions leads to immediately believing them. In this paper, I explore how the theory fares as a defence of doxasticism about delusions (the view that they are beliefs). Doxasticism has been criticised on the grounds that delusions typically do not abide by rational standards that we expect beliefs to conform to. If belief fixation is Spinozan, I argue, these deviations from rationality are not just compatible with, but supportive of, (...) their status as beliefs. (shrink)

Here I reply to the main points raised by the commentators on the arguments put forward in my Delusions and Other Irrational Beliefs (OUP, 2009). My response is aimed at defending a modest doxastic account of clinical delusions, and is articulated in three sections. First, I consider the view that delusions are inbetween perceptual and doxastic states, defended by Jacob Hohwy and Vivek Rajan, and the view that delusions are failed attempts at believing or not-quitebeliefs, proposed by Eric Schwitzgebel and (...) Maura Tumulty. Then, I address the relationship between the doxastic account of delusions and the role, nature, and prospects of folk psychology, which is discussed by Dominic Murphy, Keith Frankish, and Maura Tumulty in their contributions. In the final remarks, I turn to the continuity thesis and suggest that, although there are important differences between clinical delusions and non-pathological beliefs, these differences cannot be characterised satisfactorily in epistemic terms. (shrink)

Chris Frith has argued that a loss of the sense of agency is central to schizophrenia. This suggests a connection between hallucinations and delusions on the one hand, and the misidentification of the subject’s imaginings as perceptions and beliefs on the other. In particular, understanding the mechanisms that underlie imagination may help us to explain the puzzling phenomena of thought insertion and withdrawal. Frith sometimes states his argument in terms of a loss of metarepresentational capacity in schizophrenia. I argue that (...) this formulation is unhelpful. (shrink)

Chris Frith has argued that a loss of the sense of agency is central to schizophrenia. This suggests a connection between hallucinations and delusions on the one hand, and the misidentification of the subject’s imaginings as perceptions and beliefs on the other. In particular, understanding the mechanisms that underlie imagination may help us to explain the puzzling phenomena of thought insertion and withdrawal. Frith sometimes states his argument in terms of a loss of metarepresentational capacity in schizophrenia. I argue that (...) this formulation is unhelpful. (shrink)

Clinical delusions are commonly thought of and characterized as beliefs, both by psychiatrists and by the general population. That fact is encoded in the definition of delusion in the Glossary of Technical Terms of the most recent edition of the Diagnostic and Statistical Manual of Mental Disorders :A false belief based on incorrect inference about external reality that is firmly held despite what almost everyone else believes and despite what constitutes incontrovertible and obvious proof or evidence to the contrary.Although almost (...) every aspect of this definition is debatable, describing delusion as a type of aberrant belief has engendered a specialized discussion in itself, engaging philosophers... (shrink)

Subjects with delusions profess to believe some extremely peculiar things. Patients with Capgras delusion sincerely assert that, for example, their spouses have been replaced by impostors. Patients with Cotard’s delusion sincerely assert that they are dead. Many philosophers and psychologists are hesitant to say that delusional subjects genuinely believe the contents of their delusions.2 One way to reinterpret delusional subjects is to say that we’ve misidentified the content of the problematic belief. So for example, rather than believing that his wife (...) is has been replaced by an impostor, we might say that the victim of Capgras delusion believes that it is, in some respects, as if his wife has been replaced by an impostor. Another is to say that we’ve misidentified the attitude that the delusional subject bears to the content of their delusion. So for example, Gregory Currie and co-authors have suggested that rather than believing that his wife has been replaced by an impostor, we should say that the victim of Capgras delusion merely imagines that his wife has been replaced by an impostor.3. (shrink)

Chris Frith has argued that a loss of the sense of agency is central to schizophrenia. This suggests a connection between hallucinations and delusions on the one hand, and the misidentification of the subject’s imaginings as perceptions and beliefs on the other. In particular, understanding the mechanisms that underlie imagination may help us to explain the puzzling phenomena of thought insertion and withdrawal. Frith sometimes states his argument in terms of a loss of metarepresentational capacity in schizophrenia. I argue that (...) this formulation is unhelpful. (shrink)

Delusions, a key feature of psychosis, are usually thought of as a type of belief, as in the definition of the American Psychiatric Association: A false belief based on incorrect inference about external reality that is firmly sustained despite what almost everyone else believes and despite what constitutes incontrovertible and obvious proof or evidence to the contrary. The belief is not one ordinarily accepted by other members of the person’s culture or subculture (e.g. it is not an article of (...) religious faith). This characterization is often criticized, but other definitions typically comprise similar elements. For some, delusions are only loosely considered as beliefs (Jaspers 1963; Moor and Tucker .. (shrink)

This paper explores how metaphorical thinking might contribute to an aetiology of florid delusions in psychosis. We argue that this approach helps to account for the path from experience to the delusional assertion, which, though relatively straightforward for monothematic delusions like the Capgras delusion, has always been difficult to account for in florid delusions in psychosis. Our account also helps to account for double book-keeping and the relative agential inertia of the belief.

Kengo Miyazono, in his work Delusions and Beliefs, defends a teleo-functional account of delusions. In my contribution to this symposium, I question one of Miyazono’s motivations for appealing to teleo-functionalism over its main rival, dry-functionalism. Miyazono suggests that teleo-functionalism, unlike dry-functionalism, can account for the compatibility of the theses (i) that delusions are genuine doxastic states (doxasticism about delusions) and (ii) that delusions do not perform the typical causal roles of beliefs (the causal difference thesis). I argue, however, that there (...) are also ways for dry-functionalism to account for this compatibility. If what I have to say is correct, then Miyazono is perhaps too hasty—at least in one important respect—to opt for teleo-functionalism over dry-functionalism. Dry-functionalism has an equally good chance of satisfying some of Miyazono’s explanatory goals. (shrink)

Psychopathological delusions have a number of features that are curiously difficult to explain. Delusions are resistant to counterevidence and impervious to counterargument. Delusions are theoretically, affectively, and behaviorally circumscribed: delusional individuals often do not act on their delusions and often do not update beliefs on the basis of their delusions. Delusional individuals are occasionally able to distinguish their delusions from other beliefs, sometimes speaking of their “delusional reality.” To explain these features, I offer a model according to which, contrary to (...) appearances, delusions are not beliefs at all. Delusions are acceptances that are generated by pathologically powerful cognitive feelings. This model has implications for the way that we should think about non-pathological doxastic states and emotions. (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)

This chapter considers the nature of imagination and belief, exploring how deeply these two states of mind differ. It first addresses a range of cognitive and motivational differences between imagination and belief which suggest that they're fundamentally different states of mind. Then it addresses imaginative immersion, delusions, and the different norms we apply to the two mental states, which some theorists regard as providing support for a more unified picture of imagination and belief.

Although delusions are typically regarded as beliefs of a certain kind, there have been worries about the doxastic conception of delusions since at least Bleuler’s time. ‘Anti-doxasticists,’ as we might call them, do not merely worry about the claim that delusions are beliefs, they reject it. Reimer’s paper weighs into the debate between ‘doxasticists’ and ‘anti-doxasticists’ by suggesting that one of the main arguments given against the doxastic conception of delusions—what we might call the functional role objection—is based (...) on a fallacy. She also draws attention to certain parallels between delusions and what she calls “nihilistic philosophical doctrines,” such as the skeptical position that we have no .. (shrink)

The Psychosis of Race offers a unique and detailed account of the psychoanalytic significance of race, and the ongoing impact of racism in contemporary society. Moving beyond the well-trodden assertion that race is a social construction, and working against demands that simply call for more representational equality, The Psychosis of Race explores how the delusions, anxieties, and paranoia that frame our race relations can afford new insights into how we see, think, and understand race's pervasive appeal. With examples (...) drawn from politics and popular culture--such as Candyman, Get Out, and the music of Kendrick Lamar--critical attention is given to introducing as well as explicating on several key concepts from Lacanian psychoanalysis and the study of psychosis, including foreclosure, phallus, the Name-of-the-Father, sinthome, and the objet petit a. By elaborating a cultural mode to psychosis and its understanding, an original and critical exposition of the effects of racialization, as well as our ability to discern the very limits of our capacity to think through, or even beyond, the idea of race, is provided. The Psychosis of Race speaks to an emerging area in the study of psychoanalysis and race, and will appeal to scholars and academics across the fields of psychology, sociology, cultural studies, media studies, and the arts and humanities. (shrink)

When interacting with other people, we assume that they have their reasons for what they do and believe, and experience recognizable feelings and emotions. When people act from weakness of will or are otherwise irrational, what they do can still be comprehensible to us, since we know what it is like to fall for temptation and act against one’s better judgment. Still, when someone’s experiences, feelings and way of thinking is vastly different from our own, understanding them becomes increasingly difficult. (...) Delusions and psychosis are often seen as marking the end of intelligibility. In this paper, I argue first for the importance of seeing other people as intelligible as long as this is at all possible. Second, I argue, based on both previous literature and my own lived experience, that more psychotic phenomena than previously thought can be rendered at least somewhat intelligible. Besides bizarre experiences like illusions, hallucinations and intense feelings of significance, I also explain what it is like to lose one’s bedrock, and how this loss impacts which beliefs one has reason to reject. Finally, I give an inside account of some disturbances of reason, and show that there are important similarities between certain psychotic reasoning problems and common non-pathological phenomena. (shrink)

This chapter connects the phenomenon of double bookkeeping to two critical debates in the philosophy of delusion: one from the analytic tradition and one from the phenomenological tradition. First, I will show how the failure of action guidance on the part of some delusions suggests an argument to the standard view that delusions are beliefs (doxasticism about delusion) and how its proponents have countered it by ascribing behavioral inertia to avolition, emotional disturbances, or a failure of the surrounding environment in (...) supporting the agent’s motivation to act. Second, I will show how the mismatch between the experience of double bookkeeping and that of having the usual propositional attitudes of folk psychology suggests another, more recalcitrant argument not only against doxasticism but against the very attempt to fit delusion into folk psychology. Third, I will show how phenomenologically inspired theories of delusion, such as the multiple realities hypothesis, bypass the debates above and focus on describing and understanding the disturbances in the structure of experience undergone by patients. I conclude that the philosophical discussions ensuing from an appreciation of double bookkeeping show some of the limitations of the analytic philosophical approach to delusion. (shrink)

I argue that some cases of delusions show the inadequacy of those theories of interpretation that rely on a necessary rationality constraint on belief ascription. In particular I challenge the view that irrational beliefs can be ascribed only against a general background of rationality. Subjects affected by delusions seem to be genuine believers and their behaviour can be successfully explained in intentional terms, but they do not meet those criteria that according to Davidson (1985a) need to be met for the (...) background of rationality to be in place. (shrink)

In this paper we defend the doxastic conception of delusions against the metacognitive account developed by Greg Currie and collaborators. According to the metacognitive model, delusions are imaginings that are misidentified by their subjects as beliefs: the Capgras patient, for instance, does not believe that his wife has been replaced by a robot, instead, he merely imagines that she has, and mistakes this imagining for a belief. We argue that the metacognitive account is untenable, and that the traditional conception of (...) delusions as beliefs should be retained. (shrink)

In this chapter I defend the doxastic account of delusions and offer some reasons to believe that the double-bookkeeping argument against doxasticism (delusions are not beliefs because they do not drive action) should be resisted.

In this Part II, I investigate different approaches to the question of what makes imagining different from belief. I find that the sentiment-based approach of David Hume falls short, as does the teleological approach, once advocated by David Velleman. I then consider whether the inferential properties of beliefs and imaginings may differ. Beliefs, I claim, exhibit an anti-symmetric inferential governance over imaginings: they are the background that makes inference from one imagining to the other possible; the reverse is not (...) true, and this allows us to distinguish the two attitudes. I then go on to consider the action theory of imagining and the role that imaginings play in generating emotion. (shrink)

My response to the preceding essays begins with some preliminaries about my terminology, approach, and conception of rationality as a regulative ideal. I then comment on the Murphy's discussion about normal religious belief and religious delusions, and on causal assumptions challenged by Langdon's folies à deux. Responding to Gerrans's imagination-based account of delusion and Hohwy's discussion of illusions, I next try to envision what both doxastic and imagination-based approaches might have overlooked by asking whether there can be delusional feelings. Final (...) comments address the place of phenomenology within Coltheart's two-factor theorizing. (shrink)

The standard cognitive theory of art claims that art can be insightful while maintaining that imagining is motivationally inert [Walton 1990] even when some epistemic advantage is claimed for it [Currie 1995]. However, if we assume art as art can be insightful, we also assume that the imagining it occasions has a lasting impact on belief. In this chapter, I argue that imagining of the kind occasioned by art can be held non-occurrently [Schellenberg 2013] without delusion and can motivate behaviour (...) [Gendler 2000, 2003, 2006a/b; Langland-Hassan 2016]. As such, certain features of imagination can be appreciated in a new light. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Philosophy, Psychiatry, & Psychology 11.1 (2004) 35-41 [Access article in PDF] The Rationality of Psychosis and Understanding the Deluded Matthew R. Broome Campbell's important and influential paper (Campbell 2001) has framed the debate that Bayne and Pacherie (2004) most explicitly, and Klee (2004) and Georgaca (2004) more implicitly, engage in. Campbell has offered two broad ways of thinking about explanations of delusions—the empirical and the rational. He offers (...) some criticism of the former and an endorsement of the latter. Campbell uses examples from clinical psychopathology to illustrate his argument and Bayne and Pacherie in turn employ these. Campbell discusses the eponymously named delusions of Capgras and Cotard—the former a subtype of delusional misidentification and the latter a delusion whose content is colored predominantly with nihilistic and possibly hypochondriacal themes. Campbell, Bayne and Pacherie, and Klee discuss the empirical data in relation to such delusions and as an aid to discussing the empirical model more generally. It does seem a little unfortunate that these delusions, which are less than typical, become the focus of Campbell's paper, and Bayne and Pacherie's criticism of his work. Delusions are remarkably heterogeneous; this indeed may be part of the reason why there is so much difficulty in reaching a definition as Klee discusses, and occur in a wide variety of mental and neurological illnesses. The most common delusions are those of persecution and reference (World Health Organization [WHO] 1973) and typically occur in schizophrenia. By contrast, delusional misidentification occurs most commonly in patients with dementia, delirium, and focal cognitive impairment, but can occur in other functional psychoses such as an affective or schizophrenic psychosis. The most common form of delusional misidentification is not that of either the exotic Capgras or Fregoli syndromes but delusional misidentification for place; thus, although Bayne and Pacherie's arguments against Campbell may still hold, delusional misidentification tends to occur in the context of a patient believing that they are at home or on holiday rather than in hospital and may not necessarily involve close family members or other intimate relationships. Similarly, Cotard's syndrome tends to occur in the context of a severe depressive illness with mood-congruent psychotic symptoms, typically in an elderly individual. It does not have to have the content that the deluded is dead, but can include beliefs, for example, that the world no longer exists or that their internal organs are not present. Thus, a patient with either Capgras' or Cotard's syndrome is likely to differ from patients with delusions of persecution. They would [End Page 35] have different diagnoses, probably be older, and have a greater likelihood of structural abnormalities of the brain on imaging and consequent neuropsychological dysfunction. That is not to say that patients with schizophrenia have normal cerebral anatomy and neuropsychology, but rather that the Capgras' and Cotard's patients are likely to have neurological quality to their presentation that is clinically relevant, rather than what commonly the case in schizophrenia and the other functional psychoses, where the neurological abnormalities are only currently important at the level of academic research. Empirical Models of Delusion Formation Different delusions may not have that much in common, nor may the patients who believe in them. This in turn relates to the empirical paradigm that both Campbell and Bayne and Pacherie discuss. It is true that current research, and indeed the clinical practice of cognitive behavioral therapy for psychosis, is indebted to the work of Maher and it is within his legacy which we work. This, however, is not to say that we think his initial formulation was correct. Maher's (1988, 1992) work focused attempts in explaining delusions—both to support and refute his thesis that delusions are the consequence of normal cognitive mechanisms seeking to explain an anomalous sensory experience. Such a view initially led to work demonstrating delusions in the absence of anomalous perceptions, the presence of reasoning biases in the deluded population, and the possibility that abnormal sensory experience may be consequent upon biased cognitive processes (Garety and Freeman 1999). More recent work has demonstrated the prevalence of... (shrink)

This chapter identifies and explores a series of challenges raised by the clinical concept of delusion for theories which conceive autonomy as an agency rather than a status concept. The first challenge is to address the autonomy-impairing nature of delusions consistently with their role as grounds for full legal and ethical excuse, on the one hand, and psychopathological significance as key symptoms of psychoses, on the other. The second challenge is to take into account the full logical range of delusions, (...) which may take the form of true or false factual beliefs, positive or negative evaluations, as well as the paradoxical delusion of mental illness. The third and final challenge is to make room for non-pathological or, autonomy-preserving delusions and to offer a credible way of distinguishing between these and pathological or, autonomy-impairing delusions. By setting out these challenges, we are able to, firstly, distinguish between two separate conceptions of objectivity that may be at work in existing accounts of delusions and, secondly, to put a spotlight on an elusive yet inescapable notion of agential success that underlies our thinking about autonomy as well as mental disorder. (shrink)

I propose a new model of implicit bias, according to which implicit biases are constituted by unconscious imaginings. I begin by endorsing a principle of parsimony when confronted with unfamiliar phenomena. I introduce implicit bias in terms congenial to what most philosophers and psychologists have said about their nature in the literature so far, before moving to a discussion of the doxastic model of implicit bias and objections to it. I then introduce unconscious imagination and argue that appeal to it (...) does not represent a departure from a standard view of imagination, before outlining my model and showing how it accommodates characteristic features of implicit bias. I argue for its advantages over the doxastic model: it does not violate the parsimony principle, it does not face any of the objections so far raised to doxasticism, and it can accommodate the heterogeneity in the category of implicit bias. Finally, I address whether my view limits our ability to hold people accountable for their biases (it does not), and whether it is consistent with what we know about intervention strategies (it is). I conclude that implicit biases are constituted by unconscious imaginings. (shrink)

A number of studies have investigated how immersion in a virtual reality environment can affect participants’ implicit biases. These studies presume associationism about implicit bias. Recently philosophers have argued that associationism is inadequate and have made a case for understanding implicit biases propositionally. However, no propositionalist has considered the empirical work on virtual reality and how to integrate it into their theories. I examine this work against a propositionalist background, in particular, looking at the belief and patchy endorsement models. I (...) argue that the results therein can only be accommodated by a model which recognizes structural heterogeneity, that is, one which allows for implicit biases being both associatively and non-associatively structured. My preferred view – that implicit biases are constituted by unconscious imaginings – allows for this, as well as for heterogeneity at the level of content (propositional and imagistic), a feature which also earn its explanatory keep in this context. I conclude that empirical work on virtual reality and implicit bias gives us a reason to prefer a pluralist model of bias, and that my unconscious imagination model, in its recognizing wide-ranging heterogeneity, is uniquely placed to accommodate the results of work on virtual reality and bias mitigation. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Philosophy, Psychiatry, & Psychology 9.4 (2002) 343-347 [Access article in PDF] Mysticism and Psychosis:Descriptions and Distinctions Michael McGhee IT IS REFRESHING to read a paper that manages at once to be interdisciplinary and intercultural in its range of reference, and that also confronts a difficult and controversial question about how we are to assess the similarities and differences between psychotic and mystical experiences. Many psychiatrists have been skeptical (...) about whether there are any genuine differences, and not, mostly, because they thought that psychotics were in reality mystics. But mystical is pretty vague, as is spiritual, and that does not bode well for the enterprise of making comparisons, unless we can tie these latter terms down with some precision. How vague psychosis is I must leave others to judge, but one of the conclusions I have drawn from reading this paper is that the crucial questions turn not on agreed definitions, but on agreed judgments about what are to count as the examples or cases that fall under the definitions. I have some doubts about Caroline Brett's approach to these questions, in the first half hesitant doubts, in the second part less so. Her leading claim appears first in the Introduction:... spiritual or mystical experiences are those states in which the form of experience is altered from normal consciousness, resulting in a new understanding of the basic nature of reality, life, and the individual. Psychotic experiences are those states that also flow from alterations of the form of experience, but result in a pathological interaction between the individual and the world. Therefore, according to these definitions, phenomena occurring in a spiritual context may be identical to those traditionally viewed as symptoms of psychosis, but cannot be seen as psychotic in themselves. (Brett 2002, 322) What I was struck by in reading this passage was not so much the claim that "phenomena occurring in a spiritual context may be identical to those traditionally viewed as symptoms of psychosis, but cannot be seen as psychotic in themselves." What struck me was its implication: that psychotic experiences cannot be seen as psychotic in themselves, either. In other words, the claim is that there is a neutral core of common experience shared by psychotic and mystic alike. I do not know how controversial this is in the psychiatric literature that deals with delusion and hallucination, but I should like to explore the claim a little in what follows. Brett expands on it near the end of her paper: The pathology that differentiates the psychotic from the benign mystical state lies not in the content of beliefs, or even in the broad form of experience, but in a few interrelated commonsense factors. It consists of an inability to return to the ontological framework of consensus reality; in psychological isolation, and inability [End Page 343] to accommodate to the subjectivity of others; in a focus of interest in the mental realm and loss of practical concerns that leads to paucity of action and neglect of self-care. (Brett 2002, 336) This pushes the pathology away from the experience that might have been thought to constitute the psychosis. I wonder whether there are problems with this. The fact, if it is one, that both mystic and psychotic alike undergo "an altered state" clearly does not imply that there is a (common) altered state that they both undergo, so what are the grounds for the claim that the core or central experience is the same? What kind of experiences are claimed to be common? How are we to conceive delusion on this scenario?What makes psychotic experiences psychotic on the present pushed back view seems to be that they "result in a pathological interaction between individual and world" (my italics), which thus exonerates the experience itself of pathology, pushing it back to one possible set of consequences for someone who reacts badly to the experiential phenomena (e.g., their inability to return from it). It seems to suggest that someone can be comfortable or well adapted to their voices and visions (and surely there are such people around, for whom the boundaries... (shrink)

_Is God a Delusion?_ addresses the philosophical underpinnings of the recent proliferation of popular books attacking religious beliefs. Winner of CHOICE 2009 Outstanding Academic Title Award Focuses primarily on charges leveled by recent critics that belief in God is irrational and that its nature ferments violence Balances philosophical rigor and scholarly care with an engaging, accessible style Offers a direct response to the crop of recent anti-religion bestsellers currently generating considerable public discussion.

This chapter aims to get away from the ‘psychological attitude’ approach framing current philosophical discussion of delusion. We ask not what kind of attitude a delusion is – a belief or an imagination? Something else? – as if it were already clear what the ‘content’ of a delusion could be. We aim instead to shift attention to the question of the ‘object’ of delusions. What is delusion of? What is the object of this form of thinking? This focus on a (...) delusion’s object, over its attitudinal nature, is partly motivated by a desire properly to connect delusory thought with ordinary forms of fantastical thinking that are ubiquitous in the experiences faced by reflective humans in everyday life. We aim at securing a continuity, in a way that much extant discussion of delusion fails to, between delusory thought with more ordinary forms of thinking present in, for example, fantastical or magical thinking. Exploring familiar expressions of such thinking, especially those involved in love and loss, enables us to bring out the way in which such expressions convey forms of affective self-consciousness – that have the subject and her relations as an object – that are not naturally taken as reports liable to investigation as true or false. This raises the question about what how to think about what someone is doing when they give expression to a delusion should we think of them as expressing an attitude towards a truth or false content, or may they be doing something rather different? (shrink)

Delusions are typically regarded as beliefs of a certain kind, both by psychiatrists and by lay people. In “Double Bookkeeping and Doxasticism about Delusion,” Porcher formulates and assesses two kinds of arguments against doxasticism about delusions, the theoretical stance according to which delusions are a kind of belief. Those arguments, which Porcher calls “the argument from action guidance and the argument from phenomenology” are motivated by a phenomenon sometimes associated with delusions: double bookkeeping, a kind of ambivalence of patients, who (...) “often appear to be living in two parallel but separate worlds: consensual reality and the realm of their hallucinations and delusions” (Sass, 1994, p.... (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)

The analysis presented in this article reveals an ambiguity and tension in human rights theory concerning the delusional person’s freedom of belief and thought. Firstly, it would appear that the concepts ‘opinion’ and ‘thought’ are defined in human rights discussion in such a way that they do include delusions. Secondly, the internal freedom to hold opinions and thoughts is defined in human rights discussion and international human rights covenants as an absolute human right which should not be restricted in any (...) situation for any reason. These views, if understood literally, imply that a person has an absolute right to hold a delusion. However, this kind of conclusion has not been made in mental health laws, the ethical principles guiding psychiatric care or the practice of psychiatry. Instead, they assume that the use of involuntary antipsychotic medication is justified even thought its purpose is to influence delusions. The ambiguity and tension in human rights theory concerning the freedom of belief and thought challenge us to develop this theory within an interdisciplinary discussion so that people with delusions are taken into account properly. (shrink)

Psychosis is associated with distorted perceptions and deficient bottom-up learning such as classical fear conditioning. This has been interpreted as reflecting imprecise priors in low-level predictive coding systems. Paradoxically, overly strong beliefs, such as overvalued beliefs and delusions, are also present in psychosis-associated states. In line with this, research has suggested that patients with psychosis and associated phenotypes rely more on high-order priors to interpret perceptual input. In this behavioural and fMRI study we studied two types of (...) fear learning, i.e., instructed fear learning mediated by verbal suggestions about fear contingencies and classical fear conditioning mediated by low level associative learning, in delusion proneness—a trait in healthy individuals linked to psychotic disorders. Subjects were shown four faces out of which two were coupled with an aversive stimulation while two were not in a fear conditioning procedure. Before the conditioning, subjects were informed about the contingencies for two of the faces of each type, while no information was given for the two other faces. We could thereby study the effect of both classical fear conditioning and instructed fear learning. Our main outcome variable was evaluative rating of the faces. Simultaneously, fMRI-measurements were performed to study underlying mechanisms. We postulated that instructed fear learning, measured with evaluative ratings, is stronger in psychosis-related phenotypes, in contrast to classical fear conditioning that has repeatedly been shown to be weaker in these groups. In line with our hypothesis, we observed significantly larger instructed fear learning on a behavioural level in delusion-prone individuals compared to non-delusion-prone subjects. Instructed fear learning was associated with a bilateral activation of lateral orbitofrontal cortex that did not differ significantly between groups. However, delusion-prone subjects showed a stronger functional connectivity between right lateral orbitofrontal cortex and regions processing fear and pain. Our results suggest that psychosis-related states are associated with a strong instructed fear learning in addition to previously reported weak classical fear conditioning. Given the similarity between nocebo paradigms and instructed fear learning, our results also have an impact on understanding why nocebo effects differ between individuals. (shrink)

In this paper we defend the doxastic conception of delusions against the metacognitive account developed by Greg Currie and collaborators. According to the metacognitive model, delusions are imaginings that are misidentified by their subjects as beliefs: the Capgras patient, for instance, does not believe that his wife has been replaced by a robot, instead, he merely imagines that she has, and mistakes this imagining for a belief. We argue that the metacognitive account is untenable, and that the traditional conception of (...) delusions as beliefs should be retained. (shrink)

Nietzsche’s cardinal ideas - God is Dead, Übermensch and Eternal Return of the Same - are approached here from the perspective of psychiatric phenomenology rather than that of philosophy. A revised diagnosis of the philosopher’s mental illness as manic-depressive psychosis forms the premise for discussion. Nietzsche conceived the above thoughts in close proximity to his first manic psychotic episode, in the summer of 1881, while staying in Sils-Maria (Swiss Alps). It was the anniversary of his father’s death, and also (...) of the break-up of his friendship with Wagner, the most important relationship in his life. Despite having been acquainted with these ideas from reading philosophy and literature, Nietzsche created them de novo and imbued them with very personal meaning. Surprisingly, he never defined or explained his cardinal thoughts in his published writings, perhaps because rationally he could not. A resultant hermeneutic vacuum provoked an avalanche of interpretations in secondary literature. But could these ideas be delusions? A current definition of delusion is challenged, and an attempt is made at a limited comparison between delusion, scientific/philosophical doctrine and poetic creation. It is also argued that psychosis is a way of re-living trauma, and delusions can therefore be seen as a form of reasoning that helps to make sense of the world in a state of psychotic disintegration. Far from being false beliefs, delusions are a true expression of one’s innermost feelings and pain, albeit indirectly. The relationship between early parental loss and repeated trauma, psychosis and creativity is also explored. Indo-Pacific Journal of Phenomenology , Volume 8, Edition 1 May 2008. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Philosophy, Psychiatry, & Psychology 9.4 (2002) 353-358 [Access article in PDF] The Application of Nondual Epistemology to Anomalous Experience in Psychosis Caroline Brett THE COMMENTARIES PROVIDED by Marzanski and Bratton, and McGhee have drawn my attention to several ways in which my analysis could benefit from clarification or supplementation, and the range of the specific phenomena to which it can be applied. Since writing this paper nearly 3 (...) years ago, my own views of the area have developed, and in some aspects, shifted; nevertheless, within this response I shall comment on the specific aspects of the original paper that I feel may have been misunderstood or overlooked by the commentators, and those aspects that benefit from the broader perspective they provided.To clarify the direction of the original paper: I would describe it as an attempt to make a deeper examination of processes involved in some kinds of anomalous experience than is provided by the "cognitive problem-solving model"; in other words, to supplement rather than challenge or undermine this perspective. Moreover, the focus is intended to be more on identifying the point at which the experience, or the response to the experience (more on the relation between these two below) becomes pathological, than on cleanly distinguishing a psychotic state from a mystical one. However, because I do use these terms contrastively throughout the paper, I concede that these aims become blurred and may in fact be indistinguishable.Third, the paper concerns only a relatively narrow arena of both mystical and psychotic phenomenology, selected for the purpose of a tight conceptual analysis and comparability, and possibly suffers a lack of generalizability or scope of application as a result. Most notably, I leave aside the paranoid or persecutory interpretative framework often seen as paradigmatic of the psychotic state (although a brief mention of how emotionally relevant themes may arise out of anomalous cognition is included), focussing instead on the more "Schneiderian" aspects of psychotic phenomenology, in which there is a self-observed alteration of normal experience. 1 It may be an important point of contrast that I do not specifically focus on "hallucinations, voices, and visions" as described by McGhee and, to an extent, Jackson and Fulford. It may also be worth [End Page 353] flagging up the fact that I do not focus on "delusional beliefs" at all, instead choosing to focus on the "delusional mood," which notably does not involve crystallized delusions as such. As a result, the main aim is not to compare two descriptively defined states of mind, as seems to be suggested by McGhee in his commentary, but rather to see to what extent a certain form of experience can be understood within a particular epistemological structure, and the implications of this.Further to this issue, Marzanski and Bratton raise an objection to a view in which a common core of mystical experience is posited; one which could be identified interculturally and independently of "the language and tradition in which the self is formed." They make an important point that the perspective gained by applying the epistemology of Zen Buddhism or Advaita Vedanta may have no authority in helping to understand the locus of pathology in anomalous experiences that have occurred in an individual who is not established in these cultures or traditions or for a person who does not accept these epistemologies in the first place. The issue of the existence of some core mystical experiences that are translated into religious experiences in different cultures is a matter of comparative religion and theology, and outside the scope of this paper (although my own opinion is that such a core exists). In the absence of any argument to support this opinion, it must be conceded that this may severely limit the applicability of my analysis, especially if irreconcilable differences are thought to exist between the epistemologies of, for example, theistic and monistic philosophies. However, I would suggest that whatever wisdom can be gleaned from the various spiritual doctrines in existence around the world with regard to unusual and/or distressing states of mind should be absorbed where... (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)

*Note that this project is now being developed in joint work with Rich Woodward* -/- Some things are left open by a work of fiction. What colour were the hero’s eyes? How many hairs are on her head? Did the hero get shot in the final scene, or did the jailor complete his journey to redemption and shoot into the air? Are the ghosts that appear real, or a delusion? Where fictions are open or incomplete in this way, we can (...) ask what attitudes it’s appropriate (or permissible) to take to the propositions in question, in engaging with the fiction. In Mimesis as Make-Believe (henceforth, MMB), Walton argues that just as truth norms belief, truth-in-fiction norms imagination. Granting that what is true-in-the-fiction should be imagined, and what is false-in-the-fiction is not to be imagined, there remains the question of what to say within the Waltonian framework about things that are neither true- nor false-in-the-fiction---the loci of incompleteness. (shrink)