Metadata of the chapter that will be visualized online Chapter Title The Doxastic Status of Delusion and the Limits of Folk Psychology Copyright Year 2018 Copyright Holder Springer International Publishing AG Corresponding Author Family Name Porcher Particle Given Name José Eduardo Suffix Division Organization/University Faculdade Jesuíta de Filosofia e Teologia Address Belo Horizonte, MG, Brazil Abstract 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 antidoxasticism 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. © Springer International Publishing AG 2018 I. Hipólito et al. (eds.), Schizophrenia and Common Sense, Studies in Brain and Mind 12, https://doi.org/10.1007/978-3-319-73993-9_11 Chapter 11 The Doxastic Status of Delusion and the Limits of Folk Psychology José Eduardo Porcher Abstract 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 antidoxasticism 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. 11.1 Introduction Clinical delusions are commonly thought of and characterized as beliefs, both by psychiatrists and by the general population. Here is the definition of delusion in the Glossary of Technical Terms of the most recent edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5): 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. (American Psychiatric Association, 2013, 819) Although almost every aspect of this definition is debatable, describing delusion as a type of aberrant belief is the only one to have engendered a specialized literature J. E. Porcher (*) Faculdade Jesuíta de Filosofia e Teologia, Belo Horizonte, MG, Brazil 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 in itself, engaging philosophers, psychiatrists, and psychologists in the project of arriving at a precise characterization of this class of mental states. Intuitively, delusions do seem like they warrant the attribution of beliefs. This is mainly because of patients' verbal behavior, represented both in the assertions of delusional subjects and the apparent sincerity with which those assertions are made. Take Capgras syndrome, for example. Patients with Capgras are characterized by their inability to recognize a loved one, a close relative, or a friend (or sometimes multiple persons and sometimes even animals and inanimate objects). As Adriano Rodrigues and colleagues explain: In this monothematic delusion, the individual recognizes overtly and straightforwardly who that person is meant to be, upholding however a firm belief to the contrary, which is anchored in subjective cues such as an eerie feeling that something is not quite right about that person, complete lack of a sense of familiarity, and missing the proper affective response. Individuals with Capgras syndrome cling to the unshakeable belief that the original person in question was replaced by an impostor, who cunningly is trying to fool them- with no success at all because, of course, they know better'. (Rodrigues, Banzato, Dantas, & Dalgalarrondo, 2013, 522, my italics) Recently, David Rose, Buckwalter, & Turri (2014) have presented evidence from five studies that folk psychology not only unambiguously views monothematic delusions as beliefs, but that it views delusions as stereotypical beliefs. Furthermore, they show that frequent assertion is a powerful cue to belief attribution, more powerful than even a robust and consistent track record of non-verbal behavior. As we will see, in the specialized literature the presence of certain kinds of non-verbal behavior is one of the main reasons pointing toward the opposite attribution (or at the very least the withholding of attribution) and supporting the abandonment of the view that delusions are beliefs (henceforth doxasticism about delusion). I will present the main alternative characterizations that have emerged in the wake of doxasticism and, in the remainder of the chapter, I will question the validity of the debate between doxasticists and anti-doxasticists by stepping back and assessing the meaning and relevance of the question 'Are delusions beliefs?'. I will argue that, by focusing on what appears to be a merely terminological dispute, the theorists engaged in this debate have lost sight of two critical aspects of a precise characterization of delusions, namely, its use in the development of a scientific theory of the relevant phenomena and its ability to account for the experience of the patients. Finally, I advocate moving past the discussion concerning the doxastic status of delusion toward the description of the processes that generate delusion at every level of explanation, leaving doxastic terminology to be used in those pragmatic contexts (e.g. therapeutic, forensic) in which such terminology is inescapable. 11.2 Problems for Doxasticism The implausibility of ascribing full-fledged belief to delusional subjects has been hinted at since at least the 1910s, when both Karl Jaspers' General Psychopathology and Eugen Bleuler's Textbook of Psychiatry were published (Bayne & Pacherie, J. E. Porcher 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 52 53 54 55 56 57 58 59 60 61 62 63 64 65 66 67 68 69 70 71 72 2005; Bortolotti, 2010). One objection-originally raised by Jaspers (1913/1963) and elaborated recently by German Berrios (1991) and Louis Sass (1994)-denies that delusions are contentful states. One may call this the expressivist (Gerrans, 2001) or non-assertoric (Young, 1999) account. This view is motivated by the fact that most (if not all) delusions appear obviously false or incoherent. Berrios, for example, states that when a patient who utters a verbal formula such as 'I am dead' or 'My internal organs have been removed' is questioned as to the real meaning of these assertions, she will not be able to coherently discuss them or their implications. 'Properly described,' says Berrios, 'delusions are empty speech-acts that disguise themselves as beliefs' (1996, 126). 'Their so-called content refers neither to world, nor self'. 'Delusions are so unlike normal beliefs that it must be asked why we persist in calling them beliefs at all' (1996, 114–5). A wide variety of cases seem to support such a view. Tim Bayne and Elisabeth Pacherie (2005) cite an intermetamorphosis patient who claimed that his mother changed into another person every time she put her glasses on (De Pauw & Szulecka, 1988); another that had the delusion that there was a nuclear power station inside his body (David, 1990); and a third that had the delusion of being both in Boston and in Paris at once (Weinstein & Kahn, 1955). One may not want to deny that delusional states possess content, and still object that it is difficult to see how the delusional patient themselves could believe such content. Again, Cotard patients are a fitting example. José Luis Bermúdez voices this concern in stating that there is 'something content-irrational about the belief ... that one is dead-because, to put it mildly, the belief is pragmatically selfdefeating' (2001, 479). Not only is it unclear that a self-defeating assertion such as 'I am dead' could be coherently expressed, the question is open whether there can be selfdefeating beliefs to begin with (as opposed to mere verbal utterances). Still, one may point out that delusional subjects appear to lack reasons or evidence for their delusional state. However faulty the reasons or flimsy (and biased) the evidence one may have to support some self-deceptive belief, for instance, there will be nevertheless some kind of support for such a belief. In contrast, John Campbell cites the well-known case of 'a patient who looked at a row of empty marble tables in a café and became convinced that the world was coming to an end' (2001, 95). Notwithstanding the DSM definition of delusions (that they are held 'despite what constitutes incontrovertible and obvious proof or evidence to the contrary'), Campbell points out that it is difficult to understand how an experience of marble tables could verify the proposition 'The world is ending'. On the other hand, there is at any time a considerable body of evidence against the truth of the delusional content, to which the delusional subject seems utterly impervious. Furthermore, there are delusional patients that even recognize that they do not have evidence for their claims. A case in point is Andrew Young's and Katherine Leafhead's Cotard patient, JK: We wanted to know whether the fact that JK had thoughts and feelings (however abnormal) struck her as being inconsistent with her belief that she was dead. We therefore asked her, during the period when she claimed to be dead, whether she could feel her heart beat, whether she could feel hot or cold.... She said she could. We suggested that such feelings surely represented evidence that she was not dead, but alive. JK said that since she had such feelings even though she was dead, they clearly did not represent evidence she was alive (1996, 157–8). AU1 11 The Doxastic Status of Delusion and the Limits of Folk Psychology 73 74 75 76 77 78 79 80 81 82 83 84 85 86 87 88 89 90 91 92 93 94 95 96 97 98 99 100 101 102 103 104 105 106 107 108 109 110 111 112 113 114 115 116 117 118 If we think that some responsiveness to evidence is essential to belief, then, in case such as these, we'll be reluctant to say that delusional subjects genuinely believe what they assert. This paves the way to the most widespread objection to doxasticism, namely, that which points to the failure of integration between the subject's delusion and his or her other beliefs (Bortolotti, 2010). Delusional states present a degree of circumscription (Young, 1999, 581) that may speak against their being properly taken as beliefs. Egan (2009) calls this property inferential circumscription. As Bayne and Pacherie neatly put it: A subject will normally accept the obvious logical implications of her beliefs-at least when these are pointed out to her. And when she realizes that some of her beliefs are inconsistent, she will normally engage in a process of revision to restore consistency. In contrast, deluded patients often fail to draw the obvious logical consequences of their delusions and show little interest in resolving apparent contradictions between their delusion and the rest of their beliefs. (2005, 164) However, the majority of patients with the Capgras delusion, for example, do not draw the consequences the content of their delusion would usually mandate: their worldview does not seem to change at all as a consequence of supposedly adopting the belief that their spouses have been abducted and that the person they see in front of them is an impostor (Davies & Coltheart, 2000). Whatever this state is, therefore, it seems that it is severely encapsulated, failing to be integrated with the subject's web of belief. But beliefs are the mainstay of theoretical and practical reasoning and, while one may ascribe false belief to subjects for any number of reasons, a state that fails to have the appropriate connections to the subject's other mental states may not be properly described as a belief. This view is especially espoused by authors who (tacitly or explicitly) endorse a consistency constraint on beliefascription (Currie & Ravenscroft, 2002). Furthermore, belief has important connections to action, and many delusional subjects fail to act in ways expected of agents who really believed the content of their delusions. As Gregory Currie (2000) puts it, delusion exerts a powerful psychological force, but fails to engage behavior in the way we expect of genuine belief. Such behavioral circumscription was noted by Bleuler, who stated that his delusional patients rarely follow up the logic to act accordingly, as, for instance, to bark like a dog when they profess to be a dog. In the same manner, Capgras patients who (for all we can see) sincerely affirm 'This is not my wife' or 'My mother has been replaced by an impostor' do not as a consequence of this go looking for their missing loved ones, nor do they usually call the police to report the breaking and entering perpetrated by the person they claim to be an impostor. Finally, delusional patients often fail to exhibit the emotional responses one would expect of a person who believes the content of her assertions (Sass, 1994)- we may call this affective circumscription. Capgras patients are more often than not unmoved by the fate of their relatives whom, according to the doxastic interpretation of this delusion, they believe to have been abducted. Why don't they exhibit the affective responses which the relevant beliefs would lead us to expect? Lisa Bortolotti observes that 'although it is possible for a belief system to have some internal tension, most philosophers resist the thought that subjects capable of having J. E. Porcher 119 120 121 122 123 124 125 126 127 128 129 130 131 132 133 134 135 136 137 138 139 140 141 142 143 144 145 146 147 148 149 150 151 152 153 154 155 156 157 158 159 160 161 162 163 beliefs can have dissonant attitudes simultaneously activated and operative at the forefront of their minds' (2010, 62). Delusions lack the holistic character expected of beliefs and do not respect the notion of a coherent belief system whose adjustments to one belief implies adjustments to many others (Young, 2000). Beliefascription in the context of delusion, then, is only admissible after explaining away these disparities between the roles that delusional states play in the overall cognitive economy of delusional patients and those roles we expect beliefs to play (following either folk-psychological intuitions or fully articulated theories of belief). 11.3 Anti-doxasticism In response to the aforementioned problems, two main alternative accounts have emerged. Some authors characterize delusions with the resources of traditional folk-psychology, and they do so by insisting that while delusions are not beliefs, their status can be captured by other familiar kinds of propositional attitudes. Others propose a revision to standard folk-psychological categories, claiming that delusions are a hybrid type of propositional attitude that was simply not recognized before. Currie and colleagues (Currie, 2000; Currie & Jureidini, 2001; Currie & Ravenscroft, 2002) argue that delusions-or at least some delusions, especially those manifested in schizophrenia-are not straightforward, first-order beliefs, but rather cognitive hallucinations: imaginative states that are misidentified by their subjects as beliefs. As Currie puts it, 'what we normally describe as the delusional belief that p ought sometimes to be described as the delusional belief that I believe that p' (2000, 175). Bayne and Pacherie (2005, 165–6) identify three claims in Currie's account (where p stands for the content of the delusional state): 1. Delusional patients who seem to believe p do not actually believe p; 2. Delusional patients who seem to believe p actually imagine p; 3. Delusional patients who seem to believe p believe that they believe p. It is not altogether clear to which attitude we should affix the term 'delusion': whether we should say that the subject's imagining that p or her believing that she believes that p is the delusional state. On the one hand, if we are to take Currie's theory to resolve the problems left by doxasticism, then we should understand delusions to be imaginings. After all, it promises to account for the features of delusion that are not well accounted by the doxastic account: 'imaginings seem just the right things to play the role of delusional thoughts; it is of their nature to coexist with the beliefs they contradict, to leave their possessors undisturbed by such inconsistency, and to be immune to conventional appeals to reason and evidence' (Currie & Ravenscroft, 2002, 179). Furthermore, Currie (2000) claims his model can account for the fact that delusions typically fail to result in direct actions or strong affective responses, since this is also true of imaginings. 11 The Doxastic Status of Delusion and the Limits of Folk Psychology 164 165 166 167 168 169 170 171 172 173 174 175 176 177 178 179 180 181 182 183 184 185 186 187 188 189 190 191 192 193 194 195 196 197 198 199 200 201 202 However, the way his model is presented undeniably suggests that delusions are not the imaginings, but rather the second-order, metarepresentational beliefs which are themselves caused by wayward imaginings (Dub, 2013). Indeed, simply imagining that one is dead, or that one's spouse has been replaced by a double, or even that that divine forces were preparing one for a sexual union with God (Schreber, 1903/2000) should certainly not be seen as tantamount to being delusional. The equivocation in Currie's account is made especially clear in the following passage, where he has recently suggested that delusions, considered as a class of states, do not fit easily into rigid categories of either belief or imagination. While delusions generally have a significant power to command attention and generate affect, they vary a great deal in the extent to which they are acted upon and given credence by their possessors. In that case it may be that cognitive states do not sort themselves neatly into categorically distinct classes we should label 'beliefs' and 'imaginings', but that these categories represent vague clusterings in a space that encompasses a continuum of states for some of which we have no commonly accepted labels. (Currie & Jones, 2006, 312) Although Currie stops short of taking this idea further, the passage points to a more revisionary form of anti-doxasticism which implies rejecting the ability of the categories of folk psychology to properly characterize delusional states. This idea, in turn, can result in either attributing to the delusional subject a hybrid state somewhere between belief and imagination, or even, as we will see, in a more nuanced view of folk psychology which postulates that not all cases of attribution will yield a yes or no answer to the question 'Does the subject believe that p?'. In 'Imagination, delusion and self-deception', Egan (2009) proposes that delusions are instances of a novel attitude somehow intermediate between imagination and belief, which he calls bimagination. What this means is that this hybrid attitude would possess some of the distinctive features of believing, and some of the distinctive features of imagining. If on the one hand, classifying delusions as paradigmatic cases of belief is problematic because it predicts that delusions ought not to display the sorts of circumscription and evidence-independence that they apparently display, on the other hand, classifying them as paradigmatic cases of imagination is problematic because it predicts that they should display more circumscription and evidence-independence than they apparently display. What would be nice would be to be able to say that the attitude is something in between paradigmatic belief and paradigmatic imagination-that delusional subjects are in states that play a role in their cognitive economies that is in some respects like that of a standardissue, stereotypical belief that p, and in other respects like that of a standard-issue, stereotypical imagining that p. (Egan, 2009, 268) Is such a mixed propositional attitude feasible? Egan's argument for making room in our cognitive theories for hybrid attitudes, against possible opponents who might object on principle to the promiscuous proliferation of mental attitude types, is derived from the fact that (at least some) functional roles performed by beliefs as well as by imaginings are not a package deal. Thus, he argues that it is a mistake to think we cannot have the origin of an imagining and the behavior-guiding role of a belief, or a belief-like behavior guiding role here and an imagination-like behavior guiding role there, or a belief-like origin and an imagination-like updating policy, etc. J. E. Porcher 203 204 205 206 207 208 209 210 211 212 213 214 215 216 217 218 219 220 221 222 223 224 225 226 227 228 229 230 231 232 233 234 235 236 237 238 239 240 241 242 243 244 245 246 247 But even if we accept (as I think we should) a less restrictive and "boxological" view of mental attitudes, does this warrant the kind of attribution Egan has in mind? In other words, does the fragmentation of functional roles justify the use of labels such as 'bimagination'? Egan's account seems so ad hoc as to elicit the following question: if the promiscuous proliferation of propositional attitude types is proportional to the variety of possible functional roles, then why not just say that delusion itself is a type of propositional attitude with the characteristics that it has? Also, wouldn't every subtype of delusion, such as Cotard or Capgras, be ultimately characterized as its own kind of propositional attitude? Can such characterizations be informative at all? Rather than developing the idea that delusions are best characterized as 'vague clusterings in a space that encompasses a continuum of states for some of which we have no commonly accepted labels' (Currie & Jones, 2006, 312), Egan ends up trying to fit delusion into a categorically distinct class. As we will see, some authors have drawn a much more promising conclusion from the fragmentation of functional role, namely, that we should pursue a more nuanced view of the attitudes wherein the possession of contradictory dispositions can be made to make sense. 11.4 Problems for Doxasticism and Anti-doxasticism The discussion of the two anti-doxastic characterizations above highlights at least two important problems which are endemic to the whole debate about whether or not delusions are beliefs. The first problem concerns the legitimacy of the debate itself. The second concerns the legitimacy of the claims being made by both sides. Does the debate between doxasticists and anti-doxasticists turn on facts about the human mind? Authors such as Bayne (2010) and Dub (2013) have recently noted that it is easy to get the impression that there is nothing substantive being achieved by the positive proposals we have examined so far and that, furthermore, that the question 'Are delusions beliefs?' might only appear to be answerable on the surface. Whether the dispute between the two sides is merely terminological is a point that deserves attention insofar as it pertains to the possibility of actually answering the question 'Are delusions beliefs?'. If the question cannot be properly answered this would have important consequences for how we should go about building a scientific theory of delusion. Thus, Bayne observes: Both parties agree that the functional role played by anomalous states (such as delusions) differs from that of paradigm (ordinary) beliefs. Those who are sympathetic to the doxastic account ...add that this difference is not so marked as to exclude delusions from the doxastic realm altogether, whereas those who reject the doxastic account ... hold that although the functional role of delusions may be belief-like, it is not sufficiently belief-like for delusions to qualify as beliefs. But without an account of the functional role of belief it is not clear whether this is really a debate about how best to understand delusions, as opposed to a debate about how to use the term 'belief'. (2010, 332) 11 The Doxastic Status of Delusion and the Limits of Folk Psychology 248 249 250 251 252 253 254 255 256 257 258 259 260 261 262 263 264 265 266 267 268 269 270 271 272 273 274 275 276 277 278 279 280 281 282 283 284 285 286 287 Similarly, Dub (2013, 82) points out that the question might only be settled by deciding how to use the words 'delusion' and 'belief' rather than about what delusions and beliefs are. Toward that end, it would be useful to have some sort of diagnostic test by which we could find out whether or not a debate turns on mere terminology. Dub follows David Chalmers (2009, 88), who offers the following: check whether the dispute disappears after two different senses of the problematic term are distinguished. At first sight, this test suggests that 'Are delusions beliefs?', like 'Is a cucumber a fruit?' and unlike 'Is gold a metal?' is merely terminological. Doxasticists seem to apply the word 'belief' to a set of psychological states that includes delusions, whereas anti-doxasticists restrict the application of the word to a smaller set of psychological states which excludes delusions, just as botanists apply the word 'fruit' to a wider range of objects than are understood to be fruits in a culinary sense. Chalmers' test may be seen as unsophisticated. It invites us to distinguish different senses of a term, but it is not that easy to know when different senses are in play and there exists the possibility that conversationalists may converge on the same meanings even when using their words differently. Thus, Dub provides an heuristic that does not involve having to scrutinize the meanings of the terms being used: a dispute is merely terminological if and only if it is not possible to have the dispute without using whatever words are apparently troublesome. In reformulating the debate without using the taboo word, one will have to resort to the redescriptions, paraphrases, and translations, but we do not take on any contentious stance about whether these redescriptions are legitimate "senses" of the now-taboo word or are related to its semantic content in any particular way. (2013, 84–5) Though by no means foolproof and far from defining what a terminological dispute constitutes, Dub's diagnostic test does suggest that doxasticists and anti-doxasticists are talking past one another. With this diagnostic test in hand, we can examine the two potentially problematic terms in the assertion 'delusions are beliefs', namely 'delusions' and 'beliefs'. In the remainder of this section I will focus on potential indeterminacies in the word 'delusion' that give rise to an independent charge to both doxasticism and anti-doxasticism, namely, that of making unjustified general claims. In the next section, I will will focus on potential indeterminacies in the word 'belief' that put in jeopardy the project of pigeonholing delusions as being definitely beliefs or definitely not beliefs. The characteristic circumscription that works as an objection against doxasticism, though certainly observed in many cases of delusion, is not a feature of all delusions. Just as there are examples of the failure of delusions to be integrated with the subject's beliefs, actions, and emotions, there are also cases that do display such integration and, therefore, lend support to the attribution of belief (Bayne & Pacherie, 2005). This can easily be established with data from both empirical studies and first-person accounts of delusion. With regard to empirical data, for example, a review of 260 cases of delusional misidentification by Hans Förstl, Almeida, Owen, Burns, and Howard (1991) found that physical violence had been noted in 18% of cases. Andrew Young and Kate J. E. Porcher 288 289 290 291 292 293 294 295 296 297 298 299 300 301 302 303 304 305 306 307 308 309 310 311 312 313 314 315 316 317 318 319 320 321 322 323 324 325 326 327 328 329 330 331 Leafhead (1996) note that all their Cotard patients displayed at least some measure of congruent behaviors, such as refusing to move, to eat, or to shower. J.M. O'Dwyer (1990) reports that erotomania patients commonly act on the basis of their delusion. And Simon Wessely et al. (1993) note that 77% of a total of 59 delusional patients acted on their delusions in the month prior to admission. Therefore, circumscription objections have only the power to undermine the generality of a doxastic characterization of delusions, without thereby establishing the generality of an anti-doxastic characterization-especially because the empirical evidence just mentioned fits the doxastic model better, thus undermining the possibility that either Currie's or Egan's account could work as a general characterization of delusion. So, if doxasticism cannot provide a general account because it fails to include the cases to which antidoxasticists allude, the reverse is also true and, thus, no positive morals can be extracted from the debate. The moral here is negative: the heterogeneity of the class of delusions puts pressure on the very possibility of anyone ever arriving at a characterization that is at once general and precise. Still with respect to delusional states that are not circumscribed as antidoxasticists paint delusion to be, consider the following testimony by Esmé Weijun Wang, a writer responsible for what is perhaps the only extant account of the experience of Cotard delusion (quoted with permission). In the beginning of my own experience with Cotard's delusion, I woke my husband before sunup. Daphne, our dog, stirred, began thumping her papillon-mutt tail against the bedsheets. I'd been in my studio, but now I was shaking my husband, and I was crying with joy. 'I'm dead,' I said, 'and you're dead, and Daphne is dead, but now I get to do it over. Don't you see? I have a second chance. I can do better now.' Chris said, gently, 'I think you're alive.' But this statement, of course, meant nothing. It was his opinion, and I had my solid belief. I can state that the sky is green, but will you see it as such? I felt buoyant at the belief that I was getting a second chance in some kind of afterlife-it caused me to be kinder, to be more generous. I wasn't irritated by problems with computer downloads. I was sweet to telemarketers. It was true that I was dead, but I believed it made sense to play-act normalcy, or rather, an improved version of normalcy, because of the additional belief that I was in an afterlife. According to the logic of my delusion, this afterlife was given to me because I hadn't done enough to show compassion in my "real" life; and though I was now dead, my death was also an optimistic opportunity. (2014) Note that Wang's conviction that she was dead was not inferentially circumscribed (or at least not completely), since she also formed the coherent conviction that she was experiencing an afterlife-likely an abductive explanation of the unshakeable conviction that, although dead, she remained a subject of experiences. Moreover, her delusional convictions had behavioral and affective consequences, leading her to verbally affirm that she was dead, to be unencumbered by petty problems, and to rejoice at the second chance she had been given. While members of one of the sides of this debate can (and do) invoke examples of first-person accounts of schizophrenia, for example, to illustrate the point that at least some delusions are not belieflike , the upshot of the considerations above is that delusions are highly heterogeneous and, thus, it should come as no surprise that some delusions are more belief-like, while others depart from stereotypical beliefs. What we need, it seems, is an account 11 The Doxastic Status of Delusion and the Limits of Folk Psychology 332 333 334 335 336 337 338 339 340 341 342 343 344 345 346 347 348 349 350 351 352 353 354 355 356 357 358 359 360 361 362 363 364 365 366 367 368 369 370 371 372 373 374 375 376 377 of delusion that embraces this heterogeneity and strives for precision without losing sight of the fact that we are dealing with a class of phenomena that might very well not be amenable to sweeping general claims. 11.5 The Limits of Folk Psychology Responding to the question of whether non-linguistic animals have beliefs, Stephen Stich once paraphrased his young son in saying 'A little bit they do. And a little bit they don't' (1979, 28). From what has been discussed so far, the response to the question of whether delusions are beliefs should fall along the same lines: 'a little bit they are, a little but they are not' (Bayne, 2010). However, rather than trying to create new labels to fit borderline phenomena, we may pursue an account that at once recognizes the limits inherent in folk-psychological categories and provides us with a way to talk intelligibly and responsibly about phenomena which can't be made to fit such categories. H.H. Price, in his famous series of lectures on belief, discussed the not uncommon phenomenon wherein a person may systematically feel himself to be and act as if he were fully committed to p in one set of circumstances, while systematically feeling and acting as if the opposite were true in others. He called this 'half-belief' (1960/1969). More recently, Schwitzgebel (2001) recognized that there are countless cases in which a simple yes or no answer to the question 'Does S believe that p?' doesn't seem to be available, and that they can have a wide variety of causes. From these cases, Schwitzgebel (2001, 76) concludes that for any proposition p, it may sometimes occur that a person is not quite accurately describable as believing that p, nor quite accurately describable as failing to believe that p. The widespread presence of problematic circumstances for belief-ascription encourages an account of belief that allows us to talk intelligibly about in-between states-an account that allows us to say more than just that the subject 'sort of' believes something. Given the notion that there is a continuum ranging from complete absence to complete presence of any given belief, a probabilistic strategy might be thought to manage cases of in-between believing. According to such an account, a person's beliefs would be characterized by a degree of confidence ranging from 0 (i.e. absolute confidence in the falsity of p) to 1 (i.e. absolute confidence in the truth of p), with 0.5 in between-perhaps representing suspension of judgment or a state of skeptical doubt. Such an approach may be thought to account for at least some of the cases because we could assign our half-believing theist, for example, with a degree of confidence of 0.7 or 0.8. However, this would consist in a gross oversimplification of the kind of uncertainty or wavering present in the cases discussed. The half-believing theist cannot be properly described as simply fluctuating between different degrees of confidence, since they are, 'at a single time, disposed quite confidently to assert one thing in one sort of situation and to assert its opposite in another' (Schwitzgebel, 2001, 79). Nor can the process of gradually forgetting someone's last name, for example, be properly translated into a slow J. E. Porcher 378 379 380 381 382 383 384 385 386 387 388 389 390 391 392 393 394 395 396 397 398 399 400 401 402 403 404 405 406 407 408 409 410 411 412 413 414 415 416 417 418 decline in one's confidence in the truth of some proposition. A purely probabilistic approach fails to capture the vast array of detail present in these cases. Furthermore, it would seem that traditional representational accounts of belief cannot provide a way of successfully dealing with in-between belief states either. Indeed, to suggest that someone is in an in-between representational state appears even more unnatural than the probabilistic strategy would have it. Most talk of belief as representation makes out belief to be a categorical state-having a belief that p is something like having the sentence p inscribed in one's 'belief box' in the language of thought, according to one popular account. The metaphor must be pushed, though, if representationalists wish to embrace the very plausible presence of halfway states. Schwitzgebel points out that for that, however, they risk making a caricature of their own account by incorporating, say, explanations of gradual forgetting in terms of a sentence slowly 'losing its color', etc. To avoid the farfetched claim that sentences either are or aren't inscribed in a belief box, then, representationalists are left with the burden of coming up with helpful ways of describing in-between cases in representational terms. As we have seen, in the most difficult cases for ascription, such as the case of delusion, the communicative demands on the attributor may not successfully determine whether or not it is appropriate to describe the subject as believing the content of what they profess to believe. Schwitzgebel (2012) argues that cases like these, in which the set of ascribable dispositions available to the interpreter is such a mixed bag, leave us only with the option of specification-that is, describing how the subject's dispositions conform to the stereotype for the belief in question and how they deviate from it. There will be times, then, when withholding the use of ascriptive language is going to be preferable so as not to mislead one's audience. Such cases are those in which the observable deviations raise questions regarding both the content of the subject's attitude, and the nature of the attitude itself. If there is no way to decide whether something is determinately a case of belief, then our move should be to allow some indeterminacy in our belief talk. Schwitzgebel suggests that 'believes that p' should be treated as a vague predicate admitting of vague cases: whereas in in-between cases of canonically vague predicates like 'tall' the appropriate ascription of the predicate varies contextually, so too, he argues, do in-between cases of belief. In both cases the best approach will sometimes be to refuse to either simply ascribe or simply deny the predicate but rather to offer more detail (e.g., 'he's five foot eleven inches'). Rather than supporting the view that delusions are beliefs (or at least that some of them are), however, all that Schwitzgebel's view can really offer is a pragmatic license to talk about delusions as beliefs whenever this is not apt to mislead our intended audience, and whenever there is no better alternative. Therefore, Schwitzgebel's view is not fully a doxasticist view about delusion. Besides, it is conceivable that among the many cases that defy belief-ascriptive language there might be some cases of delusion that imagining-ascriptive language is better suited to describe (even if in localized instances, for the benefit of particular audiences). The fact that belief-ascriptive shorthand caters to the context and interests of the attributors defeats the doxasticist's purpose of defending a full-fledged doxastic 11 The Doxastic Status of Delusion and the Limits of Folk Psychology 419 420 421 422 423 424 425 426 427 428 429 430 431 432 433 434 435 436 437 438 439 440 441 442 443 444 445 446 447 448 449 450 451 452 453 454 455 456 457 458 459 460 461 462 463 view of delusions by appeal to dispositionalism about belief, as has been proposed (Bayne & Pacherie, 2005). But where does vagueness get us? Bortolotti (2010) dismisses this kind of 'sliding scale' approach on the grounds that, by not giving a straightforward answer to the question 'Does the patient believe that p?', it is unable to characterize precisely whether the patient's actions are intentional, which complicates issues of ethical and policy-guiding import. Schwitzgebel (2012) retorts that this is not nearly enough reason to discard the approach without more ado, since its proponents might just as well suggest that 'in many cases of delusion it shouldn't be straightforward to assess intentionality, and that the ethical and policy applications are complicated, so that a philosophical approach that renders these matters straightforward is misleadingly simplistic'. Nevertheless, toward the end of her book, Bortolotti hints at the in-between approach we have been discussing: Rarely do we have these clear-cut cases ... Most of the delusions we read about, and we come across, are integrated in the subject's narrative, to some extent, and with limitations. They may be excessively compartmentalized, for instance, or justified tentatively. That is what makes it so difficult to discuss the relationship between delusions, subjects' commitment to the content of the delusion, and autonomy. As authorship comes in degrees, so does the capacity to manifest the endorsement of the delusional thought in autonomous thought and action. (2010, 252) As Schwitzgebel observes, from the fact that Bortolotti (2010, 242) regards authorship and endorsement as necessary for belief, it seems to follow that in the quoted passage she is acknowledging that many actual delusions are in-between cases of belief. This wavering on Bortolotti's part is symptomatic of the increasingly widespread, if latent, perception that there may not be enough determinacy in our ordinary conception of belief for there to be a fact of the matter as to whether many belief-like states are really beliefs or not (Bayne, 2010; Hamilton, 2007). Thus, Schwitzgebel concludes that when a person deviates too much from the causal-functional patterns in behavior and cognition characteristic of belief, the assumptions inherent in the practice of belief ascription start to break down. As we have seen, he opts for allowing indeterminacy in belief talk rather than abandoning it, and I agree that that is convenient enough for everyday purposes where precision is not an issue. But what about when we are attempting to arrive at an integrative scientific theory of the relevant phenomena? How does allowing for indeterminacy in belief talk help us achieve a precise characterization of delusion, let alone an explanatory theory of it? 11.6 Sidestepping the Debate The characterizations of delusion assessed so far are found lacking in two further respects, which, I argue, deal a fatal blow not to any particular characterization, but to the project of explaining delusion by investing in folk-psychological terminology. First, by focusing too hard on which propositional attitude delusional subjects J. E. Porcher 464 465 466 467 468 469 470 471 472 473 474 475 476 477 478 479 480 481 482 483 484 485 486 487 488 489 490 491 492 493 494 495 496 497 498 499 500 501 502 503 504 are supposed to hold with respect to the content of their delusions, they fail to make any progress in addressing the question of how the delusional patient experiences his or her delusions. Second, they fail a key conceptual challenge in offering a characterization of delusion, namely, to provide a unifying framework that would make it easier to look downwards to the neural mechanisms underlying delusions, thus failing to carry explanatory weight. The theories discussed so far, all of which reduce delusion to a single propositional attitude, however sophisticated, face the charge of being descriptively inaccurate when attention is given to the experience of delusional subjects. As we have seen, some first-person accounts, such as Wang's account of her experience of Cotard's, may function as evidence against anti-doxasticism inasmuch as the circumscription invoked to attack the doxastic status of delusion is absent in at least some cases. This should not, however, be immediately seen as a victory for the doxastic side, insofar as doxasticism faces a similar problem with respect to a variety of cases. First-person accounts of schizophrenia in particular suggest that the question of how the delusional patient takes the world to be will hardly be answerable by referring to a determinate belief (or other kind of attitude) with respect to a proposition. Indeed, the more complex and florid the delusion or delusional system of the subject, the clearer this point seems to become. Consider the celebrated case of Daniel Paul Schreber, whose Memoirs of My Nervous Illness (Schreber, 1903/2000) inspired Jaspers' theory of the incomprehensibility of delusion and which has been the focus of an extensive case study by Louis Sass (1994). I can put this point briefly: everything that happens is in reference to me.... Since God entered into nerve contact with me exclusively, I became in a way for God the only human being around whom everything turns, to whom everything that happens must be related and who therefore, from his own point of view, must also relate all things to himself. (Schreber apud Sass, 1994, 61) In saying that the delusional subject believes, imagines, "bimagines," possesses some of the stereotypical dispositions of belief but not others, etc., nothing is gained in terms of actually understanding and explaining the condition. Indeed, such testimonies do not give rise to the question 'Did Schreber believe such and such?' so much as to the etiological and explanatory questions 'What gave rise to Schreber's experiences?' and 'Why did he interpret them the way he did?'. As Bayne observes, even if the concept of belief were sufficiently precise, it is a further question as to why we should care about whether delusions are anomalous beliefs, cognitive hallucinations or some type of in-between state: 'Arguably, what matters for many purposes is the question of what functional role delusions actually play, rather than whether this functional role falls within the boundary of belief or not' (2010, 332). Thus, in addition to providing overly general characterizations that are not up to the task of precisely describing the delusional subject's attitude toward their delusions, it is worth asking ourselves if and why the language of folk psychology is apt to play a relevant role in an explanation of delusion (and, for that matter, other intricate cognitive phenomena). The vocabulary of folk psychology, though a useful tool for conceptualizing and dealing with ourselves and others, abstracts entirely from 11 The Doxastic Status of Delusion and the Limits of Folk Psychology 505 506 507 508 509 510 511 512 513 514 515 516 517 518 519 520 521 522 523 524 525 526 527 528 529 530 531 532 533 534 535 536 537 538 539 540 541 542 543 544 545 546 547 548 cognitive and neural processes, thereby putting in jeopardy the possibility of an integrative explanation of the phenomena. Jakob Hohwy (2013) notes that an important, if not the most important, explanatory challenge involved in devising a characterization of delusion is to provide a unifying framework that would make it easier to look downwards to the cognitive and neural mechanisms underlying delusions. Characterizations that invest in folkpsychological terminology, being abstractions from lower-level processes, fail to provide us with such a unifying framework and hinder a multi-level explanation of delusion. For this reason, Philip Gerrans (2014) suggests that we take the advice of Dominic Murphy and let cognitive neuroscience determine our characterization of psychiatric disorder in general and delusion in particular: 'we arrive at a comprehensive set of facts about how the mind works, and then ask which of its products and breakdowns matter for our various projects' (Murphy 2006, 105). However, this should not be misunderstood as entailing that the appropriate level of explanation is the lowest-level, i.e., molecular biology. On the contrary, Murphy advocates explanatory pluralism to the effect that there is no fundamental level, and explanations in cognitive neuropsychiatry must include references to factors that span all levels- from molecular biology to phenomenology and the cognitive and social sciences. As Gerrans puts it, 'no part of biology or psychology has proprietary rights to psychiatric explanation' (2009, 113). The suggestion that we should take our lead from cognitive neuroscience and not personal-level folk psychology is then perfectly at home with such an explanatory pluralism and is only meant to drive home the point that there is no place for such abstractions in a causal, mechanistic explanation of delusion (though there might perfectly well be a place for 'belief' and the like in other pragmatic contexts). 11.7 Conclusion I have attempted to elucidate 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. Both sides of the debate offer characterizations that are easily seen to downplay the immense variety in said functional role, and the debate ultimately turns on how its members apply the words 'delusion,' 'belief,' etc., thus consisting of a terminological dispute. Though a more nuanced view of belief wherein mental states are more or less belief-like instills a healthy skepticism towards the precision of folk-psychological concepts, I have argued that it 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. J. E. Porcher 549 550 551 552 553 554 555 556 557 558 559 560 561 562 563 564 565 566 567 568 569 570 571 572 573 574 575 576 577 578 579 580 581 582 583 584 585 586 587 588 589 References American Psychiatric Association. (2013). 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José Eduardo Porcher, PhD, is a postdoctoral research fellow at the Jesuit School of Philosophy and Theology in Belo Horizonte, Brazil. In his research, he has given special attention to the problems involved in providing a precise characterization of psychological phenomena that defy belief attribution, such as self-deception and clinical delusion. J. E. Porcher 641 642 643 644 645 646 647 648 649 650 651 652 653 654 655 656 657 658 659 660 661 662 663 664 665 666 667 668 669 670 671 Author Queries Chapter No.: 11 429100_1_En_11_Chapter Queries Details Required Author's Response AU1 Jaspers (1913/1963) is not provied in the reference list. Please provide details in the list or delete the citation from text. AU2 Please provide in-text citation for Stephens and Graham (2004) or delete the reference from list if applicable.