Delusions

Normal convictions are formed in a context of social living and common knowledge. Immediate experience of reality survives only if it can fit into the frame of what is socially valid or can be critically tested. … Each single experience can always be corrected but the total context of experience is something stable and can hardly be corrected at all. The source for incorrigibility therefore is not to be found in any single phenomenon by itself but in the human situation (...) as a whole, which nobody would surrender lightly. If socially accepted reality totters, people become adrift.As Jaspers indicates in this quotation on incorrigibility, delusions may not be regarded as mere disorders of thinking, reasoning or... (shrink)

In his article, "Delusion, Reality, and Inter-subjectivity," Thomas Fuchs gives an "enactivist" account of how primary delusions in early schizophrenia evolve. First, subjects experience the "loss of familiar, commonsensical meanings"—known as delusional mood. Consecutively they experience new "revelatory significances," in perception as well as in social interaction, with all experiences becoming radically "subjectivized." Out of these "uncanny, spurious and made" experiences delusions develop. Suddenly the formerly uncanny experiences make sense. This new subjective reality, however, is "rigid." Subjects are no longer (...) able to take on different perspectives. The usually present, shared reality we live by is lost.... (shrink)

In "Delusion, Reality, and Intersubjectivity," Thomas Fuchs offers a superb presentation of an enactive/phenomenological approach to schizophrenic delusions—an approach that is clearly superior to the poor-reality-testing formula that has dominated thinking about delusion in psychiatry, psychoanalysis, and cognitive-behavioral theory. As he convincingly argues, two key tendencies go a long way toward accounting for the distinctive features of delusion in schizophrenia: 1) withdrawal from practical, sensori-motoric interaction with the physical environment; and 2) failure to experience reality in intersubjective terms—as a realm (...) of "participatory... (shrink)

Various psychopathologies of self-awareness, such as somatoparaphrenia and thought insertion in schizophrenia, might seem to threaten the viability of the higher-order thought (HOT) theory of consciousness since it requires a HOT about one’s own mental state to accompany every conscious state. The HOT theory of consciousness says that what makes a mental state a conscious mental state is that there is a HOT to the effect that “I am in mental state M.” I have argued in previous work that a (...) HOT theorist can adequately respond to this concern with respect to somatoparaphrenia and thought insertion. There is also Cotard syndrome which is a rare neuropsychiatric disorder in which people hold the delusional belief that they are dead, do not exist, or have lost their blood or internal organs. In this paper, I argue that HOT theory has nothing to fear from it either and can consistently account for what happens in such unusual cases. I analyze Cotard syndrome in light of my previous discussion of somatoparaphrenia and thought insertion, and argue that HOT theory can provide a somewhat analogous account without the worry of inconsistency. It is crucial to recognize that there are multiple “self-concepts” and levels of HOTs which can help to provide a more nuanced explanation. With regard to the connection between consciousness and self-consciousness, it is proposed that Cotard patients are indeed capable of having some “I-thoughts” about their bodies and mental states. (shrink)

Among psychiatric conditions, delusions have received significant attention in the philosophical literature. This is partly due to the fact that many delusions are bizarre, and their contents interesting in and of themselves. But the disproportionate attention is also due to the notion that by studying what happens when perception, cognition, and belief go wrong, we can better understand what happens when these go right. In this paper, I attend to delusions for the second reason—by evaluating the epistemology of delusions, we (...) can better understand the epistemology of ordinary belief. More specifically, given recent advancements in our understanding of how delusions are formed, the epistemology of delusions motivates a proper functionalist account of the justification of belief. Proper functionalist accounts of the justification of belief hold that whether a belief is justified is partly determined by whether the system that produces the belief is functioning properly. (shrink)

In this paper, I examine a kind of delusion in which the patients judge that their occurrent thoughts are false and try to abandon them precisely because they are false, but fail to do so. I call this delusion transparent, since it is transparent to the sufferer that their thought is false. In explaining this phenomenon, I defend a particular two-factor theory of delusion that takes the proper integration of relevant reasoning processes as vital for thought-evaluation. On this proposal, which (...) is a refinement of Gerrans’s account of delusion as unsupervised by decontextualized processing, I can have all my reasoning processes working reliably and thus judge that my delusion is false but, if I cannot use their outputs when revising the thought itself, the delusion will persist. I also sketch how this framework explains some interesting cases of failed belief-revision in the general population in which people judge that ~p but nonetheless continue to believe that p. (shrink)

Inference has long been a concern in epistemology, as an essential means by which we extend our knowledge and test our beliefs. Inference is also a key notion in influential psychological or philosophical accounts of mental capacities, from perception via utterance comprehension to problem-solving. Consciousness, on the other hand, has arguably been the defining interest of philosophy of mind over recent decades. Comparatively little attention, however, has been devoted to the significance of consciousness for the proper understanding of the nature (...) and role of inference. It is commonly suggested that inference may be either conscious or unconscious. Yet how unified are these various supposed instances of inference? Does either enjoy explanatory priority in relation to the other? In what ways or senses, can an inference be conscious, or fail to be conscious, and how does this matter? This book brings together original essays from established scholars and emerging theorists that illustrate how several current debates in epistemology, philosophy of psychology, and philosophy of mind can benefit from reflections on these and related questions about the significance of consciousness for inference. Contributors include: Kirk Ludwig and Wade Munroe; Michael Rescorla; Federico Bongiorno and Lisa Bortolotti; Berit Brogaard; Nicholas Allott; Jake Quilty-Dunn and Eric Mandelbaum; Corine Besson; Anders Nes; David Henderson, Terry Horgan, and Matjaž Potrč; Elijah Chudnoff; and Ram Neta. (shrink)

We seem to have a special, seemingly direct, relationship to our own thoughts that we do not have to the thoughts of others; I can become aware of my thoughts in a way that I cannot become aware of yours: through introspection. Those who have delusions of thought-insertion, however, claim not only to be aware of another's thoughts, but to have another's thoughts in their own mind. These thoughts, of course, cannot actually be someone else's thoughts. However, if we take (...) those who have this delusion at their word, it certainly seems to them that these thoughts belong to another. Although introspection is no longer generally thought to be absolutely error free, this misinterpretation seems quite a strange mistake to... (shrink)

Young’s paper (2012) offers an interesting and fruitful extension to recent work on Cotard’s syndrome, and in particular, a philosophical investigation of how and why beliefs around death and non-existence frequently co-occur with beliefs around immortality. In this brief response, we discuss a few issues from the paper. Namely, the issue of Cotard delusion being a natural kind, the seeming paradox of death and immortality and its relation to wider culture and literature, and the utility of the concept of misplaced (...) being. (shrink)

People experiencing alien control report that their thoughts, movements, actions, and emotions have been replaced by those of an "other." The latter is commonly a perceived persecutor of the patient. Here I describe the clinical phenomenology of alien control, mechanistic models that have been used to explain it, problems inherent in these models, the brain deficits and functional abnormalities associated with this symptom, and the means by which disordered agency may be examined in this perplexing condition. Our current state of (...) knowledge implicates potentially reversible dysfunction in certain key brain regions (especially the right parietal cortex), which is temporally related to the presence of symptoms. Alien control is quintessentially a disorder of agency. (shrink)

Hallucination lies at an intriguing border between psychiatry and philosophy. Although Behrendt & Young (B&Y) tie their proposal to Kantian transcendental idealism, other philosophical positions are equally consistent. Cognition is underconstrained by reality not only in hallucination but also in autism and dreaming. Sensory underconstraint is insufficient to encompass schizophrenia. There is also a breakdown in integrative capacity on the cognitive side. From a wider clinical perspective than schizophrenia, there can be underconstraint or overconstraint in sensory and cognitive functionalities.

Although the evidence remains tentative at best, the conception of hallucinations in schizophrenia as being underconstrained perception resulting from intrinsic thalamocortical resonance in sensory areas might complement current models of hallucination. However, in itself, the approach falls short of comprehensively explaining the neurogenesis of hallucinations in schizophrenia, as it neglects the role of external attributional biases, mental imagery, and a disconnection between frontal and temporal areas.

We argue that the pivotal role assigned by Northoff to the principle of top-down modulation in catatonia might successfully be applied to other symptoms of schizophrenia, for example, hallucinations. Second, we propose that Northoff's account would benefit from a more comprehensive analysis of the cognitive level of explanation. Finally, contrary to Northoff, we hypothesize that “top-down modulation” might play as important a role as “horizontal modulation” in affective-behavioral alterations.

Immédiates, efficaces et inépuisables comme des sensations, mais indépendantes du dehors et maîtresses de l’espace comme des images, les visions «imaginatives» de Thérèse, pour voisines qu’elles soient de nos visions sensorielles, méritent pourtant une place à part et ne sont ni des hallucinations vulgaires, indiscernables des sensations, ni des hallucinations psychiques. Ce sont les hallucinations thérésiennes. (Pierre Quercy 1930).

Classifying Madness (Springer, 2005) concerns philosophical problems with the Diagnostic and Statistical Manual of Mental Disorders, more commonly known as the D.S.M. The D.S.M. is published by the American Psychiatric Association and aims to list and describe all mental disorders. The first half of Classifying Madness asks whether the project of constructing a classification of mental disorders that reflects natural distinctions makes sense. Chapters examine the nature of mental illness, and also consider whether mental disorders fall into natural kinds. The (...) second half of the book addresses epistemic worries. Even supposing a natural classification system to be possible in principle, there may be reasons to be suspicious of the categories included in the D.S.M. I examine the extent to which the D.S.M. depends on psychiatric theory, and look at how it has been shaped by social and financial factors. I aim to be critical of the D.S.M. without being antagonistic towards it. Ultimately, however, I am forced to conclude that although the D.S.M. is of immense practical importance, it is unlikely to come to reflect the natural structure of mental disorders. (shrink)

Using the example of auditory hallucinations which especially occur in the psychopathology of schizophrenia this text tries to bridge the gap between empirical research in psychology or psychiatry and philosophical reflection on the mind–body problem. It is a fact that the neuronal manifestations of schizophrenia are significantly associated with psychic characteristics of this disorder. But nevertheless, it is questionable how these dimensions of schizophrenia are related to each other, exactly. The suggested intuitive plausible dualistic solutions of the mind–body problem are (...) problematic with regard to conceptual consistency as well as to the empirically founded theories about schizophrenia. A promising approach seems to be the monistic conception of the identity theory of mind . A psychic manifestation of schizophrenia and the corresponding neuronal process fuse into only one event, which can be called psychophysical units. The perceived qualitative difference between the phenomena which appear in the psychic and neuronal dimension cannot be ascribed to a difference between the phenomena themselves, but to the different representation of one and the same event in the mind of the observer. Furthermore, it can be demonstrated that the processes of interaction between psychic and physical entities, often being postulated within the pathogenesis of schizophrenia, can be integrated. Functionalism holds advantages, too. Functionalist explanations make it possible to understand many pathogenetic aspects of schizophrenia. In this way psychopathological phenomena can be accounted for failed attempts to induce certain functional states. A reasonable research paradigm should be raised from the connection between the principles of the identity theory of mind and functionalism. (shrink)

Psychopathology is the study of the signs and symptoms of psychiatric disorders - delusions, hallucinations, phobias, depression, for example. This book gives an account of the terms currently in use and attempts an in-depth analysis of the nature of each. The matter is examined both from a philosophical perspective and from the point of view of what is known about the function of the hemispheres of the brain.

The ultimate language of madness is that of reason.In short, under the chaotic and manifest delirium reigns the order of a secret delirium. In this second delirium, which is, in a sense, pure reason, reason delivered of all the external tinsel of dementia, is located the paradoxical truth of madness. And this in a double sense, since we find here both what makes madness true and what makes it truly madness.At the urging of his parents, Mr. A, a college-age young (...) man with a past diagnosis of Asperger’s... (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)

Somatoparaphrenia is a pathology of self characterized by the sense of alienaton from parts of one’s body. It is usually construed as a kind of delusional disorder caused by extensive right hemisphere lesions. Lesions in the temporoparietal junction are common in somatoparaphrenia but deep cortical regions (for example, the posterior insula) and subcortical regions (for example, the basal ganglia) are also sometimes implicated (Valler and Ronschi 2009). Patients are often described as feeling that a limb belongs to another person and (...) thus attribute ownership of the limb and bodily sensation to someone else. There is also some question as to whether or not the higher-order thought (HOT) theory of consciousness can plausibly account for the depersonalization psychopathology of somatoparaphrenia (Liang and Lane 2009, Rosenthal 2010, Lane and Liang 2010). Liang and Lane argue that it cannot. The HOT theory of consciousness says that what makes a mental state a conscious mental state is that it is the target of a HOT to the effect that “I am in mental state M” (Rosenthal 2005, Gennaro 2012). When the HOT is itself is unconscious, the conscious state is still outer-directed. When the HOT is conscious, we have introspection and so the conscious thought is directed at the mental state. In section I, I briefly review the previous exchange between Lane and Liang and David Rosenthal. In section II, I further explore somatoparaphrenia and the nature of delusion while offering a number of additional replies to Lane and Liang. In section III, I examine the central notions of “mental state ownership” and “self-concepts” in an effort to account especially for the depersonalization aspect of somatoparaphrenia against the background of HOT theory. In section IV, I argue that to the extent that somatoparaphrenia casts doubt on the notion that some thoughts are “immune to error through misidentification” (IEM), the most fundamental aspect of IEM is still consistent with HOT theory. Overall, I argue that HOT theory is left unscathed by the pheneomenon of somatoparaphrenia and can even help to explain what happens in these cases. (shrink)

This paper raises a slightly uncomfortable question: are some delusional subjects responsible for their delusions? This question is uncomfortable because we typically think that the answer is pretty clearly just ‘no’. However, we also accept that self-deception is paradigmatically intentional behavior for which the self-deceiver is prima facie blameworthy. Thus, if there is overlap between self-deception and delusion, this will put pressure on our initial answer. This paper argues that there is indeed such overlap by offering a novel philosophical account (...) of self-deception. The account offered is independently plausible and avoids the main problems that plague other views. It also yields the result that some delusional subjects are self-deceived. The conclusion is not, however, that those subjects are blameworthy. Rather, a distinction is made between blameworthiness and ‘attributability’. States or actions can be significantly attributable to a subject—in the sense that they are expressions of their wills—without it being the case that the subject is blameworthy, if the subject has an appropriate excuse. Understanding delusions within this framework of responsibility and excuses not only illuminates the ways in which the processes of delusional belief formation and maintenance are continuous with ‘ordinary’ processes of belief formation and maintenance, it also provides a way of understanding the innocence of the delusional subject that does not involve the denial of agency. (shrink)

David Christensen and others argue that Dutch Strategies are more like peer disagreements than Dutch Books, and should not count against agents’ conformity to ideal rationality. I review these arguments, then show that Dutch Books, Dutch Strategies, and peer disagreements are only possible in the case of what computer scientists call Byzantine Failures—uncorrected Byzantine Faults which update arbitrary values. Yet such Byzantine Failures make agents equally vulnerable to all three kinds of epistemic inconsistencies, so there is no principled basis for (...) claiming that only avoidance of true Dutch Books characterizes ideally rational agents. Agents without Byzantine Failures can be ideally rational in a very strong sense, but are not normative for humans. Bounded rationality in the presence of Byzantine Faults remains an unsolved problem. (shrink)

Corlett, P. R. (2019. Factor one, familiarity and frontal cortex: A challenge to the two-factor theory of delusions. Cognitive Neuropsychiatry, 24(3), 165–177. doi:10.1080/13546805.2019.1606706 ) raises two groups of challenges against the two-factor theory of delusions: One focuses on weighing “the evidence for … the two-factor theory”; the other aims to question “the logic of the two-factor theory” (ibid., p. 166). McKay, R. (2019. Measles, magic and misidentifications: A defence of the two-factor theory of delusions. Cognitive Neuropsychiatry, 24(3), 183–190. doi:10.1080/13546 805.2019.1607273) (...) has robustly defended the two-factor theory against the first group. But the second group, which Corlett believes is in many aspects independent of the first group and Darby, R. R. (2019. A network-based response to the two-factor theory of delusion formation. Cognitive Neuropsychiatry, 24(3), 178–182. doi:10.1080/13546805.2019.1606709, p. 180) takes as “[t]he most important challenge to the two-factor theory raised by Dr. Corlett”, has by large remained. Here I offer my two cents in response to the second group. More specifically, I argue that Corlett’s challenges to the logic of the two-factor theory, concerning modularity, double dissociation and cognitive penetration, seem to be based on some misunderstandings of the two-factor theory. (shrink)

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

This book proposes a novel and rigorous explanation of consciousness. It argues that the study of an aspect of our self-consciousness known as the ‘feeling of embodiment’ teaches us that there are two distinct phenomena to be targeted by an explanation of consciousness. First is an explanation of the phenomenal qualities – 'what it is like' – of the experience; and second is the subject's awareness of those qualities. Glenn Carruthers explores the phenomenal qualities of the feeling of embodiment using (...) the tools of quality spaces, as well as the subject's awareness of those qualities as a functionally emergent property of various kinds of processing of these spaces. Where much recent work on consciousness focuses on visual experience, this book rather draws evidence from the study of self-consciousness. Carruthers argues that in light of recent methodological discoveries, awareness must be explained in terms of the organization of multiple cognitive processes. The book offers an explanation of anomalous body representations and, from that, poses a more general theory of consciousness. Ultimately this book creates a hybrid account of consciousness that explains phenomenology and awareness using different tools. It will be of great interest to all scholars of psychology and philosophy as well as anyone interested in exploring the intricacies of how we experience our bodies, what we are and how we fit into the world. -/- . (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)

In folie à deux, a ‘primary’ patient transmits a delusional belief to one or more ‘secondary’ patients who then adopt and share the belief. This paper applies the two‐factor theory of delusion to retrospectively analyse published cases of folie à deux. Lessons from this retrospective analysis include, firstly, that two‐factor theorists need to shift their focus from endogenous processes to consider the exogenous source of delusional content in most secondaries. Secondly, secondaries who come to share the belief via normal processes (...) of social contagion only qualify as delusional by virtue of the abnormal persistence of their belief, albeit a temporary persistence in those secondaries who abandon their belief soon after separation from the primary. Underpinning this abnormal persistence may be a form of inhibitory failure—a difficulty with inhibiting a belief to allow reasoning for and against it being true. (shrink)

Do self‐monitoring accounts, a dominant account of the positive symptoms of schizophrenia, explain auditory verbal hallucination? In this essay, I argue that the account fails to answer crucial questions any explanation of auditory verbal hallucination must address. Where the account provides a plausible answer, I make the case for an alternative explanation: auditory verbal hallucination is not the result of a failed control mechanism, namely failed self‐monitoring, but, rather, of the persistent automaticity of auditory experience of a voice. My argument (...) emphasizes the importance of careful examination of phenomenology as providing substantive constraints on causal models of the positive symptoms in schizophrenia. (shrink)

In The God Delusion, Richard Dawkins argues that any designer capable of creating the universe and the things we find in it would have to be at least as complex as his creation. If complexity requires a designer, then the designer will require a designer, and so on to infinity. Rather than actually providing an explanation for complexity we see around us, those who invoke a cosmic designer merely postpone the problem. Here, Douglas Groothuis challenges Dawkins's argument.

A "League of Democracies," according to Mahbubani, will divide the world at the very time that a new global consensus needs to be created to address pressing global challenges.