Stanford Encyclopedia Entry on Delusions.

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)

There are a number of conflicting accounts of thought insertion, the delusion that the thoughts of another are inserted into one’s own mind. These accounts share the common assumption of realism: that the subject of thought insertion has a thought corresponding to the description of her thought insertion episode. I challenge the assumption by arguing for an anti-realist treatment of first-person reports of thought insertion. I then offer an alternative account, simulationism, according to which sufferers merely simulate having a thought (...) inserted into their heads. By rejecting realism, the paper undermines a widespread explanatory framework that unites otherwise competing cognitive models of thought insertion. (shrink)

In this paper, I will argue that the NIMH’s new Research Domain of Criteria is a useful test of the philosophical hypothesis of eliminative materialism and demonstrates the superiority of a moderate eliminativism over integrationism, which is a rival philosophical framework for the cognitive sciences. I begin by going over the motivation for RDOC, which rests on the problems with the existing Diagnostic and Statistical Manual of Mental Disorders framework in psychiatry. Then, I introduce the main tenets of RDoC before (...) discussing eliminativism and trying to show what a moderate eliminativism looks like through the example of addiction. I then contrast that approach with intregrationism to the latter’s detriment. I end by wondering whether the broadly political consequences of eliminativism give us non-scientific reasons for resisting it, as it threatens to rob ordinary people of important means of self-description. (shrink)

Orthodox neurocognitive accounts of the bodily sense of agency suggest that the experience of agency arises when action-effects are anticipated accurately. In this paper, I argue that while successful anticipation is crucial for the sense of agency, the role of unsuccessful prediction has been neglected, and that inefficacy and uncertainty are no less central to the sense of agency. I will argue that this is reflected in the phenomenology of agency, which can be characterized both as the experience of efficacy (...) and effort. Specifically, the “sense of efficacy” refers to the perceptual experience of an action unfolding as anticipated. The “sense of effort”, in contrast, arises when an action has an uncertain trajectory, feels difficult, and demands the exertion of control. In this case, actions do not unfold as anticipated and require continuing adaptation if they are to be efficacious. I propose that, taken individually, the experience of efficacy and effort are insufficient for the sense of agency and that these experiences can even disrupt the sense of agency when they occur in isolation from each other. I further argue that a fully-fledged sense of agency depends on the temporally extensive process of prediction error-cancelation. This way, a comparator account can accommodate both the role of accurate prediction and prediction error and thus efficacy and effort. (shrink)

In this précis I summarise the main ideas of my book Philosophy of Psychedelics. The book discusses philosophical issues arising from the therapeutic use of “classic” psychedelic drugs such as psilocybin and LSD. The book is organised around what I call the Comforting Delusion Objection to psychedelic therapy: the concern that this novel and promising treatment relies essentially on the induction of non-naturalistic metaphysical beliefs, rendering it epistemically objectionable. I begin the précis by summarizing material from chapters two and three (...) of the book, which review evidence for the therapeutic efficacy of psychedelics, and the facts about their clinical use that prompt the Comforting Delusion Objection. I then summarize materials from chapters four and five of the book, which argue that psychedelic therapy works neither by experience-independent processes of neuroplasticity, nor by inducing non-naturalistic metaphysical ideations, but by altering mental representations of the self. Next, I summarise the specific, speculative account of how this might work that is developed in chapters six and seven of the book. This account is based on the predictive processing theory of brain function and the self-binding theory of self-representation. Chapters eight and nine of the book argue, on the basis of this account, that psychedelic therapy can have significant epistemic and spiritual benefits that are compatible with a naturalistic worldview. I summarize this material, and then, finally, the overall conclusions about psychedelic therapy drawn in the tenth and final chapter of the book. (shrink)

In this paper, I argue (1) that the contents of some delusions are believed with sufficient confidence; (2) that a delusional subject could have a conscious belief in the content of his delusion (p), and concurrently judge a contradictory content (not-p) – his delusion could be transparent (Krstić 2020), and (3) that the existence of even one such case reveals a problem with pretty much all existing accounts of lying, since it suggests that one can lie by asserting what one (...) consciously and confidently believes is true, and (4) sincerity, since it suggests that asserting a proposition you believe is true is neither sufficient nor necessary for sincerity. If I am right about (1) and (2), then (3) and (4) follow easily. Therefore, the paper is mainly devoted to an analysis of transparent delusion and defending (1) and (2). (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)

Imagination and belief are obviously different. Imagining that you have won the lottery is not quite the same as believing that you have won. But what is the difference? According to a standard view in the contemporary debate, they differ in two key functional respects. First, with respect to the cognitive inputs to which they respond: imaginings do not respond to real-world evidence as beliefs do. Second, with respect to the behavioural outputs that they produce: imaginings do not motivate us (...) to act as beliefs do. I argue that this view is mistaken in one important respect. The distinction between imagination and belief does lie at the functional level; but the relevant functional difference does not concern behavioural outputs – since, in spite of appearances, imaginings and beliefs motivate us to act in the same ways. To see the difference, we need to focus on the inputs side – and, relatedly, on the sorts of inferential relations that imaginings and beliefs bear to each other. I show that this view does not have the absurd consequences that it may prima facie seem to have; on the contrary, it has important implications for our understanding of how the mind works. (shrink)

Predictive Processing accounts of Cognition, PPC, promise to forge productive alliances that will unite approaches that are otherwise at odds. Can it? This paper argues that it can’t—or at least not so long as it sticks with the cognitivist rendering that Clark and others favor. In making this case the argument of this paper unfolds as follows: Sect. 1 describes the basics of PPC—its attachment to the idea that we perceive the world by guessing the world. It then details the (...) reasons why so many find cognitivist interpretations to be inevitable. Section 2 examines how prominent proponents of cognitivist PPC have proposed dealing with a fundamental problem that troubles their accounts—the question of how the brain is able to get into the great guessing game in the first place. It is argued that on close inspection Clark’s solution, which he calls bootstrap heaven is—once we take a realistic look at the situation of the brain—in fact bootstrap hell. Section 3 argues that it is possible to avoid dwelling in bootstrap hell if one adopts a radically enactive take on PPC. A brief sketch of what this might look like is provided. (shrink)

Patients with psychotic disorders experience a range of reality distortions. These often include auditory-verbal hallucinations, and thought insertion to a lesser degree; however, their mechanisms and relationships between each other remain largely elusive. Here we attempt to establish a integrative model drawing from the phenomenology of both AVHs and TI and argue that they in fact can be seen as ‘spectra’ of experiences with varying degrees of agency and ownership, with ‘silent and internal own thoughts’ on one extreme and ‘fully (...) external and clearly audible voices’ in the absence of a speaker on the other. We believe a spectral model will add emphasis to the continuity of experience and help to better understand how one type of psychotic symptom may interact with another, and put forward the argument that the experience of TI itself is not sufficient to classify as a delusion. In addition we aim to discuss some of the conceptual issues surrounding AVHs and TI with first-person accounts and current philosophical and neuropsychological theories in mind. We propose that the mechanisms behind AVHs and TI are more complex than source-monitoring deficits; indeed, to understand such phenomena one must appreciate that their very ‘existence’ and ‘reality’ as experienced by the individual have much deeper implications and meaning, both philosophically and clinically. (shrink)

Shaun Gallagher calls for a radical rethinking of the concept of nature and he resists reduction of phenomenology to computational-neural science. However, classic, reductionist science, at least in contemporary computational guise, has the resources to accommodate insights from transcendental phenomenology. Reductionism should be embraced, not feared.

It is estimated that up to 7500 people develop schizophrenia each year in the UK. Schizophrenia has significant consequences, with 28% of the excess mortality in schizophrenia being attributed to suicide. Previous research suggests that suicide in schizophrenia may be more related to affective factors such as depression and hopelessness, rather than psychotic symptoms themselves. Considering suicide in schizophrenia within this framework enables us to develop a novel philosophical approach, in which suicide may not be related to loss of self-consciousness, (...) thought processing dysfunctions or perception disturbances. The action of suicide may be due neither to persistent hallucinations nor other psychotic symptoms, such as delusional beliefs, but to other underexamined, perhaps rational reasons, such as extreme social isolation, severe depression or emotional withdrawal. This paper does not examine the moral character of suicide. Instead, it argues that we should conceive the action of suicide in schizophrenia as an act that is not necessarily irrational. People with schizophrenia might end their life based on reasons if suicide is the best means to achieve their ends. However, the paper does not support assisted suicide. It aims to provide a better understanding of the reasons why people take their own lives and suggests that understanding can inform effective interventions to reduce high rates of suicide. (shrink)

A flood of new multidisciplinary work on the causes of depersonalization disorder provides a new way to think about the feeling that experiences “belong” to the self. In this paper I argue that this feeling, baptized “mineness” or “subjective presence” : 565–573, 2013) emerges from a multilevel interaction between emotional, affective and cognitive processing. The “self” to which experience is attributed is a predictive model made by the mind to explain the modulation of affect as the organism progresses through the (...) world. When the world no longer produces predicted affect the organism needs to explain this unpredicted absence of feeling. It is important to this account that cognition and perception are otherwise intact. Consequently the mind’s representation of the world and its emotionally salient properties are unchanged, leading the mind to predict a characteristic affective response. When that prediction is not fulfilled the organisms feels as if she is no longer present in experience. This is reported at the as feeling of depersonalization. (shrink)

The initial cause of Cotard delusion is pervasive dyshomeostasis (dysregulation of basic bodily function).This explanation draws on interoceptive active inference account of self‐representation. In this framework, the self is an hierarchical predictive model made by the brain to facilitate homeostatic regulation. The account I provide is an alternative to two factor accounts of the Cotard delusion that treat depersonalisation experience as the first factor in genesis of the Cotard delusion. I argue that depersonalisation experience and the Cotard delusion are produced (...) by different breakdowns in the process of self‐modelling. (shrink)

Resistance to the idea that phenomenology can be relevant to cognitive scientific explanation has faced two objections advanced, respectively, from both sides of the issue: from the scientific perspective it has been suggested that phenomenology, understood as an account of first-person experience, is ultimately reducible to cognitive neuroscientific explanation; and from a phenomenological perspective it has been argued that phenomenology cannot be naturalized. In this context it makes sense to consider that the notion of scientific reduction is linked to a (...) classic scientific conception of nature. I argue that if properly understood, the proposal to rethink the concept of nature itself, in enactivist phenomenological approaches, undermines the reductionist program and redefines what it means for phenomenology to be naturalized. (shrink)

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

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

If I see, hear, or touch a sparrow, the sparrow seems real to me. Unlike Bigfoot or Santa Claus, it seems to exist; I will therefore judge that it does indeed exist. The “sense of existence” refers to the kind of awareness that typically grounds such ordinary judgments of existence or “reality.” The sense of existence has been invoked by Humeans, Kantians, Ideologists, and the phenomenological tradition to make substantial philosophical claims. However, it is extremely controversial; its very existence has (...) been called into question. This paper aims to clarify the nature and reality of the sense of existence by studying a psychiatric condition in which the sense appears to be disrupted: depersonalization disorder (DPD). (shrink)

Many philosophers and cognitive scientists claim that our everyday or "folk" understanding of mental states constitutes a theory of mind. That theory is widely called "folk psychology" (sometimes "commonsense" psychology). The terms in which folk psychology is couched are the familiar ones of "belief" and "desire", "hunger", "pain" and so forth. According to many theorists, folk psychology plays a central role in our capacity to predict and explain the behavior of ourselves and others. However, the nature and status of folk (...) psychology remains controversial. (shrink)

This chapter proposes a radically enactive account of remembering that casts it as creative, dynamic, and wide-reaching. It paints a picture of remembering that no longer conceives of it as involving passive recollections – always occurring wholly and solely inside heads. Integrating empirical findings from various sources, the chapter puts pressure on familiar cognitivist visions of remembering. Pivotally, it is argued, that we achieve a stronger and more elegant account of remembering by abandoning the widely held assumption that it is (...) rooted in the retrieval of stored information or content in order to represent past events. We demonstrate how a radically enactive account of the roots of remembering can successfully handle classic cases discussed in the extended memory literature while, at same time, accommodating experientially rich forms of episodic memory. (shrink)

In this paper we have two main aims. First, we present an account of mood-congruent delusions in depression (hereafter, depressive delusions). We propose that depressive delusions constitute acknowledgements of self-related beliefs acquired as a result of a negatively biased learning process. Second, we argue that depressive delusions have the potential for psychological and epistemic benefits despite their obvious epistemic and psychological costs. We suggest that depressive delusions play an important role in preserving a person’s overall coherence and narrative identity at (...) a critical time, and thus can be regarded as epistemically innocent. (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 thesis is set out as a collection of self-standing essays. Throughout these essays, I try to illuminate a number of controversies surrounding the way in which delusions are formed, and relatedly, their nature and epistemic standing. In Chapter 2, after an introductory chapter, I flesh out a new ‘endorsement’ approach to the Capgras delusion, the main idea being that the delusion is formed by endorsing the content of a metaphorical-perceptual state in which a loved one is represented metaphorically as (...) an imposter. In Chapter 3, I take issue with the idea, prevalent in the literature, that Bayesian accounts of inference in delusions are best characterised as versions of ‘explanationism’. Taking one such influential account as a test case, I argue that it is no more or less compatible with the endorsement alternative, which says delusions are acquired non-inferentially from experience. In Chapter 4, I examine a recent critique of predictive processing theories of delusions, according to which such theories suffer two limitations: they fail to explain why an agent believes something delusional as opposed to nothing at all or something else; they fail to explain how delusional hypotheses are generated in the first place. I suggest ways in which these concerns might be addressed. In Chapter 5, I consider how the Spinozan theory of belief fixation can improve the prospects of doxasticism about delusions. Doxasticism has been criticised on the grounds that delusions typically do not abide by rational standards which 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. In Chapter 6, I ask whether misidentification delusions formed via endorsement processes have any measure of perceptual justification. To give the best chance of getting a ‘yes’ answer, I address the question from the perspective of perceptual dogmatism, as this appears the best option if we are to grant at least defeasible justifiedness to MDs. I argue that, even so, MDs are completely unjustified. (shrink)

In this thesis I propose a new way of understanding depressive illness as not exclusively harmful, but as related to particular, empirically evidenced, epistemic and pragmatic benefits for the subject, alongside the associated costs. For each of the benefits considered, I provide and concisely analyse the empirical evidence both in its favour and against it, suggest ways in which these benefits could apply in the circumstances presented, discuss some outstanding problems for that application as stated, and describe potential implications. The (...) issues discussed involve topics in cognitive psychology as well as in ethics, which I regard as complementary to the debate. I take the view that depression related phenomena such as low mood, low self-esteem, and mood-congruent delusions offer potential benefits to a subject under certain circumstances, but not under others. In discussing the hypotheses presented, I argue for a more complex view of depression, which includes its potential epistemic and pragmatic benefits as well as its costs and I propose possible directions for future research. (shrink)

Schizophrenia is usually described as a fragmentation of subjective experience and the impossibility to engage in meaningful cultural and intersubjective practices. Although the term schizophrenia is less than 100 years old, madness is generally believed to have accompanied mankind through its historical and cultural ontogeny. What does it mean to be “mad”? The failure to adopt social practices or to internalize cultural values of common sense? Despite the vast amount of literature and research, it seems that the study of schizophrenia (...) and of the psychoses is suffering from a generic disintegration. In this introduction, we offer an historical overview of the variety of theories and approaches to schizophrenia. We also provide an overview of how the authors in this volume attempt an integrative account where training, practice, theory and research are considered as parts of a larger whole. This is a varied and pluralistic volume, and it is up to the readers to make use of different chapters according to their own needs. (shrink)

Although delusion is one of the central concepts of psychopathology, it stills eludes precise conceptualization. In this paper, I present certain basic issues concerning the classification and definition of delusion, as well as its ontological status. By examining these issues, I aim to shed light on the ambiguity of the clinical term ‘delusion’ and its extension, as well as provide clues as to why philosophers are increasingly joining the ranks of psychiatrists, psychologists, and neuroscientists in the effort to come to (...) a comprehensive understanding of delusion. (shrink)