Mental Disorders

“On the Subject Matter of Phenomenological Psychopathology” provides a framework for the phenomenological study of mental disorders. The framework relies on a distinction between (ontological) existentials and (ontic) modes. Existentials are the categorial structures of human existence, such as intentionality, temporality, selfhood, and affective situatedness. Modes are the particular, concrete phenomena that belong to these categorial structures, with each existential having its own set of modes. In the first section, we articulate this distinction by drawing primarily on the work of (...) Martin Heidegger—especially his study of the ontological structure of affective situatedness (Befindlichkeit) and its particular, ontic modes, which he calls moods (Stimmungen). In the second section, we draw on a study of grief to demonstrate how this framework can be used when conducting phenomenological interviews and analyses. In the concluding section, we explain how this framework can be guide phenomenological studies across a broad range of existential structures. (shrink)

Discussions of psychiatric nosology focus on a few popular examples of disorders, and on the validity of diagnostic criteria. Looking at Anorexia Nervosa, an example rarely mentioned in this literature, reveals a new problem: the DSM has a strict taxonomic structure, which assumes that disorders can only be located on one branch. This taxonomic assumption fails to fit the domain of psychopathology, resulting in obfuscation of cross-category connections. Poor outcomes for treatment of Anorexia may be due to it being pigeonholed (...) as an Eating Disorder, when a disturbance of body perception may be a more central symptom than food restriction. This paper explores the possibility of restructuring the DSM taxonomy to allow for a pluralist classification of disorders. This change could improve treatment and research without requiring any changes to diagnostic criteria. (shrink)

The failure of psychiatry to validate its diagnostic constructs is often attributed to the prioritizing of reliability over validity in the structure and content of the Diagnostic and Statistical Manual of Mental Disorders. Here I argue that in fact what has retarded biomedical approaches to psychopathology is unwarranted optimism about diagnostic discrimination: the assumption that our diagnostic tests group patients together in ways that allow for relevant facts about mental disorder to be discovered. I consider the Research Domain Criteria framework (...) as a new paradigm for classifying objects of psychiatric research that solves some of the challenges brought on by this assumption. (shrink)

People suffering from Obsessive-Compulsive Disorder (OCD) do things they do not want to do, and/or they think things they do not want to think. In about 10 percent of OCD patients, none of the available treatment options is effective. A small group of these patients is currently being treated with deep brain stimulation (DBS). Deep brain stimulation involves the implantation of electrodes in the brain. These electrodes give a continuous electrical pulse to the brain area in which they are implanted. (...) It turns out that patients may experience profound changes as a result of DBS treatment. It is not just the symptoms that change; patients rather seem to experience a different way of being in the world. These global effects are insufficiently captured by traditional psychiatric scales, which mainly consist of behavioural measures of the severity of the symptoms. In this article we aim to capture the changes in the patients’ phenomenology and make sense of the broad range of changes they report. For that we introduce an enactive, affordance-based model that fleshes out the dynamic interactions between person and world in four aspects. The first aspect is the patients’ experience of the world. We propose to specify the patients’ world in terms of a field of affordances, with the three dimensions of broadness of scope (‘width’ of the field), temporal horizon (‘depth’), and relevance of the perceived affordances (‘height’). The second aspect is the person-side of the interaction, that is, the patients’ self-experience, notably their moods and feelings. Thirdly, we point to the different characteristics of the way in which patients relate to the world. And lastly, the existential stance refers to the stance that patients take towards the changes they experience: the second-order evaluative relation to their interactions and themselves. With our model we intend to specify the notion of being in the world in order to do justice to the phenomenological effects of DBS treatment. (shrink)

Deep Brain Stimulation (DBS) is a relatively new, experimental treatment for patients suffering from treatment-refractory Obsessive Compulsive Disorder (OCD). The effects of treatment are typically assessed with psychopathological scales that measure the amount of symptoms. However, clinical experience indicates that the effects of DBS are not limited to symptoms only: patients for instance report changes in perception, feeling stronger and more confident, and doing things unreflectively. Our aim is to get a better overview of the whole variety of changes that (...) OCD patients experience during DBS treatment. For that purpose we conducted in-depth, semi-structured interviews with 18 OCD patients. In this paper, we present the results from this qualitative study.We list the changes grouped in four domains: with regard to (a) person, (b) (social) world, (c)characteristics of person-world interactions, and (d) existential stance. We subsequently provide an interpretation of these results. In particular, we suggest that many of these changes can be seen as different expressions of the same process; namely that the experience of anxiety and tension gives way to an increased basic trust and increased reliance on one’s abilities. We then discuss the clinical implications of our findings, especially with regard to properly informing patients of what they can expect from treatment, the usefulness of including CBT in treatment, and the limitations of current measures of treatment success. We end by making several concrete suggestions for further research. (shrink)

Louis Charland has argued that the Cluster B personality disorders, including borderline personality disorder, are primarily moral rather than clinical conditions. Part of his argument stems from reflections on effective treatment of borderline personality disorder. In the argument from treatment, he claims that successful treatment of all Cluster B personality disorders requires a positive change in a patient’s moral character. Based on this claim, he concludes (1) that these disorders are, at root, deficits in moral character, and (2) that effective (...) treatment of these disorders requires a sort of moral education rather than clinical intervention. In this paper, I evaluate the argument from treatment through a critical analysis of two psychotherapeutic interventions that have shown recent effectiveness against borderline personality disorder. I suggest that both Dialectical Behaviour Therapy and Mentalization-Based Treatment indicate that borderline personality disorder is, at root, a deficit in non-moral cognitive and emotional capacities. I suggest that these non-moral deficits obscure the expression of an otherwise intact moral character. In light of this, I conclude that effective treatment of borderline personality disorder requires primarily clinical intervention rather than moral edification. (shrink)

This unpublished article was written around 2009 for a journal special issue of a journal which never materialized. In 2018, the article was rewritten and published in the Oxford Handbook of Philosophy and Disability. It can be found on PhilPapers as Drayson and Clark (2018), 'Cognitive Disability and the Embodied, Extended Mind'.

I attempt to describe and defend an alternative definition of insanity. I claim that my definition follows from an adequate general understanding of legal excuse and that it describes correctly the question that jurors in the recent Andrea Yates case and others like it ought to be faced with. My essay has three parts. In the first, I briefly criticize M'Naghten- and Durham-inspired insanity statutes. In the second, I sketch and defend a general understanding of legal excuse and try to (...) show how an adequate insanity statute follows from it. Finally, in the third section, I describe and defend a rough version of the statute itself. In the course of doing so, I try to explain why I believe that statute is superior to the American Law Institute's various model insanity statutes. (shrink)

I show that Pickard’s argument against the irresistibility of addiction fails because her proposed dilemma, according to which either drug-seeking does not count as action or addiction is resistible, is flawed; and that is the case whether or not one endorses Pickard’s controversial definition of action. Briefly, we can easily imagine cases in which drug-seeking meets Pickard’s conditions for agency without thereby implying that the addiction was not irresistible, as when the drug addict may take more than one route to (...) go meet her dealer. (shrink)

Gaetano commented on the problems that exist in diagnosing schizophrenia and argues that more effort should be devoted to understanding relevant subjective experiences. I am not convinced that this is necessarily so. I have argued previously that diagnosis of clinical disorders is unlikely to work well in the absence of a theory on which the diagnostic system can be based. At present, there is very little theory concerning schizophrenic disorders, or at least very little theory that elicits wide agreement and (...) has definitive empirical support. (shrink)

Dear editor, we read with interest the article by Gilio et al.. Previous transcranial magnetic stimulation studies in focal epileptic patients brought to controversial results.

It is my contention that the table of intentionality (rationality, mind, thought, language, personality etc.) that features prominently here describes more or less accurately, or at least serves as an heuristic for, how we think and behave, and so it encompasses not merely philosophy and psychology, but everything else (history, literature, mathematics, politics etc.). Note especially that intentionality and rationality as I (along with Searle, Wittgenstein and others) view it, includes both conscious deliberative linguistic System 2 and unconscious automated prelinguistic (...) System 1 actions or reflexes. -/- I provide a critical survey of some of the major findings of two of the most eminent students of behavior of modern times, Ludwig Wittgenstein and John Searle, on the logical structure of intentionality (mind, language, behavior), taking as my starting point Wittgenstein’s fundamental discovery –that all truly ‘philosophical’ problems are the same—confusions about how to use language in a particular context, and so all solutions are the same—looking at how language can be used in the context at issue so that its truth conditions (Conditions of Satisfaction or COS) are clear. The basic problem is that one can say anything but one cannot mean (state clear COS for) any arbitrary utterance and meaning is only possible in a very specific context. I analyze various writings by and about them from the modern perspective of the two systems of thought (popularized as ‘thinking fast, thinking slow’), employing a new table of intentionality and new dual systems nomenclature. I show that this is a powerful heuristic for describing behavior. -/- Thus, all behavior is intimately connected if one takes the correct viewpoint. The Phenomenological Illusion (oblivion to our automated System 1) is universal and extends not merely throughout philosophy but throughout life. I am sure that Chomsky, Obama, Zuckerberg and the Pope would be incredulous if told that they suffer from the same problem as Hegel, Husserl and Heidegger, (or that that they differ only in degree from drug and sex addicts in being motivated by stimulation of their frontal cortices by the delivery of dopamine (and over 100 other chemicals) via the ventral tegmentum and the nucleus accumbens), but it’s clearly true. While the phenomenologists only wasted a lot of people’s time, they are wasting the earth and their descendant’s future. (shrink)

I develop and defend the view that subjects are necessarily psychologically able to revise their beliefs in response to relevant counter-evidence. Specifically, subjects can revise their beliefs in response to relevant counter-evidence, given their current psychological mechanisms and skills. If a subject lacks this ability, then the mental state in question is not a belief, though it may be some other kind of cognitive attitude, such as a supposi-tion, an entertained thought, or a pretense. The result is a moderately revisionary (...) view of belief: while most mental states we thought were beliefs are beliefs, some mental states which we thought were beliefs are not beliefs. The argument for this view draws on two key claims: First, subjects are rationally obligated to revise their beliefs in response to relevant counter-evidence. Second, if some subject is rationally obligated to revise one of her mental states, then that subject can revise that mental state, given her current psychological mechanisms and skills. Along the way to defending these claims, I argue that rational obligations can govern activities which reflect on one’s rational character, whether or not those activities are under one’s voluntary control. I also show how the relevant version of epistemic ‘ought’ implies ‘can’ survives an objection which plagues other variants of the principle. (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)

In this paper I discuss the scientific respectability of delusion as a psychiatric category. First, I present the essentialist objection to the natural kindhood of psychiatric categories, as well as non-essentialism about natural kinds as a response to that objection. Second, I present a nuanced classification of kinds of kinds. Third, drawing on the claim that the attribution of delusion relies on a folk psychological underpinning, I present the mind-dependence objection to the natural kind status of delusion. Finally, I argue (...) that even if delusion as a generic kind stands little chance of being vindicated as a non-essentialist natural kind, we stand to gain from a natural kind methodology regarding subtypes of delusion for which there is evidence of genuine causal signatures and mechanisms. (shrink)

Bortolotti argues that we cannot distinguish delusions from other irrational beliefs in virtue of their epistemic features alone. Although her arguments are convincing, her analysis leaves an important question unanswered: What makes delusions pathological? In this paper I set out to answer this question by arguing that the pathological character of delusions arises from an executive dysfunction in a subject’s ability to detect relevance in the environment. I further suggest that this dysfunction derives from an underlying emotional imbalance—one that leads (...) delusional subjects to regard some contextual elements as deeply puzzling or highly significant. (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)

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)

Examino a controvérsia sobre como melhor definir o delírio—um sintoma central de patologias como a esquizofrenia e a demência—e apresentarei algumas das principais dificuldades envolvidas em sua caracterização como crenças. A partir disso, tiro conclusões sobre os limites do vocabulário mentalista da dita psicologia do senso comum e sobre a forma como delírios e outros fenômenos elusivos devem ser propriamente caracterizados pela psiquiatria para que uma explicação integrativa destes seja alcançada.

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

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)

There has recently been emphasis put on providing two-factor accounts of monothematic delusions. Such accounts would explain (1) whether a delusional hypothesis (e.g. someone else is inserting thoughts into my mind) can be understood as a prima facie reasonable response to an experience and (2) why such a delusional hypothesis is believed and maintained given its implausibility and evidence against it. I argue that if we are to avoid obfuscating the cognitive mechanisms involved in monothematic delusion formation we should split (...) the first factor (1 above) into two factors: how abnormal experience can give rise to a delusional ‘proto-hypothesis’ and how a ‘proto-hypothesis’ in consort with normal experiences and background information, can be developed into a delusional hypothesis. In particular I will argue that a schizophrenic is faced with the unusual requirement of having to identify an introspectively accessible thought as one's own, and that this requirement of identification is the central experiential abnormality of thought insertion, auditory verbal hallucination, and alien control (i.e. passivity symptoms). Additionally, I will consider non-experiential factors which are required for the formation of a delusional hypothesis. (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)

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

The aim of the article is to present the contemporary concepts of delusions from the phenomenological perspective. The difficulties to define delusions and the examples of delusional disorders, such as delusional mood, Cotard’s syndrome, or Capgras delusions, serve as the point of departure for this analysis. The questions of the phenomenological understanding of delusions are presented in the context of Karl Jaspers' theory of the incomprehensibility of psychotic thinking (primary delusions, delusional mood). The subsequent analysis presents the constraints of contemporary (...) cognitive theories of delusions. The criticism of said theories highlights the need for creating a broader concept of experience and cognition and results in the proposition to use the terms "background" and “embodiment" as theoretical tools for a more complete understanding of the peculiarities of delusional experience. (shrink)

Recent papers on the Capgras delusion have focused on the role played by subpersonal abductive inference in the formation and maintenance of the delusional belief. In these accounts, the delusional belief is posited as the first delusion-related event of which the patient is conscious. As a consequence, an explanatory role for anomalous patient experience is denied. The aim of this paper is to challenge this revisionist position and to integrate subpersonal inference within a model of the Capgras delusion which includes (...) a role for experiential content. I argue that the following revisionist claims are problematic: (a) that a fully-formed belief enters consciousness, and (b) that this is the first conscious delusion-related event. Instead, it is my contention that a delusional thought (arrived at through subpersonal abductive inference) and an anomalous experience co-occur in consciousness prior to the formation of the delusional belief. The co-occurrence of thought and anomalous experience overcomes problems with the revisionist position resulting in an account of the Capgras delusion with greater explanatory efficacy. (shrink)

In this paper we consider an argument that is very influential in the philosophical literature, the argument from causal role against the view that delusions are beliefs. The argument has two premises, that many delusions fail to play belief-roles and that playing belief-roles is necessary for a mental state to be a belief. We assess both premises and suggest that they can be resisted.

The patient with Capgras’ syndrome claims that people very familiar to him have been replaced by impostors. I argue that this disorder is due to the destruction of a representation that the patient has of the mind of the familiar person. This creates the appearance of a familiar body and face, but without the familiar personality, beliefs, and thoughts. The posterior site of damage in Capgras’ is often reported to be the temporoparietal junction, an area that has a role in (...) the mindreading system, a connected system of cortical areas that allow us to attribute mental states to others. Just as the Capgras’ patient claims that that man is not his father, the patient with asomatognosia claims that his arm is not really his. A similar account applies here, in that a nearby brain area, the supramarginal gyrus, is damaged. This area works in concert with the temporoparietal junction and other areas to produce a large representation of a mind inside a body situated in an environment. Damage to the mind-representing part of this system (coupled with damage to executive processes in the prefrontal lobes) causes Capgras’ syndrome, whereas damage to the body-representing part of this system (also coupled with executive damage) causes asomatognosia. (shrink)

Delusions are defined as irrational beliefs that compromise good functioning. However, in the empirical literature, delusions have been found to have some psychological benefits. One proposal is that some delusions defuse negative emotions and protect one from low self-esteem by allowing motivational influences on belief formation. In this paper I focus on delusions that have been construed as playing a defensive function (motivated delusions) and argue that some of their psychological benefits can convert into epistemic ones. Notwithstanding their epistemic costs, (...) motivated delusions also have potential epistemic benefits for agents who have faced adversities, undergone physical or psychological trauma, or are subject to negative emotions and low self-esteem. To account for the epistemic status of motivated delusions, costly and beneficial at the same time, I introduce the notion of epistemic innocence. A delusion is epistemically innocent when adopting it delivers a significant epistemic benefit, and the benefit could not be attained if the delusion were not adopted. The analysis leads to a novel account of the status of delusions by inviting a reflection on the relationship between psychological and epistemic benefits. (shrink)

Review of Eric Reitan's Is God a Delusion.

The unit of selection is the concept of that ‘something’ to which biologists refer when they speak of an adaptation as being ‘for the good of’ something. Darwin identified the organism as the unit of selection because for him the ‘struggle for existence’ was an issue among individuals. Later on it was suggested that, in order to understand the evolution of social behavior, it is necessary to argue that groups, and not individuals, are the units of selection. The last addition (...) to this debate was the formulation by Dawkins, in 1976, that the genes themselves are the units of selection while the organisms are merely the temporary receptacles and vehicles for such genes. Thus, the preposterous dissolution of the organism into genes and the proteins coded by such genes has been introduced in the evolutionary discourse by neglecting that the explanations for biological phenomena can be either synchronic or diachronic, depending on the phenomenon to be explained. Therefore explanations in molecular biology are synchronic while evolutionary biology needs diachronic explanations. Nevertheless, for ultra-Darwinians such as Dawkins, efficient replication is all that biology is about. Here I develop an argument in order to show that there is nothing in molecular and cell biology that might support such a contention and that the idea of the gene as the unit of selection is incompatible with the evident evolution of biological complexity. (shrink)

Three challenges to a unified understanding of delusions emerge from Radden's On Delusion (2011). Here, I propose that in order to respond to these challenges, and to work towards a unifying framework for delusions, we should see delusions as arising in inference under uncertainty. This proposal is based on the observation that delusions in key respects are surprisingly like perceptual illusions, and it is developed further by focusing particularly on individual differences in uncertainty expectations.

My central question in this paper is how delusional beliefs are related to self-deception. In section 1, I summarize my position on what self-deception is and how representative instances of it are to be explained. I turn to delusions in section 2, where I focus on the Capgras delusion, delusional jealousy (or the Othello syndrome), and the reverse Othello syndrome.

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

Bortolotti’s Delusions and Other Irrational Beliefs defends the view that delusions are beliefs on a continuum with other beliefs. A different view is that delusions are more like illusions, that is, they arise from faulty perception. This view, which is not targeted by the book, makes it easier to explain why delusions are so alien and disabling but needs to appeal to forensic aspects of functioning.

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

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

In psychiatry some disorders of cognition are distinguished from instances of normal cognitive functioning and from other disorders in virtue of their surface features rather than in virtue of the underlying mechanisms responsible for their occurrence. Aetiological considerations often cannot play a significant classificatory and diagnostic role, because there is no sufficient knowledge or consensus about the causal history of many psychiatric disorders. Moreover, it is not always possible to uniquely identify a pathological behaviour as the symptom of a certain (...) disorder, as disorders that are likely to differ both in their causal histories and in their overall manifestations may give rise to very similar patterns of behaviour. -/- Consider delusions as an example. It wouldn’t be correct to define delusions as those beliefs people form as a result of a neurobiological deficit and a hypothesis-evaluation deficit (as some versions of the two-factor theory of delusions suggest), because for some delusions no neurobiological deficit may be found, and reasoning biases and motivational factors may be contributors to the formation of the delusion (e.g. McKay et al., 2005). Moreover, it would be a mistake to define delusions as symptoms of schizophrenia alone, because they occur also in other disorders, including dementia, amnesia, and delusional disorders. Thus, aetiological considerations may appear in the description and analysis of delusions, but do not feature prominently in their definition. -/- In this paper I argue that the surface features used as criteria for the classification and diagnosis of disorders of cognition are often epistemic in character. I shall offer two examples: confabulations and delusions are defined as beliefs or narratives that fail to meet standards of accuracy and justification. Although classifications and diagnoses based on features of people’s observable behaviour are necessary at these early stages of neuropsychiatric research, given the variety of conditions in which certain phenomena appear, I shall attempt to show that current epistemic accounts of confabulations and delusions have limitations. Epistemic criteria can guide both research and clinical practice, but fail to provide sufficient conditions for the identification of delusions and confabulations, and fail to demarcate pathological from non-pathological narratives or beliefs. -/- Another limitation of current epistemic accounts – which I shall not address here – is the excessive focus on epistemic faults of confabulations and delusions at the expense of their epistemically neutral or advantageous features (see Bortolotti and Cox, 2009). This may lead to a misconception of delusions and confabulations, and to an oversimplification in the assessment of the needs of people who require clinical treatment for their psychotic symptoms. (shrink)

In this paper, I investigate in detail one theoretical approach to the symptom of thought insertion. This approach suggests that patients are lead to disown certain thoughts they are subjected to because they lack a sense of active participation in the occurrence of those thoughts. I examine one reading of this claim, according to which the patients’ anomalous experiences arise from a breakdown of cognitive mechanisms tracking the production of occurrent thoughts, before sketching an alternative reading, according to which their (...) experiences have to be explained in terms of a withdrawal, on the part of the patients themselves, from certain forms of active engagement in reasoning. I conclude with a discussion of the relationship between this view and the idea that patients’ reports of thought insertion reflect a situation in which the boundaries between the self and the world have become uncertain. (shrink)

This essay explores the topic of Dissociative Identity Disorder (formerly called “Multiple Personality Disorder”) with special attention to such Quadrophenia masterpieces as “Dr. Jimmy” and “The Real Me.” A number of major philosophical questions arise: Can two or more “persons” really inhabit the same body? How can we hold Dr. Jimmy morally responsible for the reprehensible actions of Mr. Jim? Wouldn’t it be wrong to do so if they are really different people? What is it to be the “same” person (...) over time? Does Dr. Jimmy really have free will? The focus is on the much discussed and important notions of personal identity, free will, and moral responsibility. (shrink)

Finding truth is an art that was learned and unlearned. Truth can only be found by looking for independent confirmation of our beliefs, by reality. This methodology is difficult to apply in personal- and social settings, because power and politics turn 'seeking independent confirmation' into 'avoiding dependent rejection'. A completely different social order is implied and the one keeps running the other into the ground like a tectonic plate. Philosophical Modernism showed us how dualism works, before Post-Modernism challenged it, regressing (...) to monism. (shrink)

A striking feature of post-modernism is its distrust of the subject. If the modern period, beginning with Descartes, sought in the subject a source of certainty, an Archimedian point from which all else could be derived, post- modernism has taken the opposite tack. Rather than taking the self as a foundation, it has seen it as founded, as dependent on the accidents which situate consciousness in the world. The same holds for the unity of the subject. Modernity, in its search (...) for a single foundation, held the subject to be an indissoluble unity. Post-modernism’s position, by contrast, is announced by Nietzsche: “The assumption of one single subject is perhaps unnecessary; perhaps it is just as permissible to assume a multiplicity of subjects, whose interaction and struggle is the basis of our thought and our consciousness in general? ...My hypotheses: The subject as multiplicity.” Given this, there is a natural correspondence between the success of post- modernism and the current interest in multiple personality disorder. In the latter, we actually have the experience of a “multiplicity of subjects” in their interaction and struggle. The subject stands there before us “as multiplicity.” It gives us a concrete case, one which raises some of the pressing questions associated with the post-modern denial of the subject. Confronting it, we ask: how real are the personalities composing the multiplicity of this disordered self? What, in fact, does this multiplicity tell us about the self? about its genesis and status? What does it reveal about “our thought and consciousness in general”? I plan, in the short compass of this paper, to sketch some answers to these questions. §1. A brief description of MPD. The American Psychiatric Association gives two criteria for (MPD) multiple personality disorder. First, and most obviously, there is “the existence within the person of two or more distinct personalities or personality states (each with its own relatively enduring pattern. (shrink)

In this paper we argue that dissociative identity disorder (DID) is best interpreted as a causal model of a (possible) post-traumatic psychological process, as a mechanical model of an abnormal psychological condition. From this perspective we examine and criticize the evidential status of DID, and we demonstrate that there is really no good reason to believe that anyone has ever suffered from DID so understood. This is so because the proponents of DID violate basic methodological principles of good causal modeling. (...) When every ounce of your concentration is fixed upon blasting a winged pig out of the sky, you do not question its species' ontological status. James Morrow, City of Truth (1990). (shrink)

The aim of my paper is to review the discussion concerning various difficulties which surround the definition of depression and the methods of diagnosing and treating the disease against the background of the now dominant reductionist paradigm in psychiatry, as well as to answer the question whether a new approach to psychiatric disorders proposed by philosophers of psychiatry working within the phenomenologically inspired embodied and enactive paradigm indeed offers a solution to these difficulties. I present the issues specific to the (...) subject of depression in light of the more general problems related to biological psychiatry that have recently caused much debate. In the second part of the paper, I consider enactive, phenomenological and embodied theories of depression and the possibilities of new methods of treatment. My goal is to assess whether these theories indeed add anything important to the conceptions that are already present in psychiatry. I conclude that even if the embodied philosophy of psychiatry does not solve many of the problems faced by modern psychiatry, it can, nevertheless, provide a useful theoretical basis for future changes. (shrink)