This article examines the supposedly incomprehensibility of schizophrenic delusions. According to the contemporary classificatory systems (DSM-IV-TR and ICD-10), some delusions typically found in schizophrenia are considered bizarre and incomprehensible. The aim of this article is to discuss the notion of understanding that deems these delusions incomprehensible and to see if it is possible to comprehend these delusions if we apply another notion of understanding. First, I discuss the contemporary schizophrenia definitions and their inherent problems, and I argue that the notion (...) of incomprehensibility in these definitions rests heavily on Jaspers’ notions of understanding and empathy. Secondly, I discuss two Wittgensteinian attempts to comprehend bizarre delusions: (a) Campbell’s proposal to conceive delusions as framework propositions and (b) Sass’s suggestion to interpret delusions in the light of solipsism. Finally, I discuss the phenomenological conception of schizophrenia, which conceives delusion formation as resulting from alterations of the structure of experiencing and from underlying self-disorders. I argue that although a psychological understanding that seeks to grasp meaning in terms of motivations, desires, and other more straightforward psychological connections between mental states is impossible in schizophrenia, we can in fact have a philosophical understanding of the schizophrenic world and of the emergence of delusions typically found in schizophrenia. (shrink)

By examining first-person descriptions of thought insertion I show that thought insertion is a complex and heterogeneous phenomenon. People experiencing this phenomenon have huge difficulty explaining what it is like due to the bizarre nature of the experience. Through careful analysis of first-person descriptions I identify some of the characteristics of thought insertion. I then briefly examine some of the philosophical literature regarding agency, ownership and thought insertion and conclude that the standard account of the basic characteristics of thought insertion (...) is inadequate when we consider the phenomenon as it is experienced. First person descriptions suggest that thought insertion is characterised by a lack of personal ownership and not simply by a loss of agency or authorship. This is an important factor that should inform research and therapeutic intervention. We cannot hope to arrive at appropriate therapeutic intervention or identify underlying neuronal mechanisms for the experience if we cannot say what the experience actually is. I further suggest that more analysis of first-person description is required for an improved account of the phenomenology of thought insertion. (shrink)

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

In this paper, we use a phenomenological approach to compare the unusual ways in which language can be experienced by individuals with schizophrenia or severe mood disorders, specifically mania and melancholia. Our discussion follows a tripartite/dialectical format: first we describe traditionally observed distinctions ; then we consider some apparent similarities in the experience of language in these conditions. Finally, we explore more subtle, qualitative differences. These involve: 1, interpersonal orientation, 2, forms of attention and context-relevance, 3, underlying mutations of experience, (...) and 4, meta-attitudes toward language. Such distinctions appear to reflect significant differences in underlying forms of subjectivity; they are broadly consistent with work in phenomenological psychopathology on other aspects of experience, including body, self, and social world. An understanding of such distinctions may assist with difficult cases of differential diagnosis, while also contributing to a better understanding of suffering persons and of psychological factors underlying their disorders. (shrink)

One of the tasks that recent philosophy of psychiatry has taken upon itself is to extend the range of understanding to some of those aspects of psychopathology that Jaspers deemed beyond its limits. Given the fundamental difficulties of offering a literal interpretation of the contents of primary delusions, a number of alternative strategies have been put forward including regarding them as abnormal versions of framework propositions described by Wittgenstein in On Certainty. But although framework propositions share some of the apparent (...) epistemic features of primary delusions, their role in partially constituting the sense of inquiry rules out their role in helping to understand delusions. (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)

Human rights theory generally conceptualizes freedom of thought, conscience, religion, and belief as well as freedom of opinion and expression, as offering absolute protection in what is called the forum internum. At a minimum, this is taken to mean the right to maintain thoughts in one’s own mind, whatever they may be and independently of how others may feel about them. However, if we adopt this stance, it seems to imply that there exists an absolute right to hold psychotic delusions. (...) This article takes the position that this conclusion is ethically problematic from the perspective of psychiatric treatment and the rights of persons with psychosis. The article reflects on this particular challenge and sets forth an understanding of freedom in the forum internum that might apply to situations where for various reasons it is not, necessarily accurate to maintain that persons have an absolute right to their own thoughts. For the purpose of proposing such an understanding, the article engages with current debates within human rights theory and political philosophy and analyzes discussions about psychotic delusions and the way in which involuntary treatment is justified. Based on this analysis, this article in turn conceptualizes freedom in the forum internum as ‘negative liberty’, ‘authenticity’, and ‘capability’. This article suggests that when forum internum is redefined as encompassing a right to certain internal capabilities, the right remains meaningful for persons with psychotic delusions as well. (shrink)

No particular dagger was the object of Macbeth’s hallucination of a dagger. In contrast, when he hallucinated his former comrade Banquo, Banquo himself was the object of the hallucination. Although philosophers have had much to say about the nature and philosophical import of hallucinations (e.g. Macpherson and Platchias, Hallucination, 2013) and object-involving attitudes (e.g. Jeshion, New essays on singular thought, 2010), their intersection has largely been neglected. Yet, object-involving hallucinations raise interesting questions about memory, perception, and the ways in which (...) we have knowledge of the world around us. In this paper, I offer an account of object-involving hallucinations. Specifically, I argue that they are an unusual species of perceptual remembering. (shrink)

La concepción de Marcus sobre las creencias se aplica al debate centrado en la cuestión: "¿Son creencias los delirios?" Dos consecuencias que se siguen de ello son: i) que la cuestión "¿Son creencias los delirios?" necesita reformularse, y ii) que la respuesta es: "No, algunos pacientes que sufren delirios no creen lo que, "prima facie", parecen creer".

Louis Sass disputes that schizophrenia can be understood successfully according to the hitherto dominant models--for much of what schizophrenics say and do is neither regressive (as psychoanalysis claims) nor just faulty reasoning (as "cognitivists" claim). Sass argues instead that schizophrenics frequently exhibit hyper-rationality, much as philosophers do. He holds that schizophrenic language can after all be interpreted--if we hear it as Wittgenstein hears solipsistic language. I counter first that broadly Winchian considerations undermine both the hermeneutic conception of interpreting other humans (...) in general and Sass's hope of interpreting schizophrenics in particular. I then go on to argue that even if these Winchian considerations are not accepted, Sass in any case doesn't take sufficiently seriously Wittgenstein's use of nonsense as a term of criticism. Solipsism is not something we can understand so as to be able to understand analogically the schizophrenic's "world"--for there is no such thing as understanding it. Solipsism is nonsense, is nothing--there is no "world" there, in solipsists (as I show by reference to Cora Diamond's reading of Wittgenstein). Nor in any actually analogous cases of schizophrenia. Their "alienness" is the alienness of nothingness; roughly, of the fantasy of "logically alien thought". (shrink)

Starting from a comparison of the similarities between a poem by Sylvia Plath called Tulips and the words of someone in the thrall of a delusion I develop a phenomenology of how mood is basic to our articulation of the world. To develop this argument I draw on Heidegger’s concept of attunement [befindlichkeit] and his contention that basic emotions open up aspects of the world for closer inspection and articulation. My thesis in this paper is that there is an underlying (...) structural similarity between the forms of words used in poems and those found in medically diagnosed delusions and this similarity is based on the role of mood in both arenas. The difference, I argue, is that although both forms of articulation are negotiated ‘as if’ the subject matter was literal, the person writing the poem is self-aware that their uses of language are figurative and metaphorical. This is because the emotional lens they use to describe a situation poetically can always be removed by a return to a ground-mood of acceptance, that prevents them from becoming lost in the poetical mood. The person experiencing psychosis, on the other hand, is unable to extricate herself from the mood that underlies their delusional utterances as they have lost access to the ground-mood that the poet takes for granted. I illustrate the point using Hume’s famous statement about the mood he philosophises in and look at ways sufferers from delusions could regain a sense of the non-literal projections of their words. (shrink)

This dissertation combines two scientific disciplines and research fields, namely philosophy and psychopathology. Within such a wide field of investigation, two precise perspectives are to be adopted in this inquiry: stemming from the first field, the phenomenological perspective on subjectivity and intersubjectivity; stemming from the second, the psychopathological perspective on schizophrenia. The combination of philosophy and psychopathology has often proven fruitful. Moreover, the main motivation for such combined approach is justified by the strong belief that, when critically used, phenomenology offers (...) a viable method of studying the first-personal perspective of experience, including the experiences of people with mental disorders. Philosophical analysis can thereby be used as a means to evaluate the meaning and adequacy of psychopathological concepts and ideas. As a result, phenomenological psychopathology may help understand what is often claimed to be incomprehensible. Particularly for the understanding of schizophrenia, this is taken to be a valuable contribution. For more than twenty years now, the phenomenological approach to schizophrenia has developed a strong and influential hypothesis on the basic alterations of this disorder. Schizophrenia, it is claimed, is a disorder of subjectivity, and more specifically, a disorder of the minimal self. Simultaneously, and often in conjunction, philosophical research on the self has vastly proliferated. The vivid interaction between these two fields makes the phenomenology of schizophrenia a good example of effective interdisciplinary work. Within the philosophical debate on subjectivity, intersubjectivity, or the relation between self and other, is currently a key topic. However, this has not significantly influenced the psychopathology of schizophrenia yet. The initial and fundamental claim of this dissertation is indeed that a renewed evaluation and inclusion of intersubjectivity, next to subjectivity, is to increase the validity of the phenomenological approach to schizophrenia. This would allow the previous hypothesis on schizophrenia as minimal self disorder to be challenged, criticized, or complemented, which would accordingly increase the significance and its clinical value. What I will attempt to do in this dissertation is then to thoroughly evaluate the role of intersubjectivity in schizophrenia. It will hence become clear what this role and its significance are. Consequently, I will finally argue that the basic alterations of schizophrenia concern both subjectivity and intersubjectivity. My argument is developed in four chapters. In the first, I introduce the topic of the self, including the distinction between the minimal and the extended self. This chapter equally introduces schizophrenia as a psychiatric concept, and three different clinical approaches are discussed, among which the phenomenological approach in most detail. After the topics of the self and schizophrenia, I introduce intersubjectivity, notably from a developmental-psychological perspective. By way of status quaestionis, I recapitulate the current research on intersubjectivity and schizophrenia. It will become clear that this research is relatively scarce. I then conclude the chapter with a full formulation of the two research questions informing this dissertation, namely Is schizophrenia an intersubjectivity-disorder? and Which self-concept is suited to define schizophrenia as a self and intersubjectivity disorder? The second chapter examines the phenomenology of intersubjectivity. The exact delineation of what is meant here by intersubjectivity will allow the reader to acknowledge its extent and variety. This chapter is aimed to provide the necessary philosophical tools to analyse schizophrenia in the light of intersubjectivity. In the third chapter I turn to psychopathology. In the first section, I analyse the work of seven major psychopathologists on schizophrenia. The goal of this section is to look for elements of intersubjectivity in their accounts of schizophrenia. Many of these psychopathologists have been influential for the development of the current self-disorder hypothesis, and the investigation intends to show how some crucial intersubjective elements in their work have been neglected. In the second section of this chapter, I focus on the symptoms, signs, and phenomena of schizophrenia that relate to intersubjectivity. This chapter finally offers all the material needed to positively answer the first research question. In the fourth chapter, I bring together psychopathology and philosophy, and I attempt to answer the two research questions. Since Chapter 3 allows me to affirmatively answer the first question, I examine whether the current self-disorder hypothesis is adequate to integrate intersubjectivity disturbances. It will appear that it is not, and the first section of this chapter consequently deals with the question why intersubjectivity and its disturbances have been neglected until now. In the second section it will become clear that no different self-concept is required, but that schizophrenia primarily concerns a particular capacity or orientation of subjectivity. I introduce the concept of open subjectivity and thereby answer the second research question. By describing schizophrenia as a disturbance of open subjectivity, I am finally able to integrate both self-disturbances and intersubjectivity-disturbances into a coherent and unified theory. To conclude this dissertation, I summarize and recapitulate its major issues, questions, and results in Chapter 5. Both clinical implications and possible future research are also discussed here. (shrink)

Delusions are studied in two philosophical traditions: the continental or phenomenological tradition and the Anglo-American or analytic tradition. Each has its own view of delusions. Broadly stated, phenomenologists view delusions as a disturbed experience whilst most analytic researchers view them as beliefs. It is my contention that the most plausible account of delusions must ultimately incorporate valuable insights from both traditions. To illustrate the potential value of integration I provide a novel model of the Capgras delusion which describes how an (...) analytic, cognitive neuropsychological two-factor account of the Capgras delusion and the phenomenological view of delusions might be integrated. (shrink)

A recent debate in the literature on delusions centers on the question of whether delusions are beliefs or not. In this paper, an overlooked distinction between egocentric and encyclopedic doxastic states is introduced and brought to bear on this debate, in particular with regard to delusions of misidentification. The result is that a more accurate characterization of the delusional subject’s doxastic point of view is made available. The patient has a genuine egocentric belief (“This man is not my father”), but (...) fails to have the commonly attributed encyclopedic belief (“My father has been replaced by an impostor”). (shrink)

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

On one influential view, the problems that should attract medical attention involve a disorder, because the goals of medical practice are to prevent and treat disorders. Based on this view, if there are no mental disorders then the status of psychiatry as a medical field is challenged. In this paper, I observe that it is often difficult to establish whether the problems that attract medical attention involve a disorder, and argue that none of the notions of disorder proposed so far (...) offers a successful demarcation criterion between medical and non-medical problems. As an illustration, I consider why delusions are considered pathological and whether they attract medical attention in virtue of being pathological, where ‘pathological’ stands for ‘being caused by a disorder’. Although there are several promising answers to what makes delusions pathological, available accounts of the pathological nature of delusions fail to distinguish delusions from other irrational beliefs that are not typically thought of as pathological; and cannot explain why delusions typically attract medical attention whereas other irrational beliefs do not. (shrink)

Here we consider interpersonal experience in schizophrenia, melancholia, and mania. Our goal is to improve understanding of similarities and differences in how other people can be experienced in these disorders, through a review of first-person accounts and case examples and of contemporary and classic literature on the phenomenology of these disorders. We adopt a tripartite/dialectical structure: first we explore main differences as traditionally described; next we consider how the disorders may resemble each other; finally we discuss more subtle but perhaps (...) foundational ways in which the phenomenology of these disorders may nonetheless be differentiated. These involve disruptions of common sense and conventionality, abnormalities of empathy, distinct forms of paranoia and the sense of personal centrality, and altered perceptions of intentionality, deadness, and artificiality. We end by considering some neurocognitive research relevant to these abnormal forms of subjectivity, including work on theory of mind, experience of human movement, and perception of faces. (shrink)

I begin by examining how genetics drivesschizophrenia research, and raise both familiar andrelatively novel criticisms of the evidence putativelysupporting the genetic basis of schizophrenia. Inparticular, I call attention to a set of concernsabout the effects of placentation on concordance ratesof schizophrenia in monozygotic twins, which furtherweakens the case for schizophrenia''s so-called stronggenetic component. I then underscore two criticalpoints. First, I emphasize the importance of takingseriously considerations about the complexity of bothontogenesis and the development of hereditarydiseases. The recognition of developmentalconstraints and (...) supports is crucial, for attention todevelopment exposes the naivete of too many models ofgene action in the aetiology of disease. Secondly, Iattend to those schizophreniologists who ignoremethodological criticisms and thus presume a geneticbasis for schizophrenia, and then seek the schizophrenic genotype lacking an adequatephenotype. In response I attempt to demonstrate thenecessity of a sustained effort at characterizing thephenotype of schizophrenia as an enabling conditionfor the whole enterprise of psychiatric genetics – andfor psychiatry itself. Without the organism-levelphenotype, research at the level of genes will remainunproductive – assuming of course that research at thegenetic level is appropriate at all. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Philosophy, Psychiatry, & Psychology 10.2 (2003) 135-141 [Access article in PDF] On Delusions of Sense:A Response to Coetzee and Sass Rupert Read Keywords schizophrenia, Wittgenstein, Schreber, Faulkner, Benjy, grammar, madness, Cogito The great writings on and of severe mental affliction—those for instance of Schreber, 'Renee', Donna Williams, Artaud, Faulkner's The Sound and the Fury, Coetzee's In the Heart of the Country, Kafka's "Description of a struggle," and even (I (...) would add) key parts of The Lord of the Rings—present us with something deeply enigmatic. They have, we might say, a strong grammar, a grammar—a mode of hanging together, and (in this case) of linguistically seeming to make a sense that is not our sense and that we cannot make sense of—... they have a grammar all of their own, and all of its own, a grammar that resists and rejects interpretation even as it sometimes seems to offer interpretations. 1It was Wittgenstein's view that to make mental illness unpuzzling was a mistake, or (better, perhaps) a mythologically problematic move. Wittgenstein's aim in his philosophizing was to understand what was enigmatic when it could be understood without unwisely turning it into something altogether unpuzzling... and then to acknowledge that there are some things that may remain forever puzzling, without committing oneself to the metaphysically disastrous claim that the reason they are endlessly puzzling is that they lie outside the boundaries of human life, language, or reason, as though we could peek outside those alleged boundaries to see what was there, but never truly say anything about it.There simply may be places where our understanding—phenomenological understanding, understanding of what it is like—gives out, and not because it is (or we are) merely human. For instance, perhaps one cannot capture some mental illness by intellection alone, or even perhaps at all. Perhaps the best understanding one can have of mental illness is purely negative (in a sense at least as strong as that involved in negative theology, wherein God is only defined by what it is not).Louis Sass (2003) writes I am not sure whether or not Read would accept that a philosophical position can be understandable despite its containing deep, internal logical tensions (perhaps he would not). If such understanding is possible, however, it does seem to open the way for a similar understanding of conditions like that of Schreber. (p. 127) Unfortunately, however, it is indeed not possible—that is, this notion is merely a fantasy—by my lights. Philosophical positions, all of which turn out to contain such inexorable tensions, cannot be understood: they are mirages. Solipsism, as a position, is not any better (or worse) off [End Page 135] than (say) (Metaphysical) Realism. They are both mirages, just different aspects of the same nothing. 2 Considered as positions, they are in the end literally—when one understands their logic—one and the same nothing. Wittgenstein already made this quite clear in his Tractatus. Perhaps in contrast to Sass, there is then nothing special about solipsism: it is just one mode of presentation rather than another of the illusion that there can be philosophical positions.Sass claims that in saying this kind of thing I am committed to ruling out that some mental illness can be understood or can even exist, on abstract intellectual grounds. I am not. I am simply wishing to leave open the possibility that there may be things that some people utter or seem to experience which intellection gives us little or no assistance with. If Sass wishes to deny this, then I suggest that it is he and not I who is the absolutist intellectualist here, in insisting that rewriting something deeply strange in a weaker grammar is furthering our grasp of it.My suggestion concerning Faulkner's presentation of Benjy, in my original paper, was that it is a mythological mistake to think that Faulkner provides us with the tools for giving an unpuzzling rendition of what had perhaps appeared to be "another country," inaccessible to us. Rather, Faulkner's representation... (shrink)