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

Patients suffering from the Cotard syndrome can deny being alive, having guts, thinking or even existing. They can also complain that the world or time have ceased to exist. In this article, I argue that even though the leading neurocognitive accounts have difficulties meeting that task, we should, and we can, make sense of these bizarre delusions. To that effect, I draw on the close connection between the Cotard syndrome and a more common condition known as depersonalisation. Even though they (...) are not delusional, depersonalised patients seem to have experiences that are quite similar to those of Cotard patients. I argue that these experiences are essentially characterised by a lack of subjective character and of two other structural features of experience, which I call ‘the present character’ and ‘the actual character’. Cotard's nihilistic delusions simply consist in taking these anomalous experiences at face value. (shrink)

Cotard syndrome is a clinical condition defined by the presence of nihilistic delusions. We report two patients with Cotard syndrome in whom anti-NMDAR encephalitis (ANMDARE) was confirmed. Both cases showed features of affective psychosis, developed catatonic syndrome, and worsened after the use of antipsychotics. 18F-FDG PET brain studies showed a bilateral hemispheric pattern of hypometabolism in posterior regions, mainly in the cingulate cortex and in the medial aspects of parietal and occipital lobes. A more severe hypometabolism was observed in the (...) right hemisphere of both patients. Both cases remitted with the use of specific immunotherapy for ANMDARE. (shrink)

Some people insist that they are dead. Rather than starting with the usual assumption that delusions are ‘false beliefs about external reality’ I want to consider how interpreting their claim as a report of a certain kind of anomalous experience assists us in understanding why they are certain, why their claim is immune from evidence to the contrary, and why they do not act in ways we would expect were they to believe their claim to be true of the world. (...) While this helps us understand cases where people do not act on their delusions, more must be said about the people who do act on their delusions. I shall attempt to describe a process where an intense anomalous experience leads to a context-specific narrowing of attention. The ultimate result of this is that the appearance / reality distinction becomes lost in the context of the anomalous experience. The sense of conviction that would be appropriately associated with a report of experience thus becomes inappropriately associated with a claim about external reality. While there have been efforts to provide cognitive therapy for delusional subjects such therapy seems to be based on the notion that confronting them with their contradictions will assist in weakening their sense of certainty about the delusional utterance. I consider whether more progress could be made via empathetic validation of the sense of certainty which is appropriate when associated with the person’s anomalous experience. (shrink)

Descartes was certain that he was thinking and he was accordingly certain that he existed. Like Descartes, we seem to be more certain of our thoughts and our existence than of anything else. What is less clear is the reason why we are thus certain. Philosophers throughout history have provided different interpretations of the cogito, disagreeing both on the kind of thoughts it characterizes and on the reasons for its cogency. According to what we may call the empiricist interpretation of (...) the cogito, I can only claim to be certain of having experiences, and this certainty, as well as that of my own existence, stems from their phenomenal and subjective character. According to rationalist interpretations, on the other hand, I am certain of having some self-reflexive propositional attitudes, and this certainty derives from their rational features. Psychiatric patients suffering from acute forms of depersonalization or of the Cotard syndrome often doubt that they think and exist, and might even believe that they don't. I argue that their study allows us to favor the empiricist interpretation of the cogito. (shrink)

People suffering from severe monothematic delusions, such as Capgras, Fregoli, or Cotard patients, regularly assert extraordinary and unlikely things. For example, some say that their loved ones have been replaced by impostors. A popular view in philosophy and cognitive science is that such monothematic delusions aren't beliefs because they don't guide behaviour and affect in the way that beliefs do. Or, if they are beliefs, they are somehow anomalous, atypical, or marginal beliefs. We present evidence from five studies that folk (...) psychology unambiguously views monothematic delusions as stereotypical beliefs. This calls into question widespread assumptions in the professional literature about belief's stereotypical functional profile. We also show that folk psychology views delusional patients as holding contradictory beliefs. And we show that frequent assertion is a powerful cue to belief ascription, more powerful than even a robust and consistent track record of non-verbal behaviour. (shrink)

In this paper, I am generally concerned with certain mental disorders and the doxastic attitudes that sometimes characterize them. According to recent Anglo-American philosophical studies on this topic, the latter involve beliefs that have somehow “gone wrong”: strange or irrational beliefs and cases of “motivated irrationality”. I aim to focus on pathological and deceptive phenomena such as delusion and self-deception. From a phenomenological perspective, these can also be investigated with regard to their experiential content. Adopting this approach, and starting in (...) particular with the eidetic connection between the living body and its own environment, I will examine disorders of the ecological self. Psychiatric delusion, which is at the core of this examination, is a symptom of a great number of mental disorders, such as Capgras disorder, Cotard disorder and schizophrenia. Integrating dominant (propositional) models of delusion which reduce this pathological phenomenon to a certain kind of belief, I propose an eco-phenomenological understanding of its contours. From this perspective, delusion reveals itself primarily as an illusory experience: a delusional value-perception. In particular, I offer a Schelerian-based description of a peculiar case of delusion: Capgras delusion. People who suffer from Capgras delusion claim that an otherwise familiar individual has been replaced by an impostor. I consider, although in its negative variations, the contextual (rather than internalist) character of this type of delusion. (shrink)

Basic self-awareness is the kind of self-awareness reflected in our standard use of the first-person. Patients suffering from severe forms of depersonalization often feel reluctant to use the first-person and can even, in delusional cases, avoid it altogether, systematically referring to themselves in the third-person. Even though it has been neglected since then, depersonalization has been extensively studied, more than a century ago, and used as probe for understanding the nature and the causal mechanisms of basic self-awareness. In this paper, (...) I argue that depersonalized patients indeed have an impaired basic self-awareness, and that their study allows us both to favor one specific theory of basic self-awareness and to understand what is wrong with its rivals. According to the favored theory, which I call Cartesian, we are basically self-aware in virtue of being acquainted with ourselves through introspection. (shrink)

The cognitive science of belief is a burgeoning field, with insights ranging from detailing the fundamental structure of the mind, to explaining the spread of fake news. Here we highlight how new insights into belief acquisition, storage, and change can transform our understanding of psychiatric disorders. Although we focus on monothematic delusions, the conclusions apply more broadly. -/- .