Delusional Beliefs and Reason Giving

A Chaplain's View on Religious Delusions (and Other Extraordinary Experiences): Towards a Theological Framework of Understanding

In this article, the author discusses the question of how to evaluate delusions with religious or spiritual content from a theological perspective. How does a spiritual care practitioner listen to such delusions? The author proposes a theory of meaning that can account for both ordinary and extraordinary experiences and discusses a list of theological criteria in terms of which spiritual care practitioners can understand delusional and other extraordinary experiences and beliefs with spiritual content.

Are clinical delusions adaptive?

Delusions are symptoms of psychiatric disorders such as schizophrenia and dementia. By and large, delusions are characterized by their behavioral manifestations and defined as irrational beliefs that compromise good functioning. In this overview paper, we ask whether delusions can be adaptive notwithstanding their negative features. Can they be a response to a crisis rather than the source of the crisis? Can they be the beginning of a solution rather than the problem? Some of the psychological, psychiatric, and philosophical literature has recently suggested that they can. We consider different types of delusions and different ways in which they can be considered as adaptive: psychologically (e.g., by increasing wellbeing, purpose in life, intrapsychic coherence, or good functioning) and biologically (e.g., by enhancing genetic fitness). Although further research is needed to map the costs and benefits of adopting and maintaining delusional beliefs, a more nuanced picture of the role of delusions in people's lives has started to emerge.

This article is categorized under:

Philosophy > Representation

Philosophy > Knowledge and Belief

Neuroscience > Cognition

Identity and schizophrenia: Who do I want to be?

Many individuals with schizophrenia have occasional difficulty defining both to themselves and to others who they truly are. Perhaps for this reason they make attempts to change core aspects of themselves. These attempts may be delusional, but are too often unjustly dismissed as delusional before the potential value of the change is considered. Instead of facilitation, obstacles are placed in the way of hoped-for body modifications or changes of name or of religious faith. This paper discusses the various changes of identity sometimes undertaken by individuals with schizophrenia who may or may not be deluded. Ethical and clinical ramifications are discussed. The recommendation is made that, when clinicians respond to requests for help with identity change, safety needs to be the main consideration.

Schizophrenia and the estranged self

How does schizophrenia affect a subject's sense of self? In this paper, we discuss the experience of alienation of mental states and actions that can take place in schizophrenia. We begin by highlighting this experience in delusions of thought insertion and delusions of made feelings, impulses and actions. Next, we offer a proposal about the nature of this experience by utilizing some of the current philosophical research on self-knowledge. The proposal is that the experience of thoughts, feelings, impulses and actions as not being one's own is the experience of regarding those states as not being responsive to reasons. Then, we put forward a hypothesis about why schizophrenia can lead to this experience by drawing on the psychiatric literature on the disorder. The hypothesis is that subjects who suffer the four delusions are unable to regard some of their thoughts, feelings, impulses and actions as being responsive to reasons because they suffer from a tendency to focus their attention on their own perceptual experiences, as opposed to focusing it on the world. The lesson to draw from the alienation of mental states and actions caused by schizophrenia will be, finally, that two separate components normally make up our sense of self; two components that turn out to be dissociated in the four schizophrenic delusions discussed. These are, on the one hand, the self as the bearer, or host, of mental states and actions and, on the other hand, the self as the owner and agent, respectively, of those mental states and actions.

The intrasubjectivity of self, voices and delusions: A phenomenological analysis

To advance the area of phenomenology of voices and their interrelatedness to forms of delusions this study investigated the prevalence and interrelatedness of co-occurring auditory verbal hallucinations (AVHs) and delusions. Additionally we explored the characterization of distinct sub-categories/clusters of AVHs and delusions. Ninety-two participants experiencing psychosis were administered standardized clinical measures. We found a significant diagnostic difference with increased prevalence of co-occurring AVHs and delusions within the schizophrenia group compared to the bipolar with psychosis group. Regardless of diagnosis, there was a significant positive correlation between AVHs and delusions of reference, persecution, control, thought insertion, thought withdrawal and thought broadcasting. However, no significant relationship was found between AVHs and grandiose, somatic, religious, guilty or jealousy-themed delusions. Cluster analysis yielded two distinct cluster groups. Cluster One: Voices and Thought Delusions, and Cluster Two: Voices and Thematic Delusions. Cluster One participants showed elevated disorganized, cognitive and depressive symptoms, but not negative symptoms or excitement. This study underscores the need for expanded clinical and phenomenological research into the intersection of AVHs and delusions, including work that seeks to deconstruct conventional divisions between ostensible symptoms of perception' (hallucinations) and belief' (delusions).

Epistemic injustice in assessment of delusions

Delusions are one of the most elusive concepts in psychiatry. There have been several theories on the nature and definition of delusions. Jaspers described them as entailing a total transformation of reality and considered primary delusions as un-understandable. When it comes to clinical practice, psychiatrists resort to criteria of falsity, incorrigibility, conviction and being out of keeping with the person's culture. All these criteria have been subject to various criticisms, some of which will be discussed in the paper. We will use the concept of epistemic injustice to explore the role of stereotypes and prejudice in the identification of delusions. We will discuss cases where patients are suffering from testimonial injustice by virtue of having a mental disorder that is so often associated with attributions of irrationality, bizarreness and incomprehensibility. Two vignettes will be presented to show that this is often the case in clinical practice. We will discuss relevant issues around the epistemology of the delusions. We think that in order to challenge the testimonial injustice, there needs to be an awareness of its possibility and thus recognition of the role of certain stereotypes in assessing these mental states. Challenging the stigma against mentally ill and adopting a holistic view of delusions can help tackle the prejudice that pre-empt the testimonial injustice.

Affective Dimensions of the Phenomenon of Double Bookkeeping in Delusions

It has been argued that schizophrenic delusions are “behaviourally inert.” This is evidence for the phenomenon of “double bookkeeping,” according to which people are not consistent in their commitment to the content of their delusions. The traditional explanation for the phenomenon is that people do not genuinely believe the content of their delusions. In the article, we resist the traditional explanation and offer an alternative hypothesis: people with delusions often fail to acquire or to maintain the motivation to act on their delusional beliefs. This may be due to avolition, to emotional disturbances, or to the fact that, given the peculiar content of some delusions, the surrounding environment does not support the agent’s motivation to act.

In Defence of Modest Doxasticism About Delusions

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 in-between perceptual and doxastic states, defended by Jacob Hohwy and Vivek Rajan, and the view that delusions are failed attempts at believing or not-quite-beliefs, 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.

The Epistemic Benefits of Reason Giving

There is an apparent tension in current accounts of the relationship between reason giving and self-knowledge. Philosophers like Richard Moran (2001) claim that deliberation and justification can give rise to first-person authority over the attitudes that subjects form or defend on the basis of what they take to be their best reasons. On the other hand, the psychological evidence on introspection effects and the literature on elusive reasons suggest that engaging in explicit deliberation or justification leads subjects to report attitudes that are not consistent with their previous attitudes or with their future behavior. On the basis of these findings, Tim Wilson (2002) argues that analyzing reasons compromises self-knowledge. I shall defend a realistic account of the effects of reason giving which is compatible with the empirical findings on introspection and also with the claim that deliberation and justification have epistemic benefits.

Reproductive and parental autonomy: an argument for compulsory parental education

In this paper we argue that comprehensive and systematic parental education has the potential to equip young adults with the necessary information for the responsible exercise of their autonomy in choices about reproduction and parenting. Education can allow young adults to acquire largely accurate beliefs about reproduction and parenting and about the implications of their reproductive and parental choices. Far from being a limitation of individual freedom, the acquisition of relevant information about reproduction and parenting and the acquisition of self-knowledge with respect to reproductive and parenting choices can help give shape to individual life plans. We make a case for compulsory parental education on the basis of the need to respect and enhance individual reproductive and parental autonomy within a culture that presents contradictory attitudes towards reproduction and where decisions about whether to become a parent are subject to significant pressure and scrutiny.