Remembering requires no reliability

This post is by Changsheng Lai (Shanghai Jiao Tong University).

 

Changsheng Lai

You believe that you locked the door before you left your house, but do you really remember that? Your belief about the past episode might be true, but in what sense is the past episode genuinely remembered rather than being just accurately imagined or veridical confabulated? A popular view, which I refer to as ‘mnemic reliabilism’, suggests that the process of remembering is distinguished by its reliability condition. That is, successful remembering must be produced by a reliable memory process. 

Prominent champions of this view include the simulationist Kourken Michaelian (Michaelian 2016) and the causalist Markus Werning (Werning 2020). Besides, you might also find mnemic reliabilism attractive if you are sympathetic to both the orthodox view that ‘remembering entails knowing’ and the idea that ‘knowledge requires reliability’.

In my recent paper entitled ‘Remembering requires no reliability’, I argue against mnemic reliabilism. I demonstrate that there are cases where past events can be successfully remembered despite the unreliability of the corresponding memory processes. Roughly, my cases can be divided into two types:

The first type of cases focuses on patients with neurodegenerative diseases such as Alzheimer’s disease (AD). There is ample empirical evidence to show that AD severely undermines the reliability of patients’ episodic memory by causing frequent memory distortions. However, AD does not deprive patients of the capability of remembering, at least occasionally, some past events. After all, discussions about ‘true memories’ or ‘remembering’ in AD patients are ubiquitous in the psychological literature. It is also untenable to claim that AD patients cannot successfully remember any past event just because they cannot remember many past events reliably.

The second type of cases illustrates how healthy subjects can remember the past unreliably. Empirical studies have discovered many factors that can render our memory processes unreliable. For instance, divided attention (during the stage of encoding or retrieval) has proven to be able to result in more inaccurate memories than accurate ones (Perez Mata et al. 2002). Likewise, high mental stress during post-encoding consolidation also tends to impair memory performance and increase false memories (Pardilla-Delgado et al. 2016). 

Memory processes involving those reliability-affecting factors tend to end up with false memories; however, they can still sometimes end up with true memories. For example, in Pardilla-Delgado and colleagues’ (2015) DRM-style experiments, while stressed participants remembered more false than true words, there was still a 29% chance that presented words could be accurately remembered. Therefore, an overall unreliable memory process can nevertheless lead to successful remembering.

The upshot is, any satisfactory analysis of remembering should avoid including the reliability condition. Moreover, if successful remembering can still provide defeasible justification for our memory beliefs without requiring reliability, then a reliabilist account of (memory) justification is also questionable. Finally, if reliability-affecting factors are prevalent enough in daily life, then perhaps we ought to reexamine the received view seeing memory as a reliable epistemic source.

Reichenau Summer School: Dealing with Uncertainty

In today's post I report on the Summer School in Reichenau  which I had the pleasure to attend on 25th and 26th August 2023. The theme was Belief, meaning, knowledge: how we deal with uncertainty. Delusions was a topic often discussed in the presentations, from philosophical, phenomenological, and clinical perspectives. Organisers of the event were Johannes Rusch, Daniel Nischk, Dorothea Debus, and Thomas Müller.

Rathaus Reichenau (front)

Rathaus Reichenau (courtyard)

The first speaker was Rico Gutschmidt (Konstanz) with a presentation on Mysticism and Delusions. Fundamental uncertainties are limitations of knowledge and experience and three questions arise: (1) Where do we come from? (2) Why there is anything at all rather than nothing? (3) Who are we? Although such questions are not easy to answer or possible to answer they can evoke transformative experiences. Philosophical experiences such as struggling with these questions can be transformative because they change the type of people we are. They change our attitude towards life. They contribute to the mystery of existence.

Mystical experiences are an extreme form of transformative experiences. They can be induced by substances and meditation and can include a feeling of unity with everything and the loss of the self. People feel like they understand a deeper level of reality that is often ineffable -- cannot be put into words. Such experiences can be both positive and negative, they are often overwhelming. Gutschmidt argued that mystical experiences can be reinterpreted as experiences of the unboundedness of existence.

In a recent study led by Gutschmidt and Nischk several participants were interviewed and their interviews analysed in interpretive phenomenological analysis: it was found that some delusions are very similar to mystical experiences (loss of the self etc.). So these types of delusions can also be interpreted as experiences of the mysteries of existence. In this sense, delusions are not pathological and involve a revelation of a deeper reality (enlightenment); the sense that one is outside time and space and past, present, and future are fused together; and ineffability. Patients describe delusions as meaningful experiences.

The second speaker was Uwe Herwig (Konstanz and Zurich) who presented about Psychedelics: Phenomenology and Psychotherapy. As the talk was in German, I will offer only a very brief summary of its contents. Herwig started with an introduction on psychedelics. Often psychedelic phenomena occur in ritualistic settings. Psychedelics are a group of substances that modify the qualitative nature of the experience. The words "psyche" and "delos" mean "opening the soul". A typical psychedelic substance is Psyllocybin and an atypical one is Ketamine.

Uwe Herwig presenting on psychedelics

Then Herwig provided a brief history of the use of psychedelic drugs in clinical contexts. First therapeutic use of psychedelics occurred in the fifties, mainly for anxiety and depression. New applications have been introduced since 2020, for post-traumatic stress disorder and substance dependency as well as anxiety and depression, with various measures of success. The study by Hendricks et al. (2015), showing that psychedelic use is associated with reduced psychological distress and suicidality, was discussed in some detail, as well as more recent studies. In the last part of the talk, Herwig explored the psychophenomenology and neurobiology of psychedelic treatments, arguing that such treatments work and clinicians need to be prepared to offer them.

On the second day, Philipp Sterzer (Basel) presented a paper on the Functionality of Delusions. He started defining psychosis and its symptoms (delusions and hallucinations) and described the Bayesian approach to explaining psychosis. The key is abnormality in inferential mechanisms: what we perceive is always an active process of inference where we predict what things are like given what we already know. If we fail in our prediction, then there is a prediction error, and that's usually a bad thing. But via prediction errors, we can update our beliefs. Inference is to minimise prediction errors.  

When we have psychotic symptoms, our priors are not precise and the new experience is very salient. So, the story goes, in psychosis we are more guided by the actual stimulus and tend to ignore priors. What does the evidence say? People with delusions are more resistant to visual illusions and their priors are weak. However there is also some evidence that people with hallucinations have strong priors. 

Philipp Sterzer and a picture of his book, 
Die Illusion der Vernunft

So it would seem that there are two separate mechanisms:

Weak prior -> Aberrant salience demands explanation -> Emergence of delusions (bottom-up)

Strong prior -> Sensory signals interpreted in accordance to priors  -> Persistence of delusions and emergence of hallucinations (top-down)

But a more complex hierarchical model solves the apparent paradox:

Weak low-level priors -> Aberrant Salience demands explanation -> Emergence of delusions

Strong high-level priors -> Sensory signals interpreted in accordance with priors ->  Persistence of delusions and emergence of hallucinations.

Studies on perceptual ambiguity and on perceptual uncertainty conducted in Sterzer's lab show that weak priors can be at the origins of both delusions and hallucinations. Schizophrenia patients use sensory evidence more than controls to disambiguate stimuli. In sum, what we have in psychosis is lower perceptual history biases and higher sensitivity to disambiguating evidence. In this framework, delusions are a compensatory mechanism used to minimise prediction errors. And the people most likely to adopt delusional beliefs are those whose brains create more ambiguity. 

Susanna Burri (Kostanz) was the last speaker of the day and the Summer School, and her talk was on Final (and Other) Goodbyes. She asked what a good dying process looks like: what type of death should we hope for? Two options are the Sudden Exit (e.g., just drop dead) and the Some Advance Notice (e.g., knowing you will die in two weeks).

Susanna Burri discussing good ways to die

Occasions for goodbyes include when we leave people behind (in a valued relationship); when we leave places we are attached to, or other non-persons; when there is no increased physical distance but when there is increased psychological distance (e.g., the relationship changes). A goodbye is about anticipating and acknowledging a loss. Burri offers a definition of saying goodbye:

Goodbye: to say goodbye is to openly acknowledge and reflect on the fact that a valued relationship or set-up is about to come to an end or change significantly.

What is bad about goodbyes: (1) goodbyes are meaningless performances, (2) they are awkward and delay things for those leaving, (3) they detract from the fun and they interrupt the flow for those staying, (4) they are unpleasant because they are an ending. What is good about goodbyes: (1) goodbyes are respectful and helps those left behind to adjust their expectations, and (2) they help people prepare for the ending which will make grief easier later. Preparing for a loss means interpreting it and helps us determine what the value of thing or person you are losing is. As a result, saying goodbye provides orientation: it prevents feeling lonely and drifting. Goodbyes also help showing appreciation for something that was valued.

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The Summer School was a really great opportunity to interact with people with different backgrounds and enabled participants to discuss all the key themes in detail and in a relaxed and friendly atmosphere.

Philosophy of Psychiatry and Lived Experience (2)

This blog post is by Zsuzsanna Chappell. Zsuzsanna is an independent scholar and research associate at the Centre for the Philosophy of Natural and Social Sciences, London School of Economics. She currently writes on the social philosophy and ethics of mental illness, and the role of researchers with subject-relevant lived experience in the human sciences. Previously, she held academic positions at the London School of Economics and the University of Manchester and is the author of Deliberative Democracy: A Critical Introduction, Palgrave 2012.

Zsuzsanna reports from the third annual Philosophy of Psychiatry and Lived Experience workshop. The workshop was held on 17-18 April 2023, online (hosted by the University of Umeå). The aim of these workshops has been to bring together  philosophers and philosophy-adjacent scholars who self-identify as having lived experience of mental disability / difference, and are also writing on these topics. 

Zsuzsanna Chappell

Our first post described our main activities so far and why we believe there is a need for a workshop specifically for philosophers with subject-relevant lived experience. Last week's post also summarised two of the six papers presented at this year’s workshop. This post will describe the remaining four.

Shay Welch (Spelman College): Am I Safe Enough For You? On Borderline Personality Disorder

Welch offered an erudite phenomenological insight into what it is like to live with borderline personality disorder (BPD). It is a way of being which is full of inconsistencies; of overwhelmingly hatred for oneself while still loving oneself, of over-riding boredom and emptiness accompanied by emotional fullness. Based on her own experiences of erasure and inner death, she drew out the implications of erasing this borderline sense of self, something which is demanded by society and by psychiatry. 

She contrasted BPD and responses to it with addiction, arguing that the demand on BPDers is to erase what it is tobe themselves, rather than to simply let go of a dysfunctional habit or way of life. This kind of self-erasure is a kind of violence not seen in society’s response to all mental disorders,  which for the most part BPDers will finally consent to, even if they will still continue longing for their unmedicated selves. Rather than seeing BPD as an inherent source of vice, she argued that the qualities that come from it, - whether impulsiveness or empathy, - demand a different way of cultivating virtues to a high level which can make BPDers a valuable part of our moral community. This paper is now forthcoming in The Philosophical Forum.

Rachel Handley (Trinity College Dublin): Mental Illness and Transformative Experience

For Handley, their anxiety is a special kind of transformative experience. Rather than changing them from one moment to the next, it transformed them over time. This experience, they argued, would be impossible to understand without taking into account its transformative component. This seems to have an epistemic component as well for them: the sheer outrageous excess of anxiety disorder needs to be experienced to be believed. At the same time, their anxiety was closely tied to their identity: anxiety was part of them. 

They cannot look at their disability and assess it from above, there in no non-anxious Rachel we can compare anxious Rachel to. This complicates the way in which we can understand transformative experience. It is not immediate, there is no easy baseline against which the transformation can be measured, the transformation may even be episodic. Very interestingly, they argue that certain kinds of transformations can even block further transformations, for example when it comes to resistance to a medicated self. 

Rachel Handley

Zsuzsanna Chappell (independent scholar): Shared decision-making in psychiatric diagnosis

Access to the internet and social media have made people more aware of possible diagnoses, while at the same time there is also increased official reliance on self-diagnosis (just think of Covid-19 home tests or the recorded phone messages urging us to check the NHS website before we are connected to the GP receptionist). Medical sociologists (eg Jutel) argue that as a result doctor-patient relationships have changed, have become less unequal in many ways. These changes may be harder to accept in psychiatry, given that patients are often supposed to lack insight. 

Chappell argues that this is problematic as diagnostic labels strongly influence both internal, personal identity and external, social identity, and thus some will be easier to wear than others. This gives us an increased incentive to take into account patients’ ideas of what their problems may be, especially if we believe that psychiatric diagnoses are to some extent social constructs in the way that many other medical diagnoses are not. This is made possible if we take into account the inherent relationality of diagnoses: they will influence the relationships of the patient with themselves, with their clinicians, with friends, family and wider society. 

This preserves psychiatrists’ expertise but in a modified form: the point is not to allow patients to self-diagnose themselves inappropriately, but to give greater scope to shared decision-making when differential diagnoses are available.

David Ellis (Leeds Trinity University): A Phenomenological Investigation of ADHD - Language and Medication

Ellis drew on his personal experience of growing up with with ADHD to map out how language around ADHD and its management, introduced at a young age, inevitably shapes the development of the self. This can leave ADHDers unsure whether their neurodivergence is a disability or whether their medication is “treatment” in any meaningful sense. This touches not only on experiences of authenticity, but also turns the self into a battle ground between the “normal” and the “deviant”. 

Ellis was told that his ADHD was “undesirable”, that taking tablets and learning coping mechanisms would help, to the point that he came to identify his “real” self as the self without ADHD. Yet it also became increasingly obvious to him that managing someone’s ADHD is at least as much for the benefit of doctors and teachers. In the abstract he writes: “Being given medication whilst being told that it will ‘help’ not only caused me to think that the real me is the medicated me, but that the default natural me is akin to an illness in need of treatment, and that one of its symptoms is my inability to recognise my illness and interests. This develops attitudes of self-rejection, where part of me was seen as something that should not be seen.” 

His conclusion from these reflections is that since ADHD is part of the self, it is in fact unhealthy to develop negating, medicalising views towards a part of oneself. This contradicts the language of help which is usually adopted by professionals. Ellis’s talk really brought it home to me how neurodivergent children are positioned as the problem which not only needs to be solved, but which just requires too much effort from everyone to manage. 

David Ellis

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So far, we have limited participation in our workshops to academic philosophers and philosophy-adjacent scholars who self-identify as having lived experience of mental disability / difference. (We never ask for any details or disclosure beyond a basic self-identification.) Presenters are free to give talks which are as personal or as abstract and general a they wish. 

Our group is not a “secret” one, but we have struggled with working out how to advertise it effectively beyond word of mouth. We have also talked about a workshop where we would share our work with “Sane” allies, about the possibility of starting a blog, and are planning a workshop based in an American time zone. 

This blog post is part of our efforts to publicise our work more widely. If you are a philosopher of psychiatry / mental health / neurodiversity with lived experience or if you are an ally who would like to support our project, we would love to hear from you at PhilPsyLivedExp@gmail.com

Philosophy of Psychiatry and Lived Experience (1)

This blog post is by Zsuzsanna Chappell. Zsuzsanna is an independent scholar and research associate at the Centre for the Philosophy of Natural and Social Sciences, London School of Economics. She currently writes on the social philosophy and ethics of mental illness, and the role of researchers with subject-relevant lived experience in the human sciences. Previously, she held academic positions at the London School of Economics and the University of Manchester and is the author of Deliberative Democracy: A Critical Introduction, Palgrave 2012.

Zsuzsanna reports from the third annual Philosophy of Psychiatry and Lived Experience workshop. The workshop was held on 17-18 April 2023, online (hosted by the University of Umeå). The aim of these workshops has been to bring together  philosophers and philosophy-adjacent scholars who self-identify as having lived experience of mental disability / difference, and are also writing on these topics. 

University of Umeå

Zsuzsanna Chappell (me!), Sofia Jeppsson and Paul Lodge started organising these workshops during the pandemic. We have since been joined by August Gorman and Elliot Porter. All of us are Mad philosophers and we all felt that there was a need for a safe place where philosophers with experiences which are often difficult to talk about and stigmatised could talk freely and provide feedback on each others’ work. The workshop is open to anyone with lived experience, regardless of the concept and identity they prefer to use: madness, neurodiversity, mental illness, and so on. 

Why the need for a workshop just for scholars with subject-relevant lived experience? Sofia Jeppsson writes that talking to each other as Mad / neurodivergent scholars helps us to see how diverse our experiences are. Paul Lodge views it as a form of consciousness raising among Mad scholars, and argues that a  philosophy of psychiatry, where there are relatively few contributions by Mad philosophers, is as if feminist philosophy was dominated by the voices of men. 

I (ZC) argue that it is important to have a space reserved for those of us with lived experience, as it allows us to present ideas with an audience like ourselves in mind, rather than primarily addressing the “Sane” majority and their needs. I hope that these workshops will create space for views and voices which would not otherwise be heard, and encourage more people to do this sort of philosophical work. 

Zsuzsanna Chappell

August Gorman argues that by truly grappling with the lived realities of philosophers whose experiences are at times quite different from the presumed ‘Ideal/Typical/"Normal" Person’ who plays an implicit role in shaping so many of our theories, we have to upend a lot of what is assumed. They find it useful to have a community of fellow travelers to build new things back up again with. 

Elliott Porter writes that Mad people have very particular interpretive needs, and a community of mad enquirers is therefore what we need to refine our interpretive tools.  This doesn’t just allow us to navigate madness more effectively, but it also allows us to condense the particular knowledge that Mad points of view have privileged access to.  

So far, we have limited participation in our workshops to academic philosophers and philosophy-adjacent scholars who self-identify as having lived experience of mental disability / difference. (We never ask for any details or disclosure beyond a basic self-identification.) Presenters are free to give talks which are as personal or as abstract and general a they wish. Our group is not a “secret” one, but we have struggled with working out how to advertise it effectively beyond word of mouth. 

We have also talked about a workshop where we would share our work with “Sane” allies, about the possibility of starting a blog, and are planning a workshop based in an American time zone. This blog post is part of our efforts to publicise our work more widely. If you are a philosopher of psychiatry / mental health / neurodiversity with lived experience or if you are an ally who would like to support our project, we would love to hear from you at PhilPsyLivedExp@gmail.com

Six papers were presented this year. Two are described in this post while the remainder will be described in a post to appear next week. 

Sam Fellowes (Lancaster University): How the lived experience of experts-by-experience relates to the abstract nature of science

Fellowes made a really interesting argument about how an abstract concept such as “autism” will influence the study of that same concept even if we draw of the involvement of “experts-by-experience”, that is people who have a lived experience of autism. He argued that such disorder definitions require abstract science and cannot be derived from lived experience. Of course, this led to a good debate during discussions about the extent to which those with subject-relevant lived experience can be epistemic authorities on the nature of that experience. 

Fellowes made the point that since definitions and concepts are not only abstract, but also highly abstracted from reality, they will only represent individual experiences very imperfectly. This means that experts-by-experience may be best placed to help make value judgments during the process of scientific research, while they may need to accept the existing techniques for abstraction as given. Lived experience itself will need to be interpreted through scientific notions. I really enjoyed listening to a talk on what was in essence philosophy of science rather than philosophy of psychiatry, as this showed how wide the scope of our shared topics of interest are. 

Eliott Porter

Elliott Porter (University of Birmingham): Madness, Silencing, and Colloquial Terms

Porter raised the question of how Mad people can understand themselves when so much of our colloquial language uses words such as “crazy” rather liberally. I found it especially interesting how our views diverged during Q&A. Someone else found the term “crazy” objectionable, I myself draw the line at “psycho” being used as a common term to describe e.g. ex-lovers or politicians. Porter argues that using this kind of language is subordinating and silencing. Once something or someone is ruled “insane”, we are invited not to pay attention anymore. Yet, we all continue to use such language, even if we are aware of its potentially troubling aspects.  

He argued that it is better to think of these thoughts as illegitimate, rather than symptomatic.  Illegitimacy is a local failing, whereas symptomatic thought speaks to a wider deficiency.  Drawing on the self-trust literature and McGrath’s (2019) account of undercutters to moral knowledge, he argues that madness-language with connotations of illegitimacy is a valuable hermeneutic resource for Mad people particularly because it allows us to interpret illegitimate thoughts in ways that do not undercut self-trust.

Self-narratives and Medicalization in Psychiatric Diagnosis

This post was published on the EPIC blog in July 2023. It is by Richard Hassall, a qualified clinical psychologist, now retired. After retirement, Richard enrolled at the University of Sheffield to do an MA in philosophy, followed by a PhD which was completed in 2022. At the time of writing, Richard is an affiliate researcher attached to the Department of Philosophy at Sheffield.

Richard Hassall

My area of interest is philosophy of psychiatry, with a particular interest in the nature of psychiatric diagnostic categories and the effect these have on the individuals who receive them. I argue in my PhD thesis that a psychiatric diagnosis may, in some cases, lead the recipient to becoming a victim of epistemic injustice, and specifically of hermeneutical injustice. I argue that this effect can be understood in terms of narrative theory and the self-narratives that individuals construct for themselves.

People gain meaning in their lives through their self-narratives, but such narratives can be changed by the person’s social circumstances and by extraneous events. Receiving a psychiatric diagnosis is one such event in some people’s lives, and it can significantly impact on the recipient’s self-narrative.

The codification of psychiatric diagnoses in disease nosologies, such as the DSM-5 of the American Psychiatric Association, can convey the implication that these represent disease entities of some sort. Patients are often told that their condition is “an illness like any other”. The reductionist methodology characteristic of the biomedical model of diseases can suggest that mental disorders are somehow caused by neurochemical abnormalities in the brain, an idea reinforced by the frequent treatment of such disorders with medication. Consequently, the diagnosis may be understood as a medicalized explanation of the person’s difficulties. However, most such diagnoses are based purely on symptom descriptions and do not explain how the person’s symptoms arose.

The medicalization implicit in psychiatric diagnoses conveys a biomedical narrative which may conflict with or marginalise the recipients’ previous self-narratives at a time when they will be experiencing significant emotional distress. As such, the recipients’ own hermeneutical resources can become marginalised. In other words, their capacity for understanding and expressing their own experiences can be minimised or neglected by clinicians. This can result in them becoming victims of hermeneutical injustice, particularly if they are mistakenly led to believe that their condition is a chronic one, from which full recovery is unlikely to happen.

The biomedical narrative associated with such diagnoses can undermine the recipients’ beliefs about their sense of agency and lead to feelings of hopelessness about recovery. While it is not an inevitable consequence of such diagnoses, there is evidence from testimonies of former service-users that this can happen to some people.