Inner Speech: New Voices

 Today's post is written by Peter Langland-Hassan and Agustin Vicente. Peter Langland-Hassan is Associate Professor of Philosophy at the University of Cincinnati. 

Agustin Vicente is Ikerbasque Research Professor at the University of the Basque Country, Linguistics Department. In this post, they present their new edited volume"Inner Speech: New Voices". 

Our new anthology, Inner Speech: New Voices (OUP, 2018), is the first in philosophy to focus on inner speech—a phenomenon known, colloquially, as “talking to yourself silently” or “the little voice in the head.” The book is interdisciplinary in spirit and practice, bringing together philosophers, psychologists, and neuroscientists to discuss the multiple controversies surrounding the nature and cognitive role of the inner voice.

Readers of this blog may be most familiar with theoretical work on inner speech as it occurs in the context of explaining Auditory Verbal Hallucinations (AVHs) in schizophrenia. Building on and amending early work by Christopher Frith (1992), a number of theorists have proposed that AVHs result from a deficit in the generation or monitoring of one’s own inner speech. Our book includes several chapters by well-known participants in those debates—including Hélène Loevenbruck and colleagues, Sam Wilkinson & Charles Fernyhough, Lauren Swiney, and Peter Langland-Hassan—that push the leading theories into new territory.

Stepping back, as philosophers of mind, it has always been surprising to us how little direct attention inner speech receives in philosophy and psychology. From a pre-theoretical, commonsense point of view, you might think that talking to yourself silently is one of the most important—and certainly most common—forms of thought we enjoy. And yet, few contemporary philosophers or psychologists assign to inner speech an indispensable cognitive role. This is in itself ground for puzzlement: if we could get on more or less the same without talking to ourselves, why do we spend so much time in silent soliloquy?

Are Psychopaths Legally Insane?

This post is by Katrina Sifferd, Professor of Philosophy at Elmhurst College regarding her recent paper ‘Are Psychopaths Legally Insane?’ co-authored with Anneli Jefferson, Leverhulme Early Career Fellow in the Philosophy department at the University of Birmingham.

Exploring the nature of psychopathy has become an interdisciplinary project: psychologists and neuroscientists are working to understand whether psychopathy constitutes a mental disorder or illness, and if yes, of what sort; and moral philosophers and legal scholars are using theories of psychopathy to understand the mental capacities necessary for culpable action and whether psychopaths are morally and legally responsible.

In our recent paper, Anneli Jefferson and I argue that a diagnosis of psychopathy is generally irrelevant to a legal insanity plea. It isn’t clear that psychopathy constitutes a true mental disorder; but even if it is a disorder, tests for legal insanity require that specific mental deficiencies related to a disorder serve to excuse a defendant. Specifically, a successful insanity plea requires that deficits in moral understanding or control are present at the time the defendant commits the criminal act.

The two aspects of psychopathy most likely to impact responsibility are emotional deficits (or a lack of empathy), and problems with impulse control. Some have argued that flattened affect may deny psychopaths an understanding of the moral quality of their actions; and lack of impulse control can obviously result in harmful and illegal behavior. However, recent studies indicate that persons with higher scores on the PCL-R (the diagnostic tool typically used for psychopathy) are heterogeneous both with regard to empathy/affect and impulse control.

Antisocial behavior figures prominently in the PCL-R’s diagnostic criteria for psychopathy. This heavy reliance on antisocial behavior, we think, complicates our understanding of psychopathy because the relation between social deviance and the mental deficits traditionally associated with psychopathy, including problems with affect and impulsive behavior, has not been established. Although it seems clear that persons diagnosed as psychopaths using the PCL-R have a history of anti-social behavior, it is not clear that the diagnostic pinpoints mental deficits causally related to this behavior.

The literature often subdivides psychopaths further according to behavioral profiles, hypothesized underlying causes, etc., and the different sub-divisions of psychopaths seem to have very different mental profiles. One division is between primary and secondary psychopathy (Lykken 1996; Newman et al. 2005), and another is the one between successful and unsuccessful psychopaths (Gao and Raine 2010; Ishikawa et al. 2001; Sifferd and Hirstein 2013).


Typically, only primary psychopaths are thought to have emotional deficits, and are more impulsive than secondary psychopaths (Newman et. al 2005). Successful and unsuccessful psychopaths also seem to exhibit differences regarding both affect and impulsivity. Unsuccessful psychopaths tend to have reduced prefrontal and amygdala volume, brain areas related to cognitive control and affect, respectively (Yang et al. 2005).

Unsuccessful psychopaths have also been found to have reduced autonomic levels (Hare 1982), and impaired fear conditioning (Birbaumer et al. 2005). However, psychopaths termed “successful” - due to their ability to avoid the criminal justice system - show no reductions in prefrontal or amygdala volume (Yang et al. 2005), and intact or even enhanced autonomic levels (Ishikawa et al. 2001).

Even more interesting is new evidence that psychopaths who do lack empathy may be able to correct for affective deficits precisely because they have intact cognitive control. Jurjako and Malatesti argue that although psychopaths seem to have trouble with cognitive tasks involving emotions, the deficits are highly context dependent (Jurjako and Malatesti 2017). At least some psychopaths with affective deficits may be able to correct for these via attentional control, a hypothesis which is further supported by a study by Glenn et al. (2009) which showed that psychopaths solve moral decision tasks by utilizing different brain areas than controls, including the dorsolateral prefrontal cortex. This may mean that psychopaths are able to access moral knowledge from faculties other than the affective system.

Psychopaths’ ability to correct for affective deficits seems dependent on their capacity for top-down attentional control, which is thought to be a part of the larger cognitive control system. Cognitive scientists often call the components of this system “executive functions,” and include skills such as planning and goal-setting; monitoring of perceptions, emotions, and behavior; inhibition; and task-switching, as well as top-down attention. Recent research indicates that persons diagnosed as psychopaths may have very different executive profiles (Jurjako and Malatesti 2018). Indeed, it seems persons who qualify as psychopaths using the PCL-R can have a wide range of executive functioning.

In the end, we think the group of persons diagnosed with psychopathy using the PCL-R is extremely heterogeneous with regard to the mental capacities necessary to legal responsibility. Because the diagnosis doesn’t reliably indicate deficits in moral understanding or control, psychopathy is not relevant to a claim of legal insanity, though it may indicate the need for further psychological testing.

Belief, Imagination, and Delusion

On 6th and 7th November, Ema Sullivan Bissett organised a conference on Belief, Imagination, and Delusion at the University of Birmingham. The PERFECT team attended the event and this report is the result of their collective effort!

Anna Ichino on imagination

Paul Noordhof on aim of belief

Sophie Archer (Cardiff University) started the conference with a discussion of delusion and belief, inviting us to learn some lessons from the implicit bias literature. When the avowed anti-racist says all races are equal but does not behave in ways consistent to this belief, then we assume that there is an additional mental state (not open to consciousness) that is responsible for those behaviours. Is this additional mental state a belief? Archer argues that it is not.

On the background, there is a thesis about belief. Even if a mental state responds directly to epistemic reasons, this is necessary but not sufficient for the mental state to be a belief (Epistemic Reasons). If the mental state can be directly formed or revised on the basis of conditioning, then it is not a belief (Conditioning). In the second part of her talk, Archer considered two objections to her conditions for belief. One is that the conditions are not really distinct, and the other is that the picture sketched is one that is not psychologically realistic.

Garry Young (Melbourne) addressed the revisionist model of the Capgras delusion in his talk: what causes the delusion, why the belief is accepted, and why it is maintained. Capgras is the delusion that a significant other has been replaced by an impostor. The traditional model of the delusion combines an anomalous experience that then is either explained by or endorsed as a belief. In a later revised model, the anomaly is not a conscious experience (we can call it abnormal data) and the belief is the first conscious component of the delusion.

One problem with the revised model is that by making the belief the first conscious step, it is not clear why the person does not talk about the acquired belief as an unbidden thought. In Capgras there is a mismatch between physical recognition (she looks like my wife) and lack of arousal (she doesn’t feel like my wife). So, the content of the delusions would be: “This person looks like my wife and claims to be my wife is not my wife”. This has a strong explanatory power because it makes sense of what the person experiences.

Another problem is that it is not clear what the second factor in the formation of the delusion is given that the reasoning is abductively good, providing an explanation for an unusual experience. This is highlighted by the fact that people who recover from the delusion seem to be able to check the delusion for plausibility, which makes it strange to say that previously the person lacked that capacity.

Young proposed that there are a co-occurrence and an interaction between the experience of unfamiliarity and the belief about the impostor. He describes his model as interactionist. He rejects the idea that what first enters consciousness is a fully formed belief. There is a more gradual process. For instance, the person could be considering the content of Capgras as a contender for the truth (appealing to indicative imagination). The belief has two functions, then: (a) it interprets the experience, but also (b) it gives meaning to the perceptual data. There is a mutual effect between belief and perception.

After the lunch break, it was Lucy O’Brien’s (UCL) turn. Her talk was entitled: “Delusions of Every Day Life: Death, Self-love, and Love of Another”, written with Doug Lavin. We have a sense of our own significance, a form of self love, which makes us think that our own death would be a terrible thing. When we are in the grip of self love, what can we reply to the objectivity response, that our life does not have the significance we attribute to it?

We can try and think about which property makes us value our own lives so much, but no property seems quite enough. It is more that we have lived this life with ourselves, a particular life with projects and achievements that we care about. Is this an in-built response, a kind of inevitable irrationality? Or is the response actually rational for agents like us? As in the self love case, also in the case of loving another, their death is a terrible thing for us. That is because we value them: (a) we value some character or stereotype that the loved person embodies; (b) we value the peculiarity and specificity of the loved person.

Another common ‘justification’ of love (and self love) is history: I love them because we have a history together. But also this attempt to justify assigning significance to others we love or to ourselves fails on the grounds of contingency and inefficiency (it just happens to be the case that this is the person I have lived with, another person might have pursued my projects better than I did). We could see self love and love for others as an a-rational drive but they are not so, because they do not work without the participation of our rational agency.

Ryan McKay (Royal Holloway) presented his paper next, entitled “Belief Formation in a Post-Truth World”. McKay started with a list of famous cases where people were made to believe in events that never occurred. What are the ramifications of fake news? For individuals, serious failures of judgements. But for society at large, even more serious outcomes (e.g. indifference to climate change, anti-vax propaganda). How do false beliefs get traction in human minds?

There are many factors affecting belief consumption: truth is not the only relevant consideration. In terms of content-specific reasons to adopt a belief, one reason is that a belief matches your experience. But experience can be misleading (in clinical cases, an unusual experience can generate a very implausible, delusional, belief).

Another factor affecting the adoption of beliefs is the presence of preferences for which there can be good evolutionary reasons. We assume that there is agency in everything we experience (e.g. supernatural beliefs or conspiracy theories) even if there is no agency. A third reason for adopting some beliefs for which there is no (good) evidence is the presence of motivational factors: McKay discussed the case of positive illusions in this context.

One very interesting finding McKay discussed in the context of explaining how we maintain positive illusions is the fact that more knowledge does not protect from desirability effects and excessively polarised positions in public debates. That is because we asymmetrically update our beliefs, taking on board evidence for desirable outcomes, but dismissing evidence for undesirable outcomes. Such biases in belief evaluation and belief revision underpin self-deception in deflationary accounts such as Mele’s.

There are also content-neutral factors (such as jumping to conclusion and other biases) why we adopt certain beliefs. One important issue is signalling: people use beliefs as identity markers, sending a strong signal as to what views you are committed to and which groups you belong to.

Anna Ichino (Milan) gave the final paper of the day, investigating how imagining differs from belief. She maintained that imaginings and beliefs differ only with respect to their cognitive inputs, or, in other words, that whilst beliefs are formed in response to real-world evidence, imaginings are not. She then argued against a position that has become standard in the imagination literature, defending the view that imaginings and beliefs do not differ as regards their behavioural outputs.

She took it that the relationship between beliefs and behavioural outputs is such that our beliefs cause us to act in ways that would promote the satisfaction of our desires, if they were true. Ichino then suggested that in many cases, imaginings cause us to act in ways that would promote the satisfaction of our desires, if they were true.

But, surely we can imagine all sorts of things, and not thereby act upon them? Acknowledging this thought, Ichino brought up O’Brien’s example: Lucy can imagine being an elephant, but this does not entail all of the behavioural outputs that believing that she was an elephant would promote (for instance, resigning from her job, and withdrawing from interactions because she is no longer able to comply with human social norms; buying a new bed because elephants do not fit in human beds… etc). But imaginings like these are not similarly integrated into a network of cognitions as the equivalent beliefs are. Ichino's challenge to us and to you: Find a case where an imagining does not motivate, where, all else being equal, a belief with the same content would. Can you think of one?

The second day of the conference started with a talk by Kathleen Stock (Sussex). The question guiding the talk was whether some delusions are also imaginings or involve imaginings.

Kathleen Stock on imagination and delusion

Jakob Ohlhorst on delusions as certainties

The Metaphysics of Responsible Believing

In this post, David Hunter, Professor of Philosophy at Ryerson University in Toronto, Canada summarizes his paper titled “The metaphysics of responsible believing”, recently published in the Brazilian journal Manuscrito.

An important task in the philosophy of mind and action is to understand what it is for a person to be responsible for their mental states and their actions. It is natural to think that a person is responsible for their actions only if they act freely or voluntarily. But most philosophers agree that we cannot believe, desire or intend at will. But then how can we really be responsible for these mental states? In the case of belief, this is called the problem of epistemic agency. My essay is about this problem.

In recent years, some philosophers have argued that the standard conception of action tends to obscure our practical agency. It holds that an action is (typically, anyway) a bodily movement caused in certain ways by the person’s mental states. This conception can seem appealing because, or so many think, it fits neatly into a naturalist or physicalist picture of the mind. But critics have complained that it leaves no room for the person who is doing the acting. The person acting, these critics charge, has disappeared from view.

In my essay, I argue that the standard conception’s picture of belief also makes the person disappear from view. It considers a belief to be (i) an entity inside of a person, usually inside their brain, that (ii) can be true and justified, that (iii) a person attends to and acts on during theoretical investigations, and (iv) that cause her bodily movements when she acts. The main aim of my essay is to sketch an alternative conception of belief, one that denies these four points.

Values in Psychological Science

Today's post is by Lisa Osbeck. Lisa is a Professor of Psychology with interest in the Philosophy of Science. Her work explores the psychological dimensions of science practice and considers how they can help us better understand both science and persons. In this post, Lisa presents her new book Values in Psychological Science: Re-imagining Epistemic Priorities at a New Frontier, published by Cambrige University Press.

In previous work, I collaborated with Nancy Nersessian and colleagues in an ethnographic study of four bioengineering laboratories. We analysed how emotional expression and social positioning are integrated with cognitive processes in innovative problem solving with these settings. One aspect of this work was a study of disciplinary identities and associated epistemic values, with an analysis of the ways these identities facilitate or impede creative innovation in collaborations (Osbeck, Nersessian, Malone, and Newstetter 2011; Osbeck & Nersessian 2017). In the new book I turn more directly to the question of values and how they impact psychology.

Values and Psychological Science: Re-imagining Epistemic Priorities at a new Frontier argues for a need to consider how the personal dimensions of scientific practice including value commitments, might facilitate good science in various ways. The opening chapter claims that psychology will increasingly find an opportunity for lasting impact through interdisciplinary participation that generates new questions and new possibilities for a sustainable human future.

In keeping with this claim, I argue that a set of activities is in need of greater appreciation and emphasis across research domains and orientations in psychology. I suggest that these activities are more fundamental than the methods that have been psychology's main preoccupation. As activities that are important for science, their cultivation becomes a disciplinary value, an epistemic priority. I argue that the most fundamental activities cut across the traditional domains of science and art/humanities, and therefore ground the possibility for productive and resourceful collaboration between psychology and other disciplines.

The Meanings of "Think" and "Believe"

Today's post is by Neil Van Leeuwen who talks about his recent research with Larisa Heiphetz on the differences in meanings between "think" and "believe". For related research by Heiphetz and Van Leeuwen, see here, here, and here. 

Neil Van Leeuwen

Do “think” and “believe” mean the same thing? Consider two sentences:

• Jill believes that God exists.
• Jill thinks that a lake bigger than Lake Michigan exists.

Both sentences attribute mental states to Jill. And each breaks down into an attitude (thinks/ believes) and a content (that God… / that a lake…). So we can sharpen our question: if we set the contents aside, do the words “thinks” and “believes” convey the same attitude type (or manner of processing)?

Many philosophers and cognitive scientists talk and write as if the answer were yes—as if the words “think” and “believe” were interchangeable, at least in propositional attitude reports (i.e., as if “thinks that p” and “believes that p” referred to the same attitude).

But do lay speakers use “think” and “believe” to convey the same thing? In addition to its intrinsic interest, answering this question is important for philosophers and psychologists: if the answer is no, then we theorists should be cautious about treating them as interchangeable, unless we clarify their meanings as terms of art (which we rarely do).

Larisa Heiphetz

Larisa Heiphetz, Casey Landers, and I address this very question in our new paper “Does ‘think’ mean the same thing as ‘believe’? Linguistic Insights into Religious Cognition” (forthcoming, Psychology of Religion and Spirituality). We have two main findings:

• Lay speakers of American English are more likely to use “think” for everyday, matter-of-fact attitudes (factual beliefs) and “believe” for religious and political/ideological attitudes (religious or ideological credences).
• This difference remains even when contents are held fixed: a factual belief that pis more likely to be described as “thinks”, but a religious credence that pis more likely to be described as “believes”.

These findings emerged from both corpus linguistics and behavioral studies. (Important caveat: we are not saying that these are the only uses of these two verbs; other uses exist, such as hedging. We are saying, rather, that an important pattern of differential usage exists that tracks differences in attitude type.)

Our first study explored the Corpus of Contemporary American English (COCA), a body of text with over 520 million words going back to 1990. Over several searches, we found that “believe that” had a multiple religious collocates (words or phrases associated at a higher rate than would be expected by chance), words like “miracles” and “Allah,” while “think that” had no religious collocates whatsoever. 

Casey Landers

Furthermore, we searched various religious propositional complements, like “that God is,” to see whether “think” or “believe” would precede them with significant frequency: “believe” occurred as a collocate prior to such phrases often; “think” was never a collocate. So “believe” collocates with religious complements in both directions; “think” has no specifically religious associations at all.

We then did four behavioral studies to see what attitude verbs participants would choose for different attitude report contexts (religious vs. factual for Studies 2-4; religious vs. factual vs. political for Study 5). Consider the following fill-in-the-blanks, which are representative of our stimuli in Studies 2 and 3. 

• Zane _______ that Jesus turned water into wine.
• Fred and Yuriana _______ that George Washington was the first U.S. President.
• Nick _______ that cassiterite is the chief source of tin.
• Sharon _______ that she will meet her mother at the grocery store today. 

The first context is of course religious. The other three are matters of fact: well-known fact, esoteric fact, and everyday life fact. We found participants were more likely to choose “believe” for religious attitude reports and “think” for factual attitude reports. This was true in both forced-choice (Study 2) and free-response paradigms (Study 3).

In Study 2, for example, participants chose grammatically appropriate forms of “believe” in 89% of the religious contexts (11% for “think”) and only 18% of the time in factual contexts (82% for “think”). Study 2 data look like this:

Study 3 used the same stimuli as Study 2, just with a free-response paradigm (participants could fill in any words they wanted). We found that participants still used “believe” for religious contexts 51% of the time; they used “believe” for matter-of-fact contexts only 8% of the time. Another result from Study 3 was that participants were more likely to use “know” for factual than religious items. (We weren’t expecting this, since our overall sample had a reasonable balance of religious and non-religious participants.) 

The Bloomsbury Companion to Philosophy of Psychiatry

This post is written by Şerife Tekin and Robyn Bluhm. Şerife Tekin is an Assistant Professor at the Department of Philosophy and Classics at the University of Texas at San Antonio. She has published widely in philosophy of mind, philosophy of psychiatry, and medical ethics.

Robyn Bluhm is an Associate Professor in the Department of Philosophy and Lyman Briggs College at Michigan State University. She has published widely in philosophy of neuroscience and philosophy of medicine and psychiatry. In this post, Şerife Tekin and Robyn Bluhm present their new edited volume "The Bloomsbury Companion to Philosophy of Psychiatry".

Although there has long been a close link between philosophy and psychiatry, it is only in the past few decades that philosophy of psychiatry has emerged as a field in its own right, with its specific set of questions and themes generating interest from both traditional philosophers, and mental health professionals, including psychiatrists, psychologists, and social workers.

Consider some of these themes that have generated many philosophical and scientific questions: How must we define mental disorders? What are the criteria for the validity and reliability of scientific categories of mental disorders? Are there cross-cultural differences in the properties of mental disorders? Are mental disorder criteria responsive to the experience of people with mental disorders? How do the systematic problems in psychiatric care affect intersectional identities? What are the ethical issues concerning psychiatric diagnoses and treatment? What kind of science is psychiatry?

Identification and Self-knowledge

Luca Malatesti (left in the picture below) and Filip Čeč (right) collaborated on the project Classification and explanations of antisocial personality disorder and moral and legal responsibility in the context of the Croatian mental health and care law (CEASCRO), funded by the Croatian Science Foundation (HRZZ-IP-2013-11-8071). 

Both are based in the Department of Philosophy of the Faculty of Humanities and Social Sciences in Rijeka (Croatia). Luca is associate professor of philosophy and works mainly in philosophy of mind and philosophy of psychiatry. Filip is assistant professor of philosophy and his interests include the metaphysical problem of free will and moral responsibility, and the history of psychiatry.

In this post Luca and Filip summarize their chapter ‘Identification and self-knowledge’, that is contained in the collection edited by Patrizia Pedrini and Julie Kirsch, Third-Person Self-Knowledge, Self-Interpretation, and Narrative. 

According to “Real Self” accounts, an agent is morally responsible when she acts or thinks because of propositional attitudes, such as beliefs and desires, that, in virtue of a process of identification of the agent with them, belong to her real self (Frankfurt 1971, 1988; Watson 1982, 2004). This process is taken to lead the agent to embrace and internalize these mental states in a way that they come to reflect what she really is.

Matt King and Peter Carruthers criticized these accounts of responsibility (King and Carruthers 2012; see also Carruthers 2011). They argued that these doctrines necessarily require that identifying with a propositional attitude involves knowing it transparently. This means that the agent has a privileged and unmediated epistemic perspective on her mental states over the indirect access that others might have to them. 

Moreover, they argue that contemporary cognitive science offers evidence that there are no conscious propositional attitudes and decisional processes that would ground such transparency. According to them, the only objects of transparent knowledge are perceptual and sensory data that are exploited by mentalizing mechanisms to ascribe propositional attitudes to ourselves and others. 

The Computational Mind

This post was co-authored by Matteo Colombo, an Assistant Professor in the Tilburg Center for Logic, Ethics and Philosophy of Science, at Tilburg University in The Netherlands, and Mark Sprevak, Senior Lecturer in the School of Philosophy, Psychology and Language Sciences at the University of Edinburgh. 

They share research interests in philosophy of the cognitive sciences and philosophy of science in general. Here they write about their new co-edited volume “The Routledge Handbook of the Computational Mind”.

The book aims to provide a comprehensive, state-of-the-art treatment of the history, foundations, challenges, applications, and prospects for computational ideas regarding mind, brain, and behaviour. There are thirty-five chapters from contributors across philosophy and the sciences. It is organized into four parts:

1.     History and future prospects of computational approaches

2.     Types of computational approach

3.     Foundations and challenges of computational approaches

4.     Applications to specific parts of psychology

You can read a sample chapter here.

The Handbook displays several common threads. We want to mention three, each reflecting a departure from traditional thinking about the computational mind. 

Making Up Symptoms

Today's post is by Huw Green. Green is a psychologist who recently moved back to the UK after finishing a PhD in Clinical Psychology at the Graduate Center of the City University of New York, and a clinical postdoctoral fellowship at the World Trade Center Mental Health Program at Mt Sinai Hospital New York. He is currently full time dad to a toddler and new baby while waiting to become HCPC registered and start clinical work.

Various scholars have suggested that psychiatric disorders vary across time, especially in terms of their phenomenology. In a recent paper appeared in the Psychiatric Bulletin I offer an account of how this sort of change might come about.

I start with the suggestion that changes in psychiatric terminology through history – and in particular the shift toward more homogenous descriptions of psychotic symptoms in formal documents like the DSM – have had an impact on the very experiences that terminology tries to describe. This is not my suggestion; it is an argument by Ian Hacking, who claims that new diagnostic categories bring new ways of being into existence via “looping effects.” 

Briefly, psychiatrists create new categories to describe people, and because people are not indifferent to these (i.e. are aware that they are being labelled as “depressed,” “hysteric” or what have you) they change in response to the categories. This has the further knock on effect of changing the category in response. For Hacking, psychiatry doesn’t only describe people; it changes them in virtue of those descriptions.

Unlike Hacking I think we need further conceptual resources to understand such change. His proposed “looping effects” make intuitive sense for behavior, about which we have (some) choices, but there is seemingly something different about the raw phenomenology of psychiatric disorder. 

When people feel depressed or hear voices it can seem that these experiences are just a given; they aren’t a choice. As a result they can seem less apt to be influenced by the way doctors classify and describe them. How could a professional’s description of a class of subjective experiences have an influence on the way they feel for individuals?