Tuesday 29 December 2020

Rationality in Mental Disorders

Today's post is by Valentina Cardella (Università di Messina). Here she talks about a recent paper she wrote, "Rationality in Mental Disorder: Too little or too much?", published open access in a special issue of the European Journal of Analytic Philosophy on Bounds of Rationality.

Valentina Cardella

Are people with mental disorders irrational? At first sight, this seems to be a trivial question: madness is the realm of non-sense. When someone tells you that her neighbour installed a tracking device in her abdomen, or that her internal organs are decomposing, you can’t help to wonder: how can she believe such impossible things? Where has her rationality gone? The common conceptualization of madness, which dates back to the Enlightenment, reflects this common-sense intuition: in people with mental disorders emotions are abnormal and unrestrained, and, on the other side, reason is severely affected. People with mental disorders can’t reason properly, healthy people can.

Yet, is it really so? We can bring it into question for several reasons. First, man is not a rational animal, after all. Irrationality is widespread in the general population. We are far from being rational, especially if by rationality we mean logic. When we reason, we make systematic errors, because our rationality is bounded (we don’t have enough cognitive resources to always apply correct strategies, see Simon, 1991), and because we use heuristics, i.e. quick mental shortcuts which reach satisfactory, even if not rational, solutions (Kahneman et al., 1982; Girotto, 1994).

On the other side, the clinical reality seems to show that madness is not the realm of non-sense. Even severe psychoses like schizophrenia don’t affect the ability to reason. Research in the area of both deductive and probabilistic reasoning showed that schizophrenic patients don’t break the formal rules of logic, and, surprisingly, they can also be more logical than non clinical subjects. For example, in the tasks where common sense truth and logical truth conflict, people with schizophrenia perform even better than normal controls. Asked to judge the validity of a syllogism, control subjects tend to consider it valid when its conclusion is commonsensical, while schizophrenic patients recognize the validity of the argument also when its conclusion goes against common sense.

Actually, common sense, rather than rationality, is dramatically impaired in schizophrenia. What would normally seem self-evident causes amazement and perplexity in schizophrenic subjects, who experience a detachment from the web of beliefs, attitudes and categories which represent the background of everyday life. To give an example, C.D.B., a schizophrenic patient, says that “nothing is obvious to him; everything can be uncanny. The world is complicated, difficult to understand. […] Facts are not self-evident.” 

Yet, it is worth noting that this detachment from common sense (the loss of natural evidence, cf. Blankenburg 1971), is compensated precisely by logic. C.D.B., as reported by Stanghellini, “feels the need for a general theory that makes the world understandable and his actions possible.” (Stanghellini 2000, 777). In other words, schizophrenic patients develop an intellectual attitude toward the world, the so-called morbid rationalism in Minkowski's La  Schizophrénie (1927), or hyper-reflexivity in Sass's Madness and Modernism (1992), trying to explain rationally what looks absolutely evident to common people. 

And what about delusions? Schizophrenic can be good at logic, but holding impossible beliefs is clearly irrational. Once again, this is not the case. First of all, perfectly healthy people hold beliefs that are not supported by evidence, or that break the norms of rationality: superstitious beliefs, racist beliefs, magic beliefs, paranoid beliefs (Bortolotti, 2013; Galbraith on delusions and pathologies of belief). If by rationality we mean having beliefs that are consistent and supported by facts, it seems that the vast majority of us, not to say all of us, is not rational.

Furthermore, delusional subjects use logic and reason to protect and justify their beliefs. For instance, the patient who claims that his neighbour implanted a device in his abdomen, explains that the device has been atomized, i.e., dismantled into its component atoms to pass through the body, and reassembled again on the other side, otherwise there had been an incision. The subject who believes he’s decomposing, says he realized it because of the strong smell coming from his body. As observed by Jaspers in General Psychopathology (1963), delusions are frequently accompanied by the fully preserved capacity for reasoning and formal logic.

What lesson can we learn from this data? We can say that, even if we intuitively attribute irrationality to mental disorders, this attribution lacks any evidence, since both the experimental tasks and the autobiographical reports of single patients outline a different, even opposite, picture. Maybe we keep considering irrationality a crucial feature of mental disorder for different reasons, not grounded on evidence, but on historical, psychological and sociological factors. After all, it’s very easy to call irrational what we don’t understand.


Tuesday 22 December 2020

Doctors without 'Disorders'

In today's post I am going to present an argument I developed in an article for the Supplementary Volume of the Aristotelian Society, Doctors without 'Disorders'. The paper was recently listed among the best articles in Philosophy published by Oxford University Press in 2020 (and thus it is available open access at the moment). I also presented this idea at the Joint Session last summer in a symposium on the concept of disorder and a video of the presentation is available (click below to watch).

How do we decide whether the problems we experience deserve the attention of medical professionals? Many believe that the answer hangs on whether the problem we have is caused by a disorder: if it is caused by a disorder, then medical attention is appropriate. If it is not caused by a disorder, then it is still a problem, but not a medical problem. It is a problem in living, a problem we need to try and solve by some other means.

I argue that the dichotomy between medical problems and problems in living is unhelpful, because the presence of a disorder does not successfully demarcate those problems that deserve medical attention from those that need to be addressed differently. Indeed, both in the context of somatic and mental health, we may seek medical attention for problems whose causes are unknown or problems that we know are not caused by a disorder (such as pregnancy, obesity, back pain) given the most influential accounts of what a disorder is.

Counterexamples to the rule that we seek medical attention only for problems caused by disorders abound no matter which influential account of disorder we adopt, from value-free naturalist accounts where a disorder is a biological dysfunction to value-laden constructivist or normativist accounts where a disorder is an undesirable state that can be potentially addressed by medical intervention. 

In the paper, the example I develop in some detail is that of delusions. We tend to consider delusions as pathological beliefs. But what makes them pathological? There are several hypotheses about delusions being the outcome of a cognitive dysfunction but the failures of cognition observed in people with delusions could as well be the product of reasoning biases, so the naturalist account does not help. 

Delusions are regarded as harmful, but it is not clear that harm always accompanies a delusion or that the harm experienced by the person with delusions is due to the delusions themselves. Harm could be a consequence of whatever problem delusions are a response to, or to the stigma and resulting social exclusion that the person with delusions is likely to encounter. That means that normativist accounts are also inadequate to capture what is pathological about delusions.

Even if we could offer a plausible account of the pathological nature of delusions, would that explain why people with delusional beliefs often come to the attention of mental healthcare professionals? I suggest it wouldn't. The cognitive dysfunction often associated with delusions is also appealed to in the explanation of non-pathological phenomena such as self-deception; and delusions are not the only beliefs that are irrational and potentially harmful and yet they are considered as symptoms of mental disorders whereas equally irrational and potentially harmful beliefs (such as prejudiced beliefs) are not.

Another example that is not addressed in the paper but that people have recently discussed is that of anxiety at the time of a pandemic (see brief discussion below). Does it matter whether the troubling state of anxiety many people have experienced during COVID-19 is the manifestation of a disorder or a natural response to adverse circumstances? If a medical intervention can help, should we avoid seeking it because the problem we have is not caused by a disorder? My conclusion is that the notion of 'disorder' does not successfully demarcate the scope of medical practice. Something can be at the same time a problem in living and a medical problem.

Tuesday 15 December 2020

Narrative Capacity and Moral Responsibility

This post is by Meghan Griffith (Davidson College).

Meghan Griffith

In “Narrative Capacity and Moral Responsibility”, I argue that our ability to understand and tell stories plays a role in moral responsibility. One standard approach to moral responsibility involves “reasons-responsiveness.” If we can recognize and react to reasons for acting, then it seems that we are in control of our behavior, and therefore responsible (see Fischer and Ravizza 1998 for an influential account). I think “narrative capacity” enhances our sensitivity to reasons.

Narrative capacity is a way of making sense of the world (Velleman 2003, 1) and involves understanding the “meaning-affecting” relation between events (Rosati 2013, 34). In other words, we come to understand and interpret the events in our lives within the context of a story. Each event is not interpreted on its own. Instead, its meaning is “conditioned by” its relation to other events (Schechtman 2007, 162). For example, an event might be interpreted as disappointing or ironic only because it is understood in a particular context (Velleman 2003).


There is fascinating research in psychology that discusses narrative skill as a social and cognitive achievement. Learning to “read the world” begins early. Children first develop an understanding of life events in a problem-resolution structure (Habermas and Bluck 2000, 752), later developing an understanding of their own and others’ inner mental states (Nelson 2003). They begin to see goals, motivations, and reasons for action (Rubin and Greenberg 2003, Hutto 2007). Typically, in adolescence, children begin to see their own lives as an entire “life story” (McAdams 2001).


I think narrative capacity enables us to recognize reasons we wouldn’t otherwise see, and also enables us to weigh reasons differently than we otherwise would. A philosophical account of this capacity engenders a more nuanced understanding of degrees of blameworthiness. According to traditional philosophical accounts, children are often thought to be exempt from blame because they do not know better or because they have problems with self-control.

But these traditional explanations, while not entirely incorrect, are problematically oversimplified. In some cases, what children cannot do is feel the full weight of a reason the way a typical adult would (or should). Improper weighting can result from lacking context and perspective; a young child knows it is wrong to harm but is less able to feel the full force of this as a reason. As children develop, their ability to properly weigh reasons improves. Their degree of blameworthiness therefore increases as it becomes less difficult for them to properly evaluate. There is also evidence that psychopaths struggle with narrative skills (Kennett and Matthews 2009), which might explain a reluctance to hold them fully blameworthy.


Furthermore, narrative capacity may illuminate inner psychological barriers to agential control by helping us understand why an agent encounters relative difficulty (from the inside) at seeing or responding to reasons. Past reasons-responsiveness accounts have been criticized on the grounds that they don’t illuminate inner psychological barriers to action (see McKenna and Van Schoelandt 2015).

Tuesday 8 December 2020

What Are Political Beliefs?

Today's post is by Jeroen de Ridder (Vrije Universiteit Amsterdam) and Michael Hannon (University of Nottingham). Their post is based on their chapter ‘The Point of Political Belief’ to appear in the Routledge Handbook of Political Epistemology (forthcoming in 2021), which they edited together.

About a week after CNN and most other major news outlets had called the 2020 US election for Joe Biden, secretary of state Mike Pompeo stated in a press conference: “There will be a smooth transition to a second Trump administration.” This is just one example of a political belief that seems, shall we say, slightly out of touch with reality. There are others: one out of seven survey respondents agree with the statement “Barack Obama is the antichrist” and one out of seven Trump supporters maintain that the half-empty photo of Trump’s 2017 inauguration has more people than a photo of Obama’s packed 2009 inauguration.

Do people really believe these things, in the same way they believe, say, that their father was born in Amsterdam or that Earth has one moon? Do they really take these things to be accurate representations of what the world is like? Perhaps something else is going on.

Michael Hannon

Psychologists have established that people’s political beliefs are highly susceptible to motivated reasoning, identity-protective cognition, and confabulation (see Brennan 2016 for an overview). We process political information in ways that confirm our pre-existing beliefs, nurture and maintain our political identity, and bolster group loyalties—often at the expense of truth. Instead of accurately representing the world, our political beliefs often serve socially adaptive functions: they allow us to fit in, get us invited to barbecues, and bond with people ‘like us’.

If this is right, it can also account for why some political beliefs are so easily given up or even traded for contrary ones. Geoffrey Cohen’s (2003) work provides a striking example. He ran a study in which participants were told about two welfare programs: stingy and lavish. Both Democrats and Republicans supported whatever they were told their party supported. It made little difference what the actual content of the policy was.

Jeroen de Ridder

Perhaps we can go even further. Maybe these crazy-sounding utterances and elusive convictions aren’t really beliefs at all. Maybe they’re more like the chanting of football fans or the Italian tailor-made suit of a city banker: they express a set of attitudes or a social identity, but don’t report what someone believes about the world. Saying that Obama is the antichrist or that more people attended Trump’s inauguration is simply partisan cheerleading, not an honest assertion in a political conversation.

Recent research in political behavior offers some empirical support for this idea. Bullock and colleagues (2015) found that partisans tend to give more accurate (less partisan) responses to politically charged questions when offered modest monetary incentives to answer correctly. If these survey responses reflected actual beliefs, then paying partisans to answer correctly should not affect their responses. Yet it does. This suggests that partisans will deliberately misreport their beliefs as a way to signal their allegiance to a particular ideological community. We should therefore be wary of taking factual claims about politically charged issues at face value, since they are often contaminated by the motivation to root for one’s team.

What’s the upshot? When thinking about political beliefs, we naturally assume that their function is to represent the world. But maybe that’s just wrong – for at least many political ‘beliefs’. They often appear to serve different functions: bolster group loyalty, protect identities, or receive psychological gratification. While it is easy to criticize people for making false claims or believing against the evidence, such criticisms may miss the point that for many voters, politics is not really about truth.

Tuesday 1 December 2020

Philosophy of Madness

Today's post is by Wouter Kusters, a philosopher, linguist and independent writer, teacher and consultant living in the Netherlands. In 2014 his comprehensive and transgressive book Philosophy of Madness was published in the Netherlands, and later this month the English translation will appear at MIT Press. Here you find an excerpt from the Preface to the English Edition (there is also a video presentation you can watch).

Wouter Kusters

Madness as I discuss it in this book is the imperfect translation of the Dutch waanzin, with which I focus on the range of experiences of all those who are deemed in medical jargon to be psychotic, as I myself was twice.

Its first thematic line is a philosophical examination of the experience of being psychotic. I examine what happens in the various phases of the psychotic experience. What happens to the experience of time and space? What happens to reality? How are other persons perceived, and what happens to thought? It was this highlighting, analyzing, expressing, and evoking of the experience of psychosis which made this book to such a success in the Netherlands.

I was asked to give lectures, presentations, and courses to inform and teach psychiatrists, psychologists, and all kinds of other professionals and non-professionals who work and live with psychotic people. But didn’t they already know what the experience of psychosis is like? Apparently not. 

In mental health education today, so much of the psychotic experience is hidden behind supposedly objective labels and descriptions, behind risk management, fear, and theoretical and distanced semi-professional attitudes. Consequently, the voices of the psychotic, with their full meanings, intentions, desires, and intensities, are seldom heard.

The book also touched a nerve among other kinds of readers, namely all those who at one time or another have been labeled psychotic, schizophrenic, bi-polar, or by any number of related terms. So many have gone through the same depths and heights, the same dark confusions and bright insights, but have never had the chance to allow madness to re-enter their consciousness, to be put into words, either for others or for themselves. 

In a way this is also a dangerous book, since it concerns the possible maddening effect of certain words and thoughts. I demonstrate that a certain kind of consistent philosophizing may very well result in aporias, paradoxes, unworldy insights, and circular frozenness that is reminiscent of madness. This fed another kind of reader who was primarily interested in the book for its perspective on philosophy as a dangerous, possibly maddening, activity in which the stakes are, and should be, set high.

These thematic lines blend together and can be depicted as a circle, as the proverbial snake that eats its own tail, or as a so-called Möbius strip. This paradoxical image forms the basic structure of the book and runs in coded and mirrored forms throughout the book. The empty center of the circle refers to the voice and subjectivity of the author of the text, but also to the empty mind of the reader, and to the quasi-mystical, ineffable content of the concept of madness. 

This circular, paradoxical form is the signpost in the field where madness and philosophy intertwine, contrast, and converge in the text. Without any stable stronghold in an “objective point of view” or in a “neutral language or framework,” I present this field with all its intrinsic mysteries, paradoxes, and strange obstacles of down-to-earth spirituality.