Tuesday 23 February 2021

Interview with Federico Bongiorno on Delusions

In this post, I interview Federico Bongiorno who recently completed a doctoral project on delusion formation at the University of Birmingham.

Federico Bongiorno

LB: Philosophers are intrigued by delusions. What interests you about them?

FB: There are several things that interest me about delusions, which is part of the reason why I decided to write a PhD thesis comprising of self-standing papers rather a single book-like package. I will focus on just one, the question of whether delusions can be beliefs despite being only marginally belief-like.

Participants in this debate are typically non-committal as to what beliefs are over and beyond our folk-psychological practices. So, when they ask whether delusions are or aren’t belief-like, what they want to know are things such as whether delusions play the same role as beliefs in predicting intentional behaviour, or whether they conform to the stereotypical cluster of attributes (cognitive, behavioural, phenomenal) that we would normally expect beliefs to manifest.

An aspect that has so far been largely neglected in the debate is whether delusions really are beliefs, whether there is any robust and unitary psychological entity to simultaneously fill the role set by our folk concepts of ‘belief’ and ‘delusion’. Are beliefs objects that function within scientific theories, or are they merely part of folk psychology? And are delusions belief-like in a scientific psychological sense, strictly in a folk psychological sense, both, or neither?

Addressing this gap is important, I think, for the at least the two following reasons.

First, we need to ensure that the folk concept of belief is not in conflict with the scientific kind at work in psychology and cognitive science. For otherwise, we should allow for the possibility that delusions may be consistent with one but not with the other, or vice versa.

Second, if we can make lawlike generalisations about the ways we normally fix, update, and store beliefs, then we are in a position to really tell whether the surface features of delusions are features of beliefs.

The hypothesis I explored in my PhD thesis was that delusions are the way they are, deviate from rationality in the ways they do, because of how beliefs function cognitively under highly irregular circumstances, such as anomalous sensory experiences and attentional abnormalities.

So, one thing that interests me which very few people seem to be talking about is whether the status of delusions as beliefs can be assessed outside the folk-psychological discourse, and independent of our regular sayings about belief.

LB: Some philosophers claim that delusions are endorsements of experience and other philosophers argue that delusions are explanations of the experience. What is the difference between these accounts? 

FB: One idea that has been very popular in cognitive neuropsychology and neuropsychiatry is that delusions arise as subjectively adequate responses to abnormal sensory experiences, of sight, hearing, or whatever. Call this view ‘empiricism’. Empiricism comes in at least two variants that differ concerning the specific mode in which delusions are grounded in experience: the explanationist account and the endorsement account.

As you said, on the explanationist account, delusions serve an explanatory function, they arise inferentially from one’s reasoned attempt to explain an abnormal experience. On the endorsement account, delusions are acquired immediately, non-inferentially, from experience when one takes that experience at face value.

We can illustrate the difference between these two accounts using the example of Capgras delusion, in which a close relative or spouse is believed to be a stranger and to have been replaced by an identical imposter. Both sides agree that the Capgras delusion involves an abnormal experience in response to seeing a familiar person. What is at issue is the degree of continuity between the representational content of the experience and the content of the delusion itself.

Proponents of the explanationist account will say that the content of the experience is relatively nonspecific. For instance, the experience might be a coarse-grained feeling that something is off about the person being looked at, and one would hit upon the delusional hypothesis to make sense of why the person feels off, e.g., she does because she’s not who she looks like.

By contrast, proponents of the endorsement account will take the content of the experience to be closely linked, if not identical with, the delusional content. For instance, they might think that the reason why a subject believes that the person in front of them is a stranger is because they have in fact an experience representing that person as a stranger. 

LB: Which account do you prefer? 

My preliminary answer would be neither and both. 

What I mean is that we don’t have to choose one: we can use whichever seems most appropriate depending on context. For instance, if someone believes that they are possessed by the devil because they hallucinate voices telling them to kill God, their belief is probably going to be an explanation of experience. On the other hand, if someone believes they have a second head because they hallucinate a second head, that is probably going to be an endorsement of experience.

Something else to keep in mind is that you could in principle have hybrid cases of delusions formed from a combination of endorsement and explanationist processes. Indeed, some think the Capgras delusion might be one such case: the subject would literally experience a person as a stranger at some first moment in time, and later infer that the person is an imposter to explain why she looks so much like a loved one.

So, on balance, there is no reason why we should give up one view and keep the other, given that both potentially help explain delusions.

Tuesday 16 February 2021

Delusions Beyond Beliefs

This post is by Jasper Feyaerts, who is discussing a paper he co-authored with Mads G Henriksen, Stijn Vanheule, Inez Myin-Germeys, and Louis A Sass, entitled "Delusions beyond Beliefs", and published in The Lancet Psychiatry. With this link, there will be free access to the article for a few weeks.

Jasper Feyaerts

Delusions are commonly conceived as false beliefs that result from epistemic failures to represent reality correctly. This view has been dominant throughout the history of psychiatry, and continues to inform contemporary research and practice. In explanatory research, it underlies (neuro)cognitive attempts to explain delusions in terms of impairments or biases in cognitive reasoning. In clinical practice, it motivates cognitive-behavioral strategies focusing on the rational evaluation of delusional appraisals.

Yet despite being the standard view of delusion in psychosis research, this conception has not gone entirely unchallenged. Most notably in the tradition of phenomenological psychopathology (Sass & Pienkos, 2013; Stanghellini et al., 2019), less emphasis has been put on the erroneous or belief-like nature of delusions, than on adequately identifying the specific experiential context within which delusions occur, with a particular focus on what ‘sort’ of reality delusional individuals may ascribe to them. 

Karl Jaspers in General Psychopathology, for example, already emphasized how certain types of delusions – i.e., which he called ‘primary’ or ‘true’ delusions, and considered specific for schizophrenia – are not mere ordinary empirical beliefs, but may involve global ontological changes that affect our most basic experience of reality. “Delusion proper”, Jaspers wrote, “implies a transformation in our total awareness of reality” (page 95); “reality [for the patient] does not always carry the same meaning as that of normal reality” (page 105).

In our review paper, we discuss how this phenomenological emphasis on the overall experiential context of delusions can be used to critically revisit and to enhance contemporary diagnosis, explanation and treatments for delusions. In diagnostic research, we show how claims regarding the existence of a so-called ‘continuum’ between ordinary irrational beliefs and delusions may have more to do with the vagueness and selectivity of criteria and measures used in assessing these phenomena, than with the continuous nature of delusional experience itself. 

In explanatory research, we discuss how one/two-factor-accounts and predictive models could benefit from accommodating global ontological transformations in their accounts. This could offer more specificity to the nature of anomalous experience in schizophrenia, while it also challenges the idea that delusion is always a matter of (rational or irrational) belief explaining or endorsing experience. We emphasize in particular that alterations in reality experience also alter the cognitive status of delusions. It is unclear, for example, whether straightforward believing is actually possible in a delusional world that is experienced as entirely unreal or sometimes even as somehow mind-dependent.

In therapeutic research, we suggest that the limited therapeutic benefits of current cognitive-behavioral treatments for delusions (see Jauhar et al., 2014) may be the result of applying an ordinary framework of reality experience in emphasizing rational evaluation of delusional beliefs. We argue that treatments should shift away from narrowly targeting delusions themselves (via attempts, eg., to refute or challenge them) towards altering the experiential conditions that inspire and sustain them. From a phenomenological perspective, effective treatments are most likely those that help to reduce feelings of self-alienation and uncertain embeddedness in everyday reality that are conducive to delusional experience.

Yet we also emphasize that delusions are not always experienced as a simple affliction or deficit. Indeed, for some individual with delusions, the common-sense perspective can look flat, uninspiring, and utterly constrained by conventionality, closed off from what they consider the true sources of originality and truth. As such, delusions are not only a psychopathological or psychiatric issue, they also seem to confront us with the possible contingency or ungroundedness of our ordinary reality experience.

Tuesday 9 February 2021

Motivated Reasoning in Science

Today's post is by Josh May (University of Alabama, Birmingham). In this post, he talks about one of his papers published in Synthese and entitled "Bias in Science".

Josh May

Much discussion of the replication crisis in science has focused on the social sciences, particularly psychology. A common narrative is that the social sciences are particularly susceptible to powerful biases, such as moral and political ideology. I argue instead for a parity thesis: all areas of science are subject to bias, through the general psychological mechanism of motivated reasoning. This provides a unified framework for understanding how values influence the entire scientific enterprise.

The scientific process involves numerous decisions that can be influenced by one's values--including moral, political, and prudential values--which manifest as goals or motivations. A researcher wants badly, say, to publish in a prestigious journal in order to either advance her career or maintain her status and recognition among colleagues. Or she wants badly to maintain her industry funding, or to promote a pet theory, etc. 

These motivations can then influence her reasoning about which hypotheses to test, how to operationalize variables, how to interpret the data, whether to report certain measures, and so on. Commonly this involves wishful thinking and confirmation bias, but these are just instances of the general phenomenon of one's reasoning being influenced by one's motivations---typically ante hoc, not post hoc (see May 2018: Ch 7).

So what motivates most scientists? Drawing on case studies and surveys of scientists, I highlight four ultimate goals: knowledge, ideology, credit, and profit. Of course many scientists are motivated to produce knowledge and to acquire or maintain a job ("profit"). Researchers are also motivated to promote favored ideologies---such as libertarianism, theism, and environmentalism---for which the natural sciences also have implications (think e.g. of climate change, intelligent design, vaccines). 

What is less often recognized is that, as humans, scientists are deeply social and hierarchical creatures and thus powerfully motivated to acquire, maintain, and improve their status among peers by earning "credit" for scientific advances and achievements. Thus, even when researchers are unmoved by ideology or profit, there is always the concern to impress one's peers and move up the social ladder, even if that requires questionable research practices that conflict with the knowledge motive.

Philosophers of science have long emphasized that values influence scientific practice, in both pernicious and productive ways. I similarly do not assume that motivated reasoning is always problematic. Sometimes it produces knowledge by, say, opening up neglected avenues of inquiry (e.g. Anderson 2004) or leading to an invisible hand that guides the marketplace of ideas toward knowledge (e.g. Solomon 2001; Bright 2017).

My analysis within the motivated reasoning framework argues that the natural and social sciences are more alike than different. All domains of science are subject to motivated reasoning and often the more powerful "non-epistemic" motive is social credit, not ideology, which might seem more prevalent in the social sciences. I hope this illuminates how pervasively values influence all areas of science, whether in pernicious, productive, or even benign ways. 

Motivated reasoning is a fact of human life and thus (all) of science.

Tuesday 2 February 2021

Psychiatry and Anti-Psychiatry in the 70s in Italy

Today's blog is by Matteo Fiorani (University of Rome, Tor Vergata) and it is the last in a series of posts associated with the special issue of the European Journal of Analytic Philosophy on Bounds of Rationality. Matteo's paper (open access) is entitled: "Rationality, Irrationality and Irrationalism in the Anti-institutional Debate in Psychiatry around the Second-Half of the 1970s in Italy".

Matteo Fiorani

The 1968 movements overwhelmed psychiatry with anti-authoritarian and anti-institutional criticism. The young protesters demanded, first of all, the rights of madness and, provocatively, of unreason. At the same time, they dismissed the dominant normality, represented by bourgeois common sense. They also affirmed the need not to repress contradictions and suffering. Emotions and affectivity were indeed part of the social and political world. From these premises it was possible to develop a deep political and cultural reflection on the boundary between reason and madness. The so-called official psychiatry and the scientific criteria that sought to distinguish with certainty between insanity and mental health, were radically challenged.

In Italy, psychiatric discourse was politicized as in no other Western country. Starting in the 1970s, in a scenario characterized by a profound cultural and political transformation within the left, anti-psychiatry became a word that was used, abused, mythologized and misunderstood. It was at the center of a veritable battle of ideas. The traditional concept of rationality and its very connection to irrationality were challenged, as was the idea of classical reason. The attempt was to redefine limits. Did madness really exist? Was it, in a perspective of overthrowing the bourgeois order, a manifestation of freedom and creativity? Or was it illness and suffering produced by life's experiences?

In my article I tried to give an account of all this. Not without difficulty, especially in the interpretation of the sources. On the one hand, in fact, the reviews of the movement, the writings of anti-establishment psychiatrists and the militants of the so-called New Left gave a sensation of hopeless desolation, made up of irrationalist drifts that simplified psychiatric discourse. They also left unresolved the many important questions about normality and madness raised since 1968. On the other hand, oral sources and individual experiences of psychiatric renewal, less visible and less recounted (and for this reason present in the paper as suggestions), warned me of the danger of excluding the positive legacy of those years, probably crushed by the depressed look of today. 

The hyper-politicization of the psychiatric and scientific question certainly struggled to find a synthesis and a direction. Especially since the mid-1970s, the irrationalist drifts can be interpreted as the failed attempt to affirm a new rationality that was even more rigid, even if directed against the system. In this sense, even Marxism, in its various interpretations, proved unable to find a way out. However, it was not only psychiatrists who approached anti-psychiatry texts, but also students and intellectuals (an Italian peculiarity) in search of alternative tools to interpret reality.

These people wanted to free themselves from the decades-long devaluation of science, typical of Italy (in the footsteps of the neo-idealism of Benedetto Croce and Giovanni Gentile) and to open up to foreign countries, especially the United States, where science was not devalued, but complicated, and where it was possible to criticize Galilean rationality without being accused of relativism. In short, the answer to the rationality of the system was not only an aimless flight into irrationalism (which it was). It was also an attempt to hold together rationality and irrationality, intellect and affects (reason and sentiment, we could say), to build a new free and vital subjectivity.