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The debate among philosophers about whether delusions should be classified as beliefs or not. various arguments against considering delusions as beliefs due to their inconsistency and lack of rationality. It also introduces the concept of schmeliefs, which are poorly integrated beliefs that are not sensitive to evidence and control verbal behavior but are not used in practical reasoning. The document also touches upon the different theories of belief and the challenges in defining it.
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A dissertation submitted to the Graduate School—New Brunswick Rutgers, The State University of New Jersey in partial fulfillment of the requirements for the degree of Doctor of Philosophy Graduate Program in Philosophy Written under the direction of Brian McLaughlin and approved by
New Brunswick, New Jersey October, 2013
Psychopathological delusions, such as the Capgras delusion, the Cotard delusion, and the florid delusions that accompany schizophrenia, have a number of features that are curiously difficult to explain. Delusions are resistant to counterevidence and impervious to counterargument. They are theoretically, affectively, and behaviorally circumscribed; delusional individuals tend not to act on their delusions or draw ap- propriate inferences from the content of their delusions. Delusional individuals are occasionally able to distinguish their delusions from other beliefs, sometimes speak- ing of their “delusional reality.” I argue that these features support non-doxasticism about delusions. Non-doxasticism is the thesis that, contrary to appearances, delu- sions are not beliefs at all. After developing the prospects for non-doxasticism, I of- fer a novel non-doxasticist cognitive model. Delusions are pathological acceptances that are caused by powerful and aberrant cognitive feelings.
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Brian McLaughlin. Brian has been remarkably generous with his time and dedica- tion; his encouragement, suggestions, and mentorship have all been absolutely cru- cial. To all of these people, I owe my thanks.
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To Liz.
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This dissertation provides a model of psychotic delusions in which delusions are not beliefs. The model responds to two different debates in the literature on delusions that are not often brought together. The first debate concerns the etiology —the causal origin—of delusions. How does a person suffering from a psychosis come to form a delusional belief? Why do some individuals come to believe that their spouse has been replaced with imposter? There are two main types of answer to these questions. Each makes a different claim about the number of cognitive mechanisms that need to be broken in order for a delusion to develop. One-factor theories hold that we only need to appeal to a single impairment. Delusions are normal responses to an anomalous, pathological experience. Two-factor theories, on the other hand, hold that anomalous experience is not in itself sufficient to produce a delusion. We also need to explain how the experience leads to a delusional belief, and why that be- lief is not immediately rejected for being bizarre. This requires us to posit a second pathology: an impairment or a pathological bias in whatever mechanism is involved in belief fixation. The second debate concerns the characterization of delusions. It is commonly assumed that delusions are beliefs of a certain sort. The one-factor/two- factor debate typically makes this assumption: it is typically presented as a debate about how delusional beliefs are formed. Theories that claim that delusions are be- liefs are doxasticist theories. Lately, some philosophers and psychologists have ar- gued that delusions don’t behave as one would expect beliefs to behave. Hence, they conclude, delusions are not beliefs. Rather, they are some other sort of mental state.
Theories that make this claim are known as non-doxasticist theories. I defend a non-doxasticist, one-factor model of delusions. In brief: a delusion is not a belief, but a distinct sort of mental state that I will call a acceptance , and it is formed on the basis of a powerful and anomalous cognitive feeling. Acceptances are a type of mental state distinct from beliefs. A person can ac- cept that he is being followed, for instance, without genuinely believing that he is being followed. Other philosophers have proposed similar mental states that they call ‘avowals’ or ‘opinions’. On the model I propose, cognitive feelings have an im- portant influence on acceptances. They can cause one to adopt an acceptance non- volitionally. Cognitive feelings are a type of mental state that are only lately being explored by cognitive science.^1 Examples of cognitive feelings include the feeling of confidence, the feeling of familiarity, or the feeling that one is being followed. I have tried to keep the account free of assumptions that would render it palatable to only readers of a particular theoretical stripe. The account is unabashedly natu- ralist and empirical, but beyond these minimal commitments, it is intended to be compatible with most dispositional, functional, representational, or computational theories of mentation.
Why is it interesting or valuable to develop a model of delusions? Throughout the writing of this dissertation, I have been guided by (at least) three reasons for think- ing that this is an important subject of inquiry. Each has given me a different goal. These goals range from being relatively narrow to having fairly wide-reaching conse- quences for philosophy.
understand the phrase “belief-desire psychology”, this might mean that beliefs and desires are only two of many psychological states that we might call upon in giving psychological explanations. However, in practice, many philosophers who hold fast to belief-desire psychology use beliefs and desires in pretty much all explanations, and are extremely reluctant to call upon other attitudes. Those who think we can make do with just a small stock of mental states in our expla- nations think that the mind is sparse. Should we think that the mind is sparse rather than lush? Doxasticism is the thesis that delusions are beliefs and not some other sort of mental state. I see this as representative of the conservatism that underwrites a sparse conception of mental states. The first half of the dissertation adjudicates the arguments between the doxasticists and non-doxasticists, and many of the arguments offered are not simply about delusions: they are general enough to be seen as arguments for and against a lush or a sparse conception of mental states. The implications of these debates are far-reaching. What distinguishes beliefs and desires from other propositional attitudes? Should we expect all propositional attitudes to have a direction of fit? Are beliefs and desires essen- tial to cognition? Are these simply terminological debates about the extension of ‘belief’ and ‘desire’? Chapter 5 addresses these issues directly.
The structure of the dissertation is this: the first chapter following this introduction sets up the problem to be addressed; the next two chapters attack competing at- tempts that have been made by non-doxasticists to address the problem; the chapter afterward sets up the positive proposal; the final chapter gives the positive proposal itself. Chapters 2, 4, and 6 are most explicitly about delusions. Reader coming at this dissertation from psychology or psychiatry rather than philosophy might find their interests best served by focussing on these chapters. I have attempted to leave signposts and summaries throughout each chapter to
help the reader understand where he or she is in the argument. Nonetheless, I invite the reader to refer to the The Table of Contents often, as the section headings can be used as a roadmap.
Chapter 2: Delusion as Non-Belief introduces to the reader descriptions and char- acterizations of delusion that have been given in the literature. I show that such characterizations typically presume doxasticism, but that this presumption is unwarranted. I then describe the features that are in need of explanation and that have motivated philosophers to provide non-doxasticist accounts.
Chapter 3: Conceptual Arguments and Rationality deals with the arguments that are most often made for non-doxasticism. According to these arguments, be- liefs are necessarily rational, but delusions are not rational, so delusions can- not be beliefs. I argue that these arguments are unsuccessful, and that there is no rationality requirement on belief. If non-doxasticism is to be successful, non-doxasticists should give explanatory theories rather than attempt a priori arguments that call upon conceptual requirements of belief.
Chapter 4: Unsuccessful Non-Doxasticist Theories considers non-doxasticist pro- posals that I find wanting. Major theories attacked include those of Currie, Egan, Schwitzgebel, and Campbell. A major theme of this chapter will be that it is easy for an allegedly non-doxasticist account to actually be a terminological variant of a doxasticist account.
Chapter 5: Concepts of Belief attempts to assuage the critic who thinks that the con- cept of belief is so broad that it will necessarily cover delusion, and that non- doxasticism is too revisionary. I diagnose a reason for thinking that delusions must be beliefs and argue against it, and then show that the notion of accep- tance is not as revisionary as it might at first seem, for folk psychology recog- nizes a rough distinction between beliefs and acceptances.
Chapter 6: A Positive Proposal presents the model of delusion that has been pro- mised throughout. Delusions are acceptances based on cognitive feelings. Most
Philosophers in need of colorful ways to illustrate irrational belief have long looked to the madman to supply them with examples. Descartes opens his First Meditation by enjoining the reader to consider “madmen whose brains are so damaged by the per- sistent vapours of melancholia that they firmly maintain they are kings when they are paupers, or say they are dressed in purple when they are naked, or that their heads are made of earthenware, or that they are pumpkins, or made of glass” (1641/1986). These examples are in fact more prosaic than many of the truly bizarre delusions that are relatively common among the mentally ill. Sufferers of the Capgras delusion might claim that their spouse or a loved one has been replaced with an imposter. Sufferers of the Cotard delusion hold fast to an unshakeable conviction that they are dead. Many schizophrenics suffer from thought insertion, and say that they are the thinker of someone else’s thoughts, and others suffer from delusions of reference in which ordinary objects take on all manner of dark and personal import, such as sig- nifying that they are about to be murdered. Delusional subjects usually cannot be argued out of their fantastic stories, even in the face of overwhelming evidence to the contrary. It is incredible to many of us that delusional subjects say what they do and act as they do. Delusions are surprising and eerie, but therefore intriguing. What features of the delusional individual’s cognitive architecture could be responsible? The theorist interested in explaining delusions is faced with questions about their constitution and their provenance—that is, questions about their ontology and their etiology. What are delusions? How are they formed? Traditionally, delusions have been thought to be false beliefs formed on the basis
of abnormally irrational reasoning. There are reasons to be skeptical of this char- acterization. Because of the unusual features of delusions, many philosophers and psychologists have found it problematic to interpret delusions as irrational beliefs. Delusions are like prototypical beliefs in some respects but not in others; categoriz- ing them as beliefs is uncomfortable at best. Suppose you form the belief that a doppelg¨anger has taken the place of your spouse. How should I expect you to act? I would think that you would contact the authorities, hide from the alleged imposter, try to find your real spouse, and try to figure out what led to this outlandish situation. The Capgras patient typically does none of these things. Similarly, one would expect that a person who believes that the world will end tomorrow would try to get their affairs in order, try to stop the event, or at the very least show fear. The schizophrenic suffering from delusions of catas- trophe might do none of these things. Patients might claim that their food has been poisoned by spies at the very same moment that they happily tuck into it (Sass 1994). Bleuler (1950) remarks that those who claim to be dogs don’t bark like dogs. The odd fact in need of explanation is that, in most cases, a delusional patient’s behavior seems to outright belie what the patient asserts. It appears that they are mouthing the words without really believing what they are saying. Psychiatrists have long writ- ten of their doubts that their delusional clients report genuine beliefs. Could a person really believe that her food is poisoned and yet still continue to eat? Her behavior could be explained if she had other aberrant beliefs and desires, such as a desire to die, or a belief that poison is harmless. However, patients usu- ally seem to lack these sorts of intermediary mental states. Patients will sometimes confabulate extremely unlikely and irrational justifications for their delusions, but the explanations are usually pretty clearly made-up on the spot, and they are just as problematic as the original delusion, for they do not manifest themselves else- where in the patient’s reasoning or behavior. Chris Frith and Eve Johnstone (2003) recall a patient of Alan Baddesky’s who claimed to be a Russian chess Grand Master. When asked why he didn’t speak in Russian given that he claimed he was Russian, he replied that he may have been “hypnotized to forget things like the fact that [he]
utterances metaphorically (Laing 1969). These sorts of conclusions have commanded the attention of philosophers. The unusual behavior of delusional subjects appears to be in conflict with a functionalist conception of belief. It is largely accepted that for a large class of mental states that includes propositional attitudes such as beliefs and desires, each token mental state is the type of state that it is in virtue of playing a particular functional role in an agent’s cognitive economy. In other words, a mental state is a belief-that- p only if it functions like a belief-that- p.^1 Delusions apparently fail to play the functional role of beliefs. The role played by delusions diverges from the role played by prototypical beliefs in the following ways, for instance:
(^1) Throughout this dissertation, I assume that beliefs and delusions are attitudes with propositional content. For evidence that beliefs have propositional contents, consult chapter 3 of Stich (1983).
Usually, the non-doxasticist will also offer a positive account that explains what delu- sions are. For example, Currie (2000) holds that delusions are misidentified imagin- ings; Egan (2009) holds that they are instances of a state intermediate between belief and imagination. A major goal of this dissertation is to appraise arguments for and against non- doxasticism, and to offer a particular non-doxasticist model of delusions—one that answers the questions about ontology and etiology. On the model I will present and defend, delusions are acceptances formed on the basis of pathological cognitive feel- ings. First things first. What are the basic building blocks upon which to build a non- doxasticist model? Clinicians often take non-doxasticism to be a surprising and non- standard thesis. It is natural to describe delusions as beliefs. For instance, The Di- agnostic and Statistical Manual of Mental Disorders (DSM-IV-TR) , by far the most widely used diagnostic text in psychiatric practice, defines delusions as false be- liefs not normally accepted by one’s subculture that are based on incorrect infer- ence about external reality and that persist despite counterevidence. Why should we doubt this definition? In this initial chapter, I’ll present some traditional charac- terizations of delusions, and then, in counterpoint, describe the more bewildering features of delusions that have motivated non-doxasticists to resist these traditional characterizations. Whether these data actually do support non-doxasticism will be a subject for future chapters.
Delusions have long been the archetypal indicator of madness and psychosis. They are one of the “reality distortion” symptoms; to be deluded is to have lost one’s grip on the world. This description obviously does not do a great job of telling us what delusions are. Can we do better? There are two ways of getting clearer on our subject matter: extensionally and intentionally. To give an extensional characterization of delusions,
