![[dr. bob]](/dr-bob-sm.gif)
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 4 to 28 of 50. Go back in thread:
Posted by Damos on August 17, 2005, at 20:59:08
In reply to The Role of Anomalous Experience..., posted by alexandra_k on August 17, 2005, at 19:18:19
Hmmm, okay I'm with you so far - I think.
Posted by Toph on August 17, 2005, at 22:07:05
In reply to Dead Certainty in the Cotard Delusion, posted by alexandra_k on August 17, 2005, at 18:32:47
Hi Alex. Still thinking I see, as always.
Delusions can be benign. I see lots of early-stage demented clients who have delusions about their earlier lives as they slip away from present reality. A delusion is dysfunctional and problematic when it disrupts the deluded individual's daily functioning or interferes adversely with the functioning of others. Are the dead people you describe dysfunctional because of their delusions? Is this condition ego-dystonic for the afflicted? If it is not both then they will not likely seek volutary treatment or respond to such treatment, it would seem to me.
Posted by alexandra_k on August 17, 2005, at 23:01:02
In reply to Re: Dead Certainty in the Cotard Delusion, posted by Toph on August 17, 2005, at 22:07:05
> Are the dead people you describe dysfunctional because of their delusions?
Well... On the basis of them saying 'I am dead' they are diagnosed as having the Cotard delusion. I just work with that... Some people seem to act on their delusions (e.g., go out and buy me a coffin please) while others do not. Still... The lady who persuaded her family to buy her a coffin never went so far as to ask them to bury / cremate her...
>Is this condition ego-dystonic for the afflicted? If it is not both then they will not likely seek volutary treatment or respond to such treatment, it would seem to me.
Uh. Anti-psychotics typically dispose of the delusion in a week or two...
Does it worry them?
Well... Hard to say. They would seem to pronounce it often enough to be brought to psychiatric / neurological attention...
:-)
Posted by alexandra_k on August 17, 2005, at 23:04:37
In reply to Re: Dead Certainty in the Cotard Delusion, posted by Toph on August 17, 2005, at 22:07:05
In their paper ‘Monothematic Delusions: Towards a Two-Factor Account’ Davies et al., consider that while an anomalous experience may be necessary for delusion, it cannot be sufficient. They maintain that some people have comparable anomalous experiences, yet they do not exhibit comparable delusions. While they agree that such an anomalous experience is in need of explanation they do not consider the experience to be sufficient to determine that the person must arrive at a delusional explanation for it.
Davies et al., consider that the account thus far would seem to go some of the way towards explaining why it is that the delusional hypothesis occurs to the subject. They also maintain, however, that the above account is not enough to explain why it is that the delusional subject accepts the delusional hypothesis as a belief ‘despite everything they previously knew to be true’ and despite other people attempting to persuade them out of their delusion. As such they consider that while the account thus far may go some of the way towards explaining how it is that the delusional hypothesis occurs to the subject, the account must be supplemented by a second factor to explain how it is that the subject comes to be certain that they are in fact dead, or why they persist in making their delusional utterance.
One route to belief is the route from perception to belief. While this input clause is not typically considered to be a rationality constraint we can consider whether we would call someone irrational who failed to form beliefs in this way. Suppose I am in a room walking around and I fall over a chair. You ask ‘what happened? Didn’t you see the chair?’ I reply ‘Oh, I saw it alright; I just didn’t believe it was there’. In this case I might be described as being irrational for failing to believe what I had perceived. Whether we consider this to be a failure of rationality or not it does seem that something abnormal is going on here.
It would also seem that it is not a normal, rational, or typical response to always believe what we perceive, however. Sometimes what we perceive diverges too radically from what we previously knew to be true. It diverges too much from our prior beliefs and perceptions. When we experience visual illusion it may well be a typical initial response to judge the lines to be of different length when viewing the Muller Lyer illusion. Once we come to understand something of how the illusion is produced, however, or once we see the arrows removed and reinserted then we no longer believe what we perceive. We judge the lines to be of equal length despite the way that they appear to us to be.
Davies et al., consider various suggestions that have been offered as accounts of the nature of the second factor. They settle on the line where the delusional error is to ‘accept an anomalous perceptual experience to be veridical when there is rational grounds to doubt its veridicality’. In considering the anomalous experience to be a perceptual experience Davies et al., are led into the problem of the unwanted prediction. They acknowledge that a problem with their account is that it would predict that a person with the Cotard delusion should be routinely fooled by the Muller-Lyer illusion as they come to believe what they perceive. The subject with the Cotard delusion should be unable to inhibit this response despite coming to learn about how the illusion is produced, and despite perceptual information to the contrary such as seeing the arrow heads removed and then reinserted.
One way around this problem for Davies et al’s account of the nature of the second factor would be to consider that the anomalous experience need not be perceptual. Indeed, from what we do know about the various kinds of anomalous experiences that seem to feature in the production of various kinds of delusion it seems that in the clear majority of cases the experiences have more to do with the persons affective response system or levels of physiological arousal rather than with perceptual deficit.
So the way that Maher told the story we have a neurophysiological deficit that produces an anomalous experience. Because the experience is intense and prolonged the subject is compelled to attempt to explain it and they thus develop a delusion. The way that Davies et al., tell the story is similar with respect to there being a neurophysiological deficit that produces an anomalous experience for the delusional subject. They also maintain that the delusional subject accepts their experience as veridical as normal subjects do. The delusional error, however, is that we would expect them to be able to inhibit this ‘believe what you perceive’ response when what they believe diverges too radically from everything they previously knew to be true. The delusional subject should be able to take evidence that runs contrary to their delusion and thus come to see that their delusion is false.
Posted by alexandra_k on August 17, 2005, at 23:07:26
In reply to The Second Factor in the Explanation of Delusion, posted by alexandra_k on August 17, 2005, at 23:04:37
At this point I wish to take something of a detour into having a look at the notion of rationality, and into how much we can expect to be able to understand delusion if it is in fact an irrational phenomenon. Delusions have long been taken to be a paradigmatic example of irrationality. If delusions are in fact irrational then it might be the case that they will resist our attempts to explain them. Karl Jaspers was an early psychiatrist / philosopher who considered that primary delusions, or delusions proper are ununderstandable in the sense that they cannot be explained by recourse to the subjects prior perceptions, experiences, and beliefs. Jaspers considers that while such delusions may possibly be given a neurological explanation which appeals to some underlying brain pathology he thought that primary delusions are ununderstandable from the intentional level.
John Campbell is similarly led to the conclusion that we cannot offer an intentional explanation of delusion. He maintains that ‘a finding of irrationality can always be traded for a finding of mis-translation’. Along the lines of Quine, he considers that we are required to make use of the principle of charity in intentional state attributions so we must always radically translate so as to make the subject out to be rational by their use of the term. He concludes that there is no content that we can attribute to delusional utterances that makes the subject out to be rational, and thus delusions don’t seem to be contentful states. They thus seem to be beyond the reach of intentional explanation.
It is an important point that while some delusional subjects, typically subjects with schizophrenia seem to have become enmeshed in their own solipsistic world coming up with a new delusion in response to almost every question that is put to them - this is not always the case. Some people have a mono-thematic delusions like the Cotard delusion. Mono-thematic delusions are based on a single theme and aside from that delusion the person seems to exhibit beliefs and behaviors that are comparable to normal subjects. The significance of this is that in the cases of monothematic delusions at least it would clearly be inadequate to posit a complete breakdown or failure of rationality. The delusional subject seems to have comparable rationality to normal subjects in other contexts. It seems that if we do need to add a second factor to anomalous experience in order to explain delusion then we need to specify a more limited breakdown or deficit than a complete breakdown in rationality.
To try and get into the spirit of the problem of irrationality it is worth looking at the American Psychiatric Association’s definition of delusion. The APA maintains that delusions are ‘radically false beliefs based on incorrect inference about external reality that are firmly sustained despite what everyone else believes and despite incontrovertible and obvious proof or evidence to the contrary’. It would seem to flow rather naturally from this definition to consider that the delusional subject is making a false claim about their no longer being biologically alive. This has historically been the main interpretation of the claim that the subject is attempting to express with their delusional utterance.
Clinicians attempted to provide evidence against the subject’s claim that they were dead by drawing their attention to such facts as the subject being able to walk around, being able to feel their heart beat, and feeling bodily urges such as the need to go to the bathroom. That the subject did not seem to take such biological signs of life as evidence against their delusional belief was itself taken as evidence for the irrationality of the delusional subject. It seems to have been the result of observations such as these that the APA has been led to conclude that delusions are held ‘despite incontrovertible and obvious proof or evidence to the contrary’. It was thus thought to be pointless to attempt to argue a delusional subject out of their delusion.
What doesn’t seem to have been noted is that beliefs such as ‘I can feel my heart beating’ and ‘I can still walk around’ do not seem to straightforwardly contradict the belief ‘I am biologically dead’. To extract a contradiction from these beliefs we need to add further beliefs and make them explicit.
Lets look at the logic of this:
P1) I can feel my heart beating
P2) I can still walk around
P3) I feel bodily urges such as the need to go to the bathroom
________________________________________
C1) I exhibit biological signs of lifeP4) Anything that exhibits biological signs of life cannot be biologically dead
I am (biologically) deadIf the delusional subject believes that they exhibit biological signs of life and that anything that exhibits biological signs of life cannot be dead and that they are biologically dead all at the same time then this would seem to result in the subject endorsing contradictory beliefs. I am not sure that these steps have been brought to the delusional subjects attention to see whether they are prepared to endorse these beliefs or not. Rather, their endorsement of Premises 1-3 has been taken to be sufficient evidence of their irrationality in believing a contradiction.
Posted by alexandra_k on August 18, 2005, at 0:11:43
In reply to Re: The Biological Model of Delusion, posted by alexandra_k on August 17, 2005, at 23:07:26
While the Biological model doesn’t seem to straightforwardly entail that the delusional subject is endorsing contradictory beliefs there has been another model that has been suggested in which the delusional subject is supposed to be endorsing a more explicit contradiction, or perhaps more properly, a self-defeating belief. One delusional subject is reported to have said ‘I am not and am condemned to going on being nothing forever’. Descartes showed us that so long as one appreciates that doubting is a form of thinking it is impossible to doubt one’s existence as a thinking thing. If the delusional subject is attempting to express the belief that they do not exist as a thinking thing then it would seem that not only is the subject professing to believe something that they cannot believe, but we cannot make sense of what the delusional subject is saying or believing as the content of the belief is self-defeating.
What we seem to be running into in these two interpretations are the rationality constraints that govern intentional state attributions. In the biological interpretation we seem to want to attribute beliefs that contradict other beliefs (though perhaps not straightforwardly so). In the Cartesian interpretation we seem to be wanting to attribute a straightforwardly contradictory or self defeating belief to the subject. Both of these interpretations run into difficulties with respect to making sense of the delusional subjects utterance. They reinforce the idea that delusional subjects are irrational and that delusional utterances are not amenable to rational or intentional analysis
There are two things that I wish to note at this point. Firstly I want to reiterate what I said near the start that we do not have direct access to the delusional subject’s beliefs. While delusions are typically considered beliefs, and irrational and radically false beliefs at that it is worth laboring the point that all we have direct access to is the delusional subjects utterance ‘I am dead’. To figure out the content of the delusional utterance we need to engage in translation. What we have seen so far is that the term ‘death’ may be ambiguous. According to Sass the subject may be using it to refer to their state of emotional death, or numbness. In the Biological model the subject is using it to refer to their state of biological death. In the Cartesian model the subject is considered to be attempting to use it to refer to their own inexistence as a thinking, or experiencing thing. So we have three distinct readings of what the content of the delusional utterance might be. What I wish to do now is to turn to considering two different things that the subject may be attempting to do in making their delusional utterance.
Posted by alexandra_k on August 22, 2005, at 7:42:14
In reply to Re: The Cartesian Model of Delusion, posted by alexandra_k on August 18, 2005, at 0:11:43
and whats up with that
whats up with that?
the movement from excessive caution
to reckless trust
self-stabotage?
perhaps...what would they care
why would they care
i'm just not that important...but it could get to be that way
awkward to say the least
the archive trawl
bearing my soul
potential friends
peers
employers
current ones...
and will the lurkers please stand up?sigh.
but its a part of me a part of me
and when it gets deleted i'll leave
and why can't i keep my damned mouth shut?because it is such a part of me.
and because the way things are at present
i don't really have anyone to talk to
:-(
but i have a feeling
it will come back to bite me in the *ss
self-stabotage?
perhaps...
Posted by alexandra_k on August 22, 2005, at 7:43:36
In reply to Re: The Cartesian Model of Delusion, posted by alexandra_k on August 22, 2005, at 7:42:14
and why can't small boards not be googleable and not viewable to members
please
Posted by alexandra_k on August 22, 2005, at 7:46:30
In reply to Re: The Cartesian Model of Delusion, posted by alexandra_k on August 22, 2005, at 7:43:36
i get scaired that people will see me
and laugh
that i wont be taken seriously
that they'll see me for the nutcase
i am
and nobodies going to fund thatnot that its going to happen anyways
and maybe its about that too
its not going to happen
so why worry about it
self-stabotage isn't necessary
not a factor
Posted by Toph on August 22, 2005, at 16:37:35
In reply to Re: The Cartesian Model of Delusion, posted by alexandra_k on August 22, 2005, at 7:42:14
>
> but its a part of me a part of me
> and when it gets deleted i'll leave
>I hope that this is a delusion, Cartesian or otherwise.
Toph
Posted by alexandra_k on August 22, 2005, at 17:41:25
In reply to Re: The Cartesian Model of Delusion » alexandra_k, posted by Toph on August 22, 2005, at 16:37:35
> I hope that this is a delusion, Cartesian or otherwise.
nah. thats why i left pc. 'cause my posts kept being deleted. these kinds of posts. not supportive... or something.
i'm just venting really.
i shouldn't have said that.
venting...
spread of affect...
cringe
just ignore me please.
Posted by Damos on August 22, 2005, at 18:13:08
In reply to Re: The Cartesian Model of Delusion » Toph, posted by alexandra_k on August 22, 2005, at 17:41:25
> just ignore me please.
And what if we won't huh?
They've re-imaged my computer and every post is 'NEW' AAARRRGGGHHH!!!!
Posted by alexandra_k on August 22, 2005, at 19:16:34
In reply to Re: The Cartesian Model of Delusion » alexandra_k, posted by Damos on August 22, 2005, at 18:13:08
Maher, Davies et al., and the APA definition of delusion are similar with respect to what they construe the delusional subject as doing in making their delusional utterance. They concur that in making the claim ‘I am dead’ the subject draws a false conclusion from their experience to what is the case in the world. They thus similarly consider delusional subjects to be expressing a belief about external reality – or the world beyond the subjects experience. So if this is the case then what are we to make of the subjects claim that they are dead? It might be natural to think that the subject goes from the experience of emotional death that Sass talked about to making a claim about their biological death. Whether the claim that the subject is biologically dead is true or false is mind independent in the sense that the subject can have false beliefs about the way things really are outside of their minds. It is typically granted that the claim ‘I am biologically dead’ is a false belief.
On this analysis of what the delusional subject is attempting to do in making their utterance there may be a problem with respect to consistency within the subjects belief network. Normal subjects are also not perfectly rational, however. Sometimes we discover that we do have contradictory beliefs in our belief network. While holding contradictory beliefs may not be so very abnormal we do expect people to be able to see that they are in fact endorsing a contradiction once the logic has been pointed out to them. While I am not so sure that the contradiction has been pointed out explicitly to the delusional subject it may be hard to see what sense we could make of them retaining their beliefs if it was.
This might be motivation enough for concluding that delusions are intractable from the intentional level and so one would be better off abandoning intentional explanation in favor of a neurophysiological account of the various kinds of brain damage that might result in delusion. In another more recent paper Davies et al., modify their two-factor account of delusions so that the first factor is no longer the anomalous experience that was talked about by Maher. Instead, they maintain that the first factor is neurophysiological deficit and that further research is needed to determine whether the anomalous experience features early, late, or not at all in the production of delusion. As such, they too seem to have abandoned the attempt to offer an intentional explanation of delusion. Instead they maintain that delusion should be explained by the presence of neurophysiological anomaly despite the point that the precise nature of the neurophysiological anomaly seems to be fairly idiosyncratic to particular individuals. Before we are tempted to give up on intentional explanation altogether, it might be worth considering another account that I shall offer of what the delusional subject might be attempting to do in making the claim ‘I am dead’.
Posted by alexandra_k on August 22, 2005, at 19:19:51
In reply to Re: From Experience to Belief, posted by alexandra_k on August 22, 2005, at 19:16:34
What seems to be in common to the accounts considered thus far is the notion that the delusional subject is taking their autonomic response to be informing them of the further fact that they have died. What I want to consider, however, is that this may not be the case for most subjects who maintain that they are dead. Instead of considering the subject to be attempting to make a false claim about reality on the basis of their experiences perhaps they are simply trying to report or express their experience as it seems to them to be where the anomalous experience is the loss of autonomic response. If this is indeed what some subjects are doing then this would make sense of why it is that they are so very certain about what they are saying. If they are reporting on their experience then they are indeed entitled to be certain that things are in fact the way they seem to the subject to be.
One of the problems with construing the subject as making a false claim about reality was the point that they did not seem to consider it to be relevant to what they were saying that they were still able to walk around. Perhaps they did not find it relevant because they did not draw the implicit steps. It would seem that a more likely explanation for this, however, is that it might be because facts such as their being able to walk around are indeed irrelevant to their utterance. If they are reporting on their experience then those facts would indeed be irrelevant as facts about the external world are irrelevant with respect to providing supporting or disconfirming evidence for the subjects experiences.
Campbell writes that delusional beliefs seem to have been elevated to the status of Wittgenstinean framework propositions by which he seemed to mean that they were immune to supporting or falsifying evidence. Some delusional beliefs seem to have taken on this quality. I would like to maintain that this is because reports of experience and that these are indeed immune to supporting or falsifying evidence from external reality. If this is the case then it would seem that the delusional subject is simply playing a language game in which the external world is disregarded as irrelevant. If they are simply expressing their experiences then they cannot be wrong, which may be why the delusion is held with such conviction. Their utterances would also not be in conflict with what they previously held to be true.
The most obvious objection to this line would be that the delusional subject does not preface their utterances with ‘it seem to me as though’ or ‘it is like…’. Why doesn’t the delusional subject simply say ‘I have the experience of emotional death’ or ‘I feel dead’ or something a little more like that? This is indeed a tricky problem for the line that they are reporting on their experience. One response might be that these expressions do not convey the sense of conviction that the delusional subject feels. Indeed the subject with depression might start out making claims like this, but if their depression continues untreated they may progress to claiming they are dead. Typically we don’t take pains to distinguish between a claim about reality and a claim about our experience. Typically we don’t need to because they coincide. We don’t say ‘it seems to me as though I am in pain’ because the first half of that just seems redundant. To make it clearer that the subject is attempting to report on their experience rather than a state of the world would also require them to acknowledge the external world. I think the problem is more that their experiences have taken on such an intensity and captured their attentional processes to the point that the world really has fallen out as irrelevant.
If one had lost interest in the nature of reality and instead was only focused on ones anomalous experience then this might conceivably lead to the kinds of delusional utterance that subjects actually make. The problem might not be that they have taken their experience to be veridical when they have rational grounds to doubt. Rather, the problem might be construed as their being fixated on reporting on their experience to the extent that they are playing a different language game, one in which the external world has been disregarded as irrelevant.
Posted by alexandra_k on August 22, 2005, at 19:21:56
In reply to Re: Reports of Experience, posted by alexandra_k on August 22, 2005, at 19:19:51
It is often thought to be a fairly significant problem for models of delusions that consider delusions to be false beliefs about external reality that in most cases delusional subjects do not act in ways in which we would expect them to act were they to literally believe what they are saying. In the Capgras delusion, for instance the delusional subject comes to maintain that someone who is close to them has been replaced by an impostor. We might expect that the delusional subject would attempt to talk to the alleged impostor to see whether they have access to the memories of the original. We might expect them to show some concern as to where the original has got to or concern as to what might have happened to them. Subjects with the Capgras delusion do not attempt to locate the original. They do not contact the relevant authorities to inform them of the disappearance of the original. While we could attempt to attribute all sorts of other beliefs and desires to the delusional subject in order to make these behaviors rational given their delusion and their other beliefs and desires this is not a line that anybody seems to have pursued. Rather, these facts about delusional subjects most often not acting in ways we would expect has been taken to be evidence for their irrationality. It has also led some theorists to consider that delusions may not be appropriately classified as beliefs.
Gregory Currie takes the later line and he attempts to maintain that delusions are not really beliefs rather they are ‘imaginings misidentified as beliefs by the delusional subject’. I am not sure whether this line will help solve the problem of inaction, however, as Tim Bayne has queried ‘what is the difference between believing something to be the case and believing that one believes something to be the case?’ This does seem a little odd and perhaps Curries line is not really enough to solve the problem of inaction. I think that viewing delusions as reports of anomalous experience is able to solve the problem of inaction quite naturally. There wouldn’t seem to be any obvious behavioral consequences for reporting on ones experience.
Posted by alexandra_k on August 22, 2005, at 19:29:07
In reply to Re: The Problem of Inaction, posted by alexandra_k on August 22, 2005, at 19:21:56
For any model that is able to solve the problem of inaction, there is a related problem that arises. Namely, how to account for the relatively few cases where subjects actually do act on their delusions. In an often cited case of this one man became convinced that his step-father was a robot and he decapitated him in order to look for the batteries and microfilm in his head. This seems a very strange thing to do if one is merely attempting to report on ones anomalous experience.
Rather than considering there to be a significant problem with all of the accounts offered thus far I would like to consider whether different models might be better placed to account for the different kinds of cases. It would seem that making a delusional utterance yet not behaving as though one literally believed the world was that way would be best explained by subjects attempting to report on their experiences. Where subjects do act on their delusions, however, then I think that a modified version of Davies et al’s two factor account where we have an anomalous experience rather than a perceptual experience explains the phenomenon quite well.
I would also like to suggest that subjects come to act on their delusions after progressing from reporting on their experiences to mistaking their experiences to be veridical. What this buys us is the notion that the sense of conviction has become similarly misplaced.
Posted by alexandra_k on August 22, 2005, at 19:34:22
In reply to Re: The Problem of Action, posted by alexandra_k on August 22, 2005, at 19:29:07
Treatment Implications
Traditionally it was thought that delusions were not amenable to reason and thus it was pointless to attempt to argue delusional subjects out of their delusion. Fairly recently, however, there has been a move towards offering cognitive therapy as treatment for them. Cognitive therapy is based on the notion that ones thoughts leads to ones emotional responses leads to ones actions. Thus, the paranoid subject does not feel fear and then come to their particular delusional belief in an attempt to explain or make sense of their experience of fear. Rather the notion is that the delusional belief is what is responsible for the person’s experience of fear.
Cognitive therapy attempts to alleviate their experience of fear, for example, by providing counter-evidence to the delusional belief. It is thought that by doing this and by making any contradictions explicit this will weaken the person’s sense of conviction or certainty that the delusion is true. This is thought to have the ultimate consequence of alleviating their experience of fear.
In looking at case reports of interviews with delusional subjects where therapists attempt to apply this line of reasoning to persuade people that their delusions are false I can’t help but wonder whether the therapist and delusional subject aren’t continually talking past each other. One of the main problems they have found with attempting this kind of treatment is that it is hard to build a good rapport between the therapist and the delusional subject and that there are high drop out rates as the delusional subject simply stops going to therapy.
If we grant that delusions are reports of certain kinds of experiences, or at the very least that the sense of conviction or certainty is primary and would be appropriate if associated with the anomalous experience then we may be able to explain why it is that the delusional subject shows such resistance to backing down on their delusional utterances. When people attempt to offer evidence to the contrary they may well be missing the point that the evidence is not relevant as the subject is instead attempting to report on the nature of their experiences.
If we can instead attempt to think our way into the kinds of experiences that may lead to them expressing them in the way in which they do then we may be able to arrive at an understanding of why they insist on their delusional utterance despite everyone attempting to argue them out of their delusion. Rather than by engaging in radical translation to explain how they can believe what they are saying we can engage in radical empathy to understand why they say the things they do.
Perhaps it is as Walkup notes:
The distinction between a description of the experience (sometimes called a phenomenological description) and the description of the factual state of affairs is scientifically and clinically important. Scientifically, a subject who consistently failed to describe the perception of certain illusions would be suspected of some visual or neurological abnormality. Clinically, the therapist who challenges a patient’s description of his or her experience may sound absurd, just as would a vision researcher who insisted to an experimental subject that the two lines in the Muller-Lyer illusion actually look the same length (Walkup, 1995 p. 326).
If the delusional subject is indeed reporting on their experience then they are entitled to a hold onto their experience with certainty. I wonder whether attempts to challenge delusional utterances by trapping subjects in contradiction is what ultimately leads them to endorse contradiction in order for them to retain the certainty about their experience. What might be happening here is an unfortunate state of affairs for the delusional subject who might be hard pressed to find an appropriate alternative expression of their experience. Rather than focusing on the logic of their utterance I wonder whether we might have more luck with attempting to empathize with the subjects anomalous experience. Not with the view to arguing subjects out of their delusions, but with a view to attempting to understand what they might be trying to say. And with the ultimate view of assisting them in finding more appropriate ways of expressing themselves. Rather than attempting to argue them out of their delusion by presenting evidence that is not even relevant to what they are saying one might have more luck with trying to express some empathy for the anomalous experience that they are having.
What I would like to suggest is that regardless of whether the subject actually has made the move from expression of experience to false belief about reality one may be better off establishing rapport by validating the sense of conviction or certainty which is appropriately associated with the subjects anomalous experience. Perhaps the trouble with subjects who have come to false beliefs about external realty on the basis of experience is that they have lost sight of the distinction between appearances and reality by becoming over-focused on their anomalous experience. Davies et al., talk about this as a failure to inhibit believing what they perceive, and it sounds to me that the move from experience to external reality is a lot like the notion that delusional subjects have lost their ability to ‘reality test’. The notion behind reality testing is that one should test ones hypotheses about reality against reality. The delusional subject does not seem to do this and one enumeration of this might be that external reality is irrelevant to the reality of ones experiences, and ones experiential reality is certain. One way to ultimately lose the appearance / reality distinction is to focus on appearances to the point that the external world is completely disregarded. Perhaps what has happened here is that the delusional subject has become lost in appearances being reality where their experiences are sufficiently anomalous.
This line places a heavy explanatory burden on the nature, intensity, and recurrence of the subjects anomalous experience. I think that this line shows better prospects for being able to naturally handle the fact that delusional subjects seem quite certain and are quite insistent on their utterances. It is also able to naturally handle the fact that the majority of delusional subjects do not act in ways in which we would expect were they to believe their utterance to be true of the external world.
It may be that there are two different things that we can construe the delusional subject as doing in making their utterance. We could consider that they are making a false claim about the world, and indeed in some cases I think this might be so. The other way we could go, however, is to consider that they are attempting to express their anomalous experience. The DSM considers that delusions are ‘false beliefs about external reality’ but this seems to beg the question by saying that delusional subjects should be construed as intending to do this. It may be that many subjects who utter claims characteristic of certain kinds of delusions are classified as being delusional and yet they intend their utterance to be a report on their experience. It may be that only when the subject is making a false claim about the world that they are appropriately classified as delusional because this is the way the APA defines delusion to be. We could thus consider that subjects who are reporting on their experience are not in fact delusional because delusions proper involve making a false claim about the world. But the other way we could go is to say that these subjects clearly are delusional and this shows the inadequacy of the APA definition of delusion. It seems that not a lot rests on this linguistic decision. Either way it is interesting that more people do not act on their delusion than people who do. A large class of the utterances that are typically considered to be paradigmatic examples of delusional utterance would seem to be better explained by the report of experience model, and the class of phenomena requiring explanation by a false belief model has been significantly reduced.
Posted by Toph on August 23, 2005, at 7:36:48
In reply to Re: The Cartesian Model of Delusion » Toph, posted by alexandra_k on August 22, 2005, at 17:41:25
> > I hope that this is a delusion, Cartesian or otherwise.
>
> nah. thats why i left pc. 'cause my posts kept being deleted. these kinds of posts. not supportive... or something.
>I thought this was poetry. ; )
Hey, Alex, the Sass you refer to elsewhere, is he the guy who is anti-psyhotherapy or anti-medication or anti-something?
We love you alex, and I'm sure the bloomin' (hehe) admin does too.
Posted by Toph on August 23, 2005, at 9:35:53
In reply to DELETED?!! » alexandra_k, posted by Toph on August 23, 2005, at 7:36:48
Posted by alexandra_k on August 23, 2005, at 17:25:27
Sass, Louis Arnorsson (2004) 'Some Reflections on the (Analytic) Philosophical Approach to Delusion' Philosophy, Psychiatry, & Psychology 11, 1 Special Issue: Delusions
Can't seem to find a homepage for him. Here is a link to the article (but my access to Muse is via uni subscription)http://muse.jhu.edu/journals/philosophy_psychiatry_and_psychology/v011/11.1sass.pdf
Hes also written a book (or two... which I haven't read...)
I'll be careful to get the links...
Posted by alexandra_k on August 23, 2005, at 17:33:12
In reply to ^^ Oops, Thos Szasz ^^, posted by Toph on August 23, 2005, at 9:35:53
I thought I was replying to this thread but my reply ended up in a thread of its own:
http://www.dr-bob.org/babble/write/20050807/msgs/545765.html
Posted by alexandra_k on August 23, 2005, at 17:33:59
In reply to Sass, posted by alexandra_k on August 23, 2005, at 17:25:27
Sorry... Above a reply to:
http://www.dr-bob.org/babble/write/20050807/msgs/545592.html
Posted by Damos on August 23, 2005, at 17:39:56
In reply to Re: The Problem of Action, posted by alexandra_k on August 22, 2005, at 19:34:22
Finally read this whole thread through on the way home last night. Was so into it I missed my station on the train and had to let the first bus that came go so I could finish before I got home.
Was this the seminar you delivered a few weeks back? Some of the terminology and stuff had me boggled a bit but I managed to work it out kinda.
I found myself thinking 'oh boy, is she goiing where I think she's going?' and then when I got to Reports of Experience people on the train were looking at me oddly and I realised that the 'YES' I thought I'd only thought had in fact been rather loud - oops :-) From that point on I was just egging you on to go where you were headed. And you did, and you're right, so very right. If you attack me and try to prove me wrong, what's the first thing I'm gonna do? Defend. So what do you get? A war of attrition. The therapist finally says you're not trying - kapow, termination. Or the patient finally gives up and says 'you're not even trying to understand, before you tell me I'm wrong can't you at least try.', so they leave and maybe never go back. It's a lose-lose. If you don't even attempt empathetic understanding how can you ever hope to see how this person sees the world and themself in it. How can you ever hope to see how their view can be true for them. It has to be inside-out. You have to be inside their world to be able to take them by the hand and walk them out.
I really enjoyed this thread so much, Thanks Alex
Posted by alexandra_k on August 23, 2005, at 18:11:31
In reply to Finally got to read it all - YAY » alexandra_k, posted by Damos on August 23, 2005, at 17:39:56
:-)
Sass says (paraphrasing here...)
in my opinion philosophers would be better off trying to imagine their way into the patients shoes making every effort to think feel and be like the patient...
And he quotes someone or other talking about Elvin Semrad (who I've never heard of...) paraphrasing again....
the great psychoanalyst elvin semrad could make any psychotic patient sane. by radical empathy making every attempt to think feel and be like the patient he succeeded in entering into their delusional world. he was able to draw them back out.
and what i want to say is... lets grant that thats what he did. lets just grant him that... if that is so then what is the process by which that happened? what does it mean to 'enter into the patients delusional world' - and how does one do that? And how... How on earth are you supposed to go about drawing them back out.
I was working this stuff out while me and Gabbi and Dinah were fighting over the small boards stuff over on admin.
(not to suggest that any of us were delusional lol!)I don't talk about 'treatment implication' stuff very often.. Actually that was the first time I've been so bold. I kind of feel like I don't know what I'm talking about... I'm not a clinician... What the hell do I know...
But then Ive spent a lot of time in hospital / supported accomodation talking and listening... and people talk to me about why they do not talk to their clinicians...
I was thinking of writing another peace on just that latter bit.
:-)
Yeah. Thats the seminar I gave couple weeks ago.
Thanks for taking the time :-)
Posted by alexandra_k on August 23, 2005, at 18:30:24
In reply to Finally got to read it all - YAY » alexandra_k, posted by Damos on August 23, 2005, at 17:39:56
>If you don't even attempt empathetic understanding how can you ever hope to see how this person sees the world and themself in it. How can you ever hope to see how their view can be true for them. It has to be inside-out. You have to be inside their world to be able to take them by the hand and walk them out.
Or... You can give them their anti-psychotics and just wait for them to come right... Therapy is more expensive than anti-psychotics... Also... Maybe people are a little afraid... Afraid that they will enter in and get lost themselves. Maybe... Some people lack the ability to empathise with different kinds of anomalous experience. People vary with respect to how they find Sass' 'expression of emotional death' line. Some people (philosophers) don't really seem to be able to get their heads / emotions around that one. They can typically be persuaded via a line that goes 'sometimes we talk *boút the living dead and life beyond death and these notions seem to make sense... But they can't seem to think their way into emotional numbness. Bizzare...I guess another point that I forgot to make:
what do the anti-psychotics do / why do they help?
I want an intentional level explanation not a neurological level explanation.
So... On how delusions are produced.
One could try and say that a neurophysiological anomaly produces a delusion DIRECTLY.
That is just to say that delusions are primary and can't be explained any more from the intentional level (so you would have to talk about varieties of brain damage).
Most people don't like this. They find it deeply implausible that brain damage could lead to... Well... Thought insertion in effect :-)
They consider it much more plausible that:brain damage
then anomalous experience
then cognitive deficit
then delusional belief.so... what do the anti-psychotics do then?
Davies said that his line required the anti-psychotics to remidy the cognitive deficit. He looked a bit tentative when he said that so he may want to change his mind in hindsight...
But to me that sounds implausible.
I want to say that the main problem is the intensity, nature, recurrance, of certain kinds of anomalous expeirnece. what the anti-psychotics do is mute the experience. so it is not as anomalous anymore. so attentional resources are freed up back to the contemplation of reality as well as ones experiences.
and so in the circumscribed delusions arising from head trauma we have a very specific or particular kind of anomalous experience. it is 'telling them' (if you like) something particular.
whereas in the case of schizophrenia where people seem to have retreated into their own solipsistic world... thats because their experiences are much more pervasive...
but meds alter experience.
thats what i reckon.
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