Patients suffering from the Cotard syndrome can deny being alive, having guts, thinking or even existing. They can also complain that the world or time have ceased to exist. In this paper, I argue that even though the leading neurocognitive accounts have difficulties meeting that task, we should, and we can, make sense of these bizarre delusions. To that effect, I draw on the close connection between the Cotard syndrome and a more common (and better studied) condition known as depersonalisation. Even though they are not delusional, depersonalised patients seem to have experiences that are quite similar to those of Cotard patients. I argue that these experiences are essentially characterised by a (more or less important) lack of subjective character and of two other structural features of experience, which I call 'the present character' and 'the actual character.' Cotard's nihilistic delusions simply consist in taking these anomalous experiences at face value.
Does consciousness entail subjectivity? The puzzle of thought insertion Alexandre Billon''There is a thought in me which is not mine.'' This is, roughly, the complaint of patients suffering from thought insertion. This first-rank symptom of schizophrenia is particularly puzzling for it seems to challenge a very well entrenched principle to the effect that our conscious thoughts are necessarily subjective, that we necessarily have a sense of ownership for them (Cartesian principle). Despite their wide disagreement, classical accounts of the symptom save the Cartesian principle by interpreting thought insertion as a problem of the sense of agency for thought rather than as a problem of subjectivity. I argue that those accounts fail and that thought insertion really is a problem of subjectivity. We can nevertheless save the Cartesian principle if we realize that the presupposition, shared by classical accounts, to the effect that inserted thoughts are unequivocally conscious, is illgrounded. Distinguishing between reflexive awareness and phenomenal consciousness, and relying on a careful comparison between thought insertion and other pathologies of agency, I propose a novel account of the symptom which is compatible with the Cartesian principle and which allows to take the patient's reports seriously. This account, I conclude, opens up novel perspectives on the comprehension of schizophrenia, and reveals a common confusion between two different dimensions of the mind.
Descartes was certain that he was thinking and he was accordingly certain that he existed. Like Descartes, we seem to be more certain of our thoughts and our existence than of anything else. What is less clear is the reason why we are thus certain. Philosophers throughout history have provided different interpretations of the cogito, disagreeing both on the kind of thoughts it characterizes and on the reasons for its cogency. According to what we may call the empiricist interpretation of the cogito, I can only claim to be certain of having experiences, and this certainty, as well as that of my own existence, stems from their phenomenal and subjective character. According to rationalist interpretations, on the other hand, I am certain of having some self‐reflexive propositional attitudes, and this certainty derives from their rational features. Psychiatric patients suffering from acute forms of depersonalization or of the Cotard syndrome often doubt that they think and exist, and might even believe that they don't. I argue that their study allows us to favor the empiricist interpretation of the cogito.
Basic self‐awareness is the kind of self‐awareness reflected in our standard use of the first‐person. Patients suffering from severe forms of depersonalization often feel reluctant to use the first‐person and can even, in delusional cases, avoid it altogether, systematically referring to themselves in the third‐person. Even though it has been neglected since then, depersonalization has been extensively studied, more than a century ago, and used as probe for understanding the nature and the causal mechanisms of basic self‐awareness. In this paper, I argue that depersonalized patients indeed have an impaired basic self‐awareness, and that their study allows us both to favor one specific theory of basic self‐awareness and to understand what is wrong with its rivals. According to the favored theory, which I call Cartesian, we are basically self‐aware in virtue of being acquainted with ourselves through introspection.
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