Is acting on delusions autonomous?

Abstract

In this paper the question of autonomy in delusional disorders is investigated using a phenomenological approach. I refer to the distinction between freedom of intentional action, and freedom of the will, and develop phenomenological descriptions of lived autonomy, taking into account the distinction between a pre-reflective and a reflective type. Drawing on a case report, I deliver finely-grained phenomenological descriptions of lived autonomy and experienced self-determination when acting on delusions. This analysis seeks to demonstrate that a person with delusions can be described as responsible for her behaviour on a ‘framed’ level (level of freedom of intentional action), even though she is not autonomous on a higher (‘framing’) level (level of freedom of the will), if, and only if, the goods of agency for herself and others are respected. In these cases the person with delusions is very nearly comparable to people in love, who are also not free to choose their convictions, and who could also be rightly held responsible for the behaviour flowing from their convictions.

Commentary: Denial or Delusion?

“…6 A more current evaluation of such episodic or specifi c areas in which patients appear to be convinced of an illogical belief or delusion, beyond what rationality can endorse, has been done recently by Jann E. Schlimme. 7 Because we are told that Ann "adamantly refuses" and that she is unable to be persuaded that it is not a spider bite, it appears that this belief is enduring. Schlimme states:…”