Delusions as harmful malfunctioning beliefs

Abstract

Delusional beliefs are typically pathological. Being pathological is clearly distinguished from being false or being irrational. Anna might falsely believe that his husband is having an affair but it might just be a simple mistake. Again, Sam might irrationally believe, without good evidence, that he is smarter than his colleagues, but it might just be a healthy self-deceptive belief. On the other hand, when a patient with brain damage caused by a car accident believes that his father was replaced by an imposter or another patient with schizophrenia believes that "The Organization" painted the shops on a street in red and green to convey a message, these beliefs are not merely false or irrational. They are pathological. What makes delusions pathological? This paper explores the negative features because of which delusional beliefs are pathological. First, I critically examine the proposals according to which delusional beliefs are pathological because of (1) their strangeness, (2) their extreme irrationality, (3) their resistance to folk psychological explanations or (4) impaired responsibility-grounding capacities of people with them. I present some counterexamples as well as theoretical problems for these proposals. Then, I argue, following Wakefield's harmful dysfunction analysis of disorder, that delusional beliefs are pathological because they involve some sorts of harmful malfunctions. In other words, they have a significant negative impact on wellbeing (=harmful) and, in addition, some psychological mechanisms, directly or indirectly related to them, fail to perform the jobs for which they were selected in the past (=malfunctioning). An objection to the proposal is that delusional beliefs might not involve any malfunctions. For example, they might be playing psychological defence functions properly. Another objection is that a harmful malfunction is not sufficient for something to be pathological. For example, false beliefs might involve some malfunctions according to teleosemantics, a popular naturalist account of mental content, but harmful false beliefs do not have to be pathological. I examine those objections in detail and show that they should be rejected after all.

Delusions and Three Myths of Irrational Belief

“…In recent years, there have been many attempts to explain the pathological nature of delusions, and the general direction of such attempts has been to identify the problem with something other than the epistemic features of the delusional belief. For instance, Miyazono (2015) defends the view that delusions are pathological because they are harmful dysfunctions, that is, they are beliefs that negatively affect wellbeing and are caused by mechanisms that do not work properly. According to another account, by Petrolini (2017), the pathological nature of delusions is due to the person losing the capacity for relevance detection, that is, the capacity to determine which aspects of the environment are important within a given context.…”

Are clinical delusions adaptive?

“…For instance, delusions of reference and delusions of grandeur can make the person feel important and worthy of admiration. Whether the delusions with desirable content have positive or negative psychological effects depends on the preferred notion of wellbeing, as has been argued before (for instance, see Miyazono, ). Delusions of reference and grandeur have psychological benefits on a hedonic view of wellbeing, intended as a subjective feeling about how well one's life is going.…”

“…This is to be identified with some form of reasoning bias or deficit. Error management theorists argue that delusions are the outcome of extreme, pathological versions of evolutionary biases (Miyazono, ; McKay & Dennett, , p. 502). What theory of delusion formation we adopt matters to whether we believe that delusions can be adaptive.…”

Expressivism about delusion attribution

“…Contrast this with, for example, what philosopher Kengo Miyazono (2015) writes in a paper explaining what it is that makes some delusions pathological: "I do not assume that all delusional beliefs are pathological […] I only discuss typical delusional beliefs that are pathological" (Miyazono 2015, 561, fn.1). Similarly, Valentina Petrolini (2017), also a philosopher, presents a fascinating account of what makes delusions pathological in terms of dysfunctional relevance detection.…”

“…Indeed, even if it were in practice impossible to have a delusion that wasn't pathological, it wouldn't be a contradiction in terms. For Miyazono (2015), for example, delusions might well be caused by, and indicative of, pathology (construed as harmful dysfunction (Wakefield 1992)), but aren't conceptually tied to this. We will return to the relationship between delusion and pathology later.…”