The Background Theory of Delusion and Existential Phenomenology

Situating and Clarifying the Paper

The commentaries of Nassir Ghaemi and Giovanni Stanghellini help to sketch out the intellectual landscape of philosophical perspectives in psychiatry, and situate our paper within it. A happy convergence between the analytical philosophy perspective from which we were writing, and the existential–phenomenological paradigm described by both authors, is the result. Stanghellini in particular carefully describes three main theories of existential deformations, tracing delusion formation back to either (i) a disturbance of meaning synthesis conceived as a dysfunction of a Husserlian consciousness, (ii) a disturbance of pre-reflective self-consciousness resulting in a kind of paralyzing hyperreflexivity, and (iii) (Stanghellini’s preferred model) a disturbance of embodiment. This final account views delusion as springing from a failure in the subject’s corporeal and praxical being-in-the-world. As the subject’s practical, pre-reflective grip on the world is loosened, so their minds become unconstrained by that understanding and practical rationality immanent within that grip, and thought, now unconstrained, starts to travel through delusional worlds. Stanghellini accordingly views our model as an example of a disembodiment theory, which allows it to overcome the disadvantages of the first two models, which may both, in their own ways, overvalue the rôle of (disturbances of) reflective consciousness in the formation (and delusional deformation) of everyday understanding.

Being situated within a preexisting landscape has both its benefits and its disbenefits, the principle example of the latter being the potential assimilation of anything new to what has already been said. Thus, although we are grateful to our commentators for placing us on the larger historical and conceptual map, it may be helpful to briefly rehearse our motivations for drawing on the philosophical ideas of the Bedrock and Background in our theory of delusion. Our paper was primarily motivated by a concern that current, psychologically mainstream, cognitive models of delusion, although helpfully drawing our attention to common reasoning and perceptual deficits in the person with psychosis, fail to adequately account for what is delusional about delusions. It was, in particular, to account for the certainty with which the deluded person clings to often quite extraordinary beliefs that we drew on the epistemological notion of the background. And although this epistemological notion fits quite neatly with ontological concerns regarding the embodied and praxical character of human existence, it is the particular epistemic rôle that it played in our theory—to do with the extraratiocinative constraint on judgement provided by the Background—that we wish to stress here.

We return to this shortly, but first wish to comment briefly on two specific considerations raised by the commentaries. The first concerns Stanghellini’s claim that, for us, “when studying delusions, the focus should be on providing an adequate framework for understanding, rather than providing empirical hypotheses to be tested” (2008, 311–314). It seems to us, however, that both are equally important. What we wished to stress, however, was that empirical hypothesis testing may be led astray if it is not informed by an adequate framework for understanding. For example, most cognitive psychological experiments on delusions concern themselves with the individual’s ability to make appropriate guesses (e.g., regarding the color of beads in a bag), and their tendency to jump to conclusions; they do not concern themselves with the kinds of extraordinary conviction and certainty met with in delusion. The risk run by empirical researchers of cognitive factors in delusion is that a lack of a prior adequate theorization of delusion makes for accounts that are ultimately only of the formation, not of delusion in particular but rather of false or unusual beliefs more generally. An analytical approach, however, can help to explicate the ways in which the psychiatric concept of delusion fails to be adequately characterized by the quite general ‘external criteria’ of delusion (as Jaspers [1963] called them: falsity, stubbornness, uncommon), and aids in the construction of empirical hypotheses this time constrained by an understanding of the true ‘internal criteria’ of psychotic belief. Such an approach helps to spell out the...