In Defense of Misplaced Being and the Interactionist Account

I would like to begin by thanking Peter Fifield, Mathew Broome, and Philip Gerrans for their insightful comments on my paper, which I have found constructive and productive in generating new trains of thought. Unfortunately, owing to the need for brevity, I am only able to comment briefly on some of their points.

Response to Peter Fifield and Matthew Broome

In their commentary, Intimations of Immortality, Peter Fifield and Matthew Broome discuss three aspects of my paper: my move from the notion of Cotard syndrome to that of delusion, the seeming paradox created by delusions of death and delusions of immortality, and the utility of the concept of ‘misplaced being.’ The authors dedicate most of their response to the second of these points, in the form of a detailed discussion on the wider cultural consideration of death and immortality—particularly in relation to the arts (film and other fiction). I must confess to having a limited knowledge of the subject matter discussed in this section or, indeed, of having any awareness of the fact that “the Cotard delusion has a literary connection almost as long as its history.” My own shortcomings in this regard did not prevent me from finding the commentary of much interest, however, although I do feel somewhat unqualified to respond. What I would say is that I do not believe that their detailed discussion presented in the section Literature, Death, and Immortality is in any way incompatible with points made in my paper, something I consider the authors would not disagree with.

Essentially, what this section does—which I thank the authors for—is provide a much more detailed account in support of the statement I make: that we are cognitively biased to entertain various beliefs concerning the nature of our existence, as evidenced by the prevalence and variety of such beliefs across time and place. The fact that we may not consider death and immortality to be mutually exclusive positions or a logical contradiction (which I at no point claim) does not alter the fact that we cannot know what it is like to not exist but only imagine this in various different forms (examples of which the authors provide in much more detail than I do). At one point, I do say that delusions of immortality, paradoxically, seem to run contrary to any notion of being dead or not existing, but accept that this may only seem to be the case to some and not others, especially those who are more familiar with such culturally held beliefs. What Fifield and Broome have done in their commentary, then, is to detail how this juxtaposition can and indeed does manifest itself through culture and the arts.

In light of what I have just said, I therefore accept that “it is not inconceivable that many patients who believe themselves to be dead . . . also assume they may be immortal.” It was never my intention to argue that believing both to be the case is evidence of irrationality on the part of the patient—insofar as it is irrational to believe that one is or can be both dead and immortal. Rather, I sought to use these two examples of delusional content, held to be symptoms of the same disorder, as a means of exploring the underlying etiology and, importantly, phenomenology of the Cotard patient.

Concerning my use of the term Cotard delusion, rather than syndrome, Fifield and Broome have the following to say:

One of the early tensions in the paper is that Young endorses the clinical reality of heterogeneity of the Cotard syndrome, (Young and Leafhead 1996, 154), and by moving from the notion of syndrome to delusion seems to suggest that this focus on it as a specific symptom, Cotard’s qua delusion, protects the concept from the charge of non-universality of features and supports the idea of a conceptual clinical unity. Against this, it could be argued that this may be an empty move: within the range of delusions that one could choose to call Cotard’s is an...