Delusions as Doxastic States: Contexts, Compartments, and Commitments

Although delusions are typically regarded as beliefs of a certain kind, there have been worries about the doxastic conception of delusions since at least Bleuler’s time. ‘Anti-doxasticists,’ as we might call them, do not merely worry about the claim that delusions are beliefs, they reject it. Reimer’s paper weighs into the debate between ‘doxasticists’ and ‘anti-doxasticists’ by suggesting that one of the main arguments given against the doxastic conception of delusions—what we might call the functional role objection—is based on a fallacy. She also draws attention to certain parallels between delusions and what she calls “nihilistic philosophical doctrines,” such as the skeptical position that we have no knowledge. I read Reimer as presenting the anti-doxasticist with a dilemma: they must either adopt an anti-doxastic treatment of philosophical nihilism or they must identify a crucial respect in which nihilistic states differ from delusional states. As she puts it, “If we are to withhold the label ‘belief’ from psychiatric delusions, . . . parity of reason requires that we withhold it from seemingly sincere endorsements of [standard] philosophical doctrines” (2010, 317). Although Reimer herself stops short of endorsing the doxastic conception of delusions, she is clearly very sympathetic to it.

Reimer’s discussion is a very welcome contribution to the contemporary discussion of delusions, and I have learnt much from it. I do, however, have questions. In the first part of this commentary I focus on the question of what exactly Reimer’s position is. Her view has multiple strands, and it is not clear to me that its various strands can be reconciled with each other. In the second and third sections, I take a step back from Reimer’s paper and ask what exactly might be at stake in the debate about the doxastic status of delusions.

Contexts and Compartments

Reimer begins with the worry that motivates much of the current enthusiasm for anti-doxastic treatments of delusions: Delusions do not play the functional role that beliefs (ought to) play (Bayne and Pacherie 2005; Bortolloti 2009; Stone and Young 1997). On the input side, delusions are often unresponsive to evidence; on the output side, delusions often fail to generate the kinds of actions and emotional responses that one would expect them to generate were they beliefs. As Reimer acknowledges, it is something of an open question just how much force these worries have—some monothematic delusions do seem to be evidentially grounded, and of course patients do act on their delusions at times—but there is certainly something to them. At a minimum, the functional role of many delusions seems to set them apart from quotidian beliefs. Let us call this the ‘functional role objection’ to the doxastic account.

Reimer argues that the functional role objection does not have the force that it is often thought to, for it commits what she calls the ‘fallacy of ignoring anomalies’:

the mere anomaly of psychiatric delusions, qua beliefs, is little reason to suppose that such delusions are not genuine beliefs. If something is unusual for an x, even highly unusual for an x, we cannot conclude without further argument that it is not an x.

(2010, 324)

Reimer is surely right to point out that delusions could be beliefs without behaving like ordinary or paradigmatic beliefs. But, although certain presentations of the functional role objection may have been guilty of committing this fallacy, fallacy-free versions of the objection are not hard to find. On my reading, the fundamental worry that motivates the anti-doxasticist view is the thought that delusions are anomalous in ways that are at odds with their putative status as beliefs. In a nutshell, the worry is that delusions fail to play the functional role that is essential to a state’s being a belief (see, e.g., Egan 2009, 265ff). Reimer suggests that delusions might be anomalous beliefs in the way that penguins are anomalous birds. The anti-doxasticist will resist the analogy, and may even suggest one of her own: Delusions, she might suggest, are better compared with whales—just as...