Distinguishing Between the Psychiatrically and Philosophically Deluded: Easier Said Than Done

take leave of one’s senses

English, Verb. 1. (idiomatic) To go crazy; to stop behaving rationally

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A Chief concern in “Only a Philosopher or a Madman” was to draw attention to a number of striking yet underappreciated similarities between paradigm psychiatric delusions and standard philosophical doctrines, “nihilistic” as well as “common sense.” The similarities were presented as illuminating given their potential to inform the debate over whether psychiatric delusions are properly (or usefully) conceptualized as beliefs. The paper’s central argument might be summarized as follows:

Paradigm psychiatric delusions appear to differ, in particular ways, from ordinary beliefs. In essence, the holistic features characteristic of the latter are sometimes curiously absent in the former. Standard philosophical “delusions”¹ (about whose credibility I remain officially neutral) appear to exhibit much the same differences. Yet the contents of such doctrines, whether “nihilistic” or “common sense,” are plausibly (or at least presumptively) believed by their advocates. One should thus be wary of attempts to discredit belief conceptions of delusion on the grounds of the said differences.

Although I remain sympathetic to this general line of argument, I am now inclined to view the anomaly of psychiatric (as well as philosophical²) delusions somewhat differently. Where the holistic features characteristic of ordinary belief seem to be absent, closer inspection often reveals their presence (Reimer forthcoming a, forthcoming b). The anomaly of psychiatric delusions (qua beliefs) may thus reside in what is only the apparent absence of those features. Indeed, it is arguable that paradigm psychiatric delusions, far from being “stark” (Klee 2004) are well integrated into the sort of holistic patterns of attitude, affect, and action constitutive of Davidsonian belief (Reimer forthcoming a, forthcoming b). I thus remain sympathetic to the idea that paradigm psychiatric delusions tend to be full-fledged beliefs and not simply “opinions” (Bayne 2010).

The insightful commentaries by George Graham and Tim Bayne have led me to question other details of my original paper. Points with regard to which I am inclined to take issue are concerned largely with Graham’s and Bayne’s efforts to characterize the differences between the psychiatrically and philosophically deluded. For this reason, and because “Only a Philosopher or a Madman” arguably neglects those differences, the following reply is concerned primarily with the putative differences between the psychiatrically and philosophically deluded. Because understanding the differences arguably requires appreciating the similarities, the latter are discussed as well. This time, however, I focus on a somewhat “old-fashioned” philosophical delusion, a dogmatic rather than nihilistic one: Theism.

Differences With Respect to “Stance”

Graham claims that the striking differences between the psychiatrically and philosophically deluded are usefully understood in terms of the different “stances” taken with respect to “lower order” states or attitudes. Thus, the Cotard patient takes a “delusional stance” toward the attitude she expresses via an utterance of “I do not exist.” The Ungerian nihilist (Unger 1979) takes a “philosophical stance” toward the attitude she expresses via an utterance of that same sentence. Although the contents of their bizarre attitudes would appear to be the same (I do not exist), the psychiatric patient and the philosopher are distinguished by the different stances they take with respect to those attitudes.

What exactly are the differences between these two stances? Let’s begin with the “delusional stance,” summarized by Stephens and Graham (2004, 240) as follows:

S is deluded that p, just in case p is the representational content of a lower order state or attitude of S: (a) with which S personally identifies, (b) to which S clings in the face of strong contrary considerations, and (c) about which S lacks insight into the nature and imprudent costs of maintaining.

In contrast, the philosophical stance is characterized by “dialectical nuance” and “sensitivity to counterargument.” Where the espoused attitudes are patently bizarre, there is a “robust awareness of their clash with the everyday” (Graham 2010, 338).

I am sympathetic to Graham’s idea that the “stance” taken with respect to bizarre beliefs (opinions, imaginings, premonitions, proposals, etc...