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Philosophy, Psychiatry, & Psychology 8.2/3 (2001) 225-229

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Review Article

Pathological Beliefs, Damaged Brains

Anthony P. Atkinson

Cognitive neuropsychiatry, the study of psychiatric disorders using the methods and models of cognitive neuropsychology, has paid particular attention to monothematic delusions, which include the Capgras, Cotard, and Fregoli delusions, mirrored-self misidentification, and reduplicative paramnesia. These delusions have attracted a fair amount of philosophical interest. Pathologies of Belief (Coltheart and Davies, 2000) is a welcome manifestation of this interdisciplinary interest. Originally published as a special edition of the journal Mind and Language, it consists of eight essays by psychologists and philosophers.

What are pathologies of belief? That question is not answered in this book, not directly at any rate. Clear examples can sometimes suffice, and in this case, I think they do. Obviously, the above-mentioned delusions are thought to qualify as pathologies of belief; otherwise, the book would not have the title it has. There is one chapter about theory of mind deficits (as indicated by failures on false belief tasks, for example), so presumably they qualify too. All well and good, but even if we leave aside the question of what else counts as a pathology of belief (for the book never claims to be comprehensive anyway), there is still clearly room for debate about whether all cases of delusions and theory of mind deficits count, and if not, Why? This matter is addressed in several of the chapters, though really only with respect to delusions.

The psychology of belief is, of course, a staple of the philosophical diet, so it is not surprising that some philosophers are showing a keen interest in the study of cases in which the normal processes of belief fixation go awry. The philosophers represented in Pathologies of Belief are all, broadly speaking, from the cognitive science stable, as are the psychologists. Although the discussions and arguments contained in the book are diverse, I came away feeling that while a reasonably united front was being presented, I was not much the wiser in regard to the alternatives (apart from psychodynamic approaches, which are fairly criticized for being unable, in and of themselves, to account for why many delusional subjects have some kind of neurological abnormality or damage).

Together, the essays in Pathologies of Belief illustrate in various ways what I take to be two general requirements and one desideratum for cognitive neuropsychiatry's success. The requirements, which I see as applicable to psychology in general, are the need for a pluralist approach and the need to keep the personal and subpersonal levels of description and explanation distinct, while seeking to show how accounts at one level relate to accounts at the other level. The desideratum is that we have accounts that develop general [End Page 225] links between experience and reasoning and, thus, between deficits in each. I shall discuss each of these issues in turn.

Many of the chapters advocate or illustrate a pluralist approach. They see cognitive neuropsychology as being a very promising paradigm for advancing our understanding of psychiatric disorders but are also of the view that a full understanding of those disorders requires input from research at multiple levels of enquiry. Certainly, they mean by this input from different levels within cognitive neuropsychology (evidenced, for example, by a useful reminder in Currie's chapter of the distinction between high-level functional explanations and explanations that appeal to the underlying biology). However, there is also the suggestion that elements of theories from other paradigms should be included, even those sometimes seen as being in opposition to cognitive neuropsychology (e.g., psychodynamic theories).

Andrew Young's chapter, for example, is an extended and convincing argument for why a cognitive neuropsychiatric approach is the leading contender for explaining certain delusions. An important part of this argument is psychodynamic theory's inability to account for the neurological damage found in many but not all cases of monothematic delusions. (Some instances of these delusions, sometimes observed in schizophrenics, do not have identifiable neurological correlates, as Breen et al. discuss in their chapter.) Yet Young is careful to embrace a...


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