Saving Humans with Delusions. Ema Sullivan-Bissett

This is the second in a series of five posts Lisa and I are writing on our Epistemic Innocence Project.

EI

In this post I will write about delusional beliefs, whether they might be epistemically innocent, and why this matters.

Here is where we have got to with what we mean by epistemic innocence. A cognition is epistemically innocent if it meets the following two conditions:

1. Epistemic Benefit: The cognition delivers some significant epistemic benefit to an agent at a time (e.g., it contributes to the acquisition, retention or good use of true beliefs of importance to that agent).

2. No Relevant Alternatives. Alternative cognitions that would deliver the same epistemic benefit are unavailable to the agent at that time.

The fifth addition of the Diagnostic and Statistical Manual of Mental Disorders defines delusions as ‘Fixed beliefs that are not amenable to change in light of conflicting evidence […]’ (DSM-V). Examples of delusion include: thought insertion (these thoughts are not my own), Capgras (my husband has been replaced by an imposter), Cotard (I am dead), Somatoparephrenia (this is not my arm but my mother’s), erotomania (George Clooney is in love with me), perceptual bicephaly disorder (I have two heads). One of our network members, Richard Dub, has designed some great icons representing common delusions, which can be viewed here.

Delusional beliefs have a bad reputation when it comes to their complying with epistemic standards. They are usually false, lacking in empirical support, and are inconsistent with the subjects’ other beliefs and behaviour. With respect to the first inconsistency, during one interview, a subject with delusions claimed that her husband was a patient in the hospital where she was a patient, and that her husband had died four years ago and was cremated (Breen et al. 2000). With respect to the second inconsistency, that between the delusional belief and the subject’s behaviour, subjects with the Capgras delusion—the delusion that their loved one has been replaced by an imposter—may worry that their loved one has disappeared, but they may also act in a cooperative way with the alleged imposter (see Lucchelli and Spinnler 2007). Delusional beliefs may also be unresponsive to counterevidence. It is part of the DSM-V definition of delusions that they are ‘not amenable to change in light of conflicting evidence’ (DSM-V).

In the project we are interested in whether or not delusional beliefs meet the conditions on epistemic innocence. I think that they do, and suggest some reasons for thinking so in my post on the project blog.

Determining whether delusional beliefs are epistemically innocent might have ramifications for treatment in the clinical domain. Clinical interventions may be justified by the claim that they enhance the wellbeing of the patient, but whether this is true may well depend in part on the epistemic status of delusional beliefs. For instance, Daniel Freeman and colleagues suggest that ‘[c]hallenging or evaluating delusional explanations should be done only in the context of an alternative explanation that the patient finds acceptable’ (Freeman et al 2004: 679). If the patient with a delusion does not have an alternative belief available to explain the experiences she is having (No Relevant Alternatives condition), and further, if the delusional belief bestows some epistemic benefit she would not otherwise have (Epistemic Benefit condition), challenging the delusion may not be good for her wellbeing. It is in this sense that reflecting on epistemic innocence may inform clinical decisions.

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