Delusional belief (original) (raw)
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Schizophrenia and Monothematic Delusions
Numerous delusions have been studied which are highly specific and which can present in isolation in people whose beliefs are otherwise entirely unremarkable -''monothematic delusions'' such as Capgras or Cotard delusions. We review such delusions and summarize our 2-factor theory of delusional belief which seeks to explain what causes these delusional beliefs to arise initially and what prevents them being rejected after they have arisen. Although these delusions can occur in the absence of other symptoms, they can also occur in the context of schizophrenia, when they are likely to be accompanied by other delusions and hallucinations. We propose that the 2-factor account of particular delusions like Capgras and Cotard still applies even when these delusions occur in the context of schizophrenia rather than occurring in isolation.
The Cognitive Neuropsychology of Delusions
Mind and Language, 2000
After reviewing factors implicated in the generation of delusional beliefs, we conclude that whilst a perceptual aberration coupled with a particular type of attributional bias may be necessary to explain the specific thematic content of a bizarre delusion, neither of these factors, whether in isolation or in combination, is sufficient to explain the presence of delusional beliefs. In contrast to bias models (theories which explain delusion formation in terms of extremes of normal reasoning biases), we advocate a deficit model of delusion formation-that is, delusions arise when the normal cognitive system which people use to generate, evaluate, and then adopt beliefs is damaged. Mere bias we think inadequate to explain bizarre delusions which defy commonsense and persist despite overwhelming rational counter-argument. In particular, we propose that two deficits must be present in the normal cognitive system to explain bizarre delusions: (1) there must be some damage to sensory and/or attentional-orienting mechanisms which causes an aberrant perception-this explains the bizarre content of the causal hypothesis generated to explain what is happening; and (2) there must also be a failure of normal belief evaluation-this explains why a hypothesis, implausible in the light of general commonsense, is adopted as belief. This latter deficit occurs, we suggest, when an individual is incapable of suspending the natural favoured status of direct first-person evidence in order to critically evaluate hypotheses, given equal priority whether based on direct or indirect sources of information. In contrast, delusions with 'ordinary' content may arise when a single deficit of normal belief evaluation occurs in the context of an extreme (but normal) attentional bias, thus causing failure to critically evaluate hypotheses based on misperceptions and misintrepretations of ambiguous (but ordinary) first-person experience.
Which are the best theories for delusional thinking? A matter that neurosciences cannot resolve yet
AISC midterm conference. From brain to behavior: neuroscience and the social sciences, 2019
Delusions are defined fixed and false beliefs that are resistant to change in the light of conflicting evidence, and that are not shared by a community of people. Delusions are very serious symptoms in some pathologies like schizophrenia and paranoia. Furthermore, they can characterise specific mental illnesses according to the type of pathological belief that the subject manifests. Delusions are generally harmful, impairing good functioning and causing distress. In the last decade, two kinds of theories are opposed in explanation of delusional beliefs. Doxastic theories of delusions, on the one hand, investigate the epistemic nature of delusions focusing above all on the origin and maintenance of the irrational belief. Although some proponents of this type of theories have recovered psychodynamics key-concepts such as „motivation‟ and „defence‟, the general doxastic account predicts cognitive impairments that involve both reasoning processes and evaluation systems of contextual experiences. In this view, delusional subjects may interpret some daily events like exaggerated experiences that are not correctly evaluated neither examined with respect to background beliefs and previous knowledge baggage. The epistemic content of pathological beliefs sounds irrational. However, someone has noticed that not every irrational belief (e.g., alien abduction beliefs and self-enhancing beliefs) is delusional and, thus, diagnosed as pathology according to DSM-5. This supports the idea that there is a continuity between beliefs that are “classified as clinically significant, and those that characterize the non-clinical population” (Bortolotti et al. 2016, 48). On the other hand, the narrative theories of delusions manage to take into account such ontological feature of beliefs because they phenomenologically put in the centre the Subject. According to one of the recent narrative theory (proposed by Philip Gerrans), we have to replace the (philosophically) strong concept of (pathological) „belief‟ with more flexible cognitive objects named “narrative thoughts”. Humans products self-referential narrative thoughts continuously. In this view, delusions are the result of a missed inhibition and regulation of these narrative thoughts. Which is the best explanatory account? Both theories lack to comprehend the whole phenomenon of delusions. However, data from neurosciences can be interpreted in support of both the two divergent perspectives (epistemic and narrative ones). Indeed, investigations on brain injuries or neurobiological dysfunctions seem to confirm both theories. Thus, in this field of psychopathology, neurosciences result particularly „blind‟. I will try to suggest that the advent of „Subjective Neurosciences‟ may help to indicate the route.
The clinical significance of anomalous experience in the explanation of monothematic delusions
Synthese, 2021
Monothematic delusions involve a single theme, and often occur in the absence of a more general delusional belief system. They are cognitively atypical insofar as they are said to be held in the absence of evidence, are resistant to correction, and have bizarre contents. Empiricism about delusions has it that anomalous experience is causally implicated in their formation, whilst rationalism has it that delusions result from top down malfunctions from which anomalous experiences can follow. Within empiricism, two approaches to the nature of the abnormality/abnormalities involved have been touted by philosophers and psychologists. One-factor approaches have it that monothematic delusions are a normal response to anomalous experiences whilst two-factor approaches seek to identify a clinically abnormal pattern of reasoning in addition to anomalous experience to explain the resultant delusion. In this paper we defend a one-factor approach. We begin by making clear what we mean by atypical, abnormal, and factor. We then identify the phenomenon of interest (monothematic delusion) and overview one and two-factor empiricism about its formation. We critically evaluate the cases for various second factors, and find them all wanting. In light of this we turn to our one-factor account, identifying two ways in which 'normal response' may be understood, and how this bears on the discussion of onefactor theories up until this point. We then conjecture that what is at stake is a certain view about the epistemic responsibility of subjects with delusions, and the role of experience, in the context of familiar psychodynamic features. After responding to two objections, we conclude that the onus is on two-factor theorists to show that the one-factor account is inadequate. Until then, the one-factor account ought to be understood as the default position for explaining monothematic delusion formation and retention. We don't rule out the possibility that, for particular subjects with delusions there may be a second factor at work causally implicated in their delusory beliefs but, until the case for the inadequacy of the single factor is made, the second This article belongs to the topical collection "Epistemological Issues in Neurodivergence and Atypical Cognition", edited by Alejandro Vázquez-del-Mercado Hernández and Claudia Lorena García-Aguilar. Extended author information available on the last page of the article factor is redundant and fails to pick out the minimum necessary for a monothematic delusion to be present.
Cognitive Neuropsychiatry A general neuropsychological model of delusion
Introduction. Neurocognitive accounts of delusion have traditionally highlighted perceptual misrepresentation as the primary trigger in addition to other cognitive deficits that maintain the delusion. Here, a general neurocognitive model of delusional disorder (DSM-IV) is proposed, not so much based on perceptual or cognitive deficits after right hemisphere damage as on cognitive propensities, specifically excessive inferencing (especially jumping to conclusions) and excessive reference to the self, due to left hemisphere overactivity. Method. The functional imaging, topographic EEG, and experimental imaging literatures on delusional disorder are reviewed, and 37 previously published cases of postunilateral lesion delusion (DSM-IV type, grandeur, persecution, jealousy, erotomania, or somatic), are reviewed and analysed multivariately. Results. Functional imaging and EEG topography data were slightly more indicative of left hemisphere overactivity in delusional disorder. In addition, 73o/o of the postunilateral lesion cases (x2 = 7.8, p = .005) of delusional disorder (DSM-IV type) had a right hemisphere lesion, whereas only 27o/o had a left hemisphere lesion. Conclusion. Left hemisphere release appears to be a more primary cause of delusional disorder than right hemisphere impairment, the latter merely entailing loss of inhibition of delusional beliefs. We propose that most patients with DSM-IV diagnoses of delusional disorder could be afflicted by excessive left hemisphere activity but further research is necessar .
To Believe or Not to Believe: Cognitive and Psychodynamic Approaches to Delusional Disorder
Harvard Review of Psychiatry, 2003
Given how desperately ill many of our patients are, it has always seemed a shame that our field insists on dividing itself-for example, biological vs. psychological, descriptive vs. historical, psychodynamic vs. cognitive-behavioral. Sometimes this is carried to such extremes that the patient's welfare appears to be secondary to the desire of a zealous therapist to "score points" for his or her point of view. This case report is refreshing in that it presents the history of a seriously ill woman who has been successfully treated with a combination of medication and psychotherapy strategies. A review of the cognitive-behavioral and psychodynamic formulations contained here will reveal some significant similarities: cognitive distortions and defense mechanisms, affect avoidance and affect intolerance, and so on. The technical recommendations do of course differ between models, but we should consider whether or not these schools of thought, and perhaps many others not represented here, might each include significant pieces of the same truths in working with patients.
Delusions in Context, 2018
The difficulty of distinguishing between delusions and nonpathological beliefs has taxed some of the greatest minds in psychiatry. This chapter argues that this question cannot be resolved without first having an understanding of what is involved in holding an ordinary belief. Although we should not assume that ordinary-language words such as 'belief' will correspond with a specific psychological mechanism or process, sufficient evidence is available from diverse areas of psychology to reach some conclusions about what happens when someone 'believes' something. Beliefs are propositions about the world that are generated dynamically, often during interactions with other people, and therefore depend on the human capacity for language. Although many beliefs are mundane, it is possible to identify a class of master interpretive systems that includes political ideologies and religious belief systems, which are highly resistant to challenge and capable of generating considerable emotion. These systems seem to depend not only on the ability to generate propositions about the world but also on implicit cognitive processes that are related to fundamental biological and social needs, for example the need to avoid contagion, the need to form close intimate relationships or
Monothematic delusion: A case of innocence from experience
Philosophical Psychology, 2018
Empiricists about monothematic delusion formation agree that anomalous experience is a factor in the formation of these attitudes, but disagree markedly on which further factors (if any) need to be specified. I argue that epistemic innocence may be a unifying feature of monothematic delusions, insofar as a judgment of epistemic innocence to this class of attitudes is one that opposing empiricist accounts can make. The notion of epistemic innocence allows us to tell a richer story when investigating the epistemic status of monothematic delusions, one which resists the trade-off view of pragmatic benefits and epistemic costs. Though monothematic delusions are often characterized by appeal to their epistemic costs, they can play a positive epistemic role, and this is a surprising conclusion on which, so I argue, all empiricists can agree. Thus, I show that all empiricists have the notion of epistemic innocence at their disposal.