What’s wrong with ‘mental’ disorders? : a commentary on ‘What is a mental/psychiatric disorder? : from DSM-IV to DSM-V’ by Stein et al

The editorial by Stein et al. (2010) is timely and relevant given the development of DSM-V and the likely impact that such a development will have on mental health services in the USA. The revision of the DSM will also affect international psychiatric research and global practice thanks to the interplay between the development of DSM and ICD (Fulford & Sartorius, 2009). The editorial by Stein and colleagues is very rich and there are many themes suitable for further examination and discussion. For this response, however, we have chosen to focus on two themes: the use of the term ‘mental’ and the idea of psychiatric disorders being ‘in’ an individual

Fictional persuasion, transparency, and the aim of belief

In this chapter we argue that some beliefs present a problem for the truth-aim teleological account of belief, according to which it is constitutive of belief that it is aimed at truth. We draw on empirical literature which shows that subjects form beliefs about the real world when they read fictional narratives, even when those narratives are presented as fiction, and subjects are warned that the narratives may contain falsehoods. We consider Nishi Shah’s teleologist’s dilemma and a response to it from Asbjørn Steglich-Petersen which appeals to weak truth regulation as a feature common to all belief. We argue that beliefs from fiction indicate that there is not a basic level of truth regulation common to all beliefs, and thus the teleologist’s dilemma remains. We consider two objections to our argument. First, that the attitudes gained through reading fiction are not beliefs, and thus teleologists are not required to account for them in their theory. We respond to this concern by defending a doxastic account of the attitudes gained from fiction. Second, that these beliefs are in fact appropriately truth-aimed, insofar as readers form beliefs upon what they take to be author testimony. We respond to this concern by suggesting that the conditions under which one can form justified beliefs upon testimony are not met in the cases we discuss. Lastly, we gesture towards a teleological account grounded in biological function, which is not vulnerable to our argument. We conclude that beliefs from fiction present a problem for the truth-aim teleological account of belief

Are delusions bad for you?

Lisa Bortolotti argues that there is more to judging delusions than whether they accurately reflect the worl

Does reflection lead to wise choices?

Does conscious reflection lead to good decision-making? Whereas engaging in reflection is traditionally thought to be the best way to make wise choices, recent psychological evidence undermines the role of reflection in lay and expert judgement. The literature suggests that thinking about reasons does not improve the choices people make, and that experts do not engage in reflection, but base their judgements on intuition, often shaped by extensive previous experience. Can we square the traditional accounts of wisdom with the results of these empirical studies? Should we even attempt to? I shall defend the view that philosophy and cognitive sciences genuinely interact in tackling questions such as whether reflection leads to making wise choices

The relative importance of undesirable truths

The right not to know is often defended on the basis of the principle of respect for personal autonomy. If I choose not to acquire personal information that impacts on my future prospects, such a choice should be respected, because I should be able to decide whether to access information about myself and how to use it. But, according to the incoherence objection to the right not to know in the context of genetic testing, the choice not to acquire genetic information undermines the capacity for autonomous decision making. The claim is that it is incoherent to defend a choice that is inimical to autonomy by appealing to autonomy. In this paper, I suggest that the choice not to know in the context of genetic testing does not undermine self-authorship, which is a key aspect of autonomous decision making. In the light of this, the incoherence objection to the right not to know seems less compelling

Do We Have an Obligation to Make Smarter Babies?

In this paper I consider some issues concerning cognitive enhancements and the ethics of enhancing in reproduction and parenting. I argue that there are moral reasons to enhance the cognitive capacities of the children one has, or of the children one is going to have, and that these enhancements should not be seen as an alternative to pursuing important changes in society that might also improve one’s own and one’s children’s life. It has been argued that an emphasis on enhancing cognitive capacities might encourage the commodification of children. But this objection seems misplaced. The reasons why one decides to reproduce can be subject to moral approbation or condemnation, as such rea-sons might be indicators of the quality of one’s parenting and the happiness of the future persons one is committed to bringing to life. However, once the decision to reproduce is made, no further harm comes from taking as few risks as possible on behalf of the persons to whom one is giving life with their health, character and cognitive capacities

Psychiatric classification and diagnosis. Delusions and confabulations

In psychiatry some disorders of cognition are distinguished from instances of normal cognitive functioning and from other disorders in virtue of their surface features rather than in virtue of the underlying mechanisms responsible for their occurrence. Aetiological considerations often cannot play a significant classificatory and diagnostic role, because there is no sufficient knowledge or consensus about the causal history of many psychiatric disorders. Moreover, it is not always possible to uniquely identify a pathological behaviour as the symptom of a certain disorder, as disorders that are likely to differ both in their causal histories and in their overall manifestations may give rise to very similar patterns of behaviour. Consider delusions as an example. It wouldn’t be correct to define delusions as those beliefs people form as a result of a neurobiological deficit and a hypothesis-evaluation deficit (as some versions of the two-factor theory of delusions suggest), because for some delusions no neurobiological deficit may be found, and reasoning biases and motivational factors may be contributors to the formation of the delusion (e.g. McKay et al., 2005). Moreover, it would be a mistake to define delusions as symptoms of schizophrenia alone, because they occur also in other disorders, including dementia, amnesia, and delusional disorders. Thus, aetiological considerations may appear in the description and analysis of delusions, but do not feature prominently in their definition. In this paper I argue that the surface features used as criteria for the classification and diagnosis of disorders of cognition are often epistemic in character. I shall offer two examples: confabulations and delusions are defined as beliefs or narratives that fail to meet standards of accuracy and justification. Although classifications and diagnoses based on features of people’s observable behaviour are necessary at these early stages of neuropsychiatric research, given the variety of conditions in which certain phenomena appear, I shall attempt to show that current epistemic accounts of confabulations and delusions have limitations. Epistemic criteria can guide both research and clinical practice, but fail to provide sufficient conditions for the identification of delusions and confabulations, and fail to demarcate pathological from non-pathological narratives or beliefs. Another limitation of current epistemic accounts – which I shall not address here – is the excessive focus on epistemic faults of confabulations and delusions at the expense of their epistemically neutral or advantageous features (see Bortolotti and Cox, 2009). This may lead to a misconception of delusions and confabulations, and to an oversimplification in the assessment of the needs of people who require clinical treatment for their psychotic symptoms

The Epistemic Innocence of Motivated Delusions

Delusions are defined as irrational beliefs that compromise good functioning. However, in the empirical literature, delusions have been found to have some psychological benefits. One proposal is that some delusions defuse negative emotions and protect one from low self-esteem by allowing motivational influences on belief formation. In this paper I focus on delusions that have been construed as playing a defensive function (motivated delusions) and argue that some of their psychological benefits can convert into epistemic ones. Notwithstanding their epistemic costs, motivated delusions also have potential epistemic benefits for agents who have faced adversities, undergone physical or psychological trauma, or are subject to negative emotions and low self-esteem. To account for the epistemic status of motivated delusions, costly and beneficial at the same time, I introduce the notion of epistemic innocence. A delusion is epistemically innocent when adopting it delivers a significant epistemic benefit, and the benefit could not be attained if the delusion were not adopted. The analysis leads to a novel account of the status of delusions by inviting a reflection on the relationship between psychological and epistemic benefits