Lisa Bortolotti

What factors should be taken into account when attributing criminal responsibility to perpetrators of severe crimes? We discuss the Breivik case, and the considerations which led to holding Breivik accountable for his criminal acts. We put some pressure on the view that experiencing certain psychiatric symptoms or receiving a certain psychiatric diagnosis is sufficient to establish criminal insanity. We also argue that the presence of delusional beliefs, often regarded as a key factor in determining responsibility, is neither necessary nor sufficient for criminal insanity

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 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.

It has been argued that schizophrenic delusions are “behaviourally inert.” This is evidence for the phenomenon of “double bookkeeping,” according to which people are not consistent in their commitment to the content of their delusions. The traditional explanation for the phenomenon is that people do not genuinely believe the content of their delusions. In the article, we resist the traditional explanation and offer an alternative hypothesis: people with delusions often fail to acquire or to maintain the motivation to act on their delusional beliefs. This may be due to avolition, to emotional disturbances, or to the fact that, given the peculiar content of some delusions, the surrounding environment does not support the agent’s motivation to act.

Philosophy and Happiness addresses the need to situate any meaningful discourse about happiness in a wider context of human interests, capacities and circumstances. How is happiness manifested and expressed? Can there be any happiness if no worthy life projects are pursued? How is happiness affected by relationships, illness, or cultural variants? Can it be reduced to preference satisfaction? Is it a temporary feeling or a persistent way of being? Is reflection conducive to happiness? Is mortality necessary for it? These are the questions people ask themselves when they stop and think about how they feel, how their lives are going, and how they would be going if different choices had been made or different values had been prioritized. These are the questions that contributors to this volume begin to answer, adopting different methodologies, among which the analysis of widespread intuitions about imaginary and real-life scenarios, and reflection on the interpretation of the relevant empirical evidence emerging from psychology and economics.

This paper will consider the right not to know in the context of psychiatric disorders. It will outline the arguments for and against acquiring knowledge about the results of genetic testing for conditions such as breast cancer and Huntington’s disease, and examine whether similar considerations apply to disclosing to clients the results of genetic testing for psychiatric disorders such as depression and Alzheimer’s disease. The right not to know will also be examined in the context of the diagnosis of psychiatric disorders that are associated with stigma or for which there is no effective treatment.

Here I reply to the main points raised by the commentators on the arguments put forward in my Delusions and Other Irrational Beliefs (OUP, 2009). My response is aimed at defending a modest doxastic account of clinical delusions, and is articulated in three sections. First, I consider the view that delusions are inbetween perceptual and doxastic states, defended by Jacob Hohwy and Vivek Rajan, and the view that delusions are failed attempts at believing or not-quitebeliefs, proposed by Eric Schwitzgebel and Maura Tumulty. Then, I address the relationship between the doxastic account of delusions and the role, nature, and prospects of folk psychology, which is discussed by Dominic Murphy, Keith Frankish, and Maura Tumulty in their contributions. In the final remarks, I turn to the continuity thesis and suggest that, although there are important differences between clinical delusions and non-pathological beliefs, these differences cannot be characterised satisfactorily in epistemic terms.

Thought insertion is a common delusion in schizophrenia. People affected by it report that there are thoughts in their heads that have been inserted by a third party. These thoughts are self-generated but subjec-tively experienced as alien (hereafter, we shall call them alien thoughts for convenience). In chapter 5 of Transparent Minds, Jordi Fernández convincingly argues that the phenomenon of thought insertion can be accounted for as a pathology of self-knowledge. In particular, he argues that the application of the bypass model of self-knowledge can shed light on what is amiss in people with thought insertion. In this brief commentary, we examine the proposal by Fernández, highlight some of its strengths, and raise one main objection to it. In mainstream philosophical accounts of thought insertion, people who report the delusion are thought to have ownership of the alien thoughts, but to lack a sense of agency with respect to such thoughts, and this is supposed to explain why they ascribe the thoughts to some-one else. Fernández correctly identifies the limitations of mainstream accounts of thought insertion. First, to claim that people with the delu-sion of thought insertion own the alien thoughts does not sit well with the phenomenology of thought insertion as it is reflected in people’s self-reports. Second, people do not need to experience a sense of agency with respect to a thought in order to ascribe the thought to themselves. Sense of agency is too demanding a condition for self-ascription. Fernández puts forward a novel account of thought insertion, at-tempting to solve the problems identified with mainstream accounts. He defends the view that thought insertion is a failure of self-knowledge that consists in the person failing to ascribe one of her be-liefs to herself. Similar accounts to the one Fernández develops in the chapter have been defended by Bortolotti and Broome (2009) and Pickard (2010). For Fernández, the failure in self-ascription is due to the fact that the person with thought insertion does not feel pressured to endorse the content of a belief that she has [Fernández (2013), p. 142]. Fernández explains this phenomenon in detail by reference to the bypass model of self-knowledge. When Fernández develops his own proposal, he relies on the claim that the alien thought is a belief. We challenge this claim.We agree with Fernández that, in thought insertion, the person does not ascribe the alien thought to herself and does not commit to the content of the thought being true, in spite of the thought being self-generated. Such considerations powerfully suggest to us that the alien thought is not a belief. Given the elusive nature of mental states in general and beliefs in particular, this may seem just a terminological issue. But in the present context, whether the alien thought is a belief is important in order to offer a characterisation of thought insertion that makes jus-tice to the first-person reports and other behavioural manifestations of people with the delusion. One may also argue that, as the model of self-knowledge Fernández applies to alien thoughts, that is, the bypass model, is a model of self-knowledge for beliefs, such a model could only feature in the explanation of thought insertion if alien thoughts were beliefs. But we do not think this is necessarily the case, as in the book Fernández successfully applies his bypass model to other types of mental states, such as desires.

Is it ethical to deceive the individuals who participate in psychological experiments for methodological reasons? We argue against an absolute ban on the use of deception in psychological research. The potential benefits of many psychological experiments involving deception consist in allowing individuals and society to gain morally significant self-knowledge that they could not otherwise gain. Research participants gain individual self-knowledge which can help them improve their autonomous decision-making. The community gains collective self-knowledge that, once shared, can play a role in shaping education, informing policies and in general creating a more efficient and just society.

Philosophers are interested in the phenomenon of thought insertion because it challenges the common assumption that one can ascribe to oneself the thoughts that one can access first-personally. In the standard philosophical analysis of thought insertion, the subject owns the ‘inserted’ thought but lacks a sense of agency towards it. In this paper we want to provide an alternative analysis of the condition, according to which subjects typically lack both ownership and authorship of the ‘inserted’ thoughts. We argue that by appealing to a failure of ownership and authorship we can describe more accurately the phenomenology of thought insertion, and distinguish it from that of non-delusional beliefs that have not been deliberated about, and of other delusions of passivity. We can also start developing a more psychologically realistic account of the relation between intentionality, rationality and self knowledge in normal and abnormal cognition.

The main objective in this chapter is to examine the role of judgments of rationality in the current understanding of psychiatric disorders. To what extent are the criteria for classification and diagnosis independent of judgments of rationality? The typical symptoms of many psychiatric disorders are described as instances of epistemic, procedural, or emotional irrationality, and references to such forms of irrationality are frequently made in the current classificatory and diagnostic criteria for schizophrenia, dementia, depression, and personality disorders. That said, the chapter defend the view that irrationality is neither necessary nor sufficient for a behavior to be characterized as symptomatic of a psychiatric disorder.

In this paper we have two main aims. First, we present an account of mood-congruent delusions in depression (hereafter, depressive delusions). We propose that depressive delusions constitute acknowledgements of self-related beliefs acquired as a result of a negatively biased learning process. Second, we argue that depressive delusions have the potential for psychological and epistemic benefits despite their obvious epistemic and psychological costs. We suggest that depressive delusions play an important role in preserving a person’s overall coherence and narrative identity at a critical time, and thus can be regarded as epistemically innocent.

In this paper I argue that there is no moral justification for the conviction that rights should be reserved to humans. In particular, I reject James Griffin’s view on the moral relevance of the cultural dimension of humanity. Drawing from the original notion of individual right introduced in the Middle Ages and the development of this notion in the eighteenth century, I emphasise that the practice of according rights is justified by the interest in safeguarding the powers of reason and autonomy that some individuals can exercise. Since we are in no position to rule out that non-humans can exercise these capacities, I conclude that rights should not be reserved to humans. This will lead to a reformulation of the reasons why so-called ‘marginal’ humans and non-human animals can be granted some basic rights. Being human is neither necessary nor sufficient for holding rights. All individuals, human or non-human, who can exercise reason and autonomy to some extent can be accorded basic rights in virtue of their having morally relevant preferences.

In this article I ask whether elaborated and systematized delusions emerging in the context of schizophrenia have the potential for epistemic innocence. Cognitions are epistemically innocent if they have significant epistemic benefits that could not be attained otherwise. In particular, I propose that a cognition is epistemically innocent if it delivers some significant epistemic benefit to a given agent at a given time, and if alternative cognitions delivering the same epistemic benefit are unavailable to that agent at that time. Elaborated and systematized delusions in schizophrenia are typically false and exemplify failures of rationality and self-knowledge. Empirical studies suggest that they may have psychological benefits by relieving anxiety and enhancing meaningfulness. Moreover, these delusions have been considered as adaptive in virtue of the fact that they enable automated learning to resume after a significant disruption caused by incorrect prediction-error signalling. I argue that such psychological benefits and adaptive features also have positive epistemic consequences. More precisely, delusions can be a means to restoring epistemic functionality in agents who are overwhelmed by hypersalient experiences in the prodromal stage of psychosis. The analysis leads to a more complex view of the epistemic status of delusions than is found in the contemporary philosophical literature and has some implications for clinical practice. 1 Introduction2 Types of Delusions3 What Is Wrong with Elaborated and Systematized Delusions?4 Finding Life Meaningful5 Learning Resumed6 Epistemic Innocence7 Epistemic Benefit8 No Alternatives9 Conclusions and Implications.

I argue that some cases of delusions show the inadequacy of those theories of interpretation that rely on a necessary rationality constraint on belief ascription. In particular I challenge the view that irrational beliefs can be ascribed only against a general background of rationality. Subjects affected by delusions seem to be genuine believers and their behaviour can be successfully explained in intentional terms, but they do not meet those criteria that according to Davidson (1985a) need to be met for the background of rationality to be in place

This feature in Philosophy, Psychiatry, & Psychology (PPP) is intended to provide ongoing commentary on main articles previously published in PPP. The essay by Bortolotti below is a response to John Rhodes and Richard Gipps's paper in PPP (15, no. 4:295-310).Can we understand people who report delusional beliefs? In their thought-provoking paper, "Delusions, Certainty, and the Background", John Rhodes and Richard Gipps (2008) present a novel account of delusions which has two main purposes: (1) offer an explanation of the truly puzzling features of delusional reports and (2) put forward a theory about what is likely to cause delusions. The authors claim that current theories of delusions that appeal to unusual ..

An Introduction to the Philosophy of Science provides a lively and accessible introduction to current key issues and debates in this area. The classic philosophical questions about methodology, progress, rationality and reality are addressed by reference to examples from the full range of natural and social sciences. Lisa Bortolotti uses a historically-informed perspective on the evolution of science and includes a thorough discussion of the ethical implications of scientific research. Special attention is paid to the complex relationship between the advancement of science, policy making and public interest and to the continuity between scientific research and other human activities. The book is designed to help students think for themselves about the issues identified above, and includes information tables and questions for further reflection to support all stages of the teaching and learning experience, from the comprehension of primary and other secondary texts to debate and essay writing. It also includes a thematic bibliography and a glossary of technical terms. An Introduction to the Philosophy of Science is an excellent introduction to philosophy for students and provides researchers of scientific disciplines with an opportunity to reflect upon the value and impact of their work. It is also a stimulating read for anybody who is interested in the philosophical issues raised by the status of scientific knowledge, the practice of science and the role of experts in contemporary society.

In philosophy, psychiatry, and cognitive science, definitions of clinical delusions are not based on the mechanisms responsible for the formation of delusions. Some of the defining features of delusions are epistemic and focus on whether delusions are true, justified, or rational, as in the definition of delusions as fixed beliefs that are badly supported by evidence). Other defining features of delusions are psychological and they focus on whether delusions are harmful, as in the definition of delusions as beliefs that disrupt good functioning. Even if the epistemic features go some way towards capturing what otherwise different instances of clinical delusions have in common, they do not succeed in distinguishing delusions as a clinical phenomenon from everyday irrational beliefs. Focusing on the psychological features is a more promising way to mark the difference between clinical and non-clinical irrational beliefs, but there is wide variability in the extent to which delusions are psychologically harmful, and some everyday irrational beliefs can affect functioning in similarly negative ways. In this chapter we consider three types of belief that share similar epistemic features and exhibit variation with respect to how psychologically harmful they are: (1) delusions of thought insertion, (2) alien abduction beliefs, and (3) self-enhancing beliefs. In the light of the similarities and differences between these cases, we highlight the difficulty in providing an answer to what makes an irrational belief delusional.

In this paper we address Bernard Williams' argument for the undesirability of immortality. Williams argues that unavoidable and pervasive boredom would characterise the immortal life of an individual with unchanging categorical desires. We resist this conclusion on the basis of the distinction between habitual and situational boredom and a psychologically realistic account of significant factors in the formation of boredom. We conclude that Williams has offered no persuasive argument for the necessity of boredom in the immortal life. 1.

Purpose of review: What is the relationship between rationality and mental health? By considering the psychological literature on depressive realism and unrealistic optimism it was hypothesized that, in the context of judgments about the self, accurate cognitions are psychologically maladaptive and inaccurate cognitions are psychologically adaptive. Recent studies recommend being cautious in drawing any general conclusion about style of thinking and mental health. Recent findings: Recent investigations suggest that people with depressive symptoms are more accurate than controls in tasks involving time perception and estimates of personal circumstances, but not in other tasks. Unrealistic optimism remains a robust phenomenon across a variety of tasks and domains, and researchers are starting to explore its neural bases. However, the challenge is to determine to what extent and in what way unrealistic optimism is beneficial. Summary: We should revisit the hypothesis that optimistic cognitions are psychologically adaptive, whereas realistic thinking is not. Realistic beliefs and expectations can be conducive to wellbeing and good functioning, and wildly optimistic cognitions have considerable psychological costs.

Various debates in bioethics have been focused on whether non-persons, such as marginal humans or non-human animals, deserve respectful treatment. It has been argued that, where we cannot agree on whether these individuals have moral status, we might agree that they have symbolic value and ascribe to them moral value in virtue of their symbolic significance. In the paper I resist the suggestion that symbolic value is relevant to ethical disputes in which the respect for individuals with no intrinsic moral value is in conflict with the interests of individuals with intrinsic moral value. I then turn to moral status and discuss the suitability of personhood as a criterion. There some desiderata for a criterion for moral status: it should be applicable on the basis of our current scientific knowledge; it should have a solid ethical justification; and it should be in line with some of our moral intuitions and social practices. Although it highlights an important connection between the possession of some psychological properties and eligibility for moral status, the criterion of personhood does not meet the desiderata above. I suggest that all intentional systems should be credited with moral status in virtue of having preferences and interests that are relevant to their well-being

Understood in their historical context, current debates about psychiatric classification, prompted by the publication of the DSM-5, open up new opportunities for improved translational research in psychiatry. In this paper, we draw lessons for translational research from three time slices of 20th century psychiatry. From the first time slice, 1913 and the publication of Jaspers’ General Psychopathology, the lesson is that translational research in psychiatry requires a pluralistic approach encompassing equally the sciences of mind (including the social sciences) and of brain. From the second time slice, 1953 and a conference in New York from which our present symptom-based classifications are derived, the lesson is that, while reliability remains the basis of psychiatry as an observational science, validity too is essential to effective translation. From the third time slice, 1997 and a conference on psychiatric classification in Dallas that brought together patients and carers with researchers and clinicians, the lesson is that we need to build further on collaborative models of research combining expertise-by-training with expertise-by-experience. This is important if we are to meet the specific challenges to translation presented by the complexity of the concept of mental disorder, particularly as reflected in the diversity of desired treatment outcomes. Taken together, these three lessons – a pluralistic approach, reliability and validity, and closer collaboration – provide an emerging framework for more effective translation of research into practice in 21st century psychiatry.

This open access book offers an exploration of delusions--unusual beliefs that can significantly disrupt people's lives. Experts from a range of disciplinary backgrounds, including lived experience, clinical psychiatry, philosophy, clinical psychology, and cognitive neuroscience, discuss how delusions emerge, why it is so difficult to give them up, what their effects are, how they are managed, and what we can do to reduce the stigma associated with them. Taken as a whole, the book proposes that there is continuity between delusions and everyday beliefs. It is essential reading for researchers working on delusions and mental health more generally, and will also appeal to anybody who wants to gain a better understanding of what happens when the way we experience and interpret the world is different from that of the people around us.