Lisa Bortolotti

In this paper, we are concerned with the ethical implications of the distinction between natural reproduction and reproduction that requires assistance. We argue that the current practice of enforcing regulations on the latter but not on the former means of reproduction is ethically unjustified. It is not defensible to tolerate parental ignorance or abuse in natural reproduction and subsequently in natural parenting, whilst submitting assisted reproduction and parenting to invasive scrutiny. Our proposal is to guarantee equal treatment to people engaging in either form of reproduction or parenting.

Autobiographical stories do not merely offer insights into someone’s experience but can constitute evidence or even serve as self-standing arguments for a given viewpoint in the context of public debates. Such stories are likely to exercise considerable influence on debate participants’ views and behaviour due to their being more vivid, engaging, and accessible than other forms of evidence or argument. In this paper we are interested in whether there are epistemic and moral duties associated with the use of autobiographical stories in mental health debates. We argue that debate participants have a responsibility to assess a story as evidence or as an argument when the story is put forward to support a given viewpoint. We also make some preliminary suggestions about what can be done to ensure that the use of stories contributes to the variety of the resources available to debate participants without compromising the quality of the argumentation or increasing polarisation.

Philosophers have been long interested in delusional beliefs and in whether, by reporting and endorsing such beliefs, deluded subjects violate norms of rationality (Campbell 1999; Davies & Coltheart 2002; Gerrans 2001; Stone & Young 1997; Broome 2004; Bortolotti 2005). So far they have focused on identifying the relation between intentionality and rationality in order to gain a better understanding of both ordinary and delusional beliefs. In this paper Matthew Broome and I aim at drawing attention to the extent to which deluded subjects are committed to the content of their delusional beliefs, that is, to whether they can be regarded as authors of their beliefs (Moran 2001). We consider several levels of commitment one can have to a reported belief, delusional or otherwise, and we distinguish between _ownership_ and _authorship_ of beliefs (Gallagher 2000). After examining some examples of belief authoring (or lack thereof) in psychopathology, we argue that there is no straight-forward and unitary answer to the question whether deluded subjects author their beliefs. Nevertheless, introducing the notion of authorship in the debate can significantly contribute to the philosophical literature on the rationality of delusions and can also have important implications for diagnosis and therapy in psychiatry.

It is important to be able to offer an account of which activities count as scientific research, given our current interest in promoting research as a means to benefit humankind and in ethically regulating it. We attempt to offer such an account, arguing that we need to consider both the procedural and functional dimensions of an activity before we can establish whether it is a genuine instance of scientific research. By placing research in a broader schema of activities, the similarities and differences between research activities and other activities become visible. It is also easier to show why some activities that do not count as research can sometimes be confused with research and why some other activities can be regarded only partially as research. Although the concept of research is important to delimit a class of activities which we might be morally obliged to promote, we observe that the class of activities which are regarded as subject to ethical regulation is not exhausted by research activities. We argue that, whether they be research or not, all the activities that are likely to affect the rights and interests of the individuals involved and impact on the rights and interests of other individuals raise ethical issues and might be in need of ethical regulation.

Ratnayake's interesting paper challenges two claims, that cognitive distortions in depression involve epistemic issues; and that cognitive behavioral therapy can rectify those epistemic issues. We are going to discuss both claims here and offer some reasons not to underestimate the epistemic relevance of CBT. First, there may be epistemic issues underlying cognitive distortions in depression that CBT can effectively address, including blind acceptance of negative automatic thoughts and insensitivity to evidence. But, even if CBT were primarily in the business of enhancing utility as opposed to validity, this would have significant, though indirect, epistemic benefits.All human agents, whether they have a...

In this paper, I borrow Neil Levy’s account of bad beliefs as a starting point to discuss how the social turn in epistemology affects our understanding of the formation, persistence, and spreading of conspiracy beliefs. Despite the recent convergence of philosophers and psychologists on the importance of studying the social dimensions of cognition, current models of conspiracy beliefs differ substantially as to the role that agents have in adopting and maintaining conspiracy beliefs. As a result, the proposals also differ in the remedial strategies they recommend. Here I endorse an integrative approach, which I call “agency in context”, combining explanations of bad believing in terms of the agent’s cognitive habits and information processing with societal failures in providing the support agents need to recognize marks of epistemic authority in sources of information and acquire the critical skills for the evaluation of competing explanations.

Whilst the choice of becoming a parent in the natural way is unregulated all over Europe (and proposals of regulation raise vehement objections), most European countries have (either legal or professional) regulations imposing criteria that people must satisfy if they wish to gain access to assisted reproduction and parenting. These criteria may include relationship status, age, sexual orientation, financial stability, health, and willingness to attend parenting classes. The existence of regulations in this area is largely accepted, and the objections raised usually concern the suitability of specific criteria rather than the legitimacy of imposing criteria at all. The inequality (if unsupported) could be solved by requiring both prospective natural and assisted parents to satisfy the same criteria (with some qualifications specified below) and, more importantly, to be subject to the same degree of monitoring, regardless of the way in which they became parents. Often people argue that proposals to regulate natural reproduction revive dreaded eugenic policies of the past, and that their implementation would violate some of our most cherished interests and rights: in particular the interest in becoming a parent and the right to reproduction and parenting. However, the same interests and rights are not equally safeguarded when one needs assistance to become a parent, and proposals to reduce the extent to which prospective parents requiring assistance are scrutinized are unpopular. In this paper we challenge the alleged justification of the current practices, and we show that there are serious inconsistencies in the treatment of, respectively, people who become parents naturally and people who require assistance to become parents. Thus, we propose that regulation of reproduction and parenting be revised in such a way as to eliminate the inconsistencies.

What makes solitude a positive experience? What distinguishes experiences of solitude from experiences of loneliness? We review some of the literature on the benefits of solitude, focusing on freedom, creativity, and spirituality. Then, we argue that the relationship between agent and environment is an important factor in determining the quality of experiences of solitude. In particular, we find that solitude may support a person’s sense of agency, expanding the possibilities for action that a person has, and creating the conditions for authenticity. We describe a phenomenology of solitude, based on a study that explores the nature of experiences of loneliness and solitude in a religious community. One finding is that solitude is characterised by presence, whereas loneliness is characterised by absence. Another finding is that solitude can contribute to a sense of empowerment that enables agents to pursue and achieve the goals they find valuable.

In philosophy, psychiatry, and cognitive science, definitions of clinical delusions are not based on the mechanisms responsible for the formation of delusions, since there is no consensus yet on what causes 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 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 among these cases, we highlight the difficulty in providing an answer to what makes an irrational belief delusional.

In chapter 3 of Delusions and Beliefs, Kengo Miyazono argues that, when delusions are pathological beliefs, they are so due to their being both harmful and malfunctional. In this brief commentary, I put pressure on Miyazono’s account of delusions as harmful malfunctioning beliefs. No delusions might satisfy the malfunction criterion and some delusions might fail to satisfy the harmfulness criterion when such conditions are interpreted as criteria for pathological beliefs. In the end, I raise a general concern about attributing pathological status to single beliefs out of context, and gesture towards the idea of pathology as a failure of agency to which some beliefs can contribute but that can only be identified by considering the person as a whole.

Exceptionalism is the view that one group is better than other groups and, by virtue of its alleged superiority, is not subject to the same constraints. Here we identify national exceptionalism in the responses made by political leaders in the United States and the United Kingdom to the covid-19 pandemic in early 2020. First, we observe that responses appealed to national values and national character and were marked by a denial of the severity of the situation. Second, we suggest an analogy between national exceptionalism and unrealistic optimism, i.e., people’s tendency to make rosier predictions about their future than is warranted by the evidence due to illusions of superiority and control. Finally, we argue that, at the national level, exceptionalism gave rise to an assumption of invulnerability that made for slow responses to the pandemic, and at the individual level, it served as a justification of people’s failures to adopt safety behaviors.

The main purpose of this paper is to explore the implications of the epistemic faults of delusions and confabulations for the autonomy of the people affected by these conditions. The issue whether autonomy is compromised and to what extent is of great practical relevance. Do people affected by psychiatric disorders that manifest with delusions and confabulations have capacity to consent to treatment? More generally, should they be allowed to make, and deemed responsible for, significant decisions that affect their well-being? We propose to look at autonomy as self-governance and to make a distinction between (a)whether one has the capacity to govern oneself and (b) whether one is successful at governing oneself. We argue that the capacity for self-governance depends on the capacity to develop a self-narrative which encompasses the capacity to endorse attitudes and actions on the basis of reasons. Success in self-governance depends on the coherence of self-narratives and on their correspondence to real life events.

Delusions are symptoms of psychiatric disorders such as schizophrenia and dementia. By and large, delusions are characterized by their behavioral manifestations and defined as irrational beliefs that compromise good functioning. In this overview paper, we ask whether delusions can be adaptive notwithstanding their negative features. Can they be a response to a crisis rather than the source of the crisis? Can they be the beginning of a solution rather than the problem? Some of the psychological, psychiatric, and philosophical literature has recently suggested that they can. We consider different types of delusions and different ways in which they can be considered as adaptive: psychologically (e.g., by increasing wellbeing, purpose in life, intrapsychic coherence, or good functioning) and biologically (e.g., by enhancing genetic fitness). Although further research is needed to map the costs and benefits of adopting and maintaining delusional beliefs, a more nuanced picture of the role of delusions in people's lives has started to emerge.

In this chapter we discuss the role of conscious and unconscious inference in theories of delusion formation. Two competing accounts aim to shed light on the formation of delusions: according to explanationism, the delusional belief is offered as an explanation for anomalous experience; according to the endorsement theory, the delusional belief is an acknowledgement that the anomalous experience is veridical. Whereas explanationists argue that the delusional belief is inferred from experience, endorsement theorists argue that there need be no inference from the experience to the delusional belief. Here we put pressure on the idea that the two accounts can be distinguished on the basis of whether inference is involved in delusion formation and argue that they are both compatible with the increasingly influential idea that Bayesian inference is responsible for the adoption of the delusional belief. One of the models of delusion formation focusing on Bayesian inference is the Coltheart model (Coltheart, Menzies, and Sutton, 2010) which we discuss in detail in the chapter. We show that, given its features, the model does not fit neatly under either explanationism or the endorsement theory.

: Jennifer Radden argues that there cannot be delusional pain in depression, putting forward three arguments: the argument from falsehood, the argument from epistemic irrationality, and the argument from incongruousness. Whereas delusions are false, epistemically irrational, and incongruous with the person’s experience, feeling pain from the first-person perspective cannot be false or irrational, and is congruous with the person’s experience in depression. In this commentary on Radden’s paper, we share her scepticism about the notion of delusional pain, but we find the arguments from falsehood and incongruousness ultimately unconvincing, given that delusions are not always false or incongruous. Rather, we develop the argument from epistemic irrationality, suggesting that, although some aspects of pain may exhibit informational plasticity and other characteristics shared by mental states that can be assessed for their rationality, the sensory component of pain does not. Keywords: Delusion; Pain; Epistemic Irrationality; Incongruousness; Falsity; Depression Riassunto: Jennifer Radden sostiene che non può esserci dolore delirante nella depressione, proponendo tre argomentazioni che si basano sulla falsità, l'irrazionalità epistemica e l'incongruenza. Mentre i deliri sono falsi, epistemicamente irrazionali e incongruenti con l'esperienza della persona, provare dolore in prima persona non può essere falso o irrazionale ed è congruo con l'esperienza di una persona che è depressa. In questo commento all’articolo di Radden, condividiamo il suo scetticismo nei confronti della nozione di dolore delirante, ma troviamo le argomentazioni basate sulla falsità e l’incongruenza in ultima analisi non del tutto convincenti, dato che i deliri non sono sempre falsi o incongrui. Piuttosto, sviluppiamo l’argomentazione basata sull’irrazionalità epistemica, suggerendo che, sebbene alcuni aspetti del dolore possano esibire plasticità e altre caratteristiche condivise da stati mentali che vengono valutati per la loro razionalità, la componente sensoriale del dolore non lo fa. Parole chiave: Delirio; Dolore; Irrazionalità epistemica; Incongruenza; Falsità; Depressione.

When subject to the choice-blindness effect, an agent gives reasons for making choice B, moments after making the alternative choice A. Choice blindness has been studied in a variety of contexts, from consumer choice and aesthetic judgement to moral and political attitudes. The pervasiveness and robustness of the effect is regarded as powerful evidence of self-ignorance. Here we compare two interpretations of choice blindness. On the choice error interpretation, when the agent gives reasons she is in fact wrong about what her choice is. On the choice change interpretation, when the agent gives reasons she is right about what her choice is, but she does not realise that her choice has changed. In this paper, we spell out the implications of the two interpretations of the choice-blindness effect for self-ignorance claims and offer some reasons to prefer choice change to choice error.

Irrational beliefs are often seen as beliefs that are either costly or even pathological and it is assumed that we should eliminate them when possible. In this paper we argue that not only irrational beliefs are a widespread feature of human cognition and agency but also that, depending on context, they can be beneficial to the person holding them, not only psychologically but also epistemically. Given that rationality is highly valued, judgements of rationality have wide-ranging implications for interpersonal relations at an individual and societal level. We suggest that a better understanding of rationality and its role in cognition can lead to a more compassionate treatment of people who express beliefs that are judged as irrational.

A good therapeutic relationship in mental health services is a predictor of positive clinical outcomes for people who seek help for distressing experiences, such as voice hearing and paranoia. One factor that may affect the quality of the therapeutic relationship and raises further ethical issues is the impact of the clinical encounter on users’ sense of self, and in particular on their sense of agency. In the paper, we discuss some of the reasons why the sense of epistemic agency may be especially fragile in young people with unusual experiences and beliefs. We argue that it is important to identify and avoid behaviours that can undermine young people’s contributions as epistemic agents in the clinical encounter.

In this paper we ask whether the two-factor theory of delusions is compatible with two claims, that delusions are pathological and that delusions are adaptive. We concentrate on two recent and influential models of the two-factor theory: the one proposed by Max Coltheart, Peter Menzies and John Sutton (2010) and the one developed by Ryan McKay (2012). The models converge on the nature of Factor 1 but diverge about the nature of Factor 2. The differences between the two models are reflected in different accounts of the pathological and adaptive nature of delusions. We will explore such differences, considering naturalist and normativist accounts of the pathological and focusing on judgements of adaptiveness that are informed by the shear-pin hypothesis (McKay and Dennett 2009). After reaching our conclusions about the two models, we draw more general implications for the status of delusions within two-factor theories. Are there good grounds to claim that delusions are pathological? Are delusions ever adaptive? Can delusions be at the same time pathological and adaptive?