Lisa Bortolotti

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.

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.

Delusions are a common symptom of schizophrenia and dementia. Though most English dictionaries define a delusion as a false opinion or belief, there is currently a lively debate about whether delusions are really beliefs and indeed, whether they are even irrational. The book is an interdisciplinary exploration of the nature of delusions. It brings together the psychological literature on the aetiology and the behavioural manifestations of delusions, and the philosophical literature on belief ascription and rationality. The thesis of the book is that delusions are continuous with ordinary beliefs, a thesis that could have important theoretical and practical implications for psychiatric classification and the clinical treatment of subjects with delusions. By bringing together recent work in philosophy of mind, cognitive psychology and psychiatry, the book offers a comprehensive review of the philosophical issues raised by the psychology of normal and abnormal cognition, defends the doxastic conception of delusions, and develops a theory about the role of judgements of rationality and of attributions of self-knowledge in belief ascription. Presenting a highly original analysis of the debate on the nature of delusions, this book will interest philosophers of mind, epistemologists, philosophers of science, cognitive scientists, psychiatrists, and mental health professionals.

There is an apparent tension in current accounts of the relationship between reason giving and self knowledge. On the one hand, philosophers like Richard Moran (2001) claim that deliberation and justification can give rise to first-person authority over the attitudes that subjects form or defend on the basis of what they take to be their best reasons. On the other hand, the psychological evidence on the introspection effects and the literature on elusive reasons suggest that engaging in explicit deliberation or justification leads subjects to report attitudes that are not consistent with their previous attitudes or with their future behavior. On the basis of these findings, Tim Wilson (2002) argues that analyzing reasons compromises self knowledge. I shall defend a realistic account of the effects of reason giving which is compatible with the empirical findings on introspection and also with the claim that deliberation and justification have epistemic benefits.

Clinical delusions are difficult to investigate in the laboratory because they co-occur with other symptoms and with intellectual impairment. Partly for these reasons, researchers have recently begun to use hypnosis with neurologically intact people in order to model clinical delusions. In this paper we describe striking analogies between the behavior of patients with a clinical delusion of mirrored self misidentification, and the behavior of highly hypnotizable subjects who receive a hypnotic suggestion to see a stranger when they look in the mirror. Based on these analogies, we argue that the use of hypnosis is a reliable method to investigate the surface features of clinical delusions. But to what extent can hypnosis successfully recreate delusions? Can it also contribute to a better understanding of delusion formation? Although clinical delusions and hypnotically induced beliefs are different in etiology, some analogies can be identified in the underlying processes that characterise them, based on the two-factor theory of delusion formation.

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.

Suppose that you are soon to be a parent and you learn that there are some simple measures that you can take to make sure that your child will be healthy. In particular, suppose that by following the doctor’s advice, you can prevent your child from having a disability, you can make your child immune from a number of dangerous diseases and you can even enhance its future intelligence. All that is required for this to happen is that you (or your partner) comply with lifestyle and dietary requirements. Do you and your partner have any moral reasons (or moral obligations) to follow the doctor’s advice? Would it make a difference if, instead of following some simple dietary requirements, you consented to genetic engineering to make sure that your child was free from disabilities, healthy and with above average intelligence? In this paper we develop a framework for dealing with these questions and we suggest some directions the answers might take.

According to some theories of interpretation, it is difficult to explain and predict irrational behavior in intentional terms because irrational behavior does not support the ascription of intentional states with determinate content. In this paper I challenge this claim by offering a general diagnosis of those cases in which behavior, rational or not, resists interpretation. I argue that indeterminacy of ascription and paralysis of interpretation ensue when the interpreter lacks relevant information about the system to be interpreted and about the environment in which the system is embedded. Moreover, the heuristics of interpretation that guide the ascription of beliefs can be limited in scope. In the end I suggest that by giving up the idea of a necessary rationality constraint on the ascription of intentional states we can develop a new framework for a more psychologically realistic account of interpretation.

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.

Contemporary philosophers and bioethicists argue that life extension is bad for the individual. According to the agency objection to life extension, being constrained as an agent adds to the meaningfulness of human life. Life extension removes constraints, and thus it deprives life of meaning. In the paper, I concede that constrained agency contributes to the meaningfulness of human life, but reject the agency objection to life extension in its current form. Even in an extended life, decision-making remains constrained, and many obstacles to the fulfilment of an agent’s goals are preserved. Agents with longer lives are also presented with new challenges: for instance, it might be harder for them to avoid chronic boredom, and sustain their motivation to act in the pursuit of their goals. Although objections from agency and boredom are often used in combination to support the view that a much longer life is likely to bring misery or become meaningless, I argue that the acceptance of the boredom objection undermines the persuasiveness of the agency objection.

In this chapter, our focus is the role played by notions of rationality in the diagnosis of mental disorders, and in the practice of overriding patient autonomy in psychiatry. We describe and evaluate different hypotheses concerning the relationship between rationality and diagnosis, raising questions about what features underpin psychiatric categories. These questions reinforce widely held concerns about the use of diagnosis as a justification for overriding autonomy, which have motivated a shift to mental incapacity as an alternative justification. However, this approach too has recently been criticized from a mental disability rights perspective. Our analysis of the relationship between mental capacity and rationality is used to illuminate these concerns, and to investigate further the relationship between rationality and psychiatric diagnosis.

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.