What Are We to Believe About How We Believe?

Abstract

What Are We to Believe About How We Believe? Richard P. Bentall (bio) Keywords delusion, belief, psychosis, classification The status of delusions as beliefs has taxed some of the greatest minds in psychopathology. In their paper, Mullen and Gillett (2014) reflect on this issue, addressing a number of ways in which delusions have been conceptualized, on the whole finding them inadequate. They are particularly concerned that regarding delusions simply as false factual beliefs leads to undue emphasis on criteria such as conviction, resistance to counterargument, and falsity, arguing that, in fact, these criteria do not distinguish between delusions and other highly valued ideas (e.g., religious or political convictions, although these are not discussed). Mullen and Gillett make some telling points, and their paper certainly deserves careful consideration. However, some of their assumptions are not beyond criticism. Delusions and Values It should be noted that Mullen and Gillett seem to assume that ultimately there must be some kind of difference between delusions and other kinds of beliefs; the possibility that this might be an illusion, a socially and culturally embedded consequence of conceiving madness in a particular way (as a medical phenomenon) is just not entertained. Hence, they believe that there is a paradox “that clinicians can reliably identify delusions, while being unable to offer a satisfactory definition in terms of falsity, conviction, or other characteristics” (Mullen and Gillett 2014, 35), and this leads them to worry that a dangerous consequence of viewing delusions as beliefs is that other kinds of beliefs might be misclassified as delusions. This argument led me to wonder just how reliable clinicians’ judgements about delusions really are. Certainly, the distinction is not always made easily. In 1984 brothers Ron and Dan Laffertey murdered their sister-in-law Brenda and her 15-month-old daughter Erica, claiming that they had done so in response to a religious revelation (they belonged to an extreme fundamentalist Mormon sect). The background and implications of the murder are discussed in Jon Krakauer’s (2003) fascinating book, Under the Banner of Heaven, which provides a cautionary tale about the difficulties of deciding when beliefs are delusional. At the Lafferty’s trial, the psychologists and psychiatrists who provided expert testimony failed to agree whether the brothers were mentally ill or religious zealots. (The jury subsequently found them guilty. Ron was sentenced to death but his execution is currently stayed pending further arguments about whether he is mentally competent, apparently a requirement for someone to be executed in the state of Utah.) [End Page 39] Mullen and Gillett also worry that regarding delusions as beliefs places mental health professionals in the business of drawing the acceptable limits of belief. As evidence of where this can lead, they cite the much discussed case of Soviet psychiatrists who decided that political dissidents were mentally ill. Interestingly, it seems that the psychiatrists who were responsible for treating dissidents in this way did so largely in good faith, based on the extremely broad criteria for schizophrenia adopted by the Moscow school, and not as a deliberate strategy of persecution (Reich 1984). The same can be said of those American psychiatrists who, in the same era, classified black protestors campaigning for their political rights as suffering from ‘protest psychosis’ (Metzel 2009; a lesser known episode that illustrates just how much mental health professionals may struggle to distinguish between the delusional and the non-delusional). The world would certainly be an easier place to live and practice psychiatry in if a value-free distinction between delusions and other kinds of beliefs could be found, but sometimes the world fails to order itself in a way that makes our lives easy. Even in physical medicine, diagnostic concepts carry implicit values. (If a swelling of the appendix led to a doubling of IQ without harmful consequences, appendicitis would not be a disease. A bacterial infection is only a disease because it is harmful to the human recipient; from another perspective, it is the micro-organism’s successful occupation of an evolutionary niche.) As the sine qua none of a psychiatric disorder is its behavioral manifestation (taking behavior in its broadest sense to include thoughts and feelings) it...