Mixed Bag #19: Lisa Bortolotti on Delusions and Philosophy
“Mixed Bag” is a series where I ask an expert to select 5 items to explore a particular topic: a book, a concept, a person, an article, and a surprise item (at the expert’s discretion). For each item, they have to explain why they selected it and what it signifies. — Awais Aftab
Lisa Bortolotti, PhD is Professor of Philosophy at the University of Birmingham, affiliated with the Philosophy Department and the Institute of Mental Health. Her research is in the philosophy of the cognitive sciences, and she is interested in irrationality, agency, and belief. Bortolotti is the author of Delusions and Other Irrational Beliefs (OUP 2009), The Epistemic Innocence of Irrational Beliefs (OUP 2020), and Why Delusions Matter (Bloomsbury 2023).
Book – Roberta Payne, Speaking to My Madness: How I Searched for Myself in Schizophrenia (2013)
As a philosopher, I rarely had an opportunity to talk to people with delusions in a clinical context, so I have always been an avid reader of first-person accounts. What does a delusion feel like, from the inside? I read many wonderful memoirs of people living with schizophrenia, and they all made a considerable impact on me, but none more than Roberta Payne’s book. It is so beautifully written, in a style essential and yet poetic, with no frills. Speaking to My Madness brought it home to me that delusions are so much more than things we happen to believe. They are sometimes entire worlds, unmanageable emotions, bits of ourselves that go beyond what we see and hear, what we feel and know, but remain deeply connected to our experiences and to our lives.
“I drove home. On Palm Drive, while I was listening to rock on the radio, I felt my mind change. I was aware of the same things—palm trees, bicycle riders, cars—but they were all far away and magical. “MacArthur Park” lasted all the way home. It had a weird, doomsday authority over me. I felt fragile. Then I felt hot pain rise through my chest and spread out through my veins, just as it did when I drank at night. Right on the edge of panic.
When I got home, I went and lay down on the grass under the hot sun and submitted to the pain. I couldn’t move until it got cool late that afternoon.”
The book review by Thomas Levenson titled “Schizophrenia Finds Its Virgil” reflects on the very same passage that struck me. And it ends like this: “Every now and then one comes across a writer, a voice, a text that lights up what’s involved in being human. Roberta Payne is such a writer.” I couldn’t agree more.
Concept – Epistemic innocence
Ok, this is a bit self-centered of me, but I came up with epistemic innocence because I was not satisfied that there was a concept that could capture what I cared about at the time (Bortolotti 2016; Gunn and Bortolotti 2018; Bortolotti and Sullivan Bissett 2018). The idea is that something can be deeply flawed and undesirable, and yet bear fruit. A specific type of fruit: a boost to our capacity to exercise epistemic agency. Take a belief that is false, irrational, disapproved of by everybody. The belief you can be shunned for. What if that belief plays a positive role for you, maybe temporarily? Wouldn’t this begin to explain why you have it, and why it is so hard to let it go? Maybe the belief does not make you feel better as such, but it does enable you to do something that matters to you, something that you would not be able to do without that belief.
For me, some delusions are like this: they can be epistemically innocent. Other people do not share them, we often find them implausible ourselves, they don’t fit well with the other things that we are supposed to believe. And yet they seem to be there for a reason. Without them, we could not make it. As clinicians, philosophers, and psychologists, we have been predisposed to see the faults of delusion (its being irrational, unusual, harmful, etc.) and forget what the delusion may be there to do. Focusing on just half of the picture contributes to miscommunication and misunderstanding between ourselves and others. The so-called “unintelligibility” of the delusion does not survive the realization that, as well as being irrational, unusual, or harmful, the delusion can help us navigate a difficult past, make sense of puzzling experiences, and restore a sense of ourselves as important actors and our lives as meaningful. In other words, delusion can support agency as well as compromise it.
The so-called “unintelligibility” of the delusion does not survive the realization that, as well as being irrational, unusual, or harmful, the delusion can help us navigate a difficult past, make sense of puzzling experiences, and restore a sense of ourselves as important actors and our lives as meaningful. In other words, delusion can support agency as well as compromise it.
Person – Matthew Broome
There are some people you meet, and they change your life. Meeting Matthew Broome has been pivotal to my professional life in more ways than one. At a time when my fascination with delusion was becoming a serious research interest, Matthew invited me to a journal club in London, and during our first conversation, we made plans to read each other's work and write something together. This turned into an incredibly fruitful collaboration: Matthew brought to our partnership a wealth of clinical experience, fresh philosophical ideas, in-depth knowledge of the phenomenological tradition, and a genuine enthusiasm for research that makes a difference to people who are struggling.
But even more important to me, he showed me what an academic should be like. Matthew is open-minded and modest, authentically interested in other people and their predicaments, and committed to ground-breaking research and innovation in teaching. As Director of the Institute of Mental Health in Birmingham, he created what I thought would be a utopia: a space for people with different disciplinary backgrounds (medicine, sociology, sports science, philosophy, economics,…) and with lived experience of mental health problems to come together as peers to tackle one of society’s hardest challenges.
With Matthew, I have done my best work on delusions, from investigating key questions surrounding moral responsibility to highlighting the importance of affect in the formation and surface features of delusions. We also co-edited a book called Psychiatry as Cognitive Neuroscience: Philosophical Perspectives (OUP, 2009) which was named one of the best books of the year in the Guardian and is home to some terrific papers—by Hanna Pickard, Dominic Murphy, Shaun Gallagher, and Rachel Cooper among others.
With Matthew Broome, I have done my best work on delusions, from investigating key questions surrounding moral responsibility to highlighting the importance of affect in the formation and surface features of delusions. We also co-edited a book called Psychiatry as Cognitive Neuroscience: Philosophical Perspectives (OUP, 2009) which was named one of the best books of the year in the Guardian and is home to some terrific papers.
Article – McKay, R., & Dennett, D. (2009). The evolution of misbelief. Behavioral and Brain Sciences.
People make choices that they then regret. I was asked to write a commentary on this paper, and I declined. Today, I cannot remember why. Probably I felt I didn’t know enough about the philosophy of biology to assess claims about adaptiveness. Yet, in the years that followed its publication, this paper has become central to the evolution of my view of delusions, and I am not sure how many citations it has, but I bet I am responsible for half of them (just kidding, it is a hugely influential paper).
There are so many things I love about this paper, but I will mention three here:
(1) It is written by absolute heroes of mine. Daniel Dennett has influenced my thought since graduate school, on a number of issues from rationality to the self, and Ryan McKay has been a driving force behind empirically informed delusions research, writing some classic papers on delusion formation, highlighting the continuity between delusions and other beliefs that are not considered pathological;
(2) The article offers a possible reading of delusions as adaptive—although the authors rule out that delusions can be biologically adaptive misbeliefs, they consider the possibility that their formation is not a malfunction but a design feature;
(3) The article is one of the very first that discusses positive illusions in some detail from a philosophical perspective, identifying the interest of the phenomenon for the philosophy of mind, and it was pioneering in this respect.
My work has further explored both (2) and (3), thoroughly inspired by the paper. I reflected on how delusions may enable the person to respond to the paralysis of agency precipitated by overwhelming negative emotions (Bortolotti 2015; Lancellotta and Bortolotti 2019). I also attempted to undermine the perceived gulf between positive illusions and delusions (Bortolotti 2018), challenging the thought that the former are only mildly irrational and adaptive through and through, whereas the latter are radically irrational and maladaptive.
Surprise item – A supervisor, Martin Davies
When studying for a two-year Masters degree at Oxford, I requested to have Martin Davies as a supervisor as I thought his research was very relevant to my dissertation, which was about the rationality wars in cognitive science. I was told he had far too many students already. However, I attended all his classes at the Department of Experimental Psychology. One day he told us about delusions. He showed some videos of interviews with patients conducted in Australia as part of the work by Max Coltheart and Robyn Langdon’s team at Macquarie. I was literally blown away. I couldn’t think of anything else for weeks.
Needing a scholarship to continue my studies, I applied for a PhD position at the Australian National University: that was the first year (2000) that they opened their funding scheme to overseas students. I was lucky to get an offer from the philosophy program. At the time of applying, I did not realize that Martin Davies was moving to ANU as well. I contacted him immediately when I heard, asking him whether he would supervise my doctoral work. And as he had not started there yet, he was not oversubscribed as a supervisor. My dream of studying delusions with one of the very few prominent philosophers interested in the phenomenon became a reality.
Martin was the best supervisor I could ask for: providing fair criticism when needed (and I needed a lot of guidance, both in developing my ideas and learning to express them clearly); being always loyal and supportive; never trying to impose his ideas on me but working tirelessly to help me make my ideas the best they could be. Martin has been such an inspiring supervisor: I loved the area of research he was working on, but I also started to appreciate his commitment to a winning methodology. I was struck by how he would team up with the best cognitive scientists in the area and engage in genuine, transforming collaboration. To this day, his paper on what philosophy and psychology can do for each other, with Tony Stone, is one that I read often and I recommend to my students.
Delusions is a fascinating research area but one that cannot be tackled by one discipline alone. Philosophy has a role to play, as Martin Davies taught me by example, but only when combined with expertise in psychiatry, psychology, lived experience, and other disciplines, as I learnt from years of collaboration with Matthew Broome.
Through the years, I moved from being interested in the importance of the phenomenon for the philosophy of mind to thinking about how a better understanding of delusions can positively impact our mutual relationships (Bortolotti 2023). And I want to end with precisely this thought, that a fair view of delusions can help us see significant differences in our worldviews not as reasons for exclusion, pathologization, and stigmatization, but as a challenge worth facing.
Psychiatry at the Margins is a reader-supported publication. You can subscribe to receive new posts with a free or paid subscription. To support my work and this newsletter, consider becoming a paid subscriber.