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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 10 of 10. This is the beginning of the thread.
Posted by alexandra_k on December 20, 2004, at 1:31:28
From One to Two Factors in the Explanation of Delusion
While delusions have historically been considered paradigmatic of irrationality, the psychological theorist Brendan Maher (1999; 2003) counters that delusions are ‘not an example of disordered thinking but of normal adaptive thinking applied to explain very abnormal experiences’ (2003 p.19). He maintains that an anomalous experience of a certain intensity and duration is both necessary and sufficient for a subject to adopt a delusional belief. The nature of the anomalous experience is thought to be such that the subject is compelled to attempt to explain it. Maher considers that delusions are the inevitable result of such an attempt at explanation. He concurs with Reed’s claim that
>[G]iven the necessary information, the observer can empathize with the subject; if he himself were to have such an unusual experience he would express beliefs about it which would be just as unusual as those of the subject… They can occur in anybody who experiences disturbing phenomena, while retaining the ability to think clearly enough to be able to devise explanations of those phenomena (in Maher, 1999 p. 551).
Two-factor theorists depart from Maher by considering that delusions would not seem to be ‘normal’ or ‘rational’ responses - despite the nature of the delusional subject’s experience. Davies et al., (2002 pp. 136-137) present a battery of eight different types of delusion and they suggest that a prospective account should be assessed for adequacy with respect to how well it can explain each of these types. They argue that the anomalous experience that is relevant to each of these kinds of delusion is one that is experienced by both delusional and non-delusional subjects. They take this to be evidence that while anomalous experience may be necessary for delusion it cannot be sufficient. As such they consider that Maher’s account of the role of anomalous experience needs to be supplemented by a second factor. It is this second factor that is supposed to determine whether a subject will develop a delusion in the face of an anomalous experience. Various cognitive biases and / or deficits have been proposed as candidates for the second factor.
Posted by smokeymadison on December 20, 2004, at 2:14:27
In reply to 1.2, posted by alexandra_k on December 20, 2004, at 1:31:28
so are you basically proposing that it takes a trigger as well as a "vulnerable" indidual to create a delusion? that it takes an abnormal experience as well as a certain "creativity" on the part of the individual to become delusional? if the delusion was created by a "normal" thought process, are they not unlike dreams? in that they are like dreams, i mean that the mind is attempting to make sense of phemomena that is not easy to make sense of. Or it may be that it is dangerous for the individual to take on "reality" as it actually is and so instead he or she resorts to an alternate explanation of the experience, in order to protect the integrity of the mind.
but i don't see the importance of focusing on utterances. i mean, they can be false, in that they do not reflect what one is thinking. sometimes people say things knowing that they really don't believe what they say. again, i am getting back to the fragmentation of the mind in that some small part knows that the delusion is a delusion, challenging the DSM's criteria, of course. i think that treatment would not be an option if somewhere the person did not know the delusion was a false belief. meds can't totally rewire the brain. it makes more sense to believe that they work by bringing the part that knows the truth to the forefront.
Posted by alexandra_k on December 20, 2004, at 13:19:04
In reply to Re: 1.2, posted by smokeymadison on December 20, 2004, at 2:14:27
> so are you basically proposing that it takes a trigger as well as a "vulnerable" indidual to create a delusion?
Ok well, I haven't got to what I'm proposing yet. Maher and Davies et al are both bottom-up theorists in the sense that they maintain that anomalous experience is necessary for delusion. (I briefly consider a rationalist objection to the empiricist framework later, but for the most part I just accept the empiricist framework).
What Maher and Davies et al disagree about, however, is whether an anomalous experience alone is enough to produce (and hence to explain) delusion. Maher thinks that an anomalous experience alone sufficient (thats why hes a one factor theorist) and so the delusional subject adopts a normal rationalising strategy for their experience and comes up with a delusion.
Davies et al. consider that no matter what Maher thinks DELUSIONS ARE NOT NORMAL RESPONSES TO ANY KIND OF EXPERIENCE. They think that not only do delusional subjects have an anomalous experience, they also have a cognitive (reasoning) deficit or bias (hence two factor theorists).
Most theorists consider that delusions are 'irrational' (so there is a second facotor - a faulty cognition). The trouble with this is that if they are indeed irrational, then how are we supposed to come up with a rational explanation for them? Jaspers thought that delusions proper are ununderstandable in the sense that we can only explain them with recourse to a neurological disease process. But a neurological explanation isn't good enough for me. I want a fairly much common sense (intentional) explanation. This is just what Jaspers thinks we can't have. I reckon he is just giving up. He should have tried harder.
I guess the 'trigger' would be the anomalous experience. The 'vulnerable individual' would be pre-existing cognitive deficit. (Though, to be fair it is unclear whether the cognitive deficit is supposed to be pre-existing or not..) I am not sure that those terms map very well onto 'anomalous experience' and 'cognitive deficit'. Though if the cognitive deficit is preexisting then I suppose that would work.
(P.S. I want a one-factor model myself, I like Maher's line).
> but i don't see the importance of focusing on utterances. i mean, they can be false, in that they do not reflect what one is thinking. sometimes people say things knowing that they really don't believe what they say. again, i am getting back to the fragmentation of the mind in that some small part knows that the delusion is a delusion, challenging the DSM's criteria, of course. i think that treatment would not be an option if somewhere the person did not know the delusion was a false belief. meds can't totally rewire the brain. it makes more sense to believe that they work by bringing the part that knows the truth to the forefront.The trouble is that we cannot access anothers beliefs directly. The only thing that we have to go on in making a diagnosis is the behaviour (especially the verbal behaviour) of subjects. That is a reality about diagnosis, so it is something I have gone with. Another point is that it is a matter of controversy whether delusions are appropriately classified as beliefs (this is something I touch on a bit later). I don't want to presuppose that, because I do think it is a genuine problem. Delusions don't seem to quite be beliefs.... Gregory Currie has suggested that they are 'imaginings misidentified as beliefs' (by the delusional subject) but that proposal has problems too...
Cognitive therapy for delusions requires them to be based on faulty cognitions. But maybe this is as wrong as cognitive therapies insistance that faulty thinking causes extreme / intense emotional states. Maybe they have it backwards. Some people with delusions appreciate that their 'belief' will sound implausible to others. Some seem to express confusion (at times) about just what it is they 'believe'. I like what you are saying, actually. Someone I know is currently working on different mental modules becoming isolated so that one module can believe that p and another can believe that not p at the same time. The subject could kind of waver between them... Sometimes there is good motivation for just accepting cognitive dissonance (sorting it out could take up a heck of a lot of cognitive resources which are needed for alternative projects that have more to do with survival)...
Thats why philosophers are interested in this. Delusions have much to show us about the nature of belief. It is thought that an adequate model of the belief formation processes of normal subjects should be able to explain delusions by the positing of a breakdown in this model (though I guess that presupposes that they are beliefs). And rationality / irrationality (and whether that might have a structure so that there could be a localised failure rather than a global breakdown) has long been of interest to philosophers too...
Posted by smokeymadison on December 20, 2004, at 17:04:16
In reply to Re: 1.2 » smokeymadison, posted by alexandra_k on December 20, 2004, at 13:19:04
> What Maher and Davies et al disagree about, however, is whether an anomalous experience alone is enough to produce (and hence to explain) delusion. Maher thinks that an anomalous experience alone sufficient (thats why hes a one factor theorist) and so the delusional subject adopts a normal rationalising strategy for their experience and comes up with a delusion.
>
> Davies et al. consider that no matter what Maher thinks DELUSIONS ARE NOT NORMAL RESPONSES TO ANY KIND OF EXPERIENCE. They think that not only do delusional subjects have an anomalous experience, they also have a cognitive (reasoning) deficit or bias (hence two factor theorists).
I don't believe that delusions are the result of faulty reasoning. but i would agree and disagree with "two factor" theorists in that it takes an experience (and i don't think that it has to be unusual) as well as the ability to "think outside the box" in order to create a delusion. what i mean is, those who have the capacity to become delusional possess alternate, but not necessarily pathological, reasoning skills. they solve the puzzle (what is reality) in an entirely different fashion then most people. the end result is a delusion.> Most theorists consider that delusions are 'irrational' (so there is a second facotor - a faulty cognition).
Deludions, if created by a rational brain, cannot themselves be irrational. i am thinking of the old puzzle of how to connect the dots without raising the pen. the answer is to fold the paper so the pen connects all the dots writing over the folds. People who are delusional do not possess faulty "wiring" instead, they merely draw conclusions through extraordinary mental processes that are rare.
> I guess the 'trigger' would be the anomalous experience. The 'vulnerable individual' would be pre-existing cognitive deficit.
Again, i don't believe that what makes a person likely to become delusional is a pre-existing or perhaps just present cognitive DEFICIT. it is instead, a rare cognitive ABILITY.
>
> Cognitive therapy for delusions requires them to be based on faulty cognitions. But maybe this is as wrong as cognitive therapies insistance that faulty thinking causes extreme / intense emotional states. Maybe they have it backwards.yes, i think that they do in some, if not most cases.
Some people with delusions appreciate that their 'belief' will sound implausible to others. Some seem to express confusion (at times) about just what it is they 'believe'. I like what you are saying, actually. Someone I know is currently working on different mental modules becoming isolated so that one module can believe that p and another can believe that not p at the same time. The subject could kind of waver between them... Sometimes there is good motivation for just accepting cognitive dissonance (sorting it out could take up a heck of a lot of cognitive resources which are needed for alternative projects that have more to do with survival)...
>
> Thats why philosophers are interested in this. Delusions have much to show us about the nature of belief. It is thought that an adequate model of the belief formation processes of normal subjects should be able to explain delusions by the positing of a breakdown in this model (though I guess that presupposes that they are beliefs). And rationality / irrationality (and whether that might have a structure so that there could be a localised failure rather than a global breakdown) has long been of interest to philosophers too...
thanks for the mind benders! you are really making me think!SM
Posted by alexandra_k on December 21, 2004, at 1:06:08
In reply to Re: 1.2, posted by smokeymadison on December 20, 2004, at 17:04:16
I really don't like the cognitive bias / deficit idea either. While there is some evidence that delusional subjects reason differently from non-delusional subjects it is hard to sort whether these differences in reasoning CAUSE the delusion, or are CAUSED BY the delusion. We can just flip the order again :-)
(ok, I'll admit this to you in a slightly sneaky manner... I don't like the bias / deficit idea because it is implicit that delusional subjects are DEFECTIVE in some way. I don't think this helps with compassion and attempts at empathy and understanding particularly. Also, in the literature 'delusional subjects' invariably become PATIENTS (yeech, talk about 'other') or SCHIZOPHRENICS (people are not their diagnosis, didn't ya know?) If the only mark I ever make is that people with mental illness get called 'subjects' in the literature instead (thats subjects of experience - just like you or me - though maybe that favours the anomalous experience model slightly...) well, then I would consider myself to have done something very worthwhile indeed).
I go on to consider that maybe delusional subjects are attempting to convey something slightly different by their delusional utterances than what we take them to be conveying. This semes to be lateral in a similar way to what you suggest (though you should be the judge). Maybe it is us who has missed the point.
I like your 'ability' idea. The only trouble is that that would mean that delusional subjects should OUTPERFORM normal subjects on some or other cognitive task. Actually (much to my amusement) delusional subjects have been found to perform closer to Bayesian norms of probabilistic reasoning than non-delusional controls! This is not typically the way that this finding is presented in the literature, however, it is typically presented as evidence that 'delusional subjects judge that they are certain on the basis of less evidence than non delusional controls'. But normal subjects are too conservative in their judgements of certainty (when measured against bayesian norms of probabilistic reasoning). Perhaps I should emphasise this as a superior performance?!
> thanks for the mind benders! you are really making me think!You are most welcome. Thanks for making me think in return. I am pleased and flattered that someone has made it this far! Really, I truely am :-) One does start to worry that nobody gives a d*mn really. Nobody at my university is working on this issue so I am pretty much working in isolation - though I do have contacts in Australia.
Anyway, just in case you are worried about how much I am going to be going on for (you or anyone else) 10 sections. Then that is it, I shall call it a day, I promise :-)
Posted by alexandra_k on December 22, 2004, at 17:29:03
In reply to Re: 1.2 » smokeymadison, posted by alexandra_k on December 21, 2004, at 1:06:08
> (ok, I'll admit this to you in a slightly sneaky manner... I don't like the bias / deficit idea because it is implicit that delusional subjects are DEFECTIVE in some way. I don't think this helps with compassion and attempts at empathy and understanding particularly. Also, in the literature 'delusional subjects' invariably become PATIENTS (yeech, talk about 'other') or SCHIZOPHRENICS (people are not their diagnosis, didn't ya know?) If the only mark I ever make is that people with mental illness get called 'subjects' in the literature instead (thats subjects of experience - just like you or me - though maybe that favours the anomalous experience model slightly...) well, then I would consider myself to have done something very worthwhile indeed).
And the reason I have to be sneaky about admitting this??? Because it doesn't stand up to logical scruitiny (sigh). If there is a LOCALISED bias / deficit then delusions would be perfectly understandable responses GIVEN the nature of the bias / deficit.
I am not sure really why I am so resistant to the bias / deficit idea...
Actually, I am. Because I got sick of clinician's laughing in my face when I told them I was into philosophy. BPD's aren't supposed to be paradigms of logical thinking.
You can argue most anything using reason as justification. WHAT you choose to argue, however, is guided by your intuitions. Basically you have to argue something (or you may as well go home) and it is better to argue for something you find plausible than for something you find implausible. But yeah, what you choose to argue isn't the result of logic or reason as much as the average philosopher would have us believe.Crap crap crap.
Everyone at this end reckons I need to back down a bit on my attempt to make the one factor model cover everything. Perhaps they are right.
Posted by smokeymadison on December 22, 2004, at 22:18:12
In reply to Re: 1.2, posted by alexandra_k on December 22, 2004, at 17:29:03
i loved my independent study in philosophy! i spent a semester studying moral status. basically, how all things should be treated according to their nature/attributes. i decided that i beleive that all living things deserve a certain level of moral status. my professor srgued that only living things with sentience deserved any kind of moral status. my final paper was on the moral status of all primates excluding fully cognizant human beings (who of course HAVE the highest moral status without argument). i argued that chimps/gorillas/etc should have the same moral status as mentally handicapped human beings. that is, full moral status upheld on their behalf. anyway, i can't wait to get back into class and take some more philosophy classes. BPD or not, i am fully capable of logical thought! :)
Posted by alexandra_k on December 23, 2004, at 15:27:16
In reply to Re: philosophy, posted by smokeymadison on December 22, 2004, at 22:18:12
>BPD or not, i am fully capable of logical thought! :)
Yeah, thats the spirit :-)
I haven't really done much value theory (ethics / aesthetics). It is kind of a hole in my philosophy education really. Still, if I get into the states to study, well they MAKE you do it as part of the breadth requirement.
My officemate is into ethics. He is attempting to base virtue ethics on egoism (as opposed to altruism). I don't follow an awful lot of what he is saying, but I know one thing: I will never go spelunking(?) with him!
So you have studied philosophy and psychology too. What is your major?
Posted by smokeymadison on December 23, 2004, at 17:11:19
In reply to Re: philosophy » smokeymadison, posted by alexandra_k on December 23, 2004, at 15:27:16
my major is psychology and my minor is in social work (critical family issues). i plan to work as a social worker for a few years after i graduate (hopefully spring 2006) before going to grad school. i MIGHT become a therapist if i can get all my sh*t together and keep it together for a few years and convince myself that i will continue to be stable.
Posted by alexandra_k on December 23, 2004, at 18:02:34
In reply to Re: philosophy, posted by smokeymadison on December 23, 2004, at 17:11:19
Cool :-)
> i MIGHT become a therapist if i can get all my sh*t together and keep it together for a few years and convince myself that i will continue to be stable.
I will never be a therapist. That is what I have come to realise about myself. I want the theory, I am addicted to theory, but real people just make me want to cringe and hide in the corner much of the time.
It sounds like you have your head on properly
To have it there as a maybe
And wait and see how things go.
I have heard that recovered borderlines can make very good clinicians indeed (once they have made a lot of progress to be sure).
I strongly believe there is something approaching a 'borderline intuition' - a capacity to 'mind read' emotional responses and understand their unique logic. You don't have to be borderline or traumatised to have that, but those things make it come natural.Probably just b*llsh*tt*ng here
(loads less informed than usual, however)
All the best to you :-)
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