The Distinction Between Endorsement and Explanationist Models of Delusions: The Role of ‘Blockian’ Concepts of Consciousness and Experience in the Formation of Delusions
People with delusions experience some very weird and distorted things. Just what role experience plays in the formation of delusions, however, is a topic overlooked by many commentators. Stone and Young (1997, p. 346) claim the following for people experiencing the Capgras delusion:
First, the patient experiences a perceptual disorder. The world looks different to them, and this difference demands explanation… [But] in addition to the perceptual deficit, we need to understand the second factor, the reasoning style of people who experience these delusions, in order to see why they arrive at and are satisfied with explanations that others find so bizarre.
This statement alludes to two distinct levels of experience necessary in the formation and understanding of delusions, namely whether experience is the substance of the delusion itself or whether the delusion is employed as an explanatory tool to account for a bizarre experience. In the following essay I explore the relationship between these two positions and how they relate to our understanding of delusions.
I focus upon the Capgras delusion in this essay for two reasons. Primarily, the Capgras delusion offers an interesting point of contact for the theme of this essay. It is a delusion whereby the sufferer suddenly no longer recognises an individual which they have had a complex relationship with. Something changes that provokes this unfamiliarity which I will explore using Ned Block’s concepts of Phenomenal Consciousness and Access Consciousness. And secondly, the philosophical literature is quite developed around this particular delusion.
The Distinction
Contemporary explanations argue that delusions are founded upon bizarre and unusual experiences (Pacherie, Green, & Bayne (forthcoming), p. 1). In the excerpt above from Stone and Young, the Capgras delusion is described as being provoked by a perceptual disorder. The Capgras delusion is characterised by the sufferer believing that an acquaintance has been replaced by an impostor1. An example of a perceptual disorder leading to the Capgras delusion would be the loss of recognition of certain features of a loved one, thus leading to the belief that the loved one is actually an impostor. The individual suffering the delusion undoubtedly experiences something unusual, but there remains some controversy over the role that experience plays in the formation of the subsequent delusion.
Pacherie, Green, & Bayne (forthcoming, p. 2) argue that ‘experience-based accounts of delusions involve (at least) two components: (i) an explanation of the delusional patient’s experiential state; and (ii) an explanation of the delusional patient’s doxastic state (his or her belief)’. Before I explore these two components further, first let me explain the distinction between Endorsement accounts and Explanationist accounts of delusion. The Endorsement account is characterised by an individual endorsing (or simply believing) their perceptual state; the Explanationist account is characterised by an individual who experiences, or perhaps more correctly, and not to confuse the language, constructs a delusion in an attempt to explain an unusual experience (Pacherie (forthcoming), pp. 1-2).
Problems exist for both the Explanationist and Endorsement accounts in relation to (i) and (ii) above. The Explanationist account seems almost a synonym with (i), but how does it fit with (ii)? It is not clear why an individual would construct and adopt a delusion in order to explain one or more unusual or bizarre experiences, particularly when better alternatives are available (Pacherie, Green, & Bayne (forthcoming), p. 2). The Endorsement account fits with (ii) better as the individual already believes (i) prior to the delusion being formed. What is problematic with the Endorsement account is why, even though the experience is endorsed from the begining, sufferers disregard their world-view and pre-established beliefs to accommodate the bizarre experience as fact.
Despite the issues surrounding why (ii) is formed, it is the case that many today are happy with accepting some kind of Explanationist model (Pacherie, Green, & Bayne (forthcoming), p. 3). Where many versions of both the Explanationist and Endorsement models are vague is in how the delusional content is represented to, or experienced by, the sufferer of the delusion. These models pay very little attention to the phenomena of the delusional representations themselves (Pacherie, Green, & Bayne (forthcoming), p. 3). They can claim that the delusional individual in question can construct a delusional attitude to explain an unusual experience, or they can claim that delusional people simply believe their perceptual states, but what they don’t say is what the content of the delusional representations actually may be. It is for this reason that I introduce Block’s ‘Concepts of Consciousness’ into the discussion, to explore how delusional representations may enter the individual’s cognitive environment.
Concepts of Consciousness
In ‘Concepts of Consciousness’ Ned Block (2002, p. 206) states that ‘consciousness is…a mongrel concept’. What he is claiming is that consciousness is not a single simple mind state but a number of different concepts that describe a number of different phenomena. For example, you would say that you are a conscious being simply in virtue of your current cognitive state. We would call this intransitive consciousness, or the virtue of a state being a conscious state. But you would also say that you are conscious of this very essay that you are reading, conscious of the feel of the paper (if it is printed) or the glow of the screen and the way that your cursor interacts with the text (if it is an electronic copy). We would call this transitive consciousness, or ‘consciousness of’. Therefore, applying terms to consciousness as a whole may be problematic as the different aspects of consciousness may, in fact, be quite varied. For present purposes we will focus upon transitive consciousness for we are not interested in the virtue of a delusional state being conscious, but in how the delusion is represented to, or experienced by, the delusional individual, of what the delusional individual is ‘conscious of’.
Block argues for two distinct levels of consciousness that he calls Phenomenal Consciousness (P-consciousness) and Access Consciousness (A-consciousness). P-consciousness is, in a word, experience. For all P-conscious states there is something that it is like to be in that given state; P-conscious states are those states that have an experiential property (Block 2002, p. 206). For example, you are P-conscious of this very essay that you are now reading.
P-consciousness places information into what may be called the global workspace of consciousness or GWC. When I have a particular experience my P-consciousness processes the data in that experience and stores it in the GWC for me to access. This is where Block’s concept of A-consciousness becomes apparent. The purpose of A-consciousness is to access the data that the P-consciousness process has stored in the GWC, and to broadcast this data for open use in cognitive processes. We can describe this in Block’s (2002, p. 208) terms by stating that A-consciousness is ‘an information processing correlate of P-consciousness’. It is P-consciousness and its effective operation that I will argue is at play in the formation of delusions.
P-consciousness and the Formation of Delusions
When I sit down at my desk to write an essay I am P-consciously aware of a number of different things. I can see the china cup above my hand and smell the aroma of coffee permeating from it; I can hear the slow and regular whirl of the fan and disks of my file server under my desk; and I can hear the chirping of the crickets and frogs outside, for I usually write in the evening. All of these facts of my world have been collated and stored by my P-consciousness, to later be accessed by my A-consciousness, in such a way that allows my overall cognitive faculties to function in an effective and productive manner. But what if something went wrong with my P-consciousness?
One evening I sit down to write and rather than the familiar smell of freshly ground and pulled coffee I smell the bergamot of Earl Grey tea. I distinctly remember grinding the beans and pulling the coffee so I have a little taste. The drink is being represented to me as Earl Grey tea rather than black coffee. My wife has a taste and is certain that its coffee she’s drinking. What has gone wrong? Perhaps the nerves in my taste buds have begun to play up, or the particular receptors in my brain responsible for taste have been impaired, but whatever the cause my P-consciousness is either misrepresenting the external phenomena or my P-consciousness is impaired in some way and is no longer able to effectively interact with my experiences. I taste Earl Grey tea but the drink is most certainly coffee. And furthermore, after hearing my wife’s response I become convinced that she’s an impostor, someone who looks like my wife did but an impostor nevertheless.
What is the difference between the two delusional accounts and how does the role of representation or experience influence my consequent delusional state? The case of the tea/coffee delusion is straight forward enough for it is conceptually possible that the entire content or phenomena of the delusion is being represented to my P-consciousness. In other words, the tea/coffee delusion need not be explained away in explanationist terms for the entire content of the delusion can be communicated via the experience itself. But can the same be said of the Capgras delusion, or the perception of my wife as an impostor delusion?
When perceiving my wife as an impostor there is a lot more ‘background’ information involved than in the simpler case of tasting one thing as another (tasting coffee as tea). My entire relationship with my wife would influence the resulting belief and so too would my understanding of the world. It would involve an enormous amount of energy and resources to replace one individual with another, energy and resources that would not be spent on my family. To think that this had actually happened would be a far stretch of the imagination. On this alone it would seem reasonable to assume that this particular delusion involves some sort of explanatory delusion along with a phenomenal delusion. There is certainly some sort of mishap with my P-consciousness, for some anomaly has been experienced, but a deeper cognitive interaction is also at play. To believe that my wife has been replaced by an impostor I have to believe that it is possible that she be replaced by an impostor. It is not clear how this belief, or enough phenomenal content that would lead to such a belief, can be encoded in the experience alone of some anomaly with my wife. There is certainly some issue with my P-consciousness, but the initial experience as represented is not sufficient to account for my current Capgras delusion The delusion may be provoked by an unusual experience but this is not enough to say that the delusion’s sole cause is experiential.
The role of experience is certainly central in the formation of delusions with Stone and Young asserting that experience is the primary aspect of a delusion (1997, p. 346). How the role of experience is incorporated into the overall account of delusions, however, differs from commentator to commentator. I have explored the role of experience in the formation of delusions via the two main accounts of delusions, the Explanationist account and the Endorsement account, along with the ‘Blockian’ concept of P-consciousness. While the phenomena of delusional representations (delusional experience) is fundamental in the formation of delusions, and the relationship between the representation and the delusional agent’s P-consciousness may be enough to explain some delusional states, it remains insufficient in accounting for the depth of belief in other delusional states such as those of the Capgras delusion. A complete understanding of delusions will likely, therefore, rely upon both Endorsement and Explanationist accounts, along with an analysis of the content of the agent’s experiential state.
Notes
1. For more on the Capgras delusion, and others, see Ellis, H. D., & Young, A. W. 1990, ‘Accounting for Delusional Misidentifications’, in British Journal of Psychiatry, vol. 157, pp. 239-248
References
Block, N 2002, ‘Concepts of Consciousness’ in Chalmers, D (ed.), Philosophy of Mind: Classical and Contemporary Readings, Oxford University Press, Melbourne.
Pacherie, E (forthcoming), ‘Perception, Emotions and Delusions: Revisiting the Capgras’ Delusion’, in Bayne, T & Fernandez, J Pacherie, E Green, M and Bayne, T (forthcoming), ‘Phenomenology and Delusions: Who Put the ‘Alien’ in Alien Control? ‘, in Consciousness and Cognition, pp. 1-12.
Stone, T and Young, A.W. 1997, ‘Delusions and Brain Injury: The Philosophy and Psychology of Belief’, in Mind and Language, 12(3/4), pp. 327-364.
Research Blogging Citations
Stone, T and Young, A.W. (1997). Delusions and Brain Injury: The Philosophy and Psychology of Belief Mind and Language, 12 (3/4), 327-364
