Volume 16, No. 2, 2020 – Special issue: The Bounds of Rationality

The idea that mental illnesses are impairments in rationality is very old, and very common (Kasanin 1944; Harvey et al. 2004; Graham 2010). But is it true? In this article two severe mental disorders, schizophrenia and delusional disorder, are investigated in order to find some defects in rationality. Through the analysis of patients’ performances on different tests, and the investigation of their typical reasoning styles, I will show that mental disorders can be deficits in social cognition, or common sense, but not in rationality (Sass 1992; Johnson-Laird et al. 2006; Bergamin 2018). Moreover, my claim is that psychopathological patients can also be, in some circumstances, more logical than normal controls (Kemp et al. 1997; Owen et al. 2007). From a philosophical point of view these data seem to be very relevant, because they help us to reconsider our idea of rationality, and to challenge the common way to look at sanity and mental illness.

In this paper we ask whether the two-factor theory of delusions is compatible with two claims, that delusions are pathological and that delusions are adaptive. We concentrate on two recent and influential models of the two-factor theory: the one proposed by Max Coltheart, Peter Menzies and John Sutton (2010) and the one developed by Ryan McKay (2012). The models converge on the nature of Factor 1 but diverge about the nature of Factor 2. The differences between the two models are reflected in different accounts of the pathological and adaptive nature of delusions. We will explore such differences, considering naturalist and normativist accounts of the pathological and focusing on judgements of adaptiveness that are informed by the shear-pin hypothesis (McKay and Dennett 2009). After reaching our conclusions about the two models, we draw more general implications for the status of delusions within two-factor theories. Are there good grounds to claim that delusions are pathological? Are delusions ever adaptive? Can delusions be at the same time pathological and adaptive?

In this paper, I will present and advocate a view about what we are doing when we attribute delusion, namely, say that someone is delusional. It is an “expressivist” view, roughly analogous to expressivism in meta-ethics. Just as meta-ethical expressivism accounts for certain key features of moral discourse, so does this expressivism account for certain key features of delusion attribution. And just as meta-ethical expressivism undermines factualism about moral properties, so does this expressivism, if correct, show that certain attempts to objectively define delusion are misguided. I proceed as follows. I start by examining different attempts at defining delusion, separating broadly psychiatric attempts from epistemic ones. I then present a change of approach, according to which we question whether the term “delusion” is in the business of (merely) describing reality. I then support this proposal, first, by borrowing standard lines of argument from meta-ethics (including ontological reluctance, intrinsic motivation, and deep disagreement) but also, by inference to the best explanation of some the features we see when we try to theorise about delusion (namely that it is hard to define, and that our delusion attributions are elicited by a plurality of norms).

Disorders of agency could be described as cases where people encounter difficulties in assessing their own degree of responsibility or involvement with respect to a relevant action or event. These disturbances in one’s sense of agency appear to be meaningfully connected with some mental disorders and with some symptoms in particular—i.e. auditory verbal hallucinations, thought insertion, pathological guilt. A deeper understanding of these experiences may thus contribute to better identification and possibly treatment of people affected by such disorders. In this paper I explore disorders of agency to flesh out their phenomenology in more detail as well as to introduce some theoretical distinctions between them. Specifically, I argue that we may better understand disorders of agency by characterizing them as dimensional. In §1 I explore the cases of Auditory Verbal Hallucinations (AVH) and pathological guilt and I show that they lie at opposite ends of the agency spectrum (i.e. hypoagency versus hyperagency). In §2 I focus on two intermediate cases of hypo- and hyper- agency. These are situations that, despite being very similar to pathological ones, may be successfully distinguished from them in virtue of quantitative factors (e.g. duration, frequency, intensity). I first explore the phenomenon of mind wandering as an example of hypoagency, and I then discuss the phenomenon of false confessions as an example of hyperagency. While cases of hypoagency exemplify situations where people experience their own thoughts, bodies, or actions as something beyond their control, experiences of hyperagency provide an illusory sense of control over actions or events.

 The movements and protests of 1968 worldwide criticized the traditional idea of normality. From the 1970s onwards, psychiatry and antipsychiatry became an ideological battleground centered on the boundaries between normality and madness. In this scenario, characterized by a deep cultural and political transformation within the Left, the traditional concept of rationality and its very connection with irrationality was called into question. As a consequence, the very ideal of reason was questioned. This paper will explore the debate on rationality, irrationality and irrationalism within the so-called anti-institutional psychiatry and its reception in the Italian New Left during the second half of the 1970s.

Long-standing psychiatric practice confirms the pervasive use of pharmacological therapies for treating severe mental disorders. In many circumstances, drugs constitute the best allies of psychotherapeutic interventions. A robust scientific literature is oriented on finding the best strategies to improve therapeutic efficacy through different modes and timing of combined interventions. Nevertheless, we are far from triumphal therapeutic success. Despite the advances made by neuropsychiatry, this medical discipline remains lacking in terms of diagnostic and prognostic capabilities when compared to other branches of medicine. An ethical principle remains as the guidance of therapeutic interventions: improving the quality of life for patients. Unfortunately, psychotropic drugs and psychotherapies do not always result in an efficient remission of symptoms. In this paper I corroborate the idea that therapists should provide drug-resistant patients with every effective and available treatment, even if some of such interventions could be invasive, like Electroconvulsive Therapy (ECT). ECT carries upon its shoulders a long and dramatic history that should be better investigated to provide new insights. In fact, ECT has attracted renewed interest in recent years. This is due to the fact that antidepressant drugs in younger patients show often scarce effectiveness and unpleasant side-effects. Moreover, I show that, thanks to modern advances, ECT may work as a successful form of treatment for specific and rare cases, such as severe depression (with suicide attempts) and catatonia.

The recent global pandemic has led to a shift to online conferences in philosophy. In this paper we argue that online conferences, more than a temporary replacement, should be considered a sustainable alternative to in-person conferences well into the future. We present three arguments for more online conferences, including their reduced impact on the environment, their enhanced accessibility for groups that are minorities in philosophy, and their lower financial burdens, especially important given likely future reductions in university budgets. We also present results from two surveys of participants who attended one large and three small online philosophy conferences this year. We show that participants were in general very satisfied with presentations and discussions at the conferences, and that they reported greater accessibility. This indicates that online conferences can serve as a good alternative to in-person conferences. We also find that networking was less satisfactory in online conferences, indicating a point for improvement and further research. In general, we conclude that philosophers should continue to organize online conferences after the pandemic. We also provide some advice for those wishing to organize online conferences.