Post by Admin on Aug 31, 2020 11:10:10 GMT
Deluded, with reason
Extraordinary beliefs don’t arise in a vacuum. They take root in minds confronted by unusual and traumatic experiences
aeon.co/essays/delusions-take-root-in-minds-searching-to-explain-difficult-experiences
Awoman is so certain that she’s being unfairly targeted by intelligence agents that she hurriedly crosses the road to avoid a passing police officer. A young man smashes a shop window in frustration because he’s exhausted at having his every movement filmed for a TV show. A previously loving husband rejects his wife of 30 years, convinced she’s actually an imposter in disguise.
It’s reasonably common for psychiatrists to encounter people who think and behave in such striking and peculiar ways as these. Most psychiatrists would regard such people as holding a delusion – a false belief that is strongly held, idiosyncratic and more or less impervious to evidence.
Delusions are one of the common symptoms of psychosis, which is a broader syndrome that involves experiencing an apparent disconnect from objective reality. We need to find ways to better help and support people who hold delusions – including patients diagnosed with schizophrenia, bipolar disorder or affected by drug misuse – and to do so will require a deeper understanding of how and why their unusual beliefs arise. Unfortunately, despite hundreds of research studies over decades, we have barely begun to grasp the deeply mysterious nature of delusional belief. We need a new approach.
For many years, the way that psychiatrists thought about delusions, especially paranoid delusions, was influenced by Sigmund Freud and his proposal that, like many problems, they can be understood in terms of repression. For instance, at the end of Psycho-Analytic Notes on an Autobiographical Account of a Case of Paranoia (Dementia Paranoides) (1911) – in which he gives his interpretation of a judge’s memoir about his own psychosis – Freud posited that paranoid beliefs arise from attempts to repress homosexual attraction. Freud’s rather tortuous argument was that the paranoid individual unconsciously reverses his attraction to ‘I do not love him, I hate him,’ and then projects this outwards, so it becomes instead the paranoid delusion ‘He hates (persecutes) me.’
Although later psychodynamic explanations of delusional belief became less convoluted and sex-focused, the central idea of projection – that a delusion represents a person’s emotional ‘inner world’ projected on to their understanding of the outer world – still predominated. However, psychoanalytic influence on psychiatry eventually waned in the 1980s in the United States, and never held full sway in parts of Europe.
Other psychological theories to emerge have tended to focus on the intuitive idea that delusions are caused by some kind of failure of rationality. This was the approach taken by the influential Italian-American psychiatrist Silvano Arieti, who suggested that people with schizophrenia go through a ‘cognitive transformation’ in which their thinking becomes less logical, giving rise to delusional ideas.
Specifically, in Interpretation of Schizophrenia (1955), Arieti suggested that a ‘normal person’ without psychosis ‘automatically applies the Aristotelian laws of logic without even knowing them’. These laws allow us to follow a chain of reasoning in a brief syllogism, such as:
All men are mortal.
Socrates is a man.
Therefore, Socrates is mortal.
In the case of delusional thought, Arieti argued, the ability to follow this logical sequence is lost. His suggestion that people with delusions must be illogical thinkers seems so obvious it surely has to be true. Unfortunately for his hypothesis, healthy people are anything but logical in the philosophical/Aristotelian sense, as corroborated by countless studies. This is illustrated perhaps most vividly by an example from the American psychologist Daniel Kahneman’s book Thinking, Fast and Slow (2011), known as the Linda problem:
Linda is 31 years old, single, outspoken, and very bright. She majored in philosophy. As a student, she was deeply concerned with issues of discrimination and social justice, and also participated in anti-nuclear demonstrations.
Based on this description, which is more likely true about Linda?
Linda is a bank teller.
Linda is a bank teller and is active in the feminist movement.
Most people use the brief description to do something like ‘get a sense’ for Linda’s personality and, based on that, conclude that option 2 is more likely to be true. In fact, because of the nature of the options (option 2 adds a descriptive caveat that makes it a smaller set of people than option 1), it is option 1 that is logically more likely to be true.
The Linda problem is an example of a question that should prompt us to think in terms of sheer numerical probability. The logical approach would be to consider which set (1 or 2) it would be statistically more likely for any given descriptive example to be drawn from. But this is not how we humans – psychologically healthy or otherwise – tend to think, as demonstrated by this problem and many other examples from Kahneman’s joint programme of research with Amos Tversky.
So the idea that you could reasonably distinguish psychotic individuals from non-psychotic in terms of rationality doesn’t hold. If anything, there’s evidence that people with a propensity toward delusions might be better at engaging in logical thinking than those without. Consider a 2007 study in which a team at the Institute of Psychiatry in London presented three-part arguments to delusion-prone volunteers diagnosed with schizophrenia and to healthy controls. They asked all the volunteers to judge if the arguments’ conclusions were logical or not. Some of the arguments created a conflict between purely logical reasoning and common sense by putting flatly nonsensical information into the structure of a valid logical argument, such as: ‘All buildings speak loudly; a hospital does not speak loudly; therefore, a hospital is not a building.’ If you know anything about hospitals and buildings, you know the conclusion to be factually untrue, but if you ignore the veracity of the premise statements, the conclusion is logically accurate. In the study, it was actually the volunteers with a diagnosis of schizophrenia who were better able to ignore the content and appraise the logical validity of the arguments than were the healthy controls, thus speaking against failure of logic as a cause of delusions.
More recently, researchers have adopted a new angle on the illogical reasoning explanation for delusions, proposing that they could be driven by a specific reasoning bias that the British psychologist Richard Bentall in Madness Explained (2003) describes as ‘epistemological impulsivity’ or jumping to conclusions. In the classic demonstration of this bias, volunteers are shown two jars with different proportions of red and blue beads – one has far more red, the other has far more blue. The jars are hidden and then beads from just one jar are taken out one at a time and shown to the volunteers. Their task is to judge which jar the beads are coming from – the predominantly red-bead jar or the predominantly blue-bead jar. People with delusional beliefs typically make hastier judgments, as if they are willing to use less evidence to form their conclusions, giving rise to the suggestion that this thinking style (the ‘jumping to conclusions bias’ or JTC bias) might contribute to a person developing unusual or delusional beliefs.
However, this idea has come in for recent criticism. Although meta analyses of all the available relevant data do corroborate a connection between the JTC bias and a propensity for delusional ideas, they don’t indicate that the former is necessary or sufficient to give rise to the latter. For instance, people with psychosis but no delusions also seem to demonstrate the JTC bias; at the same time, many non-psychotic people demonstrate the hasty reasoning style. In fact, a team at New York State Psychiatric Institute in 2019 reported findings from a different version of the bead-jar task, suggesting that people with more severe delusions are biased to collect more evidence than those with less severe delusions.
Extraordinary beliefs don’t arise in a vacuum. They take root in minds confronted by unusual and traumatic experiences
aeon.co/essays/delusions-take-root-in-minds-searching-to-explain-difficult-experiences
Awoman is so certain that she’s being unfairly targeted by intelligence agents that she hurriedly crosses the road to avoid a passing police officer. A young man smashes a shop window in frustration because he’s exhausted at having his every movement filmed for a TV show. A previously loving husband rejects his wife of 30 years, convinced she’s actually an imposter in disguise.
It’s reasonably common for psychiatrists to encounter people who think and behave in such striking and peculiar ways as these. Most psychiatrists would regard such people as holding a delusion – a false belief that is strongly held, idiosyncratic and more or less impervious to evidence.
Delusions are one of the common symptoms of psychosis, which is a broader syndrome that involves experiencing an apparent disconnect from objective reality. We need to find ways to better help and support people who hold delusions – including patients diagnosed with schizophrenia, bipolar disorder or affected by drug misuse – and to do so will require a deeper understanding of how and why their unusual beliefs arise. Unfortunately, despite hundreds of research studies over decades, we have barely begun to grasp the deeply mysterious nature of delusional belief. We need a new approach.
For many years, the way that psychiatrists thought about delusions, especially paranoid delusions, was influenced by Sigmund Freud and his proposal that, like many problems, they can be understood in terms of repression. For instance, at the end of Psycho-Analytic Notes on an Autobiographical Account of a Case of Paranoia (Dementia Paranoides) (1911) – in which he gives his interpretation of a judge’s memoir about his own psychosis – Freud posited that paranoid beliefs arise from attempts to repress homosexual attraction. Freud’s rather tortuous argument was that the paranoid individual unconsciously reverses his attraction to ‘I do not love him, I hate him,’ and then projects this outwards, so it becomes instead the paranoid delusion ‘He hates (persecutes) me.’
Although later psychodynamic explanations of delusional belief became less convoluted and sex-focused, the central idea of projection – that a delusion represents a person’s emotional ‘inner world’ projected on to their understanding of the outer world – still predominated. However, psychoanalytic influence on psychiatry eventually waned in the 1980s in the United States, and never held full sway in parts of Europe.
Other psychological theories to emerge have tended to focus on the intuitive idea that delusions are caused by some kind of failure of rationality. This was the approach taken by the influential Italian-American psychiatrist Silvano Arieti, who suggested that people with schizophrenia go through a ‘cognitive transformation’ in which their thinking becomes less logical, giving rise to delusional ideas.
Specifically, in Interpretation of Schizophrenia (1955), Arieti suggested that a ‘normal person’ without psychosis ‘automatically applies the Aristotelian laws of logic without even knowing them’. These laws allow us to follow a chain of reasoning in a brief syllogism, such as:
All men are mortal.
Socrates is a man.
Therefore, Socrates is mortal.
In the case of delusional thought, Arieti argued, the ability to follow this logical sequence is lost. His suggestion that people with delusions must be illogical thinkers seems so obvious it surely has to be true. Unfortunately for his hypothesis, healthy people are anything but logical in the philosophical/Aristotelian sense, as corroborated by countless studies. This is illustrated perhaps most vividly by an example from the American psychologist Daniel Kahneman’s book Thinking, Fast and Slow (2011), known as the Linda problem:
Linda is 31 years old, single, outspoken, and very bright. She majored in philosophy. As a student, she was deeply concerned with issues of discrimination and social justice, and also participated in anti-nuclear demonstrations.
Based on this description, which is more likely true about Linda?
Linda is a bank teller.
Linda is a bank teller and is active in the feminist movement.
Most people use the brief description to do something like ‘get a sense’ for Linda’s personality and, based on that, conclude that option 2 is more likely to be true. In fact, because of the nature of the options (option 2 adds a descriptive caveat that makes it a smaller set of people than option 1), it is option 1 that is logically more likely to be true.
The Linda problem is an example of a question that should prompt us to think in terms of sheer numerical probability. The logical approach would be to consider which set (1 or 2) it would be statistically more likely for any given descriptive example to be drawn from. But this is not how we humans – psychologically healthy or otherwise – tend to think, as demonstrated by this problem and many other examples from Kahneman’s joint programme of research with Amos Tversky.
So the idea that you could reasonably distinguish psychotic individuals from non-psychotic in terms of rationality doesn’t hold. If anything, there’s evidence that people with a propensity toward delusions might be better at engaging in logical thinking than those without. Consider a 2007 study in which a team at the Institute of Psychiatry in London presented three-part arguments to delusion-prone volunteers diagnosed with schizophrenia and to healthy controls. They asked all the volunteers to judge if the arguments’ conclusions were logical or not. Some of the arguments created a conflict between purely logical reasoning and common sense by putting flatly nonsensical information into the structure of a valid logical argument, such as: ‘All buildings speak loudly; a hospital does not speak loudly; therefore, a hospital is not a building.’ If you know anything about hospitals and buildings, you know the conclusion to be factually untrue, but if you ignore the veracity of the premise statements, the conclusion is logically accurate. In the study, it was actually the volunteers with a diagnosis of schizophrenia who were better able to ignore the content and appraise the logical validity of the arguments than were the healthy controls, thus speaking against failure of logic as a cause of delusions.
More recently, researchers have adopted a new angle on the illogical reasoning explanation for delusions, proposing that they could be driven by a specific reasoning bias that the British psychologist Richard Bentall in Madness Explained (2003) describes as ‘epistemological impulsivity’ or jumping to conclusions. In the classic demonstration of this bias, volunteers are shown two jars with different proportions of red and blue beads – one has far more red, the other has far more blue. The jars are hidden and then beads from just one jar are taken out one at a time and shown to the volunteers. Their task is to judge which jar the beads are coming from – the predominantly red-bead jar or the predominantly blue-bead jar. People with delusional beliefs typically make hastier judgments, as if they are willing to use less evidence to form their conclusions, giving rise to the suggestion that this thinking style (the ‘jumping to conclusions bias’ or JTC bias) might contribute to a person developing unusual or delusional beliefs.
However, this idea has come in for recent criticism. Although meta analyses of all the available relevant data do corroborate a connection between the JTC bias and a propensity for delusional ideas, they don’t indicate that the former is necessary or sufficient to give rise to the latter. For instance, people with psychosis but no delusions also seem to demonstrate the JTC bias; at the same time, many non-psychotic people demonstrate the hasty reasoning style. In fact, a team at New York State Psychiatric Institute in 2019 reported findings from a different version of the bead-jar task, suggesting that people with more severe delusions are biased to collect more evidence than those with less severe delusions.