Marks of irrationality

published in 2002 in S. Clarke and T. Lyons (eds.) Recent Themes in the Philosophy of Science, Springer

In this paper my suggestion will be that a belief system affected by delusions is irrational primarily because delusional beliefs resist revision in circumstances in which  they conflict with other beliefs in the system and independent evidence against them becomes available.

Inconsistency and interpretation

published in Philosophical Explorations in 2003

In this paper my purpose is to examine whether the case of inconsistent believers can offer a reason to object to theories of belief ascription that rely on a rationality constraint. I shall first illustrate how the possibility of inconsistent believers might be a challenge for the rationality constraint and then assess Davidson's influential reply to that challenge.

Can we interpret irrational behavior?

published in Behavior and Philosophy in 2004

According to some theories of interpretation, it is difficult to explain and predict irrational behavior in intentional terms because irrational behavior does not support the ascription of intentional states with determinate content. In this paper I challenge this claim by offering a general diagnosis of those cases in which behavior, rational or not, resists interpretation. I argue that indeterminacy of ascription and paralysis of interpretation ensue when the interpreter lacks relevant information about the system to be interpreted and about the environment in which the system is embedded. Moreover, the heuristics of interpretation that guide the ascription of beliefs can be limited in scope. In the end I suggest that by giving up the idea of a necessary rationality constraint on the ascription of intentional states we can develop a new framework for a more psychologically realistic account of interpretation.

Delusions and the Background of Rationality

published in Mind & Language in 2005

I argue that some cases of delusions show the inadequacy of those theories of interpretation that rely on a necessary rationality constraint on belief ascription. In particular I challenge the view that irrational beliefs can be ascribed only against a general background of rationality. Subjects affected by delusions seem to be genuine believers and their behaviour can be successfully explained in intentional terms, but they do not meet those criteria that according to Davidson (1985a) need to be met for the background of rationality to be in place

Stem cell research, personhood and sentience

co-authored with John Harris and published in Reproductive Biomedicine Online in 2005

In this paper the permissibility of stem cell research on early human embryos is defended. It is argued that, in order to have moral status, an individual must have an interest in its own wellbeing. Sentience is a prerequisite for having an interest in avoiding pain, and personhood is a prerequisite for having an interest in the continuation of one's own existence. Early human embryos are not sentient and therefore they are not recipients of direct moral consideration. Early human embryos do not satisfy the requirements for personhood, but there are arguments to the effect that they should be treated as persons nonetheless. These are the arguments from potentiality, symbolic value and the principle of human dignity. These arguments are challenged in this paper and it is claimed that they offer us no good reason to believe that early human embryos should be treated as persons.

An Ethical Framework for Stem Cell Research In the European Union

Co-authored with Louise Irving and John Harris and published in Health Care Analysis in 2005

The European Union is a nightmare from the perspective of the ethics and regulation of science. A hitherto insoluble problem has been the task of drafting ethical principles which do not founder on the radically different attitudes taken to the question of the moral status of the human embryo. Following the conclusions reached in an international project, EUROSTEM, we suggest that this problem can be solved by concentration on the scope of principles and we emphasize that European research should be funded in a way that does not discriminate between individual states and researchers in the EU. Finally, we observe that the availability of any eventual embryonic stem cell therapies will pose a dilemma for those countries and those people that have declared stem cell research to be unacceptable.

Embryos and Eagles: Symbolic Value in Research and Reproduction

co-authored with John Harris and published in Cambridge Quarterly of Healthcare Ethics in 2006

On both sides of the debate on the use of embryos in stem cell research, and in reproductive technologies more generally, rhetoric and symbolic images have been evoked to influence public opinion. Human embryos themselves are described as either “very small human beings” or “small clusters of cells.” The intentions behind the use of these phrases are clear. One description suggests that embryos are already members of our community and share with us a right to life or at least respectful treatment, whereas the other focuses on the differences between embryos and adult human beings with normal capacities, that is, their lack of sentience and of personal identity. The research on stem cells has been nicknamed “Frankenstein science” or presented as “research that could stop Parkinson disease.” Again, one description reminds us of scary science-fiction scenarios where the scientist is guilty of “playing God,” whereas the other description highlights the worth and potential benefits of the research outcomes.

Deception in psychology: moral costs and benefits of unsought self-knowledge

co-authored with Matteo Mameli and published in Accountability in Research in 2006

Is it ethically permissible to use deception in psychological experiments? We argue that, provided some requirements are satisfied, it is possible to use deceptive methods without producing significant harm to research participants and without any significant violation of their autonomy. We also argue that methodological deception is at least at the moment the only effective means by which one can acquire morally significant information about certain behavioral tendencies. Individuals in general, and research participants in particular, gain self-knowledge which can help them improve their autonomous decision-making. The community gains collective self-knowledge that, once shared, can play a role in shaping education, informing policies and in general creating a more efficient and just society.

Disability, Enhancement and the Harm -Benefit Continuum

Co-authored with John Harris and appeared in John R. Spencer & Antje Du Bois-Pedain (eds.), Freedom and Responsibility in Reproductive Choice. Hart Publishers 2006.

Suppose that you are soon to be a parent and you learn that there are some simple measures that you can take to make sure that your child will be healthy. In particular, suppose that by following the doctor’s advice, you can prevent your child from having a disability, you can make your child immune from a number of dangerous diseases and you can even enhance its future intelligence. All that is required for this to happen is that you (or your partner) comply with lifestyle and dietary requirements. Do you and your partner have any moral reasons (or moral obligations) to follow the doctor’s advice? Would it make a difference if, instead of following some simple dietary requirements, you consented to genetic engineering to make sure that your child was free from disabilities, healthy and with above average intelligence? In this paper we develop a framework for dealing with these questions and we suggest some directions the answers might take.

Moral Rights and Human Culture

published in Ethical Perspectives in 2006

In this paper I argue that there is no moral justification for the conviction that rights should be reserved to humans. In particular, I reject James Griffin’s view on the moral relevance of the cultural dimension of humanity. Drawing from the original notion of individual right introduced in the Middle Ages and the development of this notion in the eighteenth century, I emphasise that the practice of according rights is justified by the interest in safeguarding the powers of reason and autonomy that some individuals can exercise. Since we are in no position to rule out that non-humans can exercise these capacities, I conclude that rights should not be reserved to humans. This will lead to a reformulation of the reasons why so-called ‘marginal’ humans and non-human animals can be granted some basic rights. Being human is neither necessary nor sufficient for holding rights. All individuals, human or non-human, who can exercise reason and autonomy to some extent can be accorded basic rights in virtue of their having morally relevant preferences.

Animal rights, animal minds and human mindreading.

co-authored with Matteo Mameli and published in the Journal of Medical Ethics in 2006

Do non-human animals have rights? The answer to this question depends on whether animals have morally relevant mental properties. Mindreading is the human activity of ascribing mental states to other organisms. Current knowledge about the evolution and cognitive structure of mindreading indicates that human ascriptions of mental states to non-human animals are very inaccurate. The accuracy of human mindreading can be improved with the help of scientific studies of animal minds. But the scientific studies by themselves do not by themselves solve the problem of how to map psychological similarities (and differences) between humans and animals onto a distinction between morally relevant and morally irrelevant mental properties. The current limitations of human mindreading – whether scientifically aided or not – have practical consequences for the rational justification of claims about which rights (if any) non-human animals should be accorded.

Intentionality without rationality

published in Proceedings of the Aristotelian Society in 2005

It is often taken for granted in standard theories of interpretation that there cannot be intentionality without rationality. According to the background argument, a system can be interpreted as having irrational beliefs only against a general background of rationality. Starting from the widespread assumption that delusions can be reasonably described as irrational beliefs, I argue here that the background argument fails to account for their intentional description

Delimiting the concept of research: an ethical perspective

co-authored with Bert Heinrichs and published in Theoretical Medicine and Bioethics in 2007

It is important to be able to offer an account of which activities count as scientific research, given our current interest in promoting research as a means to benefit humankind and in ethically regulating it. We attempt to offer such an account, arguing that we need to consider both the procedural and functional dimensions of an activity before we can establish whether it is a genuine instance of scientific research. By placing research in a broader schema of activities, the similarities and differences between research activities and other activities become visible. It is also easier to show why some activities that do not count as research can sometimes be confused with research and why some other activities can be regarded only partially as research. Although the concept of research is important to delimit a class of activities which we might be morally obliged to promote, we observe that the class of activities which are regarded as subject to ethical regulation is not exhausted by research activities. We argue that, whether they be research or not, all the activities that are likely to affect the rights and interests of the individuals involved and impact on the rights and interests of other individuals raise ethical issues and might be in need of ethical regulation.

Large Scale Surveys for Policy Formation and Research–a Study in Inconsistency

Co-authored with Soren Holm and published in Theoretical Medicine and Bioethics in 2007

In this paper we analyse the degree to which a distinction between social science and public health research and other non-research activities can account for differences between a number of large scale social surveys performed at the national and European level. The differences we will focus on are differences in how participation is elicited and how data are used for government, research and other purposes. We will argue that the research / non-research distinction does not account for the identified differences in recruitment or use and that there are no other convincing justifications. We argue that this entails that eliciting participation by coercion or manipulation becomes very difficult to justify.

Disputes over moral status: philosophy and science in the future of bioethics

published in Health Care Analysis in 2007

Various debates in bioethics have been focused on whether non-persons, such as marginal humans or non-human animals, deserve respectful treatment. It has been argued that, where we cannot agree on whether these individuals have moral status, we might agree that they have symbolic value and ascribe to them moral value in virtue of their symbolic significance. In the paper I resist the suggestion that symbolic value is relevant to ethical disputes in which the respect for individuals with no intrinsic moral value is in conflict with the interests of individuals with intrinsic moral value. I then turn to moral status and discuss the suitability of personhood as a criterion. There some desiderata for a criterion for moral status: it should be applicable on the basis of our current scientific knowledge; it should have a solid ethical justification; and it should be in line with some of our moral intuitions and social practices. Although it highlights an important connection between the possession of some psychological properties and eligibility for moral status, the criterion of personhood does not meet the desiderata above. I suggest that all intentional systems should be credited with moral status in virtue of having preferences and interests that are relevant to their well-being.

Immortality without Boredom

Co-authored with Yujin Nagasawa and published in Ratio in 2009

In this paper we address Bernard Williams’ argument for the undesirability of immortality. Williams argues that unavoidable and pervasive boredom would characterise the immortal life of an individual with unchanging categorical desires. We resist this conclusion on the basis of the distinction between habitual and situational boredom and a psychologically realistic account of significant factors in the formation of boredom. We conclude that Williams has offered no persuasive argument for the necessity of boredom in the immortal life.

If You Did Not Care, You Would Not Notice: Recognition and Estrangement In Psychopathology

co-authored with Matthew Broome and published in Philosophy Psychiatry & Psychology in 2007

Young's paper (2007) identifies fundamental differences in the use of the concept of familiarity in the description of the experience of patients affected by the Capgras delusion and by prosopagnosia. Moreover, he suggests a way of disambiguating "familiarity" and proposes that the experience of Capgras patients is accounted for in terms of estrangement. Although we share the concern that the concept of familiarity might be used too broadly, we find his proposed solution problematic with respect to the Capgras delusion.

In this brief commentary, we address two interrelated issues. (1) Can estrangement from an object of experience be coherently distinguished from the failure of re-identification of that object? (2) Given that the delusional belief is what essentially characterizes the Capgras syndrome, can the experience of Capgras patients be accounted for independently of a reference to their delusional beliefs?

Reproductive cloning in humans and therapeutic cloning in primates: is the ethical debate catching up with the recent scientific advances?

co-authored with Silvia Camporesi and published in the Journal of Medical Ethics in 2008

After years of failure, in November 2007 primate embryonic stem cells were derived by somatic cellular nuclear transfer, also known as therapeutic cloning. The first embryo transfer for human reproductive cloning purposes was also attempted in 2006, albeit with negative results. These two events force us to think carefully about the possibility of human cloning which is now much closer to becoming a reality. In this paper we tackle this issue from two sides, first summarising what scientists have achieved so far, then discussing some of the ethical arguments in favour and against human cloning which are debated in the context of policy making and public consultation. Therapeutic cloning as a means to improve and save lives has uncontroversial moral value. As to human reproductive cloning, we consider and assess some common objections and failing to see them as conclusive. We do recognise, though, that there will be problems at the level of policy and regulation that might either impair the implementation of human reproductive cloning or make its accessibility restricted in a way that could become difficult to justify on moral grounds. We suggest using the time still available before human reproductive cloning is attempted successfully to create policies and institutions that can offer clear directives on its legitimate applications on the basis of solid arguments, coherent moral principles, and extensive public consultation.

Delusional beliefs and reason giving

co-authored with Matthew Broome and published in Philosophical Psychology in 2008

Delusions are often regarded as irrational beliefs, but their irrationality is not sufficient to explain what is pathological about them. In this paper we ask whether deluded subjects have the capacity to support the content of their delusions with reasons, that is, whether they can author their delusional states. The hypothesis that delusions are characterised by a failure of authorship, which is a dimension of self knowledge, deserves to be empirically tested because (a) it has the potential to account for the distinction between endorsing a delusion and endorsing a framework belief; (b) it contributes to a philosophical analysis of the relationship between rationality and self knowledge; and (c) it informs diagnosis and therapy in clinical psychiatry. However, authorship cannot provide a demarcation criterion between delusions and other irrational belief states.

Mental illness as mental: in defence of psychological realism

Co-authored with Matthew Broome and published in Humana.Mente in 2009

This paper argues for psychological realism in the conception of psychiatric disorders. We review the following contemporary ways of understanding the future of psychiatry: (1) psychiatric classification cannot be successfully reduced to neurobiology, and thus psychiatric disorders should not be conceived of as biological kinds; (2) psychiatric classification can be successfully reduced to neurobiology, and thus psychiatric disorders should be conceived of as biological kinds. Position (1) can lead either to instrumentalism or to eliminativism about psychiatry, depending on whether psychiatric classification is regarded as useful. Position (2), which is inspired by the growing interest in neuroscience within scientific psychiatry, leads to biological realism or essentialism. In this paper we endorse a different realist position, which we label psychological realism. Psychiatric disorders are identified and addressed on the basis of their psychological manifestations which are often described as violations of epistemic, moral or social norms. A couple of examples are proposed by reference to the pathological aspects of delusions, and the factors contributing to their formation.

'Faultless' ignorance: strengths and limitations of epistemic definitions of confabulation

Co-authored with Rochelle Cox and published in Consciousness and Cognition in 2009

There is no satisfactory account for the general phenomenon of confabulation, for the following reasons: (1) confabulation occurs in a number of pathological and non-pathological conditions; (2) impairments giving rise to confabulation are likely to have different neural bases; and (3) there is no unique theory explaining the aetiology of confabulations. An epistemic approach to defining confabulation could solve all of these issues, by focusing on the surface features of the phenomenon. However, existing epistemic accounts are unable to offer sufficient conditions for confabulation and tend to emphasise only its epistemic disadvantages. In this paper, we argue that a satisfactory epistemic account of confabulation should also acknowledge those features which are (potentially) epistemically advantageous. For example, confabulation may allow subjects to exercise some control over their own cognitive life which is instrumental to the construction or preservation of their sense of self.

Reproductive and parental autonomy: an argument for compulsory parental education

Co-authored with Daniela Cutas and published in Reproductive Biomedicine Online in 2009

In this paper we argue that society should make available reliable information about parenting to everybody from an early age. The reason why parental education is important (when offered in a comprehensive and systematic way) is that it can help young people understand better the responsibilities associated with reproduction, and the skills required for parenting. This would allow them to make more informed life-choices about reproduction and parenting, and exercise their autonomy with respect to these choices. We do not believe that parental education would constitute a limitation of individual freedom. Rather, the acquisition of relevant information about reproduction and parenting and the acquisition of self-knowledge with respect to reproductive and parenting choices can help give shape to individual life plans. We make a case for compulsory parental education on the basis of the need to respect and enhance individual reproductive and parental autonomy within a culture that presents contradictory attitudes towards reproduction and where decisions about whether to become a parent are subject to significant pressure and scrutiny.

A role for ownership and authorship in the analysis of thought insertion

co-authored with Matthew Broome and published in Phenomenology and the Cognitive Sciences in 2009

Philosophers are interested in the phenomenon of thought insertion because it challenges the common assumption that one can ascribe to oneself the thoughts that one can access first-personally. In the standard philosophical analysis of thought insertion, the subject owns the ‘inserted’ thought but lacks a sense of agency towards it. In this paper we want to provide an alternative analysis of the condition, according to which subjects typically lack both ownership and authorship of the ‘inserted’ thoughts. We argue that by appealing to a failure of ownership and authorship we can describe more accurately the phenomenology of thought insertion, and distinguish it from that of non-delusional beliefs that have not been deliberated about, and of other delusions of passivity. We can also start developing a more psychologically realistic account of the relation between intentionality, rationality and self knowledge in normal and abnormal cognition.

Epistemic Benefits of Reason Giving

published in Theory & Psychology in 2009

There is an apparent tension in current accounts of the relationship between reason giving and self knowledge. On the one hand, philosophers like Richard Moran (2001) claim that deliberation and justification can give rise to first-person authority over the attitudes that subjects form or defend on the basis of what they take to be their best reasons. On the other hand, the psychological evidence on the introspection effects and the literature on elusive reasons suggest that engaging in explicit deliberation or justification leads subjects to report attitudes that are not consistent with their previous attitudes or with their future behavior. On the basis of these findings, Tim Wilson (2002) argues that analyzing reasons compromises self knowledge. I shall defend a realistic account of the effects of reason giving which is compatible with the empirical findings on introspection and also with the claim that deliberation and justification have epistemic benefits.

Psychiatry as Cognitive Neuroscience: An Overview

with M Broome, in Broome and Bortolotti (eds.), Psychiatry as Cognitive Neuroscience: Philosophical Perspectives, Oxford University Press 2009.

We review the unifying philosophical theme of the edited volume: how is psychopathology studied scientifically within psychiatry and psychology through the paradigms of cognitive neuroscience and cognitive neuropsychiatry? Topics addressed in the edited volume include: the nature of psychiatry as a science; the compatibility of the accounts of mental illness derived from neuroscience, information-processing, and folk psychology; the nature of mental illness; the impact of contemporary methods in neuroscientific investigation, such as functional neuroimaging, neuropsychology, and neurochemistry, on psychiatry; the relationship between phenomenological accounts of mental illness and those provided by naturalistic explanations; the status of delusions and the (dis)continuity between delusions and ordinary beliefs; and the interplay between clinical and empirical findings in psychopathology and accounts of virtue and responsibility in moral psychology and ethics.

Do we have an obligation to make smarter babies?

In Takala et al. (eds.) Cutting Through the Surface: Philosophical Approaches to Bioethics, Rodopi 2009

In this paper I consider some issues concerning cognitive enhancements and the ethics of enhancing in reproduction and parenting. I argue that there are moral reasons to enhance the cognitive capacities of the children one has, or of the children one is going to have, and that these enhancements should not be seen as an alternative to pursuing important changes in society that might also improve one’s own and one’s children’s life. It has been argued that an emphasis on enhancing cognitive capacities might encourage the commodification of children. But this objection seems misplaced. The reasons why one decides to reproduce can be subject to moral approbation or condemnation, as such rea-sons might be indicators of the quality of one’s parenting and the happiness of the future persons one is committed to bringing to life. However, once the decision to reproduce is made, no further harm comes from taking as few risks as possible on behalf of the persons to whom one is giving life with their health, character and cognitive capacities.

The Future of Scientific Psychiatry

with M Broome, in Broome and Bortolotti (eds.), Psychiatry as Cognitive Neuroscience: Philosophical Perspectives, Oxford University Press 2009.

We offer two other examples of the way in which neurosciences, at the current stage of development, cannot do all the explanatory work in psychiatry. The first example centres on the employment of normative notions in the characterization of the manifestation of psychopathologies as deviant. The second example highlights the importance of environmental factors in the onset of psychosis. In the end, we explore some potential for future research in these areas.

Agency, Life Extension and the Meaning of Life

Published in the Monist, 2010.

Contemporary philosophers and bioethicists argue that life extension
is bad for the individual.According to the agency objection to life extension,
being constrained as an agent adds to the meaningfulness of human life.
Life extension removes constraints, and thus it deprives life of meaning.

In the paper, I concede that constrained agency contributes to the meaningfulness of human life, but reject the agency objection to life extension in its current form. Even in an extended life, decision-making remains constrained, and many obstacles to the fulfilment of an agent’s goals are preserved. Agents with longer lives are also presented with new challenges: for instance, it might be harder for them to avoid chronic boredom, and sustain their motivation to act in the pursuit of their goals.

Although objections from agency and boredom are often used in combination to support the view that a much longer life is likely to bring misery or become meaningless, I argue that the acceptance of the boredom objection undermines the persuasiveness of the agency objection.

Endeavour Bulletin issue 12, Jan 2010, pages 3-4.

Report on research activities as Endeavour Research Fellow in 2008-2009

Entry on Delusion

In the Stanford Encyclopedia of Philosophy

What's wrong with 'mental' disorders?

Commentary on D Stein et al.'s “What is a Mental/Psychiatric Disorder? From DSM-IV to DSM-V”. Co-authored with MR Broome and published in Psychological Medicine, 2010

Can the subject-of-a-life criterion help grant rights to non-persons?

Published in 2010 in Hayry et al. (eds.) Argument and Analysis in Bioethics (Rodopi), 241-248.

In this paper I compare different criteria for moral status, and assess Regan's notion of a "subject of a life".

The Concept of Scientific Research

In Romeo Casabona (ed.) "Los nuevos horizontes de la investigación genética", Camares 2011

It is a commonly accepted view that research on humans should be ethically regulated. What is it about scientific research that requires special ethical consideration? In order to answer this question, in the paper I shall suggest that we should agree on a delimitation for the concept of scientific research, a sort of demarcation criterion that can be applied successfully in those cases in which we are in doubt as to whether a human activity satisfies the conditions for scientific research. Apart from the pressing ethical issues, I believe it is important to be able to offer an account of which activities count as scientific research, given the interest that society has in promoting legitimate research programmes as a means to benefit all citizens.

My suggestion, developed together with Bert Heinrichs as part of the European project EURECA, is that we need to consider both the procedural and functional dimensions of an activity before we can establish whether it is a genuine instance of scientific research. By placing research in a broader schema of activities, the similarities and differences between research activities and other activities become visible and it is easier to show why some activities that do not count as research can sometimes be confused with research (e.g. astrology and creationism) and some other activities can be regarded only partially as research (e.g. experimental therapy or work conducted as part of a Master dissertation). Although the concept of research is important to delimitate a class of activities which we might be morally obliged to promote, it is neither necessary nor sufficient for a human activity to be a genuine instance of scientific research in order to be subject to ethical regulation. I shall argue that all those activities that are likely to affect the rights and interests of sentient individuals and persons, whether they be research or not, raise ethical issues and might be in need of ethical regulation.

Natural versus Assisted Reproduction. In Search of Fairness.

co-authored with Daniela Cutas and published in Studies in Ethics, Law and Technology, 2010

Whilst the choice of becoming a parent in the natural way is unregulated all over Europe (and proposals of regulation raise vehement objections), most European countries have (either legal or professional) regulations imposing criteria that people must satisfy if they wish to gain access to assisted reproduction and parenting. These criteria may include relationship status, age, sexual orientation, financial stability, health, and willingness to attend parenting classes. The existence of regulations in this area is largely accepted, and the objections raised usually concern the suitability of specific criteria rather than the legitimacy of imposing criteria at all. The inequality (if unsupported) could be solved by requiring both prospective natural and assisted parents to satisfy the same criteria (with some qualifications specified below) and, more importantly, to be subject to the same degree of monitoring, regardless of the way in which they became parents. 

Often people argue that proposals to regulate natural reproduction revive dreaded eugenic policies of the past, and that their implementation would violate some of our most cherished interests and rights: in particular the interest in becoming a parent and the right to reproduction and parenting. However, the same interests and rights are not equally safeguarded when one needs assistance to become a parent, and proposals to reduce the extent to which prospective parents requiring assistance are scrutinized are unpopular.

In this paper we challenge the alleged justification of the current practices, and we show that there are serious inconsistencies in the treatment of, respectively, people who become parents naturally and people who require assistance to become parents. Thus, we propose that regulation of reproduction and parenting be revised in such a way as to eliminate the inconsistencies.

Moral responsibility and mental illness: a case study

Co-authored with Matthew R Broome and Matteo Mameli, published in the Cambridge Quarterly of Healthcare Ethics in 2010

It is far too early to say what global impact the neurocognitive and neuropsychiatric sciences will have on our intuitions about moral responsibility. And it is far too early to say whether the notion of moral responsibility will survive this impact (and if so, in what form). But it is certainly worth starting to think about the local impact that these sciences can or should have on some of our distinctions and criteria. It might be possible to use some of the tools offered by these sciences in order to refine or revise some of the categories currently used, without – for the time being at least – worrying too much about the fate of the notion of moral responsibility. This is an area where a piecemeal approach might be more productive: only after an evaluation of many distinct cases and situations it will be possible to say something general about the current notion of moral responsibility.
In this article, we will focus on a single clinical case: a young man who has been convicted for assault on a neighbour and whose sentence was affected by a pre-existing diagnosis of mental illness. We will use this case, and an analysis of the similarities and differences between this case and other possible cases, in order to raise some (local but important) issues about the implications that discoveries in neuropsychology and neuropsychiatry can have for the way moral responsibility is attributed to agents and, more specifically, to agents with diagnoses of mental illnesses.

Epistemic rationality and the definition of delusions

PhilSci Archive - paper presented at EPSA 2009.

According to one argument for the anti-doxastic conception of delusions, delusions are not beliefs because they are not responsive to evidence and responsiveness to evidence is a constitutive feature of belief states. In this paper, I concede that delusions are not responsive to evidence, but I challenge the other premise of this anti-doxastic argument, namely, that responsiveness to evidence is a constitutive feature of belief states. In order to undermine the premise, I describe instances of non-pathological beliefs that strenuously resist counterevidence. I conclude that considerations about responsiveness to evidence do not necessarily lead us to deny that delusions are beliefs. On the contrary, they seem to support the view that there is continuity between delusions and non-pathological beliefs.

Intentionality and the Welfare of Minded Nonhumans

co-authored with A Blasimme and published in a special issue of Teorema on animal minds in 2010

In this paper we discuss the conditions for the possession of intentional states (especially beliefs) and for intentional agency. We then explore the implications of an analysis of intentionality in non-human animals for their entitlement to ethical treatment, and review the potential advantages and epistemological difficulties of relying on the scientific study of animal mindedness to draw ethical conclusions. In the end, we argue that ethical debates on the treatment of animals, and in particular considerations about welfare, can benefit considerably from the enterprise of exploring the extent to which non-human animals are minded.

Double Bookkeeping in Delusions: Explaining the Gap between Saying and Doing

in K. Frankish, A. Buckareff and J. Aguilar (eds) New Waves in the Philosophy of Action, Palgrave, 2010.

Delusions are usually regarded as irrational belief like states that are symptoms of a variety of psychiatric disorders, among which schizophrenia, dementia and delusional disorders. The doxastic account of delusions is the view that delusions are genuine instances of belief. One powerful objection to the doxastic account is that delusions are not beliefs because, differently from beliefs, they do not lead to action in the relevant circumstances. For instance, people with schizophrenic delusions may fail to manifest commitment to the content of their delusions either verbally or behaviourally. They may endorse attitudes that conflict with their delusions, provide bad reasons or no reasons at all for endorsing their delusions or fail to act on their delusions. This is also known in the literature as the phenomenon of ‘double bookkeeping’.

In this chapter, I shall defend the doxastic account of delusions by arguing that people may fail to act on their delusions even if they genuinely believe the content of their delusions. I shall attempt to explain the gap between reporting a state with apparent conviction and behaving in a way that is not consistent with the report by appealing to two kinds of considerations. First, as people with delusions are not perfectly rational agents, they suffer from attitude-behaviour inconsistencies. Second, people with delusions may fail to acquire or to maintain the motivation to act on their beliefs. Both explanations of the gap between saying and doing apply not just to delusional states, but to belief states more generally, although in people with delusions rationality of beliefs and motivation to act may be compromised to a greater extent than in people without.

Psychiatric classification and diagnosis. Delusions and confabulations

Published in Paradigmi in 2011

In psychiatry some disorders of cognition are distinguished from instances of normal cognitive functioning and from other disorders in virtue of their surface features rather than in virtue of the underlying mechanisms responsible for their occurrence. Aetiological considerations often cannot play a significant classificatory and diagnostic role, because there is no sufficient knowledge or consensus about the causal history of many psychiatric disorders. Moreover, it is not always possible to uniquely identify a pathological behaviour as the symptom of a certain disorder, as disorders that are likely to differ both in their causal histories and in their overall manifestations may give rise to very similar patterns of behaviour.

Consider delusions as an example. It wouldn’t be correct to define delusions as those beliefs people form as a result of a neurobiological deficit and a hypothesis-evaluation deficit (as some versions of the two-factor theory of delusions suggest), because for some delusions no neurobiological deficit may be found, and reasoning biases and motivational factors may be contributors to the formation of the delusion (e.g. McKay et al., 2005). Moreover, it would be a mistake to define delusions as symptoms of schizophrenia alone, because they occur also in other disorders, including dementia, amnesia, and delusional disorders. Thus, aetiological considerations may appear in the description and analysis of delusions, but do not feature prominently in their definition.

In this paper I argue that the surface features used as criteria for the classification and diagnosis of disorders of cognition are often epistemic in character. I shall offer two examples: confabulations and delusions are defined as beliefs or narratives that fail to meet standards of accuracy and justification. Although classifications and diagnoses based on features of people’s observable behaviour are necessary at these early stages of neuropsychiatric research, given the variety of conditions in which certain phenomena appear, I shall attempt to show that current epistemic accounts of confabulations and delusions have limitations. Epistemic criteria can guide both research and clinical practice, but fail to provide sufficient conditions for the identification of delusions and confabulations, and fail to demarcate pathological from non-pathological narratives or beliefs.

Another limitation of current epistemic accounts – which I shall not address here – is the excessive focus on epistemic faults of confabulations and delusions at the expense of their epistemically neutral or advantageous features (see Bortolotti and Cox, 2009). This may lead to a misconception of delusions and confabulations, and to an oversimplification in the assessment of the needs of people who require clinical treatment for their psychotic symptoms.

In section 1, I shall introduce epistemic definitions of delusions and confabulations. In section 2, I shall detail three ways in which delusions and confabulations infringe norms of rationality for beliefs. In section 3, I shall ask whether the pathological character of delusions and confabulations can be cashed out in terms of their epistemic faults. I shall conclude that it cannot, because even if delusions and confabulations are irrational, most non-pathological beliefs are also irrational, maybe to a lesser extent, but in qualitatively similar ways. In order to make this point, I shall show how the conditions listed in current epistemic definitions are not sufficient to distinguish clinical cases of delusions and confabulations from beliefs and behaviours that are common in the general population and are not necessarily associated with any psychiatric disorder.

Can we recreate delusions in the laboratory?

Co-authored with R Cox and A Barnier and forthcoming in Philosophical Psychology

Clinical delusions are difficult to investigate in the laboratory because they co-occur with other symptoms and with intellectual impairment. Partly for these reasons, researchers have recently begun to use hypnosis with neurologically intact people in order to model clinical delusions. In this paper we describe striking analogies between the behaviour of patients with a clinical delusion of mirrored self misidentification and the behaviour of highly hypnotisable subjects who receive a hypnotic suggestion to see a stranger when they look in the mirror.

Based on these analogies, we argue that the use of hypnosis is a reliable method to investigate the surface features of clinical delusions. But to what extent can hypnosis successfully recreate delusions? Can it also contribute to a better understanding of delusion formation? Although clinical delusions and hypnotically induced beliefs are different in aetiology, some analogies can be identified in the underlying processes that characterise them, based on the two-factor theory of delusion formation.

Introduction: Conceptual challenges in the characterisation and explanation of psychiatric phenomena

Co-authored with Luca Malatesti and published in the European Journal of Analytic Philosophy in 2010

Rationality and self-knowledge in delusions and confabulations: implications for autonomy as self-governance

co-authored with R Cox, M Broome, M Mameli, and to appear in L. Radoilska (ed.) "Autonomy and Mental Health", OUP

The main purpose of this paper is to explore the implications of the epistemic faults of delusions and confabulations for the autonomy of the people affected by these conditions. The issue whether autonomy is compromised and to what extent is of great practical relevance. Do people affected by psychiatric disorders that manifest with delusions and confabulations have capacity to consent to treatment? More generally, should they be allowed to make, and deemed responsible for, significant decisions that affect their well-being?

We propose to look at autonomy as self-governance and to make a distinction between (a) whether one has the capacity to govern oneself and (b) whether one is successful at governing oneself. We argue that the capacity for self-governance depends on the capacity to develop a self-narrative which encompasses the capacity to endorse attitudes and actions on the basis of reasons. Success in self-governance depends on the coherence of self-narratives and on their correspondence to real life events.

Our thesis is that, in most cases, people with delusions or confabulations have the capacity for self-governance, but are unlikely to be successful at governing themselves. This is because they are likely to demonstrate failures of rationality and self-knowledge that impact on the coherence of their self-narratives and the correspondence between these narratives and real life events. Although in some cases the very capacity for self-governance may be compromised (e.g., in ‘primary’ delusions where no reasons are offered in support of the delusion or in delusions and confabulations which occur at advanced stages of dementia) our claim is that having delusions and confabulations does not necessarily imply a lack of capacity for self-governance. That said, delusions and confabulations interfere with the exercise of self-governance.

Shaking the bedrock

Continuing commentary published in Philosophy, Psychiatry, & Psychology in 2011

In this paper I articulate the thesis that most delusional beliefs are continuous with other irrational beliefs. Any interpreter with some knowledge about the cognitive and affective life of subjects with delusions can at least partially understand their reports, and explain and predict their behavior in intentional terms. I identify similarities and differences between this approach to the nature of delusions and the approach adopted by Rhodes and Gipps, who have recently defended the view that people with delusions do not share the same bedrock beliefs as people without (the Background Theory of Delusions).

Sentience, the Moral Significance of

Forthcoming, and co-authored with Matteo Mameli and Alessandro Blasimme

Entry for the International Encyclopedia of Ethics edited by Hugh LaFollette for Blackwell.

Neuroscience, continua and the prodromal phase of psychosis.

Co-authored with M Broome, J Dale, C Marriott, C Merino. In Borgwardt, Fusar-Poli and McGuire (eds.) Vulnerability to Psychosis: from Neurosciences to Psychopathology, Psychology Press.

Our focus in this paper is to address some of the challenges that arise when a purely neuroscientific conception of the prodromal phase of psychosis is considered.

Affective Dimensions of the Phenomenon of Double Bookkeeping in Delusions

Co-authored with M. R. Broome and to appear in Emotion Review

It has been argued that schizophrenic delusions are ‘behaviourally inert’. This is evidence for the phenomenon of ‘double bookkeeping’, according to which people are not consistent in their commitment to the content of their delusions. The traditional explanation for the phenomenon is that people do not genuinely believe the content of their delusions. In the paper, we resist the traditional explanation and offer an alternative hypothesis: people with delusions often fail to acquire or to maintain the motivation to act on their delusional beliefs. This may be due to avolition, to emotional disturbances, or to the fact that, given the peculiar content of some delusions, the surrounding environment does not support the agent’s motivation to act.

With Power Comes Vulnerability

Co-authored with Constantine Sandis and Alessandro Blasimme, forthcoming.

The psychological approach and the vulnerability approach to animal ethics are thought to be competing frameworks and to generate independent arguments for or against current human practices involving non-human animals. The two approaches are rarely combined and it is even maintained that they have different areas of application. In this paper we argue that, at least within the debate on the treatment of non-human animals, the two approaches should not be seen as competitors. First, we maintain that whether non-human animals are minded is relevant both to whether they have moral status or moral rights and to whether they are vulnerable in some morally relevant respects and thus are the appropriate object of moral solicitude. Second, we defend the view that the possession of even the most sophisticated of psychological capacities does not rule out vulnerability. On the contrary, the possession of certain psychological capacities can increase an individual’s vulnerabilities to certain forms of harm.

Self-deception, delusion and the boundaries of folk psychology

Submitted to HumanaMente. Co-authored with M Mameli.

To what extent do self-deception and delusion overlap? In this paper we argue that both self-deception and delusions can be understood in folk-psychological terms. ‘Motivated’ delusions, just like self-deception, can be described as beliefs driven by personal interests. If self-deception can be understood folk-psychologically because of its motivational component, so can motivated delusions. Non-motivated delusions also fit (to a large extent) the folk-psychological notion of belief, since they can be described as hypotheses one endorses when attempting to make sense of unusual and powerful experiences. We suggest that there is continuity between the epistemic irrationality manifested in self-deception and in delusion.

The right not to know: the case of psychiatric disorders

Co-authored with H Widdows - published in 2011 in the Journal of Medical Ethics

This paper will consider the right not to know in the context of psychiatric disorders. It will outline the arguments for and against acquiring knowledge about the results of genetic testing for conditions such as breast cancer and Huntington’s disease, and examine whether similar considerations apply to disclosing to clients the results of genetic testing for psychiatric disorders such as depression and Alzheimer’s disease. The right not to know will also be examined in the context of the diagnosis of psychiatric disorders which are associated with stigma or for which there is no effective treatment.

Is the choice not to know compatible with the exercise of autonomy?

In preparation

Can the principle of respect for personal autonomy be the foundation of the right not to know in medical ethics? According to the incoherence objection, the right not to know information that is made available via genetic testing cannot be justified on the basis of the principle of respect for personal autonomy, because not knowing undermines the exercise of autonomy. To assess this objection, I distinguish two aspects of autonomy and compare knowledge of one’s genetic information with the discovery of one’s biases in deliberation. I conclude that the incoherence objection in its present form fails. Although there is tension between not knowing one’s biases in deliberation and choosing autonomously, there seems to be no obvious tension between not knowing information about oneself that is made available via genetic testing and choosing autonomously.

Rationality and Sanity: The role of rationality judgements in understanding psychiatric disorders

In preparation

Here my main objective is to examine the role of judgements of rationality in the current understanding of psychiatric disorders. The relationship between rationality and sanity was an important theme in the anti-psychiatry literature but remains a timely question today, due to the need to update and revise the criteria for the classification and diagnosis of psychiatric disorders. To what extent are such criteria independent of judgements of rationality? The typical symptoms of many psychiatric disorders are described as instances of epistemic, procedural or emotional irrationality, and references to such forms of irrationality are frequently made in the current classificatory and diagnostic criteria for schizophrenia, dementia, depression, and personality disorders. That said, I shall defend the view that irrationality is neither necessary nor sufficient for a behaviour to be characterised as symptomatic of a psychiatric disorder.

Does reflection lead to wise choices?

Published in Philosophical Explorations in 2011

Does conscious reflection lead to good decision making? Whereas engaging in reflection is traditionally thought to be the best way to make wise choices, recent psychological evidence undermines the role of reflection in lay and expert judgement. The literature suggests that thinking about reasons does not improve the choices people make, and that experts do not engage in reflection, but base their judgements on intuition, often shaped by extensive previous experience. Can we square the traditional accounts of wisdom with the results of these empirical studies? Should we even attempt to? I shall defend the view that philosophy and the cognitive sciences genuinely interact in tackling questions such as whether reflection leads to making wise choices.

In Defence of Modest Doxasticism about Delusions

published in Neuroethics in 2011

Here I reply to the main points raised by the commentators on the arguments put forward in my "Delusions and Other Irrational Beliefs" (OUP, 2009). My response is aimed at defending a modest doxastic account of clinical delusions, and is articulated in three sections. First, I consider the view that delusions are in-between perceptual and doxastic states, defended by Jacob Hohwy and Vivek Rajan, and the view that delusions are failed attempts at believing or not-quite-beliefs, proposed by Eric Schwitzgebel and Maura Tumulty. Then, I address the relationship between the doxastic account of delusions and the role, nature, and prospects of folk psychology, which is discussed by Dominic Murphy, Keith Frankish, and Maura Tumulty in their contributions. In the final remarks, I turn to the continuity thesis and suggest that, although there are important differences between clinical delusions and non-pathological beliefs, these differences cannot be characterised satisfactorily in epistemic terms.

Précis of Delusions and Other Irrational Beliefs

published in Neuroethics in 2011