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Intensity of Experience: Maher’s Theory of Schizophrenic Delusion Revisited

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Abstract

Maher proposed in 1974 that schizophrenic delusions are hypotheses formed to explain anomalous experiences. He stated that they are “rational, given the intensity of the experiences that they are developed to explain.” Two-factor theorists of delusion criticized Maher’s theory because 1) it does not explain why some patients with anomalous experiences do not develop delusions, and 2) adopting and adhering to delusional hypotheses is irrational, considering the totality of experiences and patients’ other beliefs. In this paper, the notion of the intensity of experience is reappraised to uphold Maher’s basic conception. Regarding 1), I propose that differences in the intensity of anomalous experience are vital to whether the patient forms delusions, while partially reforming his rationality claim regarding 2). Although adopting delusions is irrational, it is inevitable and excusable, given the intensity of the patient’s anomalous experience. With the aid of this notion, it is maintained that anomalous experience is sufficient for the development of delusions, at least in some cases of schizophrenia. Compared to other theories of schizophrenic delusion, Maher’s theory, which embraces the notion of intensity of experience, better explains why such irrational mental states as delusions develop from anomalous experiences, and why delusional patients persist in believing specific thematic content.

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Notes

  1. In this respect, bimagination is similar to the logical connective “TONK,” coined by Prior, whose introduction rule is that of OR and whose elimination rule is that of AND [13]. The introduction of von Domarus’ paralogical inference, bimagination, or TONK are not the “conservative extension” of one’s inferential system. They destroy the system because any proposition becomes deducible by introducing these inferential rules [14].

  2. Bortolotti proposed that some delusions are “epistemically innocent” because adopting them is 1) epistemically beneficial for patients, and 2) the benefit could not be attained without adopting the delusions [27]. My contention that the irrationality of delusional patients is inevitable and excusable is somewhat comparable to her position. However, there is also a difference. As Bortolotti mentioned, the notion of epistemic innocence is relevant both to a justification defense and an excuse defense in the legal system, such that condition 1) justifies the delusion, whereas condition 2) excuses the delusion ([27], p. 495). In contrast, I emphasize excuse more than justification. Just as a proscribed act is excused if the defendant acted under duress, delusional patients’ irrationality is excused if resulted from intense anomalous experiences.

  3. Comparing Coltheart and colleagues’ description of the delusion formation process and the one proposed here may be helpful. I distinguish the hypothesis formation and hypothesis evaluation stages in the delusion formation process. Coltheart and colleagues’ framework does not include the hypothesis formation stage, because a Bayesian account “says nothing about where hypotheses come from.” ([31] p. 274). In contrast, they make a finer distinction within what I broadly call the hypothesis evaluation stage. They contend that initial adoption of a delusional belief is “a perfectly rational response to very abnormal data” ([31], p. 281), and maintain that delusional subjects depart from rationality when they fail to update the once-adopted belief. They assume that the second factor affects the ability to update the belief on the basis of new evidence. I can agree with their explanation. The crucial point is that Coltheart and colleagues’ conception accords with mine in that both assume that the irrationality of delusion resides in their hypothesis evaluation stage, broadly conceived.

  4. See [50] for details. It should be noted that the chief goal of cognitive behavioral therapy regarding delusions is not always to guide patients to disavow their delusions, but to lessen their preoccupation with, and alleviate distress caused by, these delusions. Considering this aim, therapists sometimes need to work “within the delusion” ([50], p. 201).

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Acknowledgements

I have no funding to declare. I thank Philip Gerrans and Kengo Miyazono, who read an early manuscript and provided detailed and enlightening comments. I wish also to thank Rachel Gunn, John O’Dea, Yukihiro Nobuhara, Shigenori Tadokoro, Takeshi Kanasugi, and Masanori Kataoka for helpful feedback in workshops at which I presented an early manuscript. I also deeply appreciate the constructive comments by anonymous reviewers.

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  1. Department of Neuropsychiatry, The University of Tokyo Hospital, 7-3-1, Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan

    Eisuke Sakakibara

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Sakakibara, E. Intensity of Experience: Maher’s Theory of Schizophrenic Delusion Revisited. Neuroethics 12, 171–182 (2019). https://doi.org/10.1007/s12152-018-9385-4

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