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The Ontology of the Psychoses
By: Hane Htut Maung

As I was drifting off to sleep one evening, a strange man appeared before me, saying that he wished to talk about matters of psychiatry. From the ethereal nature of this occurrence, I knew that he was a hallucination. Nevertheless, glad to be entertained, I allowed myself to enter into discussion with him. HM refers to myself, Hane Maung, and MH to My Hallucination.

Delusions

HM: I must be developing a psychosis.

MH: What do you mean by that, a psychosis?

HM: Well, a psychosis is characterised by the presence of delusions and hallucinations, and here I am, not only having a vivid hallucination, but allowing myself to enter into discussion with it.

MH: Very good. So we’re agreed on that. Now, let us explore the nature of delusions and hallucinations. Tell me, my friend, what is a delusion?

HM: In common usage, a delusion is a fixed false belief.

MH: A concise answer, my friend. Although, I cannot yet tell how sound it is. So, let us examine what you are saying, that a delusion is a fixed false belief. Is that what you said?

HM: It was.

MH: So, for a person to have a delusion is for them to hold persistently onto a belief that is false?

HM: Yes.

MH: But what of beliefs that are true? Can they not be delusions?

HM: I don’t follow. Can you give an example?

MH: Indeed. Let us first consider your belief that you are a man. That belief is true, is it not?

HM: It is.

MH: And is it a delusion?

HM: No, it is not a delusion.

MH: Good. Now, let us assume that you believe you are a man, and that your reason is that it is a Tuesday, and every Tuesday you become a man. Would you consider this a delusion?

HM: Yes, I would consider this a delusion.

MH: But is not the belief true, that you are a man?

HM: Yes, it is.

MH: So, my friend, it appears that we have a delusion that is a true belief, do we not?

HM: It appears that we do.

MH: But, what makes this a delusion, if it is not the truth-value of the belief?

HM: It would have to be the reasoning behind the belief. To reason that I am a man because it is a Tuesday is outrageous.

MH: Excellent. So, if the reasoning were sound, it would not be delusion?

HM: No, it would not be.

MH: So, if you believe you are a man because you are human, male, and adult, that belief would not be a delusion?

HM: No, it would not be, because the reasoning behind the belief is sound.

MH: Very good. So, have we not showed that it is not the truth-value, but the soundness of the reasoning behind a belief which determines whether or not the belief is a delusion?

HM: Well, we have established that true beliefs can be delusions, but are there any examples of any fixed false beliefs that are not delusions, or are all fixed false beliefs delusional?

MH: An excellent question, my friend. Let us attempt to answer it. If it is the soundness of the reasoning behind a belief which determines whether or not the belief is a delusion, what would be the nature of a non-delusional false belief, if there is such a thing?

HM: It would be a false belief which has sound reasoning behind it.

MH: Good. So, let us consider a hypothetical case of a zoologist. I understand, my friend, that you have some knowledge of herpetology. Am I correct?

HM: I know a little, yes.

MH: How much do you know about constrictors? Do you know any differences between boas and pythons, for example?

HM: Well, for one, boas are viviparous, whereas pythons are oviparous.

MH: That’s a fine example. Let us use it. Imagine that a zoologist discovers a new species of constrictor. She takes the specimen to her lab, where she observes it laying eggs. Based on her observations of the snake as an oviparous constrictor, she concludes that it is a python. Is this reasoning sound?

HM: It seems reasonable to me.

MH: Good. Now, unknown to her, a different zoologist performs various genetic tests on the specimen, and discovers that it is, in fact, an unusual type of oviparous boa. However, the first zoologist remains completely unaware of this discovery, and continues to believe that the specimen is a python. In light of the new evidence, this belief is false. But, would you consider this belief to be a delusion?

HM: No, I suppose I wouldn’t.

MH: And why not?

HM: The reasoning behind it is sound.

MH: So, would you agree that we have found examples of a true belief that is a delusion and a fixed false belief that is not?

HM: Yes, I would agree.

MH: Excellent. So, are we agreed that the truth-value of a belief plays no rôle in determining whether or not the belief is a delusion?

HM: Yes, we are.

MH: Now, we decided that it is the soundness of the reasoning behind a belief that determines whether or not the belief is a delusion, did we not?

HM: Yes, and well decided.

MH: But, what determines whether or not the reasoning is sound? Do not different people agree on different criteria for soundness of reason?

HM: I suppose so, across cultures and throughout history. Not only do definitions differ across cultures, but so do methods of justification and the explanations appealed to. Also, scientific paradigms are always changing. For example, the phlogiston theory would have been considered a good explanation for combustible bodies in the 18th century, whereas now it is considered obsolete.

MH: So, what implications does this have on the process of determining whether or not a belief is delusional, or, in other words, whether or not the reasoning behind the belief is sound?

HM: One must take into consideration the cultural context in which the belief is expressed. If a person from a foreign culture held a belief, and gave reasoning for this belief in a way that seemed peculiar in our culture, but was considered sound in his, then one ought not to label his belief as delusional.

MH: Well said, my friend. So, having considered this, tell me, what is a delusion?

HM: Having considered what we have been discussing, a delusion is a belief whose reasoning is unsound according to the standards of the culture in which it is expressed. The truth-value of the belief is irrelevant.

Hallucinations

MH: Now, let us turn our attention to hallucinations. Tell me, my friend, what is an hallucination?

HM: In common usage, an hallucination is a perception of something which is not real.

MH: How very kind of you to say! Naturally, I must challenge your answer. Tell me, how do you know that your hands are real?

HM: Well, quite simply, I experience them. Through my senses, I acquire a perception of them.

MH: But do you not experience me? Have you not acquired a perception of me?

HM: I do experience you, but I question whether you have any substance in the world outside my experience. While I am convinced that my hands have an objective reality, I doubt whether you do.

MH: Tell me though, how can you be so sure of the objective reality of your hands? Do you access directly this objective reality, or do you only access your experiences?

HM: Well, if you put it that way, I only access my experiences. But, I take my experiences to be experiences of this objective reality.

MH: In which case, since I am part of your experiences, and your experiences are experiences of an objective reality, it follows that I am also part of this objective reality, does it not?

HM: By that argument, it would seem so. However, please allow me to backtrack. I suspect that I have made a mistake.

MH: Please do.

HM: Well, I previously stated that I am convinced that my hands have an objective reality, because I experience them, and I take my experiences to be experiences of an objective reality. However, perhaps it is not only my experiences that matter. Others too will confirm their experiences of my hands, and so that provides evidence that they are real. I have no direct access to any underlying objective reality, but I take my experiences to be real if they do not conflict with the experiences of others.

MH: So you’re suggesting that reality is intersubjective?

HM: Yes, it would appear that I am.

MH: I see. So imagine, for example, that you, while under the influence of a psychoactive drug, experience the frightening illusion that one of your friends is metamorphosing into a giant rodent. Now, others present at the time, including your friend, sincerely deny that this is happening. Would you say that your illusion is not real?

HM: Absolutely. I would say that it is not real.

MH: Fine. Now, my friend, having considered what we established earlier that you have no direct access to any objective reality, but only to your experiences, tell me, why would you say that this illusion is not real?

HM: Well, it conflicts with the experiences of others, and also with my own past experiences of how the world works.

MH: Good. Now, how about hallucinations that do not conflict with the experiences of others?

HM: I’m sorry. I don’t follow. Can you give an example?

MH: Yes. First, remind me what it was, in the hypothetical example we have just considered, that convinced you that your experience of your friend was not real?

HM: It conflicted with the experiences of others present at the time.

MH: So, what conditions must be met for your experiences to conflict with those of others?

HM: Well, we must all be experiencing the same event, and my experience of the event must be incompatible with others’ experiences of it.

MH: In other words, the event must be one that is commonly accessible to your experience and to the experiences of others. That is to say, it must be an event in what you call this material world that you and others all experience.

HM: Yes, I would agree with that.

MH: But, what about events that are not accessible to others?

HM: I’m sorry. I still don’t follow.

MH: Allow me to give another example. Consider the mystic, who, upon entering a trance, has the experience of other-worldly spirits. He does not experience these spirits as part of this material world we commonly experience. They do not inhabit our space or influence our dynamics. Rather, he experiences them as part of a different non-material world. Considering this, are his experiences real?

HM: Of course not. These spirits are hallucinations. They have no substance in the world outside his experience.

MH: But, didn’t we establish before that you have no direct access to any sort of world outside experience, and that your only knowledge of reality is your experience and whether it conflicts with those of others?

HM: I do apologise. I am tired. Yes, we did establish that.

MH: That is fine. It is late. Would you like to continue?

HM: Yes, please let us continue.

MH: And so we shall. Now, are the mystic’s experiences in conflict with the experiences of others?

HM: Well, no, because they are not experiences of events in the material world that other people commonly experience.

MH: So, the mystic is experiencing these other-worldly spirits, and his experiences are not in conflict with the experiences of others. Is that what we have established?

HM: Yes, it is.

MH: And so, are the spirits he experiences real?

HM: By our criteria, yes. But, I am still hesitant. What sort of reality can they have, if not in what we commonly refer to as the material world?

MH: Well, have we not established that your assumption of the reality of the material world is based on your experience of it and its relation to the experiences of others?

HM: Yes, we have.

MH: Tell me then, does it not follow that one’s experience of another world can form the basis for assuming some kind of reality of that world?

HM: I suppose so.

MH: And so, can we not say that these spirits experienced by the mystic are real, not in what you call the material world, but in another world, that is to say a phantasy realm?

HM: Yes, I can accept that.

MH: And, can you not say that I too have a real existence as a being, not in what you call the material world, but also in some kind of phantasy realm?

HM: Yes, I will acknowledge that as well. However, I do have another issue I would like to raise. Another property of phenomena I consider to be real is that they have effects on me and on others. For example, I caught a cold last month. I know that the viruses were real, because they caused me unpleasant symptoms and rendered me unable to go out in the evening with my friends.

MH: Am I not having an effect on you? Have you not learned anything valuable from our discussion that will influence your attitudes?

HM: That is a very fair point. Yes, you are, indeed, having an effect.

MH: I’m glad you think so.

Psychoses

HM: Well, my friend, it is getting late now, and you did say that you wished to discuss with me matters of psychiatry. What we have been discussing has made me question the profession somewhat, so I would like to raise one of the issues before I go to sleep.

MH: Of course. Please do.

HM: If we accept that hallucinations may be real in some other realm and that some delusions may be true, are we doctors not, by treating people who have them, wrongfully oppressing truth believers?

MH: Bacteria are real, yet do you not treat those who carry them?

HM: It depends. Many bacteria are part of the normal body flora and do no harm. There would be no reason to treat someone for carrying such non-pathogenic organisms.

MH: You raise a fair point, but I was speaking of pathogenic bacteria. Do you not treat those infected?

HM: Generally speaking, we do.

MH: And why do you treat them?

HM: The infection causes them harm. Not to treat them would be to compromise their health.

MH: Good. Now, perhaps, the state of affairs is not so different with hallucinations. Let us consider a hypothetical example of two brothers, call them A and B, both of whom have frequent visions of being visited by their deceased father. Person A becomes fixated on his visions, and, as a result, he neglects to eat or wash, fails to turn up to work, and abandons his relationships. As a doctor, do you think person A should be treated for mental illness?

HM: Yes, I think there would be grounds to treat him.

MH: I agree. Now, consider that person B, by contrast, uses his visions as a productive experience. He finds peace with his father’s death, motivation to carry on with his life, and hope surrounding his own spirituality. As a doctor, do you think person B should be treated for mental illness?

HM: No, I don’t think there would be a reason to treat him.

MH: So, you’d treat person A, but not person B. Is that what you are saying?

HM: It is.

MH: Even though both are having the same hallucinations?

HM: Yes.

MH: How would you justify this decision?

HM: The effects of the hallucinations on each of the brothers are different. Person A appears to have reacted to the hallucinations in a harmful way, as evidenced by his neglect of his self-care, occupation, and social life, whereas person B appears to have reacted to the hallucinations in a healthy way, as evidenced by his finding peace, hope, and motivation to carry on with his life.

MH: Well said. Having considered this, tell me, my friend, what it is we are treating in these cases? Are you treating the hallucinations themselves?

HM: Considering that both brothers were having the same hallucinations, but there were only the grounds to treat one but not the other, it would appear that we are not treating the hallucinations themselves.

MH: So then, my friend, what are we treating in people such as person A?

HM: It would appear that we are treating the harmful effects of these phenomena on their lives.

MH: Excellent. Now, tell me, my friend, if it is the harmful effects of these phenomena we are aiming to treat, and not the hallucinations themselves, are we, as you said, trying to oppress truth believers?

HM: I suppose not.

MH: Right. Well, it is late now. I must be on my way and let you go to sleep. Thank you for the discussion.

HM: It’s my pleasure. But, excuse me for asking, where will you go when I am asleep? What happens to you when I do not see you?

MH: I don’t know. What happens to you when I do not see you?

Before I had a chance to answer, he was gone.

Article Source: http://journal.ilovephilosophy.com

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