Delusion and Pathology

The debate about delusions in philosophy and psychiatry has mostly revolved around three questions. The nature question inquires about the kind of mental states we should take delusions to be, the etiology question explores how delusions come about, and the pathology question asks whether delusions are pathological. In this chapter, I explore a potential tension between the nature and pathology questions. One popular answer to the nature question consists in regarding delusions as beliefs (doxasticism); some versions of doxasticism additionally claim that delusions should be understood as continuous with other irrational beliefs. Yet, the joint commitment to doxasticism and continuity raises a puzzle with respect to pathology: if delusions are continuous with other beliefs, what – if anything – makes them distinctively pathological? Here I propose a way out of this tension by arguing that the combination of doxasticism and continuity does not imply a negative answer to the pathology question. I set out to develop a position that takes delusions to be beliefs and takes delusions to be pathological, without committing to them being pathological beliefs. On this view, the pathological import of delusions does not lie in their nature, but rather in their functioning – that is, in how they work within a person’s mental economy and how they interact with a broader situation. The upshot of this view is that no belief qualifies as pathological in itself, but some beliefs may indeed be pathological in virtue of their relation to a situation or context.