Beliefs, experiences and misplaced being: an interactionist account of delusional misidentification

Abstract

This paper contrasts an interactionist account of delusional misidentification with more traditional one-and two-stage models. Unlike the unidirectional nature of these more traditional models, in which the aetiology of the disorder is said to "progress" from a neurological disruption via an anomalous experience to a delusional belief, the interactionist account posits the interaction of top-down and bottom-up processes to better explain the maintenance of the delusional belief. In addition, it places a greater emphasis on the patient's underlying phenomenal experience in accounting for the specificity of the delusional content. The role played by patient phenomenology is examined in light of Ratcliffe's recent phenomenological account. Similarities and differences are discussed. The paper concludes that a purely phenomenological account is unable to differentiate between non-delusional patient groups, who have what appear to be equivalent phenomenal experiences to patients suffering from delusional misidentification but without the delusional belief, and delusional groups, something the interactionist model is able to do.

Amending the revisionist model of the Capgras delusion: A further argument for the role of patient experience in delusional belief formation

“…The patient's acceptance of the impostor belief should be understood in terms of the role it plays in explaining why there is a change in the patient's experience-the feeling of estrangement-when in the presence of his (putative) wife. Importantly, the now accepted belief shapes the nature of the experiential content such that belief and experience become congruent (Young 2008a;2011a). To explain: when the belief is formed, the patient no longer experiences a feeling of estrangement towards the putative wife because what he now perceives (shaped as it is by the belief) is an impostor.…”

“…In addition, while acknowledging the neuropsychological disruption underlying the disorder, as well as recent discussion on subpersonal abductive reasoning, I wish to emphasize the role played by patient experience-often referred to as 'anomalous' in the literature-in the explanatory account proffered here. It is my view that the co-occurrence of anomalous experience and delusional belief creates an interaction of mutual effect, such that the former validates the latter and the latter authenticates the former (Young 2008a(Young , 2011a(Young , 2011b. The result of which is an entrenched delusional state.…”