Interview with Professor Lisa Bortolotti

In this post we interview Professor Lisa Bortolotti about her ERC-funded project Pragmatic and Epistemic Role of Factually Erroneous Cognitions and Thoughts (PERFECT). Project PERFECT aims to establish whether cognitions that are inaccurate in some important respect can ever be good from a pragmatic or an epistemic point of view.

Lisa is a philosopher based at the University of Birmingham who works on ‘the limitations of human cognition and human agency, investigating faulty reasoning and irrational beliefs, delusions, confabulations, distorted memories, poor knowledge of the self, unreliable self narratives, self-deception, inconsistencies between attitudes and behaviour, unrealistic optimism, and other positive illusions’. Lisa has edited and contributed to a book that has been just published open access; Delusions in Context (Palgrave 2018). It is an exploration of delusions—unusual beliefs that can significantly disrupt people’s lives. It includes contributions from experts in clinical practice, psychology, cognitive neuroscience, and philosophy.









How did you first start thinking about the idea that delusions might perform a beneficial role?

In my post-doctoral research I became increasingly committed to defending one version of the continuity thesis. This is the idea that the irrationality of the unusual beliefs people report in the context of schizophrenia, dementia and other mental health issues (so called clinical delusions) is not qualitatively different from the irrationality of more common superstitious or prejudiced beliefs. In both cases, we tend to adopt beliefs that are not well supported by evidence and are not responsive to counterevidence. Superstitious and prejudiced beliefs are just more widely shared.

One thought that people often have about everyday irrational beliefs is that they fail epistemically (that is, in their relationship with evidence), but have other advantages that may begin to explain why we hold onto them so tenaciously. So, it may be false that wearing my lucky suit will bring me luck in the job interview, but it is a fact that when I wear that suit I feel more confident and less nervous. I began to ask whether the same was true of delusional beliefs. Could it be that there is some benefit in adopting or maintaining them? Could this benefit explain why giving up a delusional belief is so hard, and often leads to severe depression and suicidal thoughts? I was genuinely curious about such questions and did not know whether there was any literature on this. It turns out that there was very little out there—some clinicians had written about “successful psychotics” or about the “adaptive nature” of delusion formation.

So, I started from there. My view now is that in some cases the adoption of a delusional belief offers temporary relief from anxiety and, depending on the content of the belief itself, may have some protective function, that is, it helps the person avoid negative thoughts or emotions about herself. If your readers want to know more, they can check four open access papers: on delusions in schizophrenia, on delusions in depression, on delusions as protective, and on motivated delusions.

Can you give us an everyday example in which beliefs which include an irrational or delusional element have had a benefit of some sort – either to you personally or to people generally?

Yes, of course. In her influential book on positive illusions, Shelley Taylor argued that we all tend to adopt beliefs about ourselves that are optimistically biased, unless we experience depressive symptoms. So, a mentally healthy person is likely to believe that she is better than average in some domains (attractiveness, intelligence, kindness, etc.) even if the evidence at her disposal suggests that this is not the case. In a study conducted in the States in the Seventies, for instance, academics were asked whether they thought they were doing better research than average in their field, and 94% of them replied that they thought they did. Not all of them can have been right about that!

So, we do have an overly optimistic view of our talents and skills (this bias is called the superiority effect or the better-than-average effect). This means that we have epistemically irrational beliefs. We have beliefs about ourselves that are not well supported by evidence: we tend to remember our successes but forget our failures, which obviously skews our evidence about our competence in some domain. Our beliefs are not responsive to evidence either: when we get new evidence of our failures we tend not to update our beliefs accordingly, but we are very happy to update them when we get evidence of our successes. Are such biased beliefs beneficial?

Well, I think they are. Taylor argued that positive illusions are necessary for mental health. They enhance our wellbeing and increase our productivity. I was struck by the role that these positive illusions can play in supporting our agency: we are more likely to preserve our motivation to pursue our goals in the face of obstacles, and to attain our goals as a result of this perseverance, when we believe that we are skilled and successful. I defend this view in a paper on optimism, success, and agency (open access).

Your project is concerned with stories: ones that we tell ourselves and others, constructing self-narratives which can often support personal agency. Can you tell us a bit about whether your project crosses over with literary studies at all? It reminded me of folk tales and fairy tales, stories with confabulated elements but a social safe-keeping function, e.g. warning children away from doing something dangerous.

This is a very interesting question. For project PERFECT we have collaborated with psychologists and psychiatrists, mental health activists and people with lived experience of mental health issues, but we haven’t interacted much with researchers in the medical humanities, social science, or linguistics and literature. This is probably because we were having a focus on the connection between rationality and mental health, and because at the time of planning our activities I hadn’t realised how crucial the notions of self-image, self-concept, and self-narrative would have become for our investigation.

For my next project, I have filled the obvious disciplinary gap and involved from the start both linguists who are interested in shared meanings and self-image (on traditional media and social media), and social scientists who study the effects of certain forms of communication on people’s identities and groups’ identities. In the new project, we want to explore exactly what you suggest in your question, the idea that stories have multiple functions (they inform, entertain, challenge, motivate, persuade) and have different success conditions relative to those functions: an inaccurate historical report can be at the same time misleading, entertaining, and motivating. I think an analysis of the role of stories is timely and urgently needed in the current political climate, where stories are used as arguments and have proven to be very powerful at influencing people’s thoughts and actions.

Does your project connect with thinking about metaphor and illness? The benefits, or potentially harmful effect, of common cultural metaphors as ways of visualising illness and recovery?

Not specifically. In the delusion and confabulation literature the notions of metaphor and metaphorical meaning have been explored to some extent, especially among those scholars who claim that we should view delusions and confabulations not (just) as beliefs, but as fictional expressions of thoughts and feelings or as descriptions of an alternative reality that the person recognises (at some level) as non-actual. I believe this may be an interesting approach to some cases of delusion and confabulation, but for independent reasons I prefer to view most delusional reports and confabulatory explanations as expressions of a literal truth that the person is committed to.

Illness as Fiction examines factitious illness narratives: people constructing elaborate fabrications about having a serious illness that they don’t really have. This is usually because they have an underlying psychological condition (such as Munchausen syndrome) and crave the attention and sympathy they receive as a result of the performance of the illness. Have you used any case studies of Munchausen syndrome / factitious disorder in your work? If so, how does this play out as a delusional belief or distorted truth: what are the redeeming features?

We have not addressed Munchausen syndrome as such. Rather, some of the delusion and confabulation literature focuses on a very interesting phenomenon that is probably the mirror image of Munchausen syndrome, anosognosia. ‘Anosognosia’ comes from the Ancient Greek and means literally ‘denial of illness’. It occurs when people acquire a severe impairment but fail to acknowledge either the impairment itself or the impact of such impairment on their lives. Most of the studies I have seen concern anosognosia for the paralysis of a limb. So, people who have become paralysed as a result of an accident, for instance, may deny that they have a mobility issue. They are often ready to justify their denial in the face of challenges from third parties. When asked why they do not climb stairs, they do not say: “Because I am paralysed” (which would be the truth) but “Because I have arthritis” (which is a confabulation).

Whether and to what extent anosognosia has some benefits to the person experiencing it, is controversial. Some have observed that when the person does not admit to being impaired, it is difficult for her to engage in rehabilitation or otherwise cooperate with her clinical team, resulting in poorer outcomes, as well as in tensions with her family and friends, due to the clash between her version of reality and theirs. However, some other studies have found that among people with the same impairment, those who have anosognosia report higher levels of wellbeing and lower levels of anxiety, probably because anosognosia has a protective function, shielding the person from the strong negative emotions that would ensue from the truth of her new severe impairment and the dramatic change in her future prospects. It is possible that anosognosia has some temporary psychological benefits, then, enabling the person to adapt gradually to the reality of her new condition and to keep depression at bay.