The epistemic innocence of imperfect cognitions

Lead Research Organisation: University of Birmingham
Department Name: School of Philosophy Theology & Religion

Abstract

People diagnosed with psychiatric conditions such as Alzheimer's disease and schizophrenia have delusional beliefs and distorted memories. These symptoms are characterised by obvious epistemic faults. Delusions may be absurd in content and resistant to counterevidence, and autobiographical memories may be wildly inaccurate. I am interested in whether these 'imperfect cognitions' have also epistemic benefits, that is, whether they contribute to the preservation or acquisition of knowledge in the context in which they occur. For instance, one may argue that having a distorted memory of an important autobiographical event for someone with serious memory deficits is better than having no memory at all of that event. Being able to remember something about one's past helps one maintain a sense of self which is instrumental to autonomous thought and action and effective communication with others. In the proposed project my primary aim is to explore a new way of looking at delusional beliefs, distorted memories, and even 'imperfect cognitions' occurring in the non-clinical population, and develop the notion of 'epistemic innocence'. This is the idea that even a false belief, say, may be conducive to knowledge in some circumstances and have epistemic benefits that outweigh its epistemic faults. This notion may change the way we think about epistemic evaluation. Attempting to establish whether a cognition is true or rational is not a simple affair and makes sense when embedded in a context. The same false belief about the past may be epistemically innocent when had by someone with dementia whose memories are fading, and wholly epistemically objectionable when had by someone who has the capacity to reconstruct the memory of the same event more reliably. The development of the notion of epistemic innocence will impact on the philosophy of mind, and in particular on the overlap and differences between 'imperfect cognitions', and on cognitive psychology which is interested in whether the formation process of delusions and distorted memories is continuous with the formation process of non-pathological beliefs and memories. Ultimately, if it can be shown that at least some delusions and distorted memories are epistemically innocent, this will have implications for clinical psychiatry and in particular the management of symptoms of people with dementia and schizophrenia. If a false belief, say, is conducive to knowledge, we may have good reasons not to challenge it.
The main research output will be a monograph on epistemic innocence based on three research papers to be prepared during the 12-month Fellowship. In order to obtain feedback on my analysis of the epistemic benefits of imperfect cognitions and to draw the attention of the academic community to the notion of epistemic innocence, I shall host an interdisciplinary two-day workshop in Birmingham half-way through the Fellowship. Papers presented at the workshop will be gathered in an edited collection, and the speakers will be invited to join an interdisciplinary research network on the themes of the project, aimed at promoting further collaborative work. In addition to leading experts in epistemology, philosophy of mind, psychology and psychiatry, I want to engage service users, carers and clinical psychiatrists in the project. They will participate in the workshop, but I also envisage two focus groups to be held after the end of the Fellowship and funded by the University, to encourage a discussion of the possible implications of the project results for clinical practice. Other means of dissemination and knowledge exchange will be a project webpage on the existing University website and a Twitter feed. A post-doctoral research assistant will be hired part-time for 12 months (30%) to help organise the workshop, co-edit the collection of papers with me, and maintain the project webpage and Twitter feed.

Planned Impact

The Fellowship proposes to apply the newly developed notion of epistemic innocence to delusional beliefs and distorted memories occurring in schizophrenia and dementia. Reports that are regarded as the signpost of madness can be shown to have an important role in people's understanding of the world when their capacity to make plausible hypotheses and access to autobiographical memory are seriously compromised. The nature of this project lends itself to interdisciplinary and collaborative work as implications of the research will have to be assessed with respect to theories in epistemology, philosophy of mind, cognitive science and psychiatry. Some indication of how the research outcomes may impact on these fields have been provided in the academic beneficiaries section. Here I would like to focus on the impact that the research might have outside academic circles and in particular on service users, their carers, clinical psychiatrists and other mental healthcare professionals, and finally the general public.
If we realise that some of the most distressing symptoms of schizophrenia and dementia have some benefits for the people affected by these disorders, the repercussions may be quite significant, both for the management of those symptoms and the choice of treatment options. Carers and clinical psychiatrists may ask whether open challenges to delusional beliefs and distorted memories are always the best policy, if these cognitions can be shown to play an important role in the attempt by service users to preserve knowledge or acquire new information. We already know that the preservation and acquisition of relevant knowledge and self knowledge can contribute to an enhanced sense of self, increased wellbeing, and more efficient communication with others.
Suggestions that might emerge from my investigation also have the potential to change attitudes towards delusional beliefs and distorted memories occurring in psychiatric conditions, and towards more common 'imperfect' cognitions in the non-clinical population. When it comes to the divide between normal and pathological, it should be acknowledged that there is continuity between delusional and non-delusional beliefs, accurate and distorted memories. All beliefs, pathological or normal, can be unresponsive to evidence (possibly to different degrees), and all memories, no matter how accurate, can be thought of as more or less successful attempts at reconstructing the past by using fading clues. The emphasis on epistemic innocence should serve to reiterate the importance of viewing cognition as a fallible, imperfect but ultimately extremely powerful tool in the hands of finite and limited social beings like humans.
Dissemination outside academia and public engagement will take a number of different and complementary forms during and after the Fellowship. The project webpage will be available for interested parties to use, and both clinical practitioners from the Royal College of Psychiatrists Philosophy Interest Group and groups of service users and carers in the Coventry and Birmingham area will be invited to view information on it and subscribe to the relevant Twitter feed. Some of these stakeholders will be invited to take part in the project workshop and provide their valuable input and feedback in discussion time. In addition to this, there will be focus groups with clinical practitioners, service users and carers after the end of the Fellowship, supported by the University of Birmingham which is committed to promoting public engagement of funded research. During these meetings, participants will have an opportunity to hear about the Fellowship outcomes, express their views about the potential epistemic benefits of delusions and distorted memories given their first-hand experience, and think about practical applications of the findings.

Publications

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Bortolotti L (2015) Introduction. Costs and benefits of imperfect cognitions. in Consciousness and cognition

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Bortolotti L (2015) Recent Work on the Nature and Development of Delusions. in Philosophy compass

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Bortolotti L (2016) Epistemic Benefits of Elaborated and Systematized Delusions in Schizophrenia in The British Journal for the Philosophy of Science

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Bortolotti L (2015) The Ethics of Delusional Belief in Erkenntnis

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Bortolotti L (2015) The epistemic innocence of motivated delusions. in Consciousness and cognition

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Bortolotti L (2018) Stranger than Fiction: Costs and Benefits of Everyday Confabulation. in Review of philosophy and psychology

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Bortolotti L (2018) The epistemic innocence of clinical memory distortions. in Mind & language

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Fulford KW (2014) Taking the long view: an emerging framework for translational psychiatric science. in World psychiatry : official journal of the World Psychiatric Association (WPA)

 
Description I reported on the unexpected advantages of having imperfect cognitions (e.g. false beliefs).
Exploitation Route The advantages of false beliefs and other imperfect cognitions will inform our social interactions and also symptom management in a clinical context.
Sectors Education

Healthcare

Culture

Heritage

Museums and Collections

URL http://www.epistemicinnocence.com
 
Description As a result of the research conducted as part of the project I have written two policy briefs for the University of Birmingham on mental health emphasising the need to overcome stigma. These have been quite influential and commented upon by the Shadow Minister for Mental Health at the time, Luciana Berger. Since then, I have had further opportunities to engage the public in my research. In 2014 I participated in the Mental Health Foundation Dementia Inquiry as an expert witness and my contribution is cited in their final report. In October 2017, I delivered a TEDxBrum talk now available open access on YouTube where I discussed the implications of my research for the reduction mental health stigma.
First Year Of Impact 2014
Sector Healthcare,Culture, Heritage, Museums and Collections
Impact Types Cultural

Societal

Policy & public services

 
Description Expert witness for the inquiry by the Mental Health Foundation on truth telling and lying to people with dementia
Geographic Reach National 
Policy Influence Type Contribution to a national consultation/review
URL https://www.mentalhealth.org.uk/publications/what-truth-inquiry-about-truth-and-lying-dementia-care
 
Description Consolidator Grant
Amount € 1,900,075 (EUR)
Funding ID 616358 
Organisation European Research Council (ERC) 
Sector Public
Country Belgium
Start 09/2014 
End 09/2019
 
Description Mental Illness: Philosophy, Ethics, Society 
Form Of Engagement Activity A talk or presentation
Part Of Official Scheme? Yes
Geographic Reach Regional
Primary Audience Public/other audiences
Results and Impact Public Engagement activity at the University of Birmingham during the Arts & Science Festival in March 2014. The purpose was to discuss the relationship between psychiatric diagnosis and responsibility for action, based on some case studies. The event included: (1) a talk by Dr Matthew Broome, clinical and academic psychiatrist at the University of Oxford; (2) a brief commentary by Professor Lisa Bortolotti, philosopher at the University of Birmingham; (3) a Q&A session with the public; (4) a short break with refreshments; (5) a discussion group moderated by Ema Sullivan-Bissett and Kengo Miyazono, with the participation of doctoral students Ben Costello, Sarah-Louise Johnson and Rachel Gunn; follow-up online activities. The event was free and open to the general public. Clinical psychiatrists, psychologists, sixth formers and other members of the public participated.

Activity on the forum after the event was lively.
Year(s) Of Engagement Activity 2014
URL https://sites.google.com/site/epistemicinnocence/PE
 
Description Wise choices 
Form Of Engagement Activity A talk or presentation
Part Of Official Scheme? Yes
Geographic Reach Regional
Primary Audience Public/other audiences
Results and Impact Panel discussion and Q&A were recorded in a podcast which had over 10,000 downloads.

After my participation in this activity, people contacted me to hear more about my research.
Year(s) Of Engagement Activity 2014
URL https://sites.google.com/site/epistemicinnocence/PE