[ExI] Prisoner of bad philosophy: Carl Sagan couldn’t allow himself to hope

[Stathis Papaioannou]

On Sun, 5 Aug 2018 at 6:12 am, William Flynn Wallace <foozler83 at gmail.com>
wrote:

> A further criterion distinguishing religious belief from delusion is that
> in the case of delusion the belief leads to dysfunction within the society
> where the delusional personal lives; but how is this criterion to be
> applied when, for example, people blow themselves up to honour their god?
>
>> --
> Stathis Papaioannou
> Many delusions never surface.  Most of these cases are borderline paranoid
> schizophrenia. (Borderline because if it were fullblown the person would
> not know the difference between their delusions and reality and would
> likely make them manifest in some way to observers).  They are quite aware
> that their ideas are forbidden or in some way antisocial.  Thus they keep
> them inside because they know that if they made people aware of them they
> would face institutionalization or something bad.  Probably millions of
> people live and die without ever giving any indication of problems.  Recall
> that the estimation of the incidence of schizophrenia is 1% of the
> population.  I'll bet there are far, far fewer than 3 million cases of
> schizophrenia known in the USA.
>
> Does that make YOU a bit paranoid about the people around you?
>
> I am not sure that any criterion really matters here except the one that
> says that we all have to live together, and that blowing people up is to
> say the least incompatible with that.  Whether a person fits a DSM
> diagnostic category is of little interest, especially given the fact that
> psychology and psychiatry has no weapons in their arsenal to change these
> people, or at least the ones with the religious aspect.  Certainly some who
> confess delusions can get antipsychotic drugs and these can help.  Maybe
> there are some clinical studies out there which studied the effect of
> antipsychotics  on religious superstitions and delusions.  I dunno.  But
> that might be VERY interesting.
>

A therapeutic trial of an antipsychotic is perhaps the only investigation
for psychosis that we have (brain imaging can show some correlations but it
lacks sufficient sensitivity and specificity, at least at this point).
Usually it is obvious to everyone else when a patient has a delusion, but
occasionally there are cases where it is not clear, such as when the belief
is not absolutely fixed or when the patient lives in a community of people
with apparently similar beliefs; although to be fair in the latter case the
other community members will often pick that something is wrong even when
to an outsider it seems that there isn’t much difference between the
patient and the others. But if a belief is weakened by antipsychotic
medication, that is good evidence that the belief is due to psychosis.
Religious beliefs are not incidentally affected in patients who are treated
for psychosis, evidenced not by any particular study but in ordinary
clinical practice: patients just return to their premorbid state.

To put this differently, antipsychotics have very high specificity, but
only moderately good sensitivity, since they work in about 70-80 of cases.

> --
Stathis Papaioannou
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