Towards an anti-descriptivist account of delusions and hallucinations

The traditional biomedical model of mental disorders departs from an eliminativist approach to the mental disorders gathered at different classification systems (e.g., DSM). This nosological framework has raised a lot of criticism in the last decades, regarding its conceptual validity, its reiterative lack of empirical support, and its ethical problems. Thus, there is a growing recognition that traditional diagnostic criteria constitute a poor assessment tool for clinical practice. However, this recognition does not always depart from a critical reconsideration of the alleged neurobiological nature of psychopathology. On the contrary, the purpose of initiatives such as the Research Domain Criteria (RDoC) is to drop the fruitless search for biomarkers of general mental illness categories (e.g., schizophrenia), and to focus instead on specific symptoms (e.g., delusions and hallucinations). Thus, the eliminativist underpinnings of the biomedical approach to psychiatry remain intact.

In this regard, the main purpose of my PhD thesis is to conceptually analyse the notions of “delusion” and “hallucination” and the viability of the neuroreductionist programme. This critical analysis will depart from a broadly anti-descriptivist approach, integrated by the potential contributions of several contemporary philosophical approaches to mind and language such as expressivism and inferentialism. I will also explore the close links between this anti-descriptivist approach and the urgent need for person-centred approaches to the study of human behaviour, which take the person and her history of interactions with the environment as the right departing point for clinical and scientific analysis. Finally, I will consider how this approach might affect clinical praxis. From my point of view, two of its key potential contributions are: a) it reinstates the diagnosed person at the centre of the debate regarding how mental health services should be configured; and b) it can broaden the usually narrow scope of what therapeutic objectives are deemed feasible.