Emotion Review

http://emr.sagepub.com/

Affective Dimensions of the Phenomenon of Double Bookkeeping in Delusions

Lisa Bortolotti and Matthew R. Broome
Emotion Review 2012 4: 187
DOI: 10.1177/1754073911430115
The online version of this article can be found at:
http://emr.sagepub.com/content/4/2/187

Published by:
http://www.sagepublications.com

On behalf of:

International Society for Research on Emotion

Additional services and information for Emotion Review can be found at:
Email Alerts: http://emr.sagepub.com/cgi/alerts
Subscriptions: http://emr.sagepub.com/subscriptions
Reprints: http://www.sagepub.com/journalsReprints.nav
Permissions: http://www.sagepub.com/journalsPermissions.nav
Citations: http://emr.sagepub.com/content/4/2/187.refs.html

>> Version of Record - Apr 27, 2012

What is This?

Downloaded from emr.sagepub.com by ancuta anca on October 25, 2014

Affective Dimensions of the Phenomenon

of Double Bookkeeping in Delusions

Emotion Review
Vol. 4, No. 2 (April 2012) 187191
The Author(s) 2012
ISSN 1754-0739
DOI: 10.1177/1754073911430115
er.sagepub.com

Lisa Bortolotti

School of Philosophy, Theology and Religion, University of Birmingham, UK

Matthew R. Broome
Warwick Medical School, University of Warwick, UK

Abstract
It has been argued that schizophrenic delusions are behaviourally inert. This is evidence for the phenomenon of double
bookkeeping, according to which people are not consistent in their commitment to the content of their delusions. The traditional
explanation for the phenomenon is that people do not genuinely believe the content of their delusions. In the article, we resist
the traditional explanation and offer an alternative hypothesis: people with delusions often fail to acquire or to maintain the
motivation to act on their delusional beliefs. This may be due to avolition, to emotional disturbances, or to the fact that, given the
peculiar content of some delusions, the surrounding environment does not support the agents motivation to act.

Keywords
avolition, delusions, double bookkeeping, emotional disturbances, motivation, schizophrenia

People with delusions may believe that they are dead (Cotard
delusion), that a celebrity is secretly in love with them
(erotomania), or that some of their thoughts are being inserted
into their heads by an ill-meaning third person (thoughtinsertion). According to the Diagnostic and Statistical Manual
of Mental Disorders (DSM-IV 2000, p. 765), delusions are
false beliefs that resist counterevidence. However, there is a
lively debate on whether delusions should be characterized as
beliefs at all (Bayne & Pacherie, 2005; Bortolotti, 2009). As
Campbell elegantly puts the problem,
You might propose that what we have here is not, strictly speaking,
belief at all, but empty speech masquerading as belief. The trouble
with this diagnosis is that these are perfectly sincere assertions made by
people who seem to understand what they are saying, who may indeed
act on the basis of what they are saying. (Campbell, 2001, p. 91)

The thesis that delusions are not beliefs is often justified on the
basis of the view that beliefs have core features which delusions
do not share. Possibly the most powerful of these arguments is
that delusions are not beliefs because people with delusions fail

to manifest commitment to the content of their delusions. This

may be either because they fail to act on their delusions when
the opportunity presents itself (inaction), or because they act in
a way that is not consistent with believing the content of the
delusion (attitudebehaviour inconsistency). The assumption
underlying this antidoxastic argument is that typically people
manifest commitment to the content of their beliefs, and their
beliefs guide action in the relevant circumstances.
Bleuler (1950) first introduced the notion of double awareness in schizophrenia: people with schizophrenic delusions
may fail to act in accordance with their delusions. Sass (1994,
2001, 2004) and Gallagher (2009) reelaborate Bleulers idea,
and call the phenomenon double bookkeeping. They suggest
that people with delusions are at least implicitly aware that their
delusions are not about reality: A patient can view doctors and
nurses as poisoners (in delusional reality) but happily eats the
food they give her (in everyday reality) (Gallagher, 2009,
p. 260). The appeal to double bookkeeping in schizophrenia
is suggestive, but it should be accompanied by a review of the
available evidence of peoples manifest commitment to the
content of their delusions. There are some striking examples of

Corresponding author: Lisa Bortolotti, School of Philosophy, Theology and Religion, University of Birmingham, Edgbaston B15 2TT, UK. Email: l.bortolotti@bham.ac.uk

Downloaded from emr.sagepub.com by ancuta anca on October 25, 2014

188 Emotion Review Vol. 4 No. 2

Table 1. Possible reasons for inaction or inconsistency between attitudes and behaviour
(1) Failure to generate intentions or
access goals due to representational or
meta-representational factors

(2) Intentions are generated and goals

accessed but intentions are not converted
into action

(3) Lack of opportunities for action due to

emotional disturbances or the structure of the
environment

The content of the delusion is not genuinely

believed, and does not give rise to an
intention to act.

There is no appropriate emotional reaction

towards the goal (e.g., the goal is not found
desirable).

The emotions that would support relevant action

are disturbed due to stress and anxiety.

Conflicting attitudes towards the content of

the delusion give rise to incompatible goals
and paralyse action.

Motivation to pursue the relevant goals is

challenged by limitations in imagination and
projection (appetition).

There are fewer opportunities to engage in the

pursuit of the goal which would contribute to
sustaining motivation (consummation).

Relevant goals are identified, but cannot be

accessed at a later stage due to a deficit in
meta-representation (poverty of action).

Due to reduced sense of self-efficacy and

competence, the agent loses confidence in her
ability to achieve the relevant goals.

Acting consistently with the delusion is not

possible, given the content of the delusion and
the structure of the physical environment.

Fluctuating conviction in the delusional belief

undermines the stability of the agents goals.

Due to reduced sense of autonomy, the agent

doubts her capacity to carry out the relevant
actions.

Acting consistently with the delusion is not

socially supported, given the likely consequences
of relevant actions.

delusions guiding action, both from the psychological and

psychiatric literature and from clinical vignettes. Here are some
of these examples.
A person with delusions of passivity wears a cap because
he wants to prevent his neighbour from inserting thoughts
into his head.
People with Cotard delusion stop bathing and eating
(Weinstein, 1996).
People with persecutory delusions avoid specific situations or certain individuals because they perceive them
as threatening (Freeman, Garety, & Kuipers, 2001).
Self-inflicted eye injury and self-mutilation are common
in people who believe that they deserve punishment due
to their delusions of guilt (Buchanan & Wessely, 1998).
Acts of violence are motivated by delusions, especially
when people react to misperceived threats (Bourget &
Whitehurst, 2004; Frstl, Almeida, Owen, Burns, &
Howard, 1991; Junginger, Parks-Levy, & McGuire, 1998).
On the basis of these examples, we should refrain from considering double bookkeeping as a general feature of delusions
and say instead that in some circumstances people with delusions fail to act in a way that signals commitment to the content of their delusions. A question remains: Why isnt the
commitment to the content of a delusion always manifested in
behaviour? The traditional explanation for the phenomenon
is that people do not genuinely believe the content of their
delusions.
We want to resist the traditional explanation and suggest that
there are a number of plausible explanations (see Table 1). In
this article we shall not pursue the explanations in the first column. (For some attempt at defusing merely cognitive explanations, see Bortolotti (2010)). Instead, we shall explore some of
the explanations in the second and third columns. We shall
argue that people with delusions may fail to acquire or to sustain
the motivation to act on their delusions. In the next section, we
shall explore the plausibility of the view that lack of motivation

is due to volitional or emotional deficits or disturbances. In the

following section, we shall discuss the possibility that motivation
is undermined when the content of the delusion is such that the
person may not have the opportunity to act on it.

Volitional and Emotional Factors

Undermining Motivation
The hypothesis we wish to consider here is that people with
schizophrenic delusions fail to manifest their commitment to
the content of their delusions because of a breakdown of
motivation. In cognitive psychology it is believed that ones
motivation to act is affected by (a) the desirability of the goal;
(b) the perceived likelihood to achieve the goal; and
(c) the support of the surrounding environmental and social
context (see Allport, 1937; Armitage & Christian, 2004; Austin
& Vancouver, 1996; Ford, 1992; Kuhl & Beckman, 1985).
The desirability of a goal is strictly related to the beliefs,
desires and aspirations of the agent, and social pressure. The perceived likelihood to achieve the goal is affected by the agents
sense of behavioural control, that is, whether the agent represents the goal as something that can be achieved given its intrinsic features; and the agents sense of self-efficacy, that is, whether
the agent represents herself as able to perform successfully the
actions leading to the achievement of the goal. Contextual factors play a crucial role too, and this idea will become central to
our considerations in the next section: the surrounding physical
and social environment can be either responsive or unresponsive
to the agents newly formed intentions to act.
When an agent fails to act on her beliefs, or acts in a way that
appears to be inconsistent with the beliefs she reports to have, a
number of explanations for such failure are plausible, and some
of them involve the failure to acquire or sustain the motivation
to act in accordance with her beliefs. For instance, the agent
may never acquire the necessary motivation to act because she
believes that she has no genuine control over her own behaviour. Thus, her intention does not translate into action.
Alternatively, the agent may fail to sustain her own motivation

Downloaded from emr.sagepub.com by ancuta anca on October 25, 2014

Bortolotti & Broome Affective Dimensions of Double Bookkeeping 189

to act, if she has attitudes that conflict with her finding the goal
desirable. A third hypothesis is that the social and contextual factors lead the agent to see herself as incompetent in performing
the relevant action (Ryan & Deci, 2000). This is the case when
the agent lacks a sense of autonomy (intended as the belief that
the action is actually caused by her) and a sense of relatedness
(intended as support from her close personal relationships). It
may not be a coincidence that some of the conditions responsible for lack of motivation are also among the causal factors
contributing to psychopathology (Ryan & Deci, 2000, p. 76),
such as the impression that there is excessive external control
over ones thoughts and actions, which compromises the agents
sense of autonomy, and the absence of supportive personal relationships, which negatively affects the sense of relatedness.
Foussias and Remington (2008) suggest that people with
schizophrenia are not necessarily unable to represent their goals
as desirable. Rather, they find it harder than participants in control conditions to act in such a way as to enjoy the pleasant emotions associated with the pursuit and achievement of their goals
and to channel them into action. Studies presented and reviewed
by Gard, Kring, Germans Gard, Horan, and Green (2007) and
Kring and Germans (2004) seem to confirm this hypothesis. If
people with schizophrenia are asked to predict how much pleasure they will derive from a potentially pleasurable experience,
they predict that they will derive less pleasure from it than participants in control conditions. Similarly, when asked to report
after the experience how pleasant the experience was, people
with schizophrenia report that they felt less pleasure than participants in control conditions. The hypothesis is that there are
several emotional components to the enjoyment of pleasant
experiences. The anticipatory component concerns the pleasure
derived from the imagination or the expectation of a rewarding
experience. The consummatory component concerns the pleasure
derived from the actual pursuit of and engagement in the desired
activity. Finally, there is also the issue of whether pleasurable
experiences are successfully encoded and can be recalled as
pleasurable at a later time. Judging from self-reports, people
with schizophrenia seem to experience less pleasure than
participants in control conditions, but this may not be the case.
Neurobiological data suggest that people with schizophrenia are
able to enjoy pleasurable actions as much as participants in
control conditions. A possible explanation for their self-reports
is that differences between people with schizophrenia and
participants in control conditions emerge at the stage of anticipation and encoding, and do not affect the actual experience.
What are the implications of the avolition literature for
double bookkeeping? Avolition is often characterized as a form
of weakness of will and distinguished from absence of hedonic
reward. But one hypothesis is that people are less motivated to
act in a way that is consistent with the content of their delusions
because they find it harder to imagine the future outcomes of
their actions and to anticipate the pleasure they may derive from
the achievement of their goals. This hypothesis predicts that
failures of imagination and anticipation would affect ones
motivation to act in general, and not just the motivation to act in
accordance with delusional beliefs.

Another reason why people might fail to commit behaviourally to their delusions may be found in emotional disturbances.
These phenomena may contribute to a failure of motivation
which results in an agent ceasing to pursue her initial goal.
Bleuler (1950, p. 70), who identifies schizophrenia with a
breakdown of the emotions, notices that people with schizophrenia often appear indifferent in the sense that they do not
express the emotions they feel. Such indifference would now be
considered as a negative symptom of schizophrenia.
In cognitive neuro-psychological approaches to schizophrenia the relationship between emotions and psychotic symptoms
is an object of controversy. The accepted view is that emotional
disturbances (e.g., emotional excesses and deficits or lack of
regulation) are not a direct cause of psychotic symptoms, but
contribute to their maintenance and severity. For instance, in
people with schizophrenia, negative self-evaluation is correlated
with more severe positive symptoms (Barrowclough et al.,
2003). In people with delusions, distress is correlated with the
severity of the delusions (Lysaker, Lancaster, Nees, & Davis,
2003) and high levels of anger are often recorded (Cullari, 1994;
Siris, 1995). More recently, Freeman and Garety (2003) have
challenged the accepted view and suggested that emotions
directly cause delusions. This is because anxiety contributes to
delusional conviction, in a way that is quite independent of reasoning. It is proposed that delusional explanations are a direct
reflection of pre-existing beliefs about the self, world and others,
and that these beliefs are intimately linked to emotion (Freeman
& Garety, 2003, p. 931). Broome et al. (2005), who investigated the developmental and epidemiological factors influencing prodromal symptoms (i.e., the symptoms immediately
prior to the onset of a disease), observed how people at high
risk of psychosis experience distress, decreased motivation,
and poor socialization from an early age. Those in the highrisk sample who make the transition to psychotic are
often depressed and anxious before suffering from positive
symptoms.
Evidence that seems to support a positive correlation
between emotion and motivation emerges from the observation that, when there are strong emotional reactions relevant to
a persons delusions, such as anger, the person is more likely
to act on her delusions. If the emotions typically associated
with the content of the delusions are not manifested, as with
emotional disturbances, then the motivation is undermined as
a result.

Lack of Commitment and the Responsiveness

of the World
Here we shall consider a further explanation for people failing
to express behavioural commitment to their beliefs. Agents may
find themselves in a physically or socially structured environment in which there are serious obstacles to exhibiting the type
of behaviour that would be consistent with their beliefs. A typical case is that of a person failing to act on her delusion because,
given the contents of the delusion and the constraints imposed
by the world in which she lives, either there is no appropriate

Downloaded from emr.sagepub.com by ancuta anca on October 25, 2014

190 Emotion Review Vol. 4 No. 2

action that she can take, or the only appropriate action would
have unpleasant or dangerous consequences.
A woman believes that the world is ending and she is the
only one who can save the world by deciphering signs that God
sends her in her dreams. Although the womans verbal behaviour
may be a testimony of her commitment to the delusion, it is
difficult to identify desirable goals that she could achieve if she
decided to act on her delusions. The woman is well aware that
other people are unlikely to believe her, so she may not even
warn others about the end of the world.
When a man with Capgras delusion says that he cant go to
the police to report the disappearance of his wife because the
police wouldnt believe that aliens abducted her and replaced
her with an impostor, it is obvious to him as well as to others
that his social environment would not be supportive of his
action. Action may be inhibited as a result.
In both the cases above, people fail to act on their delusions
because they retain an awareness of how odd their beliefs and
behaviour may appear to others. In more radical cases, the delusion conflicts with our current understanding of the physical
world. One case discussed by Campbell (2009) and by Broome,
Bortolotti, and Mameli (2010) is that of a man who believed
that a lizard was inside his body due to the scaly appearance
of his skin. As a result, he tried to remove the lizard with a
knife, harming himself as a result (Browning & Jones, 1988).
Arguably it is not unreasonable to try and remove a source of
danger from oneself if one believes that the danger is real. If the
man believed that the doctor could not help him, and that there
were no professional lizard killers around, then the prospect of
removing the lizard himself with a knife may have seemed to
him the only rational thing to do. By comparison, one can think
about the case of a person stranded on Mount Everest who
rationally decides to remove a gangrenous or frostbitten arm to
save her life. The rational agent balances perceived risks in
order to maximize her chances of survival: in this case, the relevant risks are (a) the risk incurred in cutting oneself with a
knife and (b) the risk of being eaten from the inside by a poisonous lizard (compare the latter with the risk of gangrene leading
to certain death).
A similar riskbenefit analysis can result in inaction rather
than action for the person with delusions. If the outcome of the
riskbenefit analysis had been different, then the person afflicted
by the delusion of lizard infestation would have refrained from
acting. He could have concluded that it was less dangerous to
have his body colonized by reptiles than to attempt to remove the
reptiles with a knife. This would have led the man to do nothing
about the infestation, or maybe search for other ways to stop it.
The point we are attempting to make is that, in the case of
some delusional beliefs that are held with absolute conviction,
the very strangeness of the belief seems to inhibit action altogether, or to lead to undesirable or dangerous actions for which
motivation is likely to falter. Examples encountered in clinical
practice by one of us (MB) tend to be beliefs that conflict with
the basic laws of physics and biology:

1. a man who believed that he had a full-scale nuclear

reactor inside himself;
2. a man who felt that his body was occupied by a superhero team devoted to battling for the good of Crystal
Palace Football Club;
3. a woman who believed that she was endlessly pregnant
and giving birth to a series of Messiahs.
The people in the second and third cases felt privileged about
their conditions and, other than talking about their beliefs, they
felt no need to act on them. They, as individuals, were containers of other entities and they thought that they were themselves
not under any threat. The person in the first case did get concerned about the presence of the nuclear reactor inside himself.
However, due to the sheer impossibility and paradoxical nature
of his claims, he found it very difficult to talk about his belief to
those around him. Nonetheless, the belief had a strong negative
impact on his life.
In the description of a nuclear reactor residing inside ones
own body, language gives way because soon a point is reached
where the chain of reasoning and justification can go no further
(see Bortolotti & Broome, 2008). So, the person in the first case
often said Thats just the way it is or There is no way I can
make you understand, and no further explanation was given as
to how he could house a nuclear reactor inside himself. He was
not attempting to mislead: He was genuinely trying to explain
his predicament to those whom he came into contact. However,
given the strangeness of his belief and experiences, there was
no clear or obvious way for himself or others to act in response
to his assertions. This caused frustration and impotence in the
sufferer, and bafflement and perplexity in the people surrounding him. This is sadly a common occurrence in people with
delusions: As a result of these unsuccessful attempts at communication, they may just stop trying to engage others in their
beliefs.
For someone with very odd delusions, and in particular for
someone who holds beliefs which cannot be true, given the
physical laws that make up the universe, it has been suggested that a private reality is occupied by the person with the
delusion (Gallagher, 2009) or that her thoughts spin frictionlessly in the void (McDowell, 1994, p. 18). The person
with such odd beliefs has become disconnected from the
rational constraints of the world in parts of her thinking.
However, this disconnection is two-sided: As well as freeing
thought from the world, it frees the world from the thought.
This idea is discussed in Campbell with respect to Cotards
syndrome: The problem is how any experience at all, let
alone an experience of marble tables, could be relevant to the
verification of the proposition, the world is ending
(Campbell, 2001, p. 95). If the world is such that people with
bizarre delusions cannot think of experiences that support
their reports, then such delusions may also fail to give rise to
attainable or desirable goals, or fail to give rise to any goals
whatsoever.

Downloaded from emr.sagepub.com by ancuta anca on October 25, 2014

Bortolotti & Broome Affective Dimensions of Double Bookkeeping 191

Conclusions
The phenomenon of double bookkeeping in delusions is of great
interest: Why do people seem to lack commitment to the content
of their delusional beliefs? The standard approach is to reject
the view that delusions are beliefs and emphasize the disanalogy
between delusions and beliefs: The latter are manifested
behaviourally, whereas the former are behaviourally inert.
In this article, we suggested that there is an alternative
explanation that hasnt been sufficiently explored in the philosophical literature: People may fail to commit behaviourally
to the content of their delusions when they fail to acquire or
sustain the motivation to act on their delusions. In attempting
to make this alternative explanation plausible, we stressed the
analogy between delusions and beliefs: Both may fail to
be acted upon when certain conditions obtain, such as the
relevant goals appearing either unattainable or undesirable to
the agent.
We explored different routes to undermining motivation in
psychopathology and briefly examined the role of avolition and
emotional disturbances in the explanation of double bookkeeping. Then, we considered the contribution of the surrounding
environment to the agents appreciation of the desirability or
attainability of the goals that are relevant to her delusions.

References
Allport, G. (1937). The functional autonomy of motives. American Journal
of Psychology, 50, 141156.
American Psychiatric Association (2000). Diagnostic Statistical Manual
of Mental Disorders, Fourth edition (DSM-IV).
Armitage, C., & Christian, J. (Eds.). (2004). Planned behavior: The
relationship between human thought and action. New Brunswick,
NJ: Transaction.
Austin, J., & Vancouver, J. (1996). Goal constructs in psychology:
Structure, process and content. Psychological Bulletin, 120, 338375.
Barrowclough, C., Tarrier, N., Humphreys, L., Ward, J., Gregg, L., &
Andrews, B. (2003). Self-esteem in schizophrenia. Journal of Abnormal
Psychology, 112, 9299.
Bayne, T., & Pacherie, E. (2005). In defence of the doxastic conception of
delusion. Mind & Language, 20, 163188.
Bleuler, E. (1950). Dementia praecox or the group of schizophrenias.
New York, NY: International Universities Press.
Bortolotti, L. (2009). Delusions and other irrational beliefs. Oxford, UK:
Oxford University Press.
Bortolotti, L. (2010). Double bookkeeping in delusions: Explaining
the gap between saying and doing. In K. Frankish, A. Buckareff &
J. Aguilar (Eds.), New waves in the philosophy of action (pp. 237256).
Basingstoke, UK: Palgrave Macmillan.
Bortolotti, L., & Broome, M. (2008). Delusional beliefs and reason giving. Philosophical Psychology, 21(6), 801821.
Bourget, D., & Whitehurst, L. (2004). Capgras syndrome: A review of the neurophysiological correlates and presenting clinical features in cases involving physical violence. Canadian Journal of Psychiatry, 49, 719725.
Broome, M., Bortolotti, L., & Mameli, M. (2010). Moral responsibility
and mental illness: A case study. Cambridge Quarterly of Healthcare
Ethics, 2, 179187.
Broome, M., Woolley, J., Tabraham, P., Johns, L., Bramon, E., Murray, G., ...
Murray, R. (2005). What causes the onset of psychosis? Schizophrenia
Research, 79, 2334.

Browning, S., & Jones S. (1988). Ichthyosis and delusions of lizard

invasion. Acta Psychiatrica Scandanavica, 78, 766767.
Buchanan, A., & Wessely, S. (1998). Delusions, action and insight. In
X. Amador & A. David (Eds.), Insight and psychosis (pp. 283310).
Oxford, UK: Oxford University Press.
Campbell, J. (2001). Rationality, meaning and the analysis of delusion.
Philosophy, Psychiatry, & Psychology, 8, 89100.
Campbell, J. (2009). What does rationality have to do with psychological causation? Propositional attitudes as mechanisms and as control
variables. In M. Broome & L. Bortolotti (Eds.), Psychiatry as cognitive
neuroscience: Philosophical perspectives (pp. 137149). Oxford, UK:
Oxford University Press.
Cullari, S. (1994). Levels of anger in psychiatric inpatients and normal
subjects. Psychological Reports, 75, 11631168.
Ford, M. (1992). Motivating humans: Goals, emotions, and personal agency
beliefs. Newbury Park, CA: Sage.
Frstl, H., Almeida, O. P., Owen, A. M., Burns, A., & Howard, R. (1991).
Psychiatric, neurological and medical aspects of misidentification
syndromes: A review of 260 cases. Psychological Medicine, 21,
905910.
Foussias, G., & Remington, G. (2008). Negative symptoms in schizophrenia: Avolition and Occams razor. Schizophrenia Bulletin, 36, 359369.
Freeman, D., & Garety, P. (2003). Connecting neurosis and psychosis: The
direct influence of emotion on delusions and hallucinations. Behaviour
Research and Therapy, 41, 923947.
Freeman, D., Garety, P., & Kuipers, E. (2001). Persecutory delusions:
Developing the understanding of belief maintenance and emotional
distress. Psychological Medicine, 31, 12931306.
Gallagher, S. (2009). Delusional realities. In M. R. Broome & L. Bortolotti
(Eds.), Psychiatry as cognitive neuroscience: Philosophical perspectives (pp. 245266). Oxford, UK: Oxford University Press.
Gard, D. E., Kring, A. M., Germans Gard, M., Horan, W. P., &
Green, M. F. (2007). Anhedonia in schizophrenia: Distinctions
between anticipatory and consummatory pleasure. Schizophrenia
Research, 93, 253260.
Junginger, J., Parks-Levy, J., & McGuire, L. (1998). Delusions and
symptom-consistent violence. Psychiatric Services, 49, 218220.
Kring, A. M., & Germans, M. K. (2004). Subjective experience of emotion
in schizophrenia. In J. H. Jenkins & R. J. Barrett (Eds.), The edge of
experience: Schizophrenia, culture, and subjectivity (pp. 329348).
New York, NY: Cambridge University Press.
Kuhl, J., & Beckman, J. (Eds.). (1985). Action control: From cognitions to
behaviors. New York, NY: Springer.
Lysaker, P., Lancaster, R., Nees, M., & Davis, L. (2003). Neuroticism and
visual memory impairments as predictors of the severity of delusions in
schizophrenia. Psychiatry Research, 119, 287292.
McDowell, J. (1994). Mind and world. Cambridge, MA: Harvard University
Press.
Ryan, R., & Deci, E. (2000). Self-determination theory and the facilitation
of intrinsic motivation, social development, and well-being. American
Psychologist, 55, 6878.
Sass, L. (1994). The paradoxes of delusion: Wittgenstein, Schreber, and the
schizophrenic mind. New York, NY: Cornell University Press.
Sass, L. (2001). Self and world in schizophrenia: Three classic approaches.
Philosophy, Psychiatry, & Psychology, 8, 251270.
Sass, L. (2004). Some reflections on the (analytic) philosophical approach
to delusion. Philosophy, Psychiatry, & Psychology, 11, 7180.
Siris, S. (1995). Depression and schizophrenia. In S. R. Hirsch &
D. Weinberger (Eds.), Schizophrenia (pp. 128145). Oxford, UK:
Blackwell.
Weinstein, E. (1996). Reduplicative misidentification syndromes. In
P. Halligan & J. Marshall (Eds.), Method in madness (pp. 1336).
Exeter, UK: Psychology Press.

Downloaded from emr.sagepub.com by ancuta anca on October 25, 2014