Additional Publication Information
One of the central debates concerning delusion has to do with the role played by faulty hypothesis formation and other cognitive errors. Top-down models assign causal power to such errors in generating delusions, whereas bottom-up models regard these same cognitive errors as at least secondary to (and in some cases derivative from) the delusional experience. We support a bottom-up model of delusion, one that holds that delusional experiences are immediate and noninferential. With respect to the noninferential character of delusion, our approach is similar to that espoused by Gold and Hohwy (2000) in which delusions are referred to as "disorders of experience." At the same time, however, we also acknowledge the explanatory appeal of top-down models of delusion, in which delusions are thought to derive from predictable, cognitive errors. Rather than accept that delusions are the result of higher-order cognitive mistakes, however, we argue that the kinds of errors to which such top-down models typically appeal may themselves be understood, in certain crucial respects, in a bottom-up way or as part of the immediate experience of the delusional subject. This view is supported by Kapur's (2003) work in which schizophrenic delusion is understood in terms of aberrant salience, which in turn is explained at the neurological level as a disorder of the dopaminergic system. Thus, our model of delusion provides an integrated approach in which aberrations at the neurological level are directly related to a "disorder of experience," at the phenomenological level, without recourse to mistaken inferences at the cognitive level. Though we acknowledge that delusions are, of course, associated with higher order cognitive effects, we argue that these are not the proper locus for the explanation of the delusional experience itself.