As we saw in the last post, by constructing self-narratives, agents can not only make sense of their previous behaviour but also exercise control over their future behaviour. Their sense of self guides the formation of beliefs, plans, decisions, and so on. Failures of rationality and self-knowledge do not necessarily compromise the capacity to construct self-narratives, and thus the capacity for self-governance may be preserved. What is likely to happen, though, is that people with delusions are not very successful at governing themselves, where success is cashed out in terms of psychological well-being.
Think about it in these terms. What makes you a good ruler? Your knowledge of what your people want and need, and your capacity to take into account this information when making important decisions. When we think about self-ruling, then success seems to be hostage to self-knowledge and rationality. You need to know what you want and need (self-knowledge), what will make you happy, and you need the capacity to make decisions that take into account such information (rationality). Failures of self-knowledge and of rationality may interfere with the exercise of the capacity for self-governance.
When your story largely corresponds to reality and is coherent, psychological well-being is expected to ensue (see Wilson’s Strangers to Ourselves). When your story is coherent but inaccurate, as when delusions are woven in the self-narrative, this might also result in well-being, but only temporarily, until the pressure of fitting the story with reality becomes too much to bear - this is especially true of far-fetched delusions which are integrated in the story at the cost of creating an increasingly wide gap between story and reality. When your story is incoherent and partly inaccurate, because there is a delusion that is not completely woven in the self-narrative and conflicts with other things you believe, correspondence can be restored. You need to cross out a bit of the story (the delusional bit) and rewrite it. Cognitive behavioural therapy alongside appropriate medication can serve this purpose.
So, the presence of delusions does not necessarily signal a lack of capacity for autonomy as self-governance, but is a reason for alarm since delusions often interfere with the successful exercise of self-governance. What are the implications for policy? It would be a mistake to assume that people have lost their capacity for self-governance just because they report delusional beliefs. Failures of rationality and self-knowledge do not necessarily compromise the capacity to shape one’s own future. But such failures make it likely that decisions about one’s own future are based on unreliable information - about oneself and about the surrounding social and physical environment. That is why it would also be a mistake to assume that people with delusions can govern themselves successfully. Depending on the nature of their delusions, and on the extent to which their attitudes depart from rationality, people with delusions can make decisions that may not lead to the satisfaction of their own preferences and interests. As a result, such decisions may not be conducive to promoting their own well-being. Major departures from other people’s shared experiences cause a breakdown of communication, possibly leading to social withdrawal and isolation, and conflicting beliefs about oneself can create fragmented narratives that cannot direct future action in a consistent and meaningful way.
Notice that, here again, there’s continuity between delusional and irrational but non-pathological beliefs. The considerations above apply to many false beliefs, even when there is no identified psychiatric disorder. Non-clinical failures of rationality and self-knowledge are bad news for successful self-governance, for all of us. Minor inaccuracies in self-narratives can be beneficial, e.g. when an overly optimistic reconstruction of one’s own past performance contributes to one’s self-esteem in everyday situations. However, when inaccuracies are more widespread, then the capacity to shape one’s own life in a way that will yield well-being is compromised.