By: J.S. Blumenthal-Barby
In his book, Self-Deception Unmasked, philosopher Ale Mele writes about two types of self-deception. There is the straight-forward kind, where a person falsely believes—in the face of strong evidence to the contrary—things that she would like to be true. And then there is the “twisted” kind, where a person falsely believes what she would not like to be true. Mele gives the example of a spouse who [falsely] believes that his wife is cheating on him despite evidence to the contrary and despite not actually wanting it to be the case that she is cheating on him.
While self-deception certainly occurs in medicine all of the time, what about twisted self-deception? A patient with twisted self-deception would be one who believes that she is sick or has some disease despite evidence that she does not (or at least no evidence that she does), and despite not wanting to actually have the disease in question. A patient who is malingering would not count since she does not actually believe she is sick, but a patient with hypochondriasis would since she falsely believes she is sick even though she does not want to be sick. But we need not invoke pathologies such as hypochondriasis to find instances of twisted self-deception. We can imagine a patient who “prepares for the worst” and convinces herself that she is ill (e.g., that she has cancer), or, if she is ill, that her odds of associated mortality or morbidity are much higher than they are (e.g., that she will die from her cancer even though this is unlikely).
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