Is it me or my delusion? Harnessing authenticity for an agential view of delusionality

In the revisionist part of the book, Bortolotti aims at defending a non-pathologising view of delusions, according to which they not only compromise but support our agency. By construing delusions as meaningful protective responses, the author attempts to decouple delusionality from pathology. Nevertheless, it is not clear how, according to her approach, delusions could foster agency. Even when seen as a “way of life” and not as psychiatric symptoms, the defensive nature of delusions undermines the person’s sense of agency, for the symptom or defence mechanism never stems from the person themselves. Notwithstanding the benefits delusions might bring along, they seem to display their own intentionality to the detriment of the agent. Here, I suggest that insights from the authenticity debate in psychiatry could support Bortolotti’s revisionist aim and benefit her discussion on identity beliefs. For this purpose, I introduce the concept of self-illness ambiguity (Sadler, 2007) and compare de Haan’s notion of existential stance (2020) and Stanghellini’s concept of position-taking (Stanghellini et al., 2023) to argue that the person’s agency resides in their ability to take a stance on their (psychiatric) condition, especially when struggling with questions of authenticity. Finally, I explore why one cannot just get rid of a delusion and why, when one attempts to, it feels urgent to replace it.