CONSPIRACY THEORIES AND DELUSIONS
Authors: Lisa Bortolotti, Anna Ichino, and Matteo Mameli
To appear in: Reti, Saperi, Linguaggi
Professor Lisa Bortolotti, Professor of Philosophy, Department of Philosophy, Edgbaston
B15 2TT, Birmingham (UK). Email: l.bortolotti@bham.ac.uk
Dr Anna Ichino, Dipartimento di Filosofia, Università degli Studi di Milano, via Festa del
Perdono 7, 20122, Milano (Italia). Email: anna.ichino@unimi.it
Dr Matteo Mameli, Reader in Philosophy, King's College London, Department of
Philosophy, The Strand, WC2R 2LS, London (UK). Email: matteo.mameli@kcl.ac.uk
Abstract
Conspiracy theories are often compared to clinical delusions and correlations have been
found between accepting a conspiracy theory and schizotypal traits. In this paper, we explore
some of the similarities and differences between conspiracy theories and persecutory
delusions. We compare them in relation to surface features, aetiology, and downstream
effects. In relation to surface features and aetiology, we argue that there is some overlap
between conspiracy theories and persecutory delusions. In relation to downstream effects, we
argue that persecutory delusions are characterized by severe disruption to one’s life, whereas
conspiracy theories are in general not psychologically harmful to those who accept them. We
conclude by commenting on the consequences of comparing conspiracy theories to delusions.
Delusions are symptoms of psychiatric disorders and there is a specific kind of stigma often
directed at those who suffer from mental illness. The political use of comparing delusions and
conspiracy theories—when such comparison is aimed at producing or reinforcing
stigmatization and exclusion—is problematic and should be avoided.
1. Introduction
It has become commonplace to compare the acceptance of conspiracy theories, such as
COVID-19 denialism, to clinical delusions—that is, unusual beliefs that are symptomatic of
psychiatric disorders. An opinion piece on ABC News described climate change denial and
the belief that the Earth is flat as delusions due to their “unshakeability” (Shearman 2018); in
the Journal of the American Medical Association, a neurologist also advanced the hypothesis
that individuals who accept conspiracy theories have the same deficit as individuals with the
Capgras delusion, namely the “faulty monitoring of ideas” (Miller 2020); in a Guardian
article, an author described Naomi Wolf, a woman spreading vaccine myths on social media
and consequently banned by Twitter, as “delusional” (Connett 2021). Psychologists have
suggested a correlation between the acceptance of conspiracy theories and schizotypal traits,
that is, traits characterized by psychotic symptoms (Douglas et al. 2017).
The implication of this understanding of conspiracy theories is that the phenomenon shares
some important features with thoughts and behaviors that are recognized as marks of
insanity. This view supports a deficit model of conspiracy theorizing, according to which
people accept conspiracy theories due to cognitive biases that drastically—and
pathologically—impair reasoning.
Is likening conspiracy theories to delusions warranted? In this paper we address this issue by
exploring the similarities and differences between conspiracy theories and clinical delusions.
In section 2, we look at common definitions of delusions and conspiracy theories. In sections
3, 4, and 5, we compare surface features, aetiological features, and downstream effects of
delusions and conspiracy theories. We conclude, in section 6, by raising some concerns about
the sociopolitical consequences of this comparison.
2. Definitions and examples
Let us take a closer look at the definitions of delusions and conspiracy theories to highlight
some elements of similarity and dissimilarity.
2.1. Delusions
Delusions are common symptoms in schizophrenia, dementia, amnesia, and delusional
disorders; they can also be occasionally experienced as part of depression and obsessive-
compulsive disorder. In the Diagnostic and Statistical Manual of Mental Disorders,
published by the American Psychiatric Association, ‘delusion’ is defined as follows:
A false belief based on incorrect inference about external reality that is firmly held despite
what almost everyone else believes and despite what constitutes incontrovertible and
obvious proof or evidence to the contrary. The belief is not ordinarily accepted by other
members of the person’s culture or subculture (i.e., is not an article of religious faith).
When a false belief involves a value judgment, it is regarded as a delusion only when the
judgment is so extreme as to defy credibility (DSM-5, 2013, p. 819).
Broader definitions of delusion have also been proposed:
[A] belief which is implausible in light of general knowledge and/or the weight of
evidence to hand (which ought normally to confer doubt), and which is adopted and
maintained uncritically as true with unwarranted subjective conviction (Langdon and
Bayne 2010, p. 322).
Delusions of persecution, which are the most common type of delusions and those most
frequently compared to conspiracy theories, occur when someone believes that a person or a
group is hostile to them and intends to cause them harm. Examples include the belief that the
postman is spying on one’s house on behalf of the government or the belief that one’s coworkers are trying to get one fired. Let us offer some further examples in the words of people
who have experienced delusions, either directly or from the perspective of a caregiver.
The following is an extract from a first-person account of schizophrenia in which the author
describes the onset of psychotic symptoms after a history of depression and alcoholism:
The Alien Beings were from outer space, and of all the people in the world, only I was aware of
them. The Alien Beings soon took over my body and removed me from it. They took me to a
faraway place of beaches and sunlight and placed an Alien in my body to act like me. […] I also
saw that the Aliens were starting to take over other people as well, removing them from their
bodies and putting Aliens in their place. Of course, the other people were unaware of what was
happening; I was the only person in the world who had the power to know it. At this point I
determined that the Aliens were involved in a huge conspiracy against the world (Payne 1992, pp.
726-7).1
In this other passage, a woman describes her mother’s paranoia:
Although supervisors described her as an excellent employee, she suddenly started accusing coworkers of plotting against her.” “She […] avoids answering the phone and uses the answering
machine to screen all her calls. She still feels that most people are not benevolent” (Powell 1998,
p. 175).
1
For another first-person account of persecutory delusions involving aliens, see Bayley (1996).
2.2. Conspiracy theories
In the Encyclopedia Britannica, a conspiracy theory is defined as:
[A]n attempt to explain harmful or tragic events as the result of the actions of a small
powerful group. Such explanations reject the accepted narrative surrounding those events;
indeed, the official version may be seen as further proof of the conspiracy (Scott 2021).
The scholarly literature contains a variety of accounts and examples of conspiracy theories.
Here are two examples:
The epithet ‘conspiracy theory’ tends to be reserved for conspiracy-based explanations
which deal with large scale, dramatic social and political events (such as the AIDS
epidemic, the assassination of John F. Kennedy or 9/11); for explanations that do not just
describe or explain an alleged conspiracy, but also uncover it and in doing so expose some
remarkable and hitherto unknown ‘truth’ about the world (such as that the Illuminati
orchestrated the French Revolution or that the Bush administration had a hand in 9/11);
and for accounts that allege the existence of a plot with nefarious and threatening aims (to
destroy Christianity, establish the New World Order, take a country to war or eliminate a
racial group) (Byford 2011,page 21).
By “conspiracy theory” we indicate an explanation of a given event that: (1) refers to
actual or alleged conspiracies or plots (Conspiracy Criterion); (2) conflicts with the
received explanation of the said event, providing an alternative to the “official view” of
that event (Conflict Criterion); and (3) offers insufficient evidence in support of the
alternative explanation, so that it is not considered as a competitive scientific theory or
anything like that (Evidence Criterion). These criteria are meant to be necessary and jointly
sufficient for something to count as a conspiracy theory (Ichino and Räikkä 2020, page 3).
One example of a conspiracy theory among those related to the COVID-19 pandemic is
COVID-19 denialism, which is the idea that the virus does not exist or that is it not
significantly harmful and that figures about the worldwide impact of the virus (in terms of
infections, deaths, etc.) are fabricated. According to denialism, this fabrication is the work of
powerful individuals or organisations (such as Bill Gates or Big Pharma) who have malicious
motives and are looking for financial profits or political power: the want to sell harmful
pharmaceutical products, control people’s behavior, suppress freedom, etc.
It is worth noting that—just like delusions—conspiracy theories are given epistemic
definitions; in other words, they are given definitions that refer to notions of evidence, truth,
and rationality broadly conceived. Some philosophers have argued that, even though both
delusions and conspiracy theories are belief-like in some respects, they should be viewed
non-doxastically. According to this view, in at least some cases, people are not committed to
the truth of their delusion or of a conspiracy theory in the same way as they are committed to
the truth of their ordinary beliefs.2 Rather, when reporting a delusion or a conspiracy theory,
people might be expressing a hope, or an imagining, or a hybrid attitude. Thus, people may
take themselves to believe a conspiracy theory or to believe a delusion whilst their mental
attitude is not actually a full-blown belief, departing in some respects from the common
functional profile of beliefs. Our aim here is not to adjudicate the debate between doxastic
and non-doxastic accounts of delusions and conspiracy theories, and so throughout this article
we will simply talk about “having a delusion” and “accepting a conspiracy theory”.
3. Surface features
To offer the most charitable assessment of the view that accepting a conspiracy theory and
having a clinical delusion are alike, we focus on the comparison between (a) a conspiracy
theory attributing responsibility for an adverse event to agents the individual mistrusts and (b)
a delusion of persecution. In this comparison, two key features look immediately relevant. On
the one hand, both the conspiracy theory and the delusion appear to involve attributing evil
intentions or responsibility for adverse events to an individual or group that the person does
not trust—where trust can be withheld either with good reason or for no obvious reason. On
the other hand, a conspiracy theory—but not necessarily the delusion—involves a rejection of
an official account of the events. The conflict with an authoritative view is not necessarily
present when the delusion is formed. Delusions might simply arise to fill an explanatory gap
in situations where there are not (or not yet) established official explanations.
A person with a delusion, who has no insight into their illness, has an explanation of their
anomalous experience that is incompatible with the one offered by healthcare professionals.
However, the “rejection of the official account” differs between the case of having a delusion
and the case of accepting a conspiracy theory. For conspiracy theories, the opposition to
authority is at the heart of the acceptance of the theory, whereas for persecutory delusions,
the individual’s take on reality only happens to conflict with that of their doctors (and
everyone else’s). These considerations therefore seem to reveal, beyond a prima facie
similarity, an important difference between conspiracy theories and delusions. That being
2
For anti-doxastic accounts, see, e.g., Currie and Ravenscroft (2002), Dub (2016), and Ichino (2020) on
delusions, and Ichino and Raikka (2020) and Ichino (forthcoming) on conspiracy theories.
said, there are at least two key surface features that delusions and conspiracy theories have in
common: their alleged implausibility and their epistemic irrationality.
3.1. Implausibility
Both conspiracy theories and clinical delusions are regarded as implausible by those who do
not share them—although the degree of implausibility can vary from case to case. The
COVID-19 denier has a view that conflicts with the mainstream view. We can easily imagine
a situation in which the fact that people are ill and many are dying is initially attributed to a
health threat that turns out to be illusory. However, COVID-19 denialism is implausible
because it clashes with the evidence that has been accumulated by a great number of medical
professionals, statisticians, public health officials, etc.
Similarly, although the delusions of persecution described in the quote by Powell involve
mundane scenarios such as plotting co-workers or hostile family members, those described
by Payne could be the basis for a science-fiction story where aliens are planning to invade the
Earth and to make life miserable for those who intend to expose them. This is not just
unlikely but highly implausible given that to date there is no evidence of alien intelligent life,
let alone of aliens being able to communicate with humans.
Falsity is not a necessary condition for delusions or for conspiracy theories. Typically,
conspiracy theories and delusions do not accurately represent events and involve distortions
of reality; but in some cases, they can turn out to contain elements of truth. It is also worth
saying that both delusions and conspiracy theories can be based on people’s previous
experiences.
3.2. Epistemic irrationality
Norms of epistemic rationality refer to how well-grounded an attitude is in the light of the
evidence that is available and how responsive the attitude is to counterevidence and
counterarguments. An attitude can be epistemically irrational because it is ill-grounded or
because it is impervious to counterevidence and counterarguments (Bortolotti 2020, ch.1).
Conspiracy theories and clinical delusions have a bad reputation in both these respects and
are typically taken to be both ill-grounded and impervious to challenges.
As far as ill-groundedness is concerned, it should be noted that there is considerable variation
in the extent to which conspiracy theories and delusions of persecution are supported.
Generally, an external observer will find conspiracy theories and delusions ill-grounded.
However, there are delusions of persecution that are partially grounded in adverse
experiences of abuse in a person’s life which may partially explain why the person is
suspicious. Also, those who accept a conspiracy theory—or those belonging to their cultural
group—might have had experiences that at least partially explain why they mistrust the
alleged conspirators.
As far as imperviousness to challenges is concerned, both conspiracy theories and delusions
are thought to be unshakeable. Individuals who accept one or more conspiracy theories and
individuals with delusions do display some degree of sensitivity to counterarguments—at
least to the extent that challenges to the conspiracy theory or delusion are acknowledged and
reasons are offered in response to such challenges. However, typically neither conspiracy
theories nor delusions display relevant degrees of actual responsiveness to
counterarguments—that is, people are not actually open to abandoning or substantially
revising their attitudes when challenged. Delusions and conspiracy theories are “selfsealing”, meaning that any piece of evidence used against them tends to be reinterpreted as
evidence in their favor (Sunstein and Vermeule 2009). As a result, delusions and conspiracy
theories may become more entrenched and elaborated when challenged.
If Roberta Payne, who had the delusion about evil aliens, were told that there is no evidence
of the presence of aliens, she would have replied that the aliens are skilled at covering their
tracks—surely, they do not want to be discovered. Similarly, consider someone—let us call
him John—who claims that Bill Gates is using COVID-19 vaccines to insert microchips into
people with the secret purpose of controlling their future behavior. One might object that
there is no evidence that Bill Gates has either the technology or the power to implement such
a plan. To this John might respond that it is in Bill Gates’ interest not to let people know what
technology he has. This further articulation of the account is often accompanied by a
statement or a feeling of epistemic superiority: the individual who accepts the conspiracy
theory or has the delusion claims superior knowledge or unique access to the truth. So, John
might say: “Bill Gates will not fool me”. And, as Roberta writes: “Of course, the other people
were unaware of what was happening; I was the only person in the world who had the power
to know it”.
In relation to being self-sealing, delusions and conspiracy theories are arguably on a
continuum with ordinary confabulations.3 It remains an open question whether the acceptance
of conspiracy theories and delusions are more epistemically irrational than other attitudes.
4. Aetiology
Researchers are divided on whether having delusions of persecution and accepting conspiracy
theories have similar aetiologies. On some accounts, the similarities in surface features which
we discussed in the previous sections do not translate into similar causal histories. Oliver and
Wood (2014), for instance, argue that the main predictors of the likelihood of accepting a
conspiracy theory are a tendency to believe in unseen or supernatural forces and a preference
for narratives in which good and evil are in stark contraposition. These factors do not predict
persecutory delusions and do not suggest a disruption in normal functioning.4
Other researchers identify significant areas of overlap: both conspiracy theories and delusions
of persecution can be explained by predictive processing theories or two-factor models of
belief formation. According to predictive-processing theories (Reed et al. 2020; Hohwy
2013), conspiracy theories and delusions of persecution can be both viewed as inferences
under uncertainty and, in particular, responses to situations characterized by ambiguity or
threat. Belief-updating and learning differences are observed in individuals accepting a
conspiracy theory or having delusions of persecution. This includes a higher sensitivity to
changes in their environment and a tendency to predict uncertain events inflexibly. On this
view, the delusion or the conspiracy theory is the default explanation for mismatches between
the existing models of the world and new inputs that are due to the disruption of predictionerror signals.
3
“Conspiracy theorists are notoriously difficult to argue with, not only because their beliefs tend to be
unfalsifiable, but because their belief schema—the meta-narrative of conspiracy—provides a ready framework
for the inference and incorporation of any new facts. Yet this process of interpretation is not, of itself,
pathological, but is rather an extension or over-reaction of the everyday confabulation that causes subjects not
only to find reasons for preferring one pair of pantyhose over an identical one, for example, but to genuinely
believe that they do” (Bergamin 2020, p. 172).
4
“Although people with unusual levels of anxiety, paranoia, or personal mistrust are also likely to be attracted
to conspiracy narratives, believing in unseen forces or liking Manichean narratives is not irregular and would
not otherwise impair “normal” functioning in society. Indeed, our supposition is that these predispositions
originate in cognitive tendencies that would appear normal or even appropriate in other circumstances, such as
knocking on wood for good luck” (Oliver and Wood 2014).
Within two-factor models (McKay et al. 2007a; McKay et al. 2007b; Levy 2019; Pierre 2020;
Uscinski et al. 2020), conspiracy theories and delusions are explained by focusing on a first
factor that changes from case to case and on a second factor that is shared.
In the case of delusions, the first factor varies across types of delusions and arguably
accounts for the delusional theme. For monothematic and circumscribed delusions—those
with one theme and that do not tend to take the form of elaborated narratives—the first factor
is an anomalous experience, often due to brain damage from trauma or degenerative disease.
In the Capgras delusion, where the theme is that a loved one has been replaced by an
impostor, the anomalous experience is due to a problem with the affective route of the face
recognition system. It is not easy to identify the first factor contributing to delusions of
persecution, where the theme is that a third party is hostile and threatening. It has been shown
that people with delusions of persecution tend to interpret ambiguous stimuli (such as a
stranger glancing at them from a distance) as a sign of hostility (Freeman and Garety 2004),
suggesting that they have a somewhat distorted perception of social exchanges. Another
factor in persecutory delusions is mood instability: disturbances of mood are often a
mediating factor between trauma (such as bullying) and paranoia, leading people to
experience the world as unpredictable and unsafe (Broome and Bortolotti 2018).
In the case of conspiracy theories, the first factor is commonly described as epistemic
mistrust and the general theme is the presence of a secret plot (Pierre 2020). The mistrust in
question is generally shared by well-defined social groups and often directed at institutions—
such as the press, the experts, etc. It does not play a significant role in theories of delusion
formation, where paranoia is typically idiosyncratic.
For both delusions and conspiracy theories, the second factor is thought to be predominantly
cognitive. Most commonly, it is described in terms of reasoning deficits and biases (McKay
et al. 2007a; Pierre 2020). On these accounts, such deficits and biases explain the form of
delusions and conspiracy theories—that is, surface features such as implausibility and
imperviousness to counterevidence.
For Coltheart et al. (2010), the second factor in delusion maintenance is a cognitive deficit
inhibiting the rejection of an endorsed belief even in the presence of strong counterevidence,
making the belief virtually impossible to revise. For McKay (2012), the second factor in
delusion formation is a cognitive bias towards explanatory adequacy which leads people to
accept hypotheses that seemingly explain their experiences even when such hypotheses have
low prior probability and conflict with existing beliefs.
In the case of conspiracy theories, for some authors, the second factor consists in a variety of
cognitive biases, such as the so-called ‘intentionality’, ‘proportionality’, and ‘confirmation’
biases, as well as various forms of motivated reasoning. These biases underlie the ways in
which people seek to fill the “epistemic vacuum” created by the rejection of the official
account (Pierre 2020; Douglas et al. 2019). Although such biases may be accentuated in
people prone to having delusions and accepting conspiracy theories, this does not seem to
indicate a distinctive dysfunction. The cognitive tendencies attributed to them by predictiveprocessing accounts and two-factor accounts are not exclusive to these groups. They include:
seeking a causal explanation for threatening or unusual events; wanting to restore a sense of
control or give meaning to distressing circumstances; being willing to modify previously held
beliefs for the sake of providing a satisfactory explanation of new and salient events; and to
defy apparent counterargument in order to hold on to a seemingly satisfactory explanation
(Bortolotti and Ichino 2020; Ichino and Bortolotti forthcoming).
Both for delusions and for conspiracy theories, there may also be motivational elements, such
as a need for control and attributional biases (Pierre 2020; McKay et al. 2007b). In delusions
of persecution, poor life outcomes can be attributed to the hostility of others as a response to
low self-esteem (Bentall 2003). For conspiracy theories but not for delusions, group-marking
and in-group positivity also play a role, given the way conspiracy theories are shared within
political communities (Douglas et al. 2019).
5. Downstream effects
A key difference between conspiracy theories and delusions concerns the roles they play in
an individual’s social life and relationships: conspiracy theories are shared with relatively
large social groups and tend to strengthen group belonging and affiliation, whereas delusions
are typically idiosyncratic and deeply isolating. McKay and Ross (2020) suggest that “what
distinguishes […] beliefs in conspiracy theories from delusions may be partly a matter of
whether or not the belief strengthens community bonds. If sustaining a belief impairs your
daily functioning and disrupts your social relationships, then your belief is more likely to
count as a delusion”.
The difference in downstream effects between delusions and conspiracy theories is a point on
which there is much agreement in the literature (Brotherton 2015; Uscinsky 2019; Douglas et
al. 2019; Pierre 2020). This has important implications for how these phenomena impact on a
person’s wellbeing. It is indeed partly because of isolation and social withdrawal that
delusions of persecution are usually accompanied by anxiety and stress, which may be caused
either directly by the distressing content of the delusion or indirectly by the reactions of the
people in the surrounding social environment to the person reporting such content. Delusions
of persecution can be extremely distressing, as it emerges from first-person accounts, and can
heavily disrupt a person’s life. Payne moved cities, gave up her studies and her job, and
stopped contacting family and friends as a result of her fear of what the Alien Beings might
do to her or her loved ones. The acceptance of a conspiracy theory, in contrast, is generally
comforting and soothes uncertainty by providing a story that fits with the person’s existing
beliefs and other attitudes and is generally shared by one’s immediate social circle.
One might object that this line of argument overplays the positive effects of accepting a
conspiracy theory, whilst not paying enough attention to the negative effects. Indeed,
psychologists warn us that although it is true that conspiracy theories are accepted to satisfy
some psychological need for comfort and reassurance, the question whether they do actually
manage to satisfy such needs, thereby improving a person’s wellbeing, remains open
(Douglas et al. 2017; 2019). Moreover, even if conspiracy theories have no immediately
perceived negative effect on a person’s wellbeing, they might lead to anti-social behavior that
could result in individual and collective harm (Jolley and Douglas 2013; 2014; Douglas et al.
2019, pp. 17–21).
Moreover, not all clinical delusions are harmful or disruptive; some people find their
delusions rewarding and empowering (Jackson and Fulford 1997). This also applies to
persecutory delusions (Ritunnano et al. 2021). In the many delusions with distressing content
that are associated with harm, the delusions themselves might not be the actual cause of harm
but might be thought of as imperfect responses to situations that were already critical for the
person’s mental health (Gunn and Bortolotti 2018; Bortolotti 2020, pp. 175–176).
These considerations suggest that the difference between delusions and conspiracy theories
with respect to downstream effects are less neat than they initially appear to be.
6. Conclusions
We have shown that there are both similarities and differences between having a clinical
delusion and accepting a conspiracy theory. In particular, we have shown that: (a) in both
cases, the person claims something implausible and is not typically open to abandoning the
claim even in the light of powerful challenges; (b) although some factors responsible for the
adoption of a delusion and a conspiracy theory may be different and depend on the person’s
life history and past or present experiences, some of the underlying cognitive mechanisms
significantly overlap in the two cases; and (c) having a delusion often brings harm and
disruption to a person’s life (and this is what typically justifies medical intervention),
whereas accepting a conspiracy theory may be neutral or even psychologically and socially
beneficial for an individual—this difference likely being due to the fact that delusions
typically isolate people whereas conspiracy theories unite them.
It is difficult to draw general conclusions from the comparison between delusions and
conspiracy theories. However, one thing worth discussing is that stressing the similarities
between the two phenomena might lead one to consider the acceptance of conspiracy theories
as a symptom of a disordered mind, which might in turn lead to the stigmatization of those
who accept (one or more) conspiracy theories. It is commonplace to depict those who accept
conspiracy theories as irrational. Likening conspiracy theories to delusions brings support to
this move, pushing it even further through the suggestion that those who accept conspiracy
theories are not just irrational in an everyday sense, but are also mentally ill.
The stigma that is commonly associated with having a mental illness is harmful and ethically
objectionable in its own right.5 When this kind of stigma is directed at those who accept
conspiracy theories, it functions as a tool for excluding them from the arena of public debate
and for impairing their participation in collective discussion and deliberation.
Stigmatizing one’s political opponents without addressing their concerns and motivations is,
in general, politically undesirable. It is certainly useful to explore the similarities and
differences between delusions and conspiracy theories, just like it is useful to explore the
similarities and differences between delusions and ordinary beliefs or attitudes. However, the
political use of the comparison between delusions and conspiracy theories—especially when
5
The assumption on which stigmatizing attitudes are based, e.g., that those diagnosed with psychiatric disorders
are irrational in a way that is different in kind from people who are not, lacks justification (Bortolotti and
Puddifoot 2019).
it is aimed at producing or reinforcing stigmatization and exclusion—is problematic and
should be avoided.
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