Delusions and pathologies of belief: making sense of conspiracy beliefs via the psychosis continuum

Niall Galbraith

1 Introduction

Delusions are said to fall on a continuum representing the extreme end of a spectrum of psychotic-like traits (Murphy et al., 2010). Consistent with this view is the notion that milder forms of delusional beliefs are observable within the general population, manifesting as unusual ideas which do not cross the thresholds for clinical symptoms, but which might represent a vulnerability for psychotic disorder. In the pre-Internet age, unusual or bizarre beliefs (such as conspiracy theories) would have had fewer opportunities for social acceptance, as the proponents would have less chance to share their ideas with like-minded people. Indeed, part of the DSM-V definition of delusions stipulates that delusions are “not understandable to same-culture peers” (APA, 2013: 90). However, the rise of social media presents new platforms for socially unacceptable beliefs to gain exposure and endorsement from like-minded others, who are no longer limited by geographical constraints (Bell, 2007). Evidence suggests that conspiracy theories and other contentious beliefs have grown in popularity due to the ease with which they are propagated and reinforced through online platforms (Bessi et al., 2015). This chapter reviews the current evidence on the continuity between delusions and conspiracy beliefs. It also explores whether social media and other online platforms make vulnerable individuals more likely to adopt unsound beliefs and consider the effects this might have on mental health as well as the broader social and political implications.

2 Psychosis as a continuum

There is now a considerable body of evidence for the notion that psychosis falls at the extreme end of a spectrum which also includes healthy non-clinical experience. This theory is at odds with Kraepelin (Kraepelin, 1990; see also Bentall, 2003),

TABLE 7.1 Descriptions of the most notable types of delusion

Control

Where feelings, actions, cognitions, or sensations are believed to be under the control of an external source

Grandiose

Where the individual has inflated beliefs about his/her wealth, power, importance, or status in the world

Guilt

Hypochondria Infestation Jealousy Love

Misidentification

Beliefs of unworthiness or shame

Where the individual falsely believes s/he has a serious disease

The belief that one has become infested by small organisms

Where the individual believes that his/her partner is unfaithful

Based upon the false belief that the individual is loved by another person Where the patient believes that a familiar person has been replaced by an identical impostor (Capgras syndrome), where an unfamiliar person is believed to be someone known to the patient (e.g., their mother; Fregoli syndrome), or where inanimate personal possessions are believed to have been replaced by inferior copies (inanimate doubles)

Persecutory

Where the person believes that they are being pursued, spied on, plotted against, or persecuted

Reference

Where seemingly random events in the persons environment are assumed to have some significance or reference to the self

Religion

Where the person may believe that they have a special relationship with a religious figure or unusual religious powers

Somatic

Delusions relating to the appearance or the functioning of the body

who believed that psychosis (dementia praecox) was utterly distinct from normal behaviour. The traditional Kraepelinian view of psychiatric disorder, still reflected in the DSM-V (APA, 2013), is one where psychiatric symptoms are placed into categories with psychotic disorders falling into either schizophrenia or affective psychoses. However, the validity of such discrete categories has been questioned due to high comorbidity between diagnoses such as schizophrenia and bipolar disorder (Laursen et al., 2009) and the commonality of genetic and environmental risk factors for these diagnoses (e.g., Lichtenstein et al., 2009).

There are two perspectives on the nature of the continuity of psychosis. Firstly, the clinical view put forward by Meehl (1962, 1990) and Lenzenweger (2011) is that certain vulnerable individuals possess an inherited proneness to schizophrenic symptoms. The severity of these symptoms may be measurable along a dimension, but a dimension which is discontinuous with normality (Lenzenweger, 2011; Lenzenweger and Korfine, 1995). Meehl (1990) posits that up to 10% of the population may have such a vulnerability, which is underpinned by a central nervous system anomaly (schizotaxia), and of these, around 50% are expected to develop schizophrenia. Hence, many individuals will carry the latent liability for schizophrenia, but not all of these will develop the disease.

Claridge and Beech (1995) describe Meehl’s conceptualization of schizotypy as “quasi-dimensional”, in that it represents a disease continuum rather than a full personality dimension. More recently however, large studies of the general population (e.g., Laurens et al., 2012; Mendez et al., 2019; Nuevo et al., 2012) show robust evidence for Claridge and Beech’s fully dimensional model of the psychosis continuum. Claridge and Beech view schizophrenia as continuous with normality, a view also referred to as the ‘individual differences approach’. The severest forms of the illness exist at the extreme end of the dimension, with healthy experience as its polar opposite. Less severe forms of psychotic behaviour can be found at points along the continuum (see also van Os et al., 2009). Importantly, Claridge and colleagues’ argument in favour of the individual differences view incorporates the notion that schizophrenia and the other psychotic disorders are related and represent different points along an illness continuum. The evidence for such a view can be gleaned from three sources: family studies, reports of psychotic-like experiences in healthy individuals, and psychometric data.

a Family studies

Taylor (1992) carried out a review of family studies. He found high incidence of affective disorder in relatives of schizophrenic probands. For example, Tsuang et al. (1980) found that the risk for bipolar affective disorder in first-degree relatives of schizophrenic patients was significantly higher than in first-degree relatives of controls. Similarly, Mendlewicz et al. (1980) reported a high risk for bipolar affective disorder in first-degree relatives of schizophrenic probands. More recent studies support this finding: a higher risk of schizophrenia and schizophrenia spectrum personality disorder among first-degree relatives of recent-onset schizophrenia probands than in first-degree relatives of community control probands (Subotnik et al., 2017). Indeed, large population studies show that a diagnosis of schizophrenia is strongly associated with a range of psychotic disorders in first-degree relatives (Mortensen et al., 2010). Taylor also reviews a number of studies that report a higher occurrence of schizophrenia in relatives of affective disorder patients (e.g., Angst et al., 1980; Scharfetter and Niisperli, 1980). More recent research concords with this as Vallès et al. (2000) report risk of schizophrenia is higher in relatives of bipolar probands than in relatives of controls. Hochberger et al. (2016) report common neurocognitive dysfunction in probands diagnosed with schizophrenia, schizoaffective disorder, or psychotic bipolar disorder, as well as their first-degree relatives. Facial emotion recognition deficits are found in relatives of probands with schizophrenia, schizoaffective disorder, and bipolar disorder (Ruocco et al., 2014). Consistent with this research is the finding that schizophrenia and bipolar disorder have a common polygenic basis (International Schizophrenia Consortium, 2009).

b Psychotic-like experiences in the general population

Thus, family studies support the continuum model by revealing a genetic basis for a spectrum of psychotic disorder. Further support for the continuum comes from evidence that the spectrum of psychotic-like experience extends into the general population. Numerous studies demonstrate that healthy people can experience milder forms of psychotic-like experience, such as delusions and hallucinations (e.g., Galbraith et al., 2014; Kelleher and Cannon, 2011). For example, Posey and Losch (1983) found that 39% of a student sample reported having previously heard voices. Furthermore, 5% of these claimed to have had conversations with their voices. Tien (1991) reported data collected from approximately 18,000 people as part of a large epidemiological study of psychiatric symptoms in the United States. Between 11% and 13% of the sample reported having hallucinatory experiences at some point. In a later study, van Os et al. (2000) found that nearly 8% of a sample numbering 7076 reported hallucinatory experiences (excluding those attributable to drug use or illness). In addition, van Os et al. (2000) reported that approximately 12% of their sample were found to have delusions of varying intensity (3.3 were adjudged to have had ‘true’ delusions). In a longitudinal study, Poulton et al. (2000) found that just over 20% of their sample were found to have delusional beliefs. Other types of psychotic symptoms aside from hallucinations and delusions have been reported by healthy people. For example, Poulton et al. (2000) found that nearly 18% of their sample were assessed as having disorganized speech. A metaanalysis of psychosis proneness reports a median prevalence rate of 5% (van Os et al., 2009).

Other characteristics displayed by schizophrenic patients are found in psychometric schizotypes from the normal population. For example, Obiols et al. (1993) found that high schizotypes were poorer on a measure of sustained attention, which is known to be characteristic of people at risk for psychosis (Erlenmeyer-Kimling and Cornblatt, 1987). Cognitive biases (e.g., bias against disconfirmatory evidence or BADE) commonly found in patients with psychosis (Woodward et al., 2006) are also evident in those with subclinical delusional ideation (Zawadzki et al., 2012). People with high schizotypy display schizophrenic phenomenology (Kendler et al., 1985); they show deficits in sustained attention (Lenzenweger et al., 1991; Le Pelley et al., 2010), eye movement dysfunction (Myles et al., 2017; Siever et al., 1990), performance deficits on the Wisconsin Card Sorting Task (Сарре et al., 2012; Lenzenweger and Korfine, 1994), and a data gathering bias on tasks of statistical reasoning (Linney et al., 1998; Ross et al., 2015).

These studies suggest, therefore, that psychotic-like experiences are prevalent in the normal population albeit in a milder form. This implies that the disease continuum proposed by Meehl (1990) extends beyond those who suffer psychiat-rically defined psychosis into the healthy section of the population, thus providing support for the individual differences approach advocated by Claridge and Beech (1995).

c Psychometric studies on the structure of psychotic-like experiences

Further support for the notion of a psychosis continuum is provided by psychometric studies. Dissatisfaction with the categorical, Kraepelinian convention has inspired data-driven attempts to map the structure of psychosis in both clinical and non-clinical populations. Psychometric measures have found schizotypal traits to be roughly normally distributed in the general population (Mason et al., 1995; Bentall et al., 1989); furthermore, such measures appear to load onto factors which are consistent with the clusters of symptoms found in psychosis. Typically, the factors on schizotypy measures will reflect positive symptoms, negative symptoms, and disorganization factors (Liddle, 1987; Vollema and Hoijtink, 2000; see also Venables and Bailes, 1994), thus reflecting the major symptom groups of schizophrenia. Other measures have included a fourth factor which appears to reflect impulsive and non-conformist behaviours (e.g., Claridge et al., 1996; Mason et al., 1995) which Mason et al. (1995) suggest is a common feature of schizophrenic spectrum disorders such as bipolar affective disorder. More recently, a five-factor structure - positive symptoms, negative symptoms, cognitive disorganization, affective symptoms, and mania - has been demonstrated both in patients (Stefanovics et al., 2014) and in the general population (Shevlin et al., 2016).

It should be noted, of course, that despite the volume of research evidence available, the continuum model of psychosis is not without criticism. Parnas and Henriksen (2016), for example, argue that psychometric studies of psychotic symptoms reduce such episodes to simplified events, assuming them to be homogeneous and universal. Parnas and Henriksen argue that such a conceptualization of psychosis loses sight of the context or gestalt - the rich, contextual picture of the psychotic experience. When measured psychometrically, subclinical and clinical experiences might superficially appear to represent the same concept, but through careful clinical interview the phenomenology' behind apparently similar events can be profoundly distinct (see also David, 2010). Psychometric studies are not suited to capturing the nuanced phenomenology of psychosis. And it has been argued that methodology is crucially important to the way psychopathology is recorded, with different methods accounting for the rather broad incidence rates of psychotic-like experiences reported in the literature (David, 2010). David (2010) goes on to argue that pure quantification of symptoms can be invalid as a measure of severity and that although such measurement is convenient for large statistical surveys, symptoms can only be truly understood when also accounting for their social and phenomenological context.

In defence of the fully dimensional model however, there is evidence that psychometric measures can predict future development of psychosis, which goes some way to support the validity of the continuity model. Chapman et al. (1994) divided a student sample into high and normal scoring groups based on responses to a battery of schizotypy measures. After a ten-year follow-up, 14 of the high scorers had been admitted to hospital with psychosis, whereas in contrast, only one of the normal scorers had been hospitalized with a psychotic episode. Other longitudinal studies have supported these findings showing that risk of developing subsequent psychotic disorder is far higher in those who have reported earlier psychotic-like experiences (Hanssen et al., 2005; Kaymaz et al., 2012; Poulton et al., 2000). Thus, psychometric measures provide evidence that psychotic-like traits are distributed across the general population, and that these traits reflect not just schizophreniclike behaviours but also the schizophrenia spectrum disorders, including bipolar affective disorder and schizoaffective disorder.

In summary, the literature reviewed here presents an argument for the existence of a psychosis continuum. Research evidence has established that schizophrenia and the schizophrenia spectrum disorders represent a psychosis continuum which extends beyond disease states. There is also evidence that the presence of psychotic-like experiences in the subclinical range represents an elevated risk of subsequent clinical psychosis. This chapter attempts to draw a conceptual link between schizotypy and conspiracy beliefs. We have established that there is evidence for a psychosis continuum, the next step is to consider the continuum of belief, i.e., how beließ fit into the spectrum of psychosis. To answer this question, we must consider the literature on delusions and attempt to explain how delusions are continuous with other types of belief.

3 Delusions and other implausible beliefs

Delusions have been described as the sine qua non of psychosis (e.g., Kemp et al., 1997) (although the necessity and sufficiency of delusions for the diagnosis of schizophrenia was relaxed in DSM-V [see Bebbington and Freeman, 2017]). Delusions are beliefs which, according to the DSM-V (APA, 2013), are fixed and not amenable to change in the face of conflicting evidence. Delusions are regarded as bizarre if they are clearly implausible or not understandable to same-culture peers. Delusions are also multidimensional and may be assessed in terms of distressed caused, preoccupation, degree of conviction, and action (Garety and Freeman, 1999; Freeman et al., 2016; Gaynor et al., 2013; Sisti et al., 2012). Delusions are most commonly thought of as a symptom of schizophrenia (Tandon and Maj, 2008); however, they are also transdiagnostic and feature in a range of other conditions (e.g., depression; Johnson et al., 1991; see Bebbington and Freeman, 2017). Delusional content can take numerous forms, but certain themes are common (see also Arciniegas, 2015) as can be seen in Table 7.1.

Within the psychosis continuum framework, there has been much research on the relationship between delusional beliefs (or schizotypy more generally) and other types of belief. In the research literature, the beliefs targeted by such research have most commonly been described as magical, superstitious, or paranormal beliefs, anomalous experiences, or fantasy proneness (Brugger and Mohr, 2008; Drinkwater et al., 2020; Eckblad and Chapman, 1983; Hergovich et al., 2008; Swami et al., 2011). These terms are indeed sometimes used interchangeably to refer to the same construct; however, before proceeding we should look at how authors have sought to define these kinds of belief.

In designing the Magical Ideation Scale, Eckblad and Chapman (1983) defined magical thinking as “belief and reported experiences in forms of causation that by conventional standards are invalid” (215). Scores on the magical thinking scale are positively related to Tobacyk and Milford’s (1983) Paranormal Belief Scale (PBS;

see Tobacyk and Wilkinson, 1990), who define the paranormal as phenomena which are incompatible with current science and incompatible with “normative perceptions, beliefs, and expectations about reality” (1029). Although the definition of paranormal belief is contentious, paranormal belief is multidimensional: the PBS, for example, and the subsequent revised PBS (RPBS; Tobacyk, 2004) measure belief across seven subscales: religious belief, psi, witchcraft, spiritualism, precognition, superstition, and extraordinary lifeforms. Studies into ‘superstitious beliefs’ have often employed the superstition subscale of the PBS to measure this construct, but other scales and measures have also been used (see Fluke et al., 2014; Keinan, 2002; Wiseman and Watt, 2004). It should be noted that Wiseman and Watt (2004) note that superstition can often reflect positive beliefs (e.g., charms bringing good luck), whereas the superstition subscale of the PBS tends to focus on superstitions which are negative (e.g., Black cats can bring bad luck).

These definitions have some similarity with Lindeman and Aarnio’s (2007) proposal that magical, superstitious, and paranormal thinking are all underpinned by a tendency to make ontological confusions. This is where the core attributes of mental, physical, and biological entities are conflated such that inanimate physical objects are attributed mental ability' (e.g., knowledge, desire) or mental phenomena (such as thoughts) are given biological or physical properties.

Based on the foregoing definitions, these types of belief tend to embody a greater willingness to endorse unconventional or unscientific conceptions of phenomena in the world, including the properties of such phenomena and their effects on the environment. For the remainder of this chapter, I shall refer to these types of belief collectively as ‘implausible beliefs’. So, what do such beliefs have in common with delusions?

To answer this, let’s consider the DSM-V definition of delusions as a reference point. The DSM-V and all the paranormal definitions given previously emphasize beliefs which are held contrary' to clear evidence or conventional/scientific knowledge. Both the DSM-V and the foregoing paranormal definitions also emphasize deviation from normal life experiences - which in the case of the DSM-V is a criterion for distinguishing bizarre from non-bizarre delusions. Bizarre delusions are characterized by the DSM as implausible to same-culture peers and not derived from ordinary life experiences, whereas a non-bizarre delusion may in theory be plausible (e.g., being under surveillance by' the police) but held despite convincing evidence to the contrary. Perhaps the key' difference between the DSM-V and paranormal descriptions is the former’s emphasis on the conviction and fixedness of the beliefs. Indeed, the DSM-V cites strength of conviction as the index for differentiating delusion from strongly held ideas. Within a continuum framework therefore, we can see that the definitions of delusions and paranormal beliefs have overlap but might be distinguished by' degree of conviction.

Thus, the definitions of delusions and other implausible beliefs, such as those relating to the paranormal, have conceptual overlap. Let us now consider the research evidence for how they might coexist on a belief continuum. Firstly, as can be seen in Table 7.1, the paranormal is a common delusional theme and this is supported by empirical studies documenting such delusions (Lange and Houran, 1998, 1999). People reporting more psychotic-like symptoms score higher on the Magical Ideation Scale (Eckblad and Chapman, 1983) and when the MI items were divided into ‘paranormal’ and ‘psychotic’ content, both of these subscales correlated with paranormal belief on the Australian Sheep-Goat Scale (Thalbourne and Haraldsson, 1980), hence these relationships were not simply due to similarity between items, but perhaps share a common latent factor (Thalbourne, 1984). The most widely used psychometric measures of delusional ideation, the Community Assessment of Psychic Experiences (CAPE; Wigman et al., 2011), the Peters et al. delusions inventory (PDI; Peters et al., 1999, 2004), and the Schizotypal Personality Questionnaire (SPQ; Raine, 1991), include items on paranormal phenomena. Numerous studies from across the world on the psychometric structure of the CAPE and SPQ group paranormal/magical ideation items with other delusion-like beließ and positive symptoms (Brenner et al., 2007; Cicero, 2016; Fonseca-Pedrero et al., 2018; Schlier et al., 2015).

Research has revealed that certain cognitive biases associated with delusional beließ (for a review, see Galbraith and Manktelow, 2014) also co-occur with paranormal beliefs. For example, both delusional and paranormal beliefs are associated with a bias against disconfirmatory evidence (BADE; Woodward et al., 2006), a heightened reluctance to change one’s initial hypothesis in the face of new counterevidence. Both are associated with a liberal acceptance bias (Moritz and Woodward, 2004; Prike et al., 2018) where one is biased to be more accepting of implausible ideas. Both types of belief are associated with a data-gathering bias (Dudley et al., 2016; Fine et al., 2007; Irwin et al., 2014) characterized by a tendency to make hasty decisions based on less evidence. Increased errors in deductive reasoning have been found in both paranormal believers and delusion-prone respondents (Anan-dakumar et al., 2017; Lawrence and Peters, 2004; Sellen et al., 2005), both types of belief are related to lower reliance on analytic thinking (Freeman et al., 2014; Ross et al., 2017) and both paranormal believers and the delusion-prone respondents show evidence of statistical reasoning errors/biases (Dagnail et al., 2016; Galbraith et al., 2010; Rogers et al., 2017).

Furthermore, both types of belief show neurocognitive similarities. High scores in both magical ideation and schizotypy show reduced left hemisphere dominance for language (Leonhard and Brugger, 1998). This is perhaps due to loose semantic processing and overactivation of the right hemisphere, which Gianotti et al. (2001) argue provide the common factor in paranormal and delusional thinking and which also manifest in higher levels of creativity in both paranormal believers and those with schizotypy (Weinstein and Graves, 2002). Both paranormal believers and those higher in schizotypy show stronger right hemisphere activation (Pizzagalli et al., 2000) and also stronger ambidextrality (Gruzelier, 1994; Nicholls et al., 2005).

Before we move on to consider conspiracy beliefs, we must consider what distinguishes subclinical implausible beliefs from genuine psychotic delusions. Firstly, psychotic delusions are often comorbid with other symptoms such as cognitive disorganization, hallucinations, low mood, mania, negative symptoms, etc. (refs), but this comorbidity is not typical in paranormal beliefs.1 Secondly, the delusional continuum is indexed by degrees of conviction, preoccupation, and distress (Peters et al., 2004). Similarly, paranormal beliefs are related to negative affect (Dudley, 2000) and, although they are amenable to change (Kane et al., 2010; Wilson, 2018), they can be held with strong conviction (Musch and Ehrenberg, 2002).

Perhaps one of the features of paranormal belief which distinguishes them from delusions is simply how commonplace they are. Unlike psychotic delusions, paranormal beliefs are commonly held within society, with up to 48% of a large UK sample reporting a paranormal experience and with paranormal belief being strongly related to such experience (Pechey and Halligan, 2012). The wide acceptance of such beliefs within society clearly violates another feature of psychotic delusions, i.e., that they should not be shared by same-culture peers. However, the degree to which beliefs are shared by one’s culture perhaps represents another dimension to the psychosis continuum, as delusion-like beliefs are also prevalent in the general population: for example, in 39% of a UK general population (Pechey and Halligan, 2011) and ideas of persecution or paranoia can be shared by cultures and communities.

For example, cyber-paranoia and beliefs about online surveillance are widely expressed and are shared by mainly online communities who join in common endorsement of such ideas (Holm, 2009; Mason et al., 2014). It has been argued that these narratives are the product of modern society and are driven by social inequality (Harper, 2011). Indeed, the archetype of paranoia in which an individual believes himself to be persecuted by powerful agencies is no longer solely the domain of the isolated psychotic patient: recent years have seen the emergence of ‘targeted’ individual’ communities, in which members come together online to share their convictions about being the subject of state or agency-driven persecution (Xuan and MacDonald III, 2019).

As we can see, in the decades since the development of the Magical Ideation scale, evidence has mounted in favour of conceptual overlap between delusions and other implausible beliefs, particularly those relating to the paranormal. There is evidence that paranormal or magical beliefs feature in both psychotic delusions and subclinical delusional ideas, thus supporting the notion of a continuum of belief, a dimension of the psychosis continuum which incorporates the varying intensity of delusional beliefs. The question to which we turn next is whether the continuum of delusional belief can be extended to incorporate another type of implausible belief: conspiracies.

4 Do conspiracy beliefs fall on the delusion continuum?

To answer this question, we must consider whether conspiracy beliefs share a conceptual overlap with delusions as other implausible beliefs do (such as those relating to the paranormal). Before that however, let us define what we mean by ‘conspiracy theories’.

Conspiracy theories claim that certain events or practices are the doing of omnipotent groups operating in coalition and in secret, often to intentionally control the social order or to achieve malevolent or harmful goals (Fenster, 1999; Sunstein and Vermeule, 2009; Zonis and Joseph, 1994). Conspiracy theories often make claims which are unwarranted or clearly false given the available evidence (Sunstein and Vermeule, 2009), often arguing for patterns or connections between random or coincidental events where mundane explanations are more likely to be true (Ramsay, 2012; van Prooijen, 2018). Sometimes however, conspiracy theories, by their nature, are difficult to falsify (e.g., Newheiser et al., 2011). Although many conspiracy theories have political themes such as the 9/11 attacks, the death of Lady Diana, the Apollo moon landings, or the assassination of John F Kennedy, many others reflect supernatural ideas such as alien abduction or alien impostors (e.g., lizard people) (Banaji and Kihlstrom, 1996; van Den Buick and Hyzen, 2020).

In line with these features, the definition of conspiracy belief by van Prooijen & van Vugt (2018) summarizes five key characteristics that such beliefs should have: patterns (patterns of events that are not coincidental); agency (events that are caused purposefully not by accident); coalitions (the theory must involve groups working together); hostility (the coalition must be pursuing goals which are selfish and not in the public interest); continued secrecy (coalitions operating in secret, at least until the conspiracy is proven with hard evidence). These characteristics, van Prooijen & van Vugt (2018) argue, are necessary for conspiracy theories. Other types of belief, such as supernatural beliefs, might share some but not all of these features. For example, belief in ghosts might involve detecting patterns and agency but lacks the necessary elements of hostility and coalition (ghosts are not necessarily hostile nor do they necessarily co-conspire with others in some hostile plan). These definitions will be useful as we now turn to consider the relation between conspiracy beliefs and delusional beliefs.

4.1 Conspiracy belief and schizotypy

Firstly, the foregoing definitions of conspiracy theory reflect some of the characteristics of delusions and paranormal beliefs, in particular the presence of unwarranted claims and misinterpreted evidence. Hence, grouping conspiracies with other implausible beliefs is justified. Conspiracies also embody some of the paranoia commonly found in delusions, whereby there is suspicion of hostile groups who have malevolent intentions - however, the degree to which the believer is the sole subject of this hostility perhaps distinguishes conspiracy theories from paranoia, an issue we will return to later.

If conspiracy beliefs do fall onto the continuum of delusional belief, then we should see consistent relationships between schizotypy and conspiracist ideation. Such evidence has been mounting over the past decade or so. Darwin et al. (2011) report that both non-clinical paranoid ideation and schizotypy were both strongly related to conspiracy belief. A confirmatory factor analysis modelling the relationships between these variables was stronger when paranormal belief was omitted.

Darwin et al. (2011) suggest this indicates conspiracy beliefs have more in common with paranoia than paranormal beliefs. Conspiracy beliefs reflect milder levels of suspicion towards malevolent others which at more moderate locations on the psychosis continuum are even adaptive and protective. Only if such suspicion reaches an intensity which is maladaptive for mental health and social relationships would it be classed as a clinical delusion warranting clinical care. Numerous other studies have also shown relationships between conspiracy belief and paranoid ideation or other measures of schizotypy (Barron et al., 2018; Bruder et al., 2013; Brotherton and Eser, 2015; Denovan et al., 2020; Georgiou et al., 2019; van der Tempel and Alcock, 2015; see also Imhoff and Lamberty, 2018, for a review).

Also commonly reported in the literature are relationships between conspiracy belief and paranormal belief (Barron et al., 2018; Drinkwater et al., 2012; Lobato et al., 2014). One of the difficulties with such studies however is that the constructs of paranormal belief, magical ideation, and schizotypy can be conflated. As we have already seen, the magical ideation scale is sometimes described as a measure of paranormal belief and sometimes as a measure of schizotypy. Both descriptions have validity. As we have seen, psychometric studies of delusional beliefs incorporate items on magical or paranormal phenomena. This presents a risk of circularity however, where constructs are purported to correlate with one another and yet are measured with the same or very similar instruments.

4.2 Conspiracy belief and cognition

So, there is growing evidence that conspiracy beliefs and schizotypy are related. Let us look next at whether the tendency to believe in conspiracy theories shares some of the underlying psychological factors with delusions or other implausible beliefs. Firstly, there is evidence that certain thinking styles or information processing biases are found in conspiracy belief as they are in delusional or paranormal belief. Belief in conspiracy theories seems to be negatively related to analytical thinking (Barron et al., 2018; Georgiou et al., 2019; Stahl and van Prooijen, 2018; Swami et al., 2014). This suggests that belief in such theories is due in part to a failure or unwillingness to apply rational or critical thought when assessing evidence for one’s beliefs and perhaps a greater reliance instead on intuition. This is something which conspiracy beliefs have in common with paranormal belief and delusional ideation (Freeman et al., 2014; Ross et al., 2017; Ward and Garety, 2019). This might be more than simply a correlation too: Swami et al. (2014) found that experimental manipulations to induce better analytical thought also reduced the strength of con-spiracist beliefs. Similarly, Orosz et al. (2016) also found that strength of conspiracy belief could be reduced through rational counter-argument. Thus, as with other implausible beliefs, conspiracy beliefs might be more likely in those who are less analytical, less likely to engage in effortful consideration of the evidence, and are more likely to rely on instinctive, intuitive judgements.

The ‘need for cognitive closure’ (NFCC) construct has also been investigated as a potential factor in conspiracy belief. NFCC is characterized by a desire to gain quick answers to solutions and also a need to preserve the solution, thus maintaining order and structure and avoiding confusion and ambiguity (Webster and Kruglanski, 1994). As NFCC can be both dispositional and situational, it is appealing as an explanation for why strong beließ are formed and tenaciously held onto - judgements are formed quickly and preserved with little scrutiny of counter-evidence and alternative views, thus avoiding cognitive dissonance (Festinger, 1957). NFCC has been shown to predict political beliefs (Golec de Zavala and van Bergh, 2007) and self-enhancing beliefs about parenting (Taris, 2000) and epistemic beliefs (Rosman et al., 2016).

The evidence for NFCC playing a role in conspiracy belief is reasonably good. Leman and Cinnirella (2013) found that manipulation of NFCC can reduce belief in conspiracy. Other studies show a relation between NFCC and strength of conspiracy belief (Marchlewska et al., 2018; Umam et al., 2018). However, Moulding et al. (2016) found that intolerance of uncertainty did not predict faith in conspiracy theories, van Prooijen and Jostmann (2013) argue though that uncertainty is more likely to influence conspiracy beliefs when there is simultaneously a perception of low morality in authorities. So, there is some support for the idea that NFCC makes one more vulnerable to conspiracy belief. This same cognitive bias has been linked with delusional belief: higher NFCC has been found in delusional patients and delusion-prone non-patients (Bentall and Swarbrick, 2003; Colbert and Peters, 2002; McKay et al., 2006). NFCC has also been proposed as a mechanism for why people with delusions jump to conclusions - hasty decisions are made in order to avoid ambiguity, although the evidence linking NFCC and the JTC bias is mixed (Freeman et al., 2006; McKay et al., 2006).

Delusions, paranormal, and conspiracy beliefs share other cognitive biases too. Teleological bias (seeing intentionality and purpose in naturally occurring events) is related to both conspiracy and paranormal beliefs (Lindeman et al., 2015; Wagner-Egger et al., 2018). Misperception of patterns is evident in paranormal believers and in conspiracist ideators (van Prooijen et al., 2018). Susceptibility to the conjunction fallacy (where one incorrectly judges the conjunction of two events as more likely than either event occurring alone) is higher in conspiracy believers (Brotherton and French, 2014; Dagnall et al., 2017) and proneness for similar statistical reasoning biases is reported in paranormal believers, (e.g., Rogers, 2014) and in delusional/delusion-prone participants (Galbraith and Manktelow, 2014; Galbraith et al., 2010).

The evidence of cognitive bias in conspiracy belief offers encouraging lines of inquiry. However, the number of studies is still quite small and further replications with a broader range of methodologies are needed before strong conclusions can be drawn. A further weakness is the reliance on self-report measures of cognition. The studies on thinking style in conspiracy belief have mostly used only self-report scales such as the Rational Experiential Inventory (REI; Pacini and Epstein, 1999) despite the evidence that the REI does not necessarily correlate with actual thinking performance (Newstead et al., 2004). Similarly, research which relies solely on Webster and Kruglanski’s (1994) self-report NFCC scale is questionable for the same reason: self-reporting on one’s own cognition is unreliable and stronger conclusions can be drawn from studies which use performance measures or experimental manipulations (e.g., Whiston et al., 2015). When Mikuskova (2018) administered both the REI and the cognitive reflection test (CRT; Toplak et al., 2014), as with other studies, self-reported rational thinking on the REI was positively related to strength of conspiracy belief, but actual thinking performance as measured by the CRT was unrelated to it. Stahl and van Prooijen (2018) did however observe a negative relationship between analytic responding on the CRT and conspiracy beliefs. Importantly, Stahl and van Prooijen (1028) also found that scepticism towards conspiracies is predicted not simply by analytic cognitive style, but the combination of this and the motivation to think analytically.

Hence, there is mounting evidence that conspiracy beliefs are related to schizotypal traits and the research on cognition shows that conspiracy beliefs share similar cognitive biases with other forms of implausible belief, although this evidence is not without its weaknesses. Like other implausible beliefs, conspiracist ideation is not characterized by system 2 (Evans and Stanovich, 2013) analytical thinking and is instead associated more so with system 1 processing style: a reliance on fast, instinctive, heuristic judgement. What must be stressed however is that cognitive bias is itself continuous much like other traits (Stanovich et al., 2016) and if conspiracy beliefs are characterized by cognitive bias, this should not be taken to mean that conspiracy believers exhibit these biases and non-conspiracy believers do not. No, rather the former might display a stronger tendency for biases which are found to some degree in most individuals.

What other similarities beyond cognitive factors might help to compare or contrast delusional and conspiracy beliefs? The literature on the social and environmental factors underpinning delusions is well developed. There is also growing research evidence for the role that such factors play in conspiracy beliefs.

5 Social and environmental factors in conspiracy beliefs

Conspiracy beliefs have been proposed as serving a psychological function in the face of social threat. When societal perceptions of powerlessness, lack of control, a sense of societal threat, or anomie are prevalent (Abalakina-Paap and Stephan, 1999; Bruder et al., 2013; Jolley et al., 2018; Whitson and Galinsky, 2008), conspiracy beliefs are said to emerge as a way of making sense of and gaining control over these complex social issues (Swami and Coles, 2010). This might lead to mistrust of others and to the externalizing of anger and fear upon perceived enemies within society (Abalakina-Paap etal., 1999; Goertzel, 1994). Indeed, there is experimental evidence that an increase in anxiety can intensify conspiracist thinking towards perceived outgroups (Grzesiak-Feldman, 2013) and the relation between conspiracy and mistrust of authority is well known (Bogart et al., 2016; Freeman et al., 2020). In his existential threat model of conspiracy theories, van Prooijen (2020) proposes that existential threat motivates people to find ways to make sense of their social environment. Such perceived threat exacerbates cognitive processing biases resulting in misinterpretation of information and biased judgements. Conspiracy beliefs then arise if there is a salient and despised outgroup (which can be either low [e.g., ethnic minorities, refugees, etc.] or high in power [political parties, institutions]) onto which negative emotions can be projected. The model incorporates the Adaptive Conspiracism Hypothesis (van Prooijen and van Vugt, 2018), which proposes that conspiracist tendencies have evolved as an adaptive response to intergroup conflict throughout early human history.

According to this view, conspiracy beliefs are a rational reaction to negative societal conditions, van Prooijen’s (2020) argument - that emotional (perceived threat), cognitive (epistemic sense-making characterized by cognitive bias), and social factors (perceived ingroups and outgroups) combine in conspiracy beliefs - has similarities with Freeman’s threat anticipation model of delusions (Freeman, 2007). Freeman’s model proposes that paranoia arises from an interaction between emotion, cognition, experience, and self-concept. Negative schemas (about the self, others, and the world) may prime one to see oneself as vulnerable and inadequate and at the mercy of bad and dangerous people. The anxiety which arises from this makes one hypervigilant for threat, thus biasing the way one processes information, with a reliance on hasty or system 1 thinking. Social and internal experiences will then likely be interpreted through a lens of threat and vulnerability, leading to paranoid hypotheses.

Like van Prooijen, Freeman’s model also explains delusions as a rational response to adverse psychosocial conditions, enabling such beliefs to be seen not as pathological but rather as the product of normal belief formation processes. Such a view is implicit in the continuum model of psychosis. Paranoia should only be considered a clinical phenomenon when it becomes incompatible with well-being and reasonable social functioning. In milder form, the ability to feel some paranoia in certain contexts is adaptive, providing the individual with appropriate levels of suspiciousness to be able to detect genuine cheaters, exploiters, and hostiles when they are encountered (see Raihani and Bell, 2019). In van Prooijen’s view, the ability to form conspiracy beliefs can serve a similar adaptive function, equipping the individual with the ability to be suspicious when faced with genuine exploitation or threat from hostile groups. As Imhoff and Lamberty (2018) argue, perhaps the principal difference between paranoia and conspiracy is the extent to which perceived threat is projected onto specific outgroups and the degree to which the individual perceives themselves as the specific object of persecution. In paranoia, the hostile others may be less specifically defined than in conspiracy theories (although this is not always the case). In paranoia, the target of the hostility is the self, whereas in conspiracy theories the target is society or communities. If conspiracy beliefs have evolved from adaptive origins, why are they seen as problematic and why have they attracted the interest of so many researchers? In the next section, I will consider this question with particular focus on conspiracy beliefs in the online world.

6 Conspiracy beliefs and social media: causes and effects

Perhaps one of the reasons for the increasing interest from researchers is that conspiracy theories can do significant harm to society. Conspiracy theories about vaccines prevent people from vaccinating themselves or their children placing themselves and society at greater risk of infection (Jolley and Douglas, 2014a). Conspiracy theories about global warming as a hoax prevent people from reducing their carbon footprint (Jolley and Douglas, 2014b). Conspiracy theories often target minority groups putting them in danger (Fekete, 2012). Conspiracy theories are also related to fundamentalism and extremism (van Prooijen et al., 2015) and to mistrust of political parties or of democratic process (Goertzel, 1994; Jolley and Douglas, 2014b). Also, as conspiracies emerge only when there is a perceived hostile outgroup, conspiracies can help to motivate intergroup conflict (van Prooijen et al., 2018). Hence, there are good reasons why conspiracy beliefs might be seen as negative for society.

Another reason for interest in conspiracy beliefs is that modern-day communication, the Internet, and social media, makes conspiracies more accessible and has enabled them to proliferate (Ahmed et al., 2020; Mian and Khan, 2020). So-called echo chambers are characterized by homogeneous clusters of users who assemble online based on common views or attitudes. Such echo chambers have been studied on Facebook (Quattrociocchi et al., 2016) and Twitter (Cossard et al., 2020).

Contrary to conventional belief, humans contribute more to the ‘viral’ spread of false information online than automated robots, and false information cascades further online than true information does, primarily due to the different emotions that are evoked by false and true material, respectively (Vosoughi et al., 2018). The spread of digital misinformation has been labelled as one of the principal threats to society by the World Economic Forum (Howell, 2013). Facebook, for example, enables the formation of homogeneous communities or echo chambers, clustered around specific narratives (Del Vicario, Bessi et al., 2016). The outcome is that such echo chambers become highly polarized and the narratives within become self-reinforcing, characterized by conformation bias and the cascade of further false narratives, mistrust, and paranoia, with refuting information avoided or ignored (Quattrociocchi et al., 2016). Although it is known that humans are resistant to belief change (Lord et al., 1979), the segregated and homogeneous nature of echo chambers makes this even more difficult to achieve and on Facebook there is evidence that debunking information actually entrenches conspiracy beliefs (Zollo et al., 2017). Evidence also suggests that on Facebook, greater online activity within an echo chamber leads more quickly to more negative sentiments (Del Vicario, Vivaldo et al., 2016). Furthermore, it might be that polarization itself amplifies division: perceiving cohesion in outgroups increases one’s sense of social threat from said groups (Greenburgh et al., 2019).

Although acceptance of contradictory information is more likely if it originates from a trusted source (Margolin et al., 2018; Vraga and Bode, 2017), we should recognize that true echo chambers aggressively reject counter-evidence and harbour mistrust of dissenters. They should be distinguished from what Nguyen (2020) calls “epistemic bubbles” where dissenting voices although not visible are not necessarily actively excluded. In this vein, echo chambers exacerbate one of the common features of conspiracy theories whereby contradictory views are seen as further evidence of a hostile conspiracy. Social media also satisfies one of the other functions of a conspiracy theory, namely to offer simplicity in the face of complexity. In echo chambers, the homogeneity of the community is an antidote to confusing social structures, offering togetherness and supporting homophily (Tornberg, 2018).

Furthermore, the nature of echo chambers and social media can exacerbate the cognitive biases that underpin conspiracy beliefs. Conspiracy beliefs are characterized by less analytic thinking. Compared to true news, online political disinformation suppresses analytic responding, particularly extreme forms of disinformation (Barfar, 2019), and susceptibility to fake news is more dependent on such lazy thinking than it is on partisan bias (Pennycook and Rand, 2019). Reliance on the Internet for information begets further use (Storm et al., 2017), and reliance on technology for knowledge increases illusions of knowledge (Hamilton and Yao, 2018). Those who tend to think more intuitively or less analytically are also more likely to cognitively offload onto their device - in other words, to rely on their device to find information (Barr et al., 2015). Conversely, engaging in more analytical thought can reduce people’s reliance on smartphones (Pennycook et al., 2015). This suggests that even though conspiracy beliefs are already characterized by lower reliance on analytical thought, the location of conspiracy communities in online social media platforms can exacerbate this kind of lazy thinking even further.

In the pre-Internet age, experiences such as external thought control would have remained idiosyncratic and incompatible with common shared reality. Such experiences are classic first-rank symptoms of psychosis, normally regarded as forming bizarre delusions. A social network analysis of mind control experiences has revealed that online communities, including individuals with apparent signs of psychosis, have formed around common experience or interest in this phenomenon (Bell et al., 2006). This illustrates that the Internet provides a forum for social endorsement of even the most improbable ideas which would be very difficult to re-create in the offline world.

7 Conclusions

Thus, conspiracy beliefs represent significant social challenges, including political extremism, intergroup conflict, environmental protection, faith in democracy, and population health. Although there are likely to be individual differences in one’s proneness to conspiracy beliefs, such beliefs likely originate from long-evolved mechanisms which would have been adaptive traits for effective intergroup conflict in early human existence. In the modern day, the shifting and complex social landscape evokes a sense of threat from salient and despised outgroups. This threat drives a need to make meaning out of a confusing social milieu, a desire for sensemaking which favours overreliance on cognitive bias and system 1 thinking. The ability of the Internet and in particular social media platforms to accommodate conspiracy networks in ways that the offline world cannot match accentuates the homogeneity and polarization of such groups, the sense of threat posed by opposing outgroups and even the lazy cognitive style which conspiracy believers might have a prior proneness to.

An argument for the existence of a fully dimensional psychosis continuum has been elaborated. Delusional beliefs form an important dimension of this continuum and a question for the chapter was whether conspiracy beliefs can be understood as forming part of the continuum of delusional belief. Many of the characteristics of delusions are found in both paranormal and conspiracy beliefs. Both delusions and conspiracy beliefs emerge from processes which might have been - or remain - adaptive protections against social threat. Whilst delusions and conspiracies might differ with regard to the perceived relevance to the self, this too might represent a further dimension of the belief continuum whereby clinical delusions are characterized by highly personalized sense of threat with the elevated distress and social isolation that such individualized beliefs would present. Suspicion orientated more to the group or to wider society is more (although not always) likely to reflect the definition of conspiracy belief than clinical delusion.

There is perhaps a risk in conceptualizing in psychopathological terms what is after all, a rather common, everyday belief. But the object of this chapter is not to construe conspiracy beliefs as a clinical phenomenon. Conversely, the psychosis continuum is seen as a means of ‘normalizing’ psychopathological symptoms, of making psychotic behaviours and experiences understandable by referencing them as exaggerated forms of everyday non-clinical existence. Thus, it is important to stress that conspiracy beliefs should not be viewed as psychotic, but rather as a multidimensional belief which can vary in intensity like other types of belief. In this sense, the author hopes that conceptualizing conspiracy belief in relation to the psychosis continuum will be useful for education, intervention, and prevention rather than stigmatization.

Note

1 On the other hand, this is not the case with delusional disorder, where a delusional belief is entrenched but without comorbidities or deficits in social functioning (Marneros et al., 2012); hence, the absence of other symptoms is not sufficient to distinguish regular paranormal beliefs from delusions.

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