una concepción de la creencia (denominada "solo descendente" [downstream only]) de acuerdo con la... more una concepción de la creencia (denominada "solo descendente" [downstream only]) de acuerdo con la cual puede haber creencia sin evidencia. Defiendo esta tesis en contra de dos influyentes objeciones. La primera objeción está fundamentada en la intuición de que la creencia "apunta hacia la verdad". La segunda de ellas dice que, puesto que hay estados que intuitivamente no son creencias, pero que explican la acción de la misma manera, necesitamos consideraciones de tipo ascendente [upstream] para distinguir entre esas creencias y los estados que no son creencias.
Some theorists don't buy into subtypes, but if they adopt inner-speech based accounts across the ... more Some theorists don't buy into subtypes, but if they adopt inner-speech based accounts across the board, then what we say will be of relevance to them. It is only those who think either that AVHs are homogeneous and nothing to do with inner speech, or who think that there are subtypes, but none of those subtypes are inner speech-based who will take issue with our starting point.
medRxiv (Cold Spring Harbor Laboratory), Mar 29, 2023
Aims: The functional-organic distinction attempts to differentiate disorders with diagnosable bio... more Aims: The functional-organic distinction attempts to differentiate disorders with diagnosable biological causes from those without and is a central axis on which diagnoses, medical specialities, and services are organised. Previous studies report poor agreement between clinicians regarding the meanings of the terms and some of the conditions to which they apply, while noting the value-laden implications of relevant diagnoses. Consequently, we aimed to understand how clinicians working in psychiatry and neurology services navigate the functional-organic distinction in their work. Method: Twenty clinicians (10 physicians, 10 psychologists) working in psychiatry and neurology services participated in semi-structured interviews that were analysed applying a constructivist grounded theory approach. Results: The distinction was described as often incongruent with how clinicians conceptualise patients' problems. Organic factors were considered to be objective, unambiguously identifiable, and clearly causative, whereas functional causes were invisible and to be hypothesised through thinking and conversation. Contextual factors -including cultural assumptions, service demands, patient needs, and colleagues' views -were key in how the distinction was deployed in practice. The distinction was considered theoretically unsatisfactory, eventually to be superseded, but clinical decision-making required it to be used strategically. This included helping communicate medical problems, navigating services, hiding meaning by making psychological explanations more palatable, tackling stigma, giving hope, and giving access to illness identity. Clinicians cited moral issues at individual and societal levels as integral to the conceptual basis and deployment of the functional-organic distinction and described actively navigating these as part of their work. Conclusions: There is a considerable distance between the status of the functional-organic distinction as a sound theoretical concept generalisable across conditions and its role as a gatekeeping tool within the structures of healthcare. Ambiguity and contradictions were considered as both obstacles and benefits when deployed in practice and strategic considerations were important in deciding which to lean on.
European journal of analytic philosophy, Nov 8, 2020
In this paper, I will present and advocate a view about what we are doing when we attribute delus... more In this paper, I will present and advocate a view about what we are doing when we attribute delusion, namely, say that someone is delusional. It is an "expressivist" view, roughly analogous to expressivism in meta-ethics. Just as meta-ethical expressivism accounts for certain key features of moral discourse, so does this expressivism account for certain key features of delusion attribution. And just as meta-ethical expressivism undermines factualism about moral properties, so does this expressivism, if correct, show that certain attempts to objectively define delusion are misguided. I proceed as follows. I start by examining different attempts at defining delusion, separating broadly psychiatric attempts from epistemic ones. I then present a change of approach, according to which we question whether the term "delusion" is in the business of (merely) describing reality. I then support this proposal, first, by borrowing standard lines of argument from meta-ethics (including ontological reluctance, intrinsic motivation, and deep disagreement) but also, by inference to the best explanation of some the features we see when we try to theorise about delusion (namely that it is hard to define, and that our delusion attributions are elicited by a plurality of norms).
Thought insertion' in schizophrenia involves somehow experiencing one's own thoughts as someone e... more Thought insertion' in schizophrenia involves somehow experiencing one's own thoughts as someone else's. Some philosophers try to make sense of this by distinguishing between ownership and agency: one still experiences oneself as the owner of an inserted thought but attributes it to another agency. In this paper, we propose that thought insertion involves experiencing thought contents as alien, rather than episodes of thinking. To make our case, we compare thought insertion to certain experiences of 'verbal hallucination' and show that they amount to different descriptions of the same phenomenon: a quasi-perceptual experience of thought content. We add that the agency/ownership distinction is unhelpful here. What requires explanation is not why a person experiences a type of intentional state without the usual sense of agency, but why she experiences herself as the agent of one type of intentional state rather than another. We conclude by sketching an account of how this might happen.
In this introduction we present the orthodox account of auditory verbal hallucinations (AVHs), a ... more In this introduction we present the orthodox account of auditory verbal hallucinations (AVHs), a number of worries for this account, and some potential responses open to its proponents. With some problems still remaining, we then introduce the problems presented by the phenomenon of thought insertion, in particular the question of how different it is supposed to be from AVHs. We then mention two ways in which theorists have adopted different approaches to voices and thoughts in psychosis, and then present the motivation and composition of this special issue.
I suggest that we can think of delusional misidentification in terms of systematic errors in the ... more I suggest that we can think of delusional misidentification in terms of systematic errors in the management of mental files. I begin by sketching the orthodox Bbottom-up^aetiology of delusional misidentification. I suggest that the orthodox aetiology can be given a descriptivist or a singularist interpretation. I present three cases that a descriptivist interpretation needs to account for. I then introduce a singularist approach, one that is based on mental files, and show how it opens the way for different and potentially more plausible accounts of these three cases. I reflect on how this mental files approach can be viewed either as a supplement to the orthodox aetiology, or as suggesting an altogether different aetiology. I end by addressing a concern surrounding the explanatory power of mental files.
The meta-problem of consciousness (Chalmers (this issue)) is the problem of explaining the behavi... more The meta-problem of consciousness (Chalmers (this issue)) is the problem of explaining the behaviors and verbal reports that we associate with the so-called ‘hard problem of consciousness’. These may include reports of puzzlement, of the attractiveness of dualism, of explanatory gaps, and the like. We present and defend a solution to the meta-problem. Our solution takes as its starting point the emerging picture of the brain as a hierarchical inference engine. We show why such a device, operating under familiar forms of adaptive pressure, may come to represent some of its mid-level inferences as especially certain. These mid-level states confidently re-code raw sensory stimulation in ways that (they are able to realize) fall short of fully determining how properties and states of affairs are arranged in the distal world. This drives a wedge between experience and the world. Advanced agents then represent these mid-level inferences as irreducibly special, becoming increasingly puzzle...
una concepción de la creencia (denominada "solo descendente" [downstream only]) de acuerdo con la... more una concepción de la creencia (denominada "solo descendente" [downstream only]) de acuerdo con la cual puede haber creencia sin evidencia. Defiendo esta tesis en contra de dos influyentes objeciones. La primera objeción está fundamentada en la intuición de que la creencia "apunta hacia la verdad". La segunda de ellas dice que, puesto que hay estados que intuitivamente no son creencias, pero que explican la acción de la misma manera, necesitamos consideraciones de tipo ascendente [upstream] para distinguir entre esas creencias y los estados que no son creencias.
Because of the traditional conceptualization of delusion as “irrational belief,” cognitive models... more Because of the traditional conceptualization of delusion as “irrational belief,” cognitive models of delusions largely focus on impairments to domain-general reasoning. Nevertheless, current rationality-impairment models do not account for the fact that (a) equivalently irrational beliefs can be induced through adaptive social cognitive processes, reflecting social integration rather than impairment; (b) delusions are overwhelmingly socially themed; and (c) delusions show a reduced sensitivity to social context both in terms of how they are shaped and how they are communicated. Consequently, we argue that models of delusions need to include alteration to coalitional cognition—processes involved in affiliation, group perception, and the strategic management of relationships. This approach has the advantage of better accounting for both content (social themes) and form (fixity) of delusion. It is also supported by the established role of mesolimbic dopamine in both delusions and socia...
In this paper, I will present and advocate a view about what we are doing when we attribute delus... more In this paper, I will present and advocate a view about what we are doing when we attribute delusion, namely, say that someone is delusional. It is an “expressivist” view, roughly analogous to expressivism in meta-ethics. Just as meta-ethical expressivism accounts for certain key features of moral discourse, so does this expressivism account for certain key features of delusion attribution. And just as meta-ethical expressivism undermines factualism about moral properties, so does this expressivism, if correct, show that certain attempts to objectively define delusion are misguided. I proceed as follows. I start by examining different attempts at defining delusion, separating broadly psychiatric attempts from epistemic ones. I then present a change of approach, according to which we question whether the term “delusion” is in the business of (merely) describing reality. I then support this proposal, first, by borrowing standard lines of argument from meta-ethics (including ontologica...
Due to the traditional conceptualisation of delusion as ‘irrational belief’, cognitive models of ... more Due to the traditional conceptualisation of delusion as ‘irrational belief’, cognitive models of delusions largely focus on impairments to domain-general reasoning. Nevertheless, current rationality-impairment models do not account for the fact that i) equivalently irrational beliefs can be induced through adaptive social cognitive processes, reflecting social integration rather than impairment; ii) delusions are overwhelmingly socially-themed; iii) delusions show a reduced sensitivity to social context, both in terms of how they are shaped and how they are communicated. Consequently, we argue that models of delusions need to include alteration to coalitional cognition – processes involved in affiliation, group perception, and the strategic management of relationships. This approach has the advantage of better accounting for both content (social themes) and form (fixity) of delusion. It is also supported by the established role of mesolimbic dopamine in both delusions and social org...
Before Consciousness : In Search of the Fundamentals of Mind, 2017
Some theorists don't buy into subtypes, but if they adopt inner-speech based accounts across the ... more Some theorists don't buy into subtypes, but if they adopt inner-speech based accounts across the board, then what we say will be of relevance to them. It is only those who think either that AVHs are homogeneous and nothing to do with inner speech, or who think that there are subtypes, but none of those subtypes are inner speech-based who will take issue with our starting point.
Negative voice-content is the best sole predictor of whether the hearer of an auditory-verbal hal... more Negative voice-content is the best sole predictor of whether the hearer of an auditory-verbal hallucination will experience distress/impairment necessitating contact with mental health services. Yet, what causes negative voice-content and how interventions may reduce it remains poorly understood. This paper offers definitions of negative voice content and considers what may cause negative voice-content. We propose a framework in which adverse life-events may underpin much negative voice-content, a relation which may be mediated by mechanisms including hypervigilance, reduced social rank, shame and self-blame, dissociation, and altered emotional processing. At a neurological level, we note how the involvement of the amygdala and right Broca's area could drive negative voice-content. We observe that negative interactions between hearers and their voices may further drive negative voice-content. Finally, we consider the role of culture in shaping negative voice-content. This framework is intended to deepen and extend cognitive models of voice-hearing and spur further development of psychological interventions for those distressed by such voices. We note that much of the relevant research in this area remains to be performed or replicated. We conclude that more attention needs to be paid to methods for reducing negative voice-content, and urge further research in this important area. Auditory-verbal hallucinations (AVH), the experience of hearing a voice in the absence of an appropriate external stimulus, can occasion distress and dysfunction, presenting in a range of psychiatric diagnoses, including schizophrenia, bipolar disorder, post-traumatic stress disorder,
Inner speech is a common experience for many but hard to measure empirically. The Varieties of In... more Inner speech is a common experience for many but hard to measure empirically. The Varieties of Inner Speech Questionnaire (VISQ) has been used to link everyday phenomenology of inner speech - such as inner dialogue - to various psychopathological traits. However, positive and supportive aspects of inner speech have not always been captured. This study presents a revised version of the scale - the VISQ-R - based on factor analyses in two large samples: respondents to a survey on inner speech and reading (N = 1412) and a sample of university students (N = 377). Exploratory factor analysis indicated a five-factor structure including three previous subscales (dialogic, condensed, and other people in inner speech), an evaluative/critical factor, and a new positive/regulatory factor. Confirmatory factor analysis then replicated this structure in sample 2. Hierarchical regression analyses also replicated a number of relations between inner speech, hallucination-proneness, anxiety, depressi...
BackgroundCapgras delusion is scientifically important but most commonly reported as single case ... more BackgroundCapgras delusion is scientifically important but most commonly reported as single case studies. Studies analysing large clinical records databases focus on common disorders but none have investigated rare syndromes.AimsIdentify cases of Capgras delusion and associated psychopathology, demographics, cognitive function and neuropathology in light of existing models.MethodCombined computational data extraction and qualitative classification using 250 000 case records from South London and Maudsley Clinical Record Interactive Search (CRIS) database.ResultsWe identified 84 individuals and extracted diagnosis-matched comparison groups. Capgras was not ‘monothematic’ in the majority of cases. Most cases involved misidentified family members or close partners but others were misidentified in 25% of cases, contrary to dual-route face recognition models. Neuroimaging provided no evidence for predominantly right hemisphere damage. Individuals were ethnically diverse with a range of p...
The positive symptoms of psychosis largely involve the experience of illusory social actors, and ... more The positive symptoms of psychosis largely involve the experience of illusory social actors, and yet our current measures of social cognition, at best, only weakly predict their presence. We review evidence to suggest that the range of current approaches in social cognition is not sufficient to explain the fundamentally social nature of these experiences. We argue that social agent representation is an important organizing principle for understanding social cognition and that alterations in social agent representation may be a factor in the formation of delusions and hallucination in psychosis. We evaluate the feasibility of this approach in light of clinical and nonclinical studies, developmental research, cognitive anthropology, and comparative psychology. We conclude with recommendations for empirical testing of specific hypotheses and how studies of social cognition could more fully capture the extent of social reasoning and experience in both psychosis and more prosaic mental s...
Theoria an International Journal For Theory History and Foundations of Science, 2013
Marcus's view of belief is applied to the debate that centers on the question, "Are delusions bel... more Marcus's view of belief is applied to the debate that centers on the question, "Are delusions beliefs?" Two consequences of this are that i) the question, "Are delusions beliefs?" needs rephrasing and ii) the answer is, "No, some delusional patients do not believe what they prima facie seem to believe".
Current models of auditory verbal hallucinations (AVHs) tend to focus on the mechanisms underlyin... more Current models of auditory verbal hallucinations (AVHs) tend to focus on the mechanisms underlying their occurrence, but often fail to address the content of the auditory experience. In other words, they tend to ask why there are AVHs at all, instead of asking why, given that there are AVHs, they have the properties that they have. One such property, which has been largely overlooked and which we will focus on here, is why the voices are often experienced as coming from (or being the voices of) agents, and often specific, individualised agents. In this article, we argue not only that the representation of agents is important in accurately describing many cases of AVH, but also that deeper reflection on what is involved in the representation of agents has potentially vital consequences for our aetiological understanding of AVH, namely, for understanding how and why AVHs come about.
Verbal hallucinations are often associated with pronounced feelings of anxiety, and it has also b... more Verbal hallucinations are often associated with pronounced feelings of anxiety, and it has also been suggested that anxiety somehow triggers them. In this paper, we offer a phenomenological or 'personal-level' account of how it does so. We show how anxious anticipation of one's own thought contents can generate an experience of their being 'alien'. It does so by making an experience of thinking more like one of perceiving, resulting in an unfamiliar kind of intentional state. This accounts for a substantial subset of verbal hallucinations, which are experienced as falling within one's psychological boundaries and lacking in auditory qualities.
una concepción de la creencia (denominada "solo descendente" [downstream only]) de acuerdo con la... more una concepción de la creencia (denominada "solo descendente" [downstream only]) de acuerdo con la cual puede haber creencia sin evidencia. Defiendo esta tesis en contra de dos influyentes objeciones. La primera objeción está fundamentada en la intuición de que la creencia "apunta hacia la verdad". La segunda de ellas dice que, puesto que hay estados que intuitivamente no son creencias, pero que explican la acción de la misma manera, necesitamos consideraciones de tipo ascendente [upstream] para distinguir entre esas creencias y los estados que no son creencias.
Some theorists don't buy into subtypes, but if they adopt inner-speech based accounts across the ... more Some theorists don't buy into subtypes, but if they adopt inner-speech based accounts across the board, then what we say will be of relevance to them. It is only those who think either that AVHs are homogeneous and nothing to do with inner speech, or who think that there are subtypes, but none of those subtypes are inner speech-based who will take issue with our starting point.
medRxiv (Cold Spring Harbor Laboratory), Mar 29, 2023
Aims: The functional-organic distinction attempts to differentiate disorders with diagnosable bio... more Aims: The functional-organic distinction attempts to differentiate disorders with diagnosable biological causes from those without and is a central axis on which diagnoses, medical specialities, and services are organised. Previous studies report poor agreement between clinicians regarding the meanings of the terms and some of the conditions to which they apply, while noting the value-laden implications of relevant diagnoses. Consequently, we aimed to understand how clinicians working in psychiatry and neurology services navigate the functional-organic distinction in their work. Method: Twenty clinicians (10 physicians, 10 psychologists) working in psychiatry and neurology services participated in semi-structured interviews that were analysed applying a constructivist grounded theory approach. Results: The distinction was described as often incongruent with how clinicians conceptualise patients' problems. Organic factors were considered to be objective, unambiguously identifiable, and clearly causative, whereas functional causes were invisible and to be hypothesised through thinking and conversation. Contextual factors -including cultural assumptions, service demands, patient needs, and colleagues' views -were key in how the distinction was deployed in practice. The distinction was considered theoretically unsatisfactory, eventually to be superseded, but clinical decision-making required it to be used strategically. This included helping communicate medical problems, navigating services, hiding meaning by making psychological explanations more palatable, tackling stigma, giving hope, and giving access to illness identity. Clinicians cited moral issues at individual and societal levels as integral to the conceptual basis and deployment of the functional-organic distinction and described actively navigating these as part of their work. Conclusions: There is a considerable distance between the status of the functional-organic distinction as a sound theoretical concept generalisable across conditions and its role as a gatekeeping tool within the structures of healthcare. Ambiguity and contradictions were considered as both obstacles and benefits when deployed in practice and strategic considerations were important in deciding which to lean on.
European journal of analytic philosophy, Nov 8, 2020
In this paper, I will present and advocate a view about what we are doing when we attribute delus... more In this paper, I will present and advocate a view about what we are doing when we attribute delusion, namely, say that someone is delusional. It is an "expressivist" view, roughly analogous to expressivism in meta-ethics. Just as meta-ethical expressivism accounts for certain key features of moral discourse, so does this expressivism account for certain key features of delusion attribution. And just as meta-ethical expressivism undermines factualism about moral properties, so does this expressivism, if correct, show that certain attempts to objectively define delusion are misguided. I proceed as follows. I start by examining different attempts at defining delusion, separating broadly psychiatric attempts from epistemic ones. I then present a change of approach, according to which we question whether the term "delusion" is in the business of (merely) describing reality. I then support this proposal, first, by borrowing standard lines of argument from meta-ethics (including ontological reluctance, intrinsic motivation, and deep disagreement) but also, by inference to the best explanation of some the features we see when we try to theorise about delusion (namely that it is hard to define, and that our delusion attributions are elicited by a plurality of norms).
Thought insertion' in schizophrenia involves somehow experiencing one's own thoughts as someone e... more Thought insertion' in schizophrenia involves somehow experiencing one's own thoughts as someone else's. Some philosophers try to make sense of this by distinguishing between ownership and agency: one still experiences oneself as the owner of an inserted thought but attributes it to another agency. In this paper, we propose that thought insertion involves experiencing thought contents as alien, rather than episodes of thinking. To make our case, we compare thought insertion to certain experiences of 'verbal hallucination' and show that they amount to different descriptions of the same phenomenon: a quasi-perceptual experience of thought content. We add that the agency/ownership distinction is unhelpful here. What requires explanation is not why a person experiences a type of intentional state without the usual sense of agency, but why she experiences herself as the agent of one type of intentional state rather than another. We conclude by sketching an account of how this might happen.
In this introduction we present the orthodox account of auditory verbal hallucinations (AVHs), a ... more In this introduction we present the orthodox account of auditory verbal hallucinations (AVHs), a number of worries for this account, and some potential responses open to its proponents. With some problems still remaining, we then introduce the problems presented by the phenomenon of thought insertion, in particular the question of how different it is supposed to be from AVHs. We then mention two ways in which theorists have adopted different approaches to voices and thoughts in psychosis, and then present the motivation and composition of this special issue.
I suggest that we can think of delusional misidentification in terms of systematic errors in the ... more I suggest that we can think of delusional misidentification in terms of systematic errors in the management of mental files. I begin by sketching the orthodox Bbottom-up^aetiology of delusional misidentification. I suggest that the orthodox aetiology can be given a descriptivist or a singularist interpretation. I present three cases that a descriptivist interpretation needs to account for. I then introduce a singularist approach, one that is based on mental files, and show how it opens the way for different and potentially more plausible accounts of these three cases. I reflect on how this mental files approach can be viewed either as a supplement to the orthodox aetiology, or as suggesting an altogether different aetiology. I end by addressing a concern surrounding the explanatory power of mental files.
The meta-problem of consciousness (Chalmers (this issue)) is the problem of explaining the behavi... more The meta-problem of consciousness (Chalmers (this issue)) is the problem of explaining the behaviors and verbal reports that we associate with the so-called ‘hard problem of consciousness’. These may include reports of puzzlement, of the attractiveness of dualism, of explanatory gaps, and the like. We present and defend a solution to the meta-problem. Our solution takes as its starting point the emerging picture of the brain as a hierarchical inference engine. We show why such a device, operating under familiar forms of adaptive pressure, may come to represent some of its mid-level inferences as especially certain. These mid-level states confidently re-code raw sensory stimulation in ways that (they are able to realize) fall short of fully determining how properties and states of affairs are arranged in the distal world. This drives a wedge between experience and the world. Advanced agents then represent these mid-level inferences as irreducibly special, becoming increasingly puzzle...
una concepción de la creencia (denominada "solo descendente" [downstream only]) de acuerdo con la... more una concepción de la creencia (denominada "solo descendente" [downstream only]) de acuerdo con la cual puede haber creencia sin evidencia. Defiendo esta tesis en contra de dos influyentes objeciones. La primera objeción está fundamentada en la intuición de que la creencia "apunta hacia la verdad". La segunda de ellas dice que, puesto que hay estados que intuitivamente no son creencias, pero que explican la acción de la misma manera, necesitamos consideraciones de tipo ascendente [upstream] para distinguir entre esas creencias y los estados que no son creencias.
Because of the traditional conceptualization of delusion as “irrational belief,” cognitive models... more Because of the traditional conceptualization of delusion as “irrational belief,” cognitive models of delusions largely focus on impairments to domain-general reasoning. Nevertheless, current rationality-impairment models do not account for the fact that (a) equivalently irrational beliefs can be induced through adaptive social cognitive processes, reflecting social integration rather than impairment; (b) delusions are overwhelmingly socially themed; and (c) delusions show a reduced sensitivity to social context both in terms of how they are shaped and how they are communicated. Consequently, we argue that models of delusions need to include alteration to coalitional cognition—processes involved in affiliation, group perception, and the strategic management of relationships. This approach has the advantage of better accounting for both content (social themes) and form (fixity) of delusion. It is also supported by the established role of mesolimbic dopamine in both delusions and socia...
In this paper, I will present and advocate a view about what we are doing when we attribute delus... more In this paper, I will present and advocate a view about what we are doing when we attribute delusion, namely, say that someone is delusional. It is an “expressivist” view, roughly analogous to expressivism in meta-ethics. Just as meta-ethical expressivism accounts for certain key features of moral discourse, so does this expressivism account for certain key features of delusion attribution. And just as meta-ethical expressivism undermines factualism about moral properties, so does this expressivism, if correct, show that certain attempts to objectively define delusion are misguided. I proceed as follows. I start by examining different attempts at defining delusion, separating broadly psychiatric attempts from epistemic ones. I then present a change of approach, according to which we question whether the term “delusion” is in the business of (merely) describing reality. I then support this proposal, first, by borrowing standard lines of argument from meta-ethics (including ontologica...
Due to the traditional conceptualisation of delusion as ‘irrational belief’, cognitive models of ... more Due to the traditional conceptualisation of delusion as ‘irrational belief’, cognitive models of delusions largely focus on impairments to domain-general reasoning. Nevertheless, current rationality-impairment models do not account for the fact that i) equivalently irrational beliefs can be induced through adaptive social cognitive processes, reflecting social integration rather than impairment; ii) delusions are overwhelmingly socially-themed; iii) delusions show a reduced sensitivity to social context, both in terms of how they are shaped and how they are communicated. Consequently, we argue that models of delusions need to include alteration to coalitional cognition – processes involved in affiliation, group perception, and the strategic management of relationships. This approach has the advantage of better accounting for both content (social themes) and form (fixity) of delusion. It is also supported by the established role of mesolimbic dopamine in both delusions and social org...
Before Consciousness : In Search of the Fundamentals of Mind, 2017
Some theorists don't buy into subtypes, but if they adopt inner-speech based accounts across the ... more Some theorists don't buy into subtypes, but if they adopt inner-speech based accounts across the board, then what we say will be of relevance to them. It is only those who think either that AVHs are homogeneous and nothing to do with inner speech, or who think that there are subtypes, but none of those subtypes are inner speech-based who will take issue with our starting point.
Negative voice-content is the best sole predictor of whether the hearer of an auditory-verbal hal... more Negative voice-content is the best sole predictor of whether the hearer of an auditory-verbal hallucination will experience distress/impairment necessitating contact with mental health services. Yet, what causes negative voice-content and how interventions may reduce it remains poorly understood. This paper offers definitions of negative voice content and considers what may cause negative voice-content. We propose a framework in which adverse life-events may underpin much negative voice-content, a relation which may be mediated by mechanisms including hypervigilance, reduced social rank, shame and self-blame, dissociation, and altered emotional processing. At a neurological level, we note how the involvement of the amygdala and right Broca's area could drive negative voice-content. We observe that negative interactions between hearers and their voices may further drive negative voice-content. Finally, we consider the role of culture in shaping negative voice-content. This framework is intended to deepen and extend cognitive models of voice-hearing and spur further development of psychological interventions for those distressed by such voices. We note that much of the relevant research in this area remains to be performed or replicated. We conclude that more attention needs to be paid to methods for reducing negative voice-content, and urge further research in this important area. Auditory-verbal hallucinations (AVH), the experience of hearing a voice in the absence of an appropriate external stimulus, can occasion distress and dysfunction, presenting in a range of psychiatric diagnoses, including schizophrenia, bipolar disorder, post-traumatic stress disorder,
Inner speech is a common experience for many but hard to measure empirically. The Varieties of In... more Inner speech is a common experience for many but hard to measure empirically. The Varieties of Inner Speech Questionnaire (VISQ) has been used to link everyday phenomenology of inner speech - such as inner dialogue - to various psychopathological traits. However, positive and supportive aspects of inner speech have not always been captured. This study presents a revised version of the scale - the VISQ-R - based on factor analyses in two large samples: respondents to a survey on inner speech and reading (N = 1412) and a sample of university students (N = 377). Exploratory factor analysis indicated a five-factor structure including three previous subscales (dialogic, condensed, and other people in inner speech), an evaluative/critical factor, and a new positive/regulatory factor. Confirmatory factor analysis then replicated this structure in sample 2. Hierarchical regression analyses also replicated a number of relations between inner speech, hallucination-proneness, anxiety, depressi...
BackgroundCapgras delusion is scientifically important but most commonly reported as single case ... more BackgroundCapgras delusion is scientifically important but most commonly reported as single case studies. Studies analysing large clinical records databases focus on common disorders but none have investigated rare syndromes.AimsIdentify cases of Capgras delusion and associated psychopathology, demographics, cognitive function and neuropathology in light of existing models.MethodCombined computational data extraction and qualitative classification using 250 000 case records from South London and Maudsley Clinical Record Interactive Search (CRIS) database.ResultsWe identified 84 individuals and extracted diagnosis-matched comparison groups. Capgras was not ‘monothematic’ in the majority of cases. Most cases involved misidentified family members or close partners but others were misidentified in 25% of cases, contrary to dual-route face recognition models. Neuroimaging provided no evidence for predominantly right hemisphere damage. Individuals were ethnically diverse with a range of p...
The positive symptoms of psychosis largely involve the experience of illusory social actors, and ... more The positive symptoms of psychosis largely involve the experience of illusory social actors, and yet our current measures of social cognition, at best, only weakly predict their presence. We review evidence to suggest that the range of current approaches in social cognition is not sufficient to explain the fundamentally social nature of these experiences. We argue that social agent representation is an important organizing principle for understanding social cognition and that alterations in social agent representation may be a factor in the formation of delusions and hallucination in psychosis. We evaluate the feasibility of this approach in light of clinical and nonclinical studies, developmental research, cognitive anthropology, and comparative psychology. We conclude with recommendations for empirical testing of specific hypotheses and how studies of social cognition could more fully capture the extent of social reasoning and experience in both psychosis and more prosaic mental s...
Theoria an International Journal For Theory History and Foundations of Science, 2013
Marcus's view of belief is applied to the debate that centers on the question, "Are delusions bel... more Marcus's view of belief is applied to the debate that centers on the question, "Are delusions beliefs?" Two consequences of this are that i) the question, "Are delusions beliefs?" needs rephrasing and ii) the answer is, "No, some delusional patients do not believe what they prima facie seem to believe".
Current models of auditory verbal hallucinations (AVHs) tend to focus on the mechanisms underlyin... more Current models of auditory verbal hallucinations (AVHs) tend to focus on the mechanisms underlying their occurrence, but often fail to address the content of the auditory experience. In other words, they tend to ask why there are AVHs at all, instead of asking why, given that there are AVHs, they have the properties that they have. One such property, which has been largely overlooked and which we will focus on here, is why the voices are often experienced as coming from (or being the voices of) agents, and often specific, individualised agents. In this article, we argue not only that the representation of agents is important in accurately describing many cases of AVH, but also that deeper reflection on what is involved in the representation of agents has potentially vital consequences for our aetiological understanding of AVH, namely, for understanding how and why AVHs come about.
Verbal hallucinations are often associated with pronounced feelings of anxiety, and it has also b... more Verbal hallucinations are often associated with pronounced feelings of anxiety, and it has also been suggested that anxiety somehow triggers them. In this paper, we offer a phenomenological or 'personal-level' account of how it does so. We show how anxious anticipation of one's own thought contents can generate an experience of their being 'alien'. It does so by making an experience of thinking more like one of perceiving, resulting in an unfamiliar kind of intentional state. This accounts for a substantial subset of verbal hallucinations, which are experienced as falling within one's psychological boundaries and lacking in auditory qualities.
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Papers by Sam Wilkinson