Monday, 22 December 2008
Now I don't want to take issue with this directly. But this is because the claim seems to me to be almost entirely empty. What it needs is some fairly radical further specification - of just what the continua or discontinua are to be. And beyond that, it needs to be conclusively demonstrated that the continuum dimension is the one which was driving the original formulation of the phenomenon.
So it would, I take it, be fairly hopeless to say something like: "Delusions tend to be beliefs that are just that bit more false, tend to be a bit more unshakeable, tend to be a bit more unshared... than normal beliefs. They can therefore be understood on a continuum with normal beliefs." Because all of that might be entirely true, but touch not at all on the idea lying behind any original discontinuity thesis.
Similarly with the allegedly Jasperian idea that delusions are "un-understandable". Of course there will be all sorts of ways in which delusions are understandable, or nearly, say, as understandable as other eccentric and normal beliefs. But so what? Are we certain that the kind of un-understandability that Jaspers was after was a kind which would accrue in all contexts - be they the rational relations of the belief to other beliefs of the subject; the belief's psychodynamic / motivational character; existential aspects, etc? Jaspers seemed fairly clear, after all, that the kind of ununderstandability he was after was one of our not, as it were, being able to 'make the belief our own' - to feel our way into it from the inside - despite any amount of external or intellectual grasp we may arrive at through the deployment of whatever hermeneutic device at our theoretical disposal.
So I'd like to propose that psychologists be encouraged to just stop offering a combination of blankly empirical or 'external' (as Jaspers would have put it) criteria for some psychopathological phenomenon, and then, after having found that simply by deploying such criteria we get a nice continuum from the pathological to the normal, coming out with the claim that 'after all, the pathological phenomenon is not so pathological as we might have thought'. Maybe that final point is a good claim, maybe it isn't; whether it is or not will depend on whether the continua dimensions really do capture the essential character of the phenomenon as originally intuited by the psychopathologists.
A meta-psychological and historical comment: Variations of the above-described theoretical tendency are notable in other psychological contexts too. I remember as an undergraduate being asked to believe that Piaget's developmental stages (pre-operational, concrete and formal operational etc.) could be shown to have occurred somewhat earlier than the great man suggested. The moral seemed to be that careful, scientific, empirically guided research can reveal that more intuitive, theoretical, philosophical approaches can underestimate the capacities of the child (or underestimate our ability to understand what the person who is deluded is saying). But, needless to say, along the way some quite blandly empirical criteria which were not at all Piaget's had been substituted for his own (admittedly more theoretically complex ones), and the 'striking finding' that the great thinker had underestimated the capacities of children was largely an artefact of this criterial substitution. (The story of the developmental psychologists' misreading of Piaget's genetic epistemology is documented in Chapman's book Constructive Evolution: Origins and Development of Piaget's Thought.)
This sets me thinking about the relation between empiricist and (let's call them) ontological approaches in psychology. As the now-cliched adage from Kant has it, "thoughts without [experientially specifiable] content are empty; intuitions [i.e. sensory experiences] without concepts are blind". If I lived in France then no doubt I'd find myself railing against the theory-mongerers for their lack of attention to the empirical grounding or - a better word owed to Joseph Margolis - 'adequation' (i.e. specification as to what counts for or against a claim) of their theories. As it is, I live in England, and I find myself railing against the theoretical impoverishment of the 'intuitions without concepts' I encounter.
Saturday, 20 December 2008
Imagine this: waking one morning we discover that it is not we who are in direct contact with the bed; not we who are open to our lover’s caress; the movements our bodies make are not really our movements. Such privileges of direct expressive and receptive contact with our world and companions have, we discern, been afforded not to us, but—to our brains! We must rest content, on the side of action, with mere illusions of free will and, on the side of perception, with inspecting mere models which present themselves as reality but which are really just illusions thrown together by the brain.
The consolation prize is that, were we actually in direct contact with the world, the task of making sense of its complexities would just be overwhelming. So thankfully our clever brains perform these tasks “off-stage,” supplying us with outputs in the form of simple “pictures” or “messages” clear or intelligible enough for us poor cognitive beings to grasp. As Frith says in the conclusion of Making Up the Mind: How the Brain Creates Our Mental World — a well-written and accessible book which notwithstanding fully embraces and endorses the above-described theorization of, and some might say nightmarish predicament for, the self, mind and body — all “this complex activity is hidden from us. So there is no need to be embarrassed. Just go back to the party and have fun” (p. 193). Whether this is consolation enough may be questioned. As Malcolm (1986) once wrote regarding Searle’s notion that he was the brain stuck inside his own skull: “Searle says that we can receive messages. But in that predicament, who wants messages?” (p. 186).
Unlike Searle the philosopher, Frith the neuroscientist aims to substantiate his claims not with conceptual argumentation but with empirical evidence drawn from cognitive neuropsychology. In his own words, here are the key theses Frith takes the neuropsychological evidence to support: The “distinction between the mental and the physical is … an illusion created by the brain” (p. 17). “By hiding from us all the unconscious inferences that it makes, our brain creates the illusion[s] that we have direct contact with objects in the physical world [and that] our own mental world is isolated and private” (p. 17). These unconscious “inferences can be wrong,” even in “an ordinary, healthy brain” (p. 60). Furthermore, we have no “direct contact… even with our own bodies”; this is another “illusion” created by the brain (p. 81). Our “perception of the world is a fantasy that coincides with reality” (p. 111) arising when “our brains discover what is out there in the world by constructing models and making predictions” (p. 138).
Our knowledge of the “minds of others” is created by our brains “in the same way” (p. 159). And whilst “we experience ourselves as agents with minds of our own,” this too is an “illusion created by our brains” (p. 184). Frith acknowledges that our experience of freedom, individuality and responsibility is a cornerstone of societal stability and morality, but this is simply the “final illusion created by our brains” (p. 193).
Such claims are prima facie extraordinary, and if the neuropsychological data Frith presents could substantiate just one of them, his book might cause a major revision in human self-understanding. Yet what struck this reviewer again and again was the way in which the content of the hypotheses these data supposedly evidenced, and the theoretical unity of the text, derived principally from unargued and tacit metapsychological commitments which radically constrained the way the data were interpreted.
Concerning perception, Frith cites three sorts of evidence for his claim that “even if all our senses are intact and our brain is functioning normally, [the feeling that] we have direct access [to the physical world] is an illusion created by our brain” (p. 40). First, in chapter 2, he provides evidence from various malfunctions of, and curiosities regarding, visual experience – change blindness, subliminal perception, visual illusions, synesthesia, dreams, visual hallucinations, etc. Second, in chapter 4, he cites the fact that there is no direct mapping to be had of sensory (e.g. retinal) stimulation onto the contents of consciousness. Third, in chapter 5, he notes that we are normally unaware of the vast amount of complex neurophysiological processing (the activation of motor programs, say) that subtends everyday experience, and infers that “my perception [cannot be] of the world, but of my brain’s model of the world” (p. 132).
Whilst the data are fascinating, they are also incapable of motivating Frith’s theoretical claims, which instead appear to be consistently driven by a ‘homuncular’ conception of the self constantly invoked in the data’s interpretation. By ‘homuncular’ I mean a conception of the subject’s relation to its brain which harnesses a) a mentalistic conception of the immediate contents of perceptual consciousness as ‘inner images’ or ‘internal representations’ occurring ‘in our minds’ to b) a causalist construal of such immediate contents as the final products, delivered to the mind, by a CNS which has worked over information originally received by the sense organs (Kenny, 1984). (Conceptions of consciousness as an inner stage (or ‘Cartesian theatre’; Dennett, 1991) populated by inner visibilia may not explicitly posit an actual homunculus as an audience. The philosophical concern is however not ontological but methodological (Kenny, 1984): that theories deploying the conception do not neglect to demonstrate how, rather than simply assert that, they do not reduplicate the very phenomenon (perceptual consciousness) they aim to explain.)
The following are representative examples taken from Making up the Mind. Sense organs are said to work ‘just like a video recorder [transmitting] information about the physical world … to our minds’ (p. 21). The brain is described as “showing us false information” (p. 49); as not “telling us everything it knows” (p. 42); as “not simply transmit[ting] knowledge to us like a passive TV set … [but as] actively creating pictures of the world…from the very limited and imperfect signals provided by the senses.” (p. 85). My “brain manages to create for me the experience of a constant, unchanging world through which I move” (p. 110). It also “constructs models” (p. 138) of both the physical and the “mental worlds” of others (p. 159).
Accordingly, when dreams or illusions are offered (in ch. 2) as evidence that we have no direct visual access to the world, the conception which constrains the interpretation of the data already presupposes that, if we are not witnessing the world accurately, then we must (with some kind of further and as-yet-unexplained perceptual system) be accurately witnessing inaccurate mental images of the world. Or when (in ch. 4) the facts that retinal images are inverted or two-dimensional or duplicated are cited – or when movements of these images are as it were ambiguous between movements of the perceived objects and movements of the eye or head – it is simply presupposed that, since perception is construed as input to consciousness, the work of the visual system must be understood as one of ‘undoing’ the infelicities introduced at the sensory surfaces. Or when it is pointed out (in ch. 5) that the vast complexities of the CNS’s information processing are completely unknown to us, the inference is straightway drawn that therefore what we are aware of must be neither the world around us, nor our neurological processes, but their supposed illusory upshots.
Perhaps I should confess that I am convinced that what Kenny calls the “homunculus fallacy” is indeed a fallacy, and that Dennett is right to deconstruct the “Cartesian theatre”. Whilst in confessional mode I might also relate that Frith’s description of the mere brain as engaged in personal-level activities (knowing, believing, interpreting, deploying Bayesian inferences, etc.) strikes me as implicating him in another (‘mereological’) fallacy – that of ascribing to a part what can only coherently be ascribed to the whole (Bennett & Hacker, 2003).1 Yet my intent is not to foist my Wittgensteinian sensibilities onto the reader, but merely to relate that Frith’s striking theses regarding the allegedly illusory nature of our experience of the world are quite simply not a function of the data he presents, but rather of the homuncular framework used to interpret them – whatever we make of that framework. Perhaps it is a set of harmless metaphors – and if so this may also be the best way to take Frith’s theories.
Similar presentations of interesting data recruited by tacitly homuncular theorizations of the self arise throughout the book, whether we are considering perception (ch. 1, 2, 5), interpersonal understanding (ch. 6, 7), planning (ch. 4), or action (ch. 3, 6). For example, chapter 6 relates that an alleged everyday “experience of agency”— of being in control of our actions, making decisions to act, and acting on these decisions — is actually an illusion created by the brain. In truth, we are told, the brain distinguishes between intentional and non-intentional movement by measuring sensorimotor timing differences. These differential responses to the timings of causes and effects in perception and action are, it is said, translated for us into experiences of agency, providing an illusion of free will.
The experimental data (pp. 151-155) are again fascinating. But it is instructive that Frith appears to take his phenomenology of intentional action from cases such as (that which he quotes:) Ian McEwan’s marvelous description, in his novel Atonement, of Briony’s contemplation of her relation to her moving body:
She raised one hand and flexed its fingers and wondered… how this thing, this machine for gripping, this fleshy spider on the end of her arm, came to be hers, entirely at her command. Or did it have some little life of its own? She bent her finger and straightened it. The mystery was in the instance before it moved, the dividing moment between not moving and moving, when her intention took effect. It was like a wave breaking. If she could only find herself at the crest, she thought, she might find the secret of herself, that part of her that was really in charge.
What Frith seems to miss is that such descriptions are precisely not of everyday intentional action — but rather of an extremely alienated state of mind. Briony has dissociated from her lived bodily experience, becoming a disembodied homuncular spectator consciousness experiencing the body as merely a distant mechanism or “fleshy spider.” Our actual everyday experience of agency is rather characterized by the immanence of intention in action. Accordingly, the striking conclusion Frith draws – that the timing experiments reveal a genuine aspect of our self-conception to be illusory – is misplaced, for the conception of agency on offer here is drawn not from everyday experience but from an alienated theorization of it presupposed by his interpretation of the data.
The very idea that we have control over our actions is taken by Frith, in a curious Epilogue, to entail that there is supposed to be an inner homunculus enjoying a direct causal impact on a merely mechanical outer body:
For me it seems as if I am fully in control of my actions. This is why it is so hard to get rid of the idea of a homunculus. It is the dominant part of my experience that I am in control. … This is the brain’s final illusion: to hide all those ties to the physical and social world and create an [illusion of an] autonomous self. (pp. 188-9)
But what I suggest is the real reason for Frith’s struggle to rid himself of the homunculus is the unacknowledged homuncular conception of the relation between subject and body constantly inscribed within his theories.
Early in the book Frith tells us that he is “not a philosopher”, that he does “not expect to persuade people of truth by the power of argument”, and that the “only arguments [he] accepts] come from practical experiments” (p. 15). What Making up the Mind reveals, however, is one of the principal risks of eschewing philosophical reflection: that one’s theories will then be even more driven, and potentially vitiated, by tacit philosophical commitments which no amount of experimental data can evidence, challenge or extirpate.
- Bennett, M. R. & Hacker, P. M. S. (2003). Philosophical foundations of neuroscience. Oxford: Blackwell.
- Dennett, D. (1991). Consciousness explained. London: Penguin.
- Kenny, A. (1984). The legacy of Wittgenstein. Oxford: Blackwell.
- Malcolm, N. (1986). Nothing is hidden: Wittgenstein’s criticism of his early thought. Oxford: Basil Blackwell.
1 Both Kenny (1984) and Bennett & Hacker (2003) run together two conceptually distinct alleged ‘fallacies’: the ‘homunculus fallacy’ of tacitly reduplicating our relation to perceptibilia on a mental stage, and the ‘mereological fallacy’ of ascribing psychological properties to the brain.
Delusions are often described in textbooks as being defined, since Karl Jaspers, as false, subculturally atypical beliefs, strongly maintained in the face of counterargument. Yet such definitions fail to capture either the rich diversity or key features of delusion, and would -were it not for their prevalence - be in danger of meeting their own desiderata.
Common delusions include persecution (there is a plot or conspiracy against the subject; these are the most common delusional beliefs); grandiosity (the subject is an important personage); erotomania (the subject delusionally believes someone is deeply in love with them); and control (the belief that one’s actions, thoughts or feelings are being controlled by others). The majority of delusions concern the subject’s position in the social world, or reflect central existential issues in their lives, and they are indeed often false, atypical and strongly maintained.
It is however possible that a delusion (such as that of one’s partner being unfaithful) be accidentally true. Levels of conviction in delusions may also vary with time. Some delusions may be paradoxically true rather than false (e.g. the delusion that one is mental ill), and others may be not beliefs but rather delusional value judgements, thoughts, perceptions, memories, inner experiences and moods (Sims, 2003). The ‘delusionality’ of delusions of control, for example, arises directly from a disturbed experience of one’s own agency, rather than with beliefs about such experiences.
As Jaspers himself reported, to ‘say simply that a delusion is a mistaken idea which is firmly held by the patient and which cannot be corrected gives only a superficial and incorrect answer’ (Jaspers, 1913/1997, p. 93). Delusions rather reflect a fundamental disturbance in our relation to reality and the integrity of the self which is hard to pinpoint in a definition. Jaspers distinguished between primary delusions – which arise in an ultimately 'un-understandable' way in our contact with reality itself – and secondary delusions, which are intelligible attempts to understand baffling experiences. Whilst Jaspers’ doctrine of the un-understandability of primary delusions has often been criticised, it is important to recognise that his point is not to preclude a reflective understanding of what the deluded person says, what psychodynamics underpin it, what symbolism it expresses, etc. It is rather that we always fall short of inhabiting such beliefs or experiences from a first-person perspective.
2. Psychoanalytic Perspectives
Sigmund Freud described delusions as ‘applied like a patch over the place where originally a rent had appeared in the ego’s relation to the external world’ (Freud, 1924/1981, p. 215). He distinguished between neurotic and psychotic conditions as follows. In the neuroses the subject attempts to adapt to an incompatible reality by defending against their own feelings. The symptoms which result are the product of the internal conflicts within the patient when they try to remodel their desire. In the psychoses, by contrast, the subject attempts to solve their conflicts with reality not by altering their feelings, but by withdrawing from or ‘disavowing’ reality and replacing it instead with fantasies which are treated as realities.
In the 1960s the psychiatrist Thomas Freeman extended the psychoanalytic understanding of delusion (Freeman, Cameron & McGhie, 1966). Whilst some delusions can be understood as fantasised replacements for lost relationships, others consist of misinterpretations of experiences with others from whom the subject has not become completely detached. Accordingly the delusional subject attempt to bend or exaggerate reality to make it more tolerable and less threatening of the subject’s sense of himself or herself, rather than completely substitute for it, and the delusions are the outcome of such defensive manoeuvres.
More recent psychoanalytical thinking on psychosis has been organised, not around the concept of delusion, but rather by attempts to understand the nature of omnipotent fantasy, including the mental mechanisms of splitting, projection and projective identification, minus K, attacks on linking, and symbolic condensation. All of these processes may be implicated in the formation of delusion, but none are specific to it.
3. Phenomenological Perspectives
Phenomenology aims to elucidate the lived, non-reflective and immersed experience of being a self in relation to a meaningful environment including other selves. Accordingly, the phenomenological understanding of delusion – in particular of schizophrenic delusion – views what is specific to it as already contained in germ in a specific pre-delusional disturbance of immersed participation. More specifically, most phenomenological psychiatrists track this disturbance back to fragile temporal and corporeal processes which underpin the constitution of the self. Phenomenologists view the delimitation of self from other as arising out of an organism’s non-reflective interactions with its social and physical environment. Disturbances of that process result in disturbances in the boundary between self and world, and delusional beliefs and experiences carry this fundamental disturbance in reality contact inscribed within them.
Most phenomenological accounts take their lead from the first two stages of Klaus Conrad’s (1958) developmental account of delusion in paranoid schizophrenia. In the initial pre-delusional ‘trema’ stage, the subject starts to vaguely feel that all is not well with himself and/or the world. He may complain of an unspecific groundlessness, confusion about or lack of a sense of his own identity, diminished sense of aliveness, and lost automatic connection with reality. The body may become experienced as an object rather than as a living subject, self and other may start to become confused, the objective character of reality may be lost, and the delusional experience of reference – a sense that everything seen has been constructed for the sake of the subject – may begin (Parnas & Sass, 2001).
In Conrad’s second stage – ‘apophany’ – delusions proper arrive. Now the trema is intuitively resolved into one particular revelatory meaning, and the subject takes themselves to now ‘understand’ what had previously only been confusingly signalled. Relief is experienced from the diffuse tension and terror of the trema, and a monothematic reflective grasp of what is happening (e.g. there is a government plot against me) takes the place of the pre-reflective but destabilised grasp (‘something is up’) the subject had on their situation.
4. Cognitive Science Perspectives
Unlike psychoanalytical and phenomenological theories, cognitive psychological theories are driven by a psychological understanding of the human being as constantly and actively attempting to interpret, or make reflective sense of, their personal situation. Thus Brendan Maher (1974) suggested that delusional beliefs represent rational attempts to make sense of abnormal experiences (e.g. hallucinations or passivity experiences). Phillipa Garety by contrast has suggested that abnormal processes of reflective sense-making may be implicated in delusion formation (Garety & Freeman, 1999). She found, for example, that patients with delusions tend to jump to conclusions on the basis of surprisingly little evidence.
Several difficulties confront such cognitive psychological accounts. First, delusions – especially primary delusions – do not present themselves as active interpretative products, but rather as spontaneous and passive revelations in thought, feeling, or perception. Even the delusional ‘explanations’ that patients offer appear to be more post-hoc rationalisation than genuine justification. Second, Garety also found that the hasty reasoning style of delusional patients makes them equally likely to quickly give up their beliefs, which makes it hard to understand the typical intransigence of the delusional subject. It is also important to recognise that the explanatory task, in understanding delusional intransigence, is not merely how unshakeable beliefs arise, but how unshakeable beliefs with the face-value implausibility of delusions could arise. Finally, Maher’s theory does not explain why the patient fails to accept the obvious explanation that they are hallucinating or experiencing passivity experiences.
Cognitive neuropsychological – as opposed to cognitive psychological – perspectives, are typically not governed by an understanding of the individual as an active reflective sense-maker, and so are not restricted to theorising delusion in such terms. Hemsley (2005) provides a good example with his speculative model of schizophrenia as due to a deficiency in the influence of background context on current task performance. The model ties together the neurological (e.g. frontotemporal functional disconnections), the information processing (e.g. sensory and motor program disturbances), and the psychological (a range of symptoms including delusional beliefs and experiences) levels of explanation.
Primary delusions are accordingly theorised by Hemsley as due to a mismatch between tacit and automatically deployed frames of reference and the sensory inputs to which they are applied. Delusional experience in the trema is also understood as due to a breakdown in gestalt or context perception. Decontextualised stimuli, including those normally screened out as irrelevant, may appear equally salient – and secondary delusional beliefs may reflect a search for the meaning of stimuli which would not normally have come to conscious attention. Hemsley speculates, for example, that delusional thinking about causal relationships may result from a failure of context to constrain judgements about the relevance of the co-occurrence of stimuli.
Future work on delusion will need to weave together the above approaches. From epistemology we require adequate understandings of what it is that grounds our relation to reality (e.g. reflective thought, or bodily praxis), and what it is to lose that relation. From psychoanalysis we require an updating of the theory of delusion in the light of post-Kleinian understandings of the nature of unconscious fantasy. From phenomenology we require a precise understanding of how delusional distortions to reality contact manifest in the various (linguistic, corporeal, behavioural, intersubjective, and reflective) dimensions of human existence. And from cognitive neuropsychology we require theories aptly constrained by the above psychological domains, but informed by the latest neuro-imaging research.
psychosis, paranoia, phenomenology, psychoanalysis, cognitive science
Conrad, K. (1958). Die beginnende Schizophrenie. Versuch einer Gestaltanalyse des Wahns. Stuttgart: Thieme.
Freeman, T., Cameron, J. L., & McGhie, A. (1966). Studies on psychosis: Descriptive, psychoanalytic, and psychological aspects.
Freud, S. (1981). On psychopathology. Harmondsworth: Penguin Books.
Garety, P. & Freeman, D. (1999). Cogitive approaches to delusions: A critical review of theories and evidence. British Journal of Clinical Psychology, 38, 2, 113-154.
Hemsley, D. R. (2005). The development of a cognitive model of schizophrenia: placing it in context. Neuroscience and Biobehavioral Reviews, 29, 977-988.
Jaspers, K., (1913) Allgemeine Psychopathologie. Berlin, Springer-Verlag. (trans. J. Hoenig, and M.W. Hamilton (1963) General Psychopathology.
Maher. B. (1974). Delusional thinking and perceptual disorder. Journal of Individual Psychology, 30, 98-113.
Parnas, J. & Sass, L. (2001). Self, solipsism, and schizophrenic delusions. Philosophy, Psychiatry, & Psychology, 8, 2/3, 101-120.
Sims, A. (2003). Symptoms in the Mind. 3rd edition.
Berrios, G. (1996). Delusions. In G. Berrios, The history of mental symptoms: Descriptive psychopathology since the 19th century (ch. 6).
Munro, A. (2008). Delusional disorder: Paranoia and related illnesses.
Freeman, D., Bentall, R., & Garety, P. (2008). Persecutory delusions: Assessment, theory and treatment.