Tuesday, 10 September 2013

Thought Insertion and the Adaptive Role of Delusions

Pablo López-Silva
I am a current PhD student at the University of Manchester Philosophy Department (Mind Group). I’m working on different philosophical problems raised by schizophrenia under the supervision of Dr Joel Smith and Prof Tim Bayne.

I became interested in the philosophical discussions surrounding schizophrenia while I was taking my clinical courses for my psychology professional degree in Chile. While attending some patients, I realized that delusions seemed to have a strong adaptive function. Although this is a matter that needs further argumentation, I think that systematic research on the structure of certain delusions can facilitate better understandings of their role (Roberts, 1992) and, quite importantly, to improve therapeutic intervention (Guidano, 1991). An example of this can be offered by looking at the structure of thought insertion, an abnormal conscious experience commonly regarded as suggestive of schizophrenia (Mullins & Spence, 2003). 

Philosophers have become interested in thought insertion for its puzzling character. For instance, this symptom seems to challenge the immunity principle, and the inseparability thesis. In addition, thought insertion is a challenge to common conceptions regarding the relationship between self-awareness and phenomenal consciousness (Billon, 2013). Roughly speaking, patients suffering from thought insertion complain of being aware of thoughts which are not their own intruding into their mind.

The structure of this abnormal experience is quite complex, however the specificity of episodes of thought insertion offers an interesting opportunity to link delusions with their adaptive role in human psychological life. The idea is that patients experience as alien only a certain kind of thought-content, but not all kinds (Gallagher, 2004). The patients’ experiences seem to be quite specific, and most of the time the contents of them are associated with significant others or with certain themes that are affectively important to their biographies. For instance, Saks (2007) describes her own first episode of thought insertion by making reference to contents that seem to be affectively important to her own personal history (self-image, relationship with their parents, etc.). 

The relationship between the specificity of the contents of inserted thoughts with the personal history of the patients seems to suggest that, at least this type of delusion would have something I shall call an 'affective adaptiveness role’ i.e. delusions serve the patient's need to deal with affectively intolerable experiences. It seems plausible to think that some degree of affective significance for the patients may be involved in the genesis of thought insertion and that clinicians and philosophers should explore further this matter in order to improve therapeutic intervention.


  1. Hi Pablo, thank you for posting your ideas on thought insertion.

    From the way I read your post, you seem to suggest that the phenomenon of thought insertion might have an adaptive role in dealing with affectively intolerable experiences, and that this might be so at least for this specific type of delusion (and so maybe not so for other types).

    What are your ideas as to why such intolerable experiences specifically give rise to thought insertion and not to other related phenomena as 'voices' (whether in the context of mental disorder or not) that might perform a similar adaptive role (as their contents also often refer to one's personal history or experiences).

    Kind regards

  2. Dear JP, thank for your comment.
    As you rightly point out, I do suggest that thought insertion might have an adaptive role in dealing with certain affectively intolerable experiences. At least, it seems reasonable to suggest this based on the specific contents that are experienced as alien and the personal biography of patients suffering from TI.

    However, I do not think that this adaptive role is exclusive to thought insertion. I think this role can be also identified in the formation of alien voices. For example, Stephen & Graham (1994) comment on a case of a girl that hears her father's and paternal grandmother's voices advising her on various decisions she faced. About this case, Gibbs (2000) proposes that although the content of the delusion does not seem to have any problematic value, an intolerable affective experience can be identified in the formation of the abnormal experience i.e. aversion to decision-making for instance (what experience counts as intolerable will depend upon the personal biography and the existence of certain core affective themes organizing the psychological life of the patients see Arciero & Bondolfi, 2011). For this reason, it would be plausible to take this positive role as a feature of a group of delusions (including alien voices). In my post, I made this connection specifically with thought insertion only because I've been more focused on that experience , however, the link seems to be also applicable to the case of alien voices.

    I would not think that certain intolerable experiences give raise to a certain type of delusion, but rather that at the formation of certain delusions we can identify certain affectively intolerable experiences. Hypothesizing, I would suggest that what gives rise to a certain type of delusion is a combination between the level of intolerability of the problematic experience with the general cognitive and affective resources of the patient. However, further research should be done about this.

  3. Dear Pablo, thank you for your clear reply.

    Do you think trauma (or intolerable experiences, aversions,..) a necessary factor in the formation of these psychotic experiences?

    Kind regards

  4. Dear Pablo, thank you for your clear reply.

    I wonder whether you think trauma (or intolerable experiences, aversions,..) a necessary factor in the generation of these psychotic phenomena?

    Kind regards

  5. Dear JP Thank you for your comment.
    I do not think that affectively intolerable experiences need to be traumatic in the sense of being some kind of breakdown. I think something can become intolerable (and this depends on the subject's affective and cognitive resources). Hence, intolerability -I think- can be understood as a matter of degrees and therefore, as a continuum. Based on this, I'd say that affective equilibrium or 'personal affective parameters' are more important at the moment of defining necessary factors in the generation of psychotic phenomena.

  6. Hi Pablo

    I think/hope I understand your point about 'personal affective parameters', and I certainly follow that these parameters can colour/influence the content of psychotic phenomena like thought insertion, voices and delusions.
    I am curious whether you think an 'imbalance in one's affective equilibrum' is necessary for these psychotic phenomena to emerge in the sense that without this imbalance these phenomena wouldn't emerge. Do you think there are other possible 'routes' to psychotic phenomena like thought insertion and voices that don't involve such an imbalance?

    I am curious as to your thoughts on the following:

    - Do you think that a factor of intolerability (whether that be the experience of a trauma, an imbalance in someone's affective equilibrum..) is a necessary factor in the sense that if there is no tr

  7. Hi Pablo

    Do you think personal affective parameters are necessary for the generation of certain psychotic phenomena in the sense that without these somehow 'problematic' personal affective parameters there wouldn't be these psychotic phenomena? Do you think there are other possible 'routes' to these phenomena that don't require this affective factor?

    A question in the vicinity: what factor makes that one person with 'problematic' affective parameters develops psychotic phenomena and another not?

  8. Hi Jp

    Thanks for your comment.

    I think that personal affective parameters are necessary condition not only for the development of pathology, but also for the development of healthy mental life. The main idea is that human beings in general develop certain adaptive affective parameters over their lives as a result of environmental and biological conditions (There is interesting literature about this in Attachment Theory Research). This leaves open the possibility of understanding pathology as a continuum, rather than as a simple breakdown. However, this does not rule out other factors, I think.

  9. Hello JP;

    I was reading up about Thought Insertion on several articles, but I must admit I find it rather ridiculous when I find pages which say that all the people who have it are suffering from schizophrenia - then try to bolster up this view by saying things like "Patients hallucinate about the FBI probing their minds, and that the Government is inserting devious ideas into their brain". I've never met anyone with Thought Insertion who thought its source was from some malicious external entity.

    Rather, they will report instances like this:
    They will be standing in a crowd at some busy place; for instance, at Disneyland. They will be minding their own business and waiting in line when suddenly, for no apparent reason, they will get a random idea completely disconnected from their current train of thought.

    They ponder it briefly, discard it - when the man who's standing in front of them quite unexpectedly puts the thought into words. This indicates that there is a subconscious 'link' between their minds during the interval when he was pondering over whether to say it.

    These 'links' of the mind are not consistent, and can't be used to read another person's thoughts verbatim. It's more like getting chinks of light through a stained-glass window.

    I also have read of several instances where parents have seemingly sensed their own children, and knew instinctively when there had been a death.

    This phenomenon can't be turned on and off like a switch, and people who consciously try will find themselves unable to do so.

    It's more like looking at a distant star. When you view it from the corner of your eye it is visible, but when looked at directly, it fades away. I think it quite an interesting phenomenon for study, and it is most emphatically not exclusively limited to those suffering from schizophrenia. Nichola Tesla was just one of many famous people who have experienced something like it from time to time.
    ~Robert Olin


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