Tuesday, 21 July 2015

The Place of Egodystonic States in the Aetiology of Thought Insertion

This post is by Pablo López-Silva, a PhD student in the Department of Philosophy at the University of Manchester. Pablo (pictured above) works on philosophical problems raised by schizophrenia, and is supervised by Joel Smith and Tim Bayne. Here Pablo summarises his recent paper 'Schizophrenia and the Place of Egodystonic States in the Aetiology of Thought Insertion', published in Review of Philosophy and Psychology. 

Paradigmatic cases of thought insertion involve the delusional belief with the content [someone/something is placing a thought with the content […] into my mind/head] (Mellor 1970; Mullins and Spence 2003). Despite the diagnostic relevance of this phenomenon, the debates about its aetiology are far from resolved. In this context, two projects can be distinguished. On the one hand, the motivational project characterizes thought insertion as resulting from the mind’s attempt to deal with highly stressing psychological conflicts. On the other hand, the deficit project defines delusions as resulting from different impairments in the process of formation of beliefs.

Current dominant deficit approaches to the aetiology of thought insertion have mostly focused on the exploration of neuropsychological impairment that might lead to the production of inserted thought (see Coltheart, Langdon, and McKay 2011). However, this seems to have led deficit approaches to overlook the role that impairment in affectivity might have in the aetiological process of this delusion. There is plenty of empirical evidence suggesting that impaired affectivity is not only a result of delusional episodes (post-delusional affective problems) but also, that is one of the conditions that might explain the very formation of delusional beliefs under certain circumstances (pre-delusional affective problems). So to speak, impaired affectivity is ‘already there’ when delusional beliefs are adopted (Marwaha et al. 2013).

Affectivity in a psychotic context has been shown to be impaired in a number of different dimensions, such as mood instability, enhanced negative reactivity, emotion regulation strategies, and baseline affective negativity (Henry et al. 2008; Marwaha at al. 2013; Kramer et al. 2014; Strauss et al. 2013). All of these disturbed dimensions might play a role in triggering and constraining the formation of abnormal thoughts under pathological conditions (see O’Driscoll, Laing & Mason, 2014). Arguably, a complete picture of thought insertion should be able to integrate this evidence into its aetiological picture.

In my latest paper, I invite the reader to consider the empirical and conceptual reasons to think of impaired affectivity as a crucial doxastic element in the process of formation of delusions of thought insertion. After addressing some of the problems of a motivational account that tries to integrate the role of affectivity into the the aetiological picture of the phenomenon, I offer an alternative view that claims that affective impairments play a crucial role in constraining or triggering the formation of inserted thoughts.

In the final section of this paper, I explore a theoretical integration between my insights and the current two-factor view of thought insertion. I suggest that impaired affectivity might act as a factor-1 experiential input and, arguably, as favouring the adoption of a certain explanatory hypothesis as more plausible than its alternatives for the adaptive benefit it serves (factor-2), namely, as a way of dealing with first-order abnormal thoughts.


  1. Dear Pablo,
    I think your paper clearly shows how affective forces might actually drive the formation of psychotic phenomena (specifically thought insertion), instead of affect only being a reactionary force to ready made delusions or hallucinations. This provides a welcome counter-weight to approaches that rely - maybe too heavily - on deficit models.
    Your model does rely heavily on empirical data regarding the experience and content of inserted thougths (and/or the emotional valence of the surrounding factors operative in the formation of the inserted thoughts).
    - I am curious as to whether you plan - as part of your project - to do empirical research (questionaires, interviews) on these phenomena.
    - There are recent papers stressing the continuity/overlap of thought insertion with - for instance - AVHs (Humpston & Broome 2015) or stressing the heterogenity of the phenomenon itself (Gunn 2015). This contrasts a bit with your emphasis on the phenomenon and its aetiology being most of the time unitary, sui generis and distinct from other psychotic phenomena. Do you think your model compatible with these perspectives (only a matter of emphasis)? A related question: why does your model - as I understand it - explain thought insertion and not also AVHs? In both cases externality/alienation is present. Why would negative affectivity (of content or surrounding factors) affect the structure of a thought resulting in TI instead of AVHs?
    - You say delusions might have an adaptive/positive role in that they externalize what is negative/unbearable/egodystonic for their subject. One might also argue that this makes them extra harmful/traumatic. Since it is unclear whether this process of externalizing the unbearable in the form of a delusion makes the original trauma/negativity succesfully disappear, it might just be an extra blow in the face: the subject suffers under the original trauma/subjective moral conflict *and* experiences it in an 'objective'/external format in the form of TI. This way, the delusion only serves to affirm the negative thoughts of the subject. Do you think this a possibility?

    Kind regards.

  2. Dear Jan

    First of all, thank you for taking the time to read my paper. I’m glad you think my proposal is plausible.

    I’ll try to reply to your question as clear as possible.

    1. My model does heavily rely on empirical data (as any model to explain delusions should do in my opinion) and I would really like to deepen the exploration of the relationship between affective impairment and psychotic disorders from a phenomenological and empirical point of view. I’m planning to do this in the next few years.
    2. I’m aware of Humpston & Broome’s (2015) and Gunn’s (2015) publications. On the latter, I’m not sure if it is diagnostically systematic in the way that psychiatric diagnosis requires. People can be really messy to describe their own experience on social media so without direct feedback from them in order to confirm certain expression is hard to tell whether those narratives really target the phenomenon we are trying to find. At the same time, I do believe that the phenomenon is heterogeneous in terms of content, but from a doxastic point of view, the delusional belief in form is the same one [the is a thought X in my mind/head inserted by Y]. Now, regarding the former, I would say that the difference is in emphasis. Although I do think that thought insertion a certain phenomenological quality that seems to distinguishing in its what-it-is-like nature from AVHs. As I say, it seems that the sensory/non-sensory difference seems to be the key. However, I recognize that further phenomenological research would help to make this distinction stronger.
    3. Again, I think there is an issue regarding the emphasis of my research. I’ve been working on issues surrounding the debate about cognitive phenomenology and I’ve always interested in delusions rather than in hallucinations. You comment is interesting cause it certainly makes me some reasons to start exploring the possibilities of this model to explaining hallucinations. If we accept that perceptions can be penetrated by affects in the same way that thought are, it might see as a plausible project. Thank you!
    4. Let me clarify my point. I do think that, in some circumstances, delusions might have an adaptive role. However, I would not say that such role has something to do with externalizing a thought. Rather, it would be related to the ability of reorganizing an affectively overwhelming experience of the world and the patient himself for example. This, in turn, might help to maintain behavioural interaction with the environment despite underlying disruptions to affective processing. I have already sketched a full draft on this issue and I hope to get it published soon.

    Thank you for all your comments



    1. Looking forward to your new work! Thank you for replying.


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