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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.

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