Tuesday 13 June 2023

What Psychopathology Teaches

This post is by Darryl Mathieson, doctoral researcher in Philosophy at the Australian National University. In this post, Darryl writes about thought insertion and self-experience in schizophrenia, which is the object of a paper recently published in Review of Philosophy and Psychology.

Darryl Mathieson

The Scottish philosopher David Hume famously argued that when he introspected, he found various mental states like thoughts and perceptions, but no extra subject of experiences that we might call ‘the self’. Hume’s denial has commanded widespread philosophical agreement and has led to the thesis that the self is at best elusive, and at worst does not appear in experience at all. 

However, a different path to self-experience that we might take is to look at what happens when consciousness breaks. Just as the deafening silence left in the wake of an air conditioner shutting off makes its constant hum more salient, so too certain experiences pervade everyday consciousness and appear elusive until we are presented with their loss or disruption. One such disorder that has been used to good effect in this regard is a symptom of schizophrenia called thought insertion—a condition in which people claim to experience the thoughts of others. 

The standard explanation of thought insertion is that certain features of consciousness go missing while others remain intact, which typically involves an appeal to what is called the ‘sense of agency’ and ‘sense of subjectivity’. The sense of agency refers to an experience of being the active thinker of our thoughts. The sense of subjectivity refers to a pre-reflective experience of there being something it feels like for us to undergo or live through our changing experiences as their subject, which is also known as “for-me-ness”. The idea is that the sense of agency breaks down in thought insertion, while the sense of subjectivity remains wholly intact. 

One big problem is that this explanation can’t differentiate thought insertion from other pathological (and ordinary) absences of agency. For example, people routinely experience intrusive or unbidden thoughts which they do not actively generate (if you want to test it, tell the next person who admits to suffering from anxious thoughts to “just stop worrying”). Motivated in part by taking the broader clinical and psychopathological context of schizophrenia into account, there is a growing trend toward explaining thought insertion as a disrupted for-me-ness, which gradually becomes so disturbed that patients no longer recognize some of their thoughts as their own. 

So, what can all of this tell us about self-experience, and why does it matter? I think what is disturbed is only disturbing because it is not normally disturbed, which means that thought insertion can help us to gain some insight into our ordinary experience of ourselves, as well as help patients understand and navigate their severely disrupted experiences. 

There is something right and wrong about Hume’s denial. He was right to conclude that the self cannot be found as an introspectable object of consciousness, but failed to recognize pre-reflective forms of self-experience that psychopathological cases make salient. By imagining what it would be like to undergo conditions like thought insertion which disrupt what is perhaps the most intimate aspect of our conscious lives, we can come to appreciate how we normally experience the self. 

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