Thought insertion

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Thought insertion is defined by the ICD-10 as the delusion that one's thoughts are not one's own, but rather belong to someone else and have been inserted into one's mind. [1] [2] [3] [4] The person experiencing the thought insertion delusion will not necessarily know where the thought is coming from, but makes a distinction between their own thoughts and those inserted into their minds. [5] However, patients do not experience all thoughts as inserted; only certain ones, normally following a similar content or pattern. [1] A person with this delusional belief is convinced of the veracity of their beliefs and is unwilling to accept such diagnosis. [6]

Contents

Thought insertion is a common symptom of psychosis and occurs in many mental disorders and other medical conditions. [1] However, thought insertion is most commonly associated with schizophrenia. Thought insertion, along with thought broadcasting, thought withdrawal, thought blocking and other first rank symptoms, is a primary symptom and should not be confused with the delusional explanation given by the respondent. Although normally associated with some form of psychopathology, thought insertion can also be experienced in those considered nonpathological, usually in spiritual contexts, but also in culturally influenced practices such as mediumship and automatic writing. [1] [2]

Some patients have also stated that at some point in time they were being manipulated by an exterior or interior force (depending on the delusion that the patient faced) and only later realized that thoughts weren't theirs; this is linked to patients "losing control" of what they do.[ citation needed ]

Unbidden thoughts

Unbidden thoughts are thoughts that come to mind without the subject directly or consciously meaning to think them. Inserted thoughts, while sharing the characteristic of unconsciously or indirectly being conjured, are distinct from unbidden thoughts because of the author of the thoughts. During an experience of unbidden thinking, the subject knows that they are the author of the thought even though they may not have consciously meant to think it. During the feeling of thought insertion, however, the subject feels as though the thought belongs to another person and was inserted into their own mind, making the author of the thought someone other than themselves.[ citation needed ]

Auditory verbal hallucinations

Auditory hallucinations have two essential components: audibility and alienation. [7] This differentiates it from thought insertion. While auditory hallucination does share the experience of alienation (patients cannot recognize that the thoughts they are having are self-generated), thought insertion lacks the audibility component (experiencing the thoughts as occurring outside of their mind or spoken to them). Thus the person experiencing thought insertion recognizes that the thought is being thought of inside their mind, but fail to recognize they are the one thinking it.

Examples

Examples of thought insertion:

She said that sometimes it seemed to be her own thought 'but I don't get the feeling that it is'. She said her 'own thoughts might say the same thing', 'but the feeling isn't the same', 'the feeling is that it is somebody else's.' [5]

I look out the window and I think that the garden looks nice and the grass looks cool, but the thoughts of Eamonn Andrews come into my mind. There are no other thoughts there, only his. He treats my mind like a screen and flashes thoughts onto it like you flash a picture. [5]

The subject has thoughts that she thinks are the thoughts of other people, somehow occurring in her own mind. It is not that the subject thinks that other people are making her think certain thoughts as if by hypnosis or psychokinesis, but that other people think the thoughts using the subject's mind as a psychological medium. [8]

Theories

Standard approach

The "standard approach" is characterized by a lack of sense of agency. Most philosophers define a sense of agency as a subject's awareness that they are initiating or controlling one's own actions. According to standard approach theory, the subject does not have an awareness that they are the initiators of a thought, but they do recognize that they own the thought in that it exists within their own mind. Many have argued that the standard approach does not explain the details and the unusual pathology behind thought insertion. [5] [9] Typically, critiques argue that this account fails to provide a reason that distinguishes inserted thoughts from either ordinary thoughts that the subject did not deliberately try to conjure (unbidden thoughts) or other thoughts that are thought to be controlled by forces outside of the subject. [9] As a result, other theories of thought insertion have been proposed in order to try to explain the complexities behind the phenomenon.

Causal-contextual

The causal-contextual theory of thought insertion focuses on a lack of a feeling of ownership. This theory differs from the standard approach because rather than explaining thought insertion by saying the subject lacks a sense of agency, this model explains thought insertion by theorizing that the subject lacks a sense of ownership, which in turn creates a lack of agency. [5] Patients with schizophrenia are hypothesized to have a generalized deficit in their integration of information, illustrated through the many other symptoms of schizophrenia and psychosis. [5] According to causal-contextual theory, sense of ownership depends on integrating causal-contextual information, and a deficit in this process accounts for the abnormal experience of thought insertion.

This model has come under criticism due to its definition of sense of ownership. In philosophy, a sense of ownership is defined as a thought that occurs within the space of one's own mind. However, in the causal-contextual model of thought insertion, sense of ownership is defined as feeling as if a thought belongs to the person thinking it. [10] Because of this distinction, many (e.g. Seeger, Coliva) argue that the causal-contextual model is not a separate model of thought insertion, but rather a corollary of the standard approach. [3] [10]

Mind-to-mind paradigm

Swiney and Sousa (2013) conducted an experiment to investigate thought insertion in a normal population. [11] They attempted to create situations in which nonpathological populations would have the ability to make sense of agency misattributions in their thoughts. Participants were told that they were attached to a machine that could "transfer thoughts" from one person to another. They were then told a target word, and were to click a mouse every time they thought about the target word. However, they were only to click the mouse when they believed the target word they were thinking of was not generated by their own mind. It was stressed that the paradigm did not always work and that it was okay to not experience another person's thoughts. The vast majority (72%) of participants made at least one misattribution of agency, meaning they attributed a thought they experienced as belonging to the other participant and believed the machine had transferred the thought into their mind through the machine. This occurred after only 5 minutes. These misattributions were more frequent when the target thought was an arousing negative thought as compared to a neutral control.

Neurology

Identifying brain regions associated with thought insertion has proven difficult. First, it is difficult to find subjects who experience thought insertion frequently. Second, it is difficult to do brain imaging techniques on these subjects while they are experiencing thought insertion. Therefore, most of the findings in this field come from cases of normal people under hypnosis, as evidenced in an experiment by Walsh and colleges (2015). [2] The supplementary motor area is thought to be involved in the phenomenon of thought insertion. Thought insertion is associated with reduced activation of networks that support language, movement, and self-related processing. [2] Specifically, thought insertion is associated with a reduction in the activity of the left supplementary motor area, basal ganglia, striatal areas, right superior occipital cortex and thalamus. An altered functional connectivity between the supplementary motor area and brain regions involved in language processing and movement implementation was also found. [2]

Theory of misattributed inner speech

According to the model of misattributed inner speech, during the generation of inner speech, speech production areas fail to inhibit the speech perception area and this leads to a misattribution of one's thoughts to an external source. [7]

Comparator-model (forward model)

The comparator-model, also known as the forward model, is an elaboration of theory of misattributed inner speech. This theory relies on a model involved in inner speech known as the forward model. Specifically, the comparator-model of thought insertion describes processing of movement-related sensory feedback involving a parietal-cerebellar network as subject to feedforward inhibition during voluntary movements and this is thought to contribute to the subject feeling as though thoughts are inserted into his or her mind. It has been proposed that the loss of sense of agency results from a disruption of feedforward inhibition of somatosensory processing for self-generated movements. Frith (2012) argues that delusions and hallucination are associated with a failure in the predictive component of the model. [12] Critics of this model argue that it makes the unsupported claim that a model for movement can be transferred to account for thoughts. [13] These critics argue that this jump cannot be made because it is not known that movements and thoughts are processed in the same way. Support for the comparator-model has also been spotty. An experiment by Walsh and colleges (2015) did not support the theory behind the forward model of thought insertion. [2] They found that thought insertion was not associated with overactivation of somatosensory or other self-monitoring networks that occurs in movement. They argue that this provides evidence that a model for motor agency cannot explain thought agency.

Executive control model

The executive control model argues that thought insertion may be mediated by altered activity in motor planning regions, specifically the supplementary motor area. In one experiment, reduced connectivity between the supplementary motor area and motor implementation regions during suggested involuntary compared to voluntary movements was observed. [2]

Treatment

Most of the treatments for thought insertion are not specific to the symptom, but rather the symptom is treated through treatment of the psychopathology that causes it. However, one case report considers a way to manage thought insertion through performing thoughts as motor actions of speech. [14] In other words, the patient would speak his thoughts out loud in order to re-give themself the feeling of agency as he could hear himself speaking and then attributing the thought to himself.

Related Research Articles

Psychosis is a condition of the mind that results in difficulties determining what is real and what is not real. Symptoms may include delusions and hallucinations, among other features. Additional symptoms are incoherent speech and behavior that is inappropriate for a given situation. There may also be sleep problems, social withdrawal, lack of motivation, and difficulties carrying out daily activities. Psychosis can have serious adverse outcomes.

Paranoia is an instinct or thought process that is believed to be heavily influenced by anxiety, suspicion, or fear, often to the point of delusion and irrationality. Paranoid thinking typically includes persecutory beliefs, or beliefs of conspiracy concerning a perceived threat towards oneself. Paranoia is distinct from phobias, which also involve irrational fear, but usually no blame.

<span class="mw-page-title-main">Hallucination</span> Perception in the absence of external stimulation that has the qualities of real perception

A hallucination is a perception in the absence of an external stimulus that has the qualities of a real perception. Hallucinations are vivid, substantial, and are perceived to be located in external objective space. Hallucination is a combination of two conscious states of brain wakefulness and REM sleep. They are distinguishable from several related phenomena, such as dreaming, which does not involve wakefulness; pseudohallucination, which does not mimic real perception, and is accurately perceived as unreal; illusion, which involves distorted or misinterpreted real perception; and mental imagery, which does not mimic real perception, and is under voluntary control. Hallucinations also differ from "delusional perceptions", in which a correctly sensed and interpreted stimulus is given some additional significance.

A delusion is a false fixed belief that is not amenable to change in light of conflicting evidence. As a pathology, it is distinct from a belief based on false or incomplete information, confabulation, dogma, illusion, hallucination, or some other misleading effects of perception, as individuals with those beliefs are able to change or readjust their beliefs upon reviewing the evidence. However:

<span class="mw-page-title-main">Thought disorder</span> Disorder of thought form, content or stream

A thought disorder (TD) is a disturbance in cognition which affects language, thought and communication. Psychiatric and psychological glossaries in 2015 and 2017 identified thought disorders as encompassing poverty of ideas, neologisms, paralogia, word salad, and delusions—all disturbances of thought content and form. Two specific terms have been suggested—content thought disorder (CTD) and formal thought disorder (FTD). CTD has been defined as a thought disturbance characterized by multiple fragmented delusions, and the term thought disorder is often used to refer to an FTD: a disruption of the form of thought. Also known as disorganized thinking, FTD results in disorganized speech and is recognized as a major feature of schizophrenia and other psychoses. Disorganized speech leads to an inference of disorganized thought. Thought disorders include derailment, pressured speech, poverty of speech, tangentiality, verbigeration, and thought blocking. One of the first known cases of thought disorders, or specifically OCD as it is known today, was in 1691. John Moore, who was a bishop, had a speech in front of Queen Mary II, about "religious melancholy."

Capgras delusion or Capgras syndrome is a psychiatric disorder in which a person holds a delusion that a friend, spouse, parent, another close family member, or pet has been replaced by an identical impostor. It is named after Joseph Capgras (1873–1950), the French psychiatrist who first described the disorder.

Kurt Schneider was a German psychiatrist known largely for his writing on the diagnosis and understanding of schizophrenia, as well as personality disorders then known as psychopathic personalities.

In psychology, schizotypy is a theoretical concept that posits a continuum of personality characteristics and experiences, ranging from normal dissociative, imaginative states to extreme states of mind related to psychosis, especially schizophrenia. The continuum of personality proposed in schizotypy is in contrast to a categorical view of psychosis, wherein psychosis is considered a particular state of mind, which the person either has or does not have.

The mental status examination (MSE) is an important part of the clinical assessment process in neurological and psychiatric practice. It is a structured way of observing and describing a patient's psychological functioning at a given point in time, under the domains of appearance, attitude, behavior, mood and affect, speech, thought process, thought content, perception, cognition, insight, and judgment. There are some minor variations in the subdivision of the MSE and the sequence and names of MSE domains.

Thought broadcasting is a type of delusional condition in which the affected person believes that others can hear their inner thoughts, despite a clear lack of evidence. The person may believe that either those nearby can perceive their thoughts or that they are being transmitted via mediums such as television, radio or the internet. Different people can experience thought broadcasting in different ways. Thought broadcasting is most commonly found among people who have a psychotic disorder, specifically schizophrenia.

<span class="mw-page-title-main">On the Origin of the "Influencing Machine" in Schizophrenia</span> 1919 article in psychoanalysis

"On the Origin of the 'Influencing Machine' in Schizophrenia" is an article written by Austrian psychoanalyst Victor Tausk. He read it to and discussed it with the Vienna Psychoanalytic Society in January 1918. It was first published in 1919 in the German-language journal Internationale Zeitschrift für Psychoanalyse and, after translation into English by Dorian Feigenbaum, in The Psychoanalytic Quarterly in 1933.

The Positive and Negative Syndrome Scale (PANSS) is a medical scale used for measuring symptom severity of patients with schizophrenia. It was published in 1987 by Stanley Kay, Lewis Opler, and Abraham Fiszbein. It is widely used in the study of antipsychotic therapy. The scale is the "gold standard" for evaluating the effects of psychopharmacological treatments.

<span class="mw-page-title-main">Grandiose delusions</span> Subtype of delusion

Grandiose delusions (GDs), also known as delusions of grandeur or expansive delusions, are a subtype of delusion characterized by extraordinary belief that one is famous, omnipotent, wealthy, or otherwise very powerful. Grandiose delusions often have a religious, science fictional, or supernatural theme. Examples include the extraordinary belief that one is a deity or celebrity, or that one possesses extraordinary talents, accomplishments, or superpowers.

The sense of agency (SA), or sense of control, is the subjective awareness of initiating, executing, and controlling one's own volitional actions in the world. It is the pre-reflective awareness or implicit sense that it is I who is executing bodily movement(s) or thinking thoughts. In non-pathological experience, the SA is tightly integrated with one's "sense of ownership" (SO), which is the pre-reflective awareness or implicit sense that one is the owner of an action, movement or thought. If someone else were to move your arm you would certainly have sensed that it were your arm that moved and thus a sense of ownership (SO) for that movement. However, you would not have felt that you were the author of the movement; you would not have a sense of agency (SA).

<span class="mw-page-title-main">Vittorio Gallese</span> Italian physiologist (1959–)

Vittorio Gallese is professor of Psychobiology at the University of Parma, Italy, and was professor in Experimental Aesthetics at the University of London, UK (2016–2018). He is an expert in neurophysiology, cognitive neuroscience, social neuroscience, and philosophy of mind. Gallese is one of the discoverers of mirror neurons. His research attempts to elucidate the functional organization of brain mechanisms underlying social cognition, including action understanding, empathy, language, mindreading and aesthetic experience.

<span class="mw-page-title-main">Persecutory delusion</span> Delusion involving perception of persecution

A persecutory delusion is a type of delusional condition in which the affected person believes that harm is going to occur to oneself by a persecutor, despite a clear lack of evidence. The person may believe that they are being targeted by an individual or a group of people. Persecution delusions are very diverse in terms of content and vary from the possible, although improbable, to the completely bizarre. The delusion can be found in various disorders, being more usual in psychotic disorders.

<span class="mw-page-title-main">Neuroscience of free will</span> Neurophilosophical study of topics related to free will

Neuroscience of free will, a part of neurophilosophy, is the study of topics related to free will using neuroscience and the analysis of how findings from such studies may impact the free will debate.

Self-agency, also known as the phenomenal will, is the sense that actions are self-generated. Scientist Benjamin Libet was the first to study it, concluding that brain activity predicts the action before one even has conscious awareness of his or her intention to act upon that action. Daniel Wegner later defined the three criteria of self-agency: priority, exclusivity, and consistency.

The relationship between religion and schizophrenia is of particular interest to psychiatrists because of the similarities between religious experiences and psychotic episodes. Religious experiences often involve reports of auditory and/or visual phenomena, which sounds seemingly similar to those with schizophrenia who also commonly report hallucinations and delusions. These symptoms may resemble the events found within a religious experience. However, the people who report these religious visual and audio hallucinations also claim to have not perceived them with their five senses, rather, they conclude these hallucinations were an entirely internal process. This differs from schizophrenia, where the person is unaware that their own thoughts or inner feelings are not happening outside of them. They report hearing, seeing, smelling, feeling, or tasting something that deludes them to believe it is real. They are unable to distinguish between reality and hallucinations because they experience these hallucinations with their bodily senses that leads them to perceive these events as happening outside of their mind. In general, religion has been found to have "both a protective and a risk increasing effect" for schizophrenia.

A self-disorder, also called ipseity disturbance, is a psychological phenomenon of disruption or diminishing of a person's minimal self – the fundamental sense that one's experiences are truly one's own. People with self-disorder feel that their internal experiences are actually external; for example, they may experience their own thoughts as coming from outside themselves, whether in the form of true auditory hallucinations or merely as a vague sense that their thoughts do not belong to them.

References

  1. 1 2 3 4 Mullins, S (2003). "Re-Examining Thought Insertion: Semi-Structured Literature Review And Conceptual Analysis". British Journal of Psychiatry. 182 (4): 293–298. doi: 10.1192/bjp.182.4.293 . PMID   12668403.
  2. 1 2 3 4 5 6 7 Walsh, E.; Oakley, D. A.; Halligan, P. W.; Mehta, M. A.; Deeley, Q. (2015). "The functional anatomy and connectivity of thought insertion and alien control of movement" (PDF). Cortex. 64: 380–393. doi:10.1016/j.cortex.2014.09.012. PMID   25438744. S2CID   32993022.
  3. 1 2 Coliva, A (2002). "Thought insertion and immunity to error through misidentification". Philosophy, Psychiatry, & Psychology. 9 (1): 27–34. CiteSeerX   10.1.1.405.754 . doi:10.1353/ppp.2003.0004. S2CID   13398888.
  4. ↑ World Health Organization (January 1992). Thought blocking and thought insertion are also terms developed by the mental health system and professionals to define a phenomenon describing a technique used with so-called "synthetic telepathy" operations. The ICD-10 classification of mental and behavioural disorders: clinical descriptions and diagnostic guidelines. World Health Organization. ISBN   978-92-4-154422-1. Retrieved 16 December 2010.
  5. 1 2 3 4 5 6 Martin, J.R. (2013). "Out of Nowhere: Thought Insertion, Ownership and Context-Integration". Conscious and Cognition. 22 (1): 111–122. CiteSeerX   10.1.1.676.1811 . doi:10.1016/j.concog.2012.11.012. PMID   23262256. S2CID   13973873.
  6. ↑ Xavier Francisco Amador; Anthony S. David (2004). Insight and psychosis: awareness of illness in schizophrenia and related disorders. Oxford University Press. pp. 67–69. ISBN   978-0-19-852568-4. Retrieved 12 December 2010.
  7. 1 2 Sommer, I. E.; Selten, J.; Diederen, K. M.; Blom, J. D. (2010). "Dissecting auditory verbal hallucinations into two components: Audibility (gedankenlautwerden) and alienation (thought insertion)". Psychopathology. 43 (2): 137–40. doi:10.1159/000277003. PMID   20110766. S2CID   36837019.
  8. ↑ Young, G (2008). "On how a child's awareness of thinking informs explanations of thought insertion". Consciousness and Cognition. 17 (3): 848–862. doi:10.1016/j.concog.2007.05.005. PMID   17596965. S2CID   44282683.
  9. 1 2 Bortolotti, L (2009). "A role for ownership and authorship in the analysis of thought insertion". Phenomenology and the Cognitive Sciences. 8 (2): 205–224. doi:10.1007/s11097-008-9109-z. S2CID   143207851.
  10. 1 2 Seeger, M (2013). "Commentary on Martin & Pacherie. Out of nowhere: Thought insertion, ownership and context-integration". Consciousness and Cognition. 22 (1): 262–263. doi:10.1016/j.concog.2013.01.003. PMID   23376347. S2CID   6080000.
  11. ↑ Swiney, L; Sousa, P (2013). "When Our Thoughts Are Not Our Own: Investigating Agency Misattributions Using The Mind-To-Mind Paradigm". Conscious and Cognition. 22 (2): 589–602. doi:10.1016/j.concog.2013.03.007. PMID   23619312. S2CID   345287.
  12. ↑ Frith, C (2012). "Explaining delusions of control: The comparator model 20 years on". Consciousness and Cognition. 21 (1): 52–54. doi:10.1016/j.concog.2011.06.010. PMID   21802318. S2CID   8595849.
  13. ↑ Gallagher, S (2004). "Neurocognitive models of schizophrenia: A neurophenomenological critique". Psychopathology. 37 (1): 8–19. CiteSeerX   10.1.1.711.4188 . doi:10.1159/000077014. PMID   14988645. S2CID   4457766.
  14. ↑ Area, R.; Garcia-Caballero, A.; Gomez, I.; Somoza, M. J. (2003). "Conscious compensations for thought insertion". Psychopathology. 36 (3): 129–31. doi:10.1159/000071257. PMID   12845283. S2CID   41680371. ProQuest   230486334.
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