Thinking in schizophrenia and the social phenomenology of thought insertion

Delusions of thought insertion (TI) involve the distressing feeling that external agents have placed thoughts into one's mind, accompanied by loss of mental privacy and a sense of physical intrusion. The dominant cognitive-science explanation, the Standard Approach, attributes TI to a lack of sense of agency for one's own thoughts, leading to their externalization. This paper argues that the Standard Approach overlooks two more fundamental aspects: the multimodal nature of thinking in psychosis and the deeply social dimension of delusional experience in schizophrenia. A broader descriptive phenomenological characterization of TI is offered, and connections are drawn to current research in social perception and clinical practice.

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Abstract

ABSTRACT Patients suffering from delusions of thought insertion (TI) report that external agents of different nature have placed thoughts into their minds. The symptom involves distressing feelings of intromission and exposition, loss of mental privacy, diminished ego boundaries, and a – often neglected – peculiar “physicality”. A dominant approach within cognitive sciences characterizes TI as involving alterations in the experience of being the author of certain thoughts. For the advocates of this so-called Standard Approach to TI, the absence of a sense of agency for certain thoughts would lead to their externalization, this explaining the general structure of the clinical reports. In this paper, I problematize the phenomenological picture of everyday thoughts that the standard approach adopts when trying to make sense of TI. I claim that the standard approach neglects two more fundamental aspects of TI, namely the multimodal nature of thinking in psychosis and the deeply social dimension of the phenomenology of delusions in schizophrenia. After this, a broader descriptive phenomenological characterization of TI is provided. Finally, I establish some connections between the characterization of TI developed here and current research in social perception and clinical practice.