Beruflich Dokumente
Kultur Dokumente
Vaughan J. Carr
Centre for Brain and Mental Health Research, University of Newcastle,
Callaghan, and Schizophrenia Research Institute, Darlinghurst, NSW,
Australia
Introduction. This paper proposes the hypothesis that aesthetics plays an important
role in the construction and maintenance of delusional ideas in schizophrenia.
Method. A selective review of the literature on the cognitive science of aesthetics,
beginning with the work of William James on the stream of thought, was undertaken
together with a review of some of the cognitive neuroscience literature on delusion
formation in schizophrenia.
Results. It is suggested that delusion formation has some similarities to to the creative
process, but commences with a proto-psychotic anomalous experience in which an
aberrant Jamesian fringe experience is generated. The consequence of such deviation
from standard or expected conscious experience is to direct processing resources in a
search for meaning, but under conditions of reduced prefrontal cortex monitoring
and control mechanisms. Lowering of the usual constraints exercised by prefrontal
cortex regulatory mechanisms causes the search for explanation or interpretation to
be characterised by low self-reflection, temporal distortion and low volitional
control, permitting relatively unfiltered ideas that do not conform to convention to
emerge in consciousness. The combination of aberrant Jamesian fringe experience
and reduced prefrontal regulatory mechanisms evoke idiosyncratic contextual
associations and drive a hypersensitive salience assignment system in the search for
meaning, out of which process nascent delusional beliefs emerge. These are
accompanied by a ‘sense of rightness’ in the Jamesian fringe which signals the
presence of a ‘good fit’ between the proto-psychotic anomalous experience in the
centre of consciousness and the contextual associations evoked.
Conclusion. The ‘sense of rightness’ or ‘good fit’ is responsible for the aesthetic
qualities of the delusion and, it is proposed, accounts for the incorrigibility of the
delusions.
# 2009 Psychology Press, an imprint of the Taylor & Francis Group, an Informa business
http://www.psypress.com/cogneuropsychiatry DOI: 10.1080/13546800802332145
182 CARR
Whatever may inhibit our bodily movements or prevent the immediate realisation
of our aims and wishes is a resistance. The achievement of a goal against resistance
or defeat thereby brings with it an experience of reality: all experience of reality,
therefore, has a root in the practice of living. But the reality itself which we meet in
practice is always an interpretations [sic], a meaning, the meaning of things, events
or situations. When I grasp the meaning, I grasp the reality. (Jaspers, 1923/1962,
p. 94)
This paper puts forward the hypothesis that aesthetics plays a key role in
the construction and, especially, the maintenance of those particular forms
of meaning referred to as delusions. It begins with a discussion of a
phenomenology of consciousness first articulated by William James in his
famous chapter on the stream of thought, particularly as elaborated upon
more recently by cognitive scientists such as Bruce Mangan and Russell
Epstein. The development of delusions in schizophrenia will then be
examined within that framework with reference to some of the contributions
of modern cognitive neuroscience to our knowledge of schizophrenia.
First, some brief, preliminary comments about aesthetics need to be
made. The philosopher Immanuel Kant regarded the thinking involved in
the contemplation of the beautiful as not fundamentally different from
ordinary everyday cognition. Kant proposed the concept of ‘‘purposiveness’’
(zweckmassigkeit) as central to judgements of beauty, ‘‘purposiveness’’*or
appropriateness, suitability*implying a special sense of order, unity, and the
successful accomplishment of a purpose or satisfaction of an aim. Mangan
(1991), in his thesis on psycho-aesthetics, interprets ‘‘purposiveness’’ as a
conscious experience signalling that order has been discovered by noncon-
scious processes conveying not pleasure but a ‘‘special feeling’’ of necessity,
coherence, and harmony that cannot be conveyed in concrete terms; that is,
a sense of meaning (i.e., meaningfulness) without conceptual representation
of precisely what is meant. Mangan also applied Kant’s thinking to what he
terms the ‘‘alpha cluster’’ of aesthetic experience. The latter comprises:
ineffability*an unstatable, incommunicable, ungraspable quality; unity*the
WILLIAM JAMES AND DELUSIONS IN SCHIZOPHRENIA 183
of) new, detailed information into consciousness (Mangan, 1993). The fringe
thus provides an unobtrusive control system that monitors and evaluates the
flow of information into consciousness.
With regard to context, the fringe provides what James called ‘‘feelings of
relation’’ for the content of the nucleus, a ‘‘halo or penumbra that surrounds
and escorts it’’, consisting of an associative memory network that provides
significance, meaning, value, ‘‘inward coloring’’, cognitive tang, or import
(Mangan, 1993) for the substantive experiences at the nucleus or centre of
consciousness. In addition to the feelings of relation, the sense of context has
two other components, a faint memory of preceding thoughts, and a feeling
of where one’s thoughts are heading or ‘‘feelings of tendency’’ (Epstein,
2000). With regard to retrieval, the feelings of relation provide a vague sense
of awareness of relationships between the current thought, for example, and
others that might be relevant (Epstein, 2000), and have the effect of implying
that information of various kinds is available at the periphery to be called
into focal attention. The fringe thus provides a target at the periphery by
which the information it implies can be accessed, a transitive device by which
attention may be focused on a relevant aspect of the fringe to bring it into
the centre of consciousness for detailed information processing (Mangan,
1993).
According to Mangan (2001), the fringe has a number of distinguishing
features. First, fringe experiences are diaphanous or translucent; that is, they
have no sensory content of their own. They are of low resolution, having a
‘‘fuzzy, slurred, cloud-like character’’ (Mangan, 2001) as opposed to the
fine-grained detail that occurs in focal attention. They are elusive, slippery,
and ungraspable, eluding direct introspection, and are verified only
indirectly. Fourth, they are more evident in the periphery of experience
than with focused attention. Last, they are unobtrusive and, although they
may vary in intensity, with some exceptions (e.g., tip-of-the-tongue, feelings
of knowing, feelings of familiarity*see later) they are generally less intense
than sensory experiences. Similarities are evident between the nonsensory
fringe and the concept of preattentive processing described by Neisser (1967)
on the basis of experimental studies and subsequently elaborated by others,
including work on what has been termed ‘‘inattentive’’ experience (Mangan,
1993).
Some of the nonsensory experiences attributable to the operations of the
fringe (see Epstein, 2000) include the feeling of expectation that occurs when
our attention is drawn to something and we have a sense of what it might be
before it is actually revealed. Others include the feeling of knowing when, for
example, one has a word on the tip of one’s tongue but is unable to recall it,
the feeling of familiarity in the presence of well-known and recognised
people or surroundings, the particular sense of connection contributed by
words such as ‘‘but’’, ‘‘and’’, or ‘‘nevertheless’’ to the logical structure of
WILLIAM JAMES AND DELUSIONS IN SCHIZOPHRENIA 185
SCHIZOPHRENIA
For the mad, the insane, thing to us is that which is torn from the common context
and which stands alone and isolated, as anything must which occurs in a world
totally different from ours. (Dewey, 1934/2005, p. 202)
Just as Proust creates a metaphor that acts as a symbol for something that
cannot be directly represented in everyday cognition, namely the fringe of
associations that normally only convey an overtone to conscious impres-
sions, so does the schizophrenic patient create a symbol for something that
cannot be directly represented, the fringe of associations evoked by the
protopsychotic anomalous experience underlying psychosis.
William James argued that the most important of all the fringe feelings
(i.e., experiences, awareness) was the feeling of harmony (i.e., rightness,
being on-track) because it guides the progression of thought, and plays a role
in sustaining or aborting searches, including searches of memory. He also
proposed that as one’s search progresses, the feeling of rightness appears
each time one’s latest percept is closer to one’s inner goal image, which, in
the case of schizophrenic psychosis, is to find meaning or explanation for the
protopsychotic anomalous experiences occurring within the nucleus of
consciousness, and this feeling of rightness as one’s inner goal is approached
in some way validates and encourages the search direction. It has further
been proposed by Mangan (1993) that aesthetic feelings are particularly
intense versions of this same feeling of rightness or degree of fit between
features in the nucleus and the associated nonconscious knowledge structure
in the fringe that gives those features meaning.
I suggest that delusions achieve this same intense feeling of rightness or
degree of fit with the protopsychotic anomalous experience on the one hand
and, on the other, with the associated nonconscious knowledge structure
implied in and accessed through the fringe of the psychotic patient. When a
protopsychotic anomalous experience occurs in the nucleus of consciousness
there is a sense of dissonance generated in the fringe conveyed as a sense of
wrongness or absence of rightness, a feeling that is also implicit in the feelings
of loss of agency, loss of ownership, or loss of familiarity. This is
discomforting. The delusion puts this right and eliminates the discord. The
delusion is formed by knitting together the anomalous experience and items
from among those accessible in the associative network by a hypersensitive
salience assignment mechanism to construct an explanation for the changed
state of the world. The delusional explanation thereby creates harmony
between the contents of consciousness in the nucleus and the patient’s
associative network, and in so doing induces a feeling of rightness or good
fit in the fringe. The rightness or goodness of fit engendered by the delusion
has the potential to give it aesthetic value to the patient and the more intense
the experience of rightness the greater is the aesthetic experience of the
individual.
I propose that the feeling of rightness accounts for the resistance to
change of delusions, their maintenance in the face of disconfirmatory
evidence, and their continuation despite reasoned argument to the contrary.
The rightness of the delusion signals coherence between the content of
196 CARR
CLINICAL ILLUSTRATION
A 40-year-old single man had a system of persecutory delusions that centred
on his ‘‘feeling’’ (his word, he rejected the term ‘‘belief’’) that a microchip
had been implanted in his body. This explained a large number of his
experiences, including that people knew in advance what he was doing and
knew generally about what was going on in his life, as well as numerous
instances of alien control of his thoughts and actions, and feeling that people
were reading his mind. The central idea of the microchip came to him in
adulthood after a developmental history marked by traumatic family break-
ups and emotional and physical cruelties of various kinds. As a child he had
witnessed verbal and physical abuse in the home and his step-father had
‘‘played mind games’’ with him in which intimidation, humiliation, and
sadistic manipulation were the hallmarks. The microchip explanation
occurred to him at a time when people’s behaviour and motivations no
longer made sense to him, events seemed inexplicable, and he had the sense
that his thoughts and actions were no longer his own or under his full
control. On one occasion, in which he had an uncanny feeling of ‘‘being set
up’’ while people were approaching him to engage in conversation in ways
that did not make sense to him, someone used the word ‘‘chip’’. He
immediately fastened upon this as conveying the message that a microchip
WILLIAM JAMES AND DELUSIONS IN SCHIZOPHRENIA 197
had been inserted in his body through which he was being controlled and
monitored. This explanation ‘‘clicked’’ and everything then fell into place, all
of his current anomalous experiences now made sense to him and fitted with
memories of his traumatic earlier development. There was a peculiar
ineffability about this interpretation, it knitted together so many otherwise
disparate and puzzling experiences into a coherent whole, it had an
irresistibly captivating explanatory power, it had profound implications for
the nature of his being-in-the-world, and there was a compelling ‘‘rightness’’
about the quality of understanding or insight it conveyed.
CONCLUDING REMARKS
The role of aesthetics in the construction and maintenance of belief is almost
certainly not confined to delusions in schizophrenia or other mental
disorders, but has a role in everyday belief as intimated by Kant. John
Dewey wrote in the 1930s of the aesthetic dimensions of meaning
construction in relation to everyday thinking and belief, stating that ‘‘an
experience of thinking has its own esthetic quality . . . [it] has a satisfying
emotional quality because it possesses internal integration and fulfilment
reached through ordered and organized movement’’ (see Johnson, 2007,
pp. 103105). He outlined a similar sequence to that already described in
relation to the development of delusions: a problematic situation requiring
interpretation or explanation and engagement in an inquiring search for
generalisations in which the ‘‘unity of qualitativeness [i.e., rightness or degree
of fit] regulates pertinence or relevancy and force of every distinction and
relation; it guides selection and rejection and the manner of utilization of all
explicit terms’’ (p. 78).
Different ideas have their different ‘‘feels,’’ their immediate qualitative aspects, just
as much as anything else. One who is thinking his way through a complicated
problem finds direction on his way by means of this property of ideas. Their
qualities stop him when he enters the wrong path and send him ahead when he hits
the right one. They are signs of an intellectual ‘‘Stop’’ and ‘‘Go.’’ If a thinker had to
work out the meaning of each idea discursively, he would be lost in a labyrinth that
had no end and no center. Whenever an idea loses its immediate felt quality, it
ceases to be an idea and becomes, like an algebraic symbol, a mere stimulus to
execute an operation without the need of thinking. For this reason certain trains of
ideas leading to their appropriate consummation (or conclusion) are beautiful or
elegant. They have esthetic character. (Dewey, 1934/2005, pp. 124125)
everyday thinking and belief formation. For example, in some places AIDS
deniers claim that HIV does not exist, or that if it does exist it does not cause
AIDS, and they proffer alternative explanations for the widespread death
and morbidity caused by this disease. Influential groups in developed
countries claim that autism is caused by childhood vaccinations even though
rigorous studies do not support this belief (Editorial, 2007). Members of
certain eschatological religious groups prepare for the Rapture and
Tribulation of the end time, which they believe is imminent, reflecting the
beliefs of similar millenarian sects over hundreds of years. At a more
commonplace level there are the widely held beliefs in astrology. Adherence
to false or highly improbable propositions may be based on a variety of
factors, such as to obtain acceptance within a particular social group and
thereby achieve status of ‘‘insider’’ comforted by shared knowledge
systems. However, the aesthetic experience arising from the sense of
rightness outlined in this paper is one further factor that could play a role
in the acquisition and maintenance of false beliefs among people other than
those with clinical delusions, and is worth further exploration in this
context.
It is also possible that the feeling of rightness could be relevant to the
genesis of confabulation and the adherence to false memories. Similarly, a
feeling of rightness could be generated in affective disorders by delusional
ideas that ‘‘fit’’ with intense affective experiences. However, the present
hypothesis was developed to account for the maintenance of delusions in
schizophrenia and the role, if any, of the feeling of rightness in other
delusional states and in confabulation constitute separate questions that may
be worth pursuing.
James asserted that feelings of rightness played a role in everyday
thinking and problem solving, and not just creative or artistic thinking.
Yet, the roots of aesthetic experience have been proposed to derive from the
feeling of rightness, and the more intense the feeling of rightness the more
intense the aesthetic experience. What makes for an intense feeling of
rightness in delusional and other beliefs is not clear, but the number and
aptness, or fittingness, of associations evoked by the thought, conclusion, or
belief in the relational memory network, by encapsulating a sense of
necessity, coherence, and harmony, and thereby enriching the meaning and
feeling tone (meaningfulness) of the thought or belief, may be the key to
answering this question.
The defective belief evaluation system that has been proposed to account
for the incorrigibility of delusions in the two-factor model of delusions
(Coltheart, 2005; Davies, Coltheart, Langdon, & Been, 2001) is rendered
redundant if the present rightness/aesthetic hypothesis is confirmed as the
sole means of accounting for the incorrigibility of delusional beliefs. This
particular two-factor position appears to assume that beliefs are generally
WILLIAM JAMES AND DELUSIONS IN SCHIZOPHRENIA 199
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