Motivational urges, Motor System, and Neurological Correlates

 How can we measure the connection between human urges, the translation of those urges in the form of behavior, and the neurological mechanism of action? This is precisely the question Gupta and Aron set out to answer in their article, “Urges for food and money spill over into motor system excitability before action is taken.” No doubt, much of human behavior is driven by urges. In psychological jargon, the operational definition of an urge can be defined as how much someone desires an object, relative to its perceived value.

Wondering whether the urges for food and money are detectable by way of motor system excitability, the researchers in this article employed the use of transcranial magnetic stimulation (TMS) and concurrent electromyography to test their hypothesis. They hypothesized that stimuli associated with stronger urges, in this case food and money, would correspond to higher motor excitability and that this excitability would be evident before the participant consciously decided which motor response to make.

            As is typical, the experiment consisted of 17 young adults (9 male, mean age=21.9) who were instructed not to eat for 4 hours prior to the study. They were presented with 60 food items ranging from candy bars to clam juice, and were told to rate them on a 5 point likert scale. Two other similar experiments were conducted using a monetary paradigm instead of food. For all three experiments, there was a randomized presentation of food items (the stimuli), and each trial began by simple priming: either a picture of food or an empty rectangle. A choice screen followed, providing the participants with a Yes/No option corresponding to either the left or right index finger. Further, this Yes/No option was randomized—that is, participants would not always be presented with the “yes” option corresponding to the right index finger.

            This is interesting since it negates the possibility simple response preparation. Nor can this be simply a matter of increased arousal, since the effect was present only when action was required. Concerning this, the researchers note that “it must also reflect motivational processing that is upstream from the corticospinal system…[that] likely involves brain systems such as the orbital frontal cortex and associated limbic circuitry, including the ventral striatum ⁄ nucleus-accumbens and ventral pallidum.” (Gupta, 2010, p. 186).

            The article mentions its contribution to the growing literature of embodied cognition. Indeed, with the sensitive testing method they used, they provide the ability of observing the so called motivational “spill-over” into the motor system, even before the motor system knows exactly what to do.

            Further research is needed to investigate the action the researchers anticipated, namely that the motivational spill-over will correspond to heightened activation of motor regions of the basal ganglia.

by Phillip J. Kuna

for John G. Kuna, PsyD and Associates 

Licensed Psychologist

http://drjohngkuna.com

References

Gupta, N., & Aron, A. R. (2011). Urges for food and money spill over into motor system

excitability before action is taken. European Journal Of Neuroscience, 33(1), 183-188. doi:10.1111/j.1460-9568.2010.07510.x

Is Psychology a Science? (Part 1)

Introduction

           

 This entry will identify and integrate both the objective and subjective dimensions of human conscious experience into a unified theory. The first part of this paper will focus on situating the often referenced, but rarely resolved problem of psychology qua science. That is, since psychology’s inception it has been concerned with objectivity, with working within the structure of scientific methods, with discerning laws of human behavior that are reliable, predictable, accurate—and hopefully cross cultural and universal. Psychology has been defined variously throughout its progression, whether it be the study of human behavior, human nature, or even the ever ambiguous designation of the study of the “mind”. Yet, the method of quantifying the objective component in the midst of so much subjectivity has produced a plethora or methodologies, schools, systems and theories. Nor is this a relatively modern problematic. Despite claims that the methodological fragmentation in psychology is a recent occurrence (Goertzen, 2012), it was indeed as early as 1929, that Karl Bühler published his famous Die Krise der Psychologie.[1]

            The issue becomes even more fragmented, when one reviews the literature on the subject. Ironically, the so called ‘crisis literature’ itself is disjointed, with some arguing that the crisis is merely an institutional or disciplinary issue (Stam, 2004), while others urge that the real issue is epistemological and methodological (Staats, 1983; Kantor, 1979). This paper, however, will follow Thomas Kuhn (1996) in noting that any science that holds competing paradigms is only a pre-science until a uniform methodology is adopted and will therefore focus on the present epistemological fragmentation.

            Nor is this simply a theoretical and philosophical conundrum. On the one hand, the very reputation of the science of psychology is frequently questioned as psychological findings are often dismissed as either common sense or in no way comparable to the strict statistical measures of the hard sciences.[2] This ongoing fragmentation in the field of Psychology has indeed left not a few leading psychologists wondering how such a fracture will affect psychology’s validity as an academic and scholarly pursuit (Gardner, 2005; Rychlak, 2005; Driver-Linn, 2003). On the other hand, psychology is an inherently practical endeavor insofar as clinicians are working with individuals, families and children, and policy makers are forming decisions based on psychological findings and recommendations from authorities in field.

            After situating the state of the question and reviewing the literature, the second half of this paper, then, will focus on incorporating the work of the philosopher Bernard Lonergan in an attempt to fill the lacunae of a methodological framework that can encompass both the objective and subjective dimensions of the study of human behavior.

The nature of scientific inquiry

            Socrates was fond of meandering around Athens, asking people, “What is piety?” or “What is justice?” As would be the case today, most could readily provide examples of piety or justice, but very few could provide a systematic definition of the terms. It wasn’t until Aristotle that systematization is offered. With Aristotle, virtues such as temperance are defined as the mean between the two extreme of insensibility and intemperance.

            The above Aristotelian anecdote serves also to highlight the systematization inherent in scientific pursuit and methodology. Surprisingly, it was not too long ago that scientific methods were based on inductive reasoning. Newton, for example, first observed the apple fall and only then proceeded to form hypotheses about the physical phenomenon that he observed.  In contrast to this stands Karl Popper’s (1935) vision of science as hypothetico-deductive system, where hypotheses come first, followed by careful experimentation, and discrete falsification.

            Falsification, as the key for Popper, relies on the assumption that inductive evidence is limited. Since one is unable to observe the physical world at all times, one is not epistemically justified in creating universally applicable rules based on one instantiation. Popper provides his famous swan example: for hundreds of years, Europeans were familiar with the white swan. Using inductive reasoning, one could then conclude that all swans are white. Yet exploration to the East revealed black swans in Australia. Induction, then, can never yield certainty since only one falsifiable observation is needed to refute the (inductively based) theory.[3]

            From this, six foundational concepts necessary for scientific pursuit can be discerned. A description of these events, followed by their role within the science of psychology will be given.

        Empirical evidence is the first component to scientific pursuit. The data collected does not rely on belief or argumentation; rather it is collected through direct observation or experimentation. Careful experimentation and documentation is necessary for data collection and future replication of the study. Next, accurate science requires objectivity. Personal feelings and values should be eliminated so as not to compromise objectivity. The data should speak for itself, even if that implies a different outcome than the investigator initially desired. Third, control of all extraneous variables is necessary to validly establish cause (IV) and effect (DV). Prediction of future occurrences of the phenomenon is the fourth component of a reliable scientific method. Hypothesis testing is the fifth component. Hypothesis testing requires that the hypothesis be made prior to the experiment, serves as a prediction, and is derived from theory. Both a Null and Alternative hypothesis must be operationally defined and unambiguous so that they can be tested and replicated. Finally, the replication process ensures accuracy and confidence in creating a scientific body of knowledge. Intense discoveries that cannot be replicated should not be accepted by other scientists.

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[1] Similarly, Vgotsky’s monumental critique of the fragmented methodologies in the field of psychology was published in 1928.

[2] While relevant to the topic of the scientific nature of psychology, a discussion of Null Hypothesis testing, Bayesian vs. non-Bayesian statistical methods, and the incorporation of stricter statistical protocols that mimic the natural sciences is beyond the scope of this present discussion. 

[3] Popper was also conscious of the reciprocal interaction between the individual and her environment. He therefore rightly rejected the naïve empiricist claims of objective observation of the natural world. Rather, Popper holds that all observation begins from a specific viewpoint and is influenced by the knowledge and experience already possessed by human beings.

by Phillip Kuna, PhD (abd) 

for John G. Kuna, Psy.D. and Associates Counseling
Drjohngkuna.com

The Misattribution of Misattribution: Analysis of the Cognitive models of Hallucinations, Part IV [Conclusion]

A further study provides an integrative account of several previously discussed constructs.  Again using the misattribution theory as their springboard, Larøi, Linden and Marczewski (2004) explored the relationship between meta-cognitive beliefs, cognitive effort and emotional pertinence on a reality monitoring test of hallucination prone participants. This study is notable for its attempt, not simply to confirm the already well documented misattribution theory, but rather to explain the underlying cognitive mechanism of this process. This study is based primarily on the earlier theoretical work of Morrison, Haddock and Tarrier (1995), who argue that an affect laden cognitive dissonance occurs when an unwanted and intrusive thought contradicts a particular meta-cognitive belief system. This in turn triggers an aversive state of arousal and anxiety. Either unable or unwilling to existentially face this cognitive dissonance, the individual attributes the intrusive thought to an external source (i.e., the event becomes hallucinatory). One example of a meta-cognitive framework ripe for this phenomenon may be, “Not being able to control my thoughts is a sign of weakness” (Larøi, 2007). Finally, the researchers note cautiously that even if such cognitive stars do indeed align they should be seen within the larger context of predisposing factors to hallucinations.

            The researchers tested this hypothesis by first screening 100 undergraduates on the Launay-Slade Hallucinations Scale (LSHS). Those scoring in the upper 25^th percentile were considered hallucination prone (HP; N = 25) and those on the lower 25^th percentile were considered non-hallucination prone (NHP; N = 25). There was no significant distribution difference between genders. A French translation of the Meta-Cognitive Questionnaire (MCQ) was administered to assess participant’s meta-cognitive beliefs systems. Based on a 4-point Likert scale, the 64 question MCQ purports to assesses internal positive and negative beliefs regarding intrusive thoughts and meta-cognitive monitoring based on the following five sub-scales: 1) Positive beliefs about worry (PB), 2) Negative beliefs about the uncontrollability of thoughts and corresponding danger (UD), 3) Cognitive confidence (CC), 4) Negative beliefs about thoughts in general (specifically thoughts related to superstition, punishment and responsibility; SPR), and 5) Cognitive self-consciousness (CSC).

            Participants were then given a reality monitoring test. Similar to other such procedures, the participants were orally presented with 30 words (10 positive, 10 negative, and 10 neutral), and were asked to speak the first word that came to mind. The affect laden words were chosen based in part on the previous work of Braun, Marczewski and Van der Linden (2000). Examples include “bankrupt, suicide, cancer” for negative words, and “paradise, seduce and succeed” as positive words. Neutral words included, “pencil, domain, sheet.” Subjects could provide any verbal response except a proper noun. After a 20 minute delay, participants were shown a computer screen with the original word list, their verbal responses, and distractor words and asked to identify whether the words were from the previous list or not. If the word was from the previous list, participants were instructed to indicate the source—whether participant response or experimenter.

            As predicted, the results indicated a significant difference between the HP group and the NHP group in terms of source discrimination errors, particularly when the material was self-generated (U = 43, p < .05). Again, a significant difference was found between the HP group and the NHP group on MCQ scores. Specifically, the researchers found positive correlations between LSHS scores and all five MCQ sub-scales. Also, interestingly, positive correlations between scores on the UD sub-scale (negative beliefs about uncontrollable thoughts; Spearman r = .49, p < .05), the CC sub-scale (cognitive confidence; Spearman r = .45, p < .05) and source discrimination errors were found. Results were interpreted to support the misattribution theory, as well providing further support for the previously mentioned continuum model of hallucinations.

            While commendable for the testing of multiple constructs relating to hallucinations in normal populations and thus validating previous research, this study’s largest deficit is its inability to explain the cognitive processes involved. As I have argued, this is related to the lack of a systematic account of cognitional operations with which to validate. The implications of this critique are described more fully in the following conclusion.

            Finally, a brief but pertinent study considers the source of hallucinations in individuals with remitted schizophrenia from an information-processing deficit perspective. Miller and Saccuzzo (1979) employed a backward-masking paradigm to assess the initial stages of information-processing in individuals with schizophrenia in remission. In general, visual masking happens when one visual stimulus obstructs discernibility of another visual stimulus. Backward masking, then, is the experimental procedure whereby the target stimulus is presented first, before the masking stimulus (Skottun and Skoyles, 2009). Although somewhat dated, the Miller and Saccuzzo (1979) study is an important contribution to the study of hallucinations in schizophrenic individuals. Additional research has suggested that individuals with schizophrenia have a particular deficiency in the magno-cellular level of the visual system (Green, Nuechterlein, & Mintz, 1994), and abnormal backward visual masking is interpreted as evidence of this claim (Butler & Javitt, 2005).

            Participants included a mere 10 individuals in the normal control group, and an equally sparse 10 individuals with schizophrenia. The schizophrenic individuals, all on anti-psychotic medication, were residents at a care facility with over one year of hospitalization, and three months symptom-free prior to testing. Before testing, participant’s vision was assessed by means of the Snellen Eyey Chart, and language comprehension was measured by the Wechsler Vocabulary subscale.

            In terms of the procedure of backward masking, the researchers employed both a blank masking condition as well a pattern mask by means of a tachistoscope. Each masking condition was affixed to the tachistoscope so that the stimulus was located centrally in the field of vision. The pattern mask was two capital “W’s” adjacent to each other as well as a small, back-lit cross just above the Ws. As Miller and Saccuzzo report, “The fixation field remained constantly illuminated (1.0 ftL or 3.43 cd/m2) providing a lighted background between trials. Luminance in both the stimulus and masking fields was set at 16.33 ftL (55.95 cd/m2) throughout the experiment” (Miller and Saccuzzo, 1979, p. 447). Participants were to detect either a “T” or an “A” from a two-alternative forced choice task. Finally, each masking task was administered under five stages: a no mask control, and subsequent 10, 75, 150, and 250 millisecond delay of the mask to the stimulus presentation. 

            Results indicated that the normal control group made significantly more correct decisions on both masking conditions (p < .01). Similarly, the normal control group scored significantly higher than schizophrenic individuals on both the 2 millisecond delay (p < .01) and the 4 millisecond (p < .05) delay trials. Clearly, individuals with schizophrenia, even though they were non-symptomatic for three months, had more difficulty with detection in the presence of the masking stimulus. These results were interpreted to implicate the possible role pre-cortical processing deficiency. Miller and Saccuzzo argue that, while their conclusions are still tentative, this may be a possible means of measurement of clinical symptomology as well.

Conclusion

            In addition to the over-arching epistemological problem, several specific directions for future research have already been noted throughout this paper: the inclusion of emotionally charged stimuli in experimentation, further investigation into the mediating factors of hallucinations—particularly trauma—as well further examination of the role of cognitive effort and meta-cognitive beliefs.  

Although the hypothesis that misattributed vivid mental images were the origins of VH was proposed by Galton over than 100 years ago (Galton, 1883), a review of the literature reveals that attempts to verify and replicate this claim have been either contradictory or have failed to specify the cognitive mechanism of action. I have argued that the cause for this lack of scientific progress is due to a combination of a fundamental disagreement as well a definite absence of explicit theory of knowledge guiding such cognitive research.

            In the above discussion of the Aleman et al. article, I noted a possible underlying position of positivism. Positivism has arguably been the prevailing philosophical paradigm since inception of modern psychology (Breen and Darlaston-Jones, 2010), since it provides support for psychology as a justified scientific endeavor that is observable, replicable and objective. Recent research into the nature of human consciousness further exemplifies the still current prevalence of positivism. Chalmers (1996), for instance, argues that while attempts to explain the invisible are all well and good, what is physical is ultimately real. Ironically, even researchers in the hard sciences that psychology strives to emulate—say, physics for instance—understand that the particles they investigate are often times simply constructs of human intelligence. Such constructs, while not ultimately tangible, are ways to explain what must indeed be so if they are to offer an explanation of what has actually been observed. In other words, as the history of psychology has shown, despite its limited and initial benefits, the narrowness of positivism is not rich enough to account for the complexities of the human condition, and the future of the science of psychology may be contingent upon the integration of both the objective and subjective components inherent in human cognition.

            Although again constrained by the scope of this paper, future research would do well in looking to the seminal work of the philosopher Bernard Lonergan for a unifying epistemological foundation. Lonergan, by grounding objectivity within one’s own subjectivity and rational self-consciousness, provides a plausible, reliable and indeed first person empirical alternative to the varied epistemological and methodological approaches currently present in psychological theory (Brannick, 2006). With a unified epistemological framework in place, future research would be able to advance by constructing more specialized experiments consistent with such integrated theory of knowledge.  

            In conclusion, this was a cursory treatment of a vast and growing body of literature, and should not be considered a comprehensive review. A complete analysis would entail more detailed comparisons between the theoretical and epistemological underpinnings, especially in instances of conflicting results. Based on this preliminary research, however, I hypothesize that crux of the inconsistencies in the literature are based on a pervasive positivism that mistakenly equates knowledge to ocular vision. That is, as was seen in the Aleman et al. article, the assumption is that internal data are subjective, private events that cannot be understood since they cannot be observed. The difficulty with this position, however,  is that if knowing is simply a matter of taking a good look, then knowing knowing (i.e., meta-cognition) would be nothing more than looking at looking (cf. Lonergan, 1967a). As such, future research would do well to investigate, explicate and unify these often subtle epistemological claims underpinning psychological theory and research.

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By Phillip J. Kuna, PhD (abd)
for John G. Kuna, Psy.D. and Associates Counseling

www.drjohngkuna.com

The Misattribution of Misattribution: Analysis of the Cognitive models of Hallucinations, Part II

Our starting point is a 2008 study by Brébion et al. The researchers present a theory of source-memory deficits as possible etiological explanation for VH in individuals with schizophrenia. The Source Memory deficit theory argues that VH essentially arise from a lack of intact reality testing. In this paradigm, VH are a result of the individual’s inability to differentiate between imagination and perception—similar to the theory that auditory hallucinations arise from externalization of internal speech (Allen et al., 2004). The authors, therefore, designed a reality monitoring perception test that would measure an individual’s ability to distinguish perceived from imagined images. The researchers hypothesized that clients with VH would exhibit a greater tendency to falsely remember seeing pictures that had in fact been presented as words only.

The present study contained 41 patients with schizophrenia and 43 healthy individuals for the control group. There was no significant difference of age, gender, education, ethnicity or verbal IQ between the two groups. Verbal IQ was assessed by administration of the National Adult Reading Test (NART). Positive symptoms were assessed by administration of the Assessment of Positive Symptoms (SAPS).

The researchers employed the Battig and Montague set (1969). An invaluable tool for researchers across multiple disciplines, this instrument is a categorical norming set which purports to present exemplars and prototypes of various culturally conditioned objects. Sixteen categories from the Battig and Montague set were presented. Only common objects were used—for instance, “elephant” and “tiger” for the category of animal. Participants were shown two cards for each instance within a category. One card displayed only the word defining the object; the other card provided the picture of the object with an accompanying verbal label. The experimenter indicated the category name (“types of animals”) before presenting both cards. In order to ensure encoding, the participants were required to verbally name the two objects, as well as provide a third example. Unfortunately, participant examples were not included in their research. After an approximately 5 minute pause, a recognition test was administered. As the experimenter read aloud the list of objects as well as distractor items, the participants were required to indicate whether each item had been presented as a word, a picture, or not at all. Immediately following the recognition test, a reality-monitoring test was given. As the experimenter read the list of the 32 target items, participants were required to indicate whether a picture of the word had been displayed or merely the word. Participants were informed that all items in this test had been previously presented.

Data analysis seems to confirm the misattribution theory. The researchers found a significant interaction of subgroups and misattribution. Specifically, they found that those participants reporting VH made significantly more misattributions to pictures than the other patients, t(39) = 2.79, p < .01.

The authors note the limitations characteristic of a study on VH in individuals with schizophrenia—namely, a small sample size. They further note that, procedurally, the presentation of images and words categorically (“type of animals”) is limiting insofar as it may provide memory cues, and urge that future replication studies consider employing a non-systematic presentation of images.

Two further limitations may be equally noted. First, the researchers employed the Battig and Montague set (1969) to categorically delineate everyday objects, which itself is an updated version of the Connecticut Category Norms originally published in 1957 by Cohen, Bousfield, and Whitmarsh (Overschelde, Rawson, and Dunlosky, 2004). More than 40 years after its creation, the Battig and Montague set should most likely have been substituted for a more current standard. The Battig and Montague set, for example, includes such anachronisms as “rubbers” for shoes, and the “waltz” for a popular style of dance. A replication of Brébion’s above work using the Overschelde et al. instrument, which boasts new categories, new measures, as well as latencies for generated responses, would be highly desirable.

Second, with respect to the aforementioned epistemological framework, it is not clear to me why the researchers required participants to verbalize the image on the card. While the integration of contemporary cognitive theory into the research is laudable, the difficulty with this method is that it produced both an internal and external vocalization. Although still self-generated, this external vocalization could be disruptive to the process of understanding how only internal events (whether words or images) relate to misattributions.

A less unique, but particularly relevant study for the purposes of this paper, concerns the role of affect and intentionality as predisposing factors for a hallucinatory experience. Based in part on previous work by Gauntlett-Gibert and Kuipers (2005), that indicated the activating role of affect in hallucinatory experiences, this 2012 study by Oorschot et al., employed the Experience Sampling Method (ESM). The ESM purports to provide first person empirical feedback on emotional states by means of a structured, self-report likert scale. While proponents of the ESM method argue that it offers the advantage of providing real-time responses, instead of relying on recall and the possibility of memory deficiencies, opponents readily cite the inherent difficulties in any self-report measure, perhaps especially in patients with psychotic disorders.

Nonetheless, in this study, 184 participants (71% male) with psychosis spectrum disorder were provided a digital stop watch and assessment booklets that were collected daily. Ten times daily for six consecutive days, the programmed stop watch would signal at random intervals ( = 90 minutes) between 7:30 am and 10:30 pm, alerting the participant to begin the assessment. The ESM assessment consists of open-ended questions and a 7-point Likert scale questions aimed at measuring the participant’s emotional state, psychopathology, and environment. Likert scale questions aimed at capturing psychopathology included statements such as, “I hear voices” and “I hear phenomena”. Similarly, likert scale questions to assess emotional state were based on mood adjectives such as “I feel cheerful/satisfied/relaxed” and “I feel guilty/anxious/sad.” During pre-testing instructions, participants were required to complete a single ESM assessment to gauge their task comprehension. The experimenters regularly contacted the participants throughout the trial in order to assure compliance, and participants who responded to less than one third of the emitted signals were not included in the study. Finally, Oorschot et al. report literature citing the validity of the ESM measurement, in both normal control groups as well as psychotic populations.

Analysis revealed that, of the commendably large sample size for this population, 30% reported AH and 25% reported VH. Further, of the 1,111 instances of reported hallucinatory events, there were 196 VH and 399 AH. Participants reported 117 moments of cannabis use out of 7,399 total reported instances (9 instances were related to VH, and 31 instances related to AH).

In terms of the relationship of emotional state to hallucinatory experiences, Oorschot et al.’s predictable results found that participants expressed significantly higher negative affect (and subsequently significantly lower positive affect) during a hallucinatory event. More specifically, patients reported that VH were preceded by a decrease in positive affect. Accordingly, future research in this domain would be highly improved by the use of emotionally charged stimuli. The previously discussed Brébion (2008) article, for instance, would seem more successful if the pedestrian words and images presented (for instance, “elephant” for type of animal) were replaced with more emotionally relevant stimuli (religious or personally relevant words seem applicable).

The limitations of self-report nature of this study notwithstanding, the relationship of anxiety to the onset (and duration) of both AH and VH is significant insofar as it intersects and confirms prior research on the role of intentionality and affect in hallucinatory experiences. Prior research has already well-documented the relationship between affect and hallucinations (Gauntlett-Gilbert and Kuipers, 2003; Birchwood and Chadwick, 1997), specifically implicating anxiety and depression in the genesis of hallucinations (Freeman and Garety, 2003).

Still, observing a correlation between the variables of anxiety and hallucinations is one thing—accounting for the cognitive processes underlying this relationship is quite another. The limitation of the absence of a theory of knowledge guiding this research is reflected in the inability of researchers to construct experimental procedures with which to test specific cognitional theories. That is, as was noted above, the vast and steadily growing literature on cognitional theories of hallucinations seems primarily to confirm previous similar studies. More recent literature, failing to provide an epistemological foundation and focusing instead on new measures, different instruments, or higher sample sizes, has thus far only been able to replicate previous findings. Scientific progress, at least in a Kuhnian perspective, will require explication and unification of a theory of knowledge from which more accurate experimental models can be produced.

By Phillip J. Kuna, PhD (abd)
for John G. Kuna, Psy.D. and Associates Counseling

www.drjohngkuna.com

The Misattribution of the Misattribution Theory: An Analysis of the Cognitive Models of Hallucinations, Part I

Introduction

           

Although rare, visual hallucinations (VH) constitute a well-recognized and rather distressing occurrence to presenting clients. The Diagnostic and Statistical Manual of Mental Disorders, 5^th edition (DSM-5) defines hallucinations as “perception like experiences that occur without an external stimulus” (American Psychiatric Association, 2013).

            The literature on VH is surprisingly vast. Although typically considered the hallmark of schizophrenia spectrum, VH occur across various other pathologies, including—but not limited to—Creutzfeldt-Jakob disease, especially the Heidenhain variant (Brar & Scicutella, 2005), Parkinson’s Disease (Lees, 2005), Charles Bonnet Syndrome (Rovner, 2006), Alzheimer’s disease and dementia with Lewy bodies (Ferman et al., 2013), substance abuse (Nichols, 2004), and even sleep and sensory deprivation (Vernon, 1958).

            A significant portion of the literature of VH is dedicated to understanding the etiology, primarily as a means for prediction and treatment. Asaad and Shapiro (1986) provide a comprehensive review of relevant theories, and categorize them into the following divisions: 1) psycho-physiologic, implying a disruption of brain structures, 2) psycho-biochemical, implicating disturbance of neurotransmitters, and 3) psychodynamic, arguing for the emergence of the unconscious into consciousness. While neurological models of the mechanism of psychotic hallucinations have produced fertile research, this paper will follow Bentall (2007) in arguing that the inclusion of a cognitive heuristic in conjunction with a neurobiological approach will allow for a broader range of research avenues.

            There is a substantial and growing amount of literature describing the genesis of VH (and AHHhh) from a cognitive perspective. In this model, the fundamental hypothesis is that individuals with hallucinations are unable to differentiate between their own private, internal events and external, observable reality (Heilbrun, 1980). Thus, the misattribution of inner speech to an external source would be the source for auditory hallucinations, whereas vivid mental imagery would be the basis for visual hallucinations. Accordingly, in this model, a significant component is the cognitional operation of judgment, whereby an individual confirms or denies the veracity of an object by “testing reality”. Reality testing refers to the ability to differentiate between internal events and external reality (Garret & Silva, 2003). Structured under the umbrella of metacognition, this ability is often referenced as reality monitoring or reality discrimination in less recent literature (Bentall, 1990). In sum, while there is a growing consensus on the plausibility of the misattribution theory, the investigation of the precise cognitive mechanism of action continues.

            Further, there is growing empirical evidence in support of the continuum theory of hallucinations. Briefly, the continuum model claims that 1) psychotic symptoms such as hallucinations may be present in a percentage of the general population, and 2) that both the general population and psychotic populations share common cognitive mechanisms for hallucinatory experiences. For example, in an attempt to further understand the cognitive processes underlying the misattribution error and the role of reality testing, Perky (1910) found that normal subjects were equally susceptible as hallucinators to mistaking a real event for an imagined one. Again, the groundbreaking study by Barber and Calverly (1964) also highlights this phenomenon in normal populations. In this study, after subjects were instructed that they would hear a record of “White Christmas”, they reported hearing the record clearly, although no music was ever played. Finally, more recent research indicates that normal individuals often mistake self-generated memories for memories of the actual events (Johnson & Raye, 1981).  This research seems to confirm the notion that misattributions are not limited to psychotic individuals, but affects normal individuals as well.

            Clearly, then, the ability to distinguish reality from imagination is neither innate nor infallible, and the precise cognitive processes underlying the testing of reality still remain largely unknown. That is, it is assumed that the large majority of people can indeed differentiate between what is real and what is not and the aim of current cognitive research attempts to elucidate the exact mechanisms of this differentiation.

            To be clear, the issue of making correct judgments about the nature of reality is essentially an epistemological issue, and two related but distinct points follow. First, the science of psychology has historically had difficulty forming a unified consensus on such fundamental issues as a theory of knowledge (Martin & Sugarman, 1999). Although academic disagreement can often be the catalyst for new discoveries, lack of agreement on an issue as central as epistemology and the nature of reality leads less often to new insights than to inconsistencies in the literature. Although well beyond the scope of this paper, it can be argued that the epistemological question is of such central importance that it touches on the scientific nature of psychology itself (Staats, 1983; Kantor, 1979). Indeed, this lack of a secure and unified epistemology as foundation for psychological investigation echoes Thomas Kuhn’s (1996) argument that any science holding competing paradigms is only a pre-science until a uniform methodology is adopted.

            Second, although this paper began as a modest inquiry into VH in psychosis, an investigation of the literature revealed a glaringly absent discussion of an epistemological framework governing the research. What the research does reveal, however, is the underlying assumption that human beings create mental images as a fundamental component of knowledge. That is, the mental image (or the inner word in the modality of auditory hallucinations) is misattributed for a real image. This mental representation of sense objects, what some philosophers term ‘abstraction’ or a ‘phantasm’, (Lonergan, 1967b) is foundational for the present research on source-memory deficits and attribution errors. Unfortunately, however, specification of the theoretical framework was entirely absent. Within the realm of common sense, and the pragmatism of everyday life, one’s philosophical position—whether it be the extreme objectivity of a naïve (or critical) realism or the subjectivity of a phenomenological or Kantian idealism—is largely unimportant. In a scientific investigation of the cognitive processes underpinning the misattributions that lead to hallucinations, however, philosophical and epistemological grounding of a theoretical model is essential.

            The following review takes as its starting point this lack of epistemological clarity and uniformity. Reviewing the literature from this theoretical lens, I argue that it is precisely this lack of consensus and explication of a theory of knowledge that has led to inconsistencies within the literature. Analysis of the epistemological underpinnings of the following articles will be offered, and recommendations for future research, based on this paradigm, will be presented. 

By Phillip J. Kuna, PhD (abd)
for John G. Kuna, Psy.D. and Associates Counseling

www.drjohngkuna.com

www.drjohngkuna.com