BRITISH JOURNAL OF PSYCHIATRY (2003), 182, 293^298 REVIEW ARTICLE

Re-examining thought insertion incorporated into occult, parapsychological and religious literatures. Freud (1974) was Semi-structured literature review and conceptual analysis interested in occult phenomena and described ‘thought transference’ similar to . He observed professional SIMON MULLINS and SEAN A. SPENCE ‘fortune-tellers’ convincing people that they had acquired intimate knowledge of their lives through the transfer of thoughts. Freud’s interpretation was that such infor- mation was conveyed at an unconscious level. However, ‘true’ telepathy continues to be a subject of popular curiosity and, Background Thought insertion is Reliable clinical recording of symptomatol- were it ever authenticated, would almost commonly regarded as diagnostic of ogy and valid pathophysiological research certainly imply thought insertion. Similar require consistent use of terminology. Over beliefs are also contained in certain . Little is known of its time, thought insertion has developed a re- religious writings. For instance, in the aetiology or pathophysiology. liable definition (see Appendix), in contrast Christian New Testament, Mark 13:11 to a comparable first-rank symptom of describes an inspired external control, Aims To examine the definition and schizophrenia, thought broadcast (Pawar affecting thought and speech: application of thought insertion in et aletal, 2002). However, less is known about ‘But when they shall lead you, and deliver you up, psychiatric and alliedliteratures. the validity of though insertion. It is classi- take no thought beforehand what ye shall speak, fied as a delusion, a false belief that the neither do ye premeditate; but whatsoever shall MethodMethod A semi-structuredliteraturesemi-structured literature subject receives inserted, alien thoughts; be given you in that hour, that speak ye: for it is not ye that speak, but the Holy Ghost.’ review and conceptual analysis. but is thought insertion solely a delusion? (Authorised King James Version) This review examines the phenomenology ResultsResults When‘narrowly’defined, of thought insertion and similar, possibly Some contemporary authors have ar- thoughtthoughtinsertionis insertion is reliablyreliablyidentified identified but related phenomena and then proceeds to gued that first-rank symptoms are non- pathological in the context of spiritual not specific to schizophrenia.There is a examine the utilisation of the concept of thought insertion by authors in a variety experience. In their first case (‘Simon’), range of related phenomena (‘alienated’, of literatures. Jackson & Fulford (1997) describe thought ‘influenced’,‘made’and‘passivity’thinking),‘influenced’,‘made’and ‘passivity’thinking), insertion but discount its pathological nat- less consistently defined but also not ure because Simon appears otherwise well METHOD and is professionally successful. His experi- specific to schizophrenia.Whether ences seem congruent with his religious thoughtthoughtinsertionis insertion is solely an abnormal We performed a computerised search of the beliefs. Yet, he clearly describes household belief (or may also be an experience) is following databases: PsycInfo (1887– appliances affecting his thinking: ‘the things open to question.Nevertheless, the 2002), Medline (1966–2002), Biosis that come are not the things that I have (1985–2002), Embase (1980–2002), Philo- symptom has been used to explain been thinking about . . . They kind of short sopher’s Index (1940–2002). A total of 51 circuit the brain, and bring their message’. schizophrenia, predictdangerousness and references were obtained using the key advance theories of ‘normal’agency.Most words THOUGHT INSERTION, 201 for Thought sharing applications have been subjectto critique. FIRST RANK SYMPTOMS OF SCHIZO- PHRENIA and a further three for There are, of course, natural means by Conclusions Despite its widespread THOUGHT ALIENATION. Papers de- which one person’s thoughts can be known to another: for example, we can deduce occurrence and diagnostic application, scribing the phenomenology of thought insertion were reviewed and data supple- what others think from their manifest thoughtinsertionthoughtinsertionis is anill-understood and mented by a manual search of cited articles behaviours. However, in pathological states underresearched symptom of . and books.andbooks.In total, the full-text versions there is a subjective breach of a perceived Its pathophysiology remains obscure. of 36 peer-reviewed papers and 14 books psychological border, conceptualised as were critiqued for this review. the ‘ego-boundary’, which is described Declaration of interest None.None. ‘concretely’ (Sims, 1991). In some way, the victim’s mind/ego seems (to him or RESULTSRESULTS her) to become permeable, and abnormal The phenomenology of thought influence passes ‘into’ or ‘out from’ the insertion ‘ego’ according to the symptom type. Hence, Fish (1967) describes the ego- Cultural beliefs about inserted thoughts boundary losing its normal integrity in A belief is not regarded as delusional if it is schizophrenia: culturally acceptable; and certain phenom- ‘[The] patient knows that his thoughts and ena resembling thought insertion have actions have an excessive effect on the world gained cultural credence through being around him, and he experiences activity, which

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is not directly related to him having a definite remarks that ‘no one speaks them to the outside) from the ‘experience of alienation’ effect on him’. patient nor are the thoughts ‘‘made’’, . . . (in which a thought belongs to another Although most authors emphasise those the thoughts are notnot his own’ (italics agency; i.e. is inserted). Hence, the symptoms in which influence encroaches added).added). influence/alienation distinction equates to upon the ego (Appendix), Stanghellini & Jaspers seems to distinguish such sur- that of passivity/implantation. In each Monti (1993) delineate an experience of ac- prising or incongruous ‘inserted/implanted’ dichotomy it is the second term that satis- tivity. Patients could believe that they can thoughts from those that are ‘made by fies the contemporary definition of thought breach the ego-boundaries of others: for ex- others’, by which he seems to mean insertion (Appendix). Koehler is explicit ample, one stated that her thoughts could thoughts that emerge under the perceived that although the ‘influenced’ patient owns ‘fly’ to others, who could ‘catch’ them. influence of an external agent (so-called his or her thoughts, the thought insertion Without this sense of activity or volition ‘passivity thinking’; Appendix). patient does not. such an experience might resemble thought ‘Patients think something and yet feel that some- broadcast (Pawar et aletal, 2002).,2002). one else has thought it and in some way forced it Other termstermsOther on them. The thought arises and with it a direct Hence, the ego-boundary can be As Jaspers’ subtlety illustrates, there is a po- awareness that it is not the patient but some permeable in both ‘directions’ (‘inwards’ tential for confusion at the boundaries of and ‘outwards’) and specific first-rank external agent that thinks it. The patient does not know why he has this thought nor did he the thought insertion concept, and multiple symptoms could preferentially implicate intend to have it. He does not feel master of his terms have been used in describing similar such directional permeability. In thought own thoughts and in addition he feels in the (non-thought insertion) phenomena: ‘influ- insertion the permeation is inwards: power of some incomprehensible external force’ enced’, ‘made’ and ‘passivity’ thinking another’s thoughts breach the ego-bound- (pp.122^123). (Appendix). Although these three terms ary. In thought withdrawal and broadcast Hence, the patient with passivity think- appear equivalent, problems arise when the permeation is outwards: the patients’ ing reports: ‘Some artificial influenceinfluence playsplays others are applied inconsistently. For in- own thoughts pass externally (Table 1). on me; the feeling suggests that somebody stance, when Taylor & Heiser (1971) use has attached himself to my mind and the term ‘alienation’ (to indicate thought Thought insertion feeling . . .’ (Jaspers, 1963: p. 123; italics insertion), they contradict Fish’s (1967) The experience of thought insertion has added).added). use of the term (to indicate ‘influenced/ two components: Jaspers’ distinction between ‘implanted made’ thinking): (a)(a)the ego isistheego intrudedintruded upon;upon; thoughts’ and ‘passivity thinking’ is, there- ‘[The patient’s] thoughts are under the control of fore, a subtle one. It seems to hinge upon ananoutsideagency...othersare outside agency. . . others are participatingparticipating inin (b)(b)thethe ownership of the thought is alien. whether the thought came spontaneously his thinking’ (Fish,1967: p. 39; italics added). A much-quoted example is provided by (i.e. was ‘implanted’) or emerged under Fish differentiates this form of ‘aliena- Mellor (1970): the perceived influence of another (‘made’, tion’ from thought insertion, which he ‘passivity’ thinking). In modern parlance, describes thus: ‘I look out of the window and I think the garden looks nice and the grass looks cool, but the the former has been described as a narrowly ‘[The patient] knows that thoughts are being thoughts of Eamonn Andrews come into my defined thought insertion, whereas the inserted into his mind, and recognises them as mind. There are no other thoughts there, only latter, influenced (or ‘controlled’) thinking, being foreign and coming from without’ (Fish, his. . .He treats my mindlike a screen and flashes has been seen as comprising a broader cate- 1967: p. 39).39).1967: his thoughts ononto to ititlike like you flash a picture’. gory, with possible diagnostic implications Hence, the term ‘thought alienation’ is Earlier descriptions of thought insertion (O’Grady, 1990; cf. Peralta & Cuesta, probably best avoided, as it means different are found in Jaspers (1963). In one case a 1999).1999). things to different authors. patient describes such thoughts as Taylor & Heiser (1971) also draw a Elsewhere, Schneider (1959) uses ‘com[ing] at any moment like a gift ...I . . . I distinction between the ownership of a another term, ‘thought intrusion’, when do not dare to impart them as if they were thought and the process of thinking it. describing external influence, attributed to my own’ (Gruhle, in Jaspers, 1963). Jaspers These authors (and Koehler, 1979) distin- hypnosis by a woman with schizophrenia. refers to these thoughts as ‘implanted, com- guish the ‘experience of influence’ (in which Although his precise meaning is uncertain, ing like an inspiration from elsewhere’ and thethe processprocess of thinking is controlled from ‘intrusion’ (in this context) appears equivalent to influence. Ta b l e 1 Profiles of thought insertion and other, selected phenomena The act of thinking: ‘agency’ Symptom Ego-boundaryPermeation Agency (thinking)Thought possession The perceived process of thinking seems to be important when making some of the Thought insertionPermeated Inwards Alien Alien above distinctions (e.g. between ‘influ- Influenced thinking11 PermeatedInwards Alien Own enced’ and ‘inserted’ thoughts). During ‘in- Thought withdrawalPermeated Outwards Alien 22 OwnOwn fluence’ the process of thinking has been ‘Activity’ experiencesPermeated Outwards Own OwnOwn noticeably altered, whereas during ‘inser- Obsessional thinkingIntact N/AN/A OwnOwn OwnOwn tion’ it is reportedly absent; the thought ‘arrives’‘arrives’ de novodenovo. Indeed, Mellor (1970) 1. ‘Influenced’,‘made’ and ‘passivity’ thinking are taken as equivalent. 2. In Koehler (1979): in thought withdrawal,‘the subject is quite certain of ‘‘negatively’’ being aware that he has lost HIS states that inserted thoughts are forced OWN thoughts . . . because they have been actively taken away from without’ (original capitals). upon ‘passive’ minds and Jaspers (1963)

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comments that ‘the patient does not oppose Tilly Matthews (1800), were said by him internal voices. Other authors have des- them in any way’. The common feature that to have the power ‘to make ideasmakeideas or to stealstealorto cribed patients whose inserted thoughts has been stressed is a loss of volition. In this others . . .’ (Haslam, 1810, in Porter, 1991: ‘feel different’ (e.g. Spence et aletal, 1997),,1997), state (thought insertion), the subject is the p. 146; italics added). Tausk’s (1988) and in Cahill & Frith (1996), a patient passive recipient of alien thoughts that are patient with schizophrenia described her identified the exact point of entry of an the products of alien thinking. thoughts as being produced by an ‘electrical inserted thought into his head. As well as The philosophers Stephens & Graham machine’ controlled by others, at a dis- being alien, the thought could be ‘felt’ to (1994), conceptualise thought insertion as tance. A patient of Jaspers (1963) also enter. Hence thought insertion might not a problem of ‘agency’, which they define described the experience of electricity: be solely a belief: in some (if not all) as ‘consist[ing] in regarding one’s mental ‘one evening the thought was given to me patients it can incorporate abnormalities episodes or thoughts as expressions of one’s electrically that I should murder Lissi’ of perception. This is also implied by those own active doing: as things one does rather (original italics). Again, some of our own authors who distinguish ‘experiences of than things that happen to one’. Hence, patients bear out this experiential quality, alienation’ from ‘experiences of influence’ they differentiate ‘influenced’ thinking from prompting explanations of aetiology: (Taylor & Heiser, 1971; Koehler, 1979). thought insertion on the basis of whether or ‘One man said that thoughts were being put into not the alien performs the thinking. ‘The his mind and that they ‘‘felt different’’ from his The applications of thought merely influenced subject believes that own; another said that the television and radio insertion someone else has caused himhim to think the were responsible for different thoughts, which were‘‘tampered with electrically’’and always felt thought. . . In thought insertion, by con- DiagnosisDiagnosis the same way (i.e. recognisably different from trast, the subject believes that someone else hishis‘‘own’’)’ ‘‘own’’)’ (Spence et aletal,1997).,1997). The centrality of first-rank symptoms to the has actually done the thinking for him.He.He diagnosis of schizophrenia, although con- Diverse mechanisms are reported, in- has not been manipulated into thinking troversial (Crichton, 1996), is apparent in cluding hypnotism in Schneider’s case something; rather his agencyagency has beenhasbeen the standard diagnostic manuals (e.g. (above) and that of Reiter (1926): while bypassed completely’ (italics added). ICD–10). Thought insertion, on its own, experiencing schizophrenia, a woman Hence, the concept of agency helps us is sufficient for a diagnosis of schizophrenia believed that ‘she was hypnotised by to disambiguate thought insertion from in- to be made, if present for 1 month in the Professor C., who transferred his thoughts fluenced/made thinking (Table 1). An ‘in- absence of an organic or mood disorder to her and made her do as he wanted’. fluenced’ thought emerges when the alien (F20, ICD–10; World Health Organization, Beliefs regarding the mechanism ‘other’ interferes with the subject’s agency 1992). Hence, a simple definition of through which another usurps agency have but the subject owns the ensuing thought. thought insertion can appear to simplify assumed little importance in modern diag- In thought insertion the subject’s own practice for clinicians attempting to diag- nostic criteria. The significance of such agency is absent and an alien thought is nose a complex disorder in the absence of additional psychopathology has not been ‘inserted’. In this account, patients retain a biologically validated pathognomonic elaborated. Does it matter whether a ownership of a ‘made’ thought whereas marker. Also, first-rank symptoms can be machine, a spirit or an agent unknown to thought insertion thoughts (by definition) reliably agreed upon by different examiners the subject inserts a thought? According are experienced as ‘alien’. (e.g. McGuffin et aletal, 1984).,1984). to Berrios (1997), such content is of little Again, these distinctions are rather Consistent with this view, O’Grady explanatory interest; delusions are ‘empty subtle, and may be difficult to fully eluci- (1990) reported that ‘narrow’ definitions speech acts’. However, it is conceivable that date clinically. Stephens & Graham’s defi- of first-rank symptoms (as a group) might beliefs and attributions could help deter- nition of ‘influenced’ thinking may go be more specific to schizophrenia (cf. psy- mine whether the subject seeks, or is further than that of Jaspers (1963). The lat- chotic depression). Hence, thought inser- brought to, psychiatric attention. If subjects ter’s account does not state explicitly that tion might be more ‘schizophrenic’ than is experience a spiritual dimension to thought influenced thinking permits (self-) owner- ‘influenced’ thinking. However, relatively insertion, and are not behaviourally com- ship of the ensuing thought. However, few patients in his sample exhibited first- promised, then they might seek religious some of our own patients have made such rank symptoms and these symptoms were or spiritual contexts (Jackson & Fulford, a distinction: not investigated individually. 1997).1997). ‘A man said that ‘great forces’ were being used A later and larger study of people against his thinking, but that his thoughts were with psychoses (Peralta & Cuesta, 1999) still his own’ (Spence et aletal,1997).,1997). Is thought insertion solely a belief? found thought insertion and other first- Subjects experiencing thought insertion rank symptoms to be distributed across were included in Nayani & David’s psychotic diagnoses and not specific to Thought insertion and attribution (1996) phenomenological survey of audi- schizophrenia;the study utilised phenom- Some subjects attribute their loss of agency tory hallucinations. These subjects’ descrip- enological definitions comparable with to an identified other (e.g. Eamonn tions of their ‘alien’ thoughts varied quite those of Mellor, 1970). Thought insertion Andrews, above) but this is not universal. widely: ‘internal hallucinators’ (i.e. those was elicited in 19% of people diagnosed Similarly, patients describe various who heard voices ‘inside their heads’) des- with schizophrenia (19.7% in Mellor’s modes of causation. ‘Influencing machines’ cribed inserted thoughts in terms of bad im- study), 7.2% of those with ‘mood disorder’ were described before the first-rank symp- pulses or unpleasant visual images (e.g. to and similar percentages of those with ‘brief toms were first ‘ranked’ by Schneider. maim or kill) whereas ‘external hallucina- reactive’reactive’(8%)(8%) and ‘atypical’ psychoses ‘Air-loom machines’, reported by James tors’ described them in terms of unpleasant (6%). The figures for ‘made thoughts’

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were 35.8,27.7, 32 and 18%, respec- strength of the association with violence hemisphere lesions (Mesulam, 1981). A tively (Peralta& Cuesta, 1999). The increased with the number of delusions pre- study comparing first-rank symptoms in authors concluded that first-rank symptoms sent (Linksent(Link et aletal, 1992). However, subse- people with idiopathic schizophrenia with are symptomatic of psychosis generally, quent prospective studies have failed to those occurring secondary to temporal lobe and not schizophrenia specifically. replicate this finding, and it seems as if a epilepsy found no difference in the rates of number of confounding variables could thought insertion (implying that temporal Explaining schizophrenia account for the original results: a retrospec- lobe dysfunction might be equally relevant tive design; reliance upon self-report of to both; Oyebode & Davison, 1989). A Notwithstanding the above findings, symptoms; and failure to control for anger neuroimaging study of ‘made movements’ although schizophrenia has lacked a and impulsivity (Appelbaum et aletal, 2000).,2000). implicated the right parietal cortex but pathognomonic biological marker, its char- these data were not examined for associa- acteristic symptoms (such as thought tions with thought insertion, or influenced insertion) have been used by some to Philosophy of mind thinking, where present (Spence et aletal,, explain the syndrome.Hence, Nasrallah Understanding the nature of unusual 1997). It appears that the pathophysiology (1985) proposed that thought insertion human experience has long been common of thought insertion awaits elucidation. is an indicator of defective inter- ground for psychiatry and philosophy. Re- However, there is some evidence that hemispheric integration, thoughts from the cent interdisciplinary dialogue has been first-rank symptoms (including thought in- right hemisphere being interpreted as ‘alien’ realised (to a degree) through the mutual sertion) could be partially heritable (Loftus by the left. Crow (1998) has likewise investigation of thought insertion (e.g. et aletal, 2000; Cardno et aletal, 2002).,2002). focused upon first-rank symptoms, in Chadwick, 1994; Fulford, 1995; Spence, Other noticeable absences from our advancing the theory that schizophrenia is 1996, 2001; Gibbs, 2000; Stephens, 2000; review include systematic studies of the the ‘price humans pay for language’. Again, Thornton, 2002). The subjective experience phenomenology of thought insertion and deficits in hemispheric integration/asym- of thought insertion appears to challenge a any coping mechanisms adopted by those metry are invoked to explain first-rank key philosophical concept: ‘immunity to affected. One anecdotal report describes a symptoms. Also, Frith’s (1992) cognitive subjective error’. If a subject is aware of a patient who screamed to stop thoughts neuropsychological account of thought thought, how can she claim that the entering his mind (Spence, 1999). insertion and other first-rank symptoms thought is not hers? Assuming intelligibil- These gaps in the literature could reflect has been generalised into a model of ity, some philosophers have begun to tackle the inherent difficulty of ‘capturing’ such disordered ‘internal monitoring’. Hence, thought insertion. Hence, to Stephens & phenomena and also an assumption that inserted thoughts areexperienced as such Graham (1994) a solution is the distinction thought insertion is solely an abnormal because the subject/patient is unaware of between subjectivity and agency: although belief. Our review suggests that thought his or her own intentions (to think). the subject retains awareness of her insertion is still little understood. Further Thoughts arising unbidden are therefore thoughts (subjectivity), she has lost the research could assist in understanding both perceived as ‘alien’. Critique of this ele- associated sense of mental causation its emergence in the psychotic process and gant and influential theory is beyond the (agency). It is noticeable how similar these those related phenomena thought to affect scope of this paper but rehearsed exten- formulations are to psychological models the ‘healthy’ mind (Jackson & Fulford, sively elsewhere (Campbell, 1999; Spence, of ‘unawareness’ of voluntary processes 1997).1997). 2001; Thornton, 2002). (Angyal, 1936; Feinberg, 1978; Frith, 1992). However, what remains unex- Forensic psychiatry plained is the distinction between ‘inserted’ thoughts and those everyday thoughts that A diagnostic symptom detectable on a sin- come into our minds, apparently sponta- gle mental state examination might be par- neously, and to which we do not attach APPENDIX ticularly useful for forensic psychiatrists any paranoid interpretation (Spence, 1996). having to perform assessments under diffi- Definitions of thought insertion Invoking a ‘normal’ model of thinking, in cult conditions. Thought insertion appears and related phenomena which thoughts are preceded by ‘intentions’ useful because of its perceived diagnostic to think (Frith, 1992), is open to critique Thought insertion significance and because it is relatively reli- (see Campbell, 1999; Spence, 2001; Thorn- ‘The subject believes that thoughts that are not his able. Furthermore, there have been reports ton,ton,2002).2002). Among other problems, it opens own have been inserted into his mind.’ (Andreasen, of its possible utility in predicting danger- up an infinite regress: intentions to think 1984) ousness. Link et aletal (1992) described the would themselves be preceded by intentions The subject ‘experiences thoughts which are not his ‘threat/control-override’ syndrome after to think,tothink, ad infinitum.. own intruding into his mind. The symptom is not that epidemiological studies (initially replicated) he has been caused to have unusual thoughts, but suggested that the difference in ‘previous that the thoughts themselves are not his’ (Wing( Wing etet violence’ between former patients and con- Gaps in the literature alal,1983),1983).. trols could be accounted for by the presence Our review has revealed no pathophysio- Same meaning applied by Fish (1967), Mellor (1970) of specific symptoms, including persecutory logical studies of thought insertion per seperse andLandmark(1982).and Landmark (1982). delusions and thought insertion. Such pa- and few that have reported findings of more Equivalent terms: ‘implanted thoughts’ (Jaspers, tients reported beliefs that involved either than tangential relevance. One case report 1963); ‘experience of alienation’ ( Taylor & Heiser, a perceived threat to themselves or external suggests that symptoms resembling influ- 1971); ‘passive experience of alienation’ (Koehler, control over their minds and actions. The enced thinking can follow posterior right 1979).

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Influenced thinking Thepatient’s‘OWNthoughts...arebeingcon- CLINICAL IMPLICATIONS trolled or influenced by an outside force’ (Koehler, 1979; original capitals). && Thought insertion is a symptom of psychosis and not specific to schizophrenia Same meaning applied by Landmark (1982) and (although it occurs in approximately a fifth of patients with schizophrenia). O’Grady (1990).(19 9 0). && ‘Influenced’,‘made’ and ‘passivity’ thinking are equivalent terms, describing another Equivalent terms: ‘made’ and ‘passivity’ thinking (Jaspers, 1963); ‘thought alienation’ (Fish, 1967); symptom of psychosis which is not specific to schizophrenia (although it occurs in ‘experience of influence’ (Taylor( Taylor & Heiser, 1971); approximately a third of patients with schizophrenia). possibly ‘thought intrusion’ (Schneider, 1959). && The term‘thought alienation’means different things to different authors and might Experiences of activity be better avoided.

‘Patients...intentionallytransmittheirthoughts... LIMITATIONS [and] intentionally exert control on objects and events of the outside world’ (Stanghellini & Monti, && This review was restricted to English-language publications and might have missed 1993). relevant papers in other languages (German in particular).

REFERENCES && Most of the distinctions described are subtle and couldbevariably elucidatedin the clinic.clinic. Andreasen, N. C. (1984) The Scale for the Assessment of Positive Symptoms (SAPS). Iowa City, IA: University of && Little is known of how patients cope with such symptoms and few studies provide Iowa. clues to their pathophysiology. Angyal, A. (1936) Theexperienceofthebody-selfinThe experience of the body-self in schizophrenia. Archives of Neurology and Psychiatry,, 35,, 1029^1053.

Appelbaum, P. S., Robbins, P.C.P. C. & Monahan,Monahan, J. (2000) Violence and delusions: data from the MacArthur violence risk assessment study. AmericanAmerican SIMON MULLINS, MRCPsych, SEAN A. SPENCE, MRCPsych, Academic Department of Psychiatry,University of Journal of Psychiatry,, 157157,,566^572. 566^572. Sheffield, UK Berrios, G. E. (1997) Delusions as ‘wrong beliefs’: a conceptual history. British Journal of Psychiatry,, 159159 Correspondence: Dr Sean A. Spence,Reader in General Adult Psychiatry,Academic Department of (suppl. 14), 6^13. Psychiatry,University of Sheffield,The Longley Centre, Norwood Grange Drive, Sheffield S5 7JT,UK. Cahill, C. & Frith, C. (1996) False perceptions or false Tel: +44 (0) 114 22 61519; fax: +44 (0) 114 22 61522; e-mail: S.A.Spence@@Sheffield.ac.uk beliefs? Hallucinations and delusions in schizophrenia. In Method in Madness: Case Studies in Cognitive (First received 5 June 2002, final revision 4 October 2002, accepted 21October 2002) Neuropsychiatry (eds P.W.P.W.Halligan Halligan & J.J.C. C. Marshall), pp. 267^291.Hove: Psychology Press.

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