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Re-Examining Thought Insertion Semi-Structured Literature Review and Conceptual Analysis

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Re-Examining Thought Insertion Semi-Structured Literature Review and Conceptual Analysis 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 telepathy. 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 schizophrenia. 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 psychosis. 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 293293 Downloaded from https://www.cambridge.org/core. 30 Sep 2021 at 02:10:22, subject to the Cambridge Core terms of use. MULLINS & SPENCE 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
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