Is pain where you feel it in the body, or in the brain? Neurophenomenology and the spatial aspect of nociception

body knowledge, clinical neurophenomenology, embodiment, interoception, introspection, introspective accuracy, medicine, pain, physiology, symptom report accuracy, symptom reports, visceral perception

Pain is interesting, salient, mysterious. It may feel like it is in one specific place in or on the body. It may feel diffuse, with gradations, or it may seem referred from one area to another. What is happening in the brain and in the body as these spatial aspects of pain are experienced? How much of the causation of pain occurs where we feel it, and how much occurs in the brain? Below is a series of probes and thinking aloud about where pain is, with speculations to stimulate my thinking and yours.  I’m not a “pain expert”, nor a bodyworker that heals clients, nor a physiologist with a specialization in nociception, but a cognitive scientist, with clinical psychology training, interested in body phenomenology and the brain.  Please do post this essay to Facebook, share it, critique, respond, and comment (and it would be helpful to know if your background is in philosophy, neuroscience, bodywork, psychology, medicine, a student wanting to enter one of these or another field, etc). Pain should be looked at from multiple angles, with theoretical problems emphasized alongside clinical praxis, and with reductionistic accounts from neurophysiology juxtaposed against descriptions of the embodied phenomenology and existential structures.  As I have mentioned elsewhere, it is still early in the history of neurophenomenology…let a thousand flowers bloom when looking at pain. We need data, observations, insights and theories from both the experience side as well as the brain side. Francisco Varela aptly described how phenomenology and cognitive neuroscience should relate:

“The key point here is that by emphasizing a codetermination of both accounts one can explore the bridges, challenges, insights, and contradications between them. Both domains of phenomena have equal status in demanding full attention and respect for their specificity.”

We all know what pain is phenomenologically, what it feels like, but how to define it? The International Association for the Study of Pain offers this definition: “an unpleasant sensory and emotional experience associated with actual or potential tissue damage, or described in terms of such damage.” Of particular interest to neurophenomenology and embodied cognitive science is their claim that “activity induced in the nociceptors and nociceptive pathways by a noxious stimulus is not pain, which is always a psychological state.” Good that they do not try to reduce the experience of pain to the strictly physiological dimension, but I wonder how Merleau-Ponty, with his non-dualistic ontology of the flesh would have responded. Pain seems to transgress the border of mind and body categories, does it not? I am slowly biting off chucks of the work on pain at the Stanford Encyclopedia of Philosophy. Lots of provocative angles, including this one:

“there appear to be reasons both for thinking that pains (along with other similar bodily sensations) are physical objects or conditions that we perceive in body parts, and for thinking that they are not. This paradox is one of the main reasons why philosophers are especially interested in pain.”

Right now I am particularly interested in the spatial aspect of where pain seems to be, what I might label the spatial phenomenology of nociception. When I introspect on aching parts of my feet, it seems as if the pain occupies a volume of space. Using manual pressure I can find places on my feel that are not sore, right next to areas that are slightly sore, which are in turn near focal areas of highest pain. It seems as if the pain is locatable “down there” in my body, and yet what we know about the nociceptive neural networks suggests the phenomenology is produced by complex interactions between flesh, nearby peripheral nerves, the central nervous system, and neurodynamics in the latter especially. A way of probing this this would be to examine the idea that the pain experience is the experiential correlate of bodily harm, a sort of map relating sensations to a corresponding nerve activated by damage to tissue. So, is the place in my body where I feel pain just the same as where the damage or strain is? Or, Is pain caused by pain-receptive nerves registering what is happening around them, via hormonal and electrical signals? Or is pain actually the nerve itself being “trapped” or damaged, yet in a volume of undamaged tissue one can feel hurts? Could the seeming volume of experienced pain-space be a partial illusion, produced by cognizing the tissue damage as some place near or overlapping with yet not spatially identical to where the “actual” damage is, in other words a case of existential-physiological discrepancy? One scenario could be, roughly, that pain “is” or “is made of” nerves getting signals about damage to tissue; another would be that pain “is” the nerves themselves being damaged or sustaining stress or injury. Maybe pain involves both? Maybe some pain is one, or the other? In terms of remembering how my heel pain started, it’s not so easy, but I love to walk an hour or two a day, and have done so for many years. I recall more than ten years ago playing football in the park, wearing what must have been the wrong sort of shoes, and upon waking the next day, having pretty serious pain in my heel. Here are some graphics that, intuitively, seem to map on to the areas where I perceive the pain to be most focal:

from bestfootdoc.com

from bestfootdoc.com

from setup.tristatehand.com

from setup.tristatehand.com

from plantar-fasciitis-elrofeet.com

from plantar-fasciitis-elrofeet.com

If I palpate my heel, I become aware of a phenomenologically complex, rich blend of pleasure and pain. I crave the sensation of pressure there, but it can be an endurance test when it happens. Does the sensation of pressure that I want reflect some body knowledge, some intuitive sense of what intervention will help my body heal? How could this be verified or falsified? It is not easy to describe the raw qualia of pain, actually. I can describe it as achey and moderately distressing when I walk around, and sharp upon palpating. Direct and forceful pressure on the heel area will make me wince, catch my breath, want to gasp or make sounds of pain/pleasure, and in general puts me in a state of heightened activation. But I love it when I can get a therapist to squeeze on it, producing what I call “pain-pleasure”:

from indyheelpaincenter.com

from indyheelpaincenter.com

This diagram below helps me map the sensations to the neuroanatomy. We need to do more of this sort of thing. This kind of representation seems to me a new area for clinical neurophenomenological research (indeed, clinical neurophenomenology in general needs much more work, searching for those terms just leads back to my site, but see the Case History section in Sean Gallagher’s How the Body Shapes the Mind).

from reconstructivefootcaredoc.com

from reconstructivefootcaredoc.com

What is producing the pain-qualia, the particular feeling? Without going too far into varying differential diagnosis, it is commonly attributed to plantar fasciitis.  There the pain would be due to nociceptive nerve fibers activated by damage to the tough, fibrous fascia that attach to the calcaneus (heel bone) being strained, or sustaining small ripped areas, and/or local nerves being compressed or trapped. A 2012 article in Lower Extremity Review states that “evidence suggests plantar fasciitis is a noninflammatory degenerative condition in the plantar fascia caused by repetitive microtears at the medial tubercle of the calcaneus.” There are quite a few opinions out there about the role of bony calcium buildups, strain from leg muscles, specific trapped nerves and so forth, and it would be interesting to find out how different aspects of reported pain qualia map on to these. Below you can see the sheetlike fascia fiber, the posterior tibial nerve, and it’s branches that enable local sensations:

from aafp.org

from aafp.org

Next: fascia and the innervation of the heel, from below:

from mollyjudge.com

from mollyjudge.com

Another view of the heel and innervation:

from mollyjudge.com

from mollyjudge.com

Below is a representation of the fascia under the skin:

from drwolgin.com

from drwolgin.com

There is a very graphic,under the skin, maybe not SFW surgeon’s-eye perspective on these structures available here. Heel pain turns out to be very common, and is evidently one of the most frequently reported medical issues. Searching online for heel pain mapping brings up a representation purportedly of 2666 patients describing where they feel heel pain: heel pain mapping I can’t find where this comes from originally and can’t speak to the methodology, rigor, or quality of the study, but the supposed data are interesting, as is the implicit idea of spatial qualia mapping:  the correspondence of experienced pain to a volume of space in the body. It also quite well represents where the pain is that I feel. The focal area seems to be where the fascia fibers attach to the calcaneus, an area that bears alot of weight, does alot of work, and is prone to overuse. So, where is the pain? Is it in the heel or the brain? Is it in the tissue, the nerve, or both? Is there a volume of flesh that contains the pain? I am going to have to think about these more, and welcome your input. What about the central nervous system that processes nociceptive afferents coming from the body? A good model of pain neurophenomenology should involve a number of cortical and subcortical areas that comprise the nociceptive neural network: -primary somatosensory cortex (S1) and secondary somatosensory cortex (S2): -insula -anterior cingulate cortex (ACC) -prefrontal cortex (PFC) -thalamus Here are some representations of the pain pathways, or the nociceptive neural network:

from Moisset and Bouhassira (2007) "Brain imaging of neuropathic pain"

from Moisset and Bouhassira (2007)

Moisett el (2009)

Moisett el (2009)

 

from Tracey and Mantyh (2012)

from Tracey and Mantyh (2012)

Broadly speaking, pain seems to be generated by tissue damage, inflammation, compromising the integrity of tissue, stress on localized regions, and so forth being processed by peripheral afferent pain pathways in the body, then phylogenetically ancient subcortical structures, and then the aforementioned cortical regions or nociceptive neural network.  As I have mentioned many times, making a robust account of how various regions of the brain communicate such that a person experiences qualia or sensory phenomenology will need to reference neurodynamics, which integrates ideas from the physics of self-organization, complexity, chaos and non-linear dynamics into biology.  It is gradually becoming apparent to many if not most workers in the cognitive neurosciences that there are a host of mechanisms regions of the brain use to send signals, and many of these are as time dependent as space dependent. Michael Cohen puts it thusly: “The way we as cognitive neuroscientists typically link dynamics of the brain to dynamics of behavior is by correlating increases or decreases of some measure of brain activity with the cognitive or emotional state we hope the subject is experiencing at the time. The primary dependent measure in the majority of these studies is whether the average amount of activity – measured through spiking, event-related-potential or -field component amplitude, blood flow response, light scatter, etc. – in a region of the brain goes up or down. In this approach, the aim is to reduce this complex and enigmatic neural information processing system to two dimensions: Space and activation (up/down). The implicit assumption is that cognitive processes can be localized to specific regions of the brain, can be measured by an increase in average activity levels, and in different experimental conditions, either operate or do not. It is naïve to think that these two dimensions are sufficient for characterizing neurocognitive function. The range and flexibility of cognitive, emotional, perceptual, and other mental processes is huge, and the scale of typical functional localization claims – on the order of several cubic centimeters – is large compared to the number of cells with unique physiological, neurochemical, morphological, and connectional properties contained in each MRI voxel. Further, there are no one-to-one mappings between cognitive processes and brain regions: Different cognitive processes can activate the same brain region, and activation of several brain regions can be associated with single cognitive processes. In the analogy of Plato’s cave, our current approach to understanding the biological foundations of cognition is like looking at shadows cast on a region of the wall of the cave without observing how they change dynamically over time.” But what of the original question? Is pain where you feel it in the body, or in the brain? It seems to me the answer must be both.  The experience of pain being localized there or a little on the left is a product of local tissue signals and receptor activation, which produces peripheral afferent nerve firing, which gets processed by spinal afferent neurodynamics, brainstem activation, thalamic gating, and then somatosensory, insular, anterior cingulated, and prefrontal cortical regions. Yet the real model of pain, one that invokes mechanisms and causes, remains elusive. And a good model of pain must account for the possibility of pain without suffering as well! For now, what I can offer are probes to get us speculating, thinking critically, and eventually building a clinical neurophenomenology of pain. If that interests you, by all means get involved.

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A complex mapping of the interior sense: why Damasio’s theory of embodied cognition focuses on the brainstem and viscera

body knowledge, clinical neurophenomenology, consciousness, embodiment, interoception, physiology, visceral perception

If, like me,  you are interested in the biological dimensions of cognition, consciousness, and phenomenology, you tend to study the cortex.  Attention, decision-making, having a sense of self, perception, visual awareness, and many other key higher mental processes are modeled with data from cortical measurements, and especially with recent neurodynamics and computational neuroscience, there are increasingly sophisticated theories about the underlying mechanisms. But the cortex possibly gets too much attention compared to the rest of the brain and body.  This is partially because it indeed makes us human, but also for practical reasons, much of what we know about the brain comes from EEG research that with people is usually limited to scalp-based cortical signal acquisition. Dig a little deeper, say, when learning about emotions, and the student or scholar gets at least cursory introduction into the sub-cortical, emotion-regulating structures of the limbic system such as the hippocampus, thalamus, and hypothalamus. Our sense of salience, that things matter, our bodily sensations, our emotions and drives are associated especially with these sub-cortical structures. The study of how the brain processes emotions and bodily sensations has pointed some psychologists, neuroscientists, physicians, and philosophers in recent decades towards the idea of the experienced, phenomenologically lived body as the basis of consciousness and the self (or “self”). The growing sense for some of us about the limitations of traditional computationalist/cognitive theories has led to to the idea that mind and brain must be understood as “enactive“: via  evolutionarily and environmentally situated, physiological, embodied processes that “bring forth an experienced world”. Whatever cognition is, more than a few of us cognitive scientists nowadays think of it as somehow based in temporally ongoing, fleshy, existentially meaningful conscious life, or phenomenology. The mechanics of embodied mind, and the embodied basis of phenomenology, are very poorly understood by cognitive neuroscience, psychology, and medicine. Only very recently has there been a revival of interest especially in how visceral body states get processed by the peripheral nervous system and subsequently transformed by the central nervous system. One could understand this as a subfield of neurophenomenology:  how the brain and body enable “the bodily feelings I have now”, the experiential phenomenology of the internal body (if you have poked around this site you may have seen my own 2011 dissertation work was on this very subject). The rise of interest in embodied cognition has been hugely advanced through the work of the neurologist Antonio Damasio. This pioneer of embodied cognitive neuroscience has been focusing the attention of the psychology and cognitive neuroscience communities on the brainstem as the basis of consciousness.  The brainstem is not the usual topic when scientists bravely try to model conscious aspects of cognition, and my sense is that in the public mind it tends to register mostly when someone famous has medical problems as a result of brainstem damage causing loss of core visceral regulatory processes, such as with the death of Michael Jackson. In Damasios’ account, it is not merely a bit player in the grand drama of how body produces consciousness, but plays a starring role. Damasio (2010) states in Self Comes to Mind:Constructing the Conscious Brain , “I believe that the mind is not made by the cerebral cortex alone. Its first manifestations arise in the brain stem . ” (p. 75).

Courtesy Wikimedia Commons

Courtesy Wikimedia Commons

Above is the brainstem, in red.  It receives inputs from the spinal cord, called “afferents”, that deliver signals from sensory nerves distributed throughout the body. These sensory nerves are affected by the homeostatic and visceral states of organs, such as our heart beating, the fullness of our bladder, blood sugar levels, the gas exchange in our lungs, and so forth. How much of the time these nerve signals resulting from visceral processes enter into conscious is a murky business. Cognitive scientists and others researching consciousness have not particularly referenced interior body psychophysiology and internal body-sensation in most theories about consciousness, but the work of Damasio is changing that. In general, research on the perception of visceral states or “inner psychophysics” goes in and out of scientific fashion, according to Gyorgy Adam’s wonderful overview of many decades of research, Visceral Perception: Understanding Internal Cognition.

Courtesy of Wikimedia Commons

Courtesy Wikimedia Commons

Below is an MRI of a beating heart and other visceral organs, with the spine visible. Afferent nerves “encode” information (or “information”) about the homeostatic and other dynamics of these systems, and send signals to the spinal cord and brain.

Courtesy Wikimedia Commons

Courtesy Wikimedia Commons

While the idea that the brainstem produces the first manifestations of consciousness may seem radical, Damasio cites experimental evidence that perception of visceral states is mediated by the brainstem’s nucleus of the solitary tract and the pons. This gives us a window into understanding interoception:  the awareness of our visceral organs and internal body (though I think interoception also refers to unconscious signals from bodily organs affecting the brain and possibly influencing unconscious cognition). Building on generations of basic research on the neurophysiology of visceral perception, Damasio (2010) defines interoception as a “complex mapping of the interior sense” (p. 97). He emphasizes this occurs through an interoceptive network involving significant processing by the brainstem, which, unlike a mere relay, receives, processes and integrates afferents from the state of the visceral organs, and in turn projects to the thalamus. Through the work of Damasio, Bud Craig and others, we can model cognition as based in a central nervous system which filters and transforms signals from the lifegiving organs of the body. Building on their contributions, here is how I understand the neurophenomenology of visceral perception to work: our body organs are responding to existential life needs, our brainstem gets signals from the body organs and actively filters and transforms the signals, and in turn projects to the thalamus. Thalamo-cortical fibers then make synapses with neurons in the insula, cingulum, and somatosensory and orbitofrontal cortices, regions implicated in interoceptive activity and cognitive processes handling internal body information.  These areas all contribute to both consciousness in the foundational sense Damasio is investigating, and also produces specific awareness of our emotions and of our interior bodily sensations, such as feeling hungry. What goes on at the final stage, when cortical regions take the transformed bodily signal from the brainstem and thalamo-cortical processing, and somehow produce changes in consciousness? That gets into very complicated territory, and nowadays some of our most progressive thinkers use ideas and mechanisms from physics, such as Walter Freeman’s work on cortical neurodynamics, or that of Varela and colleagues. As of 2013 the dynamical aspects of interoception do not seem to be on many people’s radar besides mine and maybe a few others. What does it all mean for theories about the mind? If we accept that thalamic relay nuclei, activated by processed bodily interoceptive inputs in the brainstem, engage in further processing, and subsequently synapse on to (probably) dynamically interactive interoceptive centers in the insula and orbitofrontal, sensory, and cingulated cortical regions, what do we then understand about consciousness and cognition? As far as I can tell, the heart of Damasio’s theory is that visceral and homeostatic body states are “mapped” on to the brain via the brainstem,  and this mapping is what consciousness and the sense of self is “made of”. As we are organisms needing to engage in the right sort of behavior to survive, we depend on our sensory and visceral organs functioning appropriately. Our minds are thus built out of an evolutionarily developed machinery of life preservation. Put another way: the interior chemical milieu in our viscera affects nerve signals into the brainstem, and brainstem-mediated afferent signals tell our brain and mind about the state of our organs by projecting to the “gateway of the cortex”: the thalamus. A series of cortical regions process the thalamus gated body-signals, some of which are  cognitively and phenomenologically processed by a person as more emotionally and behaviorally salient, such as signals associated with food and thirst, pain and sex, and fighting or fleeing. Damasio, never one to shy away from big ideas and bold claims, sums up the state of his thinking in a 2010 interview:

Feelings, especially the kind that I call primordial feelings, portray the state of the body in our own brain. They serve notice that there is life inside the organism and they inform the brain (and its mind, of course), of whether such life is in balance or not. That feeling is the foundation of the edifice we call conscious mind. When the machinery that builds that foundation is disrupted by disease, the whole edifice collapses. Imagine pulling out the ground floor of a high-rise building and you get the picture. That is, by the way, precisely what happens in certain cases of coma or vegetative state. Now, where in the brain is that “feel-making” machinery? It is located in the brain stem and it enjoys a privileged situation. It is part of the brain, of course, but it is so closely interconnected with the body that it is best seen as fused with the body. I suspect that one reason why our thoughts are felt comes from that obligatory fusion of body and brain at brain stem level.

Can we not agree, that this is a profound way of thinking about the human condition?   Buy me a beer! Donate Button

What do clinicians come to know about their patient’s heart sensations?

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What do clinicians come to know about their patient’s heart sensations? This is not a simple question, as it simultaneously looks at patients as people with bodily experiences, but also as humans understood as systems, as a sort of living machine. What is more intimate than our heart-beating, a familiar yet mysterious sensation we know to be at the very basis of our ongoing experience? Feeling a change in the rhythm or intensity of this fundamental aspect of our embodied existence can be very worrisome. Should clinicians believe patients who complain of cardiac rhythm changes? How accurate are people at detecting medically important heart-beat fluctuations? How should clinicians understand the relationship between symptoms as reported by the patient, and underlying physiological processes? These are complex and multifaceted issues, requiring nimble clinicians who integrate scientific knowledge as well as intuition about what the patient is experiencing bodily. Clinicans develop knowledge of their own bodies through life, and then are required to learn complex anatomical, physiological, and etiological concepts they will use to interpret their patient’s symptom reports. What patients have to say about what is happening in their bodies must be taken seriously, but not necessarily believed. The interrelated problems of how clinicians interpret patient verbal reports, reason about the relation between these reports compared to measurements and scientific models, and then make judgments about the patient’s accuracy in knowing about their own bodies are topics well worth honing in on, and to my knowledge, not throughly explored from a neurophenomenological perspective.

These acts of clinician cognition concerning their patient’s symptoms are framed by an evolving social and professional context. Modern medicine, like the Roman god Janus, stands two-faced, towards healing as an art, but also towards scientific models of disease. In the current era, what is known as “evidence-based medicine” requires an important shift in how clinicians operate, from historically rather unfettered individual judgments in some contexts, to increasingly accepting consensus-developed guidelines formulated from reviews of previous findings. Clinicans who have with great effort developed the ability to intuit diagnoses may have to defend their familiar constructs, criteria, heuristics, and practices if these are not bolstered by peer-reviewed studies, randomized clinical trials, systematic reviews, Bayesian statistical approaches to clinical problem solving, meta-analysis of previous data, and effectiveness metrics. Medical organizations can mandate “best practices” of patient care, “gold standards” of cost-effectiveness for ordering certain tests, references to efficacy criteria that must be satisfied before a program of treatment is established, and more. This ongoing process is transforming medicine, requiring that the traditional art of diagnosis based on years of education and experience be integrated with operationalized definitions, committee-approved metrics, and greater formalization, thus constraining individual opinion and practices in favor of organization-mandated standard operating procedures. Can symptoms based on an individual’s embodied experience be given proper attention in this brave new world of medicine?

I hope that more researchers would address the clinical aspects of neurophenomenology. This is a relatively new and undeveloped area. While William James and Erwin Straus were clinicians, as is Antonio Damasio, other pioneers such as Maurice Merleau-Ponty and Francisco Varela backgrounded medical concerns somewhat (however, if you are unaware of Varela’s haunting work at the end of his life “Intimate Distances -Fragments for a Phenomenology of Organ Transplantation“, it is a must-read.) Shawn Gallagher has made an excellent synthesis of philosophy and clinical studies in “How the Body Shapes the Mind“, a work that bears greater attention from the small community of neurophenomenology researchers.

For my part, I shall focus in on a particular area, palpitations, where changes towards operationalizing and standardizing the definition of “clinically significant” symptoms are occurring, with the aim of modeling the relationship between patient symptom reports and “significant” arrhythmias as revealed on ECG measurements. I will especially focus on how the predictive utility and accuracy of the reports can be operationalized, and attempt to represent for one domain how patients’ verbalization of their phenomenological state can be “mapped” onto measurements of cardiac rhythm abnormalities.

How to operationalize the “body-knowledge” construct so it can be analyzed and measured

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I started using the term “body-knowledge” a few years back as a way to label the extent to which people can accurately report symptoms or interior sensations. It is not as of 2010 a popular term. The earliest citation of the term I know of is from a clinical neurology paper by Sirigu, Grafman, Bressler, and Sunderland, (1991): Multiple representations contribute to body knowledge processing: Evidence from a case of autotopagnosia

“Body knowledge” does quite not have the same meaning as “embodied cognition”, “body image”,”body schema”, “interoception”, “visceral perception”, or even “body cognition”, though there is considerable overlap. I typically use the concept body-knowledge to emphasize the verbal reporting of internal states. My epistemology teacher years ago taught me a great idea:

To know something, you have to know that you know it, and to know that you know it, you have to be able to say it.

I wouldn’t defend that as the end-all be-all theory of knowledge, but it works as a heuristic at the least. For now, I use “body-knowledge” to refer to how well people can know and verbally report on what is happening to their physiological states.

To analytically probe this construct, I started looking very deeply at a particular domain: symptom reporting about cardiovascular processes. I have found some useful results from earlier studies that serve as a guide to help approximate how accurate people are when they feel and report palpitations: their heart is racing, they feel irregular beats, heart thumping or pounding, skipped beats, and so forth. Evidently a fair amount of the time people suffering from panic disorder or anxiety “cognize” otherwise benign sensations and report heart problems, and such false positives adds a great deal of expense to the healthcare system.

Symptom report accuracy is a largely unexplored area for the young field of neurophenomenology: how much of what is happening inside our bodies is accessible to our minds? Very little of the existing neurophenomenology literature deals with these issues.

How can the “body-knowledge accuracy” construct be operationalized, analyzed and measured? For the particular domain of palpitations reporting, here are some useful core metrics:

From ‘The Validity of Bodily Symptoms in Medical Outpatients,” (Barsky, 2000) Chapter 19 in The Science of Self Report (Stone, A, ed): -When patients complaining of palpitations undergo 24-hour, ambulatory, electrocardiographic monitoring, 39% to 85% manifest some rhythm disturbance; the vast majority of these arrhythmias are benign, clinically insignificant, and do not merit treatment). Although as many as 75% of these patients with arrhythmias report their presenting symptom during monitoring; in only about 15% of cases do these symptom reports coincide with their arrhythmias.

From Barsky, Ahern, Delamater, Clancy & Bailey (1997): -145 consecutive outpatients referred to an ambulatory electrocardiography (Holter) laboratory for evaluation of palpitations were accrued, along with a comparison sample of 70 nonpatient volunteers who had no cardiac symptoms and no history of cardiac disease. A symptom was considered accurate when it followed within 30 seconds after any demonstrated arrhythmia.

-average positive predictive value (PPV)… is equal to the number of reported symptoms that were preceded by an arrhythmia divided by the total number of symptoms reported (true positives / [true positives + false positives]).

-Ninety-nine palpitation patients (68%) reported at least one palpitation during monitoring. Among those patients who were symptomatic, the mean number of diary symptoms reported in 24 hours was 3.7. The mean PPV for all symptom reports among palpitation patients was 0.399, compared with a mean PPV = .118 for the nonpatient volunteer sample (p = .01).

-the palpitation descriptors most likely to be accompanied by electrocardiographic abnormalities are heart stopping, fluttering, and irregular heartbeat. The least predictive descriptive terms used by the patients were racing and pounding.

-34% of the symptomatic palpitation patients and 11% of the asymptomatic comparison subjects were classified as accurate reporters

questions about information-processing theories of body-knowledge

cognitive science, embodiment, introspection, symptom reports

Cognitive science explains mind and brain in terms of computation, information-processing, and representationalism: the ability of a cognitive system to change internal microstructure so as to correspond with important features of the internal or external world. One could do worse than to sum up the cognitivist model of the mind as “computations over representations”, in which features of the world or body are coded by the brain as symbols.

Whatever merits this “cognitivist” research program may have for models of syntactical production, the consolidation of short-term memories into long-term, the recognition of familiar faces, logical problem-solving, and other phenomena, I suspect that critical aspects of how people have knowledge of their bodies are not adequately accounted for by cognitivist approaches. I maintain that a careful analysis of the evidence reveals cognitive science has a flawed approach to modeling how well people know what is happening inside their bodies, and what mental and biological processes underlay this knowledge.

There are many aspects of psychological life that have never been the focus of cognitive science, and this absence is at it’s foundation the Cartesian rift at the heart of objective models that depict mind as machine. People experience a world of meaning framed by temporality and grounded in the lived body, but cognitive science focuses on a subpersonal realm of symbols, algorithms, information processing, representation, where mind is reduced to computation. To the extent that this approach yields results, it should be pursued, but cognition outstrips what cognitivism can model. There are aspects of cognition that are characterized by the existential questions, embodied experience, consciousness, meaning, and other phenomena, but it is precisely these that objectivistic, Cartesian cognitive science has not, for the most part, tried to explain. The difference is that of between worlds, like the gap between music grasped as experienced and meaningful, compared to music understood as a system that can be analyzed through abstract system-centered objectivistic modeling. It is true that science is typically understood in the latter terms, but neurophenomenology aims at a dialog between psychological life as experienced and cognition understood as a mechanism produced by te brain. There is not an immediate move toward reduction nor a premature assumption that embodied experience can be automatically modeled as a byproduct of systems.

In everyday life, and especially in conditions of sickness or disease, people notice aspects, qualities, and states of their bodies, and seek to get information about and from their bodies. Getting information about body-state can involve perception of a symptom, focused attention or introspection toward specific body regions or parts, remembering the way one’s body felt previously and comparing this to a current assessment, attempting to verbally express feelings about the way one’s body seems, paying close attention to a body part that is usually indistinct or in the background but suddenly is painful, and many other similar activities. Consider the following examples:

• a subject in a clinical trial of a medical device is asked whether or not they notice anything unusual or different about the way their body feels, and if so, to rate how much on a numeric scale;

• a person taking psychiatric medication for depression tells their psychiatrist about adverse side effects, such as a decline in libido, and an inability to grieve the loss of a loved one while at a funeral;

• someone who is drinking alcohol may calibrate their intake based on the memory of nausea from previous episodes of over-consumption;

• an obese woman is reported by American media to have been shocked upon finding she was in labor and on the verge of giving birth, having no previous knowledge of her pregnancy.

• a person who is being massaged, when asked to describe the sensation, reports a mixture of significant pleasure and mild pain when pressure is applied to very specific regions of their upper-back

In these and in similar cases, individuals involved are sensing, perceiving, remembering, and judging about their symptoms, body states, feelings, and sensations, and in some examples, reporting their experience to others. These are cognitive phenomena, but can ideas derived from symbolic logic and representationalist epistemology suffice to explain them? I would argue that there are a number of open questions about the utility of information-processing theories of body-knowledge.

Are the introspective reports, assessments, and statements generated by people about their body-state generally accurate, or not? What mechanisms account for the accuracy, or lack thereof?

To what extent do legacy concepts from cognitive science or information-processing models help or hinder the development of an understanding of how people access information and gain knowledge about their bodies?

How are we to understand the meaning(s) of the term “information” used to explain how and how well people know their own mental and physiological states? What is the relationship of “information” in the sense of physiological or biological systems to consciously reportable sensation, such that a person is getting information about their body state?

Are there many kinds of “information” involved in these models of internal state perception or “body cognition” found in clinical neurology, medicine, experimental psychology, and theoretical cognitive neuroscience? Or is there but one type of “information”, with different qualities or aspects that are described or measured in different ways?

Part II of Leder’s The Absent Body

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Spatiotemporal Continuity

The mysterious quality of our visceral space is based not only on such experiences but on all that is not experienced of our inner body, I have hitherto focused on what interoceptions we do have; they are marked by a limited qualitative range and a spatial ambiguity that together restrict our perceptual discriminations. Furthermore, as I will now address, there is a paucity of even such limited experiences.

Exteroception, at least during the waking state, manifests a certain spatiotemporal continuity. My eyes scan a visual world that is without sudden gaps or crevices. If I abandon one sense, perhaps closing my eyes, the other senses help to maintain the continuity of world. Similar­ly, proprioception traces out a completed sense of my surface body, allowing me to adjust every limb, every muscle, in appropriate motoric response to tasks. Though usually this sense is subliminal, I can close my eyes and proprioceptively hone in on the position, the level of tension or relaxation, in any region of the muscular body.

By way of contrast, the stream of interoceptive experience is marked by ineluctable discontinuities. In the above example, after eating the ap­ple it largely disappeared from perception only to resurface in an exper­ience of heartburn. This then faded away to silence, broken some time later by insistent cramps. This too passed. Finally, hours later I become aware of sensations from a new region signaling the need to defecate. But these are intermittent punctuations in a shroud of absence. Most of the intricate digestive process—its enzymatic secretions and peristaltic waves, its diffusions and active transports—proceeds without the pos­sibility of conscious apprehension. This is equally true of circulation, respiration, thermal or fluid regulation. By far the greatest part of my vegetative processes lies submerged in impenetrable silence.

Causal relations are rendered uncertain by these spatiotemporal lac­unae. I cannot be sure if my cramps are caused by an apple I previously ate, for this apple has, in the interim, disappeared from experience. Mo­ments of discomfort are noted while the baseline of ordinary functioning is largely invisible, it is as if my eyes only reacted to flashes of blind­ing light, the rest of the time residing in darkness.

This darkness is never absolute. When I focus inward at even the qui­eter times I still find some vestigial sense of my midsection enveloped in a sort of sensory neutrality, neither full nor empty, pleasured nor in pain. And this vague aura is not devoid of meaning. It shows that any hunger or illness has subsided. The very absence of discomfort is tinged by a positivity.

Moreover, through a heightened focusing of attention, I can increase my awareness of visceral processes. Certain dim sensations that I had never noticed—the feeling of my pulsing blood, the depths of respira­tion, the subtler reactions of my stomach to different foods—can be brought into experience by conscious effort. As cultural variations show, a certain degree of visceral disappearance can be attributed to Western insensitivities and overcome by a systematic development of powers. The awareness of and control over the inner body exhibited by trained yogis has far surpassed what used to be thought possible in the West.

Yet even such achievements take place only within an overall context of experiential disappearance. The very need for highly specialized training is evidence of the perceptual reticence of our viscera as com­pared to the body surface. And just as it is possible to speak of null points in relation to the surface body, the corporeal depths have their own phenomenological null points. That is, there are visceral regions that are almost entirely insensitive. In focusing upon stomach and gut I have ac­tually chosen two of the more loquacious organs. The kidney, gallblad­der. bone marrow, spleen, yield far less interoceptively. The par­enchyma of the liver, the alveolar tissue of the lung, are virtually with­out sensation. Unlike the completed perception of the proprioceptive body, our inner body is marked by regional gaps, organs that although crucial for sustaining life, cannot he somesthetically perceived.

We rarely thematize this sort of disappearance. Upon introspecting, I do not feel an emptiness in my body where my liver should be. This would make the absence into a presence-as-concealed hovering before my awareness. Rather, the absence of the liver parenchyma is so total that few would ever come to realize or remark upon it. Yet a medical mishap can suddenly awaken us to the significance of such bodily lac­unae. The vast gaps in our inner perception may conceal potentially damaging processes until they are far advanced. For example, while I may feel pain once damage to the liver has progressed to the point of affecting its membranous capsule, the initial process can go unper­ceived. Similarly, hypertension is experientially hidden through much of its career. As with my surface body, I can bring to bear upon these depth organs certain strategies of reflective observation. A blood sample can tell me a good deal about my liver function. Through a sphygmomanometer I can read off my blood pressure. I can look at an X ray of my lungs. I can even gaze through a colonoscope at the lumen and folds of my own colon. Such techniques enable me to gain knowledge concerning my viscera. Yet, as with my surface body, the absences that haunt my bodily depths are not effaced by these reflective maneuvers. Though I can visu­ally observe my colon, its processes still elude experience from within, The magical power my body has to absorb water and electrolytes is not perceived as I gaze through the endoscope upon this furrowed, tubular space. The mystery of my body is only heightened by the very strange­ness of the organ before me, its phenomenological noncoincidence with my body-as-lived.

Moreover, unlike the body surface, my inner organs tend to resist even these partial reflections. My viscera are ordinarily hidden away from the gaze by their location in the bodily depths, there is aspect of withdrawal may seem contingent, resulting from a sheerly physical harrier rather than an existential principle. Ye t this is to draw a false distinction; in the lived body, the physical and existential always intertwine.

The depth location of the viscera is no more contingent than the sur­face placement of the sensorimotor organs. Eye and hand could not perform their perceptual role unless they opened onto the external world- Thus, in order to perceive they must take their place among the perceptibles. They must be located at the body surface available to the gaze of myself and others, By way of contrast, my visceral organs, not constructed for ecstatic perception, disappear from the ranks of the per­ceived, I do not perceive from these organs; hence, they can hide beneath the body surface such that I do not perceive to them either. In fact, they require this seclusion just as the sensorimotor body requires exposure. My stomach, neither an organ of exteroception nor voluntary move­ment, could not screen the environment, secure appropriate foods, repel threats. It depends on a mediating surface, active and intelligent, to stand between it and the world, selecting what is needed for metabolic maintenance and protecting the vise us from hostile impacts. The hiddenness of vital organs, though frustrating at limes of disease, is essen­tial to healthy functioning.

Thus it is quite rare for the viscera to be exposed in life. This can happen, as in surgery, wartime injury, or violent accidents, yet these are pathological and dangerous occasions, Most commonly, the direct ex­posure of the inner organs implies or threatens the death of the person, Hence, as Foucault notes in The Birth of the Clinic, when nineteenth-century medicine made the direct perception of diseased organs an epistemological goal, the corpse, not the live patient, became the paradigmatic figure of truth. For the “anatomo-clinical” gaze, “that which hides and envelops, the curtain of night over truth, is, paradox­ically, life; and death, on the contrary, opens up to the light of day the black coffer of the body.”” While Foucault addresses this as a historical devel­opment, it manifests my phenomenological point; life itself is allied to a certain concealment, a withdrawal and protection of its vital center.

How accurate are people at knowing what is happening inside their bodies?

cognitive science, embodiment, interoception, introspection, neurophenomenology, symptom reports, visceral perception

Were people utterly inaccurate at judging their body state and reporting on it, clinical medicine would be deprived of a critical tool.  Evidence has accumulated that in certain circumstances, some people are evidently able to access information about the physiological processes inside of their bodies, and to report on it.  Experiments seem to demonstrate that some people are relatively accurate perceivers of symptoms or physiological state (Jones and Hollandsworth, 1981), (Adam, 1998), and that subjects can be ranked into good or poor estimators of internal state; for instance, with perceivers of heart rate (Schandry, 1981).

When we are actually aware of specific processes inside our bodies and can state this verbally, it would seem that in some fashion unconscious information (or unconscious “information”) has generated or has been transformed into knowledge. However, there is contradictory evidence about accuracy of symptom perception: how good people really are at perceiving various physiological states, and how accurate symptom-reports or other verbal-reports actually are. Many studies have yielded data consistent with the idea that people are not particularly good at accurately reporting on their symptoms or physiological states (Pennebaker, 1982). It is worth pointing out the assertion that people are generally inaccurate about knowing about physiological processes in their bodies reformulates the principle that humans lack epistemological privilege concerning introspective or verbally reported data. In considering the question: are we are likely to be in error when we report on the contents of what is in our minds, or not, it is critical to appreciate the persuasive interpretation of experiments written up in papers such as “Telling More than We Can Know” by the psychologists Robert Nisbett and Timothy Wilson (1977), which seems to show how introspection-based retroactive judgments can are in error.  This category of research typically features subjects placed in circumstances where their choices are influenced by variables controlled by experimenters, and who give explanations for their choosing that display incorrect “folk psychological” constructions. Nisbett and Wilson’s analysis can properly interpreted as to cast doubt on the ability of people to know the causes of our behavior and “higher order” information-processing, and can be summed up with their statement that people may possess “little ability to report accurately on their cognitive processes” (p. 246).

However, I assert that this valuable critique of retrospective judgments has been improperly extrapolated to support a broad skepticism about introspection, what I shall call the “received view” or the “overly skeptical view”, which I might sum-up as the belief that introspective data should generally be regarded with skepticism. As has been noted by careful researchers on introspection, (Schwitzgebel, 2006), this more general rejection of introspection certainly goes beyond what Nisbett and Wilson argued: while they do indeed assert that the evidence of numerous studies shows people are poor at using verbal report-based introspection to the cognitive process behind our judging and deciding, they do not support a general disdain for introspective data. Rather, they state that instead of arguing that introspective reports should simply be discredited, while people do not have introspective access to the cognitive processes, they do have such access to the contents of their cognitions. For instance, Nisbett and Wilson (pg. 255) state that introspection can yield forms of knowledge: knowledge about cognitive content, as an everyday person:

“…knows what his current sensations are and what almost all psychologists and philosophers would assert to be “knowledge” at least quantitatively superior to that of observers concerning his emotions, evaluations, and plans”

Furthermore, the “received view” that introspective reports are to be generally regarded with suspicion is in tension with the clinical use of patient introspection, as well as the high accuracy ratings sometimes displayed in experiments where subjects are asked to evaluate their own physiology. Therefore, while showing appropriate regard for data suggesting limits on introspective access to cognitive information (indeed I will suggest that models of body-knowledge should account for this data), I will nonetheless highlight certain clinical and experimental data that support the following assertion, which  contradicts the view that introspective data should be generally regarded with skepticism:

There exist cognitive processes that allow people to access internal body-state or physiological information in a way that enables fairly, or even highly, accurate verbal reports.  Insofar as this is true, people evidently have some degree of epistemologically privileged access to internal body state or interoceptive information. This relative privilege allows for knowledge of the body, as distinct from mere beliefs.

However, if this is true, some accounting of to what degree or how true it is, with which mitigating conditions, and with what reference to underlying cognitive and neurophysiological mechanisms would be necessary.  For that matter, even if true, demarcating the explanatory power of this principle relative to data adequately explained by the “received view” or “overly skeptical view” is of critical importance. It may be that only special or rare abilities are at issue here, and that the people who have privileged access to their internal physiological information are outliers.

Body-knowledge: what is it?

embodiment, Francisco Varela, interoception, Uncategorized, visceral perception

I use the term“body-knowledge”  in my dissertation research primarily to refer to the experience of knowing about one’s own body, and especially embracing perception and assessments of the body through the body.  It is meant to straddle the classic cognitive psychology distinction between explicit knowledge that is verbalizable, and implicit knowledge that may only be revealed through experiments. Trying to define the term brings up a number of questions:

-How is “neurophysiological information-processing” related to “body- knowledge”?

-To what extent does the distinction between conscious and unconscious knowledge need to be invoked to explain that relationship?

-Should beliefs about the body be understood as part of body knowledge? What about attitudes, expectations, and desires concerning one’s body?

-Do the properties of the body vis-à-vis external objects and the external environment factor in, such as my knowledge of my ability to lift x kilograms of weights, or to effect changes in the world with my body?

-How is body-knowledge related to body-state information access?

This latter phrase can be thought of as “internal perception of information about the body”. For present purposes a heuristic understanding probably should suffice: body-state information access refers to what content an individual can perceive, sense, or detect about their body, but also to putative notions of information-processing in the afferent or other nerves that produce the content. As the term “cognition” signifies both mind as a collection of unconscious systems and (however problematically) mind as consciously experienced, body-state information access, as I use the phrase, straddles the divide between subjective and objective aspects of the body (compare to Merleau-Ponty’s (1968) notion of the “corporeal” or “the flesh”). One might extend the concept to mean that body-state information access also refers to a sort of “information gain” in bodily perception: for instance, being aware of digestive processes where one was not previously.

Interoception is another term needing examination: while classically interoception refers to perception of the visceral organs in the inside of the body, consider Bud Craig’s (2002) proposed redefinition (pg.655):

“Interoception should be redefined as the sense of the physiological condition of the whole body (including pain and temperature), and not just of the viscera”

Even if this broader sense becomes accepted, interoception will still include the sense of “interior perception”.  The more expansive signification should then overlap with somatic cognition, a term deployed by neuroscientists (Tanosaki, Suzuki, and Kimura, 2002) who use it to signify perception using body parts such as fingers, and also internal cognition, or even visceral cognition, labels used by researchers who model the relationship of the internal organs to the nervous system and perception (Adam, 1998, pg 156-159).

Compare these to body cognition, which might not only embrace the idea of knowledge of one’s lived, experienced body, “thinking with the body,” but also the somatic, visceral,  neurophysiological, and cognitive systems making the perception and knowledge possible. “Body cognition” would seem to have experiential or phenomenological (that is, felt) dimensions, but should also refer to what are commonly understood to be unconscious mental, neural, and other physiological processes enabling this knowing. The profusion of terms may reflect the inherent complexity of the systems involved, our partial and provisional understanding, or both. Analyzing how the notion of information relates to models that explain how unconscious neurophysiological processes give rise to conscious ones is a particular focus of my project.

As I will be use the term, body-knowledge embraces the notion of using the body as the means to perceive or assess itself, such as with symptom perception. The study of body cognition involves perspectives from many fields, but could be understood as a subset of embodied cognitive science, which differs from standard approaches to the extent that it emphasizes overcoming the Cartesian split between subject and object implicit in cognitive science, and the coupling of human mental activity to a meaningful world. One of the goals of a cognitive science of embodiment would be to construct a model of body knowledge good enough to explain how the embodied brain and mind make knowledge of the body, sensing or perceiving using the body, and the ability of people to use directed attention and introspection to gain “true information” or validated knowledge (compare to beliefs) about the body.

As I use the terms, body-knowledge and body-state information access refer to both experiential-phenomenological knowledge (“I feel hungry” or “I have an itch on my scalp, but not as bad as earlier”) that may form the basis of verbal reports as well as the unconscious, and presumably not explicitly stateable, underlying information processes comprising cognition. This distinction between stable and explicit and non-stateable or implicit knowledge is not a trivial one. Cognitive science, neuroscience, and psychophysiology propose that our conscious awareness and experience of information about the body to be to be somehow made of or caused by unconscious information, because cognitive processes are understood to be mostly unconscious.  Varela, Thompson, and Rosch (1991, pg. 49) point out that cognitive science:

“…postulates processes that are mental but that cannot be brought into consciousness at all. Thus we are not simply unaware of the rules that govern the generation of mental images or of the rules that govern visual processing; we could not be aware of these rules. Indeed, it is typically noted that if such cognitive processes could be made conscious, then they could not be fast and automatic and so could not function properly”

A critical look at the information-processing theories used to explain body-knowledge

Uncategorized

The psychologist Raymond Gibbs (2006) in Embodiment and Cognitive Science asks (pg. 28) “What underlies people’s abilities to move as they do and have any awareness of their bodies?”

images

The conventional answer given by psychology, medicine, and cognitive neuroscience is physiological and cognitive systems using information-processing. Gibbs cites the work of Bermudez, Marcel, and Eilan (1995) who list a series of multiple internal physiological information sources that enable motor activity and somatic perception (pg. 13):

“(a) Information about pressure, temperature, and friction from receptors on the skin and beneath the surface.

(b) Information about the relative state of body signals from receptors in the joints, some sensitive to static position, some to dynamic information.

(c) Information about balance and posture from the vestibular system in the inner ear and the head/trunk dispositional system and information from pressure on any parts of the body that might be in contact with gravity-resisting surfaces.

(d) Information from skin stretch and bodily disposition and volume.

(e) Information from receptors in the internal organs about nutritional and other states relevant to homeostasis and well-being.

(f) Information about effort and muscular fatigue from muscles.

(g) Information about general fatigue from cerebral systems sensitive to blood composition”

These formulations follow the contemporary scientific trend of explaining systems, processes, entities, and relationships in terms of computation and information (and, often enough, representation).  It is relatively rare in such contexts to encounter authors worrying overmuch about the meaning of the term “information” though there are attempts to effectively operationally define it via metrics, i.e. to quantify the information content of a system via Shannon-style or other measurements (Gardner, 1985). Perhaps “information” is indispensable as a term of convenience, but a critical reader should ask what the term means in context, when the term is used as a heuristic, what value the term adds, whether ambiguity is lessened or increased, and whether it would be better to emphasize the provisionality of information concepts.

Probably it would be better to refer to “information” much of the time, but this becomes stylistically cumbersome very quickly.

In any event, current theories of psychophysiological processing, clinical studies of symptom-perception accuracy, cognitive models using mechanisms explaining explicit, verbally-stateable knowledge, and other theories conceptualize our knowledge of our bodies in terms of information-processing, though the connection between “knowledge” and “information” is often not explicit.

How are we to understand the meaning(s) of the term “information” used to explain how and how well people know their own mental and physiological states? What is the relationship of “information” in the sense of physiological or biological systems to consciously reportable sensation, such that a person is getting information about their body state? Are there many kinds of “information” involved in these models of internal state perception or “body cognition” found in clinical neurology, medicine, experimental psychology, and theoretical cognitive neuroscience? Or is there but one type of “information”, with different qualities or aspects that are described or measured in different ways? What metrics or formalisms are most appropriate for each type?

Information-processing, computational, cognitivist, and representational formulations may privilege objective “system-centric” meaning of information, performing an implicit reduction of information in an experiential/phenomenological sense, without calling attention to the reduction. It may be useful, or even true, that quantities can be mapped on to qualities, following the accepted principle in philosophy of science that the ontology (known elements, entities, processes, features, properties and their relations) from one domain can be reduced to that of another domain, with properties from the one domain or level of scientific description to more fundamental explanatory ones in another domain (Churchland, 1989). In this view, the mechanistic and reductionistic work that the ontology of genes and DNA (and possibly information-processing theory) does in explaining cell biology will hold for the relationship between brain and cognition. Indeed, a standard view in psychology and neuroscience (and to an extent philosophy of mind) holds that concepts from cognitive neuroscience, computer science, and information-processing theory can mechanistically explain particular aspects of bodily awareness, and at some point law like or nomological generalizations will become apparent, effectively performing a reduction.

I maintain that we should be careful in using an overdetermined term such as “information” to prematurely unite concepts from different domains. Traditionally, the philosophy of science has had a role in calling attention to instances where the use of concepts from one domain are used to explain another without careful explication of the move that is made (what one might call “stealing a base”), but unfortunately, the specialized nomenclature of philosophy leaves some scientists and clinicians alienated from such discourse.

Stretch your imagination, take the long view, remember Thomas Kuhn: do you think people in 100 years will be explaining body-knowledge as an information-processing system?

Verbal report data: psychologists may be skeptical, but clinicians are more practical

clinical neurophenomenology, cognitive science, introspection, medicine, symptom reports

Cognitive neuroscience and psychology needs to account for  verbal report data from people about their body states. In perceptual psychology and psychophysics experiments, in cognitive studies of human problem-solving, in clinical trials of drug efficacy and safety, in phenomenological-psychological investigations into the thematics of body experience, researchers routinely ask subjects or patients to answer questions. This is so common that its significance is perhaps under-appreciated. Science, at least in a narrow sense,  is conventionally understood to be based on objectively observable facts, not subjective opinions. But certain phenomena can not only be observed from the outside, as part of a system, but can also be reported on by people from the inside, as perceived or experiential events.

This regular use of the human self-reporting capacity is more remarkable in the light of intellectual history.  “Orthodox” cognitive science developed in the era of behaviorist dominance, and inherited certain skepticism about the trustworthiness of verbal reports, which are viewed as being sources of data, but not “privileged.” This stance indicates a rejection of older philosophical and psychological traditions that emphasized the use of introspection. Nonetheless, even in the time of behaviorist hegemony, psychologists still asked subjects questions in perception experiments, and clinicians have always used patient assessments to gain insight (Nahmias, 2002). While certain path-breaking cognitive scientists and psychologists explored the nature of introspection, and worked out the circumstances in which verbal reports could be authoritative and true accounts of aspects of cognitive processes (Erickson and Simon, 1991), (Ericsson, Chase, and Simon, 1979), the results of other widely cited experiments have been interpreted to denigrate introspective data, especially that of Nisbett and Wilson’s (1977) “Telling More than we can know” paper. Their research has been interpreted to indicate, for instance, that subjects made demonstrably inaccurate judgments about their underlying mental states because human beings apparently have little or no direct introspective access to the underlying cognitive processes of the mind (pg. 233):

The accuracy of subjective reports is so poor as to suggest that any introspective access that may exist is not sufficient to produce generally correct or reliable reports.”

The interpretation of their data featured assertions that are now influential:  subjects lack  introspective access to the causal relationship between stimuli controlled by the experimenter and the verbal reports they produce. They are unable to accurately report which stimuli affected their responses. Rather, these verbal reports of effects of stimuli are based on unvalidated belief (such as naïve “folk psychological” theories about the causal connections between the stimuli and their response). Furthermore, if the reports on stimulus-response relationships are correct, it is because their naïve theories happen to be correct, and not because introspection gave them any privileged access to information. The upshot can be summarized as: subjects in situations with variables controlled by scientists make introspective judgments about why they behave in a particular manner or think a certain way, they state this explanation verbally to an experimenter, who can show the explanation to be false: (pg. 243)

“In order to test subject ability to report influences on their associative behavior, we had 81 male introductory psychology students memorize a list of word pairs. Some of these word pairs were intended to generate associative processes that would elicit certain target words in a word association task to be performed at a later point in the experiment. For example, subjects memorized the word pair “ocean-moon” with the expectation that when they were later asked to name a detergent, they would be more likely to give the target “Tide” than would subjects who had not previously been exposed to the word pairs….Immediately following the word association task, subjects were asked in open-ended form why they thought they had given each of their responses in the word association task. Despite the fact that nearly all subjects could recall nearly all of the words pairs, subjects almost never mentioned a word pair cue as a reason for giving a particular target response. Instead subjects focused on some distinctive feature of the target (“Tide is the best-known detergent”), some personal meaning of it (“My mother uses tide”), or an affective reaction to it (“I like the Tide box”).

The influence of this research has had the practical effect of renewing suspicions among psychologists and other researchers about introspective data, even if such methods continue to be used (Jack and Roepstorff, 2003) and despite the balanced view of Nisbett and Wilson where introspection has some utility regarding “sensations and/or private facts”, which takes into consideration the longtime use of introspective data as a method in psychology. Cognitive scientists, psychologists, physicians, and others can adopt their pragmatic distinction between the contents of cognition, such as sensations and emotions which can indeed be known and verbally reported, and the underlying causes, the information-processing or cognitive processes, which remain epistemologically inscrutable to introspection.

Yet while clinical medicine often regards introspective data with caution, it nonetheless uses it pragmatically. For instance, the standard neuropsychology text Clinical Neuropsychology (Heilman and Valenstein, 2003) states (pg.5)

at times, patients’ observations of their own mental state may not only be helpful but necessary.”

This implies that it is a standard clinical methodology to use introspective data, and that patients have some useful access to their own minds.

This data-collection method of asking subjects and patients for self-reports is routinely used, according to psychologist Arthur Stone (Stone, 2000) (pg. 297):

“In both clinical practice and in research, the primary method of obtaining information about physical symptomology is through self-reports. Every day, thousands upon thousands of health care providers ask their patients to describe how they are generally feeling and too discuss specific symptoms. Patients present their doctors with panoply of global states (“I feel lousy,” “I am fatigued,” “I don’t feel right”) to very concrete descriptions (“I have a sharp pain in my right knee that is worse on awakening”). Information from these interviews, along with various medical tests, provides the basis for treatment and for the evaluation of its efficacy. In medical research, information of the same sort is obtained with questionnaires and structured interviews. These data-collection methods may provide a more systematic way of gathering physical symptom information, but regardless of the mode of data collection, the information is self-reported. Thus, reports of physical symptoms may be considered the mainstay of medical practice and research”