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?

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the legacy of Cartesian “objectivity” makes it hard to understand patient verbal reports

clinical neurophenomenology, embodiment, introspection, medicine, symptom reports

Psychiatrist Allan Beveridge (2002) hones in on a facet of the patient-physician relationship relevant to neurophenomenology: the over-adoption in medicine of the scientific attitude of objectivity towards phenomena. While entirely appropriate in the many research contexts, this may make understanding the personal body-knowledge of the patient more difficult (pg. 101):

In the mental state examination, a standard method of describing the clinical encounter is to contrast the patient’s supposedly ‘subjective’ account with the doctor’s ‘objective’ description. In this model, the doctor is granted a privileged position: the clinician’s perspective is taken to be superior to that of the patient. The doctor’s objective approach is considered neutral, scientific and representing the truth of the matter. In contrast, the patient’s subjective report is regarded as unreliable, distorted and potentially false. The lowly status of the subjective perspective is further emphasized by the frequent use of the accompanying prefix, merely. On reflection, this dichotomy is an extraordinary one. It is held that the doctor is an authority on the patient’s inner experiences. The doctor knows more about how the patient is thinking and feeling than the patient him-/herself

This “scientific” medical stance towards patient subjective reporting is consistent with the Cartesian heritage of the sciences of the mind. The implications, hidden or unexamined commitments should be critically examined if the verbal reports about patient body-states are to be better grasped by science and medicine. To the extent cognitive science, psychology, neuroscience, and medical fields uncritically base their methodologies on unexamined premises, certain problems may appear just due to the very choices of what is considered “data”. The relegation of patient verbal reports to the category of “merely subjective” allows for Cartesian assumptions about cognition to create difficulties at the outset of any research project attempting to model personal knowledge of the body. It may be that the very categories of subject and object, or scientific knowledge vs. subjective or “folk psychological” naïve theories of the body, present foundational problems for understanding how neurophysiological processes relate to verbally reportable knowledge of the body. But as a practical matter, health care professionals must simply cope with patient statements as one more data source (Ersser and Atkins, 2000, pg. 68):

Clinical decisions involve information of a necessary type and quality. Professionals take account of both objective and subjective data during the clinical assessment process to decide on a patient’s health care need and care plan. The difficulty lies in professionals understanding how best to reconcile their objective perspective with that of the patient, when formulating clinical judgments

Before a doctor revives technical training, he or she is a person with experiences of health and sickness. The verbal reports of patients are interpreted by professionals with their own history of embodiment. To what extent does their personal body knowledge consciously or unconsciously affect their clinical intuition about the accuracy of patient verbal reports? Does expert knowledge of the body gained from studying anatomy and physiology allow for better knowledge of one’s own body? Such questions point to our current rather murky understanding of embodied cognition, underscoring the need for models capturing richer, more subtle aspects of experience, cognition, and brain.

symptom verbal reports and existential-physiological discrepancy

clinical neurophenomenology, interoception, introspection, medicine, symptom reports, visceral perception

While the anatomical basis of how nerve projections enable perception of the body is rather well known, physicians confront situations where patient verbal reporting about symptoms does not match models based on neurophysiological mechanisms. For instance, the Merck Manual Medical Library (2009) states:

“Painful stimuli from thoracic organs can produce discomfort      described as pressure, gas, burning, aching, and sometimes sharp pain. Because the sensation is visceral in origin, many patients deny they are having pain and insist it is merely discomfort”

The Mayo Clinic Heart Book (Gersh, 2000) describes the concept of uncomfortable feeling of thumping inside the chest known as palpitations, but does so from the point of view of patients (pg. 38):

“Although the apparent cause of the thumping in the chest would seem to be the heartbeat, this is not always the case. Some people have a normal heart rate during their palpitations. Presumably, they are either anxious or experiencing chest wall twitching that is mistaken for heartbeats”

Situations where the “folk physiological” (see Churchland, 1989, for a description of expert knowledge vs. folk beliefs) understanding of the body is apparently falsified by science can be labeled examples of existential-physiological discrepancy (Laughlin, McManus, D’Aquili, 1990). Mismatches between body-as-experienced compared to the “objective body” of scientific medicine and physiology (including the feeling of “phantom limbs” by amputees) are based on the idea that people may often have very limited “true” access to physiological processes. A more commonly presented variant or subset of this principle is the idea of “referred pain”, where the region causing understood to be causing the pain is spatially removed from the area where the patient senses it.

The Merck Manual (2009) gives an example: sometimes pain felt in one area of the body does not accurately represent where the problem is, because the pain is referred there from another area. Pain can be referred because signals from several areas of the body often travel through the same nerve pathways in the spinal cord and brain. For example, pain from a heart attack may be felt in the neck, jaws, arms, or abdomen. Pain from a gallbladder attack may be felt in the back of the shoulder.