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

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.

questions about information-processing theories of body-knowledge

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?

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

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.

History of the development of neurophenomenology-pt.1

(Part II is here, and Part III is here)

I will attempt in three essays to outline the sweep of ideas, researchers, and works that lead a few of us to speak of “neurophenomenology” as a more or less distinct field.  Part I traces 19th century psychology, neurology, and phenomenology roughly up to World War II. Part II examines the impact of cognitivism, the continued development of clinical neurology and basic neuroscience, the progression of phenomenological thought in psychology and medicine, and criticisms of cognitive science. Part III explores the early 1990’s origins of the emerging field of neurophenomenlogy within the broader context of interest in embodied cognition and consciousness studies. Any corrections, suggestions, or criticisms are welcome.

It may be too early to attempt a definitive characterization of the constitutive elements, at the least it is a combination of clinical studies by neurologists, psychiatrists, and psychologists, experimental work on the brain and mind, and philosophical analysis of consciousness and cognition. While the term “neurophenomenology” has a recent (early 1990’s) origin, the project of understanding the mysterious and profound relationship between brain events and awareness goes back at least as far as classical Greek philosophy. Physicians and philosophers have grappled with the enigma of existence and of consciousness for millenia. Psychology has roots in medicine, ethics, and the philosophy of mind and epistemology, but by the late 19th century,  the overlapping fields of biological psychology, psychiatry, behaviorism, and the psychophysiology and psychophysics of perception emerged. We can trace the series of research traditions that eventually developed  into “neurophenomenology” in the 1990’s through ideas and practices of  19th century researchers.  Understanding how these traditions drew from various sources, and subsequently interacted, requires we situate each field in then-current European disciplines. Elites were schooled in the Gymnasia, and acquired a broad and deep education before later specialization.  Physicians and/or laboratory experimentalists were expected to be familiar with classical and to an extent modern philosophy, and gentleman scholars would dabble in but also contribute to numerous fields: highly unlike the current hyper-specialization of academia. Psychology was very pluralistic at this stage: not yet fully divorced from philosophy, still possessing a sense that a field focusing on the richness and complexity of the human psyche must involve a study of consciousness.

There were numerous German psychophysics and psychological researchers looking for how consciousness and the brain were related, such as Herman von Helmholtz (1821-1894), Gustav Fechner (1801-1887), and Wilhelm Wundt (1832-1920).  Much effort was expended on rigorously correlating physiological and psychological measurements, resulting in establishing thresholds of perception and the limits of just noticeable differences. A number of laboratories used experimental methods where subjects told researchers what they were perceiving through verbal reports based on introspection.

Bold innovators like the justly renowned philosopher, psychologist and physician William James (1842-1910) also looked for the physical basis of experience. He pioneered research into neurology, performed psychological experiments, and made creative, yet disciplined, investigations into experiential aspects of mind. James’ use of crisp, lucid language describing consciousness and awareness pushed the threshold of what science, psychology, and philosophy could say about consciousness. James helped establish American experimental psychology, but really hit his stride with his still-fresh writings.  He described how memory and the enigmatic quality of the moment-by-moment flow of experience, and even wrote about altered states of consciousness. His central concept of consciousness being like a stream is still influential, and there is now a renewed appreciation for his work on how emotions are coupled to the physiological state of the body.  All in all, he is probably the most important figure in the history of American psychology. Yet his interdisciplinary boldness, penetrating curiosity and at times virtuostic powers of description of complex mental phenomena were not easily replicated by those researchers and younger colleagues he influenced.

William James, master theorist of consciousness

In the Principles of Psychology, James provided an admirably straightforward account of what introspection is:

“Introspective observation is what we have to rely on first and foremost and always. The word introspection need hardly be defined – it means, of course, looking into our own minds”

 

Fin-de-siecle psychophysics was in its golden years during his time, and while James’ wrote admiringly of the “philosophers of the chronometer” and other technically adroit experimental psychologists in his lab that measured perception and other phenomena, James himself continued his project of probing and describing the phenomenology of consciousness itself. While considered a father of introspectionist psychology and a forefather of both behaviorism and cognitive neuroscience, perhaps because of his hard-to-imitate brilliance, James did not leave a school of younger researchers to follow through on his research into consciousness.

In America, Europe, and Russia, generations of research into the organic basis of pathologies was reaching new heights of explanatory power. The German psychiatrist Emil Kraepelin (1856-1926) was formulating sophisticated theories of the physiological basis of mental illness in the early 20th century, in retrospect a crucial step in the early development of the now accomplished field we know as clinical neuropsychology. After each war, neurologists noted the correlations between location of trauma to the brains of the injured with deficits in speech, memory, movement, perception, affect,  emotion,and “body knowledge”. The Russian tradition culminated later in the influential work of Alexander Luria (1902-1977).

The force of new findings in clinical studies, physiology,  and experimental laboratory research eventually produced a scientific psychology that established itself as independent from moral philosophy, epistemology, metaphysics, and the philosophy of language. The success of  19th century psychophysics and neurophysiology, with breakthroughs such as Hermann von  Helmholtz‘s (1821-1894) measurement of the speed of the nerve impulse, provided ample justification for the fissure. Psychophysics experiments painstakingly produced data on the “just-noticeable difference” in light or stimulus intensity, etc. but there were real difficulties in establishing a consensus between the different laboratories on methodologies for dealing with subject’s reports on their perceptions.

While towering figures like Ernst Weber (1795-1878), Wilhelm Wundt (1832-1920), and Edward Titchener (1867-1927) were establishing a canon of principles and techniques for psychology, it proved extremely difficult to come up with one standard way to operationalize measurements that involved verbal reports about  subjective judgments and conscious experience. For all the brainpower deployed in various laboratories, by the 1930’s the tide was turning against scientific research into consciousness due to the influence of behaviorism, which reacted against the lack of an agreed-upon methodology in the German psychophysics-based psychology, especially involving introspection. The behaviorists marshaled an impressive array of experimental measurements techniques to establish causal relationships between stimulus and response, and then to infer lawlike generalizations. They stringently opposed the use of any mental concepts as inherently subjective and thus unscientific, and eschewed using first-person reports as much as possible. Within fields like the psychology of visual perception it was necessary to get verbal reports from subjects, but the behaviorists strove mightily to build a scientific psychology on purely physical principles. But if the behaviorists’ reacted against psychophysics for being insufficiently liberated from concerns with cognitive processes, others argued precisely the opposite. The philosopher Franz Brentano (1838-1917) wrote Psychology From An Empirical Standpoint in 1874, where he popularized the notion that the contents of experience constituted an important field of inquiry in their own right. Brentano’s influential theories of intentionality stressed the need to investigate the contents of awareness and their constitutive operations. Researchers working on cognition who were dissatisfied with the limitations of psychophysics ,and unpersuaded by the soon-to-be dominant anti-mentalist strictures of the behaviorists (such as physiologist Ivan Pavlov (1849-1936) and psychologist/advertising specialist John Watson (1878-1958))  rallied around this line of inquiry. Brentano made an impact among philosophers and psychologists and certain influential clinicians, and in some sense there is a diverse “School of Brentano“.

Arguably the most  influential among the students and followers of Brentano was the mathematician and philosopher Edmund Husserl (1859-1938). Husserl was fascinated (obsessed?) with the foundations of logic, mathematics, epistemology, and cognition.  Convinced by direct criticism from the celebrated logician Gottlob Frege (1848-1925) that psychological principles were epistemologically inadequate to foundationalize mathematical and logical truths, Husserl would eventually synthesize Brentano’s research into the primacy of intentional awareness within cognition with a quest for the undoubtable (or “apodictic”) core principles of mathematics, logic, and philosophy.  After producing light-reading classics such as Philosophie der Arithmetik, he developed a research program  into the first principles of cognition, logic, and epistemology called phenomenology.  While Husserl attracted many philosophers and certain psychologists to his cause with the 1900-1901 publication of the highly influential Logical Investigations, his continual probing of the constituent ideas underlying mathematical and logical truth was to an extent a solitary quest.

His acolytes and disciples found the Logical Investigations of great importance, yet they did not take up Husserl’s overarching project of a securing a logical foundation for all science, math, and philosophy. In the case of Martin Heidegger, phenomenology was redefined as the means for a still more fundamental investigation into ontology.

Edmund Husserl: logician, philosopher, and phenomenologist

Before WWII Husserlian phenomenology was perhaps the most important development in European philosophy, and influenced a number of other fields, such as psychology and medicine.Because his phenomenology took conscious experience as a source of data (following Brentano) many researchers interested in consciousness and cognition were excited by Husserl’s radically rigorous approach and penetrating exploration of how mental processes constitute, shape,  and structure the phenomena of which we are aware. His notion that cognition actively constructs the contents of awareness (compare to Jacob von Uexkull‘s (1864-1944) notion of the umwelt) would be familiar to modern cognitive neuroscientists but to early 20th century psychologists and philosophers was revolutionary. Husserl  influenced the philosophers Martin Heidegger (1889-1976), Jean-Paul Sartre (1905-1980), and Maurice Merleau-Ponty (1908-1961), the logician/mathematician Kurt Godel (1906-1978), the philosopher-theologian Karol Wojtyla (1920-2005), as well as (in more recent years) the prescient critic of Artificial Intelligence philosopher Hubert Dreyfus, and the cognitive neuroscientist Francisco Varela (1946-2001).

In America and Britain, these developments in Continental thought were generally of no interests to the behaviorists, who aside from biologically/medically-based critiques of the sort offered by neurologist Karl Lashley (1890-1958), enjoyed near-hegemony in scientific psychology. But eventually, the rise of computers led to the “cognitive revolution” : the  development of symbolic or information-processing theories of the mind that did not respect orthodox behaviorist’s strictures against the use of mental concepts.  In time, this  willingness to use mental concepts again would open the door to the study of consciousness in psychology and neuroscience . After WWII, the introduction  of computers led to cybernetic,  information-processing, symbolic-logical, and representational models of language, memory, behavior, reasoning, and even awareness.

(Part II is here, and part III is here)

more on the status of introspection in psychology and in neuroscience

An index of the status of introspection within psychology comes from Medin, Markman, and Ross (2004) in the textbook Cognitive Psychology, which notes (pg.20) that:

“Although introspection is not an infallible window to the mind, psychological research is leading to principles that suggest when verbal reports are likely to accurately reflect thinking”

These perspectives all can be said to implicitly or explicitly challenge what I shall call the “received view” or the “overly skeptical view”, which is an interpretation of the Nisbett and Wilson work that goes beyond what those authors’ famous paper actually said. While it is the case that the “Telling More than we can Know” Nisbett and Wilson paper argued persuasively that introspection-based reports of subjects asked to retrospect on the causes of their behavior are generally not accurate, these authors made a point of not dismissing the value of introspection and verbal reporting on the contents of cognition one is aware of , such as sensation or perception and “private facts”. But the “received view” of their research all too often neglects or ignores the more nuanced and balanced view about introspection of the authors, as well as that of other cognitive scientists who carefully investigated the issues involved, such as Anders Ericsson and Herbert Simon (1993).   This is an important concept: see Eric Schwitzgebel’s excellent take on the “Nisbett-Wilson myth“.

What is the most important concept to take away from the controversies about introspection? Probably it is that insofar as researchers want to be able to take advantage of all possible tools and data sources to make sense of the complex, enigmatic processes characterizing body knowledge, they should follow the example set by many physicians and some experimentalists, and be willing to get data by asking subjects or patients for their observations on body state. But here I will go one step further, and assert that the accuracy, or lack of accuracy, of verbal report data relative to other data, can serve as that which must be explained by a comprehensive and robust model of personal or self-reportable knowledge of the body. Doing so would require experiments where verbally reported data might be compared to, and possibly integrated with, data from external sources, such as from brain measurement: “neurophenomenology” in operationalized form.

One such effort came from a trio of researchers interested in assessing whether introspective data on pain had measurable neural correlates (Coghill, McHaffie, Yen, 2003, pg. 8538):

“Using psychophysical ratings to define pain sensitivity and functional magnetic resonance imaging to assess brain activity, we found that highly sensitive individuals exhibited more frequent and more robust pain-induced activation of the primary somatosensory cortex, anterior cingulate cortex, and prefrontal cortex than did insensitive individuals. By identifying objective neural correlates of subjective differences, these findings validate the utility of introspection and subjective reporting as a means of communicating a first-person experience”

This forward-looking research in effect turns behaviorism on its head: instead of verbal reports being rejected or at best tolerated within the overall context of strict objectivity, the very phenomenon the model seeks to explain is “subjective”!

symptom verbal reports and existential-physiological discrepancy

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.

Jack and Roepstorff on introspection

From Trusting the Subject (2003), Anthony Jack and Andreas Roepstorff write:

“The unique challenge facing a science of consciousness is that that the best instrument available for measuring experience depends on cognitive processes internal to the subject. So just how much faith can we place in the capacity of the mind to understand itself? In principle, the construction of a maximally robust methodology for introspective evidence would require a detailed understanding of the operation of introspective processes — the processes that mediate the acquisition of introspective knowledge and underlie the production of introspective reports”

And:

“It is important to realize that no principled problem stands in the way of the scientific assessment of various types of introspective evidence. The testing of the reliability, consistency and validity of various types of introspective report measures lies well within the orbit of currently available methods. A measure may be called ‘reliable’ if it yields the same results when tested in multiple sessions over time (‘test–retest reliability’) and across individuals (a cousin of ‘inter-rater’ and ‘inter-observer’ reliability). Of course, subjects’ reports may differ, and so appear to be unreliable, simply because their internal mental processes and states vary. Thus it is critical to establish well controlled experimental conditions for eliciting reports. The considerable advances in behavioural science since the time of the Introspectionists offers experimenters considerable advantages in this regard (see Ericsson, this volume). Not only do these advances make it much more probable that experimenters can establish conditions under which introspective measures can be shown to be reliable, they also provide much greater insight into the behavioural and neural correlates of experiential phenomena.

A measure may be called ‘consistent’ when it can be shown that the results are not due to specific features of the measurement technique. Tests of consistency provide a means of checking that the observed effect is not due to a methodological artefact. Thus we might test the consistency of introspective  evidence by comparing immediate forced-choice button-press reports with retrospective and open-ended verbal reports. In this way we might establish, for instance: that the results of forced-choice button-press reports have not been influenced by variations in the criterion for response or by automatisation of response such that they no longer constitute true introspective reports; and that retrospective reports have not been distorted by forgetting or memory interference effects.

‘Validity’ is the most important factor to establish, yet it is also the most theoretically complex, and a particularly vexed issue in cognitive science. A measure is validated when it can be shown to accurately reflect the phenomenon it purports to measure. Validity is complex because scientific measures are often simultaneously interpreted as providing evidence for phenomena at a number of
different levels. A rough characterisation of three major sources of evidence in cognitive science might read as follows:

-Data from functional Magnetic Resonance Imaging (fMRI) serves most directly as evidence of cerebral blood flow (which has been validated), less directly as evidence for neural activity (which is in the process of being properly validated), and least directly as a means of identifying and localising specific cognitive functions (far from well validated).

– Behavioural measures (e.g. the averaging of reaction time measures over multiple trials) serve most directly as evidence for stable patterns of behaviour, less directly as a means of assessing information processing, and least directly as means of establishing the existence and operation of specific cognitive functions.

-Introspective reports serve most directly as evidence about the beliefs that subjects have about their own experience, less directly as evidence concerning the existence of experiential phenomena, and least directly as evidence concerning the operation of specific cognitive functions.