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A meeting with Chris Frith about schizophrenia

 
A Meeting with Chris Frith

I was curious to know if Chris was still interested in an idea that he wrote about in the 1970s about a filtering fault in the brain that could explain something about the condition of schizophrenia. I asked him if the concept he had defined as meta-representation (which stemmed from this notion of faulty or lack of filtering) was still relevant to his work now. He explained that it is still relevant but that he had been trying to define the word more exactly and finds ‘metacognition’ a more precise description now.

I explained to him that I have been noticing through personal introspection how much preconception I bring to an interpretation of an event and how often those preconceptions are proven wrong. When I am occasionally made aware of these 'prediction errors’, I am shocked by the extent of these mistaken narratives of what I am perceiving. Something that at the time I felt utterly convinced by suddenly disassembles, and a completely new meaning emerges. What I am describing seems to be a simple case of delusion built from a strongly held point of view (the prior in Bayesian terms) that skews how I interpret what I think is happening. Chris responded that this is how the brain works – building narratives that make sense of a situation but which are potentially riddled with misconceptions that are framed through both recall (memory) and prediction.

Chris had sent me a case study that referred to the experience of fragmentation and sensual overload of intense phenomenal impressions experienced in schizophrenia. Previous to this meeting I had also been reading a number of biographical personal narratives describing this first person experience of schizophrenia. These texts had shared very similar qualities, and also events affirmed one another. However, this state of fragmentation, to which the accounts all refer, has not been affirmed as 'a given' by other clinical psychologists I have spoken to. In spite of this I feel swayed by these first person accounts that imply that there is indeed a reduction in the ability to filter information. (This may be characteristic of the early stages of schizophrenia.)

An aspect of the condition that I want to investigate further for this artwork is the different way of reading signs off the world evoked by schizophrenia/psychosis. I had become aware of this type of strange symbolic order when reading Strindberg's account of his psychotic period (Occult Diaries). I'm interested in the seeming interconnection (integration) of disparate events, (finding connections where others see none), that seem to oddly coalesce in the writing of Strindberg and elsewhere. The way one might form and process these connections appears to be a way to affirm our own peculiar narratives but also to allow us agency.
 
Relationships between things sometimes seem to arise suddenly and bring on a feeling that the future is being determined. On the way to meet Chris I walked past a sign outside the Institute of Philosophy advertising a lecture that evening on “the scope of intention”. I read this title exactly at the moment that I was forming an  ‘intention’ to ask Chris about a theory I had read on scope-syntax. So at that exact moment the word ‘scope’ was in my mind, with a vague thought of its meaning for philosophy. As I read that very word on the sign on the pavement in front of me, advertising a lecture in the philosophy department at UCL. I took it as a sign.

I spoke of this coincidence to Chris and he told me he had written down the word scope-syntax after my email to him on the subject as he wanted to discuss it; it was a theory he had not come across. I explained that it had to do with an evolutionary point of view – an idea that knowledge in the origins of humankind could be very local and specific. What could be understood as true in that very specific situation, but only to that locally defined circumstance, would not, however, hold as a larger general truth. Scope-syntax refers to a problem of truths becoming extended beyond their capacity, to the point where the codes or truths are not applicable anymore – hence no longer true.

Chris explained to me that we need this ability to make a coherent truth. That is what we have to do all the time but we extend the contingent local ideas we have into larger general concepts. He talked about an idea from the philosophy of science about metaphors in science. He described the metaphor of the atom as being like the solar system with spheres orbiting around a nucleus. That metaphor eventually turned into a theory, which then discarded all the bits of the metaphor that didn't work but kept the ones that did work. In this way, going outside of the scope of an idea has a positive effect and you move forward and develop new ideas; but you have to ignore certain things to do that.

My thought about this had been more on the lines of how general ideas have to smear (or ignore) too many details to be really useful – that they lack the complexity of specificity (we have to smooth our data to make sense of brain imaging experiments).  Potentially this prejudice of mine comes from a belief that every moment is unique and it requires a unique specific assessment. Does science in a sense require a general idea, a concept that can be applied universally, and art require a specific one?

I asked Chris how would one define metacognition? He told me it is thinking about thinking; that you have cognitive processes doing the computational thinking, making decisions etc., and then the metacognitive processes that monitor and control these lower level cognitive computational processes. In the 1970s there was an influential theory of consciousness (due to Tim Shallice), which said that consciousness is basically all metacognition. The unconscious activity that is going on is being monitored but it is only when something goes wrong that a signal occurs that tells you that you have to consciously do something to correct it.

Chris told me of “a very beautiful experiment” that demonstrates this. In cognitive psychology a favourite experimental task is one of reaction time. One is given signals and has to respond as quickly as possible to them. There is often a choice, so there is more than one signal. In the reaction time there is something called post error slowing – if you make an error, on the next trial, in order to correct it, you'll be slower when you reach the point of the error to respond to the stimulus. This demonstrates the process of metacognition, in that one has been monitoring the performance and noticed an error and then one slows down to stop it happening again.

Chris then outlined the beautiful experiment with expert typists. In this experiment they would hear a word in their headphones and then type it as quickly as possible – they occasionally made mistakes, which they can then see on the screen. (The designers of this experiment took an idea from Descartes when he described his experiences as being possibly due to an evil Demon putting ideas into his mind). The experimenters acted as this evil Demon in that when the typist typed an incorrect letter it sometimes it appeared as correct but other times when the typist typed the correct letter an incorrect letter appeared on the screen. What was discovered was that the typists only slowed down when it was a real error (their own error) and they didn't slow down if it was an error generated by the computer, but if you asked them after each word “did you make a mistake?” they were completely fooled by the evil Demon as they would think that they had made a mistake where they hadn’t. That clearly showed that one has a low-level metacognitive process that is producing the slowing which people are not aware of and that the higher level, which they are aware of, is actually misleading.

So you have then to consider implicit metacognition and explicit metacognition. By definition it is the explicit metacognition that we are aware of that is extremely unreliable and easily modified by social context. Yet the implicit metacognition is more silent but more precise/reliable.

In another experiment the subjects are shown two packs of cards of human faces from which they have to choose which face of the two they prefer. The experimenter then gives them the card they have just chosen and askes why they liked it., But the experimenter is an expert magician and sometimes he switches the cards by sleight of hand. He shows the subject the face that she didn't prefer instead of the one that was preferred and 75% of the time people don't notice this switch and they proceed to explain why they chose that face over the other. This is an example of how consciousness works to justify our behaviour even erroneously; that is, to convincingly explain away something we didn’t even do.
 
Chris turned to the filter again in relation to these experiments and the experience of schizophrenia. He explains how the top down effect of metacognition gives us the sensation of an intention but if this process was to operate without a filter (a hierarchy of attention is how I think of this) one will not know what to attend to in the onslaught of sensory and semantic information.

Chris told me: if something is wrong with this explicit metacognition, if it fails to function, patients not only have difficulty in explaining to others what they are experiencing, which is essentially creating a coherent story about what's going on, they actually have difficulty in even explaining to themselves what's happening.
With a lack of filtering one cannot define what is important and what is irrelevant.

I am interested in this idea that we need to create coherent narratives in order to stick everything together. I had read texts by the psychologist Peter Barham, transcriptions of patients in conversation about various ideas to do with daily life. These created extraordinary worlds with incommensurate ideas in an ever extending narrative, which drifts far from what is possible or probable.

Chris suggested that patients are not constrained by what other people think of what they are saying. We are affected by the ideas of other people, so in speaking we are concerned that a narrative will be plausible and believable by others.  If you are living in a society with very strongly held religious beliefs, for example, you need to tell a narrative that is going to fit with that. With the patient, that constraining element does not seem to happen, but they are just as good at rationalizing and creating their own internal logic.

I explained I am interested in this idea that the body sends out a number of signals/ feelings, which the mind then tries to create a narrative for – in order to explain or give a cause for the embodied experience (“ I am feeling like this because of this”). How correct are these effect and cause tales?

Chris spoke of a study in Edinburgh of people at risk of suffering from schizophrenia. If relatives/parents etc. already have schizophrenia, the risk of contracting the condition raises from 1% to 20%. The study considered people who were at risk but who had not yet suffered from a psychotic episode. These people often reported having funny ideas, but said that they knew that these were nonsense. Of those that then subsequently did fall into psychosis, after the breakdown they had the same ideas, but now believed them to be true. So it's not so much what the ideas were in themselves that are different but the belief in them. It is as if a belief turns into a perception..

I described an account that I read in which I was surprised how clear the author was, how well she could recount and recall a psychotic episode. I think I expected the mind to hide its aberrations to protect the subject when well. She describes that when the psychosis became very intense she would tell how she had killed thousands of babies and eaten foetuses, etc. In her relationship to her psychotherapist she felt she had permission to say all the terrible things that she felt without rejection. She would take a knife with her and threaten to kill her doctor. She could walk down a very dark road in therapy and it allowed her to expunge something. She claimed that it was impossible for her to do the violent things she described.

Chris and me talked a little about how occasionally schizophrenics do these violent things. I mention Richard Dadd, but this rare occurrence has had an overwhelming influence on how the condition is perceived. It’s a problematic subject – I need to think more about this. We talked about restraint. Recent laws have limited ‘facedown’ restraint in mental health incidences due to resultant deaths from this technique. I wonder how much restraint has really altered in institutions.

My thoughts turned to a cartoon in one of Chris’s books that shows a psychologist holding a Smartie tube and asking an autistic child what is in the tube – the child answers “Smarties” but he shows him that there are pencils in the tube. When another child comes into the room the psychologist asks the autistic child what will the second child say if I ask him what is in the tube and first child replies “pencils”, but, of course, when she asks the second, neurotypical child he says “Smarties”. Chris tried a version of this experiment on one of his long-term patients who had a diagnosis of schizophrenia but instead of showing a Smartie tube he showed him a packet of cigarettes and said “what is in here?” He was supposed to say “cigarettes” but instead he said “a tape recorder”…

I turned to a new subject – I said I am really very interested in the fact that Chris had said to me that he didn’t have visual representations in his memory, but instead his memories  were constituted of pure information. I explain how I am trying to conceive how thought is represented in consciousness, the aspects of abstraction or non-representation that are implied by Chris’s non-visual recall. In principle I would like to focus on the idea of perception without representation. 

I asked how him “how do you perceive memory? If you recall something, how is it being played back to you?” Chris said “played back” is the wrong metaphor because the memory is actually being constructed. He explains that there is an acquisition phase and then a storage phase and then a retrieval phase. You could say that at the acquisition phase the retrieval phase seems to recapitulate the acquisition phase. If the acquisition phase is for visual information then there is going to be activity in the visual parts of the brain to reconstruct the memory and the amount of activity in the visual part of the brain depends on how you re-remember the moment subsequently. Probably the information is not all stored in the visual parts of the brain, so when you retrieve it other bits of the brain reactivate to complete the information. This is a reconstructive process that might not always work properly. So in a sense, something in the brain (probably the hippocampus) has to collect all these bits of disparate information and put them together correctly. People with damage to the hippocampus cannot recall the past, but the outcome of this is that they also cannot imagine the future (the work of Eleanor Maguire). This is because we use the same process in constructing what might have happened in the past as we do to construct what might happen in the future, in the light of that past construction. Memory is constructive, which is why it is easy to implant false memories in people.
 
I said that I have read that in recall different parts of the brain are called upon each time, altering the reconstruction. Chris agreed that the memory gets reconstructed each time it is recalled but didn’t know where the idea of the different parts of the brain involved comes from. (I am unsure now if this was the book Pieces of Light, or where I got the idea.)

I spoke of the sensation of memory. I recounted how Chris told me that he thinks his first memory is of his mother bending down sweeping with a dustpan and brush and I asked if he sees the shape of her body and colours of her dress, the form of the brush? Chris told me it is pure information. I cannot understand what that information is without the image. He said he feels it as an action. “Do you feel it embodied?” I asked. He said, “I feel her doing it.” “Do you hear it?” I asked. He said, “I have a vague sense of the room.” 

In Pieces of Light the author mentions a sense of location and he states that memory is not about time but about location. This is something that I can notice in my dreams and also in my life through introspection – that I’m aware of a field of space that I am occupying. It is easier to introspect dreams than reality. I notice that I am seeing when seeing is necessary but I am feeling a lot; that is what pervades the dream, but I also know the parameters and shape of the space. The feeling is shaping everything that is at the centre.
 
I thought perhaps it's useful to think of a blind person’s conception of space. I also realized that if I tell my life story there are very few images – sometimes they are facts of an event but I couldn’t tell you who was there in the custody courtroom, for example, or what actually happened, just that I had to choose a parent and I changed my mind at the last moment.

We spoke about ketamine as he had taken it under a controlled experiment (it is supposed to induce something similar to the experience of psychosis in schizophrenia). Chris explained how under the influence of ketamine the space was very disrupted. I asked if he felt he couldn't move through the space. He described how there was no space between things that were spread out in space but he also had no conception of a space behind him. But his mobility was constrained in the experiment by the intravenous drip etc. and he felt unsure what would have happened if he had been asked to move: perhaps the space would open as he moved through it. Chris mentioned Paul Fletcher in Cambridge who is doing experiments with ketamine. (I would like to try it, in order to know something about what it would be like to have psychosis.) 

Chris told me of a paper he wrote with Paul Fletcher called 'Seeing is believing'. I resolved to read this. Paul Fletcher has a video of Chris under ketamine – this also seems like something I should see! I ask what the conclusions of the experiment were and Chris stated that Paul Fletcher has published a few studies on it.
Chris felt convinced that the experiments with ketamine did represent what happens in the early stages of schizophrenia.

We return to preconceptions based on prejudices. Chris stated that we may in fact need to have firm prejudices as the world is so full of ‘noise’. If you can have realistic expectations of what is going to happen in relation to these preconditions or prejudices, and are also be able to distinguish between something happening you did not expect because your prejudice is wrong or that if it is not as you expected (or could have predicted) – it was simply because the world is full of random noise – then it offers stability to your world view. It is an advantage if you have quite strong prejudices to prevent you going off on a tangent by not discounting the random noise (hence promoting integration rather than disintegration).

Notably ketamine seems to reduce your faith in your prejudices, which can be uncomfortable. I asked if this can be very creative? Chris said they would call it “imprecision of your priors”. I mentioned the executive decision making in the concept of metarepresentation (this is a problematic term for Chris now and one which he tries to avoid) that was criticised by Peter Barham: was Chris still interested in this idea of a kind of executive committee in decision making? He said he was, but wonders if there is much conscious control in metacognition.

Chris mentioned ‘point light walkers’ which is an image of a human made with about nine lights positioned at major joints. He explains that the points of light change clearly when they are generated from a man or a woman, as you can immediately see from the movement which gender it is. This is also called biological motion. He mentions a website of Troje in Canada. He tells me you can dress up these points of light with clothes etc, but users say that the points of light alone are the most realistic rendition of movement.

I explained that I want to know if the virtual has any significant impact on brain functioning as opposed to lens-based imagery or actual objects. What is the difference between perceiving a clearly synthetic reality as opposed to a lens-based one? I suggested there is implicitly and explicitly a metanarrative in the artificial world. The lens however, has become even closer to reality in the backwash of the virtual because of the more modified world of computer animation. Photography is potentially treated even more as a window and less as a construct, in some contexts(?).

Chris spoke of a Japanese roboticist (that oddly also turned up some days later in a performance lecture I saw in Canterbury – a video of an interview of him and his avatar). Chris emphasised how creepy the robots are. Chris talked of brain activity mapped in relation to viewing three characters: these were a TV presenter, an android of the TV presenter and version of the android TV presenter, but in this case with all the wires showing. The android version showed the most activity in the brain because of the prediction error it evoked, resulting from the figure looking like a person but behaving like a machine. In the uncanny valley theory the object that looks closest to reality, but not quite, is the most uncanny,

I spoke of the low-tech quality avatars originally being used in avatar therapy and how I am curious about how ‘unconvincing’ they are (also the rubber hand Anil has been using as being a joke shop hand). I query whether being more real would be more intense – more effective. But Chris suggests (in relation to the uncanny valley theory) that the old fashioned virtual reality for avatar therapy could be easier to assimilate than a more hyper-real version.

I spoke of child abuse as a major factor for schizophrenia  (Chris not convinced by this connection). Chris says that he would define it as less to do with abuse but more to do with 'volatile environments', i.e difficult to predict. I expressed a desire to bring together the different camps of thought on schizophrenia in a seminar.