Mental health meets computational neuroscience: A predictive Bayesian account of the relationship between interoception and multisensory bodily illusions in anorexia nervosa

Mental health disorders pose a significant challenge to society. The Bayesian perspective on the mind offers unique insights and tools that may help address a variety of mental health conditions. Psychopathological dysfunctions are often connected to altered predictive and active inference processes, in which cognitive and physiological pathogenic beliefs shape the clinical condition and its symptoms. However, there is a lack of general empirical models that integrate cognitive beliefs, physiological experience, and symptoms in healthy and clinical populations. In this study, we examined the relationship between altered predictive mechanisms, interoception, and pathological bodily distortions in healty individuals and in individuals suffering from anorexia nervosa (AN). AN patients (N=15) completed a Virtual Reality Full-Body Illusion along with interoceptive tasks twice: at hospital admission during an acute symptomatological phase (Time 1) and after a 12-week outpatient clinical weight-restoring rehabilitative program (Time 2). Results were compared to a healthy control group. Our findings indicated that higher levels of interoceptive metacognitive awareness were associated with a greater embodiment. However, unlike in healthy participants, AN patients' interoceptive metacognition was linked to embodiment even in multisensory mismatching (asynchronous) conditions. In addition, unlike in healthy participants, higher interoceptive metacognition in AN patients was related to prior abnormal bodily distortions during the acute symptomatology phase. Prediction errors in bodily estimates predicted posterior bodily estimate distortions after the illusion, but while this relationship was only significant in the synchronous condition in healthy participants, there was no significant difference between synchronous and asynchronous conditions in AN patients. Despite the success of the rehabilitation program in restoring some dysfunctional patterns in the AN group, prediction errors and posterior estimate distortions were present at hospital discharge. Our findings suggest that individuals with AN prioritize interoceptive metacognitive processes (i.e., confidence in their own perceived sensations rather than their actual perceptions), disregarding bottom-up bodily inputs in favour of their prior altered top-down beliefs. Moreover, even if the rehabilitative program partially mitigated these alterations, the pathological condition impaired the patients' ability to coherently update their prior erroneous expectations with real-time multisensory bottom-up bodily information, possibly locking the patients in the experience of a distorted prior top-down belief. These results suggest new therapeutic perspectives and introduce the framework of regenerative virtual therapy (RVT), which aims at utilizing technology-based somatic modification techniques to restructure the maladaptive priors underlying a pathological condition.

On `Just Not Getting It'

McNamee (2003) and Raskin and Neimeyer (2003) largely bypass my analysis (Mackay, 2003) of the uses and misuses of `meaning' in psychotherapy, and of why the philosophy of the meaning-makers has no implications for therapy, tolerant or otherwise. They focus on my critique of constructionism and constructivism. Their responses repeat rather than address errors of which I criticized constructionism/ivism. Justifications of discourse pluralism end either in self-contradiction or in infinite regress. They ignore this and multiply their difficulties by treating rationality and logic as discourse-specific and optional. They neither `bridge incommensurate discourses' nor offer a `coherent constructivism'. Further, they identify me with a `familiar realism' of their own construction, misattributing to me such doctrines as foundationalism, essentialism, absolutism and belief in transcendent reality. Raskin and Neimeyer, in particular, compound these misconstructions by misrepresenting and distorting my terms and phrases. Thus they undermine their claims to both the epistemic and practical tolerance.

Bridging Incommensurate Discourses

Mackay (2003) argues that the meaning-making literature places an emphasis on meaning from a `meaning as salience' perspective, which he claims constructionists use, illogically, to support an anti-realist view. In response, first, this article attempts to articulate language (from a constructionist stance) as an engaged activity, not a tool used to talk about the world. It is the discursive emphasis on language as an activity, as opposed to the semiotic emphasis on linguistic systems as a means through which we obtain knowledge, that positions constructionists differently vis-à-vis issues of truth, reality, meaning and objectivity. Second, this article attempts to perform constructionism-in-action by offering a way to bridge incommensurate discourses in such a manner that we can create meaningful and useful ways of going on together.

Coherent Constructivism

In this article we outline a response to Mackay's (2003) critique of constructivism as anti-realist, anti-determinist and anti-scientific. We argue that Mackay and constructivists operate from very different theoretical premises. Whereas Mackay sees his philosophical bases as foundational absolutes, constructivists see theirs (as well as Mackay's) as postulated premises. Thus, Mackay's theoretical assumptions, in combination with his construction of a `straw figure' version of his opponents, lead him to see constructivism as incoherent. However, this tells us more about Mackay's point of view than it does about constructivism's coherence. In our view, constructivism is not hostile to scientific discourse, and, indeed, converges at important points with Mackay's own treatment of `experiential meaning'. Ultimately, however, constructivists attempt to stretch the boundaries of permissible scholarly discourse beyond the realist bases advocated by Mackay, in order to analyze and critique the social epistemology by which both psychotherapeutic and scientific processes are constructed.

Unifying Psychology through Situational Realism

We propose that a coherent and thoroughgoing version of realism, known as situational realism, offers a unifying program for psychology. This realism emerges from the conditions of being that enable knowledge and discourse. Because this research originated largely in a century's work by Australian psychologists and philosophers, we will introduce and explain research and vocabulary that might be unfamiliar to some readers. The approach is characterized by seven themes: ontological egalitarianism; situational complexity and process orientation; a network or field view of causality; a realist logic; a view of relations as nonconstitutive; an externalist relational approach to mind; and acceptance of critical inquiry as the core scientific method. The combination of these features offers psychology the following: a metatheoretical framework that resolves current tensions; expansion into the field of meanings and reintegration with hermeneutics and semiotics; clarification and redirection of mainstream cognitive neuroscience and information processing; an integrative approach to personality; expansion, redirection and unification of psychological research methods; and revision and expansion in psychological practice and teaching.

Deconstructing theory: Towards an ethical therapy

Over the last two decades theorists and therapists have explored and consolidated discursive and relational approaches to therapy based on social constructionist, dialogic, and narrative thinking. Meanwhile in mainstream psychology and psychiatry a modern scientific-realist epistemology prevails. While these two paradigms are diametrically opposed in theory, they are often required to be juxtaposed in practice, especially for therapists working in mainstream mental health services. The paper addresses this theory and practice dilemma of how therapists can work in both therapy paradigms at once. This is illustrated by practice examples, including teaching relational therapy to psychologists trained as scientist practitioners and applying integrative family therapy with depressed and suicidal adolescents. Drawing on Derrida and Levinas I present an ethical practice model called paramodern therapy. By deconstructing theory an ethical and integrative therapy is possible, one which engages with modern approaches while taking on board discursive, narrative, or social constructionist metaphors.

John Anderson's development of (situational) realism and its bearing on psychology today

In 1927, the Scottish philosopher John Anderson arrived in Australia to take up the chair of Philosophy at the University of Sydney. By the late 1930s, the "macrostructure" of his realist system was in place. It includes a theory of process and a substantial metaphysics, one that opposes positivism, linguistic philosophy and all forms of idealism. However, beyond Australia it remains largely unknown, despite its bearing on a number of current issues in psychology and the social sciences generally. This article outlines Anderson's transition from Hegelian idealism to realism, describes aspects of his ontology and epistemology, compares some of Anderson's ideas with Dewey's pragmatism and explains their relevance to present-day psychology.

`Mind as Feeling' or Affective Relations?

Andersonian realism is a determinist, empiricist position that acknowledges the important distinction between qualities and relations. However, Anderson's `mind as feeling' thesis, proposing that the mind's qualities are emotional, is problematic since it fails to account for `feelings' themselves. O'Neil's (1934) alternative relational account of affects, in conjunction with Maze's (1983) theory of instinctual drives, provides a coherent platform for developing a comprehensive realist account of affects. In discussing the relation between affects, cognition and motivation, affects are viewed as drive-evaluative phenomena, and `feelings' are known bodily states arising in conjunction with motivationally driven environmental evaluations. The role that affects play in a revised desire/belief model of behaviour explanation is discussed.