Thought insertion is defined by the ICD-10 as the delusion that one's thoughts are not one's own, but rather belong to someone else and have been inserted into one's mind. The person experiencing the thought insertion delusion will not necessarily know where the thought is coming from, but makes a distinction between their own thoughts and those inserted into their minds. However, patients do not experience all thoughts as inserted; only certain ones, normally following a similar content or pattern. A person with this delusional belief is convinced of the veracity of their beliefs and is unwilling to accept such diagnosis. Thought insertion is a common symptom of psychosis and occurs in many mental disorders and other medical conditions. However, thought insertion is most commonly associated with schizophrenia. Thought insertion, along with thought broadcasting, thought withdrawal, thought blocking and other first rank symptoms, is a primary symptom and should not be confused with the delusional explanation given by the respondent. Although normally associated with some form of psychopathology, thought insertion can also be experienced in those considered nonpathological, usually in spiritual contexts, but also in culturally influenced practices such as mediumship and automatic writing. Some patients have also stated that at some point in time they were being manipulated by an exterior or interior force (depending on the delusion that the patient faced) and only later realized that thoughts weren't theirs; this is linked to patients "losing control" of what they do.
Unbidden thoughts Unbidden thoughts are thoughts that come to mind without the subject directly or consciously meaning to think them. Inserted thoughts, while sharing the characteristic of unconsciously or indirectly being conjured, are distinct from unbidden thoughts because of the author of the thoughts. During an experience of unbidden thinking, the subject knows that they are the author of the thought even though they may not have consciously meant to think it. During the feeling of thought insertion, however, the subject feels as though the thought belongs to another person and was inserted into their own mind, making the author of the thought someone other than themselves.
Auditory verbal hallucinations Auditory hallucinations have two essential components: audibility and alienation. This differentiates it from thought insertion. While auditory hallucination does share the experience of alienation (patients cannot recognize that the thoughts they are having are self-generated), thought insertion lacks the audibility component (experiencing the thoughts as occurring outside of their mind or spoken to them). Thus the person experiencing thought insertion recognizes that the thought is being thought of inside their mind, but fail to recognize they are the one thinking it.
Examples Examples of thought insertion: She said that sometimes it seemed to be her own thought 'but I don't get the feeling that it is'. She said her 'own thoughts might say the same thing', 'but the feeling isn't the same', 'the feeling is that it is somebody else's.'I look out the window and I think that the garden looks nice and the grass looks cool, but the thoughts of Eamonn Andrews come into my mind. There are no other thoughts there, only his. He treats my mind like a screen and flashes thoughts onto it like you flash a picture.The subject has thoughts that she thinks are the thoughts of other people, somehow occurring in her own mind. It is not that the subject thinks that other people are making her think certain thoughts as if by hypnosis or psychokinesis, but that other people think the thoughts using the subject's mind as a psychological medium.
Theories
Standard approach The "standard approach" is characterized by a lack of sense of agency. Most philosophers define a sense of agency as a subject's awareness that they are initiating or controlling one's own actions. According to standard approach theory, the subject does not have an awareness that they are the initiators of a thought, but they do recognize that they own the thought in that it exists within their own mind. Many have argued that the standard approach does not explain the details and the unusual pathology behind thought insertion. Typically, critiques argue that this account fails to provide a reason that distinguishes inserted thoughts from either ordinary thoughts that the subject did not deliberately try to conjure (unbidden thoughts) or other thoughts that are thought to be controlled by forces outside of the subject. As a result, other theories of thought insertion have been proposed in order to try to explain the complexities behind the phenomenon.
Causal-contextual The causal-contextual theory of thought insertion focuses on a lack of a feeling of ownership. This theory differs from the standard approach because rather than explaining thought insertion by saying the subject lacks a sense of agency, this model explains thought insertion by theorizing that the subject lacks a sense of ownership, which in turn creates a lack of agency. Patients with schizophrenia are hypothesized to have a generalized deficit in their integration of information, illustrated through the many other symptoms of schizophrenia and psychosis. According to causal-contextual theory, sense of ownership depends on integrating causal-contextual information, and a deficit in this process accounts for the abnormal experience of thought insertion. This model has come under criticism due to its definition of sense of ownership. In philosophy, a sense of ownership is defined as a thought that occurs within the space of one's own mind. However, in the causal-contextual model of thought insertion, sense of ownership is defined as feeling as if a thought belongs to the person thinking it. Because of this distinction, many (e.g. Seeger, Coliva) argue that the causal-contextual model is not a separate model of thought insertion, but rather a corollary of the standard approach.
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