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Real Hallucinations: Psychiatric Illness, Intentionality, and the Interpersonal World
A philosophical account of the structure of experience and how it depends on interpersonal relations, developed through a study of auditory verbal hallucinations and thought insertion.
In Real Hallucinations, Matthew Ratcliffe offers a philosophical examination of the structure of human experience, its vulnerability to disruption, and how it is shaped by relations with other people. He focuses on the seemingly simple question of how we manage to distinguish among our experiences of perceiving, remembering, imagining, and thinking. To answer this question, he first develops a detailed analysis of auditory verbal hallucinations (usually defined as hearing a voice in the absence of a speaker) and thought insertion (somehow experiencing one's own thoughts as someone else's). He shows how thought insertion and many of those experiences labeled as "hallucinations" consist of disturbances in a person's senseof being in one type of intentional state rather than another.
Ratcliffe goes on to argue that such experiences occur against a backdrop of less pronounced but wider-ranging alterations in the structure of intentionality. In so doing, he considers forms of experience associated with trauma, schizophrenia, and profound grief.
The overall position arrived at is that experience has an essentially temporal structure, involving patterns of anticipation and fulfillment that are specific to types of intentional states and serve to distinguish them phenomenologically. Disturbances of this structure can lead to various kinds of anomalous experience. Importantly, anticipation-fulfillment patterns are sustained, regulated, and disrupted by interpersonal experience and interaction. It follows that the integrity of human experience, including the most basic sense of self, is inseparable from how we relate to other people and to the social world as a whole.
In Real Hallucinations, Matthew Ratcliffe offers a philosophical examination of the structure of human experience, its vulnerability to disruption, and how it is shaped by relations with other people. He focuses on the seemingly simple question of how we manage to distinguish among our experiences of perceiving, remembering, imagining, and thinking. To answer this question, he first develops a detailed analysis of auditory verbal hallucinations (usually defined as hearing a voice in the absence of a speaker) and thought insertion (somehow experiencing one's own thoughts as someone else's). He shows how thought insertion and many of those experiences labeled as "hallucinations" consist of disturbances in a person's senseof being in one type of intentional state rather than another.
Ratcliffe goes on to argue that such experiences occur against a backdrop of less pronounced but wider-ranging alterations in the structure of intentionality. In so doing, he considers forms of experience associated with trauma, schizophrenia, and profound grief.
The overall position arrived at is that experience has an essentially temporal structure, involving patterns of anticipation and fulfillment that are specific to types of intentional states and serve to distinguish them phenomenologically. Disturbances of this structure can lead to various kinds of anomalous experience. Importantly, anticipation-fulfillment patterns are sustained, regulated, and disrupted by interpersonal experience and interaction. It follows that the integrity of human experience, including the most basic sense of self, is inseparable from how we relate to other people and to the social world as a whole.
- GenresPhilosophy
304 pages, Hardcover
First published September 22, 2017
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January 2, 2021
Ratcliffe has identified a very interesting question. I haven't encountered anything like it before. Moreover, it seems to yield potent directions of thought and research for understanding the mind. The question is: How do we tell whether something that shows up in our field of awareness is a state of perception, imagination, memory, or belief?
It is usually so obvious which kind of intentional state we are in that we don't notice that this is a question that can be asked. For example, when I am at the sea and see a huge wave crash onto the shore -- or when I am laying in bed at night and imagining the sea -- it is obvious, or built into these experiences themselves, that they are respectively a perceptual state and an imaginative state. It doesn't cross my mind that there might be causal factors or processes that enable this state to be registered as perceptual or imaginative.
Ratcliffe argues for a fascinating account of these causal factors behind our discrimination between different kinds of intentional states. He arrives at it by examining thought insertions and verbal hallucinations, two kinds of experience that are often labeled as psychotic and that are associated with the diagnosis of 'schizophrenia.' According to Ratcliffe, our lives consist in our inhabiting different realms of phenomenological experience that each correspond with a kind of intentional state (e.g., perception, imagination, memory). Perception provides our most basic realm of meaning, and the contents of other kinds of intentional states are derived from perceptual states. Perception discloses to us not just visual properties, but also meaning and significance. This meaning is typically social and cultural in character; it is based in social conventions and norms. Our perceptual experiences arrive at their baseline states over our developmental histories of interacting with other people who affirm, correct, or clarify our meanings.
Ratcliffe argues that our capacity to tell whether an experiential state is a perceptual one depends on our recognition of a characteristic "anticipation-fulfillment" pattern that structures the state. In all experiences, we can intuitively anticipate what might happen next, and as the experience unfolds, it might fulfill our anticipation or fail to. In perceptual experiences, for example, we typically anticipate that the objects of perception are enduring or undergo continuous changes, and that we can physically interact with them. In contrast, in imaginative experiences, we typically anticipate that we can make objects of imagination vanish by directing our attention elsewhere.
Ratcliffe argues that the anticipation-fulfillment pattern of perception is regulated by our social relations. Healthy normal people generally trust other people; they anticipate that most other people are cooperative and not harmful. They do not anticipate that everyone is malicious and out to injure them. The 'world' at large (i.e., the collection of all the places in which we find ourselves on an everyday basis) is built on interests, projects, and infrastructure that we and other people conduct. So general trust in others allows for a trust in the world that surrounds one.
But this primitive trust can be shattered. This can happen in cases of extreme socially-induced trauma (e.g., being tortured by another person). It can also happen if one has some predispositions that make severely alienated from society. According to Ratcliffe, when this trust is lost, the anticipation-fulfillment pattern of perception is altered. It turns out that the reliability and stability of objets of perception (or at least the meanings of objects - a qualification that Ratcliffe should've made, I think) is dependent on our trust in the sociocultural meanings of objects. There are general sociocultural consensuses on the meanings of objects, and when we interact with other people, they can help ensure that the meanings we end up perceiving are close to that standard.
When one loses this primitive trust, these sociocultural standards of the meanings of objects are no longer accessible. It is not that one is aware of the standards and chooses to deviate from them; rather, one is so alienated from society and lost in one's own world that one is totally oblivious to the very existence of those standards. When one encounters anomalies in perception, one cannot recognize them as anomalies; there is no standard that exists against which these perceptual features can be counted as anomalous. Over development, the baseline anticipation-fulfillment pattern of perception transforms; objects of perception no longer are encountered as reliable and stable. Instead, this pattern comes to resemble that of imagination and memory.
Our recognition of an experiential state as one of imagination or memory depends on the anticipation-fulfillment pattern of that state deviating from that of perception, the baseline. When perception is altered in this way, one can no longer tell whether one is imagining or remembering. This is not to say that one is in a homogeneous experiential state all of the time. There are still ideal features of each kind of state that might be recognizable by one. But the states that one undergoes can come to possess ideal features across perception, imagination, and memory. Experiential states can be ambiguous and incomplete, not being quite perception or imagination, for example.
Ratcliffe uses this account to explain the phenomenology of thought insertions and verbal hallucinations (chapters 3 and 4). He also uses it to explain the phenomenology of more 'everyday' kinds of hallucinations, such as hallucinations that many people in bereavement experience (e.g., a deceased loved one caressing one's hand or speaking) (chapter 7). He even uses it to make a case that philosophy, as a discipline, should reconsider its conceptions of belief and knowledge (chapter 8).
I love the core idea in this book. The question Ratcliffe asks, and his account as a response, are very unusual, plausible, and helpful for the questions I care most about (surrounding the differences between perception and language use, and the question of how it is possible for language to change perceptual experience). There are two drawbacks of the book, however. First, it is organized weirdly. Ratcliffe presents his account only in chapters 5 and 6. These two chapters can stand alone, and reading them first might be more effective.
Second, Ratcliffe's writing and style of philosophical analysis isn't always the best. Overall, he is not precise in his claims; he often relies on vague causal terms such as "influence" or "impact" when describing the relations between key concepts of his account. He also doesn't define his terms very carefully. For example, "anticipation-fulfillment patterns" is a foundational concept to his account, and yet he defines it merely by example. His writing leaves it open to interpretation what it means for some systematic reoccurrence of anticipations and fulfillments to be a pattern that structures a kind of intentional state. He also fails to make explicit which patterns are definitive of which kinds of intentional state. Overall, I wish that Ratcliffe could've gone more in-depth in the substance of his account (in those two chapters), and spent less time talking about peripheral material (spread across the other five chapters).
I am excited to see this new way of thinking about the nature of different kinds of intentional state. I've been dissatisfied with the ways philosophers typically treat this matter; there is a history of "faculty psychology," or assuming that there are distinct faculties in the mind (e.g., of perception, imagination, belief) which yield distinct kinds of states. This has seemed wrong to me; many of our experiential states include a potpourri of features that are typically associated with different faculties. Also, how should we think about the experiential states that we have when we use language? Sometimes those states can seem more perceptual, and other times they are more imagination-like.
Ratcliffe has offered a nice way into thinking about this matter. We should think about experience as presence, or as things showing up to us in our field of awareness. There are ideal structures of presence that can be associated with different 'faculties'; but our experiences rarely meet these ideal forms. Moreover, it is wonderful how Ratcliffe shows that intersubjectivity and community plays such a central role at this foundational level of experience -- social interactions can impact whether a state is perceptual or imaginative, and whether we can even have experiences that meet these ideal forms at all.
It is usually so obvious which kind of intentional state we are in that we don't notice that this is a question that can be asked. For example, when I am at the sea and see a huge wave crash onto the shore -- or when I am laying in bed at night and imagining the sea -- it is obvious, or built into these experiences themselves, that they are respectively a perceptual state and an imaginative state. It doesn't cross my mind that there might be causal factors or processes that enable this state to be registered as perceptual or imaginative.
Ratcliffe argues for a fascinating account of these causal factors behind our discrimination between different kinds of intentional states. He arrives at it by examining thought insertions and verbal hallucinations, two kinds of experience that are often labeled as psychotic and that are associated with the diagnosis of 'schizophrenia.' According to Ratcliffe, our lives consist in our inhabiting different realms of phenomenological experience that each correspond with a kind of intentional state (e.g., perception, imagination, memory). Perception provides our most basic realm of meaning, and the contents of other kinds of intentional states are derived from perceptual states. Perception discloses to us not just visual properties, but also meaning and significance. This meaning is typically social and cultural in character; it is based in social conventions and norms. Our perceptual experiences arrive at their baseline states over our developmental histories of interacting with other people who affirm, correct, or clarify our meanings.
Ratcliffe argues that our capacity to tell whether an experiential state is a perceptual one depends on our recognition of a characteristic "anticipation-fulfillment" pattern that structures the state. In all experiences, we can intuitively anticipate what might happen next, and as the experience unfolds, it might fulfill our anticipation or fail to. In perceptual experiences, for example, we typically anticipate that the objects of perception are enduring or undergo continuous changes, and that we can physically interact with them. In contrast, in imaginative experiences, we typically anticipate that we can make objects of imagination vanish by directing our attention elsewhere.
Ratcliffe argues that the anticipation-fulfillment pattern of perception is regulated by our social relations. Healthy normal people generally trust other people; they anticipate that most other people are cooperative and not harmful. They do not anticipate that everyone is malicious and out to injure them. The 'world' at large (i.e., the collection of all the places in which we find ourselves on an everyday basis) is built on interests, projects, and infrastructure that we and other people conduct. So general trust in others allows for a trust in the world that surrounds one.
But this primitive trust can be shattered. This can happen in cases of extreme socially-induced trauma (e.g., being tortured by another person). It can also happen if one has some predispositions that make severely alienated from society. According to Ratcliffe, when this trust is lost, the anticipation-fulfillment pattern of perception is altered. It turns out that the reliability and stability of objets of perception (or at least the meanings of objects - a qualification that Ratcliffe should've made, I think) is dependent on our trust in the sociocultural meanings of objects. There are general sociocultural consensuses on the meanings of objects, and when we interact with other people, they can help ensure that the meanings we end up perceiving are close to that standard.
When one loses this primitive trust, these sociocultural standards of the meanings of objects are no longer accessible. It is not that one is aware of the standards and chooses to deviate from them; rather, one is so alienated from society and lost in one's own world that one is totally oblivious to the very existence of those standards. When one encounters anomalies in perception, one cannot recognize them as anomalies; there is no standard that exists against which these perceptual features can be counted as anomalous. Over development, the baseline anticipation-fulfillment pattern of perception transforms; objects of perception no longer are encountered as reliable and stable. Instead, this pattern comes to resemble that of imagination and memory.
Our recognition of an experiential state as one of imagination or memory depends on the anticipation-fulfillment pattern of that state deviating from that of perception, the baseline. When perception is altered in this way, one can no longer tell whether one is imagining or remembering. This is not to say that one is in a homogeneous experiential state all of the time. There are still ideal features of each kind of state that might be recognizable by one. But the states that one undergoes can come to possess ideal features across perception, imagination, and memory. Experiential states can be ambiguous and incomplete, not being quite perception or imagination, for example.
Ratcliffe uses this account to explain the phenomenology of thought insertions and verbal hallucinations (chapters 3 and 4). He also uses it to explain the phenomenology of more 'everyday' kinds of hallucinations, such as hallucinations that many people in bereavement experience (e.g., a deceased loved one caressing one's hand or speaking) (chapter 7). He even uses it to make a case that philosophy, as a discipline, should reconsider its conceptions of belief and knowledge (chapter 8).
I love the core idea in this book. The question Ratcliffe asks, and his account as a response, are very unusual, plausible, and helpful for the questions I care most about (surrounding the differences between perception and language use, and the question of how it is possible for language to change perceptual experience). There are two drawbacks of the book, however. First, it is organized weirdly. Ratcliffe presents his account only in chapters 5 and 6. These two chapters can stand alone, and reading them first might be more effective.
Second, Ratcliffe's writing and style of philosophical analysis isn't always the best. Overall, he is not precise in his claims; he often relies on vague causal terms such as "influence" or "impact" when describing the relations between key concepts of his account. He also doesn't define his terms very carefully. For example, "anticipation-fulfillment patterns" is a foundational concept to his account, and yet he defines it merely by example. His writing leaves it open to interpretation what it means for some systematic reoccurrence of anticipations and fulfillments to be a pattern that structures a kind of intentional state. He also fails to make explicit which patterns are definitive of which kinds of intentional state. Overall, I wish that Ratcliffe could've gone more in-depth in the substance of his account (in those two chapters), and spent less time talking about peripheral material (spread across the other five chapters).
I am excited to see this new way of thinking about the nature of different kinds of intentional state. I've been dissatisfied with the ways philosophers typically treat this matter; there is a history of "faculty psychology," or assuming that there are distinct faculties in the mind (e.g., of perception, imagination, belief) which yield distinct kinds of states. This has seemed wrong to me; many of our experiential states include a potpourri of features that are typically associated with different faculties. Also, how should we think about the experiential states that we have when we use language? Sometimes those states can seem more perceptual, and other times they are more imagination-like.
Ratcliffe has offered a nice way into thinking about this matter. We should think about experience as presence, or as things showing up to us in our field of awareness. There are ideal structures of presence that can be associated with different 'faculties'; but our experiences rarely meet these ideal forms. Moreover, it is wonderful how Ratcliffe shows that intersubjectivity and community plays such a central role at this foundational level of experience -- social interactions can impact whether a state is perceptual or imaginative, and whether we can even have experiences that meet these ideal forms at all.
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May 26, 2021What is so intensely irritating here is Ratcliffe’s conceited commitment to the idea that when all is said and done there is a confusion at the heart of the phenomena with which he is concerned, not of course his own grasp of them, his grotesque attempt to legislate what one may or may not intelligibly experience.
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