1Theory Of Mind

Dr (Maj) Ashutosh Ratnam

Resident Psychiatry

2 OVERVIEW

IntroductionDefinition & Vocabulary Theories of Theory of Mind (ToM) Development of a ToM

Tests Evaluating a ToM NeuroanatomyClinical Implications

3 INTRODUCTION“As humans we assume that others want, think, believe and the like, and thereby infer states that are not directly observable, using these states anticipatorily, to predict the behaviour of others as well as our own. These inferences, which amount to a theory of mind, are to our knowledge, universal in human adults” (Premack, D. G.; Woodruff, G. (1978). "Does the chimpanzee have a theory of mind?". Behavioural and Brain Sciences 1 (4): 515–526.

e.g. Chimpanzee shown a video of human encountering problems Video stopped before solution reached Chimp consistently chose picture depicting human solving

problem Interpretation : attributed mental state to actor

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When competing with others for food chimps take into account what the competitor can or cannot see/hear and even what he does/does not know • Conceal own approach to food

• No understanding of false beliefs • Performance did not improve despite

knowing competitor held a false belief

Hare B, et al (2001) Do Chimpanzees know what cospecifics know? Anim. Behav. 61, 139-51

5 INTRODUCTION Definition :The ability to

recognise that all people act on the basis of mental states or propositional attitudes (beliefs, desires, etc)

attribute mental states or attitudes to oneself and to others understand that others have beliefs, desires and intentions

different from one’s own

Premack, D. G.; Woodruff, G. (1978). "Does the chimpanzee have a theory of mind?". Behavioral and Brain Sciences 1 (4): 515–526.

“Theory of mind is being able to infer the full range of mental states (beliefs, desires, intentions, emotions etc) that cause action. Having a theory of mind is to be able to reflect on the contents of one’s own and other’s minds”

Baron-Cohen S, (2001) “Theory of Mind and Autism: a review”. J of Applied Research in Mental Retardation

6INTRODUCTION Meta-representation – internal/mental representation of ourselves

and others as conscious beings who mentally represent external reality

(Firth, 1992)

- Ability to represent someone else’s act of representing the world (Josef Pener)

Mentalising – the process of deploying a ToM to infer states of minds of others

(Langdon,R, Coltheart, M, 2001)

Intentional stance – intuitively understanding that the actions of others are goal-directed and arise from particular beliefs or desires

(Daniel Dennet, 1990)

Reflexive awareness – awareness of ourselves and others as thinking beings

7Theories of ToM

1. Theory-Theory

2. Simulation Theory a) Direct Matching

b) Inverse Modelling

c) Response Modelling

Theory-Theory ‘Folk’ psychological ability resting upon knowledge of a theory

Theory = “large no. of conditional statements, with the conjunction of explanatory factors as antecedents explanandum as consequence” A person who suffers bodily damage will feel pain A person who is denied food will feel hungry

Together, forms an integrated body of knowledge concerning law-like relations between external circumstances internal states overt behaviour

Churchland, P. M. (1991). Folk psychology and the explanation of human behavior. In: J. D. Greenwood (Ed.). The future of folk psychology. Cambridge: Cambridge University Press. 51–69.

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9Theory-Theory

Use constantly, unaware of laws of which it is composed → implicit/tacit

e.g. Person untrained in science knows just as well about food and hunger

Independent of knowledge of one’s own mind human psychology

Anyone who knows laws and propositions can form predictions and explanations

10Theory-Theory acquisition

1. Learned a) By implicit “teaching” through others

b) Learning step-by-step by living with/having social interactions with others

2. Innate a) If young children ‘construct’ a theory how do all come to same

theory by age four?

b) If “learnt from” adults, can it take place w/o explicit ‘teaching’?

c) If learnt how can it be invariant across cultures/historical eras? Carruthers, 1996

11Simulation-Theory

Use “resources of our own mind to simulate others”

1. Creation of pretend states to match those of target

2. Processing of ‘pretend states’ by same mechanisms used to understand own mental states

3. Assignment/projection of those states’ interpretations onto target

Goldman, A. (2005). Imitation, mind reading, and simulation. In S. Hurley, & N. Chater, Perspectives on Imitation II (pp. 80-81). Cambridge, MA: MIT Press.

12Mirror Neurons Neuron which fires both

when animal acts observes the an action

being performed by another animal

Humans Premotor Cortex Primary Somatosensory

area Inf Parietal Cortex Supplementary Motor

Area

13Mirror Neurons

Functions Empathy

Ant Insula, Ant Cingulate Cortex, Inf Frontal Cortex

Understanding actions & learning new skills by imitation

Simulating observed actions (ToM)

Interpreting intentions of other people

Coupling of perception & action

14Simulation-Theory

Direct Matching Hypothesis Mirror Neurons mimic state of target in the observer

Smiling, Anger, etc

Mirroring elicits similar emotion/intention in observer Implicitly/explicitly projected upon target

Inverse Modeling Hypothesis Mirror Neurons simulate intended goal of action first Observer then uses conceptual ability to infer intention of action

Response Modeling Hypothesis Mirror Neurons prepare complementary action in response to

target Dynamically couple action observation to action execution

Ontogenic aspects

6 months of age: Animate Vs inanimate12 months: Joint attention14-18 months: Senses direction of another’s gaze.18-24 months: Pretense (Decoupling of reality) 3-4 years: False beliefs in others 6-7 years: Jokes, Metaphors, Irony 9-11 years: ‘faux pas’.

16Development

1. Imitative Experiences with Other People

2. Understanding Attention in Others

3. Understanding Others’ Knowledge

4. Understanding Others’ Beliefs a) True Beliefs

b) False Beliefs

5. Understanding Others’ Intentions

Firth, CD (1992) The cognitive neuropsychology of schizophrenia. Hove, UK: Psychology Press

17Development 1. Imitative experiences with others

Precursor of perspective-taking and empathy

Recognition of equivalence between physical and mental states apparent in others and those felt in self

Construction of first-person experience Map the relation between mental experiences

and behaviour (facial gesture)

Infer about experiences of others On seeing others behave like himself, infer

that others have similar mapped mental state

Meltzoff, A. N. (2002). Imitation as a mechanism of social cognition: Origins of empathy, theory of mind, and the representation of action. In U. Goswami (Ed.), Handbook of childhood cognitive development (pp. 6-25). Oxford: Blackwell Publishers.

18Development

2. Understanding Attention

Skill formed at 7-9 months age

Understanding that Seeing can be directed selectively as attention Viewer assess a seen object as ‘of interest’ Seeing induces beliefs

Sharing → Following → Directing attention (Carpenter, Nagell & Tomasello 1998)

Attention can be directed and shared by pointing Taking into account other person’s mental state

(Baron-Cohen, S. (1991). Precursors to a theory of mind: Understanding attention in others. In A. Whiten (Ed.), Natural theories of mind: Evolution, development and simulation of everyday mindreading (pp. 233-251). Oxford: Basil Blackwell.)

19Development

3. Understanding Others’ Knowledge

Povinelli & de Blois (1992) 3yrs vs 4yrs old children ‘Hider’ – hid toy in 1 of 4 containers behind screen ‘Knower’ – saw hider placing toy ‘Guesser’ – left before hider placed toy

‘Knower’ and ‘Guesser’ guided/advised children where toy was 4yr olds always chose correct cups, 3yr olds inconsistent

20Development

O Neill (1996) • Child would watch toy being hidden

in cup/box • Parent would/would not be present • When asking parent for help with

retrieval • If not present – child significantly

more often named toy, named location, gestured location

Dunham, Dunham, & O‘Keefe (2000)• if the parent‘s eyes are covered at

an irrelevant point in the hiding process (before but not during the hiding), young 2-year-olds treat the parent as ignorant

21Development

4. Understanding Others’ Intentions

Meltzoff (1995) 18 month old children E attempted to pull an object away from another to which it is

attached, but failed Infant able to infer what action person tried to perform

Call, Tomasello (1998) 2-3 year old child Able to discriminate when E intentionally vs accidentally marked a

box as baited with stickers

22Development5. Understanding Others’ Beliefs

Begin to explain others’ behaviours based on beliefs at 3yrs age

Wellman & Bartsch, 1988Sam wants to find his puppy. The puppy might be hiding in the garage or under the porch. But Sam thinks the puppy is under the porch. Where will Sam look for the puppy: in the garage or under the porch?

Three-year-olds pass this test. 3-year-olds do badly on tests of false beliefs.

Neural areas in ToM

Temporal Pole

Dorsal medial PFC

Sup temporalSulcus

24Neuroanatomy – Temporal Pole aka Association cortex

Prefrontal Cortex (through Uncinate Process) Basal forebrain Visual / Auditory / Olfactory areas

Functions Emotional attachment to peers/infants Decoding/production of social signals Narrative Coherence Coding for personal memories

Representing social motives and appropriateness behaviour of others (rTPJ) Difficulty predicting how even familiar people behave in social/emotional

circumstances

Kaplan & Sadock, Comprehensive Text book of Psychiatry 9 th edition

25Posterior Sup Temporal Sulcus

Perception of biological motionMotion cues express social information (intent)

Gaze shifts, communicative gestures Heider-Simmel animations

Attribution of mental states even in absence of motion cues (trustworthiness)

?? Three distinct regions

1. Biological motion

2. Mentalize whether or not motion

cues are present Active vs passive movement

3. Mental states from motion cues More active when mvt is

incongruous

Kaplan & Sadock, Comprehensive Text book of Psychiatry 9th edition

26Medial Prefrontal Cortex Anterior-most part of paracingulate cortex

27Medial Prefrontal Cortex

Pain / Tickling / Autobigraphical Memory / Aestheic Judgement

↓ Attending to mental state giving rise to experience

Create a representation of what one thinks/feels Perspective taking Perception of Communicative actions Present and Foreseen Social Interactions

Lesion = Frontal variant of Fronto-temporal dementia Striking personality changes, empathy impaired, ToM test

performance poor Executive functions preserved

Kaplan & Sadock, Comprehensive Text book of Psychiatry 9 th edition

28Neuroanatomy – ToM

Rt Temporal Pole Med PFC

Post Sup Temp Sulcus – biological motion, attributing cues

Distinguishing between False Belief and False-photograph test

Saxe, R; Kanwisher, N (2003). "People thinking about thinking peopleThe role of the temporo-parietal junction in "theory of mind"". NeuroImage 19 (4): 1835–42

Saxe, Rebecca; Schulz, Laura E.; Jiang, Yuhong V. (2006). "Reading minds versus following rules: Dissociating theory of mind and executive control in the brain". Social Neuroscience 1 (3–4): 284–98.

Mentalising

FALSE PHOTOGRAPH TEST

Zaitchik (1990): compared out-of-date beliefs to out-of-date photographs (same structure, cognitive demands)

3-year-olds fail this too

executive function

problems? (difficulty inhibiting the perceptually salient response? – not a problem in tasks using looking measures)

from Happé (1994)

30Tests of Theory of Mind

1. False Belief Tasks a) First Order

b) Second Order

c) Third Order

2. ToM Stories

3. Eye Interpretation Tasks

4. Hinting Tasks

5. Heider-Simmel (like) animations

6. Faux pas

31False Belief Tasks False belief = beliefs about the world which diverge from reality

Understand how knowledge is formed People’s beliefs and mental states are based on their knowledge Mental states can differ from reality Behaviour can be predicted by mental states

1. First Order a) Sally-Anne Test

b) Smarties Test

2. Second Order

3. Third Order

False Beliefs:

Sally-Anne (Maxi) test

(Baron-Cohen, Leslie, & Frith, 1985; Wimmer & Perner, 1983)

control questions:− Where is the marble really?− Where did Sally put the marble at the beginning of the story?

3-year-olds say box, where it is (fail); 4+-year-olds say basket

from Frith (1989)

33Development

3. Understanding Others’ Knowledge

Povinelli & de Blois (1992) 3yrs vs 4yrs old children ‘Hider’ – hid toy in 1 of 4 containers behind screen ‘Knower’ – saw hider placing toy ‘Guesser’ – left before hider placed toy

‘Knower’ and ‘Guesser’ guided/advised children where toy was 4yr olds always chose correct cups, 3yr olds inconsistent

False Beliefs:

Smarties test

(Perner, Leekam, & Wimmer, 1987)

control questions:− Is that what’s really in here?

− What is really in here?

again, 3-year-olds fail (say pencil); 4+-year-old pass (say Smarties)

from Frith (1989)

?

?

35False Belief Tasks What does the person with the blue shirt believe is in the bag?(false belief)Gift, present, flower, (bug is incorrect)

What‘s in the bag? (reality)Wasp, bee, insect, or bug

What does the person in blue shirt believe the person in red intends to do?(2nd order false belief)Give him a gift or present

What does the person in red assume the person with the blue shirt believes, regarding his (the one in red) intentions? (3rd order false belief)Give him a gift or present

36Theory of Mind Stories

Misunderstanding (Glove): A burglar who has just robbed a shop is making his getaway. As he is running home, a policeman on his beat sees him drop his glove. He doesn’t know the man is a burglar, he just wants to tell him he dropped his glove. But when the policeman shouts out to the burglar, ‘‘Hey you, Stop!’’, the burglar turns round, sees the policeman and gives himself up. He puts his hands up and admits that he did the break-in at the local shop.

1. Was the policeman surprised by what the burglar did?

2. Why did the burglar do this, when the policeman just wanted to give him back his glove?

37Theory of Mind Stories

Lie (Dentist): John hates going to the dentist because every time he goes to the dentist he needs a filling, and that hurts a lot. But John knows that when he has toothache, his mother always takes him to the dentist. Now John has bad toothache at the moment, but when his mother notices he is looking ill and asks him ‘‘Do you have toothache, John?’’. John says ‘‘No, Mummy’’.

1. Is it true what John says to his mother?

2. Why does John say this?

38Eye Interpretation Tasks • Pure Theory of Mind Test

• No executive function required

• Tests recognition of complex mental states

• Artificial constraints not present in real life

• Limited Choice of options • Unlimited time to study

faces • Validation study sample

size small

39Hinting Tasks Participant infers intentions behind veiled speech act Normal adults perform close to ceiling

Example Paul has to go to an interview and he’s running late. While he is

cleaning his shoes, he says to his wife, Jane: “I want to wear my blue shirt but it’s very creased.”

Question: What does Paul really mean when he says this?

(If necessary add: Paul goes on to say: “Its in the ironing basket.”

Question: What does Paul want Jane to do?)

40Faux Pas Test Faux pas = beach of etiquette

Recognition calls for a high level of ToM

Jill had just moved into a new apartment. Jill went shopping and bought some new curtains for her bed room. When she had just finished decorating the apartment, her best friend, Lisa, came over. Jill gave her a tour of the apartment and asked, “How do you like my bedroom?”

“Those curtains are horrible” Lisa said, “I hope you are going to get some new ones!”

Questions1. Did Lisa know the curtains were new?2. Did some one say something she shouldn’t have said?

Spectrum of ToM abnormalities

Deficit inTOM ability

Application Deficit in TOM

Abnormal attributions

Normal TOM

Impaired Sense of Self-Agency

Autism NormalPassivityphenomena

+ve Sx Schiz

Asperger’s-ve Sx Schiz?PD

(Abu-Akel 1999)

42ToM in Autism

S Baron Cohen, (1985) Autistic children consistently fail False-Belief tasks e.g.Sally-Anne

(80%) Down’s Syndrome children did not fail (86%) Difficulties persisted even when child matched for verbal skill

Deficits persisted on picture story, hinting, when matched for age/language

Inability to assign mental states to others Neuroimaging studies

less activation in mPFC (Happe (1996), Frontal regions ( Ring, Baron-Cohen 1999), mPFC, posterior STS, temporal poles (Castelli 2002) STS hypo-activation (Pelphrey 2005). m PFC and right STS (Wang 2007)

43ToM in AutismSocial-affective Justification (Hobson)

ToM deficits are result of distortion in ability to understand & reciprocate to emotions

Devoid of skills (social referencing ability) which later lets them comprehend and react to other people’s feelings

(Hobson, R.P. (1995). Autism and the development of mind. Hillsdale, N.J.: Lawrence Erlbaum Associates Ltd.)

Developmental Delay Consistent with varying degrees of impairment (difficulties at

various stages of growth) Early setbacks → Joint attention behaviour ability impaired Hence unable to form full ToM

(Baron-Cohen, S. (1991). Precursors to a theory of mind: Understanding attention in others. In A. Whiten, Ed., Natural theories of mind: Evolution, development, and simulation of everyday mindreading (233-251). Cambridge, MA: Basil Blackwell.)

Ontogenic aspects

6 months of age: Animate Vs inanimate12 months: Joint attention14-18 months: Senses direction of another’s gaze.18-24 months: Pretense (Decoupling of reality) 3-4 years: False beliefs in others 6-7 years: Jokes, Metaphors, Irony 9-11 years: ‘faux pas’.

45ToM in Schizophrenia Some symptoms of Schizophrenia are comparable to autism

Social dysfunction / withdrawal / impaired social cognition ? accountable by ToM deficit

ToM deficits accounting for Schizophrenia Symptoms

Firth (1992)

Inability to perceive own intentions Inability to see behaviour as result of own willed action

Disorder of Willed Action (Passivity)

Impaired self monitoring Impaired awareness of self-generation of thoughts

Delusion of alien control

Impaired monitoring of others (impaired awareness of others’ intentions/thoughts)

Persecutory delusions Delusions of reference Delusions of misidentification

46ToM in Schizophrenia

Disorganized, paranoid schizophrenia, (>) negative show ToM deficits.

Correlation of ToM deficit with symptoms severity and remission social functioning pragmatic language use

ToM deficit is independent of General intellectual ability Memory Executive function

(Leigh Harrington , Richard Siegert & John McClure (2005) Theory of mind in schizophrenia: A critical review, Cognitive Neuropsychiatry, 10:4, 249-286,)

47ToM in Schizophrenia State v/s Trait

5 studies found majority of ToM deficits disappear after acute episode Severity correlates with severity of illness.

But in a few studies it was noted that, Chronically ill patients also have ToM deficits High schizotypal patients had ToM deficits (1 study) Remitted patients > Family members of Schiz patients > controls: on ToM tasks. (3

studies)

Imaging Findings Russel et al (2000): eye-reading task on f MRI showed hypo-activity

left middle and inferior frontal regions middle temporal regions

Brune (2001): picture-story task on PET hypo-activity right prefrontal cortex

Hempel et al (2003) emotional recognition task Medial PFC

(Leigh Harrington , Richard Siegert & John McClure (2005) Theory of mind in schizophrenia: A critical review, Cognitive Neuropsychiatry, 10:4, 249-286,)

48Other Conditions with ToM Deficits

Bipolar Disorder (Kerr et al 2003, Montag et al 2009)

Depression (Wolkenstein et al, 2011)

Huntington’s Disease (Brune et al, 2011)

Frontotemporal Dementia (Gregory et al, 2002)

Callosal Agenesis (Booth et al, 2011)

Congenital Deafness Schizoid, Schizotypal

Pridmore S (2006) Download of Psychiatry, University of Tasmania Press

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REFERENCES Leigh Harrington , Richard Siegert & John McClure (2005)

Theory of mind in schizophrenia: A critical review, Cognitive Neuropsychiatry, 10:4, 249-286,

Goldman A.I, (2012) Theory of Mind, Oxford Handbook of Philosophy and Cognitive Science

Pridmore S (2006) Download of Psychiatry, University of Tasmania Press

Call J, Tomasello M., (2008) Does the chimpanzee have a theory of mind? 30 years later. Trends Cogn Sci. May;12(5):187-92.

Flavell JH, (2004) Theory of Mind Development: Retrospect and Prospect Merrill-Palmer Quarterly 50:3, 274-290

Kaplan & Sadock, Comprehensive Text book of Psychiatry 9th edition

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