OCTOBER 2009

DELHI PSYCHIATRY JOURNAL Vol. 12 No.2

Review Article

Issues in Theory of Mind Research — An Overview Manisha Jha, T.B. Singh Institute of Human Behaviour & Allied Sciences, Dilshad Garden, Delhi-110095

Introduction Human beings are essentially social creatures. In each and every encounter with other human beings and higher animals, simple observation leads to a spontaneous prediction of how they are feeling based upon how they are behaving. It is this everyday capacity to conceptualize or infer mental states to others (e.g. their belief, knowledge, desire, intentions) in order to explain much of their behaviors and predict responses which comprises the “Theory of mind” (ToM). This ability enables a person to choose interpersonal responses that are more likely to lead to successful interactions in social encounters and over time to achieve higher level of social attainment. A woman and boy walk from a car; the boy stops, frowns and turns around. Woman takes him back to the car and points in the window. This behavior makes immediate sense: the boy has forgotten something. The woman believes it is in the car. She wants him to see it is there. The term Theory of Mind (ToM) was coined by Premack and Woodruff 1 in a classic paper that discussed whether Chimpanzees have a ToM? Wimmer and Perner 2 working in this direction, tested normal children on what has become classic false belief task: Maxi story. This study as well as a number of replications3,4 subsequently confirmed that in normal children the ability to represent the relation between two or more person’s mental states emerges and becomes firmly established around the ages 4 to 6 years. Meltzoff and Moore5 have shown that children as young as several hours or days old may mimic simple behaviors, which may be part of a developing ToM; other researchers have argued that 14- to 18-month-old infants are capable of understanding intention and so have a basic comprehension of others as intentional and mental agents.6,7

The history of ToM research in children can be traced back to the claim made by Piaget that children initially have no knowledge of conceptual, perceptual and emotional perspectives (cognitively egocentric). As a result, they cannot be aware that they have their own point of view and that it differs from those of others. Considerable disagreement regarding behaviors necessarily indicating the presence of a developing theory of mind in young (1- to 3-year-old) humans stimulated research on investigating behaviors which may be precursors to the development of a fully functional theory of mind. These behaviors include joint attention, gaze following, proto-declarative pointing, comprehending objects’ animacy, and awareness of others as intentional agents. 8 Following another’s gaze with one’s own is seen in infants by about the age of six months, while markers of joint attention, including shared mutual gaze, appear later, around the age of 9-12 months. Additionally, behaviors such as proto-declarative pointing—pointing in order to draw another’s attention to an object in the environment—also emerge around the end of the first year.9 This ability to engage in shared attention is considered to be crucial for a child to learn about his or her social environment. Longitudinal studies shown that children who displayed the highest rates of joint attention at 20 months were comparativly able to score highest on theory of mind tasks at 44 months than other same age children.10 An ability to distinguish between animate and inanimate objects represents another step along the path toward development of a theory of mind. After learning to define certain objects as animate, children can then begin to develop the concept of other beings as intentional “agents.” An agent is an object that acts in a goal-directed manner, essentially planning actions and then carrying them

Delhi Psychiatry Journal 2009; 12:(2) © Delhi Psychiatric Society

195

DELHI PSYCHIATRY JOURNAL Vol. 12 No.2

out in the most efficient way in order to attain some end. Hence theory of mind appears to be an innate potential ability in humans (and, some argue, in certain other species), but one requiring social and other exper ience over many year s to bring successfully to adult stature. It is probably a continuum, in the sense that different people may develop more, or less, effective theories of mind, varying from very complete and accurate ones, through to minimally functional. It is often implied or assumed that this does not merely signify conceptual understanding “other people have minds and think,” but also some kind of understanding and working model that these thoughts and emotions are real and genuine for these people and not just ungrounded names for parroted concepts. Empathy is a related concept, meaning experientially recognizing and understanding the states of mind, including beliefs, desires and particularly emotions of others without injecting your own, often characterized as the ability to “put oneself into another’s shoes.” Though mostly ToM research has concentrated on its developmental aspect, studies have investigated the effects of aging on ToM. In pioneering work, Happe et al.11 found that Tom reasoning is normal in the elderly and they performed better on tom task as compared to the university aged controls. Contrary to this Maylore et el. 12 found significant age related deficits in performance on ToM tasks in two experiments even after accounting for age related differences in cognitive abiliy. They attributed that observed age related decline in performance on ToM tasks is consistent with the established deficits in frontal lobe function found in old age. Baron-Cohen 13 grounding on a moduler hypothesis has proposed the existence of a mindreading system which functions to make these mental state attributions to other agents. When fully developed, this ability implies four specific mechanisms devoted to (i) detecting other ’s intentionality (ii) detecting eye direction (iii) sharing attention and (iv) elaborating a ToM mechanism (TOMM). He suggested that the final module in the mindreading system, the TOMM has two major functions. First, it is able to infer the full range of mental states from observable behavior. These include pretending, thinking, knowing, 196

OCTOBER 2009

believing, imagining and deceiving. Second, the TOMM is able to integrate this mental state knowledge into a useable theory, which the child or adults can use to explain and predict others’ behavior. Baron – Cohen14 also claims that modular mechanisms are involved in the ability to identify and process mental states and those are either inborn or mature at an early age. Theories of ToM For a certain time, researchers stayed clear from the question of the acquisition of ToM, and concentrated on the description of the abilities involved in this.15 More recently that question was confronted and spawned three conflicting views of defective mentalising: Proponents of the theory – theory view hold that defective mentalising occurs either when the appropriate knowledge base has not developed16 or when the cognitive mechanism that underpins on line manipulation of that knowledge base is dysfunctional. This is termed as impaired executive planning hypotheses given that proponents of this view cite the co-occurrence of failure on executive planning task (The Tower of London Task) and failure on false belief task as support for their position. Thus theory theorists say that our ability to give explanations, predictions and interpretations of intentional behavior is subserved by tacit knowledge of an internally – represented theory of commonsense psychology. The simulation theory challenges this view, and maintains that these abilities rely on an innate capacity to simulate with others.17,18 According to Hughes and Russell19 defective mentalising occurs either when subjects are impaired in their ability to imagine any hypothetical event that differs from current reality or when subjects inappropriately prioritize competing information and fail to simulate the appropriate counterfactual inputs. This is called disengagement hypothesis. Support for the disengagement hypothesis comes from evidence that young children perform better on tasks when the conflict between competing informational components is reduced e.g., what oneself desires and what others desire. 4 One of the differences between the two theories that have influenced psychological consideration of ToM is that theorytheory describes ToM as a detached theoretical

Delhi Psychiatry Journal 2009; 12:(2) © Delhi Psychiatric Society

OCTOBER 2009

DELHI PSYCHIATRY JOURNAL Vol. 12 No.2

process that is an innate feature, whereas simulation theory portrays ToM as a kind of knowledge that allows one to mimic the mental state of another person. These theories continue to inform the definitions of theory of mind at the heart of scientific ToM investigation. The other popular alternative to these theories is that the ability to impute mental states to oneself and other is inborn, and develops through natural maturation, rather than under the influence of experience and evidence in the course of development. This approach focuses on the mental model that interprets behavior in intentional and mental terms, as beliefs, goal and desires. This structure is said to have evolved phylogenetically. The structures are evoked or activated by certain events, and once they are activated, they provide interpretations of behavior in mental terms. Leslie20 describes the understanding of minds as a process of neural maturation of three domain specific modules. He also holds that there is a specific module of the theory of mind that develops at first with pretense play at age 18 months.3 Approaches to ToM Study Most studies evaluating ToM abilities in psychiatric, developmental disorder and normal subjects have adopted a dichotomous approach, wherein failure on ToM tasks indicates an absence of this ability. That is, such researches took as its paradigm the presence or absence of conceptual abilities needed to mentalize about self and others, and the processes required for the successful application of these conceptual abilities. In this paradigm two main line of thinking emerged. First, dealt ToM impairment as a deficit in conceptualization and representational abilities. In this view, an individual who lack ToM is thought to be unable to represent mental states of others or of oneself21,22 generally ascribed to individual with autism. The second argued that the deficit is one of application and performance. Here the individual demonstrates awareness of another’s mental activity but fails to apply this knowledge (attribute mental states) due to processing constraints23-25 ascribed to individual with Asperger’s syndrome. Frith26 made clear prediction about schizophrenic subgroups performance on the test of theory of mind. According to Frith, First, patients with any

negative behavioral signs (e.g. avolition, poverty of speech, flat affect) or positive behavior signs (e.g. incoherent or inappropriate speech) would score very poorly on the task, showing a deficit of similar severity to that of autistic people, since they cannot represent any kind of mental state. Secondly, patients with paranoid symptoms (such as persecutory delusions, delusions of reference etc.) but no behavioral signs should also be impaired on the task relative to controls, but their deficit should be less than that of patient with behavior signs as they are presumed still to represent others mental states, but to make errors in the process. Finally, schizophrenic people with only passivity symptoms (e.g. delusion of control or thought insertion), or remitted patients with no current signs or symptoms, should score as well as controls on the tasks as they are presumed to represent others mental state normally. Recent empirical findings and developments in the theoretical understandings of ToM suggest that there are additional varieties of ToM impairment that can be observed in developmental and psychiatric disorders mainly two groups of patient with schizophrenia. The first group consists of patient with passivity phenomena who, despite their impaired ability to represent their own mental states such as their intentions to act seem to have no deficit in the ability to represent mental states in others. The second group consists of patient with positive symptom schizophrenia, and in particular those with paranoid and delusional schizophrenia. It has been hypothesized that the ToM failure of these patient is a consequence not so much from a deficit in the representation of mental states, as reported for example by Sarfati et al,27 but rather from a hypertrophy of it i.e. a ‘hyper theory of mind’ that often leads such patient to over attribute knowledge and other mental states to their interlocutors.28 Language Ability and ToM Beyond the basic definition of ToM, there is considerable debate as to precisely what other kinds of abilities and understandings constitute a theory of mind, when these abilities develop, and who can be said to have a theory of mind. It has been proposed that successful communication depends on inferring the beliefs and intentions of our partner

Delhi Psychiatry Journal 2009; 12:(2) © Delhi Psychiatric Society

197

DELHI PSYCHIATRY JOURNAL Vol. 12 No.2

in conversation. Such successful communication is linguistically realized in part by cohesion and in part by abiding the maxims derived from the cooperative principle.29 Both language and ToM are uniquely human, both involve manipulation of complex embedded structures, and both are subject to debate concerning the articula-tion of genetic and developmental processes. Likewise, there appears to be a crucial co-evolutionary relation between them. In this context, it can be considered that language is about mapping sentences to meaning, and theory of mind is about mapping social/ behavioral contexts onto other’s behavior in terms of their underlying mental states. There is fundamental difference between the use of mentalizing in discourse and the use of mentalizing in theory of mind tasks. During discourse mentalizing is used implicitly and automatically in the service of communicating. In this sense it is used online (online vs off line processing, e.g. Tyler30). In most theory of mind task mentalizing is carried out off line. The patient is not taking part in the interaction, but must make explicit use of mentalizing to answer questions about an interaction that has been described. This requirement puts more weight on Working Memory and on Meta cognitive processes (i.e., reflecting on mentalising). As might be expected off line tasks are more difficult than online. In humans, this cognitive mechanism is more or less permanently “online”, to the extent that we sometimes ascribe mental states to inanimate objects such as cars, computers etc.31 Conversation analysis of transcript obtained from patients with Schizophrenia with ongoing positive and negative symptoms further highlighted appropriate reporting of first and second order mental states of others in these patients and they guide their utterances on the basis of what the listener needed to know. 32 They knew that the listener had different beliefs from their own and took account of these differences in generating their replies. In these real life conversations the patients used accurate mentalising to achieve successful communication with only identifiable problem that, they could not generate understandable justification for their beliefs. Subjects recognized that their justification were not understandable but were not able to produce better justification. Furthermore 198

OCTOBER 2009

they also were unable to modify their beliefs even though they recognized that these beliefs were not shared by anyone else. Studies in which more traditional mentalizing tasks were used had incompatible findings with the above where; evidence is that patients with schizophrenia tend to perform such task badly unless they are currently symptom free. Studies in which both discourse performance and performance on mentalising task was measured on the same patients or pragmatic dysfunctions were investigated in comparison with different cognitive functions would have given better understanding . Brain imaging of adults during false-belief story tasks consistently shown activation of the temporoparietal junction in adult English speakers but not in English-speaking children or in English– Japanese bilingual persons. Cultural or linguistic influence on location of brain function and arguments against maturation of innately specified neural substrates are also available. It is reminiscent of effects of linguistic development, bilingualism and cultural differences on theory of mind development. Impact on Social Functioning Given that ToM requires quite large computational resources, it is not surprising that a dysfunction of the ToM mechanism is involved in a variety of neuropsychiatric disorders, including autism and schizophrenia and may cause severely compromised social competence in patients with such conditions.33 With increasing complexity of social interactions, ToM represents a powerful cognitive tool to determine whether or not an individual is willing to cooperate and reciprocate, or tends to intentionally deceive and manipulate others response. Since the ability to make inferences about the other people’s mental states is a key ingredient of social competence, the assessment of theory of mind would correlate more strongly with current social functioning than with more traditional neurocognitive measures. While studies have emphasized the importance of executive functioning, memory and vigilance,34 along with processing speed as cognitive predictor of vocational outcome, there are findings in favour of social cognition in predicting functional outcome. As per regression

Delhi Psychiatry Journal 2009; 12:(2) © Delhi Psychiatric Society

OCTOBER 2009

DELHI PSYCHIATRY JOURNAL Vol. 12 No.2

model higher level of competence in making social inferences was among the best predictors of global social functioning together with recent onset of illness, good verbal fluency and low levels of negative and positive symptoms than those who showed less ability in this aspect of social cognition. 35 Two forms of social cognition i.e., ability to recognize actual and suggested social cues and social problem solving in ambiguous social situations has significant association with the performance on neurocognitive tests.36 Theory of Mind tasks - which are increas-ingly being used to assess social understanding in a variety of contexts - can also make demands in other areas of cognition. In people who may have cognitive limitations (such as the very young or elderly, or those with psychological impairments), poor performance on a Theory of Mind task may be due to the general cognitive demands of the task, rather than a specific deficit in social understanding. Available data effectively suggest that ToM deficit is associated with an inability to extract relevant data from the context and that it might be possible to alleviate it in patients who are able to profit from a cognitive strategy which forces them to process the context. Socio Demographic Areas Within the field of ToM two areas still remained neglected are – individual difference and the effects of family background. In recent years some researchers have begun to focus on these areas. Majority of published studies of theory of mind development have investigated the abilities of middle and upper middle class children from generally well-educated families. There is some evidence that family background plays a role in ToM development. Children from a head start population have been reported to perform poorly on false belief tests, although in this case, performance was compared only to levels “typically reported in the literature”.37 Cross-cultural studies also have suggested that family background affects theory of mind development; for example affluent Indian children outperformed their deprived counterparts in making mental-real distinction.38 Comprehensive assessment of urban preschoolers on the task of false belief understanding, emotion understanding, language abilities, and

family background where source of information was parent interview; Individual differences in children’s understanding of false belief and emotion were associated with differences in language ability and with certain aspects of family background, in particular, parental occupational class and mother’s education.39 As thought, the number of siblings that children had did not relate to their social cognition. Contrary to this children from larger families were better than children from smaller families at predicting a story character’s (mistaken) action based on a false belief.40 It was suggested that family background has a significant impact on the development of theory of mind. Growing evidence exist of cultural differences in theory of mind. Cultural studies have often found that the ToM performance of children from nonwestern cultures, such as Asia, Africa and South America, falls short of that reported in the western literature (e.g., Vinden41 ). Meta analytic studies shown that Japanese children’s false belief performance was significantly lower than that of western children (Wellman et al42 ); similarly in other studies also43,44 Japanese children understood false belief and knowledge origins between the ages of 4 and 6 years, more than one year later and slower than western children’s development. Moreover, it was found that Japanese children base their justification for false belief judgments primarily on the protagonists’ overt behaviors and social rules rather than their internal mental states. Even within western cultures, theory of mind differs depending on children’s family background: the development of children from underprivileged family was later than typically reported within children from middle class families. 37, 39 Moreover, when directly compared with each study, children’s mastery of theory of mind differed between task and some time between sexes.37, 43 Conclusion It is widely acknowledged that ToM evolved in hominids in response to the increasing complexity of social interactions, representing a powerful cognitive tool to determine nature of social interaction. This important ability is essential to understand individual as autonomous and goal directed agents with minds that represents beliefs,

Delhi Psychiatry Journal 2009; 12:(2) © Delhi Psychiatric Society

199

DELHI PSYCHIATRY JOURNAL Vol. 12 No.2

desires, intentions etc. thus, enables to cooperate, empathize with or deceive others. While the normal acquisition of a ToM is an important developmental milestone, some conditions like the developmental disorder Autism is characterized by severe socialcognitive impairment, including the inability to understand other minds. Although adults can reflectively and deliberately use this sophisticated aspect of their theory of mind, this ability is not yet incorporated enough into the routine operation of the interpretation system to allow spontaneous, nonreflective use. The element of theory of mind that distinguishes between self and other’s beliefs is not fully incor porated into the adult’s system. Importance of social and linguistic interaction for the normal acquisition of a ToM along with elements of each theory offered to explain development of ToM will form the future basis of research.

OCTOBER 2009

8.

9.

10.

11.

12.

References 1. Premack D, Woodruff G. Does the chimpanzee have a theory of mind? Behav Brain Sci 1978; 4 : 515-526. 2. Wimmer H, Perner J. Belief about beliefs: Representation and the constraining function of wrong beliefs in young childr ens’ understanding of deception. Cognitive 1983; 13 : 103-128. 3. Leslie AM, Frith U. Autistic childr en’s understanding of seeing, knowing and believing. B J Develop Psychol 1988; 6 : 315324. 4. Moore C, Jarrold C, Russell J, Lumb A, Sapp F, Maccallum F. Conflicting desire and the child’s theory of mind. Cogn Develop 1995;10 : 467-482. 5. Meltzoff AN. Understanding the intentions of others: Re-enactment of intended acts by 18month-old children. Develop Psychol 1995; 31 : 838-850. 6. Carpenter M, Akhtar N, Tomasello M. Fourteen- through 18-month-old infants differentially imitate intentional and accidental actions. Infant Behav Develop 1998; 21 : 315330. 7. Meltzoff AN, Moor e MK. Persons and repr esentation: Why infant imitation is important for theories of human development. 200

13.

14.

15.

16. 17. 18. 19.

20.

21.

In J. Nadel and G. Butterworth, Eds. Imitation in Infancy: Cambridge Studies in Cognitive Perceptual Development, 9-35. New York: Cambridge University Press, 1999. Gallagher H, Frith C. Functional imaging of ‘Theory of mind’. Trends Cogn Sci 2003; 7 : 77-83. Barresi J, Moore C. Intentional relations and social understanding. Behav Brain Sci 1996; 19 : 107-122. Charman T, Baron-Cohen S, Sweetenham J, Baird G, Cox A, Drew A. Testing joint attention, imitation, and play as infancy precursors to language and theory of mind. Cogn Develop 2000; 15 : 481-498. Happe F, Winner E, Brownwell H. The getting of wisdom: Theory of mind in old age. Develop Psychol 1998; 34(2) : 358-362. Maylor E, Moulson J, Muncer A, Taylor L. Does performance in theory of mind task decline in age? B J Psychol 2002; 93 : 465485. Baron-Cohen S, Ring H, Moriarty J, Schmitz B, Costa D, and Ell P. Recognition of mental State terms. Br J Psychiatry 1994; 165 : 940649. Baron-Cohen S. Mindblindness: An Essay on Autism and Theory of mind. Cambridge, MIT Press, 1995. Carruthers P, Smith PK. Theories of Theories of mind. Cambridge, Cambridge University Press, 1996. Perner J. Understanding the representational mind. Cambridge: MIT Press, 1991. Gordon R. Folk Psychology as simulation. Mind Language 1986; 1 : 158-171. Goldman AI. Interpretetion Psychologised. Mind Language 1989; 4 (3) : 294-303. Hughes C, Russell J. Autistic children’s difficulty with mental disengagement from an object: Its implications for theories of autism. Develop Psychol 1993; 29 : 498-510. Leslie AM. Pretending and believing: Issues in the theory of TOMM. Cognition 1994; 50 : 211238. Bishop DMV. Annotation: autism, executive functions and theory of mind: a neuropsychological perspective. J Child Psychol Psychiatry 1993; 34 : 279-293.

Delhi Psychiatry Journal 2009; 12:(2) © Delhi Psychiatric Society

OCTOBER 2009

DELHI PSYCHIATRY JOURNAL Vol. 12 No.2

22. Sodium B, Frith U. Deception and sabotage in autistic, retarded and normal children. J Child Psychol Psychiatry 1992; 33 : 591-605. 23. Ozonoff S, Rogers SJ, Pennington BF. Evidence of an empir ical distinction from high functioning autism. J Child Psychol Psychiatry 1991; 32 : 1107-1122. 24. Raffman D. What autism may tell us about self awareness: a commentary on Frith and Happe. Mind Language 1999; 14 : 23-31. 25. Russell J, Mauthner N, Sharpe S, Tidswell T. The ‘windows task’ as a measure of strategic deception in preschoolers and autistic subjects. Br J Develop Psychol 1991; 9 : 331-349. 26. Frith CD. Theory of mind in schizophrenia. In J.C. Cutting, and David (Eds.), The Neuropsychology of schizophrenia. Hove: Lawrence Erlbaum Associates, 1994. 27. Sarfati Y, Hardy-Bayle MC. How do people with schizophrenia explain the behaviour of others? A study of theory of mind and its relationship to thought and speech disorganization in schizophrenia. Psychol Med 1999a; 29 : 613-620. 28. Abu-Akel A, and Bailey AL. The possibility of different forms of theory of mind. Psychol Med 2000; 30 : 735-738. 29. Grice HP. Logic and conversation. In Cole, P and Morgan, JL (Eds.). Syntax and Semantics. Vol. 3. Speech Acts New York, NY Academic Press, 1975; 41–58. 30. Tyler LK. The distinction between implicit and explicit language function: Evidence from aphasia. In A.D. Milner and M.D. Rugg (ed.) the Neuropsychology of consciousness, San Diego, CA, Academic Press, 1992. 31. Courtin C, Melot AM. Metacognitive development of deaf children: Lessons from the appearance-reality and false belief tasks. J Deaf Studies Deaf Educ 2005; 5 : 266-276. 32. McCabe R, Leudar I, Antaki C. Do people with schizophrenia display theory of mind in clinical interactions? Psychol Med 2004; 34 : 401-412. 33. Lissek S, Peters S, Fuchs N, Witthaus H, Nicolas V, Tegenthoff M, Juckel G, Martin Brüne. PLoS ONE 2008; 3(4) : e2023.

34. Green MF, Nuechterlein KH. Should schizophrenia be treated as a neurocognitive disorder? Schizophr Bull 1999; 25 : 309-319. 35. Roncone R, Falloon, IRH, Mazza M, Risio AD, Necozione S, Morosini P, Casacchia M. Is theory of mind in schizophrenia more strongly associated with clinical and social functioning than neurocognitive deficits? Psychopathology 2002; 35 : 280-288. 36. Lancaster RS, Evans JD, Bond GR, Lysaker PH. Social Cognition and Neurocognitive Deficits in Schizophrenia. J Nerv Mental Dis 2003; 191 : 295-299. 37. Holmes HA, Black C, Miller SA. A cross-task comparison of false belief understanding in a head start population. J Exp Child Psychol 1996; 63 (2) : 263-285. 38. Wahi S, Johri R. Questioning a universal theory of mind: Mental- real distinctions made by Indian children. J Genetic Psychol 1994; 155 : 503-510. 39. Cutting AL, Dunn J. Theory of mind, emotion understanding, language and family background: Individual differences and interrelations. Child Develop 1999; 70 : 853-865. 40. Perner J, Ruffman T, Leekam S. Theory of mind is contagious: You catch it from your sibs. Child Develop 1994; 65 : 1228-1238. 41. Vinden P. Children’s understanding of mind and emotion: A multi-cultural study. Cognition Emotion 1999; 13 : 19-48. 42. Wellman HM, Cross D, Watson J. Metaanalysis of theory of mind development: The truth about false belief. Child Develop 2001; 72 : 655-684. 43. Naito M. The relationship between theory of mind and episodic memory: Evidence for the development of autonoetic consciousness. J Exper Psychol 2003; 85 : 312-336. 44. Naito M, Koyama K. The development of false belief understanding in Japanese children: Delay and deviance? As cited in Naito, M. (2004). Is theory of mind a universal and unitary construct? International Society for the Study of Behavioral Development, Newsletter 2003; 45 (1) : 9-11.

Delhi Psychiatry Journal 2009; 12:(2) © Delhi Psychiatric Society

201