Gallagher and Hutto’s research prompts a philosophical reconsideration of how we relate to and understand others, challenging mainstream ‘theory of mind’ approaches. Their research has contributed to the development of diagnostic tools for the early detection and treatment of schizophrenia and new methodological guidelines for the clinical evaluation of Autism Spectrum Disorders. Offering new theories about the basis of social cognition, the research advanced arguments for thinking that embodied and narrative practices lie at the heart of our capacities to engage with and make sense of one another. This research influenced and inspired new ways of diagnosing and treating psychological conditions, improving the quality of life of patients.
Related United Nations Sustainable Development Goals:
3. Good health and well-being
Details of the Impact
For more than a decade, Profs Gallagher and Hutto advanced inter-connected analyses and arguments, resulting in a new framework for conceiving of the basis of our everyday ‘folk’ psychological and social cognitive abilities. Their combined research revealed the advantages of explaining our capacities for relating to and understanding others as a mix of situated embodied capacities and skills acquired by engaging in public storytelling practices. Pivotally, their approach rejected the long-held assumption that such capacities are best explained by what goes on inside the heads of individuals.
- Improved clinical practice in early detection and treatment of schizophrenia by motivating a revision in the Examination of Anomalous Self-Experience (EASE) diagnostic tool.
EASE is a questionnaire used in phenomenologically based diagnostic interviews. In its original format, EASE focused on individual self-experience and tended to under-appreciate and under-emphasise intersubjective aspects – such as difficulties in interpersonal rapport, communication, and emotional and cognitive reactions to others. Gallagher and Hutto’s research had a direct influence on correcting these limitations. Their ideas became part of the ‘necessary theoretical background’ for revision of EASE and the training of therapists, as Professor Thomas Fuchs, Principal Investigator/Coordinator of Disorders and Coherence of the Embodied Self (DISCOS). and Towards an Embodied Science of Intersubjecivity (TESIS) acknowledged. Their research inspired revisions to EASE (both in content and method). Questions were added to focus on interpersonal dimensions, and video studies of interviewees and interviewers made it possible to analyse interactions during interviews. Twelve psychiatrists and psychologists in three clinical sub-projects trained with the revised EASE and interviewed over eighty patients, leading to the recognition of thirty hitherto undiagnosed cases of early schizophrenia. Eight of these patients went on to receive appropriate treatments in Heidelberg. The revised test subsequently developed into the Examination of Anomalous World Experience (EAWE) protocol for semi-structured interviews and continues to be used by clinicians in Heidelberg.
- Influenced the use of alternative therapeutic approaches to schizophrenia by clinicians in the UK
Clinicians of the Coventry and Warwickshire Early Intervention Team used Gallagher and Hutto’s insights into embodied, enactive and narrative social cognition as an important theoretical impetus in modifying their approach to early psychotic illness. Dr Matthew Broome became acquainted with the work of Gallagher and Hutto through their mutual involvement in the Arts and Humanities Research Council (AHRC) ‘Feelings and Emotions in Psychiatric Illness’ Network (2009–10). Gallagher and Hutto’s research assisted Broome and others in understanding clinical interactions and developing therapeutic strategies. The research helped them to develop narrative-based strategies that decreased the occurrence of schizophrenic episodes in some patients. It also enabled them to better understand the importance of the role of the social environment in the early stages of psychosis. The Early Intervention team focused on subjects aged 14–35 presenting their first episode of psychotic illness, typically schizophrenia. The narrative-based strategies provided clinicians with an understanding of patients’ ‘delusional realities’ and fostered patients’ notions of self-worth and autonomy. Gallagher and Hutto’s research led to modified strategies that successfully enabled these clinicians to meet several crucial targets for treating patients: the Department of Health caseload targets (fifty-five clients per year), the National Health Service limit for the duration of untreated psychosis (a maximum of three months), and the 2016 Access and Waiting Time Target for psychosis (50% of people experiencing first episode psychosis commence care within two weeks of referral).
- Shaped the formulation of new methodological guidelines for clinical evaluation of Autism Spectrum Disorders (ASD) and monitoring of treatment
These guidelines were developed and implemented at one of the largest children’s hospitals in Europe, the Bambino Gesú Ospedale Pediatrico in Rome by Dr Laura Sparaci, who studied as a Fulbright Fellow and Visiting Researcher with both Gallagher and Hutto. The guidelines direct clinicians to focus on bodily movement and the development of gesture in early social interactions. Drawing on Gallagher and Hutto’s work, clinicians refocused on early signs of sensorimotor, pointing and gesture problems in children with ASD, instead of relying on standard ‘theory of mind’ measures. This enabled the development of a taxonomy for evaluating different options for specific treatment strategies at the hospital’s Child Neuropsychology Unit, where, on average, sixteen new ASD patients are evaluated per month and twenty-four ASD patients are treated per month.
- Influenced other treatments of ASD
Dr Belmonte, Department of Psychology at Nottingham Trent University and Visiting Researcher at the Com DEALL Trust in Bangalore, India, used the Narrative Practice Hypothesis as a theoretical grounding for a research project (BCS-0846892) that was top-ranked by the US National Science Foundation in 2008. This led to new therapies for children with severe autism to learn to convey information by training in the basic sequencing of actions to construct words and narratives. An initial clinical study in 2008, involving nine children in a therapeutic environment, yielded positive results – children who underwent the training increased the complexity of their communicative output (doi: 10.3389/fpsyg.2012.00012). The therapy now has been implemented in a computer-assisted format (doi: 10.1109/iTAG.2016.10; PointOutWords.online) and funded for a randomised controlled trial in the UK National Health Service.
- Patients suffering from schizophrenia, psychosis and autism
- Practitioners treating and diagnosing schizophrenia, psychosis and autism
- United Kingdom
Approach to Impact
Summary of the approaches to impact
Our approach to impact, exemplified by senior UOW researchers, develops pure lines of research but keeps possibilities for impact in view. These possibilities are explored through established research networks, involving international colleagues and non-academic end-users. Our networks allow for international input on potential applications for developing UOW research programs and external funding applications. We also use social media and open-access publishing to communicate research widely. Once interactions are established, the networks provide support to maintain these activities, and ensure that feedback from these end-user interactions helps direct further research.
Approach to Impact
Our approach to impact in Philosophy is built around a strategy of focusing research on issues that are already recognised as real-world problems, and providing philosophical insight through direct interactions with non-academic stakeholders. The research areas at the centre of philosophical work at UOW – the relationship between cognition and mental disorder, the ethical demands for action on climate change, and the role of autonomy in understanding the harms of sexual violence – are already easily recognised as significant and worthy of attention by non-philosophers and non-academics.
Our strategy involves building initial engagements surrounding problems related to core research, developing relationships and collaborations to extend research reach, and tuning research focus to concentrate on matters of practical significance. The impacts that arose from Gallagher and Hutto’s research began from their close collaboration, and extended to involve practicing clinical psychiatrists and clinicians. Networking activities, supported by research funding, enabled philosophers and psychiatrists to clarify and challenge shared understandings. This led practitioners to experiment with alternatives to their existing practices. As described in Part A, Gallagher and Hutto’s research affected a range of approaches to clinical diagnostics and therapy, rather than simply applying a single idea to an isolated problem. For example, as a result of coming in contact with our philosophical research, psychiatrists revised their diagnostic tools for assessing dimensions of interpersonal engagement and thus modified their methods for assessing schizophrenia.
These connections between theory and practice were further investigated in research outputs targeting practitioners, such as Gallagher and Hutto’s contributions to The Oxford Handbook to Philosophy of Psychiatry (OUP 2013). Through these channels, the unit was able to ensure that philosophically driven changes to practice established a shared basis for further collaboration.
Developing this impact required the establishment of strong research networks involving international colleagues and non-academic end-users. UOW’s contribution to these efforts began through a network associated with the ARC DP “Embodied Virtues and Expertise” (EVE) project (2010-12). Gallagher and Hutto, then appointed in the UK, were PIs on this project. Through them, UOW philosophers established research connections with two major Marie Curie Training Networks in Europe – “Disorders and Coherence of the Embodied Self” (DISCOS) (2007–11), a consortium of nine European centres of excellence in neuroscience, philosophy, psychology and psychiatry, and “Towards an Embodied Science of Intersubjectivity” (TESIS) (2011-15), one of the largest projects ever awarded by the European FP7 Programme, combining the expertise of 13 European research institutes, clinical centres and private enterprises.
Crucially, these networks enabled researchers to do much more than simply share isolated results. They enabled close interactions between researchers and a wide variety of stakeholders, including clinical practitioners. Involving practitioners centrally in these activities led to philosophers co-authoring with clinicians (Röhricht, Gallagher, Geuter and Hutto 2014 – see part A). Such work continued via UOW’s Narrative Practices in Therapy Initiative (NPT) (2014-16), led by Hutto. NPT supported a series of conferences and workshops (Feb 2015, Nov 2016, Feb 2016) on the role of narrative in psychiatry and psychotherapy. These events involved psychiatrists (Dr. Kirmayer, McGill), psychologists (Dr. Fivush, Emory College), narrative therapists (Dr. Denborough, Dulwich Centre, Adelaide), and clinicians (Dr. Cole, Poole Hospital, UK). NPT also made training in narrative therapy available to philosophers, allowing two HDR students to enhance their work by undertaking training with a practicing therapist, Dr.Taub, In-Sight Narrative Therapy, Sydney.
Research networks of this kind serve us well, enabling our unit to increase its capacity for impact by attracting new staff. The success of the EVE led, in 2014, to UOW’s appointment of Hutto as Senior Professor and Gallagher as Research Fellow. Other networks also led to the appointment of two current members of UOW staff: Kirchhoff (originally associated with EVE as a PhD student) and Satne (associated with Hutto and Gallagher as a Vice Chancellor’s postdoctoral fellow on the TESIS project). The successful networking approach of EVE, DISCOS, and TESIS has become a model for philosophical research at UOW. It was implemented in NPT, and its successor, the Narrative Research Network.
UOW continued to invest in our impact efforts by funding opportunities for philosophical researchers, including HDR students, to engage with new, large-scale international research networks involving practitioners, such as the Canada First Research Excellence Fund project ‘Healthy Brains for Healthy Lives’; the Netherlands Organization for Scientific Research funded ‘A Humanities approach to Self-management in Psychiatry and Psychosomatic Medicine’; and the Academy of Finland funded project ‘The Literary in Life’.
Our approach to impact places great value on involving non-academic users in philosophically focused projects, linking research and practice. We establish fruitful network connections through sponsored events involving potential impact partners, and support staff to engage with international impact-oriented projects. We encourage our philosophers to emulate the ‘field philosopher’ as described by Hicks (2017). Accordingly, we seek to offer philosophizing “in response to a variety of game changers that have deeply philosophical elements”, with our researchers “shuttling between the academy and the larger world”.
Gallagher and Hutto developed their unified framework by building on each other’s work for over a decade [1-7]. Their collaboration began at the University of Hertfordshire and continued at UOW, where they took up appointments in 2014 [8-10]. Drawing on phenomenology, Gallagher developed a distinctive, embodied approach to social cognition and philosophy of mind. With Hutto, he considered evidence from developmental psychology and neuroscience, arguing that embodied practices of social interaction (e.g. posture, gesture, facial expression, vocal intonation) support our skills for detecting and dealing with the purposeful intentions of others. Rather than attributing mental states, individuals cope in such interactions by perceiving and responding to the expressive attitudes of others situated in particular pragmatic and social contexts. This embodied practice approach challenges the overly individualistic explanations of these phenomena found in ‘theory of mind’ accounts in philosophy, psychology and cognitive science.
Drawing on analytic philosophy, Hutto added to the framework, developing the ‘Narrative Practice Hypothesis’. Hutto promoted the idea that our everyday ability to make sense of actions in terms of reasons takes the form of engaging in a distinctive kind of narrative practice. With Gallagher, he argued that these high-level folk psychological capacities can be explained without the need to posit the existence of any kind of inherited ‘theory of mind’ devices.
1. Hutto, D.D. 2003. ‘Folk psychological explanations: Narratives and the case of autism’, Philosophical Papers 32: 345–61.
2. Gallagher, S. 2007. ‘Pathologies in narrative structure’, in D. Hutto (ed.), Narrative and Understanding Persons. Cambridge: Cambridge University Press. Royal Institute of Philosophy Supplement: 60: 203–24.
3. Gallagher, S. and Hutto, D. 2008. ‘Understanding others through primary interaction and narrative practice’, in J. Zlatev, T. Racine, C. Sinha and E. Itkonen (eds), The Shared Mind: Perspectives on Intersubjectivity (17–38). Amsterdam: John Benjamins.
4. Hutto, D.D. 2008. Folk Psychological Narratives: The Socio-cultural Basis of Understanding Reasons. Cambridge, MA: MIT Press.
5. Gallagher, S. 2009. Delusional realities. In L. Bortolotti and M. Broome (eds.), Psychiatry as Cognitive Neuroscience (245-66). Oxford: Oxford University Press.
6. Gallagher, S., Hutto, D., Slaby, J. and Cole, J. 2013. The brain as part of an enactive system (commentary). Behavioral and Brain Sciences 36 (4): 421-422.
7. Hutto, D.D. 2013. ‘Interpersonal Relating.’ Oxford Handbook to Philosophy of Psychiatry, Fulford, KWM, Davies, M., Graham, G. Sadler, J., Stanghellini, G. and T. Thornton (eds). Oxford University Press. 240-257.
8. Röhricht, F., Gallagher, S., Geuter, U. and Hutto, D.D. 2014. ‘Embodied cognition and body psychotherapy: The construction of new therapeutic environments.’ Sensoria: A Journal of Mind, Brain & Culture, 56, pp. 11-20.
9. Gallagher, S. and Varga, S. 2015. Social cognition and psychopathology: a critical overview. World Psychiatry 14 (1): 5-14. DOI 10.1002/wps.20173
10. Parnas, J. and Gallagher, S. 2015. Phenomenology and the interpretation of psychopathological experience. In L. Kirmayer, R. Lemelson, and C. Cummings (eds.), Revisioning Psychiatry Integrating Biological, Clinical and Cultural Perspectives (65-80). Cambridge: Cambridge University Press.