Carruthers considers and rejects a mixed position according to which we have interpretative access to unconscious thoughts, but introspective access to conscious ones. I argue that this is too hasty. Given a two-level view of the mind, we can, and should, accept the mixed position, and we can do so without positing additional introspective mechanisms beyond those Carruthers already recognizes.

Alterations in consciousness are among the most common transdiagnostic psychopathological symptoms. Therefore clinical practice would benefit from a clear conceptual framework that guides the recognition, comprehension, and treatment of consciousness disorders. However, contemporary psychopathology lacks such a framework. We describe how pathology of consciousness is currently being addressed in clinical psychology and psychiatry so far, and how the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) and International Classification of Diseases, Tenth Edition (ICD-10) refer to this subject. A (...) brief review of the literature on consciousness is then given. After describing psychological perspectives on consciousness and discussing theoretical issues involved in exploring consciousness, we offer a practical clinical working definition of consciousness and we illustrate its connections with a variety of diagnoses. Making use of Jean-Paul Sartre’s distinctions among: states, functions, qualities, and structure, provide a conceptual framework to understand consciousness, to refine diagnostics and to guide the development of therapeutic possibilities in clinical practice. (shrink)

Theory of Mind (ToM) is the cognitive achievement that enables us to report our propositional attitudes, to attribute such attitudes to others, and to use such postulated or observed mental states in the prediction and explanation of behavior. Most normally developing children acquire ToM between the ages of 3 and 5 years, but serious delays beyond this chronological and mental age have been observed in children with autism, as well as in those with severe sensory impairments. We examine data from (...) studies of ToM in normally developing children and those with deafness, blindness, autism and Williams syndrome, as well as data from lower primates, in a search for answers to key theoretical questions concerning the origins, nature and representation of knowledge about the mind. In answer to these, we offer a framework according to which ToM is jointly dependent upon language and social experience, and is produced by a conjunction of language acquisition with children's growing social understanding, acquired through conversation and interaction with others. We argue that adequate language and adequate social skills are jointly causally sufficient, and individually causally necessary, for producing ToM. Thus our account supports a social developmental theory of the genesis of human cognition, inspired by the work of Sellars and Vygotsky. How are we to decide whether to take reason to be an essentially private thing that can, however, turn on a public display when it chooses to do so, or, like conversing, to be an essentially social skill, which can, however, be retained a while through periods of solitary confinement? (Annette Baier, The Commons of the Mind, p. 5). The squirrel does not infer by induction that it is going to need stores next winter as well (Wittgenstein, On Certainty§ 287). The problem of thought and language thus extends beyond the limits of natural science and becomes the focal problem of historical human psychology, i.e. of social psychology. Consequently, it must be posed in a different way (Vygotsky, Thought and Language, p. 51). From the very first days of the child's development his activities acquire a meaning of their own in a system of social behaviour and, being directed towards a definite purpose, are refracted through the prism of the child's environment. The path from object to child and from child to object passes through another person. This complex human structure is the product of a developmental process deeply rooted in the links between individual and social history (Vygotsky, Mind in Society, p. 30). (shrink)

This commentary focuses on evidence from autism concerning the relation between metacognition and mindreading. We support Carruthers' rejection of models 1 (independent systems) and 3 (metacognition before mindreading), and provide evidence to strengthen his critique. However, we also present evidence from autism that we believe supports model 2 (one mechanism, two modes of access) over model 4 (mindreading is prior).