Ferenc Köteles Body Sensations The Conscious Aspects of Interoception Body Sensations Ferenc Köteles Body Sensations The Conscious Aspects of Interoception Ferenc Köteles Faculty of Education and Psychology Eötvös Loránd University Budapest, Hungary ISBN 978-3-030-63200-7 ISBN 978-3-030-63201-4 (eBook) https://doi.org/10.1007/978-3-030-63201-4 © The Editor(s) (if applicable) and The Author(s), under exclusive license to Springer Nature Switzerland AG 2021 This work is subject to copyright. All rights are solely and exclusively licensed by the Publisher, whether the whole or part of the material is concerned, specifically the rights of translation, reprinting, reuse of illustrations, recitation, broadcasting, reproduction on microfilms or in any other physical way, and transmission or information storage and retrieval, electronic adaptation, computer software, or by similar or dissimilar methodology now known or hereafter developed. The use of general descriptive names, registered names, trademarks, service marks, etc. in this publication does not imply, even in the absence of a specific statement, that such names are exempt from the relevant protective laws and regulations and therefore free for general use. The publisher, the authors, and the editors are safe to assume that the advice and information in this book are believed to be true and accurate at the date of publication. Neither the publisher nor the authors or the editors give a warranty, expressed or implied, with respect to the material contained herein or for any errors or omissions that may have been made. The publisher remains neutral with regard to jurisdictional claims in published maps and institutional affiliations. This Springer imprint is published by the registered company Springer Nature Switzerland AG The registered company address is: Gewerbestrasse 11, 6330 Cham, Switzerland To Reni, Gergő, and Bazsi Foreword How do we know how we feel? To what degree do our internal sensations guide our thoughts, feelings, and behaviors? What is that slight pain I am feeling below my ribcage? The nature of interoception is one of the most vexing puzzles in psychol- ogy and medicine. Unlike our perceptions of light or sound or touch, which others can experience, our internal sensations are only directly available to us. We can try to describe the feelings to others but words often fail us. Every generation or so, a book comes along which provides a new window into the ways people perceive and respond to their bodies’ symptoms and sensations. Body Sensations: The Conscious Aspects of Interoception by Ferenc Köteles will be the authoritative voice for the next generation of researchers and practitioners. In this impressive volume, Köteles dissects each of the organ and muscular systems that provide perceptible signals to our brains. In addition to laying out the physiol- ogy of the neural pathways, he expertly guides the reader into the roles that learning, early experience, and various perceptual biases and distortions can play in shaping what we feel—or think we feel. In previous generations, great works on interoception were published by some of the top scholars of the time. Wilhelm Wundt and his students in Leipzig in the late 1800s defined the field by trying to map the relationships between objectively measured stim- uli (such as the brightness of light, the loudness of tones, pressure on the skin) to peo- ple’s sensory experiences of brightness, loudness, and pain. In well-c ontrolled laboratory environments, their group suggested that interoception was straightforward—the mag- nitude of stimuli was predictably related to the magnitude of the sensation. Over the next 100 years, Wundt’s optimistic view gradually diminished as researchers studied interoception among people and other organisms in real-world settings. William James (1890) argued that the conscious awareness of internal cues was the result of behavior and not the other way around. Pavlov and Luria found that an organism’s sensory experiences were shaped by multiple pathways in the brain and body, including stimuli that had been conditioned from past experiences. By the mid-1900s, the stark awareness that sensory experiences were influenced by ongoing shifts in people’s situations ushered in a new cognitive revolution (e.g., Gibson 1966; Schachter and Singer 1962). vii viii Foreword It was not until the late 1960s that there was a general acknowledgment that interoception was a challenge for all areas of psychology and medicine. The most influential force behind this idea was György Ádám. In his pioneering 1967 book, Interoception and Behavior, Ádám argued that sensory cues from our internal organs influenced almost all of our actions, including eating, balance, and attention. Although many of these signals were not consciously noticed, many perhaps most could be perceived if the person paid close attention. Over almost 50 years, he pub- lished a series of books on interoception that brought together the theoretical rigor of pioneers in physiology, perception, social psychology, evolution, and neurology. He was also a creative methodologist and experimental scientist on his own who devoted himself to understanding the biology and psychology of interoception. Ádám, however, was far more than a theoretically driven scientist. He was trained as a physician and was someone deeply interested in people. Unlike most interocep- tion researchers, he observed the complexities that patients have in explaining their symptoms to physicians. At the same time, he appreciated the difficulties of physi- cians trying to translate their patients’ symptoms into frameworks that make sense from a medical perspective. His own social skills and natural warmth encouraged patients and physicians to tell him their stories so that he could better understand the clinical challenges of interoception. Through a lucky accident, I was able to spend some time with Professor Ádám on a visit to Budapest in 1996. His 1980 book, Perception, Consciousness, and Memory, had a big impact on me while I was writing my first book on physical symptoms. When we met, I felt we had been friends for years. He had a twinkle in his eye that reflected the absolute joy he had in talking about interoception and the state of the world. I could see why those who knew him always said he was a remarkable teacher, mentor, and friend. I bring this up because one of Ádám’s students was Ferenc Köteles. In reading this book, you will see many of the same traits and intellectual interests as his men- tor. With each chapter, Professor Köteles reminds us of the long and varied history of the field of interoception. This is the most thorough book of the topic available covering some of the most recent breakthroughs in science. At the same time, you will appreciate many of the practical applications that may help you as a scientist, practitioner, or even as a regular human being who is awake in the middle of the night trying to figure out what that pain just below your ribcage might mean. The University of Texas at Austin, James W. Pennebaker Austin, TX, USA September 21, 2020 References Gibson JJ (1966) The senses considered as perceptual systems. Houghton Mifflin, Oxford, England James W (1890) The Principles of Psychology. Macmillan, London Schachter S, Singer JE (1962) Cognitive, social, and physiological determinants of emotional state. Psychol Rev 69:379–399 Preface This work presents a long journey. As we will see, many important aspects of body sensations, the major topic of this book, cannot satisfactorily be explained without having a closer look at our evolutionary heritage. In evolutionary terms, the entire story started about 500–600 million years ago (mya), increased in complexity approximately 220 mya, and might have reached its most sophisticated form only circa 50,000 years ago, perhaps even more recently. That is quite a perspective. My personal journey was also long although not that long. Still, I quite often have the impression that at least several hundreds of years would be necessary to read all the relevant books and scientific papers written on this topic. I could only devote approximately two decades to various aspects of this research area so far; my personal research interest includes the placebo and nocebo phenomenon, body awareness, symptom reporting, interoception, and the effects of complementary and mind–body interventions. It appears to be a mixed and rather over-sized bag at first sight, but all these areas have at least one thing in common: they are characterized by the complicated relationship between subjective experience and actual physio- logical changes. I have a master’s degree in both biology and psychology, and this complex background—combined with the influence of two significant mentors— strongly determines my scientific and everyday approach to pretty much everything. On top of this, the philosophical aspects of human consciousness always fascinated me. My older mentor, Professor György Ádám, was a physician and an early adept in interoception. He originally received training in the Pavlovian (classical condi- tioning) approach to interoception in the former Soviet Union; we still have his doctoral thesis written in Cyrillic script in our lab (Fig. 1). Later, he completed his knowledge with instrumental conditioning in Germany and the United States. His experimental findings and philosophical thoughts were summarized in three excel- lent monographs in English. Although he was primarily involved in the details of renal and gastrointestinal interoception, conditioning, and signal detection, he always attempted to put his findings in a broader context and tried to deal not only with the behavioral but also the psychological and even philosophical (i.e., consciousness-r elated) aspects of interoception. My younger mentor, Professor György Bárdos (himself mentored by György Ádám), is a biologist who started his ix x Preface Fig. 1 György Ádám and the title page of his doctoral (Candidate of Sciences/PhD/) dissertation written in 1955 in the Pavlov Institute of the Academy of Sciences of the Soviet Union. (Courtesy of the Ádám György Psychophysiology Lab) carrier with animal experimentation at the lab of György Ádám and worked with B.T. Engel, one of the early adepts of biofeedback research in the United States. Later in his carrier, he primarily focused on human-specific and pathological aspects of interoception. His knowledge was summarized in two monographs in Hungarian. The conversations and cooperation with these two excellent scholars who were not only experienced professionally but also very supporting personally had a decisive impact on my research interest and carrier. I am particularly indebted to them for their encouraging attitude and personal warmth. I prefer scientific books to papers. Papers are focused and concise, obviously representing the most effective option for scientific discussion and progress in the strict sense. Books, however, can tell an entire story and thus provide the reader with a more comprehensive understanding of the topic at hand. Book authors have enough room to express their subjective evaluation and hunches (which often rely on decades of rigorous work), which renders books more interesting, enjoyable, and edifying to me. I particularly like old school monographs; it turns out again and again that seemingly novel ideas were already described, or at least suspected, decades ago, and we just forgot them for a while. There also appears to be a tempo- ral fluctuation; a research area often gains momentum with each generation of researchers. Why? Perhaps because every joke is new for a newborn; or because the old questions can be asked and answered in new ways due to technological and theoretical advances. Still, I am convinced that the excellent monographs of György Ádám, Seymour Fisher, or James Pennebaker, dealing with various aspects of the topic, are worthy of studying or even teaching today (accompanied by a critical evaluation based on our recent knowledge, of course). Preface xi This monograph aims to summarize the recent scientific knowledge on conscious aspects of interoception. Actually, I prefer the term body sensations or body feelings (a more precise definition comes in Chap. 2). I believe that these conscious experi- ences are not suspicious artifacts or biased self-reports that should be eliminated from scientific research or replaced with processes that can be assessed more accu- rately and objectively. They are heavily influenced by top-down factors for sure; however, my conviction is that those factors themselves are worthy of investigation. For example, we will see later in the book that the discrepancy between actual and felt body events is a phenomenon with multiple consequences, both positive and negative. This deserves more research attention, and in fact should be taught in the elementary school to help people to make good health-related decisions later. I was always surprised by the fact that such a large discrepancy can be demonstrated in practically all areas of body-related research. In my own studies, it appeared in almost all areas from heartbeat detection ability to placebo and nocebo reactions and mind–body interventions. These findings will be discussed in a bit more detail in the book—the option of being subjective is one of the benefits and rewards of writing a monograph. Unfortunately, this work will not be without mistakes and errors. As it ranges from philosophy and various areas of psychology to neuroanatomy and medicine, perhaps nobody is able (or has the capacity) to understand each and every nuance of this broad area perfectly. Moreover, beyond personal limitations, the room is simply never enough for the detailed discussion of each and every detail. In return, I will do my best to draw a coherent picture on the topic and put it in the broadest possible perspective. The majority of the chapters of this work were written in Glenbrook Beach, New Zealand, and Kemence, Hungary. Long walks in these areas, characterized by the overwhelming presence of nature, were an incredible help to think about the details of certain findings, as well as to see the entire material from a distance that is neces- sary to identify the really relevant points and conclusions. I would like to thank many colleagues for their contribution to my understanding of this complex topic. Beyond my two mentors, I am indebted to Renáta Szemerszky, Eszter Ferentzi, Michael Witthöft, Áron Horváth, and Benedek Tihanyi T. for the conversations and research cooperation that substantially shaped my approach to interoception. Also, I am grateful to Zsuzsanna Dömötör, Barbara Csala, Luca Vig, Zsuzsanna Szabolcs, Péter Babulka, Szilvia Boros, and other former or recent mem- bers of the Ádám György Psychophysiology Lab for their help in designing and running the experiments. Finally, I thank Zsolt Demetrovics, the Dean of the Faculty of Education and Psychology, Eötvös Loránd University, for providing me with the opportunity of a 1-year-long sabbatical to prepare this work. Budapest, Hungary Ferenc Köteles September 28, 2020