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Metacognition: towards a new approach to quality of life

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Abstract

Purpose

Recent studies have demonstrated that various diseases states (e.g., schizophrenia, Alzheimer’s disease) and events (e.g., a stroke) alter a person’s perception of their physical and mental status. Most often this involves alterations in a person’s metacognitive capabilities, and this can question the conceptual model of quality of life (QoL) based on a “perspectivist” approach.

Methods

Using the example of schizophrenia, we applied a philosophical model, developed by Griffin, to deal with this potential threat to the validity of QoL assessment.

Results

Patients with schizophrenia are at risk for being impaired in their ability to assess their QoL. We hypothesise that metacognition (i.e., the ability to attribute mental states in terms of beliefs and goals to one’s self and others) is a formal condition to assess QoL. This particular skill is important because self-reflection is necessary for making a qualitative judgment. A link between this psychological concept and the philosophical concept of reflexivity may be established. We propose a conceptual approach to QoL that takes into account the patient’s reflexivity. This approach is derived from Griffin’s theory based on the list of “prudential values” and the satisfaction of the informed desires of the individual.

Conclusion

The ability of patients to evaluate and value their life should be considered to enrich the concept of QoL. The approach derived from Griffin’s theory might constitute a new avenue for QoL research.

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References

  1. Awad, A. G., & Voruganti, L. N. (2012). Measuring quality of life in patients with schizophrenia: an update. Pharmacoeconomics, 30(3), 183–195.

    Article  PubMed  Google Scholar 

  2. Awad, A. G., Voruganti, L. N., & Heslegrave, R. J. (1997). Measuring quality of life in patients with schizophrenia. Pharmacoeconomics, 11(1), 32–47.

    Article  PubMed  CAS  Google Scholar 

  3. Leplege, A., & Hunt, S. (1997). The problem of quality of life in medicine. JAMA, 278(1), 47–50.

    Article  PubMed  CAS  Google Scholar 

  4. Pennacchini, M., Bertolaso, M., Elvira, M. M., & De Marinis, M. G. (2011). A brief history of the quality of life: Its use in medicine and in philosophy. Clinical Terminology, 162(3), e99–e103.

    CAS  Google Scholar 

  5. Voruganti, L., Heslegrave, R., Awad, A. G., & Seeman, M. V. (1998). Quality of life measurement in schizophrenia: Reconciling the quest for subjectivity with the question of reliability. Psychology Medical, 28(1), 165–172.

    Article  CAS  Google Scholar 

  6. WHOQOL (1995). The WHOQOL Group The World Health Organization quality of life assessment (the WHOQOL): Position paper from the World Health Organisation. Social Science Medicine, 41, 1403–1409.

    Article  Google Scholar 

  7. Amador, X. F., Strauss, D. H., Yale, S. A., Flaum, M. M., Endicott, J., & Gorman, J. M. (1993). Assessment of insight in psychosis. American Journal Psychiatry, 150(6), 873–879.

    CAS  Google Scholar 

  8. Aghababian, V., Auquier, P., Baumstarck-Barrau, K., & Lancon, C. (2011). Relationship between insight and self-reported quality of life among schizophrenic patients. Encephale, 37(3), 162–171.

    Article  PubMed  CAS  Google Scholar 

  9. Boyer, L., Aghababian, V., Richieri, R., Loundou, A., Padovani, R., Simeoni, M. C., et al. (2012). Insight into illness, neurocognition and quality of life in schizophrenia. Progress Neuropsychopharmacol Biological Psychiatry, 36(2), 271–276.

    Article  CAS  Google Scholar 

  10. Karow, A., Pajonk, F. G., Reimer, J., Hirdes, F., Osterwald, C., Naber, D., et al. (2008). The dilemma of insight into illness in schizophrenia: Self- and expert-rated insight and quality of life. European Archives Psychiatry Clinical Neuroscience, 258(3), 152–159.

    Article  CAS  Google Scholar 

  11. Kurtz, M. M., & Tolman, A. (2011). Neurocognition, insight into illness and subjective quality-of-life in schizophrenia: What is their relationship? Schizophrenia Research, 127(1–3), 157–162.

    Article  PubMed Central  PubMed  Google Scholar 

  12. Xiang, Y. T., Wang, Y., Wang, C. Y., Chiu, H. F., Chen, Q., Chan, S. S., et al. (2012). Association of insight with sociodemographic and clinical factors, quality of life, and cognition in Chinese patients with schizophrenia. Comprehensive Psychiatry, 53(2), 140–144.

    Article  PubMed  Google Scholar 

  13. Semerari, A., Carcione, A., Dimaggio, G., Falcone, M., Nicolo, G., Procaci, M., et al. (2003). How to evaluate metacognitive function in psychotherapy? The metacognition assessment scale its applications. Clinical Psychology Psychotherapy, 10, 238–261.

    Article  Google Scholar 

  14. Boyer, L., Richieri, R., Faget, C., Padovani, R., Vaillant, F., Mundler, O., Lançon, C., Auquier, P., Guedj, E. (2012). Functional involvement of superior temporal sulcus in quality of life of patients with schizophrenia. Psychiatry Research Neuroimaging, 202(2), 155–160. doi:10.1016/j.pscychresns.2012.02.006.

  15. Amador, X. F., Flaum, M., Andreasen, N. C., Strauss, D. H., Yale, S. A., Clark, S. C., et al. (1994). Awareness of illness in schizophrenia and schizoaffective and mood disorders. Archieve General Psychiatry, 51(10), 826–836.

    Article  CAS  Google Scholar 

  16. Fett, A. K., Viechtbauer, W., Dominguez, M. D., Penn, D. L., van Os, J., & Krabbendam, L. (2011). The relationship between neurocognition and social cognition with functional outcomes in schizophrenia: A meta-analysis. Neuroscience Biobehavioral Reviews, 35(3), 573–588.

    Article  PubMed  Google Scholar 

  17. Lysaker, P. H., Dimaggio, G., Carcione, A., Procacci, M., Buck, K. D., Davis, L. W., et al. (2010). Metacognition and schizophrenia: The capacity for self-reflectivity as a predictor for prospective assessments of work performance over six months. Schizophrenia Research, 122(1–3), 124–130.

    Article  PubMed  Google Scholar 

  18. Lysaker, P. H., Dimaggio, G., Buck, K. D., Callaway, S. S., Salvatore, G., Carcione, A., et al. (2011). Poor insight in schizophrenia: Links between different forms of metacognition with awareness of symptoms, treatment need, and consequences of illness. Comprehensive Psychiatry, 52(3), 253–260.

    Article  PubMed  Google Scholar 

  19. Lysaker, P. H., Erickson, M. A., Buck, B., Buck, K. D., Olesek, K., Grant, M. L., et al. (2011). Metacognition and social function in schizophrenia: Associations over a period of five months. Cognitive Neuropsychiatry, 16(3), 241–255.

    Article  PubMed  Google Scholar 

  20. Barofsky, I. (2003). Cognitive approaches to summary measurement: Its application to the measurement of diversity in health-related quality of life assessments. Quality Life Research, 12(3), 251–260.

    Article  Google Scholar 

  21. Barofsky, I. (2012). Quality, its definition and measurement as applied to the medically Ill. New York: Springer.

    Google Scholar 

  22. Kuhse, H. (1981). Debate: Extraordinary means and the sanctity of life. Journal Medical Ethics, 7, 74–82.

    Article  CAS  Google Scholar 

  23. Fagot-Largeault, A. (1994). Reflections on the notion of quality of life. In L. Nordenfelt (Ed.), Concept and measurement of quality of life in health care (pp. 135–160). Dordrecht: Kluwer.

    Chapter  Google Scholar 

  24. Brock, D. (1993). Health care and medical ethics. In M. Nussbaum & A. Sen (Eds.), The quality of life (pp. 95–132). Oxford: Clarendon Press.

    Chapter  Google Scholar 

  25. Boyer, L., Cermolacce, M., Dassa, D., Fernandez, J., Boucekine, M., Richieri, R., et al. (2012). Neurocognition, insight and medication nonadherence in schizophrenia: A structural equation modeling approach. Public Library of Science One, 7(10), e47655. doi:10.1371/journal.pone.0047655PONE-D-12-20284.

    PubMed Central  PubMed  CAS  Google Scholar 

  26. Dimaggio, G., & Lysaker, P. H. (2010). Metacognition and severe adult disorders: From basic research to treatment. London: Bruner.

    Google Scholar 

  27. Lysaker, P. H., Carcione, A., Dimaggio, G., Johannesen, J. K., Nicolo, G., Procacci, M., et al. (2005). Metacognition amidst narratives of self and illness in schizophrenia: Associations with neurocognition, symptoms, insight and quality of life. Acta Psychiatrica Scandinavica, 112(1), 64–71.

    Article  PubMed  CAS  Google Scholar 

  28. Bora, E., Sehitoglu, G., Aslier, M., Atabay, I., & Veznedaroglu, B. (2007). Theory of mind and unawareness of illness in schizophrenia: Is poor insight a mentalizing deficit? European Archieve Psychiatry Clinical Neuroscience, 257(2), 104–111.

    Article  Google Scholar 

  29. Faget-Agius, C., Boyer, L., Padovani, R., Richieri, R., Mundler, O., Lancon, C., et al. (2012). Schizophrenia with preserved insight is associated with an increased perfusion of the precuneus. Journal of Psychiatry and Neuroscience, 37(5), 297–304.

    Article  PubMed Central  PubMed  Google Scholar 

  30. Antonius, D., Prudent, V., Rebani, Y., D’Angelo, D., Ardekani, B. A., Malaspina, D., et al. (2011). White matter integrity and lack of insight in schizophrenia and schizoaffective disorder. Schizophrenia Research, 128(1–3), 76–82.

    Article  PubMed Central  PubMed  Google Scholar 

  31. Gallagher, H. L., & Frith, C. D. (2003). Functional imaging of ‘theory of mind’. Trends in Cognitive Sciences, 7, 77–83.

    Article  PubMed  Google Scholar 

  32. Kircher, T. T., Senior, C., Phillips, M. L., Benson, P. J., Bullmore, E. T., Brammer, M., et al. (2000). Towards a functional neuroanatomy of self processing: effects of faces and words. Brain Research. Cognitive Brain Research, 10(1–2), 133–144.

    Article  PubMed  CAS  Google Scholar 

  33. Materna, S., Dicke, P. W., & Thier, P. (2008). The posterior superior temporal sulcus is involved in social communication not specific for the eyes. Neuropsychologia, 46(11), 2759–2765.

    Article  PubMed  Google Scholar 

  34. Morgan, K. D., Dazzan, P., Morgan, C., Lappin, J., Hutchinson, G., Suckling, J., et al. (2011). Insight, grey matter and cognitive function in first-onset psychosis. British Journal Psychiatry, 197(2), 141–148.

    Article  Google Scholar 

  35. Dworkin, G. (1970). Acting Freely Noûs, 4, 367–383.

    Article  Google Scholar 

  36. Dworkin, G. (1989). The concept of autonomy. In J. Christman (Ed.), The inner citadel: Essays on individual autonomy (pp. 54–62). New York: Oxford.

    Google Scholar 

  37. Frankfurt, H. (1971). Freedom of the will and the concept of a person. The Journal of Philosophy, 68(1), 5–20.

    Article  Google Scholar 

  38. Jeffrey, R. C. (1974). Preferences among preferences. The Journal of Philosophy, 71(13), 377–391.

    Article  Google Scholar 

  39. Bratman, M. (1996). Identification, decision and treating as a reason. Philosophical Topics, 2, 1–18.

    Article  Google Scholar 

  40. Bratman, M. (2000). Reflection, planning, and temporally extended agency. The Philosophical Review, 109(1), 35–61.

    Article  Google Scholar 

  41. Taylor, C. (1976). Responsibility for self. In A. Rorty (Ed.), The identities of persons (pp. 281–299). Berkeley: University of California Press.

    Google Scholar 

  42. Cummins, R. A. (2005). Moving from the quality of life concept to a theory. Journal of Intellectual Disability Research, 49, 699–706.

    Article  PubMed  CAS  Google Scholar 

  43. Staring, A. B., Van der Gaag, M., Van den Berge, M., Duivenvoorden, H. J., & Mulder, C. L. (2009). Stigma moderates the associations of insight with depressed mood, low self-esteem, and low quality of life in patients with schizophrenia spectrum disorders. Schizophrenia Research, 115(2–3), 363–369.

    Article  PubMed  CAS  Google Scholar 

  44. Read, D. (2007). Experienced utility: Utility theory from Jeremy Bentham to Daniel Kahneman. Thinking and Reasoning, 13(1), 45–61.

    Article  Google Scholar 

  45. Kelman, M. (2005). Hedonic psychology and the ambiguities of ‘welfare. Philosophy & Public Affairs, 33(4), 391–412.

    Article  Google Scholar 

  46. Picavet, E. (2000). Le concept de qualité de vie (entre besoins, satisfaction psychologique et faculté de choix. Cités, 4, 111–120.

    Google Scholar 

  47. Nozick, R. (1974). Anarchy, state and Utopia. New York: Basic Books.

    Google Scholar 

  48. Foot, P. (2001). Natural goodness. New York: Oxford.

    Book  Google Scholar 

  49. Griffin, J. (2000). Replies in Crisp R. and Hooker B. Well-being and morality: Essays in honour of James Griffin. New York: Oxford University Press.

    Google Scholar 

  50. Sidgwick, H. (1907). The methods of ethics (7th ed.). London: Macmillan.

    Google Scholar 

  51. Bentham, J. (1789). An introduction to the principles of morals and legislation. Oxford: Clarendon.

    Google Scholar 

  52. Kahneman, D., Diener, E., & Schwarz, N. (1999). Well-being: The foundations of hedonic psychology. New York: Russell Sage Foundation.

    Google Scholar 

  53. Varelius, J. (2003). Autonomy, subject-relativity, and subjective and objective theories of well-being in bioethics. Theoretical Medicine, 24, 363–379.

    Article  Google Scholar 

  54. Auquier, P., Simeoni, M. C., Sapin, C., Reine, G., Aghababian, V., Cramer, J., et al. (2003). Development and validation of a patient-based health-related quality of life questionnaire in schizophrenia: The S-QoL. Schizophrenia Research, 63(1–2), 137–149.

    Article  PubMed  CAS  Google Scholar 

  55. Calman, K. C. (1984). Quality of life in cancer patients—an hypothesis. Journal Medical Ethics, 10(3), 124–127.

    Article  CAS  Google Scholar 

  56. Harsanyi, J. C. (1997). Utilities, preferences, and substantive goods. Social Choice and Welfare, 14, 129–145.

    Article  Google Scholar 

  57. Rawls, J. (1971). A theory of justice. Oxford: Oxford University Press.

    Google Scholar 

  58. Erikson, R. (1974). Welfare as a planning goal. Acta Sociologica, 17, 273–288.

    Google Scholar 

  59. Sen, A. (1985). Well-Being, Agency and Freedom. The Dewey Lectures. Journal of Philosophy, 82, 169–221.

    Article  Google Scholar 

  60. Griffin, J. (1986). Well-Being, its meaning, measurement and moral importance. Oxford: Clarendon.

    Google Scholar 

  61. Coast, J., Flynn, T. N., Natarajan, L., Sproston, K., Lewis, J., Louviere, J. J., et al. (2008). Valuing the ICECAP capability index for older people. Social Science Medicine, 67(5), 874–882.

    Article  PubMed  Google Scholar 

  62. Parfit, D. (1984). Reason and persons. Oxford: Oxford University Press.

    Google Scholar 

  63. Scanlon, T. (1993). Value, desire, and quality of life. In M. Nussbaum & A. Sen (Eds.), The quality of life (pp. 185–207). Oxford: Clarendon.

    Chapter  Google Scholar 

  64. Christman, J. (1991). Autonomy and personal history. Canadian Journal of Philosophy, 21(4), 1–24.

    Google Scholar 

  65. Frankfurt, H. (1982). The Importance of what we care about. Synthese, 53(2), 257–272.

    Article  Google Scholar 

  66. Watson, G. (1975). Free agency. The Journal of Philosophy, 72(8), 205–220.

    Article  Google Scholar 

  67. MacIntyre, A. (1981). After virtue: A study in moral theory (2nd ed.). Notre Dame: University of Notre Dame Press.

    Google Scholar 

  68. Nussbaum, M. (2003). Capabilities as fundamental entitlements: Sen and social justice. Feminist Economics, 9(2–3), 33–59.

    Article  Google Scholar 

  69. Wittgenstein, L. (1973). Philosophical investigation. (Trad. E. Anscombe), 3 ed., Upper Saddle River, New Jersey: Prentice Hall.

  70. Boyer, L., & Auquier, P. (2012). The lack of impact of quality-of-life measures in schizophrenia: A hared responsibility? Pharmacoeconomics, 30(6), 531–532.

    Article  PubMed  Google Scholar 

  71. Locke, John., & Peter H. Nidditch. (Eds.). (1979). An Essay Concerning Human Understanding. Oxford University Press, Paperback, Language English, 776 pp

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Authors and Affiliations

  1. EA 3279, Self-perceived Health Assessment Research Unit, Aix-Marseille University, Marseille, France

    Julien Blanc, Laurent Boyer & Pascal Auquier

  2. Department of Public Health, Assistance Publique—Hôpitaux de Marseille, Marseille, France

    Laurent Boyer & Pascal Auquier

  3. UMR 7268, Biocultural Anthropology, Law, Ethics and Health, Aix-Marseille University, Marseille, France

    Julien Blanc & Pierre Le Coz

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  1. Julien Blanc
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  2. Laurent Boyer
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  3. Pierre Le Coz
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  4. Pascal Auquier
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Correspondence to Laurent Boyer.

Appendix: Presentation of the main philosophical concepts and authors cited

Appendix: Presentation of the main philosophical concepts and authors cited

Reflexivity is an abstract logical concept. It refers to the relation a term has with itself, and by extension to the relation between a term of a nature N and another term of the same nature N. Besides logic, this concept has been traditionally developed in philosophy to conceptualise consciousness, and the fact that a person cannot think without thinking he is thinking. Since Locke [71], (An Essay Concerning Human Understanding, 1690), the reflexive relation of thoughts about thoughts, or “cognitive reflexivity”, has been extensively explored in philosophy, and more recently in psychology or cognitive sciences. However, another form of reflexivity of desires about desires or “conative reflexivity” is not yet fully explored and presents a certain interest to conceptualise evaluation of QoL. Reflexivity does not denote here a sophisticated intellectual ability or skill.

First-order and second-order desires First-order desires are immediate desires for a particular action (e.g., to drink whisky) or object (e.g., to desire this glass of whisky). Second-order desires are desires about immediate, first-order desires. For example, a second-order desire is a desire not to be driven by the first-order desire to drink whisky. As a consequence, I am in harmony with myself when I have the second-order desire that my first-order desires come about.

Frankfurt, Harry Gordon (1929) American philosopher. His work during the 1970s on the concept of the self, on first and second-order desires, on personal identity and on the concept of “autonomy” has been very influential and much debated in moral philosophy. Among contemporary moral philosophers, he is one of the first who takes into account the importance of complexity in the relation individuals have to themselves in the conduct of life.

Griffin James (1933) American-born philosopher. He theorised a robust account of well-being or QoL in 1986 based on an extended critic of the three dominant QoL theories. These theories, called hedonism (the reduction in QoL to pleasure, mental states or feelings), preferentialism (equation of QoL with the satisfaction of individuals’ preferences or desires) and perfectionism (QoL as related to the realisation of an ideal form of life, objectively defined), present serious defaults. Griffin elaborated a theoretical compromise, showing that QoL cannot be properly understood without reference to “objective” non-individual values. Desires and values are codetermined. He suggested that QoL relies on the evaluations that individuals make of their lives.

Thought experiment speculative method. In philosophy, a thought experiment generally starts with “what would happen if…?” and aims at drawing a general conclusion about a concept from a counterfactual situation. It is not a demonstration.

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Blanc, J., Boyer, L., Le Coz, P. et al. Metacognition: towards a new approach to quality of life. Qual Life Res 23, 467–475 (2014). https://doi.org/10.1007/s11136-013-0485-7

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