The document discusses theory of mind, including: 1) Defining theory of mind as the ability to infer mental states like beliefs, desires, intentions in oneself and others and understand they may differ. 2) The two main theories of how theory of mind develops are the theory-theory, which proposes it is based on learned folk psychology, and simulation theory, which suggests imagining oneself in another's perspective. 3) Theory of mind develops through childhood, starting with imitation and joint attention, then understanding knowledge, beliefs, and later false beliefs around ages 3-5. Neuroimaging research implicates temporal pole, medial prefrontal cortex, and posterior superior temporal sulcus in theory of mind.

1. Theory Of Mind
Dr (Maj) Ashutosh Ratnam
Resident Psychiatry
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2. OVERVIEW
Introduction
Definition & Vocabulary
Theories of Theory of Mind (ToM)
Development of a ToM
Tests Evaluating a ToM
Neuroanatomy
Clinical Implications
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3. INTRODUCTION
“As humans we assume that others want, think, believe and the like,
and thereby infer states that are not directly observable, using these
states anticipatorily, to predict the behaviour of others as well as our
own. These inferences, which amount to a theory of mind, are to our
knowledge, universal in human adults”
(Premack, D. G.; Woodruff, G. (1978). "Does the chimpanzee have a theory of mind?". Behavioural and
Brain Sciences 1 (4): 515–526.
e.g. Chimpanzee shown a video of human encountering
problems
 Video stopped before solution reached
 Chimp consistently chose picture depicting human solving
problem
 Interpretation : attributed mental state to actor
3

4. When competing with others for
food chimps take into account
what the competitor can or cannot
see/hear and even what he
does/does not know
• Conceal own approach to food
• No understanding of false beliefs
• Performance did not improve
despite knowing competitor held a
false belief
Hare B, et al (2001) Do Chimpanzees know what
cospecifics know? Anim. Behav. 61, 139-51
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5. INTRODUCTION
Definition :
The ability to
 recognise that all people act on the basis of mental states or
propositional attitudes (beliefs, desires, etc)
 attribute mental states or attitudes to oneself and to others
 understand that others have beliefs, desires and intentions
different from one’s own
 Premack, D. G.; Woodruff, G. (1978). "Does the chimpanzee have a theory of mind?". Behavioral and
Brain Sciences 1 (4): 515–526.
“Theory of mind is being able to infer the full range of mental
states (beliefs, desires, intentions, emotions etc) that cause
action. Having a theory of mind is to be able to reflect on the
contents of one’s own and other’s minds”
Baron-Cohen S, (2001) “Theory of Mind and Autism: a review”. J of Applied Research in
Mental Retardation
5

6. INTRODUCTION
Meta-representation – internal/mental representation of
ourselves and others as conscious beings who mentally
represent external reality
(Firth, 1992)
- Ability to represent someone else’s act of representing the world
(Josef Pener)
Mentalising – the process of deploying a ToM to infer states of
minds of others
(Langdon,R, Coltheart, M, 2001)
Intentional stance – intuitively understanding that the actions of
others are goal-directed and arise from particular beliefs or
desires
(Daniel Dennet, 1990)
Reflexive awareness – awareness of ourselves and others as
thinking beings
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7. Theories of ToM
1. Theory-Theory
2. Simulation Theory
a) Direct Matching
b) Inverse Modelling
c) Response Modelling
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8. Theory-Theory
‘Folk’ psychological ability resting upon knowledge of a theory
Theory = “large no. of conditional statements, with the
conjunction of
 explanatory factors as antecedents
 explanandum as consequence”
 A person who suffers bodily damage will feel pain
 A person who is denied food will feel hungry
Together, forms an integrated body of knowledge concerning
law-like relations between
 external circumstances
 internal states
 overt behaviour
Churchland, P. M. (1991). Folk psychology and the explanation of human behavior. In: J. D. Greenwood (Ed.). The future of folk
psychology. Cambridge: Cambridge University Press. 51–69.
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9. Theory-Theory
Use constantly, unaware of laws of which it is composed →
implicit/tacit
 e.g. Person untrained in science knows just as well about food and hunger
Independent of
knowledge of one’s own mind
human psychology
Anyone who knows laws and propositions can form predictions
and explanations
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10. Theory-Theory acquisition
1. Learned
a) By implicit “teaching” through others
b) Learning step-by-step by living with/having social interactions
with others
2. Innate
a) If young children ‘construct’ a theory how do all come to same
theory by age four?
b) If “learnt from” adults, can it take place w/o explicit ‘teaching’?
c) If learnt how can it be invariant across cultures/historical eras?
Carruthers, 1996
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11. Simulation-Theory
Use “resources of our own mind to simulate others”
1. Creation of pretend states to match those of target
2. Processing of ‘pretend states’ by same mechanisms used to
understand own mental states
3. Assignment/projection of those states’ interpretations onto
target
Goldman, A. (2005). Imitation, mind reading, and simulation. In S. Hurley, & N. Chater, Perspectives on Imitation
II (pp. 80-81). Cambridge, MA: MIT Press.
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12. Mirror Neurons
Neuron which fires both
when
 animal acts
 observes the an action
being performed by
another animal
Humans
 Premotor Cortex
 Primary Somatosensory
area
 Inf Parietal Cortex
 Supplementary Motor
Area
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13. Mirror Neurons 13
Functions
 Empathy
 Ant Insula, Ant Cingulate Cortex, Inf Frontal
Cortex
 Understanding actions & learning
new skills by imitation
 Simulating observed actions
(ToM)
 Interpreting intentions of other
people
 Coupling of perception & action

14. Simulation-Theory
Direct Matching Hypothesis
 Mirror Neurons mimic state of target in the observer
 Smiling, Anger, etc
 Mirroring elicits similar emotion/intention in observer
 Implicitly/explicitly projected upon target
Inverse Modeling Hypothesis
 Mirror Neurons simulate intended goal of action first
 Observer then uses conceptual ability to infer intention of action
Response Modeling Hypothesis
 Mirror Neurons prepare complementary action in response to
target
 Dynamically couple action observation to action execution
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15. Ontogenic aspects
6 months of age: Animate Vs inanimate
12 months: Joint attention
14-18 months: Senses direction of another’s gaze.
18-24 months: Pretense (Decoupling of reality)
 3-4 years: False beliefs in others
6-7 years: Jokes, Metaphors, Irony
9-11 years: ‘faux pas’.

16. Development
1. Imitative Experiences with Other People
2. Understanding Attention in Others
3. Understanding Others’ Knowledge
4. Understanding Others’ Beliefs
a) True Beliefs
b) False Beliefs
5. Understanding Others’ Intentions
Firth, CD (1992) The cognitive neuropsychology of schizophrenia. Hove, UK: Psychology Press
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17. Development 17
1. Imitative experiences with others
 Precursor of perspective-taking and
empathy
 Recognition of equivalence between
physical and mental states apparent in
others and those felt in self
 Construction of first-person experience
 Map the relation between mental experiences
and behaviour (facial gesture)
 Infer about experiences of others
 On seeing others behave like himself, infer
that others have similar mapped mental state
Meltzoff, A. N. (2002). Imitation as a mechanism of social cognition: Origins of empathy, theory of
mind, and the representation of action. In U. Goswami (Ed.), Handbook of childhood cognitive
development (pp. 6-25). Oxford: Blackwell Publishers.

18. Development
2. Understanding Attention
Skill formed at 7-9 months age
Understanding that
 Seeing can be directed selectively as attention
 Viewer assess a seen object as ‘of interest’
 Seeing induces beliefs
Sharing → Following → Directing attention
(Carpenter, Nagell & Tomasello 1998)
Attention can be directed and shared by pointing
 Taking into account other person’s mental state
(Baron-Cohen, S. (1991). Precursors to a theory of mind: Understanding attention in others. In A.
Whiten (Ed.), Natural theories of mind: Evolution, development and simulation of everyday
mindreading (pp. 233-251). Oxford: Basil Blackwell.)
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19. Development
3. Understanding Others’ Knowledge
Povinelli & de Blois (1992)
3yrs vs 4yrs old children
‘Hider’ – hid toy in 1 of 4 containers behind screen
‘Knower’ – saw hider placing toy
‘Guesser’ – left before hider placed toy
 ‘Knower’ and ‘Guesser’ guided/advised children where toy was
4yr olds always chose correct cups, 3yr olds inconsistent
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20. Development 20
O Neill (1996)
• Child would watch toy being hidden
in cup/box
• Parent would/would not be present
• When asking parent for help with
retrieval
• If not present – child significantly
more often named toy, named
location, gestured location
Dunham, Dunham, & O‘Keefe
(2000)
• if the parent‘s eyes are covered at
an irrelevant point in the hiding
process (before but not during the
hiding), young 2-year-olds treat the
parent as ignorant

21. Development
4. Understanding Others’ Intentions
Meltzoff (1995)
 18 month old children
 E attempted to pull an object away from another to which it is
attached, but failed
 Infant able to infer what action person tried to perform
Call, Tomasello (1998)
 2-3 year old child
 Able to discriminate when E intentionally vs accidentally marked a
box as baited with stickers
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22. Development
5. Understanding Others’ Beliefs
Begin to explain others’ behaviours based on beliefs at 3yrs
age
Wellman & Bartsch, 1988
Sam wants to find his puppy. The puppy might be hiding in the
garage or under the porch. But Sam thinks the puppy is under the
porch. Where will Sam look for the puppy: in the garage or under the
porch?
Three-year-olds pass this test.
3-year-olds do badly on tests of false beliefs.
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23. Neural areas in ToM
Temporal
Pole
Dorsal
medial
PFC
Sup temporal
Sulcus

24. Neuroanatomy – Temporal Pole
 aka Association cortex
 Prefrontal Cortex (through Uncinate Process)
 Basal forebrain
 Visual / Auditory / Olfactory areas
Functions
 Emotional attachment to peers/infants
 Decoding/production of social signals
 Narrative Coherence
 Coding for personal memories
 Representing social motives and appropriateness behaviour of
others (rTPJ)
 Difficulty predicting how even familiar people behave in social/emotional
circumstances
Kaplan & Sadock, Comprehensive Text book of Psychiatry 9th edition
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25. Posterior Sup Temporal Sulcus
Perception of biological motion
Motion cues express social information (intent)
 Gaze shifts, communicative gestures
 Heider-Simmel animations
 Attribution of mental states even in absence of motion cues
(trustworthiness)
 ?? Three distinct regions
1. Biological motion
2. Mentalize whether or not motion
cues are present
 Active vs passive movement
3. Mental states from motion cues
 More active when mvt is
incongruous
 Kaplan & Sadock, Comprehensive Text book of Psychiatry 9th edition
25

26. Medial Prefrontal Cortex
 Anterior-most part of paracingulate cortex
26

27. Medial Prefrontal Cortex
Pain / Tickling / Autobigraphical Memory / Aestheic Judgement
↓
 Attending to mental state giving rise to experience
 Create a representation of what one thinks/feels
 Perspective taking
 Perception of Communicative actions
 Present and Foreseen Social Interactions
 Lesion = Frontal variant of Fronto-temporal dementia
 Striking personality changes, empathy impaired, ToM test
performance poor
 Executive functions preserved
Kaplan & Sadock, Comprehensive Text book of Psychiatry 9th edition
27

28. Neuroanatomy – ToM
Rt Temporal Pole
Med PFC
Post Sup Temp Sulcus – biological motion, attributing cues
Distinguishing between False Belief and False-photograph test
Saxe, R; Kanwisher, N (2003). "People thinking about thinking peopleThe role of the temporo-
parietal junction in "theory of mind"". NeuroImage 19 (4): 1835–42
Saxe, Rebecca; Schulz, Laura E.; Jiang, Yuhong V. (2006). "Reading minds versus following
rules: Dissociating theory of mind and executive control in the brain". Social Neuroscience 1 (3–
4): 284–98.
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Mentalising

29. FALSE PHOTOGRAPH
TEST
 Zaitchik (1990):
compared out-of-date
beliefs to out-of-date
photographs (same structure,
cognitive demands)
 3-year-olds fail this too
executive function
problems? (difficulty
inhibiting the perceptually
salient response? – not a
problem in tasks using
looking measures)
from Happé (1994)

30. Tests of Theory of Mind
1. False Belief Tasks
a) First Order
b) Second Order
c) Third Order
2. ToM Stories
3. Eye Interpretation Tasks
4. Hinting Tasks
5. Heider-Simmel (like) animations
6. Faux pas
30

31. False Belief Tasks
False belief = beliefs about the world which diverge from reality
 Understand how knowledge is formed
 People’s beliefs and mental states are based on their knowledge
 Mental states can differ from reality
 Behaviour can be predicted by mental states
1. First Order
a) Sally-Anne Test
b) Smarties Test
2. Second Order
3. Third Order
31

32. False Beliefs:
Sally-Anne (Maxi)
test
(Baron-Cohen, Leslie, & Frith,
1985; Wimmer & Perner, 1983)
control questions:
− Where is the marble really?
− Where did Sally put the marble
at the beginning of the story?
 3-year-olds say box, where it is
(fail); 4+-year-olds say basket
from Frith (1989)

33. Development
3. Understanding Others’ Knowledge
Povinelli & de Blois (1992)
3yrs vs 4yrs old children
‘Hider’ – hid toy in 1 of 4 containers behind screen
‘Knower’ – saw hider placing toy
‘Guesser’ – left before hider placed toy
 ‘Knower’ and ‘Guesser’ guided/advised children where toy was
4yr olds always chose correct cups, 3yr olds inconsistent
33

34. False Beliefs:
Smarties test
(Perner, Leekam, & Wimmer,
1987)
control questions:
− Is that what’s really in here?
− What is really in here?
 again, 3-year-olds fail (say
pencil); 4+-year-old pass (say
Smarties)
from Frith (1989)
?
?

35. False Belief Tasks 35
What does the person with the blue
shirt believe is in the bag?
(false belief)
Gift, present, flower, (bug is incorrect)
What‘s in the bag? (reality)
Wasp, bee, insect, or bug
What does the person in blue shirt
believe the person in red intends to
do?
(2nd order false belief)
Give him a gift or present
What does the person in red assume
the person with the blue shirt believes,
regarding his (the one in red)
intentions? (3rd order false belief)
Give him a gift or present

36. Theory of Mind Stories
Misunderstanding (Glove): A burglar who has just robbed a
shop is making his getaway. As he is running home, a
policeman on his beat sees him drop his glove. He doesn’t
know the man is a burglar, he just wants to tell him he dropped
his glove. But when the policeman shouts out to the burglar,
‘‘Hey you, Stop!’’, the burglar turns round, sees the policeman
and gives himself up. He puts his hands up and admits that he
did the break-in at the local shop.
1. Was the policeman surprised by what the burglar did?
2. Why did the burglar do this, when the policeman just wanted
to give him back his glove?
36

37. Theory of Mind Stories
Lie (Dentist): John hates going to the dentist because every
time he goes to the dentist he needs a filling, and that hurts a
lot. But John knows that when he has toothache, his mother
always takes him to the dentist. Now John has bad toothache
at the moment, but when his mother notices he is looking ill
and asks him ‘‘Do you have toothache, John?’’. John says
‘‘No, Mummy’’.
1. Is it true what John says to his mother?
2. Why does John say this?
37

38. Eye Interpretation Tasks 38
• Pure Theory of Mind Test
• No executive function
required
• Tests recognition of
complex mental states
• Artificial constraints not
present in real life
• Limited Choice of options
• Unlimited time to study
faces
• Validation study sample
size small

39. Hinting Tasks
Participant infers intentions behind veiled speech act
Normal adults perform close to ceiling
Example
Paul has to go to an interview and he’s running late. While he is
cleaning his shoes, he says to his wife, Jane:
“I want to wear my blue shirt but it’s very creased.”
Question: What does Paul really mean when he says this?
(If necessary add: Paul goes on to say: “Its in the ironing
basket.”
Question: What does Paul want Jane to do?)
39

40. Faux Pas Test
Faux pas = beach of etiquette
Recognition calls for a high level of ToM
Jill had just moved into a new apartment. Jill went shopping and
bought some new curtains for her bed room. When she had just
finished decorating the apartment, her best friend, Lisa, came
over. Jill gave her a tour of the apartment and asked, “How do
you like my bedroom?”
“Those curtains are horrible” Lisa said, “I hope you are going to
get some new ones!”
Questions
1. Did Lisa know the curtains were new?
2. Did some one say something she shouldn’t have said?
40

41. Spectrum of ToM abnormalities
Deficit in
TOM ability
Application
Deficit in TOM
Abnormal
attributions
Normal
TOM
Impaired
Sense of
Self-Agency
Autism NormalPassivity
phenomena
+ve Sx
Schiz
Asperger’s
-ve Sx Schiz
?PD
(Abu-Akel 1999)

42. ToM in Autism
S Baron Cohen, (1985)
 Autistic children consistently fail False-Belief tasks e.g.Sally-Anne
(80%)
 Down’s Syndrome children did not fail (86%)
 Difficulties persisted even when child matched for verbal skill
 Deficits persisted on picture story, hinting, when matched for
age/language
 Inability to assign mental states to others
Neuroimaging studies
 less activation in
 mPFC (Happe (1996),
 Frontal regions ( Ring, Baron-Cohen 1999),
 mPFC, posterior STS, temporal poles (Castelli 2002)
 STS hypo-activation (Pelphrey 2005).
 m PFC and right STS (Wang 2007)
42

43. ToM in Autism
Social-affective Justification (Hobson)
 ToM deficits are result of distortion in ability to understand &
reciprocate to emotions
 Devoid of skills (social referencing ability) which later lets them
comprehend and react to other people’s feelings
(Hobson, R.P. (1995). Autism and the development of mind. Hillsdale, N.J.: Lawrence Erlbaum
Associates Ltd.)
Developmental Delay
 Consistent with varying degrees of impairment (difficulties at
various stages of growth)
 Early setbacks → Joint attention behaviour ability impaired
 Hence unable to form full ToM
(Baron-Cohen, S. (1991). Precursors to a theory of mind: Understanding attention in others. In A. Whiten, Ed., Natural
theories of mind: Evolution, development, and simulation of everyday mindreading (233-251). Cambridge, MA: Basil
Blackwell.)
43

44. Ontogenic aspects
6 months of age: Animate Vs inanimate
12 months: Joint attention
14-18 months: Senses direction of another’s gaze.
18-24 months: Pretense (Decoupling of reality)
 3-4 years: False beliefs in others
6-7 years: Jokes, Metaphors, Irony
9-11 years: ‘faux pas’.

45. ToM in Schizophrenia
 Some symptoms of Schizophrenia are comparable to autism
 Social dysfunction / withdrawal / impaired social cognition
 ? accountable by ToM deficit
ToM deficits accounting for Schizophrenia Symptoms
Firth (1992)
45
Inability to perceive own intentions
Inability to see behaviour as result of own
willed action
Disorder of Willed Action
(Passivity)
Impaired self monitoring
Impaired awareness of self-generation of
thoughts
Delusion of alien control
Impaired monitoring of others
(impaired awareness of others’
intentions/thoughts)
Persecutory delusions
Delusions of reference
Delusions of misidentification

46. ToM in Schizophrenia
Disorganized, paranoid schizophrenia, (>) negative show ToM
deficits.
Correlation of ToM deficit with
 symptoms severity and remission
 social functioning
 pragmatic language use
ToM deficit is independent of
 General intellectual ability
 Memory
 Executive function
(Leigh Harrington , Richard Siegert & John McClure (2005) Theory of mind in schizophrenia: A critical
review, Cognitive Neuropsychiatry, 10:4, 249-286,)
46

47. ToM in Schizophrenia State v/s Trait
 5 studies found majority of ToM deficits disappear after acute episode
 Severity correlates with severity of illness.
 But in a few studies it was noted that,
 Chronically ill patients also have ToM deficits
 High schizotypal patients had ToM deficits (1 study)
 Remitted patients > Family members of Schiz patients > controls: on ToM
tasks. (3 studies)
 Imaging Findings
 Russel et al (2000): eye-reading task on f MRI showed hypo-activity
 left middle and inferior frontal regions
 middle temporal regions
 Brune (2001): picture-story task on PET hypo-activity
 right prefrontal cortex
 Hempel et al (2003) emotional recognition task
 Medial PFC
(Leigh Harrington , Richard Siegert & John McClure (2005) Theory of mind in schizophrenia: A critical review,
Cognitive Neuropsychiatry, 10:4, 249-286,)
47

48. Other Conditions with ToM Deficits
Bipolar Disorder (Kerr et al 2003, Montag et al 2009)
Depression (Wolkenstein et al, 2011)
Huntington’s Disease (Brune et al, 2011)
Frontotemporal Dementia (Gregory et al, 2002)
Callosal Agenesis (Booth et al, 2011)
Congenital Deafness
Schizoid, Schizotypal
Pridmore S (2006) Download of Psychiatry, University of Tasmania Press
48

49. REFERENCES
 Leigh Harrington , Richard Siegert & John McClure (2005)
Theory of mind in schizophrenia: A critical review, Cognitive
Neuropsychiatry, 10:4, 249-286,
 Goldman A.I, (2012) Theory of Mind, Oxford Handbook of
Philosophy and Cognitive Science
 Pridmore S (2006) Download of Psychiatry, University of
Tasmania Press
 Call J, Tomasello M., (2008) Does the chimpanzee have a
theory of mind? 30 years later. Trends Cogn Sci.
May;12(5):187-92.
 Flavell JH, (2004) Theory of Mind Development: Retrospect
and Prospect Merrill-Palmer Quarterly 50:3, 274-290
 Kaplan & Sadock, Comprehensive Text book of Psychiatry 9th
edition
49

50. THANK YOU
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