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• Published: 05 August 2019

The human imagination: the cognitive neuroscience of visual mental imagery

• Joel Pearson   ORCID: orcid.org/0000-0003-3704-5037 1  

Nature Reviews Neuroscience volume  20 ,  pages 624–634 ( 2019 ) Cite this article

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• Object vision
• Sensory systems
• Working memory

Mental imagery can be advantageous, unnecessary and even clinically disruptive. With methodological constraints now overcome, research has shown that visual imagery involves a network of brain areas from the frontal cortex to sensory areas, overlapping with the default mode network, and can function much like a weak version of afferent perception. Imagery vividness and strength range from completely absent (aphantasia) to photo-like (hyperphantasia). Both the anatomy and function of the primary visual cortex are related to visual imagery. The use of imagery as a tool has been linked to many compound cognitive processes and imagery plays both symptomatic and mechanistic roles in neurological and mental disorders and treatments.

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Acknowledgements

The author thanks R. Keogh, R. Koenig-Robert and A. Dawes for helpful feedback and discussion on this paper. This paper, and some of the work discussed in it, was supported by Australian National Health and Medical Research Council grants APP1024800, APP1046198 and APP1085404, a Career Development Fellowship APP1049596 and an Australian Research Council discovery project grant DP140101560.

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The reverse direction of neural information flow, for example, from the top-down, as opposed to the bottom-up.

Magnetic resonance imaging and functional magnetic resonance imaging decoding methods that are constrained by or based on individual voxel responses to perception, which are then used to decode imagery.

Transformations in a spatial domain.

The conscious sense or feeling of something, different from detection.

A mental disorder characterized by social anxiety, thought disorder, paranoid ideation, derealization and transient psychosis.

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Pearson, J. The human imagination: the cognitive neuroscience of visual mental imagery. Nat Rev Neurosci 20 , 624–634 (2019). https://doi.org/10.1038/s41583-019-0202-9

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3 The Relationship between Visual Perception, Imagery, and Cognitive Functions

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This chapter presents imagery’s basic characteristics and its relationship to visual perception and cognitive functions, and discusses the pictorial and propositional theories of imagery. The association of imagery with visual perception and working memory is discussed with a focus on the importance of working memory. The chapter focuses on the importance of mental imagery in learning, reasoning, and mathematical abilities, along with its role in athletic performances, and discusses mental image generation from either long-term memory or perception. It explores the question of whether the brain region responsible for perceptual processing is also responsible for the development of mental images.

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• Review article
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A review of eye tracking for understanding and improving diagnostic interpretation

• Tad T. Brunyé   ORCID: orcid.org/0000-0002-8788-8764 1 ,
• Trafton Drew 2 ,
• Donald L. Weaver 3 &
• Joann G. Elmore 4  

Cognitive Research: Principles and Implications volume  4 , Article number:  7 ( 2019 ) Cite this article

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Inspecting digital imaging for primary diagnosis introduces perceptual and cognitive demands for physicians tasked with interpreting visual medical information and arriving at appropriate diagnoses and treatment decisions. The process of medical interpretation and diagnosis involves a complex interplay between visual perception and multiple cognitive processes, including memory retrieval, problem-solving, and decision-making. Eye-tracking technologies are becoming increasingly available in the consumer and research markets and provide novel opportunities to learn more about the interpretive process, including differences between novices and experts, how heuristics and biases shape visual perception and decision-making, and the mechanisms underlying misinterpretation and misdiagnosis. The present review provides an overview of eye-tracking technology, the perceptual and cognitive processes involved in medical interpretation, how eye tracking has been employed to understand medical interpretation and promote medical education and training, and some of the promises and challenges for future applications of this technology.

Significance

During patient examinations, image interpretation, and surgical procedures, physicians are constantly accumulating multisensory evidence when inspecting information and ultimately arriving at a diagnostic interpretation. Eye-tracking research has shed light on the dynamics of this interpretive process, including qualitative and quantitative differences that help distinguish and possibly predict successes and errors. This progress affords novel insights into how the interpretive process might be improved and sustained during education, training, and clinical practice. The present review details some of this research and emphasizes future directions that may prove fruitful for scientists, educators, and clinical practitioners interested in accelerating the transition from novice to expert, monitoring and maintaining competencies, developing algorithms to automate error detection and classification, and informing tractable remediation strategies to train the next generation of diagnosticians.

Introduction

Decades of research have demonstrated the involvement of diverse perceptual and cognitive processes during medical image interpretation and diagnosis (Bordage, 1999 ; Elstein, Shulman, & Sprafka, 1978 ; Gilhooly, 1990 ; Kundel & La Follette, 1972 ; Patel, Arocha, & Zhang, 2005 ). Broadly speaking, these include visual search and pattern matching, hypothesis generation and testing, and reasoning and problem-solving. As with many more general cognitive tasks, these processes interact dynamically over time via feed-forward and feed-back mechanisms to guide interpretation and decision-making (Brehmer, 1992 ; Newell, Lagnado, & Shanks, 2015 ). The reliable involvement of these processes has made them of interest as targets for both clinical research and the design of educational interventions to improve diagnostic decision-making (Crowley, Naus, Stewart, & Friedman, 2003 ; Custers, 2015 ; Nabil et al., 2013 ). Methodologies to investigate mental processes during interpretation and diagnosis have included think-aloud protocols (Lundgrén-Laine & Salanterä, 2010 ), knowledge and memory probes (Gilhooly, 1990 ; Patel & Groen, 1986 ), practical exercises (Bligh, Prideaux, & Parsell, 2001 ; Harden, Sowden, & Dunn, 1984 ), and tracking physicians’ interface navigation behavior while they inspect visual images (e.g., radiographs, histology slides) (Mercan et al., 2016 ; Mercan, Shapiro, Brunyé, Weaver, & Elmore, 2017 ).

Medical researchers have increasingly turned to eye-tracking technology to provide more detailed qualitative and quantitative assessments of how and where the eyes move during interpretation, extending research from other high-stakes domains such as air-traffic control (Martin, Cegarra, & Averty, 2011 ) and airport luggage screening (McCarley & Carruth, 2004 ; McCarley, Kramer, Wickens, Vidoni, & Boot, 2004 ). Studies in the medical domain have provided more nuanced understandings of visual interpretation and diagnostic decision-making in diverse medical specialties including radiology, pathology, pediatrics, surgery, and emergency medicine (Al-Moteri, Symmons, Plummer, & Cooper, 2017 ; Blondon & Lovis, 2015 ; van der Gijp et al., 2017 ). Eye tracking has the potential to revolutionize clinical practice and medical education, with far-reaching implications for the development of automated competency assessments (Bond et al., 2014 ; Krupinski, Graham, & Weinstein, 2013 ; Richstone et al., 2010 ; Tien et al., 2014 ), advanced clinical tutorials (e.g., watching an expert’s eye movements over an image; (Khan et al., 2012 ; O’Meara et al., 2015 )), biologically inspired artificial intelligence to enhance computer-aided diagnosis (Buettner, 2013 ; Young & Stark, 1963 ), and the automated detection and mitigation of emergent interpretive errors during the diagnostic process (Ratwani & Trafton, 2011 ; Tourassi, Mazurowski, Harrawood, & Krupinski, 2010 ; Voisin, Pinto, Morin-Ducote, Hudson, & Tourassi, 2013 ).

Eye tracking: technologies and metrics

Modern eye tracking involves an array of infrared or near-infrared light sources and cameras that track the gaze behavior of one (monocular) or both (binocular) eyes (Holmqvist et al., 2011 ). In most modern systems, an array of non-visible light sources illuminate the eye and produce a corneal reflection (the first Purkinje image); the eye tracker monitors the relationship between this reflection and the center of the pupil to compute vectors that relate eye position to locations in the perceived world (Hansen & Ji, 2010 ). As the eyes move, the computed point of regard in space also moves. Eye trackers are available in several hardware configurations, including systems with a chin rest for head stabilization, remote systems that can accommodate a limited extent of head movements, and newer mobile eye-wear based systems. Each of these form factors has relative advantages and disadvantages for spatial accuracy (i.e., tracking precision), tracking speed, mobility, portability, and cost (Funke et al., 2016 ; Holmqvist, Nyström, & Mulvey, 2012 ). Figure  1 depicts a relatively mobile and contact-free eye-tracking system manufactured by SensoMotoric Instruments (SMI; Berlin, Germany), the Remote Eye-tracking Device – mobile (REDm).

A remote eye-tracking system (SensoMotoric Instruments’ Remote Eye-tracking Device – mobile; SMI REDm) mounted to the bottom of a computer monitor. In this study, a participating pathologist is inspecting a digital breast biopsy (Brunyé, Mercan, et al., 2017 )

Eye trackers provide several measures of visual behavior that are relevant for understanding the interpretive process; these are categorically referred to as movement measures, position measures, numerosity measures, and latency measures (Holmqvist et al., 2011 ). Before describing these, it is important to realize that the eye is constantly moving between points of fixation. Fixations are momentary pauses of eye gaze at a spatial location for a minimum amount of time (e.g., > 99 ms), and the movements between successive fixations are called saccades (Liversedge & Findlay, 2000 ). Movement measures quantify the patterns of eye movements through space during saccades, including the distance between successive saccades (degrees of saccade amplitude) and the speed of saccades (typically average or peak velocity). Position measures quantify the location of the gaze in Cartesian coordinate space, such as the coordinate space of a computer monitor, or a real-world scene captured through a forward-view camera. Numerosity measures quantify the frequency with which the eyes fixate and saccade while perceiving a scene, such as how many fixations and saccades have occurred during a given time, and how those counts might vary as a function of position (and the visual information available at different positions). Finally, latency measures allow for an assessment of the temporal dynamics of fixations and saccades, including first and subsequent fixation durations and saccade duration. Table  1 provides an overview of commonly used eye-tracking measures, and current theoretical perspectives on their relationships to perceptual and cognitive processing.

Eye tracking in medical interpretation

Some of the earliest research using eye tracking during medical image interpretation was done during x-ray film inspection (Kundel & Nodine, 1978 ). In this task, radiologists search chest x-ray films for evidence of lung nodules; Kundel and Nodine were interested in whether radiologists were making errors of visual search versus errors of recognition and/or decision-making. A search error would be evidenced by a failure to fixate on a nodule, and a recognition or decision error would occur when a fixation on a nodule is not followed by a successful identification and diagnosis. To further differentiate errors of recognition versus decision-making, Kundel and Nodine distinguished trials where the radiologist fixated within 2.8° of a nodule for greater than or less than 600 ms. If the fixation occurred for less than 600 ms this was considered a recognition error, and if greater than 600 ms it was considered a decision error. The former was considered a failure to disembed the nodule from the background noise (despite fixating on it), and the latter was considered a successful recognition of a nodule without appropriately mapping it to diagnostic criteria. Their results demonstrated that about 30% of all errors were due to a failed search. About 25% of errors were due to a recognition failure, and the remaining 45% of errors were due to decision failure. Thus, interpretive errors were primarily driven by failures of recognition and decision-making, rather than failures of search (Kundel & Nodine, 1978 ). In other words, radiologists would fixate upon and process the critical visual information in a scene but fail to successfully map that information to known schemas and/or candidate diagnoses. A follow-up study confirmed that fixations over 300 ms did not improve recognition, but did improve decision accuracy; furthermore, fixations within 2° of the nodule were associated with higher recognition accuracy (Carmody, Nodine, & Kundel, 1980 ). These early studies suggest that eye tracking can be a valuable tool for helping dissociate putative sources of error during medical image interpretation (i.e., search, recognition, and decision-making), given that high-resolution foveal vision appears to be critical for diagnostic interpretation.

Over the past four decades since this original research, eye tracking has been expanded to understanding diagnostic interpretation in several medical specializations, including radiology, breast pathology, general surgery, neurology, emergency medicine, anesthesiology, ophthalmology, and cardiology (Balslev et al., 2012 ; Berbaum et al., 2001 ; Brunyé et al., 2014 ; Giovinco et al., 2015 ; Henneman et al., 2008 ; Jungk, Thull, Hoeft, & Rau, 2000 ; Krupinski et al., 2006 ; Kundel, Nodine, Krupinski, & Mello-Thoms, 2008 ; Matsumoto et al., 2011 ; O’Neill et al., 2011 ; Sibbald, de Bruin, Yu, & van Merrienboer, 2015 ; Wood, Batt, Appelboam, Harris, & Wilson, 2014 ). In general, these eye-tracking studies have found evidence of reliable distinctions between three types of error-making in diagnostic interpretation: search errors, recognition errors, and decision errors. Each of these error types carries implications for diagnostic accuracy and, ultimately, patient quality of life and well-being. We review each of these in turn, below.

Search errors

A search error occurs when the eyes fail to fixate a critical region of a visual scene, rendering a feature undetected; these have also been labeled as scanning errors because the critical feature was not in the scan path (Cain, Adamo, & Mitroff, 2013 ). For example, a radiologist failing to fixate a lung nodule (Manning, Ethell, Donovan, & Crawford, 2006 ), a pathologist failing to fixate large nucleoli in pleomorphic cells (Brunyé, Mercan, Weaver, & Elmore, 2017 ), or a neuro-radiologist failing to fixate a cerebral infarction (Matsumoto et al., 2011 ). Theoretically, if the diagnostician has not fixated a diagnostically relevant region of a medical image then successful search has not occurred, and without it, recognition and decision-making are not possible.

Several perceptual and cognitive mechanisms have been proposed to account for why search errors occur, including low target prevalence, satisfaction of search, distraction, and resource depletion. Low target prevalence refers to a situation when a diagnostic feature is especially rare. For example, a malignant tumor appearing in a screening mammography examination has a very low prevalence rate at or below 1% of all cases reviewed (Gur et al., 2004 ). Low prevalence is associated with higher rates of search failure; previous research has shown that when target prevalence was decreased from 50 to 1%, detection rates fell from approximately 93 to 70%, respectively (Wolfe, Horowitz, & Kenner, 2005 ). Although much of the research on the low prevalence effect has focused on basic findings with naïve subjects, research has also shown that low prevalence also influences diagnostic accuracy in a medical setting (Egglin & Feinstein, 1996 ; Evans, Birdwell, & Wolfe, 2013 ). Most notably, Evans and colleagues compared performance under typical laboratory conditions, where target prevalence is high (50% of cases), and when the same cases were inserted into regular workflow, where target prevalence is low (< 1% of cases) they found that false-negative rates were substantially elevated at low target prevalence (Evans et al., 2013 ). As a diagnostician searches a medical image, they must make a decision of when to terminate a search (Chun & Wolfe, 1996 ; Hong, 2005 ). In the case of low target prevalence, search termination is more likely to occur prior to detecting a target (Wolfe & Van Wert, 2010 ).

How exactly a search termination decision emerges during a diagnostician’s visual search process is unknown, though it is likely that there are multiple smaller decisions occurring during the search process: as the diagnostician detects individual targets in the medical image, they must decide whether it is the most diagnostically valuable target (and thus terminate search), or whether they believe there is a rare but more valuable target that might be found with continued search (Rich et al., 2008 ). The risk is that after finding a single target a diagnostician may terminate search prematurely and fail to detect a target with higher value for a correct diagnosis. This phenomenon was originally coined satisfaction of search , when radiologists would become satisfied with their interpretation of a medical image after identifying one lesion, at the expense of identifying a second more important lesion (Berbaum et al., 1990 ; Smith, 1967 ). These sorts of errors may be a consequence of Bayesian reasoning based on prior experience: the diagnostician may not deem additional search time justifiable for a target that is exceedingly unlikely to be found (Cain, Vul, Clark, & Mitroff, 2012 ). More recently, Berbaum and colleagues demonstrated that satisfaction of search alone may not adequately describe the search process (Berbaum et al., 2015 ; Krupinski, Berbaum, Schartz, Caldwell, & Madsen, 2017 ). Specifically, detecting a lung nodule on a radiograph did not adversely affect the subsequent detection of additional lung nodules; however, it did alter observers’ willingness to report the detected nodules. The authors suggest that detecting a target during search may not induce search termination, but rather change response thresholds during a multiple-target search.

Once a diagnostician finds one target, there is no guarantee that it is the critical feature that will assist in rendering an appropriate diagnosis. It is often the case that critical features are passed over because they are not only low prevalence but also low salience; in other words, they might not stand out visually (in terms of their brightness, contrast, or geometry (Itti & Koch, 2000 )) relative to background noise. Research with neurologists and pathologists has demonstrated that novice diagnosticians, such as medical residents, tend to detect features with high visual salience sooner and more often than experienced diagnosticians; this focus on highly salient visual features can be at the cost of neglecting the detection of critical features with relatively low visual salience (Brunyé et al., 2014 ; Matsumoto et al., 2011 ). In one study, not only did novice pathologists tend to fixate more on visually salient but diagnostically irrelevant regions, they also tended to re-visit those regions nearly three times as often as expert pathologists (Brunyé et al., 2014 ). As diagnosticians gain experience with a diverse range of medical images, features, and diagnoses, they develop more refined search strategies and richer knowledge that accurately guide visual attention toward diagnostically relevant image regions and away from irrelevant regions, as early as the initial holistic inspection of an image (Kundel et al., 2008 ). As described in Kundel and colleagues’ model, expert diagnosticians are likely to detect cancer on a mammogram before any visual scanning (search) takes place, referred to a an initial holistic, gestalt-like perception of a medical image (Kundel et al., 2008 ). This discovery led these authors to reconceptualize the expert diagnostic process as involving an initial recognition of a feature, followed by a search and diagnosis (Kundel & Nodine, 2010 ); this is in contrast to traditional conceptualizations suggesting that search always preceded recognition (Kundel & Nodine, 1978 ). Unlike experts, during the initial viewing of a medical image novices are more likely to be distracted by highly salient image features that are not necessary for diagnostic interpretation. The extent to which a medical image contains visually salient features that are irrelevant for accurate interpretation may make it more likely a novice pathologist or neurologist will be distracted by those features and possibly fail to detect critical but lower-salience image features. This might be especially the case when high-contrast histology stains or imaging techniques render diagnostically irrelevant (e.g., scar tissue) regions highly salient. Eye tracking is a critical tool for recognizing and quantifying attention toward distracting image regions and has been instrumental in identifying this source of search failure among relatively novice diagnosticians.

In a recent taxonomy of visual search errors, Cain and colleagues demonstrated that working memory resources are an important source of errors (Cain et al., 2013 ). Specifically, when an observer is searching for multiple features (targets), if they identify one feature they may maintain that feature in working memory while searching for another feature. This active maintenance of previously detected features may deplete working memory resources that could otherwise be used to search for lower-salience and prevalence targets. This is evidenced by high numbers of re-fixations in previously detected regions, suggesting an active “refreshing” of the contents of working memory to help maintain item memory (Cain & Mitroff, 2013 ). This proposal has not been examined with diagnosticians inspecting medical images, though it suggests that physicians with higher working memory capacity may show higher performance when searching for multiple features, offering an interesting avenue for future research. Together, resource depletion, low target prevalence, satisfaction of search, and distraction may account for search errors occurring across a range of disciplines involving medical image interpretation.

Recognition errors

Eye tracking has been instrumental in demonstrating that fewer than half of interpretive errors are attributed to failed search, suggesting that most interpretive errors arise during recognition and decision-making (Al-Moteri et al., 2017 ; Carmody et al., 1980 ; Nodine & Kundel, 1987 ; Samuel, Kundel, Nodine, & Toto, 1995 ). Recognition errors occur when the eyes fixate a feature, but the feature is not recognized correctly or not recognized as relevant or valuable for the search task. Recognition is an example of attentional mechanisms working together to dynamically guide attention toward features that may be of diagnostic relevance and mapping them to stored knowledge. One way of parsing eye movements into successful versus failed recognition of diagnostically relevant features is to assess fixation durations on critical image regions (Kundel & Nodine, 1978 ; Mello-Thoms et al., 2005 ). In this method, individual fixation durations are parsed into two categories using a quantitative threshold. For example, Kundel and Nodine used a 600-ms threshold, and Mello-Thoms and colleagues used a 1000-ms threshold; fixation durations shorter than the threshold indicated failed recognition, whereas durations lengthier than the threshold indicated successful recognition (Kundel & Nodine, 1978 ; Mello-Thoms et al., 2005 ). Thus, if a feature (e.g., a lung nodule) was fixated there was successful search, and if it was fixated for longer than the threshold there was successful recognition. Under the assumption that increased fixation durations indicate successful recognition, if a participant fixates on a particular region for longer than a given threshold then any subsequent diagnostic error must be due to failed decision-making.

Using fixation durations to identify successful recognition is an imperfect approach; it is important to note that lengthier fixation durations are also associated with difficulty disambiguating potential interpretations of a feature (Brunyé & Gardony, 2017 ). In other words, while previous research assumes that lengthy fixation durations indicate successful recognition, they can also indicate the perceptual uncertainty preceding incorrect recognition. This is because a strategic shift of attention toward a particular feature is evident in oculomotor processes, for instance with longer fixations, regardless of whether recognition has proceeded accurately (Heekeren, Marrett, & Ungerleider, 2008 ). Thus, one can only be truly certain that successful recognition has occurred (i.e., mapping a perceived feature to an accurate knowledge structure) if converging evidence is gathered during the interpretive process.

Consistent with this line of thinking, Manning and colleagues found that false-positives when examining chest radiographs were typically associated with longer cumulative dwell time than true-positives (Manning et al., 2006 ). Other methods such as think-aloud protocols and feature annotation may prove especially valuable to complement eye tracking in these situations: when a diagnostician recognizes a feature, they either say it aloud (e.g., “I see cell proliferation”) or annotate the feature with a text input (Pinnock, Young, Spence, & Henning, 2015 ). These explicit feature recognitions can then be assessed for their accuracy and predictive value toward accurate diagnosis.

In addition to measuring the ballistic movements of the eyes, eye trackers also provide continuous recordings of pupil diameter. Pupil diameter can be valuable for interpreting cognitive states and can be used to elucidate mental processes occurring during medical image interpretation. Pupil diameter is constantly changing as a function of both contextual lighting conditions and internal cognitive states. Alterations of pupil diameter reflecting cognitive state changes are thought to reflect modulation of the locus coeruleus-norepinephrine (LC-NE) system, which indexes shifts from exploration to exploitation states (Aston-Jones & Cohen, 2005 ; Gilzenrat, Nieuwenhuis, Jepma, & Cohen, 2010 ). Specifically, when the brain interprets a bottom-up signal (e.g., a salient region that attracts an initial fixation) as highly relevant to a task goal, it will send a top-down signal to selectively orient attention to that region. When that occurs, there is a transient increase in pupil diameter that is thought to reflect a shift from exploring the scene (i.e., searching) to exploiting perceived information that is relevant to the task (Privitera, Renninger, Carney, Klein, & Aguilar, 2010 ; Usher, Cohen, Servan-Schrieber, Rajkowski, & Aston-Jones, 1999 ). Recent research has demonstrated that during fixation on a scene feature, the time-course of pupil diameter changes can reveal information about an observer’s confidence in their recognition of the feature (Brunyé & Gardony, 2017 ). Specifically, features that are highly difficult to resolve and recognize cause a rapid pupil dilation response within a second of fixation on the feature. This opens an exciting avenue for using converging evidence, perhaps from fixation duration, pupil diameter, and think-aloud protocols, to more effectively disentangle the instances when lengthy fixations on image features are associated with successful or unsuccessful recognition. In the future, algorithms that can automatically detect instances of successful or failed recognition during fixation may prove particularly valuable for enabling computer-based feedback for trainees.

Decision errors

As observers gather information about a scene, including searching and recognizing features as relevant to task goals, they begin to formulate hypotheses regarding candidate diagnoses. In some cases, a hypothesis may exist prior to visual inspection of an image (Ledley & Lusted, 1959 ). The main function of examining a visual image and recognizing features is to develop and test diagnostic hypotheses (Sox, Blatt, Higgins, & Marton, 1988 ). Developing and testing hypotheses is a cyclical process that involves identifying features that allow the observer to select a set of candidate hypotheses, gathering data to test each hypothesis, and confirming or disconfirming a hypothesis. If the clinician has confirmed a hypothesis, the search may terminate; search may continue if the clinician identifies potential support for multiple hypotheses (e.g., diagnoses with overlapping features) and must continue in the service of differential diagnosis. If the clinician has disconfirmed one of several hypotheses but has not confirmed a single hypothesis, the cyclical process continues; the process also continues under conditions of uncertainty when no given hypotheses have been ruled in or out (Kassirer, Kopelman, & Wong, 1991 ). It is also important to keep in mind that several diagnoses fall on a spectrum with categorical delineations, with the goal of identifying the highest diagnostic category present in a given image. For instance, a breast pathologist examining histological features may categorize a case as benign, atypia, ductal (DCIS) or lobular carcinoma in situ, or invasive carcinoma (Lester & Hicks, 2016 ). Given that the most advanced diagnosis is the most important for prognosis and treatment, even if a less advanced hypothesis is supported (e.g., atypia), the pathologist will also spend time ruling out the more advanced diagnoses (e.g., carcinoma in situ, invasive). This may be especially the case when diagnostic features can only be perceived at high-power magnification levels, rendering the remainder of the image immediately imperceptible and making it necessary to zoom out to consider other regions.

In an ideal scenario, critical diagnostic features are detected during search and recognized, which leads the clinician to successfully develop and test hypotheses and produce an accurate diagnosis. In the real world, errors emerge at every step of that process. While decision-related errors may not be readily detected in existing eye-tracking metrics, some recent research suggests that relatively disorganized movements of the eyes over a visual image may indicate higher workload, decision uncertainty, and a higher likelihood of errors (Brunyé, Haga, Houck, & Taylor, 2017 ; Fabio et al., 2015 ). Specifically, tracking the entropy of eye movements can indicate relatively disordered search processes that do not follow a systematic pattern. In this case, entropy is conceptualized as the degree of energy dispersal of eye fixations across the screen in a relatively random pattern. Higher fixation entropy might indicate relative uncertainty in the diagnostic decision-making process. Furthermore, tonic pupil diameter increases can indicate a higher mental workload involved in a decision-making task (Mandrick, Peysakhovich, Rémy, Lepron, & Causse, 2016 ). No studies have examined the entropy of eye movements during medical image interpretation, and to our knowledge only one has examined pupil diameter (Mello-Thoms et al., 2005 ), revealing an exciting avenue for continuing research. Specifically, continuing research may find value in combining fixation entropy and pupil diameter to identify scenarios in which successful lesion detection and recognition has occurred, but the clinician is having difficulty arriving at an appropriate decision.

Implications for medical education

Eye tracking may provide innovative opportunities for medical education, training, and competency assessment (Ashraf et al., 2018 ). Most existing research in this regard leverages the well-established finding that experts move their eyes differently from novices (Brunyé et al., 2014 ; Gegenfurtner, Lehtinen, & Säljö, 2011 ; Krupinski, 2005 ; Krupinski et al., 2006 ; Kundel et al., 2008 ; Lesgold et al., 1988 ). Thus, the premise is that educators can use eye tracking to demonstrate, train, and assess gaze patterns during medical education, possibly accelerating the transition from novice to expert.

Competency-based medical education (CBME) is intended to produce health professionals who consistently demonstrate expertise in both practice and certification (Aggarwal & Darzi, 2006 ). Though the concept of CBME has been around for several decades, formal frameworks for competency training and assessment have been more recently developed by CanMEDS, the Outcome Project of the US Accreditation Council for Graduate Medical Education (ACGME), and the Scottish Doctor (Frank & Danoff, 2007 ; Nasca, Philibert, Brigham, & Flynn, 2012 ; Simpson et al., 2002 ; Swing, 2007 ). In each of these cases, methods were evaluated and implemented for integrating CBME, including new standards for curriculum, teaching, and assessment. Many programs, however, have struggled to create meaningful, relevant, and repeatable outcome-based assessments for use in graduate medical education, residency, and fellowships (Holmboe, Edgar, & Hamstra, 2016 ).

Eye tracking in medical education

As students develop proficiency in interpreting visual images, they demonstrate refined eye movements that move more quickly and consistently toward diagnostic regions of interest (Richstone et al., 2010 ). In other words, their eye movements increasingly resemble those of experts as they progress through training. One possible method for facilitating this progression is by showing students video-based playbacks of expert eye movements, a method called eye-movement modeling examples (EMMEs (Jarodzka et al., 2012 )). Eye-movement modeling examples typically involve not only showing a video of expert eye movements, but also the expert’s audio narrative of the interpretive process (Jarodzka, Van Gog, Dorr, Scheiter, & Gerjets, 2013 ; van Gog, Jarodzka, Scheiter, Gerjets, & Paas, 2009 ). The idea that EMMEs can assist education leverages a finding from cognitive neuroscience demonstrating that observing another’s actions causes the brain to simulate making that same action (i.e., the brain’s “mirror system”), and helps students integrate the new action into their own repertoire (Calvo-Merino, Glaser, Grèzes, Passingham, & Haggard, 2005 ; Calvo-Merino, Grèzes, Glaser, Passingham, & Haggard, 2006 ). EMMEs also ground a student’s education in concrete examples, provide students with unique expert insights that might otherwise be inaccessible, and help students learn explicit strategies for processing the visual image (Jarodzka et al., 2012 ).

Outside of the medical domain, EMMEs have been demonstrated to help novice aircraft inspectors detect more faults during search (Sadasivan, Greenstein, Gramopadhye, & Duchowski, 2005 ), circuitry board inspectors detect more faults during search (Nalanagula, Greenstein, & Gramopadhye, 2006 ), programmers debug software faster (Stein & Brennan, 2004 ), students become better readers (Mason, Pluchino, & Tornatora, 2015 ), and novices solve puzzles faster (Velichkovsky, 1995 ). In medical domains involving visual image inspection, the viewed action is the sequence of an expert clinician’s fixations and saccades over the medical image, along with their verbal narration. Few studies have examined the impact of EMMEs in medical learning; note that we differentiate education from training in this context, with education involving the passive viewing of expert eye movements outside of an immediate training context (i.e., not during active practice). In the first study of this kind, novice radiographers viewed either novice or expert eye movements prior to making a diagnostic interpretation of a chest x-ray (Litchfield, Ball, Donovan, Manning, & Crawford, 2010 ). Viewing expert or novice eye movements improved a novice’s ability to locate pulmonary nodules relative to a free search, as long as the depicted eye movements showed a successful nodule search. This result suggests that novices can indeed leverage another’s eye movements to more effectively guide their own search behavior. More recently, medical students were shown case videos of infant epilepsy, in one of three conditions (Jarodzka et al., 2012 ). In the control condition, there was expert narration during video playback. Two experimental conditions displayed the narrated video with overlaid expert eye movements; in one condition, the eye movements were indicated by a small circle, and in the other condition, there was a “spotlight” around the circle that blurred image regions that were outside of the expert’s focus. Results demonstrated increased diagnostic performance of students after viewing the spotlight condition, suggesting that this specific condition was most effective at conveying expert visual search patterns. Thus, some research suggests that passively viewing an expert’s eye gaze can be advantageous to medical education.

While previewing an expert’s eye movements can facilitate interpretive performance on the same or very similar cases, it is unclear whether EMMEs are supporting strategy development that will transfer to dissimilar cases. Transfer describes the ability to apply knowledge, skills and abilities to novel contexts and tasks that have not been previously experienced (Bransford, Brown, & Cocking, 2000 ). Transfer can be relatively near-transfer versus far-transfer (Barnett & Ceci, 2002 ), and is considered a critical trademark of successful learning (Simon, 1983 ). An example of near-transfer might be a pathologist learning the features and rules for diagnosing DCIS on one case or from text-book examples, and transferring that knowledge and skill to a biopsy with similar features that clearly indicate DCIS (Roads, Xu, Robinson, & Tanaka, 2018 ). An example of relatively far-transfer would be successfully applying knowledge and skill to a novel biopsy with a unique cellular architecture and challenging features that are less clearly indicative of DCIS and are perhaps borderline between atypical ductal hyperplasia (ADH) and DCIS. More research is needed to understand whether EMMEs promote only near-transfer, or whether multiple EMME experiences can promote relatively far-transfer by promoting perceptual differentiation of features, accurate feature recognition, and more accurate and efficient mapping of features to candidate diagnoses. In other words, can EMMEs move beyond providing explicit hints and cues that enable interpretation and diagnosis in highly similar contexts and cases, to accelerating rule and strategy learning that enhances performance on highly dissimilar contexts and cases (Ball & Litchfield, 2017 )? Second, it is worth pointing out that some research has suggested that people may intentionally alter their patterns of eye movements if they know that their eye movements are being monitored or that videos of their eye movements will be replayed to others (Neider, Chen, Dickinson, Brennan, & Zelinsky, 2010 ; Velichkovsky, 1995 ). While any such effects appear to be both rare and subtle, they do present a challenge to interpreting whether the effects of EMMEs are at least partially due to the intent of the expert viewer as opposed to being a natural representation of their viewing patterns in normal clinical practice (Ball & Litchfield, 2017 ).

Eye tracking in medical training

As opposed to a novice passively viewing expert eye-gaze behavior, some studies have examined eye gaze as a training tool. As noted previously, we distinguish education from training by noting that training involves active practice of knowledge and skills, with or without feedback (Kern, Thomas, & Hughes, 1998 ). In most research to date, eye gaze has been used to provide immediate feedback and guidance for a novice during the active exploration of a visual stimulus. This research leverages several phenomena from the cognitive and instructional sciences. First, cueing attention toward relevant features during a training activity can promote more selective attention to cued areas and help observers remember the cued information and allocate less mental energy to the non-cued areas (De Koning, Tabbers, Rikers, & Paas, 2009 ). For instance, subtle visual cues, such as a momentary flash of light in a specific scene region, can selectively orient attention to that region for further inspection (Danziger, Kingstone, & Snyder, 1998 ). Second, watching expert eye movements can help observers recognize and learn organizational strategies for viewing and interpreting visual images, understand the expert’s intent, identify the organizational structure of the images, and better organize perceived information into mental schemas (Becchio, Sartori, Bulgheroni, & Castiello, 2008 ; Jarodzka et al., 2013 ; Lobmaier, Fischer, & Schwaninger, 2006 ). For instance, because experts tend to move their eyes and navigate visual images differently than novices, viewing expert eye movements and patterns of navigation behavior may help observers develop more efficient search strategies. Third, well-organized expert eye movements can help an observer recognize relations within and between images, helping them discriminate similar features and possibly promote transfer to novel cases (Kieras & Bovair, 1984 ). For instance, an expert may saccade intentionally between features that help the observer effectively discriminate them, possibly helping them form a more thorough understanding of how to distinguish features and associated diagnoses. It is unknown whether this refined knowledge would subsequently enable successful transfer to cases with structures and features at least partially overlapping with the learned case, suggesting an avenue for future research.

One popular way to conceptualize the utility of cueing attention toward relevant scene regions is the Theory of Hints (Kirsh, 2009 ). In this theory, when people attempt to solve problems in the real world, they rely not only upon existing knowledge (including heuristics and biases) but also the effective use of any available mental aids offered by the context. In addition to explicit verbal guidance from an instructor, or explicit feedback on worked examples, hints can also come in the form of another’s eye movements (Ball & Litchfield, 2017 ), which can implicitly (i.e., subconsciously) or explicitly orient attention and provide information to an observer (Thomas & Lleras, 2009a , b ). As evidence for relatively implicit attention guidance, novice lung x-ray interpretation can improve when they receive implicit cueing based on an expert’s eye movements (Ball & Litchfield, 2017 ). In accordance with the Theory of Hints, this guidance likely provided not only a cue to orient attention toward a particular scene region, but also increased the likelihood that the area would be considered in their diagnostic interpretation. Specifically, expert cueing can help a novice calibrate the relevance and importance of a region (Litchfield et al., 2010 ), which can be complemented by an expert’s verbal narration. Thus, it seems that cueing an observer with expert eye movements and narration not only guides attention but can also help the student assess the expert’s intentionality and incorporate that information into their emergent interpretation. As additional evidence of this phenomenon, when expert eye gaze is superimposed during a simulated laparoscopic surgery task, novices are not only faster to locate critical diagnostic regions, but also more likely to incorporate that region into their diagnosis and ultimately reduce errors (Chetwood et al., 2012 ). Similarly, when novice trainees have expert eye gaze during a simulated robotic surgical task, they tended to be faster and more productive in identifying suspicious nodules (Leff et al., 2015 ). In both cases, cueing a trainee with expert eye movements not only gets them to fixate in a desired region, but also seems to help them understand expert intent, behave more like an expert, and develop a more accurate diagnostic interpretation.

Eye tracking in competency assessment

In addition to cueing attention during image interpretation, eye tracking can also be used as a feedback mechanism following case interpretation. As we noted above, medical training frequently involves explicit feedback by instructors on exams and worked examples. But there are few methods for providing feedback regarding the dynamic interpretive process; for instance, how a microscope was panned and zoomed, which features were inspected, and precisely where in the process difficulties may have arisen (Bok et al., 2013 ; 2016 ; Kogan, Conforti, Bernabeo, Iobst, & Holmboe, 2011 ; Wald, Davis, Reis, Monroe, & Borkan, 2009 ). Identifying concrete metrics for use in competency assessment is critical for understanding and guiding professional development from novices to experts (Dreyfus & Dreyfus, 1986 ; Green et al., 2009 ). Indeed, a “lack of effective assessment methods and tools” is noted as a primary challenge for implementing the Milestones initiative in internal medicine education (Holmboe, Call, & Ficalora, 2016 ; Holmboe, Edgar, & Hamstra, 2016 ). The Milestones initiative is intended to provide concrete educational milestones for use in assessment of medical competencies during graduate and post-graduate medical education (Swing et al., 2013 ). The earliest research examining eye tracking for feedback in medicine leveraged the concept of perceptual feedback, which involves showing an observer the regions they tended to focus on during an image interpretation (Kundel, Nodine, & Krupinski, 1990 ). This procedure was shown to improve decision-making by providing a clinician with a second opportunity to review suspicious image regions and revise their diagnosis; this procedure might be especially advantageous given that most people do not remember where they looked during a search (Võ, Aizenman, & Wolfe, 2016 ).

Leveraging the concept of using one’s own eye movements as a feedback tool, one recent study suggests that eye tracking may be especially valuable for clinical feedback with emergency medicine residents (Szulewski et al., 2018 ). In that study, eye movements were tracked in emergency medicine residents during objective structured clinical examinations in a simulation environment. During a subsequent faculty debriefing, residents were led through an individualized debrief that included a review of their eye movements during the clinical examination, with reference to scene features focused on their associated decision-making processes. Results demonstrated that all residents deemed the inclusion of eye tracking in the debriefing as a valuable feedback tool for learning, making them more likely to actively reflect on their learning experience, constructively critique themselves and compare themselves to experts, and plan responses for future clinical scenarios (Szulewski et al., 2018 ). Thus, eye tracking appears to be a valuable tool for augmenting qualitative feedback of trainee performance with concrete examples and guidance to help them attend to appropriate features and incorporate them into diagnoses.

Future research directions

As eye trackers become increasingly available to consumers, lower cost, portable, and easier to use, research on principled methods for using eye tracking for competency assessment is expected to increase (Al-Moteri et al., 2017 ). It is worth noting that eye trackers with high temporal and spatial resolution and coverage range (e.g., across large or multiple displays) can still be quite cost prohibitive. As eye trackers develop more widespread use, however, one can readily envision both automated and instructor-guided feedback techniques to help quantify competency and provide grounded examples for individualized feedback. In mammography, recent research demonstrates that tracking eye movements and using machine-learning techniques can predict most diagnostic errors prior to their occurrence, making it possible to automatically provide cueing or feedback to trainees during image inspection (Voisin et al., 2013 ). In diagnostic pathology, automated feedback may be possible by parsing medical images into diagnostically relevant versus irrelevant regions of interest (ROIs) using expert annotations and/or automated machine-vision techniques (Brunyé et al., 2014 ; Mercan et al., 2016 ; Nagarkar et al., 2016 ). Once these ROIs are established and known to the eye-tracking system, fixations can be parsed as falling within or outside of ROIs. This method could be used to understand the spatial allocation of attention over a digital image (e.g., a radiograph, histology slide, angiography), and the time-course of that allocation.

While eye tracking provides valuable insights into the distribution of visual attention over a scene, it is important to realize that eye trackers are restricted to monitoring foveal vision. The fovea is a small region in the center of the retina that processes light from the center of the visual field, with a dense concentration of cone receptors that provide high visual acuity (Holmqvist et al., 2011 ). One popular theoretical assumption is that eye and head movements strategically position the retina to a more advantageous state for gathering information, such as moving your head and eyes toward the source of a sound to reveal its nature and relevance (Xu-Wilson, Zee, & Shadmehr, 2009 ). Thus, some of what we consider overt visual attention should theoretically be captured by tracking eye movements. On the other hand, it is also well-established that visual attention can be shifted and sustained covertly, allowing one to fixate the eyes on an ostensibly uninteresting or irrelevant feature while covertly attending to another (Liversedge & Findlay, 2000 ; Treisman & Gelade, 1980 ). Thus, it remains possible that some of a diagnostician’s interpretive process may occur through peripheral vision (parafoveal vision), limiting our interpretation of eye-tracking patterns made during medical image inspection.

Eye trackers are designed to track eye gaze as a series of fixations and saccades; in other words, they are designed to track foveal attention. This means that they are quite good at tracking overt central visual attention, but they are not intended for tracking covert peripheral visual attention (Holmqvist et al., 2011 ). However, we also know that visual attention can be covertly shifted to other areas of a visual scene without a subsequent overt fixation on that region (Liversedge & Findlay, 2000 ; Treisman & Gelade, 1980 ). This is typically considered a major downfall of eye tracking: that many real-world visual tasks likely involve both covert and overt visual attention, though eye tracking can only measure the latter. However, more recent research has demonstrated that microsaccades reflect shifts in covert attention (Meyberg, Werkle-Bergner, Sommer, & Dimigen, 2015 ; Yuval-Greenberg, Merriam, & Heeger, 2014 ). Microsaccades are very small saccades that are less than 1° of visual arc and occur very frequently during fixations (about two to three times per second) (Martinez-Conde, Otero-Millan, & MacKnik, 2013 ). These microsaccades tend to be directional, for instance moving slightly to the left or right of a current fixation point; research has recently demonstrated that these slight directional movements of the eye indicate the orientation of covert attention (Yuval-Greenberg et al., 2014 ). For example, if you are staring at a point on a screen but monitoring an upper-right area of the periphery for a change, then microsaccades are likely to show a directional shift toward the upper right. Microsaccades are likely to serve many purposes, such as preparing the eye for a subsequent saccade to a peripheral region (Juan, Shorter-Jacobi, & Schall, 2004 ), but can also provide meaningful metrics of covert attention. With a clinician, it is possible that while they fixated on a given number of regions they also considered additional image regions for fixation (but never visited them). In other words, microsaccades may provide more fine-grained understanding of the strategic search process within individual fixations and allow a more nuanced understanding of which regions might have been ruled-out or ruled-in for subsequent inspection.

Eye tracking also carries value for understanding longitudinal aspects of competency progression in medical education. While diagnostic performance is routinely evaluated through credentialing and certification, we have very little insight into the underlying interpretive process or the process of skills development over time. For instance, within the domain of diagnostic pathology, we know of only one study that examined longitudinal changes in pathology residents’ visual expertise (Krupinski et al., 2013 ). Unfortunately, this prior study is limited by its size and breadth (four residents at a single training location), the restriction of observers’ ability to zoom or pan the medical image, and a reliance on the same experimental images each year. Thus, most of our understanding of how image interpretation and diagnostic accuracy and efficiency emerge during professional development is restricted to insights from cross-sectional designs. But we also know that expertise development of medical students and post-graduate resident trainees is a long-term, continuous, and non-linear process. Eye tracking provides an innovative opportunity to enable a large-scale examination of how interpretive and diagnostic skills develop through multi-year residencies and into professional practice. Our current research is examining this exciting possibility.

We have focused primarily on competency development through education and training, and performance differences between novices and experts. However, it is worth pointing out that each individual student and clinician brings a unique set of individual differences to clinical diagnostics that undoubtedly influences the processes of visual search and decision-making. Individual differences include variables such as personality traits and cognitive abilities, and a substantial body of research demonstrates that these variables constantly influence real-world behavior (Motowildo, Borman, & Schmit, 1997 ). For instance, recent research has demonstrated that experienced radiologists show superior perceptual abilities to novices, as measured with the Vanderbilt Chest Radiograph Test (Sunday, Donnelly, & Gauthier, 2017 ). Here we consider one individual difference that warrants more consideration in the domains of medical image interpretation and decision-making: working-memory capacity. Generally, working memory refers to the cognitive system involved in maintaining and manipulating task-relevant information while a task is performed (Miyake & Shah, 1999 ). Working-memory capacity describes the notion that working memory is a limited capacity system: it has finite resources for processing and storage, and each person has a different resource pool that can be drawn from to successfully perform a task (Kane & Engle, 2002 , 2003 ). To measure working memory capacity, one popular task (the operation span task) involves participants solving arithmetic problems while also trying to memorize words (Turner & Engle, 1989 ). In this manner, the task demands working-memory storage (to memorize the words) while also processing distracting arithmetic problems. The ability to maintain performance on a task in the face of distraction is a hallmark characteristic of individuals with high working-memory capacity. In our discussion of search errors, we noted that working memory may be critical for helping an observer maintain previously viewed features in memory while exploring the remainder of an image and associating subsequently identified features with features stored in working memory (Cain et al., 2013 ; Cain & Mitroff, 2013 ). In this case, higher working-memory capacity may be particularly important when there are multiple targets (rather than a single target) to be identified in an image. Furthermore, in our discussion of decision errors, we noted that some theories suggest that candidate hypotheses must be maintained in memory while evidence is accumulated during image inspection (Patel et al., 2005 ; Patel & Groen, 1986 ; Patel, Kaufman, & Arocha, 2002 ). Other theories suggest that hypotheses are formed early on and then tested during image inspection (Ledley & Lusted, 1959 ); it is important to point out that novices and experts may reason very differently during case interpretation, and one or both of these approaches may prove appropriate for different observers. Some research demonstrates that individual differences in working memory capacity predict hypothesis generation and verification processes in a task involving customer order predictions (Dougherty & Hunter, 2003 ). Thus, in both search and decision-making there appear to be critical roles for working-memory capacity in predicting clinician performance. This possibility has not yet been examined in the context of medical image interpretation and diagnosis, and it is unclear how working-memory capacity might influence clinician eye movements, though it is an exciting direction for future research.

In our review of the literature, we also noted that most studies using eye tracking during medical image interpretation use static images. These include lung x-rays, histology slides, and skin lesions. This is not entirely surprising, as many medical images are indeed static, and interpreting eye movements over dynamic scenes can be very complex and time-consuming (Jacob & Karn, 2003 ; Jarodzka, Scheiter, Gerjets, & van Gog, 2010 ). There are also cases where images that are usually navigated (panned, zoomed) are artificially restricted, increasing the risk that results are no longer relevant to routine clinical practice. As modern technologies emerge in diagnostic medicine, this disconnect becomes increasingly disadvantageous. Indeed, many medical images are becoming more complex and dynamic; for example, interpreting live and replayed coronary angiograms, simulated dynamic patients during training, or navigating multiple layers of volumetric chest x-rays (Drew, Võ, & Wolfe, 2013 ; Rubin, 2015 ). Continued innovations in software for integrating dynamic visual scenes and eye movements will enable this type of research: for instance techniques that parse dynamic video stimuli based on navigation behavior (pause, rewind, play) to identify critical video frames (Yu, Ma, Nahrstedt, & Zhang, 2003 ). Some other techniques are being developed to provide rudimentary tagging and tracking of identifiable objects in a scene (Steciuk & Zwierno, 2015 ); such a technique might prove valuable for tracking a region of diagnostic interest that moves across a scene during playback (e.g., during coronary angiogram review).

It is also worth pointing out that many hospitals are introducing mandatory consultative expert second opinions for quality assurance purposes. For instance, Johns Hopkins Hospital and the University of Iowa Hospitals and Clinics introduced mandatory second opinions for surgical pathology (Kronz, Westra, & Epstein, 1999 ; Manion, Cohen, & Weydert, 2008 ). Not only are these mandates seen as valuable for the institutions involved (e.g., for reducing malpractice suits), but clinicians also perceive them as important for improving diagnostic accuracy (Geller et al., 2014 ). However, having an earlier physician’s interpretation available during diagnosis may unintentionally bias the second physician’s diagnostic process. Indeed even a subtle probabilistic cue (e.g., a red dot that suggests an upcoming image contains a blast cell) can produce response bias in experienced diagnosticians (Trueblood et al., 2018 ). Thus, while viewing an expert’s behavior may prove advantageous in certain conditions, future research must isolate the parameters that may dictate its success and balance the potential trade-off between guiding eye movements and potentially biasing interpretation. Furthermore, second opinions can also induce diagnostic disagreements among expert clinicians and necessitate time and expense for resolving disagreement and reaching a consensus diagnosis. Eye tracking may prove to be an invaluable arbiter for these sorts of disputes, allowing consultative physicians to view the eye movements of the physician who rendered the primary diagnosis. This practice may assist in helping the consultative physician understand which features were focused on, which features were missed, and understanding how the original physician arrived at their interpretation. Eye tracking could thus augment traditional text annotations to allow consultative physicians to see the case “through the eyes” of the other physician, possibly reducing disagreement or facilitating consensus through shared understanding. Similar strategies might be applied to peer cohorts or medical students and residents, allowing them to learn from each other’s search patterns and successes and failures. On the other hand, this approach could introduce bias in the second physician and unintentionally increase agreement; if the first physician arrived at an incorrect interpretation, such agreement could be detrimental, demonstrating the importance of continuing research in this regard (Gandomkar, Tay, Brennan, Kozuch, & Mello-Thoms, 2018 ).

Medical image interpretation is a highly complex skill that influences not only diagnostic interpretations but also patient quality of life and survivability. Eye tracking is an innovative tool that is becoming increasingly commonplace in medical research and holds the potential to revolutionize trainee and clinician experiences.

Abbreviations

Atypical ductal hyperplasia

Competency-based medical education

Ductal carcinoma in situ

Eye-movement modeling examples

Locus coeruleus-norepinephrine

Region of interest

SensoMotoric Instruments’ Remote Eye-tracking Device – mobile

Van Nuys Prognostic Indicator

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Brunyé, T.T., Drew, T., Weaver, D.L. et al. A review of eye tracking for understanding and improving diagnostic interpretation. Cogn. Research 4 , 7 (2019). https://doi.org/10.1186/s41235-019-0159-2

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What Is Cognitive Psychology?

The Science of How We Think

Kendra Cherry, MS, is a psychosocial rehabilitation specialist, psychology educator, and author of the "Everything Psychology Book."

Steven Gans, MD is board-certified in psychiatry and is an active supervisor, teacher, and mentor at Massachusetts General Hospital.

Topics in Cognitive Psychology

• Current Research
• Cognitive Approach in Practice

Careers in Cognitive Psychology

How cognitive psychology differs from other branches of psychology, frequently asked questions.

Cognitive psychology involves the study of internal mental processes—all of the workings inside your brain, including perception, thinking, memory, attention, language, problem-solving, and learning.

Cognitive psychology--the study of how people think and process information--helps researchers understand the human brain. It also allows psychologists to help people deal with psychological difficulties.

This article discusses what cognitive psychology is, the history of this field, and current directions for research. It also covers some of the practical applications for cognitive psychology research and related career options you might consider.

Findings from cognitive psychology help us understand how people think, including how they acquire and store memories. By knowing more about how these processes work, psychologists can develop new ways of helping people with cognitive problems.

Cognitive psychologists explore a wide variety of topics related to thinking processes. Some of these include: 

• Attention --our ability to process information in the environment while tuning out irrelevant details
• Choice-based behavior --actions driven by a choice among other possibilities
• Decision-making
• Information processing
• Language acquisition --how we learn to read, write, and express ourselves
• Problem-solving
• Speech perception -how we process what others are saying
• Visual perception --how we see the physical world around us

History of Cognitive Psychology

Although it is a relatively young branch of psychology , it has quickly grown to become one of the most popular subfields. Cognitive psychology grew into prominence between the 1950s and 1970s.

Prior to this time, behaviorism was the dominant perspective in psychology. This theory holds that we learn all our behaviors from interacting with our environment. It focuses strictly on observable behavior, not thought and emotion. Then, researchers became more interested in the internal processes that affect behavior instead of just the behavior itself. 

This shift is often referred to as the cognitive revolution in psychology. During this time, a great deal of research on topics including memory, attention, and language acquisition began to emerge. 

In 1967, the psychologist Ulric Neisser introduced the term cognitive psychology, which he defined as the study of the processes behind the perception, transformation, storage, and recovery of information.

Cognitive psychology became more prominent after the 1950s as a result of the cognitive revolution.

Current Research in Cognitive Psychology

The field of cognitive psychology is both broad and diverse. It touches on many aspects of daily life. There are numerous practical applications for this research, such as providing help coping with memory disorders, making better decisions , recovering from brain injury, treating learning disorders, and structuring educational curricula to enhance learning.

Current research on cognitive psychology helps play a role in how professionals approach the treatment of mental illness, traumatic brain injury, and degenerative brain diseases.

Thanks to the work of cognitive psychologists, we can better pinpoint ways to measure human intellectual abilities, develop new strategies to combat memory problems, and decode the workings of the human brain—all of which ultimately have a powerful impact on how we treat cognitive disorders.

The field of cognitive psychology is a rapidly growing area that continues to add to our understanding of the many influences that mental processes have on our health and daily lives.

From understanding how cognitive processes change as a child develops to looking at how the brain transforms sensory inputs into perceptions, cognitive psychology has helped us gain a deeper and richer understanding of the many mental events that contribute to our daily existence and overall well-being.

The Cognitive Approach in Practice

In addition to adding to our understanding of how the human mind works, the field of cognitive psychology has also had an impact on approaches to mental health. Before the 1970s, many mental health treatments were focused more on psychoanalytic , behavioral , and humanistic approaches.

The so-called "cognitive revolution" put a greater emphasis on understanding the way people process information and how thinking patterns might contribute to psychological distress. Thanks to research in this area, new approaches to treatment were developed to help treat depression, anxiety, phobias, and other psychological disorders .

Cognitive behavioral therapy and rational emotive behavior therapy are two methods in which clients and therapists focus on the underlying cognitions, or thoughts, that contribute to psychological distress.

What Is Cognitive Behavioral Therapy?

Cognitive behavioral therapy (CBT) is an approach that helps clients identify irrational beliefs and other cognitive distortions that are in conflict with reality and then aid them in replacing such thoughts with more realistic, healthy beliefs.

If you are experiencing symptoms of a psychological disorder that would benefit from the use of cognitive approaches, you might see a psychologist who has specific training in these cognitive treatment methods.

These professionals frequently go by titles other than cognitive psychologists, such as psychiatrists, clinical psychologists , or counseling psychologists , but many of the strategies they use are rooted in the cognitive tradition.

Many cognitive psychologists specialize in research with universities or government agencies. Others take a clinical focus and work directly with people who are experiencing challenges related to mental processes. They work in hospitals, mental health clinics, and private practices.

Research psychologists in this area often concentrate on a particular topic, such as memory. Others work directly on health concerns related to cognition, such as degenerative brain disorders and brain injuries.

Treatments rooted in cognitive research focus on helping people replace negative thought patterns with more positive, realistic ones. With the help of cognitive psychologists, people are often able to find ways to cope and even overcome such difficulties.

Reasons to Consult a Cognitive Psychologist

• Alzheimer's disease, dementia, or memory loss
• Brain trauma treatment
• Cognitive therapy for a mental health condition
• Interventions for learning disabilities
• Perceptual or sensory issues
• Therapy for a speech or language disorder

Whereas behavioral and some other realms of psychology focus on actions--which are external and observable--cognitive psychology is instead concerned with the thought processes behind the behavior. Cognitive psychologists see the mind as if it were a computer, taking in and processing information, and seek to understand the various factors involved.

A Word From Verywell

Cognitive psychology plays an important role in understanding the processes of memory, attention, and learning. It can also provide insights into cognitive conditions that may affect how people function.

Being diagnosed with a brain or cognitive health problem can be daunting, but it is important to remember that you are not alone. Together with a healthcare provider, you can come up with an effective treatment plan to help address brain health and cognitive problems.

Your treatment may involve consulting with a cognitive psychologist who has a background in the specific area of concern that you are facing, or you may be referred to another mental health professional that has training and experience with your particular condition.

Ulric Neisser is considered the founder of cognitive psychology. He was the first to introduce the term and to define the field of cognitive psychology. His primary interests were in the areas of perception and memory, but he suggested that all aspects of human thought and behavior were relevant to the study of cognition.

A cognitive map refers to a mental representation of an environment. Such maps can be formed through observation as well as through trial and error. These cognitive maps allow people to orient themselves in their environment.

While they share some similarities, there are some important differences between cognitive neuroscience and cognitive psychology. While cognitive psychology focuses on thinking processes, cognitive neuroscience is focused on finding connections between thinking and specific brain activity. Cognitive neuroscience also looks at the underlying biology that influences how information is processed.

Cognitive psychology is a form of experimental psychology. Cognitive psychologists use experimental methods to study the internal mental processes that play a role in behavior.

Sternberg RJ, Sternberg K. Cognitive Psychology . Wadsworth/Cengage Learning. 

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Cutting JE. Ulric Neisser (1928-2012) . Am Psychol . 2012;67(6):492. doi:10.1037/a0029351

Ruggiero GM, Spada MM, Caselli G, Sassaroli S. A historical and theoretical review of cognitive behavioral therapies: from structural self-knowledge to functional processes .  J Ration Emot Cogn Behav Ther . 2018;36(4):378-403. doi:10.1007/s10942-018-0292-8

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By Kendra Cherry, MSEd Kendra Cherry, MS, is a psychosocial rehabilitation specialist, psychology educator, and author of the "Everything Psychology Book."

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What are Visual Perceptual Skills?

“Visual Perceptual skills involve the ability to organize and interpret the information that is seen and give it meaning.” Our eyes send large amounts of information to our brains to process every single second.  If our eyes are sending us the proper information in a way that makes sense, the brain can then process it, thus allowing us to form thoughts, make decisions, and create action. In our office we both test for and treat the seven core visual perceptual skills. Below are the seven core visual perceptual skills, and a brief explanation of each:

1.   Visual Memory  – the visual skill that allows us to record, store and retrieve information. It allows us to learn and later recall what is learned. Look at the top picture below for 5 seconds, then cover it with your hand and see if you can find the match below:

2.   Visual Sequential Memory  – similar to visual memory in that it allows us to store and retrieve information when necessary or useful. However sequential memory helps us remember and recognize people, places we have been, and series of events, equations, and procedures. Can you remember the order of the planets without looking?

3. Visual Form Constancy  – the visual skill that allows us to distinguish one object from another similar object. Being able to tell the difference between the letter “b” and “d” or “3” and “8”. Though the forms are similar in shape, they are very different in meaning. The ability to see and distinguish these differences is form constancy. Look at the top left card, and find the one item that is the same on the card to its right. See how many matches you can find:

4.   Visual Figure Ground  – the visual skill that allows us to distinguish, segregate, isolate or find an object or stimuli in varying environments. This can include faces, figures, objects, landscapes, and letters or numbers. Properly processing our visual figure ground helps to organize the information we see in our environment. Find the following items to the left and bottom of the picture hiding inside:

5. Visual Spatial Relations  – the visual skill that allows us to process the visual environment around us and the location of objects in respect to ourselves. Which building is closer?!

6. Visual Closure  – the visual skill that allows us to detect, differentiate, select, draw conclusions and understand information when we are only given certain pieces of information, rather than the entire account, story or explanation. Can you tell what this is a picture of?!

7. Visual Discrimination  – each of the above six skills require some degree of visual discrimination. Visual Discrimination is the ability to identify detail, seeing items likes and differences in shape, color, position and orientation. How many differences can you find in these two similar pictures?!

Abby Asaad, COVT

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Are you looking for easy tips to improve students memory and recall? If so, keep reading.

1. Get the learner’s vision reviewed if it has not been recently reviewed.

2. Provide the learner the chance to find objects that are the same or varied in size, shape, color, etc.

3. Get the learner to sort objects according to size, shape, color, etc.

4. Get the learner to use play equipment such as a ladder, jungle gym, teeter-totter, or balance beam to become more aware of body position in space.

5. Get the learner to finish partially drawn figures , words, numbers, etc.

6. Get the learner to use images from magazines, catalogs, etc., to recognize features and body portions.

7. Get the learner to build an object according to a pattern (e.g., construction toys, blocks, etc.).

8. Get the learner to take part in sequencing learning activities (e.g., put numbers in order, space images in the correct order, etc.).

9. Get the learner to pick out specific objects from images , around the classroom, in their surroundings, while on the playground, etc.

10. Get the learner to perform an assortment of learning activities such as tracing, cutting, coloring, pasting, etc.

11. Get the learner to finish jigsaw puzzles , beginning with simple self-made puzzles and progressing to more complex puzzles.

12. Create an assortment of learning activities for the learner using a pegboard.

13. Give the learner an assortment of classifying learning activities (e.g., from simple classifying of types of clothes, cars, etc., to more complex classifying of which things would be located at specific stores, etc.).

14. Get the learner to find specific shapes in the room (e.g., the door is a rectangle; the clock is a circle, etc.).

15. Give the learner simple designs to be replicated with blocks, sticks, paper, etc.

16. Get the learner to find objects by looking at the outline of objects on a cardboard silhouette , etc.

17. Minimize visual stimuli on a worksheet or in a book by covering up all of the page except the learning experience on that the learner is working.

18. Get the learner to repeat the names of objects, shapes, numbers, or words presented to them for a limited period.

19. Give the learner an assortment of exercises in which they must find the missing portions, common objects, etc.

20. Give the learner an assortment of visual recall tasks (e.g., the learner writes numbers, shapes, and words they were shown for a specific time, etc.).

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Gestalt Theory: Understanding Perception and Organization

Gestalt theory, a psychological framework developed in the early 20th century by German psychologists Max Wertheimer, Wolfgang Köhler, and Kurt Koffka, provides valuable insights into how humans perceive and make sense of the world around them. The term “gestalt” itself translates to “form” or “whole” in German, emphasizing the theory’s focus on understanding patterns and configurations rather than isolated elements.

At its core, gestalt theory suggests that our minds naturally organize sensory information into meaningful wholes or coherent patterns. Instead of perceiving individual parts separately, we tend to perceive objects as complete entities with inherent relationships among their components. This holistic approach to perception allows us to recognize familiar objects and scenes effortlessly.

One of the fundamental principles of gestalt theory is known as “the law of proximity.” This principle states that elements that are close to each other tend to be perceived as belonging together. For example, when presented with a group of dots arranged closely in space, we will perceive them as forming a single shape or pattern rather than separate entities.

Overall, gestalt theory offers valuable insights into human perception and cognition by highlighting our innate tendency to organize sensory information into meaningful wholes. By understanding these underlying principles, we can gain a deeper appreciation for how our minds construct meaning from the world around us.

Overview of Gestalt Theory

Gestalt theory is a psychological framework that focuses on how people perceive and experience the world around them. It emphasizes that our perception is not simply a collection of individual elements, but rather, it is influenced by the way these elements are organized into meaningful patterns or “Gestalts.” In this section, we’ll delve into the key concepts and principles of Gestalt theory.

One fundamental principle of Gestalt theory is the idea that the whole is greater than the sum of its parts. This means that when we perceive something, we don’t just see individual objects or elements in isolation. Instead, our minds automatically organize these elements into cohesive wholes. For example, when looking at a painting, we don’t focus solely on each brushstroke or color patch; instead, we perceive it as a complete image with its own unique meaning and emotional impact.

Another important concept in Gestalt theory is known as “figure-ground relationship.” According to this principle, our minds naturally separate visual stimuli into distinct figures (the objects of interest) and background (the surrounding context). This separation allows us to focus our attention on specific elements while simultaneously perceiving their relation to the broader environment. For instance, when observing a tree in a forest, we can distinguish it from the other trees and appreciate its form despite being surrounded by foliage.

Gestalt psychology also highlights the role of perceptual grouping in shaping our perception. Our brains tend to group similar elements together based on various factors such as proximity (objects close to each other are seen as related), similarity (objects that share common features are grouped together), continuity (we tend to perceive smooth curves rather than abrupt changes), and closure (our tendency to fill in missing information to create complete shapes).

Additionally, Gestalt theorists emphasize that perception involves more than just visual stimuli; it encompasses all aspects of human experience including auditory, tactile, olfactory sensations, and even abstract concepts. Gestalt theory suggests that our minds naturally organize and interpret these diverse stimuli in a holistic manner, seeking patterns, meaning, and coherence.

By understanding the principles of Gestalt theory, we can gain insights into how our perception works and how we make sense of the world around us. It offers valuable perspectives for fields such as psychology, design, art, and even problem-solving. As we explore further in this article, we’ll delve into specific examples and applications of Gestalt theory to better grasp its practical implications.

Remember, this section is just the beginning of our exploration into Gestalt theory. Stay tuned for more fascinating insights and real-world examples that will deepen your understanding of this influential psychological framework.

Key Principles of Gestalt Theory

Gestalt theory, coined by German psychologists in the early 20th century, is a school of thought that emphasizes how individuals perceive and interpret the world around them. In this section, we’ll delve into the key principles of Gestalt theory that shed light on our perceptual experiences.

• The Law of Proximity: According to the law of proximity, objects that are close to each other are perceived as belonging together. This principle highlights how our brains naturally group elements based on their physical closeness. For example, imagine a series of dots scattered randomly on a page. Our minds instinctively organize them into clusters or patterns based on their proximity.
• The Law of Similarity: The law of similarity states that objects with similar features tend to be grouped together in our perception. Whether it’s shape, color, size, or texture, similarities between elements influence how we perceive and categorize them. Think about an array of differently shaped fruits displayed at a farmers’ market; we tend to group similar fruits together based on their shared characteristics.
• The Law of Closure: The law of closure suggests that our brains have a tendency to complete incomplete shapes or figures by filling in missing information. Even when presented with fragmented visual stimuli, we unconsciously connect the dots and perceive them as whole objects or forms. This principle explains why we can identify familiar symbols like logos even when they’re partially obscured.
• The Law of Figure-Ground Relationship: The law of figure-ground relationship describes how we perceive an image by differentiating between the main object (the figure) and its background (the ground). Our minds automatically separate an object from its surroundings to create distinct focal points in our perception. For instance, when looking at a photograph against a textured backdrop, we effortlessly distinguish between the subject and its environment.
• The Law of Continuity:

The law of continuity posits that our brains prefer to perceive continuous, smooth patterns rather than abrupt changes or disruptions. This principle suggests that we tend to follow the smoothest path when perceiving visual information and that our minds naturally connect elements along a common pathway. For example, when observing a winding river, we perceive it as a continuous flow rather than separate segments.

Understanding these key principles of Gestalt theory gives us insights into how our minds organize and make sense of the world. By recognizing these fundamental principles, we can better appreciate the complexities of perception and apply them in various design disciplines such as graphic design, architecture, and psychology.

Perception and Organization in Gestalt Theory

When it comes to understanding how we perceive the world around us, Gestalt theory provides valuable insights. This theory highlights that our minds have a natural inclination to organize sensory information into meaningful patterns and wholes, rather than perceiving individual elements in isolation.

One key concept in Gestalt theory is the idea of “figure-ground” perception. It suggests that we instinctively separate objects or figures from their background, allowing us to focus our attention on what stands out. For example, imagine looking at a photograph of a person standing in front of a beautiful landscape. Our mind automatically distinguishes between the person (the figure) and the background scenery (the ground), enabling us to perceive each element separately.

Another important principle within Gestalt theory is the notion of “closure.” Our brains tend to fill in missing information or gaps when presented with incomplete stimuli. This means that even if we are only given fragments or partial shapes, we can still recognize them as complete objects. For instance, if you see an image consisting of several disconnected lines forming an incomplete square, your mind will likely perceive it as a whole square.

Furthermore, Gestalt theory emphasizes how our minds naturally seek simplicity and order in visual perception. The principle of “simplicity” suggests that we tend to interpret complex stimuli by organizing them into simpler forms or patterns. By doing so, we make sense of what we see and reduce cognitive load. For instance, when presented with a scatterplot graph displaying various data points, our brain might automatically group similar points together based on proximity or shape.

Overall, understanding perception and organization through the lens of Gestalt theory sheds light on how our minds process visual information. It reveals our innate ability to form coherent perceptions by grouping elements together based on their relationships and characteristics. By grasping these principles, we can gain deeper insights into human cognition and enhance various fields such as design, psychology, and even marketing.

Gestalt Laws and Their Applications

Let’s delve into the fascinating world of Gestalt theory and explore its laws and practical applications. Understanding these principles can provide valuable insights into how we perceive and interpret the world around us.

• Law of Proximity: According to this principle, objects that are close together tend to be perceived as a group or related. For instance, imagine a group of people standing in a line. Even though they are separate individuals, our brain automatically groups them together due to their proximity.
• Law of Similarity: The law of similarity states that objects that share similar visual characteristics, such as shape, size, color, or texture, are perceived as belonging to the same group. Consider a collection of circles and squares arranged randomly on a page; we instinctively group the circles together and the squares together based on their similarity.
• Law of Closure: This principle suggests that our minds tend to fill in missing information or gaps in order to perceive whole shapes or patterns. For example, if you see an incomplete circle with a small gap at the bottom, your brain will naturally complete it as a full circle.
• Law of Continuity: The law of continuity proposes that our brains prefer smooth and continuous lines rather than abrupt changes in direction or pattern. When presented with intersecting lines or curves, we perceive them as flowing continuously rather than disjoined segments.
• Law of Figure-Ground Relationship: This principle deals with how we distinguish between an object (figure) and its background (ground). Our brains tend to focus on one element while perceiving others as less prominent or secondary. Think about how you can easily differentiate between words on a page and the blank space surrounding them.

These laws have various real-world applications across different fields:

• Graphic Design: Designers often utilize Gestalt principles to create visually appealing layouts by leveraging proximity, similarity, closure, continuity techniques.
• Advertising: Advertisers use these laws to capture viewers’ attention and create memorable visuals that communicate their message effectively.
• User Experience (UX) Design: Applying Gestalt principles in UX design helps designers create intuitive interfaces, ensuring users can easily navigate through websites or applications.
• Psychology and Perception: The study of Gestalt theory has contributed significantly to our understanding of human perception and cognitive processes.

By recognizing the power of Gestalt laws and implementing them consciously, we can enhance communication, design, and overall user experience in various aspects of our lives.

Gestalt Therapy: A Practical Approach

When it comes to therapy, there are various approaches that aim to help individuals overcome challenges and improve their well-being. One such approach is Gestalt therapy, which focuses on the here and now, emphasizing self-awareness and personal responsibility. In this section, I’ll delve into the practical aspects of Gestalt therapy and how it can be applied in real-life situations.

• Awareness in the Present Moment: Gestalt therapy places great importance on being fully present in the current moment. This means paying attention to our thoughts, feelings, bodily sensations, and behaviors as they arise. By cultivating awareness of what is happening internally and externally, individuals can gain insight into their patterns of behavior and make more conscious choices.

For example, let’s say someone is struggling with anger management issues. Through Gestalt therapy techniques like focusing on bodily sensations associated with anger or exploring the underlying emotions triggering this response, individuals can develop a greater understanding of their anger triggers. This heightened awareness empowers them to respond differently in similar situations in the future.

• Taking Responsibility for One’s Actions: Another key aspect of Gestalt therapy is the emphasis on personal responsibility for one’s actions and choices. It encourages individuals to acknowledge that they have control over how they perceive situations and how they respond to them.

For instance, consider a person who constantly blames external circumstances for their unhappiness or lack of success. In Gestalt therapy sessions, they would be encouraged to explore their role in creating these outcomes and take ownership of their choices. By recognizing their ability to make different decisions or change perspectives, individuals become active participants in shaping their own lives.

• Integration of Parts: Gestalt therapists often work with clients to help integrate different parts of themselves that may feel disconnected or conflicting. This involves exploring inner dialogue between these parts and finding ways to bring them together harmoniously.

Let’s imagine someone struggling with indecisiveness and feeling torn between different desires or values. Through Gestalt therapy techniques like the “empty chair” exercise, where individuals have a dialogue with imagined aspects of themselves, they can explore conflicting thoughts and emotions. This process facilitates self-acceptance and integration, leading to greater clarity and decision-making ability.

In summary, Gestalt therapy offers a practical approach to personal growth and healing by focusing on present awareness, taking responsibility for one’s actions, and integrating different parts of oneself. By incorporating these principles into therapeutic practice, individuals can develop a deeper understanding of themselves and work towards making positive changes in their lives.

Critiques and Controversies Surrounding Gestalt Theory

When it comes to the field of psychology, Gestalt theory has undoubtedly made its mark. However, like any prominent theory, it is not without its fair share of critiques and controversies. Let’s delve into a few key points that have sparked debate among scholars and researchers.

• Reductionism: One criticism often leveled against Gestalt theory is its perceived lack of emphasis on reductionism. Some argue that the holistic approach advocated by Gestalt psychologists undermines the importance of breaking down complex psychological processes into smaller components for analysis. Critics contend that this limits our understanding of human behavior and cognition.
• Subjectivity and Interpretation: Another point of contention revolves around the subjective nature of perception in Gestalt theory. While proponents highlight how individuals actively organize sensory information into meaningful patterns, skeptics argue that interpretation plays a significant role in determining these patterns. This subjectivity raises questions about the reliability and universality of perceptual organization principles proposed by Gestalt psychologists.
• Empirical Evidence: In scientific circles, rigorous empirical evidence holds great significance when evaluating theories. Some critics claim that the experimental support for certain aspects of Gestalt theory is limited or inconclusive. They argue that more research is needed to validate some fundamental assertions put forth by this influential school of thought.
• Cultural Bias: A recurring concern within critiques surrounding many psychological theories is their potential cultural bias. Similar concerns arise with respect to Gestalt theory, as some scholars question whether its principles are applicable across diverse cultural contexts or if they are rooted in Western perspectives alone.
• Integration with Other Theories: Lastly, there are debates about how well Gestalt theory integrates with other branches of psychology and related disciplines such as neuroscience or cognitive psychology. Critics argue that despite its contributions, the gestalt framework might not fully account for all aspects of human behavior and cognition when considered alongside other theoretical frameworks.

It’s important to note that these criticisms and controversies do not negate the valuable contributions made by Gestalt theory. Rather, they serve as thought-provoking avenues for further exploration and refinement of our understanding of human perception and cognition.

In the next section, we’ll explore some real-world applications of Gestalt theory in various fields to showcase its practical relevance. Stay tuned!

Influence of Gestalt Theory on Modern Psychology

Gestalt theory, with its emphasis on the whole being greater than the sum of its parts, has had a profound influence on modern psychology. By examining how individuals perceive and interpret information, Gestalt theory has provided key insights into human cognition and behavior. Let’s delve into some examples that highlight the impact of this theory.

• Perception and Organization: Gestalt psychologists emphasized that our minds have an innate tendency to organize sensory stimuli into meaningful patterns. An example of this is the concept of figure-ground perception, where we naturally distinguish between objects (figures) and their surrounding background (ground). This understanding has greatly influenced research in visual perception, advertising design, and even user interface development.
• Problem-Solving and Insight: Gestalt theory also sheds light on problem-solving processes by emphasizing the role of insight or “aha” moments. According to this perspective, problem-solving involves restructuring our mental representation of a problem to achieve a sudden realization of the solution. This notion has informed various fields like education, cognitive psychology, and creativity studies.
• Holistic Approach in Therapy: The principles of Gestalt therapy align closely with its theoretical counterpart. Instead of focusing solely on isolated symptoms or behaviors, therapists using this approach aim to understand clients as integrated beings within their environment. The therapeutic process focuses on fostering self-awareness, personal growth, and enhancing relationships through exploring emotions in the present moment.
• Social Perception: Gestalt principles extend beyond individual perception to social contexts as well. Social psychologists have applied these ideas to explore how people form impressions about others based on fragmented information or cues they receive when encountering someone for the first time. This research highlights how our minds automatically fill in missing details to create a more coherent understanding of others’ personalities.
• Group Dynamics: Understanding group dynamics is another area significantly influenced by Gestalt theory concepts such as proximity, similarity, and closure. These principles help explain how individuals form affiliations, make group decisions, and perceive themselves as part of a larger collective. Such insights have informed fields like organizational psychology and leadership development.

Gestalt theory has left an indelible mark on modern psychology by offering novel perspectives on perception, problem-solving, therapy, social cognition, and group dynamics. Its holistic approach continues to shape our understanding of human behavior and enrich various domains within the field of psychology.

In this article, we have explored the fascinating concept of Gestalt theory and its impact on psychology and perception. Let’s summarize the key points we’ve discussed:

• Perception is more than the sum of its parts: According to Gestalt theory, our minds naturally organize sensory information into meaningful patterns and wholes. We perceive objects as unified entities rather than a collection of individual elements.
• The principles of Gestalt theory: We have examined several fundamental principles that govern how we perceive visual stimuli, including figure-ground relationship, proximity, similarity, closure, and continuity. These principles help us make sense of the world around us and facilitate efficient processing of visual information.
• Applications in various fields: Gestalt theory has found applications in many domains beyond psychology. It has influenced art, design, advertising, user experience (UX) design, and even problem-solving techniques. Understanding how people perceive and interpret visual information can greatly enhance communication and effectiveness in these areas.
• Limitations and criticisms: While Gestalt theory offers valuable insights into perception, it also faces criticism for oversimplifying complex cognitive processes. Some argue that it neglects other factors such as attention and memory that influence perception.
• Ongoing research: Despite being introduced over a century ago, researchers continue to explore the intricacies of Gestalt theory and its implications today. Advancements in neuroscience allow us to delve deeper into understanding how our brains process visual stimuli.

In conclusion,

Gestalt theory provides a framework for understanding how our minds organize sensory information to create meaningful perceptions of the world around us. By studying these perceptual principles, we gain insights into human cognition that can be applied across various disciplines.

Remembering that perception is not simply about individual elements but about the whole picture helps designers create visually appealing graphics or interfaces while advertisers use this knowledge to engage their target audience effectively.

As technology advances further and our understanding grows deeper through ongoing research efforts, we can expect to uncover even more about the intricacies of perception and its implications for our daily lives.

So, next time you marvel at a beautiful painting or get captivated by an engaging advertisement, remember that Gestalt theory plays a significant role in shaping your perception.

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Meditation and flexibility of visual perception and verbal problem solving

• Published: May 1982
• Volume 10 , pages 207–215, ( 1982 )

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This study investigates the effects of the regular practice of the Transcendental Meditation (TM) technique on habitual patterns of visual perception and verbal problem solving. The study’s predictions were expressed in the context of Norman’s model, which suggests that meditation reduces conceptually driven processes. It was specifically hypothesized that the TM technique involves a reduction of habitual patterns of perceptual and conceptual activation, resulting in (1) more effective application of schemata to new information and (2) less distracting mental activity during performance. This was predicted to result in improved task performance on task conditions in which either (1) habitual patterns of performance hinder or do not aid performance or (2) habitual patterns aid performance. Subjects began the TM technique, relaxed, or added nothing to their daily schedule for 2-week periods. In addition to generalized effects of the interventions, the immediate effects of the TM technique, relaxation, and reading were compared on a letter perception task. The general hypothesis was supported for tasks of tachistoscopic identification of card and letter-sequence stimuli, but not for the verbal problem solving task of anagram solution.

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The Problem of Perception

The Problem of Perception is a pervasive and traditional problem about our ordinary conception of perceptual experience. The problem is created by the phenomena of perceptual illusion and hallucination: if these kinds of error are possible, how can perceptual experience be what we ordinarily understand it to be: something that enables direct perception of the world? These possibilities of error challenge the intelligibility of our ordinary conception of perceptual experience; the major theories of experience are responses to this challenge.

1.1 Starting Points

1.2 ordinary objects, 1.3 presentation, 1.4 direct realism, 1.5 the character of experience, 1.6 the common kind claim, 2.1 the argument from illusion.

• 2.2 The Argument from Hallucination

3.1.1 The Sense-Datum Theory in Outline

3.1.2 the sense-datum theory and the problem of perception.

• 3.1.3 The Sense-Datum Theory and our Ordinary Conception of Perceptual Experience

3.1.4 The Sense-Datum Theory and Perception of the World

3.1.5 objections to the sense-datum theory, 3.2.1 adverbialism in outline.

• 3.2.2 The Adverbialism and Qualia

3.2.3 Objections to Adverbialism

3.2.4 adverbialism and the problem of perception.

• 3.2.5 Adverbialism and Our Ordinary Conception of Perceptual Experience

3.2.6 Adverbialism and Perception of the World

3.3.1 intentionalism in outline, 3.3.2 sources of intentionalism, 3.3.3 the intentional content of perceptual experience, 3.3.4 intentionalism and the problem of perception, 3.3.5 intentionalism and perception of the world, 3.3.6 intentionalism and our ordinary conception of perceptual experience, 3.4.1 naive realism in outline, 3.4.2 naive realism and the problem of perception, 3.4.3 the development of naive realist disjunctivism.

• 3.4.4 Naive Realism Disjunctivism and our Ordinary Conception of Perceptual Experience

4. Conclusion

Further reading, other internet resources, related entries, 1. our ordinary conception of perceptual experience.

A.D. Smith claims that what most authors have in mind in talking about the Problem of Perception is the “question of whether we can ever directly perceive the physical world”, where “the physical world” is understood in a realist way: as having “an existence that is not in any way dependent upon its being... perceived or thought about” (2002: 1). The arguments at the heart of the Problem of Perception challenge this direct realist perspective on perceptual experience. But since this perspective is embedded within our ordinary conception of perceptual experience, the problem gets to the heart of our ordinary ways of thinking.

So, what is our ordinary conception of perceptual experience? And how does it embed a direct realist perspective?

We conceive of perceptual experiences as occurrences with phenomenal character. The phenomenal character of an experience is what it is like for a subject to undergo it (Nagel (1974)). Our ordinary conception of perceptual experience emerges from first-personal reflection on its character, rather than from scientific investigation; it is a conception of experience from a “purely phenomenological point of view” (Broad 1952: 3–4). We’ll present this conception by outlining what phenomenological reflection suggests first about the objects ( §1.2 ), structure ( §1.3 ), and character ( §1.5 ) of experience, and then about the relation between veridical, illusory, and hallucinatory experiences, and in particular whether these cases form a common kind ( §1.6 ).

Let’s begin with P.F. Strawson’s idea that “mature sensible experience (in general) presents itself as, in Kantian phrase, an immediate consciousness of the existence of things outside us” (1979: 97), and similarly McDowell’s idea that perceptual experience appears to be an “openness to the world” (1994: 111), conceived of as openness to mind-independent reality (1994: 25–26).

These ideas reflect the basic phenomenological observation that perceptual experiences have objects, and more specifically direct objects: objects that are simply perceived or experienced, but not in virtue of the perception or experience of distinct, more “immediate”, objects.

Various authors appeal to a notion of directness in outlining our ordinary conception of perceptual experience, and the Problem of Perception. A dissenting voice is Austin (1962), and for recent critical discussion see Martin (2017). For further discussion of how to understand notions of direct and indirect perception, see Jackson (1977), Snowdon (1992), Foster (2000), Smith (2002), and Martin (2005).

This starting point gives rise to the following questions (cf. Martin 1998: 176):

• The Objects Question: what is the nature of the direct objects of experience?
• The Structure Question: in what sense are experiences directly of their objects?

Let’s turn to the answers to these questions suggested by Strawson and McDowell’s remarks (for a more critical stance on these remarks see Mackie (2020)).

Strawson begins his argument by asking how someone might typically respond to a request for a description of their current visual experience. He says that it is natural to give the following kind of answer: “I see the red light of the setting sun filtering through the black and thickly clustered branches of the elms; I see the dappled deer grazing in groups on the vivid green grass…” (1979: 97). There are two ideas implicit in this answer. First, the description talks about objects which are things distinct from experience. Second, the description is “rich”, describing the nature of the experience not merely in terms of simple shapes and colours; but in terms of the familiar things we encounter in the “lived world” in all their complexity (see also Heidegger (1977: 156)).

So, we can highlight the following answer to the Objects Question:

• Ordinary Objects : perceptual experiences are directly of ordinary mind-independent objects .

There are three things to clarify about this. First, it incorporates realism in that it appeals to the notion of a mind-independent object of experience: one that doesn’t depend for its existence upon experience. Second, it concerns familiar or ordinary objects, things that we admit as part of common-sense ontology. Third, “object of experience” is understood broadly to encompass perceptible entities in mind-independent reality including ordinary material objects, but also features and other entities (e.g., events, quantities of stuff). When we talk of “ordinary objects”, “the world” etc, we take this as shorthand for: familiar or ordinary mind-independent perceptible entities.

Some writers have defended a thesis known as the transparency of experience (see Harman (1990); Speaks (2009); Tye (1992, 1995, 2000); Thau (2002); and for critical discussions, Martin (2002a), Smith (2008), Stoljar (2004) and Soteriou (2013)). Transparency is normally defined as the thesis that introspecting what it is like for a subject to have an experience does not reveal awareness of experiences themselves, but only of their mind-independent objects. There are two claims here: (i) introspection reveals the mind-independent objects of experience, and (ii) introspection does not reveal any features of anything else.

Transparency is similar to Ordinary Objects . The latter claim does involve something like (i). But it does not involve (ii). And it is not obvious that (ii) is part of our ordinary conception of perceptual experience. After all, we readily admit that an ordinary scene (e.g., a snow-covered churchyard) can look very different when one removes one’s glasses: one’s visual experience then becomes blurred. But this phenomenal difference does not seem to derive from any apparent difference in the objects of experience. Rather, it seems to be a difference in the way in which those objects are experienced. (See Tye (2000) and Gow (2019) for different responses. For further discussion, see Crane (2000), Smith (2008), Allen (2013), and French (2014). For a different challenge to (ii) and its ilk see Richardson (2010) and Soteriou (2013: Chapter 5), and French (2018)).

What, then, about the Structure Question? Strawson speaks of the manner in which we directly experience objects as a matter of “immediate consciousness”, and McDowell talks of our “openness” to objects. Other notions commonly invoked here include the idea that we are directly “acquainted” with objects, we directly “apprehend” them, they are “given” to us, or directly “present to the mind”. What these notions all aim to capture is the intuitive idea that perceptual experience of an object involves a special intimate perceptual relation to an object, a relation which differentiates perceptual experiences from non-perceptual states of mind which are similarly directed on the world (e.g., non-sensory, non-perceptual thoughts).

One function of this relation is to make objects present in such a way that they can shape or mould the character of one’s experience. In virtue of this, perceptions of the world are unlike (non-perceptual) thoughts about the world: they are constrained by the objects actually given. One’s perception of a snow-covered churchyard is responsive to how the churchyard is now, as one is perceiving it. But one’s (non-perceptual) thought need not be: in the middle of winter, one can imagine the churchyard as it is in spring, and one can think of it in all sorts of ways which are not the ways it presently is.

In what follows we will use the notion of perceptual presentation to capture this perceptual relation. We can thus highlight the following answer to the structure question:

• Presentation : perceptual experiences are direct perceptual presentations of their objects.

In what follows, we use “direct presentation” for short.

Putting the pieces together, our ordinary conception of perceptual experience involves:

• Direct Realist Presentation : perceptual experiences are direct perceptual presentations of ordinary objects .

If direct perceptual presentation of an ordinary object is a way of directly perceiving it, then this gives us:

• Direct Realism : we can directly perceive ordinary objects.

We can now shed light on the phenomenal character of perceptual experience. Consider, then, the following question:

• The Character Question: what determines the phenomenal character of experience?

We began with the basic phenomenological observation that perceptual experiences are directly of things. A similarly basic observation is that what it is like for us to experience is at least partly a matter of such things appearing certain ways to us. When we reflect upon what determines what it is like to have an experience, we naturally begin with what is presented to us, and how it is presented. This is why it is so natural for Strawson to describe his experience in terms of what he perceives, and for Martin to say that “our awareness of what an experience is like is inextricably bound up with knowledge of what is presented to one in having such experience” (1998: 173).

Further, when we reflect upon what determines what it is like for us to experience, we naturally begin with the ordinary objects that are presented to us, and how they are presented or appear. This is why it is so natural for Strawson to describe his experience in terms of such objects, and why many find (at least component (i) of) Transparency intuitive.

So, we can highlight the following answer to the Character Question:

• Direct Realist Character: the phenomenal character of experience is determined, at least partly, by the direct presentation of ordinary objects.

Perceptual experiences are not just veridical experiences: there are illusions and hallucinations too. What does phenomenological reflection say about how these cases relate to each other? More specifically:

• The Common Kind Question: are veridical, illusory, and hallucinatory experiences fundamentally the same, do they form of a common kind ?

In the context of the Problem of Perception, these cases are usually distinguished as follows: a veridical experience is an experience in which an ordinary object is perceived, and where the object appears as it is; an illusory experience is an experience in which an ordinary object is perceived, and where the object appears other than it is; a hallucination is an experience which seems to the subject exactly like a veridical perception of an ordinary object but where there is no such perceived or presented object. (For illusions and hallucinations which don’t fit these forms, see Johnston (2011), and Batty and Macpherson (2016)).

Clearly, there are differences between these categories, but from a phenomenological point of view, these experiences seem the same in at least this sense: for any veridical perception of an ordinary object, we can imagine a corresponding illusion or hallucination which cannot be told apart or distinguished, by introspection, from the veridical perception. This suggests the following answer to the Common Kind Question:

• Common Kind Claim: veridical, illusory, and hallucinatory experiences (as) of an F are fundamentally the same; they form a common kind .

Thus, a veridical, illusory, and hallucinatory experience, all alike in being experiences (as) of a churchyard covered in white snow, are not merely superficially similar, they are fundamentally the same: these experiences have the same nature, fundamentally the same kind of experiential event is occurring in each case. Any differences between them are external to their nature as experiences (e.g., to do with how they are caused).

2. The Problem of Perception

The Problem of Perception is that if illusions and hallucinations are possible, then perceptual experience, as we ordinarily understand it, is impossible. The Problem is animated by two central arguments: the argument from illusion (§2.1) and the argument from hallucination (§2.2). (A similar problem arises with reference to other perceptual phenomena such as perspectival variation or conflicting appearances: see Burnyeat (1979) and the entry on sense-data). For some classic readings on these arguments, see Moore (1905, 1910); Russell (1912); Price (1932); Broad (1965); and Ayer (1940), see Swartz (1965) for a good collection of readings. And for more recent expositions see Snowdon (1992), Valberg (1992), Robinson (1994: Chapter 2), Smith (2002: Chapters 1 and 7), Martin (2006), Fish (2009: Chapter 2), Brewer (2011: Chapter 1) and Pautz (2021).

The two central arguments have a similar structure which we can capture as follows:

• In an illusory/hallucinatory experience, a subject is not directly presented with an ordinary object.
• The same account of experience must apply to veridical experiences as applies to illusory/hallucinatory experiences.
• Subjects are never directly presented with ordinary objects.

(C) contradicts Direct Realist Presentation, and thus our ordinary conception of perceptual experience. And since Direct Realism seems to follow from Direct Realist Presentation, the argument challenges Direct Realism too (for more on this see §3.2.6 ).

Representing the arguments in this basic form enables us to highlight their two major movements; what Paul Snowdon calls the base case, and the spreading step (1992, 2005). In the base case a conclusion about just illusory/hallucinatory experiences is sought: (A). In the spreading step, (B), this result is generalised so as to get (C). This generalising move works on these background assumptions: (a1) that (B) yields the claim that one is not directly presented with ordinary objects in veridical experiences (given (A)), and (a2) if one is not directly presented with such objects in even veridical experiences, one never is.

We’ll look at more complex versions of the argument shortly. As we’ll see, the main burden on the arguer from illusion is in supporting the relevant version of (A), whereas the main burden on the arguer from hallucination is in defending the relevant version of (B).

Now, the argument here is purely negative. But many philosophers have moved from this to the further conclusion that since we are always directly presented with something in perceptual experience, what we are presented with is a “non-ordinary” object (see §3.1.2 ).

Applying the above structure, the argument from illusion is:

• In illusory experiences, we are not directly presented with ordinary objects.
• The same account of experience must apply to veridical experiences as applies to illusory experiences.
• We are never directly presented with ordinary objects.

Moving beyond the simple formulation, the argument is typically presented as involving these steps, for an arbitrary subject S:

• In an illusion, it seems to S that something has a sensible quality, F, which the ordinary object supposedly being perceived does not have.
• When it seems to S that something has a sensible quality, F, then there is something directly presented to S which does have this quality.
• Since the ordinary object in question is, by hypothesis, not-F, then it follows that in an illusion, S is not directly presented with the ordinary object supposedly being perceived.
• The same account of experience must apply to both veridical and illusory experiences.
• In veridical experience, S is not directly presented with the ordinary object supposedly being perceived.
• If S is not directly presented with the ordinary object supposedly being perceived in veridical experience, S is never directly presented with an ordinary object.

The most controversial premise here is premise (ii). The others reflect intuitive ways of thinking about perceptual experience, or plausible assumptions. This is clear enough with (i) and (iv). Premise (i) articulates the operative conception of illusions. An example to illustrate is a case where a white wall looks yellow to you, in peculiar lighting (Smith (2002: 25)). And premise (vi) reflects the intuitive idea that if we aren’t directly presented with the ordinary objects we seem to perceive in veridical experiences, then we aren’t directly presented with ordinary objects at all. For it would be implausible to relinquish the idea that we are directly presented with the ordinary objects we seem to perceive in veridical experience, yet maintain that we can still somehow else be directly presented with ordinary objects, e.g., with the idea that hallucinations are direct presentations of ordinary objects, or with the idea that veridical experiences are direct presentations of ordinary objects just not those we seem to perceive.

But what about (iv)? On one way of interpreting this, it reflects the Common Kind Claim applied to veridical experiences and illusions. Furthermore, various authors hold that (iv) is supported by the continuity between veridical experiences and illusory experience (Price (1932: 32), Ayer (1940: 8–9), Broad (1952: 9), Robinson (1994: 57), Smith (2002: 26–28): the fact that they may form a “continuous series” in which they “shade into one another” (Ayer (1940: 8–9)). This, it is held, supports the idea that experiential differences between illusions and veridical perceptions are differences of “degree and not of kind” (Ayer (1940: 8)).

Premise (ii) is a version of what Robinson calls the Phenomenal Principle:

If there sensibly appears to a subject to be something which possesses a particular sensible quality then there is something of which the subject is aware which does possess that sensible quality (1994: 32).

C.D. Broad motivates this principle on explanatory grounds. In cases of perceptual experience things appear some ways rather than others to us. We need to explain this. Why does the penny look elliptical to you as opposed to some other shape? One answer is that there is something directly presented to you which is in fact elliptical. Thus, as Broad says “If, in fact, nothing elliptical is before my mind, it is very hard to understand why the penny should seem elliptical rather than of any other shape.” (1923: 240). Other philosophers have simply taken the principle to be obvious. H.H. Price, for example, says that “When I say ‘this table appears brown to me’ it is quite plain that I am acquainted with an actual instance of brownness” (1932: 63).

So much for the argument’s main premises. How is it supposed to work? Here we find the suggestion that it hinges on an application of Leibniz’s Law of the Indiscernibility of Identicals (Robinson (1994: 32); Smith (2002: 25)). The point is that (i) and (ii) tell us that in an illusory experience you are directly presented with an F thing, but the ordinary object supposedly being perceived is not F, thus the F thing and the ordinary object are not identical, by Leibniz’s Law. On these grounds, the conclusion of the base case is supposed to follow. And then the ultimate conclusion of the argument can be derived from its further premises.

But as French and Walters (2018) argue, this is invalid. (i), (ii) and Leibniz’s Law entail that in an illusory experience you are directly presented with an F thing which is non-identical to the ordinary object supposedly being perceived. However, this doesn’t entail that in the illusion you are not directly presented with the ordinary object. You might be directly presented with the ordinary object as well as the F thing. We should be careful to distinguish not being directly presented with the ordinary object from being directly presented with something which is not the ordinary object (e.g., between not being directly presented with the white wall, and being directly presented with something that is not the white wall, e.g., a yellow entity). The argument is invalid in conflating these two ideas.

One option for fixing the argument is to introduce what French and Walters call the Exclusion Assumption (cf., Snowdon (1992: 74)): If in an illusion of an ordinary object as F, a subject is directly presented with an F thing non-identical to the ordinary object, then they are not also directly presented with the ordinary object.

This assumption bridges the gap between the conclusion actually achieved: namely, in an illusory experience S is directly presented with an F thing non-identical to the ordinary object, and the desired conclusion (iii). But whether this assumption is defensible remains to be seen. We leave this and the issue of validity aside and consider responses from different theories of experience below.

2.2 The Argument From Hallucination

The argument from hallucination relies on the possibility of hallucinations as understood above. Such hallucinations are not like real drug-induced hallucinations or hallucinations suffered by those with certain mental disorders. They are rather supposed to be merely possible events. For example, suppose you are now having a veridical perception of a snow-covered churchyard. The assumption that hallucinations are possible means that you could have an experience which is subjectively indistinguishable—that is, indistinguishable by you, “from the inside”—from a veridical perception of a snow-covered churchyard, but where there is in fact no churchyard presented or there to be perceived. The claim that such hallucinations are possible is widely accepted but not indisputable (see Austin (1962) and Masrour (2020)). For more on hallucinations, see Macpherson and Platchias (2013).

The argument from hallucination runs as follows:

• In hallucinatory experiences, we are not directly presented with ordinary objects
• The same account of experience must apply to veridical experiences as applies to hallucinatory experiences.

Unlike with the argument from illusion, the base case doesn’t rely on the Phenomenal Principle: (A) simply falls out of what hallucinations are supposed to be.

The spreading step can be interpreted in terms of the Common Kind Claim , applied to veridical experiences and hallucinations. Accepting (B) understood in this way puts a constraint on what can be said about the nature of veridical experience: whatever can be said had better be able to apply to hallucinations too. The argument is that, given (A), this then rules out an account of veridical experiences as direct presentations of ordinary objects. But then (C) follows (given that if we are not directly presented with ordinary objects in veridical experience, we never are).

With the argument understood in this way, we can see the power of the Problem of Perception. (A) is intuitive, and (B) is part of our ordinary conception of perceptual experience, yet what follows, (C), contradicts another aspect of our ordinary conception ( Direct Realist Presentation ). Thus, the very intelligibility of our ordinary conception of perceptual experience is threatened.

Now it might be argued that the Common Kind Claim applied to veridical perceptions and hallucinations is not as plausible as it is when applied to veridical perceptions and illusions. For veridical and illusory experiences are more naturally grouped together anyway, unlike veridical perceptions and hallucinations. For, at least before we encounter the argument from illusion, veridical perceptions and illusions are both naturally thought of as direct presentations of ordinary objects (it’s just that in illusory cases the presented objects appear other than they are). However, as noted above, from a phenomenological point of view, hallucinations too seem as though they are direct presentations of ordinary objects: from the subject’s perspective a hallucination as of an F cannot be distinguished from a veridical experience of an F. This is why it seems so plausible to think of them as fundamentally the same.

Even so, the Common Kind Claim applied to veridical perceptions and hallucinations is controversial, and rejecting it is central to the disjunctivist response to the Problem of Perception that we will consider later ( §3.4 ).

3. Theories of Experience

A number of philosophical theories of experience have emerged as responses to the Problem of Perception, or in relation to such responses. Here we consider the sense-datum theory ( §3.1 ), adverbialism ( §3.2 ), intentionalism ( §3.3 ), and naive realist disjunctivism ( §3.4 ). In this exposition we do not consider much the possibility of hybrid views. The way these positions relate to the Problem of Perception is mapped most clearly in Martin (1995, 1998, 2000).

We present these theories as operating on two levels. On Level 1, they tell us about the nature of experience. With the exception of adverbialism (for reasons that will emerge shortly), this can be investigated by considering the stance of each theory on the nature of the objects of experience, and the structure of our experience of objects. On Level 2, they tell us how what is said at the first level bears on the explanation of the character of experience. We also consider how each theory addresses the common kind question.

In what follows, we’ll work with the example of a visual experience of a snow-covered churchyard. To simplify, we will discuss the character of this experience in terms of one aspect of it: things looking white to a subject. The question at Level 1 is: what is the nature of such an experience? Does it involve the direct presentation of objects, or not? If so, what sorts of objects? If not, how are we to understand the nature of this experience? The question at Level 2 is: what is it about the nature of this experience that explains why things look any way at all to someone, and why they look, specifically, white?

3.1 The Sense-Datum Theory

What does the sense-datum theorist say at Level 1? On this theory, whenever a subject has a sensory experience, there is something which is presented to them. This relational conception of experience is sometimes called an “act-object” conception, since it posits a distinction between the mental act of being presented with something, and the object presented. More precisely, the sense-datum theorist holds that an experience in which something appears F to S, where F is a sensible quality (e.g., whiteness), consists in S being directly presented with something which actually is F (e.g. a white thing). They thus endorse the aforementioned Phenomenal Principle . The sense-datum theorist calls these objects of perception “sense-data”.

Understood in this way, a sense-datum is just whatever it is that you are directly presented with that instantiates the sensible qualities which characterise the character of your experience. This involves no further claim about the nature of sense-data, though as we’ll see shortly, sense-datum theorists do go on to make further claims about the nature of sense-data.

What about Level 2? With respect to our example, the sense-datum theorist claims that things appearing any way at all to you consists in the fact that you are directly presented with a sense-datum, and things appearing white to you consists in the fact that you are directly presented with a white sense-datum. The character of your experience is explained by an actual instance of whiteness manifesting itself in experience.

The sense-datum theorist endorses the Common Kind Claim . So, a veridical experience in which something appears white to you consists in your being directly presented with a white sense-datum; but so do corresponding illusory and hallucinatory experiences. These experiences have the same nature.

The sense-datum theorist endorses the following negative claim:

They accept this on the basis of the arguments from illusion and hallucination. However, the intended contrast with Direct Realist Presentation usually involves a stronger claim:

• We are only ever directly presented with sense-data , which are non-ordinary objects.

This involves a positive claim about what we are directly presented with, given that we are never directly presented with ordinary objects. And it embeds a claim about the nature of sense-data that goes beyond that outlined above: now sense-data are understood as non-ordinary objects.

Sense-datum theorists divide over exactly how to understand sense-data insofar as they are non-ordinary. Some early sense-datum theorists (such as Moore) initially took sense-data to be mind-independent, but peculiar non-physical objects. Later theorists treat sense-data as mind-dependent entities (Robinson (1994)). This is how the theory tends to be understood in literature from second half of the 20th century on.

Sense-datum theorists have developed more positive Problem of Perception style reasoning to support these additional ideas. For instance, Macpherson (2013: 12–13) outlines a more complicated version of the argument from hallucination than that above which concludes that “All perceptual experience, hallucinatory and non-hallucinatory, involves awareness of a mind-dependent, nonphysical object—a sense-datum”. And some sense-datum theorists have attempted to support non-ordinary sense-data outside of the context of the Problem of Perception (see Jackson (1977) and Lowe (1992)).

From now on when we speak of “sense-data” we will mean non-ordinary sense-data, and when we speak of the “sense-datum theory” we have in mind a theory that endorses not just (1) but (2).

3.1.3 The Sense-Datum Theory and Our Ordinary Conception of Perceptual Experience

The sense-datum theorist agrees with some aspects of our ordinary conception of perceptual experience. They endorse the Common Kind Claim . They also endorse Presentation – the idea that the direct objects of experience are perceptually presented to us. It’s just that they don’t agree that the direct objects of experience are ordinary objects – they are non-ordinary sense-data. They thus reject Ordinary Objects , and hence Direct Realist Presentation , and Direct Realist Character .

Is the sense-datum theory a theory on which we completely lose contact with the world, a theory on which we cannot perceive the world?

Though it is possible for a sense-datum theorist to accept this, a more popular position has been one on which we still have some form of perception of the world, just not direct perception. That is, the sense-datum theorist can say that we indirectly perceive ordinary objects: we perceive them by being directly presented with sense-data. A sense-datum theorist who says this is known as an indirect realist or representative realist (see the entry on epistemological problems of perception ). The task for such a sense-datum theorist is to spell out how the direct presentation of sense-data can lead to indirect perception of ordinary objects. This is something early sense-datum theorists pursued by asking how sense-data are related to ordinary objects. A theorist who denies that we perceive mind-independent objects at all, directly or indirectly, but only sense-data construed as mental entities, is known as a phenomenalist or an idealist (see Foster (2000), see Crane and Farkas (2004: Section 2) for an introduction to the subject; and the entry on idealism ).

The sense-datum theory was widely rejected in the second half of the 20th century, though it still had its occasional champions (e.g., Jackson (1977), O’Shaughnessy (2000, 2003), Lowe (1992), Robinson (1994), Foster (2000)). A number of objections have been made to the theory. Some of these are objections specifically to the indirect realist version: for example, the claim that the theory gives rise to an unacceptable “veil of perception” between mind and world. The idea is that sense-data “interpose” themselves between perceivers and ordinary objects, and therefore problematise our perceptual, cognitive, and epistemic access to the world. In response, the indirect realist can say that sense-data are the medium by which we perceive ordinary objects, and no more create a “veil of perception” than the fact that we use words to talk about things creates a “veil of words” between us and what we talk about. (For recent discussion see Silins (2011)).

A common objection is to attack the Phenomenal Principle (see Barnes (1944–5); Anscombe (1965)). The objection is that the Phenomenal Principle is fallacious. It is not built into the meaning of “something appears F to one” that “one is directly presented with an F thing”. Defenders of the sense-datum theory can respond that the Phenomenal Principle is not supposed to be a purely logical inference; it is not supposed to be true simply because of the logical form or semantic structure of “appears” and similar locutions. Rather, it is true because of specific phenomenological facts about perceptual experience. But this just means that theorists who reject the Phenomenal Principle are not disagreeing about whether the Phenomenal Principle involves a fallacy or about some semantic issue, but rather about the nature of experience itself.

Another influential objection to sense-data comes from the prevailing naturalism of contemporary philosophy. Naturalism (or physicalism) says that the world is entirely physical in its nature: everything there is supervenes on the physical, and is governed by physical law. Many sense-datum theorists are committed to the claim that non-ordinary sense-data are mind-dependent: objects whose existence depends on the existence of states of mind. Is this consistent with naturalism? If so, the challenge is to explain how an object can be brought into existence by the existence of an experience, and how this is supposed to be governed by physical law.

Many contemporary sense-datum theorists, however, will not be moved by this challenge, since they are happy to accept the rejection of naturalism as a consequence of their theory (Robinson (1994), Foster (2000)). On the other hand, one might think that there is no conflict here with naturalism, as long as experiences themselves are part of the natural order. But if sense-data are non-ordinary in being mind-independent but non-physical , then it is much less clear how naturalism can be maintained (cf., what Martin (2004, 2006) calls “experiential naturalism” which serves as a constraint on theories of experience and rules out some but not all forms of the sense-datum theory).

For other objections to the sense-datum theory, including the worry that it must admit “indeterminate” sense-data (e.g., on the basis of seeing a speckled hen, which appears to have a number of speckles but no definite number), see the entry on sense-data .

3.2 Adverbialism

Part of the point of adverbialism, as defended by Ducasse (1942) and Chisholm (1957) is to do justice to the phenomenology of experience whilst avoiding the dubious metaphysical commitments of the sense-datum theory. The only entities which the adverbialist needs to acknowledge are subjects of experience, experiences themselves, and ways these experiences are modified. Let us explain.

At Level 1, the adverbialist rejects the Phenomenal Principle and the whole idea that experience consists in being directly presented with perceptible entities. For the adverbialist, when someone has an experience of something white, something like whiteness is instantiated, but in the experience itself, not a presented thing. This is not to say that the experience is white, but rather that the experience is modified in a certain way , the way we can call “perceiving whitely”. The canonical descriptions of perceptual experiences, then, employ adverbial modifications of the perceptual verbs: instead of describing an experience as someone’s “visually sensing a white sphere”, the theory says that they are “visually sensing whitely and spherely”. This is why this theory is called the “adverbial theory”; but it is important to emphasize that it is more a theory about the nature of experience itself than it is a semantic analysis of sentences describing experience.

It is also intended as a theory of the character of experience (Level 2). The adverbialist claims that things appearing white to you consists in you sensing whitely . It is because you are sensing in some way that explains why things appear a certain way to you at all, and it is the fact that you are sensing whitely that explains why things appear white to you, rather than some other way. The character of your experience is explained by the specific “white” way in which your experience is modified.

The adverbialist endorses the Common Kind Claim . So, a veridical experience in which something appears white to you, consists in you sensing whitely, but so do corresponding illusory and hallucinatory experiences: these experiences have the same nature.

3.2.2 Adverbialism and Qualia

When used in a broad way, “qualia” picks out whatever qualities a state of mind has which constitute the state of mind’s having the phenomenal character it has. In this broad sense, any phenomenally conscious state of mind has qualia. (This is the way the term is used in, e.g., Chalmers (1996)). Used in a narrow way, however, qualia are non-intentional, intrinsic properties of experience: properties which have no intentional or representational aspects whatsoever. To use Gilbert Harman’s apt metaphor, qualia in this sense are “mental paint” properties (1990). Harman rejects mental paint, but the idea of experience as involving mental paint is defended by Block (2004)).

It is relatively uncontroversial to say that there are qualia in the broad sense. It can be misleading, however, to use the term in this way, since it can give rise to the illusion that the existence of qualia is a substantial philosophical thesis when in fact it is something which will be accepted by anyone who believes in phenomenal character. (Hence Dennett’s (1991) denial of qualia can seem bewildering if “qualia” is taken in the broad sense). It is controversial to say that there are qualia in the narrow sense, though, and those who have asserted their existence have therefore provided arguments and thought-experiments to defend this assertion (see Block (1997), Peacocke (1983: Chapter 1), Shoemaker (1990)). In what follows, “qualia” will be used exclusively in the narrow sense.

As noted, adverbialism is committed to the view that experiencing something white, for example, involves your experience being modified in a certain way: experiencing whitely. A natural way to understand this is in terms of the idea that the experience is an event, and the modification of it is a property of that event. Since this property is both intrinsic (as opposed to relational or representational) and phenomenal then this way of understanding adverbialism is committed to the existence of qualia.

An important objection to adverbialism is the “Many Property Problem” proposed by Frank Jackson (1975). Consider someone who senses a brown square and a green triangle simultaneously. The adverbialist will characterize this state of mind as “sensing brownly and squarely and greenly and triangularly”. But how can they distinguish the state of mind they are describing in this way from that of sensing a brown triangle and a green square? The characterization fits that state of mind equally well. Obviously, what is wanted is a description according to which the brownness “goes with” the squareness, and the greenness “goes with” the triangularity. But how is the adverbialist to do this without introducing objects of experience—the things which are brown and green respectively—or a visual field with a spatial structure? The challenge is whether the adverbialist can properly account for the spatial structure and complexity in what is given in visual experience. See Tye (1984), Breckenridge (2018: Chapter 10), and D’Ambrosio (2019) for adverbialist responses to this challenge. For a helpful overview, see Fish (2010: Chapter 3).

A further challenge is that adverbialism is “incapable of doing justice to the most obvious and indeed essential phenomenological fact about perceptual consciousness… namely… its object-directness” (Butchvarov (1980: 272)). Recall here the basic phenomenological observation we began with: perceptual experiences are directly of things.

As we’ve seen, at Level 1, the adverbialist denies that perceptual experiences are direct presentations of objects. And at Level 2, in explaining character, the adverbialist assigns no role to the direct presentation of things, just ways of sensing. But then if it is an aspect of the phenomenology of experience that our experiences have direct objects, then it is not clear that the adverbialist has the resources to capture this. For the adverbialist, to capture your experience of a snow-covered churchyard we invoke seeing whitely not seeing a white thin g. How, then, can we explain why phenomenologically , your experience is directly of a white thing – or even why it seems to be object-directed in this way? Butchvarov’s charge is that the adverbialist doesn’t have the resources to answer these questions. (See D’Ambrosio (2019) for a recent adverbialist attempt to capture something like object-directness).

The argument from illusion relies on the Phenomenal Principle . In rejecting this, the adverbialist thus rejects the argument. But what about the argument from hallucination? This does not rely on the Phenomenal Principle. The adverbialist accepts (A). And they also accept (B) in the form of the Common Kind Claim . (C) follows (given assumptions (a1) and (a2)). For this reason, the adverbialist must reject Direct Realist Presentation . So, like the sense-datum theorist, the adverbialist must admit that we are never directly presented with ordinary objects, not even in veridical experience.

3.2.5 Adverbialism and our Ordinary Conception of Perceptual Experience

Like the sense-datum theorist, though the adverbialist accepts some of our ordinary conception of perceptual experience (the Common Kind Claim ), they reject other aspects of it. The argument from hallucination forces them to reject Direct Realist Presentation (and therefore Direct Realist Character ). Underlying this is the adverbialist’s rejection of Presentation , and arguably Ordinary Objects too. They reject Presentation in denying that experiences have a relational structure. And given our discussion of Butchvarov’s challenge, it seems as though they must reject (or at least don’t have the resources to accept) Ordinary Objects . For it is unclear how they can validate the phenomenological claim that experiences are of objects, let alone directly of ordinary objects.

So, even though adverbialism arises as a response to the sense-datum theory, given its almost wholesale rejection of our ordinary conception of perceptual experience, it is unclear how much of an improvement the approach is in the broader dialectic of the Problem of Perception.

One response to this is that we should not suppose that the only way to articulate direct realism is through the claim we’ve labelled Direct Realist Presentation . There is another way to articulate it which, it might be suggested, enables the adverbialist to account for direct perception of the world. Consider, then:

• Direct Realist Presentation : perceptual experiences are direct perceptual presentations of ordinary objects.

This entails Direct Realism – that we can directly perceive ordinary objects – on the assumption that being directly perceptually presented with an ordinary object is a way of directly perceiving it. On this way of thinking, direct perception of an ordinary object is built into perceptual experience itself. However, one might reject this claim about experience (as adverbialists do), and still hold that we can have direct perception of an ordinary object. How?

Instead of thinking of direct perception of the world as built into experience, we can think of direct perception of the world as built out of experience together with the satisfaction of other conditions. This idea is usually developed through a causal theory of perception (Grice 1961): where perception of an object is analysed in terms of (i) experience of an ordinary object (conceived as something which is not sufficient for perception), and (ii) the satisfaction of a causal condition which requires that the experience be caused by the object (in a non-deviant way). This is a causal theory of direct perception on the assumption that the account doesn’t involve any perceptual intermediaries.

The adverbialist might suggest that they can embrace this: by combining their theory of experience with a causal analysis of direct perception. Thus, they can hold that when you have an experience of a snow-covered churchyard, if this experience is appropriately caused by an ordinary white thing (e.g., some snow), this is what directly perceiving such an object amounts to (given that no perceptual intermediaries are involved).

However, whether the adverbialist is entitled to this way of making sense of direct perceptual contact with the world hinges on whether they can make sense of the idea of an experience of an ordinary object . But as we have seen in considering Butchvarov’s challenge, it is unclear whether the adverbialist can do this. It is thus unclear whether the adverbialist can really make sense of clause (i).

In response, the adverbialist might offer a causal analysis of experiences being of objects. They might thus attempt to fall back on the idea that an experience in which you sense whitely is an experience “of” a white thing insofar as it is causally related to a white thing (or, insofar as it is of a type, instances of which are typically caused by white things). However, as Butchvarov argues, the fact that “x is causally related to S’s sensing in a certain way can no more reasonably be described as S’s being conscious of [i.e. having a conscious experience of] x than the fact that the presence of carbon monoxide in the air is causally related to S’s having a headache can be described as S’s being conscious of [having a conscious experience of] carbon monoxide” (1980: 273).

Even if the adverbialist is able to sustain such a causal form of direct realism, it is very different from the phenomenological form of direct realism embedded in our ordinary conception of perceptual experience. It is thus unlikely to satisfy a direct realist sensitive to the phenomenological concerns which give rise to our ordinary conception of perceptual experience.

3.3 Intentionalism

The intentionalist holds that we directly experience ordinary objects. The distinguishing feature of the view is a specific conception of the manner in which experiences are directly of ordinary objects: here the intentionalist appeals to intentionality conceived of as a form of mental representation (hence it is also sometimes called the representationalist theory of experience). “Intentionality” is a term with its origins in scholastic philosophy (see Crane (1998b)), but its current use derives from Brentano (1874), who introduced the term “intentional inexistence” for the “mind’s direction upon its objects”. Intentional inexistence, or intentionality, is sometimes explained as the “aboutness” of mental states (see the entries on Franz Brentano , representational theories of consciousness and intentionality ).

At Level 1, then, the intentionalist holds that to experience a snow-covered churchyard is to directly perceptually represent such an object (i.e. to represent such an object but not in virtue of representing another more “immediate” object). At Level 2, this is put to work in explaining phenomenal character. In relation to our example, why is this a case of things appearing any way at all to you, and why is it a case of things appearing white to you? Here the intentionalist appeals to the experience’s directly representing things in a certain way, and specifically to experience’s directly representing whiteness in the environment, to account for this. The character of your experience is explained by the specific way in which your experience directly represents the world.

Critics of intentionalism have argued that it does not adequately distinguish perceptual experience from other forms of intentionality, and therefore does not manage to capture what is distinctive about experience (Robinson (1994: 164)). One objection of this kind is that the aforementioned intentionalist explanation of character is inadequate. The worry is that believing that something is the case, for example, or hoping that something is the case, are both forms of mental representation, but neither state of mind has any “feel” or phenomenal character to call its own. (Words or images may come to mind when mentally representing something in this way, but it is not obvious that these are essential to the states of mind themselves.) So, the challenge is that if there is nothing about representation as such which explains the character of an experience, how is experience supposed to be distinguished from mere thought?

There are a number of ways an intentionalist can respond. One is simply to take it as a basic fact about perceptual intentionality that it has phenomenal character (see Kriegel (2013)). After all, even those who believe in qualia have to accept that some states of mind have qualia and some do not, and that at some point the distinction between mental states which are phenomenally conscious, and those which are not, just has to be accepted as a brute fact. Another response is to say that in order to fully explain the phenomenal character of perceptual experience, we need to treat experience as involving non-intentional qualia as well as intentionality (see Peacocke (1983: Chapter 1); Shoemaker (1996); Block (1997)). There is, accordingly, a dispute between these intentionalists who accept qualia (like Block and Shoemaker) and those who don’t (like Harman (1990) or Tye (1992)). (For more on this see the entries on qualia and inverted qualia . Additional readings are: Block (2005) (2010), Egan (2006), Hilbert and Kalderon (2000), Marcus (2006), Shoemaker (1990), Speaks (2015), Spener (2003), and Tye (2000)).

Intentionalists endorse the Common Kind Claim . So, a veridical experience of churchyard covered in white snow, consists in direct representation of such a scene, but so do corresponding illusory and hallucinatory experiences: these experiences have the same nature.

Like adverbialists, the intentionalist has no need to postulate non-ordinary perceptible entities in the cases of illusion and hallucination. It is not generally true that when a representation represents something (as being F), there has to actually be something (which is F). Thus, for the intentionalist, experience is representational in a way that contrasts with it being relational/presentational. Experience does not genuinely have an act-object structure. This is in keeping with a standard tradition in the theory of intentionality which treats it as non-relational (the tradition derives from Husserl (1900/1901); for discussion see Zahavi (2003: 13–27). So, for the intentionalist, since it is not of the essence of experience or its character that it is relational, it is not of its essence that it is a relation to a sense-datum.

Some of the most influential (at least partial) intentional theories are Anscombe (1965), Armstrong (1968), Pitcher (1970), Peacocke (1983), Harman (1990), Tye (1992, 1995), Dretske (1995), Lycan (1996); for more recent accounts, see Byrne (2001), Siegel (2010), Pautz (2010) and the entry on the contents of perception .

Within analytic philosophy, intentionalism is a generalisation of an idea presented by G.E.M. Anscombe (1965), and the “belief theories” of D.M. Armstrong (1968) and George Pitcher (1970). (Within the phenomenological tradition intentionality and perception had always been discussed together: see the entry on phenomenology. ) Anscombe had drawn attention to the fact that perceptual verbs satisfy the tests for non-extensionality or intensionality (see the entry on intensional transitive verbs ). For example, just as ‘Vladimir is thinking about Pegasus’ is an intensional context, so ‘Vladimir has an experience as of a pink elephant in the room’ is an intensional context. In neither case can we infer that there exists something Vladimir is thinking about, or that there is exists something he is experiencing. This is the typical manifestation of intensionality. Anscombe regarded the error of sense-datum and naive realist theories as the failure to recognise this intensionality. (Her own example was the alleged intensionality of ‘see’, but this is controversial.)

Armstrong and Pitcher argued that perception is a form of belief. (More precisely, they argued that it is the acquisition of a belief, since an acquisition is a conscious event, as perceiving is; rather than a state or condition, as belief is.) Belief is an intentional state in the sense that it represents the world to be a certain way, and the way it represents the world to be is said to be its intentional content. Perception, it was argued, is similarly a representation of the world, and the way it represents the world to be is likewise its intentional content. The fact that someone can have a perceptual experience of something as F, without there being any thing which is F was taken as a reason for saying that perception is just a form of belief-acquisition.

Certain cases put pressure on this. For instance, consider the famous Müller-Lyer illusion in which two lines of equal length look unequal. You can experience this even if you know (and therefore believe) that the lines are the same length. If perception were simply the acquisition of belief, then this would be a case of explicitly contradictory beliefs: you believe that the lines are the same length and that they are different lengths. But this is surely not the right way to describe this situation. (Armstrong recognized this, and re-described perception as a “potential belief”; this marks a significant retreat from the original claim).

The belief theory (and related theories, like the judgement theory of Craig (1976)) is a specific version of the intentional theory. But it is not the most widely accepted version (though see Glüer (2009) for a recent defence; and Byrne (forthcoming)). Intentionalism is, however, not committed to the view that perceptual experience is belief; experience can be a sui generis kind of intentional state or event (Martin (1993)).

Intentionalists hold that what is in common between veridical experiences and indistinguishable hallucinations/illusions is their intentional content : roughly speaking, how the world is represented as being by the experiences. Many intentionalists hold that the sameness of phenomenal character in perception and hallucination/illusion is exhausted or constituted by this sameness in content (see Tye (2000), Byrne (2001)). But this latter claim is not essential to intentionalism (see the discussion of intentionalism and qualia above). What is essential is that the intentional content of perception explains (whether wholly or partly) its phenomenal character.

The intentional content of perceptual experience is sometimes called “perceptual content” (see the entry on the contents of perception ). What is perceptual content? A standard approach to intentionality treats all intentional states as propositional attitudes: states which are ascribed by sentences of the form “S ___ that p” where ‘S’ is to be replaced by a term for a subject, ‘p’ with a sentence, and the ‘___’ with a psychological verb. The distinguishing feature of the propositional attitudes is that their content—how they represent the world to be—is something which is assessable as true or false. Hence the canonical form of ascriptions of perceptual experiences is: “S perceives/experiences that p”. Perceptual experience, on this kind of intentionalist view, is a propositional attitude (see Byrne (2001), Siegel (2010)).

But intentionalism is not committed to the view that experience is a propositional attitude. For one thing, it is controversial whether all intentional states are propositional attitudes (see Crane (2001: Chapter 4)). Among the intentional phenomena there are relations like love and hate which do not have propositional content; and there are also non-relational states expressed by the so-called “intensional transitive” verbs like seek, fear, expect (see the entry on intensional transitive verbs ). All these states of mind have contents which are not, on the face of it, assessable as true or false. If I am seeking a bottle of inexpensive Burgundy, what I am seeking—the intentional content of my seeking, or the intentional object under a certain mode of presentation—is not something true or false. Some argue that these intentional relations and intentional transitives are analysable or reducible to propositional formulations (see Larson (2003) for an attempt to defend this view of intensional transitives; and Sainsbury (2010) for a less radical defence). But the matter is controversial; and it is especially controversial where experience is concerned. For we have many ways of talking about experience which do not characterize its content in propositional terms: for example, “Vladimir sees a snail on the grass”, or “Vladimir is watching a snail on the grass” can be distinguished from the propositional formulation “Vladimir sees that there is a snail on the grass” (for discussion of watching, see Crowther 2009).

There are those who follow Dretske (1969) in claiming that these semantical distinctions express an important distinction between “epistemic” and “non-epistemic” seeing. However, the view that perceptual content is non-propositional is not the same as the view that it is “non-epistemic” in Dretske’s sense. For ascriptions of non-epistemic seeing are intended to be fully extensional in their object positions, but not all non-propositional descriptions of perception need be (for example, some have argued that “Macbeth saw a dagger before him” does not entail “there is a dagger which Macbeth saw”: cf. Anscombe (1965)). The question of whether perceptual experience has a propositional content is far from being settled, even for those who think it has intentional content (see McDowell (2008); Crane (2009)).

Another debate about the content of perceptual experience is whether it is object-dependent, or object-independent (see Soteriou (2000) and Schellenberg (2018: Part II); and for a more general discussion, see Chalmers (2006)). An object-dependent content is a content which concerns a particular object, and is such that it cannot be the content of a state of mind unless that object exists (McDowell (1987) and Brewer (1999)). An object-independent content is one whose ability to be the content of any intentional state is not dependent on the existence of any particular object (Davies (1992) and McGinn (1989)).

The intentionalist holds that the content that is common to veridical experiences and subjectively indistinguishable hallucinations is object-independent: since such hallucinations occur in the absence of objects for such content to depend upon. However, as Martin (2002b) argues, drawing on (Burge 1991), the intentionalist can still appeal to the idea that particular veridical experiences have particular object-dependent contents in addition to the object-independent contents they share with subjectively indistinguishable hallucinations.

The objects of intentional states are sometimes called “intentional objects” (Crane (2001: Chapter 1)). What are the intentional objects of perceptual experience, according to intentionalists? In the case of veridical perception, the answer is simple: ordinary objects like the churchyard, the snow etc. But what should be said about the hallucinatory case? Since this case is by definition one in which there is no ordinary object being perceived, how can we even talk about something being an “object of experience” here? As noted above, intentionalists say that experiences are representations; and one can represent what does not exist (see Harman (1990), Tye (1992)). This is certainly true; but isn’t there any more to be said? For how does a representation of a non-existent churchyard differ from a representation of a non-existent cat, say, when one of those is hallucinated? The states seem to have different objects; but neither of these objects exist (see the entry nonexistent-objects ).

One proposal is that the objects of hallucinatory experience are the properties which the hallucinated object is presented as having (Johnston (2004)). Another answer is to say that these hallucinatory states of mind have intentional objects which do not exist (Smith (2002: Chapter 9)). Intentional objects in this sense are not supposed to be entities or things of any kind. When we talk about perception and its “objects” in this context, we mean the word in the way it occurs in the phrase “object of thought” or “object of attention” and not as it occurs in the phrase “physical object”. An intentional object is always an object for a subject, and this is not a way of classifying things in reality. An intentionalist need not be committed to intentional objects in this sense; but if they are not, then they owe an account of the content of hallucinatory experiences.

How does the content of perceptual experience differ from the content of other intentional states? According to some intentionalists, one main difference is that perception has “non-conceptual” content. The basic idea is that experience involves a form of mental representation which is in certain ways less sophisticated than the representation involved in (say) belief. For example, having the belief that the churchyard is covered in snow requires that you have the concept of a churchyard. This is what it means to say that belief has conceptual content: to have the belief with the content that a is F requires that you possess the concept a and the concept F. So, to say that experience has non-conceptual content is to say the following: for you to have an experience with the content that a is F does not require that you have the concept of a and the concept F. The idea is that your perceptual experience can represent the world as being a certain way—the “a is F” way—even if you do not have the concepts that would be involved in believing that a is F. (For a more detailed version of this definition, see Crane (1998a) and Cussins (1990); for a different way of understanding the idea of non-conceptual content, see Heck (2000) and Speaks (2005). The idea of non-conceptual content derives from Evans (1982); there are some similar ideas in Dretske (1981); see Gunther (2002) for a collection of articles on this subject. Other support for non-conceptual content can be found in Bermúdez (1997); Peacocke (1992); Crowther (2006); for opposition see Brewer (1999) and McDowell (1994)).

The intentionalist rejects the argument from illusion as it hinges on the Phenomenal Principle which they reject. For the intentionalist, an illusory experience in which you see a white wall as yellow is not a case in which you are directly presented with a yellow sense-datum, but a case in which a white wall is directly represented as being yellow.

However, the intentionalist must accept the argument from hallucination. They accept (A), and they also accept (B) in the form of the Common Kind Claim . (C) follows (given (a1) and (a2)). Thus, like sense-datum theorists and adverbialists, intentionalists reject Direct Realist Presentation , and admit that we are not ever directly presented with ordinary objects, not even in veridical experience.

In response to this, the intentionalist can suggest that although they reject Direct Realist Presentation , they do not reject Direct Realism . They can suggest that the former is not the only way to understand the latter. As we saw above, another way to understand Direct Realism is with a causal understanding of direct perception.

As we noted above, it is unclear whether the adverbialist is entitled to this, since it is unclear how the adverbialist can make sense of the object-directedness of experience. But the intentionalist doesn’t face this problem. The object-directedness of experience is at the heart of their approach. Even though intentionalism denies that experiences involve the direct presentation of ordinary objects, it (a) respects and is motivated by the phenomenological observation that experiences are directly of ordinary objects, and (b) offers an alternative account of the manner in which experiences are directly of ordinary objects. As we’ve seen, instead of presentation, the intentionalist appeals to representation.

Thus, the intentionalist can maintain that when you see a snow-covered churchyard for what it is you do directly perceive a snow-covered churchyard. This is not because your experience itself directly presents you with a snow-covered churchyard. It doesn’t. After all, your experience is of such a kind that it could occur in a hallucination, where it wouldn’t directly present any ordinary object. It is rather because your experience directly perceptually represents the presence of a snow-covered churchyard and is non-deviantly caused by the churchyard in question. This is what direct perception amounts to for the intentionalist

A concern about adverbialism that we raised above, from the perspective of one who wants to uphold our ordinary conception of perceptual experience, is that (a) it rejects our ordinary conception of perceptual experience almost wholesale , and (b) adverbialist causal direct realism, even if it could be made to work, doesn’t seem to compensate for that: it isn’t sensitive enough to the phenomenological concerns that motivate our ordinary conception of perceptual experience. In contrast, intentionalism seems to fare better on both scores.

First, strictly speaking, the intentionalist must reject our ordinary conception of perceptual experience. Even though they accept the Common Kind Claim , they reject Direct Realist Presentation . Underlying this is not rejection of Ordinary Objects but of Presentation . But even here, their rejection of Presentation is not too radical. For intentionalists can say that experiences are quasi -presentational. The appeal to representation enables this. For when you directly perceptually represent the snow-covered churchyard, it certainly seems to you as if a churchyard is directly present to you, even if it is not (as you are, say, hallucinating). As we noted above, it is not clear from the resources the adverbialist offers how they can account for how it even seems as if an object is present to you. How does perceiving whitely make it seem as if a white thing is present to you?

Similarly, though strictly speaking the intentionalist must reject Direct Realist Character , the departure from this is not too radical. For instead, the intentionalist holds that the character of experience is determined, at least partly, by the direct perceptual representation of ordinary objects. It is not as if ordinary objects and their apparent presence drops out of the picture on the intentionalist account of phenomenal character. The account is similar to Direct Realist Character , just stripped of the genuine relationality.

Finally, the causal direct realist story that the intentionalist offers is intelligible in the way that it arguably isn’t for the adverbialist. And although it invokes causal notions, this is not to the exclusion of a core phenomenological understanding of direct experience of an object, which the intentionalist accounts for with the notion of direct perceptual representation.

Intentionalism, then, is a Direct Realist theory which upholds some of our ordinary conception of perceptual experience, and insofar as it rejects aspects of our ordinary conception, it does so in a non-radical way, sensitive to the phenomenological concerns that motivate this conception in the first place.

3.4 Naive Realist Disjunctivism

Consider the veridical experiences involved in cases where you genuinely perceive objects as they actually are. At Level 1, naive realists hold that such experiences are, at least in part, direct presentations of ordinary objects. At Level 2, the naive realist holds that things appear a certain way to you because you are directly presented with aspects of the world, and – in the case we are focusing on – things appear white to you, because you are directly presented with some white snow. The character of your experience is explained by an actual instance of whiteness manifesting itself in experience.

Naive realists thus assign an important explanatory role to the world itself in explaining the character of veridical experiences. But this doesn’t mean that they are committed to the idea that such character is fully explained or exhausted by the presented world. Naive realists admit that even holding fixed presented aspects of the world there can be variation in the character of experience. This is worked out in different (but compatible) ways by different theorists. One approach is to note how variations in the perceiver can make for variations in the character of experience (Logue (2012a)). Another is to highlight a third-relatum (of the relation of presentation) which encapsulates various conditions of perception such as one’s spatiotemporal perspective and the operative perceptual modality, where variation in such conditions can make for variation in phenomenal character (Campbell (2009), Brewer (2011)). Finally, some suggest that there can be variation in the way or manner in which one is related to perceived objects which makes a difference to phenomenal character (Soteriou (2013), Campbell (2014), French and Phillips (2020)). For further discussion see French (2018).

For the naive realist, insofar as experience and experiential character is constituted by a direct perceptual relation to aspects of the world, it is not constituted by the representation of such aspects of the world. This is why many naive realists describe the relation at the heart of their view as a non-representational relation. This doesn’t mean that experiences must lack intentional content, but it means that (a) insofar as appeal is made to presentation to explain character, no appeal is made to intentional content for that purpose, and (b) what is fundamental to experience is something which itself cannot be explained in terms of representing the world: a primitive relation of presentation. (For further discussion of naive realism as a non-representational view, see the articles in Part Three of Brogaard (2014)).

The other theories we have considered all endorse the Common Kind Claim . We’ve noted that naive realism applies to the veridical experiences involved in genuine perception, but does it apply more widely? Though naive realists may extend their approach to illusions, they typically deny that it applies to hallucinations and so reject the Common Kind Claim . Naive realists who deny the Common Kind Claim are disjunctivists . We call such a position naive realist disjunctivism . Let’s explore these ideas now.

There are various different naive realist approaches to illusion (see e.g., Fish (2009: Chapter 6), Brewer (2008, 2011: Chapter 5), Kalderon (2011), Genone (2014), French and Phillips (2020)). When it comes to the argument from illusion, the naive realist (like the intentionalist) rejects the Phenomenal Principle . So how does naive realism differ from intentionalism about illusions? In two respects: first, naive realists can maintain that illusory experiences are fundamentally direct presentations of the world. Second, the naive realist can explain the character of such illusory experiences without appeal to intentional content, but instead by appealing to the direct presentation of ordinary objects. Consider, for example, the approach developed by Brewer:

visually relevant similarities are those that ground and explain the ways that the particular physical objects that we are acquainted with in perception look. That is to say, visually relevant similarities are similarities by the lights of visual processing of various kinds... very crudely, visually relevant similarities are identities in such things as the way in which light is reflected and transmitted from the objects in question, and the way in which the stimuli are handled by the visual system, given its evolutionary history and our shared training during development (2011: 103)... in a case of visual illusion in which a mind-independent physical object, o, looks F, although o is not actually F, o is the direct object of visual perception from a spatiotemporal point of view and in circumstances of perception relative to which o has visually relevant similarities with paradigm exemplars of F although it is not actually an instance of F (2011: 105).

So though o may not itself be F, it can exist in certain conditions, C, such that it has visually relevant similarities to paradigm F things and in that sense it will objectively look F, or look like an F thing—that is, it will itself have a property, a look or an appearance, independently of anyone actually seeing it (see also Martin (2010), Kalderon (2011), Antony (2011), and Genone (2014) on objective looks). If o is then seen in C, o itself will look F to you in perception. Brewer spells this all out in more detail, and with various examples. One is seeing a white piece of chalk as red. The chalk is seen in abnormal illumination conditions such that the white piece of chalk itself looks like a paradigm red piece of chalk—it has “visually relevant similarities with a paradigm piece of chalk, of just that size and shape” (2011: 106). Given that it is seen in those conditions, it looks red to you, even though it is not in fact red. Here, then, we have an account of illusions in which we appeal to objects and the ways those objects are, not the ways they are represented to be, in explaining character.

What about the argument from hallucination? The naive realist thinks that at least veridical experiences are direct presentations of ordinary objects. They thus reject the conclusion (C) of the argument. But typically, naive realists accept (A). They therefore block the argument by rejecting the spreading step (B), understood in terms of the Common Kind Claim applied to veridical and hallucinatory experiences.

Such a naive realist reasons as follows: suppose that when you see a snow-covered churchyard for what it is, you have an experience which is in its nature a relation between you and ordinary objects. But a subjectively indistinguishable hallucinatory experience does not have such a nature. For such a hallucination could occur in the absence of any relevant worldly items (e.g., in the lab of a scientist manipulating your brain, in a world with no white things). Instead of taking (B) and these facts about hallucination to ground the rejection of naive realism, the naive realist instead rejects (B): even though the hallucination as of a snow-covered churchyard is subjectively indistinguishable from a veridical experience of such a scene, it is not of the same fundamental kind. (For a more nuanced formulation of the naive realist reasoning here, see Martin (2004), (2006). Raleigh (2014) and Ali (2018) advocate a naïve realist position which keeps the Common Kind Claim but rejects (A) and hence the understanding of hallucinations we are operating with here. See also Masrour (2020) who argues that it is an open question whether hallucinations are possible.).

In blocking the argument from hallucination in this way the naive realist endorses disjunctivism . This theory was first proposed by Hinton (1973) and was later developed by P.F. Snowdon (1979, 1990), John McDowell (1982, 1987) and M.G.F. Martin (2002, 2004, 2006). Disjunctivism is not best construed as it is by one of its proponents, as the view “that there is nothing literally in common” in veridical perception and hallucination, “no identical quality” (Putnam (1999: 152)). For both the veridical perception of an F and a subjectively indistinguishable hallucination of an F are experiences which are subjectively indistinguishable from a veridical perception of an F. What disjunctivists deny is that what makes it true that these two experiences are describable in this way is the presence of the same fundamental kind of mental state. Disjunctivists reject what J.M. Hinton calls “the doctrine of the ‘experience’ as the common element in a given perception” and an indistinguishable hallucination (Hinton (1973: 71)). The most fundamental common description of both states, then, is a merely disjunctive one: the experience is either a genuine perception of an F or a mere hallucination as of an F. Hence the theory’s name.

The disjunctivist rejects the Common Kind Claim . Underlying this is a rejection of what Martin (2004, 2006) calls the “common kind assumption”, namely:

• (CKA) whatever fundamental kind of mental event occurs when you veridically perceive, the very same kind of event could occur were you undergoing a subjectively indistinguishable hallucination.

But is the disjunctivist’s rejection of (CKA) plausible? The disjunctivist can note how the fact that a hallucination is subjectively indistinguishable from a veridical experience does not entail that they are of the same fundamental kind, even if it does suggest this.

However, some argue that even if such an appeal to subjective indistinguishability is not enough to establish (CKA) , it is nonetheless well supported by a causal argument (Robinson (1985)). We can suppose that when you see the snow-covered churchyard for what it is, there is some proximal cause of this experience: the experience is preceded by a certain sort of brain state B. But now we can imagine a situation in which we bring about B thus producing an experience in you, yet where B is not brought about through any interaction between you and a snow-covered churchyard—e.g., in laboratory conditions. In this scenario you have an hallucinatory experience as of a snow-covered churchyard. It is plausible to suppose that these experiences are of the very same kind given that they have the same proximal cause.

The point here is that (CKA) looks like a plausible principle for causally matching veridical and hallucinatory experiences – veridical and hallucinatory experiences with the same proximal cause. This way of motivating (CKA) appeals to a same-cause, same-effect principle:

• Causal Principle 1: an event e1 is of the same kind as an event e2 if event e1 is produced by the same kind of proximate causal condition as e2 (Nudds 2009: 336).

Is this the end of the road for the naive realist disjunctivist, then? Not quite, since as Martin argues, the naive realist should reject this principle:

On [the naive realist] conception of experience, when one is veridically perceiving the objects of perception are constituents of the experiential episode. The given event could not have occurred without these entities existing and being constituents of it; in turn, one could not have had such a kind of event without there being relevant candidate objects of perception to be apprehended. So, even if those objects are implicated in the causes of the experience, they also figure non-causally as essential constituents of it... Mere presence of a candidate object will not be sufficient for the perceiving of it, that is true, but its absence is sufficient for the non-occurrence of such an event. The connection here is [one] of a constitutive or essential condition of a kind of event. (2004: 56–57).

Martin’s point is that the naive realist may well admit the possibility of veridical experiences and causally matching hallucinations, but they will resist the idea that sameness of proximal cause implies sameness of the kind of experience involved. This is because there are non-causal constitutive condition s for the occurrence of the veridical experience which are not satisfied in the hallucinatory case.

However, Martin suggests that the arguer from hallucination can develop their case against naive realism further. This development involves an argument with two stages. First, a modified causal argument: the reverse causal argument , and second the screening-off problem.

The modified causal argument involves a modified causal principle:

• Causal Principle 2: an event e1 is of the same kind K as an event e2 if event e1 is produced by the same kind of proximate causal condition as e2 in circumstances that do not differ in any non-causal conditions necessary for the occurrence of an event of kind K (Nudds 2009: 337).

(Martin’s own modified causal principle is more complicated than this in allowing for indeterministic causation. We gloss over this important complication here). Take N to be the fundamental kind which characterizes a veridical experience of a snow-covered churchyard, according to the naive realist. Does Causal Principle 2 allow us to say that N is present in the causally matching hallucinatory case, as (CKA) predicts? No. For the hallucination is produced in circumstances that differ in non-causal conditions necessary for the occurrence of N given how the naive realist understands N : in the circumstances in which the hallucination occurs there is no appropriate object of perception, but the presence of such an object is necessary for the occurrence of N.

So how does Causal Principle 2 help the arguer from hallucination? We have to run an argument in “the reverse direction, from what must be true of cases of causally matching hallucinations, to what must thereby be true of the veridical perceptions they match” (Martin 2006: 368). That is, take a hallucination as of a snow-covered churchyard h, and suppose that h is of some fundamental kind H. Now we can apply Causal Principle 2 to show that H is present in a causally matching veridical experience of a snow-covered churchyard, v. For now v is produced by the same kind of proximal cause in circumstances where there is no difference in the non-causal conditions necessary for the occurrence of an event of kind H. This is because all that is necessary for an occurrence of H is some brain condition, which is present in the circumstances in which v is brought about. This reverse causal argument does not show that v is not of fundamental kind N. What it does show, however, is that whatever fundamental kind is present in a hallucinatory case will also be present in a causally matching veridical case. So even if v is fundamentally N it is also H. That is, we have the Reverse Common Kind Assumption:

• (RCKA) Whatever fundamental kind of event occurs when you hallucinate, the very same kind of event also occurs in a causally matching veridical experience.

But now we run into the screening-off problem . There is something it is like for you to have an hallucinatory experience as of a snow-covered churchyard, and the experience seems to relate you to a snow-covered churchyard. This fact about the hallucinatory experience is grounded in its being of kind H. But now if an experience of that kind is present in the veridical case, it is difficult to see how what the naive realist says is fundamental to that case, N, is doing anything by way of explaining what it is like for a subject to have the experience. The presence of H in the veridical case seems to make N explanatorily redundant, or “screen off” N’s explanatory role, contra the ambitions of naive realism. (For more detailed expositions of this two-stage argument see Martin (2004), Byrne and Logue, (2008), Hellie (2013) and Soteriou (2014: Chapter 6)).

The most widely discussed naive realist response to this argument is that of Martin (2004, 2006). Though there are now a range of different naive realist responses available, some of which integrate critical discussion of Martin’s own approach (see Allen (2015), Logue (2012b, 2013), Fish (2009: Chapter 4), Hellie (2013), Moran (2019), Sethi (2020)).

Martin argues that the screening-off stage of the argument is only problematic if we accept a positive, non-derivative account of causally matching hallucinations. On such an account, hallucinations have a positive nature which doesn’t derive from that of veridical perception: a nature that can be specified independently of any reference to veridical perception. For instance, hallucinations are direct presentations of sense-data, or representations of ordinary objects. Instead, Martin suggests, the disjunctivist should conceive of causally matching hallucinations in a purely negative epistemic way: such a hallucination as of an F is a state of mind which is not introspectively knowably not a veridical perception of an F. What makes it the case that your hallucinatory experience is as of a snow-covered churchyard, with a certain sort of phenomenal character, is just that it is an occurrence which cannot be discriminated, by introspection alone, from a veridical perception of a snow-covered churchyard. The particular subjective perspective that a hallucinator has in a causally matching hallucination as of a snow-covered churchyard is explained just by the obtaining of this negative epistemic condition, not by anything more positive such as a relation to a white sense-datum or the representation of white snow (c.f., Dancy (1995: 425)). On such a view, causally matching hallucinations are derivative: specifying their nature requires essential reference to the basic case of veridical perception.

If we accept Martin’s account of causally matching hallucinations, then we can see how H can be present in both the hallucinatory and the veridical case: since trivially a veridical experience of a snow-covered churchyard is indiscriminable from a veridical experience of a snow-covered churchyard. But what about screening off? Does H have a nature which means that the presence of H in the veridical case threatens the explanatory power of N? It doesn’t, Martin argues, since H’s explanatory force is derivative or dependent: it is parasitic on that of N. As Martin notes with his own example:

But if that is so [if H screens off the explanatory role of N], then the property of being a veridical perception of a tree [i.e. N] never has an explanatory role, since it is never instantiated without the property of being indiscriminable from such a perception being instantiated as well. But if the property of being a veridical perception lacks any explanatory role, then we can no longer show that being indiscriminable from a veridical perception has the explanatory properties which would screen off the property of being a veridical perception (2004: 69).

Here, then, is a summary of this complex dialectic: the argument from hallucination seems to disprove naive realism, but the naive realist appeals to disjunctivism in response. However, the causal argument puts pressure on disjunctivism, by supporting the common kind assumption . In response, the naive realist rejects the key principle of this argument (Causal Principle 1). But then a two-stage argument consisting of the reverse causal argument and the screening-off problem attempts to show that: (1) the fundamental kind of experience present in hallucination is also present in causally matching veridical experience, and (2) this undermines the naive realist idea that the character of veridical experience is shaped by the directly presented world. In response, Martin accepts a form of naive realism which embraces disjunctivism (in the form of the claim that causally matching veridical and hallucinatory experiences are fundamentally different). But which also accepts (as per the reverse causal argument) that there is a common element across the cases, for the hallucinatory kind is present in veridical cases too. But since he conceives of this common element in a derivative, and purely negative epistemic way, he blocks the argument at the second stage, rejecting screening off.

Naturally, then, much subsequent critical discussion has focused on Martin’s negative epistemic conception of hallucination. Further discussion and development of Martin’s approach is to be found in Nudds (2009, 2013) and Soteriou (2014: Chapter 6). For criticism of Martin’s approach see Hawthorne and Kovakovich (2006), Farkas (2006), Sturgeon (2008), Siegel (2004, 2008), and Robinson (2013). See Burge (2005) for a general and polemical attack on disjunctivism. For more on disjunctivism, see Haddock and Macpherson (eds.) (2008), Byrne and Logue (eds.) (2009), Macpherson and Platchias (eds.) (2013) and the entry on the disjunctive theory of perception .

3.4.4 Naive Realist Disjunctivism and Our Ordinary Conception of Perceptual Experience

According to naive realist disjunctivists, at least veridical experiences are directly of ordinary objects ( Ordinary Objects ), and are direct presentations of their objects ( Presentation ). Naive realist disjunctivists thus maintain Direct Realist Presentation , and hence Direct Realism for at least veridical experiences – indeed they maintain Direct Realism without the need for any appeal to a causal theory of direct perception. Further, naive realist disjunctivists hold that the phenomenal character of such experiences is determined, at least in part, by the direct presentation of ordinary objects ( Direct Realist Character ). The only aspect of our ordinary conception of perceptual experience which naive realist disjunctivists reject outright is the Common Kind Claim .

Sense-datum theorists and adverbialists depart substantially from our ordinary conception of perceptual experience. Advocates of each view will argue, in their different ways, that this is a consequence of responding adequately to the Problem of Perception.

Intentionalists and naive realist disjunctivists disagree, and argue, in different ways, that we can respond to the Problem of Perception without departing substantially from our ordinary conception of perceptual experience: by maintaining Direct Realism in some form, and maintaining or at least being sensitive to many of the specific phenomenological components of our ordinary conception of perceptual experience. Whilst the debate between sense-datum theorists and adverbialists (and between these and other theories) is not as prominent as it once was, the debate between intentionalists and naive realist disjunctivists is a significant ongoing debate in the philosophy of perception: a legacy of the Problem of Perception that is arguably “the greatest chasm” in the philosophy of perception (Crane (2006)). The question, now, is not so much whether to be a direct realist, but how to be one.

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• Nanay, Bence (ed.), 2010, Perceiving the World . New York: Oxford University Press.
• Noë, Alva and Evan Thompson (eds.), 2002, Vision and Mind: Selected Readings in the Philosophy of Perception Cambridge, Mass.: MIT Press.
• Nudds, Matthew, 2001, “Experiencing the Production of Sounds” , European Journal of Philosophy , 9: 210–29.
• –––, 2003, “The significance of the senses”, Proceedings of the Aristotelian Society , 104: 31–51.
• –––, 2009, “Recent Work in Perception: Naïve Realism and its Opponents”, Analysis , 69: 334–6.
• –––, 2013, “Naive Realism and Hallucinations”, in Macpherson and Platchias (eds.) 2013.
• Nudds, Matthew and O’Callaghan Casey, (eds.) 2009, Sounds and Perception, Oxford: Oxford University Press.
• O’Callaghan, Casey, 2007, Sounds: a Philosophical Theory , Oxford: Oxford University Press.
• –––, 2019, A Multisensory Philosophy of Perception , Oxford: Oxford University Press.
• O’Shaughnessy, Brian, 1980, The Will: A Dual Aspect Theory , Cambridge: Cambridge University Press.
• –––, 1989, “The Sense of Touch”, Australasian Journal of Philosophy , 67: 37–58.
• –––, 2000, Consciousness and the World Oxford: Oxford University Press.
• –––, 2003, “Sense Data”, in Barry Smith (ed.) John Searle Cambridge: Cambridge University Press.
• Pautz, Adam, 2010, “Why Explain Experience in Terms of Content?”, in Nanay (ed.) 2010.
• –––, 2021, Perception , London: Routledge.
• Peacocke, Christopher, 1983, Sense and Content , Oxford: Oxford University Press.
• –––, 1992, A Study of Concepts Cambridge, MA: MIT Press.
• Perkins, Moreland, 1983, Sensing the World , Indianapolis: Hackett.
• Pessin, Andrew and Sanford Goldberg, (eds.), 1996, The Twin Earth Chronicles , New York: M.E. Sharpe.
• Pettit, Philip and John McDowell (eds.), 1986, Subject, Thought and Context , Oxford: Clarendon Press.
• Pitcher, George, 1970, A Theory of Perception , Princeton: Princeton University Press.
• Price, H.H., 1932, Perception . London: Methuen.
• Putnam, Hilary, 1999, The Threefold Cord , New York: Columbia University Press.
• Raleigh, Thomas, 2014, “A New Approach to ‘Perfect’ Hallucination”, Journal of Consciousness Studies , 21: 81–110.
• Richardson, Louise, 2010, “Seeing Empty Space”, European Journal of Philosophy , 18: 227–243.
• –––, 2013a, “Sniffing and Smelling”, Philosophical Studies , 162: 401–419.
• –––, 2013b, “Flavour, Taste and Smell”, Mind and Language , 28: 322–341.
• Robinson, Howard, 1985, “The General Form of the Argument for Berkeleian Idealism”, in Essays on Berkeley: A Tercentennial Celebration , edited by J. Foster and H. Robinson, 163–86. Oxford: Clarendon Press.
• –––, 1994, Perception , London: Routledge
• –––, 2013, “The Failure of Disjunctivism to Deal with ”Philosophers’ Hallucinations“”, in Macpherson and Platchias (eds) 2013.
• Russell, Bertrand. 1912, The Problems of Philosophy Oxford: Oxford University Press.
• Sainsbury, Mark, 2010, “Intentionality without Exotica”, in Robin Jeshion, (ed.), Singular Thought: New Essays, 300–18, Oxford: Oxford University Press.
• Schellenberg, Susanna, 2018, The Unity of Perception: Content, Consciousness, Evidence . Oxford: Oxford University Press.
• Searle, John, 1983, Intentionality , Cambridge: Cambridge University Press.
• Segal, Gabriel, 1989, “Seeing What is Not There”, Philosophical Review , 98: 189–214.
• Sethi, Umrao, 2020, “Sensible Overdetermination”, Philosophical Quarterly , 70(280): 588–616.
• Shoemaker, Sydney, 1990 “Qualities and Qualia: What’s in the Mind?”, Philosophy and Phenomenological Research 50 (Supplement): 109–31.
• –––, 1996, “Color, Subjective Reactions, and Qualia”, in Enrique Villanueva (ed.), Philosophical Issues, 55–66, Atascadero: Ridgeview.
• Siegel, Susanna, 2004, “Indiscriminability and the Phenomenal”, Philosophical Studies , 120: 91–112.
• –––, 2008, “The Epistemic Conception of Hallucination”, in Haddock and Macpherson (eds.) 2008.
• –––, 2010, The Contents of Visual Experience New York: Oxford University Press.
• Silins, Nico, 2011, “Seeing Through the ‘Veil of Perception’ ”, Mind , 120: 329–367.
• Smith, A.D., 2002, The Problem of Perception , Cambridge, Mass.: Harvard University Press
• –––, 2008, “Translucent Experiences”, Philosophical Studies , 140: 197–212.
• Smith, Barry, C, 2015, “The Chemical Senses”, in Mohan Matthen (ed.), The Oxford Handbook of the Philosophy of Perception , 314–352, Oxford: Oxford University Press.
• Snowdon, P.F., 1979–80, “Perception, Vision and Causation”, Proceedings of the Aristotelian Society , 81: 175–92.
• –––, 1990, “The Objects of Perceptual Experience”, Proceedings of the Aristotelian Society Supplementary Volume , 64: 121–150.
• –––, 1992, “How to Interpret ‘Direct Perception’”, in Crane 1992, 48–78.
• –––, 2005, “Some Reflections on an Argument from Hallucination”, Philosophical Topics 33.1: 285–305.
• Soteriou, Matthew, 2000, “The Particularity of Visual Experience”, European Journal of Philosophy , 8: 173–89.
• –––, 2013, The Mind’s Construction: The Ontology of Mind and Mental Action , Oxford: Oxford University Press.
• –––, 2014, Disjunctivism , London: Routledge.
• Speaks, Jeff, 2005, “Is there a problem about non-conceptual content?”, Philosophical Review , 114: 359–98.
• –––, 2009, “Transparency, Intentionalism, and the Nature of Perceptual Content”, Philosophy and Phenomenological Research 79: 539–573.
• –––, 2015, The Phenomenal and the Representational , Oxford: Oxford University Press.
• Spener, Maja, 2003, Gilding or Staining the Mind: Phenomenology and the Metaphysics of Visual Experience , PhD thesis, University of London.
• Stokes, Dustin, Matthen, Mohan, and Briggs, Stephen (eds.), 2015, Perception and Its Modalities , New York: Oxford University Press.
• Strawson, P.F., 1979, “Perception and its Objects”, in G. Macdonald (ed.) Perception and Identity: Essays Presented to A.J. Ayer with His Replies , London: Macmillan; reprinted in Noë and Thompson (eds.) 2002. Page references to reprint.
• Stoljar, Daniel, 2004, “The Argument from Diaphanousness”, in M. Ezcurdia, R. Stainton and C. Viger (eds.) New Essays in the Philosophy of Language and Mind , Canadian Journal of Philosophy (Supplementary Volume), 341–90, Calgary: University of Calgary Press.
• Sturgeon, Scott, 2008, “Disjunctivism about Visual Experience”, in Haddock and Macpherson (eds.) 2008.
• Swartz, R.J. 1965, Perceiving, Sensing and Knowing , Los Angeles and Berkeley: University of California Press.
• Thau, Michael, 2002, Consciousness and Cognition , Oxford: Oxford University Press.
• Tye, Michael, 1984, “The Adverbial Theory of Visual Experience”, Philosophical Review , 93: 195–225.
• –––, 1992, “Visual Qualia and Visual Content”, in Crane (ed.) 1992, 158–76.
• –––, 1995, Ten Problems of Consciousness , Cambridge, MA: MIT Press.
• –––, 2000, Consciousness, Color and Content , Cambridge, MA: MIT Press.
• Valberg, J.J., 1992, The Puzzle of Experience . Oxford: Clarendon Press.
• Zahavi, Dan, 2003, Husserl’s Phenomenology Stanford: Stanford University Press.

Any serious attempt to master the literature on the problem of perception should include a reading of Anscombe (1965), Armstrong (1968: Chapter 10), Dretske (1969), Jackson (1977), Martin (2002), Moore (1905), Peacocke (1983: Chapter 1), Robinson (1994), Russell (1912), Smith (2002), Snowdon (1992), Strawson (1979), Tye (1992), and Valberg (1992a). Useful collections: Swartz (1965), Dancy (1988), Noë and Thompson (2002), Gendler and Hawthorne (2006), Haddock and Macpherson (2008), Byrne and Logue (2009), Nanay (2010), and Brogaard (2014). Matilal (1986) explores how issues around the Problem of Perception and theories of experience play out in Classical Indian philosophy.

For discussion of how the problem of perception, somewhat differently construed, arises in the senses other than vision, see Perkins (1983). There is much literature on non-visual perception, not all of it addressing the problem of perception, but much of it will be relevant to considering the problem of perception in non-visual modalities: on sounds, see Nudds (2001), O’Callaghan (2007), Nudds and O’Callaghan (2009); on smell, see Batty (2011), Richardson (2013a, 2013b); on touch, see O’Shaughnessy (1989), Martin (1992) and Fulkerson (2014); for the senses in general, see Nudds (2003), Macpherson (2011, 2011a) and Stokes, Matthen, and Briggs (2015)). On multisensory perception, see O’Callaghan (2019).

How to cite this entry . Preview the PDF version of this entry at the Friends of the SEP Society . Look up topics and thinkers related to this entry at the Internet Philosophy Ontology Project (InPhO). Enhanced bibliography for this entry at PhilPapers , with links to its database.

• The Illusions Index maintained by Fiona Macpherson (University of Glasgow, Centre for the Study of Perceptual Experience), designed by Keith Wilson and Mucky Puddle.
• Akiyoshi’s Illusion Pages: The Latest Works , maintained by Akiyoshi Kitaoka (Ritsumeikan University).
• Edward Adelson’s illusion pages , by Edward Adelson, MIT.

Brentano, Franz | color | consciousness | consciousness: and intentionality | consciousness: representational theories of | intensional transitive verbs | intentionality | mental representation | perception: epistemological problems of | perception: the contents of | perception: the disjunctive theory of | phenomenology | qualia | qualia: inverted | sense data

Acknowledgments

We are very grateful to Tim Bayne, David Chalmers, Katalin Farkas, Mike Martin and Susanna Siegel for their comments on previous versions of this entry. For discussion thanks to Arif Ahmed, Joshua Gert, Anil Gomes, Penelope Mackie, and Lee Walters.

Copyright © 2021 by Tim Crane < timcrane @ ceu . edu > Craig French < Craig . French @ nottingham . ac . uk >

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Visual Closure

Colleen beck otr/l.

• by Colleen Beck OTR/L
• February 13, 2023

It’s possible that you’ve heard the term visual closure before as this is a common visual skill that impacts learning, reading, and math skills. But did you know that visual processing skills also impact fine motor skills. Occupational 

therapists assess and treat visual skills as one of the underlying contributors to functional deficits. Visual closure is just one of those  visual perceptual skills  that impact everyday tasks. 

In this post will we discuss how visual closure is utilized in daily life, red flags for dysfunction, and some great activities to develop this skill.

What is Visual Closure

Visual closure refers to the brain’s ability to complete a picture or visual representation using incomplete information. This is a visual perceptual skill and a component of visual processing that enables us to visually fill in the blank with missing information. 

This visual perceptual skill allows us to see part of an object and visualize in our “mind’s eye” to determine the whole object. When we see part of an item, we use visual closure to know what the whole item is. This skill requires the cognitive process of problem solving to identify items.

This visual perceptual skill is the one used to locate and recognize items in a hidden picture puzzle. In written work, we use visual closure to recognize parts of words and letters when reading and copying work.

Visual Closure  is defined as the ability of the eyes to visualize a complete image or object when only a portion is seen. An individual can see just part of a letter or number when reading and recognize how to write that figure. We can read a word or sentence without focusing on each letter and how it is made.  

Visual Closure is an essential skill for many tasks. It is a skill that enables us to recognize a friend when it their face is partially covered by a scarf. It allows us to identify a road sign that is hidden by tree branches. It allows us to read, write, spell, complete math, and manage many other daily tasks.

Visual Closure enables us to look at an incomplete form and abstractly fill in the missing details in order to identify the form or shape. The skill allows us to comprehend portions of visual information without actively assessing each detail in isolation. This skill is one that utilizes abstract problem-solving skills.

Visual closure is a skill we use all day long. 

From learning, to driving, to getting dressed, we use this aspect of visual perception in discerning between both familiar items and unfamiliar objects in every environment.

Visual closure takes into consideration  spatial relationships , orientation in space, and knowledge about similar objects. In this way, both visual memory and  working memory  plays a role in recognizing a familiar item previously filed away in the brain’s knowledge. 

Perceptual skills like vision closure allow us to function in day to day tasks, use safety awareness, and complete everyday activities through  visual motor integration .

Visual perception is just one of many functions of the body that OT practitioners can address in therapy to improve quality of life. 

Examples of Visual Closure

We are able to visually close an incomplete image when we see part of an item partially obscured by other items in the environment.

Some examples of visual closure include:

• Recognizing that a complete object is in front of us even when part of it is covered up
• Identifying a stop sign even when it’s partially obscured by a tree branch
• Knowing that a complete fork is in the tray of utensils when we see only a portion of the fork
• Realizing the approximate size of objects when part of it is blocked from our vision
• Using the ability to make inferences about an object’s size even when portions are blocked from our line of sight
• Realizing the complete whole of an object is still there even when obscured, for example: knowing a window continues behind a curtain.
• Reading a word with fluency and effiencey, as well as reading comprehension (more on all of these areas below)
• Needed skill for spelling and sight word recognition
• Required to help figure out a shape or form that is partially hidden
• Needed to recognize an object when only a portion is visible
• Necessary skill for identifying spelling mistakes or incorrect information in written work
• Required to visually locate partially hidden objects in a busy background
• Required skill for reading words or recognizing words that are partially visible

Visual perception  involves a complex set of skills, including one that we will highlight here: visual closure. This important cognitive ability involves being able to understand and interpret incomplete or abstract visual information. In other words, it’s the ability to see an object or figure in your mind’s eye when only a part of it is actually visible. Pretty cool, right?

WHY IS Vision CLOSURE USEFUL?

Visual closure is a type of visual perception skill that allows you to understand the whole shape of an object, even if part of it is hidden. 

For example, we use this skill to recognize a letter of the alphabet when part of it is erased. Many students would recognize a visual closure worksheet without knowing it – they often look like one half of a familiar shape, and the student must draw the remaining half to create the whole the shape. 

They may also use this skill during a color-by-number worksheet, where they can recognize an image appear before it is even complete! 

This is an important skill as it increases our ability to understand the world and adapt to changes. Having strong vision skills also increases your overall visual cognitive performance, leading higher reading and writing abilities. It also sets you up for success for finding lost keys or quickly locating a spice in the cabinet. 

Visual Closure and Reading

When it comes to vision, there is a lot that goes into reading and writing. Understanding the visual differences between letters, visually connecting the form of a letter to a sound, and stringing single letters into words (and then sentences) involves coordination of visual processing and multiple skill areas. When a child picks up a pencil to write the daily homework assignments into a tracker or completes a math page, the visual processing system is going into overdrive with scanning, visual tracking, visual motor integration, and visual perceptual skill work.

In the classroom, we often times run into many students who struggle with reading. Parents may notice a difficulty with reading during homework or other reading tasks. When a child struggles with keeping their place when reading a line of text, has difficulty recognizing words they should know, struggles with reading fluency or reading comprehension, a visual processing issue may be at the center of the struggle.

One necessary foundation skill needed for reading fluency is visual closure. While it may not seem like the most predictable culprit of the visual perceptual skills that impact reading, vision closure certainly is at play.

Visual closure is a skill used when reading. These visual skills are used to visually complete the word in the mind’s eye without reading each letter. This is similar to word prediction technology. The mind is able to predict the word based on letters, and context. This enable reading fluency as well as reading comprehension.

Visual closure is one skill that allows us to recognize words without focusing on each individual letter within a word. It allows us to glance at a sight word and read the word quickly. It enables us to comprehend a reading passage with fluency and efficiency as we visualize and discern words. It allows us to read and discern words that have similar beginnings or endings.

When a child looks at words and sentences, they typically are able to fill in missing parts of information. They can predict what is coming when reading sentences, copy words if they don’t see the whole word, solve puzzles, and fill in worksheets. When visual closure and predicting information or self-correcting missing information is difficult, kids don’t recognize errors in reading, writing, and math.

Similarly, visual closure enables us to identify a word without perceiving each specific part of the letters which make up a word. It is easy to see how a child who struggles with this visual perceptual skill can labor at reading!

VISUAL CLOSURE RED FLAGS

How do I know if there is an issue with my visual closure abilities? There are signs that can indicate visual closure problems in children.

These are common red flags associated with poor visual closure in kids:

Children with difficulties in visual closure may have trouble completing mazes, puzzles, or worksheets.  They might have difficulty identifying items that are partially obscured by other items, such as finding a serving spoon or a matching sock hidden in a draw full of items.  They might have difficulty with spelling or math tasks or concepts.

• Difficulty recognizing letters or reading in certain fonts
• Often poorly forms letters while writing 
• Not being able to recognize a word that is partially hidden
• Difficulty completing words with missing letters
• Requires extra time to read because they must sound out each letter in a word rather than seeing the whole word
• Unable to find an object when it is partially covered (ex: milk in the fridge or a shirt in a drawer)
• May find puzzles too challenging 
• Figuring out how to put together toys with multiple parts
• Difficulty interpreting visual information, such as maps or diagrams

Please note that this is list not exhaustive, nor does it by any means diagnose someone with visual or cognitive deficits. It is here it give you an idea of what it may look like or feel like to have impaired visual closure understanding.  

Since we know that various visual perception skills match these red flags, we have the perfect resource for you: this  Visual Closure Workbook ! This workbook gives an in-depth look at a very specific aspect of visual perception, it gives ample ways to identify it, and provides various levels of interventions with fun themes to go along. 

Visual Closure ACTIVITIES & GAMES

The good news is that there are tons of fun ways to develop visual closure skills! Below you can find activities, games, books, and activities you can do with objects at home to build visual skills. 

Books to Develop Visual Closure

Here are a few easy activities that you can do at home to help:

Puzzles: Jigsaw Puzzles are a great way to work on this skill, as they require children to use their visual and spatial awareness skills to figure out how the pieces fit together. Start with simple puzzles and gradually increase the difficulty as your child improves.

Picture Matching: Cut out a set of pictures and have your child match the incomplete pictures to the complete ones. For example, you can cut out a picture of a house, leaving only the roof and part of the walls visible. Your child’s job is to find the matching picture of the whole house.

Printable Worksheets: Visual Closure worksheets can be a tool to support development of this visual processing skill. We love creating resources that build this area of development in various themes. We have fun downloads here on the website that targets visual closure.

• Visual Closure Bugs activity

Hidden Objects: Provide your child with a few objects and something like a blanket to cover parts of them. Have them use their visual closure skills to figure out what’s missing or covered up.

Drawing: Encourage your child to draw from memory. For example, you can show them a picture for a few seconds, then have them close their eyes and draw what they remember. This activity helps to develop their visual closure skills, as well as their memory and creativity.

Children with strong visual closure skills are better able to complete puzzles, read and write, and interpret their surroundings. On the other hand, children who struggle with vision closure may have difficulty with these tasks and may require extra support and intervention.

Dot to Dot Activities- Completing a connect the dot activity is a great way to develop visual closure skills by working on seeing the bigger picture. Best of all, these visual perception activities support development of other underlying areas, too: visual figure ground, visual scanning, form constancy, and the ability to complete a partial picture. 

If you notice your child struggling with this skill, consider seeking out the help of an occupational therapist. With the right support and activities, your child can develop their visual closure skills and improve their overall functioning.

Sydney Thorson, OTR/L, is a new occupational therapist working in school-based therapy. Her background is in Human Development and Family Studies, and she is passionate about providing individualized and meaningful treatment for each child and their family. Sydney is also a children’s author and illustrator and is always working on new and exciting projects.

The Visual Closure Workbook is a 65 page digital file designed to impact visual perceptual skills for reading comprehension and efficiency, and the ability to visualize a complete image or feature when given incomplete or partial information. With functional visual closure skills, we are able to determine

This visual perceptual skill resource includes:

• Information on visual processing and visual closure
• Tips and tools to address visual closure needs
• A thorough explanation of visual closure and what problems in this area look like in everyday tasks
• Reproducible worksheets and activity lists
• Activities to grade visual perceptual skills in hands-on activities
• 3 levels of worksheet pages in a variety of themes

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BIG List of Sample IEP Goals for School Occupational Therapy

1. Abstract thinking: The student will develop abstract thinking skills to understand and apply concepts or ideas that are not concrete or directly observable. 2. Adaptive equipment and strategies: The student will learn to use adaptive equipment or strategies to accommodate physical or cognitive challenges and maximize independence in daily activities. 3. Assistive technology: The student will learn to utilize assistive technology devices or software to enhance access to educational materials and promote independence in academic tasks. 4. Attention (auditory): The student will actively listen and comprehend verbal instructions or information without getting distracted, such as following a series of multi-step directions. 5. Attention (details): The student will increase accuracy and minimize errors in assignments or tasks that require close observation or precision, such as completing science experiments or art projects with attention to detail. 6. Attention (divided): The student will successfully multitask or shift focus between two or more tasks, such as listening to instructions while organizing materials. 7. Attention (flexibility): The student will adapt to changes in the environment or task demands without becoming overwhelmed or losing focus, such as smoothly transitioning between different subjects during the school day. 8. Attention (groups): The student will actively participate and contribute relevant ideas or responses without being distracted by peers or environmental stimuli, such as actively engaging in a classroom discussion. 9. Attention (selective): The student will effectively filter out irrelevant distractions and maintain focus on a specific task, such as ignoring background noise while working on a writing assignment. 10. Attention (sustained visual): The student will maintain visual focus on written material or visual aids for a specified duration, such as tracking a line of text while reading for 10 minutes. 11. Attention (sustained) : The student will reduce off-task behaviors, such as daydreaming or getting up from their seat without permission, and maintain focus on independent assignments. 12. Attention (task completion): The student will stay focused and persevere through assignments or activities until they are finished, such as completing a math worksheet without getting off task or seeking frequent breaks. 13. Auditory memory: The student will enhance auditory memory skills to retain and recall auditory information, such as following multi-step directions or remembering verbal instructions. 14. Auditory processing: The student will enhance auditory processing skills to accurately process and interpret auditory information, such as following instructions or classroom discussions. 15. Bilateral coordination: The student will enhance bilateral coordination skills to effectively use both hands together during tasks such as cutting with scissors, buttoning, or tying shoelaces. 16. Classroom participation: The student will increase active engagement and participation in classroom activities, including group discussions, collaborative projects, and following classroom routines. 17. Cognitive skills: The student will improve cognitive skills, such as memory, problem-solving, or critical thinking, to support academic learning and problem-solving abilities. 18. Collaborative problem-solving: The student will actively engage in collaborative problem-solving activities with peers, brainstorming solutions, sharing ideas, and working together towards a common goal. 19. Community integration: The student will enhance community integration skills to participate in community outings, field trips, or vocational experiences, promoting functional independence. 20. Community resources: The student will explore and utilize community resources, such as libraries, museums, or recreational facilities, to support learning, social participation, and leisure engagement. 21. Emotional expression: The student will learn appropriate ways to express emotions, such as through verbal communication, art, or journaling, to promote emotional expression and communication. 22. Emotional regulation during peer interactions: The student will develop strategies for emotional regulation specifically during peer interactions to manage frustration, disappointment, or conflict in social situations. 23. Emotional regulation during sensory overload: The student will develop strategies for emotional regulation specifically during sensory overload situations, such as crowded environments or noisy settings. 24. Emotional regulation during test-taking: The student will develop strategies for emotional regulation specifically during test-taking situations to manage test anxiety and optimize performance. 25. Emotional regulation in transitions: The student will develop strategies for emotional regulation specifically during transitions between activities, classes, or environments to manage anxiety or frustration. 26. Emotional regulation: The student will develop emotional regulation strategies to identify and manage emotions appropriately, supporting emotional well-being and social interactions. 27. Emotional resilience: The student will develop emotional resilience skills to bounce back from setbacks, adapt to challenges, and maintain a positive attitude towards learning and personal growth. 28. Environmental adaptations: The student will benefit from environmental adaptations, such as seating modifications, visual schedules, or sensory supports, to optimize their access and participation in the classroom. 29. Environmental organization: The student will benefit from environmental organization strategies to maintain an organized and structured learning environment that supports their attention and productivity. 30. Executive functioning: The student will enhance executive functioning skills, such as organization, time management, and planning, to facilitate successful completion of academic tasks and assignments. 31. Expressive language skills: The student will improve expressive language skills, including sentence formation, vocabulary usage, and storytelling abilities, to enhance communication in academic and social settings. 32. Fine motor coordination for handwriting: The student will improve fine motor coordination specifically for handwriting tasks, including letter formation, spacing, and legibility. 33. Fine motor dexterity: The student will improve fine motor dexterity skills to manipulate small objects, use tools, or engage in activities that require precise hand movements. 34. Fine motor skills: The student will develop finger strength and dexterity to manipulate clothing fasteners, such as buttons, zippers, snaps, or shoelaces, independently in 8 out of 10 dressing tasks. 35. Fine motor skills: The student will develop precision and coordination in using scissors to accurately cut along straight, curved, and zigzag lines, in 9 out of 10 cutting tasks. 36. Fine motor skills: The student will enhance finger isolation and control to manipulate individual small objects or buttons independently, in 7 out of 10 opportunities. 37. Fine motor skills: The student will enhance their ability to manipulate small objects using a pincer grasp, such as picking up and sorting small beads, coins, or buttons, in 9 out of 10 opportunities. 38. Fine motor skills: The student will improve eye-hand coordination and accuracy in activities such as catching and throwing a ball, hitting a target, or playing a tabletop game, in 8 out of 10 opportunities. 39. Fine motor skills: The student will improve fine motor skills to independently manipulate writing tools, such as pencils or pens, and demonstrate improved legibility in written work. 40. Fine motor skills: The student will improve hand strength and dexterity to enhance their ability to manipulate small objects, such as using tweezers or tongs, in 9 out of 10 opportunities. 41. Fine motor skills: The student will improve hand-eye coordination and control while using various art materials, such as drawing, painting, or coloring, to create age-appropriate artwork, in 8 out of 10 artistic tasks. 42. Fine motor skills: The student will refine their grasp and control while using utensils during self-feeding, demonstrating appropriate scooping, cutting, and bringing food to their mouth, in 9 out of 10 meals. 43. Fine motor skills: The student will refine their hand manipulation skills to complete age-appropriate fine motor activities, such as threading beads, building with blocks, or completing puzzles, in 9 out of 10 opportunities. 44. Fine motor skills: The student will refine their pencil grasp and control to write legibly with appropriate letter formation and spacing, in 8 out of 10 writing assignments. 45. Following multi-step directions: The student will improve the ability to follow multi-step directions accurately and independently in various academic and classroom contexts. 46. Graphomotor skills: The student will improve graphomotor skills, such as handwriting or drawing, to enhance legibility, letter formation, and fine motor control. 47. Gross motor skills: The student will develop their ability to kick a ball with control and accuracy, demonstrating improved lower limb strength and coordination, in 9 out of 10 attempts. 48. Gross motor skills: The student will develop their ability to ride a tricycle or bicycle with training wheels, demonstrating improved leg strength, coordination, and balance, in 9 out of 10 opportunities. 49. Gross motor skills: The student will enhance gross motor skills to participate in physical education classes and outdoor activities with improved coordination and balance. 50. Gross motor skills: The student will enhance their ability to jump with both feet off the ground and land with control, demonstrating improved lower limb strength and coordination, in 9 out of 10 attempts. 51. Gross motor skills: The student will enhance their ability to perform age-appropriate gross motor movements, such as hopping, skipping, or galloping, demonstrating improved rhythm, coordination, and balance, in 8 out of 10 attempts. 52. Gross motor skills: The student will enhance their overall endurance and physical fitness by engaging in activities that promote cardiovascular health, such as jogging, dancing, or participating in structured physical education classes, for a specified duration, in 9 out of 10 opportunities. 53. Gross motor skills: The student will enhance their throwing and catching skills, demonstrating improved upper limb strength, coordination, and hand-eye coordination, in 8 out of 10 attempts. 54. Gross motor skills: The student will improve their balance and coordination to walk on a straight line, navigate obstacles, or negotiate stairs independently, in 8 out of 10 opportunities. 55. Gross motor skills: The student will improve their bilateral coordination and upper body strength to engage in activities such as crawling, climbing, or navigating playground equipment, in 9 out of 10 opportunities. 56. Gross motor skills: The student will improve their body awareness and motor planning skills to participate in games or activities that require directional changes, spatial awareness, or following a sequence of movements, in 8 out of 10 opportunities. 57. Gross motor skills: The student will improve their running skills, including speed, endurance, and proper arm swing, to participate in running-based activities or games, in 8 out of 10 opportunities. 58. Hand-eye coordination: The student will enhance hand-eye coordination skills to accurately coordinate hand movements with visual input during activities such as catching or throwing a ball. 59. Handwriting skills: The student will develop letter slant skills to consistently write letters with a slight forward or backward slant, maintaining consistency throughout their written work. 60. Handwriting skills: The student will develop size consistency skills to maintain consistent letter size, both within and between words, ensuring legibility and visual coherence. 61. Handwriting skills: The student will enhance alignment skills to consistently place letters on the baseline, ensuring a neat and organized appearance of written work. 62. Handwriting skills: The student will enhance grip and pencil control skills, promoting a functional grasp and appropriate pressure on the writing utensil for improved letter formation and overall handwriting quality. 63. Handwriting skills: The student will improve letter formation skills to accurately write uppercase and lowercase letters with correct stroke sequence and direction. 64. Handwriting skills: The student will improve overall neatness and legibility of written work, focusing on consistent letter size, spacing, alignment, and clarity of letter formation. 65. Handwriting skills: The student will improve spacing skills to consistently leave appropriate spaces between words, allowing for clarity and ease of reading. 66. Handwriting skills: The student will increase writing speed and fluency, allowing for faster and more efficient written expression without sacrificing legibility or accuracy. 67. Handwriting skills: The student will learn and practice cursive handwriting skills, including connecting letters, forming loops, and maintaining proper flow and rhythm. 68. Handwriting skills: The student will refine handwriting skills to produce written work that is neat, legible, and consistently aligned with age-appropriate standards. 69. Handwriting skills: The student will refine letter shape skills to accurately produce letters with proper proportions, angles, and curves, improving overall letter legibility. 70. Inclusive play: The student will actively participate in inclusive play activities, where they can engage with peers of different abilities, promoting social interaction, empathy, and understanding. 71. Inhibitory control: The student will enhance inhibitory control skills to resist impulsive behaviors, follow rules, and maintain appropriate behavior in the classroom. 72. Motor coordination: The student will enhance motor coordination skills to participate in physical activities, such as sports or recess, with increased accuracy and fluidity of movements. 73. Motor planning: The student will enhance motor planning skills to effectively plan and execute sequential movements, such as putting on clothes, using utensils, or navigating through obstacles. 74. Multisensory learning: The student will engage in multisensory learning activities to enhance learning and retention of information through the integration of visual, auditory, and tactile modalities. 75. Oral motor skills: The student will improve oral motor skills to support speech and language development, articulation, or feeding skills. 76. Oral presentation skills: The student will enhance oral presentation skills, including clear articulation, volume control, and maintaining eye contact, to effectively communicate ideas in front of peers or teachers. 77. Peer collaboration: The student will engage in peer collaboration activities, such as group projects or cooperative learning, to foster teamwork, cooperation, and shared problem-solving skills. 78. Peer conflict resolution: The student will learn and apply strategies for peer conflict resolution, such as active listening, compromise, or negotiation skills, to resolve conflicts peacefully. 79. Peer feedback: The student will actively seek and provide constructive feedback to peers during group projects or collaborative tasks, fostering a supportive learning environment. 80. Peer interactions: The student will enhance peer interaction skills, such as sharing, taking turns, or collaborating, to promote positive social relationships and inclusiveness. 81. Peer mentoring: The student will participate in peer mentoring programs, where they can serve as mentors 82. Peer support: The student will participate in peer support programs, where they can receive support from classmates or serve as a support system for peers with similar challenges. 83. Personal space awareness: The student will develop personal space awareness skills to understand appropriate boundaries and respect personal space of others during social interactions. 84. Perspective-taking: The student will enhance perspective-taking skills to understand and consider the viewpoints and feelings of others, promoting empathy and positive social interactions. 85. Phonics and phonological awareness: The student will develop phonics and phonological awareness skills, including letter-sound recognition, blending, or segmenting, to support reading and spelling abilities. 86. Pragmatic language skills: The student will improve pragmatic language skills, including turn-taking, topic maintenance, and understanding social cues, to enhance social communication in various contexts. 87. Pre-vocational skills: The student will develop pre-vocational skills, such as time management, following workplace routines, or demonstrating appropriate work behavior, to prepare for future employment opportunities. 88. Pre-writing skills: The student will develop pre-writing skills, such as tracing lines, shapes, or patterns, to lay the foundation for letter formation and handwriting. 89. Problem-solving: The student will enhance problem-solving skills to independently identify solutions, make decisions, and overcome challenges encountered in academic and social contexts. 90. Reading comprehension: The student will improve reading comprehension skills, such as identifying main ideas, making inferences, or summarizing information, to enhance understanding of academic content. 91. Reading fluency: The student will improve reading fluency skills, including speed, accuracy, and prosody, to enhance reading comprehension and overall reading abilities. 92. Safety skills: The student will learn safety skills, including road safety, fire safety, or personal safety, to enhance awareness and make safe choices in various environments. 93. Self-advocacy in the classroom: The student will develop self-advocacy skills to communicate their needs, accommodations, or modifications with teachers and actively participate in their educational planning. 94. Self-advocacy skills: The student will develop self-advocacy skills to express their needs, seek assistance when necessary, and actively participate in their educational planning. 95. Self-care skills: The student will develop independence in self-care activities, such as dressing, grooming, and feeding, to promote greater participation and self-sufficiency in daily routines. 96. Self-initiation: The student will enhance self-initiation skills to independently start tasks or activities without constant prompts or reminders from teachers or caregivers. 97. Self-monitoring: The student will develop self-monitoring skills to assess their own performance, identify errors or areas of improvement, and make adjustments accordingly. 98. Self-regulation: The student will develop self-regulation strategies to manage emotions, impulses, and sensory needs to facilitate engagement and appropriate behavior in the classroom. 99. Sensory accommodations: The student will benefit from sensory accommodations in the classroom, such as noise-reducing headphones, visual schedules, or flexible seating options, to optimize their sensory environment. 100. Sensory diet: The student will implement a sensory diet, consisting of tailored sensory activities, to support self-regulation and attention throughout the school day. 101. Sensory discrimination: The student will improve sensory discrimination skills to differentiate and interpret sensory information, such as identifying textures, temperatures, or shapes through touch. 102. Sensory exploration and play skills: The student will actively engage in sensory exploration and play activities to promote sensory integration, creativity, and imaginative play. 103. Sensory modulation during mealtime: The student will improve sensory modulation skills during mealtime to tolerate different textures, tastes, or smells, promoting healthy eating habits and mealtime participation. 104. Sensory modulation: The student will improve sensory modulation skills to effectively respond to and regulate their responses to sensory stimuli in the environment. 105. Sensory processing: The student will improve sensory processing skills to effectively regulate responses to sensory stimuli, resulting in increased attention and engagement in the classroom. 106. Sensory regulation: The student will enhance sensory regulation skills to manage sensory sensitivities or sensory-seeking behaviors that may impact participation and attention in the classroom. 107. Sensory-based strategies: The student will learn and utilize sensory-based strategies, such as deep pressure input or fidget tools, to regulate sensory needs and promote attention and focus in the classroom. 108. Sensory-based transitions: The student will utilize sensory-based strategies to support transitions, such as incorporating movement breaks, deep pressure activities, or sensory fidgets during transitions. 109. Sequencing and organization: The student will improve sequencing and organization skills to arrange information or tasks in a logical order, enhancing problem-solving abilities and task completion. 110. Social participation: The student will increase social participation and engagement with peers during group activities, cooperative play, or structured social interactions. 111. Social problem-solving: The student will develop social problem-solving skills to analyze social situations, identify appropriate responses, and resolve conflicts effectively. 112. Social skills: The student will develop conflict resolution skills by using appropriate strategies, such as compromising, problem-solving, or seeking adult assistance, to resolve conflicts with peers, in 9 out of 10 conflict situations. 113. Social skills: The student will develop social skills, including initiating conversations, maintaining eye contact, or understanding social cues, to foster positive peer interactions and social relationships. 114. Social skills: The student will develop their ability to recognize and interpret social norms and expectations in different situations, demonstrating appropriate behavior and manners in various social settings, in 8 out of 10 opportunities. 115. Social skills: The student will develop turn-taking skills during group activities or games, waiting for their turn and appropriately sharing materials or responsibilities, in 8 out of 10 opportunities. 116. Social skills: The student will enhance their ability to interpret and understand nonverbal cues, such as facial expressions, body language, and tone of voice, to better comprehend and respond to social situations, in 9 out of 10 opportunities. 117. Social skills: The student will enhance their ability to recognize and respect personal space boundaries, demonstrating appropriate physical proximity to peers during interactions or group settings, in 8 out of 10 opportunities. 118. Social skills: The student will enhance their ability to work collaboratively in group settings, demonstrating effective teamwork, sharing responsibilities, and respecting others’ ideas and contributions, in 9 out of 10 group activities. 119. Social skills: The student will improve their ability to demonstrate active listening skills, such as making eye contact, nodding, and providing verbal or nonverbal feedback, in 9 out of 10 listening activities or conversations. 120. Social skills: The student will improve their ability to identify and express their emotions in a socially appropriate manner, using words or appropriate gestures to communicate their feelings, in 8 out of 10 opportunities. 121. Social skills: The student will improve their ability to initiate and engage in play interactions with peers, demonstrating sharing, cooperation, and imaginative play skills, in 9 out of 10 play situations or activities. 122. Social skills: The student will improve their ability to initiate and maintain conversations with peers by appropriately greeting, asking questions, and responding to conversation prompts, in 8 out of 10 opportunities. 123. Social skills: The student will enhance their ability to demonstrate empathy and perspective-taking by recognizing and understanding others’ feelings and experiences, and responding with kindness and support, in 8 out of 10 opportunities. 124. Social-emotional learning: The student will participate in social-emotional learning activities, such as mindfulness exercises, empathy-building activities, or conflict resolution strategies, to enhance emotional intelligence and social skills. 125. Spatial awareness: The student will improve spatial awareness skills to accurately perceive and navigate the physical space, including body awareness and spatial relationships. 126. Study skills: The student will learn effective study skills, such as note-taking, organization of materials, or test preparation strategies, to enhance academic performance and retention of information. 127. Technology skills: The student will develop technology skills, including keyboarding, accessing educational software, or utilizing assistive technology devices, to enhance digital literacy and access to educational resources. 128. Time management for homework completion: The student will enhance time management skills specifically for completing homework assignments, including setting priorities, estimating time, and staying on task. 129. Time management: The student will enhance time management skills to effectively allocate time for different tasks, assignments, and transitions throughout the school day. 130. Transition planning: The student will engage in transition planning activities to develop skills necessary for post-school settings, such as vocational training, higher education, or employment. 131. Transition skills: The student will develop motor planning skills to successfully transition between activities, by practicing specific movement sequences or using visual prompts to guide their actions, in 8 out of 10 opportunities. 132. Transition skills: The student will develop problem-solving skills to overcome challenges during transitions, by using strategies such as asking for help, seeking alternative solutions, or adapting to unexpected changes, in 8 out of 10 opportunities. 133. Transition skills: The student will develop transition skills, including managing changes in routines, transitioning between activities, or adapting to new environments, to promote smooth transitions throughout the school day. 134. Transition skills: The student will enhance executive functioning skills to independently initiate and complete transitions between activities, including gathering necessary materials and moving to the designated area, in 7 out of 10 opportunities. 135. Transition skills: The student will enhance self-regulation abilities to transition between activities calmly and without exhibiting disruptive behaviors, by utilizing deep breathing techniques or sensory self-regulation strategies, in 7 out of 10 opportunities. 136. Transition skills: The student will generalize transition skills across different environments and settings, by successfully transitioning between activities in various contexts, such as the classroom, therapy room, or community spaces, in 8 out of 10 opportunities. 137. Transition skills: The student will improve organizational skills to facilitate smooth transitions between activities, by using visual cues or checklists to plan and prepare for the next task, in 9 out of 10 opportunities. 138. Transition skills: The student will improve social skills during transitions, by appropriately interacting with peers and following social expectations, such as taking turns or waiting patiently, in 9 out of 10 opportunities. 139. Transition skills: The student will improve time management skills during transitions, by accurately estimating the time required for packing up and transitioning to the next activity, in 9 out of 10 opportunities. 140. Transition skills: The student will improve transition skills, including transitioning between activities or locations, to promote independence and successful navigation within the school setting. 141. Transition skills: The student will increase attention span during transitions, by engaging in a designated transition activity or following a transition routine without becoming distracted, for at least 80% of transition instances. 142. Transition skills: The student will independently transition between activities within the classroom setting, including packing up and moving to the next activity, within three minutes, in 8 out of 10 opportunities. 143. Typing skills: The student will demonstrate improved typing fluency by maintaining a consistent rhythm and flow in typing activities. 144. Typing skills: The student will develop finger placement and keyboarding technique to increase efficiency and reduce errors during typing tasks. 145. Typing skills: The student will enhance finger dexterity and coordination to facilitate fluid and smooth typing movements. 146. Typing skills: The student will enhance typing accuracy by reducing errors in typing, including correct spelling and punctuation. 147. Typing skills: The student will improve hand-eye coordination to accurately locate and press keys without visual reliance during typing activities. 148. Typing skills: The student will improve keyboard navigation skills, including locating and using function keys, arrows, and other essential keyboard shortcuts. 149. Typing skills: The student will increase independence in typing tasks by minimizing the need for visual prompts or assistance from others. 150. Typing skills: The student will increase typing speed to a specified words-per-minute (WPM) target, enabling more efficient written expression. 151. Typing skills: The student will learn and practice touch typing techniques to improve accuracy and speed in keyboarding tasks. 152. Typing skills: The student will transfer typing skills to real-life applications, such as word processing, email communication, and online research, for academic and functional purposes. 153. Visual closure skills: The student will improve visual closure skills to recognize and complete visual patterns or missing parts of visual stimuli, enhancing visual perception and problem-solving abilities. 154. Visual memory: The student will enhance visual memory skills to remember and recall visual information, such as spelling words or visual sequences. 155. Visual perception: The student will improve visual perception skills, such as visual discrimination or figure-ground skills, to accurately identify and interpret visual information in academic materials. 156. Visual tracking: The student will enhance visual tracking skills to smoothly and accurately follow lines of text during reading and improve reading fluency. 157. Visual-motor integration: The student will enhance visual-motor integration skills to accurately copy written material from the board or a source text onto their own paper. 158. Visual-spatial perception: The student will enhance visual-spatial perception skills to accurately perceive and interpret spatial relationships, such as understanding maps, graphs, or geometric shapes. 159. Vocabulary development: The student will improve vocabulary development, including understanding and using new words, to enhance communication and comprehension skills. 160. Work habits: The student will develop work habits, including task initiation, persistence, and completion, to improve productivity and follow-through on academic assignments.

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Kevin costner reveals the epic journey of his cannes western ‘horizon’ and has his say on ‘yellowstone’ rancor, breaking news.

‘I’m A Virgo’ Star Jharrel Jerome, Team On Magic Of Illusion And Solving Math Problems

“Definitely the most challenging thing I’ve had to do thus far as an actor, a lot of mental gymnastics involved,” Jharrel Jerome admits about the uniqueness of his role in the Boots Riley -created absurdist series I’m A Virgo , on which he plays a previously extremely sheltered 13-foot-tall Oakland teen. “At no point do I look my scene partners in the eye, and as an actor that’s so critical, you know, as connection.”

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Launched in June 2023 with all seven episodes, the small-screen debut of Coup frontman and Sorry to Bother You director Riley is a true display of originality in an analogue and Situationist spirit that “never turns away from what it is to be young and Black in the Land of the Free and Home of the Brave,” as I said in my review of the Prime Video series last year.

“I think the magic of what really brought me to this project was the idea of not using CGI or special effects, because that in itself is requiring a lot for the actor,” Jerome says. “And there’s no rulebook on it, right, there’s no way to do it right. There was, we were all running on the set.

“Honestly, after this everything’s going be easy,” the actor and executive producer adds to laughter from his colleagues.

Olivia Washington, Deirdra E. Govan, Boots Riley, Walton Goggins and Jharrel Jerome

Boots Riley and Jharrel Jerome

Michael Buckner for Deadline

Walton Goggins

Olivia Washington and Deirdra E. Govan

Amidst the political and social aspects of I’m a Virgo , which was tied for my top show of 2023 with the final season of Reservation Dogs , the power of illusion and visual reality was in many ways a character unto itself — especially Govan’s costume design.

“Spending time with the actors in the fitting room is my process,” said Govan, whose credits include Sorry to Bother You and Harlem . “That is my time to not only gain their trust, but also really listen to what they are tapping into and how they’re going to inhabit the skin of these characters.”

“What we should know is that the clothes were a big part of the effects,” Riley says of the pivotal role the costumes played in enabling the sense of scale, both for Jerome’s character Cootie as well as everyone else in I’m a Virgo ‘s world. “It’s half the trick of what’s happening on screen.”

Along with Jerome, Washington and Goggins (who also stars in Prime Video ‘s Fallout ), I’m a Virgo features two-time Tony nominee Kara Young, Carmen Ejogo, Mike Epps, Brett Gray and Kendrick Sampson. Elijah Wood makes a guest appearance as do the voices of Danny Glover, Joel Edgerton, Juliette Lewis and philosopher/cultural theorist Slavoj Žižek.

For more Deadline Studio at Prime Experience content, click  here .

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AstroDevam is a premium organisation providing ancient and authentic knowledge of Astrology, Vastu, Numerology, and Innovative Corporate Solutions with a contemporary perspective. AstroDevam, having patrons in more than 100 countries, has been promoted by Achary Anita Baranwal and Achary Kalki Krishnan, who not only have Master's Degrees in Astrology, but are engaged in teaching Scientific Astrology, Vastu, and Numerology for more than three decades. Read More

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