Paul Fletcher is Wellcome Investigator and Bernard Wolfe Professor of Health Neuroscience at the University of Cambridge. He is also Director of Studies for Preclinical Medicine at Clare College and Honorary Consultant Psychiatrist with the Cambridgeshire and Peterborough NHS Foundation Trust. He studied Medicine, before carrying out specialist training in Psychiatry and taking a PhD in cognitive neuroscience. He researches human perception, learning and decision-making in health and mental illness.

We do not have direct contact with external reality. We must rely on messages from the sense organs, conveying information about the state of the world and our bodies. These messages are not easy to decipher, being noisy and ambiguous, but from them we have to construct models of the world. I will discuss this challenge and how we are very adept at creating a model of reality based on achieving a balance between what our senses are telling us and our expectations of what should be the case. This is often referred to as the predictive processing framework.

Relying on this balance comes at a cost, rendering us vulnerable to illusions and biases and, in more extreme cases, to creating a reality that diverges from that experienced by others. This can arise for a variety of reasons but, at the root, I suggest, lies the nature of the brain as a model-building organ. Though this divergence from reality – psychosis – often seems inexplicable and incomprehensible, I suggest that a few core principles can help us to understand it and offers ways of thinking about how phenomena like hallucinations can be understood. Interestingly, the framework suggests ways in which apparently similar phenomena like hallucinations can arise from distinct alterations to the function of a predictive processing system.