Embodied and Embedded Approaches to the Self in Psychiatry and Psychosomatic Medicine 2011 Introduction: Concepts of the Self Thomas Fuchs Overview I. Levels and dimensions of self-awareness II. Schizophrenia as a disorder of the self Dimensions of Self-Experience Self-as-subject – self-as-object (Zahavi 2005, Legrand 2011) S O S S‘ Implicit, prereflective self-awareness, present in every experience without requiring introspection Explicit awareness of self, self-as-object Levels of Self-Experience - Basic or bodily self („ipseity“): prereflective self-awareness - Extended or personal self: reflective self-consciousness Basic Self • Relatedness of self and world • Embodied self – bodily self • self-affection • agency • ecological self-awareness • temporal coherence • intercorporeality Dimensions of the Basic Self a) Self-affection • feeling of being alive – mood – affect • interoceptive, proprioceptive, kinesthetic sensations • “Befinden” (situatedness, attunement): background feeling of body related to potentialities of a situation • existential feelings (Ratcliffe 2008) • bodily sensations implicit in world-directed attention Dimensions of the Basic Self b) Spontaneity and agency • causing effects in the environment c) Ecological self-awareness • body as zero-point of spatial orientation • sensorimotor circles (centrifugal – centripetal directions) • sensorimotor coupling with environment, bodily being-towards-the world (Merleau-Ponty) • boundaries of lived body are enacted in a flexible way Dimensions of the Basic Self d) Temporal coherence Basic self-continuity: retentional-protentional unity of internal time consciousness, duration of the present e) Shared or intercorporeal self • intercorporeal body schema, imitation in newborns • intercorporeal resonance, affect attunement • shared self-other-awareness through reciprocity Extended or Personal Self Mainly developing in year 2-4 Based on • perspective taking • self-reflection, self-consciousness • narrativity • autobiographical memory and continuity • self-knowledge, self-concept Dimensions of the Extended Self a) Perpective-taking, reflective self • intersubjective constitution of the personal self (seeing oneself “in others’ eyes”) • egocentric allocentric space • “excentric position” (Plessner) • self-other-related emotions (embarrassment, shame, guilt, pride) Dimensions of the Extended Self b) Autobiographical or narrative self • overarching temporal continuity • narrative identity: continuous reconstruction of the past and projection into the future • conceptual self, self-knowledge • no pure “self-construct” or virtual “center of narrative gravity” (Dennett), but founded on the basic levels of the self Dimensions of the Extended Self c) The polarity of embodiment • body-as-subject (Leib) – body-as-object (Körper) • tacit functioning and transparency of the lived body, operative intentionality • turning into the body-as-object in situations of maladaptation or exposure to the gaze of others • ambiguous status of the body • body schema – body image Summary: Basic and Extended Self Basic or bodily self • Self-affection • Self-agency • Sensorimotor coherence with the environment • Self-continuity • Self-with-others, shared self Extended or personal self • Perspective-taking, reflective self-awareness • Autobiographical continuity • Narrative identity • Self-concept Disorders of the Self • Disorders of the basic self (e.g. neurological disorders of embodiment, schizophrenia) • Disorders of the extended / personal self (e.g. dissociative disorders, amnesia, dementia) II. Schizophrenia as a disembodiment (1) weakening of basic, preflective sense of self (ipseity) (2) disturbance of implicit bodily functioning (3) disconnection from intercorporality (4) disorder of personal self (1) Disembodiment of Basic Self (Minkowski, Parnas, Sass, Stanghellini et al.) - loss of vital contact with reality - lack of existential feeling of presence Weakening of embodied self-awareness “I constantly have to ask myself who I actually am. It is hard to explain...most of the time I have this very strange thing: I watch myself closely, like how am I doing now and where are the "parts". (…) I think about that so much that I cannot do anything else. It is not easy if you change from day to day. As if you were a totally different person all of a sudden." (de Haan and Fuchs 2010) “It is as if I am not a part of this world; I have a strange ghostly feeling as if I was from another planet. I am almost nonexistent.” (Parnas et al. 2005) Weakening of Embodied Self-Awareness: Hyperreflexivity If a thought passed quickly through his brain . . . , he was forced to direct back his attention and scrutinize his mind in order to know exactly what he had been thinking. … He fears that he may stop thinking for a while, that there might have been “a time when my imagination had been arrested.” . . . He wakes up one night and asks himself: “Am I thinking? Since there is nothing that can prove that I am thinking, I cannot know whether I exist.” (Parnas and Handest 2003) (2) Disembodiment of action and perception - fragmentation of perceptual and motor Gestalt units - pathological explication of implicit functions of the body (a) Disembodiment of action - disintegration of habits and bodily practices - pathological explication of normally implicit functions - hyperreflective awareness - disturbance of agency (a) Disembodiment of action “If I want to do something like drinking water, I must go through it in detail, find a glass, go over there, switch on the tap, fill up the glass, drink." (Chapman 1966) “At times, I could do nothing without thinking about it. I could not perform any movement without having to think how I would do it.” (de Haan & Fuchs 2010) (a) Loss of agency “I am like a robot which someone else can use, but not me. I know what has to be done but cannot do it.” (Chapman 1966) (b) Disembodiment of perception loss of familiar patterns of perception, captivation by details fragmentation of familiar gestalt units loss of meaning and coherence (b) Disembodiment of perception “I saw everything I did like a film camera.” (Sass 1992) “For me it was as if my eyes were cameras, and my brain would still be in my body, but somehow as if my head were enormous, the size of a universe, and I was in the far back and the cameras were at the very front. So extremely far away from the cameras.“ (de Haan & Fuchs 2010) (b) Alienation of perception in beginning psychosis Growing perceptual alienation leads to “delusional mood”: - artificial, enigmatic and uncanny alteration of the environment - loss of familiar meanings (3) Disembodiment of shared or intercorporeal self Connection of intercorporality and common sense in schizophrenia: sense of detachment, 3rd person view on social interactions “loss of natural self-evidence” (Blankenburg) of the interpersonal sphere, impaired understanding of everyday situations autistic withdrawal (4) Disturbed Intersubjectivity: Transitivism „When I look at somebody my own personality is in danger. I am undergoing a transformation and my self is beginning to disappear.“ (Chapman 1966) “The others’ gazes get penetrating, and it is as if there was a consciousness of my person emerging around me … Then I don’t know who I am any more.” (Fuchs 2000) (4) Transitivism “A young man was frequently confused in a conversation, being unable to distinguish between himself and his interlocutor. He tended to lose the sense of whose thoughts originated in whom, and felt ‘as if’ the interlocutor somehow ‘invaded’ him, an experience that shattered his identity and was intensely anxietyprovoking.” (Parnas 2003) (4) Transitivism Intersubjective interaction means constant alternation between an ego-centric and an allo-centric perspective: ‘excentric position’ (Plessner 1981) (4) Transitivism “When I am looking into a mirror, I do not know any more whether I am here looking at me there in the mirror, or whether I am there in the mirror looking at me here. ... If I look at someone else in the mirror, I am not able to distinguish him from myself any more. When I am feeling worse, the distinction between me and a real other person gets lost, too. … I don’t know whether the inside turns outwards, or the outside inwards ... Are there perhaps two ‘I’s?” (Kimura 1994) (4) Transitivism and Disembodiment • Mirror image: externalisation and duplication of the self • Excentric position as integration of both perspectives • Intersubjective perspektive-taking requires a delimitation of self and other • The boundary of self and other is enacted through the dialectical movement of self-transposition and recurrence to one’s embodied center. • Every encounter with the other implies a disembodiment inhibited in statu nascendi. (4) Transitivism and Disembodiment Transitivism is based on the dialectical structure of intersubjectivity: - loss of embodied center of self short-circuit of perspectives, “melting of self and other” - loss of excentric position (as the integration of both perspectives) - disembodiment of self First manifestation of schizophrenia often in situations of social exposure or emotional disclosure where one‘s self has to be affirmed against the perspectives of others Conclusion: Schizophrenia as a disembodiment Disembodiment of self and disturbance of intercorporeality mutally influence each other. Schizophrenia can be regarded as a disturbance of the patient’s lived body and relationships with others, leading to disorders of the extended or personal self as well (transitivism, delusions). Phenomenology and Therapy Emphasis on non-verbal, implicit and holistic level of experience: - Movement therapy, dance therapy (sense of agency; body grounding; operative intentionality of the body supported by rhythm and by gestalt units of movement) - Theatre therapy (bodily performance based on role models) - Music therapy (self-affection, bodily resonance) - Art therapy (self-affection, agency, spontaneity) Thank you very much!