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!
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