Philosophical Communications, Web Series, No 26
Dept. of Philosophy, Göteborg University, Sweden
ISSN 1652-0459
Lived body, lived time and emotion
The concept of consciousness in the
phenomenological psychiatry of
Henri Ey
Helge Malmgren, PhD, MD
Dept of Philosophy, Göteborg University, Sweden
Oral presentation at Towards a Science of Consciousness, Prague, July 6-9 2003
Overview of lecture
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Why look at psychiatry in order to understand
consciousness?
Challenges from organic psychiatry
Why Henri Ey?
”Disorders of consciousness” in classical
psychiatry
Field of consciousness vs conscious self
Destructurations of the field of consciousness
Lived body, lived time and emotion: the two
challenges revisited
A true neurophenomenology…
Why look at psychiatry in order to
understand consciousness?
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The normal working of
consciousness can be elucidated
through its pathologies
This is generally recognized as a
valid motive for analyzing
neuropsychological cases
Neuropsychology, as it is defined
today, is often surprisingly
ignorant of clinical psychiatry
Large areas of organic psychiatry
(”the somatogenic syndromes”)
seems to be outside its interests
Regrettably, today’s dominating
psychiatry (DSM-IV) is thoroughly
a-theoretical in its orientation, and
furthermore it has its weakest
points in organic psychiatry
van Gogh images reproduced with permission from Webmuseum,
© 1994-2003 Nicholas Pioch.
Challenges from organic psychiatry (1): HallucinationCenestopathy-Depersonalisation (HCD) Disorder
Symptoms (Lindqvist & Malmgren 1990):
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Hallucinations (especially visual pseudohallucinations).
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Cenestopathies (bodily hallucinations;
disturbances of the body image or body
schema). Commonest form: perceived changes
of size or shape of bodily parts.
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Derealisation and depersonalisation (quasi-
sensory experiences of unreality).
– Usually preserved insight
– Seen in toxic, endocrine and other conditions
– Common occurences while falling asleep
Approximate synonyms :
– Syndrommes de dépérsonnalisation (H. Ey 1977)
– Alice in Wonderland Syndrome (Todd 1956)
(Lewis Caroll probably hallucinated in
connection with his severe migraine.)
Now, why do these symptoms go together???
Challenges (2): Korsakov’s Amnestic Disorder (KAD) and
Emotional-Motivational Blunting Disorder (EMD)
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KAD: Nowadays usually (and somewhat misleadingly) called Amnestic Disorder
Retrograde and anterograde amnesia, preserved immediate memory and implicit learning
First clinical description (still valid, and
including preserved implicit learning) by
Sergei Korsakov, around 1880.
Best known (by neuropsychologists and
philosophers) as a consequence of bilateral
hippocampal damage, but occurs with
identical clinical presentation in bilateral
damage anywhere in the limbic system
EMD: Traditionally (and very misleadingly)
called ”the frontal lobe syndrome”
Lowered motivation and flattened emotions,
reduced capacity for judgement and planning
The so-called ”dysexecutive syndrome” sometimes includes elements of EMD
Known since long (before Damasio…) to occur in lesions outside the frontal lobe,
namely, with damage to other limbic (e.g., temporal) locations
Why do these disorders have overlapping locations? (KAD implies EMD!)
Henri Ey, 1900-1977
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Author of several textbooks in general psychiatry
A generalist with his main interest in ”organic”
conditions and in hallucinatory disorders
The organo-dynamic model: a hierarchical model of
the nervous system, on the lines of H. Jackson
Deeply familiar with older and contemporary
psychology and philosophy, and building in many
respects on Freud, Piaget, Merleau-Ponty etc.
A true neuro-phenomenologist!
Only one of his books translated into English
Some main works by H. Ey (1900-1977)
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Hallucinations et délire. 1934.
Études psychiatriques, I-III. 1948-1954, 2d ed.
1952-1960.
La Conscience. 1963; 2d ed. 1968. English
translation of 2d ed.: Consciousness. Indiana
University Press 1978.
Des idées de Hughlings Jackson à un modèle
organo-dynamique en Psychiatrie. 1975.
Traité des hallucinations, I-II. 1977.
A propos translations...
French: Conscience
English: Consciousness/Awareness – Conscience
German: Bewusstsein – Gewissen
Swedish: Medvetande – Samvete
Some main uses of ”consciousness” words
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The epistemic use: ” P has a high political consciousness.”
Also: ”P is aware of/conscious of the fact that p.” In this usage,
being aware/conscious does not entail any current experience.
Attentive consciousness: ”P concentrates his consciousness on
the problem.” (Is conscious effort a subspecies or not?)
Attentive consciousness seems to entail current experience.
The free-agency use: ”He did it consciously”.
The experiential use: ”I just became conscious of a pain in my
foot.” In philosophy: conscious experience, phenomenal
consciousness, conscious awareness. (Question: Is conscious
experience just experience plus attentive consciousness?)
The psychiatric uses: ”disturbances of consciousness”. Here
consciousness is a set of higher mental functions, possibly
including the capabilities for epistemic, attentive and freeagency consciousness.
Disturbances of consciousness according to
contemporary psychiatry (excluding DSM)
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pathologically reduced wakefulness (lowered
consciousness), or
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confusion/delirium
(clouded consciousness)
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Other hallucinatory states are usually not, and the major
psychoses very seldom, counted as disturbances of
consciousness (except when leading to confusion)
Henri Ey’s comprehensive concept of
consciousness (or ”conscious being”)
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”For the Madness which the psychiatrist intends to cure is the
contrary of human consciousness.” (last sentence of book)
Are all mental disorders, then, disturbances of consciousness?
Ey makes a distinction, within the general category of
disturbances of conscious being, between destructuration of the
field of consciousness and psychopathology of the self
The first subcategory includes the classical ”clouding of
consciousness”, but also dreaming and hallucinatory states not
due to confusion/delirium, as well as depression and mania
The second category (disorders of the self) includes paranoid
delusions and the neuroses
Ways of destructuration of the field of consciousness
normal conscious being
somnolence
sleepiness
hypnagogic state
elevated mood
depersonalisation
mania
lowered mood
depression
voice hallucinosis
sopor
twilight states
light sleep
affective stupor
coma
dreaming
flight of ideas
confusion
What, then, is the field of consciousness?
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Field of consciousness = field of presence = perceptual field
But note (pace Husserl and Merleau-Ponty):
all perception is shot through by bodily awareness, by alterity
(experience of the Other), by imagination, and (last but not least)
by past experience and by plans for the future
the most basic of these plans aim at completing the perceptual
syntheses in order to test the reality of the perceptual object
the temporal dimension of perception is as much a matter of action
tendencies as of experiences
so, with due respect to the experiences of retention/protention,
don’t forget that the body schema also has a temporal aspect!
action plans are wholly dependent on interest and affectivity
hence, the intrinsic time(s) of the field of consciousness depend(s)
on emotion and motivation
A few quotations...
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On bodily awareness and
depersonalisation:
”...the body is the central object of the subject’s
world, the place in which the subject encounters
the world of others, and the vehicle of the
connection of the subjective and the objective
which he constantly lives as an existential problem.
When the experience of depersonalization occurs,
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On time, mania and
depression:
”To be afraid is to flee. To be
happy is to dash joyfully in
the future. To be sad is to
stop one’s movement or
even to reverse it by
retrograding towards past
regret or remorse.”
the solution to this problem escapes him.”
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On alterity and voice hallucinations:
”/Consciousness/ appears to have been freely
altered at this level where language enters into the
constitution of consciousness so as to furnish it
with its essential dimension... We can therefore
grasp this level of the erosion of the structure of
consciousness only for what it is: a lack of
organisation within the experience of our
communication with others...”
”Thus manic and depressive
psychoses are symmetrical
(and clinical work has
shown them occasionally to
be interchangeable)
structures of a disorder at the
same level. They are the two
sides of the ethical
temporality of a lived time
which can no longer be
constituted into a present.”
Lived body, lived time and emotion
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The mentioned properties of the field of consciousness may
help us in explaining (among other things):
– why visual hallucinations, cenestopathic experiences and
depersonalization/derealization feelings tend to go together
(since the body schema is essentially involved in perceptual
reality testing)
– why the brain structures responsible for the interchange
between short-term and long-term memory are intimately
tied to the structures regulating emotion and motivation
(since memory is temporal awareness, and temporal
awareness is steered by emotion and motivation)
A true neuro-phenomenology...
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Two more guarded conclusions:
– A careful phenomenological
approach in clinical psychiatry,
especially organic psychiatry,
will help us to better understand
normal consciousness and the
cerebral mechanisms responsible
for perception, memory, emotion
and motivation
– The psychiatric works of Henri
Ey offer an invaluable source of
clinical material, observations,
concepts and hypotheses with a
bearing on these issues