Philosophical Communications, Web Series, No 26 Dept. of

Philosophical Communications, Web Series, No 26 Dept. of

Philosophical Communications, Web Series, No 26 Dept. of Philosophy, Gteborg 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, Gteborg University, Sweden Oral presentation at Towards a Science of Consciousness, Prague, July 6-9 2003 Overview of lecture

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?

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, todays 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):

Hallucinations (especially visual pseudo- hallucinations). Cenestopathies (bodily hallucinations; disturbances of the body image or body schema). Commonest form: perceived changes of size or shape of bodily parts. Derealisation and depersonalisation (quasisensory experiences of unreality). Usually preserved insight Seen in toxic, endocrine and other conditions Common occurences while falling asleep Approximate synonyms : Syndrommes de dprsonnalisation (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): Korsakovs Amnestic Disorder (KAD) and Emotional-Motivational Blunting Disorder (EMD)

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 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) Hallucinations et dlire. 1934. tudes 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 ides de Hughlings Jackson un modle organo-dynamique en Psychiatrie. 1975. Trait 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 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 free-agency consciousness. Disturbances of consciousness according to contemporary psychiatry (excluding DSM) pathologically reduced wakefulness (lowered consciousness), or confusion/delirium (clouded consciousness) Other hallucinatory states are usually not, and the major psychoses very seldom, counted as disturbances of consciousness (except when leading to confusion) Henri Eys comprehensive concept of consciousness (or conscious being)

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? 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, dont 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... On bodily awareness and depersonalisation: ...the body is the central object of the subjects 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, the solution to this problem escapes him. 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... 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 ones movement or even to reverse it by retrograding towards past regret or remorse. 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 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... 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

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