© Th e Editor(s) (if applicable) and Th e Author(s) 2016 J.A. Simmons, J.E. Hackett (eds.), Phenomenology for the Twenty-First Century, DOI 10.1057/978-1-137-55039-2_13 13 Embodiment and Affectivity in Moebius Syndrome and Schizophrenia: A Phenomenological Analysis Joel Krueger and Mads Gram Henriksen Introduction Moebius Syndrome (MS) and schizophrenia may initially seem to have little to do with one another. Th e former is a rare congenital neurological disorder primarily characterized by bilateral facial paralysis and lateral eye movement incapacity; the latter is a psychotic disorder, typically involving delusion or hallucination, with largely unknown etiology. However, closer examination of the experience of individuals with MS and schizophrenia, respectively, reveals some intriguing points of convergence-along with some important divergences, too. Th ese convergences tend to revolve around the way individuals with MS and schizophrenia experience their embodiment and aff ectivity. J. Krueger ( ) University of Exeter , Exeter, Devon , UK e-mail: J.Krueger@exeter.ac.uk M. G. Henriksen University of Copenhagen , Copenhagen , Denmark In this comparative study, we examine such experiential manifestations in MS and schizophrenia. We suggest that using phenomenological resources to explore these experiences may help us better understand what it's like to live with these conditions and that such an understanding may have therapeutic value. Additionally, we suggest that this sort of phenomenologically informed comparative analysis of pathological conditions can shed light on the importance of embodiment and aff ectivity for the constitution of a sense of self and interpersonal relatedness in normal conditions. Such conclusions, we believe, off er important resources for continued research at the intersection of phenomenology and cognitive science in the twenty-fi rst century. Phenomenological Structures of Embodiment and Affectivity Phenomenologists argue that distinctively human forms of thought, perception, and aff ect are profoundly shaped by both the sort of bodies we have and the things they can do. Th e body (and its sensorimotor capacities) anchors us in our world and, as we shall see, acts as a mediator enabling the world to appear to us, experientially, in characteristic ways. Phenomenological approaches to the body are particularly interested in articulating the lived structures of embodiment; they are concerned with investigating how various dimensions of embodiment are experienced . Th is experiential orientation leads phenomenologists to famously distinguish between two dimensions or modes of embodiment: (1) the body through which we pre-refl ectively live, that is, the body considered as a subject ( Leib ); and (2) the body thematically perceived by me and by others, that is, the body considered as an object ( Körper ). 1 Th e body-as-subject refers to the way that embodiment is lived through from the fi rst-person perspective. From this perspective, the body is not something explicitly perceived or refl ected on-in the manner, for example, that we might critically scrutinize parts of our body and vow to get more exercise. In the latter case, where the body receives explicit thematic attention, we are concerned with the 250 J. Krueger and M.G. Henriksen body-asobject . By contrast, the body-as-subject is not really a content of experience but rather a tacit, pre-refl ective structure that organizes experience. By 'pre-refl ective', phenomenologists simply mean to characterize the manner in which the body is implicitly present as we perceive and act on the world, dynamically shaping both what we experience and how we experience it. In this sense, the body-as-subject, at least when functioning optimally, serves as the transparent medium for experience. 2 For example, when we see and reach for a mug of coff ee on our desk, we don't fi rst consciously locate our arms in space and then intentionally adjust our posture and monitor our movements as we initiate and carry through with the reach. We simply reach for the mug . We're able to spontaneously do so because of the transparent background work of the body-as-subject. Due to ongoing information from proprioceptive and kinaesthetic processes (along with visual and tactile information), we are pre-refl ectively aware of the location of our limbs without needing explicitly to attend to our body on a moment-to-moment basis. To use language that will be important later, we enjoy an immediate experiential intimacy with our body and its attendant capacities. Moreover, based upon our spatial position and bodily capacities, we are also aware of what sort of movements and actions are possible within a given space. Th e body is thus always tacitly present and poised for action. Th e lived body (or the body-as-subject) in this way serves as our anchored fi rst-person perspective on the world, grounding our egocentric frame of spatial reference by which we are disclosed to ourselves as bodily subjects situated in the world. 3 But the body-as-subject also shapes experience in another way. When we perceive the coff ee mug, we don't simply see it in objective or recognitional terms, say, merely as a thing instantiating diff erent properties such as color, shape, texture, and so on. Rather, the coff ee mug is perceptually disclosed as meaningful . An important aspect of our experience is thus to perceive the mug as soliciting a range of potential actions (grasping, picking up, throwing, etc.), specifi ed both by our body's sensorimotor capacities and by the context in which we encounter it (in the kitchen, on the desk in our study, in the dishwasher, etc.). 4 In this way, the bodyassubject functions as a transparent constraint on our experience of self 13 Embodiment and Affectivity in Moebius Syndrome 251 and world. Although it doesn't show up as an object like other objects in the world, the body-as-subject is nevertheless 'always near me, always there for me', as Merleau-Ponty observes; yet 'it is never really in front of me...it remains marginal to all my perceptions'. 5 Similarly, Sartre writes that 'the body is present in every action although invisible...Th e body is lived and not known '. 6 Of course, the body can, and often does, become an object of thematic attention. In contrast to the fi rst-person perspective of the body-assubject , we can adopt a third-person perspective on our body. For example, we can scrutinize individual body parts such as the hand we hold up in front of us or the fl abby midsection we gaze at disdainfully in the mirror. Usually, the body-as-subject eff aces itself within the fl uid performance of world-directed actions-again, it remains in the background, 'marginal to all my perceptions', as Merleau-Ponty puts it-but if something breaks down or goes wrong, our body suddenly moves to the foreground of our attention: for example, if we feel lower back pain while reading at our desk or stumble while reaching for a passing shot during a tennis match. In these cases, we become abruptly aware of our body as a thing impeding our action. Rather than tacitly organizing and enabling experience, it now explicitly disrupts it; when the implicit bodyassubject becomes explicit (i.e., a thematic object), the usually inhabited or automated bodily processes characterizing the transparent functioning of the body-as-subject become disturbed. 7 In addition to distinguishing these two modes of embodiment, phenomenologists argue that descriptions of embodied experience are incomplete without a consideration of the way they are mediated by various forms of aff ect : emotions, moods, and other feeling states. For example, we experience or relate to our body and its capacities diff erently when tired or anxious, say, in contrast to when we feel energetic or elated. Moreover, these aff ective dimensions of embodiment shape how the world shows up for us in our experience. Heidegger famously argues that moods are world-disclosing: ' Th e mood has already disclosed, in every case, Beingin-the-world as a whole, and makes it possible fi rst of all to direct oneself toward something .' 8 Th is phenomenological observation about the worlddisclosing power of aff ect is supported by diff erent empirical studies. In one series of studies, subjects were found to estimate the incline of a grade 252 J. Krueger and M.G. Henriksen to be steeper when wearing a heavy backpack as opposed to not wearing one, or feeling fatigued as opposed to refreshed. 9 Another study found that subjects' perception of grade incline is even shaped by psychosocial factors and their associated aff ects. Individuals judged hills steeper when alone than when in the presence of a supportive partner, or even when simply imagining the presence of a supportive partner. 10 In sum, phenomenologists argue that basic structures of embodiment and aff ectivity modulate our experience of self, others, and the world; our bodily presence to self and world is mediated by aff ectivity. 11 How this is so-and how these bodily and aff ective structures, as well as their modulatory eff ects, may be altered in MS and schizophrenia-will be more apparent in the subsequent analysis. To be clear, in what follows, we do not posit that either the quality of the experience of diminished embodiment and aff ectivity or the nature of the underlying structural disruptions is identical in MS and schizophrenia. Rather, we suggest that the disruptions of embodiment and aff ectivity in MS and schizophrenia and their diverse experiential manifestations highlight the importance of these basic structures for the constitution of a sense of self and worldly relatedness also in normal conditions. Diminished Embodiment and Affectivity in MS and Schizophrenia MS is a very rare form of congenital oculofacial paralysis, typically complete and bilateral, resulting from maldevelopment of the sixth and seventh cranial nerves; estimations suggest that MS aff ects approximately 0.0002–0.002 % of births. 12 Along with oculofacial paralysis, which leads to atrophy and gives the face a smooth complexion with a slack half-open mouth, individuals with MS also exhibit other abnormalities: abnormal tongue, hypodontia [i.e., missing teeth due to developmental failure (tooth agenesis)], diffi culty sucking and eating, limb defects [such as club foot or syndactyly (i.e., abnormal connection of fi ngers or toes)], and general problems with motor skills, coordination, and balance. 13 In light of these physical abnormalities, it may seem trivial to characterize MS as involving a disruption of embodiment. However, as we shall see, 13 Embodiment and Affectivity in Moebius Syndrome 253 there are subtle phenomenological alterations of embodiment, aff ectivity, and self-experience in MS that resist an exclusively neurophysiological characterization. In the case of schizophrenia, phenomenologically informed psychopathologists have long argued that the generative disorder of schizophrenia is a disturbance of the self. Th is basic intuition was developed more or less explicitly in nearly all foundational texts on the concept of schizophrenia. 14 For example, Minkowski argued that schizophrenia 'does not originate in the disorders of judgment, perception or will, but in a disturbance of the innermost structure of the self '. 15 Crucially, the 'self ' disturbed in schizophrenia does not refer to complex linguistically or conceptually mediated levels of selfhood, such as narrative identity or personhood, but to what has been called the 'minimal self ', 16 'core self ', 17 or ' ipseity '. 18 Within the phenomenological tradition, ipseity refers to a fundamental confi guration of consciousness, that is, its fi rst-personal givenness; the concept of ipseity strives to capture the implicit sense of coinciding with oneself and one's experiences at any given moment. 19 For example, when we perceive or refl ect upon something, we are implicitly or pre-refl ectively aware that we are the ones who perceive or refl ect; there is no distance between our experience and ourselves. To put it diff erently, the self, in this minimal sense ( ipseity ), is not something prior to or below the fl ux of experience, somehow linking it together, but a feature of the very manifestation of experience. 20 Th is selfpresence or self-intimacy usually permeates all our experiential modalities and secures an elusive yet enduring and vital feeling of 'I-me-myself '. In schizophrenia, however, this basic sense of self-intimacy is often threatened or rendered unstable. As Schneider puts it, '[certain] disturbances of self-experience show the greatest degree of schizophrenic specifi city. Here we refer to those disturbances of fi rst-personal givenness ( Ich-heit ) or "mineness" ( Meinhaftigkeit )'. 21 In contemporary phenomenological psychopathology, the disturbance of the self in schizophrenia is most comprehensively articulated in the so-called ipseity disturbance model, 22 which involves two complementary distortions: diminished self-aff ection (i.e., attenuated sense of existing as a living subject of awareness and action) and hyper-refl exivity (i.e., exaggerated and alienating forms of self-consciousness). 254 J. Krueger and M.G. Henriksen During the last two decades, empirical research has consistently documented that certain anomalies of self-experience (i.e., 'self-disorders') aggregate signifi cantly in schizophrenia spectrum disorders but not in other mental disorders. 23 In brief, self-disorders are non-psychotic, experiential anomalies. Th ey exhibit a trait-like quality, typically date back to childhood or early adolescence, and they tend to persist after remission from a frank psychotic episode. As we shall see, some of these selfdisorders refl ect alterations in the basic sense of self-presence and embodiment. 24 Within the phenomenological literature, Stanghellini and Fuchs have argued that an essential feature of schizophrenia is a specifi c kind of disembodiment . 25 Stanghellini employs the terms of 'disembodied spirits' and 'deanimated bodies' to describe a peculiar kind of mechanization or objectifi cation of the body-as-subject in schizophrenia. 26 Fuchs similarly describes a 'disembodiment of the self ' in schizophrenia in which the lived body's usual transparency becomes opaque and hinders the patient from inhabiting the body in the usual, unproblematic sense. 27 On both Stanghellini's and Fuchs's accounts, disembodiment in schizophrenia is intrinsically tied to the basic disturbance of ipseity . Experiential Manifestations of Diminished Embodiment and Affectivity With these phenomenological concepts in place, we will now explore disruptions of embodiment and aff ectivity in MS and schizophrenia. First, we will consider MS before turning to schizophrenia. Although MS has received considerably less attention than schizophrenia-likely due to its rarity-there are nevertheless sources available that can help highlight experiential dimensions of this condition pertinent to the present discussion. In a series of books and papers, Jonathan Cole has collected narratives of people living with MS-fi rst-person insights into the subtle alterations of embodiment and aff ectivity distinctive of this condition. 28 For our purposes, it is noteworthy that many individuals with MS report persistently experiencing an attenuated sense of their body-assubject ; rather, they appear to predominantly experience their body in a markedly 13 Embodiment and Affectivity in Moebius Syndrome 255 impersonal, almost object -like way. Th is is an especially prominent feature of their early childhood experience. Cole and his co-author Henrietta Spalding (who has MS) seek to capture this type of bodily experience with their notion of the MS subject as 'Cartesian child', 29 emphasizing how a lack of bodily intimacy, which people with MS often report, may lead to a persistent sense of detachment or alienation from one's own body. For example, James (now in his fi fties), describes how this experience has been with him as long as he can remember: 'I have a notion which has stayed with me over much of my life-that it is possible to live in your head; entirely in your head (...) I think there's a lot of dissociation. But I think I get trapped in my mind or my head'. 30 Another individual, Celia, describes an even more articulated sense of disembodiment, which she claims shaped her fundamental sense of self from a very early age: I never thought I was a person; I used to think I was a collection of bits. I thought I had all these diff erent doctors looking after all the diff erent bits...'Celia' was not there; that was a name people called the collection of bits. I did not like my feet; I liked my spirit because I was strong as a child. I like my brain...Even though I was a collection of bits I always knew there was something strong inside that I had a mental dialogue with, but it was not the physical body; it was very separate from the physical. 31 Celia describes here a profound lack of bodily self-intimacy; she regards herself not as a locus of agency and experience but almost as object-like, as a disparate 'collection of bits'. Th is lack of selfintimacy meant that she never experienced herself as fully immersed in the spontaneous movements, play, and intersubjective reciprocity that are crucial parts of childhood development. 32 Although this lack of selfintimacy has diminished somewhat in adulthood, it nevertheless seems that Celia still does not have a robust sense of her body-as-subject. She does not experience her body as a fl uidly integrated unity-a tacit, smoothly functioning system facilitating her interactions with the world and others. Instead, Celia reports consistently adopting a thirdperson perspective on her own body, including occasions (e.g., gesturing while speaking) when the body would normally recede transparently into the background. 256 J. Krueger and M.G. Henriksen All my gestures are voluntary, even now aged 46. Everything I do, I think about ...All the things I am doing, whether turning my head or moving my hands, is all self-taught. I learnt from observation as an adult...When I was a child, I could not gesture, because I was a collection of bits. My body was not me, so expression in it, with it, would not be from me either. It was not a joined-up feeling. Th ere was a huge bit missing; with the lack of balance, mobility, and problems with coordination, you don't get a sense of self . 33 Bereft of an enduring sense of bodily self-intimacy and attendant sense of self, Celia thus adopts a hyper-refl ective stance toward her body, gestures, and actions. She consciously monitors and pays attention to her body instead of pre-refl ectively living through it (as we shall see below, this hyper-refl ective stance is reminiscent of some patients with schizophrenia). Others with MS off er similar accounts. For example, James says he's only recently begun using his arms to gesture while speaking-but it continues to be a deliberate, eff ortful exercise. 34 Similarly, Lydia says: 'Instead of facial expression I use my hands and shoulders, and my voice, both in its tone and what I say; I construct it all very carefully...I have to monitor these things all the time...None of this is automatic. ' 35 She reports consciously studying how others gesture and express emotions and then, over time, deliberately incorporating these practices into her own repertoire. To return to a concept introduced earlier, the phenomenological signifi cance of these fi rst-person accounts is that individuals with MS often feel as though they do not wholly coincide with their lived body, their body-as-subject. Instead, the body is typically related to, or experientially manifest, as an object . And this diminished sense of bodily selfintimacy may be associated with diminished aff ectivity. Some individuals with MS report feeling a qualitative 'absence' or diminishment in their emotional life. For example, Eleanor says: [I]f I go back to my late teen years, I was not very embodied as a person and the physical nature of attraction was some way away...At this stage, I did not feel anything [i.e., romantic] physically; even though I had matured physically, I had no feeling. Like the other feelings it had not kicked in. 36 Along the same lines, James reports that he intellectualizes feelings instead of living in and through them: 'I sort of think happy or I think 13 Embodiment and Affectivity in Moebius Syndrome 257 sad, not really saying or recognizing actually feeling happy or feeling sad.' Th is intellectualizing tendency even includes his experience of falling in love with his wife: 'I think initially I was thinking I was in love with her. It was some time later when I realized that I really felt love.' 37 With respect to his embodied and aff ective life, he further states: 'I've often thought of myself as a spectator rather than as a participant.' 38 Finally, Celia describes similar emotional experience dating back to childhood: 'I did not express emotion. I am not sure that I felt emotion, as a defi ned concept. At my birthday parties I did not get excited. Th ere were people around excited, but I followed what they did.' 39 She continues: 'I don't think I was happy, or even had the concept of, happiness as a child. I was saddened by being in pain or having horrid things like a blood test.' 40 Surely Celia was capable of feeling some emotion. What these quotes appear to suggest, rather, is not an utter absence of emotion but more likely a restricted range of emotional sensitivity, responsivity, and expressivity. 41 In sum, we have seen that individuals with MS often experience a diminished sense of embodiment, which is consequential of but, in our view, not reducible to their specifi c physiological abnormalities. In other words, the typically persistent and pervasive lack of bodily self-intimacy does not pertain exclusively to, as might be predicted, oculofacial paralysis but to a more general overall feeling of being disconnected and at a distance from one's body-as-subject. Invariably, this experiential distance entails a feeling of bodily self-alienation (variously refl ected in complaints such as feeling 'trapped in my mind or my head', 'separation from the physical body', 'collection of bits', etc.) and, at least in the cases we have discussed, an interdependent, observational, or self-monitoring stance toward one's own body, agency, and gestures as objects , which may further increase feelings of alienation. Th is experiential distance can also aff ect the individuals' emotional life to the extent that emotions appear as if 'absent' (as in the case of Eleanor) or only accessible through refl ection or 'intellectualization' (as in the case of James) rather than pre-refl ectively felt and lived through. In our view, these forms of diminished embodiment and aff ectivity, which revolve around disruptions of the usually taken-for-granted and implicit processes of the body-as-subject are central to the experience of being disconnected from oneself in MS (refl ected 258 J. Krueger and M.G. Henriksen in statements such as 'being a spectator to rather than as a participant in one's own life', 'not feeling like a person', 'lacking a sense of self ', etc.). We now turn to schizophrenia. As we shall see, there are certain illuminating similarities between experiences of diminished embodiment and aff ectivity in MS and schizophrenia. However, when unraveling the phenomenological complexities of these experiences and their embeddedness in the underlying psychopathological Gestalt of schizophrenia, some crucial diff erences come to light, gravitating especially around disturbances of ipseity . Many patients with schizophrenia spectrum disorders experience problems with their embodiment. For example, 'K', 25 years old, describes a complicated relationship with her own body: I have always had a diffi cult relation to my body (...) It's as if there is a distance between my body and my mind. It's like my mind is a little puppeteer, sitting far away, controlling my body. It's not like I see myself from above or something. But it's like I'm not in my body or not attached to it. It's like my body is an appendix that hangs below me. My body feels alien to me (...) I wish I could be free of it. 42 Here, 'K' describes phenomena that in the clinical, self-disorders– oriented research literature are called 'psycho-physical split', referring to the experience as if the mind and the body somehow do not fi t together or are disconnected, and 'somatic depersonalization', referring to the experience of perceiving one's own body or parts of it as strange, alien, disconnected, and so on. When 'K' describes her mind as a 'puppeteer', she is not describing an out-of-body experience ('It's not like I see myself from above or something'). Rather, she is conveying an experience of not feeling truly present in her body and alienated from it ('it's like I'm not in my body or not attached to it'; 'My body feels alien to me'). Such experiences are quite common in schizophrenia spectrum disorders, though their specifi c quality and articulation may vary-for example, 'the body feels awkward as if it does not really fi t. It feels like the body is not really me, as if it is rather a machine controlled by my brain', 43 or 'I feel strange, I am no longer in my body, it is someone else; I sense my body but it is far away, some other place.' 44 In schizophrenia, diminished embodiment 13 Embodiment and Affectivity in Moebius Syndrome 259 may take on an alien or quasi-mechanical character: 'I'm blessed with a bladder-emptier that I can turn on and off , and an anal expeller', 45 or 'I'm a psycho-machine'. 46 For Peter, 18 years old, his initial, non-psychotic experiences of psycho-physical split, somatic depersonalization, and loss of control of bodily movements evolved into vague ideas about external infl uence ('it sometimes feels as if someone else is performing my actions. It's as if it's not me. I feel like a puppet') and eventually into psychosis with delusions of control. 47 Most importantly, the unstable self-presence or self-intimacy in schizophrenia is not restricted to the bodily domain but is also often pervasively manifest in other modalities of consciousness (thinking, perceiving, feeling, etc.). For example, Peter describes persistent feelings of not being fully present in the world: 'It's as if I'm inside a glass dome (...) everything seems so far away as if there is an invisible wall I cannot penetrate.' 48 Experiences of 'diminished presence', which also are manifestations of the disturbance of ipseity, often entail a felt distance toward the world and may involve a decreased capacity to become aff ected, touched, or moved by others or events and to emotionally respond to such stimulations. Th is is the case for Peter, who states: 'I don't truly feel the world, because I don't feel anything inside'; he refers to the world as a 'dream world' and himself as a 'zombie' or 'a shell devoid of emotions'. 49 Such experiences typically aff ect the spontaneous immersion in the shared social world and the ability to interact with others in a smooth, fl uid, and contextsensitive manner. Th e failing sense of self-presence may also be associated with an experience of not being fully awake, as if the very luminosity of consciousness was somehow diminished-for example, 'I am only 70 % conscious' 50 ; 'I feel a sort of emptiness in my head as if I am not awake. I feel detached or airy as if I am not present' 51 ; 'My consciousness is not as whole as it should be'; 'I am half-awake.' 52 Furthermore, many patients with incipient schizophrenia describe a variety of interdependent cognitive disturbances. Some of these are worth highlighting here because they indicate important diff erences between schizophrenia and MS, which should not to be overlooked. For example, some (but not all) thoughts, typically with a neutral or trivial content, may appear somehow alien or anonymous to the patient as if he himself has not generated them ('my thoughts feel strange as if they aren't really 260 J. Krueger and M.G. Henriksen coming from me'). 53 'Th ought pressure', that is, the experience of having many thematically unrelated thoughts or trains of thought occurring simultaneously or immediately after each other, with a loss of meaning, is another frequently found experience in schizophrenia spectrum disorders; one patient described this experience with the analogy of 'rockets shooting in all directions at once. It's one big chaos'. 54 'Th ought pressure' may be linked to 'spatialization' of thoughts, that is, an anomalous experience of thoughts not as subjectively lived through but rather as quasi-objective things , for example, localized to specifi c parts of the brain, physically moving around inside the head or pressing on the inside of the skull. Patients also often report listening to their own thoughts spoken aloud internally with they own voice or reading their own thoughts as if they were subtitles on a fi lm. In brief, these various experiences testify to the fact that the unstable sense of self-presence or self-intimacy in schizophrenia transcends beyond the bodily and aff ective dimensions into other modalities of consciousness, which, by contrast, appear unaff ected in MS (e.g., cognition, perception). Finally, we will return to 'K' and briefl y discuss some of the problems she encounters when interacting with others: I always feel that it is like enormously feigned when I have some social interaction. It feels false, like I can't react naturally or sincerely like everyone else... I have the experience that there are two of me: the one that interacts with someone and then there is the real me, who sits there behind. For example, 'I sense that the one I'm talking to fi nds my statement a little transgressive, so I add a little humour here to establish an ironic distance. Th at may perhaps... yes, that worked well...' And I do it, like, simultaneously. I don't feel present at all. 55 Here, 'K' describes hyper-refl ectivity that takes the form of an excessive self-monitoring, operating alongside her social interaction and compromising her sense of being present in social situations. With regard to certain aspects (e.g., hyper-refl ection, self-monitoring), her description may appear similar to those of patients with MS (e.g., Henrietta's and Lydia's similar reports of self-consciously monitoring every gesture and movement when interacting with others). However, we should not fail to notice the underlying schizophrenic vulnerability that is also indicated in 13 Embodiment and Affectivity in Moebius Syndrome 261 this vignette (e.g., 'I have the experience that there are two of me '), which clearly distinguishes 'K's' diffi culties from those of patients with MS. Her feeling of social interactions being 'false' and of not being able to 'react naturally or sincerely like everyone else' is deeply rooted in her persistent feeling of not being truly human, which dates to early childhood-'I feel like I'm not a natural human being or a proper human being or something like that.' 56 Th e unsettling feeling of being radically, yet often ineff ably, diff erent from others is very common in schizophrenia and typically at the very heart of the patient's suff ering. In sum, we have discussed various clinical examples of diminished embodiment and aff ectivity in schizophrenia that gravitate around disruptions of the fi rst-personal articulation of experience. As we have seen, the ipseity disturbance gives rise to a multiplicity of interconnected and mutually implicative anomalous self-experiences that threatens one's most intimate, foundational sense of self and enables a radical form of self-alienation to grow from within the disturbed subjectivity, potentially resulting in psychotic experiences of being controlled by an external force, persecuted or addressed by a hallucinatory other. Conclusion On a surface level, we found similarities among experiences of diminished embodiment and aff ectivity in MS and schizophrenia, respectively. Th ese include hyper-refl ection, self-monitoring, and profound bodily selfalienation, characterized by a pervasive tendency in both MS and schizophrenia to experience and relate to the lived body (i.e., bodyassubject) primarily as an object. In both MS and schizophrenia, the body-assubject's transparency-the tacit, mediating processes enabling it to function smoothly and unobtrusively in the world-appear disrupted. Although the origin and nature of these disruptions are very diff erent in the two conditions, in both cases the body and it capacities are no longer simply inhabited or pre-refl ectively lived through but rather explicated in a concrete, objectifying, and alienating manner. Notably, we also found crucial diff erences between experiences of diminished embodiment and 262 J. Krueger and M.G. Henriksen aff ectivity in MS and schizophrenia, refl ecting the diff erent underlying pathologies. Our study lends support to phenomenologists' claims concerning the importance of embodiment, aff ectivity, and intercorporeity (or embodied intersubjectivity) for the constitution of a sense of self in abnormal as well as normal conditions. For phenomenologists, the fl uid oscillation between the body-as-subject and the body-as-object highlights a 'bodily ambiguity' at the heart of our embodied experience: as embodied subjects, we are neither wholly subjects nor wholly objects, but somehow always both. Looking at cases where this ambiguity is disrupted, and the cascade of anomalous experiences such disruptions may entail, points to the constitutive role this bodily ambiguity plays in shaping our general way of inhabiting, experiencing, and engaging with the world. Finally, we suggest that utilizing phenomenological resources to address experiences of diminished embodiment and aff ectivity in MS and schizophrenia may enable us to better understand what it sometimes is like to live with these conditions and potentially off er targets for future research and therapeutic intervention. As phenomenology and cognitive science continue to intersect in the twenty-fi rst century, new interventions become possible in light of our research here. For example, interventions striving to enforce the individuals' experience of embodiment could easily be included as part of the treatment in both MS and schizophrenia. In the case of MS, interventions designed to help individuals with MS develop alternative embodied communication strategies (e.g., gestures) to compensate for their lack of facial expressivity seem relevant. 57 In the case of schizophrenia, interventions designed to strengthen the patient's unstable or wavering sense of self-presence or ipseity are strongly needed. Notes 1. Edmund Husserl, Ideas Pertaining to a Pure Phenomenology and to a Phenomenological Philosophy-Second Book: Studies in the Phenomenology of Constitution , trans. R. Rojcewicz and A. Schuwer (Dordrecht: Kluwer Academic Publishers, 1989); Maurice Merleau-Ponty, Th e Phenomenology of 13 Embodiment and Affectivity in Moebius Syndrome 263 Perception (London: Routledge, 2002); cf. Carman, Taylor, 'Th e Body in Husserl and Merleau-Ponty'. Philosophical Topics 27, no. 2 (1999): 205–26. 2. Shaun Gallagher, How the Body Shapes the Mind (Oxford and New York: Clarendon Press, 2005). 3. Dorothée Legrand, Claudio Brozzoli, Yves Rossetti, and Alessandro Farnè, 'Close to Me: Multisensory Space Representations for Action and PreRefl exive Consciousness of Oneself-in-the-World'. Consciousness and Cognition 16, no. 3 (2007): 687–99. doi: 10.1016/j.concog.2007.06.003 . 4. James J. Gibson, Th e Ecological Approach to Visual Perception (Hillsdale: Lawrence Erlbaum Associates, 1979). 5. Merleau-Ponty, Phenomenology of Perception , p. 104. 6. Jean-Paul Sartre, Being and Nothingness , trans. Hazel E. Barnes (New York: Washington Square Press, 1956), p. 427. 7. Th omas Fuchs, 'Corporealized and Disembodied Minds: A Phenomenological View of the Body in Melancholia and Schizophrenia', Philosophy, Psychiatry, & Psychology 12, no. 2 (2005): 95–107. 8. Martin Heidegger, Being and Time , trans. John Macquarrie and Edward Robinson (New York: Harper & Row Publishers, 1962), p. 176. 9. Dennis R. Proffi tt, Mukul Bhalla, Rich Gossweiler, and Jonathan Midgett, 'Perceiving Geographical Slant', Psychonomic Bulletin & Review 2, no. 4 (1995): 409–28. doi: 10.3758/BF03210980 ; D.R. Proffi tt, S.H. Creem, and W.D. Zosh, 'Seeing Mountains in Mole Hills: Geographical-Slant Perception', Psychological Science 12, no. 5 (2001): 418–23. 10. Simone Schnall, Kent D. Harber, Jeanine K. Stefanucci, and Dennis R. Proffi tt, 'Social Support and the Perception of Geographical Slant', Journal of Experimental Social Psychology 44, no. 5 (2008): 1246–55. doi: 10.1016/j.jesp.2008.04.011 . 11. 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For example, see Jonathan Cole, 'On Being Faceless: Selfhood and Facial Embodiment'. Journal of Consciousness Studies 4, no. 5–6 (1997): 467–84; About Face (Cambridge, MA: MIT Press, 1998); 2008. 'Th e Role of the Face in Intersubjectivity, Emotional Communication and Emotional Experience; Lessons from Moebius Syndrome', in Enacting Intersubjectivity: A Cognitive and Social Perspective on the Study of Interactions, eds. F. Morganti, A. Carassa, G. Riva (Amsterdam: IOS Press, 2008), pp. 237–49; 'Intimacy; Views from Impairment and Neuroscience'. Emotion, Space and Society 13 (November, 2014): 87–94. doi: 10.1016/j.emospa.2014.01.001 . 29. Jonathan Cole and Henrietta Spalding, Th e Invisible Smile: Living without Facial Expression (Oxford: Oxford University Press, 2009), p. 41. 30. Cole and Spalding, Th e Invisible Smile , p. 68, 72. 31. Cole and Spalding, Th e Invisible Smile , p. 42. 32. Cole and Spalding, Th e Invisible Smile , p. 56; cf. Colwyn Trevarthen, 'Th e Self Born in Intersubjectivity: Th e Psychology of an Infant Communicating', in Th e Perceived Self , ed. U. Neisser (Cambridge: Cambridge University Press, 1993), pp. 121–73. 33. Cole and Spalding, Th e Invisible Smile , p. 190; emphasis added. 34. Cole and Spalding, Th e Invisible Smile , p. 74. 35. Cole and Spalding, Th e Invisible Smile , p. 152. 36. Cole and Spalding, Th e Invisible Smile , pp. 169–70. 37. Cole and Spalding, Th e Invisible Smile , p. 72, 70. 38. Cole and Spalding, Th e Invisible Smile , p.72. 39. Cole, About Face , p. 244. 40. Cole, About Face , p. 244. 41. Joel Krueger and John Michael, 'Gestural Coupling and Social Cognition: Möbius Syndrome as a Case Study', Frontiers in Human Neuroscience 6, no. 81 (2012): 1–14, doi: 10.3389/fnhum.2012.00081 ; cf. J. Krueger, 'Dewey's Rejection of the Emotion/Expression Distinction', in Neuroscience, Neurophilosophy, and Pragmatism: Brains at Work in the World , eds. T. Solymosi and J.R. Shook (New York: Palgrave Macmillan, 2014), pp. 140–61. 266 J. Krueger and M.G. Henriksen 42. M.G. Henriksen and J. Nordgaard, 'Self-disorders in Schizophrenia', in An Experiential Approach to Psychopathology – Phenomenology of Psychotic Experiences , ed. G. Stanghellini and M. Aragona (Springer, NY, forthcoming). 43. M.G. Henriksen and J. Nordgaard, 'Schizophrenia as a Disorder of the Self ', Journal of Psychopathology 20 (2014): 435–41, p. 437. 44. Parnas and Handest, 'Schizophrenia, Consciousness, and the Self ', p. 127. 45. A. Angyal, 'Th e Experience of the Body-Self in Schizophrenia', Archives of Neurology & Psychiatry 35 (1936): 1029–53. 46. B. Kimura, 'Cogito and I: A Bio-logical Approach'. Philosophy, Psychiatry, & Psychology 8, no. 4 (2001): 331–336. Th ese reports are reminiscent of Celia's earlier description of experiencing herself in childhood as 'a collection of bits', each with their own function. 47. Henriksen and Parnas, 'Clinical manifestations of self-disorders and the Gestalt of schizophrenia', p. 659. 48. Henriksen and Parnas, 'Clinical manifestations of self-disorders and the Gestalt of schizophrenia', p. 658. 49. Henriksen and Parnas, 'Clinical manifestations of self-disorders and the Gestalt of schizophrenia', p. 659. 50. M. Cermolacce, J. Naudin, and J. Parnas, 'Th e "minimal self " in psychopathology: Re-examining the self-disorders in the schizophrenia spectrum,' Consciousness and Cognition 16 (2007): 703–14, p. 706. 51. M.G. Henriksen, A. Raballo, and J. Parnas, 'Th e pathogenesis of auditory verbal hallucinations in schizophrenia: a clinicalphenomeno logical account'. Philosophy, Psychiatry , & Psychology (forthcoming). 52. Parnas and Handest, 'Schizophrenia, Consciousness, and the Self ', p. 125. 53. Henriksen and Nordgaard, 'Schizophrenia as a Disorder of the Self ', p. 436f. 54. Henriksen and Nordgaard, 'Schizophrenia as a Disorder of the Self ', p. 437. 55. Henriksen and Nordgaard, 'Self-disorders in Schizophrenia'. 56. Henriksen and Nordgaard, 'Self-disorders in Schizophrenia'. 57. For example, see J. Michael, K. Bogart, K. Tylen, J. Krueger, M. Bech, J.R. Ostergaard, and R. Fusaroli, 'Training in Compensatory Strategies Enhances Rapport in Interactions Involving People with Moebius Syndrome', Frontiers in Neurology , 6, no. 213 (2015): 1–11. 13 Embodiment and Affectivity in Moebius Syndrome