Das Wiskott-Aldrich-Syndrom (WAS), ein genetisch bedingter Immundefekt mit klinischer Manifestation im Kleinkindalter, wird voraussichtlich in näherer Zukunft erstmals versuchsweise durch eine somatische Gentherapie behandelt werden. Im vor- liegenden Beitrag werden die wichtigsten medizinisch-naturwissenschaftlichen Fakten dieses Krankheitsbildes sowie die bisherigen Erfahrungen mit somatischen Gentherapien bei anderen Immunmangelsyndromen ausführlich dargestellt. Sodann erfolgt eine ethische Analyse eines möglichen gentherapeutischen Eingriffs bei WAS-Patienten, bei der die spezifischen Aspekte des Wiskott-Aldrich-Syndroms – insbesondere die fast ausschließliche Betroffenheit von Kindern sowie die unterschiedlich aussichtsreiche Alter- nativoption einer (...) allogenen Knochenmarktransplantation–wesentliche Aspekte der Beurteilung sind. Im Ergebnis zeigt sich, dass ein gentherapeutischer Eingriff im vorliegenden Fall nicht im Rahmen einer Forschungsstudie, d.h. als Humanexperiment, gerechtfertigt werden kann, sondern allein als individueller Heilversuch. Gleichwohl las- sen die besonderen Risiken und die Innovativität eines solchen Eingriffs es notwendig erscheinen, diesen Heilversuch – anders als andere Heilbehandlungen mit bislang unerprobten Mitteln – in streng kontrollierter Form durchzuführen. Der neuartige Gedanke eines kontrollierten individuellen Heilversuchs zeichnet sich daher für den vorliegenden Fall, und womöglich auch für vergleichbare risikoreiche Behandlungsansätze namentlich im Bereich der Gentherapie, als geeignetes Instrument der Konzeption und Beurteilung ab. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Philosophy, Psychiatry, & Psychology 12.3 (2005) 195-198 [Access article in PDF] Implicit and Explicit Temporality Thomas Fuchs Keywords implicit/explicit temporality, embodiment, intersubjectivity, desynchronization, melancholia, schizophrenia Since Minkowski (1970), Strauss (1966), v. Gebsattel (1954), and Tellenbach (1980), temporality has been a main subject of phenomenological psychiatry. Drawing on philosophical concepts of Bergson, Husserl, and Heidegger, these authors have analyzed psychopathologic deviations of time experience, mainly from an individual (...) point of view, for example, as a slowing down or inhibition of lived time in depression or obsessive–compulsive disorder. Their analyses are still most valuable today, but may be carried further by introducing concepts such as embodied and intersubjective temporality into psychopathology. Martin Wyllie (2005), by opening up a wide scope of temporal phenomena and related concepts, makes a laudable effort to contribute to such a progress.In my commentary, I would like to propose a distinction that is suggested by much of Wyllie's analysis and may shed further light on psychopathology, namely between implicit and explicit temporality. If we look at a child while obliviously playing with his toys, lost to the world, we may assume that there is no sense of the time passing. Lived time runs with the movement of life, implicit in the child's experience of being engaged in his play and directed toward his goals. It "unfolds through the processes of bodily activity" (Wyllie 2005). Future and past do not stand out against the pure presence of "becoming." This implicit mode of temporality is retrieved every time that we are absorbed in what we are doing, and may even reach the climax of "flow experiences" (Csikszentmihalyi 1988) where the sense of time is lost in unimpeded, fluent performance.However, this changes when a gap arises between need and satisfaction, desire and fulfillment, or plan and execution. Now the future appears as a "not yet" or "yet to come," experienced as the temporality of awaiting, striving, or longing for. Time is felt as passing by and refusing the desired fulfillment; it becomes conscious or explicit. A similar gap arises between the present and something irretrievably lost, bringing the past to consciousness as a "no more." Again time is experienced explicitly, but now as moving on relentlessly and separating us from the lost object. The gap to the past may not be bridged any more: this is the temporality of missing or mourning. In both cases, explicit time arises as a negation of implicit or lived time (here my use of the term is a bit divergent from Wyllie's); it is experienced as a "not yet" or "no more," often with a component of displeasure or suffering (Fuchs 2001a, 2003)."Implicit" versus "explicit time" thus come near to another distinction well known in phenomenology, namely between the "lived" and [End Page 195] the "corporal body" (Leib versus Koerper). The first term refers to the body functioning in the tacit mode, as the medium of everyday performance. The second term points to the body as turning into the object of attention, for example, when it puts up resistance to our purposes, or is used as an instrument deliberately (Fuchs 2001b). In fact, implicit temporality and tacit performance of the body are nearly synonymous: Lived time may be regarded as a function of the lived body, opened up by its potentiality and capability. The more we are engaged in our tasks, the more we forget time as well as the body; we are, as it were, "inside time." On the other hand, in explicit temporality the body often appears in the corporal or explicit mode as well. For example, when falling ill, we experience our body no more as a tacit medium but rather as an object or obstacle, while we notice the slowing down of time and may even feel excluded from the movement of life. Thus, embodiment and temporality have a parallel background–foreground structure.I now try to carry these considerations further by including the intersubjective dimension of time. In an earlier paper, I describe the attunement of the living being to its environment as a continuous synchronization on the biological as... (shrink)

Present day neuroscience places the brain at the centre of study. But what if researchers viewed the brain not as the foundation of life, rather as a mediating organ? Ecology of the Brain addresses this very question. It considers the human body as a collective, a living being which uses the brain to mediate interactions.

Current theories of social cognition are mainly based on a representationalist view. Moreover, they focus on a rather sophisticated and limited aspect of understanding others, i.e. on how we predict and explain others’ behaviours through representing their mental states. Research into the ‘social brain’ has also favoured a third-person paradigm of social cognition as a passive observation of others’ behaviour, attributing it to an inferential, simulative or projective process in the individual brain. In this paper, we present a concept of (...) social understanding as an ongoing, dynamical process of participatory sense-making and mutual incorporation. This process may be described (1) from a dynamical agentive systems point of view as an interaction and coordination of two embodied agents; (2) from a phenomenological approach as a mutual incorporation, i.e. a process in which the lived bodies of both participants extend and form a common intercorporality. Intersubjectivity, it is argued, is not a solitary task of deciphering or simulating the movements of others but means entering a process of embodied interaction and generating common meaning through it. This approach will be further illustrated by an analysis of primary dyadic interaction in early childhood. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Philosophy, Psychiatry, & Psychology 8.4 (2001) 323-326 [Access article in PDF] The Tacit Dimension Thomas Fuchs Thirty years after its appearance, Blankenburg's "Psychopathology of common sense" has not lost its relevance. In my commentary I will try to illustrate the fruitfulness of his approach by pointing to some connections with the phenomenology of the body as well as with recent memory and infant research.As Blankenburg himself indicates, (...) the notion of common sense developed by a shift of meaning from the classical sensus communis and thus has its original basis in the sensual-bodily experience. By the koinè aísthesis, Aristoteles meant a central sense organ integrating all single modalities of sensation (which he localized in the heart). In German physiology and psychiatry of the nineteenth century, the sensus communis was still translated as "Gemeingefühl" ("common feeling") or "cenesthesia" (Fuchs 1995). This term denoted the inner, proprioceptive bodily sensations, but also an original unity of the senses, which has been rediscovered by recent infant research as intermodal sensory perception. The affection of the body was thus regarded as the common basis of all sensation.Looking on this track for a bodily basis of the common sense, we find it in the habitual structure of the lived-body as analysed by Merleau-Ponty (1945). The body is the primary "matter-of-course," namely, the tacitly functioning medium of our everyday being-in-the-world prior to any subject-object split. The body schema, in Merleau-Ponty's view, is not only a system of familiar units of movement or "kinetic melodies," it also incorporates the surrounding things, tools, and spaces that are familiar to us and that we "inhabit." Thus, the musician "does not only manipulate the instrument like a separate object, but lives in it like a limb and inhabits the expressive musical space it opens" (Behnke 1997). But for Merleau-Ponty, the body schema is also the basis of "intercorporeity," i.e., a prepersonal sphere of reciprocal comportment and understanding prior to any explicit consensus and symbolic communication. In this sphere of elementary contact, the "atmospheric" senses play a major role: The sense of smell (as shown, e.g., by the expression "to scent treason" or in German, "jemand nicht riechen können" [not be able to "smell" or stand someone]) as well as the sense of taste whose ambiguous meaning, mentioned by Blankenburg, points to the bodily basis of the feeling for what is suitable, decent, or aesthetically pleasing. Even the designation of homo sapiens that we give to ourselves is derived from the latin sapere (to taste/to know), and thus shows that the knowledge characteristic for man is not an explicit one, but an intuitive, implicit knowing or "feel" for his surroundings, or as Kant says, an "aesthetic rather than intellectual judgment" (cited by Blankenburg).Polanyi (1967) has analysed this knowledge at the roots of common sense as "tacit knowledge." It is based on processes of Gestalt formation that enable us to grasp unified wholes through their constituting elements without still being aware of the latter. Thus, we understand the facial expression of others immediately but cannot tell from which details. Or we know how [End Page 323] to waltz without knowing the single movements or being able to explain it. Tacit knowledge implies all the taken-for-granted that we have forgotten once it has become our second nature and part of our bodily habits. It is mainly based on the neuronal coupling of single sensori-motor units by repeated perception or action. This unconscious knowing has only recently come to be explored by psychology under the heading of "implicit" or "procedural memory" (Schacter 1987, 1996). It contains familiar styles or "melodies" of moving, perceiving, and being-with-others in which our whole bodily and emotional experience is engaged. There is an atmospheric, "felt" quality about them that cannot be analysed into single elements. Implicit knowledge may, therefore, never be wholly expressed by words—it is only realized in the concrete situation. It may only be circumscribed by expressions such as "how it feels...," "how it is...," e.g., how it is... (shrink)

The paper first introduces the concept of implicit and explicit temporality, referring to time as pre-reflectively lived vs. consciously experienced. Implicit time is based on the constitutive synthesis of inner time consciousness on the one hand, and on the conative–affective dynamics of life on the other hand. Explicit time results from an interruption or negation of implicit time and unfolds itself in the dimensions of present, past and future. It is further shown that temporality, embodiment and intersubjectivity are closely connected: (...) While implicit temporality is characterised by tacit bodily functioning and by synchronisation with others, explicit temporality arises with states of desynchronisation, that is, of a retardation or acceleration of inner time in relation to external or social processes. These states often bring the body to awareness as an obstacle as well. On this basis, schizophrenia and melancholic depression are investigated as paradigm cases for a psychopathology of temporality. Major symptoms of schizophrenia such as thought disorder, thought insertion, hallucinations or passivity experiences may be regarded as manifesting a disturbance of the constitutive synthesis of time consciousness, closely connected with a weakening of the underlying pre-reflective self-awareness or ipseity. This results in a fragmentation of the intentional arc, a loss of self-coherence and the appearance of major self-disturbances. Depression, on the other hand, is mostly triggered by a desynchronisation from the social environment and further develops into an inhibition of the conative–affective dynamics of life. As will be shown, both mental illnesses bear witness of the close connection of temporality, embodiment and intersubjectivity. (shrink)

Despite its complex experiential structure, the phenomenon of grief following bereavement has not been a major topic of phenomenological research. The paper investigates its basic structures, elaborating as its core characteristic a conflict between a presentifying and a ‘de-presentifying’ intention: In grief, the subject experiences a fundamental ambiguity between presence and absence of the deceased, between the present and the past, indeed between two worlds he lives in. This phenomenological structure will be analyzed under several aspects: regarding bodily experience, as (...) disruption of a shared intercorporeality; as a loss of the shared world and shared habitualities, leaving the bereaved person with ubiquitous indications of absence and with a contraction of their own self; regarding temporality, as a separation of two strands of time, namely a still ongoing past and an alienated present which become more and more desynchronized; finally, as an “as-if presence” of the deceased which the bereaved continue to feel and sometimes to perceive, leading to a cognitive-affective conflict between two experienced realities. The transforming process of grief is then analyzed as a gradual adjustment to the loss, finally enabling a re-integration of the conflicting realities. This is achieved through an incorporation and identification with the deceased on the one hand, and through various forms of representation on the other hand, in particular by recollection and symbolization. (shrink)

According to current opinion in western psychopathology, depression is regarded as a disorder of mood and affect on the one hand, and as a distortion of cognition on the other. Disturbances of bodily experience and of social relations are regarded as secondary to the primarily 'inner'and individual disorder. However, quite different concepts can be found in cultures whose members do not experience themselves as much as separate individuals but rather as parts of social communities. Disorders of mood or well-being are (...) then conceived less as intra-psychic, but rather as bodily, interpersonal, or atmospheric processes. On this background, the paper describes depression as a disorder of intercorporeality and interaffectivity. After developing these phenomenological concepts, it analyses depression as a 'detunement' of the resonant body that mediates our participation in a shared affective space. Instead of expressing the self, the body is turned into a barrier to all impulses directed to the environment. This impairs particularly the patient's interaction with others, resulting in a general sense of detachment, separation, or even segregation. Moreover, the restriction of the lived body also corresponds to the triggering situations of depression, namely experiences of a disruption of social bonds. Thus, intercorporeality and interaffectivity are presented as crucial dimensions for an ecological and non-reductionist view of depression. (shrink)

The paper first gives a conceptual distinction of the first, second and third person perspectives in social cognition research and connects them to the major present theories of understanding others (simulation, interaction and theory theory). It then argues for a foundational role of second person interactions for the development of social perspectives. To support this thesis, the paper analyzes in detail how infants, in particular through triangular interactions with persons and objects, expand their understanding of perspectives and arrive at a (...) self–other metaperspective. This allows them to grasp the other’s as well as their own perspective as such, which is equivalent to an explicit third person perspective and to an explicit first person perspective or self-consciousness. The paper describes the major steps towards these perspectives, pointing to a close interdependence of both developments. It argues that embodied second person interactions are not only an enabling, but the constitutive condition for the development of an explicit first and third person perspective. (shrink)

The debate on personal persistence has been characterized by a dichotomy which is due to its still Cartesian framwork: On the one side we find proponents of psychological continuity who connect, in Locke’s tradition, the persistence of the person with the constancy of the first-person perspective in retrospection. On the other side, proponents of a biological approach take diachronic identity to consist in the continuity of the organism as the carrier of personal existence from a third-person-perspective. Thus, what accounts for (...) someone’s persistence over time, is the continuity of his mind on the one hand, and the continuity of his body on the other. In contrast to those views, the paper intends to show that bodily existence represents the basis of selfhood across time, both as the continuity of the experiential self and as the continuity of the autopoietic organism. On the one hand, the lived body conveys a continuity of the self from a first-person perspective, namely a pre-reflective feeling of sameness or a felt constancy of subjectivity. Moreover, an analysis of awakening and sleep shows that there is a continuous transition from full wakefulness to periods of deep sleep which may thus not be regarded as a complete interruption of subjective experience. On the other hand, this constancy converges with the continuity of the organismic life process as conceived from a third-person perspective. Thus, the experiential self of bodily subjectivity and the autopoietic self of the living organism should be regarded as two aspects of one and the same life process. Finally, the lived body also exhibits a specific form of memory that results from the continual embodiment of existence: it consists of all the affinities, capacities and experiences, which a person has acquired throughout his life. Thus, it provides a continuity of self that must not be actively produced through remembering, but rather integrates the person’s entire past in his present being and potentiality. (shrink)

Theories of personal identity in the tradition of John Locke and Derek Parfit emphasize the importance of psychological continuity and the abilities to think, to remember and to make rational choices as a basic criterion for personhood. As a consequence, persons with severe dementia are threatened to lose the status of persons. Such concepts, however, are situated within a dualistic framework, in which the body is regarded as a mere vehicle of the person, or a carrier of the brain as (...) the organ of mental faculties. Based on the phenomenology of embodiment, this paper elaborates a different approach to personal identity in dementia. In this perspective, selfhood is primarily constituted by pre-reflective self-awareness and the body memory of an individual, which consists in the embodiment and enactment of familiar habits, practices and preferences. After describing the different types of body memory, the paper develops a phenomenology of dementia as a loss of reflexivity and meta-perspective. This is contrasted with the preservation of individual forms of body memory even in the later stages of the illness. The ethical consequences of an embodied approach to dementia are outlined. A final look is given to narrativistic and constructionist concepts of the self in dementia. (shrink)

2013 sees the centenary of Jaspers' foundation of psychopathology as a science with the publication of his magnum opus the Allgemeine Psychopathologie (General Psychopathology), Many of the issues concerning methodology and diagnosis are today the subject of much discussion and debate. This volume brings together leading psychiatrists and philosophers to discuss the impact of this volume, its relevance today, and the legacy it left.

Normal convictions are formed in a context of social living and common knowledge. Immediate experience of reality survives only if it can fit into the frame of what is socially valid or can be critically tested. … Each single experience can always be corrected but the total context of experience is something stable and can hardly be corrected at all. The source for incorrigibility therefore is not to be found in any single phenomenon by itself but in the human situation (...) as a whole, which nobody would surrender lightly. If socially accepted reality totters, people become adrift.As Jaspers indicates in this quotation on incorrigibility, delusions may not be regarded as mere disorders of thinking, reasoning or... (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Philosophy, Psychiatry, & Psychology 9.3 (2002) 261-264 [Access article in PDF] Mind, Meaning, and the Brain Thomas Fuchs, MD, PhD Keywords: Mind, brain, meaning, translation, depression. A Systemic View of the Mind Progress in brain research over the past two decades demonstrates the power of the neurobiological paradigm. However, this progress is connected with a restricted field of vision typical of any scientific paradigm. The psychiatrist should (...) be aware of this restriction, because, unlike the brain scientist, he deals with patients, not with brains. The restricted view may be described by the terms of (1) reductionism, (2) reification, and (3) isolation.Reductionism: Neurobiology tends to regard subjectivity as a mere by-product of the brain's activity as a symbol-manipulating machine or an information processor. Consciousness becomes an epiphenomon of the neuronal machinery that, operating behind our back, creates the illusion of a continuous self and of an autonomous will (Churchland 1995; Roth 1996).Reification: Mental or subjective states seem to be localizable in the brain; thoughts or feelings, it appears, may be observed in the colored illumination of cortical and subcortical structures. This results in the belief that brain images could also show the cause of a mental illness, or even the illness itself, which then manifests, for instance, in a reduced metabolic activity in certain areas of the cortex.Isolation: As a further consequence, this view isolates the individual patient and considers his illness separated from the interconnections with his environment. However, on these interconnections his personal experiences and dispositions are founded, and it is the actual interpersonal situation that has triggered his present illness.Walter Glannon's paper successfully counters these tendencies toward a neurobiological reductionism with an extended view of the mind: "... the mind is not located in any one place but is distributed among the brain, the body, and the environment." Of course, who observes someone's brain will never see his thoughts, his pain, or his anxiety. For consciousness is not a localizable object or state at all but a process of relating to something: a perceiving of, remembering of, wishing for, aiming at, and so on. Thus on the phenomenological level, there is nothing like a "mental event" that could be isolated from the world and from the stream of conscious experiences. The mind exists only embedded in the world and in the temporal process of life.The same applies to the biological level: Consciousness is based on the continuous interaction of the brain with the organism, and of the organism as a whole with the environment. The role of the brain for mental phenomena is thus comparable to the role of the heart in the circulatory system or of the lung in the respiratory system. Of course, the lung is the central organ of breathing, but respiration may not be restricted to the [End Page 261] lung, nor to the organism as a whole. It means constant exchange with the environment, and there is no sense in asking whether the air taken in still belongs to the surroundings or already to the organism. The same systemic unity is found in the circle of perception and action mediated by the brain: When I am writing a letter, there is no place in the unity of action where my "self" ends and the "world" begins, no border that separates inner and outer worlds.There is another argument to be raised against the reification of the mind if we consider the aspect of a historical biology. From birth on, our mind as well as the correlated brain structures are essentially formed by social and cultural influences. The brain is not inserted into the world as a prefabricated apparatus but through its plastic development in and from the world. Thus it adapts epigenetically to its specific natural and social environment like a key to a lock. This complementarity makes it impossible to restrict one's view to the anatomic organ and requires an interdisciplinary approach to brain-environment investigation, as for example, under the heading of a "social cognitive neuroscience" (Ochsner and Lieberman 2001).As Glannon goes on to argue, to overcome... (shrink)

From a phenomenological viewpoint, shame and guilt may be regarded as emotions which have incorporated the gaze and the voice of the other, respectively. The spontaneous and unreflected performance of the primordial bodily self has suffered a rupture: In shame or guilt we are rejected, separated from the others, and thrown back on ourselves. This reflective turn of spontaneous experience is connected with an alienation of primordial bodiliness that may be described as a "corporealization": The lived-body is changed into the (...) objective, corporeal body or "body-for-others." The polarity of "bodiliness" and "corporeality" may further a phenomenological understanding of several mental disorders connected with shame and guilt. This is shown by the examples of body dysmorphic disorder and melancholic depression. (shrink)

The notion of embodiment is central to the phenomenological approach to schizophrenia. This paper argues that fundamental concepts for the understanding of schizophrenia have a bodily dimension. We present two single cases of first-onset schizophrenic patients and analyze the reports of their experiences. Problems such as loss of self, loss of common sense, and intentionality disorders reveal a disconnectedness that can be traced back to a detachment from the lived body. Hyperreflectivity and hyperautomaticity are used as coping mechanisms, but reflect (...) the same problem of the split between body and mind. It is argued that the sole focus on cognitive impairments leads to a distorted image of schizophrenia, and that the acknowledgment of its fundamental bodily roots enables one to see the coherence between the diverse symptoms. As for the practical implications of the phenomenological approach, further research is needed to investigate if and how body- and movement-oriented therapies might strengthen the embodiment of schizophrenic patients. (shrink)

Recent neuroscientific evidence brings into question the conclusion that all aspects of consciousness are gone in patients who have descended into a persistent vegetative state (PVS). Here we summarize the evidence from human brain imaging as well as neurological damage in animals and humans suggesting that some form of consciousness can survive brain damage that commonly causes PVS. We also raise the issue that neuroscientific evidence indicates that raw emotional feelings (primary-process affects) can exist without any cognitive awareness of those (...) feelings. Likewise, the basic brain mechanisms for thirst and hunger exist in brain regions typically not damaged by PVS. If affective feelings can exist without cognitive awareness of those feelings, then it is possible that the instinctual emotional actions and pain "reflexes" often exhibited by PVS patients may indicate some level of mentality remaining in PVS patients. Indeed, it is possible such raw affective feelings are intensified when PVS patients are removed from life-supports. They may still experience a variety of primary-process affective states that could constitute forms of suffering. If so, withdrawal of life-support may violate the principle of nonmaleficence and be tantamount to inflicting inadvertent "cruel and unusual punishment" on patients whose potential distress, during the process of dying, needs to be considered in ethical decision-making about how such individuals should be treated, especially when their lives are ended by termination of life-supports. Medical wisdom may dictate the use of more rapid pharmacological forms of euthanasia that minimize distress than the de facto euthanasia of life-support termination that may lead to excruciating feelings of pure thirst and other negative affective feelings in the absence of any reflective awareness. (shrink)

Advances in artificial intelligence (AI) create an increasing similarity between the performance of AI systems or AI-based robots and human communication. They raise the questions: whether it is possible to communicate with, understand, and even empathically perceive artificial agents; whether we should ascribe actual subjectivity and thus quasi-personal status to them beyond a certain level of simulation; what will be the impact of an increasing dissolution of the distinction between simulated and real encounters. (1) To answer these questions, the paper (...) argues that the precondition for actually understanding others consists in the implicit assumption of the subjectivity of our counterpart, which makes shared feelings and a „we-intentionality” possible. This assumption is ultimately based on the presupposition of a shared form of life, conceived here as „conviviality.” (2) The possibility that future artificial agents could meet these preconditions is refuted on the basis of embodied and enactive cognition, which links subjectivity and consciousness to the aliveness of an organism. (3) Even if subjectivity is in principle impossible for artificial agents, the distinction between simulated and real subjectivity might nevertheless become increasingly blurred. Here, possible consequences are discussed, especially using the example of virtual psychotherapy. Finally, the paper makes case for a mindful appproach to the language we use to talk about artificial systems and pleads for preventing a systematic pretense of subjectivity. (shrink)

Body Memory, Metaphor and Movement is an interdisciplinary volume with contributions from philosophers, cognitive scientists, and movement therapists. Part one provides the phenomenologically grounded definition of body memory with its different typologies. Part two follows the aim to integrate phenomenology, conceptual metaphor theory, and embodiment approaches from the cognitive sciences for the development of appropriate empirical methods to address body memory. Part three inquires into the forms and effects of therapeutic work with body memory, based on the integration of theory, (...) empirical findings, and clinical applications. It focuses on trauma treatment and the healing power of movement. The book also contributes to metaphor theory, application and research, and therefore addresses metaphor researchers and linguists interested in the embodied grounds of metaphor. Thus, it is of particular interest for researchers from the cognitive sciences, social sciences, and humanities as well as clinical practitioners. (shrink)

Cognitive neuroscience has been driven by the idea that by reductionist analysis of mechanisms within a solitary brain one can best understand how the human mind is constituted and what its nature is. The brain thus came to appear as the creator of the mind and the experienced world. In contrast, the paper argues for an ecological view of mind and brain as both being embedded in the relation of the living organism and its environment. This approach is crucially dependent (...) on a developmental perspective: the brain is conceived as a plastic system of open loops that are formed in the process of life and closed to full functional cycles in every interaction with the environment. Each time a new disposition of coherent neural activity is formed through repeated experience, structures of the mind are imprinted onto the brain. The brain becomes a mediating organ or a window to the mind, for it is structured by the mind itself. (shrink)

Recent years have seen the emergence of a new interdisciplinary field called embodied or enactive cognitive science. Whereas traditional representationalism rests on a fixed inside–outside distinction, the embodied cognition perspective views mind and brain as a biological system that is rooted in body experience and interaction with other individuals. Embodiment refers to both the embedding of cognitive processes in brain circuitry and to the origin of these processes in an organism’s sensory–motor experience. Thus, action and perception are no longer interpreted (...) in terms of the classic physical–mental dichotomy, but rather as closely interlinked. This paper describes the cycles of brain–organism interaction, of sensory–motor interaction with the environment and of embodied interaction with others. The brain is then interpreted as an organ of modulation and transformation that mediates the cycles of organism–environment interaction. Finally, consequences of the embodied and enactive approach for psychiatry are pointed out, in particular for a circular concept of mental illness. (shrink)

There is a conspicuous tendency of humans to experience empathy and sympathy preferentially towards members of their own group, whereas empathetic feelings towards outgroup members or strangers are often reduced or even missing. This may culminate in a “dissociation of empathy”: a historical example are the cases of Nazi perpetrators who behaved as compassionate family men on the one hand, yet committed crimes of utter cruelty against Jews on the other. The paper aims at explaining such phenomena and at determining (...) the limits of empathy. To this purpose, it first distinguishes between two levels of empathy, namely primary or intercorporeal and extended or higher-level empathy. It then investigates the mutual interconnection of empathy and recognition, which may be regarded as a principle of extending empathy to others regardless of whether they belong to one’s own group or not. However, this principle is in conflict with ingroup conformism and outgroup biases that hamper the universal extension of empathy. Thus, a denial of recognition and exclusion of others from one’s ingroup usually results in a withdrawal or lack of extended empathy which then influences primary empathy as well. On this basis, and using the historical example of mass executions during the Holocaust, the paper investigates the mechanisms of exclusion which may lead to a withdrawal of recognition and finally to a dissociation of empathy. (shrink)

Summary The case of an anorectic patient is presented to demonstrate how well-known symptomatic phenomena such as a supposedly distorted body perception can be understood. Further theoretical suggestions are made to explain the motive to starve, without making complicated psychodynamic assumptions. To do so, genuine gestalttheoretical concepts such as ‘centring’ and ‘reference system’ are used. This leads to hints for a temporarily perception-focused formation of the therapeutic relationship.

Not only our conscious expectations, wishes and intentions are directed towards the future, but also pre- or unconscious tendencies, hunches and anticipations. Using a term of Ernst Bloch, they can be summarized as thenot-yet-conscious. This not-yet-conscious mostly unfolds spontaneously and without plan; it is not directly anticipated or aimed at, but rather comes to awareness in such a way that the subject is, as it were, surprised by itself. Thus it gives rise to phenomena such as the striking, the coincidental, (...) the new, and the improvised, which are particularly important for understanding creative and therapeutic processes. The paper aims at providing a general phenomenological framework for the understanding of not-yet-conscious dynamics and their unfolding in different contexts. To this end, the structure of the not-yet-conscious is examined in light ofprotention, in which the phenomenon is fundamentally to be located. I propose to describe the general structure of protention as a future-directed horizon of graded probabilities, i.e., as a “protentional cone”. This cone is fed by current experiences and bodily tendencies and is focused to varying degrees by attention. This results in either more focused or rather defocused states of anticipation, the latter giving space to the not-yet-conscious as a meaning “in statu nascendi”. On this basis, selected manifestations of the not-yet-conscious are analyzed, including extemporaneous speech, artistic improvisation and creativity, bodily meaning implicates, decision-making, and meaningful coincidence. (shrink)

The distinction of „understanding“ and „explaining“, formulated by Karl Jaspers in his „General Psychopathology“, has had a lasting effect on psychiatry. As a result, phenomenological, hermeneutic, or psychodynamic approaches have often been accorded only descriptive or epiphenomenal status, while the actual causes of mental illness have been sought in neurobiologically or genetically based explanations. In contrast, this paper defends the explanatory role of understanding and phenomenological approaches. To this end, two levels of explanation are distinguished and shown to be equally (...) justified in principle, namely, motivational explanation at the macro-level and physical explanation at the micro-level. The actual causal role of motivational, i.e., understandable connections is then demonstrated by means of a conception of circular causality, which includes downward causality. Finally, the explanatory role of phenomenological analyses is also shown in psychotic disorders that refuse motivational understanding, using the example of schizophrenic delusion. (shrink)

The structure of human embodiment is fundamentally characterized by a polarity or ambiguity between Leib and Körper, the subjective body and the objectified body, or between being-body and having-a-body. This ambiguity, emphasized, above all, by Helmuth Plessner and Maurice Merleau-Ponty, is also of crucial significance for psychopathology. Insofar as mental illnesses disturb or interrupt the unhindered conduct of one’s life, they also exacerbate the tension within embodiment that holds between being-body and having-a-body. In mental illnesses, there is a failure of (...) tacit mediations upon which one’s bodily being-toward-the-world is based. Instead of serving as a medium of relating to the world, the body makes .. (shrink)

Schizophrenia is a mental disorder that calls the mineness of one's own sensations, thoughts and actions into question and threatens the person with a loss of self. In order to understand this illness in its essence, an approach based on phenomenological psychopathology is therefore indispensable. Conversely, disorders of the self in schizophrenia should be of crucial interest for any philosophy of subjectivity in order to test its concepts of self-awareness, personhood and intersubjectivity by reference to empirical phenomena.Contemporary neurobiological concepts of (...) schizophrenia predominantly emphasize the importance of impaired integration of somatosensory inputs into stable central-nervous representations... (shrink)

Borderline personality disorder (BPD) is characterized by severe disturbances in a subject’s sense of identity. Persons with BPD suffer from recurrent feelings of emptiness, a lack of self-feeling, and painful incoherence, especially regarding their own desires, how they see and feel about others, their life goals, or the roles to which they commit themselves. Over the past decade or so, clinical psychologists, psychotherapists, and psychiatrists have turned to philosophical conceptions of selfhood to better understand the borderline-specific ruptures in the sense (...) of identity, which are frequently associated with severe affective instability and turbulence in interpersonal relationships. Fuchs (2007) has suggested that these disturbances in self-experience can best be described and explained by using notions—widely discussed in philosophy and psychology—ofnarrativityandnarrative identity. On such a narrative view, key features of BPD present significant modifications of proto-narrative structures and inhibit the development of a narrative identity, resulting in a disturbed sense of identity. Although the role of narrativity in BPD has been acknowledged by many researchers, some have voiced dissatisfaction with what they take to be limitations of a narrativistic understanding of the disorders of identity characterizing BPD, and have proposed alternative, allegedly non-narrativistic, accounts. In this paper, we critically examine an example of the latter, viz. Gold and Kyratsous’ (2017) account ofthe person as an intrapersonal team reasoner. We defend a narrativistic understanding of BPD identity disorder against their objections. To this end, we propose a broader, and more finely-differentiated, concept of narrativity. On this account, four aspects of narrativity are distinguished, the disordering of which can affect those with BPD. As it turns out, our account implies that even Gold and Kyratsous—in order to ground their approach—must either make use of these aspects or propose an as-yet unarticulated alternative. This casts doubt upon whether their approach is non-narrativistic after all. (shrink)

From a phenomenological viewpoint, shame and guilt may be regarded as emotions which have incorporated the gaze and the voice of the other, respectively. The spontaneous and unreflected performance of the primordial bodily self has suffered a rupture: In shame or guilt we are rejected, separated from the others, and thrown back on ourselves. This reflective turn of spontaneous experience is connected with an alienation of primordial bodiliness that may be described as a "corporealization": The lived-body is changed into the (...) objective, corporeal body or "body-for-others." The polarity of "bodiliness" and "corporeality" may further a phenomenological understanding of several mental disorders connected with shame and guilt. This is shown by the examples of body dysmorphic disorder and melancholic depression. (shrink)

Hass wird in der Arbeit als eine anhaltende affektive Gesinnung verstanden, die auf eine erlebte Kränkung oder Ungerechtigkeit zurückgeht und auf Rache an ihrem Urheber, in extre­men Fällen auf die Vernichtung des Feindes gerichtet ist. Die Dynamik und Radikalität insbesondere des malignen Hasses resultiert, so die These des Autors, aus einer Affektretention, die durch die selbst empfundene Schwäche oder Ohnmacht des Hassenden bedingt ist. Durch diesen Rückstau wird der Hass demnach in der Latenzphase immer weiter genährt, bis er schließlich in (...) akute destruktive Handlungen umschlagen kann. Als charakteristische Struktur des Hasses wird dabei eine Dialektik von Selbststeigerung und Selbstdestruktivität mit fortschreitender Entleerung des Selbst herausgearbeitet. Diese indivi­duelle Dynamik findet sich in oft potenzierter Form im Hass von Gruppen wieder. Der Autor untersucht die Phänomenologie des Hasses und die daraus resultierende Form von Destruktivität anhand literarischer Beispiele, psychischer Störungen und gesellschaftlicher Phänomene. (shrink)

Name der Zeitschrift: Deutsche Zeitschrift für Philosophie Jahrgang: 66 Heft: 1 Seiten: 48-61.

According to current representationalist concepts, delusion is considered the result of faulty information processing or incorrect inference about external reality. In contrast, the paper develops a concept of delusion as a disturbance of the enactive and intersubjective constitution of a shared reality. A foundation of this concept is provided by a theory of the objectivity of perception which is achieved on two levels: (1) On the first level, the sensorimotor interaction with the environment implies a mobility and multiplicity of perspectives (...) that relativizes the momentary point of view. (2) On the second level, the social interaction with others implies a virtual shifting and contrast of perspectives which helps to overcome a merely subject-centered worldview through participatory sense-making.On this basis, the alteration of experience in beginning psychosis is phenomenologically described as a subjectivization of perception, resulting in an overall experience of self-centrality and derealization. Delusion then converts the disturbance of perception into a reframing of the perceived world, namely an assumed persecution by mundane enemies. Through this, a new sense-making is established, yet in a way that is fundamentally decoupled from the shared world. The possibility of intersubjective understanding is thus sacrificed for the new coherence of the delusion. Further implications of the loss of the intersubjective co-constitution of reality are analyzed, in particular related to disturbances of communication. (shrink)

Current phenomenological approaches consider schizophrenia as a fundamental disturbance of the embodied self, or a disembodiment. This includes a weakening of the basic sense of self, a disruption of implicit bodily functioning, and a disconnection from the intercorporality with others. As a result of this disembodiment, the pre-reflective, practical immersion of the self in the shared world is lost. Instead, the relationship of self and world is in constant need of reconstruction by deliberate efforts, leading to the growing perplexity and (...) hyperreflexive ruminations that are found in schizophrenic patients. The paper distinguishes different levels of self-experience and relates it to the psychopathology of schizophrenia. (shrink)

The ethical ideologies of psychologists and physicians were compared using the Ethics Position Questionnaire. The findings reveal that psychologists tend to be less relativistic than physicians. Further, we explored the degree to which physicians and psychologists report being influenced by a variety of factors in their ethical decision making. Psychologists were more influenced by their code of ethics and less influenced by family views, religious background, and peer attitudes than were physicians. We argue that these differences reflect the varied professional (...) cultures in which practitioners are trained and socialized. (shrink)

As a rule, mental illnesses are connected with increased self-observation, a narrowing of attention to one′s own person, and with the backward turn of thinking to what has already been done or has happened. These phenomena can be summed up in the concept of hyperreflexivity. In this paper, this concept is interpreted against the background of Plessner′s distinction between the lived and the objective body as implying always already a component of self-alienation. This will be illustrated in a number of (...) psychopathological conditions such as insomnia, obsessive-compulsive disorder, hypochondria and schizophrenia. (shrink)

From a neuroconstructivistic point of view, the human brain produces an internal simulation of the external world which appears in conscious experience as the phenomenal world. This concept implies in particular that the subjective body and the organic or objective body belong to fundamentally different realms, i.e. to the mental and the physical world. The spatiality of the subject-body has then to be declared an illusion, which is done by pointing to dissociations of the subject- and object-body as in the (...) rubber hand illusion or in phantom limbs. This alleged virtuality of body experience may be refuted, however, namely by referring to the intersubjectivity of perception which certifies the coextensivity of subject-body and object-body. Subjectivity is thus shown to be embodied as well as spatially extended, that means, as bodily being-in-the-world. (shrink)