Self-awareness and its pathologies

The Australasian Research Council, the research center Science Textes Languages and the Institut Jean Nicod are pleased to announce a two days interdisciplinary workshop of self-awareness and its pathologies.

The nature and even existence of self-awareness is a venerable topic in philosophy. It is equally important to psychologists, psychiatrists and neuroscientists who often look to philosophy for frameworks in which to explain disorders such as the experience of depersonalisation. One notable interdisciplinary development in the area is a focus on the role of interoceptive processes in the experience of self awareness. 
This workshop is an opportunity to assess recent work in the area focussing on, but not limited to, a range of conditions in which self awareness is compromised or in extreme cases absent.

Date : 13-14 April 2023

Localisation : Salle L382/384, Ecole Normale Supérieure, 29 rue d’Ulm, Paris

Attendance : Free, but registration is needed (at [email protected])

Program

13 Avril AM
1. 9h30-10h45 Anthony David, tba
2. 11h00-12h15 Anna Ciaunica, I Overthink Therefore I’m Not: a Active Inference Account of Depersonalisation. 

13 Avril PM
1. 14h00-15h15 Frédérique de Vignemont, When the world is no longer here,
2. 15h30-16h45 Alexandre Billon, Structural vs. affective accounts of depersonalization : lessons from the paradox of emotions in DPD
3. 17h00-17h45 Carlotta Serrahima, Transparency in panic,

14 Avril AM
1. 9h30-10h-45 Jesus Ramirez-Bermudez, Delusions of being and nothingness: (neuro)pathologies of self-awareness
2. 11h-12h15 Phillip Gerrans, Suffering and the Self. Active inference and self-modelling,

14 Avril PM
1. 14h00-15h15 Heidi Haanila, The dynamics of self-consciousness – elucidated by an analysis of Cotard syndrome
2. 15h30-16h15 Rosanna Wannberg ,Merits and pitfalls of the ”pathological” case in philosophy: the example of schizophrenia
3. 16h30-17h15 Julia Apache, Lost Agency: The Effect of Depersonalization on Time Perception and Intentional Binding

Abstracts for long talks I Overthink Therefore I’m Not: a Active Inference Account of Depersonalisation, Anna Ciaunica

 
This talk examines potential mechanisms behind an atypical sense of self and sense of agency in Depersonalisation Disorder (DPD), a condition in which people experience a ‘split’ or detachment from oneself, one’s body and the world. We use Active Inference framework to argue that atypical self-modelling—underpinned by aberrant precision control and sub-optimal sensory attenuation—disrupts the transparency of basic, pre-reflective forms of self-awareness in DPD. 
 
 If our argument is correct, then future research could usefully assess whether active multisensory engagements with the world and others via body-based, dynamic proximal (tactile and olfactory) interactions enhance the sense of self, realness and presence in people with DPD. We hypothesise that close and dynamic physical and synchronous interactions with their environment will make DPD people feel more present in their bodies, and less ‘trapped’ in their minds. This is because, paradoxically, in order to get closer to oneself, one needs to feel safe enough to be able to ‘forget’ oneself, and to focus instead on (inter)acting with the world and others, via proximal multisensory interactions (Ciaunica et al. 2021). 
 
I will conclude with presenting some new data from our lab highlighting the close relationship between atypical sensory processing, sense of agency and peripersonal space and time experience in DP. 

The dynamics of self-consciousness – elucidated by an analysis of Cotard syndrome, Heidi Haanila

Self-consciousness is a major feature of mind and an integral part of one’s psychological well-being. In this paper, I investigate the structure of self-consciousness in relation to a rare pathological case of Cotard syndrome that involves profound alterations in self-experience. Patients suffering from Cotard syndrome deny being alive, having body parts, thinking, existing or being a self. In extreme cases, patients claim that they are dead. An analysis of these alterations provides an opportunity to bring out the significant aspects of typical self-consciousness too. I analyze the atypical self-consciousness in Cotard syndrome in terms of (1) minimal self-consciousness, (2) reflective self-consciousness, and (3) their dynamics. First, Cotard syndrome manifests diminution of minimal self-consciousness, which includes disrupted affectivity and embodied first-person perspective. Second, Cotard syndrome involves distortions of reflective self-consciousness, in which an objectifying third-personal mode of self-reflection dominates. Third, the analysis of Cotard syndrome brings out the connections between minimal and reflective self-consciousness indicating that these dimensions of self-consciousness are intertwined. I highlight especially the third point, which has received relatively little attention. The analysis is conducted in a multidisciplinary framework, but the focus is on the clarification of a generic theory of self-consciousness.

DELUSIONS OF BEING AND NOTHINGNESS: (NEURO)PATHOLOGIES OF SELF-AWARENESS, Jesus Ramirez-Bermudez

 
"In this presentation, I will provide an outline of the clinical approach to (neuro)pathologies of self-awareness as applied in a neurological hospital in Mexico City. My first objective is to offer an epistemological perspective on neuropsychiatric constructs and propose that these conceptual tools serve as bridges between psychopathological and neuropathological constructs. Then, I will clarify the distinction between pathologies affecting wakefulness and alertness versus those affecting awareness in a specific way. I will discuss three clinical issues to provide an empirical basis for the theoretical analysis of self-awareness at the intersection of neurology and psychiatry.  Firstly, I will present a case of Anton syndrome. Secondly, I will discuss cases of asomatognosia and pain asymbolia. Finally, I will explain the framework of autoimmune psychosis; within this context, my aim will be to provide a clinical and theoretical approach to the problem of delusions in neuropsychiatric practice and research, ranging from delusional misidentification to Cotard's delusion."

Structural vs. affective accounts of depersonalization : lessons from the paradox of emotions, Alexandre Billon

There has been, historically, two leading accounts of depersonalization (DPD). The first one, endorsed d by Dugas in his seminal 1898 article and quite popular since then explains DPD by an affectivity deficit. The second one, advocated by Dugas thirteen years later is a structural account: it incriminates a feature of experience, mineness, that would be normally ubiquitous in experience, and would be more or less lacking in people with DPD (Dugas and Moutier, 1911). The debate between affectivity accounts and structural accounts has never been really settled and it has been recently revived (Gerrans 2022). It has been widely noted that despite subjective reports of total lack of feelings or emotions people with DPD often show normal emotional responses.
In this talk, I argue that the structural account can better explain the paradoxical nature of emotions in DPD. The only plausible version of the affective view, I argue, is committed to the claim that every normal conscious state is in fact affective.

When the world is no longer here, Frédérique de Vignemont

Patients with derealization syndrome describe that they feel cut off from their environment, as if there were a screen between them and the world. They do not feel that they share the same space with what they see and hear. Instead, they feel that the objects are located where they are not. Here I shall argue that to understand their sense of disconnection, one needs to appeal to the notion of peripersonal space (PPS). A vast array of experimental results has recently shown that there is something specific in the way we perceive the space immediately surrounding the body, by contrast with the perception of what lies farther away. Objects and events perceived in PPS have a unique immediate significance for the subject because they may soon be in contact with her. They are then represented as located in external space while being spatially referred to the body. By its dual character, PPS bridges the gap between the body and the external world. However, if it is disrupted, the perceptual environment might remain simply ‘outside’. This, I argue, can account for the sense of disconnection encountered in derealization.

Suffering and the Self. Active inference and self-modelling, Philip Gerrans


“If the self is an illusion it’s a pretty painful one” Michel Houellebecq

Perhaps the most intuitively satisfying and empirically supported explanation of depersonalisation disorder is that it is a dissociative  phenomenon. This finds clear expression in the work of Maurizio Sierra and Nick Medford. The idea is that the subject faced with intractable adversity shuts down affective responses. This leaves bodily and cognitive processing intact but the world leached of “emotional colouring”

“Emotional colouring” is a nice expression and captures the essence of affective theories of depersonalisation. The depersonalised person lives in an emotionally  monochrome world and as a result reports feelings of detachment/estrangement and loss of subjective presence.

This account dovetails nicely with 2 stage accounts of the Cotard delusion that treat it as a rationalisation of the experience of depersonalisation. However loss of affect is neither necessary or sufficient for Cotard delusion  or depersonalisation (often the depersonalised subject is miserable and anxious in which case non-specific negative affect is clearly intact). The relationship between between affective experience, self-awareness and bodily awareness is complex at all levels: neural, cognitive and phenomenological.

I present an account of that relationship. On this account depersonalisation and the  Cotard delusion represent different forms of malfunction of a process of self modelling whose hub is the anterior insula cortex. This account can explain the complex and continuous symptom profiles in terms of the level and extent of self modelling failure. In Depersonalisation the self model is largely intact. In Cotard delusion it  almost completely disintegrates.

What does Depersonalisation Disorder tell us about a healthy sense of Self? Anthony David

The clinical syndrome of Depersonalisation-Derealisation Disorder (DDD) was first described 130 years ago. It attracted little research until the last 30 years. Since then, some basic epidemiology and clinical correlates have been established and a model based on abnormal physiological reactance to emotional stimuli has gained acceptance, as an explanation for at least some aspects of the syndrome. Through application of the cognitive neuropsychiatric approach, we can attempt to better understand how normal psychological processes operate by extrapolating from their loss or disruption through psychiatric disturbance. In DDD, this leads to the hypothesis that a healthy sense of Self requires congruent inputs from cognition which appraise and understand social stimuli, and the introception of physiological arousal signals (the Cognitive-Affective-Somatic (CAS) model). From a close reading of the phenomenology of DDD we can further reason that this sense of Self is somewhat basic and pre-reflective and that many other functions can carry on in its absence (or despite its impairment). We can also begin to test this model further through comparison with other conditions associated with abnormal physiological reactance and through observations on the effects of therapeutic interventions. This should help refine our understanding of the Self and its pathologies including and especially DDD.

Abstracts for shorter talks Lost Agency: The Effect of Depersonalization on Time Perception and Intentional Binding, Julia Ayache

Depersonalization (DP) is associated with feelings of detachment from one’s self, body and the world that has attracted considerable attention considering its association with altered experience of the sense of self (Billon, 2022; Ciaunica et al., 2021). The sense of agency is a pre-reflective component of self-consciousness, characterized by the feeling of controlling one’s own actions (Gallagher, 2000) and time experience is a key aspect of both human experiences and sense of agency (Haggard et al, 2007). The sense of agency can be measured experimentally by the compression of the spatiotemporal binding of a voluntary action and its sensory outcomes (i.e., intentional binding, Haggard et al., 2002). Previous works showed an “hyper” intentional binding in psychosis and schizophrenia (Haggard et al., 2003). However, while DP is the third most common psychological symptom in the general population (Hunter et al. 2004), the effect of DP on the intentional binding effect remains an open question.
The present study explored the relationship between DP and sense of agency as measured by the intentional binding effect. Participants (N = 500) from a sample of a French population were recruited online using social media and pre-screened using a French version of the Cambridge Depersonalization Scale (CDS, Sierra & Berrios, 2000) associated with a questionnaire measuring altered subjective experiences of body-awareness, proximal space and time (STE). A subsample of high (N = 50, CDS score > 50) and low (N = 50, CDS score The outcome of this study allows improving our understanding of the phenomenological experience of self-consciousness states by disentangling the cognitive components involved in DP and sense of agency. Also, this study advances our understanding of the DP symptomatology in altered forms of consciousness states, paving the way for potential therapeutic interventions.

Merits and pitfalls of the ”pathological” case in philosophy: the example of schizophrenia, Rosanna Wannberg

In contemporary philosophy of psychiatry, it is a common strategy to question our ordinary psychological concepts by attending to their psychopathological counterparts. “Thought insertion” for instance – a symptom often associated with schizophrenia in which a subject reports “having” thoughts which are not “his” thoughts (but someone else’s) has been construed as a challenge to our ordinary conceptions of subjectivity and self-awareness. Starting with a critical assessment of this literature, my talk aims at defending a social conception of subjectivity via a reflection on schizophrenia, especially in its phases of recovery (defined as personal transformation in spite or independently or residual symptoms). I will thus argue for the philosophical advantages of what might be called the “therapeutic” case as opposed to a merely “pathological” one. More precisely, I will hold that these advantages are two-fold in nature: they are methodological, because turning to the context of recovery amounts to pointing to a normative horizon which provides a shared element required for the generalizability of conclusions; and they are also conceptual, because this widening of perspective urges us, more than the study of psychopathological symptoms, to take the social and interpersonal dimensions of the ”self" into account.

Transparency in panic, Carlotta Serrahima

Transparency is the thesis that, if one turns attention to one’s conscious experiences in introspection, one will only find features of the objects represented in these experiences. This paper focuses on panic attacks as a case against Transparency. I propose to treat panic attacks as global shifts of attention where Transparency fails: in particular, as shifts that make the conscious field salient as such. I argue that this resolves an apparent tension in the phenomenological and empirical descriptions of panic in the literature, in which panic appears as involving both excessive self-focus and depersonalization.