P S Y C H E 11(1): Feburary 2005
Review of Tile Kircher and Anthony David (eds.) The Self in Neuroscience and Psychiatry
Christian Perring
Department of Philosophy
Dowling College
Oakdale, NY 11769 USA
© Christian Perring
perringc@dowling.edu
REVIEW OF: The Self in Neuroscience and Psychiatry, Tile Kircher and Anthony David (Editors), Cambridge, UK: Cambridge University Press, 2003, 484+xi pages
Copyright (c) Christian Perring 2005
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The Self in Neuroscience and Psychiatry collects together work by an international range of psychiatrists and psychologists with a few philosophers. It is a large book with 22 papers, arranged into three parts: "Conceptual background," "Cognitive and neurosciences," and "Disturbances of the self: the case of schizophrenia." This last part takes up more than half the book and is itself split into three sections, covering phenomenology, social psychology, and clinical neuroscience. As one might expect with such headings, many papers do not in fact fit neatly into their categories but rather spill over into other areas. The diversity of topics and methodologies contained within the book mean that most readers are likely to be much more comfortable with some parts of the book than others. Furthermore, because of the interdisciplinary nature of the work, many of the authors address issues outside of their areas of direct training and expertise. For example, philosophers examine experimental data and experimentalists raise philosophical issues. The authors are brave to attempt such a project and work such as this is certainly to be encouraged. It is certainly important for researchers to address how psychiatric research should inform and be informed by our understanding of the self. Nevertheless, many readers are likely to find this interdisciplinary project a challenging read.
Some of the chapters provide a useful discussion of the literature on the concept of self. For example, Berrios and Markova give a brief but helpful and well-annotated survey of the conceptual history of the psychiatry and its theorizing about the self. Gallup, Anderson and Platek review the research on mirror self-recognition and emphasize the link between that capacity and the ability to infer mental states in other people. This provides evidence for their hypothesis that schizophrenics show theory of mind deficits. Keenan, Wheeler and Ewers examine the neural correlates of self-awareness and self-recognition and suggest that the right hemisphere/prefrontal cortex is primarily the part of the brain responsible for those capacities. Many other papers include quick reviews of the literature of their topic before going on to report on the experimental work or theoretical ideas of the authors. So the book can be used as an introduction to the bewildering diversity of approaches to the self that have been used in psychiatry. Most papers are written in language that will be comprehensible to researchers in a variety of fields.
A number of the papers take a neurological standpoint. Fu and McGuire report on studies of the neural correlates of auditory hallucinations in schizophrenia, and Panksepp explains his work on the neural nature of the self and its relevance to schizophrenia. More papers are rooted in cognitive neuroscience, laying out functional maps for the operation of the mind and discussing how disruptions in particular functions can explain the behavior and experience of people with schizophrenia. The authors of these papers make little direct reference to the operations of the brain and remain instead at the level of the functional architecture of the mind. In this vein, Barnard attempts to explain the core signs and symptoms of schizophrenia using his theory of interacting cognitive subsystems that link visual and auditory experience to language and action. His hypothesis is that asynchronous processing exchanges between two levels of meaning lead to the phenomena associated with schizophrenia. Jeannerod et al. aim at a narrower target, merely focusing on the explanation of the distorted sense of agency of people with schizophrenia. Naturally enough for modular approaches in cognitive neuroscience, they postulate a failure of the agency attribution mechanisms. Similarly, Blakemore and Frith examine the symptoms of auditory hallucinations and delusions of control and postulate that there is a failure in the mechanisms of self-monitoring. Most of this type of work is still in its initial stages and its value will be demonstrated when, among other things, it provides systematic explanation of psychopathology and receives independent confirmation from other areas of psychology. A central worry that accompanies all the system-building and map-making of cognitive neuropsychology is that the proposal of various functional modules sometimes is only motivated by a correlated behavioral finding, and the maps of interrelated functions may amount to no more than a redescription of the phenomena in other terms rather than entities with genuine explanatory value. However, it must be admitted that Blakemore and Frith and other authors in this volume do show how their models inspire experiments, make predictions, and are consistent with experimental data, and the number of papers in this book using such models suggests that theirs is a flourishing research program.
All papers in this collection demonstrate an awareness of the difficult status of the concept of self in psychiatry, but none more so than that of Northoff and Heinzel, who argue that there no single approach to self and self-consciousness is adequate to explain or even be consistent with all phenomena in neuroscience and psychiatry. Rather than conclude that all theories of self are false, they instead suggest that each theory has limited scope. They divide up the approaches into three epistemic perspectives: first-person (FPP), where mental states are directly known from one's own experience, phenomenally and qualitatively; third-person (TPP), where mental states are known indirectly, and are described in ways that allow for intersubjective communication, and where the authors say that there are no qualia. This distinction may seem rather problematic to some philosophers and psychologists, but even more troublesome are the author's claims about what they call the second person perspective (SPP). They suggest that phenomenal judgments in this perspective "can be regarded as a kind of nexus between private experience (via FPP) and public communication (via TPP)" and they conclude that the second person perspective creates the possibility of intrasubjective communication so a person can communicate with him or herself. The relatively brief comments about the three perspectives will likely be confusing to readers and are unlikely to convince readers who are not already sympathetic to their ideas. The authors conclude that the concept of self is relative to perspective, and we should abandon any attempt to find a single correct theory of self. This is a programmatic suggestion that has been elaborated at greater length in other work of Northoff. It is certainly a stimulating idea that might be linked to some of the later thoughts of Peter Strawson, but it is also hard to evaluate since it is pitched at such a broad level.
Some of the best papers in The Self are by philosophers who restrict themselves to relatively modest aims. O'Brien and Opie argue that evidence from the phenomenology of ordinary experience and also the experience of schizophrenics shows that the traditional assumption of the unity of consciousness is mistaken. They argue that the evidence supports a multitrack model of consciousness instead. Further, they suggest that the representational coherence of ordinary experience is commonly mistaken for evidence of a single-track model of consciousness. This paper is tightly argued and gives its readers the opportunity to identify points in the argument where they can take issue and come forward with rebuttals. Similarly, Gallagher's paper on the narrative of self in schizophrenia is a model of clarity. Methodically, he discusses the capacities for temporal integration of information, minimal self-reference, encoding and retrieving episodic-autobiographical memories, and engaging in reflective meta-cognition. Rather than use these to support any particular theory, Gallagher simply explains that these capacities are part of how we generate self-narratives and this helps us understand the difficulties that people with schizophrenia have with self-attribution and their sense of agency.
Gallagher's paper makes reference to another in the volume, of Phillips, on the narrative self in schizophrenia. The highlight of Phillips' paper is a description of a patient, Mr. B, whom Phillips has been treating for 25 years, as well as two other patients whom he knows well. The paper discusses some features of his patients' ability to narrate their own lives and Phillips relates this to a variety of ideas in narrative theory. This stands out as the one of the very few papers in the collection to go into the details of a person's life in any detail and so it serves a particularly valuable service.
Three papers in The Self explicitly associate themselves with the tradition of phenomenology in continental philosophy related to philosophers such as Husserl, Heidegger, Merleau-Ponty, Sartre and Ricoeur — those of Zahavi, Parnas and Sass. Zahavi sketches two philosophical conceptions of self, as a Kantian "pure identity-pole" and as narrative construction, and then proposes the phenomenological approach as a replacement of the first and as an essential foundation of the second. On this view, the self is not an entity, so it is better to talk of self-awareness, which is consciousness of the first-personal givenness of experience. As he points out, this is a very formal and minimalist concept. Zahavi gives a nice summary of some of the recent history of the phenomenological approach and relates it to work in analytic philosophy. Parnas, who has recently written papers with Zahavi, gives a more theoretically complex account of the self, at least in his reference to the development of thought in European psychiatry. He goes on to briefly catalog fourteen cases of schizophrenia where patients had a distorted experience of self and connection to the world. He uses these to argue against the biological view of schizophrenia, and for the view that it is a disorder of consciousness. Parnas also gives some suggestions for how a phenomenological research program would differ from the standard medical approach.
Sass builds on the ideas in the papers of Zahavi and Parnas to give his own particular theory about the kind of disorder of consciousness that constitutes schizophrenia. One of the great virtues of Sass' paper is his ability to bring into focus the disagreements between his approach and those in cognitive neuropsychology. He explains that on his view, it is valuable to retain a unified concept of schizophrenia, while other symptom-oriented approaches tend to see it as a collection of problems caused by biological malfunctions, and thus lacking any real unity. He proceeds to recap his well-known account of the schizophrenia disorder of consciousness as associated with hyperreflexivity, a view he has spelled out at length in a number of works. However, this account is valuable because it is concise and yet has a broad scope. The paper ends with an extended discussion of the case of Antonin Artaud providing a fuller illustration of the rather abstract points made previously.
In the final paper, the book editors, Kircher and David, attempt to synthesize many of the ideas in their collection. This is a worthy idea, but what they leave out is a clear idea of how the different ideas in The Self contradict each other and how the different research programs compete. Collaboration and the mutual enrichment with the sharing of theories is an important part of such interdisciplinary work, but there is energy to be found in the friction and spark when these different projects collide. This is an important collection showing some of the rich work that is being done in theoretical psychiatry, but more work needs to be done on assessing how the authors' suggestions relate to each other, and finding out who is right and who is mistaken.
References
Dennett, D., & Kinsbourne, M. (1992). Time and the observer: The where and when of consciousness in the brain. Behavioral and Brain Sciences, 15, 183-247.
Dennett, D. (1991). Consciousness explained. Boston: Little Brown.
Dennett, D. (1990). Quining qualia. In W. G. Lycan (Ed.), Mind and cognition: A reader (pp. 519-547). Oxford: Blackwell.
