SELF-RELATEDNESS AND
PSYCHOPATHOLOGY
Gerrit [email protected]
Autumn School Heidelberg 24-28 October 2011
Outline Background
Research on the concept of emotion (esp. anxiety) The concept of selfrelatedness
Terminology: not selfreferentiality Three layers in the conceptualization of psychopathology
Selfrelatedness and psychopathology The perspective of selfregulation The functional perspective
Applications Concept of disorder Neuroscience Psychopathology
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Selfrelatedness and psychopathology
Background – concept of emotion Tension between clinical (psychotherapeutic) and
scientific approaches Scientific approach to emotion
Emotion as state with ‘components’ (physiological, motor, verbal output)
Emotion as ‘cognitive’ interpretation (schema theory) Emotion as action tendency (dispositional approach)
Clinical approach Emotion ‘means’ something about the person in a
particular situation They say as much about the situation as about the
person Anger after an insult (nastiness of the other person or
expression of something else that is going on in me or both to a certain extent?)
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Selfrelatedness and psychopathology
Background – concept of emotion Emotions have a ‘self-referential’ structure:
Emotions neither output of a machine, nor just events in a private inner world
Emotions refer not only to an outer situation or to an inner process; by ‘saying’ something about the situation they also and at the same time ‘reveal’ something about the person who has the emotion
Understanding emotion requires understanding of the situation and of the particular way this person relates to that situation: double structure
Compare gestures: similar ‘double’ structure but element of referring back to the person less prominent and more emphasis on the activity instead of receptivity Affectivity: we are affected and the way we are affected does express
something about us (something we sometimes don’t like) Magical transformation of the world (Sartre)
However: self-referentiality is not self-reflexivity!
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Selfrelatedness and psychopathology
Does psychopathology have the same double (reflexive) structure?
And, if not, is there still room for a self-relational perspective?
Two questions5
Selfrelatedness and psychopathology
Does psychopathology have the same double (reflexive) structure?
Answer: no, many forms don’t have
And, if not, is there still room for a self-relational perspective?
Answer: yes
Two answers6
Selfrelatedness and psychopathology
‘Relative independence’ Many forms of psychopathology have a
‘relative independence’ (cf: liver function) Thought confusion (formal) Clouding of consciousness (metabolic,
toxic) Panic attacks (‘typical’ attacks) Some forms of ‘endogenous’ depression End stages of addiction Repetitive behaviour in severe OCD Stress reactions (arousal, heightened
sensory awareness) And so on….
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Selfrelatedness and psychopathology
‘Relative independence’ The confusion (panic, depression, et cetera) does
not in itself say something about the person
The confusion (panic, depression, et cetera) does say something about the person in a trivial sense, i.e., that he/she is in a certain state
However, in dealing with the confusion (panic, depression et cetera) the person does say a lot about him or herself.
In this ‘dealing with’ there is again ‘self-referentiality’
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Selfrelatedness and psychopathology
Three layers Level 1: Being in a certain state
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Selfrelatedness and psychopathology
‘I’ am in a certain state
I
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Selfrelatedness and psychopathology
Three layers Level 1: Being in a certain state
Level 2: Relating to that state
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Selfrelatedness and psychopathology
‘I’ relate to that state
I
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Selfrelatedness and psychopathology
Three layers Level 1: Being in a certain state
Level 2: Relating to that state
Level 3: By relating to that state revealing
something about oneself
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Selfrelatedness and psychopathology
By relating to that state I reveal something about myself…
I
‘The’ self
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Selfrelatedness and psychopathology
…in time…
I
‘The’ self
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Selfrelatedness and psychopathology
I – self relatednes
s
‘The’ self I - others - the world- existence as such- transcendent
reality
Functions/modes
.. in relation with others and the world
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Selfrelatedness and psychopathology
Understanding psychopathology Level 1: signs and symptoms
Level 2: interpretation of these signs and symptoms by the patient and his/her environment
Level 3: life historical perspective; ‘holistic’;
dynamical; existential
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Selfrelatedness and psychopathology
Levels of understanding psychopathology
I
‘The’ self
Level 1
Level 3
Level 2
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Selfrelatedness and psychopathology
The adapted framework
Person Disorder
A B
A = influence of personality on relatedness of the patient to the disorder – example: dependence; narcissistic vulnerability
B = influence of disorder on relatedness of the patient to the disorder – example: hopelessness in depression
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Selfrelatedness and psychopathology
What does this have to do with self-relatedness? (is the concept of ‘relatedness’ not sufficient?)
How does self-relatedness relate to psychopathology?
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Selfrelatedness and psychopathology
Selfrelatedness - concepts The ‘I’ = the person who speaks,
experiences and acts Holistic concept Primitive (P.F. Strawson) Concept at the level of everyday language
‘The’ self The part of oneself the person is (implicitly
or explicitly) referring to by speaking, acting, experiencing
There are many ‘selves’
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Selfrelatedness and psychopathology
The self - dimensions Temporal:
character traits ; dispositions short lasting states
Active – receptive (passive) Agency Basic self-awareness
Experiential Body memory Basic moods Affective dispositions
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Selfrelatedness and psychopathology
The self - dimensions
Second order capacities Self-regulation Integration ‘Reflexive mediation’ (Ricoeur)
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Selfrelatedness and psychopathology
Layers in self-regulation (Murphy 2006) Selfregulation with a fixed goal
Selfregulation by ‘re-setting’ of targets Being able to form images of targets and scenario’s Being able to (mentally) represent abstract goals
Evaluating one’s own evaluation
Homeostasis
Frustration tolerance
Long term change prevails over short term executive functioning
Altruism
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Selfrelatedness and psychopathology
Selfrelatedness – functional perspective
‘I - self’
Functions/modes
Physical - spatiotemporal positioning
Biotic - homeostasis over time
Affective - emotional attunement; attachment
Cognitive - planning, selection, flexibility
Social - positioning oneself in a social universe
Legal - larger responsibilities (institutional) Aesthetic - imaginative play in a social context
Pistic - dedicatedness; ultimate concerns
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Selfrelatedness and psychopathology
Selfrelatedeness – dimensions; modes
‘I - self’
Functions/modes
Physical
Biotic
Psychic
Cognitive
Social
Legal Aesthetic
Pistic
The self (receptive side; attunement; regulation)- Core sense of self, including basic self-awareness- Sense of agency- Experiences that form the basis of
- body memory (Damasio)
- basic mood - affective dispositions
- Second order capacities:- self-regulation- integration - ‘reflexive mediation’
(Ricoeur)
Receptive/active
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Selfrelatedness and psychopathology
What does this have to do with self-relatedness? (is the concept of ‘relatedness’ not sufficient?)
Answer: 1.Psychopathological states influence the
way we relate to ourselves (our states included) (concept of disease not confined to level 1 constructs!)
2.There are many selves and, therefore, many forms of psychopathologically self-relating
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Selfrelatedness and psychopathology
Further consequences Ad 1 (concept of disease not confined to
level 1): Being depressed in a depressed way Example: demoralization
Ad 2 (many selves to relate to): Situation-bound anxieties (social phobia)
can be related to a situational (=social) ‘self’, to character (the way one deals with the phobia; avoidant personality); and to existential concerns (the person exists as ‘disappearing’ subject)
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Selfrelatedness and psychopathology
How does selfrelatedness relate to psychopathology?
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Selfrelatedness and psychopathology
Selfrelatedeness – dimensions; modes
‘I - self’
Functions/modes
Physical
Biotic
Psychic
Cognitive
Social
Legal Aesthetic
Pistic
The self (receptive side; attunement; regulation)- Core sense of self, including basic self-awareness- Sense of agency- Experiences that form the basis of
- body memory (Damasio)
- basic mood - affective dispositions
- Second order capacities:- self-regulation- integration - ‘reflexive mediation’
(Ricoeur)
Receptive/active
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Selfrelatedness and psychopathology
Psychopathology and the self
The self PsychopathologyCore sense of selfbasic self-awarenessSense of agency Schizophrenia
Experiential basis of Body memory Disorders of body schema; anorexia nervosa?
Basic mood Dysthymia
Affective dispositions
Anxiety disorder incl PTSS
Second order capacities
Self-regulation Impulse control disturbances; addiction
Integration Personality disorder (cluster B)
Reflexive mediation Lack of insight
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The functional perspective and psychopathology
Functions/modes Psychopathology (executive functioning)
Physical spatiotemporal positioning
Neurological disorders (Parkinson; dizziness)
Biotic homeostasis Derailed HPA axis (depression)Affective
emotional attunement; attachment
Disorders of attachment; psychopathy; anxiety disorder
Cognitive
planning, selection, flexibility
Frontal lobe dysfunction in dementias, OCD and schizophrenia
Social positioning oneself in a social universe
Autism spectrum disorder, schizoid PD
Legal larger responsibilities (institutional
Behavioral disturbances
Aesthetic
(self-)expression in imagination
Hysteria; OCPD
Pistic orientation toward ‘transcendent’ reality
Lack of self-transcendence (Cloninger)
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Selfrelatedness and psychopathology
Applications - the concept of disorder
Genetic abnormalities
Neurocognitive defects
Clinical phenotype
Social and cognitive impairments
Environmental effects
- Biological- Emotional- Educational- Social
Compensating effects
- Intellectual- Social
Comorbidity
◄
►
►
►
◄
◄
Concept of disorder could in principle refer to each of these levels
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Selfrelatedness and psychopathology
Applications - neuroscience Moving away from a computationalist (modular)
approach toward a connectivist, ‘embodied cognition’ approach
Perception-action cycles Hierarchy of intersecting cycles that include the
environment (Fuster, Walter) Example: learning of contingencies in emotion
recognition vocal sound and lips facial expression and inflection of voice emotional value of these expressions ‘emerges’
over time in an adequate context
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Applications - enactive approach to psychopathology Knowing is not mirroring; it is not just respresenting
the world; it is a result of engagement with the world
The process of knowing (the ‘mind’) is an emergent phenomenon of complex interactions between the subject and the world
Therefore: meaning is contextual (example: chair) These interactions are primarily bodily (= shared
bodily practices) and acquire ‘emerging’ (=new and qualitatively distinct) properties in the course of a person’s development
Therefore: the mind is embodied; meaning is ‘in’ the body (gestures, actions, behaviour)
Self-relatedness and psychopathology
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Empathy – the common view
Resemblance- Bodily posture- Emotional expression
Inference with respect to the other
based on body-mind assocation in oneself
Subject, perceiverObject; the person that is perceived
Self-relatedness and psychopathology
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Empathy – the enactive view
We know others by acquaintance and by
sharing practices
Subject, perceiverObject; the person that is perceived
Self-relatedness and psychopathology
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Selfrelatedness – functional modes
Functions/modesPhysical
BioticAffectiveCognitive
SocialLegal
AestheticPistic
Primacy of - the world- others- spiritual
realities
Calling
Response
‘I - self’
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I – self relatednes
s
‘The’ self I - others - the world- existence as such- transcendent
reality
Functions/modes
Self-relatedness – conceptual framework
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Evan Thompson Enactivism: input and output are
interconnected (vs. sandwich model)
The ‘brainweb’ organizes itself and its interactions with the environment in parallel
Global processes “subsume their components so that they are no longer clearly separable as components”(423)
Evan Thompson Causation nothing else than
an “organizational constraint of a system with respect to its components” (interconnectedness; relatedness among processes)
Relational holism instead of top-down causation
Isomorphism between the levels
Self-relatedness and psychopathology
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Selfrelatedness and psychopathology
Self-relatedness and psychopathology
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Selfrelatedness and psychopathology
Self-relatedness and psychopathology
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Selfrelatedness and psychopathology