Michelle Maiese’s Embodied Selves and Divided Minds argues that the understanding of human consciousness as essentially embodied, is crucial for the understanding of the sense of self, personal identity, and mental disorders. She notes that the prevailing view in inquiries into human consciousness, has been one where the brain is seen as the focal point of our consciousness. It has been taken for granted that our mental capacities and our “internal model of the world” is brought about through “the computational processes in the brain” (p.1). Arguing against this claim, Maiese endorses the essentially embodied model of consciousness and cognition inspired by the works of existential phenomenologists, who emphasize the unique role of the human body in determining our mental states.

Maiese notes the link between this view of consciousness and enactivism, and proposes that “mindedness is rooted in the living bodily structural dynamics associated with metabolism, self-regulation, self-maintenance, and adaptation” (p.3). Furthermore, she argues, drawing on her previous work, that the process of sense-making is fundamentally affective: “it is in and through living animals’ desiderative feelings of caring that they make sense of their surroundings” (p.4). As such, our mindedness is not only essentially embodied, but also bound up with affectivity and emotions.

Using this central account of the mind and consciousness, the first half of the book fleshes out this account of the “embodied, enactive, and affective mind”. Chapter two explores how this way of thinking about the mind helps us to understand self-consciousness, while chapter three addresses personal identity. Using the proposed theories and accounts, the second half of the book turns to cases of mental illness, and considers schizophrenia (Chapter four) and dissociative identity disorder (Chapter five). The book concludes with suggestions for treatment methods, in line with the theories explored that would prove helpful in treating the aforementioned disorders (Chapter six).

In the first chapter, a detailed account of sensorimotor subjectivity is explored. As the basic mode of subjectivity, sensorimotor subjectivity is construed as “the matter of experiencing oneself as a situated, forward-flowing, living organismic body of suitable degree of neurobiological complexity” (p.7). This primarily bodily awareness, in turn, forms the basis of all other conscious states. Central to the exploration of the “natural matrix of sensorimotor subjectivity” is the claim that although this matrix necessarily includes the brain, it is not limited to the brain and indeed is maintained through the various bodily characteristics and mechanisms that are essential for it. Sensorimotor subjectivity has a necessarily spatial and temporal structure, since one experiences one’s conscious states, feelings and sensations as happening within the bounds of one’s body and in the here and now. It is also egocentrically structured and intentional, having an ‘inner’ source point and being directed outwards to a certain object. And lastly, sensorimotor subjectivity necessarily involves conative affectivity lending positive or negative feelings to subjective feelings, which, Maiese maintains, necessarily involve desire. This is since objects and events affect us and their meaning and importance is felt. Affectivity is linked to a creature’s needs, insofar as the needs constitute what it is like to be that creature, and to say that a creature has felt needs is to say that it desires things.

All of these elements are necessary for the structure of sensorimotor subjectivity and consciousness, and Maiese shows that they are “physically grounded in the endogenous processes and self-organizing neurobiological dynamics of our living animal bodies”. (p.13) Thus she shows that it is through our lived body and bodily experiences that we gain knowledge and understanding about the world and engage with the world from a unique point of view. Furthermore, it is shown that in more complex animals the nervous system establishes a sensorimotor cycle in which sensory experience and movements are interdependent, and in this sense the sensorimotor coordination allows for the active pursuit of what the animal needs or wants – desires – which lies at a distance in space and time. It is through this analysis that Maiese accounts for a system of consciousness based upon the body and desiderative systems.

Using the emphasis placed on affectivity and the claim to the affective quality of bodily sensitivity and sense-making, Maiese puts forward an account of “affective framing”, as found in minded animals such as ourselves. As a form of information filtering, affective framing is construed as a mode of presentation that allows the minded animal to avoid the clutter of information available to it, reduce it to something first-personally manageable and confer upon it specific cognitive significance. This notion helps to conceptualize the way in which sense-making is fundamentally emotional, and how the conative affectivity of sensorimotor subjectivity is bound up with the intentional directedness of first-person experience. It is also shown that the cognitive-emotional interpretations that constitute affective framing are physically grounded in the organismic processes of self-regulation. This notion is crucial for Maiese’s account, since it is what allows her account to be applicable to different phenomenon such as mental disorders and their treatments.

Chapter two is concerned with the notion of the self. Maiese advocates the stance of empirical realism about the self, arguing that both the sense of self and the self itself are real, and are in fact essentially embodied phenomena rooted in our biological nature. To do this, she advocates for the Essentially Embodied Self thesis which “says that our basic sense of self is immanently reflexive and pre-reflective; necessarily involves an egocentric, spatial, and temporal structure; is a natural outgrowth of our animate, neurobiological dynamics; and is rooted in desire-based, bodily feelings of caring” (p.50). Thus, it is argued that sensorimotor subjectivity provides the foundation for a sense of self. She shows that all of our conscious thoughts and sensations involve an immanently reflexive, implicit sense of self that is bound up with bodily awareness. As such, far from viewing the body as the vessel for the essentially mental nature of self, she argues that “the self should be understood as consisting in an essentially embodied point of view” (p.67). In this sense, cases of extreme physical injury, are seen to alter and cause extreme disruptions to one’s sense of self. Contrary to some other views of the self, she argues that this is because there is no purely mental, core self that exists unchanged through time no matter what happens to one’s body.

This account of the self, following directly from Maiese’s account of consciousness, holds that the central role of the body and our bodily self-consciousness, is what allows for the distinctions between the self and others, and objects in the world which allow for the construction of engagement and meaningful relations with the outside world. This is due to the “spatiotemporal continuity” of the body, since as the grounded single view point, “one’s world both radiates out from one’s body and also flows back in toward it” (p.72). Furthermore, the body is construed as “a locus of caring” (p. 80), with the basic sense of self consisting in desiderative bodily feelings that allow the subject to care in various different ways about her surroundings and her experiences, and will different parts of her body to move. This also explains the directedness of perception and action and the reason why certain objects in one’s environment are seen as significant. This further strengthens Maiese’s claim in the first chapter that one’s body is a lived body situated in the world, where the meaning, significance and possibilities for perception and action are all fundamentally a matter of desire and affectivity: “What gives one a sense of self, of an ‘I’ or a ‘me’, is the possession of an egocentric perspective, grounded in desire-based bodily feelings, and commonly manifested through agency and bodily experience” (p.82).

Chapter three aims to offer an account of personal identity following from the previous claims, and in particular as implicated by the Essential Embodiment and Essentially Embodied Self theses. In order to do this, Maiese first surveys the two main approaches to personal identity in the literature: the psychological approach, which maintains that a self persists over time by virtue of facts about psychological continuity, and the biological approach which sees psychological continuity as irrelevant and instead claim that a self persists over time by virtue of facts about biological continuity. Incorporating the strengths of both accounts, Maiese offers a hybrid account, the Minded Animal Account of personal identity, arguing that the persistence conditions of creatures like us are both biological and psychological. According to this account, although persistence over time is grounded in some sort of biological continuity, what is also necessary is “some basic capacity for mentality and mental functioning” (p.94), namely sensorimotor subjectivity, which in turn requires the continued existence and functioning of the neurobiological activity in the body. As such, a “Minded Animal” as the entity that is a creature like us, “can be defined in terms of intrinsic, structural properties, –for example, egocentricity, spatiality, temporality, and affective intentionality” (p.119). And the defining capacity of a minded animal, sensorimotor subjectivity, is fully bound up with these structural properties and affective framing patterns, argued at length in the previous chapters. This way of conceptualizing the conditions for the persistence of self, shows the interconnectedness of psychological and biological elements and the necessary incorporation of both approaches to personal identity in Maiese’s account.

Chapter four considers schizophrenia. Maiese maintains that underlying the seemingly diverse symptoms (such as delusions, hallucinations, disorganized speech and avolition) are an altered sense of selfhood and a diminished sense of ownership. A divorce between subjectivity and the sense of ownership is at the heart of the strangeness of the experiences. Following the previous arguments, namely that our drive for life is bound up with bodily attunement and the subject’s affective framing processes, and that our basic sense of self is essentially embodied and bound up with the desiderative feelings of affective framing, it is argued that the characteristic symptoms of schizophrenia are accounted for by a disruption to a subject’s affective framing processes: “Attenuated affective framing is the basic disturbance that explains subject’s bodily alienation and depersonalization, their loss of common sense, their tendency toward hyper-reflexivity, and their delusions of disownership. In other words, a disruption to affective framing is the ‘underlying characteristic modification’ that ties together the various symptoms of schizophrenia and explains subject’s loss of a sense of ownership” (p.141).

In a detailed discussion it is argued that the disruptions in mental life involved in schizophrenia ought to be understood as disruptions in essentially embodied consciousness, rather than simply in terms of breakdowns in neurobiological functioning. Following this discussion, it is shown that attenuated affective framing is at the heart of the symptoms involved in schizophrenia, since affective framing “is the process whereby we interpret persons, objects, facts, states of affairs and situations in terms of embodied desiderative feelings” (p.167), and a disruption to this process results in divorce between subjectivity and a sense of ownership, from which the various symptoms of the illness arise.

Chapter five examines the phenomenon of dissociative identity disorder (DID) and the way it relates to the proposed account of personal identity. Arguing against the Multiple Self Thesis, it is argued that DID “is a psychological disorder undergone by one minded animal, and thus by a single self” (p.187), and that it is indeed due to extreme fluctuations in the neurobiological dynamics of a single minded animal that this disorder arises. Similar to the cases of schizophrenia, symptoms of DID are accounted for in terms of the affective framing processes. However, unlike schizophrenia where a diminished affective framing capacity underlies the symptoms and experiences, many of the characteristic symptoms of DID result from overdeveloped and disjointed affective framing patterns. These disjointed affective framing patterns, it is shown, arise from an extreme form of ambivalence characterized by conflicting desires and emotions, which make it difficult for subjects to have fully unified experience of their emotions, and thus take on different perspectives and modes of bodily attunement at different moments, which result in an apparent partitioning of personalities and an inability to approach the world from a single point of view.

It is further argued that the dissociation involved in DID can be characterized in terms of depersonalization – i.e. cases where the subject feels detached or estranged from herself, or in terms of compartmentalization – an attempt to establish boundaries between various aspects of self. It is thus argued that often DID arises as a response to a traumatic experience, where the subject tries to distance herself from the event and her experience of it. The conflict often involved in these cases, such as the conflicting tendencies to both escape from a memory and deal with it, is construed as the source of such estrangement from oneself which could develop into DID. Such alterations in one’s emotions and perspectives on the world, as has been shown, are rooted in the affective framing processes and as such, the characteristic symptoms of DID are explained in these terms.

Lastly, chapter six explores the implications of the Essentially Embodied Self thesis for the treatment of schizophrenia and DID. Since, following the arguments in chapters four and five, both disorders involve disruptions to the essentially embodied sense of self, it is argued that “treatment should involve interventions that seek to transform overall bodily and neurobiological dynamics and foster more robust and integrated affective framing patterns” (p.227). Such a treatment would involve a holistic and comprehensive behavioral intervention that attends to the whole living body, while taking seriously the lived experiences of patients suffering from these disorders and focusing on the recovery of the sense of self.

Following a critical discussion of the “medical model” and the emphasis it places on a neurocentric view of psychopathology, it is suggested that this model be revised, at least in terms of its approach to mental disorders. Noting the different approaches to treating what are seen as mental disorders compared to the biological illnesses, Maiese points out that according to the view of essentially embodied mind which has been advocated in the book, any breakdown in mental functioning must be understood at least partly in terms of biological dynamics, as has been shown in cases of schizophrenia and DID. Maiese thinks we should not target a “broken brain” in cases of mental illness, but rather use an approach that would involve one’s living and lived body as a whole (p.233). This would mean attention to phenomenological distortions in one’s mode of being-in-the-world, as well as disruptions in the dynamics of the living body, in particular those of affective framing processes. Such body-centered therapies, as suggested, involve yoga, dance and movements with music, for treating both schizophrenia and DID with evidence pointing to their effectiveness.

 

Embodied Selves and Divided Minds examines the ways in which research in cognition, in particular embodied cognition, can illuminate our understanding of psychiatry and psychopathology. The detailed argumentation and reference to previous works, makes the book a rich source for those interested not only in the dialogue between philosophy and psychiatry, but also in the philosophy of mind more generally. Furthermore, the book serves as a good example of the ways in which phenomenology and philosophy of science can work hand in hand. However, the complexity of the account, especially in the first half of the book, does make the book more suitable for postgraduates and professionals in the field than undergraduates and members of the public.

The appeal of the book to such a wide range of audience is amplified by the holistic approach to the topic taken by Maiese, which means that at every stage of the argument the reader is familiarized with the expansive advances and shortcomings of the previous works in the field. This also helps Maiese in strengthening the account put forward, by enabling her, not only to construct her account with an eye on the drawbacks of the previous accounts, and attempting to answer them, but also to respond to possible objections in advance.

The account put forward, offers a strong informative position in the literature, thanks to it being grounded in both theoretical and credible scientific frameworks. This is further due to it offering an approach to psychopathology and treatment methods that view the “human in disorder” as a whole; with the bodily feelings and experiences at the heart of the account, while also attending to the phenomenological disturbances in one’s mode of being in, and relating to the world. This awareness of the holistic nature of psychopathology is reflected not only in the account as a whole and implications of it, but is also seen from the very start in various stages of development the account goes through in the course of the book. Together, these characteristics make the book an invaluable addition to the International Perspectives in Philosophy and Psychiatry series. 

 

© 2016 Moujan Mirdamadi

 

Moujan Mirdamadi, Lancaster University, Lancaster