James Phillips

Psychopathology and the Narrative Self

Focusing on four cases presented by Lloyd Wells, M.D., this paper addresses the relationship of clinical psychopathology to the philosophical concept of narrative identity. The paper begins with a review of the debate among historians, literary critics, and philosophers over the referential status of narrative identity, that is, whether the narrative self is a fictive structure unrelated to lived life or whether ordinary life is in fact lived narratively. Agreeing with those philosophers who argue for the reference of narrative identity to actual life, the author analyzes the four cases from the perspective of narrative identity to determine what light this philosophical concept sheds on the various psychopathologies. Then, having used the philosophical concept to illuminate psychopathology, he reverses direction and questions what psychopathology has to offer philosophy and its notion of narrative identity. The author argues both that the philosophical concept of narrative identity contributes to our understanding of psychopathology and that psychopathology offers challenges to the philosophical notion of narrative identity.

Arguing From Neuroscience in Psychiatry

PHILIP GERRANS “A One-stage Explanation of the Cotard Delusion” provides an elegant example of the application of neuroscientific findings to known clinical phenomena in psychiatry. Gerrans argues that, in the cases of the Cotard and Capgras delusions, a one-stage explanation is sufficient to account for the clinical phenomena. That is, the neuroanatomic defect and the consequent anomalous experience are sufficient to produce the delusion. According to Gerrans, we do not need to postulate that the delusion will emerge only if the anomalous experience is filtered through a faulty reasoning process (a two-stage explanation). Against the argument of Young and Leafhead (1996) that Cotard and Capgras delusions stem from the same neuroanatomic deficit and differentiate only in being processed differently—thus requiring a two-stage explanation—Gerrans argues that the respective neuroanatomic defects are in fact different, and that, therefore, the two delusional syndromes differ at the first stage and do not require the two-stage explanation suggested by Young and Leafhead. I do not have an opinion as to who is right in this disagreement, and I will devote these remarks to explaining why I do not have an opinion. In developing this explanation I will touch on what I find problematic in many discussions of neuroscience, neurocognitive models, and clinical psychiatry; I will thus use this article to highlight those problems. On the face of it, one would think that the issue raised by Gerrans should admit of a simple resolution. He argues that Capgras and Cotard delusions derive from different neural defects. Young and Leafhead, on the other hand, base their two-stage argument on the argument that the two delusions derive from the same neural defect. So which is it? Neuroscientists should be able to settle the issue and end the dispute. Gerrans remarks “that we need to look more closely at the CN [cognitive neuropsychiatric] explanation of the Capgras delusion.” As he describes it, face recognition involves two components, a cognitive and an affective component, with separate neuroanatomic substrates. An individual successfully recognizes the face of a friend or acquaintance when she matches the cognitive recognition (cognitive component) with the affective tone of familiarity (second component). When there is a lesion in the neural substrate of the affective component, she may recognize the face but without the tone of familiarity. In her effort to understand her affective experience of the face as alien rather than as familiar, she may conclude that her friend has been replaced by a double. Thus we have the Capgras delusion. Let us now unpack this explanation. According to Gerrans, researchers have hypothesized

Kimura Bin on Schizophrenia

WITH “COGITO AND I: A Bio-Logical Approach,” Kimura has continued his research into the core disturbance in schizophrenia. In his work, he has combined an original phenomenological approach with some fundamental concepts taken from his native Japanese and Zen culture. As in the work of others in the tradition of phenomenological psychiatry, he has focused on a basic disturbance that underlies the positive symptoms found in schizophrenic conditions. In what follows, I will attempt to relate this current effort to some of his previous work on schizophrenia. I will conclude this commentary with some remarks on what I find problematic in the treatment of Heidegger. In “Cogito and I,” Kimura plunges us directly into the core ego disturbance of schizophrenic patients by quoting two patients who, each in his own words, describe a pathological split between what we may call a “subjective” and an “objective” I or self. The latter is the self that acts and is recognizable by others (and by the patient) as the agent acting in the world. The former, the subjective self, is the non-objectified sense of self or self-awareness that accompanies all our actions. The two must be integrated, and it is a failure of this integration that is at the basis of the schizophrenic’s ego disturbance. We can gain further clarification of this central notion in Kimura’s treatment of schizophrenia through reference to some of his other discussions of the topic. In “Reflection and Self in the Schizophrenic” (Kimura 1992b), he invokes Husserlian terminology to discuss the same polarity within the self.1 In this study, he distinguishes “simultaneous reflection” (the subjective self) from “secondary reflection” (the objective self). In the latter, the self is a noematic object of reflection; it is the image of myself after the act, the I that has done something and can now be captured in reflection. While “Cogito and I” describes the schizophrenic split as between the noematic self and the noetic self of simultaneous reflection, “Reflection and Self in the Schizophrenic” locates the split further back within the noetic self. Kimura distinguishes in the noetic self an observing I from the I that is moving toward action, both prior to the noematic self of secondary reflection. “One could say that a subjective self here accompanies an other self no less subjective and observes it constantly ‘from behind’. There is no objective, noematic self involved here; a sole noetic self splits into two simultaneous ‘moments’ which occupy alternitively the places of seeing and seen, and which nonetheless remain subjective-noetic” (Kimura 1992b, 118). Pélicier emphasizes this Husserlian analysis in his exposition of Kimura Bin’s phenomenological treatment of schizophrenia:

Salvaging Locke's Self

LET ME BEGIN BY ACKNOWLEDGING Marya Schechtman’s admirably clear presentation of Locke’s view of personal identity, the problems inherent in that view, the efforts of “psychological continuity theorists” to rectify the flaws in Locke’s argument, the problems in their attempted rectifications, and finally her own proposals for rescuing Locke’s view of personal identity. My comments focus on the problems I see in her use of the psychoanalytic unconscious to preserve Lockean personal identity and on my own suggestions for sustaining her argument. In her paper, Schechtman first describes Locke’s account of personal identity and its problematic dependence on a notion of overlapping conscious memories. She then outlines the unsuccessful attempts of Locke’s descendants—the psychological continuity theorists—to make good on his account. In the final section, “An Alternative Account,” Schechtman offers her own proposal to compensate for the inadequacies of Locke’s account of personal identity by introducing the notion of the unconscious. The gaps in memory that render Locke’s version of the self fragmented and discontinuous can be filled in by substituting for Locke’s conscious self a self that includes unconscious content. “. . . [I]t is necessary to give an account of the attribution of particular actions and experiences that allows for the attribution of unconscious elements as well as conscious ones” (Schechtman 2005, 18). Schechtman marshals her argument in two steps. First, she argues for replacing a rather passive view of the self as witness to one’s past through memory with a version of the self that is actively engaged in making sense of one’s life.