So many psychiatric disorders are explained in terms of the way the patient experiences herself that, even if intuitive or philosophical theories which posit a self as the object of experience are not correct, there is an interesting phenomenon there to be explained. My idea is that the best integrative explanation of those disorders is ipso facto the best philosophical theory of self-awareness because those disorders cannot be explained other than via a model of the way the experience is generated in normal and abnormal situations.[2] Once we have explained those disorders we can determine the theoretical utility of overlapping folk, clinical and philosophical conceptions of self-awareness. Thus, the approach I take is consistent with that proposed by Dominic Murphy in his plea for a (cognitive neuro) scientific psychiatry: “we arrive at a comprehensive set of positive facts about how the mind works, and then ask which of its products and breakdowns matter for our various projects” (2006, p. 105).
So until the concluding sections I use the term self-awareness to refer to the experience we report in terms of awareness of being a unified persisting entity: the same person at a time and over time. It may turn out that such experiences are illusions or misinterpretations of some other phenomenon, perhaps because there are no such entities as selves, but I delay that discussion until the evidence is assembled. To anticipate, I think the intuitive folk concept of self-awareness is very like the intuitive concept of episodic memory, which is of “re-experiencing” a previous episode. Cognitive neuroscience tells us that in fact episodic memory experiences are constructed to suit current cognitive context rather than retrieved intact. However it does no harm in everyday life to think of episodic memory as content-preserving retrieval of past experience. Similarly the intuitive conception of self-awareness tracks processes which, when they function harmoniously, produce experiences that provide a plausible basis for the concept of a unified and persisting self. That concept, while not entirely accurate, provides a useful ability to represent and communicate sufficient unity and persistence. If I tell you I will be happy to pick you up at the airport you need to be able to rely on me to be at the Arrivals gate. The precise nature of my (dis)unification as a single self is not relevant. If I told you I would send my body but would not be present myself you would phone a psychiatrist. (It would be super to be able to deputise your body to attend departmental meetings, weddings etc. on your behalf, wouldn’t it?) Yet something like that phenomenon of alienation occurs in depersonalisation, as a deeply felt and distressing phenomenon. The difference in experience between people with depersonalisation and those without it is an essential explanandum both for psychiatry and for philosophers interested in the (possibly illusory) phenomenology of selfhood.
The rest of the chapter proceeds as follows. I first discuss the Cotard delusion, in which people say that they have died, disappeared or do not exist (délire de négation). The Cotard delusion raises a set of questions about the relationship between self-awareness, bodily experience, and affective processing. I outline some suggestive intuitive answers to these questions based on the phenomenology of the disorder but argue that they are insufficient as explanations. A deeper explanation is provided by the cognitive neuroscience of depersonalisation. That explanation relies on a theoretical framework that draws on
The appraisal theory of emotion
The simulation model of memory and prospection
The hierarchical predictive coding model of cognitive processing
This framework allows us to explain how:
affective experiences provide the basis for self-awareness as a distinct form of bodily awareness moment to moment
those moment to moment experiences of self-awareness can be annexed to cognitive processes whose temporal reach is longer than the present, creating the experience/illusion of a continuing self
when affective processing is compromised the resultant experience is reported as change, or in extreme cases, loss, of self. Mere absence of bodily or affective response per se does not lead to depersonalisation. What leads to depersonalisation is the absence of predicted affective responses that normally constitute self-awareness that leads to depersonalisation. This explanation also provides a full explanation of an intriguing phenomenological observation made by Cotard about the role of anxiety in generating depersonalisation.
With this theoretical framework in place I discuss depersonalisation disorder and depersonalisation aspects of the Cotard delusion, resolving some of the questions raised by the initial phenomenological explanation.
Once those questions are answered we can make some comments on the theoretical utility of philosophical theories of self-awareness, which for convenience I classify into four types: Illusory Self, Fat Controller, Embodied Self, Narrative Self. The Illusory Self is a version of the Humean idea that self-awareness is either illusory or a theoretically loaded misdescription of some other experiential phenomenon (perceptual, interoceptive, emotional, somatic). It is quite consistent with the Illusory Self theory that the experience is a “necessary illusion” created by architecture installed by evolution. The Fat Controller theory is that self-awareness is the experience of a genuine substantial self, a locus of higher order cognitive integration and top down control (like the aptly-named Will Self’s Fat Controller in his Quantity Theory of Insanity). Embodied Self theories identify self-awareness with forms of bodily awareness. Finally there are Narrative views of the self, thin and thick. On the thin view the self is a “centre of narrative gravity”, a fictive entity generated by the Joycean machine to organize and communicate. On thicker views the self is not a fiction but a genuine cognitive entity whose essence is to construct and communicate its own autobiography as an essential aspect of higher order cognitive control. The Thin view goes naturally with the Illusory Self view: it explains the persistence of the Illusion, while the Thick view (naturally enough) fits well with Fat Controller views.
Cognitive neuroscience does not vindicate any of these theories. However this does not mean that we should regard the phenomenon of self-awareness as empirically disconfirmed. It turns out that there are cognitive processes that generate experiences with some of the properties ascribed by different theories under different conditions. So, as with episodic memory, rather than explaining self-awareness away, we can describe and explain the nature of the experiences reported as self-awareness in terms of the structure of the processing which generates it. Self-awareness is a cognitive illusion, based on the nature of affective processing. The relevant experience plays a crucial role in higher levels of cognitive control that organise and communicate experience in narrative form: fragments, episodes, chronicles, histories and epics (Currie & Jureidini 2004; Goldie 2011; Jureidini 2012). This conjunction of processes makes self-awareness an irresistible illusion. The nature and necessity of this illusion is shown by the nature of the disorders that arise when it fails.