Unawareness of paralysis following stroke: an existential-phenomenological inquiry into the paradox of anosognosia

We inescapably experience the world through our body. Yet as our embodiment itself is the background of all our everyday experience, it appears to be experienced quietly. We tend to take for granted that our body is present in and contributing to all experience, as we also tend to take for granted the feeling that it belongs to us and it is under our control. However, certain neuropsychological disorders that arise after damage to the right hemisphere of the brain serve as a reminder that these feelings and intuitions cannot always be taken for granted. What is more ‘counter-intuitive’ than someone who is unaware of the fact that they can no longer move half their body? Or someone who cannot recognise their own arm or, leg as theirs? These disorders have troubled neurology, philosophy and psychology since the time of Charcot, Janet, Freud and Babinski and continue to represent frequent, largely unmet and poorly studied clinical challenges. The present thesis aims to explore from an interdisciplinary vantage point the way in which the body is experienced in people with such neuropsychological disorders following a stroke. More specifically, it aims to complement current scientific perspectives on these disorders with existential-phenomenological ideas regarding the experience of embodiment in these patients, with particular emphasis on the ‘pre-reflected’ dimensions of embodiment and their derivatives in mental life as highlighted by the philosopher Merleau-Ponty. The empirical part of the thesis involves behavioural and neuroimaging methodologies from the field of neuropsychology, including two case series and one single case study (total N = 14). Three hypotheses inspired by the early writings of Merleau-Ponty on embodiment were explored in these three studies, respectively: (a) whether patients with motor unawareness have a ‘pre-reflective’ awareness of their deficits; (b) whether such forms of pre-reflective awareness may paradoxically contribute to their explicit unawareness and (c) whether insights generated by the above two studies could be translated to a psychophysical intervention that can help a patient recover her explicit awareness of her paralysis. The results of these studies confirmed all three hypotheses, with some theoretical constraints that are discussed in each chapter. More generally, the results of these studies are discussed in relation to both scientific and philosophical theories of body awareness and most importantly in relation to clinical challenges and the scope of existential counselling psychology. I argue that these disorders allow a unique insight into how existential, counselling and psychotherapeutic psychology can position its practice in relation to some of these paradoxical ways of being-in-the-world that are not habitually so ‘visible’, unless revealed by brain damage. These considerations apply particularly to the more general paradox of psychotherapeutic clients who frequently come to therapy consciously hoping to change their habitual ways of being-in-the-world while implicitly, yet with almost equal force, they may hope not to change their commitment to the world

Time to get rid of the 'Modular' in neuropsychology: A unified theory of anosognosia as aberrant predictive coding

Cognitive neuroscience, being more inclusive and ambitious in scope than cognitive neuropsychology, seems to have taken the place of the latter within the modern neurosciences. Nevertheless, recent advances in the neurosciences afford neuropsychology with epistemic possibilities that simply did not exist even 15 years ago. Human lesion studies still have an important role to play in shaping such possibilities, particularly when combined with other methods of enquiry. I first outline theoretical and methodological advances within the neurosciences that can inform and shape the rebirth of a dynamic, non‐modular neuropsychology. I then use an influential computational theory of brain function, the free energy principle, to suggest an unified account of anosognosia for hemiplegia as a research example of the potential for transition from a modular, cognitive neuropsychology to a dynamic, computational and even restorative neuropsychology. These and many other adjectives that can flexibly, take the place of ‘cognitive’ next to ‘neuropsychology’ will hopefully designate the much needed rebirth and demarcation of a field, neuropsychology itself, that has somehow lost its place within the modern neurosciences and yet seems to have a unique and important role to play in the future understanding of the brain

Response to sunitinib (Sutent) in chemotherapy refractory clear cell ovarian cancer

• Case describes a response to sunitinib in clear cell ovarian cancer. • Discussion of unique molecular characteristics of clear cell ovarian cancers; • Practical points regarding dosing and toxicity when using sunitinib discussed

Sense of Agency and Its Disruption

Sense of agency—the feeling of being the author of one’s actions—may be a critical component of one’s sense of self and of one’s interaction with the world. Insights from clinical and experimental neuropsychology, as well as cognitive and computational neuroscience, have provided complementary evidence that the sense of agency arises from the integration of an array of internal and external cues. These frameworks can help to explain how disruptions in one or more of these cues may result in altered experiences of agency. This chapter reviews these explanatory frameworks and shows how important and useful they have become in making sense of an array of clinical observations, from the disorders of control and agency that result from circumscribed brain damage to the widespread attenuation of agency that may characterize psychosis in which no clear brain lesion has been identified

Active Interpersonal Touch Gives Rise to the Social Softness Illusion

Summary Social touch plays a powerful role in human life, with important physical and mental health benefits in development and adulthood. Touch is central in building the foundations of social interaction, attachment, and cognition [1-5], and early, social touch has unique, beneficial neurophysiological and epigenetic effects [6-9]. The recent discovery of a separate neurophysiological system for affectively laden touch in humans has further kindled scientific interest in the area [10, 11]. Remarkably, however, little is known about what motivates and sustains the human tendency to touch others in a pro-social manner. Given the importance of social touch, we hypothesized that active stroking elicits more sensory pleasure when touching others' skin than when touching one's own skin. In a set of six experiments (total N = 133) we found that healthy participants, mostly tested in pairs to account for any objective differences in skin softness, consistently judged another's skin as feeling softer and smoother than their own skin. We further found that this softness illusion appeared selectively when the touch activated a neurophysiological system for affective touch in the receiver. We conclude that this sensory illusion underlies a novel, bodily mechanism of socio-affective bonding and enhances our motivation to touch others