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.