The Image and Appearance of the Human Body

Paul Schilder

• Editorial: Routledge
• Año: 2013
• ISBN:
  9781136338281
• Edición: 1
• Categoría: Medicine
• Categoría: Health Care Delivery

First Published in 1999. First Published in 1999. This is the final volume of 10 from the international library of psychology, looking at physiological psychology and focuses on the image and appearance of the human body, Studies in the Constructive Energies of the Psyche. This book attempts to achieve a deeper insight into the nature of the creative process and emphasizes the constructive psychic effort by which new entities are created. Emergent evolution and gestalten in the psychic sphere are not merely data which are given to us as a present; they have to be obtained by struggling.

PART I

THE PHYSIOLOGICAL BASIS OF THE BODY-IMAGE

(1) Postural and tactile impressions in relation to the body-image

As quoted above, Head emphasizes that even when the visual image is preserved and the sense of posture is impaired, the individual will, if tactile localization is preserved, show the spots where he has been touched, though in the place of the previous posture of the arm and not on the arm, when it is removed to another place, because the movement of the arm has not come to his knowledge. Head therefore regards the postural impression as the basis for the postural model of the body. There is a standard of postures, against which all new incoming perceptions are measured. Head brings the hypotonia, the flaccidity observed in cortical lesions, leading to a disturbance of the sensibility, in immediate connection with a disturbance of the postural model of the body.

I can verify by my own experience Head’s observations that there are cases in which the patient can localize the touch and know which particular spot of the arm has been touched, but is unable to determine the position of the arm in space. But I cannot follow his argument that this proves that the postural model is based on posture. I would say on the contrary that this observation proves that an optic image of the body is now present to which the perception is brought in connection. These very observations show the importance of the optic part of the postural model of the body.

I may here draw attention to an observation I published some years ago.¹ The patient suffered from an apoplexy on a luetic basis. She had a serious right-sided hemiplegia of predilection type. She had unimportant spasms and peculiar disturbances of the sensibility of the right side. There were paraesthesias in the

¹ Cf. the case report in the Appendix (case a).

face. The sensibility to thermal stimuli, tickling, faradic current, and the sense of posture, were impaired. In contrast to this, she appreciated weights quite well. There was a tendency to hallucinatory experiences; for instance, the patient might feel her hand moved without objective basis. In the tactile sphere there was also a tendency to hallucination. The patient showed polyaesthesia (multiplication of sensations) in this part of the body for tactile, thermal, and pain sensations. One stimulus was felt there several times, at least twice. She localized the various sensations which were provoked by one stimulus in points which were nearer to the end of the body (more distal) than the irritated spots. The interval was between 4 and 10 seconds. The ensuing sensations were very often indefinite sensations of touch. The deep-sensi- bility also showed a tendency to polyaesthesia. Sensations of the otherwise healthy part of the body were transferred after an interval of from 4 to 10 seconds to the impaired side. The quality of the sensations did not change during the transfer. In this way there might appear warm sensations on the right side, which the patient could not get in any other way. This sensation on the right side of the body, which was transferred from the left side, was followed by one or several after-sensations. The discrimination (differentiations of two simultaneous touches) was good on the right side, whereas the localization showed serious disturbances which were not quite constant and were also very dependent on fatigue.

The patient could not recognize objects placed in her right hand. She probably had a lesion, which went from the capsula interna towards the cortex of the gyrus centralis posterior and of the parietal lobe. The thalamus was probably only very slightly impaired. In this case the warm sensation of the healthy left side was transferred unchanged to the right side, which in itself was not capable of feeling any heat. The patient therefore transferred sensations to symmetrical parts of her body under the lead of the unimpaired optic parts of the postural model of the body. We meet here for the first time the interesting phenomenon of Allochiria or Alloaesthesia, first described by Obersteiner. Sensations of the left side were transferred to the right side and vice versa. Our patient felt touches on the left side correctly, but this sensation was followed by one on the right side. There was an actual transfer of sensations from the left (healthy) side to the right (affected) side. It is true that there were sometimes spontaneous tactile-kinaesthetic sensations on the right side (hallucinations), but they were irregular and there was never a thermal hallucination on the right side. The left-side sensation provoked the right- side sensation. Only in two other cases (Brown-Séquard and Hammond) was the sensation transferred, as in our case, from the healthy side to the sick side. In most of the other cases the sensation was transferred from the sick side to the healthy side.

There is a good reason for the transference of the left-side sensation to the symmetrical spot of the right side of the body. According to Brown and Stewart, the sensation when a special point is touched is different from the sensation in other parts of the body ‘character’. According to them, all touches of one point must have a particular individuality, which the pain and temperature sensations of the same point have in common with them. But even if the touch of one point provoked a sensation different from all other sensations and similar to all previous touches of the same point, the correct localization of this point on the surface of the body would not be warranted. Every touch must also have a special topical position on the surface of the body. This may be called a position factor. One may not be convinced that the differentiation of individuality and character are necessary; but there is no question that the position factor is absolutely different from the factors of individuality and character. Individuality and character of symmetrical points on the surface of the body are certainly very similar to each other. We may suppose that symmetrical points are very closely connected with each other physiologically. I shall comment later on the experimental proof offered by the interesting findings of Dusser de Barenne. But there is at any rate a close psychological relation between symmetrical spots on the body. Volkmann has proved that when one exercises one side of the body the contralateral parts of the body improve in their faculty of localization. We know that every touch provokes a mental image of the spot touched. These optic images are certainly of very great importance for the localization.

In the experiments of Klein and Schilder the optic image was a small circle round the spot touched. But this limited and seemingly disconnected impression in the consciousness was an im portant lead to localization. It helped to determine the position of a finger in space which was otherwise unknown. It must therefore have helped to an ‘optic representation’ of the space round the spot touched. But no conscious optic picture of the finger and its position in space was present. We thus come to the formulation that the optic images which are in our consciousness are only a small part of what is actually going on in the psychic sphere. Whether there are images on the unconscious level or whether we deal only with somatic vestiges cannot be decided. We shall meet this problem again. But we know that whenever a touch takes place, a variety of mental processes start, which bring this touch into connection with our other experiences. Everything points to the conclusion that the ‘Localzeichen’

(sign of localization) is not given with the sensation itself but is added to it.

In our case the patient was unable to localize in spite of the fact that she could differentiate two neighbouring points. It is worthy of remark that the patient usually localized correctly a touch on her nipple. There are certainly points which are so distinguished in their individuality and character that they are easily brought in connection with the optic part of the postural model of the body. The lack of power of localization is not due to a lack in the sense of posture. The patient was also unable to localize on her trunk and unable to show the relative position of a point touched on her arm and leg. Head has already pointed out that there are schemata which teach us about the relation of the different parts of the body to each other. We arrive at the following preliminary formulation:

(1) The sense of posture plays a part in the building up of the knowledge of our body.

(2) There is connected with the faculty of localization the possibility of building up the knowledge of the relation of the different parts of the surface to each other.

(3) There is an optic image of the body, which is independent of the tactile images mentioned so far.

(4) Symmetrical parts of the body are physiologically and psychologically connected with each other.

(5) The optic perception and imagination emphasize the tactile similarity of symmetrical points.

(6) The conscious optic images and perceptions are only a small part of what is going on in the optic sphere.

(7) The localization of tactile images and impressions is a process independent of the simple perception of touch.

(2) Localization on the skin and the optic part of the body-image

Some remarks are necessary about the last point. There is no question that Lotze is right in so far as he says that localization is not given with perception as such. He is right when he emphasizes the qualitative difference between the sensations, and maintains that every qualitative well-characterized sensation brings with it the visual representation of its spatial relations. He is inclined to bring these qualitative differences in connection with associated sensations. But, according to our previous remarks, we believe in primary qualitative differences. He is wrong too in his belief that the different sensations provoke the soul to produce representations of space. There is no primary perception of space. Lotze follows in this respect the erroneous opinion of Kant. Localization is built up by optic and kinaesthetic impressions, by bringing the single impression into connection with the postural model of the body. But the postural model of the body is a product of the gestalt creative powers of our psyche. In order to understand this fully, we have to know what the optic part of the postural model of the body is.

Goldstein and Gelb describe a case of so-called perceptive mind-blindness. Even very simple optic perceptions were almost impossible. The patient failed to recognize a straight line. He was incapable of the perception of an optic movement. There were not only disturbances in the optic sensations; but Goldstein and Gelb mention the loss of optic images in this case and point also in a second similar case (case S.) to the serious impairment of the optic images. I have serious doubts about the correctness of this formulation. In cases of optic agnosia (mind-blindness) one sees generally that optic representations are present, though they cannot be used in the same way as before. Of course, they are present in a different way. An optic representation which cannot be used is certainly different from an optic representation which is at the disposal of the individual. Beyond that, the optic representation in these cases may show differences in structure from the normal optic representation. It would be difficult to call this agnostic optic representation, since the representations of normal persons also show characteristics which are very similar to the disturbed perception of the optic agnostic. Apparently we do not need more than parts, which may even be distorted in order to signify an object by representation. Furthermore, there is no question that the majority of the optic images of normal persons never come into the full light of consciousness. It is an unsolved problem whether these are ‘unconscious’ images in the psychic sense or whether we are dealing with the organic ‘unconscious’, which, according to the formulation given later, will have only a vague reflection in the psychic life. But in whatever direction the decision may go, I cannot believe that a complete loss of optic images can ever occur.

At any rate Goldstein and Gelb’s cases acted better when they had their eyes open and could look at the limb which was supposed to act. In one case the patient was unable to start a movement, unless there was the optic perception or a muscular twitching. In the case S., where the muscular twitchings were absent, looking at the limb was absolutely necessary in order to start the movement. In both cases ataxia was absent. One may infer that disturbances of tactile and postural sensibility, in a narrow sense, were absent. In spite of that, the patient Sch. especially showed a severe disturbance in the tactile localization and in the perception of tactile configurations. He could not distinguish whether he had his finger or his whole arm in the water. His discrimination was severely impaired. He made serious mistakes in localization. He could only arrive at an adequate localization by making muscular twitchings (Tastzuckungen). He quickly moved a great number of muscles till he came near to the point touched.

Goldstein and Gelb consider that touch does not provoke a primary answer in the optic sphere, as Wundt has emphasized. They point out the fact that blind people also localize on their body with similar methods, although the twitchings may, in the later years of the blind, disappear and be substituted by kinaes- thetic imaginations. I do not think that Goldstein and Gelb are justified in drawing such a general conclusion from an observation which so far has remained isolated. It is at least probable that for the majority of normal persons optic images follow tactile perception immediately in the manner Wundt (p. 279 I.e.) has surmised. But it is possible that the organism has several ways by which it can arrive at a localization of tactile impression. The tactile impression may provoke the optic image directly or via kinaesthetic impressions. It is possible that kinaesthetic impressions follow the optic image in one case. Either one of them may be sufficient for the final task. But it is at any rate a great achievement on the part of Goldstein and Gelb to have pointed out how important optic impressions are for localization. It is also a point of great importance that even the choice of a limb for the start of a movement is only possible when the optic sphere is not too severely damaged and the body-image of the optic sphere does not show too great an impairment. We also see that the ‘Locaizeichen’ is indeed dependent on a process which correlates the single impression with the whole of the impressions of the body-image.

We have also gained, through Goldstein and Gelb, the additional knowledge that the body-image and especially its optic parts are necessary for the beginning of a movement. There is at any rate an optic factor in the postural model of the body. Without it, tactile localization is impossible. But kinaesthetic experiences may take the place of the optic factors. The patient Sch. reaches a satisfactory localization of touch by experimenting, by trying out whether the character of the muscular twitches is sufficiently similar to the character of the touch. The successive twitches serve the construction of the body-image. They are more or less voluntary. The optic stimuli as well as the kinaesthetic are connected with the high level of cortical activity. When, as in the so-called Japanese illusion, hands and fingers are doubly crossed and intertwined, the optic impression of hands and fingers becomes so complicated that the optic gnosia is not sufficient to disentangle the picture. We are dealing then with a relative optic agnosia concerning one’s own body. Tactile and kinaesthetic helps are then necessary to start the movement of a specific finger. Tactile and kinaesthetic impressions are used therefore for the orientation concerning one’s own body, whenever the optic impressions become insufficient. We see how much activity is necessary to come to an orientation concerning one’s own body which is basic for every localization.

(3) Further remarks on the apparatus which serves localization

After transection of peripheral nerves on himself Head observed serious trouble in localization when the protopathic primitive sensibility returned. But this trouble in localization never went so far that the knowledge of the side of the body was impaired. Only the full function of the peripheral nerves guarantees exact localization of stimuli. This guarantee is very closely allied to the anatomical structure. Fuchs has described contralateral paraesthesias and pain after lesion of the peripheral nerves. He called this disturbance Alloparalgia. But many observations by Oppenheim, Weygandt, Mann, and Förster prove that the transfer to the contralateral side is not the important thing. Sträussler emphasized that any irritation in any part of the body provokes pain sensations in the region of the nerve lesion. I have made similar observations myself.

We do not know how the hyper-excitability in the regions of the injured nerve occurs. It seems that every acting nerve attracts other irritations. We have to do with principles similar to those indicated by Uchtomski, to the effect that an irritation may become dominant and may attract all irritations of minor degrees. Uchtomski has studied this phenomenon in connection with more central processes like the spinal heat reflex of the frog. But it is probable that all over the nervous system we deal with the principle just described, and its occurrence, therefore, does not tell us anything about the localization. But it remains remarkable that paraesthesias may so easily become contralateral. Since Fuchs’ cases probably belong to the field of causalgia (lasting pain sensations after peripheral injuries) which at the present time is considered as being connected with a sympathetic disturbance, we may adopt the theory that the relation between two symmetrical parts is partly based on sympathetic connections. Whether this connection goes over the spinal cord or not cannot be decided. But it must be remembered that vasomotor phenomena are often symmetrical. We should not consider the nervous system in isolation. After all, there are the blood-vessels, and the relation of the nervous system to structures of other kinds is certainly very close.

We stand on firmer ground when discussing the spinal mechanisms which can provoke alloaesthesia.¹ Some time ago Mott observed alloaesthesia after hemisection of the spinal cords of monkeys. Dusser de Barenne provoked a local hyperexcitability of one side of a spinal segment by the application of strychnine and cut ...