Body Schema and Body Image

Body Schema and

Body Image
New Directions
Edited by

YO C HA I ATA R IA
Tel-​Hai College, Israel

SHO G O TA NA KA
Tokai University, Japan

SHAU N G A L L AG H E R
University of Memphis, USA, and University of Wollongong, Australia

1
 3
Great Clarendon Street, Oxford, OX2 6DP,
United Kingdom
Oxford University Press is a department of the University of Oxford.
It furthers the University’s objective of excellence in research, scholarship,
and education by publishing worldwide. Oxford is a registered trade mark of
Oxford University Press in the UK and in certain other countries
© Oxford University Press 2021
The moral rights of the authors have been asserted
First Edition published in 2021
Impression: 1
All rights reserved. No part of this publication may be reproduced, stored in
a retrieval system, or transmitted, in any form or by any means, without the
prior permission in writing of Oxford University Press, or as expressly permitted
by law, by licence or under terms agreed with the appropriate reprographics
rights organization. Enquiries concerning reproduction outside the scope of the
above should be sent to the Rights Department, Oxford University Press, at the
address above
You must not circulate this work in any other form
and you must impose this same condition on any acquirer
Published in the United States of America by Oxford University Press
198 Madison Avenue, New York, NY 10016, United States of America
British Library Cataloguing in Publication Data
Data available
Library of Congress Control Number: 2020952987
ISBN 978–​0–​19–​885172–​1
DOI: 10.1093/​oso/​9780198851721.001.0001
Printed and bound by
CPI Group (UK) Ltd, Croydon, CR0 4YY
Oxford University Press makes no representation, express or implied, that the
drug dosages in this book are correct. Readers must therefore always check
the product information and clinical procedures with the most up-​to-​date
published product information and data sheets provided by the manufacturers
and the most recent codes of conduct and safety regulations. The authors and
the publishers do not accept responsibility or legal liability for any errors in the
text or for the misuse or misapplication of material in this work. Except where
otherwise stated, drug dosages and recommendations are for the non-​pregnant
adult who is not breast-​feeding
Links to third party websites are provided by Oxford in good faith and
for information only. Oxford disclaims any responsibility for the materials
contained in any third party website referenced in this work.
 Contents

Acknowledgement vii
About the Editors ix
Contributors xi
Introduction xiii

PA RT I : T H E O R E T IC A L C L A R I F IC AT IO N :
B O DY S C H E M A A N D B O DY I M AG E
1. What is the body schema? 3
Frédérique de Vignemont, Victor Pitron, and Adrian J. T. Alsmith
2. The space of the body schema: putting the schema in movement 18
David Morris
3. Body schema dynamics in Merleau-​Ponty 33
Jan Halák
4. A radical phenomenology of the body: subjectivity and sensations
in body image and body schema 52
Helena De Preester
5. Body schema and body image in motor learning: refining
Merleau-​Ponty’s notion of body schema 69
Shogo Tanaka
6. Reimagining the body image 85
Shaun Gallagher
7. The body in the German neurology of the early twentieth century 99
Andreas Kalckert

PA RT I I : B R A I N , B O DY, A N D SE L F
8. Plasticity and tool use in the body schema 117
Daniele Romano and Angelo Maravita
9. Triadic body representations in the human cerebral cortex and
peripheral nerves 133
Noriaki Kanayama and Kentaro Hiromitsu
10. Body models in humans, animals, and robots: mechanisms and plasticity 152
Matej Hoffmann
vi Contents
11. From implicit to explicit body awareness in the first two years of life 181
Philippe Rochat and Sara Valencia Botto
12. Cross-​referenced body and action for the unified self: empirical,
developmental, and clinical perspectives 194
Shu Imaizumi, Tomohisa Asai, and Michiko Miyazaki
13. Growing up a self: on the relation between body image and
the experience of the interoceptive body 210
Rosie Drysdale and Manos Tsakiris

PA RT I I I : D I S O R D E R S , A N OM A L I E S , A N D T H E R A P I E S
14. The embodied and social self: insights on body image and body
schema from neurological conditions 229
Jonathan Cole
15. Unilateral body neglect: schemas versus images? 244
Laurence Havé, Anne-​Emmanuelle Priot, Laure Pisella, Gilles Rode,
and Yves Rossetti
16. Neural underpinnings of body image and body schema disturbances 267
Jasmine Ho and Bigna Lenggenhager
17. Body schema and body image disturbances in individuals
with multiple sclerosis 285
Britt Normann
18. Body schema and pain 301
Katsunori Miyahara
19. Feeling of a presence and anomalous body perception 316
Masayuki Hara, Olaf Blanke, and Noriaki Kanayama
20. The body image–​body schema/​ownership–​agency model
for pathologies: four case studies 328
Aviya Ben David and Yochai Ataria

Index 349
 Acknowledgement

We thank Noam Tiran for his help with this volume’s preparation.
 About the Editors

Yochai Ataria is an associate professor at Tel-​Hai College, Israel. He conducted his

post-​doctoral research in the Neurobiology Department at the Weizmann Institute
of Science. He is the author of the following books: The Structural Trauma of Western
Culture (2017); Body Disownership in Complex Post-​Traumatic Stress Disorder (2018);
The Mathematics of Trauma [Hebrew] (2014); Not in our Brain [Hebrew] (2019); Levi
and Ka-​Tsetnik (2021); and Consciousness in Flesh (in press). In addition, he co-​edited
the following volumes: Interdisciplinary Handbook of Culture and Trauma (2016); Jean
Améry: Beyond the Minds Limits (2019); Kafka: New Perspectives [Hebrew] (2013); The
End of the Human Era [Hebrew] (2016); 2001: A Space Odyssey—​50th Anniversary
[Hebrew] (2019).
 
Shogo Tanaka is a professor of psychology and philosophy at Tokai University in Japan.
He received his PhD in philosophical psychology from Tokyo Institute of Technology.
Dr Tanaka is primarily interested in phenomenology and psychology and, more spe-
cifically, in clarifying the theoretical foundations of psychology from the perspective
of embodiment, being inspired by the ideas of Maurice Merleau-​Ponty. The topics
of his published papers encompass a broad range of issues, including body schema,
body image, skill acquisition, embodied self, social cognition, theory of mind,
and intercorporeality. From 2013 to 2014, and from 2016 to 2017, he stayed at the
Department of Psychiatry of the University of Heidelberg in Germany as a visiting
scholar, where he worked on phenomenology, psychology, and psychopathology. His
recent publications include: ‘Intercorporeality and Aida’ (Theory & Psychology, 27,
337–​353), ‘What is it like to be disconnected from the body?’ (Journal of Consciousness
Studies, 25, 239–​262), and other articles.
 
Shaun Gallagher is the Lillian and Morrie Moss Professor of Excellence in Philosophy
at the University of Memphis, USA, and Professorial Fellow at the School of Liberal
Arts, University of Wollongong, Australia. He was a Humboldt Foundation Anneliese
Maier Research Fellow (2012–​18). His publications include: Action and Interaction
(2020); Enactivist Interventions: Rethinking the Mind (2017); The Neurophenomenology
of Awe and Wonder (2015); Phenomenology (2012); The Phenomenological Mind (with
Dan Zahavi, 2012); and How the Body Shapes the Mind (2005). He is also editor-​in-​chief
of the journal Phenomenology and the Cognitive Sciences.
 Contributors

Adrian J. T. Alsmith, Philosophy department, King’s College, London, UK

Tomohisa Asai, Senior Researcher, Department of Cognitive Neuroscience, Advanced
Telecommunications Research Institute International (ATR), Seika, Japan
Yochai Ataria, Associate Professor, Department of Psychology, Tel-​Hai College, Israel
Olaf Blanke, Professor, Laboratory of Cognitive Neuroscience, Center for Neuroprosthetics & Brain-
Mind Institute, Swiss Federal Institute of Technology (EPFL), Geneva, Switzerland
Sara Valencia Botto, Lecturer and Researcher in Psychology, Emory University, Atlanta, USA
Jonathan Cole, Clinical Neurophysiologist and Consultant, Poole and Salisbury Hospitals, UK
Aviya Ben David, Research Assistant, Department of Psychology, Tel-​Hai College, Israel
Rosie Drysdale, Postgraduate Research Student, Department of Psychology, Royal Holloway
University of London, London, UK
Shaun Gallagher, Lillian and Morrie Moss Professor of Excellence in Philosophy, University of
Memphis, USA, and Professorial Fellow, School of Liberal Arts, University of Wollongong, Australia
Jan Halák, Assistant Professor, Department of Philosophy, Faculty of Arts, Palacký University
Olomouc, Olomouc, Czech Republic
Masayuki Hara, Associate Professor, Graduate School of Science and Engineering, Saitama
University, Saitama, Japan
Laurence Havé, ImpAct/​Trajectoires Team, Lyon Neuroscience Research Center, Bron, and Hôpital
d’Instruction des Armées Desgenettes, Lyon, France
Kentaro Hiromitsu, JSPS Research Fellow, Department of Psychology, Graduate School of Humanities
and Sociology, The University of Tokyo; Project Researcher, Department of Psychology, Graduate
School of Humanities and Sociology, The University of Tokyo; and Visiting Researcher, Department
of Cognitive Neuroscience, Cognitive Mechanisms Laboratories, Advanced Telecommunications
Research Institute International (ATR), Kyoto, Japan
Jasmine Ho, PhD Student and Member of the Cognitive Neuropsychology Research Group,
Department of Psychology, University of Zürich, Zürich, Switzerland
Matej Hoffmann, Assistant Professor, Department of Cybernetics, Faculty of Electrical Engineering,
Czech Technical University in Prague, Czech Republic
Shu Imaizumi, Assistant Professor, Institute for Education and Human Development, Ochanomizu
University, Tokyo, Japan
Andreas Kalckert, Senior Lecturer in Cognitive Neuroscience, Department of Cognitive
Neuroscience and Philosophy, Institute for Bioscience, University of Skövde, Skövde, Sweden
Noriaki Kanayama, Scientist, Human Informatics and Interaction Research Institute, National
Institute of Advanced Industrial Science and Technology (AIST), Tsukuba, and Lecturer, Center for
Brain, Mind and KANSEI Sciences Research, Hiroshima University, Hiroshima, Japan
xii Contributors
Bigna Lenggenhager, Professor and Head of the Cognitive Neuropsychology Research Group,
University of Zürich, Zürich, Switzerland
Angelo Maravita, Professor of Psychobiology and Head of Psychology Department, University of
Milano-​Bicocca, Milan, Italy
Katsunori Miyahara, Specially Appointed Lecturer, Center for Human Nature, Artificial Intelligence,
and Neuroscience (CHAIN), Hokkaido University, Sapporo, Japan
Michiko Miyazaki, Associate Professor, Faculty of Social Information Studies, Otsuma Women’s
University, Tokyo, Japan
David Morris, Professor of Philosophy, Concordia University, Montreal, Canada
Britt Normann, Professor in Health Sciences, Nord University, Bodø, and Clinical Specialist in
Neurological Physiotherapy and Researcher, Nordland Hospital Trust, Bodø, Norway
Laure Pisella, ImpAct/​Trajectoires Team, Lyon Neuroscience Research Center, Bron, France
Victor Pitron, Psychiatrist, Pitié-​Salpêtrière Hospital, and PhD Student, the Jean Nicod Institute,
Paris, France
Helena De Preester, Professor of Philososophy, The Royal Academy of Fine Arts and the Royal
Conservatory, School of Arts, University of Applied Sciences and Arts, Ghent, and Visiting research
professor, Department of Philosophy and Moral Sciences, Ghent University, Belgium
Anne-​Emmanuelle Priot, ImpAct/​Trajectoires Team, Lyon Neuroscience Research Center, Bron, and
Institut de Recherche Biomédicale des Armées (IRBA), Brétigny-​sur-​Orge, France
Philippe Rochat, Professor of Psychology and Director of the Emory Infant and Child Lab, Emory
University, Atlanta, USA
Gilles Rode, ImpAct/​Trajectoires Team, Lyon Neuroscience Research Center, Bron, and Service de
médecine physique et réadaptation, Hôpital Henry-​Gabrielle, Hospices Civils de Lyon, France
Daniele Romano, Researcher, Psychology Department, University of Milano-​Bicocca, Milan, Italy;
Department of History, Society and Human Studies, University of Salento, Lecce, Italy
Yves Rossetti, ImpAct/​Trajectoires Team, Lyon Neuroscience Research Center, Bron, and Plate-​forme
Mouvement et Handicap, Lyon Neuroscience Research Center, Bron, France
Shogo Tanaka, Professor of Psychology and Philosophy, Tokai University, Tokyo, Japan
Manos Tsakiris, Professor of Psychology, Department of Psychology, Royal Holloway University of
London, London, UK
Frédérique de Vignemont, Jean Nicod Institute, CNRS - EHESS - ENS, PSL University, Paris, France
 Introduction
Yochai Ataria, Shogo Tanaka, and Shaun Gallagher

According to the famous saying, ‘We feel well as long as we do not feel our body’. Indeed,
under normal circumstances, we largely forget our body. As long as we continue to
function smoothly in the world, our body remains in the background. By contrast,
stress, stares, injuries, disabilities, certain cultural prejudices, and the like can shift the
body into the foreground.
Not only do we forget our bodies in our everyday existence, but philosophers seem
to have ignored the question of the body for too long. Even today, philosophical dis-
cussions of the body often approach it as a thing to be examined from a scientific
viewpoint—​the body-​as-​object rather than the body-​as-​subject.
There remain many outstanding questions concerning the nature and the history of
the body. However, today, in the age of neuroscience, one of the most pressing ques-
tions seems to concern whether the body is in the brain, that is, can all bodily processes
relating to perceptual and motoric functions be reduced to neuronal representations?
A neuroscientific explanation of phantom limbs appears to suggest that our body
can be reduced to maps in the brain or that the body, as we experience it, is itself a
phantom produced by neural processes. Philosophers from Descartes (1637/​1996)
to Dennett (1991) have considered matrix-​like scenarios involving an illusory body
generated by an evil demon or a brain in a vat. Yet if we accept the notion that the
body can be reduced to the homunculus, and the world is nothing more than a rep-
resentation in our brain, how can we know for sure that we are not dreaming at this
very moment?
If the phantom limb phenomenon forces us to ask whether our body can be re-
duced to neural maps in our brain, various psychopathologies, such as anorexia and
body dysmorphic disorder, remind us that the body (which, of course, includes the
brain) is never divorced from social contexts—​from the very outset, we are thrown
into a shared world. Essentially, not only is the image of our body shaped by social
context, but rather, it has also been demonstrated that the body-​schematic sensori-
motor loop is shaped by social context (Durt, Tewes, & Fuchs, 2017). Indeed our
body is the target of a gaze or the subject of others’ judgement as well as our own
(Merleau-​Ponty, 2012, p. 170):

Man does not ordinarily show his body, and, when he does, it is either nervously or
with the intention to fascinate. It seems to him that the alien gaze that glances over
his body steals it from him or, on the contrary, that the exhibition of his body will

Yochai Ataria, Shogo Tanaka, and Shaun Gallagher, Introduction In: Body Schema and Body Image. Edited by: Yochai Ataria, Shogo Tanaka,
and Shaun Gallagher, Oxford University Press. © Oxford University Press 2021. DOI: 10.1093/​oso/​9780198851721.001.0001
xiv Introduction
disarm and deliver the other person over to him, and in this case the other person
will be reduced to slavery. Thus, modesty and immodesty take place in a dialectic of
self and other that is the dialectic of master and slave. Insofar as I have a body, I can
be reduced to an object beneath the gaze of another person and no longer count
for him as a person. Or again, to the contrary, I can become his master and gaze
upon him in turn. But this mastery is a dead end, since, at the moment my value is
recognized by the other’s desire, the other person is no longer the person by whom
I wanted to be recognized: he is now a fascinated being, without freedom, and who
as such no longer counts for me. To say that I have a body is thus a way of saying that
I can be seen as an object and that I seek to be seen as a subject, that another person
can be my master or my slave, such that modesty and immodesty express the dia-
lectic of the plurality of consciousnesses and that they in fact have a metaphysical
signification.

Our bodies can be objects of desire, shame, or even disgust. Yet we are objectified
not only by others, but also by ourselves; indeed, as the popularity of plastic surgery
indicates, many of us are never really satisfied with our bodies. The body is the locus of
the drama.
Frantz Fanon, a black psychiatrist and philosopher raised in the French colony of
Martinique and the author of Black Skin, White Masks (2008), adds a critical perspec-
tive when depicting his experience as a black man among whites. Fanon’s description
allows us to understand how the other’s gaze in a racist social world permeates our
bodily experience, in particular the idea that social distortions can impinge on the body
schema (p. 83):

And then the occasion arose when I had to meet the white man’s eyes. An unfamiliar
weight burdened me. The real world challenged my claims. In the white world
the man of color encounters difficulties in the development of his bodily schema.
Consciousness of the body is solely a negating activity. It is a third person conscious-
ness. The body is surrounded by an atmosphere of certain uncertainty. I know that
if I want to smoke, I shall have to reach out my right arm and take the pack of cig-
arettes lying at the other end of the table. The matches, however, are in the drawer
on the left, and I shall have to lean back slightly. And all these movements are made
not out of habit but out of implicit knowledge. A slow composition of my self as a
body in the middle of a spatial and temporal world—​such seems to be the schema.
It does not impose itself on me; it is, rather, a definitive structuring of the self and
of the world—​definitive because it creates a real dialectic between my body and the
world . . .

While reading Fanon’s description, it becomes clear that the question of the body
cannot be examined independently of our situatedness in the world and our most basic
sense of subjectivity. Merleau-​Ponty also highlights this close link between worldly
situation and the body (2012, p. 431).
 Introduction  xv
If the subject is in a situation, or even if the subject is nothing other than a possibility
of situations, this is because he only achieves his ipseity by actually being a body and
by entering into the world through this body. If I find, while reflecting upon the es-
sence of the body, that it is tied to the essence of the world, this is because my existence
as subjectivity is identical with my existence as a body and with the existence of the
world, and because, ultimately, the subject that I am, understood concretely, is insep-
arable from this particular body and from this particular world. The ontological world
and body that we uncover at the core of the subject are not the world and the body as
ideas; rather, they are the world itself condensed into a comprehensive hold and the
body itself as a knowing-​body.

Note, however, that even if we embrace a radical embodied approach, emphasizing

its coupling with the physical, social, and cultural environment, it would, of course,
be a mistake to reject the role that the brain plays in the lived and bodily experience
of subjectivity. Indeed, scholars have repeatedly demonstrated that there are complex
dynamic links between neuronal plasticity (and sometimes localized brain damage),
bodily function and dysfunction, and changes in the experience of self and the world.
This volume will not solve the mystery of the body. Instead, we will examine herein
the question of the body by focusing on two concepts: body image and body schema.
We can tentatively define body image as a ‘system of perceptions, attitudes, and beliefs
pertaining to one’s own body’ and body schema as a ‘system of sensory-​motor cap-
acities that function without awareness or the necessity of perceptual monitoring’. It
has been further suggested that a double dissociation exists between body schema and
body image, although, essentially, ‘body image and body schema refer to two different
but closely related systems’ (Gallagher, 2005, p. 24). That said, the goal of this volume
is not merely to explore each one of these concepts, but also to improve our under-
standing of the complex relationship between them.
We hope to demonstrate that the concepts of body image and body schema enable
us to build new bridges and generate innovative theories. Let us begin by locating the
body image/​body schema problem in the broader context of the body-​in-​the-​brain
versus the body-​in-​the-​world debate.

Body-​in-​the-​brain versus body-​in-​the-​world

Following Merleau-​Ponty, those who ascribe to the body-​in-​the-​world approach re-

ject the very notion of bodily representations, as Morris comments (Chapter 2, p. 28),
‘Why would you ever think of neurons as doing anything like abstractly representing
positions to control, when they are clearly achieving control by virtue of being distrib-
uted over, moving around in, and working within, the very body and tentacles that are
movingly touching things?’. In his 1953 lectures, Merleau-​Ponty (2011) claimed that
the body schema operates in the background; it does not involve a perceptual moni-
toring of the body. To grasp this notion, it is helpful to think about body schema in
xvi Introduction
terms of figure and ground—​in our daily life, while operating fluently in the world,
the body schema remains in the background as part of the pre-​noetic structure of
perception. However, it is far from being some kind of passive system; instead, we
may think about body schema in terms of what Husserl called the ‘I can’. Essentially,
body schema should be described in terms of knowing-​how, a pragmatic kind of
knowledge that allows our environment to become ready-​to-​hand. Continuing this
line of thought, there is no need for a central system controlling the body (or better
put: A body) within a Newtonian space, because the body itself (as a distributed
sensory-​motor system) is pragmatically oriented in space: ‘Our body is not primarily
in space, but is rather of space’ (Merleau-​Ponty, 2012, p. 149). Thus, according to this
approach, the body image plays a secondary role with respect to motor control, al-
though, as Tanaka suggests (Chapter 5), it may come to the fore when learning new
movements or skills.
By contrast, those who ascribe to the body-​in-​the-​brain approach concentrate on
the role played by the brain in the body’s interactions with the surrounding environ-
ment and with others. As the body interacts with the world, afferent signals constantly
flow from peripheral nerves to the brain and efferent signals are sent from the brain to
control the body’s muscles and joints. The findings of both sensory and motor homun-
culi (or body maps) are the most classic expressions of the body-​in-​the-​brain approach
(Penfield & Rasmussen, 1950), demonstrating the relative independence of neural rep-
resentation of the body from the physical body itself. Penfield shows that direct elec-
trical stimulations to the somatosensory cortex cause subjective experiences of touch.
This becomes even clearer when considering particular symptoms, such as phantom
limbs, amputees’ experience of ‘a tingling feeling and a definite shape that resembles the
somatosensory experience of the real limb before amputation’ (Melzack, 1990, p. 88).
Thus, phantom sensations seem to correlate with neural activation in the somatosen-
sory cortex. This body-​in-​the-​brain view tends to replace the body that we live and
experience with the complex neural representation of the body. In its most extreme ver-
sion, this view enables neuroscientists to claim that ‘your own body is a phantom, one
that your brain has temporarily constructed purely for convenience’ (Ramachandran
& Blakeslee, 1998, p. 58). Although this approach acknowledges the sensory-​motor ac-
tivities of our body in the physical dimension, they are mostly considered in terms of
internal computational models within the brain. According to this approach, the body
schema is not a system that holistically incorporates the physical body acting in the
world, but rather the sensory-​motor representation mapped within the brain.
By emphasizing both the situatedness of the body as well as the role of the brain in re-
lation to the lived body, we hope that this volume will take us another step toward a ma-
ture dialogue between the body-​in-​the-​brain approach, which should not be without
a body, on the one hand, and the body-​in-​the-​world approach, which should not be
without a brain, on the other.
Having located the body image/​body schema debate in terms of a broader set of
questions, it is time to dive into the very heart of the discussion. Given the importance
of the case of deafferentation to our understanding of body schema and body image, as
 Introduction  xvii
well as the double dissociation between body image and body schema, let us begin by
presenting the case of Ian Waterman.

Cases of deafferentation

Ian Waterman, sometimes referred to as IW in the scientific literature, became deaffer-

ented from the neck down at the age of 19. As a result of peripheral neuronopathy, he
lost his sense of touch and proprioception below the neck, and initially he was unable
to control his movements. After a lengthy rehabilitation, IW learnt how to do so mainly
via visual and cognitive efforts (Cole, 1995).
Based on this finding, it has been suggested that IW’s body schema has been re-
placed by an enhanced body image, that is, a conscious visual awareness of his body
(Gallagher, 2005, p. 52):

[I]‌f he [IW] is denied access to a visual awareness of his body’s position in the percep-
tual field, or denied the ability to think about his body, then, without the framework
of the body image, the virtual body schema ceases to function—​it cannot stand on its
own . . . IW has substituted a virtual body schema—​a set of cognitively driven motor
processes. This virtual schema seems to function only within the framework of a body
image that is consciously and continually maintained.

Frédérique de Vignemont (2018) believes that one of the most important questions
concerning deafferentation is ‘whether more than thirty years later bodily control
still requires the same effort’ (p. 148). Considering the case of Ginette Lizotte (GL),
de Vignemont suggests an alternative explanation for this relative success with regard
to movement among deafferented subjects ‘[who] can move in a relatively impressive
manner’. Given this observation, she asks: ‘But in what sense is the body schema de-
fective in these patients?’ de Vignemont argues that the body schema ‘is at least partially
preserved in deafferentation’ (p. 147). In order to support this notion, she re-​examines
the role that vision plays in body-​schematic processes: ‘The role of vision for the body
schema is thus not unusual . . . it is merely more drastically important in the case of
deafferented patients [who] . . . consciously exploit their body schema, as in conscious
motor imagery.’ Furthermore, she argues that ‘although based on different weighting of
information’, the body schema of deafferented patients relies ‘more on vision than be-
fore, but for all that, it is not “missing” ’ (p. 149).
Gallagher (2005) also explores the role of vision in body-​schematic processes: ‘Visual
sense is also a source of information vital to posture and movement.’ Thus, visual pro-
prioception and visual kinaesthesis ‘are more directly related to the body schema and
involve the tacit processing of visual information about the body’s movement in rela-
tion to the environment’. To be clearer, what we see in our daily life ‘automatically gets
translated into a proprioceptive sense of how to move’. This notion echoes Merleau-​
Ponty’s ideas (1968, p. 134):
xviii Introduction
every vision takes place somewhere in the tactile space. There is double and crossed
situating of the visible in the tangible and of the tangible in the visible; the two maps
are complete, and yet they do not merge into one. The two parts are total parts and yet
are not superposable.

Gallagher (2005) further stresses that although visual perception of the environ-
ment is important for body-​schematic processes, in daily life, the ‘direct visual per-
ception of one’s own body . . . does not play a major role in motor and postural control’,
and yet, ‘for IW it is the primary source of information about his body’ (p. 45). Indeed,
IW ‘depends heavily on visual perception of his limbs and visual proprioception in
order to control his movement’. He also argues that although usually there is ‘inter-
modal communication between proprioception and vision’, vision is nevertheless ‘not
designed to take the place of somatic proprioception’. Essentially, in the case of IW,
this intermodal communication is seriously disturbed. Gallagher (2005) concludes
by saying that in IW’s case, some realignment toward visual and cognitive control of
movement has taken place.1
de Vignemont (2018) stresses that while spending time with GL she almost ‘forgot
that there was anything abnormal besides her wheelchair . . . She could cut her meat
while having a normal discussion at lunch and even gesture with her knife and fork
like everybody else, or so it seemed’.2 Note, however, that unlike GL, IW can walk.
In that sense, GL’s situation is more similar to IW’s experience while driving, which
he appears to find easier than walking: ‘The car seems to be an extension of the body
schema’ (Gallagher & Cole, 1995, p. 386). Essentially, while driving, IW does not need
to control his full body with his vision. Likewise, his hands are always in sight. As a re-
sult the observer can develop a feeling that IW is driving on ‘automatic pilot’. However,
IW himself testifies that while driving he needs to think about how he holds the wheel
and how much force he must invest in order to move the wheel one way or the other
(and so on).
This ambiguity concerning the role of vision for body schema in deafferented
subjects may reflect a long-​standing confusion concerning body schema and body
image. Gallagher stresses that the concepts of body image and body schema have been
unclear from the very outset. Likewise, de Vignemont (2018) believes that ‘there is a
lack of precise understanding of the functional role of the body schema as opposed to
the body image and without clear definitional criteria . . . they cannot play any explana-
tory role’. This lack of clarity and precision has motivated occasional calls to abandon
the concepts. Perhaps, as de Vignemont herself suggests, ‘we should simply decide that

1 Indeed, some experimental evidence suggests that IW’s use of vision for motor control activates the ventral
visual pathway in the brain (the visual stream that underpins object recognition) rather than the dorsal visual
pathway that typically serves the motor system (Athwal et al., 1999).
2 It has been suggested (Cole, 2016; Forget & Lamarre, 1987) that GL is ataxic, meaning that she cannot drink
from a cup normally; she chews her food by counting because she cannot feel much of her mouth; she cannot put
her hand into a pocket or bring her hand to her mouth easily.
 Introduction  xix
we are better off without them’ (p. 152). Others concur, from Conrad in his 1933 book
(Das Körperschema. Eine kritische Studie und der Versuch einer Revision) to Berlucchi
and Aglioti (2010) more recently. With this in mind, let us investigate the source of this
confusion.

The source of conceptual confusion

Throughout the twentieth century, pivotal scholars regarded Head and Holmes’ (1911)
paper as definitive in the study of body schema and body image. Given the important
role of this study, some clarifications are necessary:

(1) Head and Holmes introduced the concept of body schema to explain the cog-
nitive and somatosensory deficits of patients with cerebral lesions. They con-
sidered body schema an implicit frame for the entire body, referred to when
recognizing the present posture or locating body parts.
(2) Head and Holmes argue that ‘postural recognition is not constantly in the cen-
tral field of attention’. Thus, they suggest that ‘every recognizable change enters
into consciousness already charged with its relation to something that has gone
before, just as on a taximeter the distance is presented to us already transformed
into shillings and pence’ (pp. 186–​187). Basically, body schema is an implicit
function underpinning our postural and motor control, and it rarely comes to
our conscious attention.
(3) Head and Holmes claim that ‘image, whether it be visual or motor, is not the
fundamental standard against which all postural changes are measured’ (p. 187).
Thus, visual images of the body are distinguished from body schema.

Many philosophers and neuroscientists have relied heavily on Jacques Paillard’s in-
terpretation of Head and Holmes’ study (Paillard, 2005, p. 103; citing Head & Holmes
1911,3 p. 212):

These authors suggested the distinction between a postural schema considered as

‘a combined standard against which all subsequent changes of posture are meas-
ured . . . before the change of posture enters consciousness . . . ’ and a body image as an
‘internal representation in the conscious experience of visual, tactile and motor infor-
mation of corporal origin’.

Reading Paillard’s citation carefully, it is important to note that Head and Holmes
(1911) never use the term ‘body image’ per se; likewise, they employ the concept of
representation only in reference to the image: ‘The assumption of an imagined posture

3 Referring to the 1911 paper.

xx Introduction
may be accompanied by representations of movement equivalent to the pictures of
those who visualize strongly’ (1911, p. 187). In any case, Head and Holmes do not pre-
cisely define body image but do distinguish images of the body from what they define
as schemata of the body.
Many believe that Paul Schilder (1886–​1940) was at least partly responsible for the
current confusion between body schema and body image (see Kalckert, Chapter 7).
In his German book, published in 1923, entitled Body Schema (Das Körperschema),
Schilder defines body schema as a ‘spatial image that one has from yourself ’ (p. 2; em-
phasis added [translated by Kalckert, p. 126]). In his English-​language book The Image
and Appearance of the Human Body, published in 1935, Schilder defines the body
image as the ‘picture of our own body which we form in our mind’ (p. 11). Yet on other
occasions, Schilder mixes up his terminology: ‘We mean the body schema when we
talk about the image of the own body, which is alive within us. It includes optical, kin-
aesthetic, and tactile elements, but it is not the sum of those, these achieve their true
meaning only by its relationship to this body schema’ (Hartmann & Schilder, 1927,
p. 666; emphasis added). In further cases, Schilder’s statements are even more con-
fusing: ‘The image we have of our body, or, as it is also called the body schema or pos-
tural model of the body, is partially based on sensations and partially on representations
and thoughts’ (Schilder, 1934, p. 314).
While reading Schilder’s definitions, one might suspect that he fails to properly dis-
tinguish between body schema and body image. However, we would like to offer a
different perspective on Schilder’s work. Aside from the issue of conceptual distinc-
tions, there is a question concerning how the brain, the body, and the world, including
the social environment, are entangled in our everyday life. It seems that Schilder’s work
succeeds, at least to some degree, in demonstrating how our bodily existence is inte-
grated with the social environment during our daily life. Notwithstanding the double
dissociation between body schema and body image, in everyday life, these two sys-
tems work together. In a sense, although his classification of body schema and body
image is unclear, Schilder’ analysis remains faithful to our bodily experiences in the
lifeworld.
Another source of confusion is the erroneous first translation of Merleau-​Ponty’s
Phenomenology of Perception. As Donald A. Landes, the translator of the new edition
(2012), stresses (p. xlix):

Merleau-​Ponty’s use of the term le schéma corporel introduces both historical and con-
ceptual difficulties. Merleau-​Ponty specifically rejects the interpretation of le schéma
corporel as a representation or image . . . Rather than following Schilder by writing
image in French—​or rather than adopting Lhermitte’s phrase l’image de notre corps
(‘the image of our body’)—​Merleau-​Ponty maintains schéma.

Having understood the root of this confusion, let us examine the concept of double
dissociation between body schema and body image more thoroughly.
 Introduction  xxi

Double dissociation

Based on an analysis of various pathological cases, both Paillard (1999) and Gallagher
(2005) discern a double dissociation between body image on the one hand and body
schema on the other: ‘It is possible . . . to find cases in which a subject has an intact
body image but a dysfunctional body schema, and vice versa’ (Gallagher 2005, p. 24).
For example, in some cases of unilateral personal neglect, a neuropsychological con-
dition involving a deficit in attention to, and awareness of, one side of the body fol-
lowing damage to the contralateral cortex, we can detect evidence of an intact body
schema (including controlled movement) together with the impairment of body
image for the neglected side. In one such case, the patient pays no attention to the left
side of her body and fails to dress that side, although there is no motor weakness on
that side; for instance, she uses her left hand to dress her right side (Denny-​Brown,
Meyer, & Horenstein, 1952). As we saw in the case of IW, other examples indicate the
opposite, that is, body schema deficit with an intact body image.
de Vignemont (2018) raises some doubts regarding the existence of a clear-​cut
double dissociation between body schema and body image. For instance, while the case
of unilateral neglect is referenced to show the presence of body schema and the absence
of body image, patients suffering from unilateral neglect are able to attend to the right
side of their body. According to de Vignemont, this indicates that the body image is not
completely absent, even if there is a deficit. Based on these observations, she argues that
double dissociation in a strict sense does not exist: ‘Most bodily disorders do not lead to
straightforward diagnosis in terms of either body image deficit or body schema deficit.
These deficits of body schema and body image are often intermingled and clear cases
of specific disruptions rarely found’ (p. 150; for further debate, see Havé, Priot, Pisella,
Rode, & Rossetti, Chapter 15).
Keeping this in mind, Gallagher (Chapter 6) stresses that we need to distinguish be-
tween conceptual ambiguity on the one hand and ambiguity in the phenomena them-
selves on the other; ambiguity at the level of the phenomena is not an argument against
the existence of dissociation between body schema and body image.
In a wider context, it seems that from the very outset, this ambiguity concerns the na-
ture of the relationship between the perceived body and the acting body, in particular
how these perspectives are interrelated in action. When we act in a habitual manner, we
often do so without explicitly perceiving our own bodies, whereas we may need to ex-
plicitly focus on our bodies when asked to execute a novel action.
The same kind of tension can be found between the body-​as-​subject and the body-​
as-​object. Rather than avoiding it, Merleau-​Ponty (1964, p. 162) encourages us to main-
tain what seems to be a structural ambiguity:

The enigma is that my body simultaneously sees and is seen. That which looks at all
things can also look at itself and recognize, in what it sees, the ‘other side’ of its power
xxii Introduction
of looking. It sees itself seeing; it touches itself touching; it is visible and sensitive for
itself.

According to Merleau-​Ponty, this tension is necessary for our existence: ‘There

is a human body when, between the seeing and the seen, between touching and the
touched, between one eye and the other, between hand and hand, a blending of some
sort takes place.’ If, however, this sensing–​sensed structure collapses, the very essence
of being human will lose its meaning. Moreover, should this subject–​object structure
collapse, meaning that we can no longer touch and be touched at the same time, this
signals not merely the end of the human body but in fact the end of humanity: ‘Such a
body would not reflect itself; it would be an almost adamantine body, not really flesh,
not really the body of a human being (pp. 163–​164).

The structure of this volume

This volume is divided into three parts. The first, ‘Theoretical clarification: body schema
and body image’, defines these concepts and explores the possible relations between
these systems. The second part, ‘Brain, body, and self ’, attempts to understand how the
body is represented in the brain and how this representation is developed into a sense
of self. The third part, ‘Disorders, anomalies, and therapies’, explores the role of body
schema and body image in different kinds of pathologies from phenomenological, cog-
nitive, and neural perspectives.
The book opens with a chapter by Frédérique de Vignemont, Victor Pitron, and
Adrian Alsmith, ‘What is the body schema?’ According to the authors, the body schema
can be defined as a representation of the body for action. However, they ask: what does
this statement really mean? Namely, what is the uniqeness of the body schema? Is it the
type of information that it represents, or perhaps the function of the representation? In
the second chapter ‘The space of the body schema’, David Morris focuses on the body
schema as well, albeit adopting a non-​representational approach. Given their repre-
sentational approach, a fundamental problem encountered by de Vignemont, Pitron,
and Alsmith concerns what seems to be our close interaction with the world in our
everyday life, the sense of affordances, situatedness, and moods. While the orthodox
neurocognitive approach to body representation leaves the world too far away, for
Morris, this does not constitute a problem because he regards body schema itself as of
space. Note that the role which Morris’ theoretical approach accords to body schema
leaves little room for body image.
In the third chapter ‘Body schema dynamics in Merleau-​Ponty’, Jan Halák explores
the interaction between body schema and body image, drawing on the notes made by
Merleau-​Ponty (2011) for his 1953 lectures known as The Sensible World and the World
of Expression. Halák describes the relations between the two in terms of figure (body
image) and ground (body schema). Like Morris, Halák also supports a strong em-
bodied non-​representational approach; yet he nevertheless leaves a place in his theory
 Introduction  xxiii
for the body image. Note that both Morris and Halák reject the concept of body image–​
body schema double dissociation.
Interestingly, de Vignemont, Pitron, and Alsmith, on the one hand, and Halák
and Morris, on the other, would agree that body schema should be treated in terms
of affordances. Yet, whereas the former adopt a strong representational approach, the
latter argue that according to Merleau-​Ponty, there is no need for representations,
seemingly making many of the problems dealt with by de Vignemont, Pitron, and
Alsmith non-​issues. For instance, while de Vignemont, Pitron, and Alsmith focus on
local representations of body parts, Merleau-​Ponty considers the body a holistic system
from the outset. Note, however, that if we choose to adopt the holistic approach, we may
find it difficult to explain the strong link between localized brain damage and the dys-
function of body parts, and more generally different kinds of neuropathologies. Clearly
the approach advanced by de Vignemont, Pitron, and Alsmith facilitates this sort of
explanation.
In the fourth chapter ‘A radical phenomenology of the body’, Helena De Preester
recognizes these problems and seeks to develop a theory that considers the strengths
and weaknesses of both sides, that is, combining the body-​in-​the-​brain approach with
the body-​in-​the-​world approach. To do so, she embraces Michel Henry’s radical phe-
nomenology of the body. De Preester confronts what seems to be one of the most chal-
lenging problems faced by the representational approach—​explaining the unity of
the moving body. As we saw, de Vignemont, Pitron, and Alsmith are fully aware that
embracing their own approach raises the following question: How does one experience
and act with one’s body as an integrated whole rather than a collection of parts? De Preester
tries to avoid this problem. She argues that the definition of body schema offered by
Gallagher and Cole (1995) fails to solve this puzzle, and that as long as the body schema
remains embedded in proprioception, the problem of the unity of the moving body re-
mains unsolved. From this perspective, the Merleau-​Pontyian approach, as presented
by both Morris and Halák, is not sufficiently radical. By divorcing proprioception from
body schema, Henry’s work allows her to confront this issue. According to Henry, body
schema is responsible for unity of the transcendent body. The origin of this unity lies in
the subjective body, which, in turn, is characterized by movement in the sense of ori-
ginal, immediate knowledge of movement. De Preester tries to bridge between Henry’s
radical phenomenology of the body and current cognitive sciences by suggesting that,
at least to some extent, we can think about the subjective body in terms of offline long-​
term body representations.
In the fifth chapter ‘Body schema and body image in motor learning’, Shogo Tanaka
endeavours to provide a detailed account of the nature of relations between body
schema and body image and to take the body schema–​body image distinction a step fur-
ther. Tanaka argues that motor learning demands a close dialogue between body image
and body schema. Indeed, although the authors of the previous chapters in this volume
ascribe to opposing philosophical approaches (body-​in-​the-​brain versus body-​in-​the-​
world), they share a belief in the primacy of body schema over body image. Thus, they
all agree that compared with the body schema body image plays a minor role in our
xxiv Introduction
daily lives. Merleau-​Ponty seems to support this approach: ‘Ordinary experience shows
that, in imitating others, in learning to walk, in becoming familiar with an environment,
what occurs cannot be explained by the notion that there is first an intellectual act of
“knowing” rules, maps, or words and then a move to use them’ (1964, p. 96). Bearing
this in mind, Tanaka suggests that body image nonetheless plays a fundamental role in
most processes of motor learning; hence, any theory that seeks to explain what it is like
to be-​in-​the-​world should provide a detailed account of how body image is involved in
our everyday activities.
In the sixth chapter ‘Reimagining the body image’, Gallagher accepts the co-​
construction model (Pitron & de Vignemont, 2017), which posits a functional dis-
tinction, yet strong interaction, between body schema and body image. Indeed, if one
replaces the word ‘representation’ in the following sentence with ‘systems’, it seems that
de Vignemont, Pitron, and Alsmith would agree to some extent with Gallagher: ‘The
two types of body representations [systems] are thus functionally distinct, but their con-
struction is partly based on their interactions, which allow them to minimize discrep-
ancies between them as much as possible.’ In his chapter, Gallagher tries to respond to
several objections that have been voiced against the body image–​body schema distinc-
tion over the years. The main objection is as follows: ‘We should not take body schema
and body image to be disconnected systems, even if they are distinguishable.’ Indeed,
by reading the different chapters in the first part of this volume, it is difficult to find any
theoretical support for a strict or absolute double dissociation approach. Gallagher ad-
mits that he relies heavily on rare cases such as IW, yet he believes that: (a) the fact that
IW’s case is rare is not an argument against the body image–​body schema double dis-
sociation; and (b) even if we accept that the figure-​ground concepts describe the body
image–​body schema dialogue quite accurately in our everyday life, this does not under-
mine the possibility of double dissociation.
Reading the first part of this volume, the following question arises: Does the cur-
rent debate derive from our inability to define body schema and body image properly?
Accordingly, it is appropriate to close the first part with a historical perspective on the
current debate. In his chapter ‘The body in the German neurology of the early twen-
tieth century’, Andreas Kalckert examines the history of German neurology in the
early twentieth century, demonstrating that from the very outset, the concepts of body
schema and body image were not well defined. Kalckert closes his chapter with the
following observation: ‘Fortunately or unfortunately, these discussions resemble strik-
ingly the discussions we have today. We face unclear definitions, different interpret-
ations, now and a hundred years ago’ (Chapter 7, p. 112).
In the second part, ‘Brain, body, and self ’, we consider both body schema and
body image from the perspectives of related research fields, such as cognitive neuro-
science, experimental psychology, developmental science, phenomenology, and ro-
botics. Tool use is clearly one of the most important issues for our understanding of
body schema. Therefore, it is natural to open the second part of this volume with a
chapter by Daniele Romano and Angelo Maravita concerning the question of ‘Plasticity
and tool use in the body schema’. Romano and Maravita explore the process via which
 Introduction  xxv
tools become embodied. In general, when we learn to use a new tool, we develop a
new way of interacting with the surrounding space. This malleable relationship be-
tween our body and the surrounding environment is reflected in the plastic nature of
our brain. Within our brain, changes related to tool use are not limited to spatial pro-
cessing but are also linked to sensory-​motor information processing which in turn has
the potential to transform how we are embedded within the environment. Romano and
Maravita’s findings seem to fit perfectly with how Merleau-​Ponty (1964, p. 178) regards
body schema: ‘Our organs are no longer instruments; on the contrary, our instruments
are detachable organs.’ Indeed, our body lives as a system of knowing-​how within the
surrounding space and its sensory-​motor capacity and flexibly extend into this space
through tool use. Thus, body schema is itself of space.
In the second chapter ‘Triadic body representations in the human cerebral cortex and
peripheral nerves’, Noriaki Kanayama and Kentaro Hiromitsu explore how both body
schema and body image are represented in the brain. They reconsider how the entire
neural system, including peripheral nerves, constitutes body representation. Drawing
on Schwoebel and Coslett (2005), they reject the traditional dyadic taxonomy of body
schema and body image. Instead, they present a triadic taxonomy of body schema
(sensory-​motor representation of the body), body structural description (topological
representation of body parts and whole), and body semantics (lexical meanings of body
parts). Kanayama and Hiromitsu further propose that the neural basis of the new tri-
adic taxonomy lies in three information streams in the visual cortical areas: the ven-
tral stream corresponding to body semantics, the ventro-​dorsal stream corresponding
to body structural description, and the dorso-​dorsal stream corresponding to body
schema. Their proposal preserves the concept of traditional body schema, but the con-
cept of body image is now categorized into the topological-​perceptual aspect and the
lexical-​conceptual aspect. Here we notice that their proposal partially corresponds to
the taxonomy of the body image originally presented by Gallagher (2005), that is, body
percept, body affect, and body concept. Kanayama and Hiromitsu’s recategorization of
body image seems to focus on the difference between body percept and body concept.
Concerning the taxonomy of body representations, Matej Hoffmann tackles the
problem in a comprehensive manner from the perspective of robotics. In his chapter
‘Body models in humans, animals, and robots’, Hoffmann asks: How is the physical body
represented in animals, humans, and robots in terms of information processing? He pro-
poses to classify body representations by locating them on axes such as fixed versus
plastic; amodal versus modal; explicit versus implicit; centralized versus distributed;
and so on. Hoffmann argues that the human body is more centrally controlled in terms
of movement than invertebrates, such as the octopus, which have greater freedom in
peripheral movements. However, the same condition alters the human capacity for
conscious and dexterous manipulation of objects in a detailed manner, as is evident in
tool use. Although Hoffmann focuses on the fixed and amodal nature of body models
in robots, by contrast, this shows the plasticity and multimodality of human body rep-
resentations in the organic brain. According to Hoffmann, it is possible to say that hu-
mans inevitably represent the body in the brain, that is, the central nervous system
xxvi Introduction
that controls peripheral movements, but at the same time, this enables humans to con-
duct explicit and well-​controlled bodily interactions with the environment. Within
neurological-​anatomical conditions of the human body, we find the origin that consti-
tutes both body schema and body image. On the one hand, we obtain the capacity for
well-​controlled dexterous actions toward the environment, and on the other hand, we
also gain the capacity to consciously experience our own body by perceiving it expli-
citly. Curiously, even in a purely representational approach, the body must be as both
subject and object: ‘The body catches itself from the outside in the process of exercising
a knowledge function; it attempts to touch itself touching, it begins “a sort of reflec-
tion” ’ (Merleau-​Ponty, 2012, p. 95).
The human capacity to experience the body in an explicit manner initiates the possi-
bility of being as a self. In the fourth chapter ‘From implicit to explicit body awareness
in the first two years of life’, Philippe Rochat and Sara Valencia Botto explore the de-
velopmental trajectory between body schema and body image. Rochat and Botto dis-
cern the crucial difference between body schema and body image in the implicit versus
explicit axes of body awareness, attempting to find a developmental process from the
former to the latter. Unlike the previous two chapters, Rochat and Botto emphasize
the importance of the social environments in which infants manifest primordial self-​
consciousness through social emotions such as embarrassment, shame, and pride. In
the developmental contours, we first develop our embodied interactions with the sur-
rounding environment as manifestations of body schema, underpinning an implicit
body awareness separate from the outer environment. Subsequently, internalizing the
other’s evaluative gaze through embodied, as well as social, interactions, we become
conscious of our own body as body image, which can be defined as a primitive sense of
self. Note that according to their view, our sense of self is social from the very beginning.
In contrast to this emphasis on the social, in the fifth chapter ‘Cross-​referenced body
and action for the unified self ’, Shu Imaizumi, Tomohisa Asai, and Michiko Miyazaki
explore the origin of the sense of self within an individual’s bodily experiences.
According to their own experiments using the paradigm of the rubber hand illusion,
they depict a cross-​referential relation between ownership and agency—​the sense of
ownership of a fake hand induces movement of a real hand, and the movement of a
fake hand is accompanied by the sense of ownership. They further explore the idea that
the ownership–​agency interaction underpins self-​representation in cases of infants and
adults who have undergone limb amputation. The former develop a sense of self by
matching the proprioceptively perceived body and the visually perceived body, whereas
the latter experience the loss and restoration of bodily self-​representation through the
use of prostheses.
Whereas Imaizumi, Asai, and Miyazaki emphasize the role of movement in inte-
grating multimodal representations of the body, in the last chapter in Part II ‘Growing
up a self ’, Rosie Drysdale and Manos Tsakiris attempt to shed light on the sense of self
in its relation to interoceptive, as well as exteroceptive, body awareness. Although the
sensory interplay between interoception and exteroception is not yet fully understood,
by collecting scarce evidence in developmental science, they present a framework
 Introduction  xxvii
according to which we develop the sense of self from the inside-​out. Drysdale and
Tsakiris discern the social origins of interoceptive sensitivity, arguing that ‘a mother’s
physiological regulation during pregnancy is consequential for the foetus and its sur-
vival’ (Chapter 13, p. 218). As we saw, Rochat and Botto emphasize the social origin
of the sense of self, yet it seems that the sense of self in this case means explicit self-​
consciousness. In contrast, Imaizumi, Asai, and Miyazaki explore the sense of self that
is basically implicit and constituted by the senses of agency and body ownership, which,
in their view, are not necessarily social. Drysdale and Tsakiris further trace our sense
of self to the fundamental interoceptive sensitivity, for which they find social origins.
If so, they argue, then even in the process of forming the minimal and implicit sense of
self, the infant’s embodied social interactions with the caregiver are foundational. Their
view suggests two things: (a) we need to explicate the problem of self not only in terms
of body image, but also in terms of body schema; and (b) the sociality of body schema
and the minimal sense of self should be further examined in future research.
The third part ‘Disorders, anomalies, and therapies’ begins with Jonathan Cole’s
chapter ‘The embodied and social self ’. Cole returns to IW’s case, demonstrating: (a)
how conscious control at the body image level may only partially replace the deaffer-
ented body schema; and (b) in what sense body schema and body image can be con-
sidered, at least conceptually, two different systems. Cole develops these notions further
for the social sphere, arguing that others’ responses to one’s body are crucial in devel-
oping our body image and sense of self.
In the second chapter ‘Unilateral body neglect’, Yves Rossetti and Laurence Havé
demonstrate that body image disorders in neglect are not always accompanied by body
schema disorders. They argue that even if a clear definition of these two concepts can be
articulated, the clinical reality is far more complex, both (a) in terms of the existence of
a continuum between these two extremities of bodily manifestations of unilateral neg-
lect, and (b) in terms of the dialectic relationship between the two systems. In the third
chapter ‘Neural underpinnings of body image and body schema disturbances’, Jasmine
Ho and Bigna Lenggenhager continue this line of thought. Based on neural alterations
in various body-​related brain regions, they suggest that body schema and body image
are mutually dependent; hence it is problematic to make a clear categorization of most
disorders in terms of body schema and body image. It seems that both Rossetti and
Havé, as well as Ho and Lenggenhager, argue against the notion of double dissociation
between body schema and body image. To be more accurate, they accept the concep-
tual distinction and, to some extent, agree that body schema and body image can be
traced to neuronal mechanisms, yet they reject Paillard’s strong dichotomic approach
to body schema and body image.
The current debate should not, however, prevent us from discerning that the con-
cepts of body schema and body image can be useful in various applications. Indeed, in
her chapter ‘Body schema and body image disturbances in individuals with multiple
sclerosis’, Britt Normann shows that the concepts of body schema and body image can
deepen our understanding of individuals suffering from multiple sclerosis. Normann
demonstrates that embracing these concepts can improve our ability to treat patients. It
xxviii Introduction
seems that Cole, Rossetti and Laurence, and Ho and Lenggenhager agree on this point
at least: the concepts of body schema and body image allow us not only to improve
our understanding of subjective experience in various conditions, including disabilities
and disorders, but also to understand these phenomena in a way that has clinical rele-
vance for both therapists and patients.
In the fifth chapter ‘Body schema and pain’, Katsunori Miyahara challenges the con-
temporary theories of pain, which are rooted, according to Miyahara, in the Cartesian
tradition. Embracing the concepts of body schema and body image, he claims, enables
us to (a) get closer to the subjective experience of pain and (b) build a more consistent
theory of pain, which is also more loyal to our subjective experience. Pain, Miyahara
maintains, should be understood in terms of affordances, knowing-​how, and the
‘I-​can’/‘I cannot’.
The sixth chapter ‘Feeling of a presence and anomalous body perception’, written
by Masayuki Hara, Olaf Blanke, and Noriaki Kanayama, focuses on the phenomenon
known as ‘feeling of a presence’ (FoP)—​a strange sensation that another person is
nearby when, in fact, no other person is present. Hara, Blanke, and Kanayama trace
this phenomenon back to the phenomenology of Karl Jaspers regarding his notion of
leibhaftige Bewusstheit, which refers to the subjective feeling of another’s presence as
sometimes reported by patients suffering from schizophrenia. By comparing this with
other related research from the field of cognitive neuroscience, such as TMS study con-
cerning out-​of-​body experiences, they conclude that the temporo-​parietal junction
(TPJ) plays a key role in experiencing the FoP. They argue that whereas sensing the
presence of another person when there is no one there derives from one’s own disturbed
body image, the sense of another’s agency results from a disturbed body schema.
In the last chapter of part three ‘The body image–​body schema/​ownership–​agency
model for pathologies’, Aviya Ben David and Yochai Ataria present a model based on
the conceptual gap between body schema and body image, revealing how different
kinds of conditions, including body integrity identity disorder, schizophrenia, anor-
exia nervosa, and post-​traumatic stress disorder, can be explained as part of a unified
model. This model demonstrates the explanatory power of the double dissociation be-
tween body schema and body image. More specifically, it reveals how the sensorimotor
dimension, on the one hand, and the social sphere, on the other, are at work in our
everyday lives and in cases of different disabilities.

References
Athwal, B. S., Cole, J. D., Wolpert, D. M., Frith, C., & Frackowiak, R. S. J. (1999). The role of proprio-
ceptive feedback during movement: a PET study of a deafferented subject. NeuroImage, 9, 509.
Berlucchi, G. & Aglioti, S. M. (2010). The body in the brain revisited. Experimental Brain Research,
200(1), 25–​35. doi:10.1007/​s00221-​009-​1970-​7
Cole, J. (1995). Pride and a Daily Marathon. Cambridge, MA: MIT Press.
Cole, J. (2016). Losing Touch: A Man Without his Body. Oxford University Press.
Conrad, K. (1933). Das Körperschema. Eine kritische Studie und der Versuch einer Revision.
Zeitschrift für die Gesamte Neurologie und Psychiatrie, 147, 346–​369.
 Introduction  xxix
de Vignemont, F. (2018). Mind the Body. Oxford: Oxford University Press.
Dennett, D. (1991). Consciousness Explained. Boston, MA: Penguin.
Denny-​Brown, D., Meyer, J. S., & Horenstein, S. (1952). The significance of perceptual rivalry re-
sulting from parietal lesion . Brain, 75(4), 432–​471.
Descartes, R. (1637/​1996). Discourse on Method and Meditations of First Philosophy. (D. Weissman,
Ed.). New Haven, CT: Yale University Press.
Durt, C., Tewes, C., & Fuchs, T. (Eds.). (2017). Embodiment, Enaction, and Culture: Investigating the
Constitution of the Shared World. Cambridge, MA: MIT Press.
Fanon, F. (2008). Black Skin, White Masks. (C. L. Markmann, Trans.). London: Pluto Press.
Forget, R. & Lamarre, Y. (1987). Rapid elbow flexion in the absence of proprioceptive and cutaneous
feedback. Human Neurobiology, 6(1), 27–​37.
Gallagher, S. (2005). How the Body Shapes the Mind. Oxford: Clarendon Press.
Gallagher, S. & Cole, J. (1995). Body schema and body image in a deafferented subject. Journal of Mind
and Behavior, 16, 369–​390.
Hartmann, H. & Schilder, P. (1927). Körperinneres und Körperschema. Zeitschrift für die Gesamte
Neurologie und Psychiatrie, 109(1), 666–​675. doi:10.1007/​BF02870259
Head, H. & Holmes, G. (1911). Sensory disturbances from cerebral lesions. Brain, 34(2–​3), 102–​254.
Melzack, R. (1990). Phantom limbs and the concept of a neuromatrix. Trends in Neurosciences,
13(3), 88–​92.
Merleau-​Ponty, M. (1964). The Primacy of Perception (J. Edie, Ed.). Evanston, IL: Northwestern
University Press.
Merleau-​Ponty, M. (1968). The Visible and the Invisible . (C. Lefort, Ed., & A. Lingis, Trans.). Evanston,
IL: Northwestern University Press.
Merleau-Ponty, M. (2011). Le Monde Sensible et le Monde de l’Expression: Cours au Collège de France
Notes, 1953 (E. de Saint Aubert and S. Kristensen, eds.). Genève: MētisPresses.
Merleau-​Ponty, M. (2012). Phenomenology of Perception. (D. A. Landes, Trans.). London: Routledge.
Paillard, J. (1999). Body Schema and body image-​a double dissociation. Motor Control, Today and
Tomorrow, 197–​214.
Paillard, J. (2005). Vectorial versus configural encoding of body space. In H. De Preester & V.
Knockaert (eds.), Body Image and Body Sschema: Interdisciplinary Perspectives on the Body (Vol. 62,
pp. 89–​109). Amsterdam/​Philadelphia, PA: John Benjamins Publishing Company.
Penfield, W. & Rasmussen, T. T. (1950). The Cerebral Cortex of Man. New York, NY: Macmillan.
Pitron, V. & de Vignemont, F. (2017). Beyond differences between the body schema and the body
image: insights from body hallucinations. Consciousness and Cognition, 53, 115–​121. doi:10.1016/​
j.concog.2017.06.006.
Ramachandran, V. S. & Blakeslee, S. (1998). Phantoms in the Brain. New York, NY: Quill William
Morrow.
Schilder, P. (1923). Das Körperschema—​Ein Beitrag zur Lehre vom Bewusstsein des eigenen Körpers.
Berlin Heidelberg: Springer.
Schilder, P. (1934). The somato-​psyche in psychiatry and social psychology. Journal of Abnormal and
Social Psychology, 29(3), 314–​327. doi:10.1037/​h0075479.
Schilder, P. (1935). The Image and Appearance of the Human Body. Oxford: Kegan Paul.
Schwoebel, J. & Coslett, H. B. (2005). Evidence for multiple, distinct representations of the human
body. Journal of Cognitive Neuroscience, 17(4), 543–​553.
 PART I
T HE OR ET ICA L
CL AR IF IC AT ION : B ODY S C H E M A
A N D B ODY I M AG E
 1
What is the body schema?
Frédérique de Vignemont, Victor Pitron, and Adrian J. T. Alsmith

1.1  An action-​orientated representation

The body schema is commonly defined as the representation of a body for action
(e.g., Paillard, 1999; Dijkerman & de Haan, 2007; Gallagher, 1995; Vignemont, 2010;
Schwoebel & Coslett, 2005).1 But what do we mean exactly by that? Is it only that it
contributes to the planning and the control of bodily movements? If that is the case,
then there is actually nothing specific about this type of representation of the body.
Many states indeed can play such a causal role, including some very high-​level states.
Imagine, for instance, that you want to cut a cake into six equal slices. To do so, you can
exploit your mathematical knowledge that 360 degrees divided by 6 equals 60 degrees.
This knowledge can guide your hand while splitting the cake. Your ability to do maths
can thus play a role in guiding your action, but clearly, we want the body schema to
be more intimately connected to action. The crucial question is what makes the body
schema so special. One might believe that the theories of motor control should be able
to shed light on its nature, but they generally stay remarkably silent about the body
schema. Here we shall characterize in detail its relation to action by analysing the type
of information that it represents, the way this information is represented, and the func-
tion of this representation.
Let us start with a first provisional definition of the body schema:

The body schema represents bodily parameters that are useful for action planning and
control.

Clearly, intentional movement requires information about the properties of one’s

body—​but which properties exactly? Since action occurs on a very brief timescale, one
may believe that only short-​term properties are of direct relevance for guiding action.
For instance, one needs to know the precise posture of one’s limbs. However, to move
one’s arm, one needs to know its position at time t but also its size, which usually has
not changed for the last 10 years. For example, to switch on the light, you need to know
your starting position, but also the length of your arm in order to plan how far you

1 For a detailed discussion of the notion of body representation and its many controversies, see Alsmith (2019).
In brief, we take representations to be content-​bearing states of the central nervous system. We further assume
that body representations play the role of models that represent in virtue of their resemblance to the structure of
the body.

Frédérique de Vignemont, Victor Pitron, and Adrian J. T. Alsmith, What is the body schema? In: Body Schema and Body Image.
Edited by: Yochai Ataria, Shogo Tanaka, and Shaun Gallagher, Oxford University Press. © Oxford University Press 2021.
DOI: 10.1093/​oso/​9780198851721.003.0001
4  What is the body schema?
should stretch it. Hence, one needs knowledge about long-​term structural properties
of the body, including bodily configuration, bodily size, flexibility of the joints, and
muscle strength. It is thanks to the knowledge of these structural properties that one
does not attempt to move in biologically impossible or painful ways. It is also thanks
to that knowledge that one does not over-​or under-​reach when trying to get an object.
Now the problem with this definition is that one can be aware of these bodily prop-
erties independently of any intention to move. Imagine that you are lying in your bed
half-​asleep. You consciously experience your legs stretched on the cold sheet. Does this
postural sensation involve the body schema or not? Put it another way, does the body
schema play a role exclusively for action, or also for bodily awareness? If it has a dual
function, then one might wonder for what reason we actually give more emphasis to its
motor contribution than to its experiential contribution. Furthermore, we would not
be able to understand the fact that postural sensations do not always consciously ex-
press the way we act. In one study, for instance, after the vibration of the tendon of the
biceps, participants had the illusory experience that their arm was stretching, but when
asked to point to the position of their hand, their motor response remained immune to
the illusion and they pointed to the correct hand location, and not to the felt hand loca-
tion (Kammers et al., 2006). What this study, among others, reveals is that there are sev-
eral ways to represent bodily properties useful for action. It is thus insufficient to define
the body schema only in these terms. More is needed. One suggestion is that the body
schema encodes information about these properties in a specific format. The idea of a
format or code of mental representation is familiar in cognitive science, although there
is no consensus about what formats there are or how to individuate them. Some formats
are modality-​specific—​a visual format, a tactile format, and so forth. Another type of
format can be an amodal or purely conceptual. A further type of format, which is at the
core of our interest here, is the sensorimotor one. In brief, a sensorimotor content is a
content that can be directly exploited by the motor system. If we go back to our original
example of the mathematical belief, the mathematical result needs to be translated into
a different format for it to be usable to guide action. The transition to action is then in-
direct. By contrast, the motor intention to cut the cake represents the movements to
perform in sensorimotor terms and can thus be of immediate use for the motor system.
For the body schema to be in direct connection to action, it must thus be encoded in the
same format as the motor intention. We can then suggest this new definition:

The body schema represents in a sensorimotor format bodily parameters that are useful
for action planning and control.

Let us briefly elaborate on how the notion of format allows us to account for dissoci-
ations between bodily sensations and movements. The hypothesis is that there can be
distinct representations about the same properties (such as posture), but encoded in
different formats. One may, for instance, suggest that the body is encoded in three dif-
ferent codes: sensorimotor, visuo-​spatial, and linguistic (Schwoebel & Coslett, 2005).
The difference between the three formats can be well illustrated if we consider body
 An action-orientated representation  5
metrics. Action requires fine-​grained spatial content. It thus seems a plausible hypoth-
esis that the sensorimotor content of the body schema is detailed and specific (the arm
as being 70.5 cm long, for instance—​though, obviously, in whatever unit that can be ex-
ploited by the motor system). By contrast, bodily experiences do not require such high
resolution and the visuo-​spatial content can be more approximate and sketchy (the arm
as being between 69 and 71 cm long, for instance). Finally, the linguistic content could
simply represent the fact that this is a relatively long arm.
One may wonder, however, if this new definition exhausts the specificities of the
body schema. In particular, in this definition, the link to action still remains rela-
tively remote insofar as the body schema remains causally inert. Its content seems to
be purely descriptive—​it simply gives information about the body, for instance where
my limbs are located. Describing how the body is not the same as prescribing how the
body should be. To see the difference, compare the following two mental states. I have
a visual experience of the blue sky. My visual content can be accurate or not, depending
on whether it matches the actual colour of the sky. It is then said to have a ‘mind-​to-​
world direction of fit’ (Anscombe, 1957)—​the content of the representation must fit
with the world to be true. Now I form the motor intention to grasp a bottle. My motor
intention issues commands to the skeletal muscles. Its directive content cannot be true
or false. Instead, it can be successful or not, depending on whether I actually grasp the
bottle. It has a ‘world-​to-​mind direction of fit’—​the world must be made to match the
content of the representation for it to be successful. For many, it is only when its content
is directive that a representation qualifies as action-​orientated because then only does
it tell us what to do (Grush, 2004; Millikan, 1995; Clark, 1998; Mandik, 2005). Now the
question is whether the content of the body schema is comparable to the visual con-
tent of the blue sky or to the motor content of the intention. If it were only descriptive,
as our earlier definition seems to imply, then the body schema would not be action-​
orientated—​a counterintuitive conclusion.
However, there may be a different interpretation of the body schema, according to
which it has not only a descriptive content, but also a directive content. As summarized
by Millikan (1995, p. 191):

The representation of a possibility for action is a directive representation. This is be-

cause it actually serves a proper function only if and when it is acted upon. There is no
reason to represent what can be done unless this sometimes effects its being done.

More specifically, in the now classic control-​theoretic approach to action, the motor
system uses two types of internal models: the inverse model and the forward model
(Wolpert et al., 2001). The inverse model has the role of computing the motor com-
mand needed to achieve the desired state, given the agent’s bodily postures and cap-
acities, as they are represented by the body schema. One may even say that the content
of the body schema is coercive—​it heavily constrains action planning, so that one
normally cannot help but use it to guide one’s bodily movements. In short, the body
schema makes you act in a certain way. In parallel with the inverse model is run the
6  What is the body schema?
forward model, which predicts what the action will be like, given the specific body that
executes the motor command, and allows anticipatory control of movements. Here
also, we argue, the body schema has a clear directive function. It represents the desired
posture and location. For it to be satisfied, the body must meet this posture and this
location. Hence, the direction of fit is world-​to-​mind—​the body must match its repre-
sentation, and if it does not match it, then the agent must update the motor command.
To conclude, the function of the body schema is dual—​it is both to describe the
body (at a level of spatial resolution and in a format appropriate for action) and to
guide action. This dual function is fulfilled if it provides an accurate representation
of the bodily parameters useful for action and if the motor system obeys it. The body
schema corresponds to what Millikan (1995) calls a pushmi-​pullyu representation.
Pushmi-​pullyu representations (hereafter PPRs) are governed by both truth and ac-
tivity guidance. Like Dr Doolittle’s mythical animal, PPRs face two directions—​they
have a mind-​to-​world and a world-​to-​mind direction of fit. The content of PPRs varies
as a direct function of a certain variation in some aspect of the environment that it
represents and directly guides behaviour directed toward this particular aspect of the
environment. PPRs need no inferential structure for them to have a relation to ac-
tion. There is no need to translate descriptive information into directive information.
It is constitutive of the content, which builds the command for certain behaviour into
the representations. As such, PPRs afford great economy in terms of response time
and cognitive effort. We can now propose the following final definition for the body
schema:

The body schema represents in a sensorimotor format bodily parameters that are useful
for action planning and control. Its function is both descriptive and coercive.

Now that we have a better understanding of the role that the body schema plays for
action, including the type of information that is represented, its format, and its func-
tion, it is important to acknowledge that there is not a unique representation that meets
this description.

1.2  Species of body schema

There is a sense in which the term ‘body schema’ is ambiguous, in that it functions
as a general term—​a term for the genus, if you will—​which groups together various
body representations which count as species of the body schema in virtue of satis-
fying the criteria outlined earlier. We have already distinguished between the repre-
sentation of short-​term properties such as bodily posture and the representation of
enduring properties such as body metrics. We have also discussed the roles of body
schematic processes in inverse and forward model-​based motor control. Those distinc-
tions apply independently of the type of action that one performs. We now want to pro-
pose that there is a further major distinction, which is, this time, context-​dependent—​a
 Species of body schema  7
distinction between two species: the working body schema for positive affordances,
and the protective body schema for negative affordances (Vignemont, 2018).
Most research in cognitive neuroscience has restricted their investigation of the
body schema and, more generally, of action to bodily movements such as reaching,
grasping, or pointing. These movements allow us to act on the world, to explore it, and
to manipulate objects. From an evolutionary point of view, these are the movements
with the ultimate function of mostly to find food and eat it. But there is another class of
movements, possibly even more important, the function of which concerns a different
dimension of survival, namely self-​defence. These movements are sometimes summar-
ized with the famous three Fs: freeze, fight, and flight (Hediger, 1950). One should not
believe, however, that we engage in protective behaviour only when there are predators.
At any moment, we avoid obstacles on our path, we retrieve our foot from the burning
bathwater, and so forth. We can thus distinguish between these two fundamental func-
tions, to exploit the world and to protect oneself from the world.2 What we propose
is that to these two functions correspond two species of body schema, which we call
the working body schema and the protective body schema. Here are two important
implications of this functional distinction. First, the working body schema is centred
on the hands, whereas the protective body schema covers the whole body. Second, the
working body schema is highly malleable and can easily incorporate tools, whereas the
protective body schema is more stable, keeping track of the body to protect, which,
from a biological standpoint, consists of the body that nature gave us.
Let us first consider the working body schema. Its function is to reliably covary with
any bodily instrument that can act on the world and to guide these exploratory actions.
As a consequence, it does not represent the whole acting body homogeneously. It is
indeed with the hands that we mainly act on the world, whether it is to pick berries
and bring them to our mouth, to plant seeds, or to open doors and turn on the light.
We wash our hands more often than any other parts of our body, because they are the
parts of our body that interact the most with the world. We already know that the hands
are over-​represented, compared to the rest of the body, in the famous homunculus in
the primary somatosensory and motor cortex. Here, we suggest that the working body
schema, which is implemented at a later cortical stage, also represents the hands in
greater detail than other body parts because of their special significance for acting on
the world. But we also explore the world with tools. Tools extend our space of actions,
allowing us to act further away and more efficiently. They do so by extending the space
of our body, and more specifically our working body schema. Evidence for such em-
bodiment can be found in the following study (Cardinali et al., 2009). In this study,
participants repeatedly used a long mechanical grabber. When subsequently retested
while reaching to grasp with their hand alone, the kinematics of their movements
was significantly modified, as if their arm were longer than before using the grabber.

2 One might wonder whether there is not a risk of an infinite multiplications of motor functions, and thus of a
corresponding body schema. Our level of analysis, however, is at a higher functional level, based on a fundamental
distinction between negative and positive affordances.
8  What is the body schema?
Moreover, this effect of extension was generalized to other movements, such as pointing
on top of objects, although they were never performed with the grabber. Interestingly,
we constantly take, use, and drop tools of different sizes and shapes. This requires the
working body schema to adjust each time, showing an important plasticity.
Consider now the protective body schema. Its function is to reliably covary with the
body to protect and guide defensive actions. Although rarely mentioned in the litera-
ture on body representations, this notion of the body schema can be found in the litera-
ture on pain (Klein, 2015, p. 94):

There’s a body schema representation which is primarily concerned with protective

action: that is, one which maps out parts of our bodies that we should pay special at-
tention to, avoid using, keep from contacting things, and so on. Call this a defensive
representation of the body: it shows which parts of the body are in need of which sorts
of defence.

The relatively uncontroversial starting point is that survival involves preservation

of one’s body. This is why the brain evolved dedicated mechanisms specifically tuned
to the body and its immediate surroundings, which is in direct relation with the motor
system in order to protect the body. In particular, it has been found that the perceptual
system encodes in a specific way a spatial margin of safety around the body, also known
as the peripersonal space—​predators cannot approach this specific zone without
eliciting their prey-​specific defensive responses (Graziano, 2018). Peripersonal space
is anchored in various parts of one’s body, not only the hands, but also the head, the
torso, and the feet. If there is to be a key body part to protect, it is the head rather than
the hands. But the whole surface of the body is important and no matter where it hurts,
we are able to react in the appropriate way. What is important to realize, however, is
that protective behaviours are not necessarily directed toward one’s biological body;
they are directed toward the body that one takes oneself to have, namely the body as it
is represented in the protective body schema. If the protective body schema is impaired
or manipulated, then one can fail to protect part of one’s own body (Romano et al.,
2014) or start protecting a rubber hand (Ehrsson et al., 2007). Nonetheless, situations
such as these are exceptional and most of the time the protective body schema fulfils
its function and targets exclusively one’s own biological body. In particular, it normally
does not integrate the tools that we use in everyday life. We do not feel pain in the fork
that just fell on the floor. If we protected tools as we protect our limbs, we would not be
able to use them as extensively as we do and the range of our actions would be far more
limited—​we could no longer stoke the hot embers of a fire or stir a pot of boiling soup
(Povinelli et al., 2010). This claim does not contradict the fact that we protect tools and
react if they are under threat (Rossetti et al., 2015). We actually need to keep them in
good shape in order to be able to use them. Nonetheless, their significance is not of the
same kind as the evolutionary significance of our own body and it is likely that their
protection is subserved by different mechanisms. The lack of tool embodiment at the
level of the protective body schema is actually important because it prevents us from
 Local and global body schemata  9
losing track of our biological body—​thanks to the unaltered protective body schema,
we keep a default body representation that can be used to recalibrate the working body
schema once we drop the tools.
One may reply that we can use tools such as knives to defend ourselves. This shows
only that protective behaviours can recruit the working body schema, in addition to the
protective body schema, but they play distinct roles, one to actively interfere with the
threat and the other to fix what is to be protected. More generally, although it is nomo-
logically possible for them to be dissociated, the two types of body schema generally
work hand in hand. While reaching for the salt on the table, you also avoid bumping
into the bottle of wine. While cutting a carrot, you also pay attention to not cutting your
finger. And so forth.

1.3  Local and global body schemata

There may be another distinction to draw within the body schema, this time in terms
of spatial scale. Jacques Paillard (1982) investigated the notion of body schema perhaps
more than anybody else. Consider the following remark of his (p. 66, translation FV):

It would thus seem that the ‘body schema’ could be fragmented into action subsystems
corresponding to the motor instruments involved in the specification of the structure
of the paths of considered visuomotor sub-​spaces.

Paillard introduces the notion of a visuomotor sub-​space (‘sous-​espace’) as a means

to characterize the content of representational processes underlying visuomotor adap-
tation effects across body parts. A natural corollary to Paillard’s notion of a sub-​space
is that of a high-​order representation (a ‘super-​espace’; cf. Paillard, 1982, p. 67) which
serves to coordinate its subordinate elements. This broadly reflects an intuitive explan-
andum phenomenon. Try, for instance, using a hand to touch your foot while using
the other to touch your face. To perform this task, is it sufficient to have local body
schemata that represent individual body parts, and if so, what is the best characteriza-
tion of these local body schemata? Or do we also need a global body schema, the func-
tion of which would be to structure these local representations? In Paillard’s terms, does
action require a high-​order representation (a ‘super-​espace’, cf. Paillard, 1982, p. 67) to
coordinate its subordinate elements?
Typically, when an agent acts with its body, it cannot act with it as a mere collection
of parts. Rather it must act with it as a structure, a structure of the kind that Casati and
Varzi (1999) refer to as a mereotopological structure, a whole composed of interlocked
parts, or what we will more simply refer to as an integrated whole. As an integrated
whole, body parts are interlocked, bearing a mutually constraining connection to one
another, constraining bodily movement due to the nature of their connection. We can
bring the point out by considering how different our capacity for action would be if our
bodies did not have this structure. We can try and imagine a creature, call her Scatty,
10  What is the body schema?
whose parts comprise a disintegrated whole. Scatty’s body parts do not form a whole in
the same sense that we would say the front and back of a sphere form a whole (Madden,
2015), but rather in the sense that the top and bottom of a bikini are part of the same bi-
kini. Imagine, for instance, that Scatty’s body consists only of two detached hands cap-
able of independent movement, like the character Thing from the The Adamms Family,
but in duplicate. Scatty could do much that normally embodied subjects could not. She
could rotate each of her parts 360° in a single plane in opposite directions, or simul-
taneously grab an elephant’s trunk and tail. By contrast, in our case, bodily actions are
spatiotemporally constrained by the body itself as an integrated whole—​when we move
a body part, it will take as long as it does and involve the physical displacements it does,
because that part is a part of an integrated whole (Latash, 2008).
A difficult question is how the parts of this integrated whole are individuated. Under
one description, the human body is a physical object. And just like any other such ob-
ject, it can be divided in any of an infinite number of ways we can imagine. However,
not just any manner of division will be appropriate in specifying potential objects of
body schema. Our guiding principle is that the body must be divided into parts in a
manner that retains a conceptual priority of the whole, such that representing said
parts may yield coordinated bodily action. On this analysis, the whole corresponds
to a causally interlocked structure in which physical forces are distributed in virtue
of causal connections such as hinging, overlapping musculature, connective tissue,
etc. Accordingly, the body is divided into parts, which correspond to the causally ef-
ficacious elements of a bodily movement. This meets our guiding principle insofar as
this manner of division retains a conceptual priority of the whole. This can be seen by
contrasting the parts with the notion of a component (Casati & Varzi, 1999, p. 32; see
also Sanford, 1993, pp. 221–​223). Components are distinguishable such that each can
be discerned, independently of its combination with other parts. But parts of the body
as a causal unity can only be discerned by their mutual causal relations to other parts
and the body as a whole.
One worry here is that this type of causal analysis of the body does not yield clear
enough part–​whole distinctions, as such distinctions seem to be a matter of emphasis.
An analysis might emphasize causal unity to such a degree that the only object it li-
censes is the single dynamic unity; or it might emphasize the plurality of causally effica-
cious elements to such a degree that it licenses every such element as an object of body
schematic representation. Neither option seems appropriate. The issue here, however,
is really one of scale. The two options described are just the two extremes of various
scales at which the causal structure of the body might be analysed. The appropriate
scale for our purpose is an intermediate scale—​beneath the highest-​level analysis at
which there is no division at all, but above lower-​level analyses concerning, for example,
individual muscles and their connection across fascial planes and joints. At this inter-
mediate scale, low-​level elements are brought together as functional units. Functional
units (or synergies) provide a way of drastically minimizing the body’s multiple degrees
of freedom (Latash, 2008; Turvey & Fonseca, 2014). These emerge in development as
infants learn the intrinsic dynamics of their particular body (Thelen & Smith, 1994).
 Local and global body schemata  11
New functional units can emerge in adulthood when an individual learns to manipu-
late low-​level elements in the service of learning a new skill, e.g., by moving through
a stage at which joints are held rigid and then gradually unfrozen as they come to be
coordinated as a single unit (Anderson & Sidaway, 1994; Southard & Higgens, 1987).
These functional units may correspond to conventional body part names in English or
other linguistic partonomies, but they need not do so.
This might, in turn, raise the worry that whatever is gained through a more gen-
eral causal analysis comes at the cost of determining boundaries between parts. But
this worry is misplaced. First, hinges are a crucial kind of causal connection and these
may serve to specify boundaries between causally interacting parts as a feature of the
causal analysis (Bermúdez, 1998). Second, it is worth noting that even though we may
mark boundaries within the structure of the body, none of these are bona fide bound-
aries, i.e., closed continuous boundaries, such as might be provided by enveloping skin.
Rather, these are what Smith and Varzi (2000) refer to as fiat boundaries. Fiat bound-
aries, and their corresponding objects, are of the mind’s creation, reified in their psy-
chological significance, and they may be shared between connected objects, making
their demarcation semantically vague. Thus, although the analysis posits a distinction
between functional units in causal interaction, for each functional unit posited, there
may be a range of equally plausible candidates of very slightly differing spatial extent.
Though only one of these is, in fact, that which plays the relevant causal role, the ana-
lysis per se does not distinguish it from other candidates. But this is just what we would
expect on analysis of the body’s division that prioritizes the whole. The analysis pro-
duces a structure composed of continuous, interlocked objects, rather than a structure
composed of discontinuous, discrete objects.
On this analysis of body parts, and given their corresponding representations, one
may wonder whether there is any need for positing a representation of the body as
an integrated whole. This is an issue that has undergone very little explicit investiga-
tion, but a reasonable reflection on influential accounts in light of the remarks above
suggests the following rationale (O’Shaughnessy, 1980; Vignemont, 2018). Adequate
representation of body parts for the control action requires local body schemata to
be coordinated in a manner that is sensitive to each body part’s interlocking within
the whole. Integration of structural information about all parts of the body in a global
body schema would achieve this—​for it would serve as a constraint or regulatory prin-
ciple, modifying the content of local body schemata in a manner that is sensitive to the
interlocking between body parts. Thus, a set of local body schemata would be coordin-
ated according to a specific set of relations in virtue of a global body schema.
However, it remains an open issue of whether an account of even this more refined
explanandum actually requires positing a global body schema at all (Alsmith, 2019). For
given the interlocked nature of the body itself and the representation of its parts, an ex-
planation of the structure of bodily action arguably need not appeal to a global body
schema. The purpose of such a representation, as suggested above, would be to encode
structural information about the relations between parts of the body, which can then
serve to constrain local body schemata. But it is not clear why this particular explanatory
12  What is the body schema?
role could not be served by the body itself, consisting, as it does, of interlocked parts.
That is, rather than being constrained by an overarching global body schema encoding
relations between body parts, local body schemata might be constrained by the patterns
of sensory feedback reflecting relations between body parts themselves.
Note, moreover, that there is no sensory signal dedicated to the body as an integrated
whole. There is only sensory feedback concerning body parts. Yet it is clear that this
feedback affects motor coordination. For instance, Shadmehr and Mussa-​Ivaldi (1994)
showed that motor adaptation—​adaptation to changes in the dynamics involved in
motor tasks—​generalized across tasks which were structurally similar in terms of joint
torques and trajectories. If local body schemata are themselves adaptive, it becomes
redundant to appeal to a global body schema in an account of the particular way in
which they are coordinated. The question of why a global body schema encodes one
set of relations, rather than another, must be answered by recourse to the local body
schema itself imparting the structure of the body as an integrated whole. It is not clear
then why we should appeal to the former higher-​order representation in the first place.
Any structure in that representation that would enable its supposed coordinative func-
tion would be due to the structure transferred through representations it is supposed to
coordinate.

1.4  Towards a Bayesian model of the body schema

The question now arises—​how are all these representational processes constructed in
the brain? The computational processing underlying the generation of a body schema
is still poorly understood. Since it is still relatively controversial whether there are in-
nate body representations, one can question when they start developing. Is it as early
as in utero, during which spontaneous motor activity can lead to the differentiation of
the body into parts at the cortical level, or later when more complex behaviours emerge
(Bremner, 2017)? Here we shall not answer this question but rather highlight the chal-
lenges that any account of the generation of a body schema must meet and the con-
straints that it must respect. Appealing to the Bayesian model of brain functioning, we
shall then sketch the first outlines of a computational model.
The main challenge is that a body schema is not an immutable form of representa-
tion, encoded once and for all. The construction of a body schema should not be con-
ceived as set in stone. Rather it is continuously renewed in order to adapt to structural
and contextual changes of the body. It should thus be seen as a dynamic process. Not
only do short-​term properties, such as bodily posture, keep changing, but enduring
properties, such as joint flexibility, muscle strength, weight, and size, also vary across
time. Clearly, our hands are not the same when we are 10, 20, or 80 years of age. This
is particularly true in infancy, when the growth process engages profound structural
bodily changes, but it is also true during pregnancy, for instance, or with the deteri-
oration of the body in later life or ill-​health. As noted earlier, this is also specifically
true for the working body schema each time we use and then discard a tool. How is
 Towards a Bayesian model of the body schema  13
this ever-​running process of adaptation and refinement of the body schema encoded?
A model of the underpinnings of a body schema should describe not only how it is gen-
erated at the beginning, but also how this construction process can adapt in time.
One way to address this issue is to consider the sensory determinants of a body
schema. Consider the act of peeling a fig. In addition to information about the location
and the shape of the fruit, one needs information about: (i) the posture of the fingers
of the hand holding it; (ii) the posture of the hand holding the knife; (iii) the relative
location of the two hands; (iv) the size of the various segments of the upper limbs; and
(v) the size of the knife. To this aim, several sensory inputs can be involved. It is optimal
to combine visual information with proprioceptive and tactile information in order to
achieve the most reliable estimates of the bodily parameters (van Beers et al., 1999).
Here it is important to understand that the sensorimotor format, which is classically
opposed to the visuo-​spatial format, does not prevent vision from playing an essen-
tial role for the body schema. We act on the world that we primarily see and the dorsal
pathway of visual processing directly feeds the motor system (Milner & Goodale,
1995). Vision is important for the information that it delivers not only on the world
on which we act, but also on the body that acts on it. Indeed, it offers more reliable in-
formation about spatial properties than touch and proprioception, and it often dom-
inates over them when in conflict (Welch & Warren, 1980). The interaction between
the senses thus improves the likelihood of detecting, localizing, and identifying bodily
events and properties, and any viable body schema must emerge from such a process of
multisensory integration.
The multisensory nature of the body schema has been already emphasized by sev-
eral authors (Vignemont, 2018; Wong, 2014). However, the computations underlying
how the body schema is built up out of several distinct sensory signals remain unclear.
At least two sets of important issues arise. The first problem is known in the binding
literature as the parsing problem—​how to identify and select only the relevant sensory
signals to bind together. Typically, one should not integrate proprioceptive information
about one’s hand with visual information about someone else’s hand. Spatiotemporal
congruency is part of the answer, but it cannot suffice. Let us imagine that the patient
feels her phantom hand to be at a location where there is a book. Nonetheless, seeing the
book does not cancel the experience of the phantom hand. One explanation why vision
does not erase the phantom hand is that the perceptual system does not combine the
visual information about the book with the proprioceptive information about the hand,
despite the fact that they are experienced at the same location. Tsakiris (2010) thus sug-
gests the existence of a body template or model, which guarantees that the information
bound together is about the body. The difficulty with this reply is that multisensory
integration also occurs for tools that have been incorporated into a body schema and
tools hardly meet the constraints of a body template. Furthermore, a common location
does not seem to be a necessary condition. Let us consider this time prism adaptation.
When wearing prisms, visual information about the location of one’s hand is in conflict
with proprioceptive information. Yet, they are integrated together despite the spatial
discrepancy.
14  What is the body schema?
The second set of issues arises once the relevant information is selected. How are
the relevant sensory signals integrated together to form a coherent body schema? For
one thing, the temporal encoding of sensory information changes across different sen-
sory modalities. Furthermore, each sensory modality is encoded in its own format
and, in particular, in its own spatial frame (e.g., eye-​centred vision, head-​centred au-
dition, skin-​centred touch). Consequently, the brain cannot just combine the conver-
ging sensory inputs. Rather, the perceptual system needs to go beyond the differences
between sensory formats and spatial frames of reference. Finally, sensory cues are not
given the same weight in the integration process. Consider again the example of the
fig peeler. When in the dark, visual information is downgraded while somatosensory
information is upgraded. Put the light on and the grading of sensory cues changes.
The question is: how is this order of priority settled and how is it adapted to ongoing
circumstances?
The Bayesian model has been gaining success to account for a wide range of cogni-
tive processes. In brief, it postulates that the process underlying the construction of
mental representations stems from the ability of the brain to compute probabilistic stat-
istics. At the core of the model lies the idea that the brain computes the most probable
output, given all available cues. Each time a representation is constructed, the brain
settles one set of rules integrating all relevant cues. Regarding body representations,
two kinds of information are available. On the one hand, sensory signals from distinct
modalities are integrated. On the other, previous attempts at building body representa-
tions serve as priors for future ones, i.e., ongoing body representations are constructed
in light of past body representations. The weight of those ‘priors’ is adjusted, depending
on the correspondence between present and past circumstances. If the present bodily
situation is new, sensory cues will be favoured since past experiences cannot reliably
inform about the current situation, and vice versa. In addition to past experiences,
priors also include other types of mental representations. For example, species of body
schema can serve as priors for each other’s construct—​even if, with distinct functions,
the working and the protective body schema refer to the same body. One can therefore
postulate that they are not constructed separately, but that one can inform about how
the other is built up. Along the same lines, we recently proposed that the body schema
can work as a prior for the construction of the body image (Pitron & Vignemont, 2017;
Pitron et al., 2018). Arguably, sensory processing evolved, in the first place, not to pro-
vide conscious perceptual experiences, but to provide sensory control of movements.
It was only later in evolution with the emergence of more and more complex behav-
iours that sensory processing evolved to provide internal models of the world, stored in
memory and accessible to other cognitive systems. If something like this story is true,
then the body schema is evolutionarily prior to the body image. From a developmental
perspective too, it is classically assumed that the body schema has a greater influence
on the body image than the other way around. It thus seems to indicate a predomin-
ance of the body schema over the body image. However, the body schema is only one
prior, among others, on which the body image is built, which also takes into account
social priors, affective priors, and so forth. The body image is thus not a mere copy of
 Conclusion  15
the sensorimotor representation. In the process of its construction, it gains in com-
plexity (by taking into account new inputs on top of the information that fuels the body
schema) but loses in detail and accuracy. The two types of body representations are thus
functionally distinct, but their construction is partly based on their interactions, which
allow them to minimize discrepancies between them as much as possible.
We shall not enter into further details about computational mechanisms of the
Bayesian model here. However, we wish to emphasize one important feature about it—​
not only does the Bayesian model define a set of rules underlying how mental represen-
tations are constructed, but it also accounts for how those rules are adjusted in time.
Once the set of rules is defined and a body schema is built up, the brain has post hoc
feedback informing whether the selected set of rules is the right one or not. Feedback
springs from the very nature of the body schema being constructed for action. As pre-
viously outlined, the body schema not only represents the acting body, but it also me-
diates how the action is performed. Subsequently, the body schema can be considered
well constructed when the action is well achieved. In turn, success or failure of action
thereby indicates whether the construction of the body schema was correctly com-
puted. When the action fails, that means that the process underlying the construct of
the body schema was inadequate and it has to be updated for future actions. On the
other hand, when the action succeeds, the process constructing the body schema is
confirmed.
Having emphasized how the Bayesian model can adjust its own computational
rules, we can now sketch the outlines of a computational model of the body schema.
On the Bayesian view, the body schema is dynamically constructed through a trial
and error process. On a first attempt, available cues are integrated with one particular
set of rules, with some of them being upgraded and some not. In this first try, all pos-
sible priors and sensory cues can be taken into account, irrespective of the sensory
modality or the timescale. The set of rules can be settled by chance if no previous ex-
periences are stored. The system can then determine whether this attempt was suc-
cessful, thanks to feedback from action. Through multiple trials, pertinent cues can
be identified, both contextual (priors) and sensory. The set of computational rules can
then be refined in order to reach the best bet about how the body schema shall be con-
structed. According to this view, the refinement of a body schema is thus conceived as
an ongoing process. From birth on, the brain aims to identify reliable sets of rules for
the construction of a body schema and, through multiple trials, adapt them to present
body constraints.

1.5 Conclusion

What is the body schema? To say that it plays a role for action is to say very little. Here
we tried to understand what role precisely it plays and how it achieves it. More pre-
cisely, we characterized the body schema by its sensorimotor format and by its dual
function, both descriptive and directive. However, we also highlighted the variety of
16  What is the body schema?
representations of the body that match these basic criteria. In particular, they can vary
along the following dimensions:

• their temporal scale (short-​term versus long-​term)

• their spatial scale (local versus global)
• their evolutionary role (for exploratory versus defensive actions)
• their motor contribution (for planning versus control)
• the weight given to their sensory inputs (vision versus somatosensation)
• their malleability (relatively rigid versus highly plastic).

Many have looked for dissociations between the body schema and the body image,
but it may be time to look for dissociations within the body schema. Then only shall we
be able to determine whether these distinctions are merely conceptual or whether they
also have an empirical reality.

References
Alsmith, A. J. T. (2019). Bodily structure and body representation. Synthese. https://​doi.org/​10.1007/​
s11229-​019-​02200-​1
Anderson, D. L. & Sidaway, B. (1994). Coordination changes associated with practice of a soccer kick.
Research Quarterly for Exercise and Sport, 65(2), 93–​9.
Anscombe, G. E. M. (1957). Intention (2nd ed). Oxford: Blackwell.
Bermúdez, J. L. (1998). The Paradox of Self-​Consciousness. Cambridge, MA: MIT Press.
Bremner, A. J. (2017). The origins of body representations in early life. In F. de Vignemont and A.
Alsmith (eds.), The Subject’s Matter (pp. 3–​31). Cambridge, MA: MIT Press.
Cardinali, L., Frassinetti, E., Brozzoli, C., Urquizar, C., Roy, A. C., & Farnè, A. (2009). Tool-​use in-
duces morphological updating of the body schema. Current Biology, 19(12), R478–​9.
Casati, R. & Varzi, A. (1999). Parts and Places: The Structures of Spatial Representation. Cambridge,
MA: MIT Press.
Clark, A. (1998). Being There: Putting Brain, Body, and World Together Again. Cambridge,
MA: MIT press.
Dijkerman, H. C. & de Haan, E. H. (2007). Somatosensory processes subserving perception and ac-
tion. Behavioral and Brain Sciences, 30, 189–​201.
Ehrsson, H. H., Wiech, K., Weiskopf, N., Dolan, R. J., & Passingham, R. E. (2007). Threatening a
rubber hand that you feel is yours elicits a cortical anxiety response. Proceedings of the National
Academy of Sciences of the United States of America, 104(23), 9828–​33.
Gallagher, S. (1995). Body schema and intentionality. In J. L. Bermúdez, A. Marcel, & N. Eilan (eds.),
The Body and the Self (pp. 225–​244). Cambridge, MA: MIT Press.
Graziano, M. (2018). The Space Between Us. New York, NY: Oxford University Press.
Grush, R. (2004). The emulation theory of representation: motor control, imagery, and perception.
Behavioral and Brain Sciences, 27(3), 377–​96.
Hediger, H. (1950). Wild Animals in Captivity. London: Butterworths Scientific Publications.
Kammers, M. P., van der Ham, I. J., & Dijkerman, H. C. (2006). Dissociating body representations
in healthy individuals: differential effects of a kinaesthetic illusion on perception and action.
Neuropsychologia, 44, 2430–​6.
Klein, C. (2015). What the Body Commands. Cambridge, MA: MIT Press.
Latash, M. (2008). Synergy. Oxford: Oxford University Press.
Madden, R. (2015). The naive topology of the conscious subject. Noûs, 49(1), 55–​70.
 Conclusion  17
Mandik, P. (2005). Action oriented representation. In A. Brook & K. Akins (eds.), Cognition and
the Brain: The Philosophy and Neuroscience Movement (pp. 284–​305). Cambridge: Cambridge
University Press.
Millikan, R. G. (1995). Pushmi-​pullyu representations. Philosophical Perspectives, 9, 185–​200.
Milner, A. D. & Goodale, M. A. (1995). The Visual Brain in Action. Oxford: Oxford University Press.
O’Shaughnessy, B. (1980/​2008). The Will: A Dual Aspect Theory (Vol. 1). Cambridge: Cambridge
University Press.
Paillard, J. (1982). Le corps: approche neuropsychologique et neurologique. Le corps et ses langages
d’espace. In E. Jeddi (ed.), Le Corps en Psychiatrie (pp. 53–​69). Paris: Masson.
Paillard, J. (1999). Body schema and body image: a double dissociation in deafferented patients. In
G. N. Gantchev, S. Mori, & J. Massion (eds.), Motor Control, Today and Tomorrow (pp. 197–​214).
Sofia: Academic Publishing House.
Pitron, V., Alsmith, A., & de Vignemont, F. (2018). How do the body schema and the body image
interact? Consciousness and Cognition, 65, 352–​8.
Pitron, V. & de Vignemont, F. (2017). Beyond differences between the body schema and the body
image: insights from body hallucinations. Consciousness and Cognition, 49, 115–​21.
Povinelli, D. J., Reaux, J. E., & Frey, S. H. (2010). Chimpanzees’ context dependent tool use provides
evidence for separable representations of hand and tool even during active use within peripersonal
space. Neuropsychologia, 48, 243–​7.
Romano, D., Gandola, M., Bottini, G., & Maravita, A. (2014). Arousal responses to noxious stimuli in
somatoparaphrenia and anosognosia: clues to body awareness. Brain, 137(Pt 4), 1213–​23.
Rossetti, A., Romano, D., Bolognini, N., & Maravita, A. (2015). Dynamic expansion of alert responses
to incoming painful stimuli following tool use. Neuropsychologia, 70, 486–​94.
Sanford, D. H. (1993). The problem of the many, many composition questions, and naive mereology.
Noûs, 27(2), 219–​28.
Schwoebel, J. & Coslett, H. B. (2005). Evidence for multiple, distinct representations of the human
body. Journal of Cognitive Neuroscience, 17, 543–​53.
Shadmehr, R. & Mussa-​Ivaldi, F. A. (1994). Adaptive representation of dynamics during learning of a
motor task. Journal of Neuroscience, 14(5), 3208.
Smith, B. & Varzi, A. C. (2000). Fiat and bona fide boundaries. Philosophical and Phenomenological
Research, 60(2), 401–​20.
Southard, D. & Higgens, T. (1987). Changing movement patterns: effects of demonstration and prac-
tice. Research Quarterly for Exercise and Sport, 58(1), 77–​80.
Thelen, E. & Smith, L. B. (1994). A Dynamic Systems Approach to the Development of Cognition and
Action. Cambridge, MA: MIT Press.
Tsakiris, M. (2010). My body in the brain: a neurocognitive model of body ownership.
Neuropsychologia, 48, 703–​12.
Turvey, M. T. & Fonseca, S. T. (2014). The medium of haptic perception: a tensegrity hypothesis.
Journal of Motor Behavior, 46(3), 143–​87.
van Beers, R. J., Sittig, A. C., & Gon, J. J. (1999). Integration of proprioceptive and visual position in-
formation: an experimentally supported model. Journal of Neurophysiology, 81(3), 1355–​64.
de Vignemont, F. (2010). Body schema and body image: pros and cons. Neuropsychologia, 48(3),
669–​80.
de Vignemont, F. (2018). Mind the Body: An Exploration of Bodily Self-​Consciousness. Oxford: Oxford
University Press.
Welch, R. B. & Warren, D. H. (1980). Immediate perceptual response to intersensory discrepancy.
Psychological Bulletin, 88, 638–​67.
Wolpert, D. M., Ghahramani, Z., & Flanagan, J. R. (2001). Perspectives and problems in motor
learning. Trends in Cognitive Science, 5, 487–​94.
Wong, H. Y. (2014). On the multimodality of body perception in action. Journal of Consciousness
Studies, 21, 130–​9.
 2
The space of the body schema:
putting the schema in movement
David Morris

2.1 Introduction

This chapter studies the body schema and its role in shaping our sense of lived
space, that is, our experience of spatial features of our body, things, and sur-
rounding places, and spatial relations thereof. Touch is a central focus. Section
2.2 gives reasons for this focus, primarily that touch inseparably involves bodily
movement in space. Section 2.3 studies how touching and moving something in
schematic patterns shapes our sense of its spatial features, such as its length. It
then shows how such schematic patterns can also shape our sense of distal things,
when our movements couple with our surroundings through light, via our eyes or
technological devices.
These studies show how these schematic patterns, and our sense of lived space, are
shaped from within movement, inseparable from movements that themselves dis-
tribute through the space of a body moving with things in the world. Sections 2.4
and 2.5 advance an important, consequent shift in the concept of the body schema.
Against tendencies to conceptualize the body schema as representing and control-
ling body positions through a neural system centred ‘in the head’ (the ‘body-​in-​brain’
view), the argument is that the body schema is itself of space, founded and actualized in
movements distributed over a moving body in the world (supporting ‘body-​in-​world’
views1). While this distributional dynamic does crucially operate by means of features
such as neurology, those means should be conceptualized as one evolved link, alongside
others, within overall movement organization. Movement and its evolving organiza-
tion are foundational, and the body schema is better conceptualized as a schematizing
pattern engendered within movements versus a central representor or controller that
operates in abstraction from movement.
On this view, the body schema arises within the development and evolution of more
foundational body-​schematizing movements and capacities, crucial to shaping the
body as a moving whole. Section 2.6 shows how this suggests a different approach to

1 More specifically, the argument generally supports enactivist approaches to embodied cognition, which are
insightfully defended by Gallagher (2017). Deeper nuances, concerning convergences and divergences of my ar-
gument from enactivism and its philosophy of nature (see Gallagher, pp. 21–​23), must be left for another occasion,
although they are touched on in Section 2.5.

David Morris, The space of the body schema: putting the schema in movement In: Body Schema and Body Image.
Edited by: Yochai Ataria, Shogo Tanaka, and Shaun Gallagher, Oxford University Press. © Oxford University Press 2021.
DOI: 10.1093/​oso/​9780198851721.003.0002
 Touching movement  19
questions about the distinction and relation of the body schema and body image. The
suggestion is that capacities for, and divergences between, a body schema versus a body
image emerge when body-​schematizing activity runs into various resistances or de-
mands from environmental supports, including other perceiving bodies and the social
sphere, over various timescales, e.g., of evolution, development, skill, and habit acquisi-
tion, as well as of cultural formations.

2.2  Touching movement: conceptual and methodological motives

This chapter’s underlying method is phenomenological, in a sense well captured by

Merleau-​Ponty when he says that ‘my general aim is always to . . . confront the concepts
which we are accustomed to using, and which I am accustomed to use, with the realities
they are supposed to designate’ (Merleau-​Ponty, 2016, p. 342). This conceptual effort
turns me to touch.
Touch (haptics) comprises two perceptual domains: (1) the tactile, wherein, for ex-
ample, rubbing, probing, or gripping surfaces reveal aspects such as texture or elas-
ticity; (2) what ecological psychologists call dynamic touch, wherein handling things
reveals: spatial features such as their length, girth, volume, and reach; their material
features such as density or flex; but also the spatial position or orientation of things
relative to us. For concision, I call these: (1) touching; and (2) handling (or wielding,
etc.). Clearly, these two systems often intertwine—​touching for surface properties often
entails specific handling movements; handling entails touch for grip, slipperiness, etc.
There are three conceptual-​strategic motives for turning to touch. The first is that
touch inseparably involves movement. David Katz, a Husserl-​influenced psychologist,
emphasizes this throughout his pioneering The World of Touch (Katz, 1989)—​there is
no tactile sense without the body moving over things. Where movement’s crucial role
might (mistakenly) be overlooked in vision, especially since ‘eyes do not see’ during
saccades, in direct contrast, as Katz notes, touch feels nothing without movement. He
shows this through many insightful, fine-​grained descriptive analyses, leading to a
section titled ‘Movement as a creative force in the sense of touch,’ wherein he also iden-
tifies ‘temporal atomism’ as prejudicing previous psychological experiments that freeze
movement through various snapshots. Katz’s experiments reveal movement’s crucial
role in touch, now well confirmed, for example, by ecological psychology showing how
exploratory procedures are key to touch.
Second, touch has a crucial, although neglected, role in the conceptual his-
tory of the body schema. Katz’s book (and its companion The World of Colour,
which similarly emphasizes movement) influences Merleau-​ Ponty’s concept of
the body schema, perception, and his attention to movement and time at key mo-
ments in his Phenomenology of Perception (Merleau-​Ponty, 2012 [1945])—​with
lasting effects on his subsequent 1953 lectures on the body schema (2011).2 In turn,

2 See Halak in Chapter 3 for more on the 1953 lectures, which are only recently available.
20  The space of the body schema: putting the schema in movement
Gallagher’s influential contributions on body schema versus body image draw on the
Phenomenology. While this chapter is not a contribution to Merleau-​Ponty schol-
arship, his Phenomenology offers three relevant conceptual lessons. First, Merleau-​
Ponty conceptualizes our senses of the body and the world as counterpart and arising
within one moving body-​world coupling, shaped by the body schema. He draws this
insight from experiments on Aristotle’s illusion, wherein handling a marble through
crossed fingers gives a sense of a double marble, and a counterpart, odd sense of one’s
body. Merleau-​Ponty argues this is not because fingers are displaced from proper
positions mandated by some internal controlling representation; it is because twisted
fingers cannot actually move the marble to solicit its usual rolling-​between-​fingers
response (unless we habituate to handling it this way). Second, for Merleau-​Ponty,
touch reveals that our sense of space is not structured by an a priori space, definable
in abstraction from actual touching activity. Rather, in touching, the hand learns to
move in ways that shape a spatial ‘a priori’ (see pp. 229–​231). The space of touch
is thus ongoingly constituted within and by our haptic movement-​coupling with
things. Other sense modalities constitute their own spaces, shaped by their respective
movement-​coupling modalities.3 Our overall lived space is, likewise, not defined by
any abstract a priori, but rather by the ways our several spaces of moving converge
in coupling with things, thus shaping one coordinated space of movement. Third,
Merleau-​Ponty thereby understands the body schema not as a central system con-
trolling body positions in an abstract space, but as a schematizing arising within
body-​world movement.4
The third reason for turning to touch is that it depends on moving morphology in
a different way than sight, hearing, smell, and taste (at least at first glance), since it re-
quires quite active and plastic shaping of its ‘organs’ on many scales, from shaping fin-
gers within hands, to hands in relation to one another, to arms, and to overall posture
(e.g., handling a long pole, when touching something distant).
Touch, in short, is inseparable from the moving morphology of a body in the world.
It is tempting, then, to say that touch is ‘4e’: embodied, embedded, enactive, and ex-
tended. But this is palpably obvious! Why would we ever need to say it and what
could this mean? This puts a finger on the deeper conceptual problem, namely ways
that representational and sensory-​control views obscure, or even ‘sanitize’, moving-​
morphological aspects of perception and the body schema, by putting control in the
centre, ‘in the head’ . . . such that we’d need to correctively add that, yes, touch too is
embodied. Hands and touch cannot be sanitized of embodiment. This helps us grasp
control and the body schema as distributing in and over the space of a moving-​body-​
in-​the-​world—​priming us for the points below.

3 An experiment by Klatzky (2008), another important haptic researcher, offers support for haptic space having
its own peculiar modality.
4 See Morris (2004) for more.
 Our moving sense of the space of things  21
2.3  Our moving sense of the space of things

I will gradually build these points by first studying ways in which schematic patterns
of movement shape our sense of lived space. The double marble already gives a de-
scriptive, phenomenological example—​our sense of its unified spatial volume emerges
from patterns of moving it and feeling it move in response to us. Similar movement-​
patterning can give a sense of something’s haptic size, which does not quite track geo-
metrical measures. The rosemary stuck in your teeth feels huge under your tongue,
relative to its tiny size as felt between your fingers. In painting the Taj Mahal on a rice
grain, the miniaturist-​artist would not experience the rice grain as ‘smaller’ than a
canvas, even while knowing it is smaller. Painting requires moving brushes over the rice
grain as having ‘canvas-​scope’. The artist’s extraordinary motor skills, as coupling to the
grain through magnifying lenses, effectively increase the scope of differentiated brush-
strokes through which they paint it. Our sense of size, depth, and distance is import-
antly shaped by the patterning and articulation of our moving-​coupling with things.
This is modulated by movement skills5 and organ sensitivity (which is higher in the
tongue versus the fingers, a factor in the rosemary case).
Key research on dynamic touch by the ecological psychologists Claudia Carello and
Michael T. Turvey (summarized in 2017) more directly shows how movement patterns
shape our sense of touch. In one of their early experiments, subjects hold an object they
can freely move about, with a screen hiding it from view. Subjects move an indicator
closer or farther away, along the screen, visually aligning the indicator with where they
haptically perceive the object’s tip to be. This indicates their sense of its ‘haptic length’.
The experiment reveals that people have a surprisingly good judgement of the object’s
length, yet also that haptic length does not track objective geometric length, but in-
stead ‘wieldiness’—​how easy it is to swing or twist something in various axes, which is
measured in terms of its rotational moments. With the uniformly dense objects we typ-
ically handle, our sense of an object’s ‘wieldiness’ gives a very good sense of its length—​
but experimental manipulation of rotational moments can, for example, make us feel
something as ‘longer than it is’. These manipulations demonstrate that we are sensing
wieldiness, not geometrical length as such.
Wieldiness, however, can only be felt in the real-​time of a body moving together with
an object that ballasts bodily movements. While an object’s rotational moments belong
to it, even when motionless, you cannot feel or ‘pick up information’ about these (to
use ecological psychology’s terminology) without moving it. This emphasizes that our
sense of haptic length is immanent within wielding movements.

5 Experiments show, for example, that experienced microsurgeons are better at perceiving depth (in micro-
surgery simulators) than inexperienced ones—​but depth perception improves when the simulator adds visual
navigational guides that help inexperienced neurosurgeons improve their movements (Kato, 2008). This fits
Merleau-​Ponty’s argument that movement factors, for example, how things afford more or less fine-​grained ma-
nipulation (versus, for example, mere optical angles on retinas), crucially motivate our sense of the size and dis-
tance of things seen.
22  The space of the body schema: putting the schema in movement
An astonishing set of experimental discoveries followed their initial result. You
might have thought that the hand and arm are the organs geared to picking up ‘haptic-​
length-​in-​wielding’. You’d be wrong. It works the same way in very different modalities of
wielding. It does not matter whether the wielding is free to move about the wrist only;
or about the wrist, elbow, and shoulder; or restricted by barriers; or whether you swing
the wielded object vertically or horizontally, or with different grips; or balance it on
a hand or knee and move it with another hand; or move it by affixation to a foot—​or
even to the back of the neck! This amplifies the point that haptic length is immanent in
movement—​you don’t so much feel it with your hand, as with felt invariants of move-
ment that arise in moving-​couplings with things.
A series of empirically motivated conceptual provocations deepen this point. First,
you might wonder whether movement’s role in spatial perception is peculiar to touch
(as involving movement in special ways). But ecological psychology shows that visual
perception of spatial features, such as depths of alleys, our distance from things, or our
forward speed of movement, similarly does not track or reconstruct geometry as such;
instead it picks up movement patterns, invariant flows, or transformations in visual
content. Wieldiness lets us pick up length pretty well . . . given our evolved ways of
handling things and how their mass distribution usually structures wieldiness. So too
visual flows let us pick up surrounding spatial features pretty well . . . given our evolved
ways of moving around in our usual environments and the way their textured surfaces
usually structure light as an ‘ambient optical array’. As with touch, visual flow patterns
are immanent in movement, unavailable apart from moving about.
Second, consider famous results regarding touch-​ vision sensory substitution
(TVSS). In TVSS, a video camera’s output drives an array of vibrating actuators on a
person’s back or belly (or tingles an array on the tongue). Like the blind person who,
as Merleau-​Ponty describes (2012, p. 144), no longer feels their cane pressing on their
hand but feels things through its tip (and in thus touching things, thereby feels the cane’s
length), people can learn to view objects as being distal to them, moving closer and far-
ther away, through TVSS—​instead of feeling the TVSS apparatus producing vibrations
local to their body. This requires things moving relative to the camera and works better
when the person actively moves the camera. As in ocular vision, TVSS users perceive
spatial distality in and via patterns of movement. Strikingly, these movement patterns
are relatively independent of how we pick them up: with eyes—​or TVSS (see, for ex-
ample, Cancar, Díaz, Barrientos, Travieso, & Jacobs, 2013; Siegle & Warren, 2010).6
Third, touch and vision both pick up spatial features by and within various schemas
of movements. I’ll call these prospection schemas or just prospections—​movements we
shape, that dig into, prospect, our body-​world coupling, thus picking up certain pro-
spective (futural) possibilities in response. Prospections tune to responses that unfold

6 Crucially, coupling to things by light versus mass enables very different movement dynamics. These coupling-​
dynamics, rather than luminous or vibratory stimuli, are what differentiate vision and touch—​and are key to ques-
tions of whether TVSS is a form of vision, or touch, or something new.
 Our moving sense of the space of things  23
and must be tracked over time, versus tuning to what is given right now.7 In hand-
ling, moving things around lets us prospect our mass-​coupling with them for spatial
features, such as length, size, volume, and unity, as revealed in invariant patterns in
response to our prospections. In vision, moving our ocular (or TVSS bearing) body
about lets us prospect our light-​coupling with surroundings for spatial features, such
as depth, vastness, and forward motion—​again, through invariant patterns. It is these
prospection schemas, not geometry as such, that set up the ‘spatial a prioris’ of different
movement-​couplings—​the tongue, the hand, and the microsurgically augmented
hand, each engender their own ‘scales’. (Noë and others would say that prospections
explore lawful sensory-​motor contingencies, i.e., invariant patterns in sensory flows that
are contingent on our movements.)
Fourth, Carello and Turvey’s results lead to a beautiful insight regarding movement.
Ecological psychology conceptualizes vision as picking up invariant flows in an out-
side ambient optical array. Their discovery, that felt haptic length is independent of its
particular organ, led them to conceptualize touch as picking up invariant flows in what
they call a ‘tension array’—​which is our own moving body conceptualized as a complex
structure of tensions, felt from ‘inside’. This tension array changes as we change our pos-
ture and move about, including moving with things we are wielding. In other words,
the medium and ‘organ’ of touch is movement itself, as playing out in a body that feels its
tensings in its movings. This complements Sheets-​Johnstone’s long-​standing insistence
on the primacy of kinaesthesia (summarized in 2019).
Fifth, a result by Charles Lenay sharpens this emphasis on movement. His research
studies haptic interfaces and technology in phenomenologically informed and philo-
sophically motivated ways. Lenay’s ingenious experiments often strike to deep philo-
sophical issues, by elegantly probing for minimal conditions of forms of experience.
You might, for example, think the minimal condition of spatial experience is a two-​
dimensional sensory array—​or at least more than one sensory point of interaction.
Didn’t Kant compellingly demonstrate that spatial experience is minimally constituted
by the juxtaposition of at least two concurrent experiences? But it is not so simple. Lenay
(with Steiner, 2010) designed a simple, light-​sensitive device that fits on a finger and
vibrates the finger when it is pointing directly to a light—​a ‘coupling device’. A blind-
folded subject wearing this device, seated facing a light bulb and allowed to freely move
their hand and arm, eventually develops a prospection schema (my terminology) that
enables the experience of the presence of a distal thing (the bulb).8
This is remarkable. Our sense of distality persists with what is in effect a 1-​point
TVSS device—​equivalent to seeing something as distal through a 1-​pixel camera.9 This

7 As Berthoz (2000) emphasizes, even on the most basic physiological level, our sensory receptors respond not
to 1st-​order ‘stimuli’, but to 2nd-​and 3rd-​order changes, to changes in the rate of change of pressure, i.e., to force,
acceleration—​to temporal contours of body-​world couplings.
8 At Concordia, Sha Xin Wei and I ran an ‘open-​form’, phenomenological version of Lenay’s experiment.
Blindfolded participants wearing the coupling device, in a darkened room, containing one lamp, were instructed
to ‘find something interesting’. All eventually sensed a distal thing and moved to it—​but via strikingly different
movement patterns, again suggesting a sense of space constituted within moving-​in-​the-​world.
9 Here Merleau-​Ponty’s critique of sensory atomism and Katz’s critique of temporal atomism intersect and
complicate—​one point in a moving body can yield perceptual sense.
24  The space of the body schema: putting the schema in movement
leads Lenay and Steiner to advance a philosophical argument, namely that perceived
space is constituted within and by the coupling actions through which the subject moves
about. In my terminology, our sense of space is constituted within and by movements
shaped by prospection schemas.
Here is one way into their philosophical point. Consider the sensory-​motor contin-
gency view, that perception is informed by law-​like regularities in the way things produce
sensory flows in us when we move about. A standard example is a circular plate projecting
light on our retina in an oval that changes shape as we move. We see the plate’s distal cir-
cularity in and through this flowing optical content. The optical content specified by the
plate’s sensory-​motor contingencies is such that if it were played on your retina when you
are not moving, you’d still perceive a distal circular plate. This is not so if we play back the
sensory flow of the Lenay coupling device when you are immobile—​you’d just feel episodes
of vibration in your finger, with no sensible pattern. Conceptualizing its flow as a sensory-​
motor contingency entails the insight that this flow of vibrations enables a spatial sense of
distal things only insofar as it is inseparable from, and arises within, your movement, as con-
strained by schemas themselves arising in your moving-​coupling with things. (This is so with
the plate too. But the way its distal circularity is indicated in optical contents can obscure
the immanence of this spatial sense in movement itself. However, in abstraction from your
movement, you’d have no sense of moving around the plate versus it moving, or real plates
outside versus hallucinated ones ‘inside’ you.)
This is what Lenay and Steiner are getting at in arguing that the sense of space is con-
stituted in movement itself, not in and by internal representations, or external envir-
onmental structures as such, because the content of the one-​point coupling could not
itself specify these. And this is what I am getting at when emphasizing that our sense
of space is shaped within and by movement in a feeling body, moving in the world. The
medium, milieu, and ‘organ’ of our sense of space is not ‘inside our head’, nor outside
us, independent of movement—​it is in our evolved moving-​coupling with surrounding
things; it spills over containment in an inside centre, instead distributing over our spa-
tially (and temporally) protracted movements in our surrounds. This is crucial in con-
ceptualizing the what, where, and how of the body schema.

2.4  The body schema as what schematizes body-​world

movement from within

The points above (and many others as well) lead me to conceptualize the body schema
as what orchestrates our repertoire of prospection schemas and thus shapes our
moving-​coupling with the world. In this way, the body schema enables and shapes,
for example, our sense of the spatial features of things, surrounding places, and our
relation to them.10 These prospection schemas and the body schema arise on various

10 Compare Merleau-​Ponty’s insistence in his 1953 lectures (pp. 129–​131) that the body schema is ‘inserted’ in
space, that the ‘body is [a]‌schema only because it is a moving/​motor power’, and that it operates ‘as norm, as zero-​
point of divergence, as privileged level or attitude [of a moving body]’.
 The body schema  25
timescales, from evolution, through development, habit, and skill acquisition, to the
formation of cultural practices (e.g., different navigation practices as shaping different
senses of space).
Here I deliberately conceptualize the body schema in terms of its role as ‘formal
cause’.11 The body schema is whatever it is that accomplishes the above role of con-
straining and schematizing our movements. What accomplishes this includes, as
already emphasized and soon expanded, the entirety of our moving body itself, in its
coupling with surroundings. And it can work by means of different material or efficient
causes. For example, while schematizing movement might primarily work through
kinaesthetically sensitive-​moving (feeling our inner ‘tension-​array’ when moving
with things), it can work through visual guidance, e.g., when we are coupled to the
world through technological devices. The truck driver backing into a narrow alley
‘sizes things up’ in moving, via a body schema incorporating the truck, in ways that
loop through seeing (including mirrors). The driver, though, is not self-​consciously
shifting between looking and moving as distinct and separate affairs—​they are engaged
in ‘visually sensitive-​moving’ that schematizes their movements. (Compare the way
prospection schemas in Lenay’s experiment are schematized by movements techno-
logically looped to lights.) Or consider the experience of Ian Waterman, who cannot
(due to an illness) feel his body below his neck—​he cannot feel movement invariants in
the tension-​array. Moving himself safely usually requires an exhausting mental effort
of seeing, so as to deliberately move body parts, as a separate affair. But driving a car
(Cole, 1995), or using a robot arm (see Gallagher, 2005, pp. 197–​198), offers him a very
different experience—​he can just move the controls and therein feel himself acting in
the car or robot hands, as looped into them and guided by vision. (The machinery sup-
ports his bodily tension-​array; he can sit back and relax into visually guided, machine-​
extended moving—​like the truck driver.)
Waterman’s experience leads Gallagher (2005, pp. 61–​ 62) to question Sheets-​
Johnstone’s valorization of kinaesthesis as the irreducible condition of perception and
her consequent challenges to drawing lessons from Waterman. Gallagher points out
that Waterman still has kinaesthetic feeling from the neck up, but his body schema
would work differently beyond that. My conceptual contribution and nuance are that
we should not, for example, simply distinguish body schema from body image (or intro-
duce further distinctions between long-​and short-​term body schemas; see Gallagher)
on the basis of whether, for example, visual or kinaesthetic information is ‘materially’
involved. Rather, we should conceptualize the body schema in terms of whatever is ‘for-
mally’ schematizing our movement, as enabling and shaping world-​prospections.
Consider donning glasses with a very different prescription. You may feel dis-
oriented, nearly stumble when stepping off a curb, or feel strange fitting fingers to your
computer keyboard. Changing your optical coupling to the world alters your body-​
schematizing movements and body schema. But this can also manifest in the way the

11 This approach, via constraints as formal causes, is partly inspired by Juarrero (1999). Thanks to Miguel
Sepulveda for reminding me of this.
26  The space of the body schema: putting the schema in movement
world and your body look. Your keyboarding experience might make you wonder if
your fingers are wrongly positioned or have changed size.12 Now consider habituating
to carrying loads down oddly proportioned stairs, in thick-​soled boots, in dim light.
A visual component, watching your feet, may be crucial to this elaboration of your
body schema. Yet so long as this visual component is absorbed in your new habits, as a
schematizing background of your movement, it features as part of your body schema—​
even though it could also figure as a foreground matter of body image, either implicitly
(in deliberately taking tiny steps) or explicitly (observing ‘my legs are longer in these
boots’). Similar observations could be made about felt, muscular-​animate, features of
experience—​book-​bound philosophers may have little awareness of this animate as-
pect of their body schema’s operation, while dancers and dancing philosophers, as
Sheets-​Johnstone rightly emphasizes, may have fine feeling for it.
The conceptual point is that we cannot determine whether some sector of experience
figures as body schema versus body image simply on the basis of whether it involves
some sort of visual or felt content bearing on the body. We need to pay attention to how
that content is doing work in experience of moving in the world.
There are many ways of accomplishing a body schema. We need to pay attention to that
if we are to conceptualize it properly (here I find support in Gallagher, even while going
a different way). But all sorts of confusions arise, due to the complexity of the phe-
nomena and also the importance of the body schema concept for empirical research.
This inclines research programmes to define and conceptualize it in terms of proposed
mechanisms (material and efficient causes) central or amenable to such programmes.

2.5  An evolutionary-​comparative insight into the body

schema as rooted in movement

I now amplify some deeper conceptual points by taking a somewhat strange detour,
through a very different way of accomplishing a body schema—​in the octopus. This de-
tour is prompted by Peter Godfrey-​Smith’s insightful book Other Minds: The Octopus,
the Sea, and the Deep Origins of Consciousness (2016). Godfrey-​Smith is a scuba diver,
a publishing researcher on octopus behaviour—​and a philosopher. He argues that
evolutionary-​comparative methods are important for philosophical thinking about
consciousness and embodiment—​philosophy ought to learn from the strikingly dif-
ferent, yet convergent, ways that bodies, perception, and consciousness have evolved,
for example, in humans and octopuses (which are very intelligent creatures, problem-​
solvers, and masters of material manipulation). It is a book well worth reading (as are
others on octopuses). I focus on his study of octopus movement and neurology, as
leading to conceptual points about embodiment.

12 In ‘Alice in Wonderland syndrome’ (see Perdices, 2018), people spontaneously experience their body as chan-
ging size. The phenomenon and causes are not clear.
 An evolutionary-comparative insight into the body schema  27
Our body is structured by a skeleton that defines joints and thereby limits our de-
grees of freedom of movement. We move limbs by shortening muscles, pulling limbs
together around joints (to simplify). The octopus body has a very different morpho-
logical and movement principle. It is made of muscular hydrostats (as is our tongue).
A muscular hydrostat remains constant in volume under muscular contractions, which
redistribute its volume. Imagine holding a cylindrical balloon, filled with water (water
is non-​compressible). Pressing its circular ends together widens it into a disc; squeezing
all its sides together lengthens it; contracting one side only stretches out the other side,
resulting in overall bending. Instead of being stiffened by a rigid skeleton that can bend
only around joints and vertebrae, the octopus’s muscular hydrostats at once allow its
boneless body to have a stiff layout and reshape itself and its bending points. This al-
lows somewhat arbitrary degrees of freedom of movement;13 it forms joints on the fly,
in movement. For example, when one of its suction cups grasps food, ‘two waves of
muscle activation’ propagate ‘toward one another’, one from the food toward the base
of the tentacle, the other in the reverse direction, with a joint forming ‘where the two
waves collide’ (Hochner, 2013, p. 28).
Octopuses also have very different neurology than us; they have around 500 million
neurons, but most of these, 320 million, are in the body (40 m in each arm). Hochner
shows how this sort of neuro-​musculature is well evolved for controlling movement
in an octopus’s body—​nerves local to suckers, feeding into a ladder-​like nerve net-
work within the arm, can control the joint formation just discussed. Indeed, on this
basis, Hochner argues that the octopus’s morphology itself is thus doing computing
work, in support of embodied cognition views (also see Seoane, 2018). Miłkowski
(2018), however, cautions against conceptualizing this as a computation ‘offloaded’ into
morphology.
I take away a more basic and general point, that in an octopus, prospection schemas
can arise out in the arms, between moving muscles and things felt, in ways that emphat-
ically distribute in and over the space of the body moving in its watery surround. An
inspired experiment helps clarify this and its philosophical significance.
An octopus is tested to see if it can retrieve food through a maze-​like path. In octo-
puses, food retrieval is usually guided by neurons in the tentacles responding to local
chemical signals in the water. But the maze is contrived to force the tentacle to move
above the water, to reach the food. So the octopus must visually guide its tentacle, via
neurons ‘in the head’. Most octopuses can learn to do this—​challenging claims that
they are what Merleau-​Ponty called a ‘reflex republic’ with no central coordination
(2003, p. 169, citing Uexküll on urchins and starfish). Yet strikingly, the tentacle that
is visually guided to the food also does its own exploring, beyond any ‘central con-
trol’ (Godfrey-​Smith, 2016, p. 68). This prompts Godfrey-​Smith’s argument that,
in evolutionary-​comparative terms, general notions of embodiment in philosophy
of mind are wrong-​headed. Octopuses just would not feel themselves being in their

13 In our tongue, these arbitrary freedoms are crucial to speech.

28  The space of the body schema: putting the schema in movement
bodies in the way we do. So the usual questions in philosophical discussions of embodi-
ment (whether consciousness is in the head or in the body) are inapt.
To be sure, octopuses live and behave very differently than us. Yet I’m uncertain
we can fully follow Godfrey-​Smith’s inference from their behaviour to such a claim
about octopus experience. And some people experience their hands as doing their own
alien thing; and I don’t quite feel myself in a robot-​extended body either, yet I feel my
movements extended through it. Sometimes I work through visually mediated schema
that need not require kinaesthetically feeling myself in the body, as Ian Waterman
also shows.
So I want to turn Godfrey-​Smith’s point around, to glean a different lesson about
embodiment, through another of his conceptual insights—​that octopus movement
challenges our usual sensory-​motor view of movement control, wherein nerves mediate
between sensory inputs and behavioural outputs. Instead it calls for an action-​shaping
view of nervous systems evolving as ‘solutions to a problem of pure coordination within
the organism’, coordinating ‘micro-​acts of parts of the body into the macro-​acts of the
whole’ (Godfrey-​Smith, 2016, p. 71).
Imagine octopuses evolving to the point of doing philosophy. Likely an ‘octopus
phenomenologist’ would derive a concept like the body schema—​there is some co-
ordinating of moving that importantly shapes octopus activities, such as swimming,
approaching openings as narrow versus wide, and so on. Would octopuses concep-
tualize their body schema as some sort of central representation and control system?
Likely not, because the material and efficient cause by which octopuses achieve such
schema are so palpably different. An action-​shaping (versus sensory-​motor) concept
of the body schema would be much more intuitive, conducing to a concept of the body
schema as achieved by means of various neural, muscular, environmental factors—​
but where neurons are not decisive as ‘controlling representations’. Why would you
ever think of neurons as doing anything like abstractly representing positions to con-
trol, when they are clearly achieving control by virtue of being distributed over, moving
around in, and working within, the very body and tentacles that are movingly touching
things?
Why do we, in contrast, tend to think of the body schema in terms of central con-
trolling representations? Likely this is an evolutionary-​anatomical accident—​an ac-
cident of what action-​shaping entails in the human versus octopus case. Central
coordination between limbs is crucial in vertebrates, in skeletal bodies with limited
degrees of freedom—​without it, land, air, and water vertebrates would not be able to
move around. Our central nervous system and limb-​around-​spine body organization
evolved in concert along with cephalization (this is echoed in embryogenesis). In both
us and octopuses, interconnected neurons are crucial links in actions that are shaped in
response to what our movements couple with in the world. In our case, though, these
action-​links coordinate movements better from the centre. And to work in the centre,
the neural interconnections required for coordination . . . ended up being better real-
ized through the evolution of grid-​like adjacencies of neurons . . . that make it look like
neural action-​links map and represent a body controlled in terms of plotted positions.
 Body schema and body image as emerging and diverging  29
But, just as much as in the octopus, these neurons are in a moving body. And controlling
organization is achieved by neurons not just firing one another in grid-​patterns, but
being moved into action by a body moving in coupling with the world.14 The octopus
tentacle’s movement is shaped by suckers feeling things and jointing itself—​control
is anatomically distributed in bodily movement. But couldn’t we think of the person
in Lenay’s experiment as moving a ‘fixed-​joint tentacle’ with a ‘light-​sucker-​sensor’?
Doesn’t the coordinating distribute over the space of the moving body in this case too?
And in octopuses, as well as in humans, what constrains, orchestrates, and schematizes
our moving prospection of things distributes over the entirety of the moving body in its
various couplings with its surrounds. It is just that in our case, a lot of our neurology got
stuck in a head atop a skeleton-​jointed body versus spreading through the tentacles of
a muscular hydrostat body that soft-​assembles joints on the fly. But this evolutionary-​
anatomical accident (and our computer technology) should not make us think that the
body schema is in fact ‘in the head’, as if it is a master puppeteer pulling representational
marionette-​strings. The body is not a puppet of the brain—​it moves itself with its brain,
in ways supported by environmental couplings, and gets lost or topples absent those
supports.

2.6  Body schema and body image as emerging and diverging

on various timescales of body-​schematizing movement

These evolutionary observations complement and help advance phenomenology’s

task of confronting our concepts with the phenomena they are meant to designate.
Overall, the above challenges to the concept of the body schema as an interior system
that schematizes movement through representations suggest that we should, instead,
conceptualize the body schema as arising in, and shaped by, the very movements it
schematizes.
So far, this point has been pursued, so to speak, from ‘inside’ bodily activity—​in
terms of how a body moves to schematize itself from within. But, as emphasized re-
peatedly, this schematizing distributes through, and is supported by, environmental
couplings. Body-​schematizing movement is not wholly ‘on-​board’ the body and is not
accomplished by our agency alone—​in extending into, and operating through, envir-
onmental couplings, it involves passivity to what the environment affords to, or de-
mands of, our bodily capacities. In light of this ‘resistance of passivity’,15 a body schema
organizing our activity from the ‘inside’ may not be enough—​an image of how one’s
body and capacities measure up to ‘outside’ resistances and demands may be needed.
Consider the octopus, again. Its neurology, physiology, and behaviour in natural and
experimental conditions suggest that some sort of movement schema is in operation in

14 As the dynamic systems theory shows, the body’s actual dynamics greatly simplify control problems.
15 Merleau-​Ponty (2012, p. 62). Passivity is already a key issue in his Phenomenology and is a topic of a 1954–​55
lecture course, and now of scholarship. Passivity would pose challenges to enactivist views that might overempha-
size enaction as an autonomous accomplishment of agents.
30  The space of the body schema: putting the schema in movement
its usual food-​gathering arm movements—​yet it need not have an ‘awareness’ of that
as a body schema, or an image of how its arms are positioned or jointed. Indeed, its
neurology and the experimental observation (that its arms are not fully under ‘central
control’) suggest it likely cannot glean such an image via internal ‘proprio-​reception’, as
I might feel the bend of my arm at the elbow. Nonetheless, when the maze frustrates the
octopus’s usual food-​gathering movements (shaped by ‘tasting-​and-​gathering’ schema
local to the tentacles), the octopus can visually guide its body—​suggesting it is working
with something like a body image, that it is directing its body as an object that it sees
positioned in this or that way relative to things. It is as if an environmental frustration
of body-​schematizing couplings conduces to a shift from behaviour that looks like it
can run on background schema to behaviour that might very well involve a foreground
image of its body, or at least needs to be mediated by visual interactions that could make
such an image available. (It is impossible to say from outside just what is going on.)
My suggestion here is that issues of passivity and environmental resistance are likely
crucial in the evolution of the capacity for a body image. In evolution, we would likely
find initial glimmerings of the body schema in the body-​schematizing movements
of, for example, sessile animals like anemones. These must be capable of some overall
action-​shaping and bodily coordination, but it is unlikely their nerve-​net and physi-
ology would enable some sort of distinct image of how their body is positioned in the
world as an object relative to things. In contrast, the octopus’s distinctive movement
capacities evolve together with its eyes and remarkable cognitive ability. When it runs
into novel food acquisition challenges, its evolved manner of body-​schematizing, to-
gether with its visual and cognitive capacities, affords it gleaning what appears to be an
at least implicit image of itself.
Or consider a very different case, in a taxon a bit closer to us, namely bird species
that evolve courtship dances (see Prum, 2017). Whether or not birds are aware of how
they look to others in their dancing, evolving ‘inside’ schematizing movements for such
dances would entail evolving to move in ways shaped by implicit image issues—​how
their movement couples to, or entrances, other bodies who see their movements from
‘outside’. Or consider those primates (ourselves included) who engage in deception be-
haviour. Schematizing deception behaviours, to misdirect the attention of others, is not
just an ‘inside’ matter—​it entails evolving movement capacities shaped by an at least
implicit image of how our bodily movements look to others.16 In the course of evolu-
tion, such capacities can make available an explicit body image as a foreground affair, as
we know from our own experience.
This phenomenological emphasis on the body schema and body image as insep-
arable from, and arising out of, body-​world movement, together with these prelim-
inary evolutionary indications, suggests a strategy for reframing discussions of their

16 Such phenomena might, then, suggest an interrelation between our body image and perception of the move-
ment of others as meaningful actions. This interrelation was already central to Merleau-​Ponty’s analyses of inter-
subjectivity. It might also be reflected in mirror neuron phenomena. For example, Stamenov (2005) proposes that
‘extraction of a root version of a body image from the inborn body schema’ is a primary function of the mirror
neuron system.
 Conclusion  31
distinction and relation. Results from neurology and pathology, or evidence of double-​
dissociations, may very well support the view that the body schema and body image are
distinct, yet interactive, systems. However, these results ought to be complemented by
the question—​how did these systems, that can now operate in ways that indicate dis-
tinctness, etc., arise in evolution and within more fundamental movement phenomena?
This strategy gives conceptual precedence to more basic evolutionary and movement
phenomena that I have been discussing in terms of body-​schematizing movement, that
takes place in movement itself, in evolved body-​world couplings. In the course of evolu-
tion, and in individual experience, this body-​schematizing movement can diverge into
what works and appears as the operation of a body schema, in contrast to a body image.
The distinction and interaction of these two terms can proceed in different ways (for the
skilled truck driver, vision does not need to provide an ‘image’ of the truck’s size or pos-
ition as an object relative to the alley—​but the novice might need this). These two terms
roughly correspond, on the one hand, to a way of actively organizing movement from
within, and a way of taking up, and responding to, various resistances and passivities en-
dogenous to movement in the environment. These can shift and diverge over the course
of evolution (as suggested in preliminary ways above), but also individual experience,
on timescales ranging from childhood development to habit and skill acquisition, that
reworks the schematizing of our body-​world coupling in face of frustration or through
learning or technological extensions (as discussed in several examples above). But these
issues extend into the timescale of cultural formation, as noted by phenomenologists such
as Gail Weiss (1999), who draws on feminist philosophy and philosophy of race to argue
that the body schema is not so easily separated from oppressive effects of body images.

2.7 Conclusion

A central and recurrent effort of philosophy and phenomenology is emphasizing that

the work of explaining and understanding some topic first of all requires properly con-
ceptualizing that topic. The overall conclusion and effort here is to emphasize that we
should conceptualize the body schema not as an abstract system for controlling or or-
ganizing movement (via, for example, representations or motor programmes), even
if that can be helpful in understanding various underlying mechanisms. We should
understand that the body schema is not an abstraction but is manifest in, and insepar-
able from, the body-​world movement-​couplings. There is good evidence for this from
phenomenology and experimental and other variations on experience. This is comple-
mented by evolutionary-​comparative insights that suggest that our concepts of motor
control might, in fact, be skewed by peculiarities of our body type. Understanding how
body schema capacities arise in evolution might require quite very different ways of
conceptualizing where (in the head?) or what (‘a representation?’) a body schema ‘is’.
Indeed, a deeper lesson might be that the body schema, like time, is not properly sub-
ject to ‘is’ questions, that the body schema is not a noun, but a verb, a process, a doing, a
dynamic formation arising within schematizing movements shaped out of body-​world
32  The space of the body schema: putting the schema in movement
couplings. Finally, this approach suggests a different way of conceptualizing the rela-
tion and distinction of the body schema and body image, as terms that arise, shift, and
diverge within and from body-​schematizing movements that couple with the world.

References
Berthoz, A. (2000). The Brain’s Sense of Movement. Cambridge, MA: Harvard University Press.
Cancar, L., Díaz, A., Barrientos, A., Travieso, D., & Jacobs, D. M. (2013). Tactile-​sight: a sensory sub-
stitution device based on distance-​related vibrotactile flow. International Journal of Advanced
Robotic Systems, 10(6), 272.
Carello, C. & Turvey, M. T. (2017). Useful dimensions of haptic perception: 50 years after the senses
considered as perceptual systems. Ecological Psychology, 29(2), 95–​121.
Cole, J. (1995). Pride and a Daily Marathon. Cambridge, MA: MIT Press.
Gallagher, S. (2005). How the Body Shapes the Mind. Oxford: Oxford University Press.
Gallagher, S. (2017). Enactivist Interventions: Rethinking the Mind. Oxford: Oxford University Press.
Godfrey-​Smith, P. (2016). Other Minds: The Octopus, the Sea, and the Deep Origins of Consciousness
(first edition). New York, NY: Farrar, Straus, and Giroux.
Hochner, B. (2013). How nervous systems evolve in relation to their embodiment: what we can learn
from octopuses and other molluscs. Brain, Behavior, and Evolution, 82(1), 19–​30.
Juarrero, A. (1999). Dynamics in Action: Intentional Behavior as a Complex System. Cambridge,
MA: MIT Press.
Kato, A. (2008). Distorted depth perception under the microscope: compensation by surgical navi-
gator and image projection. Acta Medica Kinki University, 33(1), 1–​8.
Katz, D. (1989). The World of Touch. Hillsdale, NJ: Lawrence Erlbaum.
Klatzky, R. L., Wu, B., & Stetten, G. (2008). Spatial representations from perception and cognitive me-
diation: the case of ultrasound. Current Directions in Psychological Science, 17(6), 359–​64.
Lenay, C. & Steiner, P. (2010). Beyond the internalism/​externalism debate: the constitution of the
space of perception. Consciousness and Cognition, 19(4), 938–​52.
Merleau-​Ponty, M. (2003). Nature: Course Notes from the Collège de France (R. Vallier, Trans.).
Evanston, IL: Northwestern University Press.
Merleau-​Ponty, M. (2011). Le Monde Sensible et le Monde de l’Expression: Cours au Collège de France
Notes, 1953 (E. de Saint Aubert and S. Kristensen, eds.). Genève: MētisPresses.
Merleau-​Ponty, M. (2012). Phenomenology of Perception (D. A. Landes, Trans.). Abingdon: Routledge.
Merleau-​Ponty, M. (2016). Entretiens avec Georges Charbonnier et Autres Dialogues, 1946–​1959.
Paris: Verdier.
Miłkowski, M. (2018). Morphological computation: nothing but physical computation. Entropy,
20(12), 942.
Morris, D. (2004). The Sense of Space. Albany, NY: State University of New York Press.
Perdices, M. (2018). The Alice in Wonderland syndrome. Neuropsychological Rehabilitation, 28(2),
189–​98.
Prum, R. O. (2017). The Evolution of Beauty: How Darwin’s Forgotten Theory of Mate Choice Shapes the
Animal World—​and Us. New York, NY: Doubleday.
Seoane, L. F. (2019). Evolutionary aspects of reservoir computing. Philosophical Transactions of the
Royal Society B: Biological Sciences, 374, 20180377.
Sheets-​Johnstone, M. (2019). Kinesthesia: an extended critical overview and a beginning phenomen-
ology of learning. Continental Philosophy Review, 52(2), 143–​69.
Siegle, J. H. & Warren, W. H. (2010). Distal attribution and distance perception in sensory substitu-
tion. Perception, 39(2), 208–​23.
Stamenov, M. I. (2005). Body schema, body image, and mirror neurons. In H. De Preester & V.
Knockaert (eds.), Body Image and Body Schema: Interdisciplinary Perspectives on the Body (pp. 21–​
43). Amsterdam: John Benjamins Publishing Company.
Weiss, G. (1999). Body Images: Embodiment as Intercorporeality. New York, NY: Routledge.
 3
Body schema dynamics in Merleau-​Ponty
Jan Halák

3.1  Introduction: the concept of body schema in

Merleau-​Ponty’s works

1The efforts to maintain a distinction between body image and body schema seem to be es-

sentially driven by the objective to defend an operative intentionality (knowing how) from
those accounts that view it as reducible to a representational intentionality (knowing what).2
In this respect, Merleau-​Ponty’s works prefigure the more recent enactivist approaches and,
interestingly, they are very often similarly defensive. Merleau-​Ponty lengthily disproves
Descartes’, Kant’s, or Sartre’s representationalist accounts and the evidence he presents has
frequently the negative form of reasons for which these accounts are not correct.
However, once the originality of operative intentionality has been acknowledged and
enough attention is being paid to how it differs from a representational intentionality,
we are faced with a question of higher order. We need to take into account the various
cases in which an explicit awareness of perceptual figures does not only result from, but
also impacts back on, the body-​schematic activity. For example, an explicit perceptual
awareness of one’s body has been shown to hinder one’s motor performance. At the
same time, it can compensate for a corporeal impairment. These phenomena call for an
explanation of how the operative intentionality of our body schema is not only opposed
to, but also complexly intermingled with, the representation-​like grasp of one’s own
body, or the body image, and of the world in general. Taking up this question, my aim
in this chapter is twofold—​to present key aspects of Merleau-​Ponty’s works on body
schema that go beyond the ‘defensive’ approach, and to clarify how they contribute to
our understanding of the relationship between body schema and body image.
Before examining the notion of body schema, I note that Merleau-​Ponty does not
use any technical term corresponding to what could be translated into English as ‘body
image’3. As I will explain in Section 3.3, Merleau-​Ponty even has philosophical reasons

1 Work on this chapter was supported by the project ‘Philosophical study of bodily intentionality in an interdis-
ciplinary context’ (2018–​2021), Faculty of Arts, Palacký University Olomouc, reg. no. FPVC2018/​06.
2 The term ‘operative intentionality’ was coined by Merleau-​Ponty based on Husserl’s and Fink’s works and
should be understood in contrast to a representational ‘act intentionality’ related to our reflective awareness and
volitional decisions (cf., for example, Merleau-​Ponty, 2012, pp. lxxxii, 441; 1968a, pp. 238–​239, 244).
3 When Merleau-​Ponty interprets the works of Lhermitte (1939) or Schilder (1935) who employ the formula-
tions l’image de notre corps and the image of the body, respectively, he consistently employs the term schéma corporel
(cf. Merleau-​Ponty, 1964c, p. 117; 2011, pp. 126–​162; 2012, p. 101 n5; cf. also Landes, 2012, p. xlix; Gallagher &
Meltzoff, 1996, p. 217; Saint-​Aubert, 2013, pp. 40–​41).

Jan Halák, Body schema dynamics in Merleau-​Ponty In: Body Schema and Body Image. Edited by: Yochai Ataria, Shogo Tanaka, and
Shaun Gallagher, Oxford University Press. © Oxford University Press 2021. DOI: 10.1093/​oso/​9780198851721.003.0003
34  Body schema dynamics in Merleau-Ponty
for privileging the notion of schema over the notion of image. Nevertheless, he occa-
sionally discusses some of the experiences targeted by the concept of body image. In
particular, he writes about the consciousness of one’s body as it is mediated by visual
perception and conceptual articulation based on linguistic symbolic systems. More im-
portantly, however, Merleau-​Ponty systematically relates his general interpretation of
perceptual and linguistic experiences to the body-​schematic operative intentionality.
Thus, on the one hand, it is essential not to approach Merleau-​Ponty’s philosophy with
a distinction between body schema and body image operated in advance (cf. Saint-​
Aubert, 2013, p. 43). This would obfuscate his subtle analyses of how perceptual and
linguistic experiences arise from our body-​schematic praxis. On the other hand, we
can gain insights into the relationship between body image and body schema as they
are understood today, by extending Merleau-​Ponty’s interpretation of the relationship
between the explicit perceptual and linguistic-​conceptual experiences and the body-​
schematic operative intentionality. My ambition in this chapter is to contribute to an
elaboration of this second point.
Regarding the concept of body schema (schéma corporel) in Merleau-​Ponty, most
attention has been dedicated to Phenomenology of Perception (see, for example, Casey,
1984; Dillon, 1987; Carman, 1999; Gallagher, 1986; Gallagher & Meltzoff, 1996; Morris,
1999; 2004, pp. 36–​52). However, as David Morris points out (2004, p. 35), much of
Merleau-​Ponty’s treatment of the concept in the Phenomenology of Perception is im-
plicit. Considerable attention has also been dedicated to Merleau-​Ponty’s lectures from
the Sorbonne (1964c; 2010b; cf., for example, Gallagher & Meltzoff, 1996; Lymer, 2011;
Whitney, 2012; 2018). Nevertheless, these lectures were primarily designed to provide
students with an overview of recent psychological theories and to teach them the ma-
terial needed for exams. Merleau-​Ponty’s main objective here was not to present his
own philosophical position. Moreover, the text we have at our disposition consists of
students’ notes approved by Merleau-​Ponty for publication, not of Merleau-​Ponty’s ori-
ginal writing (cf. Welsh, 2010, pp. ix–​x).
Although their scope was limited, these resources were the most important until
recently. Some relevant additions to them were Merleau-​Ponty’s texts written for
his candidacy for a Collège de France professorship (1964b; 2000) and several sum-
maries of the lectures from this institution (1970). Beyond that, the concept of body
schema appears in some of the lecture notes published since the late 1990s. It seems
to have marginally influenced the lectures on ‘The Problem of Passivity’ (2010a;
delivered in 1954–​1955) and, to a much greater extent, the third year of Merleau-​
Ponty’s lectures on ‘Nature’ (2003, pp. 201–​283; delivered in 1959–​1960). Here,
Merleau-​Ponty takes up his earlier works on the body schema in order to elaborate
a description of the libidinal nature of the body. The concept is also mentioned sev-
eral times in both the published and unpublished working texts for the Visible and
the Invisible (1958; 1959; 1968a; cf. also Saint-​Aubert’s overview, 2013, pp. 70–​74).
Merleau-​Ponty’s last writings show that his early works allowed him to use the con-
cept of body schema as a self-​explanatory tool suitable for a better understanding of
other problems.
 The body schema as the background of perceptual figures  35
Nevertheless, the richest source regarding Merleau-​Ponty’s discussion of the body
schema is the recent edition of his preparatory notes for his first Collège de France
course (Merleau-​Ponty, 2011, delivered in 1953)4 in combination with Merleau-​Ponty’s
summary of the course (1970, pp. 3–​11). Of a total of 14 lessons of this course, the
last five are dedicated to an extensive, explicit discussion of the body schema (see
2011, pp. 126–​162, 199–​211). Merleau-​Ponty builds here on his reading of Schilder’s
expanded English version (1935) of an earlier work. The principal sources from the
Phenomenology of Perception remain in the background (e.g., Head & Holmes, 1911–​
12; Lhermitte, 1939; Schilder, 1923), while other sources are added, sometimes via
Schilder (e.g., de Ajuriaguerra & Hécaen, 1949; 1952; Gerstmann, 1927; Lange, 1930;
1933; Mayer-​Gross, 1935; 1936; cf. the bibliography of the course, Merleau-​Ponty, 2011,
pp. 213–​217).
The text published in 2011 contains Merleau-​Ponty’s preparatory notes for his
teaching, not the courses actually delivered. Since the notes are fragmentary, frequently
allusive, and not always conclusive, this text has so far received considerably less at-
tention from commentators than other Merleau-​Ponty’s works dealing with the body
schema (see, for example, Saint-​Aubert, 2011; 2013; Halák, 2016; Kristensen, 2019).
Focusing on the principal question of how the body schema is related to intentional ex-
periences referred to as body image, my goal in this chapter is to reconstruct Merleau-​
Ponty’s position in the lecture of 1953 while supporting it with other sources mentioned
above. I first summarize what Merleau-​Ponty tells us about the original phenomenality
of the body schema and how he links it to the figure-​ground structural relationship
introduced by Gestalt psychology. Subsequently, I discuss Merleau-​Ponty’s interpret-
ation of the dynamic differentiation of the body schema as a ground of action and per-
ception. This exposition opens the way for Section 3.5, in which I aim to clarify how
the body-​schematic operative intentionality gives rise to relatively independent super-
structures of vision and knowledge.

3.2  The body schema as the background of perceptual figures

Very much in the spirit of recent discussions on the difference between body schema
and body image, Merleau-​Ponty explicitly claims that the body schema ‘is not per-
ceived’ (2011, p. 143). More precisely, he explains that it usually ‘does not need to be
expressly perceived’ (p. 142; my emphasis). It is a ‘precognitive function’ that ‘precedes
[avant] explicit perception’ (p. 143; original emphasis); it ‘adjust[s]‌my body to ob-
jects entirely below the threshold of [en deçà de] explicit perception of the body or of
the objects’ (2000, p. 18; cf. 1964b, p. 5 and 2012, p. 141). However, the fact that the
body schema does not need to be perceived does not mean, for Merleau-​Ponty, that it

4 This chapter was completed before an official English translation of the course became available (Merleau-​
Ponty, 2020). Thus, all quotations from the course are my translations.
36  Body schema dynamics in Merleau-Ponty
generally belongs to the domain of the ‘non-​conscious’, as in Shaun Gallagher’s frame-
work (cf., for example, Gallagher, 2005, pp. 55–​56, or Gallagher & Cole, 1995, p. 385).
Merleau-​Ponty crucially points out that since the variations of the body schema,
such as the changes of muscular tonus, arouse variations of the perceived space, ‘the
body schema is also a certain structure of the perceived world, and the latter has its
roots in the former’ (2011, p. 144; my emphasis; cf., for example, 2012, pp. 145, n115;
213). In other words, the body schema is the ‘relatively imperceived’ background or
ground (fond) of the perceptual figures targeted by our actions (1970, p. 4; cf., in par-
ticular, 2011, pp. 138–​139). The body schema equips us with an ‘implicit notion of the
relation between our body and things’ (1964b, p. 5; my emphasis). Our motor pro-
jects, and the perceived objects targeted by them, stand out as explicit figures against
this implicit background (2011, p. 131; 2012, p. 105). Structurally, the body schema is
a figure (Gestalt, totality superior to the sum of its parts), but it cannot be conceived
of only in terms of explicitly perceived or intellectually conceived figures, for fig-
ures themselves ‘can neither be conceived nor exist at all without horizons’ or back-
grounds (p. 103).
The lecture notes from 1953 bring important clarifications. As a ground, the body
schema is ‘not merely confused perception’ or a ‘context’ of upcoming perceptions
(Merleau-​Ponty, 2011, pp. 142, 141). For Merleau-​Ponty, there is a structural difference,
‘a difference of order’, between an explicit figure and an implicit background (p. 141).
The body schema is that through which the world is present to our action (p. 141), rather
than contents inside the world—​it is ‘the mediator of here-​there relation’ (p. 142). One’s
bodily engagement in and toward the world creates a divergence (écart) between the
perceiving and the perceived (1968a, p. 197) and thereby distributes perceptual values
between ‘indifferent backgrounds’ and ‘privileged figures’, making the latter stand
out against the former. For this reason, each figure ‘appears perspectivally against the
double horizon of external space and bodily space’, which makes the body schema ‘the
always implied third term of the figure–​background structure’ (2012, p. 103).
The body schema is thus the background, in relation to which all the particular
perceptual contents are organized (cf. 2011, p. 141). The consciousness we have of it
is normally a consciousness of a divergence from this background, a consciousness
Merleau-​Ponty calls ‘indirect’ (cf. p. 139). Certainly, the background can be perceived
as a figure by means of a perceptual operation of a superior order such as a philosoph-
ical reflection (p. 141). However, such an operation is typically not required for the
body schema to be present on the background and available for us. If, for example,
a person needs to actively explore one part of his or her body with the help of other
parts to identify its spatial position, this condition signals an impairment on the level of
the body schema. Merleau-​Ponty describes the ‘preparatory movements’ of Gelb’s and
Goldstein’s patient Schneider precisely as attempts to access his body in terms of per-
ceptual figures and to compensate the disintegration of his body as a perceptual ground
(2012, p. 110).
By consequence, Merleau-​Ponty thinks that to situate the body schema with re-
gard to what we are consciously aware of ultimately ‘requires a revision of our notion
 The body schema as the background of perceptual figures  37
of consciousness’ (2011, p. 143). Even more radically, Merleau-​Ponty suggests that we
‘abandon’ the notion of consciousness altogether and ‘replace’ it by a description of a
mutual ‘expression’ between the body schema (background) and the perceived world
(figure) (pp. 51, 53).
Merleau-​Ponty elaborates this idea by describing how the body schema ‘immedi-
ately’ gives us positions, distances, or the elapsed duration of time as ‘charged’ with
the practical value they have for us. Comparable to a ‘taximeter’ on which the distance
travelled is presented as already transformed into the cost of the journey, the body
schema presents spatiotemporal contents already ‘in terms of I can’ (2010a, p. 242).5
In the lecture of 1954–​1955, Merleau-​Ponty even speaks more broadly of a ‘practical
schema’ that (re-​)establishes the referential norms of our life ‘by distributing valences
to all that is presented’ according to what is inscribed in it from our personal and inter-
personal history (2010a, p. 169, n10). This extension is anticipated in the 1953 lecture,
where Merleau-​Ponty explains that the perceptual consciousness should be conceived
of ‘as essentially projective’ in the Freudian sense, for ‘we see on things what is mani-
festly an expression of the subject’ (2011, p. 176; original emphasis). Between the body-​
schematic ground and the figures of the sensible world, there is therefore an ‘expressive
relation’ (p. 63), for the world ‘indicates’ what is required from our body in terms of our
movement, posture, and attitude, while conversely the body opens a field for something
to be perceived and ‘completes the given’ by appropriately adapting itself to it (p. 80).
Perception, Merleau-​Ponty concludes on these grounds, ‘is already expression’ (1970,
p. 6; similarly, 2011, p. 176).
As the background which is ‘expressed’ by experienced figures, the body schema is
precisely ‘invisible’ in the sense of the late Merleau-​Ponty’s notion (1968a). Importantly,
Merleau-​Ponty explains that the concepts of visible and invisible ‘are not contradictory’
and one should employ his concept of the ‘invisible’ as one speaks of the ‘immobile’
(1964a, p. 21)—​the invisible in Merleau-​Ponty’s sense ‘is not foreign’ to the domain of
visibility; it is rather ‘the limit or degree zero of visibility, the opening of a dimension of
the visible’ (p. 21).
As applied to the body, Merleau-​Ponty’s concept of invisible combines the Gestalt-​
psychological idea of perceptual norm and Husserl’s interpretation of the body as
the ‘point-​zero’ of orientation (see Husserl, 1989, pp. 165–​166). All the explicit ex-
periences I have of my body and of the objects ‘oscillate around norms’ or reference
levels that ‘are never given’ as such but are univocally circumscribed by the way in
which those experiences differentiate one from another, and all from the level it-
self (Merleau-​Ponty 2011, pp. 178–​179). Thus, the ‘invisible’ body schema is not the
contrary of what we are conscious of, but precisely the referential level, the ‘degree
zero’ in relation to which the figures we are conscious of acquire their maximum of
determinacy.

5 Merleau-​Ponty is alluding here to Head & Holmes (1911–​1912, p. 187) (cf. Merleau-​Ponty, 2011, pp. 136, 196,
200; 2012, pp. 140–​143).
38  Body schema dynamics in Merleau-Ponty
Merleau-​Ponty’s use of the figure-​on-​a-​ground conceptual framework brings our
attention to the fact that although we are not conscious of it, the body schema is a ne-
cessary structural dimension of what we are consciously aware of. Although we do not
perceive it, we perceive according to it and in relation to it. It is precisely for this reason
that Merleau-​Ponty asserts that the body schema is ‘never absent in [an] awakened
consciousness’ (2011, p. 142). In other words, Merleau-​Ponty provides reasons for
supporting the view that the relationship between the implicit body-​schematic back-
ground and the explicit figures (including all body images) should be understood as
systematic. The body schema is not related to perceptual figures in an arbitrary way; its
presence does not unilaterally depend on situations, and it is not just a result of factual
processes. A perception, be it a perception of one’s own body (‘body image percept’), is
always a figure on a (back)ground, and as such, it is a modality of the indivisible figure-​
on-​a-​ground system.
In this respect, Merleau-​Ponty’s interpretation of the body schema marks a signifi-
cant difference from Shaun Gallagher’s approach, although both approaches could be
qualified as non-​representationalist. Gallagher explains that, inasmuch as the body
schema is essentially a corporeal automatism, it generally remains in the domain of the
‘non-​conscious’ (e.g., 2005, p. 38). Beyond that, he adds that his distinction between
body schema and body image ‘cuts across’ the distinction of conscious–​non-​conscious
(e.g., p. 18) and that, correspondingly, some aspects of the body schema may become
conscious (e.g., p. 38). Interestingly, Gallagher himself adopts the idea that the body
schema should be conceived of as a background of perceptual figures.6 However, con-
sidering his definition of the body schema as something that is not related to the con-
scious domain in a systematic way, the ‘ground’ Gallagher refers to would not have a
systematical relationship to the perceptual figures either. Although Gallagher himself
points to ‘reciprocal interactions’ between body schema and body image (e.g., p. 35), in
his framework, these relationships are described as situational. Merleau-​Ponty’s view
is, on the contrary, that the background of perceptual figures is systematically shaping
all that is phenomenal for us, and thus constitutes a structural part of the consciousness
itself. In the Merleau-​Pontyan framework, the body schema therefore cannot be called
‘non-​conscious’ in the sense of something belonging to a domain that is distinct from
what we are conscious of.7
In the following sections, I will explain how Merleau-​Ponty maintains, but also
modifies, this position by taking into consideration different processes through which
the body schema is transformed into an acquisition, an object of perception, and thus
ceases to be just its background.

6 See Gallagher (2005, p. 36; 2017, p. 191; see also Chapter 6), referring to Goldstein & Scheerer (1964). Merleau-​
Ponty did not read the latter text, but his interpretations of Goldstein’s earlier works (see, in particular, Merleau-​
Ponty, 2012, pp. 105–​140) emphasize an interdependence between the two dimensions of the figure-​on-​a-​ground,
much like Goldstein and Scheerer later did (e.g., 1964, p. 8).
7 Commentators familiar with Merleau-​Ponty’s works sometimes perceive Gallagher’s emphasis on strictly dis-
tinguishing body image from body schema as an approach ill-​equipped for positively qualifying their relations
(see, for example, Saint-​Aubert, 2013, pp. 52, 58; Kristensen, 2019, pp. 25, 32–​33). The adoption of the figure-​on-​
a-​ground model might alleviate this difficulty. However, Merleau-​Ponty’s considerations indicate that this may
require us to conceive of the schema–​image relationship as systematical, not situational.
 The unity of the body schema as a task-oriented system  39
3.3  The unity of the body schema as a task-​oriented system

Since Phenomenology of Perception, Merleau-​Ponty has insisted on the originality of the

notion of schema and clarifies its meaning by providing a series of negative, contrasting
definitions. I will now discuss two groups of these definitions, in which Merleau-​Ponty
argues against understanding the body schema as a pre-​established structure and as a
physiological mechanism.
Merleau-​Ponty argues that body schema cannot be conceived of in terms of bottom-​
up processes—​it is not a result, or a habitual residue of factually occurring sensations
or stimuli (see 2000, p. 18; 2012, pp. 101–​102). As a schema, it ‘distributes meaning’ to
individual sensations in a top-​down fashion, depending on its global unity.8 Any par-
ticular sensations of one’s body are only perceived depending on a ‘central distribution’
(2011, p. 138). This becomes particularly evident in some pathological cases, such as
autotopagnosia, phantom limb, and allesthesia (allochiria).
However, the unity of the body schema is not a fixed structure. It always remains
‘open and indefinite’ (2012, p. 242; cf. 2011, pp. 139, 142). More precisely, it is organ-
ized and specified in relation to situational praxic tasks, actual or possible (p. 102).
Correspondingly, the unity of the body schema is equivalent to its capacity for a synergic
action oriented toward these tasks (p. 152).9 Instead of being merely a pre-​established
structure, the body schema must therefore be conceived of as a unity of praxis dynamic-
ally adapting to tasks.10
Correspondingly, our consciousness of our body is ‘closely connected to what we do’
(2011, p. 131; original emphasis). Thus, to ‘have a body’ or a bodily organ is to know
where to find the praxic powers to carry out an action, and to experience a ‘coincidence’
(Deckung, as Husserl puts it) between certain aspects of the world as we act upon them,
and the body as a starting point for this initiative (pp. 150, 136). When this unity of ac-
tion is compromised due to an unusual position of the limbs or a pathology, the subject
does not experience the body as belonging to him or her, despite the body being object-
ively present and physiologically available (pp. 135, 150; cf. also below the discussion
on Japanese illusion).
In sum, the body schema is a ‘form’ (Gestalt) organizing its spatiotemporal environ-
ment, but since it is dynamically organized in reference to praxic tasks, it is a form that
is content-​dependent (2011, p. 104). In other words, the unity of the body schema is
centred on the perceptual figures as the targets of its praxis, but this makes these figures
play a role in how the body schema is itself organized. As I will explain in more detail
below, this relationship has fundamental importance for our understanding of how the
body schema can be structured by a body image.
For now, it is important to clarify how Merleau-​Ponty furthermore explains that the
body schema is neither a mechanism (2000, p. 18) nor an idea, an ‘object of knowledge’

8 Cf. Merleau-​Ponty (2011, p. 133; cf. 1964b, p. 5; 2000, p. 18; 2010b, p. 24).

9 Cf., in particular, Merleau-​Ponty (2012, pp. 211–​212, 243, 330).

10 See Merleau-​Ponty (2011, pp. 138–​139, 140–​144), interpreting Schilder (1935, pp. 75–​81).
40  Body schema dynamics in Merleau-Ponty
(2011, p. 140). On the one hand, the body schema is a ‘non-​ideal totality’ (p. 134); it is
‘concrete’, perceptible; it does not need to be ‘interpreted’ in order to be understood
(p. 133). Unlike the unity of an idea, the unity of the body schema is a ‘pre-​logical unity’
(2012, p. 241), an open unity of a ‘coexistence’ or ‘mutual implication’ of the bodily
organs acting in synergy (2011, pp. 140, 133). To have a body schema thus means to
have ‘a power to vary certain principle without an explicit knowledge of this principle’
(p. 204). On the other hand, one’s body is neither perceived nor moved as an object. The
perceptual ‘gaps’ involved in my perception of my body are ‘overarched’ by the global
unity of the body schema, and the body is therefore not ‘deployed in front of me’ as an
object (pp. 128–​129, 132). Similarly, I do not move my body instrumentally as I move
objects, because I am not aware of the means that I am using in order to attain a praxic
goal, such as which physical parts of my body are involved (p. 133).
With respect to the more recent debates on the body schema as a ‘motor program’
providing ‘physiological information’ (e.g., Gallagher & Cole, 1995, p. 369), or even
a ‘sensori-​motor machinery’ (e.g., Paillard, 1999, p. 212), it is interesting to see how
Merleau-​Ponty more precisely situates the body schema in relation to the body as a
physiological entity. The body-​schematic functioning can be viewed as situated at the
limits of what falls within my personal control—​it is ‘happening’ as a subpersonal ‘per-
formance’ or ‘process’, as Gallagher writes (2005, pp. 29, 32, 17). Although Merleau-​
Ponty himself speaks of the body as an anonymous organism (e.g., 2012, p. 86), he also
claims that his analysis of perception in terms of the body schema demonstrates an
‘existential layer’ of perception, which is situated ‘beyond the physiological mechanisms
which have been studied so far’ (2011, p. 200; original emphasis). Similarly, Merleau-​
Ponty refuses to identify Goldstein’s ‘concrete movement’ with a ‘physiological’
event (2012, pp. 124–​126), again referring to an ‘existential’ dimension of perception
(pp. 133–​137). Even though the body schema could be viewed as a pre-​personal au-
tomatism, Merleau-​Ponty points out that it also accommodates personal history and
that ‘the past of my body is present to it like its future’, since the history is ‘enclosed
in the I can’ of the body as a ‘polarization of its power’ (Merleau-​Ponty, 2010a, p. 195,
referring to Schilder, 1935). Moreover, Merleau-​Ponty notes that he is indifferent to
‘inductive discussions’ related to the body schema, such as whether it is principally pos-
tural (Head) or visual (Schilder) (2011, pp. 210–​211; cf. 2012, pp. 115–​122). In his view,
the meaning of a phenomenon cannot be established inductively because it involves a
(philosophical) interpretation (2011, p. 211).
Merleau-​Ponty even claims that his philosophical interpretation of the body schema
as an ‘existential’ function ‘is not subject to a potential refutation’ based on empir-
ical evidence (2011, p. 211). This statement can be clarified by looking more closely at
Merleau-​Ponty’s explanation of the relationships between physiological conditions of
the body and a subject’s intentions.
The ‘existential’ dimension of the body schema, which is irreducible to physiological
mechanisms, is already evident on Merleau-​Ponty’s emphasis on the spatiotemporal
cohesion of the overall activity of the body since, as we have seen, the cohesion does
not strictly correlate with objective or physiological conditions. Further precisions can
 The unity of the body schema as a task-oriented system  41
be given with the help of Merleau-​Ponty’s interpretation of spatial orientation—​a par-
ticular spatial situation can be perceived as both oblique or vertical, depending on how
the body anchors its (actual or potential) activity in the perceived space, be it merely
through a passive visual observation (2012, pp. 253–​265). This happens because the
change of the perceptual anchoring displaces the perceptual norm serving as the refer-
ence level for the determination of orientation.
In the 1953 course notes, Merleau-​Ponty elaborates this interpretation by taking into
consideration other aspects of situation, in particular the physiological conditioning
of orientation and the active, task-​oriented mobility of the body (see 2011, pp. 71–​73,
76–​79, 177–​180). Merleau-​Ponty builds here on Schilder’s description of variations of
muscular tonus, as evidenced on the so-​called Kohnstamm’s phenomenon.11 A par-
ticular muscular tonus establishes a ‘normal resting position’ which determines the
body schema ‘as norm, zero of divergence [écart], level [niveau] or [a]‌privileged at-
titude’, in which nothing is sensed as a figure (p. 131). Correspondingly, our positions
in space are experienced as a ‘divergence, anomaly’ from the norm (p. 143; cf. p. 139).
However, the experience of Kohnstamm’s phenomenon furthermore shows that the
muscular tonus defining the referential norm for explicit perceptions is variable, al-
ways provisory. More precisely, variations of the perceptual norm provide evidence of
a ‘divergence’ of spatial localization of the body ‘in the direction of the effort’ (p. 142;
cf. 1970, p. 7). As the background of action and the spatiotemporal locality from where
action proceeds, the body schema is therefore ‘not only retrospective: it is prospective’
(2011, p. 142). Consequently, it cannot be defined merely as an actual perception of an
object—​‘it is a project’ (p. 142; original emphasis).12 For this reason, ‘the body schema
and the body are situated not where they are objectively, but where we are prepared to
place them’ (2011, p. 139). In sum, the body-​schematic spatial localization transcends
the objective emplacement of the body and its physiology, because the starting posi-
tions for our activity, and thus all the explicit figures perceived as targets of this activity,
are systematically shaped by our intentions and projects.13
A further analysis of the perception of spatial orientation helps elaborate this in-
terpretation in even more detail. As Merleau-​Ponty observes, the perception of move-
ment and rest depends on the vestibular system, which is itself one of the physiological
aspects of the body schema (2011, p. 200). Similarly, Merleau-​Ponty notes that a change
in the labyrinth provokes a variation of the perceived world (p. 144) and can thus ‘dis-
place’ the vertical axis (p. 140; 2010a, p. 242). The vertical orientation, however, is not
given by one sense such as the labyrinth, and not even by the sum of the sense data
(2011, p. 178), for a disorder of the labyrinth, for instance, can be ‘masked’ by visual
orientation (pp. 148, 158). The sense of verticality is neither an interoceptive experi-
ence of the subject, nor is it given exteroceptively on the basis of what is perceived in
space (p. 178). Rather, it is given on the basis of the relation established between all

11 Cf. Merleau-​Ponty (2011, pp. 131, 139, 142), referring to Schilder (1935, pp. 75–​81).
12 On the ‘prospective’ activity of the body, see also Merleau-​Ponty (2012, in particular pp. 241, 249).
13 Merleau-​Ponty later develops this idea with the help of a psychoanalytical understanding of desire. This topic
is thoroughly discussed by Saint-​Aubert (2013).
42  Body schema dynamics in Merleau-Ponty
the experiential dimensions (p. 177). The senses provide the vertical axis only ‘as all
joined together’, which means that they ‘all indicate divergences from the vertical [axis],
without being able to provide [it]’ in isolation (p. 179). The norm of verticality is not
given as a particular content of experience; it is ‘invisible’ as the ground toward which
all the sensed aspects are oriented and around which they ‘oscillate’ throughout their
variations (p. 178; cf. above in Section 3.2). Spatial orientation is thus established and
maintained only through our active ‘engagement’ in the world (montage envers, engage-
ment), without which the body becomes enclosed in itself and is reduced to a condition
of an object (2011, p. 179; 2012, p. 265, n26).
The body schema is a norm which is open to empirical events, precisely a ‘register’
into which these events are continually inscribed (1970, p. 7; cf. 2010b, p. 200). However,
Merleau-​Ponty’s discussion of task orientation and spatial orientation shows that this
cannot lead us to the conclusion that the body schema is ‘a product of development’
(Gallagher & Meltzoff, 1996, p. 213; my emphasis; cf. Saint-​Aubert 2013, p. 52). The
body schema accommodates both physiological (objective, empirical, ontogenetic, pre-​
personal) and subjective (prospective, projective, libidinal, personal history-​related)
changes of situation. Perceptual values are determined not just on the basis of various
sense data, but because the body and the surrounding space ‘form a system’ oscillating
around norms that are maintained only through our active engagement in the world
(2011, pp. 177–​178).

3.4  Differentiations of the body-​schematic system

Perceptual meaning is based on how the figure-​ground system concretely organizes the
relation between the body schema and the perceptual environment, which potentially
includes perceptions of one’s own body. By insisting on the originality of the notion
of schema, Merleau-​Ponty already reinforced the idea that the body schema is itself
a system.14 In the 1953 lectures, Merleau-​Ponty elaborates this idea by qualifying the
body schema as a ‘diacritical system’ (2011, p. 174; my emphasis). As we will see, this
step enables Merleau-​Ponty to further clarify how perceptual figures, including the
perceptual aspects of our body image, relate to the perceptual background of the body
schema.
As stated above, the body schema opens us to divergences (écarts) from perceptual
levels. This means for Merleau-​Ponty that it only gives us ‘differences without terms’
(2011, p. 203). Perception, as such, must therefore be understood as a ‘diacritical, rela-
tive, oppositional system’ (1968a, p. 217; cf. 2011, pp. 203–​204). Individual ‘cardinal
points’ of the body-​schematic system (2012, p. 328), in particular the active limbs, are
synergically integrated into one unity; yet inasmuch as they are synergized, they also

14 See Merleau-​Ponty (2012, p. 100; cf., in particular, 1964c, p. 117; 2010b, p. 247; 2011, p. 133; 2012, pp. 108, 145
n115, 154, 191, 242, 243).
 Differentiations of the body-schematic system  43
work one in opposition to another, and thus provide us with ‘the possibility for discrim-
ination, for the use of the diacritical’ (1968a, p. 213; cf. p. 233).
Merleau-​Ponty’s discovery of Saussure in 1947 and his adoption of some elements
of the structuralist conceptual framework have at least two fundamental implications
for the interpretation of the body schema and its relation to perceptual and conceptual
aspects of body image. On the one hand, it helps Merleau-​Ponty to identify an ‘inter-
relation’ between ‘the conception of neurological pathology in terms of dedifferenti-
ation and the Saussurian notion of the diacritical sign’ (1970, p. 23; 1954, p. 84v). On
the other hand, it helps Merleau-​Ponty connect the body schema and perception as its
correlate to language and other cultural diacritical systems that similarly only involve
‘differences without positive terms’.15 Merleau-​Ponty thereby formulates a theoretical
framework in which the flexible diacritical activity of the body schema is geared into
comparatively more solid diacritical systems of perceptual figures and language, which
have their specific capacity to provide us with, among other things, perceptual and con-
ceptual experiences of our own body. I first briefly outline how Merleau-​Ponty uses the
structuralist framework to account for several types of transformations of the body-​
schematic capacity for diacritical action. The second point related to explicit visual and
linguistic experiences of our own body will be more closely analysed in Section 3.5.
We have seen how the Gestalt-​psychological conceptual framework already allows
Merleau-​Ponty to explain how a perceptual norm can be shifted, re-​established. The
fact that the open system of the body schema has the capacity to be ‘mobilized’ and
‘specified through action’ oriented towards praxic situational tasks (2011, pp. 142,
139) means, in short, that the body-​schematic ground always accommodates a per-
ceptual figure by organizing itself around it. Now, Merleau-​Ponty’s elaboration of the
Gestalt-​psychological framework from a structuralist perspective helps him to de-
scribe this accommodation in a much more detailed way.
An analysis of sleep and compensatory movements in apraxic conditions in terms
of diacritical operations shows how the body schema and perceptual figures are dy-
namically ‘geared’ one into another (engrenage, e.g., 2011, p. 178). Sleep deprives us of
our mobility as our ‘means of articulation of a universe’ into figure-​ground structures
(1970, p. 9)16 and thus leads to a disarticulation of perceptual figures. Similarly, the
events of falling asleep and waking up must be understood as provisional dedifferen-
tiation and subsequent restoration of the structure of the body schema as a dynamic
diacritical system articulating our environment.17 To fall asleep is to ‘return to the
inarticulated’ (1970, p. 47), and conversely, the first movements upon waking up and
our effort to reconstitute the body ‘as an active totality facing a situation’ (2011, p. 142)
enable us to ‘restore our diacritical and oppositional systems’ based on the minimum of
contacts with the world maintained during sleep (1970, p. 9).

15 For example, Merleau-​Ponty (1973, p. 31); quoting Saussure (1959, p. 172); cf. also Merleau-​Ponty (2011,
pp. 117–​118, 143, 203–​204).
16 Cf. Merleau-​Ponty (2011, pp. 151, 164); referring to Mayer (1937).
17 Cf. Merleau-​Ponty (2011, pp. 142, 151, 162–​163, 174, 207–​208; 1970, pp. 9, 46–​48; 2010a, pp. 138–​148).
44  Body schema dynamics in Merleau-Ponty
A condition similar to sleep can be found in Schneider, who uses additional explora-
tory movements to ‘reactivate’ ‘the amorphous mass’ of his ‘slumbering’ body schema
and to produce an increased articulation of perceptual figures (2012, p. 112; 2011,
p. 142). Here, the additional structuration brought by an increased mobility compen-
sates or substitutes18 the presence of the body schema on the background as it is present
in non-​pathological perception. The examples of sleep and Schneider’s compensatory
movements show that between the ‘degrees of articulation of our body schema’ (cf.
2011, pp. 151, 163), our movements articulating a perceptual target, and the degree
of articulation of the perceptual figure, there is a correlation and dynamic structural
interdependence.19
Merleau-​Ponty, moreover, observes that sleep apraxia leads to ‘sleep aphasia’ or the
inability to articulate linguistic meanings (2011, p. 151). Sleep disintegrates the ‘system
of speech’ as the latter is ‘a particularly fragile superstructure of the body schema’
(p. 164; cf. 1970, p. 9). The free ‘association’ of images, which is typical for sleep and
dreaming, or the paraphasia of those who are not fully awake, would result from a lack
of precise speech articulation and, consequently, the fact that, for a sleeping subject,
the meanings of language signs do not adhere to their conventional significations.
Merleau-​Ponty thus views the linguistic system of phonetic and, correspondingly, con-
ceptual oppositions as another complex of ‘figures’ that need to be taken up by our body
schema in order to maintain their meaning. This view also well corresponds with other
Merleau-​Ponty’s observations, according to which the body schema is articulated not
only in relation to present perceptual figures, but also by a virtual, imaginary, or ver-
bally presented situation (cf. 2012, pp. 110–​111).
Merleau-​Ponty’s examples of dynamic processes of (de)differentiation of our experi-
ence have fundamental importance for our understanding of how an element of body
image can affect the body schema. They more specifically show not only how the articu-
lation of perceptual, and even linguistic, figures is a culmination of our body-​schematic
mobility, but also how the figures dynamically intervene in the organization of the body
schema.

3.5  Praxis and gnosis as levels of differentiation

The interpretation of our body-​schematic praxis in terms of diacritical activity antici-

pates Merleau-​Ponty’s discussion of its relation to the gnosis or ‘contemplative, notional
knowledge’ linked to vision and our use of symbolic systems such as language (2011,
p. 151).
In Phenomenology of Perception, Merleau-​Ponty asserts that motor experience offers
us a way of reaching the world that ‘must be recognized as original, and perhaps as

18 In the 1953 lecture, Merleau-​Ponty (2011, pp. 94, 142, 158) repeatedly uses Goldstein’s term Ersatzleistung. On
the compensatory activity, see also Merleau-​Ponty (1963, p. 40; 2012, p. 80; referring to Goldstein, 1934).
19 Merleau-​Ponty also notes that the body schema always tends to become ‘indistinct’ in immobility, even
though it never ceases to exist completely (2011, pp. 139, 142; 2012, p. 110).
 Praxis and gnosis as levels of differentiation  45
originary’ (2012, p. 141). The question of originality, however, is a negative one and
can be summed up as the contention that ‘motor experience is not a particular case of
knowledge’ (p. 141). Similarly, in the 1953 lectures, Merleau-​Ponty dedicates most of
his efforts to defend the ‘originality of praxis’ or mobility (cf. 2011, pp. 151, 154, 158).
However, the course notes also carefully discuss the more interesting, and the more
challenging, question of whether our mobility is originary to meaning. The ‘originary
notion of movement’, Merleau-​Ponty claims, ‘exceeds by far’ the idea of a simple ‘change
of location’—​it is one’s ‘gesture’, ‘a means of articulation of a universe’ and one’s ‘position
among things’ (pp. 151–​152). The question is, now, whether the knowledge itself is a case
of mobility and, if yes, to what extent.
Although Merleau-​Ponty often does not provide a clear conclusion in his discus-
sions, he clearly explains that his emphasis on the role of praxis or mobility should
not be understood as a defence of an ‘anti-​intellectualist’ or ‘irrationalist’ philosoph-
ical position (2011, p. 52). Far from that, he aims to introduce a ‘new type of analysis
that applies to the intellect [entendement] itself ’ (p. 173). Several of his texts from the
same period clarify that between perception-​mobility, on the one hand, and our ‘ex-
perience of truth’ in intellectual understanding and cultural knowledge on the other,
there is a continuity, but also a qualitative difference (cf., for example, 1964b, pp. 6–​7;
1973, p. 121). Thus, the ‘theoretical’ attitude (theoria) linked to our use of language and
other symbolic systems must be conceived of as a ‘second-​level praxis’ (2011, p. 127),
but it is impossible to reduce it to the practical-​motor performance of the body as the
agent of perception (p. 199; cf. 1973, p. 129). Such a reduction is not what Merleau-​
Ponty strives for (2011, pp. 54, 199; cf. 2000, p. 29). Now, we need to understand more
precisely how knowledge (gnosis, theoria) transcends, transforms, transfigures, or sub-
limates perception-​mobility (praxis).20
Merleau-​Ponty proceeds by confronting contrasting examples. To clarify the rela-
tionships between praxis (originary mobility), gnosis (knowing), and in part also phasis
(speaking), he analyses empirical cases of apraxia and agnosia (eventually aphasia).
On Merleau-​Ponty’s reading of Schilder (1935), apraxia should be described as a con-
dition in which the subject ‘knows what’ she is supposed to do (sait ce que, gnosis)
and is able to describe it in speech (phasis), but the ‘intellectually defined task’ is not
transformed into the praxic organization required for the accomplishment of the task
(Merleau-​Ponty, 2011, pp. 144, 154–​155; cf. 2012, p. 142). The praxic difficulty is not
notional (notionnel), because the normal subject herself does not know (ne sait pas)
which part of her body accomplishes specific parts of the task (2011, p. 155). Although
there are different types of apraxia, among which only some are manifestly associated
with gnosic difficulties, they are never simply equivalent to a pure incapacity to move
a limb or to understand (concevoir) the task or to formulate it in speech. Such a condi-
tion would lead to paralysis or dementia, not to apraxia (p. 155). Crucially, as Merleau-​
Ponty points out, scientists themselves are faced with an ‘impossibility to absolutely
eliminate two [of the] factors to demonstrate the causal role of the third’ (p. 153). In

20 Cf., in particular, Merleau-​Ponty (1964b, p. 7; 2011, pp. 55, 65, 162).

46  Body schema dynamics in Merleau-Ponty
other words, it is impossible to explain one type of disorder exclusively based on the
other (pp. 145, 158; cf. 2012, pp. 115–​122).
However, the case of the so-​called Japanese illusion, which Merleau-​Ponty describes
as an ‘experimental apraxia’ (2011, p. 127), shows more specifically that ‘a partial dis-
organization of the body schema and corporeal space can have an effect on gnosis’
(p. 147).21 Due to an unnatural position of the hands and fingers in the experiment, the
visual body is no more accessible to the subject as the starting point for an action, even
though it remains accessible for it as tactile (even based on verbal command, phasis;
p. 150). This dissociation leads Merleau-​Ponty to conclude that the experimental pos-
ition produces an alienated, dissociated, external body, a body-​object, and shows how
‘human praxis sediments in vision’ (pp. 148–​149).
As it is evident, Merleau-​Ponty interprets visual perception of one’s body as a part
of the body schema, not just as a body image which would be distinct from it. In the
case of the Japanese illusion, a disorientation on the visual level results in a temporary
disorganization of the body-​schematic diacritical system, that is, a perceptual figure
disintegrates the body-​schematic ground. As both Schilder and Merleau-​Ponty point
out, the disorienting effect of the visual figure can be overcome by repeated attempts
to mobilize appropriate parts of the body, that is, by gradually readjusting the body-​
schematic ground to the unusual figure.22 This means, conversely, that in normal con-
ditions, my (external) perception of my own, and even other people’s, body is mapped
onto my body’s (internal) pragmatic-​motor possibilities and ‘speaks to’ them, as
Merleau-​Ponty himself writes (2011, pp. 130, 150; cf. Kristensen, 2019, p. 33). However,
this mapping of a body image onto the body schema is only one particular implication
of Merleau-​Ponty’s general account of the figure-​ground relationship as constituting
one system, as I have already described them above. From a Merleau-​Pontyan perspec-
tive, the body-​schematic ground of perception opens a field for some figures to appear
in it, but one’s ‘body image’ systematically maps itself on the body schema because all
perceived, or even linguistically articulated, figures call for an accommodation of the
body-​schematic background.
By consequence, the ‘construction of a visual body schema’ (schéma corporel
visuel) can ‘compensate for’ or ‘mask’ a deficiency of a more vital order, such as a
disorder of the labyrinth (Merleau-​Ponty 2011, pp. 158, 148).23 Similarly, Schneider
is able to recognize an ‘abstract’ movement when it is happening, even though he is
not able to carry it out spontaneously (cf. Merleau-​Ponty, 2012, pp. 112–​113). These
cases of dissociation of gnosic body (target of vision or pointing) from praxic body
(the starting point or ‘ground’ for action) attest the possibility for a ‘stocking of prac-
tical intentionality’ (stockage de l’intentionnalité pratique) or a ‘cumulative history’
of praxis (2011, p. 199). This means that ‘the results acquired on one level remain

21 Merleau-​Ponty builds on Schilder (1935, pp. 23–​24, 52–​56).

22 Cf. the analogical case of the so-​called Aristotle’s illusion, which Merleau-​Ponty explicitly describes as ‘a dis-
turbance of the body schema’ (2012, pp. 211–​212). See Morris (2004, pp. 39–​40) for a detailed discussion on the
illusion and how it can be overcome.
23 In my understanding, this would also apply to Ian Waterman’s case described by Gallagher & Cole (1995).
 Praxis and gnosis as levels of differentiation  47
acquired even if the same function is disintegrated on other levels’ (p. 157). Using
a Husserlian terminology, Merleau-​Ponty also repeatedly contends that the system
of gnosic superstructures should be understood as a sedimentation of praxic infra-
structures.24 By sedimenting, the figure-​ground diacritical system of perception
becomes a system of differentiation based on ‘traces of human praxis’ (trace, tracé,
p. 156). Correspondingly, Merleau-​Ponty dedicates a large part of the 1953 course
to the study of such traces on both perceptual and cultural levels, and to the way in
which they ‘express’ and ‘call for’ a specific act of a body-​schematic taking up (cf., in
particular, 2011, pp. 70–​126, 165–​170). For Merleau-​Ponty, a visual ‘trace’ is an ‘in-
scription’ of a temporal movement into a spatial figure, and therefore ‘a beginning of
sedimentation’ (p. 189; cf. pp. 113, 119).
Merleau-​Ponty also claims that the sedimentation eventually culminates in the
creation of linguistic signs, which are ‘arbitrary’ or ‘conventional’ (Saussure) and
thus guarantee a ‘radical transcendence of the signified with regard to the signifier’
(Merleau-​Ponty, 2011, p. 162). The conventional character of signs accomplishes the
process of dissociation of meaning from its praxic context and creates what Merleau-​
Ponty calls an ‘intelligence institutionalized in language’ (pp. 157–​158; cf. 1968b,
pp. 38–​39). The question of language, however, is intentionally excluded from the 1953
lecture as Merleau-​Ponty believes that the linguistic type of sedimentation requires
a dedicated inquiry (cf. 2011, p. 66). Merleau-​Ponty addresses language in his other
works from the same period (e.g., 1973; 1964b; 2000), in the course from the following
year (1954), and beyond.
In the 1953 lecture, Merleau-​Ponty therefore clarifies that all of our relationships
to objects constitute one system, even though this system is stratified into different
levels of figure-​ground dynamics. This is evident on the fact that the disruptions of this
system manifest themselves predominantly on its gnosic (visual-​symbolic) or praxic
(corporeal) pole—​apraxia and agnosia are ‘relatively independent’, even though there is
often a ‘predominance’ of one type of disorder.25
However, cases of constructive apraxia show more precisely that there can be a
gnosic difficulty rooted in the impossibility for the subject to ‘motorically take up’ (re-
prise motrice) the perception of a figure or trace ‘as incarnating a motor project’ or as
its equivalent (2011, p. 156; cf. 2012, p. 142). Similarly, on Merleau-​Ponty’s reading of
Schilder, every agnosia involves an incapacity to manipulate with some aspects of the
structure of the object and, conversely, every apraxia ‘erases a layer of signification’
from our knowledge (connaissance) of the object or at least from its practical presence
for us (2011, p. 157). Thus, in general, we need to conceive of gnosis as a second-​level
praxis or as its sublimation, a mobility of another level, because gnosic recognition and
praxic manipulation are intermingled and ‘any impairment at one level has repercus-
sions at other levels’ (p. 158). Following the idea of de Ajuriaguerra and Hécean (1949),
Merleau-​Ponty ultimately decides to conceive of praxis and gnosis (and phasis) not

24 See Merleau-​Ponty (2011, pp. 148, 151, 157, 201; cf. also the terms acquis and acquisition: pp. 141, 157, 161).

25 See Merleau-​Ponty (2011, pp. 146, 157); referring to de Ajuriaguerra & Hécean (1952).
48  Body schema dynamics in Merleau-Ponty
as distinct faculties, but as ‘poles’ or ‘levels’ of ‘one fundamental activity’ or function,
which is our mobility or praxis (2011, pp. 145, 157; original emphasis).26
Thus, on the one hand, Merleau-​Ponty acknowledges that since gnosic superstruc-
tures can compensate for a disintegration on the level of praxic infrastructures,27 the
former ‘acquire a relative independence’ from the latter (2011, p. 148). On the other
hand, however, he points out that this independence ‘is not absolute’ (p. 148), and if the
infrastructure is ‘weakened’ in some way, the superstructure is negatively affected by
this fact in the long run (p. 151).
In order to illustrate this point, Merleau-​Ponty returns once more to the case of
Schneider, who uses his ‘external verbal knowledge’ (2011, p. 157) to mask his praxic
deficiencies. The possibility of such a compensation shows that ‘language is a sym-
bolism that succeeds in masking its own ruins’ (p. 202). However, the superstructures
of language and knowledge have ‘lost their productivity’ in Schneider’s case (p. 148) and
therefore have become ‘fundamentally different’ from what they are in normal subjects
(p. 157). They became a mere mask of the praxic deficiencies rather than fully replacing
their function (p. 148; also see above: Ersatzleistung). Schneider was still able to use lan-
guage and had conserved arithmetical skills to a certain degree, but he had problems
to understand analogy, formulate new metaphors, act spontaneously, or improvise in
speech. In short, ‘the “life” of language is altered’ in him (2012, p. 201; cf. pp. 129–​130);
the integrity of language ‘is only apparent’ in his case (2011, p. 157).
In sum, Merleau-​Ponty maintains that a full integrity of gnosic superstructures pre-
supposes the integrity of the ‘power of construction’, and thereby the integrity of praxic
infrastructures (2011, pp. 148, 157). The sedimentation only remains ‘alive’ (vivante)
as a ground for some meaningful figures if our body-​schematic capacity for diacritical
activity continues to support it and carry it further. Thus, even on the gnosic level, the
incarnation ‘may be reduced, but not eliminated’ (p. 201)—​if the gnosic superstructure
is to conserve its integrity and its full sense, it must remain connected to the praxic in-
frastructure of the structuring activity of the body schema.

3.6 Conclusion

According to Merleau-​Ponty, perception is correlative to mobility and thus to the body

schema as the ‘register’ in which the motor possibilities are continually inscribed and
from which they radiate into the environment. Correspondingly, we are usually not
aware of the body schema, because it is not one of the experiential contents of the world,
but rather a standard or a Gestalt-​psychological ‘norm’ of our relation to the world.
Correspondingly, all perceptions, including those which we have of our own body
(body image percept), are figures-​ on-​
a-​
ground. As figures-​ on-​a-​
ground, percep-
tions are not merely our intentional counter-​poles, but provisorily acquired norms in

26 Cf. also Merleau-​Ponty (2011, pp. 154, 158; 2012, pp. 119, 121, 139).

27 See Merleau-​Ponty (2011, pp. 148, 157–​158, 202; cf., for example, 2012, p. 139).
 Conclusion  49
reference to which the body-​schematic operational intentionality continues its diacrit-
ical activity. Figures are not simply representations, but affordances and way-​points
for our exploration. This is how a body image percept can both compensate for a lack
on the level of the body schema and inversely hinder its activity—​visual perception of
one’s body is not only a result of body-​schematic activity, but also a provisorily estab-
lished referential norm with regard to which such activity continues to evolve. As it is
evident, a fundamental implication of Merleau-​Ponty’s decision to include the ‘ground’
of the figure-​ground structure into the phenomenal domain is that it informs us about
how the body image percept co-​organizes the body schema.
However, Merleau-​Ponty tells us much more than that. The mobility rooted in our
provisorily acquired norms inaugurates what Merleau-​Ponty calls ‘a dialectics of ex-
pression’ through which the mobility is ‘transformed into expression’ (2011, pp. 151,
158, 164). The ‘expressive’ gesture of pointing, for example, is still of the perceptual
order; it is a refinement, a more specific differentiation of the perceptual structure itself,
and thus the ‘assumption’ of the full sense of the perceived (assomption, p. 65). Gesture
is thus not a representational act relying on an ‘abstract’ attitude (cf. 2012, pp. 122–​
123), but a diacritical superstructure refining our perceptual norms. It is a figure that
accommodates articulations that would remain in the (back)ground in a merely re-
ceptive attitude. As such, a gesture is a superstructure of the body schema. In this way,
Merleau-​Ponty outlines a description of a process through which the body-​schematic
praxis sediments in perceptual superstructures or ‘expressions’, which appeal to our
body schema and require to be ‘taken up’ (reprise) on ‘higher levels’ of praxis such as
co-​perception and gestural communication.
Perceptual norms are therefore not only incessantly renewed through movement;
they are also more specifically structured by diacritical norms of superior orders, pro-
gressively more ‘sedimented’ diacritical systems such as visual figures, gestures, and,
ultimately, language. Body-​schematic operative intentionality (praxis) thus not only
serves as an infrastructure for the consciousness of various types of explicit intentional
correlates (gnosis), but also ‘incorporates’ them in itself and is modified by them (cf.
2011, pp. 141, 151, 158). Thus, even though Merleau-​Ponty maintains that our mobility
is originary with respect to meaning, his philosophy is not an anti-​intellectualism.
Perception founded in mobility does not exclude quasi-​representational experiences
of sedimented meanings as we observe them in vision or linguistic articulation. On
the contrary, body-​schematic activity is co-​organized by perceptual figures, including
our body image percepts, and eventually cultural diacritical systems that include body
image concepts. These are the grounds that Merleau-​Ponty builds on when he occa-
sionally speaks of an ‘institutional or cultural element of all perception’ (p. 177) and
claims that perception is ‘informed’ or ‘fashioned by culture’ (1968a, p. 212).
Beyond that, we have also seen that although the gnosic superstructures become
relatively independent of praxic mobility and impose their sedimented structures on
it, they also necessarily involve some type of praxis or activity. Disconnected from a
subject capable of the ‘higher level praxis’ of speech, language is reduced to a mere
‘mask’ or ‘ruin’ of language; it is ‘petrified’ and ‘emptied of its meaning’ (2011, p. 201;
50  Body schema dynamics in Merleau-Ponty
1970, pp. 119–​120). The diacritical symbolic system of language needs to be taken up in
speech, which is the agent of a supra-​perceptual body-​schematic praxis—​a superstruc-
ture of the body schema. Taking into account how various body images both stem from
a body-​schematic context and acquire a relative independence on it, Merleau-​Ponty
provides an account of experience that maintains a priority of operative intentionality
on all of its levels.

References
Carman, T. (1999). The body in Husserl and Merleau-​Ponty. Philosophical Topics, 27(2), 205–​26.
Casey, E. S. (1984). Habitual body and memory in Merleau-​Ponty. Man and World, 17, 279–​97.
de Ajuriaguerra, J. & Hécaen, H. (1949). Le Cortex Cérébral. Étude Neuro-​psycho-​pathologique.
Paris: Masson.
de Ajuriaguerra, J. & Hécaen, H. (1952). Méconnaissances et Hallucinations Corporelles. Intégration et
Désintégration de la Somatognosie. Paris: Masson.
de Saussure, F. (1959). Course in General Linguistics. New York, NY: Philosophical Library.
Dillon, M. C. (1987). Apriority in Kant and Merleau-​Ponty. Kant-​Studien, 78, 403–​23.
Gallagher, S. (1986). Body image and body schema: a conceptual clarification. Journal of Mind and
Behavior, 7(4), 541–​54.
Gallagher, S. (2005). How the Body Shapes the Mind. Oxford: Clarendon Press.
Gallagher, S. (2017). Enactivist Inverventions. Rethinking the Mind. Oxford: Oxford University Press.
Gallagher, S. & Cole, J. (1995). Body schema and body image in a deafferented subject. Journal of Mind
and Behavior, 16, 369–​90.
Gallagher, S. & Meltzoff, A. N. (1996). The earliest sense of self and others: Merleau‐Ponty and recent
developmental studies. Philosophical Psychology, 9(2), 211–​33.
Gerstmann, J. (1927). Fingeragnosie und isolierte Agraphie—​ein neues Syndrom. Zeitschrift für die
gesamte Neurologie, 108, 152–​77.
Goldstein, K. (1934). Der Aufbau des Organismus. Einführung in die Biologie unter besonderer
Berücksichtigung der Erfahrungen am kranken Menschen. Den Haag: Martinus Nijhoff.
Goldstein, K. & Scheerer, M. (1964). Abstract and Concrete Behavior: An Experimental Study with
Special Tests. Evanston, IL: Northwestern University.
Halák, J. (2016). Merleau-​Ponty on embodied subjectivity from the perspective of subject-​object cir-
cularity. Acta Universitatis Carolinae Kinanthropologica, 52(2), 26–​40.
Head, H. & Holmes, G. (1911–​12). Sensory disturbances from cerebral lesions. Brain, 34, 102–​254.
Husserl, E. (1989). Ideas Pertaining to a Pure Phenomenology and to a Phenomenological
Philosophy: Second Book Studies in the Phenomenology of Constitution. The Hague: Springer.
Kristensen, S. (2019). Körperschema und leibliche Subjektivität. In E. Alloa, T. Bedorf, C. Grüny, & T.
N. Klass (eds.). Leiblichkeit: Geschichte und Aktualität eines Konzepts. UTB GmbH: Mohr Siebeck,
pp. 23–​36.
Landes, D. A. (2012). Translator’s introduction. In M. Merleau-​Ponty. Phenomenology of Perception.
London: Routledge, pp. xxx–​li.
Lange, J. (1930). Fingeragnosie und Agraphie. Monatsschrift für Psychiatrie und Neurologie, 76,
129–​88.
Lange, J. (1933). Probleme der Fingeragnosie. Zeitschrift für die gesamte Neurologie und Psychiatrie,
147(1), 594–​610.
Lhermitte, J. (1939). L’Image de Notre Corps. Paris: Nouvelle Revue Critique.
Lymer, J. (2011). Merleau-​Ponty and the affective maternal-​foetal relation. Parrhesia, 13, 126–​43.
Mayer, F. (1937). Die Struktur des Traumes. Acta Psychologica. 3(1/​1), 81–​136.
Mayer-​Gross, W. (1935). Some observations on apraxia. Proceedings of the Royal Society of Medicine,
28, 1203–​12.
Mayer-​Gross, W. (1936). Further observations on apraxia. Journal of Mental Sciences, 82, 744–​62.
 Conclusion  51
Merleau-​Ponty, M. (1954). Le problème de la parole. Cours au Collège de France 1953–​1954. Notes.
Unpublished manuscript. Bibliothèque Nationale de France, NAF 26995, vol. 12.
Merleau-​Ponty, M. (1958). Projets de livres, 1958–​1961. Unpublished manuscript. Bibliothèque
Nationale de France, NAF 26989, vol. 6.
Merleau-​Ponty, M. (1959). Visible et l’invisible, manuscrit de travail, 1959–​1960. Unpublished manu-
script. Bibliothèque Nationale de France, NAF 26990, vol. 7.
Merleau-​Ponty, M. (1963). Structure of Behavior. Boston, MA: Beacon Press.
Merleau-​ Ponty, M. (1964a). Introduction. In M. Merleau-​ Ponty. Signs (pp. 3–​ 35). Evanston,
IL: Northwestern University Press.
Merleau-​Ponty, M. (1964b). An unpublished text by Maurice Merleau-​Ponty: a prospectus of his work.
In M. Merleau-​Ponty. The Primacy of Perception And Other Essays on Phenomenological Psychology,
the Philosophy of Art, History and Politics (pp. 3–​11). Evanston, IL: Northwestern University Press.
Merleau-​Ponty, M. (1964c). The child’s relations with others. In M. Merleau-​Ponty. The Primacy of
Perception (pp. 96–​155). Evanston, IL: Northwestern University Press.
Merleau-​Ponty, M. (1968a). The Visible and the Invisible. Evanston, IL: Northwestern University Press.
Merleau-​Ponty, M. (1968b). Résumés de Cours. Paris: Gallimard.
Merleau-​Ponty, M. (1970). Themes from the Lectures. Evanston, IL: Northwestern University Press.
Merleau-​Ponty, M. (1973). Prose of the World. Evanston, IL: Northwestern University Press.
Merleau-​Ponty, M. (2000). Titres et travaux. Project d’enseignement. In M. Merleau-​Ponty. Parcours
Deux (1951–​1961) (pp. 9–​35). Paris: Verdier.
Merleau-​Ponty, M. (2003). Nature: Course Notes from the Collège de France. Evanston, IL: Northwestern
University Press.
Merleau-​Ponty, M. (2010a). Institution and Passivity: Course Notes from the Collège de France (1954–​
1955). Evanston, IL: Northwestern University Press.
Merleau-​Ponty, M. (2010b). Child Psychology and Pedagogy: The Sorbonne Lectures 1949–​1952.
Evanston, IL: Northwestern University Press.
Merleau-​Ponty, M. (2011). Le Monde Sensible et le Monde de l’Expression. Cours au Collège de France,
Notes, 1953. Genève: MetisPresses.
Merleau-​Ponty, M. (2012). Phenomenology of Perception. London: Routledge.
Merleau-​Ponty, M. (2020). The Sensible World and the World of Expression. Course Notes from the
Collège de France, 1953. Evanston, IL: Northwestern Universtiy Press.
Morris, D. (1999). The fold and the body schema in Merleau-​Ponty and dynamic systems theory.
Chiasmi International, I, 275–​86.
Morris, D. (2004). The Sense of Space. New York, NY: State University of New York Press.
Paillard, J. (1999). Body schema and body image—​a double dissociation in deafferented patients. In
G. N. Gantchev, S. Mori, & J. Massion (eds.), Motor Control, Today and Tomorrow (pp. 197–​214).
Sofia: Academic Publishing House.
Saint-​Aubert, E. de (2011). Conscience et expression. Avant-​propos. In M. Merleau-​Ponty. Le Monde
Sensible et le Monde de l’Expression (pp. 7–​38). Grenoble: MetissPress.
Saint-​Aubert, E. de (2013). Être et Chair. Du Corps au Désir: L’habilitation Ontologique de la Chair.
Paris: Vrin.
Schilder, P. (1923). Das Körperschema: Ein Beitrag zur Lehre vom Bewusstsein des Eigenen Körpers.
Berlin: Springer.
Schilder, P. (1935). The Image and Appearance of the Human Body: Studies in the Constructive Energies
of the Psyche. London: Routledge.
Welsh, T. (2010). Translator’s introduction. In M. Merleau-​Ponty. Child Psychology and Pedagogy: The
Sorbonne Lectures 1949–​1952 (pp. ix–​xix). Evanston, IL: Northwestern University Press.
Whitney, S. (2012). Affects, images and childlike perception: self-​other difference in Merleau-​Ponty’s
Sorbonne lectures. PhaenEx, 7(2), 185–​211.
Whitney, S. (2018). Merleau-​Ponty on the mirror stage: affect and the genesis of the body proper in
the Sorbonne lectures. Journal of Phenomenological Psychology, 49(2), 135–​63.
 4
A radical phenomenology of the body:
subjectivity and sensations in body image
and body schema
Helena De Preester

4.1 Introduction

The role of sensations for body experience and body representations such as body image
and body schema seems indisputable. This chapter discusses the link between sensory
input, the experience of one’s own body, and body representations such as body image
and body schema. That happens on the basis of Michel Henry’s radical phenomenology
of the body, which unites body and subjectivity and reconsiders the role of sensory
input for the experience of the body and related representations. Without supporting,
but inspired by, Henry’s ontological dualism between subjective and objective body, it
is argued that the traditional view that considers sensory signals as all-​important for
bodily experience misses out a bodily dimension crucial for subjectivity—​the body’s
subjective dimension, not reigned by current sensory input.
This chapter has a twofold aim. First, it introduces Henry’s little-​known, but rad-
ical, phenomenology of the body. Second, and based on Henry’s phenomenology of the
body, it shows that attention for the subjective body is at odds with the all-​important
role of sensory signals in the current embodiment studies.

4.2  The starting point of Michel Henry’s radical phenomenology

of the body

Next to the pioneering and often cited work in the phenomenology of the body by
Edmund Husserl and Maurice Merleau-​Ponty, there is the less-​studied work of the
lesser well-​known phenomenologist Michel Henry. His work had a difficult and limited
reception and presents a radical philosophy of subjectivity and the body, especially in
Philosophy and Phenomenology of the Body (1965, English translation 1975), once but a
chapter of his major work The Essence of Manifestation (1963).
Subjective experience is the starting point of his analysis, like for other phe-
nomenologists before and after him. At first sight, that is not so radical. Like other

Helena De Preester, A radical phenomenology of the body: subjectivity and sensations in body image and body schema In: Body Schema
and Body Image. Edited by: Yochai Ataria, Shogo Tanaka, and Shaun Gallagher, Oxford University Press. © Oxford University Press 2021.
DOI: 10.1093/​oso/​9780198851721.003.0004
 The starting point of Michel Henry’s radical phenomenology  53
phenomenologists, he starts from subjective experience and then moves on to the body,
and not the other way round starting from the body in order to get to subjective ex-
perience. This differs from standard routine in cognitive science, where one starts from
the body in order to explain subjective bodily experience, e.g., on the basis of body
image and body schema. To start from subjective experience, however, is not just to
take into account subjective bodily experience. It turns out to have much more radical
consequences.
The focus of Philosophy and Phenomenology of the Body is Maine de Biran’s (1766–​
1824) philosophical work about the body. A basic tenet in Biran’s approach is that two
kinds of experience exist and, consequently, two kinds of being. The first kind of ex-
perience gives us transcendent being, i.e., everything accepted as existing by the em-
pirical sciences or in daily life. Transcendent being thus comprises both ‘facts of nature’
(given in external perception) and ‘psychic facts’, such as mental images, memories, or
emotions (given in introspection). Importantly, transcendent being is always given on
the basis of mediations, such as sensations or representations, and the perception of
transcendent being is thus never direct, but always marked by a so-​called phenomeno-
logical distance.
The second kind of experience is (somewhat confusingly) called ‘reflection’ and is not
mediated by phenomenological distance. The absence of distance implies that the being
given in this kind of experience is given immediately. This immediately given being is
intimate life or subjectivity itself, which stands in opposition to transcendent being in
general. Subjectivity is thus not something we originally experience in introspection.
The subjectivity we come across in introspection is given to us only indirectly, on
the basis of sensations or representations. Introspection gives us psychic life in the
psychological-​empirical sense. It is a mode of observation that is parallel to exterior
observation, but that is directed inwards. Interior observation arrives at psychic facts,
parallel to how exterior observation arrives at facts of nature. Images (observable in
introspection) and things (observable in external perception) both belong to the tran-
scendent world, which contains both psychic and physical facts. Interior observation
is therefore limited to internal but still transcendent experience. It is observation of the
psychological-​empirical.
Subjectivity, as it is originally given to us, is not psychological-​empirical, but tran-
scendental. ‘By “internal transcendental experience” ( . . . ) we understand the original
revelation of the lived experience itself such as it takes place in a sphere of radical im-
manence ( . . . )’ (Henry, 1975, pp. 15–​16, fn. 18). ‘Radical immanence’ refers to the idea
that in internal transcendental experience, subjectivity is immediately acquainted with
itself, without any intermediary such as representing (itself to itself) or applying an-
other mental faculty (to itself) in order to be known. The notion of immanence thus
points to this absence of all distance, and to the transparency and certitude that re-
sults from this knowledge without distance. The transcendental aspect refers to the idea
that subjectivity is not reducible and thus not explainable on the basis of empirical sci-
ence, e.g., by appealing to intermediating sensations or representations. Therefore, phe-
nomenological distance is utterly absent in the internal transcendental experience that
54  A radical phenomenology of the body
subjectivity has of itself and in which lived experience reveals itself to itself. Because
the sphere of subjectivity is not experienced on the basis of mediation but reveals itself
immediately to itself, it cannot be represented. For Henry, this idea is crucial—​whereas
representation logically requires mediation, and thus phenomenological distance, sub-
jectivity knows itself immediately, without any mediation. Henry does not accept psy-
chological facts such as images or representations in the study of subjectivity as it is
originally given. Every representation turns subjectivity into something it is not, i.e.,
puts it at a phenomenological distance, objectifying and thus losing it. Subjectivity is
‘in no way a phenomenon or an object which represents itself ’ (Henry, 1975, p. 42).
Subjectivity is the immediate presence to itself; it is like a light that illuminates itself (De
Preester, 2019).
The recognition of two kinds of being, transcendent (empirical) and subjective
(transcendental), instals a true ontological dualism. The dualism of Biran (and
Henry) opposes ontological monism, because the latter does not recognize that
something can be given to us other than within and through the mediation of tran-
scendent being. Biran, however, recognizes the existence of an internal transcen-
dental experience and that is why an ontology of subjectivity is required (apart from
an ontology of transcendent being). A more contemporary terminology would say
that Biran demands an ontology of first-​person perspective experience, that is, a ser-
ious philosophical recognition of the region of subjectivity. For Henry, subjectivity is
real—​it is not a sphere of nothingness in distinction to the empirical sphere of tran-
scendence that is characterized by the plenitude of reality, be this reality physical or
psychological.
For Henry, the body is situated at the heart of human reality, and the heart of human
reality is subjectivity. The body, as originally given, is situated within the realm of sub-
jective experience. The body as given originally in experience is not an objective body,
but a subjective body. Subjectivity cannot become incarnate in an objective body.
Therefore, the issue is rather which body belongs to subjectivity, and not vice versa,
how we can infuse the body with subjectivity. For Henry, the right way to proceed is to
start from the phenomenon (and the reality) of subjectivity in order to find out which
body can be discovered in the ontological region of subjectivity.

4.3  Two bodies: the subjective body and

the transcendent or objective body

Henry refuses to reduce the entire being of our body to its objective-​transcendent
being, that means to the order of reality recognized by the empirical sciences and
daily life. Nor does he follow the idea that beyond this transcendent body, there is
nothing, unless the consciousness which thinks or surveys the body (Henry, 1975,
p. 109). We will also see that Biran radically separates subjective and physiological
(i.e., objective-​transcendent) bodily determinations. A true duality exists between
the subjective and the transcendent body. This dualism of the subjective and the
 The subjective body and the transcendent or objective body  55
transcendent body, however, has nothing to do with Cartesian dualism. Cartesian
dualism reduces the body to extension and does not recognize a subjective body. The
ontological recognition of the subjective body gives to subjectivity the reality that it
too often lacks, even if this reality of subjectivity is nothing transcendent. Henry re-
fuses the conception of ontological monism in virtue of which something real cannot
be given except in the element of transcendent being, because this empties subject-
ivity of all reality.
Ontological monism is unable to recognize the subjective body. It can only consider
a reduced body, i.e., reduced to its objective manifestations, whereas consciousness
appears for it as a pure form that faces the paradox of incarnation. Henry’s view, based
on ontological dualism, offers room for the subjective body and refuses to consider
subjectivity as an empty form. ‘Actually, consciousness is not the emptiness of noth-
ingness and the body is not an object. Subjectivity is real and the body is subjective’
(Henry, 1975, p. 189). Subjectivity enjoys the status of reality but is not something
transcendent. Subjectivity is precisely that which cannot manifest itself in a tran-
scendent milieu.
Henry explains that, for Maine de Biran, the living body is first and foremost a
moving body. In line with his view on the subjective body, bodily movement is not in
the first place a matter of the objective, biological body. On the contrary, movement
is the very being of subjectivity.1 Whereas Descartes only recognized thought as the
essence of subjectivity, for Biran, both thought and movement are modes in which
subjectivity expresses itself. Both thinking and moving are determinations of subject-
ivity that are known immediately. Much to the surprise of a contemporary reader, that
means that movement does not need any mediation by sensations, representations, or
judgements in order to be known or experienced. Biran rejects the idea that we would
experience movement on the basis of such mediations because these refer real move-
ment to the transcendent world, and leaves subjectivity with the mere representation of
movement.
It is crucial to understand that, for Biran, the original, subjective body is not different
from the experience we have of it. The subject does not have experience of the original
body as of a reality different from it, i.e., as a transcendent reality. The primordial know-
ledge of movement is therefore less a knowledge of our body than the being of this body
itself. As subjects, we are one with our movements. In Cartesian terms, one could say
that the cogito equals a bodily I can. ‘The “I think” and the “I can” have the same onto-
logical status, which is that of subjectivity and the internal transcendental experiences
of which it is the milieu’ (Henry, 1975, p. 56). Subjectivity is not reduced to thought
but involves movement—​not the subjective experience of the objective movement of

1 In Biran, the experience of resistance, encountered in movement, is the basis for the idea of substance of the
transcendent world and the world enjoys the same absolute certitude as that of subjectivity (see Henry, 1975, p. 35).
Biran characterizes the being of subjectivity as the being of effort. Biran does not have a theory of passivity (as op-
posed to effort), and therefore, according to Henry, the category of substance is not clarified in his philosophy. We
do not pursue the idea that subjectivity is effort, and the related theme of the existence of the world would take us
too far afield.
56  A radical phenomenology of the body

ontological monism

consciousness:
empirical reality subjective experience of
phenomenological distance reality

experience of the
objective body
representations, judgements, objective body
sensations

moving body experience of movement

body schema, proprioception

Figure 4.1  Reality and consciousness according to ontological monism. On the left, reality
as recognized by the empirical sciences and in daily life. The body is part of empirical
reality, and therefore an objective-​transcendent body. On the right, consciousness, or the
subjective experience of the reality situated on the left. The subjective experience of the
(objective) body is to be situated here and includes the subjective experience of the moving
objective body. Since experience of reality is mediated by sensations (e.g., proprioception),
representations (e.g., body schema), or judgements, there is a phenomenological distance
between reality and experience.

the biological body, but subjective movement as a reality on its own. If the domain of
the experience of the body is not recognized as real, if one only yields to transcendent
constructs (such as objective movement), nothing is left but objective bodies, separated
from any subjectivity. As long as the body is only an element of transcendent being, real
movement happens in the objective world of extension, and we, subjects, are left with
the mere idea of movement. For Henry, in the wake of Biran, real movement is sub-
jective movement. The real body (not the idea, but the being of the body) is a subjective
and transcendental being. In other words, cogito sum, because of the reality of the sub-
jective body. The two schemas in Figure 4.1 and Figure 4.2 summarize the two posi-
tions of ontological monism and ontological (non-​Cartesian) dualism and the place of
the original, subjective body and the objective-​transcendent body.
Biran thus recognizes a sphere of original knowledge of the body in the ontological
region of (transcendental) experience or subjectivity. The original and real being of the
body is a subjective being (with an emphasis on subjective, but also on being). In other
words, the eternal division between experience, on the one hand, and reality, on the
other hand, is lifted. Subjectivity is real. And in contrast to all the assertions that hold
that the body is a thing, a constituted reality, and a part of the world, the original being
of the body is immanence, subjectivity. In the domain of subjectivity, no phenomeno-
logical distance intervenes. The original body is not different from the experience or the
knowledge we have of it. As already mentioned, the subject does not have a knowledge
of this original body as of a reality different from it (i.e., as a transcendent reality). To
objectify itself, i.e., to present itself to itself on the basis of mediations (such as sensa-
tions, representations, or judgements), is in principle impossible for subjectivity.
 The subjective body and the transcendent or objective body  57

ontological dualism

reality

(transcendental) subjectivity (transcendent) objectivity

phenomenological distance
immediate knowledge
unmediated
facts of nature
manifests itself in
‘reflection’ objective body

thoughts movement
original, subjective psychic facts
body

sensations, representations,
judgements

Figure 4.2  Reality according to (non-​Cartesian) ontological dualism. Both subjectivity

and objectivity are real. Whereas objectivity is known by subjectivity on the basis of
a phenomenological distance, subjectivity, on the left, manifests itself to itself in an
immediate way (in so-​called ‘reflection’). Subjectivity manifests itself both in thought
and in movement. The latter characterizes the subjective body. On the right, we have
(transcendent) objectivity, comprising both facts of nature, known on the basis of
exteroception, and psychic facts, known on the basis of introspection. The objective body,
as recognized by the empirical sciences, is a fact of nature. Psychic facts include sensations,
representations, and judgements.

Of course, transcendent bodies, belonging to the transcendent world, also exist, but
the transcendent body is not the original body. Rather, the transcendent body is the
body as recognized by biology; it is the realm of objective movement and sensations.
Henry explains this as follows. Bodily sensations that are about the body itself, such as
proprioceptive sensations, belong to the interiority of the body, but one should under-
stand that this interiority of the body is an empirical one, belonging to the transcendent
or empirical world. In other words, proprioception is not the means by which we ori-
ginally experience our subjective body—​subjectivity is not experienced on the basis
of the transcendent world, be this transcendent world external (the world perceived
by exteroception) or internal (on the basis of proprioception and interoception). The
core idea is that the body is not, first of all, a being in the transcendent world and then
an experience that we have of such a being. According to Henry, our original body does
not exist independently of, or prior to, this experience. The body that presents itself as
surpassing the experience we have of it is the transcendent body, not the original body.
From the point of view of this radical phenomenology of the body, cognitive science
58  A radical phenomenology of the body
focuses on the body that surpasses experience and is given to us on the basis of medi-
ation by sensations and representations (cf. below).

4.4  Body schema and the unity of the body

Up to now, ‘objective’ and ‘transcendent’ body could be used interchangeably. That

changes when the experience of the unity of our body is discussed. That happens in
terms of the ‘schema of our body’ or the body schema. Insofar as the unity of the tran-
scendent body is considered, Henry speaks of the body schema or the organic body as
the ensemble of all our organs. For Biran, the unity of the transcendent body is bor-
rowed from the unity of the original being of the subjective body, characterized by
movement. ‘The unity of the transcendent body is not a transcendent unity, it is the unity
of the power which moves the different parts of organic space and which confers upon
them their unity and permits them to appear in the coherence of a structure which
contains them all and which we can consider as the true schema of our body’ (Henry,
1975, p. 124). So even though the transcendent body is a unity, this unity itself is not
transcendent but subjective. Two relationships constitute the body schema, but they are
not on the same level. First, there is the relationship between our organs among them-
selves. These only seem to constitute the foundation for the unity of the organic body.
The unity really rests on the relationship of each of the bodily organs to the power that
moves them.
Because of this tight link with the original body, which cannot be represented be-
cause no mediations are involved in the subjective body, the body schema is not a
matter of image or representation (Henry, 1975, p. 125):

[ . . . ] the schema of our own organic body has no relationship with an image or a
representation of this sort. To say that the power of the ego2 over its organic body is
exercised through the intermediary of a corporal schema conceived as an image or
as some mediation between originally subjective movement and the terminus of this
movement is to fall back into the intellectualist thesis according to which a represen-
tation of movement or of its instruments always precedes the real accomplishment
thereof.

One should not consider the body schema in terms of a mediation between original
subjectivity, on the one hand, and the objective body as terminus of subjective move-
ment on the other hand. As we have seen, the original being of the subjective body is the

2 Henry refers here to the transcendental ego, which is nothing but subjectivity or the immediate presence to
itself. In Henry’s words: ‘The ego presents itself to itself in an internal transcendental experience, or rather, it is
because it is the very fact of thus presenting itself, [ . . . ] that it realizes in itself the first condition of the experience
of the world and the effectiveness of our access to things’ (Henry, 1975, p. 41). Auto-​presentation to self is thus
the very phenomenon of the ego, and, he adds, it is ‘in no way a phenomenon or an object which represents itself ’
(p. 42).
 Body image and the body that can be represented  59
body revealed in internal transcendental experience. For Biran, that is primarily the in-
ternal transcendental experience of movement. The organic body is the immediate (i.e.,
not mediated by sensations, representations, or judgements) and moving terminus of
the movement of the subjective body. It is the ensemble of organs or termini over which
movement has a hold. The body schema has a global character—​it ‘is a complete and
total schema and not a lacunary representation. It is precisely because it is not a rep-
resentation that it presents us with this characteristic of completeness and that we can
say that our knowledge of it is, in a certain way, an absolute knowledge’ (Henry, 1975,
p. 194, fn. 3).
Internal sensations, belonging to the organic body, occur not in exterior space, but
their place is the interior extension of the organic body. This means their place is the
transcendent milieu which subjective movement deploys and which is the terminus
of movement. For Biran, the experience of this interior transcendent milieu is prior to
the sensations which come to fill it. The experience of it is immanent to movement, not
based on representations, sensations, or judgements.
The reason is that the original body and the organic body are so close that they form
a closed system. ‘The system formed by subjective movement and the organic body is
a closed system, which is complete and self-​enclosed, and which would be what it is in
the absence of all representative knowledge of the transcendent body as an objective
being belonging to exterior space’ (Henry, 1975, p. 131). Taken together, Henry thus
states that the organic body is transcendent but enjoys a special knowledge status: ‘Even
though its phenomenological status is radically different from that of our original body,
our organic body, nevertheless, presents itself to us in a sort of absolute knowledge.
Because it is the strict non-​represented correlate of the intentionalities of our absolute
body, it is always entirely present to us and we possess it in a knowledge which excludes
all limitation and all possibility of error’ (Henry, 1975, p. 194). In Biran’s approach, the
body schema is thus not related to proprioception. Movement is not experienced on
the basis of sensations, even if these originate inside the body. That the organic body is
present and enjoys this special knowledge status (of absolute knowledge) is due to the
fact that it is not mediated by sensations, representations, or judgements. There is no
phenomenological distance involved, and in that sense, the organic body is present to
us, instead of re-​presented.

4.5  Body image and the body that can be represented

Whereas the body schema does not represent the organic body, the objective body can
be the object of a representation (Henry, 1975, p. 128):

[ . . . ] we can represent our body to ourselves and make of it the correlate of a know-
ledge analogous to that which we have of other objects or even to the explicit and
conceptual knowledge which we sometimes direct toward determined regions of the
world when we wish to make a science of it.
60  A radical phenomenology of the body
Insofar as this objective body forms a unity, it is the unity of an image or a representa-
tion, i.c. an image or a representation of the transcendent body.
The distinction between organic (transcendent) and objective (transcendent) body
is based on a distinction in experience. On the one hand, we have the immediate ex-
perience of our body revealed in movement—​the organic body with its unity derived
from the original, subjective body. On the other hand, we have objective or represen-
tative experience of the transcendent body, which is only a secondary experience of
our body. Secondary experience, in the form of representations of the body, can only
be experience from without, never from within. Moreover, the knowledge from within
cannot be represented from without. This secondary form of experience, in the form of
representations of the body, corresponds to the broad concept of body image.
Thus, it is not two bodies that we must distinguish, the subjective and objective body,
but three: the original, subjective body; the organic body (or the body schema); and
the objective body (which can be represented by a body image). The scheme below (see
Figure 4.3) depicts the three bodies.
The third body, the objective body, is the object of external perception. It can be
represented and, as such, it can become the object of thematic knowledge or scien-
tific research. The unity of the objective body must be distinguished from the unity of
the organic and subjective body. Henry also warns us that we should not confuse the

ontological dualism

original, subjective body transcendent body

organic body objective body

(body schema:
knowledge from within)

represented body
(body image:
knowledge from without)

Figure 4.3  The three bodies according to Henry (1975). The starting point is an
ontological dualism between the original subjective body immediately given in subjectivity
and the transcendent body belonging to the transcendent world. The body schema borrows
its unity from the subjective body and we have immediate and unmediated knowledge of it.
The body schema does not comprise the whole transcendent body. The transcendent body
can also be known from without, on the basis of representations or images of the objective
body. A richer body image, however, also includes body-​schematic aspects, which are then
known in a secondary way.
 The subjective, moving body and the role of sensations  61
images we can form of our body with any of the three bodies just discussed (subjective,
organic, or objective). Images of the body can be limited to the objective body, but they
can also be richer and include elements of the organic body (Henry, 1975, p. 134):

Actually, to our organic body belong all our organs including those which we do not
perceive objectively and in this way we understand that an image based on the organic
body offers us a representation of our body infinitely more rich and complete than
the one given us by an image which is related only to the being of our objective body.
The latter image, which is the image of an objective representation, includes, it is true,
elements borrowed from the original and organic body, because the constitution of
our objective body implies the intervention of such elements.

A body image can be restricted to the objective body, but it can also include aspects
of the organic body. That does not mean that the organic body is itself a representa-
tion, or that the body schema is an image or representation (see earlier). It means that
aspects of it can be represented, and thus also known in a secondary way next to the
immediate knowledge we have of it (body schema). In fact, because subjective, organic,
and objective body are so close, any body image contains more than what is, strictly
speaking, objective.

4.6  The subjective, moving body and the role of sensations

Let us recapitulate. The direction followed by Henry is to start from the phenomenon—​
and the reality—​of subjectivity in order to find out which body can be discovered in the
ontological region of subjectivity. That implies the radical recognition of a subjective
body—​a subjective experience that is not mediated by phenomena belonging to the
transcendent world, such as representations or sensations. In view of the current situ-
ation in the cognitive sciences and the neurosciences, in which representations and
sensory signals figure centrally, this seems an unacceptable point of view.
In the remainder of this chapter, we follow the basic aspects of Henry’s account of the
subjective body and the role of sensations. In the next section, we critically look at how
contemporary models of embodiment consider mediations and especially sensations
as all-​important and how that hinders the connection between subjectivity and the
body. What we do differs, however, from anti-​representationalist approaches (which
criticize mediating representations) in the philosophy of cognitive science (Gallagher,
2008; Chemero, 2009) in the sense that we do not necessarily reject representations (or
sensations), but reconsider their place and role in the subjective experience of the body.
Henry writes the following about the experience of movement (Henry, 1975, p. 70):

[ . . . ] Maine de Biran never called the feeling of muscular action sensation; his entire
philosophy consists precisely in the affirmation that the feeling of action does not re-
sult from a sensation, that action is known in itself insofar as it pertains to the sphere
62  A radical phenomenology of the body
of subjectivity, insofar as it is a fact of the relationship of immediate knowledge [or
experience] to itself.

The distinction between the feeling of action and sensation is an immediate conse-
quence of his ontological dualism between subjective and objective-​transcendent body.
Whereas the former is the realm of experience or the immediate, interior knowledge
subjectivity has of itself, the latter is the realm of the objective body, where sensations
find their place (see Figure 4.2). Henry searches for a name for this interior knowledge
proper to subjectivity, ‘for the word “sensation” cannot say it all’ (Henry, 1975, p. 70).
While it is not a matter of sensation, the feeling of action is neither a matter of judge-
ment. The limitation to only two sources of knowledge, viz. sensations or judgement, is
a heritage of Kantian philosophy. The position of Henry, or of Biran, is radical when it
comes to the experience of movement, which follows the scheme of immediate know-
ledge subjectivity has of itself, allowing no place for any kind of mediation (Henry,
1975, p. 77):

[ . . . ] the being of subjective movement is an immediate revelation of the self to itself
[ . . . ] we have asserted that movement is known to us immediately and we have denied
that muscular sensation or any other form of mediation plays the smallest role in this
primordial knowledge which is ours and which is less a knowledge of our body than
the phenomenological being of this body itself.

Henry thus refers movement to the ontological realm of subjectivity. Sensations are
only secondary, and relegated to the realm of transcendence and objectivity. Henry’s
radical phenomenology of the body puts subjectivity, including the subjective body,
first. An important consequence is that the role of sensations is marginalized. Henry’s
discussion of the approach of Maine de Biran is particularly interesting in light of the
important role of sensations in cognitive science, more specifically their role for body
representations such as body image and body schema. In order to get a clearer view on
this, we first turn to the role of representations and then to the role of sensations in con-
temporary cognitive science and the philosophy of cognitive science.

4.7  Body schema and body representations

Cognitive science has not yet resolved the issue of the unity of the moving body. We have
seen that according to Henry, the body schema is the unity of the transcendent body.
The origin of this unity lies in the subjective body, which is characterized by move-
ment in the sense of original, immediate knowledge of movement. The body schema is
therefore a unity borrowed from the unity of the original being of the subjective body.
More than half a century later, cognitive science and philosophy still struggle with the
unity of the moving body. For example, Alsmith (2019) tackles the question of how one
experiences and acts with one’s body not as a collection of parts, but as an integrated
 Body schema and body representations  63
whole. According to Alsmith (2019), a representation of the body as an integrated
whole is not necessary because the structure of the body itself can serve to coordinate
(the partial) representations of the body. In contrast, de Vignemont argues for a body
map and follows the solution standard in cognitive science to posit a corresponding
representation of the body as an integrated whole. The body map is a representation
of the body that ‘represents the structural organization of the various segments of the
body independently of current posture’ (2018, p. 87). She considers this body map as a
kind of long-​term body image, which represents what the body is usually like, similarly
to Carruthers’ offline body representation (Carruthers, 2008a).
The discussion exemplifies the two broad options available in the field of cognitive
science: explanations in terms of representations or in terms of the objective body itself.
As Alsmith (2019) remarks, representationalism or explanations that involve represen-
tations dominate contemporary psychology and neuroscience (and the philosophy re-
flecting on these disciplines). The alternative is to argue that the body itself can serve
an explanatory role. Accordingly, two conceptions of embodiment can be distin-
guished: one in which body representations have an explanatory role, and one in which
the body itself has an explanatory role (Alsmith & de Vignemont, 2012). Resistance
against representations of the body is often motivated by the idea that representations
are computationally too costly and unnecessary because of dynamical interactions with
and in the real body and world (Chemero, 2009; Gallagher, 2008). Radical embodied
cognitive science resists representations altogether, whereas other positions liberally
use both representational and non-​representational explanatory schemes (cf. Alsmith,
2019; Dijkerman & Lenggenhager, 2018; Alsmith & de Vignemont, 2012; Clark, 1997).
An earlier solution in terms of the body schema and its distinction from the body
image (Gallagher & Cole, 1995) is rejected by de Vignemont because there would be a
lack of precise understanding of the functional role of the body schema, as opposed to
body image (de Vignemont, 2018, p. 151). At first sight, the body schema (Gallagher &
Cole, 1995) closely resembles Henry’s (1965) schema of the body, especially in its close
connection with movement and its distinction from body image (see also Figure 4.3)
(p. 371):

In contrast to the reflective intentionality of the body image, a body schema involves a
system of motor capacities, abilities, and habits that enable movement and the main-
tenance of posture. The body schema is not a perception, a belief, or an attitude. [ . . . ]
Although the body-​schema system can have specific effects on cognitive experience, it
does not have the status of a conscious representation or belief.

Although the body schema is about the body as a whole (whereas a body image
functions in a rather partial way), it does not explain the experience of unity of the
body. Moreover, the input that forms the basis for the operation of the body schema
is proprioception. So even though, at first sight, the body schema (Gallagher & Cole,
1995) resembles Henry’s (1965) schema of the body, it is clearly tied to the mediation
of proprioceptive sensations, whereas in Henry’s account, the body schema precedes
64  A radical phenomenology of the body
the latter. This priority of the body schema over proprioceptive sensations is possible
because of the recognition of the subjective body, which founds the unity of the body
schema.
The role and importance of sensory input figure in the margin of this discussion,
for example when it is pointed out that the sense of the body ‘is not only dependent
on incoming sensory information but also on internal representations of our body,
some of which are highly cognitive in nature’ (Dijkerman & Lenggenhager, 2018,
p. 133). The subjective body, once the rich ground for much phenomenological de-
scription, seems somewhat hidden in the picture, whereas it is nonetheless bodily
experience, e.g., the experience of acting as an integrated whole, that is the starting
point for the discussion. The body schema, originally belonging to the subjective di-
mension of the body and intimately connected to, or even identified with, the lived
body in the phenomenological tradition (see also Merleau-​Ponty, 1945), has trans-
formed into a representation that (supposedly) underlies the subjective dimension
of embodiment, instead of being an account of it. The subjective body is not a third
option anymore next to body representations and the objective body, but should, in
principle, be reducible to these representations or to the (objective) body itself. In
this chapter, we put forward the idea that a major factor in the neglect of the sub-
jective body is the undisputed but all-​important role of sensory input for the ex-
perience of the body. This role remains hidden because the focus of the discussion
is mostly on the presence or absence of representations, as in the above discussion.
When the focus is shifted to the role of sensations, Henry’s radical phenomen-
ology of the body that gives priority to the subjective body unexpectedly comes into
view again.

4.8  Body representations and the role of sensory input

The classic conception in cognitive science is that experience of the body is based on
sensory input, although not directly resulting from unimodal body representations, but
from multisensory integration mechanisms (Blanke, 2012; Serino & Haggard, 2010).
Unisensory processing of body-​related information is thought to serve as input to
multisensory processes, leading to ever more abstract representations of the body. The
reach of sensory input is, however, limited. There are representations of the body for
which there is no sensory channel. For example, there is no sensory channel dedicated
to the body as a whole, and thus there are features that cannot be extracted at the sen-
sory level. These other features are not a matter of belief or judgement, but still experien-
tial in nature, and escape the dichotomy of sensations versus judgement. For example,
it has been argued (Tsakiris & Haggard, 2005; De Preester & Tsakiris, 2009; Tsakiris,
2010) that the sense of body ownership—​a central component of bodily experience—​
also depends on top-​down processes that act over and above multisensory integration
mechanisms (cf. the structural model of the body or body model). Although there is
no compelling evidence for the existence of innate body representations, the classic
 Body representations and the role of sensory input  65
conception that all higher-​order body representations are ultimately based on sensory
input is not always followed.
Another example is de Vignemont (2018), according to whom bodily ownership
is experiential but over and above bodily sensations. The notion of body map devel-
oped in her account of bodily ownership contains information about the configuration
and metrics of the body segments and would compensate for the insufficiencies of the
bodily senses, which do not carry this information. According to de Vignemont (2018),
the body map is partially innate, partially acquired on the basis of sensory input. For
instance, the fine-​grained details are probably contributed by vision. The body map
thus is a unified multimodal representation that integrates innate, somatosensory, and
visual information. By introducing a body map, representing long-​term properties of
the body, de Vignemont reacts against the classic conception, which says that bodily ex-
perience is exhausted by information from online sensory input.
A related discussion that is ultimately about the role of sensory input for bodily
experience happens in terms of short-​term versus long-​term body representations.
Long-​term body representations are interesting because they free body representa-
tions from their direct dependence on sensory input. Carruthers (2008a) approaches
the issue of the feeling of embodiment in terms of online versus offline body repre-
sentations: ‘Online representations of the body are representations of the body as it is
currently, are newly constructed moment by moment and are directly “plugged into”
current perception of the body. In contrast, offline representations of the body are repre-
sentations of what the body is usually like, are relatively stable and are constructed from
online representations’ (Carruthers, 2008a, p. 1302). The idea that offline representa-
tions are necessarily constructed from online representations is criticized by Tsakiris
and Fotopoulou (2008). They refer to phantoms in people who congenitally lack a limb,
and the sensitivity of infants to left–​right reversal of images of their legs. Consequently,
Carruthers (2008b) takes back the idea that the relationship between online and offline
representations is a ‘serial construction’, because offline constructions can contribute to
the construction of online representations of the body, and there may exist offline rep-
resentations of the body that are not constructed from online representations.
Scientific research on those dimensions of bodily experience that do not directly
or only indirectly depend on sensory input is not easy, because sensory input figures
centrally in experimental research. The basic assumption is that bodily experience and
bodily self-​consciousness can be studied by manipulating sensory input (Serino et al.,
2013). Theoretical models draw from clinical data (related to disorders of the bodily
self) and, more recently, from the study of healthy participants confronted with am-
biguous multisensory information about their body. ‘These paradigms typically con-
front healthy participants with ambiguous multisensory information about their body,
during which bottom-​up signals from unimodal sensory systems are integrated and
decoded by higher, multisensory levels of the hierarchy to construct an updated body
representation’ (Dijkerman & Lenggenhager, 2018, p. 133).
Higher-​order, more abstract bodily representations that are over and above the pro-
cessing of bodily sensations do not have such a prominent place in cognitive science
66  A radical phenomenology of the body
research, primarily because its specific research paradigm with a focus on the manipu-
lation of sensory signals does not easily allow this. The role attributed to higher-​order
body representations that represent the rather stable aspects of our bodies is to influ-
ence or ‘recalibrate’ (Riva, 2018, p. 241) the bottom-​up bodily information. Together,
top-​down and bottom-​up, and offline and online bodily representations (in some
magical way) would form the subjectivity of our bodily existence. Body representations
of a higher order mainly seem to satisfy the need to recognize a dimension of the body
that is different from the online representation based on current sensory input. In other
words, they satisfy the insight that bodily existence is not exhausted by sensory input
(see Figure 4.4).
Body representations that are independent from current or even past sensory input
thus play a mysterious, but crucial, role in cognitive science. Henry’s belief that the
subjective body has priority over sensations seems to be supported when accepting rep-
resentations that are over and above sensory input and that are necessary for under-
standing our subjective bodily existence (bodily ownership, bodily presence, bodily
unity, sense of embodiment). However, there is little attention for the common role of
these ‘offline’ body representations, namely to ‘explain’ the subjectivity proper to our
bodily existence over and above sensations, which seem unable to fulfil this explana-
tory role. Apart from the question of whether these offline body representations are in-
nate or somehow acquired, no one really seems to investigate the subjectivity proper to
offline body representations, even if we are forced to accept body representations that
are beyond the reach of sensations. Offline body representations are related to crucial
aspects of the experience of the subjective body, but their relationship is not clear. If it is
stated that these representations explain the experience of the subjective body, it is not
clear how they do this. The other option is to adopt Henry’s perspective and to state that

offline representations online representations

over and above

explain? leads to lead to

experience of the subjective body sensations arising from the objective body

Figure 4.4  On the right, the classical conception in cognitive science—​sensations arising
from the biological body lead to so-​called online body representations that are based on
sensory input. These online body representations play a role in the experience of the body.
On the left, so-​called offline body representations that are over and above the sensory
input, but experiential in nature. Offline body representations are related to crucial aspects
of the experience of the subjective body, but their relationship is not clear. If it is stated that
these representations explain the experience of the subjective body, it is not clear how they
do this. The other option is to adopt Henry’s perspective and to state that crucial aspects of
the experience of the body come prior to their being represented. But then it is unclear why
we need the mediation of representations on top of the experience itself.
 Conclusion  67
crucial aspects of the experience of the body come prior to their being represented. But
then, it is unclear why we need the mediation of representations on top of the experi-
ence itself.

4.9 Conclusion

Henry claims that subjectivity requires an ontology of its own, and that sensations do
not have a central role to play in subjectivity, but that experience is central. This seems
unacceptable for current cognitive science, in which representations and sensory sig-
nals figure centrally. However, cognitive science seems willing to accept representa-
tions that are over and above sensory input, but still experiential in nature. The exact
status of these ‘offline’ representations is, however, unclear. If it is true that these offline
representations are responsible for crucial aspects of bodily subjective life (e.g., bodily
ownership, bodily presence, bodily unity, sense of embodiment), then it is unclear how
these representations bring this experience about. Whereas online bodily representa-
tions are based on sensory input, offline bodily representations seem to be based on
bodily experience over and above sensory life. In other words, they seem to represent or
mediate what they are supposed to explain—​the subjective body.

Acknowledgements

Research for this chapter was funded by a research grant from KASK & Conservatory,
the school of arts of HOGENT and howest (BE). I am grateful to two anonymous re-
viewers for their time and commitment.

References
Alsmith, A. J. T. (2019). Bodily structure and body representation. Synthese, online first. doi.org/​
10.1007/​s11229-​019-​02200-​1
Alsmith, A. J . T. & de Vignemont, F. (2012). Embodying the mind and representing the body. Review
of Philosophy and Psychology, 3, 1–​13.
Blanke, O. (2012). Multisensory brain mechanisms of bodily self-​consciousness. Nature Reviews
Neuroscience, 13(8), 556–​71.
Carruthers, G. (2008a). Types of body representation and the sense of embodiment. Consciousness
and Cognition, 17, 1302–​16.
Carruthers, G. (2008b). Reply to Tsakiris and Fotopoulou ‘Is my body the sum of online and offline
body representations? Consciousness and Cognition, 17, 1321–​3.
Chemero, T. (2009). Radical Embodied Cognitive Science. Cambridge, MA: MIT Press.
Clark, A. (1997). Being there: Putting Brain, Body, and World Together again. Cambridge,
MA: MIT Press.
De Preester, H. (2019). Subjectivity as a sentient perspective and the role of interoception. In M.
Tsakiris & H. De Preester (eds.), The Interoceptive Mind—​From Homeostasis to Awareness (pp. 293–​
306). Oxford: Oxford University Press.
68  A radical phenomenology of the body
De Preester, H. & Tsakiris, M. (2009). Body-​extension versus body-​incorporation: is there a need for a
body-​model? Phenomenology and the Cognitive Sciences, 8(3), 307–​19.
de Vignemont, F. (2018). Mind the body: An Exploration of Bodily Self-​awareness. Oxford: Oxford
University Press.
Dijkerman, C. & Lenggenhager, B. (2018). The body and cognition: tThe relation between body repre-
sentations and higher level cognitive and social processes. Cortex, 104, 133–​9.
Gallagher, S. (2008). Are minimal representations still representations? International Journal of
Philosophical Studies, 16(3), 351–​69.
Gallagher, S. & Cole, J. (1995). Body schema and body image in a deafferented subject. Journal of Mind
and Behavior, 16(4), 369–​90.
Henry, M. (1973). The Essence of Manifestation (G. Etzkorn, Trans.). The Hague: Martinus Nijhoff.
(Original work published 1963)
Henry, M. (1975). Philosophy and Phenomenology of the Body (G. Etzkorn, Trans.). The
Hague: Martinus Nijhoff. (Original work published 1965)
Merleau-​Ponty, M. (1945). Phénoménologie de la Perception. Paris: Gallimard.
Riva, G. (2018). The neuroscience of body memory: from the self through the space to the others.
Cortex, 104, 241–​60.
Serino, A., Alsmith, A., Costantini, M., Mandrigin, A., Tajadura-​Jimenez, A., & Lopez, C. (2013).
Bodily ownership and self-​location: components of bodily self-​consciousness. Consciousness and
Cognition, 22, 1239–​52.
Serino, A. & Haggard, P. (2010). Touch and the body. Neuroscience and Biobehavioral Reviews, 34(2),
224–​36.
Tsakiris, M. (2010). My body in the brain: a neurocognitive model of body-​ ownership.
Neuropsychologia, 48(3), 703–​12. https://​doi.org/​10.1016/​j.neuropsychologia.2009.09.034
Tsakiris, M. & Fotopoulou, A. (2008). Is my body the sum of online and offline body-​representations?
Consciousness and Cognition, 17(4), 1317–​ 20; discussion 1321–​ 3. https://​doi.org/​10.1016/​
j.concog.2008.06.012
Tsakiris, M. & Haggard, P. (2005). The rubber hand illusion revisited: visuotactile integration and self-​
attribution. Journal of Experimental Psychology: Human Perception and Performance, 31(1), 80–​91.
https://​doi.org/​10.1037/​0096-​1523.31.1.80
 5
Body schema and body image in motor
learning: refining Merleau-​Ponty’s notion
of body schema
Shogo Tanaka

5.1 Introduction

My aim in this chapter is to explicate the interrelated roles of body schema and body
image in motor learning and to shed light on the phenomenology of body image from
a fresh perspective. Motor learning is one of the most important human capacities. For
example, we know how to walk, run, throw and kick a ball, touch-​type, play an instru-
ment, and so on, but all of these know-​how capacities are not innately gifted but must be
learnt in the course of development. Although the process of motor learning has been
explicated in terms of neural mechanisms over the past few decades (e.g., Hardwick,
Rottschy, Miall, & Eickhoff, 2013; Shmuelof & Krakauer, 2011; Wolpert, Ghahramani,
& Flanagan, 2001), most research narrowly focuses on body representation in the brain
and does not take the very experiences of the lived body into consideration.
In the field of phenomenology, Merleau-​Ponty (2012) was the first person to show
the indispensable role of body schema in motor learning, as well as in other experi-
ences in the lifeworld. For Merleau-​Ponty, motor learning was an experience of the re-
working and renewal of one’s body schema. At the time, his concept of body schema
was open to dialogue with contemporary research in neuroscience. Since then, only a
few theoretical contributions have updated the dialogue between phenomenology and
neuroscience in terms of motor learning. An analysis by Gallagher and Cole (1995) was
one such exceptional contribution. As we will see later, they investigated the case of Ian
Waterman (IW) who had recovered his motor performance after suffering from symp-
toms of neuropathy. Because IW re-​established his movement only through conceptu-
alizing and attentively perceiving his own body, Gallagher and Cole concluded that his
movement was not based on body schema, but mainly on body image.
However, accepting the conceptual distinction between body schema and body
image, as they point out, raises a series of questions—​how do both body schema and
body image contribute to motor learning? Is it possible to learn a new movement using
only body schema or body image? If not, how do both interrelate with each other in
the process of motor learning? How are both functions related to the current model

Shogo Tanaka, Body schema and body image in motor learning: refining Merleau-​Ponty’s notion of body schema In: Body Schema and
Body Image. Edited by: Yochai Ataria, Shogo Tanaka, and Shaun Gallagher, Oxford University Press. © Oxford University Press 2021.
DOI: 10.1093/​oso/​9780198851721.003.0005
70  Body schema and body image in motor learning
of motor control in neuroscience? This chapter attempts to answer these questions. In
the following, first I revisit how Merleau-​Ponty conceptualized body schema in terms
of the lived body. Second, I will have a short review of the scientific research on motor
learning. And then, comparing with Gallagher and Cole’s analysis of IW, I will examine
the symptom of Schneider, the case of whom Merleau-​Ponty referred to in considering
the function of body schema. My argument will show that Merleau-​Ponty’s idea cru-
cially lacked the theoretical distinction of body schema and body image, though his
idea of ‘intentional arc’ involved a certain aspect of the latter. And finally, I come back
to the theme of motor learning in order to answer the questions above. On the one
hand, this chapter aims to brush up on the phenomenology of embodiment by refining
Merleau-​Ponty’s notion of body schema. But on the other hand, I also aim to push for-
ward the sciences of motor learning from a theoretical perspective.

5.2  Schematic function of the lived body

First, let us confirm how Merleau-​Ponty (2012) conceptualized body schema. In a

broad sense, he regarded it as a schematic function of the lived body. Needless to say,
the lived body is one of the basic notions in phenomenology that refers to one’s own
body that one lives from the first-​person perspective, in contrast to the physical body
that is objectified to be explicated from the third-​person perspective. I live my own
body, I perceive the world through and from the body, and I act in the world through
and with the body. The most notable feature of my body in perception and action is that
I just live it without clear attention. My attention is rather oriented to the object of per-
ception or action, and my body is implicitly lived in the background. Consider the case
of writing. In contrast to my conscious perception of the letters and the paper, I am not
aware of the movement of each finger or of the hand. Merleau-​Ponty (2012, p. 94) also
emphasizes:

Insofar as it sees or touches the world, my body can neither be seen nor touched. What
prevents it from ever being an object or from ever being “completely constituted” is
that my body is that by which there are objects.

In our ordinary experiences, the body effaces itself into the background, and what
comes into the foreground of conscious experience are objects and the world (Leder,
1990). The body provides the very perspective from which I perceive diverse objects in
the world and through which the world appears to me with spatial orientations, such
as near–​far, up–​down, and right–​left (Husserl, 1989). Of course, however, the body
suddenly appears in the foreground of attention if we fail to perform in an ordinary
manner. For example, if I fall off my bicycle, I have an acute awareness of pain and con-
firm the wounded parts of the body. While my attention is focused on my own body, the
surrounding environment and the world conversely efface themselves into the back-
ground. The same thing happens when I suffer from migraine. Even though I try to
 Schematic function of the lived body  71
read a book, it becomes extremely difficult to follow the letters because the pain dis-
tracts my mind.
Thus, in considering the lived body, it is necessary to acknowledge this figure-​ground
structure between the body and the world. Insofar as an action is well organized and
smoothly performed, the lived body effaces itself into the background so that the object
and the world toward which the action is oriented appear as the figure. In contrast, once
one fails to act in a smooth manner, related body parts come to the focus of attention as
the figure. The lived body and the world are intertwined into a figure-​ground structure.
This is the basic line of thought on which Merleau-​Ponty developed his idea of body
schema. As the author argued before, his notion of body schema can be summarized as
follows (Tanaka, 2013).
(a) Body schema not only supports spatial cognition of body parts within the body it-
self, but also organizes an action toward the environment by organizing the movements
of body parts. In its historical origin in neurology, body schema was considered to be
an implicit frame of the entire body to which one refers to in recognizing present pos-
ture or in localizing body parts (Head & Holmes, 1911; Schilder, 1923). It was loosely
regarded as body representation in the brain because diverse patients were discovered
with disturbances in bodily cognition due to cerebral lesions. Instead of reducing body
schema into body representation in the brain, Merleau-​Ponty (2012) expanded the no-
tion from the viewpoint of ‘being-​in-​the-​world’, which he inherited from Heidegger
(1962). He acknowledges that body schema conveys spatial relationships of one’s body
parts; however, that is an implicit cognition felt through an ongoing action toward the
environment. For example, when I sit down on a chair, I know implicitly the spatial
relationships among the waist, the hip, and the legs. But these parts of the body come
into my awareness only insofar as is necessary to accomplish the task of sitting down on
the chair (a figure-​ground structure). Body schema enables body awareness relative to
the context of action, and the major part of it remains implicit and unfocused as the ac-
tion is performed smoothly. So, rather than supporting body awareness, body schema
coordinates body parts into a unified action toward the environment by utilizing that
awareness as a regulator for action. It is when we need to consciously control the move-
ment that we become aware of the body. For example, one becomes strongly aware of
the fingers when one begins to learn how to play the piano. The main function of body
schema is to coordinate related body parts and organize a unified action toward the
world. Merleau-​Ponty also states, ‘the body schema is neither the simple copy, not even
the global awareness of the existing parts of the body; rather, it actively integrates the
parts according to their value for the organism’s projects’ (p. 102, modified by the au-
thor according to the original French text). For this function, the lived body can efface
itself in a smooth action.
(b) Body schema brings out habitual action from the lived body in accordance with
a given situation. Along with the phenomena of phantom limbs, Merleau-​Ponty argues
that the lived body comprises two different layers: the habitual body and the actual
body. A phantom limb occurs in most individuals who have experienced amputa-
tion as a feeling that an amputated limb is still present (e.g., Jensen, Krebs, Nielsen,
72  Body schema and body image in motor learning
& Rasmussen, 1983). The individual might feel that the missing limb is still attached
to the body and moves with other body parts. Remarkably, what they experience as a
phantom limb often involves the feeling of bodily movements that they used to prac-
tise as habits. For example, Ramachandran and Blakeslee (1998) recount the symptom
of a patient in that ‘his phantom arm seemed to be able to do anything that the real arm
would have done automatically, such as warding off blows, breaking falls or patting his
little brother on the back’ (p. 22, italics added). Apparently, the patient’s body still re-
acts to a given situation in a habitual manner, accompanied by the amputated part. The
sensation of the missing limb seems to occur as part of a habitual action that has been
established between the body and a certain form of situation. Focusing on this point,
Merleau-​Ponty argues that the lived body comprises two layers of the habitual body
and the actual body. Even though the amputated part is missing in the layer of the ac-
tual body, the habitual body composed of a complex of habitual actions still tries to
respond skilfully to a given situation. Merleau-​Ponty relates the habitual body with the
function of body schema. He claims that we need to consider ‘acquiring a habit as the
reworking and renewal of the body schema’, and that through this process one ‘acquires
the power of responding with a certain type of solution to a certain form of situation’
(p. 143). Body schema establishes an effective way of coping with a certain situation as a
habit, and all of the established habits are accumulated in the layer of the habitual body.
And when one faces a situation with familiar features, body schema brings out a suit-
able action to cope with the situation appropriately.
(c) Body schema allows one to perceive the surrounding environment in terms of
action possibilities. Given that body schema has a function to bring out a suitable ac-
tion to cope with a situation, it must enable one to perceive a situation in advance (at
least implicitly) according to the possibilities of action that one has. Merleau-​Ponty
(2012) also famously states that ‘the theory of the body schema is implicitly a theory of
perception’ (p. 213). The concept of affordance (Gibson, 1979) helps us to understand
the relationship between body schema and perception. Affordance means a physical
property of the environment that offers an individual the opportunity for a particular
action. For example, a firm and level ground affords one to stand on it, walk around on
it, or lie down on it. According to Gibson (1979), we do not passively receive stimuli
in a random manner but actively grasp the action possibilities latent in the environ-
ment, that is, affordances. As we saw already, body schema, which is in contact with
the habitual body composed of diverse motor skills as habits, is ready to unfold a suit-
able action in accordance with the present situation. This means that the lived body
perceives affordances in the surrounding environment, which can be directly unfolded
as concrete actions. Skilful coping with a situation through habitual actions is made
possible when a direct circuit is established between perception of the environment and
appropriate action toward it. The perceptual appearance of a situation immediately so-
licits a particular action to cope with it. Merleau-​Ponty (2012) refers to this perception
through the concept of ‘physiognomy’. In normal cases of perception, the surrounding
world appears to us with a familiar face, so to speak, and perceiving a familiar face nat-
urally solicits us to react in a certain manner. Thus, in physiognomic perception, ‘the
 Sciences of motor learning  73
normal subject penetrates the object through perception and assimilates its structure,
the object directly regulates his movements through his body’ (p. 134). Body schema’s
capacity to organize an action makes our perception actively engaged with the environ-
ment. In this regard, Merleau-​Ponty’s view of perception is continuous to the current
enactive approach to perception (Noë, 2004).
Thus, it is clear that the function of body schema lies at the core of motor learning.
Though Merleau-​Ponty considered this topic as part of forming a bodily habit, we will
reformulate it more explicitly in the context of motor learning in the following sections.

5.3  Sciences of motor learning

In current sport psychology, one of the standard ways to define motor learning is as
‘a set of processes associated with practice or experience leading to relatively per-
manent changes in the capability for skilled movement’ (Schmidt et al., 2018, p. 238).
By repeating certain bodily movements as practice, one is led to an improvement
in motor performance, which is underpinned by newly acquired motor skills. After
learning, one’s performance might become more efficient, smooth, precise, and inte-
grated. In their classic work, Fitts and Posner (1967) showed that the overall processes
of motor learning are distinguished into three phases, that is, cognitive, associative, and
autonomous:

Cognitive phase: in the initial phase, the learner is largely dependent on con-
(1)
scious and mental processes. To grasp the very basic idea of a motor skill, the
learner needs to observe an instructor’s performance repeatedly or understand
the procedure with verbal instructions. For example, a beginner to juggling three
balls must know explicitly when to throw each ball and the order of throwing and
catching with both hands.
Associative phase: in the second phase, the learner’s focus shifts from tasks of
(2)
movement (‘what to do’) to one’s own performance (‘how to do’). To perform
in a proper manner, the learner tries to coordinate diverse body parts, adjust
the timing of movement sequences, tighten and loosen muscles, pursue a better
form of movement, and so on. And in taking sensory feedback into consider-
ation, they continue to improve on subsequent trials.
Autonomous phase: finally, the learner reaches the autonomous phase, which is
(3)
marked by the ability to perform skills more or less automatically, with little or
no attention to bodily processes (‘just do’). It is even possible to simultaneously
perform another activity. Consider the case of jogging. For most runners, the
skill of jogging is so deeply embodied that they listen to music or are even ab-
sorbed in thinking while jogging in a park.

Underlying neural mechanisms have also been explicated in recent decades. The
motor learning process is related to neural activities in diverse areas of the brain,
74  Body schema and body image in motor learning
including, but not limited to, the primary motor cortex (responsible for motor com-
mands to move body parts), supplementary motor area (contributing to temporal
motor sequences), premotor cortex (converting visual stimuli to a motor response),
visual cortex (observing movements visually), parietal association area (attending to
spatial information regarding movements), prefrontal cortex (temporarily memor-
izing procedures of movements), basal ganglia, and cerebellum. In the cognitive phase,
one needs to transpose the observed movement of another person into one’s own to
grasp the basic idea of it. The premotor cortex plays an important role in translating
visual stimuli into a motor response (Toni, Rushworth, & Passingham, 2002). The pre-
motor cortex is also known as one of the loci of the mirror neuron system that fires
both when one acts and when one observes the same action performed by another
(Rizzolatti & Craighero, 2004). The mirror neuron has been suggested to be related
to motor learning through observing and imitating another’s actions (Iacoboni &
Dapretto, 2006). In the associative phase, more detailed and nuanced control of one’s
own movement is required. The cerebellum and basal ganglia contribute to motor con-
trol in different manners that reflect on their evolutionary background (Shmuelof &
Krakauer, 2011). The basal ganglia circuit that is connected with the premotor cortex,
supplementary motor area, and primary motor cortex contributes to selecting move-
ments and ordering movement in temporal sequences (Jueptner & Weiller, 1998). The
cerebellum is also connected to these areas, but the circuit is relevant rather to motor
control based on sensory feedback as well as feedforward (Bastian, 2006). In the au-
tonomous phase, the cerebellum and primary motor cortex seem to play a key role in
consolidating motor skills as procedural memories (Krakauer & Shadmehr, 2006).
In the development of research, the brain (especially the cerebellum) has been pro-
posed to contain internal models that represent motor interactions between one’s body
and the world in a predictive manner (Wolpert, Ghahramani, & Jordan, 1995). Two
major types of internal models have been suggested. One is the ‘forward model’ that
uses the efference copy of motor commands to predict their sensory consequences. The
other is the ‘inverse model’ that provides motor commands to achieve desired outcomes
(Wolpert, Miall, & Kawato, 1998). Internal models are needed to explain fast and pre-
cise control of human movements. If one’s movement need not be carried out at a high
speed or with complexity, sensory feedback would be enough to explain the movement
(e.g., grasping a glass to drink water). For such a movement, even though one fails,
one can correct the movement after receiving sensory feedback (e.g., bumping into a
table when reaching out and then correcting the movement). However, to correspond
to a quickly changing environment by one’s own movements, it is necessary to predict
environmental changes as well as the result of the movements. Consider the case of hit-
ting a moving ball with a racket. The player is not only watching the ball, but also visu-
ally predicting its location in the next moment and transforming the estimated state
into the actual movement of hitting the ball. This is the operation of the inverse model
(see Figure 5.1), which allows the motor control system to transform desired sensory
consequences into motor actions that produce these consequences. In addition to this
process, the player hits the ball with a certain force that is estimated to be sufficient to
 Sciences of motor learning  75

Xref(t) Inverse ũ(t)

Arm
Model Arm motor Command
Arm desired
trajectory

Figure 5.1  Inverse model.

Source: Katie Amenabar, Brian Baum, Theory of Motor Control UMD Spring 2008 (Wikipedia). Reproduced
under a creative commons license CC BY-​SA 3.0.

hit it back. This is the operation of the forward model (see Figure 5.2), which allows the
motor control system to predict the sensory consequence of the motor action.
For our aim to update the dialogue between phenomenology and neuroscience, it is
necessary to reconsider the character of the ‘internal’ model that is considered to be lo-
cated inside the brain. This supposition is totally consistent with that of early twentieth-​
century neurology, which regarded body schema as body representation in the brain.
However, the internal models were originally introduced to explain the features of
human skilful movements that are possible to cope with quickly changing environ-
ment. If so, they are not really ‘internal’ only for the brain to adjust bodily movements
but are actually ‘resonant’ with environmental changes. For example, baseball out-
fielders do not catch a fly ball only by calculating the projectile motion of it from the
observer’s perspective to decide where to catch. They run in a curved path that mirrors
the curved path of the ball. As a result, the bodily movements cancel out the curves and
the ball looks as if it were tracing out a straight line (McBeath, Shaffer, & Kaiser, 1995).
The same strategy seems to function when the dogs navigate to catch Frisbees (Shaffer,
Krauchunas, Eddy, & McBeath, 2004). The internal models not only serve for adjusting
bodily movements, but are also open to the perception of the environment. As was the
body schema, they would be incorporated into the perception–​action loop between
one’s body and the world. We will reframe the concept of internal models later by taking
into consideration the roles of body schema and body image as well as putting the lived
body back in the environment.

Reference Noise x(t)

Motor Command
Input Body
Controller Plant
+ + Position
±

Efference copy
(duplicate of
control signal) +
Forward – Predicted body
Model position

Feedback Signal

Figure 5.2  Forward model.

Source: Katie Amenabar, Brian Baum, Theory of Motor Control UMD Spring 2008 (Wikipedia). Reproduced
under a creative commons license CC BY-​SA 3.0.
76  Body schema and body image in motor learning
5.4  Comparing two cases: Schneider and Waterman

To consider the difference between body schema and body image along with concrete
cases, let us refer to two neuropathological cases. The first is the case of Schneider
on which Merleau-​Ponty (2012) developed his ideas on body schema. The case was
originally reported by Gelb and Goldstein (1920) as visual agnosia (Seelenblindheit),
which derived from damage in the occipital lobe (pp. 128ff). Though his central field
of vision was not disturbed, he was unable to visually recognize letters or simple geo-
metric shapes, and he needed to trace them with his fingers to do so. This symptom
was continuous to his ability to write and draw; he was able to spontaneously write
letters or draw simple figures but was not able to intentionally reproduce visually
presented letters or figures. He could visually recognize three-​dimensional objects,
but this ability was limited to only things with which he was visually familiar in
everyday life.
His symptoms were not limited to only visual agnosia but also extended to tactile
perception and motor capacity (Gelb & Goldstein, 1920, pp. 157ff), as Merleau-​Ponty
(2012) also focused on in his discussion. For example, with his eyes closed, Schneider
was not able to localize the spot on the body parts where he was touched, including
the legs, the arm, and the head. Though he understood verbal instructions given by
a doctor, he was not able to point to his own nose. Neither was he able to consciously
move his arms or fingers when he was asked to do so following verbal instructions
(barely able to move them by paying strong visual attention to the relevant body parts).
In contrast, however, it is very curious that he was able to carry out complex actions
when they were habitual or required for the situation. For example, he was able to blow
his nose after taking a handkerchief out of his pocket. Even with his eyes closed, he was
able to take a match out of a box to light a lamp. As Gelb and Goldstein (1920) also point
out, his motor deficit included certain contrasts:

(1) Abstract movement versus concrete movement: he was not able to perform ab-
stract movements out of context but was able to move his body as a part of con-
crete actions within the context of the lifeworld.
(2) Pointing versus grasping: he could not point to his body parts following verbal
instructions but was able to touch or grasp his body parts as a part of spontan-
eous actions.

From our perspective, it is possible to evaluate that he was able to carry out complex
actions as far as they were habitualized at the autonomous phase of motor skills. What
was crucially disturbed in his ability was to objectify his own body to move it in a con-
scious manner.
To deepen our understanding, it would be helpful to compare this case with that of
IW (Ian Waterman), which was reported by Cole and Paillard (1995). IW is an excep-
tional patient who lost proprioception and sense of touch below the neck as a result of
acute sensory neuropathy. Although he maintained his potential capacity of movement
 Comparing two cases: Schneider and Waterman  77
because his efferent nerves were intact, ‘when he tried to move an arm or his trunk, he
had absolutely no control’ (p. 248). Because he lost proprioception through which one
receives sensory feedback, it was impossible for him to have any motor control. In the
case of IW, it is obvious that his body schema had lost its most basic function. He could
not recognize the spatial locations of his body parts or organize a unified action by co-
ordinating them. During the first three months, it was almost impossible for him to
interact with the environment at will.
Surprisingly, however, mainly through his own efforts during two years of rehabili-
tation, it became possible for him to stand up, walk, eat, and write in a very specific
manner. According to the description by Gallagher and Cole (1995), ‘[t]‌o maintain his
posture and to control his movement IW must not only keep parts of his body in his
visual field, but also conceptualize postures and movements’ (p. 374). In addition to
this basic attitude toward the body, he established his original method of movement as
follows: (1) Once he starts to move, he consciously keeps his balance by utilizing visual
feedback as well as thinking. For example, he consciously fixes his body below the waist
while he moves his hands so as not to lose his balance. He always pays attention to his
centre of gravity; (2) to maintain the same posture, he attends to a stationary object in
the environment as a reference point. It is impossible for him to maintain his posture
in a dark place where he cannot use visual information; (3) before he starts to move,
he assesses the surrounding environment for sufficient space to carry out the move-
ment. He checks carefully through visual perception so as not to bump into anything
around him.
His method suggests that IW consciously objectifies his own body through visual per-
ception and thoughts to realize his movements. His manner of movement is the com-
plete opposite to that of Schneider. As Gallagher and Cole (1995) appropriately point
out, IW realizes his bodily actions based not on body schema, but on body image.
Concerning the basic distinction between them, Gallagher (2005, p. 24) writes:

. . . one can make the distinction in the following way. A body image consists of a
system of perceptions, attitudes, and beliefs pertaining to one’s own body. In contrast,
a body schema is a system of sensory-​motor capacities that function without aware-
ness or the necessity of perceptual monitoring.

Recall the figure-​ground structure between the body and the world. Body schema
can function ‘without awareness or the necessity of perceptual monitoring’, as Gallagher
notes, because it mostly organizes habitual actions in certain situations where the lived
body can efface itself into the background. Contrastingly, body image is the aspect of
one’s own body that appears as a figure in our experiences. Basically, it is a mental image
based on visual perception of one’s own body, but it also contains one’s emotional atti-
tude toward it (e.g., dissatisfaction, vanity, shame) and conceptual understanding of it
(e.g., medical knowledge of one’s symptoms). The point is that body image is a reflexive
system in which one perceives, feels, and thinks of one’s own body as an intentional ob-
ject, different from body schema.
78  Body schema and body image in motor learning
Based on this distinction, we can clearly evaluate that body image did not function
in a proper manner in the case of Schneider, and this could be derived from damage
in his occipital lobe where the visual cortex is located. However, it should be noted
that Merleau-​Ponty (2012) did not distinguish body image from his notion of body
schema. To make matters worse, in the earlier version of the English translation of his
Phenomenology of Perception, the term ‘body schema’ (schéma corporel) was translated
as ‘body image’ (Merleau-​Ponty, 1962). Of course, as I pointed out earlier, it was im-
portant for Merleau-​Ponty to formulate body schema as the general schematic func-
tion of the lived body. So he tended to emphasize the implicit aspect of it, which was
actualized by body schema, not body image. However, clearly distinguishing body
schema and body image at the conceptual level is helpful to explicate empirical issues
concerning embodiment (Gallagher, 2005). Referring to the case of Schneider, we can
know that there are pathological cases in which body image is selectively disturbed (we
take up Merleau-​Ponty’s interpretation of the case below).

5.5  What should be explicated in motor learning

The theoretical distinction between body schema and body image urges us to expli-
cate further the experiences of motor learning. The first issue is the role and nature
of body image in motor learning. In the case of Schneider, because he was not even
able to move his body in an explicit manner, it is obvious that his body was not open
to learning new motor skills. As we saw above, in the initial phase (cognitive phase) of
motor learning, one needs to understand basic procedures by transposing observed
movement into one’s own. In this process, one becomes aware of one’s own body as the
perceptual figure, namely as body image, pulling it out from the implicit ground of con-
scious experience.
Though Merleau-​Ponty (2012) did not thematize body image by distinguishing it
from body schema, he indicated that the ‘intentional arc’ of body schema did not op-
erate well in the case of Schneider. Intentional arc is a term proposed by Merleau-​Ponty,
which is a reversed concept of the ‘reflex arc’ in physiology. In contrast to the direc-
tion of the reflex arc starting from an external stimulus to the spinal cord, he conceives
that body schema projects diverse action possibilities onto the surrounding environ-
ment. As a result, body schema, which is composed of motor skills acquired through
past experiences, allows one to perceive the environment as a potential place for ac-
tion filled with affordances. Explaining the intentional arc, Dreyfus (2014) also states,
‘[i]‌n learning, past experience is projected back into the perceptual world of the learner
and shows up as affordances or solicitations to further action’ (p. 234). According to
Merleau-​Ponty (2012), in Schneider’s case, ‘this is what “goes limp” in the disorder’
(p. 137). In other words, Schneider’s body schema, especially his intentional arc, no
longer projects action possibilities onto the environment but only brings out a habitual
action, which is literally required by the present situation or by the condition of his
own body.
 What should be explicated in motor learning  79
It is the ability of pretence that clearly shows the deficit of his intentional arc. As
Merleau-​Ponty (2012) focuses on, it was extremely difficult for Schneider to pretend
to do ordinary actions, such as combing his hair and hammering a nail. He was able to
do so only when he could take the situation as a real one. In contrast, however, ‘[t]‌he
normal subject and the actor do not take the imaginary situations as real, but inversely
they each detach their real body from its living situation in order to make it breathe,
speak, and, if need be, cry in the imaginary’ (2012, p. 107, italics added). In other words,
in normal cases with the aid of the intentional arc, one can project an imaginary situ-
ation onto a real one toward which the lived body tends to efface itself into the back-
ground. And by doing so, one can detach one’s body from a real situation as body image
to put it into an imaginary situation. Consider the case of a girl pretending to play kit-
chen in a park. She projects the imaginary kitchen onto the surrounding place and fol-
lows the images of potential actions that are afforded by the superimposed imaginary
situation. The intentional arc makes it possible for her to detach her body from the lit-
eral situation as body image in imaginary actions. Reading carefully, Merleau-​Ponty’s
concept of body schema includes a certain aspect of body image within his ideas on
intentional arc.
What I would like to discuss here is that the body image needed in the initial phase
of learning comprises the images of potential actions that stand out from the perceived
situation. Body schema, along with its intentional arc, projects diverse action possibil-
ities to the environment based on one’s motor skills, but what one receives as a result
of projection would involve images of action that one has not experienced or learnt as
a skill. For example, by perceiving how an instructor swims by crawling smoothly, the
learner would imagine what it is like to crawl in the water, even though they cannot ac-
tually do it in the same manner. Even when one perceives inimitable acrobatic acts at a
circus, one slightly imagines what they are like, which causes thrills and tensions within
one’s body. Compared with the body image that IW utilizes for his movements, the
body image required in the initial phase of motor learning is not clearly bounded, but
rather embedded in the perceived situation, and not objectified from the third-​person per-
spective. It is more precise to regard it as ‘motor imagery’ in which a certain movement
is mentally rehearsed from the first-​person perspective (Decety, 1996).
Based on this finding, one can say that the effective manner of utilizing imagery in
motor learning is not to clearly imagine one’s own body in performance internally, as is
often recommended in sports mental training (e.g., Taylor, 2017). It would be better to
put one’s own body in a relevant situation and to grasp the motor imagery that stands
out from the perceived situation. Being detached from a relevant situation, imagination
would only bring motor imagery viewed from the third-​person perspective. Dana and
Gozalzadeh (2017) point out that motor imagery viewed from the first-​person perspec-
tive is more effective for novices in learning a new motor skill. Grasping one’s body
image as motor imagery is key in the cognitive phase of motor learning. This process
would mean to form the inverse model through simulation. As a result of the projec-
tion of action possibilities of body schema, without any actual movement, one receives
motor imagery in the perceived situation. And motor imagery would simulate bodily
80  BODY SCHEMA AND BODY IMAGE IN MOTOR LEARNING
movement as if one’s body is thrown into a real situation. This would contribute to form
the inverse model, which simulates motor processes that would realize desired changes
both in bodily states and in the environment.
The second issue concerns the autonomous phase of motor learning. Although it is
remarkable that IW reconstructed his movements by relying mainly on body image,
his motor learning never reached the autonomous phase. His body never reacted to
a situation in an automatic mode because he had to keep his attention on his body
and conceptualize movements in advance. For example, IW ‘estimates that walking
over a flat, well-​lit surface takes about 50–​70% of his attention, though walking over
an uneven surface still requires 100%’ (Gallagher & Cole, 1995, p. 379). For him,
‘Walking . . . created anew, given constraints which remain under conscious control
and attention, and differs from day to day’ (see Chapter 14, p. 234). In his case, referen-
cing to body image enables him to relearn some patterns of ordinary move­ments, but
the learnt movements must be regulated in an explicit manner. This means that they are
never incorporated into body schema or established as a motor habit.
Then, what is the factor that transforms a newly learnt movement into a motor habit,
that is, a motor skill at the autonomous phase? Regarding this point, Merleau-​Ponty
(2012, p. 144) states:

The body, as has often been said, ‘catches’ and ‘understands’ the movement. The acqui-
sition of the habit is surely the grasping of a signification, but it is specifically the motor
grasping of a motor signification.

In the process of motor learning, there is often a crucial step that divides before and
after. The step is generally known as ‘getting the knack’ of the movement. Merleau-​
Ponty describes it as ‘motor grasping of a motor signification’ because the experience
occurs through the very movement in which all related body parts are integrated into
a certain spatiotemporal pattern to realize an action toward the environment. For ex-
ample, to ride a bicycle without falling down, one needs to coordinate different move-
ments of the head, trunk, hip, legs, and arms into a certain spatiotemporal pattern in
correspondence with the constantly changing condition of the road. And one experi-
ences this movement as an emergence of a new action through which one can cope with
a certain form of situation much more effectively than before. This is how body schema
is renewed through motor learning.
Before getting the knack, one is not able to coordinate the movements of each body
part. In the process of learning ball juggling, for example, if one focuses on throwing
the balls correctly, one easily forgets to catch them with the opposite hand. Conversely,
if one focuses on catching them, the trajectories and dropping points of the balls vary
widely as one fails to throw them stably (Tanaka, 2011a). The emergence of a coord-
inated action is experienced as an occasional correspondence between intention and
action, as if the body is led to move by itself rather than controlled by one’s mind. The
experience of getting the knack of a new movement is often accompanied by an evident
feeling of ‘I can do it’. After going through this change, one gradually becomes able to
 Conclusion  81
let the body cope with the situation in its spontaneity (Tanaka & Ogawara, 2010). This
is what is lacking within IW’s body. To reach the autonomous stage of motor learning,
it is not enough to refer to one’s body image, but it is necessary to incorporate the skill
into the body schema.
In terms of the internal models, this conversion would correspond to sophisticating
the forward model. Through the forward model, one can predict the bodily state after
movement. However, before getting the knack of the movement, the predicted bodily
state never matches with the sensory feedback after executing the movement. IW seems
to be stuck in this wondering phase without being able to receive effective feedbacks; as
Cole (see Chapter 14, p. 234) suggests, ‘his conflict was actually between vision and the
feed-​forward predictive motor programme he was using’. Contrastingly, in the moment
of emergence, one experiences the coincidence of the predicted state and the sensory
feedback for the first time. Establishing a habit means that there is no salient differ-
ence between the predicted state through the forward model and the actual sensory
feedback.

5.6 Conclusion

Thus far, I refined Merleau-​Ponty’s concept of body schema and introduced the concep-
tual distinction between body schema and body image, in line with the idea of Gallagher
(2005). By bringing the distinction into the neuropathological cases of Schneider and
Waterman, we explicated the different roles of body schema and body image in motor
learning. In short, accessing body image is a necessary condition in the initial phase of
motor learning, and renewing body schema by incorporating a new way of movement
is a sufficient condition in the advanced phase of motor learning. However, it should be
noted that the body image that is needed in the initial phase is not the clearly objectified
one from the third-​person perspective, but the first-​person motor imagery that stands
out from the perceived situation.
From a wider perspective, we can add two more points concerning the difference,
though Gallagher (2005) mainly emphasizes the objective character of body image
(Tanaka, 2011b). The first point is spatiality or perspective. As body schema tacitly or-
ganizes bodily movements from within the body toward the environment, it operates
in an egocentric manner. In contrast, as body image is one’s own body that is objectified
through perception or thought, it requires an external perspective through which the
body appears as an object to oneself. It is accompanied by an allocentric spatial cogni-
tion. Paillard (2005) points out this distinction between body schema and body image
by describing them, respectively, as a ‘body-​centric space coordinate system’ and ‘world
or object-​centric space coordinate system’. On the basis of our findings, motor imagery
experienced from the first-​person perspective seems to play a key role in converting
‘world-​centric’ body image into ‘body-​centric’ body schema. In the case of IW, he con-
sciously constructs his movements but totally lacks the function of motor imagery that
bridges his body image with his body schema.
82  BODY SCHEMA AND BODY IMAGE IN MOTOR LEARNING
The second point is the person. As body image is experienced as an image of ‘my’
own body, it always contains the character of the first person, the sense of body own-
ership, and this sense of ownership seems an explicit one rather than an implicit one.
In contrast, body schema mostly functions in an implicit manner or without aware-
ness. It is rather anonymous or pre-​personal and lacks at least an explicit sense of own-
ership, even though it seems to contribute to generate it to a certain degree (see also
Chapter 20). Considering the role of organizing an action toward the environment,
body schema might contribute toward generating a sense of agency rather than a sense
of ownership. When one intends to take a certain action, that intention seems to trigger
the function of body schema on the one hand and seems to involve a pre-​reflective
sense of agency on the other hand. As is often discussed, a sense of ownership and a
sense of agency are two main components of the minimal sense of self (Gallagher, 2000;
2012). In this regard, both body schema and body image contribute to the sense of self,
but they do so in different ways.
Merleau-​Ponty (2012) symbolized his view of the embodied self with the phrase ‘I
can’, in contrast to the Cartesian disembodied self ‘I think’. The ‘I’ is the embodied self
that is constituted of diverse motor (as well as cognitive) skills acquired through past
experiences. As we saw already, in the process of motor learning, what ‘I’ initially simu-
lates and tries at the level of body image becomes incorporated into body schema. And
once body schema is updated by acquiring a new motor skill, body schema allows ‘I’
to perceive the world with new action possibilities, that is, to perceive the world as a
place that enables ‘I’ to act in a different manner than before. The more skills I acquire,
the more expanded ‘I can’ is experienced. Motor learning opens the door to an endless
dialogue between the lived body and the world, and the ‘I’ continues updating itself
through this dialogue without fixing its identity.

Acknowledgements

This work was supported by the Japan Society for the Promotion of Science [KAKENHI
grant nos. 15H03066, 17H00903, 18K10937, and 20H04094].

References
Bastian, A. J. (2006). Learning to predict the future: the cerebellum adapts feedforward movement
control. Current Opinion in Neurobiology, 16, 645–​649.
Cole, J. & Paillard, J. (1995). Living without touch and peripheral information about body position
and movement: studies upon deafferented subjects. In J. L. Bermúdez, A. Marcel, & N. Eilan (eds.),
The Body and the Self (pp. 245–​266). Cambridge, MA: MIT Press.
Dana, A. & Gozalzadeh, E. (2017). Internal and external imagery effects on tennis skills among nov-
ices. Perceptual and Motor Skills, 124, 1022–​1043.
Decety, J. (1996). The neurophysiological basis of motor imagery. Behavioral Brain Research,
77, 45–​52.
 Conclusion  83
Dreyfus, H. (2014). Skillful Coping: Essays on the Phenomenology of Everyday Perception and Action.
Oxford: Oxford University Press.
Fitts, P. M. & Posner, M. I. (1967). Human Performance. Belmont, CA: Brooks/​Cole.
Gallagher, S. (2000). Philosophical conceptions of the self: implications for cognitive science. Trends
in Cognitive Sciences, 4, 14–​21.
Gallagher, S. (2005). How the Body Shapes the Mind. Oxford: Oxford University Press.
Gallagher, S. (2012). Phenomenology. Basingstoke: Palgrave Macmillan.
Gallagher, S. & Cole, J. (1995). Body schema and body image in a deafferented subject. Journal of Mind
and Behavior, 16, 369–​390.
Gelb, A. & Goldstein, K. (1920). Psychologishe Analysen Hirnpathologischer Fälle. Leipzig: Barth.
Gibson, J. J. (1979). The Ecological Approach to Visual Perception. Boston, MA: Houghton Mifflin.
Hardwick, R. M., Rottschy, C., Miall, R. C., & Eickhoff, S. B. (2013). A quantitative meta-​analysis and
review of motor learning in the human brain. Neuroimage, 67, 283–​297.
Head, H. & Holmes, G. (1911). Sensory disturbances from cerebral lesions. Brain, 34, 102–​254.
Heidegger, M. (1962). Being and Time (J. Macquarrie & E. Robinson, Trans.). New York, NY: Harper &
Row. (Original work published 1927).
Husserl, E. (1989). Ideas Pertaining to a Pure Phenomenology and to a Phenomenological Philosophy
(second book) (R. Rojcewicz & A. Schuwer, Trans.). Dordrecht: Kluwer Academic. (Original work
published 1952).
Iacoboni, M. & Dapretto, M. (2006). The mirror neuron system and the consequences of its dysfunc-
tion. Nature Reviews Neuroscience, 7, 942–​951.
Jensen, T. S., Krebs, B., Nielsen, J., & Rasmussen, P. (1983). Phantom limb, phantom pain and stump
pain in amputees during the first 6 months following limb amputation. Pain, 17, 243–​256.
Jueptner, M. & Weiller, C. (1998). A review of differences between basal ganglia and cerebellar control
of movements as revealed by functional imaging studies. Brain, 121, 1437–​1449.
Krakauer, J. W. & Shadmehr, R. (2006). Consolidation of motor memory. Trends in Neurosciences,
29, 58–​64.
Leder, D. (1990). The Absent Body. Chicago, IL: University of Chicago Press.
McBeath, M. K., Shaffer, D. M., & Kaiser, M. K. (1995). How baseball outfielders determine where to
run to catch fly balls. Science, 268, 569–​573.
Merleau-​Ponty, M. (1962). Phenomenology of Perception (C. Smith, Trans.). New York, NY: Routledge.
(Original work published 1945).
Merleau-​ Ponty, M. (2012). Phenomenology of Perception (D. A. Landes, Trans.). New York,
NY: Routledge. (Original work published 1945).
Noë, A. (2004). Action in Perception. Cambridge, MA: MIT Press.
Paillard, J. (2005). Vectorial versus configural encoding of body space: a neural basis for a distinction
between body schema and body image. In V. Knockaert & H. De Preester (eds.), Body Image and
Body Schema: Interdisciplinary Perspectives (pp. 89–​109). Amsterdam: Jon Benjamin.
Ramachandran, V. S. & Blakeslee, S. (1998). Phantoms in the Brain: Probing the Mysteries of the Human
Mind. New York, NY: William Morrow.
Rizzolatti, G. & Craighero, L. (2004). The mirror-​neuron system. Annual Review of Neuroscience, 27,
169–​192.
Schilder, P. (1923). Das Körperschema: Ein Beitrag zur Lehre von Bewusstsein des Eigenen Körpers.
Berlin: Springer.
Schmidt, R. A., Lee, T. D., Carolee, W., Wulf, G., & Zelaznik, H. (2018). Motor Control and Learning
(sixth edition). Champaign, IL: Human Kinetics.
Shaffer, D. M., Krauchunas, S. M., Eddy, M., & McBeath, M. K. (2004). How dogs navigate to catch
Frisbees. Psychological Science, 15, 437–​441.
Shmuelof, L. & Krakauer, W. (2011). Are we ready for a natural history of motor learning? Neuron, 72,
469–​476.
Tanaka, S. (2011a). The notion of embodied knowledge. In P. Stenner, J. Cromby, J. Motzkau, J. Yen, &
Y. Haosheng (eds.), Theoretical Psychology: Global Transformations and Challenges (pp. 149–​157).
Concord: Captus Press.
84  BODY SCHEMA AND BODY IMAGE IN MOTOR LEARNING
Tanaka, S. (2011b). A philosophy of body image. Clinical Neuroscience, 29, 868–​871. (In Japanese).
Tanaka, S. (2013). The notion of embodied knowledge and its range. Encyclopaideia: Journal of
Phenomenology and Education, 37, 47–​66.
Tanaka, S. & Ogawara, K. (2010). Formation of embodied knowledge: an analysis of the learning pro-
cess in ball juggling. Journal of Mind-​Body Science, 19, 69–​82. (In Japanese).
Taylor, J. (2017). Train your Mind for Athletic Success: Mental Preparation to Achieve your Sports Goals.
London: Roman & Littlefield.
Toni, I., Rushworth, M. F., & Passingham, R. E. (2002). Neural correlates of visuomotor associations—​
spatial rules compared with arbitrary rules. Experimental Brain Research, 141, 359–​369.
Wolpert, D. M., Ghahramani, Z., & Flanagan, R. (2001). Perspectives and problems in motor learning.
Trends in Cognitive Science, 5, 487–​494.
Wolpert, D. M., Ghahramani, Z., & Jordan, M. I. (1995). An internal model for sensorimotor integra-
tion. Science, 269, 1880–​1882.
Wolpert, D. M., Miall, R. C., & Kawato, M. (1998). Internal models in the cerebellum. Trends in
Cognitive Sciences, 2, 338–​347.
 6
Reimagining the body image
Shaun Gallagher

6.1  Body image and body schema: some basics

Body schema and body image are cross-​disciplinary concepts that have played a signifi-
cant role in psychology, neurology, philosophy, medical science, psychoanalysis, ath-
letic science, aeronautical psychology, robotics, and so forth.
The original distinction is to be found in the neurologist Sir Henry Head (1920; 1926;
Head & Holmes, 1911/​1912). Many people have argued, however, that the literatures
on these notions involve serious conceptual confusion, and this has sometimes motiv-
ated attempts to clarify these concepts or to abandon them altogether (e.g., Berlucchi &
Aglioti, 2010; Holmes & Spence, 2006).
The conceptual confusion can be seen in the following quotation from Paul Schilder
(1935, p. 11):

The image of the human body means the picture of our own body which we form in
our mind, that is to say the way the body appears to ourselves . . . We call it a schema
of our body or bodily schema, or, following Head . . . postural model of the body. The
body schema is the tri-​dimensional image everybody has about himself. We may call
it body-​image.

The terms ‘schema’ and ‘image’ are used interchangeably in a way that does not follow
Head’s usage, since Head does not call the postural model an image or suggest that we
form it in our mind. Similar confusion can be found in Seymour Fisher (1972, p. 113):

Body image can be considered synonymous with such terms as ‘body concept’ and
‘body scheme’. Broadly speaking, the term pertains to how the individual perceives
his own body. It does not imply that the individual’s concept of his body is represented
by a conscious image . . . Body image . . . represents the manner in which a person has
learned to organize and integrate his body experiences.

In response to the interchangeable usage and descriptions that confused postural

organizations with perceptions of the body, I have defended the following distinction
(Gallagher, 2005; see Gallagher, 1986):

Shaun Gallagher, Reimagining the body image In: Body Schema and Body Image. Edited by: Yochai Ataria, Shogo Tanaka, and
Shaun Gallagher, Oxford University Press. © Oxford University Press 2021. DOI: 10.1093/​oso/​9780198851721.003.0006
86  Reimagining the body image
Body image: a system of (sometimes conscious) perceptions, attitudes and beliefs per-
taining to one’s body.

Body schema: a system of (generally non-​conscious) sensory-​motor processes that

constantly regulate posture and movement and function without reflective awareness
or the necessity of perceptual monitoring.

This conceptual distinction reflects the difference between having a perception of (or
belief about, or emotional attitude toward) one’s body and having a capacity to move or
control one’s bodily movement.
I note three important points about this distinction. First, in most everyday non-​
pathological behaviour, body schema and body image are relatively integrated—​both
phenomenologically and neurologically. Second, although, as I will suggest, these prop-
erly distinguished concepts can facilitate explanation of both pathological and non-​
pathological behaviours, they are not intended to offer a complete explanation of such
behaviours. Third, the distinction cuts across the conscious versus the non-​conscious
distinction. Let me say a bit more about each of these points, starting with the last one.
On the one hand, body image may involve an explicit or conscious perception or
monitoring of one’s body. It may also involve beliefs and affective attitudes about one’s
body, which can either remain non-​conscious or be made conscious, at least in part,
through a reflective process. On the other hand, body-​schematic processes such as pro-
prioception and kinaesthesia, as well as efferent or motor control processes, may re-
main, and may function best, as non-​conscious and, at the same time, may contribute
to pre-​reflective self-​awareness, providing the agent, for example, with a sense (or ex-
perience) of self-​agency for her action (Gallagher & Zahavi, 2012). This tacit or reces-
sive self-​experience is involved in Gibson’s (1979) notion of ecological perception, that
is, the idea that, for example, we are aware of not only the environment through which
we are moving, but also our own moving.
Concerning the second point, theorists have frequently used these concepts in discussions
of body-​related pathologies, such as anorexia, body dysmorphia, or unilateral personal neglect.
To say that some condition is a disorder of the body image, however, may point the diagnosis or
therapy in a particular direction and may suggest that the problem is not primarily one about
body-​schematic motor control, but it does not amount to a full explanation. Nonetheless, such
discussions have pointed to a double dissociation and have operated as empirical evidence for
the distinction itself. For example, certain cases of unilateral personal neglect in which the pa-
tient maintains motor control for both sides of her body, even as she fails to perceive or attend to
the left side of her body (following neurological damage in the right cortical hemisphere), sug-
gest a fully functional body schema combined with a dysfunctional body image (Denny-​Brown
et al., 1952; Ogden, 1996; Pribram, 1999). Thus, a patient may use her left hand to help button
her clothes but fail to dress the left side of her body. If you hand the person a pair of gloves, she
will use her left hand to glove the right hand but then fail to glove her left hand.
The other side of the double dissociation can be found in neuropathic deafferen-
tation. In the case of Ian Waterman (IW), the subject has lost all proprioception and
 Some objections  87
tactile sense below the neck. He has profound difficulties with instrumental and loco-
motive movement—​he has to see his body and exert cognitive effort to control his
movements (Cole, 1995; 2007; Gallagher & Cole, 1995). The suggestion in this regard
is that IW has significant deficit in his body-​schematic processes and has to use an en-
hanced body image in order to move in a controlled fashion (Gallagher & Cole, 1995).
A person with this kind of deafferentation offers a clear contrast to Merleau-​Ponty’s
characterization of normal movement (2012, p. 186):

I have no need of representing to myself external space and my own body in order to
move the one within the other. It is enough that they exist for me and that they consti-
tute a certain field of action held around me.

IW presents a clear exception to this principle.

This double dissociation supports the conceptual distinction between body schema
and body image, but again this does not constitute a full explanation of these phe-
nomena. Thus, going back to the first point, theorists rightly want to investigate how
body schema and body image relate to each other. Pitron and de Vignemont (2017)
suggest three possible models. (1) The fusion model, which assumes a single, long-​
term, multifunctional body representation. The double dissociation, however, sug-
gests that this is not the right way to think about it (also see de Vignemont, 2010;
Gallagher, 1986; Paillard, 1999). (2) The independence model, which assumes that two
functionally distinct systems, one action-​oriented and the other perception-​oriented.
But this would fail to explain how in non-​pathological cases one finds an integrated
functioning. Pitron and de Vignemont (2017) rightly suggest, with some reservations,
that there is a congruency between action and perception rather than an independ-
ence. Furthermore, in some pathological cases, like anorexia, patients’ beliefs about
their body size inform their actions (Gadsby, 2017); in others, like IW, a loss of body-​
schematic function changes the nature of the body image. Accordingly, there is some
consensus for (3) the co-​construction model, which posits a functional distinction, but
a strong interaction.
There is much to be said here about the role of body-​schematic processes in move-
ment and how they relate to philosophical issues about sensory-​motor contingencies,
body–​environment coupling, expert action and affordances, etc. We find these ideas
not only in Merleau-​Ponty, but also in contemporary discussions of ecological and
enactivist versions of embodied cognition (Gallagher, 2017). Some of these issues also
inform how we might respond to several objections that have been raised against the
body image/​body schema (hereafter the BIBS) distinction, and how to think about the
body image.

6.2  Some objections

A first objection can be called the body-​in-​the-​brain objection. The claim is that the
BIBS distinction remains ambiguous (Berlucchi & Aglioti, 2010). Indeed, motivated
88  Reimagining the body image
by the same confusions and ambiguities that motivated the BIBS distinction, Berlucchi
and Aglioti propose that we turn to neuroscience for more precise answers, although
they still use the BIBS distinction to guide their neuroscientific understanding.
Furthermore, it is not clear that a neuroscientific account is more precise or less am-
biguous. For example, Dijkerman and de Haan (2007) identify two partly divided
anatomical and functional neural systems: one responsible for the immediate and auto-
matic guidance of action centred in the posterior parietal cortex, and the other respon-
sible for conscious body perception centred in the insula. But this is not an absolutely
clean neurological independence. Berlucchi and Aglioti admit that processes in the
posterior parietal cortex may also be involved in high-​level visuo-​spatial and semantic
consciousness of the body. Other studies show that the insula is involved in sensory in-
tegration and motor control processes (Farrer & Frith, 2001; Farrer et al., 2003). Similar
to Milner and Goodale’s (1995) two visual pathways, we could say that there is both
distinction and integration.
In any case, one cannot appeal to a brain-​centred neuroscience to provide a full ac-
count of the motor control (or body-​schematic) processes because any full account must
involve both central and peripheral nervous systems, as well as any bodily structures that
allow for dynamical interactions between body and environment. The body schema (or
the underlying processes that explain it) is not fully or simply in the brain. Indeed, social
and cultural dimensions impinge upon the formation and maintenance of both body
image and body-​schematic processes. As Soliman and Glenberg (2014) show, social-​
cultural constraints are not simply top-​down causal factors but permeate the operations
of body-​schematic processes, and already work from the bottom up—​that is, at the most
basic levels of motor control. We should think of BIBS processes not as belonging to ‘the
body in the brain’, but to the body in-​the-​world (Gallagher et al., 2013).
A second objection might be called the neuropsychological objection. The com-
plaint is that many neuropsychological cases are not explained by the BIBS concepts
(Berlucchi & Aglioti, 2010). Holmes and Spence (2006) and de Vignemont (2010) raise
similar worries and suggest focusing on neuropsychological experiments rather than
phenomenological or conceptual distinctions (Holmes & Spence, 2006, p. 15):

As new experimental findings, clinical abnormalities, and perceptual illusions relating

to the body are studied and integrated into the ever-​expanding academic corpus, it
may be necessary to revise the classical concepts of body image and body schema,
in order to provide more parsimonious, functional, or operational accounts of these
phenomena, and try to relate them specifically to our physiological and neuropsycho-
logical understanding of the brain.

For example, de Vignemont (2010, p. 670) lists 41 different disorders involving body
awareness.

One might therefore be tempted to conclude that one single body representation [such
as the body image] cannot suffice to account for such complexity. There needs to be
 Some objections  89
more than one . . . But how many? Two? Three? Four? Although there is a growing
consensus that there are at least two distinct types of body representation, the body
schema and the body image . . . there is still little agreement beyond that . . . Some may
conclude that we would be better off without these notions.

I think there are two responses possible to this objection. First, a point I made above,
the concepts involved in the BIBS distinction were never intended to explain every-
thing. The question should be: Is it a conceptual distinction that does any work—​
together with neuroscience and experimental psychology—​to explain pathologies?
Indeed, Holmes and Spence, like Berlucchi and Aglioti, still rely on the BIBS distinc-
tion, at least as a way to start talking about the neuroscience and neuropsychology. And
de Vignemont provides a number of reasons to maintain the BIBS distinction. Second,
even if we set aside the BIBS distinction as useful in science (although again not even
the critics seem inclined to give it up), one can justify keeping the BIBS distinction if
it remains useful in clinical applications, which it does—​for example, in fields such as
physiotherapy (Øberg, Norman, & Gallagher, 2015) and body psychotherapy (Röhricht
et al., 2014), as well as in clinical studies of eating disorders, obesity, phantom limb, ro-
botics and prosthetics, brain damage, etc. (Gadsby, 2017; Wignall et al., 2017; Natvik
et al., 2019; Razmus, 2017; Razmus et al., 2017; Beckerle et al., 2017).
A third objection is a phenomenological objection. According to Jan Halák (2016),
for example, I draw the BIBS distinction too strictly on a line that separates the body
as an agentive subject (as body schema) from the body as a perceptual object (as body
image). Accordingly, this would be a distinction that Merleau-​Ponty rejects. Moreover,
as Emmanuel de Saint-​Aubert puts it, citing Schilder and Merleau-​Ponty, the distinc-
tion under discussion here misses the ‘extraordinary encroachment’ or irreducible
circularity of perception and movement in the body schema (2013, p. 46). Clearly, if
there is a close connection between perception and movement, as Merleau-​Ponty (and
enactivists) agree, then we should not take body image and body schema to be discon-
nected systems, even if they are distinguishable.
In response, I note, first, that there is still a hierarchical distinction in Halák (2016)
between the practical ‘infrastructure’, associated with the body schema, and the ob-
jectified ‘superstructure’ of the body, corresponding to the body image. Merleau-​Ponty,
Halák (2016, p. 36) contends:

finds that the objectified body must be ‘connected’ to the practical, but also that it
acquires a ‘relative independence’ . . . Between the two dimensions of the body, there
is therefore circular influence and mutual structuration, while the super-​structure
is . . . more resistant to change, and the infrastructure more respondent to it.

But let me also note, second, that as mentioned above (as well as in Gallagher, 2005),
in everyday behaviour, processes associated with body schema and body image are typ-
ically integrated and it is not easy to pull them apart, either phenomenologically or
neurologically. In contrast to a top-​down/​bottom-​up or superstructure/​sub-​structure
90  Reimagining the body image
encroachment, circularity may be the better conception. In truth, that does not seem
too different from the co-​construction model, which posits a functional distinction,
but a strong interaction (Pitron & de Vignemont, 2017), and perhaps it can be seen as a
clarification rather than an objection.
Rather than a horizontal dualism of subject versus object, or a vertical layering of
superstructure versus infrastructure, it may be best to conceive of the strong inter-
action between body schema and body image more along the line of a dynamical gestalt
structure, as Kurt Goldstein conceives of it—​where body image and body schema are
‘always present in a definite figure-​ground relation’.1 Goldstein maps out this gestalt re-
lation in terms of his distinction between abstract (reflectively guided) versus concrete
(pre-​reflective) movement:

Although the normal person’s behaviour is prevailingly concrete, this concreteness

can be considered normal only as long as it is embedded in and codetermined by the
abstract attitude. For instance, in the normal person both attitudes are always present
in a definite figure-​ground relation. (Goldstein & Scheerer, 1964, p. 8; see Gallagher,
2017 for further discussion)

Accordingly, there are relevant qualifications to any characterization of the BIBS

relation. Even if we can establish a clean conceptual distinction between body image
and body schema, things are not always so unambiguous on the behavioural level
(Gallagher, 2005). Indeed, the ambiguity that Berlucchi and Aglioti were so worried
about may not be a conceptual ambiguity, but an ambiguity in the phenomena them-
selves. Body image sometimes has an effect on the postural or motor performances of
body schema, and vice versa. The body image or a perception of one’s own movement
can be complexly interrelated to the accomplishment of one’s own movement. This just
is what Saint-Aubert calls the ‘irreducible circularity’ between perception and move-
ment that phenomenologically inspired enactivists like myself insist on.

6.3  Enhancing the body image

In his critique of my account of the BIBS distinction in How the Body Shapes the
Mind (Gallagher, 2005), Saint-Aubert (2013) has a larger agenda. I appreciate his
agenda. It is clear he wants a more enhanced conception of body image. First, Saint-
Aubert acknowledges my starting point—​the attempt to clarify the broad confusion
about BIBS phenomena in fields such as psychology. Nonetheless, he complains that

1 Jan Halák (in this volume) does appeal to Goldstein’s concept of gestalt. He cites Merleau-​Ponty’s claim that the
body schema is ‘the always implied third term of the figure-​background structure’ of the perceived (2012, p. 103).
Halák (2016) suggests that the body schema ‘always stays in the background of the perceived’ (p. 34), but in the
present volume suggests that although the body schema for the most part stays in the background, it may come to
the fore and may be perceived as the figure, as ‘a deviation from this ground’, which might occur in philosophical
reflection or in pathological experience.
 Enhancing the body image  91
the distinction I introduce oversimplifies and fails to acknowledge the complexity
which is found in Head, Schilder, and Merleau-​Ponty. For Head, there is an inherent
complexity that reflects the animal body and its intentional being in the world; for
Schilder, a complexity where embodiment intersects with social and unconscious
processes; for Merleau-​Ponty, an acknowledgement of the complex and integrated
lines of perception and movement. Let me acknowledge the tension between my
project of clarification and the richness of those analyses—​none of which was to be
found in most of the contemporary authors I was looking at. This is also a tension re-
flected in the difference between Saint-Aubert’s project, which builds on Schilder‘s
psychoanalytic emphasis, and my own. In this respect, Saint-Aubert suggests I give
an impoverished interpretation of Schilder’s work.
I admit that I do. I needed only one thing from Schilder, which I found in the first
paragraph of the Introduction to his 1935 book The Image and Appearance of the Human
Body. It is the passage I quoted at the beginning of this chapter (Schilder, 1935, p. 11).

The image of the human body means the picture of our own body which we form in
our mind, that is to say the way the body appears to ourselves . . . We call it a schema
of our body or bodily schema, or, following Head . . . postural model of the body. The
body schema is the tri-​dimensional image everybody has about himself. We may call
it ‘body-​image’.

This is the conceptual and terminological confusion that many others repeat, some-
times with explicit references to Schilder. According to Saint-Aubert, I cite this passage
too much (and he may be right since I have now cited it twice in this chapter). It is true
that to claim that Schilder takes the body image as a conscious representation is not to
tell the entire story about Schilder’s analysis—​the body image is more than that for him.
Indeed, in other places, I do mention Schilder as someone who provided a psychoana-
lytic dimension to these considerations, and especially as someone who emphasized
(when no one else did) the social/​cultural aspects of body image (e.g., Gallagher, 2005,
p. 30). Thus, for example, I suggested (Gallagher, 2012, p. 102; citing Schilder, 1935):

More than any other theorist, Schilder also highlights the social dimension that per-
meates our bodily movements and body awareness . . . Building on psychoanalytic
theory, Schilder generalizes this idea. ‘I am of the opinion that the desire to be seen, to
be looked at, is as inborn as the desire to see.’

Thus, I acknowledge and agree with Saint-Aubert that Schilder has a richer concept
of body image than is usually noted. Schilder is nonetheless one of the first theorists to
contribute to the terminological and conceptual confusion concerning the status (con-
scious versus non-​conscious, among other things) of the BIBS distinction.
A second complaint by Saint-Aubert concerns how I deal with perception. He claims
I separate perception from motricity and, at the same time, overemphasize issues of
control and voluntariness. I note that, at least on my side, this has to do specifically
92  Reimagining the body image
with body perception (that is, an agent’s perception of her own body) rather than per-
ception in general, or what I would call action-​oriented perception of the environment.
The latter is fully integrated with body-​schematic processes, and I would make no
separation between such action-​oriented perception and motricity. I am generally an
enactivist about perception, in the sense that I understand perception to be typically
linked with action. But my capacity for action does not require a perceptual monitoring
of the acting body.
Saint-Aubert also points to my use of rare pathologies to establish a double dissoci-
ation between body image and body schema (see Section 6.1). His point is that this
does not justify making a general distinction that would necessarily apply to everyday
experience. I accept that Saint-Aubert is correct to point out that in the deafferen-
tation case of IW, the perceptual body image that IW uses to cognitively and visually
control his movement is not equivalent to how the body image functions in the non-​
pathological case, and that we should not generalize in this regard from the case of IW.
Indeed, that is part of the point. Together with Jonathan Cole, I have argued that IW’s
body image is different—​it is enhanced and more precise than typical subjects. And,
of course, the analysis of how IW relies on the body image is not meant to capture our
normal everyday relation with our body—​that is partly why the IW case is so telling.
In this respect, it is difficult not to see it as throwing contrastive light on our non-​
pathological body image. In any case, none of this undermines the double dissociation,
the point of which is meant simply to justify the conceptual distinction between relata,
without which one cannot even begin to think about a figure-​ground or circular rela-
tion. Nor does it undermine some specialized performances that involve body image.

6.4  The body image in expert performances

There are three ways to theoretically enhance the notion of body image. First, pursuing
Saint-Aubert’s project, one could add desire and unconscious aspects—​as he does à la
Schilder, Lacan (2001), or Françoise Dolto (1984). This is a project that I leave to Saint-
Aubert. Second, we could consider how social and cultural aspects inform body image
(in various modalities of perception, imagination, and affect, as well as inform body
schema—​again allowing for a close relation between these phenomena). I think there
are already some interesting studies of body image and body schema from this per-
spective, especially in feminist literature (e.g., Bordo, 1993; Weiss, 2015; Young, 1980),
gender-​related studies (e.g., Cash & Brown, 1989; Kim, Ahn, & Lee, 2016; Murnen,
2011), and studies concerning race (e.g., Capodilupo & Kim, 2014; Fanon, 2008).
And third, we could study exceptional cases, not only in disabilities or pathological
disorders of body image, but also in expert performance in sport, dance, etc. where
the body image may be practically enhanced. Here too, there have been many studies
that explore neuropathologies, and the neuropsychological cases discussed in the
various sources mentioned in Section 6.2 above. I think there have not been so many
studies of expert performance with respect to the question of an enhanced body image
 The body image in expert performances  93
(performance studies tend to focus on regulation or control of posture and movement,
that is, body schema). Accordingly, I will focus the rest of this chapter on this area.
We can see Goldstein’s gestalt figure-​ground relation in a number of different kinds
of specialized performances. Sometimes we are attentive to, or aware of, our bodies
(bringing the abstract or body image to the foreground, especially in learning new
movements); other times we are not. Body image/​body-​schematic relations in perform-
ance are a matter of degree—​a variable balance of figure and ground—​and a matter of
different kinds of awareness across a number of different kinds of performance. In this
respect, a body image is inconstant. Whether and to what degree body awareness or
attentiveness is a feature of performance not only is a matter of individual differences,
and differences in situation, but will also depend on precisely the nature of the aware-
ness or attention.
Barbara Montero (2010; 2015), drawing on her own experience as a professional
ballet dancer, argues that although certain types of bodily awareness may interfere with
well-​developed skills, it is typically not detrimental to the skills of expert athletes or
performing artists. Although Montero allows for the possibility that the performer’s
awareness stays pre-​reflective in the case of dance or musical performance, she also
thinks that optimal performance often coincides with a more explicit body image
involving ‘self-​reflective thinking, planning, predicting, deliberation, attention to or
monitoring of . . . actions . . . ’ (2016, p. 38). Montero points to qualitative studies in
athletics where a more detailed type of conscious monitoring improves performance
(2015, p. 90).
Richard Shusterman (2008), in a similar fashion, identifies two types of explicit body
consciousness that can be involved in performance: pre-​reflective conscious somatic
perception and reflective somatic perception with explicit awareness. The first includes
a visual or proprioceptive sense of one’s body parts and their relations with other body
parts, posture, and objects in the environment. One can also be aware of breathing or
of tensions in one’s body. In the second type of explicit reflective consciousness, ‘we
are not only conscious of what we perceive as an explicit object of awareness but we
are also mindfully conscious of this focused consciousness as we monitor our aware-
ness . . . ’ (p. 55). That is, we are self-​consciously aware of our own perceptual moni-
toring of our body.
The more subtle pre-​reflective self-​awareness that does not take the body as an ex-
plicit intentional object has been called a ‘performative awareness’, providing a sense
that one is moving or doing something, ‘not in terms that are explicitly about body
parts, but in terms closer to the goal of the action’ (Gallagher, 2005, p. 73). For example,
Dorothée Legrand (2007) characterizes this notion of performative awareness in ex-
pert dancers. According to Legrand, a dancer can intensively attend to her body while
dancing, without attending to it reflectively, taking it as an object. Rather, her aware-
ness of her body-​as-​subject is a heightened pre-​reflective awareness. Expertise can put
this performative character of pre-​reflective awareness ‘at the front’ of one’s experience
without turning experience or action into a mere intentional object (Legrand & Ravn,
2009; see Toner, Montero, & Moran, 2016). Likewise for the cricket or baseball player
94  Reimagining the body image
at bat who ‘can feel [proprioceptively/​kinaesthetically] when her motor system has the
right configuration’ (Christensen et al., 2013, p. 59). In such cases, body image is en-
hanced, even if not entirely foregrounded, by various specialized forms of awareness.
It is important to note that this kind of body awareness varies by degree and style
across different performance contexts, as well as between beginner and expert. Thus,
for example, studies of theatrical acting, musical performance, dance, and athletics
show a range of experiences that combine body awareness with heedful conscious-
ness of the environment, guided by task or goal, with different foci on physical and/​or
social details (Gallagher, 2018; 2021; Gallagher & Gallagher, 2019; Salice et al., 2019).
Attention may be fully on environmental conditions with minimal awareness of one’s
body; it may be a case of selective target control (Christensen et al., 2013), a sense of
a rightly configured body (Montero, 2016), a pre-​reflective performative awareness
(Legrand, 2007), or a heightened awareness of the body–​environment relation in a
form of deep absorption (Høffding, 2019). Through all of these variations, the role
of the body image varies from negligible to the focus of attention. One example of
the latter is found in a member of a string quartet, who, while engaged in an expert
musical performance, wonders whether his facial expression is well perceived by the
audience (Høffding, 2019).
Let us consider a particular athletic practice that seemingly involves a substantial
role for the body image, namely, bodybuilding. István Aranyosi (2018, p. 403) suggests
bodybuilding emphasizes posing, such that the body is judged purely on aesthetic ap-
pearance of the body. In this respect, he maintains that it is not properly a performance
sport that builds motoric or mental skill. ‘What is ultimately evaluated in the competi-
tion is not an activity or skillful excellence; you are judged not by what you do and how
well you do it, but by what you are or have to show.’ Aranyosi equates body-​as-​subject
(Leib) with the body schema and body-​as-​object (Körper) with the body image, and
argues that ‘bodybuilding is the least embodied of currently recognized sports’ (2018,
p. 408). The bodybuilder is all Körper and no Leib—​‘bodybuilding is truly an activity
directed to the body image rather than to the body schema or anything related to the
lived-​body’ (p. 408n13).
At the extreme, an obsessive preoccupation with bodybuilding can lead to muscle
dysmorphia, a body image-​related psychological disorder (Aranyosi, 2018, p. 408n13):

Obsessive preoccupation with muscle mass is a pathology connected to the world of

bodybuilding, leading to self-​injury and psychosis . . . and it is in many ways a kind of
reverse anorexia nervosa . . .

Aranyosi cites Legrand (2010, p. 194): ‘anorexics seek the preservation of their body-​
as-​subject by destroying their body-​as-​object.’ This reverses, he suggests, when the ob-
ject of pathological obsessive attention is the Körper.
Although it is not clear that we should equate the body image with Körper—​
since there may be a significant difference between the way the body is perceived or
 Conclusion  95
experienced (body image) and the way it actually is (the objective body or Körper)—​
Aranyosi does suggest a useful scale of extremes where body image is foregrounded.
Specifically, we can think of different forms of body image enhancement:

• Expert performance (e.g., dance): subtle variations in body image, integrating

with ongoing body-​schematic processes.
• The case of deafferentation (e.g., IW): an enhanced body image to compensate
for loss of body schema—​for IW, everyday movement is itself a kind of expert
performance.
• Bodybuilding: an enhanced body image for aesthetic purposes.
• Body dysmorphic disorder (BDD), as in muscle dysmorphia: obsessive concern
with the properties of one’s body, perhaps reflecting deeper social/​psychoanalytic
issues (cf. Schilder and Saint-Aubert).

These differences, and the variations discussed above, reflect different balances
in Goldstein’s gestalt, that is, in the figure-​ground relation where in some cases the
body takes centre stage (as the body image) and in other cases the body recedes
to the background. In this gestalt, I suggest there is also a complex relation be-
tween body image, dynamical and highly specific body-​schematic processes, and
other factors, including environmental and performance-​specific factors. The vari-
ations are not just in phenomenology but go deeper to include embodied, affective,
extended/​ecological, intersubjective, and normative factors—​integrated in what
Christensen, Sutton, & McIlwain (2016) have called a ‘meshed architecture’ (see
Gallagher, 2021).

6.5 Conclusion

I have considered a variety of criticisms and approaches in which the usefulness

of the BIBS distinction is still apparent. One can build on this distinction in several
theoretical and practical directions, for example, by sorting out the neuroscience, by
investigating various pathologies, by exploring deeper psychoanalytic aspects, and by
analysing different forms of embodied performance. Each of these projects is com-
plex ones. One does not properly sort out the neuroscience by taking a reductionist
approach that would simply identify body image and body schema with specific neural
circuits; reference must be made to the peripheral nervous system, the body as a whole,
and the complex dynamical relations between brain–​body–​environment. Likewise,
psychoanalytic approaches need to be supplemented by social and cultural analyses, as
Schilder himself acknowledged and as we can find in recent work in feminist, race, and
gender studies. Finally, I have argued that it is important to investigate body image and
body-​schematic processes not just in disabilities or pathological disorders, but also in
cases of expert performance.
96  Reimagining the body image
Acknowledgements

I thank my co-​editors, and an anonymous reviewer for some helpful comments on an

earlier draft of this paper. An earlier version of this paper was presented as a keynote
lecture at the International Symposium: Body Schema and Body Image, the University
of Tokyo, Japan (24 March 2018). My research on this paper was supported by a
grant from the Australian Research Council’s Minds in skilled performance project
(DP170102987).

References
Aranyosi, I. (2018). Body, skill, and look: is bodybuilding a sport? Phenomenology and the Cognitive
Sciences, 17(2), 401–​410.
Beckerle, P., Christ, O., Schürmann, T., Vogt, J., von Stryk, O., & Rinderknecht, S. (2017). A human–​
machine-​centered design method for (powered) lower limb prosthetics. Robotics and Autonomous
Systems, 95, 1–​12.
Berlucchi, G. & Aglioti, S. (2010). The body in the brain revisited. Experimental Brain Research,
200, 25–​35.
Bordo, S. (1993). Unbearable Weight: Feminism, Western Culture, and the Body. Berkeley,
CA: University of California Press.
Capodilupo, C. M. & Kim, S. (2014). Gender and race matter: the importance of considering intersec-
tions in Black women’s body image. Journal of Counseling Psychology, 61(1), 37.
Cash, T. F. & Brown, T. A. (1989). Gender and body images: stereotypes and realities. Sex Roles, 21(5-​
6), 361–​373.
Christensen, W., Sutton, J., & McIlwain, D. J. (2016). Cognition in skilled action: meshed control and
the varieties of skill experience. Mind & Language, 31(1), 37–​66.
Christensen, W., Sutton, J., & McIlwain, D. J. (2013). Cognitive control in skilled action. Online
draft. https://​waynechristensen.wordpress.com/​ 2013/​08/​15/​cognitive-​control-​in-​skilled-​action/​.
pp. 1–​72.
Cole, J. (1995). Pride and a Daily Marathon. Cambridge, MA: MIT Press.
Cole, J. (2007). The phenomenology of agency and intention in the face of paralysis and insentience.
Phenomenology and the Cognitive Sciences, 6(3), 309–​325.
de Vignemont, F. (2010). Body schema and body image—​pros and cons. Neuropsychologia, 48(3),
669–​680.
Denny-​Brown, D., Meyer, J. S., & Horenstein, S. (1952). The significance of perceptual rivalry re-
sulting from parietal lesion. Brain, 75, 433–​471.
Dijkerman, H. C. & de Haan, E. H. (2007). Somatosensory processes subserving perception and ac-
tion. Behavioral and Brain Science, 2, 189–​201; discussion 201–​239.
Dolto, F. (1984). L’image Inconsciente du Corps. Paris: Seuil.
Fanon, F. (2008). Black Skin, White Masks. (R. Philcox, Trans.). New York, NY: Grove Press.
Farrer, C., Franck, N., Georgieff, N., Frith, C. D., Decety, J., & Jeannerod, M. (2003). Modulating the
experience of agency: a positron emission tomography study. NeuroImage, 18, 324–​333
Farrer, C. & Frith, C. D. (2001). Experiencing oneself vs. another person as being the cause of an ac-
tion: the neural correlates of the experience of agency. NeuroImage, 15, 596–​603.
Fisher, S. (1972). Body image. In D. Sills (ed.), International Encyclopedia of the Social Sciences (Vol. 2).
New York, NY: Collier-​Macmillan; reprinted in T. Polhemus (ed.), The Body Reader: Social Aspects
of the Human Body (pp. 115–​121). New York, NY: Pantheon Books, 1978.
Gadsby, S. (2017). Distorted body representations in anorexia nervosa. Consciousness and Cognition,
51, 17–​33.
Gallagher, S. (1986). Body image and body schema: a conceptual clarification. Journal of Mind and
Behavior, 7(4), 541–​554.
 Conclusion  97
Gallagher, S. (2005). How the Body Shapes the Mind. Oxford: Clarendon Press.
Gallagher, S. (2012). The body in social context: some qualifications on the ‘warmth and intimacy’ of
bodily self-​consciousness. Grazer Philosophische Studien, 84, 91–​121
Gallagher, S. (2017). Enactivist Interventions. Oxford: Oxford University Press.
Gallagher, S. (2018). Mindfulness and mindlessness in performance. Italian Journal of Cognitive
Sciences, 5(1), 5–​18.
Gallagher, S. (2021). Performance/​Art. Milan: Mimesis International Edizioni.
Gallagher, S. & Cole, J. (1995). Body schema and body image in a deafferented subject. Journal of Mind
and Behavior, 16(4), 369–​390.
Gallagher, S. & Gallagher, J. (2019). Acting oneself as another: an actor’s empathy for her character.
Topoi, 39, 779–​790.
Gallagher, S., Hutto, D., Slaby, J., & Cole, J. (2013). The brain as part of an enactive system. Behavioral
and Brain Sciences, 36(4), 421–​422.
Gallagher, S. & Zahavi, D. (2012). The Phenomenological Mind. London: Routledge.
Gibson, J. J. (1979). The Ecological Approach to Visual Perception. Boston, MA: Houghton-​Mifflin.
Goldstein, K. & Scheerer, M. (1964). Abstract and Concrete Behavior. An Experimental Study with
Special Tests. Evanston, IL: Northwestern University Press. Reprint of Psychological Monographs,
53(2), 1941.
Halák, J. (2016). Merleau-​Ponty on embodied subjectivity from the perspective of subject-​object cir-
cularity. Acta Universtitatis Carolinae Kinanthropologica, 52(2), 26–​40.
Head, H. (1920). Studies in Neurology (Vol. 2). Oxford: Oxford University Press.
Head, H. (1926). Aphasia and Kindred Disorders of Speech (Vol. 1). Cambridge: Cambridge
University Press.
Head, H. & Holmes, G. (1911–​1912). Sensory disturbances from cerebral lesions. Brain, 34, 102–​254.
Høffding, S. (2019). A Phenomenology of Musical Absorption. Berlin: Springer.
Holmes, N. P. & Spence, C. (2006). Beyond the body schema: visual, prosthetic, and technological
contributions to bodily perception and awareness. In G. Knoblich, I. M. Thornton, M. Grosjean, &
M. Shiffrar (eds.), Human Body Perception from the Inside Out (pp. 15–​64). New York, NY: Oxford
University Press.
Kim, H., Ahn, J., & Lee, D. (2016). Thin female characters in children’s television commercials: a con-
tent analysis of gender stereotype. American Communication Journal, 18(2), 27–​44.
Lacan, J. (2001). Ecrits: A Selection. London: Routledge.
Legrand, D. (2007). Pre-​reflective self-​consciousness: on being bodily in the world. Janus Head, 9,
493–​519.
Legrand, D. (2010). Myself with no body? Body, bodily-​consciousness, and self-​consciousness. In S.
Gallagher & D. Schmicking (eds.), Handbook of Phenomenology and Cognitive Science (pp. 181–​
200). Dordrecht: Springer.
Legrand, D. & Ravn, S. (2009). Perceiving subjectivity in bodily movement: the case of dancers.
Phenomenology and the Cognitive Sciences, 8(3), 389–​408.
Merleau-​Ponty, M. (2012). Phenomenology of Perception. London: Routledge.
Milner, A. D. & Goodale, M. A. (1995). The Visual Brain in Action. Oxford: Oxford University Press.
Montero, B. (2010). Does bodily awareness interfere with highly skilled movement? Inquiry, 53(2),
105–​122.
Montero, B. G. (2015). Thinking in the zone: the expert mind in action. The Southern Journal of
Philosophy, 53(S1), 126–​140.
Montero, B. G. (2016). Thought in Action: Expertise and the Conscious Mind. Oxford: Oxford
University Press.
Murnen, S. K. (2011). Gender and body images. In T. F. Cash & L. Smolak (eds.), Body Image: A
Handbook of Science, Practice, and Prevention (pp. 173–​179). New York, NY: Guilford Press.
Natvik, E., Groven, K. S., Råheim, M., Gjengedal, E., & Gallagher, S. (2019). Space perception, move-
ment and insight: attuning to the space of everyday life after major weight loss. Physiotherapy
Theory and Practice, 35(2), 101–​108. doi.org/​10.1080/​09593985.2018.1441934
Øberg, G. K, Norman, B., & Gallagher, S. (2015). Embodied clinical reasoning in neurological phys-
ical therapy. Physical Therapy: Theory and Practice, 31(4), 244–​252.
98  Reimagining the body image
Ogden, J. A. (1996). Fractured Minds: A Case-​ Study Approach to Clinical Neuropsychology.
Oxford: Oxford University Press.
Paillard, J. (1999). Body schema and body image: a double dissociation in deafferented patients. In
G. N. Gantchev, S. Mori, & J. Massion (eds.), Motor Control, Today and Tomorrow (pp. 197–​214).
Sofia: Academic Publishing House.
Pitron, V. & de Vignemont, F. (2017). Beyond differences between the body schema and the body
image: insights from body hallucinations. Consciousness and Cognition, 53, 115–​121.
Pribram, K. H. (1999). Brain and the composition of conscious experience. Journal of Consciousness
Studies, 6(5), 19–​42.
Razmus, M. (2017). Body representation in patients after vascular brain injuries. Cognitive Processing,
18(4), 359–​373.
Razmus, M., Daniluk, B., & Markiewicz, P. (2017). Phantom limb phenomenon as an example of body
image distortion. Current Problems of Psychiatry, 18(2), 153–​159.
Röhricht, F., Gallagher, S., Geuter, U., & Hutto, D. D. (2014). Embodied cognition and body psycho-
therapy: the construction of new therapeutic environments. Sensoria: A Journal of Mind, Brain &
Culture, 10, 11–​20.
Saint-​Aubert, E. de (2013). Etre et Chair: Du Corps au Désir: L’habilitation Ontologique de la Chair.
Paris: Vrin.
Salice, A., Høffding, S., & Gallagher, S. (2019). Putting plural self-​awareness into practice: the phe-
nomenology of expert musicianship. Topoi, 38(1), 197–​209.
Schilder, P. (1923). Das Körperschema. Berlin, Springer.
Schilder, P. (1935). The Image and Appearance of the Human Body. London: Kegan, Paul, Trench,
Trubner and Co.; New York, NY: International University Press, (1950).
Shusterman, R. (2008). Body Consciousness: A Philosophy of Mindfulness and Somaesthetics.
Cambridge: Cambridge University Press.
Soliman, T. M. & Glenberg, A. M. (2014). The embodiment of culture. In: L. Shapiro (ed.), The
Routledge Handbook of Embodied Cognition (pp. 207–​220). London: Routledge.
Toner, J., Montero, B. G., & Moran, A. (2016). Reflective and prereflective bodily awareness in skilled
action. Psychology of Consciousness: Theory, Research, and Practice, 3(4), 303–​315.
Weiss, G. (2015). The normal, the natural, and the normative: a Merleau-​Pontian legacy to feminist
theory, critical race theory, and disability studies. Continental Philosophy Review, 48, 77–​93.
Wignall, S. J., Thomas, N. A., & Nicholls, M. E. (2017). Fat or fiction? Effects of body size, eating path-
ology, and sex upon the body schema of an undergraduate population. Body Image, 23, 135–​145.
Young, I. M. (1980). Throwing like a girl: a phenomenology of feminine body comportment motility
and spatiality. Human Studies, 3(1), 137–​156.
 7
The body in the German neurology of
the early twentieth century
Andreas Kalckert

7.1  The body image or the body schema?

In recent years, there has been an increasing interest in the experience of the body—​
not only in fields like philosophy and cognitive science, which saw almost a paradigm
shift in the notion of ‘embodiment’, but also more recently in fields like neuroscience
and psychology. One reason for this increase in interest is the emergence of new ex-
perimental tools, which allowed manipulating the experience of the own body. A well-​
known paradigm here is the so-​called rubber hand illusion (RHI), in which participants
experience a fake model hand as part of their own body (Botvinick & Cohen, 1998).
These kinds of experiments allowed to manipulate the experience of the body in a con-
trolled way and allowed more systematic investigations of the underlying cognitive and
also neural underpinnings of the experience of the own body. These processes allow to
experience the body as uniquely mine and differentiate the own body from the external
world (Ehrsson, 2012; Tsakiris, 2010).
These experimental manipulations raise also more theoretical questions of the na-
ture of the bodily experience. A recurring debate in this field is the distinction between
the body image and the body schema (de Vignemont, 2010; Gallagher, 1986; 2005).
Gallagher defined the body image as a ‘system of perceptions, attitudes, and beliefs per-
taining one’s own body’, whereas the body schema ‘involves certain motor capabilities,
abilities, and habits that both enable and constrain movement and the maintenance of
posture’ (2005, p. 24). When overlooking the literature on the RHI and similar bodily
illusions, we often see different interpretations. Some authors suggest that the RHI af-
fects the body schema, whereas others the body image. In which way the RHI affects
either both or one of these is an ongoing debate.
The terms body image and body schema underwent substantial appropriation and
re-​interpretations throughout the past decades. Whether these two concepts are actu-
ally sufficient to capture all aspects of the bodily experience is also far from settled (for
more extensive discussions, see Corradi-​Dell’Acqua & Rumiati, 2007; de Vignemont,
2010; Gallagher, 2005). The term body image is often associated with Paul Schilder
(1886–​1940), the famous Austrian neurologist and psychoanalyst, and his book The
Image and Appearance of the Human Body (1935). But opinions differ here as well; for

Andreas Kalckert, The body in the German neurology of the early twentieth century In: Body Schema and Body Image.
Edited by: Yochai Ataria, Shogo Tanaka, and Shaun Gallagher, Oxford University Press. © Oxford University Press 2021.
DOI: 10.1093/​oso/​9780198851721.003.0007
100  body in the German neurology
example, Paillard referred the term body schema to Schilder’s 1935 work (and not body
image) and the term body image to Lhermitte (1999). de Vignemont (2010) in her dis-
cussion of these terms did not even mention Schilder and refers to Bonnier’s work from
1905 as the origin for the schema term. Despite many attempts to clear the ground
(from several authors included in the present book), it is still not unanimously accepted
what these terms signify and how they are affected in certain neurological or psychi-
atric disorders, or in experimental manipulations such as the RHI.
As already noted by Gallagher, and many others before and after him, the terms
body image and body scheme have been unclear from the very beginning. Gallagher
(1986) noted briefly that Schilder used these terms interchangeably. In the following,
I would like to zoom into the use of these terms by Schilder and his contemporaries in
the German-​speaking neurology during the early twentieth century. As we will see, it is
not only Schilder who used these terms in an unclear manner, but there was a battle for
the meaning of this term among German and Austrian neurologists at that time. Many
concepts have been developed, debated, and refuted, sometimes passionately. Further,
it seems worthwhile looking at the understanding of the body experience from a neuro-
logical standpoint before Schilder and to identify from where Schilder himself got his
ideas. Surprising is the name of one important influence in all these discussions, the
name of Carl Wernicke. Schilder directly credited Wernicke for bringing up this ques-
tion of the experience of the own body.
It is interesting to note that the German-​speaking neurology of the early twen-
tieth century was very interested in the experience of the own body and its underlying
psychological and neural mechanisms. Many of these discussions gravitated around
Vienna, which, in many ways, was a hotbed for the development of neurology and
psychology at that time (Jellinger, 2006). Figures like Gabriel Anton, Arnold Pick, Josef
Gerstmann, and the aforementioned Paul Schilder, to name a few, either worked in
Vienna at some point and/​or were influenced by figures from Vienna. These names are
often mentioned when we refer to some of the original patient reports exemplifying a
specific disorder of the body. Many of these concepts are debated up to this day, like, for
example, the Gerstmann syndrome (Pearce, 1996).
However, Gerstmann and Schilder published in English in their later years. Both of
Jewish decent, they sought refuge in the United States (USA) in the wake of the Second
World War, like many of their Jewish colleagues (Loewenau, 2016; Zeidman, Ziller, &
Shevell, 2015). The work by these two authors is more known in today’s research and
debated extensively. However, many other contributions may have been overlooked
and are often not available at all or only partially available in the English literature.
These works may be helpful to understand these original concepts and the way they are
framed around that time.
In the following, I would like to have a closer look at Carl Wernicke first and illus-
trate some of his ideas on the perceptual processes underlying the experience of the
body. Then I will briefly highlight a few other studies which reported observations on
neurological patients exhibiting disturbances of the body experience. Thereafter I will
take a closer look on Paul Schilder’s use of the terms body image and body schema,
 Carl Wernicke and the body  101
respectively, in his works in the period from 1923 to 1935. I may not attempt to resolve
the discussion around these terms but illustrate how Schilder and others within the
German-​speaking neurology used and operated with these terms.

7.2  Carl Wernicke and the body

Carl Wernicke was born in 1848 in Tarnowitz in lower Silesia, today Poland. He studied
medicine at the University of Wroclaw, graduated in 1870, and started his position
there as an assistant in 1871. In his early years, Wernicke worked and learnt from fig-
ures like Theodor Meynert (in Vienna) and Carl Westphal (in Berlin). Finally, in 1885,
he returned to Wroclaw as a professor for psychiatry and nervous diseases. Wernicke
died after a bicycle accident in June 1905 (Pillmann, 2003).
It is during this time in Wroclaw when he wrote his most famous work The Aphasia
Symptom Complex (Wernicke, 1874) and for which we know Wernicke today. Wernicke,
a conceptual brainchild of Theodor Meynert, delivered here a prime example of the
localizationalist approach in neurology. Meynert, a grand figure of the Vienna med-
ical school, advocated a scientifically based psychiatry, informed by brain science
(Seitelberger, 1997). Wernick’s concept of a disconnection syndrome of brain areas
was an immensely elegant framework during his time (Graves, 1997). His Text Book
in Brain Diseases –​for Doctors and Students was released in three parts and became
a standard reference book (Wernicke, 1881a, b; 1883). In his later years, he published
another work An Outline of Psychiatry in Clinical Lectures in 1900 (Wernicke, 1906).
A commented English translation has been published recently (Wernicke, 2015). In the
following, I like to draw attention to this piece of work and his ideas on the experience
of the body, one often overlooked aspect in his work.
According to Wernicke, awareness (or consciousness) can be categorized into three
different domains: the autopsyche, i.e., the awareness of the self; the allopsyche, i.e., the
awareness of the world; and finally the somatopsyche, i.e., the awareness of the own
body. He separates here auto-​and somatopsyche, distinguishing between the aware-
ness of one’s own psychological dimensions (e.g., thoughts, emotions, memories)
and the awareness of one’s own corporeality (i.e., the experience of the body itself).
Wernicke attempted to explain how these different areas of awareness are generated
by specific neurological and psychological processes. He further proposed that dys-
functions within these domains of awareness manifest in psychological disorders (see
Wernicke, 1906, Chapter 11).
Wernicke devoted several chapters of his book to the experience of the own body. In
the fifth chapter, he starts with a specific dimension in the experience of the body. After
a lesion of the plexus brachialis, the patient could not recognize the arm as his or her
property. This observation, therefore, suggests that the integrity of the nervous system
is required to experience the corporeality of our body. More generally, he concluded
that the experience of the body is not different from any other perceptual experience of
the outside world. Identical to any perceptual act, the sensory input from the body has
102  body in the German neurology
to be transmitted to the brain, to be more precise to the ‘cortical areas experimentally
revealed by Munk’ (Wernicke, 1906, p. 38).
Munk lesioned the cortex of monkeys and dogs (Munk, 1881). His work has to be
understood in the context of Jean Pierre Flourens (1794–​1867), the famous French
physiologist famous for his ablations in pigeons, and David Ferrier (1843–​1928),
who carried out lesion experiments on several animals like monkeys. Munk located
individual cortical regions for the corresponding senses; for example, he concluded
that vision is located in the occipital lobe, and not in the parietal lobe, as suggested
by Ferrier. Munk also lesioned other frontal areas and, by inflicting more localized
lesions, he could identify cortical regions for the somatosensation of the head, the
hind, and the front legs. In a rather harsh way, Munk dismisses Ferrier’s work as
‘worthless, arbitrary inventions’ (Munk, 1881, p. 37). He credits Fritsch and Hitzig
here and their pioneering work on cortical stimulations (Fritsch & Hitzig, 1870;
Gross, 2007). Generally, he concluded that these regions represent ‘the sphere of
awareness for the corresponding body part’ (Munk, 1881, p. 50). These regions bundle
all the incoming sensory input from the skin, the muscles, and the feeling of in-
nervation. It is not just the touch sensation from the superficial skin which is pro-
cessed there. Hence, the awareness of the body is a product of cortical functions,
receiving sensory information transmitted from bodily receptors and pathways.
Only by these processes we reach the awareness of our corporeality. Wernicke could
not agree more.
Wernicke’s basic idea was that all sensory input is patterned and stored in form of
memory images (‘Erinnerungsbilder’). The sum of these images from all our sensory
organs constitutes the awareness of our corporeality (Wernicke, 1900, p. 45). The sim-
ultaneous and repetitive occurrence of these specific patterns leads to an association of
the perceptual cells’ activation (i.e., neurons; the neuron doctrine is only a few years old
around this time [Glickstein, 2006]). Wernicke stated that the association of perceptual
cells must be particularly strong when it comes to the body. The spatial relationship be-
tween the different body parts never changes and appears always in the same constella-
tion. This cannot be said from the external world. Consequently, the association of the
bodily input must be ultimately tighter than any input of the external world. Wernicke
emphasized that it is not only the input from the skin, but also the other senses like
hearing, smell, and even taste that need to be included. Further, the sensations from
the muscles and the joints, and the ‘bigger intestines’, contribute to the awareness of the
body (Wernicke, 1900, p. 44).
According to Wernicke, movements are an interesting case, as movements always
involve the whole body, and therefore appear in a more complex constellation. He re-
ferred here to Duchenne’s work (Duchenne, 1885), which he translated into German,
showing that even simple movements like finger movements affect the body as a
whole, evoking reactions of remote muscles to stabilize the posture. In the following
sixth chapter, Wernicke explored the role of movements in more detail. Movements
‘are tightly linked to the awareness of our corporality’ but ‘are extremely complicated’
(Wernicke, 1900, p. 48). First, he discussed the role of reflexive movements, which he
 Carl Wernicke and the body  103
defined as coordinated movements to ‘protect from stimuli or the removal of the re-
spective body part from the area of the stimuli’ (Wernicke, 1900, p. 51).
Wernicke derived a formula to describe the experience of movements (see Figure
7.1). He identified three factors. First, the position of the joints or ‘g’ (Gelenke = joints).
He specifically included the joints here, unlike Munk who thought that the informa-
tion from the joints is not that important. Second, the sensations from the skin or ‘h’
(Haut = skin), which stretches on the outside of the joint and compresses on the inside.
Third, the muscles or ‘m’ (Muskel = muscle), which are stretched and compressed as
well. ‘g’ and ‘h’ are in a constant relationship to each other. This formula g : h : m gives
the position sense ‘l’ (Lageempfindung = position sense). When triggered by a reflex,
‘l’ will give rise to a specific sense of movement ‘b’ (Bewegungsempfindung = sense of
movement).
All of this must be mirrored in the specific activity of perceptual cells ‘z’ (Zelle = cell).
‘m’ must be related to the activity of ‘z’, resulting in a sensation of innervation or ‘I’
(Innervationsgefuehl), so I = z:m. The sense of movement ‘b’ contains both these aspects,
the position sense ‘l’ (g : h : m) and sensation of innervation ‘i’ (= z:m). Both the position
sense and sensation of innervation have a constant relationship to each other; thus, the
sense of movement ‘b’ is derived by i: l. If there is a constant ‘b’, a repeated movement,
which happens always in the same way, then it can form a movement representation ‘B’.
Thus, we see here that Wernicke attempted to build a very clear mechanistic description
of the experience of movements.
Wernicke published this work successively from 1894 until 1900. A third edition was
posthumously published in 1906 (with a foreword by Hugo Liepmann, one of his stu-
dents). This third edition is the basis of the recent English translation. At the time of his
death, Wernicke was a highly respected figure in neurology, and his works were highly
influential, particularly in the German-​speaking neurology (Barker, 1905; Schröder,

g = Joints
Position sense l=g:h:m h = Skin
m = Muscles

Sensation of innervation i=m:z z = Cellular activity

Sense of movement b=i:l

Figure 7.1  A formula-​like description of the processes underlying the position sense,
sensation of innervation, and sense of movement. Abbreviations are derived from the
corresponding German word. Notations follow as closely as possible to Wernicke’s original
notation (see Wernicke, 1900).
104  body in the German neurology
1939). With his systematic approach to psychopathology, paired with his neurology
knowledge, in many ways echoing Meynert, Wernicke created a highly original work.
Among the many subjects he explored is the experience of the body itself, and that it
can or should be understood in neurological terms. In the following years, more and
more patient cases were reported, which displayed specific disturbances of the own
body experience. These were often discussed with reference to Wernicke’s concept, for
example, by the young Otfrid Foerster, who was working with Wernicke in Breslau and
was strongly influenced by Wernicke (Gaupp, 1943).
Foerster presents here a psychiatric case with various symptoms suggestive of de-
personalization. This affected, in particular, the experience of the patient’s body. The
patient described her episodes like the following: ‘I do not feel myself anymore. I do not
feel my body, not my head, not my limbs, my head is empty’. Foerster interpreted the
symptoms as an ‘afunction of the somatopsyche’ and diagnosed a psychosis within the
sphere of the somatopsyche, a somatopsychosis (Foerster, 1903). Another interesting
patient report comes from Hatschek, which surprised others with her ‘confidence to
recognise the hand of the doctor as her own’ (Hatschek, 1905, p. 256). She had lost all her
‘muscle sense’ and was not able anymore to identify the position of her limbs. Hatschek
assumed that this patient must have had a damage to the parietal lobe (Hatschek, 1905).
Arnold Pick’s famous cases on autotopagnosia were unable to point to body parts and
did not understand the spatial relationship of body parts (Pick, 1908; 1922). Zingerle,
who worked with Gabriel Anton in Graz (Austria), presented three patients, two with
a stroke and one probably with meningitis, showing various body-​related symptoms
(Zingerle, 1913). His first patient ‘lost her understanding of the location, extension, and
togetherness of her body parts’ (p. 14). He interpreted this as a vestibular dysfunction,
which results in ‘spatial disorientation of the body awareness, but in more severe cases
lead to a disintegration of body awareness’ (p. 16). His second patient has been a fre-
quent anecdote as he was ‘talking of someone lying next to him in bed, a woman, and he
pointed at his left side, and made teasing jokes of erotic nature’ (p. 22). The third patient
showed ‘repeatedly complete ignorance’ to his left arm (p. 33). These three examples
exemplify the variety of observations on neurological or psychiatric patients exhibiting
disorders of the body experience. Crucially, the body experience, or awareness of cor-
poreality, became a subject on its own.

7.3  New concepts: Paul Schilder and Josef Gerstmann

In 1919, two new assistants joined the Vienna psychiatric clinics, directed by the future
Nobel laureate Julius Wagner-​Jauregg (1857–​1940): Paul Schilder (1886–​1940) and
Josef Gerstmann (1887–​1969) (see Figure 7.2). Gerstmann, born in Lviv (Ukraine),
studied medicine in Vienna. After the First World War, he worked in Vienna first at the
psychiatric clinics. He then led the smaller Maria-​Theresien-​Schlössel Hospital for ner-
vous and mental diseases. Gerstmann immigrated to the USA in 1938, when Germany
invaded Austria and he lost his position. He became an increasingly involved figure in
 New concepts: Paul Schilder and Josef Gerstmann  105

Figure 7.2  Upper left: Josef Gerstmann. Upper right: Paul Schilder. Lower centre: a picture
of the Vienna psychiatric clinics around 1925. Wagner-​Jauregg is in the centre (black suit),
with Josef Gerstmann and Paul Schilder sitting to his left, side by side.
Sources: Top left and right: from the Collections of the Medical University of Vienna. Bottom: U.S. National
Library of Medicine Digital Collections, all public domain.

the USA as well. He died in 1969 (Triarhou, 2008; Zeidman et al., 2015). Paul Schilder,
born in Vienna, studied medicine here as well and joined the psychiatric clinics only a
few months after Gerstmann. In 1928, Schilder became a guest lecturer at the University
of Baltimore, where he will lecture in the following years. He settled over to the USA in
1932 and became director of the Bellevue Hospital in New York (USA). Schilder died in
1940 in a tragic car accident.
Both Gerstmann and Schilder were new upcoming neurologists, with a reputable
scientific record on a range of different neurological and psychiatric problems. Both
106  body in the German neurology
published seminal papers on the neurology of the body during their time in Vienna,
but also on a range of other topics. In 1923, Schilder published his monograph Das
Körperschema (The Body Schema—​A Contribution to the Understanding of the
Consciousness of the Own Body [Schilder, 1923]), followed by a variety of reports on
different dimensions of the self-​experience, including the experience of the body. In
1935, he published his seminal book The Image and Appearance of the Human Body in
English. It consists of three parts. In the first part, Schilder discussed the neurological
observations on the body. In the second part, he examined the libidinous aspects of
the body schema, so he approached the experience of the body in a psychoanalytical
way. In the third part, he explored the social dimension of the body image. Gerstmann
published his first observations of finger agnosia in 1924, followed by another study
in 1927 on this subject. In the following years, Gerstmann continued to develop his
concept of what we will call the Gerstmann syndrome. This concept was highly contro-
versial in the next decades (Benton, 1961), and Gerstmann spent a lot of his time to de-
fend it (Gerstman, 1958). Only recently, this has been reconciled in some way (Rusconi
et al., 2009).
When we aim to understand Schilder’s use of the body schema–​body image ter-
minology, it seems worthwhile to examine both of these books and other instances
in which he provided a definition of these terms. Whereas his early work in 1923 is
called The Body Schema, his 1935 book carries the other term in the title The Image
and Appearance of the Human Body. The latter is widely known in the English litera-
ture and cited many times. His 1923 work is less referred to, as it is only available in
German (to the best of my knowledge). Most of his work in between was written in
German and may therefore not be accessible to many readers. Thus, it is worthwhile
to have a look at this early work of Schilder and evaluate how he operated with these
terms during this time.
In 1923, Schilder defined the body schema as the ‘spatial image that one has from
yourself ’ (‘das Raumbild, das jeder von sich selber hat’; Schilder, 1923, p. 2) and that
we ‘can assume that the schema entails the individual parts of the body, and their mu-
tual spatial relationship’ (Schilder, 1923, p. 2). So he specifically focused on the spatial
relationship, the spatial extent of the body. He did so with explicit reference to Head
and Holmes and their highly influential study from 1911 (Head & Holmes, 1911).
According to Schilder, observations of allochiria, phantom limbs, apraxia, and Pick’s
autotopagnosia are direct evidence for a spatial distortion of the body schema. He
speculated that these observations may suggest the existence of several schemata from
different developmental stages. For example, the shrinking of phantom limbs could be
interpreted as a replacement of the adult schema with an earlier schema, in which the
body was smaller. It should be noted that, in some parts of this book, Schilder also
uses the term body image (‘Körperbild’) a few times, when he discussed autotopagnosia
and apraxia. In the last pages, and only shortly, Schilder posed the question of how
libidinous forces may affect the image of the body. He suspected that these have a crit-
ical role in the construction of the body schema. Schilder also hinted briefly at some
Gestalt-​psychological processes to be involved in the body schema (see pp. 86–​87).
 New concepts: Paul Schilder and Josef Gerstmann  107
In a study from 1927, Schilder and his colleague Hartmann described several ob-
servations from introspective experiments, in which participants described how they
experience the own body, for example its weight when laying down (Hartmann &
Schilder, 1927). Here, they define the body schema in the following way: ‘We mean the
body schema when we talk about the image of the own body, which is alive within us. It
includes optical, kinaesthetic, and tactile elements, but it is not the sum of those, these
achieve their true meaning only by their relationship to this body schema’ (Hartmann
& Schilder, 1927, p. 666). An interesting aspect within this definition is the idea of the
sum of the perceptual input not being sufficient to describe the result of this perceptual
process. The body schema or image is not just a sum of perceptual input. It seems as if
here the Gestalt-​psychological aspect is more prominent in the definition by Schilder
(and Hartmann).
In 1930, while in New York, Schilder wrote an article on alcohol-​induced delirium
and the body schema (Schilder, 1930). He highlighted here the role of the vestibular
sense in the construction of the body schema. Moreover, he defined the body schema
here as ‘knowledge of the own body’. Particularly, visual and kinaesthetic impressions are
used to construct it and ‘an occipito-​parietal apparatus enables these’ differentiations
within the body schema. Schilder further suggests that ‘the body image is held together
by affective components, self-​love: narcissism’ (Schilder, 1930, pp. 785–​786). Only by
including this dimension, we can understand somatopsychoses, so disturbances of the
somatopsyche, a Wernicke terminology. Schilder explicitly stated here that the body
schema is actually constructed out of libidinous processes.
In 1935, Schilder published his book The Image and Appearance of the Human Body.
He starts with a definition, which, in some way, we already heard in 1923. Though here,
it is the body image which is a ‘picture of our own body which we form in our mind’
(Schilder, 1935, p. 11), a definition which sounds suspiciously similar to his 1923 body
schema definition, except for the word spatial. In the first part of his book, Schilder
more or less reiterated some of his previous thoughts from his 1923 book on allochiria,
phantom limbs, and apraxia and extended these with more recent observations. But, for
example, whereas he discussed these observations in 1923 under the header of the body
schema, these questions are now summarized under the header of the body image. The
second and third parts of the book discussed questions which had not been fully ad-
dressed in 1923 yet. For example, he hinted at his interest in the libidinous structure
already in 1923 and began to formulate it more directly in 1927 and 1930. But only now
Schilder finally detailed out the psychoanalytical and social dimension of the body. His
use of the terms body image and body schema remained difficult still, which is apparent
from the very first page of his introduction. After introducing the idea of the body
image, he proposed that the unity of bodily experience forms the body schema, which
is a ‘tri-​dimensional image’ we may call also ‘body image’ (Schilder, 1935, p. 11). He
alternated between body schema, body image, and postural model, almost randomly.
Particularly, the latter term appears here relatively more often.
When overlooking these examples from different timepoints of Schilder’s work, it
is apparent that every time he put a certain emphasis on a specific aspect. Whereas the
108  body in the German neurology
initial body schema was focused on the spatial relationship, in 1927, it became some-
thing more than the actual sum of the perceptual input, so a Gestalt. In 1930, it is held
together by libidinous forces. Later, in 1935, our most common reference for the body
image term, we see actually that Schilder is using three different terms and explicitly
included the psychoanalytical and social dimension of the body schema or image. The
body became more than a spatial image.

7.3.1 An argument between Klaus Conrad and Paul Schilder

A remarkable paper comes from Klaus Conrad (1905–​1961), which provides an inter-
esting insight and overview of the discussions during those early years. During his time
in Vienna, Conrad worked as an assistant to Otto Pötzl (1877–​1962), who succeeded
Wagner-​Jauregg in 1928 (Ploog, 1961). So he must have been directly exposed to these
questions. In his short period in Paris, Conrad published a paper The body schema: a
critical study and an attempt of a revision (Das Körperschema: eine kritische Studie und
der Versuch einer Revision), a very direct and blunt critique of the body schema concept
(1933). Conrad remarked that the use of this term caused more confusion than clarifi-
cation, something for which authors like Schilder must be blamed. He summarized all
the different definitions of the body schema by his colleagues and, ultimately, argued
that it may be better to abandon this concept for good.
For example, he criticized previous work by Hoff and Pötzl, which postulated ‘that
the body schema is bound to the self by the intraparietal and thalamic apparatus’
(1931) as ‘obvious nonsense’ (Conrad, 1933, p. 353). He provided further examples
of what the body schema supposedly is; for example, Schilder defined it as ‘imagin-
ation (“Vorstellung”) of the body’, Gerstmann as the ‘inner view (“innere Anschauung”)
of our bodily territories’, whereas Engerth and Klein simply defined it as ‘knowledge
(“Wissen”) of the body’. Others had more far-​fetching definitions like Zodor, who de-
fined it as the ‘sum of all repeatedly, and in a specific manner constructed, schematic,
sensory movements’. Another definition comes from Adler-​Hoff who defined it as ‘a
mechanism to collect and process peripheral sensory impressions and, by suppression
of deep rotational mechanisms, build the unity of the body’ (Conrad, 1933, p. 351).
Admittedly, these examples make it indeed hard to come to a coherent understanding
of this term. Conrad has a point here.
Conrad pointed out several inconsistencies in Schilder’s use specifically—​is the body
schema a direct percept, an image, or a memory? Is it about the objective and physical
body itself, or the way it is subjectively perceived? Is it the direct percept or imagin-
ation of it, or apparent in some other forms? Conrad highlighted one particular issue
within Schilder’s framework—​that it is based on both associative (i.e., basic association
of individual percepts) and Gestalt-​psychological processes (i.e., the body schema is
more than the sum of those individual percepts). On the one hand, the body schema is
the sum of visual, tactile, and kinaesthetic input, and on the other hand, it is also more
than the sum, as a sort of body-​Gestalt. Conrad, a Gestalt-​psychologist himself, seemed
 New concepts: Paul Schilder and Josef Gerstmann  109
dissatisfied with the way Schilder used the Gestalt term and identified it as ‘the root of
all evil’ (p. 366) in this debate. He remarked that, according to his concept of the Gestalt,
the awareness of the whole body cannot be constructed out of individual smaller per-
cepts or schemata. The whole point of the Gestalt is that it is evidently more than its
individual parts. Thus, although Schilder’s and Gerstmann’s definitions may work from
an associative standpoint, in the way Wernicke conceptualized it, they cannot explain
the emergence of a bodily whole.
A further interesting point Conrad made is Schilder’s use of the word ‘schema’.
Although Schilder himself saw his concept with direct reference to Head and
Holmes (1911) (see also Schilder, 1923), Conrad pointed out that Schilder is mis-
using Head’s term. Schilder may have used this term in the sense of Pick’s concept.
But, according to Conrad, Schilder also did not comply with Pick’s schema termin-
ology. Pick, in his first report of autotopagnosia in 1908, emphasized the role of the
‘visual images’ or ‘visual impressions’ (‘optischen Vorstellungsbilder’) in his examin-
ation of a patient showing signs of disorientation of the body. Only later, for example
in his 1922 study, Pick used the term schema, now with reference to Head (see Pick,
1922, p. 311). In Pick’s understanding, there are multiple body schemata. The visual
images form just one schema (but the most important one in Pick’s concept), which
will be complemented by other schemata from other domains, such as the kinaes-
thetic ones. Head seemed to rather exclude the visual ones or demotes them to have
less relevance overall (see Head & Holmes, 1911, pp. 186–​187). In the end, Conrad
concluded that Schilder’s schema fits neither Head nor Pick and is in itself unclear.
Schilder immediately responded to Conrad in January 1934 (Schilder, 1934a). Of
course, he defended the term body schema and his concept. Schilder emphasized
that, in his previous work, he equally discussed the possibility to understand the body
schema from a Gestalt-​psychological perspective, but that was simply not sufficient to
explain all the observations. He highlighted the fact that his concept not only was asso-
ciative psychology but also aimed to include more dimensions. In turn, Schilder argued
against Conrad’s idea, which defined the body schema as something solely based on
consciousness and discarded its neurological basis. Schilder defended here Wernicke’s
concept as the original starting point of this question. Thus, one cannot conclude that
the body schema as a concept is only valid within Gestalt-​psychological terms. He
also defended Hoff and Pötzl’s conclusions on the thalamo-​parietal basis of the body
schema (Hoff & Pötzl, 1931).
Schilder also argued for his use of the word ‘Raumbild’ (spatial image). According
to his definition, it encompasses both perception and imagination. This is insofar in-
teresting as his later definition did not use this term ‘Raumbild’ any longer, and he
only talked about ‘images’. Throughout this text, Schilder alternated between the term
body image and body schema. Finally, he concluded that the problems around this
terminology are not solved yet. He ended his discussion in a diplomatic way to the
sharp attacks of Conrad. He also mentioned here that he was reviewing the literature
for a book written in English, with which he hinted at the 1935 book. This makes this
110  body in the German neurology
interaction between Schilder and Conrad very interesting, as it represents Schilder’s ar-
guments (and critique) during the writing process of his influential book.

7.3.2  A closer look on Schilder

When looking at the way Schilder operated with the terms body schema/​body image,
we see that Schilder underwent a gradual evolution. He started with a more neuro-
logical account (in 1923). Here, the body schema was a spatial schema, more related
to Head’s and Wernicke’s ideas of the neurological basis of the own body, at least from
Schilder’s point of view. The spatial aspect (i.e., ‘Raumbild’) had not been formulated
explicitly in the other works and was not mentioned in this specific way in 1935. From
the beginning, Schilder already had some suspicion that this predominantly neuro-
logical account may not be enough to explain the experience of the body as a whole.
But in 1923, there were only a few sentences hinting at other processes like libido pos-
sibly involved in the construction of the body schema, and merely vague speculations.
Consequently, in the following years, he elaborated more and more on the Gestalt-​
psychological and psychoanalytical facets of the body schema (see his 1927 and 1930
definitions). Thus, depending on which reference we take, if we look at Schilder from
1923 or 1935, we may rely on a different focus in Schilder’s arguments.
Nevertheless, in my view, we have to agree with Conrad up to a certain degree. We
can blame Schilder for some of the confusion in the 1920/​1930s and maybe also today.
He used the terms of the body schema and body image in a non-​systematic way, and
sometimes added the term postural model. The latter term has no equivalent wording
in his 1923 book, in fact, or in any other of his German publications. In his German
writings, he used the term postural model only when he referred to Head directly, but in
his English definition she seemed to equate the postural model with the body schema/​
image more directly. For example, Schilder wrote that ‘the image we have of our body,
or, as it is also called the body schema or postural model of the body, is partially based
on sensations and partially on representations and thoughts’ (Schilder, 1934b). It is
these kinds of definitions which Conrad targeted and which leave room for different
interpretations.
At the same time, we shall be aware of our own perspective—​it may be very well
the case that Schilder had no profound theoretical distinction between the two terms.
There is no single place within Schilder’s work in which he differentiates or contrasts
both these concepts directly. Only today researchers have this (more or less) sharp and
theoretically heavy distinction. There is a tendency in the present-​day literature to refer
to Schilder when talking about the body image and these ‘other’ aspects like the psycho-
analytical or sociological dimensions. Thus, Schilder has become primarily associated
with the term of the body image. He is rarely discussed when it comes to observations
such as apraxia or other movement aspects related to the body schema. Paillard (1999),
on the other hand, with his more neuropsychological approach, may refer here to those
aspects of Schilder’s arguments which were dealing with specific movement-​related
 Conclusion  111
aspects of the body experience, and their neurological underpinnings. Thus, we need to
see Schilder’s work, an admittedly multifaceted work, without our preconceptions that
the body schema and the body image are distinct functional and theoretical entities.
In my view, Schilder attempted to join the physiological basis of the body with the
concepts of Gestalt-​psychology and psychoanalysis. Wernicke’s elegant and, during
this time, powerful explanatory framework of the aphasias was a prime example of
how to combine psychology and neuroanatomy. It fulfilled Meynert’s agenda of a sci-
entifically driven psychology and psychiatry. And in many ways, Schilder followed that
principal agenda and believed that there are specific neurological processes underlying
the bodily experience. He was still a neurologist who knew that these psychological
functions must be related to specific brain areas. But at the same time, Schilder was a
proponent of psychoanalysis. He was convinced that psychoanalysis is a scientifically
valid and productive approach to understand these processes. This dual approach of
neurology and psychoanalysis may appear incompatible. Schilder’s engagement in this
emerging field of psychoanalysis has also been viewed with criticism by some of his
fellow colleagues. But for Schilder, they did not necessarily contradict each other, ra-
ther complement each other.
Schilder aspired to understand the psychological dimension of the body, not only
the neurological or physiological dimension. ‘First, it is a psychological problem how
the body image is constructed’ (Schilder, 1930, p. 785). Similarly, he stated that ‘the
conception of the somato-​psyche is a psychological conception’ (Schilder, 1934b,
p. 327). Consequently, these concepts have to be framed in psychological terms and
cannot be fully captured by purely neurological terms. However, it was Schilder’s
belief that the psychoanalytical toolset may provide the necessary terms to fully
describe the experience of the body. Crucially though, the ‘psychological and physio-
logical approach must lead to the same conclusions’ (Schilder, 1934b, p. 327). And in
many ways, this aim to combine the psychological and the physiological is as actual
as ever.

7.4 Conclusion

In this chapter, I examined the body schema/​body image terminology of Paul Schilder
and his contemporaries in the German-​speaking neurology of the early twentieth cen-
tury. It is evident that these terms have had their difficulties from the very beginning.
I would like to summarize what has been said before with the following conclusions.
First, the German-​speaking neurology and psychiatry around the nineteenth to twen-
tieth centuries had an extraordinary interest in the processes underlying the experience
of the body. We find very detailed ideas about these processes already in Wernicke’s
work and see them resonate in many authors later on. Second, the body schema has
been defined by various authors in very different ways. Thus, there is no single def-
inition, but a plethora of definitions. Third, one of the most prominent definitions by
Paul Schilder lacks consistency. Schilder used different terms like body schema, body
112  body in the German neurology
image, and postural model to a certain degree equivalently. It is, therefore, a challenge
to pinpoint sometimes what body schema is and what body image is within his work.
We should be mindful that these concepts were derived and detailed out only later, and
might not have had this theoretical gravity as it has today. Further work is needed to
compare Schilder’s concept to the work of Wernicke in more detail, but also to the work
of Arnold Pick and Josef Gerstmann. This can help us to understand how Schilder de-
rived and evolved his terminology.
And finally, as a last conclusion, fortunately or unfortunately, these discussions re-
semble strikingly the discussions we have today. We face unclear definitions, different
interpretations, now and a hundred years ago. Likewise, we have voices echoing Conrad
calling to abandon these terms, and voices who seek to help the confusion. Instead of
abandoning, it seems worthwhile to re-​examine what exactly we mean by these terms
or what we think others mean.

References
Barker, L. F. (1905). The work of Carl Wernicke (editorial). Journal of Comparative Neurology and
Psychology, 25, 525–​527. https://​doi.org/​https://​doi.org/​10.1002/​cne.920150607
Benton, A. L. (1961). The fiction of the ‘Gerstmann syndrome’. Journal of Neurology, Neurosurgery &
Psychiatry, 24(2), 176–​181. https://​doi.org/​10.1136/​jnnp.24.2.176
Botvinick, M. & Cohen, J. (1998). Rubber hands ‘feel’ touch that eyes see. Nature, 391, 756. https://​doi.
org/​10.1038/​35784
Conrad, K. (1933). Das Körperschema. Eine kritische Studie und der Versuch einer Revision.
Zeitschrift Fuer Die Gesamte Neurologie Und Psychiatrie, 147, 346–​369.
Corradi-​Dell’Acqua, C. & Rumiati, R. I. (2007). What the brain knows about the body: evidence for
dissociable representations. In F. Santoianni & C. Sabatano (eds.), Brain Development in Learning
Environments: Embodied Cognition and Perceptual Learning. (pp. 50–​64). Newcastle: Cambridge
Scholars Publishing.
de Vignemont, F. (2010). Body schema and body image—​pros and cons. Neuropsychologia, 48(3),
669–​680. https://​doi.org/​10.1016/​j.neuropsychologia.2009.09.022
Duchenne, G. B. (1885). Physiologie der Bewegungen nach elektrischen Versuchen und klinischen
Beobachtungen mit Anwendungen auf das Studium der Lähmungen und Entstellungen. Cassel und
Berlin: Verlag von Theodor Fischer.
Ehrsson, H. (2012). The concept of body ownership and its relation to multisensory integration.
In B. E. Stein (ed.), The New Handbook of Multisensory Processes (pp. 775–​792). Cambridge,
MA: MIT Press.
Foerster, O. (1903). Ein Fall von elementarer allgemeiner Somatopsychose. (Afunktion der
Somatopsyche.) European Neurology, 14(3), 189–​205. https://​doi.org/​10.1159/​000219334
Fritsch, G. & Hitzig, E. (1870). Über die elektrische Erregbarkeit cles Grosshirns. Archiv Für Anatomie,
Physiologie Und Wissenschaftliche Medicin, 37, 300–​332.
Gallagher, S. (1986). Body image and body schema: a conceptual clarification. Journal of Mind and
Behavior, 7(4), 541–​554. https://​doi.org/​10.1075/​aicr.62
Gallagher, S. (2005). How the Body Shapes the Mind. Oxford: Clarendon Press.
Gaupp, R. (1943). Otfrid Foerster—​Sein Lebenswerk im Rahmen der Wissenschaft seiner Zeit.
Zeitschrift Für Die Gesamte Neurologie Und Psychiatrie, 176(1), 485–​521. https://​doi.org/​10.1007/​
BF02967337
Gerstmann, J. (1958). Psychological and phenomenological aspects of disorders of the body
image. Journal of Nervous and Mental Disease, 126(6), 499–​512. https://​doi.org/​10.1097/​
00005053-​195806000-​00001
 Conclusion  113
Glickstein, M. (2006). Golgi and Cajal: the neuron doctrine and the 100th anniversary of the 1906
Nobel Prize. Current Biology, 16(5), R147–​R151. https://​doi.org/​10.1016/​j.cub.2006.02.053
Graves, R. E. (1997). The legacy of the Wernicke-​Lichtheim model. Journal of the History of the
Neurosciences, 6(1), 3–​20. https://​doi.org/​10.1080/​09647049709525682
Gross, C. G. (2007). The discovery of motor cortex and its background. Journal of the History of the
Neurosciences, 16(3), 320–​331. https://​doi.org/​10.1080/​09647040600630160
Hartmann, H. & Schilder, P. (1927). Körperinneres und Körperschema. Zeitschrift Fuer Die Gesamte
Neurologie Und Psychiatrie, 109(1), 666–​675. https://​doi.org/​10.1007/​BF02870259
Hatschek, R. (1905). Eine klinische Beobachtung von cerebral bedingter dissoziierter Störung der
tiefen Sensibilität. Jahrbuecher Fuer Neurologie Und Psychiatrie, 26, 253–​269.
Head, B. Y. H. & Holmes, G. (1911). Sensory disturbances from cerebral lesions. Brain, 34, 102–​254.
Hoff, H. & Pötzl, O. (1931). Experimentelle Nachbildung von Anosognosie. Zeitschrift Für Die
Gesamte Neurologie Und Psychiatrie, 137(1), 722–​734. https://​doi.org/​10.1007/​BF02864165
Jellinger, K. A. (2006). A short history of neurosciences in Austria. Journal of Neural Transmission,
113(3), 271–​282. https://​doi.org/​10.1007/​s00702-​005-​0400-​7
Loewenau, A. (2016). Between resentment and aid—​German and Austrian psychiatrist and neurolo-
gist refugees in Great Britain since 1933. Journal of the History of the Neurosciences, 25(3), 348–​362.
https://​doi.org/​10.1080/​0964704X.2016.1161407
Miller, R. & Dennison, J. (2015). Lecture 5. In R. Miller & J. Dennison (eds.), An Outline of Psychiatry
in Clinical Lectures: The Lectures of Carl Wernicke (pp. 25–​30). Cham: Springer. https://​doi.org/​
https://​doi.org/​10.1007/​978-​3-​319-​18051-​9_​5
Munk, H. (1881). Ueber die Functionen der Grosshirnrinde. Berlin: Verlag von August Hirschwald.
Paillard, J. (1999). Body schema and body image. A double dissociation in deafferented patients. In
G. N. Gantchev, S. Mori, & J. Massion (eds.), Motor Control, Today and Tomorrow (pp. 197–​214).
Sofia: Academic Publishing House.
Pearce, J. M. S. (1996). Gerstmanns syndrome. J Neurol Neurosurg Psychiatr, 61, 56.
Pick, A. (1908). Arbeiten aus der deutschen psychiatrischen Universitätsklinik in Prag. Berlin: Verlag
von S. Karger.
Pick, A. (1922). Störung der Orientierung am eigenen Körper—​Beitrag zur Lehre vom Bewußtsein des
eigenen Körpers. Psychologische Forschung, 1(1), 303–​318. https://​doi.org/​10.1007/​BF00410392
Pillmann, F. (2003). Carl Wernicke (1848–​1905). Journal of Neurology, 250(11), 1390–​1391. https://​
doi.org/​10.1007/​s00415-​003-​0250-​x
Ploog, D. W. (1961). Klaus Conrad (1905–​1961). History of Psychiatry, 13, 339–​360.
Rusconi, E., Pinel, P., Eger, E., LeBihan, D., Thirion, B., Dehaene, S., & Kleinschmidt, A. (2009). A
disconnection account of Gerstmann syndrome: functional neuroanatomy evidence. Annals of
Neurology, 66(5), 654–​662. https://​doi.org/​10.1002/​ana.21776
Schilder, P. (1923). Das Körperschema: Ein Beitrag zur Lehre vom Bewusstsein des eigenen Körpers.
Berlin: Springer Berlin Heidelberg.
Schilder, P. (1930). Vestibulo-​Optik und Körperschema in der Alkoholhalluzinose. Zeitschrift Für Die
Gesamte Neurologie Und Psychiatrie, 128(5), 784–​791. https://​doi.org/​10.1007/​BF02870499
Schilder, P. (1934a). Erwiderung zu der Arbeit von Klaus Conrad: Das Körperschema, eine kritische
Studie und der Versuch einer Revision. Zeitschrift Für Die Gesamte Neurologie Und Psychiatrie,
149(1), 583–​589. https://​doi.org/​10.1007/​bf02870531
Schilder, P. (1934b). The somato-​psyche in psychiatry and social psychology. Journal of Abnormal and
Social Psychology, 29(3), 314–​327. https://​doi.org/​10.1037/​h0075479
Schilder, P. (1935). The Image and Appearance of the Human Body. Oxford: Kegan Paul.
Schröder, P. (1939). Die Lehren Wernickes in ihrer Bedeutung für die heutige Psychiatrie. Zeitschrift
Für Die Gesamte Neurologie Und Psychiatrie, 165(1), 38–​47. https://​doi.org/​10.1007/​BF02871468
Seitelberger, F. (1997). Theodor Meynert (1833–​1892), pioneer and visionary of brain research. Journal
of the History of the Neurosciences, 6(3), 264–​274. https://​doi.org/​10.1080/​09647049709525713
Triarhou, L. C. (2008). Josef Gerstmann (1887–​1969). Journal of Neurology, 255(4), 614–​615.
Tsakiris, M. (2010). My body in the brain: a neurocognitive model of body-​ ownership.
Neuropsychologia, 48(3), 703–​712. https://​doi.org/​10.1016/​j.neuropsychologia.2009.09.034
Wernicke, C. (1874). Aphasische Syndromkomplexe. Breslau: Max Cohn & Weigert.
114  body in the German neurology
Wernicke, C. (1881a). Lehrbuch der Gehirnkrankheiten für Ärzte und Studirende Band 1. Kassel: Verlag
von Theodor Fischer.
Wernicke, C. (1881b). Lehrbuch der Gehirnkrankheiten für Ärzte und Studirende Band 2. Kassel and
Berlin: Verlag von Theodor Fischer.
Wernicke, C. (1883). Lehrbuch der Gehirnkrankheiten für Ärzte und Studirende Band 3. Berlin: Verlag
von Theodor Fischer.
Wernicke, C. (1906). Grundriss der Psychiatrie in klinischen Vorlesungen. Leipzig: Verlag von Georg
Thieme.
Zeidman, L. A., Ziller, M. G., & Shevell, M. (2015). ‘With a smile through tears’: the uprooted career of
the man behind gerstmann syndrome. Journal of the History of the Neurosciences, 24(2), 148–​172.
https://​doi.org/​10.1080/​0964704X.2014.950089
Zingerle, H. (1913). Ueber Störungen der Wahrnehmung des eigenen Körpers bei organischen
Gehirnerkrankungen. (Part 2 of 2). European Neurology, 34(1), 25–​36. https://​doi.org/​10.1159/​
000316535
 PART II
BR A IN , B ODY, A ND SE LF
 8
Plasticity and tool use in the body schema
Daniele Romano and Angelo Maravita

8.1  Tools for the humans: functional and cultural aspects

of human tool use

Tool use can be defined as ‘the external employment of an unattached environmental

object to alter more efficiently the form, position, or condition of another object, an-
other organism, or the user itself ’ (Beck, 1980, p. 10).
Acting in the environment is a complex task, which becomes even harder when tools
mediate it. The brain has to represent the body and its surrounding space, as well as
the target and the interleaving space (Gallese & Sinigaglia, 2010), and integrate the
tool into this representation. A large number of studies support the idea that tools may
hold a special status, becoming embodied in the body schema after prolonged use, and
they would not be processed as external objects anymore (Maravita & Iriki, 2004). To
some extent, tools become a part of one’s body (de Vignemont, 2011; Schettler, Raja, &
Anderson, 2019).
In this chapter, we will review how tools are integrated into body representation after
their use and how this integration affects spatial attention, multisensory processing,
and body representation. We will review the neural substrates that allow these spe-
cific processes. Finally, we will introduce up-​to-​date research on an exceptional class of
tools, namely prostheses, that stress to the extreme the idea that proficiently used tools
are processed both as external objects and as parts of the body.
The ability to use and manufacture tools is a distinctive skill of humans (Johnson-​
Frey, 2003) that separates humans from the other primates, mammals, and all other
species (Ambrose, 2001; Vaesen, 2012). Animals sporadically show tool-​mediated
behaviours in nature, e.g., great apes (Parker & Gibson, 1977) and birds (Auersperg,
Szabo, Von Bayern, & Kacelnik, 2012; Rutz et al., 2010). More consistently, animals
can learn how to use a tool after prolonged training (Ishibashi, Hihara, & Iriki, 2000;
Yamazaki et al., 2011). Nonetheless, humans use tools spontaneously and more fre-
quently. While other species limit their tool use to basic tasks like the manipulation of
simple objects (e.g., sticks for reaching, rocks for pounding), humans can create very
sophisticated items, reflecting a deep understanding of the body–​object interactions
(Johnson-​Frey, 2004). Indeed, humans have the unique ability to represent physical
causality of using tools (Johnson-​Frey, 2003), a fundamental skill to create novel,
technologically advanced devices (Osiurak, Jarry, & Le Gall, 2010; Povinelli, Reaux, &

Daniele Romano and Angelo Maravita, Plasticity and tool use in the body schema In: Body Schema and Body Image.
Edited by: Yochai Ataria, Shogo Tanaka, and Shaun Gallagher, Oxford University Press. © Oxford University Press 2021.
DOI: 10.1093/​oso/​9780198851721.003.0008
118  Plasticity and tool use in the body schema
Frey, 2010), as well as to pass the cultural knowledge about tools across generations
(Tomasello, 1999)

8.2  The tool in the (peripersonal) space

From the perspective of a human being, space can be divided into different portions.
The personal space is the portion overlapping with the physical body. The rest of the
space (i.e., the extrapersonal space) can be split into the far space (i.e., the portion
out of reach that can be explored only by vision and hearing) and the peripersonal
space (PPS). Personal space and far space define two clear and intuitive separate
areas, while the third portion of space, the PPS, is shadier. The PPS is a portion of
space closely surrounding the body where it is possible to act directly with our hands
and where rich multisensory integration of auditory, visual, and bodily events oc-
curs (Maravita, Spence, & Driver, 2003; Rizzolatti, Fadiga, Fogassi, & Gallese, 1997).
The borders that separate the PPS from the far space have no solid barriers (Bufacchi
& Iannetti, 2018; Magosso, Serino, Di Pellegrino, & Ursino, 2010) and the extension
of the PPS is malleable and depends on several factors like the reachability of the
target and its movement dynamics (Canzoneri, Magosso, & Serino, 2012; Maravita
et al., 2003).
Tools may extend humans’ action space over the limit of the physical body, making
reachable a portion of space that usually is not. Stimuli initially attributed to the far
space become reachable and are processed as if they were physically close to the body
(Maravita et al., 2003). This functional remapping of stimuli has been measured in dif-
ferent ways.
Berti and Frassinetti (2000) tested a patient presenting with unilateral spatial neg-
lect because of a stroke. They asked the patient to bisect a line (i.e., a typical test used
in the clinical setting to measure the magnitude of spatial neglect) that was presented
at a distance reachable on extending the arm (i.e., near) or far from hand’s reach (i.e.,
far). While line bisection in the near space showed a consistent rightward bias, which is
typical of neglect, bisection in the far space, performed using a laser pointer, was flaw-
less. Notably, when line bisection in the far space was done with a physical tool (i.e., a
wooden stick), which ‘brought’ the line in the reachable space, the neglect-​like behav-
iour re-​emerged (Berti & Frassinetti, 2000).
In the same task, healthy people cut the line slightly more on the left than in the ac-
tual centre (i.e., pseudo-​neglect) (Jewell & McCourt, 2000). The pseudo-​neglect reverts
to a rightward bias when stimuli are presented away from the participant and bisected
with a laser pointer. Interestingly, when a stick, instead of a pointer, is used for bisecting
the line, pseudo-​neglect is detectable for stimuli presented in the far space (Longo &
Lourenco, 2006). Giglia and colleagues induced a transient neglect-​like bias in the near
space, employing transcranial magnetic stimulation in healthy people. The neglect-​
like symptom extended to the far space when the target had to be reached with a stick
(Giglia et al., 2015).
 The tool in the (peripersonal) space  119
The remapping effect suggests thinking of the tool as a bodily extension that makes
the far space reachable. A key feature of the PPS is its sensitivity to multisensory events.
While sensory events occurring close to the body are processed faster and more effi-
ciently than those occurring far away (Longo, Musil, & Haggard, 2012), tools extend
the area of such an enhanced processing, as shown in both macaques and humans
(Maravita & Iriki, 2004).
Iriki and colleagues (Iriki, Tanaka, & Iwamura, 1996) measured the activity of
neurons in the parietal cortex of macaques, responding to both tactile stimulations and
visual stimuli appearing close to the tactile receptive field. The visual receptive fields
significantly extended following a training during which the macaque learnt how to use
a tool. The extension was such that the whole length of the tool became included in the
receptive field of the bimodal neurons (Iriki et al., 1996). The recalibration of the visual
receptive fields mediated by tool use was considered as neural evidence that the tool
became incorporated in the body schema and that stimuli close to it were processed as
stimuli close to the body (Iriki et al., 1996; Maravita & Iriki, 2004).
The work by Iriki and colleagues inspired the search for a parallel effect in humans,
in whom the use of tools would be able to modulate the integration of spatial and bodily
stimuli. In the cross-​modal congruency task, participants judge the location of a target
tactile stimulus (top or bottom elevation), while they receive a task-​irrelevant visual
distractor (a LED light flash) that may occur at a congruent or incongruent spatial ele-
vation. When the light is at an incongruent elevation to the target tactile stimulus, it
generates cross-​modal interference. The interference is stronger when visual and tactile
stimuli appear on the same side (Driver & Spence, 1998b; Spence, Pavani, & Driver,
2004). A relevant effect of the cross-​modal congruency task is that when the hands
are crossed to contact contralateral distractors, the effect reverses. Thus, when hands
are crossed, visual distractors in the right visual hemispace interfere more with tactile
stimuli on the left hand. This effect suggests that the multisensory interaction is an-
chored to the body part wherever it moves in space (Driver & Spence, 1998a). Crucially,
the same effect can be reproduced crossing two tools, instead of two hands, with visual
distractors placed at the tip of the tool and tactile targets at the hand, demonstrating
that far stimuli become spatially integrated with tactile targets connected via the tool,
as if in a congruent visuo-​tactile representation, just like on the hand itself (Maravita,
Spence, Kennett, & Driver, 2002).
Similar tool use modulation of multisensory integration has been found to affect
audio-​tactile interactions, suggesting that tool use shapes body–​space multisensory
interaction in a supramodal way (Canzoneri et al., 2012; 2013).
A parallel stream of research measured the effect of tool use on the multisensory
effect of the PPS in neuropsychological patients presenting with cross-​modal ex-
tinction following brain damage. These patients can detect independent sensory
stimuli delivered to each side of space or body. However, on bilateral simultaneous
stimulation, with a visual stimulus close to the ipsilesional hand and a touch to the
contralesional hand, they miss to report the touch. This is believed to follow a cross-​
modal competition between the two stimuli, possibly involving bimodal neurons
120  Plasticity and tool use in the body schema
encoding the PPS (di Pellegrino, Ladavas, & Farne, 1997; Mattingley, Driver, Beschin,
& Robertson, 1997). Notably, when a visual stimulus is far away from the body, i.e.,
outside the PPS, it typically triggers less extinction. However, if it is reached by a
tool held by the patient’s healthy hand, extinction rises again, as if the tool has ex-
tended the area of body/​space integration (Farné, Serino, & Ladavas, 2007; Maravita,
Husain, Clarke, & Driver, 2001).
The malleability of the PPS has been recently re-​discussed not in terms of a near/​far
dichotomy, but as a functional ‘action field’ (Bufacchi & Iannetti, 2018), whereby space
becomes relevant, and in some sense functional, to the action performed. This con-
cept could be even further expanded, by imagining force-​fields that can be modulated
by several distinct factors, such as motivation and interactivity, therefore not limited
to spatial processing, which would also include the ability of mastering tool use. By
elaborating on the original idea of Bufacchi and Iannetti, one may think about the PPS
not as a distinct portion of space, but rather as a PPS force-​field (PPSff ), which may be-
come a feature of any spatial location (see Figure 8.1). PPSff, in fact, would map features
related to the interactivity and relevance (e.g., someone may call it saliency) of that
portion of space for the individual. This feature could be measured, for example, in
terms of faster processing of stimuli falling in that portion of space or increased physio-
logical responses to potential threats (Rossetti, Romano, Bolognini, & Maravita, 2015;
Wallwork, Talbot, Camfferman, Moseley, & Iannetti, 2016). PPSff does not require close
spatial proximity to the body and can be envisioned as a sort of ‘heat map’ of space
interactivity. Following this idea, remote-​controlled objects like drones, or robotic de-
vices like those used in telesurgery, may become not physically, but functionally ‘em-
bodied’ and show their surrounding PPSff even if located very far from the controlling
physical body. All the effects obtained with multisensory interaction tasks modulated
by tool use could be interpreted in this new perspective. PPSff also provides a theoret-
ical background for all the results obtained using the Virtual Reality. The plasticity of
multisensory interaction would not be anymore a property of a physical location in
space as a function of mere distance from the biological body or its physical extension,
but would be a feature of the sensory experience related to stimuli and the possibility to
interact with them. On this line, in studies aimed at studying sensory interactions while
using telesurgery haptic devices, it has been shown that the crossed-​tools effect can be
replicated in a virtual reality setting where real tactile stimuli delivered to participants’
hands were coupled with visual distractors positioned at the tip of a virtual tool (Sengül
et al., 2013; 2012). In a similar fashion, the results by Iriki and colleagues were extended
to a virtual situation in which the animal controlled its tool use task via a video monitor
(Obayashi et al., 2001).

8.3  The tool in the body (schema)

A relevant issue in the conceptual thinking about tool use is the idea that a tool can be
included in the body representation. A fascinating concept, in this respect, is that of
 The tool in the body (schema)  121

(A) (B)

(C) (D)

Figure 8.1  Peripersonal space force-​fields. The idea of PPSff is here schematized,
considering the space surrounding an observer. We can imagine that colours represent the
PPSff property of that area. Space is represented as a pixel matrix where green corresponds
to high values of PPSff and red to low values (A). We propose that PPSff parameters change
according to several factors, including tool use (B). It also may extend to unreachable areas
because of technological devices like a drone remotely controlled by a joystick (C). PPSff
may potentially map the entire space, with several foci of high values, because of different
reasons like the presence of a tool and a concurrent potential threat with which we can
potentially interact (D).

Embodiment that can be defined as follows: ‘E is embodied if and only if some proper-
ties of E are processed in the same way as the properties of one’s body’ (de Vignemont,
2011). From this perspective, the tool can be embodied (or embodiable) in the body
representation even if a person does not feel that it ‘physically’ belongs to his/​her bio-
logical body (i.e., no sense of ownership toward the tool) or it is not physically con-
nected with the biological body. Not all the properties of one’s body must necessarily
occur in tool incorporation. The body schema is the dynamic representation of the
body devoted to action (de Vignemont, 2010), largely processed out of awareness. It is
the substrate most likely impacted by tool use. The body image is typically referred to a
more conscious representation of body processes (de Vignemont, 2010), and although
some subtle effects of tools can be hypothesized onto conscious body image (Schettler
et al., 2019), it is less likely that humans consciously represent tools as parts of their
physical body.
122  Plasticity and tool use in the body schema
There is a debate on whether the active use of the tool is necessary to embody the
object or if it is enough to hold it. The literature is still controversial on this point
(Cardinali, Brozzoli, Luauté, Roy, & Farnè, 2016; Costantini, Ambrosini, Sinigaglia, &
Gallese, 2011). Possibly, tool-​mediated space remapping can occur following either ac-
tive movements (Maravita, Clarke, Husain, & Driver, 2002; Witt, Proffitt, & Epstein,
2005) or passive movements (Galli, Noel, Canzoneri, Blanke, & Serino, 2015), or only
by holding the tool (Berti & Frassinetti, 2000; Costantini et al., 2011). What may change
is the magnitude or pervasiveness of the effect. If we consider the PPS in terms of force-​
field, then we can imagine that the parameter has a continuous scale and not an ON/​
OFF switch.
Tool use proved to be effective in changing how the brain processes multisensory
stimuli approaching the space around the body. However, if this process requires that a
tool is processed, at least to some extent, as a body part, the representation of the limb
using the tool should reflect the tool incorporation as well. Interestingly, the representa-
tion of the limb proved to be modulated by tool use immediately, by merely holding the
tool (Holmes, Calvert, & Charles, 2008; Holmes, Sanabria, Calvert, & Spence, 2007),
while others require extensive training (Marini et al., 2013; Serino, Bassolino, Farnè,
& Làdavas, 2007). The hyper-​quick plasticity has been attributed to changes in the al-
location of spatial attention rather than tool embodiment (Holmes et al., 2008; 2007).
Although the spatial attention change was initially hypothesized as an alternative ex-
planation of tool use-​induced changes in PPS processing, the ‘spatial attention shift’
and the ‘embodiment’ hypotheses may coexist and complement each other (Holmes,
2012; Maravita & Baccarini, 2013; Maravita & Romano, 2018). Orienting of spatial at-
tention may precede, or drive, the embodiment which is a process that needs more time
and repetitions to establish; this issue should be further addressed in future studies.
A plausible consequence of tool embodiment is that, besides altering multisensory inte-
gration of stimuli around the body, it should also affect the processing of bodily stimuli.
A recent study by Miller, Montroni, Koun, Salemme, and Hayward (2018) showed that
tactile stimuli delivered to the tool are processed efficiently as if they were delivered
directly to the hand. The spatial mapping of the touch was precise and accurate, even if
no direct stimulation was given to the hand. The authors coupled the experiments with
a computational model that fits with the idea that humans can utilize tools as sensory
extensions of the body—​the task of localizing an object with a tool would be distributed
across the mechanical response of the tool, the biomechanics of the extremities, and
the neural circuits of the sensorimotor system (Chiel & Beer, 1997; Miller et al., 2018).
The embodiment hypothesis initially assumed that after training, the morphological
feature of the tool is incorporated into the biological body. For example, the kinematic
pattern of a free-​hand grasp changes after training with a grabber tool. Cardinali and
colleagues found that the kinematics of the transport component of the action changes
after the training. The changes were coherent with having a longer arm, likely following
the embodiment of the tool length (Cardinali et al., 2009). Additionally, in the task de-
veloped by Maravita and colleagues (Sposito, Bolognini, Vallar, Posteraro, & Maravita,
2010), participants had to indicate the central point of their arm (e.g., ‘from elbow to
 The tool in the body (schema)  123
fingertips, indicate the centre of your arm’) to estimate the length of their arm. The arm
bisection shifted following training with a long tool as if perceiving the arm longer than
before the training (Garbarini et al., 2015; Sposito, Bolognini, Vallar, & Maravita, 2012).
These observations have been further characterized by showing that the embodi-
ment does not only correspond to the integration of the mere morpho-​functional
characteristic of the tool, but also depends on the specific sensorimotor constraints
imposed by the instrument (Cardinali, Brozzoli, Finos, Roy, & Farnè, 2016; Romano,
Uberti, Caggiano, Cocchini, & Maravita, 2019). Cardinali and colleagues asked the
participants to reach and grasp an object using a pair of pliers operated by the index
and thumb fingertips, or a pair of sticks taped to the same two fingers. The tools were
equally long, but they imposed different sensorimotor constraints on the acting fingers.
Tools induced changes in finger (but not arm’s length) kinematics, compatible with
having a bigger hand. Crucially, while the sticks selectively affected the kinematics of
the two fingers, the pliers had a more global effect on the entire hand (Cardinali et al.,
2016a). Notably, body bisection shift is not determined by the pure morphological as-
pect of the tool as well, but any changes of body representation that follow the use of the
tool are shaped by the specific motor pattern required by the tool (Romano et al., 2019).
This should be viewed as a core determinant of any effect of embodiment, together
with the morphological (Miller, Longo, & Saygin, 2014) and functional (Farné et al.,
2007) features of the tool.
The embodiment of a tool might be only achievable with some tools and may en-
compass only some aspects of true bodily experience (de Vignemont, 2011; Longo &
Serino, 2012). For example, the embodiment of a tool may not encompass a sense of
ownership (de Vignemont, 2011). Affective reactions towards a wielded inanimate tool
have been experimentally tested. Rossetti et al. (2015) measured the skin conductance
response to incoming pinprick that stopped at different distances from the participant’s
hand. Stimuli delivered close to the tip of a tool were ineffective in inducing an arousal
response before the training, while they became effective after tool-​training. The afore-
mentioned study is the first evidence of an ‘affective’ embodiment of the tool; although
it does not imply a sense of ownership toward it, it goes beyond a pure functional ad-
vantage of multisensory integration determined by the tool use, suggesting a potential
defensive response for the tool. Instead, these results nicely fit with the PPSff vision,
showing that independent portions of space might be processed differently as a func-
tion of a complex set of properties that adds to the mere distance from the body. The
interactivity of that area, the saliency of the stimulus entering that portion of space, and
the innate, or acquired, valence of the stimulus producing alteration in the physiological
responses might be as important as the distance from the physical body (Spaccasassi,
Romano, & Maravita, 2019).
While there is no agreement on whether actively using a tool is necessary to have
any sign of embodiment, it is less debated (although not that much investigated) that
long-​lasting experience facilitates the embodiment of the tools. Blind people are typ-
ically very experienced in exploring space with a cane. Serino et al. (2007) measured
the PPS by utilizing the audio-​tactile interaction task in blind subjects regularly using
124  Plasticity and tool use in the body schema
a rod. They found that the peri-​hand space of blind users immediately extended as to
include the cane as soon as the tool was held, but not if a different (shorter) instrument
was provided. A similar effect was also found in tennis players showing that PPS modu-
lation depended on the fact that they were holding their own racket or a different one
(Biggio, Bisio, Avanzino, Ruggeri, & Bove, 2017). Tennis players also showed increased
corticospinal excitability (a measure of motor preactivation) when they had to imagine
using a tennis racket, but not a golf club (Fourkas, Bonavolontà, Avenanti, & Aglioti,
2008). These results suggest a pivotal role of long-​term experience in modulating sen-
sorimotor body representations (i.e., the body schema) by means of tool use.

8.4  The tool in the brain

Tool use has been found to shape the brain in a significant way. Much knowledge has
been acquired on the neural underpinnings of expert tool use in great apes, that in-
clude the development of motor–​premotor, cerebellar, and parietal regions, also pro-
viding clues on the genetic-​based heritability of some such critical neural substrates
(Hopkins et al., 2019). However, concerning the neural substrates, the impact of tool
use on body representation have started to be clarified thanks to single-​cell recording
studies in monkeys. In the seminal paper by Iriki and co-​workers mentioned in the
previous paragraph (Iriki et al., 1996), neurons in the anterior bank of the intraparietal
sulcus (IPS) were recorded in macaque monkeys who were trained to use a rake to re-
trieve food pellets for a couple of weeks. The use of the rake is a new task for such ani-
mals who do not use tools in the natural environment. At baseline, those cells showed
bimodal receptive fields (RFs), including somatosensory responses to tactile/​proprio-
ceptive stimuli and visual responses. Critically, neurons responding to somatosensory
stimuli on the hand also responded to stimuli around the hand, while those RFs on the
shoulder responded to a wider area, corresponding to the space reachable by the arm.
Once the animals had stably learnt to use the rake, the visual RFs of most recorded bi-
modal neurons temporarily expanded any time the animal used the rake for a few min-
utes, as compared to baseline. The authors linked the expanded visual response of the
neurons with an enlarged cortical representation of the body for action, now including
the tool: ‘the neural correlate of the schema of the hand in which the tool was incorpor-
ated’ (Iriki et al., 1996, p. 2329). Visual RF expansion was functional to the baseline
activity of the neuron; while distal (i.e., hand) neurons expanded as to include the tool
axis, those of proximal (i.e., shoulder) neurons broadened to the whole area of space
reachable by the tool. The visual RFs shrank back to their original size if the monkey
retrieved food with the hand, without using the tool, for about 3 minutes, even if still
holding the tool at the time of testing.
Although the discovery of functional use-​related short-​term plasticity has be-
come particularly popular, an even more impressive result came from further studies
qualifying the long-​term changes in cortical plasticity following tool use. Hihara
and colleagues (2006), using anterograde and retrograde tracers, showed novel tool
 The tool in the brain  125
use-​dependent cortico-​cortical connections. Connections were growing from the
ventrolateral prefrontal cortex and the temporo-​parietal junction (TPj) to the IPS re-
gion adjacent to the forearm representation. Crucially, bimodal responses only occa-
sionally appeared in untrained animals (Iwamura, Tanaka, Sakamoto, & Hikosaka,
1993) and were evident in the hemisphere contralateral to the trained limb only in four
trained monkeys, not in five untrained ones, and were primarily related to the hand re-
gion (Hihara et al., 2006; Iriki et al., 1996). Such long-​term plasticity was accompanied
by neurobiological changes in neurons in the anterior bank of the IPS, suggesting an
induction of specific protein synthesis only during tool use learning (Ishibashi et al.,
2002a, b).
Which is the goal of such intriguing plasticity? The general idea is that tool use
change in brain response may be functional to code for the sensory-​motor representa-
tion of the tool. In this respect, the aforementioned adaptive and unconscious change
in the body schema, as theorized by several general models of body representation (de
Vignemont, 2010), could be supposed. Changes would be functional to control the
modified sensory-​motor schemes of the trained animal (Maravita & Iriki, 2004) or
human (Cardinali et al., 2009; 2012; Romano et al., 2019).
Such gradual changes in neuronal responses and circuitry would be functionally
guided by the action goal allowed by the tool (Cardinali et al., 2016). It was first ex-
plored by Umiltà and colleagues (Umiltà et al., 2008) who elegantly showed that mon-
keys extensively trained to use regular and reverse pliers (opposite motor kinematics,
but same action goal) to retrieve bits of food showed responses of premotor neurons
typically controlling hand grasping (area F5).
Following up on these results, the same research group showed similar premotor
activation following not just the use, but the mere observation of actions involving
tools (Rochat et al., 2010). Tools, then, would be represented as extensions not of the
physical sensorimotor activities of the body, but, more generally, as non-​corporeal
objects that subtend specific use and action goals. This ability of animals to repre-
sent tool use tasks becomes very sophisticated in humans, for whom tool use enor-
mously expands operational possibilities in the real, as well as in the virtual, world
(Arbib, Bonaiuto, Jacobs, & Frey, 2009). Furthermore, tools have robust semantic
value for humans, as shown by the more extensive network underpinning higher-​
order knowledge and skilful use of tools, like that shown by other species (Johnson-​
Frey, 2003; 2004).
The observation, recognition, and naming of familiar human-​made tools are linked,
in humans, to the activity of specific regions of the posterior parietal cortex (PPC) and
premotor, mid-​and inferior frontal cortices (Chao & Martin, 2000; Grafton, Fadiga,
Arbib, & Rizzolatti, 1997; Perani et al., 1995). Additionally, brain activations were de-
tected in the middle and superior temporal gyri for the knowledge of functional, se-
mantic, and multisensory attributes of tools (Beauchamp, Lee, Argall, & Martin, 2004;
Chao, Haxby, & Martin, 1999; Kellenbach, Brett, & Patterson, 2003).
The left anterior aspect of the supramarginal gyrus (aSMG) and the angular gyrus
(AG), for example, have been found to activate for both the motor preparation for
126  Plasticity and tool use in the body schema
a specific tool action and the actual use of the same tool, as compared to the plan-
ning and execution of meaningless hand actions (Johnson-​Frey, Newman-​Norlund,
& Grafton, 2005). Interestingly, the same activation was found for scenes performed
with different tools, suggesting a general function of the left aSMG in representing
tools of any kind, as compared to hand actions (Peeters, Rizzolatti, & Orban, 2013;
Peeters et al., 2009). A similar difference between tool and hand actions would not
be present in monkeys (Peeters et al., 2009) and would call for a specific function
of this region of the brain in the representation of tool use in humans (Orban &
Caruana, 2014).
Although the left supramarginal gyrus (SMG) has been indicated as the crucial area
to integrate information aimed at the manipulation of the tool with that related to tool
use knowledge, bilateral involvement of the SMG in the integration of information
about tool knowledge and tool manipulation is likely (McDowell, Holmes, Sunderland,
& Schu, 2018; Rallis, Fercho, Bosch, & Baugh, 2018).

8.5  Prostheses: tools or body parts?

The anthropomorphism of tools and the development of neural interfaces push to re-
considering the human–​tool interaction as a human augmentation, and not only as a
prosthetic replacement (Di Pino, Maravita, Zollo, Guglielmelli, & Di Lazzaro, 2014).
What happens when a tool substitutes functionally and/​or structurally a body part,
replacing a body part and a body function? The case of the prosthesis brings the dual
nature of tools (being functional to the body and/​or being part of the body) to the
extreme.
For example, in people with spinal cord injury, the wheelchair allows independent
locomotion, which would be limited by physical impairment. In these people, although
the wheelchair does not look like a pair of legs, the tool functionally substitutes a body
part (Pazzaglia, Galli, Scivoletto, & Molinari, 2013). The incorporation is so deep that
one’s wheelchair has a particular representation that resembles the representation of
the legs in healthy people. The embodiment of one’s wheelchair modifies the perception
of the surrounding space (Scandola et al., 2019a), as well as the motoric representation
of the actions (Scandola et al., 2019b).
An even more extreme case is that of prostheses, a special kind of tools in which
the vicariant function is accompanied by strict integration of the device with bodily
anatomy. Prostheses, in fact, not only are functional to the body, but they are also more
and more designed to become part of it.
Amputee patients are often hardly satisfied with limb prostheses (Davidson, 2002).
There is encouraging evidence that embodiment can be achieved for functionally
relevant tools as well as for fake body parts in healthy individuals (Schettler et al.,
2019). Nonetheless, in the long term, people with an upper limb amputation may
be reluctant to use their prosthesis, in favour of their intact arm, to face their dis-
ability (Davidson, 2002). A recent study evaluated the relation between the degree
 Prostheses: tools or body parts?  127
of prosthesis embodiment and its actual use in everyday life (Gouzien et al., 2017).
When assessing the reachability of external objects, a misestimation error is typic-
ally found in people with amputation with and without the prosthesis. However, the
presence of a prosthesis further modulates the misestimation. The authors found that
wearing a prosthesis influences reachability judgements and performances (Gouzien
et al., 2017). Notably, a correlation between the subjective quality of integration of the
prosthesis and the body representation change was found. The study has the merit
to unveil the dual nature of prosthesis embodiment—​the prosthesis is embodied as
a tool, with its related multisensory interaction effects on the PPS; the prosthesis is
embodied as a body part, with outcomes related to subjective experience in everyday
use (Gouzien et al., 2017).
Although the investigation on how the brain builds a sense of ownership toward
body parts is a blooming field of research (de Vignemont, 2011), our understanding
must be limited if we consider that we still struggle to build prostheses that are truly
felt as one’s own real body parts. Technological advancements are providing more and
more sophisticated prostheses, robotic devices that have servo motors and sensors that
lead both to control the movements of the device and to perceive tactile feedback on
it (Hernandez-​Arieta, Dermitzakis, Damian, Lungarella, & Pfeifer, 2007). The em-
bodiment of such a tool showed mixed results. Implicit effects of embodiment, like the
modulation of perceptual judgements or multisensory integration, can be achieved
(Marini et al., 2013; Romano, Caffa, Hernandez-​Arieta, Brugger, & Maravita, 2015;
Vu Huynh, Bekrater-​Bodmann, Fröher, Vogt, & Beckerle, 2019), while the subjective
sense of ownership toward the robotic hands may be lacking (Romano et al., 2015).
This evidence seems to call for an efficient plastic shaping of the mechanisms allowing
the integration of sensory-​motor functional tools in what different body models call
‘body schema’ (de Vignemont, 2011) and less likely in the more explicit domain of body
image (Schettler et al., 2019).
Very recently, a young woman with an upper limb amputation was implanted with
a combination of a cuff and intraneural electrodes at the stump level. This system was
combined with an advanced robotic prosthetic hand (Zollo et al., 2019) equipped
with a technology that simulates a sort of proprioceptive input. Researchers showed
that the patient improved manipulation abilities over time as a result of neural feed-
back, as compared to actions done without the simulated proprioception (Zollo
et al., 2019). This was accompanied by changes at the level of multisensory integra-
tion (Di Pino et al., 2020); however, clues to a subjective sense of ownership remain
uncertain.
While it looks clear that the prosthesis can be embodied as a tool, thus modifying the
processing of multisensory stimuli in space and reshaping the motor pattern required
by the specific actions, it is still questionable whether it is felt like a body part too. This is
a challenging research question, and a technological demand, that will be of paramount
importance for the next years in the design of robotic devices that will be used and felt
like a real body part including, maybe, the corollary of affective and protective feelings
usually felt toward physical limbs.
128  Plasticity and tool use in the body schema
References
Ambrose, S. H. (2001). Paleolithic technology and human evolution. Science, 291(March), 1748.
Arbib, M. A., Bonaiuto, J. B., Jacobs, S., & Frey, S. H. (2009). Tool use and the distalization of the end-​
effector. Psychological Research Psychologische Forschung, 73(4), 441–​462.
Auersperg, A. M. I., Szabo, B., Von Bayern, A. M. P., & Kacelnik, A. (2012). Spontaneous innovation in
tool manufacture and use in a Goffin’s cockatoo. Current Biology, 22(21), R903–​R904.
Beauchamp, M. S., Lee, K. E., Argall, B. D., & Martin, A. (2004). Integration of auditory and visual in-
formation about objects in superior temporal sulcus. Neuron, 41(5), 809–​823.
Beck, B. B. (1980). Animal Tool Behavior: The Use and Manufacture of Tools by Animals. New York,
NY: Garland.
Berti, A. & Frassinetti, F. (2000). When far becomes near: re-​mapping of space by tool use. Journal of
Cognitive Neuroscience, 12(3), 415–​420.
Biggio, M., Bisio, A., Avanzino, L., Ruggeri, P., & Bove, M. (2017). This racket is not mine: the influ-
ence of the tool-​use on peripersonal space. Neuropsychologia, 103(July), 54–​58.
Bufacchi, R. J. & Iannetti, G. D. (2018). An action field theory of peripersonal space. Trends in
Cognitive Sciences, 22(12), 1076–​1090.
Canzoneri, E., Magosso, E., & Serino, A. (2012). Dynamic sounds capture the boundaries of
peripersonal space representation in humans. PLoS ONE, 7(9), 3–​10.
Canzoneri, E., Ubaldi, S., Rastelli, V., Finisguerra, A., Bassolino, M., & Serino, A. (2013). Tool-​use
reshapes the boundaries of body and peripersonal space representations. Experimental Brain
Research, 228(1), 25–​42.
Cardinali, L., Brozzoli, C., Finos, L., Roy, A. C., & Farnè, A. (2016a). The rules of tool incorpor-
ation: tool morpho-​functional and sensori-​motor constraints. Cognition, 149, 1–​5.
Cardinali, L, Brozzoli, C., Luauté, J., Roy, A. C., & Farnè, A. (2016b). Proprioception is necessary for
body schema plasticity: evidence from a deafferented patient. Frontiers in Human Neuroscience,
10, 272.
Cardinali, L, Frassinetti, F., Brozzoli, C., Urquizar, C., Roy, A. C., & Farne, A. (2009). Tool-​use induces
morphological updating of the body schema. Current Biology, 19(12), R478–​R479.
Cardinali, L, Jacobs, S., Brozzoli, C., Frassinetti, F., Roy, A. C., & Farnè, A. (2012). Grab an object
with a tool and change your body: tool-​use-​dependent changes of body representation for action.
Experimental Brain Research, 218(2), 259–​271.
Chao, L. L, Haxby, J. V, & Martin, A. (1999). Attribute-​based neural substrates in temporal cortex for
perceiving and knowing about objects. Nature Neuroscience, 2(10), 913.
Chao, L. L. & Martin, A. (2000). Representation of manipulable man-​made objects in the dorsal
stream. NeuroImage, 12(4), 478–​484.
Chiel, H. J. & Beer, R. D. (1997). The brain has a body: adaptive behavior emerges from interactions of
nervous system, body and environment. Trends in Neurosciences, 20(12), 553–​557.
Costantini, M., Ambrosini, E., Sinigaglia, C., & Gallese, V. (2011). Tool-​use observation makes far ob-
jects ready-​to-​hand. Neuropsychologia, 49(9), 2658–​2663.
Davidson, J. (2002). A survey of the satisfaction of upper limb amputees with their prostheses, their
lifestyles, and their abilities. Journal of Hand Therapy, 15, 62–​70.
de Vignemont, F. (2010). Body schema and body image—​pros and cons. Neuropsychologia, 48(3),
669–​680. https://​doi.org/​10.1016/​j.neuropsychologia.2009.09.022
de Vignemont, F. (2011). Embodiment, ownership and disownership. Consciousness and Cognition,
20, 82–​93.
di Pellegrino, G., Ladavas, E., & Farne, A. (1997). Seeing where your hands are. Nature, 388, 730.
Di Pino, G., Romano, D., Spaccasassi, C., Mioli, A., D’Alonzo, M., Sacchetti, R., . . . Maravita, A. (2020).
Sensory-​and Action-​Oriented Embodiment of Neurally-​Interfaced Robotic Hand Prostheses.
Frontiers in Neuroscience, 14.
Di Pino, G., Maravita, A., Zollo, L., Guglielmelli, E., & Di Lazzaro, V. (2014). Augmentation-​related
brain plasticity. Frontiers in Systems Neuroscience, 8. https://​doi.org/​10.3389/​fnsys.2014.00109
Driver, J. & Spence, C. (1998a). Attention and the crossmodal construction of space. Trends in
Cognitive Sciences, 2(7), 254–​262.
 Prostheses: tools or body parts?  129
Driver, J. & Spence, C. (1998b). Cross-​modal links in spatial attention. Philosophical Transactions of
the Royal Society of London. Series B, Biological Sciences, 353(1373), 1319–​1331.
Farné, A., Serino, A., & Ladavas, E. (2007). Dynamic size-​change of peri-​hand space following tool-​
use: determinants and spatial characteristics revealed through cross-​modal extinction. Cortex,
43(3), 436–​443.
Fourkas, A. D., Bonavolontà, V., Avenanti, A., & Aglioti, S. M. (2008). Kinesthetic imagery and tool-​
specific modulation of corticospinal representations in expert tennis players. Cerebral Cortex,
18(10), 2382–​2390.
Gallese, V. & Sinigaglia, C. (2010). The bodily self as power for action. Neuropsychologia, 48(3),
746–​755.
Galli, G., Noel, J. P., Canzoneri, E., Blanke, O., & Serino, A. (2015). The wheelchair as a full-​body tool
extending the peripersonal space. Frontiers in Psychology, 6, 1–​11.
Garbarini, F., Fossataro, C., Berti, A., Gindri, P., Romano, D., Pia, L., della Gatta, F., Maravita, A.,
& Neppi-​Modona, M. (2015). When your arm becomes mine: pathological embodiment of alien
limbs using tools modulates own body representation. Neuropsychologia, 70, 402–​413.
Giglia, G., Pia, L., Folegatti, A., Puma, A., Fierro, B., Cosentino, G., . . . Brighina, F. (2015). Far space
remapping by tool use: a rTMS study over the right posterior parietal cortex. Brain Stimulation,
8(4), 795–​800.
Gouzien, A., de Vignemont, F., Touillet, A., Martinet, N., De Graaf, J., Jarrassé, N., & Roby-​Brami, A.
(2017). Reachability and the sense of embodiment in amputees using prostheses. Scientific Reports,
7(1), 1–​10.
Grafton, S. T., Fadiga, L., Arbib, M. A., & Rizzolatti, G. (1997). Premotor cortex activation during ob-
servation and naming of familiar tools. NeuroImage, 6(4), 231–​236.
Hernandez-​Arieta, A., Dermitzakis, K., Damian, D., Lungarella, M., & Pfeifer, R. (2007). Sensory-​
motor coupling in rehabilitation robotics. In Y. Takahashi (ed.), Service Robotic Application (pp.
21–​36). INTECH Open Access Publisher.
Hihara, S., Notoya, T., Tanaka, M., Ichinose, S., Ojima, H., Obayashi, S., Fujii, N., & Iriki, A. (2006).
Extension of corticocortical afferents into the anterior bank of the intraparietal sulcus by tool-​use
training in adult monkeys. Neuropsychologia, 44(13), 2636–​2646.
Holmes, N. P. (2012). Does tool use extend peripersonal space? A review and re-​analysis. Experimental
Brain Research, 218(2), 273–​282.
Holmes, N. P., Calvert, G. A., & Charles, S. (2008). Tool use changes multisensory interactions in sec-
onds: evidence from the crossmodal congruency task. Brain, Behavior, and Immunity, 22(5), 629.
Holmes, N. P., Sanabria, D., Calvert, G. A., & Spence, C. (2007). Tool-​use: capturing multisensory spa-
tial attention or extending multisensory peripersonal space? Cortex, 43(3), 469–​489.
Hopkins, W. D., Latzman, R. D., Mareno, M. C., Schapiro, S. J., Gómez-​Robles, A., & Sherwood, C. C.
(2019). Heritability of gray matter structural covariation and tool use skills in chimpanzees (pan
troglodytes): a source-​based morphometry and quantitative genetic analysis. Cerebral Cortex,
29(9), 3702–​3711.
Iriki, A., Tanaka, M., & Iwamura, Y. (1996). Coding of modified body schema during tool use by ma-
caque postcentral neurones. Neuroreport, 7(14), 2325–​2330.
Ishibashi, H., Hihara, S., & Iriki, A. (2000). Acquisition and development of monkey tool-​
use: behavioral and kinematic analyses. Canadian Journal of Physiology and Pharmacology,
78(11), 958–​966.
Ishibashi, H., Hihara, S., Takahashi, M., Heike, T., Yokota, T., & Iriki, A. (2002a). Tool-​use learning in-
duces BDNF expression in a selective portion of monkey anterior parietal cortex. Molecular Brain
Research, 102(1–​2), 110–​112.
Ishibashi, H., Hihara, S., Takahashi, M., Heike, T., Yokota, T., & Iriki, A. (2002b). Tool-​use learning
selectively induces expression of brain-​ derived neurotrophic factor, its receptor trkB, and
neurotrophin 3 in the intraparietal multisensory cortex of monkeys. Cognitive Brain Research,
14(1), 3–​9.
Iwamura, Y., Tanaka, M., Sakamoto, M., & Hikosaka, O. (1993). Rostrocaudal gradients in the
neuronal receptive field complexity in the finger region of the alert monkey’s postcentral gyrus.
Experimental Brain Research, 92(3), 360–​368.
130  Plasticity and tool use in the body schema
Jewell, G. & McCourt, M. E. (2000). Pseudoneglect: a review and meta-​analysis of performance fac-
tors in line bisection tasks. Neuropsychologia, 38(1), 93–​110.
Johnson-​Frey, S. H. (2003). What’s so special about human tool use? Neuron, 39(17), 201–​204.
Johnson-​Frey, S. H. (2004). The neural bases of complex tool use in humans. Trends in Cognitive
Sciences, 8(2), 71–​78.
Johnson-​Frey, S. H., Newman-​Norlund, R., & Grafton, S. T. (2005). A distributed left hemisphere net-
work active during planning of everyday tool use skills. Cerebral Cortex, 15(6), 681–​695.
Kellenbach, M. L., Brett, M., & Patterson, K. (2003). Actions speak louder than functions: the im-
portance of manipulability and action in tool representation. Journal of Cognitive Neuroscience,
15(1), 30–​46.
Longo, M. R. & Lourenco, S. F. (2006). On the nature of near space: effects of tool use and the transi-
tion to far space. Neuropsychologia, 44(6), 977–​998.
Longo, M. R., Musil, J. J., & Haggard, P. (2012). Visuo-​tactile integration in personal space. Journal of
Cognitive Neuroscience, 24(3), 543–​552.
Longo, M. R. & Serino, A. (2012). Tool use induces complex and flexible plasticity of human body rep-
resentations. Behavioral and Brain Sciences, 35(4), 229–​230.
Magosso, E., Serino, A., Di Pellegrino, G., & Ursino, M. (2010). Crossmodal links between vision
and touch in spatial attention: a computational modelling study. Computational Intelligence and
Neuroscience, 2010, 304941.
Maravita, A. & Baccarini, M. (2013). Beyond the boundaries of the hand: plasticity of body-​space
interactions following tool use. In Z. Radman (ed.), The Hand, an Organ of the Mind: What the
Manual Tells the Mental (pp. 77–​99). Cambridge: MA: MIT Press.
Maravita, A., Clarke, K., Husain, M., & Driver, J. (2002). Active tool use with the contralesional hand
can reduce cross-​modal extinction of touch on that hand. Neurocase, 8(6), 411–​416.
Maravita, A., Husain, M., Clarke, K., & Driver, J. (2001). Reaching with a tool extends visual–​tactile
interactions into far space: evidence from cross-​ modal extinction. Neuropsychologia, 39(6),
580–​585.
Maravita, A. & Iriki, A. (2004). Tools for the body (schema). Trends in Cognitive Sciences, 8(2), 79–​86.
Maravita, A. & Romano, D. (2018). The parietal lobe and tool use. Handbook of Clinical Neurology,
151, 481–​498.
Maravita, A., Spence, C., & Driver, J. (2003). Multisensory integration and the body schema: close to
hand and within reach. Current Biology, 13(13), R531–​R539.
Maravita, A., Spence, C., Kennett, S., & Driver, J. (2002). Tool-​use changes multimodal spatial inter-
actions between vision and touch in normal humans. Cognition, 83(2), B25–​B34.
Marini, F., Tagliabue, C. F., Sposito, A. V., Hernandez-​Arieta, A., Brugger, P., Estévez, N., & Maravita,
A. (2013). Crossmodal representation of a functional robotic hand arises after extensive training in
healthy participants. Neuropsychologia, 53C, 178–​186.
Mattingley, J. B., Driver, J., Beschin, N., & Robertson, I. H. (1997). Attentional competition between
modalities: extinction between touch and vision after right hemisphere damage. Neuropsychologia,
35(6), 867–​880.
McDowell, T., Holmes, N. P., Sunderland, A., & Schu, M. (2018). TMS over the supramarginal gyrus
delays selection of appropriate grasp orientation during reaching and grasping tools for use. Cortex,
103, 117–​129.
Miller, L. E., Longo, M. R., & Saygin, A. P. (2014). Tool morphology constrains the effects of tool use
on body representations. Journal of Experimental Psychology: Human Perception and Performance,
40(6), 2143.
Miller, L. E., Montroni, L., Koun, E., Salemme, R., & Hayward, V. (2018). Sensing with tools extends
information processing beyond the body. Nature, 561(7722), 239–​242.
Obayashi, S., Suhara, T., Kawabe, K., Okauchi, T., Maeda, J., Akine, Y., Onoe, H., & Iriki, A. (2001).
Functional brain mapping of monkey tool use. NeuroImage, 14(4), 853–​861.
Orban, G. A. & Caruana, F. (2014). The neural basis of human tool use. Frontiers in Psychology, 5, 310.
Osiurak, F., Jarry, C., & Le Gall, D. (2010). Grasping the affordances, understanding the reasoning: to-
ward a dialectical theory of human tool use. Psychological Review, 117(2), 517–​540.
 Prostheses: tools or body parts?  131
Parker, S. T. & Gibson, K. R. (1977). Object manipulation, tool use and sensorimotor intelligence as
feeding adaptations in cebus monkeys and great apes. Journal of Human Evolution, 6(7), 623–​641.
Pazzaglia, M., Galli, G., Scivoletto, G., & Molinari, M. (2013). A functionally relevant tool for the body
following spinal cord injury. PLoS One, 8(3), e58312.
Peeters, R., Simone, L., Nelissen, K., Fabbri-​Destro, M., Vanduffel, W., Rizzolatti, G., & Orban, G. A.
(2009). The representation of tool use in humans and monkeys: common and uniquely human fea-
tures. Journal of Neuroscience, 29(37), 11523–​11539.
Peeters, R. R., Rizzolatti, G., & Orban, G. A. (2013). Functional properties of the left parietal tool use
region. NeuroImage, 78, 83–​93.
Perani, D., Cappa, S. F., Bettinardi, V., Bressi, S., Gorno-​Tempini, M., Matarrese, M., & Fazio, F. (1995).
Different neural systems for the recognition of animals and man-​made tools. NeuroReport, 6,
1637–​1641.
Povinelli, D. J., Reaux, J. E., & Frey, S. H. (2010). Chimpanzees’ context-​dependent tool use provides
evidence for separable representations of hand and tool even during active use within peripersonal
space. Neuropsychologia, 48(1), 243–​247.
Rallis, A., Fercho, K. A., Bosch, T. J., & Baugh, L. A. (2018). Getting a handle on virtual tools : an exam-
ination of the neuronal activity associated with virtual tool use. Neuropsychologia, 109, 208–​221.
Rizzolatti, G., Fadiga, L., Fogassi, L., & Gallese, V. (1997). The space around us. Science, 277(5323),
190–​191.
Rochat, M. J., Caruana, F., Jezzini, A., Escola, L., Intskirveli, I., Grammont, F., Gallese, V., Rizzolatti,
G., & Umiltà, M. A. (2010). Responses of mirror neurons in area F5 to hand and tool grasping ob-
servation. Experimental Brain Research, 204(4), 605–​616.
Romano, D., Caffa, E., Hernandez-​Arieta, A., Brugger, P., & Maravita, A. (2015). The robot hand il-
lusion: inducing proprioceptive drift through visuo-​motor congruency. Neuropsychologia, 70,
414–​420.
Romano, D., Uberti, E., Caggiano, P., Cocchini, G., and Maravita, A. (2019). Different tool training in-
duces specific effects on body metric representation. Experimental Brain Research, 237(2), 493–​501.
Rossetti, A., Romano, D., Bolognini, N., & Maravita, A. (2015). Dynamic expansion of alert responses
to incoming painful stimuli following tool use. Neuropsychologia, 70, 486–​494.
Rutz, C., Bluff, L. A., Reed, N., Troscianko, J., Newton, J., Inger, R., Kacelnik, A., & Bearhop, S. (2010).
The ecological significance of tool use in New Caledonian crows. Science, 1523–​1526.
Scandola, M., Aglioti, S. M., Avesani, R., Bertagnoni, G., Marangoni, A., & Moro, V. (2019b).
Anticipation of wheelchair and rollerblade actions in spinal cord injured people, rollerbladers, and
physiotherapists. PLoS One, 14(3), e0213838.
Scandola, M., Togni, R., Tieri, G., Avesani, R., Brambilla, M., Aglioti, S. M., & Moro, V. (2019a).
Embodying their own wheelchair modifies extrapersonal space perception in people with spinal
cord injury. Experimental Brain Research, 237(10), 2621–​2632.
Schettler, A., Raja, V., & Anderson, M. L. (2019). The embodiment of objects : review, analysis, and
future directions. Frontiers in Neuroscience, 13, 1332.
Sengül, A., Rognini, G., van Elk, M., Aspell, J. E., Bleuler, H., & Blanke, O. (2013). Force feedback
facilitates multisensory integration during robotic tool use. Experimental Brain Research, 227(4),
497–​507.
Sengül, A., van Elk, M., Rognini, G., Aspell, J. E., Bleuler, H., & Blanke, O. (2012). Extending the body
to virtual tools using a robotic surgical interface: evidence from the crossmodal congruency task.
PLoS One, 7(12), e49473.
Serino, A., Bassolino, M., Farnè, A., & Làdavas, E. (2007). Extended multisensory space in blind cane
users. Psychological Science, 18(7), 642–​648.
Spaccasassi, C., Romano, D., & Maravita, A. (2019). Everything is worth when it is close to my
body: how spatial proximity and stimulus valence affect visuo-​tactile integration. Acta Psychologica,
192, 42–​51.
Spence, C., Pavani, F., & Driver, J. (2004). Spatial constraints on visual-​tactile cross-​modal distractor
congruency effects. Cognitive, Affective & Behavioral Neuroscience, 4(2), 148–​169.
Sposito, A., Bolognini, N., Vallar, G., & Maravita, A. (2012). Extension of perceived arm length fol-
lowing tool-​use: clues to plasticity of body metrics. Neuropsychologia, 50(9), 2187–​2194.
132  Plasticity and tool use in the body schema
Sposito, A. V., Bolognini, N., Vallar, G., Posteraro, L., & Maravita, A. (2010). The spatial encoding of
body parts in patients with neglect and neurologically unimpaired participants. Neuropsychologia,
48(1), 334–​340.
Tomasello, M. (1999). The human adaptation for culture. Annual Review of Anthropology, 28(1999),
509–​529.
Umiltà, M. A., Escola, L., Intskirveli, I., Grammont, F., Rochat, M., Caruana, F., Jezzini, A., Gallese, V.,
& Rizzolatti, G. (2008). When pliers become fingers in the monkey motor system. Proceedings of the
National Academy of Sciences of the United States of America, 105(6), 2209–​2213.
Vaesen, K. (2012). The cognitive bases of human tool use. Behavioral and Brain Sciences, 35(4),
203–​218.
Vu Huynh, T., Bekrater-​Bodmann, R., Fröher, J., Vogt, J., & Beckerle, P. (2019). Robotic hand illusion
with tactile feedback : unravelling the relative contribution of visuotactile and visuomotor input to
the representation of body parts in space. PLoS One, 14(1), e0210058.
Wallwork, S. B., Talbot, K., Camfferman, D., Moseley, G. L., & Iannetti, G. D. (2016). The blink re-
flex magnitude is continuously adjusted according to both current and predicted stimulus position
with respect to the face. Cortex, 81, 168–​175.
Witt, J. K., Proffitt, D. R., & Epstein, W. (2005). Tool use affects perceived distance, but only when you
intend to use it. Journal of Experimental Psychology: Human Perception and Performance, 31(5),
880–​888.
Yamazaki, Y., Echigo, C., Saiki, M., Inada, M., Watanabe, S., & Iriki, A. (2011). Tool-​use learning by
common marmosets (Callithrix jacchus). Experimental Brain Research, 213(1), 63–​71.
Zollo, L., Di Pino, G., Ciancio, A. L., Ranieri, F., Cordella, F., Gentile, C., . . . Guglielmelli, E. (2019).
Restoring tactile sensations via neural interfaces for real-​time force-​and-​slippage closed-​loop con-
trol of bionic hands. Science Robotics, 4(27), eaau9924.
 9
Triadic body representations in the human
cerebral cortex and peripheral nerves
Noriaki Kanayama and Kentaro Hiromitsu

9.1 Introduction

Is the body reducible to neural representation in the brain? This is a basic question for
body research, which could be restated as follows: ‘Can human consciousness be gen-
erated without a body?’, as in the case of ‘a brain in a vat’. There have been numerous
neuroimaging, neurophysiological, and lesion research findings showing that certain
cortical networks have a role in body representation. The brain is crucial in explaining
how the body functions and interacts with the world. If all body-​related representations
are generated in our brain, human consciousness could arise in the ‘brain in a vat’ and
we could conclude that we do not need a body for our own body representation.
Then, what is body representation? As the primary subject of this book, the well-​
known dyadic taxonomy of the body schema and body image (BSBI) is based on evi-
dence from brain-​damaged patients. Although there is growing consensus that the
BSBI exists, there is little agreement on whether this dyadic taxonomy suffices to fully
describe our body recognition system in the brain since it is not a concrete concept and
has not been clearly unified across various research fields (Berlucchi & Aglioti, 2010; de
Vignemont, 2010; Pitron & de Vignemont, 2017). Herein, we revisit the BSBI concept
based on neurological and recent neuropsychological evidence related to the cerebral
cortex and discuss the possibility of triadic taxonomy.

9.2  Nerve fibres deliver bodily information

First, body perception requires the brain circuits to acquire information on our body.
To understand the body perception neural networks, we must start our journey from
the sensory receptors receiving body-​related inputs and the nerves transferring these
inputs to the brain. Actually, the most important case for understanding the BSBI is
that of Ian Waterman (IW) who suffered from damaged nerve fibres.
IW has been often introduced as a patient who lost all bodily feedback. While he rec-
ognized his body’s parts and size, he could not perceive any sensation related to his body.
Moreover, he could not move his body without seeing his body parts, which suggests

Noriaki Kanayama and Kentaro Hiromitsu, Triadic body representations in the human cerebral cortex and peripheral nerves
In: Body Schema and Body Image. Edited by: Yochai Ataria, Shogo Tanaka, and Shaun Gallagher, Oxford University Press.
© Oxford University Press 2021. DOI: 10.1093/​oso/​9780198851721.003.0009
134  Triadic body representations in the human cerebral cortex
that he had a body schema (BS) malfunction. Cole and Paillard (1995) reported that
IW’s afferent nerve fibres were damaged and hence he could neither transfer inputs
from the body perception-​related receptors (e.g., mechanoreceptor cells on the skin
surface) to the brain nor perceive these inputs in the brain. Body representation in the
brain, especially BS, was disrupted by this nerve damage, suggesting that our BS is con-
structed and maintained by receiving continuous inputs from body-​related receptors.
Moreover, we could estimate which nerves were damaged through IW’s own reports.
He had lost ‘all touch and sense of movement and position sense below the neck’ (http://​
www.thearticulatehand.com/​ian.html). Actually, any information regarding our face
(above the neck) is transferred by the seventh cranial nerve (i.e., the facial nerve). All
bodily sensation below the neck is transferred by the spinal nerves, suggesting that only
his spinal nerves were damaged. The spinal nerves could be divided into 31 divisions,
allocated to a distinct area of our body map based on the dermatome. Given that IW
lost all body-​part sensation, the damage maybe was located in the superior part, not
differentiated to any distinct body part. The spinal nerves are also functionally differen-
tiated into six types, as shown in Table 9.1.
Among these, Aα nerve fibres include both efferent and afferent nerve types. Afferent
Aα fibres transfer muscle sensations to the brain, whereas the efferent ones transfer
motor commands from the brain to skeletal muscles. The conduction velocity of Aα
fibres is the fastest among all spinal nerves, rendering our motor control very fluent.
Similarly, Aγ fibres, which are only of the efferent type, transfer efferent signals from
the brain to muscle spindles. Although IW showed severe motor deficits, he moved his
body by careful visual inspection of his movement, after effortful training, without any
bodily feedback; keeping his posture suggested that the efferent Aα and Aγ fibres were
intact, whereas the afferent Aα fibres were damaged. This assumption was supported by
a report that the patient’s electromyogram was normal (Cole & Paillard, 1995).
Moreover, IW’s Aβ fibres must have been damaged since they transfer informa-
tion on tactile perception, including pressure, stroke, and vibration. However, it was

Table 9.1  Classification of spinal nerve fibres

Name Conduction Function Estimation for

speed (m/​s) IW

Aα 70–​120 Afferent: motor (muscle spindle and tendon Partly impaired

receptor) perception
Efferent: motor (skeletal muscle) control Partly intact
Aβ 30–​70 Pressure or mechanical perception Fully impaired
Aδ 5–​30 Thermal/​pain perception Intact
Aγ 0.5–​2 Muscle tension control (intrafusal muscle fibre) Partly intact
B 3–​14 Autonomic response –​
C 0.5–​2 Visceral pain/​thermal pain, autonomic perception/​ Intact
affective touch (somatic C)
 Connection between the body and brain  135
reported that IW could feel pain and thermal sensation on his skin (Cole & Paillard,
1995), denoting that the Aδ and C fibres could have been intact.

9.3  Connection between the body and brain as a basis for the
body schema and/​or body image

Cole and Paillard (1995)’s report may suggest that IW had impaired motor perception
(afferent Aα) and lack of skin surface sensation (Aβ), intact pain and thermal sensation
(Aδ and C), and also partly preserved motor control (efferent Aα and Aα). Then, how
does this type of nerve damage result in a distorted BS and an intact body image (BI) in
the brain? Where do the spinal nerves transfer bodily information in the cortex?
Mechanosensory information, including pressure and vibration, is captured at the
mechanoreceptors and transferred by the Aβ fibres of the spinal nerves crossing the
dorsal column–​medial lemniscal system. Almost all spinal nerves delivering tactile in-
formation cross the medulla oblongata and thalamus, reaching the primary somato-
sensory (at the post-​central gyrus) and motor (at the precentral gyrus) cortices. The
tract between the spinal nerves and the cortex, the corticospinal tract (CST), has been
very clearly visualized using magnetic resonance imaging (MRI) (Govind et al., 2012;
Yeatman, Richie-​Halford, Smith, Keshavan, & Rokem, 2018), and the connection be-
tween the spinal nerves and the cortex has been confirmed using non-​invasive means.
Govind et al. (2012) found, using proton magnetic resonance spectroscopy (MRS), me-
tabolite alteration in the entire intracranial CST in patients with amyotrophic lateral
sclerosis, and the MRS parameters in this region have been correlated with disease se-
verity, including motor control impairment. These studies suggested that information
flow through the CST is closely related to our motor control and body perception.
As a well-​known fact, the primary somatosensory and motor cortices receiving pro-
jections from the CST are somatotopically organized (Penfield & Boldrey, 1937) and
have an important role in body part localization. Recent functional MRI (fMRI) studies
using 7-​T high-​resolution scanners have revealed that different fingers are represented
in different cortical regions in the primary somatosensory cortex (Martuzzi, van der
Zwaag, Farthouat, Gruetter, & Blanke, 2014), supporting Penfield’s findings and sug-
gesting that our body map is very finely segregated in the cortex. Furthermore, an fMRI
study revealed the somatotopic organization in the primary motor cortex, which is less
organized, compared to the primary sensory cortex (Lotze et al., 2000). Additionally,
the somatotopic map in the primary motor cortex can be activated by imagined motor
control (Stippich, Ochmann, & Sartor, 2002) and movement-​related words (Hauk,
Johnsrude, & Pulvermüller, 2004). The body map can be referred to both when we ac-
tually move our body and when we represent any body movement in the brain such
as motor simulation. An fMRI study during a body part movement task conducted by
Meier et al. (2008) has suggested that the map of the motor cortex is topographically
shaped based on the motor repertoire and the used body parts during movement. This
suggested that the somatotopic map of the motor cortex was organized based on the
136  Triadic body representations in the human cerebral cortex
motor experience. Recent studies have shown that these two areas can directly commu-
nicate (Tamè et al., 2015), which is supported by the U-​shape fibres directly connecting
the somatosensory cortex with the motor cortex (Catani et al., 2012). This reference
system, based on the association between the somatotopic representation in the pri-
mary somatosensory and motor cortices and the actual physical body map intermedi-
ated by the spinal nerves, could be a fundamental basis of the BS supporting our fluent
and unconscious body control. From this perspective, we might say that the physical
body itself, as an ending of spinal nerves, is not necessarily required to construct our
BS. In the example of spinal nerve injury caused by lumbar disc herniation, although
there was unilateral spinal nerve damage located at the waist (L4–​L5 and surrounding
areas), pain perception was located in the bilateral legs (Dogan et al., 2018). The leg’s
skin, muscle, and bone were not injured; however, the patient felt leg pain based on the
mapping of the dermatome. This suggests that the physical body may not be required,
at least for our recognition of pain at any body part. Phantom limb pain, i.e., pain per-
ception on lost body parts, might also be explained in the same manner. One study
demonstrated that phantom limb pain originates from the peripheral nerves (Vaso
et al., 2014), which suggests that the nervous system could generate all our pain percep-
tion, including body parts recognition.
Interestingly, IW reported pain and thermal sensations, suggesting that the Aδ and
C nerve fibres were preserved, as mentioned earlier. These do not follow the same tracts
with Aβ fibres; they pass through the anterolateral system and thalamus and reach the
primary somatosensory, motor, and insular cortices. Actually, Kenshalo and Isensee
(1983), using single-​neuron recording in macaques, demonstrated that a nociceptive
stimulus, well known to send a signal through the Aδ and C nerves, could activate the
primary somatosensory cortex. They also showed somatotopic correspondence be-
tween the stimulated location and the activated cortical area. In humans, Andersson
et al. (1997) demonstrated, using positron emission tomography, the somatotopically
organized pain map in the primary somatosensory cortex. These findings suggest that
IW’s movement (based on the BS) is partly supported by body location information
when the feedback sensation was painful.
In healthy individuals, pain-​related signals should have little impact on motor
learning, whereas C fibre signals, activated by light touch (Olausson et al., 2002), could
be a possible cue candidate for compensative training in patients with motor control
impairment. Given that the conduction speed of C fibres is far slower than that of Aα
and Aβ fibres, mostly used to realize fluent movement, it is likely that IW’s recon-
structed BS was unable to fluently control his body. The fact that IW must use visually
guided motor control also suggests that C fibre-​based information was not enough for
natural movement.
Here, we have confirmed that all body-​related information passes through the
spinal nerve fibres. The primary somatosensory and motor areas involve somatotopy,
receiving inputs from the spinal nerve fibres, and are possible candidates for the BS
basis. The response to the question ‘Is the body reducible to neural representation in
the brain?’ is NO. If we modify the question to ‘Is BODY SCHEMA reducible to neural
 BI, the insula, and visual information  137
representation in the brain and the peripheral nerves?’, then the answer is YES. It is im-
portant to consider the peripheral nerves as an integrated part of the nervous system,
which consists of the brain and the nerves, with the body being sensed and controlled
by this system. Based on this view, we would have to consider a ‘nervous system in a vat’,
instead of a ‘brain in a vat’.

9.4  BI, the insula, and visual information

If body representation can be divided into two aspects, BSBI, then we have to consider
another question: ‘Is BODY IMAGE reducible to neural representation in the brain and
the peripheral nerves?, as is BS. To this end, we next consider the neural basis of BI in
body recognition; according to the definition by Schilder (1935), ‘the picture of our own
body which we form in our mind’, the typical BI may be similar to our visually captured
body structure. Traditional BI assessment adopts a frontal body drawing (Thompson &
Gray, 1995). Further, brain damage distorts parts of the self-​body drawing, for example
enlarging the hand contralateral to the damaged hemisphere (Rode, Vallar, Chabanat,
Revol, & Rossetti, 2018), which is in stark contrast to the BS representation. If the basis
of the BS is somatotopic representation in the cortex, the reconstructed body structure
would be the Cortical Homunculus, in which the extent of the cortical area corres-
ponding to body parts increases, based on spatial resolution, enlarging the Cortical
Homunculus’s head, lips, and hands. Most may disagree that the BI resembles the
Cortical Homunculus in terms of size ratio. The BI should be constructed with bodily
information other than that passing through the spinal nerves, for instance with visual
information of the body.
Mapping of the somatosensorily perceived physical body is represented in the
somatotopy of the somatosensory and motor cortices, whereas there is retinotopy for
vision as another candidate for body map generation (Wandell, Brewer, & Dougherty,
2005). The primary visual cortex has orderly arranged neurons showing spatial speci-
ficity on the retina. Similar to the somatotopic map for specific body parts, a specific
cortical area in the primary visual cortex corresponds to specific locations on the retina
(visual field). This is termed the ‘retinotopic map’, emerging as a mirror to project the
external visual field on the brain. Recent neuroscientific research has revealed the pos-
sibility that the spatial pattern of brain activation could reconstruct a picture that the
person has viewed (Horikawa & Kamitani, 2017; Kamitani & Tong, 2005). These find-
ings encourage us to assume that all visuo-​spatial information of the external world
captured on the retina is allocated in the retinotopic map to reconstruct a visual scene
in the brain. When our body parts or whole body are reflected on a lake surface or
a mirror or in a picture taken by a camera and come in the visual field, we, at first,
recognize our body as a visual object in our visual field. It must be just the beginning
of visually represented body in the brain. However, the body parts in the visual field
are merely specific visual patterns, not in themselves containing information related to
our body. The mere visual inputs need to get any relationship with bodily information
138  Triadic body representations in the human cerebral cortex
through the processing flow in the cortex. The association process is possibly a funda-
mental factor in BI.
Andersen et al. (1997) demonstrated bimodal neurons, responding to both somato-
sensory and visual stimuli on the body surface, in the intraparietal cortex of macaques.
The extent of bimodal neurons has been known to be expandable to the tip of a rake,
recognized as a tool to reach food (Iriki, Tanaka, & Iwamura, 1996). Moreover, brain-​
derived neurotrophic factor involvement has been suggested in this plasticity of the
bimodal neuron map in macaques (Ishibashi et al., 2002) and humans (Hiramoto et al.,
2017). This may indicate that the bimodal neurons in the parietal area, located in the
dorsal stream of the visual information processing pathway, play an important role in
associating the coordinates of the visual field map (based on retinotopic representa-
tion) and body map (based on somatotopic representation). During the rubber hand
illusion, which is considered a result of binding between visual and somatosensory spa-
tial coordinates, electroencephalographic activations related to visuo-​tactile integra-
tion have been observed in the parietal area (Kanayama, Sato, & Ohira, 2007, 2009;
Kanayama, Tamè, Ohira, & Pavani, 2012); additionally, the parietal-​centred network
could also be involved (Kanayama et al., 2007; Kanayama, Morandi, Hiraki, & Pavani,
2017b), suggesting that updating the correspondence between the visual field and body
maps likely requires interaction among occipital (as visual information), parietal (as
visual bodily image), and frontal areas, including the motor-​related cortices (as motor
information). A series of intersensory associations, starting from the dorsal stream of
visual information and ending in the motor-​related cortical areas, are possibly one fun-
damental factor generating the BI in our brain and facilitating the BSBI interaction.
Possibly, this information stream is the basis of compensatory, visually guided move-
ment control in IW.
In addition to the dorsal stream, visual information processing also implicates the
ventral stream. In this pathway, mainly semantic information is processed in the higher
visual cortices, such as V4 and the inferior temporal (IT) or middle temporal (MT)
cortices, compared to the spatial visuo-​tactile association at the dorsal stream. The IT
cortex processes material qualities including of the surface, e.g., glossiness, translu-
cency, and texture, or the internal state of an object (Goda, Tachibana, Okazawa, &
Komatsu,2014; Komatsu & Goda, 2018; Nishio, Goda, & Komatsu, 2012), suggesting
that the temporal cortical area could be related to the abstract evaluation of a visual ob-
ject to extract meaning. For example, there are some cortical regions involved in body-​
related visual object recognition: the fusiform face area (FFA) (Kanwisher, McDermott,
& Chun, 1997) and the extrastriate body area (EBA) (Downing, Jiang, Shuman, &
Kanwisher, 2001; Downing, & Peelen, 2016; Peelen, & Downing, 2007). These findings
regarding the ventral visual stream suggest that the visual pattern of body parts cap-
tured on the retina is associated with meaning and possibly labelled ‘self-​body’. This
is another candidate for the neural basis of BI. Actually, illusory self-​recognition on
the avatar’s face, which was rotated synchronously with one’s own face, as in mirror
viewing, was associated with the causal information flow from the motor-​related
brain area to the temporal visual area (Serino et al., 2015). It is safe to assume that the
 BI, the insula, and visual information  139
recognition of consistency between self and avatar face movement induces the labelling
of ‘self-​body’ on the visual pattern of the avatar’s face, and a cortical candidate is motor–​
visual association at the ventral stream of visual processing.
More importantly, the temporal cortex is structurally connected with the insular
cortex (Mesulam & Mufson, 1982), which is a known region of emotional information
processing and also receives body-​related inputs from the CST. Affective information,
generated by light touch on the body surface, passes through the C fibres and thal-
amus and directly reaches the insular cortex, considered to have a role in recognizing
affective aspects of thermal, nociceptive, and pleasant sensation (Kandel et al., 2012).
Tsakiris et al. (2007) have demonstrated that the insular cortex is involved in the rubber
hand illusion. Moreover, there was a significant correlation between insular cortex
volume and the score on a questionnaire measuring body ownership-​related malfunc-
tion in everyday life (Asai, Kanayama, Imaizumi, Koyama, & Kaganoi, 2016), sug-
gesting that the insula is involved in body ownership (Kanayama, Asai, Nakao, Makita,
Kozuma, Uyama, Yamane, Kadota, & Yamawaki, 2017a). Henderson, Gandevia, and
Macefield (2007) demonstrated that the insular cortex area activated by painful stimu-
lations differed according to the stimulated site on the body surface (leg and forearm),
indicating that the insular cortex is partly somatotopically organized, although not as
finely differentiated as the somatosensory cortex. The insula is functionally connected
to the superior temporal sulcus and supplementary motor area (SMA) and the anterior
cingulate cortex, which is related to motor control (Deen, Pitskel, & Pelphrey, 2011).
The dorsal part of the insular cortex is reportedly overactivated in patients with anor-
exia nervosa who often have BI-​related issues, compared to healthy controls, during
perceiving visceral sense (Kerr et al., 2016). The finding suggests that the dorsal part
of the insular cortex influences the symptoms observed in anorexia nervosa such as
distorted body image. Altogether, the insular cortex could be a hub associating visual
object semantics, somatosensory sensation, emotion, motor control, and visceral status
(Carr et al., 2003). The relationship between the insula and BI (processing in the ventral
visual pathway on the temporal cortex) remains unclear; it is just one cortical area can-
didate for BI generation.
As previously discussed, a specific visual pattern of an external object (here, it is the
body), captured on the retina, projected on the retinotopic map of the primary visual
cortex, and associated with body-​related information on the ventral visual stream can
be the basis of BI generation in the brain. This raises the question regarding whether
blind people do not indeed have BI; if we define BI as ‘a body image generated based
on the visual information from retina, the primary visual cortex, and ventral stream
of visual cortical areas’, then, by definition, blind people in principle have no BI. Here,
returning to the modified question in this section, i.e., ‘Is BODY IMAGE reducible to
neural representation in the brain and the peripheral nerves?’, the answer is NO. As dis-
cussed above, if retinotopical copies of the external world are mandatory for generating
the BI, it cannot originate without various patterns of optical stimulations derived from
the external world. However, if conceptual and emotional aspects must also be in-
cluded in the BI, as reviewed above, insular-​based information processes are candidates
140  Triadic body representations in the human cerebral cortex
against this argument. Therefore, this issue remains controversial, and more studies are
needed on the complicated human neural networks and their BI-​related interactions.
Here, if body recognition in the brain is based on complicated communication
among numerous cortical regions (naturally also including the cerebellum, not men-
tioned here), then the question remains: ‘Is the simple BSBI dichotomy sufficient to
explain our body recognition?’ Moreover, we might wonder whether it is possible to
clearly differentiate between the BS and BI. As another example, the ventral stream
includes the EBA that is activated during recognition of body part images, which
is a BI-​related phenomenon (Downing et al., 2001). Meanwhile, Astafiev, Stanley,
Shulman, and Corbetta (2004) demonstrated EBA’s activation without seeing a body
part during visually guided movement, which is a BS-​related action without BI. This
implies that the BI and BS are very closely related and difficult to isolate in the brain.
Reviewing the studies on cortical lesions is very helpful in further examining what in-
dependence can be assumed between the BS and the BI and whether this dichotomy
is appropriate.

9.5  Triadic taxonomy of body representation

Here, we revisit the BSBI conception based on recent neuropsychological evidence

and extend a previous triadic taxonomy of body representation (Longo, Azañón, &
Haggard, 2010; Schwoebel & Coslett, 2005; Sirigu, Grafman, Bressler, & Sunderland,
1991; Tamè, Azañón, & Longo, 2019), based on the symptomatology revealed by
studying patients with brain damage in terms of the psychological aspects of the body,
since previous dyadic taxonomy (i.e., BS and BI) has some limitation regarding the
concept and neural basis.
The problem with the previous dyadic taxonomy (Gallagher & Cole, 1995; Head &
Holmes, 1911; Schilder, 1935) is that it is based on single case reports or small patient
group studies and lacks large-​scale investigation regarding the putative human body
representation in the brain. Therefore, the BSBI concept lacks evidentiary substanti-
ation. Both online and offline information is necessary for action execution, although
BS is defined only as an online sensorimotor representation. Automatic unconscious
action execution, such as riding a bicycle, does not require offline-​stored information
of the body since there is no need for identifying body parts associated with that ac-
tion using the stored body information, while reflective conscious action (e.g., when
learning a new skill) requires offline-​stored information such as visually identifying
body parts whose location is derived from the stored body part map. Moreover, the BI
includes both perceptual and conceptual aspects (de Vignemont, 2010). At the visuo-​
spatial level, the BI provides a structural map of the relationships between body parts
(i.e., boundaries, proximity, and position relative to each other), which is referred to as
‘body structural description’. At the conceptual level, the BI is a semantic and linguistic
representation describing the functional purpose of body parts and the categorical re-
lationships between them, which is referred to as ‘body semantics’. Accordingly, as de
 Triadic taxonomy of body representation  141
Vignemont (2010) suggested, there are a number of body representations; to resolve
these problems, a novel classification explaining our bodily phenomena with regard to
brain function would be crucial.
Here, based on recent neurological, neuropsychological, and brain imaging study
findings, we discuss the plausibility of three types of body representation: body schema
(BS), body structural description (BSD), and body semantics (Bsem) (Razmus, 2017;
Schwoebel & Coslett, 2005). The BS is an online sensorimotor representation of the
body, including motor imagery, allowing us to estimate the current body position rela-
tive to the other body part positions, derived from efference copy signals (Wolpert &
Ghahramani, 2000). Previous studies have suggested that the BS underlies simulated
body movement, shown in a series of experiments examining the laterality judgement
by imaging the hand moving from its current position into the orientation of the tar-
geted hand image (Parsons, 1987). The BSD is a map of the body defining the body part
boundaries and proximity relationships (Buxbaum & Coslett, 2001). This representa-
tion derives from the offline aspect of the conventional BS and the perceptual aspect
of the conventional BI. Autotopagnosia is a bodily disorder involving BSD deficit, in
which the patients are unable to localize their own body parts (Sirigu et al., 1991). Sirigu
et al. (1991) explained that the inability to point at one’s own body or pointing incor-
rectly is due to impairment of the visuo-​spatial representation of body structures, and
more of touch localization (Kinsbourne & Warrington, 1962; Rusconi et al., 2009; Tamè,
Dransfield, Quettier, & Longo, 2017). Finally, Bsem involves lexical, semantic, and con-
ceptual aspects of body representation, including the naming and functions of body
parts, their categorical relations, and the relations of the artefacts such as accessories
(Coslett, Saffran, & Schwoebel, 2002; Laiacona, Allamano, Lorenzi, & Capitani, 2006).
Deficits of Bsem lead to an inability to name the body parts. Suzuki, Yamadori, and Fujii
(1997) reported the case of a patient with infarction in the left frontal and parietal re-
gions showing impaired body part naming comprehension (Bsem-​related function),
despite preserved comprehension of the words independently of the body and preserved
function of pointing at body parts (BSD-​based function). The interaction between the
BSD and Bsem has been supported by a developmental study, indicating that the spa-
tial body representation (i.e., motor skills) shapes the semantic body representation (i.e.,
naming the body parts) in 5-​to 11-​year-​old children (Auclair & Jambaqué, 2015).
Originally, this triadic taxonomy was only based on evidence from single cases or
small patient group studies. However, a large-​scale investigation was conducted by
Schwoebel and Coslett (2005) to examine the validity of the putative triadic taxonomy
for body representation. Behavioural tasks non-​verbally measuring three types of
body representation were used on 70 patients with single-​hemisphere stroke. Seven
tasks were given to assess the three body representations. Hand imagery/​action task
(to imagine making a specific movement and execute it) (Sirigu et al., 1996) and
hand laterality task (to judge if the stimulus is the right or left hand) (Parsons et al.,
1995) were used to assess BS. The BSD was measured with the tasks to assess the func-
tion of localization of the isolated body parts (to point to the same part of one’s own
body as presented), localization of tactile input, and matching body parts by location
142  Triadic body representations in the human cerebral cortex
(to point to one of three pictured body parts that was closest on the body surface to
the target body part picture). Finally, Bsem was assessed with tasks measuring the
ability to match body parts by function (to select one of the three pictured body parts
that was most closely related in terms of function to the target body part) and match
body parts to clothings and objects (to point to the picture of the body part with which
the item of clothing or accessory was most closely associated). The mean proportions
of correct responses for each task were analysed using principle component analysis,
and four components were found: one for BSD, one for Bsem, and the other two for
BS. Moreover, after comparing with the results of age-​matched healthy controls, it was
found that each patient group had impaired performance in each body representation
task. These results indicate three independent representations for the body behind
some bodily disorders.

9.6  Neural mechanisms underlying the three

body representations

Regarding the neural mechanisms underlying the three body representations, a study
reported that the brain regions underlying the BSD and Bsem are lateralized to the left
hemisphere; in contrast, the brain regions underlying the BS are not clearly lateralized
(Schwoebel & Coslett, 2005). Lesion analysis by Schwoebel and Coslett (2005) revealed
that brain regions including the dorsolateral frontal cortex and parietal lobe were
more frequently detected in patients with deficits in body representation, compared
with those without deficits. Although the specific brain regions or neural mechanisms
underlying each body representation remain unclear, if we focus more closely on the
brain regions involving the BSD and Bsem, we may identify involvement of the tem-
poral lobe, including the visual dorsal/​ventral pathway, as described by Schwoebel and
Coslett (2005). Furthermore, posterior parietal lobe involvement in BS impairment has
suggested an association with the dorsal stream responsible for action with and without
vision (Goodale & Milner, 1992). Here, we consider the possibility that three streams of
visual information processing in the cerebral cortex may contribute to the functioning
of the three body representations.
There are three visual information streams in the brain: the dorso-​dorsal (d-​d),
ventro-​dorsal (v-​d), and ventral streams (Galletti & Fattori, 2018; Rizzolatti & Matelli,
2003) (see Figure 9.1). These streams are dedicated to the visual processing of bodily
action and perception in accordance with each body representation (Buxbaum &
Kalénine, 2010; Jeannerod, 1994).
First, the ventral stream, from V4 to the IT lobe, generally processes information
on object colour and form (Goodale & Milner, 1992; Mishkin, Ungerleider, & Macko,
1983). Because this stream includes the EBA, selectively involved in visual processing
of the human body, it contributes to the organization and transfer of semantic infor-
mation of the human body to the IT lobe (Downing et al., 2001). The ventral stream,
including the EBA, is associated with both body visual features and posture, and
Neural mechanisms underlying the three body representations  143

Figure 9.1  Correspondence of the three streams in the brain with the three body
representations.

contextual information suggests that the EBA provides specific meaning to the bodily
state and contributes to the function of Bsem. Furthermore, a recent study showed that
the EBA is functionally related to the d-​d and d-​v streams, suggesting the possibility
that semantic bodily information depends on low-​level spatial and motor information
(Zimmermann, Mars, de Lange, Toni, & Verhagen, 2018).
Second, the v-​d stream, from MT/​V5 to the inferior parietal lobule, has been
called the ‘where system’, in which the object’s position in space is consciously pro-
cessed (Mishkin et al., 1983). Impairment of the v-​d stream reportedly induces
simultagnosia (Michel & Henaff, 2004) or autotopagnosia (Sirigu et al., 1991). These
bodily disorders are related to dysfunction in visually and consciously recognizing
body part coordinates in space, suggesting the relevance of the BSD. Neuroimaging
studies in healthy individuals revealed that the ability of spatial localization of
body parts is correlated with the activation of the intraparietal sulcus (visual arm
stimuli) (Corradi-​Dell’Acqua, Tomasino, & Fink, 2009) and the antero-​medial in-
ferior parietal lobule (tactile stimuli for fingers) (Rusconi et al., 2014), suggesting
the involvement of the v-​d stream in BSD. Finally, the d-​d stream has been called
the ‘how system’, in which body posture and body part position in space are uncon-
sciously processed to execute an action. The d-​d stream is anatomically distinguished
from the v-​d stream at the boundary of the intraparietal sulcus and connected to the
inferior parietal lobule and primary somatosensory cortex. Impairment of the d-​d
stream leads to optic ataxia (Rossetti & Pisella, 2018) and spatial disorientation of the
body (Kase, Troncoso, Court, Tapia, & Mohr, 1977), both of which can be interpreted
as deficits of spatially visually guided action.
The function of unconsciously processing sensorimotor information to reflect action
execution coincides with the BS. Accordingly, the three body representations approxi-
mate the function of the three visual streams, although the information underpinning
144  Triadic body representations in the human cerebral cortex
the human body is not limited to visual information. However, it was recently reported
that the visual cortex is implicated in supramodal sensory organization, not just visual
processing (Striem-​Amit & Amedi, 2014), suggesting that various information con-
structing the body representation is processed in streams previously considered as
vision-​specific.
Based on this evidence, we discuss the plausibility that bodily disorders due to brain
lesions can be accounted for by the triadic taxonomy of body representation and that
the streams in the brain form the body as a whole, extending to a unified embodied self.
BS dysfunction elicits disruption of online sensorimotor processing, leading to optic
ataxia or spatial disorientation of the body, as we reviewed earlier. Dysfunction of BSD
elicits autotopagnosia (Sirigu et al., 1991). Body semantic dysfunction relates to deficits
selectively associated with naming body parts (Dennis, 1976). This can be interpreted
as single body representation deficits; however, there appear to be overlaying multiple
body representation deficits that cannot be explained by the previous dyadic taxonomy
since some complex bodily symptoms are considered to be a mixture of three body
representations or more. Examining these mixed complex symptoms leads to better
understand the issues regarding clinical assessment of bodily disorders in brain-​
damaged patients.
As out-​of-​body experiences (OBEs) appear to be a distinct symptom, including mul-
tiple body representation deficits, we introduce a single case and discuss the possibility
of explaining OBEs using the triadic taxonomy of body representation. An OBE occurs
when an individual appears to view his/​her body and the world from a location outside
the physical body (Blanke, Landis, Spinelli, & Seeck, 2004; Brugger, 2002; Devinsky,
Feldmann, Burrowes, & Bromfield, 1989). The patient in our case was a 46-​year-​old
right-​handed woman with brain tumours in the left medial parietal lobe and posterior
cingulate cortex (Hiromitsu, Shinoura, Yamada, & Midorikawa, 2020). The patient
reported that she experienced OBEs several times a month before surgery and they
disappeared after surgery performed for brain tumour removal. We interviewed her
carefully; we report our findings below:

(1) She viewed her body from above and 1–​1.5 metres behind the physical body.
(2) She felt that the parasomatic body was larger than the physical body.
(3) The parasomatic body could not move.
(4) Although she recognized her own body from behind, as revealed by the state-
ment ‘I can see myself moving’, she also recognized the parasomatic body as her
own (with the descriptors ‘real form’, ‘myself ’, and ‘myself who is thinking’).

Description (1) above shows that she experienced a feeling of spatial separation of
the self and body. The body that was elevated above the ‘real’ body is called parasomatic
body; this is both a common and characteristic feature of OBEs. Description (2) indi-
cates that the subjective (i.e., parasomatic) body was larger than the objective (i.e., phys-
ical) one. In terms of the neural mechanism involved, an earlier neuroimaging study
suggested that body size perception involves the post-​central and intraparietal sulci
 Body representation in the brain and the self  145
(Ehrsson, Kito, Sadato, Passingham, & Naito, 2005). Thus, it is possible that damage
to the parietal lobe in our case may have elicited self-​body misperception. These de-
scriptions indicate disruption of bodily spatial localization. Although her physical
body existed, she observed it below her and to the front, suggesting the involvement
of BSD deficits contributing to the spatial mapping of the body. Description (3) indi-
cates motor dysfunction of the physical body. Focus on the functional difference be-
tween the parasomatic and physical bodies reveals a difference in body representation.
Description (3) implies that the body responsible for motor function is independent
of the body charged with self-​localization in space. The former corresponds to the BS
concept, and the latter to the concept of BSD. That observed physical body could move;
in contrast, the inability of the observing self to move implies dissociation between the
BS and BSD. Description (4) features the patient’s bodily state. The patient recognized
the physical body in front of and below her as herself, and simultaneously accepted the
subjective body as herself. More interestingly, she described the parasomatic body as
her ‘real form’ (a type of body representation) but also described the parasomatic body
both abstractly and conceptually as ‘myself who is thinking’. The patient clearly differ-
entiated the observing body (a subject) from the observed body (an object). Based on
these descriptions, the semantic and conceptual aspects of the conscious self appeared
to be reflected by Bsem. Together, it is considered that the OBE is a symptom suggesting
the involvement of the three body representations and the independence of each repre-
sentation as an individual function.
Considering the possibility that the three body representations coincide with specific
pathways in the brain, we should not focus on specific brain regions, but on streams or
networks including multiple regions across the brain when we strive to elucidate body
representations in the brain (Fox, 2018; Parr & Friston, 2018).

9.7  Body representation in the brain and the self

In this chapter, we revisited the BSBI from the perspective of the peripheral nerves,
CST, cortex, and information streams in the cortex. Based on these reviews, we found
that it is important to consider the peripheral nerves as an integrated part of the ner-
vous system to understand the neural basis of BS. Additionally, it was suggested that
retinotopical representation existing in the external world constitutes the basis of BI.
Moreover, we confirmed the review of the neuropsychological research based on the
three streams of visual information flow sheds doubt on the dyadic taxonomy model
of body representation and provides evidence supporting the triadic taxonomy. These
neural network-​based reviews could lead to a perspective shift toward a new paradigm
for body representation in the brain.
Patients with bodily disorders experience limitations pertaining to their own
bodies, not the bodies of others’. Our body-​related dysfunctions must belong to our-
selves. In this sense, we inevitably consider that bodily disorders involve the concept
of ‘self ’ and support that the relationship among the knowledge regarding the neural
146  Triadic body representations in the human cerebral cortex
basis of the body, the triadic taxonomy of body representation, and the concept of
the self could provide novel insight for our future BSBI studies. Body representations
are highly related to the sense of self such as the sense of ownership and the sense of
agency because our sense of self is considered to underlie bodily subjective experi-
ences (Asai et al., 2016; Gallagher, 2000). These senses of the self are defined as the
‘minimal self ’ and involve continuous embodied experience that is represented in the
reflections of the body (sense of ownership) and its actions (sense of agency) that form
its temporal extension as a narrative self. Thus, the BS is associated with the sense of
agency tacitly functioning in terms of action, often expressed phenomenologically as
‘pre-​reflective’. Conversely, BSD is associated with the sense of ownership in that this
representation refers to the conscious aspect of the self-​body. Bsem may be related to
the narrative self in terms of body information continuity, as the minimal self involves
continuous embodied experience, forming the narrative self as its temporal extension.
When BS and BSD are assumed to correspond to the current state of the self-​body in
the brain, the meaning and accumulation of the current bodily state reflect the func-
tion of Bsem. In this respect, BS and BSD are assumed to correspond to the online
representations of the body, which code for synchronic aspects of the body, and are
constructed directly from current sensory inputs; conversely, Bsem is assumed to cor-
respond to the offline representations of the body, which code for more permanent
and diachronic aspects of the body, and are partially constructed from online repre-
sentations of the body (Carruthers, 2008). Carruthers (2008) argued that the sense
of embodiment, which is the sense of being distinct from other objects and persons,
is crucial for the self in terms of constructing the meaning of the bodily state and the
anatomical, postural, and visual features of the body. Furthermore, offline represen-
tations filter sensory online inputs for attribution to the self in order to maintain a
coherent sense of one’s own body (Tsakiris & Fotopoulou, 2008). In contrast, online
representations of the body also relate to the self since the sense of agency and own-
ership, which we described above, are formed based on transient information of the
body and action (i.e., online representations of the body). Accordingly, three body
representations are associated with the self, and such relations are well organized ac-
cording to some classifications (agency, ownership, and narrative self; online/​offline
representations of the body). However, it should be noted that these three body repre-
sentations are more complex and intertwined. Next, concrete examples of interaction
among the three body representations are shown.
We then propose some examples to generate Bsem using the current state of self-​
body based on BS/​BSD. The aforementioned study regarding the embodiment of an
avatar face by seeing it moving synchronously with own head movement, like mirror
viewing (Serino et al., 2015), suggested that sensorimotor consistency (BS/​BSD-​
related function) gives the meaning of ‘self ’ to the visual pattern of the body (Bsem).
Also, in the formation of action memory (e.g., observation inflation) (Lindner et al.,
2010; Kashihara et al., 2017), whether the action is well predictable and internalized
as own repertoires (BS-​related function) affects whether the memory of such action
is associated with self-​action (Bsem). These studies may indicate that the concept of
 Body representation in the brain and the self  147
self-​including Bsem might be generated based on BS-​related functions like sensori-
motor contingency. Decomposing BS/​BI into BS/​BSD/​Bsem may be useful for under-
standing complex correspondence between body representations and the mechanism
of self-​recognition.
Recent findings revealed that various brain regions are involved in the sense of self
(Kanayama et al., 2017a), and that brain lesions are associated with an anomalous sense
of self, indicating left hemispheric involvement for the sense of the self (Hiromitsu
et al., 2018). Thus, the evidence for body representation in the brain in terms of the self
illustrates the possibility that certain streams or networks in the brain play key roles in
constructing body representation.

References
Andersen, R. A., Snyder, L. H., Bradley, D. C., & Xing, J. (1997). Multimodal representation of space
in the posterior parietal cortex and its use in planning movements. Annual Review of Neuroscience,
20(1), 303–​330.
Andersson, J. L. R., Lilja, A., Hartvig, P., Långström, B., Gordh, T., Handwerker, H., & Torebjörk, E.
(1997). Somatotopic organization along the central sulcus, for pain localization in humans, as re-
vealed by positron emission tomography. Experimental Brain Research, 117(2), 192–​199.
Asai, T., Kanayama, N., Imaizumi, S., Koyama, S., & Kaganoi, S. (2016). Development of Embodied
Sense of Self Scale (ESSS): exploring everyday experiences induced by anomalous self-​
representation. Frontiers in Psychology, 7, 1005.
Astafiev, S. V, Stanley, C. M., Shulman, G. L., & Corbetta, M. (2004). Extrastriate body area in human
occipital cortex responds to the performance of motor actions. Nature Neuroscience, 7(5), 542–​548.
Auclair, L. & Jambaqué, I. (2015). Lexical-​semantic body knowledge in 5-​to 11-​year-​old children: how
spatial body representation influences body semantics. Child Neuropsychology, 21(4), 451–​464.
Berlucchi, G., & Aglioti, S. M. (2010). The body in the brain revisited. Experimental Brain Research,
200(1), 25–​35.
Blanke, O., Landis, T., Spinelli, L., & Seeck, M. (2004). Out-​of-​body experience and autoscopy of
neurological origin. Brain, 127(PPt 2), 243–​258.
Brugger, P. (2002). Reflective mirrors: Perspective-​taking in autoscopic phenomena. Cognitive
Neuropsychiatry, 7(3), 179–​194.
Buxbaum, L. J. & Coslett, H. B. (2001). Specialised structural descriptions for human body parts: evi-
dence from autotopagnosia. Cognitive Neuropsychology, 18(4), 289–​306.
Buxbaum, L. J. & Kalénine, S. (2010). Action knowledge, visuomotor activation, and embodiment in
the two action systems. Annals of the New York Academy of Sciences, 1191(1), 201–​218.
Carr, L., Iacoboni, M., Dubeau, M.-​C., Mazziotta, J. C., Luigi Lenzi, G., & Raichle, M. E. (2003). Neural
mechanisms of empathy in humans: a relay from neural systems for imitation to limbic areas.
Proceedings of the National Academy of Sciences of the United States of America, 100(9), 5497–​5502.
Carruthers, G. (2008). Types of body representation and the sense of embodiment. Consciousness and
Cognition, 17(4), 1302–​1316.
Catani, M., Dell’Acqua, F., Bizzi, A., Forkel, S. J., Williams, S. C., Simmons, A., Murphy, D. G., &
Thiebaut de Schotten, M. (2012). Beyond cortical localization in clinico-​anatomical correlation.
Cortex, 48(10), 1262–​1287.
Cole, J., & Paillard, J. (1995). Living without touch and peripheral information about body position
and movement : studies with deafferented subjects. In J. L. Bermudez, A. J. Marcel, & N. M. Eilan
(eds.), The Body and the Self (pp. 245–​66). Cambridge, MA: MIT Press.
Corradi-​Dell’Acqua, C., Tomasino, B., & Fink, G. R. (2009). What is the position of an arm rela-
tive to the body? Neural correlates of body schema and body structural description. Journal of
Neuroscience, 29(13), 4162–​4171.
148  Triadic body representations in the human cerebral cortex
Coslett, H. B., Saffran, E. M., & Schwoebel, J. (2002). Knowledge of the human body. Neurology, 59(3),
357–​363.
de Vignemont, F. (2010). Body schema and body image: pros and cons. Neuropsychologia, 48(3),
669–​680.
Deen, B., Pitskel, N. B., & Pelphrey, K. A. (2011). Three systems of insular functional connectivity
identified with cluster analysis. Cerebral Cortex, 21(7), 1498–​1506.
Dennis, M. (1976). Dissociated naming and locating of body parts after left anterior temporal lobe
resection: an experimental case study. Brain and Language, 3, 147–​163.
Devinsky, O., Feldmann, E., Burrowes, K., & Bromfield, E. (1989). Autoscopic phenomena with seiz-
ures. Archives of Neurology, 46(10), 1080–​1088.
Dogan, I., Bozkurt, M., Kahilogullari, G., Yakar, F., Zaimoglu, M., Bakirarar, B., . . . Caglar, Y. S. (2018).
Is a unilateral surgical approach effective in patients with bilateral leg pain with unilateral lumbar
disc herniation? A prospective nonrandomized clinical and surgical study. World Neurosurgery,
117, e316–​e322.
Downing, P. E, Jiang, Y., Shuman, M., & Kanwisher, N. (2001). A cortical area selective for visual pro-
cessing of the human body. Science, 293(5539), 2470–​2473.
Downing, P. E. & Peelen, M. V. (2016). Body selectivity in occipitotemporal cortex: causal evidence.
Neuropsychologia, 83, 138–​148.
Ehrsson, H. H., Kito, T., Sadato, N., Passingham, R. E., & Naito, E. (2005). Neural substrate of body
size: illusory feeling of shrinking of the waist. PLoS Biology, 3(12), 1–​8.
Fox, M. D. (2018). Mapping symptoms to brain networks with the human connectome. New England
Journal of Medicine, 379(23), 2237–​2245.
Gallagher, S. (2000). Philosophical conceptions of the self: implications for cognitive science. Trends
in Cognitive Sciences, 4(1), 14–​21. http://​www.ncbi.nlm.nih.gov/​pubmed/​10637618
Gallagher, S. & Cole, J. (1995). Body image and body schema in a deafferented subject. Journal of Mind
and Behavior, 16(4), 369–​390.
Galletti, C. & Fattori, P. (2018). The dorsal visual stream revisited: stable circuits or dynamic path-
ways? Cortex, 98, 203–​217.
Goda, N., Tachibana, A., Okazawa, G., & Komatsu, H. (2014). Representation of the material prop-
erties of objects in the visual cortex of nonhuman primates. Journal of Neuroscience, 34(7),
2660–​2673.
Goodale, M. A. & Milner, A. D. (1992). Separate visual pathways for perception and action. Trends in
Neurosciences, 15(1), 20–​25. http://​www.ncbi.nlm.nih.gov/​pubmed/​1374953
Govind, V., Sharma, K. R., Maudsley, A. A., Arheart, K. L., Saigal, G., & Sheriff, S. (2012).
Comprehensive evaluation of corticospinal tract metabolites in amyotrophic lateral sclerosis using
whole-​brain 1H MR spectroscopy. PLoS One, 7(4), e35607.
Hauk, O., Johnsrude, I., & Pulvermüller, F. (2004). Somatotopic representation of action words in
human motor and premotor cortex. Neuron, 41(2), 301–​307.
Head, B. Y. H. & Holmes, G. (1911). Sensory disturbances from cerebeal lesions. Brain, 34, 102–​254.
Henderson, L. A., Gandevia, S. C., & Macefield, V. G. (2007). Somatotopic organization of the pro-
cessing of muscle and cutaneous pain in the left and right insula cortex: a single-​trial fMRI study.
Pain, 128(1–​2), 20–​30.
Hiramoto, R., Kanayama, N., Nakao, T., Matsumoto, T., Konishi, H., Sakurai, S., Okada, G., Okamoto, Y.,
& Yamawaki, S. (2017). BDNF as a possible modulator of EEG oscillatory response at the parietal cortex
during visuo-​tactile integration processes using a rubber hand. Neuroscience Research, 124, 16–​24.
Hiromitsu, K., Asai, T., Saito, S., Shigemune, Y., Hamamoto, K., Shinoura, N., Yamada, R., &
Midorikawa, A. (2018). Measuring the sense of self in brain-​damaged patients. Medicine, 97(36),
e12156.
Hiromitsu, K., Shinoura, N., Yamada, R., & Midorikawa, A. (2020). Dissociation of the subjective and
objective bodies: Out-​of-​body experiences following the development of a posterior cingulate le-
sion. Journal of Neuropsychology, 14(1), 183–​192.
Horikawa, T. & Kamitani, Y. (2017). Generic decoding of seen and imagined objects using hierarch-
ical visual features. Nature Communications, 8, 15037.
 Body representation in the brain and the self  149
Iriki, A., Tanaka, M., & Iwamura, Y. (1996). Coding of modified body schema during tool use by ma-
caque postcentral neurones. NeuroReport, 7, 2325–​2330.
Ishibashi, H., Hihara, S., Takahashi, M., Heike, T., Yokota, T., & Iriki, A. (2002). Tool-​use learning
selectively induces expression of brain-​ derived neurotrophic factor, its receptor trkB, and
neurotrophin 3 in the intraparietal multisensorycortex of monkeys. Cognitive Brain Research,
14, 3–​9.
Jeannerod, M. (1994). The representing brain: neural correlates of motor intention and imagery.
Behavioral and Brain Sciences, 17(2), 187–​202.
Kamitani, Y. & Tong, F. (2005). Decoding the visual and subjective contents of the human brain.
Nature Neuroscience, 8(5), 679–​685.
Kanayama, N., Asai, T., Nakao, T., Makita, K., Kozuma, R., Uyama, T., Yamane, T., Kadota, H., &
Yamawaki, S. (2017a). Subjectivity of the anomalous sense of self is represented in gray matter
volume in the brain. Frontiers in Human Neuroscience, 11, 232.
Kanayama, N., Morandi, A., Hiraki, K., & Pavani, F. (2017b). Causal dynamics of scalp electroenceph-
alography oscillation during the rubber hand illusion. Brain Topography, 30(1), 122–​135.
Kanayama, N., Sato, A., & Ohira, H. (2007). Crossmodal effect with rubber hand illusion and gamma-​
band activity. Psychophysiology, 44, 392–​402.
Kanayama, N., Sato, A., & Ohira, H. (2009). The role of gamma band oscillations and synchrony on
rubber hand illusion and crossmodal integration. Brain and Cognition, 69(1), 19–​29.
Kanayama, N., Tamè, L., Ohira, H., & Pavani, F. (2012). Top down influence on visuo-​tactile inter-
action modulates neural oscillatory responses. NeuroImage, 59(4), 3406–​3417.
Kandel, E. R., Schwartz, J. H., Jessell, T. M., Siegelbaum, S. A., & Hudspeth, A.J. (Eds.) (2012).
Principles of neural science (5th ed.). McGraw-​Hill Professional.
Kanwisher, N., McDermott, J., & Chun, M. M. (1997). The fusiform face area: a module in human
extrastriate cortex specialized for face perception. Journal of Neuroscience, 17, 4302–​4311.
Kase, C. S., Troncoso, J. F., Court, J. E., Tapia, J. F., & Mohr, J. P. (1977). Global spatial disorientation.
Clinico-​pathologic correlations. Journal of the Neurological Sciences, 34(2), 267–​278.
Kashihara, S., Kanayama, N., Miyatani, M., & Nakao, T. (2017). Attentive Observation Is Essential for
the Misattribution of Agency to Self-​Performance. Frontiers in Psychology, 8, 890.
Kenshalo, D. R. & Isensee, O. (1983). Responses of primate SI cortical neurons to noxious stimuli.
Journal of Neurophysiology, 50(6), 1479–​1496.
Kerr, K. L., Moseman, S. E., Avery, J. A., Bodurka, J., Zucker, N. L., & Simmons, W. K. (2016). Altered
insula activity during visceral interoception in weight-​restored patients with anorexia nervosa.
Neuropsychopharmacology, 41(2), 521–​528.
Kinsbourne, M. & Warrington, E. K. (1962). A study of finger agnosia. Brain, 85(1), 47–​66.
Komatsu, H. & Goda, N. (2018). Neural mechanisms of material perception: quest on shitsukan.
Neuroscience, 392, 329–​347.
Laiacona, M., Allamano, N., Lorenzi, L., & Capitani, E. (2006). A case of impaired naming and know-
ledge of body parts. Are limbs a separate sub-​category? Neurocase, 12(5), 307–​316.
Lindner, I., Echterhoff, G., Davidson, P. S. R., & Brand, M. (2010). Observation Inflation. Psychological
Science, 21(9), 1291–​1299.
Longo, M. R., Azañón, E., & Haggard, P. (2010). More than skin deep: body representation beyond
primary somatosensory cortex. Neuropsychologia, 48(3), 655–​668.
Lotze, M., Erb, M., Flor, H., Huelsmann, E., Godde, B., & Grodd, W. (2000). fMRI evaluation of
somatotopic representation in human primary motor cortex. NeuroImage, 11(5 Pt1), 473–​481.
Martuzzi, R., van der Zwaag, W., Farthouat, J., Gruetter, R., & Blanke, O. (2014). Human finger
somatotopy in areas 3b, 1, and 2: a 7T fMRI study using a natural stimulus. Human Brain Mapping,
35(1), 213–​226.
Meier, J. D., Aflalo, T. N., Kastner, S., & Graziano, M. S. A. (2008). Complex organization of human pri-
mary motor cortex: A high-​resolution fMRI study. Journal of Neurophysiology, 100(4), 1800–​1812.
Mesulam, M.-​M. & Mufson, E. J. (1982). Insula of the old world monkey. III: efferent cortical output
and comments on function. Journal of Comparative Neurology, 212(1), 38–​52.
Michel, F. & Henaff, M. A. (2004). Seeing without the occipito-​parietal cortex: simultagnosia as a
shrinkage of the attentional visual field. Behavioural Neurology, 15(1–​2), 3–​13.
150  Triadic body representations in the human cerebral cortex
Mishkin, M., Ungerleider, L. G., & Macko, K. A. (1983). Object vision and spatial vision: two cortical
pathways. Trends in Neurosciences, 6(C), 414–​417.
Nishio, A., Goda, N., & Komatsu, H. (2012). Neural selectivity and representation of gloss in the
monkey inferior temporal cortex. Journal of Neuroscience, 32(31), 10780–​10793.
Olausson, H., Lamarre, Y., Backlund, H., Morin, C., Wallin, B. G., Starck, G., Ekholm, S., Strigo, I.,
Worsley, K., Vallbo, A. B., & Bushnell, M. C. (2002). Unmyelinated tactile afferents signal touch and
project to insular cortex. Nature Neuroscience, 5(9), 900–​904.
Parr, T. & Friston, K. J. (2018). The anatomy of inference: generative models and Brain structure.
Frontiers in Computational Neuroscience, 12, 90.
Parsons, L. M. (1987). Imagined spatial transformation of one’s body. Journal of Experimental
Psychology: General, 116(2), 172–​191.
Parsons, L. M., Fox, P. T., Downs, J. H., Glass, T., Hirsch, T. B., Martin, C. C., Jerabek, P. A., & Lancaster,
J. L. (1995). Use of implicit motor imagery for visual shape discrimination as revealed by PET.
Nature, 375(6526), 54–​58.
Peelen, M. V. & Downing, P. E. (2007). The neural basis of visual body perception. Nature Reviews
Neuroscience, 8(8), 636–​648.
Penfield, W. & Boldrey, E. (1937). Somatic motor and sensory representation in the cerebral cortex of
man as studied by electrical stimulation. Brain, 60(4), 389–​443.
Pitron, V. & de Vignemont, F. (2017). Beyond differences between the body schema and the body
image: insights from body hallucinations. Consciousness and Cognition, 53, 115–​121.
Razmus, M. (2017). Body representation in patients after vascular brain injuries. Cognitive Processing,
18(4), 359–​373.
Rizzolatti, G. & Matelli, M. (2003). Two different streams form the dorsal visual system: anatomy and
functions. Experimental Brain Research, 153(2), 146–​157.
Rode, G., Vallar, G., Chabanat, E., Revol, P., & Rossetti, Y. (2018). What do spatial distortions in pa-
tients’ drawing after right brain damage teach us about space representation in art? Frontiers in
Psychology, 9, 1058.
Rossetti, Y. & Pisella, L. (2018). Optic ataxia: beyond the dorsal stream cliché. The Handbook of
Clinical Neurology, 151, 225–​247.
Rusconi, E., Pinel, P., Eger, E., LeBihan, D., Thirion, B., Dehaene, S., & Kleinschmidt, A. (2009). A
disconnection account of Gerstmann syndrome: functional neuroanatomy evidence. Annals of
Neurology, 66(5), 654–​662.
Rusconi, E., Tamè, L., Furlan, M., Haggard, P., Demarchi, G., & Adriani, M. (2014). Neural correlates
of finger gnosis. Journal of Neuroscience, 34(27), 9012–​9023.
Schilder, P. (1935). The Image and Appearance of the Human Body. Oxford: Kegan Paul.
Schwoebel, J. & Coslett, H. B. (2005). Evidence for multiple, distinct representations of the human
body. Journal of Cognitive Neuroscience, 17(4), 543–​553.
Serino, A., Sforza, A. L., Kanayama, N., van Elk, M., Kaliuzhna, M., Herbelin, B., & Blanke, O. (2015).
Tuning of temporo-​occipital activity by frontal oscillations during virtual mirror exposure causes
erroneous self-​recognition. European Journal of Neuroscience, 42(8), 2515–​2526.
Sirigu, A., Duhamel, J.-​R., Cohen, L., Pillon, B., Dubois, B., & Agid, Y. (1996). The mental representa-
tion of hand movements after parietal cortex damage. Science, 273(5281), 1564–​1568.
Sirigu, A., Grafman, J., Bressler, K., & Sunderland, T. (1991). Multiple representations contribute to
body knowledge processing. Brain, 114, 629–​642.
Stippich, C., Ochmann, H., & Sartor, K. (2002). Somatotopic mapping of the human primary sen-
sorimotor cortex during motor imagery and motor execution by functional magnetic resonance
imaging. Neuroscience Letters, 331(1), 50–​54.
Striem-​Amit, E. & Amedi, A. (2014). Visual cortex extrastriate body-​selective area activation in con-
genitally blind people ‘Seeing’ by using sounds. Current Biology, 24(6), 687–​692.
Suzuki, K., Yamadori, A., & Fujii, T. (1997). Category-​specific comprehension deficit restricted to
body parts. Neurocase, 3(3), 193–​199.
Tamè, L., Azañón, E., & Longo, M. R. (2019). A conceptual model of tactile processing across body
features of size, shape, side, and spatial location. Frontiers in Psychology, 10, 291.
 Body representation in the brain and the self  151
Tamè, L., Dransfield, E., Quettier, T., & Longo, M. R. (2017). Finger posture modulates structural
body representations. Scientific Reports, 7(January), 1–​9.
Tamè, L., Pavani, F., Braun, C., Salemme, R., Farnè, A., & Reilly, K. T. (2015). Somatotopy and tem-
poral dynamics of sensorimotor interactions: Evidence from double afferent inhibition. European
Journal of Neuroscience, 41(11), 1459–​1465.
Thompson, M. A. & Gray, J. J. (1995). Development and validation of a new body-​image assessment
scale. Journal of Personality Assessment, 64(2), 258–​269.
Tsakiris, M. & Fotopoulou, A. (2008). Is my body the sum of online and offline body-​representations?
Consciousness and Cognition, 17(4), 1317–​1320.
Tsakiris, M., Hesse, M. D., Boy, C., Haggard, P., & Fink, G. R. (2007). Neural signatures of body owner-
ship: A sensory network for bodily self-​consciousness. Cerebral Cortex, 17, 2235–​2244.
Vaso, A., Adahan, H. M., Gjika, A., Zahaj, S., Zhurda, T., Vyshka, G., & Devor, M. (2014). Peripheral
nervous system origin of phantom limb pain. Pain, 155(7), 1384–​1391.
Wandell, B. A., Brewer, A. A., & Dougherty, R. F. (2005). Visual field map clusters in human cortex.
Philosophical Transactions of the Royal Society of London. Series B, Biological Sciences, 360(1456),
693–​707.
Wolpert, D. M. & Ghahramani, Z. (2000). Computational principles of movement neuroscience.
Nature Neuroscience, 3 Suppl, 1212–​1217.
Yeatman, J. D., Richie-​Halford, A., Smith, J. K., Keshavan, A., & Rokem, A. (2018). A browser-​based
tool for visualization and analysis of diffusion MRI data. Nature Communications, 9, 940.
Zimmermann, M., Mars, R. B., de Lange, F. P., Toni, I., & Verhagen, L. (2018). Is the extrastriate body
area part of the dorsal visuomotor stream? Brain Structure and Function, 223(1), 31–​46.
 10
Body models in humans, animals, and
robots: mechanisms and plasticity
Matej Hoffmann

10.1 Introduction

Ulric Neisser distinguishes five different selves: the ecological self, the interpersonal
self, the extended self, the private self, and the conceptual self (1988). The high-​level
facets of the self—​accessible to consciousness, incorporating linguistic information,
etc.—​have been receiving relatively more attention. However, here I will focus on the
lowest level—​the ecological or sensorimotor self or the ‘body schema’—​which consti-
tutes a key foundation for the rest. The description by Graziano and Botvinick (2002)
nicely expresses the sensorimotor, multimodal, and spatial nature of the body represen-
tations on which I focus: ‘implicit knowledge structure that encodes the body’s form,
the constraints on how the body’s parts can be configured, and the consequences of this
configuration on touch, vision, and movement’.
The first key question I want to address is what the fundamental differences are in
which animals, humans, and robots represent their bodies. While the main goal is
to get an understanding of the mechanisms of ‘the body in the biological brain’, the
‘robot world’ can be instrumental here in two ways. First, there is a large body of ma-
ture mathematical tools for representing kinematics and dynamics and for employing
these representations in movement planning and control, as well as for learning models
of physical systems (system identification). These constitute, in some sense, the ‘ideal
world’, a neat mathematical description of the problem, which opens up a useful per-
spective on the body models that evolution has arrived at. Second, robots can serve
as embodied computational models of biological body representations. Humanoid
robots possess morphologies—​physical characteristics, as well as sensory and motor
apparatuses—​that are, in some respects, akin to human bodies and can thus be used
to expand the domain of computational modelling by anchoring it to the physical en-
vironment and a physical body and allowing for instantiation of complete sensori-
motor loops.
The second key question is: Which properties of the biological ‘body schema’ could
be transferred to robots to make them more adaptive and resilient? On one hand,
robots are endowed with neatly engineered body models and control algorithms. Yet,
in many respects, their performance in commanding their bodies in unstructured

Matej Hoffmann, Body models in humans, animals, and robots: mechanisms and plasticity In: Body Schema and Body Image.
Edited by: Yochai Ataria, Shogo Tanaka, and Shaun Gallagher, Oxford University Press. © Oxford University Press 2021.
DOI: 10.1093/​oso/​9780198851721.003.0010
 Body models—octopus, primates, robots  153
environments, adapting to failures or tools, etc., is still hugely lagging behind their bio-
logical counterparts. Therefore, Section 10.4 will examine which of the characteristics
of the ‘body in the brain’ robots should take on board.

10.2  Body models—​octopus, primates, robots

Biological and artificial agents have very different bodies, as well as very different rep-
resentations thereof. In this section, I will look at some of the characteristics of bodies
and ‘brains’ of invertebrates, primates, and robots. Reaching will be used throughout as
a behaviour that requires some form of—​implicit or explicit—​body model.

10.2.1  The invertebrate brain and reaching in the octopus

1Unlike in vertebrates, invertebrate species show an enormous diversity in body plans

and nervous organization (Marder, 2007; Zullo & Hochner, 2011). With more complex
bodies and nervous structures, there is a tendency toward centralization with the for-
mation of a structured cephalic ganglion. Ganglia or their groups become larger and
tend to form semi-​autonomous systems for sensorimotor control. Brain development
in the rostral part of the animal comes also from the presence of distal sensing such
as vision. Within the higher nervous system, sensory feedback areas tend to be topo-
graphically organized; central ganglia receive projections from various body parts and
show general somatotopy (Walters et al., 2004; Vitzthum, Muller, & Homberg, 2002;
Wong, Wang, & Axel, 2002). Interneurons become more common and constitute a key
element in processing and integrating information.
The most advanced invertebrate class is the cephalopods—​highly derived molluscs.
They feature, on one hand, the highest centralization of the nervous system. On the
other hand, next to the central nervous system (CNS) composed of the brain and two
optic lobes, there is a large peripheral nervous system (PNS) of the body and the arms.
The brain consists of 30–​40 interconnected lobes with a high degree of cross-​talk; yet,
the interconnections appear less elaborate than in vertebrate brains (Young, 1971).
Despite the high level of centralization and in contrast to vertebrate and insect brains,
there is no obvious somatotopic arrangement in either motor or sensory areas.
The most prominent and most intelligent, and with the largest nervous system
among cephalopods, is the octopus. The octopus has a unique embodiment—​a flex-
ible body and eight arms with virtually infinite degrees of freedom. Brain stimulation
reveals that motor control is hierarchically organized into three functional levels. In
the higher motor centres located in the basal lobes, microstimulation evokes com-
plex movements which are, however, not somatotopically represented, but controlled

1 The beginning of this section draws heavily on Zullo & Hochner (2011).
154  Body models in humans, animals, and robots
by parallel overlapping circuits representing individual motor programmes. The basal
lobes receive inputs from the optic lobes and other sensory centres.
Yekutieli et al. (2005a) and Yekutieli, Sagiv-​Zohar, Hochner, & Flash (2005b) devel-
oped a dynamic model of the octopus arm and used it to hypothesize the mechanism of
how a reaching movement is generated. Despite the complexity of the arm, they found
that in their model, only two control parameters suffice to fully specify the extension
movement of the arm: (1) the amplitude of the activation signal; and (2) the activation
travelling time. This hypothesis seems in line with electromyogram (EMG) recordings
and other evidence from the real octopus. Larger amplitudes would result in the same
kinematics, but larger forces, increasing the arm’s stability against perturbations. For
reaching directed at a particular target, two additional control parameters are neces-
sary for the orientation of the arm base. Considering both the experimental and the
simulation results, Yekutieli et al. (2005b) speculate that the octopus reaches toward a
target using the following strategy:

(1) Initiating a bend in the arm so that the suckers point outward.
(2) Orienting the base of the arm in the direction of the target or just above it.
(3) Propagating the bend along the arm at the desired speed by a wave of muscle ac-
tivation that equally activates all muscles along the arm.
(4) Terminating the reaching movement when the suckers touch the target by stop-
ping the bend propagation and thus catching the target.

There are three kinematic control parameters (two angles for arm base orientation
and one for movement speed) and one dynamic control parameter corresponding to
muscle force.
However, the behavioural repertoire of the octopus is greater. Gutnick, Byrne,
Hochner, and Kuba (2011) prepared a special setup where the octopus has to guide
one of its arms through a maze to reach food in one of three branches marked by a
visual cue. The octopus is capable of such ‘hand–​eye coordination’. Also, instead of the
stereotypical largely feed-​forward bend propagation, it uses a much slower—​but pos-
sibly feedback-​controlled—​‘search movement’. Finally, to bring food to the mouth, the
arm is bent in a specific way, creating ‘virtual joints’ along it.

10.2.2  The body in the primate brain

It is not in my capacity or my goal to review the structure and function of vertebrate

nervous systems. Instead, I will briefly discuss how the body is represented in the brain
of primates, which include monkeys, apes, and humans. Again, reaching will serve as
an example in which a body model of sorts needs to be employed.
The presence of various ‘body maps’ in the primate brain has fascinated scientists
and the general public alike, spurred by the account of Head and Holmes (1911) and the
discovery of the somatotopic representations (the ‘homunculi’) in the primary motor
 Body models—octopus, primates, robots  155
and somatosensory cortices (Leyton & Sherrington, 1977; Penfield & Boldrey, 1937).
Neurological conditions and accounts of a whole range of illusions regarding own body
perception (e.g., rubber hand illusion, out-​of-​body experience, apparition) generated
both seminal research articles (e.g., Botvinick & Cohen, 1998; Lenggenhager, Tadi,
Metzinger, & Blanke, 2007) and public interest. The attention devoted to the represen-
tations of the body in the brain has also led to numerous attempts at describing or de-
fining them, and proposals of a variety of concepts, including superficial and postural
schema (Head & Holmes, 1911), body schema, body image, corporeal schema, etc.,
have been put forth. One characteristic common to all these representations is their
multimodal nature—​they dynamically integrate information from different sensory
modalities (visual, tactile, proprioceptive, vestibular, auditory) (Azañón et al., 2016),
while not excluding motor information. However, the concepts of body schema, body
image, and many others are umbrella notions for a range of observed phenomena, ra-
ther than a result of identification of specific mechanisms. The field is thus in a some-
what ‘chaotic state of affairs’ (Berlucchi & Aglioti, 2010), with limited convergence to a
common view (Graziano & Botvinick, 2002; Holmes & Spence, 2004).
Reaching behaviour in primates bears some similarity to that in the octopus.
A reaching movement has some high-​level characteristics like the direction of a hand’s
movement in space, the extent of the movement (amplitude), the overall duration
(movement time), and other parameters such as anticipated level of resistance to the
movement (Schöner, Tekülve, & Zibner, 2018). Also, movement generation involves
cooperation between the CNS and PNS. The exact mechanisms of motor control in
humans and other primates are still debated (see, for example, Lisman, 2015). One
view—​the equilibrium point theory—​posits that high-​level descending motor com-
mands modulate the peripheral reflex loops (such as the stretch reflex) and set a desired
muscle length (Feldman, 2011). Compared to invertebrates, motor control in verte-
brates, specifically mammals and in particular primates, becomes more ‘cortical’ and
the motor cortex has the possibility of more direct control over the details of a par-
ticular movement, which is likely correlated with the need for dexterous manipulation.
Also, it may not be possible to decouple the movement preparation phase from its
execution. The actual movement may be a product of couplings of feed-​forward and
feedback control that are necessary to understand the effects such as the uncontrolled
manifold (Scholz & Schöner, 1999; Martin, Reimann, & Schöner, 2019).
It is also not completely clear whether a prerequisite for a reaching move-
ment is localizing the effector—​say the arm/​hand—​in space first. Through cortical
microstimulation, Graziano was able to elicit stereotypical movements in the monkey,
irrespective of the starting position (2006). However, Schöner et al. (2018) speculate
that the stimulation could drive an update of the hand position first, which would be
subsequently used for the movement generation—​in line with Scott and Kalaska (1997)
who found that neural tuning curves in the motor cortex depend on the arm’s kine-
matic configuration.
In this chapter, I will specifically focus on a task in which localizing the own body
cannot be circumvented—​reaching to own body parts. For example, Lisman (2015)
156  Body models in humans, animals, and robots
notes: ‘More difficult to imagine is how one can reach one’s ear lobe without visual
guidance. This requires knowledge of the position of the target and the position of the
limbs. It has only recently become clear that there is indeed a population code that rep-
resents hand position (Hauschild et al., 2012), but surprisingly little is known about the
muscle and joint signals that allow this computation to be made (Weber et al., 2011).’

10.2.3  Robot body models

The world of robots and their body models is completely different. The first striking
difference is that describing it is significantly easier; robot body representations and
control schemes are designed by engineers and are thus very transparent and, unlike in
the brain, we have complete access to all information. Let us take the iCub humanoid
robot as an example. The iCub (Metta et al., 2010) (see Figure 10.1) is a baby humanoid
robot that was designed after a 4-​year-​old child—​with similar body proportions, kine-
matic structure, and sensorimotor capacities. At the same time, it is, to a large extent, a
product of (great) engineering.
In Figure 10.1A, there is a cartoon of the robot, side by side with its computer-​aided
design (CAD) model (see Figure 10.1B) and the basic kinematic structure (joints and
links) (see Figure 10.1C). Complete knowledge of the robot structure can be used to ob-
tain a mathematical description of the robot’s kinematics. This essentially corresponds
to a sequence of coordinate transformations between all the reference frames in Figure
10.1D. Every such transformation consists of three translations and three rotations and

(A) (B) (C) (D)

Figure 10.1  The iCub humanoid robot. (A) Cartoon of the robot. (B) CAD model.
(C) Kinematic structure. (D) Reference frames in upper body.
Image credits: (A) iCub cartoon: Reproduced courtesy of Laura Taverna, Italian Institute of Technology. (B) (C)
iCub kinematic structure: Reproduced with permission from (Parmiggiani, et al., 2012), and courtesy of Alberto
Parmiggiani. (D) Reproduced courtesy of Jorhabib Eljaik.
 Body models—octopus, primates, robots  157
has thus six degrees of freedom (DoFs). However, as the robot structure is subject to
specific constraints in three-​dimensional space, four parameters suffice to characterize
the transformation between consecutive links/​joints. This is the essence of the Denavit-​
Hartenberg convention in which every link i (imagine getting from the elbow to the
wrist along the forearm, for example) is described by four parameters: two lengths ai
and di, and two angles αi and oi. In the iCub—​and in most robots for that matter—​all
joints are revolute and have a single rotation axis, i.e., a single rotational DoF, like the
human elbow (a ‘hinge joint’). Figure 10.2 shows a schematic of this representation for
the upper body of the robot.

10.2.3.1 Forward kinematics and inverse kinematics

The robot model describes the fixed characteristics of the robot body (long-​term or
‘offline’ body representation; see later). The model in Figure 10.2 can be transformed
into equations, whereby the coordinate transformation needed to get from one link
to the next (e.g., from elbow to wrist) can be obtained as a simple matrix multiplica-
tion. To go over more links/​joints (e.g., from torso to hand), these multiplications are
simply sequenced. In the canonical form, this will only work for a single posture of
the robot, like the one in Figure 10.1. To know where the body currently is in space, it
has to be combined with the robot ‘proprioception’—​the joint angle values. These are
plugged into the equations as one of the orientation parameters (oi). This operation—​
combining current joint angle values with the robot model—​is known as forward
kinematics, which provides a mapping from joint space to Cartesian space (also called

left eye Link(i) a(i) [mm] d(i) [mm] α [rad] o [rad]

mm

1 2.31 –193.3 –π/2 π/4

.5

2 33 0 π/2 π/4
82

3 0 1 –π/2 π/4
left 4 –54 82.5 –π/2 π/4
shoulder 5 0 –34 –π/2 0
2 3 6 0 0 π/2 –π/4
TABLE I
DH Parameters – Head and Left Eye
152.28 mm

1 4
Link(i) a(i) [mm] d(i) [mm] α [rad] o [rad]
1 23.36 143.3 π/2 105 * π/180
2 0 107.74 –π/2 π/2
5
forearm

torso 3 0 0 π/2 –π/2

right

4 15 152.28 –π/2 75 * π/180

137.3 mm

6
5 –15 0 π/2 0
6 0 137.3 π/2 –π/2
7 7 0 0 π/2 π/2
right 8 8 62.5 –16 0 0
hand left TABLE II
hand DH Parameters – Left Arm

Figure 10.2  iCub kinematic model—​upper body. (Left) Matlab visualization of the
kinematic chains and reference frames. (Right) Denavit-​Hartenberg (DH) parameters for
the head and left eye and left arm. Correspondences for certain link lengths are marked.
158  Body models in humans, animals, and robots
operational space or task space). Thus, transformations between, say, hand frame, body
frame, or eye frame can be readily obtained.
For a robot to reach to a specific position and with a specific orientation in Cartesian
space—​no matter in which reference frame the target is expressed as it can be trans-
formed to the base frame—​an inverse mapping is needed, from Cartesian space to joint
space, i.e., to acquire the joint angles of the robot arm when the end effector (the hand)
contacts the target. This is dealt with by inverse kinematics. Unlike forward kinematics,
this is a harder problem and not just a matter of substituting for current joint angle values
into the equations. Reaching for a target in three dimensions with a specific orientation
constraints the robot pose in six dimensions (three positions and three orientations).
Hence, a minimum of six DoFs—​six joints—​is required on the robot part. For six DoF
manipulators—​robot arms with six rotational joints—​that have a specific geometric
structure, a closed-​form solution can be obtained. That is, a solution can be found in-
stantaneously. However, in general, one has to resort to numerical methods. Robots with
more than six DoFs have multiple ways of reaching for the target and hence are called re-
dundant manipulators. Additional criteria are needed to choose among the solutions. In
the iCub, there are seven DoFs in every arm and three additional ones in the torso. The
manipulator is thus highly redundant. Inverse kinematics is solved numerically by using
a non-​linear optimizer (Pattacini, Nori, Natale, Metta, & Sandini, 2010).

10.2.3.2 Motion control
Inverse kinematics provides the joint space configuration for the robot in the final
position at the target. However, it does not automatically deal with the trajectory—​
joint and end effector positions in time—​needed to move between the initial and final
positions. Trajectory generation constitutes its own discipline that deals with planning
such smooth movements using different interpolation methods, for example. Once
the trajectory in joint space is planned, low-​leveI motor controllers in every joint can
be used to bring about the desired movements in time. In the iCub, Pattacini et al.
(2010) designed a bio-​inspired dynamical systems-​based controller that produces
smooth, minimum jerk trajectories in which the end effector (the hand) follows a
quasi-​straight line.

10.2.3.3 Dynamics
While kinematics deals with positions, velocities, and accelerations, dynamics deals
with equations of motion and forces that are needed to produce a particular movement.
The reader is referred to any robotics textbook on the topic. For the iCub, Nori et al.
(2015) provide an example.

10.3  Characteristics of body representations

In this section, I will attempt to compare the most important features of body representa-
tions in animals, humans, and robots. First, a note on terminology is in order. I use ‘body
 Characteristics of body representations  159
representations’ as a general concept that should encompass both body schema and body
image and possibly other body-​related notions. However, by using the word ‘representa-
tion’, it is not my goal to take a stance in the philosophical debate on representationalist
versus sensorimotor approaches to body awareness (de Vignemont, 2015). The account
will admittedly be biased toward the ‘representationalist’ viewpoint (e.g., Carruthers,
2008; Longo et al., 2010)—​also because I come from robotics and computer science—​and
will not address the phenomenological perspective and the ‘lived body’ (Merleau-​Ponty,
1945). At the same time, I also fully endorse the ‘sensorimotor approach’ and I want to
avoid, or at least reflect upon, imposing the representationalist stance typical of robotics
and (good old-​fashioned) artificial intelligence (Haugeland, 1985) onto the biological
‘body in the brain’ (see also our attempt in Hoffmann et al. (2017)). Webb (2006) provides
a useful clarification of the terms transformation, encoding, and representation. The word
representation should be reserved to the strong notion of standing in for something—​
properties or states of the body that can be manipulated also when the body itself cannot
be used or sensed directly. Sometimes, the body can be used directly—​imagine the
reaching in the octopus discussed above—​and it is probably more natural to think that
the ‘brain is in the body’ and does not have to have it all represented, rather than the ‘body
in the brain’ is embodied (cf. a discussion in Alsmith & de Vignemont (2012)).
According to de Vignemont (2015), there are three principal taxonomies of body rep-
resentations. I will list them below, together with their relationship to the account in this
book section:

(1) The triadic taxonomy based on the ‘format’ of body representations (Schwoebel
& Coslett, 2005) distinguishes:
(a) Sensorimotor body representation (also known as body schema).
(b) Visuo-​spatial body representation (or body structural description).
(c) Conceptual body representation (or body semantics).
My account will span roughly the first two, leaving the conceptual body repre-
sentation aside.
(2) The functional dyadic taxonomy (Dijkerman & De Haan, 2007; Gallagher, 2006;
Paillard, 1999), based on the perception–​action model of vision (‘ventral stream’
or ‘what’ versus ‘dorsal stream’ or ‘where/​how’) (Milner & Goodale, 2006),
distinguishes:
(a) Body schema—​sensorimotor representations of the body used for action
planning and control.
(b) Body image—​lacking a unifying positive definition (Berlucchi & Aglioti,
2010; de Vignemont, 2010); comprises all the ‘other’ (than body schema)
representations about the body that are not used for action: perceptual, con-
ceptual, or emotional.
My account will focus on the representations for action. Robot body models are
also primarily geared toward action. However, interestingly, as their models are
engineered from the outside, they do carry a lot of the flavour that is typical ra-
ther of the ‘what’ pathways that care about semantics of objects, etc.
160  Body models in humans, animals, and robots
(3) The temporal dyadic taxonomy (Carruthers, 2008) is based on the dynamics of
body representations and contrasts:
(a) Long-​term or ‘offline’ body representations, such as limb size—​what the
body is usually like. These are relatively stable in adulthood and may include
some innate components about body structure (e.g., two arms and two legs).
Carruthers (2008) also argues ‘that the offline body representation must be
an integrated representation, a failure to integrate leads to body integrity
identity disorder.’ ‘That is, it must represent the body as a single thing, rather
than a collection of parts.’
(b) Short-​term or ‘online’ representations of the body as it is currently, such as
in which posture, constantly updated on the basis of afferent and efferent
information.
In this case, both are obviously equally relevant. From the robotics perspective,
the long-​term body representation can be equated with body model. The short-​
term representation would be the body state. I will focus more on the long-​term
body representations.

To give the discussion concrete contours, let us look at the example in Figure 10.3.
Figure 10.3A depicts a scenario from a series of studies on infants where they were
observed reaching for a vibrotactile stimulus (buzzer) (Hoffmann et al., 2017; Leed,
Chinn, & Lockman, 2019). Two components seem necessary: (1) localizing the
stimulus on the body; and (2) reaching for it. The centre in Figure 10.3A depicts a pos-
sible decomposition into blocks. The left part (up to the ‘localization’ blocks) (Tamè,
Azañón, & Longo, 2019) deals with the ‘localization’ or somatoperceptual processing
part. Once the target is localized (spatial localization of touch block), it can be adopted
as the reaching target (illustrated with a ‘~’), and the motor action can be prepared and
executed. The different shapes for the blocks were reproduced after (Longo et al., 2010)
as follows: ‘inputs are depicted as diamond shapes, body representations as ovals, and
perceptual processes as rectangles’. It is interesting to look at this from the temporal
taxonomy perspective; it seems that only the long-​term or offline modules count as
representations here. The percepts, however, represent ‘states of the body’ and can
be viewed as short-​term or online body representations. Heed, Buchholz, Engel, and
Röder (2015) offer a different conceptualization of this scenario, also known as tactile
remapping—​the transformation of a coordinate in a skin-​based reference frame into a
coordinate in an external reference frame by integration of posture information. Heed
et al. actually present three variants of the schematics (not reproduced here): (a) remap-
ping view; (b) integration view; and (c) sensorimotor contingency view. In (b) and (c),
the arrows between the ‘localization’ part and the ‘action’ part point in both directions,
which illustrates another important aspect of the problem—​a sequential processing
view and decoupling of the perception and action parts may not be justified, something
we touched upon in Section 10.2.2. Analysis of the infant reaching behaviour in the
buzzer experiments shows that looking at the target and reaching often happen simul-
taneously; in addition, for targets on the arms/​hands, both the limb with the target and
 (A) somatic motor
superficial localization control
tactile
afference schema of touch
movement
preparation
model of body size
and shape spatial
reaching
proprioceptive localization
target
afference of touch
postural
priors
efferent spatial
commands postural localization of
schema body

inputs body representations

(B)
Anterior parietal cortex (APC)
• “Primary ” somatosensory cortex: Brodmann areas
3a, 3b, 1, 2
Posterior parietal cortex
• Area 5L (lateral)
• Intraparietal sulcus (IPS)

Premotor cortex
• Premotor ventral (PMv)/area F4 (also PMVc)–
within Brodmann area 6
(CS - central sulcus)

(C)
coordinates of reaching
activation in local controller
artificial skin frame (wrist)
skin spatial
activations calibration inverse
kinematics
coordinates of
solver
activation in
iCub Root
robot frame
joint angles kinematic reaching
model target
pose of all
body links in space
inputs
representations

Figure 10.3  Reaching to the body. (A) Scenario with reaching for vibrotactile stimuli in
infants (Hoffmann et al., 2017). Photos show an infant presented with the stimulus (left),
in the process of reaching (top right), and in the final posture (bottom right). Centre: a
conceptual model of somatosensory processing (left part, up to ‘~’, adapted from Longo,
Azañón, and Haggard (2010) and Tamè, Azañón, & Longo, (2019)) and reaching action.
(B) Schematic illustration of cortical areas that may be responsible for bringing about
the behaviour. (C) Similar scenario on the iCub humanoid robot: tactile stimulus (left),
motor action (top right), and final configuration (bottom right). Centre: block diagram
illustrating the modules used to generate the ‘self-​touch’ behaviour (Roncone, Hoffmann,
Pattacini, & Metta, 2014).
Image credits: (A) Flowchart adapted from (Tamè, Azañón, & Longo, 2019) under a Creative Commons
Attribution License (CC BY) (https://​creativecommons.org/​licenses/​by/​4.0/​) and with permission from Longo,
M. R., Azañón, E., and Haggard, P. (2010). With additional blocks illustrating the motor part. (B) Brain image
adapted from Hugh Guiney/​Creative Commons Attribution-​Share Alike 3.0 Unported license (CC BY-​SA 3.0)
(labels added). (C) Reproduced courtesy of Alessandro Roncone and Matej Hoffmann.
162  Body models in humans, animals, and robots
the reaching contralateral arm often move simultaneously (Chinn, Hoffmann, Leed, &
Lockman, 2019). The more general point of recurrent connections also relates to the
state estimation problem; the ‘percepts’ may not be the result of a single pass that com-
bines information from different sources but may be the result of conflict reconciliation
where activations need to flow back and forth.
Figure 10.3B schematically illustrates some of the cortical areas of the monkey brain
that may be involved in generating this behaviour. Finally, Figure 10.3C shows an in-
stantiation of a similar scenario on the iCub humanoid robot. There is one important
difference—​this is not a conceptualization of the behaviour; this is an actual pipeline
that has been used in Roncone, Hoffmann, Pattacini, and Metta (2014) (for the video,
see https://​youtu.be/​pfse424t5mQ). The blocks correspond to actual pieces of software.
Surprisingly, there is quite a good match with the schematics in Figure 10.3A, which
may be because the schematics of Longo and colleagues is somewhat classical and thus
compatible with engineering models that—​mostly for practical reasons—​typically
follow a modular design and ‘sense–​think–​act’ logic.
There are almost countless characteristics of body representations that we can think
of. In what follows, I will sketch some of the important ones, focusing in particular on
those where contrasting the biological and robot worlds can bring the most insight.
Hence, I will, for example, leave the unconscious versus the conscious aspect aside—​as
discussed above, the focus here is on the sensorimotor level. I will take a number of ex-
amples from biology and robotics, developing the ideas in Hoffmann et al. (2010) and
Hoffmann & Pfeifer (2018). I will also, sometimes quite speculatively, attempt to chart
the body schema and body image onto the hypothetical axes. Body image will largely
stand for visuo-​spatial representation of the body or body structural description—​
body percept rather than body concept. The brain areas involved are also only schemat-
ically illustrated.
In Figure 10.4, the iCub humanoid robot and the kinematic model of its upper body
is depicted in panel (A). The model has been essentially handcrafted by following the
Denavit-​Hartenberg convention and supplying the corresponding lengths and an-
gles from the CAD model of the robot. Panel (B) adds the possibility to calibrate the
same model automatically as the robot exploits self-​observation and self-​touch con-
figurations (Stepanova, Pajdla, & Hoffmann, 2019). Panels (D) and (E) depict other
examples of robot self-​calibration. Bongard, Zykov, and Lipson (2006) used a quadru-
pedal machine continuously ‘self-​modelling’ itself. The robot model had a special na-
ture; it consisted of a physics-​based simulator with a copy of the robot’s limbs, motors,
sensors, and even the environment. Within this engineered ‘world and body model’,
the robot would search for its kinematic structure by comparing the actions and their
sensory consequences from the physical world with those in the simulator. Sturm,
Plagemann, and Burgard (2009) had a robot arm observe ‘itself ’ using a camera and
infer its model—​learning the structure of a Bayesian network—​from motor actions
and observations in the camera. Panel (C) schematically illustrates humans and the
body schema and body image.
 body

multimodal
schema
(B)

(C)

(D)

body (E)
image
(A)

unimodal
amodal
fixed adaptive/plastic

Figure 10.4  Body representation characteristics I: plasticity and number of modalities. (A) iCub humanoid robot and its kinematic model. (B) iCub kinematic self-​
calibration using self-​observation and self-​touch (Stepanova, Pajdla, & Hoffmann, 2019). (C) Human and schematic illustration of brain areas important for body
representations: body schema (see Figure 10.3B for details) and body image (posterior parietal cortex, PPC; extrastriate body area, EBA; insula) (after Berlucchi &
Aglioti, 2010). (D) Four-​legged machine learning its body structure (Bongard, Zykov, & Lipson, 2006). (E) Robot manipulator learning body structure from self-​
observation (Sturm, Plagemann, & Burgard, 2009).
Image credits: Figure revised and expanded from (Hoffmann & Pfeifer, 2018). (A) iCub cartoon: Reproduced courtesy of Laura Taverna, Italian Institute of Technology. (B) Reproduced with permission
from (Stepanova, Pajdla, & Hoffmann, 2019) (C) Walking human: Public domain (https://​commons.wikimedia.org/​wiki/​File:BSicon_​WALK.svg). Body schema brain adapted from Hugh Guiney/​
Attribution-​ShareAlike 3.0 Unported (CC BY-​SA 3.0). Body image brain: Public domain (https://​commons.wikimedia.org/​wiki/​File:Gray731.png). (D) Reproduced with permission from (Bongard,
Zykov, & Lipson, 2006), and courtesy of Josh Bongard, University of Vermont. (E) Reproduced with permission from (Sturm, Plagemann, & Burgard, 2009), and courtesy of Jürgen Sturm.
164  Body models in humans, animals, and robots
10.3.1 Plasticity

Let us first consider plasticity or adaptivity of body models. Traditional robot models are
fixed—​an industrial manipulator is shipped with its model. It may not be directly avail-
able to the customer, but it will be embedded in the robot controller which needs the robot
model(s) for operation. Even industrial robots may require occasional (re)calibration,
which can be performed using different routines. Less accurate or more complex robots,
such as humanoids, may need recalibration more frequently. The work of Stepanova et al.
(2019) (see Figure 10.4B) is one of many examples in which the robot kinematic model
parameters are calibrated. The approach is rather straightforward; redundant informa-
tion about the positions of certain body parts—​from self-​touch or self-​observation in this
case—​drives learning; with two hands physically touching and both cameras observing
the point, any mismatch between the position of the corresponding point—​after remap-
ping into a common frame of reference—​generates an error term used to update the
model (all but the grey parameters are calibrated). Body representations in primate brains
(Figure 10.4C) are known for their plasticity on several timescales. First, body models
need to be discovered by the brain, starting already in the fetal period (see the work of
Kuniyoshi and colleagues on embodied computational models of this in Section 10.4).
Second, body models need to adapt, as the body grows, for example. Third, they adapt
or optimize when some body parts are frequently used in a specific task—​when playing
a musical instrument, for example. Fourth, they adapt also on very short timescales like
when adapting to tools or when the subject is tricked by some of the numerous illusions,
like the Pinocchio illusion. In the last case, it is rather a case of ‘short-​term body schema’
adaptation—​a state estimation process—​rather than adaptation of the body model itself,
although this may be happening simultaneously and some after-​effects observed. Next
to the temporal taxonomy (online versus offline body representations), I will speculate
about the distinction between body schema and body image on the plasticity axis. It
seems that most of the rapid recalibrations pertain to the body schema which draws more
directly on the inputs from different modalities and their integration. Taking the rubber
hand illusion (Botvinick & Cohen, 1998) as an example, the body schema adaptation is
manifested in the proprioceptive drift; however, the participants also start to quickly in-
corporate the rubber hand into their bodies—​‘own’ the rubber hand—​which is typically
associated with body image (and the insula). The suggested primacy of body schema over
body image (Pitron, Alsmith, & de Vignemont, 2018) may also be relevant here—​body
schema adaptation may, in a second step, propagate to body image.
It seems that the brain is rather ‘liberal’ about the constraints imposed on the models
and can be led into believing highly improbable things, like the ‘nose elongation’ during
Pinocchio illusion. Robot models, on the other hand, tend to have quite strict con-
straints or bounds on the model parameters—​capitalizing on the knowledge available
from the outside—​and would thus not fall for the illusions easily. At the same time,
there are limits to the plasticity. Important evidence suggestive of innate and fixed—​
immune to experience—​components of body models comes from the phantom limb
phenomenon, which may be experienced following amputation, but also even in some
 Characteristics of body representations  165
subjects who congenitally lack limbs (e.g., Ramachandran & Blakeslee, 1998). That is,
the basic body layout may be, to some extent, hard-​wired in the model and immut-
able. The self-​calibrating robots in panels (D) and (E) in Figure 10.4 move in that sense
beyond this, as they are able to learn any topology of their body layout—​that is why
they are positioned more to the right on the plasticity axis. However, this is clearly an
oversimplification—​these robots surpass the brain plasticity in this single aspect only.

10.3.2  Multimodal nature of body models

Standard robot models are amodal—​they do not depend on any sensory modality;
they directly describe physical reality like the geometry of the body (see Figure 10.2
or Figure 10.4A). This holds in some sense also for all the other robot body models in
Figure 10.4B, D, E. In Figure 10.4B, the robot model itself is identical to that in Figure
10.4A. The sensory modalities—​proprioception, touch, and vision in this case—​are
needed to collect the redundant information about the body’s position in space and
update the model. This layer is separated from the model of the robot geometry itself.
In Figure 10.4D, E, the situation is quite similar. Similarly to Figure 10.4B, Figure 10.4E
features self-​observation. In Figure 10.4D (Bongard et al., 2006), three modalities—​
touch, tilt, and clearance—​are used to compare their values from the real robot with
those from alternative body layouts in the simulator. Based on this, the case studies are
localized on the ‘modality’ axis. Body representations in the brain are famous for their
‘multimodality’. Azañón et al. (2016) review the multisensory contribution to body rep-
resentations: visual, somatosensory (tactile and proprioceptive), vestibular, auditory,
and nociceptive. Hence, ‘body in the brain’ scores highest on the ‘multimodality axis’ in
Figure 10.4. A divide-​and-​conquer approach is used throughout the article by Azañón
et al.—​modality by modality. This is also discussed by the authors—​such an approach
is useful experimentally, but implausible in reality as there would be a lot of ‘cross-​
talk’ between the modalities. Indeed, the body representations are assumed to be, in
some sense, unified or coherent. In light of the works on robot self-​calibration, this
begs the question of whether the brain arrives, in some sense, to an amodal, modality-​
independent model of the, say, body in space, onto which different sensory modalities
converge. This resembles the emulation theory of representation proposed by Grush
(2004) who uses the Kalman filter2 metaphor—​the amodal, long-​term body model is
a central representation, which also includes its relationship with individual sensory
modalities. The filter can then perform state estimation—​current state of the body—​
by executing a ‘sensory update’.3 To what extent this would be the case for the brain

2 Coming from signal processing, a Kalman filter is an efficient recursive filter—​device or process that removes
some unwanted components or features from a signal—​that estimates the internal state of a linear dynamic system
from a series of noisy measurements.
3 Grush, taking human arm as an example, contrasts an internal model in the form of a look-​up table storing pre-
vious input-​output sequences with an articulated model—​a model that includes some variables corresponding to their
counterparts in the musculoskeletal system (e.g., elbow angle, arm angular inertia, tension on quadriceps). Some of
these variables can be measured (e.g., by stretch receptors) and these sensors can also be simulated in the emulator.
 (C)
body image body schema

recurrent
parallel &
(D)
(B)

(A)

serial
explicit/veridical implicit/embodied

Figure 10.5  Body representation characteristics II: explicit versus implicit and serial versus parallel. (A) iCub humanoid robot and its
kinematic model. (B) iCub learning to reach using deep learning. (C) Human and schematic illustration of brain areas important for body
representations: body schema (see Figure 10.3B for details) and body image (posterior parietal cortex, PPC; extrastriate body area, EBA; insula)
(after Berlucchi & Aglioti, 2010). (D) The octopus and schematic of its nervous system.
Image credits: (A) iCub cartoon: Reproduced courtesy of Laura Taverna, Italian Institute of Technology. (B) Reproduced with permission from (Nguyen, Hoffmann, Pattacini, & Metta,
2019). (C) Walking human: Public domain (https://​commons.wikimedia.org/​wiki/​File:BSicon_​WALK.svg). Body schema brain adapted from Hugh Guiney/​Attribution-​ShareAlike 3.0
Unported (CC BY-​SA 3.0). Body image brain: Public domain (https://​commons.wikimedia.org/​wiki/​File:Gray731.png). (D) Photo: Common octopus-​albert kok/​CC BY-​SA (https://​
creativecommons.org/​licenses/​by-​sa/​3.0). Octopus nervous system: Jean-​Pierre Bellier/​CC BY-​SA (https://​creativecommons.org/​licenses/​by-​sa/​4.0).
 Characteristics of body representations  167
remains unclear. Different distortions of body perception—​inheriting some proper-
ties of the imperfect representations of individual modalities like the somatosensory
homunculus—​seem to suggest that the brain has not synthesized a perfect amodal
model of its body (see, for example, Fuentes, Longo, & Haggard, 2013 and Longo,
2015). Finally, we can probably say that the body schema is more strongly multimodal,
while the body image—​at least as a pictorial description of the body based on mainly
visual exteroception—​would be less multimodal.

10.3.3  Explicit/​veridical versus implicit/​embodied body models

Robot body models are explicit; it is clear what in the model corresponds to what in the
body (e.g., a certain parameter to the length of the left forearm) (see Figure 10.2 and
Figure 10.5A). They are also objective and veridical; the parameters should be the true
physical values of the quantities (lengths, angles, masses, etc.). In the biological realm,
representations in general are not like that. Of course, this depends on the school of
cognitive science, but there seems to be growing consensus about the embodied and
action-​oriented nature of cognition (e.g., Engel, Maye, Kurthen, & König, 2013). This
should hold for representations of the body as well (Alsmith & de Vignemont, 2012).
‘What the nervous system needs to do, in general, is to transform the input into the
right action’ (Webb, 2006). We can take again the example of reaching behavior. As dis-
cussed in Section 10.2.1, the octopus is able to reach for visual targets, but it may not
know—​and may not need to know—​how long its arm is or where it is exactly in space.
Orienting the base of the arm and propagating the bend until contact is detected by the
suckers may well suffice. This is embodied action and may be in line with the fact that no
specific body representation—​somatotopic or other—​sites were found in its nervous
system. The need to represent the body, its state, and the complex inverse kinematics
and dynamics has been largely offloaded to embodiment—​the properties of the mus-
cular hydrostat, supported by the PNS and low-​dimensional inputs from the CNS. This
is also in line with the thinking of Cisek and Kalaska (2003) who highlight the import-
ance of the online, dynamically generated character of movement generation. At the
same time, they also point out that due to conduction delays inherent to the sensori-
motor system, purely feedback control is limited, or at least slow, perhaps manifested
in the octopus experiments of Gutnick et al. (2011). Successful action is also the only
criterion for the ‘quality’ of what is represented about the animal’s body in its brain;
there is no need for any objective or veridical representation. Hence, the octopus has
been positioned on the far right of the x-​axis in Figure 10.5. Insects would be even far-
ther right on this axis, with their ‘body in the nervous system’ so implicit that we may be
reluctant to call this representation altogether.
Similar arguments hold for primate brains, but to a lesser extent. Numerous sites
dedicated to representing the body were found (see Figure 10.3B and Figure 10.5C).
For reaching, some evidence is suggesting that common reference frames encoded in
neurons in the posterior parietal cortex may be used for movement plans (Cohen &
168  Body models in humans, animals, and robots
Andersen, 2002), for example. However, ‘neurophysiological studies routinely fail to
find a significant population of cells whose activity explicitly encodes the output of
that transformation in a unique coordinate system. Instead the output may be im-
plicitly embedded in the distributed pattern of activity across the population . . . ’
(Cisek & Kalaska, 2003; see also Heed et al., 2015). This is perhaps even more prom-
inent in the motor cortex where it is still being debated what it is the cells are speci-
fying about reach—​muscle force, movement direction, or a more abstract end goal
of muscle action (Lisman, 2015). Somatotopy is rather functional than based on the
spatial relationships of the body. The embodied perspective is also appropriate here
(see Corbetta, Wiener, Thurman, & McMahon, 2018, for example). At the same time,
compared to the octopus, much more of the body seems more explicitly represented.
Interestingly, Longo (2015) also considers the implicit–​explicit axis for body repre-
sentations and draws a line roughly between the ‘body schema’ and the ‘body image’.
In tasks more related to action and where humans do not consciously represent their
body, the body models seem more implicit and also less accurate. These representa-
tions may also be dominated by somatosensation and inherit some of the distortions
typical of the ‘somatosensory homunculi’. Conversely, tasks that relate to conscious
perception of our body seem to draw on more explicit representations that are also
more accurate/​veridical (e.g., image of our hand). This is schematically illustrated in
Figure 10.5C.
Finally, works in robotics can also move toward more implicit models—​this is in line
with the current advent of deep learning and end-​to-​end architectures. One example
from the iCub robot is shown in Figure 10.5B (Nguyen, Hoffmann, Pattacini, & Metta,
2019). From motor babbling experience, the robot learns to associate the head and eye
configuration and stereo-​image input with arm joint configuration required to reach,
together with the body part that will contact the object. The complete mapping is impli-
citly represented in a deep convolutional neural network. Only the feed-​forward com-
ponent is represented, not the motor execution, which is performed using traditional
methods.

10.3.4  Serial versus parallel processing

Another axis that separates robot body models from their biological counterparts is se-
rial/​sequential versus parallel processing (y-​axis in Figure 10.5). This has to do with the
design, but also with the computing substrate. Robot control architectures tend to have
a serial ‘sense–​think–​act’ design; in addition, their control systems run on substrates
derived from the classical von Neumann architecture. Biological brains are known for
their massively parallel processing. This is nicely illustrated in the example of visually
guided behaviour in Figure 10.6 (Cisek & Kalaska, 2003). Interestingly, Pitron et al.
(2018) suggest some serial aspect of body representations whereby the body schema
would be feeding the body image.
 Characteristics of body representations  169
(A)
world desired
decision
model trajectory
visual cognitive
vision planning execution movement
input processes

(B) action specification

potential motor actions

“how” movement

“what” biasing factors

action selection

Figure 10.6  Sequential versus parallel processing for visually guided behaviour. (A) The
traditional ‘sequential processing’ model of visually guided behaviour. In this model,
visual input is used to construct a model of the world which is used to make decisions.
After decisions are made, a desired trajectory is generated and executed. (B) Schematic
representation of the ‘specification and selection’ architecture for visually guided
behaviour. Under this view, visual information has two different roles: specifying the
parameters of potential motor actions; and defining criteria which bias competition
among those potential actions until a single action is selected. These biasing factors include
attention, behavioural relevance, prior reinforcement, required effort, behavioural context,
learnt associations, motivations, long-​term behavioural objectives, desired outcomes,
and any other factor which influences action selection. The processes of specification and
selection occur in parallel and continue even during overt movement. A striking feature of
this architecture is the absence of a central model of the visual world.
Reproduced with permission from, Arbib, Michael A., ed., The Handbook of Brain Theory and Neural
Networks, second edition, Figure 1 from ‘Reaching Movements: Implications for Computational Models’, © 2002
Massachusetts Institute of Technology, by permission of The MIT Press.

A second aspect is the presence of recurrent connections. In robot control systems,

the flow of information is sequential and also unidirectional. Conversely, in neural sys-
tems, recurrent connections are ubiquitous. In primate brains, due to their complexity,
hierarchies are formed and information flows back and forth, combining the bottom-​
up and top-​down influences at different stages of the hierarchy. This is valid univer-
sally, with the circuitry responsible for representing the body not being an exception.
The recurrent nature is also more pronounced in primate nervous systems than in
cephalopods, say—​mainly due to the overall difference in the number of neurons and
layers of processing. This difference has also implications on the nature of the online,
or short-​term, body representations. In traditional robot frameworks, state estimation
will be at the top of the sensory processing part, perhaps combined with priors from the
model. However, in the brain, state estimation is a highly dynamic, continuous process
combining multisensory integration, top-​down priors, etc.—​through recurrent loops.
170  Body models in humans, animals, and robots
Finally, the robot case study (see Figure 10.5B) features a purely feed-​forward, hence
sequential, neural network.

10.3.5  Modular versus holistic and centralized versus

distributed representations

A final graphical attempt to contrast body models in robots and animals is depicted in
Figure 10.7. At first glance, it would seem intuitive that robot models are centralized,
while ‘body in the brain’ is highly distributed. There is typically only one body model
for a robot. In contrast, in the brain, there are numerous distributed, incomplete body
representations. In this sense, there is some overlap between centralized versus distrib-
uted and explicit versus implicit distinction. However, centralized in this case does not
imply monolithic. In fact, robot body models and associated control modules are highly
modular, as shown in Figure 10.7A. There are distinct modules like forward/​inverse
kinematics and dynamics that may draw from the same robot model and be recruited
for different purposes like state estimation, movement planning, etc. There would be
typically only one module of every kind (imagine a software library) providing this
functionality upon request. The representations/​modules will thus be universal (as op-
posed to task-​specific) and not overlapping. In nervous systems, on the other hand,
there would be often complete sensorimotor loops specialized in a particular task (and
hence task-​specific rather than universal). In that sense, every such representation
would be, in some sense, holistic. Their functionality may also be partially overlapping
or redundant. Population coding is a good example; it is striking how unspecific the
receptive fields of individual neurons often are (e.g., Georgopoulos, Kalaska, Caminiti,
& Massey, 1982). Also, many tasks may require some form of representation of the
hand in space, say, but it cannot be excluded that this will be implicitly ‘implemented’
multiple times. This distributed, specialized, and holistic nature is highest for the ner-
vous system of the octopus (see Figure 10.7C); regarding body models in primates (see
Figure 10.7B), the body schema as evolutionarily older and more ‘low-​level’ is on these
axes expected to be closer to the octopus, whereas the body image somewhat closer to
the engineered body models.

10.4  Robots as embodied models of body representations

How can the biological disciplines like cognitive psychology and neuroscience profit
from the viewpoint of robot models? The engineering perspective provides a mature
analytical machinery that deals with the relevant problems and this can be certainly
exploited. For example, consider again the ‘multimodal nature of body models’ dis-
cussed in Section 10.3.2. Next to the Kalman filter metaphor employed by Grush
(2004) to describe how estimating the current body state might work, mathematical
methods can be also employed to answer fundamental questions like under what exact
 (C)

specialized
distributed &
(B)

(A) body image body schema

robot model

forward inverse inverse

inputs kinematics kinematics dynamics

centralized
& universal
state movement movement
estimation planning execution

modular holistic
Figure 10.7  Body representation characteristics III: modular versus holistic and centralized versus distributed. (A) iCub humanoid robot, its kinematic model, and
some control modules. (B) Human and schematic illustration of brain areas important for body representations: body schema (see Figure 10.3 for details) and body
image (posterior parietal cortex, PPC; extrastriate body area, EBA; insula) (after Berlucchi & Aglioti, 2010). (C) The octopus and its nervous system.
Image credits: (A) iCub cartoon: Reproduced courtesy of Laura Taverna, Italian Institute of Technology. (B) Walking human: Public domain (https://​commons.wikimedia.org/​wiki/​File:BSicon_​WALK.
svg). Body schema brain adapted from Hugh Guiney/​Attribution-​ShareAlike 3.0 Unported (CC BY-​SA 3.0). Body image brain: Public domain (https://​commons.wikimedia.org/​wiki/​File:Gray731.png).
(C) Photo: Common octopus-​albert kok/​CC BY-​SA (https://​creativecommons.org/​licenses/​by-​sa/​3.0). Octopus nervous system: Jean-​Pierre Bellier/​CC BY-​SA (https://​creativecommons.org/​licenses/​by-​sa/​4.0).
172  Body models in humans, animals, and robots
conditions an agent (or ‘the brain’) can discover the (amodal) notion of space in which
it is embedded and infer its dimensionality from sensorimotor flow only. According
to Piaget (1954), for the infant, initially, ‘no constant relation exists between visual
and buccal space or between tactile and visual space. True, auditory and visual space
are already coordinated, as are buccal and tactile space, but no total and abstract
space encompasses all the others’. Later, these spaces are connected through prehen-
sion (reaching and grasping), and the ‘near’ and ‘far’ spaces become differentiated.
Eventually, through ‘reversible operations’—​e.g., whether the object moves in front
of me or I move the head, the image on the retina will be the same—​the child may
overcome the space of individual modalities and ‘objectify’ the world, space, and its
body; the body, say, will appear as an object with certain dimensions, independent of
its perception by individual senses. Mathematical and algebraic tools and robotics can
formalize Piaget’s ideas and provide existence proofs for under what exact conditions
an agent may develop spatial knowledge and give precise content to these concepts.
Pioneered by Henri Poincaré, compensability (~ reversible operations) was exploited
by Philipona, O’Regan, and Nadal (2003) who showed how an agent can infer the di-
mensionality of space from proprioception and exteroception, and this was extended
by Terekhov and O’Regan (2016) to use coincidence detection in neural networks as
the basis of a way of discovering the notion of space. Laflaquière, O’Regan, Argentieri,
Gas, and Terekhov (2015) explicitly considered the agent’s ‘point of view’ in the sen-
sorimotor flows. An alternative approach makes use of self-​contact; the ‘body in space’
can emerge from the structure of the proprioceptive–​tactile space in self-​touch con-
figurations (Roschin, Frolov, Burnod, & Maier, 2011; Marcel, Argentieri, & Gas, 2016).
Such models do not prove that these solutions are used by the brain, but they provide
hypotheses and one can then look for them in the neural code.
Second, next to models at high level of abstraction like the simulated sensorimotor
agents, robotics can provide a much higher degree of realism when it comes to mim-
icking biological bodies. This may be necessary to make progress beyond the existing
models addressing coordinate transformations or multisensory integration (Xing
& Andersen, 2000; Pouget, Deneve, & Duhamel, 2002) that typically concern very
simplified scenarios with one-​or two-​dimensional geometry, one or two joint angles
for the proprioceptive modality, etc. More than 15 years of research in the laboratory
of Yasuo Kuniyoshi stands out in this respect; a highly realistic musculoskeletal fetal
simulator (21 rigid body parts connected by 20 joints with 36 DoFs, 390 muscles with
proprioceptive receptors, and 3000 tactile mechanoreceptor models) has been devel-
oped and coupled to a spinal circuit model (neural oscillators, α and γ motor neurons,
and sensory interneurons) and a cortical model (2.6 million spiking neurons and 5.3
billion synaptic connections) (Yamada et al., 2016). Figure 10.8A shows the human-​like
distribution of tactile receptors on the fetal body. Mori and Kuniyoshi (2010) studied
the effect of this distribution on the emergence of sensorimotor behaviours; with a nat-
ural (non-​homogeneous) distribution, the fetus developed ‘normal’ kicking and jerking
movements (i.e., similar to those observed in a human fetus), whereas with a homo-
geneous allocation, it did not develop any of these behaviours—​just one illustration
Biological body representations should robots take on board?  173
(A) (B) (C)

Figure 10.8  Robots as embodied computational models of body representations. (A) Fetus
simulator (Yamada et al., 2016). (B) Musculoskeletal robot Kenshiro (Asano, Okada, &
Inaba, 2019). (C) iCub humanoid robot.
Image credits: (A) Reproduced from Yamada, Y. et al. An Embodied Brain Model of the Human Foetus, Sci Rep,
6 (27893), Figure 1d, doi:10.1038/​srep27893 (2016) under the Creative Commons Attribution 4.0 International
License CC BY 4.0 (http://​creativecommons.org/​licenses/​by/​4.0/​) (B) Reproduced with permission from (Yuki
Asano, Kei Okada & Masayuki Inaba, 2019) and courtesy of Yuki Asano and JSK robotics laboratory in the
University of Tokyo.

of the importance of the need for embodying the models related to body representa-
tions. Simulating physics can be computationally heavy and there is always a risk that
the simulator does not get certain properties right. Therefore, physical robots are an
indispensable tool. Figure 10.8B shows one of a series musculoskeletal humanoids—​
Kenshiro (160 ‘muscles’: 50 in the legs, 76 in the trunk, 12 in the shoulder, and 22 in
the neck) (Asano, Okada, & Inaba, 2019). Such platforms provide the right challenge
to model the impact of the details of the motor system on body representations and
reaching behaviours. Richter et al. (2016) have combined a musculoskeletal robotics
toolkit (Myorobotics) with a scalable neuromorphic computing platform (SpiNNaker)
and demonstrated control of a musculoskeletal joint with a simulated cerebellum.
Finally, the iCub baby humanoid robot (see Figure 10.8C) is my platform of choice
for models of body representations. It lacks some of the biological details of the other
platforms—​its whole body skin has a uniform density of tactile receptors and it is
driven by standard electric motors rather than by artificial muscles—​but it is a very ver-
satile platform with all the key sensory and motor capacities. For example, we showed
how it can be used to learn its ‘somatosensory homunculus’ (Hoffmann, Straka, Farkaš,
Vavrečka, & Metta, 2018) or self-​calibrate using self-​touch (Roncone et al., 2014) or
self-​touch and self-​observation (Stepanova et al., 2019).

10.4  Which characteristics of biological body representations

should robots take on board?

What properties that biological body representations manifest should robot models
copy? One feature that is clearly desirable is adaptivity. Robot models need to be
174  Body models in humans, animals, and robots
developed in the first place. Then, additional calibration procedures may be required
for every robot exemplar and also after deployment on the factory shop floor. During
operation, the robot is subject to wear and tear or other conditions might change,
calling for additional calibration. All of these processes are costly and often require
the intervention of professionals with specialized equipment and possibly suspending
production. The ‘body in the brain’, on the other hand, seems to develop largely from
scratch and displays plasticity on all of these timescales—​adapting to growth or fail-
ures, as well as performing rapid recalibration when working with a tool, for example.
Automatic robot self-​calibration is thus desired and solutions for this are being de-
veloped. For the robot to self-​calibrate, it needs redundant sources of information
about its body. There is a growing number of powerful, yet economic, sensors for
robots available (cameras, RGB-​D cameras, inertial measurement units, force/​torque
sensors, tactile sensors) and they can be exploited for calibration. Multimodality—​
another property of biological body representations—​thus enables plasticity (see
Figure 10.4). Such an extension of robot models should thus be unproblematic and is
already happening.
I have sketched also other axes—​robot body models are typically explicit, veridical
(see Figure 10.5), universal, centralized, and modular (see Figure 10.7). All of these
are—​from an engineering perspective—​very convenient properties. For example,
being explicit and universal often implies that the models are capable of extrapola-
tion; if transformations in three-​dimensional space are represented using appropriate
mathematical tools, they will always work—​even in previously unseen circumstances.
Implicit models would typically be expected to interpolate only, i.e., provide mean-
ingful estimations within the range of existing examples only. Being veridical, or ob-
jective, implies that robot body models can be easily validated from the outside. The
universal, centralized, and modular nature is ideal from a maintenance perspective.
The kinematic model is only in one place and any updates will be automatically propa-
gated to all other modules using it. One important additional convenient property that
is a consequence of the features listed above is interpretability; it is possible to under-
stand the model which is key for maintenance, debugging, etc. In this sense, there seem
to be good reasons for preserving these properties.
Yet, these very characteristics are responsible for some inherent limitations. In par-
ticular, robot body models and associated control architectures lack robustness. The
centralized and universal feature makes every module critical and that creates bottle-
necks. Redundancy is against software development principles, but it importantly
contributes to the resilience of animals. When faced with injuries, impairments, or le-
sions, they can find alternatives to performing a task. Implicit models are gaining popu-
larity with the advent of deep learning (Nguyen et al., 2019) (for a survey in robotics,
see, for example, Sünderhauf et al., 2018). This can be seen as a step toward brain-​like
models. Making robot control more embodied—​exploiting the body morphology
or local feedback loops—​would be another step in this direction. However, there
are trade-​offs associated with this; mainly, the interpretability of such implicit, or
black-​box, models is reduced, which is a downside when they are part of applications
 Conclusion  175
where, for example, safety is at stake. Another difference is the sequential versus par-
allel processing (see Figure 10.6). Having multiple potential movement plans always
ready will also improve the robustness of robot behaviour when faced with unex-
pected situations.
In summary, the strategy employed in robot modelling and control—​a single, uni-
versal, veridical body model associated with corresponding control schemes—​makes
robots rather brittle when faced with failures or unexpected changes. Instead, the so-
lution evolved by animals—​multiple, distributed, partially overlapping, task-​specific,
and parallel architectures—​makes them particularly robust and resilient.

10.5 Conclusion

I have outlined a number of characteristics of robot body models, as well as body rep-
resentations in nervous systems. Most often, the nature of these models is very dif-
ferent, often ending up on opposite ends of different schematic axes. There seems to
be a general trend—​on many of the axes sketched in Section 10.3, the sequence is from
robot body models, over body image and body schema, to the body representation in
the octopus. Paraphrasing Brooks (1991), the octopus is most faithful to the strategy
that the body is its own best model. Despite the efforts of Brooks and others, robots still
heavily rely on models of their bodies—​fixed, amodal, explicit, veridical, serial, cen-
tralized, and universal. Interestingly, the body image is the second closest to the robot
side, which begs the question—​asked by Yochai Ataria—​to what extent the robots may
be like Ian Waterman, the famous ‘man who lost his body’ (proprioception and touch)
(Cole & Paillard, 1995). Indeed, just like deafferented subjects who ‘lost their body
schema’, robots rarely recruit an implicit sensorimotor representation of their body or
the body directly (without modelling it) (see also Hoffmann & Müller, 2017). Also, as
their body models are explicit and veridical, they resemble the ‘pictorial’, body image-​
like representation of their bodies. Vision is also the main sensory modality and most
self-​calibration approaches rely on it. One difference remains—​robots have proprio-
ception, joint angle readings from encoders, and these, together with vision, are em-
ployed to bring about reaching movements. However, they rarely have touch (and may
be clumsy and slow, just like Ian Waterman) and without their body model cannot do
pretty much anything.
We have seen that the way animals and machines represent their bodies is quite dif-
ferent. Can robots contribute to our understanding of the ‘body in the brain’? As we
have seen in Section 10.4, this can be the case in two ways: (1) employing the math-
ematical machinery can provide proofs of what is possible—​extracting body as an
object in three dimensions from multimodal sensory information, for example; and
(2) using robots as embodied computational models of body representations. In all
cases, one should reflect upon using robots, such that the ‘design decisions’ typical
for robot models are not blindly applied to the biological world. In terms of perform-
ance (Section 10.5), interestingly, the rather ‘messy’ way adopted by biology—​which is
176  Body models in humans, animals, and robots
also why our understanding of the mechanisms is still limited—​is surprisingly good.
Neither the models nor the behavioural performance are optimal, but they are good
enough and highly robust. On the other hand, robot body models and control are very
neat, transparent, universal, and overall highly parsimonious and optimized. Yet, the
performance is fragile. One factor to consider here is that the criterion for quality of the
models in animals is the success in the action/​task for which the particular body repre-
sentations were recruited. Robot body models ultimately also serve actions; however,
the criterion for model quality is typically rather that it is a veridical representation of
something—​the robot link length, for example. The deep learning type of models may
provide one of the ways of bridging machine learning and neuroscience (e.g., Richards
et al., 2019).

Acknowledgements

This work was supported by the Czech Science Foundation (GA CR), project EXPRO
(nr. 20-​24186X). The chapter draws partly on an earlier manuscript in preparation and
discussions with Julius Verrel in 2012. I would like to thank the editors Yochai Ataria,
Shogo Tanaka, and Shaun Gallagher for their comments and patience. I am also in-
debted to Kevin O’Regan, Alban Laflaquiere, and Christian Mangione for comments
on a draft of the manuscript, and Gregor Schöner for discussions on the development
of reaching. Yochai Ataria drew my attention to the parallel between robots and Ian
Waterman. Kevin O’Regan pointed out the ‘body in the brain’ versus ‘brain in the body’
implications.

References
Alsmith, A. J. & de Vignemont, F. (2012). Embodying the mind and representing the body. Review of
Philosophy and Psychology, 3(1), 1–​13.
Azañón, E., Tamè, L., Maravita, A., Linkenauger, S. A., Ferrè, E. R., Tajadura-​Jiménez, A., & Longo,
M. R. (2016). Multimodal contributions to body representation. Multisensory Research, 29(6–​7),
635–​661.
Asano, Y., Okada, K., & Inaba, M. (2019). Musculoskeletal design, control, and application of human
mimetic humanoid Kenshiro. Bioinspiration & Biomimetics, 14(3). IOP Publishing Ltd.
Berlucchi, G. & Aglioti, S. (2010). The body in the brain revisited. Experimental Brain Research,
200(1), 25–​35.
Bongard, J., Zykov, V., & Lipson, H. (2006). Resilient machines through continuous self-​modeling.
Science, 314(5802), 1118–​1121.
Botvinick, M. & Cohen, J. (1998). Rubber hands ‘feel’ touch that eyes see. Nature, 391(6669), 756.
Brooks, R. A. (1991). Intelligence without reason. Proceedings of the 12th International Joint Conference
on Artificial Intelligence, 1, 569–​595.
Carruthers, G. (2008). Types of body representation and the sense of embodiment. Consciousness and
Cognition, 17 (4), 1302–​1316.
Chinn, L. K., Hoffmann, M., Leed, J. E., & Lockman, J. J. (2019). Reaching with one arm to the
other: coordinating touch, proprioception, and action during infancy. Journal of Experimental
Child Psychology, 183, 19–​32.
 Conclusion  177
Cisek, P. & Kalaska, J. F. (2003). Reaching movements: implications for computational models.
In Michael A. Arbib (Eds.), Handbook of Brain Theory and Neural Networks (pp. 945–​948).
Cambridge, MA: MIT Press.
Cohen, Y. E. & Andersen, R. A. (2002). A common reference frame for movement plans in the pos-
terior parietal cortex. Nature Reviews Neuroscience, 3(7), 553–​562.
Cole, J. & Paillard, J. (1995). Living without touch and peripheral information about body position
and movement: studies with deafferented subjects. In J. L. Bermúdez, A. J. Marcel, & E. N. (eds.),
The Body and the Self (pp. 245–​266). Cambridge, MA: MIT Press.
Corbetta, D., Wiener, R. F., Thurman, S. L., & McMahon, E. (2018). The embodied origins of in-
fant reaching: implications for the emergence of eye-​hand coordination. Kinesiology Review,
7(1), 10–​17.
de Vignemont, F. (2010). Body schema and body image—​pros and cons. Neuropsychologia, 48(3),
669–​680.
de Vignemont, F. (2015). Bodily awareness. Stanford Encyclopedia of Philosophy. Available
from: https://​plato.stanford.edu/​entries/​bodily-​awareness/​
Dijkerman, H. C. & De Haan, E. H. (2007). Somatosensory processing subserving perception and
action: dissociations, interactions, and integration. Behavioral and Brain Sciences, 30(2), 224–​230.
Engel, A. K., Maye, A., Kurthen, M., & König, P. (2013). Where’s the action? The pragmatic turn in
cognitive science. Trends in Cognitive Sciences, 17(5), 202–​209.
Feldman, A. G. (2011). Space and time in the context of equilibrium‐point theory. Wiley
Interdisciplinary Reviews: Cognitive Science, 2(3), 287–​304.
Fuentes, C. T., Longo, M. R., & Haggard, P. (2013). Body image distortions in healthy adults. Acta
Psychologica, 144(2), 344–​351.
Gallagher, S. (2006). How the Body Shapes the Mind. Oxford: Clarendon Press.
Georgopoulos, A. P., Kalaska, J. F., Caminiti, R., & Massey, J. T. (1982). On the relations between the
direction of two-​dimensional arm movements and cell discharge in primate motor cortex. Journal
of Neuroscience, 2(11), 1527–​1537.
Graziano, M. (2006). The organization of behavioral repertoire in motor cortex. Annual Review of
Neuroscience, 29, 105–​134.
Graziano, M. & Botvinick, M. (2002). How the brain represents the body: insights from neurophysi-
ology and psychology. In W. Prinz & B. Hommel (eds.), Common Mechanisms in Perception and
Action: Attention and Performance (pp. 136–​157). Oxford: Oxford University Press.
Grush, R. (2004). The emulation theory of representation—​motor control, imagery, and perception.
Behavioral and Brain Sciences, 27, 377–​442.
Gutnick, T., Byrne, R. A., Hochner, B., & Kuba, M. (2011). Octopus vulgaris uses visual information to
determine the location of its arm. Current Biology, 21(6), 460–​462.
Haugeland, J. (1985). Artificial Intelligence: The Very Idea. Cambridge, MA: MIT Press.
Hauschild, M., Mulliken, G. H., Fineman, I., Loeb, G. E., & Andersen, R. A. (2012). Cognitive signals
for brain–​machine interfaces in posterior parietal cortex include continuous 3D trajectory com-
mands. Proceedings of the National Academy of Sciences, 109(42), 17075–​17080.
Head, H. & Holmes, H. (1911). Sensory disturbances from cerebral lesions. Brain, 34, 102–​254.
Heed, T., Buchholz, V. N., Engel, A. K., & Röder, B. (2015). Tactile remapping: from coordinate
transformation to integration in sensorimotor processing. Trends in Cognitive Sciences, 19(5),
251–​258.
Hoffmann, M. & Müller, V. C. (2017). Simple or complex bodies? Trade-​offs in exploiting body
morphology for control. In G. Dodig-​Crnkovic & R. Giovagnoli (eds.), Representation and Reality
in Humans, Other Living Organisms and Intelligent Machines (pp. 335–​345). Cham: Springer.
Hoffmann, M. & Pfeifer, R. (2018). Robots as powerful allies for the study of embodied cognition
from the bottom up. In L. de Bruin, A. Newen, & S. Gallagher (eds.), The Oxford Handbook 4e
Cognition (pp. 841–​862). Oxford: Oxford University Press.
Hoffmann, M., Chinn, L. K., Somogyi, E., Heed, T., Fagard, J., Lockman, J. J., & O’Regan, J. K. (2017).
Development of reaching to the body in early infancy: From experiments to robotic models. Joint
IEEE International Conference on Development and Learning and Epigenetic Robotics (ICDL-​
EpiRob), (pp. 112–​119).
178  Body models in humans, animals, and robots
Hoffmann, M., Marques, H., Hernandez Arieta, A., Sumioka, H., Lungarella, M., & Pfeifer, R. (2010).
Body schema in robotics: a review. IEEE Transactions on Autonomous Mental Development, 2(4),
304–​324.
Hoffmann, M., Straka, Z., Farkaš, I., Vavrečka, M., & Metta, G. (2018). Robotic homunculus: learning
of artificial skin representation in a humanoid robot motivated by primary somatosensory cortex.
IEEE Transactions on Cognitive and Developmental Systems, 10(2), 163–​176.
Holmes, N. P. & Spence, C. (2004). The body schema and the multisensory representation(s) of
peripersonal space. Cognitive Process, 5(2), 94–​105.
Laflaquière, A., O’Regan, J. K., Argentieri, S., Gas, B., & Terekhov, A. V. (2015). Learning agent’s spatial
configuration from sensorimotor invariants. Robotics and Autonomous Systems, 71, 49–​59.
Leed, J. E., Chinn, L. K., & Lockman, J. J. (2019). Reaching to the self: the development of infants’
ability to localize targets on the body. Psychological Science, 30 (7), 1063–​1073.
Lenggenhager, B., Tadi, T., Metzinger, T., & Blanke, O. (2007). Video ergo sum: manipulating bodily
self-​consciousness. Science, 317, 1096–​1099.
Leyton, A. & Sherrington, C. (1977). Observations on the excitable cortex of the chimpanzee, oran-​
gutan, and gorilla. Quarterly Journal of Experimental Physiology, 11(2), 135–​222.
Lisman, J. (2015). The challenge of understanding the brain: where we stand in 2015. Neuron, 86 (4),
864–​882.
Longo, M. R. (2015). Implicit and explicit body representations. European Psychologist, 20(1), 6–​15.
doi:10.1027/​1016-​9040/​a000198
Longo, M. R., Azañón, E., & Haggard, P. (2010). More than skin deep: body representation beyond
primary somatosensory cortex. Neuropsychologia, 48(3), 655–​668.
Marcel, V., Argentieri, S., & Gas, B. (2016). Building a sensorimotor representation of a naive agent’s
tactile space. IEEE Transactions on Cognitive and Developmental Systems, 9(2), 141–​152.
Marder, E. (2007). Searching for insight: using invertebrate nervous systems to illuminate fun-
damental principles in neuroscience. In G. North & G. R.J. (eds.), Invertebrate Nervous Systems
(pp. 1–​18). Cold Spring Harbor: Laboratory Press.
Martin, V., Reimann, H., & Schöner, G. (2019). A process account of the uncontrolled manifold struc-
ture of joint space variance in pointing movements. Biological Cybernetics, 113(3), 293–​307.
Merleau-​Ponty, M. (1945). Phénoménologie de la Perception. Paris: Gallimard.
Metta, G., Natale, L., Nori, F., Sandini, G., Vernon, D., Fadiga, L., . . . Montesano, L. (2010). The
iCub humanoid robot: an open-​systems platform for research in cognitive development. Neural
Networks, 23(8–​9), 1125–​1134.
Milner, D. & Goodale, M. (2006). The Visual Brain in Action. Oxford: Oxford University Press.
Mori, H. & Kuniyoshi, Y. (2010). A human fetus development simulation: self-​organization of be-
haviors through tactile sensation. 2010 IEEE 9th International Conference on Development and
Learning (ICDL). Ann Arbor, MI.
Neisser, U. (1988). Five kinds of self‐knowledge. Philosophical Psychology, 1(1), 35–​59.
Nguyen, P. D., Hoffmann, M., Pattacini, U., & Metta, G. (2019). Reaching development through visuo-​
proprioceptive-​tactile integration on a humanoid robot-​a deep learning approach. Joint IEEE 9th
International Conference on Development and Learning and Epigenetic Robotics (ICDL-​EpiRob)
(pp. 163–​170). IEEE.
Nori, F., Traversaro, S., Eljaik, J., Romano, F., Del Prete, A., & Pucci, D. (2015). iCub whole-​body con-
trol through force regulation on rigid non-​coplanar contacts. Frontiers in Robotics and AI, 2, 6.
Paillard, J. (1999). Body schema and body image—​a double dissociation. In G. N. Gantchev, S. Mori,
& J. Massion (eds.), Motor Control, Today and Tomorrow (pp. 197–​214). Sofia: Prof. Marius Drinov
Academic Publishing House.
Parmiggiani, A., Maggiali, M., Natale, L., Nori, F., Schmitz, A., Tsagarakis, N., . . . Metta, G. (2012). The
design of the iCub humanoid robot. International Journal of Humanoid Robotics, 9(4), 1250027.
Pattacini, U., Nori, F., Natale, L., Metta, G., & Sandini, G. (2010). An experimental evaluation of a
novel minimum-​jerk Cartesian controller for humanoid robots. Proc. IEEE/​RSJ Int. Conf. Int.
Robots and Systems (IROS). Taipei.
Penfield, W. & Boldrey, E. (1937). Somatic motor and sensory representation in the cerebral cortex of
man as studied by electrical stimulation. Brain, 37, 389–​443.
 Conclusion  179
Philipona, D., O’Regan, J. K., & Nadal, J.-​P. (2003). Is there something out there? Inferring space from
sensorimotor dependencies. Neural Computation, 15, 2029–​2049.
Piaget, J. (1954). The Construction of Reality in the Child. New York, NY: Basic Books.
Pitron, V., Alsmith, A., & de Vignemont, F. (2018). How do the body schema and the body image
interact? Consciousness and Cognition, 65, 352–​358.
Pouget, A., Deneve, S., & Duhamel, J.-​R. (2002). A computational perspective on the neural basis of
multisensory spatial representations. Nature Review Neuroscience, 3, 741–​747.
Ramachandran, V. S. & Blakeslee, S. (1998). Phantoms in the Brain: Human Nature and the Architecture
of the Mind. London, UK: Fourth Estate.
Richards, B., Lillicrap, T., Beaudoin, P., Bengio, Y., Bogacz, R., Christensen, A., . . . Gillon, C. (2019). A
deep learning framework for neuroscience. Nature Neuroscience, 22(11), 1761–​1770.
Richter, C., Jentzsch, S., Hostettler, R., Garrido, J., Ros, E., Knoll, A., . . . Conradt, J. (2016).
Musculoskeletal robots: scalability in neural control. IEEE Robotics and Automation Magazine,
23(4), 128–​137.
Roncone, A., Hoffmann, M., Pattacini, U., & Metta, G. (2014). Automatic kinematic chain calibration
using artificial skin: self-​touch in the iCub humanoid robot. Proc. IEEE Int. Conf. Robotics and
Automation (ICRA). Hong-​Kong.
Roschin, V. Y., Frolov, A. A., Burnod, Y., & Maier, M. A. (2011). A neural network model for the ac-
quisition of a spatial body scheme through sensorimotor interaction. Neural Computation, 23(7),
1821–​1834.
Scholz, J. P. & Schöner, G. (1999). The uncontrolled manifold concept: identifying control variables
for a functional task. Experimental Brain Research, 126(3), 289–​306.
Schöner, G., Tekülve, J., & Zibner, S. (2018). Reaching for objects: a neural process account in a de-
velopmental perspective. In D. Corbetta & M. Sanntello (eds.), Reach-​To-​Grasp Behavior: Brain,
Behavior, and Modelling across the Life Span (pp. 281–​318). New York and London: Routledge.
Schwoebel, J. & Coslett, H. B. (2005). Evidence for multiple, distinct representations of the human
body. Journal of Cognitive Neuroscience, 17(4), 543–​553.
Scott, S. H. & Kalaska, J. F. (1997). Reaching movements with similar hand paths but different arm
orientations. I. Activity of individual cells in motor cortex. Journal of Neurophysiology, 77(2),
826–​852.
Stepanova, K., Pajdla, T., & Hoffmann, M. (2019). Robot self-​calibration using multiple kinematic
chains—​a simulation study on the iCub humanoid robot. IEEE Robotics and Automation Letters,
4(2), 1900–​1907.
Sturm, J., Plagemann, C., & Burgard, W. (2009). Body schema learning for robotic manipulators from
visual self-​perception. Journal of Physiology-​Paris, 103(3–​5), 220–​231.
Sünderhauf, N., Brock, O., Scheirer, W., Hadsell, R., Fox, D., Leitner, J., . . . Corke, P. (2018). The limits
and potentials of deep learning for robotics. International Journal of Robotics Research, 37(4–​5),
405–​420.
Tamè, L., Azañón, E., & Longo, M. R. (2019). A conceptual model of tactile processing across body
features of size, shape, side, and spatial location. Frontiers in Psychology, 10, 291.
Terekhov, A. V. & O’Regan, J. K. (2016). Space as an invention of active agents. Frontiers in Robotics
and AI, 3, 4.
Vitzthum, H., Muller, M., & Homberg, U. (2002). Neurons of the central complex of the locust
Schistocerca gregaria are sensitive to polarized light. Journal of Neuroscience, 22, 1114–​1125.
Walters, E. T., Bodnarova, M., Billy, A. J., Dulin, M. F., Díaz‐Ríos, M., Miller, M. W., & Moroz, L. L.
(2004). Somatotopic organization and functional properties of mechanosensory neurons expressing
sensorin‐A mRNA in Aplysia californica. Journal of Comparative Neurology, 471 (2), 219–​240.
Webb, B. (2006). Transformation, encoding and representation. Current Biology, 16(6), R184–​R185.
Weber, D. J., London, B. M., Hokanson, J. A., Ayers, C. A., Gaunt, R. A., Torres, R. R., . . . Miller, L. E.
(2011). Limb-​state information encoded by peripheral and central somatosensory neurons: implica-
tions for an afferent interface. IEEE Transactions on Neural Systems and Rehabilitation Engineering,
19(5), 501–​513.
Wong, A. M., Wang, J. W., & Axel, R. (2002). Spatial representation of the glomerular map in the
Drosophila protocerebrum. Cell, 109(2), 229–​241.
180  Body models in humans, animals, and robots
Xing, J. & Andersen, R. (2000). Models of the posterior parietal cortex which perform multimodal
integration and represent space in several coordinate frames. Journal of Cognitive Neuroscience,
12(4), 601–​614.
Yamada, Y., Kanazawa, H., Iwasaki, S., Tsukahara, Y., Iwata, O., Yamada, S., & Kuniyoshi, Y. (2016). An
embodied brain model of the human foetus. Scientific Reports, 6, 27893.
Yekutieli, Y., Sagiv-​Zohar, R., Aharonov, R., Engel, Y., Hochner, B., & Flash, T. (2005a). Dynamic
model of the octopus arm. I. Biomechanics of the octopus reaching movement. Journal of
Neurophysiology, 94(2), 1443–​1458.
Yekutieli, Y., Sagiv-​Zohar, R., Hochner, B., & Flash, T. (2005b). Dynamic model of the octopus arm. II.
Control of reaching movements. Journal of Neurophysiology, 94(2), 1459–​1468.
Young, J. (1971). The Anatomy of the Nervous System of Octopus Vulgaris. Oxford: Clarendon Press.
Zullo, L. & Hochner, B. (2011). A new perspective on the organization of an invertebrate brain.
Communicative and Integrative Biology, 4(1), 26–​29.
 11
From implicit to explicit body awareness in
the first two years of life
Philippe Rochat and Sara Valencia Botto

11.1 Introduction

What might constitute the awareness of an implicit body schema at the origin of de-
velopment, and how does it develop to become the explicit body image we tend to sys-
tematically promote in the evaluative eyes of others? That is the question driving this
chapter. To avoid any semantic confusion, body schema is understood here as the pre-
conscious, ‘automatic’ (i.e., implicit) dynamic system representation governing posture
and action. In contrast, body image corresponds to the explicit conceptual representa-
tion or conscious ‘idea’ of one’s embodied self. Following Gallagher and Cole (1995),
body image refers to ‘intentional states—​perceptions, mental representations, beliefs,
and attitudes—​in which the intentional object of such states is one’s own body’. In
contradistinction, the body schema refers to ‘a system of motor capacities, abilities, and
habits that enable movement and the maintenance of posture’ (pp. 370–​371).
The chapter tries to capture the evolution from implicit body schema to both implicit
body schema as well as explicit body image in the first two years of life. We first describe
the developmental starting state of body awareness in terms of body schema, something
we happen to share with all other animals (see Section 11.2). We review the evidence
demonstrating that we are not born into the blooming, buzzing confusion, as proposed
by William James over a century ago. Specifically, we want to show that from birth, and
even in the womb during the last trimester of gestation, research suggests that fetuses
and neonates express rudiments of a body schema or the implicit sense of the body
as a self-​contained organization. We review past and more recent empirical research
demonstrating the starting state of implicit body schema expressed from birth and in
the first weeks of life in typical development. In the second part (see Section 11.3), we
focus on the major changes occurring in the first two years of human life, which we
view as necessary precursors to the emergence of body image (i.e., the awareness of the
own body as an objectified entity that is represented in relation to self and others). We
propose a blueprint of cardinal changes in perception and action in both the physical
(object) and social (people) domains. These changes would underlie the social evalu-
ative function attached to the emergence of a public body image. We propose that such

Philippe Rochat and Sara Valencia Botto, From implicit to explicit body awareness in the first two years of life In: Body Schema and
Body Image. Edited by: Yochai Ataria, Shogo Tanaka, and Shaun Gallagher, Oxford University Press. © Oxford University Press 2021.
DOI: 10.1093/​oso/​9780198851721.003.0011
182  From implicit to explicit body awareness
emergence is indexed by the first manifestations of an evaluative audience perception,
or EAP, recently documented in 14-​to 24-​month-​old toddlers (Botto & Rochat, 2018).
Overall, the driving idea is that body schema and body image do not exist in isola-
tion. Instead, body schema and body image reflect complex interactions between the
embodied self and other things in the world, namely objects and people. As we will try
to show, both body schema and body image are fundamentally relational, not devel-
oping in independence of objects and people surrounding the individual. We speculate
that the development of an explicit ‘public’ sense of the body is a cardinal trademark of
what it means to be human (Rochat, 2018).

11.2  Starting state: implicit body schema in neonates

In his work on the phenomenology of perception, Merleau-​Ponty insists that what we

perceive of the body, presumably from birth on, is primarily a ‘postural schema’. The
postural schema corresponds to forms and patterns of whole-​body postural adjust-
ments in response to both external (i.e., gravitational) and internal (i.e., emotional)
forces that are exerted on the organism (Wallon, 1942/​1970). Merleau-​Ponty stated
in one of his lectures on child development he gave at the Sorbonne some 50 years
ago: ‘The awareness of my body is not the awareness of an isolated entity or “block;”
it corresponds instead to the knowledge of a postural schema, it is the perception of
my body’s position in relation to the vertical, the horizontal, and to certain important
axes of the environment’s coordinates in which my body is embedded.’ (Merleau-​Ponty,
1965, p. 23, P. R. translation from French).
There are two important ideas in this statement upheld by infant and child devel-
opment research. The first idea is that the awareness of the body, at an implicit, hence
preconceptual or cognitively inaccessible, level (see Block, 2007 for an in-​depth discus-
sion of such distinction), is not an awareness of something that exists in itself. In other
words, an implicit sense of body schema in early development is not experienced as an
isolated entity among other entities. The second idea deriving from the first is that body
schema is relational. It rests primordially on the experience of the relations between the
embodied self and the environment, both physical and social.
The past five decades of infancy research provide multiple evidence that indeed, as
suggested by Merleau-​Ponty, body perception from the very beginning pertains to an
implicit awareness of relations between the body (the embodied self) and the environ-
ment in which it is embedded, made of objects, people, layouts, movements, events,
and the force of gravity. Unlike the view of the original blooming, buzzing confusion of
neonates proposed by William James over a century ago (James, 1890/​1950), we now
know that infants are not born in a mere state of confusion with the world, but rather
show signs of perception of their own body as well as non-​self-​entities as unified dis-
crete things (Kellman & Arterberry, 2006). Specifically, we know that from birth, chil-
dren display implicit self-​awareness. For example, during the last trimester of gestation,
infants effectively bring their hand to their mouth, proceeding to suck and swallow
 Starting state: implicit body schema in neonates  183
(Prechtl, 1984). Research also shows that neonates root significantly more with head
and mouth toward a tactile stimulation from someone else’s finger than from their own
hand touching their cheek (double touch stimulation; Rochat & Hespos, 1997). Such
evidence in fetuses and neonates suggests that not only do they show orientation in
their rooting act, but also that they are capable of discriminating, at a very basic im-
plicit perceptual level, what corresponds to their own body and what corresponds to
the bodies of other people or things existing in independence of the embodied self. In
other words, we can extract characteristics of an implicit body schema, expressed at
birth and in the course of the first weeks of life, long before children begin to show signs
of a body image (i.e., a conceptual and objectified sense of their embodied self).
The content of implicit body schema is construed here as primary representations
that are emergent from the innate structure of the body, a structure that is combined
with newborn propensities to act rather than just passively respond to stimulations, as
in the case of reflexes. This content is anything but a fixed ‘ready-​made’ representational
module. It is dynamic, constantly updated as a function of experience and the rapid
postural maturation taking place during the first year of life (i.e., sitting ability and
independent locomotion (see Rochat, Goubet, & Senders, 1999; Adolph, Bertenthal,
Boker, Goldfield, & Gibson, 1997).
Other research from these past few years showed that neonates behave in relation to
their own body in ways that are different, when compared to how they behave in relation
to other physical bodies that exist in independence of their own. They feel and unques-
tionably demonstrate from birth a distinct sensitivity to their own bodily movements
via proprioception and internal (vestibular) receptors in the inner ears. Both proprio-
ceptive and vestibular sensitivities are well developed and operational at birth (Jouen
& Gapenne, 1995). Interoceptive in nature, these modalities are uniquely specifying
the own body in space. From the outset, they are a source of exclusive self-​specifying
experience. Newborns do pick up visual information that specifies ego-​motion or
movements of their own body while they, in fact, remain stationary (Jouen & Gapenne,
1995). These studies indicate that neonates experience the illusion of moving, adjusting
their bodily posture according to changes in the direction of an optical flow that is pre-
sented in the periphery of their visual field (Jouen & Gapenne, 1995). This kind of ob-
servations point to the fact that from birth, infants are endowed with the perceptual,
inter-​modal capacity to pick up and process meaningfully self-​specifying information.
Questions remain as to what might be actually synthesized or represented as an
outcome of the self-​specifying perceptual capacity manifested at birth. In particular,
what might be the experience of an implicit sense of the body at birth? Newborns
would experience the body as an invariant locus of pleasure and pain, with a par-
ticular topography of hedonic attractors, the mouth region being the most powerful
of all, as noted by Freud years ago in his account of the primitive oral stage of psycho-
sexual development (1905/​2000). Within hours after birth, in relation to this topog-
raphy, infants learn and memorize sensory events that are associated with pleasure
and novelty—​they selectively orient to odours associated with the pleasure of feeding,
and they show basic discrimination of what can be expected from familiar events that
184  From implicit to explicit body awareness
unfold over time and that are situated in a space that is embodied, structured within a
body schema (Marlier, Shaal, & Soussignan, 1998). But if it is legitimate to posit an a
priori ‘embodied’ spatial and temporal organization of self-​experience at birth, what
might be the content of this experience aside from pleasure, pain, and the sheer excite-
ment of novelty?
From birth, proprioception, alone or in conjunction with other sense modalities,
specifies the own body as a differentiated, situated, and eventually also agentive en-
tity among other entities in the world. This corresponds to what Ulric Neisser (1988;
1991) first coined as the ‘ecological self ’—​a self that can be ascribed to infants from
birth. As indicated by Neisser (1995), criteria for the ascription of an ecological self
rests on the behavioural expression by the individual of both an awareness of the en-
vironment in terms of a layout with particular affordances for action, and of its body
as a motivated agent to explore, detect, and use these affordances. As research sug-
gests, newborns fill the criteria proposed by Neisser for such awareness (e.g., Rochat
& Hespos, 1997). They also seem to possess an a priori awareness that their own body
is a distinct entity that is bounded and substantial, as opposed to disorganized and
‘airy’. Newborns perform self-​oriented acts by systematically bringing hand to mouth.
In these acts, the mouth tends to open in anticipation of manual contact and the in-
sertion of fingers into the oral cavity for chewing and sucking (Blass, Fillion, Rochat,
Hoffmeyer, & Metzger, 1989; Watson, 1995). What is instantiated in such systematic
acts is, once again, some implicit topographical awareness of the body, what we label
as an organized body schema. These acts are not just random and cannot be reduced to
reflex arcs. Rather than mere reflexes, they appear to be self-​oriented perceptual acts.
Because they bring body parts in direct relation to one another, as in the case of hand–​
mouth coordination, they provide neonates with invariant sensory information spe-
cifying the own body’s quality as a bounded substance, with an inside and an outside,
distinguished by particular texture, solidity, temperature, elasticity, taste, and smell.
Evidence of an implicit body schema is also evident in infants as young as 3 months.
A series of studies show that infants do discriminate between canonical and non-​
canonical views of their own body. In particular, they detect changes in the relative lo-
cation and movement directionality of their own limbs they see projected on a large TV
monitor (Rochat & Morgan, 1995; Morgan & Rochat, 1997; Rochat & Striano, 2000).
The a priori awareness of the own body as a bounded, substantial entity is evident in
neonates’ postural reaction and gestures when experiencing the impending collision
with a looming visual object, an event that carries potentially life-​threatening informa-
tion. Years ago, Ball & Tronick (1971) showed that neonates aged 2 to 11 weeks mani-
fest head withdrawal and avoidant behaviour when exposed to the explosive expansion
of an optic array that specifies the impending collision of an object. Infants do not
manifest any signs of upset or avoidant behaviour when viewing expanding shadows,
which indicate that an object is either receding or on a miss path in relation to them.
Consonant with Ball and Tronick’s findings, Carroll & Gibson (1981) reported that by
3 months, when facing a looming object with a large aperture in the middle, as an open
window in a façade, infants do not flinch or show signs of withdrawal as they do with a
 Interpersonal sense of self and developing body image  185
full, textured solid object. Instead, they tend to lean forward to look through the aper-
ture. In all, the detection of such affordance in the looming object indicates that there is
an a-​priori awareness that the own body is organized and substantial. There is an innate
sense that the own body occupies space and can be a physical obstacle to other objects
in motion.
Other studies indicate that from 2 months, infants are also active agents in the pro-
duction and systematic exploration of contingent sounds while sucking on a ‘musical
pacifier’ (Rochat & Striano, 1999). Specifically, they found that by 2 months, infants
respond differently to a pacifier that produces contingent sounds that are either analo-
gous or non-​analogous to the tactile pressure they produce on the pacifier. These ob-
servations demonstrate infants’ sensitivity and systematic exploration of the auditory
consequences of their own oral action (Rochat & Striano, 1999).
In summary, empirical observations warrant the ascription of an innate body
schema or implicit sense of self in perception and action. It is a perceptual awareness of
the body that is framed by innate propensities to act in particular ways. It is an implicit
(minimal) awareness of the own body as a bounded, organized, differentiated, situated,
substantial, and agentive entity among other entities in the world.

11.3  Interpersonal sense of self and developing body image

The early minimal and implicit self-​awareness of neonates manifests itself both in rela-
tion to physical objects, but also, if not primarily, in relation to others. Parallel to the ex-
pression of a body schema, infants also express a highly organized interpersonal sense
of themselves (Neisser, 1991). This implicit interpersonal sense of self is evident at
least by 2 months with the emergence of socially elicited smiling in face-​to-​face proto-​
conversations (Trevarthen, 1980; Wolff, 1987; Rochat, 2009). In this context, infants
develop social expectations, expecting others to behave in certain ways, following cer-
tain emotional bids in proto-​conversation. They express distraught when an engaged
social partner in playful interaction suddenly adopts a frozen still-​face (Tronick, Als,
Adamson, Wise, & Brazelton, 1978), and show a marked loss of attention toward an
adult who suddenly scrambles the narrative of a peek-​a-​boo game (Rochat, Querido, &
Striano, 1999).
All these findings indicate that early on, and at least from 2 months of age, infants de-
velop the sense of their own agency in relation to people. That is, they manifest an im-
plicit sense of their body as differentiated, situated, and emotionally responsive entities.
They detect invariants in social exchanges and expect certain outcomes from people,
showing surprise, if not disengagement and sadness, when such social expectations are
not met. Note, however, that all this experience happens in dyadic social exchanges,
in the pragmatics of turn-​taking face-​to-​face interactions that are primarily initiated
and driven by the adult. From around 9 months of age, things change dramatically.
This is a change that some authors go as far as characterizing it as the ‘9 month miracle’
(Tomasello, 1995).
186  From implicit to explicit body awareness
The cardinal feature of the 9-​month transition is the emergence of so-​called sec-
ondary intersubjectivity, or the shared experience expressed by the child with people
about things that surround them. In the first face-​to-​face exchanges that emerge by
2 months, if there is a sense of shared experience, it is contained within the infant–​adult
dialogue, not referring yet to anything outside of it. It corresponds to a primary inter-
subjectivity or a primary sense of shared experience accompanying dyadic, face-​to-​face
exchanges that include affective mirroring and other typically repetitive well-​outlined
playful and adult-​driven routines like ‘peek-​a-​boo’ games. It is not yet a conversation
in reference to or about something outside of the relationship. This ‘aboutness’ in con-
versation starts to emerge from 7 to 9 months with the new propensity of the child to
manifest social referencing, joint attention, referential gesture production, and compre-
hension (Tomasello, 1999). In social referencing, infants from 7 months start to check
and use the emotional expression of others watching them, and to make decisions and
disambiguate potentially critical situations in the environment such as strangers, novel
objects, or dangers like the sudden drop-​off of a visual cliff while crawling (Campos &
Sternberg, 1981; Striano & Rochat, 2000). In other words, from this point on, the child
begins to factor the evaluation of others regarding external objects and situations in the
environment.
From approximately 9 months, infants engage in bouts of joint attention, bringing
objects to the attention of others and checking back and forth whether their attempt is
successful or not (Tomasello, 1995). Likewise, they also begin to point and understand
pointing gestures by others as referring to something ‘out there’ (gestural communi-
cation). In all, by the second half of the first year, infants start to triangulate on things
with others in mind. They begin to engage in dialogues that are about objects that exist
outside of the rich one-​on-​one dyadic emotional transactions, which are in place by the
second month.
In the primary intersubjectivity associated with early face-​to-​face exchanges, infants
might have the opportunity to see and evaluate themselves in the reactions of others.
Adults of all cultures tend to engage in affective ‘mirroring’, repeating, and exaggerating
the emotions expressed by the infant (Gergely & Watson, 1999; Broesch, Rochat, Olah,
Broesch, & Henrich, 2016). However, there is no clear evidence that at this stage, the
infant sees and evaluates oneself in others. Likewise, it is not clear that with the emer-
gence of referential (secondary) intersubjectivity, infants can objectify themselves, con-
templating their embodied self as an object of evaluation. In other words, at this stage
of early development, infants would not yet show clear evidence of a body image, either
private (for oneself) or public (shared with others). This, we propose, occurs between 14
and 18 months with the development of an objectified sense of self.

11.4  Development of an objectified sense of self

By the end of the second year, children begin to pass the mirror mark test. Originally
studied by Amsterdam (1968; 1972), the mirror mark test probes for mirror
 Development of an objectified sense of self  187
self-​recognition in children, which has become the litmus test for a conceptual (rep-
resented, as opposed to implicit) sense of self (Bard, Todd, Bernier, Love, & Leavens,
2006; Lewis, Sullivan, Stanger, & Weiss, 1989; Rochat, 2003). In this paradigm, the ex-
perimenter surreptitiously marks the infant with rouge and then shows them their re-
flection in the mirror. The idea is that if children have a self-​concept, i.e., an idea of what
they look like and who they are either for self (private) or for others (public), then they
will notice that the mark seen on the reflection is actually a mark on themselves and
proceed to remove it.
While the mirror mark test is widely used to test for a self-​concept in the second year
(18 to 21 months), its interpretation is controversial. Some researchers support a leaner
interpretation, stating that the mirror mark test simply shows that the child can match
their own image to their reflection (Suddendorf & Butler, 2013). This would index a
‘private’ body image, as opposed to a public image (i.e., an image through the evalu-
ative eyes of others; Rochat, 2013). Some studies show that several other mammals pass
some versions of the mirror mark test (Anderson & Gallup, 2015; Plotnik, De Waal, &
Reiss, 2006). However, this ‘private’ passing of the mirror mark test would not demon-
strate that, unlike humans, non-​human animals understand the self to be an object that
not only is perceivable by others, but also has the potential to be evaluated by others (a
richer interpretation). The richer interpretation is warranted in humans, considering
that when children start passing the mirror mark test, they do so with accompanying
expressions of self-​conscious emotions like embarrassment.
The first signs of embarrassment are evident by the end of the second year (18 to
21 months), manifested almost exclusively in the presence of a real or imagined audi-
ence. When highlighting the difference between guilt, shame, and embarrassment,
Tangney, Miller, Flicker, and Barlow (1996) state that embarrassment entails ‘a sense
of exposure and a heightened concern for others’ judgments of the self ’ (p. 1263). In
other words, embarrassment places an emphasis on the audience and how the audi-
ence might respond to one’s behaviour. Interestingly, 14-​to 24-​month olds who pass
the mirror mark test are also more likely to display embarrassment in situations that
might elicit potential evaluations, such as when asked to dance or when they were given
compliments (Lewis et al., 1989).
With the emergence of mirror-​self recognition and self-​conscious emotions, 18-​to
21-​month-​old children also begin to use personal pronouns referring to the self, such
as ‘me’ or ‘mine’, as opposed to ‘yours’ (Lewis & Ramsay, 2004), and adjectives (‘pretty’
or ‘yucky’; Stipek, Gralinski, & Kopp, 1990). Children start to use words describing
themselves to others and in relation to others (e.g., mine instead of yours; pretty instead
of ugly). In short, when children pass the mirror mark test, they do not simply have a
representation of what they look like in the mirror. Instead, they have a concept of what
they look like to others (Rochat, Broesch, & Jayne, 2012).
As a case in point, a recent study demonstrates that around the same time children
begin to pass the mirror mark test, children also begin to modify their behaviour stra-
tegically in the presence of others, indexing the emergence of EAP. In their study, Botto
and Rochat (2018) showed 14-​to 24-​month olds how to activate a toy robot by pressing
188  From implicit to explicit body awareness
a remote-​control button and expressing either a positive value (Yay! Isn’t that great?) or
a negative one (Oh! Oops, oh no!). After this initial demonstration, they then invited the
child to play with the remotes, and then either watched the child (attentive condition)
or pretended to read a magazine (inattentive condition).
The idea was that if by 24 months, infants were sensitive to the evaluation of others,
then infants’ button-​pressing behaviour would be influenced not only by whether
someone was watching, but also by the values that the experimenter had previously ex-
pressed after pressing the remote. For instance, we would expect children to play with
the positive remote more if they were being observed but expected them to explore
the negative remote more when no one was watching. This is indeed what we found;
across four studies, toddlers tended to modify their behaviour depending on whether
they were being observed and whether we had positively or negatively valued the re-
mote action. In particular, when we were watching the child, most children activated
the remote associated with a positive value significantly more frequently. In contrast, if
the experimenter previously expressed a negative value, most children waited until she
turned her back to activate the remote. These findings corroborate the idea that by the
end of the second year, children are sensitive to how others react to their behaviour (a
sensitivity expressed already by young infants), but more importantly, also strategically
modify their behaviour depending on the relative attention of others and the values
others express toward a situation or an object of interest. In other words, children not
only realize that others can react positively or negatively toward objects, as in the case of
social referencing, but they also realize others can react positively or negatively toward
them based on what they are inclined to do, or not do. We propose that this realization
by the end of the second year accompanies what can be construed as the developmental
emergence of a public body image, because it is then that children begin to consider
what their own bodily actions signify for others (Rochat, 2018).
In addition to the emergence of EAP and a public body image, the end of the second
year is marked by an increase in attention toward social cues. For example, toddlers
show signs of conformity while passing the mirror mark test, leaving the mark on their
forehead, if surrounding others also have the same mark on their forehead (Rochat
et al., 2012). Eighteen-​month olds will also selectively imitate an adult who shows
positive, as opposed to negative, emotions while modelling an action (Repacholi &
Meltzoff, 2007). Prosocial behaviour and explicit manifestations of empathy toward
others are also increasingly evident toward the end of the second year (Martin & Olson,
2015). For example, unlike 1-​year olds, 2-​year olds will help another person without
being explicitly asked, such as handing an adult experimenter a blanket after she had
expressed that she was cold (Svetlova, Nichols, & Brownell, 2010). Showing rudiments
of empathy, toddlers also begin to respond appropriately to others’ negative emotional
displays, comforting peers when showing distress (Roth-​Hanania, Davidov, & Zahn-​
Waxler, 2011).
Finally, the emergence of over-​imitation grants further insight into the psychological
state of a child at the end of the second year. Over-​imitation—​or overly faithful re-
production of an action by others—​indicates a developing sensitivity to social norms,
 Uniquely human?  189
in other words the way things should be done. The propensity toward over-​imitation
would also be a novel way for children to assert their social affiliation, signalling to
others that they are part of the group (Over & Carpenter, 2012; Nielsen & Blank, 2011;
Keupp, Behne, & Rakoczy, 2013). As a case in point, toddlers tend to over-​imitate sig-
nificantly more in the presence of the adult model (Nielsen & Blank, 2011) or when
the modelled action is intentional, as opposed to accidental (Carpenter, Akhtar, &
Tomasello, 1998). In all, these other-​regarding developments by the child’s second
birthday reveal an increased concern with how others might respond to the child’s be-
haviour. This indicates clear signs of emerging public body image and evaluative audi-
ence perception, which lay the foundation for the development of reputation in the
preschool years (Botto & Rochat, 2019). We propose that this development represents a
crucial and distinct feature of human ontogeny.

11.5  Uniquely human?

Modifying behaviour when others are present is not unique to humans. Audience
effects—​defined as a detectable change in behaviour in the presence of others—​are evi-
dent across species. Cockroaches will run faster when other roaches are present; birds
will pretend to have a broken wing if a predator gets near their young, and monkeys
will change their alarm call when they find food depending on whether close kin are
around. Clearly, adjusting one’s behaviour in the presence of others is ubiquitous in the
animal kingdom, linked to basic adaptive fitness.
What appears to be strikingly different between audience effects in humans versus in
non-​human animals is the context and apparent motivation for strategically adjusting
their behaviour. While non-​human animals change their behaviour when there is ei-
ther survival or resources at stake, humans change their behaviour when there is no
apparent consequence and are even inclined to spend resources when others are pre-
sent, as in the case of conspicuous consumption. Indeed, studies have shown that adults
will purchase goods they dislike if a peer previously expressed affinity for that same
good (Mead, Baumeister, Stillman, Rawn, & Vohs, 2010) and will even make risky in-
vestments as a way to look good in front of their peers (Goulart, da Costa, Andrade, &
Santos, 2015). Considering that managing one’s own image is costly, it begs the ques-
tion as to why humans engage in reputation management.
Two contrasted accounts exist in the literature—​an affiliative and an identity (self)
account. In their affiliative account, Baumeister and Leary (1995) suggest that repu-
tation management protects individuals from experiencing social rejection and isola-
tion. With such development, individuals could potentially protect themselves from
all the negative psychological and physiological effects associated with social rejec-
tion (Rudolph, Caldwell, & Conley, 2005; Williams, 2007). In contrast, identity the-
ories posit that individuals seek social approval with the main motive of maintaining
a positive self-​concept (Cooley, 1902; Harter, 1999; Mead, 1934). In the footsteps of
Cooley’s (1902) and Mead’s (1934) idea of the ‘looking-​glass self ’, the perception of
190  From implicit to explicit body awareness
others appears to be a major determinant of self-​perception, with rippling effects on
development over the lifespan (Cheek, 1989). Across cultures, for example, high self-​
esteem is related to more positive relationships and academic success, whereas a nega-
tive self-​concept is related to social maladjustment, anxiety, and depression (Harter,
1999; Cole, Jacquez, & Maschman, 2001). While these two accounts are plausible, EAP
would be a pre-​condition of either account, as both entail some basic understanding of
others as evaluators. As such, the development of a public body image, as defined here,
combined with our quest for positive evaluations as proxy of social approval, would be
a major trademark of the self-​conscious and symbolic species we are (Rochat, 2018).
With such premise, EAP could be viewed as a uniquely human adaptation and a critical
aspect of what makes us psychologically distinct from other animals.

11.6 Conclusion

Babies do not come into the world in a state of confusion. They are born expressing
an implicit sense of their own body or a minimal sense of self, as instantiated in their
coordinated body movements and their immediate manifestation of self-​world differ-
entiation (e.g., Rochat & Hespos, 1997). As babies develop, this implicit body schema
evolves to become an explicit and objectified body image. To capture how the innate
implicit sense of the body (i.e., early body schema) becomes objectified and eventually
conceptualized as a body image, one has to look at crucial changes typically occurring
during the second half of the first year with the emergence of social referencing and
joint attention (Campos & Sternberg, 1981; Tomasello, 1995). From this point on,
infants start using their perception of others to gauge their situation in the environ-
ment, whether to be scared and whether it is more or less safe. This adds a referen-
tial dimension in their transaction with others (i.e., secondary intersubjectivity; see
Trevarthen, 1980).
However, this new dimension is not yet turned toward the self. One has to wait until
the second half of the second year to see the first signs of such change, when toddlers
tend to prefer those imitating them, seeing others as social mirrors reflecting who they
are as objectified entities (e.g., Agnetta & Rochat, 2004). It is also from this point on
that children typically pass the mirror mark test and begin to display the first signs of
explicit social emotions, like embarrassment or pride (Lewis et al., 1989). From the
middle of the second year, we also observe clear signs that children perceive others as
potential evaluators of them, starting to systematically and selectively manage their
behaviour to promote their own image (Botto & Rochat, 2018; 2019). In all, we pro-
pose that this transition is an important marker of what makes us the self-​conscious,
reputation-​concerned, and prosocial species we are. Questions regarding the rela-
tion between the development of body schema and body image remain open. In par-
ticular, future research should specify further the extent to which the development
toward an explicit public body image described in this chapter impacts on the implicit
 Conclusion  191
body schema—​whether such development is just additive or whether it has deeper re-
organizing power on both implicit and explicit body awareness.

References
Adolph, K. E., Bertenthal, B. I., Boker, S. M., Goldfield, E. C., & Gibson, E. J. (1997). Learning in the
development of infant locomotion. Monographs of the Society for Research in Child Development,
62(3), 1–​162.
Agnetta, B. & Rochat, P. (2004). Imitative games by 9‐, 14‐, and 18‐month‐old infants. Infancy, 6(1),
1–​36. doi:10.1207/​s15327078in0601_​1
Amsterdam, B. (1972). Mirror self-​image reactions before age two. Developmental Psychobiology, 5,
297–​305.
Amsterdam, B. K. (1968). Mirror Behavior in Children under Two Years of Age. Doctoral dissertation.
Ann Arbor, MI: University of Michigan.
Anderson, J. R. & Gallup, G. G. (2015). Mirror self-​recognition: a review and critique of attempts to
promote and engineer self-​recognition in primates. Primates, 56(4), 317–​326.
Ball, W. & Tronick, E. (1971). Infant responses to impending collision: optical and real. Science,
171(3973), 818–​820.
Bard, K. A., Todd, B. K., Bernier, C., Love, J., & Leavens, D. A. (2006). Self‐awareness in human and
chimpanzee infants: what is measured and what is meant by the mark and mirror test? Infancy,
9(2), 191–​219.
Baumeister, R. F. & Leary, M. R. (1995). The need to belong: desire for interpersonal attachments as a
fundamental human motivation. Psychological Bulletin, 117, 497–​529.
Blass, E. M., Fillion, T. J., Rochat, P., Hoffmeyer, L. B., & Metzger, M. A. (1989). Sensorimotor and mo-
tivational determinants of hand-​mouth coordination in 1-​3-​day-​old human infants. Developmental
Psychology, 25(6), 963–​975.
Block, N. (2007). Consciousness, accessibility, and the mesh between psychology and neuroscience.
Brain and Behavioral Sciences, 30, 481–​548.
Botto, S. V. & Rochat, P. (2018). Sensitivity to the evaluation of others emerges by 24 months.
Developmental Psychology, 54(9), 1723.
Botto, S. V. & Rochat, P. (2019). Evaluative audience perception (EAP): how children come to care
about reputation. Child Development Perspectives, 13(3), 180–​185.
Broesch, T., Rochat, P., Olah, K., Broesch, J., & Henrich, J. (2016). Similarities and differences in ma-
ternal responsiveness in three societies: evidence from Fiji, Kenya and US. Child Development,
87(3), 700–​711.
Campos, J. & Sternberg, C. (1981). Perception, appraisal, and emotions: the onset of social referencing.
In M. Lamb & L. Shjerrod (eds.), Infant Social Cognition: Empirical and Theoretical Considerations
(pp. 273–​314). Hillsdale, NJ: Lawrence Erlbaum Publishers.
Carpenter, M., Akhtar, N., & Tomasello, M. (1998). Fourteen-​through 18-​month-​old infants differen-
tially imitate intentional and accidental actions. Infant Behavior and Development, 21(2), 315–​330.
Carroll, J. J. & Gibson, E. J. (1981). Differentiation of an aperture from an obstacle under conditions
of motion by three-​month-​old infants. In Annual Meeting of the Society for Research in Child
Development, Boston, MA.
Cheek, J. M. (1989). Identity orientations and self-​interpretation. In D. M. Buss & N. Cantor (eds.),
Personality Psychology (pp. 275–​285). New York, NY: Springer.
Cole, D. A., Jacquez, F. M., & Maschman, T. L. (2001). Social origins of depressive cognitions: a lon-
gitudinal study of self-​perceived competence in children. Cognitive Therapy and Research, 25,
377–​395.
Cooley, C. H. (1902). Human Nature and the Social Order. New York, NY: Charles Scribner’s Sons.
Freud, S. (1905/​2000). Three Essays on the Theory of Sexuality. New York, NY: Basic Books.
Gallagher, S. & Cole, J. (1995). Body image and body schema in a deafferented subject. Journal of Mind
and Behavior, 16(4), 369–​389.
192  From implicit to explicit body awareness
Gergely. G. & Watson. J. S. (1999). Early socio-​emotional development: contingency perception and
the social-​biofeedback model. In P. Rochat (ed.), Early Social Cognition: Understanding Others in
the First Months of Life (pp. 101–​136). Mahwah, NJ: Lawrence Erlbaum Associates.
Goulart, M., da Costa, N. C., Andrade, E. B., & Santos, A. A. (2015). Hedging against embarrassment.
Journal of Economic Behavior and Organization, 116, 310–​318.
Harter, S. (1999). The Construction of the Self. New York, NY: Guilford.
James, W. (1950). The Principles of Psychology. New York, NY: Dover Publishers. (Original publication 1890).
Jouen, F. & Gapenne, O. (1995). Interactions between the vestibular and visual systems in the neo-
nate. In P. Rochat (ed.), The Self in Infancy: Theory and Research (pp. 277–​302). Amsterdam: North-​
Holland/​Elsevier Science.
Kellman, P. J. & Arterberry, M. E. (2006). Infant visual perception. In D. Kuhn, R. S. Siegler, W.
Damon, & R. M. Lerner (eds.), Handbook of Child Psychology: Cognition, Perception, and Language
(Vol. 2) (sixth edition) (pp. 109–​160). Hoboken, NJ: Wiley.
Keupp, S., Behne, T., & Rakoczy, H. (2013). Why do children overimitate? Normativity is crucial.
Journal of Experimental Child Psychology, 116(2), 392–​406.
Lewis, M. & Ramsay, D. (2004). Development of self‐recognition, personal pronoun use, and pretend
play during the 2nd year. Child Development, 75(6), 1821–​1831.
Lewis, M., Sullivan, M. W., Stanger, C., & Weiss, M. (1989). Self-​development and self-​conscious emo-
tions. Child Development, 60, 146–​156.
Marlier, L., Schaal, B., & Soussignan, R. (1998). Neonatal responsiveness to the odor of amniotic and
lacteal fluids: A test of perinatal chemosensory continuity. Child Development, 69(3), 611–​623.
Martin, A. & Olson, K. R. (2015). Beyond good and evil: what motivations underlie children’s pro-
social behavior? Perspectives on Psychological Science, 10(2), 159–​175.
Mead, G. H. (1934). Mind, Self, and Society. Chicago, IL: University of Chicago Press.
Mead, N. L., Baumeister, R. F., Stillman, T. F., Rawn, C. D., & Vohs, K. D. (2010). Social exclusion
causes people to spend and consume strategically in the service of affiliation. Journal of Consumer
Research, 37(5), 902–​919.
Merleau-​Ponty, M. (1965). Les Relations avec Autrui chez l’Enfant (Relations with Others in Children).
Paris: Centre de Documentation Universitaire.
Morgan, R. & Rochat, P. (1997). Intermodal calibration of the body in early infancy. Ecological
Psychology, 9(1), 1–​23.
Neisser, U. (1988). Five kinds of self‐knowledge. Philosophical Psychology, 1(1), 35–​59.
Neisser, U. (1991). Two perceptually given aspects of the self and their development. Developmental
Review, 11(3), 197–​209.
Neisser, U. (1995). Criteria for an ecological self. In P. Rochat (ed.), Advances in Psychology, 112. The
Self in Infancy: Theory and Research (pp. 17–​34). Amsterdam: North-​Holland/​Elsevier Science.
http://​dx.doi.org/​10.1016/​S0166-​4115(05)80004-​4
Nielsen, M. & Blank, C. (2011). Imitation in young children: when who gets copied is more important
than what gets copied. Developmental Psychology, 47(4), 1050.
Over, H. & Carpenter, M. (2012). Putting the social into social learning: explaining both selectivity
and fidelity in children’s copying behavior. Journal of Comparative Psychology, 126(2), 182.
Plotnik, J. M., De Waal, F. B., & Reiss, D. (2006). Self-​recognition in an Asian elephant. Proceedings of
the National Academy of Sciences of the United States of America, 103(45), 17053–​17057.
Prechtl, H. F. R. (ed.) (1984). Continuity of Neural Functions from Prenatal to Postnatal Life.
Oxford: Blackwell Scientific Publications Ltd.
Rochat, P. (2003). Five levels of self-​awareness as they unfold early in life. Consciousness and Cognition,
12(4), 717–​731.
Rochat, P. (2009). The Infant’s World. Cambridge, MA: Harvard Universtity.
Rochat, P. (2013). The gaze of others. In M. Banaji & S. Gelman (eds.), Navigating the Social
World: What Infants, Children, and Other Species Can Teach Us (pp. 205–​211). New York,
NY: Oxford University Press.
Rochat, P. (2018). The ontogeny of human self-​consciousness. Current Directions in Psychological
Science, 27(5), 345–​350.
 Conclusion  193
Rochat, P., Broesch, T., & Jayne, K. (2012). Social awareness and early self-​recognition. Consciousness
and Cognition, 21(3), 1491–​1497.
Rochat, P., Goubet, N., & Senders, S. J. (1999). To reach or not to reach? Perception of body effectivities
by young infants. Infant and Child Development, 8, 129–​148.
Rochat, P. & Hespos, S. J. (1997). Differential rooting response by neonates: evidence of an early sense
of self. Early Development and Parenting, 6(3–​4), 105–​112.
Rochat, P. & Morgan, R. (1995). Spatial determinants in the perception of self-​produced leg move-
ments by 3–​5 month old infants. Developmental Psychology, 31(4), 626–​636.
Rochat, P., Querido, J. G., & Striano, T. (1999). Emerging sensitivity to the timing and structure of
protoconversation in early infancy. Developmental Psychology, 35(4), 950.
Rochat, P. & Striano, T. (1999). Emerging self-​exploration by 2 month-​old infants. Developmental
Science, 2, 206–​218.
Rochat, P. & Striano, T. (2000). Perceived self in infancy. Infant Behavior and Development, 23,
513–​530.
Repacholi, B. M. & Meltzoff, A. N. (2007). Emotional eavesdropping: infants selectively re-
spond to indirect emotional signals. Child Development, 78, 503–​521. https://​doi.org/​10.1111/​
j.1467-​8624.2007.01012.x
Roth-​Hanania, R., Davidov, M., & Zahn-​Waxler, C. (2011). Empathy development from 8 to
16 months: early signs of concern for others. Infant Behavior and Development, 34(3), 447–​458.
Rudolph, K. D., Caldwell, M. S., & Conley, C. S. (2005). Need for approval and children’s well‐being.
Child Development, 76(2), 309–​323.
Stipek, D. J., Gralinski, J. H., & Kopp, C. B. (1990). Self-​concept development in the toddler years.
Developmental Psychology, 26(6), 972.
Striano, T. & Rochat, P. (2000). Emergence of selective social referencing. Infancy, 1(2), 253–​264.
Suddendorf, T. & Butler, D. L. (2013). The nature of visual self-​recognition. Trends in Cognitive
Sciences, 17, 121–​127.
Svetlova, M., Nichols, S. R., & Brownell, C. A. (2010). Toddlers’ prosocial behavior: from instrumental
to empathic to altruistic helping. Child Development, 81(6), 1814–​1827.
Tangney, J. P., Miller, R. S., Flicker, L., & Barlow, D. H. (1996). Are shame, guilt, and embarrassment
distinct emotions? Journal of Personality and Social Psychology, 70(6), 1256.
Tomasello, M. (1995). Joint attention as social cognition. In C. J. Moore & P. Dunham (eds.), Joint
Attention: Its Origins and Role in Development (pp. 103–​130). Hillsdale, NJ: Lawrence Erlbaum
Publishers.
Tomasello, M. (1999). Cultural Origins of Human Cognition. Cambridge, MA: Harvard University
Press.
Trevarthen, C. (1980). The foundations of intersubjectivity: developments of interpersonal and co-
operative understanding in infants. In D. R. Olson (ed.), The Social Foundations of Language and
Thought: Essays in Honor of Jerome S. Bruner. New York, NY: W. W. Norton.
Tronick, E., Als, H., Adamson, L. B., Wise, S., & Brazelton, T. B. (1978). The infant’s response to entrap-
ment between contradictory messages in face to face interaction. Journal of the American Academy
of Child Psychiatry, 17, 1–​13.
van Baaren, R. B., Holland, R. W., Steenaert, B., & van Knippenberg, A. (2003). Mimicry for
money: behavioral consequences of imitation. Journal of Experimental Social Psychology, 39, 393–​
398. doi:10.1016/​S0022–​1031(03)000014–​3
Wallon, H. (1970). De l’Acte à la Pensée (1942/​1970). Paris: Flammarion.
Watson, J. S. (1995). Self-​orientation in early infancy: the general role of contingency and the spe-
cific case of reaching to the mouth. In P. Rochat (ed.), The Self in Infancy: Theory and Research
(Advances in Psychology, Vol. 112, pp. 375–​394). Amsterdam: North-​Holland/​Elsevier Science
Publishers.
Williams, K. D. (2007). Ostracism: the kiss of social death. Social and Personality Psychology Compass,
1, 236–​247. doi: 10.1111/​j.1751-​9004.2007.00004
Wolff, P. H. (1987). The Development of Behavioral States and the Expression of Emotions in Early
Infancy. Chicago, IL: University of Chicago Press.
 12
Cross-​referenced body and action for the
unified self: empirical, developmental, and
clinical perspectives
Shu Imaizumi, Tomohisa Asai, and Michiko Miyazaki

12.1 Introduction

To interact with the environment and others, we possess the body, through which we
perform actions. The mental representation of the body acts as an interface between
our body and the external world and consists of two distinctive aspects: body image
and body schema. Body image refers to our conscious image of the body through per-
ceptual experience and conceptual understanding, whereas body schema refers to
unconscious systems that enable motor actions and postural control by coordinating
body parts (Gallagher, 2005; Gallagher & Cole, 1995). We must be aware of our body
and its actions to distinguish ourselves from the environment and external agents. As
such, self-​consciousness or self-​representation could be generated in the brain led by,
and/​or correlating with, body representation. Self-​representation also has distinctive
(but interactive) components: the senses of body ownership, a feeling of self-​attribution
of one’s body parts, and agency, a feeling of initiating and controlling one’s actions
(Gallagher, 2000; 2005). Therefore, it can be assumed that the body is an omnipresent
source of perceptual and conceptual bodily experience (i.e., body image) and can gen-
erate a sense of body ownership. Moreover, motor actions are implicitly guided by body
schema and, consequently, can generate a sense of agency over these actions.
This chapter will discuss how our self-​representation emerges through our body,
which is a source of body image, and through bodily action, which originates from
body schema. The discussion is based on empirical literature on healthy and psychiatric
adults and furthermore attempts to illustrate the emergence, loss, and re-​emergence of
self-​representation by integrating findings from young children and adult amputees.

12.2  Self in body and action

While the classical dichotomy between body image and body schema is still con-
troversial, there is some agreement that the body and action are both essential for

Shu Imaizumi, Tomohisa Asai, and Michiko Miyazaki, Cross-​referenced body and action for the unified self: empirical, developmental, and
clinical perspectives In: Body Schema and Body Image. Edited by: Yochai Ataria, Shogo Tanaka, and Shaun Gallagher, Oxford University
Press. © Oxford University Press 2021. DOI: 10.1093/​oso/​9780198851721.003.0012
 Self in body and action  195
self-​representation in the brain. The ‘minimal’ self can be represented by the senses of
body ownership and agency, which have distinctive mechanisms to be built up in our
sensorimotor system (see Figure 12.1), as opposed to self-​concept and self-​image with
a temporal extension (Gallagher, 2000). For body ownership, the rubber hand illusion
(RHI) (Botvinick & Cohen, 1998) provided evidence that synchronous visuo-​tactile in-
tegration is required for illusory ownership of the fake hand. This, in turn, implies that
the sense of ownership over our own body can also result from inter-​modal integration
(lower part of Figure 12.1). Accordingly, people with schizophrenia or highly schizo-
typal personality are more susceptible to RHI because their sense of ownership over
their own hand itself is presumably reduced (i.e., external misattribution). Currently,
the essential dysfunction in schizophrenia appears to lie within multimodal integration
(Tseng et al., 2015).
On the other hand, for agency, the forward model from the computational motor
control theory, specifically the comparator model, emphasizes the mismatch between
the actual and predicted states in our sensorium. When a mismatch is detected as ‘sur-
prise’, the likelihood of other-​agency (i.e., sensation not caused by oneself) is increased.
In this sense, the sense of self-​agency can be a result of the intra-​modal comparison
(upper part of Figure 12.1). Interestingly, people with schizophrenia and high schizo-
typy also exhibit external misattribution of their agency, regardless of the type of ac-
tion (e.g., speech production, keypress, and visually guided reaching) (Izawa, Asai,

Sensory Forward Model

Visual
Action Prediction
Timing
Location Sense of Agency
Motor over Action
Trajectory
Forward :
Model
Somatic
Body Schema
Efference Timing
Copy Location
:
Sensory System
Motor Internal Visual
Motor System Input Timing
Commands Location
Trajectory Minimal
Min
Mi m l Self
nima
Action Execution : Afferent
Somatic Signals
Timing
External Location
Input :

Cognitive System Body Image

Environments
Concept
Knowledge Sense of Ownership
: over Body

Figure 12.1  The minimal self from empirical, developmental, and clinical perspectives.
The awareness of body and action builds up the sense of self. This unified self (the ‘bud’)
is developing within the interaction between the sense of agency and body ownership.
The sensorimotor loop between body and action can be maintained even after mental or
physical disorders, where the local dysinteractions ‘×’ can be remedied by the minimal self.
196  Cross-referenced body and action for the unified self
& Imamizu, 2016). The grand unified theory can therefore be explored across senses
of agency and body ownership within the same spatiotemporal representation (see
Section 12.2.2 for the Bayesian brain hypothesis).
Agency over action and ownership over body share the same modules in the sen-
sorimotor system (see Figure 12.1). Indeed, empirical researchers have observed some
interaction effects between them, although there could also be a dissociation as their
mechanisms are distinctive (e.g., Imaizumi & Asai, 2015). From a developmental per-
spective, even young children can recognize the body in a mirror as their own when
performing an action (as in the mark test), suggesting that the contingency between
bodily movements and their visual feedback is required (e.g., Miyazaki & Hiraki, 2006).
From a clinical perspective, pain from a phantom limb can be reduced through the con-
gruent loop between the visual feedback and the phantom movements in the mirror
therapy (e.g., Imaizumi, Asai, & Koyama, 2017), as if the pain implies dysinteraction
between body and action. Symptoms of schizophrenia are also suggestive of this, since
patients have clinical problems both in body perception and in movements (although
these bodily disorders receive less scientific focus as delusions and hallucinations are
considered to be the first-​rank symptoms and to be separate from bodily disorders)
(Klaver & Dijkerman, 2016). Nevertheless, the following subtypes of the RHI paradigm
for healthy adults have been the major factors which have advanced the theory behind
cross-​dependency between body and action in terms of the sense of self.

12.2.1  Rubber hand illusions as a window for

body–​action interaction

After the original RHI was reported in 1998, subtypes of RHI have been suggested
(e.g., somatic RHI) (Ehrsson, Holmes, & Passingham, 2005). The original is now re-
ferred to as passive RHI (pRHI), where the participant’s hand is passively touched by
the experimenter, typically using a paintbrush. Active RHI (aRHI) was first reported
by Tsakiris, Prabhu, and Haggard (2006), where participants move their own hand
and are presented with the resultant visual feedback (via video projection, computer
graphics, or a movable rubber hand). Interestingly, proprioceptive drift, originally re-
ported in pRHI experiments, has also been observed in aRHI experiments, along with
subjective reports of illusory ownership of the proxy hand. These results from pRHI
and aRHI simply suggest that the congruent visuo-​somatosensory stimuli or move-
ment could elicit the sense of ownership over the proxy hand. However, unlike pRHI,
in the case of aRHI, participants’ movements also elicit the sense of agency over that
proxy. Therefore, another interpretation is that the elicited sense of agency ‘overrides’
the sense of body ownership (Tsakiris, Schutz-​Bosbach, & Gallagher, 2007).
Indeed, during a typical aRHI, both agency and body ownership are felt simultan-
eously (participants report: ‘I am moving this proxy hand and this is my own hand’).
The question is therefore whether both feelings are independently driven by aRHI,
or whether one is capable of modulating the other. The override hypothesis outlines
 Self in body and action  197
the possible effect of agency on body ownership, based on results that suggest the
pure feeling of agency over the proxy (i.e., without a feeling of body ownership) could
solely elicit the proprioceptive drift (Asai, 2016). This modulation was introduced by
eliminating the hand shape from the visual feedback of participants’ hand movement
(i.e., presenting only points of light movements). The proprioceptive drift was observed
even for the points of light when there was no delay between the actual hand move-
ments and their visual feedback. If proprioceptive drift is always an implicit index of
body ownership, this could mean that we infer our body (as the cause) to be in the
location where the agency (as the effect) is felt (see Section 12.2.2 for a Bayesian in-
terpretation of this). Additionally, recent studies have suggested that modulation also
occurs in the opposite direction, i.e., that body ownership could affect agency (Pyasik,
Furlanetto, & Pia, 2019).
According to the computational theory of motor control, the motor command is cal-
culated on the basis of the current state of the body. Therefore, an illusory body state
(e.g., a biased location of the hand) biases the following trajectory of visually guided
reaching (Newport, Pearce, & Preston, 2010). Another study also showed this automatic
‘compensative’ movement using pRHI (Asai, 2015). The experimental setup was similar
to the original pRHI, except for a slider which could be moved horizontally under parti-
cipants’ hands. Participants were instructed to relax their hand on the slider where they
were delivered visuo-​tactile stimulation, as with the typical pRHI. Surprisingly, their
stimulated hand moved automatically toward the rubber hand, concurrently with the
illusory feeling of body ownership. This suggests that actual drifting movements might
reflect compensation between the actual and predicted location of the hand. In this case,
where the (illusory) body is present, the action (motor reflex) is actively sampling the
reasonable or likely inputs for that body. We can now consider the generalized computa-
tional theory between body and action in our dynamical sensorium.

12.2.2  Cross-​dependency between body and action in the

Bayesian brain

When we revisit the relationship between body and action, or between subjectivities
of body ownership and agency, we are faced with two opposing explanations. One is to
consider higher interactions between the two on the basis of the specific mechanisms
for each: inter-​modal integration for body and intra-​modal comparison for action (see
Figure 12.1). The other option is to search for a grand unified theory in our brain where
body and action are represented on a generalized, but abstractive, common framework.
A Bayesian brain hypothesis suggests that our brain is the ‘phantastic organ’, serving as
the automatic inference machine of the cause (i.e., the generative model or the structure
of the world) given the effect (i.e., the sensory evidence) (Friston, Stephan, Montague,
& Dolan, 2014). According to this concept, the Bayesian brain specifically infers or
predicts visuo-​proprioceptive states of one’s own body, which is subsequently tested
against the actual afferent signals. The aforementioned interactions between body and
198  Cross-referenced body and action for the unified self
action in the pRHI and aRHI are typical Bayesian integrations or updates for the sense
of location of the hand in the subjective probability space.
In aRHI, where participants observe synchronous movements from a distance,
the movement is likely to be attributed to the self (see Figure 12.2A). As a result, the
Bayesian brain filters the input data of their own proprioception in accordance with the
self-​attributed proxy movement (i.e., the visual action) as a way of ‘predictive coding’.
The resultant representation of one’s ‘body’ is therefore biased toward the visual ‘action’.
This Bayesian update in predictive coding of proprioception is termed ‘illusory drift’.
In contrast, in pRHI, where participants observe a fake hand from a distance which is
touched synchronously with their own, the proxy body is likely attributed to the self
(see Figure 12.2B). As a result, the Bayesian brain exercises the motor reflex (‘action’)
to fulfil the predicted proprioception from the ‘body’ as a way of ‘active inference’. This
Bayesian integration in active sampling is termed ‘actual drift’.
In our brain, these calculations could be characterized as the entrainments and
convolutions between waveforms that could exist in the subjective probability space.
Though the convolutions (i.e., how the multiple waveforms are integrated) could be
retrieved by Bayes theorem, the entrainments (i.e., why the two waveforms are spe-
cifically linked with each other) is a separate question. Now, imagine again how the
relationship between body and action develops from our birth. The body and action
should be tightly coupled or unified for adaptation under the natural selection pressure

(A) Predictive coding (B) Active sampling

Subjective probability

Prior Prior Likelihood

(proprioception) (proprioception) (“body”)
Likelihood
(“action”)

Posterior Posterior
(“body”) (“action”)

Illusory drift Actual drift

Figure 12.2  Cross-​dependency between body and action in the Bayesian brain. (A) When
the movement is likely to be attributed to the self during an aRHI, the body possibly exists
within that movement. The brain filters the input data (proprioception) in accordance with
the prediction (self-​attributed ‘action’). The resultant representation (‘my action and my
invisible hand here’) updates the subjective probability of the location of my body, resulting
in illusory drift. (B) When the illusory ‘body’ is likely to be attributed to the self during
a pRHI, the motor reflex (‘action’) is exercised to fulfil the predicted proprioception,
resulting in actual drift. In our Bayesian brain model, these calculations are all performed
within the subjective probability space.
 Development of body–action interaction for the self  199
(i.e., survival) in light of the self (see right part of Figure 12.1 for analogy: the bud in the
harsh environment). In this sense, in the first instance, self-​representation is the pos-
terior, resulting from body–​action interaction, but soon becomes the prior that further
connects body and action. The self as the prior is an entraining factor between body
and action, making them cross-​dependent, even with physical and mental disorder.
The following sections will discuss this triad of factors (i.e., body, action, self) from de-
velopmental and clinical perspectives.

12.3  Development of body–​action interaction for the self

The body–​action interaction for organization of the self begins even before birth
(Hepper, 2015; Mori & Kuniyoshi, 2010; Myowa-​Yamakoshi & Takeshita, 2006), and
very young infants have a primitive self which is based on direct perception or on inter-
action with the environment (i.e., ecological self) (Filippetti, Johnson, Lloyd-​Fox,
Dragovic, & Farroni, 2013; Neisser, 1993; Rochat, 2001; 2015). For example, Myowa-​
Yamakoshi and Takeshita (2006) found that fetuses show hand–​mouth coordination
using four-​dimensional ultrasonography. Filippetti et al. (2013) demonstrated that
neonates can detect visuo-​tactile synchrony only when the visual stimulus was related
to their own bodies.
Given such high sensitivity to the multimodal sensory integration observed in pre-​
and post-​natal infants, it could be expected that the senses of body ownership and
agency are acquired early in life. However, the emergence and development of body
ownership and agency, which are characterized by subjective and phenomenologically
rich experiences, are still controversial. Empirical findings from developmental studies
on RHI are currently accumulating (Cowie, Makin, & Bremner, 2013; Cowie, Sterling,
& Bremner, 2016; Nava, Bolognini, & Turati, 2017; Nava, Gamberini, Berardis, &
Bolognini, 2018). At the age of 4 years, children begin to show behaviours that presum-
ably reflect their illusory sense of ownership over a fake hand in the pRHI paradigm,
while proprioceptive drift, as an implicit marker of body ownership, was not induced
by synchronous visuo-​tactile stimulation (Cowie et al., 2013). In contrast, at 6–​8 years,
children exhibit relatively stable proprioceptive drift. In contrast to the high sensitivity
of multimodal integration in early life (e.g., Filippetti et al., 2013), a great divergence
in the instability of multimodal integration and malleability of body ownership is ob-
served in childhood.
Furthermore, it is yet to be clarified when the sense of agency is developed or learnt
in infancy. Some researchers claim that the sense of agency or awareness of one’s own
action is acquired within the first few months of life (Rochat, 2001), while others sug-
gest that it occurs after 9 months (Verschoor & Hommel, 2017). A potential reason
for this controversy is that experimental paradigms originally used in adult studies,
where subjective responses are required, cannot be used for infants because of the im-
maturity of linguistic and/​or motor capacities. Nevertheless, novel paradigms have re-
cently been developed to examine the sense of agency in infancy (Miyazaki, Takahashi,
200  Cross-referenced body and action for the unified self
Rolf, Okada, & Omori, 2014; Wang et al., 2012; Zaadnoordijk, Otworowska, Kwisthout,
& Hunnius, 2018). For example, one task employs gaze as a trigger to cause visual out-
comes on a monitor (the image-​scratch task) (Miyazaki et al., 2014), where infants’ eye
movements result in a black screen being scratched off to gradually reveal colourful
pictures. Spontaneous eye movements based on the detection of gaze-​outcome contin-
gency could be a marker of the sense of agency.
Taken together, whereas the developmental time course of the senses of body owner-
ship and agency remains unclear, findings from studies in adults are still informative to
seek implications for developmental studies. The following section will re-​interpret the
developmental studies on mirror self-​recognition using delayed visual feedback from
the viewpoint discussed in the previous section of cross-​referenced interactions be-
tween body and action.

12.3.1  Body–​action interaction for self-​recognition in

delayed visual feedback

Self-​recognition, where one recognizes a body and a face as his/​her own, has been
regarded as a milestone in the development and manifestation of the self (Anderson,
1984; Lewis & Brooks-​Gunn, 1979). Children begin to recognize an image of their
body in a mirror as themselves between 18 and 24 months of age. We can test the
emergence of mirror self-​recognition by checking children’s behaviour, whether he/​
she attempts to remove stickers covertly placed on their forehead while referring only
to the mirrored image of the self (i.e., mark test or rouge test) (Amsterdam, 1972;
Gallup, 1970).
Unlike an RHI task which employs a mirrored image (Bertamini, Berselli, Bode,
Lawson, & Wong, 2011), the mark test is thought to be unlikely to induce proprio-
ceptive drift. Thus, body ownership over the mirrored image of the self cannot easily
be examined using the deviated body localization as a measure. Nevertheless, mirror
self-​recognition relies on multimodal integration that requires detection of visuo-​
proprioceptive or visuo-​motor contingency between a mirrored image and limb move-
ments (Bigelow, 1981), which are also prerequisites to the generation of senses of body
ownership and agency (Tsakiris et al., 2007). Thus, mirror self-​recognition could, at
least partly, overlap with the sense of body ownership and be a potential marker of the
development of the sense of body ownership in children. Revealing cognitive and sen-
sorimotor mechanisms of mirror self-​recognition is helpful to understand the develop-
mental time course of body ownership and agency.
Miyazaki and Hiraki (2006) investigated the influences of detection of temporal con-
tingency between action and its visual feedback for mirror self-​recognition. Various
levels of delay were applied to an online video of participants’ bodies to systematically
control the temporal synchrony between children’s action and video feedback. The chil-
dren, who were aged 2 to 4 years and had already developed mirror self-​recognition,
were presented a live or delayed video, and asked who was in the video (the name task)
 Development of body–action interaction for the self  201
and to remove the sticker on their forehead (the mark test). Regardless of age and tem-
poral delay, >80% of the children identified themselves in the name task. However, in
the mark test task, only 38% of 3-​year olds and 13% of 2-​year olds passed the mark test
when the delay was set to 2 seconds. For example, a 3-​year-​old boy who participated in
the condition where video feedback was delayed by 2 seconds spoke his name as soon
the video was presented, but when he noticed that his video was incorrect (i.e., tem-
porally incongruent), he distorted his face and moved his hand, then said, ‘Is that my
friend?’ These observations suggest that the 2-​second temporal delay was long enough
to confuse visuo-​proprioceptive contingency detection and that these difficulties dis-
rupt mirror self-​recognition.
In subsequent experiments, the pass rate of the delayed-​video version of the mark
test increased when the delay was 1 second and when the 2-​second delay was experi-
enced and learnt sufficiently (i.e., the experience condition). In the 1-​second delay
condition, 71% of 3-​year olds were able to pass the mark test. We observed more
exploratory behaviours to confirm a shorter delay before reaching for the sticker
than in the other conditions. In the experience condition, children were presented
with a familiar song and accompanying hand gestures and asked to mimic them
while observing the video delayed by 2 seconds. They then performed the mark test.
The result was that not only in 3-​year olds, but also in 2-​year olds, the percentage of
children who passed the mark test significantly increased (2-​year olds, 47%; 3-​year
olds, 94%).
Taken together, Miyazaki and Hiraki (2006) suggested that detection of the visuo-​
proprioceptive contingency influences the establishment of body ownership over the
mirrored image of the self, especially in 3-​year olds. The manual movements to ex-
plore the sticker may indeed be to explore the contingency. Consequently, the visuo-​
proprioceptive contingency may foster self-​recognition for the delayed visual feedback.
These findings also suggest that the action-​to-​body interaction seen in aRHI in adults
(Asai, 2016; Tsakiris et al., 2006) may be developed even in young children, although
care should be taken when interpreting the self-​recognition as a proxy of the sense of
body ownership.

12.3.2  Body–​action interaction for body topology

Body topology is a conceptual and structural understanding of the locations and con-
figurations of one’s own body parts (Brownell, Nichols, Svetlova, Zerwas, & Ramani,
2010). This chapter uses the term ‘body topology’ as an intermediary between body
concept (i.e., conceptual understanding of the body) and body percept (i.e., percep-
tual experience of one’s own body) (Gallagher, 2005). Although the body schema can
be derived from the sensorimotor system, body topology has been considered to be
derived primarily from visual inputs (Schwoebel & Coslett, 2005). However, somato-
sensory inputs from body–​action interaction may also play a role in the acquisition of
body topology.
202  Cross-referenced body and action for the unified self
Immaturity of body topology can be noted in our observation of a 23-​month-​old boy
who was presented with the mirrored image of his body in the mark test (see Figure
12.3). As soon as he found a sticker on his mirrored forehead, he initially explored the
back of his head. He searched for a while and then said, ‘There isn’t,’ but then began to
touch his cheeks while looking at his face in the mirror. He gradually moved his hands
up and finally reached for the sticker on his forehead. These observations imply that he
could easily touch his cheeks while watching his mirrored body in the initial phase, and
he explored the forehead by progressively moving upwards starting from his cheek. This
suggests that during the period in which self-​recognition is established, children do not
necessarily have a developed body topology. This might be due to a discrepancy be-
tween whether or not the location is easily identified (e.g., the cheeks and the forehead,
respectively). We assume that children can at least transiently obtain a correct under-
standing of the location of the target body part through manual-​seeking behaviour and
sensorimotor integration (i.e., visuo-​tactile-​proprioceptive). In particular, his available
body topology for the cheeks leads to direct ballistic touching movements, after which
he intentionally and gradually moves his hand toward the target location, adjusting the
movements based on the video feedback and the tactile and proprioceptive sensations.
Bodily movements, in combination with their corresponding multisensory feedback,
may update and develop children’s body topology.
To further study our notion, we developed a novel task to examine the acquisi-
tion of body topology specially for children aged approximately 2 years, who are
beginning to acquire mirror self-​recognition (Miyazaki, Asai, & Mugitani, 2019).
Kinematic tracking and augmented reality (AR) were used to superimpose a car-
toon character onto a part of the face (e.g., nose, chin) in an online video feedback
depicting a mirror image of the participant’s whole body. They were asked to touch
their own body in the location which corresponded to the target (i.e., cartoon char-
acter) while referring to the video feedback. As the target characters were popular
and attractive to children in Japan, it became possible to repeat >30 trials per person,
which enabled us to perform a quantitative analysis (e.g., error rate, time course of
responses). Results from the AR task, in addition to the assessment of children’s

(A) (B) (C)

Figure 12.3  An example of reaching behaviour in a mirror self-​recognition task. (A) A 23-​
month-​old boy initially searched for the sticker by touching the back of his head. (B) He
then touched his face while moving his hands up gradually, (C) eventually reaching the
sticker.
 Loss and restoration of bodily self-representation  203
lexical and conceptual understanding of body parts based on their parents’ reports,
suggested two types of body representation. First, body topology results from visuo-​
proprioceptive integration driven by exploratory touching behaviour. Children
initially have separate proprioceptive and/​or tactile representation for each body
part. Subsequently, each representation might be gradually organized and struc-
tured by integration of visual inputs and proprioceptive feedbacks in the explora-
tory touching behaviour, potentially acquiring body topology for the whole body.
Second, conceptual understanding of children’s body, which is more comparable
to the body concept, was suggested by their lexical acquisition. Importantly, per-
formances of these two tasks did not correlate, suggesting that different represen-
tations of body parts may develop independently. Body topology might develop
through sensorimotor integration during motor actions, and not by acquisition of
lexical knowledge. In future, we will expand our AR task and preliminary findings to
examine the development of the entire body topology.

12.4  Loss and restoration of bodily self-​representation

Healthy adults have developed body representation and self-​representation through

interactions between the body and action since early childhood. Nevertheless, through
the course of our life, we might undergo physical injuries and neurological disorders
which deteriorate the acquired body, action, and their interaction. In such cases, we
must ask whether and how we can reacquire bodily self-​representation.
Lesions in the brain and nervous system deteriorate sensorimotor systems and
consequently alter cognition and behaviour. A patient (Ian Waterman, IW) lost his
proprioceptive and tactile senses from the neck down due to nerve fibre degener-
ation and thus had deficits in voluntary control of whole body movement (Gallagher
& Cole, 1995). Nevertheless, he was able to move his body and even walk, but only
while visually monitoring kinematic states of his body. This observation suggests that
despite neurological deficits disrupting somatosensation, body-​related visual infor-
mation complements body schema for action and postural control, resulting in in-
tact bodily movements. However, even though one has an intact body and peripheral
nervous system, brain lesions may invalidate the body–​action interaction and reduce
subjective awareness of our own body and action. For instance, lesions in the right
temporoparietal area can cause delusional denial of ownership over the left limbs—​
somatoparaphrenia (Vallar & Ronchi, 2009). In contrast, lesions in the frontal area
and corpus callosum can cause alien hand syndrome, where patients experience hand
movements without the sense of agency, even though they indeed move them (Biran
& Chatterjee, 2004).
The above neurological findings and those from patient IW raise the hypothesis
that an intact brain and a preserved body–​action interaction are prerequisites for
self-​representation. The following section will discuss this by examining the loss and
204  Cross-referenced body and action for the unified self
restoration of body representation in limb amputation as a consequence of traumatic
injury and vascular diseases.

12.4.1  Amputation of physical limb and regeneration

of phantom limb

When we lose a limb due to amputation, sensory neuronal receptors and the cap-
acity for limb movement will be lost. However, nearly 90% of amputees experience
tactile and proprioceptive sensations and sensations of movements of the amputated
limb (Ramachandran & Hirstein, 1998). These subjective experiences are referred to
as ‘phantom limb’, suggesting that we can feel our body even without a physical entity
providing sensorimotor signals. The neural basis of phantom limbs is considered to
be a consequence of sensorimotor memory and/​or learnt activation in sensorimotor
cortices. Nevertheless, this residual activity in sensorimotor brain regions can cause
phantom limb pain (PLP), which is characterized by painful sensations (e.g., burning,
cramping) in the phantom limb in the absence of noxious stimuli and is experienced
by 50–​80% of amputees (Flor, Nikolajsen, & Jensen, 2006). A potential aetiology for
PLP has been attributed to cortical remapping, whereby the sensorimotor area cor-
responding to the amputated limb is invaded by another area due to a loss of afferent
signals from the amputated limb (Flor et al., 2006, but see Makin et al., 2013 for an al-
ternative theory).
Amputees with PLP are also likely to experience stiffness of the phantom limb
without movements. This, in turn, implies that the phantom limb could be an actual
motor effector enabling voluntary motor action. Indeed, for phantom limbs, motor
execution is distinct from motor imagery in terms of behavioural performance and
cortical activities (Raffin, Mattout, Reilly, & Giraux, 2012). Furthermore, analogous to
the known phenomena for intact limb movements, voluntary movements of phantom
limbs can also interfere with concurrent movements of the contralateral intact limb
(Osumi et al., 2015). Studies employing these behavioural markers have demonstrated
that stronger PLP is associated with worse voluntary control of the phantom limb
(Kikkert et al., 2017; Osumi et al., 2015). Amputees no longer receive afferent signals
from the amputated limb. This could result in incongruence between motor commands
to the amputated site and their sensory feedbacks which are simultaneously predicted
by the internal model. This persistent sensorimotor incongruence may cause stiffness
and pain of the phantom limb (Sumitani et al., 2008).
Researchers have developed mirror therapy for restoration of sensorimotor con-
gruence for phantom limb movements, which can help improve voluntary movements
of the phantom limb and consequently reduce PLP (Ramachandran & Rogers-​
Ramachandran, 1996). In mirror therapy, amputees position their intact limb in front
of a mirror which is vertically aligned with their sagittal plane so that it appears visually
as if the amputated limb is restored due to the mirror image of the remaining intact
limb. Amputees move the intact limb while intentionally superimposing the mirrored
 Loss and restoration of bodily self-representation  205
movement onto their phantom limb. In this situation, motor signals to the amputated
limb and their predicted visual feedback are matched and temporarily restore an in-
tact sensorimotor loop. Following mirror therapy, some amputees acquire voluntary
movement of their phantom limb and their PLP can be alleviated (Ramachandran &
Rogers-​Ramachandran, 1996). Mirror therapy can enhance the sense of agency over
movements of the phantom limb (Imaizumi et al., 2017), and the intensity of the sense
of agency over the phantom limb can be modulated by the delay between phantom
limb movement and its visual feedback introduced by a video-​projected version of the
mirror therapy (Imaizumi, Asai, Kanayama, Kawamura, & Koyama, 2014). Therefore,
sensorimotor congruence in phantom limbs has a role in the acquisition of voluntary
movements and agency over the movements analogous to those involving intact limbs.
Through mirror therapy, the shape of the phantom limb can also be modified such
that the telescoped phantom limb (i.e., shrunken and retracted toward the residual
stump) extends distally toward the location where an intact limb would be. The mech-
anisms for this could be analogous to RHI, where proprioceptive localization of one’s
limb shifts toward a proxy following synchronous visuo-​tactile or visuo-​motor stimuli.
While a qualitative study has suggested that mirror therapy induces telescoping
(Ramachandran & Rogers-​Ramachandran, 1996), a recent quantitative study showed
that inducing illusory body ownership over a fake body by visuo-​tactile stimulation can
cause the perceived location of the telescoped phantom limb to shift distally (Schmalzl
et al., 2011). To date, no study has systematically and quantitatively examined the ef-
fect of mirror therapy-​like visuo-​motor training on the shape of the phantom limb.
However, given that alleviation of PLP by mirror therapy via the restoration of visuo-​
motor congruence can be associated with the change in telescoping, the congruence
between voluntary movements of the phantom limb and visual feedback could modu-
late somatosensory perception of phantom limbs. This notion is supported by findings
from aRHI which suggest that bodily action modifies the sense of body ownership and
body representation (Asai, 2016; Tsakiris et al., 2006).

12.4.2  Prostheses as reacquired body

Most amputees use prosthetic limbs, regardless of the presence of phantom limb.
Daily activities using a prosthetic limb can cause it to be incorporated into ampu-
tees’ body representation as if it were the actual body part. The incorporation of tools
into body representation was first tested electrophysiologically in macaque monkeys
(Iriki, Tanaka, & Iwamura, 1996). Visuo-​tactile bimodal neurons are mapped onto the
somatosensory cortex corresponding to a unilateral hand. Following training to use a
rake to obtain food, the receptive fields of the bimodal neurons extended so that they
include the rake. This result suggests that tool use training causes dynamic updates
of body representation. Similar findings have been replicated in human behaviour,
such as improvements in kinematics and motor efficiency, using a novel tool following
training (Martel, Cardinali, Roy, & Farne, 2016). Importantly, changes in performance
206  Cross-referenced body and action for the unified self
and body representation cannot be induced by merely holding a tool and therefore
making use of it is essential. This suggests that actions which involve sensorimotor
congruence may induce modifications of body representation, analogous to the cases
we have discussed.
Prosthetic limbs in amputees can also be incorporated into their body representation
through long-​term use. For instance, proficient users of prosthetic arms exhibit kine-
matic properties comparable to those of the contralateral intact limb (Fraser, 1984) and
proprioceptive estimation of the residual limb length is biased toward the tip of the
prosthetic arm (McDonnell, Scott, Dickison, Theriault, & Wood, 1989). These find-
ings again imply that action leads to changes in body representation to incorporate the
prostheses. In contrast, the modified body representation may modulate motor action
and postural control (Imaizumi, Asai, & Koyama, 2016). As an established measure of
whole-​body motor control, stability of quiet standing posture was measured in ampu-
tees who frequently or rarely used their prosthetic arm. The results were that frequent
users showed more stable postural control when they wore their prosthesis than when
they did not, while occasional users showed a more unstable posture when they wore
the prosthesis. This suggests that following frequent and long-​lasting prosthesis use,
the prosthetic limb can be incorporated into amputees’ body schema and serve as an
unconscious reference frame to maintain body posture (Gurfinkel, Ivanenko, Levik,
& Babakova, 1995) and consequently modulate their postural control. This potential
role of incorporation of a non-​body tool for motor control is reminiscent of the effects
of body ownership on compensative bodily movement during pRHI (Asai, 2015), sug-
gesting a body-​to-​action relationship. There may be cross-​dependency between body
and action even in prosthetic body parts, as long as one intends to use it as one’s own
motor effector.
Even after loss of body, for example due to limb amputation, we can restore our own
body as a subjective form, that is, as phantom and prosthetic limbs. Through training
and acquisition of intact sensorimotor congruence in non-​body parts, they can become
one’s own body parts. Consequently, they could serve as our real body parts and enable
actual motor execution and maintenance of postural control. Such body–​action cross-​
dependency may be an underlying mechanism of restoration of the body representa-
tion. Nevertheless, whether and how phantom and prosthetic limbs interact is an open
question. For example, whether phantom limbs are telescoped while prosthetic limbs
are not, and how visuo-​somatosensory-​motor conflict affects the body–​action depend-
encies and clinical conditions such as PLP is unknown.

12.5 Conclusion

We have discussed the self-​representation consisting of the senses of body ownership

and agency which are implemented in sensorimotor systems. Cross-​dependent inter-
actions between body and action play a key role for generating self-​representation, as
exemplified by RHI paradigms. These interactions may be key for the development of
 Conclusion  207
body representation. When we lose intact body representations, we could restore them
as long as the body–​action interaction is maintained through sensorimotor interven-
tions. The body–​action interaction might underpin self-​representation throughout life.
However, evidence to support our notion, such as aRHI and prosthetic embodiment in
early childhood, is still lacking. Longitudinal and integrative studies on these topics are
required.

Acknowledgements

This work was supported by JSPS KAKENHI (17K12701, 19H04019) and the
Commissioned Research of National Institute of Information and Communications
Technology ‘Research and Development of Technology for Enhancing Functional
Recovery of Elderly and Disabled People Based on Non-​Invasive Brain Imaging and
Robotic Assistive Devices’.

References
Amsterdam, B. (1972). Mirror self-​image reactions before age two. Developmental Psychobiology,
5(4), 297–​305.
Anderson, J. R. (1984). The development of self-​recognition: a review. Developmental Psychobiology,
17(1), 35–​49.
Asai, T. (2015). Illusory body-​ownership entails automatic compensative movement: for the unified
representation between body and action. Experimental Brain Research, 233(3), 777–​785.
Asai, T. (2016). Agency elicits body-​ownership: proprioceptive drift toward a synchronously acting
external proxy. Experimental Brain Research, 234(5), 1163–​1174.
Bertamini, M., Berselli, N., Bode, C., Lawson, R., & Wong, L. T. (2011). The rubber hand illusion in a
mirror. Consciousness and Cognition, 20(4), 1108–​1119.
Bigelow, A. E. (1981). The correspondence between self-​and image movement as a cue to self-​
recognition for young children. Journal of Genetic Psychology, 139, 11–​26.
Biran, I. & Chatterjee, A. (2004). Alien hand syndrome. Archives of Neurology, 61(2), 292–​294.
Botvinick, M. & Cohen, J. (1998). Rubber hands ‘feel’ touch that eyes see. Nature, 391(6669), 756.
Brownell, C. A., Nichols, S. R., Svetlova, M., Zerwas, S., & Ramani, G. (2010). The head bone’s
connected to the neck bone: when do toddlers represent their own body topography? Child
Development, 81(3), 797–​810.
Cowie, D., Makin, T. R., & Bremner, A. J. (2013). Children’s responses to the rubber-​hand illusion re-
veal dissociable pathways in body representation. Psychological Science, 24(5), 762–​769.
Cowie, D., Sterling, S., & Bremner, A. J. (2016). The development of multisensory body representa-
tion and awareness continues to 10 years of age: evidence from the rubber hand illusion. Journal of
Experimental Child Psychology, 142, 230–​238.
Ehrsson, H. H., Holmes, N. P., & Passingham, R. E. (2005). Touching a rubber hand: feeling of body
ownership is associated with activity in multisensory brain areas. Journal of Neuroscience, 25(45),
10564–​10573.
Filippetti, M. L., Johnson, M. H., Lloyd-​Fox, S., Dragovic, D., & Farroni, T. (2013). Body perception in
newborns. Current Biology, 23(23), 2413–​2416.
Flor, H., Nikolajsen, L., & Jensen, T. S. (2006). Phantom limb pain: a case of maladaptive CNS plasti-
city? Nature Reviews Neuroscience, 7(11), 873–​881.
Fraser, C. (1984). Does an artificial limb become part of the user? British Journal of Occupational
Therapy, 47(2), 43–​45.
208  Cross-referenced body and action for the unified self
Friston, K. J., Stephan, K. E., Montague, R., & Dolan, R. J. (2014). Computational psychiatry: the brain
as a phantastic organ. The Lancet Psychiatry, 1(2), 148–​158.
Gallagher, S. (2000). Philosophical conceptions of the self: Implications for cognitive science. Trends
in Cognitive Sciences, 4(1), 14–​21.
Gallagher, S. (2005). How the Body Shapes the Mind. Oxford: Oxford University Press.
Gallagher, S. & Cole, J. (1995). Body image and body schema in a deafferented subject. Journal of Mind
and Behavior, 16(4), 369–​389.
Gallup, G. G. (1970). Chimpanzees: self-​recognition. Science, 167(3914), 86–​87.
Gurfinkel, V. S., Ivanenko, Y. P., Levik, Y. S., & Babakova, I. A. (1995). Kinesthetic reference for human
orthograde posture. Neuroscience, 68(1), 229–​243.
Hepper, P. (2015). Behavior during the prenatal period: adaptive for development and survival. Child
Development Perspectives, 9(1), 38–​43.
Imaizumi, S. & Asai, T. (2015). Dissociation of agency and body ownership following visuomotor
temporal recalibration. Frontiers in Integrative Neuroscience, 9, 35.
Imaizumi, S., Asai, T., Kanayama, N., Kawamura, M., & Koyama, S. (2014). Agency over a phantom
limb and electromyographic activity on the stump depend on visuomotor synchrony: a case study.
Frontiers in Human Neuroscience, 8, 545.
Imaizumi, S., Asai, T., & Koyama, S. (2016). Embodied prosthetic arm stabilizes body posture, while
unembodied one perturbs it. Consciousness and Cognition, 45, 75–​88.
Imaizumi, S., Asai, T., & Koyama, S. (2017). Agency over phantom limb enhanced by short-​term
mirror therapy. Frontiers in Human Neuroscience, 11, 483.
Iriki, A., Tanaka, M., & Iwamura, Y. (1996). Coding of modified body schema during tool use by ma-
caque postcentral neurones. NeuroReport, 7(14), 2325–​2330.
Izawa, J., Asai, T., & Imamizu, H. (2016). Computational motor control as a window to understanding
schizophrenia. Neuroscience Research, 104, 44–​51.
Kikkert, S., Mezue, M., Henderson Slater, D., Johansen-​Berg, H., Tracey, I., & Makin, T. R. (2017).
Motor correlates of phantom limb pain. Cortex, 95, 29–​36.
Klaver, M. & Dijkerman, H. C. (2016). Bodily experience in schizophrenia: factors underlying a dis-
turbed sense of body ownership. Frontiers in Human Neuroscience, 10, 305.
Lewis, M. & Brooks-​Gunn, J. (1979). Social Cognition and the Acquisition of Self. New York,
NY: Plenum Press.
Makin, T. R., Scholz, J., Filippini, N., Henderson Slater, D., Tracey, I., & Johansen-​Berg, H. (2013).
Phantom pain is associated with preserved structure and function in the former hand area. Nature
Communications, 4, 1570.
Martel, M., Cardinali, L., Roy, A. C., & Farne, A. (2016). Tool-​use: an open window into body repre-
sentation and its plasticity. Cognitive Neuropsychology, 33(1-​2), 82–​101.
McDonnell, P. M., Scott, R. N., Dickison, J., Theriault, R. A., & Wood, B. (1989). Do artificial limbs
become part of the user? New evidence. Journal of Rehabilitation Research and Development,
26(2), 17–​24.
Miyazaki, M., Asai, T., & Mugitani, R. (2019). Touching! An augmented reality system for unveiling
face topography in very young children. Frontiers in Human Neuroscience, 13, 189.
Miyazaki, M. & Hiraki, K. (2006). Delayed intermodal contingency affects young children’s recogni-
tion of their current self. Child Development, 77(3), 736–​750.
Miyazaki, M., Takahashi, H., Rolf, M., Okada, H., & Omori, T. (2014). The image-​scratch paradigm: a
new paradigm for evaluating infants’ motivated gaze control. Scientific Reports, 4, 5498.
Mori, H. & Kuniyoshi, Y. (2010, August). A human fetus development simulation: Self-​organization of
behaviors through tactile sensation. Paper presented at the 2010 IEEE 9th International Conference
on Development and Learning, Ann Arbor, MI.
Myowa-​Yamakoshi, M. & Takeshita, H. (2006). Do human fetuses anticipate self-​oriented actions?
A study by four-​dimensional (4D) ultrasonography. Infancy, 10(3), 289–​301.
Nava, E., Bolognini, N., & Turati, C. (2017). The development of a cross-​modal sense of body owner-
ship. Psychological Science, 28(3), 330–​337.
Nava, E., Gamberini, C., Berardis, A., & Bolognini, N. (2018). Action shapes the sense of body owner-
ship across human development. Frontiers in Psychology, 9, 2507.
 Conclusion  209
Neisser, U. (1993). The Perceived Self: Ecological and Interpersonal Sources of Self-​Knowledge. New York,
NY: Cambridge University Press.
Newport, R., Pearce, R., & Preston, C. (2010). Fake hands in action: embodiment and control of super-
numerary limbs. Experimental Brain Research, 204(3), 385–​395.
Osumi, M., Sumitani, M., Wake, N., Sano, Y., Ichinose, A., Kumagaya, S., Kuniyoshi, Y., & Morioka,
S. (2015). Structured movement representations of a phantom limb associated with phantom limb
pain. Neuroscience Letters, 605, 7–​11.
Pyasik, M., Furlanetto, T., & Pia, L. (2019). The role of body-​related afferent signals in human sense of
agency. Journal of Experimental Neuroscience, 13, 1–​4.
Raffin, E., Mattout, J., Reilly, K. T., & Giraux, P. (2012). Disentangling motor execution from motor
imagery with the phantom limb. Brain, 135(2), 582–​595.
Ramachandran, V. S. & Hirstein, W. (1998). The perception of phantom limbs. The D. O. Hebb lecture.
Brain, 121(9), 1603–​1630.
Ramachandran, V. S. & Rogers-​Ramachandran, D. (1996). Synaesthesia in phantom limbs induced
with mirrors. Proceedings of the Royal Society of London B: Biological Sciences, 263(1369), 377–​386.
Rochat, P. (2001). The Infant’s World. Cambridge, MA: Harvard University Press.
Rochat, P. (2015). Layers of awareness in development. Developmental Review, 38, 122–​145.
Schmalzl, L., Thomke, E., Ragno, C., Nilseryd, M., Stockselius, A., & Ehrsson, H. H. (2011). ‘Pulling
telescoped phantoms out of the stump’: manipulating the perceived position of phantom limbs
using a full-​body illusion. Frontiers in Human Neuroscience, 5, 121.
Schwoebel, J. & Coslett, H. B. (2005). Evidence for multiple, distinct representations of the human
body. Journal of Cognitive Neuroscience, 17(4), 543–​553.
Sumitani, M., Miyauchi, S., McCabe, C. S., Shibata, M., Maeda, L., Saitoh, Y., Tashiro, T., & Mashimo,
T. (2008). Mirror visual feedback alleviates deafferentation pain, depending on qualitative aspects
of the pain: a preliminary report. Rheumatology, 47(7), 1038–​1043.
Tsakiris, M., Prabhu, G., & Haggard, P. (2006). Having a body versus moving your body: How agency
structures body-​ownership. Consciousness and Cognition, 15(2), 423–​432.
Tsakiris, M., Schutz-​Bosbach, S., & Gallagher, S. (2007). On agency and body-​ownership: phenom-
enological and neurocognitive reflections. Consciousness and Cognition, 16(3), 645–​660.
Tseng, H. H., Bossong, M. G., Modinos, G., Chen, K. M., McGuire, P., & Allen, P. (2015). A system-
atic review of multisensory cognitive-​affective integration in schizophrenia. Neuroscience and
Biobehavioral Reviews, 55, 444–​452.
Vallar, G. & Ronchi, R. (2009). Somatoparaphrenia: a body delusion. A review of the neuropsycho-
logical literature. Experimental Brain Research, 192(3), 533–​551.
Verschoor, S. A. & Hommel, B. (2017). Self-​by-​doing: the role of action for self-​acquisition. Social
Cognition, 35(2), 127–​145.
Wang, Q., Bolhuis, J., Rothkopf, C. A., Kolling, T., Knopf, M., & Triesch, J. (2012). Infants in con-
trol: rapid anticipation of action outcomes in a gaze-​contingent paradigm. PLoS ONE, 7(2), e30884.
Zaadnoordijk, L., Otworowska, M., Kwisthout, J., & Hunnius, S. (2018). Can infants’ sense of agency
be found in their behavior? Insights from babybot simulations of the mobile-​paradigm. Cognition,
181, 58–​64.
 13
Growing up a self: on the relation between
body image and the experience
of the interoceptive body
Rosie Drysdale and Manos Tsakiris

13.1 Introduction

Contemporary embodied cognition research has prioritized the body as the starting
point for a science of self (Gallagher, 2000). To be a self and to be aware of one’s self is a
fundamental phylogenetic and ontogenetic process. The first seminal studies that ad-
dressed the question of self-​awareness across these perspectives looked at the ability to
recognize one’s body in the mirror. Recent advances in experimental psychology and
cognitive neurosciences have used a range of methods to probe the mechanisms of self-​
recognition, namely the online integration of visuo-​tactile and sensorimotor signals.
However, an overemphasis on the role of exteroceptive signals in our perception of
the body has resulted in the neglect of another important side of embodiment, namely
the interoceptive body (Tsakiris & De Preester, 2018), a system that processes afferent
signals such as cardiac, hunger, and pain sensations. Research now suggests that the
dynamic integration between exteroceptive and interoceptive processing drives the co-
herent representation and recognition of one’s body image (Badoud & Tsakiris, 2017).
To date, research with human infants has identified an early ability to detect the tem-
poral and spatial congruency of visuo-​tactile information relating to the face and body
(Filippetti, Johnson, Lloyd-​Fox, Dragovic, & Farroni, 2013; Filippetti, Orioli, Johnson,
& Farroni, 2015b; Zmyj, Jank, Schütz-​Bosbach, & Daum, 2011) that later links to an
explicit recognition of one’s self-​image in the mirror (Rochat, 2003). This early ability
to detect correspondences between multisensory bodily information may shape early
social affective competencies associated with self-​awareness such as embodied em-
pathy (Rigato et al., 2017). Yet, studies investigating the development of interoceptive
body awareness are scarce, and the complex problem of how and when infants begin to
navigate the interplay between exteroceptively and interoceptively driven body aware-
ness is a critical, yet poorly understood, process. Despite a lack of empirical studies of
interoceptive abilities in infancy, this chapter will review the literature across social-​
affective neuroscience and developmental psychology to propose a framework that ar-
ticulates how we grow a self from the inside-​out. We will touch upon the experience of

Rosie Drysdale and Manos Tsakiris, Growing up a self: on the relation between body image and the experience of the interoceptive body
In: Body Schema and Body Image. Edited by: Yochai Ataria, Shogo Tanaka, and Shaun Gallagher, Oxford University Press.
© Oxford University Press 2021. DOI: 10.1093/​oso/​9780198851721.003.0013
 Mirror-mirror on the wall, who’s this among us all?  211
recognizing one’s self in the mirror and forming a body image, consider how this links
to the development of interoception, and therefore examine the perceptual and affective
components leading up to the construction of a self. Our aim is to trace in parallel the
development of the bodily self, and awareness thereof, across its two main facets—​the
exteroceptive perception of one’s body that gives rise to one’s body image and the in-
teroceptive experience of being this body. In light of evidence from neurotypical and
neuropsychiatric populations, we also consider important implications for our under-
standing of body image and emotional awareness across life.

13.2  Mirror-​mirror on the wall, who’s this among us all?

Across pre-​verbal human infants and non-​human primates, this question has been
operationalized as the ability to recognize one’s own mirror reflection. The study of
mirror self-​recognition started with Gallup’s (1970; 1977) original studies on primates,
which developed into the ‘mirror mark’ test. Upon seeing their own reflection in a
mirror, chimpanzees showed evidence of self-​directed behaviours by using the mirror
to groom their eyes (Gallup, 1970) or by removing a mark that was previously placed
on their cheek while sedated (Gallup, 1977). These reactions were suggested to have
demonstrated a transition from social to self-​directed behaviours, when faced with the
chimpanzees’ own reflection (Mitchell, 1993). Since then, self-​recognition has been re-
ported in other primates such as elephants (Plotnik, de Waal, & Reiss, 2006) and bottle-
nose dolphins (Morrison & Reiss, 2018), and a plethora of interpretations remain a
contentious debate but go beyond the scope of this chapter.
Beyond non-​human primates, developmental psychologists focused on the ontogen-
esis of this self-​recognition process in human infancy, adopting similar self-​recognition
paradigms such as the ‘rouge’ task. In classic versions of the rouge task (Amsterdam,
1972), a red mark is discretely placed on the infant’s nose, and she is presented in front
of a mirror. As with non-​human primates, a goal-​directed movement to touch the mark
located on her face, rather than the mirror reflection, is considered an index of mirror
self-​recognition. The age at which self-​recognition abilities in these tasks emerge is
thought to range between 14 and 18 months, when infants are reported to begin ex-
pressing embarrassment on seeing that they have a mark on their face (Bertenthal &
Fischer, 1978). Later, more explicit signs of self-​recognition in these tasks appear be-
tween 18 and 24 months, when most infants show signs of reaching toward the face in
an attempt to remove the mark (Amsterdam, 1972). Studies that modified the location
of the sticker by placing it on an unseen area of the infant’s body, including her feet or
hands (Nielsen, Suddendorf, & Slaughter, 2006), extended the original findings that
infants can locate and remove the sticker by 24 months old. This modification to the
sticker location confirms that this explicit self-​recognition is not limited to the iden-
tification of observable changes to one’s own face, but also to body parts. In turn, it
highlights the significance of the body in growing an awareness of the self, which is
212  Growing up a self: on the relation between body image
particularly important, given the disproportionate emphasis on the face, relative to the
body, in infant self-​recognition research.
Infants’ success in these early mirror self-​recognition tasks has been attributed to
various underlying mechanisms (Brandl, 2018). The presence of a self-​concept may en-
able the infant to determine the correspondence between the identity of her body and
the reflected image of that body (Mitchell, 1993). Others have highlighted the percep-
tual experiences that enable the infant to match her online, felt body with the body
she sees in the mirror. Specifically, that success requires the integration of tactile, pro-
prioceptive, and motor experiences that must correspond with the visual information
provided by her reflection (Jeannerod, 2003; Rochat, 2003). More recently, research
has also recognized the importance of attending to, thus becoming familiar with, one’s
unique facial features in the immediate lead-​up to successful mirror self-​recognition
at 18 months of age (Filippetti & Tsakiris, 2018). Therefore, two crucial sources of in-
formation for self-​recognition include the online integration of visual, tactile, and pro-
prioceptive signals and the encoding of unique featural cues associated with the self.
Over time, this joint contribution enables the infant to gradually form a coherent rep-
resentation of her appearance (Keenan, Wheeler, Gallup, & Pascual-​Leone, 2000) that
can be thought of as the starting point of her body image.
In line with Gallagher and Cole (1995), we conceptualize body image as a set of
conscious states concerning the perception, beliefs, and attitudes toward one’s own
body and its predominantly visual mental representation. The critical components of
body image include perceptual aspects, such as body shape and weight estimation,
and affective-​cognitive aspects, such as body satisfaction or evaluation. This mental
representation of one’s image conveys the embodied experience we each hold con-
cerning what we think and feel about how our body looks from the outside, forming
one core component of bodily self-​awareness. Body image does not strictly involve the
moment-​to-​moment monitoring of spatial reference frames of the body’s posture and
movement. Instead, this kind of system of motor functions defines the body schema,
which operates below the level of self-​referential intentionality. However, their inter-
dependence is evident when we consider our conscious ability to become aware of
the appearance of our body and limbs in space. This tension is further highlighted
when we think about the processes involved in forming a body image. At the onto-
genetic level, one challenge relates to how a mental representation of physical appear-
ance is acquired in the first place. Given that the young infant cannot have a priori
knowledge of her appearance, the infant encountering mirrors must slowly succeed
in matching her sensorimotor experience with the observed sensorimotor behaviour
of the familiar object seen inside the mirror. It seems likely that the infant’s growing
body schema of spatial mapping through visual, tactile, and proprioceptive integra-
tion gradually builds into the perceptual aspect of the body image, as the infant be-
gins to notice the unique and potentially meaningful perceptual features of her body.
This process of self-​identification explains the generation of a mental representation
of visual appearance that is required to successfully pass the classic ‘rouge task’ of self-​
recognition described above.
 Mirror-mirror on the wall, who’s this among us all?  213
Early studies investigating infant body perception suggested that 5-​month-​old in-
fants were able to discriminate the temporal incongruence between what they did
and what they saw (Bahrick & Watson, 1985), by looking longer at a video displaying
non-​contingent visuo-​proprioceptive movements of another infant’s legs, moving
out of time with the infant’s own legs. Similar paradigms reported that infants at this
age were also sensitive to spatial calibration of their own body movements (Rochat &
Morgan, 1995). These preferences for non-​contingent stimulation seem to be relevant
to visual and proprioceptive motor cues. Conversely, recent studies that manipulate
visuo-​tactile stimulation have demonstrated newborn infants’ preference for temporal
and spatial synchrony, as opposed to asynchrony, a visual preference driven by inte-
gration of an exteroceptive nature (Filippetti et al., 2013; 2015b). Bahrick & Lickliter’s
(2012) intersensory redundancy hypothesis can be used to explain this early preference
for visuo-​tactile synchrony. The theory puts forward the primary assumption that in-
formation is selectively attended to when it is presented redundantly and in temporal
synchrony across two sense modalities. This feature effectively recruits attention and
facilitates perceptual differentiation more effectively than does the same information
presented unimodally. For instance, when presented in temporal synchrony, visuo-​
tactile stimulation specifies self-​relevant information which contributes to basic per-
ceptual learning about one’s own body in space. This visuo-​tactile experience is thought
to implicitly drive attention to the bodily self in a way that is different to the experience
of corresponding visuo-​motor signals of proprioception (Filippetti, Lloyd-​Fox, Longo,
Farroni, & Johnson, 2015a).
Despite this early ability to detect sensory correspondences, further learning is re-
quired to reach increasingly complex sensorimotor milestones, whilst also coping with
rapid changes in body and limb size. Converging studies have highlighted that across
the first year of life, significant postnatal developments in multisensory processing
contribute to infants’ growing sensorimotor competence (Bremner, 2016; D’Souza,
Cowie, Karmiloff-​Smith, & Bremner, 2016). In a sophisticated experiment, Chinn,
Hoffmann, Leed, & Lockman (2019) investigated the development of spatial coding for
successful sensorimotor coordination in infants aged 7 to 21 months. Experimenters
placed a vibrating target on various locations on the infant’s arm/​hand, prompting her
to find it. In order to localize each target, the infant must relate the visuo-​tactile and
proprioceptive information, specifying the target and the location of her arm, then
engage one or both arms and coordinate them to reach the target. The results demon-
strated improvements in inter-​sensory matching and inter-​limb bimanual coordin-
ation strategies with age. Older infants tended to simultaneously synchronize vision
and reaching more often than younger infants, as well as simultaneously move each
limb toward each other. These studies highlight that refining the sense of body dispos-
ition and limb coordination is a protracted, ongoing process, constrained by the need
to cope with substantial changes in body shape and limb size, across infancy and child-
hood. In a second experiment, Chinn (2019) showed how sensorimotor practice may
impact upon infants’ success in the ‘rouge’ task. Infants who first practised reaching to-
ward a vibrating target on the face, both away from and in front of a mirror, successfully
214  Growing up a self: on the relation between body image
reached for a mark on the face during the rouge task significantly younger than a
control group who had no prior vibrotactile reaching experience. This demonstrates
how the body schema may help to navigate the infant to the body whose image she is
learning is unique and meaningful to her.
In conjunction, these studies illustrate an ability to encode and integrate sensory in-
formation, representing a preconceptual bodily self-​awareness. The increasingly active
use of the body and the sentient experience of visual, tactile, and proprioceptive con-
tingency across the first postnatal year likely contribute to the gradual formation of
a mental representation of physical appearance. These processes define the successful
pre-​reflective first-​person experience of owning and controlling one’s body that is sub-
sequently necessary for the later, more explicit recognition of this image.

13.3  Behind the mirror: multisensory integration and

body ownership

In addition to the theoretical challenge of explaining how an infant forms a mental rep-
resentation of her image, another pertinent question concerns the continuous owner-
ship of this image throughout changes in physical appearance across one’s lifetime. By
and large, the experimental psychology literature in this area has attempted to address
these challenges by highlighting the role that online multisensory signals play in cre-
ating our sense of body ownership, as well as in providing this representation of one’s
body with sufficient plasticity to ensure both the assimilation of changes and a sense of
continuity over time. The key question of how the brain produces the experience of this
body as mine has been addressed mainly in the context of bodily illusions that can be
thought of as a model of embodiment. For example, in the rubber hand illusion (RHI)
(Botvinick & Cohen, 1998), watching a rubber hand being stroked synchronously with
one’s own unseen hand causes the rubber hand to be experienced as part of one’s body
(for a review, see Tsakiris, 2010). Over the last 20 years, the RHI has been established
as one of the most important experimental paradigms that allows the controlled ma-
nipulation of the experience of body ownership. Longo, Schüür, Kammers, Tsakiris,
and Haggard (2008) characterized the subjective experience of body ownership during
the RHI, revealing distinct components such as ownership of the limb, its location,
and the sense of control over it. Critically, the change in body ownership as a result
of the RHI can, in turn, change one’s body image. Participants who experienced the
RHI perceived their hand and the rubber hand as significantly more similar in terms
of their appearance (Longo, Schüür, Kammers, Tsakiris, & Haggard, 2009), compared
to participants who did not experience the illusion, suggesting that ownership leads
to changes in perceived physical similarity. The same principles have been used in the
enfacement illusion (Sforza, Bufalari, Haggard, & Aglioti, 2010; Tsakiris, 2008) where
watching another person’s face being touched synchronously with one’s own face
evokes changes in self-​face recognition that cause us to perceive the other person’s
face as more closely resembling our own (Tajadura-​Jiménez, Grehl, & Tsakiris, 2012).
 Outwith and within the body  215
Multisensory integration thus plays an important role in updating the mental represen-
tation of one’s face and body. Taken together, these results speak in favour of an extero-
ceptive model of the self within which bodily self-​awareness is highly malleable, subject
to the influence of exteroceptive signals of vision and touch. However, exteroceptive
input represents only one set of channels of information available for self-​awareness, as
we are also interoceptively aware of our body, as discussed in Section 13.4.

13.4  Outwith and within the body

Notwithstanding the influence that experimental work on the exteroceptive body has
had in our understanding of self-​face recognition, body ownership, body image, and
social cognition, it has become clear that we have neglected another important dimen-
sion of the body, namely the interoceptive body. As a sensory system, interoception
concerns sensations arising within the body, such as heartbeats, respiration, and
hunger. At the physiological level, interoception serves the critical function of homeo-
stasis in ensuring biological stability, and thus, it does not encompass our perception
of proprioceptive cues. Importantly, interoception is implicated in the generation and
regulation of emotional and cognitive processes relating to self and social awareness
(Critchley & Garfinkel, 2017). Our conscious awareness of interoceptive states is il-
lustrated by the ability to become aware of individual heartbeats, an index that is used
to distinguish between people across a continuum of lower to higher ability to detect
internal signals originating from the heart. Heartbeat detection procedures typically
require individuals to perceive and count the number of heartbeats occurring during
short intervals, or to detect the a/​synchronicity between individual heartbeats and ex-
ternal stimuli, producing measures of interoceptive accuracy (IAcc). Combined with
confidence ratings of performance, significant inter-​individual differences in cardiac
performance allow us to distinguish between people with higher and lower interocep-
tive awareness. IAcc is thought to reflect a trait-​like sensitivity to one’s visceral signals
that has important consequences for self-​regulation, emotional awareness, and phys-
ical and mental health (Herbert & Pollatos, 2012). It is worth noting here that the tax-
onomy of interoceptive dimensions is ever evolving (Khalsa et al., 2018; Garfinkel, Seth,
Barrett, Suzuki, & Critchley, 2015), but these discussions go beyond the scope of this
chapter. In addition, psychological research into interoceptive awareness has focused
mainly on cardiac awareness because of the known role that heart–​brain interactions
(and concomitant balance between the sympathetic and parasympathetic systems) play
in emotion processing. For the sake of clarity, we will refer to studies for which cardiac
perception serves as an index of interoceptive abilities as our main focus, despite ac-
knowledging the importance of other interoceptive processes such as respiratory or
gastroinstestinal.
Cognitive neuroscience has indirectly revealed the ubiquitous role that interoception
may play in cognitive processing and self-​awareness. Numerous functional neuroim-
aging studies have reported activations in the insula, the central interoceptive hub in
216  Growing up a self: on the relation between body image
the brain, across a range of tasks. Craig (2009) suggested that the central role of this area
is the integration of bodily and environmental information to optimize homeostatic
efficiency and represent the ‘material me’ in the brain, a hallmark of the bodily self.
Beyond homeostasis, right anterior insula activity correlates with performance in IAcc
(Critchley et al., 2004). Right mid-​posterior insula activity correlates with body owner-
ship experienced during the RHI, and the same area seems to be the critical lesion site
for neurological disturbances in the sense of body ownership (Tsakiris, 2010). These
findings suggest that the interoceptive and exteroceptive sides of the bodily self are in-
tegrated from the posterior to anterior subregions across the insular cortex (Simmons
et al., 2013), underpinning the experience of this body as mine. Despite the importance
of these neuroimaging results, they do not answer a fundamental psychological ques-
tion: what is the functional importance of the interactions between the interoceptive
and exteroceptive representations for the self in its natural embodiment, and perhaps
in the self ’s social world? The first study that tested this potential link between extero-
ceptive and interoceptive body awareness quantified IAcc, and compared this measure
with the change in body ownership caused by multisensory stimulation using RHI.
Tsakiris, Tajadura-​Jiménez, & Costantini (2011) observed a negative correlation be-
tween IAcc and RHI, such that people with lower IAcc showed a stronger RHI behav-
iourally and homeostatically (i.e., drop in skin temperature). Thus, in the absence of
accurate interoceptive representations, one’s representation of the self is predominantly
exteroceptive, suggesting an antagonism between interoceptive and exteroceptive cues
in bodily self-​awareness. The same negative correlation was later observed in children
aged 8 to 17 years (Schauder, Mash, Bryant, & Cascio, 2015) and extended to other
multisensory bodily illusions (Tajadura-​Jiménez & Tsakiris, 2014).
The instability of an individual’s coherent representation of the self can be observed
in the expression of body image disturbances, which lie at the heart of a number of clin-
ical disorders. In anorexia nervosa (AN), extreme concern with one’s weight and shape
controls food restriction and dieting behaviours (Hrabosky et al., 2009), and exposure
to body image induces negative emotions, including sadness, feelings of insecurity, and
a decreased desire to eat (Tuschen-​Caffier, Vogele, Bracht, & Hilbert, 2003). This dis-
ruption to one’s body image may be related to low IAcc, a finding previously reported
in anorexic patients (Pollatos et al., 2008). It was hypothesized that patients with eating
disorders may experience a stronger change in body ownership during RHI, possibly
due to an over-​reliance on exteroceptive information (e.g., vision) at the expense of
interoceptive information. Indeed, Eshkevari, Rieger, Longo, Haggard, and Treasure
(2012) showed that patients with eating disorders experience a stronger RHI, relative
to controls, and this was mainly attributed to heightened visual capture. When affective
touch, a type of interoceptive stimulation governed by specialized C-​tactile afferents,
was delivered in a group of anorexic patients (Crucianelli, Cardi, Treasure, Jenkinson,
& Fotopoulou, 2016), the patients reported reduced perceived pleasantness, relative to
controls. This kind of pleasant touch has been shown to enhance the experience of body
ownership during RHI (Crucianelli, Metcalf, Fotopoulou, & Jenkinson, 2013); thus, an
impaired C-​tactile system in AN may be linked to weakened interoceptive perception
 Outwith and within the body  217
and distorted body representation. Body image disturbances could therefore be inter-
preted as an interoceptive/​exteroceptive imbalance, with an increased sensitivity to ex-
ternal visual information, which overrides other inputs to and from the body. Of direct
relevance to the concept of body image, converging evidence has shown associations
between lower interoceptive abilities and body image dissatisfaction across clinical and
sub-​clinical populations (Badoud & Tsakiris, 2017).
The effects of multisensory stimulation on body ownership and body image have
been recently interpreted in the context of predictive coding. Predictive coding at-
tempts to provide a unifying theory of cortical function that underlies perception,
action, and interoception (Seth, 2013). According to the predictive coding theory,
incoming sensory data are compared with internal models, that is the brain’s ‘predic-
tion’ (best guess) about the environmental causes that affect the organism. ‘Prediction
errors’ arise when predictions and data are incompatible. Given that biological organ-
isms must maintain their bodies within a narrow range of states, prediction errors must
be minimized. Adapting the predictive coding framework to self-​processing (Apps &
Tsakiris, 2014), one’s own body is processed in a probabilistic manner as the most likely
to be ‘me’. This framework and other predictive models of self-​awareness are important
for understanding the dynamic relation between exteroceptive and interoceptive rep-
resentations of the body. For example, in the experience of body ownership during the
RHI, the exteroceptive data suggest that what I am looking at (i.e., the rubber hand) is
my hand. However, this experience is accompanied by interoceptive prediction errors
to the extent that I may not feel interoceptively that I am looking at my hand. Such
errors need to be explained away between how my true hand feels (i.e., the interocep-
tive prediction) and the prediction error caused by the fact that I cannot feel the rubber
hand interoceptively. Therefore, exteroceptive and interoceptive streams must be in
some way integrated for a body to be represented as ‘self ’.
Both predictions and the incoming sensory data vary in the precision (i.e., reliability)
of the information that they convey (Ainley, Apps, Fotopoulou, & Tsakiris, 2016).
Precision is crucial when selecting information among various modalities because
the brain preferentially weights signals that are the most precise in the given context.
During the experience of body ownership in the RHI, participants form a percept that
the prosthetic hand is their own, by minimizing prediction errors across all available
sensory modalities. It is precision that dictates which part of the conflicting evidence
is presumed to be reliable. If their interoceptive signals are precise, this would explain
why individuals with higher IAcc experience a weaker body ownership during the RHI,
by contrast with individuals with lower IAcc, as the visual or visuo-​tactile information
is not weighted sufficiently to minimize interoceptive prediction errors. Therefore, in-
dividual differences can be explained in terms of variations in the ‘precision’ with which
interoceptive signals from within the body are represented (Ainley et al., 2016; Seth,
2013), and this precision-​dependent account can also explain the effects that levels of
IAcc may have on the exteroceptively driven representation of the self. Interestingly,
a similar, but inverse, relationship holds between interoception and attitudes toward
one’s own body. Levels of IAcc are inversely correlated with self-​objectification (Ainley
218  Growing up a self: on the relation between body image
& Tsakiris, 2013) and body image dissatisfaction (Emanuelsen, Drew, & Köteles, 2015).
Taken together, these observations suggest that interoceptive influences extend from
the basic levels of multisensory integration to the conscious, affective attitudes that
we hold about our body, highlighting the role that interoception may play across dif-
ferent hierarchical levels of body representations. A predictive coding account of
self-​awareness (Apps & Tsakiris, 2014) based on the processing of interoceptive sig-
nals (Barrett & Simmons, 2015) and their subsequent mentalization (Fotopoulou &
Tsakiris, 2017) may be particularly important for understanding how we develop a
sense of self, and how the body’s viscera influences the body’s image and impacts upon
mental health.

13.5  Growing a sense of self from within

Growing a minimal sense of self is driven by embodied interactions with the caregiver,
and thus interoceptive sensitivity is social in its origins (Fotopoulou & Tsakiris, 2017).
From the very beginning, a mother’s physiological regulation during pregnancy is con-
sequential for the physiology and survival of the fetus, and after birth, parental care is
ultimately directed toward maintaining infant allostasis (Atzil, Gao, Fradkin, & Barrett,
2018). In their detailed account of embodied interactions, Atzil et al. (2018) emphasize
that caregiving practices, such as skin-​to-​skin holding, generate regular exteroceptive
sensory information which is frequently and temporally associated with interoceptive
information about allostasis. For instance, distress behaviour may be brought on by
changes in physiological imbalance, such as low blood glucose, which, in turn, elicit
optimally and temporally attuned social caregiving. This prompts the infant’s brain to
regulate its internal milieu by attending to the social sources of multisensory informa-
tion and, in turn, increasing blood glucose levels. Within a predictive coding frame-
work, this learning process is facilitated by the capacity to make predictions about the
internal and external sensory information.
Although the newborn infant does not yet have the capacity to formulate internal
predictive models without the experience of top-​down predictions, the accumulation
of bottom-​up, experience-​dependent sensory interactions likely determines the ac-
tive formation and mentalization of multimodal associations of prediction networks
within the brain (Fotopoulou & Tsakiris, 2017). For instance, the infant continuously
receives incoming signals of an exteroceptive (visual, tactile, auditory, olfactory), pro-
prioceptive and interoceptive (cardiorespiratory, gastrointestinal, pain) nature, whose
properties signal patterns of contingency. Gradually, the rewarding nature that atten-
tive parenting responses brings about in the infant provides the optimal incentive for
brain development and behaviour learning, toward social affiliation (Atzil et al., 2018).
So much so, that the brain can begin to build up expectations about the contingency of
behaviours that should occur when experiencing particular signal changes from within
the body, increasing survival through efficient Bayesian models of maternal sensory
input. Atzil et al. (2018) suggest that the plasticity and malleability of the neonatal brain
 Growing a sense of self from within  219
give rise to an enhanced sensitivity to environmental social input. Thus, the multimodal
integration and prediction of associated networks for sensing the internal and external
environment of the body develop with age, enabling the infant to actively construct
multisensory mental representations of their own and others’ bodies that are con-
tinuously updated. This exteroceptive–​interoceptive integration supports the unified,
phenomenal experience of the infant’s sense of self. As experience-​dependent sensory
processes become more frequent, they also become potentially more complex in novel
social situations where the infant’s role in the social interaction becomes more salient
from the social partner. Accordingly, as the mother–​infant dyad continues to decode
and attend to each other’s allostasis through social co-​dependency, the infant brain de-
velops as a flexible, transactive driving force for self–​other processing across life.
Evidence supporting the social origins of interoceptive sensitivity demonstrates
that mothers’ well-​timed skin-​to-​skin contact improves the growth rate of vagal tone
during the last trimester of pregnancy in premature infants (Feldman & Eidelman,
2003). Research investigating the specific mechanisms supporting interoceptive func-
tions found that stimulating C-​tactile afferents, through affective touch, resulted in op-
timal physiological changes in premature infants, including significant reductions in
heart rate (Manzotti et al., 2019). The neural correlates of this affective stroking were
investigated in ten full-​term newborns aged 11 to 36 days using functional magnetic
resonance imaging (fMRI), identifying significant activation in the posterior insular
cortex (Tuulari et al., 2019), a site implicated in the integration of interoceptive and
exteroceptive information pertaining to body ownership. Given the aforementioned
evidence suggesting that body image disturbances in AN may result from an impaired
C-​tactile processing system during affective touch, early interoceptive/​exteroceptive
interdependency may be crucial in supporting the emerging sense of bodily self. Across
development, infants must manage changes in visceral sensations that are accompanied
by substantial morphological changes in body size and relative body part proportions.
To do this, the infant brain must update its predictive models based on incoming in-
teroceptive and exteroceptive inputs. A weak interoceptive system and a subsequent
over-​reliance on exteroceptive visual information may override interoceptive, tactile or
proprioceptive inputs that are central to bodily self-​awareness. This imbalance may dis-
rupt access to the mental representation that is fundamental in governing the identifi-
cation and recognition of this body as ‘mine’. Thus, infancy may be a key developmental
period for interoception.
The first study to empirically test interoceptive sensitivity in infancy was carried out
by Maister, Tang, and Tsakiris (2017), using a measure of cardiac perception specially
developed for infants, named iBEATs. In this task, 29 infants watched characters simul-
taneously appearing on a screen, while their heart rate was recorded using an electro-
cardiogram (ECG). The characters’ movement was dictated by whether or not it was
moving in or out of temporal synchrony with the infant’s own heartbeat. In the asyn-
chronous condition, the infant’s heart rate was time-​locked, so that the character would
move either 5 seconds faster or slower than the infant’s heartbeat. Looking behaviour
demonstrated that infants looked significantly longer at the asynchronous condition,
220  Growing up a self: on the relation between body image
suggesting that infants can discriminate cardiac signals and may have an implicit sen-
sitivity to their own heartbeat at 5 months of age. Moreover, the study demonstrates
that infants can integrate this interoceptive information with external information in
an environment to drive visual preferences. In a second experiment, those infants who
performed better in the previous cardiac discrimination task (iBEATs) elicited a signifi-
cantly larger heart evoked potential (HEP) amplitude in response to fearful and angry
facial expressions, compared to neutral expressions. The HEP is a cortical response as-
sociated with interoceptive processing of cardiac signals during heartbeat detection
tasks in adolescents (Mai, Wong, Georgiou, & Pollatos, 2018) and adults (Pollatos &
Schandry, 2004). This study provides evidence that a cortical index of interoceptive
processing exists in infancy and is implicated in the processing of social and emotional
stimuli. This illustrates the integrative processes of interoceptive and exteroceptive
signals that engage the brain in perceiving information that may help infants become
aware of their own body and its image. Moreover, this integration may also help them
learn how to navigate objects and social events through processes of interoceptive in-
ference (Ainley et al., 2016). Indirect support for this is demonstrated in a study which
identified significant increases in 9-​month olds’ heart rates following direct eye contact
from an acting experimenter, which predicted gaze following toward the object of the
other’s attention (Ishikawa & Itakura, 2019). The results support infants’ sensitivity to
internal signals and their potential role in social orienting behaviours in the first year of
life. The finding that direct eye gaze triggers changes in cardiac activity illustrates that
social interactions are exquisitely tuned to the integration of exteroceptive and intero-
ceptive signals early in life.
Research tracing the neurodevelopment of interoceptive processing in children
aged 6 to 17 years demonstrated that the neural networks associated with interocep-
tive processing in adults, such as the left insula, inferior parietal lobe, and prefrontal
regions, are active at 6 years of age during a heartbeat counting task and become more
active with age (Klabunde et al., 2019). Individual differences in this ability to track
one’s internal states have been associated with differences in behavioural and emotional
regulation, with higher scores on an adapted version of the heartbeat counting task
being associated with increased adaptability and interpersonal emotional intelligence
in 6-​to 11-​year olds (Koch & Pollatos, 2014). By adolescence, weaker neural activity
in the insular cortex has been associated with both poorer mental and physical health.
Participants who were overweight were more likely to rely on external cues to guide
eating behaviours, such as the sight or smell of food, rather than on regulation of in-
ternal signals such as hunger (Mata, Verdejo-​Roman, Soriano-​Mas, & Verdejo-​Garcia,
2015), supporting the aforementioned proposal of an enhanced sensitivity to external,
over interoceptive, stimuli in disordered eating.
Despite a shortage of empirical data directly investigating interoceptive abilities and
body image in childhood and adolescence, the onset of puberty has been referred to as
another sensitive period for interoceptive processing of new, unexpected visceral sen-
sations alongside substantial changes to the appearance of the body and its parts, in-
cluding its shape and size (Murphy, Brewer, Catmur, & Bird, 2017). In a recent study of
 Conclusion  221
265 female and male adolescents aged 13 to 16 years (Todd, Aspell, Barron, & Swami,
2019), greater interoceptive awareness was significantly associated with more posi-
tive body image overall. More specifically, the appraisal and response to interoceptive
signals seemed to play the greatest role in feelings toward one’s body image. The in-
teroceptive awareness facets of attention regulation, body listening, self-​regulation, and
trusting emerged as significant predictors for at least one facet of positive body image
(including body appreciation and body pride). These results suggest the ways in which
one copes with, and adjusts to, changes in interoceptive signals may be of importance
to the way that one feels about his/​her body image. Longitudinal research is warranted
to investigate how exteroceptive and interoceptive systems update the perception of
one’s body image and its appearance across development, and what processes give rise
to potential disturbances in the perceptual and/​or affective components of body image.
In conjunction, the aforementioned evidence supports the developmental primacy of
interoceptive experiences in shaping the foundations of perceptual awareness and sup-
ports a largely social basis for interoceptive experiences across early life.

13.6 Conclusion

This chapter emphasizes that the integration of exteroceptive and interoceptive sides of
embodiment is of paramount importance in facilitating the unified sense of self, inter-
twined within the experience of one’s own body. In light of experimental evidence from
social-​affective psychology and neuroscience, research in adults demonstrates that
interoception plays a key role in the sense of body ownership (Tsakiris et al., 2011), as
well as in the representation of one’s body image and the conscious, affective attitudes
regarding its appearance (Badoud & Tsakiris, 2017; Todd et al., 2019).
The abundance of evidence supporting the emergence of explicit mirror self-​
recognition (Amsterdam, 1972) provides an avenue to explore the developmental com-
ponents leading up to this formation of a body image that tap into exteroceptively and
interoceptively driven body awareness. Yet, while the developmental literature on early
exteroceptive body awareness is gaining traction, direct empirical studies of interocep-
tive abilities in early human development are scarce. Building upon the first empirical
study of cardiac awareness at 5 months of age (Maister et al., 2017), we argue that an
early, implicit sensitivity to interoceptive signals is necessary for the infant’s growing
body representation that the infant can identify, recognize, and later hold beliefs about.
This developmental approach is complemented by a predictive coding account of pro-
cessing, and mentalizing, interoceptive signals (Apps & Tsakiris, 2014) that the infant
comes to make predictions about when identifying and recognizing her body image.
Moreover, the gradual construction and continuous assimilation to changes in body
size and limb proportion across multisensory domains are accompanied by a growing
self-​awareness that is grounded on embodied social interactions (Atzil et al., 2018).
Ultimately, our sense of self is characterized by phylogenetic and ontogenetic processes
(Fotopoulou & Tsakiris, 2017) and thus, we must continue to investigate how the self is
222  Growing up a self: on the relation between body image
constructed from the very beginning of life in order to advance a deeper understanding
of how its representation is maintained and updated across the lifespan.

References
Ainley, V., Apps, M., Fotopoulou, A., & Tsakiris, M. (2016). ‘Bodily precision’: a predictive coding
account of individual differences in interoceptive accuracy. Philosophical Transactions of the Royal
Society B, 371(1708), 20160003.
Ainley, V. & Tsakiris, M. (2013). Body conscious? Interoceptive awareness, measured by heartbeat
perception, is negatively correlated with self-​objectification. PLoS ONE, 8(2), e55568.
Amsterdam, B. (1972). Mirror self-​image reactions before age two. Developmental Psychobiology, 5,
297–​306.
Apps, M. & Tsakiris, M. (2014). The free-​energy self: a predictive coding account of self-​recognition.
Neuroscience and Biobehavioral Reviews, 41, 85–​97.
Atzil, S., Gao, W., Fradkin, I., & Barrett, L. F. (2018). Growing a social brain. Nature Human Behaviour,
2, 624–​636.
Badoud, D. & Tsakiris, M. (2017). From the body’s viscera to the body’s image: is there a link between
interoception and body image concerns? Neuroscience and Biobehavioral Reviews, 77, 237–​246.
Bahrick, L. E. & Lickliter, R. (2012). The role of intersensory redundancy in early perceptual, cogni-
tive, and social development. In A. J. Bremner, D. J. Lewkowicz, & C. Spence (eds.), Multisensory
Development (pp. 183–​205). Oxford: Oxford University Press.
Bahrick, L. E. & Watson, J. (1985). Detection of intermodal proprioceptive-​visual contingency as a
potential basis of self-​perception in infancy. Developmental Psychology, 21(6), 963–​973.
Barrett, L. F. & Simmons, W. (2015). Interoceptive predictions in the brain. Nature Reviews
Neuroscience, 16(7), 419–​429.
Bertenthal, B. & Fischer, K. (1978). Development of self-​recognition in the infant. Developmental
Psychology, 14, 44–​50.
Botvinick, M. & Cohen, J. (1998). Rubber hand feels touch that eyes see. Nature, 391, 756.
Brandl, J. (2018). The puzzle of mirror self-​recognition. Phenomenology and the Cognitive Sciences,
17(2), 279–​304.
Bremner, A. (2016). Developing body representations in early life: combining somatosensation and
vision to perceive the interface between the body and the world. Developmental Medicine and Child
Neurology, 58, 12–​16.
Chinn, L. K. (2019). Development of Self-​Knowledge: Tactile Localization to Self-​Recognition. New
Orleans, LA: Tulane University.
Chinn, L. K., Hoffmann, M., Leed, J. E., & Lockman, J. J. (2019). Reaching with one arm to the
other: coordinating touch, proprioception, and action during infancy. Journal of Experimental
Child Psychology, 183, 19–​32.
Craig, A. D. (2009). How do you feel—​now? The anterior insula and human awareness. Nature
Reviews Neuroscience, 10, 59–​70.
Critchley, H. & Garfinkel, S. (2017). Interoception and emotion. Current Opinion in Psychology,
17, 7–​14.
Critchley, H. D., Wiens, S., Rotshtein, P., Ohman, A., Dolan, R. J., Öhman, A., & Dolan, R. J. (2004).
Neural systems supporting interoceptive awareness. Nature Neuroscience, 7(2), 189–​195.
Crucianelli, L., Cardi, V., Treasure, J., Jenkinson, P., & Fotopoulou, A. (2016). The perception of af-
fective touch in anorexia nervosa. Psychiatry Research, 239, 72–​78.
Crucianelli, L., Metcalf, N., Fotopoulou, A., & Jenkinson, P. (2013). Bodily pleasure matters: velocity
of touch modulates body ownership during the rubber hand illusion. Frontiers in Psychology, 4, 703.
D’Souza, H., Cowie, D., Karmiloff-​Smith, A., & Bremner, A. J. (2016). Specialization of the motor
system in infancy: From broad tuning to selectively specialized purposeful actions. Developmental
Science, 20(4).
 Conclusion  223
Emanuelsen, L., Drew, R., & Köteles, F. (2015). Interoceptive sensitivity, body image dissatisfaction,
and body awareness in healthy individuals. Scandinavian Journal of Psychology, 56(2), 167–​174.
Eshkevari, E., Rieger, E., Longo, M. R., Haggard, P., & Treasure, J. (2012). Increased plasticity of the
bodily self in eating disorders. Psychological Medicine, 42(4), 819–​828.
Feldman, R. & Eidelman, A. (2003). Skin-​to-​skin contact (Kangaroo Care) accelerates autonomic and
neurobehavioural maturation in preterm infants. Developmental Medicine and Child Neurology,
45(4), 274–​281.
Filippetti, M. L., Johnson, M., Lloyd-​Fox, S., Dragovic, D., & Farroni, T. (2013). Body perception in
newborns. Current Biology, 23(23), 2413–​2416.
Filippetti, M. L., Lloyd-​Fox, S., Longo, M., Farroni, T., & Johnson, M. (2015a). Neural mechanisms of
body awareness in infants. Cerebral Cortex, 25(10), 3779–​3787.
Filippetti, M. L., Orioli, G., Johnson, M., & Farroni, T. (2015b). Newborn body perception: sensitivity
to spatial congruency. Infancy, 20(4), 455–​465.
Filippetti, M. L. & Tsakiris, M. (2018). Just before I recognize myself: the role of featural and
multisensory cues leading up to explicit mirror self-​recognition. Infancy, 23(4), 577–​590.
Fotopoulou, A. & Tsakiris, M. (2017). Mentalizing homeostasis: the social origins of interoceptive in-
ference. Neuropsychoanalysis, 19, 3–​28.
Gallagher, S. (2000). Philosophical conceptions of the self: implications for cognitive science. Trends
in Cognitive Sciences, 4, 14–​21.
Gallagher, S. & Cole, J. (1995). Body image and body schema in a deafferented subject. The Journal of
Mind and Behavior, 16(4), 369–​390.
Gallup, G. (1970). Chimpanzees: self-​recognition. Science, 167(3914), 86–​87.
Gallup, G. (1977). Self-​recognition in primates: a comparative approach to the bidirectional proper-
ties of consciousness. American Psychologist, 32(5), 329–​338.
Garfinkel, S., Seth, A., Barrett, A., Suzuki, K., & Critchley, H. D. (2015). Knowing your own heart: dis-
tinguishing interoceptive accuracy from interoceptive awareness. Biological Psychology, 104, 65–​74.
Herbert, B. & Pollatos, O. (2012). The body in the mind: on the relationship between interoception
and embodiment. Topics in Cognitive Science, 4, 692–​704.
Hrabosky, J., Cash, T., Veale, D., Neziroglu, F., Soll, E., Garner, D., & Phillips, K. (2009).
Multidimensional body image comparisons among patients with eating disorders, body dys-
morphic disorder, and clinical controls: a multisite study. Body Image, 6(3), 155–​163.
Ishikawa, M. & Itakura, S. (2019). Physiological arousal predicts gaze following in infants. Proceedings
of the Royal Society B: Biological Sciences, 286(1896), 20182746.
Jeannerod, M. (2003). The mechanism of self-​recognition in humans. Behavioural Brain Research,
142, 1–​15.
Keenan, J. P., Wheeler, M., Gallup, G., & Pascual-​Leone, A. (2000). Self-​recognition and the right pre-
frontal cortex. Trends in Cognitive Sciences, 4(9), 338–​344.
Khalsa, S., Adolphs, R., Cameron, O., Critchley, H., Davenport, P., Feinstein, J., et al. (2018).
Interoception and mental health: a roadmap. Biological Psychiatry: Cognitive Neuroscience and
Neuroimaging, 3(6), 501–​513.
Klabunde, M., Juszczak, H., Jordan, T., Baker, J., Bruno, J., Carrion, V., & Reiss, A. (2019). Functional
neuroanatomy of interoceptive processing in children and adolescents: a pilot study. Scientific
Reports, 9, 16184.
Koch, A. & Pollatos, O. (2014). Cardiac sensitivity in children: sex differences and its relationship to
parameters of emotional processing. Psychophysiology, 51, 932–​941.
Longo, M., Schüür, F., Kammers, M., Tsakiris, M., & Haggard, P. (2008). What is embodiment? A psy-
chometric approach. Cognition, 107(3), 978–​998.
Longo, M., Schüür, F., Kammers, M., Tsakiris, M., & Haggard, P. (2009). Self awareness and the body
image. Acta Psychologica, 132(2), 166–​172.
Mai, S., Wong, C., Georgiou, E., & Pollatos, O. (2018). Interoception is associated with heartbeat-​
evoked brain potentials (HEPs) in adolescents. Biological Psychology, 137, 24–​33.
Maister, L., Tang, T., & Tsakiris, M. (2017). Neurobehavioral evidence of interoceptive sensitivity in
early infancy. ELife, 6, e25318.
224  Growing up a self: on the relation between body image
Manzotti, A., Cerritelli, F., Esteves, J., Lista, G., Lombardi, E., La Rocca, S., & Walker, S. (2019).
Dynamic touch reduces physiological arousal in preterm infants: a role for c-​tactile afferents?
Developmental Cognitive Neuroscience, 39, 100703.
Mata, F., Verdejo-​Roman, J., Soriano-​Mas, C., & Verdejo-​Garcia, A. (2015). Insula tuning towards
external eating versus interoceptive input in adolescents with overweight and obesity. Appetite,
93, 24–​30.
Mitchell, R. (1993). Mental models of mirror-​self-​recognition: two theories. New Ideas in Psychology,
11(3), 295–​325.
Morrison, R. & Reiss, D. (2018). Precocious development of self-​awareness in dolphins. PLoS ONE,
13, 1–​12.
Murphy, J., Brewer, R., Catmur, C., & Bird, G. (2017). Interoception and psychopathology: a develop-
mental neuroscience perspective. Developmental Cognitive Neuroscience, 23, 45–​56.
Nielsen, M., Suddendorf, T., & Slaughter, V. (2006). Mirror self-​recognition beyond the face. Child
Development, 77, 176–​185.
Plotnik, J., de Waal, F., & Reiss, D. (2006). Self-​recognition in an Asian elephant. Proceedings of the
National Academy of Sciences of the United States of America, 103(45), 17053–​17057.
Pollatos, O., Kurz, A.-​L., Albrecht, J., Schreder, T., Kleemann, A., Schöpf, V., & Schandry, R. (2008).
Reduced perception of bodily signals in anorexia nervosa. Eating Behaviors, 9(4), 381–​388.
Pollatos, O. & Schandry, R. (2004). Accuracy of heartbeat perception is reflected in the amplitude of
the heartbeat-​evoked brain potential. Psychophysiology, 41(3), 476–​482.
Rigato, S., Banissy, M., Romanska, A., Thomas, R., van Velzen, J., & Bremner, A. (2017). Cortical
signatures of vicarious tactile experience in four-​month-​old infants. Developmental Cognitive
Neuroscience, 35, 75–​80.
Rochat, P. (2003). Five levels of self-​awareness as they unfold early in life. Consciousness and Cognition,
12(4), 717–​731.
Rochat, P. & Morgan, R. (1995). Spatial determinants in the perception of self-​produced leg move-
ments by 3-​to 5-​month-​old infants. Developmental Psychology, 31(4), 626–​636.
Schauder, K., Mash, L., Bryant, L., & Cascio, C. (2015). Interoceptive ability and body awareness in
autism spectrum disorder. Journal of Experimental Child Psychology, 131, 193–​200.
Seth, A. (2013). Interoceptive inference, emotion, and the embodied self. Trends in Cognitive Sciences,
17(11), 565–​573.
Sforza, A., Bufalari, I., Haggard, P., & Aglioti, S. (2010). My face in yours: visuo-​tactile facial stimula-
tion influences sense of identity. Social Neuroscience, 5(2), 148–​162.
Simmons, W., Avery, J., Barcalow, J., Bodurka, J., Drevets, W., & Bellgowan, P. (2013). Keeping the
body in mind: insula functional organization and functional connectivity integrate interoceptive,
exteroceptive, and emotional awareness. Human Brain Mapping, 34(11), 2944–​2958.
Tajadura-​Jiménez, A., Grehl, S., & Tsakiris, M. (2012). The other in me: interpersonal multisensory
stimulation changes the mental representation of the self. PLoS ONE, 7(7), e40682.
Tajadura-​Jiménez, A. & Tsakiris, M. (2014). Balancing the ‘inner’ and the ‘outer’ self: interoceptive
sensitivity modulates self-​other boundaries. Journal of Experimental Psychology, 143(2), 736–​744.
Todd, J., Aspell, J. E., Barron, D., & Swami, V. (2019). An exploration of the associations between facets
of interoceptive awareness and body image in adolescents. Body Image, 31, 171–​180.
Tsakiris, M. (2008). Looking for myself: current multisensory input alters self-​face recognition. PLoS
ONE, 3(12), e4040.
Tsakiris, M. (2010). My body in the brain: a neurocognitive model of body-​ ownership.
Neuropsychologia, 48(3), 703–​712.
Tsakiris, M. & De Preester, H. (eds.). (2018). The Interoceptive Mind: From Homeostasis to Awareness.
Oxford: Oxford University Press.
Tsakiris, M., Tajadura-​Jiménez, A., & Costantini, M. (2011). Just a heartbeat away from one’s
body: interoceptive sensitivity predicts malleability of body-​representations. Proceedings of the
Royal Society B: Biological Sciences, 278(1717), 2470–​2476.
Tuschen-​Caffier, B., Vogele, C., Bracht, S., & Hilbert, A. (2003). Psychological responses to body shape
exposure in patients with bulimia nervosa. Behaviour Research and Therapy, 41(5), 573–​586.
 Conclusion  225
Tuulari, J., Scheinin, N., Lehtola, S., Merisaari, H., Saunavaara, J., Parkkola, R., & Björnsdotter,
M. (2019). Neural correlates of gentle skin stroking in early infancy. Developmental Cognitive
Neuroscience, 35, 36–​41.
Zmyj, N., Jank, J., Schütz-​Bosbach, S., & Daum, M. M. (2011). Detection of visual–​tactile contingency
in the first year after birth. Cognition, 120, 82–​89.
 PART III
DISOR DE R S, A NOM A LI E S ,
A N D T HE R A PI E S
 14
The embodied and social self:
insights on body image and body schema
from neurological conditions
Jonathan Cole

14.1 Introduction

As Carel suggests, the healthy body presents itself to experience, both as object and
subject, with such predictability and control that it might be said, after Sartre and
Leder, to be transparent, or even absent from attention (Carel, 2016, p. 55). Our atten-
tion is normally on high-​level goals, playing a game, not on lower-​level means, e.g., the
motor control to throw a ball. It is when something goes wrong that the body moves
to the foreground of our attention, or of someone else’s. This account explores the re-
lations between body schema and image in impairment, terms used in a similar way to
Gallagher and Cole (1995, p. 371):

The body image consists of a complex set of intentional states –​perceptions, mental
representations, beliefs, and attitudes –​in which the intentional object of such states is
one’s own body.
In contrast to the reflective intentionality of the body image, a body schema in-
volves a system of motor capacities, abilities, and habits that enable movement and the
maintenance of posture. The body schema is not a perception, a belief, or an attitude.
Rather, it is a system of motor and postural functions that operate below the level of
self-​referential intentionality, although such functions can enter into and support in-
tentional activity.

Of course, the body image is adaptable in short time frames. If we strain an ankle and
limp for a few days, we cannot become alienated from the damaged leg; we incorporate
such changes, and those to do with changes in age, weight, height, etc., without diffi-
culty into both our image and schema.
These changes do not usually threaten or put into question our sense of self or body
image. But some neurological impairments do, and then the observations of subjects
with such conditions allow us to tease apart aspects of the body image and body schema
concepts. The centrality of the body is reflected in accounts of those with its most

Jonathan Cole, The embodied and social self: insights on body image and body schema from neurological conditions In: Body Schema
and Body Image. Edited by: Yochai Ataria, Shogo Tanaka, and Shaun Gallagher, Oxford University Press. © Oxford University Press 2021.
DOI: 10.1093/​oso/​9780198851721.003.0014
230  The embodied and social self
sudden and severe loss—​spinal cord injury. This is usually devastating and can need
years of adaptation—​timescales so long they are not usually considered in the litera-
ture. Yet people do come to terms with such changed embodiment over years, showing
how hugely adaptable our body image can be.
The borderlands between body schema and image are explored by reference to
subjects with deafferentation. How far can one look into the schema, when move-
ments become consciously controlled? Without peripheral feedback, is automatic
movement, or movement under visual control alone, possible? If these accounts look
inward, to the body itself, then in facial disfigurement,1 we move from the body to
its social constructed image, the consequences of the gaze of others, and the effects
this has on a person’s sense of self. Finally, given this, some effects of social media are
touched upon.

14.2  Losing the body? Tetraplegia

The body is the general medium for having a world . . . Consciousness projects itself
into the physical world and has a body . . . [it] is in the first place not a matter of ‘I think
that’ but of ‘I can’

(Merleau-​Ponty, 1962, pp. 137–​139, 146).

Perhaps the most massive and sudden change in embodiment imaginable is a spinal
cord injury at the neck, with permanent, complete paralysis, loss of sensation, and loss
of continence and sexual function—​tetraplegia or quadriplegia. This may lead to a
complete readjustment of not just one’s sense of the body, but of one’s thoughts too
(Murphy, 1987, p. 87):

A quadriplegic’s body can no longer speak a ‘silent language’ . . . the thinking activity
can no longer be dissolved into motion, and the mind can no longer be lost in an in-
ternal dialogue with physical movement . . . My thoughts and sense of being alive
have been driven back into my brain . . . consciousness of handicap even invades one’s
dreams.

Some years ago, I asked a series of people about their experiences of becoming tetra-
plegic. When you do this in some detail, then you find very different responses from
people whose impairments, from the outside, are similar. My account took readers
from more expected reactions of frustration and despair to more surprising reflections.
One man, 20 years after becoming injured, was still bitter (Cole, 2004, p. 42):

1 Here I use a preferred term of the community with these disfigurements, in the absence of clear agreement on
what term to use. Visible difference is less abrupt, but too anodyne for some, since we all have a visible difference.
 Losing the body? Tetraplegia  231
You just cannot substitute for the experience of being able to use this wonderful piece of
equipment, the body, be it running, riding or shagging.2 My greatest passion was horse
riding. The sheer enjoyment and freedom of being able to go hell for leather on the
back of this living being, with communication and some measure of control, but not
too much, was awe-​inspiring and wonderful and something that I cannot ever experi-
ence again.

Yet others had come to terms more and immediately. Another man, over a decade
injured, said (Cole, 2004, p. 66):

I was conscious for all of it . . . I was concerned with the practicalities. I never burst into
tears because, from the early stages of living with the injury, I have seen the whole thing
as a challenge. How do I overcome so and so? How do I come to terms with that?

Another agreed (Cole, 2004, p. 239):

I was very fortunate right from the outset. I had no cause for anger because it was a self-​
inflicted accident. It was just ‘Fool’. [Even] initially I did not feel any sense of loss.

After their injury, patients are nursed in bed for several months before gradually
being raised from the horizontal and then introduced to a wheelchair. Unable to feel
their body below the neck and with no movement either, sitting in a chair can be both
scary and precarious. One felt as though his sentient head and face were like a bal-
loon wafting around on an unfelt body. Such feelings usually fade; what may be less
expected, and less understood, is how subjects became both reconciled and adapted to
their new situation (Cole, 2004, p. 27):

Now I can almost kid myself that I can feel something when I sit in a chair, even though
I know I cannot. It feels exactly the same sitting in a chair now to before I was injured. It
can’t but it does. My mind tells me so. My mind makes me think I am like you over there.
It tells me there is nothing wrong, so I feel comfortable and correct. I have been longer
disabled than abled. In a relatively short time things become a norm. You almost forget
how it was before.

And another (Cole, 2004, pp. 244–​245):

I still view my body as whole; it’s just motionless. I’m not a head on a bag of potatoes.
I still know it’s there; I still like it; it is still me, and I am still it, totally.

We have defined the body image as intentional states, perceptions, attitudes, etc.,
in which the intentional object is one’s own body, without detailing those states

2 My italics throughout.
232  The embodied and social self
themselves. To be transparent, or absent, we normally require Carel’s harmony between
intention, action, and perception. What some with tetraplegia seem to be telling us is
that harmony can arise even within severe physical impairment. The body image has to
include a feeling of being at home in one’s body, of normality and contentment, even an
aesthetic, hedonic aspect, which can apparently transcend severe physical impairment.
The slow restitution of some sense of normal in such a severe and complete impair-
ment is both remarkable and, as far as I am aware, poorly understood.3 How precisely
can an immobile, insentient body be presented to consciousness as the new and ac-
cepted normal? It appears to emerge over time, an unconscious, unwilled, precious
adaptation.
The desire for embodiment, for sensation from and of the body, was illustrated by
another subject soon, 6 months since post-​injury. In common with a majority of those
with spinal cord injury, he had chronic phantom body pain. (Since the body was neuro-
logically disconnected with the brain, this is equivalent to phantom limb pain after an
amputation.) He related that, (Cole, 2004, pp. 89–​90):

My physical pain is in the hands and down the legs and in the feet. The pain does not
come on; it is there, the whole time. It is hot, like needles; the feet feel as though
someone has a bicycle pump on them, about to explode . . . Nothing makes it worse or
better. There is no choice but to endure it.

He continued (Cole, 2004, p. 90):

If I pinch my legs it is numb, so having the pain puts me in touch with my body. The
pain is the connection –​my friend the pain. It is almost comfortable, almost my friend.

In this, where central elaborated pain is perceived as arising in the unfelt, unmoving
body, is revealed the self ’s desire and need for the body.

14.3  Losing touch and proprioception, and automaticity

People who lose movement and position sense and touch, so called deafferentation,
(and who retain pain and temperature sensation and have normal motor nerve func-
tion) are so rare that some subjects have been studied extensively over years. Ian
Waterman (IW) had become deafferented from the neck down aged 19 and was ini-
tially unable to control any movement at all. Without peripheral originating feedback,
his movement brain and peripheral motor nerves were completely incapacitated (Cole,
1991; 1995; 2016).

3 Goldstein (1995) studying soldiers injured in World War I did look at their recoveries and found they found
ways to ‘become all that they could become . . . ’
 Losing touch and proprioception, and automaticity  233
After 3 months or so requiring full nursing care for all bodily functions, IW realized
that with cognitive attention towards movement and with visual supervision, he could
regain useful movement. Unlike in controls, however, as he relearnt to move—​these
movements did not require less thought.4 He did not develop motor skills or uncon-
scious programmes, and never knew if a movement done one day would be possible
the next. If he had a head-​cold, he would retire to bed, with cognition reduced so much
he could not think straight enough to control movement. His functional recovery5 was
driven by his intense desire to appear normal in a world then far harder on disability
and was facilitated by 17 months as an inpatient in a rehabilitation hospital. There, he
spent most of each day teaching himself new ways of moving, whether to dress, eat, or
drink. He stood after 12 months and began walking around 2 months after that. He de-
scribes learning to plan movements in his head before he made them, and then to use
those mental motor programmes aligned with visual supervision.
Gallagher and Cole suggested that, given this, he might be said to have replaced his
automatized, habitual motor schema with an attentionally rich body image in order
to control movement, with conscious directed attention toward previously non-​
intentional actions (1995). His case is enlightening in relation to several aspects of the
imprecise and difficult-​to-​define borderland between body image and body schema. To
what extent can he access previously acquired or innate motor programmes (at the level
of body schema), and how might these dovetail with intention? What is the level and
extent of this intention? Has he learnt to access his previous body schema more deeply?
His only feedback for over 45 years has been visual; has he learnt to use that to elaborate
or drive motor programmes, and have they become automatic?

14.3.1  Intact motor schema without proprioception?

He does have some remaining motor programmes. Gallagher and Cole mentioned the
‘waiter’s tray illusion’. If one takes a drink off a tray, the arm of the subject carrying
the tray will move upward as the drink is taken off. The upward movement does not
happen, however, if it is the holder of the tray who removes the drink (1995, p. 383).
This depends on a motor programme and still occurs in deafferented subjects (Forget
& Lamarre, 1987). Subsequently, we have also found that IW has preserved some
non-​conscious and automatic link between some arm and eye movements (Vercher,
Gauthier, Cole, & Blouin, 1997a; Vercher, Gauthier, Guedon, Blouin, Cole, & Lamarre,
1997b) None of these, however, is useful in daily life.

4 Proust’s narrator, as a child, finds himself at the end of a walk at his house unexpectedly; ‘from that moment on,
I did not have to take another step, my actions had ceased to be accompanied by any deliberate attention: Habit had
taken me in its arms, and carried me to my bed like a little child’ (Proust, 1913 [2002]).
5 In the UK, ‘functional’ can be used in medicine to mean non-​organic or elaborated symptoms. Here IW’s func-
tional recovery was without neurological improvement in his neuronopathy and a function of his intense mental
concentration toward movement, i.e., the opposite of its usual meaning.
234  The embodied and social self
IW walked for many years, until a chronic back problem led him to live from a wheel-
chair,6 and it seems unlikely that all aspects of this were under conscious control, sug-
gesting that, in some way, he was accessing a partially intact schema or a central pattern
generator. He has phasic activation and relaxation of calf muscles in relation to his gait
cycle, not under visual control and which may be non-​conscious.
Given the constraints due to his neuronopathy, walking is not normal. He does not
weight-​bear on a bent knee for fear of falling and, for the same reason, does not go
up onto the ball of his feet. So he has a rather stiff, flat-​footed Chaplin-​esque gait,
abducting his leg at the hip during the through phase of walking to avoid tripping
over the toes (Burnett, Cole, McLellan, & Sedgwick, 1989). Walking then may ac-
cess motor programmes but has still had to be modified and created anew, given con-
straints which remain under conscious control and attention, and differs from day to
day. IW was also clear that walking took huge amounts of concentration and had an
absolute requirement for visual supervision, though, interestingly, walking was easier
than standing or the transition between the two; rhythm is also very important, and he
hated to queue.
In a café, he described how he planned his walk out (Cole, 2016, pp. 128–​129):

I cannot concentrate on all aspects of walking. In a given movement, say from here to
the door, a distance of 20 feet, I think two steps ahead roughly. If it is busy, I will sit and
wait. Walking is never the same each time. I apply the strategy which is easiest at the
time; like a snooker player, some days I have flair and some days not.

IW emphasizes the importance of planning and predicting movements in his head,

suggesting he has developed willed, predictive motor programmes run under visual
supervision (and with the hope and expectation that action follows intention). One ex-
periment which provided evidence for these was relatively simple; asking him and an-
other deafferented subject GL to trace round the edges of a shape, e.g., a Star of David,
with a finger while viewing it inverted through a mirror. Control subjects find it dif-
ficult to turn the corners because of a conflict between information. GL did the task
effortlessly the first time (Lajoie et al., 1992). IW, however, was much more like control
subjects in that when he came to a point on the star, he shuddered and hesitated (Miall
& Cole, 2006). The original hypothesis was that GL succeeded because she had no con-
flict between visual and peripheral feedback. But IW’s result suggested his conflict—​
like controls—​was actually between vision and the feed-​forward predictive motor
programme he was using, and which GL, who had used online visual feedback for the
task, was not. Though not given to poetical allusions, IW did once use a metaphor for
the way in which he constructs programmes in his mind and then hopes intention will
be translated into action (Cole, 2016, p. 129):

6 Interestingly, now he is not walking, he has more time and concentration to give to the world around him.
Walking was, to an extent, an obsession and a burden he has been relieved of by his back problem.
 Losing touch and proprioception, and automaticity  235
Elements of movement are easier because I have the confidence or arrogance in my
abilities. When a bird learns to fly it leaves the nest and goes sit on a branch, and its
expectation is that the branch won’t break; it trusts the branch. To become mobile and
live independently I have learned to manage a range of movements, and I trust my ability
to choreograph them in a way that I want. That’s the payoff for all the hours, weeks, and
months of training, an implicit self-​belief; that my branch won’t break.

This aspect of IW’s recovery, the mental elaboration of predictive motor sequences or
programmes, may be one reason he has been more successful than others with his con-
dition. Their dependence on continuous mental concentration reveals their fragility.
Paillard made a distinction between movements accurate in shape and time, so-​
called morphokinetic movement, and movements accurate in relation to an external
object or place—​topokinetic movement, e.g., picking up a glass (Paillard, 1991). The
latter are far more difficult for subjects with deafferentation. IW once told me that when
driving 300 miles, the most difficult part was filling up with petrol. Having to walk
and fill up, topokinetically demanding movements, were far worse than the driving,
which he manages with a hand control of speed and braking, with the other hand on the
steering wheel.
Gallagher and Cole did not discuss this distinction, nor gesture, one of IW’s easiest,
and most automatic, of movements. Though other deafferented subjects have rather
ataxic and unsteady gestures, his are smooth and so natural that one wonders how
much cognitive control they require. In the first extended account of IW’s rehabilita-
tion, he had suggested that after his deafferentation, he had to relearn gestures under
conscious supervision to appear expressively embodied, since that was an essential part
of looking ‘normal’7 (Cole, 1991; 1995). On more reflection, and in our later account,
IW expressed himself slightly differently. The desire to gesture remained and soon after
his illness, when he could hardly sit, gestures of the arm outwards were poorly con-
trolled and dangerous, since the weight of an outstretched arm might topple him. He
learnt to reduce and inhibit them before reintroducing them with cognitive control
(Cole, 2016).
His gestures have been extensively studied in David McNeill’s lab in Chicago, (Cole,
Gallagher, & McNeill, 2002; Quaeghebeur, Duncan, Gallagher, Cole, & McNeill, 2014).
McNeill concluded that IW’s gestures were broadly accurate and normal in timing in
relation to speech (McNeill, 2005). For McNeill, this is important because it is compat-
ible with his theory that gesture is inseparable from, and part of, a thought/​language/​
gesture system within the brain which may remain intact in IW.
Though this may be the case, remember that gesture is one of the most morphokinetic
of all movements, being accurate in shape and time, but not position. IW himself, an as-
tute and critical scientist in his own right, suggests that while gesture is among his most

7 He was challenged by his first wife, who lived with the effects of polio, ‘Now you can walk, that’s OK, but what
are you going to do with it?’ He also once told me, ‘Who wants to be normal? No one puts, “He was normal” on
their tombstone.’
236  The embodied and social self
automatic of movements, it still needs to be controlled. For instance, he will release ges-
ture if sat securely and able to use a large workspace—​and still monitor visually; if he is
standing, then he may either gesture less and in a smaller space, since the outstretched
arms may make balance difficult, or not at all, depending on how mentally alert he feels
and how safe. And remember that at all times he has visual supervision. One other as-
pect of IW’s gesture which argues for some automaticity is that it unfurls over more ex-
tended periods of time, more so than locomotor or instrumental actions.
More generally, his mental rehearsal and intentional control of movement are limited
in several ways. First, there are attentional limits; IW cannot attend to all aspects of
some movements or do lots of things at the same time. His speed of movement is slow
too, determined by attentional and mental image constraints; consciously driving it
slows mobility. Third, his overall durations of sequences of motor activity are relatively
short. Given the mental effort of prediction he often pauses, rehearses the next phase
like a climber up a pitch, and then sets off again. And all depends on adequate light, and
his mental resources.

14.3.2  The levels of conscious reach: has the body image expanded?

There is little to suggest that his cognitive attention toward movement has reached
down into areas normally beyond consciousness. Rather, his recovery reflects his ex-
ceptional attention and ingenuity in elaborating and rehearsing motor programmes.
He describes his level of conscious intentional access for movement in a way similar to
controls. He says he concentrates on moving the arm, the hand, or the leg, not a joint
or muscle. I asked IW to describe his level of attention when reaching for a cup of tea
(Cole, 2016, p. 128):

I am initially being aware of my body position to hang it all off. Sitting down my legs
are in a tripod, sitting on a chair, and I have a mental image of this. Having my [other]
arm resting on the table is a good triangle position. Once the framework is safe, I know
I can reach the cup. I monitor hand out and in; I see it all except what the fingers are
doing behind the cup, but I have learned to do this [by grasping without using the
handle]. I don’t know how heavy the cup is, so pick it up and monitor it visually. I need
to see my arm up to my face, but then I can feel the cup with my face. I may not need
to see the cup return until it reaches the table. This is all very controlled and involved.

Rather than any unique or exceptional ‘reach’ or access by attention to joints or

muscle groups to which others cannot consciously attend, IW has learnt the hard way,
by exceptional attention over many years, to attend to all cognitively accessible clues
from the body. In one experiment, we were looking at his ability to move between nine
positions of wrist extension and flexion, without vision. We noticed he was better in
the mid position than in others on either side. He was not surprised since he had learnt
that if he made no effort to move the wrist in flexion/​extension, then it relaxed to a mid
 Losing touch and proprioception, and automaticity  237
position of itself. This is but one example of how attentive he has had to become to body
mechanics. As he says, he is more embodied now than before, since he needs at all times
to be aware of his position (Cole, 2016, p. 119):

Even now, I wake up and think, ‘Where am I in space?’ Each day I need to gradually
re-​associate myself before moving. So, rather than being disembodied, I am completely,
totally, embodied. If not, I would not know where I am. I re-​associate and reconnect
constantly. Everything is through vision [and thought]. I think about it all before I do it
and then; I think it out and I think it back.

14.3.3  Automaticity and visually led motor programmes?

Examples of automaticity are important because, if present, they might imply that IW’s
remaining motor schema might coordinate a few movements in the absence of per-
ipheral feedback under, for instance, visual control. Here a distinction can be drawn
between direct online visual feedback, controlling movement in real time, and visual
supervision, when a motor image or programme is unfurled with vision used to pro-
vide looser support that action follows intention.
de Vignemont has suggested a third way. She asked how disabled those with deaffer-
entation actually are and whether visual feedback might, after all, be able to replace
proprioception and enable motor ‘programme to be developed and run under visual
control’ (2018, p. 147). She writes of GL, with a similar or slightly more severe deaffer-
entation than IW (pp. 147–​149):

Spending several days with Ginette Lizotte, as her interpreter, I often forgot that there
was anything abnormal besides her wheelchair. She could cut her meat while having a
normal discussion at lunch and even gesture with her knife and fork like everyone else,
or so it seemed.

Later, she suggests that in control subjects:

even very effortful actions can be automatized (complex dance steps in instance) and
it is hard to see why this would have been impossible in [IW’s] case . . . Do deafferented
patients still need to consciously control their movements? . . . With practise, actions
become automatic . . . There seems to be no principled reason why extensive use of
visual information made by deafferented subjects could not be of this kind.

There are physical problems using vision to control movement. Visual feedback is
too slow and can only be consciously altered at a low frequency of around 3 Hz. It
also lacks the required acuity in several dimensions; we cannot see our backs to sit,
nor all parts of the limbs to stand or walk; we cannot see how windy it is outside. IW
also had to learn the physics of his body; his outstretched arm was heavy enough to
238  The embodied and social self
pull him over initially and he learnt to brace his body before doing this. Empirical
work over many years has also suggested that visual feedback is insufficient for normal
motor performance in subjects with large-​fibre sensory neuronopathy (Sainburg,
Poizner, & Ghez, 1993; Teasdale et al., 1993; Sarlegna, Malfait, Bringoux, Bourdin, &
Vercher, 2010).
IW has spent nearly 40 years thinking how to move without feedback.8 Insuperable
problems for him remain speed and complexity, let alone, of course, active touch. He
can no more run, jump, or dance, nor retrieve coins from a pocket, than he can fly. de
Vignemont appears unaware of, or to dismiss, the sheer amount of cognitive control
needed by these subjects. Because they are on show when being studied, they conceal
this effort. When not on top form, IW will retire; though happy to collaborate, he has
his pride. Recently he had an earache and did not sleep for two days. Befuddled by pain
and sleeplessness, he could no longer reach for a drink or sit. He would not tell me, his
doctor, neuroscientist, and friend, because he knew I would want to video him.
IW is not only a practised observer of his own actions, but he is also an astute judge
of science and neuroscientists (Cole, 2016). He was not impressed by de Vignemont’s
analysis (IW, personal communication):

The author has no concept of the complex strategies that go on behind the facade of
‘normality’ that GL, me and many others employ as we go about our daily business.
The author has missed the essence of the situation and simplified to make a misguided
raft of naïve statements. Absolutely, there is a conscious need to control and manage,
just look and observe [me], it is obvious.
Whilst I would accept that there becomes a level of familiarity, one must never mis-
take this requirement to ‘manage’ as ‘automatic.’ This person either hasn’t read, or cer-
tainly understood, what is going on, for me at least.
The more refined the level of movement, free sitting, free standing, walking, the
more involved the cognitive input required to manage the event. But cognitive effort
has its limitations, (in speed, complexity, mental capacity etc.).
It all becomes a case of how much you can cognitively manage. Familiarity and con-
fidence in managing some movements permits other elements to be added on. But
automatic, no, not in the general context of the word . . . The replacements for proprio-
ception and touch require constant management and monitoring.

In conclusion, in cases of acquired deafferentation, one can show some examples

of movement at the level of the motor schema. But, with the possible exceptions
of some aspects of walking, and gesture, these seem to have no useful role in daily
living. The boundaries between body image and body schema seem largely intact and
IW’s improvement in motor skills is hard won and secondary to his ingenuity. These
subjects do not seem to have developed visually controlled automaticity in move-
ment. However, whether vision might be used to develop some automatic movements,

8 He may have thought about movement more deeply than anyone in history, by necessity.
 Losing face: Möbius syndrome and visible difference  239
as de Vignemont speculates, in those few cases of congenital deafferentation which
are becoming known to neuroscience remains an unanswered empirical question
(Chesler et al., 2016). Might any visuo-​cerebellar motor control be possible if devel-
oped from birth?

14.4  Losing face: Möbius syndrome and visible difference

With Henrietta Spalding, a few years ago, I explored the experiences of people with a
rare condition, Möbius syndrome, which is characterized by several impairments, the
most obvious being the congenital absence of movement of the muscles of facial ex-
pression and of movement of the eyes laterally. We interviewed around a dozen adults
with the condition and, of those, a third described problems as children with emotional
expression and experience. One adult with Möbius remembered her childhood (Cole
& Spalding, 2012, p. 43):

I did not do ballet or horse riding; I did hospitals and operations. I had the eye doctor
and the foot doctor and a speech therapist, and a face doctor. I never thought I was a
person; I used to think I was a collection of bits.
Celia was not there; that was a name people called the collection of bits. I did not
like my feet; I liked my spirit; I liked my brain. I loved reading, I could think and dream
and imagine.
I did not express emotion. I am not sure that I felt emotion, as a defined concept. At my
birthday parties I did not get excited. There were people around excited, but I followed
what they did. I don’t think I was happy, or even had the concept of happiness as a child.

One man in his forties still had problems (Cole & Spalding, 2012, pp. 70–​72):

I have a notion which has stayed with me over much of my life –​that it is possible to live
in your head, entirely in my head. Meeting my wife, I think initially I was thinking I was
in love with her. It was sometime later when I realised that I really felt in love.
I sort of think happy or I think sad, not really recognising actually feeling happy
or feeling sad. Perhaps I have had a difficulty in recognising that which I’m putting
a name to is not a thought at all, but a feeling, maybe I have to intellectualise mood.
I have to say this thought is a happy thought and therefore I am happy.

Extraordinarily, despite emotional impoverishment as children, two women de-

scribed how they had gained emotional experience as young adults. One had not ges-
tured as a child, since she did not feel she inhabited her body. When she went to Spain
to teach English after university, she found, in a richer gestural culture, that she began
to feel the emotions she was expressing for the first time. Another woman found the
same at music school, rehearsing opera; only then did she begin to experience the emo-
tions she was expressing through music. Both seem to have found, through shared art
240  The embodied and social self
and culture, and through voice and gesture, that embodied expression of emotion led
to experiencing it for the first time. However, it was bootstrapped from expression to
experience; it required rich embedding within a shared culture.
Despite experiencing emotion through gesture and language, this does not neces-
sarily mean the movements involved are automatic. Like IW, one woman volunteered
that (Cole & Spalding, 2012, p. 201):

All my gesture is voluntary, even now aged 40. Everything I do, I think about . . . All
the things I am doing, whether turning my head or moving my hands, is self-​taught.
When I express being happy that has to be vocal and intellectual . . . There is an element
of artificiality of the expression but not the feeling. Even now I have two sorts of happy,
intellectual happy to express, and happy, happy. I can be happy, not think happy, but to
express I have to think.

Relying on the other for validation and completion, however, is a risky business. The
UK charity supporting those with visible difference, Changing Faces, recently pub-
lished a survey on attitudes to disfigurement (Changing Faces, 2017).9 One in 124 chil-
dren in the United Kingdom (UK) have a disfigurement. At school, approximately 50%
are bullied, and in only 5% can or does the school stop it. Of 800 people with mixed
types of disfigurement, a majority avoided applying for a job because they thought their
appearance would hinder them at interview, or because new colleagues would make
them uncomfortable. Despite long-​established links between disfigurement and emo-
tional and psychological well-​being, 75% of respondents reported being denied med-
ical or surgical treatment on the basis that it was ‘cosmetic’ or unnecessary in some way.
Ninety percent who use dating websites have had uninvited, unpleasant remarks about
their appearance from other users.
Remember that while some people with disfigurement have functional impairments
in facial function, many do not. For those with say, vitiligo, which leads to whitening of
areas of the skin, or with birthmarks or cutaneous growths, their face moves and works
completely normally. Their only difference is purely visible, solely in the body image,
and yet—​because of the attitudes of others—​their lives can be severely blighted. This
speaks to the close connection between body image and social life. Appearance affects
how we perceive ourselves and how we are perceived by others, which, in turn, deter-
mines our own self-​esteem. The sense of self we elaborate depends on the body image
we project and, in turn, on how that image is reflected back to us by others. It takes a
strong person, especially when young, to repeatedly shrug off taunts and bullying over
such matters. If we define the body image in terms of a person’s perceptions and atti-
tudes about their own body, these may still be shaped by others. And these influences,
as we will see, may be increasing.

9 www.changingfaces.org.uk/​campaign/​dituk
 Losing privacy? Social media and surveillance  241
14.5  Losing privacy? Social media and surveillance

From the experience of those with body-​schematic impairments or body image prob-
lems, or even mere visible difference, it can be difficult to isolate a person’s perceptual
and emotional experience of, and attitude towards, their body and their sense of self
from the influences of other people’s responses and attitudes. This being the case, then
recent developments in social media become of especial relevance. In the UK, it is not
infrequent to read of another teenager, usually a girl with her life ahead of her, commit-
ting suicide after social media trolling.
In her recent book Surveillance Capitalism, Zuboff gives some of the accounts from
teenagers of spending 24 hours without digital social media (2019, p. 445). A Chinese
girl said: ‘I felt so lonely . . . I could not sleep well . . . ’; ‘emptiness overwhelms me.’
An Argentinian boy said: ‘I felt like there was a problem with me.’ A Ugandan boy
and one American student said: ‘I went into panic mode.’ Zuboff describes how such
sudden disconnection may lead to cravings, depression, and anxiety—​all symptoms
of addiction (2019). In 2018, she relates in one report that 40% of young people aged
18–​29 years were online almost continuously, with 95% of Generation Z having
smartphones. In an earlier survey in 2016, 42% of teenagers reported that social
media affected how others saw them, affecting their happiness and how they feel
about themselves; ‘an average millennial checks their phone approximately 200 times
per day.’ She describes the anxiety of an adolescent on her birthday; will she have
enough likes? Unknowingly echoing phenomenologists like Sartre and Merleau-​
Ponty, this girl is quoted: ‘I am what others think of me. I feel a function of how others
treat me.’
Young adulthood and the teenage years are times of fragile selfhood and a need
both to rebel and yet to conform within their own in-​groups. ‘It is a time when “I”
am whatever the others think of me, and how “I” feel is a function of how others
treat me.’ Young people use the Internet for many reasons, from fashion and celeb-
rity to chat rooms and shopping. Studies have suggested that such Internet use can
work in both positive and negative ways, offering support groups and therapies,
but also glorifying and advertising weight loss, for instance (Bachner-​Melman,
Zontag-​Oren, Zohar, & Shen, 2018; Tiggemann & Slater, 2013). Bachner-​Melman
et al. suggest that in anorexia, online behaviour should be addressed as part of
the treatment and if necessary, it should be reduced and face-​to-​face contact en-
couraged. Appearance matters.10 The social contribution to the sense of self and
to body image satisfaction may have been accentuated by the development of so-
cial media.

10 Appearance Matters is the title of a series of biennial conferences run by the Centre for Appearance Research,
University of the West of England. This has run since 2003 and covers appearance-​related issues, including visible
difference, interventions, research methods, and provision of care related to disfigurement, identity, lesbian, gay,
bisexual, trans-​sexual, queer and intersex issues, etc.
242  The embodied and social self
14.6 Conclusion

The cases of IW and other highly studied and rehabilitated deafferented subjects allow
insights into the perceived body image and the movement schema revealed through
the absence of proprioception. No evidence was produced for visually run automaticity
in movement, and little for greater attentional reach into the schema itself. Instead, the
importance of mental rehearsal and ingenuity was stressed.
Again and again, the centrality of the body in the sense of image and self emerges
throughout the reflections of those with impairment. One of IW’s drivers for his re-
habilitation was to appear ‘normal’. An area which has received insufficient attention is
the Goldsteinian restoration of a sense of normality even in the presence of severe im-
pairment over time, ‘becoming all that one can become’ (Goldstein, 1995).
Murphy, who became tetraplegic late in life, wrote of the distinction between a role
and an identity (Murphy, 1987):

The totality of the impact of serious physical impairment on conscious thought . . . gives
disability a far stronger purchase on one’s sense of who and what he is than do any so-
cial role . . . which can be manipulated. Each social role can be adjusted to the audience,
each role played before a separate audience, allowing us to lead multiple lives. One
cannot however shelve a disability or hide it . . . It is not a role: it is an identity . . . society
will not let him forget it.

This passage emphasizes the importance (and tyranny) of the social in how those
with impairment view their bodies. And not only those with impairment—​those with
visible difference and without physical impairment often have to live with the stigma of
others, as the Changing Faces survey showed.11 But it can work both ways. Remember
those with Möbius who, with reduced experience of emotion as children, developed
it as young adults in a performative, intersubjective social situation, through personal
embodied expression and with the feedback from, and support of, others through cul-
ture. If these accounts stress the role of other people in one’s body image, some of the
narratives from those with tetraplegia point toward long-​term personal changes too.
Lastly, our definition of the body image included perceptions, mental representations,
beliefs, and attitudes toward our bodies. Future work might look further into the con-
tents of these. To report feeling normal in, and at one with, in one’s paralysed and insen-
tient body shows the huge and important restorative capacity within us.

References
Bachner-​Melman, R., Zontag-​Oren, E., Zohar, A. H., & Sher, H. (2018). Lives on the line: the online
lives of girls and women with and without a lifetime eating disorder diagnosis front. Frontiers in
Psychology, 9, 2128.

11 https://​www.changingfaces.org.uk/​ https://​faceequalityinternational.org/​aboutfei
 Conclusion  243
Burnett, M. E., Cole, J. D., McLellan, D. L., & Sedgwick, E. M. (1989). Gait analysis in a man without
proprioception below the neck. Journal of Physiology, 417, 102P.
Carel, H. (2016). Phenomenology of Illness. Oxford: Oxford University Press.
Chesler, A. T., Szczot, M., Bharucha-​Goebel, D., et al. (2016). The role of PIEZO2 in human mechano-
sensation. New England Journal of Medicine, 375, 1355–​1364.
Cole, J. (1991, 1995). Pride and a Daily Marathon. London; Duckworth; Cambridge, MA: MIT Press.
Cole, J. (2004). Still Lives. Cambridge, MA: MIT Press.
Cole, J. (2016). Losing Touch. Oxford: Oxford University Press.
Cole, J. & Spalding, H. (2012). The Invisible Smile. Oxford: Oxford University Press.
Cole, J., Gallagher, S., & McNeill, D. (2002). Gesture following deafferentation: A phenomenologically
informed experimental study. Phenomenology and the Cognitive Sciences, 1(1), 49–​67.
de Vignemont, F. (2018). Mind the Body. Oxford: Oxford University Press.
Forget, R. & Lamarre, Y. (1987). Rapid elbow flexion in the absence of proprioceptive and cutaneous
feedback. Human Neurobiology, 6(1), 27–​37.
Gallagher, S. & Cole, J. (1995). Body image and body schema in a deafferented subject. Journal of Mind
and Behaviour, 16(4), 369–​390.
Goldstein, K. (1995). The Organism. New York, NY: Zone.
Lajoie, Y., Paillard, J., Teasdale, N., Bard, C., Fleury, M., Forget, R., & Lamarre, Y. (1992). Mirror
drawing in a deafferented patient and normal subjects: visuoproprioceptive conflict. Neurology,
42(5), 1104–​1106.
McNeill, D. (2005). Gesture and Thought. Chicago, IL: Chicago University Press.
Merleau-​ Ponty, M. (1962). Phenomenology of Perception. London: Routledge; New York,
NY: Humanities Press.
Merleau-​Ponty, M. (1964). The Primacy of Perception. Evanston, IL: Northwestern University Press.
Miall, R. C. & Cole, J. D. (2006). Evidence for stronger visuo-​motor than visuo-​proprioceptive conflict
during mirror drawing performed by a deafferented subject and control subjects. Experimental
Brain Research, 176, 432–​439.
Murphy, R. (1987). The Body Silent. New York, NY: Henry Holt.
Paillard, J. (1991). Motor and representational framing in space. In Paillard, J. (ed.), Brain and Space
(pp. 163–​182). Oxford: Oxford University Press.
Proust, M. (1913, 1983). Remembrance of Things Past (T. Kilmartin, Trans.). London: Penguin.
Quaeghebeur, L., Duncan, S., Gallagher, S., Cole, J., & McNeill, D. (2014). Aproprioception, gesture,
and cognitive being. In C. Müller, A. Cienki, E. Fricke, S. Ladewig, D. McNeill, & S. Tebendorf
(eds.), Body –​Language –​Communication. An International Handbook on Multimodality in Human
Interaction (Vol. 1 and 2). Berlin/​Boston: De Gruyter Mouton.
Sainburg, R. L., Poizner, H., & Ghez, C. (1993). Loss of proprioception produces deficits in interjoint
coordination. Journal of Neurophysiology, 70(5), 2136–​2147.
Sarlegna, F. R., Malfait, N., Bringoux, L., Bourdin, C., & Vercher, J.-​L. (2010). Force-​field adapta-
tion without proprioception: can vision be used to model limb dynamics? Neuropsychologia,
48(1), 60–​67.
Teasdale, N., Forget, R., Bard, C., Paillard, J., Fleury, M., & Lamarre, Y. (1993). The role of pro-
prioceptive information for the production of isometric forces and for handwriting tasks. Acta
Psychologica, 82(1–​3), 179–​191.
Tiggemann, M. & Slater, A. (2013). NetGirls: the Internet, Facebook, and body image concern in ado-
lescent girls. International Journal of Eating Disorders, 46(6), 630–​633.
Vercher, J.-​L., Gauthier, G., Cole, J., & Blouin, J. (1997a). Role of arm proprioception in calibrating the
arm-​eye temporal coordination. Neuroscience Letters, 237, 1–​4.
Vercher, J.-​L., Gauthier, G. M., Guedon, O., Blouin, J., Cole, J., & Lamarre, Y. (1997b). Self-​moved
target eye tracking in control and deafferented subjects: roles of arm motor command and proprio-
ception in arm eye coordination. Journal of Neurophysiology, 76, 1133–​1144.
Zuboff, S. (2019). Surveillance Capitalism. New York, NY: Public Affairs.
 15
Unilateral body neglect: schemas versus images?
Laurence Havé, Anne-​Emmanuelle Priot, Laure Pisella, Gilles Rode,
and Yves Rossetti

15.1 Introduction

Although the number of categories and the taxonomy varied substantially along the
long-​standing debate about body representations in our brain, the prominent classi-
fication in use in the field of neuroscience, as well as in analytical philosophy, seems
to be the distinction between ‘body schema’ and ‘body image’ (e.g., Gallagher, 1986;
Longo & Haggard, 2012; Paillard, Michel, & Stelmach, 1983). It is not our aim to
evaluate this classification in the present chapter, and we rather propose to use these
two terms as useful landmarks to relate observations in the landscape of unilateral neg-
lect symptoms.
‘Body schema’ refers to low-​level sensorimotor processing involved in percep-
tual coding and motor reactions (e.g., Paillard 1980; Paillard et al., 1983). In contrast,
‘body image’ refers to both conscious and unconscious levels of body representation.
Nowadays, body image is rather defined by a conscious representation of one’s own
body, while body schema can be described as an unconscious implicit processing of
somatosensory information used for sensorimotor interactions. As a practical ex-
ample, consider the feeling of a mosquito bite on your leg. It is a common experi-
ence that it takes us more time to determine that the bite has happened right above
the junction between the lower third and the median third of the antero-​lateral side of
your right calf than to just send our hand to smash this undesirable creature precisely
there. These two processes may appear to rely on identical information (locating the
intruder), but they obviously rely on different types of computation. The faster type is
the sensorimotor transformation enabling the hand to be mostly implicitly guided to
its target, and can be considered as answering a ‘how’ question, i.e., how to reach there.
The slower one is a descriptive, often declarative, representation of the target location
on the body map, which can be considered to address a ‘where’ question, i.e., where this
is happening. These two types of spatial representations can be dissociated in patients
with numbsense who may locate a tactile stimulus by pointing on their skin, but not on
a body map (Rossetti, Rode, & Boisson, 1995). Such dissociations between implicit and
explicit processing of the same sensory signal are legion and have been mapped onto
many different neurophysiological systems (Rossetti & Revonsuo, 2000), and they re-
veal that guiding motor responses can be dissociated from perceiving. In the present

Laurence Havé, Anne-​Emmanuelle Priot, Laure Pisella, Gilles Rode, and Yves Rossetti, Unilateral body neglect: schemas versus images?
In: Body Schema and Body Image. Edited by: Yochai Ataria, Shogo Tanaka, and Shaun Gallagher, Oxford University Press.
© Oxford University Press 2021. DOI: 10.1093/​oso/​9780198851721.003.0015
 Clinical bodily manifestations of unilateral neglect  245
chapter, we shall mostly consider the functional, rather than anatomical, properties of
the alterations of body representations that may be encountered in unilateral neglect.

15.2  Clinical bodily manifestations of unilateral neglect

Prior to assessing body schema versus body image contributions to body neglect, let
us review the variety of possible bodily manifestations that can be encountered in pa-
tients with unilateral neglect (see also Vallar, 1998; Rode, Pagliari, Huchon, Rossetti, &
Pisella, 2017). Although these manifestations can be observed in isolation, the fact that
they are frequently encountered in association with neglect or may reveal neglect calls
for their inclusion in the following description.
Several types of clinical observations may be evocative of body neglect. The most ob-
vious manifestations may be dressing half of the body (see Figure 15.1A), or shaving/​

1A 1B

Figure 15.1  Typical manifestations of body neglect. Panel (A) illustrates an outpatient
administrative head of a rehabilitation centre, coming to his medical consultation, having
forgotten to fully dress on the left side (O’Shea et al., 2017). Panel (B) depicts an inpatient,
a professor of neurology, shaved only on the right side and with the left side-​piece of his
spectacle frame in the left ear, implying that the whole spectacles were oddly positioned in
front of the eyes.
246  Unilateral body neglect: schemas versus images?
making up on one side of the face (see Figure Figure 15.1B), or forgetting an object held
in the left hand, etc. Seated patients may exhibit odd arm or leg posture, such as letting
their arm hang on the side, instead of placing it on their thigh or on the table. The case
of under-​utilization of the contralesional arm is more ambiguously ascribed to either
motor neglect or body neglect (Laplane & Degos, 1983). In some patients, body neg-
lect can be present only during the acute phase, while it may be sequellar and become
chronic in others.
We will see that the description and clinical observation of unilateral body neglect
raise the following important question: does every lateralized body manifestation in-
clude neglect? This important clinical question applies to a large panel of body schema
and body image impairments with perceptual, motoric, and higher-​level representa-
tional symptoms. Many of these symptoms can be observed in association, possibly
forming specific syndromes (e.g., Anton–​Babinski syndrome where spatial and body
neglect is associated with anosognosia and anosodiaphoria).

15.2.1  Perceptual manifestations

Somatosensory neglect: patients ignore tactile, thermal, or painful stimulation,

•
which is different from hypoesthesia, which corresponds to a sensory deficit.
Indeed, somatosensory neglect can disappear after caloric vestibular stimulation
or prism adaptation (e.g., Rode & Perenin, 1992; Maravita et al., 2003), while it is
not the case in patients with hypoesthesia.
Proprioceptive neglect: Vallar, Antonucci, Guariglia, and Pizzamiglio (1993)
•
described that patients with unilateral spatial neglect showed deficits in percep-
tion of the orientation of their upper limbs placed passively in different positions.
The deficit affects the contralesional part of the body and, to a lesser extent, the
ipsilesional part. It was decreased with horizontal optokinetic stimulation on the
left side, and increased with optokinetic stimulation on the other side.
Somatoparaphrenia: one common phenomenon associated with body neglect
•
is somatoparaphrenia (Vallar & Ronchi, 2009), due to defective multisensory
integration with a disorder in spatial representation of the body. It was first de-
scribed in 1942 as ‘illusions or distortions concerning the perception of, and
confabulations or delusions referring to the affected limbs or side’ (Gerstmann,
1942). Somatoparaphrenia was distinguished from autosomatoamnesia and
autosomatoagnosia, which, respectively, define an absence of memory and an ab-
sence of consciousness of the affected limb part. Somatoparaphrenia is usually ob-
served in patients in the acute and post-​acute phase after a stroke, during days or
weeks. Somatoparaphrenia may also be observed in psychiatric affections, but the
fact that it disappeared after caloric vestibular stimulation underlines the tight as-
sociation between somatoparaphrenia and neglect (Rode et al., 1992).
Hemi-​microsomatognosia: some patients can be disturbed by misrepresentation
•
of the size of body parts. Frederiks (1963) called these troubles microsomatognosia
 Clinical bodily manifestations of unilateral neglect  247
when the hand is perceived smaller in hemiplegic patients, for example. The fre-
quency of microsomatognosia is not impacted by the side of the lesion, but it
may be alleviated by the same intervention as for unilateral neglect (e.g., Rode
et al., 2012).
Alloesthesia: this refers to the fact that tactile stimulations applied on the
•
contralesional side of the body are perceived on the ipsilesional side, while pa-
tients are not always aware of making these errors. It is frequently present in pa-
tients with extended temporoparietal area lesions, in association with neglect, and
sometimes anosognosia.
Allochiria: this is the transfer of sensations from one localization to another, what-
•
ever the sensory mode.
Misoplegia (Critchley, 1974): this word is used to describe the hostility or dis-
•
gust that can be felt by a patient toward the hemiplegic side. This reaction may ap-
pear during the clinical evolution of the patient, for example following a period of
anosognosia, and resemble an emotional reaction. The intensity of these feelings
varies among patients. The phenomenon can be verbal but can involve physical ag-
gression toward the hemiplegic part. Although the pathophysiology has not been
elucidated, it is mostly observed in patients with right hemispheric lesions.

15.2.2  Motor manifestations

Motor neglect: underuse of the left upper limb. It was first described in 1953 by
•
Critchley. Patients do not use their left hand in bimanual activities, except if at-
tention is specifically raised to the left arm. These motor manifestations resemble
hemiplegia and affect proximal and distal movements and automatic and volun-
tary motricity (Laplane & Degos, 1983). It is important to mention that motor neg-
lect is not associated with tonus trouble, anosognosia, or anosodiaphoria.
Other motor troubles: motor neglect must be distinguished from other motor
•
perturbations resulting from neglect. Slowness in initiation and execution of
movement of the ipsilateral limb in the contralateral space can be observed.
These phenomena are called directional hypokinesia (Bisiach, Geminiani, Berti,
& Rusconi, 1990; Heilman, Bowers, & Watson, 1983; Mattingley, Bradshaw, &
Phillips, 1992) and directional bradykinesia (Mattingley, Phillips, & Bradshaw,
1994). Range of motion can also be affected and leads to directional hypometria
of upper limbs (Meador, Watson, Bowers, & Heilman, 1986) or of ocular saccades
(Butter, Rapcsak, Watson, & Heilman, 1988).

15.2.3  Higher-​level representational manifestations

Heterotopoagnosia: Auclair, Noulhiane, Raibaut, and Amarenco (2009) and

•
Cleret de Langavant, Trinkler, Cesaro, and Bachoud-​Levi (2009) interpreted it as
248  Unilateral body neglect: schemas versus images?
an embodiment deficit. Patients experience difficulties pointing at somebody’s
part when prompted, or present with some disruption of body representa-
tion. Patients are not able to point correctly at their own body parts. Since
Cleret de Langavant et al. (2009) observed ‘dissociation between their grasping
and communicative pointing abilities’, they proposed the hypothesis that
heterotopoagnosia is a disorder of communicative function conveyed by
pointing, but not by grasping.
Hyperschematia: left-​sided disproportionate expansion of drawings, both by
•
copying and from memory, contralateral to the side of the hemispheric lesion was
described in several patients (Di Marco et al., 2019; Rode et al., 2014). It may in-
volve the extrapersonal space or just body representation and is linked to damage
to the fronto-​parieto-​temporal cortices and subcortical structures.
Hemiasomatognosia: patients with hemiasomatognosia ignore a part of their
•
body, particularly the left side of the body. They do not look at it, and their move-
ments are produced by the right part of the body. Frederiks (1963) proposed the
notions of conscious and unconscious hemiasomatognosia. For the first one, the
body is perceived as incomplete, but patients are aware of this illusional pro-
cess, while for the second one, patients are not aware at all of the disappearance
of a part of their body. Patients behave as if there was no left part of the body.
Frederiks (1963) used to explain this phenomenon as a lack of attention to the
hemibody.
Hemi-​depersonalization, amputee-​like sensation: some representational (and/​
•
or perceptual) troubles like tactile hemi-​depersonalization could be compared
to hemiasomatognosia. Patients complain of the sensation of absence or a ‘real
feeling of amputation’ (Melzack, 1990), or the sensation of a disconnection be-
tween the upper limb and the rest of the body, as if the upper limb has drifted dis-
tant from the body. In the reverse case, the case of a supernumerary phantom limb
was reported (Brugger, 2003; Staub et al., 2006) for proprioceptive, somatosen-
sory, and motor components. Supernumerary phantom limb is likely an illusory
representation or movement perception.
Anosognosia for hemiplegia: illusory movements can be described by patients
•
with anosognosia for hemiplegia or body neglect—​patients feel that they made a
movement while they keep staying motionless. Some of them can recognize the
illusion and be critical about their beliefs, whereas some others are absolutely
convinced they produce the movement and even perceive its consequences (e.g.,
hearing the sound of hands clapping). One may wonder whether this is related to
a real movement illusion or to confabulations (Bakheit, 2000; Feinberg, Roane,
& Ali, 2000). Anosognosia reflects a deficit in body image. A minor version of
anosognosia is found in the form of anosodiaphoria, which manifests itself as in-
difference toward the contralesional hemiparesis.
 Definitions and physiopathology of body neglect  249

clinical high-level
manifestations motor perception representation

bradykinesia hitting left body

parts fading limb reference
arm underruse frame shift
BODY SCHEMA postural
hypokinesia imbalance
head or trunk hemiasomatognosia
deviation

somatoparaphrenia

personal neglect
hemimicro hyper
somatognosia schematia

tactile
autotopoagnosia tactile alien
tactile extinction hand
left side
ommisions in fluff
BODY IMAGE test
anosognosia allochiria

Figure 15.2  Motoric, perceptual, and representational symptoms of body neglect.

Clinical manifestations of body neglect are classified in a table, providing three different
columns, according to whether they are related to motoric, perceptual, or representational
abilities, and two lines presenting clinical manifestations related to body schema or
body image.

From this nosography, we can propose that body image disorders in neglect are not
always accompanied by body schema disorders. For example, hyperschematia can be
observed without any body schema disorder (see Figure 15.2).

15.3  Definitions and physiopathology of body neglect

15.3.1  From spatial to body neglect

Spatial neglect designates ‘a consistent, exaggerated spatial asymmetry in processing

information in bodily and/​or extra bodily space due to an acquired cerebral lesion’
(Cubelli, 2017), as well as in the organization of actions and mental representations. It
can affect all stimuli lying on one side of space, or one side of a given stimuli, independ-
ently of its spatial location. The deficit can affect the patient’s body space, near and far
(beyond reaching point) space (Beschin & Robertson, 1997; Bisiach, Perani, Vallar, &
Berti, 1986; Guariglia & Antonucci, 1992; Marangolo, Piccardi, & Rinaldi, 2003; Peru
& Pinna, 1997) (see Figure 15.3). According to the affected space, the deficit is called
personal neglect, peripersonal neglect, or extrapersonal neglect, respectively. Body
neglect should, in principle, be associated with personal neglect, but if one includes
250  Unilateral body neglect: schemas versus images?

Figure 15.3  Body neglect and spatial neglect. Picture of a patient sitting in a wheelchair
while asked to arrange flowers evenly on a synthetic garden on the table (gardening task)
(O’Shea et al., 2017). The typical arrangement of the flowers at the extreme right illustrates
severe left peripersonal neglect. In addition, the tonic and severe lateral head deviation to
the right depicts the left body neglect. This figure also illustrates the vicious circle of spatial
neglect that results from the tight links between spatial neglect and body neglect; the more
the head is deviated to the right, the less attention is paid to the left, and vice versa.

motor representations pertaining to the body schema, then peripersonal space, as well
as extrapersonal space, may be involved. Indeed the distinction between body schema
and peripersonal space may be questioned (Cardinali, Brozzoli, & Farne, 2009).

15.3.2  Attention disorder versus body representation disorder?

The first description of ‘personal neglect’ is attributed to Zingerle in 1913 who reported
a single case study of a contralesional deficit affecting perceptual, motor, and higher-​
level representational functions (Benke, Luzzatti, & Vallar, 2004).
Although it is commonly observed after a right brain lesion, the underlying patho-
physiological mechanisms of neglect and its very definition are not in agreement;
clinical manifestations labelled as body neglect may be interpreted in several ways.
Although they are beyond the scope of the present review, they are worth mentioning
 Tests, diagnosis, and evaluation  251
before we analyse these deficits further. The first issue is about the pathophysiology of
body neglect; just like spatial neglect, there is an ongoing debate about the representa-
tional versus attentional origin of the bodily manifestations of neglect. The second issue
lies at the heart of the present chapter and concerns body schema versus body image
levels of representations.
Personal neglect may be conceived of either as failing to either direct attention and to
explore contralesional space (extrapersonal neglect and/​or contralesional hemisoma)
(Semenza & Goodglass, 1985; Vallar, 1998) or as a specific body representation disorder
(Coslett, 1998; Palermo, Di Vita, Piccardi, Traballesi, & Guariglia, 2014; Rousseaux,
Honore, & Saj, 2014). Further, the type of relevant body representation disorder itself is
also a matter of discussion—​deficit of the body schema (e.g., Coslett, 1998) versus def-
icit of the body image (e.g., Gallagher, 2005). Branch Coslett (1998) argued that neglect
is associated with an altered body schema as patients fail to identify photographs of the
contralesional hand. His argument was that such a task requires mentally rotating an
online representation of the subject’s body in space, hence involving the body schema.
In contrast, Shaun Gallagher (2005) posited that the body schema is preserved in neg-
lect as motor activities, such as walking or bimanual tasks, may be unaltered. However,
as patients do not attend to the contralesional part of their body for activities such as
shaving and making up, he concluded that the perceptual body image is impaired.
These arguments can only be reconciled with a more complex view of body represen-
tation disorders in unilateral neglect whereby each manifestation may be ascribed to
either body schema or image alterations, or both. Accordingly, other authors attempted
to categorize neglect manifestations between these two main body representations
(e.g., Rossetti, Rode, & Farné, 2005). Our own attempt is presented in Figure 15.2.
The debate about attentional versus representational views was expanded by fur-
ther theoretical arguments. de Vignemont (2010) suggested that the body schema is
naturally based on integrated and combined sensory inputs of different weights, and
that a reorganization of these different weights does not constitute a deficit, but rather
a simple modification of the body schema, similar to blind or deafferented individ-
uals. Therefore, one may argue that attention disorders contribute to body represen-
tation processes. A lack of attention to one side of the body could lead to a new body
schema structure, and consequently to a modified body image through a modified
body awareness.

15.4  Tests, diagnosis, and evaluation

Beyond the scope of this review, there are innumerable tests used to assess spatial neg-
lect (for a review, see Rode et al., 2017). In clinical practice, neurological examination
highlights unilateral body neglect when patients fail to detect tactile stimuli on one
side in the absence of a primary somatosensory deficit (Bisiach & Vallar, 2000). One of
the frequently observed behavioural biases in neglect is the spontaneous postural devi-
ation of the trunk or the head, which may be caused by a shift in the perceived position
252  Unilateral body neglect: schemas versus images?
of the midline of the trunk (see Figure 15.3). Conrad, Habs, Brandt, and Dieterich
(2015) emphasized the observation of daily life tasks to detect body neglect during the
use of common objects (Zoccolotti et al., 1992), such as using eyeglasses, a razor or face
powder, and comb, on their body (see Figure 15.1B). For example, a patient may ignore
the presence of their cellphone in their left hand and explain they forgot it at home,
until a message activates a tactile vibration. The Bergego scale may be used to evaluate
the consequence of spatial and body neglect on daily life (Azouvi et al., 2006). Beyond
these clinical considerations, the relevant question here is about whether one may pro-
pose specific tests to assess body schema versus body image alterations in patients with
unilateral neglect. Given the high degree of confusion between attentional and rep-
resentational aspects of neglect, as well as between body schema and body image, a
simple answer cannot be found to this simple question.
Historically, the idea that spatial reference frames assessed by straight-​ahead dem-
onstrations may provide a pathophysiological basis to unilateral neglect (egocentric
reference theory) (Jeannerod & Biguer, 1987; Jeannerod & Rossetti, 1993) extended
the existing models of visual localization with respect to the body to offer a theoretical
framework to neglect. Therefore, this theory is implicitly related to the computations
pertaining to the visuo-​motor system, hence to the body schema. The straight-​ahead
demonstration task is considered to indicate this perceived body midline, which serves
as a reference to refer to for all other measures (retinal eccentricity and ocular/​head
deviation). Measures of the body midline may rely on arm movements when patients
are asked to point straight ahead in darkness (e.g., Rossetti et al., 1998) or on arm pro-
prioception alone when an individual’s hand is moved along the frontal plane and they
are asked to interrupt the movement when it crosses their midline axis (e.g., Hatada,
Miall, & Rossetti, 2006; Michel, Pisella, Prablanc, Rode, & Rossetti, 2007). Similarly, it
may also be measured visually when patients have to interrupt a tiny light moving in
front of them along the frontal plane in an otherwise dark room (Rode et al., 2017). In
unilateral neglect patients, both visual and proprioceptive straight-​ahead body midline
evaluations are biased toward the ipsilesional side (Rode et al., 2015). This measure
is congruent with the tonic deviation of the head of the patients (see Figure 15.3).
However, the question remains about whether straight-​ahead shifts are causal or con-
secutive to attentional and representational manifestations of neglect.
As body schema is intrinsically linked to action schemes, another simple idea to
assess body schema is via actions. For example, one can ask the patient to point to a
body part (Head & Holmes, 1911/​1912). When the body part is designated by a tactile
stimulus, one may argue that performance reflects body schema alterations. For ex-
ample, a patient may point to left body parts at a slower velocity with respect to right
body parts. As a matter of fact, the kinetics aspects of pointing (slow versus ballistic
pointing) or the target type (own physical versus drawn body part) may influence the
type of body representation studied (de Vignemont, 2010). Furthermore, de Vignemont
suggested the interest of testing action in neglect patients to assess the body schema.
Indeed, grasping and reaching should involve more directly the body schema than
pointing, as they are directly related to an action (i.e., smashing the mosquito biting our
 Tests, diagnosis, and evaluation  253
leg). However, it remains difficult to specifically ascribe hypokinesia (increased reac-
tion time) and bradykinesia (slower velocity) to body schema alterations (Mattingley
et al., 1994), as external targets are used; perceptual bias may alternatively explain these
directional effects. Another action domain that is less related to external stimuli is pos-
tural control. However, patients with right hemispheric lesions with or without neglect
may equally present with a postural bias (Rode, Tilikete, & Boisson, 1997; Nijboer, Ten
Brink, van der Stoep, & Visser-​Meily, 2014). Although wheelchair-​driving may be re-
lated to postural control (Barrett, Abdou, & Caulfield, 2019), performance in this task
is related to processing extrapersonal information (Jacquin-​Courtois, Rode, Pisella,
Boisson, & Rossetti, 2008).
More on the side of body image representations, the most standard evaluation in-
cludes the classical ‘drawing-​a-​man task’ (Chen-​Sea, 2000) (see Figure 15.4). Patients
who are asked to draw an imaginary character or their own body may omit large parts
of the left side of the drawing (which corresponds to the right side of the character’s
body). However, their performance is similarly affected when they copy a drawing,

(A) (B)
MODEL

(C)

Figure 15.4  Drawing a human figure. (A) The patient is instructed to copy the
drawing. (B) The patient is asked to draw a human character. (C) The patient, Architect,
spontaneously draws a portrait of the physician. Although patients with neglect usually
keep intact semantic knowledge about human anatomy and know that humans usually
have two arms, eyes, and ears, obvious violations to these principles are commonly found
in their drawings, together with physical violation such as omitting [both local (ear, eye)
and global (half of the body, arm, left boundaries)], misplacing items (e.g., eyeball with
respect to eyelid in panel (C)), or moving them from the affected side to the healthy
side (e.g., one button in panel (A) and the left spur in panel (B)) and leaving the body
boundaries open (A, B, and C).
254  Unilateral body neglect: schemas versus images?
whether the model is a human or not (see Figure 15.4), and the drawing movement it-
self relies on the body schema.
Another classical test is referred to as the Fluff test or post-​it test (Cocchini, Beschin,
Fotopoulou, & Della Sala, 2010). It consists of our own body exploration, usually with
the eyes closed. The test requires subjects to remove targets (e.g., small post-​it notes)
attached to their clothes. Patients with neglect may typically omit targets on their left
side, which is usually viewed as a body neglect symptom. However, this test may not be
informative to distinguish between body schema or body image, since both conscious
body image representations and sensorimotor commands linked to the body schema
are associated during the search.
Coslett (1998) proposed a task of left-​and right-​hand image identification—​the
hand laterality identification task; neglect patients exhibit a deficit for left-​hand im-
ages, but not for right-​hand images. Because this test relies on mental rotation of one’s
own body parts, Coslett concluded that body neglect corresponds to a ‘disruption or
failure to attend to body schema’. Similarly, Baas (2011) used mental rotation tasks of
hands and objects to differentiate between patients with and those without personal
neglect. However, he observed that patients with personal neglect made more errors
with left stimuli whenever the stimuli were hands or objects. Following the same
idea, Ramachandran and Rogers-​Ramachandran (1996) showed that patients with
anosognosia for hemiplegia did not identify the presence of hemiplegia on the same
body side when actors were examined for motricity in front of them. This observation
questions the ability for neglect patients to refer to their own body schema to estimate
others’ actions.
Di Vita (2015) proposed the frontal body-​evocation subtest (FBE) as a means of
testing the body schema. This test was first designed by Daurat-​Hmeljiak, Stambak,
and Berges in 1978 to evaluate the spatial relationship among body parts, i.e., visuo-​
spatial body map, coupled with frontal face evocation (FFE) and lateral face evoca-
tion (LFE). Patients with personal neglect misplaced both left and right parts of the
body. This suggests a general alteration of the body representation, not just the left
side, similar to what is observed for spatial neglect. These results are compatible with
previous studies from Guariglia and Antonucci (1992) and Palermo et al. (2014)—​no
asymmetry was found in the FBE task in patients with personal neglect, but errors
were found in localizing body parts on both sides. Thus, Di Vita concluded that per-
sonal neglect was a deficit of body representation, rather than a deficit of other spa-
tial representations. A deficit of body representation would be independent from
non-​body representation. Nevertheless, one can frequently observe personal and
extrapersonal neglect in the same patient. The FBE task can be completed by the car
test to explore spatial neglect (Guariglia, Piccardi, Puglisi Allegra, & Traballesi, 2002).
It consists of replacing the parts of a picture of a car properly. Using both FBE and
car tests allows to determine whether patients present with a selective deficit in body
representation or a general representation deficit which would affect both body-​and
non-​body representations.
 Dynamics of body representations in neglect  255

body neglect

pointing to touched pointing to named or

body parts visualized
body parts

fluff test hand

frontal lateralization
body-evocation subtest

proprioceptive visual
body midline judgement body midline judgement

BODY SCHEMA
drawing a man
postural daily life BODY IMAGE
imbalance tasks

wheelchair driving
mental rotation
of objects
MOTOR

PERCEPTION
cancellation car test
HIGH-LEVEL SPATIAL
REPRESENTATION
NEGLECT

Figure 15.5  Evaluation of body versus spatial neglect by perception/​motor/​representation

tests. The localization of the tests on this two-​dimensional map depends on the way
they refer to the body neglect concept versus spatial neglect, as well as on the way they
evaluate body schema versus body image—​in the upper part of the figure, tests evaluate
predominantly body neglect, whereas in the lower part, they tend to evaluate spatial
neglect; on the left side, tests evaluate body schema, whereas on the right side, they evaluate
body image. Blue refers to motoric tests, pink to perceptual tests, and green to high-​level
representational tests.

Altogether, it is very difficult to designate specific tests as a pure representative of ei-

ther body image or body schema. In practice, a body neglect diagnosis may be simply
broadly evocative of lateralized disturbances of body representations, or it may be
based on a cluster of typical clinical signs, as well as on selected tests. For research pur-
poses, and following the above considerations about various tests, we aim at proposing
a rough classification of tests used to assess body representations in unilateral neglect
(see Figure 15.5).

15.4  Dynamics of body representations in neglect

As we have seen from several of the above sections, one of the most intriguing
aspects of neglect is the imbrication of perceptual and representational aspects,
of attentional and sensorimotor determinants, and of personal and extrapersonal
256  Unilateral body neglect: schemas versus images?
dimensions. Given this complexity and its heterogeneity, it has been growingly con-
sidered as a multifaceted disorder (e.g., Vallar, 1998), so much so that the very no-
tion of a single neglect node has remained an ongoing issue. Paradoxically though,
therapeutic interventions used in neglect have produced surprisingly generalized
effects. Specifically, physiological interventions such as vestibular stimulation (for
a review, see, for example, Rossetti & Rode, 2002) and sensorimotor adaptation to
a visual shift (e.g., Rossetti et al., 1998) have been shown to improve an unexpected
variety of neglect manifestations (Rode et al., 2017). These general effects call for a
unitary therapy–​physiological mechanism and therefore stimulate a reassessment
of unity versus heterogeneity of unilateral neglect. In the following, we will address
this question in the specific case of body neglect and focus on our central question
related to the relationship between body schema and body image alterations (see
Figure 15.6).

COGNITIVE LEVEL
EX: DISTORSION, HIGHER LEVEL
DISORDERS
aschematia
phantom limb conscious perceptual BODY IMAGE
xenomelia awareness

Structural Semantic

TOP DOWN BOTTOM UP

strategies strategies

BODY SCHEMA

preconscious
implicit

SENSORY MOTOR
EX: DEFICIT INFORMATION INFORMATION THERAPEUTICS
hemiparesia prism adaptation
hemiplegia LOWER LEVEL vestibular
hypoesthesia stimulation
vibratory
stimulation

Figure 15.6  Rehabilitation strategies and relationship between body image and body
schema in neglect. The rehabilitation methods used for neglect shed light on the two-​
way relationships between body image and body schema. Therapeutics for body neglect
treatment can rely on bottom-​up strategies, using sensory information to modify the
body schema, and subsequently the body image, or on top-​down strategies which rely on
conscious perceptual awareness of the neglect and on intentional actions, and may improve
sensorimotor interactions.
Inspired by: Rossetti et al. (2005) and Luauté (2015).
 Dynamics of body representations in neglect  257
15.4.1  Top-​down approaches

The first interventions designed for unilateral neglect were designed to follow a top-​
down strategy whereby intentional cognitive processes were trained to take control over
more automatic or sensorimotor processes. More recent bottom-​up rehabilitation strat-
egies, initially based on sensory stimulations, were designed to act at the physiological
and sensorimotor level (see Jeannerod & Rossetti, 1993). While top-​down approaches
rely on an awareness of the deficit and the highest cognitive levels like visual scanning,
cueing, and sustained attention, bottom-​up approaches allow to modify sensorimotor
processes by mere sensory manipulations (Rossetti & Rode, 2002; Rode et al., 2002).
Different ways of sensory manipulations can be used, e.g., vestibular, optokinetic,
transcutaneous electrical, transcutaneous mechanical vibratory, auditory stimulations.
Bottom-​up approaches are usually assumed to impact indirectly body image manifest-
ations via direct effects on body schema (e.g., Rossetti, Rode, & Farné, 2005). Hence,
using techniques in neglect patients shows effects not only on body schema, but also on
body image. Therefore, the question remains open about which level is causally affected
by the other. Let us first review the effects of the main techniques used to alleviate uni-
lateral neglect on its bodily manifestations.
Neglect was first described in patients with deficit in visual exploration of the left
side of the space. Consequently, the first rehabilitation techniques consisted of helping
patients to direct the gaze to the left. Lawson (1962) proposed to use visual clues placed
on the left side of the patient. Many other programmes based on visual spatial training
were inspired by Lawson’s technique (e.g., Weinberg, Piasetsky, Diller, & Gordon,
1982; Wiart et al., 1997; Diller & Weinberg, 1977). These rehabilitation techniques
are more useful to patients with space neglect than those with body neglect. It illus-
trates the way in which cognitive processes can lead to modification of body-​and space
representation—​the patient is aware of his difficulties to explore left personal and/​or
peripersonal space, and then uses adjustment processes like looking for the visual clue.
However, by voluntarily orienting to the left, patients may also pay better attention to
the left side of their own body. Related to this strategy, another technique based on
visuo-​motor imagery training has been proposed by Smania, Bazoli, Piva, and Guidetti
(1997) which allows improvement in functional tasks such as slaloming, room explor-
ation, reading, serving coffee, playing cards, and utilization of self-​care objects like a
toothbrush or a comb. Some of these tests, such as utilization of self-​care objects or
serving coffee, may involve some aspects of body neglect, but the authors found no
change in personal neglect.

15.4.2  Bottom-​up approaches

Sensory stimulations aim to modulate the spatial reference frame using different sen-
sory afferents. For example, the use of vestibular stimulation was initially proposed to
act on the egocentric reference (Jeannerod & Biguer, 1987). Beneficial effects have been
258  Unilateral body neglect: schemas versus images?
observed on spatial and body neglect with galvanic or caloric vestibular stimulations
or electric stimulation of the muscles of the neck. Although these beneficial effects are
short-​lasting, these techniques produce clear effects on a variety of neglect symptoms.
The transient effect produced by these stimulations on body schema subsequently af-
fects the conscious body image. Bisiach, Rusconi, and Vallar (1991) reported a transient
remission of somatoparaphrenic delusion in a patient suffering from a right fronto-​
temporo-​parietal infarction after unilateral vestibular stimulation. Before vestibular
stimulation, the patient attributed her left arm to her mother. After stimulation, the
patient recognized the same limb as her own arm for 2 hours, suggesting that the stimu-
lation had an effect on her body image. A similar observation was reported by Rode
et al. (1992).
Prism adaptation artificially manipulates sensorimotor coordination by shifting visual
inputs laterally. The patient is exposed actively to a prismatic displacement by wearing
prism goggles and post-​exposure measures are compared to pre-​exposure measures to
determine compensatory after-​effects. Prism-​induced adaptation results in a deviation
in direction opposite to the optical shift, often revealed by a deviation of straight-​ahead
pointing (e.g., Rossetti et al., 1998). Although prism adaptation is an intervention that
was classically considered to stimulate low-​level sensorimotor adaptive processes per-
taining to the level of body schema, the last 20 years of research have also explored the
more cognitive functions of neglect (e.g., Rossetti et al., 2004; for a review, see Jacquin-​
Courtois et al., 2013). In terms of bodily effects, tactile processing and tactile extinc-
tion (e.g., Maravita et al., 2003), postural balance (Tilikete, Rode, Rossetti, Pichon, Li,
& Boisson, 2001; Nijboer et al., 2014), wheelchair-​driving (Jacquin-​Courtois, 2008;
Watanabe, 2010), and haptic comparison of objects (McIntosh, Pritchard, Dijkerman,
Milner, & Roberts, 2001; Girardi, McIntosh, Michel, Vallar, & Rossetti, 2004) can be im-
proved by prism adaptation. Other symptoms of neglect such as in-​reading (omissions
of the left side of lines, omission or alteration of the left side of words) (Farnè et al., 2003;
Rode, Michel, Rossetti, Boisson, & Vallar, 2006) and cancellation (omissions and explora-
tory pattern starting from the left) (Rossetti et al., 1998) or size comparison (skewed ex-
ploratory patterns) (Dijkerman et al., 2003) tasks may result from an interaction between
perceptual and body schema (head deviation) and are only worth mentioning here.
Unlike top-​down methods, this procedure relies on sensorimotor adaptation and
an intriguing lack of awareness of the optical shift in neglect patients, as evaluated by
a questionnaire elaborated in collaboration with Shaun Gallagher (Rode et al., 2017;
Rossetti et al., 2015). Therefore, top-​down mechanisms can be excluded from this pro-
cedure, which incidentally may increase its efficacy (Michel et al., 2007). Among the
bodily manifestations of neglect that have been shown to improve following adapta-
tion, postural balance (Tilikete et al., 2001) may be the lowest cognitive level. However,
there is no simple explanation for how shifting visuo-​motor coordination for one arm
should result in this postural effect; usually prism adaptation does not transfer between
arms (Hamilton, 1964; Prablanc, Tzavaras, & Jeannerod, 1975) and there is very limited
transfer from distal finger movements to more proximal shoulder movements (Hay &
Brouchon, 1972).
 Dynamics of body representations in neglect  259
It is very difficult to exclude circular reasoning about the causes and effects of prism
adaptation on unilateral neglect. Prism adaptation can show different bottom-​up ef-
fects in non-​motor and non-​visual tasks, somatosensory extinction, deficits in mental
imagery of geographic map, number bisection, and visuo-​constructive disorders
(Jacquin-​Courtois et al., 2013; Rossetti et al., 2015). Therefore, beyond the mere direct
effects of prism adaptation on sensorimotor coordination and straight-​ahead reference
shifts, which are classically observed in healthy individuals, each beneficial effect of
prism adaptation may be directly generated by these effects (bottom-​up) or via cog-
nitive effects (top-​down). For example, improvement in body posture (Tilikete et al.,
2001; Nijboer et al., 2014) or wheelchair-​driving may result, at least partly, from im-
provement in orienting attention and processing sensory information. As a matter of
fact, postural control in healthy individuals is altered only following prism adaptation
to the left (Michel, Rossetti, Rode, & Tilikete, 2003), which implies that it is not a mere
sensorimotor consequence of adaptation. Additionally, sensorimotor after-​effects and
cognitive expansion effects can be dissociated both when prism adaptation is used
alone (Pisella, Kritikos, & Rossetti, 2001) or in combination with transcranial direct
current stimulation (tDCS) in order to specifically enhance the adaptive processes in-
duced by prism adaptation to maximize the duration of all effects (O’Shea et al., 2017).
Beneficial effects of mirror therapy in neglect patients were first described by
Ramachandran et al. (1999). Using a vertical mirror in a sagittal position first sends
visual information from the neglected side to the non-​neglected side. It also modu-
lates visuo-​proprioceptive integration and modifies altered body representations. The
most frequent intervention targets are upper limb motor functions. Most of the studies
showed an improvement in motor recovery (Gandhi et al., 2020). Studies of the sensory
effects of mirror therapy seem less numerous, but Arya, Pandian, Vikas, & Puri (2018)
applied sensory stimuli on the less affected hand, using a mirror box, with an increased
positive touch response. It is rather difficult to determine whether mirror therapy acts
more on the side of body schema than on the side of body image.
Another category of physiological interventions targets brain tissues, rather than a
specific function. It does not seem appropriate to classify brain modulations according
to top-​down or bottom-​up approaches, since mechanisms rely on direct activation or
inhibition of the neural network. If spatial and body neglect is due to interhemispheric
imbalance, using repetitive Transcranial Magnetic Stimulation (rTMS) or tDCS to
stimulate the cortex on the right side or inhibit the cortex on the left side could allow
to decrease neglect and increase attention directed on the left side (for a review, see
Jacquin-​Courtois, 2015).
Taken altogether, the immediate and short-​term impact of top-​down techniques
seems to affect both body schema and body image through attentional modulations or
via potential activation of the body schema during motor imagery. Conversely, bottom-​
up interventions clearly target body schema modification, especially in the form of
straight-​ahead compensatory shift. The fact that they also impact on spatial cognition
and body image is especially interesting, as they reveal powerful effects of body schema
alterations on other levels of spatial cognition, including body image. Even if there does
260  Unilateral body neglect: schemas versus images?
not seem to be specific interventions designed to affect directly the body image in neg-
lect patients, available evidence points to the crucial role of the body schema in the
structuration of body representations, including the body image.

15.5 Conclusion

We have reviewed here several aspects of body neglect in order to evaluate their rele-
vance to the distinction between body schema and body image. To simplify the overall
picture, one may argue that, on the one hand, clear definitions can be articulated for
these two concepts, but that, on the other hand, the clinical reality is far more complex
both in terms of the existence of a continuum between these two extremities of bodily
manifestations of unilateral neglect and in terms of the dialectic relationship between
the two categories.
First, we saw that it is very difficult to classify each symptomatic manifestation of
unilateral body neglect in either the body image or the body schema category. Then
we observed that the long-​standing debate between attentional and representa-
tional hypotheses of spatial neglect can be expanded to body neglect. In fact, bodily
manifestations of neglect may be conceived of as primary pathophysiological de-
terminants of the condition (e.g., egocentric reference frame deviation) or as
consequences of attentional and/​or representational biases (virtually any manifest-
ation). Therefore, this lack of clarity also impacts on the classification of body neg-
lect manifestations into two distinct categories. The potential specificity and the
mechanisms of body neglect and more generally spatial neglect remain far from
consensual. This complexity is clearly underlined by the lack of specific tests that
would be designed to distinguish between body image and body schema disturb-
ances. In the same way as only gross tendencies can be outlined to locate symptoms
of bodily neglect closer to either body schema or body image, the currently avail-
able variety of tests used to assess body neglect does not enable clinicians and re-
searchers to strictly distinguish between the two categories. Further, when it comes
to rehabilitative aspects, the complexity of the picture is worsened by the dialectic
dynamic relationships identified between body schema-​like and body image-​like
symptoms of unilateral neglect.
The evaluation, nosography, and therapeutics illustrate the dynamics of the inter-
actions between body schema and body image in body neglect. The reciprocal inter-
action between body schema and body image raises the question of the consequences
of a mismatch between body image and body schema. Does a conflict between body
representations lead to adaptation in the same way as in the presence of sensory dis-
crepancy? And which of the two items is more likely to be modified to realign with
the other one? And is an external module required to control the interactions between
the two body representations using a co-​construction model which reduces the in-
consistency between the two body representations (Pitron, Alsmith, & de Vignemont,
2018)? A related challenge is to identify the hierarchical relationships between body
 Conclusion  261
schema and body images. This touches on the question of the dynamics and plasticity
of body representations and the subsequent question of the mechanism of action of
therapeutics used in patients with body neglect or other body representation disorders.
Given the current emphasis on bottom-​up rehabilitation methods, the current idea
is that the interactions may be asymmetric, with an apparent predominance of body
schema over body representation (e.g., Rossetti et al., 2005). However, insufficient data
are available on the bodily consequences of top-​down rehabilitation approaches for the
debate to be closed. Further studies are also needed to determine the extent of the dis-
crepancy between body representations which triggers modifications and whether and
how this discrepancy gives rise to relevant error signals. This question also applies in
the temporal domain: do body representations tolerate short-​term discrepancies, and
how much and for how long do we tolerate a conflict between body representations
without giving rise to maladaptive pathological consequences?
Some of the aforementioned considerations about body neglect are also relevant to
the field of clinical management of lateralized body representation disorders, as can
be observed in complex regional pain syndrome (CRPS), schizophrenia, xenomelia,
etc. Interventions such as mirror therapy and prism adaptation are currently being
evaluated in the rehabilitation of patients with CRPS (e.g., Christophe et al., 2016).
Refinement of the diagnostic tools and concepts used to disentangle between various
manifestations and determinants of these pathological conditions should contribute
to improving their rehabilitation. Some of the current and future rehabilitation tech-
niques used in body neglect may be transposable to neurological and peripheral body
representation disorders and ultimately offer innovative treatment for other patients
with disorders in body schema and image.
In the same way as the dialectic pathophysiology of unilateral neglect splits into its
embodied and spatial determinants, body neglect can also split into body schema and
body image determinants. Bottom-​up interventions suggest that body schema im-
provement produces beneficial effects on body image and verbal instruction recipro-
cally shows attention can be intentionally driven to neglected body parts. Therefore, it
seems that a better understanding of the relationship between body schema and body
image in neglect will require that we overcome the idea of a hierarchical relationship
between these conceptual entities. Equally important is the idea that the body schema
and body image concepts should be constructively considered as materializing an
open space between two lighthouses, instead of as the only two and mutually exclusive
categories in which bodily manifestations of neglect must be confined.

Acknowledgements

This work was supported by the Labex/​Idex CORTEX ANR-​11-​LABX-​0042, the

CNRS, the INSERM, the Hospices Civils de Lyon, and the IRBA. The authors declared
that they had no conflicts of interest with respect to their authorship or the publication
of this chapter.
262  Unilateral body neglect: schemas versus images?
References
Arya, K. N., Pandian, S., Vikas, & Puri, V. (2018). Mirror illusion for sensori-​motor training in
stroke: a randomized controlled trial. Journal of Stroke and Cerebrovascular Diseases, 27(11), 3236–​
3246. doi:10.1016/​j.jstrokecerebrovasdis.2018.07.012
Auclair, L., Noulhiane, M., Raibaut, P., & Amarenco, G. (2009). Where are your body parts? A pure
case of heterotopagnosia following left parietal stroke. Neurocase, 15(6), 459–​465. doi:10.1080/​
13554790902911642
Azouvi, P., Bartolomeo, P., Beis, J. M., Perennou, D., Pradat-​Diehl, P., & Rousseaux, M. (2006). A
battery of tests for the quantitative assessment of unilateral neglect. Restorative Neurology and
Neuroscience, 24(4–​6), 273–​285.
Baas, U., de Haan, B., Grassli, T., Karnath, H. O., Mueri, R., Perrig, W. J., Wutz, P., & Gutbrod, K.
(2011). Personal neglect-​a disorder of body representation? Neuropsychologia, 49(5), 898–​905.
doi:10.1016/​j.neuropsychologia.2011.01.043
Bakheit, A. M. (2000). Illusory movements of the paralysed upper limb in stroke. Journal of Neurology,
Neurosurgery, and Psychiatry, 69(6), 837. doi:10.1136/​jnnp.69.6.837
Barrett, A. M., Abdou, A., & Caulfield, M. D. (2019). The cingulate cortex and spatial neglect.
Handbook of Clinical Neurology, 166, 129–​150. doi:10.1016/​B978-​0-​444-​64196-​0.00009-​1
Benke, T., Luzzatti, C., & Vallar, G. (2004). Hermann Zingerle’s ‘Impaired perception of the own body
due to organic brain disorders’. 1913. An introductory comment, and an abridged translation.
Cortex, 40(2), 265–​274. doi:10.1016/​s0010-​9452(08)70121-​7
Beschin, N. & Robertson, I. H. (1997). Personal versus extrapersonal neglect: a group study of their dis-
sociation using a reliable clinical test. Cortex, 33(2), 379–​384. doi:10.1016/​s0010-​9452(08)70013-​3
Bisiach, E., Geminiani, G., Berti, A., & Rusconi, M. L. (1990). Perceptual and premotor factors of uni-
lateral neglect. Neurology, 40(8), 1278–​1281. doi:10.1212/​wnl.40.8.1278
Bisiach, E., Perani, D., Vallar, G., & Berti, A. (1986). Unilateral neglect: personal and extra-​personal.
Neuropsychologia, 24(6), 759–​767. doi:10.1016/​0028-​3932(86)90075-​8
Bisiach, E., Rusconi, M. L., & Vallar, G. (1991). Remission of somatoparaphrenic delusion through
vestibular stimulation. Neuropsychologia, 29(10), 1029–​1031. doi:10.1016/​0028-​3932(91)90066-​h
Bisiach, E. & Vallar, G. (2000). Unilateral neglect in humans. In F. Boller, J. Grafman, & G. Rizzolatti
(eds.), Handbook of Neuropsychology. Handbook of Neuropsychology: Sect 1: Introduction, Sect
2: Attention (pp. 459–​502). Amsterdam: Elsevier Science Publishers B.V.
Brugger, P. (2003). Supernumerary phantoms: a comment on Grossi, et al.’s (2002) spare thoughts on
spare limbs. Perceptual and Motor Skills, 97(1), 3–​10. doi:10.2466/​pms.2003.97.1.3
Butter, C. M., Rapcsak, S., Watson, R. T., & Heilman, K. M. (1988). Changes in sensory inattention,
directional motor neglect and ‘release’ of the fixation reflex following a unilateral frontal lesion: a
case report. Neuropsychologia, 26(4), 533–​545. doi:10.1016/​0028-​3932(88)90110-​8
Cardinali, L., Brozzoli, C., & Farne, A. (2009). Peripersonal space and body schema: two labels for the
same concept? Brain Topography, 21(3–​4), 252–​260. doi:10.1007/​s10548-​009-​0092-​7
Chen-​Sea, M. J. (2000). Validating the Draw-​A-​Man Test as a personal neglect test. American Journal
of Occupational Therapy, 54(4), 391–​397. doi:10.5014/​ajot.54.4.391
Christophe, L., Chabanat, E., Delporte, L., Revol, P., Volckmann, P., Jacquin-​Courtois, S., & Rossetti,
Y. (2016). Prisms to shift pain away: pathophysiological and therapeutic exploration of CRPS with
prism adaptation. Neural Plasticity, 2016, 1694256. doi:10.1155/​2016/​1694256
Cleret de Langavant, L., Trinkler, I., Cesaro, P., & Bachoud-​Levi, A. C. (2009). Heterotopagnosia: when I point
at parts of your body. Neuropsychologia, 47(7), 1745–​1755. doi:10.1016/​j.neuropsychologia.2009.02.016
Cocchini, G., Beschin, N., Fotopoulou, A., & Della Sala, S. (2010). Explicit and implicit anosognosia
or upper limb motor impairment. Neuropsychologia, 48(5), 1489–​ 1494. doi:10.1016/​
j.neuropsychologia.2010.01.019
Conrad, J., Habs, M., Brandt, T., & Dieterich, M. (2015). Acute unilateral vestibular failure does not
cause spatial hemineglect. PLoS ONE, 10(8), e0135147. doi:10.1371/​journal.pone.0135147
Coslett, H. B. (1998). Evidence for a disturbance of the body schema in neglect. Brain and Cognition,
37(3), 527–​544. doi:10.1006/​brcg.1998.1011
 Conclusion  263
Critchley, M. (1953). Tactile thought, with special reference to the blind. Brain, 76(1), 19–​35.
doi:10.1093/​brain/​76.1.19
Critchley, M. (1974). Misoplegia, or hatred of hemiplegia. Mount Sinai Journal of Medicine,
41(1), 82–​87.
Cubelli, R. (2017). Definition: spatial neglect. Cortex, 92, 320–​321. doi:10.1016/​j.cortex.2017.03.021
Daurat-​Hmeljiak, C., Stambak, M., & Berges, J. (1978). Il Test dello Schema Corporeo. Una Prova di
Conoscenza e Costruzione dell’Immagine del Corpo [The Body Schema Test. A Test of Knowledge and
Construction of Body Image]. Firenze: Organizzazioni Speciali.
de Vignemont, F. (2010). Body schema and body image—​pros and cons. Neuropsychologia, 48(3),
669–​680. doi:10.1016/​j.neuropsychologia.2009.09.022
Diller, L. & Weinberg, J. (1977). Hemi-​inattention in rehabilitation: the evolution of a rational remedi-
ation program. Advances in Neurology, 18, 63–​82.
Di Marco, J., Lunven, M., Revol, P., Christophe, L., Jacquin-​Courtois, S., Vallar, G., & Rode, G. (2019).
Regression of left hyperschematia after prism adaptation: a single case study. Cortex, 119, 128–​140.
doi:10.1016/​j.cortex.2019.04.002
Di Vita, A., Palermo, L., Piccardi, L., & Guariglia, C. (2015). Peculiar body representation alterations
in hemineglect: a case report. Neurocase, 21(6), 697–​706. doi:10.1080/​13554794.2014.974620
Dijkerman, H. C., McIntosh, R. D., Milner, A. D., Rossetti, Y., Tilikete, C., & Roberts, R. C. (2003).
Ocular scanning and perceptual size distortion in hemispatial neglect: effects of prism adaptation
and sequential stimulus presentation. Exp Brain Res, 153(2), 220–​230. doi:10.1007/​s00221-​003-​
1595-​1. Epub 2003 Sep 4. PMID: 12955382.
Farné, A., Roy, A. C., Paulignan, Y., Rode, G., Rossetti, Y., Boisson, D., & Jeannerod, M. (2003).
Visuo-​ motor control of the ipsilateral hand: evidence from right brain-​ damaged patients.
Neuropsychologia, 41(6), 739–​757. doi:10.1016/​s0028-​3932(02)00177-​x
Feinberg, T. E., Roane, D. M., & Ali, J. (2000). Illusory limb movements in anosognosia for hemiplegia.
Journal of Neurology, Neurosurgery, and Psychiatry, 68(4), 511–​513. doi:10.1136/​jnnp.68.4.511
Frederiks, J. A. (1963). Macrosomatognosia and microsomatognosia. Psychiatria, Neurologia,
Neurochirurgia, 66, 531–​536.
Gallagher, S. (1986). Body image and body schema: a conceptual clarification. Journal of Mind and
Behavior, 7(4), 541–​554.
Gallagher, S. (2005). How the Body Shapes the Mind. New York, NY: Oxford University Press.
Gandhi, D. B., Sterba, A., Khatter, H., & Pandian, J. D. (2020). Mirror therapy in stroke rehabilita-
tion: current perspectives. Therapeutics and Clinical Risk Management, 16, 75–​85. doi:10.2147/​
TCRM.S206883
Gerstmann, J. (1942). Problem of imperception of disease and of impaired body territories with or-
ganic lesions. Relation to body scheme and its disorders. Archives of Neurology and Psychiatry, 48,
890–​913.
Girardi, M., McIntosh, R. D., Michel, C., Vallar, G., & Rossetti, Y. (2004). Sensorimotor effects on cen-
tral space representation: prism adaptation influences haptic and visual representations in normal
subjects. Neuropsychologia, 42(11), 1477–​1487. doi:10.1016/​j.neuropsychologia.2004.03.008
Guariglia, C. & Antonucci, G. (1992). Personal and extrapersonal space: a case of neglect dissociation.
Neuropsychologia, 30(11), 1001–​1009. doi:10.1016/​0028-​3932(92)90051-​m
Guariglia, C., Piccardi, L., Puglisi Allegra, M. C., & Traballesi, M. (2002). Is autotopoagnosia real? EC
says yes. A case study. Neuropsychologia, 40(10), 1744–​1749. doi:10.1016/​s0028-​3932(02)00013-​1
Hamilton, C. R. (1964). Intermanual transfer of adaptation to prisms. American Journal of Psychology,
77, 457–​462.
Hatada, Y., Miall, R. C., & Rossetti, Y. (2006). Long lasting aftereffect of a single prism adaptation: dir-
ectionally biased shift in proprioception and late onset shift of internal egocentric reference frame.
Experimental Brain Research, 174(1), 189–​198. doi:10.1007/​s00221-​006-​0437-​3
Hay, L. & Brouchon, M. (1972). Analyse de la réorganisation des coordinations visuo-​motrices
chez l’homme [Analysis of the reorganization of visual-​motor coordination in man]. L’Année
Psychologique (Paris), 72, 25–​38.
Head, H. & Holmes, H. G. (1911/​1912). Sensory disturbances from cerebral lesions. Brain, 34, 102–​254.
264  Unilateral body neglect: schemas versus images?
Heilman, K. M., Bowers, D., & Watson, R. T. (1983). Performance on hemispatial pointing task by pa-
tients with neglect syndrome. Neurology, 33(5), 661–​664. doi:10.1212/​wnl.33.5.661
Jacquin-​Courtois, S. (2015). Hemi-​spatial neglect rehabilitation using non-​invasive brain stimu-
lation: or how to modulate the disconnection syndrome? Annals of Physical and Rehabilitation
Medicine, 58(4), 251–​258. doi:10.1016/​j.rehab.2015.07.388
Jacquin-​Courtois, S., O’Shea, J., Luaute, J., Pisella, L., Revol, P., Mizuno, K., Rode, G., & Rossetti, Y.
(2013). Rehabilitation of spatial neglect by prism adaptation: a peculiar expansion of sensori-
motor after-​effects to spatial cognition. Neuroscience and Biobehavioral Reviews, 37(4), 594–​609.
doi:10.1016/​j.neubiorev.2013.02.007
Jacquin-​Courtois, S., Rode, G., Pisella, L., Boisson, D., & Rossetti, Y. (2008). Wheel-​chair driving
improvement following visuo-​ manual prism adaptation. Cortex, 44(1), 90–​ 96. doi:10.1016/​
j.cortex.2006.06.003
Jeannerod, M. & Biguer, B. (1987). The directional coding of reaching movements: a visuomotor
conception of spatial neglect. In M. Jeannerod (ed.), Neurophysiological and Neuropsychological
Aspects of Spatial Neglect (pp. 87–​113). Amsterdam: Elsevier.
Jeannerod, M. & Rossetti, Y. (1993). Visuomotor coordination as a dissociable visual function: experi-
mental and clinical evidence. Bailliere’s Clinical Neurology, 2(2), 439–​460.
Laplane, D. & Degos, J. D. (1983). Motor neglect. Journal of Neurology, Neurosurgery, and Psychiatry,
46(2), 152–​158. doi:10.1136/​jnnp.46.2.152
Lawson, I. R. (1962). Visual-​spatial neglect in lesions of the right cerebral hemisphere. A study in re-
covery. Neurology, 12, 23–​33. doi:10.1212/​wnl.12.1.23
Longo, M. R. & Haggard, P. (2012). Implicit body representations and the conscious body image. Acta
Psychologica (Amsterdam), 141(2), 164–​168. doi:10.1016/​j.actpsy.2012.07.015
Luauté, J. (2015). Rééducation de l’héminégligence: principes et méthodes. In D. Pérennou, G.
Rode, P. Azouvi, & V. Brun (eds.), La Cognition Spatiale (pp. 195–​207). Montpellier: Sauramps
Medical.
Marangolo, P., Piccardi, L., & Rinaldi, M. C. (2003). Dissociation between personal and extrapersonal
neglect in a crossed aphasia study. Neurocase, 9(5), 414–​420. doi:10.1076/​neur.9.5.414.16554
Maravita, A., McNeil, J., Malhotra, P., Greenwood, R., Husain, M., & Driver, J. (2003). Prism adap-
tation can improve contralesional tactile perception in neglect. Neurology, 60(11), 1829–​1831.
doi:10.1212/​wnl.60.11.1829
Mattingley, J. B., Bradshaw, J. L., & Phillips, J. G. (1992). Impairments of movement initiation and
execution in unilateral neglect. Directional hypokinesia and bradykinesia. Brain, 115(Pt 6), 1849–​
1874. doi:10.1093/​brain/​115.6.1849
Mattingley, J. B., Phillips, J. G., & Bradshaw, J. L. (1994). Impairments of movement execution in uni-
lateral neglect: a kinematic analysis of directional bradykinesia. Neuropsychologia, 32(9), 1111–​
1134. doi:10.1016/​0028-​3932(94)90157-​0
McIntosh, R. D., Pritchard, C. L., Dijkerman, H. C., Milner, A. D., & Roberts, R. C. (2001). Prehension
and perception of size in left visual neglect. Behavioural Neurology, 13(1–​2), 3–​15. doi:10.1155/​
2002/​252405
Meador, K. J., Watson, R. T., Bowers, D., & Heilman, K. M. (1986). Hypometria with hemispatial and
limb motor neglect. Brain, 109(Pt 2), 293–​305. doi:10.1093/​brain/​109.2.293
Melzack, R. (1990). Phantom limbs and the concept of a neuromatrix. Trends in Neurosciences, 13(3),
88–​92. doi:10.1016/​0166-​2236(90)90179-​e
Michel, C., Pisella, L., Prablanc, C., Rode, G., & Rossetti, Y. (2007). Enhancing visuomotor adaptation
by reducing error signals: single-​step (aware) versus multiple-​step (unaware) exposure to wedge
prisms. Journal of Cognitive Neuroscience, 19(2), 341–​350. doi:10.1162/​jocn.2007.19.2.341
Michel, C., Rossetti, Y., Rode, G., & Tilikete, C. (2003). After-​effects of visuo-​manual adaptation
to prisms on body posture in normal subjects. Experimental Brain Research, 148(2), 219–​226.
doi:10.1007/​s00221-​002-​1294-​3
Nijboer, T. C., Ten Brink, A. F., van der Stoep, N., & Visser-​Meily, J. M. (2014). Neglecting posture: dif-
ferences in balance impairments between peripersonal and extrapersonal neglect. NeuroReport,
25(17), 1381–​1385. doi:10.1097/​WNR.0000000000000277
 Conclusion  265
O’Shea, J., Revol, P., Cousijn, H., Near, J., Petitet, P., Jacquin-​Courtois, S., Johansen-​Berg, H., Rode, G.,
& Rossetti, Y. (2017). Induced sensorimotor cortex plasticity remediates chronic treatment-​resistant
visual neglect. Elife, 6, e26602. doi:10.7554/​eLife.26602. PMID: 28893377; PMCID: PMC5595432.
Paillard, J. (1980) Le corps situé et le corps identifié; une approche psychophysiologique de la notion
de schéma corporel. Revue Médicale Suisse Romande, 100, 129–​141.
Paillard, J., Michel, F., & Stelmach, G. (1983). Localization without content. A tactile analogue of
‘blind sight’. Archives of Neurology, 40(9), 548–​551. doi:10.1001/​archneur.1983.04050080048008
Palermo, L., Di Vita, A., Piccardi, L., Traballesi, M., & Guariglia, C. (2014). Bottom-​up and top-​down
processes in body representation: a study of brain-​damaged and amputee patients. Neuropsychology,
28(5), 772–​781. doi:10.1037/​neu0000086
Peru, A. & Pinna, G. (1997). Right personal neglect following a left hemisphere stroke. A case report.
Cortex, 33(3), 585–​590. doi:10.1016/​s0010-​9452(08)70240-​5
Pisella, L., Kritikos, A., & Rossetti, Y. (2001). Perception, action, and motor control: interaction does
not necessarily imply common structures. Behavioral and Brain Sciences, 24, 898–​899.
Pitron, V., Alsmith, A., & de Vignemont, F. (2018). How do the body schema and the body image
interact? Consciousness and Cognition, 65, 352–​358. doi:10.1016/​j.concog.2018.08.007
Prablanc, C., Tzavaras, A., & Jeannerod, M. (1975). Adaptation of the two arms to opposite prism dis-
placements. Quarterly Journal of Experimental Psychology, 27, 667–​671.
Ramachandran, V. S., Altschuler, E. L., Stone, L., Al-​Aboudi, M., Schwartz, E., & Siva, N. (1999).
Can mirrors alleviate visual hemineglect? Medical Hypotheses, 52(4), 303–​305. doi:10.1054/​
mehy.1997.0651
Ramachandran, V. S. & Rogers-​Ramachandran, D. (1996). Denial of disabilities in anosognosia.
Nature, 382(6591), 501. doi:10.1038/​382501a0
Rode, G., Charles, N., Perenin, M. T., Vighetto, A., Trillet, M., & Aimard, G. (1992). Partial remission
of hemiplegia and somatoparaphrenia through vestibular stimulation in a case of unilateral neg-
lect. Cortex, 28(2), 203–​208. doi.org/​10.1016/​s0010-​9452(13)80048-​2
Rode, G., Michel, C., Rossetti, Y., Boisson, D., & Vallar, G. (2006). Left size distortion (hyperschematia)
after right brain damage. Neurology, 67(10), 1801–​1808. doi:10.1212/​01.wnl.0000244432.91915.d0
Rode, G., Pagliari, C., Huchon, L., Rossetti, Y., & Pisella, L. (2017). Semiology of neglect: an update.
Annals of Physical and Rehabilitation Medicine, 60(3), 177–​185. doi:10.1016/​j.rehab.2016.03.003
Rode, G., Ronchi, R., Revol, P., Rossetti, Y., Jacquin-​Courtois, S., Rossi, I., & Vallar, G. (2014).
Hyperschematia after right brain damage: a meaningful entity? Frontiers in Human Neuroscience, 8,
8. doi:10.3389/​fnhum.2014.00008
Rode, G., Tilikete, C., & Boisson, D. (1997). Predominance of postural imbalance in left hemiparetic
patients. Scandinavian Journal of Rehabilitation Medicine, 29(1), 11–​16.
Rode, G., Tilikete, C., Luaute, J., Rossetti, Y., Vighetto, A., & Boisson, D. (2002). Bilateral ves-
tibular stimulation does not improve visual hemineglect. Neuropsychologia, 40(7), 1104–​1106.
doi:10.1016/​s0028-​3932(01)00187-​7
Rode, G., Vallar, G., Revol, P., Tilikete, C., Jacquin-​Courtois, S., Rossetti, Y., & Farnè, A. (2012). Facial
macrosomatognosia and pain in a case of Wallenberg’s syndrome: selective effects of vestibular and
transcutaneous stimulations. Neuropsychologia, 50(2), 245–​53.
Rossetti, Y., Jacquin-​Courtois, S., Calabria, M., Michel, C., Gallagher, S., Honore, J., Luaute, J., Farne,
A., Pisella, L., & Rode G. (2015). Testing cognition and rehabilitation in unilateral neglect with
wedge prism adaptation: multiple interplays between sensorimotor adaptation and spatial cogni-
tion. In K. Kansaku, L. Cohen, & N. Birbaumer (eds.), Clinical Systems Neuroscience (pp. 359–​381).
Tokyo: Springer.
Rossetti, Y., Jacquin-​Courtois, S., Rode, G., Ota, H., Michel, C., & Boisson, D. (2004). Does action
make the link between number and space representation? Visuo-​manual adaptation improves
number bisection in unilateral neglect. Psychological Science, 15(6), 426–​ 430. doi:10.1111/​
j.0956-​7976.2004.00696.x
Rossetti, Y. & Revonsuo, A. (eds.). (2000). Advances in Consciousness Research. Beyond
Dissociation: Interaction between Dissociated Implicit and Explicit Processing. Amsterdam: John
Benjamins Publishing Company. https://​doi.org/​10.1075/​aicr.22
266  Unilateral body neglect: schemas versus images?
Rossetti, Y. & Rode, G. (2002). Reducing spatial neglect by visual and other sensory manipula-
tions: non-​cognitive (physiological) routes to the rehabilitation of a cognitive disorder. In H. O.
Karnath, A. D. Milner, & G. Vallar (eds.), The Cognitive and Neural Bases of Spatial Neglect (pp.
375–​396). Oxford: Oxford University Press.
Rossetti, Y., Rode, G., & Boisson, D. (1995). Implicit processing of somaesthetic informa-
tion: a dissociation between where and how? NeuroReport, 6(3), 506–​ 510. doi:10.1097/​
00001756-​199502000-​00025
Rossetti, Y., Rode, G., & Farné, A. (2005). Implicit body representation in action: a neuropsycho-
logical approach. In H. De Preester & V. Knockaert (eds.), Body Image and Body Schema (pp. 111–​
115). Amsterdam: Benjamins.
Rossetti, Y., Rode, G., Pisella, L., Farne, A., Li, L., Boisson, D., & Perenin, M. T. (1998). Prism adapta-
tion to a rightward optical deviation rehabilitates left hemispatial neglect. Nature, 395(6698), 166–​
169. doi:10.1038/​25988
Rousseaux, M., Honore, J., & Saj, A. (2014). Body representations and brain damage. Neurophysiologie
Clinique, 44(1), 59–​67. doi:10.1016/​j.neucli.2013.10.130
Semenza, C. & Goodglass, H. (1985). Localization of body parts in brain injured subjects.
Neuropsychologia, 23(2), 161–​175. doi:10.1016/​0028-​3932(85)90101-​0
Smania, N., Bazoli, F., Piva, D., & Guidetti, G. (1997). Visuomotor imagery and rehabilita-
tion of neglect. Archives of Physical Medicine and Rehabilitation, 78(4), 430–​436. doi:10.1016/​
s0003-​9993(97)90237-​9
Staub, F., Bogousslavsky, J., Maeder, P., Maeder-​Ingvar, M., Fornari, E., Ghika, J., Vingerhoets, F.,
& Assal, G. (2006). Intentional motor phantom limb syndrome. Neurology, 67(12), 2140–​2146.
doi:10.1212/​01.wnl.0000249135.78905.75
Tilikete, C., Rode, G., Rossetti, Y., Pichon, J., Li, L., & Boisson, D. (2001). Prism adaptation to right-
ward optical deviation improves postural imbalance in left-​hemiparetic patients. Current Biology,
11(7), 524–​528. doi:10.1016/​s0960-​9822(01)00151-​8
Vallar, G. (1998). Spatial hemineglect in humans. Trends in Cognitive Sciences, 2(3), 87–​97.
doi:10.1016/​s1364-​6613(98)01145-​0
Vallar, G., Antonucci, G., Guariglia, C., & Pizzamiglio, L. (1993). Deficits of position sense, unilat-
eral neglect and optokinetic stimulation. Neuropsychologia, 31(11), 1191–​1200. doi:10.1016/​
0028-​3932(93)90067-​a
Vallar, G. & Ronchi, R. (2009). Somatoparaphrenia: a body delusion. A review of the neuropsycho-
logical literature. Experimental Brain Research, 192(3), 533–​551. doi:10.1007/​s00221-​008-​1562-​y
Watanabe, S. & Amimoto, K. (2010). Generalization of prism adaptation for wheelchair driving task
in patients with unilateral spatial neglect. Archives of Physical Medicine and Rehabilitation, 91(3),
443–​447. doi:10.1016/​j.apmr.2009.09.027
Weinberg, J., Piasetsky, E., Diller, L., & Gordon, W. (1982). Treating perceptual organization deficits in
non neglecting RBD stroke patients. Journal of Clinical Neuropsychology, 4(1), 59–​75. doi:10.1080/​
01688638208401117
Wiart, L., Come, A. B., Debelleix, X., Petit, H., Joseph, P. A., Mazaux, J. M., & Barat, M. (1997).
Unilateral neglect syndrome rehabilitation by trunk rotation and scanning training. Archives of
Physical Medicine and Rehabilitation, 78(4), 424–​429. doi:10.1016/​s0003-​9993(97)90236-​7
Zingerle, H. (1913). Über Störungen der Wahrnehmung des eigenenKörpers bei organischen
Gehirnerkrankungen. Monatsschrift für Psychiatrie und Neurologie, 34, 13–​36.
Zoccolotti, P., Guariglia, C., Pizzamiglio, L., Judica, A., Razzano, C., & Pantano, P. (1992). Good
recovery in visual scanning in a patient with persistent anosognosia. International Journal of
Neuroscience, 63(1–​2), 93–​104. doi:10.3109/​00207459208986659
 16
Neural underpinnings of body image
and body schema disturbances
Jasmine Ho and Bigna Lenggenhager

16.1 Introduction

A variety of neurological or psychiatric disorders are characterized by atypical own

body perception (see, for example, de Vignemont, 2011). While their symptom-
atology can comprise variable and distinct features (Brugger & Lenggenhager, 2014),
a common bipartite division distinguishes between disorders constituting a disruption
primarily of the body schema or of the body image (Gallagher, 2005; Paillard, 1999).
Disorders of the body schema have been suggested to affect the situated, operative per-
formance of bodily spatial organization that does not reach conscious awareness, while
aberrant perceptions of body image include the conscious perceptual experience, af-
fective attitudes, and a cognitive (conceptual) understanding of the body (Gallagher,
1986). Originally justified by a double dissociation in neurological patients, the need
for, as well as use and definition of the neural correlates of such distinctions have been
discussed in both conceptual and empirical research. The fact that it is difficult, if not
impossible, to clearly assign the manifold disorders of corporeal awareness to these
constructs has been considered a reason to give up such a dichotomy (Berlucchi &
Aglioti, 2010). While these concerns might be justified, we think it is interesting and
important to discuss the growing number of recent findings on neural correlates of dis-
orders of the bodily self in order to shed further light on potential neural mechanisms
underlying this distinction. Importantly, the dichotomous nature of such a distinction
does not exclude a reciprocal interaction (Gallagher, 2005), which we will elaborate
upon in the following paragraphs.

16.2  Body schema versus body image: malleability, disturbances,

and interaction

Corporeal awareness is thought to be based on an integration of more stable long-​

term representations, such as body configuration and metrics, which are classically
more linked to body image, and more malleable short-​term representations, such as
posture (Pitron, Alsmith, & de Vignemont, 2018), which are rather considered body

Jasmine Ho and Bigna Lenggenhager, Neural underpinnings of body image and body schema disturbances In: Body Schema and
Body Image. Edited by: Yochai Ataria, Shogo Tanaka, and Shaun Gallagher, Oxford University Press. © Oxford University Press 2021.
DOI: 10.1093/​oso/​9780198851721.003.0016
268  Neural underpinnings
schema substrates. Yet, how exactly short-​and long-​term properties differ for body
image and body schema is still debated (Gadsby, 2018; Gaudio & Quattrocchi, 2012;
Pitron, Alsmith, & de Vignemont, 2018). Pitron et al. (2018) specify that long-​term
body representations carry information about enduring properties of the body, but that
they can nevertheless be modulated by ongoing updating of multisensory information.
While some argue that such plasticity is specific to long-​term representations of body
schema (Gadsby, 2018), others claim that it also holds true for long-​term representa-
tions of body image (Gaudio & Riva, 2013; Pitron et al., 2018). On the other hand, tem-
porary modulation of short-​term corporeal awareness can be seen by experimentally
inducing bodily illusions through multisensory stimulation paradigms (e.g., Botvinick
& Cohen, 1998; Ehrsson, 2007; Lackner, 1988; Lenggenhager, Tadi, Metzinger, &
Blanke, 2007). Such manipulations might temporarily alter the body schema, as meas-
ured by the proprioceptive drift during the rubber hand illusion (Botvinick & Cohen,
1998), for example, but also the body image (at least the perceptual component) to
such a degree that even rather arbitrary bodies or objects can be perceived as the own
body (e.g., van der Hoort & Ehrsson, 2014; Lesur, Aicher, Delplanque, & Lenggenhager,
2020). Yet, whereas such body representations are quick to recalibrate following tran-
sient alterations, long-​term perceptual changes of corporeal awareness in clinical cases
are often enduring, such as in schizophrenia (Dakanalis et al., 2016; Graham-​Schmidt,
Martin-​Iverson, Holmes, & Waters, 2016), anorexia (Dakanalis et al., 2016), or body
integrity dysphoria (BID) (Blom, Hennekam, & Denys, 2012). Yet, despite permanent
alteration of the body image, these patients can still experience transient changes in the
perceptual body image during multisensory stimulation paradigms. For example, it has
been shown that patients with anorexia can transiently embody a larger-​sized avatar
(Provenzano et al., 2020) or that patients with BID can feel ownership over a rubber
lower limb on the affected side during a rubber foot illusion (Lenggenhager, Hilti, &
Brugger, 2015). While, for example, in the case of anorexia, some papers found that
such temporary changes in short-​term body representation also change longer-​term
representation (Keizer, van Elburg, Helms, & Dijkerman, 2016), other studies could not
evidence such changes (Provenzano et al., 2020). Recognition and a better knowledge
of the interrelation between short-​and long-​term representations of both body image
and body schema are thus crucial for better understanding disorders of the bodily self
and their underlying neural correlates, especially for the development of potential
therapeutic avenues.
Several scholars argue for a co-​construction model that maintains a general func-
tional distinction between body image and schema; however, these two constructs
can nevertheless, at least partially, interact to construct body representations and are,
as such, not mutually exclusive (Gadsby, 2018; Lesur et al., 2018; Pitron et al., 2018).
According to this model, the body schema possesses an ostensible primacy over the
body image, such that the body schema, with its strong basis in multisensory sig-
nals, emerged first for sensory processing and control of movements. In contrast, the
ontogenetic and evolutionary subsequent development of the body image led to an
emergence of more complex behaviours (Pitron et al., 2018). A greater corroboratory
 Disorders of body schema  269
influence of the body schema on body image than vice versa has been suggested (Pitron
et al., 2018), which might stem from its inherent higher reliability and smaller margin
of error. Misperceptions of the location of the limbs, for example, would generally have
more detrimental consequences for the organism than misperceptions of body image.
However, while body schema specifically encodes information about the corporeal
properties necessary for planning, controlling, and sensing movements, the contents of
the body image may carry rich information about more diverse bodily properties and
enable individuals to engage in both egocentric and allocentric frames of reference to
make judgements about the world. Therefore, the primacy of the body schema does not
exclude an influential role of the body image; rather, sensorimotor feedback received
while interacting with the world influences both body schema and body image. Under
certain circumstances, the sensory feedback shaping the body image can function as
a prior (i.e., a prediction) to influence the body schema (Pitron et al., 2018). While
the contribution of sensorimotor information is especially pertinent for the updating
of long-​term body representations during childhood and adolescence, adjustments of
body representations continue throughout life (Pitron et al., 2018), such as perceptual
and sensorimotor adjustments of body metrics following bodily illusions. While indi-
viduals may not experience conscious awareness of their body-​schematic performances
during day-​to-​day activities, calling attention to the body through visual awareness, for
example, can override body-​schematic functions (Gallagher, 2001; Gurfinkel & Levick,
1991). Similarly, percepts underlying the body image, including visual, tactile, and pro-
prioceptive attentiveness to the body, can contribute to the controlled production of
movement (Gallagher, 2001).
In the following sections, we will illustrate, with the example of somatoparaphrenia,
that neurological conditions perhaps classically considered as disorders of body schema
also entail aberrations in body image, with differentiable underlying neural signatures
(Schwoebel & Coslett, 2005). We will then focus on diseases of psychiatric nature and
contend again that these disorders too are characterized by symptoms demonstrating
disrupted processing of body schema as well as body image. While this might be the
case for a variety of bodily disorders, including, but not limited to, BID (Brugger,
Lenggenhager, & Giummarra, 2013), body dysmorphic disorder (Riva, 2014), and de-
pression (Fuchs & Schlimme, 2009), etc., we will here again focus on two representative
disorders—​schizophrenia and anorexia nervosa (AN) (see Table 16.1 for an overview).

16.3  Disorders of body schema: the example of asomatognosia

and somatoparaphrenia

Patients with asomatognosia suffer from non-​recognition of parts of their body, most
often displayed as a lack of awareness of, or the denial of ownership for, the left arm or
leg in the presence of a typically right hemisphere brain damage, as well as left hemi-
plegia, left hemisensory deficits, and hemispatial neglect (Gerstmann, 1942; Meador
et al., 2000). In contrast to the disownership of a body part experienced in patients with
270  Neural underpinnings
Table 16.1  Summarizing table of the discussed disorders of body schema and body image
and the core neural regions involved

Disorder Body Core brain Body image Core brain

schema alterations disturbance alterations
disturbance

Asomatognosia +++ Lack Typically right

of sense of hemispheric,
ownership parietal,
Denial of temporo-​
ownership parietal, frontal,
Somatoparaphrenia +++ Lack thalamo-​parietal + Self–​other Temporal regions,
of sense of projections, distinction (denial cortical midline
ownership posterior insula, of ownership), structures
Denial of thalamus disgust, loss of (mPFC, ACC,
ownership familiarity posteromedial
cortices),
orbitofrontal,
amygdala, TPJ
Schizophrenia ++ Loss Insular cortex, ++ Self-​referential Cortical midline
of sense of premotor cortex processes structures, DMN,
ownership, PCC, vPM,
sense of insular cortex
agency,
body size
distortion
Anorexia + Body size Parietal, SPL, +++ Attitudes Cortical midline
distortion insular cortex structures,
retrosplenial
cortex, DMN,
precuneus, PCC

The + signs describe how strongly the body schema and body image might be affected by the disorder.

BID, where afflicted limbs subjectively do not feel like their own, but the patients ob-
jectively know that the undesired limb belongs to them (Brugger et al., 2013), denial of
ownership in somatoparaphrenia and asomatognosia is characterized by an objective
non-​recognition of their own limb. Asomatognosia has typically been categorized as
a body schema disorder (Schwoebel & Coslett, 2005), in line with the idea that body
schema disorders, traditionally linked to alterations in adaptive short-​term body rep-
resentations, are rather linked to right hemispheric alterations (D’Imperio et al., 2017).
Interestingly, experimental manipulations with mirrors or video setups inducing a
change in perspective from a first-​person perspective, which generally ties to body
schema, to a third-​person perspective, which is more closely connected to body image,
have been shown to decrease symptoms (Jenkinson et al., 2013), further pointing to a
body schema disorder basis. While asomatognosia is broadly defined as representing
a ‘loss of awareness of one body-​half ’ (Critchley, 1953), the form and degree of the
asomatognosic response can vary considerably among patients. In some cases, patients
may mistake their arm with that of the examiner or claim they do not know to whom the
arm belongs. However, Gerstmann (1942) specifically distinguished these disturbances
 Disorders of body schema  271
from more elaborate manifestations that include confabulatory delusions, coining the
term ‘somatoparaphrenia’ as the ‘illusions or distortions concerning the perception
of confabulations or delusions referring to the affected limb or side’ (p. 895). In these
cases, patients adamantly deny ownership of their limb despite irrefutable proof, and
may even confabulate nonsensical alternative explanations pertaining to ownership of
the said limb (Critchley, 1953; Feinberg et al., 2010; Halligan et al., 1995).
Research on the neural underpinnings of somatoparaphrenia has evinced vari-
able results, likely due to the single-​case study nature of many of these studies,
which complicate the drawing of valid conclusions (Ardila, 2016). One prior study
found a consistent involvement of the right supramarginal gyrus and thalamo-​
parietal projections (Feinberg et al., 1990 ), while another rather evinced damage
of the right posterior insula (Baier & Karnath, 2008)—​both of these studies linking
asomatognosia to an erroneous updating of body representations, i.e., an updating of
the long-​term body representations based on current sensory input. In a comprehen-
sive literature review, Vallar and Ronchi (2009) identified 56 cases with unilateral, or
largely unilateral, hemispheric lesions and somatoparaphrenic symptoms that were
predominantly right hemispheric. To differentiate between neuroanatomical re-
gions correlating to simple errors in denial of ownership from those accompanied
by confabulations, Feinberg et al. (2010) specifically differentiated between patients
exhibiting somatoparaphrenic symptoms and those with asomatognosia. They con-
firmed previous findings pertaining to parietal and temporo-​parietal damage in
asomatognosia, typically involved in body schema. Patients with somatoparaphrenia
further exhibited involvement of temporal regions and the orbitofrontal cortex,
which corroborated the fact that damage to this region contributes specifically to the
occurrence of confabulatory delusions (Vallar & Ronchi, 2009), as well as to body
image. It therefore appears that a general manifestation of asomatognosia occurs
in the presence of temporo-​parietal and frontal damage, whereas the emergence of
somatoparaphrenic symptoms seems to be more selectively tied to a combination
of right temporo-​parietal, mediofrontal, and orbitofrontal dysfunction. Additional
lesion patterns primarily involving the white matter and subcortical grey structures
(thalamus, basal ganglia, and amygdala) and cortical damage in the middle and in-
ferior frontal gyri, post-​central gyrus, and hippocampus were identified in patients
with somatoparaphrenia in more recent studies (Gandola et al., 2012; Romano &
Maravita, 2019).
Cortical damage to frontal areas, such as the inferior frontal gyrus (IFG), which
is situated just anterior to the premotor cortex, could impede the integration of
multisensory (i.e., visual, tactile, and proprioceptive) information and thereby inter-
fere with the ability to construct a coherent representation of the body part with the
body schema. Neuroimaging studies of the rubber hand illusion (Botvinick & Cohen,
1998) suggest the ventral premotor cortex (vPM) as a key integrator for multisensory
information and body ownership (Ehrsson et al., 2004; Gentile et al., 2015; Tsakiris
et al., 2007), so damage to this surrounding area in somatoparaphrenia could signify a
disruption in the integration of multisensory information usually employed in creating
272  Neural underpinnings
and updating short-​term information into a coherent longer-​term representation of
body schema (Gandola et al., 2012).
Similarly, damage to the thalamus impairs sensory input from reaching and
informing higher-​order cortical areas (Sherman & Guillery, 2002). Extensive damage
to the somatosensory and motoric cortical regions, coupled with the lack of periph-
eral sensory information (Bottini et al., 2002; Moro et al., 2004), may result in the
contralesional half of the body to be no longer integrated into the body schema, despite
visual observation of the paralysed limb via intact left hemisphere structures (Bisiach &
Berti, 1987; Gandola et al., 2012; Romano & Maravita, 2019).
Damage to mediotemporal lobe structures, including the amygdala, could impair
the sense of familiarity or even induce a sense of disgust, thus entailing aspects of af-
fective body image, further aggravating the symptoms of somatoparaphrenia (Gandola
et al., 2012). Feinberg et al. (2010) argue that as a heteromodal association hub between
limbic functions of homeostasis and the unimodal zones of sensorimotor processing,
the medial prefrontal cortex (mPFC) could serve as a ‘convergence zone’ for the inte-
gration of information of these two regions. Since the mPFC has shown to be involved
in the ability to distinguish between self and others (Decety & Sommerville, 2003), im-
pairments in this region could result in confusion between the internal representation
of the self (i.e., one’s own arm) and external stimuli (i.e., another person’s arm), con-
tributing to the asomatognosic response. Several studies have substantiated the role
of mPFC activity in self–​other distinction; for example, administration of intranasal
oxytocin reduced responses of the mPFC and connectivity with other cortical mid-
line structures involved in self-​processing during a self and other trait judgement task
and blurred self–​other distinction (Zhao et al., 2016). While the distinction of self
from familiar others has functionally been tied to the mPFC and posterior cingulate
cortex (PCC), distinction of familiar others to unfamiliar others seems to underlie right
temporo-​parietal junction (TPJ) activation (Kruse et al., 2016). Similarly, distinction of
self, relative to others, during emotional states differentially activated the mPFC, PCC,
and TPJ bilaterally (Schulte-​Rüther et al., 2007).
Invernizzi et al. (2013) stress on the complexity of embodiment and the necessity
to dissociate between the sense of body ownership and agency when disentangling
sensory and motor aspects of body schema in the brain. While anosognosia for hemi-
plegia seems to be more tightly linked to anterior damage affecting motor control
processes, neural signatures of somatoparaphrenia show more crucial involvement
of grey subcortical structures and white matter bundles. Specifically, their neuro-
anatomical data suggest significant involvement of the right thalamus, basal ganglia,
and internal capsule, evidencing an involvement of grey subcortical structures seem-
ingly specific to somatoparaphrenia. Therefore, while both patients with anosognosia
for hemiplegia and somatoparaphrenia may exhibit extensive lesions of the frontal
cortex, somatoparaphrenic symptoms could stem from combination damage to both
frontal areas and subcortical grey and white matter. The existing literature therefore
suggests that damage to the surrounding cortical areas underlying body ownership,
such as the vPM, could underlie disturbances more specific to body schema, whereas
 Disorders with significant overlap  273
cortical midline structures, namely the mPFC, anterior cingulate cortex (ACC), and
posteromedial cortices (Northoff et al., 2006), could impact the affective relation to the
bodily properties of body image and potentially lead to confabulatory delusions.

16.4  Disorders with significant overlap in body image and

body schema

Several disorders cannot be dichotomously categorized as affecting solely either the

body schema or the body image; instead, many disorders, especially those of a psychi-
atric nature, exhibit symptoms characteristic of disordered unconscious monitoring of
the body schema, while also encompassing aberrant conscious attitudes and beliefs to-
ward the body (i.e., body image).

16.4.1 Schizophrenia

Disturbances of body experience in schizophrenia constitute a wide range of phe-

nomena, including disturbances in body perception (e.g., seeing distorted faces)
(Harrington et al., 1989), rejection of an aspect of the body with resultant attempts at
self-​mutilation (Large et al., 2009), or abnormal cenesthopathic sensations (Jenkins &
Röhricht, 2007). Abnormalities of self-​experience are often core symptoms of schizo-
phrenia and include aberrant perceptions of bodily self-​consciousness, such as loss of
implicit recognition of self-​body parts, misattribution of body parts when belonging to
others, or blurring of peripersonal space and self–​other boundaries (Gallese & Ferri,
2015). However, a recent combined meta-​study suggested no alterations in body own-
ership, as measured during a multisensory stimulation paradigm (Shaqiri et al., 2018).
Therefore, it is still unclear whether aberrations in multisensory integration underlie
the deficits of the bodily self present in schizophrenia or whether other properties, such
as agency or even alterations in body image, may help explain the disorder. Again, and
similarly to above-​described cases of anorexia or BID, this might suggest that while
short-​term plasticity of the bodily self is not affected, long-​term representations are.
Schizophrenia is considered a self-​disorder (Nelson et al., 2008) that is characterized
by a complex multilayered concept of self-​experience (Gallese & Ferri, 2015). The
vPM constitutes an essential anatomofunctional base for the integration of self-​related
multisensory information, and therefore for the experience of the body schema. In
addition to an aberrant implicit sense of the embodied self (Ferri et al., 2012), schizo-
phrenia is also characterized by hypofunctional vPM activation in response to the ob-
servation of bodily tactile stimulations that correlates negatively with self-​experience
disturbances (Ebisch et al., 2012). Therefore, patients’ defective anticipatory sensori-
motor processing of touch and lower vPM activity may blur self–​other boundaries and
thus, at least partially, underlie the breakdown of self-​monitoring processes observed
in patients with schizophrenia (Gallese & Ferri, 2015).
274  Neural underpinnings
Difficulties in self–​other distinction in schizophrenia have also been tied to altered
functional insular activation; posterior insular cortex activity in response to the ob-
servation of social affective touch differs significantly in schizophrenia, compared to
healthy controls (Ebisch et al., 2011). Considering that the insula constitutes a critical
anatomofunctional structure for interoception (Craig, 2002), self-​awareness (Tsakiris
et al., 2007), body part awareness (Karnath et al., 2005), and sense of agency (Farrer
et al., 2003), Gallese and Ferri (2015) propose that insular deactivation during the
observation of social affective touch may reflect a defective implicit suppression of
self-​oriented affective arousal, which may contribute to the difficulties in self–​other dis-
tinction. This relation shows that such alterations in schizophrenia can be considered
body schema disturbances.
The focus thus far has been placed on the brain lateral cortices (i.e., the vPM and
insula) and their correlation to aberrant multimodal integration and processing of the
body schema, such as the loss of implicit knowledge of self-​body parts or blurring of
peripersonal and self–​other boundaries. However, an alternative line of research pro-
poses that schizophrenia underlies a dysfunction of brain midline regions involved
in self-​referential processes (Qin & Northoff, 2011) and the default mode network
(DMN) (Raichle et al., 2001). Gallese and Ferri (2015) state that this approach cor-
relates schizophrenia with altered functional connectivity (Whitfield-​Gabrieli et al.,
2009) and changes in the homogeneity of the midline cortex (Guo et al., 2014), as well
as an anterior-​to-​posterior shift in midline cortical activity during self-​reflection (Holt
et al., 2011) and aberrant coupling both within and across the DMN and other associa-
tive neural networks (Wotruba et al., 2014).
Although these two self-​disorder perspectives of schizophrenia may initially seem
like distinct approaches, they nevertheless appear to be closely interconnected. On
one hand, multisensory integration underlying the construction of the body schema
may be disrupted at the vPM. As previously mentioned, while the body schema pre-
supposes a primacy over the body image, the body image can continue to reciprocally
influence the body schema through positive or negative feedback loops (Pitron et al.,
2018). There is also strong evidence that patients with schizophrenia suffer from an
abnormal experience of their body image, suggesting that the weakened internal mod-
elling of the self also pertains to conscious perceptual experiences of the body (Graham
et al., 2014; Graham-​Schmidt et al., 2016). General self-​referential processes are, at least
partly, connected to body-​related processing (especially to the affective and cognitive
aspects of the body image) and correlate with activity in the insula and midline cortical
structures, as well as the lateral frontal, temporal, and parietal cortices (Araujo et al.,
2015). Results from a functional interaction analysis in first-​episode schizophrenia pa-
tients evinced increased functional coupling between the vPM and the PCC that cor-
related positively with basic symptoms (subjective self-​experience disturbances), while
the posterior insular cortex showed reduced functional coupling with the PCC and
post-​central gyrus, but increased functional coupling with the anterior insula (Ebisch
et al., 2013). Therefore, aberrant functional coupling interactions involving the pos-
terior insular cortex and the vPM may converge on the PCC (Gallese & Ferri, 2015),
 Disorders with significant overlap  275
and possibly produce an imbalance between the integration of interoceptive (via the
posterior insula cortex) and that of exteroceptive (via the vPM) information in the pro-
cess. The abnormal integration of these processes may therefore consequently disturb
self-​referential processing mediated by the PCC (Ebisch et al., 2013).
Schizophrenia is characterized by multifaceted disturbances of self-​perception that
encompass aberrations in altered bodily perception affecting both body schema and
body image. Although studies selectively distinguishing between the neural underpin-
nings of aberrations in body schema and body image perception in schizophrenia are
still limited, current literature supports that alterations in multisensory integration at
the level of brain lateral cortices contribute to the disordered body schema, whereas
self-​referential processing in midline cortical structures appears to be more specifically
tied to the affective and cognitive perception of body image.

16.4.2  Anorexia nervosa

Alterations in body representations and body dissatisfaction are major clinical symp-
toms of AN (American Psychiatric Association, 2013). Patients often display signifi-
cant overestimation of their own body size (Penner, Thompson, & Coovert, 1991) or
distorted attitudinal components (Mölbert et al., 2018; Provenzano et al., 2020), a pro-
cess that involves levels of (mis)representation affecting the body schema as well as
the body image. Several authors have posited a disturbed body schema underlying
AN (Guardia et al., 2010; 2012) that may be related to a general dysfunction of the
parietal cortex, as well as to a specific dysfunction of the superior parietal lobule (SPL)
(Grunwald et al., 2002; Nico et al., 2010), which seems to be crucial for the estab-
lishment of a coherent body schema (Daprati, Siricu, & Nico, 2010). Disturbances
in visuo-​tactile (Case, Wilson, & Ramachandran, 2012) and visuo-​proprioceptive
(Eshkevari, Rieger, Longo, Haggard, & Treasure, 2012) integration has been found in
AN, although some discrepancies in the interpretations surrounding their relevance
in the disorder remain. Patients with AN demonstrate severely disturbed anticipation
of body-​related actions in the form of a significant body schema overestimation bias
related to the patient’s own body action (Guardia et al., 2010; 2012). Mismatches be-
tween incoming multisensory information and the top-​down interpretation from cor-
tical regions representing the body may lead to the maintenance of incorrect body
representations. Such deficits in multisensory processing to effectively integrate real-​
time perceptual data have been proposed to impair the egocentric system’s capacities
to update beliefs and attitudes stored in long-​term allocentric memory (Riva, 2012;
2018a, b). Impairments in multisensory processing seem to correlate with a disturbed
body schema representation in AN, evident in an impaired ability to link interocep-
tive afferent bodily signals to their potential aversive or pleasant outcomes (Dakanalis
et al., 2016; Riva, 2016; Riva & Dakanalis, 2018). This notion has been corroborated
by neuroimaging and neuropsychology studies where both structural and func-
tional alterations of the insula were found to correlate with diminished accuracy in
276  Neural underpinnings
interoceptive predictive coding (Boehm et al., 2014; Khalsa, Craske, Vangala, Strober,
& Feusner, 2015; Nunn, Frampton, Seim, Törzsök-​sonnevend, & Lask, 2011).
An fMRI study by Boehm et al. (2014) investigating alterations of DMN connect-
ivity in patients with AN showed that self-​reported interoceptive awareness problems
correlated with increased functional connectivity in the anterior insula. While the in-
sula constitutes a central hub that normally mediates switching between the DMN to
the frontoparietal network as a response to salient stimuli, the authors purport that in-
creased coupling between the DMN and the insula reflects the exacerbated difficulties
in disengaging from an internally oriented mental state when at rest in these patients,
mirroring the heightened levels of disorder-​specific rumination.
An alternative approach to AN focuses on an impairment in the ability to update the
body memory with the online (short-​term) information from incoming multisensory
perception, potentially resulting in significant spatiotemporal disturbances (Riva &
Dakanalis, 2018). According to a prominent neural model, the construction of spa-
tial cognition is posited to occur through an interface between long-​and short-​term
memory processes (Byrne, Becker, & Burgess, 2007) where a continuous translation be-
tween online first-​person perspective (egocentric) and offline third-​person perspective
(allocentric) representations occurs via a coordinate transformation in the posterior
parietal and retrosplenial cortices (Dhindsa et al., 2014). According to this model, ego-
centric representations are integrated in the parietal lobe and model short-​term spatial
memory and imagery. Therefore, there is a continuous interdependence between in-
coming sensorimotor information that is contrasted against long-​term spatial memory
of allocentric representations in the hippocampus and medial-​temporal lobe struc-
tures. Normally, there is only limited interaction between egocentric and allocentric
processes (Longo, Azañón, & Haggard, 2010)—​movements of the body (body schema)
usually occur in a ‘transient action-​oriented egocentric perceptual frame’, while long-​
term memory of body image is stored in an ‘enduring allocentric environment-​object
representation’ (Burgess, 2006; Riva, 2014, p. 6). Nevertheless, some interaction be-
tween these frames of reference do occur, as ‘long-​term spatial memory is modeled as
attractor dynamics within medial temporal allocentric representations, and short-​term
memory is modeled as egocentric parietal representations driven by perception, re-
trieval, and imagery and modulated by direct attention’ (Byrne et al., 2007, p. 340).
Whereas several of the above-​mentioned physical stimuli pertain to disturbances of
sensorimotor representation of the body (i.e., body schema), top-​down influences induced
by emotions, attitudes, and knowledge toward the body (i.e., the affective and cognitive
aspects of body image) leading to body image distortion constitute a significant clinical
symptom of the disorder as well (Mohr et al., 2010). Disordered processing of one’s own
body could be due to disturbances in spatiotemporal functioning (Amianto, Northoff,
Daga, Fassino, & Tasca, 2016) and low reflective functioning (Fonagy et al., 1996). Self-​
referential processing and autobiographical memories are relevant in the context of the
integration of corporeal awareness and underlie activity in the insula and midline cortical
structures, as well as the lateral frontal, temporal, and parietal cortices, hippocampus,
and amygdala (Araujo et al., 2015). While perceptual body image, transiently modulated
 Disorders with significant overlap  277
during bodily illusions (e.g., rubber hand illusion or full body illusions), generally does
not demonstrate overlap between the DMN and body-​related processing (Ehrsson, 2005),
the cognitive-​affective components of body image, in particular, could be more specific-
ally linked to aberrations in cortical midline structures. In AN, self-​referential processes
for own-​body processing, such as body shape concern, have been linked to stronger syn-
chronous activity between the medial parietal areas, particularly between the dorsal ACC
(dACC) and the precuneus, and the dACC and the retrosplenial cortex (Lee et al., 2014).
Increased functional task-​related connectivity with the dACC was observed particularly
for processing of the self, and with mid-​temporal areas for the processing of others (Via
et al., 2018). As a principal locus of information processing, the dACC has numerous
connections with cortical, limbic, and paralimbic regions (Margulies et al., 2007) and
may contribute to excessive cognitive control of appetite and body image distortion in
AN (Friederich et al., 2010). Even recovered patients with AN exhibit increased connect-
ivity of the precuneus and dorsolateral prefrontal cortex (dlPFC)/​IFG, highlighting the
role of these areas in cognitive and emotional control as biomarkers in AN (Ehrlich et al.,
2015). The precuneus and PCC are interconnected areas that comprise key nodes of the
DMN (Fransson & Marrelec, 2008). Connections from the PCC/​precuneus are proposed
to constitute the hub of an altered network of interconnected midline anterior and pos-
terior DMN components during self–​other body evaluation in patients with AN (Via
et al., 2018). Specifically, the dorsal PCC exhibits hyperactivation during processing of
the own body image in patients with AN, while there is a lack of precuneus and ventral
PCC activity in the processing of another’s body. Within the DMN, the mPFC supports
many self-​referential mental processes and monitoring of psychological states (Phan,
Wager, Taylor, & Liberzon, 2002) and, as such, could be considered a neural convergence
hub that receives and processes interoceptive and exteroceptive inputs (Esposito, Cieri,
di Giannantonio, & Tartaro, 2018), which develop into a conscious process through the
modulation of other brain regions (Esposito et al., 2018).
The differences in brain activation patterns to body image may be the result of a
lack of clearer differentiation between the different concepts underlying the unitary
construct of body image such as perception of one’s body size, emotions, and attitudes
(Esposito et al., 2018). By using body image as a unitary construct, and not considering
the perceptual, affective, and cognitive subcomponents, it is more difficult to draw valid
conclusions surrounding the anatomical and functional signatures of AN. The emo-
tional dimension of body image seems to be tied to altered insula, frontal cortex, and
precuneus activity (Mohr et al., 2010), suggesting that the emotional preferences for
thin self-​images in patients with AN may be the result of a higher emotional valence
(Esposito et al., 2018). Involvement of resting state networks, particularly the mPFC,
dlPFC, ACC, and PCC/​precuneus midline structures within the DMN, and the insula
within the salience network, could represent neural correlates that help explain how the
emotional component of body image affects patients with AN.
While AN may have often been classically considered as a disorder of body image,
these studies highlight the essentiality of also considering the role of body schema and
how it may form a foundational basis of aberrant perceptions that could influence body
278  Neural underpinnings
image. Furthermore, the nature of the aberrant body perceptions in AN is still not fully
understood, as attitudes toward the body, rather than perceptual accuracy of body size,
could influence the debilitating course of the disease. Therefore, careful consideration
of the perceptual, affective, and cognitive components of body image will aid in a better
understanding of AN and the differential neural correlates, as well as elucidate how
these subcomponents of body image influence the patterns in these disorders.

16.5 Conclusion

This review attempted to integrate the recent literature on neural correlates of several
neurological and psychiatric disorders of corporeal awareness into the theoretical frame-
work of body schema and body image. The clinical picture remains complex, and the
disorders discussed here highlight that conditions can rarely be simplistically deduced
to disorders of body schema or body image; rather, body image and body schema are
inherently linked in the symptomatology. While certain disorders may have been trad-
itionally determined as ones affected selectively by aberrant perceptions of body image
or body schema, it is the reciprocal interaction of these two bodily constructs that shapes
the phenomenology and clinical picture. To further complicate the picture, both body
schema and body image seem to include more plastic short-​term representation, as well
as more stable long-​term representations, which are differentially affected in most con-
ditions; that is, while body schema and body image can be permanently altered in such
disorders, patients might still show plastic changes in short-​term body representations
during multisensory stimulation paradigms. Roughly, alterations in body schema might
be linked to subcortical and cortical structures integrating sensorimotor processes into
a coherent representation (e.g., premotor and posterior parietal areas), while alterations
of body image reveal a more distributed picture, including partly overlapping structures
in the insular cortex, which could be linked more to the perceptual aspects of the body
image, but additionally also the temporal and frontal structures centering around mid-
line structures, which might be linked more to affective and cognitive aspects of the body
image (Gallagher, 1986). From the multisensory integration that shapes representations
of bodily properties to the structural and functional connectivity of large-​scale brain net-
works, disentangling the selective influence of both body image and body schema, as
well as their reciprocal interactions, will benefit future empirical studies not only to con-
clude more fine-​graded distinctions of various aspects of the bodily self, but also to better
understand their role in a range of disorders and underlying neural correlates.

Acknowledgements

B. L. and J. H. were funded by the Swiss National Science Foundation (nr. PP00P1_​
170511). We thank Marte Roel Lesur for his critical review of a previous version of the
manuscript.
 Conclusion  279
References
American Psychiatric Association. (2013). Diagnostic and Statistical Manual of Mental Disorders (fifth
edition). Available from: https://​doi.org/​10.1176/​appi.books.9780890425596.744053
Amianto, F., Northoff, G., Daga, G. A., Fassino, S., & Tasca, G. A. (2016). Is anorexia nervosa a dis-
order of the self? A psychological approach. Frontiers in Psychology, 7(849), 1–​9. https://​doi.org/​
10.3389/​fpsyg.2016.00849
Araujo, H. F., Kaplan, J., Damasio, H., & Damasio, A. (2015). Neural correlates of different self do-
mains. Brain and Behavior, 5(12), e00409. https://​doi.org/​10.1002/​brb3.409
Ardila, A. (2016). Some unusual neuropsychological syndromes: somatoparaphrenia, akinetopsia, re-
duplicative paramnesia, autotopagnosia. Archives of Clinical Neuropsychology, 31, 456–​464. https://​
doi.org/​10.1093/​arclin/​acw021
Baier, B. & Karnath, H. O. (2008). Tight link between our sense of limb ownership and self-​awareness
of actions. Stroke, 39, 486–​488. https://​doi.org/​10.1161/​STROKEAHA.107.495606
Berlucchi, G. & Aglioti, S. M. (2010). The body in the brain revisited. Experimental Brain Research,
200, 25–​35. https://​doi.org/​10.1007/​s00221-​009-​1970-​7
Bisiach, E. & Berti, A. (1987). Dyschiria. An attempt at its systemic explanation. Advances in
Psychology, 45, 183–​201. https://​doi.org/​10.1016/​S0166-​4115(08)61713-​6
Blom, R. M., Hennekam, R. C., & Denys, D. (2012). Body integrity identity disorder. PLoS ONE, 7(4),
e34702. https://​doi.org/​10.1371/​journal.pone.0034702
Boehm, I., Geisler, D., King, J. A., Ritschel, F., Seidel, M., Deza Araujo, Y., Petermann, J., Lohmeier, H.,
Weiss, J., Walter, M., Roessner, V., & Ehrlich, S. (2014). Increased resting state functional connect-
ivity in the fronto-​parietal and default mode network in anorexia nervosa. Frontiers in Behavioral
Neuroscience, 8. https://​doi.org/​10.3389/​fnbeh.2014.00346
Bottini, G., Bisiach, E., Sterzi, R., & Vallar, G. (2002). Feeling touches in someone else’s hand.
NeuroReport, 13(2), 249–​252. https://​doi.org/​10.1097/​00001756-​200202110-​00015
Botvinick, M. & Cohen, J. (1998). Rubber hands ‘feel’ touch that eyes see. Nature, 391(6669), 756.
https://​doi.org/​10.1038/​35784
Brugger, P. & Lenggenhager, B. (2014). The bodily self and its disorders: neurological, psycho-
logical and social aspects. Opinion Current Neurology, 27(6), 644–​652. https://​doi.org/​10.1097/​
WCO.0000000000000151
Brugger, P., Lenggenhager, B., & Giummarra, M. J. (2013). Xenomelia: a social neuroscience view
of altered bodily self-​consciousness. Frontiers in Psychology, 4(204), 1–​7. https://​doi.org/​10.3389/​
fpsyg.2013.00204
Burgess, N. (2006). Spatial memory: how egocentric and allocentric combine. Trends in Cognitive
Sciences, 10(12), 551–​557. https://​doi.org/​10.1016/​j.tics.2006.10.005
Byrne, P., Becker, S., & Burgess, N. (2007). Remembering the past and imagining the `future: a neural
model of spatial memory and imagery. Psychological Review, 114(2), 340–​375. https://​doi.org/​
10.1037/​0033-​295X.114.2.340
Case, L. K., Wilson, R. C., & Ramachandran, V. S. (2012). Diminished size-​weight illusion in anorexia
nervosa: evidence for visuo-​proprioceptive integration deficit. Experimental Brain Research, 217,
79–​87. https://​doi.org/​10.1007/​s00221-​011-​2974-​7
Craig, A. D. (2002). How do you feel? Interoception: the sense of the physiological condition of the
body. Nature Reviews Neuroscience, 3(8), 655–​666. https://​doi.org/​10.1038/​nrn894
Critchley, M. (1953). Parietal Lobes. London: Edward Arnold and Co. https://​doi.org/​10.1136/​
bmj.2.4851.1416
Dakanalis, A., Gaudio, S., Serino, S., Clerici, M., Carrà, G., & Riva, G. (2016). Body-​image dis-
tortion in anorexia nervosa. Nature Rev Dis Primers, 2, 160626. https://​doi.org/​10.1038/​
nrdp.2016.26
Daprati, E., Sirigu, A., & Nico, D. (2010). Body and movement: consciousness in the parietal lobes.
Neuropsychologia, 48, 756–​762. https://​doi.org/​10.1016/​j.neuropsychologia.2009.10.008
Decety, J. & Sommerville, J. A. (2003). Shared representations between self and other: a social cog-
nitive neuroscience view. Trends in Cognitive Sciences, 7(12), 527–​533. https://​doi.org/​10.1016/​
j.tics.2003.10.004
280  Neural underpinnings
de Vignemont, F. (2011). Embodiment, ownership and disownership. Consciousness and Cognition,
20(1), 82–​93. https://​doi.org/​10.1016/​j.concog.2010.09.004
Dhindsa, K., Drobinin, V., King, J., Hall, G. B., Burgess, N., & Becker, S. (2014). Examining the role
of the temporo-​parietal network in memory, imagery, and viewpoint transformations. Frontiers in
Human Neuroscience, 8. https://​doi.org/​10.3389/​fnhum.2014.00709
D’Imperio, D., Tomelleri, G., Moretto, G., & Moro, V. (2017). Modulation of somatoparaphrenia
following left-​ hemisphere damage. Neurocase, 23(2), 162–​170. https://​doi.org/​10.1080/​
13554794.2017.1329444
Ebisch, S. J. H., Ferri, F., Salone, A., Perrucci, M. G., D’Amico, L., Ferro, F. M., Romani, G. L., & Gallese,
V. (2011). Differential involvement of somatosensory and interoceptive cortices during the obser-
vation of affective touch. Journal of Cognitive Neuroscience, 23, 1808–​1822. https://​doi.org/​10.1162/​
jocn.2010.21551
Ebisch, S. J. H., Mantini, D., Northoff, G., Salone, A., De Berardis, D., Ferri, F., Ferro, F. M., Di
Giannantonio, M., Romani, G. L., & Gallese, V. (2013). Altered brain long-​range functional inter-
actions underlying the link between aberrant self-​experience and self-​other relationship in first-​
episode schizophrenia. Schizophrenia Bulletin, 40, 1072–​1082. https://​doi.org/​10.1093/​schbul/​
sbt153
Ebisch, S. J. H., Salone, A., Ferri, F., De Berardis, D., Romani, G. L., Ferro, F. M., & Gallese, V. (2012).
Out of touch with reality? Social perception in first-​episode schizophrenia. Social Cognitive and
Affective Neuroscience, 8, 394–​403. https://​doi.org/​10.1093/​scan/​nss012
Ehrlich, S., Lord, A. R., Geisler, D., Borchardt, V., Boehm, I., Seidel, M., Ritschel, F., Schulze, A.,
King, J. A., Weidner, K., Roessner, V., & Walter, M. (2015). Reduced functional connectivity in the
thalamo-​insular subnetwork in patients with acute anorexia nervosa. Human Brain Mapping, 36,
1772–​1781. https://​doi.org/​10.1002/​hbm.22736
Ehrsson, H. H. (2005). Touching a rubber hand: feeling of body ownership is associated with ac-
tivity in multisensory brain areas. Journal of Neuroscience, 25(45), 10564–​10573. https://​doi.org/​
10.1523/​JNEUROSCI.0800-​05.2005
Ehrsson, H. H. (2007). The experimental induction of out-​of-​body experiences. Science, 317(51841),
1048. https://​doi.org/​10.1126/​science.1142175
Ehrsson, H. H., Spence, C., & Passingham, R. E. (2004). That’s my hand! Activity in premotor cortex
reflects feeling of ownership of a limb. Science, 305, 875–​878.
Eshkevari, E., Rieger, E., Longo, M. R., Haggard, P., & Treasure, J. (2012). Increased plasticity of
the bodily self in eating disorders. Psychological Medicine, 42, 819–​828. https://​doi.org/​10.1017/​
S0033291711002091
Esposito, R., Cieri, F., di Giannantonio, M., & Tartaro, A. (2018). The role of body image and self-​
perception in anorexia nervosa: the neuroimaging perspective. Journal of Neuropsychology, 12, 41–​
52. https://​doi.org/​10.1111/​jnp.12106
Farrer, C., Franck, N., Georgieff, N., Frith, C. D., Decety, J., & Jeannerod, M. (2003). Modulating the
experience of agency: a positron emission tomography study. NeuroImage, 18, 324–​333. https://​
doi.org/​10.1016/​S1053-​8119(02)00041-​1
Feinberg, T. E., Haber, L. D., & Leeds, N. E. (1990). Verbal asomatognosia. Neurology, 40(9), 1391–​
1394. https://​doi.org/​10.1212/​wnl.40.9.1391
Feinberg, T. E., Venneri, A., Simone, A. M., Fan, Y., & Northoff, G. (2010). The neuroanatomy of
asomatognosia and somatoparaphrenia. Journal of Neurology, Neurosurgery and Psychiatry, 81,
276–​281. https://​doi.org/​10.1136/​jnnp.2009.188946
Ferri, F., Frassinetti, F., Ardizzi, M., Costantini, M., & Gallese, V. (2012). A sensorimotor network for
the bodily self. Journal of Cognitive Neuroscience, 24, 1584–​1595. https://​doi.org/​10.1162/​jocn_​a_​
00230
Fonagy, P., Leigh, T., Steele, M., Steele, H., Kennedy, R., Mattoon, G., Target, M., & Gerber, A. (1996).
The relation of attachment status, psychiatric classification, and response to psychotherapy. Journal
of Consulting and Clinical Psychology, 64(1), 22–​31. https://​doi.org/​10.1037/​0022-​006X.64.1.22
Fransson, P. & Marrelec, G. (2008). The precuneus/​posterior cingulate cortex plays a pivotal role in
the default mode network: Evidence from a partial correlation network analysis. NeuroImage, 42,
1178–​1184. https://​doi.org/​10.1016/​j.neuroimage.2008.05.059
 Conclusion  281
Friederich, H. C., Brooks, S., Uher, R., Campbell, I. C., Giampietro, V., Brammer, M., Williams, S. C. R.,
Herzog, W., & Treasure, J. (2010). Neural correlates of body dissatisfaction in anorexia nervosa.
Neuropsychologia, 48, 2878–​2885. https://​doi.org/​10.1016/​j.neuropsychologia.2010.04.036
Fuchs, T. & Schlimme, J. E. (2009). Embodiment and psychopathology: a phenomeno-
logical perspective. Current Opinion in Psychiatry, 22(6), 570–​575. https://​doi.org/​10.1097/​
YCO.0b013e3283318e5c
Gadsby, S. (2018). How are the spatial characteristics of the body represented? A reply to Pitron
and de Vignemont. Consciousness and Cognition, 62, 163–​168. https://​doi.org/​10.1016/​
j.concog.2018.04.011
Gallagher, S. (1986). Body image and body schema: a conceptual clarification. Journal of Mind and
Behavior, 7(4), 541–​554.
Gallagher, S. (2001). Dimensions of embodiment: body image and body schema in medical contexts.
In S. K. Toombs (eds.), Handbook of Phenomenology and Medicine. Philosophy and Medicine (Vol.
68, pp. 147–​175). Dordrecht: Springer. https://​doi.org/​10.1007/​978-​94-​010-​0536-​4_​8
Gallagher, S. (2005). How the Body Shapes the Mind. New York, NY: Oxford University Press. https://​
doi.org/​10.1093/​0199271941.001.0001
Gallese, V. & Ferri, F. (2015). Schizophrenia, bodily selves, and embodied simulation. In P. F. Ferrari
& G. Rizzolatti (eds.), New Frontiers in Mirror Neurons Research (pp. 348–​365). Oxford: Oxford
University Press. https://​doi.org/​10.1093/​acprof:oso/​9780199686155.003.0019
Gandola, M., Invernizzi, P., Sedda, A., Ferrè, E. R., Sterzi, R., Sberna, M., Paulesu, E., & Bottini, G.
(2012). An anatomical account of somatoparaphrenia. Cortex, 48(9), 1165–​1178. https://​doi.org/​
10.1016/​j.cortex.2011.06.012
Gaudio, S. & Quattrocchi, C. C. (2012). Neural basis of a multidimensional model of body image dis-
tortion in anorexia nervosa. Neuroscience and Biobehavioral Reviews, 36(8), 1839–​1847. https://​
doi.org/​10.1016/​j.neubiorev.2012.05.003
Gaudio, S. & Riva, G. (2013). Body image in anorexia nervosa: the link between functional connect-
ivity alterations and spatial reference frames. Biological Psychiatry, 73(9), e25–​e26. https://​doi.org/​
10.1016/​j.biopsych.2012.08.028
Gentile, G., Björnsdotter, M., Petkova, V. I., Abdulkarim, Z., & Ehrsson, H. H. (2015). Neuroimage
patterns of neural activity in the human ventral premotor cortex reflect a whole-​body multisensory
percept. NeuroImage, 109, 328–​340. https://​doi.org/​10.1016/​j.neuroimage.2015.01.008
Gerstmann, J. (1942). Problem of imperception of disease and of impaired body territories with or-
ganic lesions: relation to body scheme and its disorders. Archives of Neurology And Psychiatry, 48,
890–​913. https://​doi.org/​10.1001/​archneurpsyc.1942.02290120042003
Graham, K. T., Martin-​Iverson, M. T., Holmes, N. P., Jablensky, A., & Waters, F. (2014). Deficits in
agency in schizophrenia, and additional deficits in body image, body schema, and internal timing,
in passivity symptoms. Frontiers in Psychiatry, 5, 1–​11. https://​doi.org/​10.3389/​fpsyt.2014.00126
Graham-​Schmidt, K. T., Martin-​Iverson, M. T., Holmes, N. P., & Waters, F. (2016). Body repre-
sentations in schizophrenia: an alteration of body structural description is common to people
with schizophrenia while alterations of body image worsen with passivity symptoms. Cognitive
Neuropsychiatry, 21(4), 354–​368. https://​doi.org/​10.1080/​13546805.2016.1231111
Grunwald, M., Ettrich, C., Busse, F., Assmann, B., Dähne, A., & Gertz, H. J. (2002). Angle para-
digm: a new method to measure right parietal dysfunctions in anorexia nervosa. Archives of Clinical
Neuropsychology, 17, 485–​496. https://​doi.org/​10.1016/​S0887-​6177(01)00131-​7
Guardia, D., Conversy, L., Jardri, R., Lafargue, G., Thomas, P., Dodin, V., Cottencin, O., & Luyat, M.
(2012). Imagining one’s own and someone else’s body actions: dissociation in anorexia nervosa.
PLoS ONE, 7(8), e43241. https://​doi.org/​10.1371/​journal.pone.0043241
Guardia, D., Lafargue, G., Thomas, P., Dodin, V., Cottencin, O., & Luyat, M. (2010). Anticipation of
body-​scaled action is modified in anorexia nervosa. Neuropsychologia, 48, 3961–​3966. https://​doi.
org/​10.1016/​j.neuropsychologia.2010.09.004
Guo, W., Yao, D., Jiang, J., Su, Q., Zhang, Z., Zhang, J., Yu, L., & Xiao, C. (2014). Abnormal default-​
mode network homogeneity in first-​ episode, drug-​ naive schizophrenia at rest. Progress in
Neuro-​ Psychopharmacology and Biological Psychiatry, 49, 16–​20. https://​doi.org/​10.1016/​
j.pnpbp.2013.10.021
282  Neural underpinnings
Gurfinkel, V. S. & Levick, Y. S. (1991). Perceptual and automatic aspects of the postural body scheme.
In J. Paillard (ed.), Brain and Space (pp. 147–​162). Oxford: Oxford University Press.
Halligan, P. W., Marshall, J. C., & Wade, D. T. (1995). Unilateral somatoparaphrenia after
right hemisphere stroke: a case description. Cortex, 31, 173–​182. https://​doi.org/​10.1016/​
S0010-​9452(13)80115-​3
Harrington, A., Oepen, G., & Spitzer, M. (1989). Disordered recognition and perception of human
faces in acute schizophrenia and experimental psychosis. Comprehensive Psychiatry, 30, 376–​384.
https://​doi.org/​10.1016/​0010-​440X(89)90003-​5
Holt, D. J., Cassidy, B. S., Andrews-​Hanna, J. R., Lee, S. M., Coombs, G., Goff, D. C., Gabrieli, J.
D., & Moran, J. M. (2011). An anterior-​to-​posterior shift in midline cortical activity in schizo-
phrenia during self-​ reflection. Biological Psychiatry, 69, 415–​423. https://​doi.org/​10.1016/​
j.biopsych.2010.10.003
Invernizzi, P., Gandola, M., Romano, D., Zapparoli, L., Bottini, G., & Paulesu, E. (2013). What is mine?
Behavioral and anatomical dissociations between somatoparaphrenia and anosognosia for hemi-
plegia. Behavioural Neurology, 26, 139–​150. https://​doi.org/​10.3233/​BEN-​2012-​110226
Jenkins, G. & Röhricht, F. (2007). From cenesthesias to cenesthopathic schizophrenia: a historical and
phenomenological review. Psychopathology, 40, 361–​368. https://​doi.org/​10.1159/​000106314
Jenkinson, P. M., Haggard, P., Ferreira, N. C., & Fotopoulou, A. (2013). Body ownership and attention
in the mirror: insights from somatoparaphrenia and the rubber hand illusion. Neuropsychologia,
51(8), 1453–​1462. https://​doi.org/​10.1016/​j.neuropsychologia.2013.03.029
Karnath, H. O., Baier, B., & Nagele, T. (2005). Awareness of the functioning of one’s own limbs me-
diated by the insular cortex? Journal of Neuroscience, 214, 411–​417. https://​doi.org/​10.1523/​
jneurosci.1590-​05.2005
Keizer, A., van Elburg, A., Helms, R., & Dijkerman, H. C. (2016). A virtual reality full body illusion
improves body image disturbance in anorexia nervosa. PLoS ONE, 11(10), e0163921. https://​doi.
org/​10.1371/​journal.pone.0163921
Khalsa, S. S., Craske, M. G., Vangala, S., Strober, M., & Feusner, J. D. (2015). Altered interoceptive
awareness in anorexia nervosa: effects of meal anticipation, consumption and bodily arousal.
International Journal of Eating Disorders, 48, 889–​897. https://​doi.org/​10.1002/​eat.22387
Kruse, B., Bogler, C., Haynes, J.-​D., & Schütz-​Bosbach, S. (2016). Am I seeing myself, my friend or
a stranger? The role of personal familiarity in visual distinction of body identities in the human
brain. Cortex, 83, 86–​100. https://​doi.org/​10.1016/​j.cortex.2016.07.010
Lackner, J. R. (1988). Some proprioceptive influences on the perceptual representation of body shape
and orientation. Brain, 111, 281–​297. https://​doi.org/​10.1093/​brain/​111.2.281
Large, M., Babidge, N., Andrews, D., Storey, P., & Nielssen, O. (2009). Major self-​mutilation in the
first episode of psychosis. Schizophrenia Bulletin, 35, 1012–​1021. https://​doi.org/​10.1093/​schbul/​
sbn040
Lee, S., Ran Kim, K., Ku, J., Lee, J. H., Namkoong, K., & Jung, Y. C. (2014). Resting-​state synchrony
between anterior cingulate cortex and precuneus relates to body shape concern in anorexia nervosa
and bulimia nervosa. Psychiatry Research: Neuroimaging, 22(1), 43–​48. https://​doi.org/​10.1016/​
j.pscychresns.2013.11.004
Lenggenhager, B., Hilti, L., & Brugger, P. (2015). Disturbed body integrity and the ‘rubber foot illu-
sion’. Neuropsychology, 29(2), 205–​211. https://​doi.org/​10.1037/​neu0000143
Lenggenhager, B., Tadi, T., Metzinger, T., & Blanke, O. (2007). Video ergo sum: manipulating bodily
self-​consciousness. Science, 317(5841), 1096–​1099. https://​doi.org/​10.1126/​science.1143439
Lesur, M. R., Aicher, H., Delplanque, S., & Lenggenhager, B. (2020). Being Short, Sweet, and
Sour: Congruent Visuo-​Olfactory Stimulation Enhances Illusory Embodiment. Perception, 49(6),
693–​696. doi:10.1177/​0301006620928669
Lesur, M. R., Gaebler, M., Bertrand, P., & Lenggenhager, B. (2018). The plasticity of the bodily
self: head movements in bodily illusions and their relation to Gallagher’s body image and body
schema. Constructivist Foundations, 14(1), 94–​105.
Longo, M. R., Azañón, E., & Haggard, P. (2010). More than skin deep: body representation beyond
primary somatosensory cortex. Neuropsychologia, 48(3), 655–​668. https://​doi.org/​10.1016/​j.neur
opsychologia.2009.08.022
 Conclusion  283
Margulies, D. S., Kelly, A. M. C., Uddin, L. Q., Biswal, B. B., Castellanos, F. X., & Milham, M. P. (2007).
Mapping the functional connectivity of anterior cingulate cortex. NeuroImage, 37, 579–​588. https://​
doi.org/​10.1016/​j.neuroimage.2007.05.019
Meador, K. J., Loring, D. W., Feinberg, T. E., Lee, G. P., & Nichols, M. E. (2000). Anosognosia and
asomatognosia during intracarotid amobarbital inactivation. Neurology, 55, 816–​820. https://​doi.
org/​10.1212/​WNL.55.6.816
Mohr, H. M., Zimmermann, J., Rder, C., Lenz, C., Overbeck, G., & Grabhorn, R. (2010). Separating
two components of body image in anorexia nervosa using fMRI. Psychological Medicine, 40, 1519–​
1529. https://​doi.org/​10.1017/​S0033291709991826
Mölbert, S. C., Thaler, A., Mohler, B. J., Streuber, S., Romero, J., Black, M. J., Zipfel, S., Karnath, H.
O., & Giel, K. E. (2018). Assessing body image in anorexia nervosa using biometric self-​avatars
in virtual reality: attitudinal components rather than visual body size estimation are distorted.
Psychological Medicine, 48(4), 642–​653. https://​doi.org/​10.1017/​S0033291717002008
Moro, V., Zampini, M., & Aglioti, S. M. (2004). Changes in spatial position of hands modify tactile
extinction but not disownership of contralesional hand in two right brain-​damaged patients.
Neurocase, 10(6), 437–​443. https://​doi.org/​10.1080/​13554790490894020
Nelson, B., Yung, A. R., Bechdolf, A., & McGorry, P. D. (2008). The phenomenological critique and
self-​disturbance: implications for ultra-​high risk (‘prodrome’) research. Schizophrenia Bulletin, 34,
381–​392. https://​doi.org/​10.1093/​schbul/​sbm094
Nico, D., Daprati, E., Nighoghossian, N., Carrier, E., Duhamel, J. R., & Sirigu, A. (2010). The role of
the right parietal lobe in anorexia nervosa. Psychological Medicine, 40, 1531–​1539. https://​doi.org/​
10.1017/​S0033291709991851
Northoff, G., Heinzel, A., de Greck, M., Bermpohl, F., Dobrowolny, H., & Panksepp, J. (2006). Self-​
referential processing in our brain—​a meta-​analysis of imaging studies on the self. NeuroImage,
31(1), 440–​457. https://​doi.org/​10.1016/​j.neuroimage.2005.12.002
Nunn, K., Frampton, I., Seim, T., Törzsök-​sonnevend, M., & Lask, B. (2011). Anorexia nervosa and
the insula. Medical Hypotheses, 76(3), 353–​357. https://​doi.org/​10.1016/​j.mehy.2010.10.038
Paillard, J. (1999). Body schema and body image—​a double dissociation in deaffernted patients. In
G. N. Gantchev, S. Mori, & J. Massion (eds.), Motor Control: Today and Tomorrow (pp. 197–​214).
Academic Publishing House: Sofia, Bulgaria.
Penner, L. A., Thompson, J. K., & Coovert, D. L. (1991). Size overestimation among anorexics: much
ado about very little? Journal of Abnormal Psychology, 100(1), 90–​93. https://​doi.org/​10.1037/​
0021-​843X.100.1.90
Phan, K. L., Wager, T., Taylor, S. F., & Liberzon, I. (2002). Functional neuroanatomy of emotion: a
meta-​analysis of emotion activation studies in PET and fMRI. NeuroImage, 16, 331–​348. https://​
doi.org/​10.1006/​nimg.2002.1087
Pitron, V., Alsmith, A., & de Vignemont, F. (2018). How do the body schema and the body image
interact? Consciousness and Cognition, 65, 353–​358. https://​doi.org/​10.1016/​j.concog.2018.08.007
Provenzano, L., Porciello, G., Ciccarone, S., Lenggenhager, B., Tieri, G., Marucci, M., Dazzi, F.,
Loriedo, C., & Bufalari, I. (2020). Characterizing body image distortion and bodily self-​plasticity in
anorexia nervosa via visuo-​tactile stimulation in virtual reality. Journal of Clinical Medicine, 9(1),
98. https://​doi.org/​10.3390/​jcm9010098
Qin, P. & Northoff, G. (2011). How is our self related to midline regions and the default-​mode net-
work? NeuroImage, 57(3), 1221–​1233. https://​doi.org/​10.1016/​j.neuroimage.2011.05.028
Raichle, M. E., MacLeod, A. M., Snyder, A. Z., Powers, W. J., Gusnard, D. A., & Shulman, G. L. (2001).
A default mode of brain function. Proceedings of the National Academy of Sciences of the United
States of America, 98, 676–​682. https://​doi.org/​10.1073/​pnas.98.2.676
Riva, G. (2012). Neuroscience and eating disorders: the allocentric lock hypothesis. Medical
Hypotheses, 78(2), 254–​257. https://​doi.org/​10.1016/​j.mehy.2011.10.039
Riva, G. (2014). Out of my real body: cognitive neuroscience meets eating disorders. Cortex, 8, 1–​20.
https://​doi.org/​10.3389/​fnhum.2014.00236
Riva, G. (2016). Neurobiology of anorexia nervosa: serotonin dysfunctions link self-​starvation with
body image disturbances through an impaired body memory. Frontiers in Human Neuroscience,
10(600), 1–​10. https://​doi.org/​10.3389/​fnhum.2016.00600
284  Neural underpinnings
Riva, G. (2018a). Locked to a wrong body: eating disorders as the outcome of a primary disturbance
in multisensory body integration. Consciousness and Cognition, 59, 57–​59. https://​doi.org/​10.1016/​
j.concog.2017.08.006
Riva, G. (2018b). The neuroscience of body memory: from the self through the space to the others.
Cortex, 104, 241–​260. https://​doi.org/​10.1016/​j.cortex.2017.07.013
Riva, G. & Dakanalis, A. (2018). Altered processing and integration of multisensory bodily represen-
tations and signals in eating disorders: a possible path toward the understanding of their under-
lying causes. Frontiers in Human Neuroscience, 12, 1–​7. https://​doi.org/​10.3389/​fnhum.2018.00049
Romano, D. & Maravita, A. (2019). The dynamic nature of the sense of ownership after brain in-
jury. Clues from asomatognosia and somatoparaphrenia. Neuropsychologia, 132. https://​doi.org/​
10.1016/​j.neuropsychologia.2019.107119
Schulte-​Rüther, M., Markowitsch, H. J., Fink, G. R., & Piefke, M. (2007). Mirror neuron and theory
of mind mechanisms involved in face-​to-​face interactions: a functional magnetic resonance im-
aging approach to empathy. Journal of Cognitive Neuroscience, 19(8), 1354–​1372. https://​doi.org/​
10.1162/​jocn.2007.19.8.1354
Schwoebel, J. & Coslett, H. B. (2005). Evidence for multiple, distinct representations of the human body.
Journal of Cognitive Neuroscience, 17(4), 543–​553. https://​doi.org/​10.1162/​0898929053467587
Shaqiri, A., Roinishvili, M., Kaliuzhna, M., Favrod, O., Chkonia, E., Herzog, M. H., Blanke, O., &
Salomon, R. (2018). Rethinking body ownership in schizophrenia: experimental and meta-​
analytical approaches show no evidence for deficits. Schizophrenia Bulletin, 44(3), 643–​652. https://​
doi.org/​10.1093/​schbul/​sbx098
Sherman, S. M. & Guillery, R. W. (2002). The role of the thalamus in the flow of information to the
cortex. Philosophical Transactions of the Royal Society B: Biological Sciences, 357(1428), 1695–​1708.
https://​doi.org/​10.1098/​rstb.2002.1161
Tsakiris, M., Hesse, M. D., Boy, C., Haggard, P., & Fink, G. R. (2007). Neural signatures of body owner-
ship: a sensory network for bodily self-​consciousness. Cerebral Cortex, 17(10), 2235–​2244. https://​
doi.org/​10.1093/​cercor/​bhl131
Vallar, G. & Ronchi, R. (2009). Somatoparaphrenia: a body delusion. A review of the neuro-
psychological literature. Experimental Brain Research, 192, 533–​551. https://​doi.org/​10.1007/​
s00221-​008-​1562-​y
van der Hoort, B. & Ehrsson, H. H. (2014). Body ownership affects visual perception of object size by
rescaling the visual representation of external space. Attention, Perception, & Psychophysics, 76(5),
1414–​1428. https://​doi.org/​10.3758/​s13414-​014-​0664-​9
Via, E., Goldberg, X., Sánchez, I., Forcano, L., Harrison, B. J., Davey, C. G., Pujol, J., Martínez-​Zalacaín,
I., Fernández-​Aranda, F., Soriano-​Mas, C., Cardoner, N., & Menchón, J. M. (2018). Self and other
body perception in anorexia nervosa: the role of posterior DMN nodes. World Journal of Biological
Psychiatry, 19(3), 210–​224. https://​doi.org/​10.1080/​15622975.2016.1249951
Whitfield-​Gabrieli, S., Thermenos, H. W., Milanovic, S., Tsuang, M. T., Faraone, S. V., McCarley, R.
W., Shenton, M. E., Green, A. I., Nieto-​Castanon, A., LaViolette, P., Wojcik, J., Gabrieli, J. D. E., &
Seidman, L. J. (2009). Hyperactivity and hyperconnectivity of the default network in schizophrenia
and in first-​degree relatives of persons with schizophrenia. Proceedings of the National Academy of
Sciences of the United States of America, 106, 1279–​1284. https://​doi.org/​10.1073/​pnas.0809141106
Wotruba, D., Michels, L., Buechler, R., Metzler, S., Theodoridou, A., Gerstenberg, M., Walitza, S.,
Kollias, S., Rössler, W., & Heekeren, K. (2014). Aberrant coupling within and across the default
mode, task-​positive, and salience network in subjects at risk for psychosis. Schizophrenia Bulletin,
40, 1095–​1104. https://​doi.org/​10.1093/​schbul/​sbt161
Zhao, W., Yao, S., Li, Q., Geng, Y., Ma, X., Luo, L., Xu, L., & Kendrick, K. M. (2016). Oxytocin
blurs the self-​other distinction during trait judgments and reduces medial prefrontal cortex re-
sponses: oxytocin blurs self-​other distinction. Human Brain Mapping, 37(7), 2512–​2527. https://​
doi.org/​10.1002/​hbm.23190
 17
Body schema and body image disturbances
in individuals with multiple sclerosis
Britt Normann

17.1 Introduction

Body schema and body image are concepts of relevance for how we understand human
beings, disease, health, and communication, which are important aspects within all
health professions. Particularly within the field of neurology, in cases such as multiple
sclerosis (MS) where sensorimotor control over movement is a main problem, these
concepts are of high relevance. Body schema and body image may, however, mean dif-
ferent things within various theoretical positions and professional traditions. How pro-
fessionals, such as physiotherapists, conceive body and movement, core elements also
involving body schema and body image, influence their clinical practice in terms of
understanding signs and symptoms, the importance of various impairments, and how
to communicate with the patient. Accordingly, the understanding of these concepts
will colour their professional clinical reasoning, interactions, and treatment, and, as
such, the health services provided.
The current theoretical framework concerning body and movement that operates
within the field (World Confederation for Physical Therapy, 2016) relies on the bio-
medical and biopsychosocial model (Engel, 1977). In these models, body and move-
ment are viewed from a third-​person perspective, and the signs and symptoms of
persons with MS are considered neurophysiological disturbances in the subsystems of
the central nervous system (CNS). Accordingly, body schema is understood as an inner
(neuronal) representation or model of the body; body image is purely associated with
the cognitive systems (Brodal, 2010; Gjelsvik & Syre, 2016). Likewise communication
processes, so important in therapeutic contexts, are conceived in purely third-​person
terms, comprising verbal utterances, gazes, and gestures that transmit information
(Shumway-​Cook & Wollacott, 2012; Thornquist, 2009). Thus, the traditional models
fail to address the patients’ first-​person pre-​reflective bodily experience, specifically
the phenomenology associated with neurologically disturbed control of movement.
Within neurological physiotherapy, there seems to be a gap between the search for
signs, symptoms, and movement disturbances and the implications of these embodied
aspects for the patient as a person, characterized by an intentionality that is embodied
and constituted through motility, sensation, and perception (Merleau-​Ponty, 2013).

Britt Normann, Body schema and body image disturbances in individuals with multiple sclerosis In: Body Schema and Body
Image. Edited by: Yochai Ataria, Shogo Tanaka, and Shaun Gallagher, Oxford University Press. © Oxford University Press 2021.
DOI: 10.1093/​oso/​9780198851721.003.0017
286  Body schema and body image disturbances
In the case of MS, a phenomenological perspective on the body allows for an under-
standing of the dysfunctions in neurophysiological processes and their interactions
within the networks of the CNS in terms of disturbances of the individual’s intention-
ality and interactions with the world. This phenomenology may include modulations
of body schema, body image, and the patient’s sense of agency or sense of body own-
ership integral to a self-​pattern. In the wake of a recent growing philosophical debate
on body and movement within physiotherapy (Broberg et al., 2003; Macdonald &
Nicholls, 2017; Nicholls & Gibson, 2010; Nicholls & Holmes, 2012), it will be suggested
that the physiotherapist’s understanding of the individual, and how conceptions of
body schema and body image come into play, is imperative for purposes of adapting the
therapeutic approach to the specific patient and for co-​constructing meaning with the
patient, which are the two main principles to optimize recovery (Levin, Kleim, & Wolf,
2009) and participation in everyday life.

17.2  Body schema, body image, and self-​pattern

Body schema and body image are integrated into our normal everyday behaviour and
action and are difficult to distinguish, both phenomenologically and neurologically.
The usefulness of this distinction between body schema and body image is questioned
by some authors (Berlucchi & Aglioti, 1997; Biocca, 1997; Fisher, 1972), while others
argue that the distinction, established by evidence of double dissociations in patients
with neurological lesions (Gallagher, 2005; Paillard, 1999), continues to be useful, es-
pecially in understanding a variety of disorders. For the purpose of deepening our
understanding of individuals with MS and the professional interactions facilitated by
physiotherapists to optimize movement control, I argue that the distinction provides
increased depth in phenomenological analysis and may generate knowledge that po-
tentially augments opportunities for individualization and co-​construction of meaning
in the therapeutic process.
In this chapter, I follow Gallagher (2005), who defines the concept of body schema as
a close-​to-​automatic system of sensorimotor processes that constantly regulate posture
and movement to serve intentional action such as reaching and grasping, walking, and
other activities involved in daily living. The body schema generally functions without
the agent’s awareness of the body or requirement of perceptual monitoring. In contrast,
the body image may involve a reflective or perceptual awareness of one’s own body and
affective attitudes toward it, sometimes informed by one’s conceptual knowledge about
bodies in general. Both body schema and body image, as well as the relationship be-
tween the two, may be disturbed following MS.
To understand how these concepts relate to a person’s ongoing experience, it may be
helpful to relate them to a second pair of distinct concepts regarding embodied aspects
of the self, namely, the sense of agency and the sense of ownership (Gallagher, 2005).
These concepts are closely related to, and can deepen, our understanding of body
 Body schema, body image, and self-pattern  287
schema and body image. A sense of agency is a pre-​reflective sense that I am the ini-
tiator or source of an action. When I reach for an object, my sense is that I am the one
who generates the action and that I am in control of the movement (Gallagher, 2005).
In that respect, a sense of agency is dependent on the motor control processes of the
body schema, and these are often affected following MS. The sense of ownership or
‘mine-​ness’ is described as the pre-​reflective sense that it is my body that is moving in
an action and that I experience this movement as mine (Gallagher, 2005). The som-
atosensory systems, which are often disturbed in individuals with MS, are particularly
important for the sense of ownership.
To provide a broader theoretical framework for these concepts, I will employ the
concept of ‘self-​pattern’, understood as a pattern that includes these and other fac-
tors (such as self-​narrative), organized in a dynamical way to constitute an individual
person (Gallagher, 2013; Gallagher & Daly, 2018). Specifically, the elements that, in
their dynamical relations, form a self-​pattern include bodily and pre-​reflective experi-
ential aspects (including the sense of ownership and the sense of agency), affect, inter-
subjective factors, psychological and cognitive factors, the capacity for self-​narrative,
and the effects of one’s social, cultural, and normative environment. First, within the
dynamics of the self-​pattern, the somatosensory, perceptual, and motor networks of
the body involved in both body schema and body image support and shape the more
conscious and affective systems and thereby influence what a person thinks, feels, and
communicates about himself or herself and what objects or affordances in the environ-
ment the person perceives as invitations to act. These factors are reflected in a person’s
actions and self-​narrative. In an individual’s everyday life, different environments offer
different affordances for action (Gibson, 1977); such affordances, defined as relations,
directly depend on the patient’s embodied capabilities and skills. That is, affordances
offered by different environments are perceived in accordance with what one actu-
ally can do and thus are directly related to one’s body schema and the sense of agency.
This has direct implications for physiotherapy, which depends on the integration of
approaches that address sensorimotor and postural capacities and their integration in
meaningful activities.
Second, the self-​pattern includes intersubjective factors, which emphasize that I see
myself both in distinction from others (implicit in the sense of ownership) and in re-
lation to others, and that experiences relating to others contribute to my body image,
thoughts, and attitudes toward myself (Gallagher, 2013). Social interaction is an essen-
tial part of participation in activities of daily living and integral to professional inter-
action with the patient.
In the following sections, I will discuss how a first-​person phenomenology of the
body (Merleau-​Ponty, 2013) and the concepts of body schema and body image as part
of a dynamic self-​pattern (Gallagher, 2005; 2013; Gallagher & Daly, 2018) may show
that an individual’s embodied self is at stake when suffering from MS, by using citations
from in-​depth research interviews with individuals with MS, and suggest some impli-
cations for physiotherapy.
288  Body schema and body image disturbances
17.3  Disturbances of body schema in individuals with MS—​and
implications for self

Demyelination in the descending systems, involving both postural control and distal se-
lective movement, is common in individuals with MS (Compston & Coles, 2008). These
lesions often result in paresis, abnormally increased muscle tone, and hyperreactivity
(spasticity). In the clinic, these bodily changes are usually recorded at a body function
and structure level, decontextualized from the patient’s lived body. A description from
a severely disabled woman (55 years old) with spastic paraparesis, understood in light
of body schema and body image, may help us to interlink the sensorimotor impair-
ments with the experiential aspects relating to the embodied self. In the interview, she
described standing up and walking as follows:

. . . when I try to stand up, I feel a strong resistance in my body, it is as the lower part of
my body ‘fights’ against me! When trying to move forward, I feel pushed back! So, over
the years, I have found a way to ‘team up’ with my body in a way (laughing) —​I count
one, two, three while moving rhythmically forward and backwards and then the body
becomes softer or more ‘manageable’ in a way. At three, I ‘force’ myself up in standing
using my arms. Oh . . . in standing, my legs are terrible!! In a way, they are living ‘their
own life’; they push me up on my toes, the muscles feel like ‘violin-​strings’, and the
legs are heavy and stiff as ‘timber logs’, impossible to move before I have stood for a
little while, pressing myself down and moved my upper body slowly and rhythmically.
Then, when the legs usually ‘calm down’ a bit, and with effort, I can make a few steps.
However, often the leg crosses over in front of the other, like a ‘tight spring’, so it is a
perhaps strange kind of walking (laughing) but they still bring me for a few metres
around indoors on (smiling), to the window or something.

This testimony illustrates some sensorimotor disturbances of body schema and sev-
eral implications for the embodied self. Overall, the patient’s descriptions indicate a
kind of division between the upper and the lower parts of her body, where particu-
larly the latter has become the intentional object of perception. In terms of the well-​
functioning parts, such as the upper trunk, the head, and the arms, the body to some
degree operates silently in the background, while the lower part dominates her per-
ceptual field, particularly when the legs are involved in an activity. Thus, in terms of
her upper body part, body schema and body image appear to be interacting, allowing
her to be directed to her surroundings, while a dissociation between body schema and
body image is indicated regarding her pelvis and legs. Her words ‘the lower part of my
body “fights” against me’ elucidate this dissociation. Together with her descriptions
of her legs as ‘timber logs’ and ‘violin strings’, I interpret a deviation in the relation-
ship between the body-​as-​subject and the body-​as-​object, where the latter dominates
regarding her lower body parts. In line with Leder (1990), we may say that her legs
dys-​appear for her while the upper limbs dis-​appear. Interactions with the world are
dramatically weakened in activities that demand interaction between the upper and
 Disturbances of body schema in individuals with MS  289
lower body parts, such as standing up and walking, resulting in an augmented inward
orientation at the expense of an outward direction. Her lived space is different in terms
of distance, time, and objects of interest and meaning, compared to when she was
healthy. Her relationship with the world, or affordances, is changed as a consequence of
body-​schematic disturbances.
The example illuminates how the senses of agency and ownership are weakened
when paresis, increased tone, and hyperreactivity underneath the foot soles occur.
Additionally, in pathology, these senses seem to fluctuate, depending on the situation.
As shown in the example, active initiation and various degrees of control of one’s own
movement may still be possible by consciously monitoring, effort, and compensatory
strategies. Accordingly, as she is still able to interact with her surroundings, some de-
gree of sense of agency is present; however, the pre-​reflective aspects of self are severely
compromised.
The perception of having to ‘fight’ with her own body seems to enhance an observer
attitude, perceiving that part of her body as something ‘alien’ or other than herself—​
even though she perfectly knows on a reflective level that the legs are hers. These first-​
hand experiences indicate that severe spasticity over time may provoke a degree of
dissociation between body schema and body image that disturbs the senses of owner-
ship and agency regarding the affected body parts. In line with Paillard’s (1999) classi-
fications of a weakened sense of ownership, I associate her narratives with ‘abnormal’
body feelings, as well as with a degree of ‘uselessness’. The legs are useless when ‘living
their own life’, and if this was the case all the time, they may have been ‘worthless’ for
her. However, she appreciates the ability to make some steps indoors, indicating that
the dissociation fluctuates.
Interestingly, in her descriptions of how she uses self-​induced movements to ‘team
up’ with her affected body parts, I consider as a way to interlink or reintegrate body
schema and body image to strengthen her senses of ownership and agency regarding
her lower limbs. Through self-​induced movements, she enhances her own control
of her body and movements, enabling her to stand up and to take some steps. This
movement strategy, I suggest, involves some kind of embodied ‘negotiations’ with, or
processing of, the body-​schematic capacities, particularly of the pelvis and legs, ena-
bling these to scaffold her functional movements. Thus, less dissociation between body
schema and body image seems to be experienced or to use her words ‘she has “teamed
up” with her body and achieved more possibilities to interact with the world’. Despite
all the effort and discomfort, the achievement of a strengthened sense of agency seems
to be important for her. Her strategy of gaining more movement control, or sense of
agency, may have enabled her to avoid a negative view regarding herself. The close re-
lationship between the various body-​schematic capacities and thoughts, beliefs, and
emotions regarding oneself may be the reason for her to try to maintain the ability to
stand up and take a few steps on her own. By being capable of these activities, although
in a different way than when healthy, she inhabits her lived space in a way that has some
elements of previous times. She can still choose when to stand up and go to the window.
As such, these aspects may mean something for her identity and self-​confidence.
290  Body schema and body image disturbances
Lesions in the somatosensory systems are common following MS, particularly in the
initial phases of the disease (Compston & Coles, 2008) where these can be classified as
minor. Physiotherapists and neurologists are trained to identify sensory disturbances
in sensibility, such as touch, pain, temperature, proprioception, paranesthesia, etc.,
through systematically performed procedures. Somatosensory impairments are often
viewed as ‘soft’ signs. Third-​person clinical descriptions of lesions in the CNS and
disturbances of somatosensory body functions as ‘minor’ diverge from MS patients’
first-​person descriptions of their perceptions of their situations (Arntzen, Øberg,
Gallagher, & Normann, 2019; Normann, Sørgaard, Salvesen, & Moe, 2013). An ex-
ample is from an interview of a woman presenting with minimal sensory impairments
in her upper limbs following an acute worsening of the disease who described her
hands as follows:

My hands have been so strange the last few weeks, —​the constant tickling, pins and
needles I feel —​it is annoying, steels my attention —​it is difficult to explain but when
I for example sit down to read a book, I become disturbed and confused, because I feel
my eyes seek the hands all the time! I just feel I have to watch them . . . ‘The worst thing
is, however, in my work as a nurse, it is so difficult to perform injections! My shoulders
come up to my ears, I use so much effort . . . can’t interact with the patient . . . I have to
constantly watch my fingers so carefully, —​I feel exhausted and think about how the
future may be’ (tears in her eyes).

This example illuminates how disturbances of the somatosensory capacities of

body schema may influence the embodied self. First, these somatosensory disturb-
ances imply that the details of bodily movement are no longer smoothly operating in
the background because the ‘pins and needles’ demand the individual’s attention to-
ward her hands. The ability to take her hands for granted seems to be constrained. The
hands are not there pre-​reflectively for her, particularly when sitting quiet and relaxed
or while performing fine motor activities; the hands appear as objective ‘somethings’ in
her perceptual field. Her body awareness seems to be brought to a conscious level and
involves the body image. The disturbances of proprioceptive and kinaesthetic processes
that normally feed body-​schematic functions involved in motor control may now con-
tribute to a disturbance of her pre-​reflective awareness of her hands, i.e., the tacit or
recessive self-​experience involved in Gibson’s (1977) notion of ecological perception,
which is an important factor in body-​schematic control. These disturbances of her
body–​brain relationship modulate her sense of agency as they constrain her capacity
to read the book.
Thus, second, the experiences of minor somatosensory disturbances indicate a devi-
ation in the senses of ownership and agency. The ‘pins and needles’ felt in sitting could
be associated with Paillard’s (1999) descriptions of deviations in the sense of owner-
ship as unfamiliarity—​abnormal bodily feelings. The augmented orientation toward
her hands, at the expense of outward orientation, leads to limitations in her inter-
actions (as a nurse) with her patient. Performing injections is still an affordance for
 Body schema disturbances and implications for physiotherapy  291
her, a meaningful task she can accomplish. However, her sense of agency seems to be
weakened as she has to consciously ‘supervise’ or monitor the activity, which implies
a slight deviation toward body image-​driven movements. The described exhaustion
may be because of more static muscle work and, perhaps more importantly, because
the cognitive systems, which, from a neurobiological point of view, have great access to
adjusting the fine-​graded movements of the fingers, are more involved in the activity
than when healthy. Moreover, this unfamiliarity regarding her hands evokes emo-
tions and her worries for the future. The strength of these emotions may be because the
changes in her body schema, even when they are minor, are shaking her foundations as
a person—​involving agency and ownership, as well as how she views herself in regard
to maintaining her work as a nurse.
These examples and analyses suggest some changes in the experiential and existen-
tial aspects of the self-​pattern, involving the senses of agency and ownership, affective
attitudes about oneself, and the capacity for intersubjective interactions in individuals
with MS with various degrees of sensorimotor disturbances. These changes are not only
about neurophysiological and biomechanical deviations; for the individual, they are
about lived bodies, perceived affordances, and different attitudes, beliefs, and emotions
they have regarding themselves. In that respect, we may say that the body-​schematic
disturbances provide consequences for their self-​identity.

17.4  Body schema disturbances and implications

for physiotherapy

In terms of the physiotherapeutic process, phenomenologically based insights re-

garding body schema call for attention toward the importance of examining the pre-​
reflective aspects of experience, as opposed to only recording the explicit perceptual
monitoring of somatosensory capacities (measured in tests of various sensory modal-
ities) and motor activation (strength, tone, coordination) in standardized neurological
clinical examination. These assessments focus on the body as a biological system, de-
contextualized from functional activities and experiences from everyday life, and com-
munication processes that are verbal.
In the context of physiotherapy, intersubjectivity means that the patient and the
physiotherapist working together in therapy are embodied selves and perceive and ex-
press meaning through their physical interactions, movement, gazes, and gestures, as
well as words, which is in line with what Merleau-​Ponty (2013) terms ‘intercorporeity’.
Consequently, the concept of embodiment expands the professional communicative
dimensions and allows for attention to, and appreciation of, non-​verbal bodily expres-
sions that occur, sometimes on a non-​conscious or on a pre-​reflectively conscious level.
These aspects of self can be traced through the therapist’s observations of functional
movement such as dressing, walking, reaching out for an object, etc. More specifically,
while the patient is performing an activity, observations of how the patient moves with
respect to the postural base of support and movement quality, such as flow, rhythm,
292  Body schema and body image disturbances
and task accomplishment, inform the physiotherapist about what the patient directs
his/​her attention toward, the degree of control, and strategies for movement. We may
say that the patient as a body expresses some aspects of his/​her embodied self through
movement, and the physiotherapist may be attentive to these as aspects of the patient’s
self-​pattern.
Likewise, professional touch and interactions, while the patient is moving (hands-​
on facilitations of movement), allow the physiotherapist to gain information about the
patients’ body-​schematic capacities or sensibility, muscle tone, power, and coordin-
ation on a pre-​reflective level (Normann, 2018). Moreover, such specific physical inter-
actions may inform the physiotherapist and the patient about embodied capacities to
move actively together in task-​oriented activities, such as stepping and walking, and
accordingly inform both of them about possibilities for improvement. Thus, through
specific physical interactions, the physiotherapist can be attentive toward what the
patient, as a body, ‘tells’ her in terms of the sensorimotor capacities of body schema.
Additionally, the therapist may inform the patient through specific, targeted hands-​on
interactions to explore possibilities for change—​something that has the potential for
establishing an intercorporeity between therapist and patient. The distinction between
body schema and body image thus illuminates the possibilities of individualized com-
munication needed in clinical examination and treatment of individuals with MS. The
choice of addressing what the patient expresses in movement on a pre-​reflective level or
on a more reflective explicit level, or in combination, adds new dimensions to under-
standing communication in clinical practice.
To succeed in investigating these dynamical aspects of the individual’s self-​pattern,
the physiotherapist needs knowledge from several theoretical disciplines, a kind of
propositional knowledge which Ryle (1945) calls ‘knowing that’, regarding several
aspects of the human body and movement. However, more importantly, in the con-
text of professional physical interaction, embodied interactional therapeutic skills in-
volve a form of ‘knowing how’ (Ryle, 1945). Knowing how includes embodied skills,
including ‘online’ (reflection-​in-​action) recognition (Schön, 1991) of optimal move-
ment, deviations from optimal, and skills to facilitate improvements, as well as the
abilities to create trust and cooperation with the patient. When successful hands-​on
facilitation of movement is performed, e.g., during weight transfer as the patient en-
gages in stepping, the physiotherapist, in that very moment, knows on an embodied
pre-​reflective level (involving the therapist’s own body schema) when to initiate the
step. Concurrently, the patient (as a body) knows when she is capable of taking over
and making the step. They both have incorporated know-​how, enabling them to grasp
the situation. If it were necessary to bring this communication to a reflective level, the
actual moment would have passed and the experience of making an automatic step
would be inaccessible for the patient. Such skilled interactions, I will argue, constitute
an embodied communicative approach aimed at enabling the individual with sen-
sorimotor disturbances to experience more of ‘I can’ and thus potentially generate a
sense of agency, as well as positive thoughts and self-​narratives and attitudes regarding
oneself.
 Body schema and body image disturbances  293
A patient with spastic paraparesis expressed it like this and, at the same time, illus-
trated the limitations of words and the potential power of specific physical interaction
as communication (Normann et al., 2013, p. 27):

If she had only told me what to do—​I wouldn’t have had a clue!! But she guided me
(the body) with her hands while she explained how I could do it. I felt like it was some-
thing ‘new’—​a new way of moving, I activated something else, something I did a long
time ago . . . But it felt right, good and strange.

17.5  Body schema and body image disturbances: dynamics and

perceptions of change

Observations of real-​life physiotherapy sessions with individuals with MS and subse-

quent interviews with the patients provide some examples that illuminate the import-
ance of identifying reduced postural control and somatosensory functions in patients
with MS and to address them specifically in a way that provides meaning for the pa-
tients, particularly in the early phases of the disease when neuroplasticity is most avail-
able. The following report from a patient may illustrate this suggestion (Normann et al.,
2013, p. 26):

Yes, I felt it was easier to walk after the consultation. It was especially the movements
and the stimulation of my feet that made the difference (smiling) . . . especially, when
I was standing on one leg afterwards. Yes, then I felt the floor better and I managed to
put on my trousers while standing without a need for support!”

These first-​hand reflections involve the idea of having a ‘maximum grip’, which is a
key concept in Merleau-​Ponty’s (2013) philosophy. What he calls motor or embodied
intentionality, constituted by the agent’s dynamical integration of motility, sensation,
and perception, enables the body immediately to grasp affordances in a situation
without any explicit (or representational) cognition. In the above example, the body-​
schematic capacities, particularly regarding the affected foot, seem to be changed
through the physiotherapist’s hands-​on interactions, providing sensory activation and
tissue mobilization, combined with active and passive movements. These changes may
have improved interactions with the world as the patient felt the floor better and his pos-
tural capacity and balance were improved. These changes, effected on a pre-​reflective
level of awareness, may have enabled him to negotiate a ‘new’ way of getting dressed.
We may say that the patient achieved the necessary body-​schematic capacities to grasp
a specific way of moving that afforded him the possibility of putting on his trousers
while standing. As such, this is an example of how restructuring of body-​schematic
capacities immediately (re-​)organizes intentional actions without requiring concep-
tual thinking, propositional instructions, or deliberative planning. To achieve ‘max-
imal grip’ in a situation is actually what physiotherapy, at its best, is about—​enabling the
294  Body schema and body image disturbances
patient to transfer improvements in ‘bits and parts’ (such as gaining proper alignment
and an interaction of his feet with the floor) into holistic functional activities (such as
dressing, which, by the way, is one of the most complicated motor activities that we do
every day) and experience the achievement as meaningful.
Affective attitudes toward the body, which may involve body image, mean that the
person adopts a particular emotion toward her own body or body part(s). Such emo-
tional attitudes are well known in the psychosomatic field of physiotherapy (Kolnes,
2012; Thornquist, 2006), but they are less focused on in neurological physiotherapy. In
a recent interview study (Arntzen et al., 2019), participants shared their experiences
and reflections following a six-​week group-​based physiotherapy programme. One se-
verely disabled participant, able to walk indoors with two crutches for short distances,
expressed his feelings as follows (ID 13, M (64), EDSS 5.5) (Arntzen et al., 2019, p. 11):

I couldn’t do it because my body doesn’t listen. I don’t have the skill and balance and
strength to perform the exercises from instructions, and I had to give up, and I felt like
watching the ship go down . . . When you are invited to do the same as the group and
you can’t do it, you just cannot do it! Then, I moved backwards in time and remem-
bered so strongly when I had that functional level.

This quote illustrates how the patient expresses his body-​schematic capacities in a
third-​person description of himself. A dissociation between body schema and body
image appears—​his ‘body doesn’t listen’ and the senses of ownership and agency are
strongly weakened. There appears to be a mismatch between the demands/​expectations
in the situation and his body-​schematic capacities. This mismatch, the dissociation be-
tween body schema and body image, results in the feeling of ‘I can’t’. This retrospect
evaluation is even more accentuated when the other group members perform the ex-
ercises perfectly, which elicits his memory of when he was well functioning. The asso-
ciation with ‘watching a ship going down’ indicates a feeling of worthlessness, in line
with Paillard’s (1999) classifications, and thus a strong degree of reduced ownership.
Such experiences of devaluation of himself and ‘I can’t’ seem to be accompanied by
an affective grief regarding lost corporeal identity rooted in an established disturbance
of self-​pattern. The example illustrates the power of the body-​schematic capacities to
shape the individuals’ thoughts, attitudes, and emotions regarding oneself.
Interestingly, a striking feature in the observations of real-​life physiotherapy ses-
sions with individuals with MS and subsequent interviews with the patients was the
strong emotional aspects related to perceptions of improved body-​schematic capacities
during and following the training period (Arntzen et al., 2019). These expressions were
independent of the degree of disability. One participant with minor disability used
these words after the training period (ID 4, W (49), EDSS 1.5) (p. 9):

‘ . . . This is the best thing that has happened since I got the diagnosis! Yes! I get so emo-
tional when thinking about it [tears in her eyes] . . .’ ‘Ever since I got the diagnosis, I have
had a huge M-​S on my shoulders; it has unintentionally dragged me down.’ ‘ . . . Can
 Body schema and body image disturbances  295
you imagine! It [the training] had such an effect! If I had only known . . . ’ ‘ . . . When
I perceived how good it was for my entire system, for my body, I got so motivated!’

This example illustrates how positive changes in body-​schematic capacities are per-
ceived as meaningful and are accompanied by a change in her feelings regarding her-
self. The perceived bodily changes seem to ‘boost’ a stream of positive energy and to
foster new thoughts regarding her own situation. Her expressions indicate that she has
regained some aspects of her self-​pattern, or identity, possessed prior to the disease.
The strength of the emotions expressed when the patient talked about perceived bodily
changes reflects the fact that they mean so much more to the individual than the meas-
urable bodily improvements. Accordingly, the example shows how perceived physical
improvements nourish the sense of agency and the patient’s self-​narratives and thereby
provide positive changes in her self-​pattern. The perceived changes are integrated into a
meaningful structure in her life.
Sometimes, body image is informed by one’s conceptual knowledge about bodies in
general (Gallagher, 2013), from what the individual has learnt at school, from books,
and potentially from clinical encounters with the physiotherapist or the neurologist,
etc. A patient who was struggling with balance and walking and who has had a reactive
(hypersensitive) foot made the following comment, which I associate with embodied
learning. After the physiotherapist explained what she was doing while mobilizing and
desensitizing the sole of the patient’s foot and then allowed her to re-​explore her bal-
ance, the patient said (Normann et al., 2013, p. 25):

Yes, I have had several aha-​experiences today! I know from my daily life that if I trip
on a little pebble on the floor, then I fall . . . But I have never seen this problem in rela-
tion to the hypersensitivity underneath my feet. Even though I know that the smallest
irregularity underneath my feet is painful, I have never seen that (the reactive foot) as
a part of my balance problems . . . I now realize more about the interrelationships in
my body.

These reflections illustrate how the perceived improvements in walking seemed

to enable her to link together the specific disturbances regarding her feet to previous
walking experiences and the therapist’s explanations. This way of contextualizing per-
ceptions of movement may thus influence the patient’s knowledge regarding human
movement in general and her own body in particular.
The intersubjective factors of an individual’s self-​pattern emphasize that I see my-
self both in distinction from others (implicit in the sense of ownership) and in relation
to others. Likewise, experiences relating to others contribute to the formation of body
image (Gallagher, 2013). Clinical encounters are themselves intersubjective contexts.
By utilizing adapted targeted physical interactions enabling the patient to move (e.g.,
mobilization of a foot, followed by weight transfer and a step) together with the physio-
therapist, a kind of shared agency takes place. I would argue that the physiotherapist and
the patient together co-​construct the activity and the sense this activity makes to each
296  Body schema and body image disturbances
of them. In line with the concept of participatory sense-​making (Fuchs & De Jaegher,
2009), I consider the physiotherapist’s tuning into, or ‘listening’ particularly through
their hands to, the patient’s body-​schematic expressions as involving an embodied
(intercorporeal) alignment with the patient. When the facilitated movement succeeds
(the physical interaction enables the patient to transfer weight and step), joint attention
and coordination with each other evolve and new ideas of possibilities of improvement
in walking may emerge as a result of this embodied participatory sense-​making. The
enthusiastic descriptions of perceptions of improved body-​schematic capacities and
functional activities during and following a training period (Arntzen et al., 2019) may
indicate a recognition of their prior habitual body. This recognition, I associate with
enactive knowing, a concept in which embodied knowledge and how we engage with
others are essential (De Jaegher, 2019). It seems to me that pre-​reflective awareness of
body-​schematic capacities, i.e., of what I am able to do, and the senses of ownership and
agency that accompany that awareness may strengthen human knowing and enhance
one’s engagement in the interaction with others or the world.
Interestingly, in such embodied interactions, the verbal dialogue between the physio-
therapist and the patient becomes enriched as both the patient and the physiotherapist
verbalize actual bodily perceptions and new possibilities and raise new questions,
which together generate new insights for both (Arntzen et al., 2019; Lahelle, Øberg,
& Normann, 2018; Normann, Sørgaard, Salvesen, & Moe, 2014; Øberg, Normann, &
Gallagher, 2015). In contrast, when general and objectivist verbal physiotherapeutic
communications dominate in the encounter, immediate improvements in movement
are not observed; there is less interactive engagement, and the verbal dialogue is dom-
inated by the physiotherapist (Lahelle et al., 2018). These elaborations show the po-
tential for approaches that emphasize an interactive body-​schematic approach, which
strengthens both sensorimotor and postural capacities, enhances the senses of own-
ership and agency in the patient, and fosters an improved body image. An interactive
(communicative) body-​schematic approach implies that physical interactions follow
the structure of a dialogue, which involves listening to and answering each other in a
skilled and respectful way. However, since the physiotherapist is the professional, the
interaction is asymmetrical, which really means that the therapist holds a particular re-
sponsibility to listen to what the patient expresses as a body.
The intersubjective factors influencing the individual’s self-​pattern are perhaps even
stronger in group settings since both improvements and lack of such changes are visible
to the other group members. This is obvious in the previous example of ‘feeling like a
ship going down’ when watching the other group members’ successful performance of
exercises. The following conversation is from an observed scenario in which the group
performed a standing forefoot lifting exercise, and one of the patients made a comment
to another patient (a man) who initially had severely reduced balance (Lahelle, Øberg,
& Normann, 2019, p. 6):

‘Your balance is better!’ . . . ‘Yes, it’s unbelievable!’, the man replies with a proud smile
on his face. The third patient also smiles and nods her assent as the group continues
 Body schema and body image disturbances  297
the exercise, and the PT asks if they perceive that their feet are lighter to lift compared
to before they joined the group. ‘Yes, it is easier.’

The excerpt illuminates the importance of the others’ positive comments regarding a
person’s performance and how these can influence one’s well-​being. When the others in
the group and the physiotherapist accentuate the improvements, the patient’s feeling of
‘I can’ is strengthened. The bodily experiences seem to be provided with meaning, even
though it is only about a balance exercise and not his everyday life. The feeling of suc-
cess in an exercise in the group enlightens the person in a positive way and may nourish
the person’s self-​narratives.
For many adults, being unsteady is associated with loss and distress, particularly in
social settings, which therefore are often avoided. This was the background for a young
individual with MS with impaired balance prior to an individualized group-​based
intervention, and his reflections afterwards were as follows (Arntzen et al., 2019, p. 10):

Previously, I didn’t dare to try anything because I was afraid to fail, but now, I have
decided to go for it—​no matter what! . . . As I felt my body started to function again,
and I managed to do things again, I wanted to try once more things that I couldn’t
manage previously. So, my self-​confidence has improved, along with my bodily
improvements.

This quote provides an example of how disturbances of body schema may shape the
way a person considers himself. His descriptions indicate that the impaired balance
disrupted his grasp of his everyday life. The disturbed postural control and somatosen-
sory capacities were accompanied by a growing doubt about himself regarding what
he was capable of doing and what others might think about him. These thoughts con-
strained his everyday life as he ‘didn’t dare to do anything’. We may say that these body-​
schematic disturbances reduced his social life and participation—​narrowing what was
perceived as relevant affordances. Using Pacherie’s (2007) terminology, we can say that
his present intentions were affected by his disturbed motor (or body-​schematic) inten-
tionality. On the one hand, deteriorations in sensorimotor and postural capacities or
disruptions in an individual’s body schema are likely to produce more situations of
‘I can’t’; moreover, this disability will be obvious to other people and thereby induce
negative changes in body image in terms of what one thinks about oneself and one’s re-
lationship toward others and the world. On the other hand, the bodily improvements
and experiences from participating in group training seem to foster ‘new’ desires and
thoughts regarding oneself and future activities. The experience of ‘I managed to do
more things again’ indicates that one can reflectively make sense of one’s actions in
everyday life, consistent with one’s beliefs and desires and self-​narrative. These experi-
ences seemed to induce reflections that provided the patient with future intentions—​
‘I want to try once more . . . ’. When positive bodily changes are incorporated into a
meaningful structure, they may lead to more initiative and success in the activities of
daily living and accordingly allow for more positive thoughts, beliefs, and attitudes
298  Body schema and body image disturbances
regarding oneself. This example illuminates how positive changes in body-​schematic
capacities may restructure the individual’s self-​pattern, including extended and inter-
actional factors.
The link between changes in body-​schematic capacities, the senses of agency and
ownership, body image, and new affordances and options for interactions serves to
recontextualize clinical practice within the neurological field. It is no longer about
checklisting an individual’s physical, psychological, emotional, and social well-​being
as separate elements, as described by the World Confederation for Physical Therapy
(2016). The conceptual framework that includes body schema and body image allows
for a dynamical integration of these elements as they form the individual’s self-​pattern.
Accordingly, recognition of these concepts allows health personnel to understand that
sensorimotor disturbances following MS (and other neurological diseases) affect the
entire person as an embodied self.

17.6 Conclusion

In terms of body and movement, neurological physiotherapy has traditionally been

anchored in biomedical and biopsychosocial frameworks (World Confederation for
Physical Therapy, 2016) and has been concerned with task accomplishment and ef-
fectiveness (De Souza & Bates, 2011; European Multiple Sclerosis Platform (EMSP),
2012; Gjelsvik & Syre, 2016; Shumway-​Cook & Wollacott, 2012). Less attention has
been paid to what coordinated movement may mean for a person’s feeling of self or
identity. By recognizing the concepts of body schema and body image as theoretical
frameworks for understanding persons with MS, disturbances of sensorimotor capaci-
ties can be understood as disruptions of the individual’s self-​pattern, having effects on
the person’s experience, their actions, and their intersubjective interactions. As such,
this framework has the potential to provide an extended and potentially more mean-
ingful understanding of individuals with MS than views of their disturbances as merely
malfunctioning neurophysiological processes and disease activity.
An important professional consequence of using this theoretical framework is that
specificity in neurological physiotherapy is recontextualized to involve options to in-
dividualize the patient and through various modalities of interaction to influence the
patient’s self-​pattern and construction of meaning. The need for specificity regarding
body-​schematic capacities is particularly important, as sensorimotor and postural
capabilities are cornerstones for intentionality and perceptions of affordances in
daily life, as well as thoughts and attitudes toward oneself. Within the practice of
physiotherapy, relevant competences that can influence the patient’s self-​pattern in
an individualized way are: (1) advanced movement analysis to identify even minor
somatosensory, motor, and postural deviations and their consequences for the
individual’s lived space, affordances, and social interaction; and (2) multimodal
interactional skills, including specific hands-​on facilitation, to explore improvement
in relevant body-​schematic capacities in a way that the patient immediately grasps as
 Conclusion  299
meaningful and to integrate these perceived changes into functional activities of sig-
nificance for the individual. In this regard, process adjustments together with the pa-
tient, embodied invitations for active participation, and co-​construction of meaning
should be emphasized. The dynamical links between pre-​reflective self-​experiences
and the reflective and narrative aspects of the self-​pattern emphasize the importance
of searching for positive changes in movement in individual patients to expand and
deepen the dialogue and co-​construction of meaning. Meaningfulness is essential
for patients’ relearning processes and participation in their own rehabilitation and
health promotion.

References
Arntzen, E. C., Øberg, G. K., Gallagher, S., & Normann, B. (2019). Group-​based, individualized
exercises can provide perceived bodily changes and strengthen aspects of self in individuals
with MS: a qualitative interview study. Physiotherapy Theory and Practice, 1–​16. doi:10.1080/​
09593985.2019.1683923
Berlucchi, G. & Aglioti, S. (1997). The body in the brain: neural bases of corporeal awareness. Trends
in neurosciences, 20(12), 560–​564.
Biocca, F. (1997). The cyborg’s dilemma: progressive embodiment in virtual environments. Journal of
Computer-​Mediated Communication, 3(2), JCMC324.
Broberg, C., Aars, M., Beckmann, K., Emaus, N., Lehto, P., Lähteenmäki, M., Thys, W., &
Vandenberghe, R. (2003). A conceptual framework for curriculum design in physiotherapy
education—​an international perspective. Advances in Physiotherapy, 5(4), 161–​168.
Brodal, P. (2010). The Central Nervous System: Structure and Function (fourth edition). New York,
NY: Oxford University Press.
Compston, A. & Coles, A. (2008). Multiple sclerosis. The Lancet, 372(9648), 1502–​1517.
De Jaegher, H. (2019). Loving and knowing: reflections for an engaged epistemology. Phenomenology
and the Cognitive Sciences, 2019, 1–​24.
De Souza, L. & Bates, B. (2011). Multiple sclerosis. In M. Stokes & E. Stack (eds.), Physical Management
for Neurological Conditions (third edition) (pp. 89–​116). London and Edinburgh: Churchill
Livingstone Elsevier.
Engel, G. L. (1977). The need for a new medical model: a challenge for biomedicine. Science,
196(4286), 129–​136.
European Multiple Sclerosis Platform (EMSP). (2012). Recommendations on rehabilitation services for
persons with multiple sclerosis in Europe. Brussels: European Multiple Sclerosis Platform.
Fisher, S. (1972). Body image. In D. Sills (ed.), International Encyclopedia of Social Sciences (Vol. 2, pp.
113–​116). New York, NY: Collier-​Macmillian.
Fuchs, T. & De Jaegher, H. (2009). Enactive intersubjectivity: participatory sense-​making and mu-
tual incorporation. Phenomenology and the Cognitive Sciences, 8(4), 465–​ 486. doi:10.1007/​
s11097-​009-​9136-​4
Gallagher, S. (2005). How the Body Shapes the Mind. Oxford: Oxford University Press.
Gallagher, S. (2013). A pattern theory of self. Frontiers in Human Neuroscience, 7, 443.
Gallagher, S. & Daly, A. (2018). Dynamical relations in the self-​pattern. Frontiers in Psychology, 9, 664.
Gibson, J. J. (1977). The Theory of Affordances. Hilldale, USA, 1(2), 67–​82.
Gjelsvik, B. E. B. & Syre, L. (2016). The Bobath Concept in Adult Neurology. Stuttgart: Thieme.
Kolnes, L.-​J. (2012). Embodying the body in anorexia nervosa—​a physiotherapeutic approach.
Journal of Bodywork and Movement Therapies, 16(3), 281–​288.
Lahelle, A. F., Øberg, G. K., & Normann, B. (2018). Physiotherapy assessment of individuals with
multiple sclerosis prior to a group intervention—​a qualitative observational and interview study.
Physiotherapy Theory and Practice, 36(3), 386–​96.
300  Body schema and body image disturbances
Lahelle, A. F., Øberg, G. K., & Normann, B. (2019). Group dynamics in a group‐based, individualized
physiotherapy intervention for people with multiple sclerosis: a qualitative study. Physiotherapy
Research International, 25(3), e1829.
Leder, D. (1990). The Absent Body. Chicago, IL: University of Chicago Press.
Levin, M. F., Kleim, J. A., & Wolf, S. L. (2009). What do motor ‘recovery’ and ‘compensation’ mean
in patients following stroke? Neurorehabilitation and Neural Repair, 23(4), 313–​319. doi:10.1177/​
1545968308328727
Macdonald, H. & Nicholls, D. A. (2017). Teaching physiotherapy students to ‘be content with a body
that refuses to hold still’. Physiotherapy Theory and Practice, 33(4), 303–​315.
Merleau-​Ponty, M. (2013). Phenomenology of Perception. London: Taylor & Francis.
Nicholls, D. A. & Gibson, B. E. (2010). The body and physiotherapy. Physiotherapy Therapy and
Practice, 26, 497–​509.
Nicholls, D. A. & Holmes, D. (2012). Discipline, desire, and transgression in physiotherapy practice.
Physiotherapy Theory and Practice, 28(6), 454–​465. doi:doi:10.3109/​09593985.2012.676940
Normann, B. (2018). Facilitation of movement: new perspectives provide expanded insights to guide
clinical practice. Physiotherapy Theory and Practice, 36(7), 769–​78.
Normann, B., Sørgaard, K. W., Salvesen, R., & Moe, S. (2013). Contextualized perceptions of move-
ment as a source of expanded insight: people with multiple sclerosis’ experience with physio-
therapy. Physiotherapy Theory and Practice, 29(1), 19–​30.
Normann, B., Sørgaard, K. W., Salvesen, R., & Moe, S. (2014). Clinical guidance of community
physiotherapists regarding people with MS: professional development and continuity of care.
Physiotherapy Research International, 19(1), 25–​33.
Øberg, G. K., Normann, B., & Gallagher, S. (2015). Embodied-​enactive clinical reasoning in physical
therapy. Physiotherapy Theory and Practice, 31(4), 244–​252.
Pacherie, E. (2007). The sense of control and the sense of agency. Psyche, 13(1), 1–​30.
Paillard, J. (1999). Body schema and body image: a double dissociation in deafferented patients. In
G. N. Gantchev, S. Mori, & J. Massion (eds.), Motor Control, Today and Tomorrow (pp. 197–​214).
Marseilles, C N R S-​NBM.
Ryle, G. (1945). Knowing how and knowing that: the presidential address. Proceedings of the
Aristotelian Society, 46, 1–​16. doi:10.2307/​4544405
Schön, D. A. (1991). The Reflective Practitioner: How Professionals Think in Action. Great Briain: Arena,
Asgate Publishing Limited.
Shumway-​Cook, A. & Wollacott, M. H. (2012). Motor Control: Translating Research into Clinical
Practice (fourth edition). Philadelphia, PA: Lippincott Williams & Wilkins.
Thornquist, E. (2006). Face-​to-​face and hands-​on: assumptions and assessments in the physiotherapy
clinic. Medical Anthropology, 25(1), 65–​97.
Thornquist, E. (2009). Kommunikasjon: Teoretiske Perspektiver på Praksis i Helsetjenesten
[Communication: Theoretical Perspectives on Practice in the Health Care]. Oslo: Gyldendal
akademisk.
World Confederation for Physical Therapy. (2016). What is physiotherapy? Available from: https://​
www.wcpt.org/​what-​is-​physical-​therapy
 18
Body schema and pain
Katsunori Miyahara

18.1 Introduction

The aim of this chapter is to situate Merleau-​Ponty’s notion of body schema within the
context of contemporary philosophy of pain. In mainstream analytic philosophy of
mind, pains are most commonly characterized as sensory representations of one’s body.
The sensory experience of pain is primarily understood as a way of gaining knowledge
about one’s bodily state. For instance, Michael Tye notes: ‘a pain in the leg, I suggest,
is a token sensory experience which represents that something in the leg is damaged,
something moreover that is painful or hurts’ (Tye, 1995, p. 228). In opposition to these
representationalist theories of pain, the recently emerging imperativist theories pro-
pose to characterize pains as bodily commands. They envision the experience of pain
more pragmatically, as a matter of being moved to take some action. For instance, Colin
Klein maintains that ‘pains are imperatives. They are sensations with a content, and that
content is a command to protect a part of your body’ (Klein, 2015b, p. 1). As I show
below, the conceptual distinction between body image and body schema nicely cap-
tures this recent development in philosophical theories of pain. Furthermore, I suggest
that Merleau-​Ponty can add a fruitful contribution to this discussion by challenging the
hidden Cartesian assumptions widely shared among contemporary theorists.
Section 18.2 starts by expounding on Merleau-​Ponty’s notion of body schema and
discusses how it bears on his account of sensory experiences, including the experience
of pain. Section 18.3 connects these notions to current philosophical treatments of
pain. It presents a brief review of the two most influential positions in this area: repre-
sentational and imperative theories of pain. Imperativism, I suggest, partly overcomes
the Cartesian conception of the body by focusing on the role of body schema. To see
how theories of pain can escape the dualistic picture of mind and body, thus, it will
be helpful to examine imperativist explanations. Section 18.4 will undertake this task
by criticizing Colin Klein’s imperativist account of a rare pathological condition called
pain asymbolia. Section 18.5 contrasts this with an enactive approach to pain, deeply
inspired by Merleau-​Ponty’s account of the phenomenon. It turns to some lines of phe-
nomenological research to clarify and support this alternative approach.

Katsunori Miyahara, Body schema and pain In: Body Schema and Body Image. Edited by: Yochai Ataria, Shogo Tanaka, and Shaun
Gallagher, Oxford University Press. © Oxford University Press 2021. DOI: 10.1093/​oso/​9780198851721.003.0018
302  Body schema and pain
18.2  Merleau-​Ponty on body schema and pain

The notion of body schema plays a central role in Merleau-​Ponty’s analysis of human
experience developed in Phenomenology of Perception. The traditional Cartesian model
of mind and body leads us to think of human behaviour either as mechanical reactions
to physical stimuli or as rational means to achieve preconceived ends. Merleau-​Ponty
opposes both these lines of thoughts, which he refers to as empiricism and intellec-
tualism, respectively. Rather, on his view, human behaviour is fundamentally based on
an embodied form of intelligence. The body is already disposed to generate patterned,
adaptive responses to situations without being controlled by the intellectual mind.
The notion of body schema refers to these embodied dispositions that underpin non-​
intellectual, yet intelligent behaviours.
The function of the body schema corresponds to the range of phenomena we or-
dinarily associate with the notion of habits. On a standard account, habits consist of
dispositions to generate patterned responses to various circumstances. For instance,
according to Christos Douskos: ‘On the most skeletal characterization, habit is an
agent’s disposition or propensity to do something in certain circumstances, a dispos-
ition acquired by having regularly done the same thing in similar circumstances in the
past’ (Douskos, 2017, p. 1133). In a similar vein, Merleau-​Ponty suggests that habits
consist of ‘the power of responding with a certain type of solution with a certain form
of situation’ (Merleau-​Ponty, 1945/​2012, p. 143). This implies that habitual responses
are much more flexible and adaptive than mechanical reactions. Suppose you have the
habit of holding the door for the next person entering the building. Then you engage in
the same behavioural pattern of holding the door every time you encounter a situation
where you go through a door and someone is behind you. But this is not to say that you
reproduce the exact same series of movement on account of this habit. Rather, it means
that you engage in the same type of action while flexibly adjusting the precise move-
ments, depending on the specificities of the situation (e.g., whether it is a push or pull
door, whether the door is on your right or left, how far the next person is) (Miyahara
et al., 2020). Merleau-​Ponty envisions the body schema to be the system that regulates
such flexible, patterned responses to given situations performed on the basis of em-
bodied habits: ‘Acquiring a habit,’ he writes, ‘[is] the reworking and renewing of the
body-​schema’ (Merleau-​Ponty, 1945/​2012, p. 143).
As Shaun Gallagher (1995) points out, the notion of body schema significantly im-
proves our understanding of the role of the body in the organization of conscious ex-
perience. Modern neuroscience and philosophy tend to consider the body exclusively
as an intentional object of experience—​the body contributes to experience only when
we are aware of it in one way or another. Such experiences, which are in effect various
mental representations of the body, are often described in psychology as body images
(Gallagher, 1995, p. 226). In psychology, this notion is often conflated with that of
body schema, but Gallagher insists that, properly understood, they must refer to dis-
tinct forms of functions and experiences. For one thing, as we saw above, the body
schema sustains habitual engagements with the environment without involving mental
 Merleau-Ponty on body schema and pain  303
representations. To that extent, it is best expressed ‘as a set of laws rather than a set of
images’ (Gallagher, 1995, p. 233). Moreover, it points to a different form of contribu-
tion the body makes to our experience—​the body schema functions beneath the level
of consciousness without necessarily making the body itself the intentional object of
experience; however, its implicit operation significantly affects the organization of our
conscious experience. As Gallagher puts it, ‘it functions on the other side of the inten-
tional relation, that is, [ . . . ] it functions to make perception possible and to constrain
intentional consciousness in various ways’ (Gallagher, 1995, p. 226). He calls this the
pre-​noetic functioning of the body schema.
What does this precisely mean? To begin, body schemas shape our experience of
action by giving it an anticipatory structure. In habitual behaviours, we are headed to-
ward the completion of a behavioural pattern without necessarily preconceiving a spe-
cific goal or planning the upcoming course of action. They thus bear a non-​cognitive
form of intentionality, motor intentionality, which consists of ‘an anticipation or grasp
of the result assured by the body itself as a motor power’ (Merleau-​Ponty, 1945/​2012,
p. 113). Furthermore, by acquiring motor habits, we come to perceive different possi-
bilities in a given situation. In Merleau-​Ponty’s words, body schemas normally have
the function of projection—​they ‘polarise the world, causing a thousand signs to ap-
pear there, as if by magic, that guide action, as signs in a museum guide the visitor’
(Merleau-​Ponty, 1945/​2012, p. 115). Or to borrow the terminology of the ecological
psychologist James J. Gibson, body schemas regulate behaviours by enabling the per-
ception of affordances (Miyahara et al., 2020). This is not to say that habitual agents
simply come to recognize that a given situation involves a range of action possibilities
in a detached manner. Rather, the perceived situation engages them affectively and im-
mediately motivates them toward a certain type of action. In other words, perception
enabled by body schemas does not present us simply with inert action possibilities, but
with forceful ‘solicitations’ (Dreyfus, 2013) or ‘invitations’ (Withagen et al., 2012) to-
ward embodied engagement.
Accordingly, Merleau-​Ponty refuses to conceive of sense perception simply as a
matter of experiencing determinate sensory qualities. Rather, he proposes to define
‘sensation as coexistence or as communion’ (Merleau-​Ponty, 1945/​2012, p. 221). That
is to say that, in the first instance, sensations do not inform us of anything about the
world, such as when we recognize the colour of an object based on colour perception.
Rather, they are presented to the body as a solicitation to respond in certain ways, while
lacking any sort of clarity to the mind. Sensing is primarily a way of engaging with
the world, rather than that of gaining knowledge about it. Sensible qualities function
primarily as guidance for action—​‘the sensing subject,’ Merleau-​Ponty notes, ‘does not
posit them as objects, but sympathizes with them, makes them its own, and finds in
them his momentary law’ (p. 221).
It is clear that this notion of ‘sensation as coexistence’ is meant to also apply to ex-
periences of pain as he presents it right after rejecting intellectualist conceptions of
vision, touch, and pain (Merleau-​Ponty, 1945/​2012, p. 220). According to Merleau-​
Ponty, the body in pain is first and foremost the ‘affective background that first throws
304  Body schema and pain
consciousness outside of itself ’ (p. 96) by guiding the agent into embodied engagements
with the situation. For Merleau-​Ponty, the experience of pain is sustained by the oper-
ation of the body schema just as well as other sensory modes of perceptual experience.
The idea that pain functions primarily to regulate bodily behaviour is not entirely
foreign to modern science. In fact, many think that animals have evolved the capacity
to feel pain precisely because it helps them navigate the environment safely without
threatening the integrity of their body. Merleau-​Ponty would deny, however, that the
body schema simply functions to maintain the biological integrity of the human agent.
Habits do not just generate patterned behaviours, but they are themselves shaped
through repeated engagements with certain patterns of acting. Clare Carlisle nicely
summarizes the point—​‘The phenomenon of habit,’ she writes, ‘testifies to the power
of action not merely to produce an effect, but to generate and to shape further actions.
Actions, when repeated, lead to the formation of a habit; a habit represents a sort of
accumulation of actions’ (Carlisle, 2006, p. 77). Merleau-​Ponty also notes in the same
vein that the body schema is constantly enriched and reorganized in virtue of pat-
terned engagements with the environment (Merleau-​Ponty, 1945/​2012, pp. 154–​155).
Importantly, since the human environment not only is a place for biological survival,
but rather is a place to live a social and cultural life, this means that the body schema de-
velops in such a way as to adapt us better to the sociocultural environment in which we
happen to be situated. For Merleau-​Ponty, thus, the body schema is sensorimotor and
sociocultural at the same time.
This implies that embodied engagements solicited by the experience of pain should
not just serve to promote survival, but rather function to fit agents into their society and
culture. These pain-​related behaviours should thus exhibit some degree of sociocul-
tural variation—​people from different sociocultural backgrounds should exhibit dif-
ferent styles of responding to pain. This prediction gains support from several lines of
existing research. Modern city-​dwellers might think that experiences of pain typically
induce responses that serve to defend the body, such as withdrawal, avoidance, protec-
tion, and careful attending to the body. It has been shown in a classic anthropological
study, however, that the Bariba people living in Benin and Nigeria are ‘notable for con-
sistently demonstrating an “absence of manifest behavior” when confronted with ap-
parently painful stimuli, such as childbirth, wounds, or initiation ordeals’ (Sargent,
1984, p. 1299; cited in Rollman, 2004, p. 164). In their society, pain is strongly associ-
ated with shame, and thus people are strongly expected to suppress bodily expressions
of pain. Pain-​related behaviours of the Bariba people are sustained by a body schema
system adapted to their unique sociocultural environment.
But the same seems to also apply to modern city-​dwellers; even in modern cities,
parents encourage children to resist crying in face of painful situations, and the latter
develop habitual attitudes toward pain accordingly (Buytendijk, 1961, p. 144). In fact,
some authors even point out that the embodied experience of pain is mediated by the
sociocultural environment from the very beginning of our life. For instance, David
B. Morris writes: ‘Even the pain of newborns bears the imprint of social structures
(such as family or hospital) and of cultural environment (such as an ethnic group or
 Hidden Cartesian assumptions in philosophy of pain  305
nation) that necessarily surround, shape, and influence it’ (Morris, 1999, p. 118). Of
course, the newborns will not have explicit memories about their initial experience
of pain, but the way their pain has been handled by the caregivers already start to af-
fect the development of their body schemas that regulate bodily responses to painful
situations.

18.3  Hidden Cartesian assumptions in philosophy of pain

Merleau-​Ponty’s notion of body schema can offer a corrective to some of the hidden
Cartesian assumptions informing theories of pain in mainstream analytic phil-
osophy of mind. As we have seen, Merleau-​Ponty envisions the body schema as a non-​
representational system of sensorimotor functions, mediated by the sociocultural
environment, which contributes to the organization of action and perception at the
same time. Moreover, his writings suggest that the experience of pain is shaped by the
pre-​noetic functioning of the body schema. For Merleau-​Ponty, pain is thus a funda-
mentally bodily phenomenon, which refuses theoretical treatments based on a dual-
istic conception of mind and body.
To see how this notion of body schema is relevant to current debates, I briefly review
some recent developments in philosophy of pain. Within current literature, one finds
two prominent groups of theories concerning the nature of pain: representational the-
ories and imperative theories. According to representationalism, the experience of pain
consists of a form of perceptual experience of the body—​to feel pain is to have a sensory
representation of a body part as undergoing some form of damage or disorder (Bain,
2003; Pitcher, 1970; Tye, 1995; Cutter & Tye, 2011). There are different views regarding
the precise nature of the representational content of pain. On one popular account,
known as evaluativism, the experience of pain involves two layers of content—​it rep-
resents the body objectively as being in a certain state and also represents this bodily
state in evaluative terms (Bain, 2013; Cutter & Tye, 2011; Helm, 2002). When we have
low back pain, for example, we represent in our mind that our low back is in a certain
condition (say, very stiff) and also that said condition is bad for us. Other representa-
tionalists do not necessarily think that the experience of pain itself involves some form
of evaluation of the body (Brady, 2018; Jacobson, 2019; Pitcher, 1970). In any case, all
representational theories envision pain as a form of sensory experience about the body,
i.e., as a form of body image.
According to imperativism, on the other hand, pain is a non-​linguistic form of com-
mand sent out by the body, a bodily sensation with imperative content (Klein, 2007,
2015b; Martínez, 2011; Martínez & Klein, 2016). Pain motivates us to do something
in response to the experience without informing us what is going on with our body.
When we have low back pain, for example, we are immediately moved to change our
posture so as to relieve the tension in our back. In so doing, however, we are not neces-
sarily aware of the nature of the physical state of this body part. In fact, the pain-​related
response is sometimes performed so spontaneously that we are hardly aware of it. For
306  Body schema and pain
imperativists, representational theories gravely mischaracterize the experience of pain
and its close motivational connection to pain-​related behaviour.
Colin Klein argues that the imperativist concept of pain is supported by consider-
ations about its biological role. Prominent theories in pain science indicate that pain is
a kind of homeostatic sensation—​namely, a species of ‘sensations that motivate action
to preserve some bodily parameters within acceptable limits’ (Klein, 2015b, p. 10). As
such, it is comparable to other bodily sensations, such as thirst, hunger, fatigue, and the
feeling of the need to urinate, that move us to undertake behaviours that contribute to
maintaining or restoring homeostasis. Call them homeostatic behaviors. Klein argues
that these points are best accommodated by holding that pains are sensations with im-
perative content (pp. 27–​33). According to imperativism, thus, the experience of pain
is sustained by a sensorimotor system that serves to regulate homeostatic behaviours
in the environment, i.e., a form of body schema. Klein notes that, from an imperativist
standpoint, ‘pain should have a relationship to the body schema rather than the body
image’ (p. 93). More specifically, he suggests, it should be sustained by the category of
body schemas that serve to maintain the integrity of the agent’s body—​‘a body schema
representation which is primarily concerned with protective action: that is, one which
maps out parts of our bodies that we should pay special attention to, avoid using, keep
from contacting things, and so on’ (p. 94).
The contrast between representationalism and imperativism in philosophy of pain,
thus, squarely maps onto the conceptual distinction between body image and body
schema. Given this, one might think that Merleau-​Ponty would lend additional phe-
nomenological support to the latter position. Indeed, he would certainly accept the
basic observation of imperativism that pain is first and foremost a motivational sensa-
tion directly linked to our embodied responsiveness. Beyond this, however, Merleau-​
Ponty’s phenomenological account will offer challenges to imperativism.
First, consider the imperativist claim that pain is a homeostatic sensation, that its
sole function is to motivate homeostatic behaviours for protecting the body. This dir-
ectly contradicts Merleau-​Ponty’s notion of body schema as a sensorimotor system
closely coupled to the sociocultural environment. The anthropological study about the
Bariba people described above suggests that the experience of pain can stop motivating
protective responses at all, depending on the sociocultural background. But even if we
suppose that imperativism is right to say that pain is always sustained by body schemas
for protective action, we cultivate different habitual styles for doing so through our up-
bringing, which is to say that these protective responses are still shaped by sociocultural
factors. For Merleau-​Ponty, thus, the experience of pain is sustained by a sociocultur-
ally modified variation of the body schema system concerned with protective action,
which Klein talks about. For lack of a better expression, call this the body schema pri-
marily concerned with self-​preserving action, i.e., a system of sensorimotor dispositions
that regulate bodily responses to physical perturbations that normally function to pro-
tect one’s biological body while also respecting one’s sociocultural identity.
The second challenge Merleau-​ Ponty’s phenomenologically informed account
of body schema offers to imperativism is more fundamental. In Merleau-​Ponty’s
 Imperativism and pain asymbolia  307
philosophy, as we saw above, the notion of body schema facilitates us to overcome
the Cartesian dualistic picture of mind and body—​it clarifies how the body contrib-
utes pre-​noetically to the organization of action and perception, in a way traditionally
understood to be the function of the mind, and hence does not squarely fit into the
category of objects. Representational theories of pain are decidedly dualistic to the ex-
tent that they envision the experience as a form of body image—​the body is treated un-
equivocally as an object. Imperative theories partially overcome the objective concept
of the body by acknowledging its inherent intelligence—​the body is taken to be intelli-
gent enough to motivate protective actions when they are needed, namely, when one’s
biological integrity is likely to be under threat. But to the extent that the embodied in-
telligence of the body schema is understood in terms of the capacity to issue imperative
contents, it is still entrenched in the dualistic picture. While traditional dualism insists
that the disembodied mental agent governs the body, imperativism holds that the body
motivates the disembodied agent into protective actions by communicating with it in
terms of mental contents. The traditional relationship between the two terms is surely
overturned, but the fundamental separation is still retained. In this sense, imperativists
are still desperately captured by the Cartesian dualistic picture.
One consequence of this can be seen in the imperativist treatment of pain-​related
actions. As I have argued elsewhere, imperativism mischaracterizes non-​deliberate
behaviours immediately motivated by the experience of pain, which I call immediate
pain-​coping, by equating it with a form of command-​obeying action (Miyahara, ms).
Command-​obeying exhibits several features, which are not found in immediate pain-​
coping: (1) receiving a command is not necessarily, or even typically, an experience
laden with negative affectivity; (2) we can obey commands only by recognizing some-
thing, such as spoken or written statements, as commands; (3) we obey commands only
when we accept the issuer of the command as an authority in the relevant practical do-
main. In essence, pain-​coping does not involve a dualistic separation between the body
and the agent comparable to that between the issuer of the command and the one who
obeys it. It is rather a form of habitual behaviour, i.e., a patterned embodied response to
situations shaped through the agent’s history of engagement with the natural and socio-
cultural environment. Therefore, the imperativist analogy between pain and command
is flawed.
In the following, I would like to specify the charge of Cartesian dualism against
imperativism in a different way by looking into the pathological case of pain asymbolia.

18.4  Imperativism and pain asymbolia

Pain asymbolia is a pathological condition caused by brain damage, which involves

some part of the insular cortex but spares the somatosensory cortex (Grahek, 2011;
Bain, 2014; Klein, 2015a, b). People with this condition, or asymbolics, are able to
recognize physical pains, but they are no longer affectively moved by them; they do
not ‘display any affective or motor responses to painful stimuli’ (Grahek, 2011, p. 43).
308  Body schema and pain
When physically disturbed in a way that normally causes unpleasant pain, they report
that they feel pain, but they exhibit no sign of distress; they seem to experience the
pain without any unpleasantness or motivational force. Yet pain asymbolia does not
only affect the ability to feel pain in affective terms, but it also makes people react in-
differently to threatening situations more generally (Bain, 2014; Klein, 2015a, b). For
example, when they are threatened by potentially harmful objects (like a hammer, a
knife, or a needle), or unexpectedly exposed to loud noises or strong flashes of light,
they show no sign of being bothered by them. Furthermore, the indifference to pain is
not merely psychological but is also reflected in their physiological dispositions; they
exhibit an inhibited pattern of reflexive behaviour in response to normally painful
stimuli. As Klein notes, asymbolics are reported to make ‘only mild reflexive responses
to extremely intense stimuli and none at all to less intense manipulations’ (Klein,
2015b, p. 151).
Pain asymbolia offers a challenge to imperative theories of pain. On this view, pain
is a form of command and hence is inherently motivating. If imperativism is true, ac-
cordingly, pains must always motivate the agent to make the relevant kind of bodily
response. But pain asymbolics seem to experience pain without being motivated by it,
which means that pains are in fact not always motivating. Therefore, pain asymbolia
directly demonstrates that imperativism is false. Or so one might claim.
Klein responds by rejecting the assumption that if pains are inherently motivating
commands, then they must always be motivating for the agent. In general, a command
can fail to motivate an agent if the latter does not see its relevance (Klein, 2015b, pp. 79–​
82). For example, if your physical trainer tells you to run laps during a training session,
you will take it as a motivating command, but if a random stranger gives you the same
command out of the blue, you will certainly not be moved to obey it. Klein suggests that
pain asymbolics are unmotivated by physical pains for similar reasons. These patients
are not moved by pains because ‘they have lost the capacity to care about their bodies in
whatever way is relevant to pain’ (Klein, 2015b, p. 145; see also Klein, 2015a). The body
continues to command the patient to protect oneself from a physical threat, and she is
even able to notice it, but nonetheless not moved by it because she is no longer inter-
ested in protecting her body due to the brain damage. This explains why these patients
are also indifferent to indications of potential harm to their body—​if they did not care
about their body, then naturally, they ‘should be indifferent to bodily threats regardless
of modality’ (Klein, 2015b, p. 148). According to Klein, therefore, pain asymbolia poses
no threat to the imperative thesis that pains are imperatives.
But how would imperativism accommodate the fact these patients exhibit an in-
hibited pattern of spinal reflex in response to physical disturbances? Klein rightly wor-
ries that this may trouble his model—​‘Why would spinal-​level reflexes,’ he writes, ‘be
reliably suppressed by something like lack of care?’ (Klein, 2015b, p. 151). But he pro-
poses to diffuse this worry simply by pointing out that there is a range of scientific evi-
dence showing that ‘all spinal reflexes are continually modulated by top-​down signals
from the cortex’ (p. 151). It is questionable, however, whether this is particularly sup-
portive of his account. This is because even if it is agreed that there is constant top-​down
 Imperativism and pain asymbolia  309
modulation from the cortex to the spinal neurons, the question remains of how to
understand the nature of this process.
A straightforward reading of imperativism suggests that it is a form of representa-
tional process. According to imperativism, we normally care about our own bodily in-
tegrity. This makes it reasonable for us to respond as quickly as possible to potentially
or actually damaging physical perturbations. Accordingly, the cortex sends top-​down
commands to the spinal neurons, telling them to promote reflexive responses to these
kinds of stimuli. In pain asymbolia, on the contrary, the agent’s caring attitude is dis-
rupted. So there is no reason to prioritize quick responses to damaging physical per-
turbations. Accordingly, the cortex stops sending these top-​down commands and the
spinal neurons stop promoting reflexive behaviours. On the imperativist account, this
is why asymbolics exhibit an inhibited pattern of spinal reflexes vis-​à-​vis painful phys-
ical perturbations.
This imperativist account, however, suggests a serious over-​intellectualization of the
neurobiological process. If this is meant to be a causal explanation of why spinal re-
flexes are inhibited in pain asymbolia, there must be a meaningful relationship between
the semantic content of the top-​down signal to promote reflexive responses and the
normal excitation patterns of the spinal neurons. The modulatory effect exerted upon
the neurons must not be side-​effects accidentally caused by the top-​down signals in-
dependently of their semantic contents. On this account, thus, spinal neurons must be
able to determine their excitation patterns precisely on account of the semantic content
of the top-​down signal. But how can they do this? A standard response to such ques-
tions concerning the causal relevance of semantic contents appeals to deliberation and
practical reasoning. If an agent performed an action by deliberately entertaining (for
example) a linguistic command, we can safely assume that its content causally explains
why the action has been taken. It is clearly inappropriate, however, to apply the same
approach to the current case and hold that spinal neurons are able to change their exci-
tation patterns based on deliberation and practical reasoning.
Imperativists might respond by denying that they mean to propose a causal ex-
planation. To describe the top-​down signals as telling the spinal neurons to promote
reflexive behaviour, they might say, is just a convenient façon de parler to illuminate
the role of top-​down modulations in explaining the inhibition of reflexive responses
in pain asymbolia. But this only brings us back to square one; the original question
of how higher-​order states like caring can affect the excitation patterns of the spinal
neurons remains answered. In short, the imperativist account is caught in a dilemma—​
the first horn of which is to attribute over-​intellectual capacities to spinal neurons in
order to explain how one’s caring attitude can affect one’s physiological disposition to-
ward reflexive responses; the second horn is to leave this question unexplained in order
to avoid over-​intellectualizing spinal neurons. All in all, imperativism cannot offer an
adequate account of pain asymbolia without biting either of these bullets.
This indicates an additional layer of hidden dualism in imperativism, which has to
do with the separation between the body equipped with the capacity to sustain self-​
preserving behaviours (i.e., a system of body schema) and the agent who normally
310  Body schema and pain
cares about bodily integrity. Based on this distinction, imperativism locates the path-
ology of pain asymbolia in the agent’s capacity to care about the body; the body as such
is presumed to be intact. But then why do the patients exhibit an inhibited pattern
of spinal reflexes? It cannot be because something is wrong with the body. The root
problem has to be the agent’s inability to care about it. Accordingly, this is explained as
a consequence of some form of communication that takes place between the body and
the agent. It might be harmless to adopt this way of speech, depending on the context.
Taken literally as a theoretical explanation, however, this leads to the awkward con-
clusion that even spinal neurons are intellectual entities capable of deliberation and
practical reasoning. The root problem for this, I suggest, lies in the dualistic separation
between the body and the mental agent.

18.5  Phenomenology and enactivism

There is a developing focus in recent philosophy of pain on the significance of body

schema, under the banner of imperativism, but the account is still deeply entrenched
in a dualistic framework. How can theories of pain go beyond this dualistic picture of
mind and body? Merleau-​Ponty’s phenomenologically informed conception of body
schema can be of assistance here; it allows us to conceptualize the body in pain not as
some object presented to the mental agent in one way or another, but as something that
operates on the hither side of the intentional relation. In this section, I explore how to
situate this perspective in the context of contemporary philosophy of pain.
Recently, an alternative approach in this direction has begun to develop under the
label of enactive pain (Miyahara, 2019; Stilwell & Harman, 2019; see also Ongaro &
Ward, 2017). Unlike other philosophical theories of pain, the enactive approach does
not start by asking what pain is; its primary goal is not to identify the essential features
of pain as such. Instead, it first focuses on the experience of living with a body in pain.
It never considers pain in isolation but always places it within the context of embodied
and affective engagements with the situation. On this view, the experience of pain is not
just a matter of instantiating a certain kind of physiological state, but rather ‘a process
that emerges or unfolds through a whole person who is inseparable from the world’
(Stilwell & Harman, 2019, p. 654).
Imperativism and enactivism both acknowledge that the body schema plays a central
role in organizing the experience of pain. However, they conceptualize it in radically
different ways. The former holds that it contributes to pain experience by generating
sensory states with imperative content, which are precisely equated with pains. In con-
trast, the latter claims that it regulates embodied responses without involving mental
contents. The experience of pain is not a matter of instantiating a sensory state with
some mental content. Rather, it is considered as a form of embodied response to the
given situation. Pain is not an intermediate term that connects sensory input to bodily
response. Rather, when we experience pain, we are already engaged behaviourally
and affectively with the situation. The body schema sustains our experience of pain by
 Phenomenology and enactivism  311
regulating these embodied responses, according to the agent’s biological and sociocul-
tural history.
We can further clarify and support the idea by conducting a phenomenological ana-
lysis of the phenomenon. What is at stake here is the assumption that pain is a sensory
state with a mental content. The noun ‘pain’ strongly tempts us to think of it as some-
thing we experience as an intentional object. This further tempts us to explain its motiv-
ational function in our mental life by ascribing mental contents to it. Once this general
framework is in place, it becomes hard to imagine how the body schema might sustain
the experience of pain without issuing mental contents. These premises, however, are
complicated by phenomenological investigations into the relevant phenomena.
Jean-​Paul Sartre, for example, explores the experience of reading a book while your
eyes are hurting (Sartre, 1943/​2003, pp. 355–​359). In this experience, you are not aware
of the pain as an object of your consciousness. The reading is made possible by your
eye movements, but they do not operate under your conscious control. The eyes sus-
tain your awareness of the book and its content without making you conscious of the
pain itself as an object in them. But this is not to say that the pain entirely disappears
from your experience while you read. For one thing, Sartre notes, if you reflect upon
the condition of your eyes and notice that they are hurting, you will experience the
pain as something that has already been there for a while (p. 356). More importantly,
even while engaged in the reading, you experience the pain implicitly as something af-
fecting the reading experience; for example, it is given to you in the ways in which the
words appear to you as difficult to discern, the page as densely packed with lines, and
the sentences as hard to comprehend. In short, Sartre writes: ‘The pain exists beyond
all attention and all knowledge since it slips into each act of attention and knowledge’
(p. 357). The pain is simply ‘lived’ without you being consciously aware of it. As such,
it ‘belongs to the category of indefinables and indescribables’ (p. 357). This is not to
deny the possibility that pains be experienced as intentional objects. After struggling
to read the book for a while, you might find yourself holding your eyes a few times and
eventually have your focal attention captured by them; then you will become distinctly
aware of the pain as such. But this is a secondary mode of pain experience contingent
on a reflective act of consciousness. In Sartre’s words, it is only by adopting a reflective
consciousness that we ‘transcend the pure quality of consciousness in pain toward a
pain-​as-​object’ (p. 359).
This clearly demonstrates the phenomenological inadequacy of assuming that pains
are intentional objects of consciousness. Rather, pain primarily figures in conscious-
ness pre-​noetically as an organizing factor of the experience. Instead of appearing as an
object, the pain modulates the embodied engagement from the background—​it confers
it with a negative affective tone (e.g., the reading starts to get difficult and stressful);
it affects one’s perceptual sensitivity to the environment (e.g., the book appears as
packing too many lines on one page); it promotes certain bodily actions, including
those directed at the world (e.g., you lean forward to look at the text closely) and those
directed reflectively at the body (e.g., you hold your eyes); and finally, it can draw your
attention to the body (e.g., you come to pay attention to the sensation on the surface of
312  Body schema and pain
your eyes). In short, experiencing pain is not so much a matter of instantiating a static
state with a fixed mental content. Rather, it is more about going through an embodied
process uniquely modulated by the body in pain.
This is why the enactive approach holds that the experience of pain is sustained by
the functioning of the body schema. When the body undergoes some suboptimal con-
dition (e.g., eye strain), the relevant part of the body schema system—​we can suppose
this to be those for self-​preserving actions described above (see Section 18.3)—​shapes af-
fective, perceptual, and behavioural responses to the given situation accordingly before
the agent explicitly recognizes it. Nothing more is needed for the agent to experience
pain at this basic level. Depending on the bodily condition, the body schema can only
make the agent adapt to the situation better; for example, you might just adjust your
sitting posture in response to a low back pain without coming to focus on the pain as
such. Or it can make the agent reflectively attend to the relevant body part. In this case,
you may have an experience which takes the body in pain as its intentional object, i.e., a
form of body image. Even then, however, the experience is sustained by the functioning
of the body schema. In this sense, the enactive approach suggests that pain experience is
always sustained by the pre-​noetic functioning of the relevant part of the body schema.
How can the enactive approach account for pain asymbolia? The imperativist ac-
count locates the pathology in the capacity to care about one’s own body. Asymbolics
are indifferent to physical pains not because they have an impaired body schema, which
has stopped to issue imperative contents, but because they are no longer interested
in protecting their body. The problem of this account is that when it tries to explain
why the patients also exhibit an inhibited pattern of spinal reflex, it ends up attributing
overly intellectual capacities to spinal neurons, i.e., the capacity to communicate with
the cortex in semantic terms. The enactive approach is well placed to offer an alterna-
tive account that stays clear from any such problem. It does so by seeing pain asymbolia
as a pathology of the body schema. It proposes that the patients have lost their capacity
to respond, behaviourally and affectively, to physical threats to their bodily integrity;
yet they retain their capacity to mentally represent their body in non-​affective objective
terms. This is why they are indifferent to physical pains, but they are able to report their
presence when asked to do so. The body schema system for self-​preserving actions—​
which is both biologically and socioculturally grounded—​functions to regulate pat-
terned responses to physical threats, which is partly enabled by top-​down modulations
from the cortex to the spinal neurons. This is why when the relevant body schemas are
damaged, the patient also exhibit an unusual pattern of reflexive responses. On this ac-
count, there is no need to consider the excitation patterns of the spinal neurons as an
intelligent response to some semantic content (e.g., the command to promote quick
responses to intense physical stimuli).
Now recall that asymbolics are indifferent not only to actual physical pain, but also to
mere indications of physical harm posed in other sensory modalities such as vision and
audition. How will the enactive approach account for this effect? It does so in reference
to the pre-​noetic function of the body schema to organize perceptual experience. As we
saw above, the body schema sustains habitual behaviour partly by forming perceptual
 Phenomenology and enactivism  313
and affective anticipations about relevant action possibilities (i.e., ‘solicitations’ or ‘invi-
tations’). The body schema system for self-​preserving actions thus do not just respond
to actual physical perturbation presented to the body surface, but they also serve to
form perceptual and affective anticipations about upcoming events before any such
physical contact is made. If pain asymbolia consists of damage to these body schema
systems, accordingly, these patients will be expected to lack the capacity to perceive
physical threats in affectively involving terms. From the enactive standpoint, this is why
asymbolics are even indifferent to mere indications of potential physical threat.
On first look, it might seem ad hoc to claim that the operations of the body schema
for self-​preserving actions organize the perception of the environment. That they do,
however, should be obvious enough if we consider the relevant experiences. Suppose
you are travelling with a sprained ankle. Your ankle hurts. Your actions are constantly
adjusted so as not to put too much weight on it, yet non-​deliberately thanks to the pre-​
noetic functioning of your body schema system for self-​preserving actions. Importantly,
in this case, you will also perceive the environment very differently from when you did
not have the injury—​you are much more perceptive of potential threats to your ankle.
As you stand on the escalator, for instance, you will be very sensitive to how others walk
up the stairs—​you are keenly aware of the possibility that they hit you on the ankle. Their
moving feet immediately appear to you as potential threats. You will be affectively in-
volved in the threatening situation before any actual harm is done. This illustrates how
the body schema system for self-​preserving actions organizes one’s experience of the
environment by making affective responses to it, already taking account of the body in
pain. The enactive approach postulates that asymbolics lack this body-​schematic cap-
acity to undergo such affective responses to potentially harmful situations. Accordingly,
it is naturally expected that they remain indifferent not only to actual physical perturba-
tions, but also when merely presented with potential threats to their body.
As we have seen, Merleau-​Ponty insists on the primary role of the body schema in
understanding human experience. Mind and body are not separate elements of the whole
agent that somehow interact or communicate with each other to shape perception and
action. At least, this is not how they shape our experience in the first instance. Rather,
we are embodied agents who can only experience the world with our body—​how we ex-
perience the world as mental agents is deeply rooted in the pre-​noetic functioning of our
body schema. In particular, what forms the basis of the experience of pain is the habitual
body responding spontaneously to the actually or potentially harmful situation. His phe-
nomenologically informed notion of body schema thus offers a fruitful challenge to con-
temporary theories of pain that remain to be informed by hidden Cartesian assumptions.

Acknowledgements

This work is supported by the Australian Research Council Discovery Project

‘Minds in Skilled Performance: Explanatory Framework and Comparative Study’
(DP170172987).
314  Body schema and pain
References
Bain, D. (2003). Intentionalism and pain. The Philosophical Quarterly, 53(213), 502–​523.
Bain, D. (2013). What makes pains unpleasant? Philosophical Studies, 166(1), 69–​89.
Bain, D. (2014). Pains that don’t hurt. Australasian Journal of Philosophy, 92(2), 305–​320.
Brady, M. S. (2018). Painfulness, desire, and the Euthyphro dilemma. American Philosophical
Quarterly, 55(3), 239–​250.
Buytendijk, F. J. J. (1961). Pain (E. O’Shiel, Trans.). London: Hutchinson & Co (original work pub-
lished in 1943).
Carlisle, C. (2006). Becoming and un-​becoming: the theory and practice of Anatta. Contemporary
Budhhism, 7(1), 75–​89.
Cutter, B. & Tye, M. (2011). Tracking representationalism and the painfulness of pain. Philosophical
Issues, 21, 90–​109.
Douskos, C. (2017). Habit and intention. Philosophia, 45, 1129–​1148.
Dreyfus, H. L. (2013). The myth of the pervasiveness of the mental. In J. K. Schear (ed.), Mind, Reason,
and Being-​in-​the-​world (pp. 25–​50). London: Routledge.
Gallagher, S. (1995). Body schema and intentionality. In J. L. Bermúdez, A. J. Marcel, & N. Eilan (eds.),
The Body and the Self (pp. 225–​244). Cambridge, MA: MIT Press.
Grahek, N. (2011). Feeling Pain and Being in Pain. Cambridge, MA: MIT Press.
Helm, B. W. (2002). Felt evaluations: a theory of pleasure and pain. American Philosophical Quarterly,
39(1), 13–​30.
Jacobson, H. (2019). Not only a messenger: towards an attitudinal‐representational theory of pain.
Philosophy and Phenomenological Research, 99(2), 382–​408.
Klein, C. (2007). An imperative theory of pain. Journal of Philosophy, 104(10), 517–​532.
Klein, C. (2015a). What pain asymbolia really shows. Mind, 124(494), 493–​516.
Klein, C. (2015b). What the Body Commands: The Imperative Theory of Pain. Cambridge,
MA: MIT Press.
Martínez, M. (2011). Imperative content and the painfulness of pain. Phenomenology and the
Cognitive Sciences, 10(1), 67–​90.
Martínez, M. & Klein, C. (2016). Pain signals are predominantly imperative. Biology and Philosophy,
31(2), 283–​298.
Merleau-​Ponty, M. (2012). Phenomenology of Perception (D. A. Landes, Trans.). London: Routledge
(original work published 1945).
Miyahara, K. (2019). Enactive pain and its sociocultural embeddedness. Phenomenology and the
Cognitive Sciences. doi: 10.1007/​s11097-​019-​09630-​9
Miyahara, K. (ms). Coping with pain and obeying commands.
Miyahara, K., Ransom, T. G., & Gallagher, S. (2020). What the situation affords: habit and heedful inter-
relations in skilled performance. In C. Fausto & I. Testa (eds.), Habit: Pragmatist Approaches from
Cognitive Neurosciences to Social Sciences (pp. 120–​136). Cambridge: Cambridge University Press.
Morris, D. (1999). Sociocultural and religious meanings of pain. In R. J. Gatchel & D. C. Turk (eds.),
Psychosocial Factors in Pain: Critical Perspectives (pp. 118–​131). New York, NY: Guilford Press.
Ongaro, G. & Ward, D. (2017). An enactive account of placebo effects. Biology & Philosophy, 32(4),
507–​533.
Pitcher, G. (1970). Pain perception. The Philosophical Review, 79(3), 368–​393.
Rollman, G. B. (2004). Ethnocultural variations in the experience of pain. In T. Hadjistavropoulos &
K. D. Craig (eds.), Pain: Psychological Perspectives (pp. 155–​178). London: Psychology Press.
Sargent, C. (1984). Between death and shame: dimensions of pain in Bariba culture. Social Science and
Medicine, 19, 1299–​1304.
Sartre, J.-​P. (2003). Being and Nothingness (H. E. Barnes, Trans.). London: Routledge. (original work
published 1943).
Stilwell, P. & Harman, K. (2019). An enactive approach to pain: beyond the biopsychosocial model.
Phenomenology and the Cognitive Sciences, 18(4), 637–​665.
 Phenomenology and enactivism  315
Tye, M. (1995). A representational theory of pains and their phenomenal character. Philosophical
Perspectives, 9, 223–​239.
Withagen, R., De Poel, H. J., Araújo, D., & Pepping, G.-​J. (2012). Affordances can invite be-
havior: reconsidering the relationship between affordances and agency. New Ideas in Psychology,
30(2), 250–​258.
 19
Feeling of a presence and anomalous
body perception
Masayuki Hara, Olaf Blanke, and Noriaki Kanayama

19.1  The many names of the feeling of a presence

Tales of ghosts, wraiths, and other apparitions have been described from times im-
memorial and in almost all cultures in a variety of environments and individual con-
ditions. The strange sensation that another person is nearby when no one is actually
present and cannot be seen, heard, or felt by the sense of touch (the feeling of a pres-
ence, FoP) is a fascinating feat of the human mind. Not surprisingly, this apparition is
often covered in the literature of divinity, occultism, and fiction. It has also been re-
ported by clinicians for over a century now, launching its first empirical investigations.
Popularized by William James who described several cases in his influential The
Varieties of Religious Experience (James, 1902), it was the German-​Swiss psychiatrist–​
philosopher Karl Jaspers who described in Heidelberg the first series of psychiatric
patients with FoP (Jaspers, 1913). Jaspers coined the term Leibhaftige Bewussstheit
(LB) (Jaspers, 1913) and reported the FoP in patients who were likely suffering from
schizophrenia. Although Jaspers was careful in his analysis and indicated cases without
any visual, auditory, or tactile evidence for the occurrence of the felt ‘presence’, he did
observe in some of his patients such experienced sensory evidence (e.g., very small
sound induced by rustling of clothing, breathing, changes of air pressure, or smell).
We propose, as Jaspers already did, to separate pure cases of FoP from cases of FoP
characterized by such additional sensory elements in conscious experience, especially
auditory or somatosensory cues, as FoP+. Thus, FoP+ is characterized based on any
additional awareness or experience of external stimuli as evidence about the existence
of another person. If Jaspers’s patients (and many patients since 1913) did not report
any experienced auditory or tactile inputs from the external world related to the LB or
FoP, the origin has been considered mysterious. We propose here, following a long line
of neurological work, that FoP is an alteration of the body schema and is based on sen-
sorimotor mechanisms representing the person’s own body.
Other investigators in psychiatry, neurology, and clinical psychology have referred to
FoP as presence hallucination (PH). Actually, already James, a psychologist, described
FoP as a hallucination (1902): ‘it often happens that a hallucination is imperfectly de-
veloped: the person affected will feel a “presence” in the room, definitely localized ( . . . ),

Masayuki Hara, Olaf Blanke, and Noriaki Kanayama, Feeling of a presence and anomalous body perception In: Body Schema and
Body Image. Edited by: Yochai Ataria, Shogo Tanaka, and Shaun Gallagher, Oxford University Press. © Oxford University Press 2021.
DOI: 10.1093/​oso/​9780198851721.003.0019
 The many names of the feeling of a presence  317
and yet neither seen, heard, touched, nor cognized in any of the usual “sensible” ways’.
Recent work on Parkinson’s disease (PD) also used the term PH and reported a preva-
lence of 16% (35/​216 PD patients) (Fénelon, Soulas, Cleret de Langavant, Trinkler,
& Bachoud-​Lévi, 2011), classifying PH among so-​called minor hallucinations of PD
(Kulick, Montgomery, & Nirenberg, 2018; Pagonabarraga et al., 2016). Moreover, in a
study aimed at describing the details of this phenomenon in PD patients adopting the
term FoP, 31% of cases have experienced FoP and visual hallucination simultaneously
(Fénelon et al., 2011).
Among neurological authors, Critchley was the first to link FoP with related phe-
nomena observed in shipwreck survivors and also related it to the much rarer situation
when two individuals experience FoP during the same situation and more or less at
the same time ‘the Third Man’ phenomenon (1955). He also insisted that FoP is a phe-
nomenon that ‘normal humans’ can experience under certain conditions. Geiger has
summarized, in his book The Third Man Factor (Geiger, 2009), many cases of FoP and
also ‘Third Man’ reports. Often very stressful life events were present and FoP was re-
ported as ‘an unexplained friend who lent them the power to overcome the most dire
circumstances’. A detailed analysis of the reported cases would be beyond the scope of
this chapter, which focuses on neurological cases and FoP as induced in the research
laboratory.
FoP has been investigated also in epilepsy research, starting with the influential work
of Hécaen and Ajuriaguera (1952). Various names have been employed and several au-
thors have used the term of ‘sensed presence’, introduced by Critchley in 1955 (Booth,
Koren, & Persinger, 2005; Cook & Persinger, 1997; Persinger & Healey, 2002; Persinger
& Makarec, 1992). ‘Sensed presence’ has been described as ‘a perception that a person
or some “power” is present in the room’ in epilepsy (Landtblom, 2006). ‘Sensed pres-
ence’ in epilepsy patients was associated with paroxysmal irregular electroencephalo-
gram (EEG) activity in the theta band range (4–​5 Hz) (Persinger & Tiller, 2008) and
bilateral hypoperfusion (Landtblom, 2006) of the temporal lobes. More recently, Arzy
and colleagues demonstrated that FoP could be induced by electrical stimulation of the
left temporo-​parietal junction (TPJ) (Arzy, Seeck, Ortigue, Spinelli, & Blanke, 2006a;
Arzy, Thut, Mohr, Michel, & Blanke, 2006b). In their study, a young female patient who
was undergoing presurgical evaluation for potential treatment of pharmacoresistant
epilepsy received focal electrical stimulation of her left TPJ for functional mapping. TPJ
stimulations repeatedly induced classical and stereotypical FoP. The patient described
that she felt someone just behind her, next to her body, when she had the first electrical
stimulation. Several later stimulations also induced the same feeling and produced
other impressions about the illusory person. She reported that the person was young.
In addition, she described the person using the term ‘he’, although she could not clearly
confirm the gender. The person neither spoke nor moved. Additional stimulations
(after having changed the position and posture of the patient prior to the stimulations)
changed the induced FoP, i.e., the presence was felt in the same position and posture
as the patient. For example, while she was holding her knees with both her arms, she
described that ‘he was clasping her in his arms’, thus revealing a sharing of the patient’s
318  Feeling of a presence and anomalous body perception
posture and the posture of the felt presence. Overall, the patient described that the illu-
sory person was in very similar position, posture, and characteristics to hers, providing
strong evidence that the FoP is based on an illusory own body perception.
Here, we hypothesize that the FoP is based on the misperception of the source and
identity of sensorimotor signals of one’s own body. The TPJ, which is a stimulated cor-
tical area in Arzy et al.’s study, has been considered as a hub associating body-​related
information. The TPJ is close to the extrastriate body area, and more recent work has
linked the FoP, in addition to the TPJ, also to damage of the insula and frontoparietal
cortex (Blanke et al., 2014).

19.2  The FoP and body recognition

Table 19.1 lists the different names and characteristics described for the FoP in cogni-
tive and clinical neuroscience.

Table 19.1  Classification of FoP-​related phenomena

Term (abbreviation) Typical brain area Related citation

Feeling of a presence (FoP) Temporo-​parietal Intracranial Brugger et al., 1996

junction stimulation Arzy et al., 2006a
Blanke et al., 2014
Sensed presence (–​) Temporal lobe Transcranial Horowitz &
magnetic Adams, 1970
stimulation, Persinger, 1992
epilepsy Booth et al., 2005
Booth & Persinger,
2009
Presence hallucination (PH) Cerebellum/​dorsal Grey matter Fenelon et al., 2011
visual pathway, reduction in Pagonabarraga
parietal area Parkinson’s disease et al., 2014; 2016
Third Man factor (–​) –​ In a large variety of Geiger, 2009
environmental and
physical situations
Leibhaftige Bewussstheit (LB) –​ Psychosis Jaspers, 1913
(schizophrenia)

Using functional neuroimaging data and structural lesion data acquired from 12 FoP
patients, lesion overlap analysis revealed three cortical regions that are associated with
the FoP: insular cortex, frontoparietal cortex, and temporo-​parietal cortex (Blanke
et al., 2014). Some of these areas were also reported to be related to ‘sensed presence’
(Booth & Persinger, 2009; Landtblom, 2006; Landtblom, Lindehammar, Karlsson, &
Craig, 2011). These cortical areas have been considered to be related to the bodily per-
ception, including interoception (insula: Craig, 2009; Zaki, Davis, & Ochsner, 2012),
sensorimotor processing (frontoparietal area: Borstad, Choi, Schmalbrock, & Nichols-​
Larsen, 2016; Siegel, Buschman, & Miller, 2015; Wymbs, Bassett, Mucha, Porter, &
 Depersonalization and ownership  319
Grafton, 2012), and recognition of body position (temporo-​parietal cortex: Arzy et al.,
2006b; Ionta et al., 2011), compatible with our suggestion that FoP is a misperception
of the source and identity of sensorimotor signals of one’s own body, related to a broad
range of functions in body schema as well as body image.
Heydrich and Blanke (2013) compared the locations of brain lesion of ‘heautoscopy’,
which includes visual perception of a three-​dimensional body outside the own body,
and ‘autoscopic hallucination’, which shows visual perception of a two-​dimensional
body outside the own body, and demonstrated that the insular and temporo-​parietal
areas are mainly found in heautoscopy patients, whereas the parieto-​occipital area was
mainly found in patients with autoscopic hallucination. They suggested that involve-
ment of the insular cortex in heautoscopy, which is also related to an affective aspect
of the body, links heautoscopy to abnormal bodily self-​consciousness (BSC) regarding
affective somatosensory experience caused by the insular lesion. Additionally, to focus
on the lesion which was specifically associated with the FoP, group difference between
FoP patients and those without FoP but associated with the other symptoms has been
statistically tested (Blanke et al., 2014). The results suggested only frontoparietal lesions
(Brodmann area 7) were differentiated between groups with and without FoP. These
findings suggested the importance of anomalous sensorimotor processing in one’s own
body (anomalous body schema) for understanding the FoP.
If we presume the phenomenon could be understood as a misattribution of body
schema related signals, we should have any insight about the relationships between the
FoP, body ownership/​agency, and BSC. If the person misperceives the information of
the own body as if it were the illusory person, we could say that it is a kind of problem of
the sense of body ownership for the reduplicated and illusory second own body.

19.3  Depersonalization and ownership

The feeling that someone does not attribute a physical sensation of one’s body as such
(but without reduplication as in the FoP) is observed in the depersonalization/​dereal-
ization (DP/​DR) disorder (American Psychiatric Association, 2013). In patients with
this disorder, an altered experience of reality may be accompanied by an altered experi-
ence of one’s body, which is similar to the situation encountered in many cases of FoP
and ‘Third Man’ such as life-​threatening situations. In particular, given that DP/​DR
has been recognized as a symptom of post-​traumatic stress disorder (Lanius, Brand,
Vermetten, Frewen, & Spiegel, 2012; Lanius et al., 2010), acute stress could be a possible
cause of DP/​DR. The dissociative disorder, which includes DP/​DR as a subcategory,
has been considered as being related to the imaginary companion, who is an imaginary
friend generated in the mind by the child in childhood (Putnam, 1997), showing many
similarities with the FoP.
The cortical area related to DP/​DR also partly overlaps with those of FoP-​related
phenomena (Phillips et al., 2001; Sierra, Lopera, Lambert, Phillips, & David, 2002).
Sierra et al. reported two cases (2002)—​one had bilateral basal temporo-​occipital
320  Feeling of a presence and anomalous body perception
haematomas, and the other had a right subdural haematoma in the right parietal lobe.
The former experienced emotional numbing in visual perception, which could be re-
lated to the calmness in seeing an appropriate behaviour in an emergent circumstance,
reported as ‘the Third Man’. The latter felt the strange feeling as if his own body did not
belong to his body, which could be a basis to misattribute bodily awareness to the other.
The temporal cortex was also found in the FoP, PH, and ‘sensed presence’ as related to
cortical regions, and the parietal area could be involved in the report of FoP and PH.
These phenomena FoP, PH, ‘sensed presence’, and DP/​DR might partly share a cor-
tical network for generating such a body-​related strange feeling. Healthy individuals
with a high depersonalization tendency more easily feel the rubber hand illusion, as
an example of the out-​of-​body experience and misattribution of self-​body information
to any other thing, and show hyper-​connectivity centred in the parieto-​occipital area,
compared to people with a low depersonalization tendency (Kanayama, Sato, & Ohira,
2009). These common phenomena found in DP/​DR, especially DP, and FoP suggest
that misperceiving the information of one’s own body is important in DP and FoP.

19.4  Delusion of being controlled and agency

Kamiya and Okamoto (1982) introduced some interesting cases, which help us to con-
sider differences between the DP and the FoP. They highlighted the aspect of redupli-
cation in the FoP, based on the FoP’s classification among disorders of body schema
by most neurologists (e.g., with other forms of autoscopic phenomena). Thus, Kamiya
and Okamoto (1982) reported several cases of the FoP (and autoscopic phenomena)
and use the term ‘double consciousness’. Here, ‘double’ means the duplicated sense of
self. By collecting epileptic cases with any EEG abnormality, they classified them into
three symptom groups: patients in the first group had autoscopic hallucinations (i.e.,
visually perceived double; Group 1), and the others had an invisible double outside
(i.e., FoP; Group 2) or inside their body (Group 3). Interestingly, patients in Group 2 re-
ported perceiving another invisible body different from one’s own body, like a shadow.
Unfortunately, no detailed reports of abnormal EEG activity were available, preventing
any relation of these phenomena to the cortical area to be established.
What is the mechanism to assign ‘otherness’ to the invisible presence, ‘the Third
Man’, or the ‘invisible double’ if the illusory experience is based on signals from one’s
own body? Thus, DP does not generate a second subject who controls the body de-
tached from one’s own (i.e., there is no reduplicative element in DP). In FoP evoked
by electrostimulation in a non-​emergent situation, the unknown invisible presence
showed some spontaneous behaviour (Arzy et al., 2006a), which suggests the person
who felt the FoP recognized the existence as an individual agent. Actually, the FoP
was introduced as a ‘sensorimotor double’ in the detailed categorization of illusory
reduplication of the own body in many psychiatric patients (Blanke, Arzy, & Landis,
2008), clearly differentiated from visual body reduplications, which also suggests the
involvement of the problem of the body schema in the FoP. Spontaneous behaviour of
 The FoP as a possible psychological function  321
the felt presence could be based on motor imagery or altered sensorimotor processing
generated based on the body schema. From this viewpoint, we can presume the im-
portant factor is the recognition of the illusory subject of the action caused by any
malfunction of the body schema.

19.5  The FoP as a possible psychological function to generate

double using our body schema

The data reviewed above demonstrate that the FoP, even if a frequent topic in the oc-
cult literature, is a real phenomenon based on the cortical functions related to the body
schema (see Figure 19.1). The FoP, which is a complex experience, could be understood
as a function of the cortical network for our body system related to body schema, body
image, and self-​recognition, including body ownership and agency of movement.
However, by just reviewing the lesion studies and psychiatric reports, cognitive
neuroscience of the related concept has limitation to understand what the FoP is. Can
healthy individuals experience the FoP under laboratory conditions? Such a question
is very important and fundamental to any scientific understanding of the FoP and BSC.
Neurological data suggested that this should be possible, through the manipulation of
online sensorimotor signals (Arzy et al., 2006a, b; Blanke et al., 2014). Recently, we were

Sense-of-ownership Sense-of-Agency
Depersonalization prM Mislocalization of agent
Losing own BSC Presence Hallucination
SPL SI MI Auditory Verbal Hallucination

TPJ Ins
EBA BSC based FoP
FBA
Visually induced illusory presence Third man effect
Autoscopy/Autoscopic Hallucination Electrical stimulation induced FoP
Visual hallucination in Parkinson Disease Crb FoP in Schizophrenia/Epilepsy

Out-of-Body Experience
Mislocalization of body parts
Loosing visual reality

Figure 19.1  Schematic representation of neural correlates of the FoP and the relevant
phenomena.
322  Feeling of a presence and anomalous body perception
able to combine cognitive neuroscience and robotics, with the shared aim to elucidate
the brain mechanisms of the FoP, and succeeded in experimentally inducing the FoP
in the research laboratory. This is part of a wider multidisciplinary research project,
named Cognetics (Rognini & Blanke, 2016), dedicated to the application of robotics,
haptics, and virtual reality technologies to induce and study consciousness and cogni-
tion, including body image and body schema.

19.6  Robotically induced FoP

How can we experimentally induce the FoP derived in healthy people? Such a meth-
odology would allow us to make further advances in understanding the key factors
and underlying mechanism of the FoP, self-​representation, and related aspects of body
image and body schema.
Another approach was suggested by work in cognitive neuroscience. Thus, Arzy
et al. (2006a) succeeded in experimentally inducing the FoP in an epilepsy patient by
giving focal electrical stimulation to the left TPJ and revealed an important role of sen-
sorimotor signals, which was further confirmed by Blanke et al. (2014). This implies
the possibility to experimentally induce the FoP in healthy people by systematically
manipulating the sensorimotor conflicts.
Visuo-​tactile stimulation which is employed to induce bodily illusions, such as the
rubber hand illusion (RHI) (Botvinick & Cohen, 1998) and the full body illusion (FBI)
(Ehrsson, 2007; Lenggenhager, Tadi, Metzinger, & Blanke, 2007), could be an effective
method to experimentally cause sensorimotor conflicts. Synchronous visuo-​tactile
stimulation to a visible fake or virtual body and an invisible real body induces the il-
lusory body ownership over the fake or virtual body, whereas the bodily illusions are
not induced in asynchronous visuo-​tactile stimulation. In the classical RHI/​FBI para-
digm, the misattribution of body ownership to the fake body is induced, whereas the
sense of agency remains normal. The somatic RHI paradigm, in which an experimenter
guides the index finger of a blindfolded participant to touch a fake rubber hand while
the experimenter synchronously presents the same touch on the participant’s hand, al-
lows the participant to experience illusory self-​touch (i.e., self-​touch illusion) by tactile
and proprioceptive cues (Ehrsson, Holmes, & Passingham, 2005). In this case, the mis-
attribution of body ownership is experienced for the invisible fake hand, but agency
is still vested in the experimenter and the participant themselves. In the moving RHI
paradigm, the participants can move the index finger of a fake rubber hand as well as
their own index finger (Kalckert & Ehrsson, 2012). This manner allows the sense of
agency, as well as the sense of body ownership, to be experienced for the fake body and
to induce a robust illusion of owing the fake hand. However, since the visual cue of the
fake body is available as well as in the classic RHI/​FBI paradigm, the misattribution of
body ownership and agency concerns the visible fake body, but not ‘something invis-
ible’. Similarly to the RHI and the FBI, the FoP cannot be induced because the partici-
pant experiences the illusory ownership over the fake hand in advance. Therefore, it
 Robotically induced FoP  323
turns out that the misattribution of body ownership and agency to ‘something invisible’
cannot be realized only by the application of classical visuo-​tactile stimulation.
Active self-​touch with a robotic leader-​follower system could be a candidate to over-
come the aforementioned limitations of classical methods (Hara et al., 2015). In active
self-​touch, a participant can voluntarily touch a fake or virtual body by manipulating a
haptic interface (leader robot) and synchronously or asynchronously receive the same
or modulated touch on their own body from the follower robot, such that strong bodily
illusions can be induced. Since active self-​touch precisely allows experimental manipu-
lations of tactile, proprioceptive, and motor signals of one’s own body, it is likely that the
method can be used to systematically induce the FoP (robotically induced FoP). Indeed,
active self-​touch was adapted with FBI paradigms and succeeded in experimentally
inducing the FoP in healthy participants (Blanke et al., 2014). In detail, a blindfolded
and auditory-​masked participant was asked to manipulate a leader robot positioned in
front of the participant and to poke their own back applied by a follower robot, as shown
in Figure 19.2. It was found that asynchronous stimulation (leader–​follower robot ac-
tuation in the condition with the highest sensorimotor conflict), which is usually em-
ployed as a control condition in the induction of bodily illusions, induced strong FoP.
When the movements of the leader robot and follower robot were synchronized, the
self-​touch illusion (Ehrsson, Holmes, & Passingham, 2005) was induced without the FoP
(i.e., involving a fixed mislocalization of self-​touch due to the robotic arrangements). On
the other hand, asynchronous stimulation causes an additional temporal mismatch in
tactile stimulation and a mislocalization of self-​touch due to the delayed movement of
the follower robot, as well as the fixed mislocalization of self-​touch; the manipulation

“Dynamic” mismatch
Headphones
“Static” mismatch

Eyes mask

Leader haptic device Follower robot

Figure 19.2  Robotically inducing the BSC-​based FoP. ‘Static’ mismatch indicates a
fixed mislocalization of self-​touch between the touching and touched body parts which
is produced by the robotic arrangements. ‘Dynamic’ mismatch includes a temporal
difference in tactile stimulation, a mislocalization of self-​touch due to the temporal
difference, and a different tactile feedback between touch-​administering and touch-​
receiving body parts. The participants can experience the FoP when ‘static’ and ‘dynamic’
mismatches are simultaneously induced.
324  Feeling of a presence and anomalous body perception
of force feedback between one’s own hand and back is not important so much. These
cognetics data show that the FoP is based on the misperception of the source and iden-
tity of sensorimotor signals of one’s own body. When exposed to the tested sensorimotor
conflicts, participants maintain ownership and agency over their movements and body,
but also misattribute the bodily experiences generated by these signals to an invisible
presence.
From the above, so far it is considered that the active self-​touch in an asynchronous
condition is the most effective method for experimentally inducing FoP. We recently
developed an active self-​touch system that is operational in a 3T magnetic resonance
imaging (MRI) environment, thanks to MRI-​compatible leader-​follower robots. Future
work using MRI-​compatible cognetics will shed light on the underlying brain mech-
anism of the FoP and can be applied also in patients who frequently report the FoP, as in
psychiatric disease (schizophrenia) and neurological disease (PD).
In engineering, technologies that allow users to perform teleoperation or
telemanipulation are often accompanied by a feeling, as if an object or a speaker at a
remote location exists nearby. They have been studied in order to further improve the
quality of multimedia services, such as medical/​health care (Ballantyne, 2002) and edu-
cation (Kwon, Koo, Kim, & Kwon, 2010), as well as teleconference. In general, the tech-
nologies (or experiences) are known as telepresence (Minsky, 1980; Steuer, 1992) or
telexistence (Tachi, 2009; Tachi, Tanie, Komoriya, & Kaneko, 1985) and can be realized
by combining remote control, robotics, and virtual reality technologies. For instance,
a movable robot which has a display (e.g., tablet PC) showing the speaker’s face is em-
ployed to create the existence of a speaker at a remote location in teleconferences. The
speaker remotely controls the robot with observation of the reactions of the conference
participants via an onboard camera and communicates with the participants through
the robot. Since the robot behaves as an avatar of the speaker in the conference, the
conference participants can feel as if the speaker is joining the conference, which is a
different type of presence induced in a conventional visual-​and audio-​based telecon-
ference. We argue that the creation of the experience of a speaker’s existence in the tele-
conference is related to the FoP. However, telepresence and telexistence are generally
visually dominant experiences with a visual reference of the robot and might not be
exactly the same experience as the FoP derived from the body schema. We argue that
the above-​described robotic setup to induce the FoP and related technologies should be
combined with those telepresence or telexistence technologies in order to boost their
levels of immersion and realism.

References
American Psychiatric Association. (2013). Diagnostic and Statistical Manual of Mental Disorders (fifth
edition). Washington, DC: American Psychiatric Association.
Arzy, S., Seeck, M., Ortigue, S., Spinelli, L., & Blanke, O. (2006a). Induction of an illusory shadow
person. Nature, 443, 287. doi:10.1038/​443287a.
 Robotically induced FoP  325
Arzy, S., Thut, G., Mohr, C., Michel, C. M., & Blanke, O. (2006b). Neural basis of embodiment: dis-
tinct contributions of temporoparietal junction and extrastriate body area. Journal of Neuroscience,
26(31), 8074–​8081. doi:10.1523/​JNEUROSCI.0745-​06.2006.
Ballantyne, G. H. (2002). Robotic surgery, telerobotic surgery, telepresence, and telementoring.
Surgical Endoscopy and Other Interventional Techniques, 6, 1389–​ 1402. doi:10.1007/​
s00464-​001-​8283-​7.
Blanke, O., Arzy, S., & Landis, T. (2008). Illusory reduplications of the human body and self. Handbook
of Clinical Neurology, 87, 429–​458.
Blanke, O., Pozeg, P., Hara, M., Heydrich, L., Serino, A., Yamamoto, A., Higuchi, T., Salomon, R.,
Seeck, M., Landis, T., Arzy, S., Herbelin, B., Bleuler, H., Rognini, G. (2014). Neurological and
robot-​controlled induction of an apparition. Current Biology, 24(22), 2681–​2686. doi:10.1016/​
j.cub.2014.09.049.
Booth, J. N., Koren, S. A., & Persinger, M. A. (2005). Increased feelings of the sensed presence and
increased geomagnetic activity at the time of the experience during exposures to transcerebral
weak complex magnetic fields. Journal International Journal of Neuroscience, 115(7), 1053–​1079.
doi:10.1080/​00207450590901521.
Booth, J. N. & Persinger, M. A. (2009). Discrete shifts within the theta band between the frontal
and parietal regions of the right hemisphere and the experiences of a sensed presence. Journal of
Neuropsychiatry and Clinical Neurosciences, 21(3), 279–​283. doi:10.1176/​jnp.2009.21.3.279.
Borstad, A. L., Choi, S., Schmalbrock, P., & Nichols-​Larsen, D. S. (2016). Frontoparietal white matter
integrity predicts haptic performance in chronic stroke. NeuroImage, 10, 129–​139. doi:10.1016/​
j.nicl.2015.11.007.
Botvinick, M. & Cohen, J. (1998). Rubber hands ‘feel’ touch that eyes see. Nature, 391(6669), 756.
doi:10.1038/​35784.
Brugger, P., Regard, M. & Landis, T. (1996). Unilaterally felt presences: the neuropsychiatry of one's
invisible Doppelgänger. Neuropsychiatry Neuropsychol. Behav. Neurol., 9, 114–​122.
Cook, C. M. & Persinger, M. A. (1997). Experimental induction of the ‘sensed presence’ in normal
subjects and an exceptional subject. Perceptual and Motor Skills, 85(2), 683–​693. doi:10.2466/​
pms.1997.85.2.683.
Craig, A. D. B. (2009). How do you feel—​now? The anterior insula and human awareness. Nature
Reviews Neuroscience, 10, 59–​70. doi:10.1038/​nrn2555.
Critchley, M. (1955). The ideal of a presence. Acta Psychiatrica Scandinavica, 30(1-​2), 155–​168.
doi:10.1111/​j.1600-​0447.1955.tb06055.x.
Ehrsson, H. H. (2007). The experimental induction of out-​of-​body experiences. Science, 317(5841),
1048. doi:10.1126/​science.1142175.
Ehrsson, H. H., Holmes, N. P., & Passingham, R. E. (2005). Touching a rubber hand: feeling of body
ownership is associated with activity in multisensory brain areas. Journal of Neuroscience, 25(45),
10564–​10573. doi:10.1523/​JNEUROSCI.0800-​05.2005.
Fénelon, G., Soulas, T., Cleret de Langavant, L., Trinkler, I., & Bachoud-​Lévi, A.-​C. (2011). Feeling of
presence in Parkinson’s disease. Journal of Neurology, Neurosurgery, and Psychiatry, 82(11), 1219–​
1224. doi:10.1136/​jnnp.2010.234799.
Geiger, J. (2009). The Third Man Factor: Surviving the Impossible. New York: Weinstein Books.
Hara, M., Pozeg, P., Rognini, G., Higuchi, T., Fukuhara, K., Yamamoto, A., Higuchi, T., Blanke, O.,
& Salomon, R. (2015). Voluntary self-​touch increases body ownership. Frontiers in Psychology,
Consciousness Research, 6, 1–​12. doi:10.3389/​fpsyg.2015.01509.
Hécaen, H. & Ajuriaguera, J. (1952). Méconnaissances et Hallucinations Corporelles: Intégration et
Désintégration de la Somatognosie. Paris: Masson et Cie Editeurs.
Heydrich, L. & Blanke, O. (2013). Distinct illusory own-​body perceptions caused by damage to pos-
terior insula and extrastriate cortex. Brain, 136(3), 790–​803.
Horowitz, M. J. & Adams, J. E. (1970). Hallucinations on brain stimulation: Evidence for revision of
the Penfield hypothesis. In W. Keup (ed.), Origin and mechanisms of hallucinations (pp. 13–​20).
New York: Plenum.
326  Feeling of a presence and anomalous body perception
Ionta, S., Heydrich, L., Lenggenhager, B., Mouthon, M., Fornari, E., Chapuis, D., Gassert, R., & Blanke,
O. (2011). Multisensory mechanisms in temporo-​parietal cortex support self-​location and first-​
person perspective. Neuron, 70(2), 363–​374. doi:10.1016/​j.neuron.2011.03.009.
James, W. (1902). The Varieties of Religious Experience. Cambridge: Harvard University Press.
Jaspers, K. (1913). Allgemeine Psychopathologie. Berlin: Springer.
Kalckert, A. & Ehrsson, H. H. (2012). Moving a rubber hand that feels like your own: a dissociation
of ownership and agency. Frontiers in Human Neuroscience, 6, 40. doi:10.3389/​fnhum.2012.00040.
Kamiya, S. & Okamoto, S. (1982). Double consciousness in epileptics: a clinical picture and minor
hemisphere specialization. In H. Akimoto, H. Kazamatsuri, M. Seino, & A. Ward (eds.), Advances
in Epileptology: 13th Epilepsy International Symposium (pp. 397–​401). New York, NY: Raven Press.
Kanayama, N., Sato, A., & Ohira, H. (2009). The role of gamma band oscillations and synchrony on
rubber hand illusion and crossmodal integration. Brain and Cognition, 69(1), 19–​29. doi:10.1016/​
j.bandc.2008.05.001.
Kulick, C. V., Montgomery, K. M., & Nirenberg, M. J. (2018). Comprehensive identification of delu-
sions and olfactory, tactile, gustatory, and minor hallucinations in Parkinson’s disease psychosis.
Parkinsonism & Related Disorders, 54, 40–​5. doi:10.1016/​j.parkreldis.2018.04.008.
Kwon, O. H., Koo, S. Y., Kim, Y. G., & Kwon, D. S. (2010). Telepresence robot system for English tu-
toring. Paper presented at the IEEE Workshop on Advanced Robotics and its Social Impacts, Seoul,
South Korea.
Landtblom, A.-​M. (2006). The ‘sensed presence’: an epileptic aura with religious overtones. Epilepsy &
Behavior, 9(1), 186–​188. doi:10.1016/​J.YEBEH.2006.04.023.
Landtblom, A.-​M., Lindehammar, H., Karlsson, H., & Craig, A. D. B. (2011). Insular cortex activa-
tion in a patient with ‘sensed presence’/​ecstatic seizures. Epilepsy and Behavior, 20(4), 714–​718.
doi:10.1016/​J.YEBEH.2011.01.031.
Lanius, R. A., Brand, B., Vermetten, E., Frewen, P. A., & Spiegel, D. (2012). The dissociative subtype of
posttraumatic stress disorder: rationale, clinical and neurobiological evidence, and implications.
Depression & Anxiety, 29(8), 701–​708. doi:10.1002/​da.21889.
Lanius, R. A., Vermetten, E., Loewenstein, R. J., Brand, B., Schmahl, C., Bremner, J. D., & Spiegel, D.
(2010). Emotion modulation in PTSD: clinical and neurobiological evidence for a dissociative sub-
type. American Journal of Psychiatry, 167(6), 640–​647. doi:10.1176/​appi.ajp.2009.09081168.
Lenggenhager, B., Tadi, T., Metzinger, T., & Blanke, O. (2007). Video ergo sum: manipulating bodily
self-​consciousness. Science, 317(5841), 1096. doi:10.1126/​science.1143439.
Minsky, M. (1980). Telepresence. OMNI magazine. Available from: https://​web.media.mit.edu/​
~minsky/​papers/​Telepresence.html.
Pagonabarraga, J., Martinez-​Horta, S., Fernández de Bobadilla, R., Pérez, J., Ribosa-​Nogué, R., Marín,
J., Pascual-​Sedano, B., García, C., Gironell, A., & Kulisevsky, J. (2016). Minor hallucinations occur
in drug‐naive Parkinson’s disease patients, even from the premotor phase. Movement Disorders, 31,
45–​52. doi:10.1002/​mds.26432.
Pagonabarraga, J., Soriano-​Mas, C., Llebaria, G., López-​Solà, M., Pujol, J., & Kulisevsky, J. (2014).
Neural correlates of minor hallucinations in non-​demented patients with Parkinson’s disease.
Parkinsonism & Related Disorders, 20(3), 290–​296.
Persinger, M. A. & Healey, F. (2002). Experimental facilitation of the sensed presence: possible inter-
calation between the hemispheres induced by complex magnetic fields. Journal of Nervous and
Mental Disease, 190(8), 533–​541. doi:10.1097/​00005053-​200208000-​00006.
Persinger, M. A. (1992). Enhanced incidence of “the sensed presence” in people who have learned to
meditate: support for the right hemispheric intrusion hypothesis. Perceptual and Motor Skills, 75(3
Pt 2), 1308–​1310.
Persinger, M. A., & Makarec, K. (1992). The feeling of a presence and verbal meaningfulness in con-
text of temporal lobe function: factor analytic verification of the muses? Brain and Cognition, 20(2),
217–​226. doi:10.1016/​0278-​2626(92)90016-​F.
Persinger, M. A. & Tiller, S. G. (2008). Case report: a prototypical spontaneous ‘sensed presence’
of a sentient being and concomitant electroencephalographic activity in the clinical laboratory.
Neurocase, 14(5), 425–​430. doi:10.1080/​13554790802406172.
 Robotically induced FoP  327
Phillips, M. L., Medford, N., Senior, C., Bullmore, E. T., Suckling, J., Brammer, M. J., Andrew, C.,
Sierra, M., Williams, S. C., & David, A. S. (2001). Depersonalization disorder: thinking without
feeling. Psychiatry Research, 180(3), 145–​160. doi:10.1016/​S0925-​4927(01)00119-​6.
Putnam, F. W. (1997). Dissociation in Children and Adolescents: A Developmental Perspective.
New York, NY: Guilford Press.
Rognini, G. & Blanke, O. (2016). Cognetics: robotic interfaces for the conscious mind. Trends in
Cognitive Sciences, 20(3), 162–​164.
Siegel, M., Buschman, T. J., & Miller, E. K. (2015). Cortical information flow during flexible sensori-
motor decisions. Science, 348, 1352–​1355. doi:10.1126/​science.aab0551.
Sierra, M., Lopera, F., Lambert, M. V., Phillips, M. L., & David, A. S. (2002). Separating depersonalisa-
tion and derealisation: the relevance of the ‘lesion method’. Journal of Neurology, Neurosurgery, and
Psychiatry, 72(4), 530–​532.
Steuer, J. (1992). Defining virtual reality: dimensions determining telepresence. Journal of
Communication, 42(4), 73–​93. doi:10.1111/​j.1460-​2466.1992.tb00812.x.
Tachi, S. (2009). Telexistence. Singapore: World Scientific Publishing Company.
Tachi, S., Tanie, K., Komoriya, K., & Kaneko, M. (1985). Tele-​existence (I): design and evaluation of a
visual display with sensation of presence. In Morecki, A., Bianchi, G., & Kȩdzior, K. (eds.), Theory
and Practice of Robots and Manipulators (pp. 245–​254). Boston, MA: Springer.
Wymbs, N. F., Bassett, D. S., Mucha, P. J., Porter, M. A., & Grafton, S. T. (2012). Differential recruit-
ment of the sensorimotor putamen and frontoparietal cortex during motor chunking in humans.
Neuron, 74(5), 936–​946. doi:10.1016/​J.NEURON.2012.03.038.
Zaki, J., Davis, J. I., & Ochsner, K. N. (2012). Overlapping activity in anterior insula during
interoception and emotional experience. NeuroImage, 6(2), 493–​499. doi:10.1016/​j.neuroim
age.2012.05.012.
 20
The body image–​body schema/​ownership–​
agency model for pathologies: four case studies
Aviya Ben David and Yochai Ataria

20.1 Introduction

This chapter presents a phenomenological cognitive model—​the body image/​body

schema–​ownership/​agency (BI-​BS/​Ow-​Ag) model—​and applies it to the following
pathological cases: body integrity identity disorder (BIID), schizophrenia, anorexia
nervosa (AN), and post-​traumatic stress disorder (PTSD).
In Section 20.2, we outline, in brief, the double dissociation between body schema
(BS) and body image (BI). Following this, we discuss the sense of agency (SA) and
the sense of ownership (SO), once again focusing on the double dissociation between
agency (Ag) and ownership (Ow). Subsequently, we present the BI-​BS/​Ow-​Ag model,
following which we will apply it to BIID, schizophrenia, AN, and PTSD. We close this
chapter with a general discussion, an overview of its limitations, and suggestions for
future study.

20.2  Body schema versus body image: double dissociation

According to Gallagher (2005), ‘[B]‌ody image and body schema refer to two dif-
ferent but closely related systems’ (p. 24). Indeed, he describes the BI as a ‘system of
perceptions, attitudes, and beliefs pertaining to one’s own body’ (p. 24), and the BS
as ‘a system of sensory-​motor capacities that function without awareness or the ne-
cessity of perceptual monitoring’ (p. 24). While the BI can become the object of an
individual’s attention and the focus of consciousness, the BS moulds the very structure
of consciousness ‘but does not explicitly show itself in the contents of consciousness’
(p. 32). Furthermore, Gallagher (2005) continues, the ‘BI consists of a complex set of
intentional states and dispositions—​perceptions, beliefs, and attitudes—​in which the
intentional object is one’s own body’ (p. 26). On this level, the boundaries are clear,
solid, rigid, and clearly defined. By contrast, because the ‘BS functions in an integrated
way with its environment’ (p. 37), the boundaries at the level of BS are less clear, less
easily located, and more flexible. The BS, which ‘functions in a more integrated and
holistic way’ (p. 26), facilitates the feeling that our ‘body is a thing among things; it is

Aviya Ben David and Yochai Ataria, The body image–​body schema/​ownership–​agency model for pathologies: four case studies
In: Body Schema and Body Image. Edited by: Yochai Ataria, Shogo Tanaka, and Shaun Gallagher, Oxford University Press.
© Oxford University Press 2021. DOI: 10.1093/​oso/​9780198851721.003.0020
 Ownership versus agency  329
one of them. It is caught in the fabric of the world . . . the world is made of the very stuff
of the body’ (Merleau-​Ponty, 1964, p. 163). As long as the BS functions as necessary,
the sense of boundaries will be flexible and the body will remain transparent in the
course of perceiving the world.
The BS–​BI distinction can also be defined in the following way: whereas the BS
‘corresponds to an implicit and egocentric’ perspective, the BI coincides with ‘an ex-
plicit and allocentric perspective’. Note that the ‘shift from ego-​centric to allo-​centric
space . . . gives rise to a number of “self-​reflective emotions” such as shame, embarrass-
ment, feelings of guilt or pride which all depend on the internalized, evaluating “gaze of
the other” ’ (Fuchs, 2010, pp. 550–​552).
The two cognitive systems of the BS and the BI are intimately linked and can
shape each other. Similarly, for the most part, they work synchronously. That said,
by examining various pathological cases, Gallagher (2005) demonstrates the exist-
ence of a double dissociation between the BI and the BS—​defects at the BI level do
not always result in problems at the BS level; likewise, defects at the BS level do not
affect the BI.

20.3  Ownership versus agency

20.3.1  Body ownership

According to de Vignemont (2007), the body is both what we are and what belongs to us.
Furthermore, she comments, ‘it may seem as if it was nonsensical to ask whether you
are sure that this is your own body’ (p. 427). On the level of ownership, ‘this body is our
own in the sense that we know it, not in the sense that we feel it’ (de Vignemont, 2010,
p. 83; emphasis added). However, in the case of the sense of body ownership (SbO), we
not only know that the body is our own (Judgement of body ownership), but actually
feel that this is so. We can define the crucial difference between knowing and feeling that
this is my body in terms of the difference between Judgement of ownership (knowing)
and sense of ownership (feeling) (see Table 20.1). The non-​conceptual feeling of body
ownership (SbO) is rooted in the most basic sensorimotor loop and therefore clearly
takes place at the BS level; hence, we may suggest, for SbO to be able to function prop-
erly, there must be no contradictions or inconsistencies at the action-​efferent level of
the sensorimotor loop. This applies to the most basic level of mere touch, as well as the
more complex levels, which are responsible for integrating information from various
sources, e.g., matching between proprioception and visual feedback. Indeed, to achieve
SbO, the synchronization of different kinds of bodily information is necessary. When
there are no such conflicts, we feel that the body is our own. We experience this feeling
of bodily ownership in our daily lives as a ‘diffuse feeling of a coherent, harmonious
ongoing flow of bodily experiences’. However, the existence of conflicts and contra-
dictions at the action-​efferent level causes the SbO to diminish; the body is no longer
330  body image–body schema/ownership–agency model
transparent and we begin to ‘experience our body parts as strange, peculiar or alien’
(Synofzik, Vosgerau, & Newen, 2008, p. 420).
In opposition to the implicit feeling of body ownership, the knowing or judgment
of body ownership (JbO) is explicit. We conclude that this body is our own, based on
conceptual beliefs, experiences, the ability to control, and the general knowledge we
possess.
That said, we would like to suggest that the JbO can be located at the BI level. In order
to ground this notion, let us stress that whereas the SbO is, to some extent, in the back-
ground of the field of experience—​it is part of the intentional arc—​the JbO appears
explicitly, that is to say that the JbO occurs above the threshold of consciousness. As
such, it enables us to judge (at least in a limited fashion) our feelings. In that sense, the
process is of a cognitive nature.

20.3.2 Agency

We can intuitively define the sense of agency (SA) as ‘the sense that I am the one who
is causing or generating an action’ (Gallagher, 2000, p. 15). Although the SA is typic-
ally portrayed ‘as first-​order experience linked to bodily movement’ (Gallagher, 2007,
p. 355), some argue that it also includes the ability to control thoughts (Ataria & Neria,
2013; Frith, Blakemore, & Wolpert, 2000; Gallagher, 2000). Most scholars define the SA
on the intentional level, arguing that a strong sense of control must exist for an SA to
emerge—​‘If someone or something causes something to happen, that person or thing
is not an agent (even if they might be a cause) if they do not know in some way that
they have caused it to happen’ (Gallagher, 2007, p. 347; emphasis added). We need to
be conscious of our aims and intentions, beliefs, desires, and so on, and we must con-
nect between actions with conscious intentions (Farrer et al., 2003). Yet, as Tsakiris and
Haggard (2005a) claim, the SA is directly connected to motor control and efference sig-
nals. Therefore, we must discuss it in terms of the sense of body agency (SbA). The SbA
does not require any explicit awareness of our aims and intentions but ‘could be simply
a matter of a very thin phenomenal awareness . . . ’ (Gallagher, 2007, p. 347; emphasis
added). Indeed, actions can also be controlled in a weak sense (Gallagher & Zahavi,
2008, p. 165; emphasis added):

We do not attend to our bodily movements in most actions. We do not stare at our own
hands as we decide to use them; we do not look at our feet as we walk, we do not attend
to our arm movements as we engage the joystick [furthermore,] most of motor control
and body schematic processes are non-​conscious and automatic.

Gallagher (2011) emphasizes that an individual does not require a strong sense
of control over her actions to possess an SA. Rather, the SA is a pre-​reflective
 Ownership versus agency  331
experience and therefore is almost invisible. Essentially, this pre-​reflective SA is
generated by motor control processes at the BS level. Indeed, at its very core, the
SbA is rooted in the sensorimotor loop (Buhrmann & Di Paolo, 2017, p. 207; em-
phasis added):

The sense of oneself as the author of one’s own actions corresponds to what we experi-
ence during the ongoing adventure of establishing, losing, and re-​establishing mean-
ingful interactions with the world. The meaningful relation between agent and world is
given by the precarious constitution of sensorimotor agency as a self-​asserting network of
schemes and dispositions.

Succinctly, as long as the SA is not absent, it continues to exist with minimal self-​
awareness. In fact, as in the case of the SbO, we only become aware that we lack an SbA
when we lose control of our actions.
Essentially, we need to distinguish between the feeling of agency and the judgment
of agency (JA) (Synofzik, Vosgerau, & Newen, 2008) (see Table 20.1). The former is
non-​conceptual and implicit, emerging at the BS level. It is a basic and weak feeling
of self/​not-​self action causation. In opposition, the latter (JA) necessitates an inter-
pretative judgment of being the agent, based on a conceptual framing of the situation
and one’s beliefs. It emerges at the level of the BI. Indeed, as we already saw, the BI
corresponds to an explicit and allocentric perspective. Therefore, JA in general and the
judgment of body agency (JbA) in particular are not only explicit, but rather they force
one to adopt, at least to some degree, the gaze of the other, i.e., to judge oneself from a
third-​person perspective. In light of this, it is clear why we can suggest that JA emerges
at the BI level.

20.3.3  Ownership versus agency: double dissociation

According to some scholars, the SA and SO are not marked by the same phenom-
enology but are rooted in different types of cognitive mechanisms. ‘The sense of
agency involves a strong efferent component, because actions are centrally gen-
erated. The SO involves a strong afferent component, because the content of body
awareness originates mostly by the plurality of multisensory peripheral signals’
(Tsakiris & Haggard, 2005a, p. 387). Keeping this in mind, scholars have suggested
that not only are agency and body ownership ‘qualitatively different experiences’,
but that they are ‘triggered by different inputs, and recruiting distinct brain net-
work’ (Tsakiris, Longo, & Haggard, 2010, p. 2740). This can be defined as the inde-
pendence model. Continuing this line of thought, Sato and Yasuda (2005) state that
the SA and SO may ‘be partly independent’ and ‘have different processes by which
each of them is constructed’ (p. 253). Note that ‘studies of deafferentation also
332  body image–body schema/ownership–agency model
support the dissociation between agency and body-​ownership’ (Tsakiris, Longo, &
Haggard, 2010, p. 2748).1
Fundamentally then, while in our day-​to-​day lives, we tend to experience the SO
and SA as intimately linked, they are marked by a double dissociation. Nevertheless,
it would be a fundamental error to isolate the SO and SA from each other com-
pletely. For instance, even though the SbA can be extended to external tools, ‘par-
ticipants reported significantly stronger agency when the model hand was perceived
as part of one’s body than when it was perceived to be an external object’. This leads
some to argue that ‘the experience of body agency is more closely linked to the feeling
of body ownership than to external agency’ (Kalckert & Ehrsson, 2012, p. 11; em-
phasis added). Moreover, when actively controlling an external tool, the strength
of the SbO extended to this tool increases. Interestingly, however, ‘even in the ab-
sence of an engaged agency mechanism, the presence of ownership still drives a re-
sidual sense of agency’. We can explain this as a ‘general tendency to ascribe agency
to an owned body part’ (p. 12). Indeed, the SbA and SbO go hand in hand in our
everyday lives.

1 For more examples of studies that demonstrate dissociation between agency and body ownership, see: Longo,
Schüür, Kammers, Tsakiris, & Haggard (2008); Dummer, Picot-​Annand, Neal, & Moore (2009); Kalckert & Ehrsson
(2012); Kalckert & Ehrsson (2014); Riemer, Kleinböhl, Hölzl, & Trojan (2013); Braun, Thorne, Hildebrandt, &
Debener (2014); Imaizumi & Asai (2015); Argelaguet, Hoyet, Trico, & Lécuyer (2016); and Shibuya, Unenaka, &
Ohki (2017). For phenomenological studies demonstrating how long-​term meditators are able to separate these
phenomena, see: Ataria (2015a); Ataria, Dor-​Ziderman, & Berkovich-​Ohana, (2015). The same phenomena occur
during severe trauma (Ataria, 2015b, c) yet are less easy to detect.
 The BI-BS/Ow-Ag model  333
Table 20.1  A summary of the key acronyms used in this chapter

SA Sense of agency (Ag): a pre-​reflective feeling of controlling; a feeling of agency: ‘The sense
that I am the one who is causing or generating an action. For example, the sense that I am
the one who is causing something to move’ (Gallagher, 2000, p. 15).
SbA Sense of body agency: a pre-​reflective feeling of controlling one’s body; a feeling of body
agency: ‘When I reach for a cup, I know this to be my action’ (Gallagher, 2000, p. 16).
StA Sense of thought agency or, better phrased, sense of stream-​of-​consciousness agency: a pre-​
reflective feeling of controlling one’s thoughts or stream of consciousness: ‘I may experience
myself as actively or merely passively involved in the “movements” of my mind’ (Graham &
Stephens, 1994, p. 98).
JA Judgement of agency: a higher-​order cognitive process in which one decides that one is in
control: ‘Higher-​order cognition, which supports the reflective ability to make introspective
or attributive judgments about one’s first-​order experience’ (Gallagher, 2004, p. 90).
JbA Judgement of body agency: a higher-​order cognitive process in which one decides that one
controls one’s body: ‘Today and tomorrow I am fasting. Monday I start the grape diet . . . ’
(Mulveen & Hepworth, 2006, p. 288).
JtA Judgement of thought agency or, better phrased, judgement of stream-​of-​consciousness agency: a
higher-​order cognitive process in which one decides that one controls one’s thoughts or
stream of consciousness: ‘I am the cause or author of the thought’ (Gallagher, 2004, p. 91).
SO Sense of ownership [Ow]: a pre-​reflective feeling of belonging to the experiences that one
undergoes; feeling of ownership: ‘First-​order phenomenal experience; the immediate
experience that constitutes the “what it is like” or qualitative feel of consciousness. This
level of experience may also involve an intentionality or directionality toward an object; it is
about something’ (Gallagher, 2004, p. 90).
SbO Sense of body ownership: a pre-​reflective feeling that this is my body; a feeling of body ownership: ‘I
have a sense that I am the one who is moving or is being moved’ (Gallagher, 2000, p. 16).
StO Sense of thought ownership or, better phrased, sense of stream-​of-​consciousness ownership: a
pre-​reflective process in which one feels that one’s thoughts or stream of consciousness
belongs to her: ‘At the first-​order phenomenal level, the sense of ownership is the
prereflectively experiential, felt, or lived-​through sense that the thought occurs in my
stream of consciousness’ (Gallagher, 2004, p. 91).
JO Judgement of ownership: a higher-​order cognitive process that includes conceptual beliefs,
previous experience, and general knowledge, enabling one to know that she belongs to the
experiences she undergoes: ‘It wasn’t hard to realize that it was I myself who was sitting
there . . . ’ (Blanke, Arzy, & Landis, 2008, p. 432).
JbO Judgement of body ownership: a higher-​order cognitive process in which one knows that one’s
body is her own: ‘I exist for myself as a body known by the Other’ (Sartre, 1956, p. 460).
JtO Judgement of thought ownership or, better phrased, judgement of stream-​of-​consciousness
ownership: a higher-​order cognitive process in which one knows that she is having a
thought in her stream of consciousness: ‘I reflectively attribute ownership to myself or
report that “I am the subject in whom the thought is occurring” (OR “It is my body that is
moving”)’ (Gallagher, 2004, p. 91).

20.4  The BI-​BS/​Ow-​Ag model

20.4.1  The basic structure

The BI-​BS/​Ow-​Ag model (see table 20.2) attempts to explain different kinds of path-
ologies as part of a unified model. In particular, here we explain the phenomenology
of body integrity identity disorder (BIID), schizophrenia, anorexia nervosa (AN), and
post-​traumatic stress disorder (PTSD) in terms of body schema (BS), body image (BI),
ownership (Ow) and agency (Ag).
334  body image–body schema/ownership–agency model
In order to understand how our model works, we must understand the following
three stages: (1) it begins by identifying, based on phenomenological research, the
source of the problem: BS-​Ow, BS-​Ag, BI-​Ow, or BI-​Ag; in turn, (2) this basic cogni-
tive (phenomenologically based) impairment can lead to an inner contradiction within
the BS (or the BI) between Ow and Ag (the horizontal axis). In the third stage (3), this
inner contradiction can produce dis-​synchronization between the BS and BI (the ver-
tical axis). As one can see, at the heart of our model, we can detect an inherent tension
between the horizontal axis and the vertical axis. Indeed, this tension stands at the very
core of the escalation processes.

20.4.2  Most important of all: the gap

Usually, models dealing with BI, BS, Ow, and Ag focus on damage to one of these
cognitive mechanisms. We agree that it is crucial to identify the exact impairments
that occur in each one of the psychopathologies (stage 1); yet, given that in our daily
lives, these mechanisms work together, i.e., they are fully synchronized and adjusted,
we believe that the gap created between these mechanisms is of particular signifi-
cance (Ag ↔ Ow / BS ↔ BI) .
For instance, the decrease in the level of SbA toward one’s own limb feels strange, yet
it is not the loss of the SbA per se that is responsible for the occurred feelings. Rather the
fact that one has lost control (SbA ↓) over one’s own limb [(undamaged)2 SbO] makes
SbA[ ↓ ]
a significant difference: <1. The lack of agency, however, is not the entire story.
SbO[~]
Indeed, a lack of synchronization between BS and BI is responsible for the more com-
plicated issues. Thus, the escalation process, on the one hand, and the need to make
adjustments (usually top-​down processes), on the other, are responsible for the phe-
nomenology of each one of the psychopathologies (Table 20.2).

Table 20.2  The Body Image-​Body Schema/​Ownership-​Agency model

Ownership Agency

Body schema Feeling of ownership First-​order contradiction Feeling of agency

(BIID) (schizophrenia)
Second-​/​fourth-​order
contradiction

Body image Judgement of Third-​order contradiction Judgement of agency

ownership (anorexia) (PTSD)

2 In this chapter, the term is used in a relative sense. We use [~]‌in order to express this situation.
 Four case studies  335
20.5  Four case studies

20.5.1 BIID

20.5.1.1 Identifying the core problem (SbO/​BS)

The rare and unusual psychiatric condition BIID does not appear in the Diagnostic and
Statistical Manual of Mental Disorders, fifth edition (DSM-​5). Sufferers experience a
persistent and continued desire to become physically disabled, e.g., to amputate a limb,
thus adjusting their actual body to the image of the body they desire. Beginning in early
childhood, individuals with BIID generally experience the feeling that ‘their anatomical
configuration as an able-​bodied person is somehow wrong or inappropriate and that
they were meant to go through life as a disabled person’ (First & Fisher, 2011, p. 3). Such
individuals appear to sense a fundamental gap between their so-​called ‘true’ selves, as
disabled people, and their current able-​bodied state. One sufferer, interviewed by First,
claimed that after amputation, he would ‘have the identity that I’ve always seen my-
self as [having]’ (First, 2005, p. 4). Indeed, individuals suffering from BIID who have
undergone amputation report a significant improvement in their quality of life.
According to First and Fisher (2011), BIID is a mirror image of the phantom limb phe-
nomenon. An individual suffering from the phantom limb phenomenon feels ‘that his
missing limb is still a part of his body while acknowledging the reality that it is in fact absent’
(p. 6; emphasis added). By contrast, an individual suffering from BIID wants to become
an amputee. While such individuals feel that the affected limb is not part of their body,
reality forces them to acknowledge that it is indeed part of them. If phantom sensations
can be described as ‘animation without incarnation’, the desire of non-​psychotic individ-
uals to amputate a healthy limb can be characterized as ‘incarnation without animation’
(Hilti & Brugger, 2010, p. 315)—​both cases involve the experience of a fundamental dis-
parity between incarnation (the actual physical body) and animation (body map).
Individuals who develop phantom sensations develop as-​if experiences regarding a
physically absent limb. By contrast, in the case of BIID, ‘the affected limb may be entirely
functional, yet lack the sort of animation we usually feel to be an intrinsic property of any
part of our own body’ (Hilti & Brugger, 2010, p. 322). Essentially, BIID occurs even though
the relevant affected limbs ‘are experienced as being under full control of the individual’
(Giummarra, Bradshaw, Nicholls, Hilti, & Brugger, 2011, p. 321). Thus, the phenomenology
of BIID reveals that the SbO, which is located on the level of the BS, has been damaged.

20.5.1.2 Explaining BIID in terms of the BI-​BS/​Ow-​Ag model

BIID is a disorder that is embedded on the BS-​SbO level—​one does not feel that one’s
limb is one’s own. Fundamentally, despite the decrease in SbO (↓ SbO), some never-
theless insist that the limb is their own. Such individuals appear to describe what they
know to be logical rather than what they feel. To be clearer, those suffering from BIID
have lost (in the most extreme cases) the feeling of ownership. Yet, based on their system
of beliefs and habits, as well as the evident reality that the limb is attached to the body,
and given that, at least in the first stage, their Ag (SbA, JbA) remains intact, a twofold
336  body image–body schema/ownership–agency model
mismatch is created; this begins with a mismatch on the Ow-​Ag axis at the BS level:
SbA[~]
>1 (second stage), leading to the creation of a gap between the SbO (at the BS
SbO[↓]
level) and the JbO (at the BI level). This gap can result in de-​synchronization between
the BS and the BI (third stage). This twofold mismatch is expressed in a sense of the
over-​presence of a limb (Fighting It; emphasis added)3:

‘I am thinking that two legs are really not necessary at all. The extra leg is useful for
some sports, that is all’; ‘There wasn’t anything wrong in my life at all today, except the
extra leg’; ‘When I float in the sea my legs disappear and I feel so relaxed and free.’

The SbO and SbA affect the JbO and JbA, respectively. That is to say, the JbO de-
creases (↓ JbO) according to the SbO (↓ SbO), whereas with respect to the undamaged
SbA, the JbA remains, at least in the first stages, undamaged. In this situation, a new
JbA[~]
contradiction emerges on the Ow-​Ag axis at the BI level: >1. At this stage, the
↓ JbO
system tries to adapt in various ways, using top-​down processes; one alternative would
 ↓ JbA 
be to decrease the JbA:  =1 , for instance by tying up the leg or sitting on a wheel-
 ↓ JbO 
chair; another alternative is manipulating the SbO, e.g., by engaging in a sports activity
that allows one to forget one’s body (Fighting It):

‘The only time I don’t have these needs is when I am doing aggressively two-​legged things
like hiking or motorcycling’; “While I am riding, I am more content to have two legs than
at any other time.”

When the SbO is lost completely, when none of the alternatives enable the sub-
ject to close the gap, the individual tries to adapt by manipulating the most basic
problem—​the lack of SbO. Under these conditions, amputation becomes a real
option.

20.5.2 Schizophrenia

20.5.2.1 Identifying the core problem (SbA/​BS)

The symptoms of schizophrenia, a chronic and severe mental disorder that affects
how a person thinks, feels, and behaves, fall into three categories: positive, negative,
and cognitive. Individuals suffering from schizophrenia often seem to lose touch with
reality (American Psychiatric Association, 2013).
Phenomenological-​psychiatric studies (Fuchs, 2005; Fuchs & Schlimme, 2009; Sass,
Parnas, & Zahavi, 2011) describe schizophrenia in terms of disembodiment, i.e., ‘the

3 The quotes are taken from a closed Yahoo forum called ‘Fighting It’. The necessary permission to view the con-
tent of messages was acquired. Identifying details have been removed to protect the writers’ identities.
 Four case studies  337
prereflective, practical immersion of the self in the world is lost’ (Fuchs & Schlimme,
2009, p. 571). Such individuals experience the body as ‘mere things, thing-​like or corpse-​
like entities, rather than as living flesh’ (Stanghellini, Ballerini, Fusar Poli, & Cutting,
2012, p. 394), as conspicuous, and as an obstacle (Ataria, 2019; Parnas & Handest, 2003;
Sass & Parnas, 2007). Essentially, disembodiment results from impairment at the level
of the BS and sensorimotor loops, i.e., on the knowing-​how level (Arieli & Ataria, 2018;
Ataria, 2015d). In particular, the motor intentionality system ceases to function auto-
matically, making the individual aware of his actions in the course of perceiving the
world. Consequently, the pre-​reflective processes, processes that take place under the
threshold of consciousness, are made available for introspection. Schizophrenic pa-
tients exaggeratedly monitor their own sensations (hyperreflexivity), as we find in the
following testimony (de Haan & Fuchs, 2010, p. 330; emphasis added):

No matter where, the observing was with everything I did. Even when playing games on
the computer, even when I am walking through a virtual world. And the hand-​eye coord-
ination, you observe it all. Simply everything you do, everything you say.

In addition to disembodiment, ‘people with schizophrenia have difficulty in cor-

rectly attributing agency to self-​made movements’ (Graham, Martin-​Iverson, Holmes,
Jablensky, & Waters, 2014, p. 2). In our context, it is important to note that they also rely
heavily on visual feedback rather than on internal sensorimotor cues in order to attri-
bute agency to themselves (Synofzik, Thier, Leube, Schlotterbeck, & Lindner, 2010).
Continuing this line of thought, one of the main problems that schizophrenic patients
encounter ‘is a disturbance of their sense of agency: the first rank symptoms, which
represent one of the major features of the disease, are nothing but a loss of the ability
to attribute their own thoughts, internal speech, covert or overt actions to themselves’
(Jeannerod, 2009, p. 532).
Clearly, we cannot reduce schizophrenia to disembodiment and lack of agency.
However, when taken together, it becomes clear that the SA (SbA, StA) and BS4 play a
fundamental role in the phenomenology of schizophrenia.

20.5.2.2 Explaining schizophrenia in terms of the BI-​BS/​Ow-​Ag model

Hallucinations and delusions are considered the most common symptoms of
schizophrenia. Bearing this in mind, let us focus on ‘delusions of control where
the schizophrenic subject claims that someone else is causing him to act in a cer-
tain way or that someone else has his body under control’ (Gallagher, 2004, p. 89).
Before continuing, we must stress that, as in the case of losing the SA toward the

4 Priebe & Röhricht (2001) argue that schizophrenia is a kind of BI pathology. According to them, the BI def-
inition includes ‘[ . . . ] perceptual (body schema, body size perception in particular) and subjective, attitudinal
(cognitive: body concept, including thoughts, beliefs, and knowledge regarding the body; affective: body cathexis,
mainly body satisfaction) components’ (p. 290). However, given their terminology, it seems possible to suggest that
this disagreement is not essential but rather results from the different clarifications of the notions of BI and BS.
338  body image–body schema/ownership–agency model
body (↓ SbA), while the SbO remains intact, one can lose control (↓ SA) over one’s
own thoughts (sense of thought agency, StA)(↓ StA) without losing the SO toward
one’s thoughts (sense of thought ownership, StO) ([undamaged] StO) (Gallagher,
2004, p. 90):

Thoughts may occur in my stream of consciousness—​they are thoughts that I am

having—​they are not occurring in someone else’s stream of consciousness (thus I have a
sense of ownership for them)—​but I am not intentionally generating these thoughts (so
I have no sense of agency for them).

Pre-​reflectively, then, an individual suffering from schizophrenia may lose control

↓ StA
over her own thoughts: <1. Yet, as Gallagher further stresses, ‘this still leaves an
StO[  ]
important question unanswered: ‘Why does the subject misattribute agency to another
person (or machine, or thing)?’ (p. 99; emphasis added). The answer is connected to the
minimal self or ipseity. According to Parnas and Handest (2003), ‘the most prominent
feature of altered presence in the pre-​onset stages of schizophrenia is disturbed ipseity,
a disturbance in which the sense of the self no longer saturates the experience’ (p. 125).
In accordance with this line of thought, Sass has argued (2014) that disturbances in the
minimal self or ipseity stand at the very core of schizophrenia. Due to his impairment,
the schizophrenic individual loses the ability to differentiate between self and non-​self.
However, this is not a result of some higher-​order cognitive process, but part of the pre-​
reflective experience (Gallagher, 2015, p. 877):

When the subject claims that some thing or person other than himself is the source of the
thought, this is not simply the result of the subject trying to explain the experience, but
may very well be intrinsic to the experience itself . . . in that case, the attribution of agency
to some other person or thing reflects the loss of sense of agency and the feeling of alien-
ation in the primary experience.

For this reason, ‘people with schizophrenia have difficulty in correctly attributing
agency to self-​made movements’ (Graham, Martin-​Iverson, Holmes, Jablensky, &
Waters, 2014, p. 2), yet they have not lost their SbO (even if the disturbance has occurred
in this mechanism as well). A possible outcome is a gap in the Ow-​Ag horizontal axis at
↓ SbA
the BS level: <1. In this situation, there are at least two alternatives; whereas in
SbO[  ]
the first option, one’s JbA remains the same due to [undamaged] JbO and [undamaged]
SbO, in the second alternative, the JbA decreases (↓ JbA) due to damage (decreasing)
at the level of SbA (↓ SbA). The result of the first alternative is a gap between the BS and
↓ SbA
the BI (vertical axis), i.e., between feelings and judgements: <1. However, the
JbA[  ]
second alternative can lead to an inner conflict on the horizontal axis, i.e., within the BI:
 Four case studies  339
↓ JbA
<1. In turn, this may give rise to a new gap, top-​down in nature, for instance be-
JbO[  ]
tween (↓ JbO) and [undamaged] SbO. Thus, due to a decrease in the JbA (↓ JbA), one’s
JbO may also be converted (↓ JbO), and the result can be a mismatch between the SbO
↓ JbO
and the JbO at the BS-​BI vertical axis: <1.
SbO[  ]
As in the case of delusions, when the SbA as well as the JbA decrease in a funda-
mental manner (along with severe impairments to the minimal self), one may develop
a strong belief that someone else is controlling one’s movements.

20.5.3  Anorexia nervosa5

20.5.3.1 Identifying the core problem (JbO-​BI)

Individuals suffering from AN mainly exhibit the following symptoms: (1) extreme
fear of gaining weight; (2) significant reduction of calorie consumption, leading to a
particularly low body weight; and (iii) disturbance in the perception of the current
low body weight (American Psychiatric Association, 2013). The last category (3) can
be described in terms of BI disturbance (Mölbert et al., 2018). Continuing this line of
thought, Riva (2014) has suggested that ‘many unhealthy eating behaviors are func-
tional within the context of the patient’s belief system’ (p. 1; emphasis added).
To support this notion further, we may add that AN patients appear to have difficulty
in describing their bodily experience from a first-​person-​perspective (1pp). Instead,
they tend to depict bodily feelings from a third-​person perspective (3pp). The impaired
reflective function is understandable, considering that the AN perspective is rooted at
the BI level. Thus, as Skårderud (2007) stresses, they cannot reflect from 1pp and, in
turn, experience their body as an object (3pp).
Cultural studies (Calogero, Tantleff-​ Dunn, & Thompson, 2011; Dakanalis et al.,
2012) have repeatedly demonstrated that “our culture” treats women as objects.6 In the cur-
rent context, this insight is crucial. Indeed, various scholars claim that self-​objectification
is the main contributor to the onset of AN (Dakanalis et al., 2017). Developing this notion
further, Fredrickson and Roberts (1997) argue that individuals in certain cultures tend to
internalize societal ideals of beauty and examine themselves through these cultural lenses.
In particular, the sense of comfort (or discomfort) with their appearance depends on the
extent to which they accord with (or fail to accord with) this ideal perception (Tiggemann,
2011). To rephrase this notion in terms of our model, we may say that we judge our body
from the perspective of the culture to which we belong—​the JbO represents ‘the gaze of the
other’ (Sartre, 1956).

5 Today there is a growing consensus that sexual abuse in childhood constitutes a common ground in patients
suffering from eating disorders (Carter, Bewell, Blackmore, & Woodside, 2006; Madowitz, Matheson, & Liang,
2015; Malecki, Rhodes, & Ussher, 2018). Here, we will not discuss the specific role of sexual abuse in the onset AN,
but rather refer to it from another perspective—​the social one.
6 Although AN occurs in people of different sexes, ages, and ethnic origins, ‘adolescent girls and young adult
women are particularly at risk’ (Zipfel, Giel, Bulik, Hay, & Schmidt, 2015, p. 1099).
340  body image–body schema/ownership–agency model
Not only do individuals suffering from AN experience their body from 3pp, but they
also judge their bodies in an unrealistic manner. The following testimony sheds light on
this process (Mulveen & Hepworth, 2006, p. 290):

So, I’m at around 170 lbs and I have a BMI of 31.5. As I’m sure all of you know, that’s
clinically OBESE [ . . . ] But I honestly KNOW in my soul that I will kill myself someday if
I don’t start making steps to become thin . . . .

E’s bodily statistics do not match the societal ideal, leading her to conclude that
something is wrong. This is radicalized in AN individuals—​they assess the weight of
their bodies as overly high when, in fact, it is extremely low (Moelbert et al., 2017).
Indeed, this case demonstrates that AN is a situation in which, on the one hand, the JbO
on the BI level determines our existence and, on the other, the system is unable to up-
date according to reality—​namely, one’s real appearance.

20.5.3.2 Explaining anorexia in terms of the BI-​BS/​Ow-​Ag model

Misjudgment guided by the gaze of the other is the core problem in AN. In terms of our
model, we may suggest that under these conditions, the judgment of body ownership
increases (↑ JbO). As a result, a first-​order contradiction on the Ow-​Ag axis between

 ↑ JbO 
↑ JbO and [undamaged] JbA  >1 is created. If one is unable to reduce the
 JbA[  ] 
JbO, the first alternative would be to increase the JbA. For this reason, AN individuals
are obsessed with control. Our model suggests that this process should be regarded as

adaptive: ↑ JbO =1.

↑ JbA

Through the escalation process, both the JbO and the JbA increase. As a re-
sult, a fundamental gap emerges between the BI and the BS (the vertical axis). In
this situation, the AN individual manages her life at the BI level. Yet, as time goes
by, the BI begins to initiate changes at the BS level. Indeed, AN ‘is thus primarily
characterized by a deficit in body image that in turn impacts the body schema’
(Pitron, Alsmith, & de Vignemont, 2018, p. 356). Continuing this line of thought,
it has been suggested that ‘body mass changes may not only affect a person’s feel-
ings about his/​her body but may also affect the sensorimotor system’ (Metral et al.,
2014, p. 1; emphasis added). This study observed that AN participants overesti-
mate the aperture of a motor imagery task, causing them to behave in the same
way in reality—​turning sideways for a wider aperture than individuals in a control
group. Indeed, here we would like to suggest that, in some cases, the BI can even
take over the BS: ‘It appears that the most basic condition for this process to take
place is a hostile environment wherein one has no place to hide from the other’s
burning gaze’ (Ataria and Tanka, 2020).
 Four case studies  341
Given that AN is an Ow disturbance, the modification takes place due to a top-​down
 ↑ JbO ↑ JbO 
process (BI → BS), mainly on the SbO level   → . In turn, as in the case
 SbO[] ↑ SbO 
of BIID, once the SbO alters, a strong sense of over-​presence develops. As a result, the
individual cannot stand being within the body in-​the-​world; in other words, the indi-
vidual no longer feels at-​home. Indeed, Ow disturbances cause one to reject one’s own
existence; in that sense, the refusal to eat should be treated as rejecting not only the
body, but also reality itself.

20.5.4 PTSD

20.5.4.1 Identifying the core problem (JbA-​BI)

The diagnostic criteria for PTSD (American Psychiatric Association, 2013) include ex-
posure to a traumatic event that meets specific stipulations and presentation of symp-
toms from each of four symptom clusters:

(1) Re-​experiencing, such as flashbacks (reliving the traumatic event as if it were

happening again).
(2) Avoidance of memories, thoughts, feelings, or external reminders of the event.
(3) Negative cognitions and mood—​for instance, a persistent and distorted sense of
blame of self or others, estrangement from others, and the like.
(4) Arousal marked by aggressive, reckless, or self-​destructive behaviour, sleep dis-
turbances, hypervigilance, and the like.

Essentially, re-​experiencing, on the one hand, and avoidance, on the other, stand at
the very core of a post-​traumatic reaction. During flashbacks, one re-​experiences part
of the traumatic event on the bodily level. It is important to stress that one feels that
these flashbacks are one’s own; to rephrase this in terms of our model, those experiences
do not indicate a lack of SO toward these flashbacks, but rather the opposite—​they are
too much mine.
It is crucial to stress that during flashbacks, one feels as-if one’s body is once again
within the trauma, yet one nevertheless knows, at least to some degree, that one is here
and now, not in the traumatic event that occurred in the past. Fundamentally, at its very
core, those re-​experiences are as-​if—​one knows that one is not undergoing a new trau-
matic event but feels as-if one is living through the traumatic event once again.7 As we
saw, the schizophrenic individual does not experience her delusional thoughts in terms
of as-​if—​she is not re-​experiencing something but rather experiencing it directly right
here, right now.

7 Note that this observation cannot be applied to the dissociative subtype of the post-​traumatic stress type of
PTSD and complex-​PTSD. However, we are not attempting to explain these phenomena in terms of our model
(this has already been done; see Ataria, 2018).
342  body image–body schema/ownership–agency model
In terms of the bodily experience, the as-​if quality indicates that one feels that this is
one’s own body ([undamaged] SbO); yet, although one does not feel that one can control
these re-​experiences, one nevertheless does not develop a full-​blown delusional feeling
of experiencing a new traumatic event. Relying on our previous analysis of schizo-
phrenia, this as-​if phenomenon arguably indicates that in the case of re-​experience, the
SA has not been damaged. More accurately, during the flashback itself, the SA becomes
weaker (without doubt). However, those re-​experienced episodes are momentary, i.e.,
short episodes of a weakening SA. In the long term, the survivor deals with a lack of
control over such episodes, explaining why the JA eventually comes under attack. For
this reason, avoidance stands at the very core of this phenomenon. Indeed, following
flashbacks, one develops a belief that one cannot control these re-​experiences; in other
words, one’s JA is damaged. The outcome is avoidance—​if one cannot control the situ-
ation, the easiest solution is to avoid it.

20.5.4.2 PTSD in the context of the BI-​BS/​Ow-​Ag model

Impairments of the JbA at the BI level stand at the very core of (so-​called) simple PTSD.
In turn, the first-​order contradiction can be located at the BI level. Indeed, how can
one positively judge ownership toward something that one cannot control—​one’s own
body? That said, it is clear why the first-​order contradiction is between the JbA and the
JbO. The second-​order contradiction is top-​down, between ↓ JbA and [undamaged]
JbO. In turn, the survivor may develop different kinds of strategies to confront this
problem. One possible option is manipulation of the SbO. In a previous study (Ataria,
2018), we demonstrated that self-​injury is one way to manipulate the SbO. Notice that
simultaneously it is also a strategy to manipulate the JbA. With this in mind, it should
come as no surprise that ‘after a full history was obtained, it became clear that the self-​
cutting was part of a posttraumatic stress disorder’ (Greenspan & Samuel, 1989, p. 789).

 ↓ JbA 
The reverberations within the BI, at the horizontal axis of Ow-​Ag  < 1 ,
 JbO[] 
and between the BI and the BS (vertical axis), intensify over time—​so the sur-
vivor attempts to minimize the gap and adapt through avoidance. As a result, her
field of affordance shrinks and the final outcome is a survivor who avoids the world
altogether—​a survivor who avoids her BS, because, as we saw, we are thrown into the
world through our BS.

20.6 Conclusion

We would like to close this chapter by proposing some insights emerging from our
model, as well as some limitations:

(1) It is based on phenomenology, namely on the subjective experience. However,

the explanation is more cognitive and interpretative in kind and less descriptive,
thus leaving room for bias.
 Conclusion  343
(2) The model does not merely present what seems to be the primary problem, e.g.,
the SbO in the case of BIID, but the dynamic escalation process. For instance, in
their discussion, Graham et al. (2014) suggest that ‘the current findings point
to deficits in sense of agency, body image, and body schema in schizophrenia’
(p. 8); yet it goes without saying that this explanation is overly vague. In contrast,
our model presents a detailed cognitive mechanism. That said, much fine-​tuning
is obviously necessary.
(3) Our model presents some well-​known cognitive mechanisms that can be
tested in an experimental setup and hence refuted or confirmed. Yet, an ex-
ploration of processes that occur at the BS level is challenging in a typical ex-
perimental setup. Indeed, most studies describe the BI even when seeking to
explore the BS.
(4) The current model allows us to consider different kinds of psychopathologies in
terms of the BI versus the BS and Ow versus Ag:
(a) BI versus BS:
(i) Pathologies that begin in the BI have two main features: (1) society
plays a fundamental role—​although natural disasters are considered
traumatic events, individuals do not usually develop PTSD following
such events. However, when the source of the trauma is another human
being (i.e., rape), the likelihood of developing PTSD is much higher;
(2) it is top-​down in nature—​for instance, post-​traumatic survivors try
to avoid the world; those who suffer from AN try to control their body.
(ii) Pathologies embedded in the BS possess two main features: (1) they are
bottom-​up in nature and hence less controllable; (2) they entail nega-
tive bodily experience with two plausible outcomes: absence or over-​
presence of the body or part of it. We are aware that this sentence is
generic and requires further investigation.
(b) Ow versus Ag:
(i) Whereas Ow disturbance (i.e., BIID and AN) results in the rejection of
one’s own body, Ag disturbance (i.e., PTSD and schizophrenia) leads
to a complete rejection of reality. Phenomenologically speaking, these
phenomena require a much deeper study.

References
American Psychiatric Association. (2013). Diagnostic and Statistical Manual of Mental Disorders (fifth
edition). Arlington, VA: American Psychiatric Publishing.
Argelaguet, F., Hoyet, L., Trico, M., & Lécuyer, A. (2016). The role of interaction in virtual embodi-
ment: effects of the virtual hand representation. 2016 IEEE Virtual Reality (VR), 3–​10. doi:10.1109/​
VR.2016.7504682
Arieli, A. & Ataria, Y. (2018). Helplessness: the inability to know-​ that you don’t know-​ how.
Philosophical Psychology, 31(6), 948–​968.
Ataria, Y. (2015a). Where do we end and where does the world begin? The case of insight meditation.
Philosophical Psychology, 28(8), 1128–​1146. doi:10.1080/​09515089.2014.969801
344  body image–body schema/ownership–agency model
Ataria, Y. (2015b). Dissociation during trauma: the ownership-​agency tradeoff model. Phenomenology
and the Cognitive Sciences, 14(4), 1037–​1053. doi: 10.1007/​s11097-​014-​9392-​9
Ataria, Y. (2015c). Sense of ownership and sense of agency during trauma. Phenomenology and the
Cognitive Sciences, 14(1), 199–​212. doi:10.1007/​s11097-​013-​9334-​y
Ataria, Y. (2015d). Trauma from an enactive perspective: the collapse of the knowing-​how structure.
Adaptive Behavior, 23(3), 143–​154. doi:10.1177/​1059712314578542
Ataria, Y. (2018). Body Disownership in Complex Post-​ Traumatic Stress Disorder. New York,
NY: Palgrave Macmillan.
Ataria, Y. (2019). When the body stands in the way—​complex posttraumatic stress disorder, deper-
sonalization and schizophrenia. Philosophy, Psychiatry, & Psychology, 26(1), 19–​31.
Ataria, Y., Dor-​Ziderman, Y., & Berkovich-​Ohana, A. (2015). How does it feel to lack a sense of
boundaries? A case study of a long-​term mindfulness meditator. Consciousness and Cognition, 34,
133–​147. doi:10.1016/​j.concog.2015.09.002
Ataria, Y. & Neria, Y. (2013). Consciousness-​body-​time: how do people think lacking their body?
Human Studies, 36(2), 159–​178. doi: 10.1007/​s10746-​013-​9263-​3
Ataria, Y. & Tanaka, S. (2020). When Body Image Takes over the Body Schema: The Case of Frantz
Fanon. Human Studies.
Blanke, O., Arzy, S., & Landis, T. (2008). Illusory perceptions of the human body and self. In G.
Goldenberg & B. Miller (eds.), Handbook of Clinical Neurology (pp. 429–​458). Amsterdam:
Elsevier.
Braun, N., Thorne, J. D., Hildebrandt, H., & Debener, S. (2014). Interplay of agency and ownership: the
intentional binding and rubber hand illusion paradigm combined. PLoS ONE, 9(11), e111967.
doi:10.1371/​journal.pone.0111967
Buhrmann, T. & Di Paolo, E. (2017). The sense of agency—​a phenomenological consequence of
enacting sensorimotor schemes. Phenomenology and the Cognitive Sciences, 16(2), 207–​236.
doi:10.1007/​s11097-​015-​9446-​7
Calogero, R. M., Tantleff-​Dunn, S. E., & Thompson, J. (eds.) (2011). Self-​Objectification in Women:
Causes, Consequences, and Counteractions. Washington, DC: American Psychological Association.
doi:10.1037/​12304-​000
Carter, J. C., Bewell, C., Blackmore, E., & Woodside, D. B. (2006). The impact of childhood sexual
abuse in anorexia nervosa. Child Abuse & Neglect, 30(3), 257–​269.
Dakanalis, A., Clerici, M., Bartoli, F., Caslini, M., Crocamo, C., Riva, G., & Carrà, G. (2017). Risk
and maintenance factors for young women’s DSM-​5 eating disorders. Archives of Women’s Mental
Health, 20(6), 721–​731. doi:10.1007/​s00737-​017-​0761-​6
Dakanalis, A., Di Mattei, V. E., Bagliacca, E. P., Prunas, A., Sarno, L., Riva, G., & Zanetti, M. A. (2012).
Disordered eating behaviors among Italian men: objectifying media and sexual orientation differ-
ences. Eating Disorders, 20(5), 356–​367. doi:10.1080/​10640266.2012.715514
de Haan, S. & Fuchs, T. (2010). The ghost in the machine: disembodiment in schizophrenia—​two case
studies. Psychopathology, 43, 327–​333. doi:10.1159/​000319402
de Vignemont, F. (2007). Habeas corpus: the sense of ownership of one’s own body. Mind and
Language, 22(4), 427–​449. doi:10.1111/​j.1468-​0017.2007.00315.x
de Vignemont, F. (2010). Embodiment, ownership and disownership. Consciousness and Cognition,
20(1), 82–​93.
Dummer, T., Picot-​Annand, A., Neal, T., & Moore, C. (2009). Movement and the rubber hand illu-
sion. Perception, 38(2), 271–​280. doi:10.1068/​p5921
Farrer, C., Franck, N., Georgieff, N., Frith, C., Decety, J., & Jeanneroda, M. (2003). Modulating the ex-
perience of agency: a positron emission tomography study. NeuroImage, 18, 324–​33.
First, M. B. (2005). Desire for amputation of a limb: paraphilia, psychosis, or a new type of identity
disorder. Psychological Medicine, 35(6), 919–​928.
First, M. B. & Fisher, C. E. (2011). Body integrity identity disorder: the persistent desire to acquire a
physical disability . Psychopathology, 45(1), 3–​14. doi:10.1159/​000330503
Fredrickson, B. L. & Roberts, T. A. (1997). Objectification theory: toward understanding women’s
lived experiences and mental health risks. Psychology of Women Quarterly, 21(2), 173–​206.
doi:10.1111/​j.1471-​6402.1997.tb00108.x
 Conclusion  345
Frith, C. D., Blakemore, S. J., & Wolpert, D. M. (2000). Abnormalities in the awareness and control
of action. Philosophical Transactions of the Royal Society of London. Series B: Biological Sciences,
355(1404), 1771–​1788.
Fuchs, T. (2005). Corporealized and disembodied minds: a phenomenological view of the body in
melancholia and schizophrenia. Philosophy, Psychiatry, & Psychology, 12(2), 95–​107.
Fuchs, T. (2010). Phenomenology and psychopathology. In D. Schmicking & S. Gallagher (eds.),
Handbook of Phenomenology and Cognitive Science (pp. 546–​573). Netherlands: Springer.
Fuchs, T. & Schlimme, J. E. (2009). Embodiment and psychopathology: a phenomenological perspec-
tive. Current Opinion in Psychiatry, 22(6), 570–​575. doi:10.1097/​YCO.0b013e3283318e5c
Gallagher, S. (2000). Philosophical conceptions of the self: implications for cognitive science. Trends
in Cognitive Sciences, 4(1), 14–​21. doi:10.1016/​S1364-​6613(99)01417-​5
Gallagher, S. (2004). Agency, ownership, and alien control in schizophrenia. In P. Bovet, J. Parnas,
& D. Zahavi (eds.), Interdisciplinary Perspectives on Self-​Consciousness (Vol. 59, pp. 89–​104).
Amsterdam: John Benjamins.
Gallagher, S. (2005). How the Body Shapes the Mind. New York, NY: Oxford University Press.
Gallagher, S. (2007). The natural philosophy of agency. Philosophy Compass, 2(2), 347–​357.
doi:10.1111/​j.1747-​9991.2007.00067.x
Gallagher, S. (2011). Multiple aspects in the sense of agency. New Ideas in Psychology, 30(1), 15–​31.
doi:10.1016/​j.newideapsych.2010.03.003
Gallagher, S. (2015). Relations between agency and ownership in the case of schizophrenic thought
insertion and delusions of control. Review of Philosophy and Psychology, 6(4), 865–​879.
Gallagher, S. & Zahavi, D. (2008). The Phenomenological Mind: An Introduction to Philosophy of Mind
and Cognitive Science. London: Routledge.
Giummarra, M. J., Bradshaw, J. L., Nicholls, M. E., Hilti, L. M., & Brugger, P. (2011). Body integ-
rity identity disorder: deranged body processing, right fronto-​parietal dysfunction, and phenom-
enological experience of body incongruity. Neuropsychology Review, 21(4), 320–​333. doi:10.1007/​
s11065-​011-​9184-​8
Graham, G. & Stephens, G. L. (1994). Mind and mine. In G. Graham & G. L. Stephens (eds.),
Philosophical Psychopathology (pp. 91–​109). Cambridge, MA: MIT Press.
Graham, K. T., Martin-​Iverson, M. T., Holmes, N. P., Jablensky, A., & Waters, F. (2014). Deficits in
agency in schizophrenia, and additional deficits in body image, body schema, and internal
timing, in passivity symptoms. Frontiers in Psychiatry, 5(126), 1–​11. https://​doi.org/​10.3389/​
fpsyt.2014.00126
Greenspan, G. S. & Samuel, S. E. (1989). Self-​cutting after rape. American Journal of Psychiatry, 146(6),
789–​790. doi:10.1176/​ajp.146.6.789
Hilti, L. M. & Brugger, P. (2010). Incarnation and animation: physical versus representa-
tional deficits of body integrity. Experimental Brain Research, 204(3), 315–​326. doi:10.1007/​
s00221-​009-​2043-​7
Imaizumi, S. & Asai, T. (2015). Dissociation of agency and body ownership following visuomotor
temporal recalibration. Frontiers in Integrative Neuroscience, 9, 35. doi:10.3389/​fnint.2015.00035
Jeannerod, M. (2009). The sense of agency and its disturbances in schizophrenia: a reappraisal.
Experimental Brain Research, 192(3), 527–​532. doi:10.1007/​s00221-​008-​1533-​3
Kalckert, A. & Ehrsson, H. (2012). Moving a rubber hand that feels like your own: a dissoci-
ation of ownership and agency. Frontiers in Human Neuroscience, 6(40), 1–​14. doi:10.3389/​
fnhum.2012.00040
Kalckert, A. & Ehrsson, H. H. (2014). The moving rubber hand illusion revisited: comparing move-
ments and visuotactile stimulation to induce illusory ownership. Consciousness and Cognition, 26,
117–​132. doi:10.1016/​j.concog.2014.02.003
Longo, M. R., Schüür, F., Kammers, M. P., Tsakiris, M., & Haggard, P. (2008). What is embodiment?
A psychometric approach. Cognition, 107(3), 978–​998. doi:10.1016/​j.cognition.2007.12.004
Madowitz, J., Matheson, B. E., & Liang, J. (2015). The relationship between eating disorders and sexual
trauma. Eating and Weight Disorders—​Studies on Anorexia, Bulimia and Obesity, 20(3), 281–​293.
Malecki, J., Rhodes, P., & Ussher, J. (2018). Childhood trauma and anorexia nervosa: from body image
to embodiment. Health Care for Women International, 39(8), 936–​951.
346  body image–body schema/ownership–agency model
Merleau-​Ponty, M. (1964). The Primacy of Perception (J. Edie, ed.) Evanston, IL: Northwestern
University Press.
Metral, M., Guardia, D., Bauwens, I., Guerraz, M., Lafargue, G., Cottencin, O., & Luyat, M. (2014).
Painfully thin but locked inside a fatter body: abnormalities in both anticipation and execution of
action in anorexia nervosa. BMC Research Notes, 7(1), 707. doi:10.1186/​1756-​0500-​7-​707
Moelbert, S. C., Klein, L., Thaler, A., Mohler, B. J., Brozzo, C., Martus, P., & Giel, K. E. (2017). Depictive
and metric body size estimation in anorexia nervosa and bulimia nervosa: a systematic review and
meta-​analysis. Clinical Psychology Review, 57, 21–​31. doi:10.1016/​j.cpr.2017.08.005
Mölbert, S., Thaler, A., Mohler, B., Streuber, S., Romero, J., Black, M., Zipfel, S., Karnath, H.-​O., &
Giel, K. E. (2018). Assessing body image in anorexia nervosa using biometric self-​avatars in virtual
reality: attitudinal components rather than visual body size estimation are distorted. Psychological
Medicine, 48(4), 642–​653. doi:10.1017/​S0033291717002008
Mulveen, R. & Hepworth, J. (2006). An interpretative phenomenological analysis of participation in a
pro-​anorexia internet site and its relationship with disordered eating. Journal of Health Psychology,
11(2), 283–​296. doi:10.1177/​1359105306061187
Parnas, J. & Handest, P. (2003). Phenomenology of anomalous self-​experience in early schizophrenia.
Comprehensive Psychiatry, 44(2), 121–​134. doi:10.1053/​comp.2003.50017
Pitron, V., Alsmith, A., & de Vignemont, F. (2018). How do the body schema and the body image
interact? Consciousness and Cognition, 65, 352–​358. doi:10.1016/​j.concog.2018.08.007
Priebe, S. & Röhricht, F. (2001). Specific body image pathology in acute schizophrenia. Psychiatry
Research, 101(3), 289–​301.
Riemer, M., Kleinböhl, D., Hölzl, R., & Trojan, J. (2013). Action and perception in the rubber hand il-
lusion. Experimental Brain Research, 229(3), 383–​393. doi:10.1007/​s00221-​012-​3374-​3
Riva, G. (2014). Out of my real body: cognitive neuroscience meets eating disorders. Frontiers in
Human Neuroscience, 8, 1–​20. doi:10.3389/​fnhum.2014.00236
Sartre, J. (1956). Being and Nothingness (H. Barnes, Trans.). New York, NY: Philosophical Library.
Sass, L. A. (2014). Self-​ disturbance and schizophrenia: structure, specificity, pathogenesis.
Schizophrenia Research, 152(1), 5–​11. doi:10.1016/​j.schres.2013.05.017
Sass, L. A. & Parnas, J. (2007). Explaining schizophrenia: the relevance of phenomenology. In M. C.
Chung, K. W. Fulford, & G. Graham (eds.), Reconceiving Schizophrenia (pp. 63–​95). New York,
NY: Oxford University Press.
Sass, L. A., Parnas, J., & Zahavi, D. (2011). Phenomenological psychopathology and schizo-
phrenia: contemporary approaches and misunderstandings. Philosophy, Psychiatry, & Psychology,
18(1), 1–​23.
Sato, A. & Yasuda, A. (2005). Illusion of sense of self-​agency: discrepancy between the predicted and
actual sensory consequences of actions modulates the sense of self-​agency, but not the sense of self-​
ownership. Cognition, 94(3), 241–​255.
Shibuya, S., Unenaka, S., & Ohki, Y. (2017). Body ownership and agency: task-​dependent effects of
the virtual hand illusion on proprioceptive drift. Experimental Brain Research, 235(1), 121–​134.
doi:10.1007/​s00221-​016-​4777-​3
Skårderud, F. (2007). Eating one’s words, part I: ‘concretised metaphors’ and reflective function
in anorexia nervosa—​an interview study. European Eating Disorders Review, 15(3), 163–​174.
doi:10.1002/​erv.777
Stanghellini, G., Ballerini, M., Fusar Poli, P., & Cutting, J. (2012). Abnormal bodily experiences may
be a marker of early schizophrenia? Current Pharmaceutical Design, 18(4), 392–​398. doi:10.2174/​
138161212799316181
Synofzik, M., Thier, P., Leube, D. T., Schlotterbeck, P., & Lindner, A. (2010). Misattributions of agency
in schizophrenia are based on imprecise predictions about the sensory consequences of one’s ac-
tions. Brain, 133(1), 262–​271. doi:10.1093/​brain/​awp291
Synofzik, M., Vosgerau, G., & Newen, A. (2008). I move, therefore I am: a new theoretical framework
to investigate agency and ownership. Consciousness and Cognition, 17(2), 411–​424. doi:10.1016/​
j.concog.2008.03.008
 Conclusion  347
Tiggemann, M. (2011). Sociocultural perspectives on human appearance and body image. In T. F.
Cash & L. Smolak (eds.), Body Image: A Handbook of Science, Practice, and Prevention (pp. 12–​19).
New York, NY: Guilford Press.
Tsakiris, M. & Haggard, P. (2005a). Experimenting with the acting self. Cognitive Neuropsychology,
3–​4, 387–​407.
Tsakiris, M. & Haggard, P. (2005b). The rubber hand illusion revisited: visuotactile integration
and self-​attribution. Journal of Experimental Psychology: Human Perception and Performance,
31(1), 80–​91.
Tsakiris, M., Longo, M., & Haggard, P. (2010). Having a body versus moving your body: neural signa-
tures of agency and body-​ownership. Neuropsychologia, 48(9), 2740–​2749.
Tsakiris, M., Prabhu, G., & Haggard, P. (2006). Having a body versus moving your body: how agency
structures body-​ownership. Consciousness and Cognition, 15(2), 423–​432.
Zipfel, S., Giel, K. E., Bulik, C. M., Hay, P., & Schmidt, U. (2015). Anorexia nervosa: aetiology, assess-
ment, and treatment. The Lancet Psychiatry, 2(12), 1099–​1111.
 Index

For the benefit of digital users, indexed terms that span two pages (e.g., 52–​53) may, on occasion, appear
on only one of those pages. 

action  39, 194–​99 body dysmorphia  86

body–​action interaction  196–​203
body schema  3–​6, 28–​29, 30
active inference  198
active self-​touch  323–​24
actual drift  198
affective touch  216–​17, 219
affordances  6–​7, 48–​49, 72–​73, 78, 184, 287,
288–​89, 290–​91
agency  195–​96, 199–​200, 204–​5, 286–​87, 289,
290–​91, 320–​21, 330–​32
Aglioti, S.  87–​88
agnosia  45–​46, 47–​48
alien hand syndrome  203
allochiria 247
alloesthesia 247
Alsmith, A.J.T.  62–​63
amputation  204–​5, see also phantom
limb (pain)
anorexia nervosa  86, 216–​17, 241, 267–​68, 275–​
78, 339–​41
anosognosia for hemiplegia  248
apraxia  43–​44, 45–​46, 47–​48
Aranyosi, I.  94
asomatognosia  269–​73
association, motor learning  73–​74
audience effects  189–​90
automaticity  232–​39
autonomous phase, motor skills  73–​74
autoscopic hallucination  319
Bayesian model  12–​15, 197–​99
Berlucchi, G.  87–​88
bimodal neurons  119, 124, 138, 205–​6
Biran, M. de  53, 55, 58–​59
bodily illusions  267–​68, 276–​77, 322–​24.
see also rubber hand illusion
bodily self-​consciousness  65, 93, 273, 321–​22
body awareness  101, 102, 104, 108–​9, 286
development  181–​93, 211–​14
interoception  short-​term/​long-​term  65, 160
predictive coding  217–​18
pre-​reflective awareness  93–​94, 290
bodybuilding 94
body identity integrity disorder  335–​36
body image 
body representations  59–​61
body schema relationship  85–​87, 99–​101,
164, 167–​68, 328–​29
brain–​body connection  135–​37
disturbances  216–​17, 267–​84
expert performances  92–​95
German-​speaking neurology  99–​114
implicit versus explicit models  167–​68
insula and visual information  137–​40
interoception  210–​25
interpersonal sense of self  185–​86
motor learning  69–​82
movement  29–​31
plasticity 164
public  181–​82, 186, 188
unilateral body neglect  251
body image–​body schema/​ownership–​agency
model  333–​43
body integrity dysphoria  267–​68
body-​in-​the-​brain  xv–​xvii, 18, 87–​88
body-​in-​the-​world  xv–​xvii, 18, 88
body map  xvi, 62–​63, 65, 135–​36, 137–​38, 154–​55
body ownership  139, 194–​95, 199, 200–​1, 272–​
73, 286–​87, 289, 290–​91, 329–​30, 331–​32
depersonalization  319–​20
illusory  196, 197, 205, 322–​23
multisensory integration  214–​15
body representation 
body image  59–​61
body schema  62–​64
brain and self  145–​47
characteristics  158–​70
implicit versus explicit models  167–​68
online/​offline  65, 82, 160
primate brain  154–​56
sensory input  64–​67
serial versus parallel processing  168–​70
taxonomies  159–​60
triadic taxonomy  140–​45, 159
unilateral body neglect  250–​51, 255–​60
350 Index
body schema  culture 
action-​orientated representation  3–​6 objectification of women  339–​40
action-​shaping  28–​29, 30 tool use  117–​18
background of perceptual figures  35–​
38, 70–​71 deafferentation  xvii–​xix, 86–​87, 232–​39
Bayesian model  12–​15 default mode network  274, 276–​77
body image relationship  85–​87, 99–​101, 164, delayed visual feedback  200–​1
167–​68, 328–​29 delusions of being controlled  320–​21
body representations  62–​64 depersonalization  104, 248, 319–​21
brain–​body connection  135–​37 derealization 319
differentiations  42–​44 development 
disturbances  267–​84 body–​action interaction  199–​203
dynamics in Merleau-​Ponty  33–​51 body awareness  181–​93, 211–​14
feeling of a presence  321–​22 interoceptive sensitivity  219–​21
German-​speaking neurology  99–​114 de Vignemont, F.  xvii, 62–​63, 65, 87, 88, 159, 237
global  9–​12 diacritical system  42–​43, 46–​47, 48–​49
implicit versus explicit models  167–​68, 182–​85 directional bradykinesia  247
invisible 37 directional hypokinesia  247
local  9–​12 directional hypometria  247
motor learning  69–​82 dis-​appear  288–​89
movement  18–​32 disembodiment  306–​7
multiple sclerosis  288–​91 schizophrenia 337
pain  301–​15 disfigurement 240
physiotherapy  291–​93 distributed representations  170
plasticity 164 dorsal stream  138
protective  6–​9 dorso-​dorsal stream  142, 143
task-​oriented system  39–​42 double consciousness  320
tool use  7–​9, 13, 120–​24 double dissociation  xxi–​xxii, 86–​87, 328–​
unilateral body neglect  251 29, 331–​32
unity of the body  58–​59 drawing-​a-​man task  253–​54
working  6–​9 dys-​appear  288–​89
body self-​awareness see body awareness
body semantics  140–​47 ecological psychology  21, 22, 23, 86, 290
body structural description  140–​46 ecological self  152, 184, 199
body topology  201–​3 embarrassment 187
embodiment  153–​54, 167–​68, 212, 214–​15, 218
cardiac perception  219–​20 robots  170–​73
caregiver-​infant dyad  218–​19 social self  229–​43
Cartesian assumptions, pain  305–​7 tool use  120–​24
C fibres  136 emotions 
Changing Faces  240 expression  239–​40
co-​construction model  87, 267–​68 self-​conscious  187
cognetics  321–​22, 323–​24 social  190–​91
cognition, motor learning  73–​74 towards body (parts)  294
cognitive science  62–​63, 64–​65, 66–​67 empathy 188
Cole, J.  77, 86–​87, 92 enactive knowing  295–​96
command obeyance  307 enactivism  18, 87, 91–​92, 310–​13
communication  285, 292, 293, 296 enfacement illusion  214–​15
computational models  152, 170–​73 evaluative audience perception  181–​82, 187–​
Conrad, K.  108–​10 88, 189–​90
consciousness  26, 33–​34, 36–​37, 38, 39, 55, evaluativism 305
311–​12, 320, 328–​29, 337, 338 expert performances  92–​95
corporeal awareness  267–​68, 276–​77 explicit cognition  73
C-​tactile afferents  216–​17, 219 expression  36–​37, 49

facilitation of movement  292, 295–​96
Fanon, F.  xiv
feeling  61–​62
of agency  331, 334–​35
knowing and  329–​30
of a presence  316–​19, 320–​24
fiat boundaries  11
figure–​ground  35–​38, 70–​71, 90, 93
first-​person perspective  79–​80, 81, 287
Fisher, S.  85
fluff test  254
force-​fields  120
format  4–​5
forward kinematics  157–​58
forward model  5–​6, 74–​75, 81, 195–​96
frontal body-​evocation subtest  254
full body illusions  322–​23
fusion model  87
Gallagher, S.  xviii, 19–​20, 25, 38, 77
Gerstmann, J.  104–​11
Gestalt psychology  37, 43, 90, 93, 95, 106–​7,
108–​9, 111
gestures  44–​45, 49, 235–​36, 239–​40
‘getting the knack’ of motor skills  80–​81
Gibson, J.J.  72–​73, 86
global body schema  9–​12
gnosis  44–​48
Godfrey-​Smith, P.  26
Goldstein, K.  90
habit  71–​73, 80, 302, 303, 304
Halák, J.  89
hand laterality identification task  254
haptics  19–​20, 21–​22, 23, 323–​24
Head, H.  xix, 85
heart evoked potentials  219–​20
heautoscopy 319
hemi-​asomatognosia  248
hemi-​depersonalization  248
hemi-​microsomatognosia  246–​47
Henry, M.  52–​56, 58, 59, 60–​62
heterotopoagnosia  247–​48
Holmes, G.  xix
homeostatic sensation  306
humanoid robot  156–​57, 162, 168, 172–​73
hyperschematia 248
iBEATS  219–​20
‘I can do it’  80–​81, 82
iCub humanoid robot  156–​57, 162, 168, 172–​73
illusory drift  198
imagery, motor  79–​80, 340–​41
imperativism  301, 305–​10
Index  351
implicit cognition  71
independence model  87, 331–​32
insula  87, 137–​40, 215–​16, 219, 220, 274–​77, 319
intentional arc  78–​79
intentionality  285–​86
motor  293–​94, 297–​98, 303
operative  33–​34, 48–​49
representational 33
intercorporeity  291–​92
internal models  5–​6, 74–​75
interoception  210–​25
interoceptive accuracy  215–​16
interoceptive sensitivity  219–​21
interpersonal sense of self  185–​86
intersensory redundancy hypothesis  213
intersubjectivity  186, 287, 291–​92, 295–​96
inverse kinematics  158
inverse model  5–​6, 74–​75
invisible body schema  37
ipseity 338
IW see Waterman, Ian
Katz, D.  19
kinaesthesia  86, 93–​94, 107, 109
kinematics  122–​23, 154, 156–​58
Klein, C.  306, 308–​9
‘knack’ of motor skills  80–​81
knowing 
enactive  295–​96
feeling and  329–​30
knowing that and knowing how  292
Körper  94–​95
language  44, 47, 48, 49–​50
Legrand, D.  93–​94
Leib 94
Leibhaftige Bewusstheit  316
lived body  70–​73
lived space  18, 19–​20, 21, 288–​89
local body schema  9–​12
localizationalist approach  101
maximum grip  293–​94
McNeill, D.  235
medial prefrontal cortex  272, 276–​77
mereotopological structure  9–​10
Merleau-​Ponty, M.  xiii, 19–​20, 33–​51, 69, 70,
71–​73, 78, 80, 302–​5
midline structures  272–​73, 274–​75, 276–​77
minimal self  145–​46, 194–​95, 338
mirror mark test  186–​87, 196, 200, 202, 211
mirror therapy  196, 204–​5, 259
misoplegia 247
Möbius syndrome  239–​40
352 Index
modularity  162, 170
Montero, B.  93
motor control  73–​75, 134, 135, 139, 153–​54,
155, 195–​96, 197, 206, 330–​31
motor imagery  79–​80, 340–​41
motor intentionality  293–​94, 297–​98, 303
motor learning  69–​82
motor neglect  247
motor skills  72–​74, 76, 78, 79–​80, 82
movement  18–​32
facilitation  292, 295–​96
self-​induced  289
sensations  61–​62
touch  19–​20
visual feedback  196, 237–​39
Wernicke’s view  102–​3
multimodality  154–​55, 165–​67, 173–​74,
199, 200
multiple sclerosis  285–​300
multisensory integration  13–​14, 64–​65,
118, 119–​20, 122, 213, 214–​18, 271–​72,
273, 274–​76
Munk, H.  102
muscle dysmorphia  94
muscle tonus  41
neglect see unilateral body neglect
octopus  26–​28, 29–​30, 153–​54
ontological monism/​dualism  54–​56
operative intentionality  33–​34, 48–​49
orientation perception  40–​42
out-​of-​body experiences  144–​45
over-​imitation  188–​89
Paillard, J.  xix, 9, 235
pain  301–​15
asymbolia  307–​10, 312–​13
Cartesian assumptions  305–​7
enactivism  310–​13
Merleau-​Ponty on  302–​5
participatory sense-​making  295–​96
passivity  29–​30
performative awareness  93–​94
peripersonal space  118–​20
phantom body pain  232
phantom limb (pain)  71–​72, 196, 204–​5
mirror therapy  196, 204–​5
telescoping 205
phenomenological-​cognitive model  333–​43
phenomenology  19–​20, 69, 310–​13, 331–​32,
334, 335, 337, 338
radical  52–​68
physiognomy  72–​73
physiotherapy  89, 291–​93, 294, 295–​96
Pitron, V.  87
plasticity  7–​8, 120, 122, 124–​26, 164–​65, 218–​19
post-​it test  254
post-​traumatic stress disorder  341–​42
postural control  203, 206, 252–​53, 297–​98
praxis  39–​40, 44–​48
predictive coding  198, 217–​18, 221–​22
pre-​noetic functioning  302–​3, 305, 306–​7, 311–​12
pre-​reflective awareness  93–​94, 290
presence hallucination  316–​17
prism adaptation  258–​59
proprioception  xviii, 57–​58, 63–​64, 86, 93–​94,
184, 198
proprioceptive drift  196–​97, 199
proprioceptive neglect  246
prospective schemas (prospections)  22–​23
prostheses  126–​27, 205–​6
protective body schema  6–​9
psychoanalysis  91, 95, 105–​6, 107, 111
public body image  181–​82, 186, 188
pushmi-​pullyu representation  6
radical phenomenology  52–​68
reaching  153–​54, 155–​56, 160–​62
reflection-​in-​action  292
representational intentionality  33
representationalism 301
reputation management  189–​90
retinotopy  137–​38, 139–​40
robots  156–​58, 162, 164–​65, 167, 168, 170–​75
induced feeling of a presence  322–​24
rubber hand illusion  194–​95, 196–​97, 198, 214–​
18, 322–​23
Saint-​Aubert, E. de  90–​92
Sartre, J-​P  311
Schilder, P.  xx, 85, 91, 99–​100, 104–​11
schizophrenia  267–​68, 273–​75, 337–​39
Schneider case  36, 44, 46–​47, 48, 76–​78
sedimentation  46–​47
self-​calibration  162, 164–​65, 172–​74
self-​conscious emotions  187
self-​induced movements  289
self-​objectification  217–​18, 339–​40
self-​pattern  287, 291–​92, 294, 295–​96
self-​preserving action  306, 312, 313
self-​recognition  186–​87, 196, 200–​1, 211–​14
self-​referential processing  274–​75, 276–​77
self-​touch  323–​24
sensations  57–​58, 59, 61–​62, 64
sensed presence  317–​18
sense of agency  195–​96, 199–​200, 204–​5, 286–​
87, 289, 290–​91, 320–​21, 330–​32

sensorimotor processing  144, 257, 267–​68, 272,
273, 276–​77, 286, 318–​19, 340–​41
Shusterman, R.  93
skin-​to-​skin contact  218, 219
sleep  43–​44
social cues  188
social emotions  190–​91
social media  241
somatoparaphrenia  203, 246
somatopsyche  101, 104, 107, 269–​73
somatosensation  160–​62, 165–​68, 172–​73
multiple sclerosis  290–​91
somatosensory cortex  xvi, 135–​37
somatosensory neglect  246
somatotopy  135–​38, 167–​68
spatial orientation perception  40–​42
speech  44, 45–​46, 49–​50
structuralism  36, 38, 43
subjectivity  xiv–​xv, 53–​58, 60–​62
surveillance 241
tactile remapping  160–​62
task-​oriented system  39–​42
telepresence/​teleexistence  324
telescoping 205
tetraplegia  230–​32
third man factor  316–​17
third-​person perspective  70, 79–​80, 285,
294, 339–​40
time, body-​schematizing movement  29–​31
tool use  117–​32
body schema  7–​9, 13, 120–​24
functional and cultural aspects  117–​18
peripersonal space  118–​20
plasticity  120, 122, 124–​26
prostheses as tools  126–​27, 205–​6
touch 
active self-​touch  323–​24
Index  353
affective  216–​17, 219
movement  19–​20
touch-​vision sensory substitution  22
transcendent body  53, 54–​58
unfamiliarity  290–​91
unilateral body neglect  86, 244–​66
as an attention disorder  250–​51
body image  251
as a body representation disorder  250–​51
body schema  251
clinical manifestations  245–​49
definitions and pathophysiology  249–​51
dynamics of body representations  255–​60
mirror therapy  259
prism adaptation  258–​59
tests, diagnosis and evaluation  251–​55
ventral stream  138–​39, 142–​43
ventro-​dorsal stream  142, 143
Vienna psychiatric clinics  104–​11
visible difference  239–​40
visual feedback 
delayed  200–​1
movement  196, 237–​39
schizophrenia 337
visual information, body image  137–​40
visuo-​tactile integration  138, 194–​95, 210–​11,
213, 275–​76
visuo-​tactile stimulation  197, 205, 213, 322–​23
waiter’s tray illusion  233
Waterman, Ian  xvii, 69, 76–​78, 80, 86–​87, 92,
133–​35, 136, 203, 232–​39
Wernicke, C.  101–​4
working body schema  6–​9
Zuboff, S.  241