Between Phenomenology and Neuroscience (Conférences)

Between  phenomenology and neuroscience : 
a place for art ? 

Conférence le 15.07.2015 La phénoménologie est intelligible : à partir d’un tableau d’Andrew Wyeth

Centre Rainier III Monaco

                Dr Benoit KULLMANN, M.D., Neurologist
                 University Diploma of Psychiatric Phenomenology, Nice

    Between phenomenology and neurosciences, perhaps there is a place for Art. First of all I would like to thank the organizers of this meeting, which will include three presentations : we shall begin with an approach of phenomenology, the challenge being to draw upon the comment of a very famous North American painting. Then Solange Hesse, Research Ingeneer, will present the results of a scientific study of eyes-movements recordings during visual exploration of this same work of art. It's my privilege to work with professor Alain Pesce, M.D., who created a department of eye movement study using eye-tracking technics at center Rainier III in Monaco. At last Kevin Polet, neuropsychologist, trained in eye tracking technics aswell as in theory of mind and social cognition applied to facial recognition of emotions, will tell us about somme preliminary results about what he observes in neurodegenerative diseases.

An approach to phenomenology

Dr Benoit KULLMANN, M.D., Neurologist
University Diploma of Psychiatric Phenomenology, Nice

     My presentation will be a shortened adaptation of the introductory lecture given each year to the students of the french psychiatric phenomenology diploma which is organized by the University of Nice. Students come from all over France and from very different backgrounds, psychiatrists, neuroscientifics, all kind or therapists, philosophers, teachers, some are social workers caring of prisonners or disabled persons, others are managers of rehabilitation centers... Most of them have no precise idea of what is phenomenology. So I was asked,  as being neither psychiatrist nor philosopher - I'm simply a neurologist - to expose a first encounter made easy with phenomenology. Before we really start, I would like to remind us a few generalities.

    The father of phenomenology is the mathematician and philosopher Edmond Husserl (1859-1938), who was born austrian and became prussian because of some changes in Eastern Europe ; he was born jewish, but baptized as a lutheran in 1886 ; nevertheless, he was a victim of the 1933 race law of the Nazis and the five last years of is life were quite a tragic story. One of his favourite philosophers was René Descartes : in his cartesian meditations, in 1931, one can read : « Anyone who seriously intends to become a philosopher must ‘once in his life’ withdraw into himself and attempt, within himself, to overthrow and build anew all the sciences that, up to then, he accepted ». Exactly what did Descartes, turning away from contemporary knowledge and deciding, using a new method of its own, to build a new theory of elements, a new conception of the brain, a new theory of man...

    Husserl was a student of Franz Clemens Brentano (1838, Marienberg - 1917, Zurich), nephew of the romantic poet Clemens Brentano, born in an intellectual environment ; he studied mathematics, poetry, philosophy, theology, and became a specialist of Aristoteles. Then he was ordained catholic priest, became Professor at the University of Wurtzburg in Germany ; he left the priesthood because he disagreed with some catholic dogmas. He wrote Psychology from an empirical point of view, then teached at the university of Vienna, resigned to get married, and wrote in 1911 is main opus : about classification of psychical phenomenons. Brentano and Husserl are mostly known to be the promoters of a new theory of consciousness : consciousness is no more a property of soul or mind or brain, it's no more the temple of subjectivity ; it doesn't exist by itself nor in itself independantly of the object ; consciousness is part of a dynamic process, it's an act, and every act of consciousness is consciousness of something. This is what is meant by intentionnality. It has been a revolution in the way we consider the relationship between subject and object, which, henceforth, reveal themselves,  appearing one to the other in the consciousness process.

    Amid a lot of very famous students around Brentano, there were Sigmund Freud, the founder of psychoanalysis, and of course Husserl, the founder of phenomenology. Husserl himself will have a very notorious student, Martin Heidegger (1889-1976) who wrote Sein und Zeit, Being and Time, in 1927. I shall insist later on some aspects of its thought, lets say for the moment that the main concept is the Dasein, Being there, Being-in-the-world ; and being aware of being. And the human condition is mainly defined by our relationship to Time.

    Ludwig Binswanger (1881-1966), a well known psychiatrist from Switzerland, has read Being and Time in 1930 and found here, as he wrote it,  "a new horizon of understanding" : the specific relationship of man and Time, which defines the human condition for Heidegger provides the foundation for understanding normal mind as well as mental illness, previously understood through moral, religious, mimetics causalities, and lately by disorders of passions (Kant and the french school of psychiatry, Pinel and Esquirol until Charcot).

    So my presentation will be titled : the horizon and the path, a phenomenological encounter. Now you're thrown in front of this painting ; of course you all have seen it, surely you know the name of the author, the year it has been done, the wall on which it hangs in this museum. But let's do as if it this was given at once for the first time, and as if it was now up to you to understand something. One precision only : the dimensions of the canvas, 82 by 121 centimeters.

    What are you watching at first ? my colleagues will explain later how they can predict it except if you are schizophrenic or autistic. Almost everyone looks at the woman lying in the grass in the foreground. This is a painter's trick. Someone is in the foreground, seen from behind, looking the landscape the visitors are also watching. The most famous and one of the first examples of this rear view is the Wanderer above the sea of fog, done by german romantic artist Caspar David Freidrich in 1818 (Kunstalle, Hamburg). This painting is a perfect illustration of a concept, the sublime. Beauty is attractive, relaxing, it doesn't frighten you, you love its company. Sublime is simultaneously fascinating and terrifying : this man is fascinated by the sea of clouds, standing on the top of a rocky and steep mountain ; but if he slips, or goes one step further he will fall and die.
    How works this trick that brings you into the painting was interpreted by Robert Vischer, a professor of Aesthetics, i.e. philosophy of Beauty, in 1876. From the constellation of nine concepts he produced, only one still remains nowadays : die Einfühlung, which all of you know and use the translation  : empathy. There are two varieties of empathy: one is to identify what the other feels: fear, joy, sadness .... That does not mean that we share this feeling. If we share the emotions of the other, then we are in emotional contagion, in sympathy, in compassion. The distance between me and the others disappears. The second variety of empathy concerns the thoughts, the beliefs of others: again, identify does not mean sharing. I can understand what my opponent - my ennemy, my prey - thinks: it is necessary for my victory (and sometimes my lunch). This does not mean that I share his beliefs. Of course one may feels empathy at first and then sympathy, or both together at the same time.

    People say you'd better forget anything you've learnt prior you undertake a journey -even a very short journey - through phenomenology. Easy to say, very difficult to do. See : I stare at this woman. Everyone notices her twisted posture, her skinny arms and forearms, the difficulties to raise on her upper limbs, the fingers grasping grass, grabbing, clutching the ground. Have a look at the skinny fingers, the atrophy of the small muscles, interosseous muscles, thenarian muscles of the thumb, so precise is the artist. The woman who seems to be young even if we don’t see her face is struggling to move the lower part of her body ; her ankles also are abnormaly thin, skinny, moveless. One imagine that she has been dragging her legs.

    If you are a neurologist, how could you avoid identifying a neuromuscular disease ? numerous assumptions were discussed about the disease of that person, but a consensual diagnosis emerges, that of poliomyelitis sequelae, a pathological condition that was not uncommon at the time when this painting was done. Many years later, in 2001, this paper was written : distress in everyday life in people with poliomyelitis sequellae and it reminds me precisely my own experience.

    Now let this woman take us inside the painting. What is she looking at ? There is a property of what some of us - among our team -  would call the theory of mind. If I look to someone, I look what he's looking at. You can't avoid it, this elementary behaviour depends on a mirror neuron network. From the cognitive empathy view, I am able to understand what she's looking at, but I'm not able to see what she sees. I can oscillate between my own vision, and what I guess she's looking at. Here, probably this farm off the top and right. We note that the horizon is particularly high - usually in a landscape it is situated in the lower third or possibly half of the canvas. This accentuates the upward slope effect that dramatically separates the woman from the farm.

    If we had time for that, we could estimate distances between the woman and the path, the woman and the farmhouse. Probably two hundred meters and four or five hundred meters respectively. The triangulation method is known since antiquity. And we could evaluate the time to reach the house - considering the slope, if we are fit, it should take six to seven minutes ; one could make it in five minutes if he is late and expected for lunch. But the lived experience of space and time in those conditions does not really matter : you dont even notice.

    But what happens if you are in the physical condition of this woman, tired, weak, strengthless ? The lived experience of space, that we call spatiality is that there is a very long distance to cover ; the lived experience of time, that we call temporality is that it will take a very long time to reach the path... There are a fight to sustain, a lot of suffering and despair to come. These lived experiences depend on ability to act, and below, on the power of the body to perform these actions. The french philosopher Maine de Biran (1766-1824)  wrote : the body is all the powers we have on the world. While Descartes had said that the only certainty of being, was that we were thinking - cogito, ergo sum - the reality or the illusion of what we think about being ontologically of no importance ; Maine de Biran pretends that the sense of being emerges from the body in action, and especially against resistance, during exertion. All the french philosophers of action refer to Maine de Biran ( Merleau Ponty, Michel Henri, Berthoz).

    It's time for me to tell you about bodily feelings, that we distinguish from ordinary sensations. Following Sherrington's view, there are three kind of sensations : exteroception through sensors, proprioception from special sensors in joints and muscles that leads to the perception of posture and body movements ; and interoception : sensation from the inside, pain or tension in the guts or the bladder, palpitation of the heart, difficulty breathing. The difference between exteroceptive sensations and bodily feelings is that the first ones are mainly linked to the experience of objects, while the second ones are related to interoception - inner sensations - and to the concept of homeostasy, defined as the constancy of my organism: bodily feelings drive behaviors that tends to restore our physiological balance. For exemple, starting with exteroception : I smell a rose, I see a bird flying, I hear the sound of a violin :  it doesn’t affect my homeostatic balance, and I’m not going to destroy the rose, nor eat the bird, nor burn the violin. But, considering now bodily feelings, if I feel thirsty, or if I think it’s too hot here, i’m going to drink fresh water, or try to find a cooler place. Amid the main philosophers and scientists who were interested in bodily feelings, the most involved is surely Bud Craig, a neuroscientist who works in Phoenix, Arizona, and who proposed, in his seminal paper How do you feel written in 2002,  a new theory of emotion : emotion is both a bodily feeling and the homeostatic behavior driven by this bodily feeling. In summary, a body as it is hungry, thirsty, sore, asthenic, dizzying, singularly runs his experience of the world. If I die of thirst, I will rush towards the farm, open the door, go straight into the kitchen, open the fridge, and drink a cool beer. No matter who I meet, if anyone calls me or whatever may happen...

    About spatiality, lived-space, I would like to comment some quotations from Erwin Strauss, a german phenomenologist and neurologist : « The Sensation can not be treated separately from movement theory. " » I must smell to obtain the sensation of a perfume, I must move my fingers to feel the shape or the texture of an object, I must move incessantly my eyes if I want to see something. « Our living space is in fact based on our field of action, that is to say the extent to which we can act » If I'm young and healthy, discovering a landscape, I make projects : tomorrow I shall explore the barn because I think there's something happening next to the roof, next day I shall make a ride beyond the horizon... But our disabled woman will think about the difficulties to access to the next room. « The space of feeling is to the space of perception what the scenery is to geography. » This marvellous sentence means that the upper right part of this slide gives informations  with which you can create maps ; while the inferior left one, is closer to a landscape that provokes  emotion : I wish I could go here and there.

    Of course temporality was essential for Husserl but I have only time to dwell on the design of presentness in Heidegger's thought : presentness is not a fixed point, an in-between,  it is a dynamic overlap between the retention of a passing present ; and the protention, of a present open to the immediate future. Once again this painting illustrates these concepts : the character drags or just has dragged her legs on the ground, while she initiates a movement of the trunk and head toward the farm.

    We are always looking for traces, indices of the presence of others, although we intend to avoid them. Here the traces of wheels that marked the path, a ladder maybe forsaken, a plow perhaps outdated, a deserted paddock, a small empty stable.  I recently took a closer look at this UFO, unidentified floating object : perhaps a piece of garment, a worker's overalls... However, some windows seem half opened.  The same painter, as to dissipate the doubt, did this view of the path from inside the house, through one of those windows half opened ; the raised and swollen curtains evoke the wind blowing from beyond the horizon.

    Martin Heidegger wrote a book, in french Tracks which go nowhere, whose title was translated in english : off the beaten track, in which there is an essay about The Origin of the Work of Art (1935): a phenomenological analysis of Van Gogh's Old Shoes with shoelaces - a theme taken at last five times by this artist. This is what prompted me to try an approach of phenomenology from a painting's commentary. But talking about Van Gogh, some of you may have noticed something curious in the background above the barn: look closer: these black shapes are birds, probably crows. It reminds you of something? Here is a painting entitled wheatfield with crows. See the horizon placed very high, and a path. No doubt you know that this is one of the last, if not the last, painting by Van Gogh before his suicide. The ravens have a sinister meaning since antiquity. It symbolizes, among other things, malediction, curse, death. While the horizon symbolizes my freedom, to stay or to go beyond ; and the path, my journey through life. Here is a dead crow painted by the artist we are talking about.

    I would like to comment these words : « Any symptom refers, beyond the somatic condition of the patient, - the fact that from a neurological point of view she suffers from a neuro-muscular disorder - ; beyond the instinctual, oedipian or pre-oedipian, vicissitudes, -  what the hell is she doing alone in this posture, in that situation, is there a psychoanalyst here who could explain what is the meaning of this ? - so beyond neurology and psychoanalysis, any symptom refers to the structure of the being-in-the-world, to lived time and lived space, to relationships with body, with others, and with death ».

    We could still use this painting to support very simply some basic concepts of Heidegger's philosophy : das Dasein is the being-there, being in the world; but we are there without asking, thrown into the world (die Geworfenheit means throwness) ; and we know our path ends in death. In the meantime, we experience life as a fall (but not in the christian meaning of the word), with a connotation of lapsing, deterioration, expiration (der Verfall)1. As we become aware of our situation, we fall into worry (die Sorge); anyway we keep on living, we are able to develop projects (der Entwurf) : barbecues and holidays, consultations and conferences. An important concept is that of das Mitsein : being-with: we share the world with others ; from our birth, we are brought up by our parents, relatives, by our institutions, and the "us" preceeds the "I".  Das Mitsein, being with, contains a deep signification : as I have been in the company of others at first, i shall be in my own company  ; this is fundamental for the constitution of identity, it may fail and lead to mental illness. Die Befindlichkeit is the answer to the question : how do you feel. Die Stimmung means mood, atmosphere, generated by someone. Imagine you meet someone who is sad, or boring : the first thing you will try to do is to escape and find someone happy, in the vicinity of whom you will feel fine. Das Verstehen is understanding, not explaining, the situation, with the idea of grasping what's going on here ; Die Rede, speech, verbiage, is the mean by which everything is linked, but means also the tendancy to cover everything with words, to escape to silence.

    To summarize - please transpose what I'm going to say to your own field of experience: as a neurologist, I take care of symptoms: headaches, dizziness, memory loss, that I try to explain with the help of a knowledge gradually built for twenty centuries: the method we use is similar to the one described four centuries ago by Francis Bacon who would have defined - the quote is not certain - "Scientific inquiry as putting Nature to the Question (rack) to make it talk " : we get to an explanation by questioning our patients - and with the help of some complementary investigations : MRI and so on. We consider for the moment that the brain has three main functions, sensory motor, which produces actions, cognitive, which produces thoughts, limbic, which produces emotions. The brain is a network of centers and paths, path is said hodos in greek : brain is in its modern conception the product of an hodology.

    I shall now shift from cognitivism to phenomenology, and schematically show the opposition of cognitive and phenomenological views : in phenomenology we are not interested by knowledge but by lived experience, nor by explanation but by understanding, nor by the symptoms but by the being-in-the-world. We are in the world because we are embodied, and this also applies for the voice. By the mean of our body, we experience space and time, we act, we meet others : lived space, time, action, relationship with others, define what we are, and this is the reason why we do not talk about functions but about dimensions ;  phenomenology is not a matter of network, of centers and paths that we called hodology, but it is an ontological project. Freedom is to be able to shift from one point of view to the other, both ways.

    The time has come to reveal the name of the painter, Andrew Wyeth, who died in 2009 aged 92; the work, painted in 1948, is called The World of Christina, a beautiful title, which evokes being-in-the-world, and the concept die Welt, the world, so present in the work of Heidegger which distinguished die Umwelt, the environment, die Mitwelt, the contemporaries, and die Eigenwelt, the intimate world, which all three, far from being partitioned, overlap.

    Winter is another painting with a highly-positionned horizon. This a picture of the artist, who was part of modern realism movement, together with another painter very famous in Europe, especially in France, Edward Hopper. The farmhouse really exists, here is a photography. of Olson House. Maybe you would like to see the face of Christina Olson. She was not young at all. She was not attractive. Nevertheless this sleeping portrait with the cat has the strenght of some classical masterworks ; and the look here is unfriendly, dissuasive, mistrustful, but it catches you and you don't easily escape. Here are some other watercolor sketches of Christina in her house. I shall end with a sentence by Andrew Wyeth about her, so full of humanity that it could provoke goosebumps : "The challenge to me was to do justice to her extraordinary conquest of a life which most people would consider hopeless." Sometimes painters they wish to induce more than emotional and/or cognitive empathy. This very fascinating painting carries with it a lot of pathos, we experience not only emotional empathy, but we share the emotional distress of Christina ; this has been defined by Schiller years before Einfühlung as the pathetic sublime. : fascination, danger, despair. But Andrew Wyeth's message is quite different : the important thing for him is beyond fascination and threatening, admiration.

    Here is the Abbaye of Saint Pons where until last year I used to give lectures for the diploma of psychiatric Phenomenology in Nice ; and here is the Centre Rainier III, in Monaco, where I have the privilege and pleasure to work with professor Alain Pesce and the team that will do the second talk  after we take a short break and maybe there will be time left for some questions.  I thank you for your patience.

Part II : eye-tracking the way we look at works of art

HESSE Solange, Research Ingeneer, POLET Kevin, neuropsychologist, LOUCHART de la CHAPELLE Sandrine, M.D., P.D., psychiatrist, KULLMANN Benoit, M.D.,neurologist,  PESCE Alain M.D., professor of internal medicine

    Eye Tracker is a non-invasive medical device for eye movements recording by video acquisition (motor electro-oculography process). The pupil illuminated by an infrared light is detected by the software. Its position, as well as its size, speed and gain of amplitude, are recorded. These data are used to identify areas regarded by the subject.

    With this device, and inspired by “Christina's world”, we wonder about how observers explore this landscape. When they see it for the first time. Then for the second time. What emotions induces this work of art ? And how the observers will access to its meaning ?

    One objective would be to determine whether there is a specific way to explore the work of art, depending from profession, social status, age, genre or pathology.

    Through his skill, did Andrew Wyeth succeeded to guide (lead) all observers in the same way, to provoke a particular emotion among them? And is this emotion the same from an observer to another?

    As a matter of fact, some psychological profiles or some diseases are frequently associated with psycho-behavioral disorders, suggesting a modification of empathy. Could these psycho-behavioral disorders impact the way one explore a work of art?

    To answer these questions, a descriptive study is being conducted at the Centre Rainier III (Monaco) since July 2015, by Solange HESSE (Research Engineer), Kevin POLET (neuropsychologist), Benoit KULLMANN (M.D., neurologist), Alain PESCE (M.D.).

    The aim of the present study consists in analyzing the visual exploration data (obtained from the Eye Tracker) of a broad panel of volunteers who were submitted to a paradigm called "Christina", specifically built up for this study.

The paradigm is divided as follows:
- A note indicating to the participant that he will not attempt a memory test, but simply will examine a work of art, asking him to be the most spontaneous and natural as possible, as if he was visiting in a museum of fine arts.
- First view : presentation of the picture for 15 seconds.
- Check that the participant has never seen it prior the test.
- Second view : new presentation of the picture for 15 seconds.
- First question : "What has the most caught your attention in this work of art"?
According to the subject's response, semi-directed questions are then proposed, to know if he considers the character as being ill, and if so what are his arguments.
Third view (15''): the hypothesis here is that cognitive empathy shifts to emotional empathy
then informations are given : the name of the subject (Christina), of the painter (Andrew Wyeth), and the quote of the painter about Christina
Fourth view (15'') ; the hypothesis here is that émotional empathy could shift to sympathy or emotional contagion (goosebumps or equivalent)

    We analyze the paths of observations, how (without seeing the face of Christina) the observers project themselves into the landscape, looking first Christina and then what she watches, or not. We also analyze the kind of perception they have of the character's situation, and if empathy feeling is different from an observer to another.

Part III : Social cognition study amid patients with neurodegeneratives diseases : preleminary results after visual exploration analysis by Eye Tracking

POLET Kevin, neuropsychologist, HESSE Solange, Research Ingeneer, LOUCHART de la CHAPELLE Sandrine, M.D., P.D., psychiatrist, KULLMANN Benoit, M.D.,neurologist,  PESCE Alain M.D., professor of internal medicine

    I shall only resume the conclusions of the study done by Kevin Polet : starting from the hypothesis that facial emotion recognition deficit and / or allocation of a mental state is caused by a visual exploration deviant behavior, he compared eye-tracking oculomotor performances between control subjects and patients suffering from Alzheimer Type Dementia, Fronto-Temporal Dementia, and Parkinson Disease with and without Dementia, including Lewy Body Dementia understood as a clinical phenotype of alphasynucleopathy with dementia. Questions were : are they specifics among the studied pathologies ? Can we establish correlations with behavior disorders ? Preleminary conclusions are that all clinical groups are in difficulties for the Emotional Empathy. ATD and FTD patients are less efficient in recognizing emotions. Oculomotor behavioral patterns are different depending on the pathology : in FTD : fixation numbers are increased and linked to ocular disinhibition ; in ATD : mouth area becomes too prominent ; in PD : targeted difficulties for fear ans disgust were observed (cf littérature). At least correlations between deviant oculomotor behaviors ( leading to less performance in Social Cognition domains) and productive behavioral troubles (shouts, agitation, aggressiveness, wandering) have been found.

[to date, only the study of Gregory et al. 2002 showed a correlation between a deficit of social cognition and behavioral disorders NPI Cummings 1]