Fortalecimiento prestador existente y puesto en marcha

PHYSIOLOGY

[a. Neural physiology itself goes beyond causal thought.]

The definition of the object is, as we have seen, that it exists partes extra partes¹ and thus only admits of external and mechanical relations among its parts or between itself and other objects, either in the strict sense of a received and transmitted movement or in the larger sense of a relation of function to variable. In order to insert the organism into the universe of objects and to thereby seal off this universe, the functioning of the body had to be expressed in the language of the in-itself and the linear depen-dence between stimulus and receptor, or between receptor and Empfinder [the one sensing], had to be discovered beneath the level of behavior.² Of course, it was conceded that new determinations emerge in the circuit of behavior. For example, the theory of specific nervous energy³ granted the organism the power to transform the physical world. But this theory in fact attributed to the nervous apparatus the occult power of creating the different structures of our experience, and although vision, touch, and hearing are so many ways of reaching the object, these structures were

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transformed into compact qualities and were derived from the local dis-tinction between the organs in question. The relation between stimulus and perception could thus remain clear and objective; the psycho-physi-cal event was of the same order as the relations of “worldly” causality.

Modern physiology no longer resorts to these tricks. It no longer links the different qualities of the same sense and the givens of the different senses to distinct material instruments. In fact, central lesions, and even lesions to conductors, do not translate into the loss of certain sensible qualities or of certain sensory givens; rather, they result in a lack of dif-ferentiation of the function. We have already shown this above: regardless of the location of the lesion along the sensory pathways, and regardless of its genesis, what is experienced is, for example, a decomposition of color sensitivity. All colors are initially affected, their fundamental shade remains the same but their saturation decreases. Then, the spectrum sim-plifies and reduces to four colors: yellow, green, blue, and red-purple. In fact, all colors with a short wavelength tend toward a sort of blue, while all colors with a long wavelength tend toward a sort of yellow. Moreover, vision itself varies from one moment to the next, according to the degree of fatigue. In the end, a monochromatic gray is reached, although favor-able conditions (contrast, long exposure) may momentarily bring back a dichromatism.⁴ The progression of the lesion in the nervous sub-stance thus does not destroy ready-made sensible contents one by one, but rather renders the active differentiation of the stimulations, which appears to be the essential function of the nervous system, increasingly uncertain. Likewise, in cases of non-cortical lesions of tactile sensitivity, if certain contents (temperatures, for example) are more fragile and disap-pear first, this cannot be because a determinate region (destroyed in the patient) enables us to sense hot and cold, for the specific sensation will be restored if an extended-enough stimulus is applied.⁵ Rather, it is because the stimulation now only succeeds in taking on its typical form for a stronger stimulus. Central lesions seem to leave the qualities intact and rather modify the spatial organization of the givens and the perception of objects. This led to the supposition of mystical centers specialized in the localization and interpretation of qualities. In fact, modern research shows that central lesions act above all by raising the chronaxies,⁶ which are twenty or thirty times higher in the patient. The stimulation produces its effects more slowly, they survive longer, and the tactile perception of roughness, for example, is compromised insofar as it assumes a series of 102

the body as an object and mechanistic physiology 77 circumscribed impressions or a precise consciousness of different hand positions.⁷ The vague localization of the stimulus is not explained by the destruction of a localizing center, but by the leveling out of stimula-tions that no longer succeed in organizing themselves into a stable whole where each of them would receive a univocal value and would only be expressed in consciousness through a definite change.⁸ So the stimula-tions of a single sense differ less by the material instrument they use than by the manner in which the elementary stimuli are spontaneously orga-nized among themselves. This organization is the decisive factor both at the level of sensible “qualities” and at the level of perception.

This organization again, and not the specific energy of the nervous mechanism in question, makes a stimulus give rise to a tactile or a ther-mal sensation. If a given area of the skin is stimulated several times with a hair, we at first have perceptions that are punctual, clearly distinguished, and localized each time at the same point. To the extent that the stimu-lation is repeated, the localization becomes less precise, the perception spreads out in space, and the sensation simultaneously ceases to be spe-cific. It is no longer a contact, but a burning, sometimes cold and some-times hot. Later still, the subject believes that the stimulus moves and traces out a circle on his skin. In the end, nothing more is sensed.⁹ This is to say that the “sensible quality,” the spatial determinations of the per-ceived, and even the presence or absence of a perception are not effects of the factual situation outside of the organism, but rather represent the manner in which the organism comes to anticipate stimulations and in which it relates to them. A stimulation is not perceived when it reaches a sensory organ that is not “attuned” to it.¹⁰ The organism’s function in the reception of stimuli is, so to speak, “to understand” a certain form of stimulation.¹¹ The “psycho-physical event” is thus no longer of the

“worldly” type of causality. The brain becomes the place of an “articu-lation” that intervenes even before the cortical stage and that blurs, as early as the entrance into the nervous system, the relations between the stimulus and the organism. The stimulation is grasped and reorganized by the transversal functions that make it resemble the perception that it is about to arouse. I cannot imagine this form, which takes shape in the nervous system, or this unfurling of a structure as a series of third person processes, as the transmission of movement, or as the determination of one variable by another. Nor can I gain a detached knowledge of it. I only foresee what this form might be by leaving behind the body as an object,

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partes extra partes, and by turning back to the body I currently experience, for example, to the way my hand moves around the object that it touches by anticipating the stimuli and by itself sketching out the form that I am about to perceive. I can only understand the function of the living body by accomplishing it and to the extent that I am a body that rises up toward the world.

Exteroceptivity thus demands an articulation of stimuli, the con-sciousness of the body invades the body, the soul spreads across all of its parts, and behavior overflows its central region. It might be objected that this “experience of the body” is itself a “representation,” a “psychi-cal fact,” and that as such it is at the end of a chain of psychi“psychi-cal and physiological events that can only be attributed to the “real body.” Is my body not an object, precisely like external bodies, that acts on receptors and ultimately gives rise to the consciousness of the body? Is there not an “interoceptivity” just as there is an “exteroceptivity”? Can I not find in the body some threads that the internal organs send to the brain and that are instituted by nature in order to give the soul the opportunity to sense its body? Consciousness of the body and of the soul are thereby repressed, and the body again becomes that highly polished machine that the ambiguous notion of behavior had almost made us forget. If, for example, the stimulation from the leg is replaced by a stimulation along the trajectory that runs between the stump and the brain, the subject will sense a phantom leg, because the soul is immediately united to the brain, and to the brain alone.

[b. The phenomenon of the phantom limb: physiological and psychological explanations are equally insufficient.]

What does modern physiology have to say about this? A cocaine-induced anesthesia does not remove the phantom limb and there are cases of phantom limbs that result from cerebral lesions without any amputation.¹² Finally, the phantom limb often maintains the very posi-tion occupied by the real arm at the moment of injury. A war-wounded man still senses in his phantom arm the shrapnel that tore into his real arm.¹³ Must the “peripheral theory” thus be replaced by a “cen-tral theory”? But a cen“cen-tral theory would get us no further if it merely added cerebral traces to the peripheral conditions of the phantom limb, for a collection of cerebral traces could not represent the relations of 105

the body as an object and mechanistic physiology 79 consciousness that intervene in the phenomenon. The phenomenon in fact depends upon “psychical” determinants. A phantom limb appears for a subject not previously experiencing one when an emotion or a situation evokes those of the injury.¹⁴ It happens that the phantom arm, which is enormous following the operation, subsequently shrinks in order finally to be absorbed into the stump “in accordance with the res-ignation of the patient to accept his mutilation.”¹⁵ Here the phenomenon of the phantom limb is clarified through the phenomenon of anosogno-sia,¹⁶ which clearly demands a psychological explanation. Subjects who systematically ignore their right hand, and who rather offer their left hand when they have been asked for their right, nevertheless speak of their paralyzed arm as a “long and cold serpent,” which excludes the hypothesis of a genuine anesthesia and suggests the hypothesis of a refusal of the deficiency.¹⁷ Must it then be said that the phantom limb is a memory, a wish, or a belief? Lacking a physiological explanation, must it be given a psychological explanation? Yet no psychological explanation can ignore the fact that the phantom limb disappears when the sensory conductors that run to the brain are severed.¹⁸

Thus, we must attempt to understand how the psychical determinants and the physiological conditions gear into each other. If the phantom limb depends upon physiological conditions and is thereby the effect of a third person causality, then it is inconceivable how it can also result from the personal history of the patient, from his memories, his emo-tions, or his desires. Indeed, for the two series of conditions to be able to co-determine the phenomenon – the way two components determine an outcome – they would require a single point of application or a common ground, and it is difficult to see what might serve as the common ground between “physiological facts” (which are in space) and “psychical facts”

(which are nowhere), or even between objective processes, such as ner-vous impulses (which belong to the order of the in-itself), and cogitationes, such as acceptance or refusal, consciousness of the past, or emotion (which belong to the order of the for-itself). A mixed theory of the phantom limb that acknowledges the two series of conditions¹⁹ may thus be valid as a statement of known facts, but it is fundamentally obscure.

The phantom limb is not the simple effect of an objective causality, nor is it a cogitatio. It could only be a mixture of the two if we discovered the means of joining the one with the other (the “psychical” and the “physi-ological,” the “for-itself” and the “in-itself”) and the means of arranging

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an encounter between them, or if third person processes and personal acts could be integrated into a milieu they would share.

[c. Existence between the “psychical” and the “physiological.”]

In order to describe the belief in the phantom limb and the refusal of the mutilation, these authors speak of a “repression” or of an “organic suppression” [refoulement organique].²⁰ These terms, which are hardly Cartesian, force us to form the idea of an organic thought by which the relation between the “psychical” and the “physiological” could become conceivable. We have already encountered elsewhere, in the case of sub-stitutions, phenomena that exceed the alternative between the psychical and the physiological, between explicit finality and mechanism.²¹ When an insect instinctively substitutes a healthy leg for the leg that has been removed, it is not, as we have seen, that a preestablished safety mecha-nism is automatically triggered and substituted for the circuit that has just been put out of service. But no more is it because the animal is con-scious of a goal to attain and uses its limbs as different means, for then the substitution would have to be produced each time that the action is blocked and we know that it does not occur if the leg is merely tied.

The animal simply continues to exist in the same world and carries itself toward this world with all of its powers. The tied limb is not replaced by the free one because the tied one continues to count in the animal’s being and because the impulse of activity that goes toward the world still passes through that limb. There is no more choice here than in a drop of oil that employs all of its internal forces in order to solve, in practice, the maximum/minimum problem set for it. The only difference is that the drop of oil adapts itself to given external forces, while the animal itself projects the norms of its milieu and establishes the terms of its vital problem;²² but here it is a question of an a priori of the species and not of a personal choice.

Thus, behind the phenomenon of substitution we discover the move-ment of being in and toward the world, and we must now make this notion more precise. When we say that an animal exists, that it has a world, or that it belongs to a world, we do not mean that it has a perception or an objective consciousness of the world. The situation that triggers instinc-tive operations is not wholly articulated and determinate, its total sense is not possessed, which is clearly shown by the errors and the blindness 107

the body as an object and mechanistic physiology 81 of instinct. The situation provides only a practical signification, and the recognition that it induces is merely a bodily recognition. It is lived as an “open” situation and it calls for the animal’s movements – just as the first notes of the melody call for a certain mode of resolution – with-out thereby being known for itself. And this is precisely what allows the limbs to be interchangeable, to be equivalent before the evidentness of the task.

If it anchors the subject to a certain “milieu,” is “being in the world”

something like Bergson’s “attention to life” or Janet’s “reality function”?

Attention to life is the consciousness we gain of “nascent movements” in our body. But reflex movements, either sketched out or already accom-plished, are still merely objective processes whose development and results can be observed by consciousness, but in which consciousness is not engaged.²³ In fact, reflexes themselves are never blind processes:

they adjust to the “sense” of the situation, they express our orientation toward a “behavioral milieu” just as much as they express the action of the “geographical milieu” upon us. They trace out, from a distance, the structure of the object without waiting for its punctual stimulations.

This global presence of the situation gives the partial stimuli a sense and makes them count, stand out, or exist for the organism. The reflex does not result from objective stimuli, it turns toward them, it invests them with a sense that they did not have when taken one by one or as physical agents, a sense that they only have when taken as a situation. The reflex causes them to exist as a situation; it establishes a “knowledge relation”

with them, that is, it points to them as what it is destined to encounter.

Reflex, insofar as it opens itself to the sense of a situation, and perception, insofar as it does not first of all posit an object of knowledge and inso-far as it is an intention of our total being, are modalities of a pre-objective perspective that we call “being in the world.” Prior to stimuli and sensible contents, a sort of inner diaphragm must be recognized that, much more than these other ones, determines what our reflexes and our perceptions will be able to aim at in the world, the zone of our possible operations, and the scope of our life. Certain subjects can move closer to being blind without having changed “worlds.” They bump into objects everywhere, but they are unaware of no longer having visual qualities, and the struc-ture of their behavior remains unaltered. Other patients, on the contrary, lose their world as soon as the contents begin to slip away. They renounce their usual life even before it becomes impossible, they become crippled

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before literally being so, and they break their vital contact with the world before having lost sensory contact with it. Thus, our “world” has a par-ticular consistency, relatively independent of stimuli, that forbids treating

“being in the world” as a sum of reflexes, and the pulsation of exis-tence has a particular energy, relatively independent of our spontaneous thoughts, that precludes treating it as an act of consciousness. Because it is a pre-objective perspective, being in the world can be distinguished from every third person process, from every modality of the res extensa, as well as from every cogitatio, from every first person form of knowledge – and this is why “being in the world” will be able to establish the junction of the “psychical” and the “physiological.”

[d. Ambiguity of the phantom limb.]

Let us return now to the problem from which we began. Anosognosia and the phantom limb admit of neither a physiological explanation, a psychological explanation, nor a mixed explanation, although they can be linked to the two series of conditions. A physiological explanation would interpret anosognosia and the phantom limb as the mere sup-pression or the mere persistence of interoceptive stimulations. On this hypothesis, anosognosia is the absence of a fragment of the body’s rep-resentation that should be given, since the corresponding limb is in fact present; the phantom limb is the presence of a part of the body’s repre-sentation that should not be given, since the corresponding limb is in

Let us return now to the problem from which we began. Anosognosia and the phantom limb admit of neither a physiological explanation, a psychological explanation, nor a mixed explanation, although they can be linked to the two series of conditions. A physiological explanation would interpret anosognosia and the phantom limb as the mere sup-pression or the mere persistence of interoceptive stimulations. On this hypothesis, anosognosia is the absence of a fragment of the body’s rep-resentation that should be given, since the corresponding limb is in fact present; the phantom limb is the presence of a part of the body’s repre-sentation that should not be given, since the corresponding limb is in