There are conditions that produce severe behavioral disturbance and disorganization. For example, brain damage or schizophrenia may induce radical breakdown and regression. In this chapter, we focus on the body image phenomena observed in such extreme forms of pathology. We consider not only the changes in body image accompanying disorganization but also those resulting from therapeutic procedures intended to produce reintegration.
Brain damage can dismember the body image in extravagant ways. The degree of primitivization it can induce at times goes far beyond that resulting from any other type of pathology. As described elsewhere ( Fisher & Cleveland, 1968), it was the very extremeness of certain body image distortions linked to brain damage that stimulated the earliest interest in body image phenomena among neurologists such as Bonnier, Pick, Head, and Schilder. Paul Schilder ( 1950), who is recognized as one of the prime energizers of the 20th century studies of body experience, entered this domain by way of his neurological observations. The primitivization resulting from brain damage can be so extreme that afflicted persons deny the very existence of a body part, or are unable to identify the boundaries of the body, or lose the ability to differentiate the right and left body sides. Neurologists have worked hard to develop classificatory schemes that logically group the body image symptoms of the brain damaged. Their major classifications (e.g., Frederiks, 1969) relate variously to denial of body weakness or defect (anosognosia), loss of perception and recognition of one side of the body (hemiosomatognosia), inability to name body parts (autotopagnosia), absence of normal reaction to pain while elementary sensations continue to register (asymbolia for pain), perception of body parts as abnormally large or small (macro- and microsomatognosia), and seeing a literal double of oneself (autoscopia).1
One of the major themes in the literature of body image distortions in the brain damaged relates to whether body image functions are localized in a unitary fashion in specific brain locales. There has been considerable dis