1. Introduction

Our conscious personality constitutes a well integrated, dynamic biopsychosocial system that is associated with characteristic mental and behavioral actions but which remains open to change through experience and maturation which may be integrated into the core personality (Edelman & Tononi, 2000; Fuster, 2003; Janet, 1889, 1935; Van der Hart, Nijenhuis, & Steele, 2006) . However, the same is not true of the personality and consciousness of patients with dissociative disorders, a condition associated with emotional trauma so profound the conscious personality shatters (American Psychiatric Association, 1994). In dissociative disorders, the conscious personality is fragmented, and is insufficiently integrated and consists of overly rigid biopsychosocial subsystems or dissociative parts (Nijenhuis, 2011; Nijenhuis & Van der Hart, 2011); it is as if several different conscious personalities exist in the same head, but with each separate from the other. A crucial feature is that each dissociated fragment of the conscious personality has their own sense of self, world, and self-in-the-world (Nijenhuis, 2011). Each dissociated consciousness also believes their dissociative ways of experiencing and knowing themselves and the world reflect 'objective' reality. The different, often conflicting feelings, perceptions, and ideas of dissociative parts cause struggles among them, as well as fears of each other (Van der Hart et al., 2006).

More specifically, dissociative fragmentation of the conscious mind can be manifested in the expression of multiple distinct identities or personalities, each with its own unique pattern of thinking, feeling, and behaving, and with their own memories. This is not some epiphenomenon. It has been demonstrated that EEGs (Hughes et al., 1990; Lapointe et al., 2006), and cerebral blood flow (Matthew et al., 1985; Reinders et al., 2003, 2006) significantly differ when different aspects of the fragmented conscious mind come to the fore, and that the parietal lobe differs from normals (Garcia-Campay et al., 2009); a region of the brain associated with the body image (Joseph 2009).

Dissociative patients characteristically display shifts in dominance of consciousness and behavior among their parts, as well as intrusions of one part into the conscious domain of one or more other parts (Nijenhuis, 2004; Dell, 2006; Kluft, 1987; Ross et al., 1990; Van der Hart et al., 2006).

Dissociation of the personality manifests in dissociative symptoms, that can be categorized as psychoform and somatoform, and as negative and positive (Nijenhuis, 2004; Van der Hart et al., 2006; see Table 1). For example, dissociative parts of the conscious mind can have negative symptoms such as analgesia (i.e., insensitivity for pain), anesthesia (e.g., visual, kinesthetic, auditory), lack propriocepsis, as well as sense of ownership and agency with respect to particular body parts, inability to move, or to remember recent or remote episodes. They may also have positive dissociative symptoms such as pain, hearing voices of other dissociative parts; that is, one part of the dissociated mind may receive information from another region of the mind, in a manner similar to split-brain patients (Joseph 1988a,b; 2009). Negative and positive dissociative symptoms are generally linked. Thus, one part of the dissociated mind may be analgesic, but an other part may suffer pain in particular parts of their body. Dissociative parts may hear each the voices of the other fragments of consciousness, or intrude upon each other in different ways. They may reenact traumatic memories, or be intruded by a different part's traumatic memories (Van der Kolk & Van der Hart, 1989); that is, one dissociated conscious personality will remember events it did not experience, but which were experienced and committed to the memory of a different dissociated consciousness which had split off from the rest of the mind. These memories are not narratives like normal autobiographical memories, but sensorimotor and highly emotionally charged experiences (Van der Hart et al., 2006). Although they may not realize it, they are reenacting the past, and what is being being remembered, is not a memory, but is happening here and now.

These and related differences among different dissociative parts suggest that their sense of self, world, and self-in-the-world are mental contents generated by particular epistemic actions, that is, constructions developed in interaction with a material and social environment (Metzinger, 2003; Nijenhuis, 2011). This action perspective on (self-)consciousness is also grounded in the observation that 'fusion' of formerly dissociated parts is associated with instant loss of the former and rapid generation of a more or less different sense of self--including the body--world, and self-in-the-world.

Like normal individuals, dissociative parts experience and believe their dissociated self to an independent entity or substance that could live by itself, and that it consists of an invariant set of intrinsic properties, as well as a unique and indivisible unity (cf. Metzinger, 2003). The phenomena of dissociative disorders clearly challenge the reality of this view even when applied to the normal conscious personality. The way in which dissociative parts experience and know themselves and the world involve the epistemic contents of their ongoing constructive actions, the same can be said of anyone's self and world--as the Buddha contended, and as some Western philosophers contend (e.g., Kant, 1998; Schopenhauer, 1958; Metzinger, 2003).

In this light, dissociative disorders may provide a window of opportunity to examine what mental actions and biopsychosocial underpinnings are involved in what has been described as "self-consciousness"; what individuals must do to be consciously aware of themselves and their environment.

2. Parts and Wholes

Does it make sense to study parts of a whole? This question obviously applies to dissociative disorders. However, it is not any less relevant to the study of (self-)consciousness in health. This topic is therefore addressed first at some length.

As human beings, we, as a whole organism, are conscious of a world and of ourselves, and we have goals and engage in actions. Although it is true that the brain is related to consciousness and different regions of the brain subserve different functions (Joseph 1988a,b; 2009), ascribing psychological predicates to functional parts of a whole system confuses relationships between wholes and parts and could be considered a mereological fallacy (Bennett & Hacker, 2003). It is "[o]nly of a human being and what resembles (behaves like) a living human being can one say: it has sensations; it sees; hears; is deaf; is conscious or unconscious" (Wittgenstein, 1953, entry 281).

Body and Mind The 17th Century witnessed the start of a major mereological discussion on the mind-body relationship. As Spinoza (1996) emphasized, Descartes (1960) erred to distinguish between a body and a mind. Ascribing thoughts, feelings, beliefs, fantasies, and other psychological predicates to the mind rather than to a living human being or his personality as an embodied functional entity, is a fallacy. Lacking such faculties, mind is rather a term that denotes a range of human powers, the exercise of these powers, and a range of characteristic human character traits. Whereas most contemporary neuroscientists repudiate Descartes' body-mind dualism, many also assign psychological attributes to parts of a whole—i.e., the brain or parts of the brain--that are characteristic features of functions of the individual as a whole biopsychosocial system (Joseph 1988a,b; 2009). This could be construed as a mereologic error (Bennett & Hacker, 2003).

Brain/body and Environment Another mereological error is to regard the brain in separation of the environment in which it exists. The brain/body as the necessary apparatus for mental contents is dependent on the environment with respect to these contents, otherwise, the brain might remain 'empty' (Northoff, 2003). And an environment can only exist for a living brain/body because, according to some philosophers, there is no observer-independent environment (Kant, 1998; Schopenhauer, 1958). Environment and brain are bilaterally dependent, they are necessary conditions for each other (Northoff, 2003; Thompson, 2007). According to various theories of quantum physics (Bohr 1958; Heisenberg, 1958; Neuman & Tamir, 2009; Stapp 2009), they also determine each other, they interact, which also applies to the relationship between the body and the environment.

Individuals as whole organisms must adapt to and can creatively change their environment by selecting particular actions to achieve their goals. In this context, individuals at the brain level select particular dynamic patterns, and at the brain/body level engage in particular patterns of motor actions, that match and mold the environment. Conversely, the environment in which an individual lives influences the dynamic brain states and motor actions that will be selected. There is embedment, that is, intrinsic relationships between brain, body, and environment in ontological regard (Northoff, 2003; see Figure 1). Brain, body, and environment are intrinsically coupled (van Gelder, 1995; Gallagher, 2005), and this coupling is dynamic, selective, adaptive, and creative.

For example, the smell of food activates in us the motivational or action system (Lang, Bradley, & Cuthbert, 1998; Panksepp, 1998) of energy management when our organism has a shortage of calories; a function of the hypothalamus and brainstem and other neurological structures which continually sample the internal and external environment. Threat to our physical integrity awakens the action system of defense (Fanselow & Lester, 1988) mediated by, for example, the limbic system which is responsible for emotional and motivational functioning (Joseph 1992). Depending on an assessment of the actual environmental conditions, we will startle, freeze, flee, fight, or play dead.

What odors will foster eating, and what conditions present 'threat' is also dependent on phylogenetic and ontogenetic features of the subject as a whole organism. Thus, the intrinsic relationship between the embrained and embodied individual as a whole biopsychosocial system and the environment is also characterized by this system's biological, psychological, and social history. For example, this relationship will be influenced by prior and anticipated experiences, past social relations, and the individual's developmental phase. Brain, body, and environment, thus, mutually constitute and determinate each other, and they are mutually dependent (Northoff, 2003).

This ontological determination also applies to dissociative subsystems of personality. A dissociative part involves a co-constitution and co-determination of a subsystem that, as clinical observations suggest, strives to realize particular goals (see Figure 2). This subsystem consists in a particular intrinsic relationship, that is, in ongoing dynamic configurations of an individual's brain, body, and environment, as well as an intrinsic relationship of one dissociative part with other existing dissociative parts. These parts do not exist in a void, but constitute and determine each other in ontological regard. For example, as one part, a patient may not eat. Whether this part realizes it or not, he or she can only exist because there are other parts that do eat.

Where is the mind? If there are intrinsic relationships of brain, body, and environment, where does this leave the mind? The tempting (Cartesian) belief that the mind could exist in separation of the body involves an epistemic illusion caused by our inability to know how we generate our mental contents, including our sense of self. This inability is known as transparency (McGinn, 1989, 1998; Metzinger, 2003) or autoepistemic limitation (Northoff, 2003). Whereas there is no mind without a brain, the mind does not equal the brain. We tend to experience that our mind is in our head, but no one has found the mind in the brain. According to Alva Noë (2009, p. xiii):

"Consciousness isn't something that happens inside us: it is something that we do, actively, in our dynamic interaction with the world around us" (Noë, 2009, p. 24).

A feature that distinguishes dissociative parts from other subsystems of personality (e.g., the sympathetic nervous system) is that they are conscious and self-conscious (Nijenhuis, 2011). If the mind in mental health cannot be found in the brain, the mind of disociative parts cannot be found in the brain or brain/body either (though not all would agree with this statement, e.g. Joseph 2009). The mind unfolds in dynamic configurations of brain, body, and environment, particularly in embedded actions that are ongoing when these parts are awake or dreaming.

Cause and Effect The fact that cause and effect are inseparable in the case of co-occurrence and co-constitution does not imply that there is no causation at all. Aristotle distinguished apart from efficient causation three other causes. Final cause involves the goal toward which something aims, hence pertains to the integration of the brain and body within the environment. For example, mediated by the limbic system of attachment, individuals seek protection by a caretaker in situations that they perceive as calling for this form of protection (Joseph 1992). These and other action systems bias individuals as a whole system toward particular perceptions, affects, and conceptions, and toward the effectuation of particular goals through action.

As Northoff (2003) puts it, goals are about observable and to-be effectuated events in the environment. Observable events pertain to sensory perception, and to-be effectuated events include more motor action. Goal-orientation involves sensorimotor integration, which cannot be captured in terms of efficient causation. Sensations/perceptions are not the linear and physical cause of motor actions, and motor action is not the linear and physical cause of sensations/perceptions. Sensations/perceptions and motor actions rather have an ongoing effect on each other (Hurley, 1998). Moreover, physical activity such as patterns of brain activity does not reveal what the owner and agent of that activity was sensing and doing, and why. Sensorimotor integration or synthesis, more complex forms of integration, and goal-orientation (e.g., the aim to attach or defend) cannot be explained in physical terms, but involve final causes.

Formal cause describes what makes a particular 'thing' one sort of 'thing' and no other, and describes the kind of organization of the 'thing.' We thus do not simply respond to physical 'stimuli' and do not, like computers, 'process' 'information' understood as discrete, encapsulated, symbolic, and predefined, thus context-independent and context-isolated instructional codes. Rather, we are enactive complex systems that find or generate meaning in a dynamic and self-organizing fashion (Edelman & Tononi, 2000; Kelso, 1995; Thompson, 2007; Varela, Thompson, & Rosch, 1993).

As whole embodied and embedded biopsychosocial systems, we are associated with all four causes. As dynamic, self-organizing systems (formal cause), we are oriented toward observable events regarding which we aim to realize particular effects as guided by our goals (final cause). The material cause involves the physical material we are made of (e.g., cells). With regard to the brain, the efficient cause includes 'the force of the neural mechanisms by means of which different parts of the brain are specifically related to each other with the ultimate realization of self-organisation and dynamic pattern formation" (Northoff, 2003, p. 291).

Dissociative parts are also associated with all four causes. They are goal-oriented (final cause) and self-organizing (formal cause), they have an organic basis (material cause) and involve physical and neural mechanisms (efficient cause). Mediated by their goals, each dissociative part synthesizes its own kinds of perceptions, sensations, emotional feelings, thoughts, memories, and motor actions. Alternations among different parts thus go along with profound shifts in the quality and kind of syntheses, hence, shifts in consciousness.

Like mentally healthy individuals, dissociative parts also engage in the mental action of personification regarding particular perceptions, sensations, feelings, thoughts, memories, and motor actions (Van der Hart et al., 2006). Personification is generating a phenomenal self-model (the raw feeling of being someone) and a more reflective self-model (Metzinger, 2003; Nijenhuis, 2011). While each dissociative part generates a self-model, they do not personify each other. They do not feel or grasp that they are parts of a whole, that they, so to speak, are the other parts as well (in an ontological sense), and should integrate these parts' mental and behavioral contents (e.g., that the memories 'of other parts' should also be(come) their memories) in an experiential and epistemological sense.

Each dissociative part involves its own kinds of dynamic configuration of brain/body/environment. For example, as one part but not as a different part, the patient may have personified the right arm of the body that the first part has mutilated. Shifts among these parts are thus associated with profound shifts in personification, hence, in the patient's sense of self, world, and self-in-the world. Personification includes the actions of experiencing and acception ownership ('this is my hand') and agency ('I move my hand').

Another mental action is presentification (Van der Hart et al., 2006), the demanding action of integrating one's past, present and future, such that the present is experienced as the most real. More than knowing, presentification includes taking the content of one's experience and knowledge into account with respect to one's current and future actions. The extent to which dissociative parts can and will engage in presentification is quite different. They may confuse past and present (as in re-enactment of traumatic experiences), fail to presentify past episodes (as in dissociative amnesia), or overlook empending dangers.

Does it make sense to study dissociative parts? In sum, ontologicallly, dissociative parts constitute interrelated but insufficiently integrated embrained, embodied, and environmentally embedded biopsychosocial structures, that is, subsystems of personality. They include their own phenomenal and epistemic sense of self, world, and self-in-the-world (Nijenhuis, 2011; Nijenhuis & Van der Hart, 2011). As conscious and self-conscious goal-directed subsystems, they are subject to all four Aristotelian causes.

Considering these features and their degree of relative autonomy, it makes logical sense to maintain that dissociative parts of a patient decide, think, feel, want, or do something, provided we realize that (1) they are subsystems of a higher-order system that constitutes the patient's personality, (2) they are not totally separated from each other, (3) a full understanding of them involves an analysis of their mutual relations, and (4) a full understanding of the patient requires a structural and functional analysis of his or her personality as a whole biopsychosocial system.

3. Four Interrelated Epistemic Perspectives

Different dynamical configurations of brain, body, and environment account for our different epistemic abilities and inabilities. The first-person, quasi second-person, second-person, and third-person perspective are such configurations.

The first-person perspective (FPP) is about our phenomenal experience, and involves experiencing 'raw,' prereflective sensations and other feelings that are subjective, private, and internal. This perspective subserves living and experiencing of present events (Northoff, 2003). FPP involves our body as our spatial center, and our 'I' as the center of our mental states. In other words, FPP pertains to the action of generating the subjective feeling of being someone with a point of view, that is, of being an acting and experiencing self with a subjectively experienced outward perspective on his or her perceived environment, and an inward perspective regarding himself or herself (Metzinger, 2003). This someone involves our 'I' or 'self,' or phenomenal self-model. How this model is generated by some component of us as a whole system remains hidden, because the brain does not tell us how it generates its own states, including our 'I.' Due to this autoepistemic inability, we experience our phenomenal self and world as given.

Dissociative parts of the personality include their own FPP. They feel they are/have a self, and experience that their world is given. Subject to the described autoepistemic limitation, they are unable to experience that their syntheses, personifications and presentifications are personal constructions. However, for the observer, the constructive nature of these contents can be clear. For example, whereas dissociative parts experience they have their own body, observers will agree this is not the case.

Mentally healthy individuals can detect, recognize, and compare, that is, judge their our different phenomenal experiences and states (Chalmers, 1996). In Northoff's (2003) terms, this phenomenal judgment involves our Second-Person Perspective (SPP), or, as I say, our Quasi SPP (QSPP). QSPP is a form of intra-subjective communication, whereas FPP is about intra-subjective experience. This intra-subjective communication serves, among others, for the development of a 'relation of mineness' (Metzinger, 1993). For example, in QSPP, we can say "I know this is my body." QSPP therefore involves a more objective self-model than the phenomenal self-model in FPP in which we might experience 'being cold' which may but need not be expressed as "I am cold." In FPP, personification--i.e., the mental actions of owning experience and agency--is prereflective. In QSPP, personification involves at least a phenomenal judgment of ownership (e.g., "My body hurts") and agency (e.g., "I run").

SPP pertains to the relationship between the 'I' of the own person and the 'I' of another person, the 'Thou' (Buber, 1983). Access to someone else's phenomenal experience exists, but is indirect, and involves actions such as empathy, joint perspective taking, and imitation. These actions include the activity of particular brain structures and functions, e.g., mirror and canonical neurons (Pineda, 2008), that mediate our phenomenal sense of being in mental/experiential touch with another individual.

QSPP and SPP are epistemic intermediates between phenomenal experience in FPP and physical judgment in TPP. In FPP, we are experientially and spatially centered in our body, provided we, for example, do not experience out of body phenomena, or somatoform anesthesia, as can happen in dissociative disorders. In QSPP, we are also centered in our body, but since we phenomenally judge our phenomenal experience, we are linked with, but also at some distance of our mental and bodily state. This bridge between phenomenal experience and physical judgment in QSPP allows us to modulate our emotional experiences.

Many dissociative parts can reach a level of functioning high enough to engage in phenomenal judgment regarding themselves and others. Thus, they have an explicit sense of self to the extent that they engage in personification, and they are oriented in phenomenal space and time to the extent that they engage in presentification. However, what healthy individuals phenomenally judged in terms of QSPP (e.g., this is my arm, memory, motor action), dissociative parts may phenomenally judge in terms of SPP (e.g., this is not my arm, memory, motor action, but it belongs to [an other dissociative part; I am not the others [i.e., the other dissociative parts]). Confusion between QSPP and SPP is a core feature of dissociative disorders.

A dissociative part may also regard an other part in Third-Person Perspective (TPP). TPP does not include experiential and bodily centeredness, because in this epistemic perspective, we are not experientially--i.e., mentally and bodily--linked with ourselves, other individuals, other organisms, and immaterial objects. We engage in physical judgment in TPP, and cannot experience perceptions or perform motor actions (Northoff, 2003). For example, some neuroscientists tend to study the brain and its workings as physical objects in TPP. Clinicians assess patients' mental disorders in TPP, but engage in SPP when they are empathically attuned to patients in therapeutic encounters. As private persons, we may notice in TPP that our leg is broken and needs treatment, or that we are depressed or happy. In TPP, we thus observe and judge ourselves, other individuals, and objects as physical objects.

At least some dissociative parts can function at a mental level that is high enough to engage in TPP. For example, as such a part, a patient may be able to hold a job that requires the ability to engage in physical judgments. While this TPP is adaptive, dissociative parts also engage in maladaptive TPP. For example, when a dissociative part does not personify a different part that 'did not resist abuse,' he or she may physically judge that the other part is bad, and deserves punishment.

The different perspectives and the involved epistemic abilities and inabilities are interrelated. TPP is only possible on the basis of FPP, and in many cases QSPP and SPP as well. For example, scientists' TPP regarding their object of study can only exist in the framework of their FPP, QSPP, and SPP. Science would not exist without human prereflective (FPP) and reflective (QSPP/SPP) consciousness and self-consciousness. As discussed above, objects only exist in the awareness of subjects. Furthermore, QSPP/SPP depend on FPP because phenomenal judgment involves a judgment of phenomenal experience. Whereas FPP can exist without QSPP, QSPP can influence FPP because individuals' phenomenal experience tends to be affected by their phenomenal judgment.

Summary There are no selves, objects and events without experiencing and knowing subjects. Subjects include individuals whose personality is integrated, as well as conscious and self-conscious dissociative parts of an individual. Any 'self,' 'world,' and 'event' depends on an embrained, embodied, and embedded subject. Brain, body, and environment cannot exist by themselves, but exist in intrinsic relationships and dynamic configurations of brain, body, and environment. How an individual and dissociative parts of an individual experience, perceive, and conceive these embedded selves, objects and events depends on their particular epistemic perspective: FPP, QSPP, SPP, and TPP. In epistemic regard, dissociative parts engage in underinclusive and/or overinclusive acts of synthesis, personification, and presentification.

4. Research of Consciousness and Self-Consciousness

Under the formulated restrictions, the study of dynamic configurations of brain, body, and environment in dissociation can contribute to an understanding of consciousness and self-consciousness. For example, this research includes comparisons between different dissociative parts with their own goal-orientation and epistemological features such as their different syntheses, and degrees and kinds of personification, and presentification. It also encompasses comparisons between dissociative parts and mentally healthy individuals.

Comparisons of different (types of) dissociative parts indicate what neural activity, brain structures, and behavioral patterns are associated with experiencing, perceiving, and knowing oneself, other selves, objects, and events in FPP, QSPP, SPP, or TPP. For example, these studies can find differences between dynamic configurations of brain, body, and environment for dissociative parts that do not synthesize ('There is no arm') or personify particular body parts ('This is not my arm'), and those that do. Comparisons of dissociative parts and mentally healthy individuals can also document such correlates, which research is similar to comparisons of patients with structural brain defects and healthy individuals (e.g., Gallagher, 2005). For example, by comparing the neural activity of dissociative parts with a deficient phenomenal self-model and mentally healthy individuals with an adequate phenomenal self-model, it may be found what neural activity is associated with the generation of an adequate FPP and QSPP. Both subtypes of research can contribute to an understanding that the normal phenomenal sense of self, world, and self-in-the-world involve ongoing constructions, developed in interaction with a material and social environment.

Studies of dissociative parts are possible and fruitful. For example, different resting state patterns of neural activation patterns have been found for DID patients, functioning as ANP, and healthy controls (Sar, Unal, & Ozturk, 2007). This kind of research can document what brain structures and functions are associated with normal and abnormal resting states of (self)consciousness. The study of task-related states of (self)consciousness in dissociation and normality is also within reach. We had two different types of dissociative parts in women with DID listen to neutral and trauma memory scripts (Reinders et al., 2003, 2006, 2008). These types involved a part oriented to achieving goals of daily life, and a part oriented to physical defense in the form of foremost sympathetically mediated tendencies to flight and freeze. Theoretically, these types are described as Apparently Normal Parts (ANP) and Emotional Parts (EP)(Van der Hart et al., 2006). For ANP only the neutral memory script, and for EP both scripts pertained to personal experiences. ANP and EP had indistinguishable subjective, psychophysiological and neural reaction patterns for listening to the neutral memory script, but their respective reactions to the trauma memory script were, as was theoretically predicted, very different. Broadly speaking, EPs but not ANPs had strong phenomenal and psychophysiological reactions, as well as more subcortical (caudate, amygdala) and less cortical activation than ANPs. These differences were not due to role-playing, suggestion, and fantasy proneness, as some scientists have suggested (Giesbrecht, Lynn, Lilienfeld, & Merckelbach, 2008; Lilienfeld et al., 1999; Merckelbach, Rassin, & Muris, 2000; Piper & Merskey, 2004): neither high nor low fantasy prone mentally healthy women instructed to simulate ANP and EP had psychophysiological and neural reaction patterns that characterized authentic ANPs and EPs (Reinders et al., 2008).

Studies of phenomenal self-models and lack of personification in dissociative disorders and health are feasible as well. Thus, we currently prepare a study of biopsychosocial reactions of ANP and EP to audiotaped ANP's, EP's, a friend's, and a stranger's self-spoken self-descriptions. Healthy controls will listen to audiotaped self-spoken self-descriptions, and self-descriptions of a friend and a stranger. This work will allow us to explore what neural structures and patterns are involved in correct and incorrect discriminations of QSPP (I-me), SPP (I-other dissociative part/I-friend), and TPP (I-stranger).

5. Conclusion

Theoretical considerations and pioneering empirical work suggest that studies of dissociation can contribute to an understanding of consciousness and self-consciousness as phenomena implied in particular ongoing actions. Ontologically, this study examines dynamic configurations of the intrinsic relationships of brain, body, and environment, that is, links between mental, behavioral, (psycho)physical, and neuronal states, and the actions that generate these states (Joseph 2009; Northoff, 2003). Epistemically, the focus of this work is on the differences and interdependency of FPP, QSPP, SPP, and TPP. The theory of dissociation of the personality—for space only minimally introduced in this article-- can serve as a solid heuristic with regard to these explorations.

With some exceptions (e.g., Edelman & Tononi, 2000; Metzinger, 2003), the possibility of this study is hardly realized to date. For example, there are only a handful neuroimaging studies of DID, whereas there are about a thousand neuroimaging studies of schizophrenia, a disorder with a similar prevalence. Realization of the relevance of complex dissociative disorders for the study of consciousness and self-consciousness would be most rewarding for philosophy, science, and the wellfare of patients with these severe conditions alike.