Reflective mirrors: perspective-taking in autoscopic phenomena.

Introduction: ''Autoscopic phenomena refer to different illusory reduplications of one's own body and self. This article proposes a phenomenological differentiation of autoscopic reduplication into three distinct classes, i.e., autoscopic hallucinations, heautoscopy, and out-of-body experiences (OBEs).

Method: Published cases are analysed with special emphasis on the subject's point of view from which the reduplication is observed.

Results: In an autoscopic hallucination the observer's perspective is clearly body-centred, and the visual image of one's own body appears as a mirror reversal. Heautoscopy (i.e., the encounter with an alter ego or doppelgänger), is defined as a reduplication not only of bodily appearance, but also of aspects of one's psychological self. The observer's perspective may alternate between egocentric and ''alter-ego-centred''. As a consequence of the projection of bodily feelings into the doppelgänger (implying a mental rotation of one's own body along the vertical axis), original and reduplicated bodies are not mirror images of one another. This also holds for OBEs, where one's self is not reduplicated but appears to be completely dissociated from the body and observing it from a location in extracorporeal space. It is argued that perspective-taking in a spatial sense may be meaningfully related to perspective-taking in a psychological sense. The mirror in the autoscopic hallucination is a ''cognitively nonreflective mirror'' (Jean Cocteau), both spatially and psychologically. The reflective abilities of the heautoscopic mirror are better developed, yet frequent shifts in the observer's spatial perspective render the nature of psychological interactions between self and alter ego highly unpredictable. The doppelgänger may serve a transitivistic (i.e., own suffering is transferred to the alter ego) or aggressive function when this behaviour is directed against a patient. The mirror in an OBE is always reflective: It allows the self to view both space and one's psychological state from a detached but stable perspective.

Conclusions: Spatial perspective-taking should be more thoroughly assessed in patients reporting autoscopic phenomena. By elucidating the interactions between spatial phenomenology and psychological function, we may gain important insights into the relationships between the self, its body, and phenomenal space.