The Psychopathology Of Consciousness

Human consciousness has been studied since philosophy began, and the psychopathology of consciousness derives from it. After many years of research, however, there still does not seem to be a consensus on the definition of this construction.

Descartes spoke of spirit, and his work focused on understanding what it meant for a spirit to be able to say something about itself. Block (1995) spoke of two types of consciousness and Chalmers (1998) argued that it would take “a century or two” to answer this question.

At present, experts are studying psychological consciousness to find out if there are neural connections with conscious states (Perez, 2007). Research does not seem to agree on what to study: Should we focus on the relationships between states of consciousness or on the content of consciousness?

Psychopathological disorders related to consciousness

Although the definition of consciousness does not seem clear, the truth is that there are specific disorders related to consciousness. Bleuler (1857-1939), a Swiss psychiatrist, defined consciousness as ” knowledge of one’s own self-knowledge” .

In this way, people with altered consciousness are not able to respond adequately and understandably to the demands of the environment or to inner stimuli. The psychopathology of consciousness is based on this definition.

Gastó and Penades (2011, in Santos; Hernángomez and Travillo, 2018) talked about four traits of consciousness that are particularly relevant in disorders:

• The subjectivity or privacy of our minds.
• The presence of a single consciousness in each person.
• Every action  is directed at something.
• Self-awareness, which is the ability to know and acknowledge oneself.

Disorders related to consciousness are organized based on the part of the body or brain that is affected. The CeDe Psychopathology PIR Preparation Manual  (2018) is used as a reference point here.

Disorders associated with lack of consciousness: Lost in sleep

The psychopathology of consciousness includes behavioral disorders. We can characterize them as disorders of the brain, where people have trouble “waking up”, orienting themselves and responding to the stimulation of the senses. They seem dull. There are three types of disorders associated with lack of consciousness:

• Drowsiness, drowsiness and drowsiness. These are people who are not able to stay focused and pay attention even when they make a lot of effort. Drowsiness is not a subjective feeling of sleepiness due to lack of rest, but a change where there is hardly any physical or verbal stimulation.

• Dumbfounded. The person is in a deeper form of distraction and lack of stimulation. They feel confused and annoyed when another person tries to get them out of this state. There is a disturbance in their whole psychological function. There is also distorted perception, such as auditory and visual problems.
• Sedation. We can see anesthesia in conditions such as catatonic schizophrenia. The person possesses no voluntary movement and their speech is incoherent and almost incomprehensible.

The complete absence of consciousness occurs when a person is in a coma where reflexes, such as the reflex in the pupil, disappear and there is a flat electroencephalography for thirty minutes. At this point, we can say that the person is no longer conscious.

Productive disorders related to consciousness: Hallucinations in excessive amounts

In the psychopathology of consciousness, we also find changes that suggest that although there may be consciousness, it is completely distorted, leading to hallucinations and delusions.

Delirium is a confusion around the real and the imaginary. This occurs in all productive disorders related to consciousness. In addition to this confusion, individuals also experience sleep-like states with moments of clarity in between. We can see confusion in the following disorders:

• Weakened-apathetic phase. This  occurs mostly in the elderly, prior to toxic-confusing conditions. The debilitated-apathetic phase can occur in people who are at risk of suffering from delirium, and is characterized by hostility, irritability, fatigue and apathy. There are also changes in psychological functions, such as memory and concentrate.

• Confusion. This comes before the acute confused condition or delirium. Symptoms such as loss of coherence, memory distortion, incoherent language, and disruption of behavior occur.
• Delirium. Delirium is an  acute cerebral dysfunction  that produces a total change of mental state and a change of consciousness. Here there are clear changes in concentration, disturbance of perception, thoughts, short-term and long-term memory, psychomotor activity and the sleep cycle.

The change of context in delirium

Delirium usually occurs in the elderly who go to the hospital for completely different reasons. At night, they experience an acutely confused state.

The change in context and the level of anxiety that is part of being in the hospital produces this. The problem here is that hospital staff often do not know what to do to help. The key here is to change the context.

Limitation of consciousness: The distinction between thoughts and behavior

These disorders create a lack of continuity between perception and cognition,  but are characterized by seemingly “normal,” but automated, behaviors.

We found that the primary disorder in limiting consciousness is the twilight state. In the twilight state, consciousness is completely distorted, but the person’s perception of the world, even though it is distorted, is partial.

The person’s behavior seems to be in harmony with the environment and this is because their behavior is in a way automated. These automations are involuntary movements, which means that they do not perform them consciously. The people knew how to perform them before they experienced this twilight condition (sometimes called twilight amnesia).

There is a difference here between people with schizophrenia, whose automations, for example, can lead to strange behavior.

In twilight states, impulses can also appear. Impulses are impulsive actions without a cognitive basis, and this differentiates them from the compulsions that can occur in, for example, OCD.

A characteristic feature of twilight mode is that they occur abruptly. However, they also disappear very abruptly. They usually last a few hours or days and the person does not remember anything about the episode.

Rewritten changes of consciousness: They do not come alone

The psychopathology of consciousness  is also found in psychological and neurological disorders, without it being the patient’s primary problem. This is usually the case in changes such as depersonalization and derealization, which typically occur in situations of anxiety, panic, and neurosis.

Depersonalization is defined by Cruzado, Núñez, and Rojas (2013) as a change in a person’s self-awareness. The person feels that they are far away and that they are just a spectator observing their own mental processes and body movements.

They are only able to define their own symptoms with terms such as ” if “, due to the problems involved in making these descriptions.

Depersonalization, although found in psychological and psychiatric illnesses, also occurs in people without changes due to physical or emotional exhaustion, stress, and sleep deprivation.

Derealization is a similar change. However, we are talking here about a change in the person’s perception of the world, and not themselves.