The psychopathology of consciousness

Consciousness has been studied since the annals of philosophy and from this study the psychopathology of consciousness arises. In fact, after 2500 years of discipline, There does not seem to be a consensus on the definition of this construct..

Descartes spoke of spirit, and his efforts were directed at understanding what it meant that a spirit could say something about itself; Block (1995) spoke of two types of consciousness and Chalmers (1998) assumed that it would take “a century or two” to resolve this question.

Currently, it is studied psychological awareness and if there are neural correlates with conscious states (Pérez, 2007). The lines of research do not seem to agree on the object of study: Should we focus on the correlates of states of consciousness or the content of consciousness?

Psychopathological disorders of consciousness

Although the definition of consciousness does not seem clear, the truth is that there are specific disorders of consciousness. Bleuler (1857-1939), Swiss psychiatrist, defined consciousness as the knowledge of self-knowledge.

In this way, the person with an alteration of consciousness was unable to respond in an adequate and understandable way to the demands of the environment, nor to internal stimuli. Based on this definition, the psychopathology of consciousness was organized.

Gastó and Penades (2011, in Santos, Hernángomez and Travillo, 2018) spoke of four characteristics of consciousnessespecially relevant in the disorders presented below:

Subjectivity or privacy of our minds.Existence of a single consciousness in each individual.Every act goes aimed at a goal.Self-awarenesswhich is the ability to know oneself and recognize oneself as such.

Disorders of consciousness are organized according to what is affected by the alteration. It is taken as a reference CeDe Manual of Psychopathology PIR Preparation (2018) to expose them.

Deficit disorders of consciousness: lost in a dream

The psychopathology of consciousness includes behavioral deficit disorders. These are characterized by brain pictures where the person has difficulty “waking up”, orienting themselves and responding to sensory stimulation. They seem lost in time or in lethargy. There are three types of impaired consciousness:

Lethargy, drowsiness or drowsiness: They are individuals incapable of maintaining attention and alert even if they make an effort to do so. Lethargy is not a subjective sensation of sleep due to having rested poorly, but an alteration where there is hardly any physical or verbal stimulation.Obnubilation: the person is in a deeper state of distractibility and lack of stimulation, and feels confused and irritated when another subject tries to get him out of that state. There is a disturbance of his entire psychological functioning, and there are also perceptual distortions—auditory, visual—.Stupor: stupor can be seen in conditions such as catatonic schizophrenia. The subject abandon all voluntary movement and his verbalization is incoherent and barely understandable.

The complete absence of consciousness occurs when the person enters a coma, where reflexes such as the pupillocorneal disappear, and a flat electroencephalogram is shown for thirty minutes. It is at that moment when we can say that there is no longer consciousness in the person.

Productive disorders of consciousness: hallucination in excess

In the psychopathology of consciousness we also find alterations that suggest that, although there is consciousness, This is far from reality, giving rise to pictures of hallucinations and delusions.

Oneirism, or dream delirium, understood as confusion between the real and the imaginary, appears in all productive disorders of consciousness. In this confusion, people imagine dream-like states, interspersed with moments of lucidity. Oneirism or confusion can be seen through these disorders:

Asthenic-apathetic stage: It appears mostly in older people, preceding toxic-confusion symptoms. The asthenic-apathetic stage can appear in people at risk of suffering from delirium, and is characterized by affective lability, irritability, fatigue and apathy. There are also alterations in psychological functions such as memory or attention.confusional stage: precedes the acute confusional state or delirum. Symptoms such as loss of coherence, memory distortion, incomprehensible language and behavioral disinhibition occur.Delirium: Delirium is an acute brain dysfunction that produces a global alteration of the mental state and is characterized by an alteration of consciousness, where there are marked attentional alterations, and disorders of perception, thinking, short and long-term memories, psychomotor activity and the sleep-wake cycle.

Context change in delirium

Delirium usually occurs in elderly people who are admitted —for totally different reasons—. When night comes they enter an acute confusional state.

The change of context, the level of anxiety that being in a hospital implies, produces this. The serious problem is that hospital workers usually don’t know what to do. The key is the change of context.

Disorders of narrowing of the field of consciousness: division between thought and behavior

These disorders are characterized by the lack of continuity between perception and cognitionbut which presents with an apparently “normal” behavior, full of automatisms.

We find twilight states as the main disorder of the narrowing of the field of consciousness. In the twilight state, consciousness is completely clouded, but the understanding of the world, although falsified, is partial.

The subject’s behavior seems in line with the environment and this occurs because automatism appears in his behavior. These automatisms are involuntary movements—that is, they are not carried out from consciousness—that the subject knew how to do before the twilight state.

This differentiates them from people with schizophrenia, for example, whose automatisms give rise to strange behavior.

Impulsions may also appear in twilight states. Impulses are impulsive behaviors without a cognitive basis – this differentiates them from the compulsions that can appear, for example, in OCD.

The twilight states, however, come abruptly, but they also disappear abruptly. These usually last a few hours or a few days, and The subject does not remember the episode he or she has just experienced.

Circumscribed alterations of consciousness: they do not come alone

The psychopathology of consciousness It is also found in psychological or neurological disorders without this being the main problem. This is the case of alterations such as depersonalization and derealization that usually appear in anxiety and panic disorders and neurotic disorders.

Depersonalization is defined by Cruzado, Núñez and Rojas (2013) as an alteration of self-consciousness, where the person feels themselves as distant and distant; the subject is a mere spectator of the mental processes and his body; He is only able to define his symptoms with expressions such as “as if” due to the difficulty of describing them.

Depersonalization, although found in psychological and psychiatric conditions, It also appears in people without alterations due to physical or emotional exhaustion, stress or sleep deprivation.

Derealization is a similar alteration, however, it involves a change in the experience and perception of the world and not of oneself.

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