Academic journal article International Journal of Psychology and Psychological Therapy

Consciousness Disorders in Schizophrenia: A Forgotten Land for Psychopathology

Academic journal article International Journal of Psychology and Psychological Therapy

Consciousness Disorders in Schizophrenia: A Forgotten Land for Psychopathology

Article excerpt

The scientific study of consciousness has been boosted in the last two decades, especially from philosophical and neuroscientific realms. Before that, the topic was neglected, particularly in psychiatry in which, either out-of-consciousness experiences were emphasized (as in psychoanalysis) or consciousness was viewed as epiphenomenic to the underlying organic disorders that had to be studied. This situation has hardly improved in modern psychiatry. Reasons have been suggested, referring to characteristics of the phenomenon (fuzzy boundaries, conceptual confusion, epistemological controversies on first/third person description) but also to the evolution of psychiatry itself during the twentieth century (Anglo-Saxon psychiatry supremacy with its emphasis on third person descriptions, modular modelling of mental symptoms, descriptive psychopathology considered to be transparent, etc).

Accordingly, the role of a disordered consciousness in schizophrenia, which was contemplated by Continental psychiatry (Dagonet, Janet, Berze, Ey), has hardly been considered by recent psychopathology research. However, there is growing data showing that certain functions that modern science considers to be part of consciousness (sense of agency, self, episodic and autobiographic memory, executive functions, insight, monitoring) could be impaired in certain schizophrenics. From different realms (neurophenomenology, neuropsychology and neurosciences), the study of consciousness and its role in schizophrenia has been approached in recent years, and clinical phenomena such as thought insertion, depersonalisation, hallucinations, self fragmentation, disorders of episodic and working memory and sense of agency and action planning have been accounted for from the perspective of a putative disorder of consciousness.

CONCEPT OF CONSCIOUSNESS.

It can be stated that consciousness is one of the most baffling, enigmatic and mysterious phenomena in nature. Much has been written, especially in the last decade, about it and, however, little is known about what it really is, its origins and how to study it. One source of confusion is its polysémie meaning. It may be that consciousness refers to a more or less heterogeneous group of phenomena (Wilkes, 1988; Block, 1994). To make things worse, the use of analogous terms (awareness, perception, attention, inner knowledge) is of no use to conceptual clarification: some refer to different phenomena (Block, 1996; Baars, 1997) and some refer to each other in a circular manner (Giizeldere, 1995). Nevertheless, circularity in definition is not an exclusive problem of consciousness since other basic scientific terms such as energy, in physics, or stimulus, response or reinforcement, in psychology, cannot be analysed by looking at their components and need to be explained by referring to other terms (Velmans, 1996). In this sense, it may be the case that consciousness is a term that should not be defined beforehand but only after having been used in a specific context (Valentine, 1999).

Two main uses of consciousness can be distinguished (OED, 1971): (1) the ethical or social usage, applied to individuals (moral consciousness or knowledge or own misdemeanours) or groups (shared knowledge): it is the oldest use, stemming from the original Latin term and, by extension, it has led to other uses (consciousness of class, political consciousness, consciousness-raising); (2) the psychological usage, individual, also with two senses: on the one hand, consciousness as the faculty or state of being conscious of something, which is a necessary condition to any cognition, feeling or volition; on the other hand, the state of being conscious, condition of normal wakefulness. The former, derived from the modern conception of consciousness originated in 17th century with Descartes and Locke, implies a transitive or intentional component (consciousness of) and also allows for new facets of consciousness (self-consciousness, consciousness of self, qualia) to be studied separately. …

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