Self-Awareness Deficits in Psychiatric Patients

Full Title: Self-Awareness Deficits in Psychiatric Patients: Assessment and Treatment
Author / Editor: Bernard D. Beitman and Jyotsna Nair (Editors)
Publisher: W. W. Norton, 2005

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Review © Metapsychology Vol. 10, No. 33
Reviewer: Ulrich Mühe

Whether in
psychology, neuroscience and biology, or philosophy the study of
self-consciousness is currently a very dominant research area in which, more
than in many others, various disciplines come together and contribute equally
to the same debate. In this book, edited by B.D. Beitman and J. Nair, that variety
is aptly displayed. It presents the reader with current research and insight
into self-awareness in psychology and neurobiology, and should, therefore, be
of interest to anyone attracted by this topic.

It has to be said
that, due to the subject matter and the level of expertise of the contributors,
this is not a leisure read. If you have, like me, no noteworthy schooling in
psychology or related disciplines then the book looks daunting with its
detailed depictions of the brain and its various areas.  Terms range from the
accessible "neurons", "neural circuitry" and "memory
systems", to the complex presentation of statistics of various kinds, and
headlines such as "ADHD and Comorbidity", "Orbitofrontal Cortex",
"Functional Neuroimaging Correlates", or "Parallel Selves: from
primitive representations to integrated maps". Thus, this is a high-level
academic publication and intended for people working in the field.

 However, all
those who are nevertheless intrigued by the topic and are determined to
persevere will be rewarded because this is a fantastic read! The insights and
theories offered, together with particular case studies and findings, had me
captivated for the whole length of the book. Since this is an edited volume the
various contributions vary in style, tone, and accessibility, but this is to be
expected and not a reason to close the volume.

 It would go too
far [and take too long] to describe the articles in detail so I will keep the
following outline relatively short. My focus will, furthermore, be on the
introductory section since it sets the scope of the book and lays the
foundation for the subsequent chapters.

 The book is divided into two parts where
the first serves as a general, but nevertheless detailed, introduction to the
connections between brain, self, and consciousness as far as current research
can offer. I found the three articles comprising this part the most accessible.
Although the subject matter is intricate and involves extensive descriptions of
the brain’s neural network, the authors provide the reader with sufficient
figures that depict the information outlined in the text.

The introductory article in
this collection is concerned with the question of why we study self-awareness
at all. After an initial statement of the problem the authors give a short
account of the physiological building blocks that allow for our self awareness.
Most important here are: a sense of self, language, memory, bodily awareness
and the understanding of others.

The second chapter details and gives examples for much of

what was
described in the introductory chapter. The titles of some of the subsections
already sound promising (such as: "Why do we need brains?", "The
origins of free will", "Evolution of the social brain", and "In
search of the self") and the reader will not be disappointed. Further
interesting points concern energy management, the phenomenon of meaning,
choice, plasticity, risk and reward, memory, reflective thought, attention,
language and symbolic reasoning, and spatial awareness.

A detailed
description of this kind cannot do without specific information about the
physiology of the brain, and a big part of this chapter is taken up by
meticulous accounts of the brain’s architecture and the function of specific
parts (such as the amygdala,  thalamus and cortex). However, altogether 17
pictures visualise the parts and connections described in the text.

In the third
chapter two researchers hypothesise a state of "pure consciousness"
in the sense that it is "free from the processes and contents of knowing"
(p.113). Such pure consciousness without content has long been identified in
Eastern methods of meditation, but goes contrary to the main western view
according to which consciousness is always consciousness of something.
The possibility of consciousness without content would thus drastically alter
the western conception. Hence, this article is of particular philosophical
interest. Unfortunately, with just 12 pages it is the shortest article in the
collection, and eager readers will have to wait for forthcoming publications on
this topic if the suggestions are meant to become more settled and concrete.

The second part of
the book, containing the remaining seven articles, focuses on particular
self-awareness deficits such as schizophrenia, Asperger’s syndrome and autism,
alcoholic denial, borderline personality disorder, attention
deficit/hyperactivity disorder, denial of illness following stroke, and
conversion disorder [formerly hysteria].

 All the articles
outline the respective disorder, and then examine how far the deficit is
manifested in the brain. Some disorders can be cognitive although most are
non-cognitive, and in each case the connection between neurology and psychology
of the patient is examined. Most of the contributions also include information
about the treatment of the respective disorder.

Generally, I found
all the articles very interesting. While one or two make use of terms and
studies that are not explained, and thus leave the unfamiliar reader in the
dark, they usually do not go further in complexity than part 1 of the book, and
the specific disorders help to exemplify many of the connections between mind
and brain outlined at the start.

Finally, I can
only repeat that whoever is willing to make an effort to deal with the wealth
of details and information contained in this volume will be rewarded with a
very insightful and stimulating read about self-consciousness, and its neural
basis and psychology. For my part, I am glad to have read this book and
strongly recommend it to anyone interested in the issues involved.

 

© 2006 Ulrich Mühe

 

Ulrich
Mühe is currently a PhD student at the University of Kent (U.K.). His research
interests lie in epistemology, social philosophy (particularly social
ontology), phenomenology, and psychology.

Categories: Psychology