Tuesday, 9 January 2018

Self-awareness and Schizophrenia

Today’s post is by Valerie Gray Hardcastle, Professor of Philosophy, Psychology and Psychiatry and Behavioral Neuroscience at the University of Cincinatti.

I study the nature and structure of interdisciplinary theories in the cognitive sciences and have focused primarily on developing a philosophical framework for understanding consciousness that is responsive to neuroscientific, psychiatric and psychological data. Currently, I am investigating the neuroscience of violence and its implications for both our understanding of human nature and the criminal justice system.

I am also trying to figure out whether notions of embodied cognition help or hinder theorizing about consciousness. (I think that the answer will be neither.) Most recently, I have received research fellowships from the Medical Humanities Program at the University of Texas-Medical Branch; the Centre for Mind, Brain and Cognitive Evolution at theUniversity of Bochum; and the Institute for Philosophy/School of Advanced Study at the University of London. Below I summarize a recent paper of mine that discusses how studying schizophrenia can help us understand self-awareness.

Self-awareness is the kind of awareness that underlies our standard, first person attributions of consciousness. It is an awareness—often in the background—of being an agent who interacts with the world, though that awareness can be quite vague and nascent. Disturbances in self-awareness can intuitively seem quite strange, for, in its most basic form, it appears to be a fundamental aspect of our conscious experiences. This experience of a blue square is an experience that I am having now; I know this because I am the one having it. And I know it in a raw and immediate way. How is it that one could be confused about what the “I” is thinking or perceiving? And yet, it appears that certain mental disorders, like schizophrenia, can give rise to that error quite regularly.

Schizophrenia is not particularly rare, but its constellation of symptoms are at once baffling and devastating—hallucinations, delusions, flat affect, social isolation and motor impairments. Investigating these patients and their symptoms has been an important avenue in studying the nature of the self, for it allows us to see where Nature’s joints are, as it were.

For example, patients with schizophrenia have significant impairments in both processing memories and their emotional responses to the world. Being unable to access personal and emotionally charged memories has important implications for our sense of self over time. Not only do our emotionally-tinged memories help inform our day-to-day decisions as well as our long-term planning, but they also tell us about the sort of person we are. 

For example, I am the sort of person who likes strawberries but not blackberries; I miss my children now that they have grown up and moved away. My sense of self as a stable constellation of consistent reactions and feelings would be greatly disturbed if I lost my ability to access my memories of how I reacted to the world emotionally. I would not be aware of myself as a single thing existing across time; rather, I would be anchored only to the present and my current emotional reactions.

I have argued elsewhere and at length that personal memories and emotions are fundamental to having a self and to one’s sense of self. Deficits in both impact self-awareness. By not being able to project the past into the future effectively, persons’ with schizophrenia self-awareness is diminished. Their inner world becomes limited to a narrow present window, where demands are harder to recognize.

Schizophrenia is multi-faceted and complex. So is self-awareness. But by pulling apart schizophrenia’s various strands, we can learn more about how each of them affect how our self is constructed, when we need in order to be aware of a self, and how we respond to it. Appreciating the many ways in which the self is disturbed in schizophrenia helps us to understand the many dimensions that go into creating a self in the first place.

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