1. The document discusses disorders of consciousness and self, with a focus on defining consciousness from different perspectives like philosophy, psychology, religion, and quantum physics. 2. It provides an overview of consciousness in light of these disciplines and describes different dimensions and levels of consciousness from vigilance to drowsiness to clouding of consciousness. 3. Key disorders of self are discussed, including disorders of being, activity, singleness or ego consistency, identity, and boundaries of self.

1. DISORDER OF
CONSCIOUSNESS AND
SELF
PRESENTER – REHAN
MATEEN
MODERATOR – PROF S.A.
AZMI
DEPARTMENT OF
PSYCHIATRY
JNMCH, AMU

2. Any parent can vouch for just how complicated things become when a child starts
reaching the age of hard questions. We’ve all been there :
1. Child- “Why is the sky blue?”
Father- “Because, my child, the molecules in the air scatter blue light more than other
colors.”
2. Child- “Oh. Where do babies come from?”
Father- “Sperm and egg come together to form a zygote, which develops into a foetus
and then a child.”
3. Child- “Daddy, why do we eat daily?”
Father- “My child, because we need energy to survive. Otherwise we will die.”
4. Child- “Hmm. Is there a God?”
Father- “Yes. Because there must be a creator of all the creations in the world.”
5. Child- “What’s consciousness”
Father- “Ummm…..”

3. HUMANS VS ANIMALS

4. OVERVIEW
║ INTRODUCTION
║ CONSCIOUSNESS IN LIGHT OF DIFFERENT DISCIPLINES
║ NEUROANATOMY RELATED TO CONSCIOUSNESS
║ DISORDERS OF CONSCIOUSNESS
║ DIMENSIONAL CHANGES IN LEVELS OF CONSCIOUSNESS
║ QUALITATIVE CHANGES OF CONSCIOUSNESS
║ ‘EGO’ AND ‘SELF’

5. OVERVIEW
║ ‘EGO’ AND ‘SELF’ IN LIGHT OF DIFFERENT DISCIPLINES
║ DISORDERS OF SELF
║ DISORDER OF BEING OR EGO VITALITY
║ DISORDER OF ACTIVITY
║ DISORDER OF SINGLENESS OR EGO CONSISTENCY AND COHERENCE
║ DISORDER OF IDENTITY
║ DISORDER OF THE BOUNDARIES OF SELF OR EGO DEMARCATION

6. INTRODUCTION
“CONSCIOUS”
“CONSCIOUSNESS”
1500s
Latin conscius (con- “together” and socio
“to know”)
The cerebral cortex 6 months of
gestation
Neuroscientists late stages of pregnancy
• Sound of its mother’s voice
• May be learning language

7. •Consciousness is a defining characteristic of animals, although
conscious self-awareness may be particular to human beings.
•Consciousness is one of the most challenging philosophic problems of
our times dealt in different disciplines- Religion, Philosophy, Psychology,
Medicine and Quantum Physics
•It is important to emphasize that the term ‘consciousness’ does not
refer merely to the distinction between being asleep or awake. To be
awake presupposes being conscious.
•The focus is on the process of being conscious of something, rather
than merely being awake.
•In other words, it is the process of being conscious of something, in the
sense in which one is aware that he can see a particular object or hear a

8. CONSCIOUSNESS
• The words consciousness, conscious mind and awareness are used very
freely in psychiatry but often without a precise meaning.
‘is a state of awareness of the self and the
environment’.
• One must be conscious to be able to experience the world.
• Until quite recently , studies of consciousness were looked on with
suspicion by neuroscientists, thereby leaving clinicians, both
neurologists and psychiatrists, in intellectual darkness.
• The term, as used by clinicians, refers first to the inner awareness of
experience as opposed to the categorizing of events as they occur.
Second, it refers to the subject reacting to objects deliberately. Third, it
CONSCIOUSNES
S

9. Any theory of consciousness must attempt to explain certain
basic facts about mental life, namely
 That Consciousness has a subjective nature that is united by a
unique individual’s inner perspective.
 That conscious awareness appears to have a quality that is
recalcitrant to physical or materialist description, that is, that it
cannot be reduced to physico-chemical processes.
 That conscious experience is directed towards objects, that is, it
is intentional in nature. It is the particularly striking inner
subjective aspect of conscious awareness that is of prime
concern to Psychiatrists.

10. CONSCIOUSNESS VS ATTENTION
At the outset it is important to distinguish consciousness from attention.
•Attention refers to the capacity to focus our interest or consciousness on
specific aspects of the subjective world.
•The global workplace theory, an influential psychological model of
consciousness, uses a theatre metaphor in which attention resembles choosing
a television channel and consciousness is the picture on the screen.
•The distinction that is being drawn here is that between selecting an experience
and being conscious of the selected event.

11. 1856-
1939
DR SIGMUND FREUD
AN AUSTRIAN NEUROLOGIST AND FATHER OF
PSYCHOANALYSIS

12. • In Sigmund Freud’s psychoanalytic theory of personality, the
conscious mind consists of everything inside of our awareness. This
is the aspect of our mental processing that we can think and talk
about in a rational way.
• The conscious mind includes such things as the sensations,
perceptions, memories, feeling and fantasies inside of our current
awareness.
• Closely allied with the conscious mind is preconscious, which
include the things that we are not thinking of at the moment but
which we can easily draw into conscious awareness.

13. • Things that the conscious mind wants to keep hidden from
awareness are repressed into the unconscious mind. While we
are unaware of these feelings, thoughts, urges and emotions,
Freud believed that the unconscious mind could still have an
influence on our behaviour.
• Things that are in the conscious are only available to the
conscious mind in disguised form. For example, the contents
of the unconscious might spill into awareness in the form of
dreams. Freud believed that by analyzing the contents of
dreams, people could discover the unconscious influences on
their conscious actions.

14. CONSCIOUSNESS IN RELIGIONS
: “the animal part of mankind”
• Includes basic sensations such as
 hunger
 thirst
 pain and pleasure
 basic drives and pleasures
: “the part of the human being that is capable of
transcending animal instincts”
• The point of contact with God which is the real essence of human being.
LOWER
CONSCIOUSNESS
HIGHER
CONSCIOUSNESS

15. CONSCIOUSNESS IN QUANTUM PHYSICS
• Region in human brain related to happiness active individuality
combines with the universe, he eliminates the questions in his mind and
feels that his desires and needs have been met.
• The existence of the region in our brain that perceives sleep
necessitates sleep.
• The region related to belief in the brain will distinguish between the one
who finds it and the one who does not in return for the existence of an
external power and the desire to introduce itself.
• Apart from the quantum mass energy of the universe, the existence of a
superior computer technology and a power that manages it, is discussed
in quantum physics.

16. • Whether this power controls the universe with its quantum energy after
forming the universe.?
• When the quantum energy of man leaves him, man dies. This is
something like saying, “man dies, when spirit leaves him.”
• With his quantum energy, man can be anywhere through his digital code.
• It is possible when we think of the universe in a mathematical and
electrochemical model.
• This concept, which religions called GOD, is called EXTERNAL POWER
now.

17. NEUROANATOMY RELATED TO
CONSCIOUSNESS

18. DISORDERS OF CONSCIOUSNESS
It has proved complicated to describe exactly what is disordered in
pathologic states of consciousness, hence this rather convoluted
definition of a disturbed state of consciousness by Aggernaes (1975) :
“A state in a person in which he has no experiences at all, or in which all of his experiences are
deviant, concerning other or more qualities than tempo and mood colouring, from those he
would have under similar stimulus conditions in his habitual waking state. The state is a
disturbed state of consciousness only if the individual cannot return to, and remain in, his
habitual state by deciding to do so himself, and if others bring about a lasting return to his
habitual state by the application of a simple social procedure.”

19. DIMENSIONAL CHANGES IN LEVELS
CONSCIOUSNESS
Impairment of consciousness can be seen as a continuum from alertness
through to drowsiness and ultimately coma and death. In most conditions
impairment of consciousness is accompanied by diminished arousal and
alertness.
In clinical practice, the term unconscious is used in three quite different
ways that have in common only the phenomenological element in
that there is no subjective experience.
a) A person suffering from serious brain disease may be unconscious;
consciousness in this instance is seen as being on a continuum, with a
normal state of consciousness at one end and death at the other.
b) Someone who is asleep is unconscious; again there is continuum from
full wakefulness to deep sleep.
c) An alert and healthy person is aware of only certain parts of his
environment both externally and internally, of the rest, he is
unconscious. There is also a continuum here from full vigilance directed
towards the immediate object of awareness to total unawareness.

20. LEVELS OR STAGES OF DIMINISHED
CONSCIOUSNESS

21. THREE DIMENSIONS OF
UNCONSCIOUSNESS

22. VIGILANCE (WAKEFULNESS)–DROWSINESS
(SLEEP)
• Vigilance is taken to mean the faculty of deliberately remaining alert when
otherwise one might be drowsy or asleep.
• Drowsiness is a persistent state and is the next level of progressive
impairment of consciousness. The patient is awake but will lift into
sleep if left without sensory stimulation.
• In addition to the contrast between vigilance and drowsiness, there are
qualitative changes differences in the nature of wakefulness.
Drowsiness may be seen in-
 Head Injury
 Tumour
 Epilepsy
 Infection
 CVA
 Metabolic disorder of toxic state

23. LUCIDITY-CLOUDING
• Consciousness is inseparable from object of conscious attention : Lucidity
can be demonstrated only in clarity of thought on a particular topic.
• The sensorium, the total awareness of all internal and external sensations
presenting themselves to the organism at any particular moment, may be
clear or clouded. Obviously, lucidity is not unrelated to vigilance : unless
the person is fully awake, he cannot be clear in consciousness.
• Clouding of consciousness denotes the lesser stages of impairment of
consciousness on a continuum from full alertness and awareness to coma.
Clouding may be seen in-
 Drug and Alcohol Intoxication
 Head Injury
 Meningeal Irritation

24. QUALITATIVE CHANGES OF
CONSCIOUSNESS
 Lipowski (1990) defines delirium as ‘a transient organic mental
syndrome of acute onset, characterized by global impairment of
cognitive functions, a reduced level of consciousness, attentional
abnormalities, increased or decreased psychomotor activity and a
disorderd ‘sleep-wake’ cycle.
 The Diagnostic and Statistical Manual of Mental Disorders (5th edition;
DSM-5) defines delirium as a condition in which there is a disturbance
in attention that develops over a short period of time and that may
include other disturbances in cognition, including in memory,
orientation, language, and spatial ability or perception.
DELIRIUM

25. OTHER TERMS RELATED TO DISORDER OF
CONSCIOUSNESS
A twilight state is a well defined interruption of the continuity of
consciousness.
It is characterized by
a) Abrupt onset and end
b) Variable duration, from a few hours to several weeks
c) The occurrence of unexpected violent acts of emotional outbursts during
otherwise normal, quiet behaviour.
Seen in mostly organic conditions-
 Alcoholism
 Brain trauma
 General paresis
 Temporal lobe epilepsy
 May occur with dissociative state
TWILIGHT STATE

26. This is one type of twilight state specifically associated with
alcoholism.
It is important to distinguish this syndrome of acute pathological
intoxication with alcohol from delirium tremens which is a symptom of
withdrawal.
Keller (1977) has defined mania a potu as :
“an extraordinarily severe response to alcohol, especially to small
amounts, marked by apparently senseless violent behaviour, usually
followed by exhaustion, sleep and amnesia for the episode.
Intoxication is apparently not always involved and for this reason
pathological reaction to alcohol is the preferred term. The reaction is
MANIA A POTU (PATHOLOGICAL
INTOXICATION)

27. Coid (1979) describes four components of mania a potu
1) The condition follows the consumption of a variable
quantity of alcohol
2) Senseless, violent behaviour then ensues
3) There is then prolonged sleep
4) Total or partial amnesia for the disturbed behaviour occurs

28. • Automatism implies action taking place in the absence of consciousness.
• An automatism is an involuntary piece of behaviour over which an individual
has no control.
• The behaviour itself is usually inappropriate to the circumstances, and may be
out of character for the individual.
• It can be complex, co-ordinated, and apparently purposeful and directed,
though lacking in judgement. Afterwards, the individual may have no
recollection, or only partial and confused memory, of his actions.
 Most often seen in Temporal Lobe Epilepsy
AUTOMATISM

29. • This is an unsatisfactory term not clearly differentiated from twilight
state or delirium.
• The patient is disoriented and confused and experiences elaborate
hallucinations, usually visual.
• There is impairment of consciousness and marked emotional change,
which may be terror or enjoyment in of the hallucinatory experiences.
• There may also be tactile or auditory hallucination.
• The patient may appear to be living in a dream world.
DREAM-LIKE (ONEIROID)
STATE

30. • Stupor names a symptom complex whose central feature is a
reduction in,
or absence of, relational functions: that is action and speech.
• It is distinct from coma and does not lie on a continuum from
wakefulness to coma.
• This term should be reserved for syndrome in which mutism and
akinesis occurs.
STUPOR

31. • LOCKED-IN-SYNDROME : A rare but specific condition causing
quadriplegia and anarthria with preserved consciousness and
vertical eye movements.
 Lesion involving motor pathways in ventral pons
• AKINETIC MUTISM : This syndrome is characteristic of lesions in
the area of the diencephalon and upper brainstem, and also the
frontal lobe and basal ganglia and the term akinetic mutism has
sometimes been reserved by neurologists to describe a much
more narrowly defined organic syndrome.
 Frontal lobe injury
 Thalamic stroke

32. SELF AND EGO
SELF
EGO

33. RENE DESCARTES
THE FATHER OF MODERN PHILOSOPHY
1596-1650
• Identified the mind with consciousness and self-
awareness and distinguished this from the brain as
the seat of intelligence.
• First to formulate the mind-body problem in the
form in which it exists today.
• Mind can exist outside of the body, and the body
cannot think.
• Compatible with most theologies immortal
souls occupy an independent realm of existence
distinct from that of the physical world.
MIND-BODY DUALISM (CARTESIAN
DUALISM)

34. FREUD’S CONCEPT OF SELF
Freud (1933) described ego as standing ‘for reason and good
sense while the id stands for the untamed passions’.
The ego has been modified by the proximity of the external
world with its threat of danger… The poor ego has to serve three
severe masters and does what it can to bring their claims and
demands into harmony with one another. These demands are
always divergent and often seem incompatible. No wonder that the
ego so often fails in this task.
Its three tyrannical masters are the external world, the
super-ego and the id.

35. DR CARL JUNG
A SWISS PSYCHIATRIST AND PSYCHOANALYST
1875-
1961
• The Self in Jungian Psychology is one of the Jungian
archetypes, signifying the unification of consciousness and
unconsciousness in a person, and representing the psyche
as a whole.
• The Self, according to Carl Jung, is realized as the product
of individuation, which in his view is the process of
integrating one’s personality.

37. SELF CONCEPT AND BODY IMAGE
║ Self-concept tends to refer to the fully conscious and abstract
awareness of oneself.
║ Body image is concerned with unconscious and physical matters
and includes experiential aspects of body awareness.
• The body is unique in that it is experienced by a person both as
subject to experience and as an object with the same materiality as
any other physical object in the world.
• There is a way in which I am subjectively aware of my own body that
is different from how I experience a block of wood. But I am also
aware that my body is an object in the world, to be viewed and even
acted on by others.

38. • For most of the time, we are not aware of our body but, for example,
in extreme anxiety, traumatic pain and sexual excitement, there is an
awareness of the body as an object : ‘my heart banging, my finger
throbbing’
• In other words it is mostly in times of distress or pain that we become
aware of our bodies as distinct from ‘ourselves’.
• It is through our body that we have contact with the world outside our
self.
 Movements of the body relate us to external space.
 Our hands have a prehensile tool like aspect to them that allow us to
grasp objects in the world.
 Our bodies have have a physicality about them that that occupy space,
give us space, give us presence, locating as objects in the world.

39. TERMS TO DESCRIBE THE WAY A PERSON
CONCEPTUALIZES HIMSELF
use terms:
 BODY SCHEMA
 BODY CONCEPT
 BODY CATHEXIS
 BODY IMAGE
 PERCEIVED BODY
Neurologists, Neuropsychiatrists, Psychoanalysts and
Psychologists
Spatial
element
Similar to self-
concept
Notion of power,
force
Unconscious, physical matters includes
experiential aspects of body awareness
Self image in a social
setting.

40. DEVELOPMENTAL PHASES OF THE SELF
IMAGE

41. SELF IMAGE AND NONVERBAL
COMMUNICATION
• The central core of self image consists for a person of his name, his bodily
feelings, body image, sex and age.
• Nonverbal aspects of communication are important in sending and receiving
information about the personality.
• The role in society one has adopted and the group with which one identifies
self image.
 Age
 Sex
 Race
 Social class
 Rank
 Occupation
 Nationality
 Religious group
 Family connection

42. CHARACTERISTICS OF SELF
AWARENESS
• In descriptive psychopathology , one uses the term ego disorders or
disorders of self to describe the abnormal inner experiences of I-ness and
my-ness that occur in psychiatric illness.
• These may occur in the patient’s state of inner awareness irrespective of
any changes he may show in his attitude to, or experience of, the world
outside himself.
• Jaspers (1997) self-awareness the ability to distinguish I
from not I.
Despite the deeply set convention to treat the self and the body as
separate entities, it is
important to keep in focus the fact, the self and the body are truly
inseparable and that the

43. • The feeling of awareness of being or existing (ego vitality)
I know that I am alive and exist, and this is the fundamental to
awareness of self.
• The feeling of awareness of activity (ego activity)
I know that I am an agent who initiates and executes my thoughts and
actions.
• An awareness of unity (ego consistency and coherence)
At any given moment, I know that I am one person.
• Awareness of identity (ego identity)
There is continuity in my biography, physiognomy, gender, genealogic
origin, etc; I have
been the same person all the time.
• Awareness of boundaries of self (ego demarcation)
CHARACTERISTICS OF SELF AWARENESS

44. DISORDER OF BEING OR EGO VITALITY
 Patient experiences as his very existence may be altered.
 NIHILISTIC DELUSION- seen in affective psychoses
• “I do not exist, there is nothing here/I am not alive anymore/I am
rotting”
 DEPERSONALIZATION- Less pronounced nihilistic ideas (not delusions)
• Feeling of an alteration/Loss of significance for self
• “I feel unreal/A bit woozy, as though I can’t be quite certain of myself
anymore”

45. • A change in the awareness of one’s own activity occurs when the
patient feels that they are no longer than their normal natural
self.
• Feeling of unreality so that the environment is experienced as flat,
dull an unreal.
DEPERSONALIZATIO
N
DEREALIZATION

46. DISORDER OF ACTIVITY
MOVING - delusions of control of patients with schizophrenia
• “My fingers are paralysed, direction of my gaze is changed in
order to prevent my finding the correct keys,the tempo is
quickened by making the muscles of my fingers move
prematurely and still are daily occurrences and the bellowing-
miracle when my muscles serving the processes of respiration
are set in motion by the lower God (Ariman) in such a way
that I am forced to emit the bellowing noises”

47. MEMORISING AND IMAGINING
• In Depression, patient is unable to initiate an act of
memory/fantasy
“my memory has gone. I have no thoughts, I cannot think
at all”
• Schizophrenics feel that his activities / thoughts are
imposed
from outside himself.

48. WILLING
• A schizophrenic patient who no longer experiences his will
as being his own.
• Neurotic patient describe an inability to initiate activity, a
feeling of powerlessness, of being ground down in face of
changing circumstances.

49. DISORDER OF SINGLENESS OR EGO CONSISTENCY
AND COHERENCE
• Autoscopy is a profoundly conceptually challenging phenomenon in
which the usual indivisibility of the self appears to be compromised.
• Fish (1967) says ‘in this strange experience the patient sees himself and
knows that it is he. It is not just a visual hallucination because
kinaesthetic and some somatic sensation must also be present to give
the subject the impression that the hallucination is he’
AUTOSCOPY (HEAUTOSCOPY)

50.  Brugger and Regard (1997) :
1. The feeling of presence
2. Negative heautoscopy
3. Inner heautoscopy
4. Autoscopic hallucination
5. Out of body experience
6. Heautoscopy proper

51. DISORDER OF IDENTITY
• This disorder of self awareness is characterized by changes in the
identity of self over time.
• Jaspers (1997)
“When telling my story I am aware that only part of my present self
experienced all
this. Up to 23rd December 1901, I cannot call myself my present self;
the past self
now seems like a little dwarf inside me. It is an unpleasant feeling ;
it upsets my
feelings of existence if I describe my previous experiences in the first
person. I can
do it if I use an image and recall that the dwarf reigned up to that

52. POSSESSION STATE
ICD-10 DISSOCIATIVE (CONVERSION)
DISORDERS
F44
F44.
3TRANCE AND POSSESSION
DISORDERS
WHO ,1992
• The trance or altered state of conscious awareness is prerequisite,
possession state does not necessarily occur in the context of
dissociative or hysterical disorder.
• Temporary loss of both the sense of personal identity and full
awareness of surroundings.
• Taken over by another- a spirit, a force, a deity or even another

53. DISORDER OF THE BOUNDARIES OF SELF OR
EGO DEMARCATION
 Refers to the disturbance in knowing where I ends and
not I begins.
THOUGHT INSERTION
THOUGHT
WITHDRAWAL
THOUGHT
BROADCASTING
 Schizophrenia
 LSD intoxication

54.  In states of ECSTASY, there are also disturbances in the
boundaries. The participant might describe feeling at one with
the universe, merging with nirvana, experiencing unity with
the saints, identifying with the trees and flowers or a oneness
with GOD.
intense feelings of well being and heightened self-
awareness.
 Normal people
 People with personality disorder
 Epilepsy (during aura)

55. REFERENCES
1. Sim’s Symptoms in the Mind, Textbook of Descriptive
Psychopathology
2. Fish’s Clinical Psychopathology
3. Sigmund Freud’s The Unconscious Mind
4. Jung’s Theory of Self
5. Descartes’ Dualism
6. Joseph Selbie’s The Physics Of God
7. Textbook Of Clinical Neuroanatomy
THANK
YOU!