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Self-Awareness Deficits in Psychiatric PatientsReview - Self-Awareness Deficits in Psychiatric Patients
Assessment and Treatment
by Bernard D. Beitman and Jyotsna Nair (Editors)
W. W. Norton, 2005
Review by Ulrich Mühe
Aug 15th 2006 (Volume 10, Issue 33)

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.


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