This article concludes the series about the main components of the mind. We have already discussed sensations, perceptions, attention, memory, thinking, needs, and emotions. The final piece of the puzzle that unites all these parts is consciousness or awareness.
Let’s begin with the definition. Consciousness is the ability to reflect both external and internal experiences. Just as a mirror reflects everything in front of it, consciousness reflects processes happening in your mind — such as your memories, thoughts, and emotions — or external processes, like events, objects, sounds, and so on. Importantly, consciousness is not affected by what is reflected in it, just as the mirror itself is not changed by the objects it reflects.
Another useful analogy to describe consciousness is light. Imagine you are in complete darkness. When you turn on a light, you begin to see things. Consciousness is like the light from your lightbulb; it enables you to perceive things. When the light of your consciousness is projected externally, you perceive objects in the external world. When it is projected internally, you perceive objects within your mind — such as your thoughts, memories, emotions, etc. Being aware of external or internal objects allows you to act upon them and adjust your behaviour accordingly.
The pathology of consciousness can be divided into two large groups: consciousness can either shut down or become obscured.
Shutting down of consciousness is called a coma. Imagine that the light in your room grows dimmer and dimmer until it completely disappears. A complete absence of consciousness (darkness) is coma. The development of a coma due to severe brain damage (such as stroke, intoxication, head injury, and others) typically has at least three stages:
1. Stunned consciousness: At this stage, a person becomes passive and sleepy. Reactions slow down, and answers to questions are delayed, but it is still possible to communicate with the person.
2. Sopor, sometimes referred to as stupor: This state resembles sleep, but unlike normal sleep, it is impossible to wake the person. Only strong stimulation, such as pain, may cause undifferentiated responses like groaning or retracting the limb to which pain was inflicted. Unconditional reflexes, such as pupil constriction in response to bright light, are still preserved at this stage.
3. Coma: In this state, the eyes are closed, and the person is completely unresponsive, even to strong stimuli like pain. Unconditional reflexes are absent.
Depending on the severity of the brain damage, a coma can last from several hours to several months or even years, but typically no more than 4 weeks. After this period, patients begin to gradually regain consciousness, although they may never fully recover.
Obscured consciousness does not involve a complete loss of consciousness but instead narrows its scope, causing reality to be reflected in a partial and inconsistent way. Again, let’s use the light analogy. Imagine you are sitting in your room. Full consciousness is like the illumination of your room by lightbulbs in the ceiling, making you aware of everything in your room. Coma - is complete absence of light, complete darkness. Obscured consciousness is like a small flashlight; the beam from that flashlight can illuminate some parts of the room, so you are not aware of other parts that are outside of the scope.
There are several types of obscured consciousness. The first is called amentia. Amentia, or an amentive state, is a condition observed in individuals recovering from a coma. The amentive state consists of a vegetative state, a minimally conscious state, and a confusional state of consciousness.
• In the vegetative state, a sleep-wake cycle returns with periods of eye opening and closing. The patient may react to loud sounds with a startle, but they cannot communicate, follow instructions, or make purposeful movements.
• In the minimally conscious state, patients may track moving objects with their eyes, follow simple instructions, respond with yes or no gestures or words, make automatic movements like scratching their head, or attempt to reach for objects. People in this state may do one or more of these things, but not consistently.
• After improvement from this state, individuals usually enter the confusional state. Some people may skip the vegetative and minimally conscious states and transition directly from a coma to a confusional state. In the confusional state, individuals are disoriented in time and place. Their speech and thinking are incoherent, making communication difficult. They may become restless and experience hallucinations. Once the confusional state ends, their cognitive functions gradually improve, and they begin to orient themselves to time, place, and daily experiences again. However, recovery of cognitive function may be slow, and some individuals may never regain their previous level of functioning.
Another type of obscured consciousness is delirium. Delirium can be caused by the same factors as coma — such as injury, intoxication, or impaired blood flow to the brain. Delirium is similar to the confusional state in that patients are disoriented in time and place and do not understand where they are. However, in delirium, cognitive functions like attention and speech are less impaired, although communication is still difficult. In this state, because the beam of consciousness is narrow and illuminates only a small part of patient’s reality, you and your questions may fall outside the focus. Delirium is also characterized by intense visual hallucinations, which may frighten the patient so much that they may hurt themselves or others in an attempt to defend or escape. Delirium can last from several hours to several days, with a maximum duration of about a week. After it ends, patients usually do not remember the events during this altered state of consciousness.
Another type of obscured consciousness is the twilight state. This disorder is common in people with epilepsy and traumatic brain injury. Unlike amentia and delirium, which develop gradually, the twilight state develops suddenly and lasts only a few minutes before ending abruptly. Similar to amentia and delirium, the twilight state does not involve a complete loss of consciousness. Instead, it narrows the scope of consciousness for a short period. During this time, individuals may be unresponsive to communication because the person trying to communicate is outside the beam of consciousness. Other than that, their behaviour may seem unremarkable, but sometimes it can be inappropriate for the social context. For example, if a twilight state of consciousness happens during a business meeting, the person may suddenly stop their presentation and leave the room. When their consciousness returns to its full range, they may not remember why or how they left.
Finally, there is another type of obscured state of consciousness called oneiroid. Oneiroid syndrome is usually observed in patients with schizophrenia. It is characterized by vivid, dream-like pseudohallucinations, as well as a double-awareness of oneself and reality. For example, a patient may be aware that they are in the hospital, but at the same time, they may perceive themselves as a participant in a fantastical narrative. Real individuals around the patient may also be part of the same narrative. The behaviour of a patient in the oneiroid state sharply contrasts with their fantastical pseudohallucinatory experiences. Patients may lie motionless in bed with their eyes closed, or wander around, withdrawn into themselves, as they watch their fantastical adventures as if from the outside. It is like watching and being part of a fantastical movie inside their mind. At times, they can directly report their experiences. At the height of the oneiroid state, patients may develop catalepsy, which involves immobility, rigidity of muscles, and limbs staying in the same position when moved by someone else, with no response to external stimuli or speech.
The disorders of consciousness described above are seen in severe mental and neurological disorders. However, it is important to understand that consciousness, like any other mental function, is a continuum. It has a normal range, with fluctuations in the levels of consciousness. For example, we may be less aware of our surroundings when we become absorbed in daydreaming, or less aware of our emotions and thoughts during an argument. We may become more conscious of our emotions during a psychotherapy session or more aware of our thoughts when meditating. People also differ in their ability to project their consciousness inwardly or outwardly, like extraverts and introverts.
But without a doubt, more consciousness is always better, especially for those struggling with emotional disorders. Why? Because consciousness is a light illuminating your mind. With more light, you can see things more clearly. This may help you understand yourself better, identify the causes of anxiety or depression, and make necessary changes. This is why meditation and mindfulness are so useful in managing emotional disorders.
This is the final article in the series on general psychopathology. If you have read all the previous sections, you now have a general understanding of the main components of the mind. You also understand how these components may become impaired. Next articles will focus on specific disorders and how to manage them.