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Conference Probes Pathology of Self-Awareness: Page 2 of 3

Conference Probes Pathology of Self-Awareness: Page 2 of 3

This is a fairly high-order function, Beitman added, and patients suffering from a number of mental illnesses tend to have difficulties in one or several of these areas. Over the two days of the conference, psychiatrists and other mental health care practitioners learned how much deficits in self-awareness--and their own perceptions of those deficits--could affect outcomes for patients.

"I'm hoping that you come away with some ideas that maybe we don't see ourselves, because this is new territory," Beitman told his colleagues. "I know of no other conference that has made an emphasis on the study of self-awareness through deficits to this degree."

The absence of an accepted definition of self-awareness that could encompass all of its elements led to its representation in the form of the simple question posed at the beginning of the conference, said Jyotsna Nair, M.D., a speaker at the conference and assistant professor of psychiatry at the University of Missouri, Columbia, Health Sciences Center. "Self-awareness depends on a person developing more than just a concept of self, but also requires memory, language, awareness of body and the ability to form some sort of presentation of yourself," she told the attendees. "The concept of self is an evolving process that changes. It changes every day, every moment, even into old age."

Those changes are also reflected in the physiological realm, as people's brain activity shifts in response to perceptions of their environment, according to George I. Viamontes, M.D., Ph.D., a psychiatrist, cell biologist and regional medical director of United Behavioral Health in St. Louis. During a high-tech presentation that included computer-generated, animated simulations of brain functions and reactions, Viamontes showed attendees that the neurocircuitry of self-awareness could be understood by examining it from four different perspectives: evolution, neurobiology, development and states of dysfunction.

While Viamontes described the self as a "collection of tendencies, principles and capabilities that emerge as we organize around different challenges," he also spoke of it metaphorically, calling the brain circuitry that implements self-awareness a beautiful piece of work that is "integrated with such great efficiency--even though in truth it's a patchwork quilt of many components--that it appears to us to be totally seamless."

For instance, activity in the amygdala--bilateral, almond-shaped structures in the brain's temporal lobes--functions to integrate our emotional experiences into our vision of self. Levels of neurotransmitters such as norephinephrine, serotonin and dopamine play a significant role, too. We also have significant cortical development, an evolutionary contribution that's not essential for life, Viamontes said, but that we need to do the things we consider to be absolutely human.

Practitioners who attribute patients' negative responses to treatment to psychological or temperamental factors, therefore, may be missing an important biological component. "Some of these states of illness are simply that some areas in the brain are damaged, missing or not fully functional; and so the ability of a patient to organize around complex principles is limited," Viamontes told PT. "They can only function at a lower level of organization."

When it is a brain-based inability to be self-aware of an illness that results in noncompliance, "the job of the clinician is to help the patient organize at a higher level," Viamontes said. "You do it within the capabilities of the patient. You may not refute the patient's persistent paranoia, but you may be able to somehow get him to function by reorganizing how they react to this paranoia."


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