What do you think, I think, of you?
The seemingly simple question was splayed in huge black type across two giant video screens in a darkened room at a conference in Kansas City, Mo. More than 100 psychiatrists were gathered there because many of their patients are unable to find an answer to that question, and their lack of self-awareness may lie at the heart of the treatment-resistance of their conditions.
"We're trying to understand how mind and brain work together," said Bernard D. Beitman, M.D., chair of the psychiatry department at the University of Missouri, Columbia, Health Sciences Center, and organizer of the March conference titled Disorders of Self-Awareness. "We are approaching a remarkable subject and a difficult subject," he told attendees.
The inability of patients with schizophrenia, autism, personality disorders, attention-deficit/hyperactivity disorder, hysteria and substance abuse disorders to fathom their impact on the people who surround them or to recognize that their thoughts fail to conform to the realities of their lives has a negative impact on the course of treatment and decreases the likelihood that any intervention will achieve improved functioning. While psychiatrists have known for a long time that denial or lack of insight can undermine treatment, this conference sought to focus on deficits in self-awareness as pathology.
"What's unique here is that there's never been a conference that has tried to examine pathological functions to figure out what is normal functioning or normal self-awareness," Beitman said in an interview with Psychiatric Times. What may be perceived as a temperamental rejection of care or a psychologically based denial of illness may be a biologically based element of the illness itself. This possibility could have an enormous impact on treatment regimens and the way they are implemented by practitioners.
"We're still struggling with definitions," Beitman said. "We are going to be asking what is self-awareness and what are the brain structures that support our ability to be aware of ourselves. We're going to try to understand normal functioning by looking at pathological functioning, by looking at disorders of self-awareness."
"What do you think, I think, of you," summarizes the basic question involved with self-awareness, Beitman told the attendees. "It requires my ability to construct your theory of me. So that I can help me, I have to know how you think, and I have to know the subset of how you think that includes me."