Kanemoto Kousuke
Department of Neuropsychiatry, Aichi Medical University.
Seishin Shinkeigaku Zasshi. 2004;106(9):1083-109.
For decades, psychiatrists have considered that concepts of impaired consciousness in the study of psychiatry were inconsistent with those applied in the field of neurology, in which the usefulness of the concept of consciousness has long been seriously doubted. Gloor concluded that the concept of consciousness does not further the understanding of seizure mechanisms or brain function, which is the current representative opinion of most epileptologists. Loss of consciousness tends to be reduced to aggregates of individual impairments of higher cognitive functions, and the concept of consciousness is preferably avoided by neurologists by assigning various behavioral disturbances during disturbed consciousness to particular neuropsychological centers. In contrast, psychiatrists, especially those in Europe, are more likely to include phenomena involving problems related to phenomenological intentionality in impaired consciousness. For the present study, we first divided consciousness into vigilance and recursive consciousness, and then attempted to determine what kind of impaired consciousness would be an ideal candidate to represent pure disturbance of recursive consciousness. Then, 4 patients, 1 each with pure amnestic states followed immediately by complex partial seizures, an akinetic mutistic state caused by absence status, and mental diplopia as a manifestation of postictal psychosis, as well as a patient with Alzheimer's disease who gracefully performed Japanese tea ceremony, were studied. Based on our findings, we concluded that impaired consciousness as a generic term in general medicine does not indicate any unitary entity corresponding to some well-demarcated physiological function or constitute a base from which recursive consciousness emerges as a superstructure. From that, we stressed that a pure form of impairment of recursive consciousness could occur without the impaired consciousness named generically in general medicine. Second, following observation of an additional 3 cases, descriptions of naissance of the first word (taken from the autobiography of Helen Keller), visual object agnosia, and chronic schizophrenia with schizophasia were discussed to examine the relationship between impairments of recursive consciousness and semantic generation dysfunction. Attempts to bridge semantic generation and recursive consciousness, performed by psychopathologists such as Bin Kimura and Hiroyuki Koide, were also briefly discussed. In light of these case presentations and related discussions, we re-examined traditional theories of impaired consciousness, including Mayer-Gross's Gestalt theory, later replaced by Conrad and Henri Ey's theory related to intentionality. Furthermore, we attempted to link Denett's theory of consciousness to those traditional theories as well as to our own postulations, and neuropsychological data such as those of implicit memory and blindsight. Finally, the significance of Freud's unconsciousness in the framework of neuroscience was discussed.
几十年来，精神病学家一直认为，精神病学研究中意识受损的概念与神经病学领域所应用的概念不一致，而在神经病学领域，意识概念的实用性长期以来一直受到严重质疑。格洛尔得出结论，意识概念无助于对癫痫发作机制或脑功能的理解，这是目前大多数癫痫学家的代表性观点。意识丧失往往被简化为高级认知功能的个体损伤的总和，神经病学家倾向于通过将意识障碍期间的各种行为障碍归因于特定的神经心理中心来避免使用意识概念。相比之下，精神病学家，尤其是欧洲的精神病学家，更有可能将涉及现象学意向性问题的现象纳入意识受损的范畴。在本研究中，我们首先将意识分为警觉和递归意识，然后试图确定哪种意识受损状态是代表递归意识纯粹障碍的理想候选者。然后，对4名患者进行了研究，其中1名患者先是处于单纯遗忘状态，随后立即出现复杂部分性发作，1名患者因失神状态导致运动不能性缄默状态，1名患者以发作后精神病的表现形式出现精神性复视，还有1名患有阿尔茨海默病的患者优雅地进行日本茶道仪式。基于我们的研究结果，我们得出结论，作为普通医学中的一个通用术语，意识受损并不表明存在任何与某些界限分明的生理功能相对应的单一实体，也不构成递归意识作为上层建筑从中产生的基础。由此，我们强调，在普通医学中被笼统称为意识受损的情况下，可能会出现递归意识受损的纯粹形式。其次，在观察另外3个病例后，讨论了首词产生（取自海伦·凯勒的自传）、视觉物体失认症以及伴有言语紊乱的慢性精神分裂症的描述，以研究递归意识受损与语义产生功能障碍之间的关系。还简要讨论了精神病学家如木村斌和小出裕之等为弥合语义产生与递归意识之间的差距所做的尝试。鉴于这些病例展示和相关讨论，我们重新审视了意识受损的传统理论，包括后来被康拉德和亨利·埃伊的意向性理论所取代的迈耶 - 格罗斯的格式塔理论。此外，我们试图将丹尼特的意识理论与那些传统理论以及我们自己的假设联系起来，以及与诸如内隐记忆和盲视等神经心理学数据联系起来。最后，讨论了弗洛伊德的无意识在神经科学框架中的意义。
