A kind of twilight state of consciousness is pseudodementia. It can occur with severe destructive changes in the central nervous system and in reactive conditions and is characterized by acute onset disorders of judgment, intellectual-mnestic disorders. Patients forget the names of objects, they are disoriented, they can hardly perceive external stimuli. The formation of new connections is difficult, at times it is possible to note illusory deceptions of perception, unstable hallucinations with motor anxiety.
Patients are apathetic, benign, emotional displays are scarce, undifferentiated. Behavior often reminiscent of deliberately childish. So, an adult patient with a question as to how many fingers he has on his feet, takes off socks to count them.
We stopped only on some forms of impaired consciousness. In fact, their manifestations in the clinic are much more diverse, but it was important for us to acquaint the reader with those concepts in which the disturbances of consciousness are interpreted and described in the clinic.
Along with the various forms of impairment of consciousness as a reflection of the surrounding reality, a peculiar form of self-discovery disorder - depersonalization - occurs in the clinic.
It is characterized by a sense of alienation of one's own thoughts, affects, actions, his "I", which are perceived as if from the outside. A frequent manifestation of depersonalization is the violation of the "body scheme" - violation of the reflection in the mind of the basic qualities and ways of functioning of one's own body, one hundred separate parts and organs. Similar disorders, called "dysmorphobia", can occur with various diseases - epilepsy, schizophrenia, after craniocerebral trauma, etc.
The syndrome of dysmorphobia is described in detail by many psychiatrists, beginning with the work of the Italian psychiatrist Morzeli ( Morseli , 1836-1894). Patients with a similar syndrome believe that they have an "ugly nose, protruding ears, they smell bad". Patients tend to take measures to eliminate the "disturbing shortage", insist on surgery, they stand for hours in front of the mirror (mirror symptom), constantly look at themselves.This syndrome is described in detail by MV Korkina  who writes that this syndrome can be regarded as a triad consisting of: a) the idea of a physical defect with an active desire to get rid of it; b) ideas of relationships and c) low mood.
The expressed, obsessive or delirious desire of patients to correct an imaginary deficiency gave the author grounds to speak of dysmorphomania. It is not a question of the discrepancy between the meaningful reflection of the ideal notion of the external appearance of the "I" and the present, but about the rejection of oneself, i.e. about unconscious dislike.
In psychology, the problem is the "image-I" was considered within the framework of the problem of self-consciousness even beginning with W. Wundt and A. Pfender, who identified the concept of "I" and the concept of subject & quot ;. In another aspect, this problem is posed by W. James (1911), who distinguished the empirical "I" (the psychic world of the subject, which is supplemented by self-esteem) and the pure I (thinking man). Problem image-I was the subject of analysis of various psychological schools of Freudianism and neo-Freudianism, understanding, humanistic psychology, etc.
In domestic psychology, this problem already comes from L. Groth, IM Sechenov, who linked the problem of "I" with "warm feelings", interopia. The dependence of the physical image of "I" was shown; from many points, especially self-esteem, evaluation of others (IS Kon, AA Bodalev, SL Rubinshtein, etc.). SL Rubinshtein directly pointed out that the problem of studying the person "comes to the end with the disclosure of the self-consciousness of the person" [158, 676-677]. A number of works are devoted to changing the "image-I" in the mentally ill (R. Federi, S. Fisher, and others). A lot of research is devoted to the study of the violation of the "I" in patients with schizophrenia (Vekovich, Sommer).
In the work of B. V. Nichiporov, devoted to this problem, it is shown that the syndrome of dysmorphophobia is associated with low self-esteem. Such patients avoid society, retire, often experiencing their imaginary ugliness so much that it can cause suicidal attempts. At the same time, their self-esteem is not based on the richness of the concept of the ideal image of the external "I", but on the rejection of their physical "I".
The most general answer to the question about the nature of this phenomenon is found in IM Sechenov , who emphasized the role of muscular sensations in the realization of body movements and perception acts, pointed to the existence of "dark", undivided feelings emanating from internal organs creating a "sensual lining" our I and serving as the basis of self-perception.
Dark & quot; interoceptive sensations due to their constancy and monotony, as well as induction inhibition in connection with the orientation of the subject's activity outside are usually not recognized, but are a necessary background for the normal course of all mental activity. On the basis of these sensations, the child, in the process of development, learns to distinguish himself from the surrounding world.
And. M. Sechenov argued that the synthesis of sensations emanating from the internal senses and the so-called external sense organs is the core of the formation of self-consciousness: "Man continually receives impressions from his own body. Some of them are perceived in the usual ways (their own voice is by hearing, body forms by the eye and touch), while others are, so to speak, from within the body and are in the mind in the form of very vague dark feelings. Sensations of the latter kind are the satellites of the processes occurring in all the main anatomical systems of the body (hunger, thirst, etc.), and are rightly called systemic feelings. A person can not have, in fact, any objective sensation to which the systemic feeling would not be mixed in one form or another ... The first half of feelings has, as they say, an objective character, and the second is purely subjective. The first correspond to the objects of the external world, the second - sensory states of one's own body, self-perception [171, 582-583].
Normally, a person is not required to prove that his body belongs to his person and psychic experiences. In some pathological cases, this sensual lining self-awareness is violated, and as a direct knowledge there can be a feeling of alienation, of imposing, of suggesting one's own thoughts, feelings, actions.
The modern researcher of the problem of depersonalization AA Mehrabyan , showing the inconsistency of the explanation of this psychopathological phenomenon from the position of associationism, phenomenological direction, anthropological psychology, psychoanalysis, connects it with the disorder of special "gnostic feelings" - system automated feelings, merged in a normal state with a reflective component of mental images.
Gnostic feelings, according to A. A. Mehrabian , exhibit the following properties:
1) generalize previous knowledge about the subject and word in a concrete-sensory form;
2) provide a sense of belonging to mental processes to our "I";
3) include the emotional tone of a particular color and intensity.
The role of gnostic feelings in cognition and self-knowledge becomes especially noticeable in cases of pathology that engenders the phenomena of mental alienation [130; 131].
Violation of gnostic feelings can lead not only to self-knowledge disorder, but also to personal changes. This is convincingly shown by VI Belozertseva . On the material of the works of the school of Bekhterev, the author showed how the altered self-awareness in the course of the reflective activity of the diseased brain generates a new activity for the subject-the activity of self-perception. This activity in connection with the persistence of unusual feelings and their special significance for a person becomes meaningful, leading in the hierarchy of other activities. Patients throw their previous affairs and can not think of anything, except their own unusual conditions and the reasons for their occurrence.
A lot of history given in the works Bekhterev and his staff, illustrate how the desire to interpret the results of a distorted self-image patients leads to delusional interpretation of his condition. In search of the enemies patients observe surrounding behavior analyzing relationships with them, perform real actions to release from the alleged hypnotic impact and again analyze their state and the behavior of the "enemies".
In the course of this activity and real relationships with people, delusions of influence on the psychic sphere are acquired with new and new details, distorting the perception of the environment and influencing the behavior and lifestyle of patients, rebuilding the system of their relationships with people, changing their personality.>
Q. I. Belozertseva concludes that if a healthy sense of self is not related to his personal characteristics and realize themselves in social relations system, the patient can push it to the forefront of the activities did not exist before, or merely acts as a separate action in the system other activities, the activity of self-perception. Regardless of the person (whether that person wants it or not), it becomes meaningful. There is a shift of the main motif of the target is broken characteristic for a healthy subject otvyazannost hierarchy of activities from the state of the organism. Biological in the case of pathology begins to play a different role than in the life of a healthy person.
This, of course, does not mean that the disease itself as a biological factor determines the restructuring of the hierarchy of motives and self-awareness. The motive for the activity of self-perception is generated by the awareness of the unusual, the change in the sensations of one's own mental experiences, and the active attitude towards them. Consequently, the disease acts destructively on the person not directly, but indirectly, through the activity acquired in the course of a person's social development.
We brought these clinical data to show that the pathological change in the psyche, its self-consciousness is realized, like normal development, in ontogenesis, in the practical activity of the subject, in the restructuring of his real relationships - in this case, under the influence of the delirious self-perceptions interpretation of his state affecting the place of a person among other people.
Thus, I. I. Chesnokova writes that the material of clinical observations of self-consciousness disorders, expressed mainly in the depersonalization syndrome, is the actual justification of the theoretical statements about self-awareness as the central "forming" personality, connecting together its individual manifestations and features.
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