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Self-awareness is the capacity for introspection and the ability to recognize oneself as an individual separate from the environment and other individuals.
An early philosophical discussion of self-awareness is that of John Locke. Locke was apparently influenced by René Descartes' statement normally translated 'I think, therefore I am' (Cogito ergo sum). In chapter XXVII "On Identity and Diversity" of Locke's An Essay Concerning Human Understanding (1689) he conceptualized consciousness as the repeated self-identification of oneself, through which moral responsibility could be attributed to the subject—and therefore punishment and guiltiness justified, as critics such as Nietzsche would point out, affirming "...the psychology of conscience is not 'the voice of God in man'; it is the instinct of cruelty ... expressed, for the first time, as one of the oldest and most indispensable elements in the foundation of culture." John Locke does not use the terms self-awareness or self-consciousness though.
According to Locke, personal identity (the self) "depends on consciousness, not on substance" nor on the soul. We are the same person to the extent that we are conscious of our past and future thoughts and actions in the same way as we are conscious of our present thoughts and actions. If consciousness is this "thought" which doubles all thoughts, then personal identity is only founded on the repeated act of consciousness: "This may show us wherein personal identity consists: not in the identity of substance, but ... in the identity of consciousness." For example, one may claim to be a reincarnation of Plato, therefore having the same soul. However, one would be the same person as Plato only if one had the same consciousness of Plato's thoughts and actions that he himself did. Therefore, self-identity is not based on the soul. One soul may have various personalities.
Self-identity is not founded either on the body or the substance, argues Locke, as the substance may change while the person remains the same: "animal identity is preserved in identity of life, and not of substance", as the body of the animal grows and changes during its life. Take for example a prince's soul which enters the body of a cobbler: to all exterior eyes, the cobbler would remain a cobbler. But to the prince himself, the cobbler would be himself, as he would be conscious of the prince's thoughts and acts, and not of the cobbler's life. A prince's consciousness in a cobbler body: thus the cobbler is, in fact, a prince. But this interesting border-case leads to this problematic thought that since personal identity is based on consciousness, and that only oneself can be aware of his consciousness, exterior human judges may never know if they really are judging—and punishing—the same person, or simply the same body. In other words, Locke argues that you may be judged only for the acts of your body, as this is what is apparent to all but God; however, you are in truth only responsible for the acts for which you are conscious. This forms the basis of the insanity defense: one can't be held accountable for acts in which one was unconsciously irrational, mentally ill—and therefore leads to interesting philosophical questions:
[...] personal identity consists [not in the identity of substance] but in the identity of consciousness, wherein if Socrates and the present mayor of Queenborough agree, they are the same person: if the same Socrates waking and sleeping do not partake of the same consciousness, Socrates waking and sleeping is not the same person. And to punish Socrates waking for what sleeping Socrates thought, and waking Socrates was never conscious of, would be no more right, than to punish one twin for what his brother-twin did, whereof he knew nothing, because their outsides were so like, that they could not be distinguished; for such twins have been seen.
PERSON, as I take it, is the name for this self. Wherever a man finds what he calls himself, there, I think, another may say is the same person. It is a forensic term, appropriating actions and their merit; and so belong only to intelligent agents, capable of a law, and happiness, and misery. This personality extends itself beyond present existence to what is past, only by consciousness, --whereby it becomes concerned and accountable; owns and imputes to itself past actions, just upon the same ground and for the same reason as it does the present. All which is founded in a concern for happiness, the unavoidable concomitant of consciousness; that which is conscious of pleasure and pain, desiring that that self that is conscious should be happy. And therefore whatever past actions it cannot reconcile or APPROPRIATE to that present self by consciousness, it can be no more concerned in it than if they had never been done: and to receive pleasure or pain, i.e. reward or punishment, on the account of any such action, is all one as to be made happy or miserable in its first being, without any demerit at all. For, supposing a MAN punished now for what he had done in another life, whereof he could be made to have no consciousness at all, what difference is there between that punishment and being CREATED miserable? And therefore, conformable to this, the apostle tells us, that, at the great day, when every one shall "receive according to his doings, the secrets of all hearts shall be laid open". The sentence shall be justified by the consciousness all person shall have, that THEY THEMSELVES, in what bodies soever they appear, or what substances soever that consciousness adheres to, are the SAME that committed those actions, and deserve that punishment for them.
There is an ongoing debate as to whether animals have consciousness or not; but in this article the question is to whether animals have self-awareness? Like humans’ minds and brains, animals’ minds and brains are concealed and subjective also. When an individual can identify, process, store information about the self, and has knowledge of one’s own mental states they are defined to have self-awareness. Knowing that an individual stays the same individual across time and is separate from the others’ and the environment is also a factor of having self-awareness. Gordon Gallup, a professor of psychology at the State University of New York in Albany says that “self-awareness provides the ability to contemplate the past, to project into the future, and to speculate on what others are thinking”. Studies have been done mainly on primates to test if self-awareness is present. Apes, chimpanzees, monkeys, elephants, and dolphins are studied most frequently. The most relevant studies to this day that represent self-awareness in animals have been done on chimpanzees, dolphins, and magpies.
The ‘Red Spot Technique’ created and experimented by Gordon Gallup studies self-awareness in animals (primates). In this technique, a red odorless spot is placed on an anesthetized primate’s forehead. The spot is placed on the forehead so that it can only be seen through a mirror. Once the individual awakens, independent movements toward the spot after seeing their reflection in a mirror are observed. During the Red Spot Technique, after looking in the mirror, chimpanzees used their fingers to touch the red dot that was on their forehead and even after touching the red dot they would smell their fingertips. "Animals that can recognize themselves in mirrors can conceive of themselves," says Gallup. This would mean that the chimpanzees would possess self-awareness. Note that the chimpanzees have had experience with a mirror before the ‘Red Spot Technique’ was performed. Having experience with a mirror before the technique was performed reflects the past, independent movement while looking in the mirror would reflect the present, and touching the red dot would reflect what others’ are thinking which relates perfectly to Gallup’s statement in the beginning of this article. Chimpanzees, the most studied species, compare the most to humans with the most convincing findings and straightforward evidence in the relativity of self-awareness in animals so far.
Dolphins were put to a similar test and achieved the same results. Diana Reiss, a psycho-biologist at the New York Aquarium discovered that bottlenose dolphins can recognize themselves in mirrors. In her experiment, Reiss and her colleagues drew with temporary black ink on some of the dolphins in the aquarium on parts of their bodies that they could only see in a mirror. A gigantic mirror was placed inside the dolphins’ tank. The dolphins who did not get drawn on ignored the mirror, but the dolphins who did get drawn on “made a bee-line to see where they’d been marked” according to Reiss. After the experiment the dolphins that have been drawn on once, returned to the mirror to inspect themselves even when they were ‘drawn’ on again but with clear water. The dolphins recognized the feeling and remembered the action from when they were drawn on which relates to a factor of self-awareness.
Magpies are a part of the crow family species. Recently, similar to the Red Spot Technique, researchers studied magpie’s self-awareness by using the Mark Test. In this study, Prior and Colleagues performed eight sessions per magpie (5) tested twice, using two different colors; yellow and red. The bird was marked with either yellow or red, or a black imitation mark (the black mark is an imitation because magpies are black in feather color). The magpies were tested with a mirror and a colored mark, a mirror and a black mark, no mirror and a colored mark, and no mirror and a black mark. The sessions were twenty minutes long each, and each color (red or yellow) was used once. The black (imitation) mark experiment that is put on the Magpies is comparative to the Dolphins in Reiss’s study when they were ‘drawn’ on with clear water. The imitation marks (and being drawn on with clear water), if recognized shows that no anesthesia is needed and the remembrance of the action does represent self-awareness. The differences between the Red Spot Technique and Reiss’s Dolphin study compared to the Mark Test are that in the Red Spot Technique the primates are anesthetized and have prior experiences with a mirror where in the Mark test, the magpies were not anesthetized nor experienced with a mirror.
Majority of birds are blind to the area below the beak near the throat region due to it being out of their visual field; this is where the color marks were placed during the Mark Test, alternating from yellow to red. In the Mark Test, a mirror was presented with the reflective side facing the magpie being the only interpretation of the bird seeing the marked spot they had on them. During one trial with a mirror and a mark, three out of the five magpies showed a minimum of one example of self-directed behavior. The magpies explored the mirror by moving toward it and looking behind it. One of the magpies, Harvey, during several trials would pick up objects, posed, did some wing-flapping, all in front of the mirror with the objects in his beak. This represents a sense of self-awareness; knowing what is going on within himself and in the present. In all of the trials with the mirror and the marks, never did the birds peck at the reflection of the mark in the actual mirror. All of the behaviors were towards their own body but only heightened when there was a mirror present and the mark was of color. Behavior towards their own bodies concluded in the trials when the bird removed the mark. For example, Gerti and Goldie, two of the magpies being studied, removed their marks after a few minutes in their trials with a colored mark and a mirror. After the mark was removed, there were no more behaviors toward their own bodies.
A few slight occurrences of behavior towards the magpies own body happened in the trial with the black mark and the mirror. It is an assumption in this study that the black mark may have been slightly visible on the black feathers. Prior and Colleagues, stated “This is an indirect support for the interpretation that the behavior towards the mark region was elicited by seeing the own body in the mirror in conjunction with an unusual spot on the body.”
The behaviors of the magpies clearly contrasted with no mirror present. In the no-mirror trials, a non-reflective gray plate of the same size and in the same position as the mirror was swapped in. There were not any mark directed self-behaviors when the mark was present, in color, or in black. Prior and Colleagues, data quantitatively matches the findings in chimpanzees. In summary of The Mark Test, the results show that magpies understand that a mirror image represents their own body; magpies show to have self-awareness.
In conclusion, the fact that primates and magpies spot the markings on them and examine themselves better means, according to theory, that they are seeing themselves which means they are self-aware. According to the definition stated earlier in this section, if an individual can process, identify, store information (memory), and recognize differences, they are self-aware. The chimpanzees, dolphins, and magpies have all demonstrated these factors in the mentioned experiments.
V.S. Ramachandran has speculated that mirror neurons may provide the neurological basis of human self-awareness. In an essay written for the Edge Foundation in 2009 Ramachandran gave the following explanation of his theory: "... I also speculated that these neurons can not only help simulate other people's behavior but can be turned 'inward'—as it were—to create second-order representations or meta-representations of your own earlier brain processes. This could be the neural basis of introspection, and of the reciprocity of self awareness and other awareness. There is obviously a chicken-or-egg question here as to which evolved first, but... The main point is that the two co-evolved, mutually enriching each other to create the mature representation of self that characterizes modern humans".
Self-awareness has been called "arguably the most fundamental issue in psychology, from both a developmental and an evolutionary perspective".
In psychology, the concept of "self-awareness" is used in different ways:
Individuals become conscious of themselves through the development of self-awareness. This particular type of self-development pertains to becoming conscious of one's own body and mental state of mind including thoughts, actions, ideas, feelings and interactions with others. “Self-awareness does not occur suddenly through one particular behavior it develops gradually through a succession of different behaviors all of which relate to the self." It is developed through an early sense of non-self components using sensory and memory sources. In developing self –awareness through self-exploration and social experiences one can broaden their social world and become more familiar with the self.
Several ideas in the development of self-awareness have been researched. In babies self-awareness occurs in a predicted stages. Ulric Neisser (1988 cited in) states that self-awareness is built upon different resources of information including ecological, interpersonal, extended, private, and conceptual aspects of self. The ecological self is seen in early infancy it is the self in relation to the surrounding environment. It is considered low level self-awareness based on only being aware of your surrounding space. Interpersonal self also emerges in early infancy. It supports the theory of unresponsive interpersonal interaction with the environment for instance a baby cooing. Even though the social world is not responding the infant is able to discover more about themselves. This leads to the extended self where one is able to reflect on itself generating thoughts of past and future. The private self pertains to internal thoughts, feelings, and intentions. Finally, the concept of self (Ulric's theory of self-concept) is the beliefs that we hold based on representations of human nature and the self. This level of self is essential because it enables and individual to portray who they are.
According to Emory University’s Phileppe Rochat, there are five levels of self-awareness which unfold in early development and six potential prospects ranging from "Level 0" (having no self-awareness) advancing complexity to "Level 5" (explicit self-awareness).
Related to research stated above by the time an average toddler reaches 18 months they will discover themselves and recognize their own reflection in the mirror. By the age of 24 months the toddler will observe and relate their own actions to those actions of other people and the surrounding environment. As infants grow to familiarize themselves with their surround environment and a child will provide a self-description in terms of action and later in terms of qualities and traits of their environment.
Around school age a child’s awareness of personal memory transitions into a sense of ones own self. At this stage, a child begins to develop interests along with likes and dislikes. This transition enables the awareness of an individual’s past, present, and future to grow as conscious experiences are remembered more often. School age children begin to separate.
As a child’s self-awareness increases they tend to separate and become their own person. Their cognitive and social development allows “the taking of another's perspective and the accepting of inconsistencies.” By adolescence, a coherent and integrated self-perception normally emerges. This very personal emerging perspective continues to direct and advance an individual’s self-awareness throughout their adult life.
“A further and deeper development in self-awareness allows a person to become increasingly wise and coherent in the understanding of self.” The increase in awareness can ultimately lead to high levels of consciousness. This has been supported through research on enhanced self-actualization, increased attention in association with expanding ones self-concept, and a higher level of internal control and maintenance of self during stressful conditions.
Self-Awareness Theory, developed by Duval and Wicklund in their 1972 landmark book A theory of objective self awareness, states that when we focus our attention on ourselves, we evaluate and compare our current behavior to our internal standards and values. We become self-conscious as objective evaluators of ourselves. However self-awareness is not to be confused with self-consciousness. Various emotional states are intensified by self-awareness. However, some people may seek to increase their self-awareness through these outlets. People are more likely to align their behavior with their standards when made self-aware. People will be negatively affected if they don't live up to their personal standards. Various environmental cues and situations induce awareness of the self, such as mirrors, an audience, or being videotaped or recorded. These cues also increase accuracy of personal memory. In Demetriou's theory, one of the neo-Piagetian theories of cognitive development, self-awareness develops systematically from birth through the life span and it is a major factor for the development of general inferential processes. Moreover, a series of recent studies showed that self-awareness about cognitive processes participates in general intelligence on a par with processing efficiency functions, such as working memory, processing speed, and reasoning.
Before going into self-awareness in adolescents there are a few terms that must be stated that fit and help you to really understand just what self-awareness is. There are self-esteem, self -concept and self representation. Let’s start with self-esteem. This term is used in psychology to reflect person's overall emotional evaluation of his or her own worth. It is a judgment of oneself as well as an attitude toward their self (Wikipedia). Self-concept is the idea that you have about the kind of person you are, and the mental image one has of oneself according to Webster. Self representation is how you represent yourself in public and around others. Last is adolescent (teenager) and that is a person between the ages of 13 and 19 according to the dictionary. (Free Dictionary).
Self-awareness in adolescent is when they are becoming conscious of their emotions. Most children by the age to two are aware of emotions such as shame, guilt, pride and embarrassment (Zeanah,84). But they do not fully understand how those emotions affect their life. By time they become thirteen they are really starting to understand how those emotions have an impact on their lives. Although they are going through puberty they really get to understand and really get in touch with their emotions. The emotions that flow through them at the time they make decisions are not always good and that is part of what makes adults believe they are confused, but they really are not. Harter did a study of adolescents and in the study it found that adolescents (teenagers) are happy and like themselves when around their friends. But when around their parents they feel sad, mad and depressed and when it comes to pleasing them they feel hopeless because what they get from their parents is they can do nothing right. However it was also shown that when at school and around their teachers they felt intelligent and creative. But when around people they do not know they are shy, uncomfortable and nervous (60). This tells you a little bit of how they understand and show their emotions. This may also assist in making outsiders believe adolescents are confused, but they really are not confused they are just going through a lot at that time. The way they respond during the situation is just how they truly felt at that time during that situation. What needs to be realized is that they are in the process of learning to get their emotions together in under control. As adults you have already learned this therefore they should be a little more understanding to what the adolescents are going through. Although they are adolescents they know what they are doing and that’s why they follow two roles. One role is responsible and the other role is the irresponsible and it depends on who they are with to determine which role they are going to be in. When they are around teachers, parents and sometime people they do not know they play the responsible role but when around the oppose sex, friends and enemies they play the irresponsible roles (Harter,89). The responsible role is when they are dependable and you know they will make good decisions on their own. When they act in a reliable way and do things to make you pride of them. The irresponsible role is the opposite of responsible, when they are not trustworthy, they do everything you tell them not to do and should not be on their own because they may do something to get into trouble.
Autism spectrum disorders (ASDs) are a group of neurodevelopmental disabilities that can cause significant social, communication, and behavioral challenges (Understanding Autism, 2003). ASDs can also cause imaginative abnormalities and can range from mild to severe, especially in sensory-motor, perceptual and affective dimensions. Children with ASD may struggle with self-awareness and self acceptance. Their different thinking patterns and brain processing functions in the area of social thinking and actions may compromise their ability to understand themselves and social connections to others (Autism Asperger’s Digest, 2010). About 75% diagnosed autistics are mentally handicapped in some general way and the other 25% diagnosed with Asperger's Syndrome show average to good cognitive functioning (Mcgeer, 2004). When we compare our own behavior to the morals and values that we were taught, we can focus attention on ourselves increasing self-awareness. In understanding the many effects of autism spectrum disorders on those afflicted have led many scientists to theorize what level of self-awareness occurs and in what degree.
It is well known that children suffering from varying degrees of Autism struggle in social situations. Scientists have produced evidence that self-awareness is a main problem for people with ASD. Researchers used functional magnetic resonance scans (FMRI) to measure brain activity in 66 male volunteers in which half have been diagnosed in the autism spectrum. The volunteers were monitored while being asked to make judgments about their own thoughts, opinions, preferences, as well as about someone else's. By scanning the volunteers' brains as they responded to these questions, the researchers were able to see differences in the brain activity between those with and without autism. One area of the brain closely examined was the ventromedial pre-frontal cortex (vMPFC) which is known to be active when people think about themselves (Dyslexia United, 2009). This study showed that those afflicted with ASD did not have much of a separation of the brain activity when speaking about themselves as opposed to someone else like their normal counterparts did. This research suggests that the autistic brain struggled to process information about themselves. Self-awareness requires being able to keep track of the relationship one has with themselves and to understand what make them similar to others or in what ways different from others. "This research has shown that children with autism may also have difficulty understanding their own thoughts and feelings and the brain mechanisms underlying this, thus leading to deficits in self-awareness" (Dyslexia United, 2009).
A study out of Stanford University has tried to map out brain circuits with understanding self-awareness in Autism Spectrum Disorders. This study suggests that self-awareness is primarily lacking in social situations but when in private they are more self-aware and present. It is in the company of others while engaging in interpersonal interaction that the self-awareness mechanism seems to fail. Higher functioning individuals on the ASD scale have reported that they are more self-aware when alone unless they are in sensory overload or immediately following social exposure (Progress in Autism, 2011). Self-awareness dissipates when an autistic is faced with a demanding social situation. This theory suggests that this happens due to the behavioral inhibitory system which is responsible for self-preservation. This is the system that prevents human from self-harm like jumping out of a speeding bus or putting our hand on a hot stove. Once a dangerous situation is perceived then the behavioral inhibitory system kicks in and restrains our activities. "For individuals with ASD, this inhibitory mechanism is so powerful, it operates on the least possible trigger and shows an over sensitivity to impending danger and possible threats. (Progress in Autism, 2011). Some of these dangers may be perceived as being in the presence of strangers, or a loud noise from a radio. In these situations self-awareness can be compromised due to the desire of self preservation, which trumps social composure and proper interaction.
The Hobson hypothesis reports that autism begins in infancy due to the lack of cognitive and linguistic engagement which in turn results in impaired reflective self-awareness. In this study ten children with Asperger's Syndrome were examined using the Self-understanding Interview. This interview was created by Damon and Hart and focuses on seven core areas or schemas that measure the capacity to think in increasingly difficult levels. This interview will estimate the level of self understanding present. "The study showed that the Asperger group demonstrated impairment in the 'self-as-object' and 'self-as-subject domains of the Self-understanding Interview, which supported Hobson's concept of an impaired capacity for self-awareness and self-reflection in people with ASD." (Jackson, Skirrow, Hare, 2012). Self-understanding is a self description in an individual’s past, present and future. Without self-understanding it is reported that self-awareness is lacking in people with ASD.
Joint attention (JA) was developed as a teaching strategy to help increase positive self-awareness in those with Autism Spectrum Disorders (Wehmeyer and Shogren, 2008). JA strategies were first used to directly teach about reflected mirror images and how they relate to their reflected image. Mirror Self Awareness Development (MSAD) activities were used as a four step framework in which to measure increases in self-awareness in those with ASD. Self-awareness and knowledge is not something that can simply be taught through direct instruction. Instead, students acquire this knowledge by interacting with their environment (Wehmeyer and Shogren, 2008). Mirror understanding and its relation to the development of self leads to measurable increases in self-awareness in those with ASD. It also proves to be a highly engaging and highly preferred tool in understanding the developmental stages of self- awareness.
There have been many different theories and studies done on what degree of self-awareness is displayed among people suffering from Autism Spectrum Disorders. Scientists have done research about the various parts of the brain associated with understanding self and self-awareness. Studies have shown evidence of areas of the brain that are impacted by ASD. Other theories suggest that helping an individual learn more about themselves through Joint Activities, such as the Mirror Self Awareness Development may help teach positive self-awareness and growth. In helping to build self-awareness it is also possible to build self-esteem and self acceptance. This in turn can help to allow the individual with ASD to relate better to their environment and have better social interactions with others.
Autism Asperger’s Digest. (2002, May/June) Retrieved from http://autismdigest.com/self-awareness-and-self-acceptance-in-school-age-students-with-asd/
Autism-“children with autism have problem with self awareness” Retrieved December 14, 2009, from http://dyslexiauntied.blogspot.com/2009/12/autism-children-with-autism-have.html
Jackson, P., Skirrow, P., Hare, DJ. (2012, May). Asperger through the looking glass: an exploratory study of self-understanding in people with Asperger’s syndrome. http://www.ncbi.nlm.nih.gov/pubmed/21647793
McGeer, V Philosophy, Psychiatry, & Psychology, 11.3 (2004) 235-251 http://muse.jhu.edu/journals/philosophy_psychiatry_and_psychology/v011/11.3mcgeer.html
Progress in Autism: Self-awareness and regulation, a worthy challenge Retrieved January 13, 2011 from http://www.ncbi.nlm.nih.gov/pubmed/21207316?dopt=Abstract
Understanding Autism. (2003, March 1) Retrieved from http://www.atooftexas.org/understanding.html
Wehmeyer and Shogren, (2008) Retrieved from http://legacy.uphs.upenn.edu
Schizophrenia is a chronic psychiatric illness characterized by excessive dopamine activity in the mesolimbic tract and insufficient dopamine activity in the mesocortical tract leading to symptoms of psychosis along with poor cognition in socialization. Under the DSM-V, schizophrenics have a combination of positive, negative and psychomotor symptoms. These cognitive disturbances involve rare beliefs and/or thoughts of a distorted reality that creates an abnormal pattern of functioning for the patient. Multiple studies have investigated this issue. Although it has been studied and proven that schizophrenia is hereditary, most patients that inherit this gene are not self-aware of their disorder, regardless of their family history. The level of self-awareness among patients with schizophrenia is a heavily studied topic.
Schizophrenia as a disease state is characterized by severe cognitive dysfunction and it is uncertain to what extent patients are aware of this deficiency. In a study published in Schizophrenia Research by Medalia and Lim (2004), researchers investigated patients’ awareness of their cognitive deficit in the areas of attention, nonverbal memory, and verbal memory. Results from this study (N=185) revealed large discrepancy in patients’ assessment of their cognitive functioning relative to the assessment of their clinicians. Though it is impossible to access ones’ consciousness and truly understand what a schizophrenic believes, regardless in this study, patients were not aware of their cognitive dysfunctional reasoning. In the DSM-V, to properly diagnose a schizophrenic, they must have two or more of the following symptoms in the duration of one month: delusions*, hallucinations*, disorganized speech*, grossly disorganized/catatonic behavior and negative symptoms (*these three symptoms above all other symptoms must be present to correctly diagnose a patient.) Sometimes these symptoms are very prominent and are treated with a combination of antipsychotics (i.e. haloperidol, loxapine), atypical antipsychotics (such as clozapine and risperdone) and psychosocial therapies that include family interventions and socials skills. When a patient is undergoing treatment and recovering from the disorder, the memory of their behavior is present in a diminutive amount; thus, self-awareness of diagnoses of schizophrenia after treatment is rare, as well as subsequent to onset and prevalence in the patient.
The above findings are further supported by a study conducted in The American Journal of Psychiatry in 1993 by Amador, et al. (N=43). The study suggests a correlation exists between patient insight, compliance and disease progression. Investigators assess insight of illness was assessed via Scale to Assess Unawareness of Mental Disorder and was used along with rating of psychopathology, course of illness, and compliance with treatments in a sample of 43 patients. Patients with poor insight are less likely to be compliant with treatment and are more likely to have a poorer prognosis. Patients with hallucinations sometimes experience positive symptoms, which can include delusions of reference, thought insertion/withdrawal, thought broadcast, delusions of persecution, grandiosity and many more. These psychoses skew the patient’s perspectives of reality in ways in which they truly believe are really happening. For instance, a patient that is experiencing delusions of reference may believe while watching the weather forecast that when the weatherman says it will rain, he is really sending a message to the patient in which rain symbolizes a specific warning completely irrelevant to what the weather is. Another example would be thought broadcast, which is when a patient believes that everyone can hear their thoughts. These positive symptoms sometimes are so severe to where the schizophrenic believes that something is crawling on them or smelling something that is not there in reality. These strong hallucinations are intense and difficult to convince the patient that they do not exist outside of their cognitive beliefs, making it extremely difficult for a patient to understand and become self-aware that what they are experiencing is in fact not there.
Furthermore, a study by Bedford and Davis(2013) was conducted to look at the association of denial vs. acceptance of multiple facets of schizophrenia (self reflection, self perception and insight) and its effect on self-reflection (N=26). Study results suggest patients with increased disease denial have lower recollection for self evaluated mental illnesses. Disease denial, to a great extent, creates a hardship for patients to undergo recovery because their feelings and sensations are intensely outstanding. But just as this and the above studies imply, a large proportion of schizophrenics do not have self-awareness of their illness for many factors and severity of reasoning of their diagnoses.
Theater also concerns itself with other awareness besides self-awareness. There is a possible correlation between the experience of the theater audience and individual self-awareness. As actors and audiences must not "break" the fourth wall in order to maintain context, so individuals must not be aware of the artificial, or the constructed perception of his or her reality. This suggests that both self-awareness and the social constructs applied to others are artificial continuums just as theater is. Theatrical efforts such as Six Characters in Search of an Author, or The Wonderful Wizard of Oz, construct yet another layer of the fourth wall, but they do not destroy the primary illusion. Refer to Erving Goffman's Frame Analysis: An Essay on the Organization of Experience.
In science fiction, self-awareness describes an essential human property that often (depending on the circumstances of the story) bestows "personhood" onto a non-human. If a computer, alien or other object is described as "self-aware", the reader may assume that it will be treated as a completely human character, with similar rights, capabilities and desires to a normal human being. The words "sentience", "sapience" and "consciousness" are used in similar ways in science fiction.