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or a suspension of those mental activities by which people are made aware of themselves and their environment, coupled with a diminished responsiveness to environmental stimuli Some authors make a distinction between the level of consciousness meaning the state of arousal or the degree of variation from normal alertness as judged by the appearance of facial muscles, xity of gaze, and body posture and the content of consciousness, ie, the quality and coherence of thought and behavior For medical purposes, the loss of normal arousal is by far the more important and dramatic aspect of disordered consciousness and the one identi ed by laypersons and physicians as being the central issue in coma To add to the ambiguity, psychoanalysts have given the word unconscious a still different meaning; for them it is a repository of impulses and memories of previous experiences that cannot immediately be recalled to the conscious mind Much more could be said about the history of our ideas concerning consciousness and the theoretical problems with regard to its de nition Historically, there has been considerable controversy as whether it will ever be possible to understand mind and consciousness in terms of reductionist physical entities such as cellular and molecular neural systems While it serves little practical purpose to review these subjects in detail, we note that contemporary investigations indicate that a constructive approach is to de ne the neurobiological correlates of well-de ned elements of consciousness Importantly, these controversies are being informed to some degree by analyses of unusual neurologic disorders, such as those that disturb perception and consciousness of perception (phantom limb, blindsight, etc) The interested reader is referred to the discussions of consciousness by Crick and Koch, Plum and Posner, Young, and Zeman listed in the references

The following de nitions, though probably not acceptable to all psychologists, are of service to clinicians and will provide the student and practitioner with a convenient terminology for describing the states of awareness and responsiveness of their patients Normal Consciousness This is the condition of the normal person when awake In this state the individual is fully responsive to a thought or perception and indicates by his behavior and speech the same awareness of self and environment as that of the examiner This normal state may uctuate during the day from one of keen alertness or deep concentration with a marked constriction of the eld of attention to one of mild general inattentiveness, but even in the latter circumstances, the normal individual can be brought immediately to a state of full alertness and function Confusion The term confusion lacks precision, but in general it denotes an inability to think with customary speed, clarity, and coherence All states of confusion are marked by some degree of inattentiveness and disorientation In this condition the patient does not take into account all elements of his immediate environment This state also implies a degree of imperceptiveness and distractibility, referred to traditionally as clouding of the sensorium Here one dif culty is to de ne thinking, a term that refers variably to problem solving or to coherence of ideas and formation of memories Confusion results most often from a process that in uences the brain globally, such as a toxic or metabolic disturbance or a dementia Any condition that causes drowsiness or stupor, includ-

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