Schizophrenia
One of the central symptoms of schizophrenia is delusion. When people with schizophrenia are suffering extreme and pervasive delusions, they do not understand what they are doing.
It is no simple matter to define a delusion, and it is highly problematic to simply equate it with a false belief, but it is safe to say that paradigm cases of delusion imply a significant lack of, or distortion in, understanding of one's situation.
In paranoid schizophrenia, for example, patients tend to interpret what other people say with what might be called a hermeneutics (theory and methodology of interpretation) of fear and suspicion, and in extreme cases, will have elaborate and fixed fantastic theories about ways in which others are aiming to harm them.
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