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7/25/2019 18 Ongoing Discussion of Francis Crick and Christoph Koch (Vol. 2, No. 1): Commentary by Mortimer Ostow (New
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7/25/2019 18 Ongoing Discussion of Francis Crick and Christoph Koch (Vol. 2, No. 1): Commentary by Mortimer Ostow (New
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Ongoing Discussion Vol. 2, No.1
Ongoing Discussion of Francis Crick and C hristoph Koch Vol. 2,
No.1 :
Commentary by
Mortimer
Ostow New York)
1 7
The following is intended as a contribution to the dis
cussions
of
consciousness, responding to the target
article by Crick and Koch. In the interest of providing
some clinical input to the subject, I offer here some
chapter headings.
If
we follow the suggestions
of
Panksepp 1998),
Damasio 1999), and Watt 2000), we may start with
the assumption that the evolutionary rudiments of sen
tience appeared as components of instinct. Presumably
the stimulus or need for instinctual response elicited
a demand felt
as
some kind
of
uncomfortable sensa
tion, and presumably the instinctual response was ac
companied by a complementary agreeable sensation
that erased the former.
Presumably too, was the effect
of
this advance to
supplement the hard-wired instinctual systems, as well
as those systems modified by the flexibility achieved
by susceptibility to conditioning, so as to make it pos
sible to select one or more potentially optimal re
sponses in preference to others. That process entailed
the capacity to anticipate the consequences of each,
that is, to imagine, and, on a higher evolutionary
plane, to fantasy. These mechanisms supplement but
do not replace the hard-wired and conditionable in
stincts that still preempt behavior in the presence
of
adequate or unusually intense stimuli.
These are simple speculations, based upon rea
sonable assumptions, and they lead us to certain con
clusions about conscious experience in the
contemporary human. Conscious mentation must in
clude the sensitivity to certain biological including
social) needs, the opportunity to dispel unpleasant
stimuli by taking certain actions that will, in turn, re
place them with agreeable experiences; and the ability
to consider possible responses in order to select the
optimal response. Such a mechanism would provide
the capacity for imagery, imagination, fantasy, and the
ability to anticipate the future.
Fantasy has important clinical significance be
cause it guides the selection of response, but also be
cause it is often used to substitute for action. It c an
do so because as trial action it probably elicits an elab-
Mortimer Ostow, M.D., is President of the Psychoanalytic Research
and Development Fund, and Cochairman of its Study Group on Neurosci
ence, Psychopharmacology and Psychoanalysis.
oration
of
appropriate neurotransmitters in the same
pattern though in much smaller amounts, than the full
action would. Conscious affective selection requires
an accumulation of stored relevant memories. These
memories must be available for recall on appropriate
occasions. However, the durability of memory proba
bly varies with its age and other constraints of
re
cording.
We come to the subject of attention. Needless to
say, one is conscious
of
whatever is attended to, but
some images and events can become conscious even
when they are not the objects
of
attention. They are
sometimes said to be a t the periphery
of
conscious
ness. Not all percepts and memories can be conscious
simultaneously. Those become conscious that either
demand attention by virtue of their intensity or imme
diacy, promising instant or important gratification or
threat, or those that are called for by current thought,
imagination, or problem solving. What neuroscientists
have called procedural memory records events that
were consciously perceived when they occurred, when
attention was required. However, with practice, atten
tion is no longer required. But attention can restore
them to consciousness at any moment.
The psychoanalytic clinician
is
concerned with
memories that cannot be retrieved simply by at
tempting to focus attention on them. That is, attention
may a sk
for
them, but it cannot liberate them into
consciousness. Clinical experience teaches us that
these memories were laid down very early, or were
associated with significant trauma, or were repressed
in the course of
development, or were repressed be
cause they were involved in neurotic conflict. We
know of their existence because they appear directly
or symbolically in dreams, or because they can be
recaptured during the course
of
analysis.
Not all fantasies are intended to anticipate the
consequence of choice of behavior strategies. Some
are created so as to organize the memories
of past
experience. These fo rm a myth of greater or lesser
degree of veridicality that offers a mythical explana
tion of the course of the individual s life, and antici
pates his future. We speak of these as organizing
fantasies; they are not usually consciously known by
the subject, but appear often in the course of analysis,
opposed by stronger or weaker repressive forces.
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8
Performing all
of
these functions and involved in
all
of
these activities, consciousness yet is called upon
to present a seamless aspect, to continue without inter
ruption to integrate all percepts, both those arising ex
ternally and those arising internally, into a continuous
surface. It is called upon to exclude impressions from
any source, that are not compatible with the current
account of events in the world, and yet not to ignore
impressions of serious significance. Hypnagogic and
hypnopompic phenomena are examples of intrusive
impressions that are usually excluded from conscious
ness. Even dream consciousness, which seems to oc
cur without the mobilization
of
attention, attempts to
rationalize and organize the impressions that intrude
into dreams. For example, an external sound or light
or a touch or insect contact, or an excretory stimulus,
is usually seamlessly integrated into the dream. Freud
spoke
of
a censor that excludes the repressed from
consciousness.
Hartmann spoke
of
the synthetic function
of
the
ego; that is, the tendency of
the conscious ego to inte
grate impressions into a consistent whole, eliminating
inconsistencies and arbitrary sequences. These
smoothing tendencies often create illusions. The post
hoc propter hoc fallacy is a logical illusion born
of
the
need for causality, a principle described by Herman
Nunberg 1959 . The scientific method was devised
for the purpose of overcoming illusory verification of
one s
expectations. We speak
of
these
as
functions
of
the ego but they seem to be functions of consciousness.
Despite its tendency to distort data so
as
to protect its
integrated picture, consciousness is expected to distin
guish between the real and the unreal, the familiar and
the unfamiliar.
Consciousness also takes the self as its object,
including the very function of consciousness. Neuro
scientists attempt to deal with this self-reflective func
tion
of
consciousness. Psychoanalysts speak
of
self
observation. I have suggested that we can recognize
three types
of
self-observation. Primary self-observa
tion consists of taking note
of
one s subjective feel
ings; secondary self-observation consists of noting
one s objective qualities; tertiary self-observation con
sists of regarding the impressions of one s self
as
seen
by outside observers. I have found that in general, the
self-observation
of
the depressed patient is primary;
the self-observation
of
the manic is tertiary; and sec
ondary self-observation occurs only in the absence of
both mood deviations. These regularities can help in
the monitoring
of
psychiatric drug therapy. At the ex
tremes
of
mood deviation, primary and tertiary self
observation may become delusional hypochondria in
Mortimer Ostow
the former instance and delusional paranoia in the
latter.
Some neuroscientists consider consciousness and
affect not intrinsically associated,
as
opposed to others
Panksepp, 1998 who consider consciousness essen
tially an instrument for appreciating affect. As a clini
cian, it seems
to
me that every conscious state carries
its own affect. The affect need not be a distinct phasic
feeling change; it may be only a relatively constant
underlying mood.
Part
of
the neuropsychoanalytic problem is that
investigators speak
of
affect and
of
pleasure and pain
or unpleasure nonspecifically,
as
though what is true
of
one affective state is true
of
all. I have been con
tending for some time that a taxonomy of affect is
needed for clarifying the issues.
Instinctual behavior carries specific affects.
f
we
address ourselves to the phasic instincts such as the
sexual, nutritive, defensive, and thermal homeostasis
promoting instincts, we can recognize several types
of
affect. The instinctual sequence is initiated by an
experience of discomfort specific to the instinct being
triggered, whether hunger, thirst, danger, pain, exces
sive warmth or cold, or felt need for sexual experience.
There follows an interval of appetitive striving, a
search for opportunities for gratification
of
the felt
need, characterized by its specific affect, similar to
and anticipating the consummatory feeling that fol
lows. The strongest affective experiences are associ
ated with the consummation
of
the instinct, but the
phase
of
relaxation that follows the consummation
carries still another affective experience, pleasant sa
tiety.
The social instincts carry their own set
of
affects.
Establishing and breaking attachment are each accom
panied by specific affects, the former gratifying and
the latter distressing. The need for attachment may be
considered a tonic rather than a phasic instinct, and
the affects accompanying it are relatively enduring
rather than fleeting such
as
that accompanying the or
gasm. But one may recognize also affective states that
drive efforts to establish a desired status in society
and to maintain it. All complementary affects are elic
ited by failure to do so. These include pride in the first
instance and shame in the second.
elf esteem
is a
term that designates one s affective estimate
of
one s
status within society.
Mood
is
still another important and omnipresent
affect. It seems to recede when other stronger and
phasic affects supersede it, and recurs when these oth
ers subside. Good mood is encouraged by success
of
instinctual endeavors, and bad mood ensues in the
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Ongoing Discussion Vol. 2, No.1
presence
of
failure
of
these and the prevalence
of
dis
tressing experiences.
It is mood, I believe, that is established by the
action
of
Panksepp s 1998) seeking system, driven
primarily by dopamine transmitters, and active always
during both waking life and sleep, including dreaming.
It is mood too t hat is abnormal in mani c-dep ressiv e
illness, and it is mood that is affected by pharmacolog
ical agents that are u sed to treat the several forms
of
this illness. They are essentially mood regulators that
does not include the sedative and antiseizure drugs).
In ad dition to the affects in ciden t to instinctual
behavior, and in addition to mood, we recognize cer
tain affectiv e states that seem independ en t o f both. I
refer here to the experience of humor, to the pleasures
of
listening to music or the enjoyment of any aesthetic
experience, the feeling
of
the uncanny, among others.
There are th rills, su rprises, an d states of confusion.
Each
of
these affective states calls for analysis
of
its
n ature and of its relatio n to the instinctively b ased
affects. With a little ingenuity, I believe they can each
be assigned their proper classification. Some of these
affective states I relate to the experien ce o f crossin g
categ orical b oun daries. Fo r example, humor is ap
preci at ed when o ne uses a word or expression ordi
narily tho ug ht
of in one logical category, in a
surprisingly different one. The pun, which is an ele
mentary form of humor, is the simplest example. How
ever, fairly sophisticated examples
of
wit also
fit
that description.
Accordingly, when we speak of pleasure we must
acknowledge that there are a number
of
different vari
eties of pleasure: the pleasure associated with anticipa
tory appetitive activities; the pleasure associated with
consummation; the pleasure associated with postcon
summatory relaxation; the pleasure associated with el
evated mood; the pleasure associated with some
category-crossing moods such as humor and pleasant
surprise; the pleasure associated with aesthetic activi
ties; the pleasure associated with establishing and
maintaining attachments, either personal or social; the
pleasure associated with problem solving. Panksepp
relates problem solving to appetitive activity since it
represents instinctual attempts to discern threats and
discover opportunities for pleasurable gratification
1998).
Similarly, there are various categories of pain in
cluding the pain
of
the stimuli to instinctual gratifica
tion; the pain of
frustration or initiated instinctual
behavior; the pain of depressive mood; the pain of loss
of attachment, the discomfort of sleep deprivation.
Spiritual experiences are usually pleasant but may be
9
painful; for example, when, under the influence of a
depressive mood, they result in the fear
of
being vis
ited by malignant spirits, ghosts, or revenants.
Still dealing with the various states
of
conscious
ness, we cannot ignore the several important manifes
tations
of
detachment; that is, alterations of affective
consciousness that alter the impression
of
one s dis
tance from the world that is normally perceived as
real. Dep erso nalization is the feeling of being es
tranged from oneself. It is not merely tertiary self
o bserv atio n, wh ich is reg arding o ne s s elf and one s
attributes as others would see them. Depersonalization
is the feeling of no long er being o ne s familiar self.
What has been called derealization is not really a loss
of
the sense
of
reality, but loss of the sense of familiar
ity with reality, estran gemen t from it. Deja vu, o n the
other hand, is an illusory sense
of
familiarity. It is not
a specific memory of having done something before.
One can usually not specify when or under what cir
cumstances one has done it or been there, which would
imply a previous exposure to the scene. Since these
phenomena occur during temporal lobe seizures, it is
lik ely that the sense of familiarity involves temporal
lobe function. Recent observations that familiar and
unfamiliar faces are recorded at slightly different
p oin ts in and aro un d the fu sifo rm gyrus, seem to cor
roborate that impression. However, these detachment
p heno men a o ccur also in the intact individual. They
h av e b een d escrib ed as resp on ses to anxiety. I am n ot
sure that that conclusion is always correct.
Still within the realm of normality, we find states
of
detachment complemented by attachment to virtual
objects.
Of
these, the most definitive is the my stical
episode. Here the subject, usually psychiatrically nor
mal, describes a direct and immediate experience of
hallucinated or felt contact with a supernatural object,
a deity, o r aspect of nature or the cosmos. I call this
a virtual object because it is a personified representa
tion of a subjectively felt psychic influence. The mysti
cal state is o ften an ticipated by a state of depression,
anxiety, or loneliness, and results in a feeling
of
grati
fying achievement.
I see mysticism as one extreme of a series,
namely, awe, spirituality, and mysticism. Awe is pri
marily elicited by en coun tering a sight o r sou nd that
seems larger than life, that engenders a feeling of being
small o r in significant in the p resen ce of something
grand, cosmic, portentous. The affect of being awed
may be a gratifying, comforting one, or an intimidat
ing, frightening one. Although itis not conventionally
attribu ted to awe, I believ e that a sense of familiarity
contributes an element as well. When we enco un ter
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an awesome experience, we feel personally related
to it.
Spirituality refers to an experience intermediate
between awe and the full mystical experience. The
spiritual experience is a feeling of transcendence,
of
contact with supernatural entities or forces. It differs
from awe in that one is not merely impressed by the
perceived magnificent display, but one feels the influ
ence of a source of comfort and inspiration. (Note that
both the word
spiritu lity
and
inspir tion
are derived
from the Latin root
spir r
meaning to breathe. The
spirit, in both cases, is something that may be
breathed in.)
All these are alterations
of
consciousness associ
ated with strong affects. Since awe is usually inspired
by exposure to larger than life displays, I guess that
awe reproduces the child s earliest experiences of
mother. Mountains, oceans, tremendous edifices,
sweet melodies, loud rumbling noises, all suggest the
infant s earliest impressions
of
caretakers. These ex
periences are not remembered, probably because at
that early point, the brain has not yet acquired the
capacity to retain discrete iconic or phonic memories.
It may, however, be capable of recording and retaining
the affects associated with these. When these affects
are retrieved later in life, they are virtually ineffable,
orphan affects. Since they all include a component of
yearning, when invoked they encourage the impres
sion
of
contact with a virtual object.
In each of these three states, awe, spirituality, and
mysticism, we find detachment, transcendence,
yearning, a feeling of being in contact with a supernal,
supernatural entity. In each case the experience may
be preceded by anxiety or depression, loneliness, and
followed by a sense of exaltation and exhilaration. I
have observed that the spiritual expression especially,
follows the death of a loved person or separation for
other reasons.
In the case of the spiritual and mystical experi
ence, the feeling of detachment may proceed to the
point
of
trance, a significant detachment from reality,
complete diversion of
attention from the real world.
It suggests the hypnotic or hysterical trance state. Per
haps trance is the complete diversionof attention from
the real world to the illusory world of archaic affects,
complemented by virtual objects suggested by these
affects.
Continuing with our listing of the various states
of consciousness, we come now to hynagogic and hyp
nopompic experiences. These have not been exten
sively described. Mostly what are seen are images,
somewhat distorted, varying in shape and color that
Mortimer Ostow
intrude into consciousness but are fugitive. When one
attempts to attend to them, they disappear,
as
they do
when one wakes fully. They give us an illustration
of
the organizing effect
of
attention
on
the images
secreted
spontaneously by memories. Sleep onset
and offset may also be accompanied by auditory expe
riences, that are less bizarre but equally irrelevant.
Dreaming has been perhaps the most commonly
studied and discussedof the variants of consciousness.
But it is content of dreams that has been studied more
than the formal characteristics of dream conscious
ness. Dreams are not visualized as the result
of
the
direction of attention. They intrude into the dreamer s
consciousness and preempt attention.
If
the dream be
comes too horrid or frightening, the dreamer will often
attempt to arrest or dissipate it and his efforts seem
to involve mobilizing attention. If attention is mobi
lized, the dream disappears.
Like waking consciousness, dreaming conscious
ness is suffused with affect. The dreams
of
individuals
with mood disorder include apocalyptic scenarios with
representation
of
affects
of
death and destruction, al
ternating with representation and affects of rebirth.
The waking state of mind determines which of the
two elements predominates in the dreams. But even
in dreams in which content seems more dominant than
affect, we always find an affect accompaniment. For
monitoring patients who may require medication or
who are taking it, the affective signature
of
the dream
can reinforce or modify the clinical impression with
respect to the selection of the medication, and how to
vary the dose. It seems to me more clearly evident in
the case of dreaming that consciousness is there for
the purpose
of
registering the affect. Since actively
and consciously focused attention are absent, cogni
tive integration in the dream is only partial.
In an interesting pathologic variant, an individual
may awaken while dreaming an unpleasant dream,
but be unable to banish it from his mind. So he remains
unpleasantly in a state of partial dreaming, partial
waking. Full waking consciousness, attention, and dis
tress do not terminate the dream consciousness. Ap
parently, waking consciousness and dream
consciousness can coexist, though they seldom do.
Turning now to states of pathologic conscious
ness, we encounter confusion as the most common
example. It may be brought about by either structural
or toxic disorders, or nonstructural functional disor
ders. Among the latter, psychic shock, acute stress,
sudden anxiety, or depression or psychosis may induce
confusion. In the case of structural or toxic disorder,
confusion may be accompanied by impairmentof con-
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Ongoing Discussion
sciousness. In the case of purely psychic states, when
consciousness is not seriously impaired, the confusion
consists
of
impaired cognitive function and may in
clude impaired memory. Attention
is
difficult or im
possible and it cannot repair the cognitive dysfunction.
Simple unconsciousness, or coma, or coma vigil are
usually the result
of
severe brain dysfunction and ordi
narily fall outside the psychiatric situation.
In the case
of
psychosis, consciousness remains
clear and attention can be deployed. What
is
altered
is contact with consensual reality, while reality testing
is perverted so
as
to validate the departure from per
ceived reality and the adversion to the delusional real
ity of the psychosis. The process parallels that of the
full mystical experience in which reality is abdicated
in favor
of
an illusory reality. The difference lies in the
reversibility
of
the process. The mystical experience is
reversible, brief in duration (minutes or hours), and
usually consistent with the subject s religious tradition
or some variant thereof. Psychosis is not really revers
ible (without intervention such
as
medication), endur
ing (often for years), and idiosyncratic in content.
The transition from realism to psychosis, the
psychotic break, is often marked by a delusional
symbolic rebirth accompanied by the illusion that the
subject now sees what he should have seen all along:
Now I see it
alL
The delusion, usually a delusional
conspiracy, now reveals itself
as
the objective truth,
heretofore hidden from everyone s eyes. Similarly,
most mystical episodes are accompanied by a revela
tion. In religious mysticism the revelation
is
a mes
sage from God, for example, the Revelation
of
St.
John. It is the transit ion (or transport) from reality
orientation to pseudoreality in each case that is de
scribed as the revelation. What is involved here is not
a change in the function of consciousness, attention,
or
of
the sense
of
familiarity, but primarily the sense
of reality and reality testing. It is the illusion or delu
sion
of
rebirth that is the affective component of the
alteration
of
ego function, but the instinctual, insistent
need for attachment that drives both the mystical and
psychotic fantasy.
I hoped, in this communication, to list some of
the variants
of
consciousness and its deformations
along with accompanying alterations in attention. I
hoped to show too that consciousness is invariably
linked to affect. In fact, I believe, that the facts support
the proposition that consciousness evolved concomi
tantly with affect as the perceptual organ for affect.
Some
of
the variants may provide data for the neuro
scientific study of consciousness, attention, and affect.
References
Damasio, A (1999), The Feeling of What Happens. New
York: Harcourt, Brace.
Nunberg,
H
(1959), Principles of Psychoanalysis. New
York: International Universities Press.
Panksepp,
J
(1998), Affective Neuroscience. New York:
Oxford University Press.
Watt, D. (2000), Emotion and consciousness. Part II. A
Review
of
Antonio Damasio s
The Feeling
of
What Hap-
pens. Consciousness Studies
7 3 :52-73.
5021 Iselin Avenue
Riverdale 10471
e mail: mostow1234@aol.com
Ongoing Discussion of Yoram Yo
veIl
(Vol. 2, No.2 :
Commentary by Joseph W. Slap (Philadelphia) and
Jodi
H. Brown (Philadelphia)
Whether psychoanalysis can become a respected
member of the scientific community, or is destined
to be regarded as an early 20th-century intellectual
movement, may hinge on a principle enunciated by
Joseph Slap, M.D., is a Training and Supervising Analyst at The
Psychoanalytic Center
of
Philadelphia.
Jodi Brown, M.D., is a Lecturer
of
Psychiatry at the Thomas Jefferson
Medical College.
The central thesis
of
this response was presented in a paper t it led
Congruence of the Neuroscience of Perception andMemory with a Model
Dr. Yovell, namely, psychoanalytic theory can and
should go beyond our current neurobiological under
standing
of
the mind, but never contradict
it
(pp.
1-2). He states further that psychoanalytic theory
should be continuously reexamined and revised, to
ensure its coherence with emerging neurobiological
research findings (p. 2). Here is the problem: As we
of
the Mind at the Spring Meeting
of
the American Psychoanalytic Asso
ciation in Washington, DC, May 1999.
top related