18 Ongoing Discussion of Francis Crick and Christoph Koch (Vol. 2, No. 1): Commentary by Mortimer...

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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.


3/6

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


4/6

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


5/6

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-


6/6

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: [email protected]

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.

18 Ongoing Discussion of Francis Crick and Christoph Koch (Vol. 2, No. 1): Commentary by Mortimer...

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