Altered States of ConsciousnessARNOLD M. LUDWIG, MD, MADISON, WIS

BENEATH man's thin veneer of con-

sciousness lies a relatively uncharted realmof mental activity, the nature and functionof which have been neither systematicallyexplored nor adequately conceptualized.Despite numerous clinical and research re-

ports on daydreaming, sleep and dreamstates, hypnosis, sensory deprivation, hysteri-cal states of dissociation and depersonaliza-tion, pharmacologically induced mentalaberrations, and so on, there has been littleattempt made to organize this scatteredinformation into a consistent theoretical sys-tem. It is my present intention to integrateand discuss current knowledge regardingvarious altered states of consciousness in aneffort to determine (a) the conditions neces-

sary for their emergence, (b) the factorswhich influence their outward manifesta-tions, (c) their relatedness and/or common

denominators, and (d) the adaptive or

maladaptive functions which these states mayserve for man.

For the purpose of discussion, I shallregard "altered state(s) of consciousness"[hereafter referred to as ASC(s)] as anymental state(s), induced by various physio-logical, psychological, or pharmacologicalmaneuvers or agents, which can be recog¬nized subjectively by the individual himself(or by an objective observer of the in¬dividual) as representing a sufficient devia¬tion in subjective experience or psychologicalfunctioning from certain general norms forthat individual during alert, waking con¬sciousness. This sufficient deviation may berepresented by a greater preoccupation than

usual with internal sensations or mentalprocesses, changes in the formal characteris¬tics of thought, and impairment of realitytesting to various degrees. Although therewill be some conceptual pitfalls in such a

general definition, these pitfalls will be more

than compensated for by the wide range ofclinical phenomena which can now be con¬

sidered and hence studied as presumablyrelated phenomena.

Production of ASCASCs may be produced in any setting by

a wide variety of agents or maneuvers whichinterfere with the normal inflow of sensoryor proprioceptive stimuli, the normal outflowof motor impulses, the normal "emotionaltone," or the normal flow and organizationof cognitive processes. There seems to bean optimal range of exteroceptive stimulationnecessary for the maintenance of normal,waking consciousness, and levels of stimula¬tion either above or below this range appearconducive to the production of ASCs.1Moreover, by adopting Hebb's views,2 we

also find that varied and diversified environ¬mental stimulation appears necessary for themaintenance of normal cognitive, perceptual,and emotional experience, and that whensuch stimulation is lacking, mental aberra¬tions are likely to occur. Although experi¬mental evidence is sparse concerning themanipulation of motor, cognitive, and emo¬

tional processes, there seems to be ampleclinical and anecdotal evidence to suggestthat gross interference with these processesmay likewise produce alterations in con¬

sciousness.*In specifying the general methods em-

Submitted for publication April 20, 1966.From the Mendota State Hospital, Madison, Wis.Read before the Symposium on "Possession States

in Primitive People," sponsored by R. M. BuckeSociety, Montreal, March 4-6, 1966.

Reprint requests to 301 Troy Dr, Madison, Wis53704.

* See R. Shor's excellent theoretical article3 con-cerning the conditions necessary for the emergenceof trance, a term roughly similar to my usage of ASC.

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ployed to produce ASCs, I should like toemphasize that there may be much overlapamong the various methods and that manyfactors may be operating other than thoselisted. Nevertheless, for the sake of classifi¬cation (albeit artificial), I have categorizedthe various methods on the basis of certainvariables or combinations of variables whichappear to play a major role in the productionof these ASCs.

A. Reduction of Exteroceptive Stimulationand/or Motor Activity.—Under this categoryare included mental states resulting pri¬marily from the absolute reduction ofsensory input, the change in patterning ofsensory data, or constant exposure to repeti¬tive, monotonous stimulation. A drastic re¬duction of motor activity also may provean important contributing factor.

Such ASCs may be associated with soli¬tary confinement 4·5 or prolonged social andstimulus deprivation while at sea,6·8 in thearctic,9·10 or on the desert ; highway hypno¬sis n ; "breakoff" phenomena in high altitudejet pilots12; extreme boredom13; hypna-gogic and hypnopompic states; sleep andrelated phenomena, such as dreaming andsomnambulism ; or experimental sensorydeprivation states.14"16 In clinical settings,alterations in consciousness may occur fol¬lowing bilateral cataract operations17 or

profound immobilization in a body cast or

by traction.18 They may also occur in patientswith poliomyelitis placed in a tank-typerespirator,19 in patients with polyneuritiswhich is causing sensory anesthesias andmotor paralyses,18 and in elderly patientswith cataracts.20 Descriptions of moreesoteric forms of ASCs can be found inreferences to the healing and revelatory statesduring "incubation" or "temple sleep" as

practiced by the early Egyptians andGreeks 21 and "kayak disease," occurring inGreenlanders forced to spend several daysin a kayak while hunting seals.22

B. Increase of Exteroceptive Stimulationand/or Motor Activity and/or Emotion.—Under this category are included excitatorymental states resulting primarily fromsensory overload or bombardment, whichmay or may not be accompanied by stren¬uous physicial activity or exertion. Profound

emotional arousal and mental fatigue may bemajor contributing factors.

Instances of ASCs induced through suchmaneuvers are as follows : suggestible mentalstates produced by grilling or "third degree"tactics 23 ; brainwashing states 23 ; hyper-kinetic trance associated with emotional con¬

tagion encountered in a group or mobsetting 24·25 ; religious conversion and healingtrance experiences during revivalistic meet¬

ings 2S·2*.2«.27 ; mental aberrations associatedwith certain rites de passage23; spirit pos¬session states 23·24·28·30 ; shamanistic andprophetic trance states during tribal cere¬

monies 29·31 ; fire walker's trance 32 ; orgiastictrance, such as experienced by Bacchanaliansor Satanists during certain religiousrites33,34 ; ecstatic trance, such as experi¬enced by the "howling" or "whirling"dervishes during their famous devr dance 22 ;trance states experienced during prolongedmasturbation ; and experimental hyperalerttrance states.35 Alterations in consciousnessmay also arise from inner emotional turbu¬lence or conflict or secondary to externalconditions conducive to heightened emo¬

tional arousal. Examples of these stateswould include fugues, amnesias, traumaticneuroses, depersonalization, panic states,rage reactions, hysterical conversion reac¬

tions (ie, dreamy and dissociative possessionstates), berzerk, latah, and whitico psy¬choses,36 bewitchment and demoniacal pos¬session states,34,37"39 and acute psychoticstates, such as schizophrenic reactions.

C. Increased Alertness or Mental Involve¬ment.—Included under this category are

mental states which appear to resultprimarily from focused or selective hyper-alertness with resultant peripheral hypoalert-ness over a sustained period of time.

Such ASCs may arise from the followingactivities : prolonged vigilance during sentryduty or crow's watch ; prolonged observationof a radar screen 13 ; fervent praying 40·41 ;intense mental absorption in a task, suchas reading, writing, or problem solving ;total mental involvement in listening to a

dynamic or charismatic speaker 42 ; and even

from attending to one's amplified breathsounds,43 or the prolonged watching of a

revolving drum, metronome, or stroboscope.

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D. Decreased Alertness or Relaxation ofCritical Faculties.—Grouped under this cate¬gory are mental states which appear tooccur mainly as a result of what might bestbe described as a "passive state of mind,"in which active goal-directed thinking isminimal.

Examples of such states are as follows :

mystical, transcendental, or revelatory states(eg, satori, samadhi, nirvana, cosmic-consciousness) attained through passivemeditation or occurring spontaneously dur¬ing the relaxation of one's critical facul¬ties 44·45 ; daydreaming, drowsiness, "Brownstudy" or reverie ; mediumistic and auto-hypnotic trances (eg, among Indian fakirs,mystics, Pythian priestesses, etc) ; profoundaesthetic experiences ; creative, illuminatory,and insightful states45,4e ; free associativestates during psychoanalytic therapy ; read¬ing trance, especially with poetry47 ; nos¬

talgia; music-trance resulting fromabsorption in soothing lullabies or musicalscores; and mental states associated withprofound cognitive and muscular relaxation,such as during floating on the water or

sun-bathing.E. Presence of Somatopsychological

Factors.—Included under this heading are

mental states primarily resulting from altera¬tions in body chemistry or neurophysiol-ogy.48 These alterations may be deliberatelyinduced or may result from conditions overwhich the individual has little or no control.

Examples of physiological disturbancesproducing such ASCs are as follows : hypo-glycemia, either spontaneous or subsequentto fasting; hyperglycemia (eg, postprandiallethargy) ; dehydration (often partially re¬

sponsible for the mental aberrations en¬

countered on the desert or at sea) ; thyroidand adrenal gland dysfunctions ; sleep de¬privation 49"51 ; hyperventilation ; narcolepsy ;temporal lobe seizures (eg, dreamy statesand déjà vu phenomena) ; and auras preced¬ing migraine or epileptic seizures. Toxicdeleria may be produced by fever, the in¬gestion of toxic agents, or the abrupt with¬drawal from addicting drugs, such as

alcohol and barbiturates. In addition, ASCsmay be induced through the administrationof numerous pharmacological agents, such

as anesthetics and psychedelic, narcotic,sedative, and stimulant drugs.

General Characteristics of ASCsAlthough ASCs share many features in

common, there are certain general moldinginfluences which appear to account for muchof their apparent differences in outwardmanifestation and subjective experience.Even though similar basic processes mayoperate in the production of certain ASCs(eg, trance), such influences as culturalexpectations,52 role-playing,53·54 demandcharacteristics,55,56 communication factors,transference feelings,57 personal motivationand expectations (mental set), and the spe¬cific procedure employed to induce the ASCall work in concert to shape and mold amental state with a unique flavor of its own.

Despite the apparent differences amongASCs, we shall find that there are a num¬ber of common denominators or featureswhich allow us to conceptualize these ASCsas somewhat related phenomena. In pre¬vious research,5862 Dr. Levine and I were

able to demonstrate the presence of manyof these features in alterations of conscious¬ness induced by hypnosis, lysergic aciddiethylamide (LSD-25), and combinationsof these variables. Similar features (de¬scribed below), in greater or lesser degree,tend to be characteristic of most ASCs.

A. Alterations in Thinking.—Subjectivedisturbances in concentration, attention,memory, and judgment represent common

findings. Archaic modes of thought (primaryprocess thought) predominate, and realitytesting seems impaired to varying degrees.The distinction between cause and effectbecomes blurred, and ambivalence may bepronounced whereby incongruities or op-posites can coexist without any (psycho)logical conflict. Moreover, as Rapaport63and Brenman 64 have commented, many ofthese states are associated with a decreasein reflective awareness.

B. Disturbed Time Sense.—Sense of timeand chronology become greatly altered. Sub¬jective feelings of timelessness, time comingto a standstill, the acceleration or slowingof time, and so on, are common. Time may

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also seem of infinite or infinitesimal dura¬tion.

C. Loss of Control.—As a person entersor is in an ASC, he often experiences fearsof losing his grip on reality and losing hisself-control. During the induction phase, hemay actively try to resist experiencing theASCs (eg, sleep, hypnosis, anesthesia),while in other instances he may actuallywelcome relinquishing his volition and giv¬ing in to the experience (eg, narcotic drugs,alcohol, LSD, mystical states).

The experience of "loss of control" isa complicated phenomenon. Relinquishingconscious control may arouse feelings ofimpotency and helplessness, or, paradoxi¬cally, may represent the gaining of greatercontrol and power through the loss of con¬trol. This latter experience may be foundin hypnotized persons 57·65 or in audienceswho vicariously identify with the powerand omnipotence which they attribute to thehypnotist or demagogue. This is also thecase in mystical, revelatory, or spirit pos¬session states whereby the person relin¬quishes conscious control in the hope ofexperiencing divine truths, clairvoyance,"cosmic consciousness," communion with thespirits or supernatural powers, or servingas a temporary abode or mouthpiece for thegods.

D. Change in Emotional Expression.— With the diminution of conscious controlor inhibitions, there is often a marked changein emotional expression. Sudden and un¬

expected displays of more primitive andintense emotion than shown during normal,waking consciousness may appear. Emo¬tional extremes, from ecstasy and orgiasticequivalents to profound fear and depression,commonly occur.

There is another pattern of emotionalexpression which may characterize thesestates. The individual may become detached,uninvolved, or relate intense feelings with¬out any emotional display. The capacity forhumor may also diminish.

E. Body Image Change.—A wide arrayof distortions in body image frequently oc¬cur in ASCs. There is also a commonpropensity for individuals to experience a

profound sense of depersonalization, a schism

between body and mind, feelings of dereali-zation, or a dissolution of boundaries be¬tween self and others, the world, or universe.

When these subjective experiences arisefrom toxic or delerious states, auras preced¬ing seizures, or the ingestion of certaindrugs, etc, they are often regarded by theindividual as strange and even frightening.However, when they appear in a mysticalor religious setting, they may be interpretedas transcendental or mystical experiences of"oneness," "expansion of consciousness,""oceanic feelings," or "oblivion."

There are also some other common fea¬tures which might be grouped under thisheading. Not only may various parts of thebody appear or feel shrunken, enlarged, dis¬torted, heavy, weightless, disconnected,strange or funny, but spontaneous experi¬ences of dizziness, blurring of vision, weak¬ness, numbness, tingling, and analgesia arelikewise encountered.

F. Perceptual Distortions.—Common tomost ASCs is the presence of perceptualaberrations, including hallucinations, pseudo-hallucinations, increased visual imagery, sub¬jectively felt hyperacuteness of perception,and illusions of every variety. The contentof these perceptual aberrations may bedetermined by cultural, group, individual,or neurophysiological factors and representeither wish-fulfillment fantasies, the expres¬sion of basic fears or conflicts, or simplyphenomena of little dynamic import, suchas hallucinations of light, color, geometricalpatterns, or shapes. In some ASCs, suchas those produced by psychedelic drugs,marihuana, or mystical contemplation, synes-thesias may appear whereby one form ofsensory experience is translated into anotherform. For example, persons may reportseeing or feeling sounds or being able totaste what they see.

G. Change in Meaning or Significance.—At this point I should like to dwell some¬what on one of the most intriguing featuresof almost all ASCs, the understanding ofwhich will help us account for a numberof seemingly unrelated phenomena. Afterobserving and reading descriptions of a widevariety of ASCs induced by different agentsor maneuvers, I have become very impressed

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with the predilection of persons in thesestates to attach an increased meaning or

significance to their subjective experiences,ideas, or perceptions. At times, it appears as

though the person is undergoing an at¬tenuated "eureka" experience during whichfeelings of profound insight, illumination,and truth frequently occur. In toxic or

psychotic states, this increased sense ofsignificance may manifest itself in the at¬tributing of false significance to externalcues, ideas of reference, and the numerousinstances of "psychotic insight."

I should like to emphasize that this sense

of increased significance, which is primarilyan emotional or affectual experience, bearslittle relationship to the objective "truth"of the content of this experience.45 To il¬lustrate the ridiculousness of some of the"insights" attained during ASCs, I shouldlike to cite a personal experience when Ionce took LSD for experimental purposes.Sometime during the height of the reaction,I remember experiencing an intense desireto urinate. Standing by the urinal, I noticeda sign above it which read "Please FlushAfter Using!" As I weighed these wordsin my mind, I suddenly realized their pro¬found meaning. Thrilled by this startlingrevelation, I rushed back to my colleagueto share this universal truth with him. Un¬fortunately, being a mere mortal, he couldnot appreciate the world-shaking import ofmy communication and responded by laugh¬ing!

William James 66,(p 284) describes subjec¬tive experiences associated with other altera¬tions of consciousness. "One of the charms ofdrunkenness," he writes, "unquestionablylies in the deepening sense of reality andtruth which is gained therein. In whateverlight things may then appear to us, theyseem more utterly what they are, more

'utterly utter' than when we are sober."In his Varieties of Religious Experience,he adds:

Nitrous oxide and ether, especially nitrous oxide,when sufficiently diluted with air, stimulate themystical consciousness in an extraordinary degree.Depth upon depth of truth seems revealed to theinhaler. This truth fades out, however, or escapes,at a moment of coming to ; and if the words remain

over in which it seemed to clothe itself, they proveto be the veriest nonsense. Nevertheless, the senseof a profound meaning having been there persists ;and I know more than one person who is persuadedthat in the nitrous oxide trance we have a genuinemetaphysical revelation.67 <p 378)

H. Sense of the Ineffable.—Most often,because of the uniqueness of the subjectiveexperience associated with certain ASCs(eg, transcendental, aesthetic, creative, psy¬chotic, and mystical states), persons claima certain ineptness or inability to communi¬cate the nature or essence of the experienceto someone who has not undergone a similarexperience. Contributing to the sense ofthe ineffable is the tendency of persons todevelop varying degrees of amnesias fortheir experiences during profound alterationsof consciousness, such as the hypnotic trance,somnambulistic trance, possession fits,dreaming, mystical experiences, deliriousstates, drug intoxications, auras, orgiasticand ecstatic states, and the like. By no meansis amnesia always the case, as witnessedby the lucid memory following the psy¬chedelic experience, marihuana smoking, orcertain revelatory or illuminatory states.

/, Feelings of Rejuvenation.—Althoughthe characteristics of "rejuvenation" onlyhas limited application to the vast panoplyof ASCs, I have included this characteristicas a common denominator since it doesappear in a sufficient number of these statesto warrant attention. Thus, on emergingfrom certain profound alterations of con¬sciousness (eg, psychedelic experiences,abreactive states secondary to the administra¬tion of carbon dioxide, methamphetamine(Methedrine), ether or amytal, hypnosis,religious conversion, transcendental andmystical states, insulin coma therapy, spiritpossession fits, primitive puberty rites, andeven, on some occasions, deep sleep), manypersons claim to experience a new sense ofhope, rejuvenation, renaissance, or re¬birth 24,26,44,62,67-72

/. Hypersuggestibility.—Employing abroad view, I shall regard as manifestationsof hypersuggestibility in ASCs not onlythe numerous instances of "primary" and"secondary" suggestibility but also the in-

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creased susceptibility and propensity of per¬sons uncritically to accept and/orautomatically to respond to specific state¬ments (ie, commands or instructions of a

leader, shaman, demagogue, or hypnotist)or nonspecific cues (ie, cultural or groupexpectations for certain types of behavioror subjective feelings). Hypersuggestibilitywill also refer to the increased tendency ofa person to misperceive or misinterpretvarious stimuli or situations based either on

his inner fears or wishes.It is becoming increasingly apparent that

the phenomenon of suggestibility associatedwith ASCs can be best understood by analy¬sis of the subjective state itself. Recently,theoreticians seem to have become muchmore aware of the importance of the sub¬jective state to account for many of thephenomena observed in hypnotized persons.Orne, for example, stated that "an impor¬tant attribute of hypnosis is a potentiality forthe subject to experience as subjectively realsuggested alterations in his environmentthat do not conform with reality." 5(p 237)

Sutcliffe adds that "the distinguishing fea¬ture of this state is the hypnotized subject'semotional conviction that the world is as

suggested by the hypnotist, rather thana pseudoperception of the suggestedworld." 73<p 200>

In attempting to account for the dramaticfeature of hypersuggestibility, I believe thata better understanding of this phenomenoncan be gained through an analysis of some

of the subjective features associated withASCs in general. With the recession of a

person's critical faculties there is an at¬tendant decrease in his capacity for realitytesting or his ability to distinguish betweensubjective and objective reality. This, inturn, would tend to create the compensatoryneed to bolster up his failing faculties byseeking out certain props, support, or

guidance in an effort to relieve some of theanxiety associated with the loss of control.In his attempt to compensate for his failingcritical faculties, the person comes to relymore on the suggestions of the hypnotist,shaman, demagogue, interrogator, religioushealer, preacher, or doctor, all representingomnipotent authoritative figures. With the

"dissolution of self boundaries," which rep¬resents another important feature of ASCs,there would also be the tendency for theperson to identify vicariously with theauthoritarian figure whose wishes and com¬mands are accepted as the person's own.

Contradictions, doubts, inconsistencies, andinhibitions tend to diminish (all characteris¬tics of "primary process" thinking), andthe suggestions of the person endowed withauthority tend to be accepted as concretereality. These suggestions become imbuedwith even more importance and urgencyowing to the increased significance andmeaning attributed both to internal and ex¬

ternal stimuli during alterations in conscious¬ness.

With all these factors operating, a mono-

motivational or "supramotivational" state isachieved in which the person strives torealize in behavior the thoughts or ideaswhich he experiences as subjective reality.The subjective reality may be determinedby a number of influences working individual¬ly or in concert, such as the expectationsof the authority figure, the group, culture.or even by the "silent inner voice" (eg, dur¬ing autohypnotic states, prayer, auditoryhallucinations, guiding spirits) expressingthe person's own wishes or fears.

When a person lapses into certain otherASCs, such as panic, acute psychosis, toxicdelirium, etc, where external direction orstructure is ambiguous and ill-defined, theperson's internal mental productions tendto become his major guide for reality andplay a large role in determining behavior.In these instances, he is much more suscep¬tible to the dictates of his emotions and thefantasies and thoughts associated with themthan to the direction of others.

Functions of ASCsNow that we have considered certain

characteristics associated with ASCs, we

might raise the question whether they serve

any useful biological, psychological, or socialfunctions for man. It is my thesis that thevery presence and prevalence of these statesin man 71 attests to their importance in hiseveryday functioning. I find it difficult toaccept, for example, that man's ability to

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lapse into trance has been evolved just so

he can be hypnotized on stage or in a clinicalor laboratory setting. Moreover, the wide¬spread occurrence and use of mystical andpossession states or aesthetic and creativeexperiences indicates that these ASCs satisfymany needs both for man and society. Al¬though my thesis may prove teleological,I feel that this approach will shed some

further light on the nature and function ofthese states.

My viewpoint, then, is that ASCs mightbe regarded (to use Sherrington's termi¬nology) as "final common pathways" formany different forms of human expressionand experience, both adaptive and maladap-tive. In some instances the psychologicalregression found in ASCs will prove to beatavistic and harmful to the individual or

society, while in other instances the regres¬sion will be "in the service of the ego" 75

and enable man to transcend the bounds oflogic and formality or express repressedneeds and desires in a socially sanctionedand constructive way.

A. Maladaptive Expressions.—The mal-adaptive expressions or uses of ASCs arenumerous and manifold. The emergence ofthese ASCs may represent (a) attempts atresolution of emotional conflict (eg, fugues,amnesias, traumatic neuroses, depersonaliza-tion, and dissociation) ; (b) defensive func¬tions in certain threatening situationsconducive to the arousal of anxiety (eg,lapsing into hypnoidal states during psycho¬therapy 7e) ; (c) a breakthrough of forbiddenimpulses (eg, acute psychotic and panic re¬

actions) ; (d) escape from responsibilitiesand inner tensions (eg, narcotics, marihuana,alcohol) ; (e) the symbolic acting-out ofunconscious conflicts (eg, demoniacal pos¬session, bewitchment 37"39) ; (/) the manifes¬tation of self-destructive tendencies (eg, ragereactions on the battlefield, instances of voo¬doo death"); (g) the manifestation oforganic lesions or neurophysiological dis¬turbances (eg, auras, toxic conditions) ; and(h) an inadvertent and potentially dangerousresponse to certain stimuli (eg, highwayhypnosis, radar screen and sentry dutytrance).

B. Adaptive Expressions.—Man has em-

ployed a variety of ASCs in an effort toacquire new knowledge or experience, ex¬

press psychic tensions or relieve conflictwithout danger to himself or others, andto function more adequately and construc¬tively in society.

1. Healing: Throughout history, the pro¬duction of ASCs has played a major rolein the various healing arts and practices.The induction of these states has been em¬

ployed for almost every conceivable aspectof psychological therapy. Thus, shamansmay lapse into trance or possession statesin order to diagnose the etiology of theirpatients' ailments or to learn of specificremedies or healing practices.31 Moreover,during the actual treatment or healing cere¬

mony, the shaman, hungan, medicine man,priest, preacher, physician, or psychiatristmay view the production of an ASC inthe patient as a crucial prerequisite for heal¬ing. There are countless instances of healingpractices designed to take advantage of thesuggestibility, increased meaning, propensityfor emotional catharsis, and the feelings ofrejuvenation associated with ASCs. Theearly Egyptian and Greek practices of "incu¬bation" in their sleep temples, the faithcures at Lourdes and other religious shrines,the healing through prayer and meditation,cures by the "healing touch," the laying onof hands, encounters with religious relics,spiritual healing, spirit possession cures,exorcism, mesmeric or magnetic treatment,and modern day hypnotherapy are all ob¬vious instances of the role of ASCs in treat¬ment.21

Pharmacologically induced ASCs have al¬so played a major role in the healing arts.Abreactive or cathartic techniques, employ¬ing peyote, ether, COo amytal, methamphet-amine, and LSD-25 have all had wide usein psychiatry.23·78 Kubie and Margolin 79·80

have also commented on the therapeuticvalue of certain drugs to induce temporarydissociation and relieve repression.

Perhaps unrelated to the specific effectsof ASCs in treatment are the nonspecificeffects of certain other alterations in con¬

sciousness which aid in maintaining psychicequilibrium and health. For example, sleep,traditionally regarded as The Great Healer,

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and dreaming seem to serve important bio¬logical and psychological functions forman.81 The ASC associated with sexualorgasm might be considered as another bene¬ficial mental alteration which not only hasbiological survival value as a positive rein¬forcement for the sexual drive but alsoserves as an outlet for numerous human de¬sires and frustrations.

2. Avenues of New Knowledge or Experi¬ence : Man often has sought to induce ASCsin an effort to gain new knowledge, inspira¬tion, or experience. In the realm of religion,intense prayer, passive meditation, revelatoryand prophetic states, mystical and trans¬cendental experiences, religious conversion,and divination states have served man inopening new realms of experience, reaffirm¬ing moral values, resolving emotional con¬

flicts, and often enabling him to cope betterwith his human predicament and the worldabout him. It is also interesting to note thatamong many primitive groups, spirit posses¬sion is believed to impart a superhumanknowledge which could not possibly begained during waking consciousness. Suchparanormal faculties as superlative wisdom,the "gift of tongues," and clairvoyance are

supposedly demonstrated during the pos¬session fit.29

ASCs appear to enrich man's experiencesin many other areas of life. The intenseesthetic experience gained while absorbedin some majestic scene, a work of art, ormusic may broaden man's subjective experi¬ences and serve as a source of creative in¬spiration. There are also numerous instancesof sudden illumination, creative insights, andproblem solving occurring while man haslapsed into such ASCs as trance, drowsiness,sleep, passive meditation or drug intoxica¬tion.46

3. Social Function: ASCs occurring ina group setting seem to serve many in¬dividual and social needs. Although a briefdiscussion cannot do justice to the widevariety of functions which ASCs serve forvarious cultures, we can at least mentiona few.

If we may employ spirit possession as a

paradigm for the potential value of ASCs,we find that its social import and ramifica-

tions are considerable. From the individual'svantage point, possession by one of thetribal or local deities or Holy Spirit duringa religious ceremony would allow him toattain high status through fulfilling his cultrole, gain a temporary freedom of responsi¬bility for his actions and pronouncements,or enable him to act out in a socially sanc¬tioned way his aggressive and sexual con¬flicts or desires.82 Tensions and fears are

dissipated, and a new sense of spiritualsecurity and confidence may supplant thedespair and hopelessness of a marginalexistence.83

From society's standpoint, the needs ofthe tribe or group are met through itsvicarious identification with the entrancedperson who not only derives individual satis¬faction from divine possession but also actsout certain ritualized group conflicts andaspirations, such as the theme of death andresurrection, cultural taboos, and soon 24,28-30,83,84 Moreover, the dramatic be¬havioral manifestations of spirit possessionserve to convince the participants of thecontinued personal interest of their gods,reaffirm their local beliefs, allow them toexert some control over the unknown, en¬

hance group cohesion and identification, andendow the utterances of the entranced per¬son, shaman, or priest with an importancethey might otherwise not have if spoken inan ordinary setting. In general, the existenceof such practices represents an excellentexample of how society creates medes ofreducing frustration, stress and lonelinessthrough group action.

In conclusion, then, it appears the ASCsplay a very significant role in man's experi¬ence and behavior. It is also apparent thatthese states may serve as adaptive or mal-adaptive outlets for the expression of amultitude of man's passions, needs and de¬sires. Moreover, there is little question thatwe have hardly scratched the surface inunderstanding fully the facets and functionsof ASCs. As a final note, I should like toquote the very pertinent remarks of WilliamJames. 67(pp 378"379>

. .

. Our normal waking consciousness ... is butone special type of consciousness, whilst all about it,parted from it by the filmiest of screens, there liepotential forms of consciousness entirely different.

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We may go through life without suspecting theirexistence ; but apply the requisite stimulus, and ata touch they are all there in all their completeness,definite types of mentality which probably some¬where have their field of application and adapta¬tion. No account of the universe in its totalitycan be final which leaves these other forms ofconsciousness quite disregarded. How to regardthem is the question—for they are so discontinuouswith ordinary consciousness. Yet they may deter¬mine attitudes though they cannot furnish formulas,and open a region though they fail to give a map.At any rate, they forbid a premature closing of ouraccounts with reality.

SummaryDespite numerous clinical and research

reports on certain altered states of con¬sciousness, there has been little attempt toconceptualize the relationship among thesestates and the conditions necessary for theiremergence. To this end, the author hastried to integrate and discuss pertinent find¬ings from many diverse areas in an effortto gain a better understanding of these statesand the functions they serve for man andsociety.

As one views the many altered states ofconsciousness experienced by man, it soonbecomes apparent that there are a numberof essential conditions which contribute totheir emergence. Moreover, although theoutward manifestations and subjective ex¬

periences associated with various alterationsin consciousness may differ, there are anumber of basic features which most of thesestates share in common. From a functionalviewpoint, it also becomes clear that manyaltered states of consciousness serve as "finalcommon pathways" for many different formsof human expression, both maladaptive andadaptive.

Generic and Trade Names of DrugsAmobarbital—Amytal.Methamphetamine—Desoxyn, Mcthedrine.

REFERENCES1. Lindsey, D.B.: "Common Factors in Sensory

Deprivation, Sensory Distortion and Sensory Overload,"in Solomon, P., et al (eds.): Sensory Deprivation,Cambridge, Mass: Harvard University Press, 1961,pp 174-194.

2. Hebb, D.O.: The Motivating Effects of Extero-ceptive Stimulation, Amer Psychol 13:109-113, 1958.

3. Shor, R.E.: Hypnosis and the Concept of theGeneralized Reality-Orientation, Amer J Psychother13:582-602, 1959.

4. Burney, C.: Solitary Confinement, New York:Coward-McCann, Inc., 1952.

5. Meltzer, M.: "Solitary Confinement," in FactorsUsed to Increase the Susceptibility of Individuals toForceful Indoctrination, Group for the Advancementof Psychiatry Symposium No. 3, 1956.

6. Anderson, E.W.: Abnormal Mental States inSurvivors, With Special Reference to Collective Hallu-cinations, J Roy Nav Med Serv 28:361-377, 1942.

7. Gibson, W.: The Boat, Boston: Riverside Press,division of Houghton Mifflin Co., 1953.

8. Slocum, J.: Sailing Alone Around the World,London: Rupert Hart-Davis, 1948.

9. Byrd, R.E.: Alone, New York: G.P. Putnam'sSons, 1938.

10. Ritter, C.: A Woman in the Polar Night, NewYork: E.P. Dutton and Co., 1954.

11. Moseley, A.L.: Hypnogogic Hallucinations inRelation to Accidents, abstracted, Amer Psychol 8:8,1953.

12. Bennett, A.M.H.: "Sensory Deprivation in Avia-tion," in Solomon, P., et al (eds.): Sensory Depriva-tion, Cambridge, Mass: Harvard University Press,1961, pp 6-33.

13. Heron, W.: The Pathology of Boredom, SciAmer 196:52-56, 1957.

14. Heron, W.: "Cognitive and Physiological Effectsof Perceptual Isolation," in Solomon, P., et al (eds.):Sensory Deprivation, Cambridge, Mass: Harvard Uni-versity Press, 1961, pp 6-33.

15. Lilly, J.C.: Discussion, in Illustrative Strategieson Psychopathology in Mental Health, G.A.P. Sym-posium No. 2, 1956, pp 13-22.

16. Ziskind, E.: Isolation Stress in Medical andMental Illness, JAMA 168:1427-1430, 1958.

17. Boyd, D.A., Jr., and Norris, M.A.: DeliriumAssociated With Cataract Extraction, J Indiana MedAssoc 34:130-135, 1941.

18. Leiderman, H., et al: Sensory Deprivation:Clinical Aspects, Arch Intern Med 101:389-396, 1958.

19. Mendelson, J., et al: Hallucinations of polio-myelitis Patients During Treatment in a Respirator,J Nerv Ment Dis 126:421-428, 1958.

20. Bartlett, J.E.A.: A Case of Organized VisualHallucinations in an Old Man With Cataract, andTheir Relation to the Phenomena of the PhantomLimb, Brain 74:363-373, 1951.

21. Ludwig, A.M.: An Historical Survey of theEarly Roots of Mesmerism, lut J Clin Exp Hypn 12:205-217, 1964.

22. Williams, G.W. : "Hypnosis in Perspective," inLeCron, L.M. (ed.), Experimental Hypnosis, NewYork: Macmillan Co., 1958, pp 4-21.

23. Sargant, W.: Battle for the Mind, Garden City,NY: Doubleday & Co., Inc., 1957.

24. LaBarre, W.: They Shall Take Up Serpents,Minneapolis: University of Minnesota Press, 1962.

25. Marks, R.W.: The Story of Hypnotism, NewYork: Prentice-Hall, Inc., 1947.

26. Coe, G.A.: The Psychology of Religion, Chi¬cago: University of Chicago Press, 1916.

27. Kirkpatrick, C: Religion in Human Affairs,New York: John Urley and Sons, Inc., 1929.

28. Belo, J.: The Trance in Bali, New York: Colum¬bia University Press, 1960.

29. Field, M.J.: Search for Security: an Ethnopsy-chiatric Study of Rural Ghana, Evanston, 111: North¬western University Press, 1960.

30. Ravenscroft, K., Jr.: Voodoo Possession: ANatural Experiment in Hypnosis, Int J Clin Exp Hypn13:157-182, 1965.

31. Murphy, J.M.: "Psychotherapeutic Aspects ofShamanism on St. Lawrence Island, Alaska," in Kiev,A. (ed.): Magic, Faith and Healing, New York:Free Press of Glencoe, division of the Macmillan Co.,1964, pp 53-83.

32. Thomas, E.S.: The Fire Walk, Proc Soc PsychRes 42:292-309, 1934.

Downloaded From: http://archpsyc.jamanetwork.com/ by a Duke University User on 03/04/2014

33. Dodds, E.R.: The Greeks and the Irrational,Berkeley, Calif: University of California Press, 1963.

34. Mischelet, J.: Satanism and Witchcraft, NewYork: Citadel Press, 1939.

35. Ludwig, A.M., and Lyle, W.H., Jr.: TensionInduction and the Hyper-Alert Trance, J Abnorm SocPsychol 69:70-76, 1964.

36. Arieti, S., and Meth, J.M.: "Rare, Unclassifi-able, Collective and Exotic Psychotic Disorders," inArieti, S. (ed.): :American Handbook of Psychiatry,New York: Basic Books, 1959, vol 1, pp 546-566.

37. Galvin, J.A., and Ludwig, A.M.: A Case ofWitchcraft, J Nerv Ment Dis 133:161-168, 1961.

38. Jones, E.: On the Nightmare, New York:Grove Press, 1959.

39. Ludwig, A.M.: Witchcraft Today, Dis NervSyst 26:288-291, 1965.

40. Bowers, M.K.: Friend or Traitor? Hypnosis inthe Service of Religion, Int J Clin Exp Hypn 7:205-217, 1959.

41. Rund, J.: Prayer and Hypnosis, J Hypn PsycholDent 1:24, 1957.

42. Ludwig, A.M.: The Trance, read before the121st Annual Meeting of the American PsychiatricAssociation, New York, May 3-8, 1965.

43. Margolin, S.G., and Kubia, L.S.: An Apparatusfor the Use of Breath Sounds as a Hypnogogic Stimu-lus, Amer J Psychiat 100:610, 1944.

44. Bucke, R.M.: Cosmic Consciousness, New York:Dutton, E.P. & Co., 1951.

45. Ludwig, A.M.: The Formal Characteristics ofTherapeutic Insight, Amer J Psychother 20:305-318,1966.

46. Koestler, A.: The Act of Creation, New York:Macmillan Co., 1964.

47. Snyder, E.G.: Hypnotic Poetry, Philadelphia:University of Pennsylvania Press, 1930.

48. Hinkle, L.E., Jr.: "The Physiological State ofthe Interrogation Subject as It Affects Brain Function,"in Biderman, A.D., and Zimmer, H. (eds.): TheManipulation of Human Behavior, New York: JohnWiley & Sons, Inc., 1961, pp 19-50.

49. West, L.J., et al: The Psychosis of Sleep De-privation, Ann NY Acad Sci 96:66-70, 1962.

50. Tyler, D.: "Sleep Deprivation," in Factors Usedto Increase the Susceptibility of Individuals to ForcefulIndoctrination, G.A.P. Symposium No. 3, 1956, pp103-109.

51. Katz, S.E., and Landis, C.: Psychologic andPhysiologic Phenomena During a Prolonged Vigil,Arch Neurol Psychiat 34:307-316, 1935.

52. Wallace, A.F.C.: Cultural Determinants of Re-sponse to Hallucinatory Experience, Arch Gen Psychiat1:58-69, 1959.

53. Sarbin, T.R.: Contributions to Role-TakingTheory: I. Hypnotic Behavior, Psychol Rev 57:255-270, 1950.

54. White, R.W.: A Preface to a Theory of Hyp-notism, J Abnorm Soc Psychol 36:477-505, 1941.55. Orne, M.T.: The Nature of Hypnosis: Artifact

and Essence, J Abnorm Soc Psychol 58:277-299, 1959.56. Orne, M.T.: On the Social Psychology of the

Psychological Experiment: With Particular Referenceto Demand Characteristics, Amer Psychol 17:776-783,1962.

57. Kubia, L.S., and Margolin, S.G.: The Process ofHypnotism and the Nature of the Hypnotic State,Amer J Psychiat 100:611-622, 1944.

58. Levine, J.; Ludwig, A.M.; and Lyle, W.H., Jr.:The Controlled Psychedelic State, Amer J Clin Hypn6:163-164, 1963.

59. Levine, J., and Ludwig, A.M.: Alterations ofConsciousness Produced by Combinations of LSD,Hypnosis and Psychotherapy, Psychopharmacologia7:123-137, 1965.

60. Levine, J., and Ludwig, A.M.: The Hypnodelic

Treatment Technique, read before the Second Con-ference on The Use of LSD in Psychotherapy, Amity-ville, LI, NY, May 8-10, 1965.

61. Ludwig, A.M., and Levine, J.: Alterations inConsciousness Produced by Hypnosis, J Nerv MentDis 140:146-153, 1965.

62. Ludwig, A.M., and Levine, J.: Clinical Effectsof Psychedelic Agents, Clin Med, to be published.

63. Rapaport, D.: "Consciousness: A Psychopath-ological and Psychodynamic View," in Abramson,H.A. (ed.): Problems of Consciousness, New York:Josiah Macy, Jr. Foundation, 1951, pp 18-57.

64. Brenman, M.: "The Phenomena of Hypnosis,"in Abramson, H.A. (ed.): Problems of Consciousness,New York: Josiah Macy Jr., Foundation, 1950, pp123-163.

65. Gill, M.M., and Brenman, M.: Hypnosis andRelated States, New York: International UniversitiesPress, Inc., 1959.

66. James, W.: Outline of Psychology, New York:Dover Publications, Inc., 1950, vol 2.

67. James, W.: The Varieties of Religious Experi-ence, New York: Modern Library, 1929.

68. Blood, B.P.: The Anaesthetic Revelation andthe Gist of Philosophy, Amsterdam, NY, 1874.

69. Ebin, D. (ed.): The Drug Experience, NewYork: Orion Press, 1961.

70. Huxley, A.: The Doors of Perception, NewYork: Harper Bros., 1954.

71. LaBarre, W.: The Peyote Cult, Hamden, Conn:Shoe String Press, Inc., 1964.

72. Pahnke, W.N.: The Contribution of the Psy-chology of Religion to the Therapeutic Use of thePsychedelic Substances, read before the Second Con-ference on the Use of LSD in Psychotherapy, Amity-ville, LI, NY, May 8-10, 1965.

73. Sutcliffe, J.P.: "Credulous" and "Skeptical"Views of Hypnotic Phenomena: Experiments onEstesia, Hallucination, and Delusion, J Abnorm SocPsychol 62:189-200, 1961.

74. Shor, R.E.: The Frequency of Naturally Oc-curring "Hypnotic-like" Experiences in The NormalCollege Population, Int J Clin Exp Hypn 8:151-163,1960.

75. Kris, E.: Psychoanalytic Explorations in Art,New York: International Universities Press, Inc., 1952.

76. Dickes, R.: The Defensive Function of anAltered State of Consciousness, J Amer PsychoanalAssoc 13:356-402, 1965.

77. Cannon, W.B.: Voodoo Dealth, Amer Anthro-pol 44:169-181, 1942.

78. Freeman, T.: Some Comments on Views Under-lying the Use of Ether and Carbon Dioxide in Psy-chotherapy, Brit J Med Psychol 25:148-156, 1952.

79. Kubia, L.S.: The Value of Induced DissociatedStates in the Therapeutic Process, Proc Roy Soc Med38:681-683, 1945.

80. Margolin, S.G., and Kubia, L.S.: The Thera-peutic Role of Drugs in the Process of Repression,Dissociation and Synthesis, Psychosom Med 7:147-151, 1945.

81. Snyder, F., The New Biology of Dreaming,Arch Gen Psychiat 8:381-391, 1963.

82. Mischel, W., and Mischel, F.: PsychologicalAspects of Spirit Possession, Amer Anthropol 60:249-260, 1958.

83. Davidson, W.D.: Psychiatric Significance ofTrance Cults, read before the 121st Annual Meetingof the American Psychiatric Association, New York,May 3-7, 1965.

84. Deren, M.: "Religion and Magic in Haiti," inGarrett, E.J. (ed.): Beyond the Five Senses, NewYork: J. B. Lippincott Co., 1952, pp 238-267.

Downloaded From: http://archpsyc.jamanetwork.com/ by a Duke University User on 03/04/2014