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PubMed2000

The unconscious and psychosis. Some considerations on the psychoanalytic theory of psychosis.

The author contends that the various psychoanalytic theories and techniques employ different models of the unconscious, each relating to a different unconscious reality describable in terms of specific mental functions. He reviews in particular the Freudian dynamic unconscious, based on repression; the Kleinian unconscious, which adds the notions of unconscious fantasy and splitting of the object; Bion's conception of the unconscious as a mental function of which the subject is unaware but which can formulate thoughts and metabolise emotions; and the neuroscientific view of the unconscious as coinciding with that of which one is unaware and not with the Freudian repressed. The author thus distinguishes between the dynamic and the emotional unconscious and between 'unconscious' and 'unaware', and notes the role of distortion of the 'unaware' perceptions involved in the analytic relationship in the impasse situation. He is particularly concerned to show that, whereas neurosis involves the dynamic unconscious, psychosis alters the emotional unconscious, the entity underlying the sense of identity and the 'unaware' consciousness of existence. In psychosis the emotional unconscious is blinded, so that the patient is conscious but lacks awareness. The dynamic unconscious is also affected. After presenting two case histories, the author draws attention to the need for further clinical and theoretical research in this field.

Adult↗
PubMed2002

[The current conception of the unconscious - empirical results of neurobiology, cognitive sciences, social psychology and emotion research].

The influence of the unconscious on psychosomatic medicine and psychotherapy: a comprehensive concept of unconscious processes based on empirical evidence. The theory of the Unconscious constitutes the basis of psychoanalysis and of psychodynamic therapy. The traditional description of the Unconscious as given by Freud is of historical significance and not only gained widespread acceptance but also attracted much criticism. The most important findings of neurobiology, the cognitive sciences, social psychology and emotion research in relation to the Unconscious are compared with this traditional definition. Empirical observations on defence mechanisms are of particular interest in this context. A comprehensive concept of unconscious processes is revealed: the fundamental process of brain function is unconscious. Parts of the symbolic-declarative and emotional-procedural processing by the brain are permanently unconscious. Other parts of these processing procedures are conscious or can be brought to the conscious or alternatively, can also be excluded from the conscious. Unconscious processes exert decisive influence on experience and behaviour; for this reason, every form of psychotherapy should take into account such unconscious processes.

Brain↗
PubMed1988

Testing hypotheses about unconscious mental functioning.

Three research studies were designed to test the explanatory powers of two broad psychoanalytic hypotheses about the nature of unconscious mental functionings. Both hypotheses bear directly on the psychoanalytic theory of therapy. The first, the Dynamic hypothesis, assumes that unconscious mental life is determined by the dynamic interactions of unconscious forces that take place in accordance with the pleasure principle beyond the patient's control. The second, the Unconscious Control hypothesis, while not excluding unconscious dynamic interactions, assumes that the patient unconsciously may use his higher mental functions and that he exerts a certain degree of control over his unconscious mental life. He uses this control to develop goals, to test the therapist (and at the same time his pathogenic beliefs), and to regulate the coming forth of repressed mental contents, bringing them forth when he unconsciously decides that he could safely experience them. The studies demonstrate that quantitative, reliable research methods can be used to test basic psychoanalytic hypotheses about the nature of unconscious mental functioning. The findings are compatible with the Unconscious Control hypothesis as described above.

Adult↗
PubMed2000

Physostigmine reverses propofol-induced unconsciousness and attenuation of the auditory steady state response and bispectral index in human volunteers.

BACKGROUND: It is postulated that alteration of central cholinergic transmission plays an important role in the mechanism by which anesthetics produce unconsciousness. The authors investigated the effect of altering central cholinergic transmission, by physostigmine and scopolamine, on unconsciousness produced by propofol. METHODS: Propofol was administered to American Society of Anesthesiologists physical status 1 (n = 17) volunteers with use of a computer-controlled infusion pump at increasing concentrations until unconsciousness resulted (inability to respond to verbal commands, abolition of spontaneous movement). Central nervous system function was assessed by use of the Auditory Steady State Response (ASSR) and Bispectral Index (BIS) analysis of electrooculogram. During continuous administration of propofol, reversal of unconsciousness produced by physostigmine (28 microgram/kg) and block of this reversal by scopolamine (8.6 microgram/kg) were evaluated. RESULTS: Propofol produced unconsciousness at a plasma concentration of 3.2 +/- 0.8 (+/- SD) microgram/ml (n = 17). Unconsciousness was associated with reductions in ASSR (0.10 +/- 0.08 microV [awake baseline 0.32 +/- 0.18 microV], P < 0.001) and BIS (55.7 +/- 8.8 [awake baseline 92.4 +/- 3.9], P < 0.001). Physostigmine restored consciousness in 9 of 11 subjects, with concomitant increases in ASSR (0.38 +/- 0.17 microV, P < 0.01) and BIS (75.3 +/- 8.3, P < 0.001). In all subjects (n = 6) scopolamine blocked the physostigmine-induced reversal of unconsciousness and the increase of the ASSR and BIS (ASSR and BIS during propofol-induced unconsciousness: 0.09 +/- 0.09 microV and 58.2 +/- 7.5, respectively; ASSR and BIS after physostigmine administration: 0.08 +/- 0.06 microV and 56.8 +/- 6.7, respectively, NS). CONCLUSIONS: These findings suggest that the unconsciousness produced by propofol is mediated at least in part via interruption of central cholinergic muscarinic transmission.

Adolescent↗
PubMed2005

A theory of blindsight--the anatomy of the unconscious: a proposal for the koniocellular projections and intralaminar thalamus.

This paper extends the concepts introduced by the theory of premotor relations to unconscious cognitive mechanisms. According to the theory conscious mechanisms are associated with behavioural diversity, whereas unconscious output is proposed to have an obligatory association with stereotypical behaviour. The respective processes are by definition a function of the type of reafferent motor input. Concepts of simple and complex premotor networks are introduced as a means of describing unconscious and conscious processes, respectively. Evidence shows that unconscious cognitive performance differs qualitatively from conscious mechanisms suggesting parallel processes. Although the postulated anatomical substrates for conscious and unconscious processes will function in this model as parallel segregated networks, it is proposed they are distributed throughout the same cortical areas of the brain. Motor reafference is postulated to be mediated via pallidal projections to the thalamic reticular nucleus, which is known to modulate thalamocortical pathways. The role of the koniocellular pathway of the lateral geniculate nucleus remains an enigma and has some properties in common with the well-described magnocellular and parvocellular projections. There is also much speculation about the intralaminar and midline nuclei, the so-called non-specific thalamus. The paper will examine the distinctive features of thalamocortical networks and the role of the koniocellular pathway and intralaminar nuclei (ILN) of the thalamus and suggest that they form a neuroanatomical substrate for the categorizing of unconscious cognitive processes. The ILN has unique projections back to the basal ganglia, which could serve in constraining associated neocortical networks with stereotypical behaviour and thus putative unconscious processing. Only after establishing such a theoretical framework can one hope to successfully analyze the empirical literature on the syndrome of blindsight, of which a detailed account is presented. Blindsight refers to the apparent visual abilities of patients with damage to the striate visual cortex (VI). Patients will 'guess' the shape of an object or reach towards it when presented in the blind field, in spite of denying actually seeing it, i.e., they are unconsciously aware of it. Unlike the magnocellular and parvocellular geniculate pathways the koniocellular extrastriate projections partially conserve retinal information in these patients. Could the proposed network represent an anatomical model of the Freudian subconscious?

Blindness, Cortical↗
PubMed2002

Conscious and unconscious uses of memory in multiple sclerosis.

Conscious and unconscious uses of memory and priming were studied in 30 patients with multiple sclerosis (MS) and 15 normal control (NC) subjects. MS patients were classified into two subgroups according to their cognitive status; 15 of them were cognitively deteriorated (the MS-D group) and 15 cognitively preserved (the MS-P group). A process dissociation procedure [J. Mem. Lang. 30 (1991) 513] was used to separate conscious and unconscious memory performance in a word stem completion task. The results showed that the MS-D group had deficient conscious memory performance, but had intact unconscious memory as well as priming. The MS-P group showed normal conscious and unconscious uses of memory and priming. Thus, in MS-related cognitive decline, conscious memory seems to be vulnerable, whereas unconscious memory remains intact. The results provide neuropsychological support for the distinction between conscious and unconscious memory processes. Moreover, the results show the importance of studying cognitively homogenous MS groups as opposed to heterogenous ones, in order to find the underlying mechanisms of memory deficits in MS. Interestingly, the neural systems needed for the unconscious use of memory do not seem to deteriorate even in MS patients with deficient overall cognitive capacity. This finding encourages the development of future rehabilitation programs, suggesting that unconscious remembering might help MS patients with deficient conscious memory to cope with their daily activities.

Adult↗
PubMed2006

Comparison of carbon dioxide, argon, and nitrogen for inducing unconsciousness or euthanasia of rats.

We compared CO(2), Ar, and N(2) for inducing unconsciousness and euthanasia of Sprague-Dawley rats. We determined time to unconsciousness and monitored heart rate (HR) and mean arterial blood pressure (MAP) by radiotelemetry to assess stress, recovery after exposure, and time of death. Unconsciousness (mean +/- standard error) occurred 24 +/- 3, 87 +/- 8, and 93 +/- 8 s after short-term exposure to CO(2), Ar, and N(2), respectively. During exposure, CO(2) depressed HR, whereas Ar and N(2) increased HR. Upon removal from the chamber, rats' HR rapidly normalized after CO(2) or N(2) but remained elevated for 60 min after Ar. During exposure, all agents depressed MAP, which returned to resting levels 10 to 50 min after rats' removal from the chamber. For euthanasia, CO(2) at approximately 100% induced unconsciousness in 37 +/- 3 s, increased and then depressed MAP and HR, and caused death at 188 +/- 15 s. CO(2) at approximately 30% induced unconsciousness in 150 +/- 15 s, decreased HR and MAP, and induced death at 440 +/- 9 s. Ar at approximately 100% increased MAP but decreased HR, induced unconsciousness with hyperreflexia at 54 +/- 4 s, and caused death at 197 +/- 20 s. N(2) at approximately 100% decreased MAP but not HR and produced unconsciousness with hyperreflexia at 164 +/- 17 s and death at 426 +/- 28 s. We conclude that CO(2) effectively produced unconsciousness and euthanasia, but we were unable to ascertain distress. Ar also appears effective but produced hyperreflexia and tachycardia. N(2) was ineffective.

Animals↗
PubMed2003

Impaired thalamocortical connectivity in humans during general-anesthetic-induced unconsciousness.

Whereas converging lines of evidence suggest that anesthetic-induced unconsciousness may result from disruption of functional interactions within neural networks involving the thalamus and cerebral cortex, the effects anesthetics have on human thalamocortical connectivity remain unexamined with current neuroimaging techniques. To address this issue we retrospectively analyzed positron emission tomography data from 11 volunteers scanned for regional cerebral glucose utilization (rCMRglu) when awake and again during isoflurane- (n = 6) or halothane- (n = 5) induced unconsciousness using statistical parametric mapping (SPM99) and structural equation modeling. A main effect analysis, contrasting awake and unconscious metabolic activity, localized a discrete region of the left va/vl thalamus whose relative rCMRglu activity was significantly suppressed (P < 0.05, corrected) during the unconscious state. To identify brain regions whose functional connectivity with this region of the thalamus was impaired during the unconscious state, a psychophysiological interaction analysis was performed. This analysis revealed effects predominantly in topographically related areas of the primary motor and supplementary motor association cortices. Structural equation modeling of a neuroanatomical network encompassing these empirically identified regions revealed significant state-related changes in effective connectivity (chi(2)diff (6)-15.88; P < 0.05) which primarily involved impairment of thalamocortical and corticocortical projections during the unconscious state. These findings support the hypothesis that a mechanistic component underlying general-anesthetic-induced unconsciousness involves disruption of functional interactions within thalamocortical neural networks.

Anesthesia, General↗
PubMed1996

Unconscious fantasy in psychotherapy.

Recent decades have seen the growth of an extensive literature reassessing the nature and role of unconscious fantasy. While this literature represents a wide range of psychodynamic theories, some consistent themes have emerged: A comprehension of unconscious fantasy as a pervasive molder of all perception and meaning; a recognition of the stabilizing, anxiety-damping role of unconscious fantasy; a valuation of symptoms as the maladaptive intrusion of unconscious fantasy into everyday life; and a view of progress in psychotherapy as entailing modifications in the structure and/or penetrance of dominant fantasies. The broad-based interest in unconscious fantasy reflects a wide consensus that a focus on unconscious fantasy promises to establish a more solid epistemological foundation for psychodynamic theory, to relate more immediately psychodynamic theory to clinical observation, including providing more incisive and comprehensive insights into motivation, and to yield a more profound understanding of the nature of the therapeutic process and the dynamics of psychological growth. While there is some consensus on the ineluctable molding of perception and memory by unconscious fantasy, questions remain concerning the relationship of an event to its psychological integration, most notably questions regarding to what extent particular traumas yield distinctive patterns of fantasy and pathology. Further answers to these questions will provide deeper insights into how fantasy shapes our path through the world and how that path may be redirected by psychotherapy.

Drive↗
PubMed1995

The unconscious experience.

BACKGROUND: Although considerable research has been done on pathophysiology, metabolic and physical causes, and prognostic indicators, little is known about unconsciousness or coma from the perspective of the patient. OBJECTIVE: To describe the experiences of patients who were once documented as being unconscious. METHODS: Phenomenologic interviews were conducted with 100 patients whose records indicated that they had been unconscious during hospitalization. Interviews were also attempted with primary family members, significant others, or other external observers. Chart audits documenting the unconscious episode, medications, and diagnoses were also carried out. Data were compared, using van Kaam's method, and contrasted. RESULTS: Patients experienced one or more of five states: unconsciousness, inner consciousness, perceived unconsciousness, distorted consciousness, and paranormal experiences. They described hearing, understanding, and responding emotionally to what was being said when it was assumed they were not aware. In addition, 23 subjects reported near-death experiences or visits, out-of-body experiences, or some other paranormal experience. CONCLUSION: Patients' unconscious experiences can cause long-term effects. Patients often need reassurance that other patients subjected to similar conditions also have these experiences.

Auditory Perception↗
PubMed2005

Measuring unconscious knowledge: distinguishing structural knowledge and judgment knowledge.

This paper investigates the dissociation between conscious and unconscious knowledge in an implicit learning paradigm. Two experiments employing the artificial grammar learning task explored the acquisition of unconscious and conscious knowledge of structure (structural knowledge). Structural knowledge was contrasted to knowledge of whether an item has that structure (judgment knowledge). For both structural and judgment knowledge, conscious awareness was assessed using subjective measures. It was found that unconscious structural knowledge could lead to both conscious and unconscious judgment knowledge. When structural knowledge was unconscious, there was no tendency for judgment knowledge to become more conscious over time. Furthermore, conscious rather than unconscious structural knowledge produced more consistent errors in judgments, was facilitated by instructions to search for rules, and after such instructions was harmed by a secondary task. The dissociations validate the use of these subjective measures of conscious awareness.

Adult↗
PubMed2004

Unconsciousness and delirious behavior in children with febrile seizures.

The aim of this study is to clarify the incidence and clinical features of prolonged unconsciousness and delirious behavior in children with febrile seizures. We studied 213 consecutive febrile seizures during 208 febrile episodes in 203 patients. The seizure manifestations, the duration of seizures, the duration of unconsciousness, and the presence or absence of delirious behavior were determined on the basis of interviews with the parents with the assistance of medical records. The duration of seizures was less than 5 minutes in 90.2% of the seizures. The duration of unconsciousness was less than 30 minutes in 93% of the seizures. Delirious behavior was observed in 2.0% of the patients. Delirious behavior appeared before febrile seizures, and its duration was not long. On multiple regression analysis, nongeneralized seizures, seizures of >/=5 minutes, and intravenous diazepam were demonstrated to be independently associated with prolonged unconsciousness. In conclusion, prolonged unconsciousness and delirious behavior are rare in children with febrile seizures. Careful diagnostic evaluation is necessary when a child with febrile seizures has associated prolonged unconsciousness or delirious behavior.

Child↗
PubMed1992

Unconscious influences revealed. Attention, awareness, and control.

Recent findings of dissociations between direct and indirect tests of memory and perception have renewed enthusiasm for the study of unconscious processing. The authors argue that such findings are heir to the same problems of interpretation as are earlier evidence of unconscious influences--namely, one cannot eliminate the possibility that conscious processes contaminated the measure of unconscious processes. To solve this problem, the authors define unconscious influences in terms of lack of conscious control and then describe a process dissociation procedure that yields separate quantitative estimates of the concurrent contributions of unconscious and consciously controlled processing to task performance. This technique allows one to go beyond demonstrating the existence of unconscious processes to examine factors that determine their magnitude.

Attention↗