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PubMed1980

Care of the unconscious patient: a complementary perspective.

The literature associated with the care of the unconscious patient tends to concentrate on aspects of care relevant to the maintenance of the patient's equilibrium within a medical or surgical context (Atkinson 1970, Roper 1973, Ayres 1974, Burrell & Burrell 1977, Rhodes 1977). The importance of maintaining such an equilibrium is beyond dispute, but the difficulty of understanding what unconsciousness is becomes a contributory factor towards inhibiting the nurse from extending the same totality of care she would offer the conscious patient, to one who is unconscious. The writers draw parallels between features of the world of 'booming, buzzing confusion' often postulated for the neonate, and those of the unconscious patient. They claim that despite perceptual and other similarities, the framework of care instituted for the unconscious patient lacks the social dimension normally expected to be available to the infant. Care of the unconscious patient suffers from fragmentation because of its emphasis on the physical.

Comprehensive Health Care↗
PubMed2006

Implicit memory and early unrepressed unconscious: their role in the therapeutic process (how the neurosciences can contribute to psychoanalysis).

The author discusses memory from the point of view of the neurosciences and molecular biology, proposing an integration with the psychoanalytic theory of the unconscious. The discovery of the implicit memory has extended the concept of the unconscious and supports the hypothesis that this is where the emotional and affective--sometimes traumatic--presymbolic and preverbal experiences of the primary mother-infant relations are stored. They could form the ground structure of an early unrepressed unconscious nucleus of the self. Identifying the unconscious with the memory leads to a theory about its morpho-functional organization. The unrepressed unconscious can be brought to the surface in analysis through the 'musical dimension' of the transference, characterized by the voice (its intonation and rhythm) and the prosody of the language. Dreams can symbolically transform pre-symbolic and preverbal experiences, so that they can be put into words and thought about even without their recollection. Dreams can also create images to fi ll the gap of the absence of representation which characterize the unrepressed unconscious. The description of a segment of analysis of a patient suffering from death anxiety provides a clinical illustration of the theories discussed. The interpretation of her voice and of the prosody of her language, besides the work on dreams, reproduced the emotional essence of the analysand's traumatic childhood experiences. This reconstruction enabled her to speak and think about them even without the actual recollection.

Adult↗
PubMed1987

Narcissism and unconscious communication.

In this paper I suggest that analytical material implicitly carries in it a message proceeding from the unconscious and which is transmitted through representations. The message is expressed only when the object is recognized as such by the subject. In the narcissistic situation the unconscious message is not emitted. The analysis of the analytical discourse shows that the narcissistic subject does not recognize the other as the object of the unconscious dialogue. Narcissism reaches its maximum expression in material empty of unconscious meaning. Narcissism is accomplished only by the collaboration of a subject and an object who have established a tie with the aim of maintaining the illusion that this subject can dispense with all objects. This tie is set up on the patient's side by means of the discourse empty of unconscious meaning and on the analyst's side by the pseudo-interpretation. The narcissistic self-esteem resides in the complacency which the patient obtains by keeping the verbal account deprived of unconscious meaning. When the analyst fails to show up the narcissistic resistance, he contributes to the establishment of this pathological self-valuation. Narcissistic regressions always include identifications and in this they differ from the anobjectal stage that regression attempts to reach.

Adolescent↗
PubMed1980

[The unconscious and hypnosis].

Hypnosis and the unconscious: both fields equally obscure, giving rise to broad plurality of conceptions. The only point we may assert with any certainty is that they are closely linked. Historically, experiments on post-hypnotic suggestion were in fact the starting point for the discovery of the unconscious. Post-hypnotic suggestion is in effect one of the most irrefutable proofs that psychical contents can influence behaviour, albeit eluding the subject's consciousness. In this paper, we provide a description of Soviet researchers' conceptions of the unconscious, and of the point of view from which they approach hypnotic phenomena. We then study psychoanalytical theories on hypnosis, which are essentially based on transference. We show why this notion seems to us powerless to account for the specific nature of the hypnotic relationship. There is, in effect, a psycho-physiological dimension of hypnosis. It lies at the crossroads between the instrumental and the relational. But we know nothing about what unconscious processes hide at the psycho-physiological level. Psychoanalysis has brought to light the laws governing the functioning of unconscious representations. But the realm of the affect, the non-verbal, the corporal still remains beyond our knowledge. This is a hidden side of the unconscious, in relation to which hypnosis may serve as another "royal way". Finally, we point out a few directions now opening up for hypnotic research work in this perspective.

Adult↗
PubMed1995

Measuring the relative magnitude of unconscious influences.

As an alternative to establishing awareness thresholds, stimulus contexts in which there were either greater conscious or greater unconscious influences were defined on the basis of performance on an exclusion task. Target words were presented for brief durations and each target word was followed immediately by its three-letter stem. Subjects were instructed to complete each stem with any word other than the target word. With this task, failures to exclude target words indicate greater unconscious influences, whereas successful exclusion indicates greater conscious influences. Conscious influences were dominant at long durations (e.g., 214 ms), but unconscious influences were dominant at short durations (e.g., 50 ms). Performance on the exclusion task successfully predicted both qualitative differences in Stroop priming and qualitative differences in recognition memory previously associated with the different effects of conscious and unconscious influences. Taken together, these results demonstrate that an exclusion task allows both unconscious and conscious influences to be defined in terms of significant deviations from baseline performance. As such, exclusion tasks provide a method for distinguishing conscious from unconscious influences that does not require establishing thresholds for null awareness.

Adult↗
PubMed2004

The relational unconscious: a core element of intersubjectivity, thirdness, and clinical process.

The relational unconscious is the fundamental structuring property of each interpersonal relation; it permits, as well as constrains, modes of engagement specific to that dyad and influences individual subjective experience within the dyad. Three usages of the concept of thirdness are delineated and contrasted with the concept of the relational unconscious, which, it is suggested, has the advantage of being both consistent with existing views of unconscious processes and more directly applicable to therapeutic concerns. Enactments and intersubjective resistances are viewed as clinical manifestations of the relational unconscious, and the therapeutic action of psychoanalysis results, in part, from altering the structure of the relational unconscious that binds analysand and analyst.

Humans↗
PubMed2000

Toward a unified theory of narcosis: brain imaging evidence for a thalamocortical switch as the neurophysiologic basis of anesthetic-induced unconsciousness.

A unifying theory of general anesthetic-induced unconsciousness must explain the common mechanism through which various anesthetic agents produce unconsciousness. Functional-brain-imaging data obtained from 11 volunteers during general anesthesia showed specific suppression of regional thalamic and midbrain reticular formation activity across two different commonly used volatile agents. These findings are discussed in relation to findings from sleep neurophysiology and the implications of this work for consciousness research. It is hypothesized that the essential common neurophysiologic mechanism underlying anesthetic-induced unconsciousness is, as with sleep-induced unconsciousness, a hyperpolarization block of thalamocortical neurons. A model of anesthetic-induced unconsciousness is introduced to explain how the plethora of effects anesthetics have on cellular functioning ultimately all converge on a single neuroanatomic/neurophysiologic system, thus providing for a unitary physiologic theory of narcosis related to consciousness.

Adolescent↗
PubMed2004

A hemispheric asymmetry for the unconscious perception of emotion.

Previous research has demonstrated that hemispheric asymmetries for conscious visual perception do not lead to asymmetries for unconscious visual perception. These studies utilized emotionally neutral items as stimuli. The current research utilized both emotionally negative and neutral stimuli to assess hemispheric differences for conscious and unconscious visual perception. Conscious perception was measured using a subjective measure of awareness reported by participants on each trial. Unconscious perception was measured by an "exclusion task," a form of word-stem-completion task. Consistent with predictions, negative stimuli were consciously perceived most often when presented to the right hemisphere. Negative stimuli presented to the right hemisphere showed no evidence of unconscious perception, suggesting that the hemispheric asymmetry for the conscious perception of negative information occurs at the expense of unconscious perception.

Adult↗
PubMed2004

Individual differences in trait anxiety predict the response of the basolateral amygdala to unconsciously processed fearful faces.

Responses to threat-related stimuli are influenced by conscious and unconscious processes, but the neural systems underlying these processes and their relationship to anxiety have not been clearly delineated. Using fMRI, we investigated the neural responses associated with the conscious and unconscious (backwardly masked) perception of fearful faces in healthy volunteers who varied in threat sensitivity (Spielberger trait anxiety scale). Unconscious processing modulated activity only in the basolateral subregion of the amygdala, while conscious processing modulated activity only in the dorsal amygdala (containing the central nucleus). Whereas activation of the dorsal amygdala by conscious stimuli was consistent across subjects and independent of trait anxiety, activity in the basolateral amygdala to unconscious stimuli, and subjects' reaction times, were predicted by individual differences in trait anxiety. These findings provide a biological basis for the unconscious emotional vigilance characteristic of anxiety and a means for investigating the mechanisms and efficacy of treatments for anxiety.

Adult↗
PubMed1999

Unconscious processes, subliminal stimulation, and anxiety.

Ever since Poetzl's studies, subliminal stimulation has been used as a paradigm to explore the connection between unconscious processes and psychopathology. Inspired by the psychodynamic tradition, folk psychology attributes a dramatic power to subliminal stimulation. In contrast, most modern researchers argue that effects of subliminal stimulation are rather limited. Does that mean that the unconscious is irrelevant to psychopathology? Not necessarily. Ohman and Soares' hypothesis about the preattentive origins of phobic reactions represents a good example of a model in which a "quick and dirty" unconscious may produce pathogenic effects. Although the empirical basis of this model is still meagre, its attractiveness hinges on the assumption that "quick and dirty" processes that make up the first second of human information processing are essential for higher level analysis and performance. In line with this, recent studies have indicated that the attentional bias that accompanies pathological anxiety, might be an unconscious phenomenon. Theories that focus on unconscious cognitive processes involved in pathological anxiety are certainly interesting, but it should be emphasized that there are other aspects of automaticity (i.e., involuntariness) that may be as relevant to psychopathology as absence of awareness.

Anxiety↗
PubMed1992

Is the unconscious smart or dumb?

How sophisticated is unconscious cognition? This is one of the most fundamental questions about the unconscious that has been posed by research psychologists over the past century. Anthony Greenwald takes a contemporary look at this classical problem and concludes that unconscious cognition is severely limited in its analytic capability. In response, other leading scholars agree that the reality of unconscious processes is no longer questionable. Although there is some disagreement about just how sophisticated these processes are, the consensus is that exciting times are ahead for both research and theory concerning the mental processes involved in unconscious cognition.

Freudian Theory↗
PubMed1994

Unconscious perception: attention, awareness, and control.

Conscious perception is substantially overestimated when standard measurement techniques are used. That overestimation has contributed to the controversial nature of studies of unconscious perception. A process-dissociation procedure (L. L. Jacoby, 1991) was used for separately estimating the contribution of conscious and unconscious perception to performance of a stem-completion task. Unambiguous evidence for unconscious perception was obtained in 4 experiments. In Experiment 1, decreasing the duration of a briefly presented word diminished the contribution of both conscious and unconscious perception. In Experiments 2-4, dividing attention reduced the contribution of conscious perception while leaving that of unconscious perception unchanged. Discussion focuses on the measurement of awareness and the relation between perception and memory.

Attention↗
PubMed2004

Think different: the merits of unconscious thought in preference development and decision making.

The role of unconscious and conscious thought in decision making was investigated in 5 experiments. Because of the low processing capacity of consciousness, conscious thought was hypothesized to be maladaptive when making complex decisions. Conversely, unconscious thought was expected to be highly effective. In Experiments 1-3, participants were presented with a complex decision problem in which they had to choose between various alternatives, each with multiple attributes. Some participants had to make a decision immediately after being presented with the options. In the conscious thought condition, participants could think about the decision for a few minutes. In the unconscious thought condition, participants were distracted for a few minutes and then indicated their decision. Throughout the experiments, unconscious thinkers made the best decisions. Additional evidence obtained in Experiments 4 and 5 suggests that unconscious thought leads to clearer, more polarized, and more integrated representations in memory.

Adult↗
PubMed1994

Histopathologic consequences of moderate concussion in an animal model: correlations with duration of unconsciousness.

Although duration of unconsciousness is commonly used as a prognostic index following traumatic brain injury (TBI), few controlled studies have statistically evaluated the relationship between unconsciousness and histologic pathology, particularly after moderate head injury. Using a pendulum-striker concussive device, a reproducible model of TBI in rats was developed. This model is uncomplicated by skull fractures, contusions, or experimenter-induced craniotomies. In the present study, the severity of the histopathology observed in this model of moderate closed-head injury at 48 h posttrauma is linearly related to the duration of unconsciousness (p < 0.0001). The pathology, assessed with a silver stain for neurodegeneration, is particularly striking if unconsciousness persists for 4 minutes or more. These data suggest that the initial period of unconsciousness may be a useful predictor of clinical brain histopathology associated with moderate closed-head injury, predicting either the degree of pathology and/or the rate it progresses if left untreated.

Animals↗
PubMed1998

Analysis of the EEG bispectrum, auditory evoked potentials and the EEG power spectrum during repeated transitions from consciousness to unconsciousness.

We have compared the auditory evoked potential (AEP) index (a numerical index derived from the AEP), 95% spectral edge frequency (SEF), median frequency (MF) and the bispectral index (BIS) during alternating periods of consciousness and unconsciousness produced by target-controlled infusions of propofol. We studied 12 patients undergoing hip or knee replacement under spinal anaesthesia. During periods of consciousness and unconsciousness, respective mean values for the four measurements were: AEP index, 60.8 (SD 13.7) and 37.6 (6.5); BIS, 85.1 (8.2) and 66.8 (10.5); SEF, 24.2 (2.2) and 18.7 (2.1); and MF, 10.9 (3.3) and 8.8 (2.0). Threshold values with a specificity of 100% for a state of unconsciousness were: AEP index, 37 (sensitivity 52%); BIS, 55 (sensitivity 15%); and SEF, 16.0 (sensitivity 9%). There was no recorded value for MF that was 100% specific for unconsciousness. Of the four measurements, only AEP index demonstrated a significant difference (P < 0.05) between all mean values 1 min before recovery of consciousness and all mean values 1 min after recovery of consciousness. Our findings suggest that of the four electrophysiological variables, AEP index was best at distinguishing the transition from unconsciousness to consciousness.

Aged↗
PubMed1998

Prehospital pulseless, unconscious penetrating trauma victims: field assessments associated with survival.

BACKGROUND: This study was designed to determine whether out-of-hospital clinical signs could be associated with functional survival for pulseless, unconscious victims of penetrating trauma. METHODS: A retrospective review of medical data and outcome for pulseless, unconscious penetrating urban trauma victims during 1993-1994. For comparison with the penetrating study group, data for blunt pulseless, unconscious trauma victims for the same period are reported. Logistic regression, odds ratios, positive predictive values, sensitivity, and specificity were used to determine the possible association of field clinical signs with survival. RESULTS: A total of 879 penetrating and blunt trauma victims met criteria of the study. Four of 497 victims of penetrating injury survived. Three of the four survivors were neurologically intact, with the remaining survivor impaired but functional in a supervised work setting. All survivors of penetrating trauma had monitored cardiac electrical (sinus rhythm or sinus tachycardia) activity on presentation in the field, and three were stabbing victims. Age, total field treatment time, spontaneous respiration, reactive pupils, and return of pulse in the field were not found to be associated with survival. Four victims of penetrating injury survived long enough to donate perfused asystolic-sensitive (kidney, liver, lung, and pancreas) organs. There were 382 victims of blunt injury that met study inclusion criteria with five survivors. None of the five survivors of blunt injury had good neurologic function. CONCLUSION: Functional survival was rare but did occur with penetrating trauma presenting pulseless and unconscious in the out-of-hospital setting. Although the presence of a pulseless sinus rhythm or tachycardia and stabbing as a mechanism seemed to indicate better survival rates, our study failed to identify reliable out-of-hospital criteria to separate salvageable penetrating trauma victims from those who are nonsalvageable. With this lack of reliable criteria, aggressive prehospital resuscitation efforts and rapid transport to the nearest trauma center for pulseless, unconscious victims of penetrating injury seem indicated.

Adolescent↗
PubMed2004

The mind beyond our immediate awareness: Freudian, Jungian, and cognitive models of the unconscious.

Several branches of cognitive science now focus on the nature of the unconscious. This paper explores some of the findings and models from this research. By introducing formulations based on non-clinical data, the cognitive scientists--in neural linguistics, computational modelling, and neuroscience--may depart from the older psychoanalytic formulations. An understanding of unconscious neural processes is nevertheless emerging showing how synapses are modified by experience and how learning, conscious and unconscious, is due to this important aspect of brain plasticity. Freud and Jung's formulations about the unconscious psyche, representing the main tenets of depth psychology, are also based on a conception of the mind as extending beyond immediate awareness. However, their models are more hypothetical in that their data, almost exclusively, come from treatments of psychotherapy patients and their verbal accounts. So how do these two conceptions of the unconscious match, where do they differ? And how does the neural understanding in the present research support theories and practices of analytic treatments?

Awareness↗
PubMed2005

Sexual metaphor and the language of unconscious phantasy.

This paper investigates the attempt to find a 'bedrock' for psychic life in the idea of unconscious phantasy. Through a detailed examination of the development of the concept of unconscious phantasy, especially in Kleinian discourse, it is argued that unconscious phantasies are inherently metaphorical and have no 'concrete' existence in the unconscious. The use of unconscious phantasy as metaphor enables a 'two-way' form of interpretation that describes sexual behaviour and fantasy in terms of object relations (interpreting 'away from sex', while simultaneously describing object relations in terms of the sexual body (interpreting 'towards sex').

Fantasy↗