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Unconscious fantasies, structural theory, and compromise formation.

Although the existence of unconscious fantasies is an empirical assumption, in the clinical situation unconscious fantasies are treated as if they have a concrete existence. Unconscious fantasies form intermediate links in causal chains of which clinical observations constitute one end, and the components of unconscious conflicts, the other. Like all clinical material, fantasies may be affected by actual experiences; they may also be revised, layered, and can function to alter and disguise other fantasies as well as provide gratification. From a technical standpoint, it is most important to analyze their constituents and to adduce their primary purposes in the clinical situation of the moment. The nature of the evidence that identifies the presence of particular unconscious fantasies is discussed. Although a single analytic session is presented by way of illustration, I am convinced that the analyst's entire understanding of the patient inevitably channels his or her interpretive focus on the associational material of each analytic hour.

Adult↗

Unconscious fantasy: a reconsideration of the concept.

Despite general agreement about the clinical importance of unconscious fantasy, the concept itself has remained unclear. After reviewing Freud's work on the subject, the conceptual dilemma is specified: where in current psychoanalytic theory do we place this important, dynamically repressed, structuralized mental content? Three conceptual paths have been followed in attempting to deal with this problem. The first emphasizes the structural, tripartite model, discarding topographic concepts. The second replaces the structural model with a schema model borrowed from academic psychology. The third combines the structural and topographic models. None of these approaches is entirely satisfactory and without problems. Because of their central role in mental life, unconscious fantasies deserve careful definition. They should be distinguished from conscious fantasies and daydreams as well as from the process of fantasizing. They are differentiated from other varieties of unconscious content by their enduring quality and their organized, storylike quality reflecting the distortions typical of the primary process. As dynamically unconscious templates from the childhood past, they shape subsequent compromise formations and are relatively impervious to new experience. The development of psychoanalytic theory from a macrostructural to a microstructural emphasis is discussed in relation to the unconscious fantasy concept.

Fantasy↗

The real unconscious: psychoanalysis as a theory of consciousness.

Inquiries into hallucinatory wish fulfillment and the unconscious converge and, by distinguishing the concept of the unconscious in psychoanalysis from that of cognitive psychology, serve to bring out what is most essential to the psychoanalytic conception. Freud's topographical model is used to stress that the psychoanalytic unconscious can be understood only in relation to theories of consciousness and wishing. Moreover, in contrast to the cognitive conception, psychoanalysis holds that the processing of thought in the human mind is inseparable from the activity of desire. This leads to further psychoanalytic reflections on the interrelation of conscious and unconscious, wishing and thinking, and, in consequence, on transference and the mechanism of unconscious fantasy.

Cognition↗

Conscious and unconscious influences of memory for object location.

The process-dissociation procedure was used to investigate conscious and unconscious influences of memory for object location. In two experiments, subjects worked with drawings of household objects and rooms of a house depicted on a computer monitor to simulate placing objects in various locations. Memory for object locations was tested by having subjects search for those objects. A double dissociation was obtained between estimates of conscious and unconscious influences of memory computed from equations that assumed independence between these two influences: Age-related differences were found in the estimate of conscious influences, but not in the estimate of unconscious influences, whereas manipulation of habit strength affected the unconscious estimate, but not the conscious estimate. These results were closely fit by a multinomial model assuming independence between conscious and unconscious influences of memory.

Adolescent↗

The role of unconscious homosexuality in the paranoid constellation.

The literature dealing with Freud's original concept of unconscious homosexuality in the paranoid constellation is reviewed. Many of the more recent contributions view unconscious homosexual features as secondary to others; as such, they are pseudophenomena. This communication suggests that unconscious homosexuality in the male is denied, rejected, and projected because the passive, anal, sadomasochistic aspects are felt as degrading and humiliating. In the female, unconscious homosexuality is also felt as degrading and humiliating. In both sexes, the feeling of humiliation derives from real experiences in childhood. Unconscious homosexuality is viewed as the organizing principle in the paranoid constellation.

Freudian Theory↗

High density ERP indices of conscious and unconscious semantic priming.

The existence of differential brain mechanisms of conscious and unconscious processing is a matter of debate nowadays. The present experiment explores whether conscious and unconscious semantic priming in a lexical decision task at a long prime-target stimulus onset asynchrony (SOA) correlate with overlapping or different event related potential (ERP) effects. Results show that the N400 effect, which appeared when words were consciously perceived, completely disappeared when primes were masked at a level where the ability of participants to detect the prime was near chance. Instead, a rather different set of ERP effects was found to index unconscious semantic priming. This suggests that the processes at the basis of conscious and unconscious semantic analyses can under some circumstances be rather different. Moreover, our results support the notion that conscious and unconscious processes are at least partially separable in the brain.

Adult↗

Middle latency auditory evoked potentials during repeated transitions from consciousness to unconsciousness.

We have investigated the relationship between changes in the middle latency auditory evoked potentials during alternating periods of consciousness and unconsciousness produced by propofol infusion combined with spinal anaesthesia for total knee replacement. Eleven patients completed the study, of whom two had recollection of events after the onset of the anaesthetic. There were no significant differences in heart rate or systolic arterial pressure between any conscious and unconscious period. With the first change from consciousness to unconsciousness, latencies of Na, Pa and Nb increased from mean (SD) starting values of 20.0 (1.4), 31.7 (1.0) and 42.8 (1.6) ms to 22.5 (2.0), 39.3 (2.1) and 57.8 (4.4) ms, respectively. During successive transitions from unconsciousness to consciousness, awake latencies were slightly higher than those of baseline awake, whereas anaesthetised latencies were similar to the ones obtained during the first period of unconsciousness. The consistent changes demonstrated, suggest that the auditory evoked potentials could represent a reliable indicator of potential awareness during anaesthesia.

Aged↗

[Changes in peripheral lymphocytes count in unconscious patients treated at home with Japanese herbal medicines (Hozai)].

We investigated changes in peripheral white blood cells count, lymphocytes count, and serum albumin level in five unconscious patients administered Japanese herbal medicines (Hozai). The causes of unconsciousness were intracerebral hemorrhage in 3, cerebral infarction in 1, and craniopharyngioma in 1. The administered Hozai were Hotyu-ekki-to in 4 and Jyuzen-taiho-to in 1. To assess the effect of Hozai on the immune system of unconscious patients, we investigated these parameters before and after treatment. We observed normalization of WBC counts, increase of lymphocytes count, and unchanged levels of serum albumin after Hozai treatment. These findings suggest that Hozai may improve the immunological competence of unconscious patients. One of the problems affecting unconscious patients treated at home is infectious diseases, especially respiratory infections. It is considered that improvement of their immunological competence would contribute to prevent infections. These results suggest that Hozai treatment might be useful adjuvants to support the general condition of the patients treated at home.

Aged↗

[Comparison of unconsciousness prediction probability with approximate entropy and bispectral index during sedation].

OBJECTIVE: To compare the unconsciousness prediction probability (Pk) estimated by approximate entropy (ApEn) and bispectral index (BIS) during the sedation produced by target-controlled infusion (TCI) of propofol. METHODS: Twenty patients (ASA class I-II) scheduled for elective lower limb operations under epidural anesthesia were studied. TCI of propofol was initiated at target plasma concentration of 0.5 microg/ml, and increased by 0.3 to 0.5 microg/ml until loss of consciousness, and then decreased until consciousness recovery. Each target plasma concentration of propofol lasted for 12 min. ApEn and BIS were recorded simultaneously during the periods of consciousness and unconsciousness every 3 min. The Pk of unconsciousness with ApEn and BIS were calculated and compared. RESULTS: ApEn was 0.84+/-0.05 in the state of consciousness and 0.71+/-0.06 upon loss of consciousness, and BIS in the corresponding stages were 80.2+/-6.2 and 67.3+/-7.9, respectively. The Pk of unconsciousness between ApEn (Pk=0.97+/-0.06) and BIS (Pk=0.91+/-0.11) did not significantly differ (P>0.05). CONCLUSION: ApEn as well as BIS is acceptable for predicting consciousness and unconsciousness produced by TCI propofol.

Adult↗

[Conscious and unconscious acoustic perception during general anesthesia].

The possibility of processing sensory information during general anesthesia and the ability to recall it postoperatively is of major ethical, medical and even theoretical importance. Auditory stimuli especially are perceived intraoperatively and remembered postoperatively. Neuropsychological experiments indicate that sensory information can be processed and recalled both at a conscious and at an unconscious level. Therefore, we have to distinguish between explicit and implicit memory. Explicit memory is characterized by an active and conscious recall of space- and time-related events, i.e., episodes in a person's life. In contrast, implicit memory recalls passively and unconsciously without being related to space and time, i.e., language and general knowledge. Experimental results from amnesic patients indicate that these two memory systems work independently from each other. Even when explicit memory is grossly impaired the function of the implicit memory may still be completely preserved. Various studies on intraoperative awareness show that explicit memory is widely eliminated during general anesthesia. The incidence of conscious awareness that can be actively recalled postoperatively is reported to be 1-3%. In contrast, the implicit memory function can be partially preserved. When implicit memory tasks or hypnosis are employed, traces of unconscious memory of intraoperative auditory information can be shown in 20-30% of the patients. These observations are of important clinical relevance, because the unconsciously recalled information about the intraoperative procedure may have a negative influence on the patient's postoperative recovery and well-being. So far it is still not known which anesthetics most reliably suppress auditory perception and conscious and unconscious memory during the intraoperative period. Therefore, future studies should focus on several different points. The anesthetic state should be defined exactly and the functional state of the auditory modality should be monitored when auditory information is presented to the patients. The recollection of intraoperative events should be investigated using implicit memory tests, because these are regarded as more sensitive than explicit memory tests.

Anesthesia, General↗

Unconscious fantasies: from the couch to the court.

No single unifying theory exists that explains the plethora of behaviors that bring individuals before the courts on a daily basis. No biological, social, or familial model for criminal behavior is without limitations, or exempt from controversy and criticism. We suggest, however, that it is appropriate, and often necessary, for the psychiatric expert to advance lucid, intelligible, and simplified psychodynamic formulation, either alone or in conjunction with another explanatory model of criminal behavior, to assist the court in its understanding and disposition of a given case. In some cases, apparent criminal behaviors result when unconscious motivating factors, particularly unconscious fantasies, find expression in conscious life. In this article, we consider the etiologic role of unconscious fantasy in certain seemingly inexplicable criminal behaviors. The concept of unconscious fantasy is explained and a detailed case description and formulation are provided in order to illustrate the central role of unconscious fantasy in some of these behaviors. Recommendations are offered for the manner in which psychodynamic formulation should be presented in reports and in courtroom testimony through reference to the author's experience.

Adult↗

Conscious and unconscious processes: the effects of motivation.

The process-dissociation procedure has been used in a variety of experimental contexts to assess the contributions of conscious and unconscious processes to task performance. To evaluate whether motivation affects estimates of conscious and unconscious processes, participants were given incentives to follow inclusion and exclusion instructions in a perception task and a memory task. Relative to a control condition in which no performance incentives were given, the results for the perception task indicated that incentives increased the participants' ability to exclude previously presented information, which in turn both increased the estimate of conscious processes and decreased the estimate of unconscious processes. However, the results also indicated that incentives did not influence estimates of conscious or unconscious processes in the memory task. The findings suggest that the process-dissociation procedure is relatively immune to influences of motivation when used with a memory task, but that caution should be exercised when the process-dissociation is used with a perception task.

Analysis of Variance↗

Relationships between temperament dimensions in personality and unconscious emotional responses.

BACKGROUND: In addition to character dimensions, personality includes temperament dimensions, defined as individual differences in implicit associative learning responses to environmental stimuli processed by unconscious memories. We examined whether temperament dimensions were associated with patterns of unconscious emotional responses of an autonomic nature. METHODS: From 70 healthy men, high and low novelty-seeking (NS) groups and high and low harm-avoidance (HA) groups were selected using scores on the Tridimensional Personality Questionnaire measuring temperament dimensions. Emotionally negative, neutral, and positive visual stimuli were presented subliminally using backward masking, and skin conductance responses (SCRs) were measured as an autonomic index of emotional responses. Skin conductance responses to the three emotional stimulus conditions were compared between groups. RESULTS: Skin conductance responses in the high NS group were significantly greater than in the low NS group when positive or negative emotional stimuli were presented but not neutral stimuli. Skin conductance responses in the high HA group were significantly greater than in the low HA group for stimuli of all three valences. CONCLUSIONS: Autonomic response patterns to unconscious emotional perception differed between NS and HA, suggesting that different dimensions of temperament may be associated with different patterns of unconscious emotional responses. Novelty seeking and HA may be associated with specificity and susceptibility of preattentive emotional perception, respectively.

Adult↗

Unconscious priming by color and form: different processes and levels.

Using a metacontrast masking paradigm, prior studies have shown (a) that a target's color information and form information, can be processed without awareness and (b) that unconscious color processing occurs at early, wavelength-dependent levels in the cortical information processing hierarchy. Here we used a combination of paracontrast and metacontrast masking techniques to explore unconscious color and form priming effects produced by blue, green, and neutral stimuli. We found that color priming in normal observers is significantly reduced when an additional paracontrast mask precedes the target at optimal masking SOAs. However, no reduction of form-priming effects was obtained at similar optimal paracontrast SOAs. We conclude that unconscious color priming depends on an early, wavelength- or stimulus-dependent response of color neurons located at early cortical levels whereas unconscious form priming occurs at later levels.

Adult↗

Hemisphere differences in conscious and unconscious word reading.

Hemisphere differences in word reading were examined using explicit and implicit processing measures. In an inclusion task, which indexes both conscious (explicit) and unconscious (implicit) word reading processes, participants were briefly presented with a word in either the right or the left visual field and were asked to use this word to complete a three-letter word stem. In an exclusion task, which estimates unconscious word reading, participants completed the word stem with any word other than the prime word. Experiment 1 showed that words presented to either visual field were processed in very similar ways in both tasks, with the exception that words in the right visual field (left hemisphere) were more readily accessible for conscious report. Experiment 2 indicated that unconsciously processed words are shared between the hemispheres, as similar results were obtained when either the same or the opposite visual field received the word stem. Experiment 3 demonstrated that this sharing between hemispheres is cortically mediated by testing a split-brain patient. These results suggest that the left hemisphere advantage for word reading holds only for explicit measures; unconscious word reading is much more balanced between the hemispheres.

Adult↗

Use of a Behavioural Pain Scale to assess pain in ventilated, unconscious and/or sedated patients.

UNLABELLED: Current empirical evidence supports claims that pain in sedated, unconscious Intensive Care Unit (ICU) patients is underrated and under-treated. Given the severity of ICU patients' illness pain management, whilst important, may not be considered a priority and therefore can be easily overlooked. The aim of this study was to validate the Behavioural Pain Scale (BPS) for the assessment of pain in critically ill patients by evaluating facial expressions, upper limb movements and compliance with mechanical ventilation. METHODS: A prospective, descriptive repeated measures study design was used to assess the validity and reliability of the BPS for assessing pain in critically ill patients undergoing routine painful (repositioning) and non-painful (eye care) procedures. RESULTS: An average of 73% of BPS scores increased (indicating pain) after patients were repositioned, as opposed to 14% after eye care. This increase was statistically significant for repositioning (p < 0.003) but not for eye care (p > 0.3). The odds of an increase in BPS between pre- and post-procedure assessments was more than 25 times higher for repositioning compared with eye care (p < 0.0001), after controlling for analgesics and sedatives. CONCLUSION: The BPS was found to be a valid and reliable tool in the assessment of pain in the unconscious sedated patient. Results also highlighted that traditional pain indicators, such as fluctuations in haemodynamic parameters, are not always an accurate measure for the assessment of pain in unconscious patients and as such more objective pain assessment measures are essential. Finally, further validation of the BPS and identification of other painful routine procedures is needed to enhance pain management delivery for unconscious patients.

Adolescent↗

What does pain signify? A hypothesis concerning pain, the immune system and unconscious pain experience under general anesthesia.

In this paper, I present a case-study that initiates a discussion about the meaning of pain. The case-study concerns a person who was under deep sedation during colonoscopy. The person did not experience pain from a first-person perspective, although pain was evident to the medical team from a second-person perspective. The divergence of pain perspectives raises an interesting quandary. If the body communicates pain while pain consciousness is blocked by the sedation procedure, our conclusion should be that the intersubjective aspect of pain precedes the "subjective," first-person experience of pain. This conclusion is not consistent with the common representational conception of pain that places the intrasubjective point of view prior to the intersubjective point of view. The solution I offer to this quandary is the quasi-paradoxical idea that pain can be experienced unconsciously through the immune system. Following this suggestion, I hypothesize that post-traumatic stress disorders following general anesthesia may result from this unconscious pain experience. If this idea is scientifically grounded, then physicians should: (1) consider ways of blocking the unconscious pain experience produced by the immune system without interfering with the immune response, and (2) study pain as a complex cognitive and unconscious system by drawing an analogy with the immune system, which follows similar logic.

Anesthesia, General↗

Dissociation of conscious and unconscious repetition priming effect on event-related potentials.

Although the neural basis of the unconscious priming effect has previously been investigated, the results of these studies have possibly been contaminated by a conscious priming effect. The aim of the present study was to dissociate the effects of conscious and unconscious priming on event-related potential (ERP) by using the process-dissociation procedure. A prime word was presented briefly, followed by a word-stem, in each trial. Under the inclusion condition, subjects were instructed to complete the word-stem using the prime word, while under the exclusion condition subjects were asked to complete the word-stem with a word not seen as prime. The behavioral priming effect was obtained under both conditions, indicating that the prime words were processed unconsciously and influenced the word-stem completion task. We found that two ERP components were affected by repetition priming. First, the N400 amplitude was decreased by word repetition under the inclusion condition, but not under the exclusion condition. This result suggests that N400 would reflect conscious lexical processing, but not unconscious lexical activation. Second, the negativity at left front lateral region was enhanced by word repetition under the exclusion condition. We discuss this finding herein in relation to the activity of the left inferior prefrontal cortex with regard to word semantic processing.

Adolescent↗