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Unconscious primes activate motor codes through semantics.

Today, it is generally accepted that unconscious stimuli can activate a response code, which leads to a response congruency effect (RCE) on a subsequent target. However, it is not yet clear whether this is due to the semantic processing of the primes or to the formation of direct stimulus-response (S-R) associations bypassing the semantic system. Recently, it was shown that even novel primes, for which no direct S-R links exist, can also evoke an RCE that is in line with the activation of response codes through semantics. In these experiments, the authors examined 3 alternatives for this RCE from novel primes and report a novel effect in unconscious priming. First, the authors show that this effect is not limited to a small set of numerical stimuli but also extends to letter stimuli (Experiments 1-3). Second, the authors show that the RCE is not a side effect of the prime-target distance effect, as has been reported before (Experiments 1-2). Third, the authors found that, for RCE to occur, overlap at the motor level but not at the semantic level was crucial (Experiments 2-3). Finally, in addition, the results showed a category match priming effect independent of RCE. This last result is evidence that novel unconscious primes activate their semantic category prior to the target and might be considered a good marker for semantic processing.

Humans↗

[Untruth and self-deception as fundamental dimensions of human existence: the problem of the unconscious].

The models of Freud on unconsciousness lead to logical contradictions or to a fragmentation of the person if the causal energetic view of mental organization is abandoned in favour of a metaphorical interpretation of Freud's concept. On the other hand, the person is eliminated in such an causel energetic model. Existential psychotherapies refer to Heidegger who claims that consciousness is not completely self-transparent and may conceal itself by forgetting and remembering in correspondence with the interests of the person. Self- concealment of consciousness as a source of unconsciousness is a process of disintegration of sense. Therefore, the therapy should lead the patient to discover his potentialities, to enable him to recognize untruth and self-deception as contradictions to these potentialities. Untruth and self-deception are-as Nietzsche has already shown-dimensions of the unconsciousness.

Humans↗

Time course of conscious and unconscious semantic brain activation.

Event-related brain potentials (ERPs) were used to investigate the neurophysiological correlates of conscious and unconscious semantic processing. Masked words, which do not enter consciousness, as well as visible words, were shown to modulate the N400 ERP potential to subsequently presented, meaningfully related target words. The N400 is known as an electrophysiological index of semantic processing. However, for unconsciously perceived words semantic brain activation decays fast within 200 ms, but increases with time for consciously perceived words. Thus, conscious and unconscious semantic activation involves similar brain areas, but both forms of processes exhibit distinct, qualitatively different time courses.

Adult↗

Cervical spine assessment in the unconscious trauma patient: a major trauma service's experience with passive flexion-extension radiography.

BACKGROUND: There is no consensus on the most appropriate method of cervical spine assessment in unconscious trauma patients. Passive flexion-extension imaging is one option for further investigating unconscious patients whose plain cervical radiographs are normal. This study examines the usefulness of this passive imaging in investigating for occult cervical injury. METHODS: All unconscious patients admitted to The Alfred Trauma Intensive Care Unit over 1 year (January 1-December 31, 1998), who could not be clinically assessed within 48 hours in regard to their cervical spine, were identified. Results of passive flexion-extension radiography were compared with final injury status and clinical outcome as determined by retrospective review of the imaging reports, radiographic films, and case notes. RESULTS: One hundred twenty-three patients with normal three-view plain radiographs proceeded to passive functional investigation. These were false-negative in four of the seven patients with cervical spine injuries at presentation. No patients suffered any adverse neurologic events from their delayed diagnoses or from the flexion-extension procedure. CONCLUSION: Passive flexion-extension imaging has inadequate sensitivity for detecting occult cervical spine injuries. Although no patients suffered adverse neurologic complications, the potential for devastating consequences from missed cervical injury has resulted in the removal of passive flexion-extension imaging from the screening protocol.

Adult↗

Helical computed tomographic scanning for the evaluation of the cervical spine in the unconscious, intubated trauma patient.

BACKGROUND: Assessment of the spine in the unconscious trauma patient is limited by an inadequate clinical examination. The potential of a missed unstable disc or ligamentous injury results in many patients remaining immobilized in critical care units for prolonged periods. METHODS: This study evaluates helical computed tomographic (CT) scanning of the whole cervical spine as part of a spinal assessment and clearance protocol. RESULTS: Four hundred thirty-seven unconscious, intubated, blunt trauma patients underwent CT scanning of the cervical spine. Sixty-one patients had a cervical spine injury and 31 (7.0%) were unstable. CT scanning had a sensitivity of 98.1%, a specificity of 98.8%, and a negative predictive value of 99.7%. There were no missed unstable injuries. In contrast, an adequate lateral cervical spine film detected only 24 injuries (14 unstable), with a sensitivity of 53.3%. CONCLUSION: Helical CT scanning of the cervical spine allows rapid and safe evaluation of the cervical spine in the unconscious, intubated trauma patient.

Adult↗

Cervical spine clearance in unconscious traumatic brain injury patients: dynamic flexion-extension fluoroscopy versus computed tomography with three-dimensional reconstruction.

BACKGROUND: An optimal protocol for clearing the cervical spine in unconscious patients with traumatic brain injury remains controversial. Protocols include plain radiographs and computed tomography (CT), and ligamentous injury may be identified with flexion-extension radiographs. We questioned whether cervical CT with three-dimensional (3D) reconstructions may obviate the need for flexion-extension radiology in the detection of occult ligamentous injury. METHODS: Between July 1999 and November 2001, 276 unconscious traumatic brain injured patients admitted to The Alfred Hospital received cervical spine plain radiographs, CT with 3D reconstructions, and dynamic flexion-extension X-ray studies with fluoroscopy as part of a routine protocol. These patients were identified from a prospective intensive care unit database and all radiology reports were reviewed. RESULTS: Dynamic flexion-extension X-ray studies with fluoroscopy identified no new fractures or instability; there were no instances of true-positive results. Dynamic flexion-extension was true-negative in 260 of 276 (94%) patients, falsely positive in six patients (2.2%) and falsely negative in one (0.4%) patient. In nine patients, dynamic flexion-extension was inadequate. CONCLUSION: Dynamic flexion-extension X-ray studies with fluoroscopy delayed cervical spine clearance and were almost always reported as normal. In a cervical spine clearance protocol for unconscious traumatic brain injury patients, dynamic flexion-extension X-ray studies with fluoroscopy did not identify any patients with cervical fracture or instability not already identified by plain radiographs and fine-cut CT (C0 to T2) with 3D reconstructions.

Algorithms↗

Clearing the cervical spine in unconscious adult trauma patients: a survey of practice in specialist centres in the UK.

A postal questionnaire survey of neurosurgery and spinal injury departments in the UK was conducted to determine how they assessed the cervical spine in unconscious, adult trauma patients, and at what point immobilisation was discontinued. Of the 32 units contacted, 27 responded (response rate, 84%). Most centres had no protocols to guide initial imaging or when immobilisation devices should be removed. Most responding centres performed fewer than three plain radiographs, and most did not use computerised tomography routinely. Routine use of magnetic resonance imaging or dynamic flexion-extension fluoroscopy was rare, and few units regarded the latter as safe in unconscious patients. There was no consensus on when immobilisation of the cervical spine should be discontinued. Most centres that terminated immobilisation immediately after imaging did so on the basis of plain radiographs alone. Unconscious adult trauma patients remain at risk of inadequate assessment of potential cervical spine injuries.

Adult↗

Active management of the unconscious eclamptic patient.

Of the many complications which may develop after eclamptic seizures, prolonged unconsciousness is one of the most difficult for obstetricians to manage as the pathophysiology of this condition remains largely unknown. Computed axial tomography (CT scan) was performed on 20 unconscious eclamptic patients, and autopsy was obtained on an additional two patients. Changes compatible with cerebral oedema were demonstrated in 75% of patients; cerebral haemorrhage occurred in 9%. A programme of intensive neurological management aimed at optimizing cerebral perfusion and controlling intracranial pressure is outlined. We have reduced the mortality rate for unconscious eclamptic patients from 50% to 17% in our institution.

Adolescent↗

Facilitators and regulators: conscious and unconscious processes in pregnancy and early motherhood.

A model is presented, based on clinical experience, mother-child observations and survey data, delineating two different maternal orientations towards babies and motherhood. The essential difference in orientation is that the Facilitator mother adapts to her baby while the Regulator mother expects the baby to adapt. On a behavioural level these two orientations are manifest in differing maternal practices: the Facilitator mothers exclusively, responding spontaneously to her baby's needs as they arise, whereas the Regulator establishes a routine to foster predictability and shares mothering with her partner or other caretakers. This paper explores three areas within the different maternal orientations of the Facilitator and Regulator: conceptualization: conscious beliefs and expectations of motherhood and babies; practice: observable differences in adaptation to pregnancy, labour, birth and early weeks of motherhood, and differential postnatal vulnerability to psychosocial provoking factors; unconscious processes: identifications, phantasies and defences underlying these practices. The psychogenesis of the two maternal orientations is explored. It is suggested that unconscious identifications between various aspects of the mother's internal world and the foetus determine the maternal orientations, with the Facilitator mother employing idealization and manic reparation to sustain her maternal beliefs while the Regulator engages in manic defence and dissociation. Conscious and unconscious processes operate in conjunction with current socio-economic circumstances to determine maternal practice.

Attitude↗

Three cognitive markers of unconscious semantic activation.

A "response window" technique is described and used to reliably demonstrate unconscious activation of meaning by subliminal (visually masked) words. Visually masked prime words were shown to influence judged meaning of following target words. This priming-effect marker was used to identify two additional markers of unconscious semantic activation: (i) the activation is very short-lived (the target word must occur within about 100 milliseconds of the subliminal prime); and (ii) unlike supraliminal prime-target pairs, a subliminal pair leaves no memory trace that can be observed in response to the next prime-target pair. Thus, unconscious semantic activation is shown to be a readily reproducible phenomenon but also very limited in the duration of its effect.

Humans↗

Predicting unconsciousness from a pediatric brain injury threshold.

The objective of this study was to utilize tissue deformation thresholds associated with acute axonal injury in the immature brain to predict the duration of unconsciousness. Ten anesthetized 3- to 5-day-old piglets were subjected to nonimpact axial rotations (110-260 rad/s) producing graded injury, with periods of unconsciousness from 0 to 80 min. Coronal sections of the perfusion-fixed brain were immunostained with neurofilament antibody (NF-68) and examined microscopically to identify regions of swollen axons and terminal retraction balls. Each experiment was simulated with a finite element computational model of the piglet brain and the recorded head velocity traces to estimate the local tissue deformation (strain), the strain rate and their product. Using thresholds associated with 50, 80 and 90% probability of axonal injury, white matter regions experiencing suprathreshold responses were determined and expressed as a fraction of the total white matter volume. These volume fractions were then correlated with the duration of unconsciousness, assuming a linear relationship. The thresholds for 80 and 90% probability of predicting injury were found to correlate better with injury severity than those for 50%, and the product of strain and strain rate was the best predictor of injury severity (p=0.02). Predictive capacity of the linear relationship was confirmed with additional (n=13) animal experiments. We conclude that the suprathreshold injured volume can provide a satisfactory prediction of injury severity in the immature brain.

Aging↗

Reinstatement of the concept of the unconscious in the Soviet Union.

The author reports on a symposium on the concept of the unconscious held in Tbilisi, U.S.S.R., in October 1979 to which Western scientists, including psychoanalysts, were invited. He provides a brief historical review of Soviet psychology, then describes the more recent emergence of two distinct groups--"psychologists" and "antipsychologists." The "psychologists" are aware of the need for improved understanding of unconscious motivations; the "antipsychologists" maintain the physiology-oriented tradition of Pavlov. The author contrasts current Soviet views of the unconscious with those of Freud and his followers and provides an up-to-date report on current Soviet attitudes through January 1981.

Communism↗

The fate of the unconscious in future psychotherapy.

It is important in these changing times to reconsider the psychoanalytic conception of the unconscious and the phantasmal mental life that occupies it--so that we can recalibrate our clinical work with it. It is the foundation of all our endeavors. Recent developments in neurobiology, combined with a more pragmatic intersubjective approach in psychoanalysis and psychotherapy, have marginalized the status of the unconscious in the eyes of many mental health professionals. Moreover, considerations of realistic childhood traumata and neglect are being more and more counterposed to the traditional concept of the infantile neurosis. What is at stake is a dismissal of a concept that is still of enormous importance, yet one that has been too little understood. What is required is a dual-track conception in which an interplay can be seen to be taking place between the unconscious, neurobiology, and trauma in the intrasubjective as well as in the intersubjective matrix.

Adult↗

Unconscious fantasy and theories of cure.

It has long been known that patients' wishes for cure by analysis give expression to unconscious wishes for instinctual gratification which originate in childhood mental life. Patients sometimes develop theories about how they believe analysis attains its ends; these are likely to affect the way they behave in the analytic situation, and analysis of them may therefore constitute an important contribution to progress in the analysis. Two illustrative cases are presented; in both, the unconscious determinants of the patients' theories turn out to be infantile sexual fantasies connected with their uncon scious wishes for instinctual satisfaction. It is further suggested that analogous unconscious fantasies also influence the theories of analysts and other therapists about how analysis works. In some instances these factors, while not affecting theory formation explicitly, may, without being recognized as doing so, contribute to decisions regarding the modification of analytic technique. Awareness of that possibility may aid analysts in assessing the indications for such proposed modifications.

Adult↗

The scientific status of unconscious processes: is Freud really dead?

At regular intervals for over half a century, critiques of Freud and psychoanalysis have emerged in the popular media and in intellectual circles, usually declaring that Freud has died some new and agonizing death, and that the enterprise he created should be buried along with him like the artifacts in the tomb of an Egyptian king. Although the critiques take many forms, a central claim has long been that unconscious processes, like other psychoanalytic constructs, lack any basis in scientific research. In recent years, however, a large body of experimental research has emerged in a number of independent literatures. This work documents the most fundamental tenet of psychoanalysis--that much of mental life is unconscious, including cognitive, affective, and motivational processes. This body of research suggests some important revisions in the psychoanalytic understanding of unconscious processes, but it also points to the conclusion that, based on controlled scientific investigations alone (that is, without even considering clinical data), the repeated broadside attacks on psychoanalysis are no longer tenable.

Cause of Death↗

High calcitonin levels in unconscious polytrauma patients.

We measured levels of calcitonin and other markers of calcium and phosphorus metabolism in both unconscious and conscious patients after multiple trauma. We found dramatic increases in calcitonin levels in unconscious patients, and smaller increases in conscious patients. In two cases, very high levels, more than 100 x normal, appeared to be related to more rapid healing of bone. Calcitonin levels were highest immediately after admission and decreased over the ensuing two weeks. The possible relationship between unconsciousness and the increased rate of healing of fractures is discussed.

Adolescent↗

Collaborating with the unconscious other. The analysand's capacity for creative thinking.

The analysand's capacity for making use of psychoanalytic treatment has been a subject of importance since the beginning of psychoanalysis. The author addresses an aspect of the difficulty encountered by analysands in achieving a psychic state that allows the creative use of free association, dreams, parapraxes and other spontaneous phenomena occurring during the course of treatment. He suggests that a very specific state of mind is essential to both the psychoanalytic process and the creative process. Using theoretical concepts derived from Freud, Klein and Bion, he develops the idea of an internal object relationship, 'the collaboration with the unconscious other', which forms the basis for both creative thinking and the psychoanalytic function of the personality. Creative thinking is distinguished from artistic endeavour and discussed as a universal potential, on which growth in psychoanalysis depends. The term 'unconscious other' is meant to signify the subjective experience of a foreign presence within oneself from which both spontaneous creative inspiration and involuntary psychic phenomena are felt to emanate. The author presents clinical material to suggest that paranoid-schizoid and depressive anxieties form obstacles to collaborating with the unconscious other, and must be worked through in order to achieve an analytic process.

Creativity↗

Behind, beneath, above, and beyond: the historical unconscious.

The unconscious is more than a collection of intrapsychic and interpersonal variables. On a broader level, it reflects a complex, historically woven tapestry of moral and ethical values, beliefs, and assumptions. A particular historical context provides an experiential and interpretive template that conditions the boundary between what is conscious and unconscious. Beyond the scope of explicitly inherited values, beliefs, and assumptions is what the historical unconscious comprises. It lingers at the very edge of our conscious experience, behind, beneath, above, and beyond everything that is spoken or unspoken, enacted or restrained, imagined or suppressed.

Culture↗