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Neuropsychoanalysis: An Interdisciplinary Journal

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Ongoing Discussion of Francis Crick and Christoph

Koch (Vol. 2, No. 1): Commentary by Mortimer Ostow
(New York)
a

Mortimer Ostow
a

5021 Iselin Avenue, Riverdale, NY 10471, e-mail:

Published online: 09 Jan 2014.

To cite this article: Mortimer Ostow (2001) Ongoing Discussion of Francis Crick and Christoph Koch (Vol. 2, No. 1):
Commentary by Mortimer Ostow (New York), Neuropsychoanalysis: An Interdisciplinary Journal for Psychoanalysis and the
Neurosciences, 3:1, 107-111, DOI: 10.1080/15294145.2001.10773343
To link to this article: http://dx.doi.org/10.1080/15294145.2001.10773343

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Ongoing Discussion (Vol. 2, No.1)

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Ongoing Discussion of Francis Crick and Christoph Koch (Vol. 2, No.1):

Commentary by Mortimer Ostow (New York)

The following is intended as a contribution to the discussions of consciousness, responding to the target
article by Crick and Koch. In the interest of providing
some clinical input to the subject, I offer here some
chapter headings.
If we follow the suggestions of Panksepp (1998),
Damasio (1999), and Watt (2000), we may start with
the assumption that the evolutionary rudiments of sentience appeared as components of instinct. Presumably
the stimulus or need for instinctual response elicited
a demand felt as some kind of uncomfortable sensation, and presumably the instinctual response was accompanied by a complementary agreeable sensation
that erased the former.
Presumably too, was the effect of this advance to
supplement the hard-wired instinctual systems, as well
as those systems modified by the flexibility achieved
by susceptibility to conditioning, so as to make it possible to select one or more potentially optimal responses in preference to others. That process entailed
the capacity to anticipate the consequences of each,
that is, to imagine, and, on a higher evolutionary
plane, to fantasy. These mechanisms supplement but
do not replace the hard-wired and conditionable instincts that still preempt behavior in the presence of
adequate or unusually intense stimuli.
These are simple speculations, based upon reasonable assumptions, and they lead us to certain conclusions about conscious experience in the
contemporary human. Conscious mentation must include the sensitivity to certain biological (including
social) needs, the opportunity to dispel unpleasant
stimuli by taking certain actions that will, in turn, replace them with agreeable experiences; and the ability
to consider possible responses in order to select the
optimal response. Such a mechanism would provide
the capacity for imagery, imagination, fantasy, and the
ability to anticipate the future.
Fantasy has important clinical significance because it guides the selection of response, but also because it is often used to substitute for action. It can
do so because as trial action it probably elicits an elabMortimer Ostow, M.D., is President of the Psychoanalytic Research
and Development Fund, and Cochairman of its Study Group on Neuroscience, Psychopharmacology and Psychoanalysis.

oration of appropriate neurotransmitters in the same

pattern though in much smaller amounts, than the full
action would. Conscious affective selection requires
an accumulation of stored relevant memories. These
memories must be available for recall on appropriate
occasions. However, the durability of memory probably varies with its age and other constraints of recording.
We come to the subject of attention. Needless to
say, one is conscious of whatever is attended to, but
some images and events can become conscious even
when they are not the objects of attention. They are
sometimes said to be at the periphery of consciousness. Not all percepts and memories can be conscious
simultaneously. Those become conscious that either
demand attention by virtue of their intensity or immediacy, promising instant or important gratification or
threat, or those that are called for by current thought,
imagination, or problem solving. What neuroscientists
have called procedural memory records events that
were consciously perceived when they occurred, when
attention was required. However, with practice, attention is no longer required. But attention can restore
them to consciousness at any moment.
The psychoanalytic clinician is concerned with
memories that cannot be retrieved simply by attempting to focus attention on them. That is, attention
may "ask for" them, but it cannot liberate them into
consciousness. Clinical experience teaches us that
these memories were laid down very early, or were
associated with significant trauma, or were repressed
in the course of development, or were repressed because they were involved in neurotic conflict. We
know of their existence because they appear directly
or symbolically in dreams, or because they can be
recaptured during the course of analysis.
Not all fantasies are intended to anticipate the
consequence of choice of behavior strategies. Some
are created so as to organize the memories of past
experience. These form a myth of greater or lesser
degree of veridicality that offers a mythical explanation of the course of the individual's life, and anticipates his future. We speak of these as organizing
fantasies; they are not usually consciously known by
the subject, but appear often in the course of analysis,
opposed by stronger or weaker repressive forces.

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108
Performing all of these functions and involved in
all of these activities, consciousness yet is called upon
to present a seamless aspect, to continue without interruption to integrate all percepts, both those arising externally and those arising internally, into a continuous
surface. It is called upon to exclude impressions from
any source, that are not compatible with the current
account of events in the world, and yet not to ignore
impressions of serious significance. Hypnagogic and
hypnopompic phenomena are examples of intrusive
impressions that are usually excluded from consciousness. Even dream consciousness, which seems to occur without the mobilization of attention, attempts to
rationalize and organize the impressions that intrude
into dreams. For example, an external sound or light
or a touch or insect contact, or an excretory stimulus,
is usually seamlessly integrated into the dream. Freud
spoke of a censor that excludes the repressed from
consciousness.
Hartmann spoke of the synthetic function of the
ego; that is, the tendency of the conscious ego to integrate impressions into a consistent whole, eliminating
inconsistencies and arbitrary sequences. These
smoothing tendencies often create illusions. The post
hoc propter hoc fallacy is a logical illusion born of the
need for causality, a principle described by Herman
Nunberg (1959). The scientific method was devised
for the purpose of overcoming illusory verification of
one's expectations. We speak of these as functions of
the ego but they seem to be functions of consciousness.
Despite its tendency to distort data so as to protect its
integrated picture, consciousness is expected to distinguish between the real and the unreal, the familiar and
the unfamiliar.
Consciousness also takes the self as its object,
including the very function of consciousness. Neuroscientists attempt to deal with this self-reflective function of consciousness. Psychoanalysts speak of selfobservation. I have suggested that we can recognize
three types of self-observation. Primary self-observation consists of taking note of one's subjective feelings; secondary self-observation consists of noting
one's objective qualities; tertiary self-observation consists of regarding the impressions of one's self as seen
by outside observers. I have found that in general, the
self-observation of the depressed patient is primary;
the self-observation of the manic is tertiary; and secondary self-observation occurs only in the absence of
both mood deviations. These regularities can help in
the monitoring of psychiatric drug therapy. At the extremes of mood deviation, primary and tertiary selfobservation may become delusional hypochondria in

Mortimer Ostow
the former instance and delusional paranoia in the
latter.
Some neuroscientists consider consciousness and
affect not intrinsically associated, as opposed to others
(Panksepp, 1998) who consider consciousness essentially an instrument for appreciating affect. As a clinician, it seems to me that every conscious state carries
its own affect. The affect need not be a distinct phasic
feeling change; it may be only a relatively constant
underlying mood.
Part of the neuropsychoanalytic problem is that
investigators speak of affect and of pleasure and pain
or unpleasure nonspecifically, as though what is true
of one affective state is true of all. I have been contending for some time that a taxonomy of affect is
needed for clarifying the issues.
Instinctual behavior carries specific affects. If we
address ourselves to the phasic instincts such as the
sexual, nutritive, defensive, and thermal homeostasis
promoting instincts, we can recognize several types
of affect. The instinctual sequence is initiated by an
experience of discomfort specific to the instinct being
triggered, whether hunger, thirst, danger, pain, excessive warmth or cold, or felt need for sexual experience.
There follows an interval of appetitive striving, a
search for opportunities for gratification of the felt
need, characterized by its specific affect, similar to
and anticipating the consummatory feeling that follows. The strongest affective experiences are associated with the consummation of the instinct, but the
phase of relaxation that follows the consummation
carries still another affective experience, pleasant satiety.
The social instincts carry their own set of affects.
Establishing and breaking attachment are each accompanied by specific affects, the former gratifying and
the latter distressing. The need for attachment may be
considered a tonic rather than a phasic instinct, and
the affects accompanying it are relatively enduring
rather than fleeting such as that accompanying the orgasm. But one may recognize also affective states that
drive efforts to establish a desired status in society
and to maintain it. All complementary affects are elicited by failure to do so. These include pride in the first
instance and shame in the second. Self-esteem is a
term that designates one's affective estimate of one's
status within society.
Mood is still another important and omnipresent
affect. It seems to recede when other stronger and
phasic affects supersede it, and recurs when these others subside. Good mood is encouraged by success of
instinctual endeavors, and bad mood ensues in the

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Ongoing Discussion (Vol. 2, No.1)

presence of failure of these and the prevalence of distressing experiences.
It is mood, I believe, that is established by the
action of Panksepp's (1998) seeking system, driven
primarily by dopamine transmitters, and active always
during both waking life and sleep, including dreaming.
It is mood too that is abnormal in manic-depressive
illness, and it is mood that is affected by pharmacological agents that are used to treat the several forms of
this illness. They are essentially mood regulators (that
does not include the sedative and antiseizure drugs).
In addition to the affects incident to instinctual
behavior, and in addition to mood, we recognize certain affective states that seem independent of both. I
refer here to the experience of humor, to the pleasures
of listening to music or the enjoyment of any aesthetic
experience, the feeling of the uncanny, among others.
There are thrills, surprises, and states of confusion.
Each of these affective states calls for analysis of its
nature and of its relation to the instinctively based
affects. With a little ingenuity, I believe they can each
be assigned their proper classification. Some of these
affective states I relate to the experience of crossing
categorical boundaries. For example, humor is appreciated when one uses a word or expression ordinarily thought of in one logical category, in a
surprisingly different one. The pun, which is an elementary form of humor, is the simplest example. However, fairly sophisticated examples of wit also fit
that description.
Accordingly, when we speak of pleasure we must
acknowledge that there are a number of different varieties of pleasure: the pleasure associated with anticipatory appetitive activities; the pleasure associated with
consummation; the pleasure associated with postconsummatory relaxation; the pleasure associated with elevated mood; the pleasure associated with some
category-crossing moods such as humor and pleasant
surprise; the pleasure associated with aesthetic activities; the pleasure associated with establishing and
maintaining attachments, either personal or social; the
pleasure associated with problem solving. Panksepp
relates problem solving to appetitive activity since it
represents instinctual attempts to discern threats and
discover opportunities for pleasurable gratification
(1998).
Similarly, there are various categories of pain including the pain of the stimuli to instinctual gratification; the pain of frustration or initiated instinctual
behavior; the pain of depressive mood; the pain of loss
of attachment, the discomfort of sleep deprivation.
Spiritual experiences are usually pleasant but may be

109
painful; for example, when, under the influence of a
depressive mood, they result in the fear of being visited by malignant spirits, ghosts, or revenants.
Still dealing with the various states of consciousness, we cannot ignore the several important manifestations of detachment; that is, alterations of affective
consciousness that alter the impression of one's distance from the world that is normally perceived as
real. Depersonalization is the feeling of being estranged from oneself. It is not merely tertiary selfobservation, which is regarding one's self and one's
attributes as others would see them. Depersonalization
is the feeling of no longer being one's familiar self.
What has been called derealization is not really a loss
of the sense of reality, but loss of the sense of familiarity with reality, estrangement from it. Deja vu, on the
other hand, is an illusory sense of familiarity. It is not
a specific memory of having done something before.
One can usually not specify when or under what circumstances one has done it or been there, which would
imply a previous exposure to the scene. Since these
phenomena occur during temporal lobe seizures, it is
likely that the sense of familiarity involves temporal
lobe function. Recent observations that familiar and
unfamiliar faces are recorded at slightly different
points in and around the fusiform gyrus, seem to corroborate that impression. However, these detachment
phenomena occur also in the intact individual. They
have been described as responses to anxiety. I am not
sure that that conclusion is always correct.
Still within the realm of normality, we find states
of detachment complemented by attachment to virtual
objects. Of these, the most definitive is the mystical
episode. Here the subject, usually psychiatrically normal, describes a direct and immediate experience of
hallucinated or felt contact with a supernatural object,
a deity, or aspect of nature or the cosmos. I call this
a virtual object because it is a personified representation of a subjectively felt psychic influence. The mystical state is often anticipated by a state of depression,
anxiety, or loneliness, and results in a feeling of gratifying achievement.
I see mysticism as one extreme of a series,
namely, awe, spirituality, and mysticism. Awe is primarily elicited by encountering a sight or sound that
seems larger than life, that engenders a feeling of being
small or insignificant in the presence of something
grand, cosmic, portentous. The affect of being awed
may be a gratifying, comforting one, or an intimidating, frightening one. Although it is not conventionally
attributed to awe, I believe that a sense of familiarity
contributes an element as well. When we encounter

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110
an awesome experience, we feel personally related
to it.
Spirituality refers to an experience intermediate
between awe and the full mystical experience. The
spiritual experience is a feeling of transcendence, of
contact with supernatural entities or forces. It differs
from awe in that one is not merely impressed by the
perceived magnificent display, but one feels the influence of a source of comfort and inspiration. (Note that
both the word spirituality and inspiration are derived
from the Latin root spirare meaning to breathe. The
spirit, in both cases, is something that may be
breathed in.)
All these are alterations of consciousness associated with strong affects. Since awe is usually inspired
by exposure to larger than life displays, I guess that
awe reproduces the child's earliest experiences of
mother. Mountains, oceans, tremendous edifices,
sweet melodies, loud rumbling noises, all suggest the
infant's earliest impressions of caretakers. These experiences are not remembered, probably because at
that early point, the brain has not yet acquired the
capacity to retain discrete iconic or phonic memories.
It may, however, be capable of recording and retaining
the affects associated with these. When these affects
are retrieved later in life, they are virtually ineffable,
orphan affects. Since they all include a component of
yearning, when invoked they encourage the impression of contact with a virtual object.
In each of these three states, awe, spirituality, and
mysticism, we find detachment, transcendence,
yearning, a feeling of being in contact with a supernal,
supernatural entity. In each case the experience may
be preceded by anxiety or depression, loneliness, and
followed by a sense of exaltation and exhilaration. I
have observed that the spiritual expression especially,
follows the death of a loved person or separation for
other reasons.
In the case of the spiritual and mystical experience, the feeling of detachment may proceed to the
point of trance, a significant detachment from reality,
complete diversion of attention from the real world.
It suggests the hypnotic or hysterical trance state. Perhaps trance is the complete diversion of attention from
the real world to the illusory world of archaic affects,
complemented by virtual objects suggested by these
affects.
Continuing with our listing of the various states
of consciousness, we come now to hynagogic and hypnopompic experiences. These have not been extensively described. Mostly what are seen are images,
somewhat distorted, varying in shape and color that

Mortimer Ostow
intrude into consciousness but are fugitive. When one
attempts to attend to them, they disappear, as they do
when one wakes fully. They give us an illustration
of the organizing effect of attention on the images
"secreted" spontaneously by memories. Sleep onset
and offset may also be accompanied by auditory experiences, that are less bizarre but equally irrelevant.
Dreaming has been perhaps the most commonly
studied and discussed of the variants of consciousness.
But it is content of dreams that has been studied more
than the formal characteristics of dream consciousness. Dreams are not visualized as the result of the
direction of attention. They intrude into the dreamer's
consciousness and preempt attention. If the dream becomes too horrid or frightening, the dreamer will often
attempt to arrest or dissipate it and his efforts seem
to involve mobilizing attention. If attention is mobilized, the dream disappears.
Like waking consciousness, dreaming consciousness is suffused with affect. The dreams of individuals
with mood disorder include apocalyptic scenarios with
representation of affects of death and destruction, alternating with representation and affects of rebirth.
The waking state of mind determines which of the
two elements predominates in the dreams. But even
in dreams in which content seems more dominant than
affect, we always find an affect accompaniment. For
monitoring patients who may require medication or
who are taking it, the affective signature of the dream
can reinforce or modify the clinical impression with
respect to the selection of the medication, and how to
vary the dose. It seems to me more clearly evident in
the case of dreaming that consciousness is there for
the purpose of registering the affect. Since actively
and consciously focused attention are absent, cognitive integration in the dream is only partial.
In an interesting pathologic variant, an individual
may' 'awaken" while dreaming an unpleasant dream,
but be unable to banish it from his mind. So he remains
unpleasantly in a state of partial dreaming, partial
waking. Full waking consciousness, attention, and distress do not terminate the dream consciousness. Apparently,
waking
consciousness
and dream
consciousness can coexist, though they seldom do.
Turning now to states of pathologic consciousness, we encounter confusion as the most common
example. It may be brought about by either structural
or toxic disorders, or nonstructural functional disorders. Among the latter, psychic shock, acute stress,
sudden anxiety, or depression or psychosis may induce
confusion. In the case of structural or toxic disorder,
confusion may be accompanied by impairment of con-

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Ongoing Discussion
sciousness. In the case of purely psychic states, when
consciousness is not seriously impaired, the confusion
consists of impaired cognitive function and may include impaired memory. Attention is difficult or impossible and it cannot repair the cognitive dysfunction.
Simple unconsciousness, or coma, or coma vigil are
usually the result of severe brain dysfunction and ordinarily fall outside the psychiatric situation.
In the case of psychosis, consciousness remains
clear and attention can be deployed. What is altered
is contact with consensual reality, while reality testing
is perverted so as to validate the departure from perceived reality and the adversion to the delusional reality of the psychosis. The process parallels that of the
full mystical experience in which reality is abdicated
in favor of an illusory reality. The difference lies in the
reversibility of the process. The mystical experience is
reversible, brief in duration (minutes or hours), and
usually consistent with the subject's religious tradition
or some variant thereof. Psychosis is not really reversible (without intervention such as medication), enduring (often for years), and idiosyncratic in content.
The transition from realism to psychosis, the
"psychotic break," is often marked by a delusional
symbolic rebirth accompanied by the illusion that the
subject now sees what he should have seen all along:
"Now I see it alL" The delusion, usually a delusional
conspiracy, now reveals itself as the objective truth,
heretofore hidden from everyone's eyes. Similarly,
most mystical episodes are accompanied by a "revelation." In religious mysticism the revelation is a message from God, for example, the Revelation of St.
John. It is the transition (or transport) from reality

111

orientation to pseudoreality in each case that is described as the revelation. What is involved here is not
a change in the function of consciousness, attention,
or of the sense of familiarity, but primarily the sense
of reality and reality testing. It is the illusion or delusion of rebirth that is the affective component of the
alteration of ego function, but the instinctual, insistent
need for attachment that drives both the mystical and
psychotic fantasy.
I hoped, in this communication, to list some of
the variants of consciousness and its deformations
along with accompanying alterations in attention. I
hoped to show too that consciousness is invariably
linked to affect. In fact, I believe, that the facts support
the proposition that consciousness evolved concomitantly with affect as the perceptual organ for affect.
Some of the variants may provide data for the neuroscientific study of consciousness, attention, and affect.

References
Damasio, A. (1999), The Feeling of What Happens. New
York: Harcourt, Brace.
Nunberg, H. (1959), Principles of Psychoanalysis. New
York: International Universities Press.
Panksepp, J. (1998), Affective Neuroscience. New York:
Oxford University Press.
Watt, D. (2000), Emotion and consciousness. Part II. A
Review of Antonio Damasio's The Feeling of What Happens. J. Consciousness Studies, 7(3):52-73.
5021 Iselin Avenue
Riverdale, NY 10471
e-mail: mostow1234@aol.com

Ongoing Discussion of Yoram YoveIl (Vol. 2, No.2):

Commentary by Joseph W. Slap (Philadelphia) and Jodi H. Brown (Philadelphia)

Whether psychoanalysis can become a respected

member of the scientific community, or is destined
to be regarded as an early 20th-century intellectual
movement, may hinge on a principle enunciated by
Joseph Slap, M.D., is a Training and Supervising Analyst at The
Psychoanalytic Center of Philadelphia.
Jodi Brown, M.D., is a Lecturer of Psychiatry at the Thomas Jefferson
Medical College.
The central thesis of this response was presented in a paper titled
"Congruence of the Neuroscience of Perception and Memory with a Model

Dr. Yovell, namely, "psychoanalytic theory can and

should go beyond our current neurobiological understanding of the mind, but never contradict it" (pp.
1-2). He states further that psychoanalytic theory
"should be continuously reexamined and revised, to
ensure its coherence with emerging neurobiological
research findings" (p. 2). Here is the problem: As we
of the Mind" at the Spring Meeting of the American Psychoanalytic Association in Washington, DC, May 1999.