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INSIDE THE NEURON: CONSCIOUSNESS, UNCONSCIOUSNESS, SPLIT CONSCIOUSNESS

Their statues are made of silver and Gold

The product of the hands of man

Nostrils they have, but smell not;

They have hands, but feel not;

Feet they have, but walk not,

Neither do they utter a sound with their throats.

Those who make them, shall become like them,

Also those who confide in them.

-Psalm 115

Entrée: Consciousness: A Chorus of Choruses:

You can make the argument that brain science is the most powerful science of them all. The line of reasoning goes something like this: All experience funnels through our brain, the instrument of consciousness. Thought, emotion, behavior are expressed as physical events inside neural circuits. If one day we master our own biology we will know everything. When it comes down to it, all knowledge is registered in the physical brain.

Mind and brain comprise one machine conforming to the laws of chemistry and physics. Human action is the output of brain and body, the result of physical processes, of automatic cause and effect. The reason persons seem to act as free agents, is that scientists have yet to uncover all details of the working brain. If all experience results from electrophysical processes, then every mental event is determined by its antecedents. Thus the idea of free will is illusory and conflicts with biological knowledge.

For those not preoccupied with these issues, science has encroached on their self-concept very little. They are deluded into thinking they are acting of their own free will. But make no mistake. Scientific knowledge will engulf them. New discoveries and scientific techniques will one day alter their cherished beliefs. We do well to learn all we can about our physical selves, which is the ultimate source of self-knowledge.

Another view is that the brain merely brings experience to fruition. In that case, biology is slave to another process, an outside will, soul or essence. Electrical and chemical processes express mental events, but aren’t their initiators, or authors. One major support for this point of view, is that no one can tell us where the desire to perform even the simplest act, begins in the brain. The anatomist cannot say where in the brain the command even to move one little finger, starts. The philosophy separating the physical brain from some numinous agent controlling it, is the apostasy of dualism, refuted by scientific knowledge.

Scientific determinism on the one hand and dualism on the other, are insufficient models of human behavior. Both are too simplistic. The reason, I think, is that people have very long ago learned to leverage their mental abilities. We have formed complex social, linguistic, artistic, technological structures. That is the human enterprise. All of this is extra-cerebral, outside of our heads, certainly outside the purview of an individual’s head, and it is the key to our free will in the sense that these structures are no longer determined by biological events. You can make the argument that all of these endeavors began as some kind of biological or adaptive initiative, but they have attained a life of their own by this time and no longer have biological determinants. Indeed the reason for a good part of human endeavor is to somehow escape natural events. It’s why we create shelter, plant crops, fight disease, form groups, design machines, create art, study the world around us. Biology does give us basic information about our innards, but cannot tell us everything about ourselves.

Alzheimer’s disease is a case in point. In Alzheimer patients we witness a mysterious disintegration of cognitive function and then of the entire personality. Very simply, it now seems that beta-amyloid accumulates in the brain and causes the disease. Thus the dissolution of the personality reduces to the accumulation of a chemical in the brain. The slow destruction of cognitive capacity and personality is a process to be followed under the microscope. Alzheimer’s develops in Down's patients who have three copies of the twenty-first chromosome coding for extra amyloid and thus make amyloid in excess. In four types of familial Alzheimer disease that so far discovered the common feature is Beta Amyloid accumulation.[1] Amyloid accumulates in the senile plaque, a structure recognized under the microscope. The senile plaque is the major pathological element in Alzheimer disease, a probable first cause. It means little that in some studies the absolute quantity of senile plaque does not correlate as directly with dementia as much as some other microscopic features such as neurofibrillary tangles or that proteins, one designated “tau” may also be involved. This latter is an effect whereas Amyloid is the cause.

All at once we have a simple mechanism of causation of this mysterious disease. One day soon doctors will beat Alzheimer’s disease by blocking the accumulation of beta-amyloid in senile plaque. More to the point, here is an example of the gross disintegration of the personality explained by events on a microscopic and biochemical level[2].

Amyloid, and so-called paired helical filaments and other Alzheimer changes also accumulate in muscles of aged individuals. All of these changes are clearly visible in the muscle disease common after age 50 termed “inclusion body myositis[3]”. Here we find the very same pathological elements as are present in brain right in peripheral muscle!. Inflammation seems to be part of the problem, at least in many cases where the lymphocyte, a type of inflammatory white blood cell, infiltrates muscle. Changes in blood elements such as platelets reproducibly appear in Alzheimer disease suggesting that certain blood cells may be instrumental in transporting and depositing injurious substances in Alzheimer disease and inclusion body myositis, a form of senile muscle disease. Inclusion body myositis is partly ameliorated with anti-inflammatory medication and theoretically anti-inflammatory medicine may help prevent Alzheimer disease as well.

Figure 1: Senile plaque of Alzheimer disease. Microscopic abnormality explains mental changes of disease process.

Still, what is visible to family friends and physicians too in Alzheimer’s, is the disintegration of the person. Little by little former interests fall away as inclinations, motivation an inner fire extinguishes. This gives insight into normal function as well. It’s obvious that some persons have more intellectual fire and motivation and intense level of interest than others, a natural continuum of the level of interest in the world. Persons in the process of losing intellect often resemble those of lower capacity who never had it, so that you get an idea that intellect and the quality of experience may be determined by some mathematical representation of the total cognitive power of a brain. The decline in the cognitive power of the brain in Alzheimer disease relates to accumulation of a toxic substance and cell death. Persons possessing a certain gene, ApoE4, are much more likely to have Alzheimer's because beta-amyloid is more easily transported into their neurons. That is an adequate mechanism for the disease.

So Alzheimer’s is an example of how a relatively simple process, here accumulation of a toxic chemical, may have profound consequences. Fine you may say. A mystery has been solved. Having done so you open up a Pandora’s box of further issues.

Suppose modern medicine were able to prevent Alzheimer’s disease, as it seems likely to the case soon, by coming up with chemicals that simply block the accumulation or transport of amyloid? That would have profound social effects. As upwards of 50% of nursing home admissions are blamed on dementia, productive life would extend well into advanced years, so long as mental function could be preserved. The discovery of a treatment for Alzheimer’s would undoubtedly extend life. On the surface of it, this would be wonderful. Cognitive function could be preserved in one’s last years. But that would lead to other forms of social upheaval.

Industrialized countries already face a sharp increase in the proportion of elderly to young individuals who compete for economic resources. One wonders if over the long run medical advances that extend the lives of the very old are in fact a blessing. With age comes the accumulation of debility, but even more important, continued consumption of resources and wealth that could be used to improve lives of the young, the infusion of new life and ideas contributing to the well-being of a society as a whole. Always when we find a solution to a problem such as this, we create a host of other difficulties. Which is more adaptive – to extend the life and productivity of the very old or experience the springtime of renewal that can be attained only by the young? Successful treatment of Alzheimer’s and other diseases of the aged would alter our society in fundamental ways. Robust grandparents and great grandparents might be the primary caregivers of the very young, freeing persons in their middle years for other forms of productive labor. Even so lengthened life expectancy would place persons of all ages in competition for scarce resources.

Given that it is natural for the old to become less functional and die off, a planned obsolescence of sorts, one wonders if this in fact isn’t for the best. Life is finite so as to clear the way for the trial of the new and very young. This is the end result of natural selection, a trial of many possibilities. The old must make way for the new for a group to survive and adapt.

It will not be easy to find a sufficient biological explanation for another complex and poorly understood phenomenon, male homosexuality. A biological explanation for homosexuality would at one blow, negate almost all philosophical, religious and political rhetoric as those who maintain that male homosexuality is a lifestyle choice may be proven wrong. Male sexual preference is established very early in life and is likely to be biologically determined. In many primate species relatively few males have the pleasure of performing the majority of heterosexual copulations. This means that not all males contribute sperm to the gene pool, even when the ratio of males to females is close to 50:50. The presence of more males than is needed to procreate may add to the survival of a tribe, for example to increase cohesion or provide defense, so that homosexuality may be adaptive for a group whose members share many genes. Families with male homosexuals might even have some genetic advantage in that dominance hierarchies and division of labor among males may be firmly established or, alternatively, limiting numbers of offspring. New work implicates certain anatomical differences in the homosexual brain that may be heritable, especially in the hypothalamus, a tiny but powerful structure governing appetites sexual and endocrine function. These differences have not been replicated by others and are somewhat conjectural.

Consider the possibility that a homosexual tendency resides on the X chromosome. This putative gene could change the hypothalamus that controls basic emotions or work through another mechanism. If this work pans out, making homosexuality a model of biological causation, many other complex behaviors are sure to be explained as well. But it is just as reasonable to suppose that the entire answer is not in physiology or anatomy[4]. Identical twin studies among homosexuals find only an impressive concordance rate of between 50 and 67%, but still a non-genetic element is part of the story. Homosexuality must have a much more complex mechanism that the simple accumulation of a chemical substance in the brain as described for Alzheimer’s disease but if we succeed in describing the biology of homosexuality, this would have far-reaching consequences. I suspect that we may never be able to do that, that homosexuality is in part biological and part motivational. If so, or if this proves to be the case for other complex sets of behaviors, this would underscore the limits of biological causation.

Obesity is falling under the sway of brain research. Is it motivational or genetic? Pima Indians[5] who live in Arizona are obese compared with their close relatives in who reside in Mexico. That would argue against a genetic mechanism for obesity. There are also significant differences in identical twins reared apart, and a marked increase in obesity of immigrants who move into economically advantaged regions within just one or two generations. Thus obesity appears to be caused by the availability of food. Most Americans have food whenever we want it and obesity is on the rise. Persons, who have inherited efficient use of calories that has enabled survival under conditions of scarcity and starvation, suffer when things go well. They are the first to get fat and to gain weight. This implies that in conditions of scarcity of food, some obese persons who we consider to be unfit, might be the ones who survive, while those who are thin and fit in our own environment of relative abundance of food would be the ones to die off.

What then should be the approach to dealing with obesity in the economically advantaged parts of the world? In the USA obesity is a major public health problem. Policymakers have suggested that unhealthful behavior such as eating a lot of hamburgers and fats ought to be discouraged through a change in our tax structure or that insurance should be more expensive and the like. Fat people should be made to pay for their gluttonous habits. But do people truly choose to be fat? No one knows.

A combination of appetite-suppressing drugs, that simulate the action of Serotonin perhaps, or a host of newly discovered proteins that signal satiety within the brain, plus false nutrients, low calorie or non-absorbed fats and sugars, drugs that cause fat malabsorption are proposed remedies. Ironic that rich persons with access to all the food they could possibly want and more, are so bloated they need to starve themselves to escape obesity, or they need to do heavy exercise just to get rid of the excess calories they can’t stop themselves from consuming. Other folks who are less fortunate die from malnutrition and poverty. Gluttony vs. poverty. Does it seem as if we will one day find a biological or pharmacological solution to these problems? Here I have grave doubts. This too underscores the limitations of proposing a biological solution to what seems to be an non-biological problem.

The three examples above progress gradually from Alzheimer’s disease whose cause is likely to be biological, to male homosexuality which is likely to be multifactorial, to obesity which is most likely to be primarily behavioral except exceptional situations. It is clear that a biological model has sharp limitations in all of these instances.

Alcohol and drug addiction, aggression and other personality characteristics may have a biological cause. Scientists just don’t know the role of brain chemistry and physiology in these disorders. When we find changes in the brain of an addicted person are they cause or effect? An addictive tendency does tend to run in families and could be inherited. A drink of alcohol has less effect on person who is prone to become alcoholic while a single beverage provides a more dramatic quick buzz to someone who is less prone to drink, so one argument goes. A future alcoholic drinks more to attain the same effect. This is before he has habituated to the effects of the drug. Or with alcohol as with other drug-seekers, the addiction-prone may be seeking a thrill, due to a genetic character that increases activity in the thrill seeking chemical Dopamine in the brain. This mechanism would seem more applicable to stimulant type drugs, rather than sedatives such as alcohol. In any case, other sets of behaviors that seem now to be a matter of choice, will fall under the sway of biological causation. Biological research will demystify these behaviors as vague concepts such as choice and human will acquire mechanical explanations. Complex behaviors and personality characteristics that today stimulate moral arguments may be reduced to simple biological processes or turn into definable disorders treatable by medical intervention. The trend is for "psychiatric” diseases turn into "neurological" disorders as soon as problems are found within the brain, though significantly we have yet to see any very dramatic examples that have fundamentally changed our view of behavior.

Schizophrenia exemplifies this trend. Schizophrenia, or severe thought disorder with a poor prognosis, was at one time related to upbringing. Certain theorists championed concepts such as a so-called schizophrenogenic mother, who through her outrageous behavior caused her children to become schizophrenic. This theory quickly lost popularity as data about schizophrenia accumulated. The effectiveness of certain medications in schizophrenia, allowing patients with this chronic, and terrible disease to function outside the hospital, made a powerful argument for a physical cause. Certain anatomical abnormalities in the brains of schizophrenic patients relate tantalizingly to the disease. These include enlarged ventricles, indicating a loss of brain volume and anatomic changes within the temporal lobes of schizophrenics. Psychotic depression as well, is surely a neurological disease. Again the major argument at this point is pharmacological. Psychotic depression relates to disordered neural transmission, and the most efficient treatments are pharmacological. The effect of medications on these disorders has been considerable, allowing severely ill persons to function, yet the effects hasn’t exactly been staggering. Persons afflicted with psychosis very much still have their disorders even when functioning very well.

Even the approach to neuroses that traditionally have been felt to have non-physical causation, most particularly one of the most common, panic disorder, is also chemical. Insurance carriers have noticed that psychotherapy is ineffective and expensive. Holding the purse strings for medical treatments insurance payers strongly "encourage” drug treatment.

You can argue that panic disorder is caused by psychological mechanisms, even though it certainly responds to drug treatment over the short term. The brain is in the middle here, and short-term results can be gotten with drugs even though the basic cause is really an extreme fear brought about by thought processes having to do with unfulfilling life circumstances and pressures. Perhaps this process goes out of control and the fear response assumes a life of its own. Efficient short-term treatment is in the form of a quick acting sedative, more potent long-term solutions may be connected with brainstem transmitters such as Serotonin. But the basic process begins with certain ennui or life-threatening non-fulfillment that eventually needs to be addressed. One strong possibility is that the psychological process uses the brain as a substrate, a stage on which to act out its drama, and temporary treatment regimens may utilize brain chemistry even if the root cause lies elsewhere. At the very least, no one has been able to prove or disprove any of this and it is a mechanism worth remembering, because the same kind of faulty logic pervades understandings about the brain and psychological mechanisms, which affect it. Motivational processes, heretofore somewhat mysterious, are reduced to biological tendencies even disease states, removing all concepts of culpability and punishment, even considerations of motivation and free will. Consider the implication of discovering the biology of alcohol, drug addiction even kleptomania or even of finding the changes in the brains of murderers and violent criminals. When biological explanations for deviant and normal behavior too are deemed sufficient, philosophical, religious and political vision thoroughly changes. What we have then is a whole spectrum of behaviors and personality characteristics, some of which are more, some less, proven to have a biological mechanism. Yet there is the sense at least that all behavior can be reduced to a consideration of biology, mechanistic even automatic, not at all controlled by free will.

If matter and physiology is all, the real question is whether someone will one day be able to put together a mechanical device, most likely made of Silicon, that will recreate or even go beyond human experience. Brain scientists are on the verge of concluding that consciousness is no more than the mere interaction of modules or pieces brain real estate, anatomical sections of brain, now more precisely described than ever, that communicate well enough to give the illusion of experience. Even at our current level of knowledge, more data is accumulating indicating the failure of this model or at least showing that it requires fine-tuning. Consciousness produced by interacting modules yes, which include the reticular activating system, limbic structures, thalamus, frontal, parietal lobes, but these and other smaller and larger sections of brain function simultaneously and in parallel. Connections and interactions don't necessarily function in the rarefied realm of computer logic either. Some aspects of the connectivity may be illogical. These issues will be described in greater detail in the pages that follow.

The product of this interaction, we perceive as human experience, is more like a chorus composed of individual voices singing together or even a chorus of choruses. My model here is Gustav Mahler's huge 8th Symphony otherwise known as "The Symphony of a Thousand" a chorus of separate choruses (plus orchestra). A neuron is the individual voice coordinated in a group or smaller chorus, or nucleus of cells, Nuclei, sometimes silent and sometimes active, are the smaller choruses. The harmonious (or cacophonous) output, the chorus of choruses, is the symphony of consciousness. Note that the connection between these elements is not logic alone, but involves quite a bit more, emotional, musical and other relationships variously amalgamated into a cohesive conceptualization, just the kind of relationships it would be near impossible for the computer scientist to reproduce. Nervous system functional anatomy is also simultaneously hierarchical and interactive, even more a chorus of separate voices not a full linear logical progression in a top-down or interactive design. These are concepts that will be dealt with in the pages that follow.

Figure 2: A horizontal (cross-sectional) MRI image of the brain. A thin ribbon of gray encloses predominant white matter.

Looking at a gross picture of the human brain and one thing is striking. There is far more white than gray matter. The white mater is the wiring, the communication pathway between gray matter, neuron cell structures, and cortex and brain nuclei composed of cell bodies. You have to come to the conclusion that the brain must be more involved in communication between parts of the structure than initiation of messages. Messages ramify and resonate to a far greater extent than they are actually created. If experience is a chorus of different parts then it is logical to ask where is the chorus master or conductor? The simple answer is that we do not know. It is fascinating that we have come tantalizingly close to a physiological understanding of human experience but have yet to define the most important element anatomically, physiologically, a central organizing executive. Some may say that this is somewhere in the frontal lobe of the brain, the part that has most lately developed in evolution. But this is at best a vague concept. It is far more likely that what we actually perceive as a unitary experience is organized in much the same way as a choral piece or a symphony. We have a group of voices, tied together by some unitary conceptualization that comes from some outside agent, such as a composer of the work. The problem is that it’s not possible to find this organizing principle anywhere in brain anatomy.

The upshot of all of this is that we shan' t expect any computer scientist to reproduce in Silicon, human brain function any time soon. Material, physiological descriptions fall far short of reality.

Considered from the vantage point of abnormalities and deficiencies, from a disease model, you are almost forced into a mechanistic materialistic version of brain function. The brain, even the personality misfires like a car lacking some of its pieces. But the brain can function optimally, which means without disease with no lesion or disorder. The absence of disease the brain, like the rest of the body, will allow optimal normal function, just as the car with everything working will put out an optimal performance. In other words the absence of disease has nothing more than a permissive effect on behavior. Absent a certain amount of brain matter a person will not be able to learn well and he will have mental retardation or dementia. Lacking the chemical Serotonin in some areas of the brain, a person will be depressed, and so forth. A normal brain will permit someone to learn, and not to be depressed. At the same time you get the feeling that slow learning and depression will always have a physically definable cause. The question is whether these physical processes account for anything more than function in the absence of disease, whether we can extrapolate from consideration of deficits that impair function, into all aspects of normal or even better than normal human behavior. What is responsible for our going beyond our basic level of performance and is that physical or intangible? Will or will not biology eventually account for everything or will there always be some residuum that is beyond biology?

Death in the ICU or What Coma Teaches Us about Consciousness

"I don't think anyone unconscious is dead inside. They may be only more difficult to access."

-Oliver Sacks

The favorite method of neuroscience is the lesion experiment. To determine the function of a part of brain, you destroy it. Then you examine the subject animal for deficits. You conclude that the area of brain lesioned helps do the function that is lacking when it is gone. Cut out the right frontal lobe and an animal is paralyzed on its left side. The right frontal lobe must control movement on the animal's left. A simple deduction.

Brain death is the ultimate lesion. The lesion is all of the intracranial contents. So brain death gives us a chance to start with nothing. Nothing is assumed. It gives me an opportunity to start from the beginning and to build upon my arguments from scratch. The hospital Intensive Care Unit is the place where people encounter Brain Death. Because of nominal survival of the rest of the body enormous cost of continued care, it is a much harder issue to deal with than ordinary total body death. People tend to treat brain dead persons as living, even if, according to statutes in most states, they are legally dead. Even professionals have a terrible time talking to relatives of the brain dead patient because as the heart is still beating, and machines give breaths, the patient looks alive. Hence they tend to speak in equivocal terms often bewildering to the family.

The brain defines the individual. This is a given. Brain death is the very model of this teaching. When the brain is dead life is over. The quality of experience reduces to the function of the brain. An attempt to measure the quality of life reduces to assessment of cerebral function. This is what we assume, but is it true? Is it possible that brain only an apparatus of awareness, or is awareness nothing more than the sum of complex biological processes?

The Brain Is Not Different than Other Organs:

Having spent my professional life treating diseases of the nervous system, I’ve acquired a slightly different perspective on consciousness and the brain. As a medical doctor you learn to use the very same strategies to preserve cerebral function as you use for other organs. Daily experience shows the brain to be just like all the other organs in the body. It causes you to question the idea that the brain is initiator or author of experience rather a medium for experience. Just like other organs the brain depends on a specific molecular milieu for survival and optimal function, only perhaps more so; the brain is a little more particular than other organs are. Body temperature, serum sodium, potassium, oxygen, and acid-base balance must be right. This is just what the kidneys or the gut or the liver require. True, the brain is semi-isolated by a blood-brain barrier, but the brain is an organ, and behaves the same as other organs do.

Compared with the liver, kidney, I tend to put the brain on a pedestal, yet paradoxically, I have to come to the conclusion that all the great scientists who write about the brain and talk about it as the repository of consciousness and everything human, are over-glorifying the structure. I see myself as the proverbial soldier experienced enough point out that all political problems can’t be solved by war. My daily experience has humbled me. I see how little I can accomplish. The brain aids in the enterprise of consciousness but is not responsible for the consciousness in toto at least it seems to me given the explanations below. Most everyone I’ve read who writes about the brain wants to find the totality of human experience in biology. But it seems to me with our state of knowledge now and in the foreseeable future, that's an impossible aim. As much as the brain is involved with consciousness, it is largely peripheral to the process of consciousness, perhaps not as peripheral as the gut or kidney which by the way are also involved, but peripheral. I am aware this is a minority view and that it even sounds preposterous but it will be proved as we go along. At the very least we will see that by far the biggest bulk of the brain, and very probably by extension all of the brain, is peripheral to the process of consciousness, initiation of the totality of thought and feeling.

An example is a brain operation that is popular for Parkinson’s disease, the pallidotomy. The procedure is used with advanced Parkinsonians whose level of function fluctuates greatly. These poor folks, because of long periods spent with their disease, alternate between total immobility and being overdosed with their medicines, which causes them to writhe and twist about. This operation lesions out a tiny area of the Globus Pallidus, (literally gray ball because area containing primarily neuron cell bodies look gray) deep in the motor controlling area of the brain and is done with advanced physiologic monitoring with the patient awake. The movement areas of the brain that are destroyed by Parkinson's disease, connect extensively with the globus pallidus, but even so, why exactly these patients improve has not been worked out. What you see after the surgery is done can be considered in some cases, a miraculous improvement. This is an operation on the brain an one of the higher areas of the brain yielding striking improvement in gait and other functions especially on the side of the body opposite the surgery. Improvement is so dramatic it can transform a person from an invalid to an active person in one fell swoop.

How is this different than the replacement of a limb by an artificial device, a replacement that helps a person to walk anew, or a kidney or heart transplant that transforms a medical cripple into a functional human being? The answer is that this surgery on the brain is not different. The brain acts as an organ like any other whose normal function enables a person to have a normal and fulfilling existence. As such the brain acts as a tool or enabler of normal function. In the future, we may be able to enhance cerebral capacities beyond the norm. This will bring about a truly revolutionary enhancement of human capacities and a redefinition of ourselves. We would not be the same, after all but have enhanced capacity. But that is some time in the future. We will then have broken at that instant the biological ties that limit us and our potential may one day truly be limitless.

Behavioral Output Isn’t Everything:

We have the two groups of phenomena, the output of the brain i.e. human experience and behavior, and the biological brain itself. We do not know how they relate precisely. We may agree with the consensus that all thought can be reduced to an understanding of biophysical processes. One problem is that we rarely examine anything except the physical representation of consciousness, behavior. Some of this is observed with instruments such as the electroencephalogram that looks at electrical brain wave activity, but is behavior nonetheless. A lot of people have tried to simplify the debate by maintaining that manifest behavior is all there is because behavior, the output of the brain, is all that can be examined and compared objectively. In looking at the brain, behavior is a convenient starting point as the output of the organism but there are so many more phenomena that can’t be ignored by wishing them away or agreeing that you are going to ignore them. Those who look at behavior alone, such as psychologists, rarely take into account the anatomy and pathology of the brain. They may ignore internal mental states simply because they cannot be observed by anyone but the person experiencing them i.e. these states are felt to be “subjective” and therefore not applicable to scientific objective scrutiny. But because internal states are not observable doesn't mean they aren't there or can be ignored. What we can most obviously see simply doesn't tell the whole story. It is only the part of human experience that is directly observable.

Brain death is our strongest argument that all behavior is caused by biological events because you can’t show that there is any residue of the personality or behavior after the brain is dead. Thus the lack of any demonstrable behavioral output in a brain dead individual argues forcefully that the sum total of the personality is expressed in the brain. The other side of this is the distinct possibility that brain death means only the destruction of the instrument of expression not the end of that consciousness.

There is another interpretation. There could be some other agent controlling brain function in which case the brain is merely used as a physical tool of expression of this outside executive. What I'm talking about is some other entity akin to the soul or human will, an executive hovering over and controlling brain function. After the brain is gone, there is no way to show that any such entity exists, not only that such an executive, it is frequently argued, does not exist, because there is nothing, no phenomenon, that it would help to explain. We have no need to invoke, an extra-cerebral executive to explain any currently observed phenomena so why talk about it? Francis Crick, co-discoverer or the structure of DNA, says as much in his book THE ASTONISHING HYPOTHESIS: The Scientific Search for the Soul. His "astonishing hypothesis" seems to be, that the soul does not exist.. The hypothesis is not so astonishing in that it seems certainly consonant with mainstream science today. Certainly scientific principles will eventually explain everything. Mental activity, emotions are epiphenomena of neural and physical events. By the end of the book Crick seems almost to trivialize philosophical concerns over free will, in localizing it to a little talked about structure in the brain, the anterior cingulate sulcusY .

There is no denying that once you have killed the brain, you observe no further behavior at all. But on the other hand, the same cannot be said about subtotal but very extensive brain lesions where the outcome varies. Given a giant stroke that obliterates one half of the brain, a lot of people never come back as an intact entity. They never regain their personality or responsiveness. But once in a while you may witness a surprising preservation of a personality. The affected person may have had a very strong personality structure before his injury. Then despite a seemingly devastating large brain lesion, his basic personality will be preserved. A medical colleague of mine had a huge right hemisphere embolic stroke. You could see on his head scans that fully half of his brain was gone and there was, at first, tremendous brain edema or swelling that affected the other side of the brain as well. It took him a long time to come around, months before he was any good for anything, yet his struggle was heroic and today he is a very impaired but he is very much the same person. Examining him, you will find certain "deficits", basic difficulties in much the same way that you would if he had lost an arm or a leg. Vladamir Lenin suffered a whole series of strokes near the end of his life, yet there are adequate records to show that he continued to function in much the same way almost until the very end, continued with his former perceptions and assessments. Indeed near the end in his final testaments he issued perceptive pronouncements about Stalin proving that he was more clairvoyant than his contemporaries. Boris Yeltzin's extra-cerebral problem after his after his series of heart attacks and alcohol addiction is qualitatively not different than Lenin's. The loss of a part of the brain brings us closer to basic cognitive function but it is very difficult to change what is basic about a person.

We are still left with the proposition that whenever we see a fellow human being, we are evaluating him on the basis of his behavior only, what is manifest, what we can see. Various neurological conditions produce degrees of inadequacy of behavioral output. A stroke may stop a person from moving his right side or from speaking even though he wants to move and may have a lot to say.

The difference between manifest behavior and internal processing can be seen in a condition known as locked-in syndrome. This terrible naturally occurring condition leaves a patient virtually unable to move at all even though his level of awareness is there. The subject is awake and aware and thinking but is unable to move, in a state of perfect impotence, completely dependent and unable to change his environment. Though he has basic bodily functions, his heart beats and he breathes. On the surface the pitiable patient with locked-in syndrome seems to be in coma, since he does not respond to his environment. Only in the past few decades was the true nature of the condition, a form of “pseudo-coma”, appreciated, for the subject is awake and aware, only he is unable to move. Such persons were thought to be in a coma until someone noticed a level of awareness in their eyes which can be made to move and even to express thoughts via an agreed upon code with vertical up and down eye movements. Gazing into an affected person's eyes gives the first clue that a level of awareness is maintained.

The commonest lesion causing a person to be locked-in is a stroke in the pons, part of the brainstem where in a small area all of the motor output fibers course. The reason why vertical eye movements are spared is that these emerge from a slightly higher area of the brainstem, the midbrain, which is unaffected. Level of function and sophistication, sapience is still judged on the basis of behavioral output in the end. Only here, our breadth of observation is restricted to eye movements which is the only preserved voluntary motor output. Certain patients with other neuromuscular conditions causing near complete paralysis are also locked-in. Since the voluntary motor system is the major behavioral output that one can observe, and the motor system is efferent, outgoing from the brain to the environment, we say that such an unfortunate person is de-efferented, disconnected from his environment so far as motor output is concerned.

Now this is an interesting condition of complete and utter helplessness, an inability to do almost anything, to influence anything in one's environment, particularly if one's condition goes unrecognized as it sometimes does and life is just simply preserved without anyone noticing that there is still an awake thinking person inside. This is a sort of eerie "brain-in-a-bottle" experiment. By this I mean that supposing for a moment that after you died one could store your brain, in an awake and aware state, away from your body, keep it alive, with you thinking and dreaming, in a sort of nutrient fluid, floating in a jar on a shelf. How would that be for a person? Possibly one of the world's most horrifying experiences. But there are motor feedback loops as well as sensory ones, a constant communication and interplay with motor outputs that keeps the brain active in much the same way that you stay awake better even when you are tired while you are actually engaged in some activity much more than if you're sitting around just reading or listening and so very likely the de-efferented subject is somewhat numbed, anesthetized, during his long experience being cut-off from his motor output. The experience may not be quite as horrible as it seems to be. I know of cases where persons have recovered from severe paralysis, in myasthenic crises or after Guillian-Barre syndrome, an inflammatory condition of nerves causing a paralysis that can last weeks or months. Such persons aren't comfortable but don't describe a horror as bad as I would imagine under the circumstances. Perhaps some of us, being somewhat more kinetic, would not do as well under the same circumstances.

Brain Isolation:

Along these lines it is possible to come up with another means of disconnection from one’s environment which is so far is not well documented. A person may be unable to hear, see, taste, or feel. All sensory input could conceivably be interrupted in which case all sensory data from the environment would be cut off so a relevant response would also be impossible. Such a subject would be cut off from sensing his environment. He would retain all simple reflexes such as a simple withdrawal, eye movements, breathing swallowing and voluntary motor activity as well except that such activity would be irrelevant to environmental context because no data would reach consciousness and no voluntary motor output could be connected contextually to environmental stimuli. He would superficially seem to be awake and aware, but being

that he receives and processes no sensory input, he would not be responding to his environment except via automatic reflexes. Therefore he would seem to be awake but unaware.

This is similar to persistent vegetative state due to severe brain injury. The subject seems to have normal sleep and awake stages and may be looking about the room, but not fixating visually and while all the basic reflexes are there, even some rudimentary motor output, there is no evidence whatever of any awareness, awake but not aware. The eminent neurologist, Fred Plum, MD, famous as co-author of the classic text on Coma, presented a collection of patients with persistent vegetative state with complex organized motor activity even irrelevant speech. The key was that motor output, however complex, was not related to environmental stimuli[6]. But it is at least theoretically possible that even though a subject fails to show any contextual motor response, still he is awake and retains a level of awareness that is not apparent behaviorally due to the fact that all sensation is cut off. Since we speak of sensation as being afferent or traveling toward the brain, we have the obverse of the de-efferented state here what can be termed a de-afferented or locked-out syndrome. The disconnection with the environment is on the sensory sideF. One way to think about the thalamus is that New Testament expression, “No one enters the kingdom of heaven but through me.” Sensory data, as a general rule doesn’t make it to the brain, except through the thalamus.

This very situation was brought to the fore when the brain of Karen Quinlan was examined. This young woman' s plight was widely publicized one of the first "right-to-die" cases and she had been in a persistent vegetative state for many years before she finally died. Her parents petitioned for the right to withdraw medical care in her case. An examination of her brain disclosed that the brunt of brain damage was in the thalamus, the major sensory way station of the brain, through which pass tactile, visual, auditory, gustatory inputs. Such information at least raises the conjecture that a persistent vegetative state may result from ablation of sensory inputs to the brain without destroying large areas of cortex, which leaves a person both awake and aware yet behaviorally vegetative. That being said, the operational definition for a persistent vegetative state in medical parlance is that the person is allowed to be awake but is unaware, that is there is no contextual content to consciousness. This occurs in most instances with widespread destruction and dysfunction of most of the entire cerebral cortex leaving a good part of the brainstem, the lower areas of the brain, intact. The basic problem is that we are forced to make these judgments on the basis of behavioral output. The philosophical conundrum is that by these simple discreet lesions taken together, pontine destruction causing the locked-in syndrome, plus thalamic destruction causing a locked-out syndrome, that a person may attain a state of perfect untrammeled awareness, being awake, and conscious yet be completely disconnected from the environment. Further, an outside observer would be likewise unaware of the pure thought processes still occurring in that person's brain because he would be unable to get at them to make behavioral measurements. Tantamount to a soul floating bodiless in another world unable totally to communicate with our own, but while theoretically possible, this is entirely conjectural at this point[7]!! In Eastern religious circles, this perfect isolation of thought might be considered a state of nirvana. To most of us conventional types, it is more like hell.

Figure 3: An MRI brain slice. The thalamus is centrally located here, bordering the fluid-filled third ventricle. Eyes are on top, occipital lobe or back of the brain at the bottom.

I’m not saying that having pure isolated functioning cerebral cortex ever exists, even in an intensive care unit. Such a situation where a discreet lesion is made in the thalamus and also the pons would never and likely has never occurred naturally. De-afferentation in particular, is bound to have many other effects on consciousness so that a total isolation of a thinking brain from its environment is probably impossible. For one thing, the thalamus also helps to keep the cortex in a waking state. I only describe it here to illustrate the existence within the brain of afferent, incoming sensory vs. efferent, out-going, motor limbs or divisions of function.

Figure 4: Isolating lesions of the brain. The brain is partitioned from the outside world through the bottlenecks of thalamus and pons. Even with Afferent or Efferent limbs amputated it may think and emote.

One possible way to look at de-afferented state specifically would be through the sense of smell. If we had a patient with the specific thalamic destructive lesion, we could test the hypothesis of Deafferentation. Our putative thalamic lesion would not deafferent our subject entirely because olfaction (sense of smell) does not course through the thalamus, but goes instead directly to the frontal lobe. If a person in a persistent vegetative state is conscious but disconnected from all other sensory modalities, then it might be possible to communicate with that person using the sense of smell. This would have to be in a case that must be exceedingly rare, if it exists at all, of discreet thalamic damage causing a vegetative state.

Deafferentation undoubtedly has other clinical correlates. It is akin to sensory deprivation, only the complete anatomically pure case of sensory deprivation that is bound to have extreme consequences for awareness. In prisoners and other subjects who are sensory deprived, there are profound psychological changes. Lacking stimuli, many subjects will start to hallucinate. This may be due to the physiological mechanism of denervation hypersensitivity, described later. Neurons lacking input are hungry for it and tend to over-respond. Hence a person subjected to sensory deprivation may begin to come up with his own stimuli or hallucinate sometimes extremely.

Afferent, Efferent, Associative Limbs:

From the foregoing and on the basis of all current data, about brain function, we conclude that neural function has three components or “limbs”. These are Afferent, Efferent, and Associative. Afferent refers to the sensory side or processing of incoming information. Efferent, the motor or doing side, by which the nervous system manipulates one’s own body and the outside world. Associative or relating parts of the brain, refers to the sum total of internal processing of thoughts and feelings. This is what I refer to as the NeuroWeltanschuung or neurologist’s world view. For the neurologist the nervous system is the center of the world and he breaks nervous system function into afferent, efferent, and associative limbs

.

Figure 5: The neuro worldview with afferent, efferent and associative components.

A closer look at this simple construct will at the same time help explain and clarify while showing how useful these ideas are. We’ve all noticed that certain personality types have one or the other of these limbs de-emphasized or atrophied and others hypertrophied. A facile example is the artist who, stereotypically at least, is hypersensitive. The artist has a hypertrophied or overdeveloped afferent limb. Artists are supposed to feel, to receive, more profoundly than the rest of us, so much so that they are often non-productive. They lack at times, motivation and output, and are easily blocked. What does the artist do when he needs to put out his product? He retreats to his loft, to his workshop, or better, to the mountains, where he can finally cut himself off from overwhelming sensory stimuli and begin to produce, to finally paint, or to write or compose. He thereby cuts off his troubling afferent limb and finally begins to put out his oeuvre. Of course all of us know that many of the most successful artists are primarily doers rather than feelers and that most of them have a prodigious output under even adverse circumstances.

Contrary to this stereotype are both the athlete and the entrepreneur. They don’t think or feel much, not to let too many thoughts or feelings get in the way, but are always producing. They have an hypertrophied efferent limb. Then it is easy to appreciate the armchair philosophers, or mathematicians. Divorced from connections with the outside world, these folks are paid to think and associate. All of these situations are illustrated in the figures below.

Figure 6: Neuro-stereotypes on basis of occupation.

The brain lesion model provides a very useful platform for describing the necessary components for creating a conscious output. The parts of the brain necessary for conscious response have been well described using this methodology. The brain scientist breaks consciousness into two operational components, the maintenance of arousal and content of consciousness. To be conscious a person needs to be awake. Later we’ll get into the argument about whether sleep and other states are really altered states of awareness, but for the time being it simplifies things to require our conscious subject to be awake and aware.

The part of the brain that maintains arousal is a collection of anatomical structures in the brainstem designated the reticular activating system. These brainstem structures are under the cerebral cortex or you may say behind the cortex, closer to the tail of the animal. There are groups of cells that maintain arousal by virtue of connection to the cortex that essentially excites it, I like to say revs the cerebral cortex, keeps the engine of consciousness humming. When a large portion of the central brainstem is affected by such processes as trauma, tumor, infection stroke or any destructive process, a person will be unable to maintain wakefulness. On the other hand as we have seen, if the cortex is affected, a person may be awake but unaware. He may lack any substance or content to consciousness, even though seeming, superficially, to be awake. Thus the brainstem ascending reticular activating system or ARAS keeps the person awake and a good deal of its input is by way of the thalamus that connects extensively with cortex. The ARAS is ascending because the influences are going up or toward the highest areas of the brain. The thalamus is the rostral or most forward part of the ARAS.

Conditions Correlate with Specific Brain Lesions:

The table below is not fully understandable at this point. It is meant to apply the modular or component or mechanistic point of view of consciousness I have been discussing above. In the hospital ICU we see various conditions that affect behavioral output. With modern understandings we are able to relate these various conditions to specific lesions inside the brain with a fairly high degree of precision.

CONDITION	AWAKE	AWARE	LESION	EEG	EVR	REFLEXES
PVS	S/W CYCLES	NO	BILAT. CORTEX, OR THALAMUS	LOW & SLOW OR UNREACT. ALPHA	SER IS OUT BAER OK	YES
LOCKED IN	AWAKE (& altered sleep)	YES	PONS OR nerve or muscle	Near NORMAL	BAER ABN SER NL	YES
COMA	CAN’T BE AROUSED	NO	BRAINSTEM OR BILAT CORTEX	LOW & SLOW OR UNREACT. ALPHA	VARIABLE	YES
DEGEN DIS	YES (S/W Cycles)	REDUCED	VARIABLE (severe and diffuse)	NL TO SLOW	VARIES ACC’G TO CAUSE	YES
BRAIN DEATH	NO	NO	ENTIRE BRAIN	FLAT	ABSENT	SPINAL ONLY
AKINETIC MUTISM	YES	probable	MIDBRAIN OR FRONTO-MEDIAL (cingulate)	VIRTUALLY NORMAL	NORMAL	YES

Table 1 : DISTINCTIONS IN CLINICAL SYNDROMES PRESENTING WITH ALTERED CONSCIOUSNESS.(PVS= the persistent vegetative state.)

NOTES: 1. “CONSCIOUSNESS” = WAKEFULLNESS AND AWARENESS

2. PERSISTENT VEGETATIVE STATE (PVS): Complete unawareness of the self and the environment accompanied by sleep-wake cycles with either partial or complete preservation of hypothalamic and brainstem autonomic functions. In add’n: No sustained, reproducible, purposeful, or voluntary behavioral response to sensory or noxious stimuli. No language comprehension or expression. Bowel and Bladder incontinence. Full chew and swallow not present.

You Need to Be Conscious to have Pleasure or Pain:

A lot of times I'm asked if a comatose patient is suffering. How much does he know? Does he experience any pain? My stock answer is that you have to be awake and aware in order to truly experience pain and suffering. This is exactly the same argument that was used by surgeons forgoing anesthesia in newborns and prematures. The brain isn't well developed or myelinated with all connections intact. The baby is preverbal in his development. Does the infant suffer? A newborn subjected to pain or surgery will withdraw, move, grimace and cry but what is going on in his cerebral cortex and how much does he feel? You can apply the same reasoning to lower animals. What happens when you vivisect and insect or boil a lobster? Again you may observe certain behaviors that make such activity look cruel. The lobster struggles to get out of the scalding pot, but how much gray matter is there to appreciate pain and pleasure and how much suffering takes place? Tough questions. A person in coma has no awareness that we can gauge behaviorally. If he survives and rearouses and he was truly in a coma, he will never tell you about details of his experience or complain about how much he suffered, this is assuming that he was not awake at the time. So my answer has to be that there was no suffering or pain. But to be honest, I'm still not sure. What if he does suffer but doesn't remember it? You can use a drug to affect recall but has no analgesic properties, such as atropine, which is used in anesthesia. Very rarely patients, inadequately anesthetized, will recall pain. This creates an interesting philosophical conundrum. You don't use a narcotic or anesthetic that actually reduces pain or lowers the level of consciousness to dull or obliterate the experience. You merely give atropine and the person is unable to recall the experience, even though he may have experienced intense pain. He cannot recall itF. Is it cruel to inflict pain that the person is later unable to recall? As far as our subject is concerned, it never happened, yet during our procedure he may have been in agony. It's a little like the tree falling in the forest with no one to hear it. Did the sound happen with no one to recall it.? On even a more metaphysical level, I do know so far as my ability to measure it, that a comatose or brain dead person does not suffer. This is related to the question of whether brain function defines the person. We have no knowledge of experience apart from the assessment of brain function that is measured behaviorally. Some religionists say that there is a soul that is separate from the brain, perhaps hovering over the bed. But we cannot corroborate this belief phenomenologically. If we bring our comatose patient back, he will not recall suffering. Brain death and coma are a metaphor for the position that the brain makes the person, the argument made on the basis of the most extreme case. Brain function is gone, ergo what is human is gone also.

BEHAVIORAL AND ELECTRICAL CORRELATES OF LEVELS OF CONSCIOUSNESS[8]

You can follow the brain through its course of decline as global function deteriorates through the various decreasing levels of consciousness through coma, which may be considered brain failure, and then finally to brain death. The electroencephalogram (EEG) is a test that looks at the brain wave activity of the cerebral cortex and makes it convenient for us to follow the various levels of consciousness which are the same whether the person is undergoing deeper levels of anesthesia or sinking deeper and deeper into coma. Giving larger doses of inhalation anesthetics induces levels of anesthesia. The technique of anesthesia is really just a refinement of the use of volatile gases like chloroform used in the nineteenth century. Today we measure the anesthetic as a percent of inhaled and exhaled gas applied to the alveoli, the diffusing area deep in the lungs that has access to the blood. Various volatile gases such as isoflorane and analogues are breathed in with a tube and a ventilator. Levels of anesthesia can be correlated with percentages of inhaled and exhaled gas.

When you are awake, brain activity appears somewhat disorganized with rapid changes and unexpected electrical events. The tracing looks almost chaotic. The person is moving about and thinking about various things using different parts of the brain unpredictably. Mostly fast activity tells us that the brain is electrically active. But let our subject sit down and close his eyes in a relaxed or sometimes focused manner, and suddenly the electrical activity becomes very organized and regular. There is almost a perfect sine wave pattern a lot of times, usually between the frequency of 8-13 cycles per second that is called alpha wave activity. It is the EEG concomitant of restful waking. Oftentimes you see a regular pattern with a gently modulated gradually waxing and waning amplitude.

Not too long ago some psychologists were enamored with controlling brain alpha activity. They found it remarkable that people could be "conditioned", actually "learn", to produce alpha activity, something that was considered to be involuntary. Maharishis and patients wowed the psychologists with how much alpha they could produce at will. But anyone who looks at a lot of EEG’s finds the conditioning or learning how to make alpha activity absurd. Almost all of us do it naturally and effortlessly and if we are relaxed we can bring it out any time. You only have a problem making alpha if you can’t relax or focus but you certainly don’t need to be any kind of a guru.

As the level of consciousness becomes a little depressed, regular organized restful waking is again not possible and the EEG begins to become fast and disorganized. Perhaps the cerebral cortex is no longer under the tight control of lower levels of the brain that produce the alpha rhythms in the cortex. This is in the thalamus, a group of neurons that connects to wide areas of the cortex. There is fast (beta) and very fast activity of varying amplitude. This pattern occurs in persons given certain sedative especially Valium like drugs and alcohol, but also in anxious individuals. In the early stages when you start to administer anesthesia, you see this varying amplitude fast activity. Perhaps the cortex is actually more active or is less well modulated or controlled in an organized fashion by the thalamus. As a general rule on the EEG, faster activity signifies that brain cells are more easily stimulated but in a less controlled manner with more chaotic activity again. Slow activity means the cells are hyperpolarized in other words stimulated with difficulty and, conversely, fast activity implies the cells are partly depolarized. If this sounds electrical, it is. We can look at the electrical activity in individual brain cells. This will be explained below. Fast or disorganized activity seems to occur with some minimal level of impairment then, light anesthesia of low doses of some other sedative (Valium-like) drugs. What will our subject look like? You may be able to appreciate very little. He may seem mildly or subtly impaired perhaps with slurred speech. He may be somewhat irascible or uninhibited or even a little delirious.

As you go on administering more anesthesia behavior will change by degrees. As the person is even more impaired and this can either be by disease processes that injure the brain or by anesthesia where the changes are very reversible, the person's level of arousal is ever more impaired. It will become hard enough to arouse our subject to call him lethargic or even obtunded or there may still be unfocused attention, the impossibility of staying on task in an organized fashion for anything more than an instant, the impaired excited response to the environment that is delirium. At this point with even more anesthetic effect, the EEG slows, indicating that neurons are hyperpolarized and harder to stimulate. The activity is called theta, which is 3-7 cycles per second. When the EEG looks like this the impaired awareness is less subtle. A diffuse slow pattern and the behavior that goes with it are what is meant by "encephalopathy" a word that simply means the brain as a total entity is affected or diseased. The anesthesia will affect brain function reversibly. Indeed the whole job of anesthesia is to temporarily and reversibly impair brain function. Disease processes are less reversible.

Coma is an even more extreme impairment of cerebral function. As opposed to being lethargic or obtunded where our subject is still arousable, a coma is unarousable unresponsiveness. Here the EEG becomes very slow. In the extreme case the EEG is absolutely flat for a while but then some electrical activity escapes from whatever is suppressing it. It almost looks like a seizure pattern as high amplitude electrical activity suddenly appears out of a flat pattern. This is burst suppression. When a person is in a coma due to a medical illness and has this pattern, the prognosis is poor. Very few people will ever reawaken. Most of the time they are not breathing at all or breathing is too inefficient or unreliable to leave without some kind of mechanical support. The limbs may be flaccid. This shows that something extreme is affecting the brain. However, depending on what exactly is wrong, recovery might still be possible. We know this because we can reproduce this exact pattern with a high enough dose of anesthesia, in other words anesthetize a person to this very deep level and the person will make an uneventful recovery. The EEG can also be completely flat or isoelectric. Here the brain shows no electrical activity at all that is detected by our instruments. In an intensive care unit, with a coma from a medical illness, almost no one will recover from this EEG pattern. Still we know that under certain conditions this pattern is reversible, for example if the body is extremely cold (hypothermia) or with very high doses of drugs, especially Phenobarbital that suppress brain activity. In fact Phenobarbital and other barbiturates, produce exactly this sequence of EEG and clinical pattern as the dosage is gradually increased and these drugs serve almost as models for levels of consciousness, anesthesia and EEG patterns. Other anesthetics used are a little more quirky and don't exactly reproduce this sequence of patterns. Some have a little more in the way of stimulant properties as well as anesthetic properties but in general the sequence is as presented above and in the figure.

To review I have presented a thumbnail sketch of levels of arousal from being normally awake and responsive to coma, and brain death, all of which may be produced by medical illness or reversibly induced by anesthesia. Anesthesia depth provides insight into medical coma and brain failure because we can appreciate that under the right circumstances severe brain impairment may turn out to be reversible. A lot depends on the total context of brain impairment. The EEG gives us a physiological way to correlate (albeit loosely) physiology with behavior seen. Anesthesia is a nearly perfect model for levels of awareness that occur in nature..

Levels or arousal or wakefulness may implicate as we have seen, a set of structures in the brain designated as the reticular formation, much talked about in popular discussions of the brain. Anesthetics tend to affect the function of the cortical neurons directly not the reticular formation. Roger Penrose in his popular discussion The Emperor's New Mind[9] seems to confuse the idea of consciousness in his discussions, with the much simpler concept of level of arousal. Arousal is a simpler concept than consciousness implicating these deeper brainstem reticular formation structures which keep the cortex awake. The discussion of consciousness in general and why biological organisms have it and machines, even computing machines appear to lack it, has little really to do with the reticular formation but involves more the whole functioning brain in a complete organism.

The Reticular Formation Controls Sleep Wake Cycles:

At one level the reticular formation and brainstem structures that regulate arousal could be viewed as a switch which in a binary manner is either off or on. Arousal, loosely speaking whether or not a person is awake and has any self-awareness (something which as far as we can discern only animals and not machines have capacity for) is an electrical process. Judging the state of arousal is much the same as viewing a city skyscraper and observing whether or not more or less lights are on or not on, or looking at a complex computer control room with silent vs. Blinking or non-blinking lights. Activity is or is not taking place on a high level. This general electrical activity or signs of life is what determines both arousal and self-awareness and it is regulated by brainstem structures whose connections ramify widely over the entire cortex or surface of the brain. This is a switching system that is high coordinated, disorders of this coordination mechanism cause untold disturbances in arousal cycles.

The reticular formation helps to coordinate sleep stages that are somewhat the same but also differ in some ways with levels of consciousness. Sleep is broken into four stages of slow wave sleep and REM or dream sleep also called paradoxical sleep. A person in REM sleep has some physiological responses that we observe in him when he is awake, more rapid heart rate, respirations and eye movements and is mentally very active, that is actually dreaming. There may be more brain oxygen consumption than during waking. Brain EEG activity actually does resemble an awake individual with his eyes open, that is desynchronized, low voltage irregular activity. Yet in REM sleep, the subject is hardest to arouse and muscles are completely flaccid, give no resistance at all to movement.

Narcolepsy is a disease where elements of this peculiar REM sleep stage intrude into a person's normal waking day. Normally you don't go into REM sleep until you've descended through the four slow wave sleep stages. The brainstem precisely orchestrates this response. Narcoleptics typically have an irrepressible urge to fall asleep during the day and when they do, they go right off into REM sleep and may feel satisfied after just 10 or 15 minutes. When they feel strong emotions they may crumple to the floor as their muscles suddenly totally weaken and are unable to support them, acquiring on of the characteristics of REM, total flaccidity, a symptom termed cataplexy or falling down.

Cataplexy is a feature of Narcolepsy is derived from an adaptive feature of REM sleep. Imagine what would happen if during REM or dream sleep you could more than experience your dream, you could act it out! Then all of the movement inside a dream, the movement perhaps involved in imagined sex or violence in a struggle with an imagined intruder would cause a person to actually act out. The bedroom would be a shambles, one's bed partner might be beaten up and you would be exhausted in the morning after a night's exercise. This is just what happens in REM behavioral disorder, a rare condition in which subjects fail to lose the ability to move intrinsic to normal REM sleep. Subjects with this disorder have indeed committed violent acts in their sleep and this bizarre disorder has been invoked in criminal trials with sleep experts brought in on the side of the criminal defendant.

In narcolepsy REM sleep happens where and when it should not, as part of the waking day. Cataplexy is tied to high emotion because of close anatomic relationship of the upper brainstem with the limbic system whose product is emotion. Narcoleptics have other periods of weakness and paralysis connected with REM stages of sleep, which happen during their day. Also some have vivid dreams during waking or the earliest or latest stages of sleep, hypnagogic hallucinations, so called because dreams with a person awake become vividly realistic sensory experiences. What is lost in this condition is the ordinarily tight coordination of sleep and wake cycles administered by the reticular formation. F

The normal awake state, slow wave sleep and REM sleep are three normal, well-coordinated states of consciousness. Transitions between these three states are controlled by the Reticular activating system. The highest or anatomically the most forward or rostral part of the RAS is the thalamus. The thalamus is a group of nuclei, or clumps of gray matter, groups of neurons. Just one thalamic function is to drive the cerebral cortex. Inside the thalamus are some nuclei that project, connect to, wide areas of cerebral cortex. These nuclei constitute a revving apparatus for higher brain centers. The easiest way to see their effect is with the electroencephalogram. On the EEG various states of consciousness are easily distinguished by waves that have a certain rhythms which mark out, delineate, these states.

For example another beautiful sine-wave type pattern other than “alpha” described above is the sleep spindle. At 7-14 cycles per second (Hz) spindles wax and wane in amplitude and are recorded on the EEG over wide areas of cortex. The sleep spindle defines stage II of slow wave sleep and is generated or made by the reticular nucleus of the thalamus. The reticular nucleus is a group of cells that connects with a lot of cortical real estate and is thus a rhythm making area of the brain. One function of the sleep spindle may be to block the flow sensory impulses from periphery to the upper levels of the brain i.e. consciousness. Remember that if you are sleeping, as a general rule you don't wish to be affected by stimuli around you, you prefer to be disconnected from your environment (deafferented).

20-40 Hz rhythms termed gamma activity most probably generated by intralaminar thalamocortical cells characterizes waking and REM sleep[10]. So thalamic nuclei drive or rev upper brain levels. Not all cerebral EEG rhythms are driven by the thalamus, some like the slow waves of slow wave sleep and high amplitude waves termed K-complexes seem to be made autominously by networks of cortical neurons.

We are talking here about levels of consciousness self-imposed. What evolutionary advantage there is for tightly controlled sleep wake system is a mystery. Very likely we've evolved a sleep system to regulate alternations of high performance and rest necessary for the function of every machine not excluding living creatures. When you exercise heavily lactic acid and other waste products accumulate in muscle. You are able to sustain a certain amount of activity for a while, but accumulate a debt that has to be repaid and is done so with rest that regenerates the organism and gives one time to get rid of metabolic end products. This is supported by the fact that we all feel fatigued and even much more of an urge to sleep induced by heavy exercise, not just after you exercise which is why you may find it hard to fall asleep if you work out very late in the day, but after a day of heavy exercise.

Sleep stages do not precisely mirror levels of arousal as above described. What sleep and impaired arousal levels do have in common is lessening of electrical cerebral activity as seen on the EEG. When electrical frequencies are slow, it is harder to excite neurons. Slow activity signifies hyperpolarization. The individual neuron is harder to stimulate. When a lot of cortical neurons participate in this process the person is much harder to rouse and the EEG with electrodes placed over the scalp, is looking at the brain on a macro or holistic level, showing us what is happening in many neurons at once. Many different deeply situated, widely projecting cells make up the reticular formation. These influence wide sections of brain altering excitability.

In sleep we profit by looking at three parameters: EEG, muscle activity and eye movements. Recall that a person restfully awake has alpha activity on the EEG, with frequencies ranging from 8 to 12 per second. In stage I sleep the alpha diminishes and activity becomes more disorganized and is lower in amplitude. As the alpha pattern diminishes and more random activity appears over the scalp, the nice controlled sine wave pattern goes away and different regions of the brain appear to be less controlled and to function autonomously. We say activity is desynchronizedy . It is as if the part of the brain controlling brain activity has turned off, which it has. Stage II sleep is remarkable. Instead of seeing some simple EEG slowing, Brain activity is wilder best appreciated over the scalp vertex, high amplitude waves that look almost as if the person is having an epileptic seizure, so called, vertex sharp waves. It is very like an uncontrolled seizure and many persons will actually have a muscle jerk or twitch or sudden movements of their legs, awakening them or impaired sleep at this stage. A slight jerk in the legs may occasionally occur in any one of us at this stage. But it is not a true seizure. What looks wild or out of control is precisely controlled. Coordinated rhythmic electrical activity is seen in sleep spindles also in stage II sleep. These appear superficially similar to alpha activity in their patterned waxing and waning amplitude and sine wave like frequencies in about the 15 cycle per second range. The rest of the EEG activity is slow. In stages III and IV of slow wave sleep, the sleep spindles and vertex activity virtually disappear and we are left with just slow activity as the person achieves deeper levels of more classical sleep. I say this because of the relative loss of patterned electrical activity and inactivity of the brain. This serves as a prelude to REM sleep. REM happens precisely after stage IV sleep 60 to 90 minutes into the night and again and again in later cycles of slow wave then REM sleep for 4 to 6 complete cycles during a normal average night. We may spend, depending on our age, younger people spend more, older less time, babies spend the bulk of their time in REM sleep, about 25% of our nighttime sleep in REM. If you awaken a normal subject in REM sleep, he may recall a dream very vividly. Given time, he will not remember a good part of the dream. Deprive him of REM and he will not feel refreshed after a night’s sleep. Under extreme circumstances, he will go into REM sleep more easily, trying to make up for his deficit, hallucinate or even die.

One of the cardinal signs of narcolepsy REM sleep out of control, is sleep-onset REM in which REM occurs not after stage IV sleep as it is supposed to, but just after falling asleep. Dreams can happen abnormally and appear quite vivid. Some of this disordered sleeping may cause hallucinations in the elderly who lose some control of their sleep-wake cycles and explain why in the elderly as in other degenerative processes, hallucinations occur readily. Some hallucinations may actually be dreams. REM in animals, especially cats which are the best studied, is heralded with so-called PGO (for ponto-geniculo-occipital) waves. These are discharges initiated by the pons where REM is initiated to visual areas of the brain. REM is present in almost all mammals, which may imply that most of them dream, and some elements of REM can even be seen in birds. REM is present in newborns in greater quantity than inadults. Perhaps this means that young folks dream more than old people do. Eye movement has more of a scanning quality during REM which may imply the person is looking around at the scene of his own making. Muscle activity is nil and the person is flaccid, all except for the breathing muscles, but pure voluntary activity is absent.

In summary we all have a well-orchestrated sleep-wake cycle. Levels of consciousness are controlled by a rather vague physiological construct, the reticular activating system of the brainstem. This concept developed partly out of work done in the 1930's by Frederich Bremer. He cut the brainstem of a cat at different levels and observed that if the brainstem is cut high enough, the cat will remain permanently asleep. Many other researchers since have contributed to the concept of an activating center of the brain that effects the excitability of the cortex. Nowadays we have defined the effects of specific structures that project to higher brain areas as well as transmitters that seem to be involved in waking and the various levels of sleep. Some of these brain areas show up on the diagram[11]. In sleep you are aroused with varying difficulty that depends on your sleep stage. In that one respect we can see superficial resemblances with pathological alterations of consciousness and with coma induced by the anesthetist. The most important difference between sleep and coma is that sleep is an active process in which mental activity continues. In coma, as far as we can measure, there is no mental activity at all and none is recollected.

The areas illustrated in the diagram above control different stages of waking and sleep and most of them connect diffusely to the cortex. For example, the Raphe area of the midbrain uses the neurotransmitter Serotonin and seems to be involved in deep slow wave sleep. The Locus Ceruleus of the Pons, slightly lower down, secretes norepinephrine and is implicated in REM or dream sleep. From this we derive a lot of clinical information. For example drugs that counteract Serotonin or which destroy the midbrain Raphe can cause sleep disturbances or insomnia. Patients with strokes in the midbrain sometimes have vivid visual hallucinations and behave wildly. Loosely speaking, the serotoninergic Raphe may oppose the norepinephrinergic locus Ceruleus. Does the unopposed Locus Ceruleus take over leaving these poor folks in a state of dream sleep (from which hallucinations are derived)? This is a matter of some conjecture.

Sleep Is an Active Mental State

Two important points about sleep are: (1) The stages are precisely controlled. (2) Sleep is not synonymous with reduced or absent cerebral electrical activity. You can’t compare sleep to brain death or even deep coma because in sleep there is mental activity. This fact makes you think twice about the purpose of sleep. Is it only for restoration or is something else involved? Pure rest could be accomplished much more efficiently. Why go to the bother of having all that carefully planned alteration of brain activity? Why do we need paradoxical REM sleep?

Man is not the unique in possessing REM sleep. As mentioned some of the seminal early work on sleep was done on cats. Chances are that they imagine in their sleep as well. Moses Maimonides, a Twelfth century physician who did not, of course, have an EEG at his disposal, remarked that animals have imaginations. Imagination he said is not what separates men from animals. What distinguishes man from animals according to Maimonides is intellect by which he seems to mean logical scientific thought processes.[12]

From ancient times men have drawn parallels between sleep and death, positing that sleep as a bridge from the waking conscious world to a different world to come. [13] The evidence is to the contrary. Even in coma, as we have seen, and I am talking here of deep coma, chances are there is no thought content there. Patients I have spoken to do not recollect mental activity and EEG changes are not organized and not like those or REM sleep. We only see a slowing or decrease in brain activity, no orchestration as I like to call it, rather a slowing and disintegration of activity.

People have thought about dreams for thousands of years. Aristotle wrote a short treatise, “On Dreams, and On Divination in Sleep.” And the basic notion of dreams as being revelatory of the intent of the God’s and thus somehow prophetic or of the soul’s being disinhibited in sleep and exercising clairvoyant power by virtue of dreaming, was widespread. Oracles used the technique of Incubation, the practice of seeking significant dreams by sleeping in a sacred area or for the purpose of healing, was in widespread use.[14] The Bible treats dreaming pretty monolithically. Dreams are prophesy telling of future events. Deuteronomy warns of false prophets and dream interpreters but throughout the Bible the dream is a vessel conveying deep truths. Probably the first great interpreter of dreams was Joseph who was a prototypical dreamer in his own right. Joseph explained the Pharaoh's troubling dream, which turned out to be an accurate foretelling of the future, rising to a level of great power for a foreigner as a kind of first minister. Pharaoh altered his name into something that can be translated as “the explainer of hidden things”. In the Bible, you can find many examples of dreams conveying deep meanings and prophecies. Daniel gained great fame for his deep learning and wisdom, but especially as a dream interpreter and diviner. King Nebuchadnezzar of Babylon was a second monarch disturbed by a dream that foretold the future. Daniel gains his deep understanding directly from heaven, “He revealeth the deep and secret things: He knoweth what is in the darkness and light dwelleth with him.” Because of his wisdom, and studiousness and attention to deeper matters, Daniel, and others like him are more or less susceptible to the knowledge that dreams provide. The Bible is full of deep insights basically symbolic visions of a future time gained through dreams, perhaps none more spectacular than the visions of Ezekiel. Apparently prophets who communicate directly by verbal conversation such as Abraham and Moses, may be on a higher level than those who do their work through dreams. Dreams and visions in the first five books of the Bible predict what will happen to the kingdom of Judah many hundreds of years later. This is good evidence of course, that these documents were actually written, or at least revised, at that much later time. Even so, what a great literary technique this is, what greater way to make your point and at the same time give your message a profound theistic spin, a bold stroke, when you consider that the oldest books of the Bible were at least revised about twenty five hundred years ago. The best example of all is found in the book of Numbers where the non-Jewish prophet Balaam, predicts Israel’s destruction by the Assyrians and even the Romans who rose to prominence over 1000 years later! But witchcraft and false prophesy are strongly condemned even necromancy, the art of predicting the future with dead spirits of the past, common, at the time in Mesopotamia[15] but the Bible is resolute in condemnation of such practices, something which ironically enough, resulted in mass persecutions in Medieval times of accused witches, such persecution betraying the superstition of the inquisitors.

Ironic as it may seem today psychologists are still telling us that our deepest personal insights come to us in sleep. Freud to Jung are our Century’s greatest dream interpreters. But dreams for us may are a window to a Subconscious or Unconscious, not a prophetic or mystical visions or view of a future world.

The Jungian anthropologist Joseph Campbell who specialized in the role of myth in culture and many others maintain that modern men have lost contact with a subconscious that defines us. Living in our technological world we have become adept reality testers and have subjected our mythology religious and otherwise, to skeptical scientific and intellectual inquiry that has, in general, rejected the veracity and utility of our basic yearnings. We are alienated from our mythic past, our basic biological and social origins living in a more rarified and sterile environment which we have to find unfulfilling. We have lost contact with our basic identity, best defined in mythic and dream symbols. The symbol in our dreams is a polestar reorienting us and pointing the way home. Some symbols are discoverable in literature and art but the majority are even more elemental. That they continuously reappear even to the unsophisticated and unread among us is evidence that their meaning is simply universal. Some psychic symbols are personal as well, an idiosyncratic part of our own life experience. But others are archetypes whose presence and use owes to universal experiences such as birth, initiation, mate selection, child rearing, and death, life cycle events. These symbols emerge psychically with illogical behaviors, irrational fears in dreams and myth. They are felt by all of us as long as they are not denied or rejected, a part or the human journey. They need not be taught and are understood innately because they are part of all of us if we pay attention. They are thus part of a collective unconscious, which is almost an inborn or genetic defining part of humanity, a useful concept.

Sleep is Evidence For a Composite Consciousness, Two or More Simultaneous Streams of Awareness:

What is the role of the concept of conscious or unconsciousness in this conceptualization? The meaning is that these symbols work on ourselves beneath the level of the strict scrutiny and editorial processes of our stream of waking consciousness. That is why they come to the fore, emerge and are operated upon but not by the light of day. Better to appreciate them, when they can be recalled at all, at night. If we can only rediscover this myth or subliminal level of awareness, then some of our psychic angst, or alienation from part of our basic self, our biological struggle, should, so the theory goes, be reduced. This is the work of psychoanalysis. As everyone knows, the style of dream thought is fundamentally different from the logic or waking thought. Unreasonable things happen in our dreams. Our logical thought police or editors are put to rest nightly as we enter a dream world unfettered by logic or rational linguistic methods of thought. In dreams, words have many meanings. Logic and physics of the real world takes a rest. We are allowed to enter a different alter world, unburdened by the constraints of logic and formal language. The evidence is that all of us, no matter how unimaginative we are while awake, live simultaneously in two worlds or (at least) two separate states of consciousness[16]. During the day we inhabit our workaday mundane conscious world. Then there is a more imaginative dream-like state of consciousness that we journey to at night. Therefore, there are at least two parts to our mental fabric, probably best called the conscious which is language based, Euclidean, Aristotelian (our mundane waking existence) and alter-conscious for alternative conscious state rather than “sub” or “un” conscious. Jung gives the example of a recurrent dream in which he sees his house, a symbol for himself, and constantly discovers other rooms which he had no awareness of, presumably another part of his inner self and new avenue of interests and research So it is with all of us. Rather than being "un" or not conscious, or the slightly more palatable "sub" or beneath the table type of consciousness, this paradigm is an admission that there are two or more alternative streams of mental awareness that co-exist within an individual. In honor physics where the universe supposedly started with symmetry of matter and anti-matter, both components of the real stuff that makes up our universe, we may have consciousness and anti-consciousness but this is defective since it implies an adversarial relationship in which one component of awareness will annihilate the other. All of us (though some may deny it) are intrinsically conscious and alter-conscious, but it matters little what names you use as long as you recognize that your total being is broken up into at least two parts. And these are not entirely separate from one another either, though as we have seen they one or the other predominates at certain times and altered states constantly intrude on one another. Where this is most visible is in our memories of perceptions that never reach consciousness but are stored away nevertheless and many are forgotten totally except we know they are present the brain because they are always unexpectedly dredged up in our dreams. Things we saw or heard of no significance in our waking conscious life assume central importance in our dreams most likely because they are indeed important to our anti-conscious existence[17]. All of us live in at least two simultaneous worlds whether we want to admit it or not, a real practical world and a world of our imagination.

Popular psychology has made a great deal of Left and right brain functions. The left hemisphere, responsible for language in most of us, is thought to be the seat of logic, the right hemisphere, perhaps something akin to dream states and intuition. Musical function and art are deemed to be right brain functions. It is true that word production, syntax and processing are primarily performed by the left brain or “dominant hemisphere”. However artistic and musical functions particularly among those gifted enough to have significant output, involve both the left and right hemispheres. The old neurology literature cites many examples of composers and performers who lost their abilities due to left hemisphere lesions. Why? Musically gifted individuals also tend to be musically literate and logical, as they are “artistic”. And as any musician can tell you music, as is every other advanced human endeavor, is a highly composite function, involving large volumes of both cerebral hemispheres. The right hemisphere is even more involved with simple speech production than we’d bargained for. It turns out large right frontal lesions cause loss of prosody or musicality and melodiousness of speech. A more posterior right hemisphere lesion may cause there to be a problem interpreting sentences with different inflections such as a question which we typically ask by raising the pitch of our voice at the end. There does not exist a right hemisphere artistic vs. A left hemisphere logical brain. Things aren’t that simple. F

In sleep our minds are mentating but differently than when we are awake. We have much less direct contact with our environment and most thoughts, not all certainly, come from inside the brain but yet not completely disconnected. A man dreamt he was guillotined when a bedpost accidentally fell over his neck. You may dream of being hosed down with water when actually drenched with sweat etc, but for the most part dream stuff is made of memories and a different kind of internal mental processing.

Hypnosis is not Sleep

Many people put the phenomenon of hypnosis in the same category as sleep. Indeed the word comes from Greek root for sleep and hypnosis resembles sleep superficially. Hypnosis had questionable beginnings in the 18th Century. It is generally accepted that the discoverer of hypnosis was one Anton Mesmer remembered today as a medical charlatan who promulgated such ideas as animal and planetary magnetism but it is a real phenomenon, which despite vigorous investigation over the years remains largely unexplained. For example, a good level of anesthesia can be achieved for some persons undergoing invasive procedures, even amputations, with hypnosis and behavioral effects are difficult to deny. The subject is not asleep though. Most persons on the EEG are in a relaxed state of waking as evidenced by a normal alpha pattern. Some persons in a deep hypnotic state have slower activity. The subject's attention is intensely focused on a boring repetitive object or stimulus. Some modern studies utilize PET scanners that look at active brain metabolism show that there can be an increase in glucose and oxygen utilization in hypnosis, in other words an intensity of attention, arousal and brain activity. At that time he somehow eschews or casts off his normal regular awake personality and ordinary logic. He is intensely relaxed but will not drop an object out of his hand. He may even relax all muscle groups yet maintain an uncomfortable cataplectic position for extended periods of time. He will have a reduced or altered response to ordinary sensory stimuli and as mentioned, a person may even be operated on and women have had vaginal deliveries without having any pain or recollection of pain. E.R. Hilgard who studied hypnosis found that a subject who denied having any pain when asked verbally nevertheless reported pain when induced with a suggestion for automatic writing but he was not aware of this writing exercise.[18]

Using evoked responses we can electrically track sensory impulses arriving at the brain. In this way we can see that hypnosis in no way interferes with the arrival of sensory impulses to the brain. The subject is made oblivious to these stimuli. How is this achieved? Apparently through unusual concentration and focusing by relegating his attention to another area of awareness. We’ve all had the experience of having an injury which should by rights have been painful, yet because of concentration on something else, we feel nothing, until we look down and note dripping blood. All of this is taken to mean that there is achieved through hypnosis, not only an intense awake focussing, but also a kind of dissociation akin to what occurs in hysteria especially dissociate type hysteria where there exists more than one personality or consciousness within the same person. For hysterics awareness on the part of one personality for the other is essentially nil.

The comparison of hypnosis to hysteria was long ago made by Pierre Janet and it seems to be an apt one. Dissociated hysterics are those subjects made quite a lot about in fiction and by the press who have multiple personalities, a phenomenon usually attributed to childhood sexual abuse or severe trauma as in war suffered as an adult. Alternatively they may experience periods of amnesia or what is termed a fugue or fleeing state. The theory is that some aspect of one’s real life was so traumatic that person needs to amputate it or at least to flee from this part of his personality. Using hypnosis a person can toggle between personalities yet, supposedly, one personality has little to no knowledge of the other. Many instances of this phenomenon remain poorly documented enough for the skeptic to ask, who is pulling whose chain? Is the therapist being fooled by a good actor? Or maybe the therapist is trying to fool a gullible public, yet there is little doubt that states of altered knowledge or awareness of sensory stimuli, especially painful stimuli can be induced by hypnosis.

Dr. Dorothy Otnow Lewis, as psychiatrist has studied perpetrators of brutal murders and has found multiple personalities in a number of them. Her interview bring to light unspeakable ordeals of sexual and physical abuse in early childhood in a number of her subjects. The stories of abuse at least appear be substantiated by other evidence. At her beckoning she has spoken with a number of totally separate personalities residing in the same individual murderers and rapists. Questions remain about the effect of her own belief system and suggestion and whether these inmates on death row are merely play acting in a last ditch effort to try to save their own skins. Courts and juries have certainly tended to ignore her evidence and pleas for mercy. Deep unresolved questions remain about the possible veracity of her observations, whether it is ever possible for personalities to split off in this way within a single body only one of which is actually responsible for committing a heinous act! For society to continue the unspeakable abuse of a young person tortured and sexually abused as a child and end that life in an electric chair seems a cruel and unusual, certainly an irrational and uncivilized response[19].

No matter how big a skeptic you are, from a purely physiological standpoint then it is fair to ask what hypnosis is. What hypnosis isn’t is a kind of sleep or in any way an altered state of awareness. The hypnotized subject is awake relaxed and intensely focused. However what he has shown is the ability to split consciousness and compartmentalize sensory stimuli and responses to these in different simultaneous personalities. Between these personalities the bridge of memory or a stream of consciousness is affected. Notice that in dream sleep, a memory bridge between the illogical state of dreaming and logical waking is also broken so that it is possible to say that at least two different simultaneous personalities live within the same person!! Notice that I don’t maintain they are separate persons, only separate personalities (for want of a better word) because even though the manifest connection of waking memory and any obvious stream of consciousness between these states is not apparent, still, we can appreciate these parts interact with one another and effect the manifest waking person subtly. (See discussion above on dreams and sleep) I shall have more to say about all of this in succeeding discussions in the chapter on memory.

A lot has been written about hypnotized subjects being made to recall childhood memories and being regressed to distant times as a child to rework experiences. Subjects have been made to relive traumatic events and there is lively debate about what can be admitted in a court of law. Quite commonly, subjects “remember” forgotten traumatic events especially connected with sexual abuse in childhood. How much is remembered and how much is fabricated, we do not know. There are a lot of examples of spectacular accusations initiated by hypnosis. In February 1994 Cardinal Joseph Bernadin of Chicago, a man who championed the cause of sexually abused children, was exonerated after being wrongfully accused on the basis of data obtained through hypnosis of sexual abuse, illustrating the dangers of a court of law relying on information obtained during a supposed trance. The perpetrators of these false accusations might have been complete fakes, of course. Others have even been regressed to former lives, and it seems there are simple parsimonious ways to explain such clinical regressions, not the least of which is the expectation on the part of the subject and his examiner, each trying their best to either fool or live up to the expectation of the other. Can remote or pathological inaccessible memories be dredged up using the technique of hypnosis? This is hard to prove and personally remain unconvinced. In the few situations I have seen, I have been convinced that the subject is fooling his psychiatrist.

The celebrated case of Rachmaninov illustrates how hypnosis may be used as psychotherapy, a means of liberating the creative spirit. Rachmaninov, after the disaster of his first symphony, which he wrote for a forbidden and unrequited love, hit a dry spell, characterized by a deep melancholy that put an end to his creative output. He couldn’t compose. A certain Dr. Dahl supposedly helped Rachmaninov out of his deep depression. Of course, we all know that depressions of this type have a good record of spontaneous recovery, so it is debatable how much value this therapy had. The first movement of his second piano concerto, it seems to me, is an allegory for the return of his creative spirit. The orchestra is an enabler for the solo piano, as the work begins in a state of dark melancholy but gradually moves into the Springtime of hope. You can actually see a delicate flower bloom as the paralyzing melancholy ends but leaves behind a residue of deep emotion. This is as good an illustration as I know, of hopeful recovery from the effects of depression, a recovery thought to have been accomplished through hypnosis and psychotherapy.

What I am after here though is that true hypnosis as well as dreaming as an indicator of the existence of multiple simultaneous conscious selves within the same individual. In clinical hysteria, we may be seeing the very same thing. If it occurs pathologically it also is part of our normal existence and we have to ask why or how this occurs. Not two sides or hemispheres of the brain separate out but two or more multiple strands of awareness seem to be working simultaneously. We have our most direct connection with the conscious logical critical waking self. It sometimes seems possible to compartmentalize consciousness. There may be techniques that affect the a single stream of memory traces, in fact a way to break the bridge that ties together consciousness into a single whole, in other words, memory. Some of these ways include dreams, which are rarely remembered but give a view into a simultaneous but active irrational consciousness that seems to be functioning alongside a rational brain, and hypnosis and hysteria and even multiple personalities when they truly exist.

Our waking behavior is unaffected or is at least not explicitly affected by memories of these parallel awarenesses, memories forgotten, dreams, illogical alternate personalities, alter or anti-egos. Yet there is a whole phenomenology attesting to their existence.

Alternative Modes of Thought (Not Just Logic)

Most of the time we insist on logic and material proof. But we suspend logical judgment at other times when it could be said we are waxing more poetic or artistic. Thus it could be said that we have at least two sides one having limited access to the other but they are far from being mutually exclusive. There is all manner of evidence that one part interacts extensively with the other. Poetry is full of reasoning by similes and makes the most of symbolic logic yet the best poems are constructed with the utmost care and conscious calculation. Even pure music, good music is part magic and emotion but logical even purely linguistic processes are not thrown out. The best music, music that really challenges, is the product of meticulous design, working and reworking as is the best poetry. In the same way many leading scientists describe how they are helped along with a pathmaking insight when they listen to their non-logical selves in other words when they suspend logic for a while and work by a powerful insight. Some researchers describe how vexing problems are literally worked out in their sleep and in dreaming. This is undoubtedly because we are mentally active while sleeping and obsessed night and day when trying to work a problem out.

What we have then, is an interactive process that constantly occurs between all of these sides, aspects of consciousness. In truth, there is no split, but a culling and coordination of separate processes within the brain that merely contribute to the whole product that we call awareness or consciousness, if everything is working the way it should. Doubtless, as we have seen, we focus our attentions on one aspect or the other depending on our state. We attend to the dream world that is less than logical in our sleep and are more logical when awake. Still, as we have also seen, dream processing is active in an awake person and is constantly gathering fodder, material, from our waking life. Similarly, scientific insight comes from inductive and deductive logic and even from the imagination of the dream. For an individual person at a specific time, these aspects of consciousness, or splits, either are, or are not, integrated well. We may talk about an ego structure as the integration of the whole, or prefer to call this holistic principle by another name. By whatever appellation, it refers to the integration of the whole, selective focus as certain appropriate times yes, but at the end, integration, that we call the whole person. The schizophrenic seems to be permanently severely even fatally split, perhaps do to a defect in the brain, he has failed to develop this integrating principle, failing to organize and utilize these splits to his advantage.

LEFT HEMISPERE	RIGHT HEMISHPERE
LOGIC	EMOTION
CONSCIOUSNESS	UNCONSCIOUSNESS
INDIVIDUAL	COLLECTIVE CONSCIOUSNESS (JUNG)
OBJECTIVE	SUBJECTIVE (SELF) CONSCIOUSNESS
LANGUAGE BRAIN	NON-VERBAL
AWAKE	ASLEEP
DEDUCTION	INDUCTION

Table 2: Introducing some ways we traditionally split consciousness. Do we flip-flop between splits or integrate them into a whole?

Sometimes an accident or stroke destroys brain regions connected with the arousal mechanisms. Relatively small lesions in the right area of the brain can devastate a person. Clinically we see all permutations of arousal. Some persons have a relatively small brain lesion, usually involving an area in the upper brainstem, yet remain comatose, even though the cortex is not doing that badly. One of the most heartbreaking problems is when a person seems to be awake but there is no content to consciousness. This is possible when widespread areas of the cortex are destroyed. These brain cells are much more vulnerable to the effects of oxygen deprivation or the interruption of the blood supply to the brain. In that case the person is awake, as he appears to be. In fact, he may have normal sleep and wake cycles and be rousable with little other function. There is no evidence that he processes thoughts, moves with true volition or even follows any commands. He can be awake and even look around. This the persistent vegetative state, mentioned above. Akinetic mutism on the surface, almost looks like a persistent vegetative state. Akinetic mutism occurs where there is destruction of a relatively small area either in the frontal lobe or at the top of the brainstem that controls responsiveness. In the case of frontal lobe destruction as when an aneurysm bursts into medial frontal lobe structures akinetic mutism can result, presumably because this area of the frontal lobe, is responsible for motivation and drive. Specifically the area of frontal lobe involved is usually the Anterior Cingulate gyrus. A few patients who recover from akinetic mutism in this region of the brain, recalled an extreme motivational deficit, not that they can’t talk, but that nothing is worth saying. Without this basic motivational component, responsiveness is colorless, zombielike. It is almost as if all personal motivation is amputated. The patient appears to be almost unresponsive, though awake, their speech, if it exists at all, expressionless. Akinetic mutism, unmoving silence, has also been associated with damage to the midbrain and thalamus. Here, the problem may be due immobility, due to damage of certain motor areas, a little like the immobility we see in Parkinson’s disease except in a more extreme form so that the problem is entirely different. In either case, arousal is preserved, because the brainstem reticular activating system is relatively intact, but the subject stares ahead, virtually immobile, apparently without volition.

Arousal Vs. Content of Consciousness

This dichotomy in anatomy, brainstem vs. cortex, allows us to operationally distinguish consciousness as a combination of arousal and the content or quality of arousal connected with the brainstem and cortex respectively. It alters the basic way that we look at human consciousness, superseding the many purely philosophical points of view that have appeared over the years. Akin to the level of arousal is the focusing of attention. Where brain function is slightly impaired, attention mechanisms are also. For example we notice that a slight impairment of brain function occurs with such insults as lowering oxygen concentration in the blood, with a high fever, slight change in blood constituents such as Sodium concentration that affects the brain more or less diffusely. This is what we mean by the term encephalopathy. A person can be awake but has trouble staying on a mental target. He cannot follow complex ideas and is easily distracted and becomes unfocussed and upset abandoning a difficult task at hand. By contrast, a highly functioning individual has no problem staying with a programme and taking it to completion. In delirium distractibility increases mental function and staying on task is a problem and there is often excessive movement, disinhibition and irascibility.

Certain persons function in this way habitually. This is the concept of hyperactivity disorder of childhood, aptly termed "minimal brain dysfunction". What we see is abnormal disruptive behavior, learning disabilities some of which derive from an inability to focus attention, disinihibition and increased motor activity. Some recent work has found decreased metabolic function which can be seen on certain function measuring PET scanners in kindreds of children identified with Attention Deficit disorder of Childhood. By some accounts the disorder has proven to be a matter of hypofunction affecting a good portion of both frontal lobes which is perhaps genetic. We see problems not unlike this among many psychiatric patients especially chronic schizophrenics. What we notice is that brain function is diffusely impaired. In schizophrenia we find a high incidence of brain atrophy, enlarged intracranial spaces or ventricles within the brain.

Figure 7:The Lobes of the Cerebral Cortex. To aid in discussion.

All of this is brain stuff. We take it for granted that consciousness and levels of awareness have to do with the brain and chances are you didn't give this a second thought. It was not always this way. Only recently has the brain been placed in the exalted position as the central arbiter of consciousness. In the Bible the heart is the seat of intellect, not emotion. You should love God with all your heart (read intellect), soul and might. The soul was given and taken away through the nostrils and symbolically represented in the breath of life. Thus Adam was given life when he was given breath. When Aaron's sons disobeyed who came too close to God were killed by having their very breath sucked out of them through their nostrils. Air is an invisible essence, which life is, and at the same time, breathing defines life, at least for animals like man.

All of these romantic notions aside, we know today that the brain mediates emotion and intellect. The heart and lungs exist to supply the all-important brain with oxygenated blood. For Aristotle the purpose of the soft mushy remote brain, was to cool the body. I wonder if there was some person of that day, or doctors that came after him and held him in high regard, even suspected that the brain was the seat of intellect. We are a lot wiser today but only in the last 20 years or so has death been legally defined and only in some states, as an irreversible cessation of brain function. Before that death happened when the heart and lungs stopped working. Then we discovered that we could make the lungs work artificially with a ventilator and we had machines and drugs to keep the heart functioning as well and when we did we soon found out the hard way that life was over anyway because the brain ceased to function and was not viable, we had to change our definition of death.

Brain vs. Kidneys:

No one doubts today the brain's role in making us human. But the brain is at the same time an organ in the body like all the others, composed of tissues and cells. It's interesting to ponder on what makes the brain different from other organs, and in what ways it is the same. The brain is obviously different in that it holds that key to all of our thoughts, perceptions and emotions. It has an exalted position. You may see the kidney as a filtering machine. When you really study it you find it is a whole lot more than that. The kidneys remove toxins from blood and play a crucial role in homeostasis, keeping concentrations of ions and other substances within very narrow limits of concentration. The kidneys also control blood volume and pressure and even secreting hormones that prevent drops in blood pressure when you stand and the controls red blood cell production. OK, the kidney is very complex, but still, its function is a whole lot easier to grasp than brain function. For the kidney you need only define what it does. study its methods and hopefully manipulate function to improve the patient who may have problems. We have no trouble looking at the kidney purely as a machine. When it comes to the brain there has been quite a bit more debate.

It's not unusual that the kidneys suddenly fail. Urine output stops and waste products, expressed as BUN, and Creatinine, increase in the blood. This is renal shutdown. At such times whether or not the kidneys will come back, and what you should do to try to make their function return is much debated. Arguments turn on the basis of various questions. What was the level of function before the insult? What was the nature of the process that caused the kidneys to stop functioning, for example was it heart failure, fluid restriction, shock, or sepsis? Given this information one can make an intelligent guess as to whether kidney function will return and what one should do to ensure recovery of the organ. The interesting thing for me is seeing that the best prognostications of specialists are often wrong. The best ones know that they don't know. The attitude is that they don't give up but give the kidneys all the help they can and then hope for the best. Under the best of circumstances, they can't prognosticate with 100% accuracy. I've also noticed a different attitude among less experienced medical residents in training. Seeing a severe level of dysfunction they tend to be overly pessimistic and often are out "hanging crepe" for already anxious family members. At best the poor victim may survive but require a lifetime of dialysis or at best a kidney transplant if he's lucky enough, they maintain. But experience teaches that some patients start peeing when you least expect them to. Kidney function may in fact improve unexpectedly, miraculously.

Deliberately I'm using so mundane and mechanical an organ as the kidney to make a point. First, in a lot of ways the kidney is not that different from the brain. You may make the argument that since the kidney exists to serve the brain, kidneys function in essence only to provide the nervous system with the exactly controlled and comfortable milieu, so the brain can do what is really important, so kidneys are different than brains. The truth is kidney cells are subject to just same tasks to ensure survival and threats to function as brain cells. First of all the brain too is vulnerable to the above threats of heart failure, fluid imbalance, shock, and sepsis. Indeed the brain is even more vulnerable to these very insults. But think of how much more complex prognostication must be for the organ that is the seat of the soul. One important obstacle is that the brain, far more than the kidney, is broken into individual parts allowing specific functions, for example the cerebellum, the cerebral cortex, basal ganglia etc. each of which may be affected to a different degree and present with different vulnerabilities. For the brain we can determine severe damage to large parts and imaging with CT or MRI scans may show in black and white severe damage, swelling which affects the whole brain compartment or an EEG can show a severely disorganized or even flat graph. A lot of factors may conspire against the brain to severely impair brain function and we may see the patient in a deep coma. Our resident will, even more, go out and hang crepe with the family. But again, once in a while we may witness a miraculous save, so much so that our approach in prognostication has to be as a general rule statistical. We prognosticate on the basis of a group of patients in coma under approximately the same conditions, for example, after an out of hospital cardiac arrest and can say statistically on the basis of a large group of similar patients, that there may still be a tiny percentage of persons who will regain consciousness. Indeed patients in a persistent vegetative state have to be observed for three or more months before we can state with confidence that they will never again enter a sapient, a knowing state[20]. This is for a large group of patients in a gray area. For other subsets we can predict confidently that there is no chance for recovery or that the chances from the brain's standpoint are very good. A lot of times of course just looking at the brain, things don't seem to be all that bad but the poor patient is tottering on the brink of multiple organ failures and will die for that reason.

In critically ill persons the brain is frequently an item of intense concern. A change in brain function may be picked up many times by the intensive care nurse who is with the patient. Most of the time there is abundant sedation and the patient can be agitated but cognitively impaired, in other words delirious, or he may be somnolent or comatose, an impairment of level of consciousness, less often some specific or focal problem such as weakness on one side, hemiparesis. On one level the brain is merely the frailest organ but even more critically, the brain is the whole point to the exercise. If it can be determined that the brain will not recover then why continue doing anything? So it is most frequent that I am there to make this determination. What is the chance that mental function or so-called sapience, will return? If there is to be a brain impairment, how bad will it be? Are we devoting all of our best treatment and resources only to produce a totally dependent nursing home candidate?

So here we are again. We are asked to make some assessment based on both a physical and a mental essence. At base the answer to these questions resides in the individual brain cell. For the patient laying in an intensive care unit, you have to decide whether these individual cells are dead in which case no one can ever bring them back, or if there may be something impairing cell functions so much so that you see this translated into a gross impairment of behavior that is an alteration of consciousness. Brain cells may merely be placed in an inhospitable milieu that simply impairs their function in which case are likely to function again. More and more nowadays, questions about the brain bear upon the function of individual brain cells.

Brain Death, Brain Cell Death

In recent years brain lesioning especially as caused by diseases and other natural processes has been more and more conceived to be a cellular process. As regions of the brain die, a chain, actually multiple chains of events have been described. We still have a lot to learn about this complex cascade of events which has been called neuroptosis literally, a drooping neuron a type of programmed cell death. We do know that organisms need to have a way to get rid of some of their own cells. This happens in the embryo. As certain structures develop other cells are eliminated in order to form normal structure. With invasion of a disease organism, certain infected cells are eliminated and cancers may occur when abnormal cells are not adequately killed off. In these cases and others cell death is an adaptive and normal event. As a cell dies it goes through a whole sequence of events which is pre-planned and certain specific chemicals, some destructive are released and processes unleashed that implicate even simple intracellular substances such as Calcium and Nitric Oxide. If a chain of events can be precisely described, then we may someday discover a way to intervene and interrupt the process of cell death, saving our patient.

A LOOK AT THE BRAIN FROM THE CELL'S PERSPECTIVE:

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Can decisions be taken, strategy made, in as small a unit as the individual cell? The above is a picture of an ameba, a single celled animal predator, engulfing another ameba, a single cell prey. A struggle appears to ensue, very similar to the predator-prey conflicts familiar in larger animals, in which the engulfed organism, tries to escape and actually does. A drama unfolds between two single-celled protagonists, each expressing a biological imperative or will to live, the very same as the human struggle for life and limb proving that such struggles take place daily in the life of the single cell. We do not know if such decisions can be taken by even smaller units of biology, at the level of the organelle, DNA or individual protein elements. Clearly, specialized nervous system tissue is not necessary for the struggle of life, but is a unique component of living tissue. How then did the nervous system develop and why is it now considered to be the primary repository or at least mediator of awareness?

How did it all begin? What adaptive function does the nervous system serve? At first blush you might think that any complex organism containing large numbers of cells would require specialists in communication and control, but complex organisms survive quite well without nervous tissue including plants and lower animals. Tiny animals, protozoa and microscopic creatures with just a few cells exhibit complex behavior in order to survive in their specialized microscopic world. Single celled Paramecia display incredible specialization of function. The Paramecium is one cell with organelles (the diminutive form for little organs) which performs many of the same vital functions that larger communities of cells perform through specialization of cells as tissues and organs. Paramecia have a gullet, cilia for locomotion, light sensitive spot, excretory and sexual organelles and emit complex behaviors of avoidance, predation and courtship. Even single cells have a certain executive capacity. Just one thing that distinguishes them from non-living machines, which can only be vaguely described from an objective vantage point, is a will to live. You may say that machines are not alive and possess no will to live, though it's of course possible to build into them procedures that help ensure their own survival. For example, a computer may control an air conditioning unit which keeps the temperature at a certain range necessary for its circuits to function and you may ask, how is this different than the hypothalamus of the brain which also controls an inner milieu. Animals have built into them emotional responses and seem to strategize in order to avoid their own demise, to react with fear and depression at the prospect of death, but it theoretically possible to build these responses into a machine which would at least make it appear to respond in an emotional way, to mourn, exhibit a fear or rage response etc. You may counter that the machine would simply be following a procedure designed to make it appear to emote by exhibiting emotional behaviors and there would be no inner content there, only some automatic response which is not what apparently occurs in a human or an animal and you would be right. See how the ameba victim struggles against its predator in order to get free. One has the impression right or wrong that even this tiny creature strategizes to get free, that is his response in automatic only to an extent but that if conditions were only slightly different, say the was surrounded by more predator ameba protoplasm on one side than the other, he would try to break free on the thinnest side and would thus alter his response in specific ways given slight changes in his situation. All of this he does without a nervous system (and much of this behavior al response can also be reproduced by a suitably programmed machine.)

In bigger animals cells become specialists, and are more than willing to sacrifice themselves for the greater good. This is because the genetic information handed down is identical for each constituent cell which is a major determinant for such altruism, a topic we'll return to later on. As larger aggregations of cells acquire specialists, constituent cells lose something of themselves. What illustrates this better than anything else is that a good amount of genetic information is suppressed in cells in order to make special tissues and organs. A single celled protozoa expresses pretty nearly its full genetic potential. Nervous tissue expresses only a small part of its genetic potential and is no different from other types of specialized cells as nervous tissue evolved in just the same way other tissues did. A neuron or nerve cell is no smarter than any other cell specialist. We have an obvious analogy today in our medical system composed of "too many specialists", with the criticism that they forget about general medical training and are no longer able to handle basic medical problems. Specialist doctors have lost a lot of what makes them what they are, but presumably this allows the whole structure to achieve a higher level of organization. The question is whether or not this is true. Are we giant humans achieving more than tiny Amebas and Parameciums??

The Brain Represents Design, Biology, the Triumph of Randomness, Trial and Error

It is really questionable whether having a brain confers any real biological advantage. Indeed the jury is still out with regard to this question. Having a brain gives an organism a chance to strategize, for command and control and planning. A good advanced brain provides plasticity of response. Lots of people maintain that due to the development of an advances human brain the rest of biology will be vanquished that man does not have to worry about being crowded out of the evolutionary world. Surely many human weaknesses that would have meant certain death and impaired survival now persist our gene pool, that is persons with these have been able through medical to survive and reproduce. But it is also true that we are daily fighting for our lives as a species mostly against organisms whose mode of operation is to mutate very fast. For example it may very well be the case according to a variety reports, that more people not less, in the U.S. and worldwide, are dying of infectious disease, this in spite of our enormous industry in development of hundreds of second and third generation antibiotic compounds and sophisticated means of drug delivery. In an earlier age of antibiotic use, researches boasted that we would vanquish infectious diseases caused by bacteria, viruses, Ricettsiae, mycoplasmas and other organisms[22]. Now we know this isn't true.

We are experiencing the very same type of competition for food from the insect world and against fungi and other microorganisms in agriculture. We are competing with these varied primitive organisms directly and it isn't at all clear which side will win, we humans or bacteria and viruses or plant eating insects. The conflict is one of design based competition that comes from a central command and control unit of logical output which is the human brain, designer of the advanced third generation antibiotic and insecticide and of the tractor, vs. The non-logical not centrally designed biological organism which continues to depend on natural selection and random biological variation and recombination, the brain and logic against the random solutions of biology. Again the victor is not at all clear. This is analogous to a centrally planned Soviet economy vs capitalism in which the most effective and useful endeavors carve out a niche and survive.

In honor of the realization that bio-evolutionary strategy may over the long run be proved more effective than a central planning agency of the brain, design theorists and computer scientists have started to capitalize on successful biological paradigms. How is biology so successful as opposed to human planning? Biology has "reckless and random" ways. "Because humans rely on logical processes, they consider a fairly narrow range of solutions. Nature, on the other hand, takes a sprawling trial-and -error approach that tests many more potential solutions."[23] The basic conflict in strategy is preplanned logical design versus a wider trial and error strategy not limited by logic. Even computer theoreticians seem to be coming around to the idea that a random trial and error strategy may win. A trick is to design computer programs whose lines of instructions will mutate and recombine similar to the way genes and chromosomes combine and reproduce in an effort to achieve an optimal fitness. Next you employ computational systems of sufficient speed to test these recombinant strategies at great speed, simulating many generations of evolution.

Large multi-celled organisms easily get along without a nervous system. All plants do of course. They use chemical signals sent between cells that take over part of this function. Plant’s reactions to environmental stimuli tend to be stereotyped simple and slow by our human standards. Plants make extensive use of chemical messengers such as Auxins and root hormones to communicate between cells and promote growth. Indoleacetic acid utilized as an Auxin, is a chemical very similar to a mammalian transmitter involved in the control of sleep and depression, Serotonin, and its amino acid precursor, Tryptophan, something that illustrates the universality of chemical messengers that exert powerful organic effects. All organisms are currently felt to have a single ancestor. Different lines are not thought to have arisen independently in different places. The most potent argument for a common line of descent is the similarity of organelles in all cellular organisms and especially the homology between strips of nucleic acids and amino acids that make up DNA and proteins. No one has discovered lines of organisms with fundamentally different strategies for survival or totally novel subcellular components that make up their structure but this is not to say that this is impossible. You may also argue that organisms may have arisen independently but on the subcellular level at least converged so as to utilize the same proteins, nucleic acids and organelles given some general homogeneity of life on our planet, i.e. there is only one optimal biological strategy for survival. But our planet is highly diverse just looking at differences in climate as regards temperature, availability of water, oxygen etc, a consideration multiplied even further when you take into account the profound geological changes that have occurred over the eons of time since the earth's existence and the dawn of life some 3.5 billions of years ago. Just as an example the atmosphere at that time contained almost no oxygen. Initial conditions even on our own planet were not friendly to life. Our earth was down right hostile.

But consider the striking homology of organelles such as chloroplasts and mitochondria. It is generally accepted that these structures may be remnants of early bacterial invaders of cells, early symbionts or commensals with primitive early single cells that ended up helping these cells handle their energy needs. Chloroplasts and mitochondria still survive as symbionts sharing their own DNA with that of the cell's nucleus. They contain a remnant of their own DNA to this day but perhaps started out with their own DNA when they originally invaded other cells as parasites.

Figure 8: The mitochondrion (L) and Chloroplast (R). Note similarity in structure. Both help with energy metabolism[24].

So our best understanding is that all living cells and organisms are derived from a single cell and the best evidence for this is that animals and plants have a limited repertoire of chemical and physiological responses that they use over again. Proteins, nucleic acids and organelles are highly preserved. The chloroplast, which began as a remnant of a symbiont, is the single best example of a subcellular organelle that gives evidence of early divergence of groups into animals and plants.

Slow and Fast Communication – Nervous System Phylogeny:

Plants make abundant chemicals that exert profound effects on humans. These undoubtedly evolved for far different purposes, not to be used as drugs by man. A minority of these chemicals did evolve to influence other animals, but most affected other plants, some as with antibiotics as poisons against other competitors. Biology has a limited repertoire of chemical signals which with slight deviations affect a wide array of cell types. Just some examples that come to mind include digoxin, psilosibin, curare, Caffeine, cyclosporine, and penicillin. One of the reasonable fears of environmentalists is that some of these substances that may have potential medicinal value may be lost as large numbers of as yet undiscovered species are lost.

Getting back to Auxins, they help control and give direction to growth toward or away from the earth and light that nourishes the plant. Plant growth is something simpler and slower than a reflex termed a tropism. Tropism means literally going toward something nourishing such as the sun. Auxins simply give the order for plants to grow. In phototropism a plant grows toward light; in geotropism, toward the earth. The slow response to a chemical messenger controlling growth is the way plants respond to their environment.

Growing toward or away from something is an awfully slow way to respond to one's environment but fitting for an organism stuck in the soil. Plants have reasonably adapted to relatively unchanging conditions. Something's to be said for constancy when you our kids who flip from one to another station on their TV sets and end up seeing nothing, or the fellows who are trying to time the stock market, are trying to move their money in and out and never make any headway. In more instances than we allow for, inertia proves a very reasonable way to make a living. Alternate strategies do exist as in animals, which evolved efficient patterns of locomotion. It was animal motility that led to the need for nervous tissue specialized in conveying messages between cells at a rapid rate. The most primitive example is to be found in the Hydra, a tiny carnivore. A specialized nerve net coordinates movement of a whole colony of cells helping the organism to quickly seize the moment in pursuit of its prey.

This primitive nerve net functions orders of magnitude faster than can chemical signals and sets the Hydra apart from sedentary plants responding only slowly to environmental change. The Hydra's nerve net adapts rapidly, sensing change with an afferent limb coordinating sensory inputs connected to and intimately involved with an efferent component effectuating controlled movement. Nerve cells are necessary when animal cells specialize and the whole complex organism needs to respond quickly to environmental change. The first nervous tissue like other organ systems, therefore was a revolutionary solution for this need.

[25]

The most primitive nervous systems respond stereotypically. They tend to be hard-wired, meaning that they are designed merely to bring about a highly reproducible response to a specific stimulus. For the Hydra, sensing prey will be made to fire a tiny hook from his nematocyst attached to a thin thread to reel the victim in. Or his tentacles will extend when neurons in some way sense movement or the presence of prey. These are simple stereotyped responses hard-wired to occur when sensing a certain stimulus. In lower animals and in lower levels of the human nervous system too, we find a specific nexus between a sensory stimulus and a motor response coordinating pre-ordained motor responses.

Figure 9: Vertebrate brain evolution. From smaller to larger, simple to complex. Note development of more and more elaborate homologous structures. Numbers refer to cranial nerves.

An animal may respond to simple components abstracted from a large complex sensory field connected to an equally simple motor response. The responsive neurons need to latch onto specific elements of the stimulus in a large stimulus field that serve to distinguish it from among all other stimuli and at a certain specific time. Thus an attack by a male stickleback fish may be induced by a model with a red underbelly, the appearance of a male fish in breeding season. Perhaps he will respond if the red is on a certain specific shape on the underside of an object and it moves. And the female stickleback is attracted preferentially to the male with a brighter red underbelly. Ducklings will follow a moving object even as large as a human, bonding to this object as a mother a long as they are stimulated within a critical period, a phenomenon called imprinting. On some level, humans too respond to a single simple stimulus extracted from what may be a complex stimulus field, in a stereotyped fashion, a male to the woman's breast or buttocks is an obvious example. Yet we cannot over-generalize about all human or even animal behavior on the basis of this. This simple response to a releaser, the red underbelly, the moving object, the breast, is only part of a response repertoire.

Nervous systems allow two different modes of response, one a coordinated response to a simple stimulus stereotyped, always reliable, but not plastic. To change such a response, would require an alteration in genetic material since such stereotypy is ordinarily inherited, reflected in anatomical change in nervous system structure. Examples of such heritable characteristics include changes in cricket and bird songs that allow females to find and mate with eligible males of their own species. Both the song and the nervous system's pattern recognition system are inherited in the same way that a body pattern or a color would be passed down. Behavioral characteristics of animals are inherited in just the same way that physical characters are.

Figure 10: Schematic of evolution of the Mammalian brain[26]

The Hard-Wired vs. Plastic Response

Nervous system anatomy which brings about song production and reception are inherited. The architecture of neural networks involved in song production in fact, mimics reception, that is if a male cricket of a species produces a patterned sound say ^…- , then there is a group of neurons in the receptor circuits of the receiving female, which fires or responds to this same exact pattern, ^…-,so that the patterns fit together like lock and key. Songs are thus designed to stimulate neurons of animals of the same species. Animal song is critical to the mating process of crickets, katydids and songbirds. In birds though their song sounds inspired by the male desire to copulate, the basic form of the song composition is inherited. Then certain other details, what may be termed “dialects” are learned by the young male when he hears the song of more seasoned adults. Females are the recipients or objects of song while males are the makers of songY. If you listen for it at any given time, there is a veritable concert of insect and bird mating calls, female receptor neurons responding to exact patterned firing or stridulating or vocalizing male motor neuron patterned firings. Male songbird production of song patterns will not occur if his brain is not exposed to sex hormones early in life and there are sexual differences in brain structure that result from such exposure[27].

Behavioral patterns reflect patterns of inherited nervous system structure. The bloodsucking leech, for instance, goes through a complex coordinated sequence of behaviors that ends in its successfully finding, swimming toward, biting, and finally sucking the blood of its mammalian (often human) host. When satiated, alternate behaviors take over. There are programmed anatomical patterns in the leech, which owns a relatively simple nervous system consisting of just 32 ganglia containing an average of 400 nerve cells, which making this simple nervous system good subject for research. Nerve cells respond predominantly for the purpose of feeding, to the chemical messenger, Serotonin. While there are some superficial similarities in nervous systems, complex behaviors in mammals have less of a tendency to be a function of hard-wired inherited neuronal networks.

The contrasting strategy in nervous tissue design is to build in plasticity of behavioral response, not just a simple reflex. With such a design the animal need not await the passage of generations to be passed down as no permanent anatomical change is specified by genetic machinery. Indeed, if a change in the nervous system is reflected in anatomy at all, this is hard to demonstrate. Such a change is pretty subtle even under the microscope. Plasticity, whatever the mechanism for bringing it about, is an advance in neural strategy. Adaptation can take place rapidly. The down side is the response is much less reliable, so it is of less use where you need a specific response you can count on. Such a situation happens with learning. Only certain neural circuits have the capacity to learn and they are probably the minority. Even systems that learn need to have a lot of hard wired responses built in. In the most advanced animals learning alters not only a motor response, but may change a whole internal set. This change may not be very obvious even easily tested for. For example a person changes his point of view after reading a book. You can't see him change his mind unless you know to ask the right questions. Again, one does not wait through generations to change. Change is accomplished rapidly. The whole process of change is more efficient.

While simple stereotyped behavioral responses are easily correlated with neuroanatomic change, more subtle complex adaptations involved in learning are more difficult to correlate with anatomy. Given the current level of knowledge, such behavioral changes are difficult if not impossible to see anatomically or chemically though presumably these changes do take place. We have to depend on what we see from the macroscopic behavioral perspective. Simple behaviors in animals with few neurons have often been used as a model for human psychology but these models fall short of expectations. They do give some rough idea of what must take place in more complex neuronal systems. Still we suspect learned behavioral changes may someday be better correlated with anatomic findings, which are bound to be microscopic or chemical.

Quite a bit of debate has been generated on the subject of brain size, neural plasticity and intelligence. On the surface it would appear that that the total size of the nervous system should tell you the most about an animal's intelligence. Men have larger brains than women do, or certain races seem to have larger brains than others, and so are more intelligent, or so the argument goes. Theoretically, having more volume of neurons should allow for greater processing power. But consider that an animal such as the elephant may have a brain as large as 6000 grams in comparison to ours averaging about 1300 grams (about 2.9 pounds) or that of a porpoise whose brain weighs in at about 1600 grams or a blue whale's at 9 Kg!! Are these animals exceptionally bright? Perhaps they have deep imaginative powers that are not apparent to human observers.

All this must be tempered by the obvious fact noted by numerous observers that brain size does seem to correlate loosely with mental ability when body size is taken into account. In other words, the elephant's or blue whale's brain size when compared as a ratio of its body weight compares unfavorably with the primates or human brain. One measure is the so-called Jerrison's encephalization quotient, but the principle is to compare body size to brain weight and when that is done, the dolphin particularly, fares very well in relation to other primates though still below man[28]. Our intelligence resides in the large area of the cerebral cortex and the amount and number of brain cortical convolutions. The surface area of the brain across many species is proportionate to the brain weight. Still it would seem that the total computing power of the brain should be governed simply by the total mass of neuronal material.

The problem at hand is that except for some neat little tricks, the regard of a mother for its young, a not-too-large repertoire of vocal sounds and responses and some anecdotes about heroic behavior, dolphins do not seem to give us all that much evidence in their behavior of any kind of advanced intelligence even comparable to more evolved primates. But the dolphin brain's size is impressive, the amount and number of convolutions and the area of its cerebral cortex. The answer to this enigma can be found under the microscope. The human cerebral cortex is composed of six layers whose architecture determines anatomic regions called Brodmann areas. In the human cortex the cellular architecture is distinct so that numerous areas can be distinguished. These are broken loosely into more primitive archi and paleocortex and more evolved neocortex with six distinct layers. Primary sensory areas for vision, hearing and surface sensation tend to have large numbers of distinct granule cells in layer iV, while primary motor areas have large pyramidal cells in layer V. But the dolphin brain has few of these distinctive cells and regions of the cortex are not so well developed at all. Dolphin cortex, though much larger than primitive placental mammals, shares characteristics with more primitive land mammals forms from which they descended before returning from land to sea.

The human brain has on its side precision in its architecture with well-developed and differentiated sensory (granule) and motor (pyramidal) cells that were utilized more extensively later in mammalian evolution and with distinct specialized areas of cortex which developed later in land mammals. Early workers were much taken with the size of the dolphin brain which in itself proved to be a deception. Size isn't everything.

Figure 11: The dolphin brain with its large complement of convoluted cerebral cortex[29].

Figure 12 Cellular Architecture of the Dolphin brain cortex. The cortical surface is imagined to be broken into six layers containing different types of cells. For the human brain this is indeed the case but in the Dolphin the layers are indistinct[30].

We've gone from the consideration of the nervous system as a reason for being in the beginning of this chapter to a concern for a biological imperative as a strategy for adaptation. I have talked about neuronal systems as a method to bring about a rapid motor response and as a vehicle for plasticity of response in a rapidly changing stimulus field. The nervous system is more than a reason for being in biology. It has evolved into an executive, controlling nearly every aspect of biological function in higher animals and all other organ systems are subservient. This is not obvious or even true when you look at more primitive living things which have some reason other than cognition for their being alive. In animals with advanced nervous systems other organ systems are more and more controlled by the nervous system. Indeed it can be said these other organ systems need not exist at all except to serve the brain, whose highest representative is the cerebral cortex.

This chapter is to be continued in Part II

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[1] Selkoe DJ Translating Cell Biology Into Therapeutic Advances in Alzheimer’s Disease Nature 399 (Suppl) A23-A31, 1999

[2] Image courtesy of www.medlib.med.utah.edu/webpath/tutorial/cns/cns.html Jeanette Townsend, MD

[3] Adkanas D, Engle WK Sporadic Inclusion-Body Myositis and Hereditary Inclusion-Body Myopathies:Diseases of Oxidative Stress and Aging? Archives of Neurology 55:922-928 (1998) See also Sevush S, Jy W, Horstman LJ, Mao W, Kolodny l, Ahn YS Platelet Activation in Alzheimer Disease. Arch Neurology 55:530-535 (1998)

[4] See Whitam FL , Diamond M , Martin J.: Homosexual orientation in twins: a report on 61 pairs and three triplet sets.
Arch Sex Behav;22(3) (1993 Jun):187-206 also Peele, Stanton “Send in the Clones” Wall Street Journal March 3, 1997, P. A18

[5] See Walston J, Silver K, Bogardus C, Knowler WC, Celi FS, Auston S, Manning B, Strosberg AD, Stern MP, Raben N, et al. “Time of Onset of Non-Insulin Dependent Diabetes Mellitus and Genetic Variation in the beta-3-adrenergic Receptor gene. “New Engl J of Med., 333(6) (1995 Aug 10): 343-7 Also Scientific American August 1996 "Gaining of Fat" by W.Wayt Gibbs Pima Indians of Arizona living on an American Diet high in fat have the highest incidence of diabetes anywhere in the world with one half developing it by age 35 and are an average of 57 pounds heavier than their Mexican relatives. They seem to have inherited an efficient method of energy handling under adverse conditions that has resulted in their being obese under better circumstances.

Y Crick's support for this contention is that patients who have lesions in this general region of the brain, may experience either profound apathy known as abulia, and there are others whose hands seem to move, as if of their own free will, a phenomenon known as an "alien hand". The latter is an interesting condition in which the patient is uninvolved in his own hand's movement. He doesn't will it. It just happens. As we shall see, the big picture is that this reasoning on the basis of lesions is erroneous. A brain lesion that results in a lack of function such as the cingulate gyrus that causes abulia or alien hand, merely shows that this region of the brain is necessary for the disturbed function, not that it is sufficient or responsible for the function. See Francis Crick THE ASTONISHING HYPOTHESIS: The Scientific Search for the Soul. Charles Scribner's Sons. New York © 1994

[6] His classic book was written with Jerome Posner,MD, The Diagnosis of Stupor and Coma, laid the basis for evaluation of alterations of awareness. Complex motor behaviors in patients with persistent vegetative state was presented in a lecture at the meeting for The Association for Research in Nervous and Mental Disease held in New York on December 5 & 6, 1997, “Isolated Psychophysiologic Activity in the Unconscious Brain.”

F Under most circumstances, the persistent vegetative state results from widespread destruction of the cerebral cortex and is not due to blocking sensory input.

[7] "Neuropathological Findings in the Brain of Karen Ann Quinlan--The Role of the Thalamus in the Persistent Vegetative State" Kinney, Hannah C., Korein Julius, Panigrahy Ashok, Dikkes Pieter, Goode Robert New Engl J of Med 330:May 26, 1994 The article stresses the role of widespread thalamic destruction here but it is clear that her brain suffered much more widespread damage particularly the Cerebral Corices.

F The inability to recall an event does not mean that it might not affect a person in other ways that are difficult to quantify, for example, subliminally. However, atropine most probably blocks the initial entry point of memory engrams into to the temporal lobe. Therefore a memory is unlikely to affect a person subliminally or emotionally.

[8] From : Casey D, Blitt (Eds.): Monitoring in Anesthesia and Critical Care Medicine.Chap. 16 Grantham CD, Hameroff SR, Monitoring Anesthetic Depth pp 427-440 Chuchill Livingstone New York 1985

[9]Roger Penrose, The Emperor’s New Mind (New York:Oxford University Press, 1989)382-384

F This close control of REM vs non-REM states occurs in elderly patients and those with Parkinson disease, particularly those treated with L-Dopa. Patients have fragmented sleep and possiibly REM sleep intrusions causing hallucinations. See Commella CL, Tanner CM, Ruzica RK. “Polysomnographic Sleep Measures in Parkinson's Disease Patients with Treatment-induced Hallucinations”. Annals of Neurolgy 1193 (34):710-714

[10] For further discussion see Mahowald, Mark W Synchrony, Sleep, Dreams, and Consciousness: Clues from K-complexes. Neurology 49(4):909-911 1997

y Technically recent work has shown that this waking electrical activity of the cortex, far from being desynchronized, is actually still synchronized by diffusely projecting rhythm making thalamic nuclei, which simply drive the cortex at faster frequencies.

[11] From Shepherd, Gordon NEUROBIOLOGY Second Edition Oxford Univ Press, New York 1988 Page 525.

[12]”Know, thou who studiest this Treatise: if you are of those who know the soul and its powers and have acquired true knowledge of everything as it really is, you already know that imagination exists in most living beings. As for the perfect animal, I mean the one endowed with a heart, the existence of imagination in it is clear. Accordingly, man is not distinguished by having imagination; and the act of imagination is not the act of the intellect but rather its contrary. For the intellect divides the composite things and differentiates their parts and makes abstractions of them, represents them to itself in their true reality and with their causes, and apprehends from one thing to very many notions, which differ for the intellect just as two human individuals differ in regard to their existence for the imagination. It is by means of the intellect the universal is differentiated from the individual, and no demonstration is true except by means of universals.” Maimonides goes on to say that things apprehended by intellect are more remarkable by far than anything imaginable!! The truth goes well beyond our ability to imagine it. Who could imagine that with two persons living on opposite sides of the sphere which is our earth one should not fall off, yet this is in fact the case. Moses Maimonides: THE GUIDE OF THE PERPLEXED Translated by Shlomo Pines Univ of Chicago Press, Chicago Page 209-210

[13]Hamlet and Socrates treat sleep and death in the same vein. See in “To be or not to be” Soliliquy: To die-to sleep- No more; and by a sleep to say we end The heartache, and the thousand natural shocks That flesh is heir to. ‘Tis a consummation Devoutly to be wish’d. To die-to sleep. To sleep-perchance to dream: ay there’s the rub! For in that sleep of death what dreams may come When we have shuffled off this mortal coil, Must give us pause. ...” Act III, Scene I See also Plato: The apology of Socrates: “Let us reflect in another way, and we shall see that there is great reason to hope that death is a good, for one of two things: either death is a state of nothingness and utter unconsciousness, or, as men say, there is a change and migration of the soul from this world to another. Now if you suppose that there is no consciousness, but a sleep like the sleep of him who is undisturbed even by the sight of dreams, death will be an unspeakable gain. For if a person were to select the night in which his sleep was disturbed even by dreams, and were to compare with this the other days and nights of his life, and then were to tell us how many days and nights he had passed in the course of his life better and more pleasantly than this one, I think that any man, I will not say a private man, but even the great king, will not find many such days or nights, when compared with the others. Now if death is like this, I say that to die is gain; for eternity is then only a single night....”

[14]See Gregory, Richard L (ED.), THE OXFORD COMPANION TO THE MIND “Dreams in Ancient Greece” p.203 Oxford Univ Press Oxford 1987

[15]See Luck, Georg ARCANA MUNDI, Johns Hopkins Univ. Press, Baltimore, 1985 pps 166-168. I was surprised to read in a biography THE JAMESES by R.W.B. Lewis Anchor Books, New York, 1991 that the great psychologist William James was a believer in necromancers in his own day, and seems to have placed some trust in a certain Mrs. Leonora Piper, a famous medium. Otherwise incisive and logical thinkers may not be immune to the influence of the occult. (See p. 491)

[16]”It is on such evidence that psychologists assume the existence of an unconscious psyche-though many scientists and philosophers deny its existence. They argue naively that such an assumption implies the existence of two “subjects,” or (to put it in a common phrase) two personalities within the same individual. But this is exactly what it does imply-quite correctly. And it is one of the curses of modern man that many people suffer from this divided personality. It is by no means a pathological symptom; It is a normal fact that can be observed at any time and everywhere.” I would agree but respectfully suggest that the word ‘unconscious’ seems to imply that the person has lost consciousness rather than entering a state of altered awareness. From CG Jung MAN AND HIS SYMBOLS Dell publishing, New York 1964, p.5

[17]This is fairly obvious for most of us but yet is of profound theoretical importance and frequently mentioned by both Freud and Jung See Sigmund Freud, The Interpretation of Dreams trans. James Strachey (New York :Avon Books, 1965) and C.G. Jung, Man and His Symbols, (New York: Dell Publishing Co. 1964)

F See, for example, Sally Springer, Georg Deutsch, Left Brain Right Brain (San Franscisco: WH Freeman and Co., 1981) Just one of a number of popular books on the subject written by psychologists.

[18] Richard L. Gregory and O.L. Zangwill, Eds., The Oxford Companion to the Mind (New York :Oxford University Press, 1987) 329

[19] See Dorothy Otnow Lewis (1998)Guilty by Reason of Insanity A Psychiatrist Explores the Minds of Killers Ballentine, New York

[20] See "Medical Aspects of The Persistent Vegetative State" (Second of Two Parts) by the Multi-Society Task Force on PVS New Engl J of Med Vol 330 June 2, 1994

[21] From Murchie, Guy The Seven Mysteries of Life: An Exploration in Science & Philosophy ( Boston :Houghton Mifflin Company, 1978) 243

[22] See Pinner RW, Teutsch, SM, Simonsen L, et al., “Trends in Infectious Diseases Mortality in The United States” and Accompanying editorials. Journal of the American Medical Association 275(1996):189-193

[23] Quote of David Liddle, Santa Fe Institute which supports nature-inspired research, Wall Street Journal, Tuesday January 16, 1996 P. 1 "Back to Darwin In Sunlight and Cells, Science Seeks Answers to High-Tech Puzzles by Gautam Naik

By Gautam Naik

[24] Figures taken from:Hickman Cleveland D. Integrated Principles of Zoology (Saint Louis :C.V. Mosby Company, 1970 ). 58 (mito) and Wilson, Carl, Loomis Walter E, Steeves, Taylor A. Botany, 5th Ed (New York: Holt, Rinehart and Winston, 1971).110 (choloroplast)

[25]Adapted from Vines, AE & Rees, N Plant and Animal Biology Vol I Pitman New York 1968 p. 187

[26]From Earnest Gardner, Fundamentals of Neurology: A Psychophysiological Approach, 6th Ed. (Philadelphia, PA :W.B. Saunders and Company, 1975),13, 17

Y Birdsong is obviously for male listeners as well, useful to mark out territory and discourage other males.

[27]See “Animal Sexuality” by David Crews Scientific Amercan 270 (Jan. 1994):108-114

[28] See SOCIOBIOLOGY by Edward O. Wilson The abridged Edition The Belknap Press of Harvard University Press Cambridge, MA 1980 p.225-228 and Ridgway, S.H., Dolphin Brain Size In: RESEARCH ON DOLPHINS M.M. Bryden and Richard Harrison (eds.) Clarendon Press, Oxford 1986 P. 59-70

[29] Morgane,P.J., Jacobs, M.S., and Galaburda, A. Evolutionary Aspects of Cortical Organization in the Dolphin Brain in: RESEARCH ON DOLPHINS M.M. Bryden and Richard Harrison (eds.) Clarendon Press, Oxford 1986 p. 92

[30] ibid p.94