Consciousness

Andrew Newberg, M.D.

Myrna Brind Center of Integrative Medicine

Thomas Jefferson University

Historical Background

Consciousness is something we all take for granted.

John Locke's, Essay Concerning Human Understanding,

published in 1690 defined consciousness as the

perception of what passes in a man's own mind.

English word "conscious" originally derives from the

Latin conscius (con- "together" + scire "to know")

A related word is conscientia, which means shared

knowledge and primarily refers to moral conscience.

"conscientia "

Basics of Consciousness

What is consciousness?

Awakeness pt in ER: are they awake, alert, oriented, responsive?

Awareness neurological assessment - prick skin to feel pain (sharp, dull, achy)

Self-awareness e.g. Alzheimer's - lose self-awareness

How can we study or explore consciousness?

What altered states of consciousness could be

studied? e.g. under anesthesia; asleep; meditation; prayer

How is consciousness related to medicine?

Philosophical issues

awareness vs. consciousness (dog will bark at his mirror image)

at what level do we define consciousness?

Macmillan Dictionary of Psychology

The having of perceptions, thoughts, and feelings;

awareness.

The term is impossible to define except in terms that

are unintelligible without a grasp of what

consciousness means.

Many fall into the trap of equating consciousness

with self-consciousnessto be conscious it is only

necessary to be aware of the external world.

But we also have reflexive self-consciousness we

are aware of ourselves and we are aware that we are

aware


e.g. near-death experiences, drug-

induced

very interesting b/c brain

development is actually quite slow

but this is drastic and immediate

(new set of instructions that change

brain and consciousness)

areas in b/t new and old brain

that helps us understand our

emotions

all aspects of brain need to

come together to be creative,

which draw upon your sub/

unconscious too

wake up - need to go to school

Pavlov

amoeba - responds

to stimulus

thalamic sensory response (lateral and

medial geniculate) - just responding

primitively

lion: amygdala, etc. will respond first

before u even start thinking of strategy



Why do we have consciousness?

Adaptive advantage

Could consciousness be epiphenomenal

i.e. it just happened when our brain

became complex enough.

Is it dependent only on complexity

Could consciousness be an emergent

property of the brain?

How Can We Study Consciousness?

Study consciousness in other people altered - trance, meditation, sleep

Normal consciousness or altered states studied with neuroimaging

Neurological disorders such as tumors, stroke, trauma, seizures

Psychiatric disorders such as schizophrenia, dissociative states

ppl go in and out of di consciousness

Study consciousness in yourself to act like adult, child, etc.

allow you to explore your own

Introspection, contemplation, meditation consciousness in a scientific way (but

consciousness is subjective)

Study consciousness in other animals dolphins and primates know they're

looking at themsleves in the mirror

Development of computers and artificial intelligence

Turing Test conceived of by computer scientist, Alan

Turing, is a now-classical method to test if a computer is

conscious. can u tell b/t the person and the machine behind the wall?

Personal Experience

biofeedback,

Does it make sense to study neurofeedback - we try to

control our bodily functions
(slow HR down)

consciousness on your own?

Meditation techniques

Altered states of consciousness

when you're in your dream, you're acting in your dream like you are

Dream states there - you don't recognize it's a dream

but then after waking, we realize it was just a dream

studies in ppl on salicyben - powerful experiences,

Drug induced states chnages way ppl think, aect consciousness

work done w/ ketamine to treat depression, headache,

model for near-death exp

Brain stimulation (TMS)

try to aect ppl's consciousness for treatment for depression, etc.

 SPECT - inject radioactive tracer (e.g. track blood flow, NTs, etc.)

this one is for blood flow --> look at how meditation changes brain fcn and consciousness

Comparison of Meditation to Baseline

Baseline Scan Meditation Scan

Frontal

Lobe

prefrontal cortex is activated when someone does meditation, unlike rest

meditation - consciously focusing on a single object (e.g. candle) --> after 3 hrs some interesting things hapn
 ppl sound like they're speaking a language but aren't --> go somewhere else, rock back and forth, cry. When time to stop, takes
time for their brains to register and return to normal state

SPECT Images During Religious

Singing and Speaking in Tongues

Frontal Lobe Frontal Lobe

Singing Tongues
there's less activity in prefrontal cortex while speaking tongues vs. when normally talking

sleep - parietal/temporal lobes stay on but frontal lobe turns o



Functional neuroimaging studies

Neuroimaging studies can evaluate the

brain structures that appear involved in

different mental states

Also can evaluate neurophysiological

correlates of consciousness

Neuroimaging at the moment cannot

determine where consciousness is

SPECT Images Before and After an 8 Week

Meditation Program

Thalamus Thalamus

A B

Before After
like studying the wake to understand the boat b/c can't ever get to that state you were actually in but the state right after (are
you paying attn? yes (changed state))

frontal lobe more active after 8 wks of meditation

thalamic activity goes from asymmetrical to symmetrical

ppl who meditate have thicker frontal cortices (e.g. meditation is like lifting weights) --> improvements in memory, reduction in
depression/anxiety
Studies of Neurological Patients
Almost any medical factor can affect
brain function and/or consciousness
Head injury every time you bang your head, it changes your brain

Dementia/Delirium
Tumor/stroke
Psychotropic drugs antidepressants

Electrolyte disturbances hepatic encephalopathy

Hormonal imbalances
 Two interesting examples
2 separate consciousnesses

Split brain patients can send visual stimuli to di eyes and then contralateral hemispheres will
register

Usually seizure patients who have the corpus callosum

cut preventing information exchange between
hemispheres
Appears to result in two separate consciousnesses
Blindsight inthisptsis who had stroke or tumor

before the level of consciousness

Patient states they are blind even though, if tested,

they act as if they have sight
There are several possible explanations. One is that
there is damage to the striate cortex, but other
branches of the optic nerve deliver visual information
to the superior colliculus and several other cortical
areas. The other explanation is that even though the
majority of a persons visual cortex is damaged, tiny
islands of healthy tissue remain.
 Where is consciousness located
in the brain?
At least 20 locations of consciousness have been
proposed in the brain.
Thalamus, frontal lobes, temporo-parietal regions
Some locations are relatively specific (e.g.,
certain neurons in a particular nucleus).
Most neuroscientists believe mental states are
distributed throughout the brain and beyond
Thus, there is no apparent seat of
consciousness can have sections of brain and still have consciousness, so it's not a localized
region
Practical Implications Related
to Consciousness
 90% of what you know about pt comes directly from them talking to you, which requires consciousness

Medical Implications of Consciousness

Pain.
Pain has some measurable physiological
consequences
A physician can never have direct access to
the pain experienced by a patient and must
rely on her ability to infer it from the patient's
behavior
Pain assessment including verbal reports of
feeling pain.
 be careful of what you say in OR: "this doesn't look so good"

Medical Implications of Consciousness

Anesthesia: When is a patient conscious
or unconscious, and how can we know?
Should you always be careful what you
say around patients, even if you think
they are unconscious?
Imaging studies suggest unconscious
patients can perceive world around them
Medical Implications of Consciousness
Neurological disorders.
Neuropathology, whether caused by disease,
trauma, or genetic defects, can be
accompanied by profound abnormalities of
states of consciousness.
When loci in the brain are connected with these
symptoms, we have the opportunity to
understand better how the brain produces
consciousness.
Medical Implications of Consciousness
Psychiatric disorders.
Diagnosis depends on patient symptoms as
described by the patient
Depression, anxiety, stress are part of our
consciousness
Do we rely more on patient report or on data?
What about medical conditions (IBS, chronic
fatigue)?
what is the level of consciousness and how does that aect the patient experience and how does that determine
how physicians treat them?

placebo in Parkinsons --> dopamine goes up

placebo in pain --> ____ goes up

Medical Implications of Consciousness

Attitude & Healing.

It is well-established that healing is affected by
a patient's attitude and outlook.
The placebo effect plays a powerful role in
many aspects of medicine.
Optimism is associated with improved heart
disease and mortality.
 Philosophical Implications of
Consciousness
Buddhist and Hindu theories
Consciousness is a universal
characteristic
Is our brain necessary for
consciousness?
Is matter or consciousness primary in
the universe?
are we treating biological units or a conscious entity?
 our brain makes a lot of mistakes but it never bothers to tell you it made a mistake (i told you this, no i'm sure you didn't!)

Conclusions
Consciousness is one of the most mysterious aspects
of the human being.
We all have it, but can never really prove it.
What about altered states of consciousness such as
during meditation or other spiritual practices. What
do these states imply?
Can we ever know what the true nature of reality is,
or are we always trapped within our brain and our
consciousness?
How conscious do we need to be of other peoples
consciousness when it comes to medicine?