And alteration of consciousness

A 15 -year-old male attempts suicide with a liquid that causes intense abdominal pain, skeletal muscle cramps, projectile vomiting, severe diarrhea, and difficulty swallowing. On examination, he is found to be volume depleted and is showing signs of alteration of consciousness. Which of the following may account for these symptoms ... 

Anticholinergics are rarely used. One wonders why they are used at all, for in most cases, the experience is unpleasant or frightening. Still, stories are told of people who separate scopolamine and other anticholinergics from cold remedies, or people who use jimson weed, and of those who abuse prescription anticholinergics, such as amitryptyline, trihexyphenidyl, or benztropine mesylate. One can only assume that for some people, any alteration of consciousness, even though it may not be pleasant, is desirable. 

Many victims of dependence have apparently normal backgrounds. Some simply make the mistake of trying a substance in some social situation which supports the pleasurable affects, and the substance s pharmacology merely takes over, after a variable period of misuse and abuse. Other victims may have personalities which lead them to escape life s normal pressures, therefore their need for mood enhancement or alteration of consciousness can be an additional pressure on the need to continue the substance. This may be particularly true as tolerance develops and dose increase is necessary to attain the initial effect. 

It is the main goal of this book to explore, develop, and defend that thesis from the scientific, cultural, and aesthetic points of view. The larger implication of this goal is to promote the concept of a unified theory that could account for all spontaneous and induced alterations of consciousness, whether they are produced and experienced in the context of natural life, scientific experimentation, therapeutic treatment, or recreational use. 

But we already know that this conviction can be illusory and, indeed, that it normally is illusory when we dream. Because dreaming is an altered state of consciousness typically characterized by the illusion that we are awake and not rarely characterized by seeing the self as a third-person participant, it stands to reason that out-of-body experiences are natural, fully illusory alterations of consciousness. 

That is why it is wise for therapists and counselors to listen carefully to accounts of alien abduction and all other probably illusional alterations of consciousness. Even physician-scientists have an interest in eliciting an unguarded report, because we need to know the whole domain of altered consciousness if we are to explain it using physicalistic concepts. But it is more than unwise for any counselor, let alone a physician-scientist, to credit such accounts with objective veracity, especially when no other competing hypothesis is taken seriously. 

But it is not so much my point here to open a political debate about drug use and abuse as it is to define and develop the scientific principles that are at the root of that debate if you want to alter consciousness, whether it be for fun, for mischief, or for a patient s benefit, you choose a molecule that interacts directly or indirectly with the neuromodulatory systems involved in the spontaneous and innate alterations of consciousness that we all experience as we cycle through waking, sleeping, and dreaming every day and night of our lives. 

The neuromodulatory systems of the brain stem directly alter normal states of consciousness such that we experience psychosis-like phenomena in our dreams. Drugs that increase or decrease the efficacy of any one of these systems are therefore likely to be quite effective in achieving desirable shifts in the cognitive and emotional symptoms of spontaneous alterations of consciousness like schizophrenia and depression. These benefits may come at a price, however, because other state components are always tied to cognition and emotion at a deep mechanistic level. Tong-term use of neuromodulatory agonists or antagonists may reset the system in compensatory modes that are very difficult to reverse. 

The first two parts of this book explain how scientists now understand normal alterations of consciousness in brain chemical terms. In part I, The Scope and Shape of Conscious States, I define the psychological components and dimensions of conscious experience. Chapter 1 shows how subjective experience can be conceptualized and measured in relation to brain science. It also introduces the notion of a unified brain-mind. Chapter 2 emphasizes the strategy of studying both spontaneous and experimental alterations in conscious state. Chapter 3 contrasts waking and dreaming by illustrating the way that we can measure these dramatic spontaneous changes in conscious state. 

Part III lays the groundwork for understanding the brain as the physical basis of consciousness. It describes the regional, cellular, and molecular mechanisms that may contribute to alterations of conscious states. Chapter 6 begins to tease apart the major subdivisions of the brain-mind and to describe their interaction in normal conscious state alteration. In chapter 7, we meet the neuromodulatory chemical systems that appear to be causative of those alterations. 

Greeley s interviewers also asked about mystical experiences ( Have you ever felt as though you were very close to a powerful, spiritual force that seemed to lift you out of yourself ), brief alterations of consciousness that generally are ineffable (cannot be really communicated with words), revelatory (provide certain knowledge about basic human concerns), transient, and passive (in the sense that they happen to, rather than being directly caused by, the person). Much to their amazement, they... 

Several authors have documented the way that this new type of drug was perceived to work in the early days after its introduction into medicine and psychiatry (Breggin 1993b Cohen 1997 Gelman 1999 Valenstein 1988 Whitaker 2002). In 1952 Delay and Deniker noted that the apparent indifference or delay in response to external stimuli, the emotional and affective neutrality, the decrease in both initiative and preoccupation without alteration of conscious awareness or in intellectual faculties constitute the psychic syndrome due to treatment. They also described how patients returned to normality when the drug was stopped the patient, if he has been pale, regains his normal colour and activity and his normal "spirit" (Delay Deniker 1952, pp. 503-504). 

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