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Chapter One

Consciousness and Brain Science

Normal human consciousness is so rich and so naturally variegated thatany willful efforts to alter it artificially may seem, at first glance, perverse.But human beings are never satisfied with things as they are. People arealways pushing the envelope of conscious experience.

    Three of the reasons for our restless experimentalism are clear. In thefirst place, normal consciousness is not always pleasant. In mental illness,the impulse to alter consciousness via drugs that reduce hallucinationsor elevate mood is easy to understand and to accept. Short of that, manyof us feel entitled to those holidays from conscientious consciousness thata martini, a glass of wine, or a can of beer affords.

    In the second place, normal consciousness can, at its natural limit, beso alluringly ecstatic as to induce a craving for more of the same. Lostelation calls for its restoration or enhancement via a stimulant booster.Such conscious state properties as creativity, sexual pleasure, and learningcapacity can all be pumped up by bolstering or imitating the brain's ownuppers.

    In the third place, the capacity to hallucinate, to believe the impossible,and to experience visions and delusional thoughts all steeped in a brothof passionate emotion is, for normal persons as well as for the mentallyill, a variety of religious experience. At first glance it would appear thatdrug takers wanted to become psychotic.

    But why would anyone want to cultivate the symptoms of mental illness?The answers to that question are directlyrelated to the narrow definitionof Altered States of Consciousness (ASC) that arose in the psychedelicera of the 1960s. The era's radicalism was only a recrudescence of the age-oldhankering for transcendence, and it is this mystical yearning thatconstitutes the major motive for altering consciousness. Current reality,the superficial appearance of things, and our limited capacities to think andfeel are not enough. There must be something more. We seek reality beyondappearance: the supernatural that lies above the natural world, the deitywho controls our destiny, the essence of existence.

    Richard Alpert's (aka Ram Dass) accounts of going from LSD to Hindumysticism in the late 1960s is a very good example of this phenomenon.There was a resurgence of psychedelic mysticism and psychotherapy inthe "New Age" movement(s) of the 1980s among people using the drugMDMA ("ecstasy"). This was an emotion-based (vs. altered perceptual)experience. The "rave" scene among young people today (also MDMA-based)is a similar, though more hedonistic, phenomenon. Whatever themotive or goal of voluntary state alteration, it is vital to understand itsunderlying brain mechanisms.

    When I call dreaming an altered state of consciousness, I am not justbeing provocative. I mean to invoke and unify both naturalistic and artificialalterations of conscious state. The Dream Drugstore is a naturalextension of a line of my work that began in The Dreaming Brain andSleep (which were devoted to psychophysiological model building) andcontinued in Dreaming as Delirium and Consciousness, which broadenedand deepened the model to encompass a wider range of normal and abnormalstates and began to consider how exogenous chemicals mightdrive consciousness in one direction or another. Having earlier elaborateda brain-based model to account for the alterations of consciousness thatoccur naturally in dreaming, I wondered if they could help us understandthe many artificial alterations of consciousness that have been inducedby drugs and other interventions over the ages—but most dramaticallyin the last half of the twentieth century.

    This book focuses on the psychopharmacology of the psychedelics andinterprets their effects in terms of what we know about how the brainalters consciousness when it switches from waking to dreaming. I alsoapply the brain-based model of dreaming to the related phenomenon ofhypnosis; these nonpharmacological altered states share the property ofdissociation, for which I suggest new neurobiological underpinnings. Theupshot is a brain-based alternative to the psychoanalytic paradigm ofSigmund Freud.

Psychosis, Sainthood, and Psychedelism

Seeing visions or hearing voices can only be attractive if the social contextrewards and supports them and the individual believes that such experiencesare valuable. Accusatory voices that arise unbidden cause fear andsuspicion, leading to the belief that one is being persecuted by an externalagency like the devil, Martians, or the FBI. In this case, we call the perceptionshallucinations and the beliefs delusions, and in so doing label themsymptoms of mental illnesses like schizophrenia. The person with thiskind of psychosis becomes a patient, with the most dire personal andsocial consequences.

    In an earlier time, many people with visions and unprovable beliefsabout their agency could become saints if their beliefs conformed to institutionalrules. In the "New Age" movement(s) of the 1980s many "positive"visionaries were widely embraced as authentic and many seem stillto be in more restricted circles (e.g., among movie stars). But today, eventhose people whose visions are beatific and confidently attributed to abenevolent God are just as likely to be called psychotic and labeled mentallyill as those who are hounded by malevolent agencies. Although theyare less likely to be arrested and hospitalized against their will, their careersare usually sidetracked, their social contacts splintered, and theirself-esteem badly damaged.

    Whether the hallucinations and delusions that define psychosis can bevoluntarily initiated and terminated is another factor determining thevalue attributed to psychosis. The people we call patients don't have thepartial but significant volitional control that many seekers of divine communicationenjoy. The wannabe saint often used voluntary deprivationof food, domestic comfort, and—most of all—sleep to set the stage forinspiring and instructive visions and messages from the Godhead. Sleepdeprivation has been used in this way by religious reformers like EmanuelSwedenborg as well as by political groups bent on brainwashing. In thiscase, the visions, the voices, and the beliefs are not likely to be calledpsychotic, even though they fit the formal definition of psychosis perfectly!

    Now that biochemistry has given us mind-altering pills, the modernseeker of psychosis-like transcendence has it all: voluntary control, personalmeaning, and the social support of a large subculture. Psychoticexperience is, in this case, the very goal of the psychedelic drug taker.Whether indulgence in recreational drugs is entirely risk free is a questionthat I will later consider, together with some problems associated withprescription drug-taking. The main point is that whatever the context—includingdreaming—psychosis is psychosis is psychosis. To understandhow psychosis can arise naturally, the best approach is to explore thephysiology of normal consciousness and learn how the normal psychosisthat is dreaming is engendered.

Consciousness and Its Vicissitudes

The human brain is conscious. When suitably activated, gated, and modulated,it senses, perceives, attends, feels, analyzes, acts, and remembers.Moreover, it organizes its activities, takes a running account of thesefunctions in three related and highly abstract ways: first through awareness,second through a sense of a self that is aware, and third throughthe awareness of awareness. We now have the opportunity of finding outhow all of these operations are achieved.

    We can understand consciousness by applying the techniques of modernneuroscience to the study of the brain under those natural and artificialconditions that change the attributes of the brain's consciousness.The natural conditions are those related to the normal sleep-wake cycleand to its pathological vicissitudes. The artificial conditions are those behavioraland pharmacological interventions designed to alter consciousnessfor a wide variety of experiential and clinical purposes.

    Fortunately for the scientist interested in these matters, the attributesof consciousness tend to be organized in a correlated manner, resulting inwhat are called states. By states we mean syndromes or clusters of attributes.When we speak of altered states of consciousness, we refer to thetendency of consciousness to be at a higher or lower level, to be concernedwith external or internally generated data, and to be organized in a linearlogical or parallel analogical fashion, and to be more or less affect driven.

    Both the natural and artificial conditions that alter consciousness affectone or more of three crucial brain functions that correspond to the threemajor attributes of consciousness that are altered as its states change. Thefirst function is activation, corresponding to the raised or lowered levelof consciousness. The second is input-output gating, corresponding tothe provenance of the information processed. The third is modulation,corresponding to the way in which the information is processed.

    Because we can measure—or reliably estimate—all three of these brainfunctions, we can construct a three-dimensional model representing(1) the energy level of the brain and its component parts (Factor A, forActivation); (2) the input-output gating status of the brain, including itsinternal signaling systems (Factor I, for Information Source); and (3) themodulatory status of the brain, which is determined by those chemicalsystems that determine the mode of processing to which the informationis subjected (Factor M, for Modulation).

    When we enter the values of A, I, and M into the model, the state ofthe brain-mind—including its conscious aspect—is represented as a pointin a three-dimensional state space. This point is constantly moving, andits location and trajectory are controlled by intrinsic and extrinsic influences.Using the AIM model measures we can—for the first time—beginto map normal and abnormal alternatives in conscious state onto a physiologicallyrealistic schema.

    This three-dimensional state space model has already had an initialapplication in studying natural sleep and its disorders. In this book, theprinciple focus will be upon those altered states of consciousness that arethe consequence of two intentional manipulations of the brain systemcontrolling conscious states. The first is the set of manipulations primarilyaffecting factor I, the input-output gating dimension of the model. Thisincludes hypnosis, the relaxation response, meditation, and trance. Thesecond is the set of manipulations primarily affecting factor M, the modesetting dimension of the model, which includes the psychedelic drugs,stimulants, narcotics, anesthetics, and mood altering drugs. I discuss theAIM model in more detail later in this chapter, and in chapter 7, whereI fully explain its physiological basis.

Definition of States of Consciousness

Some scientists are sure that waking is the only state of consciousnessworthy of consideration because only in waking do we achieve (1) veridicalawareness of the outside world, (2) veridical awareness of our ownconscious state, and (3) awareness that we have other awarenesses.Dreaming, then, is an altered state of consciousness, because all three ofthe unique features of waking consciousness are lost. We delusionallybelieve that we are awake when we are in fact asleep; we delusionallybelieve that we are perceiving a real outside world, whereas we are actuallycreating that world without benefit of external stimuli; and we arenot capable of critically observing, assessing, and appreciating our delusionaland confabulatory awarenesses.

Waking as the Norm

Although it seems obvious that there are states of consciousness otherthan waking, it does seem scientifically reasonable to take waking as thenorm, the point of reference to which to compare other states of consciousness.

    The irony is that we begin by choosing the most coarse grained parametersof waking consciousness because they are valid and because they arereliable. Alertness is one such basic parameter. It can be self-rated and ithas easily measurable behavioral and physiological correlates. Alertnessimplies a high level of energy or activation, and it implies focused attention,usually on the external world. Internal stimuli, in fact, distract alertnessif they arise unbidden when we are trying to focus on a book, anidea, or a conversation. In alert consciousness, the mind is in an expectantsearch mode and cognitive deliberations must be minimized. This is alsotrue of meditation states and hypnosis when subjects self-activate largeregions of their brains. Of course, there may well be many shades orflavors of alertness that our initial measures will not capture. Recognizingthat our current measures are only temporarily adequate will help us rememberto fine tune them as our maps of the conscious state territorybecome more detailed.

    Two caveats arise, one methodological, the other functional.

    Methodologically speaking, it should be clear that waking consciousnessis itself a many splendored thing. That is to say, waking can be associatedwith an infinite set of conscious substates, no one of which is easilysingled out as typical, stable, or even normal in a statistical sense. Thisis a problem to which we will return when we consider imaging studies,but it is important at the onset to stress that psychologists, physiologists,or philosophers have never subjected the vast panoply of waking substatesto a detailed analysis.

    Functionally speaking, we should not assume that because waking consciousness(whatever that is) is good at some things that dreaming (say)isn't, that dreaming is an inferior, degraded state of consciousness.Dreaming may be useful in ways not yet appreciated. Dreaming iscertainly functionally superior to waking in fabricating a virtual reality.This imaginative, autocreative aspect of dream consciousness may beworth studying in its own right—not only as a way of understandingpsychotic states as I have often suggested, but also as a way of understandingthe highest functional achievements of consciousness in scienceand in art.

    The two caveats come together when we ask if waking consciousnesscan be altered in such a way as to maximize the autocreative aspects soprominent in dreaming while returning enough wake state consciousnessto critically analyze, validate, and report the creative product. The answer,still poorly articulated in mechanistic detail, is clearly "yes." Byisolating the brain-mind, setting it on automatic pilot, and opening it upto spontaneous cognition and emotion, people can achieve a wide varietyof goals, from literature (writing stories) to psychotherapy (writing storiesabout the self?).

Form vs. Content

Consciousness is always about something. Like a book, it has a plot, orlike a film it has a scenario consisting, in part, of a script or a storyline.Like language, waking consciousness is often characterized by sentence-likestatements, as well as by nonverbal perceptual monitoring, the contentsof which usually go unremarked unless something unusual happens.In waking, the verbal channel of consciousness can be effectively dissociatedfrom the perceptual channels. We say, "Don't distract me, I'm tryingto concentrate"—meaning, I want to devote my limited attentional resourcesto cogitation (thinking is, after all, the essence of cognition) andactively exclude distractions that would interrupt the flow of thought bycausing discontinuity. Whatever consciousness is about (content), it dealswith that content in different ways (form). Whether internally generatedcontent is consonant with the outside world or dissociated from it is oneformal process. Whether associations between conscious elements aretight and concrete or loose and abstract is another. Whether the contentcan be thought about, actively manipulated, or remembered is another.All three of these formal aspects of consciousness are altered when wakinggives way to dreaming.

    Waking consciousness, whatever its content, can be controlled to helpkeep it on track. Left to its own devices, it might flit from external tointernal stimuli and from one internal stimulus to another. Continuity(vs. discontinuity) is one example of this form of consciousness. A relatedformal property is congruity (vs. incongruity), which describes the coherenceof the contents of consciousness at any instant. If continuitydescribes smoothness (vs. choppiness) of flow of the stream of consciousness,congruity describes its integrity, the compatibility of its components,channels, and elements.

    As I write these words, I am aware of the conversation of my colleagueswho have just sat down in the conference room and the click-click ofmy assistant's word processor outside my open office door. But by amild effort of will I can ignore the content of their conversation andstay on the message of my writing. When the word "pregnant" enters mymind, I need a bit more of an effort to sustain my prose. Why? Pregnantis harder to ignore than pizza. Emotional salience is an aspect of contentthat interacts directly with the form of consciousness. Right this minute,I am not interested in pizza (because I just ate two hamburgers), but Iam interested in pregnant (because my wife's period is two days late).Emotion is thus an important third channel of consciousness, even ifit is often so subtle as to be ignored as the potent shaper of cognition thatpsychodynamic psychiatry and modern cognitive neuroscience haveshown it to be. In waking, we are often unaware of any ongoing emotionin our consciousness, and yet a moment's reflection will convince us thatwe are always experiencing varying proportions of positive and negativeemotion.

    Because waking consciousness is so much the norm, we often forgetthat the content of the perceptual channel of consciousness need not alwaysreflect the external world. This is still another example of the formvs. content distinction. If the percepts arise in response to entirely endogenousstimuli—as they do in dream hallucinations—the form, as well asthe content, is likely to change. This is because it is more difficult tosimulate the complexity of the external world than to copy it; when wehallucinate or dream, we need to create the stimuli that engender theimages, as well as to perceive them. This may be one reason why it is sohard to think continuously—or even at all—when our consciousness isbusy both cooking up and processing perceptual images. We have recentlycompleted a study that shows this principle to apply across thefive states of consciousness we assessed. That is to say, hallucinatory imageryand reflective thought are strictly reciprocal whether we are alert,awake, drowsy, asleep, or dreaming. The more imagery increases, theharder it is to think!

Why Distinguish Form and Content?

The first good reason to distinguish form and content is because the distinctionis so robust. The second is that although the categories and exemplarsof content are infinitely large, those of form are tractably limited.It is thus a simpler problem and science is wise to simplify. Beyond thesemethodological considerations, formal aspects of consciousness demandprior attention because they so often determine—or at least shape andlimit—content (which is not to say the converse is not true, because contentcan shape form, too). Without meaning to be confusing, we mustdistinguish form and content because they are inseparable.

    But the strongest reason of all for focusing upon form is because it isonly in the domain of form that we have any hope of mapping from mind(form) to brain (form). Thus, in cognitive science we know the brain locusof word form analysis but have no idea as to how specific words (content)are analyzed. To ignore form is a bit like studying a language withoutconsidering its grammatical structure.

    As far as altered states of consciousness are concerned, it is often theformal aspects that are emphasized: to have visions, internal stimuli mustbecome predominant; to have intense visions, they must become verypredominant, and when visions become intense, they are more likely tobecome exotic, numinous, or preternatural, and thus to suggest other-worldliness.And so on. To understand the visions of altered states, wehad better understand how the form of visual processing is altered at thelevel of the brain. We have at least an odds on chance of doing this,whereas we have no chance at all of knowing why the visionary brainsees exotic flowers.

(Continues...)

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Excerpted from The Dream Drugstore by J. Allan Hobson. Copyright © 2001 by J. Allan Hobson. Excerpted by permission. All rights reserved. No part of this excerpt may be reproduced or reprinted without permission in writing from the publisher.

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