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Several years have passed since the split brain studies conducted by Roger Sperry and Michael Gazzaniga (1962). We know the brain is differentiated, and that the two hemispheres specialize in the different functions that can be fairly generalized (Mcgilchrist, 2009). Since then, research has been uncovering a myriad of other systems in the brain, some of which operate in simultaneity, and others in sequenced relationships with one another. Many of these systems are governed by multiple feedback and feedforward loops, and a single region of the brain may serve a variety of functions, contingent upon the system it is functioning in. From the discovery of epigenetics (Masterpasqua, 2009) to spindle cells (von Economo, Koskinas,1929) and mirror neurons (Pellegrino, Fadiga, Fogassi, Gallese, Rizzolatti, 1992); to the sharing of social cognitive real estate with functions of the self (Christoff, Irving, Fox, Spreng, Andrews-Hanna, 2016); and the overlapping elicitation of regions of physical pain with the processing of emotional pain from social rejection (Kross, Bergman, Mischel, Smith, Wager, 2011), mounting evidence suggests that the brain is in fact fundamentally social. At a minimum, any study or practice of human functioning must include the environment and culture they are immersed in.

Psychologists and neuroscientist alike, are also well aware that there is a disproportionate amount of non-conscious processing in comparison to conscious processing. Studies on subliminal messaging (Ruch, Zust, Henke, 2016), priming, racial biases (Fitzgerald & Hurst, 2017), and the phenomenon of transference (Freeman, Modell, 2007),  shed light on how little we know of ourselves and what is influencing us. This comes as no surprise to the psychoanalyst. What is still being debated is whether there is a specific structure and function of the unconscious, as it appears psychologically. There are many eligible contenders, and no ‘gold-standard’ framework. In the absolute challenge that underlies the ability to measure subjective structures, much more so unconscious ones, what we essentially strive for, with logic, are models that are in alliance with widespread clinical experiences, biology and Jamesian pragmatism. How else can we measure that which we cannot see, but only experience, or infer through behaviors and interpersonal dynamics?

The fact that people, even the elderly, can change has been confirmed by research on plasticity (Park & Bischof, 2013), and the degree to which psychotherapy may alter brain structure and function have further promoted the science of psychotherapy (Cozolino, 2010). Psychotherapists feel encouraged that their methods are biologically effective, whilst the neuroscientists caution the rest to be careful not to inflate the findings. Of course, mental functions are associated with the brain, with several years of lesion studies supporting the logic that when the brain is compromised, so will certain functions (Lezak, Howieson, Bigler, Tranel, 2012). This should come as no surprise, as even a material reductionist must assume that any changes in psychological states must have some reflection in neural states. From a material perspective, what is the mind, if not emergent properties of matter reflecting on itself? Likewise, it is quite clear now, that psychological changes may result in large scale changes throughout the brain, such as the case of individuals vulnerable to traumatic events (Chan, 2016; Zhang et. al. 2015). After years of intuited belief, therapists may now rejoice that the bi-directional relationship remains quite accepted throughout the community.

The trajectory of formal psychotherapeutic development began at the level of the unconscious (psychoanalysis), and has since expanded its territories into cognition, behavior, humanism, existentialism, development, mindfulness, biology (e.g. somatic, EMDR) and others. To be a competent therapist, there is a need to become familiarized with several different theories, in order to be capable of tailoring an approach to serve a wide range of clients. Human existence is wildly complex, and a nefarious trap in psychotherapy would be the neglecting a relevant dimension. The complexity of psychological experience alongside the currents of scientific endeavor, has driven us to find anchors for approaches, imposing a necessary grounding and expansion of variables considered. To this, we find interpersonal neurobiologists, such as Dan Siegel (1999), Alan Schore (2012) and Louis Cozolino (2010) to have pertinently stressed the importance of: the right-hemisphere, attachment, evolutionary psychology, integration, the social brain, mindfulness and consilience; when considering how to incorporate neurobiology in psychotherapy. New bundles of methods emerge from the integration of fields, theories, techniques, and technologies, with many older methods becoming obsolete, or more relevant/effective as they are casted in a new light.

One frontier of relevance for mental health professionals is the frontier of consciousness. While emergent materialists are still at large (Beaumont, 2008), the conviction that a continuum of consciousness exists in all matter, and is the “primal stuff,” or pan-psychism (Chalmers, 1996) has become increasingly popular. There is even an attempt to measure levels of consciousness, through integrated information theory  (Tononi, Boly, Massimini, Koch, 2016).  Perhaps matter and consciousness rest on a continuum themselves, as the front and back of a coin; two features of the same substance, and they are needlessly categorized as independent of one another, as Nagel (2012) would suggest in neutral monism. Even more radical, perhaps the brain is more of an antenna, with its complexity allowing it to ‘tune’ into frequencies of consciousness (Nuñez, 2010); or maybe you subscribe to Dan Dennetts theory (1991), that consciousness is an illusion. At this moment, we cannot prove or disprove these theories. It seems likely that to gain momentum towards the ‘solution’ to the hard problem may require an approach that integrates neurophenomenology, psychology, quantum physics, biology, philosophy, mathematics, and computer science.

The current debates on the origins of consciousness and its relationship to matter does not preclude the necessity to do our best in formulating a theory. In fact, some would argue that consciousness might be the only thing we can be certain of, and what else may be the origin of meaning, if not consciousness? It is in this field of consciousness that we operate from, and it is because of consciousness that we can have (or appear to have) the ability to navigate our lives, making us at least partly responsible, for the direction we are headed. In this article, I will provide one hierarchical theory of consciousness and its relevance in psychotherapy.

In the spirit of Endel Tulving, Vandekerckhove and Panksepp (2009), I propose that consciousness may be understood through the lens of hierarchically ordered levels, namely the anoetic, noetic and autonoetic. Autonoetic consciousness, is understood as the layer of most complexity whose fulcrum is composed of these two baser levels. The anoetic, is considered an unreflective processing “a mixture of primary process affective and sensorial-perceptual-cognitive experiences… critically important for the creation of emergent implicit procedural memories” (p. 1020). For example: When learning how to ride a bike, one does so through trial and error, eventually the memory of riding a bike becomes automatic, as sense-memory becomes embedded in non-conscious circuitry. Thereafter, riding a bicycle, is much easier, as the process required to learn is no longer necessary. Anoetic consciousness, allows us to have a stream of waking experiences, but with a lack of knowing.

Noetic consciousness is the first sense of ‘knowing’, yet ever tied to the present, without the ability for conscious mental time travel.  So while there is a ‘knowing’ of  self, there is no self-abstraction involved, no reflections on the known autobiographical self. In the noetic consciousness then, there exists a narrative, influenced by the past and potential future, but no ability to reflect on it and contribute to its development. It is associated with semantic memory systems (factual), but not episodic (autobiographical).

The reason why we can reflect on ourselves, our history and modify our actions towards the future is because we have what Endel Tulving (1985) termed “autonoetic consciousness,” the highest form of consciousness that allows us to experience our selves as processes existing through time. Autonoetic consciousness (AC) houses two elements in its definition that has convinced me to be partial towards its usage, as opposed to term such as awareness or consciousness. In its definition there are the elements of time and space.  AC includes chronesthesia, or the awareness of time, and beyond, as it encompasses the capacity for us to project the self into the past to retrieve an episodic memory or project the self into the future to simulate a future event. It also includes space, and by space, I mean the ‘space’ necessary for us to be aware of having an autobiographical self in the first place. The ability to know that we know. Inspired by Darwinian natural selection, I think that autonoetic consciousness was an evolutionary necessity, enabling us to contribute to the process of selecting psychological and socio-cultural traits that might be passed down through the generations.

These levels may be further accompanied by ever more complex emergence of the self, as described by Antonio Damasio (2010), see figure 1.

From a neurobiological perspective, two case studies emerged on subjects unable to “mentally time travel,” despite other functions intact. The first was presented by Tulving, called K.C. and the other M.L. who endured more specific injuries to shared spaces, by Brian Levine and his colleagues (1998), whereby lesions were encountered in the right ventral prefrontal cortex, and a fiber pathway connecting the temporal lobe and ventral cortex, the uncinate fasciculus. What problems do people without autonoetic consciousness suffer from? Levine (1999) found support that autonoetic awareness serves as a platform to inhibit maladaptive behavior. The ability to inhibit, is crucial for psychotherapy, regardless of the theory. Insight and the selective targeting of cortical circuitry, plays a large role in effectively regulating limbic activity, in order to assist a patient in emotional regulation. Without inhibition, we would be unable to delay gratification for a more promising future, or prevent ourselves from acting out uncontrollably in an inappropriate context. Memory and mental time travel allows us to utilize our history to better serve our future. 

Another question of interest, is how do we know that self-identity and AC, are autonomous systems? One route is through the exploration of experiences recounted from the ingestion of certain hallucinogens and/or experience in long-term meditative practitioners. The experience I am speaking of is “ego dissolution,” the complete dissolving of self-identity and being ‘at one’ with the nature. In these states, the phenomenological experience appears to be very similar, “blissful,” “peace,” “awe,” or “oneness,” are all examples used frequently. One comes to also wonder the contributions of right-hemispheric processing in instances experienced by a left-hemisphere stroke by respected neuroanatomist, Jill Bolte Taylor:

“As the language centers in my left hemisphere grew increasingly silent and I became detached from the memories of my life, I was comforted by an expanding sense of grace. In this void of higher cognition and details pertaining to my normal life, my consciousness soared into an all-knowingness, a “being at one” with the universe… I found it odd that I was aware that I could no longer clearly discern the physical boundaries of where I began and where I ended. I sensed the composition of my being as that of a fluid rather than that of a solid. I no longer perceived myself as a whole object separate from everything. Instead, I now blended in with the space and flow around me” (p. 41-42).

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This has been an excerpt from The Science of Psychotherapy July 2019 – for the complete article and more interesting content, please subscribe to our magazine.

Dr. Aldrich Chan is a Clinical Neuropsychologist and founder of the Center for Neuropsychology and Consciousness (CNC), a private practice in Miami, Florida that provides neuropsychological and psychological services. In addition to his practice, he is an Adjunct Professor for Pepperdine University and conducts research on the Default Mode Network (DMN) and trauma at the University of Miami, exploring correlations between neuroimaging data to novel and existing neuropsychological instruments in service of early-detection for PTSD. For more information about his work, please visit his website
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