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Down the Rabbit Hole
Paul Kiritsis, PsyD Clinical Psychology, DPhil., MA (History)


Consciousness, Illness, and Belief: Know Thyself

Paul Kiritsis - Sunday, August 17, 2014

When the Greek travel writer Pausanias visited Delphi, he noted that the axiom “know thyself” [γνῶθι σεαυτόν] was inscribed in the pronaos of the main temple consecrated to Apollo. Many an intellectual have probably wracked their brains wondering what the ancient Greeks may have had in mind when they were inscribing such an ambiguous term in that sacred space. Various interpretations have been offered throughout the years–everything from dire warnings against the hubris of ego inflation to the pitfalls inherent in pandering to the opinion of the multitude. If truth be told, the zealous tendency in overvaluing our own importance and in towing social lines delineated by the prevailing status quo are two of the most vile and lamentable shortcomings of the human condition. Our psychoneural wiring appears to be flawed at the most fundamental level, rousing some pretty bizarre cognitive and behavioral patterns which are not conducive to mutuality and harmony with Nature, the creative source. I’m certain many of my readers would share the exact same sentiments as I.

Beyond that a more conscientious evaluation of possible implications afforded by this ancient maxim will throw light upon another unconscious but equally important aspect of human functioning, our biological constitution. Educating the masses on the internal biorhythms responsible for homeostatic balance, optimum psychosomatic functionality, and the contingencies serving as accomplices in the generation of disease enfranchises, empowers, and enables each individual to act volitionally and proactively in the conservation of their own health. Contrary to what the contemporary medical consensus has conditioned us to believe and accept as undisputed truth, we are directly responsible for our own wellbeing; echoing the subtle mental prompts offered by our ancient ancestors, it is vital that we “know thyself.”

Let’s begin our pilgrimage with an in-depth exposition of human biorhythms. The first thing we must become cognizant of is that the band of conscious states we might experience during our lifetimes–everything from light relaxation and alertness to daydreaming, dreaming, and psychosis–are buttressed by corresponding neurochemical conditions in the brain, with this mind-brain correlation easily charted via sophisticated non-invasive techniques like Functional Magnetic Resonance Imaging (fMRI) and Positron Emission Tomography (PET). For each mental state, then, there is a corresponding neurochemical correlate. Even the slightest variation at the chemical level has far-reaching consequences for the overall form[1] and content of consciousness. Depending on the nature of a chemical shift, the inhibition or alteration of certain electrochemical signals comprising the global firing pattern of cortical and subcortical neurons reflective of a specific mental state like deep relaxation may translate to any of the following: a protracted slice of acute concentration, a transient psychotic episode, a vivid hallucination, or a complete dissipation of consciousness such as that experienced during coma and non-REM sleep.

Everything created under the azure blue sky is in a state of perpetual transmutation, and our brain chemistry is certainly no exception. Our cognitive and emotional lives swing like giant pendulums between two perceptual walls which cannot be transcended; on one end we have gross insensitivity to the external world, a phenomenon frequently labelled unconsciousness, and on the other, an acute self-awareness orientated to time, place, and other persons and characterized by an unwavering ability to scrupulously direct attention whenever we choose and towards whatever we choose. The limited space wherein our self-sufficiency and self-functionality operate from is made available by two cerebral giants, two neurotransmitter systems known as the catecholamines–dopamine, norepinephrine, and epinephrine–and the cholines, explicitly acetylcholine. Shared but differentiated characteristics enable one system to dominate over the other without completely annulling its electrical output. Together they mediate what scientists call the sleep-wake cycle.    

Collectively the catecholamines form the aminergic system; they are excitatory, ergotropic in nature, and intimately linked with the internal processing of sensory representations gathered from one’s immediate environment. Their central headquarters can be found in the primitive brain, the brainstem. The neural circuitry linking to form the serotonin system, for instance, is couched within an important part of the brainstem called the pons but its reach is widescale, projecting up into the cortex, the mediator of higher cognitive functions, and down into the spinal cord. Its significant scope implies a level of control over global physiological functions. When the aminergic system is firing on all cylinders we find ourselves flawlessly orientated in consensus reality; we’re able to maintain deep concentration for protracted periods without reprieve; and we’re mentally agile, able to hold a thought or two in our minds, pay attention to detail, perform mathematical computations, and solve complex problems at accelerated speeds. Our cognitive and semantic capacities are at the peak of their powers; we think, overthink, and become entrapped in intellectual puzzles and conundrums. We’re also able to rise above the social synapse of alchemical relationships through which we live, develop, and have our being and become omniscient, detached eyes capable of self-reflection and analysis.

High metabolic activity, electrical activation, and information processing amongst neural networks signify elevated moods for the psychological ontology, whereby energetic, spirited, and audaciously sanguine sentiments begin scintillating like solar flashes in the sky. Under any such aminergic explosion, raw emotions like hope, curiosity, and exuberance take on an infectious quality. Cheerfulness is a natural drug, and the individual seeks it in order to quench her thirst for higher purpose in the manner that honeybees spend their fleeting lives actively seeking out the vital ingredient for their own ambrosia, an assortment of pollen-rich flowers in the beautiful country meadows. Whether we like to admit it or not, each and every member of the human race, indeed every living organism on the planet, is nonconsciously drawn to high energy environments. Like attracts like, as an esoteric thinker would say; it’s completely natural that an organic mechanism equipped with some level of sentience and hence with the subjective enterprise of self-preservation in mind would be drawn to energetic environments, in essence physical manifestations of the inner resolve to live and thrive. All life forms seek mutual relations with nourishing, energy-rich sources; it’s their one-way ticket to longevity. At any rate, cellular productivity seems to be tantamount to psychological contentment–if you neural circuits are happily buzzing away, then so will you!

On the other hand what happens when aminergic activity in the brain starts to dip? There is depreciative shift in the form and content of consciousness; our ability to fixate upon internal or external targets for indefinite periods wavers, we grow lethargic, and our capacity for self-directed attention becomes chaotic and undisciplined. Focusing on a moderately difficult task may become nearly impossible. Whereas in the prior mental state we were steadily anchored to reference points bequeathed by the consensus environment, now we find that the conscious self has begun an unbounded regress farther and farther inward, back into the confines of an artificial world where it begins humming to the rhythms of a completely different reality. Herein we find that internally-generated mental images of fantasy play, distant and recent autobiographical memories, and a kind of confabulation intrinsic to paramnesias preponderate. Remaining adrift in these trance-like states give others the impression that we’re lost to the world, at least until a thunderous clap, thump, or scream snaps us from our provisional impairment. A further loss in aminergic thrust eventually brings us to cogitative states of very deep relaxation and hypnosis, close to the equivocal fringes of hypnagogic slumber. All remaining vestiges of consciousness dissipate when the amines in the pons come perilously close to complete inertia, signaling our involuntary entrance into the abode of non-REM sleep. 

Our slipping into non-REM sleep reflects an electrochemical deadlock between the aminergic and the cholinergic systems. Neurons belonging to the second family are inhibitory, trophotrophic in nature, and directly responsible for REM-mode sleep. Dreams themselves cannot manifest in the streams, breaks, and eddies of human consciousness unless the cholinergic system sets off field potentials by washing over a deep brainstem region called the pons, a visual relay station of the subcortical thalamus named the lateral geniculate nucleus, and the occipital lobe of the visual cortex; when cholinergic excitation and a reciprocal inhibition of the aminergic neurons in the pons becomes the predominant brain state, we become like colourful puppets on interlinking chords and threads, dancing as it were to the inner orchestra of our own unconscious content. A temporary switch from top-down to bottom-up control, from cortical activation to subcortical activation, is fully responsible for the arbitrary loss of cognitive control in our internally generated perceptions.

As dreamers we suffer absorption into the colourful madhouse of dreams roughly five times each night. There is a precipitous disruption in the orderly equipoise between cognition and emotion experienced unconsciously during wakefulness, shifting internal perception so that it favours the creation of artificial realities. Semantic language, an operation of the left-hemispheric interpreter, is internalized and often implied. The internal transistor restraining our emotional geysers short-circuit, allowing the full spectrum of emotions like joy, bliss, fear, anger, eros, and grief to seize, possess, and overwhelm us completely. More interestingly so, our thoughts become conspicuous and transparent like jelly, allowing dream characters to respond to our objective thought projections without as much as uttering a word.

During REM-mode we remain oblivious to a dreamscape constantly shape-shifting in weird and wonderful ways. The temporary abeyance of an intellect able to superimpose a lifetime accumulation of learned knowledge about the world and its natural laws onto the perceptual field leaves the dreaming self without an analytical anchor; hyper-associativity and over-inclusiveness become the new world order. Hallucinations fuel delusional content and the delusional content is used as a theory of mind to evaluate further hallucinatory episodes, initiating a bidirectional cycle which spins us further and further away from the waking axis of consensus reality. We lose our aptitude to orient to time, space, and person, and become distracted by innumerable visual stimuli competing for our attention. Remnants of self-awareness are unable to break the psychotic spell of bizarre impressions through doubt, and we find ourselves wondering about mazes of our own making without any specific intention or insight. Our credulity is cringe-worthy beyond imagining; everything is now possible. Unbeknownst to us is the fact that our physical bodies are laying complacent in their beds; we don’t know that we’re dreaming. Further, the moral compass within ourselves that confers ethical sensibility and curbs not so socially desirable aspects of our personalities are negated considerably, allowing us to engage in moral transgressions like mindless psychopaths.  

Condensing these clinical observations into a succinct yet accurate description we might say that ordinary dream episodes are characterized by several consistent features–severe disorientation; an absorption and distractibility in a dreamscape likely to violate Aristotelian homogeneity; poor memory recall and confabulation; deficits in rational analysis and insight; implied language; visual-motor perceptions with obvious cinematic and surrealistic aspects couched in vivid hallucinations and delusions; and an unobstructed expression of mixed emotions like fear, anger, joy, sadness, remorse, and shame. The self or “I” is back, albeit with severely limited degrees of freedom. We do not have creative control over the visual-motor narratives flowering within our perceptual fields and we cannot enforce or direct our own will. For the most part we’ll just blend into an ambient background of fields, flitting about here, there, and everywhere without as much as a hunch for where we’re going or what we’re doing. Our minds seem to be made up, manoeuvred, and managed for us without our choosing. In retrospect we’re exactly like Plato’s prisoners who were forced to sit and observe an unintelligible shadow-play projected onto a wall before them.

After about four or five nocturnal cycles of intermittent REM and non-REM periods, a sudden but powerful recourse to norepinephrine initiated by the brainstem reinstates top-down processing, snapping the individual wide awake. We’re now free to pick up where we left off before falling asleep, thanks to the successful rebooting of the aminergic system and the subsequent activation of the cortex. Complete rejuvenation of the amines and immediate suppression of acetylcholine means we’re at our most alert and vibrant first thing in the morning. At this time we have repossession of our “I” function, the conscious self-awareness which rules our lives by the light of day. Moreover, we’re able to abscond from the ambient background of fields and move forwards and backwards in time, fixate our attention upon individual features of the external world, orientate ourselves, and make some pretty sound judgements regarding which phenomena are discontinuous and incongruous and which aren’t. However, as the day wears on aminergic thrust begins to wane and the downhill slither towards languor and nonconsciousness begins once more.  

Perhaps the most momentous feature of these two interlinking neurotransmitter systems is their divided labor which extends well beyond the transmuting trajectories of consciousness, to the innumerable nonconscious activities controlled by the primitive brain, the brainstem. I believe it’s more than safe to assume that the contracting of muscles, the pumping of the heart, the contraction of the bladder, and the secretion of hormones from internal glands remains an unconscious phenomenon for the majority of the population, the majority of the time. All such involuntary functions come under the direct auspices of body’s autonomic nervous system, which can be further subdivided into a sympathetic and parasympathetic branch. The first is mediated by norepinephrine, the second by acetylcholine. With intimate knowledge of their antagonistic relationship in tow, it is not difficult to imagine what the specific activation of their respective autonomic branches might entail.  For the sympathetic system the deployment of an ergotropic, excitatory neurotransmitter sets in motion the known fight-or-fight response; oxygen and glucose are transported to target areas where they are needed most–usually the heart and muscles–in order to expedite the relevant motor responses necessary for the organism’s immediate extrication from externally perceived threats. Anything liable to interfere with the built-in survival instinct (i.e. digestion in the stomach and intestines, salivation, and arousal for reproductive purposes) is suppressed. Once the milieu shape-shifts and perception of the external threat dissolves, the trophotrophic molecule acetylcholine activates the parasympathetic branch to decelerate heart rate, slow breathing by constricting the bronchi, and stimulate internal functions to do with cellular recuperation and general maintenance. The partition and nature of brain-body labors shared by the two chemical systems connotes a direct involvement with psychosomatic functionality and balance, and therefore with health.  

At the crux of this entire exposition is the fact that the aminergic system metabolizes energy whereas the cholinergic system conserves it. One expends by speeding up the metabolic processes responsible for cortical and subcortical activation and the other saves by slowing them. It’s an empirical, biological expression of the cosmic yin-yang cycle. Now the proper mediation of these operational ebbs and flows is entirely dependent on an involuntary act of the animal biorhythm, an automatism we recognize as sleep. Most of us will sleep away some six to nine hours of the day. By spending regular intervals of time in this trophotrophic mode of being, our amines rejuvenate to levels able to facilitate controlled and optimal functioning of mental and physical processes.

Therein lies the deepest and most fundamental moral of the health story–regular and good quality sleep is imperative to cerebral and somatic normalcy. Without it things start to go a little awry. When this perpetual cycle is disturbed or broken, the amalgam of foreground (external) and background (internal) processing we experience as integrated perception, the homeostatic balance of health, and our inherent sense of stability, order, and harmony with the cosmos will inevitably suffer. In what way, you ask? Well with the exception of its profound powers of healing and rejuvenation, REM-bound sleep, for instance, helps in the modulation of action potentials emanating from neurons in the visual cortex. Any consistent lack of it, either self-inflicted or imposed, allows cholinergic tension in the brainstem to build to unmanageable levels until acetylcholine can no longer be contained; if the neurotransmitter is allowed to wash over the pons, it activates visual-motor circuits so that the specialized neurons there fire wildly, often in the complete absence of any external stimulation. Under such altered neurochemical conditions, the brain can no longer keep dreams confined to REM-mode sleep and the latter erupt into our perceptual fields in the form of seizure-like hallucinations.

A clinical word for such a phenomenon is psychosis and an individual caught in such a transient rift is said to be experiencing a psychotic episode. If we took a long, hard look at the interlocking features of ordinary dreams, its cognitive deficits and enhanced misperceptions, we would see that they’re identical with those of a pathological process like psychosis. Non-pathological dreaming appears to be a normal psychosis and psychosis a pathological dreaming, or rather a spillage of REM-mode sleep into diurnal conscious awareness. In cases where psychotic episodes are not the result of an organic brain syndrome or structural deficit, the phenomenological homogeneity with dreams suggests that the two processes are simply nuances of the same chemical imbalance in the brain–aminergic inhibition and cholinergic excitation. Failure to make basic lifestyle changes necessary for the self-correction of a jostled biorhythm in which full-blown psychosis has manifested may incur irreversible modifications to specific morphological structures (i.e. the hippocampus or amygdala) in the brain, and hence the acquisition of a lifelong mental disorder. In the end you can elect to ignore the psychic and somatic sirens of your internal alarm system, but you do so at your own peril.   

Moreover, it’s impossible to ignore the obvious connection between REM-bound sleep and the body’s immunological response to viral and bacterial infections and cancerous tumours. Scientists who have studied the effects of sleep deprivation on rats and other animals in laboratories with the sturdiest of empirical controls find, time and time again, that lack of sleep and above all REM-mode sleep, leads to the involuntary loss of brainstem functions like temperature control and the apt mobilization of natural defences. Depriving someone of sleep can and will initiate a lethal downward roll into the decadence of low energy, foul mood, depression, psychosis, long-term organic disease due to neuronal apoptosis, and inexorably clinical death. During our lifetimes, we must make it our sacred mission to avoid activating this sequence of deleterious reactions at all costs!   

At the end of the day, the most important humanistic piece of information science can impart to any living being is to listen to the language of your own body and respond appropriately. When tired get some rest; when wakeful rise and embark on something constructive; and when hungry feed your body a nutritious, balanced meal rich in protein, slow-release carbs, and unsaturated fat but low in sugars and saturated fat. Practice mindfulness-based meditation and remain grounded in the present moment. Avoid uselessness and pointlessness at all costs, something each and every one of us does when we loiter about in artificial reconstructions of the past or the would-be of the future. Refrain from overthinking. Make moderation an adage to live and breathe by and avoid rigorous mindsets which demand ‘in excess’, even when the collective imperative decrees it is good for you.

On a different note rampant and religious overemployment of supposed beneficial attitudes and behaviours are equally unhealthy. Life can get fairly complicated so make every attempt to keep it as simple as possible. Keeping to the basics is our best bet for success. Due to differences in our genetic and phenotypic blueprints, there can never be one right prescription for leading a balanced lifestyle; each individual must find one that harmonizes with her natural constitution. To give a random example, some people require more than the average seven to nine hours of sleep per night to function efficiently and effectively. Food intake is another one which varies considerably from person to person; if you’re an avid body-builder, swimmer, or jogger your calorie intake is bound to be higher than somebody for whom exercise is as foreign as the fourteen gaseous moons of Neptune. Volitional adherence to these basic principles coupled with reason for being will ensure that your biorhythms remain in homeostatic balance, and that your body never gives up on you before its time. You, and only you, are responsible for your wellbeing.

Know thyself.


[1] When speaking about the form of consciousness, I refer to its divisible constitution: the cognitive faculties, including perception, attention, memory, and orientation, and the intuitive faculties, namely emotion.   

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