Consciousness

I should caution the reader that this particular post is less directly related to psychiatry--it's more of what I would call a "philosophical musing". So you may want to skip over this post if you're not in the mood for it. But it's something I've thought about for a long time, and I find themes pertaining to it coming up frequently in my daily work.

Consciousness is miraculous.

It may be (actually this is exactly my view), that from a scientific point of view, consciousness is the product of chemical and electrical signals in the brain, influenced by both internal and external stimuli, forming an integrated network with numerous complex feedback loops. Regardless of the causes of consciousness, it remains miraculous that any physical process could give rise to a subjective experience of awareness.

The issue of free will is related. Even if we claim that free will is an illusion, that all choices are determined by the existing structure of the brain in combination with environmental events, and furthermore that brain structure and environmental events are themselves determined by historical precedents (perhaps with a degree of true randomness at the core of physical phenomena rendering all of these processes imperfectly predictable), the awareness of having -- or seeming to have -- free will is also miraculous.

Clearly there are "degrees" of consciousness. Human awareness can vary--or be changed pharmacologically--from full alertness, or hyper-alertness, to many degrees of sedation, to unconsciousness. Apparently absolute unconscious states may only be relatively so, since some degree of stimulus may produce a response even in people who are sleeping deeply, anesthetized, or comatose. As we agree that there are degrees of consciousness, how sure can we be that there is an "absolute zero" where there is no consciousness at all?

If awareness or consciousness is the product of the brain, and the brain's function is a property of a network of chemical and electrical connections, then it may follow that any system in which there are chemical or electrical connections carries a form of consciousness. It seems grandiose -- on the part of humanity -- to claim that the human brain is the only structure capable of conscious awareness or the perception of will.

Most people would have no difficulty asserting that higher animals are conscious, though most (I included) would say that the consciousness of animals is "lesser" than that of humans. At the most obvious level, we can say that the intellectual and language feedback which enriches our conscious experience is much reduced in animals, such that very little cultural development over different generations is possible in non-humans. Another "thought experiment" type of question would be, who is MORE conscious, a fully alert dog, or a heavily sedated human? I guess many would say that there are "types" of consciousness, and that the "human" type is qualitatively different than "non-human" types, irrespective of the degree of alertness or sedation, etc.

Fewer people would claim that simpler animals are conscious.

Very few people would agree that plants are conscious.

Almost nobody would agree that rocks are conscious.

I claim that all of the above may be "conscious" in a way. I do not mean to sound mystical at all here, just extending the logic that if chemical or electrical connections in a network give rise to consciousness, then perhaps any systems of chemical or electrical connections that form feedback networks are also conscious. Therefore, all of the universe could be considered "conscious". A rock could be considered "conscious" since it is intimately linked -- chemically and electromagnetically -- to its environment, and both disintegrates and incorporates environmental elements continuously during its lifetime (obvious changes in chemistry and magnetism perhaps taking place over thousands or millions of years--an example of how some forms of "consciousness" may involve different time-scales than what we are used to).

A corollary of the above could be that since consciousness is a product of networks of chemical interaction, then all conscious beings are "interconnected", perhaps part of a higher-order consciousness. A simple example of this would be to look at politics. Often times we refer to nations as though they are people. We talk about "what Russia is thinking", or about "U.S. arrogance", etc. While this is figurative language, there is a level of literal truth, I suppose, to consider that a nation itself represents a higher form of consciousness, or could at the very least appear to be a higher form of consciousness to an external observer (i.e. someone who did not realize they were communicating with a nation instead of with a person).

I am not saying that this therefore makes it rational to start singing songs to the rocks to soothe them, or to embrace some kind of animistic belief system where we deify or personify plants, mountains, planets, gemstones, etc.

But I hope this line of thinking may cause us to extend respect and caring to all things. Fellow humans. Fellow animals. Fellow living things. Even inanimate objects. The earth. The air. The soil. Your home. Your room. Your belongings. Other people's belongings. Objects that have been thrown away. And, going inwards, to all the different parts of our body (many of which, ironically, are as inert or "dead" as stones, but still require care -- for example our teeth, hair, epidermis, or nails). Going inwards further, on an even more abstract level, your feelings, your thoughts, and your life history, all deserve respect and caring.

The act of respecting and caring for ourselves is part of healthy living. I think this respect and care can be extended to all aspects of the environment around us.

And, on a slightly mystical note I suppose, I wonder if there is something about respect and care that is always mutual--so I wonder if the universe can, on some level, always perceive, understand, and reciprocate such care. This is sort of a "karma-like" idea.

Stepping back from a mystical note, though, I think there is solid psychological evidence to support the idea that caring and respecting as a way of life is part of staying healthy and happy.

Types of Alcoholism

The term "alcoholic" has been used frequently in contemporary culture. Often the label itself may carry a certain "shock value", which, I suppose, could lead to a recently-labelled "alcoholic" contemplating more seriously a reduction in alcohol use. I always worry about labels, though, because I don't like the idea of being or sounding judgmental or critical (there is enough judgment and criticism in the world today, and in psychiatric illness a lot of extra judgment and criticism comes from one's own mind). Yet I do believe in the value of attempting to fearlessly speak the truth about things, even if they are truths that we don't necessarily want to hear.

Each person who has a drinking problem may have unique factors that have contributed.

Some researchers have categorized "alcoholism" into two types. Type I alcoholics may use alcohol as an attempt to treat anxiety, and are less likely to associate alcohol with thrill-seeking or fighting. Type II alcoholics may use alcohol spontaneously for thrill-seeking, and are more likely to have had alcohol-related problems with fighting, etc.

In my opinion, there is some support for subtyping alcoholism this way, but of course I think there is a much wider range of contributing or causative factors. I can think of some people who started out with a "type II" pattern as a teenager, but ended up in a "type I" pattern later on. Others may have a sort of mixture of "type I" and "type II" characteristics. For both subtypes there is probably a robust hereditary predisposition, some of the predisposing factors being direct (i.e. a predisposition to use alcohol excessively when available or a predisposition to react to alcohol in a certain way), and some of the predisposing factors being indirect (i.e. anxiety for type I, high thrill-seeking for type II).

Type I is more common, and is probably easier to treat, I think because there are underlying issues and needs that can be met in other healthier ways (e.g. treating anxiety, building healthier relationships, engaging in psychotherapy). Type II can be more challenging to treat, particularly because those with this type may be less likely to want treatment or change.

Here's another useful link with info about alcohol and addictions, from the Centre for Addiction and Mental Health:
http://www.camh.net

Real vs. Perceived Alcohol & Drug Use in University Students

I always ask patients about drug and alcohol use.

Often times, someone will tell me that they drink alcohol or smoke marijuana "socially" or "on weekends" or "average". I always follow this up with more questions about how much this really amounts to.

Often times, this amounts to a pattern of either daily use, or quite frequently of having binges at least once a month, sometimes once or more per week.

It is quite clear from a medical point of view that binge drinking is psychologically harmful: not only does it place someone in a position of higher risk for physical accidents (I do not have to search my memory far to think of tragic alcohol-related deaths or severe head injuries among young students in the prime of their life), the pharmacological effect of this type of usage will exacerbate all mood and anxiety problems. It will interfere with normal sleep for long periods of time after the binge is over, and if there is a mood-related or anxiety-related sleep problem already, it can push the symptom intensity up much higher and make it much more difficult to treat.

I have found that many people, upon describing their pattern of binge drinking or marijuana use, will say that their behaviour is part of normal, ubiquitous university culture, i.e. "everyone does it."

Here is what some statistics show from a local part of a large recent continent-wide survey of university students:

Percentage of students who actually have never used marijuana: 63%
Students' belief about what percentage of fellow students have never used marijuana: 16%

Percentage of students who actually use marijuana daily: 1 %
Students' belief about what percentage of fellow students use marijuana daily: 16%

Percentage of students who have actually never used alcohol: 16%
Students' belief about what percentage of fellow students have never used alcohol: 3%

Percentage of students who have used alcohol daily: 0.1%
Students' belief about what percentage of fellow students have used alcohol daily: 30%

All of these above figures show that students greatly overestimate how much their fellow students are drinking and using marijuana. Because of how powerful the influence of social pressure is, especially to young people, it is important to be reminded of the facts. It is much more the "norm" for students to drink or use marijuana rarely, if at all. And it is common -- not rare -- to be completely abstinent.

However, one concerning figure from the same study shows that about 40% of male students, and 30% of female students, have had 5 or more drinks in one sitting at least once in the past month. This is a binge. And this is associated with the greatest risk of physical and psychological harm. For almost 10% of students, binge drinking occurs 3-5 times per month, which is more or less on a weekly basis. This type of behaviour is certainly a prelude to a more severe future of alcoholism, with all its physical and psychological sequelae.

Based on my reading of epidemiological studies, it is clear to me that 2 drinks per 24 hours is the maximum quantity of alcohol reliably consistent with good health (it may be that this level of alcohol consumption actually confers health benefits compared to abstinence, at least for some people).

I am not convinced that any amount of marijuana use is consistent with good health, except perhaps for some people who may have used it just a few isolated times in their lives, in a good mood, in a pleasant environment, which may have helped them relax some of their inhibitions or gain some other insight about themselves or the world. It is more often the case, though, that such experimentation leads to negative health effects.

Internet Addiction

It has come to my attention, both in my practice, and in a recent review of results from a large survey, that many people are using the internet so much that other areas of their life are suffering.

For university students in particular, a high percentage of individuals report that their internet use is adversely affecting their grades.

The internet can gobble up time in numerous ways: if you are bored, you can find an endless stream of connections that can keep your mind absorbed with new tangents.

Many people use the internet to communicate with others. The internet can be a wonderful technological aid which fosters closeness, expands our community of friends and peers, etc. But it can also cause us to be so absorbed in the activity itself -- of talking to friends, or perhaps to strangers -- that hours of time pass by. Sometimes these hours are spent online when they might otherwise have been spent visiting a friend in person, doing a healthy activity outside, studying, etc. Sometimes these hours are spent in the middle of the night, instead of sleeping.

There are other addictive lures that may snag people's attention, including games, gambling, and porn. Perhaps all of these activities allow people to enjoy certain aspects of life with greater freedom and discretion. But they can be very addictive, in the sense that a relationship can be formed with the activity, at the expense of other life relationships (e.g. with other friends or loved ones, with work, with school, with other interests, with physical self care and exercise, etc.).

So I'm not saying that the internet is bad. But I encourage people to be careful not to be involved with a computer in an addictive way, in a way that is interfering with other life activities and relationships.

To some degree this is a cultural issue -- our modern culture is changing, and the computer is becoming increasingly a part of it. This may be integrated in a way that is healthy and part of a new "normalness", just as any new technological innovation changes behaviour and culture (from the invention of the wheel or of fire, to the printing press, to the automobile, to the TV, etc.). There are those who resist any cultural change, or pronounce it to be unhealthy. So the internet is here to stay, and I hope can remain an enhancement to our culture -- but we need to learn ways to participate in the culture in a way that is safe and healthy, and to be aware of its dangers (just as we need to be aware of the dangers of fire, wheels, or the automobile).

As a formal challenge, I encourage people to try a month without using the internet at all, and to assess how life is different during that time.

I have made a similar challenge to people about TV, to turn it off completely for a month, then to review any differences in the way they feel.

I recognize the irony that I am making these statements in a forum only available on the internet!

Boredom

The feeling of boredom may be a signal to change what we are doing, to seek something more stimulating or pleasurable.

Many signals that the brain gives us are helpful guides, which lead us to make better decisions.

Other times, the signals the brain gives us are misleading.

In the case of boredom, the brain may be conditioned to expect a lack of stimulation or pleasure in a given activity. And it may be conditioned to expect stimulation or pleasure by leaving this activity. If this behavioural pathway is followed, it may further lead to a conditioning effect, in which the initial activity feels even more boring the next time round. It is like the forest path again, and each time you go down the path, it becomes more established.

I believe that in many cases the brain causes us to leave experiences prematurely. There might be much more pleasure, stimulation, and meaning in activities that are felt to be boring, but the brain is too habitually eager to get us out quickly, to the alternate activity.

As an exercise, I encourage practicing ways to discover interest, stimulation, meaning, and pleasure, in activities that you have pronounced to be boring (e.g. working through a textbook for school; getting through a work shift; commuting; conversing with someone who isn't your favourite person, etc.). It may require looking at the experience in a different way, with an eye to find significance, meaning, and interest, rather than focusing on the aspects that you find tiresome.

One very specific way to discover this change of perception is to take a class in drawing, painting, or photography -- often part of the experience is of learning to see things in a different way, to become absorbed with interest in something you thought was mundane. Another technique is to take courses in meditation, in which one can learn to be more at peace with the present moment, even while sitting quietly with almost no external stimuli.

In my work with students, I believe this is an extremely important issue. Many students have enrolled in a course of study that may last at least four years, or may lead to a lifetime career. Yet they are bored with what they are doing. I strongly encourage choosing courses (or other life decisions) that have a hope to be interesting, and coming to the work with an attitude of finding significance, meaning, and interest, rather than expecting or continuing an experience of boredom. Boredom leads to disengagement, a fractured relationship with what you are doing, and can be the beginning of lifelong unhappiness with the present moment.

While you may need to make external changes, it is important to make a strong effort to direct internal changes too.