Mindfulness training, as practiced in the context of evidence-based psychotherapy, is focused on developing and rehearsing one’s capacity for sustained attention and concentration on an internal / external object, function or experience. Mindfulness training has been used extensively in the management of acute and chronic psychiatric conditions and has become an important component of most  approaches to the treatment of personality disorders.

However, because mindfulness training typically refers to (1) an observing subject, (2) an object , and (3) the process of paying attention itself, it inadvertently reinforces the notion that they are three distinct “separate” entities and, more importantly, it perpetuates the sense of the existing self as “real”.

In contrast, the more advanced “emptiness” (Sanskrit “Sunyata”) training focuses on how the “experience of the self” and the “cognition” of external / internal “objects” are created by and unfold in the human mind and brain. In the course of emptiness training,  the very process of subject / object (self / other) “co-construction” is examined and, gradually, deconstructed.

As a result, some of the psychiatric / psychological symptoms and the underlying pathological aspects of the self and personality  can be more easily transcended allowing for  more efficacious self-regulation and more adaptive moment-to-moment functioning.

The workshop will compare and contrast the mindfulness and emptiness trainings both in the original Buddhist context and in contemporary psychotherapy. Particular emphasis will be given to practical applications of the emptiness training within an intensive, multidimensional / multivariable treatment of personality disorders. Review of specific techniques and a live demonstration will be offered.

Increasing leadership integrity through mind training and embodied learning.

From the Internet Encyclopedia of Philosophy by:
Matthew Sharpe
Email: matthew.sharpe@dewr.gov.au
Department of Philosophy
University of Melbourne.

Originally published on: November/7/2002

Original at  http://www.iep.utm.edu/lacweb/#SH2

It would be fair to say that there are few twentieth century thinkers who have had such a far-reaching influence on subsequent intellectual life in the humanities as Jacques Lacan. Lacan’s ‘return to the meaning of Freud’ not only profoundly changed the institutional face of the psychoanalytic movement internationally. His seminars in the 1950’s were one of the formative environments of the currency of philosophical ideas that dominated French letters in the 1960’s and 70’s, and which has come to be known in the Anglophone world as ‘post-structuralism’. Both inside and outside of France, Lacan’s work has also been profoundly important in the fields of aesthetics, literary criticism and film theory. Through the work of Althusser (and more lately Ernesto Laclau, Jannis Stavrokakis and Slavoj Zizek), Lacanian theory has also left its mark on political theory, and particularly the analysis of ideology and institutional reproduction. This article, which seeks to outline something of the philosophical heritage and importance of Lacan’s theoretical work, is divided into four parts, each of which has subsections.

1. Biographical and General Introduction

Biography

Jacques-Marie-Émile Lacan was born in Paris on April 13 1901 to a family of solid Catholic tradition, and was educated at a Jesuit school. After completing his baccalauréat he commenced studying medicine and later psychiatry. In 1927, Lacan commenced clinical training and began to work at psychiatric institutions, meeting and working with (amongst others) the famous psychiatrist Clerambault. His doctoral thesis, on paranoid psychosis, was passed in 1932. In 1934, he became a member of La Societe Psychoanalytique de Paris (SPP), and commenced an analysis lasting until the outbreak of the war. During the Nazi occupation of France, Lacan ceased all official professional activity in protest against those he called “the enemies of human kind”. Following the war, he rejoined the SPP, and it was in the post-war period that he rose to become a renowned and controversial figure in the international psychoanalytic community, eventually banned in 1962 from the International Psychoanalytic Association for his unorthodox views on the calling and practice of psychoanalysis. Lacan’s career as both a theoretician and practicioner did not end with this excommunication, however. In 1963, he founded L’Ecole Freudienne de Paris (E.F.P.), a school devoted to the training of analysts and the practicing of psychoanalysis according to Lacanian stipulations. In 1980, having single-handedly dissolved the EFP, he then constituted the Ecole for “La Cause Freudienne”, saying: “It is up to you to be Lacanians if you wish; I am Freudian”. Lacan died in Paris on September 9, 1981. Intellectual Biography Lacan’s first major theoretical publication was his piece “On the Mirror Stage as Formative of the I”. This piece originally appeared in 1936. Its publication was followed by an extended period wherein he published little. In 1949, though, it was re-presented to wider recognition. In 1953, on the back of the success of his Rome dissertation to the SPP on “The Function and Field of Speech in Psychoanalysis”, Lacan then inaugurated the seminar series that he was to continue to convene annually (albeit in different institutional guises) until his death. It was in this forum that he developed and ceaselessly revised the ideas with which his name has become associated. Although Lacan was famously ambivalent about publication, the seminars were transcribed by various of his followers, and several have been translated into English. Lacan published a selection of his most important essays in 1966 in the collection Ecrits. An abridged version of this text is available in an English-language edition. (see Bibliography). Theoretical Project Lacan’s avowed theoretical intention, from at least 1953, was the attempt to reformalise what he termed ‘the Freudian field’. His substantial corpus of writings, speeches and seminars can be read as an attempt to unify and reground what are the four interlinking aspirations of Freud’s theoretical writings: (1.) a theorisation of psychoanalytic practice as a curative procedure; (2.) the generation of a systematic metapsychology capable of providing the basis for (3.) the formalisation of a diagnostic heuristic of mental illness; and (4.) the construction of an account of the individual and specie-al development of the ‘civilised’ human psyche. Lacan brought to this project, however, a keen knowledge of the latest developments in the human sciences, drawing especially on structuralist linguistics, the structural anthropology of Claude Levi-Strauss, topology, and game theory. Moreover, as Derrida has remarked, Lacan’s work is characterised by an engagement with modern philosophy (notably Descartes, Kant, Hegel, Heidegger and Sartre) unmatched by other psychoanalytic theorists, especially informed by his attendance at Andre Kojeve’s hugely influential Paris lectures on Hegel from 1933-1939.

2. Lacan’s Philosophical Anthropology: Human-Being as a Decentred Animal

a. The Mirror Stage

Lacan’s article “The Mirror Stage as Formative of the I” (1936, 1949) lays out the parameters of a doctrine that he never foreswore, and which has subsequently become something of a post-structuralist mantra: namely, that human identity is ‘decentred’. The key observation of Lacan’s essay concerns the behaviour of infants between the ages of 6 and 18 months. At this age, Lacan notes, children become capable of recognising their mirror image. This is not a dispassionate experience, either. It is a recognition that brings the child great pleasure. For Lacan, we can only explain this ‘jubilation’ as a testimony to how, in the recognition of its mirror-image, the child is having its first anticipation of itself as a unified and separate individual. Before this time, Lacan contends (drawing on contemporary psychoanalytic observation), the child is little more than a ‘body in bits and pieces’, unable to clearly separate I and Other, and wholly dependant for its survival (for a length of time unique in the animal kingdom) upon its first nurturers.

The implications of this observation on the mirror stage, in Lacan’s reckoning, are far-reaching. They turn around the fact that, if it holds, then the genesis of individuals’ sense of individuation can in no way be held to issue from the ‘organic’ or ‘natural’ development of any inner wealth supposed to be innate within them. The I is an Other from the ground up, for Lacan (echoing and developing a conception of the ego already mapped out in Freud’s Ego and Id). The truth of this dictum, as Lacan comments in “Aggressivity and Psychoanalysis”, is evident in infantile transitivity: that phenomenon wherein one infant hit by another yet proclaims: ‘I hit him!’, and visa-versa. It is more simply registered in the fact that it remains a permanent possibility of adult human experience for us to speak and think of ourselves in the second or third person. What is decisive in these phenomena, according to Lacan, is that the ego is at base an object: an artificial projection of subjective unity modelled on the visual images of objects and others that the individual confronts in the world. Identification with the ego, Lacan accordingly maintains, is what underlies the unavoidable component of aggressivity in human behaviour especially evident amongst infants, and which Freud recognised in his Three Essays on Sexuality when he stressed the primordial ambivalence of children towards their love object(s) (in the oral phase, to love is to devour; in the anal phase, it is to master or destroy …).

b. Desire is the Desire of the Other

It is on the basis of this fundamental understanding of identity that Lacan maintained throughout his career that desire is the desire of the Other. What is meant by him in this formulation is not the triviality that humans desire others, when they sexually desire (an observation which is not universally true). Again developing Freud’s theorisation of sexuality, Lacan’s contention is rather that what psychoanalysis reveals is that human-beings need to learn how and what to desire. Lacanian theory does not deny that infants are always born into the world with basic biological needs that need constant or periodic satisfaction. Lacan’s stress, however, is that, from a very early age, the child’s attempts to satisfy these needs become caught up in the dialectics of its exchanges with others. Because its sense of self is only ever garnered from identifying with the images of these others (or itself in the mirror, as a kind of other), Lacan argues that it demonstrably belongs to humans to desire- directly- as or through another or others. We get a sense of his meaning when we consider such social phenomena as fashion. As the squabbling of children more readily testifies, it is fully possible for an object to become desirable for individuals because they perceive that others desire it, such that when these others’ desire is withdrawn, the object also loses its allure. Lacan articulates this ‘decentring’ of desire when he contends that what has happened to the biological needs of the individual is that they have become inseparable from, and importantly subordinated to, the vicissitudes of its demand for the recognition and love of other people. Events as apparently ‘natural’ as the passing or holding back of stool, he remarks in Ecrits, become episodes in the chronicle of the child’s relationship with its parents, expressive of its compliance or rebellion. A hungry child may even refuse to eat food if it perceives that this food is offered less as a token of love than one of its parents’ dissatisfaction or impatience.

In this light, Lacan’s important recourse to game theory also becomes explicable. For game theory involves precisely the attempt to formalise the possibilities available to individuals in situations where their decisions concerning their wants can in principle both affect and be affected by the decisions of others. As Lacan’s article in the Ecrits on the “Direction of the Treatment” spells out, he takes it that the analytic situation, as theorised by Freud around the notion of transference (see Part 2), is precisely such a situation. In that essay, Lacan focuses on the dream of the butcher’s wife in Freud’s Interpretation of Dreams. The said ‘butcher’s wife’ thought that she had had a dream which was proof of the invalidity of Freud’s theory that dreams are always encoded wish-fulfilments. As Freud comments, however, this dream becomes explicable when one considers how, after a patient has entered into analysis, her wishes are constructed (at least in part) in relation to the perceived wishes of the analyst. In this case, at least one of the wishes expressed by the dream was the woman’s wish that Freud’s desire (for his theory to be correct) be thwarted. In the same way, Lacan details how the deeper unconscious wish expressed in the manifest content of the dream (which featured the woman attempting to stage a dinner party with only one piece of smoked salmon) can only be comprehended as the coded fulfilment of a desire that her husband would not fulfil her every wish, and leave her with an unsatisfied desire.

c. The Oedipal Complex, Castration, The Name of the Father, and the Big Other

The principle that desire is the desire of the Other is also decisive in how Lacan reformulates Freud’s theory of the child’s socialisation through the resolution of its Oedipal complex in its fifth or sixth year. Lacan agrees with Freud that this event is decisive both in the development of the individual, and in the aetiology of any possible subsequent mental illness. However, in trying to understand this stage of subjective development, Lacan distances himself from Freud’s emphasis on the biological organ of the penis. Lacan talks instead of the phallus. What he is primarily referring to is what the child perceives it is that the mother desires. Because the child’s own desire is structured by its relationships with its first nurturer (usually in Western societies the mother), it is thus the desire of the mother, for Lacan, that is the decisive stake in what transpires with the Oedipus complex and its resolution. In its first years, Lacan contends, the child devotes itself to trying to fathom what it is that the mother desires, so that it can try to make itself the phallus for the mother- a fully satisfying love-object. At around the time of its fifth or sixth desire, however, the father will normally intervene in a way that lastingly thwarts this Oedipal aspiration. The ensuing renunciation of the aspiration to be the phallic Thing for the mother, and not any physical event or its threat, is what Lacan calls castration, and it is thus a function to which he thinks both boys and girls are normally submitted.

The child’s acceptance of its castration marks the resolution of its Oedipal complex, Lacan holds, again shadowing Freud. The Oedipal child remains committed to its project of trying to fathom and fulfil this desire. It accordingly (and famously) perceives the father as a rival and threat to its dearest aspirations. Because of this, in a maverick theoretical conjunction, Lacan indeed likens the father-child relation at this point (at least as it is perceived by the child) to the famous ’struggle to the death for pure recognition’ dramatised in Hegel’s Phenomenology of Spirit. In this struggle, of course, the child invariably loses. But everything turns, according to Lacanian theory, on whether this loss constitutes a violent humiliation for the child or whether, as in Hegel’s account of ‘Lordship and Bondage’, its resolution involves the founding of a pact between the parties, bound by the solemnification of mutually recognised Law. If the castration complex is to normalise the child, Lacan argues, what the child must be made to perceive is that what satisfies or orders the desire of the mother is not any visible (imaginary) feature of the father (his obviously better physical endowments, and so on). The child must come to see that the whims of the mother are themselves ordered by a Law that exceeds and tames them. This law is what Lacan famously dubs the name (nom) of the father, trading on a felicitous homonymy in French between nom (name) and non (the ‘no!’ to incestuous union). When the father intervenes, (at least when he is what Lacan calls the symbolic father) Lacan’s argument is that he does so less as a living enjoying individual than as the delegate and spokesperson of a body of social Law and convention that is also recognised by the mother, as a socialised being, to be decisive. This body of nomoi is what Lacan calls the big Other of the child’s given sociolinguistic community. Insofar as the force of its Law is what the child at castration perceives to be what moves the mother and gives the father’s words their ‘performative force’ (Austin), Lacan also calls it the phallic order.

d. The Law and Symbolic Identification

The Law of the father is in this way theorised by Lacan as the necessary mediator between the child and the mother. A castrating acceptance of its sovereignity precipitates the child out of its ambivalent attempts to be the fully satisfying Thing for the mother. As Lacan quips, when the child accedes to castration, it accedes to the impossibility of it directly satisfying its incestous wish. If things go well, however, it will go away with ‘title deeds in its pocket’ that guarantee that, when the time comes (and if it plays by the rules), it can at least have a satisficing substitute for its first lost love-object. What has occurred, in this event, is that the individual’s imaginary identifications (or ‘ideal egos’) that exclusively characterised its infantile years have been supplemented by an identification of an entirely different order: what Lacan calls a symbolic identification with an ‘ego ideal’. This is precisely identification with and within something that cannot be seen, touched, devoured, or mastered: namely, the words, norms and directives of its given cultural collective. Symbolic identification is always idenification with a normatively circumscribed way of organising the social-intersubjective space within which the subject can take on its most lasting imaginary identifications: (For example, the hysterical-vulnerable female identifies at the symbolic level with the patriarchal way of structuring social relations between sexes, outside of which her imaginary identification would be meaningless).

e. Summary

So, to repeat and summarise: Lacan’s philosophical anthropology (his answer to the question: what is it to be human?) involves several important reformulations of Freudian tenets. By drawing on Hegel, game theory, and contemporary observations of infant behaviour, he lays greater systematic emphasis than Freud had on the intersubjective constitution of human desire. In this feature at least, his philosophical anthropology is united with that of philosophers such as Levinas, Honneth and Habermas. Equally, since for Lacan human desire is ‘the desire of the other’, what he contends is at stake in the child’s socialisation is its aspiration to be the fully satisfying object for the mother, a function which is finally (or at least norm-ally) fulfilled by the Law-bearing words of the father. Human-being, for Lacan, is thus (as decentred) vitally a speaking animal (what he calls a parle-etre); one whose desire comes to be ‘inmixed’ with the imperatives of, and stipulated within, the natural language of its society. [see Part 2] Particularly, Lacan picks up on certain cues within Freud’s texts (and those of Saint Paul) to emphasise the dialectical structuration of human desire in relation to the prohibitions of Law. If the Law of the father denies immediate access to what the child takes to be the fully satisfying object (as expounded above), from this point on, Lacan argues, (at least neurotic) desire is necessarily articulated in the interstices of what is permitted by the big Other. And it is characterised by an innate and ‘fatal’ attraction to what it prohibits as such, which is why he placed such central emphasis throughout his career on the enigmatic Freudian notion of a death drive.

f. Lacan’s Diagnostic Categories

Finally, it should be noted that, because of Lacan’s reformulations of several of Freud’s key notions, Lacan’s diagnostic heuristic differs markedly from Freud’s. For Lacan, what is decisive in understanding mental illness is not the conflict between the embattled ego and its two more ‘irrational’ psychic bedfellows, the superego and the id. It is how the subject bears up vis-à-vis the condition of being a castrated animal forced to pursue its desire on ‘the inverted ladder of the signifier’, within the phallic order of its society’s big Other. The question to be asked, for Lacan, is: how fully has the subject acceded to its symbolic castration?, and- as such- how fully has it overcome the transitivity and aggressivity characteristic of the earlier infantile stages of its development?

As in Freud, Lacan stipulates three major classes of mental illness, all of which are situated by him vis-à-vis the terms of this question, and which (as such) are elevated by him to something like three existential bearings towards the condition of being a decentred socialised animal. According to the Lacanian conceptualisation, the neurotic is someone who has submitted to castration, but not without remainder. His/her symptoms stand testimony to a lasting refusal of, and resentment towards, the castrating agency of the big Other. The pervert is someone who has only partially acceded to castration. For him/her, the Law does not function wholly to repress or render inaccessible what s/he deeply desires (the maternal body). Because of this, this Law comes itself (either in its prosecution, or in its sufferance) to function as the object of her/his desire. Finally, the psychotic is someone who has never acceded (or been drawn to accede) to the symbolic order of social interchange bound by the name of the father. For him/her, this order of the big Other, in which people follow the Law ‘because it is the Law’ can thus only ever appear to be a semblance. As is most clear in the delusions of paranoiacs, s/he will thus permanently be prey to the delusion that there must be some ‘Other of the big Other’ (eg: aliens, the CIA, God) behind the scenes, pulling the strings of the social charade.

3. Lacan’s Philosophy of Language

Perhaps the component of Lacanian theory for which it is most famous, and which has most baffled its critics, is the emphasis Lacan laid on language in his attempt to formalise psychoanalysis. From the 1950’s, in complete opposition to any Jungian or romantic conceptions, Lacan instead described the unconscious as a kind of discourse: the discourse of the Other. There are at least three interrelated concerns that inform the construction of what I am terming Lacan’s ‘philosophy of language’:

- The first is the central argument that the child’s castration is the decisive point in its becoming a speaking subject – The second is his taking very seriously what might be termed the ‘interpretive paradigm’ in Freud’s texts, according to which Freud repeatedly described symptoms, slips and dreams as symbolic phenomena capable of interpretation. – The third is Lacan’s desire to try to understand the efficacy of psychoanalytic interpretation as a curative procedure that relies solely on what Freud called in The Question of Lay Analysis the ‘magical’ power of the word.

a. Language and Law

In Part 1, in recounting Lacan’s view on the resolution of the Oedipal complex, one reason why Lacan allocated language such importance was touched upon. For Lacan, it is only when the child accedes to castration and the Law of the father, that s/he becomes fully competent as a language-speaker within his/her given social collective. By contrast, individuals suffering from psychosis, Lacan stresses (in line with a vast wealth of psychological research), are prone to characteristic linguistic dysfunctions and inabilities. Already from this, then, we can outline a first crucial feature of Lacan’s ‘philosophy of language’. Like the later Wittgenstein, Lacan’s position is that to learn a language is to learn a set of rules or laws for the use and combination of words. Accordingly, for him too, ‘learning is based on believing’ [Wittgenstein]. Particularly, Lacan asserts a lasting link between the capacity of a subject to perceive the world as a set of discrete identifiable objects, and his/her acceptance of the unconditional authority of a body of convention. I will return to this below.

b. Psychoanalysis as Interpretation: the Unconscious Structured Like a Language

Lacan’s contention concerning human-being as a parle-etre, put most broadly, is that when the subject learns its mother tongue, everything from its sense of how the world is, to the way it experiences its biological body, are over-determined by its accession to this order of language. This is the clearest register of the debt that Lacan owes to phenomenology. From Heidegger, he accepts the notion that to be a subject is to experience the world as a meaningful totality, and that language is crucial to this capability. Aligning Freud with the theories of Merleau-Ponty and Sartre, Lacan developed a psychoanalytic conception of how the body is caught in the play of meaning-formation between subjects, and expressive of the subjectivity that ‘lives’ through it, as well as being an objectificable tool for the performance of instrumental activities. For Lacan, that is, ‘the unconscious’ does not name only some other part of the mental apparatus than consciousness. It names all that about a subject, including bodily manifestations and identifications with others and ‘external’ objects that insist beyond his/her conscious control.

Freud had already commented in the Introductory Lectures to Psychoanalysis that the unconscious can be compared to a language without a grammar. Lacan, using structuralist linguistics, attempted to systematise this contention, arguing that the unconscious is structured like a language, and that ‘it speaks’/ ca parle. A symptom, Lacan (for example) claimed, is to be read as a kind of embodied corporeal metaphor. As Freud had argued, he takes it that what is at stake within a symptom is a repressed desire abhorrent to the consciously accepted self-conception and values of the subject. This desire, if it is to gain satisfaction at all, accordingly needs to be expressed indirectly. For example, a residual infantile desire to masturbate may find satisfaction indirectly in a compulsive ritual the subject feels compelled to repeat. Just as one might metaphorically describe one’s love as a rose, Lacan argues, here we have a repressed desire being metaphorically expressed in some apparently dissimilar bodily activity. Equally, drawing on certain moments within Freud’s papers “On the Psychology of Love”, Lacan argues that desire is structured as a metonymy. In metonymy, one designates a whole object (eg: a car) by naming one part of it (eg: ‘a set of wheels’). Lacan’s argument is that, equally, since castration denies subjects full access to their first love object (the mother), their choice of subsequent love objects is the choice of a series of objects that each resemble in part the lost object (perhaps they have the same hair, or look at him/her the same way the mother did …). According to Lacan, the unconscious uses the multivalent resources of the natural language into which the subject has been inducted (what he calls ‘the battery of the signifier’) to give indirect vent to the desires that the subject cannot consciously avow. Lacan’s Freudian argument is that a directly comparable process occurs in formations of the unconscious as in jokes. As Freud detailed in Jokes and Their Relation to the Unconscious, the ‘punch line’ of jokes pack their punch by condensing in one statement, or even one word, two chains of meaning. The first of these is what the previous words and cues of the joke, and our shared norms for interpretation, lead us to expect. The second is a wholly different chain of associations, whose clash with what we had expected produces our sense of amusement. In the same way, Lacan observed that, for example, when an analysand makes a ’slip of the tongue’, what has taken place is that the unconscious has employed such means as homonymy, the merging of two words, the forgetting or mispronunciation of certain words, or a slippage of pronoun or tense, etc., to intimate a whole chain of associations which the subject did not intend, but through which his unconscious desire is given indirect expression. Lacan argues that what the consideration of jokes, symptoms and slips thus shows are a number of features of how it is that human beings form sense in language. The first thing is that the sentence is the absolutely basal unit of meaning. Before a sentence ends, Lacan notes, the sense of each individual word or signifier is uncertain. It is only when the sentence is completed that their sense is fixed, or- as Lacan variously put it- ‘quilted’. Before this time, they are what he calls floating signifiers, like to the leading premises of a joke. The sense of this position can be easily demonstrated. One need only begin a sentence by proferring a subject, but then cease speaking before a verb and/or predicate is assigned to this in accordance with linguistic convention. For example, if I say: ‘when I was young I…’ or ‘it’s not like …’, my interlocutor will be understandably want to know what it is that I mean. At the end of the sentence, by contrast, the sense of the beginning words becomes clear, as when I finish the first of the above utterances by saying ‘when I was young I ran a lot’, or whatever. This understanding of sentences as the basic unit of sense, and of how it is that signifiers ‘float’ until any given sentence is finished, is what informs Lacan’s emphasis on the future anterior tense. Sense, he argues, is always something that ‘will have been’. It is anticipated but not confirmed, when we hear uttered the beginning of a sentence (see transference below). Or else, at sentence’s end, it is something that we now see with the benefit of ’twenty twenty hindsight’ to have been intended all along. This is why, in Seminar I, Lacan even quips that the meaning of symptoms do not come from the past, but from the future. Before the work of interpretation, a symptom is a floating signifier, whose meaning is unclear to the analysand, and also to the analyst. As the analytic work proceeds, however, an interpretation is achieved at some later time that casts the whole behaviour into relief in a wholly different light, and makes its sense clear.

c. The Curative Efficacy of the ‘Talking Cure’

Lacan’s emphasis on language is also over-determined by an elementary recollection that, if Freud’s intervention promised anything, it is that speaking with another person in strictly controlled circumstances can be a curative experience for people suffering from forms of mental illness. The analysand comes to the analyst with his troubling symptoms, and the analyst, at certain decisive points, offers interpretations of these behaviours that retrospectively make their meaning clear. And this is not simply an intellectual exercise. As Freud stressed, there is knowledge of the unconscious, and then there is knowledge that has effects upon it. A successful psychoanalytic interpretation is one that has effects even upon the biological reality of the body, changing the subject’s bearing towards the world, and dissolving his/her symptoms.

The need to explain this power of words and language is a clear and lasting motive behind Lacan’s understanding of language. His central and basal hypothesis concerning it can be stated in the following way. In a symptom, as we saw above, an unconscious desire seeks to make itself manifest. The symptom is recounted to the analyst, or else repeated in the way the subject responds to the analyst in the sessions. Then an interpretation is offered by the analyst, which recognises or symbolises the force of the desire at work in the symptom, and the symptom disappears. So here the recognition of a desire at the same time satisfies the desire. What this can accordingly only mean is that the unconscious desire given voice in the symptom is itself, from the start, at least in part a desire for recognition. This is an absolutely central Lacanian insight, wherein he again shows the influence of Hegel’s Phenomenology of Spirit upon his most central concepts. It synchronises exactly with the philosophical anthropology recounted above, and Lacan’s stricture concerning how human desire is always caught up in the dialectics of individuals’ exchanges with others. But, for Lacan, it also shows something vital about the language in or as which the subjects’ repressed desires are trying to find a vent. This is that language is above all a social pact. As Lacan wrote in the Ecrits: “As a rule everyone knows that others will remain, like himself, inaccessible to the constraints of reason, outside an acceptance in principle of a rule of debate that does not come into force without an explicit or implicit agreement as to what is called its basis, which is almost always tantamount to an anticipated agreement to what is at stake… I shall expect nothing therefore of these rules except the good faith of the Other, and, as a last resort, will make use of them, if I think fit or if I am forced to, only to amuse bad faith…” [Lacan, 2001: 154-155] Lacan’s idea is that to speak is to presuppose a body a conventions that ensue that, even if my immediate auditor doesn’t ‘get it’, the true meaning of what I wish to convey always will emerge, and be registered in some ‘Other’ place. (Note that here is another meaning of the big Other touched upon in Part 1. The big Other is the place, tribunal, collective or single person which we presuppose will register the truth of what we say, whenever we speak). This is why Lacan’s philosophy of language is to be read in strong opposition to any philosophical account (whether Lockean, descriptivist or phenomenological) which argues that meaning is formed prior to the communicative act. Lacan defines speech as a process in which the subjects get their meanings back from the Other in an inverted form. Think once more of what is involved in psychoanalytic interpretation. Here the meaning of a symptom is rendered by the analyst. What this means, for Lacan, is that the symptom not only bears upon the subject’s past relations to others. If it can be dissolved by an Other’s interpretation, this is because it is formed with an eye to this interpretation from the start. To quote Slavoj Zizek on this Lacanian notion of how the symptom is from the start addressed to an Other supposed to know its truth: “The symptom arises where the world failed, where the circuit of symbolic communication was broken: it is a kind of ‘prolongation of communication by other means’: the failed, repressed word articulates itself in a coded, ciphered form. The implication of this is that the symptom can not only be interpreted but is, so to speak, formed with an eye to its interpretation … in the psychoanalytic cure the symptom is always addressed to the analyst, it is an appeal to him to deliver its hidden message … This … is the basic point: in its very constitution, the symptom implies the field of the big Other as consistent, complete, because its very formation is an appeal to the Other which contains its meaning …” [Zizek, 1989: 73] Even the key meaning of transference, for Lacan, is this supposition that there is an Other supposed to know the truth of my communicative acts, even down to the most apparently meaningless ’slips’ and symptomatic behaviours. In terms of the previous section, transference is the condition of possibility for the quilting of the meaning of floating signifiers that occurs even in the most basic sentences, as we saw. What occurs in a psychoanalytic interpretation is simply one more consequential version of this process. The subject, by speaking, addresses himself to some Other supposed to know her/his truth, and at the end of this process, the signifiers he offers to the Other are quilted, and return to him ‘in an inverted form’. What has occurred at this point, on Lacan’s reckoning, is that the previously unquilted signifiers finding voice in the manifestations of his unconscious are integrated into the subject’s symbolic universe: the way s/he understands the world, in the terms of his/her community’s natural language. They have been subjectivised; which means that now s/he can recognise them as not wholly alien intrusions into his/her identity, but an integral part of this identity. Lacan’s stress is thus always, when he talks of psychoanalytic interpretation, that this interpretation does not add new content to the subject’s self-understanding, so much as affect the form of this understanding. An interpretation, that is, realigns the way the s/he sees her past, reordering the signifiers in which his/her self-understanding has come to be ordered. A crucial Lacanian category in theorising this process is that of the ‘master signifier’. Master signifiers are those signifiers to which a subject’s identity are most intimately bound. Standard examples are words like ‘Australian’, ‘democrat’, ‘decency’, ‘genuineness’. They are words which will typically be proffered by subjects as naming something like what Kant would have called ends in themselves. They designate values and ideals that the subject will be unwilling and unable to question without pulling the semantic carpet from beneath their own feet. Lacan’s understanding of how these ‘master signifiers’ function is a multi-layered one, as I shall expand in Part 3.. It is certainly true to say, though, that the importance of these signifiers comes from how a subject’s identification with them commits them to certain orderings of all the rest of the signifiers. For example, if someone identifies himself as a ‘communist’, the meanings of a whole array of other signifiers are ordered in quite different ways than for someone who thinks of himself as a ‘liberal’. ‘Freedom’ for him comes to mean ‘freedom from the exploitative practices enshrined in capitalism and hidden beneath liberal ideological rhetoric’. ‘Democracy’ comes to mean ‘the dictatorship of the proletariat’. ‘Equality’ comes to mean something like ‘what ensues once the sham of the capitalist “equal right to trade” is unmasked’. What Lacan argues is involved in the psychoanalytic process, then, is the elevation of new ‘master signifiers’ which enable the subject to reorder their sense of themselves and of their relations to others. Previously, for example, a person may have identified with a conception of ‘decency’ that has led him to repress aspects of his own libidinal makeup, which then return in neurotic symptoms. What analysis will properly lead him to do is identify himself with a different set of ‘master signifiers’, which re-signify the signifiers he had unconsciously been addressing to the Other in his symptoms, reducing their traumatic charge by integrating them into his symbolic (self-)understanding.

4. Lacanian Psychoanalysis and The Philosophy of Ethics

Whereas Freud never systematically spoke on the ethics of psychoanalysis, Lacan devoted his pivotal seventh seminar (in 1959-1960) to precisely this topic. Seminar VII: The Ethics of Psychoanalysis goes to some lengths to stress that the position on ethics Lacan is concerned to develop is concerned solely with the clinical practice of psychoanalysis. Its central topic, in line with what we examined in Part 1 concerning the intersubjective structuration of subjective desire and identity, is the desire of the analyst as that Other addressed by the patient and implicated in the way s/he structures his/her desire through the transference. Nevertheless, it remains that Lacan develops his position through explicit engagement with Aristotle’s Nichomachean Ethics, as well as Kant’s practical writings, and the texts of Marquis de Sade. Moreover, Lacan’s ethics accord with his metapsychological premises, examined in Part 1, and his theorisation of language, examined in Part 2. In this Part 3, accordingly, I want to present Lacan’s understanding of ethics as a sophisticated position that, disavowals notwithstanding, can be read as a consistent post-Kantian philosophy of ethics. Part 3 is divided into three sections. The first two sections develop further Lacan’s metapsychological and philosophical tenets. Section i. involves a further elaboration of the Lacanian conception of the ‘master signifiers’. Section ii. involves an exposition of Lacan’s notion of the ‘fundamental fantasy’. Section iii. then examines Lacan’s later notion of ‘traversing the fantasy’ as the basis of his ethical position.

a. Master Signifiers, and the Decentred Nature of Belief

As I stated at the end of Part 2, Lacan assigns great importance in his theorisation of the psychoanalytic process to what he calls ‘master signifiers’. These are those signifiers that the subject most deeply identifies with, and which accordingly have a key role in the way s/he gives meaning to the world. As was stressed, Lacan’s idea about these signifiers is that their primary importance is less any positive content that they add to the subject’s field of symbolic sense. It is rather the efficacy they have in reorienting the subject vis-à-vis all of the other signifiers which structure his/her sense of herself and the world. It is precisely this primarily structural or formal function that underlies the crucial Lacanian claim that master signifiers are actually ‘empty signifiers’ or ‘signifiers without a signified’.

As with all of Lacan’s key formulations, the notion that the master signifiers are ’signifiers without signified’ is a complex one. Even the key idea is the following. The concept and /or referent signified by any ‘master signifier’ will always be something impossible for any one individual to fully comprehend. For example, ‘Australian-ness’ would seem to be what is aimed at when someone proffers the self-identification: ‘I am an Australian’. The Lacanian question here is: what is ‘Australian’ being used by the subject to designate here? Is ‘Australian-ness’ something that inheres in everyone who is born in Australia? Or is it a characteristic that is passed on through the medium of culture primarily? Does it, perhaps, name most deeply some virtues or qualities of character all Australians supposedly have? However, even if we take it that all ‘Australians’ share some basic virtues, which are these? Can a closed list everyone would agree upon be feasibly drawn up? Is it not easy to think of other peoples who share in valuing each individual trait we standardly call ‘Australian’ (eg: courage, disrespect for pomposity)? And, since ‘Australian’ would seem to have to aim at a singular entity, not a collection, or else some grounding quality of character that could perhaps unite all of the others, which is this? And is this ‘essential’ quality- again- simply biological, perhaps genetic, or is it metaphysical, or what? What Lacan’s account of ‘master signifiers’ thus emphasizes is the gap between two things. The first is our initial certainty about the nature of such an apparently obvious thing as ‘Australian-ness’. (We may even get vexed when asked by someone). The second thing is the difficulty that we have of putting this certainty into words, or naming something that would correspond to the ‘essence’ of ‘Australian-ness’, beneath all the different appearances. What Lacan indeed argues, in line with his emphasis on the decentred self, is that our ongoing and usually unquestioning use of these words represents another clear case of how the construction of sense depends on the transferential supposition of ‘Others supposed to know’. Though we ourselves can never simply state what ‘Australian-ness’, etc. is, that is, Lacan argues that what is nevertheless efficient in generating our belief in (and identification with) this elusive ‘thing’ is a conviction that nevertheless other people certainly know its nature, or seem to. Just as we desire through the Other, for this reason Lacanian theory also maintains that belief is always belief through an Other (for example, in the Christian religion, priests would be the designated Others supposed to know the meaning of the Christian mystery vouchsafing believers’ faith). At this point, it is appropriate to recall from Part 1 Lacan’s thesis that castration marks the point wherein the child is made to renounce its aspiration to be the phallic Thing for the mother. A subject’s castration amounts at base, for Lacan, to the acceptance that it is the injunctions of the father- and through his name the conventions of the big Other of society- that govern the desire of the mother. The ‘master signifiers’ are also what Lacan calls phallic signifiers. The reason is exactly that- despite the difficulty of locating any simple referent for them- they nevertheless are the words that seem to intimate to subjects what ‘really matters’ about human existence. While no Christian believer may know what ‘God’ is, nevertheless s/he will be in no doubt of the transcendent importance of whatever It is that this word names. Lacan thus is drawing together his philosophical anthropology and his theorization of language when he defends the position that it is the consequence of ‘castration’ that subjects are debarred from immediate knowledge of what it is that the ‘phallic signifiers’ signify. He is also arguing, in the psychoanalytic field, a position profoundly akin to the Kantian postulation that finite human subjects are debarred from immediate access to things in themselves. Lacan’s argument is that it is this lost ’signified’, which would as it were be ‘more real’ than the other things that the subject can readily signify, that is what is primordially repressed when the subject accedes to becoming a speaking subject at castration. When the subject accedes to the symbolic, he repeats, the Real of aspired-to incestuous union, and the sexualized transgressive enjoyment or jouissance it would afford, is necessarily debarred.

b. Lacan’s Conception of Fantasy

If the neurotic subject does not to forego the Oedipal supposition that there is some Thing that would fully satisfy the desire of the mother, it is because s/he constructs fantasies about the nature of this lost Thing, and how s/he stands towards it. The primary means s/he deploys in this process is what I recounted above, when I noted how the difficulty in knowing the referent of the phallic master signifiers obliges subjects to construct their beliefs concerning it in a ‘decentred’ manner, through the Others. While the subject accepts that the Real phallic Thing is lost to him/her, that is, in his/her fantasmatic life s/he yet supposes that there are Others who do know what it is that phallic signifiers refer to, and have more direct access to the Real of jousissance. In line with this, Lacan’s further argument is indeed that the deepest fantasmatic postulation of subjects is always that the Real Phallic Thing that s/he has been debarred from must be held in reserve by the ‘big Other’ whose law it is that discernibly structures the mother’s desire.

What follows from this is the position that the manifestations of the unconscious represent small unconscious rebellions of the subject against the loss that s/he takes him/herself to have endured when s/he acceded to socialization. They are all under-girded by the more basic fantasmatic structuration of identity as constituted by the loss endured at castration. This is why Lacan talks of a fundamental fantasy, and argues that it is above all this fundamental fantasy that is at stake in psychoanalysis. Lacan strived to formalize the invariant structure of this ‘fundamental fantasy’ in the matheme: $ a. This matheme indicates that: ‘$’, the ‘barred’ subject which is divided by castration between attraction to and repulsion from the Object of its unconscious desire, is correlative to (”) the fantasised lost object. This object, designated in the matheme as ‘a’, is called by Lacan the ‘object petit a’, or else the object cause of desire. Lacan holds that the subject always stabilizes its position vis-à-vis the Real Thing by constructing a fantasy about how the debarred Thing is held in the big Other, manifesting only in a series of metonymic or partial objects (the gaze or voice of his/her love objects, a hair style, or some other ‘little piece of the Real’) that can be enjoyed as compensation for its primordial loss of the maternal Thing. Lacan’s argument is that the fundamental psychological ‘gain’ from the fundamental fantasy is the following. The fundamental fantasy represents what occurred at castration in the terms of a narrative of possession and loss. This fantasm thus consoles the subject by positing that s/he at one point did have the phallic Thing, but that then, at castration, it was taken away from him/her by the Other. What this of course means is that, since the Thing was taken away from the subject, perhaps also It can be regained by him/her. It is this promise, Lacan maintains, that usually structures neurotic human desire. What the fantasy serves to hide from the subject, then, is the possibility that a fully satisfying sexual relationship with the mother, or any metonymic substitute for her, is not only prohibited, but was never possible anyway. As I recounted in Part 1, the Lacanian view, which is informed by observation of infantile behavior, is that the mother-child relationship before castration is not Edenic, but characterized by imaginary transitivity and aggressivity. This is why Lacan quips in Seminar XX that ‘there is no such thing as a sexual relationship’ and elsewhere that the ‘Woman’, with a capital ‘W’, ‘does not exist’. Note then that the deepest logic of castration, according to Lacan, is a profoundly paradoxical one. The ‘no!’ of the father prohibits something that is impossible. Its very prohibition, however, gives rise in the subject to the fantasmatic supposition that the Thing in question is one that is attainable but only being debarred. Lacan thus asserts that the fundamental fantasy is there to veil from the subject the terminal nature of its loss at castration. This is not simply a speculation, however. It is supported by telling evidences that he adduces. The key point that supports Lacan’s position is the stipulation the objet petit is an anamorphotic object. What this means can be seen by looking at even the most well-known exemplar of the Lacanian objet petit a: the ‘object gaze’. Contrary to how it is sometimes read, the Lacanian ‘gaze’ is anything but the intrusive and masterful male gaze on the world. For Lacan, gaze is indeed a “blind spot” in the subject’s perception of visible reality, “disturbing its transparent visibility”. [Zizek, 1999a: 79] What it bears witness to is the subject’s inability to fully frame the objects that appear within his/her field of vision. The classic example of the object-gaze from Lacan’s Four Fundamental Concepts of Psychoanalysis is the floating skull at the feet of Holbein’s Ambassadors. What is singular about this ‘thing’ is that it can literally only be seen from ‘awry’, and at the cost that the rest of the picture appears at that moment out of focus. From this point on the canvas, Lacan comments, it is as if the painting regards us. What he means is that the skull reminds us that we, and with us our desires and fantasies, are implicated in how the scene appears. Here then is another meaning to $ a: the objet petit a, for Lacan, as something that can only operate its fascination upon individuals who bear a partial perspective upon it, is that object that ‘re-presents’ the subject within the world of objects that it takes itself to be a wholly ‘external’ perspective upon. If a subject thus happens upon it too directly, it disappears, or else- as in psychosis and the well-known filmic motif of what happens when one encounter one’s double- the cost is that one’s usual sense of how the rest of the world is must dissipate. What this indicates is that the object petit a, or at least the fascinating effect the object which bears it has upon the subject who is under its thrall, has no ‘objective’ reality independently of this subject. The logical consequence of this, though, as Lacan stipulates, is that this supposedly ‘lost’ object can never really have been lost by the subject, since s/he can never have possessed it in the first place. This is why Lacan argues the apparently chimerical position that the objet petit a is by definition an object that has come into being in being lost.

c. The Lacanian Subjects, and Ethics

Lacan argues that the subject is ‘the subject of the signifier’. One meaning of this claim at least is that there is no subject proper that is not a speaking subject, who has been subject to castration and the law of the father. I shall return to this formulation below, though, for its full meaning only becomes evident when another crucial claim that Lacan makes concerning the subject is properly examined. This is the apparently contradictory claim that the subject as such, at the same time as being a linguistic subject, lacks a signifier. There is no subject without language, Lacan wants to say, and yet the subject constitutively lacks a place in language.

At the broadest level, in this claim Lacan is simply restating in the language of structuralist linguistics a claim already made by Sartre, and before him Kojeve and Hegel (and arguably Kant). This is the claim that the subject is not an object capable of being adequately named within a natural language, like other objects can be (’table’, ‘chair’, or so on). It is no-thing. One of the clearest points of influence of Kojeve’s Heideggerian Hegelianism on Lacan is the emphasis he places on the subject as correlative to a lack of being (manqué-a-etre / want-to-be), especially in the 1950’s. Lacan articulates his position concerning the subject by way of a fundamental distinction between the ego or ‘moi‘ / ‘me’, and the subject intimated by the shifter ‘je’ / ‘I’. The subject is a split subject, Lacan claims, not only insofar as- Freud dixit- it has consciousness and an unconscious. When Lacan says the subject is split, he means also that, as a subject of language, it will always evince the following two levels. The first is the ego, or subject of the enunciated. This is the self wherein the subject perceives / anticipates its imaginary unity. Since the ego is an object, according to Lacan, it is capable of being predicated about like any other object. I can say of myself more or less truthfully that ‘I am fat’, or ‘honest’, or anything else. What my enunciated sentence will speak about in these cases, for Lacan, is my ego. But this is to be distinguished from a second ‘level’ of subjectivity: the subject of the enunciation. Here as elsewhere, Lacan’s position turns around his philosophy of language examined in detail in Part 2. The distinction between the subject of the enunciation and the subject of the enunciated follows from Lacan’s understanding of what ’speech-act’ theorists like Austin or Searle would call the performative dimension to language. Speech-act theorists emphasise that the words of given speech-acts are never enunciated in a vacuum. They are always uttered in a certain context, between language speakers. And through the utterances, subjects effectively do things (hence Austin’s title How to Do Things With Words). This is particularly evident in cases like commands or promises. When I make a promise (say: ‘I promise I’ll meet you at 5:15) I do not primarily make a claim about an existing state of affairs. It is what I have done that matters. What I have done is make a pledge to meet you at some future time. Lacan’s key argument, alongside that of Austin here, is that all linguistic acts have two important dimensions. The first is what Austin would call the constative dimension. Lacan calls this the level of what is enunciated. Words aim to express or represent factual states of affairs in the world. The second is the performative dimension, that Lacan calls the level of the enunciation. The subject of the unconscious is the subject of the enunciation, Lacan insists. This is one way he expresses the elementary Freudian hypothesis that, in symptoms and parapraxes, the subject says more than s/he intended to say. What s/he intended will usually be captured in the explicit content of what s/he has enunciated. Nevertheless, in his/her body language, or in a second chain of signification indicated by her/his mispronunciation (etc.), something other than what s/he intended will be conveyed to the analyst. This second chain of signification as it were ‘happens’- it is performed for the ‘Other supposed to know’ before it can be explicitly and consciously enunciated by the speaking individual. Lacan’s distinction between the subject of the enunciated and the subject of the enunciated can be exposed further through examining his treatment of the liar’s paradox. This is the paradox of someone saying: ‘I am a liar’. The paradox is that, if we suppose the proposition true (’person x is a liar’), we at the same time then have no reason to believe he is telling the truth when he says: ‘I am a liar’. As a liar, he can only be lying when he says this. But what this means is that we must suppose that he is a sincere truth-telling person. Lacan argues that this is a paradox only insofar as we have wrongly collapsed the distinction between the subject enunciated in the sentence, and the subject of the enunciation. A better understanding of the meaning of this utterance can be garnered by presenting the speech-act in both its two dimensions, as a case wherein (to formalise): ‘person x says: “I am a liar”‘ The point is that the ‘I’ in the spoken sentence here is what Lacan calls the subject of the enunciated. Of this ego, it may (or may not) be true that s/he is a liar. Yet, this ego is in no way to be identified with what I have called ‘person x’ in the above formalisation. ‘Person x’ here is not the subject spoken about. S/he is the person speaking. And Lacan’s point is that it this subject of the enunciation that addresses itself to the Other supposed to know in analysis, despite whatever egoic plays and ploys the analysand might masquerade before his/her analyst in what s/he enunciates. The hysteric, Lacan thus says, is someone who tells the truth about his/her desire (at the level of enunciation) in the guise of lying or at least being indifferent to the factual truths of which she speaks (at the level of the enunciated). The obsessional, by contrast, lies or dissembles the truth of his/her involvement in what s/he speaks about (at the level of enunciation) in the guise of always telling the truth (at the level of what s/he enunciates). Lacan’s position is that, when subjects wish to speak about themselves, the subject of enunciation is always either anticipated- at the beginning of the speech-act; or else missed- at the end of the speech-act, whence it has come to be falsely identified with the ego. In line with his prioritisation of the future anterior, he comments that the subject always ‘will have been’. In philosophical terms, we can say that the Lacanian subject is a presupposition of any speech-act (someone will always be speaking), yet impossible to fill out with any substantial content. It is for this reason that Slavoj Zizek has recently drawn a parallel between it and Kant’s unity of apperception in The Critique of Pure Reason. Lacan himself, in his seminar on the logic of fantasy, strove to articulate his meaning by a revision of Descartes’ famous cogito ergo sum: ‘I am not where I think’. The key to this formulation is the opposition between thinking and being. Lacan is saying that, at the point of my thought and speech (the subject of enunciation), there I have no substantial being that could be known. Equally, ‘I am not where I think’ draws out the necessary misapprehension of the nature of the subject in what s/he enunciates. If Lacan’s subject thus seems a direct psychoanalytic restatement of Sartre / Kojeve’s position, however, it needs to be read in conjunction with his doctrines concerning the ‘master signifier’ and the ‘fundamental fantasy’. Lacan says that master signifiers ‘represent the subject for other signifiers’. Given his identification of the subject with a lack of being, a first register of this remark becomes clear. The master signifiers, as examined above, have no particular enunciated content or signified, according to Lacan. But the Lacanian position is precisely that this lack of enunciated content is correlative to the subject. In this way, his theorisation of the subject depends not only on a phenomenological analysis, as (for example) Sartre’s does in Being and Nothingness. If the subject is the subject ‘of the lack of the signifier’, Lacan means not only that it cannot be objectified at the point of its thinking, as I examined above. The subject is- directly- something that emerges at the point of- and because of- a lack in the field of signification, on his reckoning. This was already intimated above, in the section on the ‘logics of the fantasy’, which recounted Lacan’s position concerning how it is that subjects develop regimes of fantasy concerning what Others are supposed to know in order to ground their own belief in, and identification with, the master signifiers. The point to be emphasised now is that these master signifiers, if they are to function, cannot do without this subjective investment of fantasy. Lacan’s famous claim there is no metalanguage is meant to imply only this: that there is no field of sense that can be ‘quilted’, and attain to a semblance of consistency, unless subjects have invested their partial, biased perspective upon that field. This is even the final and most difficult register to what Lacan aimed to express in the matheme: $ a. As I showed in Part 3, ii., the subject is correlative to the fantasmatically posed lost object / referent of the master signifiers. We can now state a further level of what Lacan implied in this matheme, though. This is that in fantasy what subjects misrecognise is not simply the non-existence of the incestuous-maternal Thing. What subjects primordially repress is the necessity of subjects’ implication in the play of signification that has over-determined the symbolic coordinates of their lives. The archetypal neurotic subject-position, Lacan notes, is one of victimisation. It is the Others who have sinned, and not the subject. S/he has only suffered. What is of course occluded by these considerations (which may be right or wrong from a moral or legal perspective) is how the subject has invested him/herself in the events of his/her life. Firstly, there is the fantasmatic investment of the subject in the ‘Others supposed to enjoy’, who are supposed not to have been made to undergo the castrating losses that s/he has undergone. As Lacan reads Freud’s later postulation of the superego, this psychical agency is constructed around residual fantasies of the Oedipal father supposed to have access to the sovereign jouissance of the mother’s body denied to the child. Secondly, what is occluded is what Freud already theorised when he spoke of subjects’ adaption to and ‘gain’ from their illness, as a way of organising their access to jouissance in defiance of the demands of the big Other. Even if the subject has undergone the most frightful trauma, Lacan argues, what matters is how this trauma has come to be signified subsequently and retrospectively by the subject around the fundamental fantasy. S/he must be made to avow that the subject-position they have taken up towards their life is something that they have subjectified, and have an ongoing stake in. This is why, in Seminar II, Lacan quips that the injunction of psychoanalysis is mange ton dasein!- eat your existence! He means that at the close of the analysis, the subject should come to internalise and so surpass the way that it has so far organised your life and relations to Others. It is this point, accordingly, that the ethics of Lacanian psychoanalysis is announced. Lacan’s name for what occurs at the end of the cure is traversing the fantasy. But since what the fantasy does, for Lacan, is veil from the subject his/her own implication in and responsibility for how s/he experiences the world, to traverse the fantasy is to reavow subjective responsibility. To traverse the fantasy, Lacan theorises, is to cease positing that the Other has taken the ‘lost’ object of desire. It is to accept that this object is something posited by oneself as a means to compensate for the experienced trauma of castration. One comes to accept that castration is not an event with a winner (the father) and a loser (the subject), but a structurally necessary factum for human-beings as such, to which all speaking subjects have been subjected. What equally follows is the giving up of the resentful and acquisitive project of trying to reclaim the objet petit a from the Other, and ’settling the scores’. This gives way to an identification with the place of this object that is at once within the fabric of the world, and yet which stands out from it. (Note that this is one Lacanian reading of ‘where It was, there I shall be’). The subject who has traversed the fantasy, for Lacan, is the subject who has not ceded on its desire. This desire is no longer fixed by the coordinates of the fundamental fantasy. S/he is able to accept that the fully satisfying sexual object, that which would fulfil the sovereign desire of the mother, does not exist. S/he is thus equally open to accepting that the big Other, and/or any concrete Other supposed by the subject to be its authoritive representative(s), does not have what s/he has ‘lost’. Lacan puts this by saying that what the subject can now avow is that the Other does not Exist: that it, too, lacks, and what it does and wants depends upon the interventions of the subject. The subject is, finally, able to thereby accept that what it took to be its place in the order of the Other is not a finally fixed thing. It can now avow without reserve that it is a lacking subject, or, as Lacan will also say, a subject of desire, but that the metonymic sliding of this desire has no final term. Rather than being ceaselessly caught in the lure of the object-cause of desire, this desire is now free to circle around on itself, as it were, and desire only itself, in what is a point of strange final proximity between Lacan and the Nietzcheanism he scarcely ever mentioned in his works.

5. Bibliography

Lacan, Jacques. Ecrits trans. Alan Sheridan (London: Routledge, 2001).

Lacan, Jacques. The Seminar of Jacques Lacan, Book I trans. John Forrester. Edited by J.A. Miller (Cambridge: Cambridge Uni. Press, 1988). Lacan, Jacques. The Seminar of Jacques Lacan, Book II trans. Sylvana Tomaselli. Edited by J.A. Miller (Cambridge: Cambridge University Press, 1988). Lacan, Jacques. The Seminar of Jacques Lacan, Book III: The Psychoses trans. Russell Grigg. Edited by J.A. Miller (W. Norton: Kent, 2000). Lacan, Jacques. The Seminar of Jacques Lacan, Book VII: The Ethics of Psychoanalysis trans. Dennis Porter (New York: Norton, 1992). Lacan, Jacques. SeminarXX: Encore! Trans. Bruce Fink (W. Norton: New York, 1975). Zizek, Slavoj. The Sublime Object Of Ideology (London: Verso, 1989). Zizek, Slavoj. Looking Awry: An Introduction to Lacan Through Popular Culture (Cambridge: Mass.: MIT Press, 1991). Zizek, Slavoj. Enjoy Your Symptom! Jacques Lacan in Hollywood (London and New York, 1992).

Author Information

Matthew Sharpe
Email: matthew.sharpe@dewr.gov.au
Department of Philosophy
University of Melbourne.

Original at

http://www.nyu.edu/gsas/dept/philo/faculty/block/papers/Theories_of_Consciousness.pdf

Abstract
This article compares the three frameworks for theories of consciousness
that are taken most seriously by neuroscientists, the view that consciousness is a
biological state of the brain, the global workspace perspective and an account in
terms of higher order states. The comparison features the “explanatory gap”
(Levine, 1983; Nagel, 1974) the fact that we have no idea why the neural basis of
an experience is the neural basis of that experience rather than another
experience or no experience at all. It is argued that the biological framework
handles the explanatory gap better than do the global workspace or higher order
views. The article does not discuss quantum theories or “panpsychist” accounts
according to which consciousness is a feature of the smallest particles of
inorganic matter (Chalmers, 1996; Rosenberg, 2004). Nor does it discuss the
“representationist” proposals (Byrne, 2001a; Tye, 2000) that are popular among
philosophers but not neuroscientists.
Three Theories of Consciousness

Higher Order The higher order approach says that an experience is
phenomenally conscious only in virtue of another state that is about the
experience (Armstrong, 1978; Byrne, 1997, 2001b; Carruthers, 2000; Lycan,
1996a; Rosenthal, 2005a). This perspective comes in many varieties, depending
on, among other things, whether the monitoring state is a thought or a
perception. The version to be discussed here says that the higher order state is
a thought (“higher order thought” is abbreviated as “HOT”), and that a conscious
experience of red consists in a representation of red in the visual system
accompanied by a thought in the same subject to the effect that the subject is
having the experience of red.
Global Workspace The global workspace account of consciousness was first
suggested by Bernard Baars (1988), and has been developed in a more neural
direction by Stanislas Dehaene, Jean-Pierre Changeux and their colleagues
(Dehaene, Changeux, Nacchache, Sackur, & Sergent, 2006). The account
presupposes a neural network approach in which there is competition among
neural coalitions involving both frontal and sensory areas (Koch, 2004), the
winning coalitions being conscious. Sensory stimulation causes activations in
sensory areas in the back of the head that compete with each other to form
dominant coalitions (indicated by dark elements in the outer group of rings in
Figure 1). Some of these dominant coalitions trigger central reverberations via
long range connections to frontal cortex, setting up activations that help to
2
maintain both the central and peripheral activations. The idea that some brain
areas control activations and reactivations in other areas is now ubiquitous in
neuroscience (Damasio & Meyer, 2008), and a related idea is widely accepted:
that one instance of reciprocal control is one in which workspace networks in
frontal areas control activations in sensory and spatial areas (Curtis &
D’Esposito, 2003). It is useful in thinking about the account to distinguish
between suppliers and consumers of representations. Perceptual systems
supply representations that are consumed by mechanisms of reporting,
reasoning, evaluating, deciding and remembering, which themselves produce
representations that are further consumed by the same set of mechanisms.
Once perceptual information is “globally broadcast” in frontal cortex this way, it is
available to all cognitive mechanisms without further processing. Phenomenal
consciousness is global broadcasting.
Although the global workspace account is motivated and described in part
in neural terms, the substantive claims of the model abstract away from neuronal
details. Nothing in the model requires the electrochemical nature of actual neural
signals. The architectural aspects of the model can just as easily be realized in
silicon based computers as in protoplasm. In this respect, the global workspace
theory of consciousness is a form of what philosophers call “functionalism”
(Block, 1980), according to which consciousness is characterized by an abstract
structure that does not include the messy details of neuroscience.
Another functionalist theory of consciousness is the integrated information
theory (Tononi & Edelman, 1998) according to which the level of consciousness
of a system at a time is a matter of how many possible states it has at that time
and how tightly integrated its states are. This theory has a number of useful
features, for example retrodicting that there would be a loss of consciousness in
a seizure in which the number of possible states drops precipitously (Tononi &
Koch, 2008). Unfortunately, such predictions would equally follow from an
integrated information theory of intelligence (in the sense of the capacity for
thought, as in the Turing Test of intelligence)–which also drops in a seizure.
Consciousness and intelligence are on the face of it very different things. We all
understand science fiction stories in which intelligent machines lack some or all
forms of consciousness. And on the face of it, mice or even lower animals might
have phenomenal consciousness without much intelligence. The separation of
consciousness and cognition has been crucial to the success of the scientific
study of consciousness. In a series of papers that established the modern study
of consciousness (Crick & Koch, 1990, 1998), Crick and Koch noted in particular
that the basic processes of visual consciousness could be found in non-primate
mammals and were likely to be independent of language and cognition. Although
its failure to distinguish consciousness and intelligence is crippling for the
integrated information theory as a stand-alone theory of consciousness, I will
mention it at the end of the article in a different role: as an adjunct to a biological
theory.
The biological theory The third of the major theories is the biological theory, the
theory that consciousness is some sort of biological state of the brain. It derives
3
from Democritus (Kirk, Raven, & Schofield, 1983) and Hobbes (1989), but was
put in modern form in the 1950s by Place (1956), Smart (1959) and Feigl (1958).
(See also Block, 1978; Crane, 2000; Lamme, 2003.) I will explain it using as an
example the identification of the visual experience of (a kind of) motion in terms
of a brain state that includes activations of a certain sort (involving feedback
loops) in area MT+ of the visual cortex. Although useful as an example, we can
expect that any theory of visual experience will be superseded.
Visual area MT+ reacts to motion in the world, different cells reacting to
different directions. Damage to MT+ can cause loss of the capacity to
experience this kind of motion, MT+ is activated by the motion after-effect,
transcranial magnetic stimulation of MT+ disrupts these afterimages and also can
cause motion “phosphenes” (Britten, Shadlen, Newsome, & Movshon, 1992;
Cowey & Walsh, 2000; Heeger, Boynton, Demb, Seideman, & Newsome, 1999;
Huk, Ress, & Heeger, 2001; Kammer, 1999; Kourtzi & Kanwisher, 2000; G.
Rees, Kreiman, & Koch, 2002; Théoret, Kobayashi, Ganis, Di Capua, & Pascual-
Leone, 2002; Zihl, von Cramon, & Mai, 1983). However, it is important to
distinguish between two kinds of MT+ activations, what I will call nonrepresentational
activations and representational activations. Some activations in
the visual system are very weak, do not “prime” other judgments (that is, do not
facilitate judgments about related stimuli), and do not yield above chance
performance on forced choice identification or detection (that is they do not allow
subjects to perform above chance on a choice of what the stimulus was or even
whether there was a stimulus or not). On a very liberal use of the term
‘representation’ in which any neural activation that correlates with an external
property is a representation of it (Gallistel, 1998), one might nonetheless call
such activations of MT+ representations, but it will be useful to be less liberal
here, describing the weak activations just mentioned as non-representational.
(The term ‘representation’ is very vague and can be precisified in different
equally good ways.) However, if activations of MT+ are strong enough to be
harnessed in subjects’ choices (at a minimum in priming), then we have genuine
representations. (See Siegel, 2008 for a discussion of the representational
contents of perceptual states.)
Further, there is reason to think that representations in MT+ that also
generate feedback loops to lower areas are at least potentially conscious
representational contents (Pascual-Leone & Walsh, 2001; Silvanto, Cowey,
Lavie, & Walsh, 2005). (For a dissident anti-feedback loop perspective see
Macknik and Martinez-Conde (2007).) Of course an activated MT+ even with
feedback to lower visual areas is not all by itself sufficient for phenomenal
consciousness. No one thinks that a section of visual cortex in a bottle would be
conscious (Kanwisher, 2001).
What makes such a representational content phenomenally conscious?
One suggestion is that active connections between cortical activations and the
top of the brainstem constitutes what Alkire (Alkire, Haier, & Fallon, 2000) calls a
“thalamic switch”. There are two important sources of evidence for this view.
One is that the common feature of many if not all anesthetics appears to be that
4
they disable these connections (Alkire & Miller, 2005). Another is that the
transition from the vegetative state to the minimally conscious state (Laureys,
2005) involves these connections. However, there is some evidence that the
“thalamic switch” is an on-switch rather than an off-switch (Alkire & Miller, 2005)
and that cortico-thalamic connections are disabled as a result of the large overall
decrease in cortical metabolism (Alkire, 2008; Tononi & Koch, 2008; Velly et al.,
2007)—which itself may be caused in part by the deactivation of other subcortical
structures (Schneider & Kochs, 2007). Although this area of study is in flux, the
important philosophical point is the 3 way distinction between (1) a nonrepresentational
activation of MT+ (2) an activation of MT+ that is a genuine
visual representational of motion, and (3) an activation of MT+ that is a key part
of a phenomenally conscious representation of motion.
The same distinctions can be seen in terms of the global workspace
theory as the distinction between (1) a minimal sensory activation (the gray
peripheral activations in Figure 1), (2) a peripheral dominant coalition (the black
peripheral activations in Figure 1) and (3) a global activation involving both
peripheral and central activation (the circled activations in Figure 1 that connect
to the central workspace). The higher order account can accommodate these
results but is focused on the distinction between a visual representation and a
conscious visual representation (2 vs 3), a visual representation that is
accompanied by a higher order thought to the effect that the subject has it.
Here are some items of comparison among the 3 theories. According to
the biological account, global broadcasting and higher order thought are what
consciousness does rather than what consciousness is. That is, one function of
consciousness on the biological view is to promote global broadcasting, and
global broadcasting in some but not all cases can lead to higher order thought.
Further, according to the biological view, both the global workspace and higher
order thought views leave out too many details of the actual working of the brain
to be adequate theories of consciousness. Information in the brain is coded
electrically, then transformed to a chemical code, then back to an electrical code,
and it would be foolish to assume that this transformation from one form to
another is irrelevant to the physical basis of consciousness.
From the point of view of the biological and global workspace view, the
higher order thought view sees consciousness as more intellectual than it is, but
from the point of view of higher order thought accounts, the biological and global
workspace accounts underestimate the role of cognition in consciousness. The
global workspace and higher order thought accounts are sometimes viewed as
superior to the biological account in that the biological account allows for the
possibility that a subject could have a phenomenally conscious state that the
subject does not know about (Block, 2007a, 2007b). And this is connected to the
charge that the biological account—as compared with the other accounts–
neglects the connection between phenomenal consciousness and the self
(Church, 1995; Harman, 1995; Kitcher, 1995).
The higher order and global workspace accounts link consciousness to
the ability to report it more tightly than does the biological view. On the higher
5
order thought view, reporting is just expressing the higher order thought that
makes the state conscious, so the underlying basis of the ability to report comes
with consciousness itself. On the global workspace account, what makes a
representational content conscious is that it is in the workspace, and that just is
what underlies reporting. On the biological account, by comparison, the
biological machinery of consciousness has no necessary relation to the biological
machinery underlying reporting, and hence there is a real empirical difference
among the views that each side seems to think favors their own view (Block,
2007b; Naccache & Dehaene, 2007; Prinz, 2007; Sergent & Rees, 2007).
To evaluate and further compare the theories, it will be useful to appeal to
a prominent feature of consciousness, the explanatory gap.
The Explanatory Gap
Phenomenal consciousness is “what it is like” to have an experience
(Nagel, 1974). Any discussion of the physical basis of phenomenal
consciousness (henceforth just consciousness) has to acknowledge the
“explanatory gap” (Levine, 1983; Nagel, 1974): nothing that we now know,
indeed nothing that we have been able to hypothesize or even fantasize, gives
us an understanding of why the neural basis of the experience of green that I
now have when I look at my screen saver is the neural basis of that experience
as opposed to another experience or no experience at all. Nagel puts the point in
terms of the distinction between subjectivity and objectivity: the experience of
green is a subjective state but brain states are objective, and we do not
understand how a subjective state could be an objective state or even how a
subjective state could be based in an objective state. The problem of closing the
explanatory gap (the “Hard Problem” as Chalmers (1996) calls it) has four
important aspects: (1) we do not see a hint of a solution, (2) we have no good
argument that there is no solution that another kind of being could grasp or that
we may be able to grasp at a later date (But see McGinn, 1991.) So (3) the
explanatory gap is not intrinsic to consciousness, and (4) most importantly for
current purposes, recognizing the first three points requires no special theory of
consciousness. All scientifically oriented accounts should agree that
consciousness is in some sense based in the brain; once this is accepted, the
problem arises of why the brain basis of this experience is the basis of this one
rather than another one or none and it becomes obvious that nothing now known
gives a hint of an explanation.
The explanatory gap was first brought to the attention of scientists through
the work of Nagel and Crick and Koch (Crick, 1994; Crick & Koch, 1998). I would
argue that the candid recognition of what we do and more importantly do not
understand played an important role in fueling the incredible wave of research
that still engulfs us.
How do the three theories account for the explanatory gap?
The HOT view says that consciousness of, say red, is a matter of three
ingredients: a higher order thought, a representation with the content red, and an
aboutness relation between the first and the second. According to the HOT
6
perspective, each of these ingredients can exist individually without any
consciousness. We have unconscious, e.g. subliminal representations of red, we
have unconscious thoughts and those unconscious thoughts are, unconsciously,
about things. According to the HOT theory, if a subject has an unconscious
representation of red, and then forms an unconscious thought about the
representation of red, the representation of red automatically is conscious. Of
course in some trivial sense of ‘conscious’ we might decide to call that
representation of red conscious, meaning only that there is a higher order
thought about it; but if the HOT theory is about consciousness in the full blooded
sense in which for a state to be conscious is for there to be something it is like to
be in that state, there is a fundamental mystery for the HOT view.
It may seem that this is just the explanatory gap in a new form, one
appropriate to the HOT theory, but that is a mistake. Consider the prime order
thought (POT) view—that says that thoughts about thoughts about thoughts…are
always conscious so long as the number of embeddings is prime. There is a
puzzle of the POT view’s own making of why a prime number of embeddings
creates consciousness, but that puzzle is not the real explanatory gap.
The real explanatory gap is the problem of why the neural basis of a
conscious state with a specific conscious quality is the neural basis of that
conscious quality rather than another or nothing at all. The real explanatory gap
does not assume any specific theory except the common basis of all scientific
approaches in the 21st Century, that conscious qualities have a brain basis.
The problem for the HOT perspective is that it is part of the idea of it that
putting together ingredients that are not in themselves conscious (thought,
aboutness and representation) automatically exhibits consciousness. The most
neuroscience can do is explain thought, explain aboutness and explain
representation. But there is no reason to expect—and it is not part of any HOT
perspective–that neuroscience will find some magic glow that occurs when those
things combine.
The fact that the HOT theory cannot recognize the real explanatory gap
makes it attractive to people who don’t agree that there is an explanatory gap in
the first place—the HOT theory is a kind of “no consciousness” theory of
consciousness. But for those who accept an explanatory gap (at least for our
current state of neuroscientific knowledge), the fact that the HOT theory doesn’t
recognize one is a reason to reject the HOT theory. The HOT theory is geared to
the cognitive and representational aspect of consciousness, but if those aspects
are not the whole story, the HOT theory will never be adequate to
consciousness.
This very short argument against the HOT approach also applies to the
global workspace theory, albeit in a slightly different form. According to the global
workspace account, the answer to the question of why the neural basis of my
experience of red is the neural basis of a conscious experience is simply that it is
globally broadcast. But why is a globally broadcast representation conscious?
This is indeed a puzzle for the global workspace theory but it is not the
7
explanatory gap because it presupposes the global workspace theory itself,
whereas the explanatory gap (see above) does not.
The most neuroscience can do for us according to the global workspace
account is explain how a representation can be broadcast in the global
workspace, but the task will still remain of explaining why global broadcasting,
however realized, is conscious. In principle, global broadcasting could be
realized in an electronic system rather than a biological system, and of course
the same issue will arise. So that issue cannot be special to the biological
realization of mind.
The biological account, by contrast, fits the explanatory gap—indeed I
phrased the explanatory gap above in terms of the biological account, asking
how we can possibly understand how consciousness could be a biological
property. So the biological account is the only one of the three major theories to
fully acknowledge the explanatory gap. From the point of view of the HOT and
global workspace theories, their task concerning the explanatory gap is not to
show how they can accommodate it, but rather to explain away our impression
that there is one. One such attempt will be considered in the next section.
There is a fine line between acknowledging the explanatory gap and
surrendering to dualism, as also discussed in the next section.
The Explanatory Gap and Dualism
Dualism is the view that there is some aspect of the mind that is not
physical (Chalmers, 1996). It comes in many varieties, but the issues to be
discussed do not depend on any specific variety.
Let us start with a historical analogy (Nagel, 1974). A pre-Socratic
philosopher would have no way of understanding how heat could be a kind of
motion or of how light could be a kind of vibration. Why? Because the pre-
Socratic philosopher did not have the appropriate concepts of motion—namely
the concept of kinetic energy and its role–or of vibration—namely the concepts
involved in the wave theory of light–that would allow an understanding of how
such different concepts could pick out the same phenomenon.
What is a concept? A concept is a mental representation useable in
thought. We often have more than one concept of the same thing. The concept
light and the concept electromagnetic radiation of 400-700 nm pick out the same
phenomenon. What the pre-Socratic philosopher lacks is a concept of light and
an appropriate concept of vibration (one that requires a whole theory). What is
missing for the pre-Socratic is not just the absence of a theoretical definition but
a lack of understanding of what things are grouped together from a scientific
point of view. We now realize that ripples in a pond, sound and light are all
phenomena of the same kind: waves. And we now realize that burning, rusting
and metabolizing are all cases of oxidation (Churchland, 2002) but the pre-
Socratics, given their framework in which the basic categories were fire, earth, air
and water would have had no way to grasp these facts. One upshot is that if
super-scientists of the future were to tell us what consciousness is, we probably
8
would not have the conceptual machinery to understand, just as the pre-Socratic
would not have the conceptual machinery to understand that heat is a kind of
motion or that light is a kind of vibration.
Armed with this idea, we can see how to steer between the explanatory
gap and dualism. What we lack is an objective neuroscientific concept that
would allow us to see how it could pick out the same phenomenon as our
subjective concept of the experience of green. And we can expect that we don’t
even have the right subjective concept of the experience of green since we are
not sure what subjective phenomena truly should be grouped together. The
resolution of the apparent conflict between the explanatory gap and physicalism
is that subjectivity and objectivity can be seen as properties of concepts rather
than properties of the states that the concepts are concepts of. This idea, that
we can see arguments that apparently indicate ontological dualism, that is a
dualism of objects or substances or properties, as really an argument for
conceptual dualism, stems from Nagel 1974 and Loar (Loar, 1990/1997) and is
sometimes called “New Wave” physicalism. (See Horgan & Tienson, 2001).
Another way of seeing the point is to consider Jackson’s (1982) famous
thought experiment concerning Mary, a neuroscientist of the distant future who
knows everything there is to know about the scientific basis of color experience,
but grows up in a black and white environment. When she sees red for the first
time, she learns what it is like to see red, despite already knowing all the
scientific facts about seeing red. Does this show that the fact of what it is like to
see red is not a scientific fact? No, because we can think of what Mary learns in
terms of her acquiring a subjective concept of a state that she already had an
objective concept of. Imagine someone who already knows that Lake Michigan
is filled with H2O, but learns something new: that Lake Michigan is filled with
water. What this person learns is not a new fact but a new piece of knowledge,
involving a new concept, of a fact the person already knew. Similarly, Mary
acquires new knowledge, but that new knowledge does not go beyond the
scientific facts that she already knew about, and so does not support any kind of
dualism. (This line of thought is debated in (Block, 2006; White, 2006).
Importantly, this line of reasoning does not do away with the explanatory
gap but rather reconceives it as a failure to understand how a subjective and an
objective concept can pick out the same thing.
These points about different concepts of the same thing has sometimes
been used to try to dissolve the explanatory gap (Papineau, 2002). The idea is
that the false appearance of an explanatory gap arises from the gap between a
subjective concept of a phenomenally conscious state and an objective concept
of the same state. But note: I can think the thought that the color I am now
experiencing as I look at an orange (invoking a subjective concept of orange) is
identical to the color between red and yellow (invoking an objective concept of
orange). But this use of the two kinds of concepts engenders no explanatory
gap.
9
Thus far, the score is: biological theory 1, HOT and global workspace 0.
But the competition has not yet encountered the heartland of the HOT theory.
Consciousness-of
It is very often (but not always–(Dretske, 1993)) assumed that a conscious
state is a state that one is conscious of being in (Lycan, 1996a). I would agree,
though with the caution that the point may be a verbal one. The HOT theory has
an attractive of consciousness-of, because consciousness-of can be cashed out
as: being the object of a HOT. However, there are two other accounts of why a
conscious state is one that one is conscious of being in, and these accounts are
preferable to the HOT account—according to the viewpoint of the biological
theory and the global workspace theory. The deflationary account (Sosa, 2003)
says that all there is to being conscious of one’s experience is the triviality that in
having an experience, one experiences it, just as one smiles one’s smile and
dances one’s dance. Consciousness-of in this sense is to be firmly distinguished
from attending to one’s experience (Burge, 2006). One can have a conscious
experience of red and that experience can have whatever awareness comes with
conscious experience, even in the absence of top-down attention to it (Koch &
Tsuchiya, 2007). Another rival to the higher order account of why a conscious
state is one that one is conscious of is the same order account in which a
conscious pain is reflexive in that it is about itself. That is, it has a content that
turns back on itself, and that is what makes a pain a state one is conscious of.
This view had its beginnings in Aristotle (Caston, 2002) and was later pursued by
Brentano (1874/1973). (See Burge, 2006; Kriegel & Williford, 2006.) Either one
of the deflationary or same order accounts can be adopted by advocates of the
biological view and the global workspace view, so I see no real advantage for the
HOT view here.
Further Problems for the HOT Theory
I argued above that the HOT theory cannot recognize an explanatory gap,
but my argument was oversimple because it neglected a crucial distinction
between two types of HOT theories. The kind of HOT theory that cannot
recognize an explanatory gap is the ambitious HOT theory of phenomenal
consciousness that analyzes phenomenal consciousness in terms of higher order
thought. But there is also a modest and therefore innocuous form of the HOT
theory that just says that, in addition to phenomenal consciousness, there is
another kind of consciousness, higher order consciousness. Phenomenal
consciousness is one thing and higher order consciousness is another. The
modest form can recognize an explanatory gap for phenomenal consciousness.
The modest account is suggested by Lycan’s remark “ [I] cannot myself hear a
natural sense of the phrase ‘conscious state’ other than as meaning ‘state one is
conscious of being in” (Lycan, 1996b). As Lycan recognizes, what one can and
cannot “hear” leaves the theoretical options open. The modest account is
tantamount to a verbal claim—that there is a sense of the term ‘conscious’
(distinct from ‘phenomenal consciousness’) that has a higher order meaning—
and does not dictate that there is no explanatory gap. The very short argument
10
against the HOT theory (that it doesn’t recognize an explanatory gap and so is
false) is an argument only against the ambitious form of the HOT theory. In the
rest of this section, I will explain some other problems with the ambitious HOT
theory that also do not apply to the modest version.
The first thing to realize about the HOT theory in both the ambitious and
modest forms is it needs considerable qualification. Suppose I consciously infer
that I am angry from my angry behavior, or in a slightly different kind of case that
need not involve conscious inference: I am aware of my anger in noticing my
angry fantasies. In these cases we wouldn’t say the anger is thereby conscious.
Further, Freudians sometimes suppose that a subject can unconsciously
recognize his own desire to, for example, kill his father and marry his mother and
the need to cloak that desire in a form that won’t cause damage to the self. But
we would not say that in virtue of such an unconscious HOT (one that cannot
readily become conscious) about it, the desire is therefore conscious! These
examples concerning what we would say suggest that a HOT about a state is not
something we regard as sufficient for the state to be conscious. Defenders of the
HOT theory introduce complications in the HOT theory to try to avoid these
counterexamples. Rosenthal (2005a) says that S is a conscious state if and only
if S is accompanied by a thought to the effect that the subject is in S that is
arrived at without inference or observation of which the subject is conscious. The
italicized phrase avoids the problems posed by conscious observation of angry
fantasies and conscious inference by stipulating that HOTs arrived at by
conscious observation and inference are not sufficient for consciousness.
(Another stipulation that I won’t describe is supposed to handle the Freudian
issue.) Suppose as a result of biofeedback training I come to have noninferential
non-observational knowledge of states of my liver (Block, 1995).
Since we wouldn’t count the state of the liver as conscious in virtue of the HOT
about it, Rosenthal (2000b, p. 240) further stipulates that only mental states can
be conscious. What if I have a HOT about my future or past mental state?
Rosenthal (2000b, p. 241) further stipulates that if one has a thought about a
state, that makes it conscious only when one thinks of it as present to oneself.
As Bertrand Russell noted in an often quoted passage (1919, p. 71), “The
method of “postulating” what we want has many advantages; they are the same
as the advantages of theft over honest toil.“ Honest toil is not required if the HOT
view is understood as a modest account, since stipulation is not a problem in a
stipulated sense of a term, but ad hoc stipulation is a problem if we take the HOT
view as an ambitious account, especially as an empirical theory of
consciousness.
A second class of issues concerns the “mismatch problem”, the possibility
of a mismatch in content between a sensory representation and the
accompanying HOT. What phenomenally conscious quality does an experience
have if a HOT to the effect that one has a dull throbbing pain in the toe is
accompanied not by any representation of toe-damage but instead a visual
representation of red—or by no sensory representation at all? If the sensory
representation determines the conscious quality all by itself, the contents of
11
HOTs are irrelevant here and if here, why not elsewhere? And if the HOT
determines the conscious quality without the sensory representation, then the
contents of sensory representations are irrelevant—so what is the difference
between thinking you have a delightful experience and actually having one
(Balog, 2000; Byrne, 1997; Levine, 2001; Neander, 1998; Rey, 2000)? Of course
new sophistication in one’s HOTs, as when one learns to recognize different
wines can cause a corresponding differentiation in the sensory states that the
HOTs are about, but HOTs are not always causally self-fulfilling (If only!!!) and in
any case, causal self-fulfillment does not answer the constitutive question of what
the difference is between thinking you have an experience of a certain sort and
actually having one. Rosenthal (2000a, 2000b; 2005b, p. 217-219) claims that a
HOT is sufficient for a conscious state even without any sensory representation
that the HOT is about. But suppose I have a sharp pain that causes a HOT to
the effect that I have a sharp pain, through the normal processes via which pains
often cause metacognitions about them. And suppose that by chance I also
have a qualitatively different sharp pain (one pain is a bit sharper than the other)
that produces no HOT at all. The content of the HOT—that I have a sharp pain–
doesn’t distinguish between the two pains even though by any ordinary standard
it is about one of them but not the other. If the HOT theory follows common
sense, saying that one pain is conscious but the other is not, it is hard to see how
that (partly causal) way of cashing out aboutness could be compatible with the
claim that a HOT to the effect that I am in pain could be a conscious pain on its
own without any sensory representation.
A third class of issues concerns children. If you have seen and heard a
circumcision, you may find it difficult to doubt that it hurts. Relevant evidence:
newborns who are circumcised without anesthesia or analgesia are more
stressed by later vaccination even 6 months later (Taddio, Goldbach, Ipp,
Stevens, & Koren, 1995). My point is not that you should be totally convinced of
phenomenal consciousness in early infancy, but rather that you should be
convinced that there is a better case for phenomenal consciousness in infancy
than there is for those instances of phenomenal consciousness being
accompanied by higher order thought.
One point against higher order thought in infancy is that frontal cortex, the
likely neural home of thought about thought (Stone, Baron-Cohen, & Knight,
1998) is immature in infancy. Gazzaniga, Ivry, & Mangun (2002, p. 642-643)
discuss two sources of evidence that areas of the brain that specialize in sensory
and motor function develop significantly earlier than areas responsible for
thinking. One source of evidence derives from autopsy results on human brains
from age 28 weeks after conception to 59 years of age. The result, diagrammed
in Figure 2, is that auditory synaptic density peaks at about 3 months (and
probably likewise for synaptic density in other sensory areas), whereas the
association areas of the frontal cortex peak at about 15 months. Similar results
apply to PET imaging which measures glucose metabolism in different parts of
the brain.
12
As infants become more mature, our confidence in their phenomenal
consciousness increases, as does our confidence in their capacity for higher
order thought. However, it continues to be doubtful that phenomenally conscious
states are always accompanied by higher order thoughts. Children even up to
age 3-4 have difficulty thinking about their own states of mind. For example,
Alison Gopnik and her colleagues (Gopnik & Graf, 1988) used a tube that was
open at both ends and contained a window that could be open or closed. The
child would be asked to either look in the window or reach into the side and
identify a common object, e.g. a spoon. Then with the apparatus taken away, the
child was asked how he or she knew the spoon was in the tube. The children
were nearly random in their answers, probably because, as Gopnik has pointed
out in a series of papers (see Gopnik, 2007), they have difficulty attending to and
thinking about their own representational states. Marjorie Taylor and her
colleagues have compared “source amnesia” for representational states of mind
with skills (Esbensen, Taylor, & Stoess, 1997). For example, some children were
taught to count in Japanese, whereas other children were taught the Japanese
word for ‘three’. Children were much less likely to be able to name the source of
their representational state than the source of their counting skill. (E.g. “You just
taught me” in answer to the skill question vs. “I’ve always known” in answer to
the representational state question.) The source amnesia results apply most
directly to conscious intentional states rather than conscious perceptual states,
but to the extent that perceptual states are representational, they may apply to
them as well. Older autistic children who clearly have phenomenally conscious
states also have problems attending to and thinking about representational states
of mind (Baron-Cohen, 1995; Charman & Baron-Cohen, 1995). Will a defender
of the ambitious HOT theory tell us that these autistic children lack phenomenal
states? Or that contrary to the evidence they do have HOT states?
I emphasize that it is difficult for young children and autists to think about
representational states of mind—but not impossible. Indeed, children as young
as 13 months can exhibit some ability to track others’ beliefs (Onishi &
Baillargeon, 2005; Surian, Caldi, & Sperber, 2007). In the case of false belief, as
in many other examples of cognition, a cognitive achievement is preceded by a
highly modular and contextualized analog of it, one that partly explains the
development of the cognitive achievement. My point is not that meta-cognition in
all its forms is impossible in young children and autists but that at all ages, our
justification for attributing conscious states exceeds our justification for attributing
meta-cognitive states.
Although the empirical case against the higher order thought point of view
is far from overwhelming, it is strong enough to make the question salient of what
the advantages of the ambitious higher order thought theory of consciousness
actually are (as contrasted with the advantages of the modest version, which
none of these points apply to).
But how do we know whether a version of the HOT theory is ambitious or
modest? One way to tell is to ask whether on that theory, a phenomenally
conscious state—considered independently of any HOT about it–is something
13
that is bad or good in itself. For example, Carruthers famously claimed
(Carruthers, 1989, 1992) that because pains in dogs, cats, sheep, cattle, pigs
and chickens are not available to be thought about, they are not felt and hence
not anything to be concerned about, that is, they are states with no moral
significance. (Carruthers later took a different view (1999) on the ground that
frustration of animal desires is of moral significance even though the pains
themselves are not.)
I turn now to related issues about the self that may seem to go against the
biological view.
The Self
The biological view may seem at a disadvantage with respect to the self.
Since Hume (Hume, 1740/2003) described the self as “that connected
succession of perceptions”, many (Dennett, 1984; Parfit, 1984) have thought
about persons in terms of integrated relations among mental states. The global
workspace view seems well equipped to locate consciousness as self-related
given that broadcasting in the global workspace is itself a kind of integration.
And the HOT view at least requires the integration of one state being about
another. By contrast, it looks as if on many views of the biological basis of a
conscious state (Block, 1995), it could exist without integration, and this point has
resulted in accusations of scanting the self (Church, 1995; Harman, 1995;
Kitcher, 1995). One response would be to favor a biological neural basis of
consciousness that itself involves integration (Tononi & Edelman, 1998; Tononi &
Koch, 2008). But it is worth pointing out that phenomenal consciousness has
less to do with the self than critics often suppose.
What is the relation between phenomenal consciousness and the self?
We could raise the issue by thinking about pain asymbolia, a syndrome in which
patients have pain experiences without the usual negative affect (Aydede, 2005):
they don’t seem to mind the pain. In this syndrome, patients sometimes describe
the pains as painful for someone else, and perhaps they are right given pain’s
unusual lack of connection to the subject’s emotions, planning and valuation.
Here is a question about such a dissociation syndrome: If such a subject thinks
about the painfulness of such a pain (as opposed to its merely sensory aspect),
is the painfulness thereby phenomenally conscious? It would seem not,
suggesting that the kind of integration supplied by HOTs is not actually sufficient
for consciousness.
Here is another conundrum involving the relation between phenomenal
consciousness and the self. In many experiments, activation in the fusiform face
area at the bottom of the temporal lobe has been shown to correlate with the
experience of a face. Now, injury to the parietal lobe often causes a syndrome
called visuo-spatial extinction. If the patient sees a single object, the patient can
identify it, but if there are objects on both the right and the left, the patient claims
not to see one—most commonly the one on the left. However two fMRI
studies(G. Rees et al., 2000; G. Rees, Wojciulik. et al., 2002) have shown that in
patient GK, when GK claims not to see a face on the left, his fusiform face area
14
lights up almost as much as when he reports seeing the face. One possibility is
that the original identification of the fusiform face area as the neural basis of face
experience was mistaken. But another possibility is that the subject genuinely
has face experience that he doesn’t know about and cannot know about. Wait—
is that really a possibility? Does it even make sense to suppose that a subject
could have an experience that he doesn’t and can’t know about? What would
make it his experience?
The question about GK can be answered by thinking about the subject’s
visual field? What is the visual field? We could define the visual field as the
subject’s visual representation of space. Consider how the visual field is
measured. If you look straight ahead and hold a rod out to the side and slowly
move it forward, you will be able to see it at roughly 100o from the forward angle.
If you do the same coming down from the top, you will see it at roughly 60o, and if
you do it from the bottom, you will see it at roughly 75o. A more accurate
mesurement can be obtained with points of light or gratings. It turns out that the
normal visual field (in the sense of the cross-section of the space represented) is
an oval, elongated to the right and left, and slightly larger on the bottom. The
Humphrey Field Analyzer HFA-II-I can measure your visual field in as little as 2
minutes. The United Kingdom has a minimum visual field requirement for driving
(60o to the side, 20o above and below); US states vary widely in their
requirements (Peli & Peli, 2002). I mention these details to avoid skepticism
about whether the visual field is real.
The visual field can help us think about GK. If GK does genuinely
experience the face on the left that he cannot report, then it is in his visual field
on the left side, and as such has relations to other items in his visual field, some
of which he will be able to report. The fact that it is his visual field shows that it is
his experience. I caution the reader that this discussion concerns the issue of
whether it makes sense to describe GK as having an experience that he can’t
know about and does not constitute any evidence for his actually having an
experience that he can’t know about (but see Block, 2007a).
A second point about the relation between phenomenal consciousness
and the self is that self-related mental activities seem inhibited during intense
conscious perception. Malach and his colleagues (Goldberg, Harel, & Malach,
2006) showed subjects pictures and audio clips with two different types of
instructions. In one version, subjects were asked to indicate their emotional
reactions as positive, negative or neutral. In another version (in which the stimuli
were presented much faster), subjects were asked to categorize the stimuli, for
example, as animals or not. Not surprisingly, subjects rated their self-awareness
as high in the introspective task and low in the categorization task. And this
testimony was supported by fMRI results that showed that the introspective task
activated an “intrinsic system” that is linked to judgments about oneself whereas
the categorization task inhibited the intrinsic system, activating instead an
extrinsic system that is also activated when subjects viewed clips from Clint
Eastwood’s “The Good, the Bad and the Ugly”. Of course this result does not
show that intense perceptual experiences are not part of a connected series of
15
mental states constituting a self, but it does suggest that theories that bring any
sense of self into phenomenal experience are wrongheaded. Malach’s result
disconfirms the claim that a conscious visual experience consists in a perceptual
state causing a thought to the effect that I myself have a visual experience
(Rosenthal, 2005a).
Machine Consciousness
The global workspace account lends itself particularly well to the idea of
machine consciousness. There is nothing intrinsically biological about a global
workspace. And the HOT view also is friendly to machine consciousness. If a
machine can think, and if it can have representational contents, and if it can think
about those contents, it can have conscious states, according to the HOT view.
Of course we do not know how to make a machine that can think, but whatever
difficulties are involved in making a machine think, they are not difficulties about
consciousness per se. (However, see Searle (1992) for a contrary view.) By
comparison, the biological theory says that only machines that have the right
biology can have consciousness, and in that sense, the biological account is less
friendly to machine consciousness. Information is coded in neurons by electrical
activations that travel from one part of a neuron to another, but in the most
common type of transfer of information between neurons, that electrical coding is
transformed into a chemical coding (via neurotransmitters) which transfer the
information to another neuron where the coding of information is again electrical.
On the biological view, it may well be that this transfer of coding of information
from electrical to chemical and back to electrical is necessary to consciousness.
Certainly it would be foolish to discount this possibility without evidence.
As should be apparent, the competitors to the biological account are
profoundly non-biological, having more of their inspiration in the computer model
of the mind of the 1960s and 1970s than in the age of the neuroscience of
consciousness of the 21st Century. (For an example, see McDermott, 2001.) As
Dennett (2001, p. 234) confesses, “The recent history of neuroscience can be
seen as a series of triumphs for the lovers of detail. Yes, the specific geometry of
the connectivity matters; yes, the location of specific neuromodulators and their
effects matter; yes, the architecture matters; yes, the fine temporal rhythms of the
spiking patterns matter, and so on. Many of the fond hopes of opportunistic
minimalists [a version of computationalism: NB] have been dashed: they had
hoped they could leave out various things, and they have learned that no, if you
leave out x, or y, or z, you can’t explain how the mind works.” Although Dennett
resists the obvious conclusion, it is hard to avoid the impression that the biology
of the brain is what matters to consciousness—at least the kind we have–and
that observation favors the biological account.1
16
Figure 1 Schematic diagram of the global workspace. Sensory activations in
the back of the brain are symbolized by dots and lines in the outside group of
rings. Dominant sensory neural coalitions (dark lines and dots) compete with
one another to trigger reverberatory activity in the global workspace (located in
frontal areas) in the center of the diagram. The reverberatory activity in turn
maintains the peripheral excitation until a new dominant coalition wins out.
Figure 2
17
Relative synaptic density of auditory and frontal cortex. Conceptual age is age
from conception. The peak at the left of roughly 3 months (postnatal) reflects a
high number of auditory synapses relative to frontal synapses. From (Gazzaniga
et al., 2002)
References
Alkire, M. T. (2008). General Anesthesia and Consciousness. In S. Laureys
(Ed.), The Neurology of Consciousness: Cognitive Neuroscience and
Neuropathology. Amsterdam: Elsevier.
Alkire, M. T., Haier, R. J., & Fallon, J. H. (2000). Toward a unified theory of
narcosis: Brain imaging evidence for a thalamocortical switch as the
neurophysiologica basis of an anesthetic-induced unconsciousness.
Consciousness and Cognition, 9(3), 370-386.
Alkire, M. T., & Miller, J. (2005). General anesthesia and the neural correlates of
consciousness. Progress in Brain Research, 150, 229-244.
Armstrong, D. M. (1978). What is Consciousness? Proceedings of the Russellian
Society, 3, 65-76.
Aydede, M. (2005). A critical and quasi-historical essay on theories of pain. In M.
Aydede (Ed.), Pain: New Essays on its Nature and the Methodology of its Study:
MIT Press.
Baars, B. (1988). A Cognitive Theory of Consciousness. Cambridge, UK:
Cambridge University Press.
Balog, K. (2000). Phenomenal Judgment and the HOT Theory: Comments on
David Rosenthal’s “Consciousness, Content and Metacognitive Judgments”.
Consciousness and Cognition, 9(2), 215-218.
Baron-Cohen, S. (1995). Mindblindness. Cambridge, MA: MIT Press.
Block, N. (1978). Troubles with functionalism. Minnesota Studies in the
Philosophy of Science, 9, 261-325.
Block, N. (1980). What is Functionalism? In N. Block (Ed.), Readings in the
Philosophy of Psychology (pp. 171-184). Cambridge MA: Harvard University
Press.
Block, N. (1995). On a confusion about a function of consciousness. Behavioral
and Brain Sciences, 18(2), 227-247.
Block, N. (2006). Max Black’s Objection to Mind-Body Identity. Oxford Studies in
Metaphysics II, 3-78.
Block, N. (2007a). Consciousness, accessibility, and the mesh between
psychology and neuroscience. Behavioral and Brain Sciences, 30, 481-548.
Block, N. (2007b). Overflow, access and attention. Behavioral and Brain
Sciences, 30, 530-542.
Brentano, F. (1874/1973). Psychology from an Empirical Standpoint (A.
Rancurello, D. B. Terrell & L. L. McAlister, Trans.). London: Routledge and
Kegan Paul.
18
Britten, K. H., Shadlen, M. N., Newsome, W. T., & Movshon, A. (1992). The
analysis of visual motion: A comparison of neuronal and psychophysical
performance. Journal of Neuroscience, 12, 4745-4765.
Burge, T. (2006). Reflections on Two Kinds of Consciousness. In Philosophical
Essays, Volume II: Foundations of Mind (pp. 392-419). New York: Oxford
University Press.
Byrne, A. (1997). Some Like it HOT: consciousness and higher-order thoughts.
Philosophical Studies, 86, 103-129.
Byrne, A. (2001a). Intentionalism Defended. The Philosophical Review, 110, 199-
240.
Byrne, A. (2001b). Review of Carruthers’ Phenomenal Consciousness. Mind,
110, 1057-1062.
Carruthers, P. (1989). Brute Experience. Journal of Philosophy, 86, 258-269.
Carruthers, P. (1992). The Animals Issue: Moral Theory in Practice. Cambridge:
Cambridge University Press.
Carruthers, P. (1999). Sympathy and Subjectivity. Australasian Journal of
Philosophy, 77(1999), 465-482.
Carruthers, P. (2000). Phenomenal Consciousness: A Naturalistic Theory.
Cambridge: Cambridge University Press.
Caston, V. (2002). Aristotle on Consciousness. Mind, 111(444), 751-815.
Chalmers, D. (1996). The Conscious Mind: In Search of a Fundamental Theory:
Oxford University Press.
Charman, T., & Baron-Cohen, S. (1995). Understanding models, photos and
beliefs: a test of the modularity thesis of metarepresentation. Cognitive
Development, 10, 287-298.
Church, J. (1995). Fallacies or Analyses? Behavioral and Brain Sciences, 18(2),
251-252.
Churchland, P. (2002). Brain-Wise: Studies in Neurophilosophy. Cambridge MA:
MIT Press.
Cowey, A., & Walsh, V. (2000). Magnetically induced phosphenes in sighted,
blind and blindsighted subjects. Neuroreport, 11, 3269-3273.
Crane, T. (2000). The origins of qualia. In T. Crane & S. Patterson (Eds.), History
of the Mind-Body Problem (pp. 169-194). New York: Routledge.
Crick, F. (1994). The Astonishing Hypothesis. New York: Scribners.
Crick, F., & Koch, C. (1990). Towards a neurobiological theory of consciousness.
Seminars in the Neurosciences, 2, 263-275.
Crick, F., & Koch, C. (1998). Consciousness and neuroscience. Cerebral Cortex,
8, 97-107.
Curtis, C., & D’Esposito, M. (2003). Persistent activity in the prefrontal cortex
during working memory. Trends in Cognitive Sciences, 7(9), 415-423.
Damasio, A., & Meyer, K. (2008). Behind the looking-glass. Nature, 454, 167-
168.
Dehaene, S., Changeux, J.-P., Nacchache, L., Sackur, J., & Sergent, C. (2006).
Conscious, preconscious, and subliminal processing: a testable taxonomy.
Trends in Cognitive Sciences, 10, 204-211.
19
Dennett, D. C. (1984). Elbow Room: The Varieties of Free Will Worth Wanting:
MIT Press.
Dennett, D. C. (2001). Are we explaining consciousness yet. Cognition, 79, 221-
237.
Dretske, F. (1993). Conscious Experience. Mind, 102(263-283).
Esbensen, B. M., Taylor, M., & Stoess, C. J. (1997). Children’s behavioral
understanding of knowledge acquisition. Cognitive Development, 12, 53-84.
Feigl, H. (1958). The `mental’ and the `physical’. Minnesota Studies in the
Philosophy of Science, 2, 370-497.
Gallistel, C. R. (1998). Insect navigation: Brains as symbol-processing organs. In
D. Scarborough & S. Sternberg (Eds.), Methods, models and conceptual issues:
Vol. 4 of An Invitation to Cognitive Science, second edition (Vol. 4). Cambridge:
MIT Press.
Gazzaniga, M., Ivry, R., & Mangun, G. (2002). Cognitive Neuroscience: The
Biology of the Mind. New York: W. W. Norton.
Goldberg, I. I., Harel, M., & Malach, R. (2006). When the Brain Loses Its Self:
Prefrontal Inactivation during Sensorimotor Processing. Neuron, 50, 329-339.
Gopnik, A. (2007). Why babies are more conscious than we are. Behavioral and
Brain Sciences, 30(5), 503-504.
Gopnik, A., & Graf, P. (1988). Knowing how you know: Children’s understanding
of the sources of their knowledge. Child Development, 59, 1366-1371.
Harman, G. (1995). Phenomenal fallacies and conflations. Behavioral and Brain
Sciences, 18(2), 256-257.
Heeger, D. J., Boynton, G. M., Demb, J. B., Seideman, E., & Newsome, W. T.
(1999). Motion opponency in visual cortex. Journal of Neuroscience, 19, 7162-
7174.
Hobbes, T. (1989). Metaphysical Writings of Thomas Hobbes. LaSalle, IL: Open
Court.
Horgan, T., & Tienson, J. (2001). Deconstructing New Wave Materialism. In C.
Gillett & B. Loewer (Eds.), Physicalism and its discontents. New York: Cambridge
University Press.
Huk, A. C., Ress, D., & Heeger, D. J. (2001). Neuronal basis of the motion
aftereffect reconsidered. Neuron, 32, 161-172.
Hume, D. (1740/2003). A Treatise of Human Nature. New York: Dover.
Jackson, F. (1982). Epiphenomenal Qualia. American Philosophical Quarterly,
32, 127-136.
Kammer, T. (1999). Phosphenes and transient scotomas induced by magnetic
stimulation of the occipital lobe: their topographic relationship. Neuropsychologia,
37, 191-198.
Kanwisher, N. (2001). Neural events and perceptual awareness. Cognition, 79,
89-113.
Kirk, G. S., Raven, J. E., & Schofield, M. (1983). The Presocratic Philosophers
(Vol. Second Edition). Cambridge: Cambridge University Press.
Kitcher, P. (1995). Triangulating phenomenal consciousness. Behavioral and
Brain Sciences, 18(2), 266-167.
20
Koch, C. (2004). The Quest for Consciousness: A Neurobiological Approach.
Englewood, Colorado: Roberts and Company.
Koch, C., & Tsuchiya, N. (2007). Attention and consciousness: two distinct brain
processes. Trends in Cognitive Sciences, 11, 16-22.
Kourtzi, Z., & Kanwisher, N. (2000). Activation in human MT/MST by static
images with implied motion. Journal of Cognitive Neuroscience, 12, 48-55.
Kriegel, U., & Williford, K. (2006). Self-Representational Approaches to
Consciousness. Cambridge, MA: MIT Press.
Lamme, V. (2003). Why visual attention and awareness are different. Trends in
Cognitive Sciences, 7, 12-18.
Laureys, S. (2005). The neural correlate of (un)awareness: lessons from the
vegetative state. Trends in Cognitive Sciences, 9(2), 556-559.
Levine, J. (1983). Materialism and Qualia: the Explanatory Gap. Pacific
Philosophical Quarterly, 64, 354-361.
Levine, J. (2001). Purple Haze: The Puzzle of Consciousness. Oxford and New
York: Oxford University Press.
Loar, B. (1990/1997). Phenomenal States. In N. Block, O. Flanagan & G.
Güzeldere (Eds.), The Nature of Consciousness: Philosophical Debates (pp.
597-616). Cambridge MA: MIT Press.
Lycan, W. G. (1996a). Consciousness and Experience. Cambridge, MA: MIT
Press.
Lycan, W. G. (1996b). Consciousness as Internal Monitoring. In N. Block, O.
Flanagan & G. Güzeldere (Eds.), The nature of consciousness: Philosophical
and scientific debates (pp. 755-772). Cambridge MA: MIT Press.
Macknik, S. L., & Martinez-Conde, S. (2007). The role of feedback in visual
masking and visual processing. Advances in Cognitive Psychology, 3(1-2), 125-
152.
McDermott, D. (2001). Mind and Mechanism. Cambridge, MA: MIT Press.
McGinn, C. (1991). The Problem of Consciousness. Oxford: Oxford University
Press.
Naccache, L., & Dehaene, S. (2007). Reportability and illusions of phenomenality
in the light of the global neuronal workspace model. Behavioral and Brain
Sciences, 30, 518-519.
Nagel, T. (1974). What Is it Like to Be a Bat? The Philosophical Review,
LXXXIII(4), 435-450.
Neander, K. (1998). The Division of Phenomenal Labor: A Problem for
Representational Theories of Consciousness. Philosophical Perspectives, 12,
411-434.
Onishi, K. H., & Baillargeon, R. (2005). Do 15-month old infants understand false
beliefs? Science, 308, 255-258.
Papineau, D. (2002). Thinking about Consciousness. New York: Oxford
University Press.
Parfit, D. (1984). Reasons and Persons. Oxford: Oxford University Press.
Pascual-Leone, A., & Walsh, V. (2001). Fast backprojections from the motion to
the primary visual area necessary for visual awareness. Science, 292, 510-512.
21
Peli, E., & Peli, D. (2002). Driving with confidence: a practical guide to driving
with low vision. Singapore: World Scientific Publishing Company.
Place, U. T. (1956). Is consciousness a brain process? British Journal of
Psychology, 47, 44-50.
Prinz, J. J. (2007). Accessed, accessible, and inaccessible: Where to draw the
phenomenal line. Behavioral and Brain Sciences, 30, 521-522.
Rees, G., Kreiman, G., & Koch, C. (2002). Neural correlates of consciousness in
humans. Nature Reviews Neuroscience, 3, 261-270.
Rees, G., Wojciulik., E., Clarke, K., Husain, M., Frith, C., & Driver, J. (2000).
Unconscious activations of visual cortex in the damaged right-hemisphere of a
parietal patient with extinction. Brain, 123(8), 1624-1633.
Rees, G., Wojciulik., E., Clarke, K., Husain, M., Frith, C., & Driver, J. (2002).
Neural correlates of conscious and unconscious vision in parietal extinction.
Neurocase, 8, 387-393.
Rey, G. (2000). Role, Not Content: Comments on David Rosenthal’s
‘Cosnciousness, Content and Metacognitive Judgments”. Consciousness and
Cognition, 9(2), 224-230.
Rosenberg, G. (2004). A Place for Consciousness: Probing the Deep Structure of
the Natural World. New York: Oxford University Press.
Rosenthal, D. (2000a). Consciousness, Content and Metacognitive Judgments.
Consciousness and Cognition, 9(2), 203-214.
Rosenthal, D. (2000b). Metacognition and Higher-Order Thoughts.
Consciousness and Cognition, 9(2), 231-242.
Rosenthal, D. (2005a). Consciousness and Mind. New York: Oxford University
Press.
Rosenthal, D. (2005b). Sensory Qualities, Consciousness and Perception. In
Consciousness and Mind (pp. 175-226). Oxford: Oxford University Press.
Russell, B. (1919). Introduction to Mathematical Philosophy. New York and
London: Routledge.
Schneider, G., & Kochs, E. F. (2007). The search for structures and mechanisms
controlling anesthesia-induced unconsciousness. Anesthesiology, 107(2), 195-
198.
Searle, J. (1992). The Rediscovery of the Mind. Cambridge, MA: MIT Press.
Sergent, C., & Rees, G. (2007). Conscious access overflows overt report.
Behavioral and Brain Sciences, 30, 523-524.
Siegel, S. (2008). The Contents of Perception. In E. N. Zalta (Ed.), The Stanford
Encyclopedia of Philosophy: URL =
<http://plato.stanford.edu/archives/fall2008/entries/perception-contents/>.
Silvanto, J., Cowey, A., Lavie, N., & Walsh, V. (2005). Striate cortex (V1) activity
gates awareness of motion. Nature Neuroscience, 8(2), 143-144.
Smart, J. J. C. (1959). Sensations and brain processes. Philosophical Review,
68, 141-156.
Sosa, E. (2003). Privileged access. In Q. Smith & A. Jokic (Eds.),
Consciousness: New Philosophical Perspectives. Oxford: Oxford University
Press.
22
Stone, V. E., Baron-Cohen, S., & Knight, R. T. (1998). Frontal Lobe Contributions
to Theory of Mind. Journal of Cognitive Neuroscience, 10(5), 640-656.
Surian, L., Caldi, S., & Sperber, D. (2007). Attribution of beliefs by 13-month-old
infants. Psychological Science, 18(7), 580-586.
Taddio, A., Goldbach, M., Ipp, M., Stevens, B., & Koren, G. (1995). Effect of
neonatal circumcision on pain responses during vaccination in boys. The Lancet,
345(8945), 291-292.
Théoret, H., Kobayashi, M., Ganis, G., Di Capua, P., & Pascual-Leone, A.
(2002). Repetitive Transcranial Magnetic Stimulation of Human Area MT/V5
Disrupts Perception and Storage of the Motion Aftereffect. Neuropsychologia,
40(13), 2280-2287.
Tononi, G., & Edelman, G. M. (1998). Consciousness and complexity. Science,
282, 1846-1851.
Tononi, G., & Koch, C. (2008). The Neural Correlates of Consciousness: An
Update. Annals of the New York Academy of Sciences, 1124, 239-261.
Tye, M. (2000). Consciousness, Color, and Content: MIT Press.
Velly, L., Rey, M., Bruder, N., Gouvitsos, F., Witjas, T., REgis, J., et al. (2007).
Differential dynamic of action on cortical and subcortical structures of anesthetic
agents during induction of anesthesia. Anesthesiology, 107(2), 202-212.
White, S. (2006). A Posteriori Identities and the Requirements of Rationality.
Oxford Studies in Metaphysics, II, 91-102.
Zihl, J., von Cramon, D., & Mai, N. (1983). Selective disturbance of movement
vision after bilateral brain damage. Brain, 106, 313-340.
1 Acknowledgements: I am grateful to Susan Carey, Peter Carruthers, Christof Koch,
David Rosenthal and Stephen White for comments on an earlier version.

INTRODUCTION

The inclusion for the first time of a chapter on the neuropsychopharmacology of the personality disorders in the “ACNP Generation of Progress” series reflects the increasing appreciation of underlying neurobiologic substraits for these disorders and the value of targeted psychopharmacologic treatment. The personality disorders, located on Axis II in DSM-III-R and DSM-IV, consist of constellations of enduring or persistent maladaptive traits and/or symptoms that are characteristic of the way an individual experiences and interacts with his/her environment. In contrast with the Axis I disorders, which are primarily symptom-oriented and wax and wane in severity (often in episodic fashion), the Axis II personality disorders are conceived to be characteristic of an individual throughout his lifetime. This conceptual distinction between the Axis I and II disorders, while heuristically useful, is becoming increasingly blurred because studies into the neuropsychopharmacology of personality disorder suggest that enduring traits reflect underlying biologic variations that may be amenable to alteration with psychopharmacologic treatment. While some have argued that these considerations argue for the abolition of Axis II, the separation of these disorders on Axis II has highlighted the fact that traits considered to be part of an individual’s stable personality can be substantially impacted by psychopharmacologic treatment.

While the DSM-III and III-R represented a significant advance over DSM-II in the identification of specific categories of personality disorder, many of these categories were found to be overlapping and have yet to be validated by external validators. By the advent of DSM-IV, validating antecedents and correlates in both biologic and psychosocial arenas have been found for some of the personality disorders, particularly schizotypal and borderline personality disorder. The total number of these disorders has been reduced from 11 to 10, and criteria have been sharpened with no major changes in the constructs (see Introduction to Clical Neuropsychopharmacology).

Because the categories are highly overlapping and describe a range of interpersonal, attitudinal, and more fundamental psychologic traits, neurobiologic and psychopharmacologic approaches to the personality disorders can also be organized around “dimensional” or “cluster” approaches to the personality disorders that may cross categorical boundaries. DSM-III and DSM-III-R was organized for heuristic purposes into clusters: the “odd” cluster, the “dramatic” cluster, and the “anxious” cluster. These clusters also may be mapped into dimensions of cognitive disorganization for the “odd” cluster, impulsivity and affective instability for the “dramatic” cluster, and anxiety for the “anxious” cluster (53). Cognitive organization refers to the capacity of an individual to attend to and select relevant information from the environment, organize it in relation to past experience, and formulate appropriate strategies to interact with the environment. Impairment in this dimension ranges from the chronic psychosis of schizophrenia, where perception of reality is markedly distorted, to the psychotic-like symptoms of schizotypal personality disorder and perhaps even to more subtle deficits in interpretation of social cues. Impulsivity, which is characteristic of borderline, histrionic, and antisocial personality disorders, may be defined as a lowered threshold for motoric action, particularly aggressive behavior, in response to environmental stimuli. Individuals with a tendency toward impulsivity tend to externalize their problems and overreact to environmental events. Affective-related symptoms are another dimension prominent in the “dramatic” cluster personality disorders. Affective instability is a criterion of borderline personality disorder and may be observed in histrionic and narcissistic personality disorders as well. Individuals with affective instability are characterized by rapidly occurring shifts in affect, changing from anger to disappointment to excitement in a matter of hours or minutes. These affective shifts are exquisitely sensitive to shifts in the environment, such as separation or frustration. Finally, anxiety thresholds vary between individuals. Individuals with high anxiety have a greater readiness to anticipate punishment or aversive consequences of their behavior and often show concomitant autonomic arousal associated with their fearfulness. They may inhibit a variety of behaviors they perceive as potentially assertive or competitive, fearing the consequences of their behavior. While a number of psychometric dimensional schema exist for the personality disorders, emerging evidence supports a biologic underpinning to these clinically based dimensions, which also may constitute target symptoms for psychopharmacologic intervention.

In this review, the available evidence regarding the biology of the personality disorders, particularly because they have implications for psychopharmacologic treatment, will be presented in relation to each of these target symptom dimensions, which may overlap with specific disorders. Most pharmacologic studies have focused on patients with specific personality disorders, such as borderline or schizotypal personality disorder, and have evaluated changes in target domains of psychosis, affect, anxiety, or impulsivity. Thus, both syndromal and dimensional considerations will be discussed. It should be noted, however, that there are few placebo-controlled pharmacologic trials in patients with well-characterized personality disorders. Therefore, the conclusions presented in this chapter must be considered tentative at this time. Accordingly, we will highlight trends in the data, both biologic and pharmacologic, and present possible future directions for research in the clinical psychopharmacologic management of patients with personality disorders.

PSYCHOBIOLOGY OF PSYCHOTIC-LIKE SYMPTOMS

The schizophrenia-related personality disorders of DSM-III and DSM-IV include schizotypal, paranoid, and schizoid personality disorders. Of these, schizotypal personality disorder is the best characterized and the most severe of the schizophrenia-related personality disorders, and it is the most closely related to schizophrenia biologically, phenomenologically, and genetically (53). In addition to psychotic-like symptoms, patients with schizotypal personality disorder also manifest social detachment and other deficit-related symptoms. Initial hypotheses centered around defining similarities between schizotypal personality disorder patients and schizophrenic patients in these domains, whereas more recent studies have pursued more specific correlates (particularly in the psychotic-like and deficit-like symptom complexes) of underlying psychopathologic processes in schizotypal personality disorder to better understand the fundamental pathophysiologic processes of the schizophrenia-related disorders (53).

Psychotic-like symptoms in these personality disorders include magical thinking, ideas of reference, and perceptual distortions and are some of the most discriminating criteria for clinically identified schizotypal personality disorder patients. Because psychotic symptoms in the schizophrenic disorders have been linked to excessive dopaminergic activity, most studies have explored this hypothesis in order to understand the biologic underpinnings of psychosis proneness in these individuals. The “dopamine hypothesis” of schizophrenia was stimulated by (a) the observation that antipsychotic medications had potent dopamine antagonist properties that correlate with their therapeutic efficacy (34) and (b) the observation of psychotogenic effects of dopamine-releasing agents such as amphetamine when administered over long periods of time. While studies measuring the dopamine metabolite homovanillic acid (HVA) in cerebrospinal fluid (CSF) in schizophrenic patients and comparing them with controls have been inconsistent (69), there are suggestions of increases in some paranoid subtypes and decreases associated with deficit-like symptoms (52). However, current hypotheses regarding the dopaminergic system in schizophrenia might suggest hypodopaminergia in frontal cortical areas and hyperdopaminergia in subcortical areas. However, indices of dopaminergic activity such as CSF and plasma HVA depend on contributions from multiple brain regions and the periphery, making interpretations of these measures problematic.

The study of schizotypal patients affords an opportunity to disentangle these two processes. Both CSF and plasma HVA levels are greater in clinically selected schizotypal patients than in normal and other personality disorder controls, specifically associated with the psychotic-like symptoms of schizotypal personality disorder (51, 52). In schizotypal relatives of schizophrenic patients, characterized more by deficit-like symptoms, plasma HVA is reduced compared to relatives of nonschizotypal relatives (Amin et al., 1993, unpublished data).

PSYCHOPHARMACOLOGY OF PSYCHOTIC-LIKE SYMPTOMS

These considerations imply that the psychotic-like symptoms of the schizophrenia-related personality disorders may be ameliorated by neuroleptics and worsened by psychostimulants such as amphetamine. In one study of borderline/schizotypal patients, amphetamine induced psychotic-like symptoms, particularly in those patients with a schizotypal personality disorder diagnosis (48). In clinical psychopharmacologic trials, neuroleptic treatment has generally been associated with global improvement in patients with borderline and/or schizotypal personality disorder (7). In two relatively large placebo-controlled trials in patients with borderline and/or schizotypal personality disorder, psychotic-like symptoms (as well as symptoms of anxiety) were reduced by treatment with a neuroleptic (thiothixene in ref. 17, haloperidol in ref. 57). The generalizability of the data from one trial may be limited, however, to personality-disordered patients with histories of brief transient psychotic-like symptoms prior to the start of the trial. A smaller study involving only females with severe borderline personality disorder found only modest efficacy for the neuroleptic (trifluroperizine) over placebo. While these data are in general agreement with those of several other studies involving neuroleptic treatment in personality-disordered patients, the most recent study found no efficacy for the neuroleptic (haloperidol) on psychotic-like symptoms in borderline and/or schizotypal personality-disordered patients (56). The authors noted, however, that the patients in their previous study, where haloperidol had been efficacious in treating psychotic-like symptoms, had significantly higher ratings of “psychoticism,” “schizotypal symptom severity,” and “global impairment” than in the more recent study. In conjunction with the finding that “severity of schizotypal symptoms” was a favorable predictor of response to thiothixine (17), these results suggest that low-dose neuroleptic treatment may be best indicated for moderately to severely impaired patients with prominent histories of psychotic-like schizotypal symptoms.

PSYCHOBIOLOGY OF DEFICIT SYMPTOMS

The social detachment in interpersonal isolation of the schizophrenia spectrum personality disorders may be rooted in biologic processes impairing cortical processing of complex interpersonal cues as well as deficits in attachment behavior. Interpersonal relationships depend on selecting appropriate information and cues from other people and synchronizing one’s responses in a reciprocal interaction. These interactional patterns might be set down in infancy and may be disrupted when there is neurologic immaturity on the part of the developing infant (53). Offspring of schizophrenic patients show pandevelopmental immaturities, raising the possibility that the diathesis to the schizophrenic disorders may impair the development of mutually satisfying interactions (53). A variety of studies implicate deficits in information processing, neuropsychological, and psychophysiologic tasks in the schizophrenia-related personality disorders, as in schizophrenia. These are often particularly associated with the deficit-like symptoms of the schizophrenic spectrum personality disorders and have been hypothesized to be related to alterations in brain structure (53a). The cognitive impairment seems to be associated with decreased indices of dopaminergic activity, consistent with the notion that adequate dopaminergic tone, particularly at D1 receptors in frontal cortical areas, may be necessary for the integrity of working memory and other executive cognitive functions. Preliminary evidence supporting this hypothesis comes from psychophysiologic, neuropsychologic, and imaging studies (53a).

Impaired eye movements tracking a smoothly moving target is one of the most consistent findings in the schizophrenia-related disorders. Abnormalities in smooth pursuit tracking are seen in schizophrenic patients and in schizotypal personality-disordered patients. Eye-tracking impairment is specifically associated with the “deficit-like” traits of schizotypal personality disorder (53).

In addition, patients with schizotypal personality disorder show abnormalities and other attentional tasks. These include the Continuous Performance Task (CPT) and the Backward Masking Task (BMT). The CPT is a test of sustained attention that involves identifying target stimuli from a continually presented array. Poor performance on the CPT has been observed in studies of schizotypal volunteers, patients, and offspring of schizophrenic patients (53a) and is correlated with social detachment in offspring of schizophrenic patients (12). The BMT is a visual information processing task which has also been reported to be abnormal in patients with schizotypal personality disorders as well as in volunteers selected because of their schizotypal traits (36). Abnormalities in electroencephalographic (EEG) responses to an unexpected stimuli provide a measure of brain responses to an attentional paradigm. Such evoked potential studies suggest alterations in a positive wave at 300 msec following a stimulus (P300) in schizotypal volunteers and patients similar to those demonstrated in schizophrenic patients. Abnormalities in galvanic skin orienting response and visual reaction time similar to that observed in schizophrenic patients also suggest altered information processing in schizotypal individuals (53a).

Imaging studies suggest that there may be increased ventricular size in the schizophrenia-related personality disorders (5). In one study, lateral ventricles were enlarged (particularly on the left side), and enlargement of the frontal horn and ventricle was associated with impaired performance on the Wisconsin Card Sort Test. In contrast, no such abnormalities have been found in patients with borderline personality disorder (53a). In exploratory analyses, increased ventricular size was associated with reduced concentrations of plasma HVA and deficit-like symptoms (53a), raising the possibilities that frontal cortical impairment may be associated with increased ventricular size and hypodopaminergia in this area. Also consistent with this possibility are magnetic resonance imaging (MRI) studies suggesting reduced frontal size correlated with schizotypal traits in volunteer subjects (44).

Schizotypal personality disorder patients or volunteers, like schizophrenic patients, also demonstrate impaired performance on tests sensitive to prefrontal function, including the Wisconsin Card Sort Test (WCST) (44, 53a). On the other hand, performance on the verbal fluency test and Wechsler Adult Intelligence Scale (WAIS) vocabulary and block design that does not significantly differ from normal controls suggests that cortical impairment is not global and may be more selective for brain circuits including frontal and perhaps temporal regions.

Poor performance on the WCST as reflected in increased preseverative errors, as well as poor performance on the Trails B Test, tends to be associated with reduced concentrations of plasma HVA, the primary metabolite of dopamine in the brain (53a). Furthermore, increased ventricular size tends also to be associated with decreased concentrations of plasma HVA. In personality disorder patients, plasma HVA shows a trend to be negatively related to the deficit-like symptoms; that is, reduced concentrations of plasma HVA are related to increased social withdrawal and constricted affect (53a). A significant correlation between deficit-like symptoms and plasma HVA has been reported in relatives of schizophrenic patients with schizotypal traits (Amin et al., 1993, unpublished data). These results contrast with clinical studies suggesting that increases in plasma HVA are correlated with the psychotic-like symptoms of schizotypal personality disorder.

Together, these findings suggest that schizotypal personality-disordered patients, particularly those with deficit-like symptoms, are characterized by impairment on a variety of cortical processing tasks, increased ventricular size, and reduced indices of dopaminergic activity. Because the dopamine system is implicated in working memory via D1 receptors in frontal cortex, it is tempting to speculate that the cortical dysfunction (in areas such as prefrontal cortex) associated with reduced dopaminergic function may contribute to the “core” deficit-related psychopathology of the schizophrenia spectrum. Other factors must modify this core diathesis in the direction of chronic psychosis for true schizophrenia to emerge. Schizotypal patients with prominent deficit-like symptoms may, however, represent the most common expression of a genetic susceptibility to a neurodevelopmental lesion which results in cortical malfunction.

PSYCHOPHARMACOLOGY OF DEFICIT SYMPTOMS

If the theory discussed above is correct, deficits in cortical function and associated social deficits might be improved with administration of agents that enhance dopaminergic activity. Preliminary data from our laboratory suggests that amphetamine may improve cognitive performance on tests sensitive to prefrontal function (such as the WCST) in schizotypal patients (53a). Therapeutic trials with dopamine reuptake inhibitors such as mazindole, psychostimulants, L-DOPA, or monoamine oxidase (MAO) inhibitors might be warranted. Also intriguing is the possibility that selective D1 agonists, when they become clinically available, might more selectively enhance cognitive function in such patients. If, as correlational analyses hint, social deficits are also related to these underlying cognitive impairments, these strategies may improve the interpersonal functioning of the withdrawn, schizophrenia spectrum personality-disordered patients.

PSYCHOBIOLOGY OF IMPULSIVE/AGGRESSIVE BEHAVIORS

Impulsivity is a defining feature of borderline personality disorder and is prominent as well in antisocial personality disorder and, to a lesser degree, in histrionic and narcissistic personality disorders. Impulsive personality disorder patients are likely to act without reflecting, particularly when it comes to the expression of aggression. They are more easily irritated and are more likely to engage in assaultive behavior, substance abuse, self-damaging acts, and promiscuity. Their impulsive traits may account for the instability of relationships in these patients and their tendencies toward dramatic presentations of themselves. In this cluster of personality disorders, the impulsivity may be differently expressed in the various disorders. For example, in the borderline personality disordered patient, impulsivity is coupled with affective instability such that the patient often reacts with impulsive or aggressive action to the dysphoria engendered by a loss or separation. Such patients frequently present as depressed or feeling abandoned following the dissolution of a relationship. In contrast, antisocial personality disordered patients are much less likely to have affective instability, and their antisocial and aggressive behaviors are fairly persistent and more likely to result in their being seen in a forensic setting rather than in a psychiatric clinic.

Impulsivity as a personality trait appears to be partially heritable. Studies of twins reared apart suggest that impulsivity in healthy, nonpsychiatric populations may be heritable (8). Twin studies of patients with borderline personality disorder also suggest that impulsivity may be partially inherited, although the diagnosis of borderline personality disorder itself is not (66). While individuals with borderline personality disorder may aggregate in families, the core features of impulsivity and affective instability appear to independently aggregate in relatives of borderline patients and may thus combine to provide the susceptibility to borderline personality disorder (55). The presence of a heritable substrait for impulsivity raises the possibility that biologic correlates of impulsivity might be identified.

Neuromodulators that play a role in stimulating and inhibiting external behavior are likely candidates for biologic systems that underlie impulsivity and/or aggression. The serotonergic system, which serves as a behavioral inhibitory system, has been increasingly implicated in the biology of these behavioral traits. In addition, impulsivity and/or aggression in personality-disordered patients may be associated with the presence of epileptiform disorders, attentional disorders, and elevated levels of circulating testosterone and/or endorphins.

Abnormalities of the serotonin are perhaps the most well-documented findings in relation to impulsive aggression and personality disorder patients. Studies in the rodent suggest that lesions of serotonergic neurons result in disinhibited aggression (6). Agents that enhance serotonergic activity can reverse this aggressive behavior as well as inhibit spontaneous or induced aggression. In primates, individual differences in serotonin activity as indexed by concentrations of CSF 5-hydroxyindoleacetic acid (5-HIAA) appear to be heritable and associated with aggressive, dominant behavior (20!popup(ch148ref20)).

Reductions in indices of central 5-HT function are also seen in humans with impulsive aggression, whether directed towards the self (e.g., suicide attempt) or against others (3). Reduced indices of presynaptic serotonergic activity including CSF concentrations of 5-HIAA have been reported in depressed patients who have made suicide attempts or who have engaged in parasuicidal behavior (9). Furthermore, serotonin and its metabolites are decreased in postmortem studies of the brains of suicide victims regardless of diagnosis (9).

Neuroendocrine challenge studies also suggest that central serotonergic activity is reduced in personality disorder patients with impulsive aggression. Prolactin responses to fenfluramine (both d,l- and d-stereoisomer forms) are blunted in personality disorder patients, specifically borderline (11) and antisocial (39) personality disorder patients. In three studies, a negative correlation has been demonstrated between the prolactin response to d,lfenfluramine (11),m-CPP (38), and buspirone (10) and inventories of irritability and aggression in patients with personality disorder. These studies provide support for the hypothesis that decreased serotonin activity is associated with aggression and impulsive behavior in patients with personality disorders. They raise the possibility, reviewed later, that selective serotonin reuptake inhibitors might ameliorate impulsive aggression in such patients.

In contrast to serotonin, the noradrenergic system may play a facilitatory role in promoting impulsivity and aggression. In preclinical studies, the noradrenergic system, with nerve cell bodies located in the locus coeruleus, plays a major role in the regulation of arousal and responsiveness to the environment. While increased activity of the locus coeruleus is associated with reactivity to novel and particularly threatening stimuli (2), decreased locus coeruleus activity has been documented during self-restitutive or vegetative activity such as eating, self-grooming, and sleeping. Heightened noradrenergic activity may be associated with increased irritable aggression (62), whereas a social withdrawal, such as is observed in separation of an infant primate from its mother, seems to be associated with decreased noradrenergic activity (35). Heightened noradrenergic activity may then be related to enhanced sensitivity or reactivity to stimuli in the environment, whereas reductions in noradrenergic activity appear to be more associated with withdrawal from the environment and restitutive functions.

These clinical observations are consistent with studies of noradrenergic abnormalities in the clinical arena. For example, reductions in the responsiveness of the noradrenergic system as indicated by responses to noradrenergic challenges such as clonidine are observed in patients with major depressive disorder, particularly those with endogenous depression (50). A hyporeactive noradrenergic system may thus be related to the disengagement from the environment observed in the patient with autonomous or endogenous depression, particularly with symptoms of withdrawal, psychomotor disturbance, and reduced concentration.

Conversely, increased engagement and reactivity to the environment seems to be associated with enhanced noradrenergic activity in clinical studies. For example, gamblers evidence increased arousal and enhanced noradrenergic activity associated with risk-taking, boredom, susceptibility, and sensation-seeking (47). Similarly, an augmented growth-hormone response to clonidine is positively correlated with scores on the irritability subscale of the Buss–Durkee Hostility Inventory (10). In a larger overlapping sample of personality-disordered patients, presynaptic measures of noradrenergic activity such as plasma norepinephrine were positively correlated with risk-taking and total scores on the Barratt Impulsivity Scale (BIS), and growth-hormone responses to clonidine were associated with irritability and verbal hostility on the BDHI (67). Thus, a heightened responsiveness of the noradrenergic system might contribute to the increased sensitivity and reactivity of personality-disordered patients with impulsivity and affective instability such as may be observed in those with “dramatic cluster” diagnoses. Agents that stabilize or reduce noradrenergic activity might be expected to partially improve irritability and reactivity in these patients.

An etiologic role for epileptiform activity in the limbic system in patients with personality disorder is suggested by some preliminary data related to (a) the presence of certain EEG abnormalities in patients with borderline personality disorder and (b) the response of dyscontrol behaviors to anticonvulsant medications (14; see below). Attention-deficit hyperactivity disorders (ADHDs) are associated with impulsivity and may persist into adulthood. The decrease in impulsivity and irritability in adults with ADHD in response to treatment with stimulants (70) suggests that some irritable impulsive patients may have an underlying adult ADHD syndrome. Finally, there are limited data which suggest that elevated testosterone (free, not total) and endorphin levels may play a contributing role in aggressive (1) and self-injurious behaviors (27), respectively.

PSYCHOPHARMACOLOGY OF IMPULSIVE AGGRESSIVE TRAITS AND BEHAVIORS

Our current understanding of these traits and behaviors suggests a number of potential treatment strategies. Evidence of a reduction in central 5-hydroxytryptamine (5-HT) neurotransmission suggests that impulsive aggressive behavior may be treated with agents which enhance 5-HT in the brain. Open-label clinical trials with fluoxetine in patients with a primary Axis II diagnosis of borderline personality disorder (7) provide evidence that these agents may be effective in reducing impulsive aggression. Effective doses in studies to date have ranged from 20 to 80 mg p.o. q.d., and positive effects have been reported to occur within the first week or within the first month of treatment (8) studies. Unfortunately, none of these studies were placebo-controlled, and the clinical presentations of the patients were varied. However, because impulsive aggressive behavior is intermittent and sensitive to environmental provocation, placebo-controlled trials of adequate duration and careful behavioral monitoring are required. Future studies need to assess the effect of 5-HT uptake inhibitors in patients who do not have comorbid disorders that are also responsive to these medications (e.g., major depression, obsessive–compulsive disorder). It is currently difficult to assess whether gains in impulsive aggressive behavior associated with treatment with fluoxetine have been due to a primary effect of the drug or occurred through a more primary effect on comorbid diagnoses such as depression or obsessive–compulsive disorder. Studies with some of the newer selective 5-HT uptake inhibitors have yet to be reported.

Other agents with putative anti-aggressive properties include lithium, beta-adrenergic antagonists, carbamazepine (and other anticonvulsants), neuroleptics, stimulants, and opiate antagonists. While not all of these agents have been studied specifically in personality-disordered patients, specifically, all have demonstrated some efficacy in disorders associated with impulsive aggressive behavior.

As of this date, lithium carbonate is the only agent which has been shown in a blind placebo-controlled study to diminish the frequency of impulsive aggressive behaviors in individuals with probable antisocial personality disorder. In a landmark study, a 3-month treatment trial of lithium carbonate was associated with a cessation of impulsive aggressive behavior in a group of prison inmates (49). Blind crossover to placebo, at the end of 3 months of treatment, resulted in a return to the baseline frequency of these behaviors. While these individuals would most likely be diagnosed with antisocial personality disorder, only acts of impulsive aggressive behavior were affected by the lithium treatment. These results suggest that other aspects of antisocial personality disorder related to “conning” or “disregard for the rights of others” may not be affected by lithium. The mechanism of lithium carbonate’s anti-aggressive action has been proposed to be secondary to its putative ability to increase 5-HT neurotransmission. However, lithium treatment enhanced prolactin responses to intravenous tryptophan, a measure of serotonin responsiveness, only at 1 week in normal controls and not at all in depressed patients, raising questions regarding serotonergic mechanisms (42). It is also possible that lithium’s effect of dampening catecholaminergic function (4) plays a role in its anti-aggressive properties observed in antisocial personality-disordered patients.

Beta-adrenergic antagonists (e.g., propranolol, pindolol) have also been shown to have anti-aggressive properties in patients with a variety of diagnoses (although no studies have been reported in patients with primary diagnoses of personality disorder). In general, high doses of these agents are necessary to produce an anti-aggressive effect. The mechanism of action for this effect is also unclear, although antagonism at beta-noradrenergic sites and possible agonism (especially at the higher doses usually employed) at 5-HT1 receptors raise the possibility that these agents may work through both noradrenergic and serotonergic mechanisms. It is also possible, however, that these agents also work through a peripheral mechanism, either in concert with a central mechanism or exclusive of one. Consistent with this possibility, nadolol, a beta-adrenergic antagonist which does not cross the blood–brain barrier, has also been reported to have anti-aggressive efficacy in violent individuals (73).

Carbamazepine treatment has been associated with a striking, and significant, reduction in the severity of episodic dyscontrol in a study of a small group of well-diagnosed female patients with DSM-III borderline personality disorder (14). In this sample, episodic dyscontrol (i.e., worst episode) was rated as moderate or severe in only 10% of cases, whereas placebo treatment was associated with episodic dyscontrol of moderate or severe intensity in 60% of cases. In addition to carbamazepine, diphenylhydantoin has been reported to decrease “anger,” “irritability,” “impatience,” and “anxiety” in neurotic (DSM-II diagnosed) psychiatric outpatients (60). While it is not known how many of these patients would meet DSM-III criteria for a personality disorder, it is noteworthy that most patients entered into this trial were characterized by prominent histories of hostility and/or anxiety. The mechanism of action for the anti-aggressive effect of these anticonvulsive agents is unknown, although it may involve stabilization of limbic neuronal discharges. Abnormal EEG patterns, similar to those seen in patients with partial complex seizures, have been reported for a small proportion of borderline personality-disordered patients in some, but not all (13), studies. It is possible that limbic excitability may underlie both the etiology and treatment responsiveness of some borderline personality-disordered patients to anticonvulsants. It is also possible that these anticonvulsive agents work partially through the central 5-HT system. Enhancement of the prolactin responses to intravenous tryptophan challenge during carbamazepine treatment has been reported, suggesting that carbamazepine may enhance 5-HT activity in humans (15).

The efficacy of neuroleptics in the treatment of impulsive aggressive behavior is likely to be associated with its effect on dopamine receptors. Low-dose high-potency neuroleptic agents have been shown to have modest efficacy in several placebo-controlled studies (17, 57) involving the use of neuroleptics in the treatment of patients with personality disorder. In the most recent study of patients with borderline and/or schizotypal personality disorder, haloperidol’s main effects were on observed measures of “hostile belligerence” and impulsive aggressive behaviors (56). In a placebo-controlled trial, treatment with the neuroleptic flupenthixol was associated with a significant reduction in suicidal behavior in personality-disordered patients with histories of recurrent suicidal behavior (37). While these patients were not formally diagnosed as personality-disordered, most of these patients would have met DSM-III criteria for borderline personality disorder.

Finally, there are some limited, but noteworthy, data regarding the effect of stimulants and opiate antagonists on impulsivity and aggression. In a placebo-controlled study of adult patients with attention deficit disorder (ADD), the stimulant pemoline was shown to significantly decrease ratings of both “impulsivity” and “hot or explosive temper” (70). Reductions in these symptoms occurred in the context of similar improvement in ratings of “attention difficulties” and “hyperactivity,” but not of “affective liability.” While patients with “borderline” or schizotypal personality disorders were excluded from study, at least 27% met Research Diagnostic Criteria for antisocial personality disorder (definite or probable). In addition, all patients had at least two or three of the following six symptoms (i.e., in addition to either motor hyperactivity or attentional deficits persisting from childhood): impulsivity, hot or explosive temper, affective liability, impaired interpersonal relationships, stress intolerance, and inability to complete tasks. It is noteworthy that the first four of these criteria are found in the DSM-III criteria for borderline personality disorder. Because patients with borderline personality disorder were excluded, this suggests that “impulsivity” and/or “hot or explosive temper” may respond to stimulant medication in the absence of a full personality-disorder diagnosis. These findings were generally replicated in another sample with the stimulant methylphenidate (71). Hence, it is possible that stimulant medication may be beneficial in treating impulsivity and irritability/anger when it occurs in the context of adult ADD. Studies with opiate antagonists in the treatment of self-injurious behavior in a variety of psychiatric patients, mostly with mental retardation, have met with mixed success (27) but may offer another avenue for research for pharmacologic intervention in very difficult patients with borderline personality disorder who cut or otherwise mutilate themselves.

Exacerbation of aggressive behavior may represent an unwanted side effect at some psychopharmacologic agents in personality-disordered patients. The tricyclic antidepressants (e.g., amitriptyline), MAO inhibitors (e.g., tranylcypromine), and alprazolam, all of which may be presented to patients with personality disorder, may increase aggressive behavior. Evidence of potential enhancement of impulsive aggressive behavior during treatment with tricyclic antidepressants in personality-disordered patients was first reported by Soloff et al. (58). Soloff and colleagues noted that borderline personality-disordered patients who had no global improvement during treatment with amitriptyline (i.e., “nonresponders,” defined as having a global assessment improvement score after medication below the average for the entire sample) demonstrated increases in ratings of impulsive and aggressive behavior compared to patients who similarly had no global improvement during placebo treatment. This increase in impulsive aggressive behavior occurred in spite of isolated improvements in measures of depression and psychoticism in the amitriptyline “nonresponders” compared to the placebo “nonresponders.” These findings suggest a dissociation between antidepressant and anti-aggressive responses to amitriptyline in a subset of patients with borderline personality disorder. Amitriptyline “nonresponders” in this study had significantly higher pretreatment ratings of hostility, psychoticism, and negativism than did amitriptyline “responders” (58), raising the possibility that personality-disordered patients with these characteristics may be at more risk for increased impulsive aggressive behavior during treatment with tricyclic antidepressants. Increases in impulsive and/or aggressive behaviors have previously been reported in depressives during treatment with tricyclic agents (43). While tricyclic antidepressants may enhance serotonergic actively, they can also enhance noradrenergic activity. Given indications of a positive relationship between noradrenergic system function and hostility and/or impulsive aggression, it is possible that tricyclic antidepressants may augment these behaviors by enhancing noradrenergic system function. Increased aggression in patients with borderline personality disorder has also been reported during treatment with MAO inhibitors (14), although this phenomenon is not well-characterized.

An increase in the severity of episodic dyscontrol in borderline personality-disordered patients treated with alprazolam was first noted by Cowdry and Gardner (14) in their placebo-controlled multiple-drug crossover study. The effect was so robust that the treatment arm involving alprazolam was discontinued after the entry of only 12 patients into the trial. This phenomenon is currently understood to represent another example of how benzodiazepine-like agents can disinhibit some individuals (18). Accordingly, caution should probably be taken in prescribing this agent to personality-disordered patients with prominent histories of impulsive aggression.

PSYCHOBIOLOGY OF AFFECTIVE-RELATED TRAITS

Depressive symptoms can appear in any patient with a personality disorder. However, affective-related traits are a common part of the diagnostic picture for several of the personality disorders in the dramatic and the anxious cluster. Affective instability characterizes one of the DSM-III criteria for borderline personality disorder, while exaggerated displays of emotion and rapidly shifting emotions characterize two of the DSM-III criteria for histrionic personality disorder. Rejection sensitivity, a trait often associated with depressive symptoms, characterizes two of the DSM-III criteria for dependent personality disorder and one for avoidant personality disorder. The clinical picture of a depressive syndrome in a patient with personality disorder offers a diagnostic challenge that is often difficult to resolve. Specifically, some personality-disordered patients presenting with depressive symptoms appear to have a type of “environmentally sensitive” affective disturbance that is part of their usual personality profile, whereas others appear to have a more sustained and discrete depressive syndrome indistinguishable from major depression.

Familial relationships have been noted between some personality-disordered patients (i.e., those with borderline personality disorder) and major mood disorder. However, recent data suggest that the relationship may be secondary to comorbid major depression in the personality-disordered probands. In recent studies (55) the familial relationship between borderline personality disorder and depression was attributed to the presence of major mood disorder in the proband itself. Family members of borderline personality-disordered patients without histories of depression had the same morbid risk of depression as did other personality-disordered patients without histories of depression. In contrast, family members of patients with borderline personality disorder had an elevated morbid risk of impulsive personality disorder traits and affective personality disorder traits (55). Individuals with impulsive personality disorder traits were characterized as having at least three of the following symptoms chronically: physical fighting with others, not associated with alcohol; nonpremeditated stealing (e.g., shoplifting); problems with drinking or drugs; binge eating; problems with gambling; sexual promiscuity; self-damaging acts (e.g., wrist-slashing etc.); and irrational angry outbursts, or overreaction to minor events, not associated with alcohol. Individuals with affective personality disorder traits were characterized as having either (a) a chronic dysphoria (e.g., depression, anxiety) or (b) fluctuations in mood not associated with highly severe mood disturbances, psychomotor agitation or retardation, psychotic features, or extreme guilt. In addition, these individuals had at least one of the following symptoms chronically: easily disappointed or self-pitying; low self-esteem; pessimistic attitude; and absence of satisfactory intimate relationships (55). These results suggest that a familial relationship exists between borderline personality disorder and personality disorder traits consistent more with the core features of borderline personality disorder (i.e., impulsivity, affective liability) than with major syndromal mood disorder.

Abnormally high rates of nonsuppression of plasma cortisol following dexamethasone has been reported in some, but not all, studies of patients with borderline personality disorder (28. Over all studies, rates of dexamethasone nonsuppression ranged from 9% to 73%. This difference in rates of dexamethasone nonsuppression appeared to be attributable to the presence of a comorbid diagnosis of major depression in most of these studies. In the studies where comorbidity of major depression is low, the rates of dexamethasone nonsuppression are correspondingly low. The same conclusion can be drawn from data from studies utilizing thyrotropin-releasing hormone (TRH) stimulation testing (33) in patients with borderline personality or other personality disorders (24). Two studies have reported elevated rates of blunted thyrotropin-stimulating hormone (TSH) in small samples of patients with DSM-III borderline personality disorder. Blunted TSH responses to TRH were 38–47% in borderline patients compared to 0–9% in healthy controls. The comorbidity of major depression or alcoholism (either of which can be associated with a blunted TSH response to TRH) in these samples, however, was between 80% and 100%, making a specific association between blunted TSH responses to TRH and borderline personality disorder unlikely. The most recent study investigating personality disorders of all types found no difference in the rate of TSH blunting or in the absolute magnitude of TSH responses to TRH in personality-disordered patients compared to healthy controls (24). These data suggest that abnormalities in TSH responses to TRH stimulation in patients with personality disorder are attributable to the presence of a comorbid diagnosis of depression or alcoholism and not to the personality disorder itself.

Other strategies designed to find biologic correlates of mood disorder in personality-disordered patients have met with mixed results. Growth-hormone responses to clonidine challenge, an index of central alpha-2 noradrenergic receptor sensitivity, in personality-disordered patients tend to be similar to those seen in healthy volunteers (10). This is in contrast to the reduction in growth-hormone responses to clonidine that are observed in depressed patients in either the acute-depressed or the remittedeuthymic state (54). Moreover, growth-hormone responses to clonidine in personality-disordered patients and healthy volunteers were correlated with irritability, not depression (10). Similarly, prolactin responses to d,l-fenfluramine challenge do not seem to discriminate personality-disordered patients with current (or past) history of depression from those who have never met criteria for depression (11); again, correlations between prolactin responses to fenfluramine challenge were seen with irritability and assaultiveness, but not with depression.

It is possible that mood dysregulation or instability is related to a dysfunction of more than one neurotransmitter system including both norepinephrine or serotonin (53). For example, amphetamine challenge is associated with an improvement in global function (including mood) in a subgroup of patients with borderline personality disorder (48). Moreover, behavioral responses to amphetamine challenge may correlate with trait indices of affective liability (23). Neurochemical events triggered by amphetamine stimulation may more accurately reflect the biologic substrate associated with affective liability and dysregulation than stimulation by more selective neurotransmitter agents. This hypothesis also may explain why treatment of mood dysfunction with tricyclic antidepressants is often not successful in patients with personality disorder.

Finally, it is possible that cholinergic sensitivity may play an important role in the mood dysregulation seen in many patients with personality disorder. An extensive body of evidence suggests that increased cholinergic receptor responsiveness may be associated with major depressive disorder (21). Physostigmine, an acetylcholinesterase inhibitor, and arecoline, a muscarinic agonist, both of which increase the signal at postsynaptic cholinergic receptors, induce a behavioral syndrome resembling depression in animals (21), acute and remitted depressed patients, and normal volunteers (21). Furthermore, these agents appear to have antimanic properties. These results raise the possibility that enhanced cholinergic receptor sensitivity may be associated with a broader sensitivity to dysphoria. In fact, in normal males, dysphoric responses to physostigmine correlate with traits of irritability and emotional liability (16).

Consistent with these studies, studies of rapid eye movement (REM) latency, partially modulated by cholinergic activity, suggest that borderline personality-disordered patients share disturbances in REM regulation with major depressive disorder. Borderline personality-disordered patients have been reported to have both decreased and more variable REM latency when compared to normal controls, and in a preliminary study they demonstrated exaggerated reduction in REM latency in response to a cholinomimetic agent. Preliminary studies suggest that personality-disordered patients with prominent affective instability, particularly borderline personality-disordered patients, have a significantly greater dysphoric response to the acetyl cholinesterase physostigmine than do patients with other personality disorder (59). The extent of the dysphoric response in this study as measured by the Profile of Mood States (POMS) was correlated with baseline affective instability. Therefore, it is possible that enhanced responsiveness of cholinergic receptors may play a role in the susceptibility to affective shifts observed in Cluster B personality disorders, such as borderline or histrionic personality disorder.

PSYCHOPHARMACOLOGY OF AFFECTIVE-RELATED TRAITS

Clinical trials designed to specifically treat depression in patients with personality disorders have tested the efficacy of standard psychotropic medications in patients with borderline and/or schizotypal personality disorder. In general, most medications which have been tested demonstrate some efficacy on measures related to state depression. These medications include chlorpromazine and loxapine (29), thiothixine (17), haloperidol (56, 57), amitriptyline (57), imipramine (32)), phenelzine (19, 40), and tranylcypromine (14). In most studies, improvements in state depression in personality-disordered patients have been minimal to modest in studies involving neuroleptics and tricyclic antidepressants and modestly robust in some studies involving MAO inhibitors.

Of the MAO inhibitors, phenelzine has been the most extensively evaluated of the MAO inhibitors. In the pre-DSM-III era, phenelzine was reported to be globally efficacious in treating a subset of patients with pseudoneurotic schizophrenia (19). This diagnostic categorization describes patients characterized by the triad of pananxiety, panphobias, and chaotic sexuality but without psychosis or major depression. With regard to DSM-III Axis II disorders, this picture comes closest to that of patients falling into the Dramatic and/or Anxiety Cluster of personality disorders. A retrospective study comparing imipramine with phenelzine found that the response rate of atypical depressives with comorbid borderline personality disorder treated with phenelzine was nearly three times as great (89% versus 31%) as the response rate achieved with imipramine. In contrast, the efficacy of phenelzine in atypical depressives without borderline personality disorder was equal to that of imipramine (56% versus 57%;) (40). Despite this earlier literature, phenelzine was reported to be remarkably ineffective in treating state depression in the only prospective placebo-controlled study of phenelzine treatment in patients with borderline and/or schizotypal personality disorder (56). In this study, phenelzine was ineffective as an antidepressant in treating both the typical and atypical signs and symptoms of depression. Two reasons for the negative finding in the study of Soloff and colleagues may relate to differences in the patient selection and in the maximal phenelzine dose. First, patients in this study were inpatients with primary entry diagnoses of borderline or schizotypal personality disorder (less than half with a diagnosis of atypical depression), whereas patients in the previous studies were outpatients with a primary entry diagnosis of atypical depression. Second, the phenelzine dose administered in the Soloff study was probably lower than that administered in either of the previous studies. The average phenelzine dose in this study was 60 mg p.o. q.d., whereas that in the previous studies was higher (i.e., nonresponding patients received 90 mg p.o. q.d. of phenelzine after 4 weeks of treatment). In addition, treatment was 6 weeks or longer in the previous studies, and this may also have affected the response rates. The relatively high frequency of adverse events occurring in the personality-disordered patients prevented phenelzine doses from being raised much above 60 mg p.o. q.d.; only 18% of patients received doses as high as 75 mg p.o. q.d. In spite of the differences between the studies, the absence of efficacy for phenelzine in a well-defined sample of hospitalized personality-disordered patients suggests that phenelzine may not be an efficacious treatment in moderately to severely impaired patients with personality disorder.

Unlike phenelzine, tranylcypromine treatment was associated with a significant antidepressant/mood-enhancing effect in a small group of treatment-resistant females with borderline personality disorder (14). In this prospective comparison of tranylcypromine to carbamazepine, it was reported that trifluoperazine, alprazolam, and placebo treatment with tranylcypromine resulted in significantly greater improvement in self-rated assessments of mood (14). While this is yet to be replicated, it is possible that tranylcypromine’s mood-enhancing effect was partly due to its amphetamine-like structure and pharmacologic effects. This hypothesis is supported by preliminary data demonstrating that some patients with borderline personality disorder have a marked mood-enhancing response to amphetamine challenge (48).

5-HT uptake inhibitors may also treat the depression seen in patients with personality disorder, specifically borderline personality disorder. However, all published data at this time are based on open-label trials (7). All three reports available suggest that fluoxetine is efficacious in treating state depression as well as other behavioral (e.g., obsessive–compulsive, impulsive) features which can respond to these agents.

Clinical trials designed to specifically treat affective liability have been few. The first placebo-controlled trial in this area compared chlorpromazine to imipramine in a group of patients with “emotionally unstable character disorder” (25). Affective liability in these patients was characterized as rapid autonomous (rather than reactive) shifts in mood. In addition, these patients displayed chronic personality traits such as difficulty with authority, job instability, and problems in interpersonal relations. Both chlorpromazine and imipramine were associated with positive outcomes compared to placebo, although there was clear superiority for chlorpromazine in these patients. Notably, the clinical responses of a subset of imipramine-treated patients was characterized by an increase in anger during the trial (see above discussion regarding tricyclic antidepressants and impulsive aggression). A second placebo-controlled trial with lithium as the experimental agent reported a decrease in the variability of mood in another group of emotionally unstable character-disordered patients (46). A more recent placebo-controlled study of lithium treatment in borderline personality disorder reported a trend for lithium over desipramine in terms of decreasing anger, but did not examine their data in terms of lithium’s potential efficacy on mood instability. While limited, these data raise the possibility that other antimanic/anticonvulsant agents (e.g., carbamazepine) could be efficacious in reducing the affective instability of patients with borderline personality disorder, although one uncontrolled study of patients with emotionally unstable character disorder demonstrated no efficacy for the anticonvulsant, diphenylhydantoin (26). Finally, the efficacy of anticholinergic agents in treating affective instability remains to be tested.

PSYCHOBIOLOGY OF ANXIETY-RELATED TRAITS

The anxiety-related personality disorders include avoidant, dependent, obsessive–compulsive, and passive aggressive (now deleted from DSM-IV). All of these disorders share behavioral traits that may be related to a heightened susceptibility to anxiety and efforts to ward off potential anxiety. For example, patients with avoidant personality disorder have excessive anticipatory anxiety regarding the prospect of future rejection and thus avoid social interactions, while individuals with dependent personality disorder may submit to the wishes of others on whom they depend for fear of rejection or conflict. While there has been almost no systematic investigation into these specific personality disorders, there have been some studies of related or comorbid conditions such as social phobia. For example, the comorbidity of avoidant personality disorder and social phobia may be as high as 90% (72).

Family studies suggest familial transmission of “anxious” personality traits and disorders (45), while twin studies suggest significant heritability of social anxiety (65). Longitudinal studies of children suggest a stable dimension of fearfulness and inhibition (22). Thus, it is likely that at least social anxiety has a genetic basis with some longitudinal stability.

Otherwise, there is limited biologic data regarding social phobia/avoidant personality disorder. Clinical studies of hypothalamic–pituitary function suggest that neither the hypothalamic–adrenal (68) nor the hypothalamic–thyroid axis (63) of these patients differ from that of healthy volunteers. Preliminary results suggest enhanced responsiveness to serotonergic probes but not to adrenergic probes (64), suggesting potential increases of serotonin function associated with enhanced behavioral inhibition, but not noradrenergic system dysfunction. While lactate infusion is a potent stimulus of panic attacks in patients with panic disorder, it produces only inconsistent responses in patients with social phobia (31). One study has suggested decreased dopamine metabolism in social phobic patients (41), but this finding will require replication.

PSYCHOPHARMACOLOGY OF ANXIETY-RELATED PERSONALITY TRAITS

Little has been published which relates to the pharmacologic treatment of patients with anxiety-related personality disorders. Placebo-controlled, double-blind data are published documenting the efficacy of MAO inhibitors in the treatment of social phobia (30). Otherwise, there has been at least one open-label report suggesting that fluoxetine may be beneficial in the treatment of avoidant personality disorder/social phobia (61).

CONCLUSION

Research into the biologic and neuropsychopharmacologic correlates of behavioral and personality traits has produced many important insights which can aid the psychopharmacologist in the treatment of patients with personality disorders. First, there may be a heritable, biologic component to some selected personality and behavioral traits. Second, the efficacy of various psychotropic agents in treating the more extreme manifestations of these traits may be related to the specific psychopharmacologic properties of the agents (e.g., serotonin-enhancing, catecholamine-dampening properties of lithium) in question (7, 56). Third, symptoms referable to different personality dimensions respond differentially to psychotropic agents within groups of patients with similar diagnoses (17, 56, 57) and within individuals (14). This latter phenomenon reflects the great biologic and clinical heterogeneity present in patients with DSM-III personality disorders.

These insights represent a clear advance in the psychopharmacologic conceptualization of the personality disorders over the past few decades. Despite this, no definitive psychopharmacologic recommendations for specific groups of patients with personality disorders can be made at this time. Many more placebo-controlled clinical trials in well-defined (both clinically and biologically) patients with personality disorder will be required before such recommendations can be made in this area. A first step might be more placebo-controlled studies of agents which have already shown some promise in preliminary placebo-controlled trials (e.g., lithium, carbamazepine, tranylcypromine) of patients with personality disorder.

published 2000

Lynn, an attractive, Yale educated, 26 year old editor of a trendy art magazine in Manhattan, is discovered comatose by her socialite mother. Once she’s resuscitated, she is found to have taken massive doses of Xanax , Prozac and vodka, leading doctors to suspect that she’d attempted suicide. Her parents are stunned, frustrated and shocked. They failed to pick up the warning signs. Her doctors diagnose a major depressive episode and after further testing conclude that she has an underlying personality disorder – narcissism, which is notoriously hard to treat. An assessment of her history reveals a troubled life. Her suicidal impulses began within two years of landing her highly competitive job. There were conflicts with her colleagues, fleeting affairs with writers, a disastrous office romance, and drinking and pot smoking binges. She’d missed appointments and deadlines, shown lapses in professional judgment and performed shoddy editorial work. Her psychiatrist admitted that he’d had to cope with frantic phone calls, unending crises, abuse of prescribed medications and periodic visits to the local ER. Nothing he tried seemed to work. What made her case so frustrating was that on the face of itLynn seemed to have every possible advantage. Yet she repeatedly sabotaged her life and her work and in the process she succeeded in destroying her health as well. It was only because of a quick-thinking medic and a young resident that she didn’t kill herself. Her doctors and therapists were clueless about what could be done for her. Was her case hopeless or were the doctors missing something?
One possible answer is suggested by another case which initially stumped doctors just as Lynn’s did.
Arthur, a forty-five year old self-made multimillionaire, becomes unable to get out of bed; he spends days in his room, alternately sleeping and crying, petrified by the thought of having to face the day or do even minor chores. Although he’s in excellent health and physically fit, he’s simply unable to function. Diagnosed with Bipolar Disorder (popularly known as manic depression), he fails to respond to aggressive treatment with all known mood stabilizers. His therapists conduct multiple trials of every conceivable antidepressant and even resort to electric convulsant shock therapy all to no avail. His psycho pharmacologist, unable to control his growing suicidal thoughts or mitigate his paranoid thinking, arranges an emergency consultation with a colleague specializing in personality disorders. After a thorough evaluation and psychological testing, the specialist recommends a new approach to treatment – Dynamic-Neurocognitive Therapy [DNT]. Three months later his symptoms begin to abate. In six months he is back in business. Twelve months later he successfully launches his next multimillion dollar business venture, gets married and remains stable and symptom-free ever since.
Before we describe this new therapeutic approach and see why it works we first need to consider a fundamental question:
What does it mean to be happy and how is one’s (un)happiness related to one’s health?
Life is to be appreciated. Human beings desire and deserve to be happy. On the surface, happiness seems to be practically a birthright of Americans – it’s right there in the Declaration of Independence. But happiness is difficult for us to define, let alone find. You would think that health would be integral to happiness. It makes sense; if you’re not feeling well it’s hard to enjoy life. But what if health and happiness are in conflict? What if being happy trumps being healthy? What if someone actually feels that she must jeopardize her health if she is to achieve happiness? If that’s the case, then we have to ask: Is it more important to be happy or to be healthy?
Supposing, though, that this is the wrong question?
In spite of the proliferation of health clubs and our obsession with dieting, millions of Americans don’t see health as a major concern. In fact, they act in ways that make them unhealthier. That’s one of the reasons why so many people drift from one doctor to another, dropping out of treatment, or trying alternative medical practitioners — they’re dissatisfied with the treatment they’re getting. And no wonder. They’re frustrated because, without their realizing it, they don’t want to be treated. They simply don’t want to get well.
Take the example of Rachael. An attractive, talented musician in her early thirties, she refused treatment for depression and alcohol and drug addiction because she was afraid that her “creative angst” would be “taken away.” In her view intoxicants heighten her sensitivity and induce altered states of consciousness that feed her creativity. She prefers to emulate her idols Jimi Hendrix, Janis Joplin and Jim Morrison. She regards a healthy lifestyle as “boring and dull.” She subscribes to the sentiment in the Neil Young song, “It’s better to burn out than fade away.”
Or consider the case of Mel, a CPA now facing eight years in prison after he embezzled $5 millions from his family business which he proceeded to squander on escort services, expensive gifts and extravagant trips. Like Rachel, he dropped out of intensive treatment because he couldn’t bear the idea of trading in an exciting life for a healthier one.
We smoke, drink, we eat badly, we pursue unhealthy relationships and engage in self-destructive behaviors. Our culture seems to reward behavior that is antithetical to health; if you want proof all you have to do is spend a night spent in front of the TV. People are gulled into thinking that a new car, a new mate, a new game or a new wardrobe will offer them happiness, at least for a little while. And if you’re feeling lousy you just have to pop a pill.
Within mainstream psychiatry and medicine Lynn, Arthur, Rachel and Mel are usually described as suffering from so called personality disorders. According to the US Surgeon General, people with personality disorders have “great difficulty dealing with other people. They tend to be inflexible, rigid, and unable to respond to the changes and demands of life. Although they feel that their behavior patterns are ‘normal’ or ‘right,’ people with personality disorders tend to have a narrow view of the world and find it difficult to participate in social activities.” Experts are divided about what causes these disorders, whether they’re mostly genetic or environmental or some combination of both. What is clear is that these disorders aren’t rare. On the contrary, estimates of the number of people affected range from about 10 percent to 33 percent of the US populationdepending on the definition, methodology and sampling method and diagnosis bias being used. It is reasonable to suppose that as many as 45 million Americans have these disorders and there may be millions more who never show up in doctors’ offices. We should also add that these disorders put people at much greater risk of other illnesses like depression and anxiety.
Today doctors generally rely on two basic types of treatment – talk therapy and drugs. We call this the medical model. As much as possible the therapist’s objective is to alleviate the patient’s symptoms like anxiety, mood swings, impulsivity and panic and make them “better.” Symptoms are what therapists focus on when patients come to their offices. If, however, a patient is determined to follow the example of Janis Joplin or Sylvia Plath then what is the doctor supposed to do? Talk therapy and drugs can accomplish a lot of good but they have their limits. The medical model is necessary but not sufficient. Unfortunately, most doctors fail to notice the underlying problem; they try to treat the symptoms but they don’t understand what’s responsible for causing them. That’s because they’re not looking in the right place or from the right perspective. Treatment, if it is successful, should help the patient’s ability to work, play and love. It should enhance capacity for happiness and compassion. This sounds all well and good until we remember that many people – whether they’re in therapy or not – don’t want to get better.
If the doctors were looking in the right place (and from the right perspective) they’d be trying to understand what’s truly driving their patients.
What doctors and therapists often fail to realize is that people with personality disorders don’t engage in destructive behavior IN ORDER to be unhealthy. Instead, they do it IN SPITE of the fact that they’re risking their health. And the reason is because we have other goals and sets of values – call them metaphors, agendas or life-paradigms. Health is only one of these life-paradigms and for many people it’s not the most important one.
We all have our own conscious and unconscious life paradigms. Jung might have called them archetypes. They govern how we view the world and ourselves in it. Rachael’s ‘paradigm’ is creativity and Mel’s is power and hedonism. For many young people between the ages of 17 and 25 pleasure is the operating paradigm. They want an enjoyable, exciting, challenging life, only they don’t want to work hard to make it happen. Of course, human beings aren’t built for a life of perpetual pleasure. In some cases, it’s not pleasure per se that they’re seeking but the pursuit itself.
But how can people get better when they don’t know that they’re ill? And how can doctors treat them if they resist getting better? In other words, how can you cure someone who doesn’t want to be cured? And what does it mean to “cure” someone anyway? How could Jimi Hendrix, Jim Morrison, or Janis Joplin be ‘cured’? For that matter, what would it mean to “cure” Picasso, Mozart, or James Joyce? Would they even want to be cured? Would it be desirable? The question is not simply theoretical; many people with considerably less talent see these artists as heroes and role models. If you couldn’t cure Picasso, or if by ‘curing’ him you risked destroying his genius, they ask, why should I want to be cured, either?
Mainstream psychiatry aims to eliminate identifiable symptoms. It may try to improve the level of adaptive functioning and try to reduce the distress patients feel. But that’s not enough. That doesn’t represent a “cure.” A cure does not necessarily have only one prescribed outcome. Health may not be what the patient wants. But the patient must be able and free to understand and make that decision rather than blindly emulate the role models promoted by our culture.
We don’t want to see people – whether they’re our patients, friends or loved ones – destroy their health or their lives. And the people who are ill – in spite of their conviction that health isn’t such a big deal – often change once they become aware of their life-paradigm. They may decide that their life-paradigm isn’t working and abandon it and attempt to become “healthier”. Others, once they become aware, may decide to continue living according to their life-paradigm because they are convinced that that is what makes their lives worth living. The key obviously is getting people to be aware.
One of the major goals of our book is to make people aware of what’s causing them to do what they do. We want to find out why people don’t want to be healthy and what they can do to change their attitude so that they can become healthier and still find happiness. We’ll offer a quiz to help readers determine what kind of life-paradigm they’re following whether they realize it or not. And because adolescents are at such risk we will also include a chapter for families of teenagers to help them steer their children away from a self-destructive path.
The book will:
* explore some of the principal “life-paradigms” as expressed and lived by so called “difficult-to-treat patients.”
* explore how the most common life-paradigms such as beauty, pleasure, power and love – can result in life styles that undermine health.
* explore the relationships between personality disorders and the notion of “life-paradigms”
* provide tools for understanding and self-diagnosis of readers’ personality type and ones dominant life-paradigm.
* introduce and describe a NEW approach to treatment of personality disorders – Dynamic-NeuroCognitive Therapy (DNCT) – based on the analysis of “life-paradigms”·
* show that far from being a speculative program, DNCT has been proven to work for a surprising number of patients in major psychiatric hospitals when conventional therapy and drugs have failed.
* explore how by using such “unorthodox’ techniques and experiences such as art, music, yoga, meditation and religion readers will have a better understanding of their own behavior whether or not they are currently in therapy.
We will present examples, exercises and real life stories illustrating how to use and benefit from this new approach. In addition, we will offer a recommended list of aesthetic experiences – works of art, significant books and musical compositions, etc. – that readers are likely to benefit from. We will also provide practical information about what to look for in choosing a therapist or psycho-pharmacologist.

Ironically, on the other side of the lake, was an old fort, old as reaching back to the ninth or maybe even eight century, to the time of the Piasts, the original settlers there, the ones first converted to Christianity by Roman explores, the Piasts who were the first owners of this land later fought over by Germans and Poles for the next 10 centuries, it was a fort which used to be an old harbor with the lake somehow deepened there to receive old ships or barges transporting people and goods to the other sides and shore of the lake. They tried to reach the bottom with a long string and a metal weight attached to it but they ran out of the string after the first 100 yards, meters? – was it deeper than that or was it something else devouring the string as it descended into that impenetrable, dark and cold beyond the acceptable cold for them, reaching beyond what could be seen, letting fantasies, imagination and stories run out of control for generations?
And the stories were mainly internal, infusing the mind with a mix of images and narratives, myths and archetypes were born and lived there, in that land, and that grounding in the actual reality of the past, of the unconscious, touching it since the very first moments of life, swimming in their lakes, touching tombs of the past in old Jewish and German cemeteries, right behind their house, where they went to play, the presence of death was a fact, its factuality was a constant presence as they jumped over graves hiding among family mausoleums, hiding in undergrounds crypts, the imminent company of the past was a reality, the past was not to be discovered as in other places, the past was the present and although they did not know it, only the past was missing for others there. And the Mind became the multiple universes in their growing brains, isn’t it what Mind is, anyway, multiple universes in their growing brains? As they lived, the images of the old, the old and new narratives, suffused, infused, contained and transformed together, made the inside outside, made the dead live again in the young ones, isn’t culture what imprints itself on all new life, unless, of course, the new is a deviant outlier?
So the old lived in him, along with the solitude of the forest and the lakes, the beauty of the land ravished by countless wars rolling over, trench to trench, leaving rusting bayonets for children to find in the next generation, leaving young boys to blow up themselves with old minds left there, or old munition they were not allowed to touch but did, of course, how could they contain their curiosity? And all that lived in him and more came later as he eventually discovered that he bridged the old with the new, being one with both. And the world was infinitely pure, smelled of morning cows ready to give milk, as they walked to the village every morning with a battered milk bucket, already expecting the fat white foam bubble in their mouths, as the sun rays flickered in trees and flowers by the old dirt road leading to what they did not know.

Those were also some of the rare moments of complete peace and serenity permeating the entire body, the quietude of each day, simple morning rituals, simple foods, the sun, the lake, boats, swimming, and the meadow there, the meadow which then became an archetype of some basic trust and serenity he carried within himself for many, many years later, the meadow extended behind the dike as the water, narrowed into an underground fall emptying into a long sedate canal leading to an old German dam and fortified underground bunkers five flooded floors deep, with dark shafts evoking a sense of the ultimate mystery, mystery that could never be resolved anyway, associated with sadness of never knowing, an impossibility of knowing certain things, or maybe the impossibility of time to stop, or to reverse, to see what was or to stop what is, and also they conveyed a sense of some greater purpose, the Germans fortifying the land to stop the Russian Red Army from advancing west, and also knowing about their ultimate failure, the war, the dead who must have been somewhere here, still, and the military bunkers were bigger, stronger than anything else they had seen, and all that now uncannily quiet, sleeping in tall grass, field flowers, trees which must have been there then, but now it all conveyed a sense of time lost, of another world which only was but somehow continued into the now of the present.

Two young parents, mother from a radically poor Ukrainian family with no past, or whatever past there was it was dark, diseased, violent, soaked in alcohol, ignorance, crashed close to the ground, shoveled into squalor of Lvov’s poorest neighborhood, often without enough food, most of the time just worst off that others, there were talks on that side of his family of some tragic illness claiming children, or maybe it was typhus, he was told that Grandma locked herself in a basement to die alone but God did not let her, and she came out weeks later, weak but cured, the same body which then lived to be almost a hundred. Father was the only child of a well off blue collar Silesian family, industrious, proud, principled, even if Grandpa cheated and drank too much, they were dignified, smoked French cigars, and always had more money than others around them, which in a relative way as everything else, made them be, or maybe just made them feel better than their neighbors, so the father carried a sense of unlimited possibility, entrepreneurial zeal, which later, killed him in his best years. And the land was wild, abundant, covered with lakes and forests, wilderness, clear water, unspoiled, even if the war just rolled over, leaving German and Russian trenches everywhere, they would find ammunition in the nearby forests where they played, sometimes little kids were blown up, he heard but never saw, but there were these very dark bunkers, dug deep, deep into the ground, often several stories deep, with half flooded elevator shafts leading to some mysterious darkness of the war ‘s arsenal, nobody ever knew what was in those bunkers, they did have some important strategic role because there were arranged along canals and lakes, meant to be used to flood the entire area as the Soviets approached, and maybe they did, or maybe there was not enough time, and they had to run, run from the Red Army, so cruel, so merciless, that the Germans just ran West to surrender to the Allies. And there were post-German houses, the houses slowly inhabited by new settlers, arriving shyly, in disbelief that all that was left behind, completely empty furnished mansions, factories stopped in half production, silverware tossed in panic, the end of war happened so quickly there was no time to hide, no time to carry things, it was all about saving lives, so the newcomers just trickled in, the communist government encouraged it, they needed new people to inhabit the land, to be, there, to work, to raise children and his was one of those families that moved there.

Flowers dancing in the light of blueberry moonlight revolving around the mind of an old sage who just appeared on the horizon of unconscious thought as it bubbled up in the brain devoid of any other thoughts, so there we were, embraced again, bodies dancing in sex yet again, liberated from our minds, we look at the world and all is not the same nor different anymore, it is in a different place but still only you and me know that it is what it was.

The language enveloped in words, as it flows inseparably from anything else and I remember tracks of a tram in an old German town where she, my grandma, took me to visit downtown, yet there was magic in sparks flowing in cascades with each old train taking a turn on this narrow street of the German town, the sky was blue, no, it was black, with sot from coal mines, people’s faces, sculptured in broad deep cuts from which nothing but soul lurked, people’s faces were soul itself, as were their hands, strong, dirtied but clean, smudged  with coal, tired and strong, branches of old tree, people were silent, words were superfluous, words took you away from yourself and themselves, took you in the open, unknown and dangerous, dangerous and forbidden, the words which came from elsewhere, not mine, not yours, unspoken, they came from the past or maybe from different countries that invaded this one, so people were already tired, tired of not having their lives, or lives being overtaken by others, pummeled into obedience by a victorious culture, forced to slave labor, and now only shame and wrath still flew in their veins as they all were returning home on the old tram as it weaved its way through yet another turn of a small street in the German town my grandma took me to when I was a child.

(…..Waiting for American Dogen )
Buddhas usually appear as “this very moment”, however perceived or defined. Being always “just that…..” Buddhas may or may not be perceived as Buddhas by others, nevertheless, they always continue being Buddhas just as they are. However, since the “as they are” is inherently empty and not any fixed entity, Buddhas appear as simply “this” […….] or “that” [……..], as me and you, as “this very moment” and as the entire Universe. They “appear” only when Mind appears (…) divided into its object / subject modes of Being. Whenever a Buddha realizes that he or she is Buddha as a human being, the Buddha, the Dharma and the Sangha rejoice, leap forward, and “Buddhism” takes yet another turn.

The last 2,600 years of Buddhism have been marked by such occasional appearance of realized Buddhas, of spiritual guides, whose insights, understanding or manifestation of the Dharma not only subsumed and included all prior teaching traditions but also reformulated them into a new philosophical turn, new school or spiritual paradigm.

Today, two centuries after Buddhism was introduced to the West, many practitioners in this country wonder how long will it take for another Buddha, another uniquely enlightened mind, another Nagarjuna, Asanga, Milarepa, Hui-Neng, Hakuin or Dogen to appear in American Buddhism?

Alas for all of us, as the timeline in the box below suggests, it may to take quite a long time again.

In the past, it was always at least 600 years after Buddhism was first transplanted to a new culture or country before a truly original teacher / reformer would appear – suggesting, if one can extrapolate from history – that it may take another 450 years for one to emerge here, in the West.

In its birthplace, India, almost an entire millennium passed, before early Buddhism, proselytized by Siddharta Gautama around 500 B.C., spread throughout Southeast Asia and Tibet and matured into its philosophical pinnacle manifested by Madhyamika (Nagarjuna 200 – 300 AD), and Yogacara (Asanga and Vasubandhu 300 – 400 AD).

In China, over 500 years passed since the time Buddhism was first introduced (ca. 100 B.C. – 100 A.D.) to the arrival of Boddhidarma ( 500 A.D), the legendary Indian monk who became the First Patriarch of Chan (Zen).

It took another 150 years and five more generations of teachers after Boddhidarma, before Hui Neng (638 – 674), the revered Sixth Patriarch appeared, and additional 200 years for Lin-chi (Rinzai) (d. 867) and Ts’ao-tung (Soto) ( 830) schools of Chan (Zen) to emerge.

Over 1,000 years passed in China, since Buddhism was first introduced, to the time when the first two major Zen koan collections – “Blue Cliff Record” (1125 A.D.) and “The Gateless Gate” (ca 1228 A.D.) were compiled.

Similarly, even if Buddhism arrived to Japan as early as 550 A.D., it took more than 250 years for it to fully settle in Kyoto during the Heian Period ( 800) and another 400 years to culminate in the Kamakura Period (1185 – 1333 A.D.).

Again, Buddhism was widely present in Japan for at least 650 years before the spiritual and poetic genius of Dogen and his mystical masterpiece Shobogenzo (1200 – 1253) appeared and established Soto Zen’s Ehei-ji temple as a major presence in the Japanese Mahayana Buddhism.

After Dogen, it was another 400 years more till the time when Hakuin (1686 – 1769) reformed Rinzai Zen and its use of koans at the Ryutaku-ji temple in Japan where it still continues today.

Buddhism was originally introduced to the West, about 1800, and it still seems to be in its infancy today.

Several generations of Asian pioneer teachers struggled with cultural and language barriers for several decades, as they attempted to bring authentic practice to the US and Europe.

First legitimate non-Asian Buddhist teachers began to emerge in the second half of the last century (ca 1950 –2000) and a transition to the second and third generations of teachers is currently under way in all major Buddhist traditions, nationwide.

More time is needed for Buddhism to take root on the American soil, more time to assimilate with the culture at large and to mature enough for its new, truly Western, form to eventually emerge.

Even more time is probably needed for an American teacher, another Nagarjuna, Asanga, Milarepa, Hui-Neng, Hakuin or Dogen to appear in the U.S., a teacher who will not only conclude the transmission of Dharma to this new land but who will also legitimize American Buddhism as a new and fully autonomous tradition.

And when it finally arrives, what is the American Buddhism likely to be, 400 – 500 years from now?

How is that future American Maitreya Buddha, likely to lead, galvanize and propel American Buddhism into its next Millennium?

Historically, Buddhism, born out of Hinduism and Yoga traditions in ancient India, has always tended to absorb native spiritual tradition and culture of the country to which it arrived. As it moved East throughout Asia, it merged with Confucianism and Taoism in China, assimilated shamanism in Tibet and adapted to the Shinto Samurai culture in Japan.

Similarly, the future of American Buddhism is likely to be shaped by the entire Western / American culture and its future evolution in the time to come.

One can anticipate that, by the year 2,500, American Buddhism in will have assimilated and merged with the following “Western” influences:

Democracy – contrary to more autocratic, male dominated Asian model, American Buddhists will embrace more democratic, egalitarian / libertarian approach, with man and women practicing together in centers governed by elective process where the role of a teacher is separate from the center’s administrator. A full spectrum of training models will develop, from more traditional monastic institutions to lay centers which are likely to grow in popularity. The Western appreciation of individuality, democracy and transparency will result in more horizontal, egalitarian approach to the interpretation of the Dharma, with multiple, loosely related “lineages” and a marketplace of individual preachers. Paradoxically, this model is likely to resemble the origins of Buddhism in 600 B.C. India where wondering “seekers” / “monks” gathered only during rain seasons to study and practice in one place and only to resume their individual/ solitary search afterwards. An individual “hermit” / Boddhisatva / preacher model is likely to emerge, in addition to more organized Buddhism-as-religion.

Science– science in general, and quantum physics and Unified Theory (when available) will replace Mahayana Buddhism as the new paradigm for the understanding of the Universe, Mind and Emptiness. American Buddhism will not only embrace science as the preferred language of the Dharma but a new, Scientific Buddhism will emerge as the dominant “school” of Buddhism not only in the West but worldwide.

Psychology – both Buddhism and psychology endeavor to alleviate suffering and to grasp the nature of Mind. Psychology without the Mysterium of spirituality and mysticism is incomplete, Buddhism without postmodern psychology is naïve. Buddhism will eventually adopt the language of cognitive neuroscience and psychology to redefine itself within the Western culture. Insights of psychology, psychiatry, brain science and psychotherapy will not only inform any serious spiritual training and practice in the future but will also permeate the “Western” interpretation of the Madhyamika / Yogacara Dharma. Buddhist teachers of the future are likely to undergo formal training in at least one of the above disciplines to match ever evolving psychological-mindedness of their Western practitioners. Seated meditation and mindfulness will continue as the key elements distinguishing Buddhists practice from other traditions.

Language – translating Buddhism into the Western context will impose the English language and its vocabulary on the Dharma. A complete translation of most of Sanscrit, Chinese, Tibetan and Japanese texts should be completed within the next 100 years and most of the Buddhist canon will be available to Western readers in English. Terminology and understanding of particular terms is likely to evolve to adjust to the usage within the Western culture. New, original, modern “sutras”, or Dharma texts, will appear and gradually replace the old ones. Future, American, Nagarjuna, Asanga, Milarepa, Hui-Neng, Hakuin and Dogen will “re-write” the old texts and create a uniquely English-language “school” of Buddhism.

Postmodern / postindustrial culture – Buddhism preceded some ideas typically associated with deconstruction and postmodernism for over 2,600 years. The lack (emptiness) of the subject and form, decentralization / multiplicity (Absolute / Relative) of signification and truth, quantum physics and interdependent origination – all point to inescapable parallels between Buddhism and the postmodern. The future Buddhism will continue to evolve within the postmodern Western culture and will become increasingly permeated by its ideas and values. Environmentalism and “engaged” Buddhism will play a significant role in defining how Buddhists will function in the future global / local marketplace.

Technology –Buddhism will evolve in the Millennium dominated by science and its applications – technology. In a few decades we will be able to effectively manipulate our genetic codes, and hence the life itself, will learn how to control and change, at will, our states of mind through new advances in molecular neuropsychopharmacology, and will be able to immerse ourselves in computerized virtual realities of our choice, leaving more mundane chores to increasingly more efficacious and omnipresent artificial intelligence tools and robotic appliances. Instantaneous visual-audio global access to any information, person or place anywhere on Earth, via the next generations of the Internet, will be taken for granted. Biological computers and ultramicrochip-enhanced biological implants will merge technology with brain functions, altering cognition, consciousness and the sense of individual identity. The new American “Scientific Buddhism” will emerge to embrace technology as its new “Great Vehicle” to ferry all sentient beings to the other shore of Existence.

Judeo-Christian tradition – Buddhism will assimilate many of the contemporary Judeo-Christian forms of monastic and lay practice, ranging from the Catholic monastery / church / priest model to the Episcopalian / Protestant / Baptist minister / preacher / congregation formats of practice. Buddhism will continue to struggle with the concept of Judeo-Christian monotheistic God. Interfaith dialogue(s) will emerge to clarify basic ideas and to enhance mutual understanding. The concepts of God and Buddha-Mind, along with neuroscience, will take the center stage in the multidisciplinary debate on the nature of the mind and spiritual and religious life.

Global marketplace – American Buddhism will embrace wholesome, not-for-profit entrepreneurial self-sufficiency, simplicity and non-attachment rather than poverty and asceticism. Although Buddhism originally developed within tribal / feudal cultures of ancient India, China and Japan, we are now witnessing an increasing emphasis on economic self-reliance rather than on alms-gathering or feudal / government donations and support. Sophisticated fund raising, students / members fees and small business ventures are likely to become dominant sources of income for Buddhist centers in the future. Separation of the spiritual teaching from the economics, similar to that of church / state in the society at large, will have to be strictly observed to prevent perception of exploitation. The issues of property ownership or de facto property control by teachers, non-attachment vs poverty vs asceticism will have to be addressed and resolved as a Dharma question and within the American Sangha to assure integrity, purity and depth of future practice.

The future is always different from our speculations about it. However, we know that Buddhism will have to change in its encounter with the West. The old Theravada / Mahayana tradition will be, eventually, replaced by a new “school” or paradigm.

Since science and technology, along with democracy and global marketplace, are the most dominant forces shaping the world today, the postmodern science will become the next discourse of Buddhism, not only in the West but worldwide.

That fully autonomous American / Western Scientific Buddhism will need a teacher, who like others did before, will propel it into the next Millennia. That person, whoever he/she will be, will find a way to translate the Dharma into a new language of science, psychology, cognitive neuroscience and postmodern / postindustrial culture.

To save all sentient beings, we all need to do our best to make it happen as soon as possible.

Buddha usually appear as “this very moment”, however perceived or defined. Being always “just that…..” Buddhas may or may not be perceived as Buddhas by others, nevertheless, they always continue being Buddhas just as they are. However, since the “as they are” is inherently empty and not any fixed entity, Buddhas appear as simply “this” […….] or “that” [……..], as me and you, as “this very moment” and as the entire Universe.

They “appear” only when Mind appears (…) divided into its object / subject modes of Being.

Whenever a Buddha realizes that he or she is Buddha as a human being, the Buddha, the Dharma and the Sangha rejoice, leap forward, and “Buddhism” takes yet another turn.

(Reprinted from MINDis 2003)