The Psychology of Consciousness: Theory and Practice: Hashim Talib Hashim Athanasios Alexiou Editors

Hashim Talib Hashim
Athanasios Alexiou Editors
The Psychology
of Consciousness:
Theory and
Practice
The Psychology of Consciousness:
Theory and Practice
Hashim Talib Hashim • Athanasios Alexiou
Editors
The Psychology
of Consciousness:
Theory and Practice
Editors
Hashim Talib Hashim Athanasios Alexiou
University of Baghdad - College of Novel Global Community Education
Medicine Foundation
Baghdad, Iraq Hebersham, NSW, Australia
ISBN 978-3-030-90691-7 ISBN 978-3-030-90692-4 (eBook)

https://doi.org/10.1007/978-3-030-90692-4
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I want to dedicate this work to my father
(Talib Hashim Manea) who supported and
cared for me all these years.
To my mother (Jawaher Mutar Mohammed)
for everything she has given me since I was
born till now.
To my grandmothers and grandfathers who
have given us such a great and
inspiring family.
To my brothers and sister who never give up
on me, and they were there all the time to
support me.
To my friends and to everyone said a
supporting word one day that made me
continue in our way.
To my professors and to my teachers and to
everyone who encouraged me to do it,
especially Dr. Samer Hoz who inspired me to
write and edit this book.
Foreword
The Psychology of Consciousness: Theory and Practice is a fundamentally impor-

tant book about one of the most important topics for the twenty-first century. It
combines the best of psychology, neuroscience, and consciousness studies, as well
as requires other disciplines to add voice to the discussion including physics, chem-
istry, and biology. Consciousness itself, of course, is the most mysterious of all
things that we contend with as human beings. We all feel quite confident that we
have consciousness and yet, it seems that it always eludes discovery whenever we
search for it with our scientific tools. Part of the reason for this problem is the con-
sciousness by its very nature is subjective. We exist within our consciousness, and
so do all of our investigations of consciousness. If science, psychology, and all the
other disciplines used to understand consciousness exist within our own conscious-
ness, we are at an immense disadvantage in trying to discover exactly what con-
sciousness is. But that is the lofty goal of this book which strives to understand the
psychology of consciousness with great breadth and depth of investigation.
This book brings together all of the new studies that have been exploring con-
sciousness and combines that understanding with ancient perspectives, spiritual
perspectives, and certainly multidisciplinary perspectives. This latter point is per-
haps the most important. The investigation of consciousness absolutely requires a
complex and integrative approach blending many fields of study and scholarship. A
related field of my own research focuses on neurotheology which seeks to under-
stand the integrative relationship between the brain and our religious and spiritual
selves. There is interesting overlap between neurotheology and the study of con-
sciousness because so many intense spiritual or mystical states are associated spe-
cifically with an altered state of consciousness. And vice versa, altered states of
consciousness are often described as being religious or spiritual. As a simple exam-
ple, recent research in the field of psychedelics has demonstrated that intense expe-
riences under the influence of drugs such as psilocybin are often reported to be the
most spiritual of all experiences for the individual. So, there is certainly a complex
relationship between intense spiritual experiences and alterations in the sense of
vii
viii Foreword
consciousness. Data such as these are part and parcel of a broader exploration of the
psychology of consciousness. And there are many other fascinating examples from
normal states of consciousness that are experienced by most people to pathological
states of the brain. Importantly, the authors do not shy away from a full exploration
of the topic of the psychology of consciousness.
They appropriately begin with definitions of consciousness. While this seems
to be a natural starting point, in and of itself, it is no easy task. First, conscious-
ness by its very nature is difficult to define. We can start with historical defini-
tions, but we must include more recent work to more deeply understand what
consciousness is. It is also interesting to consider consciousness from various
scholars including philosophers, theologians, biologists, and even those who pur-
sue artificial intelligence. Each of these different perspectives may provide a
slightly different type of definition for consciousness—some more practical and
some more esoteric. In addition to trying to drive a definition of consciousness,
we also have to consider a more operationalized perspective. In other words, how
does consciousness manifest itself within the brain, the mind, and perhaps even
the soul. These interrelationships are also essential for understanding conscious-
ness and also for pursuing future explorations both theoretical and practical.
Perhaps most important in the discussion of what consciousness is relates to the
relationship between the brain and the mind. The age-old question between the
dualistic approach that separates the brain from consciousness or an integrative
approach that combines them in some way is a fundamental target for this book.
If the brain creates consciousness, that leads to an entirely different kind of
approach than if consciousness creates the brain. These are the fascinating ques-
tions that are explored in the pages that follow.
One of the troublesome problems of consciousness is not just a basic definition
but the recognition of different levels of consciousness. There is the unconscious
mind that influences us, without us ever knowing it. Preconsciousness and subcon-
sciousness have an influence on our awareness. There is the conscious mind which
is the primary target of our understanding. But there is even a post-conscious mind
that helps us look back on our own awareness. Each of these needs to be explored in
great detail and is tackled by the authors of The Psychology of Consciousness.
Altered states of consciousness are an essential target of study when it comes to
understanding the larger concept of consciousness itself. They are also helpful in
bringing these questions to a more practical realm. By this I mean that everyone has
experienced certain states of consciousness throughout their everyday lives. The
most basic state of consciousness is waking consciousness which we use when we
go to work or school, talk with a friend, or watch television at night. This state of
consciousness is contrasted by the other most well-known state of consciousness—
sleep. We have all experienced our sleep consciousness and the different elements
that arise within it, particularly dream states. Dream states can be rather chaotic and
brief or long and complex. It is also interesting to note that when one shift from one
state of consciousness to another, we take different perspectives of those states. By
Foreword ix
this I mean that no matter how real a dream consciousness state may feel, when you
wake up, you immediately relegate that state to an inferior state of consciousness or
reality. This latter term is also an important part of understanding consciousness
since it is through our consciousness that we establish what reality actually is. But
what do we make of altered states of consciousness such as dream states, drug-
induced states, or even mystical states when it comes to which is real? It seems that
each of these states of consciousness carry with them a certain level of “realness,”
which we are able to compare against each other. But no matter how real any of
these states feel, they are all housed within our consciousness.
When considering these different states of consciousness, we also have to tie
everything back to our psychology and our biology. When talking about a drug-
induced state, we can ask the question as to what parts of the brain are affected by
the drug? Many psychedelics affect the serotonin system, for example. So why does
intense stimulation of the serotonin system lead to these powerful experiences and
altered states of consciousness. Is consciousness in the serotonin molecule itself?
Or does serotonin activate the neurons of the brain in such a way that facilitates
these shifts in consciousness? And what can we say about psychopathological states
such as depression or schizophrenia in the context of consciousness? Is there a way
to explore consciousness through the lens of psychopathology, and perhaps even
turn that discussion around to help those with these pathologies? The answers to
such questions drive at the heart of what consciousness actually is and how it works
with respect to the brain.
Moving beyond consciousness associated with human beings and perhaps other
animals, consciousness is within the field of computer-based artificial intelligence.
There has been a long debate as to whether we can produce a computer that has
consciousness. The argument focuses on whether consciousness is derivative of a
system’s degree of complexity or whether there is something beyond a complex set
of connections that leads to consciousness. If consciousness exists within the brain
simply because of its complex interconnected network of neurons, then arguably,
we can produce a complex enough computer that would become conscious itself.
But if consciousness derives from something more fundamental, it may be found
only in biological organisms. Alternatively, if consciousness is something that exists
beyond all physical matter, then it can potentially manifest in any physical system.
These are the types of fascinating questions addressed in the pages to follow.
In those pages, the authors will consider a great many of new findings related to
consciousness and strive to develop an understanding that provides important infor-
mation for many of the interrelated fields. Thus, this information is important for the
neuroscientist, the psychologist, the philosopher, and anyone else in the field of
consciousness studies. This book encapsulates a great many ideas and provides a
background that will help people to understand this incredibly complex topic. The
authors are also not afraid to explore a variety of consciousness-related topics that
may not be as popular as current mainstream ideas. But given the complexity and
the challenges around the understanding of consciousness, it is always important to
x Foreword
be open to the many possibilities, even those that seem unlikely. The famous author
and futurist, Arthur C. Clarke, once said, “The only way of discovering the limits of
the possible is to venture a little past them into the impossible.” This book provides
a little bit of a look at both the possible and the impossible and provides an essential
reading for anyone who wants to learn more about this curious thing called
consciousness.
Andrew Newberg
Department of Integrative Medicine
and Nutritional Sciences
Marcus Institute of Integrative Health,
Thomas Jefferson University, Philadelphia, PA, USA
Department of Radiology
Marcus Institute of Integrative Health,
Thomas Jefferson University, Philadelphia, PA, USA
7 December 2020
Foreword
The concept of consciousness has many meanings that are used depending on the
scientific discipline dealing with this idea. The term is also used in everyday speech.
We can describe a man who can critically evaluate his behavior as a person who is
conscious of his behavior. The same is stated by court experts when examining a
criminal who has premeditatedly committed atrocious acts. A conscious choice is
deciding about an activity after considering the benefits and consequences of such
behavior. Conscious decisions have been confirmed in numerous studies by parents
adopting a child, transsexuals who decide to correct their gender, or as is the case in
some countries, chronically ill people who decide to consciously take their own
lives (euthanasia). Consciousness is therefore intentional (Husserl 2002). It is a cer-
tain type of knowledge about a given topic that leads to making a deliberate choice.
One could also say that consciousness has its scope. We speak of global con-
sciousness in the context of targeted measures to improve the quality of life on our
planet (Elgin 1997).
Environmental consciousness is the understanding of the relationship between
human activities and the world of nature (Bonnett 2017). Social awareness is the
totality of ideas, opinions, beliefs, and views—the way we understand and define
the environment—the totality of scientific, philosophical, ideological, political,
legal, religious, and ethical views that make up the way of thinking and culture of a
given society (Durkheim 2003). Awareness of one’s surroundings allows you to
move safely in a certain area or avoid a place due to the hazards there. Self-
consciousness is the ability to undertake activity adequate to the circumstances,
using cultural capital (collective consciousness), learned skills, and respect for val-
ues and principles.
Consciousness may be disturbed or lost as a result of a sudden event or deteriora-
tion of health. It is also possible not to be aware of something due to the lack of
knowledge in a given area or because of strong emotions that interfere with a ratio-
nal assessment of the situation. Consciousness can be acquired, and by planning or
unintentional actions, one can also deprive someone of awareness. Consciousness
can be deepened, expanded, enriched, and impoverished. Consciousness is there-
fore plastic.
xi
xii Foreword
Consciousness can also be manipulated. Altered states of consciousness are most

often deliberate modifications of the perception of oneself and the environment,
provoked by means of having such potential (Bayne and Carter 2018). While the
incidental use of mood-altering agents should rather not leave permanent traces in
consciousness, frequent or habitual use of these agents may lead to profound distur-
bances of self-awareness (the conscious self), requiring specialized long-term
psychotherapy.
Pure consciousness is a state of a deep and alert mind (Husserl 2002). Dirty con-
sciousness is knowledge about oneself and one’s behavior distorted by defense
mechanisms (Woydyłło 2014). Researchers of addicts indicate several forms of dis-
tortion of self-awareness caused by the abuse of intoxicants in this group: disper-
sion, splitting, or even hollowing out the structure of the “I” (Mellibruda and
Sobolewska-Mellibruda 2006).
In recent decades, the concept of consciousness has been enriched with another
designate. When speaking of conscious machines, we mean extremely efficient
computer systems that can perform work just like a human, and even almost com-
pletely exclude human participation. It is true that calling these machines conscious
is subject to numerous discussions, but researchers indicate that technical progress
does not exclude such achievements in the future (Al-Imam et al. 2020).
The above examples of defining consciousness are only a modest fragment of
what many researchers propose, and the book that the reader holds in his hands
skillfully combines previous achievements with proposals for further expanding
knowledge in this field.
Consciousness and its disorders are subjects close to my profession. As an addic-
tion therapist, in every case of working with a patient, I encounter at least a double
image of what is fact and what has been grounded by distortions of the perception
of the person who is going to be treated. In addicts, disturbances of consciousness,
especially self-consciousness and one’s abilities, are a consequence of dualistic
self-perception in situations related to being under the influence of intoxicants and
being sober. Blocking is a common procedure triggered by the addict’s own defense
mechanisms (especially by the mechanisms of illusion and denial). A strong desire
to forget or reject unpleasant events can block the access of consciousness to
unwanted and unpleasant memories for many years. Such displacement from mem-
ory may in some way protect against unacceptable facts from one’s own life by not
allowing one’s behavior to change. However, displaced events can survive on the
unconscious level and cause emotional conflicts for a long time. The mechanism of
denial created and strengthened during the development of addiction is an effective
barrier against the acceptance of any information indicating the negative conse-
quences of using mood-altering agents. The “disarmament” of this mechanism and
unblocking of the consciousness during therapy allows us to understand that past
failures and errors are the result of using these agents. Withdrawal of drugs or alco-
hol will not erase an unfavorable image from memory, but it can certainly stop the
process of its distortion and may initiate the accumulation of new, better memories
(Motyka 2015). Self-consciousness can therefore be restored, and not only to those
Foreword xiii
who lost it as a result of illness or accident, but also to those who had manipulated
it. This is just one example of the possibilities of working on consciousness.
Learning about consciousness is a journey. Cognition may be an aim in itself, but
there may be many ways to obtain this knowledge. The traveler may choose a direc-
tion determined by philosophy, psychology, neurobiology, or other sciences refer-
ring to processes related to the creation, acquisition, consolidation, or change of
consciousness. They can also try to cover each of these domains.
It was an honor for me to write a foreword to this book. Having read the chapters
that were sent to me, I am proud to share my thoughts and encourage you to read
this book.
As I wrote above, learning about consciousness is a journey. Therefore, I invite
readers to the extraordinary journey that this book is. Each chapter can be a supple-
ment to the others, and all of them can certainly contribute to the expansion of our
knowledge (and therefore consciousness as well). The journey begins with an intro-
duction to the understanding of consciousness from ancient cultures, through the
deliberations of philosophers and psychoanalysts, to the contemporary definition of
consciousness and an interesting theory of post-consciousness proposed by the
authors. Colorful illustrations, similar to beautiful landscapes, allow you to stop
during this journey and record the adventure with this book better. The continuation
of the educational journey is getting to know the relationship between the brain and
the mind, exploring the essence of the levels of consciousness, both human and
machine. The next stages of the journey through the land of consciousness are other
interesting places, the exploration of which will certainly result in the acquisition of
new knowledge that can be stored in our personal “storage room.” Hypnosis and
awareness, sleep and dreaming, defense mechanisms and altered states of con-
sciousness are areas that are definitely worth exploring. The chapter describing
changes in consciousness caused by the agents causing such modifications is a par-
ticularly interesting stage in my adventure with this book. This is a difficult but defi-
nitely interesting subject. It is good that it was included in the “journey” proposed
by the authors.
The book is aimed at doctors, psychologists, psychiatrists, philosophers, and
mental health professionals, but in my opinion, representatives of other scientific
disciplines can also use it. Importantly, the accessible narrative makes this book
suitable for students at all levels of education.
The authors deserve special recognition for their holistic approach to the subject
matter, for taking up a topic that is not easy, yet presenting it in an accessible way
while adding something new in this regard. Each chapter encourages you to con-
tinue this intellectual and scientific journey and move on to the next pages. There
xiv Foreword
are no boring clichés and unnecessary duplications of what has already been done
in this area. Instead, there is good scientific text that is fresh, evokes reflections, and
remains in the reader’s memory.
It is a pleasant educational journey.
Let us travel then!
Marek A. Motyka,
University of Rzeszów
Rzeszów, Poland
11 December 2020
References
Al-Imam A, Motyka MA, Sahai A, Konuri VK. The “March of Progress”: from cosmic singularity
to digital singularity. Curr Trends Inf Technol. 2020;10(1):1–8.
Bayne T, Carter O. Dimensions of consciousness and the psychedelic state. Neurosci Conscious.
2018;1:niy008. https://doi.org/10.1093/nc/niy008.
Bonnett M. Environmental consciousness, sustainability, and the character of philosophy of educa-
tion. Stud Philos Educ. 2017;36:333–47.
Durkheim E. Les formes elementaires de la vie religieuse Le systeme totemique en Australie [The
elementary forms of the religious life]. Paris: Presses Universitaires de France; 2003.
Elgin D. Global consciousness change: indicators of an emerging paradigm. 1997. https://duaneel-
gin.com/wp-content/uploads/2010/11/global_consciousness.pdf. Accessed 11 Dec 2020.
Husserl E. Ideen zu einer reinen Phänomenologie und phänomenologischen Philosophie [Ideas
pertaining to a pure phenomenology and to a phenomenological philosophy]. Berlin: De
Gruyter; 2002.
Mellibruda J, Sobolewska-Mellibruda Z. Integracyjna psychoterapia uzależnień [Integrative
addiction psychotherapy]. Warszawa: Instytut Psychologii Zdrowia; 2006.
Motyka M. Pamięć niszcząca, pamięć uzdrawiająca: labirynty wspomnień osób uzależnionych od
środków psychoaktywnych [Destructive memory, healing memory: labyrinths of memories of
people addicted to psychoactive substances]. Problemy Higieny i Epidemiologii.
2015;2(96):321–8.
Woydyłło E. Dobra pamięć, zła pamięć [Good memory, bad memory]. Kraków: Wydawnictwo
Literackie; 2014.
Foreword
I believe something magical can happen when you read books.

I believe that one day the girls I see with books
all the time become great writers.
Indeed, a moment of pride.
When passion meets profession and you surround yourself with people having
the same passion as yours, motivating each other, they end up doing what their heart
says and not what people say: that’s when history is created. This is the success
mantra of many great people “Follow your dreams.” Today, their dream of writing
has turned to reality in the form of a book and has reached your hands which is now
a part of history.
The aim of this book is to acquaint the readers with the multidimensional aspects
of human psychology in a much easier way.
The content has been woven into short precise interesting parts to make reading
of the most complicated subjects easy to understand.
Interestingly, there has been a dearth of literature on this complicated subject. It
was my dream too to write a book on my most favorite subject “The Human
Psychology” to reach out to international readers. These future doctors have made
my dream come true.
I am proud of them, and they have it in them to power on.
More specifically, the objective of this book is to provide breadth and insight into
the subject with the view to stimulate the readers, so that they involve themselves
actively while reading and understanding the concepts of human psychology well.
I acknowledge the efforts of the young team behind this book.
Their hard work is appreciated, and I wish them all the best.
I hope the readers will find this book useful.
Lokesh Babu,
Sneha Mano Vikasa Kendra,
Sejal New Life Foundation
Bangalore, India
xv
Preface
The consciousness is something not well understood, and it is vague in many

aspects, so trying to understand it well is something impossible, but many theories
have emerged to discuss it. And it is necessary to write an independent book about
it to make it a popular subject for research and studies.
This book talks about the levels of consciousness and their roles in controlling
our life and behavior. He consciousness ha a main role in learning human to behave
and to live in all life’s situation and ages. This book clarifies these situations in
detail and the laws that make this system work properly. It provides many solutions
and suggestions to control ourselves and our minds and put them in the right way.
This book explains many of our behaviors depending on the psychology and the role
of the consciousness in psychiatry, how to treat diseases and mental disorders, and
how to improve the mental health as well.
This subject is not well discussed and detailed in literature so there is a need to
give this topic its role in the psychology and in scientific literature too.
This book targets the consciousness’ levels and the role of these levels in our life
and behavior, so it divides the roles among them as appropriate and in the right way
and then the humans can recognize which part is more important than the other and
on what they should focus.
We have tried to put all the knowledge related to consciousness in this book from
A to Z by making one understand the modern theories and studies clearly.
What makes this book unique is collecting all the theories and explanations of
the consciousness in an integrated style so every chapter is related to the other and
completes it.
We hope that the students, researchers, professors, and readers will understand
the consciousness in a very easy and understandable way that allows everyone in
any level to have an idea about consciousness.
Baghdad, Iraq Hashim Talib Hashim

Hebersham, NSW, Australia Athanasios Alexiou
xvii
Acknowledgments
We want to thank those people who helped us during the journey of writing this
book. They are:
Mustafa Ahmed Muhson, Yehya Zia Tuama, Ahmed Dhiya Sagban, Shoaib
ahmed, Mohammed Yasir Essar, Dr. Samer Hoz, Christos Tsagkaris, Ali Mahdi
Mansour, Mojtaba Talib, Mohammed Qasim Mohammed, Ahed El Abed El Rassoul,
Abbas Kamil, Abbas Mutar, Mohammed Abbas, Mariam Alaa, Fatima Abbas, Dr.
Nabeel Al Khateeb, Sarmed Kadhem, Zain AL Saleh, Intsar Jabbar, Dr. Alaa Jameel,
Dr. Hussein Al Zaidy, John Bchara, Morad Yasir Al Mostafa, Abdallah Reda,
Nazmus Sakib Choudhary, Fahtiha Nasreen, Hadi Hussein, and Muslim
Hassan Manea.
xix
Contents
Introduction�� 1
Hashim Talib Hashim, Mustafa Ahmed Ramadhan,
and Mehek Cheema
Brain and Mind�� 19
Hashim Talib Hashim and Adil Alhaideri
Levels of Consciousness �� 27
Hashim Talib Hashim and Mustafa Ahmed Ramadhan
Sleep and Dreaming �� 39
Saleh Abdulkareem Saleh

Defense Mechanisms and Personality Disorders�� 57
Drugs and Consciousness�� 81
Mustafa Hayder Kadhim

The Altered States of Consciousness�� 95
Hypnosis and Consciousness�� 109
Artificial Consciousness�� 119

Relativity of the Human Mind�� 127
Death and Consciousness�� 131
Index�� 135
xxi
Introduction
Hashim Talib Hashim, Mustafa Ahmed Ramadhan, and Mehek Cheema
1 Mayan and Incan Theories of Consciousness
These are the early recognized explanations of consciousness. Despite being primi-
tive, they created a steppingstone for developing consciousness theory (Wilber 2004).
They suggested a sensible organization, a sensible organization, a temporal rela-
tionship between the consciousness levels and the humans. “The awareness of being
aware” is the definition used by Shamans and priests (Mayan Theories) (Fig. 1).
It is recognized as a branch of metacognition (higher order thinking skills,
defined as cognition about cognition, thinking about thinking, and knowing about
knowing). Thus, for example, these levels will be organized in a pyramidal shape
from the cellular level to a universal level as shown in Fig. 2.
These are the steps of the development of consciousness according to Mayan
theories. At the same time, Incan theories related to civility, which means progress-
ing from level to level in relation to other changes and concerns (Fig. 3). Thus, the
third level is recognized as the level of most people, and the fifth level is the sign of
Taripay Pacha (Inca day of judgment).
H. T. Hashim (*) · M. A. Ramadhan

University of Baghdad, College of Medicine, Baghdad, Iraq
M. Cheema
Vardhman Mahavir Medical College, New Delhi, India
© The Author(s), under exclusive license to Springer Nature 1

Switzerland AG 2022
H. T. Hashim, A. Alexiou (eds.), The Psychology of Consciousness: Theory and
Practice, https://doi.org/10.1007/978-3-030-90692-4_1
2 H. T. Hashim et al.
Fig. 1 The first definition

of consciousness
Fig. 2 Τhe steps of the development of consciousness (Pons and Harris 2001; Morin 2006)
2 John Locke on Consciousness
The philosopher, John Locke, was from the earliest interested in consciousness. The
main idea of his theory was “Personal ID” and the “Consciousness after death.” He
thought that the personal human ID is essential for psychology’s continuity. He
considered personal ID or the human’s self as part of consciousness, but it is not
involved in the soul or the body matters (Kriegel 2006).
Personal identity theory is a confrontation in philosophy with the questions
humans ask about their origin and presence and the end of their life, like who is the
Introduction 3
Fig. 3 The development of consciousness according to the Incan theories
human, why we are here, will live another life after we die, etc. So, it aligns with
consciousness, starting with it and ending with it consequently.
According to Locke’s theory, “Understanding is one of the first model conceptu-
alizations of consciousness as repeated self–identification” (Nimbalkar 2011).
Locke created what’’ called an “Empty Mind” full of nothing, which can be created
by ideas such as the experience, the sensations, and the reflections. He created a
common concept between the body and the soul, which might not be acceptable to
those who identify consciousness as the brain. According to his theory, the brain is
similar to the body and, similarly to any other substance, may alter while conscious-
ness remains identical. Therefore, personal identity cannot be located in the brain
but within consciousness. The issue with this theory is life after death because to
stay alive after death, there should be a person similar to the person who was there
before death.
He suggested that consciousness can move from anyone’s soul to another one’s
soul, and he thought that the Id moves with it.
John thought that God sees differently from others, so people will judge you
about what they see, but God does not. As a result, the human will be responsible
for the actions for which the human is conscious (Butler 1975; Reid 1785).
John concluded that the actions and ideas that the person makes during youth
would shape the future and be the cornerstone for the upcoming actions.
Fig. 4 The two domains of consciousness according to the Cartesian Dualism
3 René Descartes on Consciousness
It discussed Cartesian Dualism, which concludes the coming of nonphysical thing,

which is the consciousness from the physical thing, the human body. This theory
has two domains that consciousness resides in, which are given in Fig. 4:
1. Res Cogitans (The realm of thought) is the immaterial domain.
2. Res Extensa (The realm of extension) is the material domain.
The correlation of mind and body is not about how they can react but beyond
that. It is about how they can be related and how they affect one another. The char-
acteristics of each one is different from the other.
The mind does not occupy a space as the body does. The theory of Descartes
suggests that consciousness is not a matter like the brain. It has no shape or physical
properties. Human bodies indeed occupy space, and minds do not, in the very
straightforward sense, assign linear dimensions and locations to the mind, or its
contents and activities are obscure (Miller 2005).
Mind and body interactions are impossible because it contains contraindication
of in space existence, so he suggested that the nonphysical (Not in Space) must act
on what is physical (in space). He claimed a more robust and more immense power
outside the human consciousness that affects the mind. Descartes depended on the
theory of emotions and thinking while presenting his ideas about consciousness. He
developed the meditations in Meditation I to protect this phase of detachment from
the senses. Meditation II, in the cogito, brings the realization of an initial reality. He
also states that cogito’s consequence is only understood because the mind perceives
it “clearly and distinctly.” Therefore, as the mark of reality, he creates distinct and
straightforward logical perceptions, independent of the senses.
In Meditations III–VI, Descartes then unfolds the effects of simple and distinct
perception, and in Principles I–II, he repeats and expands these outcomes. Finally,
we consider these outcomes in Seconds.
In meditation one, he brings the senses into question, while in Meditation VI, he
affirms that the senses are not supposed to be aware of the “essential essence” of
external things. In this way, his role in the Meditations differs from that in the Laws.
He permitted specific “simple natures” relating to corporeal objects to be regarded
through the representations of the senses in that work.
Introduction 5
In acquiring human intelligence, he attributed two functions to the senses.

He understood that the senses are essentially sufficient for the body to perceive
advantages and harms. But, in reality, he found their ordinary task to be “to remind
the mind of what is advantageous or detrimental to the composite of which the mind
is a member,” that is, to the composite of mind and body.
In reality, Descartes argued that all thoughts are, in some way, alive. The infor-
mation would not come from the mind alone in Descartes’ system of mental ability.
The will belongs to that role. Unless the will has confirmed or rejected the substance
provided by the intellect, a verdict, and therefore an example of (at least putative)
knowledge, does not occur in this system. In reality, Descartes argued that all
thoughts are, in some way, alive. Suppose perception (intellect, representation) is
the essence of cognition.
There are many criticisms about this theory, we will conclude them in the
following:
• It does not create a difference between thoughts and matters; instead, it makes
this dichotomy the starting point in solving-knowledge theory issues. Thought
and matter are ontological (things can exist), but consciousness describes our
reactions that are being given in immediate, during sleepness, or while awake. It
does not differ from animal to human. Human consciousness is the interaction
between physiology and behavior; both physiology and behavior are the objec-
tive processes that can be observable (Fig. 5).
• Princess Elizabeth and Pierre Gassendi presented that if the soul affects the body,
it must contact it. To do that, the soul must occupy space and have an extension.
So, we conclude that the soul is physical by the criteria of Descartes’s theory.
Fig. 5 Human consciousness is the result of the interaction between physiology and behavior
4 Spinoza Ideas
Spinoza sought to transcend Descartes’ dualism. Rather than matter and mind
becoming independent objects, Spinoza claimed that there is only one concept.
Therefore, mind and extension are the properties of that one substance.
So, this merely changed the dualism of objects to a dualism of qualities. But
unfortunately, it also retained Nature’s mechanical concept presented by Descartes,
rendering humankind exposed to an absolute mechanical fatalism.
5 Sigmund Freud on Consciousness
Sigmund Freud is considered the father of psychoanalytic theory, and we will

depend on his ideas in classifying the levels of consciousness in the next chapter. He
suggested a new and powerful way of thinking and investigating human thoughts,
actions, and interactions (Hughes and Hoffman 2008).
He limited the role of the consciousness to that of an epistemological tool to know
about certain areas of mental state, thus removing all ontological aspects. He thought
that some states of mind could be found outside human awareness. That made him
reshape the concept by rejecting the ontological principle of all states of consciousness.
According to Freud, “Consciousness is a fundamental and irreplaceable phe-
nomenon regardless of the name” (Natsoulas 2001).
Awareness has been used to express what we mean when we are conscious of
something and express the latent knowledge of something. “Conscious, if it is not
burdened with any additional meaning, may indicate what is immediately subjec-
tively and introspectively given an experience. So conscious can involve abstract
ideas, obsessional preoccupation, and even hallucination” (Mcleod 2021).
Humans are conscious of psychosis, dissociative states, intoxication, and so on. But each of
these cases is in different mental organizations of experience, obeying different organiza-
tion principles and existing with different levels of categorization and abstraction. The
experience of consciousness may differ in each state, but consciousness as a subjective and
introspective given is indivisible regardless of the state (Mcleod 2021).
Freud describes consciousness as a quality and the capacity of transforming experienced
activity into unconscious states. This is similar to how the different forms of energy are
interchanging in physics. It could also play a role in inhibiting and restricting certain
thoughts from becoming conscious. It also refers to transforming quantities of unconscious
excitation into a qualitative experience of pleasure and unpleasantness (Mcleod 2021).
Freudian theory has two components, topographical theory and structural theory.
These two theories overlap and interact with each other (Fig. 6).
Topographical Theory of the mind: It consists of three levels, and each of those
three levels is specialized in some regions and thoughts. These three levels are:
1. Unconscious
2. Preconscious
3. Conscious
Introduction 7
Fig. 6 The two

components of the
Freudian theory
We will discuss these levels in detail in chapter “Levels of Consciousness”,

which talks about the levels of consciousness as they are important and representa-
tive of human behavior. It is the most acceptable theory with some issues.
Structural Theory of the mind: These levels are also essential, and they overlap
with the levels of topographical theory, so we will leave the details to chapter
“Levels of Consciousness”.
1. Id
2. Ego
3. Superego
The structural theory overlaps with the topographical theory to create the proper
way of thinking and behaving and explain feelings and emotions.
6 Modern Theories of Consciousness
Even though the Freudian theory is still the most known explanation for con-
sciousness, many schools and fields of psychology have started to develop new
theories and levels to widen the science of consciousness. But all these theories
are going in the same way, which is to understand the human self and answer the
questions and queries of the consciousness. There are many models developed to
explain the levels of consciousness depending on many criteria. We will discuss
three models of these modern perspectives and the levels that they thought more
suitable:
6.1 Holder’s Levels of Consciousness
Holder divided the consciousness into three levels that give distinct differences in
how they are reached.
Spontaneous: The mind keeps up the development and the progression of life
regardless of the future and the past events.
Calculated: It depends on the mind’s ideas of what is right and what is wrong.
Imposed: No awareness, and it ends with failure.
6.2 Levels of Consciousness, According to Barrett
He suggested seven levels going on logically (Fig. 7).
6.3 States of Consciousness According to Gibson
Dr. Bob Gibson stated four levels of consciousness: tiers of extrasensory awareness
(Pons and Harris 2001; Tindall 1990). These levels interfere with the previous theo-
ries of the modern insight of consciousness. Gibson’s insight focuses on some
moments of a human’s personal experience.
1. Sleepness: “Unaware of all surroundings, dreams may or may not occur.”
Fig. 7 Levels of consciousness according to Richard Barrett

Introduction 9
2. Waking sleepness: “Normal tasks can be performed in sleep, but the individual
is not receptive to what is taking place.”
3. The self-awareness: “Able to identify surroundings and observe what is tak-
ing place.”
4. The objective awareness: “Identify surrounding events without opinions or
inputs.”
Gibson’s theory is more acceptable and accurate than the other theories in mod-
ern ideas. It is very descriptive and observable (Pons and Harris 2001; Tindall 1990).
6.4 8-Circuit Model of Leary About Consciousness
It is a combination of theories developed by Leary and Wilson. It consists of eight

circuits, suggesting that the altered states of human consciousness come from eight
brain regions.
This concept connects psychology to neurology and biology. It also incorporates
elements of sociology, anthropology, physics, chemistry, and advanced mathemati-
cal formulas (Wilson 2008).
6.5 Morin’s Integration
It is similar to the idea of Gibson, but it is concluded in four models as suggested

in Fig. 8.
Fig. 8 Morin’s hierarchy of conscious states

6.6 Moore and Gillette
It is an analytical description for imagination and the control of great power such as
God and prophets (Lee 2012).
7 Developmental Psychology on Consciousness
A typical agreement remains on a few key points in the developmental growth of

young children, such as the manifestation of the first social grin, the first voluntary
moves, or the first sentences (Fig. 9).
A kid put in front of a mirror before the second year will usually whistle, coo, or
show evident joy on seeing movements reflecting from the shiny surface of the mir-
ror at them. However, the specular picture correlates dramatically different activi-
ties within 2 years.
The levels are described below in detail:
Level 0: Confusion: The person is characterized as unaware. The picture of specula-
tion is confused with the reality of the world it portrays. It is seen as a simple
continuation of, not a representation of, the universe.
Level 1: Differentiation: The person begins to be aware. This is the first degree of
separation between the self and the world: a distinct self is articulated.
Level 2: Situation: The person can link the body image and the body’s movements,
so the person thinks systematically. There is no misunderstanding at this stage.
The person knows that what is seen in the mirror is particular to himself.
Level 3: Identification: The person realizes the relationship between the self and
the outside environment.
Level 4: Permanence: The person can keep thoughts by remembering and memo-
rizing them over a long time.
Fig. 9 Developmental psychology on consciousness

Introduction 11
Level 5: Self-consciousness or “meta” self-awareness: At this level which is the

last one, the person can realize the self in the other’s eyes by being aware of him
or herself.
Finally, the access and phenomenal consciousness factors depended mainly on
the capacity of children to respond to their emotional states orally and to partake in
pretend play as the primary evidence for children with the proper form of skills. The
capacity to comprehend and use verbal representation and to pretend to play needs
at least the production stage of different models. The way the universe (labeled as
“real” or “fact”) is portrayed by one model and another model is expected to display
the orally defined universe or pretend scenario (labeled as “false” or “nonfactual”).
In other terms, linguistic explanation and pretense both require clear factuality to be
minimally transparent.
Piaget has a role in developmental psychology as well. He stresses that “mean-
ingful inference” is the most common feature of the conscious systems, starting
from the most superficial understandings of consciousness. It is defined by com-
municating concepts and putting them together in the form of a relation. Piaget
argues in favor of causal isomorphism and participation in consciousness grabbing.
The implication is a relation between interpretations. Suppose the causal coordina-
tion of behavior causes their material aims to be accomplished. In that case, the
system of substantive consequences offers an aspect that is not known, either con-
cerning the objectives or about the means used, in an acquisition that involves their
importance, albeit a restricted acquisition: it is the determination of the motives,
without which milestones reflect merely facts without importance.
8 Social Psychology on Consciousness
Psychology and especially social psychology are fundamental sociological sci-

ences. In reality, social psychology has mainly grown through the efforts of sociolo-
gists even though it is confusing to be declared as a branch of sociology instead of
psychology. For instance, Professor Ellwood prefers the designation “psychological
sociology” for social psychology.
It is a valid interest to understand social activity and consciousness solely as a
process of the individual’s psychology to a particular portion of his environment,
without thinking about the formation of the character of groups emerging from
these reactions. The two sciences must remain distinct fields of study, notwithstand-
ing the good offices and desires of sociologists (Bargh 2007).
The effect of one human upon another is often a matter of behavior. One indi-
vidual activates, and the other reacts: We have the essence of social psychology in
this process. Therefore, one organism activates another through some external indi-
cation or action; it is never perception. Stimulating and inhibiting both. At times, the
responding actions may be followed by a social form of consciousness in the
persons concerned; however, as far as we know, there is no immediate action of one

person’s consciousness on another’s consciousness or actions.
In several quarters, an effort is underway to restrict the concept of culture and
social science to forms of social contact where there is knowledge of others and
social connections. This restriction is both non-essential and restricted from the
point of view of the present job. As we just pointed out, consciousness has little
impact, thus not clarifying something about human beings’ reciprocal responses.
In social psychology, its function is analytical rather than explanatory, as in the
non-social branches of research. No forces are binding the collective together, and
no way of accessing the culture of thought or organized life, except in the most
socialized and aware communities by the inner stimulation of one individual by the
actions of another. In addition, if this term is intended to mean a form of stimulation
other than physiological, it is not an “internal” inner stimulation, for there is no
form of stimulation other than physiological. It would also be more fitting to accept
that all types of animal life in which we see definite social activity are called in the
field; that is, human reactions to each other.
In our present social psychology concept, social consciousness follows such
social activity in the lower modes of existence, while of speculative importance, can
be waived as non-essential. However, the social consciousness aspect in the subse-
quent chapters will not be overlooked by any means. On the contrary, it will be
remembered wherever it is crucial in the entire situation or beneficial in determining
the standards of conduct.
In our modern understanding of social psychology, the issue of whether social
consciousness follows such social activity in the lower modes of existence, while of
speculative concern, can be waived as non-essential.
At the time, these results were shocking (to social scientists and the general pub-
lic) because they defined the strongly held belief of people that one’s conduct was
under the internal and conscious influence of one. Social psychology concentrates
on interpersonal mechanisms of a comparatively higher order of complexity than
cognitive psychology or cognitive neuroscience: for example, judgment, target pur-
suit over long periods, and actions in social interaction. Maybe as an inheritance or
vestige of this long-standing conceptual status, therefore, by taking a central func-
tion for conscious (intentional, effortful, and conscious; see next section) decision
and monitoring processes, social psychology appears to begin its study of any
dynamic, significant phenomena. The study then has the effect of exploring the
extent and function of the mechanism or phenomenon’s non-conscious components.
In other typical fields of social psychological investigation, this phenomenon can
also be observed. For example, early attribution theories were started by logical
scientists with a model of humans, using effortful and deliberate “variance analysis”
strategies to draw causality inferences. However, attribution theory moved to a more
automated and less deliberative model as the research proof came in.
The motives and origins of their actions are mainly mysterious to individuals. In
reality, new scientific research points to a profound and underlying dissociation
between conscious consciousness and the mental mechanisms responsible for one’s
Introduction 13
actions across many various fields of psychology; several of the wellsprings of

actions seem to be invisible to conscious entry.
Knowledge of impact factors on decision and social behavior has long been an
important research subject in social psychology. Starting with Nisbett and Wilson’s
1977 seminal work, researchers found that individuals were ignorant primarily of
actual strong effects on their decisions and actions. For example, laboratory subjects
watched a work interview where the interviewee spilled coffee in one study. While
others saw this tape without the event of the spill, attributes and stereotypes are first
triggered in an off-hand, indirect way and then affect the subsequent decisions or
actions of the individual, giving another indication of the dissociation between sig-
nificant environmental factors and the perception of those factors by the person.
In several experiments, the key variable as to whether a person can regulate the
external influence is not whether the person per se (i.e., whether it was subliminal
or supraliminal) is aware of the controlling stimuli, but rather whether the person is
aware of the possible effects of that stimuli.
Therefore, the subliminally presented priming stimuli have the same effect qual-
ity as those supraliminal presented, as long as the participant does not expect or
appreciate that the stimulation could affect them.
Without the need for deliberate control of the person, action tendencies can be
triggered and set into motion; even complex social activity will unfold without an
act of will or knowledge of its origins. Proof from a broad spectrum of psychologi-
cal investigation fields is associated with this proposition. For example, in cognitive
science, clinical evidence from patients with frontal lobe lesions, action and goal-
priming trials, cognitive neuroscience analyses on frontal lobe structure and func-
tion as well as distinct actional and semantic visual pathways, cognitive psychology
experiments on working memory components, and the degree on conscious access
to motor activity converge on the conclusion that complicated activity and other
higher mental processes will proceed independently.
Indeed, neuropsychological research shows that such freedom is intended for the
human brain. This is not to suggest, though, that knowledge does not exist or is
simply an epiphenomenon. It also means that if any of these things can be done
without deliberate choice or direction, then probably somewhere lies the object of
consciousness (i.e., why it evolved).
While we do not yet know anything about the evolution of non-conscious target
pursuit capacities, the most probable guess is that they evolve out of regular and
reliable practice, much like other automated processes. In the case of automatic
target pursuit, this suggests that the person most likely deliberately chooses to
achieve that particular goal in that particular situation at one point, then picks it
again, and so on until that representation of the target is so closely associated with
that representation of the condition that the former is immediately associated with
the latter.
The object of consciousness could be for the assemblage of complex uncon-
scious abilities, which is why it evolved (Fig. 10). In accordance with the general
plasticity of the growth of the human brain, human beings have the capacity to cre-
ate even more complex automatic “demons” that sublimely suit their idiosyncratic
Fig. 10 The creation of

human complex conscious
abilities
environment, desires, and purposes, unlike even our closest primate family.
Interestingly, then, one of the main aims of conscious processing at the person’s
level might be to remove the need for himself as far as possible in the future, freeing
himself up for even greater things. Indeed, if the evolved aim of consciousness
turned out to be the development of ever more complex non-aware systems, it would
be ironic, considering the juxtaposition of automatic and aware systems in contem-
porary social psychology.
9 Neuropsychology on Consciousness
In neuropsychology, localization of the psychological roles in the brain has histori-

cally been focused on the finding that there is a deficiency or disorder of a certain
psychological capacity in patients carrying a lesion in a specific cerebral area,
whereas other abilities are retained. In the frontal lobe of the left hemisphere, the
speech was located because lesions in that area induce expressive aphasia. However,
comparable destruction in the right hemisphere does not have such an effect. In
humans, cognitive perception relies on the function of the brain, so neuroscience
can help to understand cognition (Gennaro 1996).
What would it feel like for cognition to be explained by neuroscience? In doing
so, how much progress has neuroscience made? What challenges are they facing?
How will those problems be met? What is the metaphysical value of its results? This
entry answers these and similar questions.
Consciousness and unconsciousness are two separate stages of the entire body in
regular daily life, based on various active modes of brain functioning, which alter-
nate with the sleep-wake cycle somehow, but are partly independent of it. Compared
to the pathological types of brain dysfunction that underlie coma unconsciousness,
Introduction 15
Fig. 11 The neuropsychology of consciousness; linking the brain to consciousness
the normal brain is still involved. The natural unconsciousness of dreamless sleep is
a physiological state of brain functioning.
We will discuss the neuropsychology of consciousness with details in chapter
“Brain and Mind”, linking the brain to consciousness and discussing the differences
between the mind and the brain (Fig. 11).
10 Hashim and Mustafa Theory of Postconscious
It is a newly developed theory in 2019. They defined consciousness as behavior and

everything related to behavior is considered to be controlled by consciousness.
It is an extension of the Freudian theory, and it rearranges the areas of conscious-
ness with an additional new concept called “Postconscious,” which relates to future
action and upcoming thoughts (Hashim and Ramadhan 2019; Hashim 2020).
This theory is novel, and studies have taken place to deeply discover this new
level of consciousness. More details will be discussed in chapter “Levels of
Consciousness” with the other levels of consciousness (Hashim and Ramadhan 2020).
Multiple Choice Questions

1. John Locke, in his theory, concluded that:
(a) The consciousness is classified into three levels.
(b) There is not any effect for the development of the person on his conscious-
ness formation.
(c) The topographic theory is more acceptable than others.
(d) The actions and the ideas that the person makes during early life are essen-
tial for developing the future.
2. René Descartes concluded that the theory of the mind contains two domains that
the consciousness resides in, which are:
(a) Res Cogitans and Res extensa.
(b) Preconscious and Postconsious.
(c) Id and Ego.
(d) Imagination and Reality.
3. The relationship between the mind and the body is described as:
(a) A complementary relationship.
(b) There is no relation between them.
(c) How they can be related and how they affect one another. The characteristics
of each one is different from the other.
(d) Integrity relationship.
4. Topographical and structural theories have been described by:
(a) Sigmund Freud
(b) John Locke
(c) Hashim and Mustafa
(d) Spinoza
5. Holder divided the consciousness into three levels that give distinct differences
in how they are reached. These three levels are:
(a) Sleep, Walking, and Self-awareness.
(b) Spontaneous, Calculated, and Imposed.
(c) Id, Ego, and Superego.
(d) Conscious, Postconscious, and Unconcious.
6. Psychoatomic (Quantum Non-Local) is:
(a) Overmind, developed by consciousness maturity.
(b) It is the adult personality and developed from first meeting experiences. It
includes pleasure, reproduction, and nurture.
(c) It is Buddha-Monad Mind, developed by consciousness maturation. It
includes evolutionary consciousness, DNA–RNA brain feedbacks.
(d) It is a Zen-Yoga mind–body connection developed by neurological somatic
feedback and reprogramming. It includes the consciousness of the body.
7. Freud describes consciousness as:
(a) A state of awareness of our external environment.
(b) An imaginary concept to describe our awareness.
(c) An origin for our reality.
(d) A quality and the capacity of transforming experienced activity into uncon-
scious states.
8. A psychiatry branch that describes the relationship between the brain and the
psychology is called:
(a) Neurology
(b) Neurosciences
(c) Neuropsychiatry
(d) Neuropsychology
Introduction 17
9. Postconscious is an extension of Freud theory and it has been described by:

(a) Sigmund Freud
(b) Spinoza
(c) Hashim and Mustafa
(d) René Descartes
Answers
1. (d)
2. (a)
3. (c)
4. (a)
5. (b)
6. (a)
7. (d)
8. (c)
9. (c)
References
Bargh JA. Social psychological approaches to consciousness. In: The Cambridge handbook of
consciousness. Cambridge: Cambridge University Press; 2007. p. 555–69.
Butler J. Of personal identity. In: The analogy of religion. Berkeley: University of California
Press; 1975. p. 100. Original reprinted in Perry, John, 1736, ‘Personal Identity’.
Gennaro R. Consciousness and self-consciousness. Amsterdam: John Benjamins Publishing; 1996.
Hashim H. The role and the spectrum of the post-conscious in the control of behavior by geriatric
subjects. NPG Neurologie - Psychiatrie - Gériatrie. 2020;20(119):297–302.
Hashim H, Ramadhan M. The need for developing a fourth level of awareness in human conscious-
ness: unconsciousness, preconsciousness, consciousness and postconsciousness. J Psychol
Psychother. 2019;9(3)
Hashim HT, Ramadhan MA. The concept of post-consciousness & its role in human behavior. J
Conscious Explor Res. 2020;11:1.
Hughes H, Hoffman S. Consciousness and society. New Brunswick: Transaction Publication; 2008.
Kriegel U. Consciousness, theories of. Philos Compass. 2006;1(1):58–64.
Lee M. The sword: the development of consciousness. J Symbols Sandplay Ther. 2012;3(2):45–65.
Mcleod S. Unconscious mind | simply psychology. Simplypsychologyorg. 2021. <https://www.
simplypsychology.org/unconscious-mind.html> Accessed 16 Dec 2021.
Miller G. What is the biological basis of consciousness? Science. 2005;309(5731):79.
Morin A. Levels of consciousness and self-awareness: a comparison and integration of various
views. Conscious Cogn. 2006;15(2):358–71. https://doi.org/10.1016/j.concog.2005.09.006.
Natsoulas T. The freudian conscious. Conscious Emotion. 2001;2(1):1–28.
Nimbalkar N. John locke on personal identity. Mens Sana Monogr. 2011;9(1):268–75. https://doi.
org/10.4103/0973-1229.77443.
Pons F, Harris P. Piaget’s conception of the development of consciousness: an examination of two
hypotheses. Hum Dev. 2001;44(4):220–7. https://doi.org/10.1159/000057061.
Reid T. Essays on the intellectual powers of man. Edinburg/London: John Bell/G.G.J. and
J. Robinson; 1785. p. 317–8.
Tindall SC. Level of consciousness. In: Walker HK, Hall WD, Hurst JW, editors. Clinical meth-
ods: the history, physical, and laboratory examinations (PDF). Boston: Butterworths; 1990.
p. 296–9. ISBN 0-409-90077-X.
Wilber K. Integral psychology: consciousness, spirit, psychology, therapy. Nova Religio.
2004;8(2):125–7.
Wilson RA. Cosmic trigger: final secret of the illuminati. Las Vegas: New Falcon Publications;
2008. p. 1–269. ISBN 978-1561840038
Brain and Mind
Hashim Talib Hashim and Adil Alhaideri
1 Brain Regions
The brain region is separated into left and right hemispheres. The corpus callosum
joins these two hemispheres through white matter fibers (He et al. 2017).
The limbic system is responsible for memory and emotions (Fig. 1). In addition,
it enables the hippocampus, the thalamus, the hypothalamus, and the brainstem to
have complex connections. The limbic system does not have precise, specific ana-
tomical limits but contains many substantial structures.
The amygdala is a series of nuclei found inside the brain (Fig. 2). It receives
several sensory data modes as inputs. The outputs pass via the amygdala via the stria
terminalis and ventral amygdalofugal pathway (Fig. 3).
Pathologies in the basal nuclei can be traced to certain movement conditions, the
most notable being Parkinson’s syndrome, which is due to defects in substantia
nigra dopaminergic cells (Wardlaw et al. 2020; Mendez and Hong 1997; Rughani
et al. 2015).
The neocortex is the human brain’s most phylogenetically evolved organ. The
intricate folding pattern causes a smaller cranial volume to be covered by an
expanded cortical surface. The folding sequence that shapes the sulcal and gyral
patterns remains strongly maintained in humans. This makes for a cortical anatomy
nomenclature (Wardlaw et al. 2020; Herbet and Duffau 2020).
Just below the pons, the pyramids and pyramidal decussation are visualized ven-
trally. They are the descending corticospinal tracts (Jhawar et al. 2016).
The cerebellum has two hemispheres, connected via a midline structure called
“the vermis.” The cerebellar cortex has three membranes, in contrast to the neocor-
tex of the cerebrum: molecular, Purkinje, and granular (Siegel et al. 1999). There
H. T. Hashim (*) · A. Alhaideri

e-mail: [email protected]

Switzerland AG 2022
20 H. T. Hashim and A. Alhaideri
Fig. 1 The limbic system for the development of memory
Fig. 2 The amygdala
Fig. 3 The habenula in the

epithalamus
Brain and Mind 21
are afferent and efferent pathways inside the three cerebellar peduncles to and from
the cerebellum. “The dissertation of neurologist Paul Broca, who researched the
language disorders of stroke survivors, can be traced to some of the earliest contri-
butions to modern language mapping” (Binkofski and Buccino 2004; Stein 2017).
The main sensory cortex, or Brodmann’s areas 1–3, corresponds to the postcen-
tral gyrus. That of the motor cortex corresponds to the homunculus obtained from
awake mapping (Adrián-Ventura et al. 2019).
2 Brain–Mind Relationship
The word “mind” is widely used also within the scientific discourse to denote a
wide spectrum of connotations. The mind can describe the human consciousness
when the mind–brain connection is meant. However, consciousness, which can be
seen as a confounding paradox, is itself impossible to describe, given that it consti-
tutes perhaps the most immediate and intimately available feature of any person’s
existence (Kochiyama et al. 2018; Solomito et al. 2019).
While the brain is the body’s most relevant organ in relation to the mind, more
precise information is available (Duffau 2018; Solomito et al. 2019).
But if it is possible to clarify the mind–brain interaction, what sort of answer is
being sought? It is important to consider previous scientific breakthroughs to
address this key issue, culminating in a satisfactory explanation of interactions pre-
viously though difficult to describe (Forsell et al. 2020).
Although neuroanatomy provides the fundamental blueprint for nervous system
information processing, the neural function is characterized by turbulent processes
characteristic of complex systems. Thus, a complete comprehension of the brain as
it applies to behavioral information would have to include appropriate accounts of
synaptic dynamics and connectivity, as these elements are essential to conscious
brain activity (Forsell et al. 2020).
It is possible to generalize this primary instance to all human contact. How much
of the intended message is successfully conveyed on average among aware indi-
viduals communicating? We speculate that correspondence hovers between 50%
and 85%, except in the most desirable situations of friends addressing their shared
jobs or partners chatting about their family. If this is the case, 10% or less may be
the normal human contact between two people (including casual interactions).
The immature brain has uncommitted, immature associations at birth, formed
from within the primary. As a result, the senses of a newborn baby are overwhelmed
with the outer world’s many colors, noises, smells, tastes, and textures, as well as
certain perceptions and emotions that originate from inside.
Increased activation contributes to increased synaptic complexity in the develop-
ing brain. As each person’s perception is distinct, each brain–mind has different
connectivity patterns. As Greenfield states, “The brain is made up of links between
brain cells.”
Implicit memory, which arises in the early years of childhood or out of intense
dissociation produced through a traumatic experience, retains the habits that control
our forms of being, behaving, and relating without conscious consciousness. It is
Released in cases of misunderstanding which unpredictability, which inevitably
provides the models in the consultation room for both the transition and counter-
transfer encounter (Lei et al. 2017).
3 Consciousness in Medicine
It is more difficult to describe and classify the pathological state of consciousness,

as demonstrated by the many words attributed by multiple observers to altered states
of consciousness. For example, consciousness clouding, confusing conditions,
delirium, obtundation, dementia, vegetative state, coma, hypersomnia, and
brain death.
The meanings of these terms are different from one to another, and relating to a
patient’s state of consciousness, they can prove unreliable. However, it is desirable
to describe some concepts as closely as possible (Lei et al. 2017).
There are a number of medical disorders and medicines that relate to the state of
consciousness of an individual. Often it is reversible with compromised conscious-
ness, while it is not at other times.
In medicine, we have two main levels for consciousness which are as follows
(Huntley 2008):
• Consciousness: The patients are alert, awake, and responsive to stimuli like ask-
ing, talking, and expressing.
• Unconsciousness: The patient here is not alert and not awake. They are not
responsive to any stimulus like sound or touch. Therefore, sleepiness is not
unconscious.
Conclusion: there are disorders in psychiatry that can change and alter the con-
sciousness and affect the brain, and at some times, it becomes a life-threatening issue.
The abnormal states of consciousness are as follows (Daroff et al. 2012; Cecil
et al. 2012; Rakel and Rakel 2011):
• Confusion: Being confused means being disoriented to time, place, and person.
• Lethargy (tiredness): The patient is tired and likes to fall asleep.
• Delirium: Acute confessional condition, marked by diminished cognition, in a
specific concentration. Alcohol withdrawal, recreational drugs, medicines, can-
cer, organ dysfunction, and severe infections can cause.
• Obtundation: This means sluggish responses to stimuli and a decline in
alertness.
• Coma: The coma means reduced brain activity and lack of response from the
patients to any stimuli, even some reflexes.
Brain and Mind 23
There are two popular and useful tools used in assessing the level of conscious-
ness for any patient which are (Opara et al. 2014; Reith et al. 2017):
• Grady Coma Scale (GCS): Starts from 1 to 5 depending on the level of con-
sciousness and the patient’s responses to the stimuli. Grade 1 is active and Grade
5 means that the patient is in a coma.
• Glasgow Coma Scale (GCS): Starts from 1 to 15 depending on specific criteria
and stimuli and measures the responses. Less than 3 means that the patient is in
a coma or brain death, while 9 and above means that the patient’s neurological
condition is good.
1. ………… is involved in memory and emotions.
(a) Cerebellum
(b) Limbic system
(c) Thalamus
(d) Hypothalamus
2. Although neuroanatomy provides the fundamental blueprint for nervous sys-
tem information processing, the neural function itself is characterized by:
(a) Turbulent processes characteristic of complex systems.
(b) Mind–brain relationships.
(c) Conscious reactions.
(d) Moving the body parts.
3. The differences between human and other animal brains are:
(a) The neocortex is the human brain’s most phylogenetically evolved organ.
(b) The animals lack cerebellum.
(c) Humans have bigger brains than animals.
(d) Humans have more complicated brains than animals.
4. There are two hemispheres in the cerebellum, connected by a midline struc-
ture called:
(a) The limbic system
(b) The vermis
(c) The sulci
(d) The gyrus
5. The patient is alert and responsive:
(a) Unconscious
(b) Coma
(c) Conscious
(d) Sleepy
6. The patient is not responsive at all and may have reduced brain activity:
(a) Coma
(b) Lethargy
(c) Unconscious
(d) Confusion
7. Delirium is:
(a) Extreme drowsiness, listlessness, and apathy followed by decreased alert-
ness are identified.
(b) Acute confessional condition, marked by diminished cognition, in specific
concentration, sleep-wake period modification, hyperactivity (agitation) or
hypo-activity (apathy), cognitive abnormalities such as hallucinations (see-
ing objects that are not there) or illusions (false beliefs), as well as pulse
rate and blood pressure dysfunction.
(c) No response at all.
(d) Insensitive.
8. Obtundation is:
(a) This is a condition of unresponsiveness, including stimulus.
(b) Awakeness and alertness.
(c) With sluggish responses to stimuli, a decline in alertness needs repeated
stimulation to sustain concentration.
(d) Acute confessional condition, marked by diminished cognition, in specific
concentration, sleep-wake period modification, hyperactivity (agitation) or
hypo-activity (apathy), cognitive abnormalities such as hallucinations (see-
ing objects that are not there) or illusions (false beliefs), as well as pulse
rate and blood pressure dysfunction.
9. GCS of 14 is considered as:
(a) Good
(b) Fair
(c) Poor
(d) Excellent
10. In neuropsychology, the localization of psychological roles in the brain has
historically been focused on the finding that there is:
(a) A deficiency or disorder of a certain psychological capacity in patients car-
rying a lesion in a certain cerebral area, whereas other abilities are retained.
(b) A balance between the chemical and physical components of the brain.
(c) A reaction between the neurotransmitters and the body’s status.
(d) A balance between the sympathetic and parasympathetic systems.
Answers
1. (b)
2. (a)
3. (a)
4. (b)
5. (c)
6. (a)
7. (b)
8. (c)
9. (a)
10. (a)
Brain and Mind 25
References
Adrián-Ventura J, et al. Linking personality and brain anatomy: a structural MRI approach to rein-
forcement sensitivity theory. Soc Cogn Affect Neurosci. 2019;14(3):329–38.
Binkofski F, Buccino G. Motor functions of the Broca’s region. Brain Lang. 2004;89(2):362–9.
https://doi.org/10.1016/S0093-934X(03)00358-4.
Cecil RL, Goldman L, Schafer AI. Goldman’s Cecil medicine. 24th ed. Philadelphia: Elsevier/
Saunders; 2012.
Daroff R, Fenichel G, Jankovic J, Mazziotta J. Bradley’s neurology in clinical practice. 6th ed.
Philadelphia: Elsevier/Saunders; 2012.
Duffau H. The error of Broca: from the traditional localizationist concept to a connectomal anat-
omy of human brain. J Chem Neuroanat. 2018;89:73–81.
Forsell L, et al. BrainWiki—a wiki-style, user driven, comparative brain anatomy tool. Front
Neuroanat. 2020;14:548172.
He Q, Turel O, Bechara A. Brain anatomy alterations associated with social networking site (SNS)
addiction. Sci Rep. 2017;7(1):1–8.
Herbet G, Duffau H. Revisiting the functional anatomy of the human brain: toward a meta-
networking theory of cerebral functions. Physiol Rev. 2020;100(3):1181–228.
Huntley A. Documenting level of consciousness. Nursing. 2008;38(8):63–4. https://doi.
org/10.1097/01.NURSE.0000327505.69608.35.
Jhawar SS, Nunez M, Pacca P, Voscoboinik DS, Truong H. Craniovertebral junction 360°: a
combined microscopic and endoscopic anatomical study. J Craniovertebral Junction Spine.
2016;7(4):204–16. https://doi.org/10.4103/0974-8237.193270. PMID: 27891029; PMCID:
PMC5111321.
Kochiyama T, et al. Reconstructing the neanderthal brain using computational anatomy. Sci Rep.
2018;8(1):1–9.
Lei Y, et al. The brain interstitial system: anatomy, modeling, in vivo measurement, and applica-
tions. Prog Neurobiol. 2017;157:230–46.
Mendez I, Hong M. Reconstruction of the striato-nigro-striatal circuitry by simultaneous double
dopaminergic grafts: a tracer study using fluorogold and horseradish peroxidase. Brain Res.
1997;778(1):194–205. https://doi.org/10.1016/s0006-8993(97)01055-x.
Opara JA, Małecka E, Szczygiel J. Clinimetric measurement in traumatic brain injuries. J Med
Life. 2014;7(2):124–7.
Rakel RE, Rakel D. Textbook of family medicine. 8th ed. Philadelphia: Elsevier/Saunders; 2011.
Reith FCM, Lingsma HF, Gabbe BJ, Lecky FE, Roberts I, Maas AIR. Differential effects of the
Glasgow coma scale score and its components: an analysis of 54,069 patients with traumatic
brain injury. Injury. 2017;48(9):1932–43. https://doi.org/10.1016/j.injury.2017.05.038.
Rughani AI, Penar PJ, Gest TR. Brain anatomy. Medscape; 2015.
Siegel GJ, Agranoff BW, Albers RW, Fisher SK, Uhler MD. Basic neurochemistry, molecular, cel-
lular, and medical aspects. 6th ed. Philadelphia: Lippincott, Williams & Wilkins; 1999.
Solomito MJ, Reuman H, Wang DH. Sex differences in concussion: a review of brain anatomy,
function, and biomechanical response to impact. Brain Inj. 2019;33(2):105–10.
Stein J. Sensorimotor control. Reference module in neuroscience and biobehavioral psychology.
Amsterdam: Elsevier; 2017. https://doi.org/10.1016/B978-0-12-809324-5.06855-3. ISBN
9780128093245.
Wardlaw JM, et al. Perivascular spaces in the brain: anatomy, physiology and pathology. Nat Rev
Neurol. 2020;16(3):137–53.
Levels of Consciousness
1 Introduction
Before we start with the levels, we should explain Id, Ego, and Superego according
to Freud’s theory (Fig. 1):
• Id (Meeting basic needs): This is the most primitive part of the personality; it
contains the most animalistic urges. For example, eating, drinking, and having
sex. It provides gratification for human needs. If humans do not get their needs,
they will go into a disorder like anxiety, tension, and anger. This level is pre-
sented at birth. The examples for that are: when you are hungry, you will enter
the kitchen and search for food, open the food pots, search in the fridge for any-
thing that can be eaten, when you do not find anything to keep you settled, the
situation will be undesired. It is the same situation when your hungry baby is
crying; he will not stop until he gets his needed food.
• Ego (Dealing with reality): This concept tries to meet the desire that Id present
in a socially acceptable way. This can mean delaying the gratification and help-
ing to get rid of disordered thoughts like tension or anger. This level is developed
at birth. For example, when someone is Muslim, during Ramadhan, he fasts dur-
ing the day and should wait for the sunset to eat and drink. So, the Id desires to
eat and drink, and the Ego is to wait until sunset.
• Superego (Adding Morals): It is lastly developed; it depends on morals and
judgments about right and wrong. The Id and Ego can reach the same point as the
Superego does, but Superego depends on morals while the Ego depends on the
thinking and the consequences of the actions. So, losing the Superego makes Ego
dominate, and losing Ego makes Id dominate. It begins to develop at about
6 years of age. For example, when you want to steal from your family and know


Switzerland AG 2022
28 H. T. Hashim and M. A. Ramadhan
Fig. 1 Freud divides the mind into three levels according to his topographical theory: uncon-
scious, preconscious, and conscious. These three levels interfere with structural theory compo-
nents: Id, Ego, and Superego
Postconscious
Conscious
Subconscious
Preconscious
Unconscious
Fig. 2 The levels of consciousness
that no one will note or judge you, you don’t do this because you know that steal-
ing is wrong.
We will start in a sequence from the first level: unconscious, preconscious, sub-
conscious, conscious to postconscious (Fig. 2).
Levels of Consciousness 29
2 Preconscious
It refers to the thoughts that humans are not actively thinking of but can be retrieved
easily once the human wants that; it contrasts with the unconscious, whose thoughts
are repressed and cannot be retrieved or remembered easily.
Preconscious was developed in the psychoanalytic theory by Freud. However,
eclectic therapists and others may use the concept in their ideas.
The thoughts at this level are not in our current thinking, but humans can think of
them quickly by triggering them using a stimulus of something that links them.
These thoughts are pulled out of the unconscious to be stored in the preconscious
and then transformed into conscious when needed. Ego and Superego control it only
without Id (Fazekas and Overgaard 2016).
A preconscious mind is a convenient thing to have. It provides several valuable
things that the conscious mind cannot handle alone.
The type of memories stored here is the long-term memories that align with the
unconscious. They are both unconscious, and preconscious includes the memories
that can be retrieved longer than a few minutes. The repressed memories can be
recalled without a potent stimulus or trigger. So, preconscious is the caller one that
connects unconscious with conscious.
Preconscious provides solutions for worries and problems without being aware
of them. The process is going on at this level until a solution comes up. Like it works
behind the scenes (Fazekas and Overgaard 2016).
The preconscious also contains intuitive thoughts. For example, when you meet
someone, your mind will judge it as good or not good. This process occurs in the
preconscious, depending on your brain’s criteria to judge people and other thoughts
and situations (Roulin and Ramelet 2014).
Adults have more active preconscious infants and teenagers because it depends
on experience and knowledge taken throughout life and ages. These ideas support
self-protection and achievements.
Therapies in psychiatry and psychology target preconscious because they need to
change bad thoughts to overcome good ones. The therapists can usually prompt the
patient to remember facts and events that will help him build his own conclusions.
If the psychologists already know your history, they may have some ideas about
what kind of experience he might suffer to explain the current situations (Overgaard
and Overgaard 2010).
There is a type of therapy called “Connecting memories.” In this therapy, the
therapist tries to connect the patient’s memory with another one to use the same
solution for the previous problem in the current one. It is a connection between the
preconscious and conscious. The ability to solve problems and issues in the con-
scious mind depends on using the information and thoughts in the preconscious. If
humans cannot, they will be without benefit.
In conclusion, preconscious is characterized by reality testing, recallable memo-
ries, and links to word presentation—the key distinction from unconscious contents.
Words presentations are memory traces that were at one-time perception and
therefore can become conscious again.
According to the French psychosomatic school, sound organization of precon-
scious is aligned with sound mentalization, whereas occasional long-term weakness
can lead to “Operative Functioning” according to the French psychosomatic school.
Inversely, the sound functioning of the preconscious guarantees a rich capacity for
fantasizing (Overgaard and Overgaard 2010).
3 Subconscious
It is part of the mind that is not currently in focal awareness. But it is the powerful
secondary system that runs everything in a human’s life. The subconscious is a bank
of data for everything that is not in the conscious; it stores beliefs, thoughts, memo-
ries, and previous experiences. So, everything that humans see, think, and do is
stored here (Fig. 3).
Subconscious is a guidance system that monitors information and actions com-
ing out of senses and opportunities. Thus, the relationship between the subcon-
scious and conscious is bidirectional (Nelson 2005).
Emotions control communication between the subconscious and conscious, so
moving thoughts to another is done under their control. Only thoughts transferred
with guanine emotions make it possible to be back for the mind. And only the emo-
tions that are backed up by solid emotions are stored in this level. Both negative and
positive emotions have a role in this level, and the negative ones are dominant
(Nelson 2005).
Fear and negative talking to self are contributing factors in dominating the nega-
tive emotions, so to be in a good situation, you have to eliminate these thoughts.
Because sometimes, fears and bad thoughts can be real and maybe come true
(Hawkins 2015).
Fig. 3 The subconscious

includes everything that is
not in the conscious
Subconscious
Conscious
There is a solution that can be used to get rid of bad thoughts through countering
techniques. By confronting these ideas with extreme positive counter thoughts. For
example, an employee on his first interview with a human resources manager in a
company, when he thinks that he will not be competitive and efficient for the posi-
tion, immediately face these thoughts with good ones by thinking that you will
convince the manager by his skills. There is another technique called “Delete
Button.” When humans think of bad thoughts, they immediately delete them and
replace them with good ones (Hawkins 2015).
Desire has a role in this level; depending on the desire, the subconscious tries to
do anything to reach the desire that the mind seeks. For example, a very brave com-
mander in a war is facing a weak army. The weak army makes noise and hits the
drums to make the commander think they are not afraid of him; in this battle, the
commander lost because of his thoughts.
The subconscious mind combines what one sees, experiences, and any knowl-
edge that the mind absorbs that it does not otherwise actively interpret to make
coherent sense. The conscious mind cannot necessarily process disconnected
knowledge since it will be abundant information. Still, the subconscious mind
retains this data where the conscious mind can recover it as it has to protect itself for
survival (and for other purposes, such as solving puzzles).
The subconscious mind retains knowledge that the conscious mind does not
automatically process with complete comprehension, but when “reminded” by the
conscious mind, or by an astute psychoanalyst who can pull out the information
contained in the subconscious, taking it to the conscious consciousness of the per-
son, it retains the information for later retrieval.
The subconscious mind retains knowledge that the conscious mind does not
automatically process with complete comprehension, but when “reminded” by the
conscious mind, or by an astute psychoanalyst who can pull out the information
contained in the subconscious, taking it to the conscious consciousness of the per-
son, it retains the information for later retrieval.
De Becker tapped into the victim’s mind about her “prior knowledge of the sub-
conscious mind that prompted her to act unconsciously,” causing her to know that
the attacker would kill her. The analyst took her conscious mind to consider by
eliciting her initial “inner thoughts/voice” HOW her subconscious acted on her con-
scious mind. Via a sequence of events that eventually drove her subconscious mind
to function in such a way as to prevent her from being killed. Gavin was able to
evoke awareness from her subconscious mind of a threatening condition that
prompted her conscious mind to intervene to save her by her simple instinct of sur-
vival, taking to the conscious mind of the survivor that it was the “subtle warning
that alerted her.” The survivor characterized this as an unrecognized terror that
drove her to act, still consciously uncertain of exactly WHY she was afraid. Her
conscious mind had said the words, “I swear I would not harm you, although her
subconscious mind measured the circumstance even more easily than the conscious
mind could make sense of WHY there was terror. The victim said that” the beast
took over inside her. It is impossible to separate the unconscious from the subcon-
scious. Some authors have actually noted that they are used interchangeably in
common parlance and by many experienced writers. It’s good to think about con-
scious consciousness as the tip of an iceberg, as in discriminating between sup-
pressed and suppressed: it’s so apparent over the sea. Although the unconscious and
subconscious are far greater than what the eye can see together, both remain below
what is readily apparent. Thus, knowing their relative inaccessibility is the only
practical way they can be set apart (Wu et al. 2019).
In brief, you will possibly recognize from where your thought, instinct, or inspi-
ration is subconsciously derived through some introspection. Yet, it would be much
more difficult to identify the source of present-day activity that simply does not
make much sense to you for what is unconscious to you, the bottom-most portion of
the iceberg. In addition, though, it is much more likely that you can easily unveil its
roots with the help of a mental health provider (Wu et al. 2019).
Many ways to manipulate the subconscious mind specifically, including the
following:
• Affirmations
• Autosuggestion
• Binaural beats
• Hypnosis
• Placebo
• Priming
• Subliminal perception
• Subliminal stimulation
• Suggestion
4 Conscious
The conscious mind acts as the current situation for the human. It is simply our cur-
rent behaviors and actions. These two functions can be consciously responsible for
in general:
• Its ability to direct human focus.
• Its ability to create images that are not real.
The conscious mind acts as a scanner for the human self. It perceives events, trig-
gers the need to react, and then depends on the importance of that event.
It can store these events either in the Unconscious or Subconscious area of the
mind where they will be available to human needs, and humans can recall them once
they want (Young and Rund 2010).
The conscious mind includes everything inside of human awareness in the psy-
choanalytic theory. So, it makes the mind think and act rationally by mental
processing.
The conscious mind controls sensations, perceptions, memories, feelings, and
fantasies inside a human’s current awareness. The closer level of awareness to
conscious is Preconscious or Subconscious, and it includes things that we are not

aware of in the moment of thinking but can be easily recalled in the conscious mind
(Young and Rund 2010).
The conscious mind is the objective and thinking mind of humans. It has no
memory, and it can only show one thought at one time. This level has four essen-
tial functions in particular, which are considered under the two general func-
tions above:
• Identification of incoming information. This information can come from the five
senses: sight, sound, smell, touch, taste, and feeling. So, it is observing and clas-
sifying what is happening in a continuous pattern around the human.
• Comparison between the current situation with similar situations in subcon-
scious or preconscious. For example, when you see the face of someone, you will
immediately compare this face with previously known faces to see if you have
met them before; that is why you sometimes see a face and think it is familiar to
you. Another example is when you work on a machine and are afraid of hurting
your hand, your subconscious bank will tell you that it is safe because you wear
protective gloves.
• Analysis. The conscious mind analyzes the data received by the senses and
either accepts it or rejects it. It can deal with one action in a moment, like either
positive or negative, yes or no, good or bad. So, when your senses send a mes-
sage to anything the conscious is dealing with to the mind. It analyzed these
data depending on its criteria and fundamentals to process to the next function.
For example, you are walking in the street, and suddenly, you hear a high voice
coming out of a house in that street, this voice will be entered in an analysis by
the conscious.
• Deciding. It is related to the previous function of data analysis; in this function,
conscious decide what is good and bad, negative, and positive. For example, the
same situation above, after analyzing the data of that voice, your mind will
decide that this voice is an expression of either sadness or happiness, depending
on the criteria of the voice and links it to the bank in the subconscious (Zelazo
et al. 2007).
5 Postconscious
It is an imaginary (Unreal) level of consciousness that’s created to explain the

actions that the other levels of consciousness cannot explain. It deals with future
events and thinking. It is not a defense mechanism, but it solves a state of being
unsure or confused about two things: right and wrong. It makes the mind comfort-
able to avoid unwanted psychological collapses. For example, a person is about to
do something wrong or is confused between two choices. This person would strug-
gle between the conscience that allows him to go on and the unconsciousness that
stops him from doing so anytime you want to do something wrong. The
postconsciousness that offers the reason to do the wrong things will overcome this
dispute, and it is essential and will never be repeated. As humans, we have certain
situations and attitudes that other forms of consciousness cannot be clarified since
the four levels of perception in our consciousness influence all our behavior and
reactions. All of these responses are that our attitudes and disposals alter whether
we decide to make a mistake or it has just been done. As a consequence of our
behavior, which is the failures, the explanation of these changes in our reactions is
regulated as we try to approve the fourth stage of consciousness, the postconscious-
ness, in this analysis. As a consequence of our behavior, which is the failures, the
explanation of these changes in our reactions is regulated as we try to approve the
fourth stage of consciousness, the postconsciousness in this analysis (Hashim
and Ramadhan 2019; Hashim and Ramadhan 2020; Hashim 2020).
The postconscious advises you to do these reactions or instruct the body to dem-
onstrate these reactions (in a detailed description) to overlap the doubts and worries
that might exist or reassure you that you will not be discovered or captured. So, it
wants to defend you, and it tries to get you as happy as possible at the same time. In
this phase, age and gender do not influence because it happens to anyone at any age,
regardless of gender. Under the same names in Freud’s principles of consciousness,
we should not accept these emotions because they are distinct.
The postconscious is a small state that in elderly people may have less value and
can cause other effects that vary from their usual roles in their brains. Over the life
of an older person, certain thoughts and perceptions may change: some of them will
vanish, and new ideas will arise, describing odd behaviors at this point. The figures
below compare the four levels of consciousness in the factors that almost control
them and the differences between them (Figs. 4 and 5).
Fig. 4 The four levels of consciousness

Fig. 5 Comparison of the four levels of consciousness

1. It is the most primitive part of the personality; it contains the most animalis-
tic urges:
(a) Ego
(b) Superego
(c) Id
(d) Subconscious
2. When you want to steal from your family and know that no one will note or
judge you, you don’t do this because you know that stealing is wrong. This
presents:
(a) Id
(b) Superego
(c) Ego
(d) Consciousness
3. It refers to the thoughts that humans are not actively thinking of but can be
retrieved easily once the human wants that; it contrasts with the unconscious,
whose thoughts are repressed and cannot be retrieved or remembered easily.
(a) Preconscious
(b) Consciousness
(c) Postconscious
(d) Unconscious
4. The relationship between the subconscious and conscious is:
(a) Complementary
(b) Opposite
(c) Integrated
(d) Bidirectional
5. ………….. acts as a scanner for the human self. It perceives events, triggers the
need to react, and then depends on the importance of that event.
(a) Conscious
(b) Subconscious
(c) Preconscious
(d) Postconscious
6. ………… is an imaginary (unreal) state of consciousness.
(a) Subconscious
(b) Conscious
(c) Preconscious
(d) Postconscious
7. Subliminal stimulation is one of the ways that manipulate:
(a) Conscious
(b) Subconscious
(c) Preconscious
(d) Postconscious
8. One of the following is present at birth:
(a) Preconscious
(b) Conscious
(c) Unconscious
(d) Postconscious
9. All the following has an Id involvement except:
(a) Preconscious
(b) Conscious
(c) Unconscious
(d) Postconscious
10. Postconscious is:
(a) An area between conscious and unconscious.
(b) A complimentary area for consciousness.
(c) A part of the unconscious.
(d) An integrated Level of consciousness
Answers
1. (c)
2. (b)
3. (a)
4. (d)
5. (a)
6. (d)
7. (b)
8. (c)
9. (c)
10. (a)
References
Fazekas P, Overgaard M. Multidimensional models of degrees and levels of consciousness. Trends

Cogn Sci. 2016;20(10):715–6.
Hashim H. The role and the spectrum of the post-conscious in the control of behavior by geriatric
subjects. NPG Neurologie - Psychiatrie - Gériatrie. 2020;20(119):297–302.
Hashim H, Ramadhan M. The need for developing a fourth level of awareness in human conscious-
ness: unconsciousness, preconsciousness, consciousness and postconsciousness. J Psychol
Psychother 2019;9(3).
Hashim HT, Ramadhan MA. The concept of post-consciousness & its role in human behavior. J
Conscious Explor Res. 2020;11:1.
Hawkins DR. Transcending the levels of consciousness: the stairway to enlightenment. Carlsbad:
Hay House; 2015.
Nelson K. Emerging levels of consciousness in early human development. In: The missing link
in cognition: origins of self-reflective consciousness. Oxford: Oxford University Press; 2005.
p. 116–41.
Overgaard M, Overgaard R. Neural correlates of contents and levels of consciousness. Front
Psychol. 2010;1:164.
Roulin M-J, Ramelet A-S. Behavioral changes in brain-injured critical care adults with different
levels of consciousness during nociceptive stimulation: an observational study. Intensive Care
Med. 2014;40(8):1115–23.
Wu G-R, et al. Modulation of the spontaneous hemodynamic response function across levels of
consciousness. NeuroImage. 2019;200:450–9.
Young JL, Rund D. Psychiatric considerations in patients with decreased levels of consciousness.
Emerg Med Clin North Am. 2010;28(3):595–609.
Zelazo PD, Gao HH, Todd R. The development of consciousness. In: The Cambridge handbook of
consciousness. Cambridge: Cambridge University Press; 2007. p. 405–32.
Sleep and Dreaming
1 Sleep
The quality of sleep is essential for survival as food and water. Most body systems
enter the anabolic state during sleep and help maintain normal body function
(Sollars and Pickard 2015).
1.1 Structures Involved in Sleep
Many parts of the brain control sleep, like the hypothalamus.

The brainstem, thalamus, and pineal body that creates melatonin are also crucial
for controlling sleep in both directions, REM and NREM (Roenneberg et al. 2013).
1.2 Circadian Rhythms and Sleep
The term circadian means “around the day” in Latin, so circadian rhythms are phys-
ical, mental, and behavioral changes that follow a daily cycle by responding to light
and darkness. They are also present in plants, animals, and microbes. At the same
time, biological clocks are a collection of specific proteins that interact with cells
throughout the body and act as innate timing devices to produce and regulate circa-
dian rhythms (Schupp and Hanning 2003).
The circadian rhythm controls sleep patterns. SCN is triggered by incoming light
from the optic nerve and controls the production of the melatonin
S. A. Saleh (*)

Switzerland AG 2022
40 S. A. Saleh
Fig. 1 The effect of light on SCN
hormone—responsible for sleeping. When the incoming light decreases the SCN, it
stimulates the brain to produce more melatonin to make us drowsy and prepared for
sleep (Fig. 1). In this way, the circadian rhythm controls sleep and wakefulness
throughout the day and night to create a stable regular cycle. Disruption to this cir-
cadian system can result in sleep difficulties and disturbances.
1.3 Sleep Types
Two types of stages for sleep are discussed. They are (Fig. 2):
1. Non-Rapid Eye Movement (NREM).
2. Rapid Eye Movement (REM).
1.3.1 NREM Sleep
This represents the first part of the sleep cycle, and it is subdivided into three distinct
stages: stage I, stage II, and stage III (also known as N1, N2, N3). Muscle paralysis
does not occur appropriately during NREM sleep; that’s why some people do not
progress to REM sleepwalk during their sleeping because they do not lose their
motor function; also, dreaming rarely occurs in this type (Tubbs et al. 2019).
Sleep and Dreaming 41
Fig. 2 NREM and REM sleep
Stages of NREM Sleep
Stage I
Sleep starts by a transition from wakefulness to drowsiness state, during wakeful-
ness—when eyes are open—alpha and beta waves are present, and beta waves are
the predominant ones, while during the drowsiness state—when eyes closed—alpha
waves (with frequency 8–12 Hz) become predominant. Stage I starts when these
alpha waves are replaced by theta waves (with frequency 4–7 Hz). During this stage,
a selective arousal threshold will determine if a specific minor stimulus is worth
responding to and trigger the wakefulness state or should ignore it and proceed to
the next stage of sleep. Typically, this stage lasts for 5–10 min only, and it’s the entry
point for stage II.
42 S. A. Saleh
Stage II
It is a short stage in the first two cycles ranging from 10 to 20 min. Then, it becomes
dominant.
Heart rate, body temperature, breathing will decrease in this stage, and muscle
will relax even further (Varga et al. 2018).
Stage III
They are also called slow-wave sleep (SWS), representing the deepest sleep stage
and the most difficult to awaken. Older people spend less time in this stage. That’s
why they have a light sleep and are easily awakened. However, waking during this
stage will cause a transient phase of mental disorientation and a moderate decrease
in mental performance for a short period: body repair tissue growth (Della Monica
et al. 2018).
REM Sleep
This type of sleep is characterized by brain waves similar to the awake state, mus-
cles paralysis—except the diaphragm and upper airway muscles—to prevent acting
out of the dreams by inhibiting motor neurons in the brainstem and rapid jerking eye
movement from side to side. It occurs after 90 min of falling asleep. The average
time of the first REM period after falling asleep is 90 min, and the individual who is
deprived of REM sleep one night has increased REM sleep the next night (REM
rebound). Dreams mainly occur during this type and are free of sensory experi-
ences, visual content, and emotional reasoning. So, REM dreams play a role in
memory consolidation and emotional processing of complex events. Time spent in
REM sleep decreases with typical aging.
1.4 Sleep Disorders
Poor or insufficient sleep is associated with a wide variety of disturbances in most

body systems, including endocrine, metabolic, and nervous system disorders. Now
we will go through most of them and explain the main characteristics (Léger
et al. 2008).
1.4.1 Insomnia
Approximately 30–35% of adults experience transient insomnia at some point in

their lives. The diagnosis is made when these difficulties are reported for at least
three nights per week and more than 3 months.
Insomnia is further subdivided into primary insomnia, which is not attributed to

any other medical or psychological conditions, and secondary insomnia, which may
be associated with other conditions like psychological stress, chronic pain, restless
leg syndrome, drugs, and medications (Morin et al. 2006; Harvey et al. 2014).
1.4.2 Circadian Rhythm Sleep-Wake Disorders
Many disorders emerge under this title. The ICSD-3 classifies the circadian rhythm
sleep-wake disorders into seven types which include:
1. Delayed Sleep-Wake Phase Disorder: There is difficulty sleeping and waking
up (more than a 2-h delay in sleep period) and later than normal individuals. This
leads the patient to delay and poor performance at work or school due to daytime
sleepiness.
2. Irregular Sleep-Wake Rhythm Disorder: Characterized by disorganized sleep
and wake patterns. It’s more observed in older adults and patients with neurode-
generative disease (Spicuzza et al. 2015).
3. Non-24-h Sleep-Wake Rhythm Disorder: Also called free-running disorder
and characterized by a gradual delay of sleep-onset time from 1 day to the next,
so the individual begins to sleep during the daytime hours and then drift back
into the night due to failure of the circadian system to entrain to the 24-h day.
Mainly occur in totally blind people (Baumann et al. 2014).
4. Shift Work Disorder: Occurs to individuals who work on night shifts due to
misadjustment of body circadian rhythm to work schedules lead to drowsiness
during shift work difficulty falling asleep during the day.
5. Jet Lag Disorder: Occurs in individuals who travel to regions with different
time zones because the body can’t reset its circadian time to the new time zone
upon arrival, so it takes some time to correct this (Rosenberg and Van Hout 2014).
6. Circadian Sleep-Wake Disorder not Otherwise Specified: Occurs secondary
to medical or neurological disorders, for example, dementia, movement disor-
ders, and blindness (Molaie and Deutsch 1997; Salminen and Winkelmann 2018).
1.4.3 Sleep-Related Breathing Disorders
They are abnormalities of respiration that occur during sleep often associated with
a wide variety of comorbidities. The degree of airway narrowing can range from
snoring to complete collapse of the airway and cessation of airflow. According to
ICSD-3, they are classified into four types: obstructive sleep apnea (OSA), central
sleep apnea (CSA), sleep-related hypoventilation, and sleep-related hypoxemia dis-
order (Maurer et al. 2010).
1. Obstructive Sleep Apnea (OSA): One of the diseases commonly found among
patients relates to the respiratory system (Fig. 3). Usually, OSA is accompanied
by snoring and individuals unaware of their breathing difficulty even when
44 S. A. Saleh
Fig. 3 Mechanism of obstructive sleep apnea
alking at night until their sleep partner or others recognize it. These events
w
occur primarily during sleep stages I, II, and REM and are associated with severe
desaturation, while sleep stage III is protective against OSA with less severe
desaturation. In addition, individuals may have symptoms of unexplained day-
time sleepiness, restless sleep, morning headache, and mood changes. Causes of
OSA may be due to old age, traumatic brain injury, decreased muscle tone, and
obesity. The gold standard for OSA treatment is continuous positive airway pres-
sure (CPAP).
2. Central Sleep Apnea (CSA): It means that the origin of the pathology comes
from the brain that stops ventilation repetitively due to lack of brain signals that
drive respiratory muscles to control breathing during sleep, so there is no respira-
tory effort, and this is in contrast to OSA where respiratory signals from the brain
are normal and the problem in the upper airway which obstructs and not open
properly. CSA is divided into two categories:
(a) Hypercapnic type: In this type, the brain fails to send signals to stimulate
respiratory muscles for breathing due to narcotic drugs (e.g., opioids),
stroke, or trauma that affects the brainstem and inhibits respiratory signals,
or due to neuromuscular disease (amyotrophic lateral sclerosis, multiple
sclerosis) which leads to weakness in respiratory muscles then leads to a
buildup of carbon dioxide.
(b) Hypocapnic type: Occurs because of aberrant pacing and control of respira-
tion that leads to quick deep breath. Treatment of CSA depends on the cause
and the patient’s comorbidities; however, we can use CPAP and oxygen
supplementation. Also there is an implantable device that stimulates breath-
ing muscles.
3. Sleep-Related Hypoventilation: Characterized by insufficient ventilation
results in accumulation of carbon dioxide and elevation of PaCO2 during sleep.
It may be accompanied by daytime hypoventilation which further worsens the

symptoms.
4. Sleep-Related Hypoxemia: Low O2 saturation to <88% during sleep. As a
result, individuals may have complications of polycythemia, heart failure, pul-
monary hypertension, and cognitive dysfunction (Van der Salm et al. 2014).
1.4.4 Central Disorders of Hypersomnolence
Cataplexy is a sudden loss of muscle tone with full consciousness when exposed to
emotional triggers, and it’s the main feature that differentiates between both types
of narcolepsy sleep fragmentation and can also be seen in narcolepsy type 2; it is
atypical for IH.
The loss of orexin neurons occurs due to genetic and environmental factors like
autoimmune attack and destruction in susceptible individuals. Individuals with nar-
colepsy pass abruptly from waking to REM sleep with a bit of or absent non-
REM period.
Idiopathic hypersomnia (IH) is characterized by long non-refreshing naps with/
without long sleep time. The main mechanism is unknown and usually doesn’t
respond to normal treatment used in narcolepsy.
Treatment includes a combination of pharmacological and behavioral therapy.
Modafinil is the drug of choice for narcolepsy; it improves wakefulness by reducing
the reuptake of dopamine to decrease excessive daytime sleepiness. Venlafaxine is
a serotonin-norepinephrine reuptake inhibitor and antidepressant agent used to
reduce cataplexy. Usually, to get a maximum effect of these medications, we use
them with lifestyle modifications like advising the patient to take scheduled short
naps during the day and maintain a regular bedtime. This will reduce daytime sleep-
iness. However, these naps are ineffective in patients with IH. We also need to treat
other comorbidities that accompany narcolepsy because people with narcolepsy
tend to be obese, which may affect their lives. Safety precautions should be taken
before doing some activities like driving cars and working in jobs that require full
alertness during the day because patients with narcolepsy can have serious injuries
or death if they fall asleep.
1.4.5 Parasomnia
It means abnormal movements and actions occur during sleep (before sleep, during
sleep, or at arousal period after sleep) (Stefani and Högl 2019).
46 S. A. Saleh
Parasomnias Associated with NREM Sleep
This parasomnia group is associated with arousal and occurs during stage III of
NREM sleep. In addition, certain triggers can induce this type of parasomnias like
alcohol, sleep deprivation, physical activity, emotional stress, depression, and cer-
tain medications; this type includes:
1. Confusional Arousal: It’s a brief episode of arousal occurring when sleep is
interrupted, and the individual is awakened during the first half of the night (dur-
ing stage III) and characterized by mental confusion, disorientation, amnesia of
the event; that’s why their sleep bed partner may only note the episode, and the
individual can’t understand what’s going on. Most commonly occur in children
and resolve by age 5, in rare cases may continue to adulthood.
2. Sleepwalking (Somnambulism): A series of complex behaviors that occur dur-
ing sleep and ambulation. The individual looks awake with open eyes and per-
forms inappropriate actions like moving around, but actually, they are asleep.
This may lead to serious injuries because individuals are unaware of what they
are doing due to altered consciousness and impaired judgment. This episode may
terminate when the individual returns to bed or lies down outside and continues
their sleeping. The exact cause of sleepwalking is unknown, but some studies
show it runs in families.
3. Sleep Terrors: Patients wake up suddenly and start screaming and maybe crying
as well, typically lasting between 30 s and 5 min. The affected individual appears
confused, diaphoretic, tachypneic, tachycardiac, and may sleepwalk during
attacks, and usually, they don’t remember the event the following day. It is chal-
lenging to communicate and console the individual during the attack. Individuals
with sleep terrors run or jump around in an attempt to avoid harm, thereby injur-
ing themselves or others.
4. Sleep-Related Eating Disorder: The exact underlying mechanism of sleep-
related eating disorder is unclear, but it is associated with other sleep disorders
like sleepwalking, obstructive sleep apnea, narcolepsy, and periodic limb move-
ment disorder; also some medications (e.g., zolpidem) may trigger it.
Parasomnia Associated with REM Sleep
It includes REM sleep behavior disorder (RBD), recurrent isolated sleep paralysis,
and nightmare disorder.
1. REM Sleep Behavior Disorder (RBD): Recurrent episodes of verbal or com-
plex motor behavior during REM sleep. Because the dream content is violent,
the patient may exhibit jerky limb movement, punching, shouting, screaming,
hitting, and running, resulting in serious injury to the patient and their bed part-
ner. In addition, the patient may recall the events and dream content after
waking up.
2. Recurrent Isolated Sleep Paralysis: Loss of voluntary muscle movement at

sleep onset or upon awakening. The patient is conscious and may feel unable to
breathe; although the diaphragmatic muscle function is unaffected, this may be
due to atonia of accessory respiratory muscles. During the episodes, the patient
may experience visual, auditory, or tactile hallucinations and usually resolve
after seconds or minutes and can be aborted spontaneously by touching or speak-
ing to the affected patient. Sleep deprivation, irregular sleep-wake schedule,
stress, and sleeping in a supine position may trigger the episodes.
3. Nightmare Disorder: In contrast to other sleep parasomnia, patients with night-
mares recall the details of the dream content. Nightmares commonly occur fol-
lowing acute stress disorder and post-traumatic stress disorder (PTSD) and result
in episodes of fear, terror, and anxiety accompanied by increased heart rate and
respiratory rate. Certain medications like antihypertensive can induce night-
mares (e.g., beta-blockers), antidepressants (e.g., SSRI), dopamine agonists,
acetylcholinesterase inhibitors, and alcohol.
Other Parasomnias
This category of parasomnia disorders can occur in both NREM and REM sleep as
well as during the transition between sleep and wakefulness. They include:
1. Exploding Head Syndrome: A loud sound heard in the head upon awakening.
2. Sleep-Related Dissociative Disorder: Characterized by dissociative episodes
that occur just before the sleep that last minutes to hours and mimic other para-
somnias; however, it always occurs during wakefulness state. It may be accom-
panied with daytime dissociative symptoms and go away with treatment of a
dissociative disorder. Patients may be agitated and violent during the episode and
result in self-injury.
3. Sleep-Related Hallucinations: In this condition, the patient experiences audi-
tory, visual, tactile, and kinetic hallucinations at sleep onset or upon waking. The
patient wakes up terrified and may jump out of bed and get injured. This halluci-
nation episode may last for a few minutes and go away when the light is turned on.
1.4.6 Sleep-Related Movement Disorders
They are a wide range of disorders explained one by one as in the following:
1. Restless Legs Syndrome (RLS): Also known as Willis-Ekbom disease, which
is a chronic sensorimotor disorder characterized by an irresistible urge to move
the legs accompanied by an unpleasant sensation in the legs. To ensure that the
case is RLS, we must exclude other conditions that explain the symptoms like
sleep-related leg cramps, positions, discomfort, habitual foot tapping, akathisia,
and arthralgia. RLS can be idiopathic or secondary. Idiopathic form usually
begins slowly before 40 years of age, and the patient may have a family history
48 S. A. Saleh
of RLS, while in secondary form, it has a later onset in life and is associated with
other conditions like neurological disorders (e.g., multiple sclerosis), end-stage
kidney disease, iron deficiency, or pregnancy. Dopamine dysfunction may have
an essential role in the pathophysiology of RLS. Although many patients show
significant improvement after administration of dopaminergic agents, recent
studies show hyperdopaminergic states in RLS patients, in contrast to the
hypodopaminergic state, which is thought to be the primary mechanism for this
disorder. Other non-pharmacological treatments like sleep hygiene, pneumatic
pressure therapy, exercise, massage, and hot baths may be helpful to reduce the
symptoms (Stumbrys et al. 2012).
2. Periodic Limb Movement Disorder (PLMD): The contractions last 0.5–10 s,
and each episode consists of at least four consecutive movements, with 5–90 s
intervals in between. PLMD occurs in the first half of the night during NREM
sleep. PLMD is present in about 80–90% of RLS patients. Dopaminergic region
dysfunction within the hypothalamus and impaired iron availability in the brain
may be involved in PLMD.
3. Sleep-Related Leg Cramps: Intense, short-lived painful contractions of calf or
foot muscles relieved by stretching, messages, and heat application on the
affected muscles. Most commonly occur at night or during the sleep-waking of
the patient. Older adults are most commonly affected. Although sleep-related leg
cramps are more prevalent among elderly people, they may result from neuro-
muscular disorders (e.g., radiculopathies, myopathies, and Parkinson disease),
electrolyte disturbances, and medications (e.g., long-acting beta) agonists and
thiazide diuretics) and could be idiopathic with no relation to other diseases.
One-half of patients with sleep-related leg cramps have several episodes per
week or day. This may lead to sleep disturbances, difficulty falling asleep, awak-
ening at night and excess daytime sleeping.
4. Sleep-Related Bruxism: Polysomnography and masseter electromyography are
used to confirm the diagnosis. Sleep bruxism can result in morning jaw muscle
pain, temporal headache, tooth destruction, masticatory muscles hypertrophy,
and temporomandibular joint discomfort. Unfortunately, there is no effective
treatment that cures or stops sleep bruxism. However, oral appliances can be
used to protect the tooth from damage.
5. Sleep-Related Rhythmic Movement Disorder (SRRMD): Rhythmic, stereo-
typed with large-amplitude and low-frequency (0.5–2 Hz) body movements that
involve large muscle groups and occur before falling asleep or during sleep (par-
ticularly stage II NREM sleep). Movement episodes last for a few minutes and
manifest as body rocking, headbanging, and head rolling. Severe cases of
SRRMD can be treated with benzodiazepines such as clonazepam.
6. Benign Sleep Myoclonus of Infancy (BSMI): It is a benign self-limiting disor-
der characterized by repetitive flexion, extension, abduction, and adduction
myoclonic jerks during the NREM sleep period that last for a few seconds and
disappear with arousal or movement. Myoclonus jerks are more prominent in
upper than lower extremities and begin during the first month of life (first
observed at a median age of 3 days) and go before 6 months. Neurological

assessments of the infant are typically normal (Stumbrys et al. 2012).
7. Propriospinal Myoclonus at Sleep Onset (PSM): Repetitive axial jerky move-
ments during the sleep-wake transition period result in sleep-onset insomnia.
These movements generate in the spinal cord and spread rostrally and caudally
via propriospinal pathways. It is important to do polysomnography with multi-
channel surface electromyography (EMG) to diagnose PSM. Few cases of PSM
occur due to structural lesions in myelin, but the majority are due to functional
movement disorders.
2 Dreams
Many cultures worldwide suggest that dreams are a gateway to communicate with
other worlds and supernatural entities (Baird et al. 2019).
Throughout their theories, Sigmund Freud and Carl Jung put the first step about
dreams interpretations. Sigmund Freud hypothesizes that our subconscious can
reveal the wishes that used to be repressed by our conscious mind, so, during
dreams, we live out our deepest wishes and desires as he stated that dreams are the
“royal road to the unconscious.” Carl Jung had another view on dreams that, in con-
trast to Freud view he believes dreams are attempts to lead the individual toward
wholeness through dialog between the ego and the self (ego represents our con-
scious mind while self represents the totality of our physical, biological, psycho-
logical, social, and cultural being that involve the conscious as well as the
unconscious).
Dreams mainly occur during REM sleep, so at this stage, circuits in the brain-
stem are activated then trigger areas of the limbic system responsible for emotions,
sensations, and memories, including the amygdala and hippocampus. Hence, the
brain tries to interpret this electrical activity to create meaning from these signals.
In cognitive neuroscience, the present theory assumes that dreams have a role in
memory consolidation and long-term memory enhancement. Other theories suggest
that dreams have a role in controlling emotions and resolving the problems that
occur in our daily lives (Baird et al. 2019).
2.1 Dream Properties and Content
Dreams are characterized by multimodal perceptual content, dominated mainly by

visual and auditory elements, while smell, taste, movement, and tactile sensations
are less frequently experienced. Emotional content is an important feature of a
dream; the dreamer mostly experiences negative emotions like fear or anxiety.
Sometimes dreams appear strange, unrealistic, or fantasy in content compared to
waking state. This “bizarreness” of dreams could be classified into two types:
50 S. A. Saleh
temporal discontinuity when the scene changes suddenly with little or no transition
in between, for example, when the dream starts at a specific place (e.g., at home)
and suddenly change to an unrelated location (e.g., in a ship). The other is the
unlikely combination where two or more dream elements are unlikely to be com-
bined at the same time according to waking experience (e.g., playing golf on the
plane). These bizarre events are taken seriously as real-life experiences by the
sleeper as they are unaware this is not real and just a dream until waking up (except
in lucid dreams).
Memory recall of dreams at awakening is poor; that’s why we forget the exact
elements of the dream. Some individuals may have difficulty in a verbal description
of their dreams due to inherent bizarreness. Assessment of dreams scientifically is
not easy because the dreamer is the only observer of his dream, so a third observer
can’t access any subjective experience they pass through. The only way to obtain the
dream information depends on personal memory recall (Baird et al. 2019).
2.2 Dreams from Neurobiological Perspective
During REM sleep, the cholinergic neurons in pedunculopontine tegmentum (PPT)

and laterodorsal tegmentum (LDT) are activated while serotonergic neurons in the
raphe nucleus and noradrenergic neurons in locus coeruleus are repressed; this leads
to an imbalance between these opposed neurons then leads to activation of the brain
during this stage. At the same time, both sensory inputs and motor outputs are inhib-
ited. Sensory suppression is caused by inhibition of presynaptic afferent fibers from
sensory organs and muscles to the spinal cord, while motor suppression caused by
inhibition of postsynaptic neurons of the anterior horn cells. When an individual has
visual and auditory perceptions during REM sleep, this is due to endogenous activa-
tion of occipitotemporal cortical areas (inferior temporal cortex and fusiform gyrus
both belong to visual association area), so lesions in this area lead to loss of these
types of perceptions.
The primary visual cortex functionally separated from the visual association area
during REM sleep leads to endogenous activation of the visual system away from
the external environment.
Amygdala is one of two almond-shaped structures that accounts as a part of the
limbic system located within the temporal lobes, medial to the hypothalamus and
adjacent to the hippocampus and inferior horn of the lateral ventricle, typically
amygdala responds to threatening stimuli and modulates the function of the
hypothalamus.
Decreasing brain activity in the lateral prefrontal cortex and some areas of the
parietal cortex may explain why the dreamer is unable to build logical, realistic, and
meaningful dreams because these areas are working in combination and are respon-
sible for high cognitive functions and episodic memory recall during waking state,
so suppression of these cortical areas make the dreamer have bizarre events.
2.3 Lucid Dreaming
This type of dreaming is unique because it belongs to the area between dreaming
and consciousness, defined as awareness of the dream state and environment with
the ability to concentrate and make decisions. The individual can interpret the dream
while dreaming and remember it after awakening and control the sequence of the
events. The cardinal feature of transparency is the cognitive realization of “This is a
dream!” or awakening within the dream. When this realization or awakening occurs,
it is called a lucid dream. Although most lucid dreams occur during REM sleep,
some studies show they can occur during NREM sleep. The same neurobiological
basis of lucid dreams has not been identified yet. However, a hypothesis suggests
that lateral prefrontal cortices (normally inactive during REM sleep) will remain
active during lucid dreaming (Pigeon and Mellman 2017).
For most people, natural lucid dreams occur infrequently and may never occur in
their lifetime. There are two types of lucid dreams; the first, when the individual
becomes conscious and aware of their dream during the dream; this type is called
“Dream-initiated lucid dreams.” The second, when the individual is conscious and
awake, then enter lucid dreams, and this type is called “Wake-initiated lucid dreams”
(Pigeon and Mellman 2017).
2.4 Dreams, Sleep, and Consciousness Relationship
Consciousness is now considered to have two main aspects. First, consciousness as

awareness (phenomenological meaning); second, consciousness as strategic con-
trol (functional meaning). As the phenomenological aspect is the primary concern,
it is classified into three main types of awareness.
(a) Awareness as a phenomenal experience of events: It means the awareness of
recognizing things and events and is sometimes referred to as primary con-
sciousness, which is defined as the experience that results from a response to
perception, feelings, thoughts, and memories. In primary consciousness, we are
the subjects who do the thinking, feeling, and actions in response to external
environments. The target of concern in phenomenal experience may be consid-
ered external or from the outside environment. In this condition, the awareness
represents an indirect report of the external world (e.g., I can see a car or hear
my friend’s voice). Or the target of concern may be considered internal or from
inside our body, and in this condition, the awareness represents direct reports of
the inner world (e.g., I am hungry or I have pain in my arm).
(b) Awareness as meta-awareness (also called meta-consciousness): Means
awareness of mental life itself or when our consciousness re-represents the con-
tents of everyday experience. During a dream, meta-awareness is expressed in
various ways and interpreted as reality testing, which is the mental action when
the individual can decide whether an experience is a result of information out of
52 S. A. Saleh
the brain (external world) or whether it is a product of the mind, as in the

dream—also referred to as self-reflectiveness, which suggests that the dreamer
consciously reflects the truth that they are dreaming. However, reality testing is
vague in some situations, so the dreamer can’t decide whether this is the result
of mental activity or the external world. The dreamer may take part in the event
or watch it as an external observer.
(c) Awareness as self-awareness: To activate the meta-awareness about the
objects, events, feelings, and thinking, we must first be aware of ourselves or
our entity. However, self-awareness can be present when meta-awareness
is absent.
During the dream, phenomenal awareness is present. In contrast, meta-awareness is
supposed to be absent so the individual can neither determine their thoughts that
produce the dream nor experience the reality testing, so the dreamer is unaware that
they are dreaming. This event is not actual, so this may explain the bizarreness of
dreams. When meta-awareness is present and does not fade during a dream, dream-
ers can recognize that they are dreaming. That occurs in lucid dreams where the
dreamer is aware of dreaming and the self as a dreaming subject and has cognitive
insight and access to memory and the capability of control on their dream.
Self-awareness represents the conscious state where the individual’s attention is
oriented toward external events to their reflective consciousness and personal his-
tory. This type of awareness is implicated only in the direct experience of percep-
tion, sensation, and thoughts. All the operations involved in dream production are
unconscious. From the functional point of view, the role of the conscious process in
the dream is only the mental activities that monitor the output of the unconscious
elaboration, interpretation of what is happening in the dream scene, self-awareness,
and emotional experiences. In general, self-regulation and reflective consciousness
are inefficient during dreaming. While the primary consciousness and self-awareness
remain intact and efficient in the oneiric world, meta-awareness is not always pre-
served (Pigeon and Mellman 2017).
2.5 Dreaming About Future and Postconscious
Dreaming about one’s future events and thoughts does not take enough time to be
saved in our consciousness. That’s why our postconsciousness releases them to
make them satisfied and comfortable about the frightens. The dreams that cause you
to be comfortable, which I will call good dreams, while others make you uncomfort-
able, and I will call them bad dreams. Postconsciousness creates these dreams to
release the thoughts from our mind and to make us more tolerated and realistic with
our reality, not with our imaginations, so it creates some kind of imaginations (could
be real or not and could be good or bad), to fight our worries and stressing thoughts.

1. Which stage of sleep is characterized by the (WHS Nervous System Flashcards.
https://www.flashcardmachine.com/whs-nervous-system.html) presence of
sleep spindles and K-complex with the decrease of heart rate, respiratory rate,
and body temperature:
(a) Stage I of NREM
(b) Stage II of NREM
(c) Stage III of NREM
(d) REM sleep
(e) None of the above
2. The minimal sleep requirement for a 4-year-old child is:
(a) 9
(b) 7
(c) 10
(d) 14
(e) 11
3. The primary structure that is responsible for controlling our sleeping and wak-
ing cycle is
(a) Suprachiasmatic nucleus
(b) Medulla
(c) Thalamus
(d) Pineal gland
(e) Amygdala
4. Insomnia characterized by all of the following features, except:
(a) Dissatisfaction with sleep quality and quantity
(b) Disturbance of sleep can be at sleep onset or/and sleep maintenance
(c) May associated with psychological stress, chronic pain, restless leg syn-
drome, and drugs
(d) Decrease in GABA neurotransmitters in the brain
(e) It occurs 3 times:1 week during at least 1 month
5. One of the following is NOT a feature of circadian rhythm disorder:
(a) Difficulty in falling asleep and difficulty in waking up at the desired time
mostly occurs in people with neurodegenerative disorders
(b) Multiple short periods of sleep and wakes through the day with normal
sleep duration
(c) Jet lag disorder occurs in people who travel to areas with different
time zones
(d) May occur due to dementia and blindness
(e) Usually, they are treated by timed blue light and melatonin
54 S. A. Saleh
6. In obstructive sleep apnea all the following are characteristics, except:

(a) Repetitive episode of upper airway obstruction due to relaxation of
throat muscles
(b) Occur during sleep stage III and REM and associated with severe
desaturation
(c) Associated with daytime sleepiness, mood changes, and morning headache
(d) May occur due to old age, traumatic brain injury, and obesity
(e) Best treatment option is continuous positive airway pressure
7. All of the following are parasomnia disorders associated with NREM
sleep, except:
(a) Sleep walking
(b) Sleep-related eating disorder
(c) Nightmare disorder
(d) Sleep terrors
(e) Confusional arousal
8. A 33-year-old female complains of an irresistible urge to move her legs that
start after she finishes her work that increases at night and relieved by moving.
She denied any short time painful leg contraction, other neuromuscular disor-
der, or joint pain. These features mostly indicate that she has:
(a) Sleep-related leg cramps
(b) Sleep-related rhythmic movement disorder
(c) Restless leg syndrome
(d) Periodic limb movement disorder
(e) Propriospinal myoclonus of sleep onset
9. Activation-synthesis hypothesis of the neurobiological theory proposed that
dreams are:
(a) Imaginary visions and hallucinations
(b) A way of connection between our world and God’s world
(c) Electrical brain signals that activate certain areas of the brain and pick ran-
dom thoughts, images, and feelings of our memory
(d) Training places to improve our skills to avoid real life-threatening situations
(e) Have an important role in long-term memory consolidation and
enhancement
10. One of the following is NOT a feature of lucid dreaming:
(a) Belong to the area between dreaming and consciousness where the indi-
vidual is able to make decisions and changes in his or her dream
(b) May occur due to persistence activation of lateral prefrontal cortex
(c) Mostly it occurs during REM sleep period
(d) It can be induced using different strategies such as cognitive technique and
external stimulation
(e) Absent of meta-awareness and self-awareness
Answers
1. (b)
2. (e)
3. (a)
4. (e)
5. (a)
6. (b)
7. (c)
8. (c)
9. (c)
10. (e)
References
Baird B, Erlacher D, Czisch M, Spoormaker VI, Dresler M. Consciousness and meta-consciousness

during sleep. In: Handbook of behavioral neuroscience, vol. 30. Amsterdam: Elsevier; 2019.
p. 283–95.
Baumann CR, Mignot E, Lammers GJ, Overeem S, Arnulf I, Rye D, Dauvilliers Y, Honda M,
Owens JA, Plazzi G, Scammell TE. Challenges in diagnosing narcolepsy without cataplexy: a
consensus statement. Sleep. 2014;37(6):1035–42.
Della Monica C, Johnsen S, Atzori G, Groeger JA, Dijk DJ. Rapid eye movement sleep, sleep
continuity and slow wave sleep as predictors of cognition, mood, and subjective sleep quality
in healthy men and women, aged 20–84 years. Front Psych. 2018;9:255.
Harvey AG, Bélanger L, Talbot L, Eidelman P, Beaulieu-Bonneau S, Fortier-Brochu É, Ivers H,
Lamy M, Hein K, Soehner AM, Mérette C. Comparative efficacy of behavior therapy, cognitive
therapy, and cognitive behavior therapy for chronic insomnia: a randomized controlled trial. J
Consult Clin Psychol. 2014;82(4):670.
Léger D, Poursain B, Neubauer D, Uchiyama M. An international survey of sleeping problems in
the general population. Curr Med Res Opin. 2008;24(1):307–17.
Maurer VO, Rizzi M, Bianchetti MG, Ramelli GP. Benign neonatal sleep myoclonus: a review of
the literature. Pediatrics. 2010;125(4):e919–24.
Molaie M, Deutsch GK. Psychogenic events presenting as parasomnia. Sleep. 1997;20(6):402–5.
Morin CM, Bootzin RR, Buysse DJ, Edinger JD, Espie CA, Lichstein KL. Psychological and
behavioral treatment of insomnia: update of the recent evidence (1998–2004). Sleep.
2006;29(11):1398–414.
Pigeon WR, Mellman TA. Dreams and nightmares in posttraumatic stress disorder. In: Principles
and practice of sleep medicine. Amsterdam: Elsevier; 2017. p. 561–6.
Roenneberg T, Kantermann T, Juda M, Vetter C, Allebrandt KV. Light and the human circadian
clock. Handb Exp Pharmacol. 2013;(217):311–31.
Rosenberg RS, Van Hout S. The American Academy of sleep medicine inter-scorer reliability pro-
gram: respiratory events. J Clin Sleep Med. 2014;10(4):447–54.
Salminen AV, Winkelmann J. Restless legs syndrome and other movement disorders of sleep—
treatment update. Curr Treat Options Neurol. 2018;20(12):1–2.
Schupp M, Hanning CD. Physiology of sleep. BJA CEPD Rev. 2003;3(3):69–74.
Sollars PJ, Pickard GE. The neurobiology of circadian rhythms. Psychiatr Clin. 2015;38(4):645–65.
Spicuzza L, Caruso D, Di Maria G. Obstructive sleep apnoea syndrome and its management. Ther
Adv Chronic Dis. 2015;6(5):273–85.
56 S. A. Saleh
Stefani A, Högl B. Diagnostic criteria, differential diagnosis, and treatment of minor motor activity
and less well-known movement disorders of sleep. Curr Treat Options Neurol. 2019;21(1):1.
Stumbrys T, Erlacher D, Schädlich M, Schredl M. Induction of lucid dreams: a systematic review
of evidence. Conscious Cogn. 2012;21(3):1456–75.
Tubbs AS, Dollish HK, Fernandez F, Grandner MA. The basics of sleep physiology and behavior.
In: Sleep and health. Cambridge: Academic Press; 2019. p. 3–10.
Van der Salm SM, Erro R, Cordivari C, Edwards MJ, Koelman JH, van den Ende T, Bhatia KP, van
Rootselaar AF, Brown P, Tijssen MA. Propriospinal myoclonus: clinical reappraisal and review
of literature. Neurology. 2014;83(20):1862–70.
Varga B, Gergely A, Galambos Á, Kis A. Heart rate and heart rate variability during sleep in family
dogs (Canis familiaris). Moderate effect of pre-sleep emotions. Animals. 2018;8(7):107.
Defense Mechanisms and Personality
Disorders
1 Defense Mechanism
In the nineteenth century, Sigmund Freud (1856–1939) exhibited his ideas about the
defense mechanisms and their relation to the human mind, which is represented by
the Id (unconscious fundamental and unorganized part of our mind that represent
the main drive of our needs, desires, and impulses that seek for immediate plea-
sures), ego (present in the conscious and unconscious part of our mind responsible
for organization and planning, and manifest by the defensive, reasoning, reality
testing, intellectual and executive functions that regulate between our primitive
demand of Id and the higher moral values of the superego), and superego (present
in the conscious, preconscious, and unconscious part of our mind that symbolize the
higher moral values and principles that associate with the society rules, so it guides
our behavior to what is right and wrong and function by suppressing the unaccept-
able Id impulses). After that, in the twentieth century, his daughter Anna Freud tried
to complete his work by defining, analyzing, and adding more of these defense
mechanisms. Also, she proposed that defense mechanisms depend on the maturity
of the ego. Defense mechanisms are mental processes that act unconsciously to
resolve the conflicts that result from rapid change in internal and external reality
through distortion or manipulation to avoid suffering from anxiety and depression.
These conflicts may interfere with one’s family, culture, or identity values. Which
defense mechanism takes the act is something that we cannot control, but it has
many consequences on our mental health. When the individual uses the defense
mechanisms as a main coping style with life stressors, this may damage the self and
result in irrational, harmful behaviors. So defense mechanisms act as a way of
masking reality and preventing the individual from facing the problem and taking
responsibility. The target of the defenses is to rebalance the psychological state and
S. A. Saleh (*)

Switzerland AG 2022
58 S. A. Saleh
provide the mind with time to adjust to the new changes. Also, it leads to a decrease
in cognitive, emotional, and physiological stress. The motives of these defenses are
to ward off the instinctual anxiety feeling of guilt and protection of our self-esteem.
Defense mechanisms work through alteration of perception and relationship
between self, others, and the conflicts. Although defense mechanisms lead to psy-
chological adjustment and more adaptation to the internal and external reality,
sometimes it may cause psychological distortion and result in pathology. These
defenses have an important role in psychodynamic therapy; it helps make the indi-
viduals more aware of their behaviors and allow them to understand themselves
more deeply. So it could be a valuable tool to manage people with depression, anxi-
ety, and personality disorders.
2 Classification of Defense Mechanisms
There are many theories developed to classify the defense mechanisms of which the
borderline personality organization theory that developed by Otta Friedmann
Kernberg in 1967 and depend on the object relation theory to explain how the per-
sonality develops during childhood using the primitive defense mechanisms (e.g.,
projection, denial, dissociation, and splitting) as a cornerstone of this theory.
Another theory developed by Robert Plutchik (1927–2006) in 1979 depends on the
eight opposite primary emotions to explain our defense mechanisms, for example,
fear represents repression, anger represents displacement, joy represents reaction
formation, sadness represents sublimation, acceptance represents denial, disgust
represents projection, expectation represents intellectualization, and lastly surprise
represents regression, and all the other emotions and defenses are derived from
these. Finally, the last theory developed by the psychiatrist George Eman Vaillant
claims that defenses are a continuation to their psychoanalytic developmental level
and classify the defense mechanisms into a hierarchical model of four main catego-
ries ranging from the pathological level of defenses to the healthiest adaptive level
(Fig. 1). This is the same classification used by the American Psychiatric Association
(ASA) through their (DSM-4) diagnostic and statistical manual for mental disorders
(Fig. 2). We will go through most of the defense mechanisms according to Vaillant’s
Fig. 1 Vaillant
classification of defense
mechanisms level from
least adaptive
(pathological) to highest
adaptive (mature)
Defense Mechanisms and Personality Disorders 59
Fig. 2 Diagnostic and

statistical manual, fourth
edition (DSM-4), classify
the defense mechanisms
into seven levels from the
least adaptive
(dysregulation level) to the
highest level (high adaptive
level)
classification, including more defenses that were discovered after Vaillant’s original
classification:
2.1 Pathological Defenses
This level represents a failure of the individual defensive system to arrange the
response to the stressors, so when these kinds of defenses take the actions, they will
result in distortion of external reality to eliminate the individual’s need to deal with
it and make them think inconsequential and behave in irrational ways. Although
they present in some psychiatric disorders (e.g., schizophrenia), they may typically
appear in dreams (Vos and De Haes 2007).
1. Psychotic denial: Characterized by avoiding the awareness or inability of the
individual to accept part of the internal reality (their feeling, thoughts, and expe-
rience) and part of the external reality (the outside events and stressors) as it is
disturbing then make them to deal and act as if they did not exist despite the
overwhelming evidence. For example, an older person who is newly diagnosed
with cancer refuses to acknowledge his disease and start treatment despite all the
signs and symptoms he suffered from, just because the idea of having cancer is
too annoying and very hard to handle. Hence, it is easiest to deny the actual
disease.
2. Delusional projection: Characterized by fixed beliefs about the external reality
or own self that cannot be changed even in the presence of reasonable conflicting
evidence regarding its truth. These beliefs may be based on wrong or misleading
information. Their content includes many different themes: persecutory (the
most common type), referential, somatic, grandiose, and religious. It may occur
either when the individual perceives their feeling in another individual and acts
on that perception, or inversely when they perceive another individual or their
feelings inside themselves. Also, it appears in psychosis and other psychiatric
disorders. For example, an older man attacks a security guard because he believes
the government agency wants to kill him.
60 S. A. Saleh
3. Distortion: Unrealistic extreme reshaping of the external world to meet inner

core thoughts and impulses. The unconscious mind focuses only on things that
correspond with the internal wishes and ignores all the evidence that disagrees
with them. So the individual has automated thoughts that experience during all
events. Also, it is associated with unrealistic beliefs, hallucinations, delusion,
and denial to own responsibility to take action. Uncomfortable impulses are
replaced with their opposition to relieve the internal conflicts. Some studies
demonstrate that there is an association between distortion and depression. In
addition, distortion appears clearly in individuals with schizophrenia, narcissis-
tic personality disorder, and borderline personality disorder (American
Psychiatric Association 2013; Lee et al. 2020).
2.2 Immature Defenses
This defense level is responsible for suppressing emotional awareness to minimize

the distress and conflict from the external reality. Usually, it is present in adults;
however, it can appear in some personality disorders and major depressive disorder.
In addition, overuse of these defenses can result in maladaptive behaviors and
impair the individual’s ability to cope efficiently, which include:
1. Acting out is characterized by the direct expression of unconscious feelings and
thoughts through physical actions without awareness of the emotions that drive
these behaviors. It occurs due to the inability to deal with these mental contents
thus cannot express them verbally. Synonymously, acting out is used to refer to
impulsive control disorders. It also shows up in patients with borderline or anti-
social personality disorders, chronic drug abusers, failure perversion, or self-
inflicted injury to relieve the stress. For example, a child with a sick dad
misbehaves in school.
2. Passive aggression is characterized by indirect or ineffective expression of hos-
tility to others in a non-confrontational manner. This defense mechanism is very
familiar, and we use it in many situations when we are angry or dissatisfied with
the results. Hence, we indirectly express our anger to let the person in charge
know we disagree. This behavior will lead to failures, procrastination, decreased
productivity, and can’t get things done, leading to a person we can’t depend on.
Passive aggression is also associated with psychiatric disorders like acute stress
disorder, adjustment disorder, borderline personality disorder, and deliberate
self-harm. For example, an employee who gets to work late intentionally due to
a conflict with his boss (Santana et al. 2017).
3. Projection: Characterized by attributing an individual’s own unacceptable inter-
nal feelings, thoughts, or impulses to an external environment (other person or
object), which occur because the individual thinks their thoughts are unaccept-
able to reveal them directly, so they try to project them on others. During this
process, the individual is unaware that these impulses and feelings originate
internally. However, it may appear in children and be considered normal to help

them cope with behavioral problems like fears, sadness, shyness, and oversensi-
tivity. However, it indicates impairment in developmental dealing with the world
during adulthood. We could notice projection also in people with schizophrenia,
victims of childhood sexual abuse, depression, obsessive-compulsive disorder,
pain disorder, and anorexia nervosa. For example, a husband who wants to cheat
on his wife blames her for being unfaithful and does not love him (Yazdanshenas
Ghazwin et al. 2017).
4. Schizoid fantasy: Fantasy represents a wide range of creative mental processes
used to express and experience specific wishes and desires that are impossible to
have in real life, so it serves as a way to resolve uncomfortable situations.
Schizoid fantasy is characterized by a tendency to fall back into one’s imagina-
tion in order to relieve the present conflicts. For example, it is used to gratify
hidden desires for interpersonal relationships and to abort the overexpression of
aggressive sexual wishes. It dominates in children and schizoid personality dis-
order. Or they are experiencing a daydream during a conversation as a way to
repel boredom.
5. Splitting: Categorizing the self and other individuals on the extremes as either
all-good (angels) or all-bad (evils) at different times and according to the situa-
tion so the split person does not have in between (black-white thinking pattern)
and cannot accept the ambiguity and tolerate that the people could be good and
bad simultaneously. The person uses splitting to project and maintain the internal
contradictory attitudes and conflicts, but also prevent combination between
them. Spitting may also represent different sections within personality and con-
sciousness. Sigmund Freud explains splitting by referring to the trauma when
the individual experiences a traumatic event. The mind will repress the uncom-
fortable feelings. After that, these memories will split off from the consciousness
and labeled as bad events and the mind tries to avoid them. So, according to
Freud, splitting is a normal part of our personality development during child-
hood that will incorporate and form the id later on. Splitting appears very clearly
in patients with narcissistic and borderline personality disorders. For instance, a
patient recognizes the surgeon who does the operation to him as the best surgeon
in the world and the kindest one. On the second day, when the surgeon does not
come to see him, he redefines him as the worst doctor he has ever had and does
not respect his patients (Zanarini et al. 2013).
6. Idealization: Exaggerated expressing of perfect thoughts about self, others, and
the events while ignoring the unpleasant side of the truth. In idealization, there is
a minor image distortion of reality. For example, an adult who recalls childhood
memories and admires them and considers them the best moment of his life, on
the other hand, ignores the stress and bad events that accompany them.
7. Devaluation is the opposite of idealization, where the individual regards the
self, others, and situations as totally worthless and flawed. In devolution, the
individual focuses on the negative feelings and thoughts and ignores all the other
positive sides. When the person experiences idealization and devaluation, they
may use a splitting defense mechanism. It typically presents during childhood as
62 S. A. Saleh
part of the development. When the individual becomes mature and realizes that
the people can be both good and bad simultaneously, devaluation will decrease.
However, continued devaluation during adulthood may refer to a problem in
personality development due to childhood trauma. For instance, a person who
thinks he does not deserve a good job and a good life (Thomas et al. 2020; Rnic
et al. 2016; Esterberg et al. 2010).
2.3 Neurotic Defenses
This type of defense manifests as severe anxiety and arises when the individual
experiences emotional distress, instability, and unconscious struggles to alter the
internal feelings, so the individual behaves eccentrically. Due to bad behavior, the
person may relieve the internal conflicts, but it will affect their relationships and
daily life. It commonly occurs in healthy people and individuals with psychiatric
disorders such as schizophrenia, bipolar disorder, borderline personality disorder.
1. Intellectualization: By this defense mechanism, the individual uses overthink-
ing to deal with an annoying situation then isolates oneself from the feeling to
reduce the harm of uncomfortable emotions. So it looks at the event from a fact,
rational and abstract reasoning point of view to avoid provoking anxiety. So, for
example, a young boy whose parents died in a car accident tries to investigate
and understand how the accident happened instead of showing his sad feelings.
2. Reaction formation: This defense mechanism manifests by transforming the
uncomfortable wishes, thoughts, and impulses that may be considered danger-
ous into the opposite behavior unconsciously to relieve anxiety, sexuality, and
internal guilt. It keeps the original individual feelings and impulses out of the
awareness, so they are only recognized when the person shows a behavior dia-
metrically opposite to what was expected for a particular situation. Also, it is
considered transitional defense between the low-level immature (acting out)
defenses and high-level mature (altruism) defense mechanisms. Finally, it may
count as an adaptive defense because it reduces the destructive behaviors and
makes the individual quit the bad habits or do more beneficial behaviors. Some
studies show an association between reaction formation and anxiety-related
disorders such as panic disorder, anxiety disorder, and agoraphobia. In contrast,
others demonstrate that patients with bipolar disorder use reaction formation
less frequently. For instance, a well-known Stockholm phenomenon is when the
kidnap victim falls in love with the perpetrator to build a bond between them
and show affection contrary to what she was feeling at that time.
3. Dissociation: Drastic modification of customarily integrated functions of iden-
tity, memory, consciousness, and behavior to relieve the emotional distress. It
ranges from a minor adjustment in character to complete detachment from real-
ity. Dissociated individuals usually disconnect from time and external environ-
ment, and sense of self. So it will lead to amnesia and fragmentation in
personality. It can be noticed in individuals who suffered extreme traumatic

events during childhood. In severe cases, the person may display multiple per-
sonalities. Although dissociation as defense mechanism is temporary, it can
present in more frequent states and appears clearly in individuals with
dissociative identity disorder, depersonalization and derealization disorder, dis-
sociative amnesia, and patients with post-traumatic stress conversion disorder,
and borderline personality disorder. Some studies suggest that dissociation rep-
resents the base to rely upon as a mechanism for other defenses to achieve their
goals, such as repression, intellectualization, and splitting. For example, a vic-
tim girl exposed to sexual abuse when facing the abuser suddenly becomes
numb and disconnected from the environment (Tredget 2001).
4. Displacement: Unconscious redirection of the acute feelings and impulses
toward another less threatening person or object in an attempt to resolve the
internal conflicts. Individuals use displacement because they cannot express
their feelings directly due to fearing the consequences. This maladaptive mech-
anism may cause more harm to the individual due to the destruction of relation-
ships and create more problems. Displacement is seen frequently in patients
with panic disorder and individuals with childhood sexual abuse. Evidence
demonstrates the association between displacement and emotional eating (eat-
ing aggressively to cope with aversive feelings, thoughts, and memories). For
instance, an angry and conflicted mother with her husband directs her feelings
and emotions toward her children.
5. Repression: Unconscious elimination of unacceptable and painful thoughts,
memories, and feelings from conscious awareness. The individual does not
recall the memories of the traumatic events even if being conscious and aware
at that time. It may distort the reality to relieve the anxiety and internal impulses;
however, continuous repression of events may provoke anxiety and disturb the
feelings. These psychological conflicts may represent a threat and feeling of
guilt to self, so the mind represses them unconsciously to protect our self-
esteem and other relationships. Although the repressed individual may appear
healthy as ordinary people, this is a wrong impression. They may be more dis-
tressed and have a higher risk for physical disorders. Also, repression repressed
the first cornerstone for Freudian psychoanalytic theory and the development of
other defense mechanisms. For example, an individual who suffered childhood
sexual abuse does not recall any memories of that event (Iacovino et al. 2014;
Salvatore et al. 2012).
6. Isolation of affect: Unconsciously separating the internal impulses, thoughts,
and feelings from the outside environment. So the individual’s mind tries to
avoid experiencing the painful feelings associated with bad events. Although it
is associated with obsessive-compulsive disorder, it can occur in ordinary peo-
ple after experiencing traumatic situations. Isolation of affect allows the indi-
vidual to keep conflicting ideas and behaviors without feelings of guilt,
humiliation, and anxiety. For example, a person who describes a murder event
that occurred in front of him without showing any emotional responses.
64 S. A. Saleh
7. Regression: Temporary or long term and involuntary turning back in matura-

tional state of ego to an earlier developmental stage in a way of seeking more
comfort and safety from a stressful situation. So the individual will behave, act,
and feel like a child, immature or in an age-inappropriate manner to face the
uncomfortable events. Also, it makes the individual dependent on others to
make decisions and be assertive to correlate with a doubtful state. The individ-
ual’s behavior is widely variable and associated with stage fixation during early
development. Such an employee who has stressful work and conflicts with his
boss returns to his parents’ home and lies in his mother’s lap (Clarkin et al. 2021).
8. Rationalization: Justification of one’s feelings, thoughts, and acting for certain
events using plausible explanations that do not represent the events. So the indi-
vidual tries to replace the threatening situation with a more logical one and
make excuses to minimize the anxiety and protect self-esteem and self-concept.
This defense mechanism refuses to acknowledge the unpleasant aspect of real-
ity, so it deals with conflicts via lack or minimal level of awareness. Some stud-
ies show that rationalization is among the most prevalent defense mechanisms
in people with borderline, schizotypal, antisocial, and narcissistic personality
disorders (Lee 2017; Frick 2016; Zanarini et al. 2009).
9. Undoing is an attempt to give up the conscious awareness of thoughts, emo-
tions, and unacceptable and undesirable impulses and then do the reverse
behavior to correct them. So the individual will show the opposite meaning of
those impulses to revert the results of his or her act or thoughts and as these
events had never occurred. It was suggested that undoing as an intermediate
level defense mechanism between mature and immature however it is still a
maladaptive process. Undoing is one of the most prominent defense mecha-
nisms in patients with obsessive-compulsive disorder. Also it is used more fre-
quently for panic disorder and social phobia. For instance, after fighting, a
husband brings his wife something she has been waiting for a while to apolo-
gize indirectly to her since he was aggressive to her.
10. Somatization: Redirecting the unpleasant feelings and thoughts the individual
has for other people toward the self. Due to the psychological distress, the indi-
vidual may have psycho-physiological disturbance and show distress as any
known disease cannot explain physical symptoms. Usually, the signs and symp-
toms are vague, do not link to each other, and may involve multiple systems in
the body. Some psychiatric disorders represent the main form of somatization,
such as body dysmorphic disorder, conversion disorder, hypochondriasis,
somatization disorder, pain disorder, undifferentiated somatoform disorder, and
somatoform disorder not otherwise specified. Somatization may be mainly
symptom-based and represent hypochondriasis or signs-based and the conver-
sion disorder. Hypochondriasis is also sometimes considered a defense mecha-
nism by itself. Otherwise, it is labeled as somatic symptom disorder and illness
anxiety disorder. Any slight change of the physical symptom makes the indi-
vidual believe and consider this as evidence of serious illness. It may result
from misperception of body and mind conditions without the actual medical
disease. Even after the physician evaluation and reassurance, the hypochondria-
sis may persist, and the individual does not believe there is nothing to be con-
cerned about. Also, it considers a nonverbal, interpersonal connection and
help-seeking behavior to cope with stressful life events. Hypochondriasis
involves a wide variety of symptoms and psychiatric disorders like pain, body
appearance, gastrointestinal, cardiopulmonary, sensory-perceptual issues,
personality disorder, neurasthenia, obsessive-compulsive disorder, hysteria,

depression, and paranoid psychosis. For example, a young boy with a minor
cough may think that he has lung cancer, and he is going to die. While conver-
sion disorder (also named a functional neurological symptom disorder in the
DSM-5) is also considered a defense mechanism by itself, it is characterized by
converting psychological harm into physical symptoms that lead to impairment
of sensory and motor functions. Through this process, the individual uncon-
sciously relieves their anxiety—for example, a woman complained of loss of
consciousness after having a fight with her husband.
2.4 Mature Defenses
Also, referred to as adaptive defense mechanisms that we can develop overgrowing

with life and used by healthy individuals to deal with daily situations to resolve the
anxiety and impulses without affecting the individual life. They are associated with
emotionally intelligent people, life satisfaction, happiness, psychological maturity,
and successful relationships. They are consciously used by a person with the inten-
tion to increase feelings of gratification and control over life events. Even if the situ-
ation is hard to handle, the reality is kept to itself. This contrasts with immature
defenses where the reality is distorted and denied to cope with. These defenses try
to value the self, look at the events from a new perspective, and create a new mean-
ing. So this level represents the maximum capability to adapt and handle the
stressors.
1. Humor: Facing the negative impulses, thoughts, and feelings of events using a
sense of humor and comedy. The individual uses humor as a distracting method
when exposed to uncomfortable situations or is not ready to deal with them.
There are studies that show increasing use of humor enhances psychological
well-being, life quality and satisfaction, and interpersonal relationships. For
example, a medical student who has a challenging exam tends to make jokes and
do funny things to cope with his anxiety (Ronningstam 2011; Caligor et al. 2015;
Novais et al. 2015).
2. Sublimation: Expression of unacceptable thoughts, impulses, and behavior
more constructively and acceptably with changing the aim to suit social norms.
So the individual will show their internal conflict through more valuable behav-
ior. It is considered one of the most mature defense mechanisms, and only a
small number of people can maintain it regularly. Usually, it expresses sexual
and aggressive impulses and transforms this negative energy into more positive
66 S. A. Saleh
activity. Although it processes subconsciously, we can still intentionally channel

our urge into more creative and beneficial things. For instance, a young boy who
expresses his aggressiveness throughout practicing boxing or an artist who
expresses his desires by his artwork (Nestadt et al. 1990).
3. Suppression: Conscious decision to eliminate distressing impulses, thoughts,
and desires from conscious awareness in an attempt to remove these conflicts
from the present reality and deal with them later on. It lets our attention focus on
more important things and defer unnecessary issues to other times. What distin-
guishes suppression from repression and other defenses is that it operates under
our control optionally and consciously. Some studies reveal the correlation
between suppression and better psychological adjustment, flexibility, happiness,
and adaptation to the environment. While less use of suppression as a defense
mechanism is associated with some psychiatric disorders like borderline person-
ality disorder and anxiety disorder, improvement of suppression through behav-
ioral therapy can improve the symptoms of obsessive-compulsive disorder and
depression. For example, a student who has an exam tries to suppress all other
distractions to focus on his exam (Morrison 1989).
4. Altruism: Alleviating negative impulses and emotions by providing services to
others to increase self-satisfaction and gratification about oneself. Usually, the
help is provided to individuals who have the same feelings and struggles without
any obligation or expectation of reciprocal rewards. Some studies show that
altruism is associated with better physical, mental well-being, and romantic rela-
tionships. For example, a cancer survivor patient makes a large donation to char-
ity for helping cancer patients (Sulz and Hysteria 2010; McGauley et al. 2011).
5. Anticipation: The ability of the individual to expect the future events then pro-
cess them and make realistic planning and preparation for the potential risk or
stressful situations that may result from, in an attempt to mitigate the anxiety. It
involves either managing the uncomfortable event and putting in the effort to fix
it or just looking at the events from another perspective and redefining it as less
risky and feeling good about it. In addition, there are certain approaches used to
enhance the anticipation for the individuals also, it depends on the interaction
between perceptual and cognitive skills. For example, a young man prepares
himself for a job interview and plans his answers to any related questions.
6. Affiliation: The tendency to belong to other people to resolve and deal with
internal and external stressors, share problems without considering other people
responsible for them, and make a connection and cooperation. When an indi-
vidual being with others can provide a chance for distraction and a host of other
emotional support. For example, alcoholic individuals participate in group ther-
apy (Shea et al. 2004).
3 Personality Disorders
Personality represents a continuous fixed repetitive pattern of thinking, reacting,

feeling, and acting that distinguishes the individual from other people. Some factors
affect and determine personality development, including the person’s experiences
during early life, the surrounding environment, and the inherited genetic factors.
During the early years of life, the child shows a wide variety of behaviors in response
to the environment. This response and the way of handling things are unpredictable,
changeable according to the results, and occur spontaneously. While the child tries
different behaviors to deal with situations, over time, they begin to understand and
recognize which behavior or response is permissible and could achieve their desires
and resolve the distress and which are terrible choices. Passing through this process
over and over will shape the individual personality and their actions with the envi-
ronment (Zanarini et al. 1998).
A personality disorder is a mental illness disorder characterized by pervasive,
inflexible, and maladaptive deviation in the way of thinking, feeling, and acting
from the expected individual’s culture and causes significant malfunctions and dis-
turbance in the individual relationship that persist over time. It is recognized during
late adolescence or early adulthood and continues during life. Usually, the person
with personality disorder seeks medical advice due to disagreement with people
during work and interpersonal relationships rather than the distress of their thoughts
and feelings. These deviations may be ego-syntonic, and they are unaware of and
may consider their behavior appropriate as part of their character. These behaviors
negatively affect the quality of life and may result in maladaptive defense mecha-
nisms that lead to anxiety and distress.
4 Classification of Personality Disorders
The ten different types of personality disorders are categorized into three clusters
that share the same features (Table 1). Each has a distinct pattern of signs and symp-
toms that differentiate from the others and have its consequences on the individual.
We will consider the classification according to the DSM-5.
Table 1 shows clusters A, B, and C of personality disorders according to the DSM-5

Cluster A Cluster B Cluster C
Characteristic behavior Odd and Dramatic, emotional, or Anxious or fearful
eccentric erratic
Personality disorder Paranoid Antisocial Avoidant
type Schizoid Borderline Dependent
Schizotypal Histrionic Obsessive-
Narcissistic compulsive
68 S. A. Saleh
4.1 Cluster A Personality Disorder
These types of personality disorders are characterized by odd and eccentric behav-
ior. Individuals with cluster A considered the world overly self-centered; thus, they
cannot develop meaningful social relationships. Also, there is a genetic association
between this category and schizophrenia, and they are more resistant to treatment.
This cluster includes:
1. Paranoid Personality Disorder (PPD): An individual with PPD considers other
people’s actions as threatening and suspicious regardless of evidence of a threat,
so they have pervasive distrust issues. Also, they may show aggressive behavior
without justification because they consider others unfaithful and accuse them of
things that don’t exist. In addition, PPD is characterized by unforgiving, rumina-
tive, jealous, excessive self-importance, and hostility traits. Individuals with
diagnoses of PPD tend to keep observing the environment and other people for
signs of a threat to accuse others of planning to get them out, so they are always
hypervigilant. Due to this mindset, those individuals have difficulty socializing
with people or engaging in romantic relationships because they keep charging
their partners to be disloyal. Usually, individuals with PPD cannot locate a prob-
lem inside themself because their symptoms are ego-syntonic, so they tend to
project their creativity and feelings on other people. That’s why the projection
defense mechanism is considered to have an essential role in the paranoid pro-
cess. PPD occurs more commonly in men than women and especially in people
from minority cultural statuses. To make the diagnosis of PPD reliable, the
DSM-5 proposed two criteria. Criterion A; involve that individual must have a
global distrust and suspicion of others’ motivations which can be concluded in
four of the following features: (1) belief, without sufficient evidence, that other
people intentionally mean to deceive and harm them; (2) unjustified doubt about
the loyalty and trustworthiness of others; (3) avoid to confide other people due to
fearing of unfaithfulness and this information may be used against them; (4)
understanding benign remarks or events as meant to be threatening or demean-
ing; (5) tendency to keep grudges and unforgiving others; (6) recognize attacks
on their character which are hidden to others require a vindictive response; and
(7) presence of recurrent suspicion and accusing their spouse as being disloyal
without justification. At the same time, criterion B suggests that these paranoid
symptoms must not be attributed to psychotic episodes associated with schizo-
phrenia, bipolar disorder, a major depressive disorder with psychotic features.
Treatment of patients with PPD is quite challenging because they have trust dif-
ficulties and fear of being humiliated. However, psychotherapy is worth the try,
but first, the therapist has to build a good rapport with the patient. A new promis-
ing psychotherapy approach called metacognition-oriented therapy is used to
manage those patients by asserting the importance of helping individuals struc-
ture narratives of their lives and raising the reflection and metacognition capaci-
ties to understand themselves and others, making the patient more aware and
improving their interpersonal relationships (Zimmerman and Mattia 1999).
2. Schizoid Personality Disorder (SzPD): Individuals with this disorder are char-
acterized by social withdrawal, emotionally cold, carelessness about other peo-
ple’s opinions, avoidance of intimate sexual relationships with their partner,
looking to the world as an observer, not as a part of it, and avoid social situations
or occupations that require them to be engaged in teamwork. Due to this
disconnection and fear from the social world, the individual with SzPD may fall
back into one’s internal fantasy or isolate themselves as a way of defense.
Prevalence of SzPD is low in the general population and tends to range between
1 and 5%, according to the American Psychiatric Association (2013). There is
evidence of a link between genetic susceptibility to SzPD and schizophrenia.
Features of isolation, lack of relationship with peers, poor school performance,
and annoyance by others during childhood may predict the development of
SzPD later in life. Diagnosis of SzPD is applied through DSM-5 criteria, which
involve Criterion A, defined by detachment from a social and familial relation-
ship with a restricted range of emotional expressions in an interpersonal setting
that starts at or after the age of 18. While criterion B proposed the mentioned
features must not be associated with the course of schizophrenia, bipolar disor-
der, a depressive disorder with psychotic symptoms, or autism spectrum disease.
As is the case with most personality disorders, individuals diagnosed with SzPD
rarely look for treatment because their symptoms are ego-syntonic and don’t
interfere with their self-esteem. In fact, there is no specific treatment approved
for the management of SzPD. However, like other personality disorders, using
psychotherapy may improve the symptoms and help individuals with SzPD
develop social skills. In psychotherapy, the therapist tries to make the patient
observe their maladaptive behavior then encourage using new skills to counter-
act this behavior. Group therapy may be used as adjunctive treatment to help
patients interact with others to reduce their fear and identify their positive and
negative emotions. Because the prevalence of anxiety and depression is higher in
people with SzPD, pharmacological treatment may be used in these cases
(Leichsenring et al. 2011).
3. Schizotypal Personality Disorder (SPD): Individuals with this disorder have an
eccentric appearance, unconventional beliefs, distorted or magical thinking, and
interpersonal awkwardness. Also, people with this mental disease complain of
social difficulties and lack of relationships outside their family due to feelings of
pronounced discomfort. Due to a combination of social deficits and cognitive
deterioration (involves primary working memory, verbal learning, context pro-
cessing, and sustained attention), subjects with SPD suffer significantly poor
functioning and reduced quality of life in society. Although this disorder is not
widely investigated, there is some evidence suggesting low prevalence, and it
ranges from less than 1% to 4%, with a slightly higher rate in men than women.
During childhood, symptoms of SPD manifest by excessive social anxiety, sen-
sitivity, and eccentric thoughts and speech. SPD is also considered a prototype
form of schizophrenia spectrum disorders. To deal with unconscious conflicts,
individuals with SPD use immature defense mechanisms predominated by
emerging projection and passive aggression defenses to manage the situation.
70 S. A. Saleh
Also, the presence of autistic fantasy, displacement, and passive aggression

defense mechanisms may predict the development of SPD later on. It may be
challenging to differentiate between SPD, PPD, and BPD in a clinical setting
due to the overshadowing of the symptoms. However, it may be helpful to do that
via using the diagnostic criteria of each of them. To make SPD diagnosis clear,
two criteria proposed by DSM-5 must be present. Criterion A characterized by
pervasive social, interpersonal, and perceptual deficits. At the same time, crite-
rion B mentioned that these features must not correspond to the course of schizo-
phrenia, bipolar disorder or depressive disorder with psychotic symptoms, or
another psychotic disorder. Treatment of subjects with SPD involves mainly psy-
chotherapy. Although there is limited data on psychopharmacological agents, it
could be used as an adjunct to psychotherapy. For example, psychotic-like symp-
toms (odd belief, unusual perceptual experiences, idea of reference, magical
thinking, and suspiciousness) can be managed using small doses of second-
generation antipsychotic drugs (e.g., risperidone or olanzapine—also decrease
mood symptoms). In the presence of concomitant depression or mood symp-
toms, some data suggest using antidepressant agents to mitigate them.
Psychotherapy is the same for other personality disorders that involve establish-
ing an alliance as the first step because patients with this disorder usually have
no desire to make a relationship. More suspicion could be a barrier to successful
therapy. There are no trials on the effectiveness of different types of psycho-
therapy, but some experts recommend using supportive, supportive-expressive,
or exploratory-oriented approaches. Also, some reports demonstrate the effec-
tiveness flexibility of metacognitive interpersonal therapy and metacognitive
reflection and insight therapy. The use of cognitive-behavioral therapy is still
helpful. It allows the individual with SPD to focus on building social skills,
relieving mood symptoms, being more aware of one’s behavior, and maintaining
core beliefs.
4.2 Cluster B Personality Disorders
This personality disorder class has dramatic, emotional, or erratic behavioral fea-
tures. Individuals with disorders in this group have predominantly manifested by
lack of empathy, and they tend to involve themselves in impulsive, promiscuous,
and illegal experiences. Also, the disorders in this cluster have a genetic association
with mood disorders and substance use. This cluster includes:
1. Antisocial Personality Disorder (ASPD): Characterized by a chronic pattern of
violation of other people’s rights with lack of remorse and tendency to criminal-
ity, responsibility, impulsivity, hostility, and manipulation of others for personal
interest. Individuals with ASPD usually fail to develop stable interpersonal rela-
tionships because they are dominated by aggressiveness and violate other peo-
ple’s rules. In addition, they don’t obey the law, so they may have a history of
legal problems and fail to sustain consistent employment. ASPD originates dur-
ing childhood or early adolescence due to physical, emotional, and sexual mal-
treatment and continues into adulthood. The criteria of DSM-5 can confirm the
diagnosis of ASPD. Criterion A: consisted of an enduring pattern of disregard for
and violation of other rights that begin at 15 years of age. The effectiveness of
psychotherapy is questionable since the disorder tends to diminish with time.
Some studies conduct the only treatment is a passage of time. Some literature
suggests cognitive-behavioral therapy for ASPD; however, due to the patient’s
impulsivity and aggressiveness, the therapist has difficulty establishing an alli-
ance, so it has limited benefit. Treating conductive disorder during childhood
may be the best approach to minimize ASPD symptoms during adulthood.
Psychopharmacological agents (e.g., antidepressants, antipsychotics, and mood
stabilizers) could be used only to control symptoms of aggression and impulsiv-
ity and manage the concomitant disorder. An approach called mentalization-
based therapy (involving thinking about self mental state and mental state of
others) has emerged in recent years that appears to be effective in minimizing
aggressiveness. However, more data is needed to confirm these findings.
2. Borderline Personality Disorder (BPD): An enduring pattern of instability
prominent in mood, interpersonal relationships, and self-concept perspectives,
and associated with the feeling of emptiness, fear of abandonment, engaging in
impulsive behaviors, and trying to get others attention via self-mutilation and
recurrent suicidal attempt. Individuals with BPD tend to recognize the world into
the extremes of either “all good” or “all bad.” The literature revealed that indi-
viduals with BPD exhibit a higher rate of using immature defense mechanisms
that include acting out, emotional hypochondriasis, and undoing, so they may
use them as screening tools in a clinical setting to recognize patients with
BPD. Most recent studies demonstrate that using splitting, projective identifica-
tion, and affiliation defenses associate with a higher rate of suicide among peo-
ple with BPD. The DSM-5 defines BPD as a pervasive pattern of instability of
interpersonal relationships, self-image, affects and marked impulsivity that starts
early adulthood and exists in various contexts. Many modalities can be used and
proved to be successful such as dialectical behavioral therapy (DBT),
transference-focused psychotherapy (TFP), and mentalization-based therapy
(MBT). Sometimes medications could be used as an adjunct to psychotherapy to
control symptoms of BPD, such as small doses of second-generation antipsy-
chotics for managing perceptual symptoms and selective serotonin reuptake
inhibitors to reduce impulsivity and aggression behaviors (Lewis and Grenyer
2009; Lieb et al. 2004; Vaillant 1992).
3. Narcissistic Personality Disorder (NPD): Characterized by an enduring pattern
of grandiosity that causes impairment in interpersonal relationships, a require-
ment of excessive attention and admiration, exaggerated sense of self-
centeredness, and hypersensitivity to criticism. Individuals with this disorder
also have a significant psychosocial disability and low quality of life. Although
NPD is associated with many other mental health disorders, it can coexist with
substance use disorders and other personality disorders like ASPD, BPD, HPD,
72 S. A. Saleh
SPD. Some studies classified NPD into two subtypes: grandiose NPD and vul-
nerability NPD. Grandiose NPD is characterized by aggression, excessive gran-
diosity, boldness, arrogance, and self-inflated image. DSM-5 defines NPD as a
pattern of grandiosity (in fantasy or acting), constantly seeking admiration, and
lack of empathy, which appears in early adulthood and present in different situ-
ations. For NPD treatment, no data establishes a single model to be highly
effective and efficient, but a nice try of psychotherapy may be beneficial. Some
experts suggest the same psychotherapeutic approach used for BPD, but it is not
confirmed yet and needs more investigations. Severe symptoms of NPD could be
mitigated by mood stabilizer agents, antidepressant, and antipsychotic medica-
tions (Vaillant 1977; Costa 2016, 2017).
4. Histrionic Personality Disorder (HPD): Characterized by patterns of attention-
seeking behaviors associated with dramatic speech and exaggerated theatrical,
emotional expression, and could be easily provocative sexually. People with
HPD always try to be the center of attention by their physical actions because
they may feel disregarded or depressed if they are not. They also tend to appear
fascinating, tempting, lively, enthusiastic, and manipulative to achieve their
desires. To make the diagnosis of HPD feasible, the DSM-5 defines HPD as a
pervasive pattern of excessive emotional dysregulation and attention-seeking
that starts in early adulthood and persists over time in a variety of contexts, then
proposed eight criteria, five or more of them required to ensure the diagnosis.
The subjects with NPD unconsciously being dramatic as a way of dealing with
their internal conflicts and anxiety. For example, they adopt opinions of people
they admire as a fact without considering or thinking about themselves.
Unfortunately, there is no significant data about the best effective treatment for
NPD. However, psychotherapy may be the best option available that the patient
can benefit from in the long term. Supportive psychotherapy may aid people
with NPD to enhance their emotional control, increase their self-esteem, and
better perceive and cope with the environment. Cognitive-behavioral therapy
may also be used in conjunction with psychodynamic therapy to increase the
effectiveness of the treatment. The goal of psychodynamic psychotherapy is to
reduce the unconscious internal conflicts as an attempt to make the patients bet-
ter understand themselves and recognize their behaviors by learning to exchange
dramatic speech into more adaptive behaviors. Also, the same pharmacological
agents that are used in NPD could be used in severe cases to relieve the symp-
tomatic dysregulations.
4.3 Cluster C Personality Disorders
Anxious and fearful thoughts and behavior characterize this category of personality
disorders. It occurs due to a combination of genetic and environmental etiologies.
Individuals who have a disorder from this cluster suffer from poor relationships and
impairment in occupational functioning. These disorders are also genetically asso-

ciated with anxiety disorders. This cluster consists of three disorders, include:
1. Avoidant Personality Disorder (AVPD): Characterized by excessive social dis-
comfort, hypersensitivity to rejection and criticism, sense of inadequacy, avoid-
ance of social activities and interpersonal relationships, fears of embarrassment
that prevent the individual from taking a risk or being involved in new activities.
Individuals with AVPD have prominent impairment in mental, social, and
somatic aspects that lead to more difficulty in daily life than other personality
disorders. It is proven that this disorder has a developmental deficit during
infancy or early childhood that makes the individual appear shy and prefer isola-
tion. Also, exclusive studies link AVPD and social anxiety disorder (SAD). Some
reports suggest that about 40% of AVPD patients have SAD, while others have
higher rates. However, some literature considers SAD a subtype of AVPD, while
others regard it as a distinct entity with overlapping features. DSM-5 defines
AVPD as a consistent pattern of social inhibition, feeling of inadequacy, and
being excessively sensitive to negative evaluation that begins at early adulthood
and continues in different life aspects. Although few studies are conducted to
investigate the best approach to treat people with AVPD, certain modalities used
to treat SAD effectively reduce the burden of the AVPD and alleviate the symp-
toms. Cognitive-behavioral therapy (CBT) is one of these modalities that targets
negative thoughts and how these thoughts can badly affect the behaviors. Then,
try to figure out new skills to correct these behaviors through specific techniques
(e.g., graded exposure, advantages and disadvantages of avoidance, and behav-
ioral experiment). Schema therapy is another modality that uses a combination
of the already existing techniques and theoretical bases of CBT, psychoanalytic
therapy, attachment theory, and Gestalt theory to help the patients develop more
sense of self-esteem and learn their basic needs and how to achieve them adap-
tively. Lastly, the studies show that psychodynamic therapy is generally adequate
for cluster C personality disorders and not exclusively for AVPD. Although some
experts recommend using some pharmacological agents that are used to manage
SAD-like selective serotonin reuptake inhibitors, serotonin-norepinephrine
reuptake inhibitors, and antidepressants, there are no medications approved by
the authorities to manage AVPD (Vaillant 2016; Walker and Lim 2010).
2. Dependent Personality Disorder (DPD): Characterized by an excessive need for
support, low self-confidence, dependence on others to direct them, fear of rejec-
tion, submissiveness, and passive behavior. Individuals with DPD excessively
rely on other people to take care of them and fulfill their physical and psycho-
logical needs as they perceive themselves as weak and ineffectual. They are also
stuck in abusive relationships and feel disappointed and hopeless when broken
up in a relationship. The American Psychiatric Association estimates the preva-
lence rate of DPD to be about 0.49%, while other studies estimate it to range
from 1 to 5% in the general population with more affected women than men.
People with DPD are more likely to ask for treatment and guidance than other
personality disorders because they always try to find someone to care for them.
74 S. A. Saleh
Also, because they are hypersensitive to interpersonal cues, enthusiastic to

please, and capable of forming good alliances, these features may aid and ease
the treatment to achieve better outcomes. There is no specific treatment for
DPD. The general treatment for any personality disorder may be beneficial, such
as psychotherapy approaches to help individuals with DPD improve their self-
esteem and confidence, thus being independent of others and building more
positive relationships. At the same time, psychodynamic approaches aim to
reveal unconscious conflicts and make them accessible to foster insights. Lastly,
behavioral therapy aims to identify and recognize the specific dependent behav-
iors then replace them with more adaptive and autonomous acts. One problem
with treating DPD patients is that they may have difficulty terminating the treat-
ment due to fear of abandonment, so the therapist should be careful when deal-
ing with those patients (Patrick and Diamond 2017; Mulay and Cain 2020;
Fisher and Hany 2021; French and Shrestha 2020).
3. Obsessive-Compulsive Personality Disorder (OCPD): Characterized by chronic
maladaptive behaviors that consist of one’s own beliefs and attitudes, preoccupa-
tion with orderliness, seek perfectionism. Individuals with OCPD are conscien-
tious and have high standards, so they are unsatisfied with their achievements.
Although they are reliable to do many tasks and responsibilities, it may be chal-
lenging to adapt to changes because they are inflexible. They also consider every
detail and be more cautious, which makes it sometimes uncomfortable and chal-
lenging for them to decide and function properly. The studies estimate that
OCPD is the most common personality disorder, with a prevalence rate ranging
from 7% to 8% in the general population. In addition, OCPD is highly associated
with the co-occurrence of other personality disorders like PPD, SzPD, SPD, and
ASPD. Usually, symptoms of people with OCPD are ego-syntonic, so they don’t
regard themselves as having problems and thus don’t seek any treatment. In
contrast, other studies suggest contradictory findings that people with OCPD
seek treatment because of their suffering and impairment of functions. Like
other personality disorders, there is a lack of studies on OCPD treatment exclu-
sively. However, most data available from co-occurring disorders have shown to
be effective to some degree. For example, studies conducted on OCPD that coex-
ist with depression and anxiety using cognitive therapy (CT) have decreased the
severity of OCPD and other disorders. Studies that test cognitive-behavioral
therapy (CBT) in people with OCPD and mood disorders have also shown
improvement in both disorders with decreased levels of distress. Other modali-
ties such as dialectical behavioral therapy (DBT), metacognitive interpersonal
therapy (MIT), schema therapy, and supportive-expressive, dynamic psycho-
therapy also could be used to manage individuals with OCPD. Still, more ran-
domized studies need to be conducted to declare the effectiveness of each
of them.

1. A 32-year-old female presented to the psychiatric clinic for assessment due to a
third-time suicidal attempt after breaking up with her romantic partner 2 months
ago. Since that time, she has engaged in unsafe sexual behaviors and drinks
excessively. Also, she suffers from depression and intense feelings of empti-
ness. The most likely diagnosis is:
(a) Paranoid personality disorder
(b) Narcissistic personality disorder
(c) Borderline personality disorder
(d) Histrionic personality disorder
(e) Dependent personality disorder
2. A person diagnosed with a schizotypal personality disorder. The person has all
of the following features, except:
(a) Eccentric appearance and magical thinking
(b) Use passive aggression and autistic fantasy as main defense mechanisms to
deal with stressful situations
(c) Suspicious and paranoid ideation
(d) The main treatment is psychotherapy
(e) Has no desire for or enjoyment in interpersonal relationships
3. Which of the following features are present in a patient with the obsessive-
personality disorder:
(a) Difficulty in starting projects on his own due to lack of self-confidence
(b) Socially restricted
(c) Inability to complete tasks sometimes due to seeking perfection
(d) Uncomfortable when not being the center of attention
(e) The belief that the person is unique and knowledgeable
4. All of the followings are features of antisocial personality disorder, except:
(a) Violation of other people’s rights and lack of remorse
(b) Believe without sufficient evidence that other people want to hurt them
(c) Repeated lying and try to use people to get personal benefit
(d) Associated with substance abuse, bipolar disorder, and attention deficit
hyperactivity disorder
(e) The best treatment option to reduce the symptoms is to treat conductive
disorder during childhood
5. A 12-year-old child was presented to the psychiatric unit by his/her parents because
they were worried about him after their divorce. He/she does not talk to them
instead. He/she fights in the school with his/her friends and doesn’t obey his/her
teacher’s instructions. Which defense mechanism he/she exhibits by his behavior:
(a) Acting out
(b) Passive aggression
(c) Splitting
(d) Reaction formation
(e) Displacement
76 S. A. Saleh
6. A mother brought her 5-year-old daughter to the emergency department due to

abdominal pain and vomiting. After doing the required investigations, the doc-
tor diagnosed her with diabetes mellitus type I. The mother refused to accept
this diagnosis and requested another doctor’s opinion because she has an older
daughter with the same disease and cannot deal with both of them. What is the
defense mechanism the mother used:
(a) Displacement
(b) Schizoid fantasy
(c) Denial
(d) Idealization
(e) Intellectualization
7. A 20-year-old girl was exposed to rape. When the police officer asked her about
the event, she described it in detail without any emotional act. What defense
mechanism she used:
(a) Dissociation
(b) Isolation of affect
(c) Repression
(d) Spitting
(e) Projection
8. A wife who divorced her husband is looking for online divorce data to show her
friends the divorce rate to avoid the feeling of sadness and discomfort of the
situation. What defense mechanism represents the wife’s behavior:
(a) Pass aggression
(b) Projection
(c) Reaction formation
(d) Intellectualization
(e) Sublimation
9. All of the following are features of mature defense mechanism, except:
(a) Used by a healthy individual to handle uncomfortable daily events to
relieve anxiety
(b) May indicate more emotionally intelligent individual and reasonable
self-satisfaction
(c) Used consciously by the individual to control life events
(d) The reality is kept itself without distortion
(e) Associated with schizophrenia and borderline personality disorder
10. A wife who despises her husband’s daughter instead cares about her and is very
friendly and lovely with her. Which defense mechanism represents the wife’s
behavior:
(a) Reaction formation
(b) Sublimation
(c) Altruism
(d) Suppression
(e) Isolation of affect
Answers
1. (c)
2. (e)
3. (c)
4. (b)
5. (a)
6. (c)
7. (d)
8. (d)
9. (e)
10. (a)
References
American Psychiatric Association. Diagnostic and statistical manual of mental disorders. 5th ed.
Washington, DC: Author; 2013.
Caligor E, Levy KN, Yeomans FE. Narcissistic personality disorder: diagnostic and clinical chal-
lenges. Am J Psychiatr. 2015;172(5):415–22.
Clarkin JF, Caligor E, Sowislo J. TFP extended: development and recent advances. Psychodyn
Psychiatry. 2021;49(2):188–214.
Costa RM. Conversion (defense mechanism). In: Encyclopedia of personality and individual dif-
ferences. Cham: Springer International Publishing; 2016. p. 1–4.
Costa RM. Undoing (defense mechanism). In: Encyclopedia of personality and individual differ-
ences. Cham: Springer International Publishing; 2017. p. 1–2.
Esterberg ML, Goulding SM, Walker EF. Cluster a personality disorders: schizotypal, schizoid and
paranoid personality disorders in childhood and adolescence. J Psychopathol Behav Assess.
2010;32(4):515–28.
Fisher KA, Hany M. Antisocial personality disorder. In: StatPearls. Treasure Island: StatPearls
Publishing; 2021.
French JH, Shrestha S. Histrionic personality disorder. In: StatPearls. Treasure Island: StatPearls
Publishing; 2020.
Frick PJ. Early identification and treatment of antisocial behavior. Pediatr Clin. 2016;63(5):861–71.
Iacovino JM, Jackson JJ, Oltmanns TF. The relative impact of socioeconomic status and child-
hood trauma on black-white differences in paranoid personality disorder symptoms. J Abnorm
Psychol. 2014;123(1):225.
Lee RJ. Mistrustful and misunderstood: a review of paranoid personality disorder. Curr Behav
Neurosci Rep. 2017;4(2):151–65.
Lee YJ, Keum MS, Kim HG, Cheon EJ, Cho YC, Koo BH. Defense mechanisms and psychologi-
cal characteristics according to suicide attempts in patients with borderline personality disorder.
Psychiatry Investig. 2020;17(8):840.
Leichsenring F, Leibing E, Kruse J, New AS, Leweke F. Borderline personality disorder. Lancet.
2011;377(9759):74–84.
Lewis KL, Grenyer BF. Borderline personality or complex post-traumatic stress disorder? An
update on the controversy. Harv Rev Psychiatry. 2009;17(5):322–8.
Lieb K, Zanarini MC, Schmahl C, Linehan MM, Bohus M. Borderline personality disorder.
Lancet. 2004;364(9432):453–61.
78 S. A. Saleh
McGauley G, Yakeley J, Williams A, Bateman A. Attachment, mentalization and antisocial per-

sonality disorder: the possible contribution of mentalization-based treatment. Eur J Psychother
Counsell. 2011;13(4):371–93.
Morrison J. Histrionic personality disorder in women with somatization disorder. Psychosomatics.
1989;30(4):433–7.
Mulay AL, Cain NM. Antisocial personality disorder. In: Encyclopedia of personality and indi-
vidual differences. Cham: Springer International Publishing; 2020. p. 206–15.
Nestadt G, Romanoski AJ, Chahal R, Merchant A, Folstein MF, Gruenberg EM, McHugh PR. An
epidemiological study of histrionic personality disorder. Psychol Med. 1990;20(2):413–22.
Novais F, Araújo AM, Godinho P. Historical roots of histrionic personality disorder. Front Psychol.
2015;25(6):1463.
Patrick E, Diamond E. Id. In: Encyclopedia of personality and individual differences. Cham:
Springer International Publishing; 2017. p. 1–2.
Rnic K, Dozois DJ, Martin RA. Cognitive distortions, humor styles, and depression. Eur J Psychol.
2016;12(3):348.
Ronningstam E. Narcissistic personality disorder in DSM-V—in support of retaining a significant
diagnosis. J Personal Disord. 2011;25(2):248–59.
Salvatore G, Russo B, Russo M, Popolo R, Dimaggio G. Metacognition-oriented therapy for
psychosis: the case of a woman with delusional disorder and paranoid personality disorder. J
Psychother Integr. 2012;22(4):314.
Santana MR, Zatti C, Spader ML, Malgarim BG, Salle E, Piltcher R, Ceresér KM, Bastos AG,
Freitas LH. Acute stress disorder and defense mechanisms: a study of physical trauma patients
admitted to an emergency hospital. Trends Psychiatry Psychother. 2017;4(39):247–56.
Shea MT, Stout RL, Yen S, Pagano ME, Skodol AE, Morey LC, Gunderson JG, McGlashan TH,
Grilo CM, Sanislow CA, Bender DS. Associations in the course of personality disorders and
Axis I disorders over time. J Abnorm Psychol. 2004;113(4):499.
Sulz S, Hysteria I. Histrionic personality disorder. A psychotherapeutic challenge. Der Nervenarzt.
2010;81(7):879–87.
Thomas AG, Jonason PK, Blackburn JD, Kennair LE, Lowe R, Malouff J, Stewart-Williams S,
Sulikowski D, Li NP. Mate preference priorities in the east and west: a cross-cultural test of the
mate preference priority model. J Pers. 2020;88(3):606–20.
Tredget JE. The aetiology, presentation and treatment of personality disorders. J Psychiatr Ment
Health Nurs. 2001;8(4):347–56.
Vaillant G. Adaptation to life. Cambridge: Harvard University Press; 1977. 1977 [cited 2021 Sep
9]. https://opus4.kobv.de/opus4-Fromm/frontdoor/index/index/docId/28960
Vaillant GE. Ego mechanisms of defense: a guide for clinicians and researchers. Arlington:
American Psychiatric Association Publishing; 1992.
Vaillant GE. Defense mechanisms. In: Encyclopedia of personality and individual differences.
Cham: Springer International Publishing; 2016. p. 1–10.
Vos MS, De Haes JC. Denial in cancer patients, an explorative review. Psychooncology.
2007;16(1):12–25.
Walker T, Lim BK. Defense/coping mechanism. In: Encyclopedia of cross-cultural school psy-
chology. Boston: Springer US; 2010. p. 361–3.
Yazdanshenas Ghazwin M, Tavakoli SA, Latifi S, Saberi H, Derakhshanrad N, Yekaninejad
MS, Sadeghi M, Emami Razavi SH, Norouzi Javidan A, Ghodsi SM. Psychological defense
mechanisms among individuals with SCI with adjustment disorder. J Spinal Cord Med.
2017;40(5):538–47.
Zanarini MC, Frankenburg FR, Dubo ED, Sickel AE, Trikha A, Levin A, Reynolds V. Axis I
comorbidity of borderline personality disorder. Am J Psychiatr. 1998;155(12):1733–9.
Zanarini MC, Weingeroff JL, Frankenburg FR. Defense mechanisms associated with borderline
personality disorder. J Personal Disord. 2009;23(2):113–21.
Zanarini MC, Frankenburg FR, Fitzmaurice G. Defense mechanisms reported by patients with
borderline personality disorder and axis II comparison subjects over 16 years of prospective
follow-up: description and prediction of recovery. Am J Psychiatr. 2013;170(1):111–20.
Zimmerman M, Mattia JI. Axis I diagnostic comorbidity and borderline personality disorder.
Compr Psychiatry. 1999;40(4):245–52.
Drugs and Consciousness
1 CNS Stimulants
They stimulate the CNS and. These drugs include caffeine which can be found in
coffee and chocolate (Fig. 1). It mimics adenosine (a natural brain chemical)
(Weil 1998).
Many students who consume many cups of coffee experience suffering from
headaches due to the sudden decrease in the levels of caffeine in their brains (Fig. 2).
Nicotine which is found in cigarettes is a stimulant. Smokers experience an
addictive effect on nicotine, and in the same way, when they suddenly stop smoking
develop a withdrawal effect. Nicotine is an activator, activates neural mechanisms,
and shows similarity to cocaine.
1.1 Amphetamine
Dexedrine and Benzedrine are strong stimulants. They stimulate the central nervous
system and lead to energy and alertness, talkativeness, insomnia, and wakefulness.
They increase concentration and reduce fatigue (Koob and Volkow 2010).
Chemical structure: C9H13N
M. H. Kadhim (*)
University of Kufa, College of Medicine, Najaf, Iraq

Switzerland AG 2022
82 M. H. Kadhim
Why do people take Addictive Drugs?
Achieve a Media & Availability

Stress life Genetic fac-
spiritual drug use of & trying
events tors
state role models something
Fig. 1 Addiction
Fig. 2 The level of caffeine in the common drugs and foods
Mechanism of action: Psychostimulant. It acts centrally and causes releasing of

DA, NE, 5HT.
Clinical uses: Narcolepsy, attention deficits, hyperactivity disorder, obesity,

chronic pain, depression.
Many randomized clinical trials and research have proven its effectiveness and
safety in treating ADHD and improving cognitive and physical performance.
Methamphetamine is a white, crystalline drug; it is one of the most dangerous
street drugs used nowadays. Moreover, it is highly addictive and cheap.
Drugs and Consciousness 83
Bath salts are also an amphetamine-like stimulant. It can produce euphoria and a
rise in sociability and sex drive, but the side effects can be severe, including para-
noia and agitation (Koob and Volkow 2010).
1.2 Cocaine
Cocaine is another strong central nervous system stimulant. Fortunately, it is not

used anymore but still forms a major concern because of its illegal usage. It can be
smoked, inhaled, or injected into the veins. It acts immediately and absorbs quickly.
Cocaine produces profound psychological well-being, increased confidence,
decreased appetite, anxiety, irritability, and insomnia.
Sudden withdrawal signs and symptoms include suicidal thoughts, which is
severe and agitated motor activity, and irritability.
Cocaine is considered an addictive drug because of its effect on the reward path-
way in the CNS. It also increases respiratory disease, MI, stroke (especially in those
who smoke), and blood infections (Koob and Volkow 2010).
Chemical structure: C17H21NO4
Mechanism of action: NE, DA, 5HT reuptake inhibitor.
Clinical uses: Local anesthetic.

The symptoms and signs of cocaine toxicity are not just limited to certain limits.
At first, psychiatric complaints (depression potentiated by dysphoria, CNS excita-
tion, and paranoia), seizures, and even chest pain (Lindesmith 2017).
2 CNS Depressants
2.1 Alcohol
It is a depressant, and it is used extensively worldwide and among almost all people
(Feldman 2011; Su et al. 1997; Grant 1997).
84 M. H. Kadhim
Its effects are comprehensive (Fig. 3). Addiction comes from the idea of reliev-
ing tension and making the person feel happy and disconnected from the world
(Feldman 2011; Anthenelli and Schuckit 1993).
2.2 Barbiturates
“Barbiturates include drugs such as phenobarbital, frequently prescribed by physi-

cians to induce sleep or reduce stress; barbiturates produce a sense of relaxation”
(Wagner and Anthony 2002). However, they produce altered thinking, faulty judg-
ment, and sluggishness at larger doses. In addition, it is deadly when combined with
alcohol.
It affects the communications between

the brain’s pathways and change the way
the brain looks and thinks.
Chronic alcohol consumption increase

the risk of the GIT cancer. Breast cancers
are also more common in women who
drink excessively.
Alcohol drinkers can develop arrhyth-

mias, cardiomyopathy, stroke and high
blood pressure.
Alcohol can cause stomach distress,

bloating and painful ulcers.
Alcohol can affect the liver, lead to

steatosis, fatty liver and even cirrhosis.
Alcohol can weak the immune system,

makes the body a target for various dis-
eases.
Fig. 3 Alcohol effects

Chemical structure:
Barbiturates work as a GABA agonist (GABA is an inhibitory neurotransmitter).

It prolongs GABA activity and increases its duration (Clark et al. 2011; Cami and
Farré 2003).
3 Narcotics
They are a wide range of drugs that are used to relieve stress and tension and to
change the mood, and it causes addiction very widely (Wang 2017; Clark et al.
2011; Beaudoin et al. 2016).
3.1 Morphine
Medical uses: Morphine is so vital as an analgesic in acute MI. It is considered

lifesaving (relieves pain without affecting the consciousness). Patients given mor-
phine are still aware of pain, but the sensation is not unpleasant (Fig. 4).
Both morphine and codeine can prevent cough because they have antitussive
effects (Grissinger 2011; Prus 2018).
Morphine has significant effects on endocrine properties in the body (Yilmaz
et al. 1999).
The conjugates that have been mentioned above are excreted mainly in the urine,
with small quantities appearing in bile.
86 M. H. Kadhim
Fig. 4 Morphine distribution
Nausea &
Myosis
vomiting
Respiratory
depression Morphine Constipation
side effects
Urine
Sedation
retention
Fig. 5 Morphine side effects
Adverse effects (Fig. 5) with most μ agonists, severe respiratory depression is

one of the biggest concerns you need to be vigilant for (Schiller et al. 2021; Imani
et al. 2014).
3.2 Codeine
It is a natural opioid that can be used in analgesics, but it is weak. It is a selective

agonist for mu receptors of opioids.
Side effects: As with other opioids, it causes nausea, vomiting, constipation,

drowsiness, euphoria and dysphoria, meiosis, urinary retention.
Also, tolerance may develop in chronic users, but it is slowly developed to con-
stipation and meiosis.
3.3 Fentanyl
It is more potent than morphine in analgesic effects and used in anesthesia (Fig. 6)
(National Center for Biotechnology Information 2021).
Chemical structure: C22H28N2O
Hallucinations
Crying spells
Fentanyl
Behavioral changes Suicidal thoughts
side effects
Anxiety Depression
Fig. 6 Fentanyl side effects

88 M. H. Kadhim
3.4 Methadone
Methadone is a synthetic opioid administered orally (Fredheim et al. 2008).

Chemical structure: C21H27NO
Individuals with a history of prolonged QT should be used with high caution

because it can further prolong the QT interval and lead to serious life events (Ahmed
et al. 2016).
3.5 Meperidine
It is a synthetic opioid with lower potency, and it is considered a weak opioid. It has
no relation to morphine. Meperidine is a highly lipophilic drug and has anticholin-
ergic properties, increasing the incidence of delusions and delirium compared to
other opioids (Baldo 2018).
Pharmacokinetics: The duration of action of meperidine is shorter compared to
morphine and other opioids.
Drug interactions: Meperidine should be used with caution in concomitant or

recent administration of MAOIs selective serotonin reuptake inhibitors (SSRIs)
because it may lead to serotonin syndrome, which leads to shivering, diarrhea, sei-
zures, rigidity, and fever.

3.6 Oxycodone
Oxycodone is a semisynthetic derivative of morphine (National Center for

Biotechnology Information 2021).
Toxicity: Abuse or having toxic doses can lead to death (Söderberg Löfdal
et al. 2013).
4 Hallucinogens
4.1 Marijuana
It is the most common drug used for hallucination (Fig. 7). In addition, it is a com-
mon addictive drug worldwide and is highly used in high schools nowadays (Koob
et al. 2014; Feldman 2011).
Chemical structure: C21H30O2
90 M. H. Kadhim
Fig. 7 Positive and negative effects of marijuana
Tachycardia
Hallucinations
Effects of
Impaired
Increased tetrahydrocannabinol
coordination
appetite
Impaired memory
Conjunctivitis
Fig. 8 Effects of tetrahydrocannabinol
The properties of marijuana differ from one to another, but they generally cause
euphoria in addition to feeling well (Fig. 8).
There are obvious risks associated with long-term, heavy chronic users of mari-
juana (Volkow et al. 2014). “Although marijuana does not seem to produce addic-
tion by itself, there is a possibility that marijuana has similarities with other drugs
such as cocaine and heroin in how they affect the brain. In addition, there is evi-
dence that heavy use at least temporarily decreases the production of the male sex
hormone testosterone, potentially affecting the sexual activity and sperm count”
(Volkow et al. 2014).
Medical uses: “Marijuana has several medical uses; it can be used to prevent nau-
sea from chemotherapy, treat AIDS symptoms, relieve muscle spasms for people
with spinal cord injuries, and it may be helpful in the treatment of Alzheimer’s dis-
ease” (Bridgeman and Abazia 2017).
4.2 MDMA and LSD
3,4-Methylenedioxymethamphetamine (MDMA), also known as ecstasy or Molly.

It is considered a hallucinogen (National Center for Biotechnology Information 2021).
MDMA enhances feelings of increased energy and euphoria and increased

empathy and social life interactions (Kirkpatrick et al. 2014). In a pure form known
as Molly, its use is often associated with raves and music festivals, and it has led to
a rising number of overdoses and even deaths. There are a lot of data that have been
studied.
LSD is structurally similar to serotonin that produces significant hallucinations

(Fuentes, 2019).
Chemical structure: C20H25N3O

1. Which drug is most likely responsible for behavioral excitation, aggressiveness,
paranoia, and hallucinations. Also, it can cause mydriasis and elevated
HR and BP?
(a) Marijuana
(b) Fentanyl
(c) Alcohol
(d) Amphetamine
92 M. H. Kadhim
2. Morphine is used clinically in?

(a) Anxiety
(b) Depression
(c) Pulmonary congestion
(d) Colon cancer
(e) Alcohol withdrawal symptoms
3. Which one of the following results from methadone ingestion?
(a) Inhibition of aldehyde dehydrogenase
(b) Serotonin
(c) Vomiting
(d) Formaldehyde
(e) Dysuria
4. Not a side effect for opioids:
(a) Diarrhea
(b) Meiosis
(c) Sedation
(d) Respiratory depression
5. Barbiturates work as:
(a) Dopamine agonist
(b) CNS stimulants
(c) GABA agonist
(d) 5HT antagonist
Answers
1. (d)
2. (c)
3. (d)
4. (a)
5. (c)
References
Ahmed S, Zhou Z, Zhou J, Chen SQ. Pharmacogenomics of drug metabolizing enzymes and trans-
porters: relevance to precision medicine [published correction appears in Genomics Proteomics
Bioinformatics. 2018 Apr 21]. Genomics Proteomics Bioinformatics. 2016;14(5):298–313.
https://doi.org/10.1016/j.gpb.2016.03.008.
Anthenelli RM, Schuckit MA. Affective and anxiety disorders and alcohol and drug dependence:
diagnosis and treatment. J Addict Dis. 1993;12:73–87.
Baldo BA. Opioid analgesic drugs and serotonin toxicity (syndrome): mechanisms, animal mod-
els, and links to clinical effects. Arch Toxicol. 2018;92(8):2457–73.
Beaudoin FL, Merchant RC, Clark MA. Prevalence and detection of prescription opioid misuse
and prescription opioid use disorder among emergency department patients 50 years of age and
older: performance of the prescription drug use questionnaire, patient version. Am J Geriatr
Psychiatry. 2016;24(8):627–36.
Bridgeman MB, Abazia DT. Medicinal cannabis: history, pharmacology, and implications for the
acute care setting. P T. 2017;42(3):180–8.
Cami J, Farré M. Drug addiction. N Engl J Med. 2003;349(10):975–86.
Clark MA, Harvey RA, Finkel R, Rey JA, Whalen K. Pharmacology, Fifth Edition. Philadelphia:
Lippincott Williams & Wilkins; 2011.
Feldman RS. Understanding psychology. 10th ed. Amherst: University of Massachusetts; 2011.
Fredheim OM, Moksnes K, Borchgrevink PC, Kaasa S, Dale O. Clinical pharmacology of metha-
done for pain. Acta Anaesthesiol Scand. 2008;52(7):879–89. https://doi.org/10.1111/j.1399-65
76.2008.01597.x.
Grant BF. Prevalence and correlates of alcohol use and DSM-IV alcohol dependence in the United
States: results of the National Longitudinal Alcohol Epidemiologic Survey. J Stud Alcohol.
1997;58(5):464–73.
Grissinger M. Keeping patients safe from methadone overdoses. Pharm Therap. 2011;36(8):462–6.
Imani F, Motavaf M, Safari S, Alavian SM. The therapeutic use of analgesics in patients with
liver cirrhosis: a literature review and evidence-based recommendations. Hepat Mon.
2014;14(10):e23539. https://doi.org/10.5812/hepatmon.23539. Published 2014 Oct 11.
Kirkpatrick M, Lee R, Wardle M, et al. Effects of MDMA and intranasal oxytocin on social and
emotional processing. Neuropsychopharmacology. 2014;39:1654–63. https://doi.org/10.1038/
npp.2014.12.
Koob GF, Volkow ND. Neurocircuitry of addiction. Neuropsychopharmacology.
2010;35(1):217–38.
Koob GF, Arends MA, Le Moal M. Drugs, addiction, and the brain. New York: Academic
Press; 2014.
Lindesmith AR. Addiction & opiates. New York: Routledge; 2017.
National Center for Biotechnology Information. PubChem compound summary for CID 5288826,
morphine. 2021. Retrieved October 13, 2021 from https://pubchem.ncbi.nlm.nih.gov/
compound/Morphine.
Prus A. Drugs and the neuroscience of behavior: an introduction to psychopharmacology. 2nd ed.
Thousand Oaks: SAGE Publications; 2018.
Schiller EY, Goyal A, Mechanic OJ. Opioid overdose. In: StatPearls. Treasure Island: StatPearls
Publishing; 2021.
Söderberg Löfdal KC, Andersson ML, Gustafsson LL. Cytochrome P450-mediated changes in
oxycodone pharmacokinetics/pharmacodynamics and their clinical implications. Drugs.
2013;73:533–43. https://doi.org/10.1007/s40265-013-0036-0.
Su SS, Larison C, Ghadialy R, et al. Substance use among women in the United States.
SAMHSA analytic series A-3. Rockville: Substance Abuse and Mental Health Services
Administration; 1997.
Volkow ND, Baler RD, Compton WM, Weiss SR. Adverse health effects of marijuana use. N Engl
J Med. 2014;370(23):2219–27. https://doi.org/10.1056/NEJMra1402309.
Wagner FA, Anthony JC. From first drug use to drug dependence: developmental periods of
risk for dependence upon marijuana, cocaine, and alcohol. Neuropsychopharmacology.
2002;26(4):479–88.
Wang D. Opioid medications in the management of chronic abdominal pain. Curr Pain Headache
Rep. 2017;21(9):40. https://doi.org/10.1007/s11916-017-0640-x. Published 2017 Aug 8.
Weil A. The natural mind: an investigation of drugs and the higher consciousness. Boston:
Houghton Mifflin Harcourt; 1998.
Yilmaz B, Konar V, Kutlu S, et al. Influence of chronic morphine exposure on serum LH, FSH,
testosterone levels, and body and testicular weights in the developing male rat. Arch Androl.
1999;43(3):189–96. https://doi.org/10.1080/014850199262481.
The Altered States of Consciousness
1 Introduction
Thus, there are those times when our mind seems to split into two kinds of
consciousness.
Recently, researchers started studying consciousness varied by hypnosis and
drugs. Thus, psychology was regaining the definition of consciousness
(Fromm 2017).
Now, there are more research to understand the biology of consciousness. For
example, evolutionary psychologists consider that consciousness must offer a seed
and soil advantage. Another theory suggests that consciousness enhances our sur-
vival by anticipating how we live in the future and reading people’s minds.
Even so, the brain leaves us with a lot of complex problems. For example, it cre-
ates the awareness of ourselves, the pain of a headache, the feeling of fight and flight
(Fromm 2017).
2 Cognitive Neuroscience
It is the science that deals with cognition, and it involves many functions as in Fig. 1.
When researchers asked this young woman to imagine playing tennis or going to
university, fMRI scans showed brain activity as healthy volunteers (Fig. 2).
Despite these advancements, much disagreement remains. For example, some
researchers suggest that consciousness arises from specific neuronal activity. Others
suggest that the whole activity of the neurons produces consciousness.
M. H. Kadhim (*)
University of Kufa, College of Medicine, Najaf, Iraq

Switzerland AG 2022
96 M. H. Kadhim
Perception,
Motor Control Recognition,
Language Attention
Cognitive Neuroscience
Decision making Learning and memory
Fig. 1 Cognitive neuroscience, the interdisciplinary trial of the brain excitation integrated with
cognition, including memory, language, and thinking
Fig. 2 Evidence of awareness

The Altered States of Consciousness 97
3 Dual Processing
We are aware of just little about our unconscious mind. Perception, memory, think-
ing, language, and attitudes all work based on two levels: (Preller et al. 2019).
–– Conscious (highly initiative mind)
–– Unconscious and automatic (low initiative mind)
That’s what we mean when we say “dual processing.”
3.1 The Two-Track Mind
A young woman who had brain damage affecting the visual part could not recog-
nize objects and differentiate them visually. But she was only partially blind. So she
was asked to handle an object; she could adequately do that (Fig. 3).
Scientists were wondering how this happens. As all of us know, we have only one
visual system (Cofré et al. 2020).
Also, the researchers have found that the reverse damage leads to the opposite
symptoms. It means a patient may see objects but have difficulty in handling them.
3.1.1 Selective Attention
When you sense ten things by your five senses, you will process only a few of them
but not all of them. Yet your unconscious mind will take a process for the other
things that the conscious mind has not focused on.
For example, when reading this theory, you are not aware of the watch on your
hand or wearing a shoe. When you pay attention to these things, you have been
blocking from the awareness coming from the conscious mind (Cofré et al. 2020).
As you have read this example, you may be confused! I know it is genuinely
complicated that we have all of these integrative systems in our brains, but we are
unaware of them.
Another simple example of selective attention is when four people say your
name simultaneously, your mind will focus on one of them and ignore the others
(Fig. 4). Also, imagine hearing two conversations simultaneously and being asked
to remember both of them; you will not perceive what is said in the other conversa-
tion. Considering selective attention and accidents, cell phone use and driving acci-
dents are typical examples. That’s why you are not allowed to use a cell phone while
driving (Weinel 2018).
98 M. H. Kadhim
Fig. 3 Two-track mind
Fig. 4 Selective attention
3.1.2 Selective Inattention and Inattentional Blindness
A somewhat similar idea of what we have talked about in selective attention

(Johnson and Kaplan 2019) (Fig. 5).
In other experiments, there is also a blindness to change (Fig. 6). For example, it
happened when a man asked a construction worker to direct him to a specific place,
and then the construction worker was replaced by another one, but it was unnoticed
by the man who asked (Wittmann 2018).
Fig. 5 An example of inattentional blindness
Fig. 6 An example of change blindness
Out of sight, out of mind. But moreover, change deafness can happen (Fig. 7).
A common form of selective inattention happens in media, politics, and various
aspects of our lives. An astonishing form called choice blindness (Fig. 8) was
invented by a Swedish researcher, “Petter Johansson,” and his assistants. In his
example, he showed 2 female faces for 5 s to 120 volunteers and asked them which
one of those 2 women they found more attractive? Then, the researcher used a sleight
of hand (sleight of hand is part of the experimental method) to switch the photo that
were handed to the volunteers who did not pick. The volunteers were asked to justify
why they had chosen the photo and also justify the choice they haven’t made. They
were in a weird situation, and they did not noticed that (Holoyda 2020) (Fig. 9).
Selective attention and inattention can even affect your sleep (Fig. 10) and what
you have experienced in your dreams.
The other aspects of altered states of consciousness (Fig. 11) can be summarized
in the following topics:
(a) Sleep and dreams
(b) Hypnosis
(c) Drugs and consciousness
(d) Meditation and yoga
100 M. H. Kadhim
Fig. 7 An example of
change deafness
Fig. 8 An example of choice blindness
Sleep and Dreams
Sleep is a basic, natural, and easily reversible periodic phenomenon characterized by

a diminished level of awareness, reduced response to the sensory input, and execu-
tive motor output with minimal interaction of the body with the external world. More
details on this topic have already been discussed in chapter “Sleep and Dreaming
”.
Fig. 9 Pop-out
phenomenon
Fig. 10 Selective attention

and inattention may affect
your sleep
Fig. 11 The other aspects of altered states of consciousness

102 M. H. Kadhim
Hypnosis
Hypnosis is a divided state of consciousness. It can be used in managing pain and

treating many disorders or health issues. More details on this topic will be discussed
in chapter “Hypnosis and Consciousness”.
Drugs and Consciousness
There are many drugs that have an effect human’s consciousness starting from alter-
ing its states, addiction to changing the mood. More details on this topic have
already been discussed in chapter “Drugs and Consciousness”.
Meditation and Yoga
It is defined as a learned technique for refocusing attention and rebooting it, leading
to an altered consciousness (Moreira-Almeida and Lotufo-Neto 2017).
Meditation affects the mind through different techniques, but it has the same goal
of relaxing and refocusing attention. You can do it while exercising, sitting, and
lying down (Fig. 12). It would be best if you think of nothing for a while (Schmidt
and Berkemeyer 2018).
There are various ways to do meditation. Most of it is done sitting in special
postures, such as:
• the full or half lotus
• using relaxed cushions or sitting on a couch and the feet bent underneath.
All these positions have the same goal; to reach a spiritual insight that is to relax
and to be alert. There is nothing distinct about these positions. In meditation, people
need to achieve a certain level of stabilization and avoid two things: either becoming
sleepy or being nervous by distracting thoughts or perceptions. The unique postures
provide a good base, relaxed state, a straight spine, and deep breathing. So, avoiding
these two irregular things is what we have mentioned.
People say that they are feeling fully relaxed after meditation. They claim that it
has relieved their stress life event and made them more patient in facing the prob-
lems. Barnes, Kleinman, and Travis found that oxygen usage decreases, blood pres-
sure and heart rate decrease, and brain activities change during meditation (Chieffi
et al. 2018; Kandeepan et al. 2020).
With more and more training, it is possible to calm our minds and leave the dis-
tractive thoughts off. Furthermore, our brains may adapt to cope with life worries
and problems and help us to reach the inside happiness (Fig. 13). Although some
experiments are surprising, they found that meditation is no more relaxing than the
other ordinary relaxed states. Some argue that it even may be more problematic if
specific unwanted thoughts keep coming up and you cannot control your mind and
emotions. Therefore, they say it is better to do exercise than to meditate.
Fig. 12 Ways of meditation
Improves brain
concentration
Improves
Helps with social
breathing
life
efficiently
Lowers blood Common benefits of Increases pain

pressure Meditation threshold
Reduces
emotional Relaxes the mind
explosions
Induces physical
relaxation
Fig. 13 Benefits of meditation

104 M. H. Kadhim
Fig. 14 Meditation may

lead to greater spiritual
insight
Meditation is practiced in many cultures and religions. It takes various aims and
different goals among cultures. Interestingly, we found that people with different
cultures and religions seek ways to alter their consciousness to achieve spiritual
experience (Fig. 14).

1. Which of the following is not a characteristic of meditation?
(a) Increases pain threshold
(b) Relaxes the mind
(c) Elevates the BP
(d) Improves brain concentration
2. Hypnotherapy has been used for which of the following?
(a) Cancer
(b) Cardiac disease
(c) Respiratory disease
(d) Musculoskeletal problems
3. Hypnosis has all of the following, except:
(a) Two-track mind
(b) Biological influences
(c) Psychological influences
(d) Social-cultural influences
4. Selective attention is defined as:
(a) Psychological disease
(b) Focusing of mind and conscious awareness on a particular stimulus
(c) Physiological mind
(d) None of the above
5. The two-track mind is described as:

(a) Cultural mind
(b) Biological influences on the mind
(c) When you can see objects and handle them at the same time
(d) When the patient can’t see objects but can handle them
6. Selective attention and inattention can affect which of the following:
(a) Stress
(b) Diseases
(c) Eye function
(d) Sleep
7. Cognitive neuroscientists can activate specific patterns and see your brain
thinking, depending on which of the following:
(a) Basal ganglia
(b) Thalamus
(c) Brain stem
(d) Cortex
8. All of the following are classified as spontaneous states of consciousness, except:
(a) Dreaming
(b) Drowsiness
(c) Meditation
(d) Dreaming
9. Choice blindness is:
(a) Selective attention
(b) Pop-out phenomenon
(c) Hypnosis
(d) Meditation
10. Psychological influences of hypnosis include all of the following, except:
(a) Focused attention
(b) Expectation
(c) Dissociation between normal sensation and conscious
(d) Distinctive brain activity
106 M. H. Kadhim
Answers
1. (c)
Meditation helps reduce blood pressure and increases pain threshold, relaxes
the mind, and improves brain concentration.
2. (c)
It has been used as a treatment for asthma. Also, it is used for headaches and
stress-related skin disorders.
3. (a)
Two-track mind is a theory that describes the mind’s two levels, and it is unre-
lated to hypnosis.
4. (b)
Selective attention is the focus of mind and conscious awareness on a particular
stimulus.
5. (d)
It describes as the mind’s two levels.
6. (d)
Selective attention and inattention can even affect your sleep and what you have
experienced in your dreams.
7. (d)
Depending on your cortical function and consciousness, they can activate spe-
cific cortical patterns and see your brain thinking in limited ways.
8. (c)
Meditation is classified as a psychologically induced state of consciousness.
9. (d)
Choice blindness is an example of selective inattention which is used in poli-
tics, media, and various aspects of our lives.
10. (d)
Distinctive brain activity is one of the biological influences of hypnosis.
References
Chieffi IV, et al. Mind, brain and altered states of consciousness. Acta Medica. 2018;34:357.
Cofré R, et al. Whole-brain models to explore altered states of consciousness from the bottom up.
Brain Sci. 2020;10(9):626.
Fromm E. The nature of hypnosis and other altered states of consciousness: an ego psychological
theory 1. In: Hypnosis. New York: Routledge; 2017. p. 81–104.
Holoyda B. Psychedelic psychiatry: preparing for novel treatments involving altered states of con-
sciousness. Psychiatr Serv. 2020;71(12):1297–9.
Johnson EL, Kaplan PW. Clinical neurophysiology of altered states of consciousness: encepha-
lopathy and coma. Handbk Clin Neurol. 2019;161:73–88.
Kandeepan S, et al. Modeling an auditory stimulated brain under altered states of consciousness
using the generalized Ising model. Neuroimage. 2020;223:117367.
Moreira-Almeida A, Lotufo-Neto F. Methodological guidelines to investigate altered states of con-
sciousness and anomalous experiences. Int Rev Psychiatry. 2017;29(3):283–92.
Preller KH, et al. Effective connectivity changes in LSD-induced altered states of consciousness in
humans. Proc Natl Acad Sci. 2019;116(7):2743–8.
Schmidt TT, Berkemeyer H. The altered states database: psychometric data of altered states of
consciousness. Front Psychol. 2018;9:1028.
Weinel J. Inner sound: altered states of consciousness in electronic music and audio-visual media.
Oxford: Oxford University Press; 2018.
Wittmann M. Altered states of consciousness: experiences out of time and self. Cambridge: MIT
Press; 2018.
Hypnosis and Consciousness
1 Hypnosis
It is defined as a state of divided consciousness (Fig. 1). The hypnosis, when it is

applied, will split the consciousness into two levels as follows:
• One level is to obey the commands that the hypnotist says.
• The other level is to be aware of the environment around them, and they may be
aware that someone is talking to them.
Imagine that you are about to be hypnotized; you are sitting on a chair and look-
ing at a fixed spot on the wall. The hypnotist asks you to relax and suppose that you
are tired, your eyes become heavy more and more, you are becoming more deeply
relaxed, and you feel like you are dead (Orne 2017).
When hypnotic induction occurs, you will experience hypnosis. You cannot open
your eyes even if you try to open them; you cannot control yourself; you will obey
anything you have been told. For example, if you are told to forget the number 4,
you will count 6 fingers in your hands.
Can we consider hypnosis as really an altered state of consciousness? We will
discuss hypnosis through its different aspects to answer this question.
Hypnosis is a technique in which one person responds to suggestions provided
by another person (Hypnotist) for creative encounters involving changes in vision,
memory, and voluntary regulation of behavior by one person (Subject).
Hypnotized people may be ignorant of pain; they hear voices that are not there.
They are unable to recall the things that happened to them when they were hypno-
tized. They cannot see details distinctly in their field of vision and make comments
after hypnosis has been stopped, without being conscious of what they are doing or
why (Bowers and Bowers 2017)


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Overload of
message units
Hypnosis
Disorganizing inhibitory
Hyper process
suggestible state
Triggering fight
and flight
Fig. 1 Induction process of hypnosis
Both encounters are associated with a degree of subjective belief that borders on
delusion and an experience of involuntariness that borders on compulsion in the
classic example.
Subjects respond to recommendations for creative interactions in hypnosis that
may include cognitive perception, memory, and behavior changes. However, among
those incredibly hypnotizable topics, these phenomena arise more intensely
(Valentine et al. 2019).
While most individuals may undergo hypnosis to at least some degree, the most
extreme hypnosis phenomena are typically found in those that count as representing
changes in consciousness. Thus, those “hypnotic virtuosos” make up the top
10–15% of the hypnotizable distribution.
A great deal of hypnosis study thus requires a priori collection of subjects who
are highly hypnotizable, to the exclusion of those with low and intermediate hypno-
tizable. An alternative is a hybrid system in which subjects stratified for hypnotiz-
able are all subjected to the same experimental manipulations, and hypnotizable
subjects’ reactions are compared to others subjected to the same experimental
manipulations. Hypnosis is insusceptible. In either case, hypnotizable estimation is
important for research into hypnosis; there is no point in analyzing hypnosis in
people who can’t feel it.
Any psychiatric clinicians assume that if only the hypnotist follows the correct
path, nearly all can be hypnotized, but no studies favor this point of view. Similarly,
some experts suggest that hypnotizable can be increased by cultivating constructive
hypnosis beliefs, motives, and aspirations although there is also evidence that these
measures are closely related to enforcement.
The multifaceted essence of hypnosis itself is part of the issue. Hypnosis requires
improvements in conscious thought, memory, and actions, to be sure, but these
Hypnosis and Consciousness 111
improvements often arise following explicit recommendations given to the subject

by the hypnotist.
Thus, hypnosis is simultaneously a state of radical neurological improvement,
including essential vision, memory, thinking processes, and social interaction in
which hypnotic and subject come into play. Under a broader sociocultural frame-
work, together with a particular reason, a fully adequate, systematic hypnosis theory
would attempt comprehension in cognitive and behavioral terms.
The inter-individual rivalry that is part of alterations and parcel of science as a
collective enterprise frequently causes scholars to write those mutually exclusive
mechanisms were alterations of consciousness and social power-which they clearly
are not (Shor 2017).
In the case of posthypnotic amnesia and hypnotic analgesia, hypnotic anesthesia,
and negative hallucinations, it appears that hypnotized participants cannot become
conscious of thoughts and memories that would usually be expressed in phenome-
nal consciousness.
On the other hand, hypnosis has often been proposed to have the opposite ability
to allow participants to become aware of thoughts and experiences that are not ordi-
narily available through active introspection.
In hypnotic hypermnesia, for example, participants receive suggestions that they
may be able to recall events they have forgotten (Terhune et al. 2017).
Automatic processes are carried out automatically in a reflex-like manner as a
first approximation, whereas regulated processes are carried out intentionally.
The posthypnotic suggestion is probably the most dramatic example of the
apparent automaticity of hypnosis. The participants react to a suggestion offered
when they were already hypnotized after the end of hypnosis.
Any proposed sensation that might arise during hypnosis may also arise posthyp-
notically if the subject is hypnotizable enough. For this explanation, for many con-
ceptions of hypnosis as an altered state of mind, posthypnotic persuasion has often
been troublesome because the phenomenon happens after the hypnotic state has
been ostensibly ended. As far as we can see, although they respond to the posthyp-
notic recommendation, participants do not re-enter hypnosis. Centered on the unifi-
cation of four factors, hypnosis may be characterized as an altered state of
consciousness: induction technique, subjective perception, accessible behavior, and
psychophysiological indices—including neural correlates of hypnotic persuasion
discovered by brain imaging.
Hypnotic induction requires focused concentration and creative engagement to
the point that it feels true to what is being thought. The clinician and patient create
a hypnotic reality through the use and approval of advice.
For a medical reason, hypnosis may be used as a meditative condition, where one
may learn to enter intentionally and actively. Then, suggestions for the desired
effect are offered either orally or using imagery. For example, this may be to reduce
discomfort by getting access to calmness and relaxation, helping to control drug
side effects, or helping to relieve pain or other symptoms.
Hypnosis is typically a calming experience, based on the advice offered, and may
be very helpful for a tense or anxious patient (Williamson 2019).
Fig. 2 Hypnosis can assist people in accepting and experiencing what can be done by them
Hypnosis does not make the impossible possible (Williamson 2019). Instead, it
can assist people in accepting and experiencing what can be done by them. Since
civilization has existed, hypnotic states have been used for treatment (Fig. 2).
It was possible to see the right brain as the most emotional, imaginative part of
us that deals with metaphors and pictures and may be seen as our unconscious mind.
However, it is still impossible to state that we are not angry or nervous because
words are not the right brain’s language.
They work at an emotional rather than logical level while patients are highly
nervous, and one should activate and direct their imaginative creativity to what is
beneficial for them. To construct potential catastrophic situations, nervous people
use their imagination, which creates still more fear and thus more dopamine, which
can spiral into hysteria (Jensen et al. 2017).
Patients can find that their feelings are overloaded. If health providers can stimu-
late their energy, guide their creativity to feel relaxed, or re-encounter a meaningful
experience or behavior and have positive feedback, they will feel calmer and can
cope more (Williamson 2019; Lynn et al. 2020).
There are some similarities shared between hypnosis and meditation. Both are
states of concentrated attention, and both can be used to create a profound feeling of
relief (Keshmiri et al. 2020).
1.1 Hypnosis Experience
As we said, hypnosis is a social interaction where the hypnotist asks the subject to
experience certain thoughts, behaviors, and feelings.
So, we can say that we are all open to suggestions. For example, when the hyp-
notist asks the hypnotized person to stand and close his or her eyes, and tells he or
she is swinging now; surprisingly, the subject will sway slightly. Some researchers
say that people with or without hypnosis will respond differently.
The hypnotist supposes various experiences ranging from easy to difficult after a
hypnotic induction (ranging from moving your legs to opening your mouth, opening
your eyes and imagining what the hypnotist said). For example, Barnier and
McConkey had said that the people who did not react to the smell of a bottle of
ammonia are those who deeply went into the hypnosis and experienced the imagi-
nary sight.
So, there is a difference between people in hypnosis experience depending on
your hypnotic susceptibility.
In conclusion, anyone can experience hypnosis by themselves when integrating
the inward and outward imaginary ability. If you expect to be hypnotized, you will
experience it. Imagine that you are sitting at the table after hypnotic induction, and
the hypnotist asks you to draw a circle; you will write it without the ability to eject it.
1.2 ypnosis Enhancement and Its Recalling

H
of Forgotten Events
For instance, can hypnosis help elderly people to remember their primary school
classmates, to discover their fears and details of a crime? Can it be used in criminal
investigations (Franz et al. 2020)?
Also, it is an inaccurate statement to say that hypnosis can recall accurate memo-
ries of people since birth. Johnson and Hauck proved this in 1999. Furthermore,
there is no supposed ability to relive your own childhood experiences. They feel like
real children and speak like them, but there is not any change in adult brain waves
in MRI. Now, it is banned that you are making evidence from witnesses who have
been hypnotized because the hypnotist can create pseudo-memory to the hypnotized
subject. For example, by asking “did you feel that you are entering someone’s
home …. stealing their properties …. killing someone,” so you can plant false infor-
mation and create pseudo-memory.
Sometimes, hypnosis may be used in the wrong way that the hypnotist induces
the subject to do a scary deed. For example, asking the subject to stand up, take a
knife or any other thing, and throw it onto a researcher. Surprisingly, some people
do not remember their acts and deny doing such things.
1.3 Hypnosis as Divided Consciousness
There is a conflict and controversial debate about this theory. However, most hyp-
nosis researchers suggest that regular social and cognitive neuroscience play an
essential part in hypnosis.
The researcher, Perugini, in 1998, demonstrated that: “For one thing, hypnotized
subjects will sometimes carry out suggested behaviors on cue, even when they
believe no one is watching.”
In an experiment, people whether hypnotizable or not were asked to say the color
of letters (the word GREEN in red color to create a little bit of conflict). Unhypnotized
people were slowed from this conflicting idea. At the same time, hypnotized people
were quickly slowed by this conflict and were able to solve this conflict (Brain areas
involved in decoding words and revealing the conflict remained inactive). Famous
researcher Ernest Hilgard (1986–1992) believes in social influence theory and
divided-consciousness theory. It means that hypnosis involves social influence the-
ory and a defined theory of dissociation—a split between different levels of con-
sciousness. Hilgard believed that splitting consciousness is a part of everyday life
events. For example, sometimes, we paint or write a poem while listening to a
lecture.
Hypnosis also may lead to pain relief. A PET scan supported this. Thus, hypnosis
blocks our attention to painful stimuli, but it cannot block sensory input in the brain
cortex (Shalbaf et al. 2020).
1.4 Uses of Hypnosis
Many clinical and psychological applications exist for this technique in treatment,
research, and diagnosis (Fig. 3). We will mention them in the following points:
Weight
Depression Anxiety
Hypnosis Motivation
Eating disorders
Panic Attacks Phobia
Stress
Fig. 3 Hypnosis uses

1.4.1 Hypnotherapy
The application of hypnosis in psychotherapy is hypnotherapy. It is useful for doc-

tors, psychiatrists, and those who are licensed (Levitt and Chapman 2017).
It has been used in a range of forms, with varying results, such as:
• Addiction
• Psychotherapy
• Relaxation
• Sports performance
• Weight loss
• Soothing anxious surgical patients
• Phobias
1.4.2 Irritable Bowel Syndrome
For the prevention of irritable bowel syndrome, hypnotherapy has been examined.
In the National Institute for Wellbeing and Clinical Excellence guidelines released
by UK health services, hypnosis for IBS has gained modest support. It has been
applied as an aid or substitutes for chemical anesthesia and has been researched as
a means to soothe skin ailments. However, the topic is still under development and
needs more studies and research to be approved (Gruenewald et al. 2017).
1.4.3 Pain Management and Cancer Supporter
In minimizing the anxiety of cancer therapy, hypnosis effectively reduces sufferings

due to cancer and other chronic conditions. With hypnosis, fatigue and other symp-
toms linked to incurable conditions can also be treated (Gruenewald et al. 2017).
Hypnosis has also been used during oral surgery and associated pain control
regimens as a pain-relieving strategy (Gruenewald et al. 2017).

1. Hypnosis is defined as:
(a) A state of divided consciousness
(b) A state of sleepiness
(c) A state of being unconscious
(d) A state of dreaming
2. ……………… are carried out automatically in a reflex-like manner as a first
approximation?
(a) Nervous reflex
(b) Psychiatric interview
(c) Autonomic associations
(d) Conscious–unconscious relationships
3. Hypnosis may be used as a meditative condition, where one may learn to enter
intentionally and actively.
(a) For criminal reasons
(b) For resting reasons
(c) For acting reasons
(d) For a medical reason
4. For cancer patients, what does hypnotherapy do?
(a) It relieves pain
(b) It is a palliative therapy to reduce pain
(c) It reduces metastasis
(d) It limits the treatment options
5. Hypnosis has also been used during oral surgery and associated pain control
regimens as a (an):
(a) Pain-relieving strategy
(b) Anesthetic strategy
(c) Curative strategy
(d) Calming strategy
Answers
1. (a)
2. (c)
3. (d)
4. (b)
5. (a)
References
Bowers KS, Bowers PG. Hypnosis and creativity: a theoretical and empirical rapprochement. In:
Hypnosis: research developments and perspectives. New York: Routledge; 2017. p. 255–92.
Franz M, et al. Suggested deafness during hypnosis and simulation of hypnosis compared to a
distraction and control condition: a study on subjective experience and cortical brain responses.
PLoS One. 2020;15(10):e0240832.
Gruenewald D, Fromm E, Oberlander MI. Hypnosis and adaptive regression: an ego-psychological
inquiry. In: Hypnosis: research developments and perspectives. New York: Routledge; 2017.
p. 495–510.
Jensen MP, Jamieson GA, Lutz A. New directions in hypnosis research: strategies for advancing
the cognitive and clinical neuroscience of hypnosis. Neurosci Conscious. 2017;3:1–14.
Keshmiri S, Alimardani M, Shiomi M, Sumioka H, Ishiguro H, Hiraki K. Higher hypnotic suggest-
ibility is associated with the lower EEG signal variability in theta, alpha, and beta frequency
bands. PLoS One. 2020;15(4):e0230853. https://doi.org/10.1371/journal.pone.0230853.
Levitt EE, Chapman RH. Hypnosis as a research method. In: Hypnosis: research developments and
perspectives. New York: Routledge; 2017. p. 85–114.
Lynn SJ, et al. Hypnosis and health psychology. In: The Wiley encyclopedia of health psychology.
New York: Wiley; 2020. p. 257–63.
Orne MT. On the simulating subject as a quasi-control group in hypnosis research: what, why,
and how. In: Hypnosis: research developments and perspectives. New York: Routledge; 2017.
p. 399–444.
Shalbaf A, et al. Monitoring the level of hypnosis using a hierarchical SVM system. J Clin Monit
Comput. 2020;34(2):331–8.
Shor RE. The fundamental problem in hypnosis research as viewed from historic perspectives.
In: Hypnosis: research developments and perspectives. New York: Routledge; 2017. p. 15–40.
Terhune DB, et al. Hypnosis and top-down regulation of consciousness. Neurosci Biobehav Rev.
2017;81:59–74.
Valentine KE, et al. The efficacy of hypnosis as a treatment for anxiety: a meta-analysis. Int J Clin
Exp Hypn. 2019;67(3):336–63.
Williamson A. What is hypnosis and how might it work? Palliat Care. 2019;12:1178224219826581.
https://doi.org/10.1177/1178224219826581.
Artificial Consciousness
1 Introduction
In 1992, the word “artificial intelligence” was used scientifically for the first time.
Since then, scientists have not agreed on when such an accomplishment is feasible.
Every recognized physical structure does not possess the observed properties of the
human mind, including unity, representation, and being in relation to each other
(Hildt 2019).
The Turing test is the most well-known tool for measuring computer intelligence
(Shieber 2004). Therefore, it was also proposed that the suggestion of Alan Turing
to mimic not the consciousness of a human adult, but the consciousness of a human
child should be taken seriously.
2 Digital Consciousness
It means using the computers to deliver and create a machine consciousness among
robots to deliver the same or at least similar functions of the human brain by pro-
cessing data and codes (Argonov 2014; Searle et al. 1980; Oppy and Dowe 2011;
Alexiou et al. 2020) (Fig. 1).
Mathematics and logic may, to a certain degree, describe and evaluate knowl-
edge understood as rationality, and computer science and rtificial intelligence as a
whole are primarily focused on mathematics and logic (Fig. 2). However, when it
comes to consciousness, mathematics terminates, and theory continues. From the
hippocampus down to the genetic code, scholars have sought to locate the origins of
consciousness.


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Strong Weak
AI AI
Method whose Method that

ultimate purpose is makes no
the creation of assertion of a
structures that are
instantiations of link between
consciousness when consciousness
applied and technology
Fig. 1 Strong AI and weak AI
Human Machine
Consciousness Consciousness
• Biological • Mathematical
• Chemical • Logical
Fig. 2 Human vs. machine consciousness
The structure of consciousness doesn’t appear to be solely mechanical or chemi-

cal. If it does not only matter, though but something beyond matter, which it appears
to be, there is no possibility of artificial consciousness.
Perhaps consciousness will remain transcendental to human awareness, no mat-
ter how hard we try. Consciousness itself is the very source of logic. Thus, by apply-
ing intuition, it is challenging to grasp consciousness. How does someone
comprehend the source through a result of the source? To some point, perhaps, one
can understand, but not entirely.
For instance, based on studies on aggressive actions against robots, Kate Darling
argues that treating robots more like pets than just objects aligns with our social
values (Manzotti and Chella 2018).
While the precise arguments for granting robot privileges vary, similar to these
positions, they reflect on the social functions that people give to robots, the interac-
tions, and emotional connections that people develop with robots, or they can com-
municate with them (Ernst et al. 2021).
Artificial Consciousness 121
2.1 Philosophical and Ethical Aspects

of Artificial Consciousness
Several concerns about artificial consciousness and creating similar mind process-
ing capabilities to humans raise many issues to be solved and controlled (Koch
2019). Channeling the philosopher Thomas Nagel, we might conclude that if there
is anything like that in a machine, a system is alive. Can the machine have feelings
and emotions when dealing with humans? There is no evidence that our intellect
and perceptions, rather than any divine ones, are inevitable products of our brain’s
inherent causal forces.
Therefore, a host of subsidiary mechanisms such as expression, preparation,
compensation circuits, and short-term memory buffer storage have access to the
signal. What makes us aware is the process of broadcasting this information
internationally.
Aware states emerge from the workspace algorithm processing the appropriate
sensory inputs, motor outputs, and internal variables linked to memory, inspiration,
and anticipation. What awareness is about is global production. Consciousness is
just a smart hack away. You can go back to chapters “Brain and Mind” and “Levels
of Consciousness” to understand these ideas extensively (Koch 2019).
Although in ascriptions of consciousness there is broad disagreement, there is
one thing similar to all of the above; superintelligence is not needed. To show this,
the human case itself is necessary. Many hypotheses go even farther, ascribing cog-
nition to beings of rudimentary knowledge or indeed no intelligence in certain
instances. Extrapolation of human intelligence in minimally intelligent artificial
systems might make it possible to replicate consciousness. Our perception of con-
sciousness must keep pace with the development in artificial intelligence and be
extended to it.
As with artificial intelligence, in following artificial consciousness, a distinction
may be made between two linked but separate priorities.
Artificial consciousness is mainly concerned with understanding the processes
underlying consciousness. Therefore, the tools offered by engineering artificial con-
sciousness, however excellent, are considered to be of theoretical significance only
to the degree that they approximate or otherwise illuminate the processes underly-
ing consciousness.
Inside artificial consciousness, more distinctions can be made about the relation-
ship between the hardware used for an artificial consciousness system and the con-
sciousness that it is assumed to hold. Adapting terms from weak artificial
consciousness is a method that does not assert a link between consciousness and
technology. This will be a use of consciousness awareness technologies similar to
computational hurricane simulations in meteorology: such simulations can promote
understanding, but no one believes that this is because hurricanes are themselves
computational in any substantive sense.
On the other end, strong artificial consciousness is any method whose ultimate
purpose is to create structures that are instantiations of consciousness when applied.
A symbolic artificial intelligence approach to powerful artificial consciousness, for

instance, ensures that a correctly configured machine is genuinely conscious, aware,
experienced, etc. An overlooked field of probability, called lagom artificial con-
sciousness, is between these two extremes. “Lagom” is a Swedish term with no
exact English counterpart, meaning “perfection by moderation.” Unlike weak artifi-
cial consciousness, the lagom artificial consciousness view argues that the simula-
tion relationship holds due to technology and conscious mental phenomena sharing
broader explanatory properties.
Unlike strong artificial consciousness, however, lagom artificial consciousness
does not assert that instantiating these common properties alone is necessary to
instantiate awareness—something else might be needed. Thus, although strong arti-
ficial consciousness attempts to discover adequate conditions for consciousness, it
would be natural to conclude that lagom artificial consciousness only tries to dis-
cover (some of them) necessary conditions for it. But that isn’t exactly right. That
would be so if only one way of thinking existed.
The argument that the mind is computational comes with different strengths, but
the upshot can be used to keep it concise. In the related context, the argument that
some computational ideas are part of the interpretation of specific behavioral pro-
cesses, though much weaker (and thus more difficult to defeat) than the arguments
that artificial intelligence opponents typically argue against, is nevertheless intrigu-
ing. It means that computer science has a role to play in understanding the mind, and
not only in the weak manner in which hurricanes are understood. The equivalent
argument for an artificial intelligence approach to artificial consciousness is that
some programming principles are part of interpreting some conscious phenomena.
A significant difference within artificial consciousness is whether one is directly
trying to reproduce/explain human (or biological) consciousness or, more broadly,
trying to reproduce/explain consciousness. Either more ambitious or more modest
may be the search for generality. Artificial consciousness, for example, generality,
would be more ambitious in constitutive science if one sought to explain why the
agent is conscious of every possible conscious agent (Vervoort et al. 2021).
And if one’s overall aim is to clarify human consciousness, it may help achieve
the mission by explaining how a unique artificial machine can become conscious.
As Fodor says, “No one has the slightest idea of how aware something material
might be. No one knows what it would be like to have the smallest idea of how
aware any substance might be.”
A known, non-human artificial consciousness would give us something more
than a brief understanding of how consciousness might be anything material.
For discriminative accounts of consciousness, comparable arguments may be
made. Even if one could not justify why that is so, a discriminatory account of the
separate experiential states would benefit an artificial system assumed to be alive,
even if it did not have a discriminatory account that applied to the human situation.
This functionalist approach suggests that, in terms of their abstract causal struc-
ture, one should provide an overview of mental states in reality. This presumption,
at least for those cognitivistically inclined, is not troublesome in the case of thought.
It seems logical to conclude that the steps are available to the thinker in an episode
of thought; thus, it is usually possible for a thinker to write down certain steps in a
finite list. At least some people assume that it is not inconceivable that, with regard
to its experiential properties, there may be something that is biologically (and hence
behaviorally) similar to you and still separate from you, even to the extent of not
getting any memories at all.
These two intuitions are in sharp conflict: the naturalistic intuition is that you fix
everything else if you fix the actual problem. On the other hand, the zombic hunch
is that you somehow have not resolved the feeling even if you fix it physically
(Fig. 3). Thus, an unsatisfactory cognitive dissonance is created by the existence of
any of these intuitions.
There are many explanations why one would assume that artificial consciousness
cannot be done in the context of engineering or that it cannot lead to an experience
of consciousness.
Although the notion that phenomenal cognition cannot be realized in computers
seems to be an apparent inference, there are grounds for a more thorough analysis
of this issue. Advances in artificial intelligence are growing with immense speed.
There will be greater connectivity to more efficient computers that can do more
complex computation as software and hardware developments continue to advance
(Hromiak 2020).
There are computer programs to perform identification, target tracking, and face
recognition.
From simple information gathering to extremely dexterous gestures, logic, and
the development of aesthetic experiences, the human mind can perform many amaz-
ing acts and calculations (Haladjian and Montemayor 2016).
Attention is significant because it is how the brain selectively stores information
derived from sensory and memory inputs (Haladjian and Montemayor 2016).
The focus of the universe will also function on objects that show object-like fea-
tures, such as balance, symmetry, and collective destiny. “Object-based focus
involves a two-stage process that starts with the individualization of objects. Then,
to connect object attributes, which are made accessible by feature maps, selective
Naturalistic Intuition:
Everything else will be fixed if the actual thing is fixed.
Zombic Hunch:
Feeling is not resolved even if the physical thing is
fixed.
Fig. 3 The naturalistic intuition is that you fix everything else if you fix the actual problem, while
the zombic hunch is that you somehow have not resolved the feeling even if you fix it physically
attention functions on these indexed objects, resulting in sustained object-based

mental representations that enable object recognition” (Treisman and Gelade 1980).
As stated, attending to and accepting emotions must not be correlated with feel-
ing them. However, there is also a fundamental social component of thoughts.
Technology has been progressing at an impressive pace, following developments
in the mid-twentieth century, including the idea of Alan Turing for a general com-
puting machine (Bauer et al. 2013).
This suggests that even understanding simple agencies in artificial intelligence
programs is complicated. A similar but much more challenging topic concerns
awareness. In terms of halting functions, artificial intelligence systems are defined.
This experience of consciousness liberation from stopping roles is profoundly con-
nected to the unification of human consciousness and the direction and actual
importance of how feelings are perceived (Haladjian and Montemayor 2016). It is
also strongly linked to the fact that consciousness does not appear vulnerable to
duplication or reproducing, unlike programs. Like an attentional ritual, a function
ceases, but consciousness never stops, nor does it rely on a program’s conclusion
(Mudrik et al. 2014).
Human intelligence also requires empathy, which creates a much more complex
topic for artificial intelligence, as we have argued. And even if it were possible to
apply the motor skills and step-by-step logic in robotics thoroughly, we would still
not understand empathy in the artificial intelligence context. Artificial intelligence
can, at best, generate specialized epistemic agents that can achieve unique objec-
tives. However, artificial intelligence does not generate morally complex emotional
agents with phenomenal interactions, motives, or emotions (Rinesi 2015; Riedl and
Harrison 2015). It thus becomes ever more evident that while attentional mecha-
nisms and even emotion-like reactions can be engineered, these artificial systems
would not actually have a phenomenal perceptual experience.

1. The test of “non-Turing” was introduced by:
(a) Sigmund Freud in 1990.
(b) Rene in 2002.
(c) Ritchard in 1997.
(d) Victor Argonov in 2014.
2. What makes us aware is:
(a) The process of broadcasting this information internationally.
(b) The consciousness.
(c) The relativity of the human’s mind.
(d) The vegetarian state.
3. For many attention routines, the solid propensity for reducing these characteris-
tics to mechanistic algorithmic routines can work, but not for feelings and
agency, because:
(a) The emotions are separated from attention.
(b) Attending to and accepting emotions must not be correlated with feel-
ing them.
(c) Emotions are involuntary.
(d) Robots have no emotions.
4. The capability to identify and communicate with other objects is necessary:
(a) To enhance computer vision.
(b) To build more interconnecting robots.
(c) To do more research and experiments.
(d) No need for that.
Answers
1. (d)
2. (a)
3. (b)
4. (a)
References
Alexiou A, Simou P, Alexiou F, Chatzichronis S, Ashraf GM. Social and ethical impact of advanced
artificial and biological enhancements. Open Public Health J. 2020;13(1):62–8. https://doi.
org/10.2174/1874944502013010062.
Argonov V. Experimental methods for unraveling the mind-body problem: the phenomenal judg-
ment approach. J Mind Behav. 2014;35:51–70.
Bauer H, Veira J, Weig F. Moore’s law: repeal or renewal? 2013. Retrieved from McKinsey &
Company.
Ernst A, Bertrand JMF, Voltzenlogel V, Souchay C, Moulin CJA. The proust machine: what a pub-
lic science event tells us about autobiographical memory and the five senses. Front Psychol.
2021;11:623910. https://doi.org/10.3389/fpsyg.2020.623910. Published 2021 Jan 20.
Haladjian HH, Montemayor C. Artificial consciousness and the consciousness-attention dissocia-
tion. Conscious Cogn. 2016;45:210–25.
Hildt E. Artificial intelligence: does consciousness matter? Front Psychol. 2019;10:1535.
Hromiak M. A new charter of ethics and rights of artificial consciousness in a human world. arXiv
preprint. arXiv:2010.12019; 2020.
Koch C. Will machines ever become conscious? Scientific American; 2019.
Manzotti R, Chella A. Good old-fashioned artificial consciousness and the intermediate level fal-
lacy. Front Robot AI. 2018;5:39.
Mudrik L, Faivre N, Koch C. Information integration without awareness. Trends Cogn Sci.
2014;18(9):488–96. https://doi.org/10.1016/j.tics.2014.04.009.
Oppy G, Dowe D. The Turing test. Stanford Encyclopedia of Philosophy (Spring 2011
Edition); 2011.
Riedl MO, Harrison B. Using stories to teach human values to artificial agents. Paper presented at
the 2nd international workshop on AI, ethics, and society. 2015. http://www.aaai.org.
Rinesi M. The price of the internet of things will be a vague dread of a malicious world. IEET.org
website. 2015. http://ieet.org/index.php/IEET/more/rinesi20150925.
Searle J, et al. Minds, brains, and programs. Behav Brain Sci. 1980;3(3):417–57.
Shieber S. The Turing test: verbal behavior as the hallmark of intelligence. Cambridge: MIT Press;
2004. ISBN 978-0-262-69293-9.
Treisman A, Gelade G. A feature-integration theory of attention. Cogn Psychol.
1980;12(1):97–136. https://doi.org/10.1016/0010-0285(80)90005-5.
Vervoort L, et al. Artificial consciousness, superintelligence and ethics in robotics: how to get
there? Mind Matter. 2021;19(1):7–43.
Relativity of the Human Mind
1 Introduction
Relativity means the matter or anything that will be discussed can differ with the
situations and the circumstances like space and time. So people can do things and
think it is right in some situations, but the same actions will be wrong in other cir-
cumstances. For example, a man can drink alcohol on certain occasions with con-
trollable amount, but this action is wrong when it is done while driving because the
situation is different here and the consequences are massive. Also, I can think that I
am a child and whatever I do is to learn from it, but when I am an adult and do the
same mistakes, its consequences will be unforgivable because the time is different
and mind is different as well.
Humans’ minds are dealing with the actions and giving orders in the same way
of relativity so to keep a balance between our surroundings and our bodies and
believes.
Any conflict or imbalance between our minds and our environment will create an
issue that the mind cannot deal with, and this leads to psychological collapse.
In this chapter, we will discuss this topic from many fields and focus on a new
presentation for the relativity theory in human consciousness as we believe that the
human’s consciousness is relative as well and we should deal with it depending on
this idea.


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2 The Absence of Ego
The lack of ego is an extreme limit to pro-activity and leaves people passively enter-
ing your path. Nowadays, we have the virtual path; it’s quick but shallow even if the
book was there before. Even for some cosmic reason, people cross our path, which
has never changed. Today, we have a wide variety of networks. We can engage with
crowds in Facebook groups, for instance, for the first time in human history, which
makes me believe that conscious evolution can accelerate.
The “teal” campaign, as “green” is the end of life, has also become almost main-
stream. However, if you are still not familiar with the color code of evolution and
world views, please see my article on Spiral Dynamics Integral.
3 Conscious Evolution and the Future of Mankind
We may witness a significant transformation in our capacity to cope with our sur-
roundings, living beings, and nature in general while we are there. The transforma-
tion will be dramatic, as crucial individuals will get a broader perspective and break
free from the tiny circular circles of interest that have surrounded them up to this
point (Styer 2011).
When they reach the higher levels, it is not necessary for anybody, or even a
plurality of individuals, to acquire this degree of awareness for the connectivity of
all to reoccur to a critical mass of people. As the global view expands, we will take
more outstanding care of social justice, intentionally promote peace, clear up the
trash in the oceans, replant trees, and so on, climbing the rungs of the spiral phases.
This, by the way, would create a few jobs. We shall develop a healthier planet for all
living beings to ensure a safe spiral of evolution.
4 Language Development and Consciousness
Language is part of human nature and being. There are compelling grounds to
believe that no other entity possesses a distinctively human talent. Unlike other
animals, we acquire complex linguistic norms rapidly and without purposeful, con-
scious effort in our early years. As our vocabulary expands, we may investigate the
structure of phrases, the function and importance of terminology, and how phrases
and words might be employed for social and practical goals (Psychology
Today 2021).
Social actions become more complex as a result of language. Language improves
reasoning skills since it allows us to express our views explicitly. Furthermore, lan-
guage necessitates the habit of openly asking for explanations and reasons, which
Relativity of the Human Mind 129
serves as a foundation for information acquisition. Homo sapiens became sapiens

primarily as a result of language (Sorli et al. 2017).
The link is getting more difficult to establish because awareness appears to exist
in many animals, but language does not. Language appears to have formed rela-
tively lately in humans; awareness has evolved in many species, at least in its fun-
damental experiencing form, and maybe much earlier than language. Language and
awareness appear to have a meaningful link, at least intuitively. Language may also
be a necessary prerequisite for awareness. However, if language is only an excep-
tional human capacity, it will restrict human awareness; consequently, the issue’s
complexity must be addressed (Psychology Today 2021).
First, we need to understand language and its function in cognition. Thus, lan-
guage can be an ability to speak and how thoughts are encoded, as the format for
inferential reasoning.
5 Relativity of Human Behavior
Relativity in our theory means seeing things from different perspectives that change
with situations. So, for example, when you see someone has a terrible situation, you
will have your own opinion and behavior toward the issue. In contrast, the opinion
and the behavior will differ when you are in the middle of the fire (Thierry 2016).
So, the relativity in psychology is not related to space and time; it relates to situ-
ations. When the situation differs, the behavior differs too. For example, when we
put people in a bad situation like fighting and ask the other group to behave, they
advise them to calm down and think clearly. When we make the same group fight
and ask them to calm down, they respond aggressively. The same situation and the
same people but different behavior is our relativity. The control factor in these situ-
ations is the mind. Your mind interacts with situations depending on the data it
receives from the visual perspective with feelings and emotions. So, clearness dur-
ing behavior can affect decisions and, thus, the results.

1. The main interest of Tolman was:
(a) How the brain can be relative to other systems.
(b) The thinking process is managed by a behavioral process or cognitive method.
(c) How neurons work.
(d) How the relativity affects the mind.
2. The TCR actually advocates:
(a) A promising approach to true artificial, particularly with artificial conscious-
ness distinct from humans and animals.
(b) The differences between the animal and human consciousness.
(c) The electricity of the mind.
(d) The robotic consciousness.
3. The cognitive path includes:

(a) Searching for cognitive tasks related to conscious human experience and
then checking how well those tasks are performed by the target animal spe-
cies when the stimuli are presented in a specific modality.
(b) The path to human consciousness by a robotic technique.
(c) The cognitivity of the human mind.
(d) The psychological path of the human.
4. ………. is an extreme limit to pro-activity and leaves people passively entering
your path.
(a) Absence of Ego.
(b) Absence of Superego.
(c) Absence of Id.
(d) All the above.
5. The relativity in psychology is:
(a) Not related to space and time.
(b) Not related to situations.
(c) Related to both situations and space and time.
(d) Not of the above.
Answers
1. (b)
2. (a)
3. (a)
4. (a)
5. (d)
References
Psychology Today. Consciousness and language. 2021 [cited 2021 Nov 13]. https://www.psychol-
ogytoday.com/us/blog/theory-consciousness/201608/consciousness-and-language.
Sorli A, et al. Advanced relativity: multidimensionality of consciousness and mind, origin of life,
psi phenomena. NeuroQuantology. 2017;15(2):109–17.
Styer DF. Relativity for the questioning mind. Baltimore: JHU Press; 2011.
Thierry G. Neurolinguistic relativity: how language flexes human perception and cognition. Lang
Learn. 2016;66(3):690–713.
Death and Consciousness
1 Introduction
In terms of consciousness, it is possible to describe existence.

Death is more of a mechanism in some societies than a single occurrence.
Therefore, a gradual change from one spiritual state to another is inferred
(Parnia 2014).
Eternal oblivion is also called the belief in the irreversible loss of consciousness
after death. The word afterlife describes the assumption that the stream of knowl-
edge is maintained after physical death. Neither is likely ever to be proven without
the pondered having to die (Parnia 2014).
Detritivores, species that recycle detritus, may further decompose organic mate-
rial, returning it to the atmosphere for reuse in the food chain. These chemicals
ultimately become absorbed and assimilated into a living organism’s cells.
Earthworms, woodlice, and dung beetles are some examples of detritivores
(Parnia 2014).
2 The Difference Between Consciousness and Death
Death is not the opposite of consciousness. It is the lack of consciousness—that is

missing. In practical terms, the fractal catalytic model assumes that a macroscopic
coherent wave function—a coherent matter-wave—supports the neural activity. The
neural association of consciousness is this macroscopic quantum coherent wave
function. Once this wave function collapses, the topic will do so as well.


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With plenty of parallels and dislikenesses, rest and demise are if you are in yoga,
one school demonstrates to you that contemplation is a specialty of kicking the
bucket (actually what it means is that we totally free body consciousness as reflec-
tion happens to us), cognition achieves a past state psyche, but in any known dialect,
this cannot be reflected in words. As troublesome as the sweet portrayal of any
dialect (Lund 2016).
A state connected with the body and the brain is added to your inquiry about
when one more condition of a presence called otherworldly is included. Profound
rest is near-death as consciousness is permitted to choose whether to backpedal to
mind and body or free itself and choose another desire to be conceived again.
Cognizance joins itself as it leaves the body with the last thought in the brain.
Mercifully take note that cognizance will relate to only one thing at any given
moment. It gets pulled in to alter, too. So those out of the body will lose the progres-
sions realized by the gross detects, hence no more improvements in this direction,
the last idea is clutched.
Advancing fixation and culminating reflection help us, considering the fact that
the consciousness comes to the past brain, to use the embodiment of the gross facul-
ties placed away in the memory. I used pith and not the gross detect feature. The
dialect is not vital along these lines.
3 Near-Death Experiences
It is defined as the moments that come during some life events prior to death or
when the individual is about to lose his or her life (Koch 2021).
These concrete and fantastic encounters have the potential to alter their lives
permanently. NDEs are not fanciful imaginings (Van Lommel 2006).
The media coverage of near-death experiences (NDEs) is likely to have led to
expectations about how people could feel following such experiences (Carter 2010).
Local brain areas fall dark one after the other, like a municipality losing power
one community at a time.
Given the power interruptions, this experience has the potential to yield the
bizarre and unusual accounts that comprise the corpus of NDE reports. The NDE is
as genuine to the person experiencing it as anything manufactured by the imagina-
tion during regular waking hours. The mind and consciousness are extinguished
when the whole brain shuts down due to total power loss (Klein 2020; Koch 2021).
Again, an aura, a special feeling unique to a patient that indicates an impending
assault, will precede them.
Following a seizure, you may experience changes in the apparent proportions of
items, strange tastes, scents, or physical sensations, déjà vu, depersonalization, or
euphoric sentiments.
Death and Consciousness 133
4 Consciousness After Clinical Death
Many beliefs can lead us to the point that the consciousness may remain to exist
after death or at least remains working (Van Lommel 2010).
Pharmacological manipulation is used by various medications that influence
neural activity by interfering with neurotransmission, resulting in vision, emotion,
awareness, cognition, and behavior changes. Psychoactive drugs are classified into
four groups based on their pharmacological effects: euphoriants, stimulants that
induce transient improvements in either mental or physical functions, depressants
that depress or decrease arousal or stimulation, and hallucinogens that may cause
hallucinations, anomalies in perception, and other significant subjective changes in
perceptions, emotions, and consciousness (Metcalf and Huntington 2014).
Death was formerly defined as the cessation of heartbeat and breathing (cardiac
arrest). Nonetheless, the development of CPR and quick defibrillation has rendered
this paradigm obsolete, as it is frequently feasible to resume breathing and heartbeat.
Life may often be preserved without a functional heart or lungs using various life
support systems, organ transplants, and artificial pacemakers; events that used to be
causally associated with death no longer kill under all conditions (Metcalf and
Huntington 2014).

1. What is death?
(a) Death is the opposite of consciousness.
(b) It is the continuity of life.
(c) It is the freedom of the soul.
(d) It is the lack of consciousness.
2. Heart attack can be considered:
(a) A near-death experiences.
(b) A vegetarian state.
(c) An unconscious state.
(d) The start of the death.
3. Putting the person inside an MRI machine or surrounding his head with
electrodes:
(a) He reaches the NDE.
(b) HE does not reach the NDE.
(c) It is a start for the NDE.
(d) It has no relation with NDE.
4. …………….. is the irreversible loss of consciousness after death:

(a) Near-death experience.
(b) Consciousness.
(c) Eternal oblivion.
(d) Death.
Answers
1. (d)
2. (a)
3. (b)
4. (c)
References
Carter C. Science and the near-death experience: how consciousness survives death. Toronto:
Simon and Schuster; 2010.
Klein A. The death of consciousness? James’s case against psychological unobservables. J Hist
Philos. 2020;58(2):293–323.
Koch C. What near-death experiences reveal about the brain. Sci Am. 2021 [cited 2021 Nov 13].
https://www.scientificamerican.com/article/what-n ear-d eath-experiences-r eveal-a bout-
the-brain/
Lund DH. Death and consciousness. Jefferson: McFarland; 2016.
Metcalf P, Huntington R. Celebrations of death. Cambridge: Cambridge University Press; 2014.
Parnia S. Death and consciousness––an overview of the mental and cognitive experience of death.
Ann N Y Acad Sci. 2014;1330(1):75–93.
Van Lommel P. Near-death experience, consciousness, and the brain: a new concept about the
continuity of our consciousness based on recent scientific research on near-death experience in
survivors of cardiac arrest. World Futures. 2006;62(1–2):134–51.
Van Lommel P. Consciousness beyond life. New York: HarperCollins; 2010.
Index
A Benzedrine, 81
Abuse, 89 Biological influences, 104, 105
Addiction, 82 Borderline Personality Disorder (BPD), 71
Alcohol, 83 Brain–mind relationship
Altered states of consciousness, 99, 101 consciousness, 21
Altruism, 76 neuroanatomy, 21
American Psychiatric Association (ASA), 58 senses, 21
Amphetamine, 81 Brain regions
Amygdala, 19 left and right hemispheres, 19
Analgesics, 86 limbic system, 19
Antisocial personality disorder (ASPD), 70 memory, 20
Artificial consciousness neocortex, 19
attention, 123 pathologies, 19
behavioral processes, 122 sensory cortex, 21
consciousness liberation, 124
generality, 122
human intelligence, 124 C
Lagom, 122 Cataplexy, 45
mind processing capabilities, 121 Central sleep apnea (CSA), 43, 44
naturalistic intuition, 123 Choice blindness, 100
object-based focus, 123 Circadian, 39
strong consciousness, 121 Circadian rhythm sleep-wake disorders, 43
subsidiary mechanisms, 121 Clinical death, 133
tools, 121 CNS depressants
Artificial intelligence, 119, 124 alcohol, 83
Attention, 112, 114 barbiturates, 84
Automatic processes, 111 CNS stimulants, 92
Autosuggestion, 32 amphetamine, 81, 82
Avoidant personality disorder (AVPD), 73 caffeine, 81, 82
cocaine, 83
nicotine, 81
B Cocaine, 83
Barbiturates, 84, 85, 92 Codeine, 86
Benign sleep myoclonus of infancy Cognitive-behavioral therapy (CBT), 73, 74
(BSMI), 48 Cognitive perception, 110

Switzerland AG 2022
Practice, https://doi.org/10.1007/978-3-030-90692-4
136 Index
Coma, 22 Delirium, 24
Computer intelligence, 119 Dependence, 84
Computer programs, 123 Detritivores, 131
Computer science, 119, 122 Dexedrine, 81
Confusion, 23 Dialectical behavioral therapy (DBT), 71, 74
Confusional arousal, 54 Digital consciousness, 119
Connecting memories, 29 Divided-consciousness theory, 114
Conscious evolution, 128 Dopamine agonist, 92
Consciousness, 51, 85, 109, 120 Dreams
abnormal states, 22 conscious mind, 49
agreement, 10 consciousness, 51, 52, 54
awareness, 6 definition, 49
death, 131 lucid, 51
decisions and actions, 13 meta-awareness, 51, 52
definition, 2 neurobiological perspective, 50
development, 1–3 postconsciousness, 52
developmental psychology, 10, 11 properties, 49, 50
domains, 4 self-awareness, 52
explanations, 1 Dual processing, 97
Freud, S., 6 change deafness, 99, 100
language, 128, 129 choice blindness, 99, 100
levels, 8 selective attention, 97, 98
ego, 27 two-track mind, 97, 98
Id and ego, 27 Dualism, 6
personality, 27
preconscious, 29
Superego, 27 E
medicine, 22 Electromyography (EMG), 49
meditation, 4 Emotions control communication, 30
memory, 132
mind and body interactions, 4
neuropsychological research, 13 F
neuropsychology, 14, 15 Fentanyl, 87
neuroscience, 14 Freudian theory, 6, 7, 15
object, 13
personal ID, 2
psychiatry, 22 G
social psychology, 11 GABA agonist, 85, 92
Consciousness awareness technologies, 121 Gibson’s theory, 9
Glasgow Coma Scale (GCS), 23
Grady Coma Scale (GCS), 23
D
Daydreaming, 100
Death, 133 H
Defense mechanism Habenula, 20
classification, 58, 59 Hallucination
definition, 57 LSD, 91
immature defenses, 60, 61 marijuana, 89, 90
mature defenses, 65, 66 MDMA, 90, 91
mental health, 57 Histrionic personality disorder (HPD), 72
moral values and principles, 57 Human
neurotic defenses, 62–64 vs. machine consciousness, 120
pathological defenses, 59 Human awareness, 120
Delete Button, 31 Human behavior
Index 137
relativity, 129 L
Human complex conscious abilities, 14 Language development, 128
Human consciousness, 5, 122 Laterodorsal tegmentum (LDT), 50
Human intelligence, 124 Lethargy, 22, 23
Human mind Locke’s theory, 3
ego, 128
human’s consciousness, 127
relativity, 127 M
social justice, 128 Machine consciousness, 119
Hypercapnic type, 44 MAOIs selective serotonin reuptake inhibitors
Hypnosis, 102, 105 (SSRIs), 88
calming experience, 111 Marijuana, 90
clinical and psychological effects of tetrahydrocannabinol, 90
applications, 114 hallucination, 89
hypnotherapy, 115 medical uses, 90
pain management and cancer positive and negative effects, 90
supporter, 115 properties, 90
prevention of irritable bowel Meditations, 4, 102–105
syndrome, 115 Mentalization-based therapy (MBT), 71
consciousness, 109 Meperidine, 88
as divided consciousness, 113–114 Metacognition-oriented therapy, 68
emotional, 112 Metacognitive interpersonal therapy (MIT), 74
experiences, 113 Methadone, 88
hypnotic hypermnesia, 111 Methamphetamine, 82
hypnotizable estimation, 110 Morphine, 85–87
hypnotized people, 109
induction process, 110
interactions, 110 N
and meditation, 112 Narcissistic personality disorder (NPD), 71, 75
as meditative condition, 111 Narcotics
multifaceted essence, 110 addiction, 85
posthypnotic suggestion, 111 codeine, 86
radical neurological fentanyl, 87
improvement, 111 meperidine, 88
social interaction, 112 methadone, 88
uses, 114 morphine, 85, 86
Hypnotherapy, 115 oxycodone, 89
Hypnotic induction, 111 Naturalistic intuition, 123
Hypocapnic type, 44 Near-death experiences (NDEs), 132
Hypothalamus, 23 power interruptions, 132
Neurobiological theory, 54
Neuropsychology, 16
I Nightmare disorder, 54
Idiopathic hypersomnia (IH), 45 Non-human artificial consciousness, 122
Implicit memory, 22 Non-Rapid Eye Movement (NREM), 40
Inattention, 99, 101
Inattentional blindness, 99
Insomnia, 43 O
Intellectualization, 76 Obsessive-compulsive personality disorder
Irritable bowel syndrome, 115 (OCPD), 74
Obstructive sleep apnea (OSA), 43
Operative functioning, 30
J Opioids, 86–88, 92
Jet lag disorder, 53 Oxycodone, 89
138 Index
P REM sleep behavior disorder

Paranoid personality disorder, 75 (RBD), 46
Parasomnia Restless leg syndrome (RLS),
definition, 45 47, 53, 54
dissociative disorder, 47 Robotics, 124
hallucinations, 47 Robots, 119, 120
NREM sleep
confusional arousal, 46
eating disorder, 46 S
sleep terrors, 46 Schizotypal personality disorder (SPD), 69
sleepwalking, 46 Selective attention, 97–106
REM, 47 Sleep
Pedunculopontine tegmentum circadian, 39
(PPT), 50 definition, 39
Perception, 97, 102 disorders
Periodic Limb Movement Disorder breathing, 43
(PLMD), 48, 54 circadian rhythm sleep-wake, 43
Personal identity theory, 2 CSA, 44
Personality disorders insomnia, 42, 43
cluster OSA, 44
ASPD, 70, 71 hypersomnolence, 45
AVPD, 73 hypothalamus, 39
BPD, 71 NREM
DPD, 73 definition, 40
HPD, 72 heart rate, 42
NPD, 71 SWS, 42
OCPD, 74 wakefulness state, 41
PPD, 68 parasomnia, 45
SPD, 69, 70 REM, 41, 42
SzPD, 69 SCN, 40
definition, 67 types, 40
DSM-5, 67 Sleep-related movement disorders
Pharmacological manipulation, 133 bruxism, 48
Physical thing, 4 BSMI, 48
Postconscious, 15, 52 leg cramps, 48
Posthypnotic amnesia, 111 PLMD, 48
Preconscious, 29 PSM, 49
adults, 29 RLS, 47
memories, 29 SRRMD, 48
psychiatry and psychology, 29 Sleep-Related Rhythmic Movement Disorder
thinking, 29 (SRRMD), 48
words presentations are memory, 30 Slow-wave sleep (SWS), 42
Psychiatric disorders, 66 Social influence theory, 114
Psychological influences, 104, 105 Social psychological investigation, 12
Psychostimulant, 82 Social psychology, 12
Spinoza, 6, 16
Subconscious
R desire, 31
Rapid eye movement (REM), 40 emotions control communication, 30
Recognition, 97 fear and negative talking, 30
Refocusing attention, 102 mind, 30, 32
Relativity, 127, 129 unconscious, 32
Index 139
Subjective perception, 111 V

Subliminal perception, 32 Vermis, 19
Subliminal stimulation, 36
Superego, 7
Suprachiasmatic nucleus, 53 W
Weak artificial intelligence, 120–122
T
Transference-focused psychotherapy (TFP), 71 Z
Turing test, 119 Zombic hunch, 123
U
Unsatisfactory cognitive dissonance, 123

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Hashim Talib Hashim

Athanasios Alexiou Editors

ISBN 978-3-030-90691-7 ISBN 978-3-030-90692-4 (eBook)

The Psychology of Consciousness: Theory and Practice is a fundamentally impor-

Consciousness can also be manipulated. Altered states of consciousness are most

I believe something magical can happen when you read books.

The consciousness is something not well understood, and it is vague in many

Baghdad, Iraq Hashim Talib Hashim

Hashim Talib Hashim, Mustafa Ahmed Ramadhan, and Mehek Cheema

1 Mayan and Incan Theories of Consciousness

H. T. Hashim (*) · M. A. Ramadhan

© The Author(s), under exclusive license to Springer Nature 1

Fig. 1 The first definition

2 John Locke on Consciousness

Fig. 3 The development of consciousness according to the Incan theories

Fig. 4 The two domains of consciousness according to the Cartesian Dualism

3 René Descartes on Consciousness

It discussed Cartesian Dualism, which concludes the coming of nonphysical thing,

In acquiring human intelligence, he attributed two functions to the senses.

5 Sigmund Freud on Consciousness

Sigmund Freud is considered the father of psychoanalytic theory, and we will

Fig. 6 The two

We will discuss these levels in detail in chapter “Levels of Consciousness”,

6 Modern Theories of Consciousness

6.1 Holder’s Levels of Consciousness

6.2 Levels of Consciousness, According to Barrett

He suggested seven levels going on logically (Fig. 7).

6.3 States of Consciousness According to Gibson

Fig. 7 Levels of consciousness according to Richard Barrett

6.4 8-Circuit Model of Leary About Consciousness

It is a combination of theories developed by Leary and Wilson. It consists of eight

6.5 Morin’s Integration

It is similar to the idea of Gibson, but it is concluded in four models as suggested

Fig. 8 Morin’s hierarchy of conscious states

6.6 Moore and Gillette

7 Developmental Psychology on Consciousness

A typical agreement remains on a few key points in the developmental growth of

Fig. 9 Developmental psychology on consciousness

Level 5: Self-consciousness or “meta” self-awareness: At this level which is the

8 Social Psychology on Consciousness

Psychology and especially social psychology are fundamental sociological sci-

persons concerned; however, as far as we know, there is no immediate action of one

actions across many various fields of psychology; several of the wellsprings of

Fig. 10 The creation of

In neuropsychology, localization of the psychological roles in the brain has histori-

Fig. 11 The neuropsychology of consciousness; linking the brain to consciousness

10 Hashim and Mustafa Theory of Postconscious

It is a newly developed theory in 2019. They defined consciousness as behavior and

Multiple Choice Questions

9. Postconscious is an extension of Freud theory and it has been described by:

Hashim Talib Hashim and Adil Alhaideri

H. T. Hashim (*) · A. Alhaideri

© The Author(s), under exclusive license to Springer Nature 19

Fig. 1 The limbic system for the development of memory

Fig. 2 The amygdala

Fig. 3 The habenula in the

It is more difficult to describe and classify the pathological state of consciousness,

Hashim Talib Hashim and Mustafa Ahmed Ramadhan

H. T. Hashim (*) · M. A. Ramadhan

Baghdad, Iraq Hashim Talib Hashim

1 Mayan and Incan Theories of Consciousness

2 John Locke on Consciousness

3 René Descartes on Consciousness

5 Sigmund Freud on Consciousness

6 Modern Theories of Consciousness

6.1 Holder’s Levels of Consciousness

6.2 Levels of Consciousness, According to Barrett

6.3 States of Consciousness According to Gibson

6.4 8-Circuit Model of Leary About Consciousness

6.5 Morin’s Integration

6.6 Moore and Gillette

7 Developmental Psychology on Consciousness

8 Social Psychology on Consciousness

10 Hashim and Mustafa Theory of Postconscious

1.1 Structures Involved in Sleep

1.2 Circadian Rhythms and Sleep

1.3 Sleep Types

1.3.1 NREM Sleep

1.4 Sleep Disorders

1.4.2 Circadian Rhythm Sleep-Wake Disorders

1.4.3 Sleep-Related Breathing Disorders

1.4.4 Central Disorders of Hypersomnolence

1.4.6 Sleep-Related Movement Disorders

2.1 Dream Properties and Content

2.2 Dreams from Neurobiological Perspective

2.3 Lucid Dreaming

2.4 Dreams, Sleep, and Consciousness Relationship

2.5 Dreaming About Future and Postconscious

Baird B, Erlacher D, Czisch M, Spoormaker VI, Dresler M. Consciousness and meta-consciousness

2 Classification of Defense Mechanisms

2.1 Pathological Defenses

2.2 Immature Defenses

2.3 Neurotic Defenses

2.4 Mature Defenses

4 Classification of Personality Disorders

4.1 Cluster A Personality Disorder

4.2 Cluster B Personality Disorders

4.3 Cluster C Personality Disorders