PubMed · 5882873
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C L Cazzullo. 1965-12-31. [On consciousness: analytic and collective function].. https://pubmed.ncbi.nlm.nih.gov/5882873/
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OBJECTIVE: In the assessment and management of the potentially poisoned patient with altered consciousness, the most consequential and controversial interventions occur during the first 5 minutes of care. In this review article, the risks and benefits of standard diagnostic and therapeutic interventions are presented to guide clinicians through this critical period of decision making. DATA SOURCES: Data for discussion were obtained from a search of English-language publications referenced on MEDLINE for the years 1966 to 1994. Older literature was included when pertinent. Search terms included poisoning, overdose, toxicity, naloxone, glucose, thiamine, and flumazenil. STUDY SELECTION: Only large trials were used for determinations of diagnostic utility and efficacy. Small trials, case series, and case reports were reviewed extensively for adverse effects. DATA EXTRACTION AND SYNTHESIS: Trials were reviewed for overall methodology, inclusion and exclusion criteria, sources of bias, and outcome. CONCLUSION: Analysis favors empirical administration of hypertonic dextrose and thiamine hydrochloride to patients with altered consciousness. Although rapid reagent test strips can be used to guide this therapy, they are not infallible, and they fail to recognize clinical hypoglycemia that may occur without numerical hypoglycemia. Administration of naloxone hydrochloride should be reserved for patients with signs and symptoms of opioid intoxication. Flumazenil is best left for reversal of therapeutic conscious sedation and rare select cases of benzodiazepine overdose.
As part of his rediscovery of consciousness, Searle has recently provided an interpretation of Freud's account of consciousness, including the relation of consciousness to nonconscious mental occurrences [i.e., preconscious mental occurrences and unconscious (repressed) mental occurrences]. Regrettably, Searle's interpretation is based on a single paragraph from The Unconscious and serves to eliminate Freud's general view on these matters as being "incoherent." In the present article, I rediscover Freud's account and show that Searle has deeply misunderstood him, thus converting Freud into a "mental-eye" theorist of consciousness when Freud is actually an "intrinsic" theorist. I point out that Freud's and Searle's views on consciousness are actually similar, though Searle denies the existence of nonconscious mental occurrences. My discussion of Freud's account of consciousness addresses as well (a) Freud's understanding of emotions and feelings, including what he calls "misconstrued" emotions, and repression that works to suppress the development of affect, and (b) why Freud held that emotions and feelings never occur except consciously. I hope that my present contribution will be part of an intensive discussion that will proceed among psychologists of consciousness in a conscious and deliberate joint effort to develop the theory of consciousness.