what the philosopher immanuel kant · 2019-03-11 · technical overview as well as Northoff, 2013a,...

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what the philosopher immanuel kant can tell us about psychiatric disorders

Dr. Georg Northoff, MD, PhD, FRCPResearch DirectorMind, Brain Imaging and NeuroethicsCanada Research ChairEJLB-Michael Smith Chair for Neuroscience and Mental HealthRoyal Ottawa Healthcare GroupUniversity of Ottawa Institute of Mental Health Research

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The early philosopher Immanuel Kant suggested that the mind’s intrinsic features are intimately linked to the extrinsic stimuli from the environment it processes. Currently, the field faces an analogous problem with regard to the brain. Kant’s ideas may

provide insight into what the brain’s intrinsic features must be like in or-der to be linked to its neural processing of the extrinsic stimuli. Most im-portantly, he may prove helpful in better understanding what the vari-ous resting state abnormalities as observed in psychiatric disorders like schizophrenia and depression imply for the often rather bizarre subjec-tive experiences and thus consciousness in those patients.

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Dr Georg Northoff

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Kant`s view of the mind The philosopher René Descartes assumed men-

tal properties intrinsic to the mind to be distinct from the physical features of body and brain. This was countered by the Scottish philosopher David Hume, who opposed such intrinsic mental proper-ties. Instead, Hume advocated an extrinsic view of the mind, believing that mental activity can be en-tirely traced back to the extrinsic features of stimuli in the world. His German successor Immanuel Kant combined both intrinsic and extrinsic views of the mind: he claimed that consciousness and self must be considered a hybrid of processes that result from an interaction between the mind’s intrinsic features and the world’s extrinsic stimuli.

In order to reveal the nature of such intrinsic-ex-trinsic interactions, Kant attributed various faculties (i.e., intrinsic features) to the mind, primarily de-scribed in his Critique of Pure Reason (Kant, 1998). The mind’s intrinsic features included unity of con-sciousness, self as ‘I think’, and various templates of spatiotemporal continuity (which were subsumed under the umbrella term ‘categories’). According to Kant, the mind uses its intrinsic features to structure and organise the effects of the extrinsic stimuli. This, in turn, allows the latter to become associated with consciousness, self, and spatiotemporal continu-ity. Hence, consciousness, self, and spatiotemporal continuity are based on the interaction between the mind’s intrinsic features and the environment’s ex-trinsic stimuli.

Extrinsic and intrinsic views of the brain Charles Sherrington, the British neurologist work-

ing at the beginning of the 20th century, considered the brain a mere passive sensorimotor reflex appa-ratus. Extrinsic stimuli from the environment trigger neural activity in pathways that result in sensorimo-tor reflexes. This extrinsic view of the brain has been challenged by authors such as Graham Brown, Karl Lashley, and Rodolfo Llinas, based on the observa-tion of intrinsically generated activity in the brain (Llinas 2002 for an overview).

The recent discovery of high resting state activ-ity in a particular set of brain regions, the default-mode network (DMN), has once again raised the question of an intrinsic view of the brain’s neural activity (Raichle, 2009). Since its initial description, the functions of the DMN have been debated and associated with the self (Qin & Northoff, 2011) and consciousness (He & Raichle, 2009; Tononi & Koch, 2008; Northoff, 2013a–c). However, the exact fea-

tures of resting state activity in the brain and how it yields functions such as consciousness and self re-main unclear.

How does the intrinsic resting state activity of the brain interact with the extrinsic stimuli from the outside world? The relevance of such rest-stimulus interaction is supported by recent findings showing that the level of pre-stimulus resting state activity predicts the neural, phenomenal, and behavioural effects of subsequent stimuli (Northoff et al., 2010; Sadaghiani et al., 2010).

What remain unclear, however, are the exact neu-ronal features of the resting state itself that make possible such rest-stimulus interaction. These neu-ronal features must be intrinsic to the resting state while at the same time predisposing the brain to the association of its stimulus-induced activity with con-sciousness and self. Hence, in order to better under-stand our observations during rest-stimulus interac-tion, we may need to get a better grip on the resting state’s intrinsic features. Additionally, we must learn the neuronal features of the resting state itself make possible or predetermine that is predispose the way the stimuli can interact with the resting state, rest-stimulus interaction in such a way that the stimulus becomes associated with consciousness and self. We may thus need to develop an intrinsic-extrinsic inter-action model with regard to the brain.

Kant and the brain Kant’s view of the mind’s intrinsic features has

often been interpreted within a predominantly cog-nitive context. Philosophers such as Brook (1994), Kitcher (1990), and Palmer & Lynch (2010), as well as neuroscientists such as Zeki (2008) associate higher-order cognitive functions with Kant`s intrin-sic features of the mind. This is in line with predomi-nantly cognitive and reflective characterizations of consciousness (as for instance ‘access conscious-ness’ (Block, 2005)).

However, this still leaves open the question of mechanisms for the most basic forms of conscious-ness, i.e., phenomenal consciousness (Northoff, 2013; Block, 2005) and its phenomenal features like pre-reflective sense of self (Qin & Northoff, 2011) and spatiotemporal continuity (Northoff, 2013a–c). These basic forms of consciousness and self may be closely related to how the intrinsic features of the resting state interact with extrinsic stimuli, since they must occur prior to any cognition.

What Kant described as the mind`s intrinsic fea-tures, providing order and regularity to the extrinsic stimuli from the world, could be attributed to the Cover: Speedfighter/Bigstockphoto.com


What The Philosopher Immanuel Kant Can Tell Us About Psychiatric Disorders

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brain’s resting state and its intrinsic features. More specifically, the brain`s resting state activity may structure and organise stimulus-induced activity in such way that the latter can be associated with consciousness, self, and spatiotemporal continuity (Northoff, 2012a, 2012b, 2013a–c). Hence the brain itself, the resting state’s intrinsic features, may pro-vide an input yet to be explored specifically in rela-tion to the neural processing of extrinsic stimuli.

Kant’s account of the mind’s intrinsic-extrinsic interaction may give us some clues about the kind of intrinsic features within the brain’s resting state activity and how they interact with the extrinsic stimuli from the world. We may thus want to search for those intrinsic features that predispose the brain to associate consciousness, self, and spatiotempo-ral continuity with the extrinsic stimuli during sub-sequent rest-stimulus interactions. And it is exactly these functions such as self, consciousness, and spatiotemporal continuity that are abnormal in psy-chiatric patients with, for instance, depression or schizophrenia. The following section takes a more detailed look at spatiotemporal continuity.

Intrinsic activity and spatiotemporal continuity

Intrinsic activity and consciousness How does the brain’s intrinsic activity relate to

consciousness? The term intrinsic activity describes spontaneous activity generated inside the brain it-self (see Logothetis, 2009 and Northoff, 2012a for details). Since the observation of spontaneous activ-ity implies the absence of extrinsic stimuli and is thus mere rest, the term intrinsic activity is often used in-terchangeably with ‘resting state activity’, especial-ly in an experimental-operational context (see also Logothetis, 2009 for a discussion on the concept of the resting state). The brain’s intrinsic activity has re-cently also been considered a candidate mechanism of consciousness (see Lundervold, 2010 for a more technical overview as well as Northoff, 2013a, 2013c for a detailed discussion of the different theories).

One recent proposal suggests that the resting state’s slow wave fluctuations in frequency ranges between 0.001–4 Hz are central in yielding con-sciousness (He et al., 2008; He & Raichle, 2009; Ra-ichle, 2009). Due to the long time windows of their ongoing cycles, i.e., phase durations, these slow wave fluctuations may be particularly suited to in-tegrating different information. Such information

integration may then allow for the respective con-tent to become associated with consciousness (see also Fingelkurts et al., 2010 for a consideration of the resting state’s functional connectivity and low frequency fluctuations in the context of conscious-ness).

Another suggestion for the central role of the resting state in consciousness was proffered by Ru-dolfo Llinas (1998, 2002). Conducting MEG studies on subjects in the awake state and during sleep, Lli-nas observed that 40 Hz oscillations were present in both the awake and sleeping (REM sleep) states. The two states differed, however, in that a sensory stimulus could reset (and thus modulate) the 40 Hz oscillations in the awake state but not during REM sleep (in which we dream). Hence, the neural reac-tivity of the resting state to external stimuli seems to distinguish the awake state from REM sleep.

The same was observed in NREM sleep, which showed a similar non-reactivity to external stimuli. In addition, NREM sleep exhibited reduced amplitude in the 40 Hz oscillations, distinguishing it from REM sleep. Hence, the reactivity of the 40 Hz oscillations and their amplitude seem to distinguish REM and NREM sleep. This underlines the central importance of the resting state and especially of its interaction with stimuli, i.e., rest-stimulus interaction (see also Freeman, 2003, 2010, and Northoff et al., 2010 Vol-ume I, Part IV, Chapter 2), in yielding consciousness.

Another theory central to connecting intrinsic activity to consciousness originates from Dehaene (Dehaene & Changeux, 2005, 2011). Depending on the timing of the stimulus relative to ongoing spon-taneous phase fluctuations, the stimulus may or may not lead to the recruitment of the fronto-parietal neurons and network, which are considered of pri-mary importance in allowing for conscious access.

If for instance the spontaneous firing activity in the fronto-parietal network is too strong and con-tinuous, it can block and thus prevent ignition by an external stimulus. Since Dehaene and Changeux assume the fronto-parietal network to be a global neuronal workspace that is necessary for conscious-ness, the stimulus may consequently be ‘denied’ conscious access and thus remain unconscious, i.e., pre-conscious (see also Kleinschmidt et al., 2012 for the relevance of pre-stimulus resting state activity).

Taken together, these proposals provide support for a central role for the brain’s intrinsic activity in consciousness. They leave open, however, the ques-tion as to why and how intrinsic activity—the brain’s input—can create the tendency or predisposition to generate consciousness. Without intrinsic activ-


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ity, consciousness, with its special subjective and phenomenal-qualitative features, would not even be possible. Hence, intrinsic activity is indispensa-ble for the possibility of consciousness, although it is (usually) not sufficient in itself to generate actual consciousness.

Intrinsic activity seems to add a special feature to the neural processing of extrinsic stimuli that predis-poses their possible association with consciousness in the ‘right’ circumstances. To better understand what this feature is, it is necessary to grasp the tem-poral and spatial organisation of the brain’s intrinsic activity in more detail. This is the focus of the follow-ing sections.

Intrinsic activity and temporal continuity There appears to be quite an elaborate temporal

structure to the brain’s intrinsic activity, based on the fluctuations of intrinsic activity in different fre-quency ranges. Spontaneous fluctuations of neural activity in the resting state are often observed, es-pecially in the default-mode network (DMN) where they are characterized predominantly by low fre-quencies (< 0.1 Hz).

However, low (and high) frequency fluctuations in neural activity can also be observed in regions other than the DMN such as the sensory cortices, motor cortex, insula, and subcortical regions like the basal ganglia and thalamus (see Freeman, 2003; Shulman et al., 2004, 2009; Buckner et al., 2008; Wang et al., 2007; Hunter et al., 2005; Zuo et al., 2010). Rather than being specific to the DMN, low frequency fluc-tuations appear to be a hallmark feature of neural activity in general.

Further support for spontaneous resting state activity across the whole brain comes from electro-physiological studies showing spontaneous neuronal oscillations and synchronizations in various parts of the brain including the hippocampus and visual cor-tex (Buzsaki, 2006; Buzsaki & Draguhn, 2004; Arieli et al., 1996; Llinas, 1988; Singer, 2003; Fries et al., 2001, 2007). This suggests that spontaneous fluctua-tions—and thus intrinsic activity—may be prevalent throughout the whole brain in both humans and ani-mals, and not limited to the DMN.

To be more specific, spontaneous BOLD fluctua-tions as observed in fMRI are to be found in lower frequency ranges including the delta band (1–4 Hz), up- and down-states (0.8 Hz) and infra-slow fluc-tuations (ISFs) (0.001–0.1 Hz). The slow frequency fluctuations observed in fMRI have been assumed to correspond to what is measured as slow cortical potentials (SCPs) in EEG (Khader et al., 2008; He &

Raichle, 2009). These SCPs are not easy to obtain in EEG because

they are subject to artefacts caused by sweating, movements, and electrode drift; their measurement therefore requires a more direct approach by so-called DC (direct current) recording. There is some evidence that what is measured as SCP in EEG cor-responds to, or is even identical to the low frequen-cy fluctuations obtained in fMRI (see He & Raichle, 2009 as well as Khader et al., 2008 for reviews).

In addition to such low frequency fluctuations, there are also higher frequency fluctuations in the brain’s resting state activity. These cover 1 Hz and higher, thus including delta (1–4 Hz), theta (4–8 Hz), alpha (8–12 Hz), beta (12–30 Hz), and gamma (> 30 Hz) (see Mantini et al., 2007; Sadaghiani et al., 2010).

This raises the question of how low and high fre-quencies are related to each other in the brain’s rest-ing state (see also the recent reviews by Fries, 2009; Canolty & Knight, 2010; Sauseng & Klimesch, 2008; Fell & Axmacher, 2011). For instance, Vanhatalo et al. (2004) conducted an EEG study of healthy and epileptic subjects during sleep and thus during rest where, using DC-EEG, low frequency oscillations were recorded. All subjects showed infraslow oscil-lations (0.02–0.2 Hz); these were detected across all electrodes—and thus the whole brain—without any specific, visually obvious spatial distribution evident.

Most interestingly, Vanhatalo et al. (2004) ob-served phase-locking or phase-synchronization be-tween the slow (0.02–0.2 Hz) oscillations and the amplitudes of the faster (1–10 Hz) oscillations: the amplitudes of the higher frequency oscillations (1–10 Hz) were highest during the negative deflection of the slow oscillations (0.02–0.2 Hz). Even the high-er-frequency K-complexes that are characteristic of sleep, as well as interictal epileptiform events, were phase-locked to the slow oscillations in that the for-mer occurred preferentially in the negative deflec-tion phases of the latter.

An analogous phase-locking of high frequency oscillations’ power to the phases of lower ones can also be described as phase-power coupling, with phase-phase and power-power coupling also being possible (see Canolty & Knight, 2010 as well as Sau-seng & Klimesch, 2008 for excellent reviews). Such low-high frequency entrainment may occur not only during the resting state as described in the above-mentioned study but also during rest-stimulus inter-action (Northoff et al., 2010), where it may be cen-tral to integrating and embedding the stimuli (and their respective contents) into the ongoing temporal structure of the brain’s intrinsic activity.



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Figure 1The figure illustrates schematically the constitution of the supposed generation of temporal l (1a) and

spatial (1b) continuity by the brain’s intrinsic activity.

1a: The brain shows in-trinsic activity independent of the extrinsic stimuli from the environment. The intrin-sic activity shows fluctuations in different frequency ranges ranging from infraslow to fast (000.1–60 Hz) (red lines). High and low frequency fluc-tuations are connected to each other via their phases and power (yellow lines). For instance, the phases of low frequency fluctuations align themselves to the power of higher ones resulting in phase shifting and phase-power coupling. This makes it possi-ble for the intrinsic activity to bridge the temporal gaps be-tween the neural activities at different discrete points in physical time within the brain itself. There is consequently continuity of neural activity across different time points, a neuro-temporal continuity as one may say, as constituted by the brain’s intrinsic activity itself.

1b: The brain shows in-trinsic activity independ-ent of the extrinsic stimuli from the environment. The neural activities at different regions, reflecting different discrete points in physical space, are linked and con-nected to each other via functional connectivity as il-lustrated by the red arrows. This allows to bridge the spatial gaps between the neural activities at different discrete points in physical space, i.e., regions, within the brain itself. There is consequently continuity of neural activity across differ-ent regions, a neuro-spatial

continuity as one may say, as constituted by the brain’s intrinsic activity itself.


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It is apparent, then, that there is a complex tem-poral structure and organisation to the brain’s intrin-sic activity. Most importantly, this temporal struc-ture seems to bridge the temporal gaps between different discrete points in time. By linking together neural activities at different points in time, a certain degree of temporal continuity in the brain’s intrinsic activity is constituted. Before addressing the ques-tion of how this intrinsic activity’s temporal conti-nuity is related to the above-described temporal continuity of consciousness, it is necessary to briefly explore the constitution of spatial continuity in the brain’s intrinsic activity.

Intrinsic activity and spatial continuity Resting state activity can be characterized by

both spatial and temporal dimensions. This is re-flected in functional connectivity and low frequency fluctuations (see above, as well as Raichle, 2009; Northoff, 2012a). Functional connectivity describes the linkage between the neural activities of different regions across the space of the brain (see also Fin-gelkurts et al., 2004, 2005, 2010 for a discussion of this issue), while low frequency fluctuations concern the fluctuations in neural activity across time. Most importantly, both functional connectivity and low frequency fluctuations reflect neural activity across different discrete points in time and space rather than corresponding directly to the individual points themselves.

Spatially, the brain’s intrinsic activity can be char-acterized by different neural networks such as the default-mode network (DMN), the cognitive-execu-tive network (CEN), and the salience network (SN) (see Raichle et al., 2001; Menon, 2011; Raichle, 2009). The DMN concerns mainly cortical midline regions and the bilateral posterior parietal cortex (Buckner et al., 2008; Raichle et al., 2001). These regions seem to show high resting state activity, dense functional connectivity, and strong low frequency fluctuations (0.001–0.1 Hz) in the resting state. The executive network comprises the lateral prefrontal cortex, the supragenual anterior cingulate, and posterior lateral cortical regions as core regions, as these are involved in higher-order cognitive and executive functions. Fi-nally, the salience network includes regions like the insula, the ventral striatum, and the dorsal anterior cingulate cortex, which are associated with reward, empathy, intero/exteroception and other processes involving salience (see Menon, 2011; Wiebking et al., 2011; Yan et al., 2011).

All three neural networks, the DMN, CEN, and SN, show strong intrinsic functional connectivity among

their respective regions, while the functional con-nectivity to regions extrinsic to the respective net-work are usually much weaker while in the resting state. This can change, however, during stimulus-induced activity when the relationship and thus the functional connectivity between the three networks is rebalanced (see Menon, 2011).

Most importantly, none of the neural networks acts in an isolated way during either resting state or stimulus-induced activity. Instead, all three are mu-tually dependent in their level of neural activity and intrinsic functional connectivity via their functional connectivity to extrinsic regions in the respective other networks (See Menon et al., 2011). See Figure 1b on page 8.

Taken together, this characterization of the spa-tial structure of the brain’s intrinsic activity may pro-vide a neuronal mechanism for the constitution of spatial continuity that allows transitions (or, meta-phorically speaking, glue) between different discrete points in physical space. Hence, although the exact mechanisms remain unclear, the brain’s intrinsic ac-tivity seems to constitute both spatial and temporal continuity, thereby bridging the gaps between dif-ferent discrete points in time and space.

Spatiotemporal continuity and consciousness

Spatiotemporal continuity in consciousness

Experience of contents in consciousness pre-supposes a dynamic and continuous flow of time extending from the past over the present to the fu-ture, all of which are crystallized and condensed in the present moment. This is what W. James (1890) described as ‘specious present’ or dynamic flow. The organisation of time is conceived through this no-tion as a continuum rather than as a discontinuum in consciousness. This leads to the experience of what James described as the ‘stream of consciousness’, a continuous temporal flow analogous to the flow of water in a river.

Put simply, any content we experience in con-sciousness becomes integrated and embedded within this dynamic flow of time and becomes there-by a part of the ongoing stream of consciousness. Consciousness of contents can thus be compared to a boat in a river: just as the boat could not function as a boat without the flowing water of the river, con-tents cannot become conscious without an underly-ing dynamic flow, i.e., the stream of consciousness.



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Figure 2The figure illustrates schematically the constitution of spatiotemporal continuity in consciousness (2a)

and its relation to neuronal features in the intrinsic activity (b, c).

(a) The upper part of the figure shows the oc-currence of different stimuli (vertical lines) at different discrete points in physical time and space. Middle part: Independent of the respec-tive stimuli themselves, consciousness seems to be based on the extraction of their purely spatial and temporal points linking and connecting them. A spati-otemporal grid, template, or matrix is generated thereby resulting in spatiotemporal continuity. Phenomenally, this is manifest in the oc-currence of ‘inner time and space consciousness’. Lower part: Following their occur-

rence in space and time, the different stimuli are linked to objects, events or persons which as appear as contents (upper dashed green lines) in consciousness. Most importantly, these contents are integrated and embedded into the spatiotemporal grid or continuity (lower blue dashed line) which makes possible their association with consciousness.

(b) The x-axis shows the temporal durations as experienced in ‘inner time consciousness’. While the y-axis stands for the phase durations of the strong low frequency fluctuations dominating in the intrin-sic activity. The longer the phase durations during the intrinsic activity, the longer the temporal durations subjects can experience in ‘inner time consciousness’

.The x-axis shows the temporal durations during

the experience of stimulus-related contents in con-sciousness. While the y-axis stands for the coupling

between the intrinsic activities’ low frequency phases and the stimulus-induced high frequency power. The better the low-high frequency coupling, the longer the phase durations, and the longer subjects can ex-perience the stimulus-related contents in conscious-ness.


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To put this in another perspective, the contents themselves occur at specific discrete points in physi-cal time. At most they may last for a few fleeting sec-onds, after which they are replaced by others. One element of content goes and the next one comes, each occupying its own position in time. Yet despite their occurrence at different discrete points in physi-cal time, we experience a temporal continuum, a transition, between the different contents.

This temporal continuum in consciousness does not seem to obey the laws of physical time with its discrete points. Instead, it constitutes a continuum between the different discrete points in physical time, and thus what phenomenally is described as dynamic flow (James) or ‘phenomenal time’ (E.Husserl) as distinct from physical time.

While there has been much debate about time and consciousness (see chapters 1–3 in Part I of Northoff, 2012b for details), there has been less dis-cussion about the experience of space in conscious-ness. Here an analogy may be made with time. In similar fashion, the contents of consciousness are not experienced at their respective discrete points in physical space. Instead, they are embedded and in-tegrated into a spatial continuum with multiple tran-sitions between the different points. As in the case of time, the contents are woven into a spatial grid or template that emphasizes continuity and transition over discontinuity and segregation (see chapter 4 in Part I of Northoff, 2012b for details). See Figure 2a, page 8.

Consciousness may therefore be characterized phenomenally as an underlying temporal and spatial template or grid into which the different contents are woven. This underlying spatiotemporal grid seems to provide continuity between the different discrete points in time and space at which the con-tents occur. Such spatiotemporal continuity makes it possible for us to experience the different contents in consciousness in a spatially and temporally con-tinuous and homogenous that spans across the dif-ferent discrete points in physical time and space. If, in contrast, there was no such spatiotemporal grid in our brain’s neural activity, the contents could no longer linked together spatially and temporally which would make their appearance in conscious-ness impossible.

The grid can thus be characterized by spatiotem-poral continuity in the phenomenal realm of con-sciousness, as distinct from spatiotemporal discon-tinuity in physical time and space.

Spatiotemporal continuity in intrinsic activity and consciousness

The question then arises as to how the spati-otemporal continuity of intrinsic activity in the brain relates to spatiotemporal continuity on the phe-nomenal level, i.e., in consciousness as described above. All that has been shown so far is that intrinsic activity bridges the gaps between discrete points in time and space by low frequency fluctuations and functional connectivity. What remains to be seen is how such neuronal spatiotemporal continuity of the brain’s intrinsic activity is related to the phenomenal spatiotemporal continuity of consciousness.

It is currently not known how neuronal and phe-nomenal spatiotemporal continuity are linked. Yet it is possible to suggest an example of the kind of experimental data that might shed light on such a connection, from the temporal domain. Stimulus-induced higher frequency fluctuations like gamma (30–50 Hz) are aligned and entrained to the phases of the lower ones in intrinsic activity (delta: 1–44 Hz or even infraslow: 00.1–0.1 Hz). This may integrate the stimulus and its actual discrete point in time, as signified by the gamma oscillations, into a longer temporal stretch as provided by the longer phase duration of the resting state’s ongoing low frequen-cy fluctuations. By being integrated into a longer temporal stretch, i.e., the low frequency’s phase du-ration, the stimulus’ discrete point in time is resolved into the intrinsic activity’s temporal continuum.

In this way a relationship may be established with consciousness. As described above, we experience stimuli in consciousness not at their discrete points in time but rather as part of an ongoing dynamic flow of time, as part of a temporal continuum. This temporal continuum in consciousness may now be traced back to the temporal continuum provided by the intrinsic activity and its low frequency phase du-rations.

One would consequently expect the following. First, it would be assumed that the predominant phase durations match, at least in some meas-ure, the subjectively experienced time durations of events in consciousness. For instance, an extrinsic stimulus occurring at time x may take place at the phase onset of a predominant low frequency fluc-tuation in the delta/theta range of around 5 Hz. One may now assume that the consciously perceived du-ration of the objective time x and thus the stimulus itself may be extended in sympathy with the tempo-ral duration of the respective phase. If so, the degree of temporal extension would likely be dependent on where the stimulus fell in terms of the positive or



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negative peaks and/or the falling or rising slopes of the phase.

Secondly, one would expect the degree of phase-power coupling between low and high frequency fluctuations to determine at least in part the de-gree to which a particular stimulus can enter con-sciousness. The stimulus itself may induce higher frequency fluctuations like gamma (30–50 Hz). The power of such gamma fluctuations may now need to be aligned and thus coupled to the phases of the low frequency fluctuations in, for instance, the delta range. Only in this way would the extrinsic stimu-lus gain access to the brain’s intrinsic activity and its temporal and spatial structure. One would con-sequently expect the degree of low-high frequency phase-power coupling to predict the degree of con-sciousness of a particular stimulus. See Figure 2b and c, page 8.

An analogous scenario may hold in the case of the spatial dimension. The degree of spatial continu-ity and thus the spatial distance between different neural activities in the resting state may govern how the stimulus’ discrete point in space is integrated and embedded into the spatial context. Further in-vestigation is needed, however, to more closely link neuronal and phenomenal measures of both spatial distance and temporal duration. If successful, this would lead to what may be described as a neuro-phenomenal account of consciousness (see North-off, 2012b).

The assignment of consciousness to extrinsic stimuli may thus be strongly dependent on the de-gree and nature of interaction between the extrinsic stimulus’s spatial and temporal features on the one hand, and the intrinsic resting state’s spatiotempo-ral continuity on the other. It may thus be prudent to explore the exact neural mechanisms underlying the different kinds of such rest-stimulus interaction in further detail, as, for instance, whether the process is linear or non-linear (see for example Hesselmann et al., 2009; Kleinschmidt et al., 2012; Northoff, 2012a). This, though, will be a task for the future.

For now, we aim to gather further support for the link between the intrinsic activity’s spatiotemporal structure and the experience of time and space in consciousness. I propose that such a neuro-phenom-enal link is strongly supported by the concomitant alterations in both intrinsic activity and conscious-ness in psychiatric disorders like schizophrenia and depression. This will form the focus of the following sections, albeit in a very abbreviated way.

Spatiotemporal continuity in psychiatric disorders – Schizophrenia

In order to garner further support for our as-sumption that the spatial and temporal features of the brain’s intrinsic activity are central to conscious-ness and its spatiotemporal continuity, we here turn to psychiatric disorders where abnormalities in the spatiotemporal continuity of both intrinsic activity and consciousness have been described.

Schizophrenia is a complex disorder where pa-tients suffer from hallucinations (mostly auditory), delusions, thought disorders, ego and identity disor-ders, and abnormal, mostly blunted, affect and avo-lition. Depressive patients, on the other hand, can be characterized by abnormal negative affect and mood, anxiety, sleeplessness, increased ruminations and cognition revolving around the self (‘increased self-focus’), and a lack of initiative and motivation. (Northoff 2007) There have been many studies on the subjective experience and thus the phenom-enology of, in particular, ‘inner time consciousness’ in both disorders (see Fuchs, 2011 for an excellent summary). Rather than going into detail, I briefly summarize the main points following Fuchs (2011).

Instead of providing a grid or template of spati-otemporal continuity, ‘inner time and space con-sciousness’ in schizophrenia seems to be char-acterized by spatiotemporal fragmentation and disruption. These patients no longer experience temporal continuity and thus a dynamic flow of time (and space) in their consciousness. Instead, the stream of consciousness is disrupted and blocked with the three temporal dimensions of past, present and future being disconnected from one other.

The glue between the different discrete points in physical time seems to be missing in the conscious-ness of time and space. This implies that the differ-ent contents including their distinct discrete points in physical time and space can no longer be linked to each other in the consciousness; the glue and thus the spatiotemporal continuity is lost. This is very apparent, for instance, in the following quote of a schizophrenic patient in Fuchs (2011): “When I move quickly, it is a strain on me. Things go too quickly for my mind. They get blurred and it is like being blind. It’s as if you were seeing a picture one moment and another picture the next.”

The schizophrenic patient describes here that the contents of his consciousness, the different pictures, are no longer linked together. There are no longer any transitions between the different discrete points in time and space associated with the different pic-tures. The pictures are, as it were, experienced as


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pearls without an underlying chain. Since the under-lying chain—the spatiotemporal continuity—seems to be disrupted within itself, the pearls can no longer be put together, ordered, structured and organized in consciousness.

In other words, for the schizophrenic patient, both the ‘inner time and space consciousness’ and ‘consciousness of contents’ become disordered and disorganized, leading to what may be described as spatiotemporal disruption. This leads the patient to experience the contents of consciousness in an ab-normal way as is manifested in many of the schizo-phrenic symptoms such as ego disorders, thought disorders, hallucinations and delusions.

Spatiotemporal continuity in psychiatric disorders – Depression

Depressive conditions may yield further insights. Major depressive disorder (MDD) is a severe psychi-atric disorder in which patients suffer from exces-sive ruminations, increased self-focus, anhedonia, suicidal thoughts, bodily symptoms, and sleepiness (see Northoff et al., 2011; Hassler & Northoff, 2011). The nature of ‘inner time and space consciousness’ under such conditions is informative. While schizo-phrenia can be characterized by spatiotemporal disruption, in depression the balance between past, present and future in the spatiotemporal continu-ity of consciousness seems to be abnormally shifted towards the past (see Fuchs, 2011; Northoff et al., 2011; Grimm et al., 2009, 2011).

Depressed patients experience themselves as being ‘locked into the past’, while at the same time ‘seeing and experiencing no future anymore’ (North-off 2007). This is plainly manifest in an extremely high degree of hopelessness and consequent suicid-al thoughts. Hence, unlike in schizophrenic patients, the spatiotemporal continuity is not disrupted in de-pression. Instead it is abnormally shifted towards the past at the expense of the future, something that might be characterized as spatiotemporal dys-balance.

This spatiotemporal dysbalance is not only mani-fest in the abnormally past-focused ‘inner time (and space) consciousness’ in depression. It also affects the ‘consciousness of contents’ both bodily and in terms of environment. One’s own body is experi-enced as static and powerless while environmen-tal contents are experienced as disconnected, very much like distant objects from the far past. Hence, in both schizophrenia and depression, the abnormal changes in the spatiotemporal continuity seem to affect the experience of both ‘inner time and space

consciousness’ and ‘contents of consciousness’. Of interest is how these phenomenal, i.e., subjec-

tive-experiential, abnormalities relate to the brain and its intrinsic activity. I have assumed a central role for the brain’s intrinsic activity in constituting spatiotemporal continuity in consciousness. This be-ing the case, one would expect spatial and temporal abnormalities to be present in the intrinsic activity in schizophrenia and depression. This is indeed what has been found, as I discuss here briefly.

Numerous studies have recently shown resting state abnormalities in both depression (see Alcaro et al., 2010 and Northoff et al., 2011 for review) and schizophrenia (see, for instance, Northoff & Qin, 2011 for review). Findings indicate abnormal region-al patterns of neural activity and altered functional connectivity. This suggests changes in the spatial continuity of the brain’s intrinsic activity. Especial-ly in schizophrenia, changes in gamma oscillations (and low delta oscillations) have been reported (see, for instance, Jarvitt et al., 2011), indicating abnormal temporal continuity in the brain’s intrinsic activity.

Much, though, remains unclear at this point. First, the exact nature of these spatial and tempo-ral resting state abnormalities remains to be estab-lished. Secondly, their link to the above-described phenomenal abnormalities in the consciousness of time and space in these patients is not at all clear at this time.

The extrinsic stimuli may encounter an already altered temporal and spatial continuity when inter-acting with the brain’s intrinsic activity. The latter’s spatial and temporal abnormalities may be imposed upon the extrinsic stimuli, which are then experi-enced in abnormal spatial and temporal ways in con-sciousness. This in turn may account for some of the characteristically difficult symptoms of sufferers of schizophrenia and depression, symptoms that could ultimately be described as abnormal spatiotemporal constellations between intrinsic activity and extrin-sic stimuli—in short, abnormal rest-stimulus inter-action. However, as in the case of healthy subjects, much work remains to be done to establish direct links between the neuronal and phenomenal levels in these patients.

Conclusion: From Kant over the Brain to Psychiatric Disorders

I have here presented an initial outline of how the philosophy of Immanuel Kant and his concept of mind can be applied to the brain, thereby illumi-nating something of the nature of the abnormalities in psychiatric disorders. Kant suggests an intrinsic-



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extrinsic interaction model where the mind provides an active intrinsic input to the processing of extrinsic stimuli. This was put into the context of the brain, an idea which finds empirical support in recent observa-tions of the brain’s intrinsic activity—its resting state activity. Psychiatric disorders like schizophrenia and depression indeed show major abnormalities in rest-ing state activity, although the implications of this for the consciousness and symptoms of patients re-main unclear.

It is precisely at this juncture in research where Kant and his model of the mind’s input may prove helpful when applied to the brain. The brain’s intrin-sic activity may in itself provide some kind of spa-tiotemporal structure, a spatiotemporal continuity of its neural activity into which extrinsic stimuli are integrated. Such spatiotemporal continuity of the brain’s neural activity may on the phenomenal level of consciousness be manifest in the subjective expe-rience of a dynamic flow or stream of consciousness of time and space across different discrete points in physical time and space.

If so, one would expect that disruptions in the resting state activity would lead to abnormal chang-es in subjective time and space experience. Such is what we observe in psychiatric disorders. According-ly, Kant may have a role to play in helping us under-stand the implications of the brain’s neural resting state abnormalities for the subjective experience, and thus consciousness, in patients with psychiatric disorders.

Acknowledgments: I am thankful to David Hayes, Niall Duncan, and Ziri Huang who comment-ed in a very helpful way on prior versions of this pa-per. I am also grateful to the CIHR, the ISAN-HDRF, the CIHR-EJLB, and the Michael Smith Foundation for their generous financial support.

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