Many of the communications commonly encountered in anaesthetic practice elicit subconscious responses, and, because this is so, they frequently go unrecognized. This form of communication involves verbal and non-verbal cues also known as suggestions that can elicit automatic changes in perception or behaviour. Much of this chapter is based on language structures that are thought to make subconscious changes in perception, mood or behaviour more likely, both with patients and anaesthetists themselves. Recognizing subconscious responses will facilitate communication. As is discussed later, anaesthetists can communicate with patients and colleagues in ways that utilize subconscious functioning. To all intents and purposes this looks like intuitive communication, when in reality it has structure and therefore can be learned and taught. The conscious and unconscious states are familiar to all anaesthetists. However, it is frequently unappreciated that all patients, whether in an unconscious or conscious state, will also be functioning subconsciously. In the unconscious patient it is well recognized that subconscious activities still occur—for example, in implicit awareness. Most people would appreciate that there are times during consciousness when they switch off the ‘logical brain’ and enter ‘daydream’-type thinking or they ‘tune out’. People including anaesthetists tend to function subconsciously most of the time—for example, during routine activities such as driving home on ‘autopilot’ and arriving home without realizing it consciously. The ability we all have to function automatically—that is, subconsciously—frees up the conscious part of the mind to focus on other things such as planning tomorrow’s ‘neuro’ case. The teleological basis for this ability lies in being able to filter the massive amount of information continuously presented to the individual. This allows the conscious mind to focus on what it perceives to be important—facilitating learning, logical thinking and problem solving. During activities where logical thinking is not a requirement, the subconscious comes to the fore. This is characterized by dissociation from the external environment—being ‘in your own world’. Paradoxically, at times of extreme stress, the subconscious tends to take over when the conscious part of the mind becomes so overwhelmed by external inputs it ceases to function logically.
The mind beyond the head: Two arguments in favour of embedded cognition
