Student writer competition winners 2008

Consciousness and the curriculum

Anne Cannon, winner in the undergraduate category, asks why consciousness plays such a limited role in psychology degree courses

Daniel Dennett has described human consciousness as: 'just about the last surviving mystery' (Dennett, 1991). It is an area which is fundamentally important for cognitive science, philosophy, psychology and neuroscience. Eminent contemporary researchers working in the field include Vilayanur Ramachandran, Bernard Baars, Francis Crick, Kevin O'Regan, Susan Greenfield and Roger Penrose. So why does this major topic play such a minimal role in the curriculum of undergraduate psychology degrees?
Consciousness is not an easily tractable problem. David Chalmers has said:
Consciousness poses the most baffling problems in the science of the mind. There is nothing that we know more intimately than conscious experience, but there is nothing that is harder to explain. (Chalmers, 1995, p.200).

In Susan Blackmore's excellent 2003 book on consciousness, aimed at undergraduates, she describes the 'welcome complexity' of consciousness studies. She cites Thomas Nagel's 1986 book The View from Nowhere: 'Certain forms of perplexity – for example about freedom, knowledge, and the meaning of life – seem to me to embody more insight than any of the supposed solutions to those problems'.

So consciousness is a difficult topic without definite answers; but is not this all the more reason to study it? Consciousness is rarely covered in depth by psychology undergraduate degrees. Over my three years at university, I only received one hour-long seminar on consciousness. With the recent push towards degrees which train students for real-world careers, the theoretical study of consciousness has been side-lined.

Many professional psychologists also postpone questions of consciousness. They restrict their attention to the peripheral systems of the brain, which are assumed to service some kind of 'centre' where conscious experience takes place. These assumptions are found particularly in perceptual research, which often busies itself with the details of how the brain represents the outside world, without addressing the notion of for whom the world is supposedly being represented.

The problem of viewing the mind as some kind of private internal theatre is that there is no evidence for a place or time in the brain where everything comes together and consciousness occurs. Cognitive psychologists often refer to things 'entering consciousness', as though it were a fixed place in the brain, outside of which we are unconscious. Dennett called this view the 'Cartesian theatre', because of its dualist implication of a homunculus sitting in the centre of the brain, watching consciousness acted out in front of him. The 'homunculus fallacy' arguably suggests that either representationalism is an incomplete or invalid description of perception, or that some supernatural intervention or non-materialist explanation is needed. Gibert Ryle (1949) called this 'the dogma of the ghost in the machine' (also called the intellectualist legend) and argued that it resulted in an infinite regress of thought:

According to the legend, whenever an agent does anything intelligently, his act is preceded and steered by another internal act of considering a regulative proposition appropriate to his practical problem… Must we then say that for the hero's reflections how to act to be intelligent he must first reflect how best to reflect how to act? (Ryle, 1949, p.27).

Dissatisfaction with the homunculus fallacy has led the perceptual researchers O'Regan and Nöe (2001) to look for a new way of thinking about perception. They have developed a new approach, which they call enactive vision. This radical theory aims to bridge or remove the 'explanatory gap' between mechanical processes in the brain and the phenomenology of human experience.

The key idea of enactive vision is that perceiving is a way of acting in the world: 'Vision is a mode of exploration of the world that is mediated by knowledge of what we call sensorimotor contingencies' (O'Regan & Nöe, 2001, p.940). They do not deny that visual experience depends upon what takes place in the brain, or that there are cortical areas where visual information may be retinotopically organised. However, they make the important distinction that: 'the presence of these maps and the retinotopic nature of their organisation cannot in itself explain the metric quality of visual phenomenology' (O'Regan & Nöe, 2001, p.939).

O'Regan and Nöe reject recently proposed theories of consciousness such as Crick and Koch's (1990) coherent oscillations theory or Penrose's (1994) theory of quantum processes in microtubules. The problem with these theories, according to O'Regan and Nöe, is that they do not address the mystery of how any such processes might elicit what we experience as visual consciousness. O'Regan and Nöe claim that there is no a priori reason why particular neural processes (be they oscillations or microtubules) should give rise to visual experience.

O'Regan and Nöe's theory is a fantastic example of how questioning consciousness can affect psychological theory and research. For example, they apply their theory to the classic problem of the apparent stability of the visual world. The fact that eye movements causing shift and smear on the retina does not affect our perception of a stable visual world has long puzzled psychologists (e.g. Grüsser, 1986).

Traditionally, visual experience has been explained in terms of a series of snapshots building up an internal model or picture of the world. Where to place each snapshot is assumed to be determined by 'extraretinal information' which tells us the direction the eyes are pointing at any moment. However, research has shown that extraretinal information is too inaccurate to be used under normal viewing conditions (Matin, 1986). In the context of sensorimotor contingency theory, the feeling of seeing a stationary object consists in the knowledge that if you were to move your eyes slightly to the right, the object would shift the other way on the retina. There is no need for an internal image:
If there is such a thing as an internal signal in the brain that signals the eye's instantaneous position, then its purpose could not be to construct an internal image (for there would be no one to look at it) (O'Regan & Nöe, 2001, p.949)

For researchers who believe in an internal image made up of snapshots, a complicated process has been assumed to account for the absence of saccadic smearing. This process would involve suppressing the transfer of visual information to awareness during each eye saccade. O'Regan and Nöe argue that if this were true, we would perceive a 'dimming' of the world during saccades. This would then require a further 'un-dimming' mechanism to compensate, which does not seem to be the simplest or most likely solution to the problem. Within sensorimotor contingency theory, saccadic smearing actually constitutes part of what it is to see.

In a similar vein is the apparent 'filling in' of the blindspot on the retina (where the optic nerve joins the eye). Whilst constructivists such as Richard Gregory believe the brain fills in the blindspot, O'Regan and Nöe ask for whom the blindspot is being filled in? They describe the blindspot as part of what it
is to see:
…if retinal information were not to change dramatically when an object falls into the blind-spot, then the brain would have to assume the object was not being seen, but was being hallucinated. (O'Regan & Nöe, 2001, p.951)

Thus rather than solving the problem of a stable visual world, they re-work it as a non-problem.

Research in other areas of psychology is similarly affected by ideas about consciousness. For example: emotion and motivation, memory, self-concept, imagination, insight, brain damage, sleep and dreaming. Ideas about consciousness could impact upon clinical psychology, for example, in terms of how a clinician interprets self-reported mental events. Biopsychologists may also benefit from knowledge of consciousness issues, particularly in terms of the 'mind-body links' studied in pychoneuroendocrinology. It could be argued that, with limited space on the curriculum, it isn't worth studying such a highly theoretical topic. However, as Kurt Lewin said, there is nothing so practical as a good theory. The way in which we interpret consciousness can have important implications for psychological research.

In addition, to be able to critically evaluate the numerous models generated by psychologists, it is essential that we understand the theoretical assumptions inherent in the work. As scientists, it is important to be constantly aware of all our assumptions lest we disappear down a 'blind alley' with our research. Such awareness may highlight the strengths and limitations of psychological models. Consciousness studies are still in their infancy. Dennett commented that, unlike most other areas of science, we have not even developed the language to talk about consciousness. There are real advances still to be made in this area. Students need to be provided with a philosophical grounding and terminology with which to discuss the area. Through debate and discussion, new terms may emerge that help to push the area forward.

Social constructionists argue that language is not simply a mirror of reality but rather a tool which has the power to structure social reality. Once a term becomes accepted in common use, it influences how we perceive the world. Consequently, in communicating with others and in generating ideas, the terms available to us constrain what we say and what we know.

Hare-Mustin and Maracek (1997) apply this to the domain of clinical or abnormal psychology: How people talk about their experience determines what their experience is. Thus, a diagnostic label, such as 'neurotic', has a profound influence on what we think of people so labelled and how they think about themselves. (p.105)

Thus, new terminology in the domain of conscious experience could open up new ways of talking about and understanding psychological processes and disorders.

An awareness of consciousness debates would encourage future researchers to look carefully at the theoretical bias underlying their work. As potential psychologists of the future, we need to critically engage with everything we learn: 'Learning without thought is labour lost' (Confucius, c.551–479bc).
I would like to see consciousness tackled head-on in psychology degrees, rather than dimly alluded to in passing. Consciousness is a multidisciplinary subject which would broaden students' horizons, opening them up to important strands of research from neuroscience, artificial intelligence and critical psychology. More importantly, it is an exciting area of research, worth studying both for its theoretical interest and its real-world applications.

Judges' report

This was the 10th annual Student Writer Competition of The Psychologist. Like last year the number of entries was disappointing, but again we have ended up with two excellent contributions. Articles were rated blind on quality of writing; clarity of argument; and accessibility, relevance and interest for The Psychologist's audience. We thought that both winners presented clear arguments that were likely to engage our wide-ranging audience.

The winners get an expenses-paid trip to the Society's London Lectures or Annual Conference. We look forward to all your entries next year.
Jon Sutton (Editor, The Psychologist)
Paul Redford (Chair, Psychologist Policy Committee)

References

Blackmore, S. (2003). Consciousness: An introduction. Hodder & Stoughton.
Chalmers, D.J. (1995). Facing up to the problem of consciousness. Journal of Consciousness Studies, 3(1), 200–219.
Crick, F. & Koch, C. (1990). Towards a neurobiological understanding of consciousness. Seminars in the Neurosciences, 2, 263–275.
Dennett, D.C. (1991). Consciousness explained. London: Penguin.
Grüsser, O.J. (1986). Interaction of efferent and afferent signals in visual perception. Acta Psychologica, 63, 3–21.
Hare-Mustin, R. & Maracek, J. (1997). Abnormal and Clinical Psychology; The politics of Madness. In D. Fox & I. Prilleltensky (Eds.) Critical psychology: An introduction. London: Sage.
Matin, L. (1986). Visual localization and eye movements. In K.R. Boff, L. Kaufman & J.P. Thomas (Eds.) Handbook of perception and human performance. New York: Wiley.
O'Regan, J.K. & Nöe, A. (2001). A Sensorimotor account of vision and visual consciousness. Behavioural and Brain Sciences, 24, 939–1031.
Penrose, R. (1994). Shadows of the mind. Oxford: Oxford University Press.
Ryle, G. (1949). The concept of mind. Chicago: University of Chicago Press.

Prevention – psychology's forgotten mission?

Makala Ball's winning entry in the postgraduate category of our competition

The doctor of the future will give no medicine but will interest her or his patients in the care of the human frame, in a proper diet, and in the cause and prevention of disease.
Thomas A. Edison (1847–1931)

Imagine for a moment the following scene. It is 9:00 on a Monday morning, and a group of schoolchildren are sitting in class, waiting to be inoculated. However, they are not going to be given a vaccination to protect them from tetanus or polio. They are starting a preventive mental health programme to inoculate them against depression.

Does this idea seem unusual? Most people would not think twice about going to their GP for inoculations against physical health conditions. Does it seem unnecessary? The Layard Report (2005) suggests the economic cost of mental illness – through unemployment, sick leave and provision of services and carers – is around £25 billion. Arguably, a failure to identify symptoms of mental ill health and stigma are two of the biggest barriers that prevent individuals seeking help. Both of these could be addressed by such programmes, which have the potential to prevent the onset of mental health problems with unimaginable emotional and economic benefits for individuals and service providers, respectively.

Few can doubt that the money spent on establishing primary care mental health services and the further £170 million to be spent on the Improving Access to Psychological Therapies (IAPT) agenda is money well spent. However, in a climate where nearly a third of NHS bodies are in poor financial health (Audit Commission, 2007) it is obvious that the rapid expansion of mental health services to meet the growing needs of our population is not realistic or sustainable. As with physical health problems, prevention is better (and cheaper) than cure.

One suggested definition of preventive mental health is that prevention programmes are interventions that anticipate a disorder, or promote optimal health prior to the onset of a disorder (Goldston, 1977). The majority of programmes to date have been based upon cognitive behavioural therapy principles, and can be broadly categorised into three types:
Universal – Applied to whole populations, irrespective of whether they are perceived to be at risk of developing psychological problems;
Selective – Applied to individuals perceived to be at risk of developing psychological problems, e.g. due to bereavement, children of adults with depression;
Indicated – Applied to individuals who already experience mild to moderate symptoms who are perceived to be at high risk of future problems.

Preventive mental health applied to depression

How effective is prevention practice? Let's look at the example of depression – projected to be the second-highest cause of disability by 2020 (Murray & Lopez, 1997). There are some promising and exciting findings in this area. Cardemil and Barber (2001) report outcome data for five selective depression prevention programmes for adults, all of which reported fewer depressive symptoms at follow-ups ranging from six months to four years. A recent meta-analysis of targeted psychological interventions aimed at preventing depression in children and adolescents revealed that 'while small effect sizes were reported, these were associated with a significant reduction in depressive episodes' (Merry et al., 2003). The authors concluded that the results of their review were encouraging, but noted difficulties in poor methodologies with many studies.

Two more recent school-based universal depression prevention programmes that employed a more robust methodology revealed significant reductions in depressive symptoms immediately and at follow-up (Merry et al., 2004; Possel et al., 2004). Whilst some studies have queried whether universal or targeted prevention programmes are more effective, a recent evaluation found no significant differences between approaches, with all high-symptom students showing a significant decline in depressive symptoms (Sheffield et al., 2006).

Depression is just one mental health problem that has been targeted by prevention programmes, in addition to substance misuse, anxiety and suicide (for reviews see Feldner & Zvolensky, 2004; Foxcroft et al., 2003; Goldney, 1998; Goldney, 2005; Hall & Zigler, 1997; Neil & Christensen, 2007). Whilst many of these reviews highlight issues such as poor study design, nearly all support the promise of preventive practice and encourage further research.

The development of preventive approaches

Preventive practice is not a new concept. In 1908, Clifford Beers published his gripping account of the three years he spent in an asylum after suffering a breakdown and became an instrumental figure in advancing the mental hygiene movement. Despite the early awareness and attention around mental hygiene approaches, over a century later the primary focus of mental health services is still on treating symptoms rather than prevention.

In recent years, mental health professionals have witnessed a growth in the number of specialised mental health teams, in terms of age (e.g. child, adult, older adult), condition (e.g. early intervention in psychosis, drug and alcohol), and severity/complexity (e.g. crisis resolution, complex needs, assertive outreach). It has also been argued that there should be widespread introduction of a new intermediate care team that would cater for people who are do not meet eligibility criteria for primary care mental health services or community mental health teams (Sainsbury Centre for Mental Health, 2005). In contrast there are currently few, if any, NHS mental health teams that are established purely with the purpose of preventing mental health problems in adulthood.

It has been argued that there is an increasing emphasis placed on the prevention of mental health problems as a priority for psychologists (Seligman, 1998). It is of interest, therefore, to consider why psychologists are not more involved in preventive practice and research, and what the barriers might be.

Barriers to the practice of preventive mental health

One potential barrier to the involvement of psychologists in preventive practice may stem from confusion over where the responsibility for this type of work lies. This confusion has many facets, both interdisciplinary and intradisciplinary. Preventive programmes have been targeted at school-age children, university students and adults, some of whom are displaying subclinical symptoms, others that are more severe. Who is best placed to offer these interventions? Educational, clinical or health psychologists? What about school nurses? Counsellors? Community psychiatric nurses? Preventive work is often perceived as falling under the umbrella of mental health promotion, which is a responsibility of all mental health professionals, but not a core responsibility of any one professional. Perhaps we are all guilty of a 'bystander effect', whereby many of us assume someone else is better placed to carry out preventive programmes, and consequently we all do little.  

Another potential barrier is knowing who to target. Universal, selective and indicated populations are one possibility, yet each raises unique issues. With universal designs there are numerous options for selection of a target population, e.g. an educational institution, or workplace. Similarly with selective populations there is massive scope for choosing an 'at risk' group. Often the decision of who to target may be limited by resources and time, especially when conducting a programme in large institutions.

Issues of time and resources are a key barrier. The New Ways of Working for Applied Psychologists (NWWAP) and IAPT agenda have important implications for the priorities of psychologists that may not necessarily include preventive practice. Securing funding and resources may be affected by the target population and by which professionals are delivering the programmes. Time and resources may also be affected by the unique nature of preventive work, especially universal approaches, where there are an infinite number of potential recipients.

However, surely the most important barrier to preventive mental health practice is the willingness and enthusiasm of the professionals. If we are not excited and passionate about the promise that this area holds, the impetus for further research and programmes will wither. In the media today we are frequently faced with images of global warming, endangered species and childhood obesity. All are examples of the consequences of when prevention comes too late, and the costs are unimaginable. By collaborative and innovative working, psychologists can play an important role in ensuring that mental health does not frequent the media for all the wrong reasons.

The doctors of the future

The evidence base suggests that preventive work holds the potential to prevent the unnecessary suffering of masses of individuals, and there are exciting opportunities for psychologists to contribute to this dynamic area of psychology. It also poses many unique and challenging barriers. Abraham and Michie (2005) draw attention to the issue of personal responsibility of individuals in preventive health behaviour. Perhaps the idea of preventive mental health should mimic traditional inoculation approaches, where for the most part the individual decides if and when they wish to be vaccinated after being given information about the associated costs and benefits. This may seem radical, but in fact is not dissimilar from what Thomas Edison suggested approximately a century ago. And thus, we have come full circle…

References

Abraham, C. & Michie, S. (2005). Towards a healthier nation. The Psychologist, 18, 670–671.
Audit Commission (2007). Review  of the NHS financial year 2006/07.
Cardemil, E. & Barber, J. (2001). Building a model for prevention practice: Depression as an example. Professional Psychology: Research and practice, 32, 392–401.
Feldner, M. & Zvolensky, M. (2004). Prevention of anxiety psychopathology: A critical review of the empirical literature. Clinical Psychology: Science and Practice, 11, 405–424.
Foxcroft, D., Ireland, D., Lister-Sharp, et al. (2003). Longer-term primary prevention for alcohol misuse in young people: a systematic review. Addiction, 98, 397–411.
Goldney, R. (1998). Suicide prevention is possible: A review of recent studies. Archives of Suicide Research, 4(4), 329–339.
Goldney, R. (2005). Suicide prevention: A pragmatic review of recent studies. Crisis, 26(3), 128–140.
Goldston, S. (1977). Defining primary prevention. In G. Albee & J. Joffe (Eds.) Primary prevention of psychopathology (pp.18–23). Hanover, NH: University Press of New England.
Hall, N. & Zigler, E. (1997). Drug-abuse prevention efforts for young children: A review and critique of existing programs. American Journal of Orthopsychiatry, 67(1), 134–143.
Layard, R. (2005). Mental health: Britain's biggest social problem? http://cep.lse.ac.uk/textonly/research/mentalhealth/RL414d.pdf
Merry, S., McDowell, H., Hetrick, S. et al. (2003). Psychological and/or educational interventions for the prevention of depression in children and adolescents. Oxford: Cochrane Library.
Merry, S., McDowell, H., Wild, C., et al. (2004). A randomized placebo-controlled trial of a school based depression prevention program. Journal of the American Academy of Child and Adolescent Psychiatry, 43, 538–547.
Murray, C. & Lopez, A. (1997). Global mortality, disability, and the contribution of risk factors: Global Burden of Disease Study. The Lancet, 349(9063), 1436–1442.
Neil, A. & Christensen, H. (2007). Australian school-based prevention and early intervention programs for anxiety and depression: A systematic review. Medical Journal of Australia, 186(6), 305–308.
Possel, P., Horn, A., Groen, G. & Hautzinger, M. (2004). School-based prevention of depressive symptoms in adolescents: A 6-month follow-up. Journal of the American Academy of Child & Adolescent Psychiatry, 43, 1003–1010.
Sainsbury Centre for Mental Health. (2005). The neglected majority:  Developing intermediate mental health care in primary care. London: SCMH.
Seligman, M. (1998). President's column: Building human strength: Psychology's forgotten mission. American Psychological Association Monitor, 29, 2.
Sheffield, J., Spence, S., Rapee, R. et al. (2006). Evaluation of universal, indicated, and combined cognitive-behavioural approaches to the prevention of depression among adolescents. Journal of Consulting and Clinical Psychology, 74(1), 66–7