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What do we mean by
“conscious” and “aware”?
a
Adam Zeman
a
Peninsula Medical School, Exeter, UK
Published online: 24 Feb 2007.

To cite this article: Adam Zeman (2006) What do we mean by “conscious” and
“aware”?, Neuropsychological Rehabilitation: An International Journal, 16:4, 356-376,
DOI: 10.1080/09602010500484581

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 NEUROPSYCHOLOGICAL REHABILITATION
2006, 16 (4), 356– 376

What do we mean by “conscious” and “aware”?

Adam Zeman
Peninsula Medical School, Exeter, UK
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The concepts of consciousness and awareness are multifaceted, and steeped in

cultural and intellectual history. This paper explores their complexities by way
of a series of contrasts: (1) states of consciousness, such as wakefulness and
sleep are contrasted with awareness, a term that picks out the contents of con-
sciousness: these range across all our psychological capacities; the scientific
background of the two concepts is briefly outlined; (2) consciousness is con-
trasted to self-consciousness, itself a complex term embracing self-detection,
self-monitoring, self-recognition, theory of mind and self-knowledge; (3)
“narrow” and “broad” senses of consciousness are contrasted, the former
requiring mature human awareness capable of guiding action and self-report,
the latter involving the much broader capacity to acquire and exploit knowl-
edge; (4) an “inner” conception of consciousness, by which awareness is essen-
tially private and beyond the reach of scientific scrutiny, is contrasted with an
“outer” conception which allows that consciousness is intrinsically linked with
capacities for intelligent behaviour; (5) finally “easy” and “hard” questions of
consciousness are distinguished, the former involving the underlying neuro-
biology of wakefulness and awareness, the latter the allegedly more mysterious
process by which biological processes generate experience: Whether this final
distinction is valid is a focus of current debate. Varied interests converge on the
study of consciousness from the sciences and the humanities, creating scope for
interdisciplinary misunderstandings, but also for a fruitful dialogue. Health
professionals treating disorders of consciousness should be aware both of its

Correspondence should be addressed to: Adam Zeman, Professor of Cognitive and Beha-
vioural Neurology, Peninsula Medical School, Mardon Neurorehabilitation Unit, Wonford
Road, Exeter EX2 4UD, UK. E-mail: [email protected]
This paper has been adapted, in part, from “What in the world is consciousness?”, in press in
Altered States of Consciousness (Progress in Brain Research), edited by Steven Laureys
(Elsevier), 2005; “Consciousness”, in Psychogenic Movement Disorders, edited by Mark
Hallett (Lipincott, Williams and Wilkins), 2006, and “Theories of Visual Awareness”, in The
Roots of Visual Awareness, edited by C. A. Heywood, A. D. Milner, and C. Blakemore,
Progress in Brain Research, Vol. 144 (Elsevier), 2004.

# 2006 Psychology Press Ltd

http://www.psypress.com/neurorehab DOI:10.1080/09602010500484581
 WHAT DO WE MEAN BY “CONSCIOUS” AND “AWARE”? 357

scientific complexities and of its broad cultural background, which influences

the public understanding of these conditions.

INTRODUCTION
Impairment of consciousness is a ubiquitous problem in medicine generally,
and especially so in neurology and neurosurgery which focus on the function-
ing of the chief organ of awareness, the brain. In our everyday practice we
routinely categorise states of consciousness, like sleep and coma, and we
readily quantify its levels, with tools like the Glasgow Coma Scale (Teasdale
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& Jennett, 1974) and the Wessex Head Injury Matrix (WHIM) (Shiel et al.,
2000); our clinical efforts are often directed toward restoring it, where it
has been abolished by injury or disease, and to removing it, for example in
anaesthesia and the treatment of insomnia, where it is an impediment to treat-
ment or an unwanted gift. We are, in other words, experts in the assessment
and manipulation of consciousness: but what, precisely, is the function we are
observing and treating? Is it a straightforward physiological process like
digestion, a behavioural output, like dancing a waltz, or an essentially
private, scientifically inaccessible, subjective event?
Consciousness is not alone, among psychological concepts, in calling
simultaneously for biological, behavioural and first-person styles of explora-
tion. But this requirement seems to be particularly acute in the case of
consciousness: this concept, above all others, focuses our attention on the
divide between body and mind, the tension between the objective and the sub-
jective realms, analysis by science and synthesis through experience. This is
what makes the study of consciousness both so attractive and so difficult.
Janus-faced, it looks out on one side towards the sciences of the human
body and human behaviour, on the other towards our subjectivity and an
ancient set of beliefs about what constitutes personhood. In understanding
consciousness we may hope to make sense of a web of interconnected
ideas, like the self, the soul and the will. Naturally, many of us have strong
background assumptions about the nature of these, which science may be
hard-pressed to accommodate fully.
We recently probed these assumptions in a survey of 250 undergraduates at
the University of Edinburgh, sampling their views on the relationship of mind
to brain (see Figure 1; Liew, Sharpe, Zeman: data submitted for publication).
The results are a reminder that consciousness and its associated terms are by
no means straightforward terms of science: both consciousness researchers
and the wider educated public inherit a vocabulary of terms which are
steeped in religious, philosophical and cultural history. This makes it worth-
while to spend a little time at the outset reminding ourselves of the complex-
ities of the concepts of consciousness and awareness. I shall approach these
 358 ZEMAN
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Figure 1. The results of a survey of 250 students from several disciplines at the University of
Edinburgh on attitudes to mind and brain (Liew, Zeman et al., data submitted for publication).

complexities by way of a series of contrasts designed to highlight the ambi-

guities which are in play.
I should clarify one potential source of confusion at the outset. “Conscious-
ness” and “awareness” are often used interchangeably in colloquial and
medical contexts alike, and by and large I shall do so here. The one exception
is outlined in the next section, when “awareness” is used to pick out a particu-
lar sense of consciousness.

WAKEFULNESS VERSUS AWARENESS

Consciousness has two key senses in colloquial English which I shall pick out
with the terms wakefulness and awareness (Zeman, 2001, 2003). Wakeful-
ness is a state of consciousness, distinguished from such other states as
sleep and coma. These states have degrees: We can be wide awake or half
awake, just as we can be lightly or deeply anaesthetised. We are normally
confident of our ability to judge an individual’s state of consciousness, in
this first sense, with the help of objective criteria, like those of the
Glasgow Coma Scale: Having one’s eyes open is generally an indication of
wakefulness, being able to converse pretty much settles the matter.
We usually assume that anyone who is awake will also be aware—in other
words, not merely conscious but conscious of something. Objective criteria
are still helpful in ascertaining the presence of consciousness in this second
 WHAT DO WE MEAN BY “CONSCIOUS” AND “AWARE”? 359

sense—anyone who can obey your instructions and tell you the date is pre-
sumably aware—but it has a much stronger connotation of subjectivity
than the first sense: As we all know, it is often hard to be sure about what
is passing through another’s mind on the basis of their behaviour.
The general properties of awareness—the contents of consciousness—have
been much discussed. There is a consensus about the following properties: The
contents of consciousness are relatively stable for short periods of a few
hundred milliseconds, but characteristically changeful over longer ones; they
have a narrow focus at a given moment, but over time our awareness can
range across the spectrum of our psychological capacities, allowing us to be
aware of sensations, percepts, thoughts, memories, emotions, desires and inten-
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tions (our current awareness often combines elements from several of these
psychological domains); our awareness is personal, allowing us a distinctive,
limited perspective on the world; it is fundamental to the value we place on
our lives—keeping people alive once their capacity for awareness has been
permanently extinguished is widely regarded as a wasted effort (Jennett, 2005).
The relationships between wakefulness, awareness and their behavioural
indices are more involved than they appear at first sight (see Figure 2). As a
rule, while we are awake we are aware. But the phenomena of wakefulness
and awareness do not always run in parallel. The vegetative state, which
results from profound damage to the cerebral hemispheres and thalami, with
relative preservation of the brainstem, is a state of “wakefulness without aware-
ness”. Conversely, when we dream, we are asleep yet aware. Nor can we always
rely on behavioural criteria to diagnose consciousness: Patients paralysed for
surgery may be fully aware—if the anaesthetic drug has failed to reach
them—but completely unable to manifest their awareness; patients “locked
in” by a brainstem stroke may appear unconscious until someone recognises
their ability to communicate by movements of their eyes or eyelids.

THE SCIENCE OF WAKEFULNESS AND AWARENESS

Much of contemporary neuroscience, especially cognitive neuroscience, is
relevant to these two key senses of consciousness. In this section I shall
give a brief, partly historical, sketch of the key findings as a primer for
readers who are unfamiliar with this terrain.
Physiological, anatomical and pharmacological advances over the past
century have greatly enlarged the scientific understanding of wakefulness,
sleep and pathologically altered states of consciousness. In 1929 Hans
Berger demonstrated that it was possible to record the brain’s electrical
activity from the scalp. This provided a tool—the electroencephalogram
(EEG)—with which to track the concerted shifts in cerebral activity which
accompany changes in conscious state (Berger, 1929). Berger and others
 360 ZEMAN
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Figure 2. Inter-relationships between arousal and awareness. See text for explanation. “Zombies”
are theoretical beings discussed by philosophers who display the signs of consciousness, yet lack
experience. The plausibility of such beings is controversial.

soon described the fundamental rhythms of the EEG (see Figure 3): beta,
at .13 Hz, which accompanies mental effort; alpha, at 8 –13 Hz, the signa-
ture of relaxed wakefulness; theta (4–7 Hz) and delta (,4 Hz) which predo-
minate in deep sleep.
In the 1950s Kleitman and his co-workers in Chicago discovered that sleep
itself has an internal architecture (Aserinsky & Kleitman, 1955; Dement &
Kleitman, 1957). Over the first hour of sleep, the sleeper descends through
a series of deepening stages into stage III and IV sleep in which slow
waves predominate (slow wave sleep, SWS, known as non-REM, NREM,
sleep), only to ascend back through these stages into a state resembling wake-
fulness in its EEG appearance, accompanied by rapid eye movements, pro-
found muscular atonia, autonomic arousal and vivid mentation—
dreaming, paradoxical or rapid eye movement sleep (REM) (see Figure 4).
This cycle repeats itself four or five times in the course of the night, with
decreasing amounts of SWS and increasing amounts of REM as the night pro-
ceeds. Recent work on the brain’s electrical rhythms has highlighted the
potential importance of rapid, widely synchronised, high frequency gamma
oscillations (25–100 Hz) in wakefulness and REM (Llinas & Ribary,
1993), although their true significance is not yet clear.
 WHAT DO WE MEAN BY “CONSCIOUS” AND “AWARE”? 361
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Figure 3. The rhythms of the EEG: Records from diagnostic encephalograms performed in four
different patients, exemplifying beta rhythm (.14 Hz); alpha rhythm (8–13 Hz); theta rhythm
(4–7 Hz); delta rhythm (4 Hz). In each case the dotted line bisects a 2-second sample.

The anatomical and pharmacological mechanisms which control these

cycling states have also been clarified over the past hundred years. Moruzzi
and Magoun’s proposal that the brainstem and thalamus are home to an “acti-
vating system” which maintains arousal in the hemispheres has stood the test
of time (Moruzzi & Magoun, 1949). However, the notion of a monolithic
system has given way to a pharmacologically complex picture of multiple
interacting activating systems innervating the cerebral hemispheres widely
from the brainstem and diencephalon (Robbins & Everitt, 1995) (see
Figure 5). These systems are defined by their neurotransmitters, which

Figure 4. The architecture of sleep: An example of sleep staging over the course of a single night.
The sleeper passes from wakefulness to deep sleep and then ascends to REM sleep (dark bars).
Five similar cycles occur in the course of the night. The EEG tracings to the left show the EEG
appearances associated with the stages of sleep; the EEG in REM resembles the “awake” trace.
 362
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Figure 5. The pharmacology of the brainstem activating systems. A: the origin and distribution of the central noradrenergic pathways in the rat brain;
B: dopaminergic pathways; C: the cholinergic pathways; D: the serotonergic pathways. CTT ¼ central tegmental tract; dltn ¼ dorsolateral tegmental
nucleus; DNAB ¼ dorsal noradrenergic ascending bundle; DR ¼ dorsal raphe; DS ¼ dorsal striatum; HDBB ¼ horizontal limb nucleus of the diagonal band
of Broca; Icj ¼ islands of Calleja; IP ¼ interpeduncular nucleus; LC ¼ locus ceruleus; MFB ¼ medial forebrain bundle; MS ¼ medial septum;
NBM ¼ nucleus basalis magnocellularis (Meynert in primates); OT ¼ olfactory tubercle; PFC ¼ prefrontal cortex; SN ¼ substantia nigra; tpp ¼ tegmental
pedunculopontine nucleus; VDBB ¼ vertical limb nucleus of the diagonal band of Broca; VNAB ¼ ventral noradrenergic ascending bundle; VS ¼ ventral
striatum (Robbins & Everitt, 1995).
 WHAT DO WE MEAN BY “CONSCIOUS” AND “AWARE”? 363

include acetylcholine, serotonin, noradrenaline, dopamine, histamine, hypo-

cretin and glutamate. The normal succession of conscious states is regulated
by these systems: For example, in SWS all these systems become relatively
quiescent; in REM periods the ascending cholinergic system becomes dispro-
portionately active; REM periods are eventually brought to an end by rising
levels of activity in noradrenergic and serotonergic neuronal groups which
had fallen silent at REM onset. Hobson’s AIM model attempts to integrate
several lines of evidence on the genesis and nature of conscious states (see
Figure 6).
The practical upshot of these advances is a useful taxonomy of states of
healthy and disordered consciousness. In health, we cycle between wakeful-
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ness, SWS, and REM. Pathological states include coma (Glasgow Coma
Score ,7, eyes closed), the vegetative state mentioned above, brain death
and the locked in syndrome (Working party of the Royal College of
Physicians, 2003) (Table 1). While wakefulness, SWS and REM are as a
rule mutually exclusive, overlaps between these states occasionally occur
(Mahowald & Schenck, 1992) (see Figure 7). For example, sleepwalking
reflects motor activation of the kind seen during wakefulness occurring at a
time when much of the brain is deactivated as during SWS (Bassetti et al.,
2000); REM sleep behaviour disorder, in which sufferers enact their

Figure 6. The AIM model: Hobson’s AIM model locates the three principle states of health
consciousness in a “state space” defined by input (I: external in wakefulness, internal during
REM), activation (A: high in REM and wakefulness, low in NREM sleep) and mode (M: during
REM, prefrontal regions involved in regulation of waking behaviour and encoding of memories are
deactivated) (Hobson & Pace-Schott, 2002).
 364
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TABLE 1
The differential diagnosis of impaired awareness (Adapted from Working party of the Royal College of Physicians, 2003)

Minimally Death confirmed by

Condition Vegetative state conscious state Locked-in syndrome Coma brain stem tests

Awareness Absent Present Present Absent Absent

Sleep-wake cycle Present Present Present Absent Absent
Response to pain þ/ 2 Present Present (in eyes only) þ/ 2 Absent
Glasgow Coma score E4, M1-4, V1-2 E4, M1-5, V1-4 E4, M1-3, V1 E1, M1-4, V1-2 E1, M1-3, V1
Motor function No purposeful movement Some consistent or Volitional vertical eye No purposeful movement None or only reflex
inconsistent verbal movements or spinal movement
or purposeful motor eyeblink preserved
behaviour
Respiratory function Typically Preserved Typically Preserved Typically Preserved Variable Absent
EEG activity Typically slow wave Insufficient data Typically normal Typically slow wave Typically absent
activity activity
Cerebral metabolism Severely reduced Insufficient data Mildly reduced Moderately–severely Severely reduced or
(positron emission reduced absent
tomography)
Prognosis Variable: if permanent, Variable Depends on cause but full Recovery, vegetative Already dead
continued vegetative recovery unlikely state or death within
state or death weeks
 WHAT DO WE MEAN BY “CONSCIOUS” AND “AWARE”? 365
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Figure 7. State boundary dissociation. The states of wakefulness, REM and NREM sleep are
normally distinct. Many parasomnias can be understood as the result of a fusion of two or more
states. For example, overlap between the phenomena of REM sleep and wakefulness (shaded)
gives rise to REM sleep behaviour disorder; overlap between NREM sleep and wakefulness occurs
during sleepwalking and night terrors (Mahowald & Schenck, 1992).

dreams, results from a failure of the normal atonia of REM sleep, allowing
dream mentation to give rise to behaviour, like self-defence, of a kind
which would normally be confined to wakefulness (Schenck, Bundlie,
Ettinger, & Mahowald, 1986).
Knowledge of the neural basis of awareness, of our experience, has also
been transformed by the path-breaking work of the past century on the
biology of cognition, exploring the neurology of perception, language,
memory, emotion, and action. Work on these psychological processes, and
their disruption by disease, is demonstrating increasingly fine-grained corre-
lations between features of our experience and details of neural processes.
The key role of visual area V4 in the conscious perception of colour, and
in its loss in central achromatopsia (Zeki, 1990) (loss of colour vision), and
the key role of area V5 in the perception of visual motion, and in its loss in
central akinetopsia (Zeki, 1991) are much cited examples. Correlation, of
course, does not imply cause. Recent work in this area has tried to tighten
the link between brain activity and conscious experience by investigating
how cerebral activity changes when our experience changes without any cor-
responding change in the world: examples include studies of imagery (Ishai,
Ungerleider, & Haxby, 2000), hallucinations (Ffytche et al., 1998) and the
modulation of awareness by attention or during binocular rivalry (Kanwisher,
2001). A second strategy for defining the neurology of consciousness is to
approach awareness by stealth, so to speak, by exploring the neurology of
unconscious processing. I shall discuss this line of work and fill out our
 366 ZEMAN

current picture of the neurological basis of awareness in the section on narrow

and broad consciousness below.

CONSCIOUSNESS VERSUS SELF-CONSCIOUSNESS

The terms “self-consciousness” and “self-awareness” are sometimes used in
medical contexts, usually interchangeably, as if their meanings were self-
evident. I doubt this: Self-consciousness and self-awareness are peculiarly
complex ideas, not too surprisingly, as they combine three others—“self”,
“conscious” and “aware”—each of which is multifaceted (Berrios &
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Markova, 2003). I shall try to tease apart the principle strands of self-con-
sciousness/self-awareness.
The distinction between “self” and “other” is biologically crucial. There
are many activities which we need to direct towards other objects in the
world—like eating them—which it would be disastrous if we directed
towards ourselves. We should expect to find strategies for drawing this
distinction in the simplest organisms. But “self-consciousness” implies
more than an ability to behave differently towards self and other: It requires
a representation of self and other. A variety of different kinds of
representation fall out of the senses I shall discuss (and number for ease of
reference).
The colloquial sense of self-consciousness (1)—a proneness to embarrass-
ment in the presence of others—is rather sophisticated, as it implies the
person’s awareness that the awareness of others is directed on him or her.
A second sense (2), self-consciousness as self-detection, refers to a family
of forms of self-consciousness which are probably present in many
animals. This family includes awareness of stimuli which directly impinge
on the body (the ant walking up your arm); of proprioceptive information
about bodily position which contributes substantially to our body image; of
information about actions which we are about to perform or are performing,
giving rise to a sense of agency; of information about bodily state (hunger,
thirst, etc); and of emotions, like fear or affection, which signal the state of
our relationship to objects and to people around us, and without which we
are liable to lose the sense of our own reality or that of the world, as in “deper-
sonalisation” and “derealisation”.
A third sense, (3)—self-consciousness as self-monitoring—extends self-
detection in time into past and future, and in range, to encompass more
plainly cognitive abilities. It refers to the ability to recall the actions we
have recently performed (Beninger, Kendall, & Vanderwolf, 1974), and to
our ability to predict our chances of success in tasks which challenge
memory (Hampton, 2001) or perception (Smith, Shields, & Washburn,
2003): we undoubtedly possess these abilities, and ingenious experiments
 WHAT DO WE MEAN BY “CONSCIOUS” AND “AWARE”? 367

in comparative psychology (Beninger et al., 1974; Hampton, 2001; Smith

et al., 2003) suggest that many other animals have them too.
Senses (2) and (3) require representation of various activities and
capacities of self rather than any unified concept. Senses (4) and (5) draw
closer to what we normally have in mind, I suspect, when we speak of self-
awareness. The fourth sense, (4)—self consciousness as self-recognition—
alludes to our ability to recognise our own bodies as our own, for example
in mirrors (mirror self-recognition, MSR). Gordon Gallup discovered in
the 1970s that if apes are given experience with a mirror they will soon
realise that they are looking at themselves, while their monkey cousins appar-
ently fail to grasp this fact despite extensive exposure (Gallop, 1970). Human
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children develop this ability at around 18 months. Recent evidence suggests

that dolphins can also acquire MSR (Reiss & Marino, 2001); there are claims
for pigeons and magpies.
Between the ages of 18 months and around 5 years, human children take a
further major intellectual stride: they come to appreciate that as well as being
objects, which can be inspected in mirrors, they are also subjects, of experi-
ence—they possess, in other words, not only bodies, but also minds. The
awareness of ourselves as subjects of experience opens up a world of new
possibilities for understanding our own behaviour and the behaviour of
others in terms of desires and beliefs, and for implanting and manipulating
these (Baron-Cohen, 1995; Frith & Frith, 1999). It has been described as
the acquisition of a “theory of mind”. Once we realise that others, like our-
selves, have a limited, personal perspective on the world we can choose to
inform, misinform and influence them in a host of entertaining and profitable
ways. This “awareness of awareness” is the penultimate sense (5) of self-con-
sciousness. The degree to which animals other than man possess this aware-
ness is debated.
Finally, we use “self-consciousness” to refer to our self-knowledge in its
broadest sense (6)—one’s knowledge of oneself as the hero of a personal nar-
rative, deeply conditioned by one’s circumstances and cultural background:
Contrast our self-knowledge at 6, 16 and 60 or the conceptions of self in a
medieval monk and a contemporary scientist. The capacity to relive our
past in a form of “mental time-travel” constitutes the “autonoetic awareness”
which Endel Tulving has identified as the distinctively human intellectual
achievement (Tulving, 1985). Self-depiction is a central focus of art,
another distinctively human activity.
What of the relationship between consciousness and self-consciousness?
The implication of the past few paragraphs is that it would be unwise to
give a general answer to this question, one needs first to specify the senses
of consciousness and self-consciousness one has in mind. Two contrasting,
controversial, but influential ideas about this relationship deserve a mention
here, although space prevents me from pursuing them further. First, the
 368 ZEMAN

notion, linked to the phenomenological tradition, that some form of pre-

reflective self-awareness or “ipseity” is presupposed by even simple forms
of perceptual awareness (when I look at the glass I experience “my seeing
the glass”). Second, the idea that awareness is summoned into being by
self-awareness, specifically by the acquisition of a theory of mind, the idea
at the core of some “top-down” theories of consciousness (Humphrey, 1978).

CONSCIOUSNESS NARROW VERSUS

CONSCIOUSNESS BROAD
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The third distinction can be introduced via the etymology of “consciousness”.

The Latin “conscientia”, the root of our “consciousness”, was formed by the
combination of “cum”, meaning “with”, and “scio”, meaning “know” (Lewis,
1960). In its narrow, or strong, sense, conscientia meant knowledge shared
with another, often guilty knowledge of the kind one might share with a
fellow conspirator. By metaphorical extension it could refer to “knowledge
shared with oneself”, But alongside this “strong” usage, conscientia was
sometimes used in a broad, or weak, sense, in which it meant, simply,
knowledge.
The tension between these two senses lives on, I suspect, in our current use
of “consciousness”. We sometimes reserve the word for mental states, the
contents of which we can “share” fully with ourselves. For example, I am cur-
rently conscious of the book lying on my desk: I could describe it to you, read
its cover, reach out and pick it up. In other words I can report my visual
awareness of the book, and use it to guide a range of actions. This is full-
blooded awareness, consciousness “narrow” and “strong”. Yet we are often
inclined to attribute consciousness to creatures who lack the full repertoire
of “conscious” behaviour: alinguistic animals, prelinguistic infants, dysphasic
adults, for example. We are even tempted to attribute consciousness in a
certain sense in cases in which its absence in the strong sense is precisely
the focus of our interest. For example, consider experiments in which a
person’s improving performance in a psychological task reveals that they
must be learning a rule (or a “grammar”) governing the task, yet they are
unable to explain how they are improving their performance, unable to articu-
late the rule (Berns, Cohen, & Mintun, 1997). There is an inclination to say
that ‘in some sense’ they must have become conscious of the rule even
though, in another sense, they are learning it unconsciously. The first sense
here is consciousness “broad” or “weak”, consciousness as knowledge.
At the “broad” or “weak” extremes of this spectrum lie a range of pro-
cesses which we normally regard as quintessentially “unconscious”: for
example, blindsight (Weiskrantz, 1998) and its analogues blind touch and
blind smell (Sobel et al., 1999), priming by neglected stimuli (Rees et al.,
 WHAT DO WE MEAN BY “CONSCIOUS” AND “AWARE”? 369

2000), priming by masked stimuli (Dehaene et al., 1998), the processing of

“unseen” visual stimuli in experiments using binocular rivalry (Kanwisher,
2000) or binocular extinction (Moutoussis & Zeki, 2002) or in states of
impaired awareness, like the vegetative and minimally conscious states
(Laureys, Berre, & Goldman, 2001). Examples like these create an opportu-
nity for neuroscientists to contrast the features of “conscious” and “uncon-
scious” neural processing (Baars, 2002). These contrasts (see Table 2) are

TABLE 2
“Contrastive analysis”: Studies comparing conscious and unconscious brain activity

Study (context) Comparison Results

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Laureys et al., 2000 Vegetative state vs recovery Increase in cortical metabolic rate
(Vegetative state) and restoration of connectivity
with recovery
John et al., 2001 Anaesthesia vs awareness Loss of gamma band activity and
(Anaesthesia) cross-cortical coherence under
anaesthesia
Sahraie et al., 1997 Aware vs unaware mode of Aware mode associated with
(Blindsight) perception in blindsight DLPF and PS activation,
patient GY unaware with medial F and
subcortical
Dehaene, 1998 Perceived numbers vs backward Unreported numbers underwent
(Backward masked but processed perceptual, semantic and motor
masking) numbers processing similar but less
intense to reported numbers
Kanwisher, 2000 Attention to “face” or “place” Activity in FFA and PPA locked to
(Binocular rivalry) when stimuli of both kinds presence or absence of
are simultaneously in view, awareness of face and place
or perception of face or place
during binocular rivalry
Moutoussis & Zeki, 2002 Perceived vs “invisible” but Similar but less intense activation
(Invisible stimuli) processed faces/houses of FFA and PPA by Invisible
stimuli
Engel et al., 2000 Perception of one or other of Firing of cells processing currently
(Binocular rivalry) a pair of rivalrous stimuli perceived stimulus better
synchronised than firing of cells
processing suppressed stimulus
Tononi & Edelman, 1998 Perception of high vs low More widespread and intense
(Binocular rivalry) frequency flicker during activation by
binocular rivalry perceived stimulus
Petersen et al., 1998 Effortful verb generation LPF, ant cing and cerebellar
(Task automatisation) task vs performance after activitation shifts to left
training perisylvian activation
with training

Key: ant cing ¼ anterior cingulate; DLPF ¼ dorsolateral prefrontal cortex; FFA ¼ fusiform face
area: LPF ¼ lateral prefrontal cortex; medial F ¼ medial frontal cortex; PPA ¼ parahippocampal
place area; PS ¼ prestriate.
 370 ZEMAN

in their early days but so far indicate that several plausible candidates can
influence the chances that a given stream of neural processing will give
rise to awareness: The amplitude and duration of the associated activity, its
degree of synchronisation, its site (for example, cortical or subcortical) and
its neural “reach” or connectivity.
The most popular current model of conscious processing proposes that it
occurs when individually unconscious modules of cognitive function—con-
ceived of in either psychological or anatomical terms—join forces and com-
municate. In Baars’ Global Workspace Theory (Baars, 2002) and Dehaene’s
Neuronal Workspace Model (Dehaene & Naccache, 2003), information
becomes conscious when it is broadcast widely through the brain, allowing
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forms of cognitive performance which are otherwise unattainable. Dehaene

suggests, for example, that these include the bridging of delays, inhibition
of habitual responses, the planning, evaluation and monitoring of novel strat-
egies and higher level semantics. Whether awareness really depends on a
qualitatively distinct style of neural processing or rather is a straightforward
function of variables such as amplitude and site is a major empirical question
for the next decade. Studies of the recovery of awareness in patients with
coma, vegetative or minimally conscious states, should help to resolve this
central issue.

CONSCIOUSNESS INNER VERSUS CONSCIOUSNESS OUTER

Some readers will have a nagging sense that the distinction between broad
and narrow senses of consciousness in the last section misses the real point
of interest. It fails to capture the essential difference between conscious
and unconscious processes. Whether information is conscious, you may
want to say, does not depend at all upon whether we can report or act upon
it. It simply depends on whether it gives rise to “an experience”—whether
there is something it feels like to be conscious of the information (Nagel,
1979). And for any neural process, however one discovers this, there either
is or there is not an associated experience. This notion, that consciousness
is a determinate, private, invisible and crucially important internal process
or event is the “inner” concept of consciousness.
I suspect that this notion is the dominant current conception of conscious-
ness, widely shared, by scientists as well as non-scientists. It suggests the fol-
lowing kind of picture of brain– mind interaction: Certain types of process in
the brain “generate” consciousness, rather as, in the tale of the Arabian
Nights, rubbing Aladdin’s magic lamp conjures up the genie. The product
of the process, consciousness, is, indeed, rather like the genie, magical and
evanescent (although consciousness is even less visible than the genie). We
tend to think that this picture of consciousness is simply obvious, necessitated
 WHAT DO WE MEAN BY “CONSCIOUS” AND “AWARE”? 371

by a range of basic facts about experience and the brain. For example, dreams,
hallucinations, mental imagery and brain stimulation experiments teach us
that certain kinds of brain activity are all that is needed to produce experience.
The resulting experience looks nothing like the brain activity which causes it
and must therefore be different in kind from it, a stream of autonomous
mental events which arises from the physical ones in the brain.
This widespread conception of consciousness implies that awareness is a
deeply private matter, inaccessible to observation by third parties (Zeman,
2004). On this view, awareness casts an “inner light” on a private perform-
ance. In a patient just regaining awareness we imagine the light casting a fal-
tering glimmer, which grows steadier and stronger as a richer awareness
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returns. We sometimes imagine a similar process of illumination at the phylo-

genetic dawning of awareness, when animals with simple nervous systems
first became conscious. We wonder whether a similar light might one day
come to shine in artificial brains. But, bright or dim, the light is either on
or off; awareness is present or absent—and only the subject of awareness
knows for sure. The light of awareness is invisible to all but its possessor.
This inner concept creates some real difficulties for the “science of con-
sciousness”. It implies that its chief focus of interest lies beyond the reach
of scientific observation. If so we may never be able to integrate conscious-
ness fully into scientific theory. If we cannot cash the language of conscious-
ness in the currency of neuroscience, we will neither be able to provide a
deeply satisfying explanation of how matter creates mind, nor to give an intui-
tive account of how mind—our desires and intentions—influences matter.
The most we can hope for are correlations, identifying the bare mysterious
fact that certain neural processes give rise to certain kinds of experience
which themselves play no part in the explanation of behaviour. This inner
view creates an explanatory gap that seems unbridgeable. Things, in brief,
look bad for the science of consciousness.
Given the gravity of this impasse, we have reason to backtrack, to consider
the possibility that we might have been mistaken about the nature of con-
sciousness, and perhaps even about its contents. This journey back through
our assumptions is bound to be a tough one, as it tends to strike us as being
so obvious that our experience is as it seems to be, and also obvious, in the
light of what we know of neuroscience, that the brain generates experience.
So, if we backtrack, does any alternative offer itself?
One alternative emerges quite naturally when we ask ourselves how we
establish that others, including patients in states of impaired awareness, are
conscious. We do so by interacting with them, by engaging with their beha-
viour. When we do this, when we communicate or dance or play with other
people, we are left with no genuine doubt about their consciousness. This
prompts the thought that experience might not arise from the brain in the
way we normally envisage. Perhaps, rather than viewing it as a mysterious
 372 ZEMAN

emanation from the brain, we should think of it as a sophisticated form of

interaction with the world, an elaborate process of exploration. This is the
“outer” conception of consciousness. If there is something to it, our current
efforts to account for consciousness may be excessively “neurocentric”
(Zimmer, 2004). Perhaps we need to broaden the horizon of our explanation,
to consider the mind as “embodied, embedded and extended” (Broks,
2003)—embodied in the wider frame of our biological being, embedded in
the culture in which it has developed, extended in space and time through
which our transactions with the physical world proceed.
To many of us this is an alien, disturbing view of consciousness, a theory
which snuffs out its essence. Yet there are grounds for doubting that our grasp
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of the contents and nature of experience is as firm as we usually take it to be.

The evidence from work on change blindness & Noe, 2001) and inattentional
blindness suggests that our “internal representation” of our visual surround-
ings is less rich than we normally take it to be, shaking our certainty about
the contents of our experience. Evidence from sensory substitution exper-
iments (O’Regan & Noe, 2001) suggests that the “visual” properties of
visual experience may be conferred by the manner in which visual behaviour
explores the world rather than by the “specific nerve energy” of the normal
visual pathways, undermining our usual understanding of how experience
arises from the brain.
Neither the inner nor the outer concept of consciousness alone seems to be
fully equal to our needs, yet it is not clear how we should reconcile them.
Which of these concepts you prefer, the picture of consciousness “inside
the head” or the picture of consciousness “at large” in the world, will deter-
mine your view of the final distinction I shall draw, between the “hard” and
the “easy” questions of consciousness.

HARD VERSUS EASY QUESTIONS OF CONSCIOUSNESS

If you are drawn to the inner notion of consciousness, to the picture of experi-
ence as an entirely private, invisible mental process, you will have the sense
that there is a gulf, an apparently unbridgeable gulf, between all that we can
learn about the brain from science and the subjective essence of awareness.
However, if you are attracted by the idea that it may be possible to reconstrue
the concept of awareness in terms of complex interactions with the world, you
will be more optimistic about the prospects for a science of consciousness.
The distinction between the “hard” and “easy” questions of consciousness
was drawn by the philosopher David Chalmers to highlight the difference
between explaining the neural events which mediate conscious behaviour
and the (allegedly) more mysterious process by which those events give
rise to awareness (Chalmers, 1996), “how the water of the physical brain is
 WHAT DO WE MEAN BY “CONSCIOUS” AND “AWARE”? 373

turned into the wine of experience” in the words of another philosopher, Colin
McGinn (1991). Given the inner notion of consciousness this distinction
becomes an important one: Science promises to solve the hard but not the
easy question. Given the outer view, the distinction collapses: Explain how
the brain facilitates conscious behaviour, and consciousness is explained.

CONCLUSION
I have tried to give a guide, in this chapter, to the ambiguous concepts of con-
sciousness and awareness. I began with the uncontroversial distinction
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between the two key colloquial senses of consciousness, the relatively objec-
tive notion of wakefulness and the more subjective concept of awareness. I
outlined some key findings in neuroscience which have illuminated con-
sciousness in these two senses: They include the discoveries that conscious
states have electrical correlates which can be recorded from the surface of
the scalp; that these are regulated by pharmacologically specific structures
in the brainstem, thalamus and basal forebrain; and a multitude of findings
which support the general principle that the features of experience will corre-
spond to features of neural processing. We made a detour via self-conscious-
ness, teasing apart six related but separable senses of the term. Returning to
the main topic of consciousness, we identified a spectrum of senses that
extends between consciousness “narrow” and consciousness “broad”—con-
sciousness in its strong sense of knowledge shared with oneself, available
for report and the control of voluntary action, and consciousness in its
broad sense of “knowledge” pure and simple. I reviewed the evidence that
underpins global workspace theory, from contrasts between neural processes
that do and do not give rise to consciousness. We then examined the intuition
that what really matters to us when we are deciding whether a person or a state
is conscious is simply the occurrence of “experience”, not the possibility of
report or deliberate action: On this “inner” conception of consciousness,
experience is conceived as an immaterial, invisible and private process. I con-
trasted this to an “outer” conception which regards “consciousness” as short-
hand for intelligent behaviour. Finally we saw that those who are wedded to
the inner conception are likely to see the science of consciousness as con-
fronted by an insurmountable challenge—to solve the “hard” problem of con-
sciousness, bridging the explanatory gap between the physical and the
mental—while for those who accept the outer conception there is no worrying
gap between the two.
The complexities of the concepts of consciousness and awareness have
practical import: In scientific work we need to be clear which concept of con-
sciousness we hope to understand; in clinical work we need to be clear about
what kind of awareness we are hoping to restore; in communicating with
 374 ZEMAN
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Figure 8. Sources of evidence for the study of consciousness.

relatives we sometimes need to convey the subtleties of consciousness, bring-

ing home the message, for example, that recovery from coma is often a
gradual and sometimes sadly incomplete affair, not the sudden restitution
of the soul. Much of what we know about the science of consciousness
derives from clinical studies of brain injured patients. Collaborative research,
applying the tools of neuroscience to the analysis of brain injury, has the
potential to provide continuing insights into this fundamental biological
and cultural capacity.
The topic of consciousness is so rich because it lies at the intersection of
several intellectual domains (Figure 8), including some, in the humanities,
which focus on the experiences of subjects, and others, in the sciences,
which highlight processes in objects. The study of the arts, of religion and
philosophy all have their contribution to make alongside the study of the
brain and its biology. This richness creates a risk of confusion and cross-
purposes alongside the possibility of cross-fertilisation. We should keep
this rich but potentially confusing context in the back of our minds as we
navigate around the disorders of awareness.

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