The Complexity of the Syrian Situation

As I said when I posted this on Facebook, I hate these repetitious pictures that show up with different quotes on them (and here I add: especially the Gene Wilder as Willy Wonka one). But this one poses an interesting, if reductionist (as it was pointed out) question about the logistics of the Syrian situation.

My friend Ray Harris responded with this:

Ah jeez - if it were as simple as this the US, NATO would have intervened earlier. The use of chemical weapons breaches international law and it is up to the international community to act, otherwise international law is meaningless.

Nor would the US necessarily be fighting on the same side as al Qaeda. They would simply be punishing one side for a clear violation of international law.

The rebel side also includes people interested in a democratic Syria - unless you forgot that Assad is a Ba'athist dictator.

Ray also posted this and tagged me on it so that I would see it:

I am getting massively bored with all the simplistic, reductionist responses to the situation in Syria. It is extremely complex people. It is NOT like Iraq. It is NOT like Afghanistan. It is like Syria. It is NOT only because of a gas pipeline (although resources are always a factor). Nor does the US have any specific interest in Syria. But in case you have forgotten. Someone did use chemical weapons (both Hussein and Assad belong to the Ba'athist party and Hussein used chemical weapons on Kurds). And the use of chemical weapons is a clear breach of international law and someone has to police international law, otherwise it is meaningless.

Are the US hypocrites? Of course, but everyone is hypocrite. What of the Russians and Chinese?

There is a lot of propaganda flying around at the moment. Pro-Assad propaganda, pro-rebel propaganda, Iranian propaganda blaming Israel, socialist alliance propaganda blaming US imperialism, and so on and on.

After a bit of thought, this is my reply and my current (muddled) understanding of the complexity of the situation:

Ray, I get your perspective and I think, at the same time, that the situation is so absurd that is requires mockery to avoid simply giving up.

It's clearly NOT simple - if it were, there would be no hesitation on the part of Obama in launching a "punishment" - and the fact that both Britain and Germany, among others I presume, have opted out of a NATO attack, or even a "coalition" attack, is telling.

Obama has effed this up so thoroughly with his line in the sand nonsense and then his refusal to launch a strike that it is laughable. At the same time, he has good reason not to launch a strike - it likely will bring in Iran and probably Russia (who has already sent a fleet of warships into the Persian Gulf) - then we have WWIII in the Middle East.

The Syrian Rebels are also a mixed bag - some who want democracy, some who want Islamic law, some who are al Qaeda, and probably some other groups as well. We are probably supporting the rebels covertly at this point, but what will we end up with if they succeed in toppling Assad? Will we get Syria's version of the Muslim Brotherhood, and then have a messed up situation like Egypt, where we support the military in staging a coup to oust the first truly democratically elected president in decades?

That whole region is an example of what happens when we impose somewhat arbitrary lines and values (unsuccessfully) where there had been none prior, or at least not in the same way. It is ludicrous to think that creating nations at a bargaining table will put to an end to centuries of tribal hatred and a general sense among most Arab peoples of having been the oppressed - same thing happened on the African continent when the European territories demanded and took their independence. Witness Sudan - one tribe gains political and military power and then sets about eliminating the opposing tribe(s).

There is a huge difference between the fall of the Austro-Hungarian empire following WWI [Ray mentioned this in a comment] and what we are seeing now. Those European nations were already developed and they (mostly) were not a collection of tribes and/or religious sects. More importantly, the West kept military bases in many countries as a kind of reminder not to get out of line (weak colonialism), but this did not happen when the European nations carved up the Middle East.

The complexity of the situation, which I suspect you get much more than I do, is well over the capacities of our current elected leaders to deal with effectively. This is obvious.

International law, by the way, IS meaningless in a practical sense. As long as Russia and China are permanent members of the Security Council at the UN (with veto power), things like this will never be punished by the UN. The US cannot be the policeman of the planet - and the American citizens are overwhelmingly opposed to our trying to do so.

After all the words I have just typed, I have barely scratched the surface of the complexity of this situation.

The reality here on Facebook is that Americans think in sound bites, so it's no wonder we post simplistic, reductionist statements about complex events - it's what our media has trained us to do. I'll bet very few people will have read this far . . . a picture with a trite quote is much easier to digest and simply agree/disagree. But this part of it is a whole other discussion . . . .

Chris D. Frith - What brain plasticity reveals about the nature of consciousness: Commentary

Chris D. Frith used to be a hard-core materialist regarding the realm of neuroscience and consciousness. Over the years, however, he has become a leader in the research into how human minds create culture and how culture shapes human minds. Here is his own statement of his research (from his website):

Although I retired from my position at the Wellcome Centre for Neuroimaging at UCL in 2007, I am continuing to develop the new discipline of neural hermeneutics. This discipline concerns the neural basis of social interaction. I am fortunate in having a number of excellent collaborators for this enterprise, in particular, Uta Frith. In October 2011 I was elected a two-year fellow of All-Souls where I am organising a series of seminars on Meta-cognition in order to explore the critical role of this process in sharing experiences. My main experimental work is currently performed in the interacting minds centre at Aarhus University. We are trying to delineate the mechanisms underlying this human ability to share representations of the world for it is this ability that makes communication possible.

We think that there are two major processes involved. The first is an automatic form of priming (sometimes referred to as contagion or empathy), whereby our representations of the world become aligned with those of the person with whom we are interacting. The second is a form of forward modelling, analogous to that used in the control of our own actions. Such generative models enable us to predict the actions of others and use prediction errors to correct and refine our representations of the mental states of the person we are interacting with.

We are carrying out a series of behavioural and brain imaging experiments that will delineate the neural mechanisms that underlie these two processes in healthy volunteers.

The results will be relevant for our understanding of psychiatric disorders such as schizophrenia. One characteristic of the mistaken perceptions (hallucinations) and beliefs (delusions) associated with this disorder is their resistance to change in spite of their incompatibility with the beliefs and perceptions of others. This indicates a failure in the mechanism by which we align our representations of the world with those of others. Delineating the normal mechanisms of alignment will help us to identify the neural basis of hallucinations and delusions.

A couple of years ago, he published the article below in Frontiers in Psychology: Consciousness Research. This essay served as the introduction to a special issue on the relevance of brain plasticity to the understanding of consciousness. Frith suggests, based on the evidence, that "consciousness, and the qualia that make up that consciousness, are not static. The contents of consciousness are constantly changing and developing through our experiences and especially through our sharing of experiences with others."

I agree - this short essay is definitely worth the read.

Full Citation: 
Frith CD. (2011, May 11). What brain plasticity reveals about the nature of consciousness: Commentary. Frontiers in Psychology: Consciousness Research; 2:87. doi: 10.3389/fpsyg.2011.00087

What brain plasticity reveals about the nature of consciousness: Commentary

Chris D. Frith [1,2]

1. Center for Functional Integrative Neuroscience, Aarhus University, Aarhus, Denmark
2. Wellcome Trust Centre for Neuroimaging, University College London, London, UK

What is Consciousness?

Consciousness continues to be an ill-defined concept, so I shall start by discussing how the term is used in this special issue. As discussed in Overgaard and Overgaard (2010), there is an important distinction between level of consciousness and content of consciousness. Level of consciousness refers to a dimension that varies from coma at one extreme, through sleep and, at the other extreme, alert wakefulness. Philosophers call this creature consciousness since it applies to the whole creature (Rosenthal, 2009). Level of consciousness is of particular relevance to the studies of patients in persistent vegetative state discussed by Laureys and colleagues (Demertzi et al., 2011). However, most of the contributions to this special issue are concerned with the content of consciousness.

Alert wakefulness is characterized by consciousness of specific mental states. The states that we are aware of are the contents of consciousness. Philosophers call this state consciousness. This is somewhat confusing, given that, when people talk about altered states of consciousness, they are usually referring to different levels of consciousness rather than different contents of consciousness. So I will continue to use the terms level and contents of consciousness.

In studies of the neural correlates of consciousness there is great interest in contrasting the neural activity associated with stimuli that influence the contents of consciousness with the neural activity associated with the same stimuli when they affect behavior in the absence of any change in the content of consciousness (Frith et al., 1999). When a stimulus elicits neural activity and affects behavior it does not necessarily follow that we are aware of that stimulus.

A certain minimal level of consciousness is necessary for there to be any contents of consciousness, but the level of consciousness does not determine what the contents of consciousness will be. As is demonstrated in this special issue, brain plasticity has an important role in determining the contents of consciousness.

There is also a reflective aspect of consciousness which is modeled by Cleeremans (2011) and which Allen and Williams (2011) suggest may be uniquely human. Are conscious mental states thoughts about thoughts? Is consciousness by its very nature reflective? There is clearly a relationship between this aspect of consciousness and metacognition. I shall return to consideration of this relationship at the end of this introduction.

Certain Neural Structures are Necessary, but Not Sufficient for Consciousness

It is well established that brain lesions can alter the contents of consciousness. To take just one example, lesions to the extra-striate cortex can eliminate awareness of color (achromatopsia, Zeki, 1990). Brain stimulation can also generate the contents of consciousness. For example, electrical stimulation of extra-striate cortex can generate hallucinations of various visual features including color (Lee et al., 2000). This has lead to the idea of essential nodes for the specific conscious contents (e.g., V4 for color, Zeki and Bartels, 1999). In accord with this idea, Silvanto and Rees (2011) conclude that, in the absence of primary visual cortex, humans seem to have extremely limited capacity for visual awareness (but see Ffytche and Zeki, 2011).

However, these essential nodes are clearly not sufficient for consciousness. If the level of consciousness is too low, as in coma, then experience does not occur even though the essential nodes are intact. Laureys and colleagues (Demertzi et al., 2011) suggest that the lack of awareness in such cases is due to the loss of certain kinds of long-range connectivity in the brain. Similar effects may be produced by anesthesia in which long-ranged connectivity is lost temporarily (Alkire et al., 2008).

Brain Plasticity Provides Important Clues for Understanding the Nature of Consciousness and Its Relation to the Brain

The theme of this special issue is the observation that the loss of awareness associated with brain damage is frequently reversed. Unilateral spatial neglect, for example, is a disorder of consciousness associated with stroke from which recovery can be quite rapid (Cappa and Perani, 2010). In some cases it may be that brain tissue has been temporarily been deactivated, and subsequently recovers. However, in the many cases where brain tissue has been permanently damaged, we have to ask how such recovery is possible. The doctrine of essential nodes would suggest that, if the node has been destroyed, recovery should not be possible.

Mogensen (2011) presents an excellent discussion of this problem. Does recovery depend upon the growth of new connections? Does the patient develop new cognitive strategies? One important conclusion is that the brain activity supporting recovery need not be in the same location as that originally supporting the experience. This observation supports two conclusions: (1) Conscious experience (qualia) can be re-acquired through some sort of learning process. (2) The nature of the experience (qualia) is not solely determined by the nature/location of the brain activity supporting it. This second conclusion is dramatically illustrated in the studies from Kupers et al. (2011) in which congenitally blind subjects were trained to “see” using a tactile stimulator. This technique involves turning the 2D images picked up by a video camera into a corresponding pattern of 2D tactile stimulation applied to the tongue. After being trained to recognize simple patterns with this stimulator, brain imaging revealed that performance of the task elicited activity in visual cortex. In addition transcranial magnetic stimulation applied to visual cortex lead to the experience tactile qualia. This is evidence against the idea, know as cortical dominance (Hurley and Noë, 2003), that qualia are determined by the cortical location of the associated brain activity. But what then is the property of nervous activity that determines the difference in the experience of the different senses?

New Qualia Can be Learned

However, it is not only after brain damage that qualia can be relearned and even learned for the first time. There are many examples of learning in the normal case. For example, between 6 and 12 months infants lose awareness of speech sound distinctions not present in their native language. With sufficiently early intervention this loss of awareness can be reversed, but interestingly only through direct interaction with a speaker, rather than passive exposure to audio or video-tapes (Kuhl et al., 2003).

Normal subjects can also learn to become conscious of stimuli previously outside awareness. Schwiedrzik et al. (2009) used meta-contrast masking to achieve chance performance in the detection of stimuli. After 5 days of training sensitivity was significantly increased and subjects reported awareness of the stimuli. Gottfried and his colleagues (Li et al., 2008) exposed volunteers to odor molecules (rose oxide and 2-butanol) that exist in two mirror image forms (enantiomers). At the beginning of the experiment the participants were entirely unable to smell any differences between the two mirror image forms, as is the case for most people. After only seven trials (for each odor) of standard Pavlovian conditioning, participants exhibited fear responses to the odor associated with shock and not to the other form, indicating that they now could distinguish between the mirror image odors. A further perceptual experiment showed that participants could now consciously detect the difference in smell.

In these examples, it seems likely that the potential to make perceptual distinctions was already present in the brain and that training revealed and enhanced this ability. For example, given the nature of the human eye we would not expect training to lead to awareness of infrared or ultraviolet light.

But the potential for awareness can also be artificially modified. Genetic manipulation in both mice and monkeys can alter the perception of color. Male squirrel monkeys are normally dichromats, but, even as adults, can be turned into trichromats through insertion of the missing opsin gene (Mancuso et al., 2009).

But How Do We Compare Qualia?

The observation that new qualia can be acquired, whether through learning or gene therapy, reminds us of a fundamental problem in consciousness research. How can we compare qualia from one person to another? Or within the same person at different times? As Overgaard and Mogensen (2011) ask, when a brain damaged patient recovers an awareness that had been lost, how can we know whether it is the same as the awareness that was present before the brain damage? If this recovered awareness is instantiated by activity in a different brain region and depends upon a different cognitive strategy it might well be different. Are there methods for determining whether two seemingly identical conscious states are actually different?

We have long known that people do have different sensory experiences. An obvious example is color blindness. The presence of the receptors necessary for color vision is under genetic control and some people have only two receptors instead of three, leading to different forms of color blindness (dichromacy), depending on which particular pigment is missing. The visual qualia of the color blind is clearly different, but trichromats still have some idea of what color blindness is like. It has now been found that some women have more than three retinal photopigment genes. These women also perceive significantly more color appearances than men or women with the usual three photopigment genes (Jameson et al., 2001). In this case the discovery of the biological difference led to the identification of the difference in the experience of color that can be explored empirically by asking subjects to make fine color discriminations.

Another example concerns individual differences in the spatial extent of primary visual cortex (V1). People with larger V1 are more susceptible to size illusions (Schwarzkopf et al., 2011). Having identified this biological difference we now explore the idea that these people have a subtly different experience of space.

Probably the most striking success in comparing qualia across people is Bartoshuk’s et al. (2004) demonstration of the existence of supertasters. These are people who experience the sense of taste with a far greater intensity than average. This discovery depended upon the development of scales for subjective experience that do not eliminate individual differences. There is still much work to be done in developing scales for quantifying subjective experience (see, for example, Sandberg et al., 2010), but it is clearly possible for such comparisons to be made.

How Can We Learn New Qualia?

Outside the laboratory human beings spend a lot of time in discussing their experiences. We enjoy telling each other what something was like. When we share experiences with others in this way, we can learn about two kinds of things. We can learn that other people have different experiences from ourselves. However, by pooling our experiences we can also get a better estimate of that the world is like, since, most of the time, two heads are better than one (Bahrami et al., 2010).

In order to pool our experiences we need to down play our differences and take the best features from each experience. Since successful joint action (as well as joint perception) depends upon such pooling, this may be why we are so often unaware of subtle, but consistent differences in experience. The implication is that, as a result of sharing experiences, our qualia may shift toward that of the person we are sharing with. I predict that the greatest shift will occur in the least expert member of the group. So I find most plausible the suggestion from Allen and Williams (2011), that we learn new qualia by interacting with others. This seems to be the case, for example, with activities like wine tasting (Smith, 2007). But for sharing our experiences we have to introspect upon and communicate our experience. This requirement emphasizes the reflective aspect of consciousness that is probably uniquely human. Reflecting upon our own experience is an example of metacognition, that is thinking about our thoughts.

There are considerable advantages for concentrating on this aspect of consciousness since metacognition is more precisely defined. Furthermore powerful techniques are now available for the quantification of metacognition (e.g., Galvin et al., 2003) and such measures have been applied to show that disruption of activity in dorsolateral prefrontal can change meta-cognitive sensitivity without altering discrimination performance (Rounis et al., 2010). Cleeremans (2011) uses the concept of metacognition to develop a computational model of how a brain can learn to be conscious by constructing a theory of its own behavior.

For me, a particularly interesting idea for further exploration is that this process of learning to be conscious of new things (i.e., to acquire new qualia) critically depends upon social interactions. In the various examples I mentioned above the learning of new qualia depended upon feedback from a teacher. To learn to experience the difference between the mirror image smell molecules required the experimenter to signal the distinction. More particularly, the American babies only learned to make the distinctions involved in Mandarin Chinese phonology through direct interaction with a speaker (Kuhl et al., 2003).

Conclusion

This special issue on the relevance of brain plasticity to the understanding of consciousness reminds us that consciousness, and the qualia that make up that consciousness, are not static. The contents of consciousness are constantly changing and developing through our experiences and especially through our sharing of experiences with others. Such change and development does not cease after brain damage. Indeed it is the dynamic relationship between brain and consciousness that enables the recovery of lost experience.

References

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Allen, M., and Williams, G. (2011). Consciousness, plasticity, and connectomics: the role of intersubjectivity in human cognition. Front. Psychol. 2:20. doi: 10.3389/fpsyg.2011.00020 CrossRef Full Text

Bahrami, B., Olsen, K., Latham, P. E., Roepstorff, A., Rees, G., and Frith, C. D. (2010). Optimally interacting minds. Science 329, 1081–1085. Pubmed Abstract | Pubmed Full Text | CrossRef Full Text

Bartoshuk, L. M., Duffy, V. B., Green, B. G., Hoffman, H. J., Ko, C. W., Lucchina, L. A., Marks, L. E., Snyder, D. J., and Weiffenbach, J. M. (2004). Valid across-group comparisons with labeled scales: the gLMS versus magnitude matching. Physiol. Behav. 82, 109–114. Pubmed Abstract | Pubmed Full Text

Cappa, S. F., and Perani, D. (2010). Imaging studies of recovery from unilateral neglect. Exp. Brain Res. 206, 237–241. Pubmed Abstract | Pubmed Full Text | CrossRef Full Text

Cleeremans, A. (2011). The radical plasticity thesis: how the brain learns to be conscious. Front. Psychol. 2:86. doi: 10.3389/fpsyg.2011.00086 CrossRef Full Text

Demertzi, A., Schnakers, C., Soddu, A., Bruno, M.-A. l., Gosseries, O., Vanhaudenhuyse, A., and Laureys, S. (2011). Neural plasticity lessons from disorders of consciousness. Front. Psychol. 1:245. doi: 10.3389/fpsyg.2010.00245 CrossRef Full Text

Ffytche, D. H., and Zeki, S. (2011). The primary visual cortex, and feedback to it, are not necessary for conscious vision. Brain 134(Pt 1), 247–257. Pubmed Abstract | Pubmed Full Text

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Galvin, S. J., Podd, J. V., Drga, V., and Whitmore, J. (2003). Type 2 tasks in the theory of signal detectability: discrimination between correct and incorrect decisions. Psychon. Bull. Rev. 10, 843–876. Pubmed Abstract | Pubmed Full Text

Hurley, S., and Noë, A. (2003). Neural plasticity and consciousness. Biol. Philos. 18, 131–168.

Jameson, K. A., Highnote, S. M., and Wasserman, L. M. (2001). Richer color experience in observers with multiple photopigment opsin genes. Psychon. Bull. Rev. 8, 244–261. Pubmed Abstract | Pubmed Full Text

Kuhl, P. K., Tsao, F. M., and Liu, H. M. (2003). Foreign-language experience in infancy: effects of short-term exposure and social interaction on phonetic learning. Proc. Natl. Acad. Sci. U.S.A. 100, 9096–9101. Pubmed Abstract | Pubmed Full Text

Kupers, R., Pietrini, P., Ricciardi, E., and Ptito, M. (2011). The nature of consciousness in the visually-deprived brain. Front. Psychol. 2:19. doi: 10.3389/fpsyg.2011.00019  CrossRef Full Text

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Li, W., Howard, J. D., Parrish, T. B., and Gottfried, J. A. (2008). Aversive learning enhances perceptual and cortical discrimination of indiscriminable odor cues. Science 319, 1842–1845. Pubmed Abstract | Pubmed Full Text | CrossRef Full Text

Mancuso, K., Hauswirth, W. W., Li, Q., Connor, T. B., Kuchenbecker, J. A., Mauck, M. C., Neitz, J., and Neitz, M. (2009). Gene therapy for red-green colour blindness in adult primates. Nature 461, 784–787. Pubmed Abstract | Pubmed Full Text | CrossRef Full Text

Mogensen, J. (2011). Reorganization of the injured brain: implications for studies of the neural substrate of cognition. Front. Psychol. 2:7. doi: 10.3389/fpsyg.2011.00007 CrossRef Full Text

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Overgaard, M., and Overgaard, R. (2010). Neural correlates of contents and levels of consciousness. Front. Psychol. 1:164. doi: 10.3389/fpsyg.2010.00164 CrossRef Full Text

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Rounis, E., Maniscalco, B., Rothwell, J. C., Passingham, R. E., and Lau, H. (2010). Theta-burst transcranial magnetic stimulation to the prefrontal cortex impairs metacognitive visual awareness. Cogn. Neurosci. 1, 165–175.

Sandberg, K., Timmermans, B., Overgaard, M., and Cleeremans, A. (2010). Measuring consciousness: is one measure better than the other? Conscious. Cogn. 19, 1069–1078. Pubmed Abstract | Pubmed Full Text

Schwarzkopf, D. S., Song, C., and Rees, G. (2011). The surface area of human V1 predicts the subjective experience of object size. Nat. Neurosci. 14, 28–30.  Pubmed Abstract | Pubmed Full Text

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Smith, B. C. (ed.). (2007). Questions of Taste: The Philosophy of Wine. Oxford: Signal Books.

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On Being - Nadia Bolz-Weber on Seeing the Underside and Seeing God: Tattoos, Tradition, and Grace

Nadia Bolz-Weber was Krista Tippett's guest last week for the NPR On Being show. Nadia has a blog called the Sarcastic Lutheran: The cranky spirituality of a postmodern Gal, as well as a couple of books (links below). She is the mission developer for House for All Sinners and Saints (HFASS) in Denver, Colorado, an urban liturgical community with a progressive yet deeply-rooted theological imagination. 

This is a cool pastor - if I had a pastor like this when I was young, I would have been a lot more tolerant of religion.

Nadia Bolz-Weber on Seeing the Underside and Seeing God: Tattoos, Tradition, and Grace

September 5, 2013

She’s the tattooed, Lutheran pastor of the House for All Sinners and Saints in Denver, a church where a chocolate fountain, a blessing of the bicycles, and serious liturgy come together. She's a face of the Emerging Church — redefining what church is, with deep reverence for tradition.

• Listen - Radio Show/Podcast  (mp3, 51:00)
• Unedited Interview - Nadia Bolz-Weber  (mp3, 76:32)
• Transcript

Recommended Reading

Pastrix: The Cranky, Beautiful Faith of a Sinner & Saint
By Nadia Bolz-Weber
Jericho Books (2013)


Salvation on the Small Screen? 24 Hours of Christian Television 
By Nadia Bolz-Weber
Seabury Books (2008)




Under the Tent with Nadia Bolz-Weber (video)
Watch Krista's unedited conversation with a leading voice in the Emerging Church. Live from the Wild Goose Festival in Hot Springs, North Carolina, this interview is a dynamic 90 minutes of discussion about tattoos and tradition, death and resurrection, and redefining what church is.

Daniel Collerton - Psychotherapy and Brain Plasticity

From the Frontiers in Psychology: Consciousness Research site: Daniel Collerton, a professor of clinical psychology, is one of the leading researchers in the area of hallucinations and dreams (see "Dreaming and hallucinations – Continuity or discontinuity? Perspectives from dementia with Lewy bodies," Consciousness and Cognition; Vol 20(4), December 2011, Pages 1016–1020). He is the author of New Horizons in the Neuroscience of Consciousness (2010).


In this review article he looks at how psychotherapy demonstrates brain plasticity and what that may reveal about consciousness in general. He suggests that functional changes in the brain as a result of cognitive behavioral therapy (CBT), for example, suggests that "consciousness changes in response to plasticity in the linked systems of the frontal, cingulate, and limbic cortices." The downsife of this, at present, is that we are not clear on how changes in those areas affect (or correlate to) different states of consciousness.

Full Citation: 
Collerton D. (2013, Sep 6). Psychotherapy and brain plasticity. Frontiers in Psychology: Consciousness Research. 4:548. doi: 10.3389/fpsyg.2013.00548

Psychotherapy and brain plasticity

Daniel Collerton^1,2

• ¹Clinical Psychology, Northumberland, Tyne and Wear NHS Foundation Trust, Gateshead, UK
• ²Newcastle upon Tyne, Newcastle University, UK

In this paper, I will review why psychotherapy is relevant to the question of how consciousness relates to brain plasticity. A great deal of the research and theorizing on consciousness and the brain, including my own on hallucinations for example (Collerton and Perry, 2011) has focused upon specific changes in conscious content which can be related to temporal changes in restricted brain systems. I will argue that psychotherapy, in contrast, allows only a focus on holistic aspects of consciousness; an emphasis which may usefully complement what can be learned from more specific methodologies.

Introduction

For the last century or so, psychotherapy has aimed to change the mind. And if it has been effective in doing so, it must have lead to lasting changes in conscious content, and potentially in the process of consciousness itself. Few other human endeavors seek so systematically to produce predictable enduring variation in emotion, cognition, behavior and somatic perceptions; changes which can persist for many years beyond the end of therapy. Over the last few decades, as methods have become available for measuring brain structure and function, it has provided a potential real-life method by which meaningful changes in consciousness can be related to measures of brain function. Admittedly, thus far interest has been on understanding what brain function can tell us about how psychotherapy works (for example, Jokić-Begić, 2010) rather than the aim of this paper—what psychotherapy can tell us about how the brain and mind are linked. However, in theory, it should be possible to assess consciousness, or at least some aspects of it, before and after psychotherapy, and to relate these to brain changes. And indeed, as described later, such studies have been done. The evidence is still sporadic and somewhat contradictory, but there is more potential now than ever before to correlate psychotherapy-related changes in mind to changes in brain.

In this paper, I will survey the current situation, outlining the formidable conceptual and practical difficulties which still need to be overcome, and suggest a potential strength of psychotherapy as a tool for understanding consciousness which, in combination with advances in functional imaging analysis, may give a way forwards.

Challenges of Definition and Measurement

There are a number of intractable definitional and measurement issues in this field which have been only partially solved.

Consciousness itself is a fuzzy concept—and its components are no clearer, as illustrated by the continuing discussions on whether it even exists as a meaningful phenomenon. James explicitly posed the question in the first, 1904, volume of the Journal of Philosophy, Psychology, and Scientific Methods and over a century later the answer is still not clear. As exemplified by Newell and Shanks (in press), the nature and role of consciousness and its relationship to behavior are still under discussion.

The term psychotherapy equally lacks definition. It has been applied to an exceptionally wide range of approaches with differing models, techniques, goals, and outcomes. Feltham and Horton's (2012) Handbook, for example, surveys some 23 major approaches from Dialectical Behavior Therapy to Psychodrama.

Finally, though methods of investigating in vivo brain function are incomparably better than even a decade ago, they are still limited in cognitive, temporal, and spatial resolution, while the large and intrusive technology involved limits applications to settings which bear little relationship to everyday life.

In the face of fuzzy concepts and methods, there is a scientific temptation to retreat into investigating relatively specific, easily measureable, aspects of consciousness and the brain. However, looked at in another way, this very lack of focus may be a strength rather than a weakness in that it forces attention to holistic changes in consciousness which can then be related to systemic changes in neural networks.

The Effects of Psychotherapy

Within the vast variety of psychotherapies, Cognitive Behavioral Therapy (CBT) has become the most widely accepted approach, and has amassed a strong body of evidence of effectiveness (Butler et al., 2006). It leads to long lasting, reproducible changes in emotion, cognition, behavior, and somatic symptoms across a range of mood and other psychological disorders. This strongly suggests that CBT is a powerful means of changing consciousness. CBT has always had a marked emphasis on measurement and it is also the therapy whose effects have most often been related to brain changes. For these reasons, I will take it as the exemplar psychotherapy for the purpose of this paper, while acknowledging that other approaches may be equally valid.

If we want to relate the effects of psychotherapy on consciousness to brain changes, it would seem necessary to know the changes it produces and how it does so. Consciousness itself is not directly accessible of course, so, as summarized in Table 1, researchers have taken a number of routes to inferring what is in the consciousness of a patient. Self-report, observer report, behavioral measures, and experimental tasks can be used to more or less directly infer changes in the content of patient's conscious thought. Taken together, these methodologies have produced good evidence that the complex combinations of emotions, cognitions, behaviors and somatic symptoms which characterize mood disorders do shift as a result of CBT.

TABLE 1

Table 1. Indicators of consciousness used in CBT outcome studies.

What Changes as a Consequence of Psychotherapy?

However, evidence is lacking as to what specifically changes as a consequence of psychotherapy (see, for example, Murphy et al., 2009). Despite the range of different ways of measuring the effects of psychotherapy noted above, it is striking how closely these are related. Thus, change in one symptom area, for example cognition, is accompanied by changes in other symptom areas such as emotion or behavior; at least as averaged over the timescales and group numbers common in treatment trials.

Similarly, though there is evidence that different modalities of therapy may have different levels of effectiveness (see Tolin, 2010 for a meta-analytic comparison of CBT with other therapies), where this does occur this appears to be more a quantitative than a qualitative difference. The outcomes of psychodynamic, person-centred, and behavioral psychotherapy are broadly equivalent despite their varieties of approaches and targets for therapeutic change (Stiles et al., 2008; Budd and Hughes, 2009) perhaps because they work via common final paths (Mansell, 2011).

Even treatments as different as CBT and pharmacotherapy appear to have broadly similar outcomes in, for example, depression (DeRubeis et al., 2008) with no reliable evidence of the differential effects of CBT on negative cognitions or medication on somatic symptoms as might have been expected from their mechanisms of action. Attempts to predict which patients might benefit from any specific intervention have not been successful.

Taking all of these comparisons together, there is very little evidence that specific areas of consciousness can change in a meaningful way without these effects rippling through the rest of consciousness. This suggests that trying to fractionate the effects of psychotherapy on consciousness into components might not be possible. It is the totality of consciousness which changes as a result of CBT rather than one specific aspect of it.

Implications for Linking the Effects of Psychotherapy to Brain Plasticity

This has implications for relating the effects of CBT to brain plasticity. Traditionally, neuroscience has adopted a reductionist approach to the brain; relating specific psychological functions to specific brain areas. This has been enormously successful with many psychological functions. Amongst many other pairings, neuropsychological localization has linked learning to the hippocampus and other structures in the medial temporal lobe, object perception to the ventral visual stream, and language to the left temporal cortex. However, the localization paradigm has left in its wake the binding problem—how the functions of disparate brain areas are tied together to produce the usual subjective sense of a single coherent consciousness. In this context, perhaps the holistic effects of CBT and other psychotherapies on consciousness become a means of side stepping the binding problem. If significant changes in bound consciousness can be related to restricted changes in brain function, that might narrow down the candidate brain areas which may underlie consciousness.

Effects of CBT on Measures of Brain Function

The plasticity in human brain which underlies individual, idiosyncratic and instantaneous elements of consciousness—specific words, thoughts, images, feelings, and memories—comes from tiny, subtle, and dynamic changes which are embedded within and across networks of microscopic cells. In comparison, our ways of measuring plasticity in the human brain have to trade off cognitive (the ability of scans to resolve precise psychological states, particular memories for instance), spatial, and temporal resolutions with even the best resolution vastly greater than the fundamental mechanisms of plasticity. The spatial resolution limit of a Magnetic Resonance Imaging (MRI) scan, our best current means of directly assessing brain structure and function, contains somewhere around 9 million brain cells (deCharms, 2008).

However, this has not prevented functional imaging, particularly functional MRI (fMRI) to identify which areas of the brain change following psychotherapy. (There have been a rather small number of structural imaging studies of the effects of psychotherapy, mainly in eating disorders, but many of these have been confounded by the effects of weight gain and loss on brain structure (Lobera, 2011) making it difficult to interpret their results).

The dominant paradigm has been to compare levels of brain activity pre and post CBT to see what changes. This approach has mainly been used in depression and has identified that changes are localized to specific frontal, cingulate, and limbic areas. There is decreased activity in the limbic system, especially the amygdala, with dorsolateral prefrontal cortex becoming relatively more active and orbitomedial and cingulate cortex less so; a move toward normality from patterns observed before treatment (Ochsner et al., 2002; Goldapple et al., 2004; Malhi et al., 2004; Ritchey et al., 2011; Höflich et al., 2012) and consistent with what is know of the processing of emotional stimuli (Simpson et al., 2000; Northoff et al., 2004; Leppänen, 2006; Beck, 2008). Pre-treatment levels of cingulate activity can even predict response to CBT with some reliability (Konarski et al., 2009; Ritchey et al., 2011; Siegle et al., 2012).

There have not been comparisons between the effects of different types of psychotherapy on the brain (potentially interesting in view of their equivalent effects on consciousness), but there are conflicting reports of the effects of pharmacotherapy; similar changes in brain activity to those following psychotherapy were not seen after antidepressant treatment by Goldapple et al. (2004) though they were identified by Furmark et al. (2002); opening up, but not confirming, the possibility that different brain changes might have similar effects on consciousness.

Taken as a whole, this evidence would suggest that the holistic changes in consciousness seen after psychotherapy for depression are associated with changes in a relatively restricted number of brain areas; mainly frontal, cingulate, and limbic cortex, with the implication that plasticity in those areas is particularly associated with persistent variations in consciousness.

However, a one to one correspondence between change in depression and change in specific brain areas may be over stated (Linden, 2006; Frewen et al., 2008; Dichter et al., 2012). For example, very similar changes in those brain areas are seen after CBT and other psychological treatments for anxiety (Furmark et al., 2002; Paquette et al., 2003; Straube et al., 2006; Porto et al., 2009; Freyer et al., 2011), schizophrenia (Wykes et al., 2002), eating disorders (Vocks et al., 2011) and Irritable Bowel Syndrome (Lackner et al., 2006). This is consistent with a consciousness network which depends upon these brain areas (and no doubt others) but it also suggests that there is a large overlap in the brain changes associated with different holistic states of consciousness. At present, fMRI data would suggest that, simply put, CBT is associated with a decrease in emotionality (less limbic activity) and an increase in thoughtfulness (increased dorsolateral frontal activity), as would be expected from its aims and methods (Clark and Beck, 2010). Though we may be able to link consciousness to a subset of anatomical structures using psychotherapy as an investigative tool, we appear to lack specificity in our account of how different states of consciousness could arise. Is it that in using psychotherapy to localize holistic changes in consciousness to a restricted set of brain structures, we have lost the ability to account for why consciousness is so idiosyncratic and so changeable?

A Potential Way Forward

An analogous challenge has arisen in fMRI studies of visual perception. Early attempts to localize specific perceptions to specific brain areas worked only for grossly different stimuli—visualizing navigating a house compared to imagining playing tennis (Owen et al., 2006)—or for simple stimuli in early, highly specialized, visual areas (Kay et al., 2008). More latterly, however, multivoxel pattern analysis (MVPA), in which patterns of activity across wide areas of the brain are analyzed, has produced a significant increase in cognitive resolution. Fairly similar stimuli, for example chairs and shoes (Norman et al., 2006; deCharms, 2008; Poldrack, 2011), or over-riding categories of images such as living or non-living (Naselaris et al., 2012) can now be recognized from pattern information fMRI (Formisano and Kriegeskorte, 2012) data. Not only perceptions, but also images and memories (Chadwick et al., 2012; Rissman and Wagner, 2012) are starting to be distinguished. Beginnings are starting to be made in reproducing data across as well as within subjects (Accamma and Suma, 2012; Raizada and Connolly, 2012). Significantly, cognitive resolution appears to increase as the focus of the analysis is widened to include more brain areas.

MVPA might therefore lead to the ability to map holistic changes in consciousness to patterns within and across the regions that classic fMRI has identified as responsive to psychotherapy (Siegle et al., 2007). Thus it may provide the mechanism to bridge holistic and specific variations in consciousness and brain.

Conclusions

It is clear that CBT, and probably other psychotherapies, alters consciousness in personally important, lasting, and measurable ways. Brain function and brain structure are different after CBT. Looking at functional changes in the brain suggests that consciousness changes in response to plasticity in the linked systems of the frontal, cingulate, and limbic cortices. However, we do not know how modulations in those areas link to different states of consciousness. Using the most recent imaging analysis to map activity simultaneously across these regions might give the missing specificity; allowing whole brain changes to be mapped to holistic changes in consciousness.

In order to do this, our next challenge will be to develop ways of capturing the experience of consciousness as a whole rather than, as we have tried to do in the past, the individual thoughts, images, and emotions which are bound together to produce it.

Conflict of Interest Statement

The author declares that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

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