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In everyday psychiatric practice consciousness is a basic datum, an unquestioned axiom. Indeed, a recent edition of the Oxford Textbook of Psychiatry contains no discussion of consciousness as such, and spends less than a page on 'disorders of consciousness', most of which is devoted to its 'clouding'(1) . Yet I entered psychiatry partly because I thought that my puzzlement about consciousness might partly be relieved by studying its pathology.
Perhaps I was not entirely on a false trail. Karl Jaspers, who was a psychiatrist and contemporary of Jung before he became a philosopher, published in 1913 his Allgemeine Psychopathologie ( General Psychopathology (2)). This grounded orthodox British and German psychiatry in the phenomenological approach, which was subsequently taught since to generations of trainees. One of his central distinctions is between 'erklärende Psychologie' and 'verstehende Psychologie', that is to say between a psychology which explains and one which understands; the latter he also describes as a psychology of 'meaningful connections'. This distinction reflects the Cartesian dualism between brain and mind, between the objective and the subjective.
Freud of course also wrote in German, but his influence until recently was greater America than Europe. In spite of his expectation that in time a neurological basis would be found for psychology and for psychopathology (so bridging the Cartesian divide), most would see his work as a clear example of a psychology of meaningful connections, a psychology of the mind and not the brain. Though certainly not the discoverer of the unconscious, he brought to prominence the undoubted truth that all that is mental is not necessarily conscious. For Freud, the unconscious is an aspect of the mind which equally influences action, though the issues raised for example by the concept of an unconscious desire are left unaddressed by him.
However, in his depiction of the unconscious Freud did not go far enough: as Claxton among many others has highlighted (3) , most brain functioning has to do with the unconscious regulation of bodily processes. What is striking perhaps is that a few at least of these processes can be brought into awareness (into mind),and indeed can by some people be made subject to conscious control. Claxton has also stressed the multiple nature of the conscious self: 'one man in his time plays many parts'.
Different strands in psychiatry have chosen one side of the Cartesian divide or the other as their (implicit or explicit) foundation. Thus biological psychiatry assumes that the brain is the seat and origin of the mind, and uses drugs or similar interventions to influence the mental state via the brain. Psychodynamic psychiatry , and psychotherapy more generally works, as I have said, directly on the mind through the meaning of words. Cognitive therapies assume that complex parallel connections in the brain result in an emergent mind, and thus use techniques that are believed to modify the patterns of those connections. Neuropsychiatry focuses on neural systems, neurotransmitters and organic brain mechanisms. Social psychology and psychiatry set out to modify the mind of the individual by manipulating the environment. And so on; each sub-specialism is grounded on one side or the other of the Cartesian divide, though in each case the effect of an intervention is assummed to bridge that divide.
When I first entered the speciality 30 years ago the antagonism between the two poles represented by brain-based organic psychiatry and mind-based psychodynamic psychiatry was bitter and often destructive. Superficially that battle is now largely over. We know a great deal now about when to employ which particular approach or technique to best therapeutic effect. Thus most modern psychiatrists describe themselves as eclectic, using their judgement to deploy the appropriate treatment at the time when it will be most effective: antidepressants first, later psychotherapy and family or social interventions, for example. While this mixed approach is enormously to the benefit of their patients, it ignores an underlying weakness of the eclectic position: because it contains but conceals a fundamental paradox (how is it that consciousness can span that divide), if pursued without discrimination it can lead only to frustration and a dead end.
The transpersonal psychiatrist Stanislav Grof, among others (4) , has set out evidence for experiences which suggest (though they do not prove) the penetration of events in an earlier existence into a current consciousness (5) . (In this context we can recall that William James pointed out that the brain may transmit rather that generate consciousness, for which it may act as a filter or lens. (6)) Grof describes criteria that mental health professionals and others can use to distinguish between pathological conditions like schizophrenia from such transpersonal experiences. Ken Wilber, to whom I refer later, also provides guidance, within a complex but convincing theoretical framework, for separating mystical and transcendental states from the pathological, which alone is the concern of psychiatry (7).
I confess that I am uneasy about the concept of a model in this context. It runs the risk of falling into one or both of the fallacies described by Whitehead: that of misplaced concreteness and that of simple location . We should not seek for a reduced simulacrum, like a model train, nor for a mere simplification, like a flow chart. Better perhaps to develop a procedure or method for attaining to an understanding of the paradox of the mind.
My starting point is that although mental activity can (usually) be correlated with activity in the brain, it cannot be reduced to such brain activity. However, while consciousness has no existence (concreteness, location) in the external world, it is indubitably real. Entities, and human beings in particular, have both exterior (objective, third-person, brain) aspects, and interior (subjective, first-person, mind) aspects; both are equally real, and neither can be reduced to (explained by) the other.
In earlier times (both of our culture and of the individual) this distinction between inner and outer had not been made. One of the achievements of the Enlightenment and of Modernism is to have differentiated mind from body. The central task facing us now is to integrate them (not reintegrate, since in the West at least they have never before been distinguished.) Post-modernism will lead nowhere since it relies on a false and featureless relativism and not on a broad-based but narrowing developmental hierarchy or holarchy. This issue of consciousness is an example of the more general point, that what is puzzling and paradoxical at the evolutionary level at which a particular differentiation has occurred can never be understood at that level. Only when that level is transcended can resolution take place, the differentiated be integrated, and understanding dawn.
Those who read the Journal of Consciousness Studies (8) , or any of his recent books (9) (10) , , will recognise that this analysis is derived directly from Ken Wilber, though his scheme (or model!) is much more detailed and elaborated. Not only that, he lays out a great deal of evidence to support both the broad sweep and the details of his claims. Without that evidence this scheme may seem empty: all that this analysis above tells us is that we have recognised a problem but not yet solved it. With the detail and the evidence his 'organising generalisations' become increasingly compelling.
Let us then accept that individual and cultural development takes place as a sequence of stages each of which transcends and includes its predecessor, and in which the paradoxes and puzzles of one stage can only be understood when we attain the next. This suggests an important conclusion: it is not the content of our current science (either its data or its method) that makes the hard problem of consciousness so hard, it is the way we do our science . And the way we do science is a reflection of what we are : integration of inner and outer, the solution of the problem of consciousness 'demands a transformation of consciousness in the researchers themselves' (11) .
What might be the nature of that transformation? Wilber has his own answer, but I want merely to point towards a man who may have glimpsed its nature: the German scientist and poet Goethe. He made good use of the tools available in his day to investigate the surface of things, but he understood that a scientist's principal tool is his own consciousness, and he understood that science ( and all knowledge) begins with an injunction to act (a piece of behaviour - look through this microscope and you will see bacteria), proceeds to observation and concludes with verification. Although he scorned 'thinking about thinking', he developed 'organs of perception' which enabled him to perceive what Henri Bortoft calls 'multiplicity in unity' where others struggled towards 'unity in multiplicity' (12) . This enabled him not only to perceive through time and space the many holographic representations of the one Plant, but also to participate in the reality of that plant; in that act of participation he sensed the Unity of which he and the Plant were both manifestations. In this way he began to unite subject and object, and thus to integrate mind and matter. But here begins another essay.
So in order to resolve the hard problem of consciousness researchers must transform their own consciousness. Rather than follow this daunting and necessarily reflexive conclusion any further, I want finally to return to the pathology of our mental life. Does the model sketched above contribute to psychiatric understanding, and could psychiatry help refine the model?
In this particular staged view of development, not only does each stage transcend and includes its predecessor, each stage also contains the potential for its own characteristic pathology if this transformation goes wrong. Thus psychosis relates to failure to establish the sense of a physical self, narcissistic and borderline pathologies to failure to develop an emotional self, neurosis to difficulties in differentiating mind and body, and so on. Although there is little new in this, it confirms the rightness of an expanded and well-structured diagnostic and therapeutic repertoire, and finally disposes of the stale antagonism between the organic (pill-pusher) and dynamic (talking treatment) wings - both and everything between have a valued place, sometimes alone, sometimes in combination.
I still believe as I did when a child and as do all good 'scientists' (potentially all of us) that the way things go wrong can teach us about how they work. As a child though I was immersed (as many scientists still are) in the fallacy of misplaced concreteness. Now I recognise that the inner and the outer are both real, and that grasping the way things are is not necessarily a matter of studying a mechanism, but often, perhaps always, a matter of understanding, of 'Verstehen', of intuition. As Jaspers acknowledged, perceiving meaningful connections is an essential element of good psychiatry. The hard problem of consciousness will only be solved when we can grasp synoptically, and thus participate in, the meaningful connection between mind and brain. Most of us are not yet sufficiently evolved to achieve that awesome understanding. Since we can only model something we already understand, any attempt to model consciousness without first transforming it within ourselves must fail.
1. Gelder, M., Gath, D., Mayou, R. (1992) Oxford Textbook of Psychiatry Oxford University Press
2. Jaspers, K. (1963) General Psychopathology trans. by J. Hoenig and M. W. Hamilton Manchester University Press
3. Claxton, G. (1994) Noises from the Darkroom Aquarian: HarperCollins
4. Woolger, R. (1994) Other Lives, Other Selves Aquarian: HarperCollins
5. Grof, C. & Grof, S. The Stormy Search for the Self (1990) Thorsons (written with his wife)
6. James, W. (1901) Human Immortality Gifford Lectures
7. Wilber, K. (1980) The Atman Project: a transpersonal view of human development Quest: Theosophical Publishing House (A second edition was published in 1996)
8. Wilber, K. (1997) An Integral Theory of Consciousness Journal of Consciousness Studies , 4 , 71-92
9. Wilber, K. (1996) A Brief History of Everything Shambhala
10. Wilber, K. (1995) Sex, Ecology, Spirituality: The Spirit of Evolution Shambhala
11. Wilber, K. (1997) op cit p85
12. Bortoft, H. (1996) The Wholeness of Nature: Goethe's Way of Science Floris