More thoughts about the role of awareness, cognition, and consciousness

Victor J. Schoenbach, 8/27/2006, 9/29/2009, 8/19/2010

If you read or listened to my lecture on the Role of Epidemiology in Public Health (link), you probably realized that it is very much a work-in-progress. I’ve been thinking about and working with the ideas in it for many years, but in an avocational manner. Here are some of the things I've come across and thought about. (Google recently pointed me to

One of the themes I’ve reflected on is the need to increase our understanding of human awareness, or consciousness, and the determinants of how our species thinks, perceives, and behaves. The terms awareness and consciousness seem metaphysical to many and need operational definitions. But we use these concepts in our everyday lives.

We think and perceive differently when we are awake than when we are asleep, and differently when we are dreaming than when we are not dreaming. These three states of consciousness - waking, dreaming, and deep sleep - provide different types of awareness. Even in deep sleep we have some awareness, since otherwise we could not be roused by an alarm clock. The Science of Creative Intelligence envisions four additional states of consciousness, and one of these - transcendental consciousness, often called “restful alertness” - is widely experienced through the Transcendental Meditation technique. (website)

“Awareness” and “consciousness” are also used to refer to ways of thinking in our ordinary waking consciousness, as illustrated in such phrases as “raising consciousness”, “being environmentally aware”, and so on. There are people who when they walk into a room seem to immediately pick up on the emotional ambience, whereas others do not. So people have different types and levels of awareness, and it is often a great advantage to have broader awareness - the ability to imagine and envision possible consequences, ramifications, implications. I think the case can be made that a great deal of harm to public health arises from narrow awareness, from being oblivious to the broader impacts of our words and actions. So although I do not have a plan for how to measure awareness, I think that the epidemiology of awareness is a field worth developing.

There is actually a growing body of scientific literature looking at biological and psychological aspects of cognition, decision-making, and consciousness itself. In a classic article in Science magazine, in 1974, Amos Tversky and Daniel Kahneman (Judgment under uncertainty: heuristics and biases, Science 185:1124) recounted their experiments and theory about how people make decisions involving probabilities. The authors identified several techniques (“heuristics”) that people rely on to reduce complex judgments to simpler ones, thus enabling faster responses - though at a price. Although most of the experiments involved university students, Tversky and Kahneman have been able to demonstrate the same sorts of tendencies among professionals.

For example, the “representativeness” heuristic involves assigning objects to classes based on their characteristics but ignoring information on prior probabilities (we have seen these in the form of population prevalence, as for a condition being detected by population screening). The heuristic can be observed by presenting a scenario in which there are two kinds of professionals (e.g., accountants and attorneys), providing a description that could refer to either of the professions, and asking subjects for the probability that someone fitting the description is, for example, an accountant. Because there are two possibilities, subjects typically assign a probability of 0.5, regardless of whether they have also been told that the ratio of the occupations in the reference group was 0.7:0.3 or 0.3:0.7.

Another aspect of the representativeness heuristic is a tendency to ignore the implications of sample size. Here is an example from Tversky and Kahneman’s article:

“A certain town is served by two hospitals. In the larger hospital about 45 babies are born each day, and in the smaller hospital about 25 babies are born each day. As you know, about 50 percent of all babies are boys. However, the exact percentage varies from day to day. Sometimes it may be higher than 50 percent, sometimes lower.

“For a period of 1 year, each hospital recorded the days on which more than 60 percent of the babies born were boys. Which hospital do you think recorded more such days?

____ The larger hospital (21)
____ The smaller hospital (21)
____ About the same (that is, within 5 percent of each other) (53)”
(Tversky and Kahneman, 1974, p1125).

The numbers of undergraduate students endorsing each response choice indicate that they are taking no account of the concept that larger samples are less likely to stray from the population mean (clearly the students had not read the EPID600 lecture on Cross-sectional Studies).

Tversky and Kahneman describe a number of misconceptions about chance, such as a belief in a tendency for deviations from the population mean in one direction to induce a deviation in the opposite direction. Additional biases described are an irrational belief in the ability to predict outcomes, a tendency to attach too much confidence to these predictions, biases of imagineability, and anchoring in the assessment of subjective probabilities.

Another important bias in choice under uncertainty is the tendency for choices to be influenced by the way in which the question is presented (Tversky A, Kahneman D. The framing of decisions and the psychology of choice. Science 30 January 1981:211(4481):453 - 458)). Tversky and Kahneman illustrate the framing effect with an experiment involving two problems:

“Problem 1 [N=152]: Imagine that the U.S. is preparing for the outbreak of an usual Asian disease, which is expected to kill 600 people. Two alternative programs to combat the disease have been proposed. Assume that the exact scientific estimate of the consequences of the programs are as follows:

If Program A is adopted, 200 people will be saved [72 percent]

If Program B is adopted, there is 1/3 probability that 600 people will be saved, and 2/3 probability that no people will be saved. [28 percent]

Which of the two programs would you favor?”

In Tversky and Kahneman’s words, “the prospect of certainly saving 200 lives is more attractive than a risky prospect of equal expected value, that is, a one-in-three chance of saving 600 lives.”

“Problem 2 [N=155]:

If Program C is adopted 400 people will die. [22 percent]

If Program D is adopted three is 1/3 probability that nobody will die, and 2/3 probability that 600 people will die. [78 percent]

Which of the two programs would you favor?”

Here, the majority prefer the risky choice.

All four programs (A,B,C,D) have the same expected value for the outcomes: 400 people die, and 200 are saved. The difference between the first and second alternatives within each problem is the presence of uncertainty. The difference between the first and second problems is the framing of the alternatives in terms of lives saved or lives lost. The pattern observed in this and other experiments is that “choices involving gains are often risk averse and choices involving losses are often risk taking”.

I’ve recently come across several articles that probe cognitive processes and their neurobiological bases. I have a long way to go to digest them, but I think they provide examples of the kind of understanding we need to develop.

A study published several years ago (“Frames, biases, and rational decision-making in the human brain”, Benedetto De Martino, Dharshan Kumaran, Ben Seymour, and Raymond J. Dolan. Science 4 Aug 2006;313:684-687 plus supplemental on-line material) builds upon the Tversky and Kahneman findings to suggest that there are consistent interpersonal differences in susceptibility to being influenced by framing, and that activation of the area of the brain known as the amygdala is associated with the framing effect. (Abstract)

Two more recents students of - and talented authors about - human decision-making are Dan Ariely (website) and Jonah Lehrer (website). Dan Ariely gave a Dean’s Lecture at the UNC Gillings School of Global Public Health in 2010 (webcast).

A team of researchers at Duke University have carried out several studies showing facial traits of corporate chief executive officers influence judgments of “competence”. Competence ratings are associated with executive compensation but not with performance of the firms. (Graham, John R., Harvey, Campbell R. and Puri, Manju, A Corporate Beauty Contest. March 2010. SSRN: //ssrn.com/abstract=1571469.

There is a faculty member at UNC (Keith Payne, Ph.D.) whose Social Cognition lab studies questions such as “Why do people sometimes act in prejudiced ways even when they intend to be fair?”, “Do you have opinions or beliefs that you don’t know about?”, “How do people set aside unwanted biases and act the way they want to?”, and “What happens when that process breaks down?”.

Another recent article (Damon Tomlin et al., Agent-specific responses in the cingulated cortex during economic exchanges. Science 19 May 2006;312:1047-1050) reports the results of experiments examining brain activity during a series of games in which subjects are engaged in a game that requires assigning social agency (judging who is responsible for an outcome). The authors “found two distinct response types along the cingulate cortex consistent with agent-specific responses that signal ’me’ and ’not me.’” (p1049) (Abstract)

Although I’ve not yet read the articles themselves, I found an intriguing exchange of letters in the 11 August 2006 issue of Science (vol 313, pp760-761) debating the article “On making the right choice: the deliberation-without-attention effect” (AP Dijksterhuis et al., Science 17 Feb 2006, p.1005). The article claimed to have observed that under complex decision circumstances, unconscious thinkers made better decisions than did conscious deliberators. In their response to a critical letter, the authors suggest that “the idea that conscious deliberation before making decisions is always good is simply one of those illusions consciousness creates for us.” (11 Aug 2006, p760) (Abstract)

A fascinating article in Science (Joshua M. Ackerman et al. Incidental haptic sensations influence social judgments and decisions 25 June 2010;328:1712-1715) reports that “In six experiments, holding heavy or light clipboards, solving rough or smooth puzzles, and touching hard or soft objects nonconsciously influenced impressions and decisions formed about unrelated people and situations. Among other effects, heavy objects made job candidates appear more important, rough objects made social interactions appear more difficult, and hard objects increased rigidity in negotiations. Basic tactile sensations are thus shown to influence higher social cognitive processing in dimension-specific and metaphor-specific ways.” (Abstract)

National Public Radio’s Weekend Edition Sunday on 12/17/2006 included a report “The Science Behind Making Moral Decisions” in which researchers describe psychological and neurological research probing the processes that underlie decisions about ethical and unethical behavior.

Finally, an article by Thomas Suddendorf (Foresight and evolution of the human mind. Science 19 May 2006;312:1006-1007), discussing whether the capacity for foresight is present in our evolutionary ancestors, concludes “It is time to carefully investigate foresight, because humans may need to get better at it if we are to continue to survive.” Amen.

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