Hitting and missing on consciousness

Disturbances of conscious experience are central features of many psychiatric and mental health disorders. Experimental studies of conscious perception are therefore increasingly cited in clinical and translational work under the assumption that they identify neural mechanisms specific to subjective experience. Over the past decades, recording and analysis techniques have advanced substantially and many candidate neural markers of consciousness have been proposed; however, these markers may not genuinely reflect consciousness per se unless the underlying experimental paradigms are sufficiently stringent. We focus on one of the most widely used paradigms in basic and clinical research on consciousness: contrasting successful and unsuccessful detection of near-threshold sensory stimuli ("Hit & Miss" paradigms). Reporting stimulus presence depends not only on subjective experience but also on decision criteria that can vary independently of any genuine conscious threshold, as well as on fluctuations in perceptual processing capacity and prestimulus cognitive states. We explain why proposed refinements, such as the Perceptual Awareness Scale, binocular rivalry, and no-report paradigms, do not fully resolve these problems, and why many putative "neural correlates of consciousness" may instead index more general cognitive/perceptual capacities. These confounds have important implications for how basic consciousness research is interpreted in relation to hallucinations, flashbacks, and other disorders of experience. We outline alternative experimental strategies, inspired in part by blindsight and related dissociation paradigms, that more cleanly separate conscious perception from decision criteria and perceptual capacity, and may therefore provide a more reliable foundation for linking neural data to subjective experience in psychiatry and clinical neuroscience.