The higher-order thought (HOT) theory of consciousness is a reductive representational theory of consciousness which says that what makes a mental state conscious is that there is a suitable HOT directed at that mental state. Although it seems that any neural realization of the theory must be somewhat widely distributed in the brain, it remains unclear just how widely distributed it needs to be. In section I, I provide some background and define some key terms. In section II, I argue against the view that HOT theory should treat first-order (i.e. world-directed) conscious states as requiring prefrontal cortical activity though it is reasonable to suppose that conscious states are realized in the brain. In section III, I then explore some of the key background metaphysical issues involved in understanding the nature of consciousness, such as the debate between realism and idealism as well as the prospects for solving the so-called “hard problem” of consciousness. Some of the differences in question often mirror the traditional differences between Western and Eastern perspectives on the nature of consciousness. Overall, I argue that some form of realism and physicalism is more plausible than the opposing views. I also argue that materialists (and especially HOT theorists) can offer plausible replies to the hard problem.