Coma and the tyranny of mental life

A research team led by neurologist Nicholas Schiff has recently published a brain scanning study on two patients who may show evidence of an internal mental life, despite being in a coma-like “minimally conscious state”.

MCS usually occurs after severe brain damage and is a condition where patients seem to be unconscious, but show intermittent awareness of the self or the environment, although they are not able to communicate or maintain this awareness for pronlonged periods of time.

It is thought to be ‘less severe’ than coma, where patients are entirely unresposive, or persistent vegetative state, where patients are unconscious but may show simple automatic functions such as the sleep-wake cycle or eye-tracking.

Schiff’s study found that an area of the temporal lobe, known to be involved in language comprehension, was activated when the two unconscious patients were played recordings of a friend or relative recounting a familiar event.

These responses were remarkably similar to the responses recorded from healthy participants used as controls. This surprised the researchers, who expected far less brain activity in the MCS patients.

One further result they describe as “haunting” was finding activity in the patients’ occipital lobe. The researchers speculate that activity in these areas may reflect memories and mental images triggered by the recordings and the sound of their family member’s voice.

Little is known about the functioning of the brain during these coma-like or miminally conscious states, and medical science is often surprised by the recovery of function even after prolonged periods of unconsciousness.

Terry Wallis, the subject of a recent Channel 4 documentary, regained consciousness after a record 19 years in a coma.

Link to abstract of Schiff study.
Link to news story about the study from Yahoo News.
Link to information on Terry Wallis, his recovery and the documentary about him (“The Man Who Slept for 19 Years”).

3 Comments

  1. Posted February 9, 2005 at 7:12 pm | Permalink

    Disturbing stuff
    Karl Zimmer is good on this here:

    http://www.corante.com/loom/archives/consciousness_and_the_culture_wars_part_three.php

    But Vaughan, why the ‘tyranny’ of mental life?

  2. Vaughan
    Posted February 9, 2005 at 9:23 pm | Permalink

    Because it seems the patients may have memories triggered by external prompting, but are unlikely to have conscious control over them, perhaps to call them up unbidden, or surpress others they would rather forget.
    It seemed in stark contrast to locked-in syndrome, another, almost as terrifying disorder. This is where the brain stem is damaged and although the conscious mind seems intact, there is no conscious control over the body.
    Jean-Dominique Bauby, editor of the French Elle magazine, suffered a stroke and became ‘locked-in’. He subsequently wrote the book “The Diving Bell and the Butterfly” by indicating one letter at a time with the flick of an eyelid, virtually his only method of communication.
    It is a humane and beautifully written book, but the difference between the conditions is striking. Bauby writes:
    “My cocoon becomes less oppressive, and my mind takes flight like a butterfly. There is so much to do. You can wander off in space or in time, set out for Tierra del Fuego or King Midas’ court.
    You can visit the woman you love, slide down beside her and stroke her still sleeping face. You can build castles in Spain, steal the Golden Fleece, discover Atlantis, realize your childhood dreams and adult ambitions.”
    Both conditions seem to involve being ‘trapped’ in the body in some way, although perhaps the mind is much less self directed in MCS, remaining in a passive, but in some respects, surprisingly functional state.

  3. Posted February 10, 2005 at 6:57 pm | Permalink

    Yikes. I remember writing an essay for creative writing at school on precisely this issue – whether an internal mental life could be a legitimate bulwark against euthanasia, or ceasing active life support. But that’s partly why this research is so important – and important that we continue to recognise that not responding to environment /= not conscious /= no longer capable of conscious experience, while at the same time being aware that if the brain is sufficiently damaged, the latter category may well occur, even if the person seems ‘alive’ to ourselves.
    Also, this phenomena occurs in the book Mother London by cult writer Michael Moorcock (and I say cult in the sense that he has a massively loyal fan-base, and has carved very much his own path in literature, not cult in the sense that some people use – “This is going to be a cult classic!” ie shit). That character spends some 16 years under, with some awareness of the outside but mainly preoccupied with a rich, continuous internal narrative involving film stars and figures from her past. It’s an interesting read, though, I stress, not a replacement for either of the two real-life accounts Vaughan mentions.


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