How the magic of cinema unlocked one man’s coma-bound world

Image from NIH. Click for source.An Alfred Hitchcock film helped to prove one patient had been conscious while in a coma-like state for 16 years. The discovery shows that neuroscience may still have lots to learn from the ancient art of storytelling, says Tom Stafford.

If brain injury steals your consciousness then you are in a coma: we all know that. What is less well known is that there exist neighbouring states to the coma, in which victims keep their eyes open, but show no signs of consciousness. The vegetative state, or ‘unresponsive wakefulness syndrome’, is one in which the patient may appear to be awake, and even goes to sleep at times, but otherwise shows no reaction to the world. Patients who do inconsistently respond, such as by flinching when their name is called, or following a bright object with their eyes, are classified as in a ‘minimally conscious state’. Both categories of patients show no signs of deliberate actions, or sustained reaction to the environment, and until recently there was no way for anyone to discern their true, inner, level of consciousness.

The fear is that, like the ‘locked-in syndrome’ that can occur after strokes, these patients may be conscious, but are just unable to show it. The opposite possibility is that these patients are as unconscious as someone in the deepest coma, with only circuitry peripheral to consciousness keeping their eyes open and producing minimal responses automatically.

In the last 10 years, research spearheaded by cognitive neuroscientist Adrian Owen has transformed our understanding of these shadowlands of consciousness. There is now evidence, obtained using brain scans, that some patients (around one in five) in these ‘wakeful coma’ states have conscious awareness. If asked to imagine playing tennis, the brain areas specifically controlling movement become active. If asked to imagine finding their way around their house, the brain regions involved in navigation become active. Using these signals a small minority of patients have even communicated with the outside world, with the brain scanner helping observers to mind-read their answers to questions.

The practical and ethical implications of these findings are huge, not least for the treatment of the hundreds of thousands of people who are in hospitals around the world in these conditions right now.

But the meaning of the research is still hotly debated. One issue is that the mind reading uses neural responses to questions or commands, and careful controls are needed to ensure that their patients’ brains aren’t just responding automatically without any actual conscious involvement. A second issue, and one that cannot be controlled away, is that the method used may tell us that these patients are capable of responding, but it doesn’t tell us much about the quality of conscious experience they are having. How alert, aware and focused they are is hard to discern.

In a relatively new study, a post-doctoral fellow at Owen’s lab, Lorina Naci, has used cinema to show just how sophisticated conscious awareness can be in a ‘minimally conscious’ patient.

The trick they used involved an 8 minute edit of “Bang! You’re dead”, a 1961 episode of “Alfred Hitchcock Presents”. In the film, a young boy with a toy gun obsession wanders around aiming and firing at people. Unbeknownst to him, and the adults he aims at, on this day he has found a real gun and it has a live bullet in the chamber.

The film works because of this hidden knowledge we, the viewers, have. Knowing about the bullet, a small boy’s mundane antics become high drama, as he unwittingly involves unsuspecting people in round after deadly round of Russian roulette.

Naci showed the film to healthy participants. To a separate group she showed a scrambled version involving rearranged one-second segments. This ‘control’ version was important because it contained many of the same features as the original; the same visual patterns, the same objects, the same actions. But it lacked the crucial narrative coherence – the knowledge of the bullet – which generated the suspense.

Using brain scanning, and the comparison of the two versions of the film, Naci and colleagues were able to show that the unscrambled, suspenseful version activated nearly every part of the cortex. Everything from primary sensory areas, to motor areas, to areas involved in memory and anticipation were engaged (as you might hope from a film from one of the masters of storytelling). The researchers were particularly interested in a network of activity that rose and fell in synchrony across ‘executive’ areas of the brain – those known to be involved in planning, anticipation, and integrating information from different sources. This network, they found, responded to the moments of highest suspense in the film; the moments when the boy was about to fire, for example. These were the moments you could only find so dramatic if you were following the plot.

Next the researchers showed the film to two patients in wakeful comas. In one, the auditory cortex became activated, but nothing beyond this primary sensory region. Their brain was responding to sounds, perhaps automatically, but there was no evidence of more complex processing. But in a second patient, who had been hospitalised and non-responsive for 16 years, his brain response matched those of the healthy controls who’d seen the film. Like them, activity across the cortex rose and fell with the action of the film, indicating an inner consciousness rich enough to follow the plot.

The astounding result should make us think carefully about how we treat such patients and marks an advance on the arsenal of techniques we can use to connect to the inner lives of non-responsive patients. It also shows how cognitive neuroscience can benefit from the use of more complex stimuli, such as movies, rather than the typically boring visual patterns and simple button-press responses that scientists usually use to probe the mysteries of the brain.

The genius of this research is that to test for the rich consciousness of the patient who appears unresponsive you need to use rich stimuli. The Hitchcock film was perfect because of its ability to create drama by what we believe and expect not because of what we merely see.

My BBC Future column from last week. The original is here. The original paper is: Naci, L., Cusack, R., Anello, M., Owen, A. M. A common neural code for similar conscious experiences in different individuals. PNAS. 2014;111(39):14277–82.

Spike activity 25-09-2015

Quick links from the past week in mind and brain news:

Science has a fascinating piece on how cultures developed words for numbers – many languages don’t have words for numbers above five.

The majority illusion. The social illusion covered by Tech Review where something can seem socially common despite being rare in the overall group.

Wired has a thought-provoking piece on the potential role of the internet in hastening the demise of dying languages.

Researchers who reported a study on how oxytocin increases trust try and fail to replicate their own results. Good coverage from Neuroskeptic.

The LA Times has a good piece in light of the Hajj disaster that dispels some crowd behaviour myths.

There’s a brilliant piece from boxer Jerome Wilson on what it’s like to recover from a serious brain trauma in The Telegraph. Really, it’s great, go and read it.

The Guardian covers the news that a man completes a 3.5-metre course thanks to computer system that reroutes signals from his brain to electrodes on his knees.

DeepMind’s AI can now beat humans at 31 Atari 2600 arcade games, reports TechRepublic. Still thinks ET was rubbish.

Pacific Standard has a fascinating piece on how our understanding of Neanderthals has dramatically and rapidly shifted.

Guy puts cameras in his home to record every second of his new baby’s life to record his exposure to language and work out how new words emerge. Great study and findings covered in Science News.

AlterNet has a good piece critiquing the concept of ‘sex addiction‘.

A museum of many minds

I spent a very long time in the old Bethlem museum, owing to the fact that there’s little else to do when you live at one of the world’s oldest psychiatric hospitals.

The Bethlem Royal Hospital, or Bedlam as it’s been known in centuries past, has moved many times over its lifetime, but it’s now located in one of London’s comfortable, sleepy suburbs. Unfortunately, there is very, and I mean, very little to do there on weekends.

The museum was occasionally open on Saturdays, and during the six months I lived at the hospital, I visited. Repeatedly, as it turned out.

But for an institution that was founded in 1247, that has been a central character in London’s history and formative in our understanding and misunderstanding of madness, the museum was surprisingly crap.

It lived in a small, bleak portakabin in the corner of the grounds. You would walk in, stare at a few tiny walls of exhibits and then chat to the curator, who would be so bereft of visitors that it would be like a turning on a ‘history of the Bethlem’ fire hose for a few minutes before you left them to solemnly contemplate the archives once more.

But after years of neglect, the portamusem has been replaced by the Museum of the Mind in the Bethlem Royal Hospital’s central building. To get an idea of how much the new museum is being valued, they kicked the hospital bosses out to make space for it.

Apart from the museum space, it also has two galleries. One dedicated to work from current patients and another that has guest exhibitions. It also does talks from historians and art workshops – on everything from art techniques to building websites. You can even buy Bedlam mugs and pencils in the museum shop – for reasons I’m not entirely sure of.

The museum itself is beautifully put together and is entirely focused on tackling the most contentious issues in mental health. Here’s a quote, painted in large letters on one of the walls:

“The words of psychiatry are often unjust stewards, sorry guardians of meaning, workers of deception.”

The quote, quite profound in itself, doesn’t have the same impact until you understand that it’s from Aubrey Lewis the ‘father of British psychiatry’ and one of the most important people in the history of the profession.

And it is this rather confrontational approach to psychiatry’s assumptions, now and in the past, which permeates the museum.

Many of these challenges come from the voices of patients themselves, either contemporary or historical, and the testimonies to medically-induced suffering sit alongside the testimonies to its value as a remedy to mental distress.

For those looking for something of the London gothic, there are strait-jackets, manacles, and panels from a genuine padded cell from an old asylum, but it’s hardly the gaudy tourism of the London Dungeon – not least because the framing is quite different – the question of what it means to be humane in treating people with mental health difficulties is a central theme.

This approach also means artwork from patients, some of whom have been the country’s most distinguished artists in their own right, is integral to the design of the museum.

While you’re visiting, by the way, have a walk through the hospital grounds. They’re open to the public, extensive and beautiful. Locals walk their dogs there and come in the use the swimming pool. It’s quite different from how many people imagine a psychiatric hospital to be (and it has to be said, quite different from how many other psychiatric hospitals are).

And before you leave the museum, don’t miss the guest book. I’ve visited twice but the comments and art in the guestbook have been one of the highlights.
 

Link to the Museum of the Mind website.
 

Disclaimer: I still work for the NHS Trust which is responsible for the museum and occasionally still work at the Bethlem. However, I have since moved out to less salubrious accommodation in South London’s out-of-control rental market. Do note, however, that the Bethlem is genuinely out of the way in suburban London. It takes a while to get there and there is still nothing else to do there on weekends.

Spike activity 18-09-2015

Quick links from the past week in mind and brain news:

GlaxoSmithKline straight-up lied about teen suicide attempts in a trial that was used to convince regulators that Paxil was safe for kids. In-depth from the BMJ. Good summary from The Atlantic.

The New York Times on basically the same shit from Johnson & Johnson over Risperdal. Jaw-dropping punchline: the profits were worth more than any financial blow-back in fines and law suits.

Fascinating article on how the ability to deceive is being built into AI and robot interactions from Fusion. To the bunkers!

The Whitehouse, yes, President Obama, issues an executive order requiring all government services to use behavioural science nudges ‘to Better Serve the American People’. “Your neighbours believe that we have always been at war with Eastasia…”

The neuroscience of Donald Trump. I SHIT YOU NOT. A Salon piece that should be a warning to everyone not to write neuroscience articles while high on butane.

The head of the world’s biggest mental health science organisation, the NIMH, is leaving to join Google. Will be deleting YouTube videos that mention the DSM.

Wired reports on a new campaign to ban sex robots. It’s the date-that-drags-on robots I want to see the back of.

The big review paper on the lack of political diversity in social psychology is finally out. Heterodox Academy has links to the full text.

MyCentralJersey reports on Jason Lunden, an autistic neuroscientist who researches the neuroscience of autism.

There’s a brilliant piece in The Psychologist about Geel in Belgium, where for 700 years boarders with learning disabilities and mental health problems have lived with residents.

Your ears emit sounds

There’s a fascinating article on the evolution of hearing in The Scientist that also contains an interesting gem – your ears produce sounds as well as perceiving them.

In addition to amplifying hair-cell activity, these active mechanisms manifest as spontaneous movements of the hearing organ, oscillating even in the absence of sound stimuli. Such spontaneous movements actually produce sound that is emitted through the middle ear to the outside world and can be measured in the ear canal.

I wondered whether this only applied to non-human animals – it’s not clear from the text – but a brief search brings up various studies on spontaneous otoacoustic emissions in humans. For example:

Spontaneous otoacoustic emissions were evaluated in 36 female and 40 male subjects. In agreement with the results of previous surveys, emissions were found to be more prevalent in female subjects and there was a tendency for the male subjects to have fewer emissions in their left ears.

It also turns out that spontaneous otoacoustic emissions are used to test hearing in newborn babies.

It’s an interesting problem, because normally hearing is tested by giving people tests where they are played various sounds or silence at certain time points and they have to signal whether they think they heard the sound, and correct decisions are counted.

This clearly doesn’t work with babies but one way of testing hearing is by measuring the response of nerve signals that connect to the auditory brain stem.

This training video shows how it’s done but in the last section there’s a test which relies directly on detecting the ‘echoes’ created by otoacoustic emission when a tone is played directly into the ear.
 

 

Link to The Scientist article on the evolution of hearing.

Spike activity 11-09-2015

Quick links from the past week in mind and brain news:

Mental illness throughout the animal kingdom. Interesting piece from BBC Earth.

The Guardian has an excellent in-depth article on scorpion venom as a way of identifying brain tumours during neurosurgery.

There’s an excellent piece on the history of using deception in psychology studies over at Aeon.

The Covnersation has an excellent piece on how so much talk about ‘the brain’ in education is meaningless.

Psychology Should Aim For 100% Reproducibility. Some Grade A trolling from Neuroskeptic.

Robohub has an interesting piece on ‘morphological computation’ and the hidden superpower of soft-bodied robots.

Yet another ancient human / hominin species is discovered. Great coverage from The Atlantic. So where’d all our cousins go?

Twelve minutes of consciousness

The Economist has an excellent video on consciousness, what it is, why and how it evolved.

The science section of The Economist has long had some of the best science reporting in the mainstream press and this video is a fantastic introduction to the science of consciousness.

It’s 12 minutes long and it’s worth every second of your time.