Posts Tagged ‘The Diving Bell and the Butterfly’

The Silent

May 14, 2016

The fifth cryptomind discussed in “The Mind Club” is The Silent.  This chapter is about those we cannot communicate with who, because of trauma to the brain, cannot communicate with us.  The EEG can be used to take measurements.  Disordered conscious states can be diagnosed by the EEG patterns.  An ordering of conscious states follows:

Locked in syndrome
Minimally conscious
Vegetative State
Brain Death

It is unfortunate that unless EEG measurements are done along with further diagnosis the Locked in syndrome can be mistaken for a lower level of consciousness.

The term locked-in syndrome was coined by Fred Plume and Jerome Posner.  For many years it was not realized that someone was actually locked-in.  Healthy memory remembers watching a movie when someone asked suppose some is locked inside the unconscious state.  The reply was that that was something too horrible to imagine.  But there are real people who can accomplish some impressive feats.  Jean-Dominique Bauby was an editor who suffered a stroke and found himself locked-in.  But he was able to communicate by blinking his one eye that was functioning.  It took him 200,000 blinks to write the Diving Bell and the Butterfly.  He lived to see the book published, but he died before he saw the enormous success of the book and the beautiful movie  with the same title that was based on the book.

People react and adapt to this locked-in state differently.  Bauby could have continued a productive career had he not died.  But an Englishman, Tony Nicklinson, did not and wanted to commit suicide.  However, being locked-in he could not commit suicide.  He petitioned the court to allow doctors to provide an assisted suicide.  After much deliberation, the courts decline.  However, he did manage to commit suicide by refusing to swallow.

In addition to EEGs, fMRIs can provide very useful information.  The primary problem with fMRI’s is that they are expensive.

To read more about current research on this topic, see some of the healthy memory blog posts by Dehaene (see the Healthymemory blog post titled, “The Ultimate Test”).

The authors of  “The Mind Club” also examine the other end of life.  That is, when does life begin.  This is a large religious issue that can impact people of different religious beliefs.  A symposium organized in 1968 by the Christian Medical Society affirmed that “the preservation of fetal life…may have to be abandoned to maintain full and secure family life, as well as in cases of rape, incest, fetal deformity, and threat to the mother’s well-being, whether physical or emotional.  However, evangelical opinion swung after church leaders such as the eminent Jerry Falwell reacted to the 1973 Roe v. Wade decision and advocate a “life at conception” interpretation of the Bible.   As the Catholic Church claims that life begins at conception certain Protestant sects did not want to appear remiss.

However, if memory serves healthy memory correctly, at one time there were arguments among Catholic philosophers as to when the soul entered the body.  Furthermore, healthy memory believes that there were different times depending upon whether a male of female was involved.  If any readers can help me out on this particular point, it would be much appreciated.

Nevertheless, it is healthymemory’s belief that the soul is the issue.  The soul is a religious entity and the argument should be argued in theological terms.  Biological terms are irrelevant.

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The Ultimate Test

April 7, 2016

The Ultimate Test is the sixth chapter of “Consciousness and the Brain:  Deciphering How the Brain Codes our Thoughts” is an outstanding book by the French neuroscientist Stanislas Dehaene who is the Chair of Experimental Psychology at the College of France.  This is the seventh consecutive post on this outstanding book. According to Dr. Dehaene the ultimate test of any theory of consciousness is the clinic.  Every year thousands of patients fall into a coma.  Unfortunately, many of these patients will remain permanently unresponsive in a dreaded condition called the “vegetative state.”  Worse yet, is that in Intensive Care Units (ICUs) over all the world, half of the deaths result from a clinical decision to remove life support.  How many of these decisions are wrongly made?

Coma is defined  clinically as a prolonged  loss of the capacity to be aroused.  However, coma patients are not brain-dead.  Brain death is a distinct state,characterized by a total absence of brain stem reflexes.  In brain-dead patients, positron emission tomography (PET) and other measures such as Doppler ultrasonography show that cortical metabolism and the perfusion of blood to the brain are annihilated.  Most countries, the Vatican included, identity brain death with death, period.

What is of primary interest is the “locked-in syndrome.”  This state typically results from a well-delimited lesion, usually on the protuberance of the brain stem.  Such a lesion disconnects the cortex the cortex from its output pathways  in the spinal cord.  If the cortex and the thalamus are spared, it often leaves consciousness intact.  As you can well imagine, this is a terrible state in which to find oneself.

The book “The Diving Bell and the Butterfly” (there is also an outstanding movie by the same name) was written by Jean-Dominique Baby, who was the editor of the French fashion magazine, “Elle.”  He wrote this book one character at a time by blinking his left eyelid while an assistant recited the letters of the alphabet.  He eloquently told his story with two hundred thousand blinks telling the story of a beautiful mind shattered by a cerebral stroke.  Fortunately he lived to se the book published, but, unfortunately, he died three days later.

Comparatively speaking, Jean-Domonique Baby was well-off. Many locked-in patients have no motor responses, no means of communicating with the world.  Fortunately fMRIs can identify these individuals, given enough time.  Unfortunately, fMRIs are extremely expensive and are beyond the budgets of too many medical facilities.  But, fortunately, Dr. Dehaene has developed an inexpensive test using EEG recordings using 256 electrodes.  Information exchanged over long cortical distances is an excellent index of consciousness in patients with brain lesions.  Computations are done for each pair of electrodes for a mathematical index of the amount of information shared by the underlying brain areas.  Vegetative-state patients showed a much smaller  amount of shared information than conscious patients and control patients.  This finding fits with  with a central tenet of global workspace theory, that information exchange is an essential function of consciousness.  A follow-up study showed that the few vegetative patients who showed high information sharing had a better chance of regaining consciousness within the next days or  months.

So technology and the global workspace theory provide good diagnostic techniques.  It is hoped that interventions will be developed in the future to unlock those in a locked-in state.  Dr. Dehaene has described some promising work being done in this area.