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11/3/09

Steven Pinker on Consciousness and Pulling The Plug

To dictate his memoir The Diving Bell and the Butterfly: A Memoir of Life in Death, Jean-Dominique Bauby used his eyelid to signal the words to his typist. That was all the communication he had available. In December of 1995, at 43, the editor in chief of France's Elle magazine suffered a stroke which severely damaged his brain stem. After several weeks in a coma, he woke to find that he was one of the rare victims of a condition called Locked-In Syndrome" or LIS, which had left his mind functioning but his body almost completely shut down. He was in a coma for weeks and then awakened to find that he understood others but could not communicate with them--almost. His mind functioned as usual but his body was completely paralyzed--except for one eyelid. The book was made into a profound and deeply engrossing movie. After finishing his book, Bauby died in 1997.

Consider, then, this situation as described by Steven Pinker. It is not LIS, but a condition called Persistent Vegetative State. Here is a woman whose brain was more profoundly injured than Bauby's, yet it reflected consciousness of events going on around her. Was there an "I" in her mind, aware of all that was going on but unable to communicate?:

"The young women had survived the car crash, after a fashion. In the five months since parts of her brain had been crushed, she could open her eyes but didn't respond to sights, sounds or jabs. In the jargon of neurology, she was judged to be in a persistent vegetative state. In crueler everyday language, she was a vegetable.

So picture the astonishment of British and Belgian scientists as they scanned her brain using a kind of MRI that detects blood flow to active parts of the brain. When they recited sentences, the parts involved in language lit up. When they asked her to imagine visiting the rooms of her house, the parts involved in navigating space and recognizing places ramped up. And when they asked her to imagine playing tennis, the regions that trigger motion joined in. Indeed, her scans were barely different from those of healthy volunteers. The woman, it appears, had glimmerings of consciousness."

Pinker says this about her condition: "Try to comprehend what it is like to be that woman. Do you appreciate the words and caresses of your distraught family while racked with frustration at your inability to reassure them that they are getting through? Or do you drift in a haze, springing to life with a concrete thought when a voice prods you, only to slip back into blankness? If we could experience this existence, would we prefer it to death? And if these questions have answers, would they change our policies toward unresponsive patients--making the Terri Schiavo case look like child's play?" More

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