I read an interesting article in the New Yorker the other day. It followed the research of neuroscientist Adrian Owen and his work on patients in vegetative states. In some patients, when he gave the verbal command to "imagine you are playing tennis," their brain regions lit up on an fMRI indistinguishably from your average walking, talking, and recognizably conscious human being asked to perform the same task. Moreover, the patients were able to sustain this activity (so presumably the tennis imagination) for over thirty seconds suggesting some degree of focus.
The article goes on to discuss implications. It points out that Owen only found a few patients in vegetative states with this ability. Others were not at all responsive. It was a pretty good indication that the patients who were able to follow his command had some sort of retention of cognition that others did not. However, they were not diagnosed incorrectly. The question then becomes: if the criteria by which physicians diagnose vegetative states applied to these patients, do we need a better test?
Here's a test. See if they regain consciousness within the next 100 years. Ok, not a very practical test... next please.
How about this then. Primates can direct a computer cursor via implanted electrodes in the brain. If vegetative patients react to verbal commands, then perhaps they can "type out" a sentence by reacting to a looping soundtrack of the alphabet being read out?
A better test than the fMRI or than the general diagnostic one for persistent vegetative state? And to what end?
If there is some other consequence of being able to imagine tennis, ie that they are more likely to "wake-up" sooner and are perhaps more worth talking to and attempting to amuse, then the fMRI is something their relatives might want done in order to determine which situation applies. On the other hand, the general advice is to continue interacting with such people anyway. So it may not make any difference to how they get treated at all.
Hi PZ, sorry to post a request as a comment.
I was going through your comment [ http://pharyngula.org/index/weblog/comments/scott_adams_is_a_wally/ ] on Scott Adams's post. I am not able to reach the Scott Adams's post [ http://dilbertblog.typepad.com/the_dilbert_blog/2005/11/intelligent_des… ] either directly or through google-cache. May be your scientific criticism led him to take it offline. Can you or any of your commenter share the original post? I want to discuss it with some students here in India.
Also thanks a lot for the nice list of books on evolution [ http://pharyngula.org/index/weblog/comments/a_book_list_for_evolutionis… ] :) Is any short primer available as PDF or Blog post as well?
To what end?
Mostly that with our new tricks, we may be able to retrieve a "person" (social definition) from a situation where we previously had to give up on them.
This is very cool and all that, but it's important to remember that anything we can do to help these people out is pretty much gravy. Before the advanced technology, they were lost to us, regardless of their own subjective awareness.
Answer: Sure. Why not? We ALWAYS need better tests. In anything. The question is how to devise them.
A couple years ago I had a wisdom tooth pulled. The oral surgeon gave me a kind of anaesthetic that put me under completely, yet allowed me to respond to his directions (such as "turn your head towards me"). It was a very interesting experience, inasmuch as I was far more unconscious than during sleep, yet able to process information. I'm not sure how this relates to being in a vegetative state, but it raised a lot of questions in my mind about what consciousness actually is.
Did Owen check to see which patients in their pre-vegetative states actually played tennis?
I for one, never having set sneaker to court, doubt I could maintain visualizing myself in a match for thirty seconds even in a waking state...
Owen's results might improve if he asked each patient to imagine themselves in a known favorite activity.
This is certainly an interesting post. One thing that really surprised me:
"Few vegetative or minimally conscious patients ever recover fully, and many are unlikely to improve. (Some neurologists estimate that an adult who has been vegetative for six months following a traumatic brain injury has only a twenty-per-cent chance of regaining consciousness.)"
How does 20% of a poulation translate into "few" If tomorrow 20% of the population died in car/accidents/flue/terror attacks or some other single-cause event, no journalist would say "a few people died"
20% would indicate to me that more of this kind of research in needed, and brian imagery tests might be used. The trouble with all this is funding. Do you put money here or somewhere else?
So an auditory cue stimulates a related set of action potentials in the brain. (Sorry if I'm mangling terminology, I'm not well educated in this area.) The question I have is, was the patient conscious of "imagining playing tennis?" Isn't it possible that a single connection between the auditory input and a processing function was working, but that other important parts required for awareness were still missing?
And to Mark Borok: Do you remember responding to the verbal commands, or were you just told that you would or did?
The brain is much more fascinating when its various parts don't connect than when it works well, I think.
@ 7; he asked them all to imagine tennis *unless* he knew of a sport they particularly played (for instance, one patient was known to be an avid soccer player, so they asked him to imagine soccer).
@8; "few recover FULLY .... 20% chance of REGAINING CONSCIOUSNESS." I thought emphasizing the appropriate parts of the statement might answer your questions. Regaining consciousness is a far cry from talking, understanding, moving one's limbs, et al. Generally, those 20% have trouble getting to the talking and understanding phase, much less "full" recovery.
@2, On the contrary. Medical insurance doesn't cover therapy for anyone in these loss-of-consciousness conditions. Only if and when they show sustained improvement is it covered: so, for instance, if deep-muscle massage is shown to help a patient in this condition (and one of the patients in the aforementioned article, I believe, was such a one) medical insurance will not pay for it . . . unless fMRI studies of this sort can conclusively show that patients *are* still in some way conscious *and* are benefiting. As it stands, patients in this condition do not receive any care beyond keeping them alive.
@9 - I had the same thought. Just because a brain area lights up in response to some acoustic signal does not mean that "anybody is home". It only shows that some brain functions are likely somewhat intact.
But you could imagine some refinement shedding more light on the question. More complicated tasks and questions could put some limits on how much cognition there was. (Maybe you could come up with a new word for a new sport (floodling?), and describe the sport, then later ask them to imagine a floodling match...)
It's a pretty cool result.
Did Owen check to see which patients in their pre-vegetative states actually played tennis?
Yes. As a matter of fact, he altered his protocol for a patient who played soccer but not tennis.
Medical insurance doesn't cover therapy
That's a very US reply. I'm talking about what doctors (in the UK, at any rate) suggest to relatives of the patients about what those relatives should do. Medical treatment here (if there is any) is generally on the NHS - except when it isn't!
@13; the article is from the U.S., describing patients in the U.S., with medical insurance woes endemic to the U.S. It seemed a relevant reply.
Though, frankly, I don't think my answer is much different in regards to the U.K.; in the U.S. doctors had neither reason nor pay to continue therapy with vegetative patients. UK doctors simply had no reason. The consequences are much the same.
Why is it you keep harping on about doctors doing the therapy? Realistically, the only people who care about the patient are the relatives and they are entirely capable of carrying out the relevant acts themselves.
@11: "Quidditch" (would work for anyone declared vegetative prior to the first book).
Regarding the fMRI: what point in performing a test if the result is not a change in management or outcome? This needs further (prospective, randomized, controlled) investigation.
"...their brain regions lit up on an fMRI indistinguishably from ..(a)... conscious human being asked to perform the same task..."
IN this way, the unconscious person reacted exactly like an aware person, who is not only receiving the information command, but also processing it. The vegetative person os processing, then, it seems.
"And to Mark Borok: Do you remember responding to the verbal commands, or were you just told that you would or did?"
I was told that I would, and I vaguely remember something like that, but the memory is of what seemed like a one-second interval. I remember feeling/hearing the crunching sound of the impacted wisdom tooth being cracked apart, and something else. Time was either compressed, or else I only remember a fraction of the time it took to extract the tooth. The first time I went under, back in 1975 or 76, I was completely unconscious. No sense of even time passing, just got knocked out and then came to in a groggy state. This second time it felt like a different kind of unconsciousness altogether.
If I had to pass my entire life in that state, I would consider myself to be not alive in any meaningful sense.
@15, yes, the only people that really care are the patients. But to say they're completely capable of performing the therapy themselves is a joke.
I'm not just talking about specialized knowledge, here. To enact any sort of therapy on a regular basis in the hospital is something far out of the league of a relative, considering the emotional and mental tolls such trips have on them. Most people simply cannot cope with it; there's a reason that parents moved to senior citizen's homes are so rarely visited after the initial placement.
*If* I were to grant no specialized knowledge is necessary, you're still discussing something that might be *possible*, but wouldn't *happen* in reality.
And I'm not conceding that no specialized knowledge is involved.
Many, many years ago, I talked to a co-worker who said that she had been in a coma for several weeks, and had become alarmed when she heard her caretakers talking about unplugging her. But she had been unable to make any sign to them. I do not know what condition was diagnosed. She obviously had wakened and she appeared to be completely normal.
yes, the only people that really care are the patients.
Please learn to read some time. It will make having a meaningful conversation possible. At least it would with the addition of thinking. Otherwise you're just writing (/ typing).
@21, Although James typed "patients" instead of "relatives", I think it's obvious what he meant.
Looking at the context of his post, he's talking about how relatives care about the patients, but it's unrealistic to expect them to provide these therapies themselves, regardless of the need for special knowledge in doing so.
Pointing out a mistake when the meaning is clear and then arguing from it is a classic troll maneuver.
Ever since I learned about how Parkinson's disease removes the ability to control facial expression, I've wondered about this sort of thing.
How powerful the crude model of the brain as inputs/processor/outputs is! Just like with a computer, you can have non-functioning outputs with normally functioning inputs and processing.
It seems almost certain that some people lying motionless are consciously experiencing great pain. We are compelled to find ways of discriminating among various classes of vegetative state and consciousness in general. This will certainly have implications for treatment and plug-pulling decisions. And a lot of vain moral philosophizing, and the parlour game called "philosophy of mind" will be rendered superfluous.
And a lot of vain moral philosophizing, and the parlour game called "philosophy of mind" will be rendered superfluous.
That you would say this suggests you do not actually know terribly much about philosophy of mind. In particular, you seem unaware that the most significant contributors to the field in recent years have in fact been first to the party on the precise issues under discussion here. To say the least, they tend to stay quite current on neuroscience, since that's clearly where the answers to their questions are coming from. Material dualism is a dead issue in the mainstream of thought, being properly recognized as a "god of the gaps" sort of position, and it turns out that the question "what do we mean by a mind" only gets more interesting without it.
I wonder if you are suffering from the common confusion of philosophy with religion or "new age" claptrap. As natural philosophers gradually became physicists three hundred years ago, so philosophers of mind are gradually becoming cognitive scientists today, and for the most part they embrace this transformation. Believe it or not, philosophers generally don't complain when they find themselves in a position to potentially answer a few of those nagging questions people have been asking for thousands of years.
Gelf, this I'll only say once, and feel free to revel in it: in some ways, I'm an unapologetic anti-intellectual.
That out of the way, I will not soon forget -- lest problems with neural circuitry manifest themselves -- sitting in philosophy of mind lectures hearing a professor jabber for the most part incomprehensibly. One thing however did stand out: his certainty that no medical-neurological-empirical discovery could ever answer his big questions about the mind. This was in the late 70's, and yes, much more is known now, but a heck of a lot was known back then, too.
What I smell, cynic that I am, is Johnny-come-lately-ism: philosophers finally getting on board with the empirical world, trying to salvage some self-respect and justifying their paycheques and the infrastructure that supports said paycheques.
I believe this is the essence of the matter, although I acknowledge there may be exceptions, early-adopters that make good observations and ask good questions, etc. What I'd like to know is whether there have been works of philosophy of mind that led to specific research programs, or that at least made even a minority of good researchers sit up and say, "Wow. This makes me want to change the questions I'm asking."
it's unrealistic to expect them to provide these therapies themselves
No, it's not. Apparently you could do with learning to read too (ie go back and read previous posts properly). What part of spending time attempting to contact / amuse, inform the vegetative patient (eg reading them the latest newspaper or a book or keeping them up to date on family matters) just in case there's someone trapped in there do you regard as so technically difficult that relatives couldn't possibly manage it?!
What I'd like to know is whether there have been works of philosophy of mind that led to specific research programs, or that at least made even a minority of good researchers sit up and say, "Wow. This makes me want to change the questions I'm asking."
It turns out that there is a fascinating area of overlap between the previously disparate fields of neurology, psychology, computation and philosophy of mind. Although there is a certain dependence upon hard research in the supporting scientific fields, it seems to be those dirty philosopher types who are stepping up to the challenge of pulling them together into a unified theory of cognition.
Among personal favorites of mine, I would refer you to Marvin Minsky and our bright pal Dan Dennett. They aren't just writing the works of philosophy that lead to specific research programs; they're leading the specific research programs. Even Dawkins' "meme" notion is a side trip into territory that is properly regarded as philosophy of mind in that it generalizes the theory of natural selection in a way that grants objects of consciousness an independent ontology. I will grant you that Minsky's philosopher credential would appear somewhere below the AI credential on his CV, but he does dive headlong into the philosophical end of the pool, and his "society of mind" model for cognition seems a little more plausible all the time. Combine memetics (as a specific supervenient model) with the society of mind (as "mental middleware") and you get a very interesting candidate model for what's going on under the hood of a mind that is at once independent of and at least conceivably testable against specific human neurology.
The argument one could make is that once philosophers begin making testable hypotheses and testing them, they cease to be philosophers. This is a fair criticism, except that philosophers are the intellectual ancestors of scientists in the general case. Your assertion that philosophers "finally [get] on board with the empirical world" is precisely backwards. Quite the contrary, the way it always happens is that the empirical world catches up with the philosophers, and many of them just necessarily turn out to be wrong when that happens.
You are probably inclined to suppose that it is irresponsible of philosophers to talk about specific problems before the empirical data are in. Again, on the contrary, my position is largely that it is irresponsible not to. "We don't know how to test this yet, so let's ignore it" is an abominably incurious position that would certainly prevent data regarding some questions from ever being collected at all. The only caveat is that empirical data, when available, win. This does make philosophy a vanishing discipline in some respects, but it is asymptotically so even in the most optimistic case (which would be Kurzweil's, I believe), and as this reduction is coincident with achieving the very aims of the exercise (contrast with religion), I do not believe it to be a weakness.
To sum up, a question is philosophical only until we know how to ask it properly, but figuring out how to ask it is not a step you can skip.