States of Diminished Consciousness

A newly published book titled “Into the Gray Zone”, by neuroscientist Adrian Owen, delves into the mental lives of people in ‘vegetative states’ using the latest brain imaging tools. He was able to demonstrate decision-making capability on the part of patients thought to be incapable of that level of mental activity. That presupposes the existence of ordered sensory processing, first of all, which is saying a lot already. On top of that, there must be the capacity to organize a response, which calls for coordinated activity over various parts of the brain. That too is impressive — even if that response is only planned but not executed. The response is necessarily limited to activity internal to the brain. What Owen gets to see is the equivalent of what goes on in a normally functioning brain when a response is merely being visualized rather than overtly executed–like mentally rehearsing a putt. There is little doubt now that some people stuck in vegetative states are capable of organizing such internal ‘visualizations’.

Obviously such experiments hinged on the availability of modern brain imagery, but the evidence that such people were capable of responding to what was happening in their environment is not new. Relatives who spend extended time with their incapacitated loved ones have long had robust convictions that context-sensitive responding could occur episodically. For example, tears might be observed at special moments.

Similarly, we have long had evidence from neurofeedback that such people are capable of responding to the sensory cues of biofeedback instrumentation and then of organizing a response appropriate to the reinforcements. In one dramatic case, a female patient doing our traditional neurofeedback from many years ago resolved her persistent constipation with the feedback, and also normalized her irregular menstrual period.

Even further back, we have the report from Margaret Ayers of having worked successfully over many years with people in states of mild coma. At a workshop she reflected on her cumulative experience as follows: Of 32 patients in level two coma for periods greater than two months, she was able to recover consciousness in 25 within two sessions of training, and two more recovered consciousness with additional sessions. Five were unresponsive out to six sessions, at which time the training was typically abandoned.

Each of these cases was of course dismissed in turn as merely anecdotal by the medical staff in charge, and so the evidentiary value for the claims for neurofeedback was negligible at the time. That’s because spontaneous recoveries were known to occur. But they are expected at roughly a 10% level, which was vastly exceeded here. Given our new awareness about residual brain function in such cases, it should be possible to see the old data in a new light. Ayers’ data makes the case for the existence of sensory processing, first of all, and beyond that to the organization of a regulatory response of the central nervous system. In neurofeedback a new feedback path has to come into existence, one that never existed during the person’s prior period of functionality. The brain of the person in coma had to be capable of responding to novelty.

Now that the earlier data by Margaret Ayers are a lot more difficult to dismiss in the face of the new findings, one may also point out that in bringing people out of coma there cannot be a placebo explanation. And once it is proved that neurofeedback is not reducible to a placebo, we ought not to have to prove it every time all over again.

Once we get past the placebo bugaboo, all of the clinical work that has been done to date can finally get the recognition that it is due. It needs to be acknowledged that we are not at the starting gate here. We’re thirty years into this, and sound findings are strewn all along the path, relevant to the entire frontier of mental health. By now relevant studies are well represented in the literature.