Unresponsive wakefulness syndrome (UWS, previously known as vegetative state) occurs after patients survive a severe brain injury. Patients suffering from UWS have lost awareness of themselves and of the external environment and do not retain any trace of their subjective experience. Current data demonstrate that neuronal functions subtending consciousness are not completely reset in UWS; however, they are reduced below the threshold required to experience consciousness. The critical factor that determines whether patients will recover consciousness is the distance of their (...) neuronal functions from this threshold level. Recovery of consciousness occurs through functional and/or structural changes in the brain, i.e., through neuronal plasticity. Although some of these changes may occur spontaneously, a growing body of evidence indicates that rehabilitative interventions can improve functional outcome by promoting adaptive functional and structural plasticity in the brain, especially if a comprehensive neurophysiological theory of consciousness is followed. In this review we will focus on the pathophysiological mechanisms involved in UWS and on the plastic changes operating on the recovery of consciousness. (shrink)

Merker’s definition of consciousness excludes self-reflective thought, making his proposal for decorticate consciousness not particularly groundbreaking. He suggests that brainstem sites are neglected in current theories of consciousness. This is so because broader definitions of consciousness are used. Split-brain data show that the cortex is important for full-blown consciousness; also, behaviors exhibited by hydranencephaly patients and decorticated rats do not seem to require reflective consciousness.

In January 1959, famous radio DJ Peter Tripp stayed awake for 200 hours in a glass booth on Times Square, exposing his weakening body and distracted sleepless mind to the public. Tripp's playing with the borderlines of consciousness was a media attraction, but the DJ also served as a guinea pig for scientific research. From the late 19th century on, several experts had tried to explore the world of wakefulness by observing stay-awake-men. With their help, researchers tested methods of measuring (...) alertness, validated and modified theories about sleep, and tried to answer the question of how long and under what circumstances human beings, above all workers and soldiers, were able to stay awake and remain efficient and accountable. By reconstructing the history of the stay-awake-men, this article shows how the perception of “being awake” changed over time and thereby points to the historicity of our very basic notions for describing the states of the human mind. (shrink)

I leave it open whether the teleological, cosmological and ontological arguments can be held together by simply stating that the common experience of our daily waking from sleep is direct evidence of God's actuality. St. Paul's vision that in God "we live and move and have our being" seems to support directly the practical value of efforts towards a restatement of the traditional arguments. It may be also of significant value for our educational systems, to give a positive content to (...) the somewhat negative term, transcendence. (shrink)

Reinterpretation of our data concerning sleep onset, motivated by the desire to pay close attention to “intra-individual regularities,” suggests that the experience of control might be a key factor in determining the subjective sense that sleep has begun. This loss of control seems akin to what Frith and others have described as “passivity experiences,” which also occur in schizophrenia. Although clearly sleep onset is not a schizophrenic episode, this similarity might help to explain other features of sleep onset. We further (...) speculate that we could build upon the discovery of various “intra-individual regularities” to construct a model of sleep onset and other forms of sleep mentation. (shrink)

Patients in a vegetative state/ unresponsive wakefulness syndrome (VS/UWS) pose ethical dilemmas to those involved. Many conflicts occur between professionals and families of these patients. In the Netherlands physicians are supposed to withdraw life sustaining treatment once recovery is not to be expected. Yet these patients have shown to survive sometimes for decades. The role of the families is thought to be important. The aim of this study was to make an inventory of the professional perspective on conflicts in long-term (...) care of patients in VS/UWS. A qualitative study of transcripts on 2 Moral Deliberations (MD’s) in 2 cases of patients in VS/UWS in long-term care facilities. Six themes emerged: 1) Vision on VS/UWS; 2) Treatment and care plan; 3) Impact on relationships; 4) Feelings/attitude; 5) Communication; 6) Organizational aspects. These themes are related to professionals and to what families had expressed to the professionals. We found conflicts as well as contradictory feelings and thoughts to be a general feature in 4 of these themes, both in professionals and families. Conflicts were found in several actors: within families concerning all 6 themes, in nurse teams concerning the theme treatment and care plan, and between physicians concerning all 6 themes. Different visions, different expectations and hope on recovery, deviating goals and contradictory feelings/thoughts in families and professionals can lead to conflicts over a patient with VS/UWS. Key factors to prevent or solve such conflicts are a carefully established diagnosis, clarity upon visions, uniformity in treatment goals and plans, an open and empathic communication, expertise and understanding the importance of contradictory feelings/thoughts. Management should bridge conflicts and support their staff, by developing expertise, by creating stability and by facilitating medical ethical discourses. Shared compassion for the patient might be a key to gain trust and bridge the differences from non-shared to shared decision making. (shrink)

In this article, I show how Husserl’s reflections on attentive or patent intentionality and on the differentiation between background and foreground that is brought about by attentive interest allows us to better understand the distinction between sleep within wakefulness and genuine sleep as well as the distinction between the intentionality that occurs while awake and when asleep. In this way it also becomes more clear what wakefulness amounts to.

The human brain is the first computer to which all others are compared. Yet we know painfully little about how a brain accomplishes its peculiar computations. In particular, consciousness is at once familiar and mysterious, and needs to be understood both for science and for medicine. Boldly, but gently this book introduces a reader to the neural circuitry that achieves consciousness. This amazing interconnection enables consciousness to flow like a stream, intimately relevant to the outside world; and for this to (...) happen, fundamental cues emerge from mental images to bring forth associated recalls. Alas cues can be inconsistent, causing memory failure; fortunately a subliminal cue editor encourages remembering forgotten items. Furthermore, cues generally address several memories, forcing the brain to make a selection. This necessitates another special circuit whose purpose is subliminal editing. The simplified explanations provided in this book make it clear that neurons do far more than ordinary devices, since a single neuron is capable of remarkably dense combinational and sequential logic. Beginning with their interesting and unexpected logical behavior, the reader will genuinely enjoy Dr. Burger's synthesis of a system for biological consciousness, a system that may someday result in credible artificial consciousness. (shrink)

The central strength of the Hegelian dialectical tradition is that reason is not divorced from its own internal limits in the name of a reason free from ideological mediation and constraint. This article holds onto this insight in the examination of the recent returns to religious categories in political philosophy and political theory. In this respect the article follows a two-fold logic. In the spirit of Hegel and Marx, it seeks to recover what is 'rational in religion'; and, at the (...) same time, examines the continuing entanglements of politics with religious categories. That this is an atheistic and materialist project is not in a sense strange or anomalous. On the contrary, it is precisely the 'secularisation' of Judeo-Christian categories in Kant, Hegel and Marx's respective theorisation of history, that provides the dialectic ground of the atheistic recovery and invocation of Judeo-Christian thought in recent political philosophy. Consequently the discussion of religion, or 'religion beyond religion', here, has very little to do with the spread of obscurantism and anti-rationalism in the global upsurge of reactionary Christian and Islamic fundamentalisms, neo-Pagan mysticisms, and other retreats from the real, or with the left-liberal denunciation of religion in the recent writings of Richard Dawkins and Christopher Hitchens. Rather, 'religion' here, in its Judeo-Christian legacy, is that which embodies the memory or prospect of a universal emancipatory politics. (shrink)

When an individual is comatose while parts of her brain remain functional, the question arises as to whether any mental characteristics are still associated with this brain, that is, whether the person still exists. Settling this uncertainty requires that one becomes clear about two issues: the type of functional loss that is associated with the respective profile of brain damage and the persistence conditions of persons. Medical case studies can answer the former question, but they are not concerned with the (...) latter. Conversely, in the philosophical literature, various accounts of personal identity are discussed, but usually detached from any empirical basis. Only uniting the two debates and interpreting the real-life configurations of brain damage through the lens of the philosophical concepts enables one to make an informed judgment regarding the persistence of comatose persons. Especially challenging are cases in which three mental characteristics that normally occur together—wakefulness, awareness and memory storage—come apart. These shall be the focus of this paper. (shrink)

For millennia self has been conjectured to be necessary for consciousness. But scant empirical evidence has been adduced to support this hypothesis. Inconsistent explications of “self” and failure to design apt experiments have impeded progress. Advocates of phenomenological psychiatry, however, have helped explicate “self,” and employed it to explain some psychopathological symptoms. In those studies, “self” is understood in a minimalist sense, sheer “for-me-ness.” Unfortunately, explication of the “minimal self” (MS) has relied on conceptual analysis, and applications to psychopathology have (...) been hermeneutic, allowing for many degrees of interpretive latitude. The result is that MS’s current scientific status is analogous to that of the “atom,” at the time when “atom” was just beginning to undergo transformation from a philosophical to a scientific concept. Fortunately, there is now an opportunity to promote a similar transformation for “MS.” Discovery of the brain’s Default Mode Network (DMN) opened the door to neuroimaging investigations of self. Taking the DMN and other forms of intrinsic activity as a starting point, an empirical foothold can be established, one that spurs experimental research and that enables extension of research into multiple phenomena. New experimental protocols that posit “MS” can help explain phenomena hitherto not thought to be related to self, thereby hastening development of a mature science of self. In particular, targeting phenomena wherein consciousness is lost and recovered, as in some cases of Unresponsive Wakefulness Syndrome (UWS), allow for design of neuroimaging probes that enable detection of MS during non-conscious states. These probes, as well as other experimental protocols applied to NREM Sleep, General Anesthesia (GA), and the waking state, provide some evidence to suggest that not only can self and consciousness dissociate, MS might be a necessary precondition for conscious experience. Finally, these findings have implications for the science of consciousness: it has been suggested that “levels of consciousness” (LoC) is not a legitimate concept for the science of consciousness. But because we have the conceptual and methodological tools with which to refine investigations of MS, we have the means to identify a possible foundation—a bifurcation point—for consciousness, as well as the means by which to measure degrees of distance from that foundation. These neuroimaging investigations of MS position us to better assess whether LoC has a role to play in a mature science of consciousness. (shrink)

In this paper, I explore a noted empirical link between regret and insomnia. Drawing on Brian O’Shaughnessy analysis of wakeful consciousness, I sketch three candidate ways of excavating a conceptual connection. Regret involves a certain kind of temporal orientation that, for O’Shaughnessy, only the state of wakefulness makes possible. Regret involves mental activity – it is productive of and precipitates patterns of counterfactual thought and imagining. Further, picking up a cue from Bernard Williams’ celebrated conception of agent-regret in ‘Moral Luck’, (...) sometimes the mental activity that occurs in regret is affective and expressive – as I argue, it is expressive of the wish that things were otherwise were satisfied now. Finally, I take up the puzzle as to why occurrent regret is not merely incompatible with sleep – insofar as it necessitates wakefulness - but may preclude falling asleep and I offer a tentative solution, focusing on the self-conscious character of occurrent regret. (shrink)

Disorders of consciousness (DoC)—that is, unresponsive wakefulness syndrome/vegetative state and minimally conscious state—are debilitating conditions for which no reliable markers of consciousness recovery have yet been identified. Evidence points to the GABAergic system being altered in DoC, making it a potential target as such a marker.

Patient outcome after serious brain injury is highly variable. Following a period of coma, some patients recover while others progress into a vegetative state (unresponsive wakefulness syndrome) or minimally conscious state. In both cases, assessment is difficult and misdiagnosis may be as high as 43%. Recent advances in neuroimaging suggest a solution. Both functional magnetic resonance imaging and electroencephalography have been used to detect residual cognitive function in vegetative and minimally conscious patients. Neuroimaging may improve diagnosis and prognostication. These techniques (...) are beginning to be applied to comatose patients soon after injury. Evidence of preserved cognitive function may predict recovery, and this information would help families and health providers. Complex ethical issues arise due to the vulnerability of patients and families, difficulties interpreting negative results, restriction of communication to “yes” or “no” answers, and cost. We seek to investigate ethical issues in the use of neuroimaging in behaviorally nonresponsive patients who have suffered serious brain injury. The objectives of this research are to: (1) create an approach to capacity assessment using neuroimaging; (2) develop an ethics of welfare framework to guide considerations of quality of life; (3) explore the impact of neuroimaging on families; and, (4) analyze the ethics of the use of neuroimaging in comatose patients. (shrink)

Understanding loss of consciousness after brain injury poses a practical test for the field of consciousness research, with both clinical and ethical implications. We here discuss three major pathological disorders of consciousness; coma, the unresponsive wakefulness syndrome and the minimally conscious state, which together represent a lesion model for the investigation of human awareness. We review the anatomical and neurophysiological correlates of each condition, and discuss the current findings in context of several theoretical frameworks of consciousness.

Sleep is phenomenologically rich, teeming with different kinds of conscious thought and experience. Dreaming is the most prominent example, but there is more to conscious experience in sleep than dreaming. Especially in non‐rapid eye movement sleep, conscious experience, sometimes dreamful, sometimes dreamless, also alternates with a loss of consciousness. Yet while dreaming has become established as a topic for interdisciplinary consciousness science and empirically informed philosophy of mind, the same is not true of other kinds of sleep‐related experience, nor is (...) it true of sleep itself. I argue that this is a mistake. Conscious experience in sleep is more diverse than dreaming and we need to explain its different forms as well as the alternation between conscious and unconscious sleep states. We also need to ask how different kinds of sleep‐related experience relate to foundational issues about sleep and wakefulness as well as sleep stages. I survey recent findings and theoretical developments from sleep and dream research to show how the traditional view of sleep and its relation to wakefulness and consciousness is flawed. I then suggest that by refining our frameworks of sleep‐related experiences and sleep staging in tandem, we can work toward a better view. As we are only beginning to understand the diversity of consciousness in sleep, an important aim is programmatic: We need a philosophy of sleep and of consciousness in sleep, not just a philosophy of dreaming, and a future theory of sleep needs to integrate phenomenological considerations with neuroscientific and behavioral evidence. Working toward such a theory will radically transform our understanding of sleep, wakefulness, and our conscious minds. (shrink)

Nearly all Disney movies represent to people mere possibilities. One can conceive of scenarios with genies, wooden puppets coming to life, flying elephants, and mermaids. And there certainly seems to be no special problem in conceiving of a scenario where all the author's experiences are a mere dream induced by a Maleficent‐like evil genius. The problem in the present context is that the possibility of a dream‐inducing Maleficent‐like evil genius guarantees that how things appear would be no different, whether she (...) is dreaming or not. But maybe there is a difference: does it not appear to her that there is a difference between dreaming and wakefulness? The very fact that she is aware of such a distinction at all suggests the distinction is real. People prefer a real life over an experientially identical dream life, or even a more pleasurable dream life, because there is more to life than just experience. (shrink)

Unresponsive wakefulness syndrome is a disorder of consciousness wherein a patient is awake, but completely non-responsive at the bedside. However, research has shown that a minority of these patients remain aware, and can demonstrate their awareness via functional neuroimaging; these patients are referred to as having ‘cognitive motor dissociation’. Unfortunately, we have little insight into the subjective experiences of these patients, making it difficult to determine how best to promote their well-being. In this paper, I argue that the capacity to (...) experience pain or pleasure is a key component of well-being for these patients. While patients with unresponsive wakefulness syndrome are believed to be incapable of experiencing pain or pleasure, I argue that there is evidence to support the notion that CMD patients likely can experience pain and pleasure. I analyze current neuroscientific research into the mechanisms of pain experience in patients with disorders of consciousness, and provide an explanation for why CMD patients likely can experience physical pain. I then do the same for physical pleasure. I conclude that providing these patients with pleasurable experiences, and avoiding subjecting them to pain, are viable means of promoting their well-being. (shrink)

意識是如此不可捉摸又抽象的概念，「測量」意識簡直就像科幻小說情節。科學家近年來在這方面已大有進展，藉由各項腦造影技術和實驗手法，能夠分析不同意識狀態下的大腦活動型態。.

The thirteen essays collected in this volume investigate the possibility that the word "God" can be understood now, at the end of the twentieth century, in a meaningful way. Nine of the essays appear in English translation for the first time. Among Levinas's writings, this volume distinguishes itself, both for students of his thought and for a wider audience, by the range of issues it addresses. Levinas not only rehearses the ethical themes that have led him to be regarded as (...) one of the most original thinkers working out of the phenomenological tradition, but he also takes up philosophical questions concerning politics, language, and religion. The volume situates his thought in a broader intellectual context than have his previous works. In these essays, alongside the detailed investigations of Husserl, Heidegger, Rosenzweig, and Buber that characterize all his writings, Levinas also addresses the thought of Kierkegaard, Marx, Bloch, and Derrida. Some essays provide lucid expositions not available elsewhere to key areas of Levinas's thought. "God and Philosophy" is perhaps the single most important text for understanding Levinas and is in many respects the best introduction to his works. "From Consciousness to Wakefulness" illuminates Levinas's relation to Husserl and thus to phenomenology, which is always his starting point, even if he never abides by the limits it imposes. In "The Thinking of Being and the Question of the Other," Levinas not only addresses Derrida's Speech and Phenomenon but also develops an answer to the later Heidegger's account of the history of Being by suggesting another way of reading that history. Among the other topics examined in the essays are the Marxist concept of ideology, death, hermeneutics, the concept of evil, the philosophy of dialogue, the relation of language to the Other, and the acts of communication and mutual understanding. (shrink)

If what we want from moral inquiry were the obtainment of objective moral truths, as moral realism claims it is, then there would be nothing morally unsatisfactory or lacking in a situation, in which we somehow had access to all moral truths, and were fundamentally finished with morality. In fact, that seems to be the realists’ conception of moral heaven. In this essay, however, I argue that some sort of moral wakefulness – that is, always paying attention to the subtleties (...) of life and people, and never taking for granted what their moral significance can possibly be – is an essential moral value, and, therefore, moral realism, which promotes a moral ideal that allows such moral lethargy and inattentiveness is morally objectionable. (shrink)

The debate on personal persistence has been characterized by a dichotomy which is due to its still Cartesian framwork: On the one side we find proponents of psychological continuity who connect, in Locke’s tradition, the persistence of the person with the constancy of the first-person perspective in retrospection. On the other side, proponents of a biological approach take diachronic identity to consist in the continuity of the organism as the carrier of personal existence from a third-person-perspective. Thus, what accounts for (...) someone’s persistence over time, is the continuity of his mind on the one hand, and the continuity of his body on the other. In contrast to those views, the paper intends to show that bodily existence represents the basis of selfhood across time, both as the continuity of the experiential self and as the continuity of the autopoietic organism. On the one hand, the lived body conveys a continuity of the self from a first-person perspective, namely a pre-reflective feeling of sameness or a felt constancy of subjectivity. Moreover, an analysis of awakening and sleep shows that there is a continuous transition from full wakefulness to periods of deep sleep which may thus not be regarded as a complete interruption of subjective experience. On the other hand, this constancy converges with the continuity of the organismic life process as conceived from a third-person perspective. Thus, the experiential self of bodily subjectivity and the autopoietic self of the living organism should be regarded as two aspects of one and the same life process. Finally, the lived body also exhibits a specific form of memory that results from the continual embodiment of existence: it consists of all the affinities, capacities and experiences, which a person has acquired throughout his life. Thus, it provides a continuity of self that must not be actively produced through remembering, but rather integrates the person’s entire past in his present being and potentiality. (shrink)

New brain-computer interface and neuroimaging techniques are making differentiation less ambiguous and more accurate between unresponsive wakefulness syndrome patients and patients with higher cognitive function and awareness. As research into these areas continues to progress, new ethical issues will face physicians of patients suffering from total locked-in syndrome, characterized by complete loss of voluntary muscle control, with retention of cognitive function and awareness detectable only with neuroimaging and brain-computer interfaces. Physicians, researchers, ethicists and hospital ethics committees should be aware of (...) and prepared to handle ethical issues unique to these totally locked-in patients. Several thought experiments are discussed, to highlight potential ethical dilemmas surrounding surrogate decision-making, autonomy, end-of-life care, and pediatric care, which will be unique to total LIS patients. These, along with other ethical problems especially relevant to total LIS patients, merit further discussion among physicians, researchers, ethicists and hospital ethics committees, to facilitate consensus regarding these issues, and improve patient care. (shrink)

Ernest Sosa has argued that the solution to dream scepticism lies in an understanding of dreams as imaginative experiences – when we dream, on this suggestion, we do not believe the contents of our dreams, but rather imagine them. Sosa rebuts scepticism thus: dreams don’t cause false beliefs, so my beliefs cannot be false, having been caused by dreams. I argue that, even assuming that Sosa is correct about the nature of dreaming, belief in wakefulness on these grounds is epistemically (...) irresponsible. The proper upshot of the imagination model, I suggest, is to recharacterize the way we think about dream scepticism: the sceptical threat is not, after all, that we have false beliefs. So even though dreams don’t involve false beliefs, they still pose a sceptical threat, which I elaborate. (shrink)

Neurovascular coupling (NVC), the transient regional hyperemia following the evoked neuronal responses, is the basis of blood oxygenation level-dependent techniques and is generally adopted across physiological conditions, including the intrinsic resting state. However, the possibility of neurovascular dissociations across physiological alterations is indicated in the literature. To examine the NVC stability across sleep–wake states, we used electroencephalography (EEG) as the index of neural activity and functional magnetic resonance imaging (fMRI) as the measure of cerebrovascular response. Eight healthy adults were recruited (...) for simultaneous EEG-fMRI recordings in nocturnal sleep. We compared the cross-modality (EEG vs. fMRI) consistency of functional indices (spectral amplitude and functional connectivity) among five states of wakefulness and sleep (state effect). We also segregated the brain into three main partitions (anterior, middle and posterior) for spatial assessments (regional effect). Significant state effects were found on δ, α and fMRI indices and regional effects on the α and fMRI indices. However, the cross-state EEG changes in spectral amplitude and functional connectivity did not consistently match the changes in the fMRI indices across sleep–wake states. In spectral amplitude, the δ band peaked at the N3 stage for all brain regions, while the fMRI fluctuation amplitude peaked at the N2 stage in the central and posterior regions. In regional connectivity, the inter-hemispheric connectivity of the δ band peaked at the N3 stage for all regions, but the bilateral fMRI connectivity showed the state changes in the anterior and central regions. The cross-modality inconsistencies across sleep–wake states provided preliminary evidence that the neurovascular relationship may not change in a linear consistency during NREM sleep. Thus, caution shall be exercised when applying the NVC presumption to investigating sleep/wake transitions, even among healthy young adults. (shrink)

Pain, suffering and positive emotions in patients in vegetative state/unresponsive wakefulness syndrome (VS/uws) and minimally conscious states (MCS) pose clinical and ethical challenges. Clinically, we evaluate behavioural responses after painful stimulation and also emotionally-contingent behaviours (e.g., smiling). Using stimuli with emotional valence, neuroimaging and electrophysiology technologies can detect subclinical remnants of preserved capacities for pain which might influence decisions about treatment limitation. To date, no data exist as to how healthcare providers think about end-of-life options (e.g., withdrawal of artificial nutrition (...) and hydration) in the presence or absence of pain in non-communicative patients. Here, we aimed to better clarify this issue by re-analyzing previously published data on pain perception (Prog Brain Res 2009 177, 329–38) and end-of-life decisions (J Neurol 2010 258, 1058–65) in patients with disorders of consciousness. In a sample of 2259 European healthcare professionals we found that, for VS/uws more respondents agreed with treatment withdrawal when they considered that VS/uws patients did not feel pain (77%) as compared to those who thought VS/uws did feel pain (59%). This interaction was influenced by religiosity and professional background. For MCS, end-of-life attitudes were not influenced by opinions on pain perception. Within a contemporary ethical context we discuss (1) the evolving scientific understandings of pain perception and their relationship to existing clinical and ethical guidelines; (2) the discrepancies of attitudes within (and between) healthcare providers and their consequences for treatment approaches, and (3) the implicit but complex relationship between pain perception and attitudes toward life-sustaining treatments. (shrink)

Although death statutes permitting physicians to declare brain death are relatively uniform throughout the United States, academic debate persists over the equivalency of human death and brain death. Alan Shewmon showed that the formerly accepted integration rationale was conceptually incomplete by showing that brain-dead patients demonstrated a degree of integration. We provide a more complete rationale for the equivalency of human death and brain death by defending a deeper understanding of the organism as a whole and by using a novel (...) strategy with shared objectives to justify death determination criteria. Our OaaW account describes different types of OaaW, defining human death as the loss of status as a human OaaW. We defend human death as similar to nonhuman death in terms of wakefulness, but also distinct in terms of the sui generis properties, particularly conscious awareness. We thereby defend the equivalency of brain death and human death using a resulting neurocentric rationale. (shrink)

BackgroundFunctional neurodiagnostics could allow researchers and clinicians to distinguish more accurately between the unresponsive wakefulness syndrome and the minimally conscious state. It remains unclear how it informs surrogate decision-making.ObjectiveTo explore how the next of kin of patients with disorders of consciousness interpret the results of a functional neurodiagnostics measure and how/why their interpretations influence their attitudes towards medical decisions.Methods and SampleWe conducted problem-centered interviews with seven next of kin of patients with DOC who had undergone a functional HD-EEG examination at (...) a neurological rehabilitation center in Germany. The examination included an auditory oddball paradigm and a motor imagery task to detect hidden awareness. We analyzed the interview transcripts using structuring qualitative content analysis.ResultsRegardless of the diagnostic results, all participants were optimistic of the patients’ meaningful recovery. We hypothesize, that participants deal with the results of examinations according to their belief system. Thus, an unfavorable evaluation of the patient’s state had the potential to destabilize the participant’s belief system. To re-stabilize or to prevent the destabilization of their belief system, participants used different strategies. Participants accepted a “positive” HD-EEG result since it stabilized their belief system.ConclusionWe hypothesize, that a group of next of kin of patients with DOC deals with functional neurodiagnostics results on the basis of the result’s value and their high hope that the patient will recover meaningfully. A psychological mechanism seems to moderate the impact of functional neurodiagnostics on surrogate treatment decisions. (shrink)

The extended dual-aspect monism framework of consciousness, based on neuroscience, consists of five components: (1) dual-aspect primal entities; (2) neural-Darwinism: co-evolution and co-development of subjective experiences (SEs) and associated neural-nets from the mental aspect (that carries the SEs/proto-experiences (PEs) in superposed and unexpressed form) and the material aspect (mass, charge, spin and space-time) of fundamental entities (elementary particles), respectively and co-tuning via sensorimotor interaction; (3) matching and selection processes: interaction of two modes, namely, (a) the non-tilde mode that is the (...) material and mental aspect of cognition (memory and attention) related feedback signals in a neural-network, which is the cognitive nearest past approaching towards present; and (b) the tilde mode that is the material and mental aspect of the feed forward signals due to external environmental input and internal endogenous input, which is the nearest future approaching towards present and is a entropy-reversed representation of non-tilde mode; (4) the segregation and integration of information, and (5) the necessary ingredients of SEs (such as wakefulness, attention, re-entry, working memory, stimulus at or above threshold level, and neural-net PEs). This framework leads to structural and functional coherence between the mind and the brain, bridges the explanatory gap (the gap between SEs and their neural-correlates), and leads to our mundane subjective experiences. This extended dual-aspect monism (eDAM) framework (Vimal, 2008, 2010, 2013, 2015a, 2015b) could be the fundamental basis of various religions and philosophies. This is a Western perspective. On the other hand, Eastern perspectives emphasize the practical methods for achieving altered experience at samadhi state. An important corollary of these methods (such as yogic method) is the sublimation of negative aspects of seven groups of self-protective energy system (desire, anger, ego, greed, attachment, jealousy, and selfish-love) into their positive aspects. Their negative aspects create war and suffering, whereas their positive aspects advance science and technology, family values, peace, and happiness. Here, the Western perspective framework is extended to include the concepts of the sublimation process to encompass Eastern perspectives. The four elements (war, suffering, peace, and happiness) are ubiquitous in both space and time because they are essential contributors to the variations for natural selection in our evolutionary system. The sublimation process optimizes the system: minimizes war and suffering, maximizes peace and happiness, and enhances family values and individual progress. This is consistent with both Eastern and Western perspectives. (shrink)

Descartes affords several notions of consciousness as he explains the characteristics of the diverse features of human thought from infancy to adulthood and from dreaming to attentive wakefulness. The paper argues that Descartes has a rich and coherent view of conscious mentality from rudimentary consciousness through reflexive consciousness to consciousness achieved by deliberate, attentive reflection.

Several theories link consciousness to complex cortical dynamics, as suggested by comparison of brain signal diversity between conscious states and states where consciousness is lost or reduced. In particular, Lempel-Ziv complexity, amplitude coalition entropy and synchrony coalition entropy distinguish wakefulness and REM sleep from deep sleep and anesthesia, and are elevated in psychedelic states, reported to increase the range and vividness of conscious contents. Some studies have even found correlations between complexity measures and facets of self-reported experience. As suggested by (...) integrated information theory and the entropic brain hypothesis, measures of differentiation and signal diversity may therefore be measurable correlates of consciousness and phenomenological richness. Inspired by these ideas, we tested three hypotheses about EEG signal diversity related to sleep and dreaming. First, diversity should decrease with successively deeper stages of non-REM sleep. Second, signal diversity within the same sleep stage should be higher for periods of dreaming vs. non-dreaming. Third, specific aspects of dream contents should correlate with signal diversity in corresponding cortical regions. We employed a repeated awakening paradigm in sleep deprived healthy volunteers, with immediate dream report and rating of dream content along a thought-perceptual axis, from exclusively thought-like to exclusively perceptual. Generalized linear mixed models were used to assess how signal diversity varied with sleep stage, dreaming and thought-perceptual rating. Signal diversity decreased with sleep depth, but was not significantly different between dreaming and non-dreaming, even though there was a significant positive correlation between Lempel-Ziv complexity of EEG recorded over the posterior cortex and thought-perceptual ratings of dream contents. (shrink)