Conscious states as objects of awareness: on Uriah Kriegel, Subjective consciousness: a self - representational theory Content Type Journal Article Pages 1-9 DOI 10.1007/s11098-011-9763-9 Authors Brie Gertler, Corcoran Department of Philosophy, University of Virginia, Charlottesville, VA 22904, USA Journal Philosophical Studies Online ISSN 1573-0883 Print ISSN 0031-8116.

Realism about consciousness conjoins a claim that consciousness exists with a claim that the existence is independent in some interesting sense. Consciousness realism so conceived may thus be opposed by a variety of anti-realisms, distinguished from each other by denying the first, the second, or both of the realist’s defining claims. I argue that Dennett’s view of consciousness is best read as an anti-realism that affirms the existence of consciousness while denying an important independence claim.

Are conscious states conscious in virtue of representing themselves? Content Type Journal Article Pages 1-8 DOI 10.1007/s11098-011-9762-x Authors Berit Brogaard, Department of Philosophy, University of Missouri, St. Louis, 599 Lucas Hall, One University Blvd., St. Louis, MO 63121-4400, USA Journal Philosophical Studies Online ISSN 1573-0883 Print ISSN 0031-8116.

Recent progress in neurosciences has improved our understanding of chronic disorders of consciousness. One example of this advancement is the emergence of the new diagnostic category of minimally conscious state (MCS). The central characteristic of MCS is impaired consciousness. Though the phenomenon now referred to as MCS pre-existed its inclusion in diagnostic classifications, the current medical ethical concepts mainly apply to patients with normal consciousness and to non-conscious patients. Accordingly, how we morally should stand with persons in (...) minimally conscious state remains unclear. In this paper, I examine whether the notion of human dignity could provide us with guidance with the moral difficulties MCS gives rise to. More precisely, I focus on the question of whether we are justified in holding that persons in minimally conscious state possess human dignity. (shrink)

The concept of futility is sometimes regarded as a cloak for medical paternalism in that it rolls together medical and value judgments. Often, despite attempts to disambiguate the concept, that is true and it can be applied in such a way as to marginalize the real interests of a patient. I suggest we replace it with a conceptual toolkit that includes physiological futility, substantial benefit (SB), and the risk of unacceptable badness (RUB) in that these concepts allow us to articulate (...) what is at stake in ethical judgments where outcomes are crucial in determining what should be done. (shrink)

One of the final obstacles to understanding consciousness in physical terms concerns the question of whether conscious states can exist in posterior regions of the brain without active connections to the brain's prefrontal lobes. If they can, difficult issues concerning our knowledge of our conscious states can be resolved. This paper contains a list of types of conscious states that may meet this criterion, including states of coma, states in which subjects are absorbed in (...) a perceptual task, states in brains with damaged prefrontal lobes, states of meditation and conscious states of some infants and animals. Recent evidence also suggests that conscious states of some people with autism may meet this criterion. (shrink)

Abstract In a recent issue of Neuroethics , I considered whether the notion of human dignity could help us in solving the moral problems the advent of the diagnostic category of minimally conscious state (MCS) has brought forth. I argued that there is no adequate account of what justifies bestowing all MCS patients with the special worth referred to as human dignity. Therefore, I concluded, unless that difficulty can be solved we should resort to other values than human dignity in (...) addressing the moral problems MCS poses. In his new book Christopher Kaczor criticizes the argument I put forward. Below, I respond to Kaczor’s criticism. I maintain that the considerations he presents do not undermine my argument nor succeed in providing adequate justification for the view that all MCS patients possess the worth referred to as human dignity. Content Type Journal Article Category Original Paper Pages 1-11 DOI 10.1007/s12152-011-9147-z Authors Jukka Varelius, Department of Behavioural Sciences and Philosophy, University of Turku, Turku, 20014 Finland Journal Neuroethics Online ISSN 1874-5504 Print ISSN 1874-5490. (shrink)

Intuitively it has seemed to many that our concepts conscious state and conscious creature are sharp rather than vague, that they can have no borderline cases. On the other hand, many who take conscious states to be identical to, or realized by, complex physical states are committed to the vagueness of those concepts. In the paper I argue that conscious state and conscious creature are sharp by presenting four necessary conditions for conceiving borderline cases in general, and showing (...) that some of those conditions cannot be met with conscious state. I conclude that conscious state is sharp, and the conclusion is then extended to conscious creature. The paper ends with a brief discussion of some implications. (shrink)

Explanation does not exist in a metaphysical vacuum. Conceptions of the structure of a phenomenon play an important role in guiding attempts to explain it, and erroneous conceptions of a phenomenon may direct investigation in misleading directions. I believe that there is a case to be made for thinking that much work on the neural underpinnings of consciousness—what is often called the neural correlates of consciousness—is driven by an erroneous conception of the structure of consciousness. The aim (...) of this paper is lay bare some connections between the explanation of consciousness and the structure of consciousness, and to argue for a conception of the structure of consciousness that is more adequate than that which currently drives much research into the neural correlates of consciousness. (shrink)

Patients in a Minimally Conscious State (MCS) constitute a subgroup of awareness impaired patients who show minimal signs of awareness as opposed to patients in a Vegetative State who do not exhibit any such signs. While the empirical literature is rich in studies investigating either overt or covert signs of awareness in such patients the question of self-awareness has only scarcely been addressed. Even in the occasion where self-awareness is concerned, it is only higher-order or reflective self-awareness that is the (...) target of such investigations. In the first part of this paper, I briefly review the relevant clinical neuroscience literature to demonstrate that the conception of self-awareness at play in such studies is indeed that of reflective self-awareness. In the second part, I present the philosophical notion of pre-reflective (or minimal) self-awareness. This is shown to primarily refer to the implicit awareness of our embodied subjectivity which essentially permeates all our experiences. As discussed, this minimal self-awareness is not specifically addressed when clinically or experimentally assessing patients in MCS. My suggestion is that neuroimaging studies targeting minimal self-awareness as in First-Person Perspective-taking paradigms could be used with MCS patients to shed light on the question of whether those individuals are minimally self-aware even in the case where they lack self-reflective abilities. Empirical evidence of this kind could have important theoretical implications for the discussion about the notion of self-awareness but also potential medical and social/legal implications for awareness impaired patients’ management. (shrink)

I draw attention to an ambiguity of the expression ‘phenomenal consciousness’ that is an avoidable yet persistent source of conceptual confusion among consciousness scientists. The ambiguity is between what I call phenomenality and what I call conscious states, where the former denotes an abstract property and the latter denotes a phenomenon or class of its instances. Since sentences featuring these two terms have different semantic properties, it is possible to equivocate over the term ‘consciousness’. It is (...) also possible to fail to distinguish between statements that are true about conscious states in virtue of their phenomenality, and statements that are true in virtue of other properties of conscious states. I review empirically informed arguments by scientists Bernard Balleine and Anthony Dickinson, Stevan Harnad, and Jeffrey Alan Gray, arguing that each of them makes errors based on the ambiguity. I conclude with some tentative suggestions for avoiding further confusion about the ambiguity. (shrink)

Sleep researchers in different disciplines disagree about how fully dreaming can be explained in terms of brain physiology. Debate has focused on whether REM sleep dreaming is qualitatively different from nonREM (NREM) sleep and waking. A review of psychophysiological studies shows clear quantitative differences between REM and NREM mentation and between REM and waking mentation. Recent neuroimaging and neurophysiological studies also differentiate REM, NREM, and waking in features with phenomenological implications. Both evidence and theory suggest that there are isomorphisms between (...) the phenomenology and the physiology of dreams. We present a three-dimensional model with specific examples from normally and abnormally changing conscious states. Key Words: consciousness; dreaming; neuroimaging; neuromodulation; NREM; phenomenology; qualia; REM; sleep. (shrink)

In a recent issue of Neuroethics, I considered whether the notion of human dignity could help us in solving the moral problems the advent of the diagnostic category of minimally conscious state (MCS) has brought forth. I argued that there is no adequate account of what justifies bestowing all MCS patients with the special worth referred to as human dignity. Therefore, I concluded, unless that difficulty can be solved we should resort to other values than human dignity in addressing the (...) moral problems MCS poses. In his new book Christopher Kaczor criticizes the argument I put forward. Below, I respond to Kaczor’s criticism. I maintain that the considerations he presents do not undermine my argument nor succeed in providing adequate justification for the view that all MCS patients possess the worth referred to as human dignity. (shrink)

This chapter explains how mindmelding — the direct experience by one person of another's conscious states — is in fact possible. The temporal lobes causally interact with the prefrontal lobes by way of fiber bundles that run underneath the cortical surface. This provides the perfect first experiment in mindmelding: to ‘branch’ those fiber bundles and run the other end into the brain of another person. Evidence is provided that these bundles have close connections to consciousness, in that whatever (...) affects them has immediate effects on consciousness. Then, before responding to several objections, the chapter considers another issue brought up by these experiments — the question of the relation between mindmelding and mindreading. Is mindmelding similar to mindreading? Does the existence of a mindreading system help us achieve mindmelding? (shrink)

Consciousness is known to be limited in processing capacity and often described in terms of a unique processing stream across a single dimension: time. In this paper, we discuss a purely temporal pattern code, functionally decoupled from spatial signals, for conscious state generation in the brain. Arguments in favour of such a code include Dehaene et al.'s long-distance reverberation postulate, Ramachandran's remapping hypothesis, evidence for a temporal coherence index and coincidence detectors, and Grossberg's Adaptive Resonance Theory. A time-bin resonance (...) model is developed, where temporal signatures of conscious states are generated on the basis of signal reverberation across large distances in highly plastic neural circuits. The temporal signatures are delivered by neural activity patterns which, beyond a certain statistical threshold, activate, maintain, and terminate a conscious brain state like a bar code would activate, maintain, or inactivate the electronic locks of a safe. Such temporal resonance would reflect a higher level of neural processing, independent from sensorial or perceptual brain mechanisms. (shrink)

Patients in a minimally conscious state (MCS) fall into a different diagnostic category than patients in the more familiar vegetative states (VS). Not only are MCS patients conscious in some sense, they have a higher chance for recovery than VS patients. Because of these differences, we ostensibly have reason to provide MCS patients with care that goes beyond what we provide to patients with some VS patients. But how to justify this differential treatment? I argue we can’t justify it (...) solely by looking to MCS patients’ actual levels of consciousness. We must look also to the ways in which these patients are potentially conscious. Specifically, I argue that certain sensible and well-regarded policy recommendations cannot be justified by looking solely to patients’ actual levels of consciousness, but that they can be justified by looking to patients’ potential for consciousness. Insofar then as we have prima facie reason to follow the recommendations, we also have prima facie reason to view the potential for consciousness as morally salient. If that is true, however, several important implications follow: first, if the potential for consciousness is morally salient, this translates into actual and pressing obligations to patients with disorders of consciousness generally. Second, if the potential for consciousness is morally salient, this has implications that go beyond our obligations to patients with disorders of consciousness. Indeed, if the potential for consciousness is morally salient, this adds an important layer of complexity to the normative landscape, a layer we may not have sufficiently noticed before. (shrink)

The phenomenon of hypnosis provides a rich paradigm for those seeking to understand the processes that underlie consciousness. Understanding hypnosis tells us about a basic human capacity for altered experiences that is often overlooked in contemporary western societies. Throughout the 200 year history of psychology, hypnosis has been a major topic of investigation by some of the leading experimenters and theorists of each generation. Today hypnosis is emerging again as a lively area of research within cognitive neuroscience informing basic (...) questions about the structure and biological basis of conscious states. This book describes the latest advances in understanding hypnosis and similar trance states by researchers within the neuroscience of consciousness. It contains many new and exciting contributions from up and coming researchers and provides a lively debate on methodological and theoretical issues central to the development of emerging research paradigms in the neuroscience of conscious states. The book introduces and describes many of the recent new tools that have become available to researchers in this field. Academics, researchers, and clinicians wanting to develop their knowledge of the latest findings, theories and methods in the scientific study of hypnosis and related states of consciousness will find this an up to date guide to this rapidly advancing field. (shrink)

The right to die has for decades been recognised for persons in a vegetative state, but there remains controversy about ending life-sustaining medical treatment for persons in the minimally conscious state. The controversy is rooted in assumptions about the moral significance of consciousness, and the value of life for patients who are conscious and not terminally ill. This paper evaluates these assumptions in light of evidence that generates concerns about quality of life in the MCS. It is argued that (...) surrogates should be permitted to make decisions to withdraw life-sustaining medical treatment from patients in the MCS. (shrink)

Neurostimulation to restore cognitive and physical functions is an innovative and promising technique for treating patients with severe brain injury that has resulted in a minimally conscious state (MCS). The technique may involve electrical stimulation of the central thalamus, which has extensive projections to the cerebral cortex. Yet it is unclear whether an improvement in neurological functions would result in a net benefit for these patients. Quality-of-life measurements would be necessary to determine whether any benefit of neurostimulation outweighed any harm (...) in their response to different degrees of cognitive and physical disability. These measures could also indicate whether the technique could be ethically justified and whether surrogates could give proxy consent to its use on brain-injured patients. (shrink)

The “disability paradox” is the idea that for those who become severely disabled, their own quality of life assessment remains at or slightly below the QoL assessments of normal controls. This is a source of skepticism regarding third-person QoL judgments of the disabled. I argue here that this skepticism applies as well to those who are in the minimally conscious state. For rather simple means of sustaining an MCS patient’s life, the cost of being wrong that the patient would not (...) want further support is high. Pair this cost with the reason to be skeptical of third-person judgments, and my argument suggests not withholding food and water from MCS patients. (shrink)

Conscious states—state that there is something it is like to be in—seem both rich or full of detail and ineffable or hard to fully describe or recall. The problem of ineffability, in particular, is a longstanding issue in philosophy that partly motivates the explanatory gap: the belief that consciousness cannot be reduced to underlying physical processes. Here, we provide an information theoretic dynamical systems perspective on the richness and ineffability of consciousness. In our framework, the richness of (...) conscious experience corresponds to the amount of information in a conscious state and ineffability corresponds to the amount of information lost at different stages of processing. We describe how attractor dynamics in working memory would induce impoverished recollections of our original experiences, how the discrete symbolic nature of language is insufficient for describing the rich and high-dimensional structure of experiences, and how similarity in the cognitive function of two individuals relates to improved communicability of their experiences to each other. While our model may not settle all questions relating to the explanatory gap, it makes progress toward a fully physicalist explanation of the richness and ineffability of conscious experience—two important aspects that seem to be part of what makes qualitative character so puzzling. (shrink)

Objective: The value of spontaneous EEG oscillations in distinguishing patients in vegetative and minimally conscious states was studied. Methods: We quantified dynamic repertoire of EEG oscillations in resting condition with closed eyes in patients in vegetative and minimally conscious states (VS and MCS). The exact composition of EEG oscillations was assessed by the probability-classification analysis of short-term EEG spectral patterns. Results: The probability of delta, theta and slow-alpha oscillations occurrence was smaller for patients in MCS than for VS. (...) Additionally, only patients in MCS demonstrated fast-alpha oscillation occurrence. Depending on the type and composition of EEG oscillations, the probability of their occurrence was either aetiology dependent or independent. The probability of EEG oscillations occurrence differentiated brain injuries with different aetiologies. Conclusions: Spontaneous EEG oscillations have a potential value in distinguishing patients in VS and MCS. Significance: This work may have implications for clinical care, rehabilitative programs and medical–legal decisions in patients with impaired consciousness states following coma due to acute brain injuries. (shrink)

Striking experimental results by Benjamin Libet and colleagues have had an impor- tant impact on much recent discussion of consciousness. Some investigators have sought to replicate or extend Libet’s results (Haggard, 1999; Haggard & Eimer, 1999; Haggard, Newman, & Magno, 1999; Trevena & Miller, 2002), while others have focused on how to interpret those findings (e.g., Gomes, 1998, 1999, 2002; Pockett, 2002), which many have seen as conflicting with our commonsense picture of mental functioning.

Consciousness is known to be limited in processing capacity and often described in terms of a unique processing stream across a single dimension: time. In this paper, we discuss a purely temporal pattern code, functionally decoupled from spatial signals, for conscious state generation in the brain. Arguments in favour of such a code include Dehaene et al.’s long-distance reverberation postulate, Ramachandran’s remapping hypothesis, evidence for a temporal coherence index and coincidence detectors, and Grossberg’s Adaptive Resonance Theory. A time-bin resonance (...) model is developed, where temporal signatures of conscious states are generated on the basis of signal reverberation across large distances in highly plastic neural circuits. The temporal signatures are delivered by neural activity patterns which, beyond a certain statistical threshold, activate, maintain, and terminate a conscious brain state like a bar code would activate, maintain, or inactivate the electronic locks of a safe. Such temporal resonance would reflect a higher level of neural processing, one that is independent from sensorial or perceptual brain mechanisms. (shrink)

For a wide range of concepts, a thinker’s understanding of what it is for a thing to fall under the concept plausibly involves knowledge of an identity. It involves knowledge that the thing has to have the same property as is exemplified in instantiation of the concept in some distinguished, basic instance. This paper addresses the question: can we apply this general model of the role of identity in understanding to the case of subjective, conscious states? In particular, can (...) we explain our understanding of what it is for someone else to be in a particular conscious state in terms of our knowledge of the relation of identity which that state bears to some of our own states?[1] This is a large issue, with many ramifications both within and beyond the philosophy of mind; so let me give a map for the route I aim to take. We first need to consider the features of explanations of concepts in terms of identity in domains outside the mental. There are substantial constraints on legitimate explanation of concepts in terms of identity. There are also reasons that it is harder to meet these constraints in the case of concepts of conscious states than it is in other cases. I will go on to suggest a way in which we can overcome the special difficulties of the conscious case, and to try to elaborate the nature both of our understanding of first person applications of concepts of conscious states, and of our grasp of an identity relation applied to these states. A positive account of understanding in this area, as in any other, has to dovetail with a credible epistemology of conscious states in oneself and in others. I will offer something under that head, and say how the resulting position steers a middle way distinct from each of the two classic rival positions on conscious states of the later Wittgenstein on the one hand, and of Frege on the other. (shrink)

Sleep researchers in different disciplines disagree about how fully dreaming can be explained in terms of brain physiology. Debate has focused on whether REM sleep dreaming is qualitatively different from nonREM (NREM) sleep and waking. A review of psychophysiological studies shows clear quantitative differences between REM and NREM mentation and between REM and waking mentation. Recent neuroimaging and neurophysiological studies also differentiate REM, NREM, and waking in features with phenomenological implications. Both evidence and theory suggest that there are isomorphisms between (...) the phenomenology and the physiology of dreams. We present a three-dimensional model with specific examples from normally and abnormally changing conscious states. Key Words: consciousness; dreaming; neuroimaging; neuromodulation; NREM; phenomenology; qualia; REM; sleep. (shrink)

In this article, I consider whether the advance directive of a person in minimally conscious state ought to be adhered to when its prescriptions conflict with her current wishes. I argue that an advance directive can have moral significance after its issuer has succumbed to minimally conscious state. I also defend the view that the patient can still have a significant degree of autonomy. Consequently, I conclude that her advance directive ought not to be applied. Then I briefly assess whether (...) considerations pertaining to respecting the patient's autonomy could still require obedience to the desire expressed in her advance directive and arrive at a negative answer. (shrink)

Empirical evidence indicates that conscious states, distinguished by the presence of phenomenal qualities, are closely linked to synchronized neural activity patterns whose dynamical characteristics can be attributed to self-organized criticality and phase transitions. These findings imply that insight into the mechanism by which the brain controls phase transitions will provide a deeper understanding of the fundamental mechanism by which the brain manages to transcend the threshold of consciousness. This article aims to show that the initiation of phase transitions (...) and the formation of synchronized activity patterns is due to the coupling of the brain to the zero-point field (ZPF), which plays a central role in quantum electrodynamics (QED). The ZPF stands for the presence of ubiquitous vacuum fluctuations of the electromagnetic field, represented by a spectrum of normal modes. With reference to QED-based model calculations, the details of the coupling mechanism are revealed, suggesting that critical brain dynamics is governed by the resonant interaction of the ZPF with the most abundant neurotransmitter glutamate. The pyramidal neurons in the cortical microcolumns turn out to be ideally suited to control this interaction. A direct consequence of resonant glutamate-ZPF coupling is the amplification of specific ZPF modes, which leads us to conclude that the ZPF is the key to the understanding of consciousness and that the distinctive feature of neurophysiological processes associated with conscious experience consists in modulating the ZPF. Postulating that the ZPF is an inherently sentient field and assuming that the spectrum of phenomenal qualities is represented by the normal modes of the ZPF, the significance of resonant glutamate-ZPF interaction for the formation of conscious states becomes apparent in that the amplification of specific ZPF modes is inextricably linked with the excitation of specific phenomenal qualities. This theory of consciousness, according to which phenomenal states arise through resonant amplification of zero-point modes, is given the acronym TRAZE. An experimental setup is specified that can be used to test a corollary of the theory, namely, the prediction that normally occurring conscious perceptions are absent under experimental conditions in which resonant glutamate-ZPF coupling is disrupted. (shrink)

ObjectiveWhen regaining consciousness, patients who emerge from a minimally conscious state (EMCS) present with different levels of functional disability, which pose great challenges for treatment. This study investigated the frontoparietal activity in EMCS patients and its effects on functional disability.Materials and methodsIn this preliminary study, 12 EMCS patients and 12 healthy controls were recruited. We recorded a resting-state scalp electroencephalogram (EEG) for at least 5 min for each participant. Each patient was assessed using the disability rating scale (DRS) to (...) determine the level of functional disability. We analyzed the EEG power spectral density and sensor-level functional connectivity in relation to the patient’s functional disability.ResultsIn the frontoparietal region, EMCS patients demonstrated lower relative beta power (P < 0.01) and higher weighted phase lag index (wPLI) values in the theta (P < 0.01) and gamma (P < 0.01) bands than healthy controls. The frontoparietal theta wPLI values of EMCS patients were positively correlated with the DRS scores (rs = 0.629, P = 0.029). At the whole-brain level, EMCS patients only had higher wPLI values in the theta band (P < 0.01) than healthy controls. The whole-brain theta wPLI values of EMCS patients were also positively correlated with the DRS scores (rs = 0.650, P = 0.022). No significant difference in the power and connectivity between the frontoparietal region and the whole brain in EMCS patients was observed.ConclusionEMCS patients still experience neural dysfunction, especially in the frontoparietal region. However, the theta connectivity in the frontoparietal region did not increase specifically. At the level of the whole brain, the same shift could also be seen. Theta functional connectivity in the whole brain may underlie different levels of functional disability. (shrink)

The minimally conscious sta te (MCS) is usually ascribed when a patientwith brain damage exhibits obser vable volitional behaviors that predict recovery ofcognitive funct ions. Nevertheless, a patient with brain damage who lacks motorcapacit y might nonetheless be in MCS. For this reason, some clinicians use neuralsignals as a communicative means for MCS ascription. For instance, a vegetativestate patient is diagnosed with MCS if activity in the motor area is observed whenthe instruction to imagine wiggling toes is given. The validi (...) ty of using neuralsignals in ascribing MCS requires a special sort of inference. That is, no-reportparadigmatic assessments must have inductively strong ways of inferring a pur-ported informationa l content from the observed neural signal that grounds the factthat the patient has top-down cognitive control (or residual volition). Shannon’smathemat ical theory of communication and Bayes’ theorem reveals the formalstructure of neural communication. On the basis of relevant data from the neuro-science literature, I conclude that the formal structure combined with the data showsthat neural signals can be used as a communicative means for operational diagnosticcriteria for MCS ascription. (shrink)

Background: Patients in a vegetative state pose problems in diagnosis, prognosis and treatment. Currently, no prognostic markers predict the chance of recovery, which has serious consequences, especially in end-of-life decision-making. Objective: We aimed to assess an objective measurement of prognosis using advanced electroencephalography (EEG). Methods: EEG data (19 channels) were collected in 14 patients who were diagnosed to be persistently vegetative based on repeated clinical evaluations at 3 months following brain damage. EEG structure parameters (amplitude, duration and variability within quasi-stationary (...) segments, as well as the spatial synchrony between such segments and the strength of this synchrony) were used to predict recovery of consciousness 3 months later. Results: The number and strength of cortical functional connections between EEG segments were higher in patients who recovered consciousness (P < .05 – P < .001) compared with those who did not recover. Linear regression analysis confirms that EEG structure parameters are capable of predicting (P = .0025) recovery of consciousness 6 months post-injury, whereas the same analysis failed to significantly predict patient outcome based on aspects of their clinical history alone (P = .629) or conventional EEG spectrum power (P = .473). Conclusions: The result of this preliminary study demonstrates that structural strategy of EEG analysis is better suited for providing prognosis of consciousness recovery than existing methods of clinical assessment and of conventional EEG. Our results may be a starting point for developing reliable prognosticators in patients who are in vegetative state, with the potential to improve their day-to-day management, quality of life, and access to early interventions. (shrink)

The phenomenon of hypnosis provides a rich paradigm for those seeking to understand the processes that underlie consciousness. Understanding hypnosis tells us about a basic human capacity for altered experiences that is often overlooked in contemporary western societies. Throughout the 200 year history of psychology, hypnosis has been a major topic of investigation by some of the leading experimenters and theorists of each generation. Today hypnosis is emerging again as a lively area of research within cognitive (systems level) neuroscience (...) informing basic questions about the structure and biological basis of conscious states. This book describes the latest advances in understanding hypnosis and similar trance states by researchers within the neuroscience of consciousness. It contains many new and exciting contributions from up and coming researchers and provides a lively debate on methodological and theoretical issues central to the development of emerging research paradigms in the neuroscience of conscious states. The book introduces and describes many of the recent new tools that have become available to researchers in this field. Academics, researchers, and clinicians wanting to develop their knowledge of the latest findings, theories and methods in the scientific study of hypnosis and related states of consciousness will find this an up to date guide to this rapidly advancing field. (shrink)

Wijdicks and colleagues1 recently presented the Full Outline of UnResponsiveness (FOUR) scale as an alternative to the Glasgow Coma Scale (GCS)2 in the evaluation of consciousness in severely brain-damaged patients. They studied 120 patients in an intensive care setting (mainly neuro-intensive care) and claimed that “the FOUR score detects a locked-in syndrome, as well as the presence of a vegetative state.”1 We fully agree that the FOUR is advantageous in identifying locked-in patients given that it specifically tests for eye (...) movements or blinking on command. This is welcomed given that misdiagnosis of the locked-in syndrome has been shown to occur in more than half of the cases (see Laureys and colleagues3 for review). As for the diagnosis of the vegetative state, the scale explicitly tests for visual pursuit, and hence can disentangle the vegetative state from the minimally conscious state (MCS). The diagnostic criteria for MCS have been proposed4 only recently, but Wijdicks and colleagues1 do not mention the existence of this clinical entity in their article. As for the vegetative state, MCS can be encountered in the acute or subacute setting as a transitional state on the way to further recovery, or it can be a more chronic or even permanent condition. The MCS refers to patients showing inconsistent, albeit clearly discernible, minimal behavioral evidence of consciousness (eg, localization of noxious stimuli, eye fixation or tracking, reproducible movement to command, or nonfunctional verbalization).4 The FOUR scale does not test for all of the behavioral criteria required to diagnose MCS.4 It is known from the literature (see Majerus and colleagues5 for review) that about a third of patients diagnosed with vegetative state are actually in MCS, and this misdiagnosis can lead to major clinical, therapeutic, and ethical consequences. We tested the ability of the newly proposed FOUR scale to correctly diagnose the vegetative state in an acute (intensive care and neurology ward) and chronic (neurorehabilitation) setting.. (shrink)

This short comment on the Court of Protection decision in W v M draws attention to the primacy the judge gave to the preservation of life and discusses the relative lack of weight accorded to M's previously expressed views.

The value of resting electroencephalogram (EEG) in revealing neural constitutes of consciousness (NCC) was examined. We quantified the dynamic repertoire, duration and oscillatory type of EEG microstates in eyes-closed rest in relation to the degree of expression of clinical self-consciousness. For NCC a model was suggested that contrasted normal, severely disturbed state of consciousness and state without consciousness. Patients with disorders of consciousness were used. Results suggested that the repertoire, duration and oscillatory type of EEG (...) microstates in resting condition quantitatively related to the level of consciousness expression in brain-damaged patients and healthy-conscious subjects. Specifically, results demonstrated that (a) decreased number of EEG microstate types was associated with altered states of consciousness, (b) unawareness was associated with the lack of diversity in EEG alpha-rhythmic microstates, and (c) the probability for the occurrence and duration of delta-, theta- and slow-alpha-rhythmic microstates were associated with unawareness, whereas the probability for the occurrence and duration of fast-alpha-rhythmic microstates were associated with consciousness. In conclusion, resting EEG has a potential value in revealing NCC. This work may have implications for clinical care and medical–legal decisions in patients with disorders of consciousness. (shrink)