Review by New York Times Review
BEFORE THE INVENTION of the mechanical ventilator, there was no plug to pull. Starved of oxygen, victims of severe brain trauma were more likely to die on the emergency room table than to linger in an ethical limbo, with doctors and loved ones agonizing over whether the patient was "really alive." By the time Jeff Tremblay, a teenager in Canada, was beaten comatose and airlifted to a hospital in Edmonton, the use of artificial life support had become routine. After three weeks on a ventilator in 1997, he could breathe without assistance, but was that a blessing? He remained locked in what his doctors diagnosed as a vegetative state, unresponsive and seemingly unaware. Jeff's father believed otherwise - that his son understood their one-way conversations and was captivated by the movies he wheeled him to at the cineplex. But he couldn't know for sure. In 2012,15 years after the assault, he heard of a miracle worker named Adrian Owen, a scientist renowned for scanning the brains of vegetative patients and finding what he believed were signs of consciousness - of minds trapped inside bodies longing to break out. In Owen's chronicle of these cases, "Into the Gray Zone: A Neuroscientist Explores the Border Between Life and Death," he describes what happened next. In an initial examination Jeff indeed seemed dead to the world, failing to respond to simple commands to look in the mirror or stick out your tongue. When an object was moved in front of his face, he was barely able to track it with his eyes. But when Jeff was put into a scanner - an fMRI machine (for functional magnetic resonance imaging) - and shown a short Alfred Hitchcock film, "Bang! You're Dead," parts of his brain lit up. "In response to sounds, Jeff's auditory cortex sprung to life," Owen recounts. "When the camera angle changed or the young boy ran across the screen, Jeff's visual cortex activated." Those might have been reflexive responses. But there seemed to be more going on. "At all the critical twists and turns in the plot," Owen writes, "Jeff's frontal and parietal lobes responded exactly like those of a person who was conscious and aware." These are regions of the brain connected with higher thought and the capacity to experience the world. Jeff remained badly damaged - suspended in a gray zone somewhere between consciousness and brain death - but his family felt reassured. They hadn't been talking to a zombie for all those years. Inside that broken body there still seemed to be a Jeff. Owen's encounters with vegetative patients, each one seemingly more fantastic, have been media sensations. In pages filled with exclamation points and swimming in italics, Owen reprises his cases with enthusiasm and empathy, explaining just enough science for the experiments to make sense. His first encounter, described many times in the popular science press, was with Kate Bainbridge, a nursery school teacher in Cambridge, England, who lapsed into the gray zone after a bad cold developed into a serious virus that caused debilitating brain and spinal cord inflammation. After a few weeks in intensive care she emerged from a coma but showed no signs that she was cognizant or leading any kind of inner life. But when she was put into a PET scanner and presented with pictures of her family, her brain responded in ways one might expect from a healthy person. Gradually she recovered mentally, though not physically. "I thought I was in prison," she told Owen years later, as she sat in an electric wheelchair. "I had no idea where I was." Other experiments have been less clearcut. Not long after Bainbridge came a vegetative patient, called Debbie in the book, whose temporal lobes seemed to respond normally to recorded speech. But it wasn't clear from the scanning whether she knew what (or that) she was hearing. Reaching deeper, Owen found clues that a stroke victim named Kevin could perform a more sophisticated linguistic task. When he was exposed to recordings of sentences with double meanings ("he fed her cat food") his brain scan showed patterns like those of a conscious person trying to resolve the ambiguity. That still wasn't enough to demonstrate that a patient was mentally alive. On a beach in Australia, Owen writes, he had an epiphany: To make a strong case that some vegetative patients were thinking and feeling he would have to catch their brains in the act of making a willful decision. And so we meet Carol, a 23-year-old woman who had been struck by two cars as she was crossing a busy road, distracted by her cellphone. Her head dented in from a craniectomy - the removal of a piece of skull to relieve the pressure of her swollen brain - she lingered for months in a vegetative state. While she was under the scanner, Owen asked her to imagine that she was playing a game of tennis. He had seen how in healthy people this request activated an area near the top of the head called the premotor cortex. The same thing happened with Carol. Then he asked her to imagine that she was walking around her house. This time a different area, the parahippocampal gyrus (involved in spatial memory and navigation), responded - again as in a normal person. Carol, it seemed to Owen, had made a deliberate choice. "We had sent a clear Are you there?' signal into inner space and the answer 'Yes, I am here' had come back loud and clear," Owen writes. "The case was closed. Carol was conscious." THE CLIMAX OF the book comes with Scott, who seemed stuck in a vegetative state 12 years after a car accident in 1999. As a BBC film crew stood by, Owen presented the patient with yes or no questions. "Scott, are you in any pain? Do any of your body parts hurt right now?" If the answer was yes he was told to imagine walking through his house. If the answer was no he was to imagine playing tennis. Scott signaled the negative. He wasn't in pain. His mother said she had known that all along. Not everyone is convinced that the output of a scanner can be translated so unambiguously into thoughts and intentions. Explaining the subjective mind and how it arises from flesh is among science's unsolved problems. Parashkev Nachev, a neurologist at University College, London has criticized Owen for reading too much into the data and for raising false hopes. "I find the whole media circus surrounding the issue rather distasteful," he told Roger Highfield, a British science journalist, in 2014. "The relatives of these patients are distressed enough as it is." Owen believes that his work is beneficial not only to science but also to vegetative patients, encouraging doctors and nurses to treat them more empathetically. That, he believes, might conceivably increase the odds of a partial recovery - if the patients really know what's going on. In a scene toward the end of the book, Owen celebrates with colleagues at a Paris restaurant. As the courses arrive and the wine is poured, he foresees a "not-too-distant future" where brain-computer interfaces "may allow people in the gray zone to take online courses, type emails, hold conversations and express their innermost feelings." Maybe so, but given the difficulty of interpreting gray zone experiments that seems like a stretch. For all the good they've done, mechanical ventilators have left us with ethical dilemmas that neurotechnologies are unlikely to resolve. They might even make them worse, with lawyers and expert witnesses arguing over signals from a scanner and whether they stand as evidence of a conscious self. The venerable mind-body problem, argued to a standstill by philosophers and scientists, will move to the courtroom, the mystery stubbornly intact. ? To prove that vegetative patients Eire thinking, Owen catches their brains making a decision. GEORGE Johnson is the author of "The Cancer Chronicles."
Copyright (c) The New York Times Company [August 27, 2017]
Review by Publisher's Weekly Review
In this vivid, emotional, and thought-provoking account, Owen, research chair in cognitive neuroscience and imaging at the University of Western Ontario's Brain and Mind Institute, surveys his research on the human brain in a non-responsive state. Case by case, Owen probes the limits of human consciousness while taking readers bedside to observe trauma victims, many who have been in coma-like states for years, but whose severely damaged brains show clear signs of responding to his bizarre tests. As technology advances from PET scans to fMRIs, Owen and his colleagues devise more complicated means of communicating with "gray zone" patients. International headlines are made and ethical questions are raised. One patient, who regains her ability to speak and walk, shares what it was like to be treated as vegetative despite her awareness of everything going on around her. Using an experiment involving a Hitchcock film, Owen finds that several subjects believed to be vegetative are fully aware. "It was a haunting reminder of the resiliency of consciousness," Owen writes, reflecting on "the meaning of what it means to be alive and whether anyone can be said to be irretrievably lost." Occasional platitudes aside, Owen's story of horror and hope will long haunt readers. Agent: Gail Ross, Ross Yoon Literary. (June) © Copyright PWxyz, LLC. All rights reserved.
(c) Copyright PWxyz, LLC. All rights reserved
Review by Library Journal Review
A fascinating layman's review of findings on the brain, this title ponders: When is an unresponsive person still conscious? Owen (Canada Excellence Research Chair in Cognitive Neuroscience & Imaging, Brain & Mind Inst., Western Univ., London, Ont.) revisits the early days of his career as a neuroscientist in England, when he was breaking up with his girlfriend Maureen, a fellow researcher who switched to psychiatric nursing to help people. In one of several serendipities in Owen's career, Maureen had an aneurysm that left her in a vegetative state. Her predicament was never far from Owen's mind as his work turned toward the clinical. Employing the latest scanning technology-first, PET; later, fMRI (functional MRI)-Owen used innovative methods and made international headlines with his discovery that many patients who appeared minimally responsive were actually conscious. More than a mere discussion of science, this gripping book considers the legal and ethical implications of the author's investigation of this "gray zone" between brain death and normal cognitive alertness. Verdict Those interested in the research details will want to look up the studies cited, but anyone eager to learn more about the brain, the mind, consciousness, and the history of 20th-century neuroscience will enjoy this engaging combination of science, detective story, and memoir.-Nancy H. Fontaine, Norwich P.L., VT © Copyright 2017. Library Journals LLC, a wholly owned subsidiary of Media Source, Inc. No redistribution permitted.
(c) Copyright Library Journals LLC, a wholly owned subsidiary of Media Source, Inc. No redistribution permitted.
Review by Kirkus Book Review
An exploration of the current medical research on brain health and the consciousness of patients who suffer catastrophic head trauma.Throughout a fascinating multidecade research study, renowned neuroscientist Owen (Cognitive Neuroscience/Western Univ., Canada) probed the mysterious and uncharted shadowlands of the so-called "gray zone," the middle ground between brain death and neural cognitive alertness. His interest was triggered after a former partner suffered a brain aneurysm and was left in a vegetative state, though the author often wondered if some sort of brain activity resided within her. Owen spotlights clinical case studies he monitored in which critically injured patients became "trapped in between in the minimally conscious state" yet demonstrated brain activity; some even returned to full consciousness. With each patient experiment and experience, the author and his fellow researchers expanded their scope of knowledge and pieced together cohesive theories and conclusions about brain function, memory commitment, and conscious awareness. Continually aided by revolutionary brain scanning technology in which "we connect with these brains, visualizing their function and mapping their inner universe," his research has also incorporated many different aspects of life as well. Owen wrestled with issues such as a patient's right to die and the difference between a human brain understanding speech patterns presented to it versus simply experiencing them. With remarkable clarity, Owen punctuates his findings with concise dispatches on the human condition and the disparities between what is considered quality of life and what some consider an inhumane, dysfunctional existence. In an engrossing and intensive narrative, the author shares his findings that 15 to 20 percent of the diagnosed vegetative-state patients he interacted with were actually partially to fully conscious, though their bodies were unable to physically respond to outward stimuli. By calling attention to this neurological phenomenon, Owen advocates for improved therapies and further experiments to more fully understand these "intact minds adrift deep within damaged bodies and brains." A striking scientific journey that draws hopeful attention to how the brain reacts, restores, and perseveres despite grave injury. Copyright Kirkus Reviews, used with permission.
Copyright (c) Kirkus Reviews, used with permission.
