“I see what you’re saying…I see how you might think that…,” just phrases in conversation, right? They imply some casual level of understanding during a chat. But can neuroimaging give us a better window into human consciousness itself, and be used to help coma patients communicate decisions, as suggested by a recent paper?
[Canine consciousness “imaging” depicted above; below is an artistic composite of PET scans in various states of human consciousness. Glasgow 15 is clinical consciousness after a mild head injury].
“I know what you’re thinking….” That kind of phrase is almost a cliche setup line in comedy; the punch line can be surprising and hilarious. Seems like anyone with an iota of empathy can be a mind-reader in a comedic way, with all due respect to the “Amazing Kreskin” and other magical mentalists [one is sure that neuroscientists have humor, empathy and a sense of magical performance too, as long as their grants come through!]
But if one takes the words literally, in a concrete way…is there really a way see what another person is thinking?
“I can see where you’re thinking is …”(neuroimagers might add “…in your brain…” ) By tracking living brain changes on images, neuroimaging can show what anatomic areas seem to be using more blood, and/or more glucose [and how is that regulated again?] , using methods to correlate with speech or written communication.
The fascinating field is not new. Before metabolic PET scans and functional MRI there were EEG’s to trace brain electrical activity in various states of consciousness. More dramatic work was done by the neurosurgeon WG Penfield (born in Spokane) in the 1950’s. Using local anesthetics, he used open skull techniques [the Montreal procedure] on conscious talking patients. He did direct “imaging,” so to speak, mapping and stimulating brain areas to refine neurolocalization, as he did epilepsy surgery.
One early study of functional MRI in consciousness is over 20 years old. A study of Tibetan monks in meditation was done over 15 years ago. More recent imaging extends some of those findings in persons with brain injury or dementia. PET scans are used in the research of dementias, helping to localize abnormal amyloid beta or tau, look for glucose changes, and more recently to look at patterns of synaptic glycoprotein 2A (Feb 2022).
One group is considering whether Alzheimer’s Disease (AD) might be called a “disorder of consciousness.” This paper has a nice glossary (last Oct 2021) which defines “noetic” consciousness, self-awareness, etc. It also has a section on neuroimaging:
In their concluding remarks: “AD is characterized by dysfunction of arousal and awareness of the self and environment. It should be considered a disorder of consciousness, as this highlights the clinical characteristics of the disease and reflects what is important to patients and caregivers…”
But is any of this currently useful? One might say that Stephen Hawking, who had progressive Amyotrophic Lateral Sclerosis (ALS) had a “locked in syndrome” (LIS). His muscular system deterioration kept him from using a keyboard, but his prodigious intellect and consciousness was still obvious. So engineers created various devices that helped him communicate, some of them based on subtle cheek muscle twitches.
Perhaps bioengineers can help folks with various neurologic diseases communicate too, like they did for Hawking. Perhaps imaging can help with that effort.
“Assistive neuroimaging” might be useful in persons with even more limited ways to communicate. A paper from last month (Feb 2022) describes a patient from ten years ago in a “persistent vegetative state,” with no signs of awareness using routine clinical tools. He was then enrolled in a study that seemed to show that his brain images could change, implying awareness. It was interpreted that he could answer some yes/no questions consistently and perform in tasks like distinguishing his own name from others.
The crux of the current paper is whether this kind of interpretative technology is not only good enough to elicit a person’s answers for decisions, but whether the uncertainties and medical ethical framework supports actions based on those interpretations.
Those conundrums might be approached tangentially through films. The strange sci-fi movie Chaos Walking from last year (2021) featured “showing” male thoughts that were given an audiovisual reality. Despite having two young British stars, Daisy Ridley and Tom Holland, the movie evidently bombed with viewers. A comedy from 2019 was What Men Want, about a woman who wakes up from a magic potion to find she can hear men’s thoughts; 20 years ago the comedy was What Women Want, about a man who wakes up after an electric shock to find he can hear women’s thoughts.
In general, as the films suggest, maybe we don’t really want to know what another person is thinking… it’s so much nicer, civil and polite to keep it all superficial! In a superficial blog piece like this, can you tell what AdGadfly is really thinking?? Hope not!
But for those with brain disorders that affect communication, like LIS, the situation might be horribly frustrating.
When some of the assisted neuroimaging work was published in NEJM (Monti et al, 2010), Dr. Allan Ropper wrote the editorial “Cogito Ergo Sum by MRI.” The Latin expression phrase, usually translated as “I think, therefore I am,” is famously associated with the 17th century philosopher Descartes, an advocate of mind-body dualism. The editorial ends with:
“The mind is an emergent property of the brain and cannot be “seen” in images. The article by Monti et al. is provocative; however, physicians and society are not ready for ‘I have brain activation, therefore I am.’ That would seriously put Descartes before the horse.”
