Owen’s book examines borders of consciousness

“Imagine playing tennis.”

With the release of Western neuroscientist Adrian Owen’s book about the borderlines of consciousness, that phrase may well enter the international lexicon as a shorthand offering hope to intact minds locked within unresponsive bodies.

Into the Gray Zone was released this week in North American by Simon & Schuster.

The book is getting a worldwide publicity push as Owen, who is Canadian Excellence Research Chair in Cognitive Neuroscience and Imaging, explores the spaces in between life and death for people in a vegetative state.

Through his work at Western’s Brain and Mind Institute, as well as earlier at Cambridge University in the United Kingdom, Owen and his team have been able to discover how some people are aware, despite other diagnoses to the contrary. These patients have suffered catastrophic brain injury and live in a “grey zone” – neither in a coma nor awake – and not responsive to the world around them.

Owen captured international medical and media attention when he found through fMRI scans that 20 per cent of these non-responsive patients may, in fact, be conscious.

“I was initially reluctant to write this book, but I became convinced that all of us – not just neuroscientists and other researchers – have much to learn from the stories of people previously dismissed as being in a vegetative state,” Owen said. “Our team at the Brain and Mind Institute at Western is in the vanguard of discovering what it is that makes us human, what it is to be conscious, what it is that makes us truly alive. Into the Gray Zone gets to the heart, and the brain, of that important study of life and death and the myriad degrees of awareness in between.”

Owen’s work has enabled him to learn that patients are not only aware and can have memories of the people they were before injury, but their brains can also lay down new memories – ones that reflect keen awareness of their circumstances and surroundings since they entered the grey zone.

While patients were in the scanner, Owen asked them to picture walking from room to room in their house. He also asked them to imagine playing tennis. In a patient who is conscious, each visualization would light up different parts of their brains in the scanner.

In the book, Owen describes how ‘Carol,’ who had suffered a traumatic brain injury, became the breakthrough patient during testing at Cambridge in 2006. “We had found Carol. I 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 wrote.

Much of the ground-breaking work has taken place at Western where, among other research, Owen used the tennis and house-tour visualizations as surrogate answers to yes-no questions.

In 2012, they asked brain-injured patient ‘Scott,’ “Are you in pain?” If the answer was no, he was to imagine playing tennis. If yes, he was to imagine walking around his house.

Owen describes that ‘no’ response as one of the most emotional findings of his career.

“He expressed himself, speaking to us through this magical connection we had made between his mind and our machine. To communicate for the first time with another human being who has been unable to communicate for more than a decade is an extraordinary experience.”

That “imagine playing tennis” line is an emotive echo of mid-20th-century neurosurgeon Wilder Penfield’s pioneering work to map the human brain. In a discovery made famous by Heritage Minutes, one of his patients during brain mapping exclaims, “I can smell burnt toast!”

Into the Gray Zone tells the stories of unlocking the inner worlds of patients ‘Kate,’ ‘Amy,’ ‘Jeff’ and ‘Juan’. It also explores the ethics and philosophical questions of what Owen calls “the critical spectrum between the unconscious and the conscious.”

In the end, though, Owen concludes, “the heart of grey-zone science is about finding people who have been lost to us and reconnecting them with the people they love and who love them.”

The book is dotted with questions about quality-of-life care, end-of-life care and the science and ethics of emerging technology that might one day allow us to decode how our minds operate. When doctors, families and other caregivers work with these patients, it introduces is complex new layers of consideration about care, consent, right-to-die and right-to-life issues.