Into the Grey Zone can be read on several levels: as an enthralling scientific detective story, as a story of broken minds and brains, or as a book that feels incomplete, because the story it tells is not yet scientifically, medically, ethically or philosophically complete. Owen presents one of the most remarkable scientific stories of recent decades: the investigation of the fractional human consciousness remaining in damaged brains situated in unmoving bodies. He and his colleagues have shown that a substantial percentage of patients thought to be in a coma (perhaps one in five) are in a “grey zone” somewhere between consciousness and coma. Such patients are not vegetative: they are in there somewhere, but what condition they are in is difficult to know.
Owen describes using the latest brain-imaging technology to communicate with these seemingly mute, inexpressive, comatose patients. Fragmentary consciousness (and often more than this) and a capacity for contact remain; sometimes these patients make a remarkable return from their submerged world to ours. They communicate by imagining activity in brain areas that perform distinctively different functions. Owen asks such patients questions and tells them to imagine playing tennis (relying on the premotor cortex) if the answer is “Yes” or walking about their homes (relying on the parahippocampal cortex) if the answer is “No”. Suddenly, disturbingly, formerly mute patients are able to communicate what they think and feel – if they are in pain, if they are in distress, if they want to die – and to do so reliably.
It is probably a good thing that Owen is no philosopher. There are no perorations here about qualia or the “hard problem” of consciousness; no extended minds, rejuvenated panpsychism or mysterianism litter the book. Instead, we meet a hard mind-brain identity equivalence: “we are our brains”. For Owen, consciousness is a biological problem, with consciousness (somehow) arising from the tiny robots that are the brain cells comprising our brains. He sets aside all the philosophical talk and counter-talk to focus on how a brain (especially a broken, damaged or compromised brain) gives rise to consciousness. As a result, he has shifted the terms of the philosophical and ethical debate. Biomedical ethicists now must ponder if living wills should be acted upon: “I said beforehand that I wished to die. Now, I lie here silent and unmoving, and tell you, through a machine, that I do not.” Which wish do you act on?
The book does feel incomplete: this is no criticism. We are beginning a strange new scientific revolution: one taking us into the deep, dark silence of the brain – the brain that renews our fragile consciousness every morning, turns it off every night, and that struggles through the fog of injury, disease and near-death to make itself heard. Into the Grey Zone deserves to be widely read, for it touches the core of what it means to be consciously human – and to lose human contact while conscious, while trapped and unmoving. Perhaps the closest we might come to this in everyday life is the condition of sleep paralysis, where you are conscious, dreaming and paralysed. Deservedly uncomfortable reading indeed.
Shane O’Mara is professor of experimental brain research at Trinity College Institute of Neuroscience, Dublin, and author of Why Torture Doesn’t Work: The Neuroscience of Interrogation (2015).
Into the Grey Zone: A Neuroscientist Explores the Border Between Life and Death
By Adrian Owen
Faber & Faber, 320pp, £16.99
Published 7 September 2017