Trapped in your own mind?! - Tilted Forum Project Discussion Community

xepherys · 09-08-2006, 11:21 AM

http://arstechnica.com/journals/scie.../2006/9/8/5230

Quote:

September 08, 2006 @ 11:01AM - posted by Jonathan M. Gitlin
A mind trapped

As regular readers might know, not all traumatic brain injuries (TBIs) are the same. Severe brain injuries can run the gamut from comas to minimally conscious states (MCS) to persistent vegetative states (PVS). And, it seems, not all PVSs are equal, based on a report in this week's Science, regarding the results of fMRI scans performed on a patient who had been in a PVS for five months.

The patient, a 23-year-old woman, suffered a TBI following a car accident, and was diagnosed as being in a PVS following a period in a coma. She displayed sleep-wake cycles, but was not responsive to stimuli, and showed no intentional movement. During an fMRI scan, however, the patient showed brain activity consistent with processing speech compared to random noise, suggesting a certain level of consciousness.Supplementary motor area (SMA) activity during tennis imagery in the patient and a group of 12 healthy volunteers (controls).

In order to confirm these findings, a second fMRI study was performed, where the patient was asked to imagine walking through the rooms of her house, or playing a game of tennis. The results of her fMRI were identical to those from healthy control subjects. Both this, and her cooperation with the researchers, suggest a level of consciousness that belies her diagnosis of being in a PVS. Since then, the patient has exhibited a few more signs of consciousness, being able to track objects for a few seconds with her eyes.

Now, as with the last case of Terry Walker, a brain damaged patient confounding our expectations, I must stress that these findings do not apply to the case of Terri Schaivo, the PVS patient in Florida who was the center of a controversy last year. Terri Schaivo's brain scans showed quite clearly that a large portion of her cerebral cortex was atrophied following oxygen deprivation. Hypoxia is particularly damaging to neurons, and the findings of this single case cannot be applied to all PVS patients. This patient, and Terry Walker, both suffered TBIs but not hypoxia.

It does raise the question of how PVS patients are cared for, though. Despite physical examinations, some PVS patients might be similarly locked in, unable to display signs of conscious thought. Although fMRI scans are costly and time consuming, they may prove useful in determining whether or not patients that have been diagnosed with PVS might bge able to recover some level of interaction with their surroundings. On a personal level, I'm not sure how well I could cope, were I to be in the same position. To be locked inside one's own body, with no way of communicating to those around you must be the worst prison of all.

I'd be interested in seeing this thread take two directions, maybe simultaneously... First, what do you imagine it would be like to be trapped in your own mind? How do you think you'd fare if you were relatively conscious of your situation? Secondly, what do you think about the possible medical ramifications that might come to light if they start using fMRIs as a standard procedure for such patients?

I've heard stories of similar things, often situations where anesthesia doesn't work right so you are aware but cannot communicate. Could you imagine being like that for MONTHS or YEARS? I can't imagine I could come out of it sane... I wonder if claustrophobia could get tripped during a period like this? It seems quite scary to me.

I do, however, think this discovery is wonderful, and could really help people down the road. Perhaps a lot of use will make MRI scans less expensive and offer additional/better treatment options for patients with issues other than this even.

Crack · 09-08-2006, 12:26 PM

Kill me. Just end it right then. Years of being able to know what was going on around me, but not being able to move or talk or communicate in the least?

Kill me.

ratbastid · 09-08-2006, 01:00 PM

Quote:

Originally Posted by Crack

Kill me.

Put it in writing right now. Once the unthinkable happens, you have no way of telling them that.

When the whole Schiavo thing was on the news, lurkette and I got VERY clear with each other that we're not interested in living on life support.

Cynthetiq · 09-08-2006, 01:02 PM

i'm already trapped in my own mind....

Ustwo · 09-08-2006, 01:42 PM

I'm an atheist. Keep me alive, oblivion can wait.

raeanna74 · 09-08-2006, 01:47 PM

I don't know how I'd fair. Right now. I'd say kill me painlessly if there was no hope of me recovering. Then, I can't say. Unless there was any hope of regaining SOME form of communicating with people I know I would eventually become locked in a mental circle of struggle, frustration, depression until I would WISH I could kill myself by THINKING it.

I think this is a valuable discovery to eliminate some of the debate around people who are in this situation.

ngdawg · 09-08-2006, 01:59 PM

I'm sort of on the fence, personally. On the one hand, if I were to be comatose but an MRI showed brain activity, I certainly would not want the plug pulled. On the other hand, as science stands now, there's no way of either lifting the patient out of that state or communicating with the patient and I don't know I would want to be trapped like that.
Karen Ann Quinlan brought a lot of this debate to the forefront. After months of legal wrangling back and forth, they 'pulled the plug' only to have her live more than 10 years more, still in a vegetative state. Seems she wasn't as braindead as they thought. And therein lies the fear-what if they decide to pull the plug and there would have been more chance of recovery?

laconic1 · 09-08-2006, 02:08 PM

That is a tricky one. I've always felt if my brain did not have any function to just let me go. But in a scenario like this where it is functional? I guess I would want to live, since I would be cognizant of the possibility of recovery.

analog · 09-08-2006, 03:42 PM

Here's the thing, too... unless the brain stem was damaged, there's no reason these people's bodies can't live on their own. Many aren't on "life support", but are simply attached to monitors like any person would be. They breathe fine on their own, but only require IV nutrition (or a feeding tube) since they're not able to eat- IV nutrition, however, is not considered life support. You're just feeding them.

The reason this is extra important is because a lot of these people have no "plug" to "pull". So, the only way to put them out of their misery would literally mean intentionally ending their life, not simply removing or discontinuing artificial support and "letting nature take its course". You would actually have to end their life.

Euthanasia for a person who is on full life support is a controversial enough topic, with the only issue being that you remove them from the machinery keeping them alive, letting them die naturally.

This situation is more akin to giving a person a painless death, such as a person dying of cancer. You're "putting them out of their misery", since the process of slowly dying from a cancer can be extremely painful and agonizing. In these cases, however, the patient is conscious and usually able to fully articulate their desire to be euthanized.

For a person who is in a persistant vegetative state, but shows signs of brain activity we measure as a sign of some level of consciousness, they are incapable of telling us what they want. If it's not in a living will, they have to be left alive, even though there is currently no way to bring a person back from such a state.

So do we let them live, because they're alive? Or do we realize the maddening cage we're keeping them in and end their mental suffering?

This is another great discussion to impress upon people the importance of a living will, and making sure everyone close to you understands your wishes, just in case.

Ch'i · 09-08-2006, 05:22 PM

If it was a lucid dream, then maybe.

hulk · 09-08-2006, 09:11 PM

I'd assume it would be, Ch'i, or that they'd have a degree of control over their thoughts as they reacted to what was asked. It wouldn't be all bad if so - being all-powerful, although in the region of your own mind, has its perks.

Pip · 09-09-2006, 10:21 AM

Tough one. I'm a big daydreamer, so if I got to listen to books on tape and some nice music to feed the imagination I could be content.

On the other hand, I know how I become when I'm very ill. I get the worst cabin fever. It's okay to loaf in front of the TV or read books all day when I know I could take a walk in the woods or go to town - if I wanted to. But as soon as I'm limited to loafing activities only I go stir-crazy. The two times I've had concussions I've messed up my recovery something fierce because I simply cannot lie still in a dark and quiet room like I'm supposed to for even a day. It's boring!

But between being a bit bored and being dead? Bored.

ratbastid · 09-09-2006, 10:57 AM

Quote:

Originally Posted by Ustwo

I'm an atheist. Keep me alive, oblivion can wait.

There are much worse things than oblivion.

Aurakles · 09-09-2006, 11:32 AM

Quote:

Originally Posted by Ch'i

If it was a lucid dream, then maybe.

...that would be nice.

Dissociated · 09-10-2006, 12:50 AM

I suppose its a hard question to answer unless you've experienced such an event yourself. Scary thing to think about, being trapped within you own mind..... I'd have to say I'd rather move on and die. It just seems more natural.

09-08-2006, 12:26 PM	#2 (permalink)
Crack Misanthropic Location: Ohio! yay!	Kill me. Just end it right then. Years of being able to know what was going on around me, but not being able to move or talk or communicate in the least? Kill me. __________________ Crack, you and I are long overdue for a vicious bout of mansex. ~Halx

09-08-2006, 01:02 PM	#4 (permalink)
Cynthetiq Tilted Cat Head Administrator Location: Manhattan, NY	i'm already trapped in my own mind.... __________________ I don't care if you are black, white, purple, green, Chinese, Japanese, Korean, hippie, cop, bum, admin, user, English, Irish, French, Catholic, Protestant, Jewish, Buddhist, Muslim, indian, cowboy, tall, short, fat, skinny, emo, punk, mod, rocker, straight, gay, lesbian, jock, nerd, geek, Democrat, Republican, Libertarian, Independent, driver, pedestrian, or bicyclist, either you're an asshole or you're not. What's the best nation in the world? DO-NATION!

09-08-2006, 01:42 PM	#5 (permalink)
Ustwo Pissing in the cornflakes	I'm an atheist. Keep me alive, oblivion can wait. __________________ Agents of the enemies who hold office in our own government, who attempt to eliminate our "freedoms" and our "right to know" are posting among us, I fear.....on this very forum. - host Obama - Know a Man by the friends he keeps.

09-08-2006, 01:47 PM	#6 (permalink)
raeanna74 I'm not a blonde! I'm knot! I'm knot! I'm knot! Location: Upper Michigan	I don't know how I'd fair. Right now. I'd say kill me painlessly if there was no hope of me recovering. Then, I can't say. Unless there was any hope of regaining SOME form of communicating with people I know I would eventually become locked in a mental circle of struggle, frustration, depression until I would WISH I could kill myself by THINKING it. I think this is a valuable discovery to eliminate some of the debate around people who are in this situation. __________________ "Always learn the rules so that you can break them properly." Dalai Lama My Karma just ran over your Dogma.

09-08-2006, 01:59 PM	#7 (permalink)
ngdawg peekaboo Location: on the back, bitch	I'm sort of on the fence, personally. On the one hand, if I were to be comatose but an MRI showed brain activity, I certainly would not want the plug pulled. On the other hand, as science stands now, there's no way of either lifting the patient out of that state or communicating with the patient and I don't know I would want to be trapped like that. Karen Ann Quinlan brought a lot of this debate to the forefront. After months of legal wrangling back and forth, they 'pulled the plug' only to have her live more than 10 years more, still in a vegetative state. Seems she wasn't as braindead as they thought. And therein lies the fear-what if they decide to pull the plug and there would have been more chance of recovery? __________________ Don't blame me. I didn't vote for either of'em.

09-08-2006, 02:08 PM	#8 (permalink)
laconic1 Junkie	That is a tricky one. I've always felt if my brain did not have any function to just let me go. But in a scenario like this where it is functional? I guess I would want to live, since I would be cognizant of the possibility of recovery.

09-08-2006, 03:42 PM	#9 (permalink)
analog Banned	Here's the thing, too... unless the brain stem was damaged, there's no reason these people's bodies can't live on their own. Many aren't on "life support", but are simply attached to monitors like any person would be. They breathe fine on their own, but only require IV nutrition (or a feeding tube) since they're not able to eat- IV nutrition, however, is not considered life support. You're just feeding them. The reason this is extra important is because a lot of these people have no "plug" to "pull". So, the only way to put them out of their misery would literally mean intentionally ending their life, not simply removing or discontinuing artificial support and "letting nature take its course". You would actually have to end their life. Euthanasia for a person who is on full life support is a controversial enough topic, with the only issue being that you remove them from the machinery keeping them alive, letting them die naturally. This situation is more akin to giving a person a painless death, such as a person dying of cancer. You're "putting them out of their misery", since the process of slowly dying from a cancer can be extremely painful and agonizing. In these cases, however, the patient is conscious and usually able to fully articulate their desire to be euthanized. For a person who is in a persistant vegetative state, but shows signs of brain activity we measure as a sign of some level of consciousness, they are incapable of telling us what they want. If it's not in a living will, they have to be left alive, even though there is currently no way to bring a person back from such a state. So do we let them live, because they're alive? Or do we realize the maddening cage we're keeping them in and end their mental suffering? This is another great discussion to impress upon people the importance of a living will, and making sure everyone close to you understands your wishes, just in case.

09-08-2006, 05:22 PM	#10 (permalink)
Ch'i Artist of Life	If it was a lucid dream, then maybe.

09-08-2006, 09:11 PM	#11 (permalink)
hulk C'mon, just blow it. Location: Perth, Australia	I'd assume it would be, Ch'i, or that they'd have a degree of control over their thoughts as they reacted to what was asked. It wouldn't be all bad if so - being all-powerful, although in the region of your own mind, has its perks. __________________ "'There's a tendency among the press to attribute the creation of a game to a single person,' says Warren Spector, creator of Thief and Deus Ex." -- From an IGN game review.

09-09-2006, 10:21 AM	#12 (permalink)
Pip Likes Hats Location: Stockholm, Sweden	Tough one. I'm a big daydreamer, so if I got to listen to books on tape and some nice music to feed the imagination I could be content. On the other hand, I know how I become when I'm very ill. I get the worst cabin fever. It's okay to loaf in front of the TV or read books all day when I know I could take a walk in the woods or go to town - if I wanted to. But as soon as I'm limited to loafing activities only I go stir-crazy. The two times I've had concussions I've messed up my recovery something fierce because I simply cannot lie still in a dark and quiet room like I'm supposed to for even a day. It's boring! But between being a bit bored and being dead? Bored.

09-10-2006, 12:50 AM	#15 (permalink)
Dissociated Upright	I suppose its a hard question to answer unless you've experienced such an event yourself. Scary thing to think about, being trapped within you own mind..... I'd have to say I'd rather move on and die. It just seems more natural.