Science or Séance?

Research Blogging / by Dave Munger /

Media fanfare over an incapacitated car accident victim (and the nurse who “communicates” for him) raises the question of how we can know whether a person is conscious.

Few things are more horrifying than the prospect of being fully conscious but locked in your body, unable to move or communicate in any way. The anonymous blogger and cancer surgeon “Orac” has called such a predicament “a fate worse than death.” Perhaps that’s why the case of Rom Houben, a Belgian man incapacitated by a car crash 23 years ago, has recently garnered so much attention.

Doctors had told Houben’s mother that he was in a persistent vegetative state—alive, but not conscious. For years she was assured there was no hope for her son to recover his mental facilities. Then neurologist Steven Laureys reexamined the case and claimed that Houben was in fact conscious. Even more incredibly, Houben had apparently learned to communicate using an assistant who helped him point to letters on a computer touchscreen. Houben was not only conscious, it appeared, but lucid to the point of eloquence, responding almost poetically to eager reporters’ enquiries.

Could Houben’s doctors really have gotten his diagnosis so wrong for so many years? Was he a prisoner in his own body, having thoughts and emotions but being unable to share them until now? Many are skeptical of the method Houben’s advocates claim he uses to tell this account, known as facilitated communication or FC. Initially proposed as a means for severely autistic children to communicate, FC involves a facilitator guiding the hands and fingers of an incapacitated patient to select alphanumeric symbols on a touchscreen, ostensibly based on subtle cues the facilitator feels from the patient. In this way, meaningful messages can be painstakingly constructed. But researcher and science writer Martin Robbins points to a 2001 review of 29 separate studies on FC that calls into question from whom these messages are truly coming.

Photo courtesy of Nancy Wombat

The reviewer, Mark Mostert, a professor of special education at Regent University School of Education, found that only 10 of the 29 studies showed any support for FC, and all of these were either methodologically flawed or lacking in scientific controls. In one controlled study, for example, the facilitators left the room while the research subjects were shown objects. When the facilitators returned, there was no evidence that the subjects could successfully communicate what objects they had seen despite earlier claims of lucid communication. Only in uncontrolled or methodologically flawed studies, where facilitators could easily guess what the expected response would be, was any evidence of “communication” found. Mostert concludes that no true communication is occurring in any of the cases.

In Houben’s case, Robbins says, the videos clearly show that he is often not looking at the touchscreen. There is even a video showing Houben “typing” away while his eyes are closed. Such evidence makes it much harder to accept that what is being communicated in Houben’s interviews are his own thoughts rather than those of his facilitator.

That said, just because Houben can’t “speak” with FC doesn’t mean he’s not conscious. As British science writer Christian Jarrett points out, it is possible to detect a brain response even in people with no ability to show a physical response. Earlier this year, Caroline Schnakers of the Université de Liège described using electroencephalography (EEG) to detect the voluntary brain activity of an apparently comatose woman in response to her own name (and not other names). The woman was later able to physically respond as well.

But is a dim EEG response really indicative of “consciousness?” Much of our brain functions without our awareness—for example, the parts of the brain responsible for controlling breathing and heart rate. Indeed, I’ve reported on many studies where people respond to stimuli without even being consciously aware of them. We like people more or less based on undetectable aromas. Our brains respond before we’re conscious of having made a decision.

Perhaps the most dramatic demonstration was an investigation published in PLoS Biology of 10 epileptic patients who agreed to participate in a study of consciousness while undergoing brain surgery to treat their seizures. As British neuroscience student and science writer Moheb Costandi reports, a neurosurgeon placed electrodes in their brains, directly measuring brain activity while each patient saw words flashing on a screen. The researchers, led by Raphael Gaillard of the Cognitive Neuroimaging Unit at INSERM, found brain activity both for overtly displayed and masked (subliminally presented) words. A masked word was displayed for just 29 milliseconds, with distracting hash marks both before and after presentation so that the observers had no conscious recollection of seeing the word. For masked words, brain activity was present in many areas but dissipated much quicker than after the overtly displayed words were shown.

So both our behavior and our brains can be affected by stimuli of which we’re not conscious. Costandi also discusses a study where vegetative and minimally conscious patients can learn to respond to stimuli. Does this mean they are conscious? Not necessarily. We can train snails and cockroaches, but we don’t believe they possess “consciousness” like a human.

And what of Rom Houben? Has he truly recovered? It’s difficult to say as long as his handlers continue to attempt to talk with him using deeply flawed facilitated communication. As Orac notes, if Houben really does have some potential to communicate with the outside world, the FC moderation will make it nearly impossible for us to find out. Despite his moving story, we’ll probably never know if he was ever truly conscious for the decades he was hospitalized. Even if his ability to communicate is definitively demonstrated, it will be difficult to confirm that he wasn’t comatose when he was originally diagnosed or how long he remained in that condition before his recovery began. In the meantime, serious research on comas and consciousness continues. You’ll find discussion and analysis of it at ResearchBlogging.org.

Originally published December 9, 2009

Tags cognition communication research truth

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