DISPATCHES FROM THE FRONTAL LOBE
NEUROSCIENTIST ADRIAN OWEN COMMUNICATES WITH THOSE WHO CAN’T IN INTO THE GRAY ZONE
Into the Gray Zone: A Neuroscientist Explores the Border Between Life and Death By Adrian Owen Scribner 320 pp; $ 34.99
At the heart of every scientific discovery is a great detective story. While hi g h- s c hool teachers and pop- science writers may bore their audiences with a barrage of facts, the tale behind those facts is often a thrilling mystery that twists and turns in unexpected ways. Likewise, Adrian Owen’s Into the Gray Zone does not provide much in the way of insights but instead offers a riveting yarn of how researchers tackled an intractable scientific problem, namely how to make contact with those who can no longer communicate with the outside world.
Owen, a neuroscientist based at Western University, has spent much of his career trying to answer a deceptively difficult question: How can we be sure if someone is conscious or not? The obvious answer, of course, is to ask that person to tell us, or to ask them for a visual cue. But this becomes problematic if that person cannot speak or move. For those with locked- in syndrome, as described by JeanDominique Bauby in The Diving Bell and Butterfly, a series of eyeblinks can be used to communicate letters, words and ultimately their thoughts. ( Bauby is said to have blinked 200,000 times to “write” his memoir, a herculean effort.) But what about those in “persistent vegetative states,” who do not demonstrate any voluntary movement and generally do not react to stimuli in their environment?
Into the Gray Zone describes a number of these patients who — through car accidents, stroke or neurodegenerative diseases — sustain traumatic brain injury that leaves them incapable of interacting with the outside world. These individuals have long been presumed to have no consciousness, which has undoubtedly affected their treatment by professional caregivers; after all, why speak to someone who can’t hear you? But family members often insist that their loved one is still in there, trapped inside their body with virtually no way to communicate. Relatives may believe this because they are more sensitive to the signs — a sigh, a squeeze of the hand — or because they are simply looking for hope in a horrific situation. But no compelling evidence had been shown to demonstrate consciousness in persistent vegetative states.
Enter Owen and his research, which suggests that up to 20 per cent of these patients may in fact be aware of their location, the passage of time and their sense of self. Into the Gray Zone takes readers through the steps of how these discoveries were made, and this feature — a narrative arc that shows how science is done — sets Owen’s book apart from the majority of contemporary pop-science fare, and makes it a delight for readers. From emerging technologies to valid criticism of his research, Owen shows us the thought process of his team as they iterate upon and improve their methods, and thus their results. Like any good mystery, it would be a shame for the solution to be spoiled in advance, but suffice it to say that Owen demonstrates, with a high degree of certainty, that not only are many of these patients conscious to some degree, they are also able, through a novel trick of functional brain imaging, to communicate with the researchers.
But once you can communicate with someone trapped inside their body, a person incapable of perf orming e ven t he most basic behaviours or speech, troubling questions arise. Are they unhappy? Are they suffering or i n pain? Do they want to die? Thankfully, Owen does not shy away from such difficult topics and the ethical quandaries they present for both researchers and society. Occasionally his scientific detachment is j arringly incongruent with the circumstances, such as when he calls a patient’s referral a “scientific fairy tale” immediately before describing their tragic car accident, or describes new results as “sexier” while an incapacitated patient lies in the MRI scanner. But overall Owen presents a very compassionate case for why this research is beneficial not just for the science of con- sciousness, but also for the well-being of the individuals trapped in persistent vegetative states. In fact, the book’s human story far surpasses the scientific one: we learn little about the neuroscience of consciousness, but much about Owen’s motivations for doing the research, and how the findings have direct and indirect benefits for the patients and their families.
Ultimately, Owen has written a better book by focusing more on the narrative journey and less on the science. He presents research as detective work, and shows the scientists themselves as human beings capable of doubt and compassion. He also spends considerable time on the stories and incredible fortitude of these patients and their families in the face of such hardship. In contrast to many contemporary pop- science offerings, Into the Gray Zone is a great example of conveying the mystery and humanity of scientific research to the general reader.