Self Comes to Mind

coma, a situation in which all phenomena associated with consciousness (wakefulness, mind, and self) appear to be absent. 2
    The troubling condition of vegetative state also provides valuable information on another aspect of the distinctions I am drawing. In a study that justifiably attracted much attention, Adrian Owen was able to determine, using functional magnetic resonance imaging, that the brain of a woman in a vegetative state exhibited patterns of activity congruent with an examiner’s questions and requests of her. Needless to say, she had been diagnosed as unconscious. She did not overtly respond to questions asked or directions offered, and she did not spontaneously give any evidence of active mind. And yet her fMRI study showed that the auditory regions of her cerebral cortices did become active when she was asked questions. The activation pattern resembled what one may see in a normal conscious subject responding to a comparable question. Even more impressive was the fact that when the patient was asked to imagine a tour of her own home, the cerebral cortices exhibited a pattern of activity of the sort one can find in normal conscious subjects doing a similar task. Although the patient did not reveal this exact same pattern on other occasions, a small number of other patients have since been studied in whom a comparable pattern was seen, though not in all attempts. 3 One of those patients, in particular, was able to evoke responses previously associated with yes or no by means of repeated training. 4
    The study indicates that even in the absence of all behavioral signs of consciousness, there can be signs of the kind of brain activity commonly correlated with mind processes. In other words, direct brain observations offer evidence compatible with some preservation of both wakefulness and mind, while behavioral observations reveal no evidence that consciousness, in the sense described earlier, accompanies such operations. These important results can be parsimoniously interpreted in the context of the abundant evidence that mind processes operate nonconsciously (as reviewed in this chapter and in Chapter II). The findings are certainly compatible with the presence of a mind process and even a minimal self process. But in spite of the significance of these findings, scientifically and in terms of medical management, I am reluctant to regard them as evidence for conscious communication or as reasonable justification to abandon the definition of consciousness discussed earlier.
Removing the Self and Keeping a Mind
     
    Perhaps the most convincing evidence for a dissociation between wakefulness and mind, on the one hand, and self, on the other, comes from another neurological condition, epileptic automatism, which can follow episodes of certain epileptic seizures. In such situations, a patient’s behavior is suddenly interrupted for a brief period of time, during which the action freezes altogether; it is then followed by a period, generally brief as well, during which the patient returns to active behavior but gives no evidence of a normal conscious state. The silent patient may move about, but his actions, such as waving goodbye or leaving a room, reveal no overall purpose. The actions may exhibit a “minipurpose,” like picking up a glass of water and drinking from it, but no sign that the purpose is part of a larger context. The patient makes no attempt to communicate with the observer and no reply to the observer’s attempts.
    If you visit a physician’s office, your behavior is part of a large context that has to do with the specific goals of the visit, your overall plan for the day, and the wider plans and intentions of your life, at varied time scales, relative to which your visit may be of some significance or not. Everything you do in the “scene” at that office is informed by these multiple contents, even if you do not need to hold them all in mind in order to behave coherently. The same happens with the physician, relative to his role in the scene. In a state of diminished consciousness, however, all that background influence is reduced to little or nothing. The behavior is controlled by immediate cues, devoid of any insertion in the wider context. For example, picking up a glass and drinking from it makes sense if you are thirsty, and that action does not need to connect with the broader context.
    I remember the very first patient I observed with this condition because the behavior was so