confirmation bias, 152–53, 154, 155

  consciousness

  attempts to understand relationship between language and, 77–79

  awareness component of, 31

  brain-damaged patients and missing elements of, 66

  brain-stem damage affecting, 51, 75

  children and level of, 64, 66

  complexity of answering questions as sign of, 144

  controversies over definition of end of, 69

  differences of opinion about emergence of, 65–66

  discussions about best way to measure and threshold in, 173–74

  ethical and legal questions related to beginning of, 66–67

  ethical complexities and legal issues in testing for, 112

  family’s decisions about care related to patient’s degree of, 174–75

  Glasgow Coma Scale for measuring, 149

  infants and level of, 64–65, 66, 71

  intention and, 90, 97, 100

  language understanding as key to, 83

  level of brain function in, 63–64

  newborn babies and development of, 193–94

  new focus on disorders of, 99–100

  scanning research showing brain activity in spite of lack of, 59

  scanning “signatures” of, 245

  scanning tasks and reportability of, 193, 194

  Schiavo case autopsy on lack of, 71–72

  sentence processing as confirmation of, 85, 86

  shift of Owen’s research to focus on, 87

  task needed for identifying in physically nonresponsive patients, 100–101

  tennis imaginary game task for detection of, 110, 111, 112–13, 117, 121–22

  vegetative-state diagnoses challenges from detection of, 117–18

  wakefulness component of, 31, 75

  Constitution (US), 183

  Cooper, Anderson, 113

  cosmic consciousness, 254

  court rulings, on withdrawal of life support, 179–80, 181–82, 183

  cranial nerve, result of damage to, 51

  Crick, Francis, 72

  Cruse, Damian, 213, 230, 231, 233, 234, 235–36, 237, 238–39

  Cruzan, Nancy

  court decision on, 182–83

  public reaction to decision on, 183–84

  Cusack, Rhodri, 192–93, 195

  Dalai Lama, 65

  Dan (brain-injury patient), 248–50

  Davis, Matt, 73–74

  death

  process of withdrawing life support resulting in, 177

  scanning question to vegetative-state patient about, 140–41

  Debbie (vegetative-state patient), 51–59, 60–61

  accident causing brain damage in, 51

  brain responses seen in scanning results for, 57, 58, 63, 65, 73, 76

  deciding on and developing tests to use with, 53–54

  denial of second scan for, 60–61

  difficulties in analyzing scanning results (“being on the fence”) for, 58, 76

  elements of consciousness in, 66, 125, 202

  family’s view about responses by, 52

  impact of brain damage on functioning of, 52

  minimally conscious state diagnosis given to, 61

  need to move quickly with studies of, 54

  publication of research on, 58, 108

  recovery of, 61, 112

  scanning sessions with, 52–53, 56–57

  speech recognition by, 65, 66, 76, 78

  words and noise chosen to elicit brain response in scanning of, 54–56, 238

  declarative memory, 142

  decompressive craniectomy, 107, 108

  digital imaging. See functional magnetic resonance imaging (fMRI); positron-emission tomography (PET)

  disorders of consciousness, 99–100, 120, 124, 146, 150

  dogs, consciousness of, 251–52

  dopamine, in Parkinson’s disease, 47, 220

  Dove, Anja, 89, 95, 96, 97

  Duncan, John, 57, 277

  dying, scanning question to vegetative-state patient about, 140–41

  electroencephalograpy (EEG) assessments

  brain-computer interfaces and, 246

  emergence of consciousness in infants and, 244, 245

  Juan (brain-injured patient) and, 212, 214

  Leonard (brain-damaged patient) and, 233–39, 240

  mobile lab (EEJeep) for, 230–31

  “signatures” of consciousness on, 245

  technical limitations of, 247

  epilepsy, 9, 10, 51

  automatisms in, 10

  brain surgery to alleviate, 9, 51

  ethics

  asking brain-damaged patient about desire to die and, 139–40

  complicated decisions with gray-zone patients and, 178

  emerging technologies for reading minds of others and, 252

  forensic use of fMRI and, 249

  new computerized technology use by brain-damaged patients and, 248

  Schiavo case and right-to-die movement and, 72, 181

  withdrawing life support and, 172

  ethics committee

  advance scrutiny of research studies by, 111

  refusal of second scan by, 60–61

  right-to-die situations and, 182

  scanning in the first days after injury and, 176–77

  scanning protocol changes refused by, 110–11, 112

  face blindness, 18

  face imagining task, 101, 102, 103

  face recognition

  brain function and, 190

  cognitive and eye control demands of, 192

  damage to fusiform gyrus and effect on, 17–18

  fMRI task on recognizing features in, 190–92, 193

  unconscious brain monitoring for, 33–34

  visual information processing in brain-damaged patient (Kate) during, 29–31, 32–33, 34, 66, 101

  faces, unconscious remembering of, 92

  families of patients

  belief about awareness of vegetative-state patients held by, 152–53, 155–56, 161–62

  confirmation bias in observations of, 152–53, 155

  events occurring without witnesses and opinions of, 155

  Hodgkin’s disease treatment and, 129–30

  long-term care of brain-damaged patients by, 22, 44, 118–19

  objections to withdrawal of life support from, 172, 178, 179, 180–81, 181–82, 183

  Owen’s personal family experiences and decision to work with, 16, 130–31

  support for scanning sessions in, 166

  threshold between unconscious and conscious and care decisions of, 174–75

  viewing and music preferences of patient and, 162–63

  Fernández-Espejo, Davinia, 151, 158–59

  fetal development

  brain development during, 67, 68

  consciousness during, 65, 67–68

  early brain reflexes during, 68

  pain response during, 66, 67

  film-watching task. See Hitchcock film-watching tasks

  fluorodeoxyglucose (FDG) scan, 133

  fMRI. See functional magnetic resonance imaging

  frontal lobes, 54

  automatisms with epileptic seizures in, 10

  general intelligence (g) and, 94–95

  language processing in, 82, 84

  memory processing in, 19–20, 89–90, 95–96

  Parkinson’s disease and, 86

  perseveration in attention and damage to, 46

  postinjury behavior after damage to, 9

  working memory and, 19–20, 47–48, 94

  functional magnetic resonance imaging (fMRI)

  advantages of using, 80

  Carol (vegetative-state patient) and, 108–10

  consciousness detection in vegetative-state patients using, 103–6, 114, 121

  experience of using, 127–28, 131–32

  face imagining task tested in, 101, 102, 103

  follow-up calls with families after, 209

  Juan (brain-injured patient) and lack of response on, 208–9

  language-processing studies using, 80–81

  minimally conscious patients’ responses on, 123

  nursery-rhyme singing task tested in, 101, 102, 103

  Owen’s Royal Society paper on, 137–38

  remembering paintings test of memory using, 95–97

  Scott (vegetative-state patient) and questions answered on, 156, 158–61, 162–64, 165–66

  search for mental imagery tasks for research into consciousness using, 101–3

  sentence processing research using, 82

  “signatures” of consciousness on, 245

  technological approach in, 80

  tennis imaginary game task used in, 103–6, 114, 115–17, 121

  two-way communication tasks with, 124, 127–28

  funding of scanning studies, 44, 48, 54, 145–46

  fusiform gyrus, 17–18, 31, 34, 115, 190, 191, 194, 255

  Garrow, David, 71

  general intelligence (g), 47, 94–95, 279

  Giacino, Joe, 60, 61, 100

  Glasgow Coma Scale, 149–50, 170

  globus pallidus, 207–8, 221

  Gonzalez-Lara, Laura, 209, 213, 216, 231, 232–33, 239–40

  Goodale, Mel, 146, 173

  gray matter, function of, 28

  gray zone

  automatic responses to stimuli in, 52

  automatisms as kind of, 10

  awareness of surroundings as possible state in, 118

  coma leading to, 170–71

  conscious decision to remember as way of studying, 97–98

  consciousness and level of brain function in, 63–64

  detection of consciousness using scanning as challenge to concept of, 117

  differences among patients classified as being in, 59

  difficulty of measuring awareness in, 31, 52, 58

  Grzebski’s seemingly miraculous recovery from, 221–22

  Juan’s seemingly miraculous recovery from, 209–10, 221, 216–21, 223–24

  minimally conscious patients and, 4, 60

  recovered brain-damaged person showing possibility of returning from, 41–42

  gray-zone patients

  brain-computer interfaces for communicating with, 123–24, 246–48

  confirmation bias in observations of abilities of, 152–53, 155

  events occurring without witnesses and reports about abilities of, 155

  state of physical nonresponsiveness and mental activity in, 123

  tennis imaginary game task response by, 123

  two-way communication tasks for, 124

  window of opportunity for working with, 169–70

  gray-zone science

  Laureys team in Liège, Belgium, and, 59, 120, 136–40, 144

  Weill Cornell Medical College article on, 58–59

  Grzebski, Gertruda, 222

  Grzebski, Jan, 221–22

  headaches, in oligoastrocytoma, 13, 14

  Hebb, Donald, 91

  herpes simplex virus brain infection, 165

  hippocampus

  “cognitive” map in, 101–2

  damage to, and loss of memory, 165

  place cells for mental mapping of environment in, 101

  recall of events before accident and functioning of, 144

  Hitchcock film-watching tasks, 196–204, 213–14, 215, 227, 244–45, 250

  brain reactions to bangs and flashes in, 196

  healthy participants’ reactions to, 197, 202

  Juan (brain-injured patient) and lack of response on, 208–9, 215

  media reaction after publication of results of, 204

  selection of film for, 196–97

  Hodgkin’s disease, 128–30

  Hutchinson, Cathy, 247, 248

  hyperbaric oxygen therapy, 217

  imaging studies. See functional magnetic resonance imaging (fMRI); positron-emission tomography (PET); scanning studies

  imagining faces task, 101, 102, 103

  imagining tennis game task. See tennis imaginary game task

  Institute of Psychiatry, University of London, 8, 9, 15

  intention

  brain function and, 72, 80

  conscious decision to remember and, 92–94, 96, 97–98

  consciousness and, 90, 97, 100

  future brain-computer interfaces and, 246

  need for “active task” to study, 100–101

  theory of mind and, 202

  interference, and recall in memory, 212

  intraventricular hemorrhage, 176

  IQ tests, 47, 94–95

  James S. McDonnell Foundation, 146

  Jennett, Bryan, 171

  John (Liège vegetative-state patient), 136–41

  change to minimally conscious assessment for, 144

  later loss of contact with, 144, 145

  media reaction to paper on, 145

  memories retained by, 143–44

  question about wanting to die used with, 140–41

  reactions to publication of paper on, 145

  two-way communication tasks in scanning of, 137–41, 143–44, 145

  vegetative-state diagnosis of, 136

  Johnsrude, Ingrid, 73–74, 75, 82, 84

  Journal of Cognitive Neuroscience, 58

  Juan (brain-injured patient), 207–21, 222–23, 227

  desire for follow-up scanning sessions with, after recovery, 210–11

  devising tests to check memories of early fMRI scans of, 211–13

  family’s support for, 216–17, 217–18, 222

  Hitchcock film task and, 208–9, 215

  incident causing brain damage in, 207–8

  Juan’s talking about experiences of early brain-damaged state and scans, 216–21, 225

  lack of response on initial fMRI scans by, 208–9

  later visit with, after memory fMRI scans, 216–17

  memory test using fMRI scans with, 213–14

  seemingly miraculous recovery of, 209–10, 221, 216–21, 223–24

  struggles to understand fMRI scan responses of, 215–16

  unresponsive state of, 208

  Judaism, and health-care decisions, 126–27

  Kate (brain-damaged patient), 28–42, 53–54, 57, 109

  elements of consciousness in, 66

  face-recognition scans with, 29–31, 32–33, 34, 66, 101

  later comments on her recovery process by, 40–42, 225

  media reaction to research on, 34–35

  medical condition causing brain damage in, 28–29, 40

  publication of research on, 34–35, 108

  recollection of vegetative episode by, 36, 39–40

  recovery and rehabilitation after, 35, 37

  speech recovery by, 38, 39

  visit with, twenty years after scans, 37–39

  visual information processing during scanning studies of, 29–31, 32–33, 34

  Keith (vegetative-state patient), 179–80, 184–85

  auto accident causing brain injury in, 179

  fMRI scans of, 184–85

  life-support decision for, 179–80, 187

  vegetative-state diagnosis of, 179

  Kevin (vegetative-state patient), 75–77, 79, 89, 99

  attempting to determine level of understanding of, 81, 82

  brain responses observed in, 79

  deep unresponsiveness of, 75, 79

  fMRI scans of, 84–85

  intelligibility of sentences with background noise scans for, 75–76, 76–77, 84

  later residential care of, 89

  massive stroke causing brain damage in, 75

  meaning understood by, 81

  PET scans of, 76–77, 79, 81, 82

  publication of research on, 108

  scientific reactions to interpretation of studies using, 85–86, 99

  sentence processing of ambiguous words by, 85, 86

  vegetative-state diagnosis of, 75, 76, 85, 89

  Kinghorn, Wes, 230

  knowledge

  complexity of answering questions using, 142–43

  sense of suspense and, 203–4

  Koko (gorilla), and meanings of hand signs and words, 251

  Kouider, Sid, 244, 245, 251

  Lancet (medical journal), 34, 44, 58, 171

  language

  attempts to understand relationship between consciousness and, 77–79

  consciousness and understanding of, 83

  voice-to-text translators and understanding of, 83

  language processing

  ambiguous words and, 81–82, 83–84, 85

  attempting to determine level of understanding of, 81, 82–83

  brain function and, 54–55, 80–81, 81–82, 84

  complexity of answering questions using, 143–44

  designing experiment to study, 73–74

  fMRI scans used in study of, 80–81, 82

  intelligibility of sentences with background noise in, 74, 75–76, 76–77

  meaning in, 81

  temporal lobe and, 54–55, 74, 76, 82, 84, 85, 144

  Laureys, Steven, 59, 99, 100, 120, 121, 136, 139–40, 146, 186, 187

  legal cases

  automatisms and crime and, 10–11

  Bland case, 70

  right-to-life and the right-to-die movements and, 69, 70

  Schiavo case, 69

  legal issues

  advanced directives and, 2, 177, 184, 187

  decisions regarding life-sustaining therapy and, 118

  diagnosis of gray-zone vegetative state and, 118

  food and water as “medical treatment” and, 172

  “right to die” cases and, 70–71, 181, 183–84

  testing for consciousness and, 112

  Leonard (brain-damaged patient), 228–29, 231–41

  EEG assessment of, 233–39

  follow-up call about, 239–40

  initial brain injury of, 228–29

  wife’s support for, 239–41

  Liège, Belgium, research team, 59, 120, 136–40, 144

  life support

  court rulings on withdrawal of, 179–80, 181–82, 183

  Cruzan case and, 182–84

  families’ objections to withdrawal of, 172, 178, 179, 180–81, 181–82, 183

  hospital use of, 2, 124, 170, 171, 198, 248

  personal wishes about withdrawal of, 186–87

  process of withdrawing, 177

  Quinlan case and, 181–82, 183–84

  religious belief and, 178, 179

  Schiavo case and, 70–72

  liminal states, 244

  living wills (advanced directives), 177, 184, 187

  locked-in patients, 4, 186–87, 277

  machine consciousness, 251, 252

  Mackworth, Norman, 45

  mapping tasks. See also spatial-navigation tasks

  brain function (“place area”) for, 101–2, 190, 195, 255

  Marslen-Wilson, William, 57