Hospital medicine takes a pretty crude approach to consciousness. You’re considered mentally AWOL if you don’t respond to simple commands or physical prodding. But studies of post-operative patients have found that many of them recall having dreamt during anaesthesia. And in some disturbing cases they’ve even felt pain or heard the surgeons talking. This suggests that it’s possible to be outwardly dead to the world, but conscious inside (locked-in patients and imaging studies of brain-injured patients in a persistent vegetative state also imply the same thing). Researchers have nicknamed people in this state “inverse zombies” – a play on the standard philosophical zombie concept, in which a person may appear to be outwardly conscious, but is in fact, dead inside.
A problem with much of the research into “inverse zombies” is that it’s been conducted opportunistically in hospitals. The experimental set-up is messy, the patients have a variety of health complications, and they’ve often been given a cocktail of anaesthetic drugs. These studies have found rates of awareness during anaesthesia at around 0.023 to 1 per cent and rates of anaesthesia dreaming at rates of 6 to 53 per cent.
Now Valdas Noreika and his collaborators have performed a carefully controlled lab study of subjective (or “phenomenal”) consciousness during anaesthesia, with the help of 40 healthy male university students. These brave souls were given progressively higher doses of one of four different anaesthetic drugs: dexmedetomidine; propofol (the drug that tragically killed Michael Jackson, who was using it as a sleeping aid); sevoflurane; and xenon. Dexmedetomidine and propofol are given intravenously; the other two are inhaled.
After the doping had begun, the researchers gave the participants the verbal command “Open your eyes!” at five minute intervals. Once a participant stopped responding they were considered to be unconscious in the traditional medical sense and the dose was gradually lowered until they responded again. Throughout, the researchers recorded the surface electrical activity from the front of the participants’ brains using a “Bispectral Index Monitor (BIS)” – a form of electroencephalography (EEG), which provided an objective measure of the depth of sedation.
The induction phase – from the last response to “Open your eyes!” to the loss of responsiveness – lasted typically from around 5 to 10 minutes; the period of sedation or loss of responsiveness itself lasted around 10 minutes; this was followed by a 2 minute recovery phase and then 5 minutes of EEG scanning. At this point, the participants were interviewed about their subjective experiences during the time they were knocked out.
The key finding is that dreams or sensations were experienced during nearly 60 per cent of the anaesthesia sessions. These ranged from perceptual sensations (including “quick visual experiences”; out-of-body sensations; an altered sense of time); dream-like experiences (had a fragmentary dream about “a trip in Eastern Europe” said one participant); vision-based dreams related to the lab situation (“one of the nurses got suspended from her work”); and dreams with auditory content based on the lab situation (“a friend’s roommate … sitting next to me here in the lab, telling me we have to go to the city”). Sometimes these experiences were accompanied by negative emotions (“a bit anxious”); other times positive (“felt extraordinarily good”). The type of experiences didn’t vary with the particular anaesthetic given.
Noreika and his team say these findings are important because they highlight the inadequacy of the standard medical definition of loss of consciousness (i.e. a loss of responsiveness), which is used in many anaesthesia-based studies into the neural correlates of consciousness. This standard definition, they argue, fails to take into account the frequent persistence of phenomenal consciousness in the absence of responsiveness. “Arguably, if one aims to explore the neural correlates of phenomenal consciousness, it would be fruitful to contrast the neural activity during dreaming anaesthesia vs. the neural activity during dreamless anaesthesia,” they said.
The study is vulnerable to some obvious criticisms. The depth of sedation was shallower than is typically used in surgery, so the results may not generalise to higher doses of anaesthesia. Also, the participants were forewarned that they would be interviewed about any experiences they had whilst unconscious, which could have led them to come up with the kind of answers that they felt the researchers were after. Defending the validity of their results, Noreika’s team pointed out that subjective reports of experience were more frequent when the objective BIS measure indicated shallower sedation – just as you’d expect if the experiences were real. “The results confirm that subjective experience may occur during clinically defined unresponsiveness,” the researchers said.
Noreika, V., Jylhänkangas, L., Móró, L., Valli, K., Kaskinoro, K., Aantaa, R., Scheinin, H., and Revonsuo, A. (2011). Consciousness lost and found: Subjective experiences in an unresponsive state. Brain and Cognition, 77 (3), 327-334 DOI: 10.1016/j.bandc.2011.09.002