Intensive Care Med DOI 10.1007/s00134-015-3697-1
Christos Lazaridis
FROM THE INSIDE
Where was I when I was in a coma?
Received: 29 January 2015 Accepted: 11 February 2015 Ó Springer-Verlag Berlin Heidelberg and ESICM 2015 C. Lazaridis ()) Division of Neurocritical Care, Department of Neurology, Baylor College of Medicine, 6501 Fannin Street, MS, NB 320, Houston, TX 77030, USA e-mail: [email protected] Tel.: 713-798-8472
‘‘Where was I when I was in a coma?’’ she asked. I answered trivially ‘‘you were asleep ... you were sedated on the ventilator’’, more to put her at quick ease and even more to avoid a difficult question that did not appear to have an immediate answer. Would a detailed neuroanatomo-physiologic description suffice to answer this? Don’t we need to also know where she was before the insult, where she is now, and if she is back in the same place? It misleadingly sounds like a question about location, yet this is a question about being. With that in mind the original question is reframed as ‘‘what (or who?) was I when I was in a coma?’’ Admittedly, many think that she was and she is, even throughout the coma, a single, unified, and unique entity. A common view is that each of us has a ‘‘soul’’ that individuates us and contains what is needed for us to persist. The term ‘‘soul’’ is here placed in quotation marks to delimit the term and include the idea of a non-materialistic, not strictly religious, further fact (e.g., the Platonic soul or the Kantian noumenal self) as our core essence. Nevertheless, on both conceptual and empirical evidence grounds there is very little to support such a view. I believe though that the ‘‘soul theory’’ fails in another fundamental way. It does not capture the deep wonder of my patient to her intuition that she was
somehow absent during her coma state. It would be absurd to be talking about a soul in coma, or an intermittently present or functioning soul. In fact, if we did concede that the soul can be intermittently present then we would lose the very reason to accept such a view, which is to have a criterion of continuity and unity. Maybe then we can focus on a reductionist, physicalist, brain-based approach and face the brute fact that we are human animals. It could be argued that the presence of the same human animal is what grounds the unity of my patient. Further, the presence of the same brain via altered states of anatomy and physiology is to account for the different states of being. Although this physical description is true, it again does very little to alleviate the profound sense of mystery that my patient felt. This mystery, I believe, is born out of misidentifying ‘‘one of us’’ (mature adult human persons) as either souls or human animals. The next step to take then is, after we have rejected that we are or that we have souls, to reject that we are human animals and instead describe us as something embodied, intermittently present and yet conditionally persistent and individuated over time. This idea follows the thinking of an influential contemporary philosopher, Derek Parfit. In recent work with the characteristic title ‘‘We are not human beings’’, Parfit argues that we are embodied Lockean persons. John Locke was the seventeenth century philosopher who defined a person as ‘‘a thinking intelligent being, that has reason and reflection, and can consider itself as itself, the same thinking thing in different times and places’’. A person on this Lockean-conception is a self-conscious, rational entity. The backbone of this embodied-part view is the idea that we are not human beings, or animals, but are the conscious, thinking, controlling parts of these animals. A couple of weeks later she was doing a lot better, I visited and asked her if she remembered asking me about her coma. She did not, yet found the question interesting anew. I confessed that my first impulse when she asked
me was to answer that during coma she had been nowhere (yet under strict medical supervision!). I explained then that the more careful answer is that during coma she was no one; she gave me a puzzled look, and I quickly added that her person was ‘‘carried through’’ the thoughts of her loved ones and of the medical team that cared for her. We continued conversing, she did not remember much from the past few weeks and was told that she seemed less interested in some of her prior favorite activities. Could she be a different person now? Was I talking to the same
patient who had asked me the original question? Was the pre-injury person the same with the coma-questioner and with the patient-in-rehab? Before leaving her I said I was really glad she was doing so much better; she smiled and answered remarkably: ‘‘and I am glad to be someone again’’. Conflicts of interest Christos Lazaridis is the single author and reports no conflicts of interest in relation to this manuscript. No funding has been received in relation to this manuscript.
Christos Lazaridis
FROM THE INSIDE
Where was I when I was in a coma?
Received: 29 January 2015 Accepted: 11 February 2015 Ó Springer-Verlag Berlin Heidelberg and ESICM 2015 C. Lazaridis ()) Division of Neurocritical Care, Department of Neurology, Baylor College of Medicine, 6501 Fannin Street, MS, NB 320, Houston, TX 77030, USA e-mail: [email protected] Tel.: 713-798-8472
‘‘Where was I when I was in a coma?’’ she asked. I answered trivially ‘‘you were asleep ... you were sedated on the ventilator’’, more to put her at quick ease and even more to avoid a difficult question that did not appear to have an immediate answer. Would a detailed neuroanatomo-physiologic description suffice to answer this? Don’t we need to also know where she was before the insult, where she is now, and if she is back in the same place? It misleadingly sounds like a question about location, yet this is a question about being. With that in mind the original question is reframed as ‘‘what (or who?) was I when I was in a coma?’’ Admittedly, many think that she was and she is, even throughout the coma, a single, unified, and unique entity. A common view is that each of us has a ‘‘soul’’ that individuates us and contains what is needed for us to persist. The term ‘‘soul’’ is here placed in quotation marks to delimit the term and include the idea of a non-materialistic, not strictly religious, further fact (e.g., the Platonic soul or the Kantian noumenal self) as our core essence. Nevertheless, on both conceptual and empirical evidence grounds there is very little to support such a view. I believe though that the ‘‘soul theory’’ fails in another fundamental way. It does not capture the deep wonder of my patient to her intuition that she was
somehow absent during her coma state. It would be absurd to be talking about a soul in coma, or an intermittently present or functioning soul. In fact, if we did concede that the soul can be intermittently present then we would lose the very reason to accept such a view, which is to have a criterion of continuity and unity. Maybe then we can focus on a reductionist, physicalist, brain-based approach and face the brute fact that we are human animals. It could be argued that the presence of the same human animal is what grounds the unity of my patient. Further, the presence of the same brain via altered states of anatomy and physiology is to account for the different states of being. Although this physical description is true, it again does very little to alleviate the profound sense of mystery that my patient felt. This mystery, I believe, is born out of misidentifying ‘‘one of us’’ (mature adult human persons) as either souls or human animals. The next step to take then is, after we have rejected that we are or that we have souls, to reject that we are human animals and instead describe us as something embodied, intermittently present and yet conditionally persistent and individuated over time. This idea follows the thinking of an influential contemporary philosopher, Derek Parfit. In recent work with the characteristic title ‘‘We are not human beings’’, Parfit argues that we are embodied Lockean persons. John Locke was the seventeenth century philosopher who defined a person as ‘‘a thinking intelligent being, that has reason and reflection, and can consider itself as itself, the same thinking thing in different times and places’’. A person on this Lockean-conception is a self-conscious, rational entity. The backbone of this embodied-part view is the idea that we are not human beings, or animals, but are the conscious, thinking, controlling parts of these animals. A couple of weeks later she was doing a lot better, I visited and asked her if she remembered asking me about her coma. She did not, yet found the question interesting anew. I confessed that my first impulse when she asked
me was to answer that during coma she had been nowhere (yet under strict medical supervision!). I explained then that the more careful answer is that during coma she was no one; she gave me a puzzled look, and I quickly added that her person was ‘‘carried through’’ the thoughts of her loved ones and of the medical team that cared for her. We continued conversing, she did not remember much from the past few weeks and was told that she seemed less interested in some of her prior favorite activities. Could she be a different person now? Was I talking to the same
patient who had asked me the original question? Was the pre-injury person the same with the coma-questioner and with the patient-in-rehab? Before leaving her I said I was really glad she was doing so much better; she smiled and answered remarkably: ‘‘and I am glad to be someone again’’. Conflicts of interest Christos Lazaridis is the single author and reports no conflicts of interest in relation to this manuscript. No funding has been received in relation to this manuscript.
