Consciousness and Coma - Research Paper Example

Consciousness and Coma Introduction                                                                                                                       The consciousness or state of mind of an individual might range from being absolutely stable to a state where the level of response comes down such that one cannot react to the external stimuli. To state the situation of coma patients whether they are able to perceive the environment round him or remain totally in a state of unawareness one must take into consideration the psychological and the scientific background. The words ‘consciousness’ and ‘coma’ are two different states of mind. If defined from a broader perspective, consciousness is the state of awareness of the self and coma is the state of complete unawareness. Psychologically ‘consciousness’ is deep rooted in man’s thought structure and his response to the surrounding. The faculty of the mind undergoes a subjective experience stimulating his senses. In the field of medicine, consciousness is determined by a patient’s response to medication and physical activities. Psychologically ‘coma’ is the unconsciousness of the mind unable to perceive his own state and an unwilling suspension of the thought structure of the mind. To a doctor it is the patient’s nervous breakdown and retarding movement of the body and the mind due to any brain injury caused by a shock or accident. More specifically the patients in the situation of Coma tend to respond in a different manner than as normal patients. The patients in the situation of Coma are found to communicate to the external world through some reflex movements of the body muscles. Coma patients are observed to make their muscle tendons stiff enough as to render some communicative signals to the outer world. This type of non-verbal communication patterns emerges from the patient’s increased involvement with the inner consciousness, which causes the happening of reflexive actions (Tomandl & Jacob, n.d.) The interplay between the conscious state of mind and the surroundings determine the consequences faced by the comatose patient. In order to understand the connection between the state of coma and consciousness it is important to identify the various states of the conscious human mind. The psychiatrists also deal with this joint study of consciousness and coma. Psychologists are interpreting these in various ways. Both the terms define opposite conditions of mind but they are inter-related.  Coma is the change from consciousness to unconsciousness. Consciousness varies in degrees- crude consciousness, phenomenal consciousness and access consciousness.  Crude consciousness is the alertness and confines to normal sleep and wake cycle. Phenomenal consciousness is the awareness of the mind. It deals with the ability of the brain to deal with internal and external phenomena without creating any cognitive awareness. Access consciousness is the high level of awareness of the self. These levels of consciousness determines that how an individual react to his surroundings. Coma is the end of free will and makes a person lose his mental stability and physical balance. Theories on consciousness have been formulated by various schools like that led by Tichener. According to this school, the level of consciousness is determined by sensations, images or memories and feelings. (Young, Ropper and Bolton, 1998, pp 3-5) Perhaps, the parameters of the society decide whether these patients of neurological disorders have the right to socialize or not! The symptoms leading to ‘coma’ state and its consequential impact suggest the changes undergone by the conscious state of mind when an individual slips into coma. The word has its origin in the Greek word ‘comus’ meaning deep sleep. Actually, in the ancient Greek society midnight revelries are associated with drinking wine that lead to the suspension of senses for a period. However, a person in this state of deep sleep due a shock is known in the doctor’s language as ‘Comatose’. It is said that chronic depressions results in eye abnormalities, breathing problems and cardiac arrest. The period of trauma begins and the person fails to respond to external stimuli in a proper way. It also leads to motor dysfunction, nausea, vomiting, ataxia, occipital headache and increasing somnolence. These are the symptoms, which ultimately lead to reduction in the level of consciousness, ultimately leaving the person physically handicapped. The mechanisms in this state of coma are crucial to find out whether a person in coma is unconscious or conscious in his own way but unable to respond to his surroundings. These mechanisms involve reduction of blood supply to the brain, disturbances in metabolic functions, reticular formation affected due to lesions electrical disturbances and psychiatric disturbances, which reduce their sensory perception. These perhaps make a coma patient a living dead. The coma patients suffer from inability to open and close eyelids, inability to perform verbal communication, restricted movement of the body and inability to follow any kind of instructions. Quite obviously, he would be unable to react to the surroundings in a proper and he will start feeling a sense of negation. Recent researches reveal that the vegetative state of consciousness is an improved state of coma. However, the severity of this abnormal stage is less in a number of coma patients. This is the Vegetative state.  The vegetative state is an improved condition of coma. Here, the patient is aware. He is able to perform basic processes of the body like breathing, sleeping, cardiac movements etc. The sensory articulation of the brain also enhances. The patient may be shifted from hospital care to domestic care.  In the vegetative state, the sleep cycle becomes activated with intervals of opening and closing of eyes. The patient develops the ability to make moaning sounds and the ability to change facial expression is enhanced. The patient may respond by crying or smiling. He feels the sense of direction and is able to focus on a particular object or person, which can be determined through the movement of his eyeballs. He may also respond to large noise or sound. However, he is unable to perform verbal communication and body movements. These suggest that patients are not altogether in unconscious zone and are able to feel and sense. The mental health can improve gradually. (McCullagh, 2004, pp. 34-37).The vegetative state is evidence to the suggestion that a domain of consciousness operate in the mind of a coma patient. However, a 23-year-old woman from Missouri was left in a vegetative state due to major accident and her parents requested the doctors to remove the artificial means of hydration and nutrition. This reflects the hapless condition of the comatose, as he cannot even decide whether to live or die. He has no choice to make decision regarding his own life. The patient is disconnected from communication with the family (Morrison & Monagle, 2009, pp. 80-127). It is important to study the connection between depressed consciousness and coma to understand the mental situation of a coma patient. The intensity of coma can be measured by Glasgow Coma Scale state of mind. The scale ranges from 3 to 15. The number ‘3’ indicates acute stage of coma and ‘15’ is the numerical representation of the healthy neurological system. The Ranchos Los Amigos scale is also an important indicator in measuring the level of coma impairment. This scale of observation is for the patients undergoing coma from a few weeks to months. These scales of measurements both speak of coma related impairment as well as of a degree of alertness in a comatose. In depressed consciousness, the victim is subject to sleepiness and there is a decreased level of alertness. This may turn into coma due to chronic and prolonged metabolic failure. The transition from consciousness to coma is a dire shock and leads to disillusionment in coma patients (Laureys Boly& Maquet, July 3, 2006). Recovery of coma patients depends upon the response to their conscious state of mind to their surroundings. Coma is definitely a stage of inactivity but it has become all the more fatal if followed by pneumonia, bedsores, infections etc. The people recovering from coma may suffer from permanent muscle contraction and joint disorder. The brain death however marks the end of the coma patient. It is an irreversible final phase. The cerebral nerves fail to perform due to lack of oxygenation.  The recoveries of the patients vary from individual to individual. However, research shows that most of the patients regain their mental stability within a few weeks.  The coma patients would react to their surroundings is uncertain. The emotional support of the family is taken into consideration in the treatment of the coma patient (Laureys Boly& Maquet, July 3, 2006). The rehab centers play a crucial role to aid in recovery of the coma patients who need both medical and emotional support to gain back their desired level of consciousness. Every disease or injury has to be treated medically, which is the primary requisite but after every injury or accident the patient seek a room for emotional and mental support. The rehab centers are marching forward to aid the deprived ones, catering to their needs and are guiding the families of the patients in taking proper measure. However, the rate of neurological damage caused to the patient determines the period of coma and chances of recovery.  The way of recovery starts from coma and gradually leading to vegetative state. Many patients recover but there are also people who die after this neurological failure. There are no fixed prescriptions for the survival of coma patients. Recent research works on this neurological disturbance have definitely opened a new horizon for the doctors as well as for the patients and his families. A comatose has the every right to be uplifted from the moribund state. (Laureys Boly& Maquet, July 3, 2006). Society is the mandatory institution, which a man has to live in, if he wants to enjoy the privileges. Society determines the position of an individual, critically evaluates his work, and accordingly attributes him with the deserved recognition. Some people employ themselves in extraordinary activities like portraying the conditions of the coma patients. Movies like “The Dreamlife of Angels” and “Reversal of Fortune” depicts the hapless condition of the coma patients and their prolong waiting to awake from this deep but agonized state of sleep. The state of comatose patients is therefore a state of wakefulness without awareness in coma patients. The brain is a house of complicated phenomenon and the recovery of a coma patient is not an easy procedure as it is shown in movies to create a sensational response from the audience and movie buffs. To move to practical grounds there are a few case studies- Rom Houben was assumed to be in a state of coma undergoing complete unconsciousness but recent hi-scan examination shows that his brain has been functioning normally ever since he was paralyzed. His agony lie sin the fact that for the last 23 years he could not tell that he is able to understand everything. One patient was able to say ‘yes’ or ‘no’ during the MRI but no verbal means of communication was possible when at the bedside. This ‘wakefulness without awareness’ is also the case with a 39 years old patient who remained in this period for 19 years. (Laureys Boly& Maquet, July 3, 2006). Interactions between doctors and the coma patients’ associates bring about a fatal decision in dealing with their consciousness, popularized as the practice of euthanasia. It is also very important to understand the relation between doctor and his patient. The system has to deal with the psychological aspect.  In spite of the efforts of the doctors the patients, staying aloof from people gradually gets detached from public consciousness.  They demand for self- assisted death. This is what one may call euthanasia, the right to die or planned death. In fact, self-assisted death and organ transplantation goes hand in hand. Is it that they just live to come to other person’s aid! The plight of a comatose is such that this minimal level of consciousness gives him the feeling of being deprived and left out. This desire to die speaks loads about their mental frustration. (Monagle & Thomasa, 2004, pp 302-606) The family support is essential to boost their morale. Dr. William Stanley Haney’s views on consciousness suggest that the very assessment of the intricacies involved in the various stages of consciousness and coma is a complicated procedure altogether. In a broader perspective, Haney (2008) has dealt with consciousness. However, his contribution is entirely to the literary field but the sociological and psychological issues are touched upon quite meticulously. The aesthetic values of the Indians have motivated him. ‘Rasa’ or the aesthetic rapture speaks of consciousness as the source of internal happiness. Every individual is influenced by the consciousness of culture and identity but true consciousness is timeless and not bounded by space and is related to mysticism. However, the hardcore reality of a coma patient is different. The living dead is deprived of the privileges of the external world and physically handicapped. Therefore, the sense of aesthetic rapture does not stimulate his soul. He suffers from alienation, cannot idealize and sounds pessimistic. (Haney, 2008, pp 3-25) Conclusion Coma and Consciousness are often taken to be contradictory terms in the context of medical history. The patients suffering from deep coma are found to respond to the external world in a different fashion than the normal patients. It is observed that patients in coma endeavor to communicate through the use of non-verbal signals. The patients in coma are said to be guided by inner voices. They respond to external touch sensations through the stiffening of muscle tissues as signs of non-verbal communications. If one sees from the cultural perspective, coma is man’s unawareness about his position in the society and ignorance about his cultural entity. Becket, the playwright has spoken about this consciousness of identity in his drama “The Blood Knot”. The battle of races to seek identity is emphasized. To Haney consciousness is the ground of intellect and knowledge. Hobbes has rightly said that knowledge is power. It leads to aesthetic experience of the mind and without consciousness; one remains a naïve and loses his perception of the self. Therefore, definitely a comatose individual is difficult to survive, as he is rendered powerless by the society. Therefore the comatose patient does respond to the surroundings but within their subconscious state of mind, which sometimes become visible externally and it is at this point when the patient gradually begins to recover. (Haney, 2002, pp. 9-27).        References Tomandl, S. & Jacob, A. (n.d.). Comma Communication-FAQ’s. Retrieved on December 9, 2010 from: http://www.comacommunication.com/faq.htm#FAQ_1 Haney, W.S., 2008, Integral Drama: Culture, Consciousness and Identity, Amsterdom: Rodopi. Haney, W.S., (2002), Culture and Consciousness, Lewisburg: Bucknell University Press. Laureys, S., Boly, M. & P. Maquet, (July 3, 2006) “Tracking the Recovery of consciousness from Coma”, The Journal of Clinical Investigation, 116(7), Retrieved on 24 November, 2010 http://www.jci.org/articles/view/29172/version/1#B11 Morrison, E.E. & J.F. Monagle, (2009), Health Care Ethics, Ontario: Jones And Bartlett Publishers International. McCullagh, P. J., (2004), Consciousness in a Vegetative State? A Critique of the PVS Concept Young, B.J., Ropper, A.M.,&C.F.Bolton,(1998),Coma  and Impaired Consciousness , New York, McGraw-Hill Professional Outline Introduction Thesis statement The interplay between the conscious state of mind and the surroundings determine the consequences faced by the comatose patient. Paragraph-1 To study the various degrees of consciousness Psychological interpretations Ideas formulated by the school of Tichener Paragraph-2 Origin of the word “coma” Causes of coma Syndromes of coma Effects of coma Paragraph-3 The condition of a comatose in the vegetative state Vegetative state and the research works done Dilemma of a patient in a vegetative state Degree of consciousness in a vegetative patient Paragraph-4 Intensity of coma Prolonged depressions Disillusionment in coma patients Paragraph-5 Recovery from coma The role of the family members of a coma patient The chances of collapse after recovering from coma and its psychological analysis Paragraph-6 No fixed treatment for coma patients Role of the rehab centers Emotional urgings of the coma patients Society and coma patients Depiction of coma patients in movies Paragraph-7 A comatose patient is without awareness of the self or the surrounding An individual in the state of coma is a living dead Case studies Paragraph-8 Doctor-patient relationship Defeated morale Pains of coma patients and the practice of euthanasia Paragraph-10 Dr. William Stanley Haney and his views on consciousness Sociological and psychological perspectives Aesthetic sense of consciousness Conclusion Read More