n
articulate, liberally educated neurologist at the University of
Edinburgh, Adam Zeman has written columns for The Times of London and is
an occasional commentator for the BBC and the co-author of a book on
ethical problems in neurology. His new book covers many aspects of
consciousness for general readers. His treatment of the disorders of
knowledge is superb. If you were intrigued with ''The Man Who Mistook
His Wife for a Hat,'' you'll appreciate the buildup to what Oliver Sacks
described in that work. Zeman's much more subtle examples give you some
appreciation for how seeing and describing can become disconnected from
recognition and other forms of knowledge.
There have been a number of fine books on consciousness in the last
dozen years, starting with Daniel Dennett's ''Consciousness Explained,''
which was written from the standpoint of a philosopher well versed in
cognitive sciences and evolution. I am also fond of ''The Feeling of
What Happens,'' by Antonio Damasio. Like Zeman, Damasio is a neurologist
steeped in both literature and philosophy. But Zeman's ''Consciousness''
is the broader book, the one that could be used in an undergraduate
humanities or psychology course to fill in the neuroscience background
for readers coming to it for the first time. Indeed, Zeman first
introduces his subject and then spends a hundred pages on neurobiology
and human evolution before returning to consciousness. Readers impatient
for consciousness per se can skim these chapters without losing the
thread, though they are relatively painless introductions to what
consciousness is built atop of.
Consciousness implies both awake and aware. ''Sleep, like
wakefulness, is organized from the brainstem,'' Zeman writes. ''It has a
hidden structure of its own: in the course of the night we cycle
repeatedly from light sleep to deep, from deep to dreaming sleep. The
brainstem continues to generate these rhythms after the destruction of
the hemispheres, as, for example, in the 'vegetative state.' By
contrast, death of the brainstem is almost always followed, within hours
or days, by death, pure and simple.'' The nerves controlling the entire
body pass through the brainstem, and some brainstem strokes injure these
connections while leaving the patient surprisingly alert and aware. ''In
these circumstances awareness may survive while almost all means of
expressing it are lost, an unhappy state of affairs known as the
'locked-in syndrome.' Sufferers from this disorder usually retain the
ability to make voluntary up and down movements of their eyes, and can
use these to communicate.'' He adds that we can't deny ''the disturbing
possibility'' that this disorder may affect more people than we can now
properly recognize as being afflicted by it.
A couple of chapters after I read this, my 91-year-old mother
suffered a similar brainstem stroke. There were periods when she could
communicate only by moving her eyes and eyelids. Because she was
sometimes able to get a few words out, it was obvious she was tracking
what we said and was thinking ahead as usual; her consciousness was
trapped in a body that would no longer obey her. We knew her wishes
about such situations quite well, her sister having lingered five years
in a similar state, but my mother was still competent to make her own
decision if we could frame it for her limited ability to communicate. So
her doctor told her that her situation was unlikely to improve, that we
proposed doing nothing except comfort drugs and that she probably would
die within a few days. Was that what she preferred? We thought she would
have to communicate by blinking her eyelids. But she burst forth with
her longest utterance since her stroke: ''You're the best doctor I ever
had.'' Those turned out to be her last words. She died two days later.
Consciousness is, however, more than just the minimum requirements of
awake and focused. Zeman explains that ''sensation becomes conscious
only when it undergoes some further process -- when it encounters past
associations, or is used to govern future action, or becomes the object
of reflection or is felt to impact upon the self.'' There is an
''important link between consciousness and volition. . . . Willed or
voluntary acts are those with aims of which we are conscious and are --
usually -- prepared to acknowledge.'' Consciousness, he concludes,
''bridges perception and action, the events we perceive and the ones we
bring about.''
But consciousness is fragile, and ''however magical it may be, it is
a physical affair: mundane requirements for oxygen and glucose,
electrical equilibrium, clean blood and adequate sleep must be met in
the brain -- or consciousness fails. . . . However coherent our
experience and behavior may appear, they are prone to fragment under
stress. . . . Faints, fits and intoxication all reveal that perception,
memory, movement and speech are separable capacities.'' He adds: ''It
may be arrogant to deny that consciousness can ever slip its moorings in
the brain -- after all, much of the world's population believes firmly
that it can -- but the evidence in favor of this happening is tenuous at
best.''
Though the book's subtitle proclaims it a ''user's guide,'' the
phrase is not easy to find in these pages, making one suspect it was
tacked on by the publisher to make the book sound approachable and
instructive -- which, fortunately, it is. However, it is not tuned in to
two important issues that one would expect to find in a user's guide.
The first concerns how aspects of consciousness develop in childhood.
As a child, you eventually come to realize that someone else may not
know what you know. This much is covered well. But such structured
thinking begins as a 2-year-old makes the transition from two-word
utterances to speaking long sentences that cannot be understood without
some structuring principles. They are usually called grammar or syntax,
and we use them to create past and future tenses and to nest phrases
inside clauses and vice versa. Children understand structured sentences
long before they can produce them -- if they can hear long sentences or
watch them being signed. Certainly, one of life's major tragedies occurs
when a child is not recognized as being deaf until well after the major
windows of opportunity for soft-wiring the brain in early childhood have
closed (much of structuring is not hard-wired instinct). We know how
essential this tune-up period is for normal adult consciousness from the
short-sentence, present-tense-only adult abilities of deaf children of
hearing parents who failed to provide an environment during preschool
years that was adequately rich in sign language. (Deaf children of
signing deaf parents do fine.)
That suggests that a child born both deaf and blind has little
opportunity to soft-wire a brain capable of structured consciousness.
But what about Helen Keller and what Zeman calls ''her rich inner
life?'' Zeman, alas, makes the usual mistake of describing her as ''born
blind and deaf,'' when in fact she probably had 19 months of normal
exposure to language before being stricken by meningitis (by 18 months,
some children start to express structured sentences, showing that they
had been understanding them even earlier). So she probably soft-wired
her brain for structured stuff like syntax before losing sight and
sound.
A user's guide also needs something about how we create a plan or
utterance of high quality -- something better than our dreams, where we
see cognitive processes freewheeling without much quality control. They
provide us with a nightly experience of people, places and occasions
that do not fit together. Fortunately our movement command centers are
inhibited during most dreams, so we don't get into trouble acting on
nonsense. Awake, we are always searching for coherence, trying to shape
combinations that ''hang together'' well enough to act on. When our
quality control fails and incoherence is the best thing our
consciousness has available during waking hours, it tends to be called
hallucination, delusion or dementia.
A great deal of our consciousness -- indeed, our intelligence --
involves guessing well, as we try to make a coherent story out of
fragments. Zeman lumps this under a search for meaning, but his
description is memorable: ''Eye and brain run ahead of the evidence,
making the most of inadequate information -- and, unusually, get the
answer wrong. . . . Our knowledge of the world pervades perception: we
are always seeking after meaning. Try not deciphering a road sign, or
erasing the face of the man in the moon. What we see resonates in the
memory of what we have seen; new experience always percolates through
old, leaving a hint of its flavor as it passes. We live, in this sense,
in a 'remembered present.' ''