Into the Gray Zone: A Neuroscientist Explores the Border Between Life and Death

by Adrian Owen

In this “riveting read, meshing memoir with scientific explication” (Nature), a world-renowned neuroscientist reveals how he learned to communicate with patients in vegetative or “gray zone” states and, more importantly, he explains what those interactions tell us about the working of our own brains.“Vivid, emotional, and thought-provoking” (Publishers Weekly), Into the Gray Zone takes readers to the edge of a dazzling, humbling frontier in our understanding of the the so-called “gray zone” between full consciousness and brain death. People in this middle place have sustained traumatic brain injuries or are the victims of stroke or degenerative diseases, such as Alzheimer’s and Parkinson’s. Many are oblivious to the outside world, and their doctors believe they are incapable of thought. But a sizeable number—as many as twenty percent—are experiencing something intact minds adrift deep within damaged brains and bodies. An expert in the field, Adrian Owen led a team that, in 2006, discovered this lost population and made medical history. Scientists, physicians, and philosophers have only just begun to grapple with the implications. Following Owen’s journey of exciting medical discovery, Intothe Gray Zone asks some tough and terrifying questions, such What is life like for these patients? What can their families and friends do to help them? What are the ethical implications for religious organizations, politicians, the Right to Die movement, and even insurers? And perhaps most intriguing of in defining what a life worth living is, are we too concerned with the physical and not giving enough emphasis to the power of thought? What, truly, defines a satisfying life? “Strangely uplifting…the testimonies of people who have returned from the gray zone evoke the mysteries of consciousness and identity with tremendous power” (The New Yorker). This book is about the difference between a brain and a mind, a body and a person. Into the Gray Zone is “a fascinating memoir…reads like a thriller” (Mail on Sunday).

Genres: Nonfiction, Science, Psychology, Neuroscience, Medical, Medicine, Health

330 pages, Kindle Edition

First published June 20, 2017

Reviews

[Petra X · Rating 5 out of 5]

Please read, you don't have to 'like' it, but really this could save your life or the life of a loved one. If you are 100% paralyzed from a brain injury, whether it is from disease or an accident, you are very likely to be diagnosed quite quickly as being in a vegative state.

The next step is to remove the life support. And you're dead. But say your body is dead but your mind is 100% alive and well in that heavy, iron Diving Bell and you could hear and see everything that was going on? You might want to live if people knew that and were willing to provide you with intellectual stimulation and know your choices? This book details exactly how that communication is possible.

I was out having a drink with a nurse-anaethetist the other night, pretty highly educated and involved in hospital care, and he didn't know about this. So don't think that if you or a loved one should end up in this terrible state of looking permanently comatose, that your doctors will know about this. You have to write it down and discuss it with your nearest and dearest.

This may work immediately, or it may not work for weeks, or possibly months. It is only going to work in a minority of people as the others are either genuinely vegetative or technology has not advanced to the stage where we can see that there is still a person in there.

How it was done, at least one of the ways, the author writes, is to put the person in a scanner and play them a short Hitchcock movie. Everyone normal reacts to movies in the same way at the same time. When a gunshot is fired, one part of the brain of everyone watching reacts. A kiss, and it's another part, and so on. So if the person in the scanner is played the movie and reacts that way, they must be able to see, hear and follow the action. That's very far from being in a vegetative state.

Choices. In the book, the author says that the patient is given two choices, since we are Goodreaders, let's say, we are asked, "Do you like the book that is being read to you?" For yes, imagine a tennis match, for no, think of walking through your home. Again, different areas of the brain light up as the ones doing the thinking need more oxygen, more fuel, and the scanner identifies.

The next question is, obviously, would you want to live like this? The answer surprisingly was 72% of patients said, "Yes". Life is precious. Maybe having people coming and talk to you, read you the papers, read good books, play films is enough? For some that were breathing on their own, they were wheeled out and taken home for the weekend, or to the movies. I can envisage that for the very rich, they could have their own scanners (as well as nursing support) at home, and their day could be planned according to their wishes and abilities.

So consider this and talk about ir, let your family know what they should do, should such a tragedy befall you. Tell them about this and ask them what they would want.

Obviously a 10 star book.
_____________________

Notes on reading This is immensely interesting. It is (so far) the history and development of how scanners, from radio-active to MRI's have been used to detect brain activity in certain parts of the brain in people who have been judged 'vegetative' after strokes or accidents resulting in brain injury.

I found it fascinating that a sentence as simple as 'he fed her cat food' would need to be analysed. Did he feed a cat, or did he feed a girl or woman? We use context to know the answer. If he or a friend didn't have a cat , then there was a female with very strange tastes in food, or else was being given it forcibly!

A computer couldn't know what the sentence meant because it wouldn't know who if anyone owned a cat. But the brain can work it out using prior knowledge, context and likelihood. Different parts of the brain are used than those for a simple sentence that requires no interpretation, "he fed the cat Whiskas".

This parsing of meaning couldn't be done by someone without consciousness, they would have to think about the sentence, and different parts of the brain would be put to work consuming more oxygen as they did so, which could be detected by the MRI scanner. Ergo, the body might be vegetative but the mind was certainly not! And that was just the start...

[Darlene · Rating 5 out of 5]

This book, Into the Gray Zone: A Neuroscientist Explores the Border Between Life and Death by Adrian Owen piqued my interest because I have thought a great deal about just what it means to be conscious. Every now and then, we see stories in the media of people who have been in a vegetative state for years. The case of Terri Schiavo comes to mind immediately, mainly because of the very public legal battle which took place. I can't help but consider and attempt to imagine what being in that state feels like. What DOES it mean to be conscious? In its simplest definition, consciousness is described as "having an awareness" and being "able to feel and think". In this fascinating book, Adrien Owen, through his incredible research, inspires readers to examine what it means to be conscious and whites the difference between a brain and a mind? His research with patients in a vegetative state raises questions about our widely held definition of consciousness.

Adrian Owen is a neuroscientist who has been working for decades with patients who have been described as being in a vegetative state or non-responsive due to brain injuries or degenerative diseases such as Alzheimer's. What he believes he has discovered is not without controversy; nevertheless, through his research and experimentation, he has found that in about 20% of cases the patients are actually in a space between full consciousness and brain death.. a space he calls the 'gray zone.' These patients often seem oblivious to the world around them and are viewed by medical professionals as being incapable of thought. Dr. Owen strongly disagrees. He believes that their "intact minds are adrift deep within damaged brains and bodies." And he set out to prove just that...

This book is not at all daunting to read. It is not filled with medical jargon or written in the language of a professional journal article. And lest you think that Dr. Owen writes only of his successes, he also documents his frustrations and failures. Through years of trial and error and with the fortunate advancement in technology, Dr. Owen pioneered a new technique using fMRI machines (functional magnetic resonance imaging) to attempt to assess brain function. To help the reader understand exactly how the process worked, he presented a number of case studies. Initially, he pulled together a control group of healthy people and came up with an interesting way to elicit the same responses in the brains of all of his subjects. He needed something which would 'light up' the same areas in all brains being tested. He and his team brainstormed and they thought of two scenarios: in the first scenario, the subjects were asked to think about and imagine playing the game of tennis. Using the fMRI, Dr. Owen was able to see that when his subjects thought about playing tennis, the part of the brain which is situated near the top of the head (which is known as the premotor cortex) lit up every time. The second scenario he used with his healthy subjects was to ask them to imagine or visualize themselves walking through their homes. This time, the part of the brain associated with spacial memory 'lit up' in each subject.

Taking the information he collected using his healthy subjects, Dr. Owen was prepared to attempt the experiment with patients in a vegetative state. Dr. Owen needed to be able to demonstrate that just as in healthy people, he could use the fMRI machine on damaged brains to "catch them in the act of making a willful decision." A number of his patient case studies have stuck in my mind... The first patient he tried the technique on was named Carol. Carol was a 23-year-old woman who had been hit by two cars as she attempted to cross a busy street and while she was distracted by her cellphone. She had been in a vegetative state for months. Placing her under the scanner, Dr. Owen asked her to imagine she was playing tennis. He then asked her to imagine she was walking around her home; and to his surprise and delight, the premotor cortex and the spatial memory parts of her brain 'lit up' ... just as they had in his healthy subjects.

To carry the experiment one step further and in an attempt to communicate with a patient, Dr. Owen and his team devised a list of questions to ask the patient and would instruct the patient to imagine playing the game of tennis to signal a 'yes' response'; and to imagine walking through his hometown signal a 'no' response. Dr. Owen attempted this experiment with a patient named Scott, a man who had been in a vegetative state for the 12 years since he had been involved in an automobile accident. Scott was presented with clear 'yes' or 'no' questions.... "Are you in any pain?" and "Do any of your body parts hurt right now?" are examples of questions used in Scott's case. Scott was instructed to imagine playing the game of tennis if his answer was 'yes' and to imagine walking through his home if his answer was 'no' . The spatial memory part of Scott's brain 'lit up', signaling to Dr. Owen that he was not in any pain.

Are these successful experiments proof that a 'gray zone' does exist in some patients who have been considered non-responsive by the medical community? I found the case studies presented in this book to be exciting and promising; but Dr. Owen has been criticized by others in his field. Some of his detractors believe he is reading too much into the data he has collected and is providing false hope to patients and families who have already been traumatized. Dr. Owen believes that at the very least, his findings have encouraged doctors, nurse and family members to view these patients with more empathy and this empathy may increase the likelihood of a partial recovery.

I personally feel this breakthrough his exciting. But I also have to admit that the case studies provided were also disturbing to me. For so long, medical professionals have believed that they could say, with a degree of certainty, that patients in a vegetative state were not conscious or aware of their surroundings. Dr. Owen's research makes it clear that thinking of these patients as unresponsive is far from certain in at least 20% of the cases. As I often do when reading these types of books, I attempted to imagine how these patients must feel being essentially trapped inside of their own bodies. That reminded me of the age old fear of being buried alive.. and that's an awful thought! I also feel that Dr. Owen's research presents moral, ethical and legal challenges and because of this, society will be forced to try to answer some very difficult and important questions... what makes a life valuable or worth living? What IS the difference between a brain and a mind? And what does it mean to be conscious? Plenty of food for thought....

[Cheryl · Rating 5 out of 5]

Adrian Owen is a world renowned neuroscientist who has conducted research involving cognitive abilities in people with traumatic brain injuries.

In his newly published book, Into the Gray Zone, Owen writes about the cutting edge procedures he and his colleagues have developed in order to try to establish whether or not patients who have been diagnosed as being in a persistent vegetative state are, in fact, cognizant of their surroundings.

Although some parts of the book are difficult to comprehend, Owen successfully explains in layman’s terms, how the injuries sustained by patients impact various parts of the brain, and what long term consequences they produce.

Each chapter details the experiences Owen has encountered while working with specific patients and their families. Each person experienced a sudden, unexpected brain injury that left them trapped inside their body with no way to communicate their thoughts! The damage sustained by their brains has placed them in the "gray zone"-- somewhere between life and death. Each story is heartbreaking. Yet Adrian Owen is optimistic that advances in brain research and technology will someday provide better outcomes for people with traumatic brain injuries.

I would give this book more stars if I could. It is one of the most interesting and informative books I have ever read. Thank goodness for these intelligent, dedicated researchers whose goal is to help people when others have simply given up on them. I was moved by Adrian Owen’s comment about his research: “Beyond the elegant experiments and dazzling technology, the heart of gray-zone science is about finding people who have been lost to us and reconnecting them with the people they love and who love them. Each contact still feels like a miracle……..What began as a scientific journey more than twenty years ago, a quest to unlock the mysteries of the human brain, evolved over time into a different kind of journey altogether: a quest to pull people out of the void, to ferry them back from the gray zone, so they can once again take their place among us in the land of the living.”

[Mircea Petcu · Rating 5 out of 5]

Cercetătorii au reușit să comunice cu un pacient aflat în stare vegetativă, prin intermediul RMNf. Este impresionant. Și ce gând înfiorător, să rămâi blocat în propriul corp.

[Sandie · Rating 5 out of 5]

It is so rare that a book comes along that sparks my interest and intellect (such that it is!) like this one. I have found myself quoting parts to friends, taking pics of pages and sending them off, and pondering who I will bless with a copy. The book is so accessible and is presented very well, interspersed with enough human examples to make it hard to put down (such a well worn phrase but certainly applies in this case). The author is also clearly empathetic to the plight of his experimental “subjects” and the families who believe in their loved ones consciousness and responsiveness despite evidence to the contrary. I am sure that part of my intrigue is that I worked freshly out of college and many years ago in a brain injury rehabilitation center, doing both therapy and admission work. If the current technology had been available, what a difference it would have made in many lives and given answers and peace to tortured families. We saw very little miraculous recoveries but yet the hope of family members was inspiring and devastating at the same time. Using the methods of communication that Owen presents, what are the ethics of using the results to determine admission to a very expensive rehab center to improve odds of serving only those with”potential”? An interesting thought....

[Cheenu · Rating 5 out of 5]

This book deals with consciousness in a very practical setting - how to tell if an uncommunicative, unresponsive vegetative state person is consciousness or not?

Tough to read at times because it is one of the worst things you can imagine happening to you or your loved ones.

There is no philosophy or theories of consciousness here. It is an personal account of the author's research journey to get a clearer picture of what state exactly is a vegetative person in.

Highly recommended read.

[Bonnye Reed · Rating 5 out of 5]

GNab I received a free electronic copy of this book from Netgalley, Adrian Owen, and Scribner in exchange for an honest review. Thank you all, for sharing your hard work with me.

Adrian Owen outlines and details his work with patients suffering neurological damage due to accident or illness over the last 29 years, the equipment and processes used to recognize consciousness in those persons diagnosed as being in a vegetative state. This was a hard book to read. In our world we get used to happily-ever-after. We see it in our books and our films, those adult fairy tales that carry the day.

Every inch of progress made in neuroscience was hard fought on several fronts - general perception, funding, equipment. But these scientists have climbed those unknown mountains, and found many positives for those suffering injury, Parkinson's or Alzheimers, and found new ways to communicate with people in the Grey Zone. What a wonderful breakthrough!

pub date June 20, 2017
Scribner

[Jeanette · Rating 3 out of 5]

This book is well worth the read. The author cleverly tells his own progressive career path and life story, surprisingly revealing much about himself and his feelings beyond the science.

And the science is interesting and the brain scanning for those who are deemed or may be in "the gray zone" the core of what this book describes. The neuroscience of the operating brain and especially within those who are in coma, unconscious and all the intermittent layers of possible in between and scaled for "activity".

It's scary and absolutely ominous that in the past, like in burial habits- that there has been strong assumptions upon those with no reactions as being close to death or unaware, which have been entirely wrong.

He gets into tangents of history and specific cases which were very illustrative. Perhaps I wanted to hear more about possible optimum treatment? Regardless, it has made me think about powers of attorney to a greater degree that the one I hold/ have. And also when around the unconscious and non-responsive I would and will always talk to them by name and declare in each detail exactly what/where and how touch or sound or involvement is occurring.

The mapping of the brain as this author surveys consistently- that is very difficult work. He explains the white matter well here. Better than most in his field for sure. But I would have liked more about the scanning maps and less about his constantly moving and job/ tenure/ traveling details. The last sections which contained his thought summations upon the possible future in this field - 2 stars.

[Bookaddictpnw · Rating 3 out of 5]

Admittedly, non-fiction books about anything medical seem to be a siren song for me; I find them boundless fascinating. Having read and loved Being Mortal, The Remedy, and My Own Country, I was immediately drawn to this one. Adrian Owen, a neuroscientist, embarked into a career to explore, learn, and hopefully discover what occurs in a patient's brain when diagnosed as being in a 'vegetative state.' Throughout the book, he intersperses real life patient stories, discussions of his own personal life and experiences with the medical world, as well as the head injury of the woman he once loved. I found his patient stories the most fascinating, with many "wow" moments as more and more of the gray zone was opened up to Owens and his fellow scientists, as both technology and learning progress continued to expand. At times, the medical-ese stumped me and got a bit dry, but Owens was able to jump back into a narrative pace that helped bring the story alive to someone like me, fascinated with medicine but a complete dunce when it comes to the science of it all. For those people who are impacted by a brain trauma, who work with children or adults with brain injuries, or for those other people like me who are just suckers for a good medical mystery, this book is a great choice.

[Cathy · Rating 4 out of 5]

I really enjoyed reading the details about scanning of the brain and how different tests measure certain areas. I am hopeful that technology will help those deemed to be in a vegetative state and if it helps support staff, nurses and doctors treat people more humanely while in that state, then more power to it! The author did admit there is so much we do not know but I just felt that the book finished on a trippy note. Kind of like 'we smart humans will conquer and solve the mystery of the brain!' Maybe it's the 'science replacing God' attitude that I cannot appreciate. I don't know, but it's a very interesting book.

[Erin Clemence · Rating 4 out of 5]

In “Into the Gray Zone” neuroscientist Adrian Owen examines consciousness, traumatic brain injury, and the degree that those deemed “vegetative” experience the world around them.

Owen is world renowned, having studied medical subjects in the U.K and North America (primarily Canada), and has been at the forefront of the specific neuroscientific discipline of human consciousness. Do those who have suffered a brain injury, and are deemed “vegetative”, still have a consciousness? Can they feel? Can they communicate? Do they exist somewhere “in the gray” zone with no way to contact the “outside” world but still have all faculties intact?

Through “Gray Matter”, Owen explains how he got into this specific discipline, and what motivates him to continue. Using subjects from cases over the years (and around the world), Owen uses advancing technology and science (starting in the nineties to 2017, when the book was published) in an effort to detail what those who are “lost in the gray matter” are experiencing. Owen is extremely respectful to his patients’ and their families, and includes follow-up on their outcomes (when applicable), giving a more human side to scientific memoir.

As a self-proclaimed “brain geek”, I was immediately captivated by the subject matter, yet put at ease by Owen’s generalizable language. He identifies portions of the brain affected in each case study, complete with their scientific names and locations on the brain itself (I must admit, I drew and labeled a very rudimentary brain with Owen’s information. I did this out of personal interest, as it was absolutely not necessary in order to keep up with the book). Owen describes modalities and machines that he uses to asses his subjects, and how he monitors and records the readings, so some of the scientific language may be a bit thick in parts as he details this, but the overall subject matter is fascinating and thought provoking.

Owen’s discoveries are on the cusp of changing neuroscience, not only with comatose patients for also for those who struggle with Alzheimer’s or Parkinson’s disease, and although the idea of being “locked in” is a terrifying thought for anyone, Owen provides a glimmer of hope. I thoroughly enjoyed his science-based yet human-focused exploration into the human brain, and the concept of “consciousness”.

[Patricia · Rating 5 out of 5]

Into the Gray Zone by Adrian Owen is about his journey as a neuroscientist looking for indications of consciousness in patients typically diagnosed as being in a persistent vegetative state, the "gray zone". The book step-wise takes us along for the ride, as Dr. Owen works with increasingly better technology, and then works with his research team and colleagues to use that technology in a smarter and smarter way, since time analyzing gray zone patients is precious in more ways than one. We also get to know the patients and importantly their loved ones. The book tackles questions such as “What is consciousness?”, “How and when does consciousness arise?”, and “How can you possibly recognize consciousness in a patient in the gray zone?”. The book also addresses how communication might be established if consciousness is discovered. The story is well-constructed and also leaves the reader pondering even bigger questions such as the impact to society of direct brain-computer communication technology potentially being commonly used in the future. A great read!

[Carolyn · Rating 3 out of 5]

I really enjoyed this, I just thought it was about the “crossing over” period, not the mental states of vegetative persons.

[Laura · Rating 5 out of 5]

An incredibly detailed and fascinating insight into the world of patients in vegetative states of mind and how the author and a team of specialists seemingly discovered a way to communicate with them. The idea that vegetative patients experience a degree of consciousness is remarkable; it helps that this book was very well written with the non medic in mind.

The area of neuropsychiatric care is massive and seems to go on forever. The author gives thorough consideration to readers unfamiliar with biology and the wider sciences; and of course for every theory, test and scan there is a patient story behind it. There are some really intriguing stories to be told here and I’m sure there were many more the author couldn’t fit in to his book.

A must read for those interested in psychology, psychiatry and the neurosciences.

[Lisa · Rating 2 out of 5]

This is my own academic area and I was interested to see how the author packaged the science for public consumption. Unfortunately I was very disappointed. This book really is straight memoir with elementary neuroscience sprinkled in. The writing is composed of boring simple sentences and the comments are repetitive. His attempts at approaching ethics and philosophy were personal convictions, making these thoughts shallow and useless. The author does reiterate that only 17% of the people he's scanned respond to fMRI questioning but to devote a book only on them and not reporting on the 83% that do not respond is a selection bias and a disservice to other families.

[Mary · Rating 4 out of 5]

Into the Gray Zone is a scientific quest to discover and learn about the territory of the mind and the brain. What happens to people that are in a coma? Are they aware of their surroundings? Do they still have memories or likes and dislikes? Or do they float without thought through a dark void?

This book follows a series of clever and evolving tests designed to answer these and other questions. For example, a comatose patient has his or her brain activity monitored and is asked to imagine playing tennis. If the person is conscious, this lights up activity in a certain part of the brain. Then he or she is asked to imagine walking through the rooms of their home. Again, if the party is conscious, a different area of the brain shows a spike in activity. Then the scientists move to using these two scenarios to serve as yes and no and ask the comatose patient simple questions.

If you are interested in science, you will find this book a fascinating read and enjoy learning about how these experiments continue to evolve and where they might lead in the future.

[John Martindale · Rating 4 out of 5]

This book is the fascinating story of how a scientist was able to discover and prove that some individuals in vegetative states are in fact conscious, aware of their environment, and the passing of time, though they are completely unable to use their body to convey this to others. It is sobering to consider, and I liked how the author reflected upon the implications of it. As the book closes, he leaves one hopeful that as science continues to advance, more ways should open up for those in comas to be able to communicate and begin to function again with those in the land of the living.

[Dan Graser · Rating 5 out of 5]

Adrian Owen has achieved in this book that rare combination of fascinating science (that is in no way dumbed-down) and a gripping narrative told with great human connection.

The focus here is on patients whose brains have slipped into the region between consciousness and total brain death, known as, "The Gray Zone." Very frequently they are colloquially (and medically) referred to as being in a vegetative state or non-responsive. This happens frequently due to serious infection, debilitating neurological disorder, or traumatic injury (and in some cases a combination of those factors). The result of this fascinating study is a new view of what it means to be conscious and what our brains are capable of even when it appears all is lost, physically. Our modern abilities to keep people alive even after horrific brain injury has entirely given rise to our ability to study how the brain is functioning on those in the borderlands between life and brain death.

Thankfully, this book is by a scientist and a genuine neuroscientist at that, and not a pseudo-intellectual, asinine "guru" who is here to tell you anodyne things you already want to hear about consciousness (something none of them are qualified to speak about). As such there is no leaping to conclusion or vague, tedious philosophizing, just fascinating detail about several case studies.

This is a new field, really new seeing as the first major studies began in 1997 and as such we hear not only the growth of our knowledge in this area but also the benefit of technology, in the form of fMRI scanning, to greatly aid how this area is probed. Owen writes with great explanatory power but also with a personal touch of enthusiasm and connection to his patients/study-subjects that makes for a completely satisfying and illuminating read.

What you will find is that this gray zone is actually filled with life, the brain capable of incredible feats even when externally it appears to have shut down, and our abilities to keep victims alive under extraordinary circumstances is fundamentally changing how we understand the workings of the brain in many states. Dr. Owen is an engaging and insightful guide and the studies he presents here, with the authority and depth of knowledge of a genuine neuroscientist, are likely some of the most interesting stories you will read.

[Alyson · Rating 4 out of 5]

This is a very comprehensive report on a fascinating and terrifying subject that is very well researched and told in a completely approachable manner. Narrator Steve West should be commended for his talent in the audiobook version. Huge science went into this book, and yet humanity and caring, really caring about people and their lives, their existence on earth, is what comes across most. Oliver Sacks and his books came to my mind while listening to this audiobook. Questions are answered here, yet we are left with many more at the conclusion. This is an eye opening look at consciousness that leaves any reader only hoping that pulling the plug on a loved one never becomes a decision that needs to be made in this lifetime. And living wills will be more difficult to resolve as well. Yikes.

[Chelsea · Rating 4 out of 5]

I’ve had this book for a few years and have not even taken a second look at it until recently and I’m glad I did. This book reminded me of how much we still do not know about our own brains and how far science has come and how far it can go.

Into the Gray Zone is an in depth look at the experiments conducted by Adrian Owen, a neuroscientist that focuses specifically on brain injuries. Owen outlines several experiments while also examining the deeper question of what exactly constitutes consciousness and the moral, ethical, and emotional implications in the search for the answer.

This book is ruminative, slightly technical at times, but generally accessible to everyone so I’d recommend to anyone whether they are interested in science or not :)

[Essam Munir · Rating 5 out of 5]

This is the voice of those who lost it!
Vegetative state in itself is an interesting and painful condition for everyone (the family and physicians). This book and the stroke of my insight are the books that need to be read by physicians to get insight to the workings of the brain of those who suffered this.

[Alisa Kester · Rating 3 out of 5]

Interesting stuff...but it felt like the content could have been condensed to article length without losing anything of importance. This particular science is in its infancy; there really isn't a great deal to say yet.

[Signe · Rating 3 out of 5]

This book is about how various TBI patients were tested for the consciousness they were believed not to possess due to their unresponsiveness. It was found that about 15-25% of people considered brain-dead were actually just trapped inside their bodies with a certain level of consciousness.

This is not really news to most people, though the methods of investigation were novel and proved consciousness in a scientific manner. But -- is that reason enough to put people who cannot consent because they are locked-in through a battery of tests? I'm feeling very uncomfortable with that. One man, who ended up healing from his TBI told the researcher that the process he put him through "terrified" him; he also expressed that not enough information was given about it. The kicker is that even if they found a patient to have rich experience of consciousness like "regular" people, there was absolutely nothing that could be done for them but to leave them in that locked-in state!

Imagine laying there for 19 years, unable to track people's movements with your eyes because they didn't work, unable to move, unable to speak or contact the outside world in any way -- yet conscious the entire time. A doctor comes along who "sees you" (or suspects to), injecting you with gadolinium, subjecting you to fMRIs, asking you to do certain tasks ... If it were me, I'd think "finally, somebody realizes I'm in here and they're going to help me!". Nope, they're just treating you like a guinea pig with no consequent help for your condition whatsoever. Back to long term care to be washed like a dead chicken, have your bones fracture when nurses change your diapers, etc. while your brother "feels happy that all the time [he] spent talking to you wasn't in vain."

Having been unresponsive myself, I find this horrifying. My biggest recommendation is to get a living will, substitute decision-maker, Medical Power of Attorney and let everyone know your wishes should you become locked in. Personally, after being in hospital 2 years myself and seeing the victims of severe TBI, I would specify and insist on no feeding tube, and no breathing assistance. Who cares if I'm aware of everything going on around me? That's even greater reason (to me) to allow a natural death.

You can explore the border between life and death by studying people like the 16th Karmapa and talking to the doctors present at his death, where he confounded them by living in body that should have been dead (according to science), while taking his consciousness in and out of his body just to show them that there is a grey area. There's not just "alive" or "dead". Tibetan Buddhists, especially of the Kagyü and Nyingma lineages, are experts in death and dying. They have retreats that mimic death to prepare for it. Study them. Ask them about death and dying, and what kind of consciousness may exist in a non-responsive person. They know more than science will ever teach you because they have experienced it -- and there's no collateral damage of terrifying your patients, confusing them, or giving them false hope. This is exactly the kind of thing I fear most about becoming locked-in again. Get consent before-hand, like organ donors give, or don't do this experimentation at all.

[Adrian Manea · Rating 5 out of 5]

After finishing this book, I kept thinking about something I didn't like, some negatives to point out. And I found none! It's both rich in scientific details (as far as a popular science book could be), has engaging prose with lots of personal touches, and it contains philosophical reflections about personality and consciousness. Furthermore, it had a rich bibliography and index, like a good science book.

All in all, a great recommendation! The only pinch of salt I would add is that, statistically speaking, the cases that are presented are breakthroughs and exceptions rather than "the usual". Nevertheless, the mere fact that it shows what is possible (even if not always likely) makes it special.

[Kinga Szczerba · Rating 4 out of 5]

4,25⭐️
fascynująca

[Matt Simkulet]

“Life is a dazzling improvisation.”

[Blue · Rating 5 out of 5]

Into The Gray Zone by Adrian Owen is a captivating account of research about the non-physical existence of people who have no means of using movement or their bodies to communicate with the outside world.

The book is perfectly written and paced for the lay audience, explaining thought processes, concepts, and technical advances in enough detail to bring clarity, but not too much to drag down the exciting findings and emotional ups and downs of the impact the research has on the researchers, patients, and patients' families (as well as the greater world out there). The book explains the advances from using PET scanning to fMRI to further technologies, as well as some other approaches used by Owen's contemporaries (EEG, for example) to delve into the locked-in mind, its thoughts and emotions, its capacity to feel, understand, and respond. There are many important counterpoints to the interpretations of the findings of researchers like Owen, and the book does a very good job of addressing the main ones. In this sense, even the lay audience can get a real feel of what real science is, that scientists, though they have to sound sure of findings and meanings of those findings to secure funding and to force advances based on findings, are not and should not be overconfident, should always welcome counter arguments to their own interpretations, should seek to collaborate with others, should use new technologies all the time to try to expand their own horizons, should question their own personal and professional motives. Often, the public thinks that scientists are either people who think they know everything or people who waste money to find out things that make little difference; this book is a testament that neither of those beliefs are true for many scientists.

The book describes milestones in Owen's research: first being able to detect a change in the brain activity of "vegetative" patients, then trying to prove that some brain activity is not just an automatic response from the brain, but a genuine sign of "mental doing," and then trying to use this knowledge to try to communicate with locked-in patients who have no other means of meaningfully communicating with the outside world. Though the book concentrates on Owen's research by discussing some milestone cases (individuals who suffered brain injury and were living in vegetative or minimally responsive states when Owen and his team used their scanning protocols to try to understand if these individuals had any level of brain activity, response to outside cues, etc.), it delves into much bigger issues, like what it means to be conscious, how consciousness can be measured, what is the difference between reporting vs. being conscious, how is our definition of consciousness biased by our own understanding of ourselves and others, what is the link between consciousness and language, theory of mind, etc.

Overall, Into The Gray Zone is an excellent read that explores the capacities of the human brain, its resilience, and the scientific research that tries to understand these aspects of our existence.

Also recommended for those who like imaging technology, playing tennis, and Hitchcock films.

[Sam · Rating 5 out of 5]

At the time of this review, Into the Gray Zone: A Neuroscientist Explores the Border Between Life and Death has a little under 1300 ratings. Read this book regardless of your existing knowledge of the brain!

Adrian Owen investigates consciousness and awareness in individuals who are in vegetative and minimally conscious states. He eloquently shares his beliefs and questions of consciousness as he retells his journey to discover brain activity that indicates awareness. Starting in 1997, he provides real cases of traumatized individuals which include his ex-partner.

His knowledge is presented in a digestible fashion, the contents of the book are well balanced, and there was never a moment where I felt overwhelmed or lost. Not a single sentence was glazed over. I especially appreciated the transparency regarding the consequences and ethics of neuroscience research.

This book was so rewarding not only in scientific knowledge but in motivations to be conscious of those who are seemingly unconcious. The many experiences he had throughout the years reinforce the idea that physical movement is not an indicator of awareness. A conscious human can still be awake inside a traumatized body.

[Diyan Ridzuan · Rating 5 out of 5]

As a scientist working in research and developments, I found this book is really interesting to read. I like how straightforward the story and the sentences is written.The book can be read by anyone outside the research area because it is written in layman terms and it is actually been written as a story, according to timeline of the writer. It is amazing to see how Adrian Owen making research breakthroughs in the neuroscience applied for people in the gray zone. The findings from this work as detailed from this book can help us to understand people in such conditions and this is where people should learn to treat the paralyzed patients better because (spoiler) they are conscious! <3

[Michelle Upton]

Fascinating, jarring, hopeful, sad, and wondrous. I couldn’t put this book down!