What's on her mind, anyway?
Mel Gibson heard directly, in his role as an arrogant advertising executive
in the romantic comedy movie "What Women Want." After suffering an electric
shock from a bathroom hair dryer, he could hear what women were thinking.
Until then, he'd been pretty oblivious what women were thinking about his
own behavior
What he learned surprised him. Eventually, as he saw himself through other
people's thoughts, he realized some of his limitations and became somewhat
more humble.
The rest of us, including medical professionals, also have a lot to learn
about what's going on in other people's minds. This is especially poignant
when we deal with people suffering with brain or mental disturbances.
Normally active people often wrongly guess the mental state of people
afflicted with apparently devastating conditions or even total paralysis.
For example, over time, people suffering with amyotrophic lateral sclerosis
(ALS or Lou Gehrig's disease) lose the ability to control or use their
muscles. Initially, these people notice weakness in their arms or legs, or
difficulty swallowing or speaking. Nerve cells, which normally activate
muscles, deteriorate. The electric signals from the brain and normally
carried by nerves cannot reach muscle cells. As a result, muscles do not
contract or move.
In such conditions, a person is often alert and conscious, but cannot speak
or even move fingers, eyelids or other parts of the body to signal their
needs or thoughts. Medical caregivers often call this a "locked-in" state,
as the person's mind cannot express itself with muscular and physical
motion.
As researchers at Institute of Medical Psychology and Behavioural
Neurobiology in Tbingen, Germany, put it on their website
http://www.mp.uni-tuebingen.de/mp/index.php?id=137 "From a healthy
individual's point of view one might consider the quality of life in such
patients very low. However, it has been repeatedly shown that quality of
life can be maintained despite the physical decline."
Scientists can now use external electrodes attached to the skin over the
head to detect brain waves, as used in electroencephalograph machines.
Computers recognize brain wave patterns under the patient's control.
Specially designed computer microchips then stimulate the patient's own
muscles or directly control a control battery-powered wheelchair to move
around. Patients can also communicate through the computer.
These machines are called brain-computer interfaces or BCIs.
Niels Birbaumer, Ph.D., one of the German scientists, found that a patient
could learn to use such a brain-computer interface to communicate before
total paralysis sets in. Later, even after becoming totally paralysed, these
people were able to communicate using the device.
Dr. Birbaumer also found that these patients had a much better quality of
life than their family or medical professionals guessed. This was true even
in completely paralyzed patients who depended on a motor-driven respirator
for breathing.
In a recent article "Breaking the silence: Brain-computer interfaces (BCI)
for communication and motor control," in the journal Psychophysiology
Dr. Birbaumer found that "only 9% of the patients showed long episodes
of depression, most of them in the time period following the diagnosis and a
period of weeks after tracheostomy," a hole surgically created through the
front of the neck to allow assisted breathing. "In fact, they are in a much
better mood than psychiatrically depressed patients without any
life-threatening bodily disease." He concludes, "The facts on end-of-life
issues and quality of life, do not support hastened death decision in ALS."
We're sure the same is true for many people suffering brain injury from
trauma or stroke. We've all seen reports in newspapers and medical journals
about patients regaining consciousness and an ability to communicate, even
after many years of unconsciousness.
For example, Terry Wallis, in a "coma" for about 20 years after a severe
automobile crash, is speaking and making jokes, although he thinks Ronald
Reagan is President, according to the Indianapolis Star.
Medical judgments about premature babies are also very limited. Doctors told
Andrew Schlafly's parents that their son born two months prematurely "would
never attend a regular high school. College was out of the question"
according to the New Jersey Daily Record. He's now 6 feet 6 inches
tall and is taking Harvard University's toughest freshman math class, Math
55.
Most medical studies only look at the first few days, or months after brain
damage, creating "a silent epidemic in which there is only minute attention
devoted to the long-term diagnostic, prognostic, therapeutic, and social
problems of persistent (albeit sometimes transient) disorders of
consciousness" according to Prof. Steven Laureys of the University of Liege
in Belgium writes in the Journal of Clinical Investigation .
We hope these experiences teach us how little we know about what other
people are thinking, especially the most limited among us.
Editor's Note: Robert J. Cihak wrote this week's column
