Neuroscientist Adrian Owen and his colleagues, in 2006, reported the results of a woman in an unresponsive state was asked to imagine playing tennis. Her brain showed a pattern of activity nearly identical to a healthy person’s. “She wasn’t vegetative at all,” Owen wrote in his book, Into the Gray Zone: A Neuroscientist Explores the Border Between Life and Death. “She was responding to us, doing everything we asked.”
Owen had been looking for signs of consciousness in patients with disorders of consciousness (DoC) since the late 1990s. His patients suffered from DoC as a result from traumatic brain injuries or other incidents where the brain was deprived of oxygen from. With DoC, also known as a vegetative or minimally conscious state, a person is awake, but not aware. They open their eyes, occasionally move, and seem to be ‘almost-there’.
Owen and others have published work finding that 15 to 17 percent of DoC patients can produce brain responses like the woman playing imaginary tennis. Although there is a drive to set up and enforce better guidelines for diagnosing DoC, and diagnosis improves, the problem of ways to treat these patients still remains.
A paper published on October 9 in The Neuroscience of Consciousness examined one out-of-the-box proposal from April: giving DoC patients psilocybin, the active ingredient in magic mushrooms, to see if it can restore consciousness in some way.
Andrew Peterson, an assistant professor at the Institute for Philosophy and Public Policy at George Mason University, said his gut reaction was “‘Are you tripping!?’—pun intended.” But later conceded it was worth consideration.
Peterson and his co-author, neuroscientist Enzo Tagliazucchi, applied an ethical model called the Value-Validity Framework to the idea—a way of questioning if a trial’s outcomes would be worth whatever burden it places on the patients. While their paper is neither an endorsement nor a disparagement of the concept, which Peterson hopes provides a road map for those wanting to do research in consciousness.
The testing of psilocybin to DoC patients is based on theories around brain complexity and consciousness. Brain complexity is the level to which different regions of the brain communicate with one another, and lower states of awareness are associated with less complexity.
Psychedelics seem to increase levels of complexity beyond what’s normal, according to Gregory Scott, a neurologist at Imperial College London and an author of the paper from April. There are several examples of the relationship between brain complexity and consciousness, and evidence of increased brain complexity in healthy people given psilocybin, however, the link between psilocybin and improvements in consciousness remains unresolved. For this reason Scott and his co-author, Robin Carhart-Harris, head of the Psychedelic Research Group at Imperial, proposed such a trial.
“The simple way of framing it is that disorders of consciousness have low complexity, and these drugs seem to increase complexity,” Scott said. “Let’s see what these drugs do in disorders of consciousness. Can they increase complexity and accordingly increase consciousness levels?”
‘’Through a trial, they could measure psilocybin’s therapeutic value, and also learn something about consciousness,’’ Scott said. ‘’Psilocybin interacts with a particular kind of serotonin receptor, and increases the activity of neurons with a lot of those receptors. Those neurons are concentrated in parts of the brain that have been implicated in consciousness, and seeing how they respond could guide our understanding of just how crucial these areas are.’’
Scott and Carhart-Harris suggested an extremely slow start with healthy subjects first, either sedated or sleeping, to see how psilocybin affects consciousness and complexity in those states. Only if the results are promising and the study design proves to be safe, would they move on to patients with any form of DoC.
Since no such trial exists yet and any kind of research on people with DoC is ethically fraught as they are unable to give consent, or say if what’s being done is hurting them. Psilocybin received a ‘Breakthrough Therapy’ designation from the FDA for trials in treatment-resistant depression, but DoC patients, who often have brain injuries and co-morbid illnesses don’t qualify.
One ethical concern is the ‘self-awareness paradox’. Although the goal would be to restore consciousness, what if that awareness causes emotional or physical pain?
Having a ‘bad trip’ is also a possibility. According to Tagliazucchi, with assistance, people are able to manage any anxiety that might arise, but in DoC patients will not be able to communicate. If a “bad trip” could occur “in a completely isolated individual, and this is a situation we have never encountered before in our research with healthy participants,” Tagliazucchi said.
Although such outcomes are concerning, the purpose of Peterson and Tagliazucchi’s new paper is to consider the ethics as we should any other intervention. Do psychedelics raise any ethical issues that are unique? “Not necessarily,” Peterson said, “Psychedelics are just one kind of new drug that could (or could not) be effective for this clinical purpose,” Peterson said. (They also pointed out that more invasive measures like deep brain stimulation are already being tried on these patients—is that ethical?).
Owen thinks a hesitation toward psychedelics shouldn’t stop people from considering it and that it’s worth a carefully designed, safe trial. When he first started to study consciousness in vegetative patients, people thought that was a waste of time and resources. “If we’d succumbed to those ‘knee-jerk’ early reactions, 20 years of extremely valuable science would never have occurred,” he said.
Scott feels that doing nothing isn’t the most ethical option either, especially since the number of people ending up with DoC increases. Those who suffer traumatic brain injuries or heart attacks during which their brains are deprived of oxygen are more likely to survive given the improvement in acute medicine.
“It’s potentially the case that we’re generating more people who are in this state because those people would have died 20 to 30 years ago,” he said. “If people say you can’t ethically do anything, that we should leave them alone – that produces a neglected group who no one’s really thinking about how we can help. When you look at it from that point of view, it’s a fairly dreadful situation, just in a different way.”
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