Consciousness – Case Studies

By Zoe Youngzie Lee, Deanna Necula

The difficult questions of consciousness are closely connected with various aspects of our community, such as legal and medical cases.

Disorders of Consciousness

          Julia Tavalaro had a stroke when she was 31. She seemed to fall into coma. But inside her paralyzed body and muted voice, she was fully awake; she could see, hear, feel, taste, smell, understand, even remember and think. But because she could only move her eyes and head to an imperceptible degree, no one noticed and thought that her ghastly howls were some unconscious activation of her body. She stayed this way for almost thirty years until she was finally “discovered.” She now communicates with doctors and visitors by moving her eyes up or down to indicate “yes” or “no” about what she wants to say as one points to alphabets on a board. With a special computer sensitive to the movements of her head, she is able to write poems and memoirs (Meyer, 1995).1

It took thirty years to find out that Julia was conscious. During those years Julia went through emotions of anger, fear, and most of all, despair. Although her will to live conquered psychosis or death, her quality of life had been greatly reduced. Our current inability to answer the Hard Problem leads to many misdiagnoses of distinguishing whether disorders of consciousness patients are really conscious or not. The rate of misdiagnosis is approximately 40%, and we are in need of a better method to recognize patients like Julia (Monti et al., 2009).2

Leibniz seem to have been on the right track when he claimed that not all minds are conscious, and that they can alternate between different states of consciousness. Dr. Martin Monti at UCLA defines consciousness as a combination of two dimensions; awareness and wakefulness. A patient in coma may be fully aware, but not awake; one in vegetative state may be awake, but not aware of what is happening in the environment. Brain imaging studies are being done on disorders of consciousness (DOC) patients to see if there are any patterns of conscious brain activity. Monti et al. found, with functional MRI scans, that five of 54 DOC patients showed willful modulation when asked to imagine themselves walking from a room to another or hitting a tennis ball (2009). The results matched those of healthy control subjects who were asked to do the same task. Similar results were seen when the research group asked questions (e.g. “Do you have a brother?”) and had the patients answer yes or no by actively counting “yes” or “no” in an audio stream.

There still are many limiting factors in determining the conscious state of DOC patients. To name one, it is yet impossible to know whether the patients who were unable to respond were unconscious, asleep, or whether the level of the cognitive task exceeded their abilities (2009). The study does, however, show the possibility of a better method of diagnosing and communicating with DOC patients.

Watch a talk by Dr. Monti on Disorders of Consciousness: https://www.youtube.com/watch?v=HW_4QArGScg

          Neurolaw

          In 2009, Stefania Albertani force-fed her sister psychoactive drugs and set the corpse on fire. The atrocity’s brutality garnered widespread media attention, and without the aegis of self-defense, provocation, or mental illness, Albertani was sentenced to life in prison. However, what seemed a straightforward “open-and-shut” case became vastly more complicated after an appeal; litigators produced evidence of Albertani’s apparent neurological abnormalities, citing them as the source of her criminal behavior and calling for immediate exoneration. Albertani’s defense team proposed a sentence reversal following neurological proof that Albertani’s brain presented abnormalities in the anterior cingulate gyrus and the insula, regions associated with impulse control and aggression. Geneticists reported below-average MAO-A gene activity– the so-called “warrior gene”— a trait linked to increased aggression and social disruption. Both served to convince adjudicators that Albertani’s actions had not been voluntary in the sense of malicious intent; rather, they had been the product of neurological flaws that altered Albertani’s state of free will and governed her behavior. In late 2009, a judge reduced Albertani’s sentence from life to 20 years on the basis of the neurological and genetic evidence– a first for Italian courts and a landmark decision for “neurolaw” litigation (Sample, 2013)3.

Some defense attorneys have capitalized on the urgency of volition in the justice system by circumventing the “problem of intention” with “neurolaw”. Coined by Sherrod J. Taylor in 1991, “neurolaw” refers to the growing field of litigation in which defendants ascribe fault to neural malfunctions (Erickson, 2010).4 Defense teams using the “it was my brain not me” tactic argue that one cannot be held responsible for one’s actions if they have a neurological problem that blurs the line between what is voluntary and what is not. As neuroimaging equipment and genetic testing technology improve, becoming more reliable, accurate, and most importantly, less costly, more defense attorneys are switching from claiming mental illness to claiming neural damage, a condition far more verifiable, less stigmatized, and more likely to garner jury sympathy (Springer, 2012).5

Ian Sample, a journalist for “The Guardian”, quantifies the rapid growth of neurolaw, citing evidence asserting that “the number of neurolaw cases rose from 100 to 250 a year over [eight years, and] In 2005, neuroscience appeared in 30 felony cases that did not involve homicide… that number rose to more than 100 in 2012” (Sample, 2013). Avid proponents of neurolaw run contrary to the ingrained view that criminals take actions that are intentionally immoral and thus should be punished accordingly, believing instead that “crime is a sign of underlying brain pathology”, as criminal law professor Erickson phrases it (Erickson, 2010). Therefore, many neurolaw advocates consider punishment irrational because it penalizes individuals for behavior beyond their control, and consequently they view neurolaw as a valuable tool for securing the best possible judicial outcome for their client (2010).

References

1   Meyer, R. E. (1995, December 17). Julia Understands Everything. Los Angeles Times. Retrieved from http://articles.latimes.com/1995-12-17/magazine/tm-14900_1_julia-tavalaro

2   Monti, M. M., Vanhaudenhuyse, A., Coleman, M. R., Boly, M., Pickard, J. D., Tshibanda, L., … Laureys, S. (2010). Willful Modulation of Brain Activity in Disorders of Consciousness. New England Journal of Medicine, 362(7), 579–589. http://doi.org/10.1056/NEJMoa0905370

3   Sample, I. (2013, November 10). US courts see rise in defendants blaming their brains for criminal acts. The Guardian. Retrieved December 6, 2015, from http://www.theguardian.com/world/2013/nov/10/us-rise-defendants-blame-brains-crimes-neuroscience

4   Erickson, S. (2010). Blaming the Brain. Minnesota Journal of Law, Science, and Technology, 27-77.

5   Springer, T. (2012). International Neurolaw: A Comparative Analysis. Berlin: Springer.

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