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• Into the Gray Zone - 2017 Scribner, New York

• Wikipedia - https://en.wikipedia.org/wiki/Adrian_Owen

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  Adrian Owen, British neuroscientist
  Adrian M. Owen (born 17 May 1966) is a British neuroscientist and author. He is currently the Canada Excellence Research Chair in Cognitive Neuroscience and Imaging[1] at The Brain and Mind Institute, The University of Western Ontario, Canada. He is best known for publishing a scientific paper in 2006 in the journal Science showing that some patients, thought to be in a vegetative state, are in fact fully aware and (shown subsequently) able to communicate with the outside world using techniques such as functional magnetic resonance imaging (fMRI) and electroencephalography (EEG).

  Contents [hide]
  1 Early life and education
  2 Career
  3 Research
  4 Other academic roles
  5 Awards
  6 Personal life
  7 References
  8 External links
  Early life and education[edit]
  Adrian Owen was born 17 May 1966 in Gravesend, England, and educated at Gravesend Grammar School. He completed his PhD at the Institute of Psychiatry, London (now part of King's College London) between 1988 and 1992.

  Career[edit]
  In 1992, Owen moved to the Cognitive Neuroscience Unit at the Montreal Neurological Institute, McGill University to work with Michael Petrides and Brenda Milner. He was awarded The Pinsent Darwin Scholarship by the University of Cambridge in 1996 and returned to the UK to work at the newly opened Wolfson Brain Imaging Centre, Cambridge. In 1997 he moved to the Medical Research Council's Cognition and Brain Sciences Unit (CBU), Cambridge (formally the Applied Psychology Unit) to set up the neuroimaging programme there and to pursue his research in cognitive neuroscience. He was awarded MRC tenure in 2000 and made Assistant Director of the MRC CBU in 2005, with overall responsibility for the onsite imaging facilities (3T Siemens Tim Trio MRI and 306-channel Elekta-Neuromag MEG systems).

  In 2010, Owen was awarded a $10M Canada Excellence Research Chair in Cognitive Neuroscience and Imaging at The University of Western Ontario (UWO)[1] and moved most of his research team to Canada in order to take up this position in January 2011.[2]

  Research[edit]
  Over the last 20 years, Owen has published more than 250 peer-reviewed scientific papers and over 35 chapters and (edited) books.[3] His work has appeared in many of the world's most prestigious scientific and medical journals, including Science, Nature, The Lancet and The New England Journal of Medicine. His H-Index (Google Scholar) is currently 87.[4]

  His early publications on patients with frontal or temporal-lobe excisions[better source needed][5][6][7][8][9][10] pioneered the use of touch screen based computerised cognitive tests in neuropsychology. Over the last 20 years, these tests have gone on to be used in more than 600 published studies of Parkinson's disease, Alzheimer's disease, Huntington's disease, Depression, Schizophrenia, Autism, Obsessive-Compulsive Disorder and ADHD, among others.

  His post-doctoral research on working memory with Michael Petrides, (PNAS, Cerebral Cortex, Journal of Cognitive Neuroscience, Brain and others) was instrumental in refuting the then prevailing view of lateral frontal-lobe organisation advanced by Patricia Goldman-Rakic and others, and is still widely cited in that context. His 1996 paper on the organisation of working memory processes within the human frontal lobe continues to be one of the most highly cited articles ever to appear in the scientific journal Cerebral Cortex.[11]

  His 2006 paper in the journal Science[12] demonstrated that functional neuroimaging could be used to detect awareness in a patient who was incapable of generating any recognised behavioural response and appeared to be in a vegetative state. This landmark discovery has implications for clinical care, diagnosis, medical ethics and medical/legal decision-making (relating to the prolongation, or otherwise, of life after severe brain injury).[5][13][14][15] In a follow up paper in 2010 in The New England Journal of Medicine.[16] Owen and his team used a similar method to allow a man believed to be in a vegetative state for more than 5 years to answer 'yes' and 'no' questions with responses that were generated solely by changing his patterns of fMRI activity.[17]

  This research attracted international attention from the world’s media; it was reported in many hundreds of newspapers around the world (including twice on the front page of the New York Times and other quality journals) and has been widely discussed on television (e.g. BBC News,[18] Channel 4 News, ITN News, Sky News,[19] CNN[20]), radio (e.g. BBC World Service[21]) ‘Outlook’ documentary, NPR Radio (USA), BBC Radio 1, 2, 3 and 4), in print (e.g. full featured articles in The New Yorker[22] The Times, The Sunday Times, The Observer Magazine etc.) and online (including Nature, Science and The Guardian podcasts). To date, the discovery has featured prominently in 6 television documentaries including 60 Minutes (USA),[23] Panorama BBC Special Report (UK),[24] Inside Out (BBC TV series) (UK),[25] and CBC The National (Canada).[26]

  In 2009, Owen and his colleague, Adam Hampshire, launched Cambridge Brain Sciences, a free web-based platform for members of the public and the wider scientific community to assess their cognitive function using scientifically proven tests of memory, attention, reasoning and planning. To date, the tests on the site have been taken by more than 100,000 people worldwide.[27]

  In April 2010, Owen and his team published the largest ever public test of computer-based brain training in the journal Nature.[28] The study, conducted in conjunction with the BBC, showed that practice on brain training games does not transfer to other mental skills. More than 11,000 adults followed a six-week training regime, completing computer-based tasks on the BBC's website designed to improve reasoning, memory, planning, visuospatial skills and attention.[29] Although improvements were observed in every one of the cognitive tasks that were trained, no evidence was found for 'transfer' effects to untrained tasks, even when those tasks were cognitively closely related. Details of the results were revealed on BBC1 in Can You Train Your Brain?, a Bang Goes the Theory special and published on the same day in Nature.[30]

  In November 2011, Owen led a study that was published in a weekly peer-reviewed medical journal, The Lancet.[31] The Researchers found a method for assessing whether or not some patients who appear to be vegetative, are in fact, conscious and are just not able to respond. This new method is using electroencephalography (EEG), which is not only less expensive than MRI, but is also portable and can be taken right to the patients bedside for testing.[32][33]

  Other academic roles[edit]
  Deputy Editor-In-Chief of the European Journal of Neuroscience (1997–2005)
  Associate Editor of the Journal of Neuroscience (2006-2012)
  Member of the Neurosciences and Mental Health Committee of the Wellcome Trust, the UK's largest non-governmental source of funds for biomedical research (2007-2012)
  Served on the Advisory Board of the Annals of the New York Academy of Sciences (2007–present)
  Current Member of the Wellcome Trust Peer Review Panel, UK (2012–present)
  Current Member of the Gairdner Medical Review Panel. Canada (2012–present)
  Current Member of the Peer Review Committee for the Canadian Institutes of Health Research (2014–present)
  Owen also held/holds affiliations with:

  University of Belgrade, Serbia, Visiting Professor (2000-2001)
  Institute of Psychiatry, London, UK, Visiting Professor (2008–present)
  Clare Hall, Cambridge, UK, Official Fellow (2000-2011)
  Robarts Research Institute, London, Canada, Research Affiliate (2011–present)
  National Core for Neuroethics, University of British Columbia, Canada, Faculty Affiliate (2012–present)
  Member of the Rotman Institute of Philosophy at Western University, Canada (2012–present)
  Member of the International Scientific Committee for the Institute of Cognitive Neurology (INECO) and the INECO Foundation, Argentina (2013–present)
  Awards[edit]
  The Pinsent Darwin Scholarship by the University of Cambridge (1996)
  Shortlisted for the Morgan-Stanley ‘Great Briton of 2006’ prize (2006)
  Voted ‘Scientist to Watch in 2008’ by the Financial Times, UK (2008)
  Voted the 50th most important scientist in the UK in The Times (London) ‘Top 100’ Science List (2010)
  Hellmuth Prize for Achievement in Research Award, Western University, London, Canada (2013)[34]
  Personal life[edit]
  Owen lives in London, Ontario with his son, Jackson. He has one brother, Christopher J. Owen, who is Professor of Physics and Head of the Space Plasma Group at University College London (UCL) Department of Space and Climate Physics. He also has one sister, Frances Walsh who is an Oncology Research Nurse, in Warwickshire England. For the past twenty-years, Owen has played guitar and sung in various bands made up of fellow scientists and musicians.

  References[edit]
  ^ Jump up to: a b

• Amazon - https://www.amazon.com/Into-Gray-Zone-Neuroscientist-Explores/dp/1501135201

  About the Author
  Adrian Owen is currently the Canada Excellence Research Chair in Cognitive Neuroscience and imaging at The Brain and Mind Institute, Western University, Canada. He has spent the last twenty years pioneering breakthroughs in cognitive neuroscience. Among the media outlets that have featured Adrian’s research are The New York Times, The Wall Street Journal, The New Yorker, Nature, The Lancet, Science, and The New England Journal of Medicine. A resident of London, Ontario, he can be found at OwenLab.uwo.ca.

• The Globe and Mail - https://www.theglobeandmail.com/life/health-and-fitness/health/neuroscientist-adrian-owen-recounts-his-decades-of-research-for-new-book/article35321685/

  Q&A
  Some unresponsive patients see, hear and comprehend more than previously thought
  Open this photo in gallery:Globe and Mail Update
  Twelve years after a car accident put an man in a vegetative state, Adrian Owen and other scientists prove his mind was still alert.

  ISTOCKPHOTO

  WENCY LEUNG
  PUBLISHED JUNE 15, 2017
  UPDATED JUNE 16, 2017
  Consider what makes you the person you are: your memories, your personality, your ability to think and feel. Now imagine losing your ability to make contact with the outside world.

  If others could no longer tell whether you were aware of yourself and your surroundings, would you still be you?

  Dr. Adrian Owen has devoted his research to reaching out to patients with serious brain damage who exist in a murky state of consciousness. He has been asked to test the consciousness of individuals such as Toronto patient Hassan Rasouli, whose case sparked a historic Supreme Court ruling on determining whether to withdraw life support; Oakville resident Juan Torres, whose astounding recovery from brain damage defied doctors' expectations; and even the late Israeli prime minister Ariel Sharon, who was incapacitated in his final years following a stroke.

  As Owen explains in his new book, Into The Gray Zone: A Neuroscientist Explores the Border Between Life and Death, an estimated 20 per cent of patients whom doctors typically regard as vegetative or non-responsive are more aware than they seem. They can see, hear and understand what's going on around them, but are unable to communicate with the outside world.

  If they could, what would they say? Owen, who is a Canadian Excellence Research Chair in cognitive neuroscience and imaging based at the University of Western Ontario's Brain and Mind Institute, has been trying to find out.

  Excerpt: In Adrian Owen's new book, grey-zone science is pushed to the next level

  Related: What makes a life worth living? The debate behind continuing life support

  Twenty years ago, the British neuroscientist was stunned to discover that the brain scans of a patient, who was presumed in a vegetative state, showed her brain responded to photos of familiar faces.

  The discovery led him to develop techniques – using brain-scanning technology – to determine whether patients are conscious, and eventually to communicate with some of them who are.

  Owen has encountered his share of skepticism, including from colleagues who have questioned his findings. As Owen mentions in the book, the director of the Applied Psychology Unit of the Medical Research Council at Cambridge, where he was previously based, was less optimistic of the results of an early experiment that indicated brain response from a vegetative-state patient, telling him: "It could just be an automatic response."

  Other scientists wrote an article in the Lancet in 2013, expressing their concerns about the validity of one of his team's studies, which used electroencephalography (EEG) to detect awareness in patients.

  Owen says this kind of scrutiny is all part of the scientific process.

  "When you publish a new technique in neuroscience – especially one that involves complex mathematics and computing – it is inevitable that some people will either not completely understand the methods, or think that they have a better way of doing the same thing," he says.

  If he can bring his research into clinical practice, his findings could have significant implications for the diagnosis and care of severely brain-damaged patients. Yet, in an interview with the Globe, Owen explains he and his fellow researchers still have a long way to go to fully understanding the grey zone and they're still refining the technology for communicating with those trapped there. But for those with whom he has made contact, having others know they're aware has given them back their sense of "personhood," he says.

  What is the difference between being in a vegetative state, being in a coma and being locked-in?

  A person in a coma really looks like they're asleep. They have closed eyes, they don't have sleeping and waking cycles, and they very rarely move at all. That's typically the first thing that happens to you after you have a serious brain injury. A coma will rarely last more than a couple of weeks.

  After that, some people emerge into a vegetative state, and this is a condition where, now, patients have their eyes open. They look around the room, though not at anything in particular. They'll have sleeping and waking cycles. They'll do spontaneous things such as grunt and snore when they're asleep. And you can exist in that stage for decades. They never respond to any form of external stimulation, which is true of both coma and vegetative state. And that's the basis upon which we've always believed these patients aren't aware.

  Locked-in syndrome is less often confused with the other two. It's a situation where a patient is cognitively fine, but they've physically lost all movement to their body or typically they can just retain eye movement or eyebrow movement. Famously, some patients have been able to use that to communicate with the outside world.

  So what does it mean to be in the 'grey zone'?

  Some patients who appear to be in a vegetative state – and by that I mean using every clinical tool our best neurologists have available to them, they will make no responses – are actually mentally conscious. They can hear, they can see, but are nevertheless not able to make any responses to the outside world. In a functional sense, they are "locked in" inside their heads, but they don't have locked-in syndrome.

  The reason I use the term "grey zone" is there is no clinical name. We have no title we can give these patients. This is a population of patients who have always existed, but we only discovered them in 2006.

  You predict 20 per cent of unresponsive patients are in this grey zone. What can you say about the other 80 per cent?

  There are two ways of answering that question. One of them is just drawing on parsimony and saying, as far as we know, they are what they appear to be. That is, they are in a vegetative state. Their brain is just operating on autopilot. They breathe, they swallow, they blink, but they have no awareness of who they are.

  The other answer I can give you is that perhaps some of them are not in that situation. Until 10 years ago, we thought 100 per cent of vegetative patients were exactly as I described, completely unaware. And now we know that's not true for at least 20 per cent. Scientifically, there are very good reasons that number could go higher.

  I don't for a minute want to suggest all patients are aware or all patients are conscious; the effects of very severe brain damage are devastating. But it's certainly possible some of them have a level of awareness that we don't yet understand.

  With your first patient, Kate, you discovered she was able to recognize photos of familiar faces. How did seeing her brain activity in the scanner affect her quality of life?

  It was 20 years ago this year that we scanned Kate. At the time, people thought we were absolutely bonkers for putting patients like Kate in scanners because this is very expensive technology. People thought, there's no point. You're going to see no brain activity.

  So it was an enormous surprise to find that when we showed her a picture of a face that was familiar to her, the part of the brain we know is involved in facial recognition lit up. This changed the way people thought about Kate, [who eventually regained the ability to speak] and people certainly started to treat her very differently immediately afterward. As she said to me many times since, "At that point, I went from being a body to being a person again."

  At what point did you feel sure the brain signals you were picking up weren't just coincidental?

  From the very beginning. By the time I put Kate in the scanner, I'd had almost 10 years of experience running brain-imaging studies. So this wasn't something we just stumbled upon. By then, I understood a lot about what would and what would not activate the brain.

  It literally worked like this: I pointed at an area of the brain and said, "If she can recognize faces, that area of the brain is going to light up." And that is exactly what happened. It's just not the type of thing that happens by scientific chance. We then did it on a second patient, and it happened again. So you very quickly build up a level of confidence.

  What I think we were less sure about was what exactly those signals meant. It was about 10 years before we could point to a patient like Kate and say, "That person is definitely conscious."

  Can you explain how you were able to communicate with patients in the grey zone by asking them to imagine different scenarios?

  If you were able to raise and lower your arm on demand, it wouldn't take me very long for me to decide you were conscious. You obviously understand the instructions you've been given, and you're generating an action based on those instructions. That's exactly what we were doing with patients, but the actions they were producing were brain actions versus bodily actions.

  It's a huge scientific step, but a very small theoretical one to turn that into a method of communication, where we basically asked someone questions. We'd say, "If the answer is 'yes,' imagine playing tennis. If the answer is 'no,' imagine moving around your house."

  In the very early studies, we would ask people questions we knew the answers to. So we'd say things like, "Is your name Adrian?" And if the tennis-playing area of the brain lit up, the area involved in motor imagery, we knew they were saying "yes," which meant not only were they communicating with us, they also know their name is Adrian. And then, we'd say, "Okay, is your name Paul?" In that case, the spatial navigation area of the brain would light up and then we would know they were saying "no."

  This method is obviously restricted to "yes" or "no" questions, because they could only do these two things. But it very quickly became like the parlour game 20 Questions, and you can learn an awful lot about people. We moved onto things like, "Are you happy?" and "Are you in pain?" and in one case, "Do you want to continue living like this?"

  In the book, you were apprehensive about asking whether a patient was in pain. How come?

  Well, it terrified me, to be honest. It was the first time we'd really asked a question where I knew we could have an enormous impact on a patient's life. Until then, it had been questions to verify communication, like, "Do you know what year it is? Do you know where you are?" They were more practical nuts-and-bolts questions about how much the patient knew about who they were and their predicament.

  For 12 years, [a patient named] Scott had been supposedly in a vegetative state at that point. The idea, for me, that he could have been in pain that entire time and we knew nothing about it, it's terrifying. I think that does start to touch on what many people think of as a fate worse than death.

  Ultimately, in your own research, what do you hope to achieve?

  One of the things most of these patients complain about, they don't tend to recover and say, "I really missed seeing my children grow up." They say, "I really missed the sense of control. Every single decision was made for me. Every single light switch that was turned on, every time I was fed, every time the TV channel was changed, that decision was made for me. I had no control of my life."

  The goal I've really been pursing in 20 years is to try to return some autonomy and decision-making to patients wherever possible. I see family members making incredibly hard decisions about whether to, for example, withdraw life support in the neurointensive health unit. Given that we now know there are patients who we used to think were incapable of making those decisions, who may well be capable and may well want to make that decision, what I'm trying to do is develop technologies and use neuroscience to try wherever possible to give that voice back to these patients.

  This interview has been condensed and edited.

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• Global News - https://globalnews.ca/news/3549218/western-neuroscience-professor-publishes-book-on-border-between-life-and-death/

  HEALTH
  June 22, 2017 4:23 pm Updated: June 22, 2017 4:34 pm
  Western neuroscience professor publishes book on “border between life and death”
  980 CFPL
  By Andrew Lawton
  Host AM980

  more
  Prof. Adrian Owen's "Into the Gray Zone" documents 20 years of research into how patients once believed to be in vegetative states are actually more alert than once realized.
  Prof. Adrian Owen's "Into the Gray Zone" documents 20 years of research into how patients once believed to be in vegetative states are actually more alert than once realized.

  Supplied / Simon and Schuster
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  When neuroscientist Adrian Owen looked at the brain scan of his first patient 20 years ago, a woman by the name of Kate, what he saw changed the way doctors viewed the non-responsive.

  When Owen showed Kate, who was believed to be in a vegetative state, photos of familiar faces, her brain lit up on a functional magnetic resonance imaging (fMRI) scanner.

  The patient was part of a group so relatively new that it didn’t even have a name. It still doesn’t, but Owen has coined it the “gray zone”— an estimated 20 per cent of patients believed to be in vegetative states who are actually able to process — and even communicate — information in their own brains.

  After 20 years of research, Owen has written a new book marketed for a general audience, rather than academic journals, entitled Into the Gray Zone: A neuroscientist explores the border between life and death.

  READ MORE: Newmarket program enhances quality of life after stroke, head injury or brain illness

  Owen, who was born in the United Kingdom, is currently the Canada Excellence Research Chair in Cognitive Neuroscience and Imaging at Western University’s Brain and Mind Institute in London, Ont., a position he’s held since receiving a $10-million grant in 2010.

  The implications of Owen’s work have transcended the boundary between the medical and legal world. If vegetative patients can actually communicate through technology, what does that mean for patient care decisions like withdrawal of life support or even euthanasia?

  Into the Gray Zone does address these ethical and legal questions, as well as some that are philosophical, such as whether consciousness can survive the loss of the body that houses it.

  Speaking to AM980 Thursday afternoon, Owen said he wanted tell a different side of the story he’d been presenting through academic research over the course of his career.

  READ MORE: Canadian-based researcher to share ‘Nobel of neuroscience’ Brain Prize

  “I sort of came to the point where I’d be writing scientific papers about our discoveries in patients who were comatose or in a vegetative state for 20 years, and I came to the conclusion that it really was about time we wrote a few of the patients’ stories and tried to give some perspective from the patients themselves and their families, and to try to give an idea of what it’s like to be in this situation,” he said.

  Owen said that it’s impossible to understand what could have happened in past cases had the technology and method driving his research been used, but he is optimistic about the future, noting how relatively new this all is in the field of science. Before he started researching what he now calls the gray zone, there would be no way to even identify patients he says are in it.

  “It hasn’t been discovered because we simply didn’t have the technology,” Owen said. “Something like fMRI technology was only invented not much more than 20 years ago in the early 1990s. Prior to that, we really would have no way of knowing that these patients are there. It’s really taken the 20 years since we established these techniques to learn how to use them to tackle these really difficult clinical problems.”

  Owen’s research is extensive, but by no means exhaustive. Moving forward, he says he’d like to apply the techniques to patients immediately after brain injuries rather than months, years or decades later.

  READ MORE: ‘We can basically consider ourselves a world leader’: Researcher excited by Lethbridge’s new neuroscience lab

  “What we’re really interested in doing now is saying, ‘Can we apply some of these techniques in the first few days after a brain injury when somebody comes out of a serious car accident and they’re still in the intensive care unit?'” Owen said. “Can we put those patients into a scanner? Because, to be honest, that’s where decisions are really being made about whether people should live or die, whether life support should be withdrawn…. I’ve got very high hopes that some of our techniques are going to yield dividends there and are going to prove to be useful.”

• CBC Radio - http://www.cbc.ca/radio/thecurrent/the-current-for-june-21-2017-1.4169386/june-21-2017-full-episode-transcript-1.4171796#segment2

  Wednesday June 21, 2017
  June 21,2017 Full episode Transcript

  MORE STORIES FROM THIS EPISODE
  What do women want? Sex researcher explores mysteries of female desire
  'It's still amazing to me': Neuroscientist on connecting with patients in vegetative states
  The National's Peter Mansbridge signing off for final time on Canada Day
  June 21,2017 Full episode Transcript
  FULL EPISODE
  Note: Transcripts may contain errors. If you wish to re-use all, or part of, a transcript, please contact CBC for permission. Please check the corresponding audio before quoting in print. Copyright © CBC 2016

  PRINT TRANSCRIPT
  The Current Transcript for June 21, 2017
  Host: Anna Maria Tremonti
  STORIES FROM THIS EPISODE
  Transcript: Prologue
  Transcript: The National's Peter Mansbridge signing off for final time on Canada Day
  Transcript: 'It's still amazing to me': Neuroscientist on connecting with patients in vegetative states
  Transcript: What do women want? Sex researcher explores mysteries of female desire
  LISTEN TO THE FULL EPISODE
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  Full Episode for June 21, 2017 - The Current
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  Prologue
  [Music: Theme]

  SOUNDCLIP

  [Music]

  Where it's happening an assignment actuality.

  Transportation in Canada's north is about to be revolutionized. Peter Mansbridge talks to Manitoba highways Minister Joe Borowski about it.

  ANNA MARIA TREMONTI: It was the late 60s when he took a job that no one else seemed to want. Covering news on the fly in northern Manitoba. But it would set Peter Mansbridge on a career path full of breaking stories, cut throat federal politics and major world events. And when the Americans tried to lure him south, the CBC offered a job he couldn't refuse, chief correspondent and anchor of The National. Behind the scenes he was steering journalistic choices in front of the camera even in disaster, he's been unflappable. And now after almost 30 years at the National he's signing off. In a moment, Peter Mansbridge on what has changed and what remains. Also today.

  SOUNDCLIP

  [Woman screaming] Yes. Yes. Yes. Oh. Oh. Oh. Oh God. Oh.

  VOICE 1: I will have what she is having.

  AMT: I'll have what she's having. When Meg Ryan's character faked an orgasm in a diner that scene became part of filmic lore but perhaps she was ahead of her time on the issue of what women feel. Today our project The Disrupters looks at research that's challenging the assumptions about female sexual desire and arousal, will tell you more in an hour. And then he was in a vegetative state unresponsive unable to comprehend. And then he recovered.

  SOUNDCLIP

  He could describe going into a scanner he could identify the people that had been present on that day. Could describe what we asked him to do in the scanner. It actually was a real wakeup call for me.

  AMT: Adrian Owens work tracking the brain activity of vegetative patients has implications that are promising and frightening and profound. Hear him in half an hour. I'm Anna Maria Tremonti. This is The Current.

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  The National's Peter Mansbridge signing off for final time on Canada Day
  Guest: Peter Mansbridge

  The Current
  The National's Peter Mansbridge signing off for final time on Canada Day
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  SOUNDCLIP

  [Music: The National]

  The National with Peter Mansbridge.

  Good evening. It was John Turner who wielded the knife today. Turner who faced a revolt over his leadership last week today fired a senator who was closely tied to it. Senator Pietro Rizzuto though is no longer the co-chair of the party's campaign committee.

  AMT: Well that's how it began. May 2nd 1988 Peter Mansbridge introduced a story about John Turner and introduced himself as the new anchor of CBC television's flagship news program, The National. Now nearly 30 years later Peter is set to retire his final program will be on July 1st, the country's 150th birthday, appropriate considering he's a known history buff. He has traveled the world and given voice to the biggest stories the country and the world has seen. And Peter's here with me today to talk about his decades with the CBC, his time in the field and as anchor of The National and also to reflect on the future of journalism. Peter Mansbridge Welcome.

  PETER MANSBRIDGE: Welcome. It is very kind of you would. Do we have time to discuss all those things you just listed? [Laughs]

  AMT: [Laughs] As much as we can get through. That first night, you must remember that.

  PETER MANSBRIDGE: I've been doing The National at that point on weekends and filling in for Knowlton on occasion since 1982 but it was still, it was a big deal. Suddenly you know it was kind of my chair and my responsibility. And I was accountable for the things that happened on the program. And so it was it was a big night.

  AMT: The other thing is that many people might not remember CBS wanted you and CBC wanted you to stay.

  PETER MANSBRIDGE: Right.

  AMT: And you became the anchor.

  PETER MANSBRIDGE: At that point I was I was working Sundays, I was working the weekends and there was no sense that Knowlton was going anywhere. We never even discussed it. And it was, you know, it was a fascinating offer and it was because it was CBS and the states and New York it was quite a bit of money. And then Knowlton sort of got in the way called me over to his place and he said you know I've been writing books I've got a couple more to write. I want to spend more time on the books. I will Move aside if you want to move into this job. And that's how it happened.

  AMT: Well let's talk about that because for every ending there is a beginning and we had the CBC archives look for some of the earliest tape that have the reporting, and this is well we edited it a bit. Let's listen to this.

  SOUNDCLIP

  [Music]

  Assignment.

  Where it is happening, an assignment actuality.

  VOICE 1: Transportation in Canada's north is about today revolutionized. Peter Mansbridge talks to the Manitoba highways Minister Joe Borowski about it.

  JOE BOROWSKI: A concept we're dealing with is that to have a hovercraft you operate year round, like a bus to transport people and goods over land, which would require clearing of bush, say 100 foot, right of way and using the hovercraft to transport people and goods to isolated communities where it's not possible, economically possible to build roads.

  PETER MANSBRIDGE: Now how far is this being explored? Have you actually talked with the hovercraft companies about this?

  JOE BOROWSKI: Yes I have talk to them, I have met with him, I have even tested some out a little to see the type which are not the type of machines we have in mind at all.

  AMT: There you go, Peter Mansbridge. I think that's from 1970. You know I listen to that we actually did a hovercraft story about the North on The Current last year. They're still talking about it.

  PETER MANSBRIDGE: Yes. They are still talking about it.

  AMT: And you did begin your career at CBC Radio.

  PETER MANSBRIDGE: I did CBC northern service. Churchill was CHFC and for Churchill was the station and it linked with Yellowknife and what we called Frobisher Bay at that time, McAlary to New Vic in Goose Bay, Happy Valley, Goose Bay, Labrador. And that was kind of the beginning of almost a northern news service.

  AMT: It's interesting because in the north and the high Arctic CBC still has more journalists than any other news organization.

  PETER MANSBRIDGE: And great stories to cover. You know I was the lone guy in Churchill they didn't have a newscast when I got there and I wanted to start one because I felt more interest in doing news than in doing music which I was terrible at. So we started, I actually started a newscast. But Churchill is this great community where there were all kinds of stories. We all know about the polar bears but there was a port that was open for a couple of months or years. So there was trade with the Soviet Union at the time lot of grain went out of Churchill. There was a rocket range at the at Fort Churchill, Canada's only rocket range sending a black Brant rockets into the northern lights. So there were all kinds of possibilities for stories. None of them were getting out. That's how I made my name for myself, by feeding items to Winnipeg and to Toronto with CBC Radio.

  AMT: Never went to journalism school?

  PETER MANSBRIDGE: Never went to journalism school.

  AMT: Didn't do an internship?

  PETER MANSBRIDGE: No, I didn't finish high school, didn't go to university. Not proud of that fact, but those are the facts and it says something about how things were in 1968 when I was hired, that first year In Churchill. It was they couldn't get anybody to go there. And the guy literally heard my voice announcing a flight in the terminal building. I was you know 19 years old loading bags for Transair, some flight to Thomson upon Winnipeg and he heard my voice he came up to me right there in the terminal building and he said: “Hey you got a good voice, ever thought about radio?”. I said: “No I've never thought about radio.” And he said: “Well I've got a job, you want to start tomorrow night?”. Went in there and had five minutes to explain how the controls worked and bingo I was on the air.

  AMT: Wow. It is amazing, huh?

  PETER MANSBRIDGE: And I fell for it immediately loved the whole idea of broadcasts.

  AMT: You were in the north you also worked in Saskatchewan for a while later on in the CBC.

  PETER MANSBRIDGE: Yeah. Started in Churchill moved to Winnipeg, in the local news room and that's when I started into that evil platform known as television. And we did kind of both radio and TV. I was there until 75 then moved to Regina as The National reporter. So I was reporting for The National out of region covering the whole province so it was in Saskatoon, Prince Albert, Regina quite a bit. For a year, went with Allan Blakeney to China at a time it was still a big deal to go to China. He got in for three weeks. Mao was still alive and all these exciting things to happen on that trip. But as it turned out Mao was dying. We didn't know that at the time. They canceled all the meetings. Once Blakeney got there and instead put us on a tour of China on an old steam train and it was fantastic. You know it was like this great experience.

  AMT: You had to tell the real story, a great story.

  PETER MANSBRIDGE: Absolutely.

  AMT: It's interesting because you really I mean, one of the things about journalism is you get to see the world you get to see your own country too. You've got to understand more parts of Canada just by living and traveling and reporting, huh?

  PETER MANSBRIDGE: Yes. Yes. You couldn't you couldn't buy the experiences that I've had and travel, all over this country, to almost every community, meeting all kinds of people and traveling the world. And as you know from somebody who's done a lot more international travel than I have and usually in the hotspots when you were when you were there, but you also learn more about your country when you're doing that.

  AMT: Yeah.

  PETER MANSBRIDGE: You know when you hear from others about their perceptions of Canada it opens your eyes about the country you live in. You learn things about yourself you didn't know.

  AMT: It's very true. How do you think CBC News has changed in those decades since you were that kid in Churchill?

  PETER MANSBRIDGE: Well we were using black and white film and that is how long ago it was. And so there have been lots of changes in terms of the technology of the business and I've watched all that happen and tried to make the judgment about whether it was good or not for journalism, as things got more and more, you know things got faster and the demands on journalists increased tremendously. I mean even when you were reporting as a foreign correspondent you were kind of focused on one, at most, two platforms right?

  AMT: That's right and no one could find me because the cell phone coverage wasn't very good, if it ever existed at all.

  PETER MANSBRIDGE: Is that why we couldn't find it? [Laughs]

  AMT: Yes. That is why you could not find me. [Laughs] That is my story, yes.

  PETER MANSBRIDGE: But now, you know you watch Nahlah or Margaret Evans or you know Adrian or Susan or any of these correspondents, great correspondents. When the story is happening in their region they don't have a minute off in the day they're filing for some platform all the time.

  AMT: That's right and they're available, they're accessible through a phone or even through video automatically.

  PETER MANSBRIDGE: Exactly.

  AMT: That technology has been rapid.

  PETER MANSBRIDGE: It has. You know and when you're talking about corresponds with that caliber you know you're getting 100 percent journalism.

  AMT: Well you know there's a lot of humanity in stories and there's a lot of politics, but sometimes those two things collide and events that happen you know the world won't be the same. And so I got some more tape of you. This is a bit of tape from September 11th 2001.

  SOUNDCLIP

  That's some of the old video from New York, just in the last couple of hours. This now looking back live at the island of Manhattan where it is still just total devastation and chaos all over that end of the of Manhattan. We should also advise you that there is now a major Canadian angle to this story because all air traffic from New York and Washington and all transatlantic flights heading in that direction has been diverted to Canada.

  AMT: Okay. Early times in that day. Tell me about that day at CBC News, Peter, 9/11?

  PETER MANSBRIDGE: It was a tough day. I mean we knew thousands of people had died. We weren't aware exactly why it happened in those early hours, but we saw it happen which is unusual. Usually you are dealing with reports that something happened and but here we actually saw the planes going into the building. As the day wore on, and I think I was on for like 44 hours straight with an hour break in the middle of the first night, and what I hadn't grasped was the impact it was having on everyone, not just the people in New York but people you know in cities and communities right across Canada. And I didn't realize that until I took that our break and I went to my dressing room and the light was blinking the message light on my phone and it was my daughter. One of my daughters in Winnipeg and. Her message was pretty simple it was I love you and I thought well that's nice. But why did she choose that and then that's when the light went on.

  AMT: That everybody watching was affected.

  PETER MANSBRIDGE: Exactly. This was happening with families all over the world. They wanted to just touch base with other members of their family, because they all knew that they were going through something that they'd never gone through before and hopefully never would again. But it was having an enormous impact. So that changed my kind of reporting and in what became the second day of all this was the impact it was having not just on those who were directly affected in New York but all over.

  AMT: It was incredible because it really was unfolding in real time the towers collapse and everything just keeps happening. It was not anywhere near to a static story.

  PETER MANSBRIDGE: Parliament Hill shootings, was the same thing.

  AMT: Well parliament house shootings. We have a clip from that as well October 22nd 2014. Listen to this.

  SOUNDCLIP

  It is the kind of day Canadians had only ever really known from afar. A chaotic and frightening attack on the heart of their country, rRight on Parliament Hill. Another Canadian soldier the second this week was ambushed and killed. The attack then moved inside parliament. Bullets flew. People fled. Buildings were locked down. Police say the attack caught them entirely by surprise. They had no advance warning.

  AMT: That sounds like it was probably closer to the end of the day you're talking there.

  PETER MANSBRIDGE: I think that probably the National I totally go scripted.

  AMT: Because you were you were there live. You're always unflappable live. You are, yeah I know, I have to say. In the English, in the language of broadcasting I've never seen anyone do live the way you do live, and have I've seen you do live a lot.

  PETER MANSBRIDGE: You know I trust the people around me to. You know, that day I was out, so I was having a breakfast. I was having breakfast with a source on a story and my phone went off and bang I came in here. Breakfast was downtown, so I was able to get here 10 minutes and was on the air but I was put in the position of working with people I'd never worked with before. A director and a producer from news network who worked the morning shift. And I could tell, you what this was like and your listeners probably don't. But when we were sitting here we're talking on the air there's often somebody talking to us through our headsets. And if that person isn't calm, especially in a difficult situation boy things can go wrong fast. These people were fantastic and I could tell even though I didn't know them that within 30 seconds I can trust this person. And so that's how I was getting all of the information and I added my own cautionary warnings about being careful about what to believe because the story is going to change. If you know one thing for sure it's going to change even when you're getting it from authorities not rumors. I mean the Ottawa police that they were convinced there was a second shooter and they said that.

  AMT: That is right. That is right.

  PETER MANSBRIDGE: So they were going into the Rideau center across the from the Chateau Laurier. It turned out there wasn't, It was one guy.

  AMT: The National aired several hours after the shooter was dead on that day and the threat had passed. But that really raises the key role of the National. What is like the role of The National in the hours after a major traumatic event, when it goes to air?

  PETER MANSBRIDGE: Well the National has always been through my lifetime the program of record on CBC Television, for what happened on that day. That you may not have heard anything all day or seen anything all day or read anything all day, but at 10:00 at night when you get there you're going to be told what you need to know about what happened on that day. Or even if you heard things. This will be the program of record that will tell you the truth as best we know. Now we're in an era where most people because of their access to information are getting information all day long. They can't get away from sitting there on their phone in their hand. You know, whether they're at work or at school or wherever they may be. And so at 10:00 at night the argument becomes do you still need a program of record? Or are you moving forward? Are you advancing? That's a debate that's going on right now around The National.

  AMT: We talked about the technology but what do you think of the changes in this business as you move away from the National? What concerns you about the changes in journalism that you see or what excites you?

  PETER MANSBRIDGE: Look at the end of the day the best, in my view the best journalism and journalists are those who tell stories well. And no matter the technology and the advances that we have and the way we can collect information, at the end of the day somebody's got to tell a story.

  AMT: I can't let you leave without talking about CBC. What do you think of the future of the CBC?

  PETER MANSBRIDGE: The future of the CBC is in two sets of hands, the people of Canada and those of us who work here and the kind of work we do. The people of Canada have consistently said they believe, this was consistent across the country, that they believe in the need for a national public broadcaster especially at a time when the influence continues so strongly from south of the border, with you know excellent programming but it leaves a vacuum for us to fill. Because somewhere on that dial you need Canadian content, whether it's online, radio, television, you need it if you want to understand the country live in. Now you can argue about how well we do that. And some people make very strong arguments they don't think we do a good enough job, that's a separate argument as to whether or not there should be a CBC. And so I you know I think that as long as we have that support of the people then there will be a CBC.

  AMT: Going to miss it?

  PETER MANSBRIDGE: Oh yes. [Laughs] Yes, and the closer it gets we're now down to minutes, the more I realize how much I will miss it. I will miss the comradery and the friendship most. I mean I love to travel, the places I've been to the stories I've covered, but the opportunity to work with the people I've worked with, including you, all these many years although you're just still a kid compared with me. But you know the opportunities we've had, right? Places we’ve been, people we've met, people we've interviewed talked to, it's been such a treat.

  AMT: What's next for you?

  PETER MANSBRIDGE: The CBC wants me to stay. You know I am retiring. I will go on a pension you know. But I will still be a freelance broadcaster of some kind. And the CBC wants me to consider doing some prime time documentaries on subjects that interest me and I'm fascinated by that possibility and hopefully we'll work something out. But initially certainly this summer I'm just going to enjoy some free time.

  AMT: But you'll never stop telling stories?

  PETER MANSBRIDGE: I hope not.

  AMT: Peter, thank you.

  PETER MANSBRIDGE: Thanks, Anna Maria.

  AMT: Peter Mansbridge, chief correspondent for CBC News anchor of CBC TV's The National, with me in our Toronto studio. The CBC News is next and then patients in a vegetative state were once thought to be totally brain dead. It turns out up to 20 percent have some awareness of their surroundings.

  SOUNDCLIP

  They are awake but they appear to be entirely unaware of where they are, who they are and the situation that they're in.

  AMT: A neuroscientist developing ways to communicate with unresponsive patients. You want to hear what he's discovered? When we return. I'm Anna Maria Tremonti. This is The Current.

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  'It's still amazing to me': Neuroscientist on connecting with patients in vegetative states
  Guest: Adrian Owen

  The Current
  'It's still amazing to me': Neuroscientist on connecting with patients in vegetative states
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  AMT: Hello I'm Anna Maria Tremonti and you're listening to The Current.

  [Music: Theme]

  AMT: Still to come, rethinking female desire.

  SOUNDCLIP

  People had these spontaneous feelings of desire. They were like lightning bolts that zapped you out of nowhere. And that that initiated a process of seeking out sex.

  AMT: For years women's sexuality has been oversimplified, misunderstood and compared to men's. Meredith Chivers researches disrupting those long held assumptions. We'll talk about her work in half an hour. But first they're awake, they're aware but they cannot communicate what's actually happening inside their brains.

  SOUNDCLIP

  [Sound: Noisy crowd]

  REPORTER: Inside a Florida hospice. A woman lives quietly dying.

  VOICE 1: Father we come in the name of our Lord…

  REPORTER: and then in doing so he has forced even wider the moral cracks that already divide her country.

  AMT: The case of Terri Schiavo was the first time a person's consciousness or lack of consciousness was debated so publicly. The Florida woman suffered brain damage in 1990. She was left in a so-called vegetative state. Her husband thought she should be allowed to die. Her family wanted to keep her alive. And after 15 years of court cases and political debates, her feeding tubes were removed in 2005. Terri Schiavo died a few weeks after that. The question of what constitutes consciousness is something with which scientists have been grappling for years. And one of the people at the leading edge of that research is Adrian Owen. He's the Canada Excellence Research Chair in Cognitive Neuroscience and imaging at the Brain and Mind Institute at Western University in London, Ontario. He has just written a book Called Into The Gray Zone: A Neuroscientist Explores The Border Between Life And Death. And Adrian Owen is with me in our Toronto studio. Hello.

  ADRIAN OWEN: Hello, there.

  AMT: How important was that case of Terri Schiavo?

  ADRIAN OWEN: I think it was very important because I think it first brought attention to it to these conditions and people really started to wake up to the fact that they existed at all.

  AMT: How do you define the gray zone?

  ADRIAN OWEN: I think there are many different types of gray zone states. what I'm referring to in the book is really anywhere between brain death and that is a condition in which there's no way back it's irreversible and where most of us are enjoying our normal lives. I'm particularly focused on states like the one that Terri Schiavo was in, the vegetative state because I think this is a very intriguing Condition, right there somewhere in the middle.

  AMT: And when we say someone is in a vegetative state what does that actually mean?

  ADRIAN OWEN: It's often referred to as a state of wakefulness without awareness. And that's because these patients will open their eyes. They may appear to look around the room. They won't fixate on anything in particular. But the most important characteristic is that they'll never respond to any form of external stimulation. So if you try and attract their attention or get them to wiggle a finger or move a leg they won't make any responses. So they are awake but they appear to be entirely unaware of where they are, who they are and the situation that they're in.

  AMT: And this is different from someone in a coma?

  ADRIAN OWEN: That's right. Coma often occurs before the vegetative state. And a coma patient will typically look as though they're asleep. They'll have eyes closed and they won't wake up and go to sleep.

  AMT: How many people are living in a vegetative state right now?

  ADRIAN OWEN: It's a very difficult question to answer because there aren't any central records. There are many different ways that you can get into a vegetative state. It could be a traumatic brain injury or it could be something like a heart attack that is led to a loss of oxygen to your brain. And that means that the patients are very widely spread among different clinical units. Often they will survive for many decades and will be looked after at home or in hospices so because there are no central records it's very hard to put a number on it. We know there are many tens of thousands around the world but to really know exactly how many. It's impossible.

  AMT: How did you start trying to connect with people in a vegetative state?

  ADRIAN OWEN: Almost 20 years ago to the day, we first put a patient who is in a vegetative state into a brain scan and this is back in Cambridge in the U.K. And to be really honest I don't think any of us knew exactly what we were doing. This was really quite an odd thing to do at the time because up and up until that point, everybody assumed that none of these patients would have any residual brain activity. So I think the assumption was that we would see nothing.

  AMT: And this is a woman called Kate?

  ADRIAN OWEN: That's right. And Kate we put Kate into a PET scan. That's what we used to use in those days and we showed her pictures of faces of friends and family. And what was astonishing at the time was that the parts of her brain that we know are responsible for recognizing faces lit up exactly as they would in a healthy awake person. But at that point Kate looked to be in entirely vegetative in and entirely non responsive.

  AMT: And you discovered that she was fully conscious.

  ADRIAN OWEN: Actually, it was many years before we could really look back and understand what that meant. It required that we develop many other techniques. We moved on to use another form of brain scanning known as FMRI or functional magnetic resonance imaging. We scanned many different vegetative patients trying to explore a way of actually getting into their heads if you'd like to try and understand what these residual signs of brain activity really meant.

  AMT: So how did you use the FMRI to test for consciousness?

  ADRIAN OWEN: Well, it was a real turning point in the story I think and that was back in 2006. We realize that you're simply doing things to patients in the scanner like showing them faces wasn't going to so the really big question; Were they conscious? Was there any definitive evidence of consciousness? So we put together what I mean I think it seems like quite a strange experiment but we decided to ask the patient to imagine that she was playing tennis in the scanner. And the idea here was to try and activate the parts of the brain that we know are involved in moving your arms around. And we knew that if she did that it would indicate that she understood the instruction that we were giving her and that she could generate this sort of mental imagery in her head. And that's what we were really looking for. We were looking for a response that couldn't just happen automatically with something that the patient would have to want to do. And you know we got very lucky the first patient we tried this on responded exactly as we had hoped.

  AMT: Because you were looking for something… even if you don't know how to play tennis you know what tennis looks like so you can imagine it, right? You needed something that was almost universal.

  ADRIAN OWEN: Yeah it's actually it's a surprisingly reliable response. I sort of think of it as being analogous to asking your patient to raise their left arm. Everybody even if you haven't played tennis, you know that it involves waving your arms around with a tennis racket. And that's essentially all we were trying to get the patient to imagine doing. And it's worked many times successfully since people actually find the surprisingly easy to do in the scanner.

  AMT: So you have them imagine that they were playing tennis and what did you see?

  ADRIAN OWEN: We saw activity in a part of the brain known as the premotor cortex, and that's the part of the brain that is not only involved in imagining movements but in setting up sequences of movements. And because she produced that activity because her premotor cortex lit up, when we said imagine playing tennis and then the activity went away when we said okay, now stop, just relax. We could tell that she was making responses very much as though we'd said to her you know raise your arm now put your arm down now. It was it was the analogous situation. She was responding except with her brain rather than with her body.

  AMT: You also would ask her to walk through her own home.

  ADRIAN OWEN: Yes well I think it was very important to establish that she could do more than one thing. I mean there's always an element of chance in these things and we wanted to be absolutely sure that she was really responding. So we had a second task in there we said well, imagine walking from room to room in your home. Because again we know the areas of the brain that are involved in what we call spatial navigation, finding your way from one place to another in a familiar environment. And there are different areas. Now this is not the premotor cortex the areas the brain that are quite far away from that. And by getting it to do these two different things and systematically activating one area of her brain and then a different area of the brain, we could be absolutely sure that she really was in there understanding what we were asking her to do and producing these really quite complicated patterns of brain activity.

  AMT: And then you took it further to actually communicate with patients. Tell us about Scott.

  ADRIAN OWEN: Scott was a patient here in Canada. He was a local patient in London, Ontario. And Scott had been supposedly in a vegetative state for about 12 years at the point that we'd seen him. When I first met him he was much like any of the other of the hundreds of patients we've seen over the years. He was entirely non-responsive. We couldn't get him to look this way or look that way or blink or move. He really did appear to be in a vegetative state.

  AMT: You started to use these methods of tennis and walking around the house to actually ask him questions. What did you do? What did you learn?

  ADRIAN OWEN: Of course the first thing to do was to find out if he was in there and that was the big breakthrough. Sure enough when we said imagine playing tennis is his premotor cortex lit up. And when we asked him to move around his house other areas of the brain lit up, so we knew he was there. And again we had FMRI at our disposal so his family very kindly allowed us to scan Scott on a number of occasions. And we said to him Well we want you to do now is we're going to ask you some questions and if the answer is yes imagine playing tennis and if the answer is no Imagine moving around your house, and this is so very simple but effective means of communicating with him.

  AMT: And so what did you find out?

  ADRIAN OWEN: We began with questions that were really designed to find out what he understood about his situation. So we asked him things like what year it was. Was it 2012 the year we scanned him or was it 1999 the year that he had his accident. And it was very clear from his responses that he knew exactly what year it was. You know he knew that he was Scott. He knew where he was that he was in a in a hospital he was being scanned in a in a research institute. And then we moved on to ask questions that we felt were important in trying to improve his quality of life because I think this is really at that point that was where we were pushing the research. We really wanted to try and make a difference to some of these patients. So I guess the most important question I think we asked Scott was whether he was in any pain, because I think most people can appreciate the idea that a patient may be not only conscious for a long period of time, in Scott's case more than a decade. But also perhaps in pain is really quite a horrific idea for all of us.

  AMT: You asked his mom if you can ask that question didn't you?

  ADRIAN OWEN: I did. I did. Yes.

  AMT: Was he in pain?

  ADRIAN OWEN: No. And I have to say I am enormously relieved that that was his answer on two occasions. We asked him the same question. On both occasions he said no that he wasn't in any physical pain.

  AMT: You know you're talking about this as if you were having a conversation with someone and but this was remarkable. You were able to tell through their reaction on an FMRI what they are thinking and that they are thinking.

  ADRIAN OWEN: Yeah. Well I've been doing this for many years now and I honestly I still you know I still find it astonishing that we're able to do this. And in many ways it's still amazing to me when we when we break through and made contact with a patient and we start to explore what it must be like to be in this situation. It's still amazing to me.

  AMT: Well in the case of Scott it changed his care right. Suddenly the caregivers were telling him their names. His mom would sit and talk to him as dad would like they understood that he could hear them. So it changed the way they reacted around him, did it not?

  ADRIAN OWEN: This actually happens very frequently in my experience. I mean Scott's case his family were always extremely attentive. And I don't think there was any question that for them it necessary change their behavior but certainly care staff and nursing staff. I often find that once they know that the patient is conscious they really start to behave in a very different way. In the book I went back to talk to Kate the first patient we'd ever scanned. And I asked her about this.

  AMT: Because she came out of her vegetative state.

  ADRIAN OWEN: That's right. And you know she was able to describe what it was like to be treated just as a body. She put it to then later on be treated like a person. And she said well you know I suddenly became a person again. And I think that's really very often the case that these people once we identify that they are actually in their own, they're aware and often they've been like this for many many years. It brings back a sense of a person a sense of somebody actually being real.

  AMT: What if someone told you they were miserable and wanted to die? What would you do?

  ADRIAN OWEN: I think that's a really important question and it's very difficult to answer because you know right now we don't really have an ethical framework in place for what we would do with that information. I mean it's a question that are often asked; why didn't you use this to it to ask patients whether they want to live or die? And I think you know until we really know what we would do with that that answer you know, I don't think asking the question is appropriate. I also think there's another factor you need to consider. You know we're really still at the stage of our asking yes no questions of these patients.

  AMT: Early days.

  ADRIAN OWEN: Exactly and if you really wanted to be absolutely sure that somebody you know did have a strong opinion about what they wanted to happen to them, you'd want to spend quite a lot of time making sure that this wasn't a temporary situation. Are they in a in a fit state to make that decision? And these are things that face to face are relatively easy to do compared to doing it via a brain activity response in an FMRI scanner.

  AMT: And it's not always fail proof what happened in the case of Won?

  ADRIAN OWEN: No Won is an amazing patient. Again this young man from here right here in Canada. His parents brought him to London to be scanned at western and then we scanned Won. We actually did everything we had. I mean this is just a couple of years ago when we had MRI scans and we had EEG scans and there was nothing that we could do to give us any information that Won was actually aware. And you know I sent him back to his home with nothing really to tell his parents. We had found nothing but a few months later, Laura my research coordinator called up here Won’s mother and said how's he doing? You know we like to follow up with all our patients to see if there's any change in his mother literally he said well why don't you ask him? And Won had made a really quite miraculous recovery. I mean he had recovered to an extent that I have never seen before in another patient. He had gone from being in a vegetative state and an entirely non-responsive in any of the situations that we put him into, being able to learn to walk again to go back to college to get back into many of the activities that the social that he previously had. But what was really remarkable about Won is that he was able to report the experience of coming to my lab many months earlier. He could describe going into the scanner he could identify the people that had been present on that day. He could describe what we asked him to do in the scanner. It actually was a real wake up call for me.

  AMT: How so? Because it doesn't really matter how many times we find these patients and even communicating via these yes no responses. There's always a sort of a distance. A distance where, we are connecting in a way and they are telling us a little bit about you know what it's like to be in a situation that the human connection is still not quite there because we're doing it through technology. We're communicating through technology and in Won’s case, it really hit home to me that he was there he was experiencing everything that we were experiencing on the day. He was listening to every conversation and he was remembering, it and he was reporting back to us what it felt like to be in that situation. And I think it made me realize really that you know these are people that have emotions and feelings and thoughts and we must never we must never forget that I think.

  AMT: And any explanations to why that there was no brain activity through the FMRI?

  ADRIAN OWEN: It's really impossible to know. It's often the case that a patient won't produce the activity that we're hoping for, and you know we try and get around that by scanning them on multiple occasions, because the patient sometimes they fall asleep in the scanner and they don't respond. In Won’s case we knew that he was awake because his eyes were open during the scan. It could possibly be that the parts of his brain that we needed to see activate when for example we asked him to imagine playing tennis, perhaps that part was damaged so he wasn't able to activate that part of your brain, even though as we know now he was perfectly conscious and aware at the time. You know sometimes these things can be deceiving and you know I've met many patients over the years who have clinically been written off as in a vegetative state only to find in fact the situation is quite the opposite.

  AMT: Well that's what I'm wondering. I mean you know what you're discovering is profound. We would you know as a society write off so many people and what you're discovering what it's 15 to 20 percent of people in vegetative states are conscious is that the percentage?

  ADRIAN OWEN: Yeah. I mean that percentage that's what the data says, now. We've conducted two studies of groups of patients and on both occasions is it between 15 and 20 percent. But you know bear in mind that by the time patients come to see us they typically been evaluated by clinical experts on you know on many occasions. And in a sense then, these are often the really difficult cases that people that really do seem to be in of it of it in a vegetative state. But you know out there in the world we know that the misdiagnosis rate is actually much higher. There are many studies in fact at least four studies have shown that up to 40 percent of patients are misdiagnosed. And by that I mean that these are patients who are assumed to be in a vegetative state but in fact when they are examined by clinical experts it becomes evident that they do have some residual awareness.

  AMT: I can't imagine I mean the idea that you're locked in and you are conscious and you can't let anyone know. Frightening.

  ADRIAN OWEN: Yeah. I mean I think that's really what's driven our research over the past 20 years is the idea that we can return some sort of autonomy to patients. Somebody asked me recently you know how many patients do you need to find this in for this to be worthwhile? And my also about one. You know I mean I think the idea is so shocking for most of us that you know if we'd only managed to do it once or twice I'd be happy. The fact that we've managed to do it on multiple occasions where it's 15 to 20 percent of patients I think is really very important.

  AMT: And you make the point that we are our brains that you know, it tells us what it means to be ourselves.

  ADRIAN OWEN: Yeah I mean I do think we are our brains. I mean we live in a world where it's possible to transplant many organs. You know we can have a kidney transplant, a heart transplant or a lung transplant but through any of those complex procedures we come out the other side the same person maybe you know a little bit altered by the experience. But fundamentally we are the same person. But you know imagine if we were to transplant a brain and that's not something that we can do. But imagine that we could you would absolutely be a different person. You'd have different memories, different personality, a different outlook, different perspective. And you know this is why I say in the book that really we are our brains. I mean that's one of the most important lessons that I've learned from neuroscience.

  AMT: You have a personal connection to a lot of this in your own life, a woman who ended up in a vegetative state?

  ADRIAN OWEN: Yeah I had. I mean the book begins by describing a former partner of mine some years after we had separated. I heard through mutual friends that she had had a brain aneurism, rupturing over an artery in her brain that had put her into a vegetative state. And this was actually about a year before I came across Kate. And I think that was the first the first experience, probably even the first time I'd heard the expression vegetative state. I mean this is this was prior to the Terri Schiavo case really you know opening this whole area up and I do wonder whether that is what pushed me in the direction of being interested in this situation. And a year later when Kate came along perhaps that's what really made me think well this is something i should spend a bit of time working on.

  AMT: And how long did she live?

  ADRIAN OWEN: She live for about 20 years.

  AMT: So as you worked on this, what had happened to her was always there you stayed in touch with her brother?

  ADRIAN OWEN: I did. I have a very good relationship with her brother and we even tried to scan her on one occasion, and that proved to be logistically impossible. She was in Scotland and I was working down in Cambridge in the U.K. at the time. It turned out that a colleague of mine actually ended up scanning her. He sent me the scans and asked me to look at them and try and interpret them because I had more experience than he had, and that was sort of an eerie moment it had happened just after I arrived here in Canada and it was I was sort of a sort of you know it was a difficult moment, I would say.

  AMT: What did you learn from those scans?

  ADRIAN OWEN: The findings were negative. There was no evidence of any residual brain activity. There was no suggestion that Maureen was still aware. I guess in some ways I was relieved by that I mean at that point it was many years since we had seen each other and I think in some ways I felt better about that than finding out that she'd actually been aware and nobody had known that for that whole period.

  AMT: It's so fascinating that we've spent this time talking and I have now 15 more questions the legal, ethical, medical implications of what you're working on are huge and still need to be addressed.

  ADRIAN OWEN: Yeah this is evolving all the time. That's really how my life has changed over that 20 year period. 20 years ago I was just a neuroscientist, just meeting and talking science with other neuroscientists.

  AMT: Down in the basement of the hospital.

  ADRIAN OWEN: Right now, you know, If one day I'll be discussing the situation with ethicists the next day I'll be dealing with lawyers about a legal case since it's astonishing to me how many people and how many different disciplines are touched by these conditions and what it tells us about the brain.

  AMT: And you're making the rest of us aware as well.

  ADRIAN OWEN: I hope so.

  AMT: Thank you for your work. Thanks for coming in.

  ADRIAN OWEN: Thanks for having me. Adrian Owen the Canada Excellence Research Chair in Cognitive Neuroscience and imaging at the Brain and Mind Institute at Western University. He's written a book called Into The Gray Zone: A Neuroscientist Explores The Border Between Life And Death. And he was here in our Toronto studio let us know what you think. You can tweet us @thecurrentCBC find us on Facebook. Go to the website cbc.ca/thecurrent and stay with us in our next half hour. What comes first arousal or desire? The latest segment in our project The Disrupters looks at the mechanics of women's sexuality and how little we know about it. Sex researcher Meredith Chivers has dedicated her career to finding some answers. Her insights, coming up next. I'm Anna Maria Tremonti, This is The Current on CBC Radio 1 Sirius XM, Online on cbc.ca/thecurrent and on your radio app.

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  What do women want? Sex researcher explores mysteries of female desire
  Guest: Meredith Chivers

  The Current
  What do women want? Sex researcher explores mysteries of female desire
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  AMT: Hello I'm Anna Maria Tremonti and this is The Current. In 2000 Mel Gibson starred in a romantic comedy What Women Want. Early in the film. His character falls in a bathtub while holding a hairdryer, work with me here. The flug accident gives him the ability to read women's minds and get access to their secret desires.

  SOUNDCLIP

  [From the movie 'What Women Want" from 2000]

  Flo: Mr. Marshall...

  Nick Marshall Good morning, Flo.

  Flo: Let me get you a cab, sir.

  Nick: Sure.

  Flo whistles for a cab.

  Nick: Thank you, Flo.

  Flo [to herself]: You're welcome my little sweet-ass.

  Nick: What did you say?

  Flo: Me? Nothing.

  Nick: You sure?

  AMT: Sure. While men's sexual desire is generally perceived as simple and straightforward. Women’s simply is not and there's no Hollywood magic to help that out. Today as part of our project The Disrupters we're talking about female desire and I'll speak with the Canadian sex researcher who's overturning assumptions about what actually turns women on. But first The Current dropped by an Ottawa sex shop and bookstore called Venus Envy. Here is owner Sam Wittels take on female desire.

  SOUNDCLIP

  For us. We think that having all the knowledge you want or need is the key to a good happy healthy and hot sex life. And the story did start as store for women and people who love them. So we'll start here with our are safer sex condoms and lube Sections. This is our vibrator section here. We spend a lot of time talking about vibrators helping people pick out their first vibrator and more the second and third. One thing that turns women on is just having their pleasure being seen as important. Often what people need in order to kind of reconnect with their desire is, you know the same things people need to reconnect with pleasure in all aspects of their lives. So, ways to have less stress or calmdown the distractions or think about work less. Because you know it's hard to feel sexy and be in the moment when you're running through a grocery list or thinking about the millions of things you have to do that day or that week. So, yes, sometimes the sexiest thing you can do look is like hire a babysitter.

  AMT: Well, hiring a babysitter may be a great place to start. But researchers are learning that when it comes to understanding what turns women on there are still many more questions than answers. Meredith Chivers is working on finding those answers. She's a Canadian sex researcher who's gained international recognition for her work in disrupting assumptions about female sexual desire. And just a warning our conversations going to be a frank discussion about sex and sexuality. Meredith Chivers is an associate professor in the Department of Psychology at Queens University. She's also the director of the sexuality and gender Lab. And she joins us from Kingston, Ontario. Hello.

  MEREDITH CHIVERS: Hello.

  AMT: What did you think of what we just heard from the women sex store?

  MEREDITH CHIVERS: I think that that is some fantastic advice, and I think that first of all giving women the knowledge that they need to understand their sexual response and to connect with their bodies is so incredibly important. And that's certainly one of the things that drives the work that we do in my lab, doing the basic science that we need to understand how women's sexual desire and sexual response works. And as well, the idea of reducing stress, reducing distractions and getting into the moment and I'll definitely underscore hiring the babysitter that's a good idea as well.

  AMT: [Laughs] Okay. Just how complicated is female desire?

  MEREDITH CHIVERS: I think that it's an unknown at this point to some degree. I think that the characterization of women's sexuality as you know, complicated or very complex is one that is often put out there as a comparison with men or male sexuality. And I think that part of the reason why we might think that is that we're expecting women's sexuality to behave like men's. And the more research that I do with my team here in Kingston and my collaborators around the world we realize that it's not, and that the models of male sexuality that have predominated for decades don't fit. And that we need to do the science to understand how women's sexuality is unique.

  AMT: Well how has female sexual desire been understood or misunderstood in the past, then?

  MEREDITH CHIVERS: Well dating back to the 50s and the pioneering work of Masters and Johnson the predominant model of sexual desire was that desire was the initiation of sexual response, that people had these spontaneous feelings of desire. They were like lightning bolts that zapped you out of nowhere and that that initiated a process of seeking out sex, either with a partner or partners or with yourself and then feeling turned on. And if you're lucky having an orgasm, for example. And over the years as more data has accumulated in this you know querying this idea of spontaneous desire. And as psychologists have spent some time thinking about this problem it doesn't really make sense that sexual motivation would emerge out of the blue. Sexual motivation isn't a drive like thirst or hunger. It may feel like we're going to die if we don't have sex but that's really not going to happen. So in psychological terms it's not a drive. But instead we are drawn towards the things that have previously been pleasurable or reinforcing. And so instead of desire being this spontaneous thing or something that's within us and some people have more, some have less. It is that desire can be triggered or it can be kindled or it can respond to sexual stimuli. And that's what we've been investigating in my laboratory is this idea that desire is responsive.

  AMT: So tell us about some of the studies you conduct in your lab what sort of test do participants undergo?

  MEREDITH CHIVERS: So we predominantly do sexual psychophysiology research. And what that means is we have folks come into our laboratory. They are in a private room and we'll attach a number of sensors to their body that measure for example their heart rate. But specifically we ask them to attach sensors to their genitals so that we can measure what happens to their genitals as they're getting turned on. We also ask people to tell us how they're feeling. Answer questions and use various kinds of devices to report how they're feeling in the moment. And we also have started using eye trackers. So these are devices that use cameras to follow where people are looking on a computer screen so that we can directly see what it is that they're looking at in real time. And we've also started using measures of neuro-sexual response, to get an idea of what's happening in the brain in those very early moments when people are first looking at sexual stimuli using electroencephalography or EEG. And so we have folks come in we take all of these kinds of measurements to get a sense of what happens in the moment when people get turned on. What happens with their genitals. What happens with what they're feeling. What is the relationship between mind and body. We're also really curious about the question of the kinds of things that turn people on because we've done research that suggests that there's quite a lot of variability in the kinds of things that turn women on.

  AMT: Okay so what are some of the less predictable things that straight women, to begin with straight women, react to in the lab?

  MEREDITH CHIVERS: So we've seen women who report exclusive or sexual attraction to men show fairly significant sexual responses to both male and female sexual stimuli. And that effect is seems to be quite unique to women who report that they're exclusively turned on by men. So it's a bit of a puzzle it doesn't correspond with what they're reporting is their sexual attractions. But we see that their genital responses, their eye tracking responses, their neural responses tend to be equivalent to these male and female sexual stimuli. But as we sort of go down the continuum of increasing sexual attraction to women. So bisexual women, queer women, lesbian identified women towards these sort of other end of the spectrum of people who would say oh I'm sexually attracted only to women. As we move down that there seems to be more differentiation in their sexual responses, more to female sexual stimuli than to male.

  AMT: And why do you think that is.

  MEREDITH CHIVERS: It's a great question. We don't know the answer to that. I think that it's pretty fascinating sort of clue to see that it's only exclusively heterosexual women who are showing this non differentiated pattern when it comes to gender. I recently proposed a number of different hypotheses that could be pursued to try to explain what's happening here. And there were a couple that really attracted some attention and I'll talk about them now. So one of them is the idea of objectification of women in the media, that there's an overwhelming degree in the western world where we see sexualized images of women everywhere. And so the possibility is that for exclusively heterosexual women their sort of sexual psychology has developed being marinated and sort of saturated in these ideas of sexualizing women and perhaps that has the capacity to shift their ability to become turned on by women. Right now we don't have the science to support that hypothesis or reject that hypothesis but I think it's a really interesting one to pursue. So a second hypothesis that I think also is quite compelling is the idea that the sexual response patterns may be emerging because there hasn't been much reinforcement of sex in one way or another for heterosexual women. So it's well known that straight women are less likely to experience sexual pleasure and orgasm during penetrative sex with men. But if you look at queer women and their sexual relationships it's overwhelmingly larger percentage of women who say well of course when I'm having sex with my girlfriend I'm experiencing sexual pleasure and an orgasm. That's part of what we're doing. But for straight women that reinforcement or that reward might be less predictable. And so perhaps for queer women they've had more and more experiences of being attracted to and sexual with women that are then paired with pleasure. And this might then shape their sexual responses to be greater to female the male stimulation for exclusively heterosexual women, you know unfortunately the status quo is very low rates of experiencing sexual pleasure with their male partners. And so they may not have that kind of an experience.

  AMT: Hmm. And why would that be?

  MEREDITH CHIVERS: I'm a whole number of factors can contribute to that. I mean communication between the couple is a huge point for couples to be able to have frank discussions about what feels good. I think another problem with the heterosexual, we call them sexual script so what people do when they get together and have sex, is that penile vaginal intercourse is the main event and most sexual interactions proceed along this trajectory where there's some foreplay that happens. But really the main event is getting to a penis and a vagina. And for a lot of women who have sex with men that's not necessarily what is going to give them the most sexual pleasure. And so it requires a degree of you know open communication and the couple and a degree of assertiveness on the woman's part to be able to say: “Hey! I'm happy to do this but I really need you to do these things for me as well, so I can also enjoy having sex?”

  AMT: Okay. And you've looked at women whose bodies react to less predictable images, specifically the bonobo ape. What were you seeing?

  MEREDITH CHIVERS: So to give some context to that study. The reason we did it was that I wondered whether this what we called a nonspecific pattern of genital response had really nothing to do with the genders of the people depicted in the film. So for my Ph.D. work at Northwestern University I had shown a diverse group of women films of gay men and lesbian women and heterosexual couples having sex and their general responses were fairly equivalent to all of these different stimuli. And so we wondered if it had had to do with the fact that there's just a lot of sex happening. Maybe it's the sexual activity that they're watching which kindles and triggers this what seems like a very automatic physical sexual response. And so we needed to come up with a stimulus that was frankly sexual but didn't contain any plausible sexual partner. And so bonobos were a great choice. They tend to mate in a very human like fashion almost like a missionary position. And what we found was that women had small but significantly different from non-sexual stimuli. Had these small genital responses to these bonobo films which suggested to us that simply just seeing sexual activity was enough to activate women's sexual response systems.

  AMT: And into all of this, is an area related to sexual assault? And I want to ask you about that because of how women's bodies can respond sometimes. You've been contacted about your research by survivors of sexual assault. What have you heard? What are they telling you?

  MEREDITH CHIVERS: Yes, absolutely. So I have in the work that I've done proposed that this very automatic genital response that women can experience when they see all kinds of sexual stimuli whether they're ones that they prefer or not, and in particular there are data suggesting that women when they listen to stories that involve non-consensual or violent sex or see films that depict this that they have these genital responses but they report that they don't feel turned on. And this also meshes with some of my clinical experience so I'm a clinical psychologist as well and have done therapy with women who've experienced sexual trauma. And some women have reported experiencing feelings of physical sexual arousal during a sexual assault. And as you can imagine this can be incredibly troubling for women who feel like in a moment where they were not consenting and they're experiencing violence and harm that their body is betraying them. And so one of the ways that I've reconceptualise this is that perhaps what's happening physically is a very automatic kind of response that is preparing women's physical body for sex whether it's wanted or not. And in some ways this might be akin to when people salivate when they see food. Maybe these genital responses that women are having now these increases in blood flow that increased lubrication to the genitals might reduce the amount of harm that she experiences if she were ever forced to have sex against her will.

  AMT: And in fact you've heard from women, have you not, who say that they realize that their body lubricated and they're really troubled by that, because it was a sexual assault?

  MEREDITH CHIVERS: Yes. Absolutely. Yes so I have had several women reach out to me and expressed gratitude at the reframing of this idea that it wasn't their body betraying them but it was their body protecting them, that they had experienced during sexual assault either feelings of physical sexual arousal or in some cases orgasms, and were deeply troubled as to what those physical signs of sexual response mean in terms of consent. And in fact going back a decade there were cases where those physical signs of arousal may have been interpreted as consent. You know other people who have contacted me in waves of media coverage of this work have been lawyers internationally who have been faced with you know testimony that women were lubricated or experienced an orgasm during this sexual assault and so, isn't this a sign of consent? And of course it isn't. You know consent is a freely given verbal agreement to have sex that has nothing to do with what a body is doing.

  AMT: It's fascinating and it's very fraught too, huh?

  MEREDITH CHIVERS: It is very fraught. This is challenging work to do.

  AMT: I just want to shift to ask about pharmaceuticals and all of this. Pharmaceutical companies have marketed products for women so-called sexual dysfunction. What would you make of those products?

  MEREDITH CHIVERS: I think that there is a large untapped market that is motivating these investigations. I think we always need to keep in mind the potential for vast amounts of money to be made in that pursuit. At the same time as I said I'm a clinician and if it were possible to provide women with a pharmaceutical that could help women who have for a whole variety of reasons experienced a loss of their sexual desire I would absolutely support that. I do think that using any pharmaceutical needs to happen in the context of broader psychotherapy, given everything we know about the other factors I talked about; communication with your partner's sexual assertiveness and perhaps addressing you know other longstanding issues surrounding comfort with one's sexuality. But I'm not going laterally against the idea of a pharmaceutical. I do think however that the ones that have to this point been made available have not been particularly impressive in how they've performed.

  AMT: As a feminist do you think women should have access to something like Viagra?

  MEREDITH CHIVERS: I think women should have free access to whatever they want. Viagra in particular you know, sure. Viagra actually works for women in the sense that it increases genital blood flow. You know the trials and marketing Viagra for women out the data suggested that you do see these physical sexual responses but women didn't report that they were actually feeling turned on. So you know it really wasn't having an appreciable effect on increasing women's sexual arousal and so those trials as I understand it were halted. But yes I think that women should have free access to whatever they want.

  AMT: I want to talk a little bit more about arousal and desire and what your work reveals about how that works for women. You've looked at women with low sexual desire and the responses they have compared to women with high desire. What did you find?

  MEREDITH CHIVERS: So a lot of this work is very preliminary. We're just now beginning to analyze data from a longitudinal study where we brought women into the laboratory who did have sexual difficulties and who didn't. And over a series of three months they came in for a monthly visit. They were exposed to a sexual or non-sexual film. And then we observed their sexual behavior. They filled out questionnaires, three days after they participated. The very preliminary data suggest that they responsive desire that we asked women about, so the desire that they felt after they got turned on in the laboratory, actually didn't look that different whether they had clinically significant low sexual arousal and desire versus not. These weren't women who had been diagnosed with a sexual dysfunction. But you know using self-report measures of distress and symptoms these women didn't show what we had expected which was lower feelings of desire for a partner or a lower desire to engage in solitary sex or masturbation after they watch these films. So really perplexing. We're not really sure what that means.

  AMT: I was just going to ask you if you knew what it meant.

  MEREDITH CHIVERS: No we have no idea. I mean I this is often my problem, which is we go in with a hypothesis that seems so reasonable and then we're faced with data that tell a very different story and then we need to do the science to follow up on those findings to try to make sense of what's happening. But I do think that these data might suggest that you know low sexual desire might reflect women’s more global impression of their desire and maybe not the capacity for their desire to be triggered in the moment. Another perplexing finding that is emerged out of this research is that if you look at the sexual responses of women who are diagnosed with low sexual arousal for example their genital responses don't look any different from women who have no sexual difficulties in the lab. And that really suggests to us that women still have this capacity to experience physical sexual arousal and so could we then help women to reconnect with their body to experience that. And so I wonder if women still retain this capacity to experience this physical sexual response and if desire isn't this spontaneous thing that initiate sexual response but actually emerges from people feeling turned on, that we might actually be able to kindle women's sexual desire by having them find the things that turn them on and then tune into their feelings of desire.

  AMT: Okay. I hear what you're saying that's pretty fascinating. You know there are those who look at the research that you do and others do and they think it's frivolous. How do you respond to that?

  MEREDITH CHIVERS: Well they're wrong. Sexuality is a fundamental part of everyone's being. And it is always shocking to me how little we know given how important our sexualities are. Whether we're having sex or not whether we're asexual or you know identify as lesbian, queers, straight or whether we're transgender, whatever. This is a fundamental part of being human. And I think it is shocking the degree to which we have very little idea of how these components have our sexual response works.

  AMT: And lately there have been American researchers coming to Canada to continue their work. Why is that?

  MEREDITH CHIVERS: Well I'll tell you my story so I was a graduate student in Chicago at Northwestern University I am Canadian but I went to the U.S. for my Ph.D. work and the political climate around the time that I was finishing up my Ph.D. was it was the Bush government. And there was a vote in Congress in the summer of 2003 to just unilaterally revoke funding federal funding for sexuality research based on moral and political positions. That for me it was all a sign that I needed that it was time to go home. There was no way that I was going to be able to fund the work that I wanted to do in women's sexuality in the U.S. And so I came back to Canada. And you know I'm so proud of our country and the number of incredible sexuality researchers that we have in Canada who frankly have been able to receive funding that otherwise they probably would have never gotten anywhere else in the world. You know the tri Council funding, so the Canadian Institute for Health Research, the social science and humanities research council, the natural sciences, engineering research councils of Canada have in so many ways allowed for Canada to become a world leader in sexuality research. And so I think that's why we're seeing folks from the U.S. deciding that maybe it's time to go elsewhere and maybe Canada is the right place to be.

  AMT: It's fascinating work. Thank you for sharing some of what you've been discovering.

  MEREDITH CHIVERS: Thank you so much for having me.

  AMT: Meredith Chivers an associate professor in the Department of Psychology at Queens University. Director of the sexuality and gender lab at the University she joined us from Kingston, Ontario. Let us know what you think you can tweet us @thecurrentCBC, find us on Facebook, go to our website cbc.ca/thecurrent, click on Contact. That's our program for today stay with Radio 1 for q. Comedian W. Kamau Bell has made a career out of awkward moments and he's got a new show that's no different. He describes United Shades of America as a black man who goes to places he should not. Coming up he'll tell Tom Power all about it. If you missed part of our program today catch up with the CBC Radio app free to download from the App Store or Google Play. We began today with a goodbye on July 1st. Peter Mansbridge retires as host of CBC TV's The National will give Peter the last word today. I'm Anna Maria Tremonti. Thanks for listening to The Current.

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Print Marked Items
Mind reader
Henry Marsh
New Statesman.
146.5381 (Aug. 25, 2017): p42+.
COPYRIGHT 2017 New Statesman, Ltd.
http://www.newstatesman.com/
Full Text:
Into the Grey Zone
Adrian Owen
Guardian Faber, 320pp. 16.99 [pounds sterling]
The physical basis of consciousness is perhaps the greatest mystery and problem in modern science. There
can be little doubt that consciousness is a physical phenomenon but we cannot even begin to explain how it
arises in brains. The simple--and doubtless simplistic--medical model of consciousness is that the cerebral
hemispheres, where thinking and feeling goes on, are like millions of light bulbs. Consciousness is the
brightness with which they shine. If you progressively damage the cerebral hemispheres, consciousness
dims. Small areas of damage to the hemispheres have little effect on consciousness: many neurosurgeons
have seen patients who walked into hospital with a knife or a nail, for instance, stuck in their brains, and yet
who are fully conscious.
The hemispheres are powered, in ways we do not understand, by the brainstem, the part of the brain
between the hemispheres and the spinal cord. In the medical model, the brainstem is equivalent to an
electric cable supplying the millions of light bulbs. Small injuries to the brainstem can cause profound
coma--all the light bulbs will be dimmed at once.
Many years ago, when I was still training to be a neurosurgeon, I admitted an elderly American man who
had collapsed with a brainstem stroke while watching the Championships at Wimbledon. He was
completely paralysed but able to move his eyes up and down in response to my speaking to him. It seemed
fairly clear to me that he was "locked in"--fully conscious but trapped within his body The next morning, I
showed the poor man to my consultant on the ward round. "These are just reflexes," he said of the patient's
eye movements. "Just reflexes," he repeated fiercely, as he quickly walked away--meaning, I suppose, that
he preferred to think that the man was not conscious or suffering.
I did not agree but nor, to my shame, did I return and talk to the patient and comfort him. I fear that my
failure was even more egregious than my consultant's denial of the obvious, but it is extraordinarily difficult
to talk to an immobile body, knowing that you cannot get any response, and even more difficult to know
what to say It feels like talking to a corpse. It is not just that the thought of what the patient might be
experiencing is too horrible to contemplate but also that it feels unnatural. It is indeed unnatural, to the
extent that modern medicine can now keep people alive with profound brain damage who, in the past,
would invariably have died in the first few days after the stroke or injury.
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So there is now a group of people who are mute and immobile and require 24-hour nursing care. They are
categorised as being in a persistent vegetative state (PVS) if they show no reactions whatsoever, and as
being in a minimally conscious state (MCS) if they respond to stimulation to some extent. Some, like the
patient in Wimbledon, are fully aware and "locked in" (as was Jean-Dominique Bauby, the author of The
Diving-Bell and the Butterfly).
Adrian Owen is a neuropsychologist who has devoted his life to working with these patients. In Into the
Grey Zone, he describes how, almost by chance, he became involved in putting PVS patients in scanners
that show brain activity rather than just brain anatomy. He demonstrated that some PVS patients, despite
being completely mute and immobile, show evidence of mental activity and are possibly conscious. We
must say "possibly", because consciousness is an entirely subjective phenomenon and cannot be measured
or directly observed from outside. It can only be inferred.
The method Owen developed was to ask PVS patients to imagine that they were playing tennis. In some of
these patients--but only a minority--the functional scans showed activity in the parts of the brain that light
up in normal volunteers' brains when they are asked to imagine playing tennis. He concluded that the PVS
patients whose scans show this same activity must be conscious. Not everybody who works in this field
agrees--it can be argued that awareness, which these patients certainly show, is not the same as having a
conscious sense of self. There is much room for philosophical speculation and argument.
Owen was able to establish communication of a sort with some of these patients, by asking questions to
which the patients could reply yes (by imagining a game of tennis) or no (by imagining walking around
their home), but the communication was very limited.
There was tremendous media excitement about this groundbreaking work, as Owen recounts in some detail.
But what does his discovery mean? Do PVS patients think and feel? Are they in hell, or perhaps even in
heaven? Is the law right in permitting PVS patients to be allowed to die--withdrawing food and water so
that they slowly starve to death? All that is clear is that some patients who have previously been diagnosed
as being in PVS have some kind of inner, mental life. What this life might be like is impossible to know. It
is, in many ways, a deeply disturbing thought, above all for the patients' families.
This is a fascinating and highly readable book, written with evangelical fervour, but it needs to be read with
some care. Owen has made a remarkable discovery and is right to be proud of it. He describes in gripping
and moving detail--and there is no doubting his deep compassion for the patients and their families--how
his work evolved, but only towards the end of the book does he start to admit how complicated the problem
is.
There are many causes of PVS and MCS. Carol, his first subject, who made a remarkable (but incomplete)
recovery, having been written off as being in PVS, had suffered from an inflammatory condition of the brain
that was entirely different from what many of the other patients he describes suffered: head injuries with
extensive structural brain damage. Patients who become clearly conscious after severe head injuries often
have terrible personality changes and disabilities, and the same would probably apply to many of the PVS
and MCS patients if they are conscious, albeit mute and immobile. As it is, many of the PVS patients Owen
studied showed no brain activation when asked to imagine playing tennis. Finally, consciousness is a
complex grey-scale phenomenon, not simply a matter of on or off. In places, Owen comes close to making
it sound as though all PVS patients were potentially wide awake but locked in.
We cannot know what these patients are experiencing but what we do know is that the suffering of their
families is terrible, as I have seen in my life as a neurosurgeon. Anybody who has read Cathy
Rentzenbrink's beautiful book The Last Act of Love will know this, too. Owen's work raises many more
questions than it answers. The complicated problems of how to look after PVS patients and how their
families should see them have become a lot more difficult.
Owen is now working in Canada, trying to use electroencephalography to detect awareness and possible
consciousness in comatose patients--a less complex method than using brain scanners. It is not yet clear
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whether this will work. "Emerging technologies will undoubtedly one day allow us to read the minds of
others," he states . I am not so sure, but time will tell.
Henry Marsh is a consultant neurosurgeon and the author of "Admissions: A Life in Brain Surgery"
(Weidenfeld & Nicolson)
Caption: Conscious decisions: Owen showed that some vegetative patients may still have mental activity
Source Citation (MLA 8th
Edition)
Marsh, Henry. "Mind reader." New Statesman, 25 Aug. 2017, p. 42+. General OneFile,
http://link.galegroup.com/apps/doc/A506036786/ITOF?u=schlager&sid=ITOF&xid=dad7f3fb.
Accessed 18 Dec. 2017.
Gale Document Number: GALE|A506036786
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Owen, Adrian: INTO THE GRAY ZONE
Kirkus Reviews.
(Apr. 15, 2017):
COPYRIGHT 2017 Kirkus Media LLC
http://www.kirkusreviews.com/
Full Text:
Owen, Adrian INTO THE GRAY ZONE Scribner (Adult Nonfiction) $28.00 6, 20 ISBN: 978-1-5011-
3520-0
An exploration of the current medical research on brain health and the consciousness of patients who suffer
catastrophic head trauma.Throughout a fascinating multidecade research study, renowned neuroscientist
Owen (Cognitive Neuroscience/Western Univ., Canada) probed the mysterious and uncharted shadowlands
of the so-called "gray zone," the middle ground between brain death and neural cognitive alertness. His
interest was triggered after a former partner suffered a brain aneurysm and was left in a vegetative state,
though the author often wondered if some sort of brain activity resided within her. Owen spotlights clinical
case studies he monitored in which critically injured patients became "trapped in between in the minimally
conscious state" yet demonstrated brain activity; some even returned to full consciousness. With each
patient experiment and experience, the author and his fellow researchers expanded their scope of knowledge
and pieced together cohesive theories and conclusions about brain function, memory commitment, and
conscious awareness. Continually aided by revolutionary brain scanning technology in which "we connect
with these brains, visualizing their function and mapping their inner universe," his research has also
incorporated many different aspects of life as well. Owen wrestled with issues such as a patient's right to die
and the difference between a human brain understanding speech patterns presented to it versus simply
experiencing them. With remarkable clarity, Owen punctuates his findings with concise dispatches on the
human condition and the disparities between what is considered quality of life and what some consider an
inhumane, dysfunctional existence. In an engrossing and intensive narrative, the author shares his findings
that 15 to 20 percent of the diagnosed vegetative-state patients he interacted with were actually partially to
fully conscious, though their bodies were unable to physically respond to outward stimuli. By calling
attention to this neurological phenomenon, Owen advocates for improved therapies and further experiments
to more fully understand these "intact minds adrift deep within damaged bodies and brains." A striking
scientific journey that draws hopeful attention to how the brain reacts, restores, and perseveres despite grave
injury.
Source Citation (MLA 8th
Edition)
"Owen, Adrian: INTO THE GRAY ZONE." Kirkus Reviews, 15 Apr. 2017. General OneFile,
http://link.galegroup.com/apps/doc/A489268421/ITOF?u=schlager&sid=ITOF&xid=47f6ebef.
Accessed 18 Dec. 2017.
Gale Document Number: GALE|A489268421
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http://go.galegroup.com/ps/marklist.do?actionCmd=GET_MARK_LIST&userGroupName=schlager&inPS=true&prodId=ITOF&ts=1513655748469 5/5
Into the Gray Zone: A Neuroscientist
Explores the Border Between Life and Death
Publishers Weekly.
264.14 (Apr. 3, 2017): p63+.
COPYRIGHT 2017 PWxyz, LLC
http://www.publishersweekly.com/
Full Text:
Into the Gray Zone: A Neuroscientist Explores the Border Between Life and Death
Adrian Owen. Scribner, $28 (320p) ISBN 9781-5011-3520-0
In this vivid, emotional, and thought-provoking account, Owen, research chair in cognitive neuroscience
and imaging at the University of Western Ontario's Brain and Mind Institute, surveys his research on the
human brain in a non-responsive state. Case by case, Owen probes the limits of human consciousness while
taking readers bedside to observe trauma victims, many who have been in coma-like states for years, but
whose severely damaged brains show clear signs of responding to his bizarre tests. As technology advances
from PET scans to fMRIs, Owen and his colleagues devise more complicated means of communicating
with "gray zone" patients. International headlines are made and ethical questions are raised. One patient,
who regains her ability to speak and walk, shares what it was like to be treated as vegetative despite her
awareness of everything going on around her. Using an experiment involving a Hitchcock film, Owen finds
that several subjects believed to be vegetative are fully aware. "It was a haunting reminder of the resiliency
of consciousness," Owen writes, reflecting on "the meaning of what it means to be alive and whether
anyone can be said to be irretrievably lost." Occasional platitudes aside, Owen's story of horror and hope
will long haunt readers. Agent: Gail Ross, Ross Yoon Literary. (June)
Source Citation (MLA 8th
Edition)
"Into the Gray Zone: A Neuroscientist Explores the Border Between Life and Death." Publishers Weekly, 3
Apr. 2017, p. 63+. General OneFile, http://link.galegroup.com/apps/doc/A489813743/ITOF?
u=schlager&sid=ITOF&xid=2f04af5f. Accessed 18 Dec. 2017.
Gale Document Number: GALE|A489813743

Marsh, Henry. "Mind reader." New Statesman, 25 Aug. 2017, p. 42+. General OneFile, http://link.galegroup.com/apps/doc/A506036786/ITOF?u=schlager&sid=ITOF. Accessed 18 Dec. 2017. "Owen, Adrian: INTO THE GRAY ZONE." Kirkus Reviews, 15 Apr. 2017. General OneFile, http://link.galegroup.com/apps/doc/A489268421/ITOF?u=schlager&sid=ITOF. Accessed 18 Dec. 2017. "Into the Gray Zone: A Neuroscientist Explores the Border Between Life and Death." Publishers Weekly, 3 Apr. 2017, p. 63+. General OneFile, http://link.galegroup.com/apps/doc/A489813743/ITOF? u=schlager&sid=ITOF. Accessed 18 Dec. 2017.

• New York Times
  https://www.nytimes.com/2017/08/22/books/review/into-the-gray-zone-adrian-owen-.html
  Word count: 1619

  BOOK REVIEW | NONFICTION
  A Pioneering Neuroscientist Reports From ‘the Border of Life and Death’
  By GEORGE JOHNSONAUG. 22, 2017

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  INTO THE GRAY ZONE
  A Neuroscientist Explores the Border Between Life and Death
  By Adrian Owen
  304 pp. Scribner. $28.

  Before the invention of the mechanical ventilator, there was no plug to pull. Starved of oxygen, victims of severe brain trauma were more likely to die on the emergency room table than to linger in an ethical limbo, with doctors and loved ones agonizing over whether the patient was “really alive.”

  By the time Jeff Tremblay, a teenager in Canada, was beaten comatose and airlifted to a hospital in Edmonton, the use of artificial life support had become routine. After three weeks on a ventilator in 1997, he could breathe without assistance, but was that a blessing? He remained locked in what his doctors diagnosed as a vegetative state, unresponsive and seemingly unaware.

  Jeff’s father believed otherwise — that his son understood their one-way conversations and was captivated by the movies he wheeled him to at the cineplex. But he couldn’t know for sure. In 2012, 15 years after the assault, he heard of a miracle worker named Adrian Owen, a scientist renowned for scanning the brains of vegetative patients and finding what he believed were signs of consciousness — of minds trapped inside bodies longing to break out.

  In Owen’s chronicle of these cases, “Into the Gray Zone: A Neuroscientist Explores the Border Between Life and Death,” he describes what happened next. In an initial examination Jeff indeed seemed dead to the world, failing to respond to simple commands to look in the mirror or stick out your tongue. When an object was moved in front of his face, he was barely able to track it with his eyes.

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  But when Jeff was put into a scanner — an fMRI machine (for functional magnetic resonance imaging) — and shown a short Alfred Hitchcock film, “Bang! You’re Dead,” parts of his brain lit up.

  “In response to sounds, Jeff’s auditory cortex sprung to life,” Owen recounts. “When the camera angle changed or the young boy ran across the screen, Jeff’s visual cortex activated.”

  Those might have been reflexive responses. But there seemed to be more going on. “At all the critical twists and turns in the plot,” Owen writes, “Jeff’s frontal and parietal lobes responded exactly like those of a person who was conscious and aware.” These are regions of the brain connected with higher thought and the capacity to experience the world.

  Jeff remained badly damaged — suspended in a gray zone somewhere between consciousness and brain death — but his family felt reassured. They hadn’t been talking to a zombie for all those years. Inside that broken body there still seemed to be a Jeff.

  Owen’s encounters with vegetative patients, each one seemingly more fantastic, have been media sensations. In pages filled with exclamation points and swimming in italics, Owen reprises his cases with enthusiasm and empathy, explaining just enough science for the experiments to make sense.

  His first encounter, described many times in the popular science press, was with Kate Bainbridge, a nursery school teacher in Cambridge, England, who lapsed into the gray zone after a bad cold developed into a serious virus that caused debilitating brain and spinal cord inflammation. After a few weeks in intensive care she emerged from a coma but showed no signs that she was cognizant or leading any kind of inner life. But when she was put into a PET scanner and presented with pictures of her family, her brain responded in ways one might expect from a healthy person.

  Gradually she recovered mentally, though not physically. “I thought I was in prison,” she told Owen years later, as she sat in an electric wheelchair. “I had no idea where I was.”

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  Other experiments have been less clear-cut. Not long after Bainbridge came a vegetative patient, called Debbie in the book, whose temporal lobes seemed to respond normally to recorded speech. But it wasn’t clear from the scanning whether she knew what (or that) she was hearing.

  Reaching deeper, Owen found clues that a stroke victim named Kevin could perform a more sophisticated linguistic task. When he was exposed to recordings of sentences with double meanings (“he fed her cat food”) his brain scan showed patterns like those of a conscious person trying to resolve the ambiguity.

  That still wasn’t enough to demonstrate that a patient was mentally alive. On a beach in Australia, Owen writes, he had an epiphany: To make a strong case that some vegetative patients were thinking and feeling he would have to catch their brains in the act of making a willful decision.

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  And so we meet Carol, a 23-year-old woman who had been struck by two cars as she was crossing a busy road, distracted by her cellphone. Her head dented in from a craniectomy — the removal of a piece of skull to relieve the pressure of her swollen brain — she lingered for months in a vegetative state. While she was under the scanner, Owen asked her to imagine that she was playing a game of tennis. He had seen how in healthy people this request activated an area near the top of the head called the premotor cortex. The same thing happened with Carol.

  Then he asked her to imagine that she was walking around her house. This time a different area, the parahippocampal gyrus (involved in spatial memory and navigation), responded — again as in a normal person.

  Carol, it seemed to Owen, had made a deliberate choice.

  “We had sent a clear ‘Are you there?’ signal into inner space and the answer ‘Yes, I am here’ had come back loud and clear,” Owen writes. “The case was closed. Carol was conscious.”

  The climax of the book comes with Scott, who seemed stuck in a vegetative state 12 years after a car accident in 1999. As a BBC film crew stood by, Owen presented the patient with yes or no questions.

  “Scott, are you in any pain? Do any of your body parts hurt right now?” If the answer was yes he was told to imagine walking through his house. If the answer was no he was to imagine playing tennis.

  Scott signaled the negative. He wasn’t in pain. His mother said she had known that all along.

  Not everyone is convinced that the output of a scanner can be translated so unambiguously into thoughts and intentions. Explaining the subjective mind and how it arises from flesh is among science’s unsolved problems. Parashkev Nachev, a neurologist at University College, London has criticized Owen for reading too much into the data and for raising false hopes.

  “I find the whole media circus surrounding the issue rather distasteful,” he told Roger Highfield, a British science journalist, in 2014. “The relatives of these patients are distressed enough as it is.”

  Owen believes that his work is beneficial not only to science but also to vegetative patients, encouraging doctors and nurses to treat them more empathetically. That, he believes, might conceivably increase the odds of a partial recovery — if the patients really know what’s going on.

  In a scene toward the end of the book, Owen celebrates with colleagues at a Paris restaurant. As the courses arrive and the wine is poured, he foresees a “not-too-distant future” where brain-computer interfaces “may allow people in the gray zone to take online courses, type emails, hold conversations and express their innermost feelings.” Maybe so, but given the difficulty of interpreting gray zone experiments that seems like a stretch.

  For all the good they’ve done, mechanical ventilators have left us with ethical dilemmas that neurotechnologies are unlikely to resolve. They might even make them worse, with lawyers and expert witnesses arguing over signals from a scanner and whether they stand as evidence of a conscious self. The venerable mind-body problem, argued to a standstill by philosophers and scientists, will move to the courtroom, the mystery stubbornly intact.

  George Johnson is the author of “The Cancer Chronicles.”

  A version of this review appears in print on August 27, 2017, on Page BR13 of the Sunday Book Review with the headline: Awakenings. Today's Paper|Subscribe

• Harvard Law
  http://blogs.harvard.edu/billofhealth/2017/10/05/book-review-into-the-gray-zone-by-adrian-owen/
  Word count: 1255

  Book Review: “Into the Gray Zone” by Adrian Owen
  Posted on October 5, 2017 by lgriffin
  By Leslie C. Griffin

  I recommend neuroscientist Adrian Owen’s new book, Into the Gray Zone. The “gray zone” refers to patients who undergo such traumatic brain injury that they are diagnosed as vegetative, minimally conscious, comatose, or in other medical states where they aren’t fully present. Owen’s career has been devoted to getting full access to their brains through various forms of brain testing.

  The author nimbly combines scientific, philosophical and personal approaches to brain injury. He repeatedly details the scientific means that allowed him to start and extend his career. We learn about his use of PET (positron-emission tomography) and then his move to fMRI (functional magnetic resonance imaging).

  Kate was the first patient whose consciousness he recognized through PET scans. Kate—surprisingly—recovered, and later wrote to Owen, asking him to use her case to show others that they too could be discovered despite their illness. Owen “felt an enduring, close connection with Kate, something that had a profound influence on me and my work; she was always Patient #1, always the person I’d refer to when I gave lectures about how this journey began” (p. 37).

  Kate is followed by Debbie, Kevin, Carol, Scott, and Juan. Although some patients may appear completely unconscious, studies show their brains are doing many things that their medical staff hadn’t spotted. Carol’s terrible looks, for example, show the devastating effects of brain trauma, which might horrify new scientists. Nonetheless, Carol was able to demonstrate that she was conscious in Owen’s testing.

  Over time, fMRI changed the nature of the testing. Moreover, Owen gradually figured out that his patients needed instructions so he could fully test their intent. He ordered them to think of playing tennis or walking around their house. Once again, surprisingly, many apparently vegetative patients’ brain activity matched that of healthy human beings.

  Owen also shrewdly includes philosophical approaches to consciousness throughout the book. It is, after all, what he is searching for. But he acknowledges that who has it, and who doesn’t, remains a perplexing inquiry. A six-month old? A four-year old? A teenager? One of his patients? From age to brain injury, we see the repeated philosophical difficulty of defining the scientists’ goal of finding people whose brains are really working.

  Unlike some scientists, Owen also includes a personal approach to the story, including his own life and a caring attitude toward his patients. We learn two moving life events. First, he was very sick as a child and needed extensive help from numerous medical people to get his health back.

  Second, we learn of his girlfriend and fiancée, Maureen. They lived together until they had a somewhat unpleasant break-up. Maureen then suffered a serious brain injury, from which she suffered until her death. Over the years he stayed in contact with her brother and studied her scans while her parents oversaw her care. Perhaps another surprise—at the end he feels that he is looking at scans of the woman he loved, not the one he fought and broke up with.

  When Maureen was healthy she had urged Owen to acknowledge that medicine was about caring for people, not simply uncovering scientific insights. By the end of the book, she had won him over: “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” (p. 258).

  These two experiences are reflected in the caring attitude Owen conveys toward his patients, starting with Kate and continuing throughout the book. There is also the frustration that some subjects do well and others don’t. For that reason, Owen has stopped using the word recovery because “[f]ew of the patients that I have seen return to anything resembling a ‘normal’ life. Indeed, most don’t recover at all” (p. 223).

  There is the contrast, for example, of Scott and Juan. Scott told the doctors through their testing that he was present and not in pain. The doctors were surprised, but not his mother, who said, “I knew he wasn’t in pain. If he was, he would have told me!” (p. 161). Scott, however, was not as lucky as Juan, who woke up one morning with a range of brain injuries that left him lying in his own vomit. Yet, seven months later, when Owen’s office called Juan’s family, they learned that he was doing well, and later went back to college and a full life. “Juan, the best ‘recovery’ story that I can tell after twenty years in this field, is the rare, rare exception that tells us that there is always some hope, however small. Juan has come almost all the way back from the gray zone, yet his experience there will have undoubtedly endowed him with a perspective and qualities that he didn’t have before. Juan has seen things that most of us will never see in our lifetimes.” (pp. 223-24).

  I read this book because I am a bioethics professor and, like Juan, one of the lucky ones. While I was out for a walk in October 2016, a stranger tried to murder me by throwing me on my head and kicking me. I was in the hospital for two months. My attacker was recently sentenced to 6-15 years.

  Fewer people know my almost-secret injury—that in 1993, as a pedestrian, I was hit by a car, banged my head against the ground, and had two brain surgeries.

  Both times, then and now, the doctors predicted I would either die or live institutionalized with permanent severe brain injury. Instead, after time in the hospital, I worked after 1993 and continue to work now, not needing any care.

  To my own experience, I add the people I met who have struggled with one brain injury or another. Many remained in the hospital, still injured, while I left. Other people have—almost—recovered from strokes, and yet still have aphasia or dementia.

  Both hospitalized and non-hospitalized brain injury victims continue to suffer from some aspects of their ordeal. Our shared experiences leave me curious why doctors don’t pay more attention to their healthy or almost-healthy patients. The well or almost-well would add to our scientific understanding of the brain. Yet many doctors remain unaware of their patients’ post-injury, out-of-hospital brain conditions.

  Similar to the lives of many patients in this book, across the country numerous family members have stepped in to guide their relatives through their differing losses. It was relatives, not doctors, who ultimately helped Maureen, Kate, Debbie, Kevin, Carol, Scott, and Juan live the best lives they could.

  Many doctors and scientists need to be more like Adrian Owen. They could learn that medicine and science improve when they reach beyond pure science to include philosophy and personal interest so that patients in the gray zone “can once again take their place among us in the land of the living” (p. 258).

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• National Post
  http://nationalpost.com/entertainment/books/book-reviews/in-into-the-gray-zone-neuroscientist-adrian-owen-communicates-with-those-who-cant
  Word count: 942

  In Into the Gray Zone, neuroscientist Adrian Owen communicates with those who can't
  Jay Hosking: Into the Gray Zone is a great example of conveying the mystery and humanity of scientific research to the general reader

  Special to National Post
  Special to National Post
  June 27, 2017
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  By Jay Hosking

  Into the Gray Zone: A Neuroscientist Explores the Border Between Life and Death
  By Adrian Owen
  Scribner
  320 pp; $34.99

  At the heart of every scientific discovery is a great detective story. While high-school teachers and pop-science writers may bore their audiences with a barrage of facts, the tale behind those facts is often a thrilling mystery that twists and turns in unexpected ways. Likewise, Adrian Owen’s Into the Gray Zone does not provide much in the way of insights but instead offers a riveting yarn of how researchers tackled an intractable scientific problem, namely how to make contact with those who can no longer communicate with the outside world.

  Owen, a neuroscientist based at Western University, has spent much of his career trying to answer a deceptively difficult question: how can we be sure if someone is conscious or not? The obvious answer, of course, is to ask that person to tell us, or to ask them for a visual cue. But this becomes problematic if that person cannot speak or move. For those with locked-in syndrome, as described by Jean-Dominique Bauby in The Diving Bell and Butterfly, a series of eye-blinks can be used to communicate letters, words, and ultimately their thoughts. (Bauby is said to have blinked 200,000 times to “write” his memoir, a Herculean effort.) But what about those in “persistent vegetative states,” who do not demonstrate any voluntary movement and generally do not react to stimuli in their environment?

  Into the Gray Zone describes a number of these patients who – through car accidents, stroke, or neurodegenerative diseases – sustain traumatic brain injury that leaves them incapable of interacting with the outside world. These individuals have long been presumed to have no consciousness, which has undoubtedly affected their treatment by professional caregivers; after all, why speak to someone who can’t hear you? But family members often insist that their loved one is still in there, trapped inside their body with virtually no way to communicate. Relatives may believe this because they are more sensitive to the signs – a sigh, a squeeze of the hand – or because they are simply looking for hope in a horrific situation. But no compelling evidence had been shown to demonstrate consciousness in persistent vegetative states.

  Scribner Scribner
  Enter Owen and his research, which suggests that up to 20 per cent of these patients may in fact be aware of their location, the passage of time and their sense of self. Into the Gray Zone takes readers through the steps of how these discoveries were made, and this feature – a narrative arc that shows how science is done – sets Owen’s book apart from the majority of contemporary pop-science fare, and makes it a delight for readers. From emerging technologies to valid criticism of his research, Owen shows us the thought process of his team as they iterate upon and improve their methods, and thus their results. Like any good mystery, it would be a shame for the solution to be spoiled in advance, but suffice it to say that Owen demonstrates, with a high degree of certainty, that not only are many of these patients conscious to some degree, they are also able, through a novel trick of functional brain imaging, to communicate with the researchers.

  But once you can communicate with someone trapped inside their body, a person incapable of performing even the most basic behaviours or speech, troubling questions arise. Are they unhappy? Are they suffering or in pain? Do they want to die? Thankfully, Owen does not shy away from such difficult topics and the ethical quandaries they present for both researchers and society. Occasionally, his scientific detachment is jarringly incongruent with the circumstances, such as when he calls a patient’s referral a “scientific fairy tale” immediately before describing their tragic car accident, or describes new results as “sexier” while an incapacitated patient lies in the MRI scanner.

  A reminder of the evolving, ‘restrained rapture’ of Toronto architecture
  ‘Too much blood for good literature’: On Arundhati Roy’s imperfect follow-up to The God of Small Things
  But overall, Owen presents a very compassionate case for why this research is beneficial not just for the science of consciousness, but also for the well-being of the individuals trapped in persistent vegetative states. In fact, the book’s human story far surpasses the scientific one: we learn little about the neuroscience of consciousness, but much about Owen’s motivations for doing the research, and how the findings have direct and indirect benefits for the patients and their families.

  Ultimately, Owen has written a better book by focusing more on the narrative journey and less on the science. He presents research as detective work, and shows the scientists themselves as human beings capable of doubt and compassion. He also spends considerable time on the stories and incredible fortitude of these patients and their families in the face of such hardship. In contrast to many contemporary pop-science offerings, Into the Gray Zone is a great example of conveying the mystery and humanity of scientific research to the general reader.

• Metapsychology Online Reviews
  http://metapsychology.mentalhelp.net/poc/view_doc.php?type=book&id=7945
  Word count: 5312

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  Bernard Williams
  Better Humans?
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  Defining the Beginning and End of Life
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  Demons of the Modern World
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  Destructive Trends in Mental Health
  Developing the Virtues
  Did My Neurons Make Me Do It?
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  Double Standards in Medical Research in Developing Countries
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  Early Warning
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  Emerging Conceptual, Ethical and Policy Issues in Bionanotechnology
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  Encountering Nature
  Encountering the Sacred in Psychotherapy
  Engendering International Health
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  Enough
  Eros and the Good
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  Essays on Derek Parfit's On What Matters
  Essays on Free Will and Moral Responsibility
  Ethical Choices in Contemporary Medicine
  Ethical Conflicts in Psychology
  Ethical Dilemmas in Pediatrics
  Ethical Issues in Behavioral Research
  Ethical Issues in Dementia Care
  Ethical Issues in Forensic Mental Health Research
  Ethical Issues in the New Genetics
  Ethical Life
  Ethical Reasoning for Mental Health Professionals
  Ethical Theory
  Ethical Wills
  Ethically Challenged Professions
  Ethics
  Ethics
  Ethics
  Ethics and Animals
  Ethics and Science
  Ethics and the A Priori
  Ethics and the Discovery of the Unconscious
  Ethics and the Metaphysics of Medicine
  Ethics at the Cinema
  Ethics Case Book of the American Psychoanalytic Association
  Ethics Done Right
  Ethics Expertise
  Ethics for Everyone
  Ethics for Psychologists
  Ethics for the New Millennium
  Ethics in Cyberspace
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  Ethics, Culture, and Psychiatry
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  Evaluating the Science and Ethics of Research on Humans
  Evil
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  Evil in Modern Thought
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  Evolutionary Ethics and Contemporary Biology
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  Experiments in Ethics
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  Fact and Value
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  False-Memory Creation in Children and Adults
  Fat Shame
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  Feminism and Its Discontents
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  Final Exam
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  Flashpoint
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  Foundational Issues in Human Brain Mapping
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  From Darwin to Hitler
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  Getting Real
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  Handbook for Health Care Ethics Committees
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  If That Ever Happens to Me
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  In Defense of Flogging
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  Into the Gray Zone
  Is Human Nature Obsolete?
  Is Long-Term Therapy Unethical?
  Is There a Duty to Die?
  Is There an Ethicist in the House?
  Issues in Philosophical Counseling
  Judging Children As Children
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  Kant on Moral Autonomy
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  Learning from Baby P
  Leaving You
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  Let Them Eat Prozac
  Levelling the Playing Field
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  Moral Psychology: Volume IV
  Moral Realism
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  My Body Politic
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  Nietzsche on Ethics and Politics
  No Child Left Different
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  Oath Betrayed
  Of War and Law
  On Apology
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  Out of Eden
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  Oxford Handbook of Psychiatric Ethics
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  Text and Materials on International Human Rights
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  The American Psychiatric Publishing Textbook of Forensic Psychiatry
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  Into the Gray ZoneReview - Into the Gray Zone
  A Neuroscientist Explores the Border Between Life and Death
  by Adrian Owen
  Simon & Schuster Audio, 2017
  Review by Christian Perring
  Sep 26th 2017 (Volume 21, Issue 39)
  Often in medical ethics, we discuss famous cases of persistent vegetative states such as Karen Quinlan, Nancy Cruzan, and Terri Shiavo. We explain that in a PVS there is no hope of recovery or even any return to consciousness. Of course, there are some stories in the news of people who were in comas for many years who finally awake, and we say that they must have been misdiagnosed. But Adrian Owen's book Into The Gray Zone shows that things are more complicated than we have been saying. He says that about 20% of people diagnosed as being in a PVS are in fact capable of experiencing what is going on around them and it may be possible to communicate with them. His book tells of his research about how to establish that communication.

  We are familiar with locked-in syndrome, where patients are completely paralyzed but are still conscious. Jean-Dominique Bauby described this in his memoir The Diving Bell and the Butterfly. He woke up after a stroke unable to move anything except for his eyes, and he eventually wrote his memoir simply by moving his eyes and interacting with a computer. Owen says that people in the Gray Zone may not even have that much ability, but can still have a conscious life.

  One of his main points is that it is far too simplistic to divide people up into a people who are in a PVS and those who are not. Rather than there being a uniform condition PVS that is the same for all in it, in fact every case is different. Each person with significant brain damage has a different set of deficits and a different chance of recovery. Probably the majority have no hope of recovery, but there is a significant portion of people diagnosed as being in a PVS who have some potential and can recover some abilities. So the very category of PVS is thrown into doubt as being a useful one. While most people whose higher brain functions seem to have ceased have no chance of any recovery, some portion of them can recover, and we need to be more careful about how we diagnose them, and we need to work on identifying those who are still conscious and find ways to communicate with them.

  Owen explains his research journey of investigating people who have suffered major brain damage. He started as a researcher in the UK at the University of Cambridge. Over his career he has moved around a good deal, and he is currently located at the University of Western Ontario. He tells his story by going through some of his most important cases and some of his own personal life events, including his relationship with Maureen, who he was once very close, and then split up with. Strangely, even though their relationship didn't last very long, she plays a significant role in the story. Owen also explains his intellectual journey of coming to think more carefully about the nature of consciousness and personhood. He describes some of his discussions with experts from psychology, neuroscience, and philosophy, bringing out the richness of the issues and the difficulty of achieving consensus.

  It's Owen's results that are the most striking. While these have been covered in many documentaries and in the news, they are still not widely appreciated. He has been able to communicate with people who were diagnosed with PVS though ever-increasingly sophisticated brain scans by telling them to imaging playing tennis if the answer to his question is yes, or imagining their homes if the answer is no. Different parts of the brain are involved in the different activities and it is possible for people to give answers to questions in some very rare cases even though there is no way for them to control any part of their body.

  So Into the Gray Zone is a significant book for anyone interested in the varieties of consciousness, minimally conscious states, persistent vegetative states, and the way we deal with patients who have significant brain damage. It suggests that we should be much more careful in diagnosing and caring for people who seem to have lost consciousness.

  It is worth checking out the videos of patients on the website for the book.

  The unabridged audiobook is performed by Steve West with clarity and consistency that make the technical details easy to follow.

  © 2017 Christian Perring

  Christian Perring teaches in NYC.

• The Globe and Mail
  https://www.theglobeandmail.com/arts/books-and-media/book-reviews/matters-of-life-and-death/article35826381/
  Word count: 1329

  BOOK REVIEW
  Review: Leslie Kean's Surviving Death and Adrian Owen's Into the Gray Zone explore human consciousness
  Open this photo in gallery:
  SASHA CHAPIN
  SPECIAL TO THE GLOBE AND MAIL
  PUBLISHED JULY 28, 2017
  UPDATED JULY 28, 2017
  Surviving Death: A Journalist Investigates Evidence for an Afterlife

  By Leslie Kean

  Crown, 416 pages, $36

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

  By Adrian Owen

  Scribner, 304 pages, $34.99

  Books about death are automatically fascinating. Death, after all, is life's only real given, but it's also life's only real mystery. We're all going to get there, but we don't know what's going to happen on the other side. It's unknowable. Even if you believe in heaven, you really don't know what heaven's going to feel like. Maybe you won't like it. Regardless, as much as we can gather information about death – learn about its tendencies and what it feels like when it's approaching – the feeling itself, that moment of consciousness disappearing, is completely inaccessible.

  Or is it? Not according to Leslie Kean's compulsively readable new book, Surviving Death. Kean says that, actually, we know plenty about what happens after we die. She tells us all about it, drawing on testimony from cardiac patients who have had near-death experiences, dialogues with psychic mediums and the apparent ability of some children to recall past lives. The upshot, according to Kean: Death may not truly be the end of consciousness.

  The whole book builds toward this possibility, what Kean calls the survival hypothesis – that, when we conk out, the soul flees the body and lurks in some other realm, until potentially inhabiting another body. Basically, Kean is trying to prove that reincarnation is a real thing, despite what all those joyless, skeptical scientists would tell you. And she purports to prove it objectively. The stakes are high: Kean writes that a "greater understanding of the nature of consciousness and its possible survival beyond bodily death could have far-reaching, enlightening effects on humanity."

  And she does a great job. There's a lot of compelling data in this book. It's hard not to feel a little chill as you read the story of James Leininger, a child who is believed to be the reincarnation of a Second World War bomber pilot. When he was two years old, he started having vivid nightmares about airplane crashes. Upon waking, he had a habit of telling his father weirdly specific details about who he was in the dream: a pilot with the aircraft carrier Natoma who had once flown a Corsair fighter and was in a squad with another pilot named Jack Larsen. James insisted that, in this previous life, he was also named James.

  All of these things turned out to be plucked from the life of an actual person, who died in exactly the kind of plane crash that James had nightmares about. It all matched up exactly. Assuming that his parents reported everything correctly, explaining this is difficult without at least a tentative belief in the possibility of the survival hypothesis.

  But the spookiest account in the book is probably that of Maria, a migrant worker who died temporarily in 1977. During a moment of cardiac arrest, she reported that she flew from her body. And while she was up there, she saw a scuffed-up tennis shoe sitting on a windowsill of one of the top storeys of the hospital – a shoe that would have been invisible from any of her previous vantage points. Maria excitedly told a nurse about the shoe, who went up to look for it and found it to be exactly as Maria had described. How do you explain that?

  By the end of the book, Kean's evidence seems overwhelming. If you take her seriously, you'll believe what she has to say. And she does a great job of seeming objective. She quotes scientists she claims are respectable, writes in laconic prose and addresses potential objections with generosity.

  The only problem is that if you know even a little about the field of parapsychology – the study of psychic powers, basically – you'll know that Kean is deeply credulous. The whole book rests on her acceptance of supernatural powers of the mind. She makes the claim that "extraordinary abilities … have been studied under controlled conditions" and that "after over a hundred years of research, and even though mainstream science may not accept it, this repeated documentation has established that these abilities are real."

  Well, not really. The field of parapsychology has produced some interesting research, but it has also been riddled with controversy, poor experimental design and fraud. The most promising experiments have come from Daryl Bem, who has done all sorts of wacky things, such as showing subjects two curtains, one of which hides a pornographic image, and asking them to point out the image. Some of his experiments seem to indicate psychic effects. The problem is that they repeatedly fail to replicate and tend to produce measurable effects that barely lie within the realm of statistical significance.

  As such, the book loses a bit of its magic. While Kean provides some apparently solid evidence for her propositions, she also provides a lot of applesauce, which makes it hard to believe her. And I'm genuinely sorry about this, because being an adherent of mainstream science is way less fun.

  This is effectively demonstrated by Into the Gray Zone, the model of how pop science involving sensational subjects should be done. The book documents neuroscientist Adrian Owen's remarkable research into a weird phenomenon: People in vegetative states occasionally exhibit signs of consciousness.

  Owen's research has a shocking result: Some apparently comatose people are fully conscious. Not barely conscious – fully. They remember who entered their hospital room and what words were spoken to them. They play for years in a memory palace, unencumbered by their physical bodies.

  Owen is a good scientist, so he doesn't exaggerate his findings or weave them into a grand metaphysical web, as Kean does. As a result, Owen's book occasionally lags, even though it details a scientific triumph. He carefully recounts experimental procedure, making it clear what certain brain-measurement systems can and can't do. He describes in great detail how years of work with vegetative patients finally yielded a solid method of measuring consciousness. Are you asleep yet?

  Owen's methods are cool and strange. Apparently, everyone who imagines playing tennis exhibits the same brain activity, so you can ask vegetative patients to say yes to questions by imagining tennis. However, the explanation of how Owen got there is, at times, fairly dull. And, though he strings his findings together with a narrative about his life, written in an amiable, conversational tone, you start to wonder why it's a book instead of a long article.

  This is the problem with writing about science: Even if you find astonishing things in the lab, it's the result of months or years of drudgery, failure and false starts. So if you write about science and every page offers slam-bang confirmation of some amazing new reality, then you're probably lying. But if you write an accurate narrative about scientific discovery, it won't be much of a beach read.

  Ultimately, Kean's book provides a fascinating glimpse behind the veil of consciousness – and a reassuring message: Our souls persist, there's evidence of the afterlife and there is essentially nothing to fear from death – except perhaps brief final pain. Owen's book, meanwhile, provides an interesting brush against the limits of our lived experience, but doesn't offer anything hugely uplifting. It's a shame that only one of these books is credible.

  Sasha Chapin is a writer in Toronto whose first book, Perfect Information Game, will be published in 2019.

• South China Morning Post
  http://www.scmp.com/magazines/post-magazine/books/article/2108912/locked-syndrome-explored-new-book-gray-zone
  Word count: 289

  BOOKS
  REVIEWS

  Charmaine Chan

  Into the Gray Zone by Adrian Owen
  Locked-in syndrome explored in new book Into the Gray Zone
  Neuroscientist Adrian Owen examines the fine line between life and death and shows what it means to be alive

  3 SEP 2017

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  A patient in a coma. Picture: Alamy
  A patient in a coma. Picture: Alamy
  Into the Gray Zone
  by Adrian Owen
  Simon & Schuster

  The gray zone is the stuff of nightmares but, equally, hope. Imagine hearing the order “do not resuscitate” when you are trapped in a vegetative state but actually conscious.

  With this book, British neuroscientist Adrian Owen, who has spent two decades trying to “pull people out of the void”, forces us to consider that belt between life and death, and points to a study of 91 people with “locked-in” syndrome (conscious but able to communicate only with their eyes) that revealed only seven wanted to be euthanised.

  Owen tells movingly, sometimes thrillingly, of people whose conditions have helped others understand what it means to be alive. For example, in response to his question, “Are you in pain?” an otherwise unresponsive patient indicated using only brain activity: “No.” That breakthrough can be seen through a BBC video link mentioned in the book.

  Also important is the section in which Owen explains that consciousness (and the ability to experience pain) is “highly unlikely” in any form before about 33 weeks after conception.

  Metaphysical arguments in the absence of physical answers, are, he says, irrational.

• San Francisco Review of Books
  http://www.sanfranciscoreviewofbooks.com/2017/06/book-review-into-gray-zone.html
  Word count: 552

  Tuesday, June 27, 2017
  Book Review: 'Into the Gray Zone: A Neuroscientist Explores the Border Between Life and Death' by Adrian Owen

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

  Review by David Wineberg

  There are endless ways to damage ourselves. There are endless ways to damage our brains, possibly the most frightening condition of all. Because We Are Our Brains – our awareness, our consciousness, our personalities. In The Gray Zone examines those minds trapped in their unmoving bodies, still able to observe, retain and exist. But on the outside, no one knows that. Without intending to, neuroscientist Adrian Owen has spent a lifetime discovering how to penetrate those immobile presences, and actually communicate with some of them. It is a very upbeat voyage of discovery, emotionally told. Owen makes it not just bearable but fascinating. It is very difficult to stop reading.

  His own relationships were fraught with brain damage – that of his mother and his ex. His own childhood was marred by the medical torture of cancer. But the unshakeable enthusiasm, joy at discovery and excitement of at achievements large and small have made for a breakthrough career, and a clear acceleration towards the day when brains will be able to communicate.

  The stories are of men and women of all ages, seemingly vegetative. Owen’s early research on the brain led him to the realization that different thoughts are processed in different areas, because our brains are that specialized. There is a place in the brain that does nothing but process places, and another that does nothing but process actions. If you think of a place where you took action, your brain will hand off the thought from one section to the other. Owen’s breakthrough idea was to put vegetative patients in an fMRI scanner and tell them to think of an action (playing tennis) for “no” or walking through their home for “yes”. The live scans now possible show the various areas of the brain light up in response to yes/no questions, proving these inanimate people are still in there, still aware, still fighting. Possibly one in five is conscious enough to provide this sort of “conversation”.

  More remarkable, perhaps, is that some recover. Owen has had face to face conversations with patients who remember his experiments. Their experiences, their observations, and their trials are beyond gripping – they are heart-rending.

  The lesson, if there is one, is to treat vegetative patients with total respect. They want to know names, titles and roles. They want explanations of what treatment they are about to receive. The pointless chatter and undeserved reinforcement are very much appreciated if not critical to their potential appreciation and quality of life.

  Into the Gray Zone is a shock and an inspiration. There are surprises at every turn. There is suspense, success, failure and reward. It is a book of life.

  Editor's note: This review has been published with the permission of David Wineberg. Like what you read? Subscribe to the SFRB's free daily email notice so you can be up-to-date on our latest articles. Scroll up this page to the sign-up field on your right.

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