The Sickness (Not) Unto Death: A Neurological Crotchet, Maybe (or More Likely Not)

Fear and Trembling and The Sickness (Not) Unto Death

It seems potentially significant that a reader of some of the middlebrow American intellectual journals (i.e., me) could have completely failed to notice this year’s Søren Kierkegaard bicentenary. There was a time, not all that many decades ago, when Kierkegaard was de rigueur reading for certain types of atheists and believers alike. Today nobody even reads the writers who told us about Kierkegaard.

Those of us then-undergraduates who were already chafing at the old-fashioned existentialism of our elders were delighted by the line in Carl Dreyer’s 1955 film Ordet (The Word) spoken by the rural Danish father whose theology-student son has succumbed to the delusion that he is Jesus and been sent home to be kept from harm; when the visiting pastor asks sympathetically, “Has he always been this way?” the father answers, “No. He got this way reading Søren Kierkegaard.” At the end of the movie, the lunatic son raises a woman from the dead by the power of the Word, leaving us freshmen viewers thoroughly bewildered (in that era before magical-realist cinema made the occasional miracle par for the course).

Today’s eighteen-year-olds might offer a glib, probably erroneous naturalistic explanation for the resuscitation, for it turns out that we are raising people from the dead all the time, though not nearly as often as we apparently could if we put our minds and technology to it. For brain cells do not fatally decay until at least eight hours or so after cardiac arrest has put an end to breathing and brain activity alike, and if body temperature is lowered sufficiently, resuscitation of the dead remains feasible for even longer—provided the underlying cause of death is sufficiently reversible. The body revolts with massive inflammation against this insult to the previously normal course of events, but with the right amount of tweaking of the metabolism, the circuits that modulate consciousness come back into normal operation, and presto, the person is back, not exactly good as new but with a fighting chance of continued survival after a period of flatlining from which it would previously have been considered impossible to restore normal cardiac activity and brain functioning.

Or so writes Sam Parnia, M. D. and his co-author Josh Young, in Erasing Death: The Science That Is Rewriting the Boundaries Between Life and Death. Dr. Parnia presumably knows whereof he writes, having had considerable direct experience in pulmonary and critical care medicine as well as continuing to study the (here extensively cited) literature as assistant professor of critical care medicine and director of resuscitation research at the State University of New York at Stony Brook.

At the very least, this new capacity for resuscitation complicates the issue of when death begins. Dr. Parnia insists that if having no brain activity whatsoever (because the cells are suffering from oxygen starvation following the cessation of heart and lung activity) does not constitute death, then what does? But if death is reversible right up to the point when cellular degeneration renders resuscitation impossible, what does this imply for the transplantation of organs in cases when death has not been caused by irreversible injuries?

That would be a difficult enough concept to contemplate, but Dr. Parnia is determined to address the nature of consciousness as well. He explains succinctly the biochemical methods by which today’s anesthetic drugs turn off the circuits that modulate consciousness like turning off a light switch (as those of us who have had surgical procedures recently can testify), but then complicates the picture by citing the discomfiting research by which physicians discovered that patients in deep coma could respond to commands to imagine themselves playing tennis (the appropriate parts of the brain showed discernible activity), and the extent to which seemingly comatose patients undergoing resuscitation from cardiac arrest were aware of what was going on in the room around them—to cite only two classic examples. It would appear that consciousness is there even when it isn’t functioning normally—responding to linguistic commands, which is considerably more than simple stimulus-response, whether self-awareness is present or not. (The problem of language acquisition in the first place is just one of the many side issues that aren’t addressed in Dr. Parnia’s main quest for how we can be functioning as though we were conscious when the circuits that modulate consciousness are indisputably not in operation.)

This body of evidence for the need to revise our notions about consciousness slides over into the case of that small percentage of resuscitated patients who have witnessed, while in a state of clinical death, the activity in the room from the perspective of a corner of the ceiling above the action. Dr. Parnia is of the opinion that the commonplace explanation for this (the so-called “dying brain hypothesis”) is contradicted by simple medical evidence to the contrary, and insists that we should entertain the hypothesis that consciousness is in fact an autonomous entity of some as yet unknown composition, modulated by brain circuitry but capable of perception outside the ordinary physical organism.

Dr. Parnia is director of the international AWARE study that has attempted to determine whether patients who experience out-of-body perception can actually see and remember some aspect of the room not visible from below. With the characteristic perversity of events, the patients reporting the most spectacular experiences have suffered their cardiac arrest in rooms not equipped for the AWARE project, and most resuscitated patients have no recollection of anything whatsoever. (Dr. Parnia points out the massive brain trauma involved in resuscitation, and notes that most people have no recollection of their dreams, either, even though we know that each of us dreams every night.)

Frustratingly, Dr. Parnia seems to have made his way through the debate on the nature of consciousness without noticing the available literature on the portion of the brain that governs the specific out-of-body experience of floating above the scene. It’s assumed to govern the sense of physical placement and displacement, but I have seen no convincing explanation for why stimulating it should create an illusion as specific as the visualization of the immediate surroundings from overhead, rather than from, say, under the table or upside down—or what would bring it into play with some regularity in cases of brain shutdown due to oxygen starvation, followed by the restoration of brain activity. Surely this is as pertinent a question as how it comes to be that any patients at all can reconstruct events that happened while their brains were in a condition of complete stasis—if they compile the narrative in a single moment upon the restoration of brain activity, that in itself would involve perceptual behaviors of the organism we currently regard as impossible. We could bracket the problem of lights and tunnels and such seemingly paranormal paraphernalia, and still be left with a fundamental conceptual dilemma.

Dr. Parnia admits his own particular cultural filters, or at least implies what they are, and such filters inevitably shape our interpretation of data—were it otherwise, run-of-the-mill atheists would not turn into raving lunatics when confronted with this kind of violation of their cultural shibboleths—but he coyly sidesteps the degree to which he shares the overall beliefs of the “distinguished professor of surgery and anatomy” whose proposals he finds most relevant to his research. (I shall refrain from telling you who it is, since the name alone is unlikely to shed light on Dr. Parnia’s presuppositions, and examination of his beliefs would be a subject for a separate essay.) As a good empiricist, Dr. Parnia is unwilling to hypothesize, for the purposes of his book and his research project, anything other than that consciousness can function outside the body, for an unknown length of time, for reasons we do not understand but could come to understand, just as we have come to understand the other phenomena of the universe.

Whether this would entail erasing the boundaries between nature and what we used to think of as supernature, and what sort of conceptual structure might already have been constructed over the centuries based on this epistemological premise—that is a question Dr. Parnia also passes over in silence.

What we cannot speak about we must pass over in silence—at least, within the ground rules of the particular language game we have agreed to play at this particular moment. And Erasing Death already has problematic moments in that regard, which the attentive reader will notice as lapses into seeming naiveté about the nature of our emotional life—but it would be difficult to incorporate all the paradoxes of neuroscience into the book without completely derailing its original purpose. Suffice it to say that Dr. Parnia dismisses as an obvious absurdity a paradox about which David Eagleman spends an entire chapter of Incognito wringing his hands in bewildered dismay—and Eagleman is the neuroscientist who ends his book with a just-so story about the possible nature of consciousness that, curiously enough, happens to agree with Dr. Parnia’s hypothesis.

Being Crotchety, 2: Mark Lilla writes a new preface for Isaiah Berlin's Against the Current

Kierkegaard Unfair to Schlegel (that’s the title of a forgotten short story by Donald Barthelme, in case you were wondering)


Mark Lilla writes about “Isaiah Berlin Against the Current” in the April 25, 2013 New York Review of Books, citing the insights available to the historian of ideas that may be less apparent to those who examine ideas in more isolated contexts.

He quotes a rather lovely passage from something Berlin wrote about J. G. Hamann, “whose angry, brilliant, quasi-mystical writings,” as Lilla phrases it, “inspired the German Romantics and modern philosophical antirationalism.” Lilla’s expansion of Berlin’s remarks interests me as much as what Berlin himself has to say. (In the passage that Lilla quotes, Berlin was concerned with the horrifying consequences of German Romanticism run amuck, a chain of consequences that began with Hamann’s enunciation of “truths too contemptuously ignored by the triumphant rationalist schools, not only in his own century, but in the great Victorian advance and its continuation in countries that came relatively late to this feast of reason”—the truths of the “outraged sensibility” of one who “understood that ethics is concerned with relations between real persons.” Lilla notes that Berlin’s reading of Hamann and his discontents reflects something of the great historian of ideas’ own “capacity for sympathy and loathing of cruelty.” But that is not where I want to go with this note.)

Lilla singles out a particularly instructive example of what a historian of ideas like Isaiah Berlin can extract from examining, not “the truth conditions of an assertion and the inferences that can reasonably be drawn from it” but “the inferences people actually have drawn from it under different conditions, what they thought it implied, and what it inspired them to do.” While living in London, Hamann came to believe in David Hume’s brand of extreme skepticism at the same time that he underwent a religious crisis. Hamann extracted unexpected implications from Hume’s arguments—arguments that Hume had intended to “undermine the claims of religion, and the reality of miracles in particular.” Writing to his friend and newfound opponent Immanuel Kant, Hamann essentially quipped that Hume needed a leap of faith just to eat breakfast (actually, he wrote that Hume “needs faith if he is to eat an egg”) and thus, as Lilla puts it, asserting that “by denying religion the support of reason, Hume had also protected it from rational scrutiny, leaving the field open for faith.” This prospect so horrified Immanuel Kant that he set about trying to define the relationship between reason, perception, and the limits of knowledge. “The challenge posed by the bitter, obscure Hamann was what put him on the path to the Critique of Pure Reason."

I really do not want to revisit all of this stuff (as they put it sometime in the Late Paleolithic, “been there, done that, bought the T-shirt”) but I do think we ought to revisit the issues, rather than the history of them, by juxtaposing the world’s multiple parallel solutions to the ongoing cognitive and behavioral dilemmas of existence in the world, and trying to unravel or unpack (pick your metaphor) what the ideas meant and might mean in terms of contemporary thought, action and passion. At the same time, we ought to remain aware of the unfortunate history that has flowed from taking the ideas themselves too seriously, or following them too far to their logical or their emotional conclusions.