Medical aspects
The medical approach to consciousness is practically oriented. It derives from a need to treat people whose brain function has been impaired as a result of disease, brain damage, toxins, or drugs. In medicine, conceptual distinctions are considered useful to the degree that they can help to guide treatments. Whereas the philosophical approach to consciousness focuses on its fundamental nature and its contents, the medical approach focuses on the amount of consciousness a person has: in medicine, consciousness is assessed as a "level" ranging from coma and brain death at the low end, to full alertness and purposeful responsiveness at the high end.[160]
Consciousness is of concern to patients and physicians, especially neurologists and anesthesiologists. Patients may suffer from disorders of consciousness or may need to be anesthetized for a surgical procedure. Physicians may perform consciousness-related interventions such as instructing the patient to sleep, administering general anesthesia, or inducing medical coma.[160]Also, bioethicists may be concerned with the ethical implications of consciousness in medical cases of patients such as the Karen Ann Quinlan case,[161] while neuroscientists may study patients with impaired consciousness in hopes of gaining information about how the brain works.[162]
Assessment
In medicine, consciousness is examined using a set of procedures known as neuropsychological assessment.[93] There are two commonly used methods for assessing the level of consciousness of a patient: a simple procedure that requires minimal training, and a more complex procedure that requires substantial expertise. The simple procedure begins by asking whether the patient is able to move and react to physical stimuli. If so, the next question is whether the patient can respond in a meaningful way to questions and commands. If so, the patient is asked for name, current location, and current day and time. A patient who can answer all of these questions is said to be "alert and oriented times four" (sometimes denoted "A&Ox4" on a medical chart), and is usually considered fully conscious.[163]
The more complex procedure is known as a neurological examination, and is usually carried out by a neurologist in a hospital setting. A formal neurological examination runs through a precisely delineated series of tests, beginning with tests for basic sensorimotor reflexes, and culminating with tests for sophisticated use of language. The outcome may be summarized using the Glasgow Coma Scale, which yields a number in the range 3–15, with a score of 3 to 8 indicating coma, and 15 indicating full consciousness. The Glasgow Coma Scale has three subscales, measuring the best motor response (ranging from "no motor response" to "obeys commands"), the best eye response (ranging from "no eye opening" to "eyes opening spontaneously") and the best verbal response (ranging from "no verbal response" to "fully oriented"). There is also a simpler pediatric version of the scale, for children too young to be able to use language.[160]
In 2013, an experimental procedure was developed to measure degrees of consciousness, the procedure involving stimulating the brain with a magnetic pulse, measuring resulting waves of electrical activity, and developing a consciousness score based on the complexity of the brain activity.[164]
Disorders of consciousness
Medical conditions that inhibit consciousness are considered disorders of consciousness.[165] This category generally includes minimally conscious state and persistent vegetative state, but sometimes also includes the less severe locked-in syndrome and more severe chronic coma.[165][166] Differential diagnosis of these disorders is an active area of biomedical research.[167][168][169] Finally, brain deathresults in an irreversible disruption of consciousness.[165] While other conditions may cause a moderate deterioration (e.g., dementia and delirium) or transient interruption (e.g., grand mal and petit mal seizures) of consciousness, they are not included in this category.
Anosognosia
One of the most striking disorders of consciousness goes by the name anosognosia, a Greek-derived term meaning 'unawareness of disease'. This is a condition in which patients are disabled in some way, most commonly as a result of a stroke, but either misunderstand the nature of the problem or deny that there is anything wrong with them.[170] The most frequently occurring form is seen in people who have experienced a stroke damaging the parietal lobe in the right hemisphere of the brain, giving rise to a syndrome known as hemispatial neglect, characterized by an inability to direct action or attention toward objects located to the left with respect to their bodies. Patients with hemispatial neglect are often paralyzed on the right side of the body, but sometimes deny being unable to move. When questioned about the obvious problem, the patient may avoid giving a direct answer, or may give an explanation that doesn't make sense. Patients with hemispatial neglect may also fail to recognize paralyzed parts of their bodies: one frequently mentioned case is of a man who repeatedly tried to throw his own paralyzed right leg out of the bed he was lying in, and when asked what he was doing, complained that somebody had put a dead leg into the bed with him. An even more striking type of anosognosia is Anton–Babinski syndrome, a rarely occurring condition in which patients become blind but claim to be able to see normally, and persist in this claim in spite of all evidence to the contrary.[171]
Stream of consciousness
William James is usually credited with popularizing the idea that human consciousness flows like a stream, in his Principles of Psychology of 1890. According to James, the "stream of thought" is governed by five characteristics: "(1) Every thought tends to be part of a personal consciousness. (2) Within each personal consciousness thought is always changing. (3) Within each personal consciousness thought is sensibly continuous. (4) It always appears to deal with objects independent of itself. (5) It is interested in some parts of these objects to the exclusion of others".[172] A similar concept appears in Buddhist philosophy, expressed by the Sanskrit term Citta-saṃtāna, which is usually translated as mindstream or "mental continuum". Buddhist teachings describe that consciousness manifests moment to moment as sense impressions and mental phenomena that are continuously changing.[173] The teachings list six triggers that can result in the generation of different mental events.[173]These triggers are input from the five senses (seeing, hearing, smelling, tasting or touch sensations), or a thought (relating to the past, present or the future) that happen to arise in the mind. The mental events generated as a result of these triggers are: feelings, perceptions and intentions/behaviour. The moment-by-moment manifestation of the mind-stream is said to happen in every person all the time. It even happens in a scientist who analyses various phenomena in the world, or analyses the material body including the organ brain.[173] The manifestation of the mindstream is also described as being influenced by physical laws, biological laws, psychological laws, volitional laws, and universal laws.[173] The purpose of the Buddhist practice of mindfulness is to understand the inherent nature of the consciousness and its characteristics.[174]
Narrative form
In the West, the primary impact of the idea has been on literature rather than science: "stream of consciousness as a narrative mode" means writing in a way that attempts to portray the moment-to-moment thoughts and experiences of a character. This technique perhaps had its beginnings in the monologues of Shakespeare's plays and reached its fullest development in the novels of James Joyce and Virginia Woolf, although it has also been used by many other noted writers.[175]
Here, for example, is a passage from Joyce's Ulysses about the thoughts of Molly Bloom:
Spiritual approaches
To most philosophers, the word "consciousness" connotes the relationship between the mind and the world. To writers on spiritual or religious topics, it frequently connotes the relationship between the mind and God, or the relationship between the mind and deeper truths that are thought to be more fundamental than the physical world. The mystical psychiatrist Richard Maurice Bucke, author of the 1901 book Cosmic Consciousness: A Study in the Evolution of the Human Mind, distinguished between three types of consciousness: 'Simple Consciousness', awareness of the body, possessed by many animals; 'Self Consciousness', awareness of being aware, possessed only by humans; and 'Cosmic Consciousness', awareness of the life and order of the universe, possessed only by humans who are enlightened.[177] Many more examples could be given, such as the various levels of spiritual consciousness presented by Prem Saran Satsangi and Stuart Hameroff.[178]
Another thorough account of the spiritual approach is Ken Wilber's 1977 book The Spectrum of Consciousness, a comparison of western and eastern ways of thinking about the mind. Wilber described consciousness as a spectrum with ordinary awareness at one end, and more profound types of awareness at higher levels.[17
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