Many vegetative patients are actually 'covertly conscious'
This unsettling new understanding of vegetative patients raises medical ethics issues.
- For a long time, doctors assessed whether patients were in vegetative states through behavioral tests.
- However, brain scans have revealed that some of these patients are actually in a state of "covert consciousness."
- Covertly conscious patients are aware of their surroundings, but cannot respond to external stimuli.
In 2005, a 23-year-old woman was caught in a traffic accident that gave her a traumatic brain injury. Her doctors diagnosed her as being in a vegetative state — that is, absent of awareness and responsiveness, but still able to keep her heart pumping, her lungs breathing, to fall asleep and become awake, and so on.
Five months after her accident, however, researchers conducted an experiment showing that she had not completely lost her conscious awareness. Using an fMRI, researchers asked her to imagine playing tennis or walking through her house. Though the patient had been unable to respond to any other cues, the fMRI showed that her brain lit up when asked to imagine these things, suggesting that she was, in fact, conscious to some degree — just unable to move her hands or open her eyes on command. This patient would be the first time that signs of consciousness were detected in an ostensibly vegetative state using fMRI.
The trouble with diagnosing vegetative states
Since then, more and more cases of this sort have come to light. In fact, over the years, researchers estimate that around 10 to 20 percent of supposedly vegetative patients in fact experience what's called "covert" consciousness. Patients with covert consciousness do not respond to behavioral tests of awareness yet show brain activity related to awareness. It is important to note that covertly conscious patients do not fail to respond to behavioral tests because they are paralyzed. Instead, they fail to respond because the parts of their brain that respond to stimuli are damaged — they can still move, and sometimes will, but typically not in response to external stimuli.
After a traumatic brain injury that lands a patient in an ostensibly vegetative state, many clinicians assume a poor prognosis. As a result, many families decide whether to keep their loved one on life support or to withdraw it within the first three days after admission.
"The problem with severe brain injury," said neuroscientist Nicholas Schiff in The Scientist, "is that you have people who all look the same who could have very different trajectories of recovery over time, response to treatment, or already achieved level of recovery." Better diagnostic tools are needed to "sort the variance and also to figure out who we should look at more closely and immediately."
A better method
A healthcare professional administers an EEG.
BSIP/Universal Images Group via Getty Images
Patients with covert consciousness have been shown to recover at higher rates than those in persistent vegetative states even though they appear to be the same from the outside. Deciding to pull the plug on a loved one is never an easy task, but the uncertainty of whether or not they are truly beyond help makes it even more difficult.
Fortunately, researchers are working on ways to improve diagnosing these cases of covert consciousness. While fMRIs were the original way that researchers detected covert consciousness, applying them in critical care settings can be challenging. Electroencephalographs (EEGs) are likely to be far more useful as a diagnostic tool.
The first large-scale demonstration of using EEGs to diagnose cases of covert consciousness was recently published in the New England Journal of Medicine, where doctors asked patients to move their hands (which neither vegetative nor covertly conscious patients can do), and then used machine learning to decipher their EEG readings to identify brain activity in response to the commands. Twelve months later, 44 percent of those patients who were detected to have some brain activity were no longer vegetative and could function independently compared to just 14 percent of patients with no sign of activity in the EEG.
"This is very big for the field," Nicholas Schiff told The New York Times. "The understanding that, as the brain recovers, one in seven people could be conscious and aware, very much aware, of what's being said about them, and that this applies every day, in every I.C.U. — it's gigantic."
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Whether or not women think beards are sexy has to do with "moral disgust"
- A new study found that women perceive men with facial hair to be more attractive as well as physically and socially dominant.
- Women tend to associate more masculine faces with physical strength, social assertiveness, and formidability.
- Women who display higher levels of "moral disgust," or feelings of repugnance toward taboo behaviors, are more likely to prefer hairy faces.
Beards and perceptions of masculinity<img type="lazy-image" data-runner-src="https://assets.rebelmouse.io/eyJhbGciOiJIUzI1NiIsInR5cCI6IkpXVCJ9.eyJpbWFnZSI6Imh0dHBzOi8vYXNzZXRzLnJibC5tcy8yMjU5OTg0MC9vcmlnaW4uanBnIiwiZXhwaXJlc19hdCI6MTY0NzkxMjM3N30.cH-GqNwP5GVqvstgJWAhBPn1B_lYpVEAI0I7iax7EQw/img.jpg?width=1245&coordinates=0%2C1900%2C0%2C849&height=700" id="caae6" class="rm-shortcode" data-rm-shortcode-id="cb0a355a4e8e1899789bc45f3f7aef56" data-rm-shortcode-name="rebelmouse-image" />
Photo Credit: Wikimedia<p>The study used 919 American (mostly white) women ages 18-70 who rated 30 pictures of men they were shown with various stages of facial hair growth. The photographs depicted men with faces that had been digitally altered to look more feminine or more masculine, with a beard and without a beard. The women rated the men according to perceived attractiveness for long-term and short-term relationships. The study found that the more facial hair the men had, the higher the men were rated on their attractiveness, particularly for their suitability for a long-term relationship.</p><p>Part of this might be attributed to facial masculinity — i.e. protruding brow ridge, wide cheekbones, thick jawline, and deeply set narrow eyes — which conveys information to a woman about a man's underlying health and formidability. Women tend to associate more masculine faces with physical strength and social assertiveness. It can also indicate a man with a superior immune response. The researchers suggested that their findings favoring bearded men could be due to the fact that facial hair enhances the masculine facial features on a man's face, like creating the illusion of a thicker jaw line. This could communicate direct benefits to women like resources and protection that would enhance survival among mothers and their infants. In other words, while a beard doesn't mean superior genetics in and of itself, it might be a primitive, ornamental way of saying, "Hey girl, I'm a testosterone-fueled lean, mean, pathogen fighting machine." <br></p><p>It could also be that a beard becomes its own destiny. The researchers in this study cite prior research that found that by growing a beard, men felt more masculine and had higher levels of serum testosterone, which was linked to a higher level of social dominance. They also tended to subscribe to more old-school beliefs about gender roles in their relationships with women as compared to men with clean-shaven faces.<span></span><br></p>
What does disgust have to do with beard preference?<p>Obviously, not all women dig beards. The researchers were particularly interested in what traits make a women prefer bearded men over clean-shaven faces. They looked into several factors including a woman's disgust levels on various concepts, her desire to become pregnant, and her exposure to facial hair in her personal life. </p><p>According to the study, women who were not into facial hair were turned-off by potential parasites or other critters they imagined could be in the hair or skin. Women ranking high on this "ectoparasite disgust" scale might have viewed beards as a sign of poor grooming habits. However, women who ranked higher in levels of "pathogen" did find the bearded men to be desirable, possibly because they perceived beards as a signal of good health and immune function. An intriguing discovery in the study was links to morality. Women who displayed higher levels of "moral disgust," or feelings of repugnance toward taboo behaviors, were more likely to prefer hairy faces. The authors opined that this could reflect a link between beardedness, politically conservative outlooks, and traditional views regarding performances of masculinity in heterosexual relationships.</p>
Additional findings<img type="lazy-image" data-runner-src="https://assets.rebelmouse.io/eyJhbGciOiJIUzI1NiIsInR5cCI6IkpXVCJ9.eyJpbWFnZSI6Imh0dHBzOi8vYXNzZXRzLnJibC5tcy8yMjU5OTg1My9vcmlnaW4uZ2lmIiwiZXhwaXJlc19hdCI6MTYyNDI1NjUyOX0.P9B8WbmJR0q4nfzYZKbuNSA-2SAigVWJgrQE-_Gxlds/img.gif?width=980" id="49143" class="rm-shortcode" data-rm-shortcode-id="2ed3b1d6f20fc170bf2974646e565e8d" data-rm-shortcode-name="rebelmouse-image" />Giphy<p>The correlations that existed between married and single women's rating on the attractiveness of beards were not particularly clear, although the researchers noted that single and married women who wanted children tended to find beards more attractive than the women who didn't want children. They also found that women with bearded husbands found beards to be more attractive, which might indicate that social exposure to beards influences how desirable they are perceived of as being. Or it could be that men with wives who like beards grow beards.</p><p>It's important to note that culture plays a huge role in how attractive women perceive certain male characteristics as being. This study looked at a small, culturally specific group of American women, so no big, universal claims should be made about masculinity, facial hair, and male desirability to women. However, research like this is important in highlighting how human grooming decisions are driven by much more than fashion trends. Sociobiological, economic, and ecological factors all play a part in the way we choose to present ourselves.</p>
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