In August 1997, Patient 2 was kicked in the chest and had a heart attack. He went into a coma and was declared to be in a vegetative state.
Sixteen years later, at the age of 34, he was still in a coma, though minimally conscious: He could sometimes follow objects with his eyes.
Still, in all that time, he didn’t respond to his family members. He couldn’t move or speak in reaction to any stimulus. “It was impossible to determine, based on the patient’s behaviour, whether, or how, he perceived the world around him,” researchers wrote in a study published in the Proceedings of the National Academy of Sciences in January.
But then researchers discovered something extraordinary: When they screened an Alfred Hitchcock short film for Patient 2, who lay unresponsive inside a functional Magnetic Resonance Imaging (fMRI) scanner, his brain lit up the same way the brains of healthy participants did.
Instead of using traditional tests like visual patterns and button presses to understand levels of consciousness, the researchers, from the University of Western Ontario, decided to turn to the shared experience of cinema to compare the responses of healthy people and two people in a coma, including Patient 2.
They showed participants an episode of “Alfred Hitchcock Presents” from 1961 titled “Bang! You’re Dead,” in which a five-year-old boy discovers a loaded gun, thinking it’s a toy. The eight-minute movie follows the boy as he points the gun at people and pulls the trigger, unaware of the Russian roulette that is at play.
Each time the boy fired the gun, a region of the brain linked to information integration and suspense lit up in the healthy participants and in Patient 2, Tom Stafford explained in a story for BBC Future. That suggested to researchers that he was more conscious than he seemed.
This test could be a new way to determine if coma patients have “locked-in syndrome,” which is when they are conscious but unable to communicate or respond outwardly to any stimuli. This is especially important since the consciousness of coma patients is frequently misdiagnosed using current tests, the study authors note.
This new method can’t revive patients who are comatose. And Patient 1, who was also classified as minimally conscious, didn’t respond to the movie the way Patient 2 and the healthy participants did.
It’s important to clarify, as well, that a “minimally conscious state” is distinct from a “permanent vegetative state,” from which there is no hope for responsiveness or recovery. Distinguishing between the two states, bioethics nonprofit The Hastings Center notes, “requires careful clinical evaluation.”