The brain is a marvel of nature. Nestled inside its protective embrace are among the most precious tissues of the living world that enable special talents and functions, connecting us seamlessly both to internal needs and external demands. The brain integrates a two-dimensional body, a three-dimensional mind and a multi-dimensional universe into an experience called life that, at a metaphysical level, is nothing but consciousness—a finite phenomenon with infinite abilities.
Decades of scientific investigation involving biologists, physicists and spiritual gurus has unraveled the importance of consciousness and its impact on health and disease. We neurosurgeons understand this but are still not clear about where it resides. As we work with and through the physical brain, we travel ever deeper in our endlessly fascinating search for functional consciousness.
We have succeeded in finding, studying and even tracking the physical, biological, electrical and neurological activities that keep the brain and life ticking. But even the most advanced animal experiments and microscopic probes have failed to locate consciousness, the very fount of life. However, what we do know is that the brain-mind complex has something to do with it.
Centuries of research has revealed that consciousness is a non-material component inherent in all material bodies and, therefore, it is a universal phenomenon, not an individual property. Our spiritual masters recorded this elegantly in ancient scriptures ages ago. However, consciousness is an even larger concept, an ethereal quantity without which we would have no sense of our surrounding environment and would be quite incapable of experiencing any internal or external impulse.
A healthy brain has a natural capacity to connect or disconnect us to consciousness. In disease, when brain structures are disrupted, this is instantly or progressively lost, which in turn, alters the state of consciousness. Based on this knowledge several states of consciousness have been described: from total unconsciousness caused by severe damage to partial, sub and minimal levels of conscious resulting from various degrees of partial damage.
Patients of degenerative disease and dementia lose the core function of consciousness or the ability to comprehend and respond appropriately to internal and external environments despite the ability to move around. It is apparent, therefore, that a certain basic number of healthy neurons are required to establish connectivity, but no one knows what this number is or should be. Intermittent consciousness, akin to fluctuating cell phone connectivity, has also been noticed during the progression of diseases.
Neuro critical care remains obsessed with stimulating the brain by all available means—physical, chemical, pharmacological and electrical—and monitoring and maintaining normal physiology. Although available stimulation techniques including DBS have not been successful in eliciting sustainable consciousness, it is my belief that more of our efforts need to be directed at repairing and regenerating the brain to a level where it is able to connect automatically and by itself to consciousness. No amount of stimulation on a damaged or diseased brain will work. It’s like flogging a dead horse.
Going ahead I believe we must strive to create an effective environment, conducive for the regeneration of the brain, protect what still exists and try to establish the “minimum” essential brain required for a sustainable conscious state.