I want to begin by discriminating between various major disturbances in consciousness. In coma someone will show no wakefulness, attention, emotion, purposive behaviour or consciousness. It is like deep sleep. In what is called vegetative state a patient will have a pattern of some kind of sleeping and waking, some responsiveness, for example, in the eyes; but the patient shows no signs of consciousness in the normal sense. In what is called locked-in syndrome, the sufferer will awaken, will be conscious but will be reduced in her movements, typically to eye movements in the vertical direction and to blinking. I am relying solely on reports of this distressing condition, particularly those of the neurologist, Antonio Damasio, who comments on one unexpected feature of patients with this condition – “they do not experience the anguish and turmoil that this horrifying situation would lead observers to expect. They have a considerable range of feelings, from sadness to, yes, joy. And yet, from accounts now published in book form, the patients may even experience a strange tranquillity that is new to their lives. They are fully aware of the tragedy of their situation, and they can report an intellectual sense of sadness or frustration with their virtual imprisonment. But they do not report the terror one imagines would arise in their horrible circumstances. They do not seem to have anything like the acute fear experienced by so many perfectly healthy and mobile individuals inside a magnetic resonance scanner, not to mention a crowded elevator” (The Feeling of What Happens p 292).
Damasio has a multilayered view of human consciousness, and its connection to emotion and our bodily sense of ourselves, which means I do not want to attempt a full presentation of why he thinks such patients do not experience the distress one might imagine they would. The essence of his analysis is that their lack of movement directly reduces their emotional reactivity. Damasio has as one element in his picture of the living organism the importance of managing life, of maintaining stability, which he prefers, following Steven Rose, to call “homeodynamics” rather than the more conventional “homeostasis”. It’s dynamic, in movement, even in stability. He integrates wakefulness, motion, consciousness into the chemical and neurological elements of the overall activity which manages life. When the possibility of more stressful interaction and response to the environment is lost, as in ‘locked-in syndrome’, when, as Damasio puts it, “the brain is deprived of the body as a theatre for emotional realisation”, then the patient’s life of feeling will be tuned to the basic regulatory aspects of the internal milieu and these are inherently calm and harmonious. If the ability to modify existence is lost, then an adjustment takes place: it is not the case that knowledge of what is missing or unattainable dominates. The very limitations of bodily existence seem to be that which can allow the certainty of being to control the uncertainty of knowing. This balances the creative help that our knowing brings to our being in everything that belongs to human culture.
Karl König, in The Human Soul, links the experience of anxiety to a fundamental loss of the meaning of touch, of the unconscious certainty of existence which lies in touch. Anxiety has elements both of drifting, rising, floating indeterminacy, and of oppression, tightness, constraint. We have lost the security of the body. In another context König presents us with the triangle of our security being formed by
A triangle formed both in connection and in separation between the three elements. He too looks at restrictions in movement, different degrees of paralysis (though not the ultimate conscious paralysis of locked-in syndrome) and describes how the realisation of our selfhood, the activity of our body, and our experience of the three dimensions of space all rely on each other. I am particularly interested at this point in the distinctions he draws between, first, my sense of myself moving forward, yet with the world behind me, from, second, the self I am in the interplay of up and down, of lightness and heaviness, of buoyancy and rootedness, and, third, the ‘me’ who has his own individual orientation to right and left and who through this achieves self-awareness and a new healthy distance from the world. I come alive in these dry dimensions of in front, behind, above, below, left and right. This is the active certainty achieved by the bodily self exploring space, the certainty the child is deprived of when her education is divorced from bodily senses.
In yet another context, König makes a distinction which clarifies the way our stability relies on both activity that is more inwardly directed and activity that goes out into the world. He calls the first the search for certainty and the second the search for security. I think his choice of words reveals the distinction he is after between the certainty of the world’s truth and the security of knowing our own reality. Our thinking can be contributing, at certain times more to our activity in the world, at other times more to the creation of our inwardly established identity. Our willing, similarly, can be outwardly directed to our contributing to the world, or concerned, more or less consciously, to the inward forming of our self – from the unconscious growth and development of the child to the spiritual self-education of the mature adult. As has already been suggested, if certainty and security depend on the variety of ways in which we contact and connect the I-activity to both body and world, then so too will anxiety spring from disturbances of that matrix. There is the Grimm fairytale of “The Youth who set out to learn what Fear was”. Nothing can make him shudder – ghosts, hanged men, wild beasts, skulls and coffins. Only when he has tried everything, married the King’s daughter, does her maid go and fetch a pail full of little fish from the stream, so that his wife could pour them over his naked body as he slept – “Oh, how I shudder, how I shudder, dear wife. Yes now I know what shuddering is.” Only now, out of this strange, invasive experience of touch – of little fish slithering over his body, waking him out of unconsciousness – does the physical expression of fear come – the shudder which he had never known before.
In the eighth of the Duino Elegies which Rainer Maria Rilke finished in 1922, he laments that “We’ve never, no, not for a single day,/pure space before us, such as that which flowers/endlessly open into: always world, /and never nowhere without no”. This fundamental defect is deeper, for Rilke, than our failures of heart or our fear of death, for it means we are always ‘spectators’ – ‘we live our lives, for ever taking leave’. The poem ends, with the image of a man as he leaves his valley. He turns and stops and lingers on the last hill. For this poet of intense consciousness, seeing and being become the prison of awareness lost in space.
There is an escape in mysticism, or the absorption of the child, but there is also the engaging with the world of space, the world of touch, recognising that in the body which consolidates our sense of self also lives the fear which our contact with the world may release. Antonio Damasio uses the beginning of the play ‘Hamlet’ to illustrate his picture of consciousness. Afraid, the guard calls out in the night “Who’s there?” when he hears footsteps. For Damasio this is the question which consciousness answers before it is asked, in giving us a sense of ourselves as agents. Out of the experience of being changed comes, eventually, the feeling of being in charge.
Damasio is committed to an idea of evolving consciousness in which altruism, for instance, is an expression of our evolving beyond the self-protecting body-based conscious self. For me, the fear which can stimulate self-awareness can also lead us, via a conscious cultivation of our inner certainty to an experience of ourselves as spiritual beings. Through our bodily self we find our individuality through the changes and growth we go through. At times we live as though our soul and spirit being is always trying to escape the body, at times as though it has been excluded from it. If we can accept the dynamics within our identity then we may be able to face our fear of death, our uncertainty as individuals, our uncertainty about the future. I feel the person who finds calm in the loss of locked-in syndrome is experiencing the nakedness of a kind of death, a bareness of being, which gives a present security because it contains within it a hint of resurrection. The calm which the locked-in patient cannot escape, in a modest way we can find for ourselves and in so doing find a certainty of spirit. It means letting go of something and most of us are fortunate that the letting go can be of our own choosing.