More Brain Points

 "When We All Fall Asleep, Where Do We Go?"

    The question posed above is the name of popular singer-songwriter Billie Eillish's debut solo album. While the content of the album uses the question more to provoke ideas about the darker sides of our subconscious minds, I would like to address it quite literally. When we all fall asleep, where do we go?Often, the answer to this question is deceptively simple; dreams. When we fall asleep, we all dream. What, then, are dreams? A prominent theory, known as the activation-synthesis theory of dreams, claims that our nocturnal adventures are a result of our prefrontal cortex attempting to make sense of the sporadic activation of our midbrain. They are, according to this theorem, simply neural static that our brains are trying fervently to deconvolute. 

    Why then, does it seem that so frequently they contain aspects of our daily lives? Why are we so often thrust back into the office, classroom, or position of responsibility that we so eagerly abandoned for the sanctity of sleep? Is it simply because our brains are still parsing information from earlier in the day? Cognitive clippings on the cutting-room floor of the daily cycle of encoding, processing, and retrieval of memory? Or are dreams something more? Karen Konkoly, along with her colleagues at Northwestern University, have compiled evidence that shows not only are dreams more complex than this, but that they can be externally manipulated, and even allow for two-way conversation.

   Nearly 20 years before Dr. Konkoly compiled an empirical, replicable account of this two-way dreamspeak, the family of 26-year-old Scott Routley felt confident they had discovered precisely this . In 1999, Scott was on his way home from his grandfather's house, who lived in Ontario, Canada. A few blocks later, a police cruiser racing to the scene of a crime would blow through the red light in an intersection and T-Bone Scott's car. While the police officer sustained only minor injuries, Scott's life was changed forever. Scott was pronounced comatose and given a score of 4 on the Glasgow coma scale. This is a scale that ranges from 3-15, the lower digits characterized by things such as "no pupil response, no movement, no sounds, does not open eyes," whereas a 15 on the scale describes a perfectly responsive patient. Scott's family was devastated, he had suffered a cranial herniation and a massive concussion during the crash, a fate the doctors would describe simply as "grim." Scott's mother, Anne, did not despair, in fact, for 12 years, she would visit her son 4-5 times a week and pester the resident neurologist, claiming that her son was communicating with her. Whenever Anne was humored, and Scott was observed, however, he of course displayed no response to visual, auditory, or physical stimuli. Anne's persistence paid off, Adrian Owen, an esteemed British neurologist, decided to meet with Anne in 2017.

    He was familiar with similar cases across the world, a grieving mother refusing to accept their child's disability was very common. Dr. Owen also knew that a busy resident neurologist, with a desk full of patient charts and a schedule full of appointments, was unable to personally attend to every comatose patient every moment. If anyone was to observe anomalous behavior in these patients, it would be the family. Dr. Owen decided to put Scott into an fMRI. If Anne was correct, and her son was still conscious, while his base level of brain activity may appear nonexistent, he should still be able to respond to auditory stimuli, if only through thought. As the fMRI began, Dr. Owen asked Scott if he would imagine himself playing tennis. Seconds passed, and Dr. Owen began rehearsing in his mind how he would explain to this excessively optimistic mother that her son was no longer truly there. However, his thoughts were interrupted by a symphony of light on the fMRI readout screen. The motor cortex, like other areas of the brain, becomes activated not only when one is utilizing it, but also when one consciously thinks about using it. This was where Dr. Owen saw activity, parts of the brain that had been inactive before the prompt had come to life. Dr. Owen repeated this prompt several times, and each time received the same distinct response. "Goosebumps," He writes in his account of the event; "I just got goosebumps." Dr. Owen follows-up with another question, and notes corresponding neuronal responses. He was talking to a patient who had been comatose for 12 years. Given they now had a way to communicate with Scott, Dr. Owen asked Anne if she would like to know if her son was in any pain. She responded: "Go ahead ask him, but I know if he was, he would have told me by now." Dr. Owen spoke into the microphone: "Scott, are you in any pain? If you are not, please imagine that you're playing tennis." After another agonizing few seconds, Scotts motor cortex again flashed like the northern lights.

    

    I am not sure if Dr. Karen Konkoly was familiar with this story when she began her experiments, but 4 years after these events, she and other sleep scientists from around the world have also been engaging in two-way communication with the unconscious. Participants were taught how to lucid dream in response to an auditory cue given by the experimenter once REM sleep waves were observed on an EEG readout. Once in a lucid dream state, a state of awareness that one is unconscious, something that quite similarly resembles a comatose state, participants would respond with an affirmative cue. The media of these cue would change from study to study, some participants would move their eyes rapidly from the left to the right, some would flex certain facial muscles, and others still were even able to provide guttural verbal cues. Once the experimenters were confident that they had established communication with the subjects, they would begin asking questions. One participant describes what it's like to communicate with those outside the dream world: "When they were asking me [2+2] I didn't hear them, instead I saw the lights in the building I was in in my dream begin to flash in Morse code, asking the question. In order to respond, I picked up a bowl I saw on the ground and flashed the light out the window in the Morse code for 4." This participant, in response to these questions, responded with four, distinct ocular saccades from the left field of view to the right when they received this question. Another participant describes the experience: "I was fighting a bunch of goblins with my sword, when suddenly a large booming voice came from nowhere and scared all the goblins away, I heard a loud rushing noise in my ears, and then heard the voice ask me if I was asleep or not. I nodded yes." and in the real world, he responded with the flex of the zygomatic muscle. 

    

    While lucid dreaming is notoriously hard to teach, and the realm of the subconscious still quite difficult to study, these examples pose pointed questions. What if we could train everybody to lucid dream, and to respond to auditory cues while asleep? We could transform frantic mothers sitting beside their loved ones in silence, to a conversation carried out in Morse code or binary question responses. Family members who thought themselves fated to spend hours on end with a seemingly lifeless husk of their former loved one could now have conversations, discuss their lives, and ask questions. Imagine the revolution in patient care that would happen if you could simply ask a comatose patient what their end of life wishes were. I think the most important question of all, however, is not where we go when we fall asleep, but why we cannot go there while we are awake.

Konkoly, Karen R., et al. “Real-Time Dialogue between Experimenters and Dreamers during Rem Sleep.” Current Biology, vol. 31, no. 7, 2021, https://doi.org/10.1016/j.cub.2021.01.026.

Owen, Adrian. “How Science Found a Way to Help Coma Patients Communicate.” The Guardian, Guardian News and Media, 5 Sept. 2017, https://www.theguardian.com/news/2017/sep/05/how-science-found-a-way-to-help-coma-patients-communicate.