664 Book Reviews

The Neurology of Consciousness: Cognitive Neuroscience and Neuro-

pathology edited by Steven Laureys and Giulio Tononi. Academic
Press, 2008. 423 pp. $104 (hardcover). ISBN 9780123741688.

This information-packed volume, without doubt a landmark event in the

developing neuroscientific study of consciousness, deserves the attention
of anyone interested in this subject. It is a sequel and companion to an
earlier collection, The Boundaries of Consciousness: Neurobiology and
Neuropathology, also edited by Steven Laureys (2005), which contains
the proceedings of a 2004 conference sponsored by the Association for the
Scientific Study of Consciousness (ASSC). Published initially as a special
issue of Progress in Brain Research (volume 150), Boundaries has been
reissued in paperback and appears on the ASSC website as one of its official
titles. Both volumes include many prominent figures in contemporary
neuroscience, and the two volumes together constitute about as clear,
comprehensive, and authoritative a picture as one can find anywhere of the
current state of mainstream neuroscientific thinking about consciousness
and the brain. Like classical physics of the late 19th century, it is a picture
of great power and beauty; nevertheless, just as discordant phenomena such
as black-body radiation and the photoelectric effect presaged the rise of
quantum mechanics, this book, precisely because of its clarity, reveals signs
of trouble ahead.
The two volumes overlap considerably, with many topics and authors
carried directly over from the first to the second. The new volume, however,
in addition to updating various topics covered previously, shows greater
signs of editorial and doctrinal control, with a narrower range of subjects
treated in more deliberately organized fashion. Whereas Boundaries
contains 40 chapters contributed by 87 authors, ordered according to no
discernible principle, the present volume contains 28 chapters by 39
authors, organized into four main sections. I will begin by summarizing, in
necessarily telegraphic fashion, the main content of these chapters.
Section I, “Basics,” consists of six chapters. The first, by Antonio
Damasio and Kaspar Meyer, titled “Consciousness: An Overview of the
Phenomenon and of Its Possible Neural Basis,” sketches the general picture
that will be developed in detail in subsequent chapters. Consciousness is
produced by the brain, has a nested multilevel structure that emerges in the
course of biological evolution, and can be studied both behaviorally, from
the third-person perspective of an external observer, and introspectively,
from the first-person perspective of the subject within. Alterations of
consciousness and behavior produced by particular types and locations of
Book Reviews 665

brain injury are particularly valuable in revealing brain structures associated

with normal conscious functioning, and this results in a methodological
emphasis, echoed throughout the book, on in-depth n = 1 neurological
investigations of patients with rare forms of injury. Consciousness per se,
as distinguished from its occurrent contents, seems to require integrity of
a distributed system of midline structures including the upper brainstem,
thalamus, and medial cortical areas including in particular frontal, posterior,
and cingulate cortex. Chapter 2, by Hal Blumenfeld, provides an excellent
description of neurological examination techniques and their deployment
in differential diagnosis of the major forms of impaired consciousness
including brain death, coma, vegetative states, minimally conscious states,
and associated conditions such as the terrifying locked-in syndrome in
which patients can be fully and normally conscious but deprived of all
or nearly all motor function and unable to communicate. In brain death,
all cortical, subcortical, and brainstem function has been irreversibly lost,
and only spinal-cord reflexes remain. Stages of recovery—ranging from
comatose states in which patients are totally unresponsive and unarousable,
to vegetative states with sleep/waking cycles and brainstem reflexes
present and eyes occasionally opening but without signs of purposeful or
meaningful response to external stimuli, to minimally conscious states with
inconsistent but clear indications of consciousness—occur in conjunction
with progressive functional restoration of the activation systems in the
upper brainstem and diencephalon and their associated cortical targets.
Blumenthal correctly emphasizes the difficulties of these diagnostic
distinctions and provides numerous hints and guidelines for making them
correctly. He also points out in this connection the increasing use and
potential diagnostic value of modern neuroimaging procedures. These in
turn form the subject of Chapter 3 by Steven Laureys, Melanie Boly, and
Giulio Tononi, which provides a brief but generally accurate introduction to
the main imaging techniques and associated image-processing and analysis
procedures. In a magnificent Chapter 4 titled “Consciousness and Neuronal
Synchronization,” eminent German neuroscientist Wolf Singer outlines
theory and evidence linking conscious states to the formation of large-
scale distributed neural assemblies united by shared neuroelectric activity
transiently synchronized at frequencies extending into the gamma range.
This picture is common to all forms of contemporary “global workspace” or
“global neuronal workspace” theory, of which Singer is a principal architect.
An excellent Chapter 5 by Geraint Rees develops that picture in greater
detail in the context of visual consciousness, seeking to identify differences
in terms of neural activity between identical stimuli that do, versus do not,
reach conscious awareness. In general, activity in functionally specialized
666 Book Reviews

areas of the visual system corresponding to stimulus properties such as color,

shape, and motion in depth is necessary but not sufficient for awareness
of those properties. In keeping with the global workspace picture, visual
awareness occurs when the received stimuli are also able to ignite larger-scale
patterns of synchronous neuroelectric activity reciprocally linking widely
distributed cortical zones including frontal cortex. Chapter 6 by Naotsugu
Tsu-chiya and Christof Koch is still more specialized in character, focusing
on the relationship between consciousness per se and selective, top-down
visual attention, and arguing on the basis of various kinds of psychophysical
and neurophysiological observations that these are distinct phenomena.
Section II, “Waking States, Sleep, and Anaesthesia,” consists of four
chapters. Chapter 7 by Marcus Raichle and Abraham Snyder, titled “Intrinsic
Brain Activity and Consciousness,” develops a theme first introduced in
Chapter 1 by summarizing important recent work by themselves and others
on the structure of background activation in the awake but resting brain—the
so-called “default mode network”—which appears to be closely associated
with the sense of self at the root of one’s first-person conscious perspective
and with consciousness per se (versus specific contents of consciousness),
and which accounts for a large proportion of the brain’s energy consumption.
This network includes in particular midline cortical structures of frontal
and parietal cortex whose activities are correlated among themselves but
anti-correlated with those of structures activated under particular task
conditions. Individual moments of conscious experience with all their
specific contents are thus portrayed as being somehow realized upon this
more fundamental “backbone” system. In Chapter 8 Giulio Tononi ably
summarizes the current state of knowledge concerning normal sleep and
dreaming plus associated topics such as daydreaming, lucid dreaming,
sleepwalking, and narcolepsy, emphasizing overall patterns of brain
activity associated with these various conditions. Chapter 9 by Claudio
Bassetti provides a more specialized and clinically oriented review of one
particular sleep-related phenomenon, somnambulism. The final chapter
of this section, by Michael Alkire, provides an authoritative review of the
effects of general anesthetics on brain and consciousness. Although much
remains to be learned, anesthetics clearly produce their effects by disrupting
operation of the global workspace—i.e. by preventing the precise temporal
coordination of neuroelectric activity across large-scale thalamocortical
networks that is deemed necessary by contemporary systems neuroscience
for the occurrence of conscious experience.
Section III, “Coma and Related Conditions,” contains eight chapters.
These are mainly clinical in orientation and with one possible exception
noted below broadly consistent with the general global-workspace picture
Book Reviews 667

developed in earlier chapters. Chapter 11

by G. Bryan Young deals with coma, and
covers precipitating conditions plus issues
surrounding differential patient diagnosis,
prognosis, and management. Chapter 12 by
James Bernat presents his widely accepted
concept of human death as brain death—
irreversible cessation of the clinically
relevant functions of the brain—contrasting
this formulation with various alternatives
and outlining the required diagnostic and
confirmatory tests that are used to determine
its occurrence. Chapter 13 by Adrian Owen,
Nicholas Schiff, and Steven Laureys focuses
on the vegetative state and the potentially
vital contribution of neuroimaging techniques such as PET and fMRI to
differential diagnosis. Of particular theoretical interest, however, is their
claim to have demonstrated, using such techniques, the presence of conscious
awareness in patients who are truly vegetative by the standard behavioral and
neurological criteria; I will return to this subject later. Chapter 14 by Joseph
Giacino and Nicholas Schiff covers minimally conscious states, which have
only recently been distinguished from vegetative states and understandably
present many of the same difficulties of differential diagnosis, prognosis,
and care. These authors emphasize again the increasing role of neuroimaging
studies in clarifying anatomical and functional differences between these
disorders, and in identifying possible neural correlates of the considerable
fluctuations in functional competence that commonly accompany both of
them. Chapter 15, by five authors including Steven Laureys, deals with
the locked-in syndrome and is strongly clinical in orientation; one point of
special interest, however, is that such patients typically show normal or only
mildly abnormal EEGs and evoked potentials, unlike persons suffering the
more severe disorders of consciousness treated above. Chapter 16, by Pietro
Petrini, Eric Salmon, and Paolo Nichelli, discusses degenerative disorders
such as Alzheimer’s disease and frontotemporal dementia, emphasizing the
degree to which the progressive destruction of particular aspects of mind
and consciousness mirrors the progressive destruction of anatomical and
functional connectivity among disease-specific cortical areas in different
classes of patients. Chapter 17 by Andrea Kubler surveys recent work on
brain–computer interfaces (BCI), by means of which paralyzed or locked-
in patients without usable motor function can interact with the external
environment through self-regulation of selected aspects of brain activity.
668 Book Reviews

Accomplishments are so far rather modest, but they are of enormous value
to those who need them, and there appear to be possibilities of extending
the basic approach to more severely impaired patients such as those in
minimally conscious states. In Chapter 18, which concludes this section,
Joseph Fins outlines scientific and ethical challenges posed by work with
patients suffering from disorders of consciousness, particularly in light of
our currently primitive level of understanding, and presents his “pragmatic”
approach to managing these challenges in typical neuropalliative care
settings.
Section IV concerns “Seizures, Splits, Neglects, and Assorted Disorders,”
and contains no fewer than 10 chapters. The first of these, by Hal Blumenfeld,
surveys the main forms of epileptic seizure (absence, generalized tonic–
clonic, and complex partial seizures), all of which produce impairments
of consciousness despite seemingly wide differences in etiology, outward
form, and accompanying electrophysiology. Relying on recent advances in
both electrophysiology and other neuroimaging modalities, he is able to
show that these seizures in fact share a common pattern of disrupted activity
in key elements of a global network associated with normal consciousness,
including upper brainstem and medial thalamus, anterior and posterior
interhemispheric connections, and frontal and lateral association cortex. He
also underscores the interesting fact that the excessive and abnormal neural
synchrony associated with seizure activity, like the absence of such large-
scale synchronous interactions in coma and vegetative states, is incompatible
with normal consciousness. Chapter 20 by Michael Gazzaniga and Michael
Miller attempts to summarize decades of work on split-brain subjects,
and to explain the astonishing fact that the linguistically competent left
hemisphere in such patients shows no awareness that the right hemisphere
has gone missing, despite its demonstrated superior capabilities for certain
specialized perceptual and cognitive tasks. They do this by assimilating
the split-brain case to other known forms of anosognosia such as left-side
neglect in patients with strokes of the right parietal region. They conceive of
the general situation as one in which an “interpreter” located somewhere in
the left hemisphere—a conscious person, essentially—is constantly making
up a story about its world based on all the information presently being
funneled to it from a vast number of specialized brain modules. Where
this interpreter is located and how it operates is not specified. They also
offer some speculations about the probably impoverished but conscious
experience of the disconnected right hemisphere. I should probably confess
in passing that I have always found the split-brain work rather confusing and
ultimately uncertain in terms of its bearing on mind/brain relations; see also
Nagel (1979:Chapter 11). Chapter 21 by Lionel Naccache on the neurology
Book Reviews 669

of visual consciousness describes how recent studies of neuropsychological

syndromes such as blindsight, visual agnosia, and so on, together with
associated experimental studies in healthy subjects of the principles
they suggest, have led to development of the global neuronal workspace
theories of consciousness advanced by himself and various colleagues (e.g.,
Baars 1997, Crick & Koch 2003, Dehaene & Naccache 2001, Edelman &
Tononi 2000, Engel, Fries, & Singer 2001, Varela, Lachaux, Rodriguez,
& Martinerie 2001). Chapter 22, by Patrick Vuilleumier, concerns the
neurophysiology of “hysteria” or conversion disorder, and asks whether the
relatively few neuroimaging studies that have so far been carried out have
shed any new light on the central enigma as to how ideas in a patient’s mind
can produce circumscribed and physiologically improbable effects, such as
glove anesthesia, in that patient’s body. Indeed, it is noteworthy that this
diagnosis is usually applied only after recognized organic or physiological
causes of the presenting symptoms have been ruled out. The main
generalization from neurophysiological studies to date seems to be that the
problems arise somehow within high-level attentional and control systems
associated with orbitofrontal and medial prefrontal cortex rather than
within the lower-level perceptual and motor processes themselves. Whether
this approach will yield anything more than speculative translation of old
psychodynamic concepts into modern neurophysiological ones remains to
be seen. Chapter 23 by Olaf Blanke and Sebastian Dieguez covers out-of-
body and near-death experiences. In the Boundaries volume these topics
had been covered separately, with Blanke writing the OBE chapter from a
relentlessly reductive-physicalist point of view and Chris French, widely
regarded as a moderate skeptic, writing on NDEs in critical but open-
minded fashion. French’s replacement by Blanke immediately struck me as
an ominous development, and indeed this new combined chapter proved to
be profoundly unsatisfactory for reasons I will explain shortly. Chapter 24
by Bradley Postle, titled “The Hippocampus, Memory, and Consciousness,”
reviews (with special reference to the celebrated patient Henry M.) the
highly selective effects on various types of memory as well as imagination
and consciousness that result from injury to structures in and around the
medial temporal lobe. Chapter 25 by Chris Butler and Adam Zeman surveys
three clinical syndromes of transient amnesia—transient global amnesia,
transient epileptic amnesia, and psychogenic (hysterical) amnesia—and
what is presently known about their etiology and impacts on memory and
consciousness. Chapter 26 by Paolo Nichelli examines effects of various
forms of aphasia on working memory, inner speech, error monitoring,
and consciousness, using Alan Baddeley’s multicomponent model of
working memory as a theoretical framework. Chapter 27, “Blindness and
670 Book Reviews

Consciousness,” by Pietro Pietrini, Maurice Ptito, and Ron Kupers, surveys

a variety of clever neuroimaging and transcranial magnetic stimulation
(TMS) studies in blind and sighted humans, as well as some neurosurgical
studies with animals, to explore issues related to sensory overlap and
substitution, cortical plasticity, and the abstract or “supramodal” character
of cortical representations of the perceptual world. With regard to the latter,
for example, parts of the dorsal or “where” pathway in the visual system are
activated by apparently moving auditory stimuli as well as similarly moving
visual stimuli, and this occurs in congenitally blind or early-blind subjects
as well as sighted ones, indicating that the auditory effect is not mediated
by visual imagery. Visual cortex in congenitally blind persons can become
involved in a host of perceptual and cognitive tasks not normally associated
with visual cortex, and this appears to occur primarily by unmasking and
reinforcement of preexisting connections rather than generation of novel
ones.
Chapter 28 by Giulio Tononi and Steven Laureys, titled “The Neurology
of Consciousness: An Overview,” appears as the final chapter of Section IV,
but it could easily have constituted a separate Section V on its own. It is by
far the longest chapter in the book, masterfully summarizing information
presented in earlier chapters and integrating it with a still larger range
of neurological and neurobiological research and theory. To indicate its
impressively rich and thoughtful contents, I can do no better than to quote
their own Abstract:

First, the chapter reviews the evidence suggesting that consciousness

can be dissociated from other brain functions, such as responsiveness to
sensory inputs, motor control, attention, language, memory, reflection, spa-
tial frames of reference, the body, and perhaps even the self. The chapter
then summarizes what has been learned by studying global changes in the
level of consciousness, such as sleep, anesthesia, seizures, and vegetative
states. Next, it asks what can be said at this point about the role of different
brain structures in generating experience. Then dynamic aspects of neural
activity are discussed, such as sustained vs. phasic activity, feedforward vs.
reentrant activity, and the role of neural synchronization. The chapter ends
by briefly considering how a theoretical analysis of the fundamental prop-
erties of consciousness can complement neurobiological studies. (p. 376)

The specific “theoretical analysis” referred to here is the information

integration theory of Tononi (2004) and subsequent refinements, but as the
authors acknowledge this is one variant of a larger class of global neuronal
workspace theories having a great deal in common. Tononi thinks that his
theory has certain advantages over the others (p. 405), but I am skeptical
of this and in any case what matters more for present purposes is the deep
Book Reviews 671

commonalities among them. Specifically, despite differences in detail, all

hold that the kinds of complex, unified experience that constitute normal
waking consciousness require, as a necessary condition of their occurrence,
an intact brain capable of sustaining large-scale cooperative neuroelectric
interactions linking widely distributed regions of the thalamocortical
network at frequencies extending into the gamma range. Furthermore, they
all agree that these neurophysiological conditions are abolished in largely
parallel ways under a variety of conditions in which consciousness is
severely attenuated or abolished, including coma and vegetative states, deep
sleep, adequate general anesthesia, and cardiac arrest. This general picture
constitutes the central take-home message of the book, and it has continued
to develop and flourish in the more recent neurobiological literature (e.g.,
Dehaene & Changeux 2011, Edelman, Gally, & Baars 2011, Siegel, Donner,
& Engel 2012).
Having described as best I can in such short compass the great strengths
of this book, let me turn now to some defects, starting with minor ones. The
book was typeset in India and printed and bound in China, and although
this process undoubtedly helped keep the price down it somehow resulted
in an unusually large number of misspellings and grammatical oddities.
Production people or perhaps even the editors themselves could also
have done more to improve numerous sentences written in non-English
(especially German) syntax, and to fix missing or incomplete references. I
also wish they had not used numerical referencing, which saves space but
makes it much harder to locate work by particular authors.
A slightly more serious issue concerns the wide variation among
chapters in terms of clinical versus theoretical emphasis. Some chapters,
particularly in Sections III and IV, are sometimes so densely packed with
clinical jargon as to be nearly unintelligible to someone not specifically
immersed in the corresponding medical specialty.
Most serious by far are issues related to doctrinal control. This is a
book totally committed a priori to the standard mainstream view that mind
and consciousness are generated, without residue, by physical processes
occurring in brains. Thus for example Laureys declares in his Preface (p.
ix) that it “tackles one of the biggest challenges of science; understanding
the biological basis of human consciousness.” A little further on he says
without qualification that “You are your brain,” ironically citing Wilder
Penfield in this context without mention of Penfield’s well-known dualist
sympathies. Similarly, Allan Hobson in his Prologue (p. xi) proclaims that
“Consciousness, like sleep, is of the Brain, by the Brain, and for the Brain. A
new day is dawning.” Dissenting views and evidence potentially threatening
to the classical physicalism giving rise to these triumphal proclamations are
672 Book Reviews

apparently not to be tolerated, and in fact are systematically and I presume

deliberately excluded from the book.
The exclusions take two main forms. The first involves editorial
decisions about what topics to include in the book and what to leave out.
Widely shared and increasing philosophical doubts about physicalism, for
starters, are nowhere mentioned, and the “hard problem” is never confronted
(Chalmers 1996, Koons & Bealer 2010). I was also disappointed, although
not surprised, that states of consciousness represented in the book range
almost exclusively downward from normal waking consciousness, with
scarcely a mention, let alone discussion, of things such as mystical or even
psychedelic states.
Much more distressing, however, is the treatment within the book itself
of evidence discordant with its central point of view. There are a number
of relevant examples, but I will focus here on two in particular. The first
concerns the claims made in Chapter 13 and elsewhere about conscious
experience occurring in vegetative states. This claim was initially advanced
by Owen, Coleman, Boly, Davis, Laureys, and Pickard (2001), who carried
out fMRI studies with a female victim of traumatic brain injury from a
car accident. This patient strictly satisfied the current diagnostic criteria for
persistent vegetative state (PVS), including in particular total behavioral
unresponsiveness. The key finding was that when she was asked to imagine
playing tennis, or walking around in her own house, distinct patterns of
cortical “activation” appeared that strongly resembled those produced by
the same instructions in normal awake subjects. The investigators argued,
and continue to argue, that this demonstrates conclusively the presence of
conscious awareness in otherwise totally unresponsive persons. They have
subsequently discovered several additional cases of similar type (Monti,
Vanhaudenhuyse, Coleman, Boly, Pickard, Tshibanda, Owen, & Laureys
2010), but it is worth mentioning in passing that all of these involve
traumatic brain injury rather than the sort of global anoxia resulting from
cardiac arrest.
Several things need to be said about this. First, I do not find their
argument compelling, either logically or evidentially: logically, because
we do not know enough about the limits of unconscious processing to
be so confident that conscious awareness necessarily accompanied the
fMRI effects seen in her brain; evidentially, because we are told very little
about the baseline condition of that brain in terms of physical damage,
metabolic status, and neuroelectrical output both resting and stimulus-
evoked. It certainly doesn’t help that Steven Laureys was apparently duped
by “facilitated communication” into thinking that the Belgian PVS patient
Rom Houben had really been fully conscious during the 23 years following
Book Reviews 673

his car accident (Boudry, Termote, & Betz 2010). What would be really
convincing, of course, would be for the patient herself to wake up and report
remembering the experiments, but so far as I know that hasn’t happened
and is unlikely to happen. The more fundamental and interesting point,
however, is this: If that patient (and others like her) can be more or less
fully conscious under conditions in which the global workspace has really
been functionally degraded in the devastating manner characteristic of
vegetative and comatose states, then global workspace theory as currently
formulated is false. That important possibility goes unnoticed in Chapter 13
or anywhere else in this book.
The same possibility arises, of course, in any other condition in which
the global neuronal workspace becomes functionally disabled, and this
leads to the second and more important example, the chapter by Blanke and
Dieguez on OBEs and NDEs. By way of background, let me say first that
in Chapter 6 of Irreducible Mind (Kelly, Kelly, Crabtree, Gauld, Grosso,
& Greyson 2007) we made an explicit argument of the type just indicated,
and did so in the deliberately chosen context of OBEs and NDEs occurring
in conjunction with deep general anesthesia and cardiac arrest. We made
that choice specifically because it is relatively straightforward in such
cases, as compared with cases of the sort above that involve traumatic brain
injuries of incompletely known, uncertain, and probably fluctuating sorts,
to demonstrate that complex, profound, and life-transforming experiences
can and sometimes do occur under conditions in which the global neuronal
workspace has been unambiguously disabled, and in which contemporary
mainstream neuroscience therefore decrees that no experience of any sort,
let alone that sort, should be possible. This conflict is head-on, profound,
and in my opinion inescapable (see also Holden, Greyson, & James 2009,
van Lommel 2010).
Blanke and Dieguez, however, do not see it that way, and although
they certainly know of this argument they do not deign even to mention it,
let alone discuss it. Instead, they try desperately to evade it. Their chapter
amounts to an update of Blanke’s original unsatisfactory treatment of
OBEs in the Boundaries volume, now extended to cover NDEs in parallel
reductive fashion. For them the conventional production model of brain/
mind relations is proven, axiomatic, unquestionable. In forcing OBEs and
NDEs into that framework, however, they necessarily do violence to the
data at a number of critical points. In discussing cases occurring under
general anesthesia, for example, they try to evade the disabling of the global
workspace by making the astonishing suggestion (p. 308) that all such
patients must in fact have woken up during the surgery due to inadequate
anesthesia. Now it is undoubtedly true that there have been some patients
674 Book Reviews

who woke up during surgery and then had an OBE or NDE in connection
with that experience, but in general these are very different states with
radically different phenomenologies and sequelae and very little overlap.
Surgical awakenings are in the vast majority of cases highly traumatic
events characterized by total paralysis, fear, panic, pain, and helplessness,
with a legacy of resentment and high rates of post-traumatic stress disorder;
only a tiny minority include OBEs or NDEs, and it is surely little wonder
that one would do anything possible to escape such terrifying circumstances
if means were available! All of this is heavily documented in our chapter
in Irreducible Mind. Blanke and Dieguez even ignore the main message
of a case which they themselves cite approvingly (Lopez, Forster, Annoni,
Habre, & Iselin-Chaves 2006), one involving a teenage boy who during one
operation had an unpleasant awakening, and during another a typical NDE
without awakening. The authors of that paper, as well as the boy himself,
clearly recognized that inadvertent surgical awakenings and NDEs are
utterly different phenomena that need to be clearly differentiated; why can’t
Blanke and Dieguez?
Moving on to NDEs occurring in conjunction with cardiac arrest, they
make another astonishing and in my opinion scientifically indefensible
move. Specifically, they assert (on p. 315 and elsewhere) that in studies
such as that of van Lommel, van Wees, Meyers, and Elfferich (2001),
we really don’t know whether patients were unconscious or what sort of
condition their brains were in. Why not? Because full neurological and
EEG examinations could not be performed on those particular individuals
under the demanding conditions of resuscitation. With all due respect, that
is pure evasion: The presence of cardiac arrest or ventricular fibrillation
is determinable with complete reliability from EKG records, which
van Lommel et al. had for all of their patients, and the consequences of
such events for cerebral physiology are also known in detail and with
high reliability from a large number of previous experimental studies in
both animal and human subjects. These consequences are spelled out in
considerable detail both in our chapter and in van Lommel (2010), among
other places, and they are unquestionably tantamount to total disabling of
the global neuronal workspace during the period of arrest.
The only remaining way to try to circumvent this argument is to
argue that the experience actually occurred at another time, usually
either before full arrest or during recovery from it. This move is blocked
by subjects’ verifiable reports of events occurring during the period of
unconsciousness, but of course Blanke and Dieguez give no credence to
any such reports, or to anything paranormal for that matter. Cases such as
that of Pam Reynolds are not even mentioned in their chapter, unlike Chris
Book Reviews 675

French’s in the Boundaries volume. They also totally fail, again unlike
French, to come to grips with the hyper-reality, enhanced mentation, and
transformative impact characteristic of deep NDEs. Instead, like many
previous reductively inclined commentators, they wear on at length, with
abundant but largely irrelevant citations of neurological literature, about
alleged phenomenological similarities and hence “links” between NDEs
and sundry other syndromes of known etiology. We’ve seen this approach
before, and we and many other commentators have pointed out numerous
deep flaws in it, but to hear Blanke and Dieguez tell it there’s only one
scientifically proper way to think about the matter, and that’s their way, as
if no such problems had been discovered. This is not genuine science, in my
opinion, but rather a quasi-religious scientistic defense of a dogmatically
held a priori opinion. I think Chris French himself also underestimated the
challenge posed to current neuroscientific thinking by OBEs and NDEs, but
he at least was willing to look at actual evidence and think about its possible
meaning. Blanke and Dieguez are apparently incapable of that.
What should be the governing principle here was stated forcibly by
Francis Bacon (1620/1960) at the beginning of the scientific era: “The
world is not to be narrowed till it will go into the understanding . . . but the
understanding to be expanded and opened till it can take in the image of the
world as it is in fact” (Bacon 1960:276). What is ultimately at stake here is
correct interpretation of the intimate mind–brain correlation that everyone
agrees holds under normal conditions of conscious mental life. From a
historical point of view it is perfectly natural to interpret this correlation
exclusively, as current mainstream thinking does, in terms of production
of the mental by the physical, and it is certainly appropriate and desirable
that this point of view be developed as vigorously and fully as possible. The
volume under review does that for the most part in a sophisticated, wide-
ranging, and up-to-date way, and for that reason I strongly recommend
it. But in the examples cited I think we also see facts that are not readily
accommodated by the standard view, and that could make better sense in
terms of an alternative and broader interpretation proposed by James (1900)
and Myers (1903), among many others, according to which mind normally
operates in close coordination with the brain as a sensorimotor organ, but has
features and capacities that cannot be explained in conventional physicalist
terms. It is only by honestly and squarely facing potentially decisive facts
of the sorts described above, and many others like them (Kelly et al. 2007),
that we can hope eventually to arrive at the correct view, whatever that
might be. As Myers himself cautioned, “Our notions of mind and matter
must go through many a phase as yet unimagined.”
676 Book Reviews

EDWARD F. KELLY
Division of Perceptual Studies, Department of Psychiatry & Neurobehavioral
Sciences, University of Virginia, 210 Tenth St. NE, Charlottesville, VA 22902
[email protected]

References
Baars, B. J. (1997). In the Theater of Consciousness: The Workspace of the Mind. New York: Oxford.
Bacon, F. (1960). The New Organon and Related Writings. New York: Liberal Arts Press. [Original
work published in 1620]
Boudry, M., Termote, R., & Betz, W. (2010). Fabricating communication: The case of the Belgian
coma patient. Skeptical Inquirer, 34, 12–15.
Chalmers, D. (1996). The Conscious Mind: In Search of a Fundamental Theory. New York: Oxford.
Crick, F., & Koch, C. (2003). A framework for consciousness. Nature Neuroscience, 6, 119–126.
Dehaene, S., & Changeux, J.–P. (2011). Experimental and theoretical approaches to conscious
processing. Neuron, 70, 200–227.
Dehaene, S., & Naccache, L. (2001). Towards a cognitive neuroscience of consciousness: Basic
evidence and a workspace framework. Cognition, 79, 1–37.
Edelman, G. M., & Tononi, G. (2000). A Universe of Consciousness: How Matter Becomes Imagination.
New York: Basic Books.
Edelman, G. M., Gally, J. A., & Baars, B. J. (2011). Biology of consciousness. Frontiers in Psychology,
2 (article 4). doi: 10.3389/fysg.2011.00004
Engel, A. K., Fries, P., & Singer, W. (2001). Dynamic predictions: Oscillations and synchrony in top-
down processing. Nature Reviews: Neuroscience, 2, 704–716.
Holden, J., Greyson, B., & James, D. (2009). The Handbook of Near-Death Experiences: Thirty Years
of Investigation. Santa Barbara, CA: Praeger Publishers.
James, W. (1900). Human Immortality: Two Supposed Objections to the Doctrine (second edition).
Boston/New York: Houghton, Mifflin. [Original work published in 1898]
Kelly, E. F., Kelly, E. W., Crabtree, A., Gauld, A., Grosso, M., & Greyson, B. (2007). Irreducible Mind:
Toward a Psychology for the 21st Century. Lanham, MD: Rowman & Littlefield.
Koons, R. C., & Bealer, G. (Eds.) (2010). The Waning of Materialism. New York: Oxford.
Laureys, S. (Ed.) (2005). The Boundaries of Consciousness: Neurobiology and Neuropathology.
Amsterdam: Elsevier.
Lopez, U., Forster, A., Annoni, J. –M., Habre, W., & Iselin-Chaves, I. A. (2006). Near-death experience
in a boy undergoing uneventful elective surgery under general anesthesia. Pediatric
Anesthesia, 16, 85–88.
Monti, M. M., Vanhaudenhuyse, A., Coleman, M. R., Boly, M., Pickard, J. D., Tshibanda, L., Owen, A.
M., & Laureys, S. (2010). Willful modulation of brain activity in disorders of consciousness.
New England Journal of Medicine, 362, 579–589.
Myers, F. W. H. (1903). Human Personality and Its Survival of Bodily Death. London: Longmans, Green.
Nagel, T. (1979). Mortal Questions. Cambridge: Cambridge University Press.
Owen, A. M., Coleman, M. R., Boly, M., Davis, M. H., Laureys, S., & Pickard, J. D. (2001). Detecting
awareness in the vegetative state. Science, 313, 1402.
Siegel, M., Donner, T. H., & Engel, A. K. (2012). Spectral fingerprints of large-scale neuronal
interactions. Nature Reviews: Neuroscience, 13, 121–134.
Tononi, G. (2004). An information integration theory of consciousness. BMC Neuroscience, 5, 42.
doi:10/1186/1471-2202-5-42
van Lommel, P. (2010). Consciousness Beyond Life: The Science of the Near-Death Experience. New
York: Harper Collins.
van Lommel, P., van Wees, R., Meyers, V., & Elfferich, I. (2001). Near-death experiences in survivors
of cardiac arrest: A prospective study in The Netherlands. Lancet, 358, 2039–2045.
Varela, F. J., Lachaux, J.–P., Rodriguez, E., & Martinerie, J. (2001). The brainweb: Phase synchron-
ization and large-scale integration. Nature Reviews: Neuroscience, 2, 229–239.