Title: Into the Gray Zone: A Neuroscientist Explores the Border Between Life and Death
Author: Dr. Adrian Owen
Publisher: Scribner
Format: Paperback
Rating: 3 out of 5
How I got it: I was given an advanced reader’s copy in exchange for this review

About 5 years ago, I read Westlake Soul by Rio Youers. It’s a short sci-fi novel where the title character lives in a persistent vegetative state. He rests in his bed and appears unresponsive to the outside world, but inside, his mind is a ferment of activity. In his own head, Westlake is a superhero, and his nemesis is Dr. Quietus, a personification of death.

In Westlake Soul, Youers imagines the inner life of someone locked into their own body. Do such people have consciousness? Are they aware of what goes on around them, even if they’re unable to make that awareness known?

Into the Gray Zone, by London-based neurologist Adrian Owen, is a non-fiction book that answers those questions. Specifically: yes, it is possible, and even somewhat common, for people in persistent vegetative states (who are in “the gray zone”) to be fully aware of what’s going on around them.

The book describes the initial discovery of this fact, as well as the subsequent experiments that Owen and his colleagues developed to provide further proof. The experiments themselves are rather elegant. First, they needed to prove that patients in the gray zone could still perceive and and understand familiar words and images. Then, they needed to prove that these patients could display intent.

They did that by scanning the brains of gray zone patients after asking them to think of a specific activity or image. Thinking of one kind of activity (playing tennis) results in different patterns of brain usage then thinking of another (finding your way around your house). The true stroke of brilliance is that, upon realizing that these two types of thoughts result in distinct brain patterns, you can use that as the basis for getting the patients to answer simple yes/no questions. “Do you feel any pain? If yes, imagine playing tennis. If no, imagine walking around the house.”

On the surface, this discussion of how our brains work is fascinating. Being able to determine who is in the gray zone yet conscious — and even communicate with them — is a huge achievement. World-changing, even!

But, while Owen may have a knack for explaining complicated concepts clearly to the reader, I still found Into the Gray Zone hard to read. But it’s not a problem of content. Rather, it’s one of tone.

Owen claims to respect his patients. However, I get the sense that the book is more about his personal journey and career rather than the wonders and potential terrors of the human brain.

This is immediately noticeable in the first chapter, where Owen talks about one of his former patients:

One patient I worked with had minimal frontal-lobe damage but became wildly disinhibited as a result. Before his injury he was described as a “shy and intelligent young man.” Postinjury he abused strangers in the street and carried a canister of paint with him to deface any public or private surfaces he could get his hands on. His speech was littered with expletives. His wild behavior escalated: he persuaded a friend to hold his ankles while he hung from the window of a speeding train, a lunatic activity by any measure. His skull and most of the front part of his cortex were crushed when he crashed headlong into a bridge. By some circular twist of fate, his minor frontal-lobe injury led directly to major damage to the same part of his brain.

Notice anything about that passage? If not, try this one less than 2 pages further in:

My patient was a lanky youth with wild hair whom I tested for memory impairments following surgery that he had received to combat seizures. He was also the defendant in a murder trial. The victim was his own mother, strangled while she was securely locked in the house with her son. Just the two of them. The case turned on his being a martial arts expert with a history of epileptic automatisms, and he could (although the evidence remained entirely circumstantial) have killed her through a series of routine martial arts maneuvers and remained entirely unaware of this dreadful act.

When I tested his memory using what were then our state-of-the-art computerized tests, I sat near the door — a strategy I had seen in numerous TV crime dramas. I didn’t feel safe. I needed a weapon. All this now seems ludicrous, but there I was, sitting in a closed office with a man who was accused of killing his own mother with his bare hands without even knowing that he’d done it! If he had done it, could he be judged responsible? I wasn’t sure. The thinking then and now was that automatisms, rather than expressing subconscious impulses, are automatic programs firing in the brain, completely outside our control. If he had been a carpenter, he would have been sawing a piece of wood rather than karate-chopping his mom.

Both of these anecdotes display a disturbing lack of respect for his patients. A studious young man turns into a hellraiser because of a brain injury but hey, he gets his just desserts because said injury becomes the “twist of fate” that enables him to experience a horrible death. As for the second patient, how about using the phrase “karate-chopping his mom” to add a dose of levity to the idea of matricide? Sounds fun, right?

Into the Gray Zone goes into great detail about the medical advances and unpredictable developments that have allowed researchers to communicate with people in the gray zone. But through it all, I get the distinct sense that Owen needs more empathy. Or at least, the two anecdotes I’ve quoted above predisposed me towards treating this book with skepticism.

I’ve read works on similar topics by authors like Oliver Sacks and Gabor Maté. While they may be somewhat dry in places, both doctors approach talking about their patients with a sense of care and even wonder. In contrast, while Owen displays amazement about the scientific advances he’s been able to contribute to, he also spends a significant amount of time talking about how a failed relationship with a colleague named Maureen informed his practice.

Maureen, a fellow student while he was in medical school, was also studying the brain. But while he wanted to unravel its mysteries — treating the brain as a fascinating yet confounding object — she wanted to care for people with psychiatric problems. They eventually broke up; years later, she suffered an aneurysm and never recovered, becoming vegetative herself.

Her spectre haunts the book — Owen constantly talks about how his thoughts of her and his hope for an eventual cure for her condition motivated him to understand patients in the gray zone. But he also admits that it was only after both her and his own mother entered the gray zone that he truly felt empathy for people in the gray zone and the family members left behind who were trying to cope. Before that, his patients just seemed like puzzles to solve.

I’m really disturbed by this, as it just reinforces a popular stereotype that good doctors, the ones that deserve acclaim, don’t necessarily need to care about people to succeed. We see it in House and other forms of pop culture that venerate the Jerk Doctor. Now, Adrian Owen may not be a jerk, but I’m still put off by how much of the focus on Into the Gray Zone he places on himself.