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Prolonged disorders of consciousness: Damaged brains, damaged minds?

Keizer, B., & van Erp, W. S.

13 januari 2023

Prolonged disorders of consciousness (PDOC) are some of the most dramatic sequelae of acquired brain injury. After surviving severe brain damage, in many instances with the help of aggressive neurosurgical interventions, PDOC patients recover their ability to breathe independently and open their eyes spontaneously, but show little or no signs of conscious awareness. Two clinical entities are recognised: the unresponsive wakefulness syndrome (UWS), previously known as the vegetative state (Jennett and Plum, 1972; Laureys et al., 2010), and the minimally conscious state (MCS) (Giacino et al., 2002). While science is steadily unravelling the neurophysiological substrates of these conditions, in daily practice PDOC still confront us with existential themes. These may come in the guise of prognostic uncertainty, or conflicts between professionals and patients’ family members. In this paper, we provide some tentative reflections on our struggle with the concept of mind in a damaged brain.