1 in 10 people thought to be permanently unconscious as a result of brain trauma may actually be aware. The hunt is on for ways to rescue them from their limbo

Peter Strain

“I HAVE pictures of five patients on my wall,” says Nicholas Schiff. “They all seem to be in a vegetative state, but we know they are conscious. It’s to remind me they are out there and we are not helping them.”

Schiff, based at Weill Cornell Medical College in New York, is one of the world’s leading experts in disorders of consciousness. Many of his patients are in a vegetative state. Their injuries have left them with no awareness of themselves or of the world around them. Or so we thought.

In 2006, it was discovered for the first time that a woman believed to be in a vegetative state was actually conscious, after brain scans revealed she could imagine different things on request. That breakthrough was quickly followed by a devastating revelation: our ability to determine whether someone is conscious based on their behaviour alone isn’t accurate enough.

It is now known that some people have what is called “covert consciousness”, in which they have awareness that comes and goes, but can’t move any of their body. At first, it was believed to be a tragic but rare misdiagnosis. Now, results from a 10-year investigation suggest that many people could be trapped in this way. Their bodies lie still, but their minds are active. This creates an urgent need to find techniques that could awaken them. It also raises ethical questions about what we need to ask these people, and ourselves, when they do manage to make themselves heard.

As recently as the late 1990s, it was assumed that people in a vegetative state, by definition, had …