We have asked, and tried to answer, many questions in this book. We’ve saved the toughest for last.
“Gillian” was only 23 years old. She lay motionless in a British hospital bed in 2005, having suffered severe brain injuries after being struck by two cars while crossing the street. Days became weeks, which became months. Still, she remained unresponsive. Her physicians determined that she met the clinical criteria for a diagnosis of persistent vegetative state (or unresponsive wakefulness, the gentler diagnostic name more common today).
Gillian’s neurologists continued to be interested, though, in the possibility that she had residual cognitive function—that despite the lack of outward signs of consciousness, her brain might still, in less perceptible ways, be responsive to stimuli. Eager for some sort of resolution, her family agreed to allow neuroscientist Adrian Owen to place Gillian in an MRI scanner. Changes in blood flow throughout her brain would be recorded, and their interpretation would allow Owen to draw conclusions about activity in her different brain regions.
These remain some of humanity’s knottiest mysteries: What gives rise to consciousness? Where is it situated in the brain? How do we measure it or even tell whether it’s there in the first place? Physicians, philosophers, lawmakers, and others have long looked into such matters, each through their own occupational lenses, each guided by different stakes and stakeholders. But the existential question persists: What does it really mean to have consciousness?
The challenges inherent in assessing consciousness are only amplified under the most tragic circumstances, such as Gillian’s. These cases have been known to escalate into hornets’ nests of lawsuits, political posturing, and indignant punditry, but the questions they raise are complex even at a scientific level. Differentiating unresponsive wakefulness from a minimally conscious state can be one of the hardest tasks a physician faces; research indicates misdiagnosis rates north of 40 percent.
From a neurological perspective, consciousness has two components: wakefulness and awareness. Wakefulness is straightforward: Can a person open his or her eyes? But awareness—therein lies the rub. Awareness requires evidence of cognitive activity tied to interaction with the surrounding environment. What counts as sufficient cognitive activity is often a point of contention.
So consciousness is anything but an either/or diagnosis. In fact, researchers and clinicians have developed an entire continuum of terminology to refer to levels of decreased consciousness, starting with confusion, drowsiness, and stupor and running through minimal consciousness, unresponsive wakefulness, and coma. There is a clear appeal, then, to current research that uses cutting-edge technology to identify anything approaching a “brain signature” of what consciousness looks like at a neural level. As with other difficult questions about human nature—How can we tell if someone is lying? How do we really know if someone harbors particular prejudices?—the hope is that measuring the brain directly will provide clearer, less subjective answers.
Back to Gillian. For weeks she had been in the same hospital rooms with family members, within earshot of their familiar voices, but this appeared to have had little effect on her consciousness. When her doctors asked her questions that might have emotional resonance, again, there was no visible response.
But now Gillian lay in an MRI tube, giving Owen and his colleagues a direct channel to any brain response. All they needed to do was figure out what type of stimulus her brain might respond to. First they read aloud a series of sentences, some including ambiguous words (for example, creek versus creak). The neural scan indicated increased response from the left inferior frontal region of Gillian’s brain—same as would typically be observed in healthy subjects.
Still, the researchers cautioned, “neural response to the meaning of spoken sentences, although suggestive, is not unequivocal evidence that a person is consciously aware.” Apparently, studies of people who are sleeping or under anesthesia demonstrate that evidence of speech perception can be found even in the brains of those lacking in conscious awareness.
So for an even more rigorous effort to assess consciousness, the researchers required a more emotionally resonant stimulus. In their collective scientific wisdom, what they ultimately settled on was…
Tennis.
That’s right, tennis. Owen’s research team gave Gillian spoken instructions to imagine herself playing tennis, the ball floating from one side of the court to the other. In response, her brain showed signs of significant activity in the supplementary motor area—the part of the primate brain that contributes to the control of movement. What’s more, her neural responses were indistinguishable from those observed in the brains of healthy volunteers used for comparison.
There would be no miraculous recovery for Gillian. But her case inspired a set of procedures, now known collectively as the “tennis test,” which have played a major role in recent reconceptualizations of how to assess consciousness. Heated debate continues: Describing responses from colleagues after he published his first tennis-test paper, Owen says, “I received two types of e-mail….‘This is amazing—well done!’ and ‘How could you possibly say this woman is conscious?’ ” Without question, though, the work has had an impact, such as inspiring the formation of an international consortium of researchers seeking to generate inexpensive, relatively portable ways of assessing borderline states of consciousness. One possibility is to combine an assessment such as the tennis test with old-fashioned electroencephalography (EEG, in which electrodes are attached to the scalp to measure brain activity).
Amazing, when you think about it: a means by which individuals in a vegetative or unresponsive state, who are minimally conscious or who have locked-in syndrome—unable to move or speak but able to think—may be able to communicate with those around them via modulation of neural activity. Ask the patient a series of questions, tell her to think about tennis only if the answer is yes, and then look for activity in the supplementary motor area of the brain.
Nearly as amazing? That when it came to answering an age-old question about consciousness, one with life-and-death implications that cuts to the very core of what it means to be human, this team of neurologists and cognitive scientists turned to athletic competition. There it was in Gillian’s MRI scans: the brain on sports.
NOW, it’s not that we—or the researchers who devised the tennis test—are proposing that sports leave a unique imprint on the brain. Quite the contrary: We’ve spent the preceding chapters trying to make the case that there are rational underpinnings for all the supposed craziness and unusual behavior that sports seem to trigger. That is, that “your brain on sports” is really just your regular brain acting as it does in other contexts.
After all, that’s why researchers investigating consciousness and traumatic brain injury came upon the idea that thinking about tennis would be an ideal stimulus. It’s because sports = everyday life: the rivalries, the rationalizations, the striving for finish lines. Sports are familiar, they are ubiquitous, they are eminently human. Remember what Errol Morris said about the It’s Not Crazy, It’s Sports short films? “Sports, as we all know, touches on everything.” Even for poor Gillian.
As you now know, sports and athletic competition are fertile ground for scientists across disciplines to test their hypotheses about basic aspects of human nature. From economists studying appearance, leadership, and compensation among NFL quarterbacks, to the political scientist investigating international relations via the World Cup draw, to psychologists exploring praise and performance as they play out on the college ice hockey rink.
All of which is to say that, while it’s our hope that you’ve found this book entertaining, we’re also willing to sign off on your petition to get course credit for completing it. Remember this the next time you catch flak for prioritizing a sporting event over a work meeting or family obligation: You didn’t have your priorities out of alignment; you were doing background research. You weren’t a couch potato passively absorbing the big game; you were simply brushing up on the latest behavioral science. That big-screen TV you just bought, along with the latest sports-channel package? Educational tax write-off, if you ask us.*
As many a graduation ceremony speaker has intoned over the years, a true education never ends. We concur. But we’ll also note: Final exams prove a lot more fun when they come with instant replay, a halftime show, and nachos.
* Note to Legal: Jon and Sam are not certified tax advisers.