Coma - A Healing Journey by Amy Mindell, Ph.D.

Recent advancements in medical technology have made it possible in some

cases to keep someone alive longer than would have been possible even ten years ago.
Yet, along with these remarkable developments, we are presented with new and serious
difficulties. Vital functions can be maintained mechanically; at the same time, new and
complex questions arise about the ethical and emotional issues concerning the
continuance or discontinuance of life support, the type and extent of care for a person in a
persistent vegetative state, where a person on life support should be cared for, longterm
care issues associated with managed care in the !nited "tates, and insurance issues.
#any of the people who survive brain in$uries are between eighteen and twentyfour
years of age, have vital young bodies, and may need longterm care. %or families,
frustration and anguish are further exacerbated by questions about the best form of care,
insurance coverage, and moving the comatose person from site to site not to mention
the &baseline& trauma of the family resulting from the loved one's sudden coma, and their
reliance on the predictions of medical staff about outcome.
(lthough far more people are in longterm vegetative states today than in the past, most
caregivers know little more about how to communicate with these individuals than people
knew centuries ago. #edical staff rarely have enough time to communicate effectually
with a comatose person and more to the point are not trained in interacting with
people in altered states of consciousness.
)his lack of training may stem from the prevalent viewpoint in the field of
medicine, in which altered states of consciousness such as coma have not been
understood as meaningful aspects of our experience. )he comatose person is assumed to
be unconscious and unaware. *n general, modern medical interventions for coma
emphasi+e the importance of focusing on sustaining life and arousing people from the
comatose state. *f the person does not awaken or does not respond to questions, the
situation is sometimes viewed as a medical failure, a factor further depressing everyone
involved.
,urrently, we do not have methods of communicating with someone in this state
and helping that person follow her inner experiences. -ecause we are unable to
communicate directly with her, no one is ever really certain about the comatose person's
wishes. )his results in greater stress and agony for all. (n updated training must include
special methods geared toward sensitively communicating with the person in this alltoo
frequent state of consciousness. .e have been encouraged by positive feedback from
professional caregivers who have applied our coma methods successfully.
)he advent of home hospice care has reminded us of the possibility of creating a warmer,
more intimate environment for those in the last stages of life, many of whom may fall
into a coma at some point. /ospice care helpers offer loving support and care; yet, family
members and friends may be unprepared for and afraid of a homebased hospice
situation.
#ost of us are unaccustomed to being with people who are in comatose states or
neardeath conditions. *f you are assisting a loved one who is in a comatose state, in
addition to the medical issues, you also must contend with pressing personal concerns,
such as feeling fearful and uncertain about being with someone who is in a coma, perhaps
suffering anguish yourself about your loved one who is &hanging on& so long. 0ven basic
questions can tax you1 &"hould * stay in the room all the time2& &.ill she ever wake up2&
&/ow can * communicate with him now that he is so far away2& &,an the person hear
me2& &/ow do * deal with the possible death of this person * love2&
.e ponder unfinished relationship issues, religious beliefs, family ties and separations,
hopes of recovery, or relief from pain. #uch of our distress comes about because we do
not know what the person in coma is experiencing.
Process-Oriented View A Path with Heart
)he processoriented view of comatose states is that they are due to mechanical
and chemical problems and that they reflect deep, altered states of consciousness in
which the person is going through potentially meaningful inner experiences. .e do not
focus on the comatose person solely from the viewpoint of pathology that the person is
ill and must be healed but from a phenomenological viewpoint. )hat is, we observe and
try to assist the person's inner experiences. 3eople do not operate as simply as machines
that can break down and be repaired; people are full of potential growth in all states of
consciousness even up to and perhaps beyond the moment of death.
"ome people in coma may be unconsciously searching for the chance to go deeply inside
without the disturbances of, or having to relate to, everyday life. *n coma work, we
assume that if the heart is still beating, we should make the attempt to communicate and
not rule out the possibility of reaching these littleknown corners of life.
,omatose individuals inevitably appreciate the assistance of someone who is able to
relate to them in special ways and who lovingly assists them in following and unfolding
inner experiences. ,oma work makes it possible for individuals in coma to communicate
with a helper if they like, and to have a voice in decisions about their care.
* remember a particularly moving case (rny told me about. /e was working with
a sixyearold 0uropean boy who had a brain tumor and had fallen into a coma. )he boy
was expected to die very soon. (rny used special communication methods he had
developed to ask the boy yesandno questions and receive answers. (rny had noticed
that the skin on the boy's cheeks would sometimes turn very red. (rny set up a
communication system1 when the skin became very red, this meant yes. .hen there was
no color change, the answer was no. /e asked the boy a number of basic children's
questions1
&(re you in a coma because you hate your brother and sister2& 4o response.
&(re you in a coma because you don't want to go to school2& 4o response.
(fter exhausting many possibilities, (rny asked his last question1
&(re you in a coma because you want to be closer to 5od2& )he little boy's cheeks grew bright
red. (t that point the father said, &4o6 /e cannot become a priest6&
.hat a shock6 (rny asked the parents to step outside so he could continue to discuss with
the child his religious desires. 7ater, he talked with the parents about their opposition to
their son becoming a priest. ( number of weeks later, (rny heard that the child had come
out of the coma, and today he is studying theology at a university.
%urther material on1 ,ommunication and 7ove as 5oals; and /ow to ,ommunicate with ,omatose 3eople.
This article was
excerpted from
"Coma - A Healing Journey"
by Dr. Amy Mindell