Consciousness and Anesthesia

Do we "cease to exist" while under anesthesia?

A very typical and unquestioned belief is that when we are under general anesthesia, we become ‘unconscious’ and are completely ‘unaware’ of anything. We simply ‘cease to exist.’

Outside observers see how the body becomes completely unresponsive, even to what would be otherwise the most painful experience. We seemingly have all the good reasons to believe that in such a condition, one is unconscious. After all, those who receive anesthesia or are in a deep coma don’t move, don’t speak, have their eyes shut, and don’t react to any painful stimulus.

Notice how basing our conclusions on the fact that someone doesn’t move, doesn’t speak, has their eyes shut, and doesn’t react to pain stimuli is an exclusively third-person perspective assessing external facts. We look at a patient’s body, only at its external physical traits, and then jump to some conclusion about his/her inner state of consciousness.

On the other hand, it is also true that, once awake, the patient reports a void of subjective experience. From the first-person perspective, when people wake up from anesthesia or a coma, they assure you that there was nothing; they didn’t exist. Everyone who has been under anesthesia can testify to how one wakes up with this sensation and with an abysmal sense of temporal void, with no sense of any time flow. In a sense, many of us can relate to this. I remember when I went under general anesthetization for a surgical procedure. There seemed to be nothing between the moment I fell into a coma-like state and the awakening when I couldn’t remember anything. Everything is gone, and even the sense of time disappears: Reality disappears and reappears in the blink of an eye.

So, what else should we conclude? Under anesthesia, we are unconscious.

This is the unquestioned premise with which many neuroscientists and philosophers of mind work.

However, the question is whether this rationale is sound. Are we really knocked out of existence during anesthesia?

All this seemed obvious to me. I had no doubts about it until, a couple of decades ago, an extremely vivid experience showed me the logical fallacy of this reasoning.

I once woke up from what we would call ‘sleep without dreams’–an awakening with the kind of feeling one has after a night of deep sleep, similar to a post-anesthesia wake-up, apparently without any dreams and no sense of time. It is a sensation of having gone ‘out of existence.’

To my surprise, however, after a while, a plethora of (more or less fragmentary) dreams bubbled up. Suddenly, I could recall forgotten dreams: it was no longer a dreamless sleep. I focused on that remembrance and could easily compare and sense the differences between the sleep state without dreams and the same sleep with dreams. In a sense, it was a controlled experiment of popping in and out of existence!

What this experience made clear to me is how everything depends on gaps in our memory. If you remember an experience, you say, “I was conscious” during that experience. If you don’t remember any experience, you will tell yourself, “I was unconscious.” But you were not. Can you recall your experiences as a newborn baby? I’m guessing you can’t. Therefore, are babies unconscious zombies that don’t feel anything? It is unlikely that your parents would agree with such very questionable extrapolation.

I don’t want to convince you that during anesthesia, we are conscious, feel the pain of the surgery, or are dreaming or having whatever experience (though some studies suggest this to be the case). From the scientific point of view, we should remain agnostic in these regards. The only point I would like to make here is that much too often, we make unwarranted assumptions that seem indisputable but which, upon closer scrutiny, are not at all obvious, and nevertheless jump to metaphysical conclusions.

On these unreasonable premises and much too simplistic reasoning, some philosophers found their careers. Their narrative is that, when waking up from anesthesia, which is a psychoactive substance modifying our brain chemistry, since we can’t report any experience, we must assume, without questioning further, that said anesthesia makes us completely unconscious and, thereby, must almost axiomatically posit that the brain produces consciousness. On this premise, people build enormous theoretical frameworks and ideological castles about the nature of consciousness.

This is not just a philosophical hairsplitting exercise. These kinds of misplaced assumptions and inferences have far-reaching ethical consequences that, for example, also frame the legislation over the destiny of patients in a coma or vegetative state.

What all this shows is that sometimes, especially when it comes to deep existential questions involving our psychological dimensions, we must be careful in walking through a potentially dangerous conceptual minefield by learning to determine what the real facts are and what our (unconscious?) assumptions are. Always question yourself about what your premises are and how far they are justified. In some cases, it might be a choice between life and death.

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