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Bottom view of three professional doctors leaning over the patient and wearing medical masks while holding the anesthetic inhaler

What Is Your Soul Doing When You’re Under Anesthesia?

It’s an intriguing and important question and you may be surprised by some of the answers

First, no one should worry about unpleasant awareness during anesthesia. I’ve performed more than 7000 brain operations and I’ve never had a patient experience unpleasant awareness related to anesthesia. It does happen, but it’s rare, and I’ve never seen it. I’ve had general anesthesia myself four times, and as I tell my anesthesiology colleagues, I’m a big fan of anesthesia. Modern anesthesia is safe, highly effective, and indispensable. Don’t be afraid of it. But I do need to tell you that there are scientific facts about anesthesia and awareness that may surprise you.

Second, when I use the word “soul,” rather than “mind” or “consciousness,” to describe mental states, I am not using the word in a spooky or New Age way, as if I were describing a ghost. “Soul” is a technical term in Aristotelian philosophy. The soul is the form of the living body — the set of principles and abilities that constitute being alive.

A simple way to think about the soul is that it is the difference between a body just before and just after death. A soul is everything that is true of a living body that is not true of a dead body. Soul is the organization and activity of your cells and your muscles, your organs and your mind. The mind, in this sense, is some of the abilities of the soul — the ability to perceive, to remember, to feel emotions, to reason, etc.

“Consciousness,” as I have explained in a prior post, is a meaningless term derived from the misunderstanding that we are meat machines. We aren‘t machines, and there’s no scientific evidence that we can be “turned off” in the way machines can be. The body can work poorly or stop working and disintegrate but there is strong scientific evidence that the mental abilities of the soul survive disability and even the death of the body.

I use the word “soul” because I think it is the most rational and scientific way to speak about human abilities. It is more comprehensive and true to life than “mind,” and it makes it clear that we are not “conscious machines” with on-off switches.

So, here’s the question again: What is your soul doing when you’re under anesthesia? Is it working during the two hours it takes to fix your hernia? Are you really “unconscious” when they take out your gallbladder?

Obviously, your soul is working under anesthesia in the sense that your heart is beating and your kidneys are making urine, which are soul activities. What you may not know is that there is abundant scientific evidence that mental activities of the soul — perception, emotion, memory for example — continue while you are under anesthesia, albeit in an altered state.

For example, two recent research papers add to the abundant research on awareness during anesthesia.

[A]ccording to a group of doctors in Finland, it may be that we never fully lose consciousness under anesthesia. Two new studies, both published in the July issue of the British Journal of Anaesthesia, suggest that the brain is still partly conscious under the influence of anesthetics, even though the person who has taken the drug isn’t reacting or seemingly aware. “The brain is working more than we have thought during general anesthesia,” said Dr. Harry Scheinin, an anesthesiologist at the Terveystalo Pulssi Hospital and adjunct professor at the University of Turku, both in Finland.

Yasemin Saplakoglu, “You Might Be Slightly Conscious Under Anesthesia” at LiveScience

The article describes the first study of 47 adults under anesthesia:

[T]he researchers shook the participants [who were under light anesthesia] and spoke loudly to wake them up, and then asked them what their experience had been like. All the while, the researchers recorded the participants’ brain activity with a device called an electroencephalogram (EEG). Most of the participants reported experiencing dreams mixed in with reality. These were pretty typical dreams, said Scheinin, who co-led the research effort. “There are people who thought [a] couple of years ago, that if you are dreaming during general anesthesia or surgery, … the anesthesia [dose] may be too low, but I don’t agree. I think dreaming can be relatively common and normal in surgical anesthesia.” It’s possible that “general anesthesia can be [closer] to normal dreaming or sleeping than we have previously thought,” Scheinin added. (It is thought that a dreaming person, for example, is partly conscious, he said.)

Yasemin Saplakoglu, “You Might Be Slightly Conscious Under Anesthesia” at LiveScience

In the second study, the researchers measured brain waves in anesthetized people while they played recordings of normal and bizarre sentences. The brain waves of the patients suggested that they at least partially understood some of the sentences, even while “unconscious” under anesthesia.

The level of anesthesia in these experiments was light — surgical anesthesia is usually deeper — but it is clear that the generally reported incidence of awareness of 0.1% of patients during anesthesia is almost certainly an underestimate.

Allan Leslie Combs,  Professor in the Transformative Inquiry department at CIIS and director of the Center for Consciousness Studies, who was not involved in the research noted that the main loss is memory:

But what is commonly lost is memory, Combs said, which is what the second study suggested. In other words, even though a person may not fully lose consciousness while under certain anesthetics, that person does lose the memories that occur at this time.

Yasemin Saplakoglu, “You Might Be Slightly Conscious Under Anesthesia” at LiveScience

As to whether awareness occurs during deeper levels of anesthesia — particularly awareness for which the patient is amnestic after surgery — that issue has not been studied using the methods in these experiments. It is worth noting that the large literature on near death experiences and the growing literature on awareness in very deep coma suggest that awareness even with complete or almost complete cessation of brain activity is fairly common.

We are not machines. Our mental powers are altered by drugs and injury and death but there is strong scientific evidence that mental powers of the soul persist in many conditions which we traditionally have called “unconsciousness.”

What is particularly noteworthy about all of these areas of cutting-edge research on anesthesia, sleep, coma, and near death experiences is that they all point to the same conclusion: our souls — and specifically the mental powers of our souls — are not “turned off” by anesthesia, by sleep, or even by coma or death.

The most parsimonious inference we can draw from this science is that the soul is subsistent, meaning that it has capacity for independent existence. This is of course a widespread religious belief and a highly defensible philosophical inference. It is also good modern neuroscience.

You may also enjoy: Your soul has no “off switch.” Michael Egnor: Why did the concept of “consciousness” suddenly appear in the early modern era after millennia of profound contemplation of the soul and its mental powers had never invoked it? A major modern misunderstanding of the human mind is to assume that it is like a machine with an “on” and an “off” switch.

Michael Egnor

Senior Fellow, Center for Natural & Artificial Intelligence
Michael R. Egnor, MD, is a Professor of Neurosurgery and Pediatrics at State University of New York, Stony Brook, has served as the Director of Pediatric Neurosurgery, and award-winning brain surgeon. He was named one of New York’s best doctors by the New York Magazine in 2005. He received his medical education at Columbia University College of Physicians and Surgeons and completed his residency at Jackson Memorial Hospital. His research on hydrocephalus has been published in journals including Journal of Neurosurgery, Pediatrics, and Cerebrospinal Fluid Research. He is on the Scientific Advisory Board of the Hydrocephalus Association in the United States and has lectured extensively throughout the United States and Europe.

What Is Your Soul Doing When You’re Under Anesthesia?