Dr. Michael Egnor, a seasoned neurosurgeon, shared profound insights in an interview with Robert J. Marks, challenging conventional views on the relationship between the mind and the brain. Drawing from decades of experience in the operating room, Egnor recounts cases that defy traditional neuroscientific understanding, suggesting the mind transcends the physical brain.

Awake Brain Surgery: A Window into Consciousness

Awake brain surgery, a technique used for about a century, allows neurosurgeons to operate on the brain while the patient remains conscious. Egnor describes removing a tumor from a patient’s left frontal lobe, specifically the anterior part known as the frontal pole, while engaging in casual conversation about topics like the weather and hospital. The patient’s head was secured, sedatives were administered, and local anesthesia numbed the scalp, as the brain itself feels no pain. Using an electrical probe, Egnor mapped the brain’s surface to locate and protect the speech area, ensuring no damage during tumor removal.

Remarkably, as he removed significant portions of the brain’s association areas — regions thought to govern reasoning and abstract thought — the patient remained lucid and unaffected. This experience led Egnor to question textbook descriptions of brain function, as the patient’s cognitive abilities persisted despite the loss of tissue traditionally associated with higher-order thinking. He noted, “There’s something about the relationship between the mind and the brain that’s not in the textbooks.”

The Limits of Neuroscientific Theory

He is skeptical of neuroscience’s reliance on materialistic theories of consciousness. He critiques the myriad competing theories — such as Global Workspace Theory (GWT) and Integrated Information Theory (IIT) — that assume that  consciousness arises solely from cortical activity.

Egnor’s clinical observations contradict these models. He cites patients with minimal or no cortex who remain conscious, suggesting that consciousness may not be entirely dependent on brain tissue. This disconnect highlights a gap between theoretical neuroscience and the realities of clinical practice, where many neuroscientists lack hands-on experience with living brains.

Marks draws a parallel with artificial intelligence (AI) research, noting that many AI theorists lack practical coding experience, leading to speculative claims untethered from reality. Egnor argues that experiential knowledge, gained through direct interaction with the brain, reveals complexities that academic models often overlook.

Persistent Vegetative State and Hidden Awareness

One of the most compelling discussions centers on persistent vegetative state (PVS), a condition traditionally viewed as a near-total loss of consciousness. Egnor references the work of neuroscientist Adrian Owen, who used functional MRI (fMRI) to detect awareness in patients diagnosed with PVS. In a landmark 2006 study, Owen placed a woman in PVS into an fMRI scanner and asked her to imagine activities like walking or playing tennis. Her brain activity mirrored that of healthy volunteers, indicating comprehension and intentional thought. Further tests confirmed that her brain responded only to meaningful instructions, not scrambled words.

Owen’s findings, published in Science as “Detecting Awareness in the Persistent Vegetative State,” revealed that many PVS patients studied with fMRI, EEG, or PET scans show signs of consciousness. Some could even perform mental tasks, like solving math problems or recounting family histories, using brain activity patterns as a communication code.

This research has led to the recognition of a new diagnosis, the minimally conscious state. The new term acknowledges that these patients are not “vegetative” but conscious, albeit unable to express their perceptions physically due to severe brain damage.

Paradoxical Lucidity: Moments of Clarity

Egnor also explores paradoxical lucidity, a phenomenon where patients with severe cognitive impairments such as Alzheimer’s disease, experience sudden, temporary clarity. It often occurs right near the end of life, in which case it is called terminal lucidity. Egnor recounts cases where patients, after years of cognitive decline, briefly regain the ability to converse coherently or recall memories vividly. This challenges the notion that a damaged brain equates to a destroyed mind, suggesting a more complex interplay between the two.

Near-Death Experiences: Pam Reynolds’ Case

The interview delves into the extraordinary case of Pam Reynolds, a woman who underwent a radical procedure to repair a life-threatening basilar artery aneurysm. Neurosurgeon Robert Spetzler cooled her body to 50°F, stopped her heart, and drained her brain of blood to perform the surgery. During this period, with no detectable brain activity, Reynolds later reported a vivid near-death experience. She described “popping” out of her body, observing the surgery from above with heightened clarity, and accurately recalling surgical instruments, conversations, and music played in the operating room. She also recounted traveling through a tunnel and meeting deceased relatives before returning to her body.

This meticulously monitored case, with EEG and other measurements confirming that she had no brain activity, challenges materialistic explanations of consciousness, because Reynolds’ detailed perceptions occurred when her brain was effectively “offline.”

Conjoined Twins and the Nature of the Mind

Finally, Egnor discusses the case of conjoined twins Tatiana and Krista Hogan, who share a thalamic bridge connecting their brains. This connection allows them to share sensations, emotions, and even vision — one twin can sense touch on the other’s body or see through her sister’s eyes. However, their intellectual activities, such as learning or reasoning, remain distinct. One twin does not automatically know what the other has learned, and they exhibit different personalities, preferences, and free will. This suggests that while their brains are physically linked, their minds remain separate, supporting the idea that the mind is not wholly reducible to the brain.

A Case for the Soul

Egnor’s experiences, detailed in his book The Immortal Mind: A Neurosurgeon’s Case for the Existence of the Soul (co-authored with Denyse O’Leary), challenge the materialistic view that the mind is merely a byproduct of brain activity. From awake surgeries to near-death experiences and conjoined twins, these cases suggest that consciousness may exist independently of physical brain structures. Egnor’s work invites readers to reconsider the mysteries of the mind, urging a more open and curious approach to understanding human consciousness.