Syndromes in search of a name: Disorders of consciousness, neuroethics, and nosological humility

For a volume dedicated to illnesses which have no name, the evolving story of how disorders of consciousness came to be named is instructive. In 1972 Bryan Jennett and Fred Plum introduced the persistent vegetative state as a syndrome in search of a name. In the half century since, neuroscience has been refining how it names and classifies serious brain injury. Based on his volume, Rights Come to Mind: Brain Injury, Ethics, and the Struggle for Consciousness, the author describes the evolution of this nosology as it was informed by a deeper understanding of mechanism, new technologies such as neuroimaging, and improved epidemiology. By recounting how conditions were identified, named, and later renamed-for example, the redesignation of the permanent vegetative state to the chronic vegetative state in 2018-the author speaks to humility and the limits of knowledge; the place of temporality in diagnostic categorization; the importance of naming wisely; and how classification can lead to novel therapeutics. The paper concludes with the normative importance of new nosologies, chief among them the recognition of covert consciousness and cognitive motor dissociation. Such nosologic refinements point to the disability rights of patients with severe brain injury and the mandate for social integration and the recognition of consciousness where and when it exists.