Locked-in syndrome is a severe neurological condition characterised by total or near total paralysis of motor function with preservation of vertical eye movements. Quadriplegia, lower cranial nerve paralysis and mutism are particular features of this neurological state.1 In contrast with other neurological disorders such as akinetic mutism, coma or vegetative state, consciousness in locked-in syndrome remains intact, as do intellectual and linguistic abilities and emotional functions.2 3 However, communication capabilities are severely limited because the motor abilities required for self-expression are lost.

The study of psychological adjustment to this extreme condition provides the potential for insights of wider psychological and philosophical interest as well as for important clinical implications not only for patients with locked-in syndrome but also for others with extreme disabilities.

The patient described here suffers from chronic locked-in syndrome following a brainstem stroke 4 years ago. He has found an outlet for his thoughts and feelings through his poetry. These poems provide the opportunity for this study.

Case report

PK was born in Poland in 1956. He obtained his art qualifications in Poland where he worked as a satirical cartoonist. He obtained several awards for his drawings which were exhibited internationally and also won the National Award for Poetry in Poland.

On the 1 April 2001, PK suffered a brainstem stroke. After …