Why We Need a Little Fear

Fear is a fundamental part of making good decisions.

Posted Dec 14, 2010

Like freedom from want, freedom from fear sounds better than the reality. We all know what it's like to feel overwhelmed by fear, but few of us know what it's like to be unburdened by fear. We imagine it would make us bolder and braver. In reality, it would make us stupider. Fear, as it turns out, is a fundamental part of making good decisions.

Consider the case of a 24-year-old woman we'll call Lucy. She began having seizures after a week-long fever. The seizures become more and more frequent, even with anti-seizure medication. Within a week, Lucy's brain was in a dangerous state called status epilepticus-essentially, one continuous seizure. When standard therapy didn't work, her doctors performed emergency brain surgery to prevent further brain damage or even death. The surgery, a temporal lobectomy, removed the part of Lucy's brain that seemed to cause 80% of the seizures. The surgery was deemed a success: Lucy's seizures were now under control, and she was released from the hospital.

This was not the end of the story. Five years later, Lucy showed up in the emergency room again. She has suffered another generalized seizure. The attending physicians described her as "lethargic and unresponsive, but medically stable." That's when things get weird. According to the original case report in the Journal of Neurology, Neurosurgery, and Psychiatry, "She was left unattended in an examination room. About 30 minutes later, she was found in an adjacent room performing fellatio on an elderly male cardiac patient."

Hmmmm. Not the usual hospital patient behavior (at least, not outside of television medical dramas, in which case the recipient would at least have been an attractive doctor). And also not the first sign of trouble. It turns out Lucy had continued to have seizures after the surgery, usually when she forgot to take her medication. For one to two hours after each seizure, she would engage in a wide variety of unusual sexual behaviors, such as masturbating in public and trying to seduce family members and neighbors. She also lost control around food in the post-seizure period. Her family reported extreme binge eating episodes that disappeared between seizures.

What could explain this impulsive behavior that flew in the face of Lucy's normal behavior and what society says is wrong? First, it helps to know what exactly the surgeons did to Lucy's brain. The temporal lobectomy removed Lucy's left amygdala, a region of the brain associated with threat detection and fear. The amygdala is commonly thought of as a prim

itive brain region that prompts instinctive responses, such as fleeing a threat. You see a tiger chasing you, and you run. But the amygdala is also an important source of the feeling that something isn't quite right. By reminding us of potential risk and harm, this primitive center can actually put the brakes on other impulses. You might feel an impulse to seduce your neighbor, but the fear factor (or, in the case of other impulses, the "ick" factor) can squash that temptation faster than you can say, "What if I get caught?"

Lucy's temporal lobectomy was one-sided. The right amygdala remained intact, which apparently was enough to help her function normally without her left amygdala. But her occasional seizures temporarily disabled her remaining amygdala. Each seizure created a brief window of time in which she had the functional equivalent of a complete temporal lobectomy. And in this window, her behavior went from normal to bizarre. She lost inhibition over the two appetites humans most carefully control-sex and food.

What is the moral of this story for us? First, I think we can all agree that medical case reports in stuffy scientific journals are more interesting than we realized.

Second, this case demonstrates that primitive fear instincts are as important for self-control as the higher power to override instincts. Many of us let fear get in the way of long-term goals, and that's not good. But it's a mistake to think the solution is to overcome fear in general. You can't (at least, not without a temporal lobectomy). And even if you could, you wouldn't like the results. We need our instincts to let us know when something is just wrong -- an immediate emotional evaluation that is even more powerful than complex reasoning and logic.

When it comes to self-control, that instinctive feeling is going to help you make a wise decision. For example, people who experience activation in the brain's pain region when thinking about buying something pricey are more likely to hold on to their cash. And people whose brains interpret cookies as a threat to their health and goals are more likely to stick to their diets. In many cases, stress is the enemy of self-control -- but sometimes, it helps us win the war.

Case cited: Anson, JA, & Kuhlman, DT (1993). Post-ictal Kluver-Bucy syndrome after temporal lobectomy. Journal of Neurology, Neurosurgery, and Psychiatry, 56, 311-313.


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