I am Phineas Gage

I have never doubted that Hume was right about the human mind. Reason is—and can only be—the slave of the passions. Perhaps the reason that I have never doubted Hume is that I have never found a better way of explaining myself.

Students of psychology will be familiar with Phineas Gage, the railroad construction foreman whose personality was forever altered when a tamping iron was blown through his head, destroying part of his frontal lobe. The damage to his brain caused the once even-tempered railroad foreman to become an impatient, reckless, unbalanced figure.



Researcher António Damásio has studied more modern patients with frontal lobe damage, and many of his studies are chronicled in his wonderful book, Descartes' Error. But one passage of this book in particular struck such a chord with me that I have repeated it to almost anyone who will listen. Damásio tells the odd but fascinating story of a patient with damage to the ventromedial prefrontal cortex (VMPFC) who was asked to decide between two dates for his next appointment:

For the better part of a half-hour, the patient enumerated reasons for and against each of the two dates: previous engagements, possible meteorological conditions, virtually anything that one could reasonably think about concerning a simply date.... [He was] walking us through a tiresome cost-benefit analysis, an endless outlining and fruitless comparison of options and possible consequences.... [W]e finally did tell him, quietly, that he should come on the second of the alternative dates. His response was equally calm and prompt. He simply said: “That’s fine.”

I described my thoughts on that patient in my college thesis.

[W]hen faced with a decision, our brain faces a vast decision-making landscape.... In normal subjects, people can make quick decisions because the landscape is uneven—somatic markers attach an emotional sense of “importance” to certain features and thus drive us to consider or choose those options.... The resulting choice is not necessarily rational, but it occurs with great speed. In the case of prefrontal patients, however, the decision-making landscape is flat. In the case of the subject choosing between two dates described above, his prefrontal cortex proceeded to slowly traverse every possible consideration of his choice because nothing popped up that had any emotional significance. However, that this patient failed to ever give up and choose a date at random or to even suggest that Damasio choose a date for him, implies that his VMPFC damage caused another deficit: not only could he not make a choice, he lacked even the desire to do so.

The reason intact, the passions muted. Whenever I read Damásio's passage above, I saw every decision I've ever had to make. I obsess and overanalyze, and I often make a choice only when forced. I have trouble with the simplest of decisions. The reason is there, but without the passions, it is impotent. Reason can only analyze; it cannot motivate.

Counterintuitively, without passion, the "passions" run wild. Passion, in Hume's world, is workhorse of the will. Reason may decide what the best thing for us is, but it is passion that drags us kicking and screaming to that outcome. Without passion, you eat poorly and fail to keep to regimens of exercise or sleep. You become Phineas Gage. You become an obsessive Dr. Jekyll, who agonizes over even the simplest of decisions, coupled with an unrestrained Mr. Hyde, unable to exert control over his emotions.

So what do I have to motivate me, if I lack strength of will? I have no god who guides me. Whatever part of the brain attunes you to a higher spirit, I lack it. That perhaps leaves only conscience. Pain is a good motivator, and avoiding pain is usually a successful way to motivate good behavior. I live day to day with an incredibly powerful and overdeveloped conscience that causes me physical pain when I hurt other individuals. Have I developed this conscience in lieu of a god as a way to live as a good person? Is it my conscience that has allowed me to be as successful as I am?

Thus conscience does make cowards of us all;
And thus the native hue of resolution
Is sicklied o'er with the pale cast of thought,
And enterprises of great pith and moment
With this regard their currents turn awry,
And lose the name of action.

But the Mad Prince's "enterprises of great pith and moment" worked out none too well. Perhaps he should have listened better to his conscience.