4
THE OTHER SIDE OF THE CURVE
IN 2008, AFTER more than four years at NIMH, I wrapped up my postdoctoral position. The Department of Psychology at Georgetown University, a few miles to the south in Washington, DC, had advertised a tenure-track position for a cognitive neuroscience researcher specializing in social and affective processes, with a focus on child development. It was an enormous stroke of good fortune. The odds of a PhD landing any tenure-track professorship are low. To snag one requires luck and good timing—a university where you’d like to work must be looking for someone with your particular research focus and skills the same year that you are looking for a position. Then you just need to beat out another hundred or so applicants for it. That year, both luck and timing were on my side, and I was offered the spot at Georgetown, where I have been ever since. But my research program has expanded considerably to include research with individuals who are as unlike psychopaths as you could possibly imagine.
I have not, however, abandoned my brain scanning research with children with serious behavior problems. All told, I have now spent over a decade on this work. And the research my students at Georgetown and I have conducted has expanded our initial findings about the role of the amygdala in understanding others’ fear. For example, my student Joana Vieira and others have now found that psychopathic adults and adolescents have amygdalas that are not only underactive but smaller than average as well. In one study by Adrian Raine, the amygdalas of psychopathic adults were found to be about 20 percent smaller than those of controls. Another recent study even found that young men with smaller amygdalas were more likely to have been psychopathic even as children and were more likely to engage in persistent violence in the future. Essi Viding’s studies of adolescents have found that the severity of psychopathic personality traits in this age group corresponds to how densely concentrated the gray matter in their amygdala is.
And in a 2014 study of amygdala activity, my student Leah Lozier found still more direct evidence that a lack of amygdala responsiveness to others’ fear drives psychopathic children’s antisocial behavior. For that study, we scanned the brains of over thirty children with serious conduct problems—children who frequently fought, stole, lied, and broke rules. Some of them had psychopathic traits, like low levels of traits like compassion, caring, and remorsefulness, and others didn’t. As I’ve described, it has long been suspected that antisocial behavior in children with versus without psychopathic traits is driven by distinct brain processes, and this study helped to confirm that. In children who had conduct problems in the absence of psychopathic traits, the amygdala responded more strongly to fearful expressions than it did in normal children. This is consistent with the idea that these children’s antisocial behavior is a by-product of overreactive emotionality, which may cause them to erupt in response to ambiguous or mild threats. Patterns like this are sometimes linked to anxiety, depression, or exposure to trauma. On the surface, however, it’s not always easy to tell these children apart from those who have psychopathic traits, as I had learned early on in my research at the NIH.
Liz and I had recruited a boy named Daniel toward the very beginning of our study—he was perhaps the third or fourth teenager we evaluated. Daniel was unlike most of our other participants in several ways. Nearly all the children I have described so far were white and living in intact, functional families in middle-class or even wealthy neighborhoods, and they went to good schools. Not all the children we studied fit this description, but a lot of them did, and the seeming ease and normalcy of their lives made their cruel and disruptive behavior much harder to explain than if they had led lives of real hardship, as Daniel had.
Daniel was the most outwardly alarming of all the subjects we brought in. Fifteen years old when we first met him, he was a rangy black boy who stood nearly six feet tall and walked with an unhurried saunter and a flat stare. Every time I saw him he was wearing his standard uniform of black sneakers, voluminously baggy black jeans, and a pristine white T-shirt. Some days he topped it off with a black bandanna tied around his head in such a way that his hair poofed out in perfect spheres on either side of his head like Mickey Mouse ears. He once told us about the protracted security screening he always received coming through the NIH gates, and I wasn’t remotely surprised. I saw how people responded to him just walking through the NIH corridors. Patients and physicians alike scuttled out of his way like shore crabs whose rock had been overturned, casting furtive sideways glances at him. Walking next to him was an odd experience—as a small woman, I’ve never personally experienced responses like that in my life. What must it feel like to send ripples of alarm through strangers around you wherever you go? I will never really know, of course, and I never thought to ask Daniel.
The security screeners and NIH personnel weren’t wrong to worry about Daniel. He had engaged in more theft, overt violence, and other criminal behavior than nearly any of our other subjects. He couldn’t count the number of fights he’d been in. He had been shot at and had shot at other people. He stole from neighbors and stores and restaurants and had tried a variety of drugs. In his telling, he felt neither fear nor remorse about any of it. We had only limited background information about him, unfortunately, because his mother’s own mental health problems were severe, so we stuck to a brief and not very informative interview with his aunt. On the basis of this and our interview with Daniel, he received a high enough psychopathy score to qualify for a brain scan.
His MRI session started like any other, with my explaining how the brain scan would work and what he’d need to do while we sat in the cramped control room, which looked like a shabby sort of mission control, with tangles of wires and monitors and knob-and button-bedecked consoles cluttering every surface. As I talked, I noticed that his eyes kept darting toward the control room window, through which the gray, humming hulk of the scanner could be seen. “Something wrong, Daniel?” I eventually asked. “Any questions I can answer for you?”
“What’s this going to feel like? Is it… it gonna hurt?”
“Oh my gosh, no, definitely not, Daniel! We wouldn’t ask you to do something that hurt. It’s really just a big camera. Does it hurt to get your picture taken?”
He shook his head.
“Well, this is just the same. It doesn’t feel like anything.”
He nodded. But I glanced past his head at Liz, who raised her eyebrows at me. The fact that he even asked the question was odd. No other kids with psychopathic traits had asked anything like this. Before the scan, they only ever seemed either mildly curious or bored. Even our healthy controls rarely asked for reassurance.
As the scanning preparations went on, Daniel kept asking more questions. How long would it last? Could we stop the scan if he wanted to come out early? How many other people had we scanned? Could his cousin (who was in the waiting room) come in the scanning room with him? He didn’t want to be in the scanner alone. No, we couldn’t bring his cousin in the scanning room, but we could bring him into the control room, which we did.
“How you doing, man?” asked his cousin, surveying the scene.
“I’m good,” said Daniel. But he didn’t look good. He looked nervous.
I opened the door to the magnet. We were ready to start. “Okay, Daniel. We’re all set. Think you’re ready to go in?”
But Daniel didn’t get up. He just stared through the door at the magnet.
Finally, he shook his head. I was astonished to see his eyes welling up. “I can’t do it. I can’t do it. I want to go. I want my mom.”
He wanted his mom? He was too nervous to go in the MRI? This hardened teenage veteran of gun battles and drug deals was too scared to do something that several sweet ten-year-olds had already sailed through? But it was what happened next that really floored me: he apologized.
“I’m really sorry, guys,” he said. “I can’t do it. I wanted to do it, though. I thought I could do it.”
Then he stood up and grabbed me. He pulled me into a big bear hug.
From inside a nest of skinny teenage arms I managed a muffled “It’s totally okay, Daniel. Of course it’s okay. Thank you for trying. I’m glad you came in today anyhow.”
Daniel had totally fooled us. He was a boy who had been forced to adopt the trappings of a hardened adult, and had done so convincingly. But he was not a child with a broken VIM—he was a child whose broken life had pushed him to engage in the same sorts of behaviors that an actually callous, remorseless child would. Underneath, Daniel was, I believe now, probably an ordinary boy in the very best sense, one capable of affection and compassion and remorse who deserved (as do so many children) a much better shake in life than he had gotten. By now he would be about twenty-six years old. I still think of him and his sweet, fierce hug and hope he somehow managed to overcome all the obstacles life had thrown in his path.
What my student Leah’s study found is that the brains of violent but emotionally sensitive children like Daniel (at least, the ones who are willing to be scanned) can, on average, be distinguished from those of children who are violent but callous. The Daniels of the world are actually highly emotionally reactive (no matter how well they try to conceal it) and show elevated amygdala responses to others’ fear. In contrast, children who are legitimately callous and remorseless show very little amygdala response to others’ fear. More, the degree to which actually callous children’s amygdalas are nonresponsive to fear seems to be a biomarker of sorts for aggression—particularly the goal-directed, proactive kind of aggression that is notoriously linked to psychopathy. In our study, the relationship between the severity of a child’s psychopathic traits and the severity of their proactive aggression could be accounted for, statistically speaking, by how underreactive the child’s amygdala was to fearful expressions.
It was powerful support for the idea that the way our brains respond to others’ distress is intrinsic to our capacity to experience caring and concern for others.
I am often asked if doing this kind of research is depressing. Sometimes it is, of course. I feel tremendous sympathy and sorrow for the parents of the children we meet, who are worried and anxious and frustrated, understandably, about their children. I wish I could do more to help them. And I worry for their children’s futures. But I really enjoy working with the children themselves. Children who are callous and remorseless are rarely terribly anxious or unhappy themselves—quite the contrary.
To get an overall sense of their mental well-being we sometimes ask children to rate themselves on a scale from 1 to 10, with 1 meaning that they are very unhappy with themselves and 10 meaning that they think they are terrific. A typical child will usually respond with a 7 or 8. But I have heard children with psychopathic traits shout out “Ten!” “Eleven!” even “Twenty!” And remember, these are children who may have been kicked out of multiple schools, who have been arrested, who have no real friends, and whose parents live in fear of them. It’s a great reminder of the vast gulf that can separate perception from reality.
The children are often impish and funny and interesting, just like any other teenagers, only more so. Sometimes they can be exasperating—like the psychopathic boy who was getting bored toward the end of his MRI scan here at Georgetown and tried to convince my graduate students to let him come out early because, he said, somehow as he was lying immobile inside the MRI and pushing buttons, his leg had broken. My students had trouble keeping a straight face in response to that one. Other children have caused various kinds of trouble on testing day. One boy locked his mother out of their house when it was time to leave for their scanning session, then refused to let her back in. Another stole food from a cafeteria right outside the scanner. He ate it, unconcerned, in the waiting room. A couple of the girls peed all over their pregnancy testing kits, clearly not bothered that I would be handling them afterward. An enormous number of the boys seem to rarely bathe, judging from the way their feet smelled when they took their shoes off before their scan. But their confidence was untarnished. One memorable teenage boy flirted so incessantly with my flustered twenty-six-year-old graduate student that his mother asked, only half-jokingly, if he was going to invite her to his prom.
But usually by the time they made it all the way into the MRI, the children were motivated to complete their testing and get on to the part where they got some money and a picture of the inside of their brain (the printout of which they could flap in their mother’s face, crowing, “See, look, I really have one!”).
Unexpectedly, one aspect of this line of research has been downright uplifting, and that is the stark contrast it has revealed between the highly psychopathic adolescents and young adults we have studied and everyone else.
Individuals who are considered “highly psychopathic” make up maybe 1 or 2 percent of the population. This small minority is not categorically different from everyone else, though, as far as we can tell. Rather, they have a larger agglomeration of traits that are present in smaller amounts in much of the rest of the population. One study found that perhaps 30 percent of the population registers as at least a little psychopathic on a variant of the PCL used for screening adults in the general community, the Psychopathy Checklist—Screening Version (PCL-SV). Interestingly, that’s about the same percentage of volunteers who were unwilling to take any shocks to help “Elaine.” It’s also about the same percentage of people found by my colleague David Rand to behave uniformly selfishly toward strangers in an online study he conducted. Subjects in that study had the option to share a small stake of money with a stranger they would never meet, for no reason except sheer generosity. Some 39 percent of the subjects never shared the money. But the remaining 61 percent were generous at least some of the time. Likewise, about 70 percent of people would score a big fat zero on a standard measure of psychopathy. That is an incredibly reassuring number.
It’s an all-too-common perception that human nature is “fundamentally selfish”—egotistical, Machiavellian, callous. Philosophers have been fretting over this issue for millennia, at least as far back as Aristotle, who concluded that, “All the friendly feelings are derived to others from those that have the Self primarily for their object.” Even a person’s apparently selfless deeds are, according to Aristotle, ultimately performed to accrue “honor and praise on himself.” This line of thinking dictates that even when people appear to be acting in caring ways toward others, their behavior always somehow can be traced back to concern for themselves. Did someone give money to charity? A tax write-off! Volunteer to help the homeless? Trying to feel better about his own life! Rescue a woman from a fiery inferno, Cory Booker style, and risk getting burned to death? Well—there must be some self-serving reason buried in there! “Honor and praise,” perhaps.
The belief that human nature is fundamentally selfish remains a cornerstone of much modern economic, biological, and psychological research. It’s the basis, for example, of the economic assumption of so-called rational self-interest, according to which all human motivation can be reduced to a little internal ledger that calculates the benefits and costs of any potential decision or course of action and strives to pick the option that maximizes benefits for the self—the option that, very simply, is the most selfish. Belief in this view of human nature is pervasive. In 1988, when a representative sample of over 2,000 Americans was asked, “Is the tendency of people to look out for their own interests a serious problem in the United States?” 80 percent agreed that it was. In 1999, a New York Times/CBS poll of nearly 1,200 Americans similarly found that 60 percent believed that most people are overly concerned with themselves and not concerned enough about other people, and 63 percent believed that most people cannot be trusted. (A nearly identical percentage of people polled by the 2014 General Social Survey [GSS] agreed that most people cannot be trusted.) Forty-three percent agreed that most people are just looking out for themselves.
But the studies of Milgram, Batson, Blair, and many others, including myself, raise a problem with this view of human nature: people vary. There is no one “human nature.” To take one obvious example, some people are psychopathic. And if you want to know what a person who is genuinely, fundamentally selfish looks like, just look at a psychopath. They are the Aristotelean ideal of a person whose apparently friendly or helpful actions always really do have the self primarily for their object. They are genuinely unmoved by others’ suffering and unmotivated to relieve or prevent it. Their apparently good deeds really are aimed at achieving some self-benefit. Take Brent, for instance, a psychopathic boy we studied at NIMH, who fashioned himself as a middle school Robin Hood and sought out bullies to beat up after school—but only to increase his own status and keep others afraid of him and in his debt. The whole point of studying people like Brent—of singling them out and evaluating them with clinical measures—is that they are different from other people. Their callousness and indifference toward others’ suffering, their willingness to manipulate and exploit others for their own benefit, are not normal. Studying people with psychopathic traits is a great way to gain a renewed appreciation for the fact that most people are not like them at all but instead seem to be genuinely capable of caring about the needs of other people.
Now, saying that most people aren’t psychopaths isn’t exactly a ringing endorsement of their characters. But the fact that psychopathy is continuously distributed implies something more interesting than just the fact that psychopaths lie at the far end of the callousness spectrum, with most other people bunched up toward the “zero” end. Most human physiological and personality traits aren’t distributed in this uneven way. Most traits, from height to cholesterol levels to intelligence to personality traits like extraversion, are distributed in a bell-shaped curve across the population, with most people clustered in the middle of the scale and fewer people residing at either the low or high end. So, for example, the average height of an American woman is about five-four, and the height of about two-thirds of all the women in the country is within a couple inches of that. Only a small number of women are, like me, shorter than five-one; a similarly small percentage are taller than five-seven. Most other variable traits are distributed the same way. This pattern of distribution is so common that it is literally called the normal curve.
Psychopathic traits as measured by the Psychopathy Checklist don’t fit this distribution. Instead, as one recent study found, they are distributed in what is called a half normal curve—it looks like a typical bell-shaped curve that has been sliced in half down the middle, leaving only the right-hand side. What this odd distribution suggests is that psychopathy measures like this are not capturing all of the available variance in traits related to psychopathy, like empathic concern and compassion. Instead, the “half normal” distribution may indeed represent only half of what is actually a symmetrical bell-shaped distribution, which ranges from people with unusually low levels of concern for others at one end (the psychopaths) to a clump of ordinary people in the middle, and then, perhaps, moving past that group, to another, smallish group of individuals on the opposite end of the curve from psychopaths whose capacity for caring and compassion is even higher than average—the “anti-psychopaths,” you might call them. If this is true—if the small population of truly psychopathic people among us is really balanced out by another small population of anti-psychopaths—it would be compelling evidence that selflessness is just as fundamental to human nature as selfishness.
But who are these anti-psychopaths? Almost no attempts have been made to find them or study them systematically—until now.
The idea to find and study anti-psychopaths may originally have been sparked by, of all things, a paper on face recognition published by some of my former colleagues at Harvard right around the time I began working at Georgetown. Recognizing a person’s identity from their face is an important and astonishingly complex feat—one we may fail to realize is astonishingly complex because we are so incredibly good at it, better even than the best computers to this day. (The face-sorting algorithms in Google Photos still can’t quite keep my children’s faces straight.)
At least, most people are incredibly good at it. For over 100 years, rare cases have been documented in which a stroke or head injury has caused a person to suddenly develop prosopagnosia, or “face blindness,” which all but eliminates the ability to recognize individual faces. Affected individuals no longer recognize the faces of close friends or family members; some even fail to recognize their own face in a mirror. Much more recently, it has been determined that not only can prosopagnosia emerge in the absence of any injury, but it’s not even rare: as many as one in forty people may have developmental prosopagnosia, meaning that they have been effectively face-blind their whole lives. Their numbers include the primatologist Jane Goodall and the late neuropsychologist Oliver Sacks. People with this condition represent the very low end of the continuum of face recognition abilities, which are quite variable; about 60 percent of this variation reflects genetic causes.
If prosopagnosia is starting to sound parallel to psychopathy in some ways—a developmental disorder that is highly heritable and results in significant impairments in roughly 1 to 2 percent of the population and milder impairments in a big chunk of the rest of the population—you’re having the same thoughts I did.
But a recent discovery about face processing makes these parallels even more striking: it turns out that people with unusual abilities populate both ends of the face recognition continuum. Those people with developmental prosopagnosia who populate the low end are counterbalanced by a group of super face recognizers on the high end—individuals who are extraordinarily good at remembering and recognizing faces. Super face recognizers might smile and greet a woman passing by on the street who happened to be their waitress five years earlier in a restaurant in a different city. Or they might instantly recognize a middle-aged former schoolmate they haven’t seen since elementary school thirty years prior. Super face recognizers’ abilities are so astounding that they can come off as freakish or creepy. One super recognizer the Harvard research team studied told them, “I do have to pretend that I don’t remember [people], however, because it seems like I stalk them, or that they mean more to me than they do, when I recall that we saw each other once walking on campus four years ago in front of the quad!”
We know that inherited variation contributes to extremes in many basic human traits, like intelligence and height. If inherited variation can also contribute to extremes in complex social skills like the ability to recognize faces, resulting in both those with profound impairments and those with extraordinary talents, it is not so difficult to imagine similar patterns emerging for personality traits like caring and compassion as well. In which case, the psychopathic individuals who populate the very low end of the “caring continuum” should be balanced out by another small population of individuals at the very high end of the continuum who are unusually compassionate. Whereas psychopaths are unusually inclined to harm others to benefit themselves, this opposite population may be unusually inclined to risk harm to themselves to benefit others.
Call them the extraordinary altruists.
The world is absolutely bursting with people who have committed moving acts of altruism. They volunteer to help needy animals or children or the mentally ill. They donate money to strangers in faraway cities or countries. They open up their veins to give their blood to the sick or injured. They remove garments from their own bodies to clothe impoverished people in their communities—sometimes in real time. One 2015 online video showed a woman pulling off her own shoes and socks and giving them to a homeless woman whose calloused feet were bare; in another, a young man on the New York subway pulled off his own shirt and hat and carefully helped a shivering and shirtless homeless man into them. Both of these altruists were unaware that they were being filmed at the time. Although such acts are lovely and heartwarming, I would still describe them as everyday altruism rather than extraordinary altruism, for the simple reason that acts of this kind are so wonderfully ordinary.
The generally accepted definition of altruism is “a voluntary behavior aimed at benefiting the welfare of another person.” Donations to charity, volunteering, donating blood, and helping a stranger all neatly meet this definition, and all these behaviors are squarely in the big central bulge of the compassion curve because they are all (happily) quite common. How common? The 2016 World Giving Index estimates that, in a given month, 2.4 billion people in the world—over half of all the people they surveyed—give some sort of help to a needy stranger. In addition, 1.5 billion donate money to a charity and over 1 billion people volunteer their time. That is a truly staggering amount of help offered to strangers by ordinary people around the globe—every month. The United States is, proportionally, among the most giving countries on the planet, ranking number two out of the 140 countries polled. Seventy-three percent of Americans reported that they had helped a stranger in the past month, 46 percent had volunteered their time, and 63 percent had donated money to charity. The amount of money that Americans give to others in a given year is enormous—in 2015 it was $373 billion, at that point an all-time high. The majority of that money ($265 billion) was given by individuals rather than foundations or corporations, and most of it went to secular causes like health and education. The United States’ closest competitors in terms of generosity are Myanmar, which is routinely ranked number one on the World Giving Index, as well as Australia, New Zealand, and Sri Lanka, which rounded out the 2016 World Giving Index slots for numbers three through five.
How common are other kinds of ordinary altruism, like blood donations? The World Giving Index doesn’t measure blood donations, but the World Health Organization does. The WHO records roughly 108 million blood donations per year around the world. That number includes, according to the American Red Cross, 14 million units of blood collected annually in the United States, which are donated by some 7 million Americans. Because fewer than four in ten Americans are eligible to donate blood, this means that every year nearly one-quarter of all eligible Americans donate blood. This steady stream of donated blood has been given away completely for free since 1974, when the United States moved to an all-volunteer blood supply. In some ways, blood donations are a victim of their own ubiquity. How common they are makes it easy to stop appreciating the generosity of all the millions of people who permit their own blood to be siphoned out of them by strangers so it can be carted away to a blood bank, then injected into still other strangers.
But the risks and discomforts associated with giving blood away to strangers are very minor, which helps to explain why so many people give. The same cannot be said for the donation of other body products, like bone marrow or peripheral stem cells. I’m familiar with the process of stem cell donation, as my mother went through it over a decade ago to save the life of her sister, who was deathly ill from otherwise untreatable lymphoma (and who is, happily, alive and well today). For blood cancer patients like my aunt, such donations often represent the only available cure.
Stem cell and marrow donations involve considerably more time, effort, and discomfort than donating blood. Either type of donation is preceded by hours of medical testing and screening. In addition, for several days leading up to the donation, donors must inject themselves with a medication called filgrastim, which increases the body’s production of the life-saving cells but can also cause bone and muscle pain. Finally, peripheral stem cells are harvested from the bloodstream via an hours-long extraction process during which the donor’s entire blood supply is siphoned out through a needle in one arm, run through a filter, and returned to their body through a needle in the other arm. So donating stem cells is not exactly a fun process, although it’s less intrusive than donating bone marrow, a surgical procedure during which marrow is extracted directly from the bones with a needle. Getting back to normal after either procedure takes donors anywhere from a few days to a month or more. But despite all this—despite the effort and inconvenience and discomfort and the fact that they cannot receive any payment at all—an enormous number of people have donated marrow or peripheral stem cells to save the lives of total strangers. Some 10 million people are registered as potential donors in the National Bone Marrow Registry, and about 5,000 of them donate each year.
Donating marrow or stem cells to a stranger begins to strain the limits of what can reasonably be termed “everyday altruism.” That said, bone marrow and peripheral stem cells grow back. Healthy bodies produce them constantly. Removing them is very low-risk and causes only temporary discomfort. For this reason, although donating marrow or stem cells to a stranger is a wonderful and admirable thing to do, I still would not term it truly extraordinary altruism.
Truly extraordinary altruism must not only meet all the usual benchmarks of altruism—a voluntary behavior aimed at benefiting someone other than the self—but it should go beyond ordinary altruism in three ways. First, the beneficiary should be someone unrelated and unknown to the altruist at the time they decided to act. Second, the act must present a significant risk or cost to the altruist. Third, the behavior should be non-normative—something people are not expected or taught to do. Not only does an act that satisfies all of these stipulations impress us as morally exceptional, but it becomes very difficult—impossible, arguably—to attribute the cause of the act to anything but genuinely altruistic motivation, because no amount of fiddling with the ledger could make the benefits to the altruist exceed the costs.
This is important to establish for two reasons. First, truly extraordinary altruism, a behavior that lies at the far end of the caring continuum, is most likely to represent a true mirror image of psychopathy, which lies at the other end. An extraordinary altruist is the most likely to genuinely show us what an anti-psychopath might look like. Exploring extraordinary altruism is also important because a sizable subset of the population is resistant to the possibility of truly altruistic motivation. And I have learned that even people who are receptive to the idea of altruism in the abstract often suspect that particular instances of apparent altruism are actually driven by selfish motives. To have any hope of identifying the neural underpinnings of the human capacity for altruism, it is important to first find examples of it that we can generally agree are driven by genuinely altruistic motivation rather than some other more self-serving cause.
What makes things tricky is that most human behavior is multiply motivated—driven by many forces operating on many levels, both conscious and unconscious, and many of these forces are indeed self-serving. Take an example of ordinary altruistic behavior from my own recent past: I invited my younger brother to live in my basement for a month while he looked for a new home for his family. At a behavioral level, this was surely altruistic: it was a voluntary offer on my part that entailed some (small) costs to myself, and the offer was aimed at benefiting my brother’s welfare—saving him some money, keeping him fed, making sure he was comfortable. But a skeptic could ask, “Was it really altruistic? Was the behavior really primarily motivated by your desire to help him?”
The answer isn’t as easy as me retorting, “Of course it was! I’m the one inside my own brain, and I know the reason I helped my brother, and it was because I wanted to improve his welfare.”
This response assumes that I can know the reasons for my own decisions and behavior. But this assumption is baseless, in part because the “me” that I am aware of isn’t really inhabiting my entire brain. The conscious mind is aware of only a tiny fraction of the processes going on inside the whole brain. What is your pituitary up to right now? How about your brain stem? Are you aware of them? Can you control them? Do you know why they are doing what they’re doing? No. They are more or less cut off from your conscious mind, as are many other neural processes. As a result, although people are reasonably good at correctly reporting on things that they can observe directly, like their own behavior, they are only so-so at reporting internal states like how they are feeling, and they often have no idea why they are feeling or acting as they are—and can be easily misled.
There are countless demonstrations of this in the psychology literature. One I like comes from one of Daniel Batson’s studies of altruism in which he administered a pill called Millentana to his participants at the outset of the study. As he gave them the pill he told some of the participants that Millentana was a drug that would make them feel very warm and sensitive. Others he told that it would make them feel uneasy and uncomfortable. Both explanations were pure fiction—Millentana was actually cornstarch, a psychologically inert placebo.
After swallowing the Millentana and a fictitious explanation of its effects, participants watched a stranger receiving painful shocks. After the first few, some participants were given the option to either receive the remainder of the shocks in her place or leave the study early (with the awareness that the stranger would keep receiving shocks after they departed). Batson found that 83 percent of those who believed that Millentana was making them feel warm and sensitive volunteered to take the shocks for the stranger whereas only 33 percent of the uneasy and distressed participants did. What produced this massive difference in behavior? A little trick that duped the participants into believing that a pellet of cornstarch was fiddling with their emotional states and massively changing their tendency to act altruistically. There is no record of Batson asking the “warm and sensitive” participants why they felt and acted more than twice as altruistic as the “uneasy” participants, but they presumably would have chalked it up to the drug, which Batson knew (as do we) actually had no effect. Batson’s experiment was a stark demonstration of how easily feelings, motivations, and behaviors can be shaped by forces outside of people’s awareness.
Two forces that biologists have convincingly shown to be drivers of everyday altruistic behavior—and that could well have played an unconscious role in motivating my offer to help my brother—are inclusive fitness, which biases organisms to help genetic relatives, and reciprocal altruism, which biases organisms to help those they interact with frequently, related or not. Both of these forces are ultimately self-serving, although the behaviors they promote are no less beneficial for others. Inclusive fitness drives altruism toward relatives across many species and promotes successful propagation of the altruist’s own genes. The thinking is that by helping my brother, who shares about 50 percent of my genes, I’m helping my own genetic legacy in some small way. Any help I give him improves his fitness and thus his likelihood of passing along his own genes—and by extension mine. It’s a convincing explanation for why the preponderance of costly helping behavior across species, from ants to birds to people, benefits genetic relatives. This drive to help genetic relatives occurs somewhere deep down in the nervous system via mechanisms that we share with monkeys and birds and ants, and may not require our conscious awareness. So I can’t possibly know to what extent this phenomenon affected my offer to temporarily house my brother—although I would readily admit that I would have been unlikely to make a similar offer to, say, a fourth cousin.
“Aha!” you might say, “but we help family not just because we are closely related to them genetically, but because we are emotionally close to them.” This is true, and this is where reciprocal altruism comes in. We offer most of our altruistic helping to people with whom we have long-standing close relationships or with whom we share membership in an important social group, whether it be a family, a neighborhood, a workplace, or a group of friends. The rules of reciprocal altruism are simple: help those who have helped you in the past or who are likely to help you in the future. I bring you some coffee today, you spot me money for lunch tomorrow. I help raise your barn today, you scare a thief away from my cattle tomorrow. I help you escape danger today, and maybe you’ll help me out of a pinch tomorrow or at some other future point. When everyone follows the rules of reciprocal altruism, which members of social species largely do, everyone prospers. It’s a game with very good long-term odds. The whole setup only works, though, when applied to those with whom you expect to keep interacting and who can therefore be reasonably expected to reciprocate. When people interact with strangers they have no expectation of ever seeing again, altruism, especially costly altruism, tends to plummet.
Given this, it’s amazing in some ways that we are still as nice as we are to strangers—giving them directions and making change and holding doors open and giving them donations of money and blood. Neither inclusive fitness nor reciprocity can explain such behaviors. Often, these various forms of low-cost helping may indeed be driven primarily by a selfless desire to help others, although still other forces can be at play as well. For one, because these kinds of behavior satisfy established social norms, we often engage in them merely from habit or by default and, as a bonus, get to feel a sense of satisfaction of having lived up to cultural ideals (whereas we might feel shame if we failed to do so). And sometimes these low-cost behaviors personally benefit the altruist in ways that go beyond future reciprocity. I benefited, for example, from helping my brother. He is fun and funny and interesting, and I loved getting to spend extra time with him while he was staying with me. Likewise, charitable donations can result in tax write-offs, and gallantly holding open doors and volunteering for charities can yield valuable boosts to social reputation. Any self-serving benefits may be small for a given instance of these forms of altruism, but because the costs are also low, the benefits still outweigh them. Thus, although all of these kinds of low-cost altruistic behaviors are wonderful—and often at least partly motivated by altruism—it’s nearly impossible to say for sure what is driving any single instance of donating or direction-giving or change-making or door-holding or basement-letting because there are so many possibilities, and because the various reasons can operate in tandem—a single instance of giving can simultaneously reflect kin selection, expectations of reciprocity, social norms, and a genuine desire to help.
This brings us back to the question of extraordinary altruism, which, again, is a voluntary behavior aimed at benefiting a stranger and which is non-normative and presents a serious risk or cost to the altruist. These stipulations ensure that, in contrast to most acts of ordinary altruism, all the possible alternative motivations have more or less been ruled out. The most common alternative possibilities—that the act was primarily motivated by kin selection, expectations of reciprocity, social norms, habit, or self-benefit—have all been stripped away. The stringency of this definition means that very few behaviors unambiguously qualify. One that does is the heroic rescue of a stranger—like the rescue that saved my life back in 1996.
When it first occurred to me that studying people who are unusually caring might be just as informative as studying those who are unusually uncaring, my thoughts naturally turned to heroic rescuers. I thought first of Lenny Skutnik, one of the more famous names in altruism research. Skutnik was a Congressional Budget Office employee in Washington, DC, who was carpooling home to Lorton, Virginia, one frigid January afternoon in 1982 when an insufficiently de-iced plane took off from National Airport, stalled out, lost altitude, then plummeted into the Potomac River near where Skutnik’s car was idling in traffic. Helicopters arrived some twenty minutes later to retrieve the few surviving passengers from the ice-choked river. One of them, Priscilla Tirado, was by then so weakened by hypothermia and panic that she slipped from a rescue line back into the water as Skutnik raced to a nearby riverbank. When he arrived, the scene was eerily quiet. Then a woman’s terrified voice pierced the quiet: “Will someone please help!?”
Skutnik’s immediate reaction—“like a bolt of lightning or something hit me,” he later said—was to strip off his coat and boots and hurl himself into the 29-degree water. He swam out some thirty feet to retrieve the half-frozen Tirado and haul her back to safety. It was an incredibly dangerous thing to do. Another would-be rescuer had already been forced back by the punishing cold and ice floes. Even back on shore, Skutnik’s focus remained on the others around him. As he sat shivering in an ambulance that had run short on blankets, he gave another soaked survivor his own coat. For his deeds, Skutnik received a Carnegie Hero Fund Medal and an invitation from President Reagan to attend a State of the Union Address, at which he was hailed as an American hero—albeit a reluctant one. Like Cory Booker, he consistently resisted being labeled a hero and was never comfortable with the adulation and attention he received.
I was tempted to reach out to Skutnik. He is a canonical example of real-world extraordinary altruism who I knew had lived in northern Virginia, minutes from my office in Georgetown. Assuming he hadn’t moved, I could probably walk to his house. But, frustratingly, for the purposes of trying to contact him, he might as well have lived on Venus.
As a university scientist who studies human behavior, I am bound by the rules of an institutional review board (IRB), the duty of which is to protect the welfare of university research participants. My research subjects don’t need a lot of protecting, as my studies are not terribly risky. I’m not allowed to call filling out surveys or participating in a brain scan “no risk,” as it’s technically possible to suffer some sort of harm anywhere. A subject could get a paper cut from a questionnaire, or experience claustrophobia inside the MRI scanner (and of course there’s the risk of serious harm if metal is introduced). But these research techniques are considered “minimally risky”—that is, they are no more risky than other routine activities like going to school or seeing a doctor. But risks and benefits must be considered in relation to one another, and my research also does not benefit my participants at all. They aren’t receiving treatment or therapy or training that might help them personally. So to ensure a favorable risk-benefit ratio, I am required to be cautious about avoiding any practice that might make participants feel pressured to subject themselves to even the low risks that my research presents. So, for example, I can’t pay them too much. I can’t offer to pay a fourteen-year-old $1,000 for a half-hour brain scan. The chance to earn that much money might make even a very claustrophobic child feel like he had no choice but to take part. I also am required to use no-pressure recruitment tactics. I can post advertisements on flyers or in newspapers or email listservs because those advertisements don’t leave anyone feeling personally obligated to respond. What I absolutely could not do under any circumstances was cold-call Lenny Skutnik to ask him if he’d like to take part in a brain imaging study. Although a journalist or writer or market researcher or second-grader doing a class project or literally anyone other than a university-affiliated researcher could legally and ethically look up Skutnik’s name in the directory and give him a call if they wanted to ask him some questions, I, as a university-affiliated researcher, could not. And that was that.
Luckily, heroic rescuers aren’t the only people out there who meet the requirements of extraordinary altruism. Some two decades ago, another form of extraordinary altruism was born, one that has been described as the moral equivalent of saving a drowning stranger: altruistic organ donation, which is the donation of an internal organ, usually a kidney, to a stranger. In stark opposition to a psychopath like Gary Ridgway, who destroyed a stranger’s kidney in an attempt to end his life, these altruists give a stranger a kidney in an effort to save someone else’s life.
This kind of donation is quite a recent phenomenon. Before the 1990s, donating a kidney to anyone who wasn’t a relative was considered an “impenetrable taboo.” Most transplant physicians would refuse to perform the surgery. The reason had little to do with the technical difficulty of transplanting an organ between strangers. The first successful kidney transplant from a living donor was recorded in 1954, and the first from a living donor who was genetically unrelated to the recipient in 1967. It also certainly had nothing to do with a lack of need. Then, as now, the number of people with end-stage renal disease who desperately needed a kidney and couldn’t find either a deceased or living donor grew every year. Today over 90,000 people are on the wait list. So why did it take so long until most transplant centers would consider transplants from altruistic donors?
The reason largely boils down to the pernicious belief that human nature is fundamentally selfish.
Unlike completing a questionnaire or an MRI, donating an organ entails real risks. Surgeons know this better than anyone. Physicians’ first and most important oath is primum non nocere: first, do no harm. A successful surgery is one after which the patient wakes up better off than they were before, or at least no worse off, an outcome that requires a team of surgeons, nurses, technicians, and anesthesiologists to carry out dozens of delicate and precise maneuvers exactly right. Even when they do, unforeseeable mishaps sometimes occur. Infections, clots, and bad reactions to anesthesia are just a few of the complications that can cause surgery to go south. These issues are rare, thankfully, during modern kidney removals: only about one in 50 nephrectomies results in serious complications like bleeding, and only one in 3,000 results in death.
So donating a kidney is actually considered a low-risk surgery. But to put it in perspective, compare the risk of kidney donation to the risk of skydiving—that pursuit of risk-takers and adrenaline junkies. The odds of dying after tumbling out of a plane beneath a parachute are about one in 100,000, which means that the risk of death from donating a kidney is over thirty times higher. And unlike skydiving, kidney donations pose some long-term risks as well. Officially, living kidney donors have about the same long-term health outcomes as the average person. But donors must be healthier than average to qualify for surgery. High blood pressure, obesity, or diabetes all rule out donation. So if people who start out with above-average health have only average lifetime outcomes following surgery, it suggests that the loss of a kidney could entail slight long-term risks, like increased blood pressure and a risk of kidney failure.
But what really separates kidney donation from surgeries that are not considered “impenetrably taboo” is not its risks—which, again, are not high—but its complete lack of benefits for the donor, at least from a medical perspective. Comparably risky surgeries are usually performed to remove organs that are diseased or causing the patient pain or even just inconvenience, like the removal of a gallbladder prone to stones or of a uterus to prevent pregnancy. And of course, millions of non-zero-risk surgeries have been performed for decades for purely cosmetic reasons. What makes these surgeries ethically uncomplicated, though, is that all their risks and benefits, however minor, redound to the same person. This person has presumably decided that the balance between risks and benefits is favorable, and that surgery is ultimately in his or her best interest.
What makes a kidney donation different is not its overall risk-benefit ratio, which is very favorable. It is that the risks and benefits are shared—unequally—between two people. The donor volunteers to take on only medical risks to give the recipient all the medical benefits. Living organ donations represent, in the words of the surgeon Dr. Francis Moore, “the first time in the history of medicine [that] a procedure is being adopted in which a perfectly healthy person is injured permanently in order to improve the well-being of another.” If you assume that human nature is fundamentally and uniformly selfish, and that all human decisions and behavior “have the Self primarily for their object,” the whole thing simply makes no sense.
Nevertheless, after the first successful living kidney transplant, surgeons gradually began performing more such surgeries in the ensuing decades. The problem of kidney failure was not going away—indeed, it kept getting worse. The wait list ballooned with every passing year. But for the most part the only acceptable donors were deemed to be people very closely related to the patient, preferably blood relatives, although in some cases spouses or other relatives would be considered. A few transplant surgeons would even perform donations between unrelated but emotionally close donor-recipient pairs, but most would not. Why? Again, the rationale boiled down to the belief that such a surgery was only justifiable if donors personally stood to benefit at least as much as they risked from the surgery—a rationale based wholly on the norm of self-interest. The thinking went: perhaps a mother who donates a kidney to her daughter, or a husband who donates to his wife, isn’t medically benefiting from the procedure. But they will benefit by being spared the grief of losing a loved one, or the hardship of losing someone they depend on, or from having to support the patient through endless rounds of dialysis. Perhaps these benefits, all added together, could outweigh the risks of the surgery. Surgeons would even go so far as to add improved self-esteem to the “gain” side of the donor’s ledger. But the idea of removing someone’s kidney in the absence of any concrete compensatory gains they might accrue by donating remained unfathomable.
What changed in the late 1990s? Arguably, it was (in part) the persistence and openness of a woman who has chosen, until now, to remain anonymous. I can reveal here, with her permission, that her name is Sunyana Graef. She is a sixty-eight-year-old mother of two who lives in Vermont, where she has worked for twenty-eight years as a Zen Buddhist priest. She is one of altruistic kidney donation’s “index cases”—a patient whose altruistic donation played a major role in changing the donation landscape. Graef was not the first person ever to donate a kidney to a stranger; there are reports of such donations as early as the 1960s. One detailed case study of another altruistic donor who falsely reported that she knew her recipient (and was later found out) was reported in 1998.
But Graef’s was the first reported nondirected donation. This is considered the most extreme form of altruistic donation, as the donor does not specify a recipient, does not know the recipient’s identity before surgery, and in some cases never learns who received their kidney. A donation of this kind—one that restores an unknown and unspecified receiver to full health and life—achieves the very highest moral status. The Hebrew philosopher Maimonides considered a gift that leaves both the giver and the beneficiary anonymous and that ends the beneficiary’s need for further charity to be the very highest form of giving. Ancient Greek philosophers would have considered such an act to exemplify the highest form of love, which they termed agape—unconditional love for any person, regardless of circumstances, rather than for any particular person or group. Most relevant for Graef, Zen Buddhism also advocates love and compassion that flows toward all beings, rather than being directed at any one individual.
A second major difference was that, prior to Graef’s donation, donations between strangers had largely been performed quietly and, on the part of the surgeons involved, often reluctantly. These donations were rarely formally recorded, and they generated no major cultural shifts. The same cannot be said for Graef’s donation.
It was 1998 when Graef first contacted a nationally renowned transplant center in Massachusetts and told them that she had given it some thought and really wanted to give one of her kidneys to someone on the transplant waiting list. She had never heard of anyone giving a kidney to an unspecified stranger before, but it seemed like it should be possible, and such a donation would be in keeping with her Buddhist vow to help all living things. She already volunteered some money and time to help others, but as a mother and full-time priest, she didn’t have very much of either, and it didn’t feel like enough. But she did have two kidneys. She had read up on, and was comfortable with, the level of risk the surgery would involve, as was her husband. The recipient could be anyone, she said, who didn’t kill for a living (like a hunter). And she wanted the donation to be anonymous. Her plan was to register at the hospital under an assumed name and to never meet the person who received her kidney so as not to cause the recipient to feel any debt or obligation to her. What do you think the transplant coordinator said? The response was polite, but flat: No way. Under no circumstances would they entertain the idea of this donation.
Think of it! That year some 35,000 Americans were stuck on the kidney transplant waiting list, most of them too sick to survive for more than a few years without a donor. And as any transplant professional would know, most of them wouldn’t find one. Many patients have no family members eligible to donate, and there are never enough deceased donors to make up the difference. (Transplants from deceased donors are less effective anyhow.) And here came a woman offering to give one of these patients a golden ticket—restoration to health and a normal life—by undergoing a surgery that is sufficiently safe that if she had been the patient’s sibling or parent it would have been perfectly acceptable. But the transplant center told her no, absolutely not—not because what she was seeking was impossible or even terribly difficult from a surgical perspective, but because what she sought seemed psychologically impossible.
For anyone who believes that human nature is fundamentally selfish, Graef’s request could only be explained by one of two unappealing alternatives. The first was that her wish reflected some self-interested calculus and she expected to receive benefits sufficient to compensate her for the risks she would assume. But the nature of her request eliminated any concrete benefits. By requesting that the transplant center pick the recipient, she ensured that this person would not be a relative or friend of hers, so her wishes couldn’t have been driven by the desire to help a blood relative or by expectations of reciprocity. And her request for anonymity ensured that she couldn’t receive any social or financial reward. Organ donors can’t legally receive payment anyhow. (This requirement, by the way, makes them the only ones involved who get no concrete benefits from their donation—the physicians, technicians, and hospital staff all get paid, and the recipient gets a kidney.) And by never meeting the recipient, Graef wouldn’t even have the pleasure of seeing this person returned to good health or hearing the words “thank you.”
The only other alternative—again, for anyone who believes that rational self-interest drives all human decisions—was that her wish did not reflect a rational calculus. In other words, she was crazy. She was irrational or delusional. Perhaps she believed that undergoing the surgery would fix some problem in her own life. Perhaps she was suicidal and hoping the surgery would go awry. Or perhaps she was seeking medical attention for pathological reasons; she could have been exhibiting a symptom of a rare factitious disorder called Munchausen syndrome. Any of these motivations would render her an unacceptable candidate for surgery.
Fortunately, Graef wasn’t content with the first answer she got. In her mind, the donation was already a foregone conclusion at that point. “It was like it wasn’t my kidney anymore. I just needed to find a way to make the donation happen,” she later recalled to me.
So she next reached out to the kidney transplant program at Brown University, which was (and still is) run by transplant director Dr. Reginald Gohh. To her relief, Dr. Gohh didn’t say no. Not that he immediately said yes either. He directed a major transplant center, but he had never heard of a donation request like this before. So Gohh first set up an interview in an attempt to figure out who this unusual woman was and to understand her request better. He came away impressed by her level of knowledge about the transplant and the seeming sincerity of her request. But before Graef could even begin the medical workup that precedes a kidney donation, Gohh wanted her to first speak to an entire team of transplant professionals to see if they also believed her to be both sincere and rational. The team included the transplant coordinator, a social worker, a transplant nephrologist, and a transplant surgeon.
All came away convinced of something that was at that time fairly radical: that this prospective donor wasn’t crazy or irrational or deluded, that she was sincerely motivated by altruism, and that, moreover, her motivation for donating was morally admirable and a legitimate reason for proceeding.
The transplant took place on February 8, 1999. A surgical team made a single incision in Graef’s abdomen, removed her left kidney, then quickly transferred it to a second operating room to be stitched into the abdomen of the recipient. Both Graef and her recipient—whom she has never met—experienced smooth and uncomplicated recoveries and soon resumed their normal lives. Graef was back at work in her temple a week after the transplant.
But neither Graef nor Dr. Gohh was content to leave it at that. Gohh came away convinced that donations like this one were ethically justified and should be performed when medically appropriate. Graef agreed that, as long as her anonymity would be preserved, it was important to let others know that surgeries like hers were possible. So in early 2000, Dr. Gohh wrote up Graef’s case, and the article was published the following year in three brief pages of the medical journal Nephrology Dialysis Transplantation, thereby helping to usher in a new era of altruism.
In 1999, the United Network on Organ Sharing (UNOS) recorded five anonymous altruistic kidney donations in the United States. In 2000, there were another twenty, and by 2001 there were thirty more. The numbers increased every year until they reached their peak in 2010, when 205 people anonymously donated their kidneys to strangers. Currently, between 100 and 200 altruistic donations take place in the United States every year. And this number counts only those that, like Graef’s, are “nondirected,” meaning the transplant center selects the recipient, who usually does not meet the donor before the transplant (although they often meet afterward). Many more donors elect to give their kidney to specific strangers whose need they learn about on Facebook or Reddit or a billboard or through a website like matchingdonors.com. Nearly all transplant centers will now consent to perform either type of altruistic donation, and gone are the days when surgeons would use terms like “repugnant,” “offends the human conscience,” and “pathologic by psychiatric criteria” (really) to describe these donors. Thousands of lives have been saved by the growing acceptance that a genuine desire to help another person, despite the costs to oneself, may motivate the donation of a kidney.
In 2009, I read “The Kindest Cut,” Larissa MacFarquhar’s wonderful New Yorker article about advances in altruistic kidney donation. It prompted me to do some more background research, which made the many similarities between altruistic kidney donors and other altruists clear. Heroic rescuers tend to make their decisions to help rapidly and intuitively. My colleague David Rand, a behavioral scientist at Yale, has conducted research showing that recipients of the Carnegie Hero Fund Medal overwhelmingly report that their decisions to rescue strangers were fast and spontaneous rather than deliberative. Altruistic kidney donors like Graef tend to report having a similar experience, often stating that when they first realized that they could donate a kidney to a stranger, they just “knew”—as though a bolt of lightning had struck them—that they wanted to do it, and they rarely felt any ambivalence or hesitation afterward. Also, like Cory Booker and Lenny Skutnik and many other heroic rescuers, they tend to be humble about their actions afterward, actively resisting being labeled heroes. Graef maintains to this day that she was really just a “conduit” for the donation, that Dr. Gohh and the surgeons, physicians, nurses, and even secretaries and janitorial staff at Brown’s transplant center made the donation possible and were the real donors.*
Altruistic kidney donors are unlike heroic rescuers, however, in one key way as far as research is concerned: they can be contacted en masse, without cold calls or coercion, through transplant centers and listservs. I decided that altruistic kidney donors were the extraordinary altruists who could help me explore the idea of a compassion continuum—the anti-psychopaths whose brains might reveal the roots of human altruism.
I spent the next year seeking funding for the project, which was no small task. Few organizations that fund scientific research have missions and funds compatible with studying the brains of extraordinary altruists. I caught a very lucky break, though. In late 2009, the renowned social psychologist Martin Seligman, in cooperation with the John Templeton Foundation, put out a call for neuroscience research proposals aimed at testing positive features of human nature like morality, resilience, and altruism. Bingo. I applied, and in 2010 I received a $180,000 “Positive Neuroscience” award to conduct the first-ever research on the neural basis of extraordinary altruism.
I originally thought the hardest part of the research might be locating enough altruistic kidney donors to complete the study. I wanted to find twenty altruists whose brains I could scan, and I had only a very small population from which to draw—there were roughly 1,000 nondirected kidney donations ever recorded at that time in the United States, and an unknown number of other altruistic donors. I was willing to fly the donors in from anywhere (and thanks to my grant, I had the money to do so), but who knew how many eligible volunteers I would be able to find? I would have to rule out anyone with magnetic metal inside their body, for example, and metal clamps are sometimes used in nephrectomies. I couldn’t include anyone taking medications for anxiety or depression or chronic pain, or anyone with claustrophobia. And of however many altruists remained who met all our criteria, how many would even want to participate? Normally, recruiting anyone older than college students for psychology research is like pulling teeth. Research doesn’t pay enough to attract the average busy, working adult; IRB restrictions against coercion prevent us from paying anyone with a decent income enough to actually compensate them for their time. And that’s by design. The goal is for research volunteers to partake in studies, not for the money, but out of a desire to help science and the public at large—out of altruism.
So as you might be able to guess, I didn’t actually need to worry about finding study participants at all.
I’ve actually never experienced anything like it. In early 2011, shortly before I left for a psychology conference in Texas, I had reached out to several organizations that work with kidney donors. I posted recruitment advertisements in a couple of national listservs for living kidney donors, and I asked the Washington Regional Transplant Center to contact the dozen or so altruistic donors in the area whom they had on file.
I didn’t have a smart phone back then, so I couldn’t check my email until midway through the first day of the conference. When I opened up my laptop and logged in, my jaw literally dropped open. It was like I had tapped into the matrix. My inbox was full of messages from altruistic kidney donors:
“I donated a kidney to a stranger last February. I would be happy to participate in your study.”
“Hi, I saw on Facebook that you are studying living kidney donors. I donated to a stranger in 2009 and would love to participate.”
“I am responding to a Facebook post by Abigail Marsh seeking volunteers to participate in your study.”
“Please know that I am EXTREMELY interested in participating in the study should the study want me.”
“I was an altruistic kidney donor… would be more than happy, and honored, to take part in a study.”
My favorite may have been:
“I WOULD VERY MUCH BE INTERESTED IN BEING A LAB RAT AND HAVING STUDIES DONE ON ME.”
This doesn’t happen in the normal world of behavioral research. Maybe it does for researchers who are studying life-saving cancer treatments or paying people thousands of dollars to sleep in a sleep lab, but for basic research on human behavior—no. I had been conducting psychology research for over a decade, and recruitment had invariably been a long, slow slog just to find a sufficient sample of somewhat enthusiastic volunteers. When you’re seeking a small, select population, it is even harder. Recruiting and screening twelve eligible adolescents with psychopathic traits for my first fMRI study at NIMH took about two years, and they’re not even very rare.
But despite altruistic kidney donors comprising less than 0.001 percent of the population, it took less than two days to recruit twelve of them, and within a week we’d heard from enough altruists to fill the study. The emails they sent were some of the friendliest, most effusive messages I’d ever received from strangers.
It was an apt introduction to the world of extraordinary altruism.
* As Graef describes it, this sentiment aligns with the Buddhist teaching that the highest form of giving is one that recognizes no giver, no receiver, and no gift, and that is derived from an understanding of our inherent oneness.