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WHAT MAKES AN ALTRUIST?
BEFORE WE DELVE deeper into the world of extraordinary altruism, I’d first like to invite you to accompany me on a trip that may be essential to understanding this world. Come ride with me, if you will, on a beam of light. This is not Einstein’s beam of light. It will not provide any insights into the conjoining of time and space. This beam will perform a feat, however, that I think is equally spectacular: enabling the conjoining of two human minds.
How information inside one person’s head ever makes its way into the interior of someone else’s head remains one of the great mysteries of psychology. Language obviously plays a crucial role. It would be nearly impossible to understand cognitively complex phenomena in others, like beliefs and desires and intentions, without language. Think of how much information you can glean about another person’s beliefs and goals when they say something like, “Hey, let me try!” or, “I’ll do that for you.”
But language is a foggy window into the mind. Most internal states are never verbalized. Some thoughts are too private or too banal to express. Other internal states cannot be put into words because they are too complicated, or because they are unknown even to the person experiencing them, lurking somewhere inaccessible in the unconscious. And language can mislead—sometimes intentionally, as in the case of irony or deception, and sometimes simply by happenstance. Is a person who says, “I’ll do that for you,” being helpful, impatient, or chauvinistic? The words themselves are silent.
Because the stream of spoken speech is only ever a fragmented reflection of the mind that produces it, much of what we know about others’ complex mental states—their beliefs and desires and intentions, sometimes called “cold cognitions”—is simply educated guesswork. Sometimes it seems like we actually know what intentions underlie an utterance like “I’ll do that for you” if it comes from a good friend, or if it’s accompanied by a smile versus a sigh. But this so-called knowledge is an illusion. We have no direct access to others’ thoughts. The best we can do is patch together inferences about what the people around us believe or intend or want by pinning observations of their behavior into the complex web of knowledge we have about them individually and about people in general. Although most adult human brains can do all of this quite quickly, it’s a terrifically complicated process, and it’s a wonder we ever get it right. Often we don’t, of course. Although most people believe that they are good at understanding others’ true internal states, psychological studies of lie detection suggest otherwise. When put to the test, nearly everyone’s ability to tell the difference between what others say and what they actually think when the two things differ is little better than chance. You might as well flip a coin.
The same is not true for understanding others’ emotions (“hot cognitions”). Although sometimes we infer how other people are feeling using similar inferential processes, that’s far from our only option. Actual, valid information about people’s internal emotional states is literally pouring out of them all the time in forms that we can access directly with our eyes, ears, hands, and even noses. Clues about others’ emotions seep from their pores in chemical form, enabling us to literally smell others’ fear. (This is not a myth! It actually happens.) Internal emotional states echo in the pitch and timbre of people’s voices, shift the movements and postures and even temperatures of their bodies, and festoon the surface of their faces. This last source of information is particularly important for humans. Our species pays more attention to, puts more weight on, and gets more information from facial movements than any other single channel of information.
Few researchers have contributed as much to figuring out how we use facial movements to understand others’ internal states as the psychologists Paul Ekman and Wallace Friesen. In 1978, Ekman and Friesen created the first comprehensive inventory of all possible expressive movements a human face could make. They paid particular attention to facial movements that, when combined, yield one of six widely recognizable emotional expressions: anger, disgust, happiness, sadness, surprise, and—of particular relevance to altruism—fear. They generated a set of black-and-white photographs of these expressions that have been used in thousands of psychology and neuroscience studies around the world in the ensuing decades. Although many other sets of emotional facial expressions have been created since then, all of which offer different strengths, none of them, in my view, has been more carefully constructed and standardized than Ekman and Friesen’s originals. The common use of these expressions by investigators around the world has permitted studies of emotion to be replicated by multiple research groups; this is a rare and valuable phenomenon in behavioral research and one that provides a much higher degree of confidence in the research results.
I have used this set of facial expressions myself since I was an undergraduate. In the process, I became very familiar with what Ekman and Friesen look like, as they lent their own faces to their research. I nearly jumped out of my skin the first time I turned around at a conference to see the long, mournful face of Wallace Friesen staring back at me, both familiar and disconcertingly new, in the way that a face only seen before on a screen looks in three dimensions. I imagine he gets that response a lot.
Ekman and Friesen determined that for a face at rest to transform into one that appears fearful, three specific sets of movements are required. First, and most importantly, the levator muscles of the upper eyelids must be contracted to pull back the lids and widen the eyes. Human eyes are ideally designed to make this objectively subtle muscle movement obvious. Nearly unique among all species with eyes are the vivid white sclera that surround the human iris. (This is why one tactic animators use to make animals appear more human is to give them bold white sclera. It’s a trick you see in movies from Bambi to Finding Nemo to The Planet of the Apes. Actual deer and fish and chimpanzee sclera are dark or hidden. But if you make them larger and paler, the animal suddenly appears human.) The bold visual contrast created by the juxtaposition of white sclera, pigmented skin and iris, and black pupil draws in the viewer’s gaze. This effect is made more potent when fear sweeps the lids backward to reveal even more of the gleaming sclera underneath. “Look at me! Meet my gaze!” these sclera scream.
But although wide eyes may draw the viewer in and create an appearance of vulnerability, in isolation they don’t yet convey fear. Fearful brows must also contort into a new shape. The frontalis muscles in the forehead draw the brows upward toward the hairline, while other muscles like the corrugator supercilii, small triangular muscles that overlie the inner corner of the brows, simultaneously crinkle the inner edges of the brows inward and slightly down. (The goal of many a Botox injection is to disable these muscles.) Together, these movements create the oblique brows that so effectively heighten the appearance of vulnerability and distress, which are the signature attributes of fear. Finally, the lips of a canonically fearful face are tightened and drawn backward and slightly down. The rounded grimace that results is similar to those used by our various primate cousins to signal submission and appeasement. Vulnerability, distress, submission, appeasement—recall that these traits, which are all maximized by the movements that compose a fearful expression, are the same traits that trigger the Violence Inhibition Mechanism.
The facial muscles whose movements yield these effects are unique within the human body. Ekman has observed that the expressive muscles in the face include the only muscles in the body whose job it is to pull on skin rather than on bones. This is because their reason for existing is not to move the body through space for utilitarian purposes, but to contort the visible surface of the face down or up or out in order to communicate. The resulting messages are wonderfully efficient. Not only do the contortions that yield fearful expressions work to inhibit others’ aggression, but they do so very quickly. Facial muscles can contract to convey fear in a few hundred milliseconds—less time than it takes to draw in enough breath to scream. They owe this efficiency to the fact that the nerves controlling them emanate from the brain stem and midbrain, the deepest, most primitive parts of the human brain.
The rapid emergence and primitive control of human facial expressions is mirrored by the rapidity and primitiveness of how other brains respond to the sight of them. To appreciate this, let us now bestride our beam of light and tag along as it carries information about a fearful face deep into the brain of an observer.
In the nanoseconds after a person’s face registers fear, much of the light striking his or her face ricochets backward from it again, radiating outward toward every other creature in the vicinity and carrying information about that face with it. That is all it means for an object to be visible: that it reflects light back toward the viewer’s eyes. The regions of the face don’t release reflected light evenly, though—pupils swallow it hungrily, while bright white sclera fling it nearly all back. Variations in the density and direction of reflected light enable the light to carry with it a detailed recording of all the curves and colors of the face. Let’s choose one of the many available beams reflected from the sclera upon which to ride, and off we go, racing at 3 million meters per second toward the eye of a nearby human onlooker.
We reach it nearly instantaneously. After we cross the clear dome of the cornea, we pass through the pupil and into the prism of the lens, which twists us upside down and sideways as it focuses the incoming light into a sharp image. Then, after we sail through the clear jelly filling the eyeball, we make a soft, inverted landing on the fleshy retina at the back of the eye. Here we make an astonishing transformation: we are digitized. The information our light beam carries about the wide, white sclera where it originated is transformed into a digital blip of information by photoreceptor cells in the retina. Millions of these cells pulse when struck by bright white light, sending staccato messages down the optic nerve toward the brain.*
Our beam of light, now transformed into a nerve impulse, is racing away from the eye down the optic nerve on its way to the onlooker’s brain. Our speed has slowed but is still blisteringly fast by human standards, about 60 meters per second. As a result, mere fractions of a second after the onlooker has taken in the wide, white sclera—plus the brows and mouth—of a fearful expression, that information has set the onlooker’s brain aflame.
It’s hard to overstate the effect of seeing another person’s fear on a human brain. The sight changes patterns of activity in nearly every crevice of the brain, although not all at once. The first region to receive the message from the retina is a pair of evolutionarily ancient structures deep in the brain’s core called the superior colliculi. The colliculi are two backward-facing nubs of tissue perched like pert Barbie breasts atop the brain stem. Their role is to rev up a lightning-fast response to important visual information coming in, well before the person even has any conscious awareness of what was seen. Images processed in the colliculi aren’t sharp or detailed, but what they lack in precision they make up for in speed. Like a microscopic, warp-speed relay race, the colliculi pass the gist of the information carried by beams of light (“Lots of sclera! So much white!”) to new fibers that extend upward to an oblong mass of neurons perched in the center of the brain, the thalamus. We zip in milliseconds to this structure, which acts like the brain’s switchboard, taking in signals from dispersed areas of the brain and relaying them out again to other areas. When it receives the signal from the colliculi that the wide, white sclera of a fearful expression have been detected, the thalamus knows just where to send that information next—to the amygdala.
Findings presented in a 2016 article in Nature Neuroscience demonstrated for the first time that visual information about human fearful facial expressions is conveyed via this long-hypothesized ancient pathway. The researchers inserted electrodes directly into the amygdalas of eight adult humans to record activity there while the researchers showed them pictures.* They found that a mere seventy-four milliseconds after a fearful face flashed across a computer screen, the electrodes began buzzing with activity, signifying that the amygdala had already received information about the rough contours of the face and begun to generate a response. This is far too fast for the information to have arrived in the amygdala via any pathway other than the rapid, ancient route we have just traveled through the colliculus and thalamus. And here’s the wild part: no other facial expression that we know about gets passed along this same privileged, speedy route to the amygdala. Not resting faces, not happy faces, not angry faces. Just fear. The mystery is: why?
Let’s follow our transduced light beam for a moment more before digging into this mystery, which is itself deeply intertwined with the mystery of human altruism.
Upon exiting the thalamus, we arrive first in the amygdala’s lateral nucleus, one of several semi-separate clusters of neurons within the amygdala, each of which serves a distinct role. The lateral nucleus is a sort of foyer to the amygdala where most incoming information arrives. Here we may be forced to watch helplessly as the message carried by our light breaks up, caroming in dozens of different directions simultaneously through the rest of the amygdala, then outward through the rest of the brain, as multitudes of neural cavalry are rallied to respond to what has been seen. The hubbub of activity in the amygdala following the perception of a fearful face is much greater than what follows the perception of any other expression. This is true even when the fearful expression is mostly obscured, leaving only the sclera visible. It’s true even if those sclera are presented so quickly that the viewer has no conscious awareness of having seen anything at all. Dartmouth College professor Paul Whalen and his colleagues once demonstrated this by flashing just the wide, white sclera of fearful facial expressions on a plain black background to brain imaging study participants for a mere seventeen milliseconds—far too quickly to be consciously detected. They found that the amygdala still burst into a furious volley of activity—much more than when only the sclera of neutral expressions were presented. This remarkable degree of sensitivity shows that others’ fear is unusually important information to the amygdala. But why?
For quite some time the thinking was that fearful expressions are important because they tell viewers that they should be fearful too. A person expressing fear is clearly afraid of something—a snake, a gun, the edge of a cliff. The resulting facial expression, according to this story, serves as an alarm signal telling anyone else in visual range that they may need to flee or brace for danger.
It’s not an implausible explanation. Most social species use alarm signals like special calls to warn others around them of danger. Sending such calls is actually considered a form of altruism, as callers risk drawing predators’ attention to themselves to warn others of danger. And just as theories of kin selection and reciprocity would predict, risky alarm calls are most likely to be used to alert family or other social group members. The auxiliary benefits of these calls extend far beyond the caller’s family or even the caller’s own species, though. Many species benefit from the alarm calls of even distantly related species. Birds can recognize the alarm calls of other local species of birds and even squirrels. Tropical toucanlike birds called hornbills even distinguish between and respond appropriately to the two distinct alarm calls that neighboring Diana monkeys use to warn against different types of danger (leopards versus eagles), as though they have learned the monkeys’ language of fear.
Do fearful expressions in humans serve a similar purpose as these calls? Many have argued or assumed that the amygdala’s robust response to fearful expressions is proof that they do. As a rule, the amygdala does respond rapidly to sensory events in the world that portend danger—the rippling eddy of a snake, the click of a gun being cocked, the feel of the wind along a cliff. The amygdala can learn very quickly, sometimes after a single trial, to link cues like these to incipient harm. Thereafter, when these cues are detected, cells within the amygdala fire furiously, sending urgent messages out to the rest of the brain that danger is near. My mother can thank her amygdala for the fact that she once found herself leaping into a frantic and slightly embarrassing stationary panic in front of the neighbors after a harmless garter snake slithered across our driveway. She had just recently returned home from a trip to the Amazon rainforest, where her tour group had nearly stepped on a deadly fer-de-lance lying across their path. My mother’s amygdala had not forgotten how close she had come to danger. The coordinated volley of firing in the amygdala in response to danger is central to the felt experience of fear, as we know from studying patients like S.M. who lack both an amygdala and the ability to experience fear and from studying psychopaths in whom both the amygdala and the experience of fear are stunted.
So yes, it’s certainly possible that amygdala responses to fearful expressions represent a learned response that these expressions signal the presence of danger. But there are also problems with this explanation. First, it’s unlikely that this is the primary function of fearful expressions, given the impracticality of a visual alarm signal. Eyes, it seems almost too obvious to say, see only what they’re looking at. What if you’re looking in the wrong direction, or blinking, or sleeping, when the alarm goes off? There is a reason why fire alarms don’t take the form of a little flame symbol silently lighting up in the ceiling. Ears and noses, by contrast, are always open and picking up information coming in from any direction. As a result, in most species, alarm signals take the form of barks and squeals or bursts of pheromones, not visual cues. For the same reason, the fearlike facial expressions of other primates don’t really function as alarm signals. Instead, they are used to signal submission and appeasement—to inhibit others’ aggression.
Amygdala responses to fearful expressions are also quite different from responses to other expressions that clearly signal threat. Angry facial expressions provide an interesting contrast. When someone is staring at you with their eyes narrowed, their brows lowered, and their teeth bared, this is clearly a threat. Anytime you see a face like this, an aggressive attack may be imminent. The face of the man who broke my nose in Las Vegas contorted exactly this way right before he hit me. But the amygdala normally doesn’t respond to angry facial expressions at all. Angry faces actually generate even less of an amygdala response than a neutral resting face. And the amygdala’s response to threatening scenes, like images of mutilated bodies, also looks different than its response to fearful faces. When the researchers who measured activity in the implanted amygdala electrodes showed their subjects images like these, they found no comparable rapid response. This almost certainly means that information about these scenes had arrived in the amygdala via a different path.
Yet another problem with the “threat response” theory is that it has difficulty explaining why damage to the amygdala impairs not just people’s ability to respond appropriately to fearful expressions but their ability to even identify them—to come up with a name for what the expresser is feeling. When S.M. sees a fearful face, it isn’t as though she knows what to call it but fails to show appropriate signs of fearful avoidance or vigilance in response. It’s that she sees it and is mystified by its very meaning, like a color-blind person searching for a number in a featureless array of brown dots.
Psychopaths’ seeming blindness to others’ fear can also be striking. I am still haunted by a story once related at a conference by my friend and colleague, the psychopathy researcher Essi Viding, at University College London. She was testing a psychopathic inmate in an English prison and had shown him a long series of emotional faces. He was among the subset of psychopaths who are completely blind to others’ fear: he got every single fearful expression wrong. Not once did he recognize the wide eyes, oblique brows, and grimace of a fearful face as signifying fear. He knew he was performing badly too. When he got to the final fearful expression in the set and yet again failed to identify it, he mused aloud, “I don’t know what that expression is called. But I know that’s what people look like right before I stab them.”
Remarkably, this psychopath was able to recall having seen similar expressions before—and even to pinpoint the circumstances in which he’d seen them. But he was unable to discern that this particular and familiar combination of features, even in an obviously frightening situation, signified fear. How can this be explained? Not by the “threat response” theory.
There is another quite distinct (although not mutually incompatible) explanation for all of these findings, which is that amygdala responses to fearful expressions represent not a response to “threat” but rather a deep, atavistic form of empathy.
When a light-borne message arrives in the amygdala that the wide, distressed eyes and grimace of a fearful face have been detected, the cascade of neural firing that ensues in this structure may actually reflect a simulation of the interior state of the expresser—almost like an internal translation of the other person’s fearful state. It’s this simulation that allows the perceiver to understand and put a name to the expresser’s state, but leaves those without functioning amygdalas drawing a blank. It’s this simulation that causes faint whispers of fear to cascade down from the amygdala to a nub of brain tissue called the hypothalamus and from there outward through the rest of the body, causing most people’s hearts to beat a little faster and their palms to sweat a little more in response to seeing another’s fear—yet another response, not incidentally, that S.M. and psychopaths fail to show.
If all this is true—if a tiny blip of digital information carried on a beam of light can create an echo of a fear response in another person—it means that amygdala responses to fearful facial expressions represent a true conjoining of the interiors of two human brains. This would be a monumental thing. The ability to internally re-create another person’s emotion, and thereby understand it, is a basic but essential form of empathy. This form of empathy is critical to the capacity to generate still more profound social responses, like caring that another person is frightened or distressed, and wanting to make that person feel better.
This isn’t such a far-fetched possibility. A similar sort of empathic response has already been identified in various parts of the brain in response to pain. Dozens of brain imaging studies have now shown that the sight of another person in pain results in increased activity in a constellation of brain regions called the pain matrix. These regions include cortical regions like the mid-cingulate gyrus and anterior insula as well as deeper, subcortical regions that are also active during the personal experience of pain. The uncanny overlap in the regions that become active both when experiencing or witnessing—or even imagining—another person’s pain strongly suggests an empathic response.
Even stronger support for this possibility comes from a clever brain imaging study reported in 2010 by Tania Singer, Grit Hein, Daniel Batson, and their colleagues, who examined empathic pain responses in sixteen Swiss soccer fans. All the fans were selected for being impassioned supporters of their local team. The researchers wanted to know how they would respond to the sight of pain being inflicted both on fellow fans of the local team and on fans of a rival team, using—you guessed it—electric shocks.
After each soccer fan arrived for the study, he was positioned in the MRI scanner by the researchers, who then taped customized electrodes to the back of his hand. Once the scan began, so did the shocks. The researchers measured the subjects’ brain activity as electricity coursed through the electrodes and across the skin of their hands. The shocks varied in intensity, with some being very mild, and others being more painful. When the researchers analyzed the subjects’ brain data afterward, they found, as expected, that activity in the anterior insula, a key component of the pain matrix, ratcheted steadily upwards as the intensity of the pain increased. The insula lies deep beneath the temples on either side of the head and is thought to encode the emotional significance of unpleasant body sensations. When those parts of the insula are active, in other words, it signals that what’s happening feels bad. What the researchers wanted to know was how this same area would respond when the subject watched allies and rivals experiencing pain. Would it signal that what was happening to other people also felt bad?
During the study, each subject was flanked by two strangers, and all three of them were wired up to electrodes. It must have been quite a squeeze, with three grown men lined up side by side in the cramped confines of a scanner room, all of their hands positioned to be visible to the subject lying flat on his back in the scanner, peering out of it through an angled mirror. On one side of the subject sat the ally, who the subject knew was a fan of his own team. On the subject’s other side sat a fan of a rival team. As the subject watched from inside the scanner, both the ally’s hand and the rival’s hand were also subjected to electrical shocks of varying intensities. Imagine it: You’ve just met a stranger, spoken to him for a few minutes, and know that he shares your love and loyalty for your favorite team. Now imagine watching his hand twitch and jerk as electric shocks jolt through it. Would you cringe with discomfort? Twitch slightly yourself? Batson and Singer’s findings suggest that you might. As subjects watched the ally being shocked, activity increased in the same region of the anterior insula that was active when they experienced pain themselves, just as you would expect if the subject were simulating the ally’s pain. Remarkably, though, subjects’ response when they saw their rival shocked was quite different. As this stranger’s hand twitched and jerked in response to the shocks, the subjects’ insulas were nearly silent.
From Batson’s prior research, we know that many participants in a study like this will not only experience concern for a stranger being shocked but be willing to actively help the stranger by taking on extra shocks themselves if need be. Singer and Batson again found this to be true. When given the opportunity to take on half of a stranger’s remaining shocks, many participants volunteered to do so. But again, this was largely only true for their allies. When the rival received the shocks, participants were much less likely to offer to help. More, the participants’ willingness to help fellow fans rose and fell in tandem with activity in their anterior insula. The more the insula responded empathically to a fellow fan’s pain, the more likely it was that help would be extended.
Could amygdala responses to others’ fear represent a similarly empathic response, one that could predict compassionate responses to others’ distress? Perhaps. My research on psychopathy is consistent with this possibility. As I (and others) have found, adolescents and adults who are psychopathic claim not to experience strong fear themselves. This deficit seems not only to leave them callous in the face of others’ fear but to impair their ability to even recognize others’ fear. Other studies of large samples of adults have yielded similar findings, namely, that people who report experiencing less fear in their own lives also have more trouble recognizing it in others. It is as though a meager personal experience of fear prevents someone from even understanding what fear is, much as people who are color-blind to red and green shades cannot really understand what “red” is. The fact that psychopaths have limited personal experiences of fear and have difficulty even labeling others’ fear strongly suggests that they are fundamentally impaired in their ability to empathize with fear—that they cannot encode and translate others’ internal fearful experience into something they can understand. That psychopaths’ amygdala responses to others’ fear are abnormal supplies further evidence that dysfunction in this structure—a core structure necessary both for recognizing others’ fear and for generating a fear response—underlies their deficits.
I should note that amygdala-based deficits impair understanding of others’ fear across the board, not only when it is expressed via the face. The amygdala is essential for recognizing not only fearful facial expressions but fearful vocal expressions as well. One recent study investigating the acoustic properties of screams found that the amygdala is particularly attuned to their rough, ragged sound. Studies of patients with amygdala lesions have found these individuals to be similarly impaired in recognizing fearful vocalizations, as well as fearful body postures—even spooky music, of the kind that creates chills of fear in most people, leaves them unaffected. Quite recently, my student Elise Cardinale and I found that the amygdala is also important for identifying behaviors (threats, for example) that cause others fear. In a series of studies we conducted, high psychopathy scorers failed to recognize that a threatening utterance like “You better watch your back” is likely to frighten someone, and their impairments corresponded to reduced recruitment of the amygdala when considering the acceptability of uttering such a statement.
These findings are, I think, a critical piece of the puzzle. They bolster the case that amygdala deficits in psychopathy don’t impair only responses to others’ fear expressed via the face. If that were true, it would imply that the problem is simply perceptual and that psychopaths’ problems could be solved just by giving them little strategies or clues to help them recognize others’ fear—like looking for wide eyes or raised and crinkled brows. If it were only that simple! Instead, it seems, the amygdala is the final common pathway for generating a coordinated understanding of others’ fear at a gut level, whether it is seen or heard or smelled or simply imagined. And even more importantly, the fact that psychopathic individuals struggle to understand others’ fear across all these modalities provides a concrete link between empathy for fear and the experience of concern and compassion—the traits that are quintessentially absent in psychopaths.
It’s not clear that the same link exists for other forms of empathy. Psychopaths are not generally impaired in understanding various other internal states, such as beliefs and goals, or even most other emotions. This reinforces the idea that empathy is not a single broad construct. There are many forms of empathy, and it is possible to possess some in abundance but lack others. Psychopaths are not really impaired in understanding anger or disgust, for example. It’s not even clear whether psychopathy impairs empathy for pain. Although empathy for pain is an important social response, little evidence links a lack of empathy for pain to actual callousness. Behaviorally, there is not at this point a strong body of research showing that psychopaths have reduced experiences of pain, or that they have difficulty recognizing when others are in pain. Evidence from brain imaging studies is similarly mixed. One recent brain imaging study of psychopathic adolescents showed reduced activity in the pain matrix, but my own similar study with James Blair did not. And one study of adult psychopaths found more activity in the anterior insula in response to others’ pain. All signs, then, point to the idea that psychopathy may be more closely intertwined with deficits in empathy for fear than empathy for pain.
Is it simply a coincidence that those individuals who are most marked by their lack of compassion and caring are also deficient in recognizing and responding to others’ fear? Or is this actually the heart of the matter? Is the ability to generate an amygdala-based empathic response to others’ distress—and fear in particular—somehow tied to the capacity for caring and compassion? If so, this might be a critical step toward understanding extraordinary altruism.
If understanding others’ fear and emotional distress is essential to generating care and compassion in response to that distress, then it is clear what a peek inside the brains of extraordinary altruists should reveal. These individuals, whose attitudes toward others’ welfare are so unlike those of psychopaths, whose behavior indicates that they experience unusually enhanced feelings of care and compassion for others, should show responses in the lab that are the polar opposite of what has been found in psychopaths: they should be more sensitive to other people’s fear, and their amygdalas should be more responsive to fearful faces. Their amygdalas might even be larger than average as well.
Extraordinary altruists should have, in short, anti-psychopathic brains.
Another brain scan, another bunch of brain scanning subjects causing problems. This was not what I’d expected would happen on our first day of scanning altruistic kidney donors’ brains to see if they were, in fact, “anti-psychopaths.”
Recruiting the altruists had been astonishingly easy. Not only were they enthusiastic about participating, but they often pitched in, unasked, to help me recruit—peppering their Facebook feeds and blog posts with messages about the study and encouraging others to take part. Not one of the altruists expressed hesitation when my students explained that, for the study, they would need to travel to Georgetown for a day or two and spend over five hours completing a long battery of brain imaging and behavioral testing for a fairly paltry $150 in compensation. All of them led busy lives, and many were professionals with well-paying jobs—software engineers and bankers and physicians and marketers—but they didn’t hesitate to arrange to take days off work and fly across the country to help us out. One young altruist from the Midwest told us that he was very interested in taking part but would need a few months to save up for the plane ticket. “No, no, no!” we hastened to tell him. “We’ll cover all your travel costs and pay you—you don’t have to pay anything to participate!” But think of it—he was perfectly willing to do so.
Another altruist named George Taniwaki flew in to see us from the Pacific Northwest. I know how long it takes to travel from the Seattle area to Washington, DC, as I’ve done it many times myself. It’s a long day of travel on the best day. And this was not the best day. Sea-Tac Airport was socked in by fog and freezing rain, and his flight got canceled—twice. And then it got rescheduled twice. Many people would have given up after the first four hours of waiting. But George sat there in that airport all day, waiting, refusing to go home if there was any chance at all he might still be able to make it to Georgetown in time for his scheduled brain scan. (Most MRI scanners, including ours, are tightly scheduled, and it’s nearly impossible to reschedule a ninety-minute session at the last minute.) After sitting and waiting in an uncomfortable airport seat for most of a day, and then taking a five-hour flight to DC, he finally made it to Georgetown. Then, rather than rest after his testing wrapped up the next day, he invited us all out to have dinner with him. I had never before considered whether eating dinner with a study participant following the conclusion of testing entails an ethical or scientific dilemma. Whoever heard of the question even coming up? In any case, I couldn’t come up with any reason not to go, so we went, and we had a lovely evening. (I of course wouldn’t let him pay for us.)
It was not this altruist, however, who caused trouble on scanning day. The culprits were the first three altruistic donors we brought into the lab, all on the same day. They were three women who had flown in from all over the country and who knew each other through the living donor community. They were excited that we brought them in at the same time so that they could spend the evening enjoying the city together. They were equally excited about the opportunity to take part in the study. One of them, Angela Cuozzo, later blogged about how fortunate she had felt to be able to participate, adding that the anticipation leading up to the weekend had been nearly “killing” her.
Perhaps all this excitement was the reason that these three fortyish women ended up on the verge of setting off shrieking, clanging alarms all over the section of the Georgetown School of Medicine campus where the MRI suite is housed, which not even our most behaviorally disordered teenager had ever accomplished. Why? Because they were so determined not to be late for their scans. The first scan was scheduled for 9:15 a.m., the next for 10:45 a.m., and the final one for 12:15 p.m. The three were staying in a hotel about a five-minute shuttle ride from campus. So naturally, all three of them departed for campus more than an hour before the first scan. Then they got a little mixed up trying to locate the MRI suite from the spot where the shuttle dropped them off (which is completely understandable, as the suite is notoriously difficult to find). So they raced down a series of unmarked corridors in the hospital until they got so lost that they attempted to break through a secure fire exit as a shortcut. Thank goodness that plan didn’t work.
They ended up backtracking and eventually managed to find their way to us, still arriving well ahead of time, around 8:30 a.m. They then waited patiently on the little gray couches in the waiting area, amid back issues of Consumer Reports and Redbook, until it was their turn to be tested. That meant that the last of the three scheduled subjects had arrived over three hours early for her brain scan. And had been worried about being late! This is a degree of conscientiousness that I feel must be nearly unprecedented in the history of psychological research. It presented me with a “problem” I had never faced before: feeling sincerely unworthy in the face of the kindness and helpfulness of my research subjects.
The scanning itself felt familiar, even if the project was anything but. Once again, my subjects watched from the dark bore of the MRI scanner as black-and-white pictures of Ekman and Friesen and all the others flashed before them one by one. Sometimes the faces wore faint smiles. Others glowered angrily. And of course, still others showed the wide eyes, oblique brows, and grimaces of fear. While they watched, the subjects held in each hand old-school black-plastic video game–looking controllers. Long wires sprouting from the controllers snaked through the MRI and across the floor of the scan room, then through holes carved into the wall of the adjoining control room, where we sat watching and where our computers recorded the subjects’ responses. To keep them focused on the faces, we had instructed them to push the red button atop one controller every time they saw a man’s face and to press the button on the other controller for a woman’s face. Simple. Man or woman? Man or woman? Over and over and over again—more than 300 times over the course of about twenty minutes.
All the while, another roomful of nearby computers ran the scanner, manipulating the massive magnetic field surrounding the subjects’ heads. CLACK-CLACK-CLACK-CLACK-deedeedeedeedee-deedeedee, rumbled the scanner, its machinations causing tiny charged particles inside the altruists’ brains to tumble and spin on their axes. Inside the scanner, the birdcage-shaped coil encircling their heads collected the faint radio signals created by all this tumbling and spinning. I could picture the pink, two-centimeter ovals of the amygdalas pulsing deep within their brains, waiting for their cue. The subjects hadn’t been told to pay attention to the expressions on the flickering faces, but no matter. Flash! A bright, white sclera leapt from the screen. Did the amygdala blaze to life a few dozen milliseconds later, its cells pulsing out a Morse code message to the rest of the brain? Look sharp! Someone’s scared! If so, it would momentarily increase this structure’s fuel consumption by a tiny amount, no more than 1 percent or so. But that would change the way the protons within it danced and spun just enough for us to measure—enough to inform us how an extraordinary altruist responds to others’ fear.
As friendly and helpful and generous as the altruists were, and as patiently as they lay in the scanner pushing the red buttons, many of them didn’t hesitate to tell me—tactfully—how wrongheaded the study was. Harold Mintz was perhaps the most vocal of them. Harold’s story is an unusual one, even in the world of altruistic kidney donors, because, like Sunyana Graef, he had never heard of anyone donating a kidney to a stranger before he came up with the idea on his own. He first had the idea around the time Graef did, in 1998 (what was in the air that year?), at which time he was living in Arlington, Virginia. Unlike Graef, he didn’t live near a transplant center willing to remove his kidney and give it to a stranger. He tried contacting the National Kidney Foundation, but all he got in return was a stack of pamphlets in the mail that explained how to donate his organs after he died. Hey, he thought, I’m not dead yet. So he called them back. He tried to clarify: “I’m just curious about donating now to somebody here in the DC area.”
A long silence followed. Then:
“You can’t do that. It’s illegal.”
But they took down his name and number and said they would call him back if anything changed.
Yeah, sure, Harold thought.
But something did change. That same year, the Washington Regional Transplant Consortium was in the early stages of developing what would become the first community-based living organ donor registry. They got Harold’s contact information from the National Kidney Foundation and called him back two years later to say that they were launching the program. Did he still want to donate? He jumped at the chance. After a long bout of psychiatric and medical screening, Harold became the very first person the program approved to donate.
Knowing Harold, this doesn’t surprise me at all. I find it hard to imagine meeting with him and denying him the chance to give away his kidney. He looks like a cigarette billboard cowboy, complete with a wild shock of graying hair and a fulsome grizzled mustache, and he has the charisma of a preacher. He’s one of those people who seems to make the air around him sparkle. I’ve shown clips of my interviews with him at conferences, and attendees will circle back to me years later to ask about the “mustache guy.”
Harold describes his decision to give away a kidney as if it’s the most obvious, the most straightforward decision a person could make. When asked to explain why he donated, he responds with a question that most people find easy to answer, which is, “Would you give a kidney to your mother to save her life?”
Essentially everyone answers yes.
He’ll nod, then scribble down a few letters on a piece of paper. He’ll then ask, “Okay, why? Why would you donate to your mom?”
Everyone, he says, replies exactly the same way. I did as well when he asked me: “Because she’s my mom.”
Harold then flips the paper around to show the letters “BSMM” written on it: Because She’s My Mom. He already knew what they would say.
And what people say is telling. The response “because she’s my mom” is not really an explanation at all. It’s hardly better than just saying, “Because.” It’s not a description of costs and benefits, or an exegesis on the details of what the surgery might entail and the likely long-term outcomes of kidney disease. The answer is much more primitive: she’s my mom, she’s going to die otherwise, so I’ll give her my kidney and worry about the details later. In this way, in this response, we are almost all the same.
Then Harold will push further: “So we got that, you’d do it for your mom. Okay, how about your sister or your brother? How about your best friend, who’s not related? How about your teacher, or your boss?” He extends the circle further and further out, challenging you to tell him when you would stop caring enough about another person’s life to give them your kidney. “What if,” he asks, “that person is going to die next week and you’re the only person who can save them? There is somebody dying right now while we’re having this conversation, where the doctors know exactly what to do to fix them. We can actually stop somebody from suffering—from losing what they might have.”
These questions echo a conversation Harold had while being screened for his donation. He had asked the transplant team, “If I don’t give my kidney to somebody this week, will someone die waiting for it?”
“Yes,” they told him.
That sealed the deal. For him, Harold says, taking all of this into account, donating his kidney really wasn’t a choice. It was an opportunity. “Because someone is going to die” was for him just as obvious and simple an explanation for donating his kidney to a stranger as “because she’s my mom” is for everyone else.
On December 12, 2000, in an operating suite at Georgetown University, steps away from where we would later scan his brain, a team of surgeons removed Harold’s left kidney and stitched it into the abdomen of a young woman named Gennet Belay, a wife, mother, and Ethiopian immigrant who at the time had only 6 percent of her kidney function remaining. In a short film called 1-800-Give-Us-Your-Kidney, Belay’s husband recalled that her doctor had told her at one point she had only three days left to live. Harold’s kidney started working to filter her blood almost immediately after the transplant and continues to do so to this day. Harold sends it a birthday card every year. Belay considers the day of the transplant her own “re-birthday”—the day Harold returned her to a life free of disease and medical complications.
Harold recalls feeling no anxiety or fear or doubt leading up to the donation, only excitement and a little frustration that the whole process took so long to get under way. He never once reconsidered his decision. And without question, he would do it again if he had the opportunity, which of course he won’t have—even the most impassioned altruist has only one spare kidney to give.
I once asked Harold, as I ask all the altruists we meet, to tell me why he thinks he is one of the less than 0.001 percent of the population for whom giving a kidney to a stranger is just as obvious as donating to their mother would be for most other people. What is different about him? His response is vehement, and it echoes the words of Cory Booker and Lenny Skutnik. “I’m not different. I’m not unique,” he maintains. “Your study here is going to find out that I’m just the same as you.”
As he sees it, our study wasn’t even asking the right question. Altruistic kidney donors like him are, in his view, ordinary people who are in the right circumstances at the right time, with the right information. Being portrayed as any kind of hero frustrates him to no end. He has told me unambiguously and repeatedly that he is not.
Perhaps he’s right. As a scientist, I try to keep my mind open to any possibility not conclusively ruled out by the evidence. It’s possible that, as Harold maintains, donating a kidney is mostly circumstantial, that nearly anybody with the right combination of knowledge and prior personal experiences would be similarly motivated. Many of the kidney donors we’ve worked with believe this is true. The first three altruists we tested—the ones who tried to break through the emergency exit door—all gave responses to this effect when I asked them, in separate interviews, why more people don’t donate:
“I would say: information.”
“Lack of education.”
“It’s just not knowing.”
If more people knew about donation, they averred, more people would donate.
Of course, this must be true to some extent. Every altruistic kidney donor was once not an altruistic kidney donor, but rather someone who, in most cases, had never even heard about nondirected donations. Then, eventually, each of them discovered that it was possible to donate a kidney to a stranger, or they learned how many strangers out there needed a kidney and this new information was the precipitating event that led them to donate. What distinguished their predonation and postdonation selves was the information they possessed. That altruists explain their donations this way is quite consistent with a general phenomenon known in social psychology as the actor-observer effect: people tend to explain others’ behaviors with reference to internal causes like personality, but explain their own behavior with reference to external causes—in this case, the acquisition of new information.
But that seems unlikely to be the only reason that people give strangers their kidneys. For one, the rest of us respond quite differently to exactly the same information. If you’re like me, you might have followed along with Harold’s line of questioning for a while. You’d donate to your mother for sure. So would I. Your brother, yes. Best friend, okay. But somewhere along the way there’s a shift. The answer no longer seems so obvious. Your neighbor, or your teacher? Your boss? Maybe. For me, these decisions start to feel different somehow, less instinctive. The details I’m happy to shove aside until later for my mom’s sake rapidly return to the forefront when I think about donating to someone more distant. By the time I get all the way to thinking about donating to someone I’ve never met… there’s just a blank. Nothing about that decision feels obvious at all.
This is a common response even in people who are deeply and painfully familiar with the desperate need for donor kidneys and the lifesaving power of altruistic donations. In the film about Belay’s transplant, her husband mused, “As far as Harold is concerned, it’s not easy risking your life to save somebody else who you don’t even know, who you have never seen. I was asking myself, ‘Could I do that?’ And my answer was—no. I know what it means. When you have only one kidney, you are risking your life. He must have… a special heart.”
A special heart—or a special brain?
It took more than a year, but we eventually collected enough data to find out. In all, we scanned the brains of nineteen altruistic kidney donors while they viewed the various emotional facial expressions. They included Harold, Angela Cuozzo and the other women who were so determined not to be late, George Taniwaki, who had flown in from Seattle, a real estate consultant, a mechanic, and a dozen others. In addition to measuring activity in their amygdalas and elsewhere during the scans, we also collected anatomical scans that would inform us about the size and shape of all the various structures within each of their brains, including their amygdalas.
For comparison, we also collected identical data from twenty control participants of the same average age, years of education, IQ, and other variables as the altruists. The only other requirement for controls was to have never donated an organ to anyone. That’s most of the population, of course. A dragnet of any single city block within a mile of Georgetown University would probably yield twenty such adults, so you’d think it would have been a cinch to find them and test them. You’d be wrong. It really reinforced for me how incredibly abnormal (in a good way) the altruists’ eagerness to participate was—especially given all the travel hassles involved—that it took us twice as long to find enough controls for the study as it did to find the same number of altruists. This is despite the fact that the controls were all recruited locally and didn’t have to travel anywhere, and despite the fact that there are literally 100,000 times as many of them as there are altruistic kidney donors. (I remain, of course, fantastically grateful to all of the controls who did participate—the study would have been impossible without them.)
My students analyzed our data using the same painstaking process as usual. Hours and hours and hours of computers whirring away to turn gigabytes’ worth of raw binary code into three-dimensional images of human brains that flickered and glowed with activity. Our final analysis aimed to see how much more active the amygdala was when the two groups of subjects looked at fearful expressions as compared to neutral expressions. The moment of truth arrived again. When we compared the altruists’ brains with those of controls—who were like the altruists in every way we could think to measure except for not having donated a kidney—what would we find?
Bingo. There it was again. Glowing like a little star. Half a cubic centimeter or so of flesh inside the altruists’ right amygdala had recruited more blood to fuel its activity after fearful expressions appeared.
Now, all we really knew from this finding was that cells somewhere in the altruists’ amygdalas—was it the lateral nucleus? some other nucleus? we couldn’t say—were more active when they gazed at a stranger’s fearful expression than when they gazed at a neutral expression. Was this the legitimately empathic response we suspected? Or was it something else, like a response to threat?
One clue came from the results of a comparable analysis we conducted to evaluate altruists’ and controls’ responses to angry expressions. This time we found that the pattern was reversed—the amygdala was less active in altruists than controls when they saw angry faces. This pattern isn’t consistent with the idea that altruists’ amygdalas are simply “threat detectors” when it comes to expressive faces. A useful contrast can be drawn with people who have clinical anxiety disorders like generalized anxiety disorder or generalized social phobia. When these people view facial expressions in the scanner, they show heightened amygdala responses to a whole range of negative stimuli, including fearful expressions, angry expressions, and other expressions like contempt. Anxious people are overly vigilant to possible threats and danger, and their amygdalas tend to be perennially hyperactive; in them, amygdala activity to a whole range of cues may well reflect some form of threat detection. But the fact that the altruists were more sensitive only to fear suggests something else was afoot.
Another clue as to what that “something else” might be came from additional data we had collected after we wrapped up brain scanning with each subject. After they’d had a little break and some lunch, we invited them to come back to our lab for questionnaires and some computer tasks. One of these was an emotional face recognition task that contained both angry and fearful facial expressions. When we analyzed how well the two groups of subjects identified the emotion conveyed by these two expressions, our findings mapped neatly onto our brain imaging data and echoed the emotion recognition data I had collected for my dissertation a decade before. Compared to controls, altruists recognized fearful expressions relatively better. By contrast, they recognized angry expressions relatively worse. It was only their empathic accuracy for others’ fear that was better than average. This finding reinforces the idea that empathy can take many forms and that each form is driven by partially distinct processes, such that it is perfectly possible to have a high degree of empathy for others’ fear but not their anger. When it came to the altruists’ empathic sensitivity for fear, the signs pointed to the amygdala driving this accuracy. Across our subjects, we found a strong correlation between how active a subject’s amygdala was to fearful expressions and how well that person recognized these expressions later on.
So far, our altruists looked remarkably like “anti-psychopaths”: they recognized others’ fear relatively better than controls did, and this ability seemed to correspond to a more robust response in the right amygdala to these expressions. What about the final feature of psychopathy we had considered—the overall size of the amygdala? My student Paul Robinson crunched the numbers to generate mock-ups of the average shape and size of all of the subjects’ amygdalas, although I was a little dubious about whether this effect would pan out, to be honest. But the results clearly showed that in this respect as well, the altruists appeared to be the opposite of psychopaths. Their right amygdalas were physically larger than those of controls, by about 8 percent. The significance of this effect held up even after controlling for something we had not predicted, which was that the altruists’ brains were larger overall than controls’ brains.
Despite what Harold and many of our other subjects believed, something about the altruists’ brains really was special. Altruists, it seems, may be more strongly affected by the “field of force” that promotes compassion because the sight of someone suffering affects them more strongly than it affects the average person. They appear to be equipped with just a little more of the three features that psychopathy research has identified as being essential to ordinary compassion—the basic neural hardware required to be sensitive to signs of extreme distress in others, which highly psychopathic people lack. And that little something extra—the extra sensitivity, the extra activity, and the extra volume—may provide altruists enough of a boost to move them past ordinary levels of compassion into something extraordinary.
Perhaps these small changes can help to explain why the strange blank feeling I get when I contemplate donating a kidney to a stranger feels like something to an altruist. As the altruists tell it, that same sense of certainty and purpose I feel when contemplating donating a kidney to someone I love is what most of them felt when they first contemplated donating to someone they’d never even met, that sense of, “Okay, you can have my organs… it’s a no-brainer,” as one young kidney donor from Arizona put it. Or in the words of another altruist, “I had no particular reason other than, like I said, you see someone drowning, you are going to pull them out of the water.… I knew you gotta help when someone suffers.” Simple as that. Clear as Lenny Skutnik diving into the Potomac. Instinctive as Cory Booker racing into a neighbor’s burning house. Fast as my roadside rescuer hitting the brakes. The fact that their choices seem to boil down to gut-level, intuitive feelings all made so much sense once we discovered differences in the altruists’ amygdalas.
The amygdala, as brain structures go, is pretty deep under the hood. It can respond to stimuli you have no conscious awareness of—bright white sclera flickering for a few milliseconds; the smell of someone’s sweat when they’re frightened—and change your behavior and ongoing thoughts very quickly in response. If something very fast and very unusual is happening in this ancient structure when extraordinary altruists witness or contemplate someone else’s distress, is it any wonder they have trouble articulating what it is? It may legitimately feel like the decision is a “no-brainer” when there is no easy access to the part of the brain where these critical calculations are taking place, although perhaps a better term for it would be “deep-brainer.”
The fact that altruists show heightened empathic responsiveness to others’ fear also reveals an important truth: there is a critical distinction between being fearless and being brave. Many psychopaths are genuinely fearless, and as a result they have difficulty understanding others’ fear. That altruists are so empathically responsive to others’ fear suggests that, rather than being fearless, they are unusually sensitive to fear. Recall the half-dozen different ways in which Cory Booker described the terror he felt while rescuing his neighbor from a fire. And Lenny Skutnik, who saved a stranger from an ice-choked river full of wreckage and jet fuel, later found himself overwhelmed by nerves during an interview with Ted Koppel. I have asked dozens of altruistic kidney donors if they consider themselves to be fearless or low-anxiety people, and the answer is nearly always an emphatic “no.” Almost none of them engage in classically risky activities like skydiving, which, you will recall, is actually less risky than donating a kidney. Sunyana Graef said, when I asked her about risk-taking, that she had “gone parasailing once”; otherwise, she definitely didn’t engage in any risky behaviors, she said, because doing so “wouldn’t be right.” More than one of the altruists we’ve studied was afraid to fly, judging by their requests to take anti-anxiety medications during the flight to Washington. (Unfortunately, we had to request that they not do so, as the drugs’ residual effects could have interfered with the brain scans.) During her interview, one altruistic donor from New York reeled off a list of small, everyday things that she worried about, from being late with her rent check to running out of gas on the freeway. And another from San Francisco said that for most of her life she had been afraid of “everything in life… absolutely everything.”
Her words reminded me of those of the heroic Civil War battlefield nurse Clara Barton, who reflected in her autobiography: “Writers of sketches, in a friendly desire to compliment me, have been wont to dwell upon my courage, representing me as personally devoid of fear, not even knowing the feeling. However correct that may have become, it is evident I was not constructed that way, as in the earlier years of my life I remember nothing but fear.”
Our findings suggest that Barton’s words reflect a deep truth, which is that true selfless heroism emerges not from the absence of fear, but because of it. People who rescue strangers from fires or drowning or who donate their kidneys to strangers seem to be acutely aware of what it means to be afraid. And this awareness may be in part what moves them to help others. Their bravery lies in their ability to recognize and empathize with acute distress, while simultaneously overcoming or overriding their own fear in the face of danger. They are able to respond altruistically because, even while they empathize with others’ fear, they do not allow fear to flood their own system and prevent them from acting to help.
How on earth do they pull this off? At least on the face of it, it doesn’t appear that they make any conscious efforts to suppress their own fear; indeed, altruistic kidney donors often report being surprised to discover how they were feeling as their donation date approached. When I have asked donors what their dominant emotions were right before they went under anesthesia, the response I get the most often is Harold’s answer: “Excitement.” Another young altruist in his twenties said that right before his donation, “I was really excited for it actually. I do not know why. I do not know what was the exciting aspect about it. I think just knowing that I was gonna be able to help somebody so much was really cool to me and everyone was so worried, like I was going to die on that table. Everyone was like, ‘Why you are doing this? You are going to die!’ And for me, I almost felt strange not being worried about it.”
Many donors have even said that they felt an unexpected sense of peace or certainty. One altruist explained, “I would not consider myself fearless. I do not take a lot of risks. Somehow, I never thought this was a risk. I just knew from the beginning that I was going to get through it fine. I do not know why I knew that, but I knew that.” Sentiments like these echo the words of Lenny Skutnik, who, again, was not a generally fearless person, but recalled feeling no fear before he leapt into the Potomac—an extraordinarily risky and painful choice—but only a calm conviction that everything was “going to be all right.”
How is it that people who have normal—or even higher than normal—sensitivity to fear and anxiety find themselves feeling anywhere from calm to excited before voluntarily undergoing significant pain and risk to save another person’s life? What neurobiological process could conceivably transform an act that is objectively risky or costly into one that generates feelings of calm, even positive excitement? The answer to this question may be the final piece required to understand the puzzle of extraordinary altruism, and it may boil down to the basic mechanisms that underlie the capacity for care.
* As an aside, this is not the fate of every beam of light that makes it into a human eye. Some small proportion of the light that enters the eye is reflected back again, in slightly different ways by each of the various substances composing the eye. These subtleties are powerfully important. Faint gradations in the way the cornea, iris, lens, vitreous, and retina of a living eye reflect light appear to be an essential means of convincing a viewer that the being possessing that eye is not only humanlike but is actually alive, rather than a drawing or a humanlike doll with glassy and unconvincing eyes. It is no accident that when a person dies, we sometimes say that the light has left their eyes. The tapestry of reflected light from a living onlooker’s eyes that rebounds back into the eyes of the frightened soul, then, carries with it literal glimmers of hope that another living being has borne witness to their fear.
* This procedure was conducted in patients with epilepsy in whom depth electrodes had been placed to enable their physicians to localize the origins of their seizures.