Alex Honnold clung two thousand feet above the Yosemite valley floor, a human speck on a sea of granite.
It was September 6, 2008, and Honnold was attempting to free-solo the Regular Northwest Face route up Half Dome. In 1957, when the route was first established, pioneering climber Royal Robbins and his team spent five days labouring with ropes, bolts, and pitons to reach the top. Fifty-one years later, Honnold was looking to do the same route in a matter of just a few hours, alone, with no ropes or any safety gear whatsoever. It would become the first in a series of iconic, ropeless, big-wall climbs—culminating with the ascent of El Capitan, or El Cap, documented in the Oscar-winning film Free Solo—that would make Honnold the most famous rock climber and one of the most famous outdoor athletes in history.
Honnold had started out that morning on Half Dome wearing nothing but shorts, a long-sleeve T-shirt, his rock shoes, and a chalk bag strapped around his waist. He had a few Clif Bars in one pocket, a small flask of water in the other.
He had climbed up and up and up. Drank, ate, dipped his hands into the chalk bag. Pulled off his T-shirt somewhere along the way. As he put hundreds of feet of rock behind him, he felt fear, or something along the fear-anxiety spectrum, a handful of times. “Holy shit!” he thought at one point, about a thousand feet up, as he realized he’d worked his way off the established route by accident. “This is hardcore.” But, as he wrote later in his memoir, Alone on the Wall, “It wasn’t true panic that I felt—just an uncomfortable anxiety.”
He’d focused his mind, rallied, and found his way out of that jam. Then, hundreds of feet higher, just a few dozen feet from the top, he’d come to the last tricky bit of slab climbing. This was where he stalled out.
“I had a moment of doubt,” he wrote years later. “Or maybe panic. It was hard to tell which.”
As he paused there, clinging to the rock, he alternated his hands on a single “pathetic ripple” of a handhold—holding with one while he rested the other. His feet weren’t on proper holds at all; he was using a technique called smearing, relying on the oppositional forces of his rubber-soled shoes angled and pressed hard against the granite to maintain traction. He could hear tourists at the top, laughing and chatting just above him. His calves burned from the pressure of holding himself in place. Minutes ticked away. He had to move soon.
Finally he stood tall, reached out, and grabbed the next hold, the one that had seemed tenuous. His feet held. His hands held. He had made it through, and moments later he pulled himself over the top of the wall and found himself in a crowd of a hundred tourists—shirtless, panting, and totally anonymous. No one at the summit even realized what he’d done.
Later, in his journal, Honnold noted that he had completed the climb in two hours and fifty minutes but that he was dissatisfied with his performance. “Sketchy on slab,” he wrote, with a sad-face emoji. “Do better?”
I’ve followed Alex Honnold’s career for years, and while I find him fascinating, it’s not often that I find him relatable. We are, to put it mildly, very different people. But when I was rereading his description of that brief stall on Half Dome and its impact on how he viewed the whole climb, I thought back to my own efforts to conquer my fear of heights during my summer of DIY exposure therapy: completing the route didn’t count toward a cure, there was no victory, if I couldn’t train my brain to stay calm.
Honnold likes to insist that he’s really a pretty normal person, fear-wise. “I feel fear just like the next guy,” he writes at one point in Alone on the Wall. “If there was an alligator nearby that was about to eat me, I’d feel pretty uncomfortable.” “Pretty uncomfortable” is a milder word choice than most people are likely to use for that scenario, though.
“I get asked all the time about risk,” he writes. “The usual questions are ‘Do you feel fear? Are you ever afraid? What’s the closest you’ve ever come to death?’ I get really tired of answering those questions over and over again.”
Fair enough. But the questions are understandable. From what we, the public, get to see of Honnold’s professional life, his relationship to fear isn’t anything like most people’s. It certainly isn’t like mine. His ability to execute precision climbing moves, for hours on end, when any mistake would result in his sudden and certain death, is barely possible even to comprehend. He seems immune to the shaking and sweating, the hammering heart and the constricted airway, that would find most of us trapped in such a situation.
Still, there are other arenas where his responses seem more normal. Like me, and like Dr. Mujica-Parodi and all her sweaty research subjects, Honnold has tried skydiving. Thinking that he might eventually advance to BASE jumping—parachuting from a cliff or tall structure—Honnold jumped out of a plane for the first time in 2010, one of a handful of dives he completed before giving up the sport. I felt a satisfying sense of recognition, of validation, when he wrote that he “hated everything about them.”
“I felt vaguely motion-sick on the bumpy plane rides up, crammed in with the other jumpers like sardines and breathing exhaust fumes,” he writes. “And I found falling out of a plane to be just plain scary.”
Alex Honnold! He’s just like us!
Or maybe not. A couple of years ago, the writer J.B. MacKinnon persuaded Honnold to climb into an fMRI machine so that neuroscientist Jane Joseph could study his brain. A story had been circulating about a neurobiologist, waiting in line for an autograph at one of Honnold’s public events, who’d leaned over to his neighbour in line and muttered, “That kid’s amygdala isn’t firing.” Joseph planned to see if that armchair diagnosis was correct.
MacKinnon’s Nautilus story, “The Strange Brain of the World’s Greatest Solo Climber,” tells what happened next:
An initial anatomical scan of Honnold’s brain appears on MRI technician James Purl’s computer. “Can you go down to his amygdala? We have to know,” says Joseph….
Purl scrolls down, down, through the Rorschach topography of Honnold’s brain, until, with the suddenness of a photo bomb, a pair of almond-shaped nodes materialize out of the morass. “He has one!” says Joseph, and Purl laughs. Whatever else explains how Honnold can climb ropeless into the Death Zone, it isn’t because there’s an empty space where his amygdala should be. At a glance, Joseph says, the apparatus seems perfectly healthy.
But she wasn’t done yet. Inside the machine, Honnold had been instructed to look at a series of images designed to provoke fear, distress, disgust, or alarm in the viewer. There were images of bloody corpses, images of feces, images of…mountain climbing.
On the glowing screen showing Honnold’s brain activity, the amygdala did not light up to show that it was triggering a fear response. “Maybe his amygdala is not firing—he’s having no internal reactions to these stimuli,” Joseph said. “But it could be the case that he has such a well-honed regulatory system that he can say, ‘OK, I’m feeling all this stuff, my amygdala is going off,’ but his frontal cortex is just so powerful that it can calm him down.”
Joseph had scanned a control subject too: another rock climber about Honnold’s age, someone who would also be classed as a “high-sensation seeker.” Like Honnold, he had seemed, to his observers’ eyes and by his own account, largely unaffected by the images as he looked at them. But his brain scan had told a different story: his amygdala was active, even if he wasn’t consciously perturbed, or admitting that he was.
What to make of it? Honnold’s amygdala is technically functional. He seems, though, to have a higher threshold than most people do for its activation, likely through some combination of nature and nurture—an inherent variation in his responses further honed to a fine, fearless edge by his years of discipline and training and exposure to high-risk situations. It’s clear that his relationship to fear, his response to potential threats, looks different from the average human’s—and different even from that displayed by his fellow seekers of danger.
“Danger scares me,” Honnold wrote in his memoir, after relaying the story of the autograph-seeking scientist who figured his amygdala must not work right. “But as I’ve told countless folks who ask, if I have a certain gift, it’s the ability to keep myself together in places that allow no room for error. I somehow know, in such a fix—like the moves above Thank God Ledge on Half Dome where I stalled out in 2008—how to breathe deeply, calm myself down.” It was that same kind of calm, I realized, that I had been chasing during my exposure therapy efforts.
It wasn’t that I had ever hoped or expected to reach a place where rock climbing felt as ordinary, as neutral, to me as sitting on the couch or walking along a flat, smooth path. I didn’t want to be oblivious to my surroundings and the risks they might present. But I wanted to be able to rise above them, to breathe through them, to prevent the panic from swelling up through my chest and overtaking me.
I suppose that ability, that resistance, is a kind of fearlessness, and Alex Honnold’s extreme version of it has dazzled viewers around the world. But there’s another kind of fearlessness too, one that’s created when a person’s amygdala—unlike Honnold’s—is truly, totally non-operational. Somewhere in the American Midwest, hidden away from movie cameras and magazine photographers, there is a woman living something remarkably close to a life free of fear. She is well known to neuroscientists and fear researchers as Patient S.M.
One day in the mid-1960s, a baby girl was born who didn’t scream or cry. She barely even whimpered, but her silence wasn’t due to a lack of feeling: the baby had a strange thickening in the tissue around her vocal cords, and with that obstruction it was difficult for her to produce any sound.
She had lesions on her skin too, and those—combined with the trouble with her vocal cords—eventually led to her being diagnosed with an incredibly rare genetic condition, Urbach-Wiethe disease.
Urbach-Wiethe attacks people on two fronts: in their skin and throat tissue, and in their brains. Beyond the characteristic thickening of the tissue around the vocal cords, which gives Urbach-Wiethe patients a distinctively hoarse, scratchy speaking voice, the disease also causes skin lesions, generally on the limbs, which lead eventually to widespread scarring. On the neurological front, Urbach-Wiethe causes calcification in the brain structures it infiltrates, and sometimes the damage is extensive enough that it effectively knocks those structures offline. Only a few hundred people have been identified as having the condition.
A number of diseases will attack our brains with what one neuroscientist calls “creepily specific lesions,” damaging only certain brain structures for reasons we don’t entirely understand. Herpes simplex encephalitis is one example; rabies, most famously, is another, targeting the hypothalamus. Urbach-Wiethe disease, for its part, appears to have a particular predilection for the amygdala.
So the baby girl grew up with a strange-sounding voice and waxy-looking, scarred skin. She was treated about as well as you would expect by other kids and, as you might also expect, wound up feeling unattractive and alienated. Then, when she was around age ten, the disease began to creep into her brain.
One day, when she was still a small child, before the disease did its work on her neurons, she went for a hike in the woods with her father. Walking through some loose brush, she fell several feet into a large pit that had been partially hidden by fallen branches and leaves. The pit was home to a nest of baby snakes, and as they slithered, startled, around and over her, sliding across her legs, she screamed and screamed to her father for help. Her remembered terror was still vivid even decades later. But that was likely one of the last times she felt that kind of fear.
Years passed. She had her DNA sequenced by a doctor in Switzerland; later, she had regular laser surgeries to pare back the excess tissue around her vocal cords and prevent a dangerous obstruction of her airway. She turned eighteen. She had her first sexual relationship and got pregnant, and the man left her when he found out about the baby.
The young woman entered her twenties and wound up in an abusive relationship with a new man with whom she had two more children. The father of her second and third children left her during her last pregnancy, and a couple of years later, now a single mother of three, she married. The marriage lasted less than a year before collapsing when the woman confronted her husband about his infidelity. The confrontation ended with the man strangling her until she blacked out. When she woke up, he was gone.
The baby who didn’t cry, the girl with the funny voice, is now a woman in her fifties. Her life story is studded with grim facts like these. She has been assaulted and had a gun held to her head. She has experienced more harrowing and violent events than many of us endure in a lifetime. But if you met her and she told you about them, she would describe them to you calmly, without showing any sign of fear.
The woman, who would become known as Patient S.M., had her first brain scan when she was twenty years old. Our technology has come a long way since that first scan in 1986, but even back then, the damage was striking: two pale, bean-shaped patches in the darker mass of her brain matter, mirroring one another in each hemisphere: voids where her two amygdalae should have been. In the decade since it had begun to do its work, the disease had destroyed the structures virtually completely while leaving practically everything else untouched, one of those “creepily specific” excisions, the kind of thing the scalpel-happy psychosurgeons of the past might have, on some level, envied or admired.
In “A Tale of Survival from the World of Patient S.M.,” published in the book Living Without an Amygdala, the neuroscientists Justin Feinstein, Ralph Adolphs, and Daniel Tranel describe S.M.’s lesions as “the most complete amygdala lesions ever reported” from Urbach-Wiethe disease. The damage was “unlike anything that had been seen before.”
That first scan came about after S.M. was referred by another neurologist to the clinic at the University of Iowa. There, Antonio Damasio and his wife, Hanna Damasio, had recently launched a registry of neurological patients with brain lesions, and S.M. joined the registry as patient number forty-six. She made herself available to researchers interested in learning what they could from her, and plenty of them took her up on the offer.
“She was sort of the star patient, based on the number of Nature papers that she generated,” Adolphs told me when we spoke by phone, laughing at the memory of the piles of work she inspired. (Studies of S.M. have generated dozens of peer-reviewed publications that have, in turn, been cited more than thirteen thousand times.) Adolphs arrived in Iowa in 1993, as a post-doctoral fellow studying under Antonio Damasio, and his work there over four years changed the course of his career.
“It was really just serendipitous,” he said. Adolphs had been studying cognitive neuroscience in his earlier work, and when he got to Iowa, there was the Damasios’ registry, just waiting to be used. He dug in. “I guess it was pretty much random that I happened to study some that had interesting dissociations with respect to emotion, like Patient S.M…. And then that sort of launched my career in social and affective neuroscience.”
Studies of patients with brain lesions like the ones in the Damasios’ registry are valuable because the absence of something can be instructive about its role when it is present. (“Neurology’s favorite word is ‘deficit,’ ” Oliver Sacks once wrote.) Think of a car engine. If the car is running fine, and the engine is intact, there is only so much that an outside observer can deduce about how it works. But if you remove a single part and carefully observe the effect its removal has on the operation of the whole (and then repeat this carefully observed removal with various other single parts, systematically, one at a time), you might eventually start to understand things better. In S.M.’s case, her lack of a functioning amygdala has taught us a lot about the role that brain structure plays in the overall system—and, more broadly, about what it even means for us to feel fear.
Fear, or the lack of it, quickly became the focus of the studies done on S.M. People tested her ability to recognize fear on the faces of others (she can’t see it, although she can perceive their sadness or anger). They also studied her inability to pick up on bodily cues suggesting fear or danger. They tested her physiological fear responses—her reaction to loud noises, for instance, like the one that terrorized Little Albert a century ago. They scrutinized her decision-making, her relationship to risk-taking and rewards. They did their best to figure out, by its absence in S.M., exactly what role the amygdala plays in the car’s engine.
Then, in 2003, nearly two decades after they’d begun studying her, the researchers at Iowa decided to broaden their approach. They launched a multi-year study with one central aim: to see if they could frighten their apparently fearless research subject.
More specifically, they wanted to understand the amygdala’s role in the experience of fear. An array of studies had established that the structure is involved in fear-related functions. We know it plays a role in fear conditioning, for one, and in the triggering of physiological fear responses. We know that it gets involved when our breath shortens and our attention to a possible threat narrows and intensifies. We know it has a role to play in all of that. But what about the feeling of fear itself?
They set out to expose S.M. to a series of stimuli that you’d expect would trigger some degree of fear in the average person. They judged her reactions on two fronts: by monitoring her for typical fear behaviours (jumping back in startlement or screaming, for instance) and by asking her to complete self-reports about her feelings during each round of testing. They predicted that they would be unable to induce fear in their subject—but even so, her imperviousness surprised them.
They started with snakes and spiders, creepy-crawlies whose proximity makes many people, even if they aren’t phobic at all, at least mildly uncomfortable. Some degree of discomfort around these kinds of creatures is deep-seated, honed by millions of years of evolution. And besides, S.M. had told them the story of the hike, the pit, and the baby snakes slithering everywhere while she screamed. She had told the researchers repeatedly over the years that she “hated” snakes and that she did her best to avoid them. Though she was now apparently fearless, the memory of her childhood terror in those horrible moments in the pit remained intact.
So when Feinstein, Adolphs, and the rest brought her to an exotic pet store, they expected that she would avoid the snake section. She loved other animals, and they figured she would focus her attention on the hamsters and the puppies, and that they might even get a glimpse of some nervous or fearful behaviours if she came close to the snakes by accident.
They were wrong. When S.M. and the researchers entered the store, she headed straight for the snakes, fascinated, peering at them closely through the glass. Noting her interest, a store employee removed a smaller, non-venomous variety from its enclosure for her to hold. S.M. let it wrap itself around her hands. She stroked its scaled skin; she touched its flickering tongue. “This is so cool,” she said. Later, she asked fifteen different times if she could try holding the larger, more dangerous snakes. (The store’s employees refused her each time.) It wasn’t just a matter of her feeling safe in the confines of the pet store either. Later, a family member told the research team that she’d once tried to touch a snake she encountered in the wild too.
So much for her fear of snakes.
It was the same with the store’s tarantula. She had told the researchers that she avoided spiders, but now she begged to be allowed to hold the furry menace.
Next, the team took S.M. for a visit to the Waverly Hills Sanatorium, in Louisville, Kentucky. Once home to dozens of tuberculosis patients, the place now bills itself as one of the most haunted buildings in the world. Every Halloween, the sanatorium is transformed into an enormous haunted house, dimly lit and elaborately decorated and filled with actors dressed as monsters, ghosts, and killers. S.M. and the researchers made their visit while the haunted house was in full swing.
Their group was paired with five other women who were visiting at the same time. The women must have been confused by S.M.’s boldness—from the start, she charged ahead, calling out things like “This way, guys!” as she led them deeper into the building. The actors were good at their jobs: when costumed monsters and bloodied murderers leapt out of the shadows, the other members of the group screamed and jumped. But not S.M. She smiled and laughed. Once, she even reached out to poke a monster in its masked face (she was “curious,” she said later) and turned the tables by scaring the actor inside the costume.
Unsurprisingly by now, the clips the team showed S.M. from scary movies produced no fear either, although she reacted to other film footage in the ways you might generally expect of people, exhibiting sadness at sad moments, disgust at gross-out scenes, and so on. In a 2011 article detailing the whole study, Feinstein, Adolphs, Damasio, and Tranel wrote, “On no occasion did S.M. exhibit fear.”
But finally, two years later, Justin Feinstein found a way to make Patient S.M. feel afraid.
The scientists who study emotion make a distinction between what they call “exteroceptive” fear and “interoceptive” fear—the fear that comes upon us from outside of ourselves, and the fear that affects us from within. Everything researchers had done to try to trigger S.M.’s seemingly nonexistent fear response had been exteroceptive, aimed at her through visual, auditory, or other external sensory triggers. Now, though, Feinstein and his colleagues decided to take a different approach.
Previous research showed that the inhalation of carbon dioxide can induce fear, and even panic attacks, in humans. And in mice, the amygdala has been shown to be involved in the detection of carbon dioxide. Feinstein hypothesized that if he exposed S.M. to a commonly used carbon dioxide inhalation test, she would display a reduced level, relative to most other people, of CO2-provoked fear.
On the day of the test, S.M. was asked to lie back in a reclining chair and a plastic mask was placed over her nose and mouth. Then she took one big breath through the mask, inhaling air that had been mixed with 35 percent carbon dioxide, 875 times the normal amount of CO2 in the air we typically breathe.
This is a well-established experimental tactic, and its effects usually expire within a minute. The presence of the CO2 in our system triggers alarm bells both in our central and peripheral nervous systems. Although the single breath of CO2-laden air does not actually affect subjects’ oxygen levels, it creates an illusory sense that they need air—what researchers call “air hunger.” In one quarter of participants, the experiment tends to induce feelings of deep fear and even, in some cases, a full-blown panic attack.
S.M. did not react in the muted way that Feinstein and the rest expected. Immediately after her inhalation, she began to gasp for air. Her breathing accelerated, and at the eight-second mark after her intake of CO2, she began waving her right hand around, gesturing at the air mask. Her toes curled, her fingers flexed, and her body locked up with tension. She said “Help me!” through the plastic covering her mouth fourteen seconds into the experiment, and one of the researchers removed the mask from her face. She grabbed his hand as soon as he’d done so. “Thank you,” she said, eyes wide, nostrils flaring. But for another two minutes, she fought to breathe. She gasped and gulped for air; she waved a hand towards her throat. “I can’t breathe,” she said.
In the end, it was nearly five minutes before she recovered, far longer than the typical panics induced by the experiment, which last for a minute or two. “S.M. had just experienced the first panic attack of her life,” Feinstein wrote later. “Every experimenter in the room was shocked. S.M. had actually felt fear. She called it the ‘worst’ fear she had ever felt. In all likelihood, it was probably the first time she had experienced fear since childhood.”
(Feinstein told me that he and his colleagues were “walking around that week like deer in headlights.” But despite their shock, “it was a great moment,” he said. “Because that’s the whole point of science, to be proven wrong.” You learn more when your hypotheses are convincingly overturned.)
To see if the effect was replicable, the team in Iowa reached out to a researcher who’d been studying German twins who also had extensive bilateral amygdala lesions resulting from their Urbach-Wiethe disease. The two women flew across the Atlantic and, like S.M. before them, breathed in the gas. The researchers also brought in a group of control subjects with their amygdalae intact.
Feinstein and company went three for three: both twins experienced full-blown panic attacks when the gas hit their systems. The rate of panic among the control group, meanwhile, was much lower. Not only were the supposedly fearless patients experiencing fear, they were doing so at a higher rate, and with a greater intensity, than people without lesions.
There were two takeaways from these results. First, the presence of a functioning amygdala was not, as might have been assumed from the existing body of research, a prerequisite either for the bodily or the emotional experience of fear. And second, it seemed possible that the amygdala might have not only a triggering role in our fear responses, but also a muting, suppressing, or control function. That would help to explain the exaggerated responses of the Urbach-Wiethe patients to the gas: once their panic responses were triggered, they lacked the brakes that their amygdalae would have provided to control themselves again. They could not, as Alex Honnold apparently can, simply will themselves to calm down.
“In one breath,” Feinstein wrote, “we immediately learned that the amygdala could not be the brain’s quintessential and sole ‘fear center.’…Without a functioning amygdala, S.M. was still able to experience an intense and prolonged state of fear.”
There’s another way in which S.M. expresses something we might recognize as fear. But it’s not fear for herself—it’s fear for her children. Or at the least, if not true fear, then certainly a deeply protective instinct that she never applies to her own safety. As a mother, it seems, she can recognize an immediate threat, and respond.
Once, when a woman S.M. described as a “six-foot-five neighbour lady” slapped her young son, S.M. rushed into the fray, shoved the woman, and wound up facing down not only the “neighbour lady” but several of the woman’s family members, taking on all comers before the police arrived to break things up. Another time, when her son found a small bag of crack cocaine in the yard, S.M. took the drugs to the police and told them who she thought the dealer was. Soon after, written death threats started appearing on her doorstep, and one day a man materialized in her apartment hallway, held a handgun to her head, said “bam!” and then walked away. But when her boy found another baggie in the backyard, S.M. went back to the police again, hoping to make her home and her neighbourhood safe for her kids.
These are actions any other mother might take—nothing out of the ordinary, really, except for the part where she felt no fear whatsoever when a gun’s muzzle was rested against her skull. But paired with her complete lack of concern for her own safety, even in situations when her children were out of harm’s way, it suggests something: that a mother’s grizzly-bear instinct is not triggered by her amygdala. Our fears can spring from multiple sources within us.
These days, S.M. has very little contact with her three grown children. But she still has a mother’s fears. Once, intrigued by the seeming disconnect, a researcher asked her about her son.
“Your son is now a soldier in Afghanistan, right?” the researcher said. “Are you worried about him?”
“Yes,” she said. “I am.”
The researcher asked her what she was worried about.
“I am worried about him being hurt, having bad things happening to him. Someone can be holding a gun to my son right now.”
“There’s something interesting there,” the researcher said. “You basically say that if someone held a gun to you, you wouldn’t be afraid. But if someone did that to your son, then you would be afraid?”
S.M. replied with a denial. “I am not afraid,” she said. “I just don’t want that for him. What you need to understand is that I am worried, but not afraid.”
So what, then, was the difference between fear and worry?
“ ‘Afraid’ means being frightened,” S.M. said. “Being scared. And ‘worried’ means not wanting something to happen. I have always been worried about things, but I am never afraid. If I could stand between my son and the bullet, I would do that because I am not afraid.”
I was fascinated by S.M.’s existence. I’ve sometimes felt as though my life is less a pursuit of happiness and more an ongoing, endless duel with fear. So the idea that there was someone out there who hardly even knew what it was to feel it? I was hooked. Trying not to seem like a voyeur, I asked Ralph Adolphs what S.M. was really like.
“Certainly, if you just met her, and you didn’t know anything, and you just interacted with her, you would be hard pressed to really find anything all that unusual,” he told me. “Unless you really asked her, or you took her on a roller-coaster ride or to a haunted house or something…she would seem, you know, relatively normal. Like a very pleasant, friendly kind of person, but not way out in terms of her behaviour.” That wasn’t at all unusual for lesion patients, he told me. Even amnesic patients, like the famous Patient H.M., who was almost entirely incapable of forming new long-term memories, and lived his life in roughly thirty-second increments, generally come across in casual conversation as though there is nothing out of the ordinary about their (actually extraordinary) minds.
“You’re never going to ask, you know, what year is it, or who’s president, or something weird,” Adolphs said of his amnesic research subjects. “If you just encountered them on the street, you would ask them, ‘How’s it going?’ And they would say, ‘Fine. I’m having a great day.’ You could ask, ‘So what have you been doing?’ ‘Oh, you know, various things.’ ”
Adolphs noted his patients’ incredible capacity to compensate, socially and otherwise, for their deficits. “They’re able to construct an intact person,” he told me, and that ability is increasingly a focus of the research in his lab: “Rather than asking, What is a deficit in these people? asking, What’s the rest of the brain doing to make up for what’s missing?” Adolphs is continually impressed by the brain’s plasticity, its ability to regroup and reorganize itself as required. “We don’t know what the limits of that are, to be honest. It seems remarkable.”
It is remarkable. Patient S.M. is now in her mid-fifties, and her health problems are beginning to pile up. But it’s incredible that she has survived this long without access to humanity’s primary internal alarm system. Her lesions are unique among known human cases, but here’s a grim point of comparison from our primate relatives. In 1968, when S.M. was still a toddler with her amygdala intact, a psychiatrist named Arthur Kling captured a group of wild rhesus monkeys on a small island off the coast of Puerto Rico. He removed their amygdalae and set the monkeys free. Within two weeks, all of them were dead, either by starvation, drowning, or attacks from their intact peers.
When I first set out to learn about S.M., I had expected to find a cautionary tale. And yes, her life has been harrowing; her fearlessness has led her into danger, has isolated her from others, and has made her world smaller in many ways.
People, mostly men, have taken advantage of her and abused her. She has spent most of her life subsisting off government disability payments. She has often been hungry, because she isn’t driven to eat, and she’s not great with money—without fear of consequences, why would you be? She has difficulty maintaining friendships, apparently because she lacks the inhibitions that most of us labour under. When she meets someone she likes, she comes on strong, offers limitless generosity and asks for the same in return, and her intensity can drive people away. Turns out the fear of rejection can be a useful social handrail.
“It is a hard life,” Justin Feinstein told me. “She lacks a social bubble. Typically we all have some imaginary bubble drawn around our bodies, and if anyone invades that personal space, we feel some sense of discomfort, right? Whereas with her, you could be standing literally nose to nose, tip to tip, with a stranger, and she doesn’t feel at all uncomfortable.” He’s interested in the idea of the amygdala not only as a triggering mechanism but as a kind of brake on our behaviour as well. “What you see in S.M. is really a manifestation of somebody living life without those brakes.”
Life without brakes: hard to fathom for someone like me, fighting to free myself from a heavy foot on the brake pedal.
Despite everything, I found much to admire in S.M.’s life. Her trust in others, even if occasionally misplaced, is the kind of thing we could probably all use a little more of. Her adaptability, her capacity to survive despite the blank spots in the map of her brain, amazed me. I thought about her charging ahead through that haunted house, laughing, calling for the group to follow her lead. Her fearlessness made her so open to the world. I envied that, at least a little.
If the “fearless” people I’d read about were like a buffet of characteristics to choose from, I suppose that’s what I’d select for myself: S.M.’s incredible openness, her boldness, and Alex Honnold’s seemingly limitless capacity for calm.
In the end, though, I knew that fear was necessary. Mine might sometimes feel like it was on overdrive, but it was there for a reason: to help me survive. Justin Feinstein had described fear to me as a “key ingredient” in the continued existence of the species across millennia (and not just our species, if we define “fear” more broadly). Even if it sometimes inconvenienced me, it wasn’t something to wish away.