Damasio: Descartes' Error

Damasio, Antonio: Descartes' Error; Penguin Books, London, 2005

I'm leading this discussion for the class and I'm also very interested in this book so this blog entry is going to be pretty long.  I've been looking forward to this book for several reasons.  One reason is the science aspect and including something in our exploration from a modern scientific perspective.  The second reason is based on where in our reading list this book is placed - towards the end where we are trying to synthesize what we have been reading and thinking about. It's a big jump from Freud in the early 20th century to Damasio at the end of the century and to Phillips in this millennium but it's great to read works by thinkers who are considering what has come before them and where we are now.

I hadn't heard of this book, nor Antonio Damasio before.  The book was written in the mid-1990s and Damasio is a neuroscientist.  Born in Lisbon in 1944 but living and working in the USA most of his career.  His wife, Hanna Damasio, is also a neuroscientist, and they have frequently collaborated together in their work.

Damasio's premise for this book is that the brain, and more particularly the mind, is not an organ or entity separate from the body but rather intimately connected to and dependent on the body for its integrity.  Where some previous thinkers, most notably Rene "cogito ergo sum" Descartes, have felt that the self belongs outside the body proper (either to the mind or to the spirit), Damasio argues that the self is very much a product of brain and body; that the integrity and persistence of the self rely on the integrity of both brain and body and the ongoing communications between the two; and that "mental activity, from its simplest aspect to its most sublime, requires both brain and body proper."[pg xxi)

In his introduction, Damasio states that both “high-level” and “low-level” brain regions, from the pre-frontal cortices to the hypothalamus and brain stem, cooperate in the making of reason.  But where we have long thought that reason is separate from passion and feelings (though affected by them, usually adversely), feelings are an important component and tool in rational decision-making.

Feelings, along with the emotions they come from, are not a luxury. [...] Feelings are neither intangible nor elusive.  Contrary to traditional scientific opinion, feelings are just as cognitive as other percepts.  They are the result of a most curious physiological arrangement that has turned the brain into the body's captive audience.

[...] Were it not for the possibility of sensing body states that are inherently ordained to be painful or pleasurable, there would be no suffering or bliss, no longing or mercy, no tragedy or glory in the human condition. (pg xvii)

 Damasio goes on to state that "Feelings are the base for what humans have described for millennia as the human soul or spirit." pg xx  He asks the series of questions that have engaged mankind (I use 'mankind' deliberately here) for millennia:

How is it that we are conscious of the world around us,
that we know what we know,
and that we know that we know?  pg xxi

[I couldn't help but think of Donald Rumsfeld's infamous quote on the topic of 'what we know we know', when he spoke at NATO; not that different from Damasio's but which seemed to confirm a reputation for cloudy political double-speak: "There are things we know that we know. There are known unknowns. That is to say there are things that we now know we don't know. But there are also unknown unknowns. There are things we do not know we don't know."]

I liked Damasio's view on the limits of science:

I am sceptical of science's presumption of objectivity and definitiveness.  I have a difficult time seeing scientific results, especially in neurobiology, as anything but provisional approximations, to be enjoyed for a while and discarded as soon as better accounts become available.  pg xxii

I agree with this but what I really agree with is that his follow up statement that this doesn't mean that science is not useful, that where we are now in the state of our knowledge is not of value even though where we [ideally] end up will be somewhere else.  As Damasio put it, this scepticism doesn't mean he is not enthusiastic about attempts to improve these provisional approximations.

Damasio begins his text by recounting the story of Phineas Gage, a railway foreman in 1848 who suffers a severe linear brain injury (from a long narrow metal rod driven through his head from under his left cheekbone and up and out through the top of his skull, travelling dorso-medially and anteriorly).  He survived his injury and once he had recovered from the hemorrhage and infection he seemed miraculously intact: could walk, speak, function etc.  It was only after his physical recovery that severe and debilitating changes in his personality, his reasoning, his self became apparent and not only apparent but a severe problem for his functioning in society.  It appeared that an area of his brain had been damaged that was responsible for very specific functions to do with reasoning and "in particular to the personal and social dimensions of reasoning." (pg 10).  Damasio uses this case, and Hanna Damasio's computer reconstruction of which brain areas might have been damaged, as well as modern day cases of patients with similar symptoms to hypothesize what might be going on in several specific sectors of the brain and what this implies for concepts of reason, self, ethics etc

Gage's example indicated that something in the brain was concerned specifically with unique human properties.  pg 10

Among these unique human properties, Damasio lists: "the ability to anticipate the future and plan accordingly within a complex social environment; the sense of responsibility toward the self and others; and the ability to orchestrate one's survival deliberately, at the command of one's free will. " The case Damasio makes for the information we can derive from Gage's situation is compelling, though I gather not non-controversial.  I found an article online by Malcolm Macmillan in The Psychologist - UK [Article on Phineas Gage and Descartes' Error - The Psychologist ] which emphatically did not agree with Damasio's assumptions about Gage's injury.  If we disregard this aspect, Damasio does go on to discuss patients he has seen and other medical reports from more modern times regarding patients with similar areas of damage or similar symptoms and I do consider he makes a good case - or provisional assumption - about certain areas and functions of the brain.


Damasio makes mention of phrenology, which topic has come up occasionally amongst our 19th century authors.  I didn't know much about it other than it involved bumps on the head but Damasio explains more in an aside on page 14.  He describes it as "a curious mix of early psychology, early neuroscience, and practical philosophy" and was especially influential on the humanities in the 19th c.  It's founder, Franz Joseph Gall, had an amazing conception that there were areas of specialization in the brain and he went against the established dualist thinking that separated mind and body.  What phrenology has become more known for is the erroneous assertion that there are specific single brain centres for each function and that the power of the function was related to the size of the centre (and which could be assessed via telltale bumps on the skull).  A phrenologist travelling through Massachussett in later years wrote about Phineas Gage's accident and concluded in 1882 that the iron rod had passed "in the neighbourhood of Benevolence and Veneration.  [...] His organ of Veneration seemed to have been injured..."  Much more evocative than ventromedial prefrontal area or cytoarchitectonic areas 3, 1, 2 and Area S2.

While individual areas are important for the various functions of the mind, these functions cannot usually be localized to one single specific site.  Most (if not all) brain functions are a result of the interaction of multiple specific areas and systems of the brain.  "The mind results from the operation of each of the separate components, and from the concerted operation of the multiple systems constituted by these separate components." pg 15

One characteristic of the patients that Damasio describes is that their brain injury has impaired their ability to make good decisions (which is evident in themselves but even more striking when compared to their personalities, decision-making and rationality before their brain damage).  Interestingly, Damasio comments about one patient that these changes seen were not "consequent to a former weakness of character, and they certainly were not controlled willfully by the patient." pg 37  He does not discuss much about other brain diseases or types of injury (other than direct trauma due to direct force or due to stroke) other than glancing references to injury from drugs/alcohol as well as genetic and social influences on the brain but thoughts of fetal alcohol syndrome and child abuse did come to mind. For Damasio's patients, after their brain injury "the machinery for [their] decision making was so flawed that [they] could no longer be an effective social being."  He describes patients that are now unable to learn from their mistakes.  "It is appropriate to say that his free will had been compromised." pg 38  Later on Damasio refers to the work of Francis Crick and his thoughts about a 'neural substrate for free will' in his 1994 book The Astonishing Hypothesis: The Scientific Search for the Soul.  [pg 73] Interestingly these patients, though completely unable to function in society, can have normal IQ tests and function normally on many cognitive tests.

Damasio speaks about diseases of the brain (epilepsy, brain tumour, stroke) vs diseases of the mind (manic-depression or schizophrenia) and the value judgements our culture places on them, where

diseases of the brain are seen as tragedies visited on people who cannot be blamed for their condition, while diseases of the mind, especially those that affect conduct and emotion, are seen as social inconveniences for which sufferers have much to answer. Individuals are to be blamed for their character flaws, defective emotional modulation, and so on; lack of willpower is supposed to be the primary problem.  pg 40

Emotion has long thought to affect reasoning, usually in a negative way, interfering in 'good' decision making.  "As a result, we usually conceive of emotion as a supernumerary mental faculty, an unsolicited, nature-ordained accompaniment to our rational thinking.  If emotion is pleasurable, we enjoy it as a luxury; if it is painful, we suffer it as an unwelcome intrusion."  [pg 52]  This is not to say that emotions can't cause biases that can lead to irrational decisions - where would advertising be if this were not the case?

Damasio discusses the complexity of the human organism (and of the mammalian class as a whole) and how this would have required a more complex brain than one based on simple sensory organs and simple reflexes.  What gives us a 'mind' is the ability 'to display images internally and to order those images in a process called thought."  [pg 89]  Images are not only visual but could be olfactory, auditory or tactile.

My view then is that having a mind means that an organism forms neural representations which can become images, be manipulated in a process called thought, and eventually influence behaviour by helping predict the future, plan accordingly, and choose the next action. pg pg 90

This is where Damasio starts to part company from Descartes.

The overall function of the brain is to be well informed about what goes on in the rest of the body, the body proper; about what goes on in itself; and about the  environment surrounding the organism, so that suitable, survivable accommodations can be achieved between organism and environment.  from an evolutionary perspective, it is not the other way around. If there had been no body, there would have been no brain.  pg 90

Damasio gives us just a hint of the complexity of the mammalian nervous system and asks "what does all that complexity buy us?" [pg 93]  It allows us to acquire strategies for reasoning and thus for decision making.  One concept that Damasio relies on is the concept of "dispositional representations".  These are the repositories of "facts and strategies" in each our brains of both innate and acquired knowledge about ourselves and our environment. [pg 94]

One odd little item that Damasio brought up again and again was a visual concept for the brain's functional regions of a homunculus or human figure distorted based on the relative "richness" of the area (ie: area connected to lip sensation would be bigger than mid-leg).  He ascribes this concept to Canadian Wilder Penfield [pg 72] and brings it up again and again - obviously an early 'provisional approximation' of how the brain works that really bugs Damasio.  However he seems to get this quite confused with a concept of a homunculus as a "little person inside our brain perceiving and thinking about the images the brain forms" [pg 99] a concept which has nothing to do with Wilder's surgical neuro-mapping.  Damasio quite rightly notes that for this intra-brain homunculus to be true, we would have to conceive of an endless nest of Russian Dolls with each brain containing a little human whose brain contains an even smaller human whose brain contains an even smaller ...

Damasio makes a strong case for the importance of the sensory aspects of each organism in their mental functioning and this holds true in humans for their cognitive ability and consciousness.  He emphasizes that the innate drives and neural circuits in the brain "intervene not just in bodily regulation but also in the development and adult activity of the evolutionarily modern structures of the brain." pg 110  He is speaking of the experience-driven sections of the brain which are evolutionarily more modern than the "reptile brain" (limbic system and brainstem).  We are born with innate sectors of our nervous system responsible for basic life processes necessary for homeostatic regulation such as breathing, thermoregulation, immune system, endocrine system etc.  Though these areas are genetically provided to us that doesn't mean they are not influenced by outside factors: environment, nutrition, experiences etc.  More than that, these innate drives have important effects on the experiential parts of our brain.  This influence is carried out by modulator neurons in the brainstem and basal forebrain over cerebral cortex and subcortical areas.  For Damasio it looks a bit like this (pg 111):

1. the innate regulatory circuits are involved in the business of organism survival and because of that they are privy to what is happening in the more modern sectors of the brain;
2. the goodness and badness of situations is regularly signalled to them; and
3. they express their inherent reaction to goodness and badness by influencing how the rest of the brain is shaped, so that it can assist survival in the most efficacious way.

Damasio is firmly against the tabula rasa (blank slate) theory of the brain, that the brain begins with no innate preferences or abilities and that all develops based on environment and learning (nurture vs nature).  He supports the idea that we are born with a set of drives and instincts (the least controversial of these being appetite, procreation, care of kin, shelter seeking etc).  He also considers that emotions and feelings are central to rationality and are a powerful manifestation of drives and instincts. pg 115

Many of these basic drives are covert and we are not even aware of them but Damasio considers that instincts which "are slightly more complex regulatory mechanisms, involving overt behaviours, let you know about their existence indirectly, when they drive you to perform (or not) in a particular way.  pg 116  This could be via a body state (hunger or thirst) or emotion (fear or anger).  As our environments become more complex, our survival strategies also had to evolve (and have to evolve) to become more complex.  These 'suprainstinctual' survival strategies, the control of "animal inclination by thought, reason, and the will was what made us human, according to Descartes Passion of the Soul." pg 124  For Freud it was the superego (which would "accommodate instincts to social dictates").

For most ethical rules and social conventions, regardless of how elevated their goal, I believe one can envision a meaningful link to simpler goals and to drives and instincts. Why should this be so?  Because the consequences of achieving or not achieving a rarefied social goal contribute (or are perceived as contributing), albeit indirectly, to survival and to the quality of that survival.  pg 125

For those who feel that this debases altruism, love, compassion, free will, by trying to reduce them to neurobiological regulation, Damasio replies that "the partial explanation of complexity by something less complex does not signify debasement."[pg 126]  He is postulating

an organism that comes to life with automatic survival mechanisms, and to which education and acculturation add a set of socially permissible and desirable decision-making strategies that, in turn, enhance survival, remarkably improve the quality of survival, and save as the basis for constructing a person.  [...]  The neural mechanisms that support the supra instinctual repertoire may be similar in their overall formal design to those governing biological drives, and may be constrained by them.  Yet they require the intervention of society to become whatever they become, and thus are related as much to a given culture as to general neurobiology.  Moreover out of that dual constraint, supra instinctual survival strategies generate something probably unique to humans: a moral point of view that, on occasion, can transcend the interests of the immediate group and even the species.  pg 126

 Damasio also departs from some mainstream thinking in his differentiation between emotions and feelings.  For Damasio emotions are the body's responses, changes in "body state" connected to particular mental images that have activated a particular body system (viscera, skin, cardiovascular system, respiratory system, endocrine).  Feelings are the continuous monitoring of body changes and "the experience of such changes in juxtaposition to the mental images that initiated the cycle.  The substrate of a feeling is completed by the changes in cognitive processes that are simultaneously induced by neurochemical substances.  pg 146  It is the juxtaposition of "the ongoing representation of the body with the neural representations constituting the self." pg 146  Damasio writes about the three different types of feelings:

1. those based on basic universal emotions (happiness, sadness, anger, fear, disgust) and which cause our attention to be allocated to body signals 
2. those based on emotions that are subtle variations of the basic universal ones: euphoria and ecstasy (variations on happiness), melancholy and wistfulness (sadness), panic and shyness (fear), remorse, guilt, embarrassment, vindication etc.  These are tuned by experience
3. Background feelings - the body state prevailing between emotions, related somewhat to mood.

A composite, ongoing representation of current body states is distributed over a large number of brain structures (pg 151).  There are "on-line, dynamic body maps as well as more stable "off-line maps of general body structure that are dispositional.  The background body state monitoring is usually not a focus of attention or even perceived but it contributes to our sense of how we feel and it can move to the forefront of our attention when needed (i.e.: asthmatic attack, visceral pain etc).  The right hemisphere is more significant or involved in this monitoring than the left side though regions from both sides of the brain are involved.  Studies of patients with injuries involving the sectors of the brain concerned with this continuous monitoring show cognitive defects that suggest that "what does not come naturally and automatically through the primacy of feeling cannot be maintained in the mind."[pg 154]  This is another interesting comment of Damasio's, that feelings and sensory inputs are not only necessary for the body state information they provide which is used for rational decision-making but that this afferent information and processing is also important for maintaining this focus and knowledge.  Our sense of self is dependent on continuous feedback mechanisms about our pre-existing and current body states.  For Damasio, "feelings are just as cognitive as any other perceptual image, and just as dependent on cerebral cortex processing as any other image."  

I see feelings as having a truly privileged status.[...] Because of their inextricable ties to the body, they come first in development and retain a primacy that subtly pervades our mental life. pg 159

He also touches on superstition.  It's a necessary thing for us to make causal links between people and events and certain feelings but sometimes we make the wrong links.  "Superstition is based on this sort of spurious causal association" pg 162  This is a really significant weakness in human rationality, our propensity to assign cause to things - to NEED to assign a cause to things - without critical thought.  I see this all the time with testimonial-based claims (vs evidence based medicine), with people wanting to blame illness on the water, on something that happened years ago, on rare diseases that do not commonly occur locally.

REASONING

Que chacun examine ses pensées, il les trouvera toutes occupées au passé et à l'avenir. Nous ne pensons point au présent ; et, nous y pensons, ce n'est que pour en prendre la lumière pour disposer de l'avenir.

  Blaise Pascal, Pensées, 1670 (fragment 172)

The purpose of reasoning is deciding and the essence of deciding is selecting a response option. Phillip Johnson Laird put it [pg 165] :
"In order to decide what to do, judge; in order to judge, reason; in order to reason, decide."
Some decisions are instinctual such as jumping out of harm's way, ducking your head from an incoming baseball.  Others are exceeding complex involving challenging assessment, moral evaluations and competing interests, judgements of short term and longterm gains as well as probabilities.  Descartes separated them into 2 camps: "one outside the body, as a hallmark of the human spirit, while the other remained inside, the hallmark of animal spirits, so separate that one stands for clarity of thought, deductive competence, algorithmicity, while the other connotes murkiness and the less disciplined life of the passions."  pg 168  Damasio came up with a somatic marker theory to explain how humans reason out these complex decisions.  He suggests that the brain can create stored connections that connect an instinctual response (good and bad) to scenarios or situations.  The neural system involved in these markers is "the pre-frontal cortices, which is also coextensive with the system critical for secondary emotions." [pg 180] These somatic markers help us winnow down on possible response options when faced with complex decisions but quickly eliminating several "bad" options from the possible responses, actions or decisions. pg 173.  It would also apply to:

the choice of actions whose immediate consequences are negative, but which generate positive future outcomes. [...]  Willpower draws on the evaluation of a prospect, and that evaluation may not take place if attention is not properly driven to both the immediate trouble and the future payoff, to both the suffering now and the future gratification. [...] Willpower is just another name for the idea of choosing according to long-term outcomes rather than short-term ones." pg 175

This discussion extended into a discussion of altruism which could be explained by benefits such as self-esteem, social validation, exaltation and avoidance of guilt and shame. pg 176

Some sublime human achievements come from rejecting what biology or culture propels individuals to do.  Such achievements are the affirmation of a new level of being in which one can invent new artifacts and forge more just ways of existing.  Under certain circumstances, however, freedom from biological and cultural constraints can also be a hallmark of madness and can nourish the ideas and acts of the insane.  pg 177 

He also discusses intuition, which is merely a covert preselection winnowing down possible options through a biological mechanism, for decisions primarily in the personal and social domains. pg 187-189
Another area Damasio touched on but did not explore to any great extent was the effect of "sick cultures" on normal adult systems of reasoning.  He uses the examples of Nazi Germany, Russia (one assumes during the purges) and the Pol Pot regime in Cambodia but then makes a vague mention of "sizable sectors of Western society are gradually becoming other tragic counterexamples." pg 179

Damasio discusses some of the neuroanatomy underpinning his hypotheses.

The prefrontal sectors are indeed in a privileged position among other brain systems.  Their cortices receive signals about existing and incoming factual knowledge related to the external world; about innate biological regulatory preferences; and about previous and current body state as continuously modified by that knowledge and those preferences. pg 181

Categorization is important to humans in their efforts to organize and prioritize information (experiential). The dispositional representations we create are stored in convergence zones in the prefrontal cortices.  These contingencies are what make up our individual experience.  Bioregulatory and social knowledge tends to be stored in the ventromedial sector while knowledge of the external world (objects, people, space-time, language, mathematics) tends to be located in the dorsolateral regions. pg 182-183  This somatic marker system develops as we age and experience and comes to include symbols of somatic states and what Damasio calls "as-if" loops, circuits that occur solely in the brain (through image generation, representations) rather than a body-brain loop. pg 184

Damasio also evaluated decision-making from an evolutionary perspective pg 191.

1. oldest decision-making device pertains to basic biological regulation
2. the next oldest decision-making device pertains to the personal and social realm;
3. the most recent decision-making process pertains to a collection of abstract-symbolic operations under which we can find artistic and scientific reasoning, utilitatian-engineering reasoning, and the developments of language and mathematics.

It's a great system but it doesn't work perfectly.  We don't always make rational decisions, in fact we probably often make irrational decisions.  We are easily manipulated by our emotions and our desire to assign a cause to events.

But even if our reasoning strategies were perfectly tuned, it appears, they would  not cope well with the uncertainty and complexity of personal and social problems. pg 191

Damasio blames some of this irrationality on the influence of biological drives such as obedience, conformity, the desire to preserve self-esteem.  Decision-making also requires working memory and attention.  He posits that the somatic markers also act as "a booster for continued working memory and attention," [pg 198] saying that the proceedings are energized by signs the process is actually being evaluated, or is progressing.  I certainly find this.  If I am working on something and I feel like progress is either being made or at least possible, then I'm motivated to keep working.  However f I am working at something and feel there is no hope of succeeding, then I lose interest, focus and energy. "Somatic markers which arise out of activating a particular contingency boost attention and working memory throughout the cognitive system. " pg 198
Cognitive reasoning processes working at both the subconscious and the conscious level are both necessary for reasoning.

It seems to take both types of processing for the well-tempered decision-making brain to operate. pg 214  

The mind derives from the entire organism as an ensemble. pg 225  It depends on mind-body interactions.  The body contributes information that is part of the workings of the normal mind. pg 226  Some of this information is what Damasio terms "primordial representations" (bioregulatory information, visceral, skin and musculoskeletal information including proprioception and place in space,.  This is the information about the body proper. pg 229  Though these are important (especially evolutionarily), what now dominates are the non-body images.  Some of the patients that Damasio discusses suffer from anosognomia, where they are paralyzed but due to the areas of the brain affected, they do not have awareness or cognition of what is going on with their bodies.  He postulates that this is because they are relying on old information about their bodies (since the source of new, continuous ongoing information about their body states have been cut off.) pg 237  For Damasio, the self is rooted in a relatively stable, endlessly repeated biological state. pg 238  Our sense of self comes from autobiographical information, ongoing information about our body states, categorized facts about ourselves, our preferences, dispositional memories of recent events, plans ("a memory of a possible future").  The self consists of 2 sets of representations: Dispositional

The endless reactivation of updated images about our identity (a combination of memories of the past and of the planned future) constitutes a sizeable part of the state of self... pg 239

as well as the primordial representations  (what the body has been like lately - the background body state and the emotional state).

At each moment the state of self is constructed, from the ground up.  It is an evanescent reference state.  pg 240

I got bogged down in his descriptions of the metaself pg 241-243 but when he says that " the neural basis of consciousness, namely the acknowledgement of a biological self imbued with value" pg 244 makes sense to me.
Damasio  brings passion and reason together in Chapter 11 towards the end of his book.  Feelings depend on a multi-component system dependent on biological regulation.  Reason depends on specific brain systems some of which process feelings as well.  This seems to connect reason, feelings and the body.

It is as if we are possessed for a passion for reason, a drive that originates in the brain core, permeates other levels of the nervous system, and emerges as either feelings or nonconscious biases to guide decision making.  pg 245

He then refers to the Faustian contract that has brought progress to humanity.  pg 246  One of Damasio's concerns in figuring out the neurobiological basis for feelings is our current "culture of complaint" which pervades the social discourse and also leads to attempts to correct personal and social problems with medical and non-medical drugs.  Again he briefly touches on issues of education and children's overexposure and desensitization to violence and its consequences and how it downgrades the value of emotions, but he doesn't go any further on these topics. pg 246

Descartes error was in thinking that the brain was the repository of self, exclusive of the body, in separating the body from the brain.  I think therefore I am.  Cogito ergo sum.  Damasio rephrases this as

We are, and then we think, and we think only inasmuch as we are.  pg 248

He brings this back to western medicine in its study and treatment of disease; with its divisions or lack of awareness and acknowledgement of the min-body connection.  He posits that this is likely a main driver behind the push toward alternative medicines.  pg 251

Damasio adds a postscriptum with some comments on Ethics and survival.  The evolution of ethics would have required several things [pg 261]:

1. A large capacity to memorize categories of objects and events.
2. A large capacity to manipulate the components of those memorized representations and fashioning new creations by novel combinations.
3. A large capacity to memorize those new creations (anticipated outcomes, plans, the "memories of the future")

Pain and pleasure are the basic drives, the innate drives but they can be modified by education (experience, learning).  Pain + annoyance = suffering.  The evolutionary advantage of suffering is a a heightened attention and focus on action to avoid negative consequences.