Other explanations may exist for the behavior exhibited by both Gage and other patients suffering from prefrontal lobe damage. Gage’s behavior and the changes in his personality could be explained as his way of dealing with disfigurement that he suffered after the accident, or a coping mechanism. Lack of desire could translate into a state of severe depression in which the afflicted individual is unable to translate his intellect or past experience into present actions and decisions because there is no motivation for making such decisions. Severe apathy could render the emotional faculties virtually extinct and effectively cripple him.

Damasio never addresses the possibility that a value system could be “reconstructed” in an individual with frontal lobe damage. Religion has traditionally been a way that individuals have been “rehabilitated”. From criminals to alcoholics, spirituality has been used to give individuals purpose, meaning, and ultimately a value matrix. If such a value system could be reconstructed in an individual like Gage, desire that he once lacked to make a decision that was beneficial would exist- providing purpose and a reason to choose one alternative over another. Obviously this is a hypothesis in its earliest stages of development, but it does open up many possibilities to finding ways to help individuals with frontal lobe damage that are unable to function in everyday life.

While these are only possible alternative explanations, it does illustrate a significant point. In the area of neuroscience, every possible explanation should be explored so as to provide suffering individuals with a possibility of living a normal life- before discarding them as a victim of a physical fluke. Specifically, Damasio’s work has interesting connection to such issues as how to understand psychopaths, agents who lack normal feelings of guilt and other moral motives based on empathy. It seems that psychopaths are not rational amoralists but rather are unable to follow through reliably on long-term plans they make in their own interests. A failure of emotional empathy–with one’s own future self, in effect–apparently yields elements of practical irrationality.

It is possible that a deep knowledge of right and wrong consists of emotional and volitional components in addition to a cognitive one. Thus one should not claim in confidence that the psychopath’s moral deficiency is due solely to a cognitive failure, or that his lack of the deep knowledge of right and wrong can be explained entirely in terms of a defect of practical reason. Improperly functioning somatic markers may be part of the psychopath’s problem. However, physical limitations should not blindly absolve any individual of moral responsibility. The implications suggested by Damasio would change the way that we deal, as a society, with criminals. Are they responsible for what they have done? Can we blame everything on neurobiology? Does environmental damage cause the same significant damage as a tumor?

These questions and other like them cannot be taken lightly when examining the role of neurology in the criminal justice system. As philosophy and science strive to answer these questions and other like them, steps to understand the mind-body relationship should be carefully considered. In seeking to better understand humanity, we must also preserve the humanity of those we study. Damasio’s work has been invaluable to understanding more of the relationship between the mind and body, and he presents compelling reasons for accepting the existence of such a relationship. However, his work alone is not sufficient to justify a verdict in favor of strictly biological explanations for emotional bankruptcy, psychopaths and other sociopaths.

We spend a considerable amount of time planning for the future. We do our planning within a social context, following rules of social conduct while selecting courses of action most advantageous to personal survival and well – being. Rene Descartes phrase “I think therefore I am” has evolved over time into other phrases which celebrate the mind-body dualism celebrates by Descartes. “It’s all in your mind” and “mind over matter” are just two examples of the idea of dualism extending from academia into everyday life.

In “Descartes Error” Antonio Damasio condenses past thought from Aristotle to modern psychologists and proposes that emotion and rationality are not necessarily at odds. He presents his ideas first and foremost as a neurologist, relying on physiological responses and scientific information to support his position. Descartes “error”, according to Damasio, was to regard emotion as something separate from intellectual activity. Through his observation of patients with brain damage, Damasio became convinced that reason alone is insufficient for the efficient operation of the intellect. Damage to certain brain areas, notably the prefrontal cortex, can leave the patient apparently intellectually unimpaired but incapable of making complex decisions. Such a patient, for example, may understand the factors involved in conducting his business but may keep reaching decisions that are inherently disastrous.

The archetypal example of the effects of prefrontal damage is Phineas Gage. In 1848 New England, Gage suffered an injury in which a tamping rod he was using to compress a blasting charge was blown through his skull by an explosion. The majority of the front part of his brain was destroyed, but he survived and at first glance seemed to be unaffected. However, his personality was profoundly altered; from being a responsible foreman he became reckless and irrational, unable to hold down a job for any length of time.

Another individual studied by Damasio had a brain tumor successfully removed but his frontal lobes were inevitably damaged during the operation. Although his intelligence was unaffected, he could no longer carry on his professional work. He had to be prompted to go to work, and when he got there he might start on one task and persist with it even when it was time to change to something else, or he might spend the whole day pondering how to classify a paper he had just read. Thus he could manage isolated tasks well but couldn’t integrate them into a wider frame of reference. In spite of being confronted with the disastrous consequences of his decisions, he was unable to learn from them.

These patients were apparently more or less intact intellectually but their ability to function as complete human beings was subtly but profoundly impaired. So what is wrong with patients like these? What is missing?

The answer, according to Damasio, is emotional biasing or in other words, desire.

In people with normal brains, their decisions are “weighted” by emotions and this enables them to take decisions quickly according to how they feel. These cases of prefrontal damage hinted at the possibility that certain brain regions may be responsible for the ability to plan future survival within a complex social environment, and that this ability relies upon intact systems underlying both cognition and emotion- this concept is referred to as the “Gage Matrix”. Patients with damaged prefrontal lobes are emotionally bankrupt, unable to determine what choice they desire to make.

The somatic marker hypothesis is Damasio’s explanation of the true processes underlying decision-making. Body states and emotions become associated with certain outcomes, influencing our decisions; this is the hypothesis, briefly stated. Damasio claims that the capability to form and access somatic markers is central to the decision process, and this is why the patients with prefrontal lobe damage show the deficits that they do.

The somatic marker hypothesis derives from the commonly accepted idea that behavior is directed as much as by how we feel as how we think. The concept of the somatic marker is that changes in the peripheral nervous system constitutes a ‘gut’ feeling that helps you make correct choices prior to thinking about that choice. Thus the somatic marker helps you decide upon what course of action to take before you rationally consider what actions to indeed take.

To be continued…