National Geographic

Meet the woman without fear

SMKentucky, USA. A woman known only as SM is walking through Waverly Hills Sanatorium, reputedly one of the “most haunted” places in the world. Now a tourist attraction, the building transforms into a haunted house every Halloween, complete with elaborate decorations, spooky noises and actors dressed in monstrous costumes. The experience is silly but still unnerving and the ‘monsters’ often manage to score frights from the visitors by leaping out of hidden corners.

But not SM. While others show trepidation before walking down empty corridors, she leads the way and beckons her companions to follow. When monsters leap out, she never screams in fright; instead, she laughs, approaches and talks to them. She even scares one of the monsters by poking it in the head.

SM is a woman without fear. She doesn’t feel it. She has been held at knifepoint without a tinge of panic. She’ll happily handle live snakes and spiders, even though she claims not to like them. She can sit through reels of upsetting footage without a single start. And all because a pair of almond-shaped structures in her brain – amygdalae – have been destroyed.

Ralph Adolphs, Antonio Damasio and Daniel Tranel at the University of Iowa have been working with SM for over a decade. She is a 44-year old mother-of-three, who suffers from a rare genetic condition called Urbach-Wiethe disease, which has caused parts of her brain to harden and waste away. This creeping damage has completely destroyed her amygdala, a part of the brain involved in processing emotion (white arrows in the diagram below). She’s one of the few people who shows such a striking pattern of damage.

Amygdala

Even so, her IQ is normal. Her memory is good, as are her language and perception skills. But she has problems dealing with fear. Way back in 1994, the group showed that SM has trouble recognising fear in other people. She can’t tell what fearful facial expressions mean, even though she’s more than capable of discerning other emotions. Even though she’s a talented artist, she can’t draw a scared face, once claiming that she didn’t know what such a face would look like. Now, in a study led by Justin Feinstein, the team have found that SM cannot feel fear either.

During her visit to Waverley Hills, SM rated her level of fear throughout the experience. She said that she was excited and enthusiastic in the same way that she feels when she rides a rollercoaster, but never scared – her scores always stayed at zero. In a similar trip to an exotic pet store, her levels of fear never climbed over a score of 2 out of 10. Even though she claimed to “hate” snakes and spiders, she was drawn to the snake enclosure, was excited about holding a serpent (“This is so cool!”) and had to be told not to touch or poke the bigger, more dangerous snakes (and a nearby tarantula). Why? She was overcome with “curiosity”.

When Feinstein showed SM a set of film clips, she generally behaved on cue, laughing at the happy clips and shouting in revulsion at the disgusting ones. But in response to ten scary film clips (including The Shining, Seven, and The Ring)… nothing. She showed no signs of terror, nor did she report any. She said that most people would probably be scared by the films but she herself felt nothing.

SM’s unusual reactions during these isolated scenarios are reflected in her day-to-day life. When Feinstein gave her an electronic handheld  “emotion diary”, she reported feeling every basic emotion other than fear. In fact, out of a range of 50 possible emotional descriptions, the one she rated most highly over 3 months was “fearless”. (It’s fascinating data, although (and Feinstein admits this) it’s unfortunate that he didn’t collect similar data from healthy individuals to compare against).

After more digging, Feinstein uncovered a history of behaviour consistent with a lack of fear. SM’s eldest son can’t remember a single instance when mom felt fear or looked like she was scared. His anecdotes even support the results of Feinstein’s pet store trip.  “Me and my brothers… see this snake on the road,” he writes. “I was like, ‘Holy cow, that’s a big snake!’ Well mom just ran over there and picked it up and brought it out of the street, put it in the grass and let it go on its way… She would always tell me how she was scared of snakes and stuff like that, but then all of a sudden she’s fearless of them. I thought that was kind of weird.”

Other events in SM’s life are less benign. Fourteen years ago, she was walking through a small park at 10pm, when a man beckoned her over to a bench. As she approached, he pulled her down stuck a knife to her throat and said, “I’m going to cut you, bitch!” SM didn’t panic; she didn’t feel afraid. Hearing a church choir sing in the distance, she confidently said, “If you’re going to kill me, you’re gonna have to go through my God’s angels first.” The man let her go and she walked (not ran) away. The next day, she returned to the same park.

These sorts of things happen to her a lot. It’s not that SM has had a cosseted life. She lives in a poor area “replete with crime, drugs and danger”. As Feinstein writes, “she has been held up at knife point and at gun point, she was once physically accosted by a woman twice her size, she was nearly killed in an act of domestic violence, and on more than one occasion she has been explicitly threatened with death.” But in most of these situations, she didn’t act with urgency or desperation, something that police reports have corroborated.

It’s not that she doesn’t understand the concept of fear; after all, she knew that other people might be scared by the films she saw. However, she has a lot of problems with detecting danger. In a previous study, the team showed that she has no personal bubble. She’ll happily stand a foot away from complete strangers, far closer than most people would be comfortable with (even though, again, she understands the concept of personal space). It’s no surprise that she gets herself into a lot of difficult situations.

It’s fascinating how this looks to other people. A few years back, the team asked two clinical psychologists to interview SM without any knowledge of her condition. They described her as a “survivor”, as “resilient” and even “heroic” in how she coped with adversity. If you ask the woman herself, she’ll say that she feels upset or angry in the face of danger, but never fearful. Feinstein even thinks that because of her brain damage, she could be immune to posttraumatic stress disorder, a trait that she shares with some combat veterans.

It wasn’t always like this. She remembers being afraid of the dark as a young child, running away screaming when her older brother jumped out from behind a tree, and being pinned to a corner by a large Doberman (“That’s the only time I really felt scared. Like gut-wrenching scared”). But all of these events happened before her disease wrecked her amygdalae. During her adult life, Feinstein couldn’t find a single episode where she clearly experienced fear.

But Elizabeth Phelps, who studies emotion at New York University, isn’t convinced. Her team has also worked with people whose amygdalae have been severely damaged and while they also have trouble recognising fear in others, they all feel fear in their normal lives (as assessed with similar diaries to the ones that Feinstein used).

Given the fact that SM is just a single patient, and inconsistencies with previous research, Phelps says, “I don’t think the authors were appropriately cautious.” However, she adds, “It could be the difference between their findings and ours is linked to when during development the amygdala lesion occurred in our respective patients.”  Feinstein acknowledges that SM has injuries to other parts of her brain and these could have exacerbated the harm done to her amygdala to produce her unique immunity to fear.

Phelps also points out that SM has been “tested extensively and has some knowledge of her condition”. Perhaps she is overplaying her lack of fear, even subconsciously, to conform to the team’s expectations? Feinstein thinks that’s “highly unlikely”. He and his colleagues have never mentioned to SM that they’re focusing on fear. Their experiments largely involve a spectrum of emotions and they tell SM that they’re interested in emotion, memory and other general concepts. When explicitly asked, she said that they’re interested in how her brain damage affects her behaviour.  More importantly, Feinstein says, “After over two decades of extensive testing with SM, we have been repeatedly impressed by her lack of insight into her specific fear impairments.”

Even SM’s case doesn’t imply that the amygdala is the brain’s fear centre. Feinstein thinks that it’s more of a “broker”, going between parts of the brain that sense things in the environment, and those in the brainstem that initiate fearful actions. Damage to the amygdala breaks the chain between seeing something scary and acting on it.

If that seems like a good thing, think again. In comic books, conquering fear is a good basis for a successful vigilante lifestyle. In real life, the consequences are far direr. As Feinstein writes, “[SM]’s behaviour, time and time again, leads her back to the very situations she should be avoiding, highlighting the indispensable role that the amygdala plays in promoting survival by compelling the organism away from danger. Indeed, it appears that without the amygdala, the evolutionary value of fear is lost.”

Reference: Current Biology in press; reference to be confirmed

More on SM: Brain damage pops woman’s personal bubble

More on fear:

If the citation link isn’t working, read why here
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There are 23 Comments. Add Yours.

  1. Blake Stacey
    December 16, 2010

    Copy edit: “She’s one of the few people who [shows] such a striking pattern of damage.”

  2. åse
    December 16, 2010

    Very nice. I’ve read about studies using her since – oh – 90’s, and I usually bring her up in my classes when I teach emotion. I think I’ll link this in so my students can read it. They always ask me specifics about her, and, of course, I only know about her through the experimental papers.

  3. Robert
    December 16, 2010

    Fascinating stuff. I’m always struck by stories of people who lack (or have) emotions or abilities most of us would like to get rid of (or acquire). Fear, pain, etc., while uncomfortable, are hugely beneficial, while abilities like perfect memory that seem hugely beneficial can be taxing to one’s psychological health.

  4. gregorylent
    December 16, 2010

    same with enlightened people … no fear. zero.

    so maybe look states of consciousness in addition to brain meat.

  5. Scientific Chick
    December 16, 2010

    Neat story! Confirms nicely the role of the amygdala. But surely that’s not the only thing the amygdala mediates? Anything else funny with this lady?

  6. Justin Feinstein
    December 16, 2010

    Dr. Phelps raises an excellent point. It will be important to replicate these findings in other patients with bilateral amygdala damage. The patient she refers to is a single patient who still has part of her left amygdala intact. Moreover, the study she refers to only uses a single self-report measure to assess fear. Our approach with SM was to come at this question from as many angles as possible, never relying on a single questionnaire or observation. For example, if we had taken SM’s word at face value, we could have easily reached the conclusion that she is actually scared of snakes because she has been telling us for many years how much she hates snakes. It wasn’t until we placed her into an environment filled with snakes that the true manifestations of her missing amygdala were revealed as she eagerly started touching them. Future work into the experience of fear in patients with amygdala damage should aim at probing fear using a comprehensive set of measures and techniques, while also taking into account the size of the lesion, the age at which the brain damage was acquired, and the etiology of the damage. Only then will we be able to fully understand the nuances that lead to deficits in fear following amygdala damage.”

  7. CIV
    December 16, 2010

    It seems odd that she would go from saying she’s scared of snakes to eagerly picking them up and handling them. I would think that if she knows she used to be scared of them, she would somehow be able to reflect on this or take a pause before fiddling with them. The article says she doesn’t realize she is no longer afraid, but that seems very strange, especially if she knows she was afraid before but can no longer feel the fear.

  8. åse
    December 16, 2010

    Thinking about emotion, and feeling the emotion is separate things, and previously felt emotions need not be felt simply because you know about them. Perhaps an example would be to think about someon you used to be in love with a long time ago, and no longer do. In this case, there is also a bit of the brain that is mediating the felt part (not the cognitive part) that is missing.

  9. Amy
    December 16, 2010

    The paragraph that mentions that SM has “some knowledge” of her condition confuses me. It goes on to say that the team hasn’t told her they’re focusing on fear. Is it the case that nobody has clearly explained to her that she lacks a normal fear response? Shouldn’t they do so for her own safety – so that she can try to compensate by using conscious reasoning?

  10. Shecky R.
    December 16, 2010

    Wondering if she exhibits any of the social gregariousness that Williams Syndrome individuals show… other than the reduced “personal bubble” element I don’t really detect such here, but pretty clearly the amygdala is involved in both conditions.

  11. Captain Skellett
    December 16, 2010

    She wasn’t scared after watching scenes from the Ring? I’m a fearsome pirate, but that movie gave me the shakes. I’m looking over my shoulder right now to make sure creepy dripping girl child isn’t behind me.

  12. Swift Loris
    December 16, 2010

    @gregorylent, interesting point. Probably not quite so cut-and-dried; the ego-self might feel fear, but that fear wouldn’t disturb the Self aspect with which the enlightened person is identified.

  13. Beats
    December 17, 2010

    Wow that was a pretty good read. She is a woman without fear, I have heard that Waverly Hills Sanatorium gets pretty spooky around halloween.

  14. Djuke Veldhuis
    December 17, 2010

    Very nice article Ed, first time I’ve heard about this condition, but will definitely look into it more now. Mind currently whirring with thoughts on relationship with anxiety disorders etc.

  15. Jay
    December 17, 2010

    I had no idea that this was an actual condition. I feel as if I have something extremely similar to this, but I doubt I have any damage to my brain. None which any scans have ever shown, at least.. I did find the Saw movies grossly realistic, however.

  16. Betty
    December 17, 2010

    Am I the only one who has a problem with how she deals with this with her children? She may not be afraid to live in a dangerous neighborhood… But she must know what could happen to her children! She honestly sounds selfish to me.

  17. micmcn
    December 18, 2010
  18. Sciencegirl
    December 20, 2010

    well if she still capable to use reason, then her fears are under control by reason. what other functions does the amydala has in the human brain?

    well after reading some more on the subject I’ve come to the conclusion that this woman’s amydala isn’t damaged at all, the amydala has other function on the brain like vision, audio, smell just to name a few, and she is showing no damages on those other areas, at least this article isn’t mentioning damages in other areas of the emotions coming from the amydala’s part of the brain…so i am not convince that there is any damages on the amydala, and from what i understood so far there are multiple brain functions that are processed in the amydala.

  19. pconroy
    December 20, 2010

    I predict a sad ending for this woman without fear!

    My grandfather was said by my father and others who knew him to be “Completely Fearless”, and indeed as someone who worked in a senior position in Dublin Castle trying to preserve British hegemony in Ireland, he should have had much to fear. He survived multiple assassination attempts, once while driving a car by himself on a country road, when he was ambushed by a half dozen IRA men armed with rifles and shotguns, he calmly returned fire and managed to keep driving, with all wheels shot out under him, and survived completely unscathed. In his late 60’s, he would dive into the ocean and swim 3 miles against a dangerous rip tide, off the coast of Antrim, on annual vacations. But his lack of fear eventually caught up with him. As a 73 yo he faced down a rampaging bull, known to have a bad temper (“wicked” as they say in Ireland), alone and unarmed and was brutally gored to death. When my father came on the scene, the bull was kneeling on my grandfather’s chest, had crushed all his ribs and internal organs, one of his horns was lodged in my grandfather’s smashed skull, which was in two parts.

  20. Ishrat
    December 22, 2010

    I agree with Betty. How come she does not think of her children living in a drug and violence infested area? Is she lacking the feeling of love for her children too?

  21. Ed Yong
    December 22, 2010

    Ishrat and Betty are absolutely right, of course. Why hasn’t this woman simply moved to a nice posh area where nothing bad ever happens and her children could be dressed by birds every morning? What possible reason could there be for not doing so, other than financial, personal or social factors? Nothing, that’s what. Having ruled all those other reasons out, through the medium of shoving our heads up our backsides and disengaging our brains, we can safely conclude that she is a loveless automaton.

    Another triumph for logic.

  22. Beat M
    July 15, 2011

    I saw a show (Ghost Hunters maybe?) where they were at Waverly Hills Sanatorium. I couldn’t imagine running through there in the dark and not being scared.

  23. James
    October 5, 2011

    Oh, an excellent article! I have no clue how you were able to say this post..it’d take me weeks. Well worth it though, I’d suspect. Have you considered selling advertising space on your website?

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