A large part of a psychiatrist's day is spent navigating the world of
emotions, feelings, and consciousness. Yet what is actually known about these
ephemeral mental states?
Antonio Damasio, M.D.: Consciousness "can help you deal with
situations that are unpredictable."
Photos: Joan Arehart-Treichel
Arnold Modell, M.D. "Consciousness benefits not avoidance behavior
but approach behavior."
During the past two decades quite a bit has been learned about emotions,
something about feelings, yet very little about consciousness, two sessions at
a recent meeting of the American Psychoanalytic Association in New York City
One session was conducted by Antonio Damasio, M.D., a professor of
neuroscience and psychology at the University of Southern California. The
other session included Damasio and Arnold Modell, M.D., a professor of
psychiatry at Harvard Medical School.
Emotions, Damasio explained, are essentially automatic reactions to a
stimulus in the world or in one's mind. Sometimes people's brains respond with
a particular emotion because of evolution—for instance, a dark form or a
loud noise can provoke fear.
Yet other times, people learn to react emotionally. For example, one
individual may be emotionally moved by a Chopin piano concerto, whereas
another person may not. Moreover, emotions can be grouped into three
tiers—background emotions such as enthusiasm; primary emotions such as
fear, anger, and sadness; and social emotions such as compassion.
Scientists have identified specific areas of the brain that trigger
emotions, Damasio noted. The amygdala, ventromedial prefrontal cortex,
anterior cingulate cortex, anterior insula, and basal ganglia are some of the
regions that are known to be involved.
Researchers have also found out that specific brain areas are involved in
processing specific emotions. For example, the ventromedial prefrontal cortex
is involved in the manufacture of social emotions. About a dozen brain
structures are implicated in sparking fear. Also, investigators have
discovered some of the changes that occur in the brain as a result of
emotions. For instance, regardless of whether they are positive or negative,
emotions can influence attention or working memory, and while a small
emotional response can enhance attention or memory, a large response can
As for feelings, Damasio added, they are not the same as emotions, but are
rather composite perceptions about things, situations, or people. For example,
a person might say, "I'm not feeling very well today" or "I
just don't feel that that house is the right one for us." In fact, an
individual can have a feeling about an emotion he or she has experienced.
Also, "You have parts of the brain that lead to emotional states and
parts of the brain that lead to feelings about these states," and the
two may be different. A case in point: A fMRI study showed that when subjects
experienced the emotion of sadness, certain brain areas became activated, yet
when they formed a feeling about their sadness, other brain domains were
In contrast, some brain areas may be involved in processing both emotions
and feelings, Damasio suggested. Take the insula. In a recent experiment, a
skin wound was inflicted on subjects while their partners looked on. The brain
activity of both the subjects and their partners was monitored before, during,
and after the wound infliction. Results revealed that the insula in both the
subjects' and partners' brains became activated right after the wound was
inflicted. In other words, as the subjects felt pain in reaction to the wound,
their partners "felt" their pain as well—in other words,
experienced the emotion of compassion.
Also, feelings have both a mental and physical component, Damasio pointed
out. For example, during combat and while in a great state of fear, a soldier
can become wounded, yet not feel any pain. "We have this way of fooling
ourselves about the body," Damasio said.
Finally, when it comes to consciousness, which Webster's New Collegiate
Dictionary defines as "the quality or state of being aware,
especially of something within oneself," a few glimmerings of knowledge
been obtained. For example,"emotions and feelings are obligate presences
in consciousness," Damasio declared. "I think I am on solid ground
in saying that." Nonetheless, a vast number of questions about
consciousness still lack answers.
For instance, what is the evolutionary value of consciousness? No one is
sure, but Damasio speculates that one of its values is that "it can help
you deal with situations that are unpredictable," and one way by which
it can do so is by "allowing you to manipulate images in a process of
thought." Yet another value of consciousness, Modell believes, is that
it benefits "approach behavior." In other words, he explained,
people can engage in avoidance behaviors without being conscious of it, yet
they need consciousness to engage in approach behaviors—say, selecting a
Are patients in a coma conscious? No one knows, but Damasio thinks not.
Consciousness, he explained, includes not only brain activity but a sense of
self. So even though stimulation can activate parts of the brain of comatose
patients, they probably do not have a sense of self.
When people talk in their sleep, are they conscious? Probably to some
degree, Damasio speculated, because consciousness seems to be necessary for
speaking. And the same holds for sleepwalking, he reasoned. "But I'm not
sure," he confessed. "All I know about consciousness and
sleepwalking comes from Lady MacBeth."
And how about people who assume more than one personality? Do they have
more than one consciousness? Damasio believes not because he has never heard
of anyone simultaneously engaging in multiple personalities. Yet an analyst in
the audience challenged his conclusion: "I have worked with patients who
have exhibited more than one personality at one time." ▪