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Overturning assumptions about the neural location of fear in humans, University of Iowa neuroscientists successfully frightened the previously “fearless” Patient S.M. in 2013. Examining this Iowa study on fear as a productive problem for both neuroscience reporting and studies of affect in the humanities, this article asks how narratives of fear travel to implicate our understanding of contemporary scholarship in the humanities and sciences. It questions the ways in which scientific case studies themselves, alongside popular scientific and philosophical appropriations of scientific material, are determined by affective responses formed in relation to narrative.

In the spring of 2013, a group of researchers at the University of Iowa enthusiastically reported fear.1 Their joy stemmed from the unexpected occurrence of fear in a research subject whom they had been trying to scare for over two decades, someone they had believed was constitutionally fearless. The group, led by Justin Feinstein, upended decades of conviction about the amygdala, a part of the brain thought essential to the affective formula for humans experiencing fear and panic.

A typical human has two amygdalae, relatively small groups of clustered neurons deep within each of one’s temporal lobes. Suspicions about what operations the amygdalae perform or mediate are widespread, and thus the research questions they present for neuroscientists [End Page 377] are legion.2 The amygdalae studied in Iowa City for the past decades by, for instance, John Wemmie, Daniel Tranel, and Antonio Damasio, appeared to substantiate the claim that an absence of amygdalae creates an absence of fear.3 The 2013 report, however, overturns this rule.

At the center of the Iowa team’s 2013 report is Patient S.M. (also known as SM-046), who has neither of her amygdalae. The 49-year-old mother of three has been the subject of neurological, neuroscientific, psychological, and experimental focus at the University of Iowa in some way since 1986 when she was twenty years old.4 She is diagnosed with Urbach-Wiethe, a genetic orphan disease with varied dermatological and/or neurological symptoms. In this instance, both of Patient S.M.’s amygdalae calcified, hardened, and eventually became lesions in her brain by the time she had finished her teens. Back in 1995, for example, Damasio, Tranel, and others at Iowa continued to reaffirm that “SM-046 does not experience fear in a normal way, as we have found no convincing evidence that she feels frightened given the appropriate stimulus, and … she fails to exhibit the full range of psychophysiological responses to fear.”5 As recently as 2011, Justin Feinstein and colleagues subjected Patient S.M. to several affect-loaded environments: “an exotic pet store with snakes and spiders, walking through a haunted house, and watching film clips [End Page 378] of scary movies.”6 Predictably, she experienced no fear. And while “nearly a century ago, it was discovered that CO2 inhalation can trigger panic attacks,” this possibility had never been tested on individuals with amygdala lesions.7 So, in the 2013 lab experiment, the Iowa team exposed Patient S.M. to 35% carbon dioxide gas, which, according to the report, “evoked” observable fear and panic.8 What I wish to do in this article is to question the ways in which scientific case studies themselves, alongside popular scientific and philosophical appropriations of scientific material, are determined by affective responses formed in relation to narrative.

I first follow the text of the Feinstein team’s 2013 report and consider the conventions of genre that frame it. The second section looks at the consequences of a narrative analysis of science writing for studies of affect theory in the humanities. This leads me, in the third section, to contemplate the history of patient-characters in scientific case studies as a practice of writing that enfolds cultural parables. Finally, I return to one famous neuroscientific case study in order to hear an echo of Patient S.M. and to demonstrate how narratives constructed around patient-characters determine both scientific agendas and conclusions, as well as their recirculation in critical-theoretical analyses in affect theory today.

Situated Sensations

Feinstein and the Iowa team were greatly surprised by the experiment and its results, but a casual reader might fail to sense this from the report eventually published in Nature Neuroscience. Entitled “Fear and Panic in Humans with Bilateral Amygdala Damage,” the 2013 report ostensibly observes just that, and overturns the “amygdala as essential for fear” precedent. But something was flattened between the Iowa team’s reporting and its final publication. In the author manuscript, publicly accessible in the National Institutes of Health archive, the affective experience of the experiment on the scientists themselves is still audible, but it is silenced in the published edition.

In fact, the author manuscript shares with readers how Patient S.M.’s fearful reaction to the carbon dioxide caused the authors to become so “surprised by this result” that they only then went on to test the setup on two other subjects with bilateral amygdala damage (monozygotic twin sisters). The final publication reports only [End Page 379] that—in response to S.M.’s reaction—the authors wished to “further explore this issue,” as if it were already an element of the experiment’s design. Initially, the experiment’s affective incitement led the authors to characterize the laboratory situation by way of its “surprisingly” abrupt reversal of their steadfast hypothesis in the abstract of the report, but that sensation is simply stricken from the final abstract. “Even more strikingly, CO2 triggered a panic attack in all three amygdala-lesion patients,” write the authors when originally describing their core results. The Nature Neuroscience editors, however, replace that dependent clause with the more affectively depleted and austere “notably.”9 Had the original manuscript been allowed to stand, a reader might have been alerted to the affected sensitivities and proclivities of the researchers themselves as they attempted to reconcile what they had witnessed in the experiment with the narrative fashion and expectations of a larger public.

Considering this, I get the feeling that there were many different emotions and intensities in effect for all the players involved before, during, and after the experiment: anxiety, surprise, elation, fear, concern, distress, and accomplishment, among others. On the one hand, the scientific rigor, historical interest, and personal connection between the Iowa researchers and Patient S.M., if nothing else, testify to the powerful role that emotion plays in practices of inquiry in various disciplines. On the other hand, the report satisfies the previously open conclusion of the lengthy tale of Patient S.M., and provides her ideal foil: while she is not scared by the exterior, affective world of snakes and spiders and scary movies, a gaseous cocktail inhaled in the “safe” space of a laboratory finally disarms her steeliness.

What’s most intriguing to me in this scenario is not that the Iowa team’s practices of science for the past twenty years were necessarily “wrong,” but that their declaratory tales about the brain’s mechanics of fear turned out to be so. Now, in retrospect, their publications represent not a progression of facts culminating in a veridical outcome, but an ensemble of misreadings of the brain and of fear. This rerouting of affect matters. In the most recent narrative, S.M.’s story arc—her seemingly non- or extra-human fearlessness thwarted—legitimizes the Iowa group’s neuroscientific work by penning a narrative resolution fit for widespread interest in media outlets such as the Guardian, [End Page 380] the New York Times, NPR, and Time magazine.10 One effect of negotiating all of the emotions and intensities involved is that it compels writers—scientists, journalists, and academics alike—to forage for a genre that situates S.M. within the sensibilities of our contemporary moment. Different communities make sense of the experiment in various ways. The Iowa scientists, surprised by the need to exchange their paradigm of neural fear circuitry, reshape the arc of S.M.’s story as a historical misplacement, and write the report as a redemptive clerical gesture—she now belongs here, not there, with these understandings of fear and not those. Other media, coping with reporting the ambiguous character S.M., frame the Iowa laboratory as a space of relief, of neuroscientific resolution and clarification and of overcoming struggle.

“All genres are affective conventions that allow readers to expect to feel held by a world, even for a moment,” imparts Lauren Berlant.11 I propose that reading the 2013 Iowa report in conversation with the concept of neuronarrative12 invites a productive analysis of genre studies as well as of the place and role of science in theorizations of affect. Amplifying the affective conventions “being absorbed and enjoyed” exposes the “implied affective and code-sharing” narrative worlds suggested by a publication such as a scientific report.13 A reading of the Iowa team’s report allows one to hear the narrative in the neuroscientific reporting, an approach that disturbs the sense that the brain can only be announced, known, and heard in the technologized and biologized vernacular of science. It exposes the role of the scientist as storyteller, bringing its narrators within earshot of neuronarratives (or the “auditory grasp” of those mobilities and [End Page 381] engendered effects of which Derrida speaks in “The Law of Genre”).14 While the use of the term “neuronarrative” might describe a type of storytelling that advantages neurobiology when explaining setting, action, plot, or characters, that limited use misses the genus of writing in which neurobiology itself becomes characterized: laboratory write-ups that depend upon the use of patients as emotive characters that orient neuroscience explanations. Here, the patient S.M. intertwines with the narrative quest to solve the riddle of the Iowa team’s main character S.M.; this entanglement determines the science that scientists translate into publications. As I analyze later, the history of using stories of patient-characters frames the very roles patients play in writing science.

Thus, while one might protest that the report is not, on its face, embraced within the possible genre of neuronarrative, for that exact reason it partakes in it: “a sort of participation without belonging,” interjects Derrida.15 It makes use of the genre for explanatory purchase. Indeed, the report does important cultural work, not just biologically but also narratively: first, it allows an established (physiological and discursive) neural network to dissolve by un-thinking particular assumptions of cognitive connections and patterns (the amygdala is no longer imaginable as the gateway of fear), and second, it re-envisages Patient S.M. to articulate a tale different from an allegory of fearlessness (the “inhaled CO2 activated a pathway that had remained mostly dormant up until the point of the experiment,” hint Feinstein et al.16). Listening for the affects convened, recruited, and satisfied in the report throws up questions about the ways in which narrative conventions and affective conventions provide a horizon for the limits of neuroscientific investigation. The intervention I propose in this article, therefore, is not about case studies as pedagogy per se, but about the role of the case who—not that—the Iowa team both study and story.

“She is not emotionless, but rather fearless”

The takeaway lesson for the Iowa team in the 2013 report is that “Contrary to our hypothesis, and adding an important clarification to the widely held belief that the amygdala is essential for fear, these results indicate that the amygdala is not required for fear and panic [End Page 382] evoked by CO2 inhalation.”17 The experiment seems to expose a way to outsmart a particular ideological pathology. For neuroscientists in general, the results problematize claims of a localizable fear mechanism in the brain. That is, they question the idea that fear could have a universal cranial postcode. With regard to the affects involved, neuroscientist Joseph LeDoux takes umbrage at the Feinstein team’s interchangeable use of the term “fear” “to describe both feelings and brain/bodily responses elicited by threats.”18 For LeDoux, this move represents an uncritical interpretation and deployment of the concept of fear, because the “language implies that the defense mechanisms go hand in hand with the feeling of fear.”19

This particular dispute—whether or not circulating affects register through conscious awareness or unconscious reflex (or, in Feinstein’s language, those “afferent sensory pathways that project” onto areas of the brain20)—plays into the familiar debates on intentionality that both Ruth Leys and Grant Bollmer, for instance, identify in their exposés of affect studies in the humanities. Leys, professor at Johns Hopkins University and author of Trauma: A Genealogy, publishes extensively on the appeal and study of affect in the humanities and the sciences, and is critical of the urge (coming particularly from Brian Massumi and William Connolly) to naturalize politics and culture by linking them to the materialisms of the (neuro)sciences. For Leys, “what fundamentally binds the new affect theorists and the neuroscientists is their shared anti-intentionalism,” which is “the belief that affect is independent of signification and meaning” and therefore renders affect “a matter of autonomic responses that are held to occur below the threshold of consciousness and cognition and to be rooted in the body.”21 She observes a false binary between mind and matter in this ideology, which insists that “the way to understand fear or joy is that they are ‘triggered’ by various objects, but the latter are nothing more than tripwires for an in-built behavioral-psychological [End Page 383] response.”22 Neurobiology, in the accounts she criticizes, operates beyond and prior to consciousness and the realm of discourse.

Grant Bollmer examines the historical and cultural production of affective and nonaffective bodies as part of his larger interest in networks and power at the intersection of biology and technology. Bollmer also scratches his head at affect theorists in the humanities who, for him, seem to evacuate any hermeneutic or phenomenological political possibility from the political project of cultural studies when they embrace anti-intentional ontologies of affect.23 Taking into account Leys’s critique, Bollmer proposes that affect “may have intentional or non-intentional aspects; it may be articulated to systems of signification or it may not.”24 He observes: “Affect, in the neuropsychological form appropriated by affect theory, is mobilized not to celebrate some wild free potentiality of the body. Affect is invoked to make the body speak in a way that interpretation and language matter not and materiality—as revealed through medical imaging technologies—yields truth.”25 One antidote for the project of what to do with theorizations of affect and theorizations of neurobiology, for Bollmer, is to read those mobilizations and invocations: to understand “how affect is employed” to unite or divide bodies, materials, or discourses “without assuming material, biological force of ‘relation’” that miraculously appears from nature.26

Biological pathology is another dispute in affect studies with which the Iowa team’s report engages. The team’s protracted interest in the link between amygdalae and fear has to do with “S.M.’s abnormality.”27 That is, for Feinstein et al., S.M. is brain-damaged, and experiences a deficit of fear where fear ought typically to occur. She is a “unique case” of brain disorder,28 “immersed in a secure Pollyanna world.”29 But these normative portrayals instill within me an unease about the ways in which patient-characters in affect theory are pathologized into character types. From Parkinson’s sufferers [End Page 384] to schizophrenics, autistics, epileptics—and here, the fearless (via a degenerative brain disorder such as Urbach-Wiethe)—French theorist Catherine Malabou “claims that the uniting feature of all of these conditions is an absence of affect, ‘an emotional deficit’, that emerges from the neurocognitive materiality of the brain.”30 Malabou brings questions of phenomenology and materialism, through the lens of neuroplasticity, to the study of affect. For Malabou, “brain damage” always “interrupts the economy of our affects.”31 The brain lesions result in “the formation of ‘someone else,’ a new self, a self that is not able to recognize itself,” since the accident “erases any trace and every memory, and that destroys any archive.”32 “Such a subjectivity,” she adds, “is absent to itself and to its essence as well as to its accidents—a subjectivity without affects.”33 Yet, “To say that SM is emotionless or unable to feel emotion is simply false,” the Iowa team pre-empt.34 “She is not emotionless, but merely fearless,” nuances neurobiologist Dario Dieguez.35 Thus we may ask what is to be done about how, on the one hand, Bollmer calls out Malabou’s ordering of S.M. as an affectless case within her genre of “the new wounded,” and how, on the other hand, S.M. persists in being affective and affected by ambiguous understandings of those concepts (and since 2013 with fear as well, it would seem).36 Neither version is truly appealing to me, for both co-opt the productive problem of affect as ammunition for disciplinary turf wars. I am not interested in offering a neurological methodology or an ontology of affect; rather, I invite a theorization of narrative to determine the ways in which cultural objects productively problematize rather than illustrate those existing ideological frameworks.

The seductiveness for cultural critics of affect studies, I fear, lies in the fact that an object like the Feinstein study is recruited in the service of a wider ontological argument. Constantina Papoulias and Felicity Callard, for instance, investigate the recently fashionable [End Page 385] interest in affect in the humanities. They discover that “the turn to affect in cultural theory” is “accompanied by a dependency on particular citations from neuroscientific and developmental psychology literature.”37 In fact, just as Leys points to Eve Sedgewick, Papoulias and Callard find work that imports neuroscience into ontologies of affect as “emblematic” in current affect studies and “indicative of an increasingly common position taken by cultural and social theorists.”38 What I wish to avert is the positioning of the Feinstein study as exemplary or emblematic of a particular theoretical argument, to risk flattening the object into “just an example” of a grander theory or theorization rather than reading the study as an object on its own terms. This point of departure more closely aligns with an investigation into how, within “cultural theory’s narratives, by contrast, affectivity becomes a placeholder for the inherent dynamism and mutability of matter,” as Papoulias and Callard observe.39

On its face, the Feinstein study exposes a previous ignorance. But it also describes how it is possible to expose someone to fear and panic. That is, even if one naïvely understands carbon dioxide as affective—that it is literally in the air—then one can think about the circulation of affects as a type of exposure. Exposure, in this case, defines how the version of fear offered functions, and this is achieved through narrative exposition particular to the literacies required for its readability.

Mieke Bal suggests that “the triple meaning of the verb ‘to expose’ [exposition, exposé, exposure] constitutes the field of cultural analysis because it defines cultural behavior if not ‘culture’ as such.”40 The verb refers to “the action of ‘making a public presentation,” where the exposure involved “is an act of producing meaning.”41 Exposure acquires intelligibility, therefore, in exposition, in the public telling and sharing and reproduction of ideas. Jonathan Culler contextualizes this practice in describing how “stories … are the main way we make sense of things, whether in thinking of our lives as a progression leading somewhere or in telling ourselves what is happening in [End Page 386] the world.”42 Extending this departure, Giorgio Agamben includes writing and technologies of storytelling as Foucauldian apparatuses connected with power, those things that have “in some way the capacity to capture, orient, determine, intercept, model, control, or secure the gestures, behaviors, disciplines, judicial measures, and so forth” in cultural negotiations.43

Therefore, I approach the 2013 Feinstein report on its own terms, as my interlocutor in a conversation about fear and affect, before interpreting its implications for the neuroscience of fear and affect studies. This nexus of narrativity, power, and articulation ushered through exposure cues my analysis of the peculiar narrative politics densely texturing the object. Here I want to press the point that a neuroscientific explanation engages the logic of storytelling: to understand fear and its operations is to grasp a narrative showing how one affect leads to another, and how one affect can overcome something else to produce a similar exposure (i.e., activating “a pathway that had remained mostly dormant up until the point of the experiment”44). The concept of fear is at play in the Feinstein study, and the plot of fear is what narratives shape.

In the next section, I look at the ways in which the Iowa team’s textual crafting of Patient S.M. quotes character-based case studies from medical literature within a history of ideas. The concluding section argues that the specific citations embedded in the report are freighted with a politics of storycraft, which exposes the narrative entanglements performed by cultural critics of affect studies as well as by neuroscience researchers.

Quoting Cultural Anxieties

First, a little neurobiological storytelling. Just outside Cavendish, Vermont, in the summer of 1848, a man named Phineas Gage was preparing a road bed for the Rutland and Burlington Railroad by placing explosive powder into holes drilled into rock. Gage used a tamping iron to pack the explosives, and late one afternoon an accidental explosion blew the roughly 31/2-feet (1 meter)-long iron completely through his head. It entered through his face under the left cheekbone, exited the top of his skull, and landed some 80 feet (25 meters) [End Page 387] behind him.45 Gage survived that day, and continued to live for almost a dozen years before dying of epilepsy in San Francisco.

The accident obviously left a severe lesion in Gage’s brain. Psychological changes are reported to have occurred as a result. Some twenty years after the accident, John Harlow, the physician who treated him in Cavendish, wrote that Gage’s “mind was radically changed, so decidedly that his friends and acquaintances said he was ‘no longer Gage.’”46 In concourse with a progressive history of neuroscience,47 interest in Patient S.M. was part of an interest in studying a damaged (or deceased) brain for insights into how the healthy brain functions. Gage’s situation became popular for didactic purposes. Thus, in his afterlife, Phineas Gage enjoys a long history of appropriation, serving as the protagonist of a morality tale of alcoholism, associated with yarns about a carnival freak show, contained in medical illustrations, featured as an anthropological object tutorial, and utilized as a union worker story, to name just a few examples. In 2000, Malcolm Macmillan took up the uses and abuses of Phineas Gage stories as an object of cultural study in its own right. He found that Gage “appears in nearly sixty percent of the introductory textbooks of psychology” published between 1983 and 1998.48 These publications, however, do not all recount the same story; each appearance becomes an instance of cultural (and scientific) memory for a particular present to carry a particular message. Science resources the patient-character Gage as needed to warrant and texture wildly varying conclusions, and figures of Gage therefore operate from a reservoir of imaginative explanations.

Second, consider similar reverberations of literary influence in scientific agenda-setting. In 2012, Rodrigo Quian Quiroga, a neuroscience researcher and reader in bioengineering at the University of Leicester, published Borges and Memory, a reflexive text that chronicles how the work of twentieth-century Argentinian writer Jorge Louis Borges explicitly motivated Quiroga’s scientific agenda, investigations, [End Page 388] and conclusions about the brain.49 “I discovered Borges as a teenager and was fascinated by the mathematical precision with which he describes what defies every logic,” writes Quiroga. “I rediscovered a story of his, ‘Funes the Memorious,’ … which with astonishing clarity ended up sorting the pieces of the [research] puzzle I had been working on.”50 Quiroga cautions that he is “not trying to force a link or suggest that Borges foresaw modern neuroscience,” but admits that “Borges is perhaps the catalyst that persuaded me to tell a story” about “Funes’s roots and his relation to the principles of neuroscience.”51

In this way, narratives—and adolescent stories explaining later interests—frame disparate elements and stray observations of scientific subjects, as well as give rise to the questions by which one approaches one’s scientific pursuits. Narrative fiction operates as a conversational partner for neuroscience: “Borges gave me a muchneeded chance to take a pause and to think in depth and debate (in my mind) with Descartes, Bishop Berkeley, and [William] James,” writes Quiroga; “How misguided we scientists are when we think we are the first to deal with the big questions!”52 Quiroga emphasizes the conversational, affective space that fiction provides for his neuroscientific analysis when he describes how “having these imaginary discussions with Borges and following his thoughts and his readings gave me the break I had long needed to step aside for a while and see things in perspective.”53 Here narrative fiction and narrative characters serve to anchor, unclutter, and tidy disparate science.

Third, consider the intertextual and cultural influences of patientcharacters. In the March 2011 Harper’s magazine “Readings” section (which regularly features a diverse collection of reprints of interesting documents and artworks), three paragraphs from Feinstein et al.’s 2011 Current Biology report (describing a field trip S.M. took with Feinstein to a haunted house as part of the snakes and spiders episode) appear under the heading “The Woman Who Felt No Fear.” The verbatim reappearance of the report in a literary frame exposes a neuronarrative architecture entangled with the curious and storied [End Page 389] life of this patient-character. Even Quiroga (like the writers and scientists who use Gage), in his pausing to rethink neuroscience through Borges’s fictional character Funes, cannot help but tap the reservoir of other neuroscientific characters in order to share his research and make it audible to contemporary ears. Quiroga recalls how, in 1953, neurosurgeon William Scoville removed both the right and the left hippocampi from the brain of Henry Molaison, a severely epileptic 27-year-old. “The surgery, which indeed managed to stop his seizures,” details Quiroga, “radically changed the history of neuroscience and our knowledge of memory, but unfortunately transformed Henry Molaison into Patient H.M. forever.”54 Scoville’s procedure left Molaison with a bilateral hippocampal lesion, and therefore “H.M. was incapable of forming new memories, a condition known as anteretrograde amnesia.”55 He could remember things and events from before the surgery, but was unable to generate new memories, like the meaning of new words, or his new postal address after moving house, or that he had just eaten lunch. Patient H.M. became a hit with researchers of all types, and the several hundred articles relating to studies of him—which, like those of the Iowa team working with S.M., were mainly conducted by a few key people—are widely cited and circulated today.56

I recount the three nested stories above to call attention to their significance for the crafting of our contemporary neurobiological and affective narratives. Like Phineas Gage and Patient H.M., Patient S.M. stars in contemporary scientific pedagogy. As with her medicalhistorical male counterparts, there are similar appropriations of her story and studies about her in an effort to ascertain, deal with, and manage contemporary problems. Several recent 101-level psychology textbooks employ her as a character device to witness evidence of the amygdala’s role in emotion.57 I will volunteer one instance to demonstrate the conclusion I take from such usage. In one book, the story of Patient S.M. appears in a pull-quote bubble entitled “Neuroscience Applies to Your World: Is Fear Good For Us?.” The excerpt [End Page 390] teaches students how “On the surface, you might think that living a fear-free life might be great, but a closer look at S.M. shows the darker side of fearlessness.”58 The bubble story goes on to briefly report how, one evening, Patient S.M. remained unbothered while being held up at knifepoint in an Iowa parking lot. In light of the legend here shared, I have to smirk, recalling Herman Melville’s Starbuck aboard the Pequod when he implies to the crew that “an utterly fearless man is a far more dangerous comrade than a coward.”59 Melville’s narrator Ishmael positions a lack of respect for the White Whale—for what is dangerous—as nothing short of foolish. The psychology textbook would seem to enable and sustain that politics of foolishness. While I pause at a tale here about the consequences of having superhuman abilities, what is interesting is that the 2011 Feinstein study—the one with snakes and scary films—reported this attempted knifing episode as an anecdotal aside. The Iowa team were certainly not present collecting data when this happened to Patient S.M., but they felt that this self-reported memoir was significant enough to further evidence their findings about the amygdala.

As it happens, the authors—that is, the “we” who narrate the 2013 Feinstein report—internally focalize the story’s action by way of observing “self-reported levels of fear and panic,” “anecdotal accounts,” and what “the patients reported.”60 Although the report’s story strives to incorporate three biomarkers (respiratory rate, heart rate, and skin conductance), the supplemental denouement describing the study’s methods notes that most of the biomarker data for S.M. and the other two amygdala-damaged subjects were unrecordable or corrupted, and that the researchers in fact went to great lengths to inductively include publishable graphs and charts. The researchers themselves chronicle the climactic moment—Patient S.M.’s response to the CO2—as “gasping for air, [showing] distressed facial expressions,” and displaying “escape behavior (for example, ripping off the inhalation mask).”61 In other words, what provides the 2013 report’s thrust is not a matter-of-fact summarizing of data, but a first-hand account of the “feelings induced by the CO2,” the “emotional changes” experienced, and the reactions S.M. expressed [End Page 391] in that laboratory room in Iowa City.62 Here, only narration exposes fear; it is in such stories that the fearful, panicky events can ultimately be exposed.

While S.M. may indeed be an exceptional person, the inscription of the exceptional person is a tradition in science that both precedes and determines the conditions of her narrative. The argument here is that the quotation of character sketches, whether through Phineas Gage, Patient H.M., or Patient S.M., enfolds and condenses cultural parables. The 2013 Feinstein article is an exposé of the amygdala, but it is more than that: it embodies a crafting of medical pedagogy, patient-characters, psychology fashion, thriller anecdotes, and journalism in its inscription. That is, in declining affect as a stable, independent, and quantifiable variable, hearing the narrativity involved exhibits an arc of affectivity that interrupts, shapes, and instigates scientific inquiry. As Bollmer observes, “If we start from the position of history, refusing to accept affect as an eternal, transcendent guide for cultural politics, we can observe that there are categories produced by psychology, with reference to the brain, made visible with medical imaging technologies, which serve to marginalize and exclude specific bodies from humanity.”63 What is exposed in this regard is that “specific bodies are placed into apparatuses”—narrative apparatuses in the register of Agamben, I argue—that inscribe “contingently produced ways of dividing and shaping possibilities for bodies and political agency.”64 Political formulations are organized through affect, in relationships that have more to do with feelings, anxieties, and desires than with the autonomous, impartial rational thought often coded and read as a “scientific report.”

The Laboratory as Literary Space

In this final section, I want to promote Malcolm Macmillan’s study of Phineas Gage as a way to return to scholarship on affect by thinking about the scene, or event, of affective relationality as fractured and multiply temporal.

While a few primary documents exist concerning the Gage case, “the only picture of Gage that we have” comes from the reports of John Harlow, the physician who treated Gage in Cavendish, and Henry Bigelow, a Harvard professor and surgeon who reported the case.65 To Macmillan’s dismay, “much of what is contained” in the [End Page 392] contemporary textbooks featuring Gage “is strikingly at variance with” the few extant primary documents.66 Among the five dozen or so books Macmillan examines, he reserves space in several places for an analysis of Antonio Damasio’s Descartes’ Error: Emotion, Reason, and the Human Brain (1994). Here it ought to be noted that until 2005, Damasio was professor and head of neurology at the University of Iowa and co-authored many of the publications on Patient S.M. during that time. Macmillan cites Damasio’s book as one of several dozen “erroneous accounts” of Gage that demonstrate “an ignorance of what … our primary sources say about circumstances of the accident.”67

First, Macmillan observes that “The Gage of fable” narrated by Damasio has it “that [Gage] ‘never returned to a fully independent existence,’” whereas no evidence exists to warrant that assertion.68 In fact, Gage went on to work as a stagecoach driver in Chile for seven years, during which time “he [and his mental faculties] would have had to adapt to the challenges of the routes travelled while at the same time dealing politely with passengers’ demands.”69 Macmillan adds, “It seems unlikely that a Phineas still disinhibited by his accident would have qualified.”70

Second, Damasio distorts Gage’s post-accident engagement with friends and family to the point that “as A. R. Damasio has it,” writes Macmillan, “Gage virtually became a psychopathic personality who lied and could not be trusted to honour his commitments.”71 This is at odds with Harlow’s report in 1868 that describes how Gage “was accustomed to entertain his little nephews and nieces with the most fabulous recitals of his wonderful feats,” and another report of Gage performing various kinds of farm work up until the day he collapsed.72

Third, Gage’s “supposed … lack of concern for matters he had formerly cared about. … and his showing little emotion, losing his former values, and becoming unreliable in his personal habits,” Macmillan writes, “almost certainly seep in” as characteristics “from the [End Page 393] brain surgery and psychosurgery literature” of the twentieth century.73 Here Macmillan exposes a discursive feedback whereby scientific investigations reported and written about in the 1930s and 1960s became anachronistically rewritten into Gage’s nineteenthcentury circumstances, and, in the present, now become the source material for further narratives in neuroscience.

Lastly, Damasio’s retelling of Gage as a “degenerated character” with an affective deficit is an ideological commitment he himself makes clear in his book’s agenda.74 His “message” in Gage’s case is “that observing social convention, behaving ethically, and making decisions advantageous to one’s survival and progress require knowledge of rules and strategies and the integrity of specific brain systems.”75 Grant Bollmer identifies this rhetoric as one that recuperates vitalism in studies of affect. The discourse frames individuals as their neurobiology—the killer, the addict, the deviant, the wounded—through which normality is maintained in its difference. Here, parables of lessons learned help neural lesions to supplant psychology when ordering humans.

Thus framed, Gage is utterly contemporary and conversational with S.M. Indeed, Damasio himself explicitly connects the affective deficiencies of Patient S.M. and Phineas Gage in Descartes’ Error. He introduces S.M. not by her pseudonym, but as “a woman with a lifelong pattern of personal and social inadequacy” who “has little concern for the problematic situations into which she gets herself.”76 “The ‘folly’ of her behavior,” writes Damasio, “is not unlike that found in Phineas Gage” and “cannot be blamed on poor education or low intelligence.”77 When one takes into consideration the corollary write-ups of Patient S.M., which describe her as one whose “social behavior remains relatively intact … is married, raising children and is able to hold down a job … [and] is able to carry out a fairly normal social life … [without] any impairment in reciprocal social interaction,”78 Damasio’s caricature seems not just more fabulous, but entirely devoted to shoehorning S.M. into his own favored diagnostic [End Page 394] pattern, where broken brains equal broken affects; in this case, a broken amygdala translates to a broken or missing fear response. The thicket of stories that both give occasion to a patient-character like S.M. and that specifically capture, regulate, and orient Patient S.M. in the literature exposes the narrative’s layered operations that guide its reading.

Writing in 2013, Malabou, when inquiring into the destructive work of neural and psychic disconnection, invokes “the famous case of Phineas Gage, which is related by Damasio in Descartes’ Error.”79 The event of the accident is “purely contingent, external, and totally unanticipated” in her reading of Damasio’s version of Gage, and “cannot be assimilated or interiorized by the psyche or by the brain”; somewhat predictably, given Malabou’s derivative source, the cerebral event “is not a partial modification but a complete metamorphosis of the personality.”80 As noted earlier, the lesson Malabou takes from Damasio’s parable of Gage is that “brain damage” always “interrupts the economy of our affects.”81 To buttress her interpretation of Damasio’s story, and to nourish her conclusion that “All the cases of brain damage Damasio exposes are cases of absent subjectivity. … a subjectivity without affects,”82 she flips back to “Descartes’ Error, in chapter 3, ‘A Modern Phineas Gage.’ This modern Phineas Gage is named Elliot.”83 The story—or Malabou’s story of Damasio’s story—is that Elliot had a brain tumor removed and therefore “‘Elliot was no longer Elliot,’” according to Damasio-via-Malabou. The intertextual reference to Harlow’s phrasing that “Gage was no longer Gage” is not innocuous. It demonstrates a contiguity of narratives that converge on an ability to recruit medical characters in the service of narrating coherent ontologies of the affective subject, and to support the ideology that “the ‘absence’ of affect is assumed to indicate a reduced capacity of the body to experience a natural, vital force essential for the lived embodiment of the biological organism.”84

I underscore Damasio’s work in this paper not for purposes of culpability, but to complicate a story about fear from Iowa City that, on its face, would seem coherent and whole. Damasio’s writing, as a direct result of the extended experiments he and his colleagues at [End Page 395] the University of Iowa perform on Patient S.M., speaks to the way power becomes focalized through narrative characters in multiple frames of reference at various times. From this perspective, the 2013 Feinstein report can be read not as an instance or an example of the neuronarrative genre but as a use of it: an allusion to the conventions that form it. Among the questions this reading forces me to ask is how a text generates a much larger structure of meaning that is not contained or constrained by what the text explicitly says. Stories—here, the affective ones in science—depend on other stories for coherence and intelligibility, and therefore determine affective responses formed in relation to narrative. Further, when Emily Martin appraises the motivation and potential resourcefulness of affect studies in the humanities via neurobiology, she proposes that

the affect/intentionality system is a set of arrangements by which a society transforms neurological processes into products of human activity. Affects are a social effect rather than the result of human biology. Intentions in this regard are conceived as the remainder—the material brain and those neurological interactions that are necessary to reproduce it. Looked at this way, what we see as the affects are the product of a social process that has separated them from larger contexts rather than a new entity we have discovered in nature.85

Here she suggests a resonance of practices between the neuroscientific laboratory and critical theory in the humanities, and a possible antidote to both analytics’ moving away from the social, culture textures that prompt inquiry in each. That affects are better understood as a “product of social processes” that include narrative demonstrates how questions through the frame of neuronarrative make audible a concern for what kind of world is summoned into being through intertextual affective scientific writing.

Felicity Callard and Constantina Papoulias are thrilled to point out that humanities scholars such as William Connolly, Andrew Ross, Nigel Thrift, Eric Shouse, and Elizabeth Wilson all cite Antonio Damasio to buttress their own theorizations of affect.86 The stakes, as they see it, are that the humanities write their stories of affect by quoting the neurosciences. As I demonstrate, however, the trafficking of ideas—and characters—is a bit more complex, involving the politics of history, a history of political and social anxieties over what it means to feel human, as well as how best to express that feeling. Excavating the exposition published by Feinstein and his [End Page 396] colleagues in 2013 demonstrates that even neuroscience’s authority struggles to account for the arc of its own narrator. Here what is seen and described as fear in Feinstein’s report turns out to be a caricature of fear that only arrives by traveling through anatomical expectations, the literary laboratory, mediated medical recollections, thriller scenarios, and anecdotal scientific observations. Thus my reading of the positioning of affect in that report shows that the neurosciences and the humanities invite and decline certain narratives in order to structure the very research agendas and questions pursued. It exposes the powerful work that certain available narrative plots do in various practices of inquiry on their quests for capturing, understanding, and theorizing affects.

This entanglement demonstrates how the report implicates an understanding of our contemporary through a history of the present. I underscore the anxieties—dare I say, “fears”—over how certain accounts of affect participate in culture: as fable, as evidence, as intellectual capital, as characterization, as discipline, and as ideological duties that narratively prompt both theorizations and experimental accounts of affect. [End Page 397]

Timothy Yaczo
University of Amsterdam
Timothy Yaczo

Timothy Yaczo is a doctoral fellow and lecturer at the Amsterdam School for Cultural Analysis. His current project, entitled “Brains With Character,” tracks the reciprocal and catalytic relationships between neuroscience and literary media. He studied at Miami University and Queen Mary University of London, before coming to the University of Amsterdam in 2008.


1. Justin S. Feinstein et al., “Fear and Panic in Humans with Bilateral Amygdala Damage,” Nature Neuroscience 16:3 (2013): 270–272.

2. The amygdalae are recruited to project various explanations for human behavior. In addition to studies associating one or both of the amygdalae with emotions, fear, anxiety, or panic, R. J. R. Blair links a compromised amygdala function with psychopathy: “The Amygdala and Ventromedial Prefrontal Cortex: Functional Contributions and Dysfunction in Psychopathy,” Philosophical Transactions of the Royal Society B 363:1503 (2008): 2557–2565, esp. p. 2557. Dick Swaab believes volumetry and functional amygdala connectivity correlates with sexual orientation: “Sexual Orientation and Its Basis in Brain Structure and Function,” Proceedings of the National Academy of Sciences of the United States of America 105:30 (2008): 10273–10274. And Kevin Bickart et al. maintain that amygdala volume “correlates with the size and complexity of social networks in adult humans”: “Amygdala Volume and Social Network Size in Humans,” Nature Neuroscience 14:2 (2011): 163–164, quote on p. 163.

3. A smaller Iowa team in 2011, also with Feinstein as the lead author, reported that “the human amygdala plays a pivotal role in triggering a state of fear and that the absence of such a state precludes the experience of fear itself”; see Justin S. Feinstein et al., “The Human Amygdala and the Induction and Experience of Fear,” Current Biology 21 (2011): 34–38, quote on p. 34.

4. Daniel Tranel and Bradley Hyman, “Neuropsychological Correlates of Bilateral Amygdala Damage,” Archives of Neurology 47:3 (1990): 349–355, esp. p. 350.

5. Ralph Adolphs, Daniel Tranel, Hanna Damasio, and Antonio Damasio, “Fear and the Human Amygdala,” The Journal of Neuroscience 15:9 (1995): 5879–5891, quote on p. 5887.

6. Feinstein et al., “The Human Amygdala” (above, n. 3), p. 34.

7. Adam E. Zieman et al., “The Amygdala Is a Chemosensor that Detects Carbon Dioxide and Acidosis to Elicit Fear Behavior,” Cell 139 (2009): 1012–1021, quote on p. 1013.

8. Feinstein et al., “Fear and Panic” (above, n. 1), p. 270.

9. Justin S. Feinstein et al., “Fear and Panic in Humans with Bilateral Amygdala Damage,” National Institutes of Health Public Access Author Manuscript (2013), pp. 1–9,, quotes on pp. 1–2; Feinstein et al., “Fear and Panic” (n. 1), p. 270.

10. Mo Costandi, “Fearless Brain-Damaged Patients Are Terrified of Suffocation,” Guardian, February 3, 2013; James Gorman, “Study Discovers Internal Trigger for Panic Attack in the Previously Fearless,” New York Times, February 3, 2013; Sarah Zielinski, “What Makes You Feel Fear?,” National Public Radio, February 4, 2013; Maia Szalavitz, “How to Terrify the Fearless,” Time, February 11, 2013.

11. Lauren Berlant, “Sex in the Event of Happiness.” Presentation at the University of Iowa Conference on “Affect and Inquiry,” Old Capitol Museum, Iowa City, March 29, 2014.

12. For discussions on the concept of neuronarrative, see, for example, Francisco Ortega and Fernando Vidal, “Brains in Literature/Literature in the Brain,” Poetics Today 34:3 (2013): 327–360; Gary Johnson, “Consciousness as Content: Neuronarratives and the Redemption of Fiction,” Mosaic: A Journal for the Interdisciplinary Study of Literature 41:1(2008): 169–185; and Stephen J. Burn, “Mapping the Syndrome Novel,” in Diseases and Disorders in Contemporary Fiction: The Syndrome Syndrome, ed. T. J. Lustig and James Peacock (New York: Routledge, 2013), pp. 35–52.

13. Berlant, “Sex” (above, n. 11).

14. Jacques Derrida, “The Law of Genre,” in Modern Genre Theory, trans. Avital Ronell, ed. David Duff (Harlow, UK: Longman-Pearson, 2000), pp. 219–231, quote on p. 220.

15. Ibid., p. 224.

16. Feinstein et al., “Fear and Panic” (above, n. 1), p. 272.

17. Ibid., p. 271.

18. Joseph LeDoux, “The Slippery Slope of Fear,” Trends in Cognitive Neuroscience 17:4 (2013): 155–156, quote on p. 156.

19. Ibid. LeDoux’s writing over the course of his career takes a certain care to sequester the study of “fear” from the study of “threats.” LeDoux encourages distinguishing processes that give rise to conscious feelings of “fear” from nonconscious neural automations that respond to “threats.” Where LeDoux and the Feinstein team overlap, however, is in their working assumption that neural architecture maintains a one-to-one ratio with the particular vocabulary used to describe it.

20. Feinstein et al., “Fear and Panic” (above, n. 1), p. 272.

21. Ruth Leys, “The Turn to Affect: A Critique,” Critical Inquiry 37:3 (2011): 434–472, quote on p. 443 (emphasis in original).

22. Ibid., p. 438.

23. See Grant David Bollmer, “Pathologies of Affect: The ‘New Wounded’ and the Politics of Ontology,” Cultural Studies 28:2 (2014): 298–326, quote on p. 318.

24. Ibid.

25. Ibid., pp. 311–312.

26. Ibid., p. 318.

27. Feinstein et al., “The Human Amygdala” (above, n. 3), p. 36.

28. Ibid., p. 37.

29. Antonio Damasio, quoted in Ruth Leys, “How Did Fear Become a Scientific Object and What Kind of Object Is It?,” Representations 110:1 (2010): 66–104, quote on p. 86.

30. Bollmer, “Pathologies” (above, n. 23), p. 307.

31. Catherine Malabou, “Go Wonder: Subjectivity and Affect in Neurobiological Times,” in Self and Emotional Life: Philosophy, Psychoanalysis, and Neuroscience, by Catherine Malabou and Adrian Johnson (New York: Columbia University Press, 2013), pp. 1–72, quote on p. 58.

32. Ibid. (emphasis added).

33. Ibid. (emphasis in original).

34. Feinstein et al., “Human Amygdala” (above, n. 1), p. 37.

35. Dario Dieguez, “The Neuroscience of Fear and Loathing,” Global Neuroscience Initiative Foundation Brain Blogger, January 19, 2011.

36. Bollmer, “Pathologies” (above, n. 23), p. 307.

37. Constantina Papoulias and Felicity Callard, “Biology’s Gift: Interrogating the Turn to Affect,” Body & Society 16:1 (2010): 29–56, quote on p. 31.

38. Ruth Leys, “The Turn to Affect: A Critique” (above, n. 21), pp. 246 and 247.

39. Papoulias and Callard, “Biology’s Gift” (above, n. 37), p. 29.

40. Mieke Bal, The Practice of Cultural Analysis: Exposing Interdisciplinary Interpretation (Stanford, CA: Stanford University Press, 1999), p. 5.

41. Mieke Bal, Double Exposures: The Subject of Cultural Analysis (London: Routledge, 1996), p. 2.

42. Jonathan Culler, Literary Theory: A Very Short Introduction (Oxford: Oxford University Press, 1997), p. 82.

43. Giorgio Agamben, “What Is an Apparatus?,” in What is an Apparatus? And Other Essays (Stanford, CA: Stanford University Press, 2009), pp. 1–24, quote on p. 14.

44. Feinstein et al., “Fear and Panic” (above, n. 1), p. 272.

45. Malcolm Macmillan, “Restoring Phineas Gage: A 150th Retrospective,” Journal of the History of the Neurosciences 9:1 (2000): 46–66, esp. p. 47.

46. Quoted in ibid., p. 65.

47. This linear history draws a line from the study of anatomy through nineteenthcentury neurologists, such as Paul Broca, who, in observation of the speech-impaired “Patient Tan,” discovered the brain area regulating speech production which is named after him; or Carl Wernicke, who, studying brain damage in patients, localized aphasia to a brain area that was named after him.

48. Macmillan, “Restoring Phineas Gage” (above, n. 45), p. 47.

49. Rodrigo Quian Quiroga, “Borges and Memory.” Presentation at the Art of Neuroscience Symposium, Eye Film Institute, Amsterdam, March 11, 2014.

50. Rodrigo Quian Quiroga, Borges and Memory: Encounters with the Human Brain, trans. Juan Pablo Fernández (Cambridge, MA: MIT Press, 2012), p. 5.

51. Ibid., pp. 7 and 8.

52. Ibid., p. 7.

53. Ibid., p. 207.

54. Ibid., p. 52.

55. Ibid., pp. 52–53.

56. Ibid., p. 64.

57. For examples, see Rod Plotnik and Haig Kouyoumdjian, Introduction to Psychology, 10th ed. (Belmont, CA: Wadsworth-Cengage Learning, 2013), p. 362; Ellen Pastorino and Susann Doyle-Portillo, What is Psychology? Essentials, 2nd ed. (Belmont, CA: Wadsworth-Cengage Learning, 2013), p. 60; and Kenneth Carter and Colleen Seifert, Learn Psychology (Burlington, MA: Jones and Bartlett Learning, 2013), p. 429.

58. Pastorino and Doyle-Portillo, What is Psychology? (above, n. 57), p. 60.

59. Herman Melville, Moby-Dick; or, The Whale (Boston, 1892), p. 111.

60. Feinstein et al., “Fear and Panic” (above, n. 1), pp. 270–271.

61. Ibid., p. 271.

62. Ibid., pp. 270–271.

63. Bollmer, “Pathologies” (above, n. 23), p. 321.

64. Ibid., p. 322.

65. Macmillan, “Restoring” (above, n. 45), p. 47.

66. Ibid.

67. Ibid., p. 49.

68. Ibid., p. 55.

69. Malcolm Macmillan and Matthew Lena, “Rehabilitating Phineas Gage,” Neuropsychological Rehabilitation 20:5 (2010): 641–658, quote on p. 644.

70. Ibid.

71. Macmillan, “Restoring” (above, n. 45), p. 54.

72. John Harlow, quoted in ibid., p. 66.

73. Ibid., p. 58.

74. Antonio Damasio, Descartes’ Error: Emotion, Reason, and the Human Brain (New York: Avon Press, 1994), p. 12.

75. Ibid., p. 17 (emphasis in original).

76. Ibid., p. 69.

77. Ibid.

78. D. G. Amaral, M. D. Bauman, and C. Mills Schumann, “The Amygdala and Autism: Implications from Non-Human Primate Studies,” Genes, Brain and Behavior 2:5 (2003): 295–302, quote on p. 299.

79. Malabou, “Go Wonder” (above, n. 31), p. 57.

80. Ibid.

81. Ibid., p. 58.

82. Ibid., emphasis in original.

83. Ibid., p. 59.

84. Bollmer, “Pathologies” (above, n. 23), p. 308.

85. Emily Martin, “The Potential of Ethnography and the Limits of Affect Theory,” Current Anthropology 54:S7 (2013): S149-S158, quote on p. S156.

86. Papoulias and Callard, “Biology’s Gift” (above, n. 37), p. 52.

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