The Fear Factor Read online

  So she next reached out to the kidney transplant program at Brown University, which was (and still is) run by transplant director Dr. Reginald Gohh. To her relief, Dr. Gohh didn’t say no. Not that he immediately said yes either. He directed a major transplant center, but he had never heard of a donation request like this before. So Gohh first set up an interview in an attempt to figure out who this unusual woman was and to understand her request better. He came away impressed by her level of knowledge about the transplant and the seeming sincerity of her request. But before Graef could even begin the medical workup that precedes a kidney donation, Gohh wanted her to first speak to an entire team of transplant professionals to see if they also believed her to be both sincere and rational. The team included the transplant coordinator, a social worker, a transplant nephrologist, and a transplant surgeon.

  All came away convinced of something that was at that time fairly radical: that this prospective donor wasn’t crazy or irrational or deluded, that she was sincerely motivated by altruism, and that, moreover, her motivation for donating was morally admirable and a legitimate reason for proceeding.

  The transplant took place on February 8, 1999. A surgical team made a single incision in Graef’s abdomen, removed her left kidney, then quickly transferred it to a second operating room to be stitched into the abdomen of the recipient. Both Graef and her recipient—whom she has never met—experienced smooth and uncomplicated recoveries and soon resumed their normal lives. Graef was back at work in her temple a week after the transplant.

  But neither Graef nor Dr. Gohh was content to leave it at that. Gohh came away convinced that donations like this one were ethically justified and should be performed when medically appropriate. Graef agreed that, as long as her anonymity would be preserved, it was important to let others know that surgeries like hers were possible. So in early 2000, Dr. Gohh wrote up Graef’s case, and the article was published the following year in three brief pages of the medical journal Nephrology Dialysis Transplantation, thereby helping to usher in a new era of altruism.

  In 1999, the United Network on Organ Sharing (UNOS) recorded five anonymous altruistic kidney donations in the United States. In 2000, there were another twenty, and by 2001 there were thirty more. The numbers increased every year until they reached their peak in 2010, when 205 people anonymously donated their kidneys to strangers. Currently, between 100 and 200 altruistic donations take place in the United States every year. And this number counts only those that, like Graef’s, are “nondirected,” meaning the transplant center selects the recipient, who usually does not meet the donor before the transplant (although they often meet afterward). Many more donors elect to give their kidney to specific strangers whose need they learn about on Facebook or Reddit or a billboard or through a website like matchingdonors.com. Nearly all transplant centers will now consent to perform either type of altruistic donation, and gone are the days when surgeons would use terms like “repugnant,” “offends the human conscience,” and “pathologic by psychiatric criteria” (really) to describe these donors. Thousands of lives have been saved by the growing acceptance that a genuine desire to help another person, despite the costs to oneself, may motivate the donation of a kidney.

  In 2009, I read “The Kindest Cut,” Larissa MacFarquhar’s wonderful New Yorker article about advances in altruistic kidney donation. It prompted me to do some more background research, which made the many similarities between altruistic kidney donors and other altruists clear. Heroic rescuers tend to make their decisions to help rapidly and intuitively. My colleague David Rand, a behavioral scientist at Yale, has conducted research showing that recipients of the Carnegie Hero Fund Medal overwhelmingly report that their decisions to rescue strangers were fast and spontaneous rather than deliberative. Altruistic kidney donors like Graef tend to report having a similar experience, often stating that when they first realized that they could donate a kidney to a stranger, they just “knew”—as though a bolt of lightning had struck them—that they wanted to do it, and they rarely felt any ambivalence or hesitation afterward. Also, like Cory Booker and Lenny Skutnik and many other heroic rescuers, they tend to be humble about their actions afterward, actively resisting being labeled heroes. Graef maintains to this day that she was really just a “conduit” for the donation, that Dr. Gohh and the surgeons, physicians, nurses, and even secretaries and janitorial staff at Brown’s transplant center made the donation possible and were the real donors.*

  Altruistic kidney donors are unlike heroic rescuers, however, in one key way as far as research is concerned: they can be contacted en masse, without cold calls or coercion, through transplant centers and listservs. I decided that altruistic kidney donors were the extraordinary altruists who could help me explore the idea of a compassion continuum—the anti-psychopaths whose brains might reveal the roots of human altruism.

  I spent the next year seeking funding for the project, which was no small task. Few organizations that fund scientific research have missions and funds compatible with studying the brains of extraordinary altruists. I caught a very lucky break, though. In late 2009, the renowned social psychologist Martin Seligman, in cooperation with the John Templeton Foundation, put out a call for neuroscience research proposals aimed at testing positive features of human nature like morality, resilience, and altruism. Bingo. I applied, and in 2010 I received a $180,000 “Positive Neuroscience” award to conduct the first-ever research on the neural basis of extraordinary altruism.

  I originally thought the hardest part of the research might be locating enough altruistic kidney donors to complete the study. I wanted to find twenty altruists whose brains I could scan, and I had only a very small population from which to draw—there were roughly 1,000 nondirected kidney donations ever recorded at that time in the United States, and an unknown number of other altruistic donors. I was willing to fly the donors in from anywhere (and thanks to my grant, I had the money to do so), but who knew how many eligible volunteers I would be able to find? I would have to rule out anyone with magnetic metal inside their body, for example, and metal clamps are sometimes used in nephrectomies. I couldn’t include anyone taking medications for anxiety or depression or chronic pain, or anyone with claustrophobia. And of however many altruists remained who met all our criteria, how many would even want to participate? Normally, recruiting anyone older than college students for psychology research is like pulling teeth. Research doesn’t pay enough to attract the average busy, working adult; IRB restrictions against coercion prevent us from paying anyone with a decent income enough to actually compensate them for their time. And that’s by design. The goal is for research volunteers to partake in studies, not for the money, but out of a desire to help science and the public at large—out of altruism.

  So as you might be able to guess, I didn’t actually need to worry about finding study participants at all.

  I’ve actually never experienced anything like it. In early 2011, shortly before I left for a psychology conference in Texas, I had reached out to several organizations that work with kidney donors. I posted recruitment advertisements in a couple of national listservs for living kidney donors, and I asked the Washington Regional Transplant Center to contact the dozen or so altruistic donors in the area whom they had on file.

  I didn’t have a smart phone back then, so I couldn’t check my email until midway through the first day of the conference. When I opened up my laptop and logged in, my jaw literally dropped open. It was like I had tapped into the matrix. My inbox was full of messages from altruistic kidney donors:

  “I donated a kidney to a stranger last February. I would be happy to participate in your study.”

  “Hi, I saw on Facebook that you are studying living kidney donors. I donated to a stranger in 2009 and would love to participate.”

  “I am responding to a Facebook post by Abigail Marsh seeking volunteers to participate in your study.”

  “Please know that I am EXTREMELY interested in participating in the stud
y should the study want me.”

  “I was an altruistic kidney donor… would be more than happy, and honored, to take part in a study.”

  My favorite may have been:

  “I WOULD VERY MUCH BE INTERESTED IN BEING A LAB RAT AND HAVING STUDIES DONE ON ME.”

  This doesn’t happen in the normal world of behavioral research. Maybe it does for researchers who are studying life-saving cancer treatments or paying people thousands of dollars to sleep in a sleep lab, but for basic research on human behavior—no. I had been conducting psychology research for over a decade, and recruitment had invariably been a long, slow slog just to find a sufficient sample of somewhat enthusiastic volunteers. When you’re seeking a small, select population, it is even harder. Recruiting and screening twelve eligible adolescents with psychopathic traits for my first fMRI study at NIMH took about two years, and they’re not even very rare.

  But despite altruistic kidney donors comprising less than 0.001 percent of the population, it took less than two days to recruit twelve of them, and within a week we’d heard from enough altruists to fill the study. The emails they sent were some of the friendliest, most effusive messages I’d ever received from strangers.

  It was an apt introduction to the world of extraordinary altruism.

  * As Graef describes it, this sentiment aligns with the Buddhist teaching that the highest form of giving is one that recognizes no giver, no receiver, and no gift, and that is derived from an understanding of our inherent oneness.

  5

  WHAT MAKES AN ALTRUIST?

  BEFORE WE DELVE deeper into the world of extraordinary altruism, I’d first like to invite you to accompany me on a trip that may be essential to understanding this world. Come ride with me, if you will, on a beam of light. This is not Einstein’s beam of light. It will not provide any insights into the conjoining of time and space. This beam will perform a feat, however, that I think is equally spectacular: enabling the conjoining of two human minds.

  How information inside one person’s head ever makes its way into the interior of someone else’s head remains one of the great mysteries of psychology. Language obviously plays a crucial role. It would be nearly impossible to understand cognitively complex phenomena in others, like beliefs and desires and intentions, without language. Think of how much information you can glean about another person’s beliefs and goals when they say something like, “Hey, let me try!” or, “I’ll do that for you.”

  But language is a foggy window into the mind. Most internal states are never verbalized. Some thoughts are too private or too banal to express. Other internal states cannot be put into words because they are too complicated, or because they are unknown even to the person experiencing them, lurking somewhere inaccessible in the unconscious. And language can mislead—sometimes intentionally, as in the case of irony or deception, and sometimes simply by happenstance. Is a person who says, “I’ll do that for you,” being helpful, impatient, or chauvinistic? The words themselves are silent.

  Because the stream of spoken speech is only ever a fragmented reflection of the mind that produces it, much of what we know about others’ complex mental states—their beliefs and desires and intentions, sometimes called “cold cognitions”—is simply educated guesswork. Sometimes it seems like we actually know what intentions underlie an utterance like “I’ll do that for you” if it comes from a good friend, or if it’s accompanied by a smile versus a sigh. But this so-called knowledge is an illusion. We have no direct access to others’ thoughts. The best we can do is patch together inferences about what the people around us believe or intend or want by pinning observations of their behavior into the complex web of knowledge we have about them individually and about people in general. Although most adult human brains can do all of this quite quickly, it’s a terrifically complicated process, and it’s a wonder we ever get it right. Often we don’t, of course. Although most people believe that they are good at understanding others’ true internal states, psychological studies of lie detection suggest otherwise. When put to the test, nearly everyone’s ability to tell the difference between what others say and what they actually think when the two things differ is little better than chance. You might as well flip a coin.

  The same is not true for understanding others’ emotions (“hot cognitions”). Although sometimes we infer how other people are feeling using similar inferential processes, that’s far from our only option. Actual, valid information about people’s internal emotional states is literally pouring out of them all the time in forms that we can access directly with our eyes, ears, hands, and even noses. Clues about others’ emotions seep from their pores in chemical form, enabling us to literally smell others’ fear. (This is not a myth! It actually happens.) Internal emotional states echo in the pitch and timbre of people’s voices, shift the movements and postures and even temperatures of their bodies, and festoon the surface of their faces. This last source of information is particularly important for humans. Our species pays more attention to, puts more weight on, and gets more information from facial movements than any other single channel of information.

  Few researchers have contributed as much to figuring out how we use facial movements to understand others’ internal states as the psychologists Paul Ekman and Wallace Friesen. In 1978, Ekman and Friesen created the first comprehensive inventory of all possible expressive movements a human face could make. They paid particular attention to facial movements that, when combined, yield one of six widely recognizable emotional expressions: anger, disgust, happiness, sadness, surprise, and—of particular relevance to altruism—fear. They generated a set of black-and-white photographs of these expressions that have been used in thousands of psychology and neuroscience studies around the world in the ensuing decades. Although many other sets of emotional facial expressions have been created since then, all of which offer different strengths, none of them, in my view, has been more carefully constructed and standardized than Ekman and Friesen’s originals. The common use of these expressions by investigators around the world has permitted studies of emotion to be replicated by multiple research groups; this is a rare and valuable phenomenon in behavioral research and one that provides a much higher degree of confidence in the research results.

  I have used this set of facial expressions myself since I was an undergraduate. In the process, I became very familiar with what Ekman and Friesen look like, as they lent their own faces to their research. I nearly jumped out of my skin the first time I turned around at a conference to see the long, mournful face of Wallace Friesen staring back at me, both familiar and disconcertingly new, in the way that a face only seen before on a screen looks in three dimensions. I imagine he gets that response a lot.

  Ekman and Friesen determined that for a face at rest to transform into one that appears fearful, three specific sets of movements are required. First, and most importantly, the levator muscles of the upper eyelids must be contracted to pull back the lids and widen the eyes. Human eyes are ideally designed to make this objectively subtle muscle movement obvious. Nearly unique among all species with eyes are the vivid white sclera that surround the human iris. (This is why one tactic animators use to make animals appear more human is to give them bold white sclera. It’s a trick you see in movies from Bambi to Finding Nemo to The Planet of the Apes. Actual deer and fish and chimpanzee sclera are dark or hidden. But if you make them larger and paler, the animal suddenly appears human.) The bold visual contrast created by the juxtaposition of white sclera, pigmented skin and iris, and black pupil draws in the viewer’s gaze. This effect is made more potent when fear sweeps the lids backward to reveal even more of the gleaming sclera underneath. “Look at me! Meet my gaze!” these sclera scream.

  But although wide eyes may draw the viewer in and create an appearance of vulnerability, in isolation they don’t yet convey fear. Fearful brows must also contort into a new shape. The frontalis muscles in the forehead draw the brows upward toward the hairline, while other muscles like the
corrugator supercilii, small triangular muscles that overlie the inner corner of the brows, simultaneously crinkle the inner edges of the brows inward and slightly down. (The goal of many a Botox injection is to disable these muscles.) Together, these movements create the oblique brows that so effectively heighten the appearance of vulnerability and distress, which are the signature attributes of fear. Finally, the lips of a canonically fearful face are tightened and drawn backward and slightly down. The rounded grimace that results is similar to those used by our various primate cousins to signal submission and appeasement. Vulnerability, distress, submission, appeasement—recall that these traits, which are all maximized by the movements that compose a fearful expression, are the same traits that trigger the Violence Inhibition Mechanism.

  The facial muscles whose movements yield these effects are unique within the human body. Ekman has observed that the expressive muscles in the face include the only muscles in the body whose job it is to pull on skin rather than on bones. This is because their reason for existing is not to move the body through space for utilitarian purposes, but to contort the visible surface of the face down or up or out in order to communicate. The resulting messages are wonderfully efficient. Not only do the contortions that yield fearful expressions work to inhibit others’ aggression, but they do so very quickly. Facial muscles can contract to convey fear in a few hundred milliseconds—less time than it takes to draw in enough breath to scream. They owe this efficiency to the fact that the nerves controlling them emanate from the brain stem and midbrain, the deepest, most primitive parts of the human brain.