The Fear Factor Read online

  Harold recalls feeling no anxiety or fear or doubt leading up to the donation, only excitement and a little frustration that the whole process took so long to get under way. He never once reconsidered his decision. And without question, he would do it again if he had the opportunity, which of course he won’t have—even the most impassioned altruist has only one spare kidney to give.

  I once asked Harold, as I ask all the altruists we meet, to tell me why he thinks he is one of the less than 0.001 percent of the population for whom giving a kidney to a stranger is just as obvious as donating to their mother would be for most other people. What is different about him? His response is vehement, and it echoes the words of Cory Booker and Lenny Skutnik. “I’m not different. I’m not unique,” he maintains. “Your study here is going to find out that I’m just the same as you.”

  As he sees it, our study wasn’t even asking the right question. Altruistic kidney donors like him are, in his view, ordinary people who are in the right circumstances at the right time, with the right information. Being portrayed as any kind of hero frustrates him to no end. He has told me unambiguously and repeatedly that he is not.

  Perhaps he’s right. As a scientist, I try to keep my mind open to any possibility not conclusively ruled out by the evidence. It’s possible that, as Harold maintains, donating a kidney is mostly circumstantial, that nearly anybody with the right combination of knowledge and prior personal experiences would be similarly motivated. Many of the kidney donors we’ve worked with believe this is true. The first three altruists we tested—the ones who tried to break through the emergency exit door—all gave responses to this effect when I asked them, in separate interviews, why more people don’t donate:

  “I would say: information.”

  “Lack of education.”

  “It’s just not knowing.”

  If more people knew about donation, they averred, more people would donate.

  Of course, this must be true to some extent. Every altruistic kidney donor was once not an altruistic kidney donor, but rather someone who, in most cases, had never even heard about nondirected donations. Then, eventually, each of them discovered that it was possible to donate a kidney to a stranger, or they learned how many strangers out there needed a kidney and this new information was the precipitating event that led them to donate. What distinguished their predonation and postdonation selves was the information they possessed. That altruists explain their donations this way is quite consistent with a general phenomenon known in social psychology as the actor-observer effect: people tend to explain others’ behaviors with reference to internal causes like personality, but explain their own behavior with reference to external causes—in this case, the acquisition of new information.

  But that seems unlikely to be the only reason that people give strangers their kidneys. For one, the rest of us respond quite differently to exactly the same information. If you’re like me, you might have followed along with Harold’s line of questioning for a while. You’d donate to your mother for sure. So would I. Your brother, yes. Best friend, okay. But somewhere along the way there’s a shift. The answer no longer seems so obvious. Your neighbor, or your teacher? Your boss? Maybe. For me, these decisions start to feel different somehow, less instinctive. The details I’m happy to shove aside until later for my mom’s sake rapidly return to the forefront when I think about donating to someone more distant. By the time I get all the way to thinking about donating to someone I’ve never met… there’s just a blank. Nothing about that decision feels obvious at all.

  This is a common response even in people who are deeply and painfully familiar with the desperate need for donor kidneys and the lifesaving power of altruistic donations. In the film about Belay’s transplant, her husband mused, “As far as Harold is concerned, it’s not easy risking your life to save somebody else who you don’t even know, who you have never seen. I was asking myself, ‘Could I do that?’ And my answer was—no. I know what it means. When you have only one kidney, you are risking your life. He must have… a special heart.”

  A special heart—or a special brain?

  It took more than a year, but we eventually collected enough data to find out. In all, we scanned the brains of nineteen altruistic kidney donors while they viewed the various emotional facial expressions. They included Harold, Angela Cuozzo and the other women who were so determined not to be late, George Taniwaki, who had flown in from Seattle, a real estate consultant, a mechanic, and a dozen others. In addition to measuring activity in their amygdalas and elsewhere during the scans, we also collected anatomical scans that would inform us about the size and shape of all the various structures within each of their brains, including their amygdalas.

  For comparison, we also collected identical data from twenty control participants of the same average age, years of education, IQ, and other variables as the altruists. The only other requirement for controls was to have never donated an organ to anyone. That’s most of the population, of course. A dragnet of any single city block within a mile of Georgetown University would probably yield twenty such adults, so you’d think it would have been a cinch to find them and test them. You’d be wrong. It really reinforced for me how incredibly abnormal (in a good way) the altruists’ eagerness to participate was—especially given all the travel hassles involved—that it took us twice as long to find enough controls for the study as it did to find the same number of altruists. This is despite the fact that the controls were all recruited locally and didn’t have to travel anywhere, and despite the fact that there are literally 100,000 times as many of them as there are altruistic kidney donors. (I remain, of course, fantastically grateful to all of the controls who did participate—the study would have been impossible without them.)

  My students analyzed our data using the same painstaking process as usual. Hours and hours and hours of computers whirring away to turn gigabytes’ worth of raw binary code into three-dimensional images of human brains that flickered and glowed with activity. Our final analysis aimed to see how much more active the amygdala was when the two groups of subjects looked at fearful expressions as compared to neutral expressions. The moment of truth arrived again. When we compared the altruists’ brains with those of controls—who were like the altruists in every way we could think to measure except for not having donated a kidney—what would we find?

  Bingo. There it was again. Glowing like a little star. Half a cubic centimeter or so of flesh inside the altruists’ right amygdala had recruited more blood to fuel its activity after fearful expressions appeared.

  Now, all we really knew from this finding was that cells somewhere in the altruists’ amygdalas—was it the lateral nucleus? some other nucleus? we couldn’t say—were more active when they gazed at a stranger’s fearful expression than when they gazed at a neutral expression. Was this the legitimately empathic response we suspected? Or was it something else, like a response to threat?

  One clue came from the results of a comparable analysis we conducted to evaluate altruists’ and controls’ responses to angry expressions. This time we found that the pattern was reversed—the amygdala was less active in altruists than controls when they saw angry faces. This pattern isn’t consistent with the idea that altruists’ amygdalas are simply “threat detectors” when it comes to expressive faces. A useful contrast can be drawn with people who have clinical anxiety disorders like generalized anxiety disorder or generalized social phobia. When these people view facial expressions in the scanner, they show heightened amygdala responses to a whole range of negative stimuli, including fearful expressions, angry expressions, and other expressions like contempt. Anxious people are overly vigilant to possible threats and danger, and their amygdalas tend to be perennially hyperactive; in them, amygdala activity to a whole range of cues may well reflect some form of threat detection. But the fact that the altruists were more sensitive only to fear suggests something else was afoot.

  Another clue as to what that “something else” might
be came from additional data we had collected after we wrapped up brain scanning with each subject. After they’d had a little break and some lunch, we invited them to come back to our lab for questionnaires and some computer tasks. One of these was an emotional face recognition task that contained both angry and fearful facial expressions. When we analyzed how well the two groups of subjects identified the emotion conveyed by these two expressions, our findings mapped neatly onto our brain imaging data and echoed the emotion recognition data I had collected for my dissertation a decade before. Compared to controls, altruists recognized fearful expressions relatively better. By contrast, they recognized angry expressions relatively worse. It was only their empathic accuracy for others’ fear that was better than average. This finding reinforces the idea that empathy can take many forms and that each form is driven by partially distinct processes, such that it is perfectly possible to have a high degree of empathy for others’ fear but not their anger. When it came to the altruists’ empathic sensitivity for fear, the signs pointed to the amygdala driving this accuracy. Across our subjects, we found a strong correlation between how active a subject’s amygdala was to fearful expressions and how well that person recognized these expressions later on.

  So far, our altruists looked remarkably like “anti-psychopaths”: they recognized others’ fear relatively better than controls did, and this ability seemed to correspond to a more robust response in the right amygdala to these expressions. What about the final feature of psychopathy we had considered—the overall size of the amygdala? My student Paul Robinson crunched the numbers to generate mock-ups of the average shape and size of all of the subjects’ amygdalas, although I was a little dubious about whether this effect would pan out, to be honest. But the results clearly showed that in this respect as well, the altruists appeared to be the opposite of psychopaths. Their right amygdalas were physically larger than those of controls, by about 8 percent. The significance of this effect held up even after controlling for something we had not predicted, which was that the altruists’ brains were larger overall than controls’ brains.

  Despite what Harold and many of our other subjects believed, something about the altruists’ brains really was special. Altruists, it seems, may be more strongly affected by the “field of force” that promotes compassion because the sight of someone suffering affects them more strongly than it affects the average person. They appear to be equipped with just a little more of the three features that psychopathy research has identified as being essential to ordinary compassion—the basic neural hardware required to be sensitive to signs of extreme distress in others, which highly psychopathic people lack. And that little something extra—the extra sensitivity, the extra activity, and the extra volume—may provide altruists enough of a boost to move them past ordinary levels of compassion into something extraordinary.

  Perhaps these small changes can help to explain why the strange blank feeling I get when I contemplate donating a kidney to a stranger feels like something to an altruist. As the altruists tell it, that same sense of certainty and purpose I feel when contemplating donating a kidney to someone I love is what most of them felt when they first contemplated donating to someone they’d never even met, that sense of, “Okay, you can have my organs… it’s a no-brainer,” as one young kidney donor from Arizona put it. Or in the words of another altruist, “I had no particular reason other than, like I said, you see someone drowning, you are going to pull them out of the water.… I knew you gotta help when someone suffers.” Simple as that. Clear as Lenny Skutnik diving into the Potomac. Instinctive as Cory Booker racing into a neighbor’s burning house. Fast as my roadside rescuer hitting the brakes. The fact that their choices seem to boil down to gut-level, intuitive feelings all made so much sense once we discovered differences in the altruists’ amygdalas.

  The amygdala, as brain structures go, is pretty deep under the hood. It can respond to stimuli you have no conscious awareness of—bright white sclera flickering for a few milliseconds; the smell of someone’s sweat when they’re frightened—and change your behavior and ongoing thoughts very quickly in response. If something very fast and very unusual is happening in this ancient structure when extraordinary altruists witness or contemplate someone else’s distress, is it any wonder they have trouble articulating what it is? It may legitimately feel like the decision is a “no-brainer” when there is no easy access to the part of the brain where these critical calculations are taking place, although perhaps a better term for it would be “deep-brainer.”

  The fact that altruists show heightened empathic responsiveness to others’ fear also reveals an important truth: there is a critical distinction between being fearless and being brave. Many psychopaths are genuinely fearless, and as a result they have difficulty understanding others’ fear. That altruists are so empathically responsive to others’ fear suggests that, rather than being fearless, they are unusually sensitive to fear. Recall the half-dozen different ways in which Cory Booker described the terror he felt while rescuing his neighbor from a fire. And Lenny Skutnik, who saved a stranger from an ice-choked river full of wreckage and jet fuel, later found himself overwhelmed by nerves during an interview with Ted Koppel. I have asked dozens of altruistic kidney donors if they consider themselves to be fearless or low-anxiety people, and the answer is nearly always an emphatic “no.” Almost none of them engage in classically risky activities like skydiving, which, you will recall, is actually less risky than donating a kidney. Sunyana Graef said, when I asked her about risk-taking, that she had “gone parasailing once”; otherwise, she definitely didn’t engage in any risky behaviors, she said, because doing so “wouldn’t be right.” More than one of the altruists we’ve studied was afraid to fly, judging by their requests to take anti-anxiety medications during the flight to Washington. (Unfortunately, we had to request that they not do so, as the drugs’ residual effects could have interfered with the brain scans.) During her interview, one altruistic donor from New York reeled off a list of small, everyday things that she worried about, from being late with her rent check to running out of gas on the freeway. And another from San Francisco said that for most of her life she had been afraid of “everything in life… absolutely everything.”

  Her words reminded me of those of the heroic Civil War battlefield nurse Clara Barton, who reflected in her autobiography: “Writers of sketches, in a friendly desire to compliment me, have been wont to dwell upon my courage, representing me as personally devoid of fear, not even knowing the feeling. However correct that may have become, it is evident I was not constructed that way, as in the earlier years of my life I remember nothing but fear.”

  Our findings suggest that Barton’s words reflect a deep truth, which is that true selfless heroism emerges not from the absence of fear, but because of it. People who rescue strangers from fires or drowning or who donate their kidneys to strangers seem to be acutely aware of what it means to be afraid. And this awareness may be in part what moves them to help others. Their bravery lies in their ability to recognize and empathize with acute distress, while simultaneously overcoming or overriding their own fear in the face of danger. They are able to respond altruistically because, even while they empathize with others’ fear, they do not allow fear to flood their own system and prevent them from acting to help.

  How on earth do they pull this off? At least on the face of it, it doesn’t appear that they make any conscious efforts to suppress their own fear; indeed, altruistic kidney donors often report being surprised to discover how they were feeling as their donation date approached. When I have asked donors what their dominant emotions were right before they went under anesthesia, the response I get the most often is Harold’s answer: “Excitement.” Another young altruist in his twenties said that right before his donation, “I was really excited for it actually. I do not know why. I do not know what was the exciting aspect about it. I think just knowing that I was gonna be able to help somebody so much was really cool to me and everyone was
so worried, like I was going to die on that table. Everyone was like, ‘Why you are doing this? You are going to die!’ And for me, I almost felt strange not being worried about it.”

  Many donors have even said that they felt an unexpected sense of peace or certainty. One altruist explained, “I would not consider myself fearless. I do not take a lot of risks. Somehow, I never thought this was a risk. I just knew from the beginning that I was going to get through it fine. I do not know why I knew that, but I knew that.” Sentiments like these echo the words of Lenny Skutnik, who, again, was not a generally fearless person, but recalled feeling no fear before he leapt into the Potomac—an extraordinarily risky and painful choice—but only a calm conviction that everything was “going to be all right.”

  How is it that people who have normal—or even higher than normal—sensitivity to fear and anxiety find themselves feeling anywhere from calm to excited before voluntarily undergoing significant pain and risk to save another person’s life? What neurobiological process could conceivably transform an act that is objectively risky or costly into one that generates feelings of calm, even positive excitement? The answer to this question may be the final piece required to understand the puzzle of extraordinary altruism, and it may boil down to the basic mechanisms that underlie the capacity for care.

  * As an aside, this is not the fate of every beam of light that makes it into a human eye. Some small proportion of the light that enters the eye is reflected back again, in slightly different ways by each of the various substances composing the eye. These subtleties are powerfully important. Faint gradations in the way the cornea, iris, lens, vitreous, and retina of a living eye reflect light appear to be an essential means of convincing a viewer that the being possessing that eye is not only humanlike but is actually alive, rather than a drawing or a humanlike doll with glassy and unconvincing eyes. It is no accident that when a person dies, we sometimes say that the light has left their eyes. The tapestry of reflected light from a living onlooker’s eyes that rebounds back into the eyes of the frightened soul, then, carries with it literal glimmers of hope that another living being has borne witness to their fear.