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The Man Who Couldn't Feel Anxious

Is anxiety a brain-based or body-based experience?

I recently watched a TV documentary that shed some interesting light on this question.

The BBC's "Incredible Medicine: Dr Weston's Casebook" showcased a man named Jordy Cernik who apparently feels no fear at all. I couldn't find a video clip but here is a written piece telling Mr Cernik's story.

The story in brief: Jordi developed a rare condition, Cushing's syndrome, which causes hormone production in the adrenal glands to go haywire, necessitating their surgical removal in Jordi's case. Soon after, Jordi noticed he'd completely lost the capacity to feel fear, and has since gone on to raise lots of money for charities by performing various terrifying feats.

On the face of it, this is highly surprising because the adrenal glands are only one means available to the brain for generating a "fight-or-flight" response in the body. The other major route is the sympathetic nervous system (part of the autonomic nervous system). Sympathetic activation is actually what triggers adrenalin release, but it can also independently raise heart rate, trigger sweating in the hands, etc.

Moreover, Jordi's brain was still in tact. I think most people would assume that the experience of anxiety would be reflected in a pattern of brain activity, at least as much as a bodily arousal.

So you'd still expect Jordi to feel some fear, albeit maybe blunted by the lack of adrenalin and cortisol.

In the BBC programme, Jordi is filmed abseiling vertically down a tower hundreds of feet high, while a researcher monitors his skin conductance. Biofeedback aficionados may recognise skin conductance as a highly sensitive indicator of anxiety, or at least of the fight-or-flight response. You'd expect a sudden leap in skin conductance when you step off a building - driven by increased sweating in the skin linked to sympathetic activation.

But Jordi showed virtually no skin conductance response at all, backing up his claims to experience no fear.

Even if he were feeling excitement rather than fear, you'd expect a jump in skin conductance. The difference between excitement and anxiety is less to do with the actual body response (the two are pretty similar there) and more to do with the interpretation: anxiety is when you don't want the experience and try to resist it, while in excitement you welcome it.

Jordi still new when he should be feeling fear (which is fortunate, as he can then avoid making bad decisions). In his brain, the amygdala are still in tact - these are well-known brain structures associated with fear. What they actually do is only the triggering of emotional responses. In Jordi's case the alarm was presumably still sounding but it was more like a fire alarm test - nobody runs screaming from the building.

What had happened to Jordi's fear systems? I don't suppose anyone really understands, but it looks like a complete loss of regulatory feedback control. Normally there's a loop between the adrenals and the brain whereby they mutually influence each other. It seems for Jordi the lack of response from the adrenals meant the whole circuit shut down.

(Actually, what the BBC programme doesn't make clear but the above newspaper article does, is that there were complications for Jordi's surgery, including some brain surgery.)

The main point of interest for me is that the body response is very much a significant part of the neuroscience of emotion - it looks like maybe the brain can't generate fear on its own.

What are the implications for biofeedback and neurofeedback? Sometimes I suspect there's a presumption that neurofeedback (which is of course biofeedback that directly uses measures of brain activity, rather than "downstream" indicators such as HRV) is more like the real deal, because the brain is the key. But for me the moral of Jordi's story is that emotion is very much a product of the communication loop between brain and body, and to make a difference you only need to affect the loop somewhere. Personally I prefer "peripheral" biofeedback because it's quicker and the link to subjective experience is more apparent.

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