An important patient that came the way of Antonio Damasio, who I'll be referring to by the name Elliot for the rest of our discussion. When I say Damasio from here on it I'll be talking about Antonio as opposed to his spouse Hannah; At any rate, the patient is someone that Damasio calls Elliot. Elliot had been a successful mid-level executive, had an enviable position in life, was doing all kinds of good things, had the respect of his peers and friends, love of his family and so on. But then, began to show signs of a brain tumor, but this is a tumor that was not itself something that couldn't be taken care of by just removal, so, the tumor was removed but in the course of that removal together with the damage that the tumor had done before it was removed, a lesion was caused, and in roughly the same area that the steel rod had done damage to Phineas Gage's brain. Now, after the surgery, Eliot made a full recovery in terms of getting his health back, but his behavior began to change. He was unable to keep that job that he had before, and Damasio was able to attest to this. He and his colleagues put Elliot through a number of different batteries of psychological tests. His IQ was good, he went and did well on the WAIS battery of examinations. He did well in memory test, he can carry on a conversation. His intelligence was in general normal or even in the superior range on certain measures. Nevertheless, he was not able to make basic practical decisions when faced with a task, such as: By 5 PM today, you need to make sure you get the quarterly report done or something of the kind. He would spend hours deciding how to organize the different papers inside of that report as opposed to just saying let's find some system of organization and go with it. He was unable to rank appropriately the things that mattered, relative to the things that didn't matter. He was not able to prioritize in such a way as to make good use of his time. Likewise, as a result rather, he ended up losing that position. He ended up thereafter getting into various questionable business relationships with people who tended to fleece him. He was not able to reason well in terms of being able to make good decisions as a business person. Likewise, he was not able to be a good family man, his marriage ended in divorce. Many of his loved ones looked on in puzzlement, bewilderment, and in some cases horror as his life in effect unravelled. What was so puzzling about this was that he, on the surface, was able to carry on a conversation, could discuss intelligently the current events, history, science and so forth. He was knowledgeable. He was able to, in a superficial way, present as being on top of things, and yet he was unable to make practical decisions. It's as if the lesion that this tumor produced in his brain thereby produced a serious lesion in his practical rationality in terms of his ability to make good choices. Furthermore, as Damasio brought him in as a patient, there was a question whether or not he'd be able to be qualified for Social Security benefits because it was not clear whether he was just really unable to keep a job, or whether he was just being lazy, but as Damasio studied him in greater detail, Damasio was able to convince the insurance companies and Social Security that in fact there was a deep biological reason for Eliot's problem, and so he should have his insurance benefits reinstated, and his disability benefits reinstatement as well. Then Damasio and colleagues put him through a number of other tests and found, for example, that when presenting Elliot with some disturbing images of people who've just been shot, of buildings on fire, of ships capsizing at sea and so forth, of animals suffering in one way or another, Elliot was cognitively aware of what he was seeing, he understood what he was seeing. He understood that this was a picture of a dog being bitten by another dog and bleeding all over the place for example. But, Elliot was not likely to show an emotional reaction to these sorts of images. He knew that they were sad or disturbing. He saw that intellectually, but he was not himself, made sad or disturbed by these images. So, Damasio concludes that in some respects, Elliot was a new Phineas Gage. He points out that Eliot was never impolite, was not irascible, was not offensive to people in the way that Phineas Gage was, but nevertheless Damasio finds a commonality between the two of them because he feels that there is a impractical nature to their behavior. Likewise, Damasio describes Elliot as one who knows but does not feel. He knows what he's seeing, he's aware of the emotionally charged situation in front of him that something's got to be done in a certain time, that something that is observing is suffering for example, but it doesn't feel the importance of reacting appropriately. Damasio writes, "The cold-bloodedness of Eliot's reasoning prevents his evaluating different outcomes to his actions." So, Eliot had a lesion in his brain that is similar to the lesion that was caused by the steel rod that went through Phineas Gage's head. The result is that Damasio wants to hypothesize that there's something in common, not just neurologically but behaviorally with these two patients. Not just in terms of overt behavior, but more precisely in terms of their ability to, as we would now say, make good choices. So, Damasio is now looking for, at this point in the book, looking for an hypothesis as to what would explain the commonality that defines between Phineas Gage, Elliott and other patients that he discusses, the general clues that he's got in front of him are going to be primarily that neither of them is able to balance the set of choices that they have available to them with a sense that your gut might be able to tell you which one is reasonable choice to take, which one is the most rational in the sense of practical rationality, which one is the most practically rational choice to take of those that are available.
