S.M. (patient)

S.M., also sometimes referred to as SM-046, is a female patient first described in 1994[1] who has had exclusive and complete bilateral amygdala destruction since late childhood as a consequence of an extremely rare genetic condition known as Urbach–Wiethe disease. S.M. is notable in that, because of this damage, she has little to no capacity to experience fear or anxiety in her everyday life, a characteristic which has resulted in her being dubbed by the media as the "woman with no fear".[2] S.M. has been studied extensively in scientific research, and has helped researchers to elucidate the function of the amygdala.[3]

Characteristics

Experiments with S.M. revealed no fear in response to exposure to or handling of snakes and spiders (including tarantulas), a walk through a haunted attraction (Waverly Hills Sanatorium, specifically), or fear-inducing film clips (e.g., The Blair Witch Project, The Shining, and The Silence of the Lambs), instead only interest, curiosity, and excitement.[3] Research has revealed that S.M. is not immune to all fear however; along with other patients with bilateral amygdala damage, she was found to experience fear and panic attacks in response to simulation of the subjective experience of suffocation via carbon dioxide inhalation, feelings which she and the others described as completely novel to them.[4]

S.M. is described as very outgoing, extremely friendly, and disinhibited, as well as "somewhat coquettish" (playfully flirtatious) and having an abnormally high desire and tendency to approach others.[5] She is greatly impaired in recognizing negative social cues, such as being incapable of recognizing fear in the facial expressions of other people[1] and having difficulty judging trustworthiness and approachability in the faces of others.[5][6] These traits show consistency with the fact that she tends to quite indiscriminately approach and engage in physical contact with others.[6] In addition, S.M. appears to experience relatively little negative emotion,[3] whilst simultaneously experiencing a relatively high degree of positive affect, despite great adversity in her life (more on that below).[5] In accordance, she tends to be very positive about most people, situations, and issues.[5] S.M. also exhibits impairments in the emotional processing of music; specifically, she shows selectively impaired recognition of sad and scary music.[7]

In addition to her lack of fear, S.M. shows a lack of a sense of personal space, and experiences virtually no discomfort standing extremely close to strangers, even nose-to-nose with direct eye contact. She does understand the concept of personal space however, and acknowledges that other people need more personal space than she does.[8] S.M. also shows memory differences. Emotionally arousing stimuli is well known to experience an enhancement of consolidation into long-term declarative memory (see emotion and memory), and this effect appears to be dependent on the amygdala.[9][10] In accordance, S.M. displays impaired declarative memory facilitation for emotional material, while her memory consolidation for neutral material is normal.[11][12] Additionally, S.M. appears to have a relatively high capacity for empathy compared to others,[5] which is in accordance with an emergence of "hyper empathy" in another woman who underwent right amygdalohippocampectomy to control severe epilepsy.[13]

Personal life

In her personal life, S.M. has been the victim of numerous acts of crime and traumatic and life-threatening encounters. She has been held up at both knifepoint and gunpoint, was almost killed in a domestic violence incident, and has received explicit death threats on multiple occasions. Despite the life-threatening nature of many of these situations however, S.M. did not exhibit any signs of desperation, urgency, or other behavioral responses that would normally be associated with such incidences. The disproportionate number of traumatic events in S.M.'s life has been attributed to a combination of her living in a dangerous area filled with poverty, crime, and drugs, and to a marked impairment on her part of detecting looming threats in her environment and learning to steer clear of potentially dangerous situations. S.M. herself has never been convicted of a crime.[3][14]

S.M. has been married and is an independent mother of three healthy children.[3][15]

See also

References

  1. ↑ 1.0 1.1 Adolphs R, Tranel D, Damasio H, Damasio A (1994). "Impaired recognition of emotion in facial expressions following bilateral damage to the human amygdala". Nature 372 (6507): 669–72. doi:10.1038/372669a0. PMID 7990957.
  2. ↑ Suzzan Babcock. In Search of Peace: For the Children. Author House. pp. 359–. ISBN 978-1-4969-5336-0.
  3. ↑ 3.0 3.1 3.2 3.3 3.4 Feinstein, Justin S.; Adolphs, Ralph; Damasio, Antonio; Tranel, Daniel (2011). "The Human Amygdala and the Induction and Experience of Fear". Current Biology 21 (1): 34–38. doi:10.1016/j.cub.2010.11.042. ISSN 0960-9822. PMC 3030206. PMID 21167712.
  4. ↑ Feinstein, Justin S; Buzza, Colin; Hurlemann, Rene; Follmer, Robin L; Dahdaleh, Nader S; Coryell, William H; Welsh, Michael J; Tranel, Daniel; Wemmie, John A (2013). "Fear and panic in humans with bilateral amygdala damage". Nature Neuroscience 16 (3): 270–272. doi:10.1038/nn.3323. ISSN 1097-6256. PMC 3739474. PMID 23377128.
  5. ↑ 5.0 5.1 5.2 5.3 5.4 Tranel D, Gullickson G, Koch M, Adolphs R (2006). "Altered experience of emotion following bilateral amygdala damage". Cogn Neuropsychiatry 11 (3): 219–32. doi:10.1080/13546800444000281. PMID 17354069.
  6. ↑ 6.0 6.1 Adolphs R, Tranel D, Damasio AR (1998). "The human amygdala in social judgment". Nature 393 (6684): 470–4. doi:10.1038/30982. PMID 9624002.
  7. ↑ Gosselin, Nathalie; Peretz, Isabelle; Johnsen, Erica; Adolphs, Ralph (2007). "Amygdala damage impairs emotion recognition from music". Neuropsychologia 45 (2): 236–244. doi:10.1016/j.neuropsychologia.2006.07.012. ISSN 0028-3932. PMID 16970965.
  8. ↑ Kennedy, Daniel P; Gläscher, Jan; Tyszka, J Michael; Adolphs, Ralph (2009). "Personal space regulation by the human amygdala". Nature Neuroscience 12 (10): 1226–1227. doi:10.1038/nn.2381. ISSN 1097-6256. PMC 2753689. PMID 19718035.
  9. ↑ Anderson, Adam K.; Phelps, Elizabeth A. (2001). "Lesions of the human amygdala impair enhanced perception of emotionally salient events". Nature 411 (6835): 305–309. doi:10.1038/35077083. ISSN 0028-0836. PMID 11357132.
  10. ↑ Strange, B. A.; Hurlemann, R.; Dolan, R. J. (2003). "An emotion-induced retrograde amnesia in humans is amygdala- and -adrenergic-dependent". Proceedings of the National Academy of Sciences 100 (23): 13626–13631. doi:10.1073/pnas.1635116100. ISSN 0027-8424. PMC 263864. PMID 14595032.
  11. ↑ Adolphs, R; Cahill, L; Schul, R; Babinsky, R (1997). "Impaired declarative memory for emotional material following bilateral amygdala damage in humans.". Learning & Memory 4 (3): 291–300. doi:10.1101/lm.4.3.291. ISSN 1072-0502.
  12. ↑ Adolphs, R. (2000). "Impaired Emotional Declarative Memory Following Unilateral Amygdala Damage". Learning & Memory 7 (3): 180–186. doi:10.1101/lm.7.3.180. ISSN 1072-0502. PMC 311327. PMID 10837507.
  13. ↑ Richard-Mornas, Aurélie; Mazzietti, Audric; Koenig, Olivier; Borg, Céline; Convers, Philippe; Thomas-Antérion, Catherine (2013). "Emergence of hyper empathy after right amygdalohippocampectomy". Neurocase 20 (6): 666–670. doi:10.1080/13554794.2013.826695. ISSN 1355-4794.
  14. ↑ Terburg, D; Morgan, B E; Montoya, E R; Hooge, I T; Thornton, H B; Hariri, A R; Panksepp, J; Stein, D J; van Honk, J (2012). "Hypervigilance for fear after basolateral amygdala damage in humans". Translational Psychiatry 2 (5): e115. doi:10.1038/tp.2012.46. ISSN 2158-3188. PMC 3365265. PMID 22832959.
  15. ↑ Amaral DG, Corbett BA (2003). "The amygdala, autism and anxiety.". Novartis Found Symp 251: 177–87; discussion 187–97, 281–97. PMID 14521193.

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