Reimagining Boot Camp, Nursing Home Rebellions, and the Locus of Control
The trip was intended as a celebration, a twenty-nine-day tour of South America that would take Robert, who had just turned sixty, and his wife, Viola, first to Brazil, then over the Andes into Bolivia and Peru. Their itinerary included tours of Incan ruins, a boat trip on Lake Titicaca, the occasional craft market, and a bit of birding.
That much relaxation, Robert had joked with friends before leaving, seemed unsafe. He was already anticipating the fortune he would spend on calls to his secretary. Over the previous half century Robert Philippe had built a small gas station into an auto parts empire in rural Louisiana and had made himself into a Bayou mogul through hard work, charisma, and hustle. In addition to the auto-parts business, he also owned a chemical company, a paper supplier, various swaths of land, and a real estate firm. And now here he was, entering his seventh decade, and his wife had convinced him to spend a month in a bunch of countries where, he suspected, it would be awfully difficult to find a TV showing the LSU-Ole Miss game.
Robert liked to say there wasn't a dirt road or back alley along the Gulf Coast he hadn't driven at least once to drum up business. As Philippe Incorporated had grown, Robert had become famous for dragging big-city businessmen from New Orleans and Atlanta out to ramshackle bars and forbidding them from leaving until the ribs were picked clean and bottles sucked dry. Then, while everyone nursed painful hangovers the next morning, Robert would convince them to sign deals worth millions. Bartenders always knew to fill his glass with club soda while serving the bigwigs cocktails. Robert hadn't touched booze in years.
He was a member of the Knights of Columbus and the chamber of commerce, past president of the Louisiana Association of Wholesalers and the Greater Baton Rouge Port Commission, the chairman of his local bank, and a loyal donor to whichever political party was more inclined to endorse his business permits that day. "You never met a man who loved working so much," his daughter, Roxann, told me.
Robert and Viola had been looking forward to this South American trip. But when they stepped off the plane in La Paz, midway through the monthlong tour, Robert started acting oddly. He staggered through the airport and had to sit down to catch his breath at the baggage claim. When a group of children approached him to ask for coins, Robert threw change at their feet and laughed. In the bus to the hotel, Robert started a loud, rambling monologue about various countries he had visited and the relative attractiveness of the women who lived there. Maybe it was the altitude. At twelve thousand feet, La Paz is one of the highest cities in the world.
Once they were unpacked, Viola urged Robert to nap. He wasn't interested, he said. He wanted to go out. For the next hour, he marched through town buying trinkets and exploding in a rage whenever locals didn't understand English. He eventually agreed to return to the hotel and fell asleep, but woke repeatedly during the night to vomit. The next morning, he said he felt faint but became angry when Viola suggested he rest. He spent the third day in bed. On day four, Viola decided enough was enough and cut the vacation short.
Back home in Louisiana, Robert seemed to improve. His disorientation faded and he stopped saying strange things. His wife and children, however, were still worried. Robert was lethargic and refused to leave the house unless prodded. Viola had expected him to rush into the office upon their return, but after four days he hadn't so much as checked in with his secretary. When Viola reminded him that deer hunting season was approaching and he'd need to get a license, Robert said he thought he'd skip it this year. She phoned a doctor. Soon, they were driving to the Ochsner Clinic in New Orleans.
The chief of neurology, Dr. Richard Strub, put Robert through a battery of tests. Vital signs were normal. Blood work showed nothing unusual. No indication of infection, diabetes, heart attack, or stroke. Robert demonstrated understanding of that day's newspaper and could clearly recall his childhood. He could interpret a short story. The Revised Wechsler Adult Intelligence Scale showed a normal IQ.
"Can you describe your business to me?" Dr. Strub asked.
Robert explained how his company was organized and the details of a few contracts they had recently won.
"Your wife says you're behaving differently," Dr. Strub said.
"Yeah," Robert replied. "I don't seem to have as much get-up-and-go as I used to."
"It didn't seem to bother him," Dr. Strub later told me. "He told me about the personality changes very matter of fact, like he was describing the weather."
Except for the sudden apathy, Dr. Strub couldn't find evidence of illness or injury. He suggested to Viola they wait a few weeks to see if Robert's disposition improved. When they returned a month later, however, there had been no change. Robert wasn't interested in seeing old friends, his wife said. He didn't read anymore. Previously, it had been infuriating to watch television with him because he would flip from channel to channel, looking for a more exciting show. Now, he just stared at the screen, indifferent to what was on. She had finally convinced him to go into the office, but his secretary said he spent hours at his desk gazing into space.
"Are you unhappy or depressed?" Dr. Strub asked.
"No," Robert said. "I feel good."
"Can you tell me how you spent yesterday?"
Robert described a day of watching television.
"You know, your wife tells me your employees are concerned because they don't see you around the office much," said Dr. Strub.
"I guess I'm more interested in other things now," Robert replied.
"Oh, I don't know," Robert said, and then went silent and stared at the wall.
Dr. Strub prescribed various medications--drugs to combat hormonal imbalances and attention disorders--but none seemed to make a difference. People suffering from depression will say they are unhappy and describe hopeless thoughts. Robert, however, said he was satisfied with life. He admitted his personality change was odd, but it didn't upset him.
Dr. Strub administered an MRI, which allowed him to collect images from inside Robert's cranium. Deep inside his skull, near the center of Robert's head, he saw a small shadow, evidence that burst vessels had caused a tiny amount of blood to pool temporarily inside a part of Robert's brain known as the striatum. Such injuries, in rare cases, can cause brain damage or mood swings. But except for the listlessness, there was little in Robert's behavior to suggest that he was suffering any neurological disability.
A year later, Dr. Strub submitted an article to the Archives of Neurology. Robert's "behavior change was characterized by apathy and lack of motivation," he wrote. "He has given up his hobbies and fails to make timely decisions in his work. He knows what actions are required in his business, yet he procrastinates and leaves details unattended. Depression is not present." The cause of this passivity, Dr. Strub suggested, was the slight damage in his brain, which had possibly been triggered by Bolivia's altitude. Even that, however, was uncertain. "It is possible that the hemorrhages are coincidental and that the high altitude played no physiologic role."
It was an interesting but ultimately inconclusive case, Dr. Strub wrote.
Over the next two decades, a handful of other studies appeared in medical journals. There was the sixty-year-old professor who experienced a rapid "decrease in interest." He had been an expert in his field with a fierce work ethic. Then, one day, he simply stopped. "I just lack spirit, energy," he told his physician. "I have no go. I must force myself to get up in the morning."
There was a nineteen-year-old woman who had fallen briefly unconscious after a carbon monoxide leak and then seemed to lose motivation for the most basic tasks. She would sit in one position all day unless forced to move. Her father learned he couldn't leave her alone, as a neurologist wrote, when she "was found by her parents with heavy sunburns on the beach at the very same place where she laid down several hours before, under an umbrella: intense inertia had prevented her from changing her position with that of the shadow while the sun had turned around."
There was a retired police officer who began waking up "late in the morning, would not wash unless urged to do so, but meekly complied as soon as his wife asked him to. Then he would sit in his armchair, from which he would not move." There was a middle-aged man who was stung by a wasp and, not long after, lost the desire to interact with his wife, children, and business associates.
In the late 1980s, a French neurologist in Marseille named Michel Habib heard about a few of these cases, became intrigued, and started searching archives and journals for similar stories. The studies he found were rare but consistent: A relative would bring a patient in for an examination, complaining of a sudden change in behavior and passivity. Doctors would find nothing medically wrong. The patients scored normally when tested for mental illness. They had moderate to high IQs and appeared physically healthy. None of them said they felt depressed or complained about their apathy.
Habib began contacting the physicians treating these patients and asked them to collect MRIs. He then discovered another commonality: All the apathetic individuals had tiny pinpricks of burst vessels in their striatum, the same place where Robert had a small shadow inside his skull.
The striatum serves as a kind of central dispatch for the brain, relaying commands from areas like the prefrontal cortex, where decisions are made, to an older part of our neurology, the basal ganglia, where movement and emotions emerge. Neurologists believe the striatum helps translate decisions into action and plays an important role in regulating our moods. The damage from the burst vessels inside the apathetic patients' striata was small--too small, some of Habib's colleagues said, to explain their behavior changes. Beyond those pinpricks, however, Habib could find nothing else to explain why their motivation had disappeared.
Neurologists have long been interested in striatal injuries because the striatum is involved in Parkinson's disease. But whereas Parkinson's often causes tremors, a loss of physical control, and depression, the patients Habib studied only seemed to lose their drive. "Parkinsonians have trouble initiating movement," Habib told me. "But the apathetic patients had no problems with motion. It's just that they had no desire to move." The nineteen-year-old woman who couldn't be left alone at the beach, for example, was able to clean her room, wash the dishes, fold the laundry, and follow recipes when instructed to do so by her mother. However, if she wasn't asked to help, she wouldn't move all day. When her mother inquired what she wanted for dinner, the woman said she had no preferences.
When examined by doctors, Habib wrote, the apathetic sixty-year-old professor would "stay motionless and speechless during endless periods, sitting in front of the examiner, waiting for the first question." When asked to describe his work, he could discuss complicated ideas and quote papers from memory. Then he would lapse back into silence until another question was posed.
None of the patients Habib studied responded to medications, and none seemed to improve with counseling. "Patients demonstrate a more or less total indifference to life events that would normally provoke an emotional response, positive or negative," Habib wrote.
"It was as if the part of their brain where motivation lives, where élan vital is stored, had completely disappeared," he told me. "There were no negative thoughts, there were no positive thoughts. There were no thoughts at all. They hadn't become less intelligent or less aware of the world. Their old personalities were still inside, but there was a total absence of drive or momentum. Their motivation was completely gone."
The room where the experiment was conducted at the University of Pittsburgh was painted a cheery yellow and contained an fMRI machine, a computer monitor, and a smiling researcher who looked too young to have a PhD. All participants in the study were welcomed into the room, asked to remove their jewelry and any metal from their pockets, and then told to lie on a plastic table that slid into the fMRI.
Once lying down, they could see a computer screen. The researcher explained that a number between one and nine was going to appear on the monitor. Before that number appeared, participants had to guess if it was going to be higher or lower than five by pressing various buttons. There would be multiple rounds of guessing, the researcher said. There was no skill involved in this game, he explained. No abilities were being tested. And though he didn't mention this to the participants, the researcher thought this was one of the most boring games in existence. In fact, he had explicitly designed it that way.
The truth was, the researcher, Mauricio Delgado, didn't care if participants guessed right or wrong. Rather, he was interested in understanding which parts of their brains became active as they played an intensely dull game. As they made their guesses, the fMRI was recording the activity inside their skulls. Delgado wanted to identify where the neurological sensations of excitement and anticipation--where motivation--originated. Delgado told participants they could quit whenever they wanted. Yet he knew, from prior experience, that people would make guess after guess, sometimes for hours, as they waited to see if they had guessed wrong or right.
Each participant lay inside the machine and watched the screen intently. They hit buttons and made predictions. Some cheered when they won or moaned when they lost. Delgado, monitoring the activity inside of their heads, saw that people's striata--that central dispatch--lit up with activity whenever participants played, regardless of the outcome. This kind of striatal activity, Delgado knew, was associated with emotional reactions--in particular, with feelings of expectation and excitement.
As Delgado was finishing one session, a participant asked if he could continue playing on his own, at home.
"I don't think that's possible," Delgado told him, explaining that the game only existed on his computer. Besides, he said, letting the man in on a secret, the experiment was rigged. To make sure the game was consistent from person to person, Delgado had programmed the computer so that everyone won the first round, lost the second, won the third, lost the fourth, and so on, in a predetermined pattern. The outcome had been determined ahead of time. It was like betting on a two-headed quarter.
"That's okay," the man replied. "I don't mind. I just like to play."
"It was odd," Delgado told me later. "There's no reason he should have wanted to continue playing once he knew it was rigged. I mean, where's the fun in a rigged game? Your choices have no impact. But it took me five minutes to convince him he didn't want to take the game home."
Copyright © 2016 by Charles Duhigg. All rights reserved. No part of this excerpt may be reproduced or reprinted without permission in writing from the publisher.