In Antonio Damasio’s book, Descarte’s Error, he relates the story of a patient he calls Elliot, who appeared to be “intelligent, skilled and able-bodied,” but who nonetheless was incapable of working and whose application for disability benefits had been denied. When Dr. Damasio met Elliot, he was coherent and capable of talking about all that was occurring in the world, including political affairs, history, and business. His memory of his life story was flawless.
Elliot had an excellent job and was rising up the ladder in a good firm. Eventually, however, he began to develop headaches that interfered with his ability to concentrate. His condition worsened, and his work had to be completed or corrected by others. His family physician suspected a brain tumor, which turned out to be correct. Just above his naval cavities he had a tumor about the size of an orange that compressed both frontal lobes. Though benign, the tumor was growing rapidly and he had to undergo surgery if he were to survive. His medical team successfully removed the tumor. Unfortunately, however, he was left with a radical change in personality.
Though he continued to be intelligent, he could not get up for work without prompting. He proved to be unable to manage time, and devoted inordinate effort to activities that were only loosely related to his main tasks or were relatively trivial compared to other pressing matters. He read and understood the materials provided to him, but he would devote his time to activities he found most interesting rather than those that were most important. For example, he occasionally began sorting client documents, which he ordinarily did well. Suddenly fascinated by a particular document, he would waste an entire day reading and analyzing it, ignoring more important tasks. Soon he lost his job, fell prey to con artists, and lost all his money and his family.
Elliott suffered no anxiety from his poor decisions. He accepted catastrophic reversals with complete aplomb, never losing any sleep. He could have starved to death, calmly accepting his terrible fate.
Star Trek fans think of emotions as interfering with rather than supporting rationality. When the Enterprise faced annihilation at the hands of the evil Klingons, Captain Kirk nearly always turned to Mr. Spock, whose emotionless logical advice often saved the day. Had Elliott been advising Captain Kirk, he might have been too busy making a paper clip chain to consider how to maneuver the ship away from the Klingon death rays.
Decision-making can be rational only if we suffer the emotional consequences of error. Though anxiety can be disabling if it is excessive, it is an adaptation crucial for survival. If he were not a fictional character, it is likely that Mr. Spock would need Dr. Damasio to testify in his social security disability hearing.