Tranel Daniel, Gullickson Greg, Koch Margaret, Adolphs Ralph
University of Iowa College of Medicine, Iowa City, Iowa 52242, USA.
Cogn Neuropsychiatry. 2006 May;11(3):219-32. doi: 10.1080/13546800444000281.
It has been well established that the amygdala is critical for processing various aspects of emotion, and in particular, for the perception of negative emotions such as fear. Perhaps the strongest evidence for this conclusion in humans comes from an extensive series of investigations in patient SM, an extremely rare neurological patient who has complete, focal bilateral amygdala damage. One question that has remained unanswered, however, is whether SM has a normal phenomenological experience of emotion, especially negative emotion. To explore this issue, we designed a study in which two experienced clinical psychologists conducted "blind" interviews of SM (the psychologists were not provided any background information regarding SM), with a special emphasis regarding the nature of her emotional experience. Both of them reached the conclusion that SM expressed a normal range of affect and emotion, and neither felt that SM warranted a DSM-IV diagnosis. However, they both noted that SM was remarkably dispassionate when relating highly emotional and traumatic life experiences, and they noted that she did not seem to have a normal sense of distrust and "danger". To the psychologists, SM came across as a "survivor", as being "resilient" and even "heroic" in the way that she had dealt with adversity in her life. In the full light of SM's neurological and neuropsychological profile, however, these observations reflect the fact that SM is missing from the experiences in her life some of the deepest negative emotions, in a manner that parallels her defect in perceiving such emotions in external stimuli. These findings have interesting parallels with recent animal work (cf. Bauman, Lavenex, Mason, Capitanio, & Amaral, 2004a), and they provide valuable insights into the emotional life of an individual with complete bilateral amygdala damage.
杏仁核在处理情绪的各个方面，尤其是在感知恐惧等负面情绪方面起着关键作用，这一点已经得到了充分证实。在人类中，支持这一结论的最有力证据可能来自对患者SM进行的一系列广泛调查。SM是一位极其罕见的神经学患者，双侧杏仁核局部完全受损。然而，一个尚未得到解答的问题是，SM是否具有正常的情绪现象学体验，尤其是负面情绪体验。为了探讨这个问题，我们设计了一项研究，由两位经验丰富的临床心理学家对SM进行“盲法”访谈（心理学家未被告知任何有关SM的背景信息），特别关注她的情绪体验的性质。他们两人都得出结论，SM表现出正常范围的情感和情绪，两人都认为SM不符合《精神疾病诊断与统计手册》第四版（DSM-IV）的诊断标准。然而，他们都指出，SM在讲述高度情绪化和创伤性的生活经历时非常冷静，而且他们注意到她似乎没有正常的不信任感和“危险”感。对心理学家来说，SM给人的印象是一个“幸存者”，她在应对生活中的逆境时表现得“坚韧”甚至“英勇”。然而，从SM的神经学和神经心理学特征来看，这些观察结果反映出这样一个事实：SM在生活经历中缺失了一些最深刻的负面情绪，这与她在外部刺激中感知此类情绪的缺陷类似。这些发现与最近的动物研究（参见Bauman、Lavenex、Mason、Capitanio和Amaral，2004a）有有趣的相似之处，它们为双侧杏仁核完全受损个体的情感生活提供了有价值的见解。
