Elliot had a small tumour cut from his cortex near the brain's frontal lobe. He had been a model father and husband, holding down an important management job in a large corporation and was active in his church. But the operation changed everything.
Elliot's IQ stayed the same - testing in the smartest 3 per cent - but, after surgery, he was incapable of decision. Normal life became impossible. Routine tasks that should take 10 minutes now took hours. Elliot endlessly deliberated over irrelevant details: whether to use a blue or black pen, what radio station to listen to and where to park his car. When contemplating lunch, he carefully considered each restaurant's menu, seating and lighting, and then drove to each place to see how busy it was. But Elliot still couldn't decide where to eat. His indecision was pathological.
This was an unexpected discovery. At the time, neuroscience assumed that human emotions were irrational. A person without emotions should therefore make better decisions. His cognition should be uncorrupted. The charioteer should have complete control. To Damasio, Elliot's pathology suggested emotions are a crucial part of decision-making. Cut off from our feelings, the most banal decisions become impossible. A brain that can't feel can't make up its mind....
Damasio began studying other patients with similar brain damage. These all appeared intelligent and showed no deficits on any conventional cognitive tests. And yet they all suffered from the same profound flaw: because they didn't experience emotion, they had tremendous difficulty making decisions.
In his earlier book, Descartes' Error: Emotion, Reason And The Human Brain, Damasio described trying to set up an appointment with an emotionless patient: alternative dates are suggested and the patient pulls out an appointment book and consults the calendar. For 30 minutes the patient enumerated reasons for and against each of the two dates: previous engagements, possible meteorological conditions, virtually anything that one could reasonably think about. "He was now walking us through a tiresome cost-benefit analysis, an endless outlining and fruitless comparison of options and possible consequences. It took enormous discipline to listen to all of this without pounding on the table and telling him to stop," Damasio wrote.