“Can I Have My Amygdala Removed?”

By Neuroskeptic | October 7, 2018 6:45 am

Brain surgery is not usually something that people actively seek out. However, there may be an exception: the idea of the removal of the amygdala seems to hold a fascination for many people.

Questions about the desirability of an amygdala-free life can be found in many places online. On Quora, there have been many queries about what amygdala removal would entail, and at least one brave user outright asked Can I have my amygdala removed? I came across the question on two other sites within the past week.

amygdala21

So what’s going on? Those curious about amygdala removal seem to see it as the embodiment of fear, anxiety and stress. Would its removal really render you fearless? What would the side effects be?

Amygdala removal in humans is actually a fairly well-known procedure, but it isn’t used to reduce anxiety or fear. Amygdalectomy (also known as amygdalotomy) has historically had two main indications: to treat certain types of epilepsy, and to control of aggression, mostly in patients with mental illness and intellectual disability.

Doctors in Japan pioneered amygdalectomy for aggressive behavior in the early 1960s, using injections of oil and wax. Over the next two decades, perhaps 500 patients had variants of this procedure worldwide in a handful of centres including Indiana, USA and Madras, India.

While amygdala removal for psychiatric reasons is largely a thing of the past now, it isn’t quite extinct even today. In 2017, in China, doctors reported the amygdalectomy of a teenage girl with “mental retardation with psychiatric symptoms and aggression.”

medi-96-e5840-g002

So the answer to the Quora question is: yes, in theory, you could have your amygdala removed, although finding a surgeon willing to do it might be tricky.

But what would amygdalectomy do? In the patients who received the procedure for aggression, studies reported beneficial effects in most cases with relatively few side-effects (although a death rate of 3.8% occured in one study), but these data are hard to interpret because these patients had severe symptoms to begin with, and most of them received only cursory follow-up.

Fortunately, there do exist cases of ‘natural amygdalectomy’ in otherwise healthy people. The most famous such patient is called SM, who suffers from a rare genetic disorder called Urbach-Wiethe disease, causing her to suffer selective degeneration of the amygdala bilaterally.

Patient SM has been referred to as the “woman without fear”, as she displays no fear of snakes and spiders, or threatening situations, and is reported to be able to discuss traumatic events in her life with no distress whatsoever.

SM might therefore seem like an advertisement for the amygdala-less lifestyle. However, a more recent study revealed that SM (and two other patients with similar lesions) did experience fear and even panic in response to inhaling CO2, just like most people do. In fact, the amygdala-less patients seemed to experience more extreme panic than healthy controls did. This suggests that the capacity for fear was preserved in response to at least some stimuli.

What’s more, SM has been reported to have some difficulties in social interaction, including an impaired ability to take the perspective of others, and possible difficulties making eye-contact.

So, while ridding oneself of the curse of the amygdala might be technically possible, it’s not clear that it would be a good thing. Ultimately, evolution gave us the amygdala for a reason, and a life without fear might be a shortened one. I suspect what amygdalectomy-seekers are really looking for is a life without excessive fears that they feel are holding them back.

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  • Aina Puce

    SM also has had trouble recognizing threatening situations & has been a crime victim on numerous occasions. https://en.wikipedia.org/wiki/S.M._(patient)
    Would you really want to go through life like that?

  • katiedid

    I always wonder how deeply they interview family members when assessing how much a brain surgery “worked”. My mom had a burst aneurysm and emergency surgery in her frontal lobe and by all clinical accounts and interviews with her she was back to “normal”. But her personality is completely different from what it was pre-aneurysm and she is very childlike in a lot of ways.

    • Cricket

      This. My Dad had a business partner who had an aneurysm, and after his “recovery”, he seemed normal – but even his wife said he was someone else, and he was no longer capable of operating the business, doing considerable damage to some of the machinery that he’d been previously capable of operating, for instance. But legally, he was competent.

  • smut clyde

    Adolphs and Tranel long ago renounced their simple ‘amygdala = fear’ model and moved on to more sophisticated theories about recognising certain facial cues for processing facial expressions. Turns out, though, that journalists don’t want nuanced, hard-to-explain theories.

  • http://jayarava.blogspot.com Jayarava

    I have had great success with “eye-movement desensitisation and reprocessing” (EMDR) with defusing fear and anxiety associated with traumatic childhood memories. No brain surgery required. And free via the UK National Health Service.

    Its likely that if we ever have rational drug policies, that MDMA (aka Ecstasy) combined with EMDR style therapies will dramatically improve the treatment of trauma memories. Early studies are highly encouraging.

    • smut clyde

      I have no doubt that EMDR helps some people, but so did the placebo treatment of rhythmic finger-tapping, in one clinical comparison. This was followed by the announcement by EMDR’s promoter that rhythmic finger-tapping is in fact an alternative modality of EMDR, and both work equally well.

      Let us just say that the willingness of the NHS to pay for EMDR is a vexed point in some circles. Perhaps our host can be persuaded to blog about it.

      • http://jayarava.blogspot.com Jayarava

        Yes, my “EMDR” did not involve eye movements per se. But after decades of trying all kinds of therapies and drugs that did not work, this does.

        The NHS collect a lot of statistics – a questionnaire at every session – and I presume they would not be offering it if the results did not speak for themselves. A freedom of information request would probably secure an overview of those stats which would give some measure of effectiveness.

        But basically I don’t care what anyone says about it, because I’m free of crippling anxiety and flashbacks for the first time in 50 years. If placebo was going to cure me, then it would have done so for one or other of the other treatments over the decades.

      • Robert Nolan

        I had a session with my old therapist just using handles that vibrated in a varying rhythm, the point being synchronized bilateral stimulation (according to the current understanding as he knows it and as I know it, the principle behind EMDR) and it was profoundly different than any other session we had. Things clicked together. I was able to more easily go into deeper bases for my emotional responses to things. It was something, for sure.

    • Hana

      How do you feel? Does it really work? i suffer from intrustive thiughts disorder, would it work on me? Sorry but im very interested.

      • http://jayarava.blogspot.com Jayarava

        Sounds like it might be worth talking to a practitioner at least.

  • Smitty Werbenjagermanjensen

    Thoughts on this as a form of palliative care (especially for the bedridden), an amygdalectomy or something functionally akin to it using focused ultrasound.

    See https://www.youtube.com/watch?v=htYzFiVFbpQ & https://thejns.org/view/journals/j-neurosurg/aop/article-10.3171-2018.2.JNS172514.xml for the means.

    The wiki makes it sound perfect for this purpose:

    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.[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]
    https://en.wikipedia.org/wiki/S.M._(patient)#Characteristics

  • Dane Parker

    As one who suffers from generalized anxiety—but not fear or panic, though that doesn’t make my episodes any less miserable—I admittedly have often pondered the idea an amygdalectomy and its implications. But having subsequently researched the amygdala, it seems clear that (assuming anxiety and fear can be parsed into discrete structures) a bit more is involved; and so any neurologically surgical approach would need to encompass other areas of the brain.

    The upshot is such a solution is all the more daunting and unrealistic given all the unknowns and subsequent lack of precision such a procedure would presently entail. If it ever is to become a viable treatment option, we must increase our knowledge in a way that narrows our discernment of specifically anxiety and fear mechanisms of the brain. And even then we would need the surgical technology that could both selectively yet comprehensively target precisely all such regions involved. It is, as it were, sometimes a great notion.

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Neuroskeptic is a British neuroscientist who takes a skeptical look at his own field, and beyond. His blog offers a look at the latest developments in neuroscience, psychiatry and psychology through a critical lens.

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