“Like what?”
“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.”
II.
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.