We can make decisions using the prefrontal cortex , the executive brain , which is what conventional wisdom suggests or rely on emotions , the flurry of feelings arising from the limbic system
26
THE HEALTH | DECEMBER , 2023
| Column |
BRAINNOTES
Do we decide better using our emotions ?
We can make decisions using the prefrontal cortex , the executive brain , which is what conventional wisdom suggests or rely on emotions , the flurry of feelings arising from the limbic system
BY TONY PEREIRA
DO WE make better decisions using logic or emotion ? I imagine most people would say logic . Recently I had the experience of seeing both processes in action . But more about that later . When we fall in love , where does that feeling come from ? Wedding invitations , Valentine ’ s Day cards , Hallmark movies , that fuzzy , romantic feeling , what ’ s that ?
We would be tempted to say that the feeling of love is something generated in our heart . For sure , when we lose someone , there is an ache that we literally feel in our hearts .
But in reality , these feelings arise from a part of the brain called the limbic system . To be clear , the limbic system refers to a collection of different brain structures ( see diagram ) including the amygdala , hippocampus , thalamus , hypothalamus and basal ganglia .
The amygdala is the panic button in the limbic structure . When we feel threatened , the amygdala is activated , alerting other parts of the brain of the imminent threat .
The thalamus functions as a relay station in the brain . All sensory information comes via the thalamus and is transmitted to other brain parts . Emotions , like fear , anger , anxiety , and happiness arise from the limbic system .
The feeling of love for example , happens when the brain releases a neurotransmitter called oxytocin . It gives us the feeling of bonding . Parents also experience the release of oxytocin when they see their newborn child . The next time you see your kid or partner , and you feel this warm sensation , it is oxytocin being released .
The prefrontal cortex is that part of the brain which is sometimes referred to as the executive brain . This portion of the brain is activated when we are in problem-solving mode or have to make difficult decisions . This part of the brain uses more energy than the limbic system ; hence , we get tired when we use the prefrontal cortex for an extended period without rest .
RELYING ON EMOTIONS
Recently , I was confronted by a difficult medical situation . What I went through has made me question – do we make better decisions using the prefrontal cortex , the executive brain , which is what conventional wisdom suggests or relying on emotions , the flurry of feelings arising from the limbic system ?
To summarise the situation : I developed an infection . I believe it was triggered after I had a meal in a restaurant . Something must have been contaminated .
The thalamus functions as a relay station in the brain . All sensory information comes via the thalamus and is transmitted to other brain parts . Emotions , like fear , anger , anxiety , and happiness arise from the limbic system .”
The bacteria causing the infection was identified as Enterococcus . The urologist prescribed an antibiotic and said that it would take a few days for the infection to be cured . I felt much better , but when I went for a follow-up consultation , the specialist suspected the bacteria was still in my system .
He said they would do another test , and if it was still positive , he asked me to start on Augmentin , an antibiotic . Augmentin is a well-known drug , and I did not give it a second thought .
I did not appreciate that Augmentin is penicillin based , and I am allergic to penicillin . Although there was a note of that on my file , the doctor missed it . After just one day , I realised something was wrong , and a quick search on the internet told me why .
I went to the emergency at my usual hospital , and the medical staff suggested admission to deal with the rashes that had developed all over my body . From there on , everything is a blur . I took a turn for the worse . It was feared that my allergic reaction had progressed to Stevens-Johnson syndrome , a rare but very serious skin condition . I was going downhill . The doctors also believed I had also developed sepsis , as there was bacteria in the blood culture .
As I reflect on decisions that were being made all around me , a number of thoughts come to mind : when I was first admitted , the medical team attending to me adopted a typical System 1 thinking , which is the automatic response .
I had an allergy , and the normal response is to administer an antihistamine and a steroid . When I did not improve , the team continued to adopt System 1 thinking and increased the dosages . This continued for a few days .
I recall the specialist telling me that this was the standard treatment given to a patient in my condition . But the allergy worsened , and I was getting seriously ill .
It was put to me that I had Acute Generalised Exanthematous Pustulosis
Tony Pereira is an Independent Consultant and Founder of SuperTrouper365
( AGEP ), an uncommon pustular drug eruption characterised by superficial pustules and later , Stevens-Johnson which is a rare and extremely serious condition that causes your skin to come loose and detach .
I believe the judgment of the medical team was influenced by an element of worry - the standard amygdala response because an oversight on their part caused the initial problem .
WHEN LOGIC , NOT EMOTION IS APPLIED
It was at this point , where a bit of System 2 thinking would have been helpful . But I feel that in all the confusion and worry , the response was the typical fight , freeze , or flee response instead , which took over .
When this happens , clarity is absent . What was necessary at that point was a step back to analyse the situation and come up with a different approach . My wife made the final decision as to what to do . She asked for all medication to be stopped .
A distraught wife taking on the doctors ? The classic emotion versus logic tension ? The medical team warned her this was a significant risk but she held firm .
When all the steroidal medication was finally discontinued upon her insistence , I immediately started to improve . I am thankful I am here to tell the tale !
I later asked my wife how she had the courage to rely on her emotions to make this decision and even suggested that sometimes we get the right outcome when we use emotion . She pondered for a bit , then told me that probably it was not emotion but logic that she applied .
She was closely observing me , the patient . The deterioration was accelerating as the medication was being upped . Perhaps it was the doctors who might have been swept away by emotion , fear and anxiety ( the limbic system ) when the prescribed treatment wasn ’ t yielding results and that stopped them from applying good , old-fashioned observation and logic ( prefrontal cortex ).
What I took away from my 12-day stay in the hospital is that even the most accomplished medical experts , men and women of science , may automatically use System 1 when oftentimes , System 2 thinking is actually required . I experienced firsthand the consequences of this when individuals react to messages relayed from the amygdala .
No matter what profession we are in , however qualified we may believe we are , it is important from time to time , to stop , take a step back , re-look , and re-analyse . It may very well make the difference between life and death .
The brain is amazing . Use it well . – The Health