The Woman Who Felt No Fear

0:00Hi, I'm Wendy Zukerman and you're listening to Science Versus. Today on the show, we are opening up a case file.

0:11This is where we report on case reports, which are curious stories from the scientific nerd literature. Basically an N of 1, a patient where something weird as f*** happened to them to go on this adventure. We have science journalist and friend of the show, Joel Werner. Hello. Hello. I'm a curious nerd. This is perfect. Let's go. All right, Joel, to kick us off today, can you tell me about a time that you felt afraid? Very afraid. Look, it's a long list. My fear runs deep. Really? Are you afraid, Kat? Oh, yeah, absolutely. I think the last time I felt truly afraid was when I found out how many people listen to podcasts at double speed.

0:53What's wrong with you people? This is supposed to be a fun thing. You're supposed to relax. Don't rush through it. No, but seriously, growing up in Australia, I spent a lot of time in the ocean as a kid. And it's really easy for the ocean to go from being like an idyllic, beautiful day to being a near-death experience. And like, I have this one memory of being at a surf beach and I had gone to the beach with some friends and we'd sort of swum out beyond the first breakers, like the shore break where the first waves crash and we're catching some waves, you know, frolicking in the water. It's like a soda commercial.

1:31And then, uh, yeah, suddenly get dumped by a wave, get thrown around underwater, stick my head up, take in a breath. And as I come up, there's another wave crashing on me straight away. And so it happens again. And then I think when the waves hit in a particular frequency, then you suddenly just like you're every gasp of air is a little bit shallower than the last one and you start panicking a little bit. Is that what you were doing? Oh, definitely. Yeah, yeah, yeah. I was, it went from feeling like, you know, oh, I've been thrown around for one or two waves to being like, if this keeps going, if I don't get out of this, then there's a good chance that something bad could happen.

2:10So what did you do? How did you get out? Well, I ended up being able to swim with the waves. So I kind of caught a wave through to that shore break area. And then once you can stand, you can kind of like stand up and battle the surf. with your legs as well. But I think it's that feeling when you're just floating in the ocean and getting pummeled by the waves. It's, yeah, it's pretty intimidating. Well, today on the show, we're telling you about someone who would be in that situation and their heart might not even skip a beat. They wouldn't be scared at all. Wow. Someone who has nerves of steel.

2:44Not the fraidy cat that I am. Someone the complete opposite of you. And it's all coming up after the break.

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4:06Welcome back today on the show. We're bringing you a case file, strange reports, case reports from the literature. And we're here with Joel Werner. Hello, hello. Hello. All right, we're going to jump right in. This is a story about a woman who we're going to call SM. And years ago, she started getting these strange spells where she would smell a funny odour, and it was followed by this sensation of being detached or feeling like she was watching herself from above. And so she gets a referral to the University of Iowa for a check-up, see what's going on. She heads there, and in a paper about SM, and kind of this moment, really, doctors describe her as pleasant and cheerful, but also quick to become friendly with examiners and experimenters.

5:01Which is exactly how Dr. Justin Feinstein, who worked at the University of Iowa, describes her. She's extremely friendly. She's very trusting. thing, she starts speaking to you right away as if you have this long history, as if she's already your friend. The next thing you know, she's asking personal details about your life and she's telling you very personal details about her life. So she's a bit too much. We all know people like this. So this isn't, you know, we don't need to study people who are just like don't know boundaries, don't understand social boundaries, right? But there's some other reasons we might want to study So doctors start running tests to see what's going on with these spells.

5:44And they give her a CT scan, which uses a kind of X-ray on your brain. And normally with a CT scan, you just want to see a lot of grey brain. That's how, you know, you don't want to see like white patches in there, suggesting there's some bone somewhere in your brain. But here's what they saw when they looked at SM's brain. It's quite exquisite. What they saw was very much unprecedented at the time. It was these two bean-shaped patterns, hyper-intense, bright white patterns. So weird. It's so weird. Looking at the CT scans, it's so specific. It's really bizarre. Even neurosurgeons said, how is nature carving out this little almond-shaped nucleus and leaving the rest of the brain mostly intact?

6:37So bright white patterns, like with an x-ray, does suggest there's something hard in your brain. Huh. Let me show you this CT scan. So you see those little... Oh, yeah. Like they jump out at you. It's almost like two sort of eyes within the brain. Yeah, little poked out eyes. Yeah, not meant to be there. For you and me, presumably, yeah, that should look grey. So it turns out that SM has a genetic mutation that calcifies this very particular part of her brain. So the rest of her brain is fine. It's just these specific almond-shaped bits get calcified. Yes. It's so weird. It's so weird. The condition is called Urbach-Vitae disease.

7:23It does other things to your body, but in the brain, it's just really calcifying those two almond-shaped bits. That's so bizarre. And the bits that this disease is going after, very interesting, it's the amygdala. Ah, okay. Joel, you did a bit of a brain. I've dabbled in neuroscience in the past. Yes. What does the amygdala mean to you? Well, given the story we were talking about before as well, which is like maybe a big clue, it sort of has something to do with the way that we process fear. Yes. Yes, exactly. So the amygdala, we have two on each side of our brains, but for SM, she has none. And it's really, the amygdala is considered the fear center of the brain.

8:13It does other stuff, but as one paper put it, in the minds of many scientists, the amygdala is synonymous with fear. And basically many researchers have thought that you need it to feel fear. So we use the amygdala to recognize fear, to feel fear. when you look at pictures of threatening animals and threatening people, your amygdala lights up. There have been studies into what happens if we mess up an animal's amygdala. So rats who have lesions in their amygdala will go up to a cat. In fact, one of the rats in this very particular study nibbled on the cat's ear. Cat didn't like that. No, no, not a wise decision if you're a rat.

8:57No, no. So do they think that, so say when I'm out in the surf and I'm getting pounded by these waves and then I start to think, oh, maybe I can't get out and that panic feeling overwhelms my brain, that's the neurons in my amygdala are firing off. Yes. Yeah, they're playing a big role in that whole reaction that you're feeling. But if I have these calcified almonds in their place, then maybe I'm just like, lovely day for a surf today. Well, the question was, how would she react? Particularly at this stage when doctors are just meeting her. And this is exactly what they wanted to know. Because she is so unique here in the world of like brain science.

9:41Justin said that at this University of Iowa, they basically collected patients with weird brain lesions and brain stuff going on. It's like a very specific type of Pokemon card. Like you got to collect them all. They had like thousands of people with different brain conditions. Amazing. And with SM. SM is one of the only living humans walking around this earth without an amygdala. So researchers wanted to study her. And researchers like Justin to find out what does this mean? Does she really not feel fear? Would she really go into that water? And how would she react? She's bungee jumping every weekend, going skydiving.

10:21Well, great, great example because just to give you a bit of context about what's possible here, do you know who Alex Honnold is? He's a climber who climbed El Capitan. Oh, the Free Solo guy. Yes, yes, yes, yes. Okay, so he, for those who don't know, there was a documentary about him called Free Solo. He climbed this cliff 3 ,000 feet up into the air without a harness, without a rope, just him on his own. I feel like my amygdala was like working overtime just watching that documentary. I was having sweaty palms, like that sinking feeling in your stomach. And so he has a functioning amygdala, but researchers have found that it's a little bit tamped down.

11:10So when they did some studies on him, they were like, they showed him images that with you and me, our amygdalas would be like, bing, bing, bing, bing, bing. and his was like, so that is what's possible. And yet he still has an amygdala. Wow. And I just do want to say that the reason scientists wanted to get to the bottom of this, it's not just as a medical curiosity of what is SM capable of, but understanding what the amygdala does, understanding fear could help us with many different things. It could help us understand how we all understand fear. It could help us unravel treatments for PTSD and anxiety, which in some cases are thought to be where your fear response is maybe a little different to other people.

11:57So the researchers start doing experiments on SM. And they start simple. Like at first they'll show her these photos of people's faces with different expressions on them. It's a very sort of classic experiment. Surprise and disgust and anger and happiness and fear. She clearly could see the picture. She could tell if it's male or female. She could tell you all the description of what color hair they have, what color eyes they have. She could recognize anger and happiness and disgust. But then fear, she had this whopping deficit. Wow. Yeah, she couldn't recognize when someone else was afraid. It's not that she just can't recognize emotion generally in people, that she's picking up all of these other emotions, but then fear, nothing.

12:45Yeah, the whopping death. It's very strange, right? Next, they wanted to know, basically, could we scare her? And they really wanted to do what's called condition this fear response into SM. So what they do is they show her slides with different colours. And when a blue square would appear, the shape would be paired with a very loud boat horn.

13:15Wow. Look, I had a boat on and then forgot it at home. Like, I'm not going to lie. I'm kind of thankful that I didn't get pranked by a blowhorn. This isn't like early 2000s reality TV. This is serious science journalism here. It was really loud. I also feel like what else are they conditioning? Well, the thing is, for you and me, it wouldn't take that long to show us the blue square, pair it with the loud sound, and then as soon as we see the blue square, we'll be like, but for SM, never flinched. What? Never had any reaction. They could not condition her to feel fear. Amazing. All right, they ask her questions out in the real world.

14:01Have you ever been scared? And they get into specifics, asking her questions about things that a lot of people are scared of. what kind of animals do you not like? Is there anything that maybe you're afraid of or you just don't find very pleasant? And she goes, well, I'm not really afraid of any animals, but I just don't like snakes. She kept saying that. Snacks. Fair. Now, it's interesting here because Justin and his colleagues think that SM's brain wasn't always, like the amygdala wasn't always calcified in that way and that it actually started in her adolescence. And maybe when she was younger, she had an amygdala because she had stories that when she was little, she did feel fear.

14:48And she told this story that when she was on a hike with her dad, she actually fell into this pit of baby snakes. And she remembers at that time being extremely scared and yelling for her father to come get her out of it. But Justin figures, well, fast forward. Let's see how she reacts to snakes now. So he takes her to an exotic pet store. Picture it. I don't know, 50 or so cages of different snakes. They had small ones, very tiny Slytherin snakes. They had really large ones that probably were almost 8 to 10 feet. Did she show any sign of fear? She did not. It was so fascinating. In fact, it was the exact opposite.

15:38She was extremely curious. You know, I'll never forget her holding one of the snakes and touching its flicking tongue and looking right into its eyes and going almost nose to nose. Wait, so she intellectually understood that she should have some kind of fear of snakes based on this early childhood experience, but she actually didn't feel the fear when confronted with this eight-foot snake. Yeah, even though she had said, you know, I don't like them, she showed no sign of that. And, in fact, at one point the employee at the store had to tell her, like, stop trying to touch the snakes because we think you're going to get bit and some of these snakes are actually quite dangerous.

16:22Wow. And Justin thought maybe there was something about being in the pet store that made her kind of blasé about snakes. Like maybe, you know, it felt like a safe environment. And so he asked her son, one of her sons, has she ever showed, you know, this kind of fear in the real world? And her son actually told this story of a time where he and his other brother were playing in the yard and they see this really big snake and they say, oh my God. And again, SM just grabs the snake, just throws it onto the grass, gets it away. and the son said she seemed to feel this. Wow. That's like some Steve Irwin level snake handling there.

17:06It's like, let's just get it out of here. I know. Justin takes it up a notch and takes her to a very scary spot. I can't believe you took her to a haunted house as part of a study. You know, and it wasn't just any haunted house. It was Waverly Hills Sanitarium, which is considered one of the most haunted places in the world. Okay, so Waverly Hills Sanatorium in Kentucky used to be a hospital for tuberculosis patients and a lot of people died there. A lot of people died. And it closed down decades ago, was abandoned, but now you can go on tours there. The sanatorium even has a TikTok account. So, Joel, I want you to describe this video.

17:55it is scary. It looks like, I mean, I'm not into haunted houses, but this looks like a scary place. What are you seeing? Okay, so there's like, it's a very gothic looking building. There's gargoyles on the top. Oh, we're going down some creepy stairs. Yeah. Oh, what's that on the walls? Yeah. Okay. I'm out already. Like if I'm there, I'm just like looking for the entrance. It looks really scary, right? It looks pretty weird. Yeah. I gotta say though, it's kind of weird hearing a scientist talk about like one of the most haunted places in America. It's like, buddy, come on. What's even funnier here is that other papers have cited this paper with quite seriousness and been like, look, they even took her to a haunted house, guys.

18:42It was rating a nine on the haunted scale as deeply haunted. But it's a freaky place. It's a creepy place. And when Justin took SM, it was actually Halloween when the owners of the sanatorium really go to town and they create this very intense experience. It was extremely creepy. Imagine, you know, going in through very dark corridors into rooms that you can't really tell what's on the other side. Really loud bangs and startling sounds going off. Chainsaws coming out, the strobing lights, the people hiding in weird corners. It was managing to scare me, but there was SM leading us into battle saying, this way, guys, follow me, go through this hallway, now let's go through this.

19:29She was having a blast. Amazing. She's just like, cocktail hour. Exactly. Can we get that chainsaw on some lines? I want a mojito. She never screamed, never jumped backwards, never flinched. lind justin wrote she would gaze with amusement at the monstrous creatures smiling or laughing at them in one instance even scaring an actor she's given it back she's just like i'm here to party let's go and i have to say that at this point reading about sm i was a little bit jealous about what it would be like to have no amygdala, to live like that. Just to think of all the things that I haven't done in my life because I've been afraid and she feels no fear.

20:20How are you feeling? I don't know. Like, I feel like fear, like, and you know, correct me if I'm wrong, but I feel like fear plays an important part in like our survival, you know, like it's good to be afraid of things. That is exactly what Justin said. Justin was like, you know, we need that spidey sense telling us, don't jump into that water, don't eat those poisonous berries. Don't believe the myth of trickle-down economics. Yeah, I mean, don't go down that street, don't approach that person or that snake. Here's Justin again. The whole point of fear is to teach you something, right? So the amygdala's role is really to keep you alive.

21:05and to keep you away from the things that can kill you. And not having a functioning amygdala, at times for SM, it has been rough. Her life has actually been at risk quite a few times. So researchers like Justin, who study SM, have protected her privacy very carefully and no journalists have ever been able to talk to her. But several years ago, when Alex Spiegel was co-hosting the NPR podcast Invisibilia, she was able to send a short list of questions to one of the neuroscientists who's been studying SM for the last few decades. His name is Daniel Trinnell. And SM told him this story. So it's nighttime.

21:44She's walking through a park near a church. I was walking to the store and I saw this man on the park bench. He said, come here, please. So I went over to him. I said, what do you need? He grabbed me, tried to hurt, and he held a knife to my throat and told me he was going to cut me. I told him, I said, go ahead and cut me. I said, I'll be coming back and I'll hunt your ass. Oops, am I supposed to say that? I'm sorry. That's okay. It's an intense situation. How did you feel when that happened? I wasn't afraid. And for some reason he let me go. And I went home. Call the police? No. What an intense story.

22:40She's got a knife held to her throat by a man in a dark park and still doesn't feel fear. Yes. And she told Justin this story too. And she even took him to the park where it happened. The way she describes it is she wasn't panicked. She could hear the church choir in the background actually practicing. And it sounds like the guy may have been a little freaked out by how calm she was, and he let her go, and she walked home. Wow. Isn't that, it's like, it's so, and the fact that she walked home, Justin said she didn't run. She just walked. And I guess this is what we were talking about before, when like, you know, fear is very useful because for most of us, if we're in that situation, we're not even approaching the creepy guy on the bench.

23:32We're clocking him and just getting out of there as soon as we can. Yeah. And it's not just this incident with the knife. At another time, a stranger put a gun to her head, yelled at the top of his lungs, bam, before running away. That didn't scare her. SM said she found the whole experience strange. So are there situations where anyone with a functioning amygdala would be out of there, would have sort of sensed the fear in the moment and would have sort of extracted themselves from that situation? But for her, because she doesn't have that ability, her brain just doesn't experience that fear.

24:08She just stays in the situation until it's too late, essentially, and people are pulling knives and pulling guns on her. Is that sort of what they think is happening? That why, I mean, she also lives in an area that's not super safe. There is a lot of violence. There's a lot of drug violence where she lives. And in that instance with the gun, how it happened is that her kid had found some drugs in the yard. And she suspected who it was in the neighbourhood who was dealing and went to the police and just said, that's that person. and as a result was getting a bunch of threatening letters, including a gun being pointed at her.

24:48But it's the sort of thing that if you live in that neighborhood and you've got kids, I don't think I would be going to the cops. Keep your head down. Keep your head down. And whereas she doesn't have that level of fear, so she just was like, well, I don't want drugs in my neighborhood. Wow. Yeah. And like the other really sort of curious thing about these times is if any of this stuff happened to you and me, it would stay with us. We would, you know, for weeks, you know, months, maybe, maybe years, we would be thinking over this time about how terrible it was, you know, because the amygdala plays such an important role in, like, capturing those memories.

25:32But maybe it's not so surprising that with SM... The traumatic events do not seem to stick. It doesn't seem to have an imprint on her long term. So when you would ask her about these horrible events, how would she react? She would tell you very matter-of-factly what had happened. And in some cases, she would actually tell you it with a bit of pride, like, look what, you know, I've had to overcome in life. So by this point, when it comes to sort of Justin's journey of trying to scare SM, and doing all these experiments over years. I mean, he's really thinking, this woman just cannot feel afraid.

26:17She seemed fearless. After the break, forget snakes and haunted houses, Justin is going to try something completely different that may just change the way we think about fear.

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