How We Decide (15 page)

Consider the case of Mary Jackson, an intelligent and driven nineteen-year-old with a bright future. Although she grew up in a blighted inner-city neighborhood, Mary received a full scholarship to an Ivy League university. She was a history major with a pre-med concentration and hoped one day to become a pediatrician so she could open up a medical clinic in her old neighborhood. Her boyfriend, Tom, was an undergraduate at a nearby college, and they planned to get married after Mary finished medical school.

But then, in the summer after her sophomore year, Mary's life began falling apart. Tom noticed it first. Mary had never drunk alcohol before—her parents were strict Baptists—but she suddenly started frequenting bars and dance clubs. She began sleeping with random men and experimented with crack cocaine. She disowned her old friends, avoided church, and broke up with Tom. Nobody knew what had gotten into her.

When Mary returned to school, her grades began to slip. She stopped attending class. Her semester report card was dismal: three F's and two D's. Mary's adviser warned her that she would lose her scholarship and recommended psychiatric counseling. But Mary ignored the suggestion and continued to spend most of her nights at the local bar.

Later that spring, Mary developed a high fever and a hacking cough. At first, she assumed her sickness was just the side effect of too much partying, but the sickness wouldn't go away. She went to the student health center and was diagnosed with pneumonia. But even after she was treated with intravenous antibiotics and oxygen, the fever lingered. Mary's immune system seemed compromised. The doctors ordered more blood tests. That's when Mary learned she was HIV-positive.

Mary immediately broke down in a fit of hysterical tears. She told her doctor that she didn't understand her own behavior. Until the previous summer, she had never felt the urge to do drugs or sleep around or skip class. She had been diligently focused on her long-term goals of going to medical school and starting a family with Tom. But now she was unable to control her own impulses. She couldn't resist temptation. She made one reckless decision after another.

Mary's doctor referred her to Dr. Kenneth Heilman, a distinguished neurologist now at the University of Florida. Heilman began by giving Mary some simple psychological tests: He asked her to remember a few different objects, and then distracted her for thirty seconds by having her count backward. When Heilman asked Mary if she could still remember the objects, she looked at him with a blank stare. Her working memory had vanished. When Heilman tried to give Mary a different memory test, she flew into a rage. He asked her if she had always had such a bad temper. "Up to about a year ago, it was extremely rare that I got angry," Mary said. "Now it seems I am always flying off the handle."

All of these neurological symptoms—the diminished memory capacity, the self-destructive impulsiveness, the uncontrollable rage—suggested a problem with Mary's prefrontal cortex. So Heilman gave Mary a second round of tests: He put a comb in front of her but told her not to touch it. She immediately started combing her hair. He put a pen and paper in front of her but told her to keep her hands still. She automatically started writing. After scribbling a few sentences, however, Mary became bored and started looking for a new distraction. "It seemed that rather than having internal goals motivate her behavior," Heilman wrote in his clinical report, "she was entirely stimulus dependent." Whatever Mary saw, she touched. Whatever she touched, she wanted. Whatever she wanted, she needed.

Heilman ordered an MRI. That's when he saw the tumor: a large mass emanating from the pituitary gland and pressing on Mary's prefrontal cortex. This was the cause of her decline. That growth had left her with executive dysfunction, an inability to maintain a coherent set of goals and contemplate the consequences of one's actions. As a result, Mary was unable to act on any ideas but the most immediate. The tumor had erased some of the necessary features of the human mind: the ability to think ahead, plan for the future, and repress impulses.

"You see this with a lot of patients with frontal-lobe problems," Heilman says. "They can't hold back their emotions. If they get angry, then they'll just get in a fight. Even if they know that getting in a fight is a bad idea—the cognitive knowledge might still be there—that knowledge is less important than the intensity of what they are feeling." Heilman believes that in Mary's case, her damaged prefrontal cortex meant that her rational brain could no longer modulate or restrain her irrational passions. "She knew her behavior was self-destructive," Heilman says. "But she did it anyways."

The tragic story of Mary Jackson illuminates the importance of the prefrontal cortex. Because she was missing this specific brain region—it was damaged by the tumor—she couldn't think abstractly or resist her most immediate urges. She was unable to keep information in short-term memory or follow through on her long-term plans. If Mary Jackson was fleeing a fire, she never would have stopped to light the match. She would have kept on running.
^*

Imagine that you are playing a simple gambling game. You are given fifty dollars of real money and asked to decide between two options. The first option is an all-or-nothing gamble. The odds of the gamble are clear: there is a 40 percent chance that you will keep the entire fifty dollars, and a 60 percent chance that you will lose everything. The second option, however, is a sure thing. If you choose this alternative, you get to keep twenty dollars.

What option did you choose? If you're like most people, you took the guaranteed cash. It's always better to get something rather than nothing, and twenty dollars is not a trivial amount of money.

But now let's play the game again. The risky gamble hasn't changed: you still have a 40 percent chance of keeping the entire fifty dollars. This time, however, the sure thing is a loss of thirty dollars instead of a gain of twenty.

The outcome, of course, remains the same. The two gambles are identical. In both cases, you walk away with twenty of the original fifty. But the different descriptions strongly affect how people play the game. When the choice is framed in terms of
gaining
twenty dollars, only 42 percent of people choose the risky gamble. But when the same choice is framed in terms of
losing
thirty dollars, 62 percent of people opt to roll the dice. This human foible is known as the framing effect, and it's a by-product of loss aversion, which we discussed earlier. The effect helps explain why people are much more likely to buy meat when it's labeled
85 percent lean
instead of
15 percent fat.
And why twice as many patients opt for surgery when told there's an 80 percent chance of their surviving instead of a 20 percent chance of their dying.

When neuroscientists used an fMRI machine to study the brains of people playing this gambling game, they saw the precise regions that these two different yet equivalent frames activated. They found that people who chose to gamble—the ones whose decisions were warped by the prospect of losing thirty dollars—were misled by an excited amygdala, a brain region that, when excited, evokes negative feelings. Whenever a person thinks about losing something, the amygdala is automatically activated. That's why people hate losses so much.

However, when the scientists looked at the brains of subjects who were
not
swayed by the different frames, they discovered something that surprised them. The amygdalas of these "rational" people were still active. In fact, their amygdalas tended to be just as excitable as the amygdalas of people who were susceptible to the framing effect. "We found that everyone showed emotional biases; no one was totally free of them," says Benedetto de Martino, the neuroscientist who led the experiment. Even people who instantly realized that the two different descriptions were identical—they saw through the framing effect—still experienced a surge of negative emotion when they looked at the loss frame.

What, then, caused the stark differences in behavior? If everybody had an active amygdala, why were only some people swayed by the different descriptions? This is where the prefrontal cortex enters the picture. To the surprise of the scientists, it was the activity of the prefrontal cortex (not the amygdala) that best predicted the decisions of the experimental subjects. When there was more activity in the prefrontal cortex, people were better able to resist the framing effect. They could look past their irrational feelings and realize that both descriptions were equivalent. Instead of just trusting their amygdalas, they did the arithmetic. The end result is that they made better gambling decisions. According to de Martino, "People who are more rational don't perceive emotion less, they just regulate it better."

How do we regulate our emotions? The answer is surprisingly simple: by thinking about them. The prefrontal cortex allows each of us to contemplate his or her own mind, a talent psychologists call metacognition. We know when we are angry; every emotional state comes with self-awareness attached, so that an individual can try to figure out why he's feeling what he's feeling. If the particular feeling makes no sense—if the amygdala is simply responding to a loss frame, for example—then it can be discounted. The prefrontal cortex can deliberately choose to ignore the emotional brain.

This is one of Aristotle's essential ideas. In
The Nicomachean Ethics,
his sprawling investigation into the "virtuous character," Aristotle concluded that the key to cultivating virtue was learning how to manage one's passions. Unlike his teacher Plato, Aristotle realized that rationality wasn't always in conflict with emotion. He thought Plato's binary psychology was an oversimplification. Instead, Aristotle argued that one of the critical functions of the rational soul was to make sure that emotions were intelligently applied to the real world. "Anyone can become angry—that is easy," Aristotle wrote. "But to become angry with the right person, to the right degree, at the right time, for the right purpose, and in the right way—that is not easy." That requires some thought.

One way to understand how this Aristotelian idea actually plays out in the brain is by examining the inner workings of a television focus group. Practically every show on television is tested on audiences before it hits the airwaves. When this testing process is done properly, it demonstrates a fascinating interplay between reason and emotion, instinct and analysis. In other words, the whole enterprise mimics what's constantly happening inside the human mind.

The process goes something like this: People representing a demographic cross section of America are ushered into a specially equipped room that looks like a tiny movie theater, complete with comfy seats and cup holders. (Most television focus groups take place in Orlando and Las Vegas, since those cities are full of people who have arrived from all across the country.) Each participant is given a feedback dial, a device that's about the size of a remote control and has a single red dial, a few white buttons, and a small LED screen. Feedback dials were first used in the late 1930s, when Frank Stanton, the head of audience research at CBS Radio, teamed up with Paul Lazarsfeld, the eminent sociologist, to develop the "program analyzer." The CBS method was later refined by the U.S. military during World War II as it tested its war propaganda on the public.

The modern feedback dial is designed to be as straightforward as possible so that a person can operate it without taking his or her eyes off the screen. The numbers on the dial increase in a clockwise direction, like a volume knob; higher numbers signal a more positive response to the television show. The participants are told to rotate their dials whenever their feelings change. This gives a second-by-second look at the visceral reactions of the audience, which are translated into a jagged line graph.

Although every television network depends on focus groups for feedback—even cable channels like HBO and CNN do extensive audience research—the process has very real limits. The failures of focus groups are part of industry lore:
The Mary Tyler Moore Show, Hill Street Blues,
and
Seinfeld
are all famous examples of shows that tested terribly and yet went on to commercial success. (
Seinfeld
tested so badly that instead of being featured on NBC's 1989 fall schedule, it was introduced as a midseason replacement.) As Brian Graden, president of programming at MTV Networks, says, "Quantitative data [of the sort produced by feedback dials] is useless by itself. You've got to ask the data the right questions."

The problem with the focus group is that it's a crude instrument. People can express their feelings with dials, but they can't
explain
their feelings. The impulsive emotions recorded on the dials are just that: impulsive emotions. They are suffused with all the usual flaws of the emotional brain. Did the focus-group audience not like
Seinfeld
because they didn't like the main character? Or did they dislike the show because it was a new kind of television comedy, a sitcom about nothing in particular? (The
Seinfeld
pilot begins with a long discussion about the importance of buttons.) After all, one of the cardinal rules of focus groups is that people tend to prefer the familiar. The new shows that test the best often closely resemble shows that are already popular. For example, after the NBC sitcom
Friends
became a huge commercial hit, other networks rushed to imitate its formula. There were suddenly numerous comedy pilots about pretty twentysomethings living together in a city. "Most of these shows tested really well," one television executive told me. "The shows weren't very good, but they reminded the audience of
Friends,
which was a show they actually liked." Not one of the knockoffs was renewed for a second season.

The job of a television executive is to sort through these emotional mistakes so he or she isn't misled by the audience's first impressions. Sometimes people like shows that actually stink and reject shows that they grow to enjoy. In such situations, executives must know how to discount the responses of focus groups. They need to interpret the quantitative data, not just obey it. This is where the second-by-second responses of feedback dials are especially useful, since they allow executives to see what exactly people are responding to. A high score in minute twelve might mean that the audience really liked a particular plot twist, or it might mean that they liked looking at the blonde in her underwear. (A conclusive answer can be gotten by comparing the ratings of men versus women.) One cable channel recently tested a reality-television pilot that scored well overall but showed sharp declines in audience opinion at various points throughout the show. At first, the executives couldn't figure out what the audience didn't like. Eventually, however, they realized that the audience was reacting to the host: whenever she talked to the contestants, people turned down their dials. Although the focus-group audience said they liked the host and rated her highly when she talked to the camera, they didn't like watching her with other people. (The host was replaced.) And then there's the "flat line": when a focus-group audience is especially absorbed in the show—for example, during a climactic scene—they often forget to turn their dials. The resulting data can make it appear that the show has hit a rough spot, since many of the dials are stuck in a low position, but the reality is precisely the opposite. If the executives don't realize that the focus-group participants were simply too involved in the program to pay attention to their dials, they might end up altering the best part of the show.