Let’s start with something simple: the feeling of pain. The sensory and emotional feeling of pain arises from distinct neural signals and has a well-defined and obvious role in our lives. Pain encourages you to put down that red-hot frying pan, punishes you for pounding your thumb with that hammer, and reminds you that when sampling six brands of single-malt Scotch, you should not make them doubles. A friend may have to draw you out before you understand your feelings toward that financial analyst who took you to the wine bar last night, but a pounding headache is a feeling you’d think you could get in touch with without anyone’s help. And yet it is not that simple, as evidenced by the famous placebo effect.
When we think of the placebo effect, we may imagine an inert sugar pill that relieves a mild headache as well as a Tylenol, as long as we believe we’ve taken the real thing. But the effect can be dramatically more powerful than that. For example, angina pectoris, a chronic malady caused by inadequate blood supply in the muscle of the heart wall, often causes very severe pain. If you have angina and attempt to exercise—which can mean simply walking to answer the door—nerves in your heart muscle act like a “check engine” sensor: they carry signals via your spinal cord to your brain to alert you that improper demands are being placed on your circulatory system. The result can be excruciating pain, a warning light that is hard to ignore. In the 1950s, it was common practice for surgeons to tie off certain arteries in the chest cavity as a treatment for patients with severe angina pain. They believed new channels would sprout in nearby heart muscle, improving circulation. The surgery was performed on a large number of patients with apparent success. Yet something was amiss: pathologists who later examined these patients’ cadavers never saw any of the expected new blood vessels.
Apparently the surgery was a success at relieving the patients’ symptoms but a failure at addressing their cause. In 1958, curious cardiac surgeons conducted an experiment that, for ethical reasons, would not be permitted today: they carried out sham operations. For five patients, surgeons cut through the skin to expose the arteries in question but then stitched each patient back together without actually tying off the arteries. They also performed the true operation on another group of thirteen patients. The surgeons told neither the patients nor their cardiologists which subjects had had the real operation. Among the patients who did receive the real operation, 76 percent saw an improvement in their angina pain. But so did all five in the sham group. Both groups, believing that a relevant surgical procedure had been performed, reported far milder pain than they had had before surgery. Since the surgery produced no physical changes in either group (in terms of the growth of new blood vessels to improve circulation to the heart), both groups would have continued to experience the same level of sensory input to the pain centers of their brains. Yet both groups had a greatly reduced conscious experience of pain. It seems our knowledge of our feelings—even physical ones—is so tenuous that we can’t even reliably know when we are experiencing excruciating pain.8
The view of emotion that is dominant today can be traced not to Freud—who believed that unconscious content was blocked from awareness via the mechanism of repression—but to William James, whose name has already come up in several other contexts. James was an enigmatic character. Born in New York City in 1842 to an extremely wealthy man who used some of his vast fortune to finance extensive travels for himself and his family, James had attended at least fifteen different schools in Europe and America by the time he was eighteen—in New York; Newport, Rhode Island; London; Paris; Boulogne-sur-Mer, in northern France; Geneva; and Bonn. His interests flitted similarly, from subject to subject, landing for a while on art, chemistry, the military, anatomy, and medicine. The flitting consumed fifteen years. At one point during those years he accepted an invitation from the famous Harvard biologist Louis Agassiz to go on an expedition to the Amazon River basin in Brazil, during which James was seasick most of the time and, in addition, contracted smallpox. In the end, medicine was the only course of study James completed, receiving an MD from Harvard in 1869, at the age of twenty-seven. But he never practiced or taught medicine.
It was an 1867 visit to mineral springs in Germany—where he traveled to recuperate from the health problems resulting from the Amazon trip—that led James to psychology. Like Münsterberg sixteen years later, James attended some of Wilhelm Wundt’s lectures and got hooked on the subject, in particular the challenge of turning psychology into a science. He began to read works of German psychology and philosophy, but he returned to Harvard to complete his medical degree. After his graduation from Harvard, he became deeply depressed. His diary from that time reveals little but misery and self-loathing. His suffering was so severe that he had himself committed to an asylum in Somerville, Massachusetts, for treatment; however, he credited his recovery not to the treatment he received but to his discovery of an essay on free will by the French philosopher Charles Renouvier. After reading it, he resolved to use his own free will to break his depression. In truth, it doesn’t seem to have been that simple, for he remained incapacitated for another eighteen months and suffered from chronic depression for the rest of his life.
Still, by 1872 James was well enough to accept a teaching post in physiology at Harvard, and by 1875 he was teaching The Relations Between Physiology and Psychology, making Harvard the first university in the United States to offer instruction in experimental psychology. It was another decade before James put forth to the public his theory of emotions, providing the outline of that theory in an article he published in 1884 called “What Is an Emotion?” The article appeared in a philosophy journal called Mind, rather than in a psychology journal, because the first English-language journal of research psychology wouldn’t be established until 1887.
In his article, James addressed emotions such as “surprise, curiosity, rapture, fear, anger, lust, greed and the like,” which are accompanied by bodily changes such as quickened breath or pulse or movements of the body or the face.9 It may seem obvious that these bodily changes are caused by the emotion in question, but James argued that such an interpretation is precisely backward. “My thesis on the contrary,” James wrote, “is that the bodily changes follow directly the PERCEPTION of [an] exciting fact, and that our feeling of the same changes as they occur IS the emotion…. Without the bodily state following on the perception, the latter would be purely cognitive in form, pale, colorless, destitute of emotional warmth.” In other words, we don’t tremble because we’re angry or cry because we feel sad; rather, we are aware of feeling angry because we tremble, and we feel sad because we cry. James was proposing a physiological basis for emotion, an idea that has gained currency today—thanks in part to the brain-imaging technology that allows us to watch the physical processes involved in emotion as they are actually occurring in the brain.