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Cited by 282Psychosomatic Disorders and Their TreatmentsPhilosophy and Theoretical ScienceTactile and Sensory Interactions

Persistence of feelings and sentience after bilateral damage of the insula

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Damasio, A., Damasio, H., Tranel, D.·2013·Cerebral Cortex
DOI 10.1093/cercor/bhs077PMC PMC3657385
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Abstract

It has been convincingly established, over the past decade, that the human insular cortices are involved in processing both body feelings (such as pain) and feelings of emotion. Recently, however, an interpretation of this finding has emerged suggesting that the insular cortices are the necessary and sufficient platform for human feelings, in effect, the sole neural source of feeling experiences. In this study, we investigate this proposal in a patient whose insular cortices were destroyed bilaterally as a result of Herpes simplex encephalitis. The fact that all aspects of feeling were intact indicates that the proposal is problematic. The signals used to assemble the neural substrates of feelings hail from different sectors of the body and are conveyed by neural and humoral pathways to complex and topographically organized nuclei of the brain stem, prior to being conveyed again to cerebral cortices in the somatosensory, insular, and cingulate regions. We suggest that the neural substrate of feeling states is to be found first subcortically and then secondarily repeated at cortical level. The subcortical level would ensure basic feeling states while the cortical level would largely relate feeling states to cognitive processes such as decision-making and imagination.

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  • Patients with total destruction of the prefrontal lobes and insula not only report preserved feeling states, but display excessive emotionality.

    “patients with total destruction of the very structures which are specifically identified by cortico-centric theorists of affect—namely the prefrontal lobes and insula (e.g., Craig, 2009; LeDoux and Brown, 2017)—not only report preserved feeling states, but, as mentioned already, they display excessive emotionality (see Damasio et al., 2012)14.”

    From The Hard Problem of Consciousness and the Free Energy Principle (2019) · cites this paper as Damasio et al., 2012

    The Discussion reports preserved feelings and describes Patient B.’s life as a virtually continuous affective reaction, undampened by higher-order cognitive controls. But the Neuroanatomical Evidence section says that only certain frontal regions were damaged and that the remainder of the frontal cortices were intact. The claim’s description of total prefrontal-lobe destruction is therefore unsupported. (LLM, conf=0.89)

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  • Patients with bilateral insular damage still preserve certain aspects of emotional awareness, suggesting emotional feelings might first emerge from brainstem and hypothalamus, later enriched by insula.

    “patients with bilateral insular damage still preserve certain aspects of emotional awareness, suggesting that emotional feelings might first emerge from the brainstem and hypothalamus, which are later enriched and refined by the insula”

    From Anterior insular cortex and emotional awareness (2013) · cites this paper as Damasio et al., 2013

  • Three recent case studies reported intact interoceptive awareness and self-awareness after bilateral insular lesions.

    “Three recent case studies specifically examined the effects of bilateral insular lesions on subjective awareness and reported intact interoceptive awareness (Khalsa et al., 2009) and self-awareness (Philippi et al., 2012; Damasio et al., 2013).”

    From Anterior insular cortex and emotional awareness (2013) · cites this paper as Damasio et al., 2013

  • Intact emotional and interoceptive abilities have been observed in patients with insula and ACC lesions during adulthood.

    “One indication that online interoception may not be required is the observation of intact emotional and interoceptive abilities in patients with insula and ACC lesions during adulthood (Damasio et al., 2013; Feinstein et al., 2016).”

    From Atypical interoception as a common risk factor for psychopathology: A review (2021) · cites this paper as Damasio et al., 2013

  • Arguments for the subcortical basis of subjective experience in humans provide important convergent evidence for the role of a PI in subjective experience.

    “arguments for the subcortical basis of subjective experience in humans [16,40–43] provide important convergent evidence for the role of a PI in subjective experience [9,16].”

    From Phenomenal interface theory: a model for basal consciousness (2025) · cites this paper as [41]

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Research works printed but not linked: 1

  1. Swanson LW. 1987. The hypothalamus. In: Hokfelt T, et al. editors. Handbook of chemical neuroanatomy, vol 5, Integrated systems of the CNS, Part I. Amsterdam, the Netherlands: Elsevier. p. 1--124.

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Authors
Damasio, A., Damasio, H., & Tranel, D.
Affiliations
  • University of Southern California (US)
  • University of Iowa (US)
ORCID
Tranel, D.
Venue
Cerebral Cortex
Publisher
Oxford University Press (OUP)
Published
2012-04-03
Volume
23
Issue
4
Pages
833-846
ISSN
  • 1047-3211 (ISSN-L)
  • 1460-2199
DOI
10.1093/cercor/bhs077
PMC
PMC3657385
OpenAlex
W2105911464
Cited by
282
References
76
Citations by year
2026: 3 · 2025: 13 · 2024: 38 · 2023: 29 · 2022: 13 · 2021: 21 · 2020: 14 · 2019: 17 · 2018: 22 · 2017: 19 · 2016: 33 · 2015: 23 · 2014: 10 · 2013: 24 · 2012: 3
FWCI
13.71
Type
journal article
Language
en
Open access
Locations
  • Cerebral Cortex (publishedVersion)
  • Europe PMC (PubMed Central) (publishedVersion)
  • PubMed Central (publishedVersion)
  • PubMed (publishedVersion)
Funders
  • G. Harold and Leila Y. Mathers Foundation
  • National Institutes of Health (5p50ns019632-28)
  • National Institute of Neurological Disorders and Stroke (P50NS19632)
Topics
  • Health Sciences › Medicine › Psychiatry and Mental health › Psychosomatic Disorders and Their Treatments
  • Social Sciences › Psychology › Experimental and Cognitive Psychology › Philosophy and Theoretical Science
  • Life Sciences › Neuroscience › Cognitive Neuroscience › Tactile and Sensory Interactions
Keywords
insula, feelings, sentience, emotions, pain, herpes simplex encephalitis, somatosensory cortex, cingulate cortex, decision-making, imagination
MeSH terms
Aged, 80 and over, Cerebral Cortex, Emotions, Food Preferences, Humans, Longitudinal Studies, Magnetic Resonance Imaging, Male, Neuropsychological Tests, Psychological Tests, Sensation, Tomography, X-Ray Computed, Spouses, Encephalitis, Herpes Simplex, Imaging, Three-Dimensional, Recognition, Psychology

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