Friends Don’t Let Friends Skip Ventromedial Pre-Frontal Cortex Day

“Don’t go wasting your emotion…”


My schedule as a second-year medical student leaves room for weight-lifting. Monday through Thursday, I mosey down to the main campus gymnasium in the morning and pump some iron.

Monday is chest and triceps day.

Tuesday is back and biceps day.

Wednesday is quadriceps and hamstrings day

Thursday is shoulders and abs day.

Friday-through-Sunday are for rest and/or cardio.

My workout buddies and I schedule things like this purposefully: no major muscle group is left to atrophy, or waste away. Every group is tested, and then given the chance to recuperate.

Recently, though, I’ve begun to wonder whether my workout routine is as thorough as I thought. I’m worried I’ve let something crucial atrophy through disuse—my emotional strength.

Well, “emotional strength” is too broad. I still feel. Sadness, gladness, anger, desire: I can still reach these emotional states in extreme circumstances. What I’m worried I’ve let weaken is whatever stringy, high-endurance muscle it is that regularly grabs a brush, dips it into palettes of emotion, and tints every corner of life’s canvas.

The muscle that takes somebody dropping a door in your face and paints that moment frustrating.

The muscle that induces pity at the sight of a homeless man sleeping on a city bench.

The muscle that senses shade, a breeze, and brown leaves descending lazily, and colors that  moment with sublime joy.

I think I’ve found the muscle in question. And it’s not actually a muscle—it’s a part of the brain: the ventromedial portion of the pre-frontal cortex.

The pre-frontal cortex is the portion of the brain that controls executive function. In other words, it’s our decision-making center. After reading Robert Sapolsky’s pop neurobiology tome, Behave, I learned there are two important divisions within the pre-frontal cortex, the dorsolateral pre-frontal cortex and the ventromedial pre-frontal cortex. Sapolsky abbreviates these as the dlPFC and the vmPFC, respectively.

According to him, the dlPFC is “the decider of deciders, the most rational, cognitive, utilitarian, unsentimental part of the PFC. It’s the most recently evolved part of the PFC and the last part to fully mature.”

By contrast, the vmPFC is crucial for the emotional and social components of decision making. It connects to the emotion-producing limbic system of the brain and then slaps feelings into our decision-making equation. “It activates,” Sapolsky says, “if the person you’re rooting for wins a game, or if you listen to pleasant versus dissonant music (particularly if the music provokes a shiver-down-the-spine moment).”

The effects of disabling either of these portions of the PFC illustrate their function.

Damage the dlPFC and self-control evaporates: immediate gratification becomes irresistible even when better long-term options are clear. Without a dlPFC, we reach for the donut every time.

Conversely, damage to the vmPFC makes humans cold and ichthyoid. Intelligence remains unimpaired, but the feeling behind decision-making just isn’t there. “Damaging the vmPFC, thus removing limbic input to the PFC, eliminates gut feelings, making decisions harder,” Sapolsky explains.

People with vmPFC damage can make utilitarian calculations and exercise self-control, but are crucially disabled when it comes to the social function. Sapolsky again: “They show poor judgement in choosing friends and partners and don’t shift behavior based on negative feedback… [their] behavior is inappropriate in a detached way. This is the person who, encountering someone after a long time, say, ‘Hello, I see you’ve put on some weight.’ And when castigated later by their mortified spouse, they will say with calm puzzlement, ‘But it’s true.’”

One interesting revelation from all this, to me, is that emotions are adaptive. We can’t just rationally convince ourselves not to go back into business with a partner who cheated us — we need to feel angry at him, too.

Another interesting revelation—though a less well-studied one— is that the dlPFC and vmPFC can oppose one another. A study found, for example, that the vmPFC activated and the dlPFC went quiet when jazz pianists improvised.

I think all this information points to a diagnosis. As my dlPFC has fully matured, and as education has trained it, my ability to put off gratification and make intelligent choices—I’ll flatter myself—has increased. Getting up in the morning and opening my laptop to study just isn’t as hard as it used to be. While I’ve lavished attention on my dlPFC, though, its PFC sibling has languished. I’ve gotten vmPFC atrophy.

Like most self-diagnoses, this one is disturbing. I don’t want to be a cold fish. I like being rational, but I want to be emotional, too. I’d love to feel what rabbi and author Milton Steinberg describes as the “joy-drenched essence of all things.” But I’d settle for just feeling pulsing essences of bitterness, righteousness, loyalty, love, or triumph in the decisions I make.

I remember thinking like that once. How do I do get back there?

The diagnosis suggests a treatment. The vmPFC is a emotional/social brain division. To get it strong again, I probably need to get out more. I’ve been Raskolnikov-ing a bit, lately, and I have to stop isolating myself. Moreover, when I do get out and talk to people, I need to have some conversations that aren’t highly intellectualized. I need to practice attaching emotions to things, not stripping them away for the sake of abstract consideration.

Here’s the new workout plan I’m writing myself:

Sunday-Saturday is vmPFC day.

3 sets x 10 repetitions talking to people

3 sets x 10 repetitions trying to connect with them emotionally.

It’s a simple plan, and maybe it doesn’t have quite enough rest days, but I’m holding out hope that it will help me get back into shape. At least, it will get me to the gym, and that’s often the hardest part.

OK, enough writing for tonight. Time to go out and put this into practice.

Oh, wait, I did want to say one more thing before I go: if you’re ever out there in the metaphorical gym, too, and you see me, don’t hesitate to ask for a spot.

Some workouts are better with a buddy.

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