What is all this? Rows I, III, and V show coronal slices of a healthy comparison brain and II, IV, and VI those of Patient B.

Pretty much every study relevant to me mentions the insula, as it’s well accepted that it’s involved in the processing of feelings like pain/pleasure and feelings of emotions. So I see activation in the insula and go yeahyeah, of course. 

But here’s a case study of a Patient B who presented with Herpes Simplex Type 1 encephalitis, that lead to complete bilateral insula damage. However, the rub is B was still able to express emotions and remain self aware/introspective. 

One of my favorite answers in the self awareness battery was when the researcher asks, “Am I aware of myself?” and B says, “You look very handsome. I think you know what to do here.”

Nice one.

Anyway, the deal is this case study lends strong evidence to support the suggestion that the neural substrate of feeling states starts at a subcortical level then goes up to the cortical level. Layers people. Layers.  

Damasio A, Damasio H, & Tranel D (2012). Persistence of Feelings and Sentience after Bilateral Damage of the Insula. Cerebral cortex (New York, N.Y. : 1991) PMID: 22473895