A teenager’s suicide attempt is misattributed to problems of
the heart, adolescent crisis or substance abuse; promiscuous behavior is blamed on
childhood “sexual abuse.” Bipolar patients from time to time describe their parents as
“monsters” or “emotionally abusive,” which some psychotherapists accept on blind
faith without ever talking to the parents. Bipolar II patients are often diagnosed as
unipolar and/or borderline personality (Akiskal, 2004), treated with antidepressants
without mood stabilizers, resulting in tragic aggravation of the course of the
illness (Akiskal and Mallya, 1987; Akiskal et al., 2005a). Excessive spending,
squandering, of one’s economic resources and pathological generosity may lead
to financial ruin before bipolarity is considered.
Changes in socio-emotional behavior and conduct, which are characteristic symptoms of frontal lobe damage, have less often been described in patients with focal subcortical injuries. We report on a case of pathological generosity secondary to a left lenticulocapsular stroke with hypoperfusion of several anatomically intact cortical areas. A 49-year-old man developed excessive and persistent generosity as he recovered from a left lenticulocapsular hematoma. His symptoms resembled an impulse control disorder. (99m)Tc-HMPAO SPECT demonstrated hypoperfusion mostly in the ipsilateral striatum, dorsolateral, and orbitofrontal cortex. This case study adds pathological generosity to the range of behavioral changes that may result from discrete unilateral lesions of the lenticular nucleus and nearby pathways. In our particular case, post-stroke pathological generosity was not ascribable to disinhibition, apathy, mania, or depression. Because pathological generosity may lead to significant distress and financial burden upon patients and their families, it may warrant further consideration as a potential type of impulse control disorder.
Neurocase. 2014;20(5):496-500. doi: 10.1080/13554794.2013.826681. Epub 2013 Aug 20.
Pathological generosity: an atypical impulse control disorder after a left subcortical stroke.
Abstract
Man’s Stroke Leads To ‘Pathological Generosity’
The history of neuroscience is littered with patients whose behavior changed in bizarre ways after they suffered brain damage. Some people could no longer recognize animals, or couldn’t speak but could still sing. For neuroscientists, these cases offer opportunities: by studying how people’s behaviors change after brain injuries, they gain insight into what role the injured areas play in everyday tasks. And so it was with João—researchers hoped that his compulsive giving could shed light on normal generosity, helping them understand why human beings give and why, biologically, giving feels good.
Explaining generosity is a headache for biologists; Charles Darwin considered the trait one of the gravest threats to his theory of natural selection.
Giving, it seems, might become compulsive in some people because they crave the rush of dopamine that accompanies it.
Kin selection explains altruism as disguised selfishness: I might sacrifice my well-being in the short term, but helping my siblings survive will ultimately boost the chances of my genes being carried on in the future.
“Generosity may be a burden to those who love us,” he says.
Mohandas Karamchand Gandhi and the treatment his family members got from him
As the editors of the Science Daily put it,“…‘joy of giving’ has an anatomical basis in the brain – surprisingly, one that is shared with selfish longings and rewards.”
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