We called this period conceptual seven of the 10

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decks C and D were good. We called this period conceptual. Seven of the 10 normal participants reached the conceptual period, during which they continued to avoid the bad decks, and continued to generate SCRs when - ever they considered sampling again from the bad decks. Remarkably, the three normal par - ticipants who did not reach the conceptual period still made advantageous choices ( 4 ). Just as remarkably, the three patients with prefrontal damage who reached the concep - tual period and correctly described which were the bad and good decks chose disadvan - tageously. None of the patients generated an - ticipatory SCRs (Fig. 1). Thus, despite an accurate account of the task and of the correct strategy, these patients failed to generate au - A. Bechara and D. Tranel, Department of Neurology, Division of Behavioral Neurology and Cognitive Neuro- science, University of Iowa College of Medicine, Iowa City, IA 52242, USA. H. Damasio and A. R. Damasio, Department of Neurolo- gy, Division of Behavioral Neurology and Cognitive Neu- roscience, University of Iowa College of Medicine, Iowa City, IA 52242, and The Salk Institute of Biological Stud- ies, La Jolla, CA 92186, USA. *To whom correspondence should be addressed. R EPORTS z SCIENCE z VOL. 275 z 28 FEBRUARY 1997 1293 on May 27, 2018 Downloaded from
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tonomic responses and continued to select cards from the bad decks. The patients failed to act according to their correct conceptual knowledge. On the basis of these results, we suggest that the sensory representation of a situation that requires a decision leads to two largely parallel but interacting chains of events (Fig. 2). In one, either the sensory representation of the situation or of the facts evoked by it activate neural systems that hold nondeclara - tive dispositional knowledge related to the individual’s previous emotional experience of similar situations ( 5 ). The ventromedial fron - tal cortices are among the structures that we suspect hold such dispositional knowledge, the activation of which, in turn, activates autonomic and neurotransmitter nuclei (such as those that deliver dopamine to selected cortical and subcortical forebrain regions), among other regions. The ensuing noncon - scious signals then act as covert biases on the circuits that support processes of cognitive evaluation and reasoning ( 6 ). In the other chain of events, the representation of the situation generates (i) the overt recall of per - tinent facts, for example, various response op - tions and future outcomes pertaining to a given course of action; and (ii) the applica - tion of reasoning strategies to facts and op - tions. Our experiment indicates that in nor - mal participants, the activation of covert bi - ases preceded overt reasoning on the available facts. Subsequently, the covert biases may have assisted the reasoning process in cooper - ative manner, that is, biases would not decide per se, but rather facilitate the efficient pro - cessing of knowledge and logic necessary for conscious decisions ( 7 ). We suspect that the autonomic responses we detected are evi - dence for a complex process of nonconscious
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