Your patients remain conscious during the procedure.
That’s right; it means I can witness how this physical tissue gives rise to a person’s mind. You’re not just looking at cells; here, biological mechanics become emotion, longing and thoughts. This closeness dissolves all that is abstract. And desire is not an ethereal feeling, but a physical, living spark that lies within our anatomy.
How do you define desire; how do you define longing?
Wishes, addictions, quiet hopes and powerful compulsions – for me, all of that falls under the term ‘Desire’. I deliberately capitalise the ‘D’ in the English word to make it clear: it is not merely about lust or wanting to possess something. This desire is our life force; without it, we are like driftwood washed ashore by the waves. Through desire, we gain the ability to act of our own accord. Longing, on the other hand, is for me a desire that stretches out over time: the painful hum of that same engine when the object of our desire remains far away or unfulfilled – or exists only as a precious memory.
And where in the brain is it located?
Not in a single place. The three circuits extend far and deep, from the area behind the mouth to beyond the forehead. Imagine three enormous tree canopies that have grown side by side. The trunks can be distinguished from one another. But the branches are so densely intertwined that no one can say where one tree ends and the next begins.
You’re talking about a neurological origin for the entire spectrum of desire. So does the brain make no distinction at all between longing and, say, an appetite for something?
Your question hits the nail on the head. When we talk about ‘appetite’, we usually mean food. From a biological perspective, however, appetite is the fundamental driving force behind all desire. The circuits of desire generate every form of appetite: the restless hunger for more, as well as the razor-sharp craving for a single goal. This could be a warm chocolate croissant, a Porsche 911 or inner peace. Language, poetry and philosophy distinguish between all these nuances. They differentiate a subtle longing from a physical craving. Yet underlying them all is the same shared neurological origin: the circuits of desire.
Whilst we’re on the subject of language: words such as ‘Sehnsucht’ and ‘Vorfreude’ are considered virtually untranslatable.
They are wonderful terms, and as soon as one tries to translate them, they seem to slip away. Not because the feelings are alien to us. Longing and anticipation describe that elusive realm of human experience that also encompasses instincts, premonitions, déjà vu and auras. And yes, they possess a very real signature, located in a region whose role is to reconcile the competing demands of the three neural circuits and to translate the inner cacophony into a lived experience of mind and body: the insula, the insular cortex. In a sense, it forms the hub at which all the spokes converge.