Tomorrow Never Comes

Abulia, the Lobotomy, and What Is Left When the Future Is Subtracted

The failure beneath the failures

This unit has been, in large part, a catalogue of frontal failures, and we have learned the architecture by watching it break. We saw judgment fail — the ventromedial patient who chooses against his own interest. We saw holding fail — the goal captured by the present object, the prepotent rule, the salient distractor. We saw feeling fail — the gambler who knows which deck is bad and draws from it anyway. We saw moral restraint fail — the conscience that was never built, or was destroyed. But in every one of these failures, notice, the animal still acted. It set out toward something, chose some course, pursued some end, however badly chosen or poorly controlled. The machinery was broken in a particular place, and the rest carried on around the break.

There is a more total failure than any of these, and it is where the unit must end, because it reveals — more starkly than any intact brain or any partial lesion could — what the whole apparatus was for. It is the failure not of any specific competence but of the orientation toward the future itself: the loss of the impulse to set out at all. The patients who show it retain, in the cruelest way, nearly everything. Their intelligence is intact; they perceive the world accurately; they hold their knowledge; they can converse, when prompted, and reason, when pressed. What they have lost is the lean into tomorrow — the disposition to provision for it, to pursue anything within it, to be moved by it. They can make plans, and they simply do not carry them out. The future has stopped governing their behavior, and what is left is a person who lives, entirely and only, in the present that the earlier units built.

This section examines that failure from two directions — one a stroke, one a surgery — and lets it close the unit’s argument. The two could hardly be more different in origin, but they converge on the same subtraction, and the convergence is the point.

Abulia: reactive, but not self-moving

The first picture comes from a small number of patients who suffered strokes deep in the brain, in the basal ganglia — the striatum and its neighbors, the very machinery the last unit identified as the engine of action selection and the wanting that drives pursuit. The striking thing about these cases is what resolved and what did not. In the days after the stroke, the patients had minor motor signs — a slight facial weakness, mild difficulty with words — and these cleared completely within days. The motor system was essentially fine. What remained, and did not clear, was something far stranger and harder to name.

The syndrome is called abulia, or sometimes psychic akinesia — and that second term, which means something like “stillness of the mind,” is the more telling. These patients were not paralyzed; they could move. What they had lost was the initiation of behavior from within. Described by their clinicians, they showed a profound lack of spontaneous activity — they rarely spoke unless spoken to, produced sparse and laconic answers after long delays, and had to be continually prompted to keep even a conversation going. A woman who had been known for her energy, drive, and initiative became slow, poorly motivated, emotionally flat, indifferent to her household and her social life. A man who had run a business could no longer attend to it, for sheer lack of initiative and endurance; over the following months he gained a great deal of weight, the appetite for food untouched while the drive to do anything else had drained away. Neither patient was depressed in the ordinary sense — there was no sadness, no psychosis, no anxiety — and, eerily, neither seemed to notice the change; each insisted they felt well and unchanged. The drive was simply gone, and gone too was the capacity to register its absence.

The clinical summary captured the essence in a single contrast: these patients showed a marked reduction of self-activation, but remained reactive to external stimulation. That sentence is the heart of abulia, and it is exactly the dissociation this unit has prepared us to read. The animal as a reactive controller — responding to what is present, doing what the immediate environment prompts — was intact. What was lost was the animal as a self-moving controller, the part that generates behavior from within, that sets out toward goals the present does not contain. The present could still move these patients; the future could not. Prompt them and they respond; leave them and they sit. The engine that turns a represented future into present pursuit had failed, and what remained was a person who could still be pushed but could no longer pull.

The lobotomy: severing the front of the brain

The second picture comes not from disease but from one of the darker chapters in the history of medicine, and it must be told with that darkness intact, because the thing that was done to these patients was a moral catastrophe even where it was scientifically revealing.

In the middle of the twentieth century, the frontal lobotomy — the surgical destruction of the white matter connecting the prefrontal cortex, especially its orbital and ventromedial regions, to the rest of the brain — was performed on tens of thousands of people, by some estimates forty to fifty thousand in the United States alone. The operation was crude; in its most notorious form the surgical tool was driven through the eye socket and swept through the frontal connections, an instrument of severance, not of precision. It was done to people with serious mental illness in an era with almost no effective treatments and vast, overwhelmed institutions, and its purpose — stated openly, not hidden — was to make difficult patients manageable. The placidity that followed was the goal. “The lobotomy got them home,” one of its popularizers said, and the sentence should be read for the horror in it: the procedure succeeded, on its own terms, by producing people who were calm because something in them had been switched off.

What had been switched off is what makes these cases belong here. The surgeons who performed the operation — and Freeman and Watts, two of its principal practitioners, wrote about this with a clinical clarity that is chilling precisely because it is so observant — described a remarkably consistent change, and it is the same subtraction we have just seen in abulia, produced now by cutting the front of the brain away from the back. Their descriptions are worth hearing, because the patients in them are unmistakably the patients of this whole unit.

The lobotomized patients showed, the surgeons wrote, a striking placidity and indifference where before there had been agitation. They would not eat the food in front of them on their own initiative, yet would chew and swallow with precision the moment a nurse fed them — reactive, again, but not self-moving. They could carry out a routine task, but when one task is finished, they do not go on to the next; they just sit. They were not distressed by failure — one patient, given problems she had solved before the surgery and now could not, went on making mistake after mistake with no sign of embarrassment or concern, far past the patience of the examiner. They could discuss their own sensations and emotions, even recall feelings they had had before the operation, but dispassionately, with the absence of any strong emotional component. And, most tellingly of all: they make plans for tomorrow, but somehow, tomorrow never comes. They do enough for today, and then stop.

Read that last line against everything this unit has built. Here is a person with intelligence intact, perception intact, the ability to converse and to plan in the abstract — and what has been removed, by severing the orbital and ventromedial cortex from the rest of the brain, is precisely the governance of present behavior by the future. The plan can be made; it cannot be carried out, because carrying it out requires that the represented future actually move the present, and that is the connection the surgery destroyed. Tomorrow never comes because the cortex that would have made tomorrow bear on today has been cut away.

The patient who could not say beforehand

Among Freeman and Watts’s descriptions there is one that compresses the entire unit into a single patient’s words, and it deserves to stand on its own.

The patient was a man who, after his lobotomy, slapped his nurses and pulled a fire alarm — impulsive, disinhibited acts of the kind we met in the very first frontal syndromes. Afterward, asked about what he had done, he said: “Now that I have done it, I can see it was not the thing to do, but beforehand I couldn’t say whether or not it would be alright.”

Sit with that sentence, because it is the whole unit spoken by someone living inside the deficit. Now that I have done it, I can see it was not the thing to do — the knowledge is intact; he can evaluate the act perfectly well once it is real, once it has happened, once it is present. But beforehand I couldn’t say whether or not it would be alright — what he has lost is the ability to evaluate it before, in prospect, while it was still only a contemplated action. This is the say-the-right-thing-do-the-wrong-thing dissociation we met in the gambling task and again in the moral cases, now stated from the inside, with devastating clarity. The somatic marker that should have priced the imagined act — that should have generated, before the slap, a faint version of the regret he felt after — was not there. He could feel the consequence once it arrived. He could not feel it in advance, where feeling it would have stopped him. The future could not be felt beforehand, and so it could not govern what he did.

Freeman and Watts, observing this, reached toward a hypothesis about what the frontal lobes were for, and it is the hypothesis this entire unit has been an extended argument for — proposed by them, remarkably, in 1939, decades before there was any mechanism to attach to it. The frontal cortex, they suggested, is concerned with the projection of the whole individual into the future — with the capacity to foresee, to forecast the results of one’s actions, to visualize what effect those actions will have upon oneself and one’s environment. A person with intact frontal lobes, they wrote, can define the goal toward which he is working and estimate how near he is to reaching it, calling upon his past experience as a guide and upon his emotional mechanisms for driving force — for the search for satisfaction and the avoidance of distress. Strip that away, and what remains is the patient who lives in today: not stupid, not unfeeling in the moment, but no longer projected into a future that could pull him forward.

What the subtraction reveals

The two pictures — the stroke that silenced the striatum, the surgery that cut the front of the brain from the back — converge, and the convergence is the unit’s closing argument. In both, the reactive controller survives. The patient still responds to the present, still eats when fed, still answers when addressed, still recognizes an error once it has been made. The homeostatic, present-tense machinery of the book’s first five units is intact; the animal as a responder to now is essentially whole. What is subtracted, in both, is the anticipatory controller — the provisioning, the pursuit, the projection into tomorrow, the governance of present behavior by represented and felt futures. Lose the striatal engine of self-generated action, or sever the cortex that values and feels imagined outcomes from the brain that would act on them, and the same thing goes: the forward lean. The present remains; the future drops out.

This is the deepest evidence the unit can offer for what the frontal lobes are, and it is evidence of exactly the kind this unit promised at the outset. We said, at the start, that the lesion method runs a subtraction: remove a part and ask what the person can no longer do. We can now answer the question the whole unit posed. When the anticipatory frontal apparatus is subtracted — whether by stroke or by the surgeon’s blade — what can the person no longer do? Not perceive, not reason, not remember, not respond. What they can no longer do is lean into tomorrow — provision for it, pursue it, feel it in advance, be moved by it. The frontal lobes are the part of the controller that lives in the future, and the proof is that when you take them away, the person stops living there, and lives only in the present that the rest of the brain still serves.

And here, finally, we can settle the matter the unit raised at its very beginning and has been quietly pursuing throughout. If there were ever a place in the brain where the homunculus lived — the inner agent, the chief, the self who decides — it would be here, in the frontal lobes, which sit atop the hierarchy and whose damage looks more than any other like the loss of a person’s will. The lobotomy was, in a terrible and unintended way, an experiment in looking for that agent: cut the frontal connections and ask what is missing. And the answer, in every one of these patients, is never the chief is gone, and the brain now sits leaderless, awaiting orders that do not come. The answer is always specific, and always the same: the orientation toward the future is gone. The person is all there — present, perceiving, knowing, reacting — and what is missing is not a self but a function, the very function this unit has spent its length describing. We looked in the one place the homunculus should have been, removed it, and found not a missing agent but a missing capacity: the capacity to be governed by what is not yet here. That is what the frontal lobes contribute, and it is all we need them to contribute. There was never a chief. There was only the controller, and its most distant reach — into tomorrow — is what these patients lost.

Where this leaves us, and where the next unit begins

We have built, across this unit, the anticipatory controller in full: a system that gathers possible futures by exploring, represents and feels their worth, holds a chosen one in command against the pull of the present, extends that feeling outward to the futures of others, and — as we have just seen — collapses, when subtracted, into a person who can no longer set out toward any future at all. The frontal lobes, we can now say plainly, are the organ by which an embodied controller comes to be governed not only by the deficit it feels now but by the states it can represent, value, and feel in advance. That is what it means to call them the anticipatory layer of the brain, continuous with the homeostatic machinery beneath them rather than a chief above it — the same control, reaching further in time.

But the unit closes by exposing a dependency it could not satisfy, and that dependency is the door into what comes next. To project oneself into the future — to do the very thing Freeman and Watts named, to visualize what an action’s effects will be, to simulate an outcome before it arrives — the brain must be able to construct a future that does not yet exist. And it cannot construct such a future from nothing. The materials out of which an imagined tomorrow is built come from the remembered past: the brain assembles a possible future by recombining the fragments of what it has already experienced. The capacity to imagine forward and the capacity to remember backward turn out to be, on a growing body of evidence, two uses of a single constructive system — a point we have already heard foreshadowed, when Freeman and Watts spoke of the frontal lobe calling upon past experience as a guide to forecast the future. The patient who cannot project himself into tomorrow and the patient who cannot recall yesterday may be failing, in part, for related reasons.

So the road out of the frontal lobes runs directly into the machinery of memory — not memory as a passive archive of the past, but memory as the constructive system that supplies the parts from which futures are imagined. Having spent this unit on the controller that lives in tomorrow, we turn next to the system that remembers yesterday, and discover that the two are far more deeply entwined than they appear: that we remember, in large part, in order to imagine, and that a brain built to anticipate the future had first to become a brain that could reconstruct the past. That entanglement — between remembering and imagining, between the past we reconstruct and the future we project — is where the next unit begins.

What we are sure of, and what is still open

As before, the settled core and the frontier — and here, where the clinical material is grave and the interpretive frame is strong, the distinction is especially worth keeping.

What is well established. Damage to the basal ganglia, particularly the striatum, can produce abulia — a profound loss of self-initiated behavior and motivation, with preserved capacity to respond to external prompting, and often without the sadness, anxiety, or psychotic features of other disorders. Damage to or surgical disconnection of the orbital and ventromedial prefrontal cortex produces a recognizable syndrome of placidity, indifference, loss of initiative, blunted emotional response, failure to be distressed by failure, and impaired carrying-out of plans despite preserved intelligence and the ability to plan in the abstract — a syndrome documented in detail, if monstrously, in the lobotomy literature. The reactive-but-not-self-moving dissociation is real and recurs across these cases. The historical facts of the lobotomy era — its scale, its crude technique, its explicit aim of producing manageability — are well documented.

What remains contested or unsettled. The localization here is genuinely messy, and the reader should not take the tidy story as the whole truth. Abulia arises from striatal damage but also from medial frontal and other lesions; the syndromes of “frontal” damage in the lobotomy literature came from lesions that were enormous, variable, and uncontrolled, severing far more than any one region, so attributing the specific deficits to specific structures is hazardous in exactly the way the unit’s opening cautioned. The interpretive frame this section places on these cases — that what is fundamentally subtracted is “the projection of the individual into the future,” the governance of present behavior by represented futures — is a reading this book finds powerfully illuminating and consistent with everything that precedes it, but it is a frame, not a measured fact, and other descriptions of these syndromes (in terms of apathy, of reward processing, of activation) capture overlapping ground. And the claim that imagining the future and remembering the past are two uses of one constructive system, while strongly supported by recent work, is the subject of the next unit and will be examined there rather than assumed here. What is secure is the phenomenon: subtract enough of this apparatus, by stroke or by blade, and what is lost is not intelligence or perception but the orientation toward tomorrow — and that loss, more than any intact brain could, tells us what the orientation was worth.