Neurotechnology and Operational Medicine - Neurotechnology in National Security and Defense - page 69

disease perception, interoception can be envisioned as a process that maps sensor
information onto symptom representations and modulates attention to those symp-
toms. In a more general decision-making sense, it can be envisioned as forming a
“gut feeling” of subjective state along a continuum from well-being to discomfort to
danger to panic. Craig (2009) has recently reviewed evidence for an important role
of the insular cortex and amygdala in interoception. It is also modulated by prior
experience (both conscious memory and classical conditioning) and is updated on
the basis of results of upstream cognitive processes.
The selection of higher order cognitive processing components for the schema
recognizes that human decision-making displays bounded rationality (Simon 1955),
which is a necessary consequence of limits imposed by the structure of the environ-
ment, the structure of the perceived solution space (mental models), and human cog-
nitive capabilities (Simon 1956). The schema itself is a form of “satisficing” (Simon
1955) that concludes a search of limited options as soon as a “good enough” criterion
is reached. The instantaneous interoceptive status is subjected to initial situation
assessment estimate of context, which is influenced by the individual's tempera-
ment and, in many contexts, sense of duty, obligation, and responsibility. In cogni-
tive terms, this initial estimate is based upon a fast and frugal heuristic (Gigerenzer
and Todd 1999; Goldstein and Gigerenzer 1999) or “rule of thumb” (Kahneman and
Tversky 1979) assessment of the current situation within the context of their knowl-
edge base and roles. Further analysis of this rapid estimate is used to attribute the
status to a cause (e.g., “It must have been something I ate.”) and to generate distress/
disability, illness worry/rumination, and illness behaviors (Pilowsky 1993). The
outcomes of these cognitive processes can influence interoception directly; alter-
natively, effects on emotional arousal can affect both interception and sensorimotor
activity. From a neuroscientific perspective, these cognitive processes likely engage
both (1) mechanisms for setting affective state that are associated with the ventro-
lateral prefrontal, orbitofrontal, and ventral anterior cingulate cortex and (2) mecha-
nisms for regulation of the affective state that involve at least the dorsal (lateral and
medial) prefrontal and dorsal anterior cingulate cortex (Balaban et al. 2011; Craig
2009; Phillips et al. 2003; Staab et al. 2013). The result of this process is an updating
of anxiety-misery and fear-avoidance dimension (Sylvers et al. 2011) representations
of the elements and context of the situation. The anxiety-misery dimension reflects
future, sustained, and diffuse threats that one approaches (and probes) to improve
awareness. The fear-avoidance dimension reflects specific, clear, and present threats
that are avoided. Social interactions with caregivers and others (team members
and mutual aid partners in a working environment), which can be influenced by
self-labeling adoption of a sick role (Barsky and Boras 1999), can intervene in the
environment in parallel to influences of one's own actions.
There are two approaches to scale this architecture to include local or global
aspects of scenarios. First, the model of an individual can be generalized to encom-
pass any response personnel, victim, or bystander in an operational medicine sce-
nario by simply changing the term “symptom” to an analogous concept, “noteworthy
aspects of the current environment or unfolding scenario.” The task of the agent,
then, is to develop the analog of a patient's interoceptive situation assessment rela-
tive to the current responsibility domain of concern, which is analogous to a patient's