The somatic marker hypothesis (SMH; [Damasio, A. R., Tranel, D., Damasio, H., 1991.
Somatic markers and the guidance of behaviour: theory and preliminary testing. In
Levin, H.S., Eisenberg, H.M., Benton, A.L. (Eds.), Frontal Lobe Function and Dysfunction.
Oxford University Press, New York, pp. 217-229]) proposes that emotion-based biasing
signals arising from the body are integrated in higher brain regions, in particular
the ventromedial prefrontal cortex (VMPFC), to regulate decision-making in situations
of complexity. Evidence for the SMH is largely based on performance on the Iowa Gambling
Task (IGT; [Bechara, A., Tranel, D., Damasio, H., Damasio, A.R., 1996. Failure to
respond autonomically to anticipated future outcomes following damage to prefrontal
cortex. Cerebral Cortex 6 (2), 215-225]), linking anticipatory skin conductance responses
(SCRs) to successful performance on a decision-making paradigm in healthy participants.
These 'marker' signals were absent in patients with VMPFC lesions and were associated
with poorer IGT performance. The current article reviews the IGT findings, arguing
that their interpretation is undermined by the cognitive penetrability of the reward/punishment
schedule, ambiguity surrounding interpretation of the psychophysiological data, and
a shortage of causal evidence linking peripheral feedback to IGT performance. Further,
there are other well-specified and parsimonious explanations that can equally well
account for the IGT data. Next, lesion, neuroimaging, and psychopharmacology data
evaluating the proposed neural substrate underpinning the SMH are reviewed. Finally,
conceptual reservations about the novelty, parsimony and specification of the SMH
are raised. It is concluded that while presenting an elegant theory of how emotion
influences decision-making, the SMH requires additional empirical support to remain
tenable.