Graphic by Eilidh McNaughton By Rebekah wattsPhineas Gage was a railroad worker who, in 1848, was involved in an accident when an explosion propelled a long metal rod through his head. The rod caused serious injury to his left prefrontal cortex, entering through his left cheek and leaving through the midline of his skull anterior. The consequences of this accident were widely reported and caused a wave of disbelief amongst the public. Immediately after the event, Phineas Gage was still able to walk and communicate, but arguably what was more surprising was that he remained consciously aware through most of the period following the incident (Neylan, 1999). The repercussions of this freak accident were crucial to the discovery of behavioural syndromes that could stem from damage to the frontal lobe. Phineas Gage, although still consciously aware, and able to communicate and walk, experienced a noticeable change in his demeanour – with acquaintances reporting that he was “no longer Gage” (Neylan, 1999). It was reported that Gage was always a responsible, intelligent and socially adapted individual. However, following this accident (and the consequent damage to his frontal lobe), Gage became irresponsible, rude and unpredictable – it was commented on that his respect for social conventions had seemingly vanished (Damasio et al., 1994). It couldn’t be ignored that his personality – the characteristics that made him his unique self – had unexpectedly changed; Phineas Gage had become an almost polar opposite version of himself. Some thirty years later, Dr Ferrier, an early researcher in the theory of cerebral localisation – which mapped cerebral functions and described the role the frontal lobes had in higher executive functions – explained that damage to the frontal lobe can have noticeable effects on personality, using the case of Phineas Gage as a crucial example (Neylan, 1999). Research into the role of the frontal lobe has since revealed that the brain is not limited to its involvement in language, motor functions and perception, but also has a huge role in controlling socially acceptable behaviour (Damasio et al., 1994). Specifically, the frontal lobe has been argued to be unique in its connection to three limbic systems (which whilst independent from one another, are linked) – the cortical limbic lobe, the limbic midbrain region and the peripheral visceroendocrine system, which has been related to changes in an individual’s mood (Nauta, 1973; as cited in Stuss, 1992). The research that has stemmed from the case of Phineas Gage is still prevalent in psychological studies today, and the outcomes seen in the damage to Gage’s frontal lobe are reflected in many modern-day cases across different areas of study. Neary (1990; as cited in Stuss, 1992) found a positive correlation between dementia and diseased white matter in the brain. A common experience of patients suffering from dementia of the frontal lobe – in which the diseased white matter is concentrated in the frontal lobe – is a change in their personality. Similarly, Blumer and Benson (1975; as cited in Stuss, 1992) reported that in instances where patients have experienced damage to their frontal lobe, a decrease in drive (defined as the force that encourages human activities), motivation and interest is observed. A further observation that reflects the outcome of Phineas Gage’s freak accident is the increased severity of depression associated with lesions of the frontal lobe (Robinson et al., 1985: as cited in Stuss, 1992), and alternatively, the association between mania and lesions in the orbitofrontal areas of the brain (or areas closely linked to these areas) (Bakchine et al., 1999, and Starkstein et al., 1988; as cited in Stuss, 1992). Furthermore, the effects that damage to the frontal lobe can have on an individual’s personality can be visible when looking at patients developing sociopathy, psychopathy, or those with antisocial personality disorder. Sundram et al. (2012) analysed the brains of adults with antisocial personality disorder and compared them to healthy age, handedness and IQ-matched controls; it was concluded that there was significant evidence of a correlation between white matter abnormalities in the frontal region of the brain and antisocial personality disorder and psychopathy. Tranel and Damasio et al. (1994; as cited in Chow, 2000) studied the localisation of strokes, head trauma and lesions in patients developing sociopathy; they found that of the nine patients, six had damage to their orbitofrontal cortical (which can lead to the occurrence of mania, as highlighted in Stuss, 1992), two had a right sided lesion and one had a left sided lesion. These findings emphasise the strength of the association between personality change and damage to the frontal lobe – a concept forced into the light by the incident of Phineas Gage. The case of Phineas Gage has been crucial to our psychological understanding of personality and how it can be changed through abnormalities in the brain. Arguably, without the occurrence of this freak accident in 1848, our understanding of changes in personality would be much delayed. There is still much to be researched and developed within the psychological understanding and research of personality. Chow (2000) stressed that whilst instruments are currently used to obtain data personality changes of patients with frontal disorders – assessing which changes occurred before the damage and which changes were as a result of the damage – the usefulness of these instruments in predicting real-life performances of these patients is limited to non-existent. A key example of this was presented by Benson (1994; as cited in Chow, 2000), who described a patient with bifrontal disorder who, despite consciously agreeing not to drink water from the water fountain on the hospital ward, and remembering these directions, was unable to control his actions (meaning he drank from the water fountain). The patient described by Benson illustrates the downfalls of the current instruments used to measure personality in psychology – without collecting more personal and subjective data about the patient from those in their lives (for example) the data obtained from these instruments is unlikely to be reflective of the individual’s real-life actions. References:
Chow, T. W. (2000). Personality in frontal lobe disorders. Current Psychiatry Reports, 2(5), 446–451. https://doi.org/10.1007/s11920-000-0031-5 Damasio, H., Grabowski, T., Frank, R., Galaburda, A., & Damasio, A. (1994). The return of Phineas Gage: clues about the brain from the skull of a famous patient. Science, 264(5162), 1102–1105. https://doi.org/10.1126/science.8178168 Neylan, T. C. (1999). Frontal Lobe Function. The Journal of Neuropsychiatry and Clinical Neurosciences, 11(2), 280–281. https://doi.org/10.1176/jnp.11.2.280 Stuss, D. T., Gow, C. A., & Hetherington, C. R. (1992). “No longer gage”: Frontal lobe dysfunction and emotional changes. Journal of Consulting and Clinical Psychology, 60(3), 349–359. https://doi.org/10.1037/0022-006x.60.3.349 Sundram, F., Deeley, Q., Sarkar, S., Daly, E., Latham, R., Craig, M., Raczek, M., Fahy, T., Picchioni, M., Barker, G. J., & Murphy, D. G. M. (2012). White matter microstructural abnormalities in the frontal lobe of adults with antisocial personality disorder. Cortex, 48(2), 216–229. https://doi.org/10.1016/j.cortex.2011.06.005
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