• Brain Injury And Phineas Gage

I had to read about Phineas Gage when I was in college – I believe I had to read about him in a psychology class I took.

After a metal rod went through his head, Gage’s personality was drastically altered (according to what I read in college).

One of a few reasons I find this an interesting story is that so many Christians give horrible advice to anyone who is suffering from a mental health disorder, that if they just pray hard enough, have enough faith, trust Jesus, or attend church weekly, that they will be healed of their mental health problems.

I wonder how such Christians would deal with Gage’s story? I doubt that his condition could’ve been changed from church attendance or Bible reading. Personal sin did not cause his issues.

Phineas Gage and the effect of an iron bar through the head on personality

The extraordinary case of Phineas Gage has been used and abused by neurologists and even the occasional creationist. Mo Costandi summarises what we know, and what we don’t

Phineas Gage – on Wikipedia

Phineas P. Gage (1823–1860) was an American railroad construction foreman remembered for his improbable[B1]:19 survival of an accident in which a large iron rod was driven completely through his head, destroying much of his brain’s left frontal lobe, and for that injury’s reported effects on his personality and behavior over the remaining 12 years of his life‍—‌effects sufficiently profound (for a time at least) that friends saw him as “no longer Gage”. [H]:14

…Phineas Gage influenced 19-century discussion about the mind and brain, par­tic­u­larly debate on cerebral local­i­za­tion, ​​[M]:ch7-9[B] and was perhaps the first case to suggest the brain’s role in deter­min­ing per­son­al­ity, and that damage to specific parts of the brain might induce specific per­son­al­ity changes.

Photo slide: View drawing of Gage’s brain trauma, with notations

Phineas Gage, Neuroscience’s Most Famous Patient

Snippets:

by Sam Kean

… But even today scientists have only a vague idea of how the prefrontal lobes exercise that control. And victims of prefrontal injuries can still pass most neurological exams with flying colors. Pretty much anything you can measure in the lab—memory, language, motor skills, reasoning, intelligence—seems intact in these people.

It’s only outside the lab that problems emerge.

In particular, personalities might change, and people with prefrontal damage often betray a lack of ambition, foresight, empathy, and other ineffable traits.

These aren’t the kind of deficits a stranger would notice in a short conversation. But family and friends are acutely aware that something is off.

Frustratingly, Harlow limited his discussion of Gage’s mental status to a few hundred words, but he does make it clear that Gage changed—somehow. Although resolute before the accident, Harlow says Gage was now capricious, and no sooner made a plan than dropped it for another scheme.

Although deferential to people’s wishes before, Gage now chafed at any restraint on his desires. Although a “smart, shrewd businessman” before, Gage now lacked money sense.

And although courteous and reverent before, Gage was now “fitful [and] irreverent, indulging at times in the grossest profanity.” Harlow summed up Gage’s personality changes by saying, “the equilibrium … between his intellectual faculties and his animal propensities seems to have been destroyed.” More pithily, friends said that Gage “was no longer Gage.”

….People butcher history all the time, of course, for various reasons. But something distinct seems to have happened with Gage. Macmillan calls it “scientific license.” “When you look at the stories told about Phineas,” he says, “you get the impression that [scientists] are indulging in something like poetic license—to make the story more vivid, to make it fit in with their preconceptions.”

Science historian Douglas Allchin has noted the power of preconceptions as well: “While the stories [in science] are all about history—events that happened,” Allchin writes, “they sometimes drift into stories of what ‘should’ have happened.”

With Gage, what scientists think “should” have happened is colored by their knowledge of modern patients. Prefrontal lobe damage is associated with a subsequent slightly higher rate of criminal and antisocial behavior. Even if people don’t sink that low, many do change in unnerving ways: They urinate in public now, blow stop signs, mock people’s deformities to their faces, or abandon a baby to watch television.

It’s probably inevitable, Macmillan says, that such powerful anecdotes influence how scientists view Gage in retrospect: “They do see a patient and say, ‘Ah, he’s like what Phineas Gage was supposed to be like.’ ”

To be clear, Harlow never reports anything criminal or blatantly unhinged about Gage’s conduct. But if you’re an expert on brain damage, scientific license might tempt you to read between the lines and extrapolate from “gross profanity” and “animal passions” to seedier behavior.

Van Horn did introduce a new wrinkle, however. He studies brain connectivity, the emerging awareness that, while neurons are important to brain function, theconnections between neurons are equally vital.

Specifically, the patches of neurons that compute things in the brain (grey matter) reach their full potential only when networked together, via axon cables (white matter), to other centers of neural computation.

And while Gage suffered damage to 4 percent of his grey matter, Van Horn concluded, 11 percent of his white matter suffered damage, including cables that led into both hemispheres. Overall, the injury “was much more profound than even we thought,” he says.

How that damage affected Mr. Gage’s behavior, though, is tough to predict. Van Horn has read Macmillan’s work closely, and he says it scared him away from undue speculation. “I didn’t want to piss [Macmillan] off,” he jokes. Van Horn nevertheless did compare the destruction of Gage’s white matter to the damage wrought by neurodegenerative diseases like Alzheimer’s.

Gage might even have displayed classic symptoms of Alzheimer’s, he argues, such as moodiness and an inability to complete tasks. John Harlow’s original case report did state that Gage’s changes were “nothing like dementia,” Van Horn acknowledges. But Harlow examined Gage shortly after his accident, Van Horn says, not months or years later, when such symptoms might have emerged.

Despite different interpretations, Damasio, Ratiu, and Van Horn all agree about one thing: Their models are basically sophisticated guesswork. Clearly, the tamping iron destroyed some brain tissue.

But the flying bone shrapnel and the fungal infection would have destroyed still more tissue—and that destruction is impossible to quantify.

Perhaps even more important, both the position of the brain within the skull, and the location of various structures within the brain itself, actually vary a lot from person to person—brains differ as much as faces do. When cataloguing brain destruction, then, millimeters matter. And no one knows which exact millimeters of tissue got destroyed in Gage. 

…Another, deeper reason Gage will probably always be with us is that, despite all that remains murky and obscure, his life did hint at something important: The brain and mind are one.

As one neuroscientist writes, “beneath the tall tales and fish stories, a basic truth embedded in Gage’s story has played a tremendous role in shaping modern neuroscience: that the brain is the physical manifestation of the personality and sense of self.” That’s a profound idea, and it was Phineas Gage who pointed us toward that truth.

Video: Dr Peter Ratiu – A famous patient revisited: Phineas Gage

Phineas Gage: The man with a hole in his head

Snippets:

Under the expert care of local doctor John Harlow, Phineas kept on living for 12 years [after the accident which put a large metal rod through his brain].

Little did he know that his momentary lapse of concentration would lead to him becoming one of the most famous case studies in brain science to this day.

Because although Phineas survived, he was a changed man. Now he was reportedly unreliable, partial to swearing and often making inappropriate remarks.

“It’s reported that he became what now would be classically described as ‘disinhibited’ – this is a classic term for what happens to some people after damage to their frontal lobes,” says John Aggleton, professor of neuroscience at Cardiff University.

“So, he loses his inhibitions, both in a social and emotional context. He would be rather high.

“Difficult company, to put it mildly.”

For specialists, this was a staggering revelation. For the first time, this was evidence that damage to the brain could affect our behaviour and personality.

“When Phineas’ accident occurred, there was no accepted doctrine of the brain having functions,” says Malcolm Macmillan, professor of psychology at Melbourne University, and author of An Odd Kind of Fame: Stories of Phineas Gage.

Why Brain Scientists Are Still Obsessed With The Curious Case Of Phineas Gage

Snippets:

by Jon Hamilton

Gage didn’t die. But the tamping iron destroyed much of his brain’s left frontal lobe, and Gage’s once even-tempered personality changed dramatically.

“He is fitful, irreverent, indulging at times in the grossest profanity, which was not previously his custom,” wrote John Martyn Harlow, the physician who treated Gage after the accident.

This sudden personality transformation is why Gage shows up in so many medical textbooks, says Malcolm Macmillan, an honorary professor at the Melbourne School of Psychological Sciences and the author of An Odd Kind of Fame: Stories of Phineas Gage.

“He was the first case where you could say fairly definitely that injury to the brain produced some kind of change in personality,” Macmillan says.

And that was a big deal in the mid-1800s, when the brain’s purpose and inner workings were largely a mystery. At the time, phrenologists were still assessing people’s personalities by measuring bumps on their skull.

Gage’s famous case would help establish brain science as a field, says Allan Ropper, a neurologist at Harvard Medical School and Brigham and Women’s Hospital.

“If you talk about hard core neurology and the relationship between structural damage to the brain and particular changes in behavior, this is ground zero,” Ropper says. It was an ideal case because “it’s one region [of the brain], it’s really obvious, and the changes in personality were stunning.”

So, perhaps it’s not surprising that every generation of brain scientists seems compelled to revisit Gage’s case.

…There is something about Gage that most people don’t know, Macmillan says. “That personality change, which undoubtedly occurred, did not last much longer than about two to three years.”

Gage went on to work as a long-distance stagecoach driver in Chile, a job that required considerable planning skills and focus, Macmillan says.

This chapter of Gage’s life offers a powerful message for present day patients, he says. “Even in cases of massive brain damage and massive incapacity, rehabilitation is always possible.”

How Phineas Gage’s Freak Accident Changed Brain Science Forever

Today, we take it for granted that certain parts of the brain are responsible for certain aspects of our behavior. But in the 1800s, scientists were just grasping a rough understanding of the brain’s purpose. That all changed — violently — on a fateful day in 1848, when an iron rod rocketed through the brain of a young rail foreman named Phineas Gage.

Video: A Rod Through His Brain: The Story of Phineas Gage


More on this Blog:

ACFJ Blog’s Hennessy Domestic Violence Series: Yes, Codependency Makes An Appearance

What Made Mental Illness a ‘Sin’? Paganism – podcast and article from Christianity Today

How The Bible Can Be Damaging to People with Depression via Patheos Blog

For Most, Jesus and the Gospels Are Not the Answer for Depression, Suicide, and Other Mental Health Maladies (Part 1)

Dear Ray Comfort and David Barton: Depression is Not a Culture War Battle by Warren Throckmorton

Lost Connections: Uncovering the Real causes of Depression and the Unexpected Solutions by Johann Hari

You Can Write Your Way Out of an Emotional Funk. Here’s How. by Susan David

For Some of Us Running Is the Key To Managing Depression And Anxiety by Scott Douglas

1 in 3 Protestant Churchgoers Personally Affected by Suicide

Why Does Being a Woman Put You at Greater Risk of Having Anxiety? by Cari Romm

When Your Spouse is Mentally Ill, from Christianity Today

Regarding Grief, Sickness and Depression: Hold Your Tongue and Offer Your Heart Instead by Heather Plett

Synthetic ‘Love Hormone’ Could Be Key To Treating Mental Illness

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