The Phineas Gage Case: How Traumatic Brain Injury to the Frontal Lobe Shaped Our Understanding Of Personality and Emotional Regulation

itsbrainblend
Dec 23, 2024
4 min read

Updated: Dec 26, 2024

● Phineas Gage

The case of Phineas Gage allowed researchers and psychologists to investigate and

study the frontal lobe of the brain. His injury provided the first clue that there was a

link between brain injuries and personality changes. In his reports, Harlow described

that the physical injury profoundly altered Gage's personality. Although his memory,

cognition and strength had not been altered,he became a man of bad and rude

ways, disrespectful to colleagues, and unable to accept advice. The disagreements have a number of different base. But, even if there was no bias and it were possible to determine the path of the tamping iron exactly, there was more damage than that caused by its passage. Haemorrhaging and damage from it was massive, the iron pushed fragments of bone through the brain that were not recovered (Gage was still vomiting some of them several days after the accident), and a massive abscess. Hanna Damasio and her colleagues make the unlikely assumption that Gage's brain and its position within the skull can be estimated from the skull itself, and that its functions were localised in an average way.

● Our frontal lobe- in relation with phineas gage

Our frontal lobe contains brain areas that manage who you are — especially your

personality — and how you behave. Your ability to think, solve problems and build

social relationships, sense of ethics and right vs. wrong all rely on parts of your

frontal lobe. Experts know this because of a railroad foreman named Phineas Gage. In 1848, an accidental explosion at a railroad construction site propelled an iron rod through

Gage’s head, destroying the left side of his frontal lobe. Before the accident, Gage

was a calm, respected leader among his coworkers. Gage survived, but after the

accident, his personality changed. He would lose his temper, act disrespectfully and

constantly use profanity. However, Gage’s personality changes weren’t permanent. Four years after his accident, Gage moved to Chile in South America and became a stagecoach driver. Somewhere in late 1858 or early 1859, a doctor who examined Gage said he was physically healthy and showed “no impairment whatsoever of his mental faculties.” While Gage mostly recovered from the accident, he died from seizures in San

Francisco in 1860. The seizures were very likely the result of damage from the

accident. However, his case remains one of the most useful in modern medicine’s

understanding of what the frontal lobe does, especially when it comes to your

personality.

● The frontal lobe

It is a relatively large lobe of the brain, extending from the front of the brain almost

halfway towards the back of the brain. Damage to the frontal lobe of the brain can

cause a range of symptoms, including motor weakness and behavioural problems.

The frontal lobe works alongside other brain regions and contributes to overall brain

function.

● A report of the Vietnam Head Injury Study

Knowledge stored in the human prefrontal cortex may exert control over more

primitive behavioural reactions to environmental provocation. Therefore, following

frontal lobe lesions, patients are more likely to use physical intimidation or verbal

threats in potential or actual confrontational situations. To test this hypothesis, we

examined the relationship between frontal lobe lesions and the presence of

aggressive and violent behaviour. Fifty-seven normal controls and 279 veterans,

matched for age, education, and time in Vietnam, who had suffered penetrating head

injuries during their service in Vietnam, were studied. Family observations and

self-reports were collected using scales and questionnaires that assessed a range of

aggressive and violent attitudes and behaviour. Two Aggression/Violence Scale

scores, based on observer ratings, were constructed. The results indicated that

patients with frontal ventromedial lesions consistently demonstrated Aggression/Violence Scale scores significantly higher than controls and patients with

lesions in other brain areas. Higher Aggression/Violence Scale scores were

generally associated with verbal confrontations rather than physical assaults, which

were less frequently reported. The presence of aggressive and violent behaviours

was not associated with the total size of the lesion nor whether the patient had

seizures, but was associated with a disruption of family activities. These findings

support the hypothesis that ventromedial frontal lobe lesions increase the risk of

aggressive and violent behaviour.

● How does this happen?

TBI produces rapid deformation of the brain, resulting in a cascade of specific

pathological events. The resulting changes in the anatomy and neurophysiology of

the brain can disrupt multiple cerebral networks affecting cognitive, autonomic and

emotional functions, as well as other aspects of behaviour

Personality change may include poor motivation, and a tendency to be self-centred

and less aware of the needs of others. Patients may be described as lazy and

thoughtless. Some become disinhibited and rude. Agitation and aggression can be

very difficult to manage. In post-concussion patients, this can be related to overstimulation—it may be your body’s way of coping when your brain can’t handle everything it needs to. Rather than being frustrated with yourself (or, if you’re a family member, getting angry about the crying), handle the situation with levity. It’s healthier to laugh and acknowledge that the tears are out of your control than to struggle against them and increase your frustration.

References

The damage to Phineas Gage's brain. (n.d.). The University of Akron.

https://www.uakron.edu/gage/damage.dot

Frontal Lobe: What It Is, Function, Location & Damage. (2022, December 5).

Cleveland Clinic. https://my.clevelandclinic.org/health/body/24501-frontal-lobe

Moawad, H., & Figueroa, W. (2022, July 11). Frontal lobe: Functions, structure, and

damage. MedicalNewsToday.

https://www.medicalnewstoday.com/articles/318139#functions

Nelson, C. A. (n.d.). Frontal Lobe Brain Injury. Physiopedia.

https://www.physio-pedia.com/Frontal_Lobe_Brain_Injury

A report of the Vietnam Head Injury Study J. Grafman, PhD, K. Schwab, PhD, D.

Warden, MD, A. Pridgen, BS, H. R. Brown, HMCM, USN (Ret), and A. M.