The strange case of Phineous Gage

1
The strange case of Phineous Gage
2
Phineous Gage

• Railroad foreman
• Well-respected, hard-working
• 1848 tamping iron accident
• He never lost consciousness, and had no obvious
  neurological symptoms
• But he was no longer Gage

3
Phineas Gage
the powder exploded, carrying an iron instrument
through his head an inch and a fourth in
circumference, and three feet and eight inches in
length, which he was using at the time. The iron
entered on the side of his face, shattering the
upper jaw, and passing back of the left eye, and
out at the top of the head. The most singular
circumstances connected with this melancholy
affair is, that he was alive at two oclock this
afternoon, and in full possession of his reason,
and free from pain. from Free Soil Union,
September 1948
4
The equilibrium or balance between his
intellectual faculties and animal propensities,
seems to have been destroyed.(Former R.R.
Employer)
5
(No Transcript)
6
Brain Anatomy - Phineas Gage

• Personality changed Gage became crude,
  uncaring, impulsive, irrational, anti-social
• Damasio H., Grabowski T,. Frank R., Galaburda
  AM., Damasio AR. (1994). The return of Phineas
  Gage clues about the brain from the skull of a
  famous patient. Science. 264(5162)1102-5,.
• Ventromedial region of the frontal lobes on both
  sides - causing a defect in rational decision
  making and the processing of emotion

7
Phineous Gage

• Gages Doctor described Gages post accident
  personality as
• Fitful, irreverent, indulging at times in the
  greatest profanity which was not previously his
  custom, manifesting but little deference for his
  fellows, impatient of restraint and advice when
  it conflicts with his desires, at times
  pertinaciously obstinate, yet capricious and
  vacillating, devising many plans of future
  operation, which are no sooner arranged than they
  are abandoned a child in his intellectual
  capacity and manifestations, he has the animal
  passions of a strong man.

8
(No Transcript)
9
He was no longer Gage

• Several different angles of where the rod passed
  through his skull

10
Phineous gage
11
Some symptoms associated with frontal lobe damage

• Working memory deficits
• Temporal memory / Source memory
• Perseveration
• Loss of spontaneous behavior
• Apathy
• Planning deficits/impaired goal-directed behavior
• Disinhibition/impulsive behavior
• Impaired attention
• Depression
• Elevated mood

12
Mood/Affect/Emotion Symptoms

• Depression
• Mood elevation
• Apathy

13
Frontal Lobotomies

• 1935 chimps who were neurotic before surgery
  became more relaxed after it
• 1930s Egaz Moniz begins frontal lobotomies in
  humans (and eventually wins Nobel Prize)
• 1950s psychosurgery in vogue 40,000 frontal
  lobotomies in North America
• The story of Agnes (Kolb Whishaw)
• no outward signs of emotion
• no facial expression
• no feelings toward other people (but still liked
  her dog)
• felt empty, zombie-like
• Other patients lose prosody emotional component
  of speech
• orbitofrontal cortex
• Patients with damage can remember info but dont
  have emotions associated with it

14
Frontal Lobe

• Lobotomy Early Critisicms
• Hoffman (1949)
• "these patients are not only no longer
  distressed by their mental conflicts but also
  seem to have little capacity for any emotional
  experiences - pleasurable or otherwise. They are
  described by the nurses and the doctors, over and
  over, as dull, apathetic, listless, without drive
  or initiative, flat, lethargic, placid and
  unconcerned, childlike, docile, needing pushing,
  passive, lacking in spontaneity, without aim or
  purpose, preoccupied and dependent."

15
Frontal Lobe

• Frontal Lobe Damage
• May have normal IQ on standard tests
• Poor control reasoning, planning emotions
• Disinhibition poor control of emotions
• Poor mental flexibility
• Perseveration e.g. trouble stopping action once
  initiated, e.g. dialing 999.
• Frontal lobe modulates functions of other regions

16
(No Transcript)
17
(No Transcript)