One cannot take an introductory psychology or neuroscience class without hearing about the railway construction worker, Phineas Gage. In 1848 while blasting rock in Vermont an ill-fated crowbar was propelled through the left-side of Gage’s face and out the top of his skull. Remarkably, Gage never lost consciousness and managed to survive another 12 years with his cognitive skills reportedly intact, but as the story goes Gage’s personality was never the same after the incident (Costandi, 2010). Before the bilateral laceration to Gage’s frontal lobes, coworkers described Gage as personable, but that shortly after the event he began to exhibit psychopathic personality traits. It is said Gage lost all social inhibition and grew violent physically and sexually, all while maintaining his intellect (Costandi, 2010).
Over a hundred years before neuroimaging, the story of Phineas Gage gave scientists and medical professionals their first look in to functional neuroanatomy. Gage’s story indicated that personality was held in a different part of the brain than intellect and motor control. Today, it is widely accepted that the frontal lobes primarily control mood, decision making, judgment and inhibition (Scott, 2013). Phineas Gage was not the only person in history to have their frontal lobes physically altered bringing forward a change in personality. Between the 1940s and 1960s, around 40,000 patients underwent the psychosurgery popularized by Walter Freeman and James Watt called the frontal lobotomy: In which slender metal rod was inserted through a drilled hole in the skull or behind the eye socket and pivoted around two centimeters into the frontal lobes (Pressman). The surgery was done to correct many psychological ailments; from depression, schizophrenia, and anxiety to disruptive behavior, pain and moodiness (Pressman). The practice of lobotomizing patients ceased in the early 1960s as patients were seen to lack emotional expression and to have little to no energy or drive (Dewey, 2007). Additionally, some patients appeared to be ‘stimulus-bound’ responding to pleasurable things around them such a eating and masturbation, with no regard to consequence and exhibited an inability to set goals (Dewey, 2007).
My question is, why did Phineas become a violent and cruel person after the severing of his frontal lobes, while the thousands of lobotomy patients merely listless after having an ice pick swirled through their frontal lobes? The answer might lie in the area between the orbital frontal cortex (OFC) and the amygdala. The orbital frontal cortex, is a part of the brain that controls decision making and impulsivity. The OFC also receives external stimuli and projects them to the amygdala, which is the center of the brain that control fear. Both the OFC and the amygdala have reduced volume and activity in patients with ASPD (James, 2003). Could Phineas Gage have had the projection pathways from his OFC to his amygdala altered by his deep lesion, while the lobotomy patients only had their OCT changed by their more superficial lesions? According to the picture below, one could see that this could be the case…
Orbital Frontal Lobe. (Wikipedia, 2015)
The Amygdala. (Davis, 2011)
The frontal lobotomy. In this photo one can see that a frontal lobotomy would affect the Orbital Frontal Cortex (OFC). (Freeman, 2010)
Gage (Keuchenius, 2014)
Here one can see that the rod could have damaged the OFC and the area between the OFC and the amygdala, destroying the projection pathway between the two areas. Could the damage between these two parts of the brain lead to psychopathic behavior exhibited by Gage, by blocking communication between the impulse control center and the fear control center of the brain, leading anti-social behavior? If so, what future research question should scientists be asking?
Currently, there is no efficacious pharmacological or psychotherapy treatment options for disruptive behavior disorders such as oppositional defiant disorder, conduct disorder, antisocial personality disorder, or psychopathy (Uptodate, 2015). Currently, prescribers will recommend therapy and give an atypical antipsychotic or mood stabilizer to reduce violent behavior, but neither therapy nor drugs have not been shown to change the underlying personality that promotes social irresponsibility and guiltless behavior (Uptodate). Is it time medical researchers started looked to neuroanatomy to alter personality? Neuroscientist have ways to mechanically stimulate the OFC and the amygdala using deep brain stimulation, but with a possibly poor connection between the two parts of the brain this stimulation might not improve behavior.
We need to look for ways to strengthen the pathway Phineas Gage had severed, the connection that may be underactive in ASPD patients between their OFC and amygdala. Neuroscience has taught us that neurogenesis occurs throughout the adult lifespan. Through intensive and early therapy focusing on fear conception and impulsivity, practitioners might be able to ‘rewire’ the brain to strengthen the connection between the impulse center and the fear centers of the brain. Also in the past decade there have been medical advances made targeting neural pathways such as vagus nerve stimulation and prescribing pharmaceutical agents such as D-cycloserine during therapy to enhance synaptic activity (Wikipedia, 2015). While at this time practitioners have no perfect way to strength brain circuits, neurosciences research in this field could change the future treatment of not only personally disorders, but many psychiatric conditions.
Costandi, M. (2010, November 8). Phineas Gage and the effect of an iron bar through the head on personality. Retrieved March 11, 2015, from http://www.theguardian.com/science/blog/2010/nov/05/phineas-gage-head-personality
Davis, L. (2011, September 1). Arguing with Your Spouse: The Emotional Hijacking. Retrieved March 12, 2015, from http://www.psychologicalgrowth.com/arguing-wtih-your-spouse/
Dewey, R. (2007, January 1). Effects of Lobotomies | in Chapter 02: Human Nervous System | from Psychology: An Introduction by Russ Dewey. Retrieved March 11, 2015, from http://www.intropsych.com/ch02_human_nervous_system/lobotomy_effects.html
Freeman, S. (2010, January 1). How Lobotomies Work. Retrieved March 12, 2015, from http://science.howstuffworks.com/life/inside-the-mind/human-brain/lobotomy1.htm
James, R. (2003, January 2). Neurobiological basis of psychopathy | The British Journal of Psychiatry. Retrieved March 11, 2015, from http://bjp.rcpsych.org/content/182/1/5
Keuchenius, K. (2014, October 31). Phineas-Gage. Retrieved March 12, 2015, from http://www.united-academics.org/magazine/mind-brain/mind-blowing-brain-cases-the-man-with-a-hole-in-his-head/attachment/phineas-gage/
Ressler, Kerry J., and Helen S. Mayberg. “Targeting Abnormal Neural Circuits in Mood and Anxiety Disorders: From the Laboratory to the Clinic.” Nature Neuroscience 10.9 (2007): 1116-124. Web. 8 Apr. 2015. http://www.nature.com/neuro/journal/v10/n9/abs/nn1944.html
Orbitofrontal cortex. (2015, January 1). Retrieved March 12, 2015, from http://en.wikipedia.org/wiki/Orbitofrontal_cortex
Pressman, M. (n.d.). Frontal Lobotomy and Ethical Questions of Psychosurgery. Retrieved March 11, 2015, from http://neurology.about.com/od/Neurosurgery/a/Frontal-Lobotomy.htm
Scott, T. (2013, January 1). Frontal Lobe – The Brain Made Simple. Retrieved March 11, 2015, from http://brainmadesimple.com/frontal-lobe.html
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