Phineas Gage suffered an injury to his ventromedial prefrontal cortex, which is to say the front middle portion of his skull (Carlson, 2014). Rather than dying, Mr. Gage survived and made a physical recovery, save for the use of his left eye. However, the injuries to his brain resulted in a massive shift in personality, one which ruined him financially and socially. For the sake of clarity, I will abbreviate the ventromedial prefrontal cortex to the initials VM, as was done in the research document written by Bechara, Tranel, and Damasio (2010).
Based on accounts from family and friends, Mr. Gage’s disposition pre-injury was that of a hardworking, considerate, and mature young man who was competent enough to maintain the position of a railway foreman. After the injury, Mr. Gage seemingly lost his ability to control his emotions, discern between wise and impulsive actions, and became essentially inconsiderate of others. In essence, Mr. Gage lost his personal temperance and wisdom. He became the proverbial unwise man.
What is interesting of Mr. Gage’s condition, and indeed most individuals suffering from VM injuries, is that Mr. Gage was still capable of rationally analyzing and discussing social situations. That this intellectual ability does not extend into personal behavior implies that the qualities of self-control and wisdom are produced by multiple functions found in different parts of the brain.
Because our thoughts and behaviors are physically derived, the concept of responsibility and culpability becomes murkier. In earlier times Mr. Gage’s personality shift post injury could have been explained as either being a lack of character on his part or as an evil spirit, much in the same way that spirits were attributed as the cause of illnesses and insanities in the New Testament times (Matthew 17:18). Matthew 17:15 describes a boy as suffering from seizures and in Matthew 17:18 Jesus’ curing the boy is described as, “Then Jesus rebuked the demon in the boy, and it left him. From that moment the boy was well” (New Living Translation). However, because we now have a greater appreciation for the interaction between the brain and the mind, we have to adapt our definitions of mental behavior to encompass our expanded understanding of God’s creation.
Research indicates that the primary gap in cognitive ability seen in VM injuries is that they cannot appreciate the long term negative consequences for their actions as well as they can appreciate the potential gains for risky behavior (Bechara, Tranel, & Damasio, 2010). Researchers attempted to produce differences in behavior in gambling habits by varying the immediacy of the consequences for risky behavior. However, the VM patients’ behavior did not alter even when they suffered extreme negative consequences. I am therefore inclined to say that the Mr. Gage’s interests would have been best served if a family member had been allowed to take over his finances. However, because the VM suffers’ behavior reflects a lack of sensitivity towards negative reinforcement, it may be that behavioral modification relying on positive reinforces is a potential route to rehabilitating the VM’s behavior.
Bechara, A., Tranel, D., & Damasio, H. (2000, November). Characterization of the decision-making deficit of patients with ventromedial prefrontal cortex lesions. Brain, 123(11), 2189-2202. Retrieved from http://sbnec.org.br/gene/Bechara%202000.pdf
Carlson, N. R. (2014). Foundations of behavioral neuroscience (9th ed., pp. 6-109). Upper Saddle River, NJ: Pearson.