The most famous case of a change in personality following frontal-lobe damage is Phineas Gage, a twenty-five-year-old foreman who worked for the Rutland & Burlington Railway Company. On 13 September 1848, he was blasting away rocks to clear the way for the rails. To do this, a hole was drilled into the rock, packed with gunpowder, covered with sand and then tamped down with an iron rod to seal the charge. On that fateful day, apparently Phineas was distracted momentarily. He dropped the rod directly on to the gunpowder, igniting it to create an explosion that shot the 6ft metal rod through his left cheekbone under the eye and out the top of his skull to land 60ft away, taking a large part of his frontal lobes with it.
Remarkably, Phineas survived but he was noticeably changed in personality. According to the physician that looked after him, before the accident Phineas was ‘strong and active, possessed of considerable energy of character, a great favorite with his men’ and ‘the most efficient and capable foreman’. After the accident, the doctor produced a report to summarize why the railway company would not re-employ him. Phineas was described as ‘fitful, irreverent, grossly profane and showed but little deference for his fellows’. He was ‘impatient of restraint or advice that conflicted with his desires’. In short, he had become a grumpier, ruder, more argumentative person, such that his former friends and acquaintances said he was ‘no longer Gage’.
Due to the power of brain plasticity, Gage did eventually recover well enough to hold down another job as a stagecoach driver, but it is not clear whether his personality ever returned to that of the likeable fellow he had been before the accident. There has been considerable debate about Phineas Gage and whether his personality was permanently changed because the records at the time were poorly kept.24 The story has been retold many times and something of a myth has been built up around this famous case. We have a much clearer picture with Alexander Laing, a former trooper in the British Army Air Corp, who is a modern-day Phineas Gage.25 Following a skiing accident in 2000, Alexander suffered frontal-lobe brain damage that left him paralysed and unable to speak. He recovered quickly but on returning home became very antisocial, aggressive and unable to suppress his sexual urges. He is reported to have walked around his parents’ house naked and acted inappropriately to women in public. At the time, his stepmother said, ‘The damage to Alexander’s frontal lobes seems to have exaggerated his character, although experts aren’t sure if this is the case. I think the impulses were always there, but the lack of inhibition means he cannot control himself.’ Of the time around his injury Alexander recalled ten years later, ‘The frontal lobe damage was the worst. It meant I lost my inhibitions and did stupid things. It was like being permanently drunk. Afterwards I got into trouble of all sorts, I was even arrested twice. It was not a good time.’
Today, Alexander runs marathons for charity and seems to have got the better of his impulses, though his personality will probably never be the same as before the injury. During the 2011 London Marathon, he stopped after running 23 miles and began an impromptu dance in response to a Gospel choir performing at the side of the road to encourage runners, much to the delight of the gathered crowds. Only after the intervention of a medic assisting at the marathon was Alexander persuaded to stop dancing and return to the race. He believes that religion has kept him on the straight and narrow, showing that with the right social support, patients with frontal-lobe damage can experience considerable recovery. It also helps that we now have a better medical understanding of the importance of the frontal lobes in controlling our impulses. These cases reveal what happens to adults’ social behaviours following damage to the frontal lobes. Understanding the relationship between EF and the frontal lobes helps explain why young children often behave in a way in which they seem oblivious to others around them and the embarrassment they create for their parents. Their immature frontal lobes have not yet been tuned up by the processes of domestication in the ways of how to conduct oneself in public.
Temper tantrums
‘Daddy, I want it and I want it now!’
Who can forget Veruca Salt, the spoiled brat in Roald Dahl’s Charlie and the Chocolate Factory who got everything she wanted? She may have been obnoxious but she really was no different from many young children when they cannot get their way. Around the end of infancy, children enter a phase that parents refer to as the ‘terrible twos’. At this age, children have sufficient communication skills to let others know what they want but they are unwilling to accept no for an answer. It is a very frustrating time for parents because unless they give in to their child’s demands the child can throw a temper tantrum – often for the benefit of a full public audience in a shopping mall or theatre. There is no point trying to reason with most two-year-olds because they do not understand why it is in their interests not to have what they want immediately. That requires the silent manager of the PFC to speak up.
One way to think about the PFC is that rather than supporting just one type of skill, it is engaged in all aspects of human behaviours and thoughts. As we grow older, our behaviours, our thoughts and our interests change. Situations that require some level of coordination and integration will require the activity of the frontal lobe EFs which do not reach mature levels of functioning until late adolescence.26 When adults have to learn a new set of information that conflicts with what they already believe to be true, there is heightened PFC activation during the transition phase, as revealed by functional brain imaging. One interpretation is that they are simply concentrating more, enlisting greater EF activity, but that activation depends on whether they have to contradict their initial beliefs. In this situation, the PFC activity is interpreted as reconciling incompatible ideas by inhibiting and suppressing knowledge that they previously held.27 So rather than regarding any limited ability as being due to immaturity of the PFC, it is probably more accurate to say that changing behaviours and thoughts have not yet been fully integrated into the individual’s repertoire – they are still learning to become like others.
In many social situations, young children think mostly about themselves, which explains why their interactions can be very one-sided. Some of us never grow out of this type of behaviour. These are the selfish individuals we all have encountered who only think about themselves. They do not care about what others think and behave as if their needs and opinions are the only important things in the world. They lack the patience and understanding that is required to have a balanced social relationship.
What happens to children who lack self-control when they grow up into adults? Terrie Moffitt and her team followed up over 1,000 children who had been born in the New Zealand city of Dunedin in 1972–3 and studied them from birth to the age of thirty-two years.28 Each child was assessed for measures of self-control from three years of age based on reports from the parents, teachers, researchers and the children themselves. The results were startling. Children with high self-control were healthier, happier, wealthier and less likely to commit crime. These effects still held when intelligence and social background were taken into consideration. However, this was an observational study so it is difficult to know exactly what aspect of self-control was responsible for the outcome. What aspects of EFs were playing a major role in the children’s entry into society? To answer that, we need a marshmallow, or possibly two.