Life After Brain Injuries: Are We Still the Same People …

Biology 202 2002 Second Paper On Serendip

During the summer of my junior year, a friend of mine, we will call her "Jen", got into a horrible car accident. Apparently sitting in the middle of the backseat, only strapped in with a lap belt, my friend hit her head on the side window, smashing the window upon impact. After 3 weeks of being in a coma, my friend eventually recovered. Even though she was deemed "physically" healed, my friend was truly never the same. Not only had her demeanor and interests changed, but also it seemed as if she had become a completely different person after her accident. I thought it very sad at the time, because the friends who had been close to her before were no longer close. I did not understand what they meant when they said that she had become a different person. Certainly, I realized that she had changed, but I could not fathom that she was now so different that they could no longer treat her like the old "Jen". I believed that this new "Jen" was still the same person as before-that the inner soul with which they had become friends had never and, indeed, could never change. However, after reading Descartes' Error: Emotion, Reason, and the Human Brain, by Antonio R. Damasio, I regret the harsh judgments I made about "Jen's" friends. Dealing with someone who has suffered from a tremendous change in personality is not as easy as one would expect.

Descartes, a famous philosopher, once made the statement, "Cogito ergo sum" (6). Like, Descartes, I previously believed that a separation between the mind and one's body existed. I believed that the mind of an individual was his or her soul and that the brain and body were just the machinery used to share that soul with the outside world. I never thought that an injury to the brain could cause a change in the entire essence of a person. However, Damasio espouses beliefs which are the exact opposite of Descartes. Damasio argues that the brain and mind are two inseparable entities and that thinking is the function of the brain. Aristotle once stated, "If the eye had a soul, it would be seeing". Using this format, a soul is defined as the function of something. If the function of the brain is to think, then it would follow that the soul of a person exists in one's mind, where the capability to think is lodged. If this mind is the consequence of a functioning brain, then it can be said that when a brain suffers an injury, an individual's entire essence is injured as well. This idea of a person's essence, or soul, changing is controversial. I believe this controversy arises because it is too frightening for a person to fathom that his intrinsic being could be permanently changed as a result of an unpreventable action. However, the evidence in favor of the premise that the mind is a function of the brain, or the brain is equal to one's behavior, is astonishing (5).

Brain injury is any injury that results in damage to the brain. For many people who suffer from brain injury, the problems associated with it become a permanent part of their lives. The problems that develop depend upon which part of the brain is injured. People can lose cognitive and motor functions as well as their ability to express thoughts and perceive their surroundings. The most unnerving consequence of a brain injury can be a change in personality. Often after being injured victims, like my friend "Jen", develop an apathy and decreased motivation for life. Emotion can run to both extremes: a forever high, or as in the case of my friend, an absence there of (1). In society there is a difference in the response shown to someone who has suffered a brain injury that changes his or her personality, and someone whose injury has affected any other part of the body, or even other types of injuries to the brain. What accounts for this difference? If an individual loses a limb, he loses the function of that limb as well. It makes sense then that when an individual loses part of his brain, the function of that part goes too. This is in correlation with the statement, brain = behavior. Each part of the brain seems responsible for different behaviors, a fact that is reinforced when examining injuries to different areas of the brain and the varying results that occur. For example, if an individual suffers injury to their amygdala, he becomes calm and almost devoid of emotional ups and downs. People have therefore reasoned that this area of the brain is responsible for exhibiting anger and possessing violent emotions (9). If the function of a specific area of the brain is a defining characteristic of an individual's personality, then it is almost as if a new person develops, in place of the old, when an injury to that area occurs.

In the summer of 1848, a man named Phineas Gage incurred a traumatic injury to the frontal lobe region of his brain after a sudden explosion sent a rod straight through his head. Against many odds, Phineas survived, but afterwards his demeanor changed dramatically. Once a calm, balanced, and levelheaded man, Gage became an overly emotional, unbalanced and quite vulgar man upon recovery. Friends he had had previously, now compared him to an animal and made the perplexing statement, "Gage was no longer Gage" (3). The most frightening thing about this story is that, although Gage was very different, he was not aware of the changes within himself. In class we have explored the nervous system and noted that there is a separate I-function involved, making one aware of the "self". With each class, it becomes more evident that this I-function has less and less control on the rest of the nervous system. Many times the I-function is not aware of things that the nervous system is doing until the person is told what his or her nervous system is doing, (i.e., when the brain makes up an image for the place of vision, the optic nerve, where no sensory receptors are located). So the question I have for people like Gage, who seem to be totally dissimilar people after suffering a brain trauma, is whether or not their I-functions are aware of the change in personality? People suffering from a personality change are unable to will themselves back to their old personality, even after their I-function is made aware. This furthermore, supports that brain equals behavior, because if behavior was independent of the brain, one would be able to change their personality back despite the brain changes. However, can we ever be sure that, because we are not mind readers, that even though their personality changes, they are not thinking in the same manner, as Descartes would argue? And if the individual thinks in an entirely new manner, would that really be enough to consider him or her a totally different person?

The likely reality is that when someone's brain is injured, the function is forever injured as well. There is no separation between mind and brain. Popular opinion of the mind's function is that it is a result of a brain process. Although when the brain loses a function, it is not unlike the reaction incurred in any other part of the body, but the more important query remains. Which characteristics do we use when defining a person's being? If Gage had suffered from a trauma to any other part of his body and survived, his friends would never have said that Gage was no longer the same person. Often when people undergo a personality change, their IQ remains unaffected by the injury. This is because of the various tasks delegated to the brain. The frontal lobe has evolved to be the main organizer. If people, like Gage, damage this region of their brain, their persona changes because this region is imperative for defining one's personality. However, if Gage had suffered from an injury to his temporal region, his personality would seem the same, only his memory would be adversely affected (9). An example of a personality change as a result of frontal lobe damage is a 12 year old boy who was in a car accident. Since the accident, the child has been aggressive and suffers from unpredictable destructive fits. Although his I.Q remains at 128 since the accident he has been expelled 3 times from different schools for his hostile persona, brought about after the damage to his brain (4). What, then, is the most important factor accounting for the way a person becomes defined; what has happened to make the various regions of the brain become so specialized? Has there been a gradual process through evolution that makes the loss of the frontal lobe harder to deal with than the loss of other regions of the brain, or other body parts? Or has the brain always functioned in this manner? When examining the responses to what appears to be injuries that are all serious in nature, it becomes apparent that some injuries are, indeed, more acute than others. Although an injury which is noticeable may on the surface seem more life changing, it cannot be argued that it is the injuries which are held within one's mind that are the most devastating to a person's being. Yes, they are all injuries to the body, but only those touching the brain have the capacity to change the "soul" of a person.

1)Brain Injury Society, A good site defining what brain injury is, its causes, and its treatments

2)Traumatic Brain Injury Resource Guide, a good diagram of the frontal lobe of the brain and a good description of its functions

3)Cyber Museum of Neurosugery, a good site about Phineas Gage

4)Alasbimn Journal, a legal page discussing the issues of aggressive personality change and the law

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Life After Brain Injuries: Are We Still the Same People ...