Mental diseases: a public health problemMay, James Vance
Science
Mental diseases: a public health problem
May, James Vance
Mental health services; Psychology, Pathological
One of the earliest accurate descriptions of brain injury associated
with mental symptoms was that of the well-known "crowbar" case. It will
be recalled that while blasting in Vermont in 1848 a man by the name of
Gage had an iron bar driven through the frontal region of his skull,
making a complete recovery and living for over twelve years after
the accident. An autopsy showed that only the prefrontal cortex was
involved. A very interesting report on his mental condition was made by
Dr. John M. Harlow:[149] "His contractors, who regarded him as the most
efficient and capable foreman in their employ previous to his injury,
considered the change in his mind so marked that they could not give
him his place again. The equilibrium, or balance, so to speak, between
his intellectual faculties and animal propensities seems to have been
destroyed. He is fitful, irreverent, indulging at times in the grossest
profanity (which was not previously his custom), manifesting but little
deference for his fellows, impatient of restraint or advice when it
conflicts with his desires, at times pertinaciously obstinate yet
capricious and vacillating, devising many plans of future operations,
which are no sooner arranged than they are abandoned in turn for others
appearing more feasible. A child in his intellectual capacity and
manifestations, he had the animal passions of a strong man. Previous
to his injury, though untrained in the schools, he possessed a well
balanced mind, and was looked upon by those who knew him as a shrewd,
smart business man, very energetic and persistent in executing all his
plans of operation. In this regard his mind was radically changed, so
decidedly that his friends and acquaintances said he was 'no longer
Gage.'"
Various other cases reported have established the fact that mental
deterioration usually follows extensive injuries to the frontal lobes.
Witmer[150] summarizes this as consisting of "slight intellectual
degradation, moral and emotional perversion, deficiency of attention,
and volitional inefficiency."
Public-domain text, read in full here on John Shaqi.
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