# Frontal lobe damage



## Stormcat (Dec 15, 2015)

Years ago, my one character was beaned on the head by a falling rock. He survived, his mind on the other hand...

I'm trying to do research into the damage done to the frontal lobe of the brain. I've heard about the famous case of Phineas Gage, but in all my research it never explicitly states WHAT changed about his personality. What was he like before the accident? Are there other cases of frontal lobe damage I should know about?

I know the frontal lobe controls emotions and impulse control, but what about anything else? Would he have any obvious signs or symptoms? Would he suffer seizures occasionally?


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## Red Sonja (Dec 15, 2015)

What is a lobotomy? 

Right, that used to be (still is) a medical procedure in which part of the frontal lobe is scrambled with a sharp instrument, similar to the manner in which one "piths" a frog to paralyze it so it can be dissected alive. Frontal lobotomy used to be a treatment for various types of mental illness that manifest in behavior that's hard to control, or general psychotic-type behavior. 

There's a lot of literature and historical data out there about the effects of lobotomy. (I remember some novel or another in which the serial-killer protagonist kidnaps subjects and tries to lobotomize them with an icepick so they'll be like zombie slaves but the title escapes me at the moment. It was a good seller at the time.) 

PS: Lobotomy isn't much used today for treatment of mental illness. Drugs are most often used instead now to control psychotic behavior. 

Behavior can change in lots of different ways after damage to the frontal lobe; sometimes slight damage will cause significant behavior changes and sometimes massive damage will not seem to have made much of a difference. 

What is that character supposed to be doing in the story? You do have quite a bit of wiggle room with frontal lobe damage, from "catatonic vegetable" to "that guy with a weird facial tic." 

And no, frontal lobe damage does not always result in seizures.


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## Plasticweld (Dec 15, 2015)

I didn't have frontal lobe damage but a bad concussion and a loss of about 2 years worth of memory, and short term memory loss for almost a half a year after; I could not tell you what I had done a few days prior  to that day.


For the most part it was a positive experience, I don't say that in jest because there are ways that you adapt and modify your behavior when your supposed to remember something and you don't.   


At the time I had a business selling hardware and tools to farmers in the area, thankfully I always kept notes on my customers and what we talked about as a sales technique.  For the newer customers I found that the only things I remembered were those written on the card, if nothing was written then I would swear I had never seen their face before.  Pictures jogged my memories as well but where there were no pictures there is no memory.   


I functioned fine it was a matter of just not recalling details to certain things, kind of like forgetting something but filling in the blanks as you go.


It did change the way I interact with people, I assume that everyone I meet is someone that I know and is a close friend, I do this because often I would meet someone and they came up to me and asked how my family was, what the kids were doing and life in general.  Most of the time when this happens I would swear I had never met them before but I obviously had.  By treating everyone I met as though they were close friends I avoided making someone feel like I had forgotten them.  The plus side is that if I did not know you, the average reaction to being treated as a friend, created one.   It is not bad thing. 



I ask a lot of questions, I am not shy about doing so.  I found that things I should have known I don't and by asking someone to explain something I could learn what I had missed.  It was common to have that feeling of no knowing I compensated by always asking questions.  It has carried over to my life many years later, I ask people about themselves as an effort learn more about them, this started as a way of compensating for what I didn't know but broke down any barriers about being shy and learning more about people.  I am sure if you were to ask anyone I know they would still tell you, I ask a lot of questions. 


I have found that it's ok to be confused and still remedy the  situation, it is ok to ask.  The best way to have long lost friends is to treat everyone as a long lost friend.  

As far as personality change given the loss of memory was a big plus as, I think it made me aware of more things.   I am also told I was an optimist before getting banged in the head so who knows... that was more than 25 years ago... I think :}


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## InstituteMan (Dec 15, 2015)

I've been told--perhaps in error--that frontal lobe damage leads to poor self control. 

The classic examples of poor self control due to frontal lobe damage that I've heard about are sexual, such as inappropriate leering and even touching after a beloved grandparent (who would never behave in such a way before) suffers a stroke, Alzheimers, or other type of dementia. It could be that sexual conduct rises to the surface because those urges are so powerful, but it also could be that we are so squicked out by sexual activity (especially by the elderly) that those are the examples that are recounted, rather than the more mundane inability to stop eating a favorite cookie.


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## Red Sonja (Dec 15, 2015)

InstituteMan said:


> I've been told--perhaps in error--that frontal lobe damage leads to poor self control.
> 
> The classic examples of poor self control due to frontal lobe damage that I've heard about are sexual, such as inappropriate leering and even touching after a beloved grandparent (who would never behave in such a way before) suffers a stroke, Alzheimers, or other type of dementia. It could be that sexual conduct rises to the surface because those urges are so powerful, but it also could be that we are so squicked out by sexual activity (especially by the elderly) that those are the examples that are recounted, rather than the more mundane inability to stop eating a favorite cookie.



You're right: These are only the cases you hear about because, you know, prurience. Damage to the frontal lobe can manifest a number of different ways. Sometimes it gets better (or the patient adapts/compensates), sometimes it can lead to worse things over time. That's the fascinating thing about the human brain! 

There are general signs of frontal lobe impairment that has occurred for whatever reason (a knock on the head, stroke, anoxic brain damage like from narcotics overdose). Loss of self-control can be part of that, seizures can be part of it, aphasia (meaning one thing but the wrong words come out when one tries to speak), loss of muscle control -- or not. 

That's good news for the writer because you don't have to just totally buckle down and learn a lot of stuff about frontal lobe damage to be able to write a character that has it. 

Again I invite you to think of why lobotomy was performed in ye good olde days: It was to control behavior, wasn't it? That means the lobotomized patient becomes less responsive, less active. He has a tendency to stare off into space. 

Hm, now I want to listen to a Ramones record for some strange reason.

PS: Alzheimer's doesn't cause frontal lobe damage, LOL. Er, sorry, but it's a different sort of thing. Science hasn't figured out exactly what Alzheimer's is caused by yet but it tends to work from the inner part of the brain outward. It's not frontal-lobe-based.


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## Wandering Man (Dec 15, 2015)

Phineas was an upstanding citizen before his injury. He followed all of the social mores of the time.

The injury involved a spike driven through his skull, and the injury involved a specific area of the brain, and this is an important distinction to be aware of.

After the injury he exhibited poor impulse control. He got int fights, gambled and lost, and I think there may have been some promiscuity. If he thought of something, he said it. He became crude, vulgar, and was generally poor company.

As far as your hero is concerned, unless he suffered a penetrating wound, there would likely be multiple systems involved.

In most blunt trauma head injuries your going to get coup and contra coup injury. The location of the skull that is struck may be damaged. And then the brain gets thrown to the opposite side and get damaged from the force and compression.

The skull has boney protrusions on the floor, under the frontal love that can abraide neurons if the head twists side to side. This may effect concentration and impulse control.

the boney protrusions in the temporal are can also knock out short term memory while the brain is sloshing around.

The degree of damage and observable deficits depends on severity of impact, and innate resources.

For a bright person, they might just notice they are slower, and fatigue more easily.

The brain is a lot more elastic than we once believe, and recovery happens, although seldom complete recovery.

The biggest jump in recovery usually happens over the first year.

Brain damage tends to be cumulative, though, and additional head trauma may result in magnified symptoms.


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## Stormcat (Dec 16, 2015)

This is all good information, but I think I need to divulge more information about this character.

-He was bonked on the head in his late twenties and that was thirty years ago.
-He is the "supreme executive" of a nation I made up. He has a regent to rule in his place, but sometimes legislation is passed on his (the accident victim's) behalf. Naturally, the Regent is abusing his power and manipulating the Supreme executive for his own ends.
-Before the accident, he had bad OCD. He still has OCD, but would the symptoms of the OCD be magnified or mitigated?
-He murdered his wife in a fit of rage, then ordered a cover-up of the event. The only witness, his son, is too traumatized to talk about the event. "Dad" is unaware of what his son saw and most likely does not care.

I'm trying to develop this character, so I need to know the "quirks" of someone with frontal lobe damage.


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## Wandering Man (Dec 16, 2015)

You might try reading Where is the Mango Princess? or Over My Head to get some ideas:

http://www.amazon.com/dp/0375704426/?tag=writingforu06-20

http://www.amazon.com/dp/0740705989/?tag=writingforu06-20

Both of these are stories written about or by people who have suffered from a traumatic brain injury.

I hope this helps.


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## Wandering Man (Dec 16, 2015)

Oh, and have you read this book?

http://www.amazon.com/dp/0262632594/?tag=writingforu06-20

You may end up becoming more of an authority on brain injury and brain function than you intended ...


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## Stormcat (Dec 22, 2015)

Apparently there's a Syndrome for frontal lobe damage, it exists in the ICD-10, but I don't know the specifics of it. I just so happened to glance at it during coding practice. Anyone know any more about it?


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