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What Is a Case Study?

When you’re performing research as part of your job or for a school assignment, you’ll probably come across case studies that help you to learn more about the topic at hand. But what is a case study and why are they helpful? Read on to learn all about case studies.

Deep Dive into a Topic

At face value, a case study is a deep dive into a topic. Case studies can be found in many fields, particularly across the social sciences and medicine. When you conduct a case study, you create a body of research based on an inquiry and related data from analysis of a group, individual or controlled research environment.

As a researcher, you can benefit from the analysis of case studies similar to inquiries you’re currently studying. Researchers often rely on case studies to answer questions that basic information and standard diagnostics cannot address.

Study a Pattern

One of the main objectives of a case study is to find a pattern that answers whatever the initial inquiry seeks to find. This might be a question about why college students are prone to certain eating habits or what mental health problems afflict house fire survivors. The researcher then collects data, either through observation or data research, and starts connecting the dots to find underlying behaviors or impacts of the sample group’s behavior.

Gather Evidence

During the study period, the researcher gathers evidence to back the observed patterns and future claims that’ll be derived from the data. Since case studies are usually presented in the professional environment, it’s not enough to simply have a theory and observational notes to back up a claim. Instead, the researcher must provide evidence to support the body of study and the resulting conclusions.

Present Findings

As the study progresses, the researcher develops a solid case to present to peers or a governing body. Case study presentation is important because it legitimizes the body of research and opens the findings to a broader analysis that may end up drawing a conclusion that’s more true to the data than what one or two researchers might establish. The presentation might be formal or casual, depending on the case study itself.

Draw Conclusions

Once the body of research is established, it’s time to draw conclusions from the case study. As with all social sciences studies, conclusions from one researcher shouldn’t necessarily be taken as gospel, but they’re helpful for advancing the body of knowledge in a given field. For that purpose, they’re an invaluable way of gathering new material and presenting ideas that others in the field can learn from and expand upon.


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A case of “Borrowed Identity Syndrome” after severe traumatic brain injury

Maria pachalska.

1 Institute of Psychology, Gdansk University, Gdansk, Poland

2 Faculty of Psychology and Health Sciences, Frycz Modrzewski Cracow University, Cracow, Poland

Bruce Duncan MacQueen

3 Institute of English Literature, Gdansk University, Gdansk, Poland

Bozydar L. J. Kaczmarek

4 Institute of Psychology, Szczecin University, Szczecin, Poland

5 Institute of Psychology, Maria Curie-Sklodowska University, Lublin, Poland

Magdalena Wilk-Franczuk

6 Health and Medical Sciences Department, Frycz-Modrzewski Cracow University, Cracow, Poland

Izabela Herman-Sucharska

7 Magnetic Resonance Laboratory, Collegium Medicum, Jagiellonian University, Crakow, Poland

It is well known that traumatic brain injury often changes the way the patient perceives reality, which often means a distortion of the perception of self and the world. The purpose of this article is to understand the processes of identity change after traumatic brain injury.

Case Report

We describe progressive deterioration in personal identity in a former physician who had sustained a serious head injury (1998), resulting in focal injuries to the right frontal and temporal areas. He regained consciousness after 63 days in coma and 98 days of post-traumatic amnesia, but has since displayed a persistent loss of autobiographical memory, self-image, and emotional bonds to family and significant others. Qualitative ‘life-story’ interviewing was undertaken to explore the mental state of a patient whose subjective, “first person” identity has been disengaged, despite the retention of significant amounts of objective, “third person” information about himself and his personal history (though this was also lost at a later stage in the patient’s deterioration).

Identity change in our patient was characterized by a dynamic and convoluted process of contraction, expansion and tentative balance. Our patient tends to cling to the self of others, borrowing their identities at least for the period he is able to remember. Identity is closely connected with the processes of memory.


The results will be examined in relation to the microgenetic theory of brain function. The brain mechanisms that may account for these impairments are discussed. Findings from this study have important implications for the delivery of person-focused rehabilitation.

The traditional approach to disorders consequent to brain injury centers on the description of concrete symptoms that be shown to correlate significantly with injuries to particular brain regions. This approach began with the pioneering works of Broca [ 1 ] and Wernicke [ 2 ], and has continued in much contemporary work in neuropsychology [ 3 – 5 ]. A.R. Luria [ 6 ] tried to go beyond merely listing the particular symptoms observed, introducing the idea of the “basic defect,” i.e. a single underlying disorder that is presumably causing the manifold observable difficulties the patient manifests in performing the tasks involved in a neuropsychological examination. Thus a basic defect in phonemic hearing would affect performance in all tasks involved with that function, such as verbal memory, word repetition, reading, writing, etc., while performance should be unimpaired in tasks that do not require phonemic hearing. Only in this way would it be possible, in Luria’s view, to describe a syndrome characterized by a particular set of disorders following a specific brain lesion.

Luria’s approach was certainly a step forward, both in the better understanding of the nature of the symptoms observed in a particular patient and in conducting more effective therapy. Yet Luria’s approach was only able to explain some of the symptom changes observed in a patient during the process of recovery. It does not provide an explanation for the appearance of clinically distinct syndromes over the course of progressive deterioration, as observed in many post-TBI patients. One such patient will be described in the present report, with particular emphasis on some unusual disorders of personal identity in a former physician who sustained a serious brain injury due to a car accident in 1998. The injury resulted in focal injuries in the frontal and right temporal areas and coma lasting 63 days. The real purpose of this paper, however, is to explore the mind of a patient whose identity has been disrupted, and who has experienced the loss of his self image and relations with his immediate surroundings.

This case study follows patient PA from the age of 43 at the time of injury until his current age of 54 years. The patient is a board-certified gynecologist and obstetrician. Prior to the accident, he was the head of the OB-GYN department in a provincial hospital in southern Poland. He was married with three children, currently ranging in age from 13 to 26 years. The oldest daughter finished the Academy of Fine Arts in 2009 and is making a career as a painter. There were some problems with the marriage after his wife discovered that he had had a lover, who, as reported by his family and the lover herself, he had claimed to regard as the love of his life.

In November 1998, the car PA was driving struck a tree when he swerved to avoid a head-on collision. He incurred multi-organ injuries, including a very severe TBI. He remained conscious for a short period of time immediately after the accident, however, and his memory concerning the event itself seems to be intact as of this writing. An intracranial hematoma developed immediately after admission to hospital, and the patient lost consciousness. His Glasgow Coma Scale score 24 hours after the accident was 3, the lowest possible. He remained in a coma for 63 days, but was not operated; his post-injury amnesia lasted 98 days.

Neuroimaging ( Figure 1 ) shows damage mainly in the right hemisphere, most significantly affecting:

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MRI scan of PA’s brain, performed four months post injury. ( A ) Axial SE T1 sequence: malacia in the right lower frontal gyrus (short arrow) and lower temporal gyrus (long arrow). ( B ) Axial FLAIR sequence: hyperintensive gliotic lesion, right lower frontal gyrus (arrow). ( C ) Axial FLAIR sequence: atrophy and malacia, right gyrus rectus (arrow).

When first examined by the authors in January 1999, the patient was found to be suffering from:

Initial signs of misidentification were observed in February 1999. These included:

At that time he was able to recognize (i.e. name) some personal items (e.g. keys, comb, toothbrush), but denied that they belonged to him. Later in his recovery, he was able to name objects relevant to his past, e.g. cigarettes, a bottle of cognac, but did not recognize these items as being connected with his previous experience.

We learned from an interview with his wife that on the day of the accident a major marital crisis had occurred, resulting from the patient’s infidelity. His wife had discovered that PA intended to go to a party with his lover. After a fierce quarrel he eventually backed down, and went with his wife instead; however, during the trip there was a sudden change in the situation on the road, and PA drove into a tree while passing a delivery truck. His wife did not suffer any serious injuries, because PA at the very last moment before the collision steered the car in such a way so as to take on himself the full force of the impact.

The patient’s mother is of the opinion, and has often repeated it, that the cause of the accident was the hysterical behavior of her daughter-in-law. The truth is that her son had always driven much too fast and recklessly; PA has loved sports cars since childhood, and dreamed of taking part in car rallies.

Very significant changes in his habits and behavior were noted in the 6 months following his arousal from coma. Prior to his accident he had been a vegetarian, a smoker, a moderate drinker, a known wit, who enjoyed social intercourse and parties. Following the injury, he had no recall of this lifestyle and personal history. At the same time PA exhibited symptoms of mirror sign, and a few months later of Capgras Syndrome, which included suspicion and confabulations regarding his wife and children (whom he called imposters), denial that he even knew his erstwhile lover, and even denial of his dog (who seemed not to recognize him when he returned home, and barked at him). However, facial recognition of public figures was preserved. Below are some examples of the patient’s problems:

Mirror sign

A physiotherapist named Jacek was helping PA stand in front of a full-length mirror:

Therapist (Th): Who is that, Peter? Who do you see there?

PA: I don’t know. Oh my God! That monster is staring at me [shouting].

Th: And who else do you see in the mirror?

PA: I don’t know, but maybe Jacek, I think you said so, isn’t that right?

Although he was not able to recognize himself in the mirror, he recognized and gave the name of the therapist. He also remembered his own name when asked. Ten minutes after this incident, however, he did not remember that he had been standing before a mirror or what the therapist’s name was.

Denial of the family

Another feature of the disorder was denial of the family. Here is an extract from an interview with the patient in the presence of his parents, his wife and his oldest daughter, who was 19 at the time:

Th: You are pleased that you’ve been visited by your family, aren’t you?

PA: Me? Of course not! I don’t have a family. I don’t know these people. My family was all killed in an accident.

Th: And…

PA: I don’t know these people. They are body doubles… doubles of my entire family or I don’t know [shouting]!

This seems a very clear case of Capgras syndrome [ 7 ]. Neuropsychologists and psychiatrists have known for nearly 100 years that a small number of psychiatric patients become profoundly suspicious of their closest relationships, often cutting themselves off from those who love them and care for them. They may insist that their spouse is an impostor, that their grown children are body doubles; that a caregiver, a close friend, even the entire family is fake, a duplicate version.

Denial of the lover

Another symptom we observed during this period was denial of the extra-marital relationship (supposedly “the love of his life”). Upon being visited by his former girlfriend in the hospital, he displayed complete non-recognition.

L: How are you feeling, darling? [attempts to kiss him]

PA: Don’t kiss me [shouting]!. I don’t know you!

After one hour the therapist asked him about the visit (which had been arranged by PA’s mother).

Th: So, you have been visited by your girlfriend?

PA: That hag is supposed to be my lover?

Th: She’s a beautiful woman, isn’t she?

PA: Perhaps I could consider that woman beautiful, yes… I would regard her as beautiful, she is about 40, isn’t she? No girlfriend of mine could be so old! Besides, I’ve never had a lover.

Although PA did not recognize his lover, a few minutes later in conversation he suddenly stated that it was not permissible for a physician to enter into such a close relationship with a patient – even though no one had yet said to him that the woman who was claiming to be his lover had previously been his patient, and in fact the subject of conversation had already changed. This might suggest that he recognized her as a former patient (which in point of fact is true), but not as his lover. On the other hand, his wife is also a doctor, so his “pangs of conscience” might be related to his marriage, though that seems rather far-fetched. It is nearly impossible to establish, in his cognitive state, to what extent his failure to acknowledge his lover is repressed guilt, and to what extent it should be called amnesia, or confusion.

About half an hour after his lover had left the room, the patient asked the therapist, “Aren’t you… hmm… my fiancée or something… she must be somewhere, but I don’t know where she is and nobody can find her.”

It is possible that he was remembering the unpleasant conversation with his fiancée and was somehow looking for her to make things right. Some traces may have been maintained In his memory, then, of his feelings for this woman, and these memories were activated, with a marked delay, by the visit of his girlfriend. In his state of cognitive confusion he misidentified his therapist as his lover, but the emotional memory indicating that the lover had been lost was essentially correct.

Denial of the dog

One of the most interesting aspects of PA’s problems with autobiographical memory is his complete denial of having ever had a dog, when before the accident he and the dog had been extremely close. This constitutes a first in reported cases of a similar nature.

T: Is this your dog? [in the presence of his pet, a dachshund, who is barking at him. Apparently, the dog does not exhibit positive feelings towards the patient here and now].

PA: Nothing of the kind! A lump of fur like that! I don’t own a dog. I wouldn’t want such a rubbishy thing! I’m afraid of this dog. It wants to bite me!

PA was able to recognize public figures, but during this period he was watching an excessive amount of television, and had become interested in politics only after the accident. It is quite possible, however, that these faces of public figures constitute islands of episodic or autobiographical memory, which excludes any assumption that his disturbances might be linked to difficulties in facial recognition per se . After being shown pictures of two important Polish politicians he stated:

“… here is the President and the Prime Minister… they have power… It’s them who changed the calendar… and everyone thinks that I’m 40 when I’m really 20…”.

Identity misidentification

This last utterance showed another important characteristic of PA’s mental state, namely, the problems with identity. Not only was he unable to state his age, but he reacted with anger to an attempt by the therapist to specify his true identity, which is illustrated by the following conversation:

Th: Who are you?

PA: Who am I? I don’t know! Perhaps you could tell me?

Th: You are a doctor – a gynecologist.

PA: No! I’m too young to be a doctor.

Th: How old are you?

PA: Probably 7 or 8 years old.

It was eventually established that he possessed some murky recollections of childhood up to the age of eight. At that time he had dreamed of becoming a car mechanic, and now he sometimes claimed to be one. He also vaguely remembered his first year at school, but from the age of eight. He complained that he felt lost. This can be noted in his commentary accompanying his drawing of a ladybug ( Figure 2 ):

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Patient’s drawing representing himself as a ladybug. The patient’s inscription reads as follows: “My insides remind me of a ladybug. She’s looking for something, because it’s empty inside her, like it’s empty inside me.”

“My inner self reminds me of a ladybug. It’s obviously looking for something because she feels foggy and empty… LIKE ME… everything has to be searched for ”.

The loss of identity was accompanied by delusions, which is illustrated by the following utterance:

… the government has not only changed the money and I can’t recognize it, but also the calendar to avoid paying the life annuity… they added 30 years to the established calendar and as a result I am supposed to be 45 years old, but really, I’m 25. They want to get rid of me. I’m scared.

He would often change his stated age depending on the person with whom he found himself in contact.

Over time PA began to develop an “auto-Fregoli” syndrome. His lack of a personal sense of identity made him borrow the identity of others. Below are presented examples of some of the more interesting identities assumed by PA:

All these temporary acquired identities were based on situational stimuli: the identities borrowed by this patient are content-specific. It is also important to state that these identities have a temporal frame: for acquired identities, approximately 1–2 hours, which seems to be a factor of the maximum duration of his episodic memory. He would momentarily associate himself with an object or person which in some way attracted his attention, though what motivation there was for this particular object or person remains unknown, when other “opportunities” were ignored. The individuals selected were never older than their late 20s, and not infrequently they were children.

Of importance is the fact that after an hour (or sometimes two) PA would forget about his newly adopted identity, and again did not really know who he was. Sometimes he accepted his true identity, as suggested by a researcher. However, in general he would protest, and present himself as a car mechanic.

PA’s identity disturbances are persistent. The patient still does not know who he is. He continues to ascribe to himself the identity of those with whom he comes into contact. He believes that his family all died in an accident, but does not show any emotional reaction to this. He complains that he loves no one and no one loves him. He is totally alone, but he has no clear recognition of his situation. After reading about Cotard’s delusion, a rare psychiatric syndrome in which people consider themselves to be dead, he consequently claimed that he was just such a case and was in fact dead, or perhaps reincarnated [ 8 ].

It came as a surprise, however, to discover, 3 years after the accident, that his medical knowledge was very well preserved. After meeting a TBI patient who had been pregnant and had lost her child, he advised her in a very professional way, and told her what drugs she could take for the depression that had developed following the loss of the child. In a thematic picture completed half an hour later concerning his most important memories from childhood, he drew four pregnant women ( Figure 3 ) and entitled the picture “Maternity”; he later stated:

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A therapeutic drawing made by PA (the task was to draw something from childhood), which he entitled “Maternity.” Note that he has drawn two pairs of pregnant women, clearly making them into doubles. This is not because of double vision.

“They could have been my patients. But I can’t really recall whether I had such patients. When I think about it I see a black hole, such a void”.

He was also able to recognize and describe the ultra sonogram of a baby shown to him by his daughter, commenting:

“…. it’s a baby in ultrasound 3D … it could be in the 29 th or 30 th week of pregnancy. Do you think it’s that old? It looks very healthy!

Yet he protested with anger when his daughter said that this was his grandson, crying:

“… Oh no! Don’t try and pull the wool over my eyes! I can’t be a grandfather because I don’t have any children. My whole family died in an accident.

Moreover, he was able to give details of gynecological operations, but was extremely surprised to find that he could do so. He did not remember studying medicine, but was able to recognize the university building. This reflects a discrepancy between well-preserved medical knowledge and the lack of autobiographical memory. He had no recollection of having obtained a medical diploma even when it was shown to him, claiming that what he was seeing must have been counterfeit.

At the same time he proved to have preserved semantic memory, while autobiographical memory appeared to be lost. Thus he stated that people had children:

“to develop a so-called procreative family, to maintain the human species, to pass on their genes.

Yet he denied having children of his own, even when he was presented with their pictures:

“… These are children, but not mine. I’m 18 years old. I’m too young to have children, right? It’s not my blood and genes these children are carrying.

Chronic status and ongoing rehabilitation

PA has been under neuropsychiatric and neuropsychological observation for 10 years, from January 1999 to June 2009. Treatment was based on a comprehensive model, including neuropsychological rehabilitation. In neuropsychological testing we found the following symptoms:

In this context it is perhaps significant that the metabolic changes in PA’s brain, measured by HMRS, are at present close to the spectrum seen in fronto-temporal dementia (FTD) [ 9 , 10 ]. Figure 4 shows a statistically significant drop in NAA concentration, and also in the relative NAA/Cr concentration.

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The HMRS Spectrum – Patient PA (below-normal NAA peak, above normal mI peak)

At the same time there is a statistically significant growth in the concentration of mI, as well as the relative mI/Cr concentration. Another important indicator is the relative relation of the NAA/mI concentrations; this value shows a statistically significant drop when compared to age- and gender-matched norms. It should be added here that the localization of pathological changes in the case of the spectrum obtained from patient PA is similar to that of patients with FTD. In PA’s case, however, these changes are localized chiefly in the right frontal lobe, and not bilaterally, as in the typical FTD patient.

The collapse of family ties

Memory disturbances cannot totally explain forgotten family ties [ 11 – 13 ]. Prior to the accident, PA’s family had relatively normal family ties, though the bond between the patient and his wife was strained by the fact that he had a lover. Now the patient does not remember that he has loved anyone, and his family feels baffled by his strange behavior. His wife, his children, and his parents say he is quite a different man than he used to be. They say it is difficult to have warm feelings towards a man who is so quarrelsome, rude, and irresponsible. They feel his presence as a stranger among them. Moreover, the bonds that united and bound the remaining members of the family to each other have also collapsed, or have been seriously shaken.

It is also plausible that the dissociation of PA’s identity may be caused, at least to some extent, by his premorbid personality traits. Interviews with his family have revealed that his mother was a dominant person who used to made all her sons to act in accordance with her will despite their own wishes. We learn that PA dreamed of being a car mechanic but he became a doctor as his mother had wished. It is of interest to note that being a car mechanic is one of his adopted personalities now. It was also noted that the patient’s attitude towards his mother underwent considerable changes. He is disobedient and shouts at her, though she shows no emotional reaction to this kind of behavior. It may be concluded, then, that she was always a self-disciplined cold mother, and this – as we know – may lead to a number of emotional disorders in the child. In fact, childhood trauma is believed to be one of the causes of Dissociative Identity Disorder [ 14 ].

Another significant trait of PA’s personality was his tendency to lie. First of all he had a number of love-affairs, which meant he had to make various stories to hide this from his wife and family. Moreover, his wife reports that he tended to tell small lies to his friends just “to make life more interesting,” to use his own words. Naturally, this does not explain the nature of PA’s disorders, but they cannot be explained solely by memory disturbances as well, though memory, especially autobiographical memory, certainly plays an important role in integrating one’s concept of self.

At the same time, both linguistic functions and acquired knowledge (including medical skills) have remained intact to a considerable degree. It is worth noting here that these are functions that do not concern PA personally. In other words, he has lost mainly the emotionally loaded information, which may explain – at least to some extent – his emotional reactions to suggestions concerning his true personal relations.

Short-term memory

PA’s memory disorders include not only autobiographical memory, but also short-term memory. Some deficits were apparent on standardized memory tests, based on recall after 20–30 minutes of filled delay, but we observed clinically that he seemed unable to recall anything at all 2 hours after the event occurred. In order to measure this, we designed a simple experiment, which consisted in choosing a particular event that occurred during the ordinary hospital day (e.g. a visitor, a meal, a physiotherapy session or the like), and then asking PA what he remembered immediately after the event, and then again at four time points: 30 minutes, 60 minutes, 90 minutes, and 120 minutes. This experiment was repeated 6 times during PA’s hospitalization at the Cracow Rehabilitation Centre in summer of 2003, and again in the summer of 2004. The amount of information recalled immediately after the event was treated as 100% for baseline, and the amount of recall at subsequent time points was calculated in terms of information units.

As shown in Figure 5 , the intensity of the effect achieved when PA records a given event in memory diminishes rapidly over time, in comparison to the effect that accompanied the event itself. The magnitude of the negative effect exceeds the dimensions of the positive effect. Considering the automatic scaling on the graph, the differences at a time of storage of 1.5 hours appear to be slight, but these differences – like the others – are statistically significant.

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Recollection of a given event in the neuropsychological examination of short-term memory in patient PA.

Two examples follow:

On one occasion, according to hospital schedule, PA was sent to kinesitherapy for 2 hours. When he returned to the ward, we asked PA what had happened, and he gave a reasonably full account of the exercises he had been through, which coincided in all essentials with the physiotherapist’s report. When asked for the same information 30 minutes later, some details were missing, but the essentials were in place. At one hour, however, he remember only the last half-hour of exercises, and insisted that he had been there only half an hour. His account at 90 minutes was extremely sketchy, and there were some confabulations. At two hours, he denied that he had ever been in physiotherapy. He did remember that he had already been asked several times for that information, but became agitated that we were pestering him about something that never happened. He began to express indignation that no one had remembered to take him to kinesitherapy, and all attempts to convince him that he had actually been there met with an increasingly aggressive reaction.

On another occasion, nearly a year later, he was visited one day by his wife, who spent an hour with him on a day when she usually was unable to come see him. Immediately after she left, he gave a reasonably full account of the event, which his wife later verified as substantially accurate. Within half an hour, he remembered only that his wife had “probably” been there, though he expressed uncertainty as to whether this had not happened the day before. At 90 minutes he remembered that someone had been there, but not who. At two hours he was insisting that he had been alone all day, with no visits.

Thus memory traces of emotionally laden material, both positive and negative, tend to diminish and disappear completely after a period of two hours. This would not be especially surprising, if the material forgotten consisted of a list of random numbers or words, or even a story read aloud by an examiner, as in most standard memory tests. In fact, however, PA forgets everything that happens to him, no matter how much it matters to him. Moreover, he does not remember that he has forgotten something, a state which occurs only in medium-to-late stages of dementia. This means that both long-term and short-term memory are severely disturbed.

What makes the case described above nearly unique is the progression of symptoms, which seem to cover an entire spectrum of memory disturbances. At any given moment, the mosaic of PA’s memory deficits and retained capacities could be accounted for in the familiar terms of classical neuropsychology, as a set of disturbances resulting from damage to a particular module or memory system (short-term, long-term, episodic, semantic, and so forth). If PA were to be included in a large group study of severe TBI patients, his scores at any given moment would enable him to be assigned to a sub-group without any particular difficulty. The problem is that if the same tests were administered only a few months (or even weeks) later, he would just as easily be assigned to another, quite different group, at a moment when he seems to have regained some aspects of memory, while losing his grip on something he had previously had under control.

Yet it does not suffice merely to superimpose a “typical” neurodegenerative process on a “typical” focal lesion to produce a picture resembling PA’s symptoms. Though it is not impossible that FTD is developing in PA’s brain independently of the TBI, this would be a most remarkable coincidence, and in any event the course of both diseases would certainly be profoundly affected by the presence of the other. In order to understand PA’s case properly, it is essential to look at what has happened to him, not as “status post,” i.e. a particular event (cause, i.e. the accident) with its various sequelae (effect, i.e. the symptoms), and not even as a disease, where the onset of illness (the cause) is assumed to set in train a cascade of events (the symptoms), but rather as a process (the patient’s life as a whole), whose course has been radically altered by an event. This is illustrated by Figure 6 .

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A schematization of changes in trajectory caused by a sudden event

For the present purposes, let segment A-B represent the course of PA’s life, where A represents the starting point and B the goal to which PA aspires. The appearance of a strong external force (C, here representing the accident) pushes the vector in a different direction, to his current status, represented as D. What is most important here is that the vector C-D is not simply the result of the direction and strength of C, but rather the effect of C on the original vector A-B.

The fluctuation of syndromes observed in PA can be best explained by microgenetic theory. The syndrome described here results from the unfolding of the lower layers of the process of becoming, from core (self) to perception (world), which frames the mind/brain state. Consciousness is the relation of early to late or depth to surface in this process [ 15 , 16 ]. Visual and verbal imagery, including conceptual or intentional feeling, arise at intermediate phases, so long as an external world is realized. The arrow in Figure 7 represents sensation acting on the phase of imagery to externalize and adapt the state to the physical world. The phase-transition is non-temporal until it terminates. The mind/brain state and immediate present develop in a fraction of a second, replaced by overlapping states.

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The transition, or process of becoming, from core (self) to perception (world) frames a mind/brain state. Consciousness is the relation of early to late or depth to surface in this process. Visual and verbal imagery, including conceptual or intentional feeling, arise at intermediate phases, so long as an external world is realized. The arrow represents sensation acting on the phase of imagery to externalize and adapt the state to the physical world. The phase-transition is non-temporal until it terminates. The mind/brain state and immediate present develop in a fraction of a second, replaced by overlapping states [ 15 ].

As mentioned in the introduction by Brown and Pachalska [ 17 ], a traditional approach to symptoms observed after brain lesions does not provide an explanation for the change observed in clinical syndromes in the course of recovery or deterioration. It provides support for the explanation of the symptom according to microgenetic theory.

This case raises the question of the origin of:

According to Marcia [ 18 ] there are four phases in the process of forming an identity:

These phases are typically presented as phases in human development over one’s lifespan, but in the case of our patients it is possible to see each of them emerging after coma through all four phases. In akinetic mutism and the phases that follow, the patient shows no willful behavior in spite of possessing a working nervous system, central and peripheral, primarily because there is no consciousness that action as such exists or is possible.

Our case shows that a self is not a persistent object but a recurrent state. Hume (1740/1967: Book I, Part IV, Section VI) [ 21 ] questioned the existence of identity, which he believed to be an illusion, and so he could not account for the sense of identity over time [ 22 ].

James [ 23 ] as well as Whitehead [ 24 ] were of the opinion that identity was due to an overlap of mental states. Self has to be created in each moment, and this creative process leads to a more dynamic way of thinking about the mind and brain [ 25 ].

Microgenetic theory provides an account of the process of creating the self [ 26 – 34 ]. It emphasizes the span of neural time (in microseconds in the case of a healthy adult) that on the one hand enables continuity of the self, and on the other buffers it from falling apart [ 35 – 37 ]. The way the self is structured is shown in Figure 8 . There is a minimal self, the irreducible core, whose existence is necessary in order for the organism to be an organism, and not merely a collection or colony of cells [ 38 ]. We feel this minimal self in our most fundamental biological/mental state, the awareness of being “right here right now” and having some kind of experience. A longitudinal self arises when memory allows the discrete moments of “minimal self” time to be bundled in larger units, making it possible not only to feel one’s existence in the present moment, but also to conceive of that existence in the past and imagine it continuing into the future.

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The interconnections among the self and the minimal and longitudinal self.

The case of PA demonstrates that the minimal self can persist, stranded in the moment, without the privilege of mental time travel that episodic memory affords. An integrated longitudinal self, however, requires alignment of one’s current mental state and enduring semantic knowledge of personal traits, goals, beliefs, and values. It requires seamless access to the episodic memory of past and present selves that ground semantic self knowledge and infuse it with emotional meaning.

In other words, a person whose identity is stable needs to be:

Unfortunately, all those conditions are not present in the patient described here, which resulted in the gradual loss of the sense of personal identity. His case, however, allows one to draw a hypothesis on the way the self has to be buffered in order to protect it from disintegration.

The process of insulating the self is secured due to the expansion from the core self into the subjective “I”, then the formation of an object world distinct from the “I”, which thus preserves its integrity and identity through time – or at least for some segment of time.

There is a paradox in all this, which is that the subjective self, having created an objective world and separated itself from it, at the same time becomes conscious of itself as an object. The “I” can conceive of, evaluate, look at, analyze, interpret the “me”, the self seen by the subject as an object among other objects. This distinction between the “I” and the “me” makes possible not only introspection, but also social thinking, the ability to conceive of oneself as a human object among other human objects, without losing the “I” – or at least without the necessity to lose it, though the risk is certainly there.

The distinction between “I” and “me” is more on the order of actual and potential than knower and known [ 39 ]. The knowing self – the minimal “I” at the threshold of consciousness - knows that which develops out of it. The subliminal “me” that remains beneath as the potential for the ‘I’ is implicit, unconscious and inaccessible. It represents, or is part of, the tacit knowledge of the individual, what the person knows or has the capacity (competence) to know, and it gives rise to the conscious self, to thought and action. The known self is not actually known, it is felt, intuited, sought after. It participates covertly in thought, but is not ultimately revealed.

Variability of syndromes

The changes that have occurred in the clinical picture of PA’s mental status are perplexing. He has passed through a mosaic of disturbances, which resulted in a continuous deterioration of his identity:

As illustrated in Figure 9 , time has played an important role in the process of PA’s continuous deterioration. In fact, he has completely lost orientation in his surroundings, and his attempts to discover his true identity have ceased.

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Development of syndromes in patient PA over time.

In a recent publication, the first author of the present study has described these changes in self-identity, which include many, if not most, of the syndromes of impaired recognition of self and others described in the literature [ 40 , 41 ]. The problem of personality and the self-concept can be approached, from the standpoint of pathology, in terms of patterns of transition from one symptom-complex to another in the same individual, and not as isolated defects in particular individuals within a population. Disorders of the self cannot be localized to separate brain areas, but constitute a spectrum in the process through which personality is preserved and sustained. The case described here provides convincing evidence that the stability and identity of the self depends, not on the association of discrete components, but on a recurrent process that maintains the self-concept over time, in aging, through sleep, and in the course of changing life events.

Time, perception, and self

As noted elsewhere by the first author of the present study [ 41 , 42 ] the basic components of identity, those that can be weakened or destroyed by brain damage, are the following:

It turns out that one of PA’s problems is the loss of the feeling of time, due mainly to the disturbances of autobiographic memory [ 43 ]. MacQueen [ 39 ] has suggested that when speaking of that type of memory we concentrate on “auto-”, and forget about the original meaning of “biography.” The ancient Greek word bios meant “life,” and grapho meant “to write.” Our autobiography is therefore essentially a story, composed of the events of our own life, and is therefore narrative in its very nature. It is not, however, an orderly and exhaustive story that includes literally all the events of our life, but rather a kind of sketch made up of only those events which are of importance to us. As a rule these are emotionally loaded events, as well as those which proved to be of vital consequence for our future. In this respect autobiographic memory is more like a play or a film, in which significant events (episodes, scenes, moments) are combined in a way to form a comprehensive and continuous story. The story gains its coherence due to the logical sequence of events, where the viewer is left to assume or infer a logical sequence from one event to the next. In the case of the autobiography (understood here as a mental construct, not a literary genre), such a sequence of events is ensured by our memory. Thus identity problems in TBI patients should hardly be surprising. Even if the sequence of symptoms presented by PA seems unique, the complaint that one is “a different person” after the injury is not [ 41 , 42 ].

This means that both long-term and short-term memory are severely disturbed. In consequence, he lives only in the present, since both past and future have ceased to exist for him. As pointed out by Brown [ 43 ], the past is an essential component of the feeling of the present, which develops out of the immediate state revived in the present moment, while the future does not exist other than as an idea, or a feeling of the surge forward to the present [ 30 ]. No wonder PA has lost his sense of self, as he has no elements to refer to.

To make matters worse, he also encounters difficulties in evaluating the surrounding world, which is blurred and difficult to comprehend. It is worthy to remind here that we create our picture of current reality on the basis of our previous knowledge and experience [ 40 ], and PA has lost an access to them. According to microgenetic theory the primary activity of mind is to ‘chunk’ experience into private and public objects or events [ 27 – 29 ]. In other words, we are able to perceive (or recognize) only those objects and events that correspond to models created in our mind by experience. The models sculpt a complex reality into meaningful and comprehensible wholes [ 44 ]. As Brown [ 15 ] puts it: “The inner connectedness of the world is not its ostensible relatedness in the world, but its formative trajectory in the mind/brain.” (p. 251).

PA is not able to “chunk” his experience, to create meaningful units out of the continuous flow of stimuli he is confronted with. Hence, the world around him is chaotic and incomprehensible, and he is an observer, whose only function is to react to situations he does not understand. In consequence he has no means to form his self-awareness. Only his core self, acting at the limbic, unconscious level is intact. This is reflected in his emotional reactions to any attempt to make him realize who he really was, as well as reactions to music he formerly liked. In a way, there is a regression to a former state of consciousness, which may also explain why he has stopped smoking and drinking: after all, these are not the activities of the boy he believes himself to be.

Acting on the limbic level explains also his inability to control his emotions and his inappropriate social behaviors. But most disastrous is the fact that he has lost his identity, since he has no elements to rely upon. Hence, he tends to cling to the self of others, borrowing their identities at least for the period he is able to remember.

Additional problems are created by frontal lobe dysfunction, which makes it difficult – if not impossible – for PA to assemble the disparate pieces of his foggy world.


We want to express our gratitude to those friends who have patiently heard us out on many of these topics and offered their own insightful opinions. They include Prof. Danuta Kadzielawa, Prof. Marek Moskala and Prof. David Bradford. We especially want to express our gratitude to our dear friend Prof. Jason W. Brown for his advice, support and inspiration over the years.

Source of support: Departmental sources


Msm and case studies of people with brain injuries.

In your essay, it is important that you are able to link research evidence to specific theoretical claims. Case studies of people with acquired brain injuries have been particularly useful in providing support for one of MSM’s key claims, but the same studies have also highlighted some of the weaknesses of this model.

What is a case study?

Case studies allow us to gather in-depth information on areas where it may be impossible to carry out experiments. Clearly, from an ethical standpoint we cannot deliberately injure someone purely to see what behavioural and cognitive changes may result! Instead, scientists often make use of naturally occurring cases where someone has an acquired brain injury, meaning they were functioning perfectly well beforehand, i.e. they have been involved in an accident, had an illness that has affected their brain or undergone surgery for a tumour or to treat epilepsy, for example.

Case studies focuses on an individual or small group and use information from a variety of sources including medical and educational reports and records, interviews, standardised tests and observations, and so on to gather a wide range of detailed information. The use of multiple research methods is known as method triangulation.

Case studies generally lack control as the injury was naturally occurring, this said, they can inspire more scientific studies that are able to examine cause and effect.

As you may recall from the localisation topic, case studies focusing on people who have sustained brain damage allow researchers to explore the function of various brain regions through examining the impact of the damage on their behaviour and cognitive functioning.

Can you think of any scientific weaknesses of such studies?

Often there is no valid evidence of the person’s skill level prior to the brain injury, and therefore it is not possible to conclude with certainty that the brain injury has caused any issues the person appears to have, as these problems may have pre-dated the injury. This is clearly not always the case but worth bearing in mind 😉

The table below details three case studies conducted with people with brain injuries. Case studies like these indicate that there are different memory stores but perhaps it is too simple to think that there are only three stores, memory for different types of information seems to be situated in different areas. This is shown by HM and Clive Wearing’s unaffected procedural memories.

Use the worksheet above to find out more about these three case studies and think about how they could be used to support or refute the claims made by Atkinson and Shiffrin’s multistore model, i.e. that there are three separate memory stores through which information flows in a linear fashion, that short and long term memory are single (unitary) stores.

Clive Wearing

Find out more about the case of Clive Wearing using these clips from youtube:

HM – Henry Molaison

One interesting aspects of the HM case study is that although it is claimed HM was incapable of laying down new long term memories (anterograde amnesia) over time it was shown that he was able to learn a new skill; mirror drawing.

Learn more about HM with this podcast form the BBC:

Practice drawing stars like HM: Click below and scroll down to “ Milner Research Replication” .

Practice what you know about the HM case study and how it relates to MSM using this quizizz:

The Case of KF

To learn more about the case of KF why not check out one of the original papers about this patient here :

Case study of KF Original Paper: warrington1969 

A clip of Warrington talking about KF

The following worksheet demonstrates how the case study of KF exemplifies all the key features of the case study as a research method in psychology, but is also useful for adding to your detailed knowledge of the aim, procedure, findings and conclusions of the study itself.

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Melissa Shepard MD

The Neuroscience of Behavior: Five Famous Cases

Five patients who shaped our understanding of behavior and the brain..

Posted  January 16, 2020 | Reviewed by Lybi Ma

“Considering everything, it seems we are dealing here with a special illness… There are certainly more psychiatric illnesses than are listed in our textbooks.” —Alois Alzheimer (In: Benjamin, 2018)

Once thought to be the product of demonic possession, immorality, or imbalanced humors, we now know that psychiatric symptoms are often caused by changes in the brain. Read on to learn about the people who helped us understand the brain as the driving force behind our behaviors.

By Henry Jacob Bigelow; Ratiu et al.

Phineas Gage

In 1848, John Harlow first described the case of a 25-year-old railroad foreman named Phineas Gage. Gage was a "temperate" man: hardworking, polite, and well-liked by all those around him. One day, Gage was struck through the skull by an iron rod launched in an accidental explosion. The rod traveled through the prefrontal cortex of his brain. Remarkably, he survived with no deficits in his motor function or memory . However, his family and friends noticed major changes in his personality . He became impatient, unreliable, vulgar, and was even described as developing the "animal passions of a strong man." This was the first glimpse into the important role of the prefrontal cortex in personality and social behavior (David, 2009; Thiebaut de Schotten, 2015; Benjamin, 2018).

Louis Victor Leborgne

Pierre Broca first published the case of 50-year-old Louis Victor Leborgne in 1861. Despite normal intelligence , Leborgne inexplicably lost the ability to speak. His nickname was Tan, after this became the only word he ever uttered. He was otherwise unaffected and seemed to follow directions and understand others without difficulty. After he died, Broca examined his brain, finding an abnormal area of brain tissue only in the left anterior frontal lobe. This suggested that the left and right sides of the brain were not always symmetric in their functions, as previously thought. Broca later went on to describe several other similar cases, cementing the role of the left anterior frontal lobe (now called Broca’s area) as a crucial region for producing (but not understanding) language (Dronkers, 2007; David, 2009; Thiebaut de Schotten, 2015).

Unknown, Public Domain.

Auguste Deter

Psychiatrist and neuropathologist Aloysius Alzheimer described the case of Auguste Deter, a 56-year-old woman who passed away in 1906 after she developed strange behaviors, hallucinations, and memory loss. When Alzheimer looked at her brain under the microscope, he described amyloid plaques and neurofibrillary tangles that we now know are a hallmark of the disease that bears his name. This significant discovery was the first time that a biological molecule such as a protein was linked to a psychiatric illness (Shorter, 1997; David, 2009; Kalia & Costa e Silva, 2015).

In 1933, Spafford Ackerly described the case of "JP” who, beginning at a very young age, would do crude things like defecate on others' belongings, expose himself, and masturbate in front of other children at school. These behaviors worsened as he aged, leading to his arrest as a teenager . He was examined by Ackerly who found that the boy had a large cyst, likely present from birth, that caused severe damage to his prefrontal cortices. Like the case of Phineas Gage, JP helped us understand the crucial role that the prefrontal cortex plays in judgment, decision-making , social behaviors, and personality (Benjamin, 2018).

HM (Henry Gustav Molaison)

William Scoville first described the case of HM, a 29-year-old man whom he had treated two years earlier with an experimental surgery to remove his medial temporal lobes (including the hippocampus and amygdala on both sides). The hope was that the surgery would control his severe epilepsy, and it did seem to help. But with that improvement came a very unexpected side effect: HM completely lost the ability to form certain kinds of new memories. While he was still able to form new implicit or procedural memories (like tying shoes or playing the piano), he was no longer able to form new semantic or declarative memories (like someone’s name or major life events). This taught us that memories were localized to a specific brain region, not distributed throughout the whole brain as previously thought (David, 2009; Thiebaut de Schotten, 2015; Benjamin, 2018).

Facebook/LinkedIn image: Gorodenkoff/Shutterstock

Benjamin, S., MacGillivray, L., Schildkrout, B., Cohen-Oram, A., Lauterbach, M.D., & Levin, L.L. (2018). Six landmark case reports essential for neuropsychiatric literacy. J Neuropsychiatry Clin Neurosci, 30 , 279-290.

Shorter, E., (1997). A history of psychiatry: From the era of the asylum to the age of Prozac. New York: John Wiley & Sons, Inc.

Thiebaut de Schotten, M., Dell'Acqua, F., Ratiu, P. Leslie, A., Howells, H., Cabanis, E., Iba-Zizen, M.T., Plaisant, O., Simmons, A, Dronkers, N.F., Corkin, S., & Catani, M. (2015). From Phineas Gage and Monsieur Leborgne to H.M.: Revisiting disconnection syndromes. Cerebral Cortex, 25 , 4812-4827.

David, A.S., Fleminger, S., Kopelman, M.D., Lovestone, S., & Mellers, J. (2009). Lishman's organic psychiatry: A textbook of neuropsychiatry. Hoboken, NJ: Wiley-Blackwell.

Kalia, M., & Costa e Silva, J. (2015). Biomarkers of psychiatric diseases: Current status and future prospects. Metabolism, 64, S11-S15.

Dronkers, N.F., Plaisant, O., Iba-Zizen, M.T., & Cabanis, E.A. (2007). Paul Broca's historic cases: High resolution MR Imaging of the brains of Leborgne and Lelong. Brain , 130, 1432–1441.

Scoville, W.B., & Milner, B. (1957). Loss of recent memory after bilateral hippocampal lesions. J. Neurol. Neurosurg. Psychiat., 20, 11-21.

Melissa Shepard MD

Melissa Shepard, MD , is an assistant professor of psychiatry at the Johns Hopkins School of Medicine.

psychology case study brain damage

January 2023 magazine cover

Knowing what you value will help you build the most meaningful life possible.

psychology case study brain damage

Brain Stuff

Famous case studies in neuroscience and psychology, acquired savant syndrome.

psychology case study brain damage

Patient HM (Henry Molaison) : Man who experienced anterograde amnesia and partial retrograde amnesia after a bilateral temporal lobectomy to cure his epilepsy. 

Patient RB:  Man who experienced a stroke that damaged the CA1 region of his hippocampus. As a result, he lost his ability to form new memories.

Clive Wearing: British man with a severe anterograde and retrograde amnesia. He has lost most of his declarative memory, but his implicit memory is still in tact.

Anti-NMDA Receptor Encephalitis

Susannah Cahalan : Woman who had developed an unusual set of symptoms that included a rapid onset psychosis. Her autobiography, Brain on Fire , is a first hand narrative of this condition. Her story has also been turned into a movie.

Patient Tan (Victor Louis Leborgne) : Man who had severe expressive aphasia after syphilis damaged his left frontal lobe. He was examined by Dr. Paul Broca, who conducted the autopsy on Tan’s brain and discovered a large lesion. His specific form of aphasia was later called Broca’s aphasia.

Lazare Lelong : A patient of Dr. Paul Broca with expressive aphasia. Post mortem examination showed injury to the same area of the brain as seen in other case studies of a similar type of aphasia.

Jebediah Buxton:  Man with savant skills for mathematical calculations. 

Brain Injury

psychology case study brain damage

Phineas Gage:  Man who survived after a large metal rod was sent flying through his skull and brain. Following the injury, he had a marked change in behavior that was uncharacteristic of him before the injury.

Jill Bolte Taylor: Neuroscientist who experienced a rupture of an arteriovenous malformation , resulting in severe bleeding in the left hemisphere of her brain. Her autobiography, My Stroke of Insight, details her experiences from having the stroke to rehabilitation. She has also given a TED talk about her stroke.

Parkinson's Disease

"The Frozen Addicts" : Group of six people in California who mistakenly took a toxin called MPTP. After exposure, the patients developed bradykinesia (slowness of movement) and tremors, which resembles the symptoms of Parkinson's disease.

Urbach-Wiethe Disease

Patient SM : Person with severe amygdala damage as a result of highly specific calcification. Because of this damage, she exhibited no fear on behavioral testing.

A representation of Psyche, taken from the BPS logo

Psychology’s 10 Greatest Case Studies – Digested

These ten characters have all had a huge influence on psychology and their stories continue to intrigue each new generation of students.

27 November 2015

By Christian Jarrett

These ten characters have all had a huge influence on psychology and their stories continue to intrigue each new generation of students. What’s particularly fascinating is that many of their stories continue to evolve – new evidence comes to light, or new technologies are brought to bear, changing how the cases are interpreted and understood. What many of these 10 also have in common is that they speak to some of the perennial debates in psychology, about personality and identity, nature and nurture, and the links between mind and body.

Phineas Gage

One day in 1848 in Central Vermont, Phineas Gage was tamping explosives into the ground to prepare the way for a new railway line when he had a terrible accident. The detonation went off prematurely, and his tamping iron shot into his face, through his brain, and out the top of his head. Remarkably Gage survived, although his friends and family reportedly felt he was changed so profoundly (becoming listless and aggressive) that “he was no longer Gage.” There the story used to rest – a classic example of frontal brain damage affecting personality. However, recent years have seen  a drastic reevaluation  of Gage’s story in light of new evidence. It’s now believed that he underwent significant rehabilitation and in fact began work as a horse carriage driver in Chile. A  simulation of his injuries  suggested much of his right frontal cortex was likely spared, and  photographic evidence  has been unearthed showing a post-accident dapper Gage. Not that you’ll find this revised account in many psychology textbooks:  a recent analysis  showed that few of them have kept up to date with the new evidence. H.M.

Henry Gustav Molaison (known for years as H.M. in the literature to protect his privacy), who died in 2008, developed severe amnesia at age 27 after undergoing brain surgery as a form of treatment for the epilepsy he’d suffered since childhood. He was subsequently the focus of study by over 100 psychologists and neuroscientists and he’s been mentioned in over 12,000 journal articles! Molaison’s surgery involved the removal of large parts of the hippocampus on both sides of his brain and the result was that he was almost entirely unable to store any new information in long-term memory (there were some exceptions – for example, after 1963 he was aware that a US president had been assassinated in Dallas). The extremity of Molaison’s deficits was a surprise to experts of the day because many of them believed that memory was distributed throughout the cerebral cortex. Today, Molaison’s legacy lives on: his brain was carefully sliced and preserved and turned into a 3D digital atlas and his life story is reportedly due to be turned into a feature film based on the book researcher Suzanne Corkin wrote about him:  Permanent Present Tense, The Man With No Memory and What He Taught The World .

Victor Leborgne (nickname “Tan”)

The fact that, in most people, language function is served predominantly by the left frontal cortex has today almost become common knowledge, at least among psych students. However, back in the early nineteenth century, the consensus view was that language function (like memory, see entry for H.M.) was distributed through the brain. An nineteenth century patient who helped change that was Victor Leborgne, a Frenchman who was nicknamed “Tan” because that was the only sound he could utter (besides the expletive phrase “sacre nom de Dieu”). In 1861, aged 51, Leborgne was referred to the renowned neurologist Paul Broca, but died soon after. Broca examined Leborgne’s brain and noticed a lesion in his left frontal lobe – a segment of tissue now known as Broca’s area. Given Leborgne’s impaired speech but intact comprehension, Broca concluded that this area of the brain was responsible for speech production and he set about persuading his peers of this fact – now recognised as a key moment in psychology’s history. For decades little was known about Leborgne, besides his important contribution to science. However, in a paper published in 2013, Cezary Domanski at Maria Curie-Sklodowska University in Poland uncovered new biographical details, including the possibility that Leborgne muttered the word “Tan” because his birthplace of Moret, home to several tanneries.

Wild Boy of Aveyron

The “Wild boy of Aveyron” – named Victor by the physician Jean-Marc Itard – was found emerging from Aveyron forest in South West France in 1800, aged 11 or 12, where’s it’s thought he had been living in the wild for several years. For psychologists and philosophers, Victor became a kind of “natural experiment” into the question of nature and nurture. How would he be affected by the lack of human input early in his life? Those who hoped Victor would support the notion of the “noble savage” uncorrupted by modern civilisation were largely disappointed: the boy was dirty and dishevelled, defecated where he stood and apparently motivated largely by hunger. Victor acquired celebrity status after he was transported to Paris and Itard began a mission to teach and socialise the “feral child”. This programme met with mixed success: Victor never learned to speak fluently, but he dressed, learned civil toilet habits, could write a few letters and acquired some very basic language comprehension. Autism expert Uta Frith believes Victor may have been abandoned because he was autistic, but she acknowledges we will never know the truth of his background. Victor’s story inspired the 2004 novel  The Wild Boy  and was dramatised in the 1970 French film  The Wild Child .

Nicknamed ‘Kim-puter’ by his friends, Peek who died in 2010 aged 58, was the inspiration for Dustin Hoffman’s autistic savant character in the multi-Oscar-winning film  Rain Man . Before that movie, which was released in 1988, few people had heard of autism, so Peek via the film can be credited with helping to raise the profile of the condition. Arguably though, the film also helped spread the popular misconception that giftedness is a hallmark of autism (in one notable scene, Hoffman’s character deduces in an instant the precise number of cocktail sticks – 246 – that a waitress drops on the floor). Peek himself was actually a non-autistic savant, born with brain abnormalities including a malformed cerebellum and an absent corpus callosum (the massive bundle of tissue that usually connects the two hemispheres). His savant skills were astonishing and included calendar calculation, as well as an encyclopaedic knowledge of history, literature, classical music, US zip codes and travel routes. It was estimated that he read more than 12,000 books in his life time, all of them committed to flawless memory. Although outgoing and sociable, Peek had coordination problems and struggled with abstract or conceptual thinking.

“Anna O.” is the pseudonym for Bertha Pappenheim, a pioneering German Jewish feminist and social worker who died in 1936 aged 77. As Anna O. she is known as one of the first ever patients to undergo psychoanalysis and her case inspired much of Freud’s thinking on mental illness. Pappenheim first came to the attention of another psychoanalyst, Joseph Breuer, in 1880 when he was called to her house in Vienna where she was lying in bed, almost entirely paralysed. Her other symptoms include hallucinations, personality changes and rambling speech, but doctors could find no physical cause. For 18 months, Breuer visited her almost daily and talked to her about her thoughts and feelings, including her grief for her father, and the more she talked, the more her symptoms seemed to fade – this was apparently one of the first ever instances of psychoanalysis or “the talking cure”, although the degree of Breuer’s success has been disputed and some historians allege that Pappenheim did have an organic illness, such as epilepsy. Although Freud never met Pappenheim, he wrote about her case, including the notion that she had a hysterical pregnancy, although this too is disputed. The latter part of Pappenheim’s life in Germany post 1888 is as remarkable as her time as Anna O. She became a prolific writer and social pioneer, including authoring stories, plays, and translating seminal texts, and she founded social clubs for Jewish women, worked in orphanages and founded the German Federation of Jewish Women.

Kitty Genovese

Sadly, it is not really Kitty Genovese the person who has become one of psychology’s classic case studies, but rather the terrible fate that befell her. In 1964 in New York, Genovese was returning home from her job as a bar maid when she was attacked and eventually murdered by Winston Mosely. What made this tragedy so influential to psychology was that it inspired research into what became known as the Bystander Phenomenon – the now well-established finding that our sense of individual responsibility is diluted by the presence of other people. According to folklore, 38 people watched Genovese’s demise yet not one of them did anything to help, apparently a terrible real life instance of the Bystander Effect. However, the story doesn’t end there because historians have since established  the reality was much more complicated  – at least two people did try to summon help, and actually there was only one witness the second and fatal attack. While the main principle of the Bystander Effect has stood the test of time, modern psychology’s understanding of the way it works has become a lot more nuanced. For example, there’s evidence that in some situations people are more likely to act when they’re part of a larger group, such as when they and the other group members all belong to the same social category (such as all being women) as the victim.

Little Albert

“Little Albert” was the nickname that the pioneering behaviourist psychologist John Watson gave to an 11-month-old baby, in whom, with his colleague and future wife Rosalind Rayner, he deliberately attempted to instill certain fears through a process of conditioning. The research, which was of dubious scientific quality, was conducted in 1920 and has become notorious for being so unethical (such a procedure would never be given approval in modern university settings). Interest in Little Albert has reignited in recent years as an academic quarrel has erupted over his true identity. A group led by Hall Beck at Appalachian University announced in 2011 that they thought Little Albert was actually Douglas Merritte, the son of a wet nurse at John Hopkins University where Watson and Rayner were based. According to this sad account, Little Albert was neurologically impaired, compounding the unethical nature of the Watson/Rayner research, and he died aged six of  hydrocephalus (fluid on the brain). However, this account was challenged by a different group of scholars led by Russell Powell at MacEwan University in 2014. They established that Little Albert was more likely William A Barger (recorded in his medical file as Albert Barger), the son of a different wet nurse. Earlier this year, textbook writer Richard Griggs weighed up all the evidence and concluded that the Barger story is the more credible, which would mean that Little Albert in fact died 2007 aged 87.

Chris Sizemore

Chris Costner Sizemore is one of the most famous patients to be given the controversial diagnosis of multiple personality disorder, known today as dissociative identity disorder. Sizemore’s alter egos apparently included Eve White, Eve Black, Jane and many others. By some accounts, Sizemore expressed these personalities as a coping mechanism in the face of traumas she experienced in childhood, including seeing her mother badly injured and a man sawn in half at a lumber mill. In recent years, Sizemore has described how her alter egos have been combined into one united personality for many decades, but she still sees different aspects of her past as belonging to her different personalities. For example, she has stated that her husband was married to Eve White (not her), and that Eve White is the mother of her first daughter. Her story was turned into a movie in 1957 called  The Three Faces of Eve  (based on a book of the same name written by her psychiatrists). Joanne Woodward won the best actress Oscar for portraying Sizemore and her various personalities in this film. Sizemore published her autobiography in 1977 called  I’m Eve . In 2009, she appeared on the BBC’s  Hard Talk  interview show.

David Reimer

One of the most famous patients in psychology, Reimer lost his penis in a botched circumcision operation when he was just 8 months old. His parents were subsequently advised by psychologist John Money to raise Reimer as a girl, “Brenda”, and for him to undergo further surgery and hormone treatment to assist his gender reassignment. Money initially described the experiment (no one had tried anything like this before) as a huge success that appeared to support his belief in the important role of socialisation, rather than innate factors, in children’s gender identity. In fact, the reassignment was seriously problematic and Reimer’s boyishness was never far beneath the surface. When he was aged 14, Reimer was told the truth about his past and set about reversing the gender reassignment process to become male again. He later campaigned against other children with genital injuries being gender reassigned in the way that he had been. His story was turned into the book  As Nature Made Him, The Boy Who Was Raised As A Girl  by John Colapinto, and he is the subject of two BBC Horizon documentaries. Tragically, Reimer took his own life in 2004, aged just 38.

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Case Study: Traumatic Brain Injury in an Elderly Woman

Abstract [ edit | edit source ]

The following fictional case study discusses possible interventions for restoring physical and cognitive function during an in-patient rehabilitation program of a 65-year old woman who presented with a traumatic brain injury (TBI) . She underwent surgical procedure to correct a subdural haematoma in the frontal lobe, resulting from a TBI. She entered the in-patient rehabilitation program two weeks after a craniotomy, with stable vitals. The initial examination findings included impaired memory, balance issues, limited ambulation and increased tone in the left upper and lower extremities as well as right upper extremities. Physiotherapy interventions consisted of balance training, task-specific exercises, strength training, flexibility exercises, gait training and postural education. Outcome measures were then used to reassess the patient's progress at week 4 of in-patient rehabilitation, including: the Berg balance scale, Ranchos Los Amigos scale, Modified Ashworth Scale, gait speed and distance measurements. The Functional Independence Measure (FIM) score improved from 68 upon rehabilitation to 106 when she was discharged to a home-rehabilitation program.

Introduction [ edit | edit source ]

Traumatic brain injury (TBI)s a major health condition [1] , and one of the common causes is falls [2] [3] . More specifically, subdural haematomas have been identified as one of the most prevalent injuries in patients who presented to the emergency department due to a TBI [3] . Few studies have looked at the role of rehabilitation and its effects on the improvement of functional outcomes in patients who have undergone surgery for subdural haematomas [4] . The purpose of this fictional case study is to explore the rehabilitation of an elderly woman with an acute TBI, post-surgical intervention.

Client Characteristics [ edit | edit source ]

A 65-year-old woman was getting groceries with her friend when she slipped on ice, hit her head and lost consciousness. An ambulance was called, and she was rushed to the hospital. The patient lost consciousness for one hour and remained in an altered state of consciousness for 24 hours. Diagnostic imaging confirmed right-sided focal subdural haematoma. Her Glasgow Coma Score (GCS) score upon arrival was 9 (E5; M2; V2) and she presented as a level III on the Ranchos Los Amigos Scale . The severity of her TBI was classified as ‘moderate’.

The patient underwent a craniotomy the following afternoon. After 2 weeks in the ICU, the patient’s Functional Independent Measure (FIM) score improved from 57 to 68 and was deemed appropriate for the in-patient rehabilitation unit. The patient presented with 7 days of retrograde amnesia , and no signs of anterograde amnesia. Her pre-existing conditions included hypertension and osteoporosis , and the medications she was taking for these conditions included Perindopril (Coversyl) and Alendronate (Fosamax), respectively. She had limited range of motion and required assistance with ambulation. Due to her FIM score, hospital protocol dictated that she was to enter an in-patient rehabilitation which includes daily physiotherapy.

Examination Findings [ edit | edit source ]

2 weeks post-op: in-patient rehabilitation program [ edit | edit source ], subjective [ edit | edit source ].

During the examination, information was collected from the patient’s chart, from members within the multidisciplinary team , the patient and her husband. As mentioned, diagnostic imaging confirmed right-sided focal subdural haematoma, affecting the frontal lobe. When speaking with the patient, she had complaints of dizziness and a headache earlier that morning. Prior to her fall, she was living with her husband in a bungalow and was independent in all activities of daily living . She is a retired teacher, and her husband is a healthy 68-year-old retired farmer. Her husband reported that she was active and independent and did not use any walking aids prior to her fall. She enjoyed activities such as pickleball, camping, hiking, baking and playing with her grandchildren. Her husband also stated that they had 4 steps to get into their house, with a railing on the right side. Her main goal was to return home and resume her regular activities. Upon gathering a subjective interview, her husband also explained that he was very concerned about his wife and that he was having difficulties coping with her changes in behaviour.

Objective [ edit | edit source ]

After the patient was admitted to in-patient rehabilitation, the patient’s screening results showed stable vital signs with a heart rate of 76bmp, blood pressure of 115/76, SpO2 of 97% and intact integuments. The physiotherapist proceeded to choose various outcome measures to obtain the patient’s mental status at baseline and monitor any changes over time. 

The  Galvestron Orientation and Amnesia Test (GOAT)  was used to evaluate the patient’s orientation and ability to recall events before and after the incident [5] . Her GOAT score was 60/100, which was below the cut-off of 66, suggesting impaired memory [5] . Specifically, the patient had in-depth current memory and remembered most events after she gained consciousness in the ICU; however, she showed signs of retrograde amnesia from events that happened within 7 days prior to the incident [5] . 

The  Ranchos Los Amigos scale is a useful tool to rate the patient’s cognitive level after the patient regains consciousness from a TBI [6] .  During initial assessment, she presented with level VI (Confused-appropriate) on the Ranchos Los Amigos scale [6] . As such, the patient was ready for rehabilitation since she was able to consistently follow simple directions (i.e., one step commands), showed carry over for relearned familiar tasks (e.g., self-care), and could attend to highly familiar tasks for a certain period of time [6] . However, the physiotherapist kept in mind that the patient required maximal assistance in learning new tasks due to the lack of carryover from previous sessions [6] . Additionally, the physiotherapist ensured to take proper safety measures (i.e., maximal supervision) since the patient was unaware of her impairments and was inconsistently oriented to person, time, and space [6] .  

The  Moss Attention Rating Scale (MARS) measures the effects of impaired attention on cognitive and motor performance specific to patients with TBI in acute rehabilitation [7] . Considering that patients at Rachos level VI mostly benefit from learning tasks in a non-distracting environment, the physiotherapist used MARS, an observational rating scale, to assess the patient’s daily attentional state and used the results to provide appropriate cueing to help the patient focus [7] . 

Total Raw Score: 62/110 

psychology case study brain damage

The Agitated Behavior Scale (ABS) was chosen to objectively measure the extent of agitation including levels of: disinhibition, aggression and liability, and is specific to the acute phase of acquired brain injury [9] . The patient scored 20/56 upon initial assessment, which is considered borderline normal [9] . Although patients at Ranchos level VI tend to have decreased agitated behaviour, the ABS was administered to monitor the extent of decrease over time [9] .   

The Neurobehavioral Functioning Inventory Depression Scale (NFI) is used to measure post-injury depressive symptoms such as frustration, restlessness, loneliness, etc [10] . Research shows that the NFI Depression Scale is highly reliable and valid, and is sufficient at identifying minimal, borderline and clinical depression in patients with a TBI [10] . The patient scored 26/65 on the NFI Depression Scale. This score classified her as 'minimally depressed', which means that the patient rarely experiences depressive symptoms, therefore immediate intervention was not required, however signs of depressive symptoms were monitored throughout treatment [10] .  

Clinical Impression [ edit | edit source ]

Physiotherapy diagnosis [ edit | edit source ].

Patient presented with a moderate TBI with imaging confirming an acute subdural haematoma affecting the frontal lobe of the brain . The patient demonstrated signs of increased tone, limited ROM, general weakness, and cognitive and behavioural deficits, such as, memory problems and mild agitation. Activities, such as walking, sitting, ascending/descending stairs, and moving limbs in isolation were affected. The patient was unable to resume regular activities such as pickleball, camping, hiking, baking, and playing with her grandchildren. However, she hoped to restore as much function as possible during rehabilitation so she could go back to doing things she enjoys. Patient was determined to be a good candidate for physiotherapy to help regain balance control, improve joint range of motion , reduce spasticity and overall restore physical function.

Problem List [ edit | edit source ]

Intervention [ edit | edit source ]

The patient was at Ranchos level VI (confused-appropriate), and was not cognitively aware of her condition, therefore the focus of her in-patient rehabilitation was to create a program based on not only the patient's goals, but also the facility's protocol on TBI rehabilitation. The treatment included restoring function and progressing the patient to a point where she was safe to return home with her husband. The treatment followed evidence-based clinical practice guidelines for TBI, specifically Understanding Traumatic Brain Injury  by Ontario Neurotrauma Foundation and  Rehabilitation Following Acquired Brain Injury by the British Society of Rehabilitation Medicine (BSRM). Thus, in-patient rehabilitation involved components of task-specific training, balance re-training, gait re-education, strength training and aerobic fitness training, all in the context of functional tasks where possible [14] . 

To maximize outcomes of treatment, the in-patient rehabilitation program was adapted to use appropriate learning strategies based on the patient’s cognitive abilities. Treatment began by having a structured routine [15] , using distributed practice, explicit feedback [16] , closed environments, and clear and concise instructions. As the patient improved in cognitive and physical function, treatment progressed to using random practice schedule [17] , open environments, implicit feedback [16] and more complex cognitive tasks. To avoid fatigue, the patient’s energy levels were monitored and treatment was adapted as needed. Adaptations included: lowering frequency, intensity, and/or amount of exercises during treatment sessions. The adaptation chosen depended on her needs at the time. Upper extremity ROM and strengthening was incorporated into dynamic sitting exercises to reduce the number of exercises provided and to avoid redundancy. Finally, segments of education for both the patient and her husband were included in treatment. Education sessions included the physical, cognitive, behavioural and emotional impacts of TBI, as well as the prognosis and symptoms of TBI [14] . It was important to educate her husband on areas of treatment he could help with, and how he could support his wife throughout her prognosis [14] . 

*NOTE: Treatment occurred daily, for 1-hr sessions. All of the exercises are listed below, however, not all were performed in a single treatment session. Each day of the week, treatment involved a selection of these exercises, and parameters varied, depending on the patient's tolerance. In addition, it was recommended that the patient work on these exercises outside of rehab as well, either with her husband or other staff [14] .        

Patient Oriented Goals [ edit | edit source ]

Balance and Mobility [ edit | edit source ]

Treatment started with basic static sitting and standing postures. Treatment progressed to dynamic exercises after the patient tolerated static postures. These exercises were included in the program to help the patient gain balance prior to introducing more dynamic, functional and complex movements, such as walking and/or ascending and descending stairs [14] [18] .    

Strength Training [ edit | edit source ]

Core strengthening  and strengthening of the lower extremities helped improve coordination and efficiency of walking [18] [19] .

Flexibility/Range of Motion Training [ edit | edit source ]

Therapy focused on stretching muscle groups that have developed contractures or have tightened throughout hospital stay.

Task-Specific Training [20] [ edit | edit source ]

*Practicing with staff or PT whenever she needed/wanted to get out of bed was encouraged. Her husband was educated on how to assist her with transfers.

Gait Training [ edit | edit source ]

Ambulation is a common goal of many TBI patients, making gait training an important aspect of rehabilitation [14] [18] . However, the type of gait training varies depending on the severity of the TBI [18] . The most common forms include range of motion activities, weight shifting, and lower extremity and core strengthening, which were addressed earlier in treatment [18] [20] . However, higher level exercises such as dual-task techniques can be introduced to make treatment more engaging and functional for the patient [18] .

Aerobic Exercise Training [ edit | edit source ]

Exercise can improve cardiorespiratory fitness as well as cognitive function among patients with TBI [25] .

Use the FITT principle

Outcome [ edit | edit source ]

4 weeks in in-patient rehabilitation (re-assessment) [ edit | edit source ].

The ROM and flexibility exercises helped normalize the patient's muscle tone, especially in the left side of the body, The left upper extremities and lower extremities showed a slight increase in extensor and flexor muscle tones, respectively, classified as Grade 1 on the Modified Ashworth Scale .

With the decrease in contracture, she was able to isolate movements on the left side of the body, which facilitated her ability to perform ADL's such as self-care. Additionally, the therapist observed her Ranchos level to be VII (automatic-appropriate), suggesting that the patient required minimal assistance in daily living skills. Similarly, her FIM score of 106 suggested that she no longer required assistance to accomplish tasks, but might require supervision to ensure safety [13] .

psychology case study brain damage

Additionally, gait training combined with static and dynamic balance resulted in improvement of her gait:

Discharge Planning [ edit | edit source ]

The patient was considered appropriate for discharge based on the following information: 

Prior to discharge, the physiotherapist and occupational therapist had an education session with the patient and her spouse focusing on safe community ambulation and performing ADLs within the home. The patient also received a document with the same information to refer to when needed. 

The patient has been referred to a home-based rehabilitation program where she will be followed by a physiotherapist and an occupational therapist.

Discussion [ edit | edit source ]

The fictional case study followed a 65-year of woman attending physiotherapy in an in-patient rehabilitation unit following a craniotomy for a subdural haematoma . The initial examination findings, 2 weeks after surgery, included impaired memory, balance issues, limited ambulation and increased tone in the left and right upper extremities and left lower extremities. Physiotherapy interventions consisted of balance training, task-specific exercises, strength training, flexibility exercises, gait training and postural education. Upon reassessment of outcome measures, 4 weeks after in-patient rehabilitation, the patient showed improvement in her FIM score, Berg Balance Scale, lower muscle tone (i.e., Modified Ashworth Scale), faster gait speed and endurance.  

This case study included traditional physiotherapy to improve her strength, range of motion, performance of functional tasks, transfers, and posture. In addition to traditional methods, virtual reality was used to improve her gait. Based on her outcomes, the use of virtual reality to improve gait showed promise. Although there are many studies that demonstrate the benefits of the use of virtual reality and gait training, few physiotherapists use virtual reality in practice [18] . This raises the question of whether this is due to lack of knowledge of the benefits, lack of funding or both. Future inquiry should address the barriers to implementing the use of virtual reality in physiotherapy practice and beneficial technologies regarding the rehabilitation of patients with TBIs. 

Furthermore, it is important to take the patient’s cognitive status into consideration during treatment and in discharge planning. Physiotherapists in this case study tailored rehabilitation to the patient’s cognitive abilities to maximize treatment outcomes by using implicit learning early in rehabilitation, and explicit learning later in treatment. Implicit learning strategies were used early in rehabilitation because the treatment focused on functional tasks, and implicit learning ensures acquisition and retention of a given skill [16] . In contrast, explicit learning allows the patient to transfer learning to different tasks, which had higher importance after the patient mastered the skill [16] . This being said, research on motor learning strategies used in TBI patients is not clear [16] . Some studies show that implicit feedback is less impaired following a TBI, therefore it is argued that explicit feedback should be the focus in treatment [16] . Other research argues that implicit learning should be the focus [16] . Therefore, it is unclear as to which approach is better, and what sequence the learning styles should be provided during TBI rehabilitation [16] .  

In summary, although the patient in this case study showed general improvements in functional ability, there are some evidence gaps regarding the effectiveness of certain rehabilitation interventions following a TBI. In particular, further research must be done on the effectiveness of implicit and explicit learning strategies, as well as the effectiveness and prevalence of virtual reality use in rehabilitation following a TBI. 

References [ edit | edit source ]

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psychology case study brain damage

Darren's story

psychology case study brain damage

Phineas Gage: His Accident and Impact on Psychology

Kendra Cherry, MS, is an author and educational consultant focused on helping students learn about psychology.

psychology case study brain damage

Emily is a board-certified science editor who has worked with top digital publishing brands like Voices for Biodiversity,, GoodTherapy, Vox, and Verywell.

psychology case study brain damage

Author unknown / Wikimedia Commons

Frequently Asked Questions

Phineas Gage is often referred to as the "man who began neuroscience." He experienced a traumatic brain injury when an iron rod was driven through his skull, destroying much of his frontal lobe .

Gage miraculously survived the accident. However, his personality and behavior were so changed as a result of the frontal lobe damage that many of his friends described him as an almost different person entirely. The impact that the accident had has helped us better understand what the frontal lobe does, especially in relation to personality .

Phineas Gage's Accident

On September 13, 1848, 25-year-old Gage was working as the foreman of a crew preparing a railroad bed near Cavendish, Vermont. He was using an iron tamping rod to pack explosive powder into a hole.

Unfortunately, the powder detonated, sending the 43-inch-long, 1.25-inch-diameter rod hurling upward. The rod penetrated Gage's left cheek, tore through his brain , and exited his skull before landing 80 feet away.

Gage not only survived the initial injury but was able to speak and walk to a nearby cart so he could be taken into town to be seen by a doctor. He was still conscious later that evening and able to recount the names of his co-workers. Gage even suggested that he didn't wish to see his friends since he would be back to work in "a day or two" anyway.

The Recovery Process

After developing an infection, Gage spent September 23 to October 3 in a semi-comatose state. On October 7, he took his first steps out of bed, and, by October 11, his intellectual functioning began to improve.

Descriptions of Gage's injury and mental changes were made by Dr. John Martyn Harlow. Much of what researchers know about the case is based on Harlow's observations.

Harlow noted that Gage knew how much time had passed since the accident and remembered clearly how the accident occurred, but had difficulty estimating the size and amounts of money. Within a month, Gage was well enough to leave the house.

In the months that followed, Gage returned to his parent's home in New Hampshire to recuperate. When Harlow saw Gage again the following year, the doctor noted that while Gage had lost vision in his eye and was left with obvious scars from the accident, he was in good physical health and appeared recovered.

Theories About Gage's Survival and Recovery

The type of injury sustained by Phineas Gage could have easily been fatal. While it cannot be said with certainty why Gage was able to survive the accident, let alone recover from the injury and still function, several theories exist. They include:

The Effects of Gage's Injury

Popular reports of Gage often depict him as a hardworking, pleasant man prior to the accident. Post-accident, these reports describe him as a changed man, suggesting that the injury had transformed him into a surly, aggressive heavy drinker who was unable to hold down a job.

Harlow presented the first account of the changes in Gage's behavior following the accident. Where Gage had been described as energetic, motivated, and shrewd prior to the accident, many of his acquaintances explained that after the injury he was "no longer Gage."

Since there is little direct evidence of the exact extent of Gage's injuries aside from Harlow's report, it is difficult to know exactly how severely his brain was damaged. Harlow's accounts suggest that the injury did lead to a loss of social inhibition, leading Gage to behave in ways that were seen as inappropriate.

Some evidence suggests that many of the supposed effects of the accident may have been exaggerated and that Gage was actually far more functional than previously reported.

Severity of Gage's Brain Damage

In a 1994 study, researchers utilized neuroimaging techniques to reconstruct Phineas Gage's skull and determine the exact placement of the injury. Their findings indicate that he suffered injuries to both the left and right prefrontal cortices, which would result in problems with emotional processing and rational decision-making .

Another study conducted in 2004 used three-dimensional, computer-aided reconstruction to analyze the extent of Gage's injury. It found that the effects were limited to the left frontal lobe.

In 2012, new research estimated that the iron rod destroyed approximately 11% of the white matter in Gage's frontal lobe and 4% of his cerebral cortex.

Phineas Gage's Impact on Psychology

Gage's case had a tremendous influence on early neurology. The specific changes observed in his behavior pointed to emerging theories about the localization of brain function, or the idea that certain functions are associated with specific areas of the brain.

In those years, neurology was in its infancy. Gage's extraordinary story served as one of the first sources of evidence that the frontal lobe was involved in personality.

Today, scientists better understand the role that the frontal cortex has to play in important higher-order functions such as reasoning , language, and social cognition .

What Happened to Phineas Gage?

After the accident, Gage was unable to continue his previous job. According to Harlow, Gage spent some time traveling through New England and Europe with his tamping iron to earn money, supposedly even appearing in the Barnum American Museum in New York.

He also worked briefly at a livery stable in New Hampshire and then spent seven years as a stagecoach driver in Chile. He eventually moved to San Francisco to live with his mother as his health deteriorated.

After a series of epileptic seizures, Gage died on May 21, 1860, almost 12 years after his accident. Seven years after his death, Gage's body was exhumed. His brother gave his skull and the tamping rod to Dr. Harlow, who subsequently donated them to the Harvard University School of Medicine. They are still exhibited in its museum today.

Phineas Gage Summary

In 1948, Phineas Gage had a workplace accident in which an iron tamping rod entered and exited his skull. He survived but it is said that his personality changed as a result, leading to a greater understanding of the brain regions involved in personality, namely the frontal lobe.

A Word From Verywell

Gage's accident and subsequent experiences serve as a historical example of how case studies can be used to look at unique situations that could not be replicated in a lab. What researchers learned from Phineas Gage's skull and brain injury played an important role in the early days of neurology and helped scientists gain a better understanding of the human brain and the impact that damage could have on both functioning and behavior.

Gage died from an epileptic seizure almost 12 years after the accident. These seizures started a few months before his passing, though his health had started to decline several months before the seizures began.

The damage occurred to Phineas Gage's frontal lobe, the region of the brain at the front of the head. The frontal lobe plays a role in our ability to speak, make decisions, and move. It is also partially responsible for our personality.

Post-accident, Gage's demeanor was said to have changed from pleasant to surly and he went from being a hardworking, motivated man to a man who had trouble keeping a steady job. Some reports suggest that Gage's personality changes were exaggerated, and that they may also have been temporary, fading a couple of years after the accident.

Phineas Gage lived almost 12 years after the rod pierced his skull. He died on May 21, 1860. This would make him just short of 37 years old at the time of his death.

Gage's accident helped teach us that different parts of the brain play a role in different functions. Through studying Gage's frontal lobe damage, we gained a better understanding of what the frontal cortex does with regard to personality. We also began to know more about the effects of frontal lobe damage and how it may change a person.

Sevmez F, Adanir S, Ince R. Legendary name of neuroscience: Phineas Gage (1823-1860) . Child's Nervous System . 2020. doi:10.1007/s00381-020-04595-6

Twomey S. Phineas Gage: Neuroscience's most famous patient .  Smithsonian Magazine.

Harlow JM. Recovery after severe injury to the head . Bull Massachus Med Soc . 1848. Reprinted in  Hist Psychiat. 1993;4(14):274-281. doi:10.1177/0957154X9300401407

Harlow JM. Passage of an iron rod through the head . 1848. J Neuropsychiatry Clin Neurosci . 1999;11(2):281-3. doi:10.1176/jnp.11.2.281

Itkin A, Sehgal T. Review of Phineas Gage's oral and maxillofacial injuries . J Oral Biol . 2017;4(1):3.

de Freitas P, Monteiro R, Bertani R, et al. E.L., a modern-day Phineas Gage: Revisiting frontal lobe injury . The Lancet Regional Health - Americas . 2022;14:100340. doi:10.1016/j.lana.2022.100340

Macmillan M, Lena ML. Rehabilitating Phineas Gage . Neuropsycholog Rehab . 2010;20(5):641-658. doi:10.1080/09602011003760527

O'Driscoll K, Leach JP. "No longer Gage": An iron bar through the head. Early observations of personality change after injury to the prefrontal cortex . BMJ . 1998;317(7174):1673-4. doi:10.1136/bmj.317.7174.1673a

Macmillan M. An Odd Kind of Fame: Stories of Phineas Gage . MIT Press.

Damasio H, Grabowski T, Frank R, Galaburda AM, Damasio AR. The return of Phineas Gage: Clues about the brain from the skull of a famous patient . Science . 1994;264(5162):1102-5. doi:10.1126/science.8178168

Ratiu P, Talos IF. Images in clinical medicine. The tale of Phineas Gage, digitally remastered . N Engl J Med . 2004;351(23):e21. doi:10.1056/NEJMicm031024

Van Horn JD, Irimia A, Torgerson CM, Chambers MC, Kikinis R, Toga AW. Mapping connectivity damage in the case of Phineas Gage . PLoS One . 2012;7(5):e37454. doi: 10.1371/journal.pone.0037454

Shelley B. Footprints of Phineas Gage: Historical beginnings on the origins of brain and behavior and the birth of cerebral localizationism . Archives Med Health Sci . 2016;4(2):280-6. doi:10.4103/2321-4848.196182

Garcia-Molina A. Phineas Gage and the enigma of the prefrontal cortex . Neurologia . 2012;27(6):370-5. doi:10.1016/j.nrleng.2010.03.002

Johns Hopkins Medicine. Brain anatomy and how the brain works .

By Kendra Cherry Kendra Cherry, MS, is an author and educational consultant focused on helping students learn about psychology.

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Brainwashed: 3 of Psychology’s Greatest Case Studies

brain scans

Traumatic Brain Injury (TBI) is a serious, debilitating, and usually lethal injury resulting from trauma to the head. It is alarmingly common, with around 1.7 million Americans suffering from it. If your injury is because of someone’s negligent actions, however, call a brain injury lawyer in your locality to help you with compensation.

Brain injury can take many forms; some might even remain stagnant months after an accident . Often times, however, they manifest quite obviously. Not only lethal, those suffering from TBI might also experience some life-altering changes to their physical, cognitive, psychosocial, and emotional abilities

Case studies in psychology help experts understand how the human mind works. In this case, the following case studies all have something to do with brain injury. Here are three of the greatest case studies in the field of psychology related to brain injury:

1. Phineas Gage

The case of Phineas Gage is one of the most interesting instances of brain injury throughout history. According to historical records, Gage was tamping explosives to the ground at Central Vermont in 1848 for a new railway line when he encountered a terrible accident.

One of the explosives he was handling detonated prematurely, launching his tamping iron straight to his face. The iron went right through his brain and popped out from the top of his head. Astonishingly, he was able to survive. There were, of course, lasting consequences after suffering an injury of this size.

Aside from permanent physical injuries, he sustained behavioral changes as well. He became listless and aggressive, seemingly an effect of the frontal brain damage affecting his personality.

2. Henry Gustav Molaison

brain surgeon

Henry Gustav Molaison, who has suffered epilepsy since he was a child, opted to undergo brain surgery to treat his childhood condition. Molaison’s surgery involved taking out huge chunks of his hippocampus on either side of his brain as an attempt to treat his epilepsy.

This, later on, proved disastrous as this second case study, just at the tender age of 27, developed severe amnesia . Studies show that he was unable to retain any information in his long-term memory, going on to forget anything post-surgery.

At the time, experts thought that memory was distributed equally throughout the cerebral cortex. This is why they were so baffled by the extremity of Molaison’s condition. His unique condition spurred several other experts to literally dissect his brain and preserve it as a 3D digital atlas.

3. Victor “Tan” Leborgne

The peculiar case of Victor “Tan” Leborgne spurred psychologist’s to change their views against language function and how this was distributed through the brain. Leborgne, a Frenchman, had a speech impediment, and could only utter “tan,” besides the expletive phrase “sacre nom de Dieu”.

In 1861, he was referred to Paul Broca, a neurologist, for diagnosis and treatment. He died not long after. Broca then examined his brain and noticed a lesion in his left frontal lobe. Coupled with the knowledge of his impaired speech but normal comprehension, he deducted this part was responsible for speech production.

Suffering brain injuries , especially at the hands of another person, can be extremely traumatizing, and the road to recovery may be long and expensive. Luckily, nowadays healthcare is a lot more accessible than it was several years ago.

You no longer have to suffer through the consequences of botched brain procedures or negligent head trauma from the hands of another person. You now have experts like brain injury lawyers to help you make a claim and receive just compensation.

Be the first to know!


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    When you’re performing research as part of your job or for a school assignment, you’ll probably come across case studies that help you to learn more about the topic at hand. But what is a case study and why are they helpful? Read on to lear...

  2. Why Are Case Studies Important?

    Case studies are important because they help make something being discussed more realistic for both teachers and learners. Case studies help students to see that what they have learned is not purely theoretical but instead can serve to crea...

  3. What Are Some Examples of Case Studies?

    Examples of a case study could be anything from researching why a single subject has nightmares when they sleep in their new apartment, to why a group of people feel uncomfortable in heavily populated areas. A case study is an in-depth anal...

  4. A case of “Borrowed Identity Syndrome” after severe traumatic brain

    This case study follows patient PA from the age of 43 at the time of injury until his current age of 54 years. The patient is a board-certified gynecologist

  5. MSM and case studies of people with brain injuries

    In your essay, it is important that you are able to link research evidence to specific theoretical claims. Case studies of people with acquired brain

  6. The Neuroscience of Behavior: Five Famous Cases

    Five patients who shaped our understanding of behavior and the brain. · Phineas Gage. In 1848, John Harlow first described the case of a 25-year-

  7. Famous case studies in Neuroscience and Psychology

    Paul Broca with expressive aphasia. Post mortem examination showed injury to the same area of the brain as seen in other case studies of a

  8. Psychology's 10 Greatest Case Studies

    Psychology's 10 Greatest Case Studies – Digested · Phineas Gage · Victor Leborgne (nickname “Tan”) · Wild Boy of Aveyron · Kim Peek · Anna O. · Kitty

  9. Six Landmark Case Reports Essential for Neuropsychiatric Literacy

    psychology, and the history of medicine for opinions as to the ... left-sided brain damage, albeit without autopsy confirma-.

  10. Case Study: Traumatic Brain Injury in an Elderly Woman

    The following fictional case study discusses possible interventions for restoring physical and cognitive function during an in-patient rehabilitation

  11. Case Study Peter's Story

    small amount of physiotherapy at home and a couple of psychology sessions with.

  12. Case study

    This pathway is accessible at any point following an acquired brain injury. People who have been through assessment and rehabilitation at a BIRT centre often go

  13. Phineas Gage: Biography, Brain Injury, and Influence

    Learn Gage's story and its impact on psychology. ... subsequent experiences serve as a historical example of how case studies can be used to

  14. Brainwashed: 3 of Psychology's Greatest Case Studies

    1. Phineas Gage. The case of Phineas Gage is one of the most interesting instances of brain injury throughout history. · 2. Henry Gustav Molaison.