u06d1 The Case of Phineas Gage The case of Phineas Gage illustrates the important role of the orbitofrontal

cortex in regulating emotional behavior. How does this interesting case help us understand the emotional features of disorders involving brain damage, especially dysfunction of the frontal lobes? Response Guidelines Respond to at least one other learner. Your response is expected to be substantive in nature and to reference the assigned readings, as well as other theoretical, empirical, or professional literature to support your views and writings. Reference your sources using standard APA guidelines. The orbitofrontal cortex (OFC) is a region of the ventral medial prefrontal cortex (vmPFC) located on the ventral surface of the frontal lobes. Its important to note that lesions in the OFC extend to proximal cerebrovascular regions including sectors of the median region of the PFC (Croft, 2009). Moreover, neural connectivity between vmPFC and higher order association cortices in a normal brain extends to dorsalmedial thalamus, temporal cortex, cingulated cortex, ventral tegmental area, olfactory system, lateral hippocampus, and amygdala (Carlson, 2013). Its important to note that although functional localization of specific areas of the PFC has been documented, global neural activations with other cognitive and neuroanatomical correlates to the PFC is still largely unknown (Shamay-Tsoory et al., 2003). Noteworthy is that serotnergic innervation is transmitted to the vmPFC as an aggression inhibitor in coordination with affective regulatory function of the amygdala (Croft, 2009). Numerous research studies indicate that individuals who incur lesions to the vmPFC experience debilitating impairments of decision making, emotional regulation, perspective taking ability and psychosocial behavioral control. A significant amount of extant research demonstrating the critical importance of the vmPFC in regulating emotion has been derived from case histories of patients who have incurred damage to this region. Unquestionably the most famous landmark incident of vmPFC damage involved Phineas Gage, a 25 year old construction foreman working on the Rutland and Burlington Railroad in New England in 1848. Gages skull was impaled by a tamping iron, approximately 1.1 m long and 3 cm thick, which thrust upward under his cheekbone and emerged out of the top of his skull, virtually destroying bilateral functionality of the vmPFC (Larner & Leach, 2002). The attending physician, Dr. John Harlow, treated Gage within hours of the accident and continued to observe noticeable changes in his personality until Gages death in 1861. It was noted that Gages psychological dysfunction was intrusive. He was no longer a notably shrewd and efficient businessman, but showed significant deficits in regulating emotions and decision making, sometimes demonstrating irreverent, irresponsible and capricious behavior patterns. After Gages death, researchers reconstructed his brain tissue and determined a

bilateral lesion of the ventromedial frontal lobes had occurred, sparing the dorsolateral frontal cortices, Broca area and motor cortices (Croft, 2009). Although patients with bilateral damage indicate more severe outcomes than patients with unilateral lesions, cases such as these elucidate the causal relationship between neurophysiological lesions of the PFC region and behavioral and emotional impairment. Moreover, it suggests that the vmPFC acts as an interface between cognitive and neuroanatomical activations of cortical regions (e.g. amygdala) which process learned and unlearned emotional response to environmental stimuli and constituent affective control of a constellation of complex behaviors. Some researchers have adopted the term, acquired sociopathy to describe the condition of patients with brain lesions to the PFC who acquire a propensity for inappropriate emotional reactions (e.g. impulsive, rude, angry, etc.) (Shamay-Tsoory et al., 2003). Recent research has also underscored the deficit in a theory of mind among patients with lesions in the PFC compared with those who have non-PFC lesions. Theory of mind (ToM) essentially refers to the flexibility of perspective taking in describing ones ability to make inferences regarding the mental state (knowledge, intentions, beliefs) of others (Zald & Andreotti, 2010). Additional studies related to ToM suggest that empathetic response or the reactions of an individual to the observed experiences of another, is also impaired among patients with prefrontal lesions (Shamay-Tsoory et al., 2003). In his vanguard work on the functional capacity of the PFC in emotional regulation, Daniel Siegel (2010) defines empathy as the capacity to create mindsight images of other peoples minds. In essence, the PFC not only facilitates attunement to another individuals cognitive expressions, but it also elicits complex perspective taking to interpret the intentions and emotions of others. These characteristics are particularly critical in this authors specialization as a Complementary and Alternative Medicine (CAM) practitioner. Noteworthy is that CAM therapists have an asymmetrical relationship with clients in a therapeutic counseling relationship based upon apparent differences in therapeutic roles and subsequent establishment of the assessment parameters (Brown, 2000 as cited in Brabender & Fallon, 2009). General client rapport and the multicultural goal of egalitarianism are best achieved by acknowledging asymmetry, understanding its effects, and creating relationships of mutual respect through demonstrated empathetic concern. The pathway to healing in CAM modalities begins by demonstrating sensitivity and empathy as a practitioner for a clients personal problems, background and culture. Moreover, although cultural differences may exist within the clinical environment, overemphasizing them without finding relevancy in common beliefs and behavior can elicit variable levels of treatment resistance, thus hindering persuasive communication and distracting from therapeutic goals. Empathetic concern and flexible perspective taking facilitates the process of establishing client

rapport, as well as a clients pursuit of meaningful and sustainable changes in the quest to self actualizing the healing process. Anthony Rhodes General Psychology PhD. References Boes, A. D., Grafft, A. H., Joshi, C., Chuang, N. A., Nopoulos, P., & Anderson, S. W. (2011, Behavioral effects of congenital ventromedial prefrontal cortex malformation. BMC Neurology, 11, 151-151. doi: http://dx.doi.org/10.1186/1471-2377-11-151 Brabender, V., & Fallon, A.. (2009). Ethical Hot Spots of Combined Individual and Group Therapy: Applying Four Ethical Systems. International Journal of Group Psychotherapy, 59(1), 127-47. Carlson, N. R. (2013). Physiology of behavior (11th ed.). Boston, MA: Pearson Education, Inc. ISBN: 9780205239399. Croft, K. E. (2009). Exploring the role of ventromedial prefrontal cortex in human social learning: A lesion study. The University of Iowa). ProQuest Dissertations and Theses, , 169. Retrieved from http://search.proquest.com/docview/304900642?accountid=27965. (304900642). Larner, A., & Leach, J. P. (2002). Phineas Gage and the beginnings of neuropsychology [Electronic version]. Advances in Clinical Neuroscience and Rehabilitation, 2(3), 26. Shamay-Tsoory, S. G., Tomer, R. R., Berger, B. D., & Aharon-Peretz, J. J. (2003). Characterization of Empathy Deficits following Prefrontal Brain Damage: The Role of the Right Ventromedial Prefrontal Cortex. Journal Of Cognitive Neuroscience, 15(3), 324-337. doi:10.1162/089892903321593063 Siegel, D. (2010). Mindsight. Bantam Books: New York. Zald, D., Andreotti, C. (2010). Neuropsychological assessment of the orbital and ventromedial prefrontal cortex. Neuropsychologia. (48)12, 33773391. http://dx.doi.org/10.1016/j.neuropsychologia.2010.08.012