Frontal lobe
All neurologists, I imagine, have a favorite lobe. Mine is the frontal lobe. Let me explain why.
Athena sprang fully formed from Zeus’s forehead. Obviously this means she erupted from his frontal lobe, that’s what makes her the goddess of wisdom.
Obviously.
Anyways.
While things are not neatly encoded in discrete brain regions in general, it’s still fair to say the frontal lobe houses much of what makes us human.
All neurologists, I imagine, have heard the story of Phineas Gage. It is well-worn and driven into our skulls, not unlike Mr. Gage’s fate, though his was with an iron tamping rod and not a retelling of an unfortunate brush with fate. Phineas Gage was a construction foreman from Vermont whose fame (or perhaps infamy) stemmed from a catastrophic accident while working to blast rock at a site for a planned railroad line. Though the explosive was packed in the hole with the rod, supposedly the layer of sand or other inert material meant to contain the blast was forgotten. How the explosion happened is a matter of speculation but what is known is that the blast sent that rod clear through Phineas’s left cheek and left frontal lobe.
There are wild accounts of his apparent disinhibition, markedly diminished judgment, features which were supposedly not like the old Phineas Gage. These were tales of his descent into chaos, which now appear to have been wildly exaggerated. Judgment impaired? A bit, but he was able to work as a stagecoach operator in Chile, not knowing either the language or the country. Planning? Not as good as it used to be, but not entirely torpedoed into dust. All in all, from whatever factual evidence we have, he held it together.
That isn’t to say the frontal lobe doesn’t affect our inhibitions or lack thereof, or play a role in our ability to be organized and judge. We all talk about frontal lobes, talking about their development (though specifically prefrontal cortex), culminating for most around their late 20’s. The literature is full of evidence that frontal lobe damage can cause real changes which affect the subtle substrates of a person’s personality and ability to function. Brain tumors sapping a person’s ability to react, to feel, to emote. Strokes rendering a person silent, but still able to understand. Accumulations of abnormal proteins causing the previously milquetoast to morph into something gluttonous, lascivious, and bawdy.
Frontal lobe seizures throw seizure semiology on its head, and at times make us question where the border of neurological and psychological lies, if such a border even exists. Screaming, crying, running, bouncing, all could be frontal lobe seizures in the appropriate context. Languages shift, reverting to the words and sounds we first learned, leaning into them perhaps for comfort and familiarity. And so we as neurologists watch closely, listen carefully to the patient’s stories, seeing where things shift from what could be categorized as a behavioral phenomenon to something more complicated.
But zooming out for a moment, it is mind-boggling that something abnormal which could measure mere millimeters or centimeters within one or both frontal lobes could upend so much of how we carry ourselves in the world. We may look unchanged, but in conversations and random moments, how we interface with society, those deficits can reveal themselves. We are slower to get moving, more prone to react in all the ways we normally wouldn’t, we find our tongues perplexed by certain words.
It would be nice if all the things which could erupt from our frontal lobe were divine. But sometimes, the divine and dire brush shoulders in ways I wish they didn’t.
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