HOW
PHINEAS LOST IT
ALAN ALDA This is the skull of Phineas Gage, who over
150 years ago became one of the most celebrated cases
in the history of medicine -- which is why he's still
here in the Warren Museum at Harvard Medical School.
A smart and likable young man, according to his friends,
Phineas was working as the foreman at a railroad construction
gang in Vermont when a blasting accident blew this three-foot
long iron rod through his left cheek and clear through
the top of his head. The rod landed about 25 yards behind
him. And Phineas got to his feet and walked away. As
a local newspaper put it the next day, "The most singular
circumstance connected with this melancholy affair is
that he is alive and in full possession of his senses
and free of pain." But while he lived another twelve
years with part of his brain destroyed, he was, as his
friends said, "no longer Gage." He was described as
"fitful" and "grossly profane." On the one hand "impatient
and obstinent" and on other, unable to make plans for
the future: unable, in fact, to make up his mind. Phineas
Gage's fame stems not only from him simply surviving
such a ghastly accident, but he was the first patient
to suggest a link between personality and the functions
of the front part of the brain, the frontal lobes. In
this show, we're going to explore how our frontal lobes
shape who we are and how we go about our lives. But
first we're going to find out exactly what happened
to Phineas' brain when that iron bar blew clean through
it on September 14, 1848.
ALAN ALDA (NARRATION) The Gage skull is easily the
most prized possession of the Warren Museum. Only members
of the Museum staff are allowed to lay hands on it.
Recently a specialist in trauma medicine at Harvard
Medical School began wondering how Phineas could possibly
have survived the accident. The researcher asked for
permission to examine the skull with the latest diagnostic
technology -- fortunately available right next door
to the Warren Museum at Brigham and Women's Hospital.
Phineas' day trip has brought him to one of the hospital's
state-of-the-art CT scanners, more usually employed
checking for disease in living patients. The puzzle
he's here to resolve is one that has tantalized Dr Peter
Ratiu from the moment he first saw the skull in the
museum. How could the rod pass clean through the skull
and cause so little damage?
PETER RATIU We know where the rod went. But the problem
is the rod is twice as big as the opening. So it was
a miracle enough that he survived. That would have been
a direct godly intervention to stick a one-in-a-half
inch rod through a half-inch hole.
ALAN ALDA How has that been accounted for up until
now?
PETER RATIU Nobody bothered to measure.
ALAN ALDA (NARRATION) What Peter Ratiu suspects is
that to let the rod through the skull must have cracked
and opened like a door on its hinge.
ALAN ALDA So the rod went in through here? PETER RATIU
The rod went through here and entered the skull. This
is the most obvious crack ….
ALAN ALDA (NARRATION) Today Peter his hoping the CT
scan will reveal a pattern of cracks in the skull consistent
with his explanation for Gage's survival… That the rod
actually opened the skull as it passed through, the
skin and tissue of Gage's face and skull stretching
for an instant then snapping the skull closed again.
ALAN ALDA Is this something you've experienced before?
PETER RATIU Absolutely not. This guy dodged five ways
to die. Each one is a sure shot. So never try this.
ALAN ALDA It's amazing.
ALAN ALDA (NARRATION) While Peter Ratiu is interested
in how Phineas survived, what's made Gage famous is
how he later behaved.
ALAN ALDA What's the area of the brain that was affected
during this accident?
JORDAN GRAFMAN I think the area that everybody focuses
on are the frontal lobes. Now they're might have been
some damages to areas a little bit outside the frontal
lobes but what makes this person and their case interesting
to scientists is the fact that their injury was in the
frontal lobes and a result of the injury, Gage's personality
changed.
ALAN ALDA Can we tell what kind of personality change?
I mean, was it an inability to make decisions, or…it's
hard to tell.
JORDAN GRAFMAN It's hard to tell. Other than the fact
we know is it changed. He couldn't resume his former
position . Although he did work afterwards…
ALAN ALDA He wasn't good as a foreman.
JORDAN GRAFMAN …he wasn't good as a foreman. Which
requires executive skills.
ALAN ALDA I brought a brain in a box here and I wonder
if you can show me where on the brain the accident affected
him?
JORDAN GRAFMAN Sure. So these are the frontal lobes
of the brain. This is the right side, and the left side.
And the rod probably entered somewhere from the bottom
of the frontal lobes on the left side and came out somewhere
on the top of the frontal lobes. So all the tissue in
between here to here no doubt was damaged, as well as
some of the surrounding tissue.
ALAN ALDA What was the thinking in those days about
the relationship of the brain to the personality? How
did they organize their thoughts about that?
JORDAN GRAFMAN Well, there wasn't a lot of sophisticated
thinking. Here's an example of such thinking. This is
a phrenology skull. And you can see etched into the
skull in different places are what might be called faculties.
ALAN ALDA (NARRATION) Phrenology was invented by a
very bright fellow called Franz Joseph Gall, who thought
that different parts of the brain did different things.
His mistake was in believing bumps in the skull reveals
what lies beneath.
ALAN ALDA Has any one of these areas shown to conform--?
You don't even have categories like this?
JORDAN GRAFMAN Alan, It was a crap shoot, you know?
ALAN ALDA I know…benevolence? Nobody's looking for
benevolence in the brain, are they?
JORDAN GRAFMAN We're all looking for benevolence. But
not right now in the brain.
ALAN ALDA Reasoning faculties he's got over here.
JORDAN GRAFMAN So that's not a bad place to have it.
There's probably some relationship between the functions
of the frontal lobe and your ability to do some certain
of reasoning.
ALAN ALDA He's got language under the left eye. Is
that possible? I mean-why would he say that? Is there
brain under the left eye?
JORDAN GRAFMAN I don't know what kind of plaster cast
he was studying to in order to do that. Under your left
eye is your left cheek.
ALAN ALDA (NARRATION) Gall may have been wrong in the
details, but his concept of the brain as an organ with
specialized regions has been vindicated. And of all
the specialized regions, none is more important in distinguishing
us from the rest of the animal kingdom - and from our
pre-human ancestors -- than the enormously enlarged
front part of our thinking brain, the frontal lobes,
or pre-frontal cortex.
JORDAN GRAFMAN It serves as sort of the central executive,
the chairman of the board of the brain. And it helps
guide our behaviors, it helps us plan, it helps us carry
out plans, it helps us reason about difficult topics,
it helps us make certain kinds of decisions, it helps
us inhibit behaviors that are not really appropriate,
more primitive behaviors. For example, say you want
to be on a diet and you love chocolate and in front
of you, you see this wonderful, delicious chocolate
cake in front of you but you know you shouldn't have
it. So the front--.
ALAN ALDA So the back of my brain…
JORDAN GRAFMAN Wants it.
ALAN ALDA …and the front of my brain....
JORDAN GRAFMAN Is saying, "not good for me."And so
you're able to put it off because you have another goal.
Maybe the goal is to lose weight. Maybe the goal is
to live longer. So these goals are gonna to be much
more important than sort of the short term goal based
on just seeing the chocolate cake in front of you.
ALAN ALDA (NARRATION) For much of this show we'll be
peering into our pre-frontal cortex to discover how
it works - and how it allows us to be ourselves - in
ways that Phineas irrevocably lost that day he became
"no longer Gage.".
JORDAN GRAFMAN If you were to look at any part of the
cortex and say what makes us human, well, we always
look to language-related cortexes. But I happen to think
it's the pre-frontal cortex and the anterior part that
makes us most human.
ALAN ALDA Did you ever notice that I have a tremendous
shelf right there?
JORDAN GRAFMAN And I'm impressed by that.
ALAN ALDA I know it's back to phrenology, but--.
JORDAN GRAFMAN Whatever works.
WHY KIDS DON'T GET IT
ALAN ALDA (NARRATION) The first stop for my brain and
me is at the Shriver Center in Waltham, Massachusetts,
which houses one of the leading laboratories investigating
the minds of children. In the cheerful basement is a
large room where kids of all ages hang out with their
parents. We all know that kids brains work differently
from grow-ups'. And it turns out from work here and
at other labs that while much of a child's brain is
up and running from the start, the slowest to come on
line is the pre-frontal cortex -- which, as we're about
to find out, accounts for a lot.
ALAN ALDA These kids look very comfortable in here.
What are they here for?
ADELE DIAMOND We give them games to play, problems
to solve, which teaches us how they're understanding
the world and how their mind is working. Every time
they do something and they do it differently than us,
they did it that way because it made sense to them.
So we're trying to figure out how they're understanding
the world and how their mind is changing as they get
older and the relationship of that to how their brain
is changing. Now this is supposed to be boring…
ALAN ALDA (NARRATION) Adele Diamond frequently plays
a game with babies like 10-month old Alexandra which
are spellbinding in what they reveal about the infant
mind.
ADELE DIAMOND OK, Alexandra, watch. Alexandra. OK.
Where'd it go? Where'd it go? Where'd the toy go? Good
job! Yeah, good job.
ALAN ALDA (NARRATION) Like most babies her age, Alexandra
finds this part of the game child's play.
ADELE DIAMOND OK, hold her hands again.
ALAN ALDA (NARRATION) But now Adele hides the toy a
second time.
ADELE DIAMOND Watch where it's going. Watch Alexandra,
look, hello, watch where it's going. OK Alexandra, go
ahead, where'd it go? Where'd it go? Where did the toy
go, Alexandra? Where'd the toy go?
ALAN ALDA (NARRATION) Alexandra seems a little bemused
- but not half as much as I am.
ADELE DIAMOND Look, look, it's over here. Yeah. OK,
let's try again. OK, hold her hands. Yeah. Are you watching?
Are you watching?
ALAN ALDA (NARRATION) Despite watching intently as
the toy goes into the left hand well for a second time…
ADELE DIAMOND She's so sure of herself.
ALAN ALDA It's amazing. Now what's happening there?
Why is that happening?
ADELE DIAMOND Well, what I think is happening is she's
got only a very fragmentary memory of it being there.
And she got rewarded for going here. So I think you
have a battle going on, between the fragile memory of
where the toy went and this very strong impulse to go
to what was rewarded before. So they go back. They go
back.
ALAN ALDA (NARRATION) Monkeys with damaged frontal
lobes make the same, suggesting it's Alexandra's immature
frontal lobes that cause her to keep going back to the
same old well. By the time she's Graylen's age, Alexandra
will be having no problem with the well task. But she'll
still be doing things that to an adult brain seem baffling.
RESEARCHER And in the color game all the red ones go
here and all the blue ones go here, right?
ALAN ALDA (NARRATION) Graylen is three.
RESEARCHER Can you point and show me where the blue
ones go? Yeah, perfect. Where do the red ones go? Perfect.
ALAN ALDA (NARRATION) The cards can be sorted either
by shape or by color. Graylen's first learning the color
game.
ALAN ALDA She has to match up the cards with the colors
of the objects…
ADELE DIAMOND And now she's going to do the shape game,
when she has to match the shapes.
RESEARCHER Can you show me where the stars go? Yeah.
Where do the trucks go? Oh, excellent.
ADELE DIAMOND Now they won't be red or blue, so she
can only match them by shape, see, it's a yellow star.
This is training.
RESEARCHER Now remember. Stars go here, and trucks
go here. Here's a truck. Where are you going to put
that?
ADELE DIAMOND OK, so now she's done color, and she's
done shapes. No problem with either.
RESEARCHER Can you point and show me where the trucks
go? Where do the stars go? Good job. Here's a truck.
Where are you going to put that?
ALAN ALDA That was a blue truck.
ADELE DIAMOND Yes.
ALAN ALDA So…
ADELE DIAMOND Now it's the testing. Now she's got the
conflict.
ALAN ALDA (NARRATION) In the shape game, the color
doesn't count - and Graylen has learned the game well.
RESEARCHER Can you point and show me where the stars
go? Excellent. Where do the trucks go? Yeah. Here is
a star. Where're you going to put that? Now remember,
all the stars go in this box and all the trucks go…
ADELE DIAMOND Notice that every trial either the experimenter
restates the rules or the child answers, restating the
rules. RESEARCHER Where'd the stars go? Good girl. What
about the trucks? Where do they go?
ALAN ALDA She's learning in a way to ignore the color
during this part.
ADELE DIAMOND Yes. And then she's got to undo that.
RESEARCHER You know what we're going to do now, Graylen,
now we're going to play the color game again, all right?
Now remember, in the color game, blue ones go here and
red one go here? Can you show me where the red ones
go? Where do the blue ones go? Excellent. Here's a blue
one.
ALAN ALDA Hmmm…
ADELE DIAMOND Yeah.
RESEARCHER Have a look and tell me where the blue ones
go. Excellent. Where do the red ones go? Yes. Here's
a red one. Where does that go?
ALAN ALDA Wow, where do the blue ones go, where do
the red ones go. Here's a red one. Star.
ADELE DIAMOND Right.
ALAN ALDA It's really remarkable.
ADELE DIAMOND What I think is happening is before the
child sees the card, the child has clearly in mind what
the rules are and what she's supposed to do. She knows
that red ones go here and blue go there. She's got it.
Then she sees this card that is relevant to both dimensions
in incompatible ways. And that creates a problem for
her. What we call this is attentional inertia. They
can't get their attention off of what had been relevant
before.
ALAN ALDA So what you start with seems to get dominance
in some way. Why is that? Because it's been reinforced
many times?
ADELE DIAMOND I think so, yes. You've got used to doing
those rules that way.
ALAN ALDA (NARRATION) The part of the brain that's
good at sticking to the tried and true is down in the
more primitive regions. In the adult brain, it's the
pre-frontal cortex that jumps in and over-rules the
ingrained response.
RESEARCHER What is that?
JULIANNA A star.
ALAN ALDA (NARRATION) But in a three-year-old brain
like Julianna's, the pre-frontal cortex still isn't
up to the job of switching her mind to the new set of
rules. Adele Diamond has an idea she's testing here
that if a child herself names the color or shape it
will help her get out of her rut.
RESEARCHER And what is this called?
JULIANNA Truck.
RESEARCHER Where do trucks go?
ADELE DIAMOND Before the experimenter said, this is
a truck. Now she's saying what is it and having the
child say this is a truck. That's the only difference.
RESEARCHER What color's that?
JULIANNA Red.
ADELE DIAMOND I think that it provides a verbal scaffold
to help her move her attention. When she's named it
as something else, I think that helps her get over the
hump of moving her attention to what's newly relevant
now. That's what I think is happening.
RESEARCHER What color is this?
JULIANNA Red.
RESEARCHER Where do red ones go?
ALAN ALDA (NARRATION) For a moment it looks as is Julianna's
got it…
ALAN ALDA Oh, oh, oh a little indecision there.
ALAN ALDA (NARRATION) But even with a verbal cue helping
out…
RESEARCHER Can you tell me what color this one is?
JULIANNA Blue
ALAN ALDA (NARRATION) Julianna's frontal lobes aren't
quite up to the task.
ADELE DIAMOND OK, so she made a liar out of me.
RESEARCHER So this is the adult version of the child
card sort that you just saw, and it's computerized…
ALAN ALDA (NARRATION) Well, here's the inevitable moment
when my pre-frontal cortex is going to be on public
display. The word tells me whether to respond to the
shape or the color. So far so good - when they're all
shapes, my frontal lobes have it easy. When the rule
changes, things get trickier. Now the heat's really
on - sometimes the rule is color, sometimes it's shape.
The computer's been measuring my reaction time - which
in the mixed trial slowed drastically.
ALAN ALDA I am all washed up.
ADELE DIAMOND The children make the mistake at the
level of accuracy. They actually get it wrong. Adults
make the same kinds of mistakes but now at the level
of reaction time. We're slower to do the things that
the children do wrong.
ALAN ALDA Now what's this telling us about what's happening
in the brain? In an adult brain, that's supposed to
be totally developed. Well, maybe I'm on the downside…
ADELE DIAMOND The older part of the brain- the part
that's involved with habit and doing what comes naturally
- has had a lot more time to develop than pre-frontal.
So fragile pre-frontal cortex can't always solve everything.
It's hard to switch, it's hard to change what your system
has gotten used to doing.
ALAN ALDA (NARRATION) This time my system is getting
used to pressing the button on the same side as the
gray dot - which isn't too hard. But now of course the
rule changes. When the dot's striped I have to press
the button on the opposite side - and I'm slower. Then
when the dots are mixed…
ALAN ALDA Ah! Ah!
ADELE DIAMOND Everybody make mistakes.
ALAN ALDA I'm pressing everything. If it was a pinball
machine I'd have done fine.
ALAN ALDA (NARRATION) At least I got to do my test
sitting comfortably at a computer. Ten-year-old Kevin
is going to do the same test while lying in an MRI machine
- actually a mock MRI machine, or his braces - and maybe
his teeth -- would be yanked right out of his mouth.
ALAN ALDA Are my credit cards OK doing this?
ADELE DIAMOND It wouldn't be if it was a real scanner
because of the magnetic field. But this is just like
the real thing except that there's no magnet here so
your credit cards are safe. This is what we use to get
people acclimated to the scanner.
ALAN ALDA Oh, I see.
TECHNICIAN OK Kevin. Here we go. Here's your box. Put
you hands on this, hold your thumbs just like that.
OK, I'll slide you in a little bit.
ALAN ALDA (NARRATION) Kevin's prefrontal cortex - as
his parents will no doubt discover in the next few years
- still has quite a bit of maturing to do.
TECHNICIAN There you go. How's that?
KEVIN Great.
TECHNICIAN OK, so we'll get started here…
ALAN ALDA (NARRATION) But when he performed this task
in a real scanner, the images revealed a critical part
of his pre-frontal cortex already hard at work.
ALAN ALDA This is your brain here?
KEVIN Yeah.
ALAN ALDA Do you recognize it?
KEVIN Yeah.
ADELE DIAMOND So first what I thought I'd do is show
you some of the anatomy of his brain. You're going to
see us go from the front of his brain to the back, and
as we're doing that you'll see what it looks like at
each of those levels. Pretty neat, huh? So these are
the slices, Kevin, that we took through your brain when
we were looking at the functioning of your brain when
you were doing the task.
ALAN ALDA (NARRATION) The area that lit up brightest
was up over his forehead and near the surface of his
brain, called the dorsolateral pre-frontal cortex.
ADELE DIAMOND So this is how much harder his dorsolateral
pre-frontal cortex had to work when he had gray dots
and striped dots.
ALAN ALDA Were you aware that it was harder? Did you
see yourself, like, trying to concentrate on it?
KEVIN Yeah.
ADELE DIAMOND Yeah, it's harder when they're mixed
together than when you just have one.
ALAN ALDA Would you get them wrong and then realize
it a second later?
KEVIN Yeah.
ALAN ALDA Yeah, that happened to me all the time. And
then I'd go "oh, oh," and get real excited.
ADELE DIAMOND And you tend to see almost across whatever
task that the more difficult condition you get activation
of dorsolateral pre-frontal cortex. When you have to
concentrate, when it's hard, when you need executive
control, you need dorsolateral pre-frontal. The more
you can go on automatic, the more you don't have to
concentrate as much, the less you need dorsolateral
pre-frontal.
ALAN ALDA (NARRATION) So your dorsolateral pre-frontal
cortex is critical to helping you make up your mind.
But as we'll see in our next segment, it doesn't work
alone…
TOUGH CHOICES
ALAN ALDA (NARRATION) Our next stop as my brain and
I try to make up our mind is the campus of Princeton
University, where inside the Department of Psychology
another test of my pre-frontal cortex awaits.
JONATHAN COHEN All right, so name the color and ignore
the word.
ALAN ALDA Okay, name the color and ignore the word.
Name the color. Yellow. Red. Yellow. Green. I did it.
I'm so ashamed.
ALAN ALDA (NARRATION) A classic in psychology, this
is called the Stroop test.
ALAN ALDA Name the color, ignore the word. Green. Yellow.
Red. Green-Blue. Yellow. Yellow. Blue. Red.
JONATHAN COHEN OK.
ALAN ALDA Boy.
JONATHAN COHEN You did it.
ALAN ALDA But I probably took three times longer.
JONATHAN COHEN Well describe to me what you felt when
you were doing it.
ALAN ALDA I just tried to look at it as some symbols
that had a color and I was trying to read the color.
And then, at one point, all I saw, I mean, I heard myself
speaking what was written there. Even though I had decided
to just think of it as a meaningless.
JONATHAN COHEN You scratched the itch.
ALAN ALDA Well, yeah, it just produced the word in
me. I want to look at this on my brain, okay?
ALAN ALDA (NARRATION) If I'd been in an MRI machine
at the time, no doubt my dorsolateral pre-frontal cortex
would have been glowing like mad. But Jonathan Cohen
is more interested in another part of the pre-frontal
cortex, deeper down in the brain, which also seems to
get involved when we're faced with inner conflict.
JONATHAN COHEN It's this strip of cortex right over
here lying right over the corpus callosum which is this
white area right over there.
ALAN ALDA (NARRATION) This brain region is called the
anterior cingulate, which Cohen believes is watching
out for those times when it's hard to make up your mind
- when you're struggling to say red when you're seeing
the word green. The anterior cingulate then signals
the pre-frontal cortex to focus, focus, focus…
ALAN ALDA There's an organization to this tissue that's
built in, that works that way, that helps you do that,
that takes a recognized mistake and on the next trial,
sends stuff in that make it a little better. I mean,
this is built that way, from what you're saying?
JONATHAN COHEN That's the hypothesis. I mean, in some
sense it has to be, right? The question is, how? And
what we're trying to understand is, how that happens.
Just as an aside, one of my favorite book as a kid was
"How Things Work". I don't know if you ever saw that.
ALAN ALDA Yeah.
JONATHAN COHEN But it was a book that basically showed
the mechanisms underlying all these things that we interact
with on a daily life. You have a ballpoint pen…You press
the clicker once and the stylus comes out. You press
it again…
ALAN ALDA And it goes back. Same click.
JONATHAN COHEN Yeah. That's magic, right? What was
great about that book was that it demystified that magic.
It said how that happened. There's not a little guy
in there keeping track, "oh, we pressed it last time,
it went out, I better pull it back in." It's not some
homunculus. There's some mechanism that explains it.
And the joy of science is discovering that mechanism.
ALAN ALDA (NARRATION) It's not just when the brain's
having trouble saying red instead of green that the
anterior cingulate yells to the prefrontal cortex for
help. Consider this classic problem in philosophy, involving
a train, or in some versions, a trolley. You're standing
next to a railroad switch as a train approaches. If
you do nothing, the train will surely kill five foolish
but innocent people standing on the track. You could
save them by hitting the switch, diverting the train.
The problem is that there's another foolish innocent
standing on the second track.
JOSHUA GREENE So the moral question is, is it possible
to hit the switch so you only run over one person instead
of five? What do you think? Off the top of your head?
ALAN ALDA Off the top of my head it seems it would
be regrettable to kill anybody, but if you could save
the five people, then you would throw the switch.
JOSHUA GREENE Well, that's what pretty much everybody
we ask says. Okay, now here's a slightly different case.
Trolley headed towards five people, this time, there's
no other track. You're on a footbridge standing over
the track. And you're standing next to this big person.
And this time, the only way you can save those five
people is to push the big guy off of bridge. He'll land
on the tracks. He'll get squashed by the train. He'll
die, but the five people will live.
ALAN ALDA Okay, so, will I push him off the bridge?
JOSHUA GREENE Yeah.
ALAN ALDA Well, it's so hypothetical. I mean, I don't
even understand…First of all, I don't understand how
he could … I'd have to be really convinced that he could
stop the train. But I'd be, as I'm sure most people
would be, less inclined to push the guy. But, um…I don't
know….It depends. It kind of depends, I mean, do I have
anything against this guy?
JOSHUA GREENE No.
ALAN ALDA Would it matter to me if I lost him?
JONATHAN COHEN Yeah. Is that what you really want to
do?
JOSHUA GREENE The fact that you're looking for all
these sort of angles and ways out and things to question
is very telling. Because most people are made rather
uncomfortable by that one.
ALAN ALDA Right. I'm taking a very active role--.
JOSHUA GREENE Structurally, these are very similar
cases. I mean, it's death by trolley to one person in
order to save five people. Perhaps you can try and find
a reason why it's OK. And this is what philosophers
have been busy doing…Well we put the philosophical question
about what is right and wrong aside for a second, and
we asked, what's going on in the brain?
ALAN ALDA (NARRATION) What they found when people struggled
with these problems in a scanner is that regions of
the brain thought to be involved in emotion lit up when
people thought about pushing the guy off the bridge.
And just as I did, it took them longer to make that
decision than the less personal one of throwing the
switch. The Princeton researchers also borrowed a story
line from the last episode of MASH in their exploration
of how the brain wrestles with moral dilemmas. A bus
full of people has to hide from enemy soldiers…
SOLDIER Quiet, nobody make a sound until they've passed.
ALAN ALDA (NARRATION) But a crying baby endangers everyone's
life. In the MASH story Hawkeye urges the mother to
keep the baby quiet - and she ends up smothering it.
In the Princeton study, subjects were asked to decide
if its OK to smother the baby in a case like this. They
were also asked about a second moral choice.
JOSHUA GREENE A teenage mother, gives birth in the
locker room at school and she just doesn't want to deal
with it. Is it okay for her to just throw the baby in
the dumpster? Almost everybody says no, that's not okay
and they say no very quickly. That's a personal case,
in the sense of having that up close and personal interaction.
It's the same kind of action, killing your own child,
as in the MASH sort of case. But, very different in
terms of what's going on in people's heads. In both
cases, according to our view, there's a proponent emotional
response, saying "no, no, don't do it." In the case
with the teenage mother, because, at least, according
to our moral views, there's really is no …There are
no strong countervailing rational considerations that
would make that OK. You could probably come up with
some if you modify the case a bit, but there the thought
is that the emotion occurs and it just wins because
there's nothing to oppose it. Where as in the MASH kind
of case, you have that proponent emotional response,
but then your reason kicks in says, well, wait a second,
if you don't do this, everyone could die, including
the baby. So there's this drawn-out conflict and instead
of people answering in two seconds or three seconds,
they take closer to ten seconds to give their answer.
ALAN ALDA (NARRATION) Josh Greene is now looking at
the brain scans of people wrestling with the MASH kind
of case to see if the anterior cingulate - which the
Princeton group believes is monitoring conflict- is
working overtime listening to all the different parts
of the brain - both rational and emotional -- clamoring
for input before someone finally makes up their mind.
How emotion and rationality compete in decision making
is also the subject of an experiment that I'm about
to be suckered into - along, apparently, with some dozen
Princeton students.
ALAN SANFEY Our subject today is going to Alan Alda,
whom I'm sure you all recognize, and slightly different
from out run of the mill Princeton undergraduate. And
so, the way it'll work is that each of you, in turn,
will play one round of the game. You'll be brought into
a room and sat in front of a computer terminal. You'll
play the game with Alan who's gonna be downstairs in
the scanner. Just Alan, if you just kinda shake people's
hands. Maybe you can just briefly introduce yourself
and give your name.
PETER VINCENTERS I'm Peter Vincenters. I'm a junior
in mechanical engineering.
ALAN ALDA How do you do?
KATHLEEN I'm Kathleen Brand, I'm a chemical engineer.
ALAN ALDA (NARRATION) Now all I know about the game
so far is that I'll be asked to accept or reject various
financial offers each of these fellow players will be
making.
ROB Hi, I'm Rob Wurtz, senior economics major.
FINN Finn Colabra, I'm a senior electrical engineer.
ALAN ALDA How do you do? I gotta watch out for the
economics guy.
ALAN ALDA (NARRATION) I'll be having my brain scanned
while each of the other players offers to split ten
dollars with me. I can either accept or reject the offer
- but if I turn it down, we both get nothing.
ALAN ALDA Well, if they give me a ridiculous offer,
then I lose money because I don't accept their ridiculous
offer?
JIM RILLING That's correct. If you reject the offer,
neither of you get anything.
ALAN ALDA This game is like life.
ALAN ALDA (NARRATION) So it's into the MRI machine
I go - a real one this time. I get given a button box
to respond to the offers, which I can see projected
on to a mirror above my face.
TECHNICIAN Alan, are you able to read the words "Welcome
to the Experiment" written on the screen there?
ALAN ALDA Yes.
ALAN ALDA (NARRATION) I hadn't expected a computer
as a partner - but it's offer seems what a reasonable
machine would make - so OK, I'll take it. Kelly seemed
a nice person… and she is, fine. Kathleen, let's see…
What? That's ridiculous. No way. I'm beginning to wonder
if this is a set-up and the people aren't actually playing,
just lending their faces. Ah, another selfish oaf… Take
that. Clare… surely…Oh, dud, dum, dum…yes, no… No. To
heck with it. I'm now pretty sure I'm being manipulated
by the experimenters, not those nice polite Princeton
students…Oh, here's the computer again - maybe I can
teach it a lesson in manners too. Zap. OK, after some
thirty minutes in the scanner wrestling with my outrage
- freedom.
ALAN ALDA Was there somebody live on the other end?
ALAN SANFEY Well, um, no. Not exactly, no.
ALAN ALDA At one point they were alive. When you took
their picture.
ALAN SANFEY Exactly.
ALAN ALDA I think it occurred to me somewhere in the
middle of the first run, I think.
ALAN SANFEY Did that affect how you played the game?
ALAN ALDA No, I played it as if they were real people.
JONATHAN COHEN You actually rejected a couple of offers
from the computer where it made avowedly unfair offers
but nevertheless there's presumably there's no personal...
ALAN ALDA Well, the chances were better for me if I
could move the computer around than if I just had an
emotional reaction to it.
JONATHAN COHEN Or if it was just a dry response. Which
is, "Hey, it's just a computer, what do I care? I'll
take the two bucks and run. There's no consequences
down the road for what I get.
ALAN ALDA And it's just a couple of bucks, I could--.
JONATHAN COHEN We discussed that too. And at first
we thought, maybe this is an inconsequential part of
your salary, but then we realized, this is PBS…maybe
this is more than your getting.
ALAN ALDA No. I did very well today.
JONATHAN COHEN We haven't paid you yet. This is part
of the experiment. IRISH
JONATHAN COHEN You want this right now?
ALAN ALDA You think I'll be giving this back to Princeton.
Forget it. What did I make? IRISH
JONATHAN COHEN Forty eight dollars.
ALAN ALDA Forty eight dollars.
JONATHAN COHEN Not bad, huh?
ALAN ALDA Now, of course, you know, this has nothing
to do with the science, but how did I do compared to
other people?
JONATHAN COHEN I'll let these guys answer, because
they're the ones…
ALAN ALDA Is that about average?
ALAN SANFEY That's actually low. Because most people
would be…would reject less offers.
ALAN ALDA They would. Because--. What do they report
when they talk to you? Why would reject?
ALAN SANFEY Typically around the 7 and 3 mark, people
have typically told us, "It's a little bit unfair but
it's not too bad." So they tend to accept that. They
also tend to accept everything a computer offers them.
They don't really draw distinction between fairness
and unfairness of a computer. Most of them will reject
a 9 and 1 offer, and about half will reject the 8 and
2, and most will accept the 7 and 3.
ALAN ALDA Yeah. I must say, it would be interesting
to know what you recorded when I was offered the 7 and
3. Because I thought, well, gee, that's being awfully
particular. Why don't you take the three? But I thought,
no, no.
ALAN ALDA (NARRATION) Decisions that mix emotion with
reason are awfully hard to make - and the longer it
takes, if the Princeton team is on the right track,
the more that little strip of brain called the anterior
cingulate is calling on your frontal lobes to resolve
the conflict, and make up your mind.
INTO THE DARK
COURTNEY Hi Michelle, I'm Courtney, one of the dieticians.
ALAN ALDA (NARRATION) So far we've focused on how the
brain uses specialized regions to make up its mind.
But now we're going to see how the brain can sometimes
change its mind about what region does what. Michelle
Geronimo has volunteered to be the subject of an extraordinary
experiment. I'm here to lend a little moral support.
In a few moments, Michelle is going to lose her sight.
ALAN ALDA Is this real food?
COURTNEY These are food models that we use for teaching
purposes.
ALAN ALDA That's a great relief.
MICHELLE GERONIMO For me too.
ALAN ALDA Because if that was the real food I wouldn't
wear that blindfold if I were you.
ALAN ALDA (NARRATION) Neuropsychologist Alvaro Pascual-Leone
makes sure Michelle won't peek by tucking a tell-tale
snippet of photographic film into the blindfold.
ALAN ALDA Your last look, huh?
MICHELLE GERONIMO Yeah, into the darkness.
ALVARO PASCUAL-LEONE Here we go.
MICHELLE GERONIMO Here we go.
ALAN ALDA (NARRATION) It's now 9 am Monday morning.
ALVARO PASCUAL-LEONE We're going to start bandaging,
OK?
ALAN ALDA (NARRATION) Michelle will be totally blind
until 3 pm Friday. Aisling Ward There are eye pockets,
so you can blink.
ALAN ALDA (NARRATION) Here's the moral support I mentioned.
ALAN ALDA Michelle, can you hear me?
MICHELLE GERONIMO Yes I can.
ALAN ALDA Hi!
ALAN ALDA (NARRATION) To get a sense of Michelle's
next few days, I'm being blindfolded for the morning.
CAROL Are you both ready to start walking with the cane?
ALAN ALDA Yeah, who's this, here? Who's that, the cameraman?
PETER Yes sir.
ALAN ALDA Well get out of the way!
ALAN ALDA (NARRATION) We're headed for the hospital's
Clinical Research Center -- and at once my awareness
of the surroundings shifts from sight to my other senses.
CAROL The differences in sound quality…
ALAN ALDA Sound and temperature.
ALAN ALDA (NARRATION) In fact the whole point of the
experiment Michelle's about to go through is to see
if this shift in sensory input has an impact on her
brain -- in particular, on her sense of touch while
she learns to read Braille.
ALAN ALDA D. It feels a little thicker on the top.
LAURIE It's like a C with another dot.
ALAN ALDA (NARRATION) I'm having trouble even feeling
the dots, let alone interpreting them as letters.
ALAN ALDA Eventually you get the shape of it and they
just go automatically into your brain as a letter, I
guess. LAURIE Right. GIL "As things turned out, my mother
and I were able to leave Cuba together in 1962…"
ALAN ALDA (NARRATION) But we now need to back up a
little in our story, and meet Gil Bush, who's been blind
from birth. He earns his living as a proof-reader for
Braille publications. Information pours into his brain
-- principally through the tip of his right index finger
-- at an astonishing rate. For years, brain scientists
have been fascinated by this skill and have wondered
if it involves a change in the way the brain is organized.
This little device presents Braille letters to a fingertip
for just a few milliseconds. GIL E. I. L.O.
ALAN ALDA (NARRATION) With Gil's baseline skill established,
now comes the dramatic part of the experiment.
ALVARO PASCUAL-LEONE I'm just taking the magnetic stimulation
coil…
ALAN ALDA (NARRATION) This coil will deliver a powerful
magnetic jolt to Gil's brain, temporarily disabling
the region immediately beneath it.
ALVARO PASCUAL-LEONE We're targeting the back of your
brain and in fact the back part we call the visual cortex.
ALAN ALDA (NARRATION) The visual cortex handles information
from the eyes -- at least in those of us with sight.
ALVARO PASCUAL-LEONE Does it feel OK? GIL It feels
fine.
ALAN ALDA (NARRATION) Which makes this experiment seem
rather odd. Why zap the visual cortex, when what's being
tested is a skill involving touch, which is processed
in another part of the brain entirely? In fact, this
is a recreation of an experiment first done by Alvaro
and his colleagues several years ago. Gil's experience
today perfectly replicates that experiment. GIL They
felt very dim, like the dots weren't coming up as well
as before.
ALAN ALDA (NARRATION) Gil's accuracy declined too.
The extraordinary implication is that Gil's visual cortex
is involved in reading Braille -- as if his brain has
somehow rewired itself to recruit for touch, brain cells
most of us use for seeing. And this is the reason for
Michelle's abrupt encounter with blindness. The question
is: Can her brain also rewire itself to help read Braille
-- in her case after just a few days as compared with
Gil's lifetime without sight?
MICHELLE GERONIMO Or king, king, G -- six dots.
ALAN ALDA (NARRATION) But for me, three hours of total
blindness is enough.
ALAN ALDA That is bright. Michelle, I can't see!
MICHELLE GERONIMO That's comforting!
ALAN ALDA (NARRATION) Later on that first day of Michelle's
blindness, she goes to have her head examined -- in
an MRI machine that will take pictures of her brain
while different senses are stimulated. To understand
the results we need a brief lesson in brain anatomy.
ALAN ALDA Can you show me the parts of the brain that
I use when I'm looking at stuff?
ALVARO PASCUAL-LEONE Yeah. Let me open up your head.
ALAN ALDA OK.
ALVARO PASCUAL-LEONE So basically of course the light
would be coming in through here, and it actually travels
all the way to the very back of the brain, the occipital
cortex, that is the visual cortex.
ALAN ALDA Back over here.
ALVARO PASCUAL-LEONE Back over there.
ALAN ALDA So if that's where I see, where do I feel?
ALVARO PASCUAL-LEONE Right, so the information from
your hand, from your right hand, will come to the left
side of your brain, specifically here, to the posterior
part of the central sulcus. Information from your left
hand will come to the other side, on the right side
of the brain.
ALAN ALDA (NARRATION) In this day one testing of Michelle's
brain, the results were no surprise. When the index
finger of her left hand was stimulated, the touch-sensing
region on the right side of her brain lit up, just as
it would in you or me. But now Michelle settles down
for her 100 hours of blindness. A favorite movie doesn't
need the picture. There are walks around the hospital
corridor. Activities to exercise her sense of touch.
MICHELLE GERONIMO Happy Valentine's Day.
ALAN ALDA (NARRATION) And practice reading Braille
-- hours and hours of practice reading Braille. Until
finally it's Friday. CLOCK 12:39 pm
MICHELLE GERONIMO 12:39 pm, which means I have 2 hours
and 21 minutes left.
ALAN ALDA (NARRATION) Michelle's week of total darkness
was relieved by one vivid visual hallucination.
MICHELLE GERONIMO I had an image on my blindfold, on
the left side, black and white still shot of a face,
looking to the left, really clear, really distinct really
odd -- because it was Elvis Presley. And it was Elvis
the later years, Elvis with a little more hair and the
rhinestone outfit with the white collar.
ALAN ALDA (NARRATION) In these last few hours of blindness,
Michelle returns to the MRI scanner. This time her brain
looks very different. Instead of her touch-sensing region
lighting up, now her visual cortex is activated. It's
as if, finding itself with nothing better to do, the
visual cortex has stepped in to help with a task it's
more skilled at than is the touch region -- making sense
of symbols. This possibility is strengthened when Michelle
is tested as Gil was -- to see if disrupting her visual
cortex impairs her ability to read Braille. Her Braille
test is a little easier than Gil's -- to identify whether
pairs of letters are the same or different. Now Michelle's
visual cortex gets 10 minutes under the magnetic coil.
ALVARO PASCUAL-LEONE OK, we're all done.
RESEARCH ASSISTANT Michelle, we're going to test your
right index finger again.
MICHELLE GERONIMO OK.
RESEARCH ASSISTANT Ready?
MICHELLE GERONIMO Yes. Different. Different.
ALAN ALDA (NARRATION) Sure enough, just like Gil, her
accuracy drops markedly. For Alvaro, already happy as
the results emerge, there's a bonus.
MICHELLE GERONIMO I found that my fingers have been
a little less sensitive, since the TMS testing, the
stimulation, to the feel of the characters from the
Braille task.
ALVARO PASCUAL-LEONE That's fabulous. We'll pay you
another $500!
MICHELLE GERONIMO Thank you.
ALVARO PASCUAL-LEONE That is exactly what we're looking
for. We were wondering whether there would be some function
related to touch that would be taken over by the visual
cortex over the time that you've been blindfolded. And
the fact that your fingers feel less sensitive now would
suggest that that actually has been the case. Wow! This
is good.
ALAN ALDA (NARRATION) Alvaro has reason to be excited.
Michelle's experience is dramatic confirmation of his
hypothesis that the brain can reorganize itself in just
a few days, let alone a lifetime.
ALVARO PASCUAL-LEONE I would say that the brain is
like, you know, market economy. There is demand for
a certain thing, we activate what it needs to cover
that demand. There is no demand for it, we use it for
something else. It is just like any good shopkeeper
would do: you adjust whatever you offer to people passing
by by virtue of what they are going to need.
MICHELLE GERONIMO I feel this blindfold has become
part of my face.
ALVARO PASCUAL-LEONE You ready? You want to keep your
eyes closed to begin with.
MICHELLE GERONIMO Oh, geez. Hi. When the blindfold
came off I was a bit disoriented and a bit unbalanced.
I'd been dependent on hearing to orient myself, and
then when the vision came back I found myself off guard
and had to take things in a new way now. But now I'm
alright.
ALVARO PASCUAL-LEONE So, we'll ask you to put on a
blindfold again -- just for the test -- and do the Braille
discrimination.
ALAN ALDA (NARRATION) Having her vision restored has
in fact had an even more profound effect than Michelle
realizes. When her visual cortex is zapped the next
morning, her ability to read Braille is unaffected.
After just a few hours of working at its usual job,
her vision center has apparently found it's much too
busy to any longer help out with touch. Michelle's five
days of blindness has provided astonishing confirmation
of the malleability of the human brain.
THE POWER OF HALF
ALAN ALDA (NARRATION) We're began our show with the
story of Phineas Gage, who lived without a chunk of
his brain. We're ending with the story of an equally
remarkable young woman.
JORDAN GRAFMAN This is the right side of her brain;
this is the left side of her brain. And what happened
was, in utero, she had a stroke. And the stroke, not
entirely, damaged a large proportion of her left hemisphere.
ALAN ALDA So that never developed?
JORDAN GRAFMAN Never developed.
ALAN ALDA What is the left hemisphere usually there
for?
JORDAN GRAFMAN Verbal processing. Language processing.
Not all aspects of language by the way, but enough that
we consider it the hemisphere that really dominates
our language abilities. It also plays a fairly large
role in recognizing objects. Our ability to look at
objects to know what they are and even how to use them.
ALAN ALDA So if those functions of the brain were only
to be found in that area, then you'd expect that a person
without that part of the brain would have difficulty
saying words or recognizing objects. But this is not
the case with Michelle?
JORDAN GRAFMAN This is not the case with Michelle,
and that's why I'd like you to come and meet her.
ALAN ALDA (NARRATION) Missing almost the entire left
side of her brain,
MICHELLE MACK has an obvious problem controlling the
right side of her body. But at the Catholic Church where
her mother's a pastor, it's equally obvious that Michelle
has few problems either with language or recognizing
objects. She regularly helps out with the church records.
MICHELLE MACK I take them home and I update them on
my computer at home and I bring them back to my mother
and I file them.
ALAN ALDA (NARRATION) Recently Michelle's mother Carol
contacted
JORDAN GRAFMAN at the nearby National Institutes of
Health outside Washington DC.
CAROL MACK I wonder what testing Dr Grafman will be
doing.
ALAN ALDA (NARRATION) Every month or so now, mother
and daughter drive to the NIH to join Grafman and his
team in a study of how Michelle's right brain copes
with a workload most brains share with the left. Today,
Carol told the film crew of a skill even Grafman doesn't
know about.
ALAN ALDA If I say a date, you can come up with what
day of the week it is?
MICHELLE MACK Yeah, I think so, yes.
ALAN ALDA Well, let me not go too far out. Let's say
this year, the year 2000, October 19th.
MICHELLE MACK OK. October 19th is going to be on a…
Thursday.
ALAN ALDA OK, I don't have a calendar so I can't check
that. So far you're doing great. OK. So let me go a
year later. The year 2001, August 12th.
MICHELLE MACK OK… Sunday.
CAROL MACK They're all checking! (Off camera) They're
both right.
ALAN ALDA They're both right?
CAROL MACK They're both right.
ALAN ALDA Maybe we should stop at 100% correct, right?
That's amazing.
MICHELLE MACK That's great. I hope this is on tape.
ALAN ALDA Did you know she had this ability?
JORDAN GRAFMAN Not until right now. And that's why
it's fun to work with Michelle because she's always
surprising us.
ALAN ALDA (NARRATION) Jordan's work with Michelle is
only beginning. But already it's apparent not only that
her right brain has taken on tasks usually done by the
left, but that it's had to make some changes of its
own. For instance, Michelle has problems with tests
of her visual-spatial skills, even though her right
brain -- where these are normally tackled -- is intact.
ALAN ALDA It's almost a question of geography. Like
there's a whole bunch of word people who have no place
to live on the left side, and they're crowding on to
the right piece of geography and there's only a certain
amount of land there…
JORDAN GRAFMAN They're not asking permission.
ALAN ALDA That's right. They're coming in, they're
barging in and the folks who are living there who handle
spatial stuff are getting crowded out. Not as many of
them can do the spatial stuff. That's what it sounds
like is happening.
JORDAN GRAFMAN Couldn't have said it better!
ALAN ALDA But that's fascinating isn't it. I mean there's
this old saying that you hear all the time, you know,
we only use 10% of our brain. It sounds to me we're
all using every bit we've got…
JORDAN GRAFMAN Every bit we've got, and we'd try to
stake out more if we could.
ALAN ALDA Right. And it's almost as if there are parts
of our brain competing…
JORDAN GRAFMAN Exactly.
ALAN ALDA …for a place to work.
JORDAN GRAFMAN Exactly. As you learn new things, there's
always somewhat of a cost. There's a finite amount of
space and a finite amount of tissue, and you can enrich
that tissue but you're also going to compete with adjacent
territory as you learn new skills and have new abilities.
And you use the whole brain, and the whole brain is
a competitive organ. Each piece of the brain is competing
with its neighbors to get more territory, to have more
action. And it's happening now in you and it's happening
in Michelle as she takes the tests and develops throughout
her life.
ALAN ALDA (NARRATION) That's it for our show on how
our brains make up our minds. See you next time.
