22 Caliber Surgery: George’s Horrible, Awful OCD Cure

George was a psychiatric patient whose Obsessive Compulsive Disorder was so advanced that it drove him to attempt suicide. He survived the attempt, but in doing so, he was miraculously cured of his OCD symptoms. In this episode, we talk about the frontal lobe, the function of the prefrontal cortex, and famous neuroscience stories like Phineas Gage and George. Then we chat with Comedian Dan Wilbur. 

Trigger warning: This episode contains themes of mental health, guns and suicide.

There’s a famous story of a man named Phineas Gage. Gage was a foreman for the Rutland and Burlington Railroad in Vermont. His job was to oversee the construction of new railroad tracks and manage the crew who was responsible for both clearing the land and laying down the track. He was described as a capable, responsible and hardworking man, but also one who had excellent social skills and a kind demeanor. That’s how he rose to the job position of Foreman by the time he reached his mid-20s. 

The year was 1848 and the railroad crew was clearing land near Cavendish, Vermont. Part of the job was blasting rock out of the way to clear the lane for the railroad. This involved drilling a hole in rock, loading it up with explosive powder, then filling the rest of the hole with sand and tamping it down with a tamping iron – a 43 inch iron rod about an inch and a quarter in diameter. On September 13th, Phineas Gage went to use the iron tamper and didn’t realize he had made a fatal mistake. He forgot to pour the sand into the hole. So instead of tamping down inert sand, he was shoving the iron rod directly into the exposed black powder. The first thrust of the tamping iron caused a spark in the powder and huge explosion. 

The ensuing explosion propelled the tamping iron out of the hole and directly back toward Gage. It entered his face through his left cheekbone, behind his left eye and exited out the top of his skull, landing several feet away. Remarkably, he never lost consciousness. He was talking with those around him, despite having a hole through his head. But the reason we know about this horrible accident is because of what happened after the mishap. It made him into a landmark figure in the fields of neuroscience and psychology.  

Here’s why. After the accident, Gage was able to recover physically. His speech remained intact, as did his comprehension and memory. The problem was that he turned into a total jerk. Gone was the pleasant demeanor, the social skills, the work ethic and the responsible Phineas Gage everyone knew. He was reported to be unable to stick to plans, prone to outbursts of anger, and indifferent to the feelings of others. He became unreliable in work settings and had difficulty maintaining relationships. Descriptions of him included being profane, irreverent, and impatient, all of which were stark contrasts to his previous temperament. 

The rod had damaged Gage’s left frontal lobe. The shift in his behavior highlighted the role of the frontal lobes in regulating personality, decision-making, and social behavior. This is what made his case a foundational study in neuroscience. The prefrontal cortex is critical for executive functions such as decision-making, impulse control, emotional regulation, and social behavior. The damage to this region is believed to be responsible for the profound changes in Gage’s personality and behavior following the accident.

Similar stories have happened throughout history. One of the more interesting cases was in the case of the man who became the infamous Texas Tower Shooter at the University of Texas in 1966. Charles Whitman was later found to have a brain tumor near his amygdala, a part of the brain involved in emotional regulation and aggression. This discovery led some experts to speculate that the tumor might have influenced his violent behavior, causing him to lose control of his emotions and impulse regulation.

Today’s story is a similar situation. It happened on November 11, 1983. It’s a dark story, but one with a happy ending.

I wanted to give another trigger warning. We’ll be discussing topics of mental health, guns and suicide.

Most of the following information comes from one source. Well, it was reported in 1988 in a bunch of newspapers, the February 23 edition of the Los Angeles Times, The Washington Post – just about every major newspaper ran this story, but I did some digging and was able to track down the story’s origin. They all quoted this Psychiatrist, Dr. Leslie Solyum. So I found his body of published papers and I actually found the academic paper that he wrote about the subject. So this comes direct from the 1987 British Journal of Psychiatry, issue 151. And it tells the story of one of Solyum’s personal patients. The patient’s identity was kept anonymous, but he refers to the man as “George.” 

At an early age, George started experiencing symptoms of severe obsessive compulsive disorder. He had come out as gay to his parents and while his dad was accepting, his mom didn’t handle the news well. The OCD started after telling his parents and continued through the age of 15 without interfering too much with his life. At that point, it amounted to excessive hand washing, constantly checking things and being obsessed with dirt and contamination. The older he got, the worse it became until he was admitted to the hospital for it. The treatments he was given didn’t work – they tried exposure therapy, response prevention and supportive psychotherapy. His grades in school suffered and a heavy cocktail of psychoactive drugs didn’t work for him so he ended up stopping treatment. He used to be a straight-A student, but his motivation had disappeared and his grades fell. He had no more drive. 

Feeling helpless, George had made several suicide attempts. At its worst, his OCD was so severe he couldn’t continue with normal tasks until he did things like repeating 50 different chants to himself. His mother – with their already strained relationship threatened to commit him to a mental institution and when he told her how awful he was feeling, she said something along the lines of “Go and shoot yourself.” 

Sadly, this was a push too far for George and he did exactly that. He was 19 years old at this point and had shot himself in the mouth with a .22 caliber rifle. Miraculously, he survived and when doctors examined him, they found the bullet had lodged itself into his premotor cortex in the left frontal lobe and fragments of the bullet were scattered throughout. He was left impaired when it came to motor skills on his right side, and his speech was affected. But something else had happened. As soon as three weeks after surgery to remove the bullet, his OCD had lessened dramatically. 

George used to spend 4 hours doing bathroom rituals. That was now down to just 30 minutes. All of these OCD behaviors eventually went all the down to 15 minutes. After two weeks, he considered himself “mostly cheerful.” He was still a neat freak, but almost all of his over the top OCD behavior had gone away.  What’s more, he found motivation in his life again and was able to complete high school. His grades were great again and he was described as calm and cheerful. His test scores improved and looking at the data, Dr. Solyum concluded that there was no other explanation for the sudden behavior change than the altering of the frontal lobe. He had essentially conducted a leucotomy – which as far as I can tell is another word for lobotomy to his left frontal lobe. 

In a way, it was sort of a reversal of the case of Phineas Gage. George wanted to die, and in attempting to carry that out, he appears to have cured himself of the very thing that pushed him to those extreme measures. 

This was a bizarre and extremely rare case. If you’re feeling suicidal, please talk to somebody. There are many resources to consult – and I’ve left a few of them here in the show notes. It’s important to know that there’s no other record of this freak type of incident happening – it’s not a cure. In fact, these types of injury studies have helped provide information to doctors about the function of the frontal lobe and basal ganglia and in very, very rare cases, surgical procedures are still carried out to sever the connections in small parts of the brain. Long gone are the days of rough and often unsuccessful lobotomies. These types of surgeries are only carried out between 10-30 times a year in the United States. And not all of them are successful in their goal of behavioral change. This particular case was like a crude accidental version of this type of lobotomy. It’s a bizarre case – like Phineas Gage the railroad foreman. 

Nobody knows exactly what happened to George. His identity has remained anonymous. But his story has lived on. The Internet Says it’s True. 

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