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One hundred years ago a neurologist in Vienna became interested in the hysterical symptoms of patients which heretofore had been bypassed by the psychiatric community. While Freud's clinical techniques and psychoanalytic theories, after initial resistance, found widespread acceptance, he was never able to finish his “Project for a Scientific Psychology” in which he tried to bridge the biological and psychological knowledge and concepts at the end of the nineteenth century.
The last ten years have seen a resurgence in scientific interest by neuroanatomists, neurophysiologists, psychologists, psychoanalysts, and even immunologists to take on the never-ending challenge of the mind-brain dilemma. Among the many recently published books, Antonio R. Damasio's Descartes' Error: Emotion, Reason, and the Human Brain is outstanding in bridging the gulf between the newest neuroscientific findings and clinical presentations, all written in an extremely readable and compelling fashion. Damasio, chairman of the department of neurology at the University of Iowa College of Medicine, begins his book with the story of Phineas Gage, who prior to the Civil War, fascinated the medical community by not only surviving the ramming of a massive iron rod through his skull and brain, but also showing no signs of motor, sensory, or cognitive deficits. However, despite the apparent intactness of his cognition, Gage no longer could draw on his memory and formal logical reasoning to make the complex decisions that social situations and the ability for future directed planning required. Using detailed photographs of Gage's skull, which is preserved at the Warren Medical Museum of Harvard Medical School, Damasio's wife Hannah and colleagues were able to demonstrate through computerized three-dimensional mapping that the ventromedial prefrontal region of the frontal lobe was indeed damaged in Gage.
Drawing on his own clinical work with a number of patients who had sustained specific lesions of the fro