Personality changes after operations on the cingulate gyrus in man.

The use of anterior cingulectomy in the treatment of certain mental disorders gave us the opportunity of studying in a small group of patients, whose basic personality was unaffected by their illness, the changes which may follow lesions of this area. This paper is concerned with a report of six such cases. The effect of lesions of the cingulate gyrus in animals has recently been described. Electrical stimulation of the area by Smith (1945), and ablation in monkeys by Ward (1948a and b) and by Glees, Cole, Whitty, and Cairns (1950) all resulted in striking transient changes in affective behaviour. It seemed desirable therefore to explore the possible therapeutic effects in man of an operation designed to remove a part of this small region. Accordingly in 1948, the late Sir Hugh Cairns started operating on some chronic, severely disturbed mental hospital patients. The long-term results in such patients are reported elsewhere (Tow and Armstrong, 1953). In all cases there were significant changes in behaviour early after operation. There was evidence, both somatic and psychological, of lessened tension, amounting for a time to apathy and indifference. Negativism and aggressive outbursts were reduced, and patients who had appeared inaccessible for years responded again to their environment. Though mostly transient, these early changes in deteriorated patients were considered to justify a trial of the operation in selected patients with a basically well preserved personality suffering from severe, prolonged, and disabling psychiatric illness. Of these, two were unimproved by the operation, and had a standard leucotomy some nine months later. They are therefore only briefly mentioned. The other six have been observed for periods of three to four years since operation, and the personality changes noted form the basis of this report. Although clinical improvement resulted in all six cases, we are not concerned primarily with therapeutic results. These have already been described briefly (Whitty, Duffield, Tow, and Cairns, 1952), and we here attempt to describe the changes that occurred after operation, in the hope that they may illustrate some functions of the cingulate gyrus in normal cerebral economy, and thereby suggest therapeutic possibilities and limitations in individual cases of mental disorder. Our information was collected not only from intensive study of the patients themselves, but also by personal interviews with near relatives, friends, and employers. By crude clinical standards the psychological changes are not great; but even with the few cases so far studied in detail there seem to be certain constant and interesting alterations in personality.