[music playing]

[gunfire]

Michael: We were on patrol. We ran into a bloody nose ambush, and a grenade came in. A man in front of me, and a man behind me were both killed. I just came out with a few holes in me.

Narrator: X-rays revealed that shrapnel from the grenade had penetrated the front of Michael's brain.

DR. JORDAN GRAFMAN: Michael has undergone a rather dramatic transformation. Before his injury, he was a bright and very promising and assertive soldier. And subsequent to his injury, Michael became unemployable, made many mistakes in social behaviors and relations, and has to live a much more limited life now.

Narrator: Demoted and eventually discharged from the army, Michael has been unable to hold down a steady job. He's now working under supervision as a hospital janitor.

Woman: He's a troubled young man. He doesn't know, himself, what he's doing or where he's going. He has no rhyme or reason for what he wants to do, whereas before he did have. A lot of times when you see him, or he comes to visit, it's— he's lost. He's aimless. And you ask him, what would you do or what would you like to do, and it's— well, it depends on his mood that day. He either shrugs his shoulders and, I don't know, or I'd like to get a real nice car, which has nothing to do with anything.

DR. JORDAN GRAFMAN: I'm going to start out by giving you 10 chips. Each chip is worth $0.05.

Narrator: Dr. Jordan Grafman is trying to establish why Michael's life has fallen apart. What aspects of his mental abilities have suffered because of the damage to his frontal lobe?

DR. JORDAN GRAFMAN: Eight.

Michael: 40.

DR. JORDAN GRAFMAN: Nine.

Michael: 45.

DR. JORDAN GRAFMAN: 10.

Michael: 50.

DR. JORDAN GRAFMAN: [inaudible].

Narrator: This gambling task is designed to test his ability to weigh out the likely consequences of his actions. The point of the test is to see at what stage in the game he decides to stop.

DR. JORDAN GRAFMAN: Do you want to stop, or do you want to continue?

Michael: Continue.

Narrator: High cards, Mike wins a chip. 10 or less, and he loses one.

Michael: Continue.

Narrator: The cards are deliberately arranged to give him a good winning streak followed by steady run of losses. Normally, people stop while they're ahead.

Michael: Continue. Should have kept it. Continue. Continue.

DR. JORDAN GRAFMAN: That's it. We're at the end. You gave me back all your chips. Why didn't you stop earlier?

Michael: I would have stopped on the third low card normally if it was my own money. Since it was your chips I was playing with—

DR. JORDAN GRAFMAN: You felt you'd take a chance.

Michael: I'd risk it all.

DR. JORDAN GRAFMAN: Despite coming up with what seemed like a rational explanation for his poor performance on this test, we know that in real life, Michael has a tendency to give away money. So, in fact, it doesn't hold up under the strains and responsibilities of his own daily life.

Narrator: Michael's personal life has also suffered as a result of his brain damage. He seems unable to sustain relationships. He now lives alone after a series of impulsive marriages.

Michael: The second girl that I married— she was a runaway. And the reason she ran away from home was because her stepmother slapped her, and I don't even remember asking her to get married. And the third girl— well, she was a prostitute. So she was in a hurry to get married. I don't know why.

Narrator: The damage to Michael's frontal lobe has destroyed his ability to work towards a long term goal or to think through the consequences of his actions.

DR. JORDAN GRAFMAN: If the situation is well structured, and he's given instructions as to what to do, Michael can perform quite well, particularly if the instructions are laid out in a stepwise manner. However, as the situation becomes less structured and Michael is forced to rely on his own internal thinking to develop and then execute activities and plans, that's where he begins to have trouble. That's where his distractibility begins to show and his difficulty in following ideas and his social problems.

Narrator: Michael's brain damage also seems to prevent him recognizing how much his life has been affected.

Michael: I believe it did change me from what everybody else has told me— being on one side of the fence, I don't see it, but they see me changed. So I kind of figure, well, yeah, it's changed me, because I know some things I did, I wouldn't have done.

Narrator: Cases like Michael's strongly suggest that the frontal lobe plays a vital part in allowing us to develop mental action plans for the future and then to follow them through. Without this ability, however intelligent Michael may be, the opportunities open to him are severely limited.