The psychology case study is one of the oldest research methods in the discipline. One individual, sometimes with an abnormality, is studied in great depth. Psychology, as a science, seeks to discern universal truths, so the study of atypical individuals must be done with caution. These unrepresentative studies, though, suggest avenues for future research. Some of psychology’s most rewarding findings have been influenced by initial case studies. These findings were then corroborated by representative, rigorous research methods, namely the experiment.
1. Phineas Gage
One of the few portraits of Phineas Gage, holding the same tampering iron that damaged his brain.
On a day in 1848, Phineas Gage, a mild-mannered railroad worker, used a tampering iron to pack gunpowder into a rock. But a spark accidentally detonated the gunpowder, causing the rod to shoot up through his left cheek and the top of his skull. His left frontal lobe was severely damaged, but he survived. In fact, he immediately sat up and was able to talk. But Gage’s personality dramatically changed. He became short-tempered, rude, impulsive, and immoral. Friends said he was “no longer Gage.” He lost his job as a foreman and spent some time traveling the road as a circus attraction.
Almost all of what we know about Gauge is from published accounts by Dr. John Martyn Harlow. For a case so often cited, relatively little is known about the Gage’s, namely his life before and after the accident. The extent of Gage’s personality changes may have been inaccurate. Later evidence show that Gauge, for the last decade of his life, worked the same job in two locations. This is not consistent with the image of Gage as a capricious, emotionless drifter.
Nonetheless, Gage’s early case study illustrated the significance of association areas, the areas of the cerebral cortex involved in the higher mental functions (thinking, learning, remembering, etc.) that make us truly human. It was also one of the first cases that showed a neurological basis for personality and behavior. More recent studies in psychology look into these possible connections between morality, emotion, and the brain. But they owe a debt of gratitude to Phineas Gage.
2. “Genie,” the feral child
Genie after being rescued, malnourished and unable to properly walk.
Genie is a relatively recent example of a feral child. Feral children are humans raised in social isolation, experiencing little or no human contact in their lives. Feral children are typically the result of either child abandonment or abuse. Due to malnourishment and lack of mental stimulation, feral children never fully cognitively develop.
Genie was such a child. Found in 1970 at the age of 13, Genie had spent most of her life confined in a bedroom, strapped to a potty chair. Her father had believed she was mentally retarded, so he took steps to “protect her.” He beat her every time she made a sound. Her physical and mental development was stunted, and she never learned to speak or walk properly.
After she was found and properly cared for, Genie progressed, learning to communicate nonverbally with her caretakers. But as funds and research interest dried up, she went through a series of foster homes and today, at age 54, is psychologically confined. She has regressed, reverting to her coping mechanism of silence.
Genie’s case contributed significantly to psychological and linguistic theory. It showed the significance of enculturation in acquiring social skills. From a young age, mental stimulation is needed for motor and sensory development. Without mental stimulation, neurogenesis is hindered. Feral children like Genie support the “critical period hypothesis” of language acquisition. After the first few years of life (a critical developmental period), learning a language becomes more difficult (almost impossible) for a human child. Missing this window. Genie never learned to speak a grammatically correct verbal language.
3. H.M.
A portrait of H.M., Henry Molaison, in 1953.
Henry Gustav Molaison was perhaps the most important patient in the history of neuroscience. At the age of 9, a bicycle accident damaged his brain and caused him to suffer from seizures. In 1953, as a last resort for curing these convulsions, surgeons removed slivers of tissue from his hippocampus, an area we know now (thanks to HM) is critical in the formation of long-term memories. H.M. was left with severe anterograde amnesia. He basically lived in the past, unable to create new memories. Even his past memories were clouded by mild retrograde amnesia, leaving him only able to remember the gists of childhood events.
Dr. Brenda Milner’s study of H.M. paved the way for the study of human memory and memory disorders. In repeated trials, Dr. Milner told H.M. to perform a simple motor task, such as outlining a five-point star. Each time, H.M. recognized it as an entirely new experience. Yet he became more proficient at the task with practice. H.M. could be classically conditioned, learning things without the awareness of having learned them.
Thanks to Dr. Milner’s study, we know that memory consists of two systems that operate together. One is explicit, or declarative. It involves facts we know and can declare. It of course depends on the hippocampus, which H.M. had partially removed. The other is retention that is independent of conscious recollection: subconscious learning of motor functions. This finding revolutionized the understanding of memory and the neurological mechanisms behind it.
4. Jill Price
Jill Price, who published her story in a 2008 memoir.
Jill Price is one of the very few patients with hyperthymesia, an incredible memory that allows her to remember numerous obscure aspects of her life in incredible detail. She can, for example, remember what she had for dinner 20 years ago, on an ordinary August afternoon. This ability has caused her significant emotional trauma due to her remembrance of every derogatory remark or traumatic event in her life. Jill Price is still participating in psychological studies that hope to shed light on her condition.
Recent memory tests , however, show that Jill Price isn’t exactly a memory whiz, and that her abilities have been blown out of proportion. Mrs. Price cannot memorize a new list of words with great accuracy. Her memory is, in many respects, average. She can remember famous dates and names, but only if she finds them somehow relevant to herself. One of the key, previously underestimated, elements of Mrs. Price’s condition is her OCD-like symptoms. She hoards and feels a need to organize her life. Perhaps most significantly, she spends much of her time constantly thinking about herself and events in her life, elaborately encoding them into her memory.
All of this evidence, along with brain scans that show enlarged regions consistent with an OCD patient, suggests that Jill Price has a rare offshoot of Obsessive-compulsive disorder, and that her memories are a result of obsession. Only future research can corroborate or disprove this promising theory.
5. The John/John Case
David Reimer, formerly Brenda Reimer.
Dr. John Money was an influential sexologist that pioneered the theory of gender neutrality. He argued that, in the classic nature vs. nurture debate, nurture fully determined gender. Gender was supposedly malleable and determined in the first few years of cognitive development. Once the “gender gate” closed, a human’s gender identity was relatively stable.
The Reimer twins were circumcised at 6 months old. Unfortunately, the electrical equipment used in the circumcision malfunctioned, severely damaging Bruce Reimer’s penis. A few months later, his parents wrote to Dr. Money seeking help. Under his advice, Bruce Reimer was sexually reassigned in 1967. He was castrated and a vulva was surgically created. His parents attempted to raise him as a girl, Brenda.
In infrequent annual follow-ups, Brenda’s parents lied about the surgery’s success. Dr. Money then used this case study as proof of his controversial gender theory. The case revolutionized the way psychologists viewed gender, which apparently had no biological basis.
Growing up, Brenda acted masculine and was teased constantly at school. She could not socialize as a girl. Contrary to Dr. Money’s reports, she did not identify as female. At age 13, Brenda’s parents told her about her past. Brenda, relieved, then fully identified as a male, taking the name “David.” She underwent gender reassignment surgery and lived the rest of her life as a male.
Dr. Money failed to follow up with his patient because doing so would have shattered his influential theory. But David Reimer finally went public in 1997, telling his story with the aid of Dr. Milton Diamond, a noted rival of Dr. Money. David Reimer, who had suffered from depression throughout his life, committed suicide seven years later.
This landmark case study was frequently cited by the feminist movement, anthropologists, developmental psychologists and biologists, and psychiatrists to argue that nurture, not nature, explained all gender differences. Dr. Money’s theory became widely accepted. Intersex children, in accordance to this study’s findings, were regularly sexually reassigned.
The impact of this controversy is still being felt. The one case study that backed Dr. Money’s theory perfectly was unscientific, misleading, and unethical. Dr. Money’s legacy is posthumously harmed, and his theory is once again with valid proof.
Proceeding With Scientific Caution and Skepticism
As we’ve seen, case studies can be incredibly informative, despite dealing with a few atypical individuals. But the use of case studies in psychology must be done both carefully and ethically.
The John/Joan case was discussed last because it basically shows us everything the full range of a case study’s effects, both positive and negative. Case studies can provide opportunities for experimentation that cannot be artificially created. Two twin boys — one “normal” male and one to be raised as a female — gave Dr. Money a chance to put his theory to the test.
When a case study is correct, it can be used as definitive proof of one theory or disproof of another. But the above case study shows us that, when flawed, these studies can lead to misleading, incomplete, or downright false information. Not only are they not representative, the scientists studying them can be biased. Dr. Money fell in love with his own theory and refused to see any contrary evidence as reliable. A psychologist must be explicit about one’s biases when performing a case study, and avoid becoming too emotionally invested in a particular viewpoint.
Ethical Concerns
Lastly, the use of case studies sometimes raises serious ethical concerns. A patient like H.M. was agreeable, otherwise healthy, and enjoyed participating in studies. But what about the others?
– Genie was treated well initially. But when it became clear that there could be no “Miracle Worker” to help her learn to fully verbally communicate, the scientific community lost hope and interest. Funding dried up. Genie’s foster parents, no longer generating scientific data, passed her on to another foster home. Genie was clearly exploited by her caretakers for their own means, which is evident in the custody battles over her (before, but not after, there was scientific funding available to study her). A unique opportunity to study an atypical individual can bring out the worst in psychologists. In focusing on gathering data, they seem to like Zambardo in the infamous Stanford prison experiment, forget that they are dealing with real people, sometimes facing serious emotional trauma.
– Jill Price’s condition had been exaggerated by early studies that ignored the OCD symptoms of her condition. If we all spent as much time as she did obsessing over the details of our personal lives, couldn’t we all have such a remarkable memory? By promoting her as a “superwoman,” perhaps we have enabled her condition and glamorized it, instead of allowing her to properly focus on undergoing therapy. Perhaps though, future studies will shed light on hyperthymesia as a form of OCD, leading to improved quality of life for individuals suffering from this rare disorder.
Lastly, we come to the David Reimer case, which is a recent reminder to psychologists about ethical concerns. Dr. Money’s scientific follow-ups were inappropriate. But the initial decision to perform the surgery was perhaps most disturbing. In retrospect, we know that it didn’t work out. It obviously caused a human being to undergo unnecessary trauma, and likely contributed to David Reimer’s sever depression, which ended in his 2004 suicide.
Should Dr. Money have done the study? One of the things that psychology has undoubtedly proved is that hindsight is 20/20. Perhaps a more interesting question is this: What if it worked? What if Brenda Reimer lived life as a healthy woman? Would that have been moral justification for such an experiment? What is the appropriate way for a parent to treat an intersex child? Should they choose a gender, or let their child choose it themselves later on life?
These are all questions that fall into a moral gray area that nobody, even scientists, can confidently navigate. For the many ethical concerns raised by case studies, we unfortunately have more questions than answers.
Video Resources
Phineas Gage – Personality change as a result of a head injury:
Genie: Nova’s Secret of the Wild Child special:
Developmental molecular biologist and author John Medina, on what we learned from HM:
A revealing 20/20 interview with Jill Price:
An news program clip on the John/John controversy:
References
Carey, B. (2008, December 04). H. M., an Unforgettable Amnesiac, Dies at 82. Retrieved May 01, 2011, from http://www.nytimes.com/2008/12/05/us/05hm.html
David Reimer: David Reimer The boy who lived as a girl. (2004, May 10). Retrieved May 01, 2011, from http://www.cbc.ca/news/background/reimer/
Dr Money and the Boy with No Penis. (n.d.). Retrieved May 01, 2011, from http://www.bbc.co.uk/sn/tvradio/programmes/horizon/dr_money_prog_summary.shtml
Gray, K., & Escherich, K. (2008, May 9). Woman Who Can’t Forget Amazes Doctors. Retrieved May 01, 2011, from http://abcnews.go.com/Health/story?id=4813052
James, S. D. (2008, May 07). Wild Child Speechless After Tortured Life. Retrieved May 01, 2011, from http://abcnews.go.com/Health/story?id=4804490
Macmillan, M., Macmillan, I., Macmillan, M., & Lena, M. L. (2009, July 30). Phineas Gage Information [Scholarly project]. In The Phineas Gage Information Page. Retrieved May 01, 2011, from http://www.deakin.edu.au/hmnbs/psychology/gagepage/
Marcus, G. (2009, March 23). Total Recall: The Woman Who Can’t Forget. Retrieved May 02, 2011, from http://www.wired.com/medtech/health/magazine/17-04/ff_perfectmemory?currentPage=all
Myers, D. G. (2010). Psychology. New York, NY.: Worth.
The Boy who was Turned into a Girl. (n.d.). Retrieved May 01, 2011, from http://www.bbc.co.uk/science/horizon/2000/boyturnedgirl.shtml
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