Do you expect me to talk?
No, Mr Bond, I expect you to suffer from slurred speech and other debilitating short term effects of a traumatic brain injury.
MI6’s finest, James Bond, often takes a good beating in the service of his country at the hands of them henchman of his adversaries. He’ll collapse, barely conscious, with blood dripping from the corner of his mouth. We cheer his remarkable recovery before he speeds away in his gadget strewn supercar to save the day and bed the leading lady before the credits roll. But how close is this to reality?
Physical assault often results in damage to the brain even if the head appears to be relatively intact. A blow to the head can cause the brain to move rapidly within the skull, shaken and stirred if you will, and can then stop abruptly. The damage can be to specific structures, or scattered with small bruises scattered about the surface.
If the victim is unlucky enough to suffer a fractured skull there is a 25% chance of a blood clot forming around the outer surface of the brain. Such clots are associated with pressure, which presses down on the brain, so emergency brain surgery may be required.
Even if Bond manages to avoid such damage, it is unlikely that he won’t experience some of the myriad other symptoms associated with the short term effects of a traumatic brain injury.
He may vomit, suffer from dizziness and blurred vision, weakness and slurred speech; not the most ideal physical state to be in when trying to exact one’s revenge. Racing after the villains in a high performance car would be significantly more difficult if he was suffering an epileptic seizure as often happens with brain injuries of this type - a medical problem which is incompatible with driving.
Hollywood heroes have seen something of a renaissance with the success of the Marvel and DC franchises; and where there are aliens, supersuits and deities there is sufficient licence to overlook the effects of an assault that a lesser being would experience.
But for mere mortals like Bond, the longer term problems associated with traumatic brain injuries pose further problems. Many individuals who have suffered even mild closed head injuries show marked lethargy and fatigue for several months – hardly in keeping with moving on to the next top secret mission.
Several aspects of the brain’s functions are organised spatially, and so the type of deficit that results from brain damage depends on the precise location of the insult. Damage to the brain areas that control voluntary movement are not uncommon following fights, and this may result in the weakness of a limb – a limitation which will really test the hand-to-hand combat skills.
Our hero’s sensory systems might survive intact, except perhaps his sense of smell. Olfactory information is transmitted from the nose to the brain via very delicate processes that run through tiny holes in the base of the skull. These nerves often shear during head injuries. So James may not be able to fully appreciate the Don Perignon and caviar at his next high roller Poker game.
But maybe the greatest ignominy that our action hero will have to face will be in the bedroom. There’s a strong possibility that the head injury will leave him impotent for several months. And perhaps incontinent for some time. So perhaps the leading lady will have to extend her thanks in a less intimate manner.
And on top of all of that, we have to worry about the consequences to two specific particularly vulnerable brain structures.
One of these areas, the prefrontal cortex, lies at the very front of the brain and can be damaged by crashing into the inside of the victim’s own cranium. This brain structure plays critical roles in enabling us to plan and organise our social behaviour, and to inhibit automatic responses which may be socially undesirable. So perhaps there will be fewer quipped one-liners.
The second highly vulnerable structure, the amygdala, can also be damaged by striking the inside of the skull. The amygdala plays a prominent role in how we experience emotions and how we control our aggressive tendencies. Consequently victims of assaults may well show permanent changes in their temperament which leaves them hyperemotional, socially inappropriate and prone to aggressive outbursts.
The susceptibility of these two brain areas to damage during assaults and the resultant increased tendency to behave impulsively and aggressively has the potential to set up a vicious circle. The damage increases the probability of getting into a fight, and this increases the chances of further damaging these brain structures and so on. Maybe this accounts for some of the sequels and action movie franchises.
To add insult to serious injury, it may well be the case that Bond wouldn’t be able to keep his job in the real world; many victims of traumatic brain injury are incapable of holding down a high powered job.
Of course, we know that fiction bends the truth for the purposes of entertainment, and with Spectre hitting the cinema screen, the realities of traumatic brain injury will be far from the forefront of our minds.
But perhaps we’ve becoming desensitised to the severe consequences of assault due to such scenes, and maybe it would serve us well to remember that taking a ‘good kicking’ leaves more of a mark than some smouldering scar tissue.
Dr Ian Mitchell, School of Psychology
Dr Ian Mitchell is the author of Broken Brains, an engaging introduction to brain function and dysfunction aimed at those interested in learning more about the brain in an accessible way.