Thread by @dbfisch

Was #TheDarkKnight's Two-Face the product of brain injury? Harvey Dent was hospitalized after surviving the explosion and disfiguring burns that transformed him into the psychopathic villain, Two-Face. The background offers insight into the villain's psychological origins. (1/6)

A monitor shows a computed tomography (CT) scan of Dent's head, which reveals contusions (blood) in both frontal lobes of the brain. Such contusions are common after traumatic brain injury, resulting from the brain striking the front of the skull during sudden deceleration. (2/6)

The frontal lobes support higher-order cognition, such as planning, emotional regulation, and impulse control. The ventromedial prefrontal cortex (vmPFC), the frontal region most vulnerable to contusions, is important for moral judgement and emotional decision-making. (3/6)

Unsurprisingly, damage to the frontal lobes, and to the vmPFC in particular, has been linked to impaired moral judgment, aggressive behavior, and rarely even psychopathy. Phineas Gage, a classic case, was said to "fly in a rage" after trauma to the frontal lobe. (4/6)

Moreover, associated with its role in emotional decision-making, the vmPFC has been linked to gambling; injury of the vmPFC makes it difficult to perceive the aversive emotions associated with losing a gamble (such as a coin flip) leading to persistent, risky behavior. (5/6)

Given their size, Dent's contusions would likely have behavioral consequences. So while the explosion led to Two-Face's iconic appearance, its impact on his brain may have been the true origin of his character -- a victim of traumatic brain injury at the hands of the Joker. (6/6)

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