A neurologist is examining a patient who suffered frontal lobe damage from a stroke.
The doctor sets a pair of glasses on the table between them during the examination.
The patient reaches out, picks up the glasses, and puts them on—over the pair of glasses he’s already wearing.
The doctor, curious, places another pair of glasses on the table.
The patient picks them up and puts them on. Now he’s wearing three pairs of glasses, stacked on top of each other.
The doctor continues. Four pairs. Five pairs. Six.
The patient keeps putting them on, one after another, until he’s wearing six pairs of glasses simultaneously.
The doctor asks: “Why are you doing this?”
The patient responds: “I don’t know. The glasses are there, so I put them on.”
This is utilization behavior—a neurological condition where patients compulsively use any object placed within reach, even when it makes no sense to do so.
And they can’t stop themselves, even when they recognize how absurd it is.
The First Descriptions
French neurologist François Lhermitte first systematically described utilization behavior in the 1980s.
He observed patients with frontal lobe damage who exhibited strange, compulsive object use:
A patient handed a comb immediately combs their hair—even if their hair is already combed, even if they combed it moments ago.
A patient presented with a toothbrush starts brushing their teeth—in the middle of a doctor’s office, without toothpaste, sometimes while still wearing their glasses.
A patient sees a glass of water and drinks it—even if they’re not thirsty, even if they just drank.
The behavior isn’t random or confused. The patients use objects correctly. They know what a comb is for, what a toothbrush does, how to wear glasses.
The problem is they can’t inhibit the impulse to use the object simply because it’s present.
The Testing Paradigm
Lhermitte developed a systematic way to test for utilization behavior:
He’d place objects on a table in front of patients: glasses, a toothbrush, a comb, a pen and paper, a hammer and nail.
Normal control subjects would sit and wait for instructions. “There are some objects on the table. What should I do with them?”
Patients with utilization behavior would immediately start using them:
- Put on the glasses
- Comb their hair
- Brush their teeth
- Write with the pen
- Try to hammer the nail (potentially dangerous)
They’d do this without being asked, without apparent awareness that it was inappropriate, and without being able to stop themselves even when told to.
The Severity Spectrum
Utilization behavior exists on a spectrum:
Mild: A tendency to reach for and manipulate objects more than normal. Can resist with conscious effort.
Moderate: Compulsively uses objects when they’re presented but can stop if explicitly told not to.
Severe: Cannot resist using any object within reach, even when aware it’s inappropriate, even when instructed not to.
The most severe cases are startling to witness:
A patient at a dinner table doesn’t just use their fork and knife. They use everyone else’s too—reaching across the table to grab utensils from other people’s place settings and using them, stacking them, manipulating them continuously.
A patient in a room with multiple staplers picks up each one and staples papers compulsively, going through entire boxes of staples for no purpose.
The Neurological Basis
Utilization behavior results from damage to the frontal lobes, particularly:
The prefrontal cortex: Responsible for executive function, impulse control, and inhibiting inappropriate responses.
The supplementary motor area: Involved in planning and controlling voluntary movement.
These regions normally suppress automatic responses to environmental stimuli. When you see a glass of water, you don’t automatically drink it—you consider whether you’re thirsty, whether it’s yours, whether it’s appropriate to drink it now.
Frontal lobe damage impairs this inhibitory control.
The brain regions that recognize objects and know how to use them remain intact. The regions that say “not now” or “that’s not yours” or “you don’t need to do that” are impaired.
The result: stimulus-driven behavior. Objects in the environment automatically trigger use, and there’s no executive control to inhibit the response.
It’s Not Compulsion in the OCD Sense
Utilization behavior is distinct from compulsions in OCD:
OCD compulsions are driven by anxiety and intrusive thoughts. The person feels they must perform the behavior to relieve anxiety or prevent something bad from happening. There’s an emotional component and often elaborate rituals.
Utilization behavior is driven by environmental stimuli. The person sees an object and automatically uses it. There’s no anxiety, no ritual, no sense of “must do this or else.” Just automatic response to stimuli.
OCD patients recognize their compulsions as irrational and usually resist them (even if unsuccessfully).
Utilization behavior patients often don’t recognize the behavior as inappropriate until it’s pointed out. They’re not resisting an urge—they’re simply responding to the environment automatically.
The Awareness Paradox
Many patients with utilization behavior have intact awareness in some ways:
If you ask them “Why did you put on six pairs of glasses?” they’ll say “I don’t know” or “They were there.”
If you ask “Does it make sense to wear six pairs of glasses?” they’ll say “No, that’s silly.”
If you ask “Can you stop doing it?” they’ll say “I’ll try”—and then immediately put on another pair of glasses when you place it in front of them.
They have intellectual awareness that the behavior is inappropriate. They have motivation to stop. They lack the executive control to actually inhibit the behavior.
This creates a strange disconnect: they can tell you what they’re doing is absurd while continuing to do it anyway.
Environmental Dependency Syndrome
Utilization behavior is part of a broader category called environmental dependency syndrome—where behavior becomes excessively controlled by environmental cues rather than internal goals and plans.
Related behaviors include:
Imitation behavior: Compulsively imitating the gestures or actions of people around them, even when inappropriate.
Verbal utilization behavior: Responding to any question or statement automatically, even when the response doesn’t make sense in context.
Magnetic gaze: Eyes compulsively tracking moving objects or people, unable to maintain focus.
All of these reflect the same underlying problem: loss of top-down control (internal goals and plans guiding behavior) and excessive bottom-up control (environmental stimuli directly triggering responses).
The Link to Everyday Life
While severe utilization behavior is rare, milder versions are common:
You see your phone and automatically pick it up, even though you just checked it.
You see food and automatically eat it, even though you’re not hungry.
You hear a notification sound and automatically look, interrupting whatever you were doing.
These are stimulus-driven behaviors. The difference between this and clinical utilization behavior is one of degree, not kind.
Most people can inhibit these automatic responses with some effort. Frontal lobe damage severely impairs or eliminates that ability.
Treatment and Management
There’s no cure for utilization behavior, but management strategies include:
Environmental modification: Remove unnecessary objects from the environment. If the patient can’t see it, they can’t compulsively use it.
Explicit instructions: Give clear, specific instructions about what to do and what not to do. Some patients can follow explicit instructions even when they can’t inhibit automatic responses.
Supervision: In severe cases, constant supervision to prevent inappropriate or dangerous object use.
Rehabilitation: Occupational therapy focused on rebuilding executive control and impulse inhibition.
The effectiveness varies. Patients with mild to moderate utilization behavior can often improve with training and environmental management.
Severe cases remain challenging—the fundamental neural infrastructure for impulse inhibition is damaged and may not recover.
The Philosophical Implications
Utilization behavior raises profound questions about free will and agency:
Are we our impulses or our inhibitions?
The patient with utilization behavior has the impulse to use objects—the same impulse anyone has when seeing a familiar object.
What they lack is the inhibition—the “executive no” that prevents acting on every impulse.
So which is the “real” person—the impulse to use the glasses, or the ability to decide not to?
How much of normal behavior is automatic?
We like to think our actions are consciously chosen. But utilization behavior reveals how much of behavior can be stimulus-driven and automatic.
The patient putting on six pairs of glasses isn’t choosing to do so in any meaningful sense. The glasses are triggering an automatic response.
How different is that from your automatic response to your phone buzzing? Or food being placed in front of you? Or a door handle triggering the automatic reach-and-pull response?
Maybe more of “normal” behavior than we’d like to admit is automatic response to environmental cues, just with better executive oversight.
What is the self without executive control?
Patients with utilization behavior often describe feeling like passengers in their own bodies—watching themselves do things without being able to control it.
They know what’s happening. They know it’s inappropriate. They just can’t stop it.
If the “executive you” that makes decisions and inhibits impulses is damaged, what’s left? Automatic responses to stimuli? Is that still “you”?
The Most Disturbing Cases
Some utilization behavior cases are darkly absurd:
A patient given a syringe immediately tries to inject himself—with an empty syringe, without medical need, simply because “it’s a syringe, that’s what you do with it.”
A patient presented with scissors starts cutting—papers, fabric, hair, whatever is available.
A patient given a lighter starts trying to light things on fire.
In these cases, utilization behavior becomes dangerous. The automatic response to “use the object” overrides safety considerations.
This has led to protocols in testing: don’t present patients with potentially dangerous objects unless prepared to immediately intervene.
The Recovery Trajectory
Some patients show improvement over time as the brain compensates for frontal lobe damage.
The utilization behavior may become less severe. Patients develop strategies to resist impulses. Alternative brain regions may partially take over executive functions.
But recovery is often incomplete. Many patients continue to show some degree of stimulus-driven behavior years after injury.
The brain’s executive control systems are complex and distributed. Damage to frontal regions can’t always be fully compensated for.
The Research Value
Utilization behavior has taught neuroscientists important lessons:
Object recognition and object use are separate from executive control.
You can know what an object is and how to use it without having the top-down control to decide whether to use it.
Inhibition is an active process.
Not doing something isn’t passive—it requires active neural processes to suppress automatic responses.
The frontal lobes are critical for context-appropriate behavior.
It’s not enough to know what to do. You need to know when to do it, when not to do it, and why.
Living With Utilization Behavior
For patients and families, utilization behavior creates practical and social challenges:
Safety concerns: Objects that could be dangerous must be removed from the environment.
Social awkwardness: The patient may use objects inappropriately in social situations (eating from others’ plates, using others’ utensils, putting on others’ clothing).
Caregiver burden: Constant vigilance is required to prevent inappropriate object use.
Loss of independence: The patient can’t be trusted alone in environments with unrestricted objects.
But with proper management, many patients maintain quality of life. The key is environmental control and clear structure.
The Spectrum of Control
Utilization behavior sits at one end of a spectrum:
At one extreme: complete stimulus-driven behavior. Every object triggers automatic use, no inhibition possible.
At the other extreme: complete top-down control. Behavior driven entirely by internal goals and plans, unaffected by environmental cues.
Most people exist somewhere in the middle—influenced by both environmental stimuli and internal control, with reasonably good ability to inhibit automatic responses when necessary.
Utilization behavior patients shift toward the stimulus-driven end. Their environment controls them more than they control their environment.
And that reveals something important: the balance between stimulus and control, between automatic response and deliberate choice, is maintained by specific brain regions.
Damage those regions, and the balance collapses.
The Final Question
When you see a patient put on six pairs of glasses, one after another, unable to stop despite recognizing how absurd it is—you’re witnessing something profound:
The separation of knowing from doing. Of awareness from control. Of intention from action.
They know they shouldn’t.
They want to stop.
They can’t.
And that reveals the uncomfortable truth:
Knowing what you should do isn’t the same as being able to do it.
Wanting to control yourself isn’t the same as having control.
The patient with utilization behavior has lost the neural infrastructure that translates “I shouldn’t do this” into actually not doing it.
And that infrastructure—the frontal lobe executive control systems—is what makes deliberate, chosen action possible.
Lose it, and you become a responder to stimuli rather than an agent of choice.
You become your environment’s puppet, compulsively acting out the affordances of every object you encounter.
Six pairs of glasses. One broken ability to say no.
And a profound lesson about what it means to have—or lose—control over your own actions.
Medical Sources:
- Lhermitte, F. (1983). “‘Utilization behaviour’ and its relation to lesions of the frontal lobes.” Brain, 106(2), 237-255.
- Lhermitte, F., Pillon, B., & Serdaru, M. (1986). “Human autonomy and the frontal lobes. Part I: Imitation and utilization behavior.” Annals of Neurology, 19(4), 326-334.
- Boccardi, E., et al. (2002). “Utilization behaviour consequent to bilateral SMA softening.” Cortex, 38(3), 289-308.
- Eslinger, P. J., & Damasio, A. R. (1985). “Severe disturbance of higher cognition after bilateral frontal lobe ablation.” Neurology, 35(12), 1731-1741.
This concludes the Tales from the Mind series. Each case reveals something profound about the fragile architecture of human consciousness, identity, and agency.