Anyone lucky enough to have been in the room for the recording of InKredulous at QED will have witnessed the moment Andy Wilson learned that the story of Phineas Gage is pretty well known. If you weren’t there, have a listen to the recently released episode, it’s just one of many excellent moments in Andy’s skeptical panel show.
One thing that occurred to me while watching the live recording was that while many people have heard of Phineas Gage, very few people seem to know the full story. This is probably the most famous case study in clinical neuroscience, it’s a story familiar to psychology students the world over yet it is often repeated full of inaccuracies, speculation, and embellishment. So what is the true story of Phineas Gage?
As a quick refresher, here is the first and most famous part of the story.
In 1848 Phineas Gage, aged around 25 years old, was a railway worker for the Rutland and Burlington railroad, working near the town of Cavendish Vermont. His job included, among other duties, blasting rock to clear the way for new train lines. The process of blasting rocks involved creating holes in rocks or in the ground which would then be filled with blasting powder followed by an inert mixture. The contents of the hole would be tamped down to ensure that when the blasting powder ignited, the full force of the blast would go into the rock.
On 13th September 1848, while Phineas was tamping down the powdery contents of one hole with a tamping rod, the blasting powder ignited. The resulting blast was so powerful, it propelled the 6kg, one-metre-long iron rod through Phineas’ skull and into the air, before landing, according to some reports, 25 meters (80 feet) away.
Despite the power of the blast, Gage lost consciousness only temporarily, if at all (again, not all reports agree on this point). Despite his extreme and gruesome injury, Phineas was able to walk, with some assistance, to an ox-cart, which he rode into the center of Cavendish, where he met and greeted Dr Harlow. The notes Dr Harlow made detailing the first time he met Phineas are available to read online and I thoroughly recommend reading them, if you have a strong stomach.
Suffice to say, Phineas suffered extensive trauma to his brain and had lost a sizable chunk of his left frontal lobe, and, as the story goes, his personality completely changed. This is where most people’s knowledge of what might be the most famous case study in neuro-psychology ends. Those who do learn of what happened to Gage after the accident often learn myths; textbooks are full of inaccurate and embellished accounts of Phineas’ life after the accident that made his name synonymous with brain injury. But this is, in my opinion, where the story gets really interesting.
When I first heard the story, like many others I was told that Gage’s life after the accident was one of vagrancy, alcoholism and “base behavior” (to my 16-year-old mind, I was pretty sure this was code for bum sex. Copious bum sex. Bum sex with men no less!). He gambled, got into fist fights, swore, spat in the street, and stopped taking care of his health, hygiene, and appearance. This once intelligent, respectable and popular man became unrecognisable; a slovenly, impulsive, reckless hooligan who a Freudian might describe as being driven by pure Id. One account describes him as “a child in his intellectual capacity and manifestations, he has the animal passions of a strong man”.
Some versions of the story claim that Phineas Gage, forever changed and rendered unable to hold down a job of any sort, resorted to traveling the USA with his iron rod, charging people to come see the man who survived having 6kg of iron rip through his skull. Some accounts have Phineas becoming one of P. T. Barnum’s human attractions. Yet others report that Phineas returned to his family, unable to care for himself, he wasted away physically and mentally.
Whatever the details of this oft-told tale, the intended message is clear: the remarkable and tragic case of Phineas Gage illustrates the importance of the frontal lobe. This evolutionarily-recent portion of brain is clearly the seat of consciousness! Of executive functioning! It’s that lump of neurons sitting just above your eyebrows that separates us from our poop-flinging chimpanzee cousins! Or at least, that’s what we want to believe.
A little time ago, I decided to brush up on my knowledge of Phineas, and found evidence that while he did undergo some personality changes after having a portion of his frontal lobe forcefully evicted from his skull at a fair rate of knots, those changes were nowhere near as extensive as they are often said to have been. Not only that, while there are kernels of truth in the story recounted above, there is strong evidence that Phineas made a remarkable recovery.
According to firsthand accounts from Dr Harlow, the physician who first treated Phineas, the immediate aftermath of the accident was “stormy”. Upon first meeting Dr Harlow, Phineas was coherent and genial, but over the course of the following four weeks, Phineas’ health began to decline, with Phineas seemingly being close to death on several occasions. However, this decline appears to be due to the wound he sustained in the accident becoming infected, and not the direct result of losing brain matter.
In those first months after the accident, Phineas was indeed a changed man. When he was recovered enough to speak to his old colleagues, they remarked that he was “no longer Gage”, but instead was humourless, short tempered, and rude. While one may be tempted to suggest that these changes were the direct result of Phineas being deprived of a sizable chunk of his prefrontal cortex, I can’t help but wonder exactly how charming even the most affable among us would be less than a year after suffering a violent and spontaneous high-speed lobotomy leading to infections and seizures.
When looking at contemporaneous accounts of Phineas in the months after his accident, it is all but impossible to tease apart which changes were due directly to the loss of brain tissue and damage done in the process of trying to fish bits of broken skull out of Phineas’ brain, how much was due to damage caused by infection, how much may have been due to steps taken to treat the infection, and how much was due to psychological trauma undoubtedly caused by the whole ordeal.
These issues in drawing simple lines of cause and effect aside, there is evidence that whatever changes did occur to Phineas’ personality, they were neither as extreme nor as permanent as many believe.
Records detailing the next phase of Phineas’ life are patchy, but it does appear that Phineas was indeed no longer able to continue working as a railway foreman and it does appear that he traveled around the US with his tamping rod. However, he was not traveling around as a one man “freak show” to be gawped at, but instead delivered lectures about his injuries, and he may well have even organised his own travels and venues for his lectures. There is also some evidence that Phineas did indeed make contact with P T Barnum, but one thing we can be sure of is that Phineas did not spend the rest of his life as a traveling curiosity.
In 1852, Phineas moved to Chile where he worked as a stagecoach driver on the Santiago-Valparaiso run, a 13-hour journey covering 110 miles. This was a job which undoubtedly required high levels of cognitive and motor skill. The roads were rough, winding and treacherous, driving horses through such conditions would have been no easy task. Furthermore, a stagecoach takes passengers, which means that Phineas would have needed to handle luggage, take passenger fares, give change, and keep his coach running to schedule. All this on top of being responsible for caring for and feeding the horses. This doesn’t sound like a job for an individual who has lost all independence and is no longer capable of resisting impulses or engaging in social niceties.
In 1859, Phineas moved closer to his family who were then living in San Francisco and worked on a farm for a while. In early 1860, it appears that Phineas suffered a series of seizures which increased in severity and lead to his death in May 1860, almost 12 years after the accident that likely shortened his life and made his name live on in textbooks, classrooms and blog posts across the internet.
As fascinating as the well-known part of Phineas Gage’s story is, I think the second half of Phineas’ story is more remarkable, and just as worth telling as the first. While the tale of his injury has a pleasingly simplistic narrative, with a clear story of cause and effect, by ignoring or editorialising the story of Phineas’ life after his accident, we miss out an incredible illustration of how plastic the human brain is. What’s more, we play into the myth that brains can be easily carved up into functional zones, and we forget what a remarkably resilient person Phineas Gage must have been.
