The Importance of the Hole in Phineas Gage’s Head

Phineas Gage

On September 18, 1848, near Cavendish, Vermont, Phineas Gage, a construction foreman working for the Rutland and Burlington Railroad, was badly injured in a freak accident. As his crew attempted to form a railroad cut through some hard rock, Gage packed gunpowder in a blasting hole with an iron rod (known in the trade as a “tamping iron”). Somehow, a spark set off an explosion that drove the tamping iron (3 feet, 7 inches long and 1 ¼ inches in diameter) into Gage’s open mouth, through the left frontal lobe of his brain, and out the roof of his skull. The metal rod landed 80 feet away, smeared with Gage’s blood and brains. Although he suffered much and almost died, the hardy Gage made a miraculous recovery and, to quote this fascinating article in Slate, passed into history as “neuroscience’s most famous patient.”

This article, which focuses on the history of science, reveals much about the weaknesses of both historians and scientists. The image of the real, post-accident Gage was distorted by two, interacting forces. First, in an attempt to peddle his own pet theories about the way the brain worked, the doctor who treated Gage proved rather cavalier with the facts when it came time to assess the impact of the accident on Gage’s mental state. Second, in later years, historians and psychologists carelessly accepted the testimony of this doctor and proved too lazy to look at all of the available evidence. They merely passed on received wisdom about Gage without interrogating it because it fit their preconceptions. Supposedly, the accident turned Gage from a hard-working, conscientious foreman into a dangerous, drunken wanderer. From this perspective, Gage “was no longer Gage.” Gage literally became a textbook example of what happens when somebody’s frontal lobe is traumatized. Neuroscientists and psychologists have come to believe that the frontal lobes are associated with impulse control and planning (among other things), so they were all too willing to accept that damage to this part of the brain could lead to a fundamental and irreversible transformation of one’s personality. Eventually, the lesson they perpetuated was that “the frontal lobes house our highest faculties; they’re the essence of our humanity, the physical incarnation of our highest cognitive powers.” When this part of our brain is damaged, so the argument goes, a part of our humanity disappears.

As one scholar, Malcolm Macmillan, points out in the article, “once you have a myth of any kind . . . it’s damn near impossible to get it destroyed.” This dictum is especially true for textbooks because “textbook writers are a lazy lot.” Perhaps a more charitable explanation is that textbook writers cannot be experts in all they survey, but Macmillan’s main point still stands. Macmillan’s recent research seems to indicate that Gage “resumed something like a normal life,” carried out “highly skilled” tasks, and “recovered some of his lost mental functions.” Recently discovered photographs of Gage (one found in 2009, the other in 2010–the latter is shown above) taken in 1849 reveal a disfigured but handsome, confident, and well-dressed man. In other words, Gage was not fundamentally transformed for the worse by his unfortunate accident.

The most significant point about this story is not that Phineas Gage was slandered (although it is surely worth contemplating how hard it can be on an individual to serve as a symbol or case study for others). Even more important, scholars’ inattention and lack of curiosity have imprisoned them in paradigms about the brain that might not be altogether true. Their preconceptions shaped the evidence, and the evidence reinforced their preconceptions. These understandings of the brain might very well have prevented suffering people from obtaining the help they need. If Gage could bounce back without rehabilitation or therapy, his story provides a “powerful message of hope” for others who have suffered damage to their frontal lobes (e.g., stroke victims, those plagued by Alzheimer’s, and veterans who have undergone brain trauma). As Macmillan has pointed out elsewhere, if Gage could achieve such improvement without medical supervision, “what are the limits for those in formal rehabilitation programs?”

The strange case of Phineas Gage (who, incidentally, was born in Lebanon, New Hampshire) teaches us something important about history. Historians and scientists, like all other people, are inclined to see what they want to see. Seeing what they are inclined to see often means accepting the conventional wisdom in their fields. This kind of mental laziness, however, is in constant tension with the dynamic nature of both fields, which demand and often witness perpetual re-investigation of familiar arguments and data. Our natural inertia, then, conflicts with our curiosity and our ambition to say something new and interesting. It took over 160 years for a historian to recreate and rescue Phineas Gage. In some cases, the wheels of history grind onward slowly, but the nature of the discipline is such that they always grind onward.