Phineas Gage: Mind’s the Gap

Written by Sam Marks


On 13 September 1848, Phineas Gage, a railroad foreman, was working on the construction of the Rutland & Burlington railroad in Vermont, United States. Part of his job was to blow up rock outcroppings that blocked rail paths. This was done using a large iron tamping rod which packed blasting powder, gravel, sand, and other materials into the centre of the rock. At one point, around 4.30pm when Gage was tamping explosives, his attention was drawn to workers behind him. Looking over his right shoulder, Gage inadvertently brought his head right in line with the tamping rod. Exactly as Gage began to speak to the workers, the rod sparked against the rock and ignited the powder. The explosion rocketed the rod out of hole, shooting it right up through the left side of Gage’s face and straight out of the back of his skull, knocking the foreman to the ground and leaving him for dead.  

Miraculously, Gage survived the incident, and even managed to get up and walk to find assistance from the rest of his crew. Gage was transported back into town by cart and taken to see the town doctor, Edward H Williams. Unsurprisingly, Williams did not initially believe Gage’s story and thought it impossible for anyone to survive such a significant degree of trauma to the head. However, while being examined, Gage vomited up blood, causing a “half teacupful”, size of his brain to exit the top of his head and fall on the floor, according to Williams. Williams would go on to describe the encounter with Gage as “one of the great understatements in medical history”. 

Sometimes referred to as “The American Crowbar Case”, Gage’s near-impossible survival became subject to immense questions in the field of psychology. Even to this day, the case of Gage is regarded as one of the leading developments of neurology, the diagnosis of conditions involving the brain. The tamping rod damaged his pre-frontal cortex: the part of the brain associated with personality, planning, and decision-making. Post-recovery, Gage exhibited personality and behavioural changes leading to greater research in how the brain and damage to it impacts personality. But while the case study of Phineas Gage was a key moment in the evolution of neurology as a force in psychology, most accounts of Gage have overstated the medical changes that actually occurred. More recent scholarship has shown that published accounts of Gage, both scientific and otherwise, severely exaggerate the effects that Gage exhibited after his recovery. Regardless, the story still serves as a fixture in the world of psychology and cognitive sciences that is still used as a prime example of how the brain impacts personality.    

Following Dr Williams’ attendance, Dr John Martyn Harlow, who knew Gage before the accident, took over the supervision of the case. Gage’s recovery was varied and inconsistent. One day Gage could be experiencing extreme delusions, while the next day he could be able to identify his family and friends. He experienced comatose episodes, the inability to speak coherently, and exhaustion. After the laborious work of Dr Harlow to stabilise Gage, he was seeming near full recovery come mid-November.  

Around ten weeks after his injury, Gage was healed enough to return home to Lebanon, New Hampshire. But his accident changed the course of psychology as it was known. Gage had suffered severe trauma to the head and yet somehow managed to survive and make a full recovery (albeit missing an eye and a molar that the rod had taken out). But Dr Harlow had noted that friends thought his mind was so radically changed that he was “no longer Gage”.  

Early observations of Gage post-accident portrayed him as different, more confrontational, and abrasive compared to his former self. Yet later observations of Gage allege that he had largely returned to his pre-accident mental state. The change in perceptions of Gage by observers poses a series of questions: why did Gage’s post-accident behavior change over time? What factors might have caused his change in behavior? And how did doctors at the time analyse his changes in behaviour?  

Dr. Harlow’s 1848 report on Gage was immediately met with skepticism from the medical community. Harlow even recounted how a southern professor had patronisingly dismissed Gage as a “Yankee invention”. In the same way as Dr Williams had initially been skeptical of Gage’s accident upon its description to him, the medical community took a similar stance on the improbability of the case. This skepticism did not last long due to Harvard Professor Henry Jacob Bigelow’s 1850 report on Gage that gave the medical marvel authenticity among the established medical community. However, these two reports differed significantly in their interpretations of the “Crowbar Case”.  

Harlow was a proponent of phrenology: using the shape of skulls to predict mental traits. Additionally, he relied on the theory of cerebral localisation: that different parts of the brain control different aspects of the body and personality. Bigelow took the opposite approach, arguing that Gage’s recovery proved that damage to cerebral hemispheres would not alter intellect. Although Bigelow relied upon, and even quoted, Harlow for his publication, the opposing perspectives complicated understandings of the Gage case. Neither were entirely accurate, and both were victims of their author’s scientific biases. 

When looking at Gage’s case holistically, the occurrence of Gage’s behaviour differs between the writings. Bigelow minimised the behavioural changes that effected Gage due to his anti-phrenology views. His position in the American medical community enabled him to rely on Harlow’s accounts but use them to benefit his views. Gage had been a hardworking and capable man before and after his accident, which Bigelow attributed to his personality being unaffected by the blast. But Bigelow’s work relies heavily on the accounts of Harlow despite his different perception of the incident.  

Arguably the most concrete source on Gage, Harlow was significantly focused on Gage after his recovery and until his death. In 1869, nine years after Gage’s death, Harlow published a second account of Gage’s health. Before his accident, Gage was known by the railroad company to be “the most efficient and capable foreman in their employ”. In his final days, Harlow noted that Gage “was prone to quit in a capricious fit or be let go because of poor discipline” and was unable to live independently. Despite Harlow’s exaggerations, he serves as the strongest bet in getting a full picture of Gage. His second publication, however, did not aid his credibility.  

The publication was misinterpreted by future commentors that Gage was permanently changed following his accident and lived the rest of his life with abnormal behaviour. Future commentators, some of whom never met or observed Gage, greatly misrepresented his character. Some sources claimed his post-accident self was prone to bullying, lying, and vagrancy. A more extreme case even goes to describe Gage as a psychopath with an inability to understand ethics. Another recalls an instance where Gage beat his wife and children, even though Gage had done neither. The medical research surrounding Gage shifted more into folklore, with the curious case becoming less rooted in reality throughout time. But what really happened to Gage? 

Gage returned home after his accident. He was unable to regain his job as a railroad foreman due to the company believing his condition would impair him. For a time, Gage worked as a living exhibit at Barnum’s American Museum (P.T. Barnum’s business prior to his circus) which collected oddities and abnormalities to put on display. After failing to promote himself as an attraction, Gage worked for a stable owner and coach service in Hanover, New Hampshire. But the last section of his life would see him move outside of his native New England. 

In August 1852, Gage moved to Chile to work as a stagecoach driver. He remained there until his ill health saw him travel to San Francisco in 1859 to be cared for by his family. Eager to work, Gage took up a job as a farmer, and died on 18 May 1860 after a series of epileptic seizures. He was just thirty-five years old.  

It has been suggested by Malcolm MacMillan that Gage was helped by social recovery. His work as a stagecoach driver provided him with routine in “a highly structured environment in which clear sequences of tasks were required”. Gage effectively prospered through the duration of his life by returning to the hard work of his pre-accident self. John Fleischman described it as “[figuring] out how to live” and this practice is done in situations where neural tracts are damaged to this day.   

Through all the misrepresentations and exaggerations of Gage’s situation, Harlow’s analysis is arguably the most succinct account of the medical mystery. In the year prior to his death, Gage certainly saw a great change in personality due to his injuries. But even now scholars continue to debate to what extent Gage was affected by his condition or by his situation.  The young man whose skull was punctured was thrown at odds from the hardworking lifestyle he had once lived. He was unable to make money to the point where he even failed at being a tourist attraction. And still, he was able to live for another twelve years, travel to Chile, and hold a demanding job as a stagecoach driver until sickness got the better of him. Only when away from his friends and family did Gage see his greatest stretch of success, lasting approximately eight years. Due to the series of frustrating and life-changing situations, it is not hard to imagine why he might have been viewed as “no longer Gage”. But whether his injury or his situation was the primary cause of this label remains hotly debated. 


Bibliography

Bigelow, Henry J. “Dr. Harlow’s Case of Recovery from the Passage of an Iron Bar through the Head.” In The American Journal of the Medical Sciences: The Official Journal of the Southern Society for Clinical Investigation : An International Journal of Biomedical Research. Lippincott Williams & Wilkins, 1850. 

Changeux, Jean-Pierre. Neuronal Man: The Biology of Mind: 21. Translated by Laurence Garey. With a New preface by Vernon B. Mountcastle edition. Princeton, N.J: Princeton University Press, 1997. 

Fleischman, John. Phineas Gage : A Gruesome but True Story about Brain Science. Boston : Houghton Mifflin, 2002. http://archive.org/details/phineasgagegrues00john. 

Fodor, Jerry A. “The Modularity of Mind: An Essay on Faculty Psychology.” In Reasoning: Studies of Human Inference and Its Foundations, edited by Jonathan E. Adler and Lance J. Rips, 878–914. Cambridge: Cambridge University Press, 2008. https://doi.org/10.1017/CBO9780511814273.046. 

Harlow, John M. Recovery from the Passage of an Iron Bar Through the Head. Publications of the Massachusetts Medical Society 2:327–347, 1868. 

Harvard Medical Alumni Association. Harvard Medical Alumni Bulletin. Boston, Mass. : Harvard Medical School Alumni Association, 1958. http://archive.org/details/harvardmedicalal33harv. 

Macmillan, Malcolm. An Odd Kind of Fame: Stories of Phineas Gage. MIT Press, 2002. 

Moffatt, Gregory K. A Violent Heart: Understanding Aggressive Individuals. Greenwood Publishing Group, 2002. 

The Boston Medical and Surgical Journal. Cupples, Upham & Company, 1849. 


Featured image credit: Operative surgery illustrated (1852). Public domain. Accessed via Wikimedia Commons: https://commons.wikimedia.org/wiki/File:Operative_surgery_illustrated_-containing_more_than_nineteen_hundred_engravingsincluding_two_hundred_original,_and_fifty_colored_drawings-_with_explanatory_text(1852)_(14765427832).jpg.

%d bloggers like this: