In September 1848, the life of a young railway foreman was turned upside down by a terrible accident at work .

At that time, his work consisted of blowing up rocks with explosives to allow the train tracks to pass, and he needed to place gunpowder and sand in a hole drilled in the stone.

Phineas Gage: a case study

Unfortunately, a mistake in the procedure meant that, when this worker tried to compact the gunpowder placed in the cavity using a metal bar, a spark jumped out. The mixture exploded a few centimetres from the young man’s face and, as a result, the metal bar, one metre long and about three centimetres in diameter, passed through his skull before landing more than twenty metres from where it was initially located.

Phineas Gage , as this was the name of the worker, regained consciousness a few minutes later with a hole tracing a diagonal from one of his cheeks to the top of his head, just above his forehead. Much of his frontal lobes of the brain had ceased to exist as such. However, Phineas Gage not only survived this experience, but was able to regain most of his mental abilities and went down in history as one of the most studied cases in the fields of psychology, medicine and neuroscience.

Dr. Harlow and the Medical Miracle

Almost everything we know about Phineas Gage is what was documented about him by Dr. Harlow , the doctor who treated him. This doctor was strongly impressed by the fact that Gage was conscious and able to speak when he entered his office, but he was even more surprised that his patient recovered within a few months of his arrival, after a period of fevers and delusions.

Thus, after only 10 weeks Gage’s brain functions seemed to have recovered almost automatically , as if the brain’s cellular tissues had been able to reorganize themselves to compensate for the absence of several cubic centimeters of frontal lobe. However, Dr. Harlow was struck by something else: although objectively the foreman did not appear to have significant intellectual or movement deficits, his personality seemed to have changed as a result of the accident. Phineas Gage was no longer exactly the same.

The new Phineas Gage

When Gage returned to work on the site, the measured and cordial worker that everyone knew had disappeared to make way for a person with a bad temper, easy to irritate , given to insults, with a propensity to waste and with a very short-sighted view of life. He was, in general, an impatient and irreverent person, who allowed himself to be carried away by desires that were the fruit of a whim and who thought little of others.

He soon stopped working for the site and, a few months later, Phineas Gage went to work at the Barnum Museum, displaying himself next to the metal bar that had pierced his head. In the years that followed he lived in Chile, where he worked as a horse-drawn carriage driver, until he returned to the United States feeling deteriorated and somewhat ill. There he had his first epileptic attacks, which would accompany him until his death in 1860 .

Why is the Phineas Gage case relevant?

This small historical episode is an obligatory stop in many university careers related to neurosciences and behavior because, in fact, it was one of the first well-documented examples in which it was seen how material changes in the brain modified not only cognitive capacities, but also aspects of psychology that have traditionally been associated with the “soul”, that is, with the way of being and the essence of human beings .

There is a theory that Phineas Gage became someone else not through a learning process or self-reflection, but through a very specific accident that physically modified his brain. What was proven later may have been an example of how the brain reorganizes itself to make up for the material deficiencies produced by the explosion from the most limited resources available to it, but the side effects of this were noted in aspects that were believed not to be so subject to the material world as, for example, memory.

In some way, the accident of the metal bar served to point out the biological bases on which rather abstract psychological processes are sustained , such as the management of emotions and decision making.Furthermore, the case of Phineas Gage also served to reinforce the hypothesis that different areas of the brain are involved in different aspects of behaviour.

Possible Prefrontal Syndrome?

Today it is believed that Phineas Gage’s personality change may actually be an example of Prefrontal Syndrome, caused by altered functioning of the frontal lobes . The frontal area of the brain has an important role in linking present motivations to future objectives, which includes the possibility of locating long-term goals, the capacity to renounce immediate rewards in favour of more ambitious projects, and the ability to take into account the consequences that one’s actions have on the people around us and, in general, on society.

This would explain that the new style of behavior of the Phineas Cage who had suffered the accident with the metal bar resembles in some aspects the repertoire of behaviors to be expected in someone with psychopathic personality. Psychopaths also seem to show different neuronal activation dynamics in the frontal lobes than the rest of the population, but in Gage’s case this would be produced by the reorganization of the neurons after having injured the brain.

Another likely explanation for Phineas Gage’s case

The idea that brain injury was the fundamental cause of Phineas Gage’s personality change is widespread, but there is also another alternative explanation: that the changes were due to the social impact of being disfigured.

As Zbigniew Kotowicz points out, it is very likely that at least part of his behavior changes were due to the social impact of being seen by others as someone who is missing a part of his brain. As always, it is difficult to separate the biological aspects from those of a social and cultural nature , and it may be that in the end the same thing happened to Gage as happened to Dr. Frankenstein’s monster in Mary Shelley’s novel: that it was society, rather than his own nature, that transformed him into a foreign body.