Neuroscience’s psychopathic view of Phineas Gage

The short video attached toQuest for the connectome: scientists investigate ways of mapping the brain(The Guardian, 7 May, 2012) opens with some paparazzi awaiting what we assume to be the arrival of a celebrity in a limousine. It draws to a halt, cameras flash and the door opens. To the accompaniment of dramatic music, out steps a young lady carrying a glass jar containing—a brain.

See it here.

This section lasts for only 30 seconds, but it’s revealing. The brain is a star, a celebrity. We want to know every detail of its inner workings, how we can get ours to work like it should. Neuroscientists bask in this reflected glory. They’re stars too.

The next week, The Guardian revealed that neuroscientists are now going to map perhaps the most famous brain in modern science, that of Phineas Gage. (Phineas Gage’s Connectome, The Guardian, 16 May, 2012).

None of us can control how we will be remembered, or if we will be remembered at all. But not even in his wildest dreams could Phineas Gage have imagined that he would become the poster boy of neuroscience over 150 years after his death. How did this happen?

Phineas was justly famous in his life time for having survived the passage of an iron rod, 13 Ib, 3 feet 7 inches, one inch in diameter, blasted through his brain. He was a foreman working on the construction of the Rutland and Burlington Railroad, in Virginia. A blasting charge went wrong and this tamping iron became a missile, driven with such force that having passed through his skull it landed more than 100 yards away.

It was 1848, a year of revolts across Europe, ultimately unsuccessful; the year Marx and Engels wrote The Communist Manifesto. In other words, it was a very long time ago.

Phineas lay in relative peace until the Decade of the Brain, when Hanna Damasio, Thomas Grabowski, Randall Frank, Albert M. Galaburda, and Antonio R. Damasio, published ‘The Return of Phineas Gage: Clues About the Brain from the Skull of a Famous Patient’, in Science, 1994.

In the intervening years, that Gage underwent some sort of personality change, from an agreeable workman to a belligerent fellow, passed into received wisdom without the inconvenience of anyone scrutinizing the facts. It is this ‘personality change’ on which so much rests in neuroscience.

Damasio et. al. want to understand ‘The brain lesion that caused the profound personality changes for which his case became famous’ (Abstract: my emphasis). This is a large assumption; is there any evidence to support it?

It wasn’t a question that engaged these researchers. Instead, they assumed that the tamping iron must have damaged those parts of the brain responsible for ‘the planning and execution of personally and socially suitable behaviour’., i.e., for moral reasoning. Given this, the question becomes, How might that part of Gage’s brain be identified? Like this:

  1. Get hold of the dead man’s skull and tamping iron. Both were in his grave and retrieved by exhumation.
  2. Photograph his skull inside and out and obtain an x-ray.
  3. Using Magnetic Resonance Imaging (MRI) technology recreate Gage’s skull in 3 dimensions.
  4. Determine the likely trajectory of the tamping iron and simulate it.
  5. From this identify the likely parts of Gage’s brain to have been damaged.

All this, Damasio et. al, duly did. In other words, they attempted to use modern technology to ‘reconstitute the accident, and [to determine] the probable place of the lesion’.

They conclude that:

Gage fits a neuroanatomical pattern that we have identified … [in other patients]  … Their ability to make rational decisions in personal and social matters is invariably compromised and so is their processing of emotion’ (p. 1104).

Indeed, Damasio et al.’s

‘interest in the case grew out of the idea that Gage exemplified a particular type of cognitive and behavioral defect caused by damage to ventral and medial sectors of prefrontal cortex …’ (p. 1103).

It seems to me that rather than define and describe the problem—Gage’s ‘profound personality change’—and discover a cause that might explain it, Damasio et. al. assumed both the existence of a personality change and the cause of it—a brain lesion. It only remained for them to identify the location of the lesion. He was, as they say, an exemplar of ‘a particular type of cognitive and behavioural defect’ caused by damage to the prefrontal cortex part of the brain.

On this shaky basis, neuroscience has drawn some wide reaching conclusions about emotions.

And yet consider the very different analysis of Phineas Gage in: Zbigniew Kotowicz, The Strange Case of Phineas Gage. History of the Human Sciences. 2007. 20: 115.

Kotowicz looks into what Damasio et. al. assume and tells us that most of the descriptions of Gage’s ‘changed personality’ were based on hearsay. His physician observed him a year after the accident and described him as calm, ‘talking with composure and equanimity of the hole in his head’.

Damasio et. al. are too fixated on Gage’s brain to spare a thought for his disfigured face. Once we begin to consider his face ‘his post-accident life begins to make perfect sense’.

People with disabilities, especially disfigured faces, are often stigmatized by those they meet. Rather than a ‘personality change’ caused by a lesion on his brain, perhaps it was the stigmatizing response of others to his disfigurement that changed Gage’s demeanour. His employer no longer wants him and he ‘is shown the road that leads out to the margins’ (Kotowicz). How would each of us respond to this?

He begins to recover in the company of those for whom his disfigurement does not matter or is not visible, his mother, horses and dogs. He decides that he is better off in the company of animals.

For a year and a half he worked in a livery stable. He then left for Valparaiso in Chile where he helped set up a coach line and cared for horses and drove coaches for eight years—which requires great skill.

Horses are extremely emotionally sensitive, so their silent testimony surely questions the assumption that his ability to make rational decisions in personal and social matter and to ‘process emotions’ is compromised. His response to his situation (to work with horses) is eminently rational.

In not even thinking of the effects of his disfigured face, in assuming what needs explaining—Gage’s actual behaviour—these neuroscientists display what they impute to Gage: a disregard for the rights and feelings of others, an inability to feel empathy.

Kotowicz tells us that this insensitivity is ‘a slur on the dead man’s good name’, a man who ‘deserves deep respect’ (Kotowicz pp. 122-123). He surely has a point.

The title of Damasio et. al.’s influential paper ‘The Return of Phineas Gage’ gives the impression that Phiineas Gage has returned home where he belongs, to neuroscience. It is redolent of the 16th century true story brought to life in The Return of Martin Guerre. A young man leaves his young wife to fight in a war and travel. Years later, he returns to the village but is revealed to be an impostor.

Damasio et. al’s ‘Phineas Gage’ is an impostor too, a creation of neuroscientists. He didn’t ‘return’—he was dug up! The real one had a face as well as a brain. ‘Anguish, disorientation, confusion can be seen on a face, but they are not visible in the brain; and, we cannot speak to a brain’ (Kotowicz, p. 126).

Why does all this matter?

It matters because, if you become ill, neuroscience is likely to treat you much as it treats Phineas Gage. It will look to your brain and not to your social milieux and your real life problems. It will give you a pill to change your brain, not help to change your situation.

None of this is to decry the brain, only its fawning, star treatment. The brain has to be understood in the context of the rest of the body and that body has to be understood in its social context.

One last question: doesn’t the fact that Gage could function rather well despite having this iron missile through his brain suggest a rather different set of research questions?

Further reading:

Kotowicz, Zbigniew. ‘The Strange Case of Phineas Gage. History of the Human Sciences. 2007, vol. 20, no. 1. pp. 115-131. 

Macmillan, Malcolm. ‘Restoring Phineas Gage: A 150th Retrospective’. Journal of the History of the Neurosciences: Basic and Clinical Perspectives. 2000, vol. 9, no. 1. pp. 46-66.

Damasio, Hanna, Thomas Grabowski, Randall Frank, Albert M. Galaburda, and Antonio R. Damasio. ‘The Return of Phineas Gage: Clues About the Brain from the Skull of a Famous Patient’, Science, 1994, vol. 264, no. 5162, pp. 1102-1105.

Van Horn, John Darrell, Andrei Irimia, Carinna M. Torgerson, Micah C. Chambers, Ron Kikinis, Arthur W. Toga. Mapping Connectivity Damage in the Case of Phineas Gage. PLoSOne.

If you’d like a copy of any of these readings but don’t have access to a library, email me and I’ll send you a copy.

6 thoughts on “Neuroscience’s psychopathic view of Phineas Gage

  1. Pingback: King Richard’s Skull vs. Phineas Gage’s Brain « The Business of Emotions

  2. Pingback: PHINEAS CAGE « Tsjok's blog

  3. Pingback: What an iron bar through the brain tells us about emotions « The Business of Emotions

  4. Mandy says:

    Phineas Gage’s story is one we did learn about in school-grade nine science or perhaps grade ten biology. I can recall in that class that I was left under the impression that perhaps the part of his brain that was “blown” away wasn’t perhaps the only reason for his changes-now why I am not sure and perhaps my teacher was one who did more homework that was conventionally required.
    I guess what I want to know is how does the brain and its regions change our personality. Yes, I agree becoming disfigured, etc. would change a person, but wouldn’t it also cause someone to become depressed? I am only going here and asking questions as I have looked further into Sylvia Plath and Dorothy Parker and the deep depression they battled and their obsession with suicide. What is it in the brain that can cause beautiful, resourceful, talented people to attempt suicide multiple times and yet someone who is physically (and most probably mentally) damaged in some way does not turn to suicide? I know that I need to do more research and reading into the brain but it is such a mysterious creature that it begs the question.
    Tonight I was watching a television show that stated “The artist didn’t want to seek help for their depression because they were afraid that it would ruin their creative nature.” I can see that. I know myself, when I write poetry when I tap into the dark corners of my mind I am much more creative and create much more appealing pieces. I have never had a piece from joy published-only from pain or insecurity. I don’t want to admit it. Why is this? Is it that we will never be able to understand the brain nor understand how it works completely? The quest for the connectome is noble and overwhelming. It is too complex, fathoming the intricacies of the brain, the high resolution imaging-it is just overwhelming and beyond my feeble mind’s understanding. In the six months prior to her death she wrote some of her most creative poetry(1). Perhaps neurosis is located in the same area of the brain that was lost by Phineas. Great food for thought and a segway into an amazing part of the unknown and emotions ties to it.


  5. daveicrewcut says:

    sorry for the typo above,,,my husband is a teacher..not sure what ‘my hand’ is doing there… :(

  6. daveicrewcut says:

    I was quite intrigued by the story of Phineas Gage and by Damasio’s work in general. I managed to find a copy of Descartes’ Error on Scribd for download for $5. A pretty good deal I thought. I must admit that I find the world of neuroscience a tad intimidating. I feel somewhat like a student in biology class….sadly, that was never one of my strengths :(. My hand is a husband is a high school science teacher and I was a little surprised he had never encountered the fascinating story of Phineas Gage. I have given him soem material to read…before long I quite suspect it will become the topic of a very interesting class for his high school students. Thanks for sharing. I’ll be sure to read more…..

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