In the previous post, ‘Neuroscience’s psychopathological view of Phineas Gage,’ I questioned the received wisdom on this man. Here I would like to suggest an alternative explanation of his behaviour following his accident, i.e., he was stigmatized because of his disfigured face.
The classic book on stigma is Erving Goffman’s Stigma: Notes on the management of spoiled identity. 1963. It begins:
The Greeks … originated the term stigma to refer to bodily signs designed to expose something unusual and bad about the moral status of the signifier. The signs were cut or burnt into the body and advertised that the bearer was a slave, a criminal or a traitor—a blemished person, ritually polluted, to be avoided, especially in public places.
Later, in Christian times, two layers of metaphor were added to the term: the first referred to bodily signs of holy grace that took the form of eruptive blossoms on the skin; the second, a medical illusion to this religious allusion, referred to bodily signs of physical disorder.
Goffman changed the way stigma is understood. As the subtitle of his book suggests, it is a ‘spoiled identity’ in need of ‘management’. ‘Normals’ tend to view the stigmatized as not fully human, as damaged goods, certainly as inferior.
Let us imagine Gage’s social interactions in this light.
He was visibly different, indeed, aesthetically displeasing. The left side of his face was paralysed and was larger than the right. He lost the sight in his left eye and its eye lid drooped. This disfigurement may have caused others to shy away from him. Certainly, it would have distracted from social discourse and put a strain on his social relationships.
We know that ‘normals’ tend to generalize from a known disability to imagined ones. Deaf and dumb people can be thought simple. Blind people can be shouted at, as if they were deaf as well. One wonders what additional defects were imputed to the disfigured Gage.
Our appearance affects how we feel about ourselves. Perhaps Gage’s disfigured face damaged the way he felt about himself. He may have felt guilt and shame about being the centre of attention, at being ‘different’.
Gage’s disfigurement was manifestly visible. This reduced his options. He could not conceal it; he could only conceal himself. He did just that. He moved to Chile and worked with horses for eight years.
But stigma is somehow thought to be a sign of an internal moral flaw and surely Gage was not responsible for this terrible accident. That is certainly how we see it today; he was just unlucky, it could have happened to anyone. But the United States mid-nineteenth century was deeply religious. John Harlow, one of the physicians who treated him, ended his address to the Massachusetts Medical Society, 3 June 1868, with ‘I dressed him, God healed him.’ Medical science did not know how he survived and why he lived. Perhaps Christianity could. Certainly, it could have happened to anyone, but it didn’t: it happened to him. Why?
All this, of course, is speculation. But these questions ought to have been asked in addition to considering the effect of that tamping iron on his brain.
John M. Harlow. ‘Recovery from the passage of an iron bar through the head’. History of Psychiatry. 1993 4: 274