A Different Perspective on Phineas Gage

For those of us who have taken Psych 101, we all know the name of Phineas Gage. The man who took a pole through his head, altering his personality which has been used to support claims that one's personality is fundamentally decided by the frontal cortex of the brain.

We hear accounts of how Gage's friends claimed he was

“no longer Gage”

And that he was suddenly without any social inhibitions.

Normally I would have pointed to the work of Wilder Penfield, or Viktor Frankl to demonstrate that Gage would have still had a will and consciousness which was immune to manipulation by the environment or to physical manipulation of the brain, and could still have chosen his actions, however a re-evaluation of the accuracy of that story has seriously questioned the accuracy of the current Gage myth. Please consider the following abstract from History of the Human Sciences, Vol. 20 No. 1, 115-131 (2007)

The 19th-century story of Phineas Gage is much quoted in neuroscientific literature as the first recorded case in which personality change (from polite and sociable to psychopathic) occurred after damage to the brain. In this article I contest this interpretation. From a close examination of the story of Gage I have come to conclude that first of all there was nothing psychopathic in Gage’s behavior and that changes in his life are more coherently explained by seeing them as his way of dealing with disfigurement that he suffered after the accident. This is not just a matter of reinterpreting a case. The way Gage has been presented and discussed in neuroscientific literature suggests that the new paradigm of neuroscientifically oriented psychiatry may lead to an erosion of clinical knowledge.

The actual story of Gage is quite sad.

First he meets his workmates. Their attitude towards him has changed; now they turn their eyes away, they are not the same easygoing fellows; and the girls do not laugh and flirt with him as they did. And if there was some lassie that he was particularly fond of, well . . . all this must be really difficult to take. Someone will look at him, and we can imagine him snapping back, ‘What are you staring at, you bastard?’ And there are also those who are only too ready to give advice, but giving advice to someone in Gage’s predicament is a risky business. Again, we can imagine him telling them to go to hell. Very ungrateful; definitely, to ‘his friends and acquaintances’ he is ‘“no longer Gage”’. It is different at home, at his mother’s, where the final recovery takes place. He entertains his nephews and nieces by making up fantastic stories; they must love Uncle Phineas, and they do not care about his scars. He also grows fond of pets, especially dogs and horses. Animals not only do not care about his scars, they do not even see them. Gage quickly becomes attached to them. But the outside world of adults cannot be ignored. Gage needs to go back to work. And here comes the first tangible blow: he is not wanted back …”

Gage went on to work at a freak show (briefly), then at a stable giving care to horses until his health failed, and he went to live with his mother, working on a farm until he died. Subsequent scientific mythmakers have portrayed him as psychotic, even to the point of being unable to plan for future events, but for those who know what happened to him after the incident, this is clearly at odds with the accounts of the doctors who knew him, and at odds with the rest of his life.

A more accurate story of Phineas Gage, which describes both the myth and the reality can be found here. This information was actually surprising and kind of new to me, so a Hat Tip to O'Leary on UD, is in order, which includes more excerpts and discussion.

What I thought was particularly interesting however, was this quote from the abstract.

The way Gage has been presented and discussed in neuroscientific literature suggests that the new paradigm of neuroscientifically oriented psychiatry may lead to an erosion of clinical knowledge.

What this says to me in not so many words is that the strictly physicalist/materialist approach to psychiatry is going to harm us by creating a false sense of impotence in clinical psychiatry which has typically had great success in the top down (dualist sympathetic) approach using the mind to influence the brain.

I have previously blogged about the dogmatic emphasis upon the "rules of science" limiting investigation of anything stipulated to be supernatural, and how this epistemologically cripples any human endeavor to discover truth through science, and how our society may suffer because of it. This is another case in point.