Phineas Gage - Psychology and Traumatic Brain Injury
The brain injury suffered by Phineas Gage after an extraordinary industrial accident in 1868 has provided psychology with a remarkable example of the effects of frontal lobe brain damage and the personality and behaviour changes that can occur as a result.
Phineas Gage – Psychology’s Most Famous Case Study
Phineas Gage was a 25 year old man working on a rail-road bed in Vermont in September of 1848 when he suffered a horrific accident. While using a tamping iron to pack explosives into a newly created hole to clear surrounding rocks, the powder exploded and propelled the iron upwards with some velocity towards Gage himself.
The tamping iron, which was around 13lbs in weight, 1 meter long and 3 cm in diameter pierced through his lower cheek, passed through his brain and exited at the top of his head, falling to the ground some feet away.
Reports vary as to whether Gage lost consciousness for a short period in the immediate aftermath of the injury, but he was able to travel in a cart sitting upright into the nearest town in order to obtain medical assistance.
Dr Edward Williams was the first doctor to see Gage after the accident and found his account of what had happened quite hard to believe.
“I first noticed the wound upon the head before I alighted from my carriage, the pulsations of the brain being very distinct….I did not believe Mr Gage’s statement at that time, but thought he was deceived. Mr. Gage persisted in saying that the bar went through his head….”— Dr Edward Williams
Traumatic Brain Injury and Dr John Harlow
John Harlow was a medical doctor who treated Gage after the injury and for the following years of his life.
It is Dr Harlow’s reports and records of this time that have provided the most accurate information on Gage’s injury and the changes to his character afterwards.
He reports that initially Gage appeared to have no harmful effects of the injury. He was able to speak clearly, understand what was being said to him and recall details of the accident itself.
Gage’s comment to Dr Harlow on the evening of his accident highlights how well he was feeling considering what had just happened to him. Dr Harlow reports Gage stated he "does not care to see his friends, as he shall be at work in a few days." (Harlow, J. M. 1868)
In the days that followed, Gage did experience periods of delirium where he had difficulty communicating unless prompted.
Ten days after the accident he lost complete vision in his left eye.
“Up to this time it had not occurred to me that is was possible for Gage to recover “— Dr John Harlow
Recovery from Brain Injury
To everyone's surprise, Gage recovered very well from his injuries as the days passed. By the 56th day post-injury he was lucid with no clear mental defects and was physically active.
By January 1949 Gage had returned home with his head wound almost entirely healed, however pulsations of the brain were clearly visible and his head shape had noticeably changed comparatively to pre-injury.
He had partial paralysis to the left side of his face but reported no pain in his head just an unusual sensation which he found difficult to describe.
By April of that year he had returned to Vermont looking to start work on the railroads again.
Psychology - Personality Change
Prior to his accident Gage had been described as an intelligent and responsible man who was respected and well-liked by his peers.
He held a responsible job as a foreman which he carried out conscientiously, in a reliable and organized manner. His employers described him as efficient and capable.
His previous employers did not offer him his foreman role back as they felt his character and personality had changed considerably and he was no longer suitable for that role.
Although Gage’s intelligence, movement, speech and learning did not appear to be affected, it was clear there were changes in his personality.
Psychological Effects of Brain Injury
Phineas Gage is the first known case of personality and behaviour change due to such brain injury. His case provided evidence that damage to the frontal cortex in the brain can have this kind of effect.
Before this there was little evidence available to suggest areas of the brain itself were directly associated with such cognitive functions.
This was a huge breakthrough within psychology where a direct relationship between physical areas of the brain and cognitive functions and abilities could be established.
Gage’s personality transformed from a polite, friendly and reliable man to an unreliable individual who made bad judgements and seemed to have lost many of his social skills.
At that time, Dr Harlow suggested the damage from the iron bar had disrupted his abilities to plan and maintain socially accepted behaviour, but there was no way to investigate this any further.
“His friends and acquaintances said he was "no longer Gage."— Harlow, J. M. 1868
This was the first time a suggestion had been made that there were areas of the brain specifically dedicated to rationality.
The idea of a neural basis for reasoning and social behaviour was very new. This suggestion was not based on any scientific evidence, but came solely from observations of behaviour and personality changes in a patient.
At that time people did not give much attention to this theory, primarily due to the lack of solid evidence.
Brain Damage Case Study: Patient EVR
150 years later patient EVR had surgery to remove a tumour from the frontal lobes of his brain. It was a very deep tumour and he was left with brain damage in the base of his left frontal lobes after the operation.
Following his recovery, his change in behaviour was very similar to that of Gage recorded in 1868.
EVR, before his brain tumour, was a married man with children and was considered an active and respected member of his community.
He had a responsible job as a financial officer and was held in high regard by his family and friends. After his tumour was removed, he reportedly divorced his wife, married a prostitute, lost his job and went bankrupt (Abbruzzese et al, 1993).
Psychological testing did not reveal any abnormalities with EVR's intelligence or basic skills and he was very able to discuss and debate matters of current interest such as the economy and foreign affairs.
His decision making skills however had suffered greatly. He became very indecisive over simple tasks such as shopping and eating out and often would end up in a cycle of options and comparisons being unable to make a decision at all.
Remodelling the Skull of Phineas Gage
In 1866, with his family’s permission at the request of Dr Harlow, Gage’s skull was exhumed in order for the physical damage from the injury to be examined scientifically.
After initially donating the iron bar which caused him his injury to a Medical School, Gage had reclaimed the bar and used to take it with him as he travelled and worked in new places.
It is believed he was buried with the bar at his funeral and his family also gave the iron bar to researchers to aid with their research.
Psychology and Neurology Professor Hanna Damasio and her colleagues tried to recreate the damage that must have occurred to Gage’s brain using his skull and the original bar.
She recreated the original shape of his brain prior to the accident using exact measurements and neuroimaging techniques.
Simulation of Gage's Injury
Using Gage’s skull and the detailed accounts of the accident, Damasio was able to reconstruct the likely trajectory of the tamping iron and simulated those trajectories using modern computer programming. In this way she was able to see exactly which brain regions were damaged due to the injury.
A number of conclusions were made from this research. Broca’s area, known to control speech was not affected however, a large region in both frontal lobes of the brain clearly had sustained damage.
Phineas Gage’s Legacy in Psychology
This type of brain damage has been seen in other patients who experienced similar behaviour changes to Gage. This has confirmed the prediction that social and personal rational decision making is heavily disrupted alongside the processing of emotion.
It appears that memory and general logic are not affected. Damasio also found the damage to Gage's brain was in the same areas as damage to EVR’s brain after surgery, which further provided evidence that frontal lobe brain damage can have a significant effect on an individuals personality and behaviour (Damasio et al, 1994).
Gage found work in various places in the years following his accident, including farm work and employment as a stagecoach driver. He survived for a further 12 years and died after a number of seizures in 1860 assumed to be connected to his injury.
The story of Phineas Gage is remarkable not only in how he survived such horrific injuries but also the legacy he left in advancing neurospychology and neuroscience research dramatically. Gage’s skull and the iron bar are now exhibited at the Warren Anatomical Medical Museum at Harvard University.
Abbruzzese, M., Ferri, S., Bellodi, L., and Scarone, S. (1993) Frontal lobe dysfunction in mental illness. Psycoloquy 4(9), frontal-cortex.1.
© 2015 Fiona Guy