Before there was the man who mistook his wife for a hat, there was Phineas Gage, the young railroad foreman who became a textbook staple for surviving an accident in which a railroad spike was driven through his head.
Cases like his fascinate scientists and lay people alike, since knocking out parts of the brain can tell us something about what they do. And yet, as writer Sam Kean took a closer look, the story he uncovered didn’t match the one being repeated in textbooks and some popular treatments. As he reports here in Slate, the real story is far more interesting.
Other victims in the annals of medicine are almost always referred to by initials or pseudonyms. Not Gage: His is the most famous name in neuroscience. How ironic, then, that we know so little else about the man—and that much of what we think we know, especially about his life unraveling after his accident, is probably bunk.
The one part of the story that is apparently not bunk is the horrific nature of the accident, which Kean describes in enough detail that you might not want to read the story while you’re eating breakfast. A metal spike really did enter under Gage's eye socket, knock out a molar, and exit through the top of his head.
It's mind-boggling that he survived, but survive he did, with his speech and motor skills apparently intact.
The questionable part of the story is the personality transformation that allegedly followed, in which Gage went from an upstanding citizen to shady drifter who slept around, drank, brawled and made other kinds of trouble common to the 19th century. The story is often told to illustrate how the frontal lobes control judgment and self-restraint.
Kean’s most prominent source is a psychologist and historian named Malcolm Macmillan, from the University of Melbourne, who has been on a 40-year mission to straighten out the story. Macmillan says we don’t know enough about Gage’s behavior before or after the accident to say he had such a personality change. What is in the record is that after the accident, Gage moved to Chile and drove a carriage over steep and treacherous mountain passes.
Kean writes that the textbook version of the story perpetuates a dangerous myth that the seat of humanity, or perhaps the soul, reside in the frontal lobes.
“More uncomfortably, some scientists have questioned Gage’s humanity. Descartes’ Error, a popular book from 1994, trotted out many familiar tropes: that women couldn’t stand to be in Gage’s presence, that he started “drinking and brawling in questionable places,” that he was a braggart and a liar and a sociopath. The neuroscientist author then got metaphysical. He speculated that Gage’s free will had been compromised, and raised the possibility that “his soul was diminished, or that he had lost his soul.”
The story is also a lesson about textbook lore – and how much it can start to become unhinged from the facts:
Science historian Douglas Allchin has noted the power of preconceptions as well: “While the stories [in science] are all about history—events that happened,” Allchin writes, “they sometimes drift into stories of what ‘should’ have happened.”
Macmillan especially bemoans “the degree of rigor mortis in textbooks,” which reach a large, impressionable audience and repeat the same anecdotes about Gage in edition after edition. “Textbook writers are a lazy lot,” he says.
That’s a harsh accusation and no textbook writers are allowed to defend themselves in the piece, but it’s an important message that we shouldn’t treat textbooks as gospel in any case. And as is the case here, the story that emerges from a deeper look often turns out to be more interesting.