What Really Happened to Phineas Gage? – Psychology’s Most Famous Case Study

Phineas Gage close-up

If you have ever studied psychology, you probably know the name “Phineas Gage.” He was an American railway worker whose life changed dramatically on September 13, 1848. He was removing rocks so a railway to be laid, which sometimes requires drilling holes into the big boulders that can’t be pushed aside, and pushing in gun powder with an iron rod before exploding them from a safe distance. That day, however, he accidentally scraped the boulder which ignited the gun powder, projecting the rod into the air. It went straight through his head… but he lived. His legacy lives on as psychology’s most famous case study; but his legend is usually distorted in myth.

The meter-long (3cm in diameter) rod went straight up into his skull, from under his left eye, and it exited out the top of his head. He regained consciousness a few moments later, 30 meters from where the iron rod landed. There’s no telling how calmly he got up, but with what I am sure is a lot of blood gushing out of him, he began his oxcart ride back into town for some much-needed medical attention.

As the British Psychological Society (BPS) notes, this is where things become confused. Emeritus Professor Richard Griggs from the University of Florida analyzed the accounts of Gage within 23 textbooks used in universities, and he found that most of them are either misleading, inaccurate, or leave out important information.

For example, the general account of Gage is that he never worked again. Some sources claim that he became a vagrant, or a circus freak who grossed people out with the hole in his head. According to Griggs, the worst falsehood that he came across was that Gage survived for 20 years with the iron rod still stuck in his head.

So… what actually happened?

Phineas Gage with skull picture

Not what you had imagined, I suspect.

We know the answer because of the extensive historical analysis of primary sources by University of Melbourne Professor Malcolm Macmillan and his colleague Matthew Lena, in Boston. Also, the relatively recent discovery of actual photographic evidence helps paint that picture. The picture, that is, of a major recovery.

For someone who was impaled with a meter-long iron rod, Gage was pretty lucky. It seems that the rod only damaged the left side of his brain, and it created an opening to drain the infection; so he lived on. His was the first recorded case of a personality changing from brain damage, which is why it’s so famous. Gage’s personality went from a charming, pleasant, energetic man to a grossly profane jackass, totally uncharacteristic of his former self.

However, over time it seems that his life became more normalized, and he worked mostly by driving stagecoaches, always with his rod in hand (as it had become his inanimate companion). Sometime in the early 1850s, he decided to leave America with a colleague who set up routes for him to drive stagecoaches in Chile. He did that for several years before returning to his family in 1859, where he died in February the following year from epilepsy. He lived eleven and a half years after his accident.

Working in a foreign environment would have necessitated being polite, probably picking up some foreign words, and otherwise being a good worker for his customers. Neuroscientists have demonstrated that damaged brain areas can be retrained to compensate for deficiencies, this environment may have been very beneficial to him. While such neural healing doesn’t always work out well (e.g., phantom pain), I suspect that this helped Gage live quite a normal life. However, Griggs found that modern textbooks tend not to mention these facts. As the BPS reports:

[ . . . ] Fourteen of the books tell you about the first research that attempted to identify the extent of his brain injuries, but just four of the books give you the results from the most technically advanced effort, published in 2004, that first suggested his brain damage was limited to the left frontal lobe (watch video).”

[ . . . ] Only 9 of the books feature either of the two photos to have emerged of Gage in recent times.

[ . . . ] Only three detail his mental recovery.

[ . . . Only] 4 mention the years he worked in Chile.

Clearly, contemporary texts sometimes have intellectually lazy accounts of historically significant events and cases. As Griggs says, “It is important to the psychological teaching community to identify inaccuracies in our textbooks so that they can be corrected, and we as textbook authors and teachers do not continue to ‘give away’ false information about our discipline.”

The only way we keep psychology as a scientific study is by keeping it from being shrouded in myth, folklore, urban legend, and nonsense. After the accident, Phineas Gage lived on to lead a life that might not have been as “exciting” as many textbooks claim… but it’s the truth.

I think the fact that someone whose head was impaled with an iron rod lived a pretty normal life afterward is an interesting story all on its own.

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