Phineas Gage neuroscience case: True story of famous frontal lobe patient is better than textbook accounts.

The first story that appeared about Gage contained a mistake. The day after his accident, a local newspaper misstated the diameter of the rod. A small error, but an omen of much worse to come.

Psychologist and historian Malcolm Macmillan, currently at the University of Melbourne, has been chronicling mistakes about Gage for 40 years. He has had a peripatetic career: Among other topics, he has studied disabled children, Scientology, hypnosis, and fascism. In the 1970s, he got interested in Gage and decided to track down original material about the case. He turned up alarmingly little, and realized just how rickety the evidence was for most of the science about Gage.

Macmillan has been sifting fact from fiction ever since, and he eventually published a scholarly book about Gage’s story and its afterlife, An Odd Kind of Fame. Although slowed by a faulty hip replacement—he has trouble reaching books on the bottom shelves at libraries now—Macmillan continues to fight for Gage’s reputation, and he has gotten so involved with his subject that he now refers to him, familiarly, as Phineas. Above all, Macmillan stresses the mismatch between what we actually know about Gage and the popular understanding of him: “Despite there being no more than a couple hundred words attesting to how he changed, he came to dominate thinking about the function of the frontal lobes.”

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Bigelow’s assessment meshed well with the medical consensus at the time, which held that the frontal lobes didn’t do much—in part because people could suffer grave injuries to them and walk away. Scientists now know that parts of the frontal lobes contribute to nearly every activity inside the brain. The forefront of the lobes, called the prefrontal area, plays an especially important role in impulse control and planning.

But even today scientists have only a vague idea of how the prefrontal lobes exercise that control. And victims of prefrontal injuries can still pass most neurological exams with flying colors. Pretty much anything you can measure in the lab—memory, language, motor skills, reasoning, intelligence—seems intact in these people. It’s only outside the lab that problems emerge. In particular, personalities might change, and people with prefrontal damage often betray a lack of ambition, foresight, empathy, and other ineffable traits. These aren’t the kind of deficits a stranger would notice in a short conversation. But family and friends are acutely aware that something is off.

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In particular, Macmillan suggests that Gage’s highly regimented life in Chile aided his recovery. People with frontal-lobe damage often have trouble completing tasks, especially open-ended tasks, because they get distracted easily and have trouble planning. But in Chile Gage never had to plan his day: Prepping the coach involved the same steps every morning, and once he hit the road, he simply had to keep driving forward until it was time to turn around. This routine would have introduced structure into his life and kept him focused.



Phineas Gage neuroscience case: True story of famous frontal lobe patient is better than textbook accounts.