phineas gage case study a level psychology

Phineas Gage: His Accident and Impact on Psychology

Olivia Guy-Evans, MSc

Associate Editor for Simply Psychology

BSc (Hons) Psychology, MSc Psychology of Education

Olivia Guy-Evans is a writer and associate editor for Simply Psychology. She has previously worked in healthcare and educational sectors.

Learn about our Editorial Process

Saul McLeod, PhD

Editor-in-Chief for Simply Psychology

BSc (Hons) Psychology, MRes, PhD, University of Manchester

Saul McLeod, PhD., is a qualified psychology teacher with over 18 years of experience in further and higher education. He has been published in peer-reviewed journals, including the Journal of Clinical Psychology.

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Key Takeaways

• In 1848, 25-year-old Phineas Gage survived an accident where an iron rod was propelled through his left cheek and skull. He made an improbable recovery and lived for 12 more years.

Examination of Gage’s exhumed skull in 1867 revealed the probable trajectory of the tamping iron through left frontal lobe structures, offering insight into his improbable survival and selective changes in behavior following this massive traumatic brain injury.

• Gage’s case is famous in psychology as it shows the resilience of the human brain and profoundly influenced early understanding of cerebral localization.

What happened to Phineas Gage?

Phineas Gage was an American railroad construction foreman born in 1823 near Lebanon, New Hampshire.

On September 13, 1848, when Gage was 25 years old, he was working in Cavendish, Vermont, leading a crew preparing a railroad bed for the Rutland and Burlington Railroad by blasting away rock using explosives.

Around 4:30 pm, as Gage was using a 43-inch-long, 13-pound iron tamping rod to pack the explosive powder into a hole in the rock, the powder detonated unexpectedly.

The tamping iron launched from the hole and entered the left side of Gage’s face from the bottom up.

The iron rod entered Gage’s left cheek near the lower jaw hinge, passing behind his left eye socket, penetrating the base of his skull, traversing the left frontal lobe upwards at an angle, and exiting through the top frontal portion of his skull before landing about 25-30 yards behind him.

After the incident, Gage was thrown onto his back from the force of the iron rod and had some brief convulsions of the arms and legs.

Within minutes, however, assisted by his crew, Gage could stand, speak, and walk to an oxcart to be transported nearly a mile to the inn where he resided in Cavendish village.

Dr. Edward H. Williams arrived about an hour later to examine Gage. In his 1848 report, Williams noted visible pulsations of Gage’s exposed brain through an inverted funnel-shaped opening at the top of his skull from which brain tissue protruded.

Williams claimed that Gage was recounting his injuries to bystanders, and he did not initially believe the story, thinking that Gage was ‘deceived.’

Apparently, Gage had greeted Williams by angling his head at him and saying, ‘Here’s business enough for you.’

During repeated episodic vomiting, Williams observed additional small amounts of Gage’s brain matter expelled onto the floor through the frontal exit wound, as the cerebral tissue had likely detached from the skull during the passage of the tamping iron.

From Harlow’s written account, Gage was considered to be fully recovered and felt fit enough to reapply for his previous role as a foreman.

After an arduous early recovery, Gage eventually regained physical health, though his personality was markedly altered. He lived another 11 years before dying from severe epilepsy in 1860 at age 36.

How Did Phineas Gage’s Personality Change?

The descriptions of Gage’s personality and behavior before the accident are limited.

Before his accident, 25-year-old Gage was described by his railroad employers as a capable and efficient foreman, displaying a strong work ethic, drive, and dependability in overseeing his crews.

However, after surviving passage of the tamping iron through his frontal lobe in 1848, significant changes in Gage’s personality emerged during his physical recovery.

The contractors, who had regarded Gage as ‘efficient and capable’ before the accident, could no longer offer him work due to considerable changes in Gage’s personality.

In medical reports by Dr. John Martyn Harlow in 1848 and 1868, Gage is depicted as struggling with volatility, profanity, little deference for others, impatience, obstinance, unpredictability, and devising plans hastily abandoned.

Harlow wrote that Gage’s equilibrium between intellectual faculties and animal propensities was destroyed, reverting to childlike mental capacity regarding self-restraint and social appropriateness.

Though the specific neuroanatomical links were unclear at the time, Friends and colleagues felt Gage was “no longer Gage” after the traumatic brain injury, unable to process emotions or control impulsive behavior like his pre-accident self.

The shocking changes aligned with emerging localization theories that the frontal lobes regulate personality.

Marlow (1868) described Gage as follows:

“The equilibrium or balance, so to speak, between his intellectual faculties and animal propensities, seems to have been destroyed. He is fitful, irreverent, indulging at times in the grossest profanity (which was not previously his custom), manifesting but little deference for his fellows, impatient of restraint or advice when it conflicts with his desires, at times pertinaciously obstinate, yet capricious and vacillating, devising many plans of future operations, which are no sooner arranged than they are abandoned in turn for others appearing more feasible. A child in his intellectual capacity and manifestations, he has the animal passions of a strong man.”

“Previous to his injury, though untrained in the schools, he possessed a well-balanced mind, and was looked upon by those who knew him as a shrewd, smart business man, very energetic and persistent in executing all his plans of operation. In this regard his mind was radically changed, so decidedly that his friends and acquaintances said he was ‘no longer Gage.”

Through Harlow’s reports, it can be suggested that Gage’s personality changed due to the accident he endured.

The accounts imply that the injury led to a loss of social inhibition, meaning that Gage would behave in ways that were considered inappropriate.

Accuracy of Sources

In his 1848 and 1868 reports, Dr. Harlow provides a limited description of Gage’s pre-accident, stating he was “temperate inhabit, of great energy of character, possessed of considerable stamina of both brain and body” and was “a great favorite” with his men (Harlow, 1848, 1868).

However, later accounts add exaggerated positive traits not found in Harlow’s description. For example, Suinn (1970) describes Gage as enjoying “the respect as well as the favor of his men,” while Myers (1998) calls him “soft-spoken,” and Lahey (1992) says he was “polite and reasonable.”

Other sources paint him as friendly, affable, dependable, conscientious, and happy (Macmillan, 2000).

Similarly, post-accident descriptions often emphasize Gage’s negative qualities while ignoring any positive traits he retained.

Harlow documents personality changes but notes Gage remained employable for a period as a long-distance stagecoach driver in Chile (Harlow, 1868).

However, many accounts focus solely on traits like aggression, unreliability, or aimlessness (Macmillan, 2000). Damasio goes so far as to describe him as behaving violently with no self-control (Blakeslee, 1994).

In this way, later accounts tend to polish Gage’s pre-accident image as an upstanding citizen while presenting an almost cartoonishly perturbed version post-injury – neither in keeping with Harlow’s more nuanced clinical descriptions.

This likely reflects enthusiasm for fitting Gage’s case to localization theories. Macmillan (2000) argues that we must cautiously analyze such embellished personality descriptions when assessing Phineas Gage’s legacy.

Severity of Gage’s Brain Damage

When Gage died in 1861, no autopsies were performed until his skull was later recovered by Harlow years later. The brain damage that caused the significant personality changes was presumed to have involved the left frontal region of the brain.

It was not until 1994 that complex computer-based methods to examine brain damage could be used to investigate whether other areas of the brain were affected.

Damasio et al. (1994) used measurements from Gage’s skull and neuroimaging techniques to determine the exact placement of the entry and exit point of the iron rod on a replica model (see Fig. 1).

They found that the damage caused by the rod involved both the left and right prefrontal cortices.

The left and right cortices are responsible for emotional processing and rational decision-making; therefore, it can be assumed that Gage had deficits in these areas.

A later study by Ratiu et al. (2004) also investigated Gage’s injury and the location of where the iron rod entered and exited the head. They used Gage’s actual skull rather than a model of it, as Damasio et al. (1994) had used.

Ratiu et al. (2004) generated three-dimensional reconstructions of the skull using computed tomography scans (CAT) and found that the extent of the brain injury was limited to the left frontal lobe only and did not extend to the right lobe (see Fig. 2).

More recently, Van Horn et al. (2012) used a CAT scan of Gage’s skull as well as magnetic resonance imaging (MRI) data obtained from male participants of a similar age to Gage at the time (aged 25-36).

Their results supported Ratiu et al. (2004) in that they always concluded that the rod only damaged the left lobe and not the right.

Van Horn, however, went a step further in their research and investigated the potential levels of white and grey matter damaged due to Gage’s injury. White matter is deep in the brain and provides vital connections around the brain, essential to normal motor and sensory function.

Grey matter in the brain is essential to many areas of higher learning, including attention, memory, and thought.

The research by Van Horn proposed that Gage lost about 11% of his white matter and about 4% of his grey matter. White matter has the ability to regenerate, so this could explain why Gage recovered as well as he did.

Van Horn et al. (2012) compared Gage’s white matter damage to the damage that is caused by neurogenerative diseases such as Alzheimer’s.

This is supported by other studies that have found that changes in white matter is significantly associated with Alzheimer’s disease (Nasrabady, Rizvi, Goldman & Brickman, 2018; Kao, Chou, Chen & Yang, 2019).

It could be suggested that Gage’s apparent change in personality could have been the result of an early onset of Alzheimer’s.

However, as Dr. Harlow, who examined Gage, only reported on Gage’s behaviors shortly after his accident, rather than months or years later when Alzheimer’s symptoms may have emerged, we cannot be certain whether Gage actually had this condition.

All studies investigating the brain damage suffered by Gage is essentially all speculation as we cannot know for certain the extent of the accident’s effects.

We know that some brain tissue got destroyed, but any infections Gage may have suffered after the accident may have further destroyed more brain tissue.

We also cannot determine the exact location where the iron rod entered Gage’s skull to the millimeter. As brain structure varies from person to person, researchers cannot ever know for certain what areas of Gage’s brain were destroyed.

What Happened to Phineas Gage After the Brain Damage?

Dr. John Martyn Harlow took over Gage’s case soon after. Harlow (1848) reported that Gage was fully conscious and recognized Harlow immediately but was tired from the bleeding.

In the next couple of days, Harlow observed that Gage spoke with some difficulty but could name his friends, and the bleeding ceased. Gage then spent September 23rd to October 3rd in a semi-comatose state but was able to take steps out of bed by October 7th.

By October 11th, Harlow claimed Gage’s intellectual functioning began to improve. He recognized how much time had passed since the accident and could describe the accident clearly.

Four years after his injury, Gage moved to Chile and worked taking care of horses and being a stagecoach driver.

Harlow noted emerging personality changes in this period, with Gage becoming more erratic in behavior and responsibility.

In 1860, Gage moved to San Francisco to live near family but began suffering epileptic seizures – likely related to scar tissue and injury sequelae.

The convulsions worsened over months, and on May 21, 1861, almost 13 years after his shocking accident, Gage died at age 38 from complications of severe epilepsy.

How did Phineas Gage die?

On May 21st, 1861, twelve years after his accident, Gage died after having a series of repeated epileptic convulsions.

In 1867, Harlow arranged an exhumation of Gage’s body, claiming his skull and tamping iron for medical study.

These historic artifacts remain on display at the Harvard School of Medicine.

Though Gage initially survived, it was the secondary long-term effects of this massive brain injury that ultimately led to his premature death over a decade later.

Why Is Phineas Gage Important to Psychology?

Gage’s case is important in the field of neuroscience . The reported changes in his behavior post-accident are strong evidence for the localization of brain function , meaning that specific brain areas are associated with certain functions.

Neuroscientists have a better understanding of the function of the frontal cortex today. They understand that the frontal cortex is associated with language, decision-making, intelligence, and reasoning functions. Gage’s case became one of the first pieces of evidence suggesting that the frontal lobe was directly involved in personality.

It was believed that brain lesions caused permanent deficits in a person. However, Gage was proven to have recovered remarkably and lived a mostly normal life despite his injury. It was even suggested by a psychologist called Malcolm Macmillan that Gage may have relearned lost skills.

People with damage to their frontal lobes tend to have trouble completing tasks, get easily distracted, and have trouble planning.

Despite this damage to his frontal lobe, Gage was reported to have worked as a coach driver which would have involved Gage being focused and having a routine, as well as knowing his routes and multitasking.

Macmillan (2002), therefore, suggests that Gage’s damage to the frontal lobe could have somewhat repaired itself and recovered lost functions. The ability of the brain to change in this way is called brain plasticity .

Over time, Gage’s story has been retold, and this has sometimes led to a lot of exaggeration as to the personality changes of Gage.

Some popular reports described him as a hard-working, kind man prior to the accident and then described him as an aggressive, dishonest, and drunk man who could not hold down a job and died pennilessly.

Gage’s story seemed to take on a life of its own, and some even went as far as to say that Gage became a psychopath after his accident, without any facts behind this.

From the actual reports from the people in contact with Gage at the time, it appears that his personality change was nowhere near as extreme and that Gage was far more functional than some reports would have us believe (Macmillan, 2002).

Blakeslee, S. (1994, July 6). A miraculous recovery that went wrong . New York Times.

Damasio, H., Grabowski, T., Frank, R., Galaburda, A. M., & Damasio, A. R. (1994). The return of Phineas Gage: clues about the brain from the skull of a famous patient . Science, 264 (5162), 1102-1105.Harlow J. M. (1848). Passage of an iron rod through the head. Boston Medical and Surgical Journal, 39 , 389–393.

Harlow, J. M. (1868). Recovery from the Passage of an Iron Bar through the Head . Publications of the Massachusetts Medical Society. 2 (3), 327-347.

Kao, Y. H., Chou, M. C., Chen, C. H., & Yang, Y. H. (2019). White matter changes in patients with Alzheimer’s disease and associated factors . Journal of Clinical Medicine, 8 (2), 167.

Lahey, B. B. (1992). Psychology: An introduction . Wm. C. Brown Publishers.

Macmillan, M. (2000). Restoring Phineas Gage: A 150th retrospective. Journal of the History of the Neurosciences, 9 (1), 46-66.

Macmillan, M. (2002). An odd kind of fame: Stories of Phineas Gage. MIT Press.

Myers, D. G. (1998). Psychology (5th ed.). Worth Publishers.

Nasrabady, S. E., Rizvi, B., Goldman, J. E., & Brickman, A. M. (2018). White matter changes in Alzheimer’s disease: a focus on myelin and oligodendrocytes. Acta neuropathologica communications, 6 (1), 1-10.

Ratiu, P., Talos, I. F., Haker, S., Lieberman, D., & Everett, P. (2004). The tale of Phineas Gage, digitally remastered . Journal of neurotrauma, 21 (5), 637-643.

Suinn, R. M. (1970). Fundamentals of behavior pathology. Wiley.

Van Horn, J. D., Irimia, A., Torgerson, C. M., Chambers, M. C., Kikinis, R., & Toga, A. W. (2012). Mapping connectivity damage in the case of Phineas Gage . PloS one, 7(5) , e37454.

Further Reading

• Griggs, R. A. (2015). Coverage of the Phineas Gage Story in Introductory Psychology Textbooks: Was Gage No Longer Gage?. Teaching of Psychology, 42(3), 195-202.
• Wilgus, J., & Wilgus, B. (2009). Face to face with Phineas Gage. Journal of the History of the Neurosciences, 18(3), 340-345.
• Macmillan, M., & Lena, M. L. (2010). Rehabilitating Phineas Gage. Neuropsychological Rehabilitation, 20, 641–658.
• Macmillan, M. (2000). Restoring phineas gage: a 150th retrospective. Journal of the History of the Neurosciences, 9(1), 46-66.
• Kotowicz, Z. (2007). The strange case of Phineas Gage. History of the Human Sciences, 20(1), 115-131.
• O”driscoll K, Leach JP. “No longer Gage”: an iron bar through the head. Early observations of personality change after injury to the prefrontal cortex. BMJ. 1998;317(7174):1673-4. doi:10.1136/bmj.317.7174.1673a

If a person suffers from a traumatic brain injury in the prefrontal cortex, similar to that of Phineas Gage, what changes might occur?

A traumatic brain injury to the prefrontal cortex could result in significant changes in personality, emotional regulation, and executive function. This region is vital for impulse control, decision-making, and moderating social behavior.

A person may exhibit increased impulsivity, poor judgment, and reduced ability to plan or organize. Emotional volatility and difficulty in interpersonal relationships may also occur.

Just like the case of Phineas Gage, who became more impulsive and less dependable, the injury could dramatically alter one’s character and abilities.

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Biopsychology: Localisation of the Brain Function

Last updated 10 Apr 2017

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Localisation of function is the idea that certain functions (e.g. language, memory, etc.) have certain locations or areas within the brain. This idea has been supported by recent neuroimaging studies, but was also examined much earlier, typically using case studies.

One such case study is that of Phineas Gage , who in 1848 while working on a rail line, experienced a drastic accident in which a piece of iron went through his skull. Although Gage survived this ordeal, he did experience a change in personality, such as loss of inhibition and anger. This change provided evidence to support the theory of localisation of brain function, as it was believed that the area the iron stake damaged was responsible for personality.

There are four key areas that you need to be aware of: motor, somatosensory, visual and auditory areas.

The motor area is located in the frontal lobe and is responsible for voluntary movements by sending signals to the muscles in the body. Hitzig and Fritsch (1870) first discovered that different muscles are coordinated by different areas of the motor cortex by electrically stimulating the motor area of dogs. This resulted in muscular contractions in different areas of the body depending on where the probe was inserted. The regions of the motor area are arranged in a logical order, for example, the region that controls finger movement is located next to the region that controls the hand and arm and so on.

• Somatosensory Area

The somatosensory area is located in the parietal lobe and receives incoming sensory information from the skin to produce sensations related to pressure, pain, temperature, etc. Different parts of the somatosensory area receive messages from different locations of the body. Robertson (1995) found that this area of the brain is highly adaptable, with Braille readers having larger areas in the somatosensory area for their fingertips compared to normal sighted participants.

• Visual Area

At the back of the brain, in the occipital lobe is the visual area , which receives and processes visual information. Information from the right-hand side visual field is processed in the left hemisphere, and information from the left-hand side visual field is processed in the right hemisphere. The visual area contains different parts that process different types of information including colour, shape or movement.  

• Auditory Area

The auditory area is located in the temporal lobe and is responsible for analysing and processing acoustic information. Information from the left ear goes primarily to the right hemisphere and information from the right ear goes primarily to the left hemisphere.  The auditory area contains different parts, and the primary auditory area is involved in processing simple features of sound, including volume, tempo and pitch. 

• Broca's Area

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Uncovering the Impact of Phineas Gage’s Accident on Psychology

Phineas Gage is a name that has become synonymous with studying psychology. His case has greatly interested researchers and students alike for years. Gage experienced a traumatic brain injury in 1848 when an iron rod was driven through his skull, destroying much of his frontal lobe. Despite the severity of his injury, Gage survived the accident, and his story has contributed significantly to our understanding of the brain and its functions.

Gage’s case is unique because it is one of the first recorded instances of a person surviving a severe brain injury. The accident profoundly impacted Gage’s personality, behavior, and cognitive abilities. Before the accident, Gage was described as a responsible and hard-working man. However, after the injury, he became impulsive, inconsistent, and unable to plan for the future. His case has been a subject of much debate and speculation, and it has contributed significantly to our understanding of the brain and its functions.

This article will explore Phineas Gage’s accident and its impact on psychology. We will examine his life before and after the injury, his personality and behavior changes, and the significance of his psychology case. We will also discuss how Gage’s case has contributed to our understanding of the brain and its functions.

The Life of Phineas Gage

Phineas Gage was born on July 9, 1823, in Grafton County, New Hampshire. He was the first of five children born to Jesse Eaton Gage and Hannah Trussell Gage. According to records, Phineas was a healthy and intelligent child who enjoyed playing outdoors and was well-liked by his peers.

Early Years

Phineas grew up in a modest household and attended school until he was 12. He then began working on his family’s farm, where he gained experience working with animals and machinery. In his late teens, he moved to Vermont to work as a farmhand and eventually found employment as a stagecoach driver.

Career as a Railroad Construction Foreman

In 1848, at 25, Phineas worked as a railroad construction foreman for the Rutland and Burlington Railroad Company. On September 13 that year, he suffered a traumatic brain injury when an iron rod measuring 43 inches long and 1.25 inches in diameter was accidentally driven through his skull. The rod entered below his left cheekbone and exited through the top of his head, destroying much of his frontal lobe.

Despite the severity of his injury, Phineas survived and could walk and talk within minutes of the accident. However, his personality and behavior were dramatically altered. He became impulsive, irritable, and unable to plan or make decisions. He also struggled with memory loss and had difficulty with social interactions.

After the accident, Phineas worked odd jobs and traveled around the country, becoming a celebrity due to his survival story. He eventually settled in San Francisco, where he worked as a longshoreman until his death on May 21, 1860.

Phineas Gage: The Accident

The incident.

We have all heard of Phineas Gage, who survived a devastating brain injury that changed his personality forever. But what exactly happened to him? In 1848, Gage was a 25-year-old railroad construction foreman working in Vermont. On September 13 that year, he was using a tamping iron to pack explosive powder into a hole when the powder ignited, sending the iron rocketing through his skull.

The iron, 43 inches long and weighing over 13 pounds, entered Gage’s head just below his left cheekbone and exited through the top of his skull, landing several yards away. Miraculously, Gage remained conscious throughout the ordeal and was able to speak within minutes of the accident.

Immediate Aftermath

The immediate aftermath of the accident was chaotic. Gage’s coworkers rushed to his aid and found him sitting up, blood pouring from his head. They took him to a nearby hotel, where a physician named Edward H. Williams examined him. Williams later described the scene: “I first noticed the wound upon the head before I alighted from my carriage, the brain pulsations being very distinct. Mr. Gage, during the time I was examining this wound, was relating how he was injured to the bystanders. I did not believe Mr. Gage’s statement then but thought he was deceived.”

Despite Williams’ skepticism, Gage’s account of the accident was accurate. He was eventually taken to his boarding house, where Dr. John Martyn Harlow attended. Harlow later wrote that “the iron entered the left side of the face, shattering the upper jaw, and passing back of the left eye, tearing the left lobe of the brain, and passing out at the top of the head, carrying with it a portion of the brain and other substances.”

Gage’s survival was miraculous, but it came at a significant cost. The iron had destroyed much of his left frontal lobe, which regulates emotions, personality, and decision-making. Gage’s behavior changed dramatically in the aftermath of the accident, and he became irritable, impulsive, and unpredictable. His story would become one of the most famous case studies in psychology and neuroscience, and it continues to fascinate researchers and laypeople today.

Medical and Psychological Impact

Phineas Gage’s accident had significant medical and psychological consequences. This section will discuss his injury’s physical consequences, behavioral changes, and long-term effects.

Physical Consequences

The iron rod that went through Phineas Gage’s skull damaged much of his frontal lobe, resulting in significant physical consequences. He lost his left eye and partially lost vision in his right eye. Additionally, he suffered from seizures and chronic headaches.

Behavioral Changes

Phineas Gage’s injury also resulted in significant behavioral changes. He became impulsive, irritable, and lacked empathy. He struggled with decision-making and planning, and his personality underwent a complete transformation. His friends and family reported that he was no longer the person he was before the accident.

Long-Term Effects

The long-term effects of Phineas Gage’s injury were significant. He could not return to his previous job as a railroad construction foreman and struggled to maintain employment. He became a circus attraction, traveling around the country as a living example of the effects of brain injury.

Phineas Gage’s case profoundly impacted the field of psychology, as it was one of the first documented cases of the link between brain damage and behavior. It helped researchers understand the role of the frontal lobe in decision-making, planning, and personality.

Significance in Psychology

Phineas Gage’s accident and its aftermath have significantly impacted the field of psychology. It has provided valuable insight into brain function, influenced neuropsychology development, and had implications for personality theory.

Insights into Brain Function

Gage’s injury provided a unique opportunity to study the relationship between the brain and behavior. It demonstrated that damage to specific brain areas can result in profound changes in personality and behavior. It also highlighted the importance of the prefrontal cortex in regulating social behavior, decision-making, and emotional regulation.

Influence on Neuropsychology

Gage’s case was one of the first documented cases of brain injury resulting in significant changes in behavior. It influenced the development of neuropsychology, a field that focuses on the relationship between brain function and behavior. Neuropsychologists use a variety of tests to assess cognitive function, including memory, attention, and language skills. They also use brain imaging techniques like magnetic resonance imaging (MRI) to study the brain’s structure and function.

Implications for Personality Theory

Gage’s case challenged the prevailing view of personality as fixed and unchanging. It demonstrated that brain injury can alter personality and that different parts of the brain are responsible for various aspects of personality. For example, damage to the prefrontal cortex can result in impulsivity, poor judgment, and emotional instability. This has led to theories that emphasize personality’s dynamic nature and the brain’s importance in shaping behavior.

Overall, Phineas Gage’s case has had a lasting impact on psychology. It has provided valuable insights into brain function, influenced neuropsychology development, and challenged prevailing views of personality.

Public Response and Legacy

Public perception.

After Phineas Gage’s accident, his story quickly spread throughout the public. People were fascinated by the idea that a simple iron rod could cause such a dramatic change in a person’s personality. However, the public’s understanding of Gage’s case was often oversimplified and exaggerated. Many people believed that Gage’s accident had turned him into a completely different person when, in reality, the changes were more subtle and complex.

Over time, Gage’s story became a cautionary tale about the dangers of head injuries. It was used to warn people about the potential consequences of traumatic brain injuries and to encourage them to take precautions to protect their heads.

Legacy in Science and Popular Culture

Phineas Gage’s case profoundly impacted the field of psychology and neuroscience. It was one of the first documented cases of a person with a brain injury that affected their personality and behavior. Gage’s case helped to establish the idea that different parts of the brain are responsible for various functions and that damage to these areas can cause specific changes in behavior.

Gage’s story has also had a lasting impact on popular culture. It has been referenced in countless books, movies, and TV shows and has become a symbol of the strange and mysterious workings of the human brain. In recent years, Gage’s case has even been used to promote the idea of neuroplasticity, which suggests that the brain can change and adapt throughout a person’s life.

Overall, Phineas Gage’s accident and its aftermath have left a lasting legacy in both the scientific and popular realms. While the public’s understanding of Gage’s case may be oversimplified, his story’s impact on psychology and neuroscience must be considered.

Frequently Asked Questions

Did phineas gage lose his eye.

No, Phineas Gage did not lose his eye in the accident. However, the iron rod that went through his skull damaged his left eye and caused him to lose vision in that eye.

When did Phineas Gage’s accident happen?

Phineas Gage’s accident happened on September 13, 1848. He was working on a railroad construction crew in Vermont when the iron rod he was using to tamp down blasting powder accidentally ignited the powder, causing the rod to shoot through his skull.

How long did Phineas Gage live after the accident?

Phineas Gage lived for another 12 years after the accident. He suffered from seizures and personality changes due to the damage to his brain, but he could continue living a relatively everyday life until he died in 1860.

How did Phineas Gage survive?

Phineas Gage’s survival is considered a medical miracle. The iron rod that went through his skull destroyed much of his frontal lobe, responsible for many essential functions such as decision-making, personality, and social behavior. However, the fact that the rod went through his brain in a relatively straight line and did not damage other vital areas likely contributed to his survival.

Why did Phineas Gage not feel pain?

It is unclear why Phineas Gage did not feel pain immediately after the accident. Some speculate that the damage to his brain may have affected his ability to perceive pain, while others believe that his body went into shock and he did not feel the pain at the time.

What happened to Phineas Gage, and how did it impact the field of psychology?

Phineas Gage’s accident and subsequent personality changes profoundly impacted the field of psychology. His case was one of the first to suggest a link between brain function and behavior, and it helped to establish the field of neuropsychology. Gage’s story also highlighted the importance of the frontal lobe in regulating personality and decision-making, and it continues to be studied by psychologists and neuroscientists today.

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Language: English | Portuguese

Phineas Gage's great legacy

O grande legado de phineas gage, ricardo vieira teles, filho.

1 Faculty of Medicine, Universidade Federal de Goiás – Goiânia, GO, Brazil.

The case of Phineas Gage is an integral part of medical folklore. His accident still causes astonishment and curiosity and can be considered as the case that most influenced and contributed to the nineteenth century's neuropsychiatric discussion on the mind-brain relationship and brain topography. It was perhaps the first case to suggest the role of brain areas in determining personality and which specific parts of the brain, when affected, can induce specific mental changes. In addition, his case contributed to the emergence of the scientific approaches that would later culminate in psychosurgery. Gage is a fixed element in the studies of neurology, psychology, and neuroscience, having been solidified as one of the greatest medical curiosities of all time, deserving its prominence.

O caso de Phineas Gage é parte integrante do folclore médico. Seu acidente ainda causa espanto e curiosidade, e pode ser considerado como o caso que mais influenciou e contribuiu para a discussão neuropsiquiátrica do século XIX sobre a relação mente-cérebro e topografia cerebral. Foi talvez o primeiro caso a sugerir o papel de áreas cerebrais na determinação da personalidade e que partes específicas do cérebro, quando afetadas, podem induzir mudanças mentais específicas. Além disso, seu caso contribuiu para o surgimento de abordagens cientificas que culminariam posteriormente na psicocirurgia. Gage é um elemento fixo nos estudos de neurologia, psicologia e neurociências, tendo sido solidificado como uma das grandes curiosidades médicas de todos os tempos que merece seu destaque.

THE ACCIDENT

Gage, a 25-year-old male, 1.70 m in height and weighing approximately 70 kg, was employed in railroad construction at the time of the accident. As the company's most capable employee, with a well-balanced mind and a sense of leadership, he was directing a rock-splitting workgroup while preparing the bed of the Rutland & Burlington Railroad south of Cavendish, Vermont, USA. At 4:30 PM on September 13, 1848, he and his group were blasting a rock, and Gage was assigned to put gunpowder in a deep hole inside it. 1

The moment he pressed the gunpowder into the hole with a bar, the friction caused sparks, and the powder exploded. The resulting blast projected the meter-long bar, which was 3.2 cm in diameter and weighed about 6 kg, through his skull at high speed. The bar entered his left cheek, destroyed his eye, passed through the left front of the brain, and finally completely left his head at the top of the skull on the right side. Gage was thrown on his back and had some brief convulsions, but he woke up and spoke in a few minutes, walked with a little help, and sat in an ox cart for the 1.2-km trip to his quarters. 1

In the city about 30 minutes after the accident, Doctor Edward H. Williams arrived to provide medical care. Gage had lost a lot of blood, and his following days were quite difficult. 1 The wound became infected, and Phineas was anemic and remained semicomatose for more than two weeks. He also developed a fungal infection in the exposed brain that needed to be surgically removed. His condition slowly improved after doses of calomel and beaver oil. By mid-November he was already walking around the city. 2

THE CONSEQUENCES

For three weeks after the accident, the wound was treated by doctors. During this time, he was assisted by Dr. John Harlow, who covered the head wound and then reported the case in the Boston Medical Surgery Journal. In November 1849, invited by the professor of surgery at Harvard Medical School, Henry Jacob Bigelow, Harlow took Gage to Boston and introduced him to a meeting of the Boston Society for Medical Improvement ( Figure 1 ). 3

In his reports, Harlow described that the physical injury profoundly altered Gage's personality. Although his memory, cognition and strength had not been altered, his once gentle personality slowly degraded. He became a man of bad and rude ways, disrespectful to colleagues, and unable to accept advice. His plans for the future were abandoned, and he proceeded without thinking about the consequences. 4 And here was the main point of this curious story: Gage became irritable, irreverent, rude and profane, aspects that were not part of his way of being. His mind had changed radically. His transformation was so great that everyone said that “Gage is no longer himself.” 5

As a result of this personality change, he was fired for indiscipline and could no longer hold a steady job. He became a circus attraction and even tried life in Chile, later returning to the United States. However, there is something still little known about Gage: his personality changes lasted for about four years, slowly reverting later. As a proof of this, he worked as a long-haul driver in Chile, a job that required considerable planning and focus skills. He died on May 21, 1861, 12 years after the accident, from an epileptic seizure that was almost certainly related to his brain injury. He was not submitted to an autopsy, but his mother, after exhumation of the body, donated his skull and iron rod at the request of Dr. Harlow, which, in turn, sometime later donated them to Harvard University ( Figure 2 ). 1

Gage's case is considered to be one of the first examples of scientific evidence indicating that damage to the frontal lobes may alter personality, emotions and social interaction. 6 Prior to this case, the frontal lobes were considered silent structures, without function and unrelated to human behavior. Scottish neurologist, David Ferrier, was motivated by this fact to investigate the role of frontal lobes in brain function. Ferrier removed the frontal lobes in monkeys and noted that there were no major physiological changes, but the character and behavior of the animals were altered. 7

Knowledge that the frontal lobe was involved with emotions continued to be studied. The surgeon Burkhardt in 1894 performed a series of surgeries in which he selectively destroyed the frontal lobes of several patients in whom he thought might control psychotic symptoms, being the modern prototype of what was later known through Egas Moniz as psychosurgery. 7 Today, it is well understood that the prefrontal cortex of the brain controls the organization of behavior, including emotions and inhibitions.

Folkloric as it may be, but nonetheless remarkable, the contribution of Phineas Gage's case should not be overlooked, as it provided scientists the baseline for the promotion of studies in neuropsychiatry, and a source of inspiration for world medicine. 8 In 2012, a team of neuroscientists used computed tomography of Gage's skull with typical brain MRI scans to show how the Gage brain connection could have been affected. 9 And it is not just the researchers who keep coming back to Gage. Medical and psychology students still learn about Gage from their history lessons. Neurosurgeons and neurologists still sometimes use Gage as a reference when evaluating certain cases. 10 The final chapter of his life also offers us a thought-provoking learning about cases of massive brain damage, showing us that rehabilitation may be possible. 11

Therefore, Gage — inadvertently — made a huge contribution to neurology in several areas, including the study of brain topography in behavioral disorders, the development of psychosurgery, and finally the study of brain rehabilitation. Also, Gage's case had a tremendous influence on early neuropsychiatry. The specific changes observed in his behavior pointed to theories about the localization of brain function and correlated with cognitive and behavioral sequelae, thereby acquainting us with the role of the frontal cortex in higher-order actions such as reasoning, behavior and social cognition. In those years, while neuropsychiatry was in its infancy, Gage's extraordinary story served as one of the first pillars of evidence that the frontal lobe is involved in personality, which helped solidify his remarkable legacy in world medical history.

This study was conducted at the Universidade Federal de Goiás, Goiânia, GO, Brazil.

Funding: none.

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Phineas Gage: His Accident and Impact on Psychology

Author unknown / Wikimedia Commons

• Phineas Gage's Accident
• Change in Personality
• Severity of Brain Damage
• Impact on Psychology

What Happened to Phineas Gage After the Brain Damage?

Phineas Gage is often referred to as the "man who began neuroscience." He experienced a traumatic brain injury when an iron rod was driven through his skull, destroying much of his frontal lobe .

Gage miraculously survived the accident. However, his personality and behavior were so changed as a result of the frontal lobe damage that many of his friends described him as an almost different person entirely. The impact that the accident had has helped us better understand what the frontal lobe does, especially in relation to personality .

At a Glance

In 1848, Phineas Gage had a workplace accident in which an iron tamping rod entered and exited his skull. He survived but it is said that his personality changed as a result, leading to a greater understanding of the brain regions involved in personality, namely the frontal lobe.

Phineas Gage's Accident

On September 13, 1848, 25-year-old Gage was working as the foreman of a crew preparing a railroad bed near Cavendish, Vermont. He was using an iron tamping rod to pack explosive powder into a hole.

Unfortunately, the powder detonated, sending the 43-inch-long, 1.25-inch-diameter rod hurling upward. The rod penetrated Gage's left cheek, tore through his brain , and exited his skull before landing 80 feet away.

Gage not only survived the initial injury but was able to speak and walk to a nearby cart so he could be taken into town to be seen by a doctor. He was still conscious later that evening and able to recount the names of his co-workers. Gage even suggested that he didn't wish to see his friends since he would be back to work in "a day or two" anyway.

The Recovery Process

After developing an infection, Gage spent September 23 to October 3 in a semi-comatose state. On October 7, he took his first steps out of bed, and, by October 11, his intellectual functioning began to improve.

Descriptions of Gage's injury and mental changes were made by Dr. John Martyn Harlow. Much of what researchers know about the case is based on Harlow's observations.

Harlow noted that Gage knew how much time had passed since the accident and remembered clearly how the accident occurred, but had difficulty estimating the size and amounts of money. Within a month, Gage was well enough to leave the house.

In the months that followed, Gage returned to his parent's home in New Hampshire to recuperate. When Harlow saw Gage again the following year, the doctor noted that while Gage had lost vision in his eye and was left with obvious scars from the accident, he was in good physical health and appeared recovered.

Theories About Gage's Survival and Recovery

The type of injury sustained by Phineas Gage could have easily been fatal. While it cannot be said with certainty why Gage was able to survive the accident, let alone recover from the injury and still function, several theories exist. They include:

• The rod's path . Some researchers suggest that the rod's path likely played a role in Gage's survival in that if it had penetrated other areas of the head—such as the pterygoid plexuses or cavernous sinus—Gage may have bled to death.
• The brain's selective recruitment . In a 2022 study of another individual who also had an iron rod go through his skull—whom the researchers referred to as a "modern-day Phineas Gage"—it was found that the brain is able to selectively recruit non-injured areas to help perform functions previously assigned to the injured portion.
• Work structure . Others theorize that Gage's work provided him structure, positively contributing to his recovery and aiding in his rehabilitation.

How Did Phineas Gage's Personality Change?

Popular reports of Gage often depict him as a hardworking, pleasant man before the accident. Post-accident, these reports describe him as a changed man, suggesting that the injury had transformed him into a surly, aggressive heavy drinker who was unable to hold down a job.

Harlow presented the first account of the changes in Gage's behavior following the accident. Where Gage had been described as energetic, motivated, and shrewd prior to the accident, many of his acquaintances explained that after the injury, he was "no longer Gage."

Severity of Gage's Brain Damage

Since there is little direct evidence of the exact extent of Gage's injuries aside from Harlow's report, it is difficult to know exactly how severely his brain was damaged. Harlow's accounts suggest that the injury did lead to a loss of social inhibition, leading Gage to behave in ways that were seen as inappropriate.

In a 1994 study, researchers utilized neuroimaging techniques to reconstruct Phineas Gage's skull and determine the exact placement of the injury. Their findings indicate that he suffered injuries to both the left and right prefrontal cortices, which would result in problems with emotional processing and rational decision-making .

Another study conducted in 2004 used three-dimensional, computer-aided reconstruction to analyze the extent of Gage's injury. It found that the effects were limited to the left frontal lobe.

In 2012, new research estimated that the iron rod destroyed approximately 11% of the white matter in Gage's frontal lobe and 4% of his cerebral cortex.

Some evidence suggests that many of the supposed effects of the accident may have been exaggerated and that Gage was actually far more functional than previously reported.

Why Is Phineas Gage Important to Psychology?

Gage's case had a tremendous influence on early neurology. The specific changes observed in his behavior pointed to emerging theories about the localization of brain function, or the idea that certain functions are associated with specific areas of the brain.

In those years, neurology was in its infancy. Gage's extraordinary story served as one of the first sources of evidence that the frontal lobe was involved in personality.

Today, scientists better understand the role that the frontal cortex has to play in important higher-order functions such as reasoning , language, and social cognition .

After the accident, Gage was unable to continue his previous job. According to Harlow, Gage spent some time traveling through New England and Europe with his tamping iron to earn money, supposedly even appearing in the Barnum American Museum in New York.

He also worked briefly at a livery stable in New Hampshire and then spent seven years as a stagecoach driver in Chile. He eventually moved to San Francisco to live with his mother as his health deteriorated.

After a series of epileptic seizures, Gage died on May 21, 1860, almost 12 years after his accident. Seven years after his death, Gage's body was exhumed. His brother gave his skull and the tamping rod to Dr. Harlow, who subsequently donated them to the Harvard University School of Medicine. They are still exhibited in its museum today.

Bottom Line

Gage's accident and subsequent experiences serve as a historical example of how case studies can be used to look at unique situations that could not be replicated in a lab. What researchers learned from Phineas Gage's skull and brain injury played an important role in the early days of neurology and helped scientists gain a better understanding of the human brain and the impact that damage could have on both functioning and behavior.

Sevmez F, Adanir S, Ince R. Legendary name of neuroscience: Phineas Gage (1823-1860) . Child's Nervous System . 2020. doi:10.1007/s00381-020-04595-6

Twomey S. Phineas Gage: Neuroscience's most famous patient .  Smithsonian Magazine.

Harlow JM. Recovery after severe injury to the head . Bull Massachus Med Soc . 1848. Reprinted in  Hist Psychiat. 1993;4(14):274-281. doi:10.1177/0957154X9300401407

Harlow JM. Passage of an iron rod through the head . 1848. J Neuropsychiatry Clin Neurosci . 1999;11(2):281-3. doi:10.1176/jnp.11.2.281

Itkin A, Sehgal T. Review of Phineas Gage's oral and maxillofacial injuries . J Oral Biol . 2017;4(1):3.

de Freitas P, Monteiro R, Bertani R, et al. E.L., a modern-day Phineas Gage: Revisiting frontal lobe injury . The Lancet Regional Health - Americas . 2022;14:100340. doi:10.1016/j.lana.2022.100340

Macmillan M, Lena ML. Rehabilitating Phineas Gage . Neuropsycholog Rehab . 2010;20(5):641-658. doi:10.1080/09602011003760527

O'Driscoll K, Leach JP. "No longer Gage": An iron bar through the head. Early observations of personality change after injury to the prefrontal cortex . BMJ . 1998;317(7174):1673-4. doi:10.1136/bmj.317.7174.1673a

Damasio H, Grabowski T, Frank R, Galaburda AM, Damasio AR. The return of Phineas Gage: Clues about the brain from the skull of a famous patient . Science . 1994;264(5162):1102-5. doi:10.1126/science.8178168

Ratiu P, Talos IF. Images in clinical medicine. The tale of Phineas Gage, digitally remastered . N Engl J Med . 2004;351(23):e21. doi:10.1056/NEJMicm031024

Van Horn JD, Irimia A, Torgerson CM, Chambers MC, Kikinis R, Toga AW. Mapping connectivity damage in the case of Phineas Gage . PLoS One . 2012;7(5):e37454. doi: 10.1371/journal.pone.0037454

Macmillan M. An Odd Kind of Fame: Stories of Phineas Gage . MIT Press.

Shelley B. Footprints of Phineas Gage: Historical beginnings on the origins of brain and behavior and the birth of cerebral localizationism . Archives Med Health Sci . 2016;4(2):280-6. doi:10.4103/2321-4848.196182

By Kendra Cherry, MSEd Kendra Cherry, MS, is a psychosocial rehabilitation specialist, psychology educator, and author of the "Everything Psychology Book."

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Lessons of the brain: The Phineas Gage story

Harvard Correspondent

In 1848, an iron bar pierced his brain, his case providing new insights on both trauma and recovery

Imagine the modern-day reaction to a news story about a man surviving a three-foot, 7-inch, 13½-pound iron bar being blown through his skull — taking a chunk of his brain with it.

Then imagine that this happened in 1848, long before modern medicine and neuroscience. That was the case of Phineas Gage.

Whether the Vermont construction foreman, who was laying railroad track and using explosives at the time of the industrial accident, was lucky or unlucky is a judgment that Warren Anatomical Museum curator Dominic Hall puzzles over to this day.

“It is an impossible question, because he was extraordinarily unlucky to have an iron bar borne through his skull, but equally lucky to have survived, on such a low level of care,” said Hall. “We are lucky, to have him.”

Gage’s skull, along with the tamping iron that bore through it, are two of the approximately 15,000 artifacts and case objects conserved at the Warren, which is a part of the Center for the History of Medicine in Harvard’s Francis A. Countway Library of Medicine .

The resultant change in Gage’s personality — when he went from being well-liked and professionally successful to being “fitful, irreverent, and grossly profane, showing little deference for his fellows” and unable to keep his job — is widely cited in modern psychology as the textbook case for post-traumatic social disinhibition.

But as the years have gone by and we’ve learned more about his life, argued Hall, the teachings have changed.

“In 1848, he was seen as a triumph of human survival. Then, he becomes the textbook case for post-traumatic personality change. Recently, people interpret him as having found a form of independence and social recovery, which he didn’t get credit for 15 years ago.”

When Gage died 12 years after the accident, following epileptic seizures, his body was exhumed, while his skull and tamping iron were sent to the physician who had cared for him since the accident, John Harlow. Harlow later donated the items to the Warren, where they have remained for 160 years.

“In many ways, I see Gage similarly to how you would see a portrait of one of the famous professors hanging on the wall — he’s an important part of Harvard Medical School’s identity,” said Hall. “By continually reflecting on his case, it allows us to change how we reflect on the human brain and how we interact with our historical understanding of neuroscience.”

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41 Phineas Gage: A Neuropsychological Perspective of a Historical Case Study

Alan G. Lewandowski, Clinical Neuropsychologist, Neuropsychology Associates

Joshua D. Weirick, Post-Doctoral Research Fellow, Department of Speech, Language and Hearing Sciences, Purdue University

Caroline A. Lewandowski, Private Practice

Jack Spector, Clinical Neuropsychologist, Independent Practice

• Published: 07 May 2020
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• Permissions Icon Permissions

The case of Phineas Gage is one of the most frequently cited cases from 19th century medical literature and represents the first of a series of famous cases involving the brain and behavior. While many reiterations of Gage’s case have been published, it remains important to modern neuroscience due to its unique historical significance, ongoing clinical relevance, and the insights it offers neuropsychology into the functional effects of brain injury on thinking, emotions, and behavior. This chapter revisits the critical aspects of this landmark case from a contemporary clinical perspective and discusses the implications of injury to the prefrontal cortex and pathways.

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• CAREER Q&A
• 01 February 2023

How a grisly historical accident set one neuroscientist on the road to writing a book

• Emily Cooke 0

Emily Cooke is a writer and communications professional based in London.

You can also search for this author in PubMed   Google Scholar

Chantal Prat (right) with her daughter Jasmine, wearing an electrode cap. Credit: Shaya Lyon

Chantel Prat researches individual differences in language processing and cognition at the University of Washington in Seattle. Her first book, The Neuroscience of You , explains how human brains work, how they help us to survive and why we should embrace our uniqueness. Published last year, it has been praised by numerous outlets and is a bestseller at the Elliot Bay Book Company, Prat’s favourite Seattle book shop.

When did you first fall in love with the brain?

I was 17 years old and in a pre-med programme at the University of California, San Diego. In one of my first psychology classes, we learnt about the railway construction foreman Phineas Gage, who had a metre-long spike forced through his frontal lobe in a work accident in 1848. Gage walked away from this gory accident with most of his physical abilities intact, but the things that made him him — his way of thinking, feeling and behaving — changed.

Once a very dependable man, he became much more unpredictable. The way an injury to Gage’s brain changed his personality was my first insight into the relationship between the mind and the brain at the level of the individual, and the differences in the ways that brains work that make you you.

John Polich — my instructor in the honours programme and a neuroscientist who studied cognitive psychology for his PhD — advised me to study psychology, to see how the brain gives rise to human experience. Back then, neuroscientific insight was limited, because the field was relatively new.

Phineas Gage holds the tamping iron that was driven through his head in 1848. He lived for a further 12 years. Credit: GL Archive/Alamy

Two years after that pre-med programme, my daughter Jasmine was born. I was a single mum, both as an undergraduate and a graduate student.

(Alongside the brain, and horses, Jasmine is the other love of my life.)

I first recorded Jasmine’s brain when she was 17 months old. She helped me get my first job, because the cognitive neuroscience lab I wanted to join at UC San Diego wanted people with baby-charming experiences. Getting a baby to wear an electrode cap (like a swimming cap with devices sewn into it that allow us to eavesdrop on the electrical activity of the brain) is still one of the hardest jobs in neuroscience, I think.

What inspired you to write The Neuroscience of You ?

In 2016, talking to my husband Andrea Stocco — a fellow cognitive neuroscientist here at Washington — I wondered why people are so often convinced that they’re right. If I can show how different brains make different inferences in the same situation, maybe I can get them to relax their view that their reality is the only reality.

I thought it was important to give people concrete data about the ways that different brains understand the world because it might help us connect with and understand others who work differently. I wanted to walk someone to the point in the book where they can be curious about different opinions, rather than feeling threatened about their own beliefs.

As a first step, I collected names of agents from people I knew who either had written books or were thinking about it. I then started calling them, describing myself and my book idea. I was surprised by how many thought these ideas were new, because most books said brains work with a one-size-fits-all approach. My agent, Margo Beth Fleming, was a clear match in terms of her expertise, portfolio, communication style and the kind of coaching and support I felt I needed. She has been a lighthouse for this whole process.

What was your experience of writing The Neuroscience of You ?

In 2019, I attended the Tribeca Film Festival in New York City because a movie showing there — I am Human , which explores advances in neurotechnology by following three people with neurological conditions — features my research. While I was there I met with representatives of different publishing houses.

Jill Schwartzman, who became my editor at Penguin, asked if I had time to write the book. I was really underprepared. I thought I had time in my schedule, but I still had to do my academic work.

Then, six months in, the pandemic blew everything up. My brain responded to it in a way that seemed very different from the people around me. Some were getting into the best shape of their lives. Others were cooking more than ever. I started thinking about stress and cortisol in the brain and realized that our genes and our neurotransmitters influence the way we respond to stress.

Writing the book was both a scary and a vulnerable thing — I share lots of personal information. The response has been overwhelmingly positive. People reach out on my website and tell me about themselves, reciprocating personal things and how important it is for them because they’re struggling with something — Parkinson’s disease, for example. My agent said I would have conversations with thousands of people I’d never meet, which is really cool.

What advice would you give to a researcher wanting to write a popular-science book?

Start with an idea that you love, then get people you trust — an editor, agent or fellow author — to talk you through the process. You might not know what is missing, so expert guidance is important.

Also, talk to other scientists who have written books. I received recommendations for agents and guidance on proposal writing, for example.

I remember my agent asking what I thought was important in an imprint, and I had no idea what one was. I thought it was a font. (It’s a trade or brand name used by publishers to market books to different consumer segments.) She showed me a family tree of publishing houses, explaining imprints, their specializations, audiences and expertise. Without a guide, I would have been very lost.

I write in the book that it is more about ‘finding your lane’ than ‘winning a race’, which is good writing advice. Don’t compare yours to other books. If you’ve found your lane, occupy that space and enjoy it.

The historian Margaret O’Mara, author of the 2019 book The Code about Silicon Valley, gave me valuable advice — divide stuff into what you have to do, what you want to do and what others want you to do. This puts your workload in perspective.

With the book-promotion schedule, I did 12-hour days of radio tours at first. I still do three to four interviews a week — whether podcasts, radio or other media.

The nice thing about an academic book is that, unlike a popular title that comes out with a buzz that fades, this is science — it will be true in six months, so I’m pacing myself.

Inevitably, it will come back to bite me at some point and I will have to say no to more, but it is really exciting. In March, for example, I’ll be giving a talk at the Osher Lifelong Learning Institute at the University of Washington, for people over the age of 50. Opportunities like these remind me why I am excited, connecting with lifetime learners and discussing individual differences.

doi: https://doi.org/10.1038/d41586-023-00291-y

This interview has been edited for length and clarity.

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Who Was Phineas Gage?

Categories Biopsychology

Phineas Gage was a young man seriously injured in a work-related accident. So what makes him so significant in psychology? His brain injury was shocking and the result impact on his personality quickly became one of the most famous case studies in psychology and neuroscience.

Table of Contents

Phineas Gage: A Closer Look

On September 13, 1848, a 25-year-old railroad foreman named Phineas Gage was injured in a horrific accident. While using an iron rod to tamp explosive powder into a hole, the powder ignited and sent the 43-inch long rod hurtling upward. The rod pierced through Gage’s cheek, passing though the frontal lobe of his brain before exiting the top of his skull and landing approximately 80 feet away.

Amazingly, Gage not only survived the accident, he also went on to become one of the earliest and most famous cases in the then just emerging field of  neurology .

  A View of the Accident Site

This image depicts an area of railroad approximately three-quarters of a mile outside of Cavendish, Vermont. It was in this area where Gage was working for former Rutland & Burlington Railroad to prepare the railroad bed. It was in this area or a site nearby that Gage suffered from the accident that would change his life and make him famous in the annals of neurology.

News of Gage’s Accident

The above news clipping appeared in the  Boston Post  on September 21, 1848.

The article states:

“ Horrible Accident  – As Phineas P. Gage, a foreman on the railroad in Cavendish, was yesterday engaged in tamping for a blast, the powder exploded, carrying an instrument through his head an inch in length, which he was using at the time. The iron entered on the side of his face, shattering the upper jaw, and passing back of the left eye, and out at the top of the head. The most singular circumstance connected with this melancholy affair is, that he was alive at two o’clock this afternoon, and in full possession of his reason, and free from pain.”

The piece contains a few inaccuracies, including suggesting that Gage’s jaw was shattered and understating the dimensions of the projectile. His attending doctor, John Martyn Harlow, kept notes on the case as it progressed, which he later published. While he described Gage as conscious and rational in the immediate aftermath of the accident, the man was certainly not “free from pain” as the above article suggested. In the days and weeks that followed, Gage would lapse into a state of delirium, followed by a semi-comatose state brought on by an infection.

An Illustration of Gage’s Injury

This image depicts the path of the iron rod through Gage’s skull. The illustration was included in Dr. Harlow’s account of the accident and subsequent impact on Gage, which was first published in 1868 in the  Bulletin of the Massachusetts Medical Society .

“The missile entered by its pointed end, the left side of the face, immediately anterior to the angle of the lower jaw, and passing obliquely upwards, and obliquely backwards, emerged in the median line, at the back part of the frontal bone near the coronal suture,” Harlow wrote.

The Extent of Gage’s Brain Injury

Today, researchers have only Harlow’s description of the injury and examinations of Gage’s actual skull and the tamping rod to provide evidence of the type of injury that was sustained. Several different studies have been conducted to try to determine exactly how much of Gage’s brain was affected by the projectile. One 1994 study suggested that both prefrontal cortices were affected, while a 2004 study indicated that the damage was limited to the left frontal lobe. In 2012, a new study estimated that approximately 11-percent of Gage’s frontal lobe was destroyed and that 4-percent of his cerebral cortex was impacted.

While we will never be able to tell the exact extent of the damage, we do know that a significant portion of his frontal lobe was damaged.

The frontal lobe plays a vital role in problem-solving, decision-making, and planning. The area known as the prefrontal cortex is associated with the expression of personality. Other functions associated with the frontal lobe including reasoning, judgment, and impulse control.

In Harlow’s descriptions of Gage after the accident, he suggests that Gage would often make plans but fail to carry them out and that many of his friends described his personality as greatly changed, to the point that they felt he was “no longer Gage.”

Phineas Gage Life Mask

Prior to the 2009 and 2010 discovery of photographs of Phineas Gage, the only existing depiction that existed was a life mask made of his face and skull. The life mask was made for Henry Jacob Bigelow sometime around 1849 or 1850. Bigelow was a surgeon and professor at Harvard who published an article in  American Journal of the Medical Sciences  on Gage’s case, which helped generate considerable attention. Today, the life mask can be seen at the Warren Anatomical Museum at the Harvard University School of Medicine.

A Second Portrait of Phineas Gage

The second known photo of Phineas Gage came to light in 2010. The image was in the possession of members of Gage’s family. Like the previously seen portrait, Gage is shown proudly holding the tamping iron that so dramatically altered his life.

Gage’s Skull and the Famous Tamping Iron

Gage died in 1860 following a series of epileptic seizures, just 12 and a half years after his accident. In 1866, Harlow requested that the family exhume the body. The skull was removed and sent to Harlow, along with the iron tamping bar that had been in Gage’s possession at the time of his death. Today, both the skull and the iron rod can be seen at Harvard Medical School’s Warren Anatomical Museum.

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41 Phineas Gage: A Neuropsychological Perspective of a Historical Case Study

Alan G. Lewandowski, Clinical Neuropsychologist, Neuropsychology Associates

Joshua D. Weirick, Post-Doctoral Research Fellow, Department of Speech, Language and Hearing Sciences, Purdue University

Caroline A. Lewandowski, Private Practice

Jack Spector, Clinical Neuropsychologist, Independent Practice

• Published: 07 May 2020
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The case of Phineas Gage is one of the most frequently cited cases from 19th century medical literature and represents the first of a series of famous cases involving the brain and behavior. While many reiterations of Gage’s case have been published, it remains important to modern neuroscience due to its unique historical significance, ongoing clinical relevance, and the insights it offers neuropsychology into the functional effects of brain injury on thinking, emotions, and behavior. This chapter revisits the critical aspects of this landmark case from a contemporary clinical perspective and discusses the implications of injury to the prefrontal cortex and pathways.

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How Phineas Gage’s Freak Accident Changed Brain Science

Vermont Historian Explains How A Railway Accident Paved The Way for Neurosurgery And More

Cavendish might look like any other small Vermont town. Nestled between rolling hills and the Black River, with one main street running through town, it’s a launching point for trout anglers, snowmobilers and skiers. But this rural town of just over a thousand people can claim a remarkable historical figure: Phineas Gage .

Gage was a young construction foreman who suffered a gruesome accident that changed the history of brain science.

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In 1848, while blasting through rock to build the new railroad, an explosion sent a 3-foot, 13-pound iron rod up through his cheekbone and out the top of his skull. The tamping rod landed 80 feet away, “ smeared with blood and brain .”

Remarkably, Gage lived for another 11 years. He lost one eye and had a permanent hole in his skull, covered by a thin layer of skin.

Gage was a medical marvel.

There had been a long-running debate in the 19th century on whether different regions in the brain govern different behaviors. Here was a case of severe damage to the left frontal lobe, followed by a dramatic personality shift. It seemed to prove the point once and for all.

“It laid the path for the first real brain surgery in 1885 ,” said Margo Caulfield, director of the Cavendish Historical Society, told “ To the Best of Our Knowledge .” “It opened up a whole new horizon. You can survive a brain injury, you can touch the brain, which means you can do surgery. It’s really, really huge.”

Gage himself was never the same after the accident.

He’d been well-liked by his co-workers and his employer, but later, his doctor reported that he became “ fitful, irreverent, indulging at times in the grossest profanity .”

A friend said, “ Gage is no longer Gage .”

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Gage was unable to work on the railroad, but he still needed a job.

For a while, he made money by exhibiting himself around New England as a curiosity, showing off the holes in his head and his famous tamping iron.

Then, he was offered a job as a long-distance stagecoach driver on the Val Paraiso-Santiago route in Chile. It was a 100-mile route, and 13 hours of handling a coach and six horses, plus passengers, over rough terrain.

Gage lived in Chile for seven years and then started having epileptic seizures.

He died in 1860 at the age of 36.

Over the years, scientists have interpreted Gage’s story in different ways.

At first, he was seen as a triumph of human survival. Then for decades he became a textbook case for post-traumatic personality change. More recently, Gage’s case has been interpreted as a story of resilience. For a man who was supposedly anti-social and volatile, Gage’s ability to hold onto a challenging job in Chile suggests he’d regained his independence and social adaptability.

Perhaps Gage’s story is a textbook case of another sort, showing the brain’s capacity for rewiring after trauma. This gift of neuroplasticity is why we’re able to handle so much that life throws at us.

“I am fascinated by what he overcame to survive for as long as he did,” Caulfield said. “The resiliency piece of his story fascinates me … I think resiliency is just hard-wired into our DNA.”

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Why Brain Scientists Are Still Obsessed With The Curious Case Of Phineas Gage

Jon Hamilton

Cabinet-card portrait of brain-injury survivor Phineas Gage (1823–1860), shown holding the tamping iron that injured him. Wikimedia hide caption

Cabinet-card portrait of brain-injury survivor Phineas Gage (1823–1860), shown holding the tamping iron that injured him.

It took an explosion and 13 pounds of iron to usher in the modern era of neuroscience.

In 1848, a 25-year-old railroad worker named Phineas Gage was blowing up rocks to clear the way for a new rail line in Cavendish, Vt. He would drill a hole, place an explosive charge, then pack in sand using a 13-pound metal bar known as a tamping iron.

But in this instance, the metal bar created a spark that touched off the charge. That, in turn, "drove this tamping iron up and out of the hole, through his left cheek, behind his eye socket, and out of the top of his head," says Jack Van Horn , an associate professor of neurology at the Keck School of Medicine at the University of Southern California.

Gage didn't die. But the tamping iron destroyed much of his brain's left frontal lobe, and Gage's once even-tempered personality changed dramatically.

"He is fitful, irreverent, indulging at times in the grossest profanity, which was not previously his custom," wrote John Martyn Harlow, the physician who treated Gage after the accident.

This sudden personality transformation is why Gage shows up in so many medical textbooks, says Malcolm Macmillan, an honorary professor at the Melbourne School of Psychological Sciences and the author of An Odd Kind of Fame: Stories of Phineas Gage.

"He was the first case where you could say fairly definitely that injury to the brain produced some kind of change in personality," Macmillan says.

And that was a big deal in the mid-1800s, when the brain's purpose and inner workings were largely a mystery. At the time, phrenologists were still assessing people's personalities by measuring bumps on their skull.

Gage's famous case would help establish brain science as a field, says Allan Ropper , a neurologist at Harvard Medical School and Brigham and Women's Hospital.

One Account Of Gage's Personality Shift

Dr. John Harlow, who treated Gage following the accident, noted his personality change in an 1851 edition of the American Phrenological Journal and Repository of Science.

"If you talk about hard core neurology and the relationship between structural damage to the brain and particular changes in behavior, this is ground zero," Ropper says. It was an ideal case because "it's one region [of the brain], it's really obvious, and the changes in personality were stunning."

So, perhaps it's not surprising that every generation of brain scientists seems compelled to revisit Gage's case.

For example:

• In the 1940s, a famous neurologist named Stanley Cobb diagrammed the skull in an effort to determine the exact path of the tamping iron.
• In the 1980s, scientists repeated the exercise using CT scans.
• In the 1990s, researchers applied 3-D computer modeling to the problem.

And, in 2012, Van Horn led a team that combined CT scans of Gage's skull with MRI scans of typical brains to show how the wiring of Gage's brain could have been affected .

"Neuroscientists like to always go back and say, 'we're relating our work in the present day to these older famous cases which really defined the field,' " Van Horn says.

And it's not just researchers who keep coming back to Gage. Medical and psychology students still learn his story. And neurosurgeons and neurologists still sometimes reference Gage when assessing certain patients, Van Horn says.

"Every six months or so you'll see something like that, where somebody has been shot in the head with an arrow, or falls off a ladder and lands on a piece of rebar," Van Horn says. "So you do have these modern kind of Phineas Gage-like cases."

Two renderings of Gage's skull show the likely path of the iron rod and the nerve fibers that were probably damaged as it passed through. Van Horn JD, Irimia A, Torgerson CM, Chambers MC, Kikinis R, et al./Wikimedia hide caption

Two renderings of Gage's skull show the likely path of the iron rod and the nerve fibers that were probably damaged as it passed through.

There is something about Gage that most people don't know, Macmillan says. "That personality change, which undoubtedly occurred, did not last much longer than about two to three years."

Gage went on to work as a long-distance stagecoach driver in Chile, a job that required considerable planning skills and focus, Macmillan says.

This chapter of Gage's life offers a powerful message for present day patients, he says. "Even in cases of massive brain damage and massive incapacity, rehabilitation is always possible."

Gage lived for a dozen years after his accident. But ultimately, the brain damage he'd sustained probably led to his death.

He died on May 21, 1860, of an epileptic seizure that was almost certainly related to his brain injury.

Gage's skull, and the tamping iron that passed through it, are on display at the Warren Anatomical Museum in Boston, Mass.

• Brain research
• neuroscience
• Brain injuries

Phineas Gage

In this post

You may have already heard of Phineas Gage, such is his infamous history with psychology. He was working on a railway line in the USA when there was an explosion, which resulted in an iron rod being fired through his head. He survived the accident even though there were serious injuries to his face and brain but it was soon discovered that in terms of his personality, he was completely different after the accident than he was before it.

Before the accident he was described as a very calm man who was very popular, but afterwards he was considered to be rude and irresponsible.

Gage died 12 years after the accident and after hearing of his death, his doctor, John Harlow, who had worked with him at the time of his accident, asked for his body to be exhumed so that he could look at his skull and try to identify how this caused the change in his personality.

Many years later, Damasio and her colleagues were able to make use of much better technology to further investigate the damage that had been caused to Phineas Gage’s brain and the effects that this had on his personality.

Damasio et al. aimed to build a replica model of Gage’s skull (using the actual skull as a guide) so that they could show exactly where the iron rod entered and exited Gage’s head.

A 3D representation of the skull and the injuries it received meant that it was much clearer which parts of his brain would have been affected by the accident and Damasio et al. wanted to see if any other areas of the brain had also been damaged.

• Pictures and measurements of Gage’s skull were taken
• A 3D replica model was built based on the information from the skull
• Information was also taken from the iron rod (which had been buried with Gage!)
• Information from the rod and the skull together meant that the trajectory of the iron rod could be accurately mapped
• Altogether 20 different points of entry and 16 points of exit were identified and the five most likely paths were chosen
• Each of these five paths were explored to map out which areas of Gage’s brain would have been damaged by each path.

It was thought that damage to both the left and right hemispheres of the brain were likely and that no other area than the frontal lobe would have been affected.

The iron rod would have gone through Gage’s left eye socket and then upwards in its trajectory. This means that rather than affecting the right frontal lobe, only the white matter (tissue containing nerve fibres) in the brain’s left hemisphere would have been affected. However, this meant that neural messages in this area of the brain would not have been transmitted because white matter is where neurons pass messages along axon fibres.

The findings from the 3D model and its implications for the parts of the brain that were thought to be damaged were compared to reports of the changes in Gage’s personality. It was concluded that a specific area of the frontal lobe (the ventromedial area) is responsible for making controlled decisions, regulating impulses and urges and dealing with emotions in a proper way.

These findings were compared to 12 other individuals who had experienced similar brain injuries and the same problems with control and impulse were found, showing that it is likely possible to predict the behaviour of people who have sustained this kind of brain injury.

Strengths of the study

• Modern-day technology is very reliable and therefore the 3D model that was created would have been very accurate and information could be ‘seen’ rather than just guessed at from written reports
• Predictions can now be made about people’s behaviour when they have experienced injuries in specific areas of the brain; this can help people to adjust to new lifestyles and may help in treating them as well.

Weaknesses of the study

• Information about the change in Gage’s personality were gleaned from details written more than a century ago, meaning its accuracy is questionable
• As this was a case study, it is difficult to generalise the findings to a wider population so predictions about possible changes in behaviour may not be applicable to everyone.

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Fascinating Case Studies for A-Level Psychology

Human behaviour is a vast and intricate tapestry, woven from countless psychological threads we are still trying to unwind through scientific study. To truly understand the complexities of why we think, feel, and act the way we do, psychologists often turn to case studies.

These detailed examinations of individuals or groups provide profound insights into various psychological phenomena. In this blog post, we will explore some of the most fascinating case studies covered in A-level Psychology, shedding light on the diverse aspects of human behaviour.

The Story of Phineas Gage: A Journey into the Brain

One of the most iconic case studies in psychology is that of Phineas Gage, a railroad construction foreman who survived a traumatic brain injury in 1848. Gage's story is not only remarkable due to his survival but also because of the profound changes in his personality and behaviour that followed the accident.

Gage was working with explosives when a tamping iron was accidentally driven through his skull, entering his left cheek and exiting through the top of his head. Astonishingly, Gage remained conscious and was able to walk and talk immediately after the incident. However, the injury severely damaged his frontal lobes, particularly the prefrontal cortex, which is associated with decision-making, social behaviour, and personality.

Before the accident, Gage was described as a hardworking, responsible, and sociable individual. After the injury, his behaviour changed drastically. He became impulsive, irritable, and prone to inappropriate social behaviour. This dramatic transformation provided early evidence of the role of the frontal lobes in personality and self-control, illustrating how brain injuries can alter human behaviour.

Little Albert: Unveiling the Mechanics of Fear

The case of Little Albert is another cornerstone in the study of human behaviour, particularly in understanding how emotions can be conditioned. Conducted by John B. Watson and Rosalie Rayner in 1920, this controversial experiment aimed to demonstrate that fear could be learned through classical conditioning.

Little Albert, an 11-month-old baby, was exposed to various stimuli, including a white rat, a rabbit, and a dog, to which he initially showed no fear. Watson and Rayner then paired the presence of the white rat with a loud, frightening noise. After several pairings, Albert began to exhibit fear responses not only to the white rat but also to other similar objects, such as a fur coat and a Santa Claus mask.

This experiment illustrated the principles of classical conditioning and provided insights into the development of phobias. It showed that emotional responses could be conditioned and generalised to other stimuli, laying the groundwork for further research in behaviourism and therapeutic techniques for treating phobias.

Genie: The Wild Child and the Critical Period Hypothesis

The case of Genie, a girl discovered in 1970 at the age of 13, presents a tragic yet enlightening exploration of language acquisition and development. Genie had been severely neglected and isolated by her abusive father, spending most of her early life confined to a small room with minimal human interaction.

When Genie was found, she had little to no language skills, and her case became a focal point for studying the critical period hypothesis—the idea that there is a specific window in early childhood during which language acquisition occurs most naturally and effectively.

Despite intensive rehabilitation efforts, Genie never fully acquired normal language abilities, although she did make some progress. Her case provided compelling evidence supporting the critical period hypothesis and highlighted the profound impact of early environmental deprivation on cognitive and social development.

The Stanford Prison Experiment: Unmasking the Darkness Within

Conducted by Philip Zimbardo in 1971, the Stanford Prison Experiment remains one of the most infamous and ethically debated studies in psychology. Zimbardo sought to investigate the psychological effects of perceived power and authority by simulating a prison environment with college students assigned to roles as either guards or prisoners.

The experiment quickly spiralled out of control as the ‘guards’ adopted authoritarian behaviours, subjecting the ‘prisoners’ to psychological abuse and dehumanising treatment. The ‘prisoners,’ in turn, became increasingly passive and distressed. Originally planned to last two weeks, the experiment was terminated after just six days due to the extreme and disturbing behaviour exhibited by the participants.

This study revealed the power of situational factors and social roles in shaping behaviour, demonstrating how ordinary individuals can engage in harmful actions when placed in certain contexts. It raised important ethical questions about the treatment of participants in psychological research and the potential for abuse of power.

HM: Unlocking the Secrets of Memory

The case of Henry Molaison, known as HM, has been pivotal in advancing our understanding of memory. HM underwent brain surgery in 1953 to alleviate severe epilepsy, during which large portions of his medial temporal lobes, including the hippocampus, were removed. While the surgery successfully reduced his seizures, it also left him with profound anterograde amnesia, rendering him unable to form new long-term memories.

HM could remember events from before the surgery but could not create new memories, effectively living in a perpetual present. Despite this, his short-term memory and procedural memory (such as learning new skills) remained intact. His case provided critical insights into the different types of memory and the specific brain regions involved in memory formation and retrieval.

Researchers studying HM's condition learned that the hippocampus is essential for the consolidation of new explicit memories but not for procedural memory. HM's case underscored the complexity of memory systems and has informed the development of treatments and interventions for memory disorders.

Kitty Genovese: A Catalyst for Understanding Bystander Behaviour

The tragic murder of Kitty Genovese in 1964 in New York City became a catalyst for research into bystander behaviour and the diffusion of responsibility. Genovese was attacked and murdered outside her apartment, with reports indicating that numerous neighbours heard her cries for help but did not intervene or call the police.

This incident spurred psychologists John Darley and Bibb Latané to investigate the phenomenon of the bystander effect. Their experiments demonstrated that individuals are less likely to help a victim when others are present, due to a diffusion of responsibility and social influence. The more witnesses there are, the less personal responsibility each person feels to act.

The Genovese case and subsequent research have had a lasting impact on our understanding of social psychology, highlighting the factors that influence helping behaviour and the importance of fostering a sense of personal responsibility in emergency situations.

David Reimer: The Boy Who Was Raised as a Girl

David Reimer's story is a poignant and controversial case study in the field of gender identity and the nature versus nurture debate. Born biologically male in 1965, David suffered a botched circumcision that led his parents, under the guidance of psychologist John Money, to raise him as a girl named Brenda.

Money believed that gender identity was primarily shaped by socialisation, and David's case was intended to prove this theory. However, despite being raised as a girl, David consistently exhibited male behaviours and experienced significant psychological distress. At the age of 14, he learned the truth about his birth and subsequently transitioned back to living as a male.

David Reimer's case challenged the notion that gender identity is solely a product of upbringing and highlighted the complex interplay between biological and environmental factors. It underscored the importance of considering individual experiences and the potential harm of imposing rigid gender roles.

The case studies discussed in this blog post provide a glimpse into the diverse and intricate world of human behaviour. Each case offers unique insights into psychological phenomena, from the effects of brain injuries and the mechanisms of fear conditioning to the critical periods of development and the impact of social roles.

These stories remind us that psychology is not just an abstract science but a deeply human endeavour, seeking to understand the minds and experiences of real people. As A-level psychology students, delving into these case studies will not only enrich your knowledge but also inspire you to appreciate the complexity and wonder of the human mind. By exploring these fascinating cases, you are embarking on a journey to uncover the mysteries of behaviour and contribute to the ever-evolving field of psychology.

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