Phineas Gage - the man who had his brain blown out
In 1848, Phineas Gage (then 25), was the foreman of a crew cutting a new railroad in Vermont USA. He was using a tamping iron (you can see him holding that very tamping iron above) to pack explosives to blow up a hole in the ground. Unfortunately, the explosives detonated. The tamping iron was blasted up with such force that it penetrated Gage's left cheek, blasting through his brain, exited the top of his skull, and landed almost 30 metres away. When they found the tamping iron, the crew also found the remains of what used to be Gage's Pre-Frontal Cortex.
Quite amazingly, Gage was still conscious despite such a horrific accident. A few minutes later, he was writing in his workbook after being loaded onto an ox-cart to be transported to a medical facility. And Gage recognised the company doctor, Dr John Martyn Harlow, who came to attend to him. In fact, he still possessed enough humour to quip: “Here is business enough for you.”
Gage survived the accident, although he spent most of the next 5 weeks in a coma because of an infection of the wound. He looked to be in really bad shape, but Dr Harlow's skill ensured he survived, although blinded in his left eye.
By itself, this is already a most remarkable story. But it doesn't end there. Gage was now a person living without part of his Pre-Frontal Cortex. How would life be without such a major portion of his brain? Can he really live a normal life?
Observation 1: Gage did change for the worse...
Before the accident, Gage was even-keeled and respected. And he showed with his post-accident humour showed why he was well-liked by people around him.
Things changed after the accident, captured but Dr Harlow, who knew him before the accident and who treated him throughout. In various accounts, Harlow wrote that: "Gage remembers passing and past events correctly, as well before as since the injury."
However, he wrote that "Gage's intellectual manifestations were feeble, being exceedingly capricious and childish, but with a will as indomitable as ever; is particularly obstinate; will not yield to restraint when it conflicts with his desires. 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.... A child in his intellectual capacity and manifestations, he has the animal passions of a strong man...." Finally, Harlow wrote that accounts from Gage's friends and acquaintances said he was ‘no longer Gage'.
If you have read the page on the Pre-Frontal Cortex, these descriptions of Gage are very fitting. The PFC is responsible for:
analysis and rational decision making
but beyond that, the PFC is dedicated to socially appropriate behaviour. In life, we will be placed in many different situations with a variety of people, and how we choose to act based on the context we're in is a major challenge which the PFC helps us to navigate. When it is appropriate to joke, and when is it not? Why is it appropriate to pay a restaurant for food but not your spouse? Why should you tell the complete ruth and when should tell a partial truth?
the PFC plays an additional role of inhibiting animalistic thoughts, originating in more primitive parts of our brains, that we are prone to having. It is your PFC that tells you, you don't need to punch someone just because they have a different view.
patients like Gage, who lose particular parts of their brains
his memory and learning was not affected, which is only to be expected. It is not the PFC that deals with memory, it's the hippocampus. You might also be interested in the extraordinary account of another patient, SM, who lost his hippocampus.
Without a fully functioning, Gage fell on hard times. He was removed from his job at the rail company. Also, ever wondered why he would still pose with that tamping iron that ruined his life? Well, that was his new "job", his means of survival - he posed with the tamping iron as an exhibit in a travelling circus.
Observation 2: But he improved over time...
A little bit of good news. Gage eventually did improve. After a few years recovering and in the circus, he was stable enough to get himself a job as a stagecoach driver. He was also described as being generally socially acceptable.
How does this happen? One of the most discoveries of our brain is how plastic it is - what we term neuroplasticity. That is, that your brain can change, even at the most fundamental levels. Gage lost part of his PFC, which meant that the neural networks that existed before, connecting to other parts of the brain was lost. But his brain transformed and adapted. The remaining parts of the PFC literally grew new neural networks to fill in for the missing part, allowing him to re-establish some control.
We have observed many instances of neuroplasticity. Post-traumatic stress disorder causes our amygdala, the part of our brain regulating fear, anger, anxiety, and aggression, to physically grow bigger and more influential. People who have lost their sight were able to rekindle the use of some of their visual neurons for other tasks, like hearing. And as you are reading this, and hopefully other pages, your brain is also transforming - some neurons might be forming new synapses, or existing synapses strengthened, so that you become more sensitive to neuroscience.
Crucially, there are limits to neuroplasticity (which I note that some irresponsible motivational speakers and influencers have claimed otherwise. You cannot be whomever you wish to be. You can't "neuroplasticity" to have the creative talents of Mozart or to recover fully from a serious injury. Phineas Gage was able to improve, but he was never himself again
Read more about neuroplasticity here.
What happened to Phineas Gage in the end? Unfortunately, life was really hard for him. After working as a stagecoach driver for a few more years, he returned to his family in San Francisco in 1860, whereupon he developed epilepsy. In May 1861, 12 years after the injury, he died due to status epilepticus, a seizure in his brain.
The brain is the most important and complex part of your body. If you lose a finger, or an arm, or a leg, or even a kidney, you might be physically different. But any damage to your brain causes you to be a completely different person. Gage and many others who suffered brain injuries often became a shell of their former selves and would face many challenges in life. But even though their lives often had elements of tragedy, they also played a massive role in helping us understand our brains in ways we simply couldn't before.