Brain and Behavior: Phineas Gage Revisited

This is the skull of Phineas Gage, who over 150 years ago became one of the most celebrated cases in the history of medicine. Which is why he's still here in the Warren Museum at Harvard Medical School.

A smart and likable young man according to his friends, Phineas was working as the foreman of a railroad construction gang in Vermont when a blasting accident blew this three foot long iron rod through his left cheek and clear through the top of his head. The rod landed about 25 yards behind him and Phineas got to his feet and walked away. As a local newspaper put it the next day, "The most singular circumstance connected with this melancholy affair is that he is alive and in full possession of his senses, and free of pain."

But while he lived another 12 years with part of his brain destroyed, he was, as his friends said, "no longer Gage." He was described as fitful and grossly profane. On the one hand, impatient and obstinate. And on the other, unable to make plans for the future. Unable in fact, to make up his mind.

Phineas Gage's fame stems not only from his simply surviving such a ghastly accident, but because he was the first patient to suggest a link between personality and the functions of the front part of the brain, the frontal lobes. In this show, we're going to explore how our frontal lobes shape who we are and how we go about our lives.

What's the area of the brain that was affected during this accident?

Well, I think the area that everybody focuses on is the frontal lobes. Now there might have been some damaged areas a little bit outside the frontal lobes.

Mm hmm.

But what makes this person and their case interesting to scientists is the fact that the injury was in the frontal lobes, and as a result of the injury, Gage's personality changed.

Can we tell what kind of personality change? I mean, was it an inability to make decisions? Or it's hard to tell?

It's hard to tell. Other than the fact we know it changed, he couldn't resume his former position.

Yeah.

Although he did work afterwards. I mean—

But he wasn't good as a foreman.

He wasn't good as a foreman, which requires executive skills.

I brought a brain in a box here, and I wonder if you can show me where on the brain—

Sure.

The accident affected him?

So these are the frontal lobes of the brain. This is the right side and the left side. And the rod probably entered somewhere from the bottom of the frontal lobes on the left side and came out somewhere on the top of the frontal lobes. So all the tissue in between here to here no doubt was damaged, as well as some of the surrounding tissue.

What was the thinking in those days about the relationship of the brain to the personality?

Yeah.

How did they organize their thoughts about that?

Well, there wasn't a lot of sophisticated thinking. Here's an example of such thinking. This is a phrenology skull. And you can see etched into the skull in different places are what might be called faculties.

Phrenology was invented by a very bright fellow called Franz Joseph Gall, who thought that different parts of the brain did different things. His mistake was in believing bumps in the skull reveal what lies beneath.

Has any one of these areas shown to—you don't even have categories like this anymore, do you?

Al, it was a crap shoot.

Yeah.

[LAUGHING]

I mean, benevolence. I don't think—nobody's looking for benevolence in the brain, right? Or are you?

We're all looking for benevolence.

[LAUGHING]

But not right now in the brain.

Reasoning faculties he's got over here.

So that's probably not a bad place to have it. There's probably some relationship between the functions of the frontal lobe and your ability to do certain kinds of reasoning.

He's got language under the left eye.

Yeah.

Is that possible? Is there—

[LAUGHING]

I mean, when I say is that possible, why would he say that? Is there brain under the left eye?

I don't know what kind of plaster casts he was studying in order to do that. Under the left eye is your left cheek.

[LAUGHTER]

Gall may have been wrong in the details, but his concept of the brain as an organ with specialized regions has been vindicated. And of all the specialized regions, none is more important in distinguishing us from the rest of the animal kingdom, and from our pre-human ancestors, than the enormously enlarged front part of our thinking brain. The frontal lobes or prefrontal cortex.

It serves as sort of the central executive, the chairman of the board of the brain. And it helps guide our behaviors. It helps us plan, it helps us carry out plans. It helps us reason about difficult topics, it helps us make certain kinds of decisions. It helps us inhibit behaviors that are not really appropriate, more primitive behaviors.

For example, let's say you want to be on a diet and you love chocolate. And in front of you, you see this wonderful, delicious chocolate cake.

Right.

But you know you shouldn't have it.

Right.

Well, the frontal—

So the back of my brain is—

Wants it!

Wants it. And the front of my brain—

Is saying, not good for me.

Right.

And so you're able to put it off because you have another goal. Maybe the goal is to lose weight.

Yeah.

Maybe the goal is to live longer.

Right.

So these goals are going to be much more important than this sort of short term goal based on just seeing that chocolate cake in front of you.

Right.