The rehabilitation of Phineas Gage

Medical journal Neuropsychological Rehabilitation has a fascinating article on Phineas Gage’s years after his dramatic injury, updating previous accounts and suggesting he made a remarkable recovery after his initial change in character.

The piece is co-authored by Malcolm Macmillan, author of the definitive Gage book An Odd Kind of Fame and can contains many important updates and corrections on the story since the biography was released.

Unfortunately, the article is locked behind a $30 paywall (harsh, bit it keeps the plebs out) which is a pity as it carefully dsicusses Gage’s post-injury life and notes that while he seemed to have a marked change in character and behaviour shortly after the tamping iron was blown through his frontal lobes, in the long-term, he seemed to recover very well.

Reviewing Phineas’ post-accident history we note:

1. He resumes work on the family farm within four months of the accident, and seeks his old job as foreman within another four.

2. He adapts within two or three years to the vocation of “exhibiting”, possibly managing his appearances, advertising, and travel independently, and probably re-learning lost social skills.

3. He works for Currier during 1851-1852, where he possibly learns stagecoach driving and builds on his social re-learning.

4. He is settled and reliable enough in his behaviour for an employer to take him to Chile as a coach driver.

5. He works in Chile for 7 years in a highly structured occupation (possibly for just one employer) where he adapts to the language and customs, and uses the complex psychological and cognitive-motor skills required by his job.

6. Eventually his mental faculties are such that a doctor who had known him well sees “no impairment whatever” in them.

7. He is “anxious to work” after recovering from illness in San Francisco, and finds farm employment.

8. He continues to work even after his first seizure. Only now does he become unsettled and dissatisfied with a succession of employers.

We see in all of this how consistently Phineas sought to readapt.

On this summary, Phineas Gage made a surprisingly good psycho-social adaptation: he worked and supported himself throughout his post-accident life; his work as a stage-coach driver was in a highly structured environment in which clear sequences of tasks were required of him; within that environment contingencies requiring foresight and planning arose daily; and medical evidence points to his being mentally unimpaired not later than the last years of his life. Although that Phineas may not have been the Gage he once had been, he seems to have come much closer to being so than is commonly believed.

By the way, did you know a second photo of Gage has been uncovered. You can see it above. Apparently after the publicity surrounding the first the Gage family of Texas found this one in their family collection.

UPDATE: Thanks to Avicenna for noting that the full text of the article is available online here.

Link to PubMed entry for Neuropsychological Rehabilitation article.
Link to awesome Wikipedia article on Gage.