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Phineas Gage, Neuroscience’s Most Famous Patient

Each generation revises his myth. Here’s the true story.

People butcher history all the time, of course, for various reasons. But something distinct seems to have happened with Gage. Macmillan calls it “scientific license.” “When you look at the stories told about Phineas,” he says, “you get the impression that [scientists] are indulging in something like poetic license—to make the story more vivid, to make it fit in with their preconceptions.” Science historian Douglas Allchin has noted the power of preconceptions as well: “While the stories [in science] are all about history—events that happened,” Allchin writes, “they sometimes drift into stories of what ‘should’ have happened.”

With Gage, what scientists think “should” have happened is colored by their knowledge of modern patients. Prefrontal lobe damage is associated with a subsequent slightly higher rate of criminal and antisocial behavior. Even if people don’t sink that low, many do change in unnerving ways: They urinate in public now, blow stop signs, mock people’s deformities to their faces, or abandon a baby to watch television. It’s probably inevitable, Macmillan says, that such powerful anecdotes influence how scientists view Gage in retrospect: “They do see a patient and say, ‘Ah, he’s like what Phineas Gage was supposed to be like.’ ” To be clear, Harlow never reports anything criminal or blatantly unhinged about Gage’s conduct. But if you’re an expert on brain damage, scientific license might tempt you to read between the lines and extrapolate from “gross profanity” and “animal passions” to seedier behavior.

If repeated often enough, such stories acquire an air of truthiness. “And once you have a myth of any kind, scientific or otherwise,” Macmillan says, “it’s damn near impossible to get it destroyed.” Macmillan especially bemoans “the degree of rigor mortis in textbooks,” which reach a large, impressionable audience and repeat the same anecdotes about Gage in edition after edition. “Textbook writers are a lazy lot,” he says.

Historians have also noticed, not surprisingly, that myths have more staying power when they’re good stories—and Gage’s is truly sensational. Once upon a time, a man with a funny name really did survive having an iron rod explode through his skull. It’s tragic, macabre, bewildering—and even comes with the imprimatur of a science lesson. In contrast to other scientific fables, Gage’s has an intriguing twist as well. Most other scientific myths depart from reality by inflating the heroes (usually scientists) into godlike creatures, wholly pure and wholly virtuous. Gage, meanwhile, gets demonized. He’s Lucifer, fallen. Gage’s myth has proved so tenacious in part because it’s fascinating to watch someone break bad.