The strange case of Phineas Gage

Abstract

The 19th-century story of Phineas Gage is much quoted in neuroscientific literature as the first recorded case in which personality change (from polite and sociable to psychopathic) occurred after damage to the brain. In this article I contest this interpretation. From a close examination of the story of Gage I have come to conclude that first of all there was nothing psychopathic in Gage’s behavior and that changes in his life are more coherently explained by seeing them as his way of dealing with disfigurement that he suffered after the accident. This is not just a matter of reinterpreting a case. The way Gage has been presented and discussed in neuroscientific literature suggests that the new paradigm of neuroscientifically oriented psychiatry may lead to an erosion of clinical knowledge.