page_title: Phineas Gage
section_title: Social recovery
hierarchical_section_title: Phineas Gage / Mental changes and brain damage / Social recovery
caption_attribution_description: English: Concord Coach no. 251An original Concord Stage Coach on display at the Wells Fargo History Museum in Old Town San Diego State Historic Park.
context_page_description: Phineas P. Gage was an American railroad construction foreman remembered for his improbable survival of an accident in which a large iron rod was driven completely through his head, destroying much of his brain's left frontal lobe, and for that injury's reported effects on his personality and behavior over the remaining 12 years of his life‍—‌effects sufficiently profound that friends saw him as "no longer Gage."
  Long known as the "American Crowbar Case"‍—‌once termed "the case which more than all others is calculated to excite our wonder, impair the value of prognosis, and even to subvert our phys­i­o­log­i­cal doctrines" ‍—‌Phineas Gage influenced 19th-century discussion about the mind and brain, par­tic­u­larly debate on cerebral local­i­za­tion, ​​ and was perhaps the first case to suggest the brain's role in deter­min­ing per­son­al­ity, and that damage to specific parts of the brain might induce specific mental changes.
context_section_description: Macmillan writes that this contrast‍—‌between Gage's early, versus later, post-accident behavior‍—‌reflects his "[gradual change] from the commonly portrayed impulsive and uninhibited person into one who made a reasonable 'social recovery'", citing persons with similar injuries for whom "someone or something gave enough structure to their lives for them to relearn lost social and personal skills":
  Phineas' survival and rehabilitation demonstrated a theory of recovery which has influ­enced the treat­ment of frontal lobe damage today. In modern treat­ment, adding struc­ture to tasks by, for example, mentally vis­u­al­is­ing a written list, is con­sid­ered a key method in coping with frontal lobe damage.
  According to contemporary accounts by visitors to Chile,​​ Gage would have had to
  rise early in the morning, prepare himself, and groom, feed, and harness the horses; he had to be at the departure point at a specified time, load the luggage, charge the fares and get the passengers settled; and then had to care for the passengers on the journey, unload their luggage at the destination, and look after the horses. The tasks formed a structure that required control of any impulsiveness he may have had.
  En route (Macmillan continues):
  much foresight was required. Drivers had to plan for turns well in advance, and sometimes react quickly to manoeuvre around other coaches, wagons, and birlochos travelling at various speeds ... Adaptation had also to be made to the physical condition of the route: although some sections were well-made, others were dangerously steep and very rough.
  Thus Gage's stagecoach work‍—‌"a highly structured environment in which clear sequences of tasks were required [but within which] contingencies requiring foresight and planning arose daily"‍—‌resembles rehabilitation regimens first developed by Soviet neuropsychologist Alexander Luria for the reestablishment of self-regulation in World War II soldiers suffering frontal lobe injuries.
  A neurological basis for such recoveries may be found in emerging evidence "that damaged [neural] tracts may re-establish their original connections or build alternative pathways as the brain recovers" from injury. Macmillan adds that if Gage made such a recovery‍—‌if he eventually "figured out how to live" (as Fleischman put it) despite his injury‍—‌then it "would add to current evidence that rehabilitation can be effective even in difficult and long-standing cases"; and if Gage could achieve such improvement without medical supervision, "what are the limits for those in formal rehabilitation programs?"  As author Sam Kean put it, "If even Phineas Gage bounced back‍—‌that's a powerful message of hope." 
caption: A Concord coach, likely the type driven by Gage in Chile[50]
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