Between 2003 and 2021, I worked at Headway East London, a community centre for brain injury survivors – people who’d lived through accidents and illnesses that had often profoundly changed them. At the time I joined, the organisation embraced the sound principle that people were – or could be – experts in their own conditions, and that our job was to help them find the answers they needed through friendship and advocacy. This went a long way, but some of the most prevalent challenges could neither be described nor interpreted in everyday terms. Our work dovetailed with the clinical and social care professions, which used the language and ideas of neuropsychology, so these became our language and ideas too.
Of the neuropsychological concepts I encountered, ‘disinhibition’ was perhaps the most consequential. It referred to the impulsivity of people whose injuries had degraded their executive functions – those frontal lobe processes said to keep humans on the straight and narrow. Disinhibited clients behaved in ways that challenged social expectations, swearing belligerently, launching surprise sexual advances, suddenly becoming violently angry, bursting into tears, or laughing at things others didn’t find funny. A constant source of wonder and work, these clients would go missing, arrive in the morning with black eyes or missing teeth, and upset other clients with their tirades and unpredictable moods.
We mostly used the term ‘disinhibition’ as a mitigation: an invitation to think creatively about how to help our clients stay out of trouble. But sometimes the usage was closer to a condemnation. More than once, I led the process of excluding someone who was being threatening or intimidating – someone ‘too disinhibited’ to safely be included in the community. And even where it was generous, I now see how broad and presumptive my use of the term became. Both in speech and thinking, I had internalised the casual use of an idea from journal articles, medical referral documents and the conversation of clinical professionals.
Then, one day, someone challenged me on the term. I was in a staff meeting with my colleague Callum, himself the survivor of a brain injury from a car accident. He described how, that morning, a client called Yvette had noted his earrings and asked him about his sexuality in a way he had felt was derogatory. He’d told her how he felt, and was now asking the team for feedback on his handling of the situation. That’s when I used the ‘d’ word.
I don’t know if I really thought Yvette was disinhibited; the idea had just become an ingrained, reflexive part of my vocabulary. So when Callum noted how reliant my use of the term was on cultural and moral assumptions, how it risked dehumanising Yvette and foreclosing other interpretations of her behaviour, it was like somebody opening a window I’d thought was painted shut. As I thought about it afterwards, I wondered what I’d been doing for the past two decades. In attributing behaviour to disinhibition, had I been making my own life easier by reducing our clients’ motives to something that didn’t require investigation? Had I, in fact, been constructing them as people who didn’t have motives, only impulses? Where did the idea of disinhibition even come from?
The literature paints Gage as a kind of avatar for behavioural dysfunction
As I looked into the history of the term, I began to suspect I might have fallen for a pseudoscientific idea. I learned that, while neuroscientists have shown that brain injury survivors sometimes struggle with certain tests of attentional and motor control, there’s little evidence linking this kind of ‘executive’ disinhibition with behavioural change – the social disinhibition I had been attributing to our clients. Instead, theories about this kind of disinhibition tend to rely on case studies.
I began researching the lives of two 19th-century figures who have both been described as disinhibited. The first was a railroad construction foreman, Phineas Gage. The second was the photographer Eadweard Muybridge (born Edward Muggeridge in England). The two were contemporaries, and both lived in San Francisco for a time. Both were injured in accidents. But there the similarities end. Despite Muybridge’s brain injury being well documented and despite it transforming him, as some claim, in profound and disastrous ways, he scarcely features in the brain science literature, and his legacy remains predominantly that of an artistic and technical genius. Gage, by contrast, became famous for the outrageous behaviour that supposedly resulted from his injury. The literature paints him as a kind of avatar for behavioural dysfunction, with every other aspect of his life overshadowed by his status as disinhibition’s patient zero. Why are the legacies of these two ‘disinhibited’ people so different? I believe the answer tells us almost everything we need to know about the condition, about its origins and its continued use today.
On the day of his accident in September 1848, Phineas Gage was working near the town of Cavendish in Vermont, using an iron ‘tamping rod’ to pack an explosive charge into a hole. The charge exploded prematurely, firing the iron straight through his head. Miraculously, Gage survived. He was transported, bloodied but conscious, to his hotel room, where a doctor called John Harlow cleaned and dressed his wounds. Gage convalesced for 73 days and then returned to his hometown in neighbouring New Hampshire. Harlow described Gage’s recovery as ‘without a parallel in the annals of surgery’, attributing it to Gage’s ‘physique, will, and capacity of endurance’ and to the ‘recuperative powers of nature’. But Harlow also noted a marked change in Gage’s personality: formerly a ‘favourite’ among his men and a ‘shrewd, smart business man’, Gage had become ‘fitful, irreverent, indulging at times in the grossest profanity.’ Gage was now ‘a child in his intellectual capacity’, Harlow continued, with ‘the animal passions of a strong man’. So changed was he, claimed Harlow, that friends and acquaintances said he was ‘no longer Gage’. The doctor concluded that this decline was a consequence of the damage done by the tamping iron to the frontal lobes of Gage’s brain.
Initially reported as a curiosity, the story’s scientific significance began to gain recognition in 1878, when the Scottish neurologist David Ferrier used it in an influential lecture series. Ferrier was responsible for popularising the idea that dominated the brain sciences during the 20th century – that of cerebral localisation, mapping the brain’s division into discrete functional zones. He also promoted the idea that the frontal lobes inhibit physical activity in order to allow for mental reflection. Terms like ‘executive function’ and ‘disinhibition’ came later when the theory was elaborated across the 20th century, but the central idea was the same as that hinted at by Harlow and stated plainly by Ferrier: that the frontal lobes were responsible for the inhibition of the animal passions that might disturb temperate, ethical behaviour. This formulation aligned with Sigmund Freud’s influential tripartite model of the human psyche in which the impulsive id is modulated by the more discerning ego and inhibited by the morally oriented superego. Disinhibition became paradigmatic of the localisation agenda, and Gage became its standard-bearer.
If you search ‘frontal lobe injury’ online, you’ll find a version of Gage’s story rehearsed on every page
More than a century later, Gage’s transformation would still be referenced as the quintessential case study. ‘He took to gambling and sleeping with prostitutes,’ as the neuroscientist David Eagleman said in a talk at the Royal Society for the Arts in 2010. ‘He could not be trusted to honour his commitments,’ wrote the cognitive neuroscientist Hanna Damasio and colleagues in 1994; Gage ‘began a new life of wandering [and] never returned to a fully independent existence.’ Damasio’s coauthor and partner Antonio used Gage’s life as a major reference point in his prizewinning and widely translated book, Descartes’ Error (1994), describing Gage’s failure to secure steady work due to ‘poor discipline’ and his subsequent ‘career as a circus attraction’ at Barnum’s Museum in New York City, ‘vaingloriously showing his wounds … peddling misery for gold.’ This bleak portrait ends with Gage’s final days and death, believed to be from a seizure, in 1860:
In my mind is a picture of 1860s San Francisco as a bustling place, full of adventurous entrepreneurs engaged in mining, farming, and shipping … But that is not where we would find [Gage] if we could travel back in time. We would probably find him drinking and brawling in a questionable district, not conversing with the captains of commerce … He had joined the tableau of dispirited people who, as Nathanael West would put it decades later, and a few hundred miles to the south, ‘had come to California to die.’
Since Descartes’ Error, claims about Gage have included a 2016 paper that described him as an ‘extremely cruel’ person who ‘enjoys harming people’, and the terms ‘abusive’ and ‘harsh’ were used in a 2020 editorial. He changed, as one commentator wrote in 2000, from a ‘mild-mannered, responsible foreman’ to ‘an aggravated, antisocial deviant’.
In 2018, Gage was chosen as the first of six ‘essential landmark case reports’ for neuropsychiatry. If you search ‘frontal lobe injury’, ‘frontal lobe disorder’ or ‘executive functions’ on Wikipedia today, you’ll find a version of Gage’s story rehearsed on every page. If you search functional localisation, it’s a picture of Gage’s skull from Harlow’s paper that greets you, pierced by the tamping iron like an olive on a cocktail stick.
Phineas Gage’s skull, 1868. Courtesy Wikipedia
The sensational impact of this version of Gage’s story would be fine if it weren’t for the fact that it’s largely fictional.
There are three primary sources written about Gage by people who met him. Harlow wrote his first report in 1848, limited to an account of the recovery, and a second in 1868, which reproduced the first and added further interpretations. Another physician, Henry Bigelow, wrote a paper after meeting Gage the year following the accident. Of the two, only Harlow mentions Gage’s personality change. His total word count on the subject is just over 300. At no point does he ask Gage about it or offer any quotes from him – Gage was dead by the time Harlow wrote the second paper. Nothing written by anyone who knew Gage before his injury survives, only paraphrases noted down by the two doctors. So, the sources are scant to begin with. And, according to the psychologist and historian Malcolm Macmillan in 2008, most of those who have written about Gage since the primary sources were published do not appear to have checked them, promoting some aspects of the story, ignoring others and embellishing liberally. Macmillan’s conclusions were echoed in a separate 2022 review of more recent Gage literature, which found that half of the 25 papers analysed gave negative descriptions of Gage that were not based on the primary sources.
Macmillan offered a very simple test: if a description of Gage isn’t quoted from the primary sources, then it is ‘not a fact about Phineas Gage’. The number of Gage-related statements that have failed the test quickly mounts up. What Eagleman and Antonio Damasio said about Gage drinking, brawling, gambling and visiting prostitutes aren’t facts. Neither was Damasio’s description of Gage working ‘vaingloriously’ as a ‘circus attraction’. The available sources suggest he appeared at a museum (no circus) and was mostly alone when touring New England after his injury, and none of them give any detail about the manner in which he presented himself. Hanna Damasio’s claim that Gage ‘began a new life of wandering’ seems to be extrapolated from a single use of the word ‘wanderings’ by Harlow, in context of the difficulty he had in tracking down Gage in later life. Nowhere did Harlow or Bigelow suggest that ‘wandering’ was typical of Gage’s post-injury existence. These authors may have become aware of their errors in the years since they were published, but I can’t find any evidence of retractions.
The available facts about Gage fly in the face of claims made about his transformation and reduced capacities
Of the various falsehoods written about Gage, perhaps the one most clearly contradicted by the primary sources is the Damasios’ claim that Gage ‘could not be trusted to honour his commitments’ and that he ‘never returned to a fully independent existence’. In fact, the sources make no mention of Gage being dependent on anyone from the time he recovered from the injury until the last year of his life when he succumbed to illness. They also clearly state that, after he gave up his public appearances, he worked at a livery stable for 18 months and then he moved to Valparaíso in Chile where, according to Harlow, he worked for nearly eight years, ‘caring for horses, and often driving a coach heavily laden and drawn by six horses’.
As Macmillan pointed out, the available facts about Gage fly in the face of claims made about his transformation and reduced capacities. Macmillan gave a carefully sourced description of the demanding nature of Gage’s job in Chile: the dependability required of him in rising in the small hours, loading passengers’ luggage and possibly handling fares; the high level of dexterity and sustained attention necessary for driving six horses; the foresight and self-control involved in navigating the unwieldy coach along the crowded and sometimes treacherous Valparaíso-Santiago road. He also pointed out that Gage, at first a stranger to Chile, would have had to learn something of its language and customs and ‘deal with political upheavals that frequently spilled into everyday life’.
When discussing social disinhibition, most researchers cite cases in addition to Gage, but very few miss out Gage. His was the story that started off the whole idea and has remained by far the most frequently referenced, both in the clinical literature and in wider English language publishing. Given just how weak the evidence of his disinhibition really is, this level of reliance on his case seems astonishing. By contrast, we know with great confidence that our second historical figure, Eadweard Muybridge, did something terrible in the years after his accident. Something both violent and criminal, for which he was tried but not convicted.
Raised in a middle-class family in England, Muybridge arrived in San Francisco in 1855 to open a bookselling business. He was still there in 1860 when Gage died. But by July of that year, when he was 30 years old, he had decided to sell the business and set out on the first leg of a long journey back to Europe. ‘After taking supper at a house on the road, I left on a stage drawn by six wild mustangs,’ he later described. He had no memory of what happened next but recounted what a fellow passenger had told him:
[A]fter travelling half an hour the break got out of order and the mustangs ran away. I tried to get out of the boot of the stage by cutting the canvas with a knife. Here the stage struck a stump and I was thrown out. Two passengers were killed and all injured.
Nine days later, Muybridge found himself ‘lying on a bed at Fort Smith, 180 miles from the place.’ As well as the period of unconsciousness and amnesia, he reported double vision, the loss of his sense of smell and taste, and a degree of ‘confused ideas’. These acute symptoms, he said, lasted three months but he continued to have treatment for a year. He spent several years back in England and Europe after the accident.
Brain experts speculate that Muybridge’s injury may have ‘unveiled his artistic and inventive genius’
After he returned to California in 1867, Muybridge’s friends noted a significant change, stating that he was ‘not the same man in any respect’ after the injury. Formerly a ‘genial, pleasant and quick businessman’, these friends said he was now ‘very eccentric’, ‘his ways and expression of face were odd’ and he was ‘not so good a businessman’. As further evidence, one friend cited the fact that he had altered the spelling of his name, and another that his hair colour had changed from black to grey. Also, that Muybridge brought some $4,000 worth of goods from Europe but refused to sell any to him. Another friend described Muybridge’s inconstancy after the injury, telling of how he would now often make bargains or contracts only to renege within 24 hours, and would refuse to take payment for a photograph ‘if he did not see beauty in it’. The same friend mentioned a ‘strange freak’ of an incident in which the photographer insisted on having his picture taken while sitting above a precipice at Yosemite Valley.
Stereograph by Eadweard Muybridge of himself on Contemplation Rock at Yosemite, 1872. Courtesy the California Historical Society
A handful of brain experts have made diagnostic claims about Muybridge in retrospect. The neurosurgeon Sunil Manjila and his colleagues take Muybridge’s impaired senses as confirmation of frontal brain injury. Among the signs of altered personality, they list his habit of changing his name and the ‘unorganised and disjointed’ nature of his landscape photographs, which they describe as ‘an enigma’ to the viewer. They also speculate that Muybridge’s injury may have ‘unveiled his artistic and inventive genius’ spurring him to take copious nude images in defiance of a culture in which ‘controversy about nudity was significant’. The California-based psychologist Arthur Shimamura takes the same images as evidence of an ‘obsessive-compulsive’ tendency, adding that Muybridge’s ‘social disinhibition’ is demonstrated by his inclusion of his own nude body.
Self-portraits by Muybridge from his photographic studies of motion, c1887. Courtesy the Library of Congress
Indeed, the change in Muybridge’s career path appears stark. From a humble bookseller he became one of the most influential photographers in history, credited with new techniques that reduced shutter speeds from several minutes to less than a second, and with capturing the first ever images of animals in motion.
Photos by Muybridge, 1878. Courtesy Wikipedia
More salient than any of these observations, however, and the reason why any of them have been committed to paper, is the astonishing act of violence Muybridge committed in October 1874. Earlier that year, he discovered that his wife, Flora, had become romantically involved with a local theatre critic and, by one biographer’s description, ‘swindler’ called Harry Larkyns. Soon after that, Muybridge came to suspect that his infant son was in fact Larkyns’s child. Muybridge travelled to the town of Calistoga, 75 miles north of his home in San Francisco, and knocked on Larkyns’s door. When Larkyns appeared, Muybridge shot him in the chest with a pistol. Larkyns died at the scene. Muybridge did not resist arrest, freely admitting to the murder, and was held in custody until his trial the following February.
It’s this saga of betrayal and murderous jealousy that Manjila and colleagues refer to when they speak of Muybridge’s ‘emotional instability, aggressiveness, and possessiveness … after the accident’. And the testimonies offered by Muybridge’s friends about the changes caused by his brain injury all come from newspaper reports covering his subsequent trial. When Shimamura speaks of Muybridge having ‘emotional outbursts’, he’s referring to a description given in the San Francisco Chronicle of the moment Muybridge’s acquittal was handed down:
[H]is eyes were glassy, his jaws set and his face livid. The veins of his hands and forehead swelled out like whipcord. He moaned and wept convulsively, but uttered no word of pain or rejoicing.
This context has profound implications for the way we understand the descriptions of Muybridge’s character. If the testimonies of his friends are to be believed, it was the instability brought on by the brain injury that led Muybridge to kill Larkyns. ‘The killing would have surprised me much before his accident but not much after it,’ said one defence witness, according to the Sacramento Daily Union. The brain scientists take it at face value – labelling the murder as Exhibit A in their argument for Muybridge’s disinhibition.
Why, then, don’t we find Muybridge alongside Gage in neuropsychology textbooks or Wikipedia articles about frontal lobe function? The simplest answer is that neither the testimonies about his personality change nor the retrospective assessments of the clinicians are believable. Some of them amount to very little even on paper – the mention by his friends of Muybridge’s hair changing colour and his idiosyncratic approach to business, for example. But, more pressingly, the testimonies were given in support of an insanity plea submitted by Muybridge’s defence council, in the hope of saving him from the death penalty. How sure can we be that his friends would have said the same things without the urgent stakes of the trial hovering in their minds?
Even if we accept the testimonies as the whole truth, it’s notable that the jury present at the trial roundly rejected the insanity plea. In violation of the law and of the judge’s instructions, when they acquitted Muybridge, it was on the grounds that Larkyns’s death was not a murder committed by a mad person but a justifiable homicide committed by a sane one. Perhaps they’d read the interview with Muybridge published by the San Francisco Chronicle while he was in prison awaiting trial. He is quoted as saying:
I objected to the plea of insanity because I thought a man to be crazy must not know what he was doing, and I knew what I was doing. I was beside myself with rage and indignation, and resolved to avenge my dishonour.
As Rebecca Solnit observes in her Muybridge biography River of Shadows (US)/Motion Studies (UK) (2003), and as the jury surely knew, his crime was ‘not an act of impulse but a carefully laid plan’.
We are prevented from explaining away Muybridge’s motives through the attribution of disinhibition
Muybridge was clearly irascible and potentially dangerous, but the richness of the historical record about him makes it hard to tell a simple story. He is often remembered as a genius or an innovator. Solnit describes him as ‘the man who split the second, as dramatic and far-reaching an action as the splitting of the atom.’ She then explicitly characterises him in terms of contradictions:
The alienation that is a hallmark of Muybridge’s personal life is evident in his photographs; the independence of vision in the photographs also characterised his maverick life. But the masterful clarity of Muybridge’s photography is in stark contrast to the emotionally over-wrought man on exhibit in the trial.
Independence and masterful clarity exist in tandem with alienation, a maverick nature and emotional overwhelm. Muybridge is afforded all of these competing aspects of self without compromise. No one characteristic is taken as dominant or final. Even – or especially – as regards the murder, we are prevented from explaining away Muybridge’s motives through the attribution of disinhibition. The historical record tells us he killed Larkyns because he wanted to, because he was angry and humiliated, because he believed he was in the right, and for a host of complex emotional reasons we will never have access to.
While the complexity of the records prevents reductive interpretation of Muybridge, it is, in Macmillan’s words, ‘the very slightness of reliable fact which allows myths about Phineas [Gage] to flourish’. But that’s not all: the relative social standing of the two men has also played a role in shaping their respective legacies.
Muybridge’s work as an artist and his status as one seem to have acted as prophylactics, first against criticism during his lifetime and then against reductive interpretation in retrospect. The art historian Sarah Gordon has written about the way Muybridge’s human nudes were received when they were first published. Included in his second series of motion studies, made at the University of Pennsylvania, the work was supervised by the specially formed body dubbed the ‘Muybridge Commission’. Led by the university’s provost William Pepper and including a selection of authoritative figures, the Commission was formed explicitly to mitigate the effects of Muybridge’s questionable reputation and ensure safe passage for the pictures after publication. According to Gordon, the Commission deliberately attached a scientific-sounding name – Animal Locomotion – to the publication and a ‘prohibitively high price’ so that ‘only wealthy, upper-class individuals and members of institutions would have immediate access to the photographs’. They then signed up many of their own powerful friends and institutional contacts as subscribers: the former US president Rutherford B Hayes, the inventor Thomas Edison, the writer and critic John Ruskin, the industrialist Cornelius Vanderbilt, the universities Harvard, Yale and Johns Hopkins, the Library of Congress, and the Smithsonian Institution all bought copies. The Commission later sent a copy to the Sultan of Turkey, ruler of the Ottoman Empire. As Gordon puts it: ‘Pepper and his colleagues … relied both on their social status and on the public’s uncritical trust in professionals to shield images of the nude body from moral scrutiny.’
The forces of social status and uncritical trust in professionals that worked so well in Muybridge’s favour did the opposite for Gage. During his life, he may well have had friends. People were willing to employ him. He was cared for by his family towards the end. And there’s no suggestion in the primary sources that he ever became isolated or spurned from any community. However, without powerful or wealthy friends to defend his reputation, the story told about Gage by Harlow operated in isolation after his death. In the absence of dissenting voices, it was treated as fair game by commentators with their own professional agendas.
Appropriate behaviour isn’t maintained by the individual. It’s produced collectively through continual negotiation
The comparison of these two people illustrates the core problem that dogs the idea of social disinhibition: the fact that it relies for its meaning on the highly variable interpretation of what constitutes appropriate behaviour. The members of the jury at Muybridge’s trial – recruited explicitly to represent the wider community’s ethical priorities – believed it was appropriate for Muybridge to kill his wife’s lover. In fact, not only was Muybridge acquitted for the murder, he was celebrated, as recorded in the Sacramento Daily Union:
A large crowd gathered in front of the court-room, and as Muybridge descended the steps a free man, they cheered vociferously and long. He was surrounded by the crowd, every man of which seemed anxious to congratulate him first.
These events are fascinating and slightly baffling from a contemporary perspective – to explain them might take a whole new essay. But they demonstrate how unpredictable morality is and show something important about how it works: what constitutes appropriate behaviour isn’t something maintained by the individual. Rather, it is produced collectively through continual negotiation. The individual brain can’t take sole responsibility for the practices we all rely on for counterbalancing our wilder impulses. That’s why we have legal systems. And when people do get isolated, they are at greater risk of criminalisation.
Among those who have accepted the revision of the Gage story, the consensus seems to be that his character probably did change but that any disinhibition that did occur was temporary. But it’s important we subject even this claim to counter-proposals, that we ask what else might have provoked such a temporary change, assuming we believe in it. Some have suggested that psychological trauma might have played a role. On meeting Gage in the hour after his injury, Harlow found his patient ‘perfectly conscious’ but ‘getting exhausted from the hemorrhage [sic]’ which had made him and the bed on which he lay ‘one gore of blood’. Another witness described how, at one point Gage got up and vomited ‘a large quantity of blood, together with some of his food’ and how ‘the effort of vomiting pressed out about half a teacupful of the brain, which fell upon the floor, together with the blood, which was forced out at the same time’. So, yes, traumatic.
But maybe Gage was just pissed off. The idea that a person could not only have an injury of the kind Gage survived, come very close to death, lose sight in one eye, then lose their job, and not feel at least a little aggrieved and confused for a while seems an unworldly expectation. As research conducted by the University of Oxford demonstrates, survivors of life-changing injuries report profound and varied impacts on their attitudes, whether their injuries included neurological consequences or not.
During a phone conversation as I was writing this essay, my former colleague Callum, who first got me thinking about disinhibition, described his own experience of behavioural change in the aftermath of brain injury:
I don’t remember the first 10 days after my injury, but friends later told me about some of the funny, wild things I said during that time, like when one of them came to visit and I suggested, in front of my family, that we smoke a joint together. Then, later on, between about one and three months after the injury, I remember wheeling myself out of the hospital many times, even though I’d been told again and again not to do things on my own.
Given that he doesn’t remember it, the first of these examples probably falls within what clinicians would call post-traumatic amnesia (PTA) – an acute period in which head trauma patients aren’t forming new memories and can often be disoriented. Since it was after Callum’s PTA had ended, the second example could have been labelled disinhibition: the kind of inconvenient behaviour that makes life hard for institutional staff and about which survivors can be both stubborn and wily. Callum was clear that both examples were out of character but that they still held meaning. ‘In the first instance, even though my family were a bit surprised at what I was saying, it also reassured them that I was still the same person. I was suggesting doing things that demonstrated I remembered my friends, even if my family didn’t want to hear about those things.’
This persistence of self was something Callum also emphasised about the apparent disinhibition. Disobeying doctors’ orders by wheeling himself out of the hospital may have been atypical for his pre-injury character, but this behaviour still belonged to him rather than to some mysterious new identity ‘unveiled’ by the injury. ‘I’m not a different person,’ he said. ‘I’m me after something traumatic has happened to my brain. It was still me doing those things. It was me who was disinhibited.’ And he also insisted that the behaviour held value. ‘I did it because it made me feel good. It was a way of proving to myself that I could do things. Maybe, on some biological level, I had to be that brave and confident because I was going through something so enormous.’
The descriptions have to reflect human experience, rather than reaching for simple or dramatic images
This is the first time I’ve come across an explanation of disinhibition that treats it as purposeful for the person; as necessary in some way, rather than as a symptom to be suppressed. Nevertheless, it’s consistent with certain theoretical frameworks, like that of the influential German neurologist Kurt Goldstein, who believed that the behaviour of the injured person always drove towards self-actualisation, a term he introduced.
We’ll never know how Gage might have interpreted his own behaviour after the accident. But in influencing the perception of frontal lobe injuries, getting his story straight still matters. As the philosopher and psychologist Stephan Schleim points out: the myths about Gage ‘might stigmatise patients and their families and even lead to a self-fulfilling prophecy, if people are then excluded and denied treatment as hopeless cases’.
The brain sciences have an important role to play in formulating descriptions that help people understand and articulate what has happened to them, that illuminate the path towards self-knowledge and self-compassion, that provide concrete ideas for coping. But for this to be helpful, the descriptions have to reflect human experience, rather than reaching for simple or dramatic images because they support a favoured theory.
Because he was not famous, we have very little written down by Gage. And because he was not an artist in any recognised sense, we don’t have an archive of things he made. But we do have two photographs of him. Identified in 2009 and 2010, they represent the nearest thing we have to a first-person testimony.
Gage may not have operated the camera but we can assume that he prepared himself and made decisions about how he wished to be presented. And the pictures created are in stark contrast to the way Gage has been represented for so long by the research literature. He appears upright, clean-shaven and neatly dressed, with a steady expression and a firm grip on his tamping iron. His left eyelid is closed – he lost the sight in that eye – but you have to look very closely to detect any other sign of his injury. To me, he looks a little older in one photograph than in the other, but he wears a very similar outfit. Perhaps not a person with a great deal of money, then, but someone determined to make a good impression, someone who cares, you might say, both about himself and about the experiences he creates for others. (Compare these sober portraits with the provocative ones Muybridge created of himself in the nude.)
What’s truly iconic about Gage is that he survived, both as a body and a person
The stories told about Gage and the theories of frontal lobe function that draw on his life speak powerfully to our beliefs about morality and free will. But they are not really scientific. Instead, they are drawn from spiritual beliefs and superstitions. They revive the 17th-century ideas of Thomas Hobbes about civilisation’s role in suppressing the most barbarous aspects of human nature. They sustain imagery from pseudosciences like phrenology, in which personality and morality were ‘read’ in the shape of a person’s skull. They reinforce hierarchical metaphors of the human soul belonging to ancient Greeks like Plato, who believed reason was ‘immortal’ and ‘divine’ and was placed in the head, closer to the heavens, as a sign of its superiority to the emotions residing the torso.
In a 2020 review of the concept of social disinhibition, the neurologist and psychiatrist Edward Huey suggested that the idea became widespread because it was ‘compatible with strongly held cultural beliefs about the importance of inhibiting inherent drives and desires’. It remained popular because of what he calls its ‘intuitive appeal’ and because of its simplicity. And it’s this same simplicity, he writes, that should now provoke us to discard the concept: ‘[T]he theory of disinhibition has been overextended. It is used to explain so much that is now poorly defined and vague.’ He argues not for a single theory to replace disinhibition but for a wider, more tailored approach to investigating the many different circumstances currently lumped together under its umbrella.
Maligned for more than a century, Gage deserves a better legacy. As one group of commentators put it in 2018:
Phineas Gage, touted as the archetypal case of prefrontal behavioural syndrome, may actually be as important for demonstrating the possibility of functional recovery after severe traumatic brain damage during adulthood.
It’s a sentence that offers two directions for the future. The pursuit of simple explanations is a symptom of the desire for psychology to operate like a natural science – a case of wishful thinking. If we could stop thinking of the brain like it’s a Rubik’s cube, then perhaps we would have more capacity to talk about what’s truly iconic about Gage: that he survived, both as a body and a person. Perhaps we could remember him not as the gothic monster imagined in the literature but instead as someone who rescued dignity from catastrophic circumstances, who achieved both self-reliance and meaningful connection, without the aid of rehabilitation professionals, and against extraordinary odds.
And if we want to improve our theories about brain injury, it would be better to develop them in partnership with living brain injury survivors rather than basing them on the lives of those long departed. It might be more time-consuming to work this way, and the results may not be free of contradiction. But that’s people for you. They don’t always make sense.
