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Utilisateur:Examen Intelligentia/Brouillon

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Gage and his "constant companion"—his inscribed tamping iron—sometime after 1849, seen in the first image of him identified.

Phineas P. Gage (1823 – May 21, 1860) was an American railroad construction foreman remembered for his improbable[1] 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 twelve years of his life—effects sufficiently profound (for a time at least) that friends saw him as "no longer Gage". His case influenced nineteenth-century discussion about the mind and brain, particularly debate on cerebral localization,[2][3] and was perhaps the first to suggest that damage to specific parts of the brain might induce specific personality changes.[4][5]

The iron's path, according to Harlow[6]

Gage is a fixture in the curricula of neurology, psychology, and related disciplines,[7][8] "a living part of the medical folklore"[9] frequently mentioned in books and scientific papers;[10] he even has a minor place in popular culture.[11] Despite this celebrity, the body of established fact about Gage and what he was like (before or after his injury) is small, which has allowed "the fitting of almost any theory [desired] to the small number of facts we have."[12] Historically, published accounts of Gage (including scientific ones) have almost always severely exaggerated and distorted his behavioral changes, frequently contradicting the known facts.

A report of Gage's physical and mental condition shortly before his death implies that his most serious mental changes were temporary, so that in later life, he was far more functional, and socially far better adapted, than in the years immediately following his accident.

Accident modifier

 
Line of the Rutland & Burlington Railroad passing through "cut" in rock south of Cavendish. Gage met with his accident while setting explosives to create either this cut or a similar one nearby.

On September 13, 1848, 25-year-old Gage was directing a work gang blasting rock while preparing the roadbed for the Rutland & Burlington Railroad south of the town of Cavendish, Vermont. Setting a blast involved boring a hole deep into an outcropping of rock; adding blasting powder, a fuse, and sand; then compacting this charge into the hole using the tamping iron. While Gage was doing this the iron sparked against the rock and the powder exploded. Rocketing from the hole, the tamping iron—1.1 m long and 3.2 cm in diameter[13][14]—"entered on the [left] side of [Gage's] face ... passing back of the left eye, and out at the top of the head".[15]

Despite the severity of this injury, within seven weeks Gage was able to walk again, and within nine months he had made a complete physical recovery, except for ptosis and blindness of the left eye, and some paralysis of the left side of the face. Large amounts of bone at the top of the head were permanently lost, his doctor noting "a deep depression, [5 cm by 4 cm] wide, beneath which the pulsations of the brain can be perceived."[16]

Later life modifier

 
(l) Bigelow's estimate of the iron's path. (r) Ratiu et al. concluded Gage's mouth had been open at the crucial moment, and that his skull "hinged" open as the iron passed through.

For a time Gage earned money appearing in public with his tamping iron,[17][18][19] and for about eighteen months he worked for the owner of a livery and coach service in Hanover, New Hampshire.[20][21]

In August 1852 Gage was invited to Chile to work as a long-distance stagecoach driver there, "caring for horses, and often driving a coach heavily laden and drawn by six horses" on the Valparaiso – Santiago route.[22][23] After his health began to fail in mid-1859,[24] he left Chile for San Francisco. There he recovered under the care of his mother and sister,[25] who had relocated there from New Hampshire around the time Gage went to Chile.[26] Then, "anxious to work", he found employment with a farmer in Santa Clara.[27]

In February 1860[28] Gage began suffering epileptic seizures, which became progressively more severe.[29][30] He died during status epilepticus[31] in or near[32] San Francisco on May 21, 1860.[33]

Mental changes modifier

 
The left frontal lobe (red), the forward portion of which was damaged by Gage's injury.

Gage certainly displayed some kind of change in behavior after his injury,[34] but the nature, extent, and duration of this change have been difficult to establish. Only a handful of sources give direct information on what Gage was like (either before or after the accident),[35] the mental changes described after his death were much more dramatic than anything reported while he was alive,[36] and few sources are explicit about the period of Gage's life to which their various descriptions of him (which vary widely in their implied level of functional impairment) are meant to apply.[37]

Gage's physician, John Martyn Harlow, described the pre-accident Gage as hard-working, responsible, and "a great favorite" with the men in his charge, his employers having regarded him as "the most efficient and capable foreman in their employ". But these same employers, after Gage's accident, "considered the change in his mind so marked that they could not give him his place again":

« The equilibrium or balance, so to speak, between his intellectual faculties and animal propensities, seems to have been destroyed. He is fitful, irreverent, indulging at times in the grossest profanity (which was not previously his custom), manifesting but little deference for his fellows, impatient of restraint or advice when it conflicts with his desires, at times pertinaciously obstinate, yet capricious and vacillating, devising many plans of future operations, which are no sooner arranged than they are abandoned in turn for others appearing more feasible. A child in his intellectual capacity and manifestations, he has the animal passions of a strong man. Previous to his injury, although untrained in the schools, he possessed a well-balanced mind, and was looked upon by those who knew him as a shrewd, smart business man, very energetic and persistent in executing all his plans of operation. In this regard his mind was radically changed, so decidedly that his friends and acquaintances said he was "no longer Gage".[38] »

In 1860, an American physician who had known Gage "well" in Chile described him as "engaged in stage driving [and] in the enjoyment of good health, with no impairment whatever of his mental faculties".[39][40] Together with the fact that Gage was hired by his employer in advance, in New England, to be part of the new coaching enterprise in Chile,[41][42] this implies that Gage's most serious mental changes had been temporary, so that the "fitful, irreverent ... capricious and vacillating" Gage described by Harlow immediately post-accident became, over time, far more functional and socially far better adapted.[43][44]

Macmillan writes that this contrast—between Gage's early, versus later, post-accident behavior—reflect Gage's "[gradual change] from the commonly portrayed impulsive and uninhibited person into one who made a reasonable 'social recovery' ",[45] 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".[46]

Exaggeration and distortion of mental changes modifier

Psychologist Malcolm Macmillan's analysis of scientific and popular accounts of Gage found that they almost always distort and exaggerate his behavioral changes well beyond anything described by anyone who had contact with him.[35] In the words of Barker, "As years passed, the case took on a life of its own, accruing novel additions to Gage's story without any factual basis";[47] even today (writes historian Zbigniew Kotowicz) "Most commentators still rely on hearsay and accept what others have said about Gage, namely, that after the accident he became a psychopath."[48]

Behaviors ascribed to Gage after his accident which are either unsupported by, or in contradiction to, the known facts include mistreatment of wife and children (of which Gage had neither);[49] inability or refusal to work;[50][51][52] inappropriate sexual behavior, promiscuity, or impaired sexuality;[53] lack of forethought, of concern for the future, or of capacity for embarrassment; parading his self-misery, and vainglory in showing his wounds;[54] irresponsibility and untrustworthiness;[55] aggressiveness and violence;[56] vagrancy and begging;[57] plus drifting,[58] drinking,[59] bragging,[60] lying,[61] brawling,[62] bullying,[63] psychopathy,[64] inability to make ethical decisions, loss of all respect for social conventions, acting "like an idiot",[65] and dying "due to a debauch".[66] None of these behaviors is mentioned by anyone who had met Gage or even his family; as Kotowicz put it, "Harlow does not report a single act that Gage should have been ashamed of."[67] Gage is "a great story for illustrating the need to go back to original sources", writes Macmillan,[68] most authors having been "content to summarize or paraphrase accounts that are already seriously in error."[69]

Photographie modifier

Two daguerreotype portraits of Gage were identified in 2009 and 2010. They show "a disfigured yet still-handsome" Gage with one eye closed and scars clearly visible, "well dressed and confident, even proud" and holding his iron.[70][71]

Références modifier

  1. ↑ Henry Jacob Bigelow, « Dr. Harlow's Case of Recovery from the Passage of an Iron Bar through the Head », American Journal of the Medical Sciences, vol. 20,‎ , p. 13 – 22, at 19 (lire en ligne)
  2. ↑ Macmillan (2000), ch. 7-9
  3. ↑ Barker (1995)
  4. ↑ Macmillan (2000), p. 1
  5. ↑ Macmillan (2012), part C
  6. ↑ Harlow 1868, p. 21
  7. ↑ Andrew Larner et John Paul Leach, « Phineas Gage and the beginnings of neuropsychology », Advances in Clinical Neuroscience and Rehabilitation, vol. 2,‎ july – august 2002, p. 26 (lire en ligne)
  8. ↑ Macmillan (2001), p. 149
  9. ↑ Ratiu et. al, p. 637
  10. ↑ Macmillan (2000), ch. 14
  11. ↑ Macmillan (2000), ch. 13; Macmillan (2008), p. 830
  12. ↑ Macmillan (2000), p. 290
  13. ↑ Harlow (1868), p. 5
  14. ↑ Macmillan (2000), p. 25
  15. ↑ (en) « Horrible Accident », Boston Post,‎ (crediting Ludlow (Vermont) Free Soil Union, unknown date).
  16. ↑ Harlow (1868), pp. 12-13
  17. ↑ Macmillan & Lena (2010), pp. 3-4
  18. ↑ Harlow (1868), p. 14
  19. ↑ Macmillan (2008), p. 829
  20. ↑ Harlow (1868), p. 14
  21. ↑ Macmillan (2000), p. 101
  22. ↑ Macmillan (2000), p. 103-4
  23. ↑ Harlow (1868), p. 14
  24. ↑ Macmillan (2000), p. 122n15
  25. ↑ Harlow (1868), p. 15
  26. ↑ Macmillan (2000), p. 103-4
  27. ↑ Harlow (1868), p. 15
  28. ↑ Macmillan (2000), p. 122n15
  29. ↑ Macmillan (2000), p. 14
  30. ↑ Harlow (1868), p. 16
  31. ↑ Macmillan (2012), part E
  32. ↑ Macmillan (2012), part B
  33. ↑ Macmillan (2000), p. 122n15
  34. ↑ Macmillan & Lena (2010), pp. 12-15
  35. ↑ a et b Macmillan (2000), pp. 116–19, ch13–14; Macmillan (2012), part C
  36. ↑ Macmillan (2000), pp. 375-6
  37. ↑ Macmillan & Lena (2010), pp. 6-7
  38. ↑ Harlow (1868), pp. 13-14
  39. ↑ J.W. Hamilton, « Editorial and Miscellaneous. The Man Through Whose Head an Iron Rod Passed Is Still Living », Ohio Medical and Surgical Journal, vol. 13,‎ , p. 174 Reprinted: (en) Medical and Surgical Reporter, vol. 5, Philadelphia, Crissly & Markley, (lire en ligne), p. 183
  40. ↑ Macmillan & Lena (2010), p. 8
  41. ↑ Harlow (1868), p. 15
  42. ↑ Macmillan & Lena (2010), p. 15
  43. ↑ Macmillan (2008), p. 831
  44. ↑ Macmillan & Lena (2010), pp. 2,15
  45. ↑ Christian Jarrett, « Neuroscience still haunted by Phineas Gage », sur BPS Research Digest – British Psychological Society,
  46. ↑ Macmillan (2008), p. 831
  47. ↑ Barker (1995), p. 678
  48. ↑ Kotowicz (2007), p. 125
  49. ↑ Gregory K. Moffat, « Fundamentals of Aggression », dans Angela Browne-Miller, {{Article encyclopédique}} : paramètre encyclopédie manquant, ABC-CLIO, (ISBN 978-0-313-38276-5, lire en ligne), p. 44
  50. ↑ (en) Don H. Hockenbury et Sandra E. Hockenbury, Psychology, (ISBN 978-1-429-20143-8), p. 74
  51. ↑ (en) Philip M. Groves et K. Schlesinger, Introduction to Biological Psychology, Dubuque, Iowa, 2nd,
    • (en) James W. Kalat, Biological Psychology, Belmont, California, Wadsworth,
    • (en) B.B. Lahey, Psychology: An Introduction, Dubuque, Iowa, 4th, , p. 63
    • (en) A. Smith, The Body, Harmondsworth, England, Penguin,
    • Macmillan (2000), p. 323.
  52. ↑ (en) John Altrocchi, Abnormal Behavior, Harcourt, Brace, Jovanovich, (ISBN 978-0-15-500370-5)
    • (en) C.G. Morris, Psychology: An Introduction, 9th,
    • Macmillan (2000), pp. 107, 323.
  53. ↑ (en) Graham Beaumont, Pamela Kenealy et Marcus Rogers, The Blackwell Dictionary of Neuropsychology, Wiley, (lire en ligne)
    • (en) A.B. Crider, G.R. Goethals, R.D. Kavanagh et P.R. Solomon, Psychology, Scott, Foresman,
    • (en) David G. Myers, Psychology, Worth Publishers, (ISBN 978-0-87901-644-9, lire en ligne)
    • Macmillan (2000), pp. 319, 327 – 8
  54. ↑ Macmillan (2000), pp. 119, 331.
  55. ↑ (en) Sandra Blakeslee, « Old Accident Points to Brain's Moral Center », New York times,‎ , p. C1
    • Macmillan (2000), p. 116.
  56. ↑ (en) Stuart J. Dimond, Neuropsychology: A Textbook of Systems and Psychological Functions of the Human Brain, London, Butterworths,
    • Macmillan (2000), pp. 321, 331.
  57. ↑ (en) Richard M. Restak, The Brain, Bantam Books,
  58. ↑ (en) Colin Blakemore, Mechanics of the mind, Cambridge University Press,
    • (en) H. Brown, Brain and Behavior: A Textbook of Physiological Psychology, New York, Oxford University Press,
    • (en) Leslie A. Hart, How the Brain Works: A New Understanding of Human Learning, Emotion, and Thinking, Basic Books,
    • Macmillan (2000), pp. 316, 323.
  59. ↑ C.D. Hughes, « Neurological progress in America », Journal of the American Medical Association, vol. 29,‎ , p. 315 – 23 (DOI 10.1001/jama.1897.02440330015001e, lire en ligne)
    • (en) A. Smith, The Mind, London, Hodder and Stoughton,
    • (en) Andrew Wilson, The old phrenology and the new, vol. CCXLIV, , 68 85 (lire en ligne)
    • Macmillan (2000), pp. 118, 316, 321.
  60. ↑ Nye (1942), pp. 366 – 7
  61. ↑ Macmillan (2000), pp. 119, 321.
  62. ↑ Macmillan (2000), p. 119.
  63. ↑ (en) Lester Sdorow, Psychology, Dubuque, Iowa, Brown,
    • Macmillan (2008), p. 830; Macmillan (2000), p. 321.
  64. ↑ (en) Jean-Pierre Changeux, Neuronal Man: The Biology of the Mind, 1st American, , 158 – 9
    • Macmillan (2000), p. 321.
  65. ↑ Macmillan (2000), p. 39.
  66. ↑ « Notes. Lodgement of Foreign Bodies in the Brain », North Carolina Medical Journal, Wilmington, vol. 1,‎ (lire en ligne)
  67. ↑ Kotowicz (2007), pp. 122-3
  68. ↑ Beryl Lieff Benderly, « Psychology’s tall tales », gradPSYCH, American Psychological Association,‎ , p. 20 (lire en ligne)
  69. ↑ Macmillan (2000), p. 315
  70. ↑ Twomey (2010)
  71. ↑ B. & J. Wilgus, « Face to Face with Phineas Gage », Journal of the History of the Neurosciences, vol. 18, no 3,‎ , p. 340 – 5 (PMID 20183215, DOI 10.1080/09647040903018402, lire en ligne)
    • B. & J. Wilgus, « Phineas Gage – Hiding in Plain Sight », The Daguerreian Society Newsletter, vol. 21, no 3,‎ july – september 2009, p. 6 – 9
    • B. & J. Wilgus, « Meet Phineas Gage », sur www.brightbytes.com, (consulté le )
    • B. & J. Wilgus, « A New Image of Phineas Gage », sur www.brightbytes.com, (consulté le )

Sources modifier

  • John Martyn Harlow, « Recovery from the Passage of an Iron Bar through the Head », Publications of the Massachusetts Medical Society, vol. 2,‎ , p. 327 – 47 (lire en ligne) Reprinted: David Clapp & Son (1869)
  • Z. Kotowicz, « The strange case of Phineas Gage », History of the Human Sciences, vol. 20, no 1,‎ , p. 115 – 31 (DOI 10.1177/0952695106075178)
A. « Phineas Gage Sites in Cavendish »
B. « Phineas Gage: Unanswered questions »
C. « Phineas Gage's Story »
D. « Corrections to An Odd Kind of Fame »
E. « Phineas Gage: Psychosocial Adaptation »
F. « Phineas Gage and Frontal Lobotomies »
  • P. Ratiu, I.F. Talos, S. Haker, D. Lieberman et P. Everett, « The Tale of Phineas Gage, Digitally Remastered », Journal of Neurotrauma, vol. 21, no 5,‎ , p. 637 – 643 (PMID 15165371, DOI 10.1089/089771504774129964)

Voir aussi modifier

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External links modifier


Catégorie:Naissance en juillet 1823 Catégorie:Décès en mai 1860 Catégorie:Neurotraumatisme Catégorie:Cas de neurologie Catégorie:Décès à 36 ans Catégorie:Borgne

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