On September 13th, 1848, Phineas Gage would go on to revolutionize the field of neuroscience. He was no doctor or researcher, yet his story would become one of the best-known cases in the field of neuropsychology. As a railroad worker in Vermont, he and his crew were tasked with blowing up rocks to make way for a new rail line (Hamilton). As he was tamping down some sand over the explosive, he accidentally scraped rock with his iron rod, creating a spark that would set off the charge. This explosion sent up the 43-inch iron rod careening through into his left cheek, eventually exiting from the top of his head, destroying much of his left prefrontal cortex in the process (Cherry). The scene was truly gruesome. The arriving doctor described how he saw Mr. Gage keel over and vomit, the effort of which ‘pressed out about half a teacupful of the brain, which fell upon the floor’ (Shahab). Miraculously, Gage would go on to survive and make an almost full recovery. Apart from losing vision in his left eye, he appeared to have little to no deficits in regular physiological function. And yet, he would never be the same again; the previously hardworking, intelligent, kind, and a mild-mannered man had completely changed. Gage was now totally inappropriate, unable to stick to his schedule, showed little empathy or care for others, and overall showed very little similarity to the man he once was. He had changed so much that his friends and family famously said that he was ‘no longer Gage’ (Twomey). His loved ones were not exaggerating; the prefrontal cortices (most of the left and some of the right) that he had damaged are known to mediate emotional processing and rational decision-making (Damasio). In a very real way, Phineas Gage was no longer the same person he once was. Although he went on to live a fairly normal and uneventful life after the accident, what if Gage had become criminally inclined after his injury? Could we honestly say that it would have been his fault, or would we have excused it on behalf of the traumatic brain injury he suffered? This type of scenario is far from speculative. Time and time again, individuals with some form of brain damage–be it a brain tumor or lesions in the cortex–have been shown to develop criminal behaviors that reverse course when the underlying condition is treated (Vanderbilt University Medical Center). In one particularly difficult case, a 40-year-old schoolteacher was found to have been downloading tons of child pornography. It was only after doctors removed the egg-sized tumor from his head that man recognized the appalling nature of his act and no longer suffered from his urges (Choi et al.). This kind of situation raises some pressing questions about morality and personal responsibility. Should the man (and people in similar situations) be held legally responsible? After all, such criminal acts are not victimless; if he had acted on his impulses with the children he was teaching, it would seem absurd to simply let him off ‘scot-free’. But on the other hand, there were clear extenuating circumstances that were out of his hands which pushed him to commit the heinous acts Situations, where there is a physicality to the neurological condition, are more likely to be forgiven. An iron rod to the head, a tumor in the orbitofrontal cortex (Darby et al.), most would agree that these individuals were only partially responsible for their actions given the brain damage they suffered. This accordance is unlikely to be offered to a serial killer who is clearly unwell. And yet, it could be argued with some merit that such a psychopath was themselves not responsible for the ‘faulty’ neural circuit they were born with (Aggarwal). If neurology could one day attribute violent or criminal behavior ‘to a specific morphological structure and electrochemical transmission within the brain … [would that] wipe out the concept of personal responsibility?’ (Douglas) How are we, as a society, meant to navigate this ambiguity? Should most criminals and incarcerated persons go free due to situations out of their control, or should this excuse only be afforded to ‘normal’ people who develop the behaviors due to some accident? With the global prison population increasing at historic rates (Birbeck), such questions in neuroethics are as pressing and relevant as ever. After all, the stated purpose of prison is deterrence and rehabilitation. However, how is that meant to treat one who is ‘no longer Gage’?
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Shahab, Dr Aiman. “Phineas Gage - A Brain Anomaly.” MEDizzy Journal, 1 Apr. 2020, journal.medizzy.com/phineas-gage-a-brain-anomaly/. Accessed 17 Dec. 2020.
Twomey, Steve. “Phineas Gage: Neuroscience’s Most Famous Patient.” Smithsonian, Smithsonian.com, 2010, www.smithsonianmag.com/history/phineas-gage-neurosciences-most-famous-patient-11390067/.
Vanderbilt University Medical Center. "Brain lesions, criminal behavior linked to moral decision-making network." ScienceDaily. ScienceDaily, 18 December 2017. <www.sciencedaily.com/releases/2017/12/171218154935.htm>.
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