Using Phineas Gage for Questions on Personal Identity and Other Topics in Philosophy of Mind, Experimental Philosophy, Cognitive Science, etc.

Philosophers generally take disabilities (plural) and impairments to be self-evident, natural, and politically neutral human characteristics or attributes that certain people possess and embody.  In recent years, however, a growing number of philosophers have challenged this view, consolidating an area of philosophy for which I coined the name “philosophy of disability.” Many philosophers of disability, assuming the tenets of a dominant social theory of disability (call it “the British social model of disability”), argue that although impairments are politically neutral human characteristics, disability (singular) is a pervasive form of social disadvantage that is imposed upon “people with impairments.”

As I (e.g., 2001, 2006, 2015, 2017) and others have noted, the British social model of disability is structurally analogous to the version of the sex-gender distinction to which, since at least the mid-1970s, many feminists have appealed in order to counter assumptions about the allegedly innate character of gender roles. Of course, much subsequent feminist theory, most notably Judith Butler’s (1999) theory of gender performativity, has troubled the distinction between sex and gender itself, arguing that the discursive construction of gender actually produces the idea that sex is a natural human trait and antecedent to gender.

Like feminists who challenge the prediscursive status conferred upon the category of sex in the sex-gender distinction, I have aimed to denaturalize the putatively prediscursive foundation of the impairment-disability distinction, namely, impairment. In Foucault and Feminist Philosophy of Disability, I argue, contra the British social model, that both impairment and disability are socially constructed, invented rather discovered, made rather than found. In short, disability is constructed all the way down, is a dispositif (to use Foucault’s term), a complex apparatus of force relations that produces impairment as its naturalized foundation in order to camouflage its own thoroughly political motivation. An aim of my research is to indicate how this apparatus of power—that is, the apparatus of disability—has operated within philosophy to bring impairment (the allegedly natural and disadvantageous foundation of disability) into being as that kind of thing.

Among the questions that my research implicitly and explicitly asks are these: How have impairment and disability been constituted within philosophy, including within its professional and institutional practices and its theoretical discourses? How has philosophy construed disability—and its naturalized antecedent, impairment—as a certain kind of problem for the present and, in doing so, propped up the apparatus of disability? What is the relation between this conceptualization of disability as a problem that ought to be rectified, what is taught about disability in philosophy, and the underrepresentation of disabled philosophers in the profession?

One of the examples that I have used to show how philosophers and cognitive scientists, among others, have contributed to, sustained, and elaborated the problematization (to use another of Foucault’s term) of impairment and disability in philosophy is the case of Phineas Gage about whom both cognitive scientist Nina Strohminger (2014) and philosopher Kevin Tobia (2016) have recently published articles in Aeon. Indeed, as I point out in my book, the story of Gage has become institutionalized and persistently embellished in introductory textbooks in cognitive science, philosophy of psychology, and cognate subfields.

In 1848, Gage, a railroad supervisor, was impaled by a tamping iron that entered his left cheek and exited the back of his skull. Malcolm Macmillan (2002), in An Odd Kind of Fame: Stories of Phineas Gage, notes that two-thirds of introductory psychology textbooks mention Gage. Over the course of more than a century and a half, in fact, an almost mythical narrative has been elaborated within psychology and medical textbooks about the aftermath of Gage’s injury, a mythology to which philosophers and cognitive scientists have subscribed and have promoted.

As Allan Ropper (a neurologist at Harvard Medical School and Brigham and Women’s Hospital) puts it, Gage’s “famous case” helped to “establish brain science as a field.” “If you talk about hard core neurology and the relationship between structural damage to the brain and particular changes in behavior,” Ropper says, “this is ground zero.” Ropper explains that Gage’s brain injury offered scientists and medical practitioners “an ideal case” because it involved one region of the brain, was very evident, and the resulting changes in personality “were stunning” (Ropper qtd. in Hamilton 2017).

These sorts of claims about the impact of Gage’s injury have led philosophers of mind and cognitive scientists (among others) to use the story of Gage (and stories of other real or hypothetical people who have sustained brain injuries) as a springboard to advance arguments, develop experiments, and formulate positions on, inter alia, personal identity, the true self, the moral self, and so on (Strohminger 2014; Knobe 2016; Tobia 2016). My argument is that the uses to which philosophers of mind and cognitive scientists routinely put the story of Gage deserve more critical consideration from the philosophical community at large.

Steve Twomey (2010) notes that “John Martyn Harlow, the doctor who treated Gage for a few months afterward, reported that Gage’s friends found him ‘no longer Gage.’” To Harlow, Twomey remarks, “the balance between Gage’s ‘intellectual faculties and animal propensities’ seemed to have [disappeared].” Gage was “unable to stick to plans, uttered ‘the grossest profanity’ and showed ‘little deference for his fellows.’” Macmillan points out that subsequent accounts of Gage’s changed character have gone far beyond Harlow’s observations, transforming Gage into an ill-tempered, shiftless drunk (2002). As Twomey asserts, and as my own research on Gage indicates, these accounts about Gage’s demeanor post-accident vilify him, seem exaggerated, and in fact seem largely fabricated.

Consider that Harlow, to whom most references in the literature appeal, treated and observed Gage for only a few months, a relatively short span of time given Gage’s injury and the changes in his life that it would have entailed. Furthermore, Harlow’s description of the post-incident-Gage does not seem to warrant the dispositional and personality changes—cruel, mean, and so on—that have been attributed to Gage in the scientific and philosophical literature over the years.

In short, the ways that (if not the very fact that) cognitive scientists and philosophers use the story of Gage are highly contestable. They cannot be sure that the cited reports from Gage’s friends (if in fact made) were not in some way conditioned by their own misunderstandings of his behaviour, their revulsion and prejudices about his changed physical appearance, or simply their own impatience as he learned new ways to comport himself in the world. Some accounts of Gage’s life post-incident contradict the oft-cited reports, indicating that Gage had a pleasant enough demeanor post-injury, but was socially outcast and unable to find employment.

Macmillan, who allows that Gage did undergo a change in personality post-injury, remarks nonetheless that the personality change that Gage experienced “did not last much longer than [two or three years]” (2002). As Macmillan points out, Gage eventually secured employment as a long-distance stagecoach driver in Chile, an occupation that would have required considerable skill, focus, and amicable behavior.

That Gage’s situation has been exaggerated and embellished within the contexts of the literature of (inter alia) neuroscience, cognitive science, philosophy of mind, experimental philosophy, and medicine reminds us that science, philosophy, and medicine are embedded social practices rather than disinterested domains that exist apart from and immune to ableist biases and other elements of the apparatus of disability.

Although, in a brief and equivocal footnote, Tobia and David Shoemaker (co-authors of a forthcoming publication on personal identity that uses Gage) cite my criticisms of how philosophers deploy Gage, these authors nevertheless proceed to use the incident in Gage’s life in exactly the same exploitative way that earlier philosophers have used it, suggesting that the benefits for philosophical inquiry that can be derived from this particular use of Gage in philosophy and cognitive science outweigh the urgency of accountability for the deleterious disciplinary, professional, institutional, social, and political effects that such endeavours produce (see Shoemaker and Tobia, forthcoming).

Indeed, my argument is that the use to which philosophers (and others) have put the Gage case and their implicit and explicit rationale and justifications for continuing to do so are clear and distinct examples of how the political causes and effects of philosophical inquiry are persistently neutralized, covering over the situated character of the contexts of discovery from which philosophical questions emerge and presenting them as objective, value neutral, and disinterested. Thus, I contend that we should ask these questions (among others) about this line of inquiry in philosophy of mind, experimental philosophy, cognitive science, and related fields:

How has this (embellished) narrative about Gage contributed to the problematization of disability in philosophy?

In what ways has this mythical narrative about Gage enabled the naturalization and materialization of impairment within certain subfields of the discipline and thus further enabled the consolidation of the relation between philosophy and the apparatus of disability?

In what ways does this mythology about certain disabled people ultimately shape, condition, and determine research programs and teaching in cognitive science, neuroscience, and philosophy of mind?

How has this vilification of Gage within academic contexts relied upon and reproduced pervasive social prejudices and assumptions according to which certain disabled people are aggressive, violent, and even dangerous?

How, and to what extent, do the repeated articulations of this myth about Gage confirm what philosophers already believed about (some) disabled people?

Finally, to what extent does the repeated articulation of this fanciful narrative about Gage (and there are surely others, including the discourses in ethics and cognitive psychology on “psychopaths”) foster the hostile environment that disabled philosophers confront in philosophy and sustain their underrepresentation in it (see Tremain 2017)?


Butler, Judith. 1999. Gender Trouble. 2nd ed. New York: Routledge. First published in 1990.

Hamilton, Jon. 2017. “Why Brain Scientists Are Still Obsessed With the Curious Case of Phineas Gage.” Shots: Health News From NPR (blog). NPR. May 21.

Knobe, Joshua. 2016. “Personal Identity and the True Self.” Flickers of Freedom (blog).

MacMillan, Malcolm. 2002. An Odd Kind of Fame: Stories of Phineas Gage. Cambridge, MA: A. Bradford/MIT Press.

Shoemaker, David, and Kevin P. Tobia. Forthcoming. “Personal Identity.” In The Oxford Handbook of Moral Psychology. Oxford: Oxford University Press.

Strohminger, Nina. 2014. “The Self Is Moral.” Aeon.

Tobia, Kevin. 2016. “The Phineas Gage Effect.” Aeon.

Tremain, Shelley. 2001. “On the Government of Disability.” Social Theory and Practice 27 (4): 617–36.

Tremain, Shelley. 2006. “Reproductive Freedom, Self-regulation, and the Government of Impairment in Utero.Hypatia: A Journal of Feminist Philosophy 21 (1): 35-53.

Tremain, Shelley. 2015. “This Is What a Historicist and Relativist Feminist Philosophy of Disability Looks Like.” Foucault Studies 19 (1): 7-42.

Tremain, Shelley L. 2017. Foucault and Feminist Philosophy of Disability. Ann Arbor: University of Michigan Press.

Twomey, Steve. 2010. “Phineas Gage: Neuroscience’s Most Famous Patient.” Smithsonian, January.

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