Based on the facts of this case summary, please explain what may have been a primary reason AND an alternate explanation for the changes in Gage's behavior after the accident.

Here are the facts:

"The fateful day was 13 September 1848. Phineas Gage was a 25-year-old man working for a rail-building company; he was foreman of a gang of men employed in blowing away rock to clear the way for a new stretch of rail. On that day, he was laying explosives for another blast. But things went wrong. While he was tamping it with the blunt end of a sharply pointed iron bar, he got distracted and the explosive went off. The 13 14 -pound iron, over 3 12 feet (1.05 m) long and 1 34 inch (44.45 mm) in diameter, pierced Gage's head. It entered beneath his left cheek, passed behind the eye, pierced the base of the skull, went through the front of the brain, and fell on the ground over 100 feet (30.4 m) away, covered in blood and brains.

Most extraordinarily, Gage did not even lose consciousness. He 'was thrown upon his back', exhibited 'a few convulsive motions of the extremities' (Macmillan, 2002: 415) and within a few minutes spoke. "This does not seem very different from a boxer recovering after a heavy knockout. He was taken by cart to the local town. During the journey he sat erect and on arrival got out of the cart himself, with just a little assistance from his workmates. On meeting the doctor who was to attend to him, he is supposed to have said, 'Doctor, here is business enough for you', which surely rates as one of the great understatements of all time. And while the gaping wound was being dressed ('the pulsations of the brain [were] very distinct' [ibid.: 415]), Gage recounted the accident to him (Kotowicz, 2007).

Before the injury, Gage was described as mentally "well-balanced" which typically means thoughtful, self-regulated and emotionally self-controlled. He was a foreman in charge of a large crew of workers and was well liked by his employer and his men. He was thought of as an intelligent and capable businessman, very energetic and persistent in carrying out his plans.

After the accident, his behavior changed. For example, routinely he used vulgar language. He didn't seem to care about the effect of his behavior on those around him. He did not want to accept the advice of others, was described as stubborn but capricious meaning he changed his mind at any whim. It may be that the brain injury caused these changes in his personality, but there may be another explanation.

Before a verified photograph of Gage had been identified, researchers used computer simulation to depict his injuries. Prior to the accident, he was described as very handsome, tall (for the historical period), and charming. The pictures below were painstakingly created using a man who meets Gage's description and an image of the tamping rod. The second and third pictures were made with specialized computer software to depict the probable appearance of Phineas Gage after healing from his wounds.

Sources

Damasio, H., Grabowski, T., Frank, R., Galaburda, A. M., & Damassio, A. R. (20 May 1994). The return of Phineas Gage: Clues about the brain from the skull of a famous patient. Science, 1102.

Kotowicz, Z. (2007). The Strange Case of Phineas Gage. History of the Human Sciences, 115 - 131.

Macmillan, M. (2002). An odd kind of fame: Stories of Phineas Gage. Cambridge, MA: MIT Press.