by Emma Byrne
Harlow had an inquisitive mind, a strong stomach, and what must have been a really persuasive bedside manner because he left notes explaining how he literally got inside Gage’s head to try to figure out—by touch alone—the exact shape of the damage done by the bar. He wanted to check whether there were any bits of bone or shrapnel in the wound and so, around three hours after the accident, he decided to use his finger:
“I passed in [to the hole in the top of Gage’s head] the index finger its whole length, without the least resistance, in the direction of the wound in the cheek which received the other [index] finger in like manner.”
It’s a striking image: Harlow poking one finger up through the hole in Gage’s cheek and another through the hole in the top of Gage’s head like a pair of Chinese finger cuffs. This was only the first of many painstaking measurements he made. Over the coming years Gage would be sketched, have plaster casts made of his head, and be measured countless times. Harlow eventually concluded that Gage’s left frontal lobe was destroyed (that fateful half a teacupful) but that the right side was completely intact.
We now know that Harlow’s description of Gage’s injury was spot on. His observations were confirmed in 2004 when doctors from the Brigham and Women’s Hospital in Boston, Massachusetts, made a 3D computer model from Gage’s skull—which Gage’s family had bequeathed to Harlow when Gage died—showing the exact path of the tamping iron through his head. The damage corresponds perfectly with Harlow’s records.1
The painstaking nature of Harlow’s observations are vitally important because they helped us to understand how much brain structure matters. After the accident, Gage made an excellent physical recovery but he seemed to be a different man, so much so that the same bosses who thought him a “smart and capable” and “shrewd” man before his accident refused to hire him when he reapplied for his old job as a foreman in 1849. At the time of his death, twelve years after his accident, he was working as an itinerant farmhand. One of a whole range of symptoms he experienced was a new-found compulsion to swear. Dr. Harlow wrote that Gage had become “fitful, irreverent, indulging at times in the grossest profanity (which was not previously his custom).”
For these reasons, Gage provided an important bit of evidence in the pudding wars. If the blancmange theory was correct, Gage could lose a chunk of his brain and still be left with all of his faculties intact. His brain would be the same as before—just smaller. However, Gage seemed to come out of the experience a very different person—and in a way that seemed both too profound and too specialized to be the psychological effect of having a six-kilogram missile take a shortcut through your noggin. “The equilibrium or balance, so to speak, between his intellectual faculties and his animal propensities, seems to have been destroyed,” wrote Harlow. Gage’s intelligence, memory, and skills were intact, but his self-control was shattered. His new habit of swearing—of using “gross profanities”—appeared to show that a vital ingredient of Gage’s personality used to reside in the destroyed left frontal lobe.
!
People arguing for a differentiated brain weren’t particularly close to the idea of brain structures as we understand them today. The structure-theorists of the time were, in the main, phrenologists: people who believed that you could deduce someone’s personality type from the bumps on their head.
Phrenology had become popular enough as a scientific fad that articles in newspapers and magazines would frequently cite phrenological “evidence” in criminal cases. Phrenology and Gage intersected in several news articles at the time, such as an 1848 piece “Alive from the Dead, Almost” in the North Star, a newspaper published in Danville, Vermont. The author of the piece thought that phrenology would neatly explain the changes in Gage’s condition: “Striking him on the face just below the cheekbone, [the bar] forced itself through the skull near the top of the head, passing directly through what phrenologists call the organ of veneration.” An 1851 American Phrenological Journal report (“A Most Remarkable Case”) went on to say that the organs of benevolence and veneration had both been damaged and that this explained “his profanity, and want of respect and kindness.” This was to be the first of several times that Gage’s case would be used as evidence for whatever neuroscientific theory had the upper hand over the next 150 years.
These days phrenology is rightly dismissed as a pseudoscience; the theories that phrenologists drew up were never really supported by the evidence. But those early observers of temperament and behavior at least opened the door to the idea that the brain had specialized areas. As a result, doctors began to pay close attention to brain injuries and their consequences. The systematic study of the structure of the brain and its relation to behavior had begun and the “blancmange” theory would never quite regain the upper hand. As phrenology fell out of favor, scientists began to question whether the iron bar might have carried away something much more fundamental. Their answer came partially from Victorian England, and was rooted in the study of swearing.
The Victorian Origins of Neuroscience
In the late 1800s, the treatment of “lunacy”—a catchall term that included everything from epilepsy to depression, schizophrenia to the after-effects of stroke—took place in asylums. In the middle of the nineteenth century there were just 10,000 people in asylums like London’s notorious Bedlam, but by the 1890s over 100,000 people were locked up, often in straitjackets or shackles, sedated with bromide, no matter what their condition.
John Hughlings Jackson was a Victorian scientist and one of the founders of neuroscience as a discipline. Born in 1835 near Harrogate to a yeoman father, he went on to study medicine in London and St. Andrews, where he was one of a new breed of young doctors who helped to develop an innovative kind of medicine rooted in deductive reasoning. It was this novel way of medical thinking that would later influence Sir Arthur Conan Doyle when he created that most famous deductive reasoner, Sherlock Holmes.
Insane asylums were open to the public as freak shows and drew large crowds. While his contemporaries visited places like Bedlam for the shock and entertainment value, Jackson took the study of “lunacy” seriously. He wanted to know why patients suffered from certain, stereotypical types of seizures. By doing so, he made a number of significant breakthroughs in our understanding of the brain. He noted, for example, that an epileptic patient’s seizures more strongly affected the side of the body opposite the site of the brain damage. This helped to prove what we now take for granted: that the left side of the brain controls the right side of the body and vice versa.
He also showed that parts of the brain work in concert with each other. For example, his observations of the way that seizures spread in the body, from the fingers or toes all the way up to the face, allowed him to deduce how the body sends movement signals via the nerves.
In his epilepsy research, Jackson also left a fascinating record of the behavior of another kind of patient—the “aphasic.” Bedlam and other asylums housed many patients with brain damage that disrupted their ability to speak. Aphasics were patients who couldn’t repeat what they’d said when asked, couldn’t describe what they’d said and couldn’t come up with new things to say. Victorian sensibilities meant that most physicians reported that these patients were completely incapable of speaking: aphasia means literally “without speech.” Jackson didn’t like the term “aphasia” because, he argued, it was both too specific and too general. Aphasia didn’t stop his patients from speaking, like some sort of laryngitis of the mind. Rather, it robbed them of the ability to express themselves both verbally and nonverbally with gestures. But most aphasics did still speak—or at least they said words. The problem was that these words didn’t seem to mean anything.
Jackson thought that the words and phrases used by aphasics were verbal tics, woven so tightly into the patient’s mind that they could no more discard them than they could stop themselves from blinking. Some of the most common of these tic-like sayings were swear words, blasphemies, and—in the case of one of h
is patients—only the rather sweetly vulgar “Poo!” A patient with this type of aphasia was on the receiving end of a cruel double whammy. She couldn’t speak voluntarily, couldn’t ask for help, or express love or longing and at the same time was stuck repeating the same few phrases over and over again in an unstoppable verbal loop.
Jackson noticed two things about these patients. Firstly, there was a difference between speaking words and understanding them. “When, from disease in the left half of the brain, speech is lost altogether, the patient understands all we say to him, at least on matters simple to him,” wrote Jackson. This observation, unexceptional though it might seem, revealed something fundamentally important: speaking and understanding language are not the same thing, and are not located in the same part of the brain. Language is not a tune played by a single instrument, but a complicated orchestral score.
Secondly, Jackson noticed that brain-damaged patients could at least express emotion verbally, even with the few utterances that they had left, by using their tone of voice. “[The patient’s] recurring utterance comes out now in one tone and now in another, according as he is vexed, glad, &c.,” he wrote. “As stated already, he may swear when excited.” While these aphasic patients were never going to win prizes for their oratory, they were far from speechless.
We might never have known this at all, if it weren’t for the iconoclastic Jackson’s documentation of swearing among his patients. He was practically unique in this. To most observers at the time (and even some neuroscientists today) swearing didn’t count as “real” speech. Instead, swearing was thought to be bestial, more like an animal’s howl than human expression. Swearing was unacceptable in polite society and so it was overlooked by most of the doctors who attended Bedlam’s inmates. But Dr. Jackson had no problem with recording swearing, and so as early as the 1880s swearing was recognized as a strangely resilient part of speech. Jackson’s observations about the tenacity of bad language were groundbreaking, but for nearly a century after he wrote them, scientists still didn’t realize quite how important that remaining profanity among aphasics is, or that the residual bad language can actually be used to communicate. We’re only just beginning to understand why swearing is so good at sticking around.
There then follows an almost century-long hiatus in the study of swearing. Since there were plenty of scientists around who were prepared to study sex, death, and disease during this period, it’s hard to fathom exactly why swearing was given such a wide berth. Even today I’ve noticed that many papers on the topic still start with an apology. I think swearing was neglected because it wasn’t seen as a field important enough to overcome the “ick” factor.
This distaste or disdain for swearing meant that it went largely unexamined until the late 1980s, when researchers finally started to take the matter seriously again. Studies of brain-damaged patients in the United States, the UK, France, Germany, and Italy confirmed that swearing among aphasics is widespread, if not universal. Most of the authors of these studies rather delicately decided not to include the swear words used by their patients, which is really frustrating; without this data it is impossible to say what sorts of swear words are most likely to be preserved.
Thankfully, this was not the case with a 1999 study by two California-based neuroscientists, Professors Diana Van Lancker and Jeffrey Cummings. They noticed that aphasic patients frequently said things like “bloody hell,” “bloody hell bugger,” “fuckfuckfuck, fuck off,” and “oh you bugger,” as well as other repetitive sayings like “well I know,” “wait a minute,” or “don’t be sad.”2
They studied one unfortunate patient, let’s call him Charles, who had had the entire left side of his brain removed. As a result, Charles couldn’t give the names of simple things that he was shown, like safety pins, measuring tapes, watches and clocks. Safety pin became “sood” and the other items he couldn’t name at all. Even when asked to repeat words, he would make many mistakes, saying “November” or “sandwich” instead of “remember” and “vegent-lich” when he meant “constitution.”
However, he had no problem swearing. In a five-minute recording in which he was asked to name the objects he was shown and repeat words that he heard, he said “Goddamn it!” seven times and “God!” and “shit” once. Professor Van Lancker noticed that Charles could swear far more easily than he could manage any of the other words he tried to use, and that his swearing was fluent and easy to understand while his other speech was slurred and strained. The real breakthrough came when the researchers showed a picture of Ronald Reagan to Charles. He eventually managed to name the ex-president, but initially responded with some surprisingly fluent swearing.3 This patient still had strong political opinions and the wherewithal to express them, with a little help from dirty language. In short, he could communicate, under the right conditions, by using swearing as a gateway to other forms of expression.
Van Lancker and Cummings wanted to pursue this line of research, but their first challenge came when they discovered that there was not, and still isn’t, a standardized clinical test for swearing competence, although there is a clinical test to measure sense of humor. (More on that later.) What’s more, swearing was still taboo, despite the evidence for its psychological benefits for the patient. Van Lancker and Cummings noted, somewhat bitterly: “patients are usually discouraged from using curse words during recovery as if cursing were not functionally useful during the recovery process.”
Sadly, this line of research seems to have petered out through lack of support, again based on our general discomfort around swearing. This is really depressing: swearing is the one remaining means of communication that can be used by people who have suffered a massive and life-changing illness or injury, but rather than encouraging them to use what little language they have left, the emphasis is still on teaching stroke victims to control their swearing, essentially silencing what’s left of these patients’ voices because of our own strong feelings about strong language.
Why exactly is swearing so resilient in patients who have lost most of their speech? We don’t know for sure, but swearing plays so many roles in the way we communicate —it’s used to threaten, to warn, to intensify, to amuse. As a result, swearing has deep connections in many parts of the brain, particularly to those parts that help us process emotions. And some of those parts of the brain are so fundamental that they have been with us since before we became human.
What’s Right? What’s Left?
There’s plenty of common knowledge about the left and right sides of the brain. Most of it is bunk, or at least oversimplified to the point of near uselessness. But when it comes to swearing—and language in general—the picture is pretty clear-cut.
If you damage or lose the left side of your brain you’re most likely to develop some form of aphasia. That’s because some very important structures necessary for using language tend to be found here. Aphasia is a dramatically noticeable change in a person’s ability to communicate and so scientists have been able to discern a lot about the workings of the left hemisphere. Although it has presented more of a challenge, scientists have also started to unpack the more subtle and hard-to-isolate effects of right-hemisphere damage.
For example, there’s the case of David, who suffered massive damage to the right-hand side of his brain after a stroke.4 David was seventy-five years old and had been bilingual his entire life. He was fluent in both Hebrew and French both before and after his stroke. According to his doctors, David was a literate and eloquent man, even after suffering brain damage, but after his stroke something strange happened to his ability to speak. You might not notice there was anything wrong with David in the course of an ordinary conversation, but he had lost all the automatic sayings that he’d known for almost his entire life. For example, he couldn’t recite the Jewish verses, prayers, and blessings he’d said every day since he was a little boy. He had lost the ability to count by rote from one to twenty, too. In fact, everything he’d learned by heart simply vanished fro
m his mind.
These phrases and verses weren’t the only thing to disappear. While David wasn’t much of a swearer before his stroke, afterward he said that he never got the urge to swear at all. When researchers asked him which swear words might be appropriate in situations that were described to him he couldn’t think of any, nor could he complete half-formed swearing phrases like “mother_____.”
David’s experience is uncommon but not unique. People with damage to the right hemisphere tend to become emotionally detached and excessively literal. These patients have problems with jokes and metaphors, can’t recognize idioms, and, in most cases, completely give up on profanity even if they had been fluent swearers before. This is when a standardized test for swearing competence would come in handy.
Unlike swearing, there is a standardized clinical test for humor, called the “Humor Orientation Scales.” Dr. Lee Blonder and Dr. Robin Heath applied this to other patients with damage to their right hemisphere after a stroke.5 They discovered that these patients tend to be able to understand the logic of jokes but they just don’t laugh—or even smile —when someone tells a joke around them. Also, if they try to make jokes they are usually either inappropriate or completely fall flat—perhaps because they can’t imagine the likely emotional effect of the joke on other people.
Telling a joke (and understanding one) is a complex emotional process. We need to be able to model the fictional emotional states of the characters in the joke, as well as the likely emotions of the person hearing (or telling) the joke. Joke blindness hints at an emotional deficit in the brain. One of the standard tests for humor involves asking patients to complete jokes. They are read a setup and asked to pick an appropriate punchline for jokes like this: