The historical case of Phineas Gage (1848) is an integral part of medical folklore, illustrating the involvement of the frontal lobes in problem solving, memory, judgment, impulse control and social and sexual behavior. 

Before an accident in which a large iron rod was driven completely through his left frontal lobe, Gage had been a most capable and efficient foreman, one with a well-balanced mind, and who was looked on as a shrewd, smart businessman. Post-accident, Gage was fitful, irreverent and grossly profane, showing little deference for his fellows. He was also impatient and obstinate, yet capricious and vacillating, unable to settle on any of the plans he devised for future action.

On July 13, 2024, in an assassination attempt, a bullet struck President Donald Trump from an AR-15-style rifle at a distance of approximately 134 meters and traveling at approximately 3,200 feet per second (roughly 975 meters per second) at the muzzle. While not an iron rod, the transfer of force may have been significant.

On April 5, 2026, the president took to social media, threatening to bomb another country’s civilian infrastructure — power plants and bridges. As Congresswoman Pingree says, it’s time to invoke the 25th Amendment after “openly talking about committing war crimes like he’s live-posting a sporting event. This man has the nuclear codes. The Cabinet and Congress must confront the obvious.” 

The damage that a modern-day Phineas Gage sitting in the Oval Office can wreak is inestimable.  The congresswoman’s declaration could not be more timely.

 Peter Pressman, MD
Winter Harbor

Edward A. McCulloch, Ph.D.
Tucson, Ariz.