No Longer Phineas Gage: How to Improve Memory, Planning, Self-Control, Conscientiousness, Executive function, and Get Control of Your Life.

Everyone who’s ever taken a neuroscience course knows about Phineas Gage. For those of us who haven’t, all you need to know is that he was a nineteenth century railroad construction foreman who, in a freak accident, got a large iron rod driven through his head, destroying most of his brain’s left frontal lobe. Remarkably, he survived. Here is one researcher’s account of how Gage was changed after his injury:

“The equilibrium or balance, so to speak, between his intellectual faculties and animal propensities, seems to have been destroyed. He is fitful, irreverent, indulging at times in the grossest profanity (which was not previously his custom), manifesting but little deference for his fellows, impatient of restraint or advice when it conflicts with his desires, at times pertinaciously obstinate, yet capricious and vacillating, devising many plans of future operations, which are no sooner arranged than they are abandoned in turn for others appearing more feasible. A child in his intellectual capacity and manifestations, he has the animal passions of a strong man. Previous to his injury, although untrained in the schools, he possessed a well-balanced mind, and was looked upon by those who knew him as a shrewd, smart businessman, very energetic and persistent in executing all his plans of operation. In this regard his mind was radically changed, so decidedly that his friends and acquaintances said he was “no longer Gage”.”

Accounts of his post-injury neuropsychiatric symptoms have taken on mythic proportions over the years, and are probably often quite exaggerated. Nevertheless, based on what we know of the functions of the frontal lobes today, it would make sense that many of the changes described, though perhaps exaggerated, are probably pretty solidly based in fact.

The frontal lobes contain the prefrontal cortex, the area of the brain that is evolutionarily the newest and the one that makes us most human. From Wikipedia:

The prefrontal cortex (PFC) is the anterior part of the frontal lobes of the brain, lying in front of the motor and premotor areas.

This brain region has been implicated in planning complex cognitive behavior, personality expression, decision making, and moderating social behavior.[1] The basic activity of this brain region is considered to be orchestration of thoughts and actions in accordance with internal goals.[2]

The most typical psychological term for functions carried out by the prefrontal cortex area is executive function. Executive function relates to abilities to differentiate among conflicting thoughts, determine good and bad, better and best, same and different, future consequences of current activities, working toward a defined goal, prediction of outcomes, expectation based on actions, and social “control” (the ability to suppress urges that, if not suppressed, could lead to socially unacceptable outcomes).

Many authors have indicated an integral link between a person’s personality and the functions of the prefrontal cortex.[3]

Probably the best way I’ve ever heard of summing up the role of the prefrontal cortex is to imagine that the whole brain is an orchestra, and all the various regions musicians in it, except for the prefrontal cortex, which is the conductor. The conductor makes sure that all the musicians are playing the same piece of music in harmony and synchronicity.

Have you ever wondered how meditation exerts positive effects on the brain and personality of practitioners? It does so because the act of meditating requires intense activation of the prefrontal cortex, which “conducts” the rest of the brain to work in a way that doesn’t come to it easily. Just like a muscle, the prefrontal cortex becomes stronger from this intense usage and the more you meditate, the stronger your prefrontal cortex becomes. This results in improvements in many areas of neuropsychiatric functioning, including reductions in the symptoms of ADHD, depression, pain, anxiety, and stress, as well as increases in self-control and good mood.1 2 3 4 5 6 7

Meditation is arguably the ultimate neuropsychiatric treatment. However, many people aren’t psychologically prepared to invest the necessary time into practicing it often enough to see significant results (which seems to be meditating for fifteen minutes a day for two weeks). For those of us with limited time and/or patience, there are other ways to improve the functioning of our prefrontal cortex. Several dopaminergic and noradrenergic antidepressant and ADHD medications stimulate the prefrontal cortex to some extent, but they do so weakly, and they non-selectively stimulate subcortical areas as well. There are a few exceptions to this rule though. The best I’ve found so far is a pharmaceutical drug called guanfacine.

Guanfacine is a noradrenergic agonist (meaning that it mimics norepineprhrine, a neurotransmitter that regulates alertness, attention, etc.) that stimulates the alpha-2A receptors in the prefrontal cortex with a high degree of selectivity.8 It is designed to ameliorate the prefrontal cortex dysfunction typically seen in people with ADHD or ADD. The title of the 1998 study that persuaded me to try guanfacine was: “Guanfacine, But Not Clonidine, Improves Planning and Working Memory Performance in Humans”. The authors concluded: “The 29 μg/kg dose of guanfacine improved spatial working memory and planning. It is possible that the greater selectivity of guanfacine for α2A-adrenoceptor subtype may underlie its differences from clonidine.” I’m a big proponent of anything that selectively stimulates the prefrontal cortex, so I thought I’d give it a try.

I started taking about 2.9mg of guanfacine day three days ago, and the change in my behavior has been fairly dramatic. I’ve been planning a lot more since I started taking it, to the point that my girlfriend complained today that I’m planning too much, a criticism which I assure you has never been leveled at me in my entire life. I’ve also found myself being more helpful around the house, having more self-control, and being more productive. I attribute the fact that I started this blog yesterday to the effects of guanfacine.

So, if you have a disorder like ADD, ADHD, or depression in which the prefrontal cortex isn’t being stimulated enough, or if you just feel like you could use some help with planning, short term memory, and other higher cognitive functions, I highly recommend trying guanfacine and seeing if it works for you.


1: ADHD, Brain Functioning, and Transcendental Meditation Practice (2011).

2: Mindfulness meditation counteracts self-control depletion (2012).

3: The effectiveness of a stress coping program based on mindfulness meditation on the stress, anxiety, and depression experienced by nursing students in Korea (2009).

4: How Does Mindfulness Reduce Anxiety, Depression, and Stress? An Exploratory Examination of Change Processes in Wait-List Controlled Mindfulness Meditation Training (2013).

5: Mindfulness-Based Stress Reduction, Mindfulness-Based Cognitive Therapy, and Zen Meditation for Depression, Anxiety, Pain, and Psychological Distress (2012).

6: The Effect of Mindfulness-Based Therapy on Anxiety and Depression: A Meta-Analytic Review (2010).

7: Loving-kindness and compassion meditation: Potential for psychological interventions (2011).

8: Pharmacological and therapeutic directions in ADHD: Specificity in the PFC (2007).