Book reviews

Abstract

Goldberg, E. (2001). The executive brain: Frontal lobes and the civilized mind. Oxford: Oxford University Press. 272 pp, ISBN 0-19-514022-2, $29.95 (Hbk). “In this book I explore the one part of your brain that makes you who you are and defines your identity, that encapsulates your drives, your ambitions, your personality, your essence: the frontal lobes of the brain” (p. 1). So begins this highly personal account of higher cognitive function. In it the author sketches a trajectory from pre-Glasnost USSR (under the tutelage of A.R. Luria) to the academic life in New York City, punctuated by a series of studies, each one informed by a clinical interest in the consequences of frontal lobe injury. Goldberg has a characteristic personal style: enthusiastic, witty and opinionated. His interest in executive function is grounded in his own story: How he left the USSR through the application of a careful, and necessarily extended, game plan. While wishing to escape, he also had to avoid implicating those for whom he cared. The latter included Luria and his wife (there is a most atmospheric portrait of the couple on p. 10). In this book, intended primarily for the “lay reader”, executive function is always instantiated in real-life situations and perfused with an abiding sense of New York. Here, the example of an executive task is to choose a restaurant in which to dine; working memory is engaged while phoning “your dentist”; and a patient sustains his head injury by falling from a horse in Central Park. The case studies are excellent and follow in the exemplary tradition of Luria and Oliver Sacks (below). Goldberg devotes necessary chapters to anatomy, and function, then differentiates dorsolateral and orbitofrontal organic syndromes, next focusing upon the prospects for therapy (pharmacological and psychological) before a final meditation upon whether frontal lobe organisation and dominance might inform societal organisation and hierarchical systems. This is a compelling account but it is always partial. One is always aware that one is reading Goldberg's opinion, a distillation of his own conclusions (although he is honest and explicit about this). Goldberg is “anti-modularity”, against the rather tight, restricted modularity that might emerge from an over-zealous localisation of brain functions. Instead, he posits gradients of propensity toward key functions; these distributed across the cortical mantle. However, his delineation of dorsolateral and orbitofrontal syndromes suggests that some degree of functional localisation remains necessary. The author's own contributions to the field emerge chapter by chapter and include a concern with the right hemisphere's role in novelty processing and generation, the gradient model (above), the existence of a reticulofrontal syndrome, the application of cognotropic agents to rehabilitation (and early attempts at cognitive therapy), the rolling out of brain function towards societal structure and a Web-like model of culture. The latter seems to include the implication that there is a need for an overarching “controller” of global activity (akin to prefrontal cortex), a proposition that might provoke concern among some readers. Which nation or agency is best placed to fulfil such a role? Relatively few scientific papers are discussed in this book; conference abstracts and peer-reviewed articles are treated as equivalent; and some of the arguments do not quite cohere. The role of the right hemisphere in novelty processing seems a little forced (pp. 50–51). When brain-imaging experiments reveal focal activations on both sides of the brain, Goldberg emphasises those on the right. Indeed, sometimes he appears to ignore the activation of left-sided structures. At times the personal nature of this book (and its being partly prompted by Goldberg's friend Sacks) provoked an amused response in this reviewer. When Goldberg begins to argue for left-handers being different and their possibly contributing disproportionately to the good of the human race, through their novelty-seeking and creativity (p. 101) one has the premonition that the author himself will turn out to be left-handed. And, sure enough, on p. 102 we read: “I am myself a product of educational atavism and a converted left-hander”. When visiting Thailand, Goldberg observes a gibbon being able to interrupt an ongoing behaviour, momentarily attend to something else, and then return to the previous behaviour. He realises that the gibbon's brain has used an internal representation to “bridge” its behaviour “between before and after the distraction”. Out of sight is no longer out of mind. The frontal cortex allows an element of field-independent behaviour. Goldberg reflects that he should have liked to have bought the gibbon and taken it back to New York to be his “pet and companion”. Such an anecdote appears to have provoked amicable one-up-manship in Sacks. In his foreword to the book, he writes: “I felt a great sympathy for him [Goldberg] because I had had an almost identical experience with an orangutan myself, and had more than half-wished we could at least send postcards to each other”. Goldberg's unique contribution appears with his interest in decision making, and the cortical regions implicated in those decisions that are essentially actor-centered. These are best exemplified by personal preferences, decisions over phenomena which are essentially subjective, and for which there is no “right” answer. For instance, which of two given visual designs will a subject like more? Goldberg has designed an original, non-veridical, task probing preferences and his findings implicate left and right prefrontal cortices. They also suggest a sexual dimorphism, with greater context-dependence in males (suggesting a certain “adaptability” to the environment) and a greater context-independence in females (suggesting greater consistency across varying environments). These findings may inform other aspects of male and female behaviour, and Goldberg relates them to those biological findings that suggest greater prefrontal asymmetry in males. This is where his data may begin to undermine certain of his theories. For instance, in the male brain, a right prefrontal lesion is apparently associated with greater context dependence (perhaps suggesting a greater ability to adapt to change), while a left prefrontal lesion (in the male) results in context-independence (the application of a stable strategy, across varying contexts). Now it might be argued that these findings argue for a left prefrontal contribution towards adaptability, in novel settings, and this would seem to contradict Goldberg's contention that the right hemisphere is the prime site for novelty processing. The author does not address this issue. However, the notion that there are different cognitive styles across the sexes and the prefrontal cortices is worthy of further investigation. These styles may clearly suit different environments. The context-independent response profile, which favours response consistency in all scenarios, will not adapt well to extreme change, but may comprise a useful “universal default strategy” (an all-purpose “best” response) in a (moderately) uncertain world. One context that recurs each year is Christmas time and the desired acquisition of a suitably inspiring gift for trainees on the clinical team. For some years my default strategy has been to give an Oliver Sacks book for Christmas, in the hope that it might pique their interest in neuropsychiatry. Now I think an alternative strategy has emerged. The executive brain offers a compelling account of neuropsychology; it goes some way toward explaining the fascination of clinical neuroscience. SEAN A. S PENCE Senior Clinical Lecturer in Psychiatry, University of Sheffield, The Longley Centre, Sheffield, UK Vrij, A. (2001). Detecting lies and deceit: The psychology of lying and the implications for professional practice. Chichester, UK: Wiley. 254pp, ISBN 0-471-85316-X, £29.95. Few psychology texts may contain more references to American presidents than this comprehensive overview of the science of deception. The author outlines the three main modes of detection available to “lie detectors”: analyses of nonverbal behaviours, verbal behaviours, and psychophysiological measurements. In each case there are broad indicators of deception, in the laboratory and the field, but it would be a mistake to regard any of these as pathognomonic. Indeed, when professional lie detectors believe they have a heuristic (e.g., “liars look away”) they may well be mistaken. It is interesting to note that while normal subjects commonly report that they do not often lie themselves, they also say that they are good at detecting deception practised by others. Perhaps surprisingly, the opposite applies: humans often lie but are poor at telling when they are being duped. Both “lay” and “professional” lie detectors exhibit a “truth bias”, being better at detecting (or perhaps assuming) truthfulness, than detecting deception. This may be just as well for, as Vrij points out, lies seem to smooth social interaction and we may not like those who tell us the truth all the time! Liars may be popular, and there may be different kinds: the highly sociable and adaptive, the manipulator (who may be psychopathic) among them. Assumptions about behavioural cues are fraught with snares but there are some that may be pertinent: Liars may often reduce their “illustrators”, expressive movements of their hands and arms, during interview (particularly when their lies are complex). Hence, police and customs officers might do better to avoid the face and look instead from “head to toe”. However, they must beware of cultural stereotyping. The (honest) behaviours of certain nonwhite groups may coincide with what white officers' think deception “should” look like (i.e., increased limb movement, averted gaze). Indeed, it is almost amusing how often the observer's idea of lying behaviour is the opposite of what a liar actually does (for instance, with regard to their limb movements). If we can avoid the face and instead listen to the voice we may be on safer ground. Perhaps politicians should be interviewed on radio rather than TV! Or else we should see them standing, not portrait-style as a “talking head”. However, though subtle modulations of voice pitch during lying, or “micro-expressions” around the eyes, can be detected with technical equipment they might easily be missed “live”. So the problems for professional lie detectors remain grossly phenomenological, unless they have considerable technical support. Vrij devotes compelling chapters to the technology that is believed by many courts: The polygraph procedures admissible in certain states (in the USA), the transcript analyses used in certain parts of Europe (e.g., Statement Validity Analysis). These are well described (together with their pitfalls). Finally, having given secrets away to prospective liars, Vrij lends his advice to those charged with detecting deception. Much of this serves to emphasise the executive component of deceit and how performance by the liar may be constrained or broken down: by demanding detail or prolonged discourse; by examining the suspect from a distance. All these details cohere to form a picture of the liar as a cognitive entity. This book provides a wealth of insight. Presidents beware! SEAN A. SPENCE Senior Clinical Lecturer in Psychiatry, University of Sheffield, The Longley Centre, Sheffield, UK Enoch, D., & Ball, H. (2001) Uncommon psychiatric syndromes (4th ed.). London: Arnold. 288 pp, ISBN 0340763884, £25.00 (Pbk) This is the fourth edition of a monograph originally published in 1967 by Enoch and the late Sir William Trethowan. In his preface to the new edition, David Enoch states that the prediction that the book would become a classic has now been realised—Has it? Twenty-five years ago the collection of essays on rare psychiatric syndromes was timely: it brought to the attention of psychiatrists, psychologists, and others a range of bizarre behaviours that, though uncommon, were worthy of serious scientific consideration. Unfortunately, from the outset, Enoch and his co-authors chose to advance a psychodynamic framework for understanding these so-called syndromes, which I believe to be a sterile approach that has yielded few insights and enabled little theoretical progression whatsoever. That is not to deny the possible psychological and experiential factors determining the forms of these behaviours; it is the idea that these are primary factors that I dispute. What I find utterly unacceptable are statements such as this one referring to the Cotard delusion: “Psychodynamic concepts favour the explanation that the delusion of negation arises from the death wish inherent in the collective unconscious …“. What “death wish”? What “collective unconscious”? Uncommon Psychiatric Syndromes describes some 11 disorders, including the eponymous “syndromes” described by Capgras, de Clérembault, Ganser, Tourette, Cotard, and Ekbom. Each disorder is described within its historical context, interesting case examples are described in great detail and treatments are outlined. Individual factors, such as face recognition in Capgras patients and sexual dysfunction in those displaying the Othello syndrome, are also considered, alongside some of the relevant literature. The key word here is some. Coverage of the recent literature in each chapter is at best patchy, which may account for the failure to include the most up-to-date theoretical discussions. Instead, as I have already indicated, the rather tired and outdated psychodynamic approach is repeatedly taken out, dusted, and applied in the usual arbitrary post hoc fashion that in the past, arguably, held back progress in psychiatry. Take this statement about people who deny they are alive: “…such patients usually have conflicts in the narcissistic, oedipal or homosexual sphere” and they “…freely resort to fatalistic symbolism to describe their experiences”. Now, a novelist can get away with such speculation but a scientist is required to bring forward proof to support each assertion. Enoch and Ball do not give us any evidence at all. True, in this latest edition, the authors do also invoke genetic and neuropsychological work but their preference is for the speculative and the floridly Freudian rather than for more systematic, principled, and predictive considerations. Another example of their approach can be found where they describe a case of erotomania (or de Clérembault's syndrome) in a female academic, whose inappropriate love object, a middle aged professor, was surmised to be homosexual, “though this could not be proven”(!) and, therefore, he was unattainable. Such speculation is not isolated and I include it primarily to illustrate the book's tenor: All too often either such unsupported propositions are issued or literary quotations are offered to buttress an argument, sometimes, it seems, to the exclusion of hard evidence; and, not surprisingly, unjustifiable inferences are often drawn. Interestingly, despite favouring conjectural psychological explanations for the syndromes they describe, Enoch and Ball all too often indicate that ECT and neuroleptic drug treatments are their usual recourse. Psychotherapy is sometimes mentioned but, it seems, this is not usually applied in any principled way. One of the more disappointing features of this edition of Uncommon Psychiatric Syndromes is that it was published a decade after the advent of cognitive neuropsychiatry but the phrase is not to be found on any of its 260 pages. Consequently, certain kinds of contemporary theoretical approaches to our understanding, say, of delusions are completely overlooked. Surely the point of producing successive new editions of any volume is to incorporate relevant new material? Some 1990s literature is indeed included in the fourth edition but the scholarship is not systematic and much of the most relevant work has been overlooked. This is not just a pedantic complaint about incomplete literature reviews. Because more recent theoretical work within the cognitive neuropsychiatric tradition is omitted, Enoch and Ball fail to consider alternative theoretical explanations for, say, the monosymptomatic delusions, that not only may help to explain many of their uncommon psychiatric syndromes but might also have encouraged them to attempt some sort of integration across the syndromes they describe. That is not to say that it is possible to provide a unifying theoretical account covering all 11 collections of odd behaviour but the integrative cognitive approaches taken by Richard Bentall, Max Coltheart, Phillipa Garrety and many others are absent, as are the more philosophical contributions of Martin Davies, Philip Gerrans, and Tony Stone. Finally, let me return to Enoch's claim that Uncommon Psychiatric Syndromes is now a “classic”. Cars are described thus when they are more than 20 years old and, by that criterion, the book is a classic. In academic circles, however, the term is usually reserved for those works that have received 1000 or more citations. According to the Web of Science this book has received relatively few citations since its first publication. Nonetheless, it has sparked an interest in some who have proceeded to a more systematic analysis of more esoteric psychiatric symptoms and been able to make at least some connections between them and normal human behaviours. These endeavours now can be seen in many publications—one of which, I am pleased to say, is Cognitive Neuropsychiatry. HADYN ELLIS School of Psychology, Cardiff University, UK