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Psychopathology and brain dysfunction
BiologicalPsychology 7
(1978) 219-221 © North-Holland Publishing Company
BOOK REVIEW C. S H A G A S S , S. G E R S H O N a n d A. F R I E D H O F F (Eds.): Psychopathology ( R a v e n Press, N e w Y o r k , 1 9 7 8 , 3 9 9 pp., $ 2 2 . 5 0 )
and
Brain Dysfunction
Psychopathology and Brain Dysfunction, is a volume that contains the proceedings of the 66th Annual Meeting of the American Psychopathological Association. The 20 chapters of the book, authored by different specialists, are grouped in six sections: I Brain organization; II Brain chemistry; III Seizure phenomena; IV Studies of sociopathy; V Huntington's disease; and VI Electrophysiology. The editors wrote in the preface that 'relevance to psychopathology was the unifying theme in selecting contributors from the large domain of research in brain and behavior'. Within psychopathology, however, no theme was discussed or dealt with specifically. The presentations cover a wide variety of subjects and, as can be almost predicted in this type of effort, the quality is uneven. Alpert and Martz suggest some possible implications of recent studies on brain asymmetry in psychopathology. Specifically they focus on the identification of factors that can shape the evolution of the schizophrenic process. Witelson reviews her studies on development dyslexia and, in a lucid and thoroughly written chapter, puts the data in the context of available information on hemisphere specialization and discusses the implications that the work may have for the etiology, nature, and remediation of developmental dyslexia. Her work emphasizes the dual processing involved in reading: a linguistic (to decode letters phonetically) and a spatial one (to recognize whole words visually). In his chapter Heath reviews the extensive work in animal experimentations and the recordings from humans with electrodes implanted in brain regions involved in emotional behavior (its experience and expression). Heath's results tend to support the concept that there exists in the CNS, reciprocally related mechanisms for control of drives (e.g. fear, anger), placed in different regions than the drives themselves, which can be referred to as antidrives. Accordingly, relief will be the fear antidrive and placidity, the anger antidrive (Konorsky, 1967). Locke argues that 'an obvious access route for exploration of the problem of the organization of mind is a study of behavior'. Behavior is overt, it underlies communication and in Locke's words ' . . . means movement' the study of which ' . . . might constitute a suitable beginning for a study of the defiant problem of mind' . . . A brief summary of some neural aspects related with movement organization is then presented. Pribram presents data which suggest that the basal ganglia activities are related to precessing sensory input (as well as to motor function). Further Pribram suggests that some of the selection processes associated with infertemporal cortex may be, at least m part, ascribed to activity in basal ganglia. Fuxe et al. review their work on gaba-dopamine interactions in a series of carefully planned and executed pharmacological experiments. As the cornerstone of the dopamine hypothesis in schizophrenia is mainly pharmacological (the antidopamine effect of some antipsychotic drugs), this work is highly relevant to a better understanding of the mechanism of action of these drugs and to a more direct test of the dopamine hypothesis per se. Smythies succinctly and clearly reviews a series of facts related to the biochemical organization of the brain which are relevant to the problem of the etiology of psychoses and then dis219
220
Book review
cusses specific hypotheses on the etiology of schizophrenic disorders: the transmethylation hypothesis, reduced tryptophan uptake hypothesis, and dopamine hypothesis. Schildkraut present findings in support of the hypothesis that biochemical measurements of various catecholamine metabolites may help to differentiate among the subtypes of depressive disorders. Friedhoff, in his presidential address chapter, discusses the possibility that changes in sensitivity of neuronal receptors can be the cause of certain hormonal and transmitter disturbances of which schizophrenia can be a representative case. Woodbury and Kemp review some recent studies on experimental models that resemble certain type of epilepsies in man. The possible role(s) of gila cells in buffering potassium, in modulation of acid base changes in the extraceliular fluid, and in anion transport systems are discussed. In a provocative chapter, slightly tarnished by teleological interpretations, Stevens discusses the possible significance of the EEG spike. She addresses herself to situations in which spikes appear normally from the surface and depth EEG in animals and man, and suggests that they 'may [thus] represent a powerful mode of information transmission or amplification which is particularly associated with maturation and reproduction, including hormone release during sleep and in response to changes in light, season and sexual activity'. Struve et al. review evidence suggesting that biological variables, revealed as EEG irregularities, observed in patients who have attempted suicide and/or with suicide ideation, 'may interact with the more accepted psychosocial antecedants of suicide'. Fink updates his work on biological changes that accompany electroconvulsive therapy. The mechanism(s) of action of the procedure remains obscure, although it still is a useful therapeutic tool. Monroe et al. present their findings in recidivist aggressors purporting CNS impairment. They suggest ictal phenomena underlying episodes and the possibility of pharmacological control in the future. Ziskind et al. review their work that shows differences in conditionability in sociopaths. Whittier discusses Huntington's chorea as a paradigm of brain dysfunction with psychopathology. Gershon and Buchsbaum review their work on averaged evoked response (AER) and its change with increasing intensity of stimuli. Patients with affective disorders show greater rates of increase in AER amplitude (augmenting) for certain components of the response ( P I 0 0 N190) than do matched controls. Unipolar patients in turn may show lesser rates of increase or even amplitude decreases (reducing). Their work suggests the possibility of using the amplitude/ intensity slope as a marked for a genetically transmitted vulnerability to affective disorders. John et al. present their sophisticated (although still to be refined) methods of quantification of electrophysiological measurement of organic brain dysfunction in children. Dongier et al. review their work on event-related slow potentials in psychiatry, a recently introduced method of evaluating psychiatric patients, still largely unexplored. Shagass provides a balanced overview of clinical neurophysiological research in psychiatry and suggests further investigations. He points out that the distinction, well recognized in French psychiatry (Ey, Bernard and Brisset, 1974), between transitory (state) phenomena and enduring (trait) characteristics is a fundamental problem in biological psychiatry. Shagass also indicates the need for increasing attention to topography in electrophysiological investigation, a dimension largely neglected in clinical psychiatric studies. I agree with the statement in the preface that to the question 'Exactly what is wrong with the brain in mental illness?', the reader 'could hardly leave this volume without being convinced that some answers are on the way'. In this context the book is valuable as an information source. Yet, although one can certainly realize that knowledge in psychopathology has significantly increased as revealed in the topics presented, one cannot avoid also experiencing the
Book review
221
fact that understanding in the field did not improve to an equal degree. It is difficult to tie the new discoveries within the existing framework of ideas in psychopathology. In this rievewer's view, the conceptual limitations of the neurological models tacitly taken for granted throughout the different chapters of the book, are a too strict adherence to the Jaeksonian principles of hierarchy and dissolution of functions and structures in the central nervous system (CNS) (Stengel, 1963). As it pertains to nervous disorders, Jackson postulated that 'disease does not create, it sets free'. In psychopathology, 'mental symptoms are not caused, they are permitted'. This view seriously curtails present notions that consider the mind (and its disorders) in the context of emergentist materialism, a view consistent with current knowledge of central nervous system activity (Bunge, 1977). In the Jacksonian view, pathological phenomena are explained as a release at lower levels of activities normally controlled by higher levels, these released contents being the positive symptoms of disease. The negative symptoms are the disappearance of the actions normally carried out by these higher levels, whose lesions(s) also release the lower levels. Contrarywise, explanation of emergence is anything but straghtforward: it is matter not of deducing consequences from a theory concerning some lower level, but of suitably enriching the latter with new assumptions and data (Bunge, 1977). In summary, 'Psychopathology and Brain Dysfunction' is a book that, while it shows that large amounts of new information have been added recently to solve problems in the field, it also reveals that there is a need for new theoretical formulations which can adequately approach these findings on a more fruitful scientific basis.
Bernardo Dubrovsky References Bunge, M. (1977). Emergence and the mind. Neuroscience, 2 , 5 0 1 - 5 0 9 . Ey, H., Bernard, P. and Brisset, C. (1974). Manuel de Psychiatric, Paris: Masson. Konorski, J. (1967). Integrative Activity of the Brain, Chicago: The University of Chicago Press. Stengel, E. (1963). Hughling Jackson's influence in psychiatry. Britisch Journal of Psychiatry, 109,348-355.
(1978) 219-221 © North-Holland Publishing Company
BOOK REVIEW C. S H A G A S S , S. G E R S H O N a n d A. F R I E D H O F F (Eds.): Psychopathology ( R a v e n Press, N e w Y o r k , 1 9 7 8 , 3 9 9 pp., $ 2 2 . 5 0 )
and
Brain Dysfunction
Psychopathology and Brain Dysfunction, is a volume that contains the proceedings of the 66th Annual Meeting of the American Psychopathological Association. The 20 chapters of the book, authored by different specialists, are grouped in six sections: I Brain organization; II Brain chemistry; III Seizure phenomena; IV Studies of sociopathy; V Huntington's disease; and VI Electrophysiology. The editors wrote in the preface that 'relevance to psychopathology was the unifying theme in selecting contributors from the large domain of research in brain and behavior'. Within psychopathology, however, no theme was discussed or dealt with specifically. The presentations cover a wide variety of subjects and, as can be almost predicted in this type of effort, the quality is uneven. Alpert and Martz suggest some possible implications of recent studies on brain asymmetry in psychopathology. Specifically they focus on the identification of factors that can shape the evolution of the schizophrenic process. Witelson reviews her studies on development dyslexia and, in a lucid and thoroughly written chapter, puts the data in the context of available information on hemisphere specialization and discusses the implications that the work may have for the etiology, nature, and remediation of developmental dyslexia. Her work emphasizes the dual processing involved in reading: a linguistic (to decode letters phonetically) and a spatial one (to recognize whole words visually). In his chapter Heath reviews the extensive work in animal experimentations and the recordings from humans with electrodes implanted in brain regions involved in emotional behavior (its experience and expression). Heath's results tend to support the concept that there exists in the CNS, reciprocally related mechanisms for control of drives (e.g. fear, anger), placed in different regions than the drives themselves, which can be referred to as antidrives. Accordingly, relief will be the fear antidrive and placidity, the anger antidrive (Konorsky, 1967). Locke argues that 'an obvious access route for exploration of the problem of the organization of mind is a study of behavior'. Behavior is overt, it underlies communication and in Locke's words ' . . . means movement' the study of which ' . . . might constitute a suitable beginning for a study of the defiant problem of mind' . . . A brief summary of some neural aspects related with movement organization is then presented. Pribram presents data which suggest that the basal ganglia activities are related to precessing sensory input (as well as to motor function). Further Pribram suggests that some of the selection processes associated with infertemporal cortex may be, at least m part, ascribed to activity in basal ganglia. Fuxe et al. review their work on gaba-dopamine interactions in a series of carefully planned and executed pharmacological experiments. As the cornerstone of the dopamine hypothesis in schizophrenia is mainly pharmacological (the antidopamine effect of some antipsychotic drugs), this work is highly relevant to a better understanding of the mechanism of action of these drugs and to a more direct test of the dopamine hypothesis per se. Smythies succinctly and clearly reviews a series of facts related to the biochemical organization of the brain which are relevant to the problem of the etiology of psychoses and then dis219
220
Book review
cusses specific hypotheses on the etiology of schizophrenic disorders: the transmethylation hypothesis, reduced tryptophan uptake hypothesis, and dopamine hypothesis. Schildkraut present findings in support of the hypothesis that biochemical measurements of various catecholamine metabolites may help to differentiate among the subtypes of depressive disorders. Friedhoff, in his presidential address chapter, discusses the possibility that changes in sensitivity of neuronal receptors can be the cause of certain hormonal and transmitter disturbances of which schizophrenia can be a representative case. Woodbury and Kemp review some recent studies on experimental models that resemble certain type of epilepsies in man. The possible role(s) of gila cells in buffering potassium, in modulation of acid base changes in the extraceliular fluid, and in anion transport systems are discussed. In a provocative chapter, slightly tarnished by teleological interpretations, Stevens discusses the possible significance of the EEG spike. She addresses herself to situations in which spikes appear normally from the surface and depth EEG in animals and man, and suggests that they 'may [thus] represent a powerful mode of information transmission or amplification which is particularly associated with maturation and reproduction, including hormone release during sleep and in response to changes in light, season and sexual activity'. Struve et al. review evidence suggesting that biological variables, revealed as EEG irregularities, observed in patients who have attempted suicide and/or with suicide ideation, 'may interact with the more accepted psychosocial antecedants of suicide'. Fink updates his work on biological changes that accompany electroconvulsive therapy. The mechanism(s) of action of the procedure remains obscure, although it still is a useful therapeutic tool. Monroe et al. present their findings in recidivist aggressors purporting CNS impairment. They suggest ictal phenomena underlying episodes and the possibility of pharmacological control in the future. Ziskind et al. review their work that shows differences in conditionability in sociopaths. Whittier discusses Huntington's chorea as a paradigm of brain dysfunction with psychopathology. Gershon and Buchsbaum review their work on averaged evoked response (AER) and its change with increasing intensity of stimuli. Patients with affective disorders show greater rates of increase in AER amplitude (augmenting) for certain components of the response ( P I 0 0 N190) than do matched controls. Unipolar patients in turn may show lesser rates of increase or even amplitude decreases (reducing). Their work suggests the possibility of using the amplitude/ intensity slope as a marked for a genetically transmitted vulnerability to affective disorders. John et al. present their sophisticated (although still to be refined) methods of quantification of electrophysiological measurement of organic brain dysfunction in children. Dongier et al. review their work on event-related slow potentials in psychiatry, a recently introduced method of evaluating psychiatric patients, still largely unexplored. Shagass provides a balanced overview of clinical neurophysiological research in psychiatry and suggests further investigations. He points out that the distinction, well recognized in French psychiatry (Ey, Bernard and Brisset, 1974), between transitory (state) phenomena and enduring (trait) characteristics is a fundamental problem in biological psychiatry. Shagass also indicates the need for increasing attention to topography in electrophysiological investigation, a dimension largely neglected in clinical psychiatric studies. I agree with the statement in the preface that to the question 'Exactly what is wrong with the brain in mental illness?', the reader 'could hardly leave this volume without being convinced that some answers are on the way'. In this context the book is valuable as an information source. Yet, although one can certainly realize that knowledge in psychopathology has significantly increased as revealed in the topics presented, one cannot avoid also experiencing the
Book review
221
fact that understanding in the field did not improve to an equal degree. It is difficult to tie the new discoveries within the existing framework of ideas in psychopathology. In this rievewer's view, the conceptual limitations of the neurological models tacitly taken for granted throughout the different chapters of the book, are a too strict adherence to the Jaeksonian principles of hierarchy and dissolution of functions and structures in the central nervous system (CNS) (Stengel, 1963). As it pertains to nervous disorders, Jackson postulated that 'disease does not create, it sets free'. In psychopathology, 'mental symptoms are not caused, they are permitted'. This view seriously curtails present notions that consider the mind (and its disorders) in the context of emergentist materialism, a view consistent with current knowledge of central nervous system activity (Bunge, 1977). In the Jacksonian view, pathological phenomena are explained as a release at lower levels of activities normally controlled by higher levels, these released contents being the positive symptoms of disease. The negative symptoms are the disappearance of the actions normally carried out by these higher levels, whose lesions(s) also release the lower levels. Contrarywise, explanation of emergence is anything but straghtforward: it is matter not of deducing consequences from a theory concerning some lower level, but of suitably enriching the latter with new assumptions and data (Bunge, 1977). In summary, 'Psychopathology and Brain Dysfunction' is a book that, while it shows that large amounts of new information have been added recently to solve problems in the field, it also reveals that there is a need for new theoretical formulations which can adequately approach these findings on a more fruitful scientific basis.
Bernardo Dubrovsky References Bunge, M. (1977). Emergence and the mind. Neuroscience, 2 , 5 0 1 - 5 0 9 . Ey, H., Bernard, P. and Brisset, C. (1974). Manuel de Psychiatric, Paris: Masson. Konorski, J. (1967). Integrative Activity of the Brain, Chicago: The University of Chicago Press. Stengel, E. (1963). Hughling Jackson's influence in psychiatry. Britisch Journal of Psychiatry, 109,348-355.