This article was downloaded by: [Adelphi University]

On: 22 August 2014, At: 23:48

Publisher: Routledge
Informa Ltd Registered in England and Wales Registered Number: 1072954 Registered office: Mortimer
House, 37-41 Mortimer Street, London W1T 3JH, UK

Neuropsychoanalysis: An Interdisciplinary Journal for

Psychoanalysis and the Neurosciences
Publication details, including instructions for authors and subscription information:
http://www.tandfonline.com/loi/rnpa20

Decision-making, emotion, and cognitive

neuropsychiatry
Oliver Turnbull

Bangor, UK
Published online: 09 Jan 2014.

To cite this article: Oliver Turnbull (2002) Decision-making, emotion, and cognitive neuropsychiatry,
Neuropsychoanalysis: An Interdisciplinary Journal for Psychoanalysis and the Neurosciences, 4:2, 211-215, DOI:
10.1080/15294145.2002.10773400
To link to this article: http://dx.doi.org/10.1080/15294145.2002.10773400

PLEASE SCROLL DOWN FOR ARTICLE

Taylor & Francis makes every effort to ensure the accuracy of all the information (the Content) contained
in the publications on our platform. However, Taylor & Francis, our agents, and our licensors make no
representations or warranties whatsoever as to the accuracy, completeness, or suitability for any purpose of
the Content. Any opinions and views expressed in this publication are the opinions and views of the authors,
and are not the views of or endorsed by Taylor & Francis. The accuracy of the Content should not be relied
upon and should be independently verified with primary sources of information. Taylor and Francis shall
not be liable for any losses, actions, claims, proceedings, demands, costs, expenses, damages, and other
liabilities whatsoever or howsoever caused arising directly or indirectly in connection with, in relation to or
arising out of the use of the Content.
This article may be used for research, teaching, and private study purposes. Any substantial or systematic
reproduction, redistribution, reselling, loan, sub-licensing, systematic supply, or distribution in any
form to anyone is expressly forbidden. Terms & Conditions of access and use can be found at http://
www.tandfonline.com/page/terms-and-conditions

211

Research Digest
Decision-making, emotion, and cognitive neuropsychiatry
Edited by Oliver Turnbull (Bangor, UK)

Downloaded by [Adelphi University] at 23:48 22 August 2014

Featured Article
Vuilleumier, P., Chicherio, C., Assal, F., Schwartz,
S., Slosman, D., & Landis, T. (2001), Functional
neuroanatomical correlates of hysterical sensorimotor loss. Brain, 124: 10771090. There have
been several recent attempts to identify the
neurobiological correlates of hysteria, typically
focussing on the ``prototypical'' case of unilateral
paralysis. However, in the context of this growing
literature, the Vuilleumier et al. investigation is
unique in several waysand oers some remarkably reliable ndings on the neurobiology of the
disorder. Firstly, the study represents the largest
series of patients with conversion disorder ever
investigated in a controlled neurophysiological
setting. Secondly, it introduces the method of
passively vibrating the aected (and the unaected)
limb. This approach is known to activate a range
of sensory and motor areas, but avoids the many
ambiguities (and possible variations in eort,
strategy etc.) that occur when a hysteric is invited
to move a limb which they know they cannot
move. Finally, it introduces a before-and-after
procedure, whereby patients were followed up
and re-scanned when their paralysis had improved (complete recovery, during the 24 month
recovery period, occurred in four of the seven
patients). This allows the patient to act as their
own controlcounteracting a range of potential
objections, for example relating to the pre-morbid
personality of hysterics, or co-morbidity in a
smallish sample. The ndings were remarkably
consistent across all cases. All patients showed
hypoactivation in a small number of sites in the
contralateral basal ganglia, and especially in the
contralateral thalamus. Thus, there was less brain
activity in just one class of motor structures,
restricted to the side which controlled the
paralysed limb. It is also notable that, in those
who recovered, these areas of under-activation
were no longer present. Indeed, the level of underactivation in these regions during the rst scan

predicted the extent to which the patient would

later recoveroering the tantalizing possibility
of a ``hard-science'' marker of conversion disorder, in contrast to the traditional (and oftcontested) diagnosis by exclusion. From a clinical
perspective, Vuilleumier et al., note that this
``positive'' diagnosis of hysteria appeared to oer
reassurance to both patients and their medical
sta. A further point of optimism was that these
brain regions are also involved in a range of nonmotor activities, for example memory, oering
the interesting possibility that these ndings
might well be applicable to other classes of
conversion disorder. Of course, to say that this
nding represents a neural correlate of one class
of hysteria is far from a complete account of the
disorder: all disorders (indeed, all of mental life)
must have a neural correlate. However, these
brain regions are a ``neural correlate'' of some
importance. Vuilleumier et al., note that ``the
basal ganglia have a unique position within premotor pathways in that their activity is especially
dependent on environmental context cues and
motivational factors'', so that inhibition is generated ``outside conscious will by various emotional
stressors'' (p. 1086). These neurobiological ndings are clearly consistent with emotion-based
accounts of the conversion disordersof which
psychoanalysis is probably the most prominent
example.
General
Manes, F., Sahakian, B., Clark, L., Rogers, R.,
Antonin, N., Aitken, M., & Robbins, T. (2002),
Decision-making processes following damage to the
prefrontal cortex. Brain, 125: 624639. The last
few years have brought us far greater understanding of the complexities of executive function,
and the importance of the frontal lobes as their
anatomical substrate. In particular, we have
increasingly come to believe that the dorso-lateral

Downloaded by [Adelphi University] at 23:48 22 August 2014

212
surfaces of the frontal lobes are central to
planning, set shifting, and working memory;
while the medial surfaces are of great importance
for receiving feedback about the consequences of
our actions (or our ``trial'' actionsin those of us
who look before we leap). This dichotomy has
been borne out in the ndings of the Iowa group
(led by Antonio Damasio), suggesting that
patients with ventromesial frontal lesions do very
poorly on emotion-learning tasks, which is a
likely cause of their dramatic inability to operate
eectively in everyday life: a situation sometimes
referred to as acquired sociopathy (see the Digest
of 2000: 2, p. 277 for more details). In this paper
from Trevor Robbins' Cambridge (UK) group, a
series of 19 patients with highly focal frontal
lesions was investigated on a series of tasks,
including those used by the Iowa group. They
show two clear ndings. Firstly, they suggest that
the Iowa Gambling Task, which the Iowa group
had argued was a sensitive measure of medial (but
not dorso-lateral) frontal impairment, is poorly
performed by both the medial and the lateral
group. Secondly, patients with lesions that were
focal to a single surface failed to show the
``acquired sociopathy'' features that the Iowa
group had claimed were a feature of ventromesial
frontal lesions. Instead, the risky decision-making
was found only in the group with large bilateral
lesions which, the Cambridge group point out
(p. 636) was the lesion size typical of the Iowa
group's patients, including Damasio's celebrated
case EVR. One imagines that this paper will not
go down well in the corn-elds of Iowa, and it
seems unlikely that the Iowa group will concede
this one without a ght. The Cambridge paper
has some potential aws, such as the fact that
psychiatric symptomatology was an exclusion
criterionan opening which the Cambridge
group themselves admit to (p. 637). This debate
is far from over. Nevertheless, it is entertaining to
sit on the sidelines and view this heavyweight
sparring matchand the nal outcome will
doubtless be a better understanding of the nature
of the frontal lobes in executive function.
Gergely, G., Bekkering, H., & Kiraly, I. (2002),
Rational imitation in preverbal infants. Nature,
415: 755. The question of imitation in humans has
been reawakened by the discovery of so-called
``mirror neurons'' (see Research Digest, 1999,
1(2): 279). Given that the issue of imitation is also
(except in the most zombie-like of situations)
synonymous with internalization, this question is
of central interest to psychoanalysis. The Gergely
et al. study presents further evidence on the
sophistication of the imitation skills of infants. In

Research Digest
Meltzo's classic 1988 study infants learned to
illuminate a touch-sensitive light-box using their
forehead. One surprise of this study was that the
infants (roughly one-year olds) learned to press
the light-box using such an impractical and
uncommonly-used part of their body (the
head)when they could have used their hands
instead. Gergely et al. suggest that the infants did
not see the hands of the experimenter in the
classic study, and hence ``inferred that the head
action must oer some advantage in turning on
the light'' (p. 755). In their study Gergely et al.
either kept the hands visible to the infant when
using their forehead to turn on the light (the
situation in which head use might oer ``some
advantage''), or clearly showed the infant that the
demonstrator's hands were ``occupied'' pretending that they were cold and wrapping the hands in
a blanket (a scenario where there was a ``reason''
for using the head rather than the hands. When
the hands were free, some 70% of infants reenacted the head action. However, only some
20% used their forehead in the hands-occupied
condition. The authors conclude that the infants
had evaluated the rationality of the action, and
re-enacted it only when it seemed like an eective
means of achieving the goal. In the handsoccupied condition the ``motivation'' for the
adult to use their forehead is clear: the forehead
was (viewed from the infant's perspective) used
only because the hands are not available, so why
bother to use that cumbersome method when you
might as well use your hands? The nding
suggests a good deal of thinking (though it may
be not be of the explicit sort) about the motives
behind the actions of others in infants. Clearly, if
one year olds draw conclusions of this sophistication on the basis of acts as simple and visible as
switching on a light, their ability to infer
motivated states in others is worthy of more
detailed investigation.
Bottini, G., Bisiach, E., Sterzi, R., & Vallar, G.
(2002), Feeling touches in someone else's hand.
NeuroReport, 13: 249252. For those unaware of
the complexities of anosognosia (i.e., denial of
decit), this paper presents a truly bizarre set of
ndings. An elderly female patient was (as is
typical in the clearest cases of anosognosia)
paralysed on her left side after a large right
hemisphere stroke. As is commonly encountered
in such patients, she was also unable to report
when her left hand was touched. A further nding
(less common in such patients) was also present:
she showed a delusional belief that the hand was
not hers (i.e., somatoparaphrenia). In fact, she
claimed that it belonged to her niece. The genius

Downloaded by [Adelphi University] at 23:48 22 August 2014

Research Digest
of the Bottini et al. paper is that it asks a question
that links the issues of sensory loss with those of
somatoparaphrenia: for the patient did appear to
be able to report tactile events on her left side
when an examiner suggested that they were
touching her niece's hand! These data should be
considered in the context of the ``anosognosia as
defence'' argument that has been promoted by
various authors sympathetic to neuropsychoanalysis since the mid-1990s (see the recent paper
in this journal by Turnbull and Owen (Volume 4,
Issue 1) for more detail). While the Bottini et al.
paper does not explicitly mention the ``defence''
concept (or cite the appropriate papers) their
ndings are entirely compatible with the view that
anosognosia is a defence. Thus, when the patient
is asked to ``own'' the left limb, she is forced to
accept the fact she is paralysed. When the limb
``belongs'' to her niece, she can happily attend to
the paretic limb without accepting that she has
any physical decitand hence report tactile
sensation. It is heartening too see data compatible
with ones ndings. The trick is getting the authors
to acknowledge that the nding is explicable as a
defencegiven the view held by many neuroscientists that psychoanalytic ideas are unscientic.
Halligan, P. W., & David, A. S. (2001), Cognitive
neuropsychiatry: Towards a scientic psychopathology. Nature Neuroscience, 2: 209215. This
paper is an attempt to summarize (and advertise)
the newly developing eld of cognitive neuropsychiatrya eld which the authors date as
emerging in the 1990s. While some readers of this
journal may be unfamiliar with the term ``cognitive neuropsychiatry'', the topic which the eld
covers is, in many respects, identical to that of
neuropsychoanalysis. Halligan and David (editors
of the journal Cognitive Neuropsychiatry) presents
a series of justications for the eld that those in
neuropsychoanalysis will be familiar with. Thus:
there is a growing sense of convergence between
the neurosciences and psychiatry; however,
``traditional neurological or psychiatric frameworks oer little prospect for elucidating the
psychological mechanisms that underlie neuropsychiatric conditions such as delusions or
hallucinations'' (p. 209). What is needed, they
argue, is the infusion of ideas from another part
of psychology, which will transform the eld by
oering new perspectives on previously intractable problems. Having agreed with readers of this
journal on the importance and source of the
problem in modern neuroscience, and even the
nature of the treatment, cognitive neuropsychiatry
diers from neuropsychoanalysis only in its
suggested solution. For Halligan and David it is

213
cognitive psychology that will provide the lens
through which we can derive a new understanding
of psychiatry. They provide a wide-ranging list of
possible problems, and identify the likely cognitive systems that (they argue) form the basis for
each disorder. Thus, amnesia and fugue states are
linked with autobiographical memory, delusions
and thought disorder with the semantic system,
verbal hallucinations with the phonological loop
of the working memory system. Few would
disagree that all of these cognitive systems are
centrally involved in producing each of these
psychiatric signs. Where I (and I suspect many of
our readers) part company is that such accounts
(almost always) avoid a centrally causal role for
emotion and motivation. Indeed, it is telling that
one of the great success stories of cognitive
neuropsychiatry, an account of Capgras delusion,
does suggest an emotional basis for the disorder
(Ellis, 1998; Hirstein and Ramachandran, 1997)
though the role for emotion would probably not
be that favoured by the analytic community. How
then should those within neuropsychoanalysis
view cognitive neuropsychiatry? pessimistically
because of their lack of awareness of the central
importance of emotion and motivation? I suspect
that optimism is the more appropriate attitude.
Because cognitive neuropsychiatry is interested in
the same clinical material and scientic problems
as neuropsychoanalysis (see the Halligan and
Oakley review below), and because there is (to my
mind, at least) no way of studying these problems
without becoming aware of the role of motivation
and emotion, it surely cannot be very long before
the two new elds move closer together.
Halligan, P., & Oakley, D. A. (2000), The greatest
myth of all. New Scientist, 18 November: 3439. It
is always interesting to see the ways in which the
messenger shapes the acceptability of the message
and messages about consciousness seem more
acceptably scientic when they are presented by
neuroscientists than psychoanalysts. The Halligan
and Oakley piece presents the argument that
``speaking, writing and all of the brain's information processing activities occur at an unconscious
level, only later giving rise to a continuous
conscious experience of the world and of yourself'' (p. 37). On this argument, then, all mental
activity is unconscious, and only later becomes
available to conscious experience. For the neuroscientic community, these ideas are quite novel.
Indeed, the by-line of the piece argues that the
authors are ``re-writing the rules on consciousness''. However, psychoanalytically-minded
readers will be left with a profound sense of deja
vu with this repackaging of Freud's classical

Downloaded by [Adelphi University] at 23:48 22 August 2014

214
ideas, even if the component parts of this newly
revealed system are labelled Level 1 (i.e., the Cs.)
and Level 2 (i.e., the Ucs.). A recent paper by
Mark Solms (1997) clearly outlines Freud's
position on the question of how ``much'' of
mental life is conscious, and points out that Freud
consistently held the view that all of mental life is
unconsciousmaking Halligan and Oakley views
entirely consistent with Freud's (or is that the
other way round . . .?). When I put this ``rediscovery'' issue to Peter Halligan recently, he
pointed out that ``nothing's ever new ([especially
when ideas] originate from the unconscious), but
the rediscovery by other means than having read
and understood Freud was fun'' (P. Halligan,
personal communication, 1 May 2002). Given
that neuropsychoanalysis currently shares its
topic of interest with several other elds (see the
Halligan and David review above), it seems
inevitable that each eld will stumble on previously-identied ndings. For these reasons it is
delightful to see long-cherished psychoanalytic
ideas vindicated. Long may the trend continue
though in the future I plan to bite my tongue a
little more rmly when I feel like producing those
sentences whose basis is: ``I told you so''.
Bartals, A., & Zeki, S. (2001), The neural basis of
romantic love. NeuroReport, 11: 38293834. This
functional imaging study studied the neurobiology of romantic love, by scanning 17 subjects who
were ``truly, deeply and madly'' in love (p. 3829),
as veried by self-report, the Passionate Love
Scale questionnaire (!), and a measure of skin
conductance. It may be noteworthy that some
75% of the 70 original applicants (and 11/17 of
the scanned subjects) were female. Subjects
viewed colour images of either the loved person,
or those of three friends matched for age, sex, and
duration of friendship. Using the standard functional imaging research design, the ``lover'' versus
``friend'' images were subtracted, identifying a
range of structures associated more with romantic
love than with extraneous variables (such as
viewing faces, or being confronted with memoryevoking situations). There was selective activation
in a range of brain regions now known to be
associated with emotions (and especially attachment): the insula, the anterior cingulate, the
caudate and the putamen. It is also of some
interest that many of these brain areas are also
activated when subjects view sexually arousing
stimuli (Redoute et al., 2000). A number of cortical
sites showed deactivation, consistent with the
recent claim (Damasio et al., 2000) that selfgenerated emotions activate primarily subcortical
sitesshowing none of the hemispheric asymmetry

Research Digest
ndings that once predominated in the eld of
emotion research. However, apart from the
obvious conclusion that people in love feel emotional about their loved one, it is not entirely clear
how to interpret these complex ndings, at least
until we better understand the precise neurobiology
of specic emotional states. Nevertheless, it is
heartening to see neuroscientists tacking complex
issues such as romantic love, and also to be doing
so using a paradigm that leaves space for the
personal circumstances of an individual life, rather
than a ``one-size-ts-all'' methodology.
Hines, M. (2001), Review of Doreen Kimura's
(1999) Sex and Cognition. Archives of Sexual
Behavior, 5: 551554. Our society continues to
make much of sex dierences in psychological
function. The experimental literature has especially focussed on dierences in cognitionwith
notable ndings of ``advantages'' for males in the
spatial domain (and perhaps mathematical ability), and for females in linguistic ability. Kimura's
book makes much of these dierences, but the
review of Melissa Hines oers a concise summary
of why we should not be fooled. Thus: (i) there
are no sex dierences for most important
cognitive functions (especially general intelligence). Also, (ii) the dierences apply only to
aspects of some cognitive domains (e.g., males are
better at mental rotation but not spatial memory,
females are better at verbal uency but not
vocabulary tasks). In addition, (iii) where dierences do exist they are very small (typically less
than a quarter of a standard deviation), and (iv)
are dwarfed by the eects of culture and
educational background (so that the gap between
Japanese and American children on mathematical
tasks is far larger than the dierence between
American boys versus girls). This of course begs
the question of why our society (and human
societies in general?) make so much of sex
dierences. One plausible answer is that the sex
dierences of note are to be found in the domain
of emotion rather than cognitionthough this
topic is largely uninvestigated. Interested readers
might wish to pursue this further in Panksepp
(1998, pp. 230 and 397). I hope that when
neuroscience gets round to studying this unexplored side of the sex dierence eld we will try
and pay more attention to the evidence. However,
in all likelihood, we won'toering those with
preconceptions a whole new class of evidence to
fan the ames of sexual dierence.
Davidson, R. J., & Irwin, W. (1999), The
functional anatomy of emotion and aective style.
Trends in Cognitive Science, 3: 1121. This paper

Downloaded by [Adelphi University] at 23:48 22 August 2014

Research Digest
oers a readable summary of functional imaging
work on the neurobiology of emotionwhich
narrowly predates the widely publicized work of
Damasio's Iowa group (Damasio et al., 2000). Is
has an especially appropriate box (p. 12) on the
``complexities'' (i.e., potential pitfalls) of functional imaging work on emotion. This includes a
section on the problems inherent in using the socalled ``subtractive'' methodology (as in Damasio
et al., 2000)which may present more confounds
in work on emotion than it does in cognition. It is
a useful introduction to all who seek to work on
emotion using functional imaging methods. In
passing, readers might note Davidson and Irwin's
denition of the function of the mesolimbic
dopamine system. For several decades Jaak
Panksepp has been championing its function as
one of expectancy and novelty seeking, rather
than simple reward, and has tried to summarize
the concept in naming it the ``seeking'' system.
Now that others are catching up on Panksepp's
idea, Davidson and Irwin have characterized this
dopamine it as a ``pre-goal attainment positive
aect'' system. It's amazing how many dierent
ways there are to say ``seeking'' . . .

215
References
Damasio, H., Grabowski, T., Bechara, A., Damasio,
H., Ponto, L. L. B., Parvisi, J., & Hichwa, R. D.
(2000), Subcortical and cortical brain activity
during the feeling of self-generated emotions.
Nature Neuroscience, 3: 10491056.
Ellis, H. D. (1998), Cognitive neuropsychiatry and
delusional misidentication syndromes: An exemplary vindication of the new discipline. Cognitive
Neuropsychiatry, 3: 8190.
Hirstein, W., & Ramachandran, V. S. (1997), Capgras
syndrome: A novel probe for understanding the
neural representation of the identity and familiarity
of persons. Proceedings of the Royal Society of
London, 264: 437444.
Panksepp, J. (1998), Aective Neuroscience: The
Foundations of Human and Animal Emotions.
Oxford: Oxford University Press.
Redoute, J., Stoleru, S., Gregorie, M-C., Costes, N.,
Cinotti, L., Lavenne, F., Le Bars, D., Forest, M. G.,
& Pujol, J-F. (2000), Brain processing of visual
sexual stimuli in human males. Human Brain
Mapping, 11: 162177.
Solms, M. (1997), What is consciousness? Journal of
the American Psychoanalytic Association, 45: 765
778.