Pragmatic Neuropsychology
A Review of The Neurological Side Of Neuropsychology by Richard Cytowic
John A. Allen
Department of Psychology
George Mason University
Fairfax, Virginia 22030
USA
jalle7@gmu.edu
Copyright (c) John A. Allen 1997
PSYCHE, 3(3), July 1997
Previously held: http://psyche.cs.monash.edu.au/v3/psyche-3-03-allen.html
KEYWORDS: neuropsychology, neurology, clinical assessment, brain, mind, behavior.
REVIEW OF: Richard E. Cytowic (1996) The Neurological Side of Neuropsychology. MIT Press: Cambridge, Massachusetts. Hbk US$55.
pp. 529. ISBN 0-262-03231-7.
1. Introduction
Richard Cytowic is perhaps best known for his work on synesthesia
(Synesthesia: A Union of the Senses (1989); The Man Who Tasted
Shapes (1993); Synesthesia: Phenomenology and Neuropsychology: A
review of current knowledge (1995)). However, his most recent book, an
approach to the field of neuropsychology, is squarely aimed at the
textbook market. Thus, readers who expect merely more about synesthesia
from its "guru" will be disappointed. Also, because it is a practical
book, it will have limited appeal to those seeking invigorating
discussions of current research topics and issues in consciousness and
the mind. On the other hand, for those readers who are simply
interested in learning more about the relationships between neurology
and contemporary neuropsychology or an introduction to neuropsychology
in general, Cytowic's new volume may be of interest. It will appeal
particularly to those who would like to gain a better understanding of
what practitioners of behavioral neurology and clinical neuropsychology
encounter in their work with patients. It is also a book professionals
interested in the "human" side of neuropsychology might want to consider
for their reference bookshelves.
2. Content and Orientation
The Neurological Side of Neuropsychology is an ambitious work packed
with useful information about symptoms, syndromes, lesion effects,
perceptual and cognitive deficits, clinical assessment, and a host of
other topics of interest to a broad range of neuroscience professionals.
In a sense, it is three small books rolled into one, i.e., a book about
the history of ideas about mind, brain, and behavior (Part I,
Conceptualizations), a practical guide to assessment strategies and
techniques (Part II, Clinical Assessment), and a collection of papers
about selected processes and pathological conditions (Part III, Specific
Neuropsychological Topics).
The author's conceptual centerpiece is that contemporary neuropsychology
is a multi-disciplinary enterprise whose working model of brain, mind,
and behavior is not based on the global or hierarchical views of the
past, but a new multiplex model. Such a view stresses such things as
the nonlinear flow and parallel processing of information, the concept
of a distributed system (e.g., non-localization of function), and a more
decentralized view of the role of the cortex. The importance of
non-neural information also is stressed (e.g., volume transmission) as
is the involvement of "lower" brain structures (e.g., limbic system) in
determining the salience of information. Throughout the book, Cytowic
interprets symptoms, syndromes, and neural structures in terms of this
general model as a means of explaining the elusive nature of cognitive
processes (e.g., memory) or to prevent student-readers from making
simplistic assumptions and conclusions that frequently can lead to
erroneous clinical interpretations and courses of action. Such errors
occur, Cytowic suggests, when we fail to take into account the fact that
cognition, emotion, and behavior and their neural substrates are
interactive and nonlinear rather than linear and hierarchical.
The primacy of emotion and its continual influence on cognitive
processes and experience is another point of emphasis that Cytowic
weaves into his presentation. One of the most interesting chapters is,
in fact, specifically directed toward the elusive and intricate
relationships between emotion, consciousness, and self-awareness. His
discussion of distributed processes and how they act to tie experience
to the external world via attentional representation is
thought-provoking as is his argument that metaphoric concepts are based
in physical experience.
Cytowic's discussion of emotion is only one of the six chapters that
round out Part III. Each focuses on a specific neurological area that
frequently confronts the clinical practitioner. Among these are:
general disconnection syndromes (chapter 7), memory and amnesia (chapter
9), dementia (chapter 10), epilepsies (chapter 11), spatial knowledge
(chapter 12), and language (chapter 13). Although each of these
offerings provides many useful facts and concepts to the reader, as a
group they suffer from a lack of coordination between them. Even so,
three chapters stand out: viz., spatial knowledge (chapter 12), dementia
(chapter 10), and the epilepsies (chapter 11).
The author's discussion of spatial knowledge is particularly well done.
In it, he eschews the customary overemphasis on vision in space and
spatial representation, and instead offers the reader a more balanced
account that includes discussion of other modalities and concepts
(audition, form constants, auditory scene analysis, body schema
disturbances, etc.). Cytowic's chapters on dementia and epilepsy are
notable for their organization and informativeness. His presentation on
dementia as a collection of disorders with no set clinical path or
pattern is particularly good. In it he provides the reader with a
logical and useful schema for understanding the diffuse nature of this
disease. The same general comments apply to the chapter on epilepsy.
Both chapters are excellent introductions to these important areas.
Regretfully, Cytowic's chapters on language (chapter 13) and memory and
amnesia (chapter 9) do not match the strength or informativeness of the
other special topic chapters. In his chapter on memory and amnesia, for
example, little more than an elementary introduction to the area is
provided. As for the "language" chapter, although a number of exciting
topic areas worthy of fuller discussion are noted, little is done with
them. In both chapters this reader came away with the impression that
Cytowic missed an opportunity to apply his considerable knowledge and
skills for the benefit of the student-reader.
3. As a Textbook
Content aside, a number of things are bothersome about this book when
viewed as a textbook. First, to this reviewer's mind a text should
accomplish some of the following: 1) It should organize and present
material so that students come away with a greater appreciation and
understanding of the topic area; 2) It should introduce new terminology
and vocabulary so that readers are not left wondering about a term (here
a glossary can help); 3) It should weave and tie ideas together in a
logical and integrated package; 4) Tables, figures, and other supporting
materials should be chosen to help the reader understand the points that
are being made in the text; 5) Like other kinds of written material, a
textbook should have a logical beginning, middle, and end; and perhaps
most important of all, 6) Students should come away with an optimistic
sense of the area borne of their new knowledge, skills, attitudes,
insights, and so on. In short, a textbook should instruct and teach.
Now, to say that Cytowic failed on each of these hypothetical guidelines
would be untrue, if not grossly unfair. Nevertheless, he departed far
enough from them to warrant mention. In his introductory chapter, the
author states that his intent is to present a practical,
problem-centered introduction to contemporary ideas in neurology and
neuropsychology for beginners. He further suggests that method will be
emphasized over facts to help the student to see the "forest" rather
than the "trees," patients over abstractions, and so on. Although
Cytowic does present a generally problem-centered approach to the
reader, one is hard-pressed to see how most students could easily come
away with a useful overview of the area based on a reading of his volume
alone. This is due to several factors, not the least of which are the
lack of summaries to integrate the material. Indeed, one cannot help
but be struck by the fact that the book ends abruptly with a chapter on
language (chapter 13) without even so much as a one- or two-page summary
of what has gone before. For that matter, even the final chapter lacks
an integrating summary. A related problem is lack of a feeling of
continuity not only between the chapters, but among the three major
parts of the book as well. It is hard to avoid the impression that the
some of the chapters were written as stand-alone pieces without a great
deal of consideration as to where they might best "fit" within the book
as a whole. This is particularly troublesome with some of the chapters
in Part III (Specific Neuropsychological Topics).
As for terminology, there is no way, of course, to get around the fact
that many "fifty-dollar" words and terms are used in the area (e.g.,
prosopagnosia, attentional dysmetria, Gerstmann syndrome, etc.). To his
credit, Cytowic does a generally admirable job of introducing and
explaining most of them to the reader. However, appropriately placed
glossaries for easy referral by the reader would have been a nice touch.
Clinical terms notwithstanding, readers not familiar with basic
neuroanatomy and its own special terminology will encounter special
difficulty in all but the most clinical of chapters. The remedy for
this does not lie in the hands of the author, of course, but with the
prerequisites necessary for understanding any of book of this kind.
Cytowic's use of tables and figures is another matter. Although many of
the tables and figures are informative, one gets the impression that
overall, relatively little attention was paid to the decision to include
them, or if they were chosen, how they were integrated with the text.
Many figures in particular seem to stand alone or add little to the
understanding of what is discussed in the text (e.g., Figure 6.8, page
256). The tendency to put too much detail in some of the tables is also
a problem and sometimes it is unclear why a table was substituted for
additional textual material. Couple these problems with the general
lackluster appearance of the figures, tables, and sidebars (N.B. which
is not a fault of the author's but of the publisher, MIT Press) and a
visually unexciting presentation is the result.
On the positive side, one of most refreshing and welcome aspects of the
book has to do with Cytowic's conviction that to appreciate the
intricacies of mind and brain and their relationship to behavior, it is
essential for the student and would-be practitioner to have some overall
sense of what has gone before. To that end, in Chapters 2 and 3 the
author takes the reader on a historical tour of models, conceptions,
methods, and developments that led to present day attempts to understand
the mind and brain and their manifestations in behavior. Throughout the
volume Cytowic takes pains to cite and provide precursor and historical
material when a context for understanding a current view, conception, or
position is necessary. While more knowledgeable scholars may find this
material sketchy and superficial, he is to be commended for his efforts
in this regard.
One of the most delightful features of the book, that is quaintly
reminiscent of William James in his Principles of Psychology, is the
tendency of the author to give direct practical advice, directions, and
cautions to wannabe-practitioner readers. It ranges from broad
imperatives like, "Beware of little knowledge," to examples of how to
write up your notes when conditions did not lend themselves to an
adequate screening of a patient's intellectual and cognitive
functioning. On balance, they are well chosen and give the reader the
feeling that the success of the reader as a working neuroscientist is
uppermost in the author's mind as teacher. They also underscore the
rich and considerable experience of the author in the field both as
teacher and as a day-to-day laborer in the field.
In short, despite the fact that the author does seem to know what is
needed in the way of a textbook for the newcomer to the field (Chapter
1), his attempt to implement those characteristics and features in his
own book misses the mark on a number of counts. Thus, in contrast to
its appeal as a reference or source book, its usefulness as a focal
textbook in formal lecture-type courses would appear to be limited. Its
value as one of a number of required readings in a seminar course is
another matter. There it has much to offer in helping students develop
a well-rounded view of the practical side of modern neuropsychology.
Coupled with additional readings in neurophysiology, neuroanatomy, and
general psychological processes, it could fill the "clinical" niche very
well in a comprehensive course in neuropsychology.
4. Summary and Conclusions
Organizing the formidable set of facts and concepts in neuropsychology
into a readable and instructive text is not a task for the
fainthearted. With some notable exceptions, Cytowic has met this
challenge and done a credible job. Certainly, he has produced a
relatively painless introduction to the area for a broad range of
neuroscience professionals. The Neurological Side of Neuropsychology
is a practical book about neuropsychology. As such it is aimed more at
the would-be practitioner in field than researchers. However, any
professional doing research on the mind, brain, consciousness, and
behavior will find much in Cytowic's book that will help ground them in
the practical facts of modern neuropsychology. They are encouraged to
consider Cytowic's book in terms of its value in presenting the raw
facts gleaned from clinical neuropsychology.
References
Cytowic, R.E. (1995) Synesthesia: Phenomenology and Neuropsychology.
PSYCHE: An Interdisciplinary Journal of Research on Consciousness,
2(10). http://psyche.cs.monash.edu.au/v2/psyche-2-10-cytowic.html
Cytowic, R.E. (1993) The Man Who Tasted Shapes: A Bizzare Medical
Mystery Offers Revolutionary Insights into Emotions, Reasoning, and
Consciousness. New York: Jeremy P. Tarcher/Putnam.
Cytowic, R.E. (1989) Synesthesia: A Union of the Senses. New York: Springer Verlag.
