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Cognitive deficits in brain disorders
  1. Timothy Hodgson

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    Edited by John E Harrison and Adrian M Owen (Pp 370, £39.95). Published by Martin Dunitz, London, 2002. ISBN 1-85317-921-3

    Conceived by its editors over a beer in the Cambridge Arms pub, this multiauthored volume aims to be a definitive textbook on the cognitive correlates of neurological disease. The chapters cover the entire spectrum of neuropsychological symptoms, some themed according to anatomical loci, others concentrating on particular disorders. Some of the chapters are outstanding in their clarity and insight; the majority are solid, scholarly affairs, while even the poorer chapters give food for thought.

    I have to admit that I found the editors’ opening contribution to fall into the last category. Harrison and Owen’s chapter comes across as overly pessimistic and lacking in enthusiasm towards the project of relating brain structure to function. After all, without attempts to relate symptoms to neurological damage, how can we be sure that the neuroimagers’ illuminated brains have any basis in reality?

    The other contributions come from institutions as far afield as the United States and Australia, although the majority are from academics based in the United Kingdom. In fact, many owners of the lovely “mug shots” on the opening pages have their offices within staggering distance of the Cambridge Arms. As such, there is a danger that the book is biased towards a particular methodological perspective. Yet it is a Cambridge academic who provides the most original contribution in the entire volume.

    James Russell’s chapter is a critique of theories relating to autism. While some of the preceding chapters simply describe performance profiles on neuropsychological test batteries, Russell thinks more carefully about his topic, considering exactly what features “autistic tests” have in common. He argues for a rejection of the idea that autistic patients have abnormal “theory of mind”. In its place Russell proposes a pragmatic-cognitive account, in which self monitoring and control functions are emphasised rather than representational states.

    For example, it has been suggested that the failure of autistic children to engage in make believe games reflects an inability to conceptualise “imaginary play”. Russell points out that the concept of pretend play is unlikely to be relevant to its development. More important is an ability to generalise associations between perceptual cues and behaviour. A toddler who is pretending that a banana is a telephone does not conceptualise the banana as a “pretend phone”. As far as the child’s brain is concerned the banana is a phone. But autistic children are unable to process objects in this way. Their behaviour is bound by narrow categorisations and interpretations of the world.

    Parts of this book made me feel that neuropsychology may be suffering from a similar problem. There is a tendency to classify tasks according to the cognitive modules they purport to test, rather than examining the relative demands they place on neural control systems. Perhaps only when armed with a better understanding of how brains really work will neuropsychologists make more progress in relating structure to function.

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