Descriptive Psychopathology: The Signs and Symptoms of ...

55 Chapter 3: The brain and psychopathology(e.g. maintaining blood pressure, posture) is recognized as neurologic. Memory,internal imagery, emotion, and thinking are subjectively experienced and arecategorized as “mental”, but they are no less neurologic than the homeostaticfunctions of the human nervous system.For example, personal (biographic) memories, learned information, and skillsare experienced as mental activity and in the early stages of dementias such asAlzheimer’s disease sufferers characterize the loss of these memories as “losingtheir minds”. What is experienced, however, is the effects of the degeneration ofthe neurologic structures subserving memory. 11Subjective experience is also engaged with visual imagery of things learned andexperienced, and then recalled. The images are stored in long-term memory andare retrieved to create a short-term image that is useful in many cognitiveactivities (e.g. object and facial recognition, carpentry). 12 Retrieving the imagesis associated with left frontal region activation. 13Some images are generic (e.g. the image of a table, clock, and bicycle). These“Gestaltic” images are subserved by right hemisphere pathways. Cognitive assessmentof right hemisphere functioning relies on testing the patient’s ability todraw general images from memory (e.g. the face of a clock with the handsat 2:45). Other images are specific (e.g. the dining room table in your house,the clock on the living room mantle, your mountain bike). The generation ofthese images is associated with frontal activation, specifically in the anteriorcingulate gyrus. This imagery is assessed when asking patients to describe theirpossessions and biographical-related environment. 14Subjective experience of emotional life is another hallmark of “the mind”.Damasio (1999) suggests awareness of experiencing an emotion in response toexternal events, and the recognition that the emotion is internally generated,transient, and has been experienced before and will likely be experienced againforms the beginnings of conscious awareness of self. Nothing in human experienceis more personalized than this recognition of being an independent livingentity with a past and a future. Such experience, however, is fundamentallyneurologic, and when the neurology subserving emotion is diseased, manypsychiatric and neurologic conditions emerge. Even socially learned emotionalresponses reflect specific neurologic activity. 15 Although disgust is a universalhuman experience, what is disgusting varies widely within and across cultures.Almost stepping on a juicy beetle waddling across one’s path might be disgustingto a Western professional rushing to work, but it is a lip-smacking, nourishingsnack to a hunter-gatherer deep in a rain forest.Laughter and humor also reflect emotional experience that seems characteristicallyhuman and “mental” in origin. But they are given high evolutionaryimportance by Darwin. 16 Laughter is a universal human behavior and one of