Descriptive Psychopathology: The Signs and Symptoms of ...

150 Section 3: Examination domainslaterality differences in speech gesture during conversation, men when listeningmaking increased left-hand gestures, while women show no laterality, a findingconsistent with other gender differences in cerebral laterality. 55Larger arm movements during speech are hypothesized to facilitate spatialrepresentations in working memory during the conversation and close scrutinyof persons conversing reveals that these larger gestures mimic the shape or spatialidea of what is being discussed. 56 One schizophrenic man with formal thoughtdisorder repeatedly used the neologism “glob” while making a hand movementindicating putting on a glove, thus providing the meaning of his phonemic paraphasia.Such representative hand movements are helpful clues to understandingpatients with word-finding difficulties.A patient who does not gesture during the conversational aspects of theevaluation has dysfunction in the motor system, the language system, or both.Left hemisphere strokes in pure right-handed men are associated with loss ofgesture laterality. 57 Manic patients exaggerate their speech gestures, while depressedpatients and those with Alzheimer’s disease have reduced gesturing. 58SummaryThe form of the psychopathology of behavioral syndromes is consistent acrosscultures and, for many syndromes, across centuries. The image of melancholia,mania, neurasthenia, and obsessive–compulsive disorder is recognizable worldwideand from texts from antiquity. The patient’s dress, hygiene, manner,and general behaviors are all reflections of brain function as well as culture andsubculture, and when deviant, shape differential diagnosis.NOTES1 Fish (1967, p.1).2 “Odd” does not necessarily mean “bad”, just as “deviance” and “abnormal” do not alwaysmean disease. A person with a 150 IQ is statistically deviant on that measure. Professionalathletes are deviant in their skills because most persons cannot perform at their level.3 Mason (2000).4 Todorov et al. (2005).5 Rapoport et al. (1995).6 Goodall and Van Lawick (1971).7 Wahler et al. (2001).8 Hempel (1993).9 Being able to make a decision among choices is an executive function. The famous neurophysiologist,Aleksandr Luria, describes an experiment in which he damaged the frontal