PSYC31H3 Week 1 Notes on Chapter 1
What Is Clinical Neuropsychology?:
• Clinical Neuropsychology: A division of psychology specializes in the clinical
assessment and treatment of patients with brain injury or neurocognitive deficits.
• Experimental Neuropsychology: The field of psychology that focuses on brain-
behaviour relationships usually using animals as subjects.
• Positron-Emission Tomography (PET):
• Computed Tomography (CT):
• Functional Magnetic Resonance Imaging (fMRI):
• The term neuropsychology was first used by Sir William Osler in an address
entitled “Specialism in the General Hospital.”
• American Psychological Association (APA):
Ancient Hypothesis to Modern Theories of Brain Functioning:
• The early study of the brain is explored through archival data and relics from
• Ancient civilizations provide us some indications of what they viewed as the role
of the brain and how individuals with brain difficulties should be or were treated.
Neolithic Period or Stone Age:
• Trephination: The oldest known surgical technique in which a small piece of bone
is removed from the skull leaving a hole in the skull; the procedure has been
done for medical and religious reasons.
The procedure is believed to have developed as a way to relieve the
pressure caused by brain swelling.
Examples of behaviours that would cause this surgery included:
behaviours that resemble the delusions and hallucinations of
schizophrenia or possibly, behaviours similar to our case study that were
secondary to traumatic brain injury (TBI). Many accounts of trephining relate the procedure to the release of evil
spirits which were though to reside within the individual’s head (brain).
Verona systematically studied trephined skulls to see if there was a
pattern to the use of trephining:
He looked at 750 skulls collected from Peru. He realized the
Peruvians did trephine woman and children but mostly trephining
was restricted to men.
Most trephinations appeared to occur after the individual had
received a skull fracture from a club or a projectile from a slingshot.
So more often than not the trephinations were for medical reasons
not religious ones.
There was an awareness of possible infections during trephinations…
however sometimes there was damage to the brain due to lack of
• The Egyptians’ lack of brain knowledge is shown through examining early
Egyptian burial practices. The Egyptians’ lack of brain knowledge is shown
through examining early Egyptian burial practices. The process of mummification
could take as long as 70 days to complete. The reason for the length of
mummification is due to the fact that many of the internal organs are kept and
preserved….however the brain is scraped out and discarded.
• Edwin Smith Surgical Papyrus: Early Egyptian manuscript which described the
techniques used to treat various forms of difficulties including brain trauma.
Imhotep is thought to be the founder of Egyptian medicine and the original
author of the papyrus.
Included in the document are references to head or brain injuries and their
treatment. It gave reference to what are currently the meninges (the layers
of tissue covering the brain) and the cerebrospinal fluid.
Also discussed early ways to determine which patients could be
successfully treated, which patients’ status was questionable, and which
patients were too severely impaired for treatment. As stated by Finger
(2000), this manner of determining the severity of injuries foreshadows our
current system of triage, particularly within the military.
• Brain-Behaviour Relationships: A relationship that exists between certain
functions of the brain and overt behaviours. • After conquering Egypt Alexander the Great founded the city of Alexandria.
Herophilus (335 – 280 BC) and Erasistratus (304 – 250 BC) worked in the city.
They were the first to the purpose the brain as the center of reason. They
provided the first accurate and detailed description of the human brain including
In this city they were free of the prohibitions of Athens which forbade the
use of dissection.
They did most of the work through dissection of dead bodies, and
vivisections on condemned criminals.
Vivisection: The dissection of the body, animal or human, while it is still
• Ventricular Localization Hypothesis: The hypothesis that mental and spiritual
processes reside within the ventricles canals.
• Cell Doctrine: A term synonymous with the ventricular localization hypothesis,
i.e., that the ventricles were the location of higher order mental and spatial
• The ventricles are the sites that produce and transport cerebrospinal fluid and
have no role in higher order brain functioning.
• Cerebrospinal Fluid: (Cushions the brain within the skull) is made in the choroid
plexus and flows through the ventricles and the subarachnoid space, the space
between the layers of the brain.
• Pythagoras (582-507 BC), a mathematician, was the first to suggest that the
brain was the organ responsible for human thought. Helped write the Brain
• Brain Hypothesis: The hypothesis that the brain is the source of human thought
• Hippocrates (460 – 379 BC), considered to be the founder of modern medicine,
further expanded the understanding of the brain. Created the Hippocratic Oath.
He removed himself from the religious description of the brain and heart
but also began the use of observation as a tool of science.
• Hippocratic Oath: An agreement that Hippocrates demanded of physicians
ensuring that they would do no harm in their quest to appropriately treat their patients. Would not aid in suicide, perform abortions, or make personal
• He believed that the brain controlled all sensing and movements. He was also
the first to indicate that damage to one side of the brain affected the other side of
Contralateral Control: The premise that one side of the brain controls the
motor and sensory functions of the opposite side of the body.
• Hippocrates practiced holistic medicine.
Holistic Medicine: A type of medical practice that treats the entire patient; it
involves physical, psychological, and spiritual aspects of healing.
• Plato (420-347 BC), a student of Socrates and a philosopher of human
behaviour, thought that the soul was divided into three functions: appetite,
reason, and temper, which resided within the brain. He also discussed the mind-
Mind-Body Question: Philosophical question regarding the relationship
between the physical body and the spiritual mind.
Took his concept further by describing physical health as the harmony
between the mind and body.
Earliest references to mental health. He suggested that a balance
between all parts of life would lead to good mental health, a concept with
strikingly modern qualities.
• Aristotle (384-322 BC), a student of Plato, disagreed with him and believed the
heart rather than the brain to be the main organ of rational thought.
Cardiac Hypothesis: The hypothesis that the heart is the center of rational
• They believed in the importance of the brain, but they disagreed regarding the
particular part of the brain was responsible for each attribute.
• Galen (131-201 AD) was a giant in the history of the understanding of physiology
and anatomy, he is considered the first experimental physiologist and physician.
He also described many of the major brain structures. Believed only valid
sources of data were direct observations.
He challenged Aristotle’s belief that the heart was the center of functioning
and stated that the brain was the center of reason and emotion. He gained most of his knowledge through dissections and vivisections of animals as
well as tending to gladiators that were injured.
Believed in the theory that the functions of the body and brain were based
on a balance of bodily fluids or humours (blood, yellow bile, phlegm, black
Humours: The belief that a balance of bodily fluids including blood, mucus,
and yellow and black bile were responsible for the functioning of the body
and the brain.
The Middle Ages (500 – 1400):
• There was a return to superstitious beliefs regarding the causes of many of the
difficulties people exhibited. Examples of symptoms often mistaken for
possession by the devil include visual and auditory hallucinations and delusions
of grandeur or persecution, commonly noted in schizophrenia.
• Albertus Magnus (1206-1280) theorized that behaviour resulted from a
combination of brain structures including the cortex, the midbrain, and the
Renaissance Europe (1400-1600):
• Leonardo da Vinci (1452-1519) conducted several hundred human dissections
on cadavers in secret due to religious prohibition against autopsies. He drew
detailed diagrams of the human body from the dissections.
• Andreas Vesalius (1514-1564) published the first accurate book on human
anatomy entitled On the Workings of the Human Body. It was one of the most
important medical science books ever written. He ultimately proved that Galen’s
views on ventricular flow were incorrect.
He began the history of public dissection allowing medical students and
doctors to view the procedure in a manner foreshadowing current medical
• Rene Descartes (1596-1630) disagreed with the tripartite soul introduced by
Plato. He believed in a complete separation of the mind and body. He felt that
the mind was immaterial and without substance, whereas, the body functioned
similar to a machine.
Dualism: The view that within each person resides two entities, a mind
with mental properties and a body with physical properties. Monism: The view that there is only one basic and fundamental reality,
that all existence is this one reality; hence, the mind and body operate
according to the same principles.
He speculated the mental processes resided within the pineal gland. His
idea was that the pineal gland is the only structure not composed of
bilaterally symmetrical halves.
• Thomas Willis (1621-1675), known for his study of blood circulation and for
whom the Circle of Willis was named, also studied brain function. He published
the Cerebri Anatome, a work without equal at the time, which was mainly
devoted to the study of the brain.
He stated that the cerebral gyri controlled memory and will. According to
Willis, imagination was also a cerebral function located in the corpus
callosum. The corpus striatum was thought to be related to sensation
and movement. The cerebellum was thought to control the voluntary and
involuntary systems. At the point in history, the pons and medulla were
considered to be part of the cerebellum.
• Emanuel Swedenborg (1688-1772) concluded that the cerebral cortex was the
source of understanding, thinking, judging, and willing.
He also went further than Willis and stated that certain functions were
represented at different anatomical sites on the cortex. Swedenborg saw
the localization of function as the way to understand the difficulties which
arose with patients with various types of pathologies.
18 Century: Localization Theory:
• Localization of Brain Functioning: The theory that certain abilities are localized to
certain areas of the brain.
Franz Joseph Gall (1758-1828) began to write about this idea in 1810. He
stated that certain physiological characteristics of individuals appeared to
reflect their intellectual or cognitive capabilities.
He correlated 27 faculties of the mind with skull features and located
these abilities on maps of both hemispheres. He became an early
advocate of the idea of cortical localization of function.
Phrenology: Inaccurate theory developed by Gall which stated that bumps
on the head related to certain abilities residing within the brain; the theory led to the belief in reading the bumps and increasing abilities by rubbing
the corresponding bumps.
He also proposed that the cortex and its sulci and gyri were functioning
parts of the brain and not just coverings of the pineal body. He also stated
that a large pathway, the pyramidal tract, leads from the cortex to the
spinal cord, implying that the cortex sends information to the spinal cord
to command movement of the muscles.
He and his colleagues also discovered the role of the corpus callosum in
the communication between hemispheres.
• Johann Spurzheim (1776-1832) was Galls student until they disagreed on the
fact that there were no bad or evil functions as described by Gall. He contended
that bad traits were caused by underdevelopment of the specific functions.
• Pierre Flourens (1794-1867) disputed Gall stating there was no localization of
function within the cortex.
He supported his opinion through studying animals and ablated their
He proclaimed there was no specific localization of ability, but rather the
amount or extent of tissue damage is what mattered. In other words, the
greater the mass of impaired tissue, the more dysfunctional the individual
He also stated that the brain operated in an integrated fashion, not with
discrete functions…Early description of neuroplasticity.
Neuroplasticity: The brain’s natural ability to form new connections to
compensate for injury or changes in one’s environment.
19 -Century Advances:
• Scientific Method: A method of research in which a problem is identified, a
hypothesis is formulated, and relevant data are gathered; from these data,
cause-effect relationships can be stated.
• Whilhelm Wundt (1832-1920) is credited with the first psychology laboratory in
Germany in 1879.
• Through the use of the scientific method researchers began to be able to make
cause and effect statements for the first time. • Phillipe Pinel (1745-1826), a French physician, was shocked by what he saw as
brutality toward the mentally ill. Objectionable practices included not only
incarcerating patients with prisoners, but also punishment such as chaining
individuals to walls for behaviours over which they clearly had no control, such as
delusions and hallucinations. Pinel became head of two asylums or mental
hospitals, Bicetre and Salpetriere. Pinel’s ideas for change included the use of
kindness and humanity in the treatment of the patients. These principles of
treatment led to better lives for the patients.
Asylum: An early institution specializing in the care of the mentally ill.
• Mental Hygiene Movement: The movement to treat psychiatric patients with
kindness and dignity; it instigated the release of mental patients from prison and
the building of mental hospitals.
• Moral Therapy: Therapy created for mental patients based on the ideas of the
mental hygiene movement; kindness and respect were the main components.
• Diagnostic Classification System: A system for classifying medical and
psychiatric disorders; it lists symptoms of a particular disorder and various other
important facts for diagnosis; in psychology, it usually refers to the DSM-IV-TR
published by the American Psychiatric Association.
Emil Kraepelin (1856-19260 was one of the first individuals to describe
illness and categorized it based on what was termed endogenous
(curable) versus exogenous (incurable).
Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text
International Classification of Diseases (ICD-10):
• Charles Darwin (1809-1882) conceptualizing the Origin of Species. His theory of
evolution and the belief that all living things have a common ancestry was an
impetus for the study of lower animals with relation to understanding human
Localization of Brain Functioning Areas: Higher Cortical Areas:
• Paul Broca (1824-1880) is often given credit for the discovery of localization of
language within the left hemisphere. His work was clearly based on the following
Jean-Baptiste Bouillaud, he made all of his assertions based on clinical
data and/or autopsies. After examining data from a large number of cases,
he asserted that the brain had several special organs. One of the special organs related to speech and difficulties with speech were evident when
the specific area was damaged.
Simon Alexandre Ernest Aubertin (1825-1881) a French Physician, who
argued (based on clinical cases) that there were specific higher order
cognitive functions localized within certain areas.
Marc Dax (1771-1837), A French neurologist, who discovered through
clinical practice the link between the damage to the left cerebral
hemisphere and the loss of the ability to produce speech
Gustave Dax (1815-1874) while studying medicine in the 1860s, published
his father’s works along with his own findings. The Dax work was
published 6 weeks before Broca’s Paper was published with both stating
The area in the posterior, lower region of the left frontal lobe became
known as Broca’s area.
Broca is also credited with articulating the concept of Aphasia.
Aphasia: An impairment of the ability to use or comprehend
language, usually acquired as a result of a stroke or other brain
injury; it may involve difficulties with spoken, written, or gestured
Broca also helped perpetuate the idea that verbal abilities were confined
to the left hemisphere. In essence, Broca discovered through clinical
cases that language production was localized to the left hemisphere.
Lateralization: The idea that certain abilities reside in one side of
the brain or the other; for the majority of individuals, verbal abilities
reside in the left hemisphere and spatial abilities reside in the right
• Carl Wernicke (1848-1904), described a second language area of the brain. He
was able to discover the new area through the study of dysfunctions in his
patients’ abilities. This second area was located in the temporal lobe somewhat
to the posterior and inferior to Broca’s area.
Damage here led to a particular dysfunction, the inability to make sense
with language even though the utterances were grammatically correct
whether spoken or written.
Wernicke’s discovery le