Summarizing Neurologist Elkhonon Goldberg’s Book Entitled “The New Executive Brain: Frontal Lobes in a Complex World” (Part I)By Rick Leonhardt
In my post of November 21st, 2011, I mentioned that I would be summarizing a fascinating book by the neurologist Elkhonon Goldberg entitled The New Executive Brain: Frontal Lobes in a Complex World. Well, this post contains my promised summary. This summary will take the form of a series of bullet points contained within multiple posts:
• Goldberg suggests that as the frontal lobes “come online” (to use a computer metaphor) during adolescence they will appear to the mid-brain (or thalamic) regions of the brain as, for lack of a better frame, “ghostly spirits.” (As an aside, Goldberg talks about how these ghostly spirits do not go away in cases of schizophrenia.) I cannot help but think that one reason teens engage in self-harm behavior is to deal with these ghostly spirits.
• Goldberg mentions a book that I read many years ago. The book is by Julian Jaynes and is entitled The Origin of Consciousness in the Breakdown of the Bicameral Mind. When I originally read Jaynes’ book, I found it to be fascinating but I failed to understand its central point. Well, Goldberg makes clear what Jaynes is trying to say. According to Goldberg, Jaynes tries to tell us that as the higher order executive brain functions came online for the first time during ancient Greek and Roman times (believe it or not), people “freaked out” for lack of a better description. Developmentally, people became schizophrenic or essentially of two minds (e.g., the bicameral—bi·cam·er·al—mind). Rather than freak out and go mad, people developed myths and gods and stories to normalize the developmental appearance of the executive functions (EF). As I argue in my November 21st post, during times of old, initiation rites of passage and even fairy tales were used to help adolescents go through the process of first “meeting” the executive brain and then incorporating executive functioning into an overall brain functioning system. As developmental psychologists are quick to point out, adolescence is a time of being, well, crazy. Some teens are able to get through this period of “brain marriage” relatively unscathed; others are not so lucky. I would go so far as to argue that early safe and secure attachment relationships between children and their primary attachment figures pave the way toward a happy, long and prosperous marriage of the brain.
• Goldberg writes, “Evolution of the brain is characterized by the slow, painstaking transition from a [mid-] brain simply reacting, to [an upper-] brain capable of sustained, deliberate action.” When Goldberg writes about “sustained, deliberate action,” he’s referring to the executive functions of planning, delaying gratification, mental modeling, focusing attention, appropriately starting and stopping behavior, mental time travel, and the such. In his book The Shallows—What the Internet Is Doing to Our Brains, Nicholas Carr equates “painstaking transition” with what he calls “deep relationships.” Carr argues that we need deep relationships to help us with the painstaking transition from reactive brain to proactive brain. I would suggest that secure attachment relationships are a form of deep relating. Sadly Carr warns that extensive Internet use is undermining all forms of deep relationships, especially the deep relationship that typically forms between book author and book reader. With such things as myths, fairy tales, initiation rites of passage, and all manner of deep relationships either gone or on the wan, people—especially teens—are once again freaking out as they encounter the bicameral mind. Sadly, doctors are all too eager to ply people with psychotropic drugs so that they never have to experience the ghostly call to develop executive functioning. For more on this theme see Ronald Dworkin’s book Artificial Happiness: The Dark Side of the New Happy Class.
• Consider the following quote by Goldberg concerning frontal lobe anosognosia. Wikipedia defines anosognosia thus: “a condition in which a person who suffers disability seems unaware of the existence of his or her disability”:
The mechanisms of frontal lobe anosognosia are poorly understood. In a broad sense, they probably have to do with the impaired editorial function of the frontal lobes: comparing the outcome of one’s operations with one’s intentions. Or they may reflect an even deeper aspect of frontal lobe disease: the fundamental loss of intentionality inherent in it. An organism with no desires, no goals, no objectives will by definition experience no sense of failure.
On a simple level, the attachment behavioral system that Bowlby studied and eloquently described for us in his three volumes, is a biologically mediated motivational system that gives us desires (for secure attachment), goals (to stay in proximity to one’s primary attachment figure), and objectives (to balance the simultaneous desire to move out toward novelty with the desire to return to the home of stability and routinization). As Goldberg suggests, it is trying and failing that introduces us to the editorial process of “comparing the outcome of one’s operations with one’s intentions.” Without such trying and failing patterns, we will never encounter nor appreciate this editorial process. We will remain in a state of anosognosia. Simply, the attachment behavioral system and early attachment relationships create an environment in which we can develop the editorial function that Goldberg points to. And I would argue that the insecure attachment patterns give us canned or locked forms of comparing intention to outcome. Hopefully the reader can begin to see that artificial forms of happiness—the self-esteem movement, psychotropic drugs, extreme exercise, certain forms of alternative medicine, etc. (pulling from Dworkin here)—impede the development of the editorial function. Artificial happiness leaves us in a state of anosognosia.
• Consider this quote by Goldberg:
We recognize that the capacity for volitional control over one’s actions [attachment researchers refer to this as “regulation”] is not innate, but that it emerges [my emphasis] gradually through development. A temper tantrum thrown by an adult will trigger a very different reaction from one following a temper tantrum thrown by a child. The capacity for the volitional control over one’s actions is an important, perhaps central, ingredient of social maturity.
Allan Score, a psychiatrist from southern California, has proposed a provocative hypothesis about this [e.g., how regulation and volitional control gets set up]. He believes [as do most Bowlbians] that early mother–infant interaction is important for the normal development of the orbitofrontal cortex during the first months of life. By contrast, early-life stressful experiences may permanently damage the orbitofrontal cortex, predisposing the individual to later-life psychiatric diseases [especially those involving emotion regulation].
I have included the above quote because Goldberg is essentially talking about the role early attachment relationships play in the later development of executive functions (EF). I should mention that our Foundation has made grants in support of Dr. Schore’s research. I found it interesting that Goldberg expressed ambivalence concerning the attachment–EF connection. Goldberg expresses this ambivalence when he states: “If [the attachment–EF connection] is true, this is a mind-boggling proposition, since it implies that early social interactions help shape the brain.” Goldberg does not seem convinced but that’s exactly what Bowlbians believe, that “early social interactions help shape the brain” (quoting Goldberg again). Now, what I find fascinating is that even though Goldberg is hesitant to embrace the attachment–EF connection, he goes on to unwittingly provide evidence in support of such a position. The following bullet point contains an example.
• A bit further along in his book, Goldberg makes this simple connection:
Since the prefrontal cortex is critical for making predictions, its development will be fostered by environments where predictions are readily possible and hindered by environments where predictions cannot be readily made.
At the risk of being glib, the above is attachment theory 101. According to Bowlby’s theory, kids raised in highly chaotic, unpredictable environments will have a hard time developing what Bowlby called open and flexible Inner Working Models. Suffice it to say that Inner Working Models are part and parcel of executive functioning. So, here’s an example of where Goldberg provides evidence in support of Bowlbian attachment theory even though he’s a bit suspect of the Bowlbian position that early social interactions help to shape the brain. OK, one more example.
• Behaving very much like a follower of Bowlby, toward the end of his book Goldberg talks about ethology or animal behavior. Goldberg states: “[S]ensory deprivation of an infant monkey will produce an actual atrophy of the corresponding brain tissue.” This was the discovery that Harry Harlow made with his monkey studies. Bowlby “attached” himself to Harlow’s research as a way of saying that enriched early attachment experiences enhance brain development whereas deprived early attachment experiences impede brain development. I would argue that even though Goldberg does not seem to be aware of the Bowlby–ethology connection, he still gets that an early enriched environment plays a significant role in brain development. Goldberg tells us that “it has been known that immersion into an enriched environment facilitates recovery from the effects of brain damage in rats.” Allow me to quote Goldberg at some length:
Now the mechanisms behind this recovery are finally becoming clear. The recovery of animals with traumatic brain injury [TBI] was compared under two conditions: in an ordinary environment and in an environment enriched with an unusual amount of diverse sensory stimulation. When the brains of the two groups of animals were compared, striking differences were revealed. The regrowth of connections between the nerve cells (“dendritic sprouting”) was much more vigourous in the stimulated group than in the ordinary group.
What Bowlbian attachment researchers are discovering is that one of the best so-called “enriched environments” is the enriched environment that typically results when a safe and secure attachment relationship is in evidence. So, Goldberg definitely seems to be in favor of the idea that enriched environments lead to brain growth and even regrowth, but he may not be that enamored of the enriched environments that safe and secure attachment relationships provide. And I think Goldberg makes an important point: there are different enriched environments that can have a positive affect on brain development. Bowlbians prefer the enriched environments of safe and secure attachment relationships. Others prefer to plop a baby down in front of a TV to watch a Baby Einstein or Baby Mozart DVD. The former is slow and painstaking; the latter quick and easy.
• Returning to an earlier part of his book, Goldberg talks about the current ADD (attention deficit disorder) epidemic. “The reasons for ADD becoming a social phenomenon,” writes Goldberg, “has to do with a complex combination of several cultural factors.” Allow me to quote Goldberg at length as he lists these cultural factors:
First, it has to do with the guilt, parental or personal, for one’s child’s or one’s own failures. A clinical diagnosis removes the guilt and even the sense of responsibility [e.g., the motivation to engage in a “try and fail” pattern described above]. In an age when diagnostic labels proliferate, this offers a convenient way of unburdening the responsibility for life’s failure. Second, it has to do with the ever-expanding scope of perceived individual rights and antidiscrimination [which are hallmarks of a postmodern attitude]. A clinical diagnosis earns all kinds of concessions and exemptions in wide-ranging situations [that are perceived as being limiting, contingent, even oppressive]. Third, the ADD phenomenon is true to the indefatigable American belief that anything can be fixed with the right pill (in this case, Ritalin). This may explain why another heavily inflated diagnosis of our time, learning disability (LD), is nonethless nowhere nearly as commonly made or sought after: there is no ready promise of a magic pill [that can bring Artificial Happiness pulling from Dworkin].
In my opinion, Goldberg is talking about the dilemmas that get set up as we move from a modern attitude to a postmodern attitude. In my summary of a book by Gerald Midgley, I wrote the following:
In his article entitled The Fractured Dream of Social Parenting—Child-Care Policy Lessons and Losses (which can be found in the following special issue on child-care) …
Crippen, A. (Ed.) (2003). The child-care ‘crisis’ and its remedies. Family Policy Review, Fall 2003
… conservative Allan Carlson puts it this way: “The psychological evidence is overwhelming, and still mounting, that children in extended day care—even very good day care—are on average more aggressive, less sociable, and less emotionally secure: traits that, ironically, undo the key socialist goal of enhanced human cooperation.”
In essence, parents wish to be parents (which is a modern, biological attitude) but they do not like that parenting is contingent, limiting, painstaking, time-consuming, personal, and even on some levels imprisoning (which is a postmodern, liberationist attitude). The result is the liberal dilemma that Carlson points to. As Goldberg alludes to, one way out of the liberal dilemma is to seek out a diagnosis of ADD and immediately request a cure, namely, a psychotropic drug like Ritalin. A diagnosis of ADD (or its kissing cousin ADHD) combined with a psychotropic drug like Ritalin brings about Artificial Happiness (a la Dworkin) because it allows for the delusion that the liberal dilemma has been solved. Parents can now have their cake (e.g., kids as defined by a modern attitude) and eat it too (e.g., “it” being postmodern liberation from any restriction, limitation, contingency, etc.). So, in using the diagnosis/drug solution to the liberal dilemma, parents are definitely formulating an executive plan, but it’s one that largely does not include their kids. This begs the question: how will this executive plan affect the development of executive functioning in the next generation of kids?
I’ll end part I with this quote from a 1975 book by the husband and wife psychoanalytic team of Alexander and Margarete Mitscherlich entitled The Inability to Mourn:
The hope for a better future cannot be used as the moral justification for an attitude which involves risk to life and limb. People [especially kids] cannot be required to sacrifice themselves for an anti-morality, for the “better” morality of a “better” future. To revolutionaries and fanatics this must seem like moral weakness—sometimes perhaps rightly, particularly when grossly unjust power relations cannot be overthrown without risking one’s life [whether biological or psychological].
Whereas we may applaud the revolutionary’s desire for change, we may wish to cast a leery and disparaging eye toward the revolutionary’s desire to ask their children to also risk life and limb. As Sandy Hotchkiss puts it in her book Why Is It Always About You, “In the pursuit of their own happiness, too many parents have indulged in grandiosity, omnipotence, envy, and perfectionism, ignoring the separate needs of their children and misunderstanding or misreading the developmental underpinnings of their sometimes challenging behavior.”