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Neuropsychoanalysis: An Interdisciplinary Journal for

Psychoanalysis and the Neurosciences
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The Executive Brain: Frontal Lobes and the Civilized

Mind
Oliver Turnbull PhD

Centre for Cognitive Neuroscience, School of Psychology, University of Wales, Bangor,

LL57 2AS, Wales, UK
Published online: 09 Jan 2014.

To cite this article: Oliver Turnbull PhD (2002) The Executive Brain: Frontal Lobes and the Civilized Mind,
Neuropsychoanalysis: An Interdisciplinary Journal for Psychoanalysis and the Neurosciences, 4:2, 206-208, DOI:
10.1080/15294145.2002.10773402
To link to this article: http://dx.doi.org/10.1080/15294145.2002.10773402

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The Executive Brain: Frontal Lobes and the

Civilized Mind by E. Goldberg. Oxford: Oxford
University Press, 2001
This fascinating book is, by the author's own
admission, ``somewhat of a hybrid'' (p. 1). In one
respect, it is an engaging and wide-ranging review
of the nature of executive function, and the role of
the frontal lobes as the substrate of this class of
regulatory process. No reader is likely to come
away from the book without adding to their
knowledge of the role of the frontal lobes in grand
topics a diverse as drive, maturity and free will.
The reader will also learn much about the role of
the frontal lobes in disorders as wide-ranging as
schizophrenia, ADHD and criminal behaviour.
However, the book is a hybrid because it also
intensely autobiographicalfor the topic of
Goldberg's science is also the story of his
remarkable journey from a training under Aleksandr Luria in the cold-war Soviet Union to his
career as a scientist in the USA. These scientic
and autobiographical themes, which in principle
might mix very poorly, in fact seem to knit
together seamlessly. More importantly, because
human beings read so much more avidly when
they have a character with whom to identify, this
mix-and-match approach seems to make the book
more, rather than less, readable. For example
Goldberg points out that ``the career of every
clinician is punctuated by a few formative cases''
(p. 119). He then goes on to describe one such key
case in his early career, the oridly frontal
``Vladimir'', who it seems was allocated to Goldberg primarily because he was one of the few male
trainees on Luria's predominantly female sta,
and hence more likely to cope with Vladimir's
``clinical antics'' (p. 119). Is there a clinician alive
who can read such an account without casting
his/her mind back to who their formative patients
were, and whether (as in Goldberg's case) much
of their later career seems to have been determined by the happenstance of clinical allocation?
I was especially moved by the second chapter of
the book, where Goldberg describes his family
background, his relationship with the great
Aleksandr Luria, and the circumstances that led
him to leave the Soviet Union. My summarizing
skills do no justice to this fascinating tale, but
suce it to say that it involves Goldberg
voluntarily taking a post as perhaps the most
over-qualied hospital orderly in the Soviet
Union. Abiding by the principle discussed above,
whereby Goldberg's autobiographical insights are
always viewed through the lens of executive
function, he points out that ``even in the highest
reaches of power, decision-making is a pretty

Book Reviews
sloppy process'' (p. 7). However, he suggests,
there are occasionally decisions that are so
complex, and the consequences of some choices
so dramatic, that they permit absolutely no
margin for error. Goldberg can recall making
only one such decision in his life (by his criteria I
can recall none in mine), and it was this choice
that led him to voluntarily take a job as a medical
orderly, regularly delivering cadavers to a morgue
in the early hours of the morning, assisted only by
a ``toothless, perpetually drunk woman'' with a
magnicent command of Russian profanities
(p. 18).
The book is, however, more about science
than it is an autobiography. It is peppered with
brief case descriptions of patients with frontal
lesions, such as the robber of a convenience store
whose plan of the theft (if it deserves the word
``plan'') was so inept that he was captured within
two hours of committing the oence (pp. 150
155). There is the successful entrepreneur, disabled by dysexecutive problems after a horse
riding accident, whose wealth does little to shelter
him from a catalogue of maladaptive choices:
ordering every item on a restaurant menu,
competing with his children for his wife's attention, and wearing his favourite sheepskin jacket at
all times of yearincluding Central Park in a
sweltering July (pp. 157160). In addition to
describing many of his own patients, much of the
case material comes from the research of others,
such as Chapter 9, which carries accounts of the
recent work on the role of early experience in the
development of the frontal lobes: specically
those cases of early frontal lobe lesions leading
to ``acquired sociopathy'' (Anderson et al., 1999).
This is a set of ndings of great psychoanalytic
importance, which resonates well with the work
of Alan Schore (1994), and has been reviewed
elsewhere in this journal (Turnbull and Pally,
2000, p. 277). However, this is not a book from
which the knowledgeable researcher will gather a
great deal of new information about executive
function. The chapters on the dorsolateral versus
orbitofrontal regions (Chapters 8 and 9) are
highly readable, and include some lovely vignettes.
However, like all popular accounts, Goldberg
must cut corners on complex issues. The last
decade has seen a range of developments on the
question of the specic functions attributable to
the major surfaces of the frontal lobe (e.g., Manes
et al., 2002; Bechara et al., 1994; see Bechara et
al., 2000, or Robbins, 1996 for review), but these
newer ndings are undeniably complex, and it will
be a few years yet before the eld can digest them
well enough for them to appear in a book aimed
at Goldberg's target audience.

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Book Reviews
Many psychoanalytic readers will be interested in the section of the book that covers issues
of recovery and treatment, especially in relation
to cognitive decline in the elderly (Chapter 11).
Like many neuropsychologists, Goldberg has
long felt frustrated at the ``helpless voyeurism''
(p. 193) experienced by those of us who diagnose
decit in neurological patients, and diligently
chart decline, but can do little to directly assist
our patients in their struggle against the eects of
neurological disease. Goldberg has been much
taken by the recent ndings of a lower incidence
of dementia in those who are more mentally
active, and intellectually inquisitive, across their
lifespan. We have known of such eects for
several years now, and the nding seems to be
extremely robust, and not due to any of the
obvious confounding variables: such as the fact
that mentally active individuals might have access
to better dietary regimes, or better healthcare.
Indeed, there are clear eects seen in several
studies of nuns (most famously the Sisters of
Notre Dame), who spend virtually their entire life
in circumstances where diet and access to
healthcare are tightly controlled for.
On this basis Goldberg (and others) now
oer ``comprehensive cognitive workout circuits''
(p. 214), which amount to mental tness centres,
by analogy with those exercise regimes targeted at
other parts of the body. As they undertake
physical exercise to protect against heart disease,
they now undertake cognitive exercise to protect
against dementia. However, as many psychoanalysts would be happy to assert, there is more
to mental life than cognition, and it may be that a
process of sustained re-evaluation of one's life (as
long-term psychoanalysis requires) may oer
many of the benets currently claimed for acts
of intellectual curiosity. I mention this speculation only because of the recent nding that
psychoanalysts (whose occupation might well be
dened as oering hourly requirements of mental
self-examination in both the cognitive and emotional domain) have amongst the lowest mortality
rates of all the professions in the USA (Doidge,
2001; Jerey, 2001). To the best of my knowledge,
the calculation of mortality rates in psychoanalysis has yet to be extended to the issue of
degenerative disease. Thus, if anyone out there is
looking for a PhD topic, I suggest the investigation of the incidence of dementiaboth in
analysts, and in analytic patients.
I highly recommend this book, though it is
dicult to nd a specic reason to motivate this
conclusion. As an account of Goldberg's life, it is
inadequate, focusing as it does primarily on the
fascinating period preceding his departure from

207
the Soviet Union. As an account of the functions
of the frontal lobes, it lags behind many more
academic texts on the subject, in that the topic is
never covered in an entirely systematic way, and
that it lacks the detailed referencing that one
would expect of more academic tomes. For those
seeking a comprehensive review of dysexecutive
disorders, I would look elsewhere. In Goldberg's
defense, the book was meant neither as an
autobiography nor a textbook. It is aimed at a
dierent audience, and for this group it is an
excellent bookwhich might be inspirational to
many readers who have no pressing desire to
work their way through Stuss and Benson (1986),
Fuster (1989), Luria and Tsvetkova (1990) or
Passingham (1993). With its odd mixture of case
description, literature review, data presentation,
and personal anecdote, the book manages to
draw the reader into the world of executive
function far more successfully than its more
academically written counterparts. It makes executive function personal, which is precisely what
it should befor, as Goldberg points out, this
psychological function ``is not an attribute of you;
it is you'' (p. 104).

References
Anderson, S. W., Bechara, A., Damasio, H., Tranel,
D., & Damasio, A. (1999), Impairment of social and
moral behaviour related to early damage in human
prefrontal cortex. Nature Neuroscience, 2: 1032
1037.
Bechara, A., Damasio, H., & Damasio, A. R. (2000),
Emotion, decision making and the orbitofrontal
cortex. Cerebral Cortex, 10: 295307.
Bechara, A., Damasio, A. R., Damasio, H., &
Anderson, S. W. (1994), Insensitivity to future
consequences following damage to human prefrontal cortex. Cognition, 50: 715.
Doidge, N. (2001), Introduction to Jerey: Why
psychoanalysts have low mortality rates. Journal
of the American Psychoanalytic Association, 49: 97
102.
Fuster, J. M. (1989), The Frontal Lobes. New York:
Raven Press.
Jerey, E. H. (2001), The mortality of psychoanalysts.
Journal of the American Psychoanalytic Association,
49: 103111.
Luria, A. R., & Tsvetkova, L. S. (1990), The
Neuropsychological Analysis of Problem Solving.
Florida: Paul M. Deutsch Press.
Manes, F., Sahakian, B., Clark, L., Rogers, R.,
Antonin, N., Aitken, M., & Robbins, T. (2002),
Decision-making processes following damage to the
prefrontal cortex. Brain, 125: 624639.
Passingham, R. (1993), The Frontal Lobes and Voluntary Action. Oxford: Oxford University Press.

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Robbins T. W. (1996), Dissociating executive functions

of the prefrontal cortex. Philosophical Transactions
of the Royal Society of London (B Biological
Sciences), 351: 14631470.
Schore, A. (1994), Aect Regulation and the Origin
of the Self. Mahwah, NJ: Lawrence Erlbaum
Associates.
Stuss, D. T., & Benson, D. F. (1986), The Frontal
Lobes. New York: Raven Press.

Book Reviews
Turnbull, O. H., & Pally, R. (2000), Research Digest.
Neuropsychoanalysis, 2: 277281.

Oliver Turnbull, PhD

Centre for Cognitive Neuroscience
School of Psychology
University of Wales
Bangor, LL57 2AS
Wales, UK