Inside the Executive Brain

1.

In 1967, Elkhonon Goldberg, then a twenty-year-old student of neuropsychology in Moscow, met a young man, another student only a few years older than himself. Vladimir, Goldberg tells us, had been standing on the platform of the Moscow subway, tossing a soccer ball from hand to hand, when the ball fell onto the rails. Jumping down to retrieve it, Vladimir was hit by a train and sustained severe damage to the front part of the brain, the frontal lobes, both of which had to be amputated.

“The career of every clinician,” Goldberg writes, “is punctuated by a few formative cases. Vladimir was my first formative case. Unwittingly, through his tragedy, he introduced me to the rich phenomena of frontal-lobe disease, triggered my interest in the frontal lobes, and so helped shape my career.” While Vladimir spent most of his time staring blankly into space (though when disturbed he might release a stream of profanities or hurl a chamberpot), Goldberg found that he could sometimes engage him with “a casually profane, locker-room-style banter…[and] a friendship of sorts developed between a brain-damaged student and a student of brain damage.”

Goldberg’s mentor, the great Russian neuropsychologist A.R. Luria, was becoming increasingly interested in the frontal lobes, considered to be the “highest” parts of the brain, and suggested that his study might become Goldberg’s project too. This project has now lasted a third of a century, and has taken Goldberg into some of the profoundest and strangest realms of brain-mind functioning and its mishaps. Like Luria, he has employed a mixture of specially tailored and ingenious tests with minute naturalistic observation, alert to the vagaries of frontal lobe function not only in the clinic but in the streets, in restaurants, in the theater, everywhere. (Goldberg speaks of himself here as a “cognitive voyeur.”) All this is leavened with exceptional imaginative and empathic powers, in his effort to see the world through his patients’ eyes. With thirty years of observation and experience, he has achieved a level of insight which, one feels, would have delighted and amazed his mentor, Luria.

In his new book The Executive Brain: Frontal Lobes and the Civilized Mind,1 Goldberg takes us on a journey, his own journey, from those early Moscow days to the present, a journey at once intellectual and personal. He provides a brilliant exposition of the complex functions of the frontal lobes, the most recently evolved and especially human part of the brain, examining the great range of frontal lobe “styles” in normal people, the tragic incidents that may occur with neurological disease or brain damage, the ways in which their function can be tested, and, not least, the ways in which they can be strengthened—many of which Goldberg himself has pioneered, not only in brain-damaged patients but in those with healthy brains as well.

Goldberg’s notions of “cognitive fitness”—having one’s cognitive faculties honed, available, maximally efficient—and a “cognitive gym,” with a series of visual and intellectual computer games and exercises, are particularly challenging…


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