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3 - Paradoxical functional facilitation and recovery in neurological and psychiatric conditions

Published online by Cambridge University Press:  05 December 2011

By
Narinder Kapur
Edited by
Narinder Kapur
With
Alvaro Pascual-Leone ,
Vilayanur Ramachandran ,
Jonathan Cole ,
Sergio Della Sala ,
Tom Manly  and
Andrew Mayes
Foreword by
Oliver Sacks
Narinder Kapur
Affiliation:
University College London
Narinder Kapur
Affiliation:
University College London
Alvaro Pascual-Leone
Affiliation:
Harvard Medical School
Vilayanur Ramachandran
Affiliation:
University of California, San Diego
Jonathan Cole
Affiliation:
University of Bournemouth
Sergio Della Sala
Affiliation:
University of Edinburgh
Tom Manly
Affiliation:
MRC Cognition and Brain Sciences Unit
Andrew Mayes
Affiliation:
University of Manchester
Oliver Sacks
Affiliation:
Columbia University Medical Center
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Summary

Summary

In neurological conditions, the major sets of paradoxical cognitive phenomena generally take one of five forms: (1) enhanced cognitive performance of neurological patients vis-à-vis neurologically intact individuals (‘lesion facilitation’), and (2) alleviation or restoration to normal of a particular cognitive deficit following the occurrence of a second brain lesion (‘double-hit recovery’). (3) A third set of paradoxical cognitive phenomena represents what may be termed ‘hinder–help effects’, where a variable that produces facilitation or detriment of performance in healthy participants results in opposite effects in neurological patients. (4) A fourth form of paradox relates to anomalies in the usual relationship between the presence/size of a brain lesion and the degree of cognitive deficit (‘lesion–load paradox’). (5) A fifth paradox is where there may appear to be direct or indirect benefits for long-term neurological outcome as the result of specific cognitive deficits being present (‘paradoxical positive outcome’). Discussion of neurological conditions will mainly be concerned with the first two sets of paradoxical phenomena, although the remaining three sets will also be reviewed briefly. In psychiatric disorders, analogous paradoxical phenomena have mainly been found in instances of enhanced cognitive performance in conditions such as depression and schizophrenia vis-à-vis healthy control participants, and also in reports of ‘post-traumatic growth’ after a major psychiatric illness or negative life events.

Introduction

As outlined in Chapter 1, the study of brain–behaviour relationships from cases of cerebral pathology has traditionally been embedded in the lesion-deficit model.

Type
Chapter
Information
The Paradoxical Brain , pp. 40 - 73
Publisher: Cambridge University Press
Print publication year: 2011

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