The brain behind the mental status
The brain behind the mental status ll behavior, no matter how complex, is an expression of the brain working. “The mind” cannot be separated from the body. Within a modern cognitive neuroscience framework, the mind becomes representative short-hand for brain processes within our
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. Brain activity outside of subjective experience (e.g. maintaining blood pressure, posture) is recognized as
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Memory, internal imagery, emotion, and thinking are subjectively experienced and are categorized as “mental”, but they are no less neurologic than the
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of the human nervous system. For example, personal (biographic) memories, learned information, and skills are experienced as mental activity and in the early stages of dementias such as Alzheimer’s disease sufferers characterize the loss of these memories as “losing their minds”. What is experienced, however, is the effects of the degeneration of the
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subserving memory. Subjective experience is also engaged with visual imagery of things learned and experienced, and then recalled. The images are stored in long-term memory and are retrieved to create a short-term image that is useful in many cognitive activities (e.g. object and facial recognition, carpentry). Retrieving the images is associated with left frontal region activation.Some images are generic (e.g. the image of a table, clock, and bicycle). These “
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” images are subserved by right hemisphere pathways. Cognitive assessment of right hemisphere functioning relies on testing the patient’s ability to draw general images from memory (e.g. the face of a clock with the hands at 2:45). Other images are specific (e.g. the dining room table in your house, the clock on the living room mantle, your mountain bike). The generation of these images is associated with frontal activation, specifically in the anterior cingulate gyrus. This
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is assessed when asking patients to describe their possessions and biographical-related environment.
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experience of emotional life is another hallmark of “the mind”. Damasio (1999) suggests awareness of experiencing an emotion in response to external events, and the recognition that the emotion is internally generated, transient, and has been experienced before and will likely be experienced again forms the beginnings of conscious awareness of self. Nothing in human experience is more personalized than this recognition of being an independent living entity with a past and a future. Such experience, however, is fundamentally neurologic, and when the neurology subserving emotion is diseased, many psychiatric and neurologic conditions emerge. Even socially learned
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reflect specific neurologic activity. Although disgust is a universal human experience, what is disgusting varies widely within and across cultures.
Almost stepping on a juicy beetle waddling across one’s path might be disgusting to a Western professional
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to work, but it is a lip-smacking, nourishing snack to a hunter-gatherer deep in a rain forest. Laughter and humor also reflect emotional experience that seems characteristically human and “mental” in origin. But they are given high evolutionary importance by Darwin. Laughter is a universal human behavior and one of the first social vocalizations of human infants, emerging between 2 and 6 months after birth. Congenitally deaf and blind infants laugh although never having perceived the laughter of others. Despite substantial individual variability,
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is a stereotypic, species-specific behavior. Its precursor is the “play-face” and pant-like vocalizations of apes in social play during their “safe times”, and is considered an important evolutionary development in small hominid group cohesion. In humans, laughter and humor has been elaborated to support novel social functions, but it remains a brain-derived expression with reproductive (e.g. being emotionally attractive) and resource-gathering advantage (e.g. getting along with co-workers and superiors and in leadership strategies). The loss of the ability to laugh is always pathological.18 Among patients with melancholia, regaining the ability to laugh (e.g. at the examiner’s humor) is an important sign of the resolution of the depressive illness. Cortical activities such as internal speech and verbal-based thinking are experienced as a significant part of mental life, but these thoughts are expressions of neurologic functioning. Internal speech is experienced throughout wakefulness as a running commentary on what has recently happened, what is happening, and what may happen. But the elements of internal speech are subserved by the same
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as conversational speech. Functional imaging of normal persons to simple language-based tasks show different left cerebral hemisphere metabolic response patterns to each task. Hearing and speaking words as in conversational speech, generating words (ideas) as in “mental speech”, and seeing words as in reading are all experienced as mental activity. But these functions and the brain areas subserving them are the same behavior–brain relationships associated with stroke and
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. The “mental status examination” is thus anachronistic. The
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and cognitive assessments incorporated in it do not characterize “the mind”, but rather the brain, and the effort is best described as “the behavioral examination of the brain”
Taken and adapted http://www.transpersonalstudies.org/ImagesRepository/ijts/Downloads/Integral%20Approach%20to%20Mental%20Suffering.pdf_for academic purposes and