The Organism (KURT Goldstein) PDF

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Kurt Goldstein was a pioneer of neuropsychology; his long career bridged a time-span between nineteenth century European behavioral neurology and the modern era of clinical neuropsychology. In this retrospective analysis of his major contributions, it is suggested that many of his previously ignored or rejected ideas have gained wide acceptance in their modern versions. Illustrations of this suggestion are offered in the areas of conceptualization of symptom formation, frontal lobe function, the abstract attitude, aphasia, schizophrenia, rehabilitation, and neuropsychological assessment. The Organism: A Holistic Approach to Biology Derived from Pathological Data in Man As a neurologist at the Frankfurt Institute for Research into the Consequences of Brain Injuries from 1916 onward, Goldstein and his collaborators had worked with countless brain-injured veterans of the First World War with the purpose of returning them to some level of function in society. That these patients adapted and seldom suffered complete loss of a field of performance convinced him that previous mechanistic notions of brain function were incorrect (Stahnisch & Hoffmann, 2010). Goldstein’s attempts to disseminate his ideas in Germany came to an end with the rise of the Nazis, who targeted him immediately in 1933 as a Jewish academic with important socialist leanings. Exiled, he took up a brief residence in Amsterdam from 1934 to 1935 where, with the support of the Rockefeller Foundation, he dictated The Organism to a secretary. An anxious refugee, most of his library inaccessible, and much of his life’s work destroyed, the footnotes of the resulting manuscript were often inaccurate or even missing in many places. Goldstein excused this by arguing that he was not attempting a tractate on the history of medicine, but it is doubtful that he had any choice but to rely on his foregoing paper manuscripts and even upon his memory in places.

In The Organism, Goldstein declared that human life cannot be compared to a system which simply returns to a state of balance after stimulation from outside. Goldstein, after critiquing different attempts to classify the instincts, writes that all instinctual manifestations emerge from "the drive to selfactualization." At any moment the organism has the fundamental tendency to actualize all its capacities, its whole potential, as it is present in exactly that moment, and in exactly that situation in contact with the world under the given circumstances. Goldstein's main concern was to apply the figure-ground principle of gestalt psychology from perception to the whole organism, presuming that the whole organism serves as the ground for the individual stimulus forming the figure - thus formulating an early criticism of the simple behavioristic stimulus-response-theory. The organism presents ground-breaking arguments:  

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Goldstein pointed out the experience of individuals with lesioned brains makes it obvious that our neurological and neuropsychological functioning is socially intertwined with that of other brains. Goldstein described preferred behavior (in contrast to non-preferred behavior) as the realization of a reduced subset of all possible performances available to oneself (whether in motility, perception, posture, etc.) that are characterized by a feeling of comfort and correctness. Goldstein claimed that specific colors elicit specific emotional responses. Subsequently, clinicians have asserted that children's use of color in art, for example, is a manifestation of their underlying emotional status. Goldstein sees symptoms not as isolated expressions of local damage in the nervous system but as "attempted solutions" the organism has arrived at, once it has been altered by disease. "Symptoms," for Goldstein, betoken whole levels of organization, adaptation to an altered inner state (and world). It is impossible, he emphasizes, to consider any illness — but above all, a

neurological illness — without reference to the patient's self, and the forms of his adaptation and orientation within it. Disease, for Goldstein, involves a "shrinkage" (or, at the least, a "revision") of self and world, until an equilibrium of a radically new sort can be achieved." The Organism: A Holistic Approach to Biology Derived From Pathological Data in Man (1934), written during his year’s exile in Amsterdam. Goldstein viewed behavior as the unified activity of the whole organism, whose basic “motive” is optimum self-actualization in a given environment. Reflexes, clinical symptoms, or functions subjected to laboratory investigation are part processes, and failure to consider that their isolation is artificial results in erroneous interpretation. Study of brain-injured patients reveals the general change underlying specific symptoms and manifestations, namely, an impairment of the patients’ “ab stract attitude” and a preponderance of “concrete” modes of behavior, affecting all performance fields. The “abstract attitude” is defined, basically, as man’s capacity to reason deliberately, to plan and account for his actions, to view particular objects or events as instances of a class. Upon loss of these capacities the individual is at the mercy of the immediate, concrete sensory or mnemonic stimulus situation and is unable to transcend it. Impairment of abstraction is not limited to brain-injured patients. It manifests itself also in psychotic processes. Whatever its cause, impaired abstraction restricts the patient’s opportunities for self-realization. Consequently, his conduct becomes rigid; he is vulnerable to anxiety, to the “catastrophic reaction,” that is, to the threat of being unable to actualize himself, and to the danger of “losing existence.” Magnum Opus A fact that the term "self-actualization" was originally introduced by Kurt Goldstein as a biological concept to indicate the tendency of the organism's innate motivation to actualize as much as possible which was subsequently extended. He also referred to the same drive as an "actualizing tendency" and a "formative tendency”. Goldstein’s The organism became his magnum opus and has reintroduced a new generation of scientists and laymen to some powerful insights concerning the physiological interplay in the human and animal nervous systems between their parts and the whole. But what is Magnum opus? Because Goldstein is an astounding “forgotten figure” despite of his work being influential to specific individuals, there is rather less of his definition about Magnum opus. However, for the “part process” it has been introduced by Carl Jung in his analytical psychology. Definition: Carl Gustav Jung (1875 – 1961), the founder of analytical psychology, usually referred to as “Jungian psychology”, saw in Gnostic alchemy a precedent to the process of individuation, as encountered in his own clinical practice. This was a breakthrough for Jung and offered a vast amount of data supporting his theory of the collective unconscious; more specifically, that psychic transformation follows an archetypal and universal process. This transformative process happens through the integration of the conscious and unconscious aspects of the subject’s psychology. Jung describes this process as having four stages: confession, elucidation, education and transformation. Individuation as the goal of the Magnum Opus Individuation, in Jungian psychology, is the process whereby an individual realizes a state of spiritual and psychological wholeness. Through this process, that, which was previously fragmented and broken, is restored and synthesized so that a whole and unique individual emerges; an individual who fully accepts,

and is one with, him or herself; an individual who is fully authentic and embraces his or her destiny. It is a movement away from being a pawn in the hands of fate, to consciously collaborating in the realization of one’s unique destiny. This definition of Magnum opus is also in great relation to what Goldstein achieved in just 6 weeks for him to write his The Organism. A highlight of the book is Chapter VI in which Goldstein provides a number of illustrative examples of patients and animals suffering cortical damage but quickly adapting in order to “cope” with their milieu (the “catastrophic reaction” as he famously called it). Goldstein’s statement that “patients (as well as observers) are surprised to see what performances they [the brain injured patients] can accomplish if one makes greater demands on them” reveals a curiously modern outlook on the intriguing possibilities for neurological rehabilitation. Schizophrenia Although trained as a medical doctor, Goldstein pioneered many important advances in psychology. As an early pioneer of neuropsychology, he studied the effects of brain damage on abstraction abilities. His work leads him to conclude that although physical areas of the brain, such as the frontal lobes and the subcortical ganglia, may be damaged, psychological trauma was a more pressing concern. His conclusions on schizophrenia emphasized the disease as a protective mechanism against anxiety rather than an organic defect. Schizophrenia is thought to be the result of a culmination of biological and environmental factors. While there is no known cause of schizophrenia, there are genetic, psychological, and social factors thought to play a role in the development of this chronic disorder. Causes Typically, there is no single precipitating event that leads to the onset of schizophrenia. Onset usually occurs during late adolescence and early adulthood, a time when young people are transitioning into independent roles as adults. They take on more responsibilities, are thrust into new situations (e.g., going to college—sometimes far from home), and are making decisions and connections that will shape their career and life path in general. If they did not learn adequate coping skills to handle these rapid changes and without mental health support (e.g., counseling at a college health center), this transition can be fraught with turmoil. These types of situations could trigger the onset of schizophrenia. It could also drive an individual to self-medicate with drugs or alcohol, which are also considered triggers. So, what is happening in the mind of someone with schizophrenia that is different? While there is no definitive answer to this question, neurotransmitters— the chemical messengers that send information throughout the brain and body—appear to play an important role in the development of schizophrenia symptoms. Neuroimaging studies have found structural differences in the brains and central nervous systems of people with schizophrenia. It is possible that hundreds of genes play a subtle role in disrupting brain development itself. The brains of individuals with schizophrenia also have less gray matter, which plays an important role in information processing, memory, and evaluating rewards and consequences. Some of these brain changes occur during fetal development, childhood development, the onset of schizophrenia, and relapse into active psychosis. Longer relapses into active phase schizophrenia are associated with greater gray matter loss. Although the neuropsychologist Kurt Goldstein (1878–1965) is certainly one of the most influential figures of interwar holism, his approach does not fit the description of holism as an antimodernist irrationalism. According to Goldstein, holism has to be understood as a consequence of and not in opposition to modern science. In his neuropsychological research, Goldstein tried to show that linguistic abilities cannot be located in circumscribed areas of the brain, but can only be understood if the whole organism is taken into account. This neurolinguistic approach was meant to provide the empirical foundation of a holistic picture of human nature: the human mind is not decomposable into small mechanisms and “human behavior is intelligible only as viewed in connection with the organism as a

Language and Cognition-Kurt Goldstein's Theory of Semantics Kurt Goldstein rejected the strong localization hypothesis in the field of aphasiology and attempted to link language disturbances to an underlying general intellectual impairment. Goldstein's criticism was based on his subtle symptomatology, his organismic biology, and his philosophical reflections. In his concept of abstract attitude Goldstein searched for a general psychological function that might explain a variety of aphasic symptoms. Abstract attitude bridges the gap between cognitive and linguistic structures. According to Goldstein, it is the basis for words to have a meaning, to be employed in a categorical sense. Since amnesic aphasics are confined to a concrete attitude, their words have lost their representational function. Although Goldstein's concept of abstract attitude is no longer used in scientific discourse, it is analyzed for its heuristic value. It led Goldstein to questions about the relation between cognition and language and to fragments of a semantic theory. The Paradoxical Position of Kurt Goldstein in the History of Aphasia Despite his own holistic statements and proclamations, Goldstein’s neurological writings do not turn out as unambiguously holistic as one would expect. Especially illuminating is his 1927 Lokalisation in der Großhirnrinde that starts with the expected general attack on the localizationist program and the presentation of an alternative holistic account: “For the unprejudiced observer a living organism is not a composition of ears, eyes, brain, legs, etc., but is an organism with ears, eyes, brain, legs, etc. The psychological human is not a composition of his thoughts, speech, actions, feelings [. . . ] but he is a thinking, speaking, feeling, visually experiencing human.” (Goldstein, 1927a, p. 630) Despite these kinds of remarks, Goldstein accepts Paul Broca’s “flawless establishment of the dependency of the impairment of articulated speech from a lesion in the third left frontal convolution”. Furthermore, the entire second half of the article is devoted to an almost classical account of different forms of aphasia and Goldstein’s basic classification of aphasic symptoms barely differs from localizationist presentations: 1. First, Goldstein discusses peripheral forms of aphasia, which include Wortstummheit (“word dumbness” or “motor aphasia”) and Worttaubheit (“word deafness” or “sensory aphasia”). Word dumbness and word deafness mirror Broca’s and Wernicke’s aphasia and Goldstein does not deny the traditional claim that they are caused by circumscribed lesioned areas in the brain. 2. Second, Goldstein turns to the Zentrale Aphasie (central aphasia), which is characterized by Goldstein as a dedifferentiation of inner speech. Often, language production and understanding are to a large extent intact while disturbances such as repetition, paraphasia, and syntactic mistakes occur. Goldstein states that central aphasia is nothing but his preferred name for conduction aphasia, which had already been described by Wernicke in his landmark essay on the “aphasic symptom complex.” Goldstein disagrees with Wernicke’s term conduction aphasia

“because we are not dealing with a defect of conduction [ . . . ] but with dedifferentiation of a complex apparatus which I believed to be justified to ‘localize’ in the center of the speech area” (Goldstein, 1927a, pp. 759–795). 3. Finally, Goldstein describes the Amnestische Aphasie (amnesic aphasia) as possessing the dominant symptom of a severe problem in recalling words or names. Goldstein argues that amnesic aphasia is caused by an impairment of the ability to form abstract concepts. This explanation is quite unique and will be discussed in section Empirical Evidence for the Holistic Program. Goldstein’s basic classification of aphasic symptom complexes is not revolutionary, but mirrors the traditional localizationist accounts in many ways. Given these observations, Goldstein’s approach does not seem to be a holistic rejection of localizationism. On the contrary, Goldstein offers a more or less traditional classification of aphasic symptoms and even accepts that different symptom complexes can be correlated with brain lesions at different locations of the brain. The Paradox Solved An especially instructive example for Goldstein’s apparently paradoxical stance is his discussion of motor aphasia. The main symptom of this kind of aphasia is the difficulty or even inability to produce (spoken or written) language, while word comprehension is generally preserved. In a discussion of motor aphasia, Goldstein notes that “the anatomical localization of this type of aphasia correspondents to the classic area of Broca, though not in the limited sense of the foot of the third frontal convolution, as it is usually assumed” (Goldstein, 1948, p. 199). For Goldstein, there is no reasonable doubt about the importance of the third frontal convolution for motor aphasia. He even explicitly rejects Niessl von Meyendorf’s alternative hypothesis that motor aphasia is caused by damage of the operculum of the precentral convolution (Von Meyendorf, 1911). The real research questions are whether the neural correlate of motor aphasia has to be extended beyond the traditional assumed structure of the third frontal convolution and how additional symptoms are related to lesions of neighboring regions. Goldstein stresses that these questions remain largely open: “There are numerous anatomic components involved in the structure of motor speech, and in any given case, we have great difficulty in attempting to determine the significance of the various defects for the impairment of motor speech” (Goldstein, 1948, p. 205f). This call for caution, however, was not disputed by Goldstein’s contemporaries and cannot be seen as a serious argument against localization of motor speech in the brain. At a first glance, Goldstein’s theory of motor aphasia seems to be barely different from classical localizationism, but a closer look reveals that a crucial qualification is necessary. While it is true that Goldstein accepts correlations between aphasic symptoms and circumscribed brain areas, the main point of his holism is not what neural correlates can be found, but how these correlates have to be understood. According to Goldstein, the fatal flaw of the localizationist tradition is an unjustified interpretation of the neurolinguistic data. To understand Goldstein’s holism, it is important to differentiate between two aspects of the localization problem. On the one hand, localization in a weak sense can mean the correlation of symptoms and brain lesions. Goldstein does not reject this kind of weak localizationism, although he often points out that the classical tradition had been too optimistic in its attempts to identify circumscribed neural structures. On the other hand, the classical tradition understands localization in a much stronger sense. Strong localizationism starts with correlations between aphasic symptoms and brain lesions, but goes a step further by taking the neural correlates as evidence for the seat of linguistic abilities in the brain. In the case of motor aphasia, classical localizationists argue that the correlations show that the knowledge

necessary for language production is actually located in this part of the brain. In this sense, Wernicke assumed that the third frontal convolution is the seat of the Bewegungsvorstellungen (movement images), which allow expression of thoughts in speech. It is exactly this strong interpretation of localizationism that is rejected by Goldstein. Empirical observations of neurolinguistic correlations are innocent as long as they are not misunderstood in the sense of the strong localizationist program. Goldstein stresses this point by arguing that “one can deny circumscribed localization and nevertheless ascribe to the lesion of a circumscribed part of the brain a particular significance for a definite disturbance”. The differentiation between “weak localizationism” and “strong localizationism” therefore allows the apparent paradox in Goldstein’s work to be dissolved. Indeed, Goldstein is a holist and a localizationist, but this only sounds paradoxical if one does not discern different meanings of the word “localization.” As soon as one understands that Golds...