Ch. I – Method of Determining Symptoms. Certain General Laws of Organismic Life. Observations on Persons with Brain Injuries

Epoché (II), 18. 6. 2020

A synopsis of our reading of The Organism by Kurt Goldstein

I. “Method of Determining Symptoms. Certain General Laws of Organismic Life. Observations on Persons with Brain Injuries” (pp. 33-67)

Abridgment by: Sebastjan Vörös
[his outline and commentary of the whole book can be found here

The starting point = phenomena exhibited when the brain cortex is damaged. This, for two reasons:

(a) because, with some justification, we attribute a particular dominating significance to the cortex, phenomena appearing during its injury will be especially relevant for our understanding of the essential nature of man;

(b) because the analysis of these phenomena enables us to demonstrate certain general laws of the disintegration of function, which will be especially relevant for our understanding of the organism’s function (33).

Predominant (classical) view = cortical injury → loss of circumscribed functions (e.g., speech, visual perception, motor performance), therefore: circumscribed centers control these circumscribed functions.

However, improved observation has led to a different view:

“It has been found that, even in cases of circumscribed cortical damage, the disturbances are scarcely ever confined to a single field of performance. In such intricate syndromes, we deal not only with a simple combination of disparate disturbances but also with a more or less unitary, basic change that affects different fields homologously and express itself through different symptoms.” (33)

What led to new facts was not greater skillfulness, but a difference in the methodology (34).

The problem of methodology has the greatest significance for psychopathology and for biological research in general. Classicists, for instance, start from the notion of a hypothetical “primary symptom” (examples): in motor-speech disturbance this would be an impairment of motor-speech images, in word deafness, an impairment of the sensory speech images.

When we start examining a given pathology, it is understandable that we initially focus on the most striking phenomena. This, in itself, is not dangerous, so long we bear in mind that the phenomena that first draw our attention are not necessarily essential, or basic. Such phenomena may simply stand out by virtue of a certain circumstance, and may, upon close examination, appear incidental. The danger arises only when this discrimination between essential and incidental phenomena is neglected. The real crisis arises when, in the face of new findings, the investigator cannot free himself from his former theory, but tries to preserve it and tries to accommodate it to the facts by constant emendations. This error has been common in the evolution of the classical doctrine (34-5).

The problem of determining symptoms

The main problem of the classical doctrine was the failure to recognize the complexities involved in symptomatics:

“We have become so accustomed to regard symptoms as direct expressions of the damage in a part of the nervous system that we tend to assume that, corresponding to some given damage, definite symptoms must inevitably appear. We do so because we forget that normal as well as abnormal reactions (‘symptoms’) are only expressions of the organism’s attempt to deal with certain demands of the environment. […] Symptoms are answers, given by the modified organism, to definite demands: they are attempted solutions to problems derived, on the one hand, from the demands of the natural environment, and on the other, from the special tasks imposed on the organism in the course of the examination. […] It is of primary interest that the appearance of symptoms depends on the method of investigation […] By focusing only on certain phenomena or on a selected few, the investigator comes to isolate ‘symptoms’. Phenomena, more striking than others, are registered first and thus give the impression of being the dominant symptom. Most likely to attract attention, of course, are the atypical reactions in a normal situation and, in particular, the complete absence of any reaction when one is expected.” (35)

That is to say, complete loss of a special function = outstanding phenomenon, and conceals the fundamental defect. These outstanding symptoms are, as mentioned, elicited by specific questions presented by the examiner, which in turn are dictated by the investigator’s fundamental ideas about the phenomena being studied. It is true that these ideas may have been suggested by the data, but very often, a theory has evolved on the basis of symptoms that have gained their apparent preeminence purely by chance. This bias has often resulted in delaying the understanding of the symptoms and the advance of research. In general, theorizing presupposes that one has grouped the symptoms into the more or less relevant – the primary (basic) and secondary (incidental) -, and when making these distinctions, the investigator is commonly prejudiced by theoretical viewpoints that have proved useful in other fields of research and that he believes to be useful for the material at hand. (36)

The classical approach in neurology has tried to explain psychopathological symptoms by drawing on reflexology and the prevailing association psychology. The theory that the nervous system consists of a number of separate mechanisms, each operating independently, led to the idea that circumscribed injuries must result in disorders specific to the mechanisms involved. Consequently, the investigator looked for these mechanisms, and found them, because he noticed only the disorders that best corresponded to the theory. Just as normal events can be explained as composites of elementary processes, so symptoms were interpreted as changes of similar mechanisms of mental elements. Actually, such explanations were merely the outcome of theoretical presuppositions (reflexology, association psychology). However, once the basic concept of the importance of specific areas for certain functions was formulated and (seemingly!) confirmed, it determined all subsequent investigations, particularly because of its applicability to practice. If other phenomena were found, they were [a] pushed aside as “complications” that disturbed the “purity” of the case, and were considered the result of some injury incurred simultaneously in another area. Or perhaps they were [b] explained away as merely secondary effects contingent on the hypothetically primary disturbance. (36-7)

Three methodological postulates

Goldstein feels that what makes his approach different from all the others is that he has endeavoured to record, in an open-minded fashion, all phenomena. This led him to 3 methodological postulates:

(1) Consider initially all the phenomena presented by the organism (in this case, a patient), giving no preference, in the description, to any special case. At this stage no symptom is to be considered of greater or lesser importance. If we adopt this stance, we might learn that a given symptom, which at first sight seems very prominent, is not, in fact, of primary significance, whereas a trifle that barely attracts notice may be of the utmost importance. (37-8)

Example: amnesic aphasia: As long as only the most prominent symptom – the difficulty in finding words – was considered, the reduced evocability of speech images appeared a perfectly satisfactory explanation. However, a closer inspection revealed that amnesic aphasics haven’t lost the use of words per se, but the ability to employ words as bearers of meaning. Under circumstances in which the latter is not demanded, and the words “belong” to an action or concrete situation, the patient “has the words”. The inability to find and use words voluntarily is not due to the primary defect of the speech mechanism but due to a change in their total personality which bars them from the situation in which meaning is required (38).

(2) Describe phenomena as accurately as possible. It was a frequent methodological error to accept what amounted to a mere description of the effect; but the effect might be ambiguous with respect to its underlying function. The older investigations usually confined themselves to the “plus or minus method”, i.e., the question of whether a patient succeeded or failed to give a correct response to the task. However, this is potentially misleading. For instance, if we focus only on the positive result, we may overlook deviations from normality, because the individual completes the task by a detour (38-9). Alternatively, we can wrongly equate the negative result as a simple failure, whereas actually it may throw considerable light on the mental functions of the patient (40).

Example: Colour-sorting test: Patients with loss of “categorical behaviour” find it difficult to consider an individual colour according to a category such as redness, greenness, etc. For instance, when asked to select all red-coloured skeins in the Holmgren wool samples, they often place the colours “in a row” (lightest -> darkest). This might lead to a conclusion that they have proceeded categorically. However, this conclusion is based on an error of observation, for it can easily be shown that they have not proceeded categorically: they are not able to arrange the colours in a row as to their brightness, if asked to do so, and they fail in the task of putting together all reds in a heap. What the patients do, when they place the colours in a row, is they place one shade beside another, one at a time. By following this procedure of “successive pairs”, single pairs of similar shades are formed under the guidance of the concrete sensory cohesion between the last skein and the next one (39).

(3) No phenomenon should be considered without reference to the organism concerned and to the situation in which it appears. This postulate will be dealt with in greater detail throughout the text.

2 possible objections:

    (1) According to (1)-(3), one can never determine at what point an examination can be regarded completed. As a matter of fact, Goldstein retorts, it never is! What is crucial is that the examination can be carried far enough at least to ensure that a theory can be developed that will render understandable all observed phenomena in question, and will make it possible to predict how the organism will react, even in such tasks as hitherto uninvestigated (40-1). 

    (2) The proposed procedure enforces a limit on the number of cases investigated, which might vitiate the conclusiveness of the statements (41). Goldstein replies in a twofold manner: (a) the study of a even a myriad of imperfectly investigated cases will not guide us toward recognition of the true facts; (b) important though it may be to seek repeated confirmation of our findings through new case material, such confirmation adds nothing essential to our knowledge. Those patients must be subjected to investigation who offer a guarantee of unequivocal statements of fact as well as of theoretical interpretation. And even if it turns out that the new analysis may induce us to modify somewhat our original assumptions, if the analysis of the first observation was sufficient, this modification can be made easily, whereas imperfect analysis of ever-so-many cases may be very misleading (just look at contemporary medical literature!) (41-2).

Disintegration of performances and the hierarchy within the organism

What do we mean by “performance”? According to Goldstein, “performance of an organism” is any kind of behaviour, activity, or operation as a whole or in part that expresses itself overtly and bears reference to the environment. This, evidently, excludes physiological processes, mental activities, attitudes, etc. More specifically, “performance” is a coming to terms of the organism with environmental stimuli by a behavioral act, be this (i) eyelid closure or (ii) running toward a goal (42).

In light of this, the following outline can be presented:

(1) A single performance or performances in a specific field (e.g., visual, motor) never drops out alone; invariably, all performance fields are affected (yet the degree to which they are affected varies).

(2) A single performance field never drops out completely. Some individual performances are always preserved.

(3) The modification of performances manifested by a patient in different fields is in principle of the same nature. Different symptoms can be regarded as expressions of one and the same basic disturbance.

(4) The basic disturbance can be characterized either as a change of behaviour or as an impairment of the brain matter (discussion of this postponed till later, p. 200). Here, Goldstein (example) refers to Sch. again, particularly his ability to carry out concrete (→ immediate reality), but not abstract movements (→ domain of “the possible”). This disturbance, he contends, manifests itself in all responses, such as action, perception, thinking, volition, feeling, etc. (43).

Depending on which of these manifestations of the basic disturbance has been brought into focus, they have been named respectively: disturbance of “symbolic expression” (Henry Head), of the “representational function” (Willem von Woerkom), of “categorical behaviour” (Gelb and Goldstein). What is crucial to this disturbance is the impairment of the capacity to comprehend the essential features of an event, or the impaired capacity to deal with that which is not real – with the possible (44)[!!!].

Inquiring into how individual performances are affected, we find that (1) voluntary performances are particularly affected, while activities directly determined by the situation remain relatively intact. Similarly, (2) the isolated performances are affected to a greater extent than the so-called total responses. And although the symptoms vary with the severity of the impairment and the degree to which one area or another is affected, the basic disturbance remains the same (44-5). What can be seen from this and similar examples is that (1 + 2 → 3) cortical injury does not result in the loss of isolated performances but in systematic disintegration following the principle that certain forms of behaviour will be impaired while others remain intact (45).

Objection: Are we really dealing only with the impairment of certain kinds of behaviour? Have not “contents” also dropped out?
Answer: Definitely! But often, these losses are of secondary importance, since contents appear only within certain kinds of behaviour.

Example: amnesic aphasia (again): Patients suffering from a. a. have lost the ability to call objects by their names. Seemingly, they lack the “content”, i.e.,  names. However, closer analysis reveals that we are dealing with a disturbance of “categorical” behaviour, an impairment of the capacity to handle “meaning”, which is prerequisite for naming objects. However, some contents – e.g., foreign words – may be embedded in other forms of behaviour – those belonging to acquired faculties – and might therefore be preserved even in such conditions as amnesic aphasia (45).

Accurate observation reveals that disintegration of function always results in the same pattern of distribution of the intact and affected modes of behaviour. There is a hierarchy or descending scale of disintegration, in which the higher performances are more disturbed than the simpler ones (e.g., categorical behaviour always suffers first). Goldstein maintains, somewhat surprisingly perhaps, that the most complicated performances, those first to be impaired, are probably the ones most essential and most vital to the existence of the organism – they have the highest functional significance. Through the deterioration of those performances the organism loses its most characteristic properties. This “hierarchy of disintegration” provides us with the idea of a hierarchy of capacities and performances – a stratified structure of the organism (46; cf. also 363).

Characterization of performances according to their functional significance or value and their survival importance

What does it mean for certain forms of behaviour to be “intrinsically valuable”?

(i) On the one hand, it could mean that they are significant for the preservation of the nature of the organism (“higher”, i.e., more conscious/voluntary performance).

(ii) On the other hand, it could mean that they are most important because they resist the effect of injury (“lower”, i.e., automatic performance).

It is usually argued that (ii) are more important than (i), inasmuch as they ensure mere existence (this idea is captured in the common expression “the instinct of self-preservation”).

Goldstein begs to differ:

“[T]he normal organism is characterized as a “Being” in a temporal succession of definite form. For the realization of this “Being”, the existence, the “mere being alive”, plays, of course, a prominent but by no means the essential role. Under extreme circumstances, it can be compatible with the “nature” of an organism to renounce life, that is, to give up its bodily existence, in order to save its most essential characteristics – for example, a man’s ethical convictions (see p. 256). Preservation of material existence becomes “essential” only after defect sets in, and possibly, in certain emergencies. In the latter case, the body achieves the position of supreme importance, since all the other possibilities of self-realization are bound to it.” (47)

For this reason, Goldstein distinguishes between:

(a) functional significance/value = “essential to the nature of the organism”;

(b) survival significance/value = “paramount in the preservation of the organism’s life”.

In the normal organism, (a) and (b) usually go hand in hand, inasmuch preservation of (b) also means preservation of (a) as much as possible; in the pathologically changed organism, (b) comes to the fore (47-8).

Certain general rules determining organismal life

(x) “Ordered” (normal) behaviour and “disordered” behaviour. Catastrophic reaction.

A description of mere defects does not adequately characterize the injured condition of the organism. To understand the latter fully, we must also pay close attention to the intact performances. In order to understand the interrelationship between effective performances and failures, we need to consider the total behaviour of an organism. The latter can be divided into two basic classes (48):

(i) “ordered” behaviour = effectual performances → here, responses appear to be constant, correct, adequate to the organism to which they belong, and adequate to the species and to the individuality of the organism, as well as to the respective circumstances; the individual himself experiences them with a feeling of smooth functioning, uncontraint, well-being, adjustment to the world, and satisfaction, i.e., the course of behaviour has a definite order, a total pattern in which all involved organismic factors participate in a fashion appropriate to the performance in question: “Hence, ordered and normal behavior are synonymous inasmuch as the behavior is normal because it is ‘ordered’.” (48-9)

(ii) “disordered”/“catastrophic” behaviour = deficient performances → here, responses are not only “inadequate”, but also disordered, inconstant, inconsistent, and embedded in physical and mental shock; the individual feels himself unfree, buffeted, and vacillating; he experiences a shock affecting not only his own person, but the surrounding world as well; he is in that condition that we usually call anxiety (49).

After (i), the organism can ordinarly proceed to another action, without difficulty or fatigue. Whereas, after (ii), his reactivity is likely to be impeded for a longer or shorter interval. The disturbing aftereffect of (ii) is long-enduring (49).

(x) Tendency to ordered behaviour

In time, the patient will – despite the persistence of the defect – return to an ordered condition.

During the acute state, the picture is usually so complicated and varying as to make an unambiguous analysis impossible. However, it is not useless; on the contrary, it can teach us a lot about certain types of behaviour. It is especially significant in its analysis of shock. After “recovery” (state of “re-ordering”), the picture is much better suited for analysis, if for no other reason, than its relative consistency (49).

If we examine patients in this re-ordered condition, we find out that the remaining performances show a number of peculiarities that are of interest because they throw light on the question of how the disordered organism regains a state of order (50).

[x] Lack of self-perception of defects and the tendency to exclude defects

The first thing we are struck with, is that the disturbing stimuli apparently have no effect on the behaviour. This becomes evident when we study the subjective experiences of the patients, as well as their objective behaviour. Since the investigations of Gabriel Anton, this phenomenon has been known as “lacking self-perception of the defect”.

This phenomenon has been construed as a peculiarity resulting from a definite kind of damage to the cortex, and has been accounted for in two ways:

(i) in terms of localization; or

(ii) in terms of faculty disturbances (e.g., disturbances of attention, perception, and memory).

None of these explanation has proved adequate, according to Goldstein: (i) Redlich & Bonvicini have pointed out that we’re dealing, in such cases, with general mental disturbances that have nothing to do with abnormalities of memory, imagery, etc.; (ii) Anton has emphasized the great similarity between the behaviour of these patients and that of certain hysterics; (iii) Goldstein has observed that the resulting ineffectiveness can also be found in cases without any injury of the brain or mental disturbance per se (e.g., total blindness produced by gross damage to the peripheral optic nerve) (50-1). [note these interesting syndromes/cases: 1, 2, 3]

Goldstein’s conclusions: this phenomenon is not confined to any specific type or place of lesion in the brain; and we cannot speak simply of psychotic reactions. Rather, we are dealing with apparently quite normal biological reactions to a very grave defect (50-1).

(x) Modification of preserved performance and of milieu in a defect

Disturbances can be rendered ineffective only if such demands that would provoke their coming to the fore are not made on organism, i.e., only if the patient’s milieu is modified in an adequate way. These modifications are [a] partly brought about by the activity of the persons dealing with the defective organism (e.g., the experimenter or the physician) and [b] partly by the organism itself (51).

(x) Avoidance of catastrophic situations

Injured animals, for instance, seek situations in which they are not exposed to dangers that may arise because of their disabilities. (Example: sympathectomized animals show a clear aversion to cold air and draft in the winter; they prefer to stay near the radiator.) 

In human beings, the modification of milieu manifests itself in very definite changes of behaviour. Specifically, patients avoid all situations that would occasion catastrophic reactions. Note that this does not mean that the patient has consciously recognized the situation and its danger. The nature of his defect usually makes this impossible for him, and actually he often remains quite passive in the matter. However, if the patient has had frequent opportunities to observe that certain situations entail catastrophic reaction and if he can learn to recognize these situations through certain “criteria” that are within his mental grasp, then he can also actively avoid the situation (51-2).

(x) Substitute performance

The “avoidanceof dangerous situations is brought about especially by the patient’s tendency to maintain a situation with which he can cope. If forced into a situation that he has identified as dangerous, he deliberately seeks to escape through a “substitute performance”. Patients develop great ingenuity in this respect. The content of this substitute performance may seem quite meaningless and is perhaps even disagreeable to the patient, but the important thing is that he will be less disturbed by it. The significance of substitute performances thus lies not so much in their content as in the fact that this mode of response lies within the capacities of the patient and that nothing can happen that might lead to catastrophe (52).

(x) Tendency to undisturbed state: Constant activity

The considerations above make intelligible why the patient is practically never idle. The patients are always occupied with something. The performances that the patient can carry out and to which they tend to cling have the character of stereotypy and exhibit little variation. Thus, the patients exhibit a tendency to maintain the most uniform and undisturbed condition. However, careful observation reveals that this uniformity is not a genuine restful state of a leisurely, contemplative person. By always “doing something” that he is capable of, the patient keeps himself so occupied, so secluded from the outside world that he remains unaffected by many events in his environment. This escape from the environment into a condition that protects him from situations that are dangerous to him has its analogy in the so-called “death feint” of animals. Important: just as the latter is not the result of a volitional act but a biological phenomenon occasioned primarily by shock and anxiety, so also is the former. (52-3)

(x) Tendency to orderliness

One of the ways in which patients avoid catastrophic situations is a tendency to oredliness. Such individuals may become veritable fanatics in this respect. Disorder is unbearable for such patients. Now, there is no such thing as objective “order” or “disorder”. For patients, “disorder” means an arrangement that forces on one not simply a single, definite criterion such as “availability of objects”, but several or many. “Complete disorder” would not force anything on the individual, but would leave him completely free choice (53-4). 

There are, of course, several possible arrangements of the same objects, depending on the attitude (e.g., active vs. contemplative attitude) with which one approaches things. The more manifold the tasks are that a person can perform, the more his arrangements will appear disorderly to the person who is only capable of fulfilling a few tasks. For such persons, the position of objects next to each other, or objects together in small heaps, will represent the “real” order, the best order, while everything else will stand for dis-order. All patients with brain injury have a tendency toward such “primitive” order

The principal demand that “disorder” makes on them are choice of alternatives, change of attitude, and rapid transition from one behaviour to another. This is exactly what is difficult or impossible for them to do. To avoid anxiety patients therefore cling to the order that is adequate for them but appears abnormally primitive, rigid, and compulsive to normal people. Put differently, the “sense of order” in the patient is an expression of his defect, an expression of his impoverished capacity for adequate shifting of attitude (54).

(x) Anxiety and avoidance of “emptiness”

The dread of catastrophic reactions is also the reason behind the tendency to avoid emptiness. Note that it is not here a question of having an idea or subjective experience of emptiness. However, there is no doubt about the anxiety and restlessness when confronted with a situation which demands experience of emptiness.

Example: aphasic patients: if asked to write on a piece of paper lying in front of them, they usually start directly at the top edge and crowd their writing as close as possible, line on line; only with the greatest effort, if at all, can they be persuaded to leave a larger interlinear space.

The dread probably emerges from the fact that empty space does not become an adequate stimulus and therefore leads to an inadequate catastrophic reaction. It is because of this dread that patients tend to cling tenaciously to something “filled”, to an object, with which they can establish contact through activity. The patient is clinging to concrete contents, knowing that as soon as he gives up this point of reference, he will become helpless, ineffective, disturbed, and driven to catastrophic reactions (55).

(x) Relative maintenance of ordered behaviour by shrinkage of milieu according to defect

A defective organism achieves ordered behaviour only by a shrinkage of its environment in proportion to the defect (for more on this cf. p. 338). This needs to be taken into account in our observations of injured animals (56).

(x) Tendency to optimal performance (example: hemianopsia – the adjustmental shift)

The injured organism tends to maintain a performance capacity on the highest possible level. When one performance field is disturbed, the most important performances of that field survive the longest and tend to be most readily restored (56).

Example: hemianopsia: A patient with total destruction of the calcarine (= primary visual) cortex of one hemisphere, suffers from hemianopsia, i.e., total blindness of corresponding halves of the visual field of both eyes. However, although this condition appears consistently, under examination with a perimeter, the behaviour of these patients in everyday life fails to indicate that they see nothing in one half of the visual field [analogy with “split brain patients“?]. Subjectively, they feel that their vision is somewhat impaired, but it is by no means true that they see only one half of the object or even that they see objects less distinctly on one side.

Precise exploration reveals that patients are not, in fact, limited to half a field of vision, but that their field of vision is arranged around a center like in normal patients, and likewise, the region of their clearest vision lies approximately at this center. A visual field of such formation is actually a requisite for the most important visual functions, especially for the perception of objects (56-7).

The stimuli originating in the part of the outer world corresponding to the blind half of the patient’s retina seem to be registered with the intact part of the retina. Example: If, for instance, we present the patient with a series of figures next to each other on a blackboard and ask him to state which he sees most distinctly, he does not designate, like a normal person, that figure that would register on an area corresponding to the macula but one that lies a little to the side. How is this possible? Close inspection reveals that the patient’s eyes have shifted! Since the possession of a visual field that is arranged around a center is extraordinarily important for vision, and since an object is clearly seen only if it lies in the center of the visual field that surrounds this object, the patient’s eyes have undergone a displacement (57-8).

(x) Further illustrations of the tendency to optimal performance (example: hemiamblyopia – adaptation without shift)

Example: In hemiamblyopia, where the damaged calcarine cortex is still capable of performing its function, but to a reduced extent, the transformation does not occur! Even though one half of the objects produce a fainter impression, this apparently does not disturb perception essentially not to such an extent that a displacement is demanded. The eye displacement must limit the extent of the visually prehensile, outer world, which involves not only quantitative, but also qualitative deficiencies (e.g., when a complete recognition of an O requires the perception of its aspects that lie more to the side):

“The organism bears all these impediments if a good vision is otherwise impossible; but it ‘avoids’ them if adequate vision can still be maintained in some measure without eye shifting – as in hemiamblyopia. What is germane is not the best possible performance in one field but the best possible performance of the organism as a whole. [!] Therefore, transformation or modification in one field will always be oriented about the functioning of the total organism.” (58)

(x) Further illustrations of the tendency to optimal performance (example: monocular diplopia – adaptation to a defect)

Example: monocular diplopia: some patients suffer a reduction of visual efficiency in certain areas of the retina; if a good visual performance is required, it can take place only by a duplication of the object seen (= diplopia). If damage to retina has made good visual response impossible, there will occur a spreading of the excitation – from the proper location to the location nearer to the macula – and the appearance of two images: one that is seen better, but is displaced towards the macula, the other is seen more poorly, but is correctly localized. Since the spread of the excitation necessarily involves the appearance of a double image, the organism apparently reconciles itself to the fact of being less disturbed by diplopia than by a more deficient vision (59).

(x) Modification and preservation of performances: The rules of adjustmental shift in defects

Surveying all the facts about adjustmental shifts, Goldstein provides some general rules:

(1) “Priority”: When a performance field is impaired, those performances tend to survive that are most important or necessary with regard to the functioning of the whole organism.

(2) “Conservatism”: If it is possible that the needs of the total organism, with reference to a special performance field, can be fulfilled in the usual way, the premorbid modus operandi will be maintained. If this is impossible, an adjustmental shift occurs, conforming in principle to (1).

(3) “Tolerance”: The organism tolerates those performances in other fields that must necessarily result from the adjustmental shift in any one field. Here again the principle is valid that the whole organism is less handicapped by these disturbances than it would be by the original impairment in the field that is now modified in its function.

(4) “Suddenness”/“Unawareness”: The shift occurs suddenly: it is not a result of training, and it happens without the knowledge of the patient. (60)

From this, a general conclusion could be drawn: the organism tends toward an optimal performance (60-1).

Objection: Is not, say, the eye displacement of the hemianopic patient a pathological phenomenon from which we have no right to conclude that a normal organism is governed by the same tendency?

Answer: The behaviour of the hemianopic is in principle not different from that of a normal person (61).

In the patient, a region of the retina, which in relation to the center of the clearest vision (the anatomical macula) is located relatively peripherally, now assumes the role of a new fovea – it becomes a so-called pseudo-fovea. But with this alteration, the function of every point on the retina must likewise have undergone transformation. Centrally located areas are now hypofunctioning, or, to express it otherwise, they now function as peripheral zones normally do. 

Fuch’s measurements of visual acuity show that visual acuity decreases from the new center toward both sides – the decrease involves even the anatomical macula: in visual acuity, the pseudo-fovea may surpass the anatomical fovea by ⅙, ¼ or even ½. Ordinarly, the patient sees those objects, which are projected on the pseudo-fovea, as lying straight ahead, just as normal people see “straight ahead” the objects projected on the anatomical fovea. In a corresponding degree, all other spatial values of the retina must have changed. However, the change does not produce a new formation that is fixed once and for all. Fuchs has shown that the position of the pseudo-fovea varies according to the particular visual object that confronts the patient. But if we compare these findings to those in normal people, we discover that even in the latter case there is no constant relation between a particular part of retina and a particular function. According to Gelb’s findings, visual acuity of any point of the retina is determined by its participation in the configurational process, corresponding to a definite object. Similarly, Jaensch has shown that, in normal people, the visual field varies in accordance with the attitude of the individual toward the object (61-2).

Ergo: the change in function of individual points in the calcarine region of the hemianopic fits completely within the frame of normal occurrences (62).

*(x) Energy and performance

[a] External stimuli do not only initiate the process in the nervous system (NS), but also represent sources of energy. Besides the external stimuli, however, [b] internal stimuli play a considerable part as well. Further, it should be emphasized that [c] the connection between the NS and the rest of the body is not to be ignored: the whole organism stands for one unit, in which the NS, if considered in isolation, is only an artificially isolated part. Thus, inasmuch as the NS in vivo is an integral part of the organism, its sources of energy must be the same as those that sustain the activity of the whole organism. Here, individual organs (e.g., the ductless glands) have a specific significance (63).

Now, what does the symptom analysis tell us about the dependency of performance on the available energy? To begin with, the available energy supply is constant, within certain limits. If one particular performance requires especially great energy expenditure, some other performance suffers in the process.

In light of his previous investigations of hallucinatory phenomena, Goldstein points out that there seems to be an antagonism between sensory and thought performances – reduced vividness of our sensory experiences during the thought processes, etc. -, as well as between motor and sensory phenomena, verbal and nonverbal performances, and so on. Given the fact that a brain lesion impedes the functioning, this means that special energies will become necessary to maintain that function. This is supported by the observation that patients fail in those performances, which they otherwise can accomplish, when performances involving an injured area are simultaneously required of them.

Example: Aphasics: If we ask the aphasic patient to read aloud, he may not be able to understand what he reads, because of the impediment of the speech activity. The energy is exhausted in coping with this impediment. Yet if he reads silently, he may be able to read with full understanding.

The said fact is reflected in the, at the first glance, surprising phenomenon, namely that frequently, patients who suffer complete destruction of a field essential to a certain performance may on the whole be less afflicted than those who suffer only partial destruction.

Example: hemiamblyopia vs. hemianopsia: a patient with hemiamblyopia (= less extensive injury of one calcarine area) is, to a certain extent, more disturbed in his vision than a patient with hemianopsia (= full destruction of one calcarine area); this is easily explained in terms of energy: the organism tends to function in the accustomed manner as long as an at least moderately effective performance can be achieved in this way (64).

Example: word deafness (Otto Plötzl): the patient with complete word deafness subsequently started comprehending some words (to the extent of being able to repeat them); concomitant with the improvement of deafness his “inner speech” started to deteriorate; as long as word deafness was complete, the total energy could be placed at the disposal of the apparatus of inner speech; but as soon as the return of function in the region of “word deafness” demanded a particularly strong energy supply, the substratum of inner speech, now supplied with a smaller quantity of energy, decreased in function. 

In sum: the differential energy distribution must be taken into full consideration in every symptom analysis (65):

“The quantity of available energy depends essentially on the total condition, not only of the brain, of the state of nutrition in the brain, and so on, but also of the entire body. Thus, it becomes intelligible why the patient’s performance will vary in accordance with his well-being, degree of fatigue, and so on.” (65-6)

(x) Reference of symptoms and performances to the whole of the organism.

The question here emerges as to what we really mean by the word “whole”. This, in a sense, is a crucial question that needs to be answered. If, for instance, we say that the organism tends to modify itself, in spite of the defect, in such a way that those performances most important for it are made possible, we are positing a certain essential characteristic of the organism, without offering any explanation for the way in which this knowledge has been obtained. Although this allows us to attain knowledge of general rules of holistic/organismic processes, it remains painfully insufficient, for it is exposed to a certain skepticism regarding these rules, especially with regards to the question as to whether the characteristics we have assumed are in fact “genuine” properties of the organism concerned (66). 
In order to answer this question we must, then, truly know the organism. Goldstein is adamant that this knowledge is attainable only through the scientific or analytic, “anatomizing” method: only the empirical data thereby obtained can be considered. However, this analysis can take on several forms: it may bring into focus (i) the morphological and physiological organization, or (ii) the physical and chemical composition, or (iii) somatic and mental phenomena, etc. It is not enough to simply survey this manifold material and see what sort of picture of the organism we end up with. Instead, we have to deal with the more fundamental question ofwhether, and to what extent, the material yielded by analysis is at allsuitable to provide the picture of the organism; whether or not it impels us to regard the organism as a whole, and if so, how we arrive at ta conception of the whole”, as represented in this organism. According to Goldstein, it is immaterial which sort of facts we take as our point of departure in this endeavour, so he proposes that we start with the so-called reflex theory (67).

(Compared to anthropogenic meadows, wildflower meadows are significantly richer in biodiversity. The former are suitable habitats for the species that fruit before the first mowing or have underground parts (bulb, rhizome, tuber, etc.). Sprinkling the meadows with liquid manure to maximize the yield of biomass adversely affects the species that prefer nitrogen-poor soils, e.g., orchids.)

Discussion

The following topics were pointed out during the discussion:

I) The most complicated performances are the most essential/vital to the existence of the organism. They are significant for the preservation of the nature of an organism. Based on the studies of his patients, Goldstein deduced a general observation on the tendency of the organism to preserve what is of a functional significance to it. That is, it strives to sustain not only the best possible performance in one field that has been impaired but the best possible performance of the organism as a whole. To demonstrate his point, Goldstein employed and/or wrote about a variety of methods and strategies in the realm of prereflective phenomena, which makes The Organism a valuable compendium.

Goldstein’s understanding of the neurological symptomatic stems from his apprehension of the injury as affecting the organism in its totality. The atomistic approach falls short here. However, in order to be able to participate in the scientific society he attuned his holistic outlook to the general rules accepted at the time.

What is the totality of the organism according to Goldstein? It could either be a function that an organism is trying to accomplish, which in turn determines the functioning of the totality of its organs, or a body as a whole. The problematic remains vague throughout the book. As a therapist Goldstein defines a healthy organism as one that is able to actualize oneself. Except in ‘defects’ and ’emergencies’, functional significances prevail over the survival ones.

Is normality therefore a tendency toward self-actualization – namely, toward being the best version of oneself – or is it an average? Frankl and Canguilhem argued a homeostatic organism to be pathological. Homeostasis is a neurotic attempt to sustain a status quo. Self-actualization is only possible when an individual transcends themself in order to acquaint with an unknown situation.

II) Findings about the inadequacies of atomistic approach stem not from the existing methodologies having become more precise, but from employing a whole new methodology. As Fleck and Kuhn emphasized, the appearance of symptoms depends on the method of investigation. Given that explanations seem to be an outcome of theoretical presuppositions, what does that tell us about scientific research itself? Is it a “self-fulfilling prophecy”? A researcher’s methodology is influenced by, or rather, it is rooted in their theoretical and metaphysical background. Fleck described a thought style, which arises in the intellectual collectives and shapes their members’ attitude towards the world and their mode of existence. They enter a world of new meanings, acquired through their practical work, explicit and implicit knowledge. The genesis of the facts, given that it exists, might not be purely contingent. 

An interesting phenomenon occurs in psychotherapy, where a patient or a group of them tune up to their therapist’s methodology. Guided by one therapist, a group of patients will talk about their pathological behaviours in a descriptive way. When guided by another therapist who is interested in existentialism, the aforementioned patients’ focus will shift to the existentialist topics. The therapist enters the setting as a person in their totality, and the latter resonates in their patients. This way, the method used by a certain doctrine seems to affirm itself as effective. Given that the communication during the session was genuine, the method may truly be effective, regardless of the doctrine.

III) In his methodological postulates Goldstein highlights the importance of a good description. However, what does it mean to describe?

Describing is similar to an analysis – they both differentiate. The following questions were raised:

i) What criteria for differentiation does one employ when describing a certain phenomenon?

ii) How does one know if the chosen criteria are suitable for describing this exact phenomenon?

iii) Is it possible to speak of a correct description of a certain phenomenon?

Heidegger pointed out two possible ways of differentiating:

a) as belonging together – a lived experience where one unbiasedly observes the interconnected components of a phenomenon as it unveils;

b) as belonging together – the key concept here is relatedness, the criteria for which one determines in advance; when observing a phenomenon, one relates its components by the chosen criteria. This way of differentiating can be found in mechanicism. Yet the same could be said of the holistic approaches: their presupposition is the organism. Are the latter necessarily better than the first when describing the living systems? We could be wrong about something as ‘evident’ as what we perceive as the totality of an organism. It might be only an interplay between the mechanicistic components.

IIIa) What is a lived experience? Is it even possible to withdraw from the ways I was taught to handle with the phenomena, and observe them unobstructed by the bias originating from my theoretical and metaphysical background? Science might be able to offer a more rigorous approach to observing, possibly avoiding the intuitive particularities that exist in an individual.

Husserl wrote about the realms of experience where the attainment of eidos is not precluded by the way an individual structures their experience. On the other hand, lived experience is the ground for all the other constructs. Therefore, though being a construct in itself, it could be regarded as constitutional. But why necessarily ascribe such a role to the lived and not the scientific experience? Interpretation is present in every act of observation, so there ought to be no reason to consider the scientific interpretation to be less vivid that the phenomenological one. Be that as it may, there are numerous approaches to the scientific interpretation. Kuhn made a distinction between the normal and crisis science. Trying to compare them by the criteria set by either of them results in aporia. For example, the ontology of quantum mechanics becomes bizzare if conformed to the strictly realistic science. Sellars argued that the only way to compare two scientific approaches is by the number of differentiations each of them makes. Contrary to Husserl’s aiming for the eidoi, lived experience is more about the nature of an individual’s perception of relations and differences. Lived experience has in its core a non-dualistic dynamic that science lacks, namely the figure against the ground. These two occur simultaneously, the figure as the explicit and the ground as the implicit. Taking Bortoft’s concept of differencing-relating, we can say that the dynamic of the phenomenal is the differencing on the ground of relating. Classical science does not acknowledge the dynamic of differencing, but instead begins with differentiating the phenomena and then searches for the relations between them.

Husserl’s idealistic concept of science as based on metaphysics (e.g., pre-Galilean mathematics) was in a way oblivious of the scientific revolution that was taking place in the 1930s. The idea of obtaining the certainty of a final theory was waning, all the more rapidly with the advances in quantum mechanics. And yet the idea persisted in the scientific milieu to this day. Here are several examples:

a) (Nobel laureate in Physics) Steven Weinberg’s Dreams of a Final Theory.

b1) Stephen Wolfram postulates computation to be the bedrock of everything; hypergraphs could describe the entirety of the universe, combining rudimentary computations into explanations. Hence, consciousness is no more than a computation.

b2) Roger Penrose argues explicitly against such interpreting of the consciousness and believes it to be a quantum process. His thesis nevertheless aims toward finality, searching for the conjoinable atoms of consciousness. 

For example, both the composer who illustrates a landscape with his musical piece and a pointillist aspire to depict nature with an utmost accuracy. Merleau-Ponty stressed the indispensability of reflection if one is to possess the abstract attitude. Still, in the search for the overarching form we should not obliviate the concrete matter. For example, both the composer who illustrates a landscape with his musical piece and a pointillist aspire to depict nature with an utmost accuracy. Goldstein’s work is thrivingly full of interesting existential topics, and we might be the biologists who try to understand a forest by inspecting its root biomass, not once taking a peek at its canopy. Yet we are trying to avoid the opposite extreme, as exemplified by Daniel Kahneman’s usage of homunculi as a metaphor for the cognition without explaining why he chooses to do so. One’s lifework might never outgrow the Heideggerian falling mode of existence. It is the philosophers’ task to address the origin of our attitudes.

IV) With regard to Goldstein’s remark on Being on p. 47: “As we shall see, the normal organism is characterized as a “Being” in a temporal succession of definite form. For the realization of this “Being”, the existence, the “mere being alive,” plays, of course, a prominent but by no means the essential role,” we mentioned Goethe’s notion of it. He suggested that there is no strict distinction between a Being’s essence and its manifestation as a phenomenon; instead, they are interconnected in the sphere of immediacy, the Being therefore being a circularity.

V) Goldstein’s description of his patients’ tendency to avoid emptiness bears a strong existential tone; it could be valuable when discussing the implications for the cultural aspect of humanity, e.g., horror vacui in visual art.

Questions to consider:

a) Rather than providing a definition of a totality of an organism, Goldstein deems an organism to be healthy if it is able to actualize itself. Is normality therefore a tendency toward self-actualization – namely, toward being the best version of oneself – or is it an average?

b) A researcher’s methodology is influenced by, or rather, it is rooted in their theoretical and metaphysical background. Given that the explanations seem to be an outcome of theoretical presuppositions, what does that tell us about the scientific research? Is it a “self-fulfilling prophecy”? 

c) In his methodological postulates, Goldstein highlights the importance of a good description. However, what does it mean to describe? 

c.1) What criteria for differentiation does one employ when describing a certain phenomenon?

c.2) How does one know if the chosen criteria are suitable for describing this exact phenomenon?

c.3) Is it possible to speak of a correct description of a certain phenomenon?
→In our discussion about Ch. III & IV (cf. section IIIa) we furthered this topic, formulating a possible answer regarding the desciption of living beings.

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