Re‐thinking the brain: a frog leaps

The notion that one was, when one had completed one’s studies (first the biological sciences and then medicine itself), going to be able to understand how people thought and how they behaved, was undoubtedly one of the factors that kept me struggling on with the load of medicine. And somehow at that time the mystique of my teachers and seniors suggested that they did indeed have that knowledge. Also of course at the simplest level it was clear that the nervous system could be stimulated and that stimulation of a nerve in the frog did cause contraction of the muscle. It seemed that people knew how frogs leapt. When I asked my distinguished tutor what I should read about thinking and behaviour in the human from the neurophysiological point of view he recommended Eccles’ Neurophysiological Basis of Mind1 – a struggle. More realistically, one was being encouraged to read the works of Sherrington, and elegant they were to read but somewhat disappointing in a way. What remained in one’s mind was how reflexes structured certain fairly simple motor activities of the body, but it seemed a long way off from any real understanding neuropathologically of the processes of learning and control. How naive this was rapidly became clear when one actually started clinical work in a defined area, such as that of neurodisability in childhood, and one became conscious of the extraordinary limitations of the neurological background which would allow one to explain, understand and, most importantly, to ameliorate the difficulties one saw in children. Looking at domains of behaviour one quickly realized that the motor domain was in many ways the easiest to study because its output side was reasonably easy to measure. One noted too, when one started medical training, that the markers of disability were physical (height or facies) and less commonly neurological. Hypotonicity was the only ‘neurological marker’ in Down syndrome. There were difficulties in trying to develop other markers which extended to the individual’s behaviour and cognitive function. The demeaning label of the ‘epileptic personality’ had been discarded about the time I heard of it. This danger of stigmatization meant that people were cautious in identifying personality characteristics which were regularly occurring features of a condition. It is not perhaps surprising therefore that the field of behavioural phenotypes was initiated with the identification of the extreme behaviour in Lesch Nyhan syndrome, ascribed to one initially bio-chemically identified syndrome, with its genetic features described later. This preamble is to defend E diorial