Frontal Lobes

   Among the lobes of the brain, the frontal lobes have the main responsibility for executive functions; neuropsychiatric lesions of the frontal lobes are likely to result in disinhibition, apathy, and executive deficits such as lack of persistence and perseveration (too much persistence). This kind of knowledge was built up in years of experience with head trauma: noting the deficits that a particular injury produced. (See Body Image: Disturbances of: Head [1918].) Yet, in functional psychiatric illness (depression, schizophrenia, and other major disorders without a known structural cause), the frontal lobes have a particular role as well. In 1913, in the eighth edition of his textbook, Emil Kraepelin noted that the histological findings of a number of researchers pointed to some kind of lesion in the frontal lobes (Psychiatrie, 8th ed., III [2], p. 903). Yet, the light microscopes used by that generation of investigators were unable to spot differences in the size of various brain structures in health and illness: They could only note disorder in the various cell layers of the cerebral cortex.

   With the advent of sophisticated techniques of neuroimaging in the 1970s and after, however, it became possible to detect differences in the size and function of various brain structures in schizophrenics compared to controls. At this point, investigators revived the "hypofrontality" hypothesis of schizophrenia. In 1974 in the Acta Psychiatrica Scandinavica, David H. Ingvar (1924–2000) and Göran Franzén (1929–), of the departments of clinical neurophysiology and psychiatry at Lund University, using radionuclides, noted abnormalities in blood flow in the frontal lobes of schizophrenic patients. In 1985, in a volume on localizing schizophrenia that was edited by Nancy Andreasen, Daniel Weinberger (1947–), then chief of the section on neuropsychiatry at the National Institute of Mental Health, asked "Is schizophrenia a frontal lobe disease?" and mobilized the evidence that pointed to yes. Nancy Andreasen’s own magnetic resonance imaging study, completed in 1986 and published in the Archives of General Psychiatry, added further evidence to the rapidly growing incrimination of the frontal lobes. This work on "hypofrontality" represents an interesting, if unwitting, confirmation of the ideas about the frontal lobes of the classic psychiatric tradition.