Cross-Cultural Neuropsychology in Historical Perspective: Origins, Echoes, Challenges, and Future Directions

Clinical neuropsychology is cross-cultural “when there are significant cultural or language differences between the examiner, examinee, informants, tests, and/or social context” (Judd et al., 2009, p. 128). Clinical neuropsychology, therefore, has been cross-cultural from the earliest examples of cognitive and mental (IQ) testing in the early 20th century, with the translation of the Binet scales from French to English by the American psychologist H. H. Goddard and the administration of the translated battery (by non-Hispanic White psychologists, via oral interpreter) to European immigrants arriving at Ellis Island. This chapter reviews that remote history; the earliest cultural neuropsychological research by A. R. Luria and colleagues in Uzbekistan, Central Asia, in the 1930s; and the more recent decades of “modern” cross-cultural neuropsychological research and practice, from the 1990s to 2018. Unfortunately, the field has most commonly downplayed or ignored the influences of culture and language on neurocognitive testing and clinical neuropsychological assessment in favor of a quantifiable, empiricist, and “universalist” view of brain-behavior relationships. This, in turn, has been problematic for the clinical assessment of rapidly increasing populations of ethnoculturally and linguistically diverse patients. A serious paucity remains of clinical neuropsychologists who are ethnoculturally and linguistically diverse and/or who possess the cross-cultural psychometric knowledge and linguistic fluency to evaluate such patients. Although there are reasons for optimism based in recent decades of research and clinical progress, the extent to which this health care specialty will remain viable and useful to increasingly large portions of US and world populations is uncertain.

Early Evolution and Forgotten Founders of Clinical Neuropsychology

The history of clinical neuropsychology and development of the profession into its present form depended on several lines of inquiry about human behavior, illness, and brain function. Clinical neuropsychology required apparatus to measure cognitive functions, group research to objectively measure and catalogue those functions across the normative spectrum, more sophisticated neurodiagnostic nosology, and an approach that integrated behavioral, psychological, medical, and statistical expertise. Many scientists and practitioners since the late 1880s participated and contributed to this endeavor. This chapter describes how several “forgotten” and better-remembered founders of neuropsychology were able to advance the development of this profession, and how their contributions fit into the ongoing science that became clinical neuropsychology.

History of Functional Brain Imaging

Modern functional neuroimaging techniques can be dated to the 1960s, although humans have been trying to understand the functional organization of the brain for millennia. Precursors of modern techniques were quite crude and date roughly to the 19th century. Rapid technological advances during the end of the 20th century provided researchers with tools capable of measuring hemodynamic activity within the brain, such as changes in blood flow and metabolism, and these techniques quickly became core methodological approaches in the disciplines of cognitive and clinical neuroscience. Notably, clinicians and researchers were significantly aided in their ability to examine diffuse neural networks underlying complex cognitive functions such as working memory, learning, and attention in normal subjects and patient populations. Although the clinical application of functional neuroimaging methodologies have been limited to date, research in this area is rapidly growing and empirical support exists for effective use of techniques such as fMRI and PET, for instance, in presurgical mapping and early detection of Alzheimer’s disease.

Phineas Gage: A Neuropsychological Perspective of a Historical Case Study

The case of Phineas Gage is one of the most frequently cited cases from 19th century medical literature and represents the first of a series of famous cases involving the brain and behavior. While many reiterations of Gage’s case have been published, it remains important to modern neuroscience due to its unique historical significance, ongoing clinical relevance, and the insights it offers neuropsychology into the functional effects of brain injury on thinking, emotions, and behavior. This chapter revisits the critical aspects of this landmark case from a contemporary clinical perspective and discusses the implications of injury to the prefrontal cortex and pathways.

A Quantitative Review of the History of Clinical Neuropsychology in North America: Influential People and Organizations

Objective: To quantitatively measure influence of both individuals and organizations in the field of neuropsychology, analyzing data from four organizations: The International Neuropsychological Society (INS), the National Academy of Neuropsychology (NAN), Society for Neuropsychology (SCN; APA Division 40), and the American Academy of Clinical Neuropsychology (AACN).Methods: Individuals were ranked in four domains of influence: (1) organizational leadership (e.g., number, significance of offices); (2) speaking at annual meetings (number, significance of presentations); (3) editorial board membership (number, significance of board membership) for the official journals of INS, NAN, SCN and AACN; (4) impact of publications (citation impact). The top 100 individuals were ranked for each of the four domains, extending back in time to the founding year of each organization (Puente & Marcotte, 2000; Rourke & Murji, 2000; Bush, 2011; McCartney, 2011) up through and including 2017. Rankings were transformed to a common metric. For the analysis of organizational influence (membership size, size of meeting, impact factor of each official organization journal), we analyzed data from the past 20 years through and including 2017.Results: The top 100 neuropsychologists in each of the four domains represent about 3% of persons surveyed, and often appeared in other domains. Nonetheless, factor analysis yielded two factors: (1) a factor characterizing organizational leadership, editorial board membership, and speaking at annual meetings; and (2) a factor defined solely by citation impact. Organizationally, AACN is growing most rapidly, with membership stable in INS and declining slightly in NAN and SCN. Many leading neuropsychologists belong to all four organizations.

Origins of Neuropsychology Research and Teaching at the University of Melbourne, Australia

The University of Melbourne hosts a well-known graduate training program in clinical neuropsychology, which was the first formal training program in neuropsychology established in Australia. What is less well known is that neuropsychology research has a much longer history at the University of Melbourne, beginning in the second decade of the 20th century. This chapter briefly traces the early history, which centered on collaborations between staff at the then Melbourne Teachers College and the university department of anatomy. The historical account then leaps forward half a century to describe some of the University staff and key decisions involved in establishing the graduate neuropsychology training program that continues to the current time. Again, many aspects of this more recent history, including the diversity of staff involved, are not well known. Relying on personal recollections, correspondence between staff, and minutes of faculty meetings, this account aims to pay tribute to the many staff involved in the origins of clinical neuropsychology teaching at the University of Melbourne.

History of Neuropsychology in Latin America

This chapter presents the history of neuropsychology in Latin America during five main periods. Prior to 1950, the term “neuropsychology” was rarely used. The development of this specialty in Latin America did not take place until the second half of the 20th century, centered primarily in Argentina and Uruguay. Historically, the development of neuropsychology has been slowed down by local wars, armed conflicts, and dictatorships. During the Second World War, intellectuals and scientists in neuroscience emigrated to Latin America and helped to advance the field. The period between 1970 and 1999 was mainly characterized by the evolution of neuropsychology in Colombia and Mexico and by the influence of the United States in Latin American neuropsychology. From 2000 until 2017, neuropsychology experienced a rapid growth, including establishment of graduate programs, societies, clinics/centers, Latin American scientific journals, and research publications, as well as the creation of Spanish language neuropsychological tests. As of 2018, most professionals in neuropsychology in Latin America work in private practices or universities, and their main activity is assessment and diagnosis of neurodevelopmental and neurodegenerative disorders, although they also engage in rehabilitation and teaching activities. Due to the lack of written records, there is scarce information regarding the history and current state of neuropsychology in some Latin American countries, including Belize, Haiti, and the Dominican Republic. Current barriers to the advancement of the field and future directions to improve the current situation are described.

Stimulation: History of Brain Mapping

The history of brain mapping using stimulation is long and nonlinear. It started with very imprecise stimulation of the brain using electrical discharges in the early 1800s. With better control of the electrical sources and more precise application of the stimuli, the real mapping of brain functions began in the 1870s, starting with the easily observed effects of activation of neurons in the motor cortex. Work since then has shown that the cerebral mantle is highly specialized and, more interesting, that experience and practice can cause significant alterations of the organization of neurons in the cortex and subcortical structures. New techniques to alter neuronal activity are being developed each year and will certainly increase our understanding of how the brain is organized and how it can be modified.

Historical Development of Neuropsychological Rehabilitation

Psychologists who understand the nuances of impaired cognitive abilities, especially within the context of personality and emotional factors, are uniquely qualified to provide interventions for cognitive and psychosocial difficulties following brain injury. Such interventions fall under the labels cognitive rehabilitation and neuropsychological rehabilitation. Following a brief overview of the historical precursors of neuropsychological rehabilitation, the chapter focuses upon developments in the 20th century through the present, some European, mostly German and Russian, and primarily those in the United States. The manner in which the fields of clinical neuropsychology and rehabilitation medicine provided context and complemented the development of neuropsychological rehabilitation is highlighted. Current trends and future implications are addressed, with an emphasis on the examination of individual patient characteristics and therapy factors to optimize clinical outcomes.

Erich Feuchtwanger and the Frontal Lobes: A Historical and Statistical Reanalysis

Erich Feuchtwanger’s 1923 monograph provided one of the first major descriptions of the neurobehavioral outcome of prefrontal damage. Feuchtwanger collected qualitative and quantitative data from 400 World War I veterans, 200 with penetrating wounds to prefrontal cortex, and 200 with nonfrontal damage. A data reanalysis with modern actuarial calculation showed that neurobehavioral signs associated with prefrontal caseness varied widely in prevalence and strength of association. “Witzeln” (social insensitivity) was uncommon but highly specific, while slowed processing was common but only modestly specific. Feuchtwanger’s data predate by 90 years the modern view that the prefrontal zones regulate social and emotional behaviors.