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September 1985

Personality Disorder-Reply

Author Affiliations

Charles A. Dana Research Institute Behavioral Neurology Section Bullard and Denny-Brown Laboratories Beth Israel Hospital 330 Brookline Ave Boston, MA 02215

Arch Neurol. 1985;42(9):840. doi:10.1001/archneur.1985.04060080018008

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Dr Horton's letter does not lend itself to a simple reply. While it gives apparent support to the concept of a right-hemisphere learning disability, some of the associated reasoning raises questions we would like to address.

The experience gained in the past has shown that cerebral localization is effective only when the level of behavioral abstraction is commensurate with the level of anatomic analysis. Thus, the neural substrates for speech comprehension, visuospatial analysis, and even memory can be localized with relative consistency. On the other hand, more global faculties such as generosity, prudence, or ennui do not easily lend themselves to brain-behavior correlations. Transitional relatedness probably belongs to this second group of behaviors, and the rubric of personality disorders, although of considerable heuristic value for clinical psychiatry, is unlikely to conform to specific cerebral localization. For example, while "personality" can be altered by parietal lobe lesions, it is also influenced

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