Originally published under the title Defending the
Cavewoman, this book by the late Dr. Harold Klawans uses case studies in
clinical neurology as the basis for the author’s speculations on complex issues
in evolutionary psychology, such as how language evolved, why the hominid brain
increased in size and complexity, and the effects of technology on survival and
adaptation.

Each chapter of this very readable
book revolves around a case study taken directly from the clinical experience
of the author, and follows a progression from meeting the patient, through the
interview and examination, to diagnosis. This includes a detailed description
of the author’s thought processes throughout, with all of the background
information upon which he drew to come to his conclusions. The final section of
each chapter consists of the author’s thoughts about the case, how the case
exemplifies general facts about the structure of the body and the brain, and
elucidates issues in human evolution.

I found the descriptions of the
clinical cases to be the most interesting parts of the book, but this is also
the area where I have the least expertise. I suspect that even an experienced
neurologist or neuropsychologist would find these cases interesting because
they recount patients with rare disorders, or common disorders with unusual
(even bizarre) stories behind them. For example, Klawans consulted on the case
of “Lacey”, a girl discovered at approximately six-years old, locked in the
closet of a building that was about to be demolished. She had presumably spent
her life locked in this closet, being fed and interacted with only minimally.
As a consequence, Lacey was malnourished and did not speak when she was first
discovered, but during her subsequent hospitalization she quickly improved,
picking up basic phrases from other people and from television. Such “wild
child” cases are thankfully rare, and the few highly publicized cases (The
Wild Child of Aveyron, “Genie”) are considered natural experiments that
inform the nature/nurture debate and the existence of critical periods for
learning. Cases such as these are both extraordinary and instructive, shedding
light on biological mechanisms and human nature.

While it is legitimate to use these
cases to teach people about basic concepts in behavioral neuroscience, the
background information is usually too detailed and not explicitly linked to the
case at hand. It comes across as if the author pasted textbook-like sections
into each chapter in order to demonstrate his own knowledge, more than to help
the reader (displays of knowledge on issues scientific and cultural are
characteristic of the prose). For example, in chapter ten, which recounts the
transmission of Huntington’s disease through a particular family, Klawans
devotes five pages to a lesson on basic genetics, including everything from how
sexual reproduction works to how proteins get produced from the RNA, derived
from DNA etc. In reality, one could understand and appreciate the story with
just a paragraph’s worth of information on how Huntington’s disease occurs
through abnormal replication of a segment of DNA, and how the number of these
replications affects the patient’s presentation and age of onset.

The evolutionary speculations can
be interesting and fulfilling as long as you approach the book as the
entertaining science diary of an intelligent, well-read man who thinks about
big questions. Unfortunately, like the popular science-fiction writer Kurt
Vonnegut Jr. (who is invoked throughout Strange Behavior), Klawans does
not distinguish between medical fact and pure speculation, putting the onus on
the reader to know which is which. Many books written by academics for the
lay-person have this quality, in part because the raison d’être of such
books is to allow the author to publish relatively unfounded beliefs that may
turn out to be prescient, but are nevertheless discouraged in peer-reviewed
journals. So, maybe you can blame the author only to the extent that you can
blame publishers and editors for allowing such material to pass as nonfiction,
or to the extent that you believe readers are not responsible for making these
distinctions for themselves.

This is a book worth reading. I
qualify this enthusiasm with two pieces of advice: 1) Do not get bogged down
with the scientific background information; ultimately you don’t need it to
appreciate the story and 2) do not be too seduced by the evolutionary theories
at the end of each chapter; ultimately they are musings, rather than tested,
challenged, or supported hypotheses. 
Klawans’ long, distinguished career obviously exposed him to a wide
variety of interesting and instructive cases, yielding a thought-provoking book
that demonstrates how medical diagnosis is an art as much as it is a science.

©
2002 Stephanie D. Preston

Stephanie D. Preston,
Ph.D., University of Iowa Hospitals and Clinics