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SOCIAL COGNITION AND THE FRONTAL LOBES: AMAZING WHAT PATIENTS CAN TEACH
YOU IF YOU JUST LISTEN, OBSERVE, THINK AND MEASURE
Donald T. Stuss, PhD, C. Psych., ABPP-CN
President and Scientific Director, Ontario Brain Institute, , Senior Scientist, Rotman
Research Institute at Baycrest, University Professor University of Toronto, Psychology
and Medicine (Neurology, Rehabilitation Sciences), Associate Scientist, Discipline of
Imaging in the Program of Neuroscience, Sunnybrook Health Sciences Centre
Toronto, Ontario, Canada

Following the theme of "Back to the Future", this presentation is a personal history of
how studying patients – without the benefit of fMRI – provided landmarks on a journey
in understanding personality changes, social behaviour, and levels of self- and otherawareness.
Early lessons were learned from research and observation in patients who
had undergone frontal lobotomies 25 years earlier. Discovery of a patient with an
"atypical" psychiatric disorder labelled the Capgras Syndrome led to the hypothesis of a
neurological base for this disorder. Continued re-view emphasized the multideterminant
nature of social behaviour, and led to the evolution of a hierarchical model
of awareness. The second phase of research also was focused in patients on the
assumption that lesion research is foundational for determining the necessary relations
between brain and behaviour. This phase can be characterized by two goals:
refinement of the processes underlying social cognition; relating these processes more
directly to distinct brain regions. This research was conducted in patients with focal
frontal lesions, and in general can be seen as based on the early studies: reaction to
humorous stimuli and social situations; theory of mind; and the understanding of risktaking
and impulsivity. The learning objectives of this session are: 1) to identify several
determinants underlying the expression of social behaviour, based on refinement of
operational definitions of behavior; 2) to cite anatomic structures involved in different
processes related to social cognition, and their interactions; and 3) to describe a
hierarchical model of awareness, and the relationship of the model to different
expressions of disturbed awareness, as well as to psychiatric disorders.