The Syndrome

To isolate a new functional syndrome that does not have its characteristics mapped out by previous studies is a difficult and delicate process. The investigator has to be sensitive to the presence of a novel dissociation, itself a far from straightforward matter. Then a set of simpler and duller explanations in terms of syndromes that are already known have to be assessed. Only if they can be adequately rejected has a putative functional syndrome been isolated and only then can one begin to consider its theoretical implications. In this chapter, I am going to illustrate the process by considering a single syndrome – the short-term memory syndrome – from both a clinical and a theoretical perspective.

It is in clinical practice that new syndromes are detected. An unexpected result on a particular test is noticed and explored. In the present case, the unexpected result occurred on the Wechsler IQ battery. Many clinicians begin their assessment of a patient by using Wechsler subtests, not primarily to obtain an estimate of IQ but to see if any particular pattern of scores occurs across the different subtests (e.g. McFie, 1975; Lezak, 1976). In the late 1960s, Elizabeth Warrington was using this procedure to assess a patient, KF, who had sustained a severe head injury. He had a very low score on the Digit Span subtest, with performance on other subtests being relatively normal (Table 3.1) Obviously, no theoretical inferences can be made unless the deficit is reliable.