Soviet Psychology

ISSN: 0038-5751 (Print) (Online) Journal homepage: http://www.tandfonline.com/loi/mrpo19

Loss of Spontaneity Due to Combat Injury to the

Frontal Lobes

B. V. Zeigarnik

To cite this article: B. V. Zeigarnik (1987) Loss of Spontaneity Due to Combat Injury to the
Frontal Lobes, Soviet Psychology, 26:1, 60-71

To link to this article: http://dx.doi.org/10.2753/RPO1061-0405260160

Published online: 19 Dec 2014.

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 B. V. ZEIGARNIK

Loss of Spontaneity Due to

Combat Injury to the Frontal
Lobes
This study was carried out with patients who had received firearm
wounds to the frontal lobes of the brain during World War 11. A total of
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255 patients were examined; 105 had wounds in the left hemisphere;
85, wounds in the right hemisphere; and 65, wounds along the midline
or a bilateral, symmetric wound of the frontal lobes.
I shall not attempt here to give a classification of the disorders in
mental activity observed in patients with frontal lobe lesions. However,
I should like to demonstrate the variegated picture of these disorders
that we were able to obtain in our study.
The patients we observed included some with scarcely noticeable
changes, some with gross disorders of affective life, and some disin-
hibited patients whose intellectual capacities were still intact. In addi-
tion, we also observed patients with an apathetic syndrome, who spent
whole days in inactivity, indifferent to their surroundings.
One special group was composed of patients in whom a distinct
psychopathoid syndrome began following the frontal lobe injury. Fi-
nally, we distinguished groups with various nuances of intellectual
disorders, beginning with slight changes and ending with a group of
“frontal” dementias with an amnestic symptom cluster.
Thus, the most varied mechanisms can be used as a basis for classify-
ing disorders secondary to ‘‘frontal lobe” injuries.
However, no matter how heterogeneous the groups obtained as a
result of such a classification, and no matter how broad the range of
their disorders, one single type of change accompanied all, namely, a
personality change that was expressed in disorders in the patient’s
activity.
From N. I. Grashchenko (Ed.), Nevrologiya voennogo vremeni [Neurology of the war
years]. Moscow, 1949.

60
 LOSS OF SPONTANEITY DUE TO COMBAT INJURY 61

In this sense, my psychological rendering of the concept of spontane-

ity differs somewhat from the usual clinical rendering of this concept
since clinically one speaks of lack of spontaneity when patients show no
interest in the life around them, i.e., when their external behavior
reflects their internal inanition. . . .
I shall attempt to analyze the disorders in activity of “frontal lobe”
patients at two levels. On the one hand, I shall present an analysis of
such disorders under conditions requiring practical action. On the
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other, I shall analyze disorders in spontaneity of “frontal lobe” patients

in a situation requiring theoretical thinking.

Let me begin my description with an analysis of disorders in the

activity of “frontal” patients in an experimental situation simulating
life conditions.
We know from numerous studies that a person’s motivation deter-
mines the nature of his actions (Leont’ev, Luria, S . Ya. Rubinshtein,
Zeigarnik). Consequently, we may anticipate that a change in the moti-
vational sphere will also produce a sharp change in all of the person’s
practical activity.
To demonstrate this, let me give some experimental examples from
material I have described in much more detail elsewhere. . . .1
Description of the experiment “returning to an interrupted act. ”

The subject is asked to perform a task that should vary as a function of

his cultural level and level of intelligence (this task must be simple: to
draw, to mold clay, to make a figure out of squares in accordance with a
pattern, etc.). Before the subject finishes the task, we interrupt him
with a request to undertake another task that is different from the first
in content (the experimenter focuses the subject’s attention on the
second act by saying “Now do this,” disregarding what happens to the
first as much as possible).
The experimenter observes the behavior of the subject after he fin-
ishes the second task.
Numerous studies of normal subjects have shown that after finishing
the second task, the subject usually returns to the uncompleted one.
This return to an uncompleted activity may take the form of a direct
continuation of the act or only a tendency to return to it. . . .To under-
stand why a subject returns to an interrupted act we must try to imagine
what the experimenter’s request to perform any experimental task
 62 B. V. ZEIGARNIK

specifically means for the subject. The experimental situation will

always have a hidden meaning for the subject, e.g., it may have the
significance of an “examination” in which the subject would like to
test or check his own strength.
One thing is clear: an experimental situation that requires repeated
performance of a meaningless task becomes meaningful because of the
arousal of other motives, even mediated and indirect motives, and
other attitudes. An isolated, random assignment loses the character of
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an isolated act; it acquires the specific character of a purposeful activity

determined by a specific motive.
Despite its random nature, the assignment can serve as a means of
satisfying some specific need aroused experimentally in the given case.
Hence, when we interrupt this action, we do not interrupt its course or
its structural aspect, but intrude into the course of an act with which the
subject has developed a certain relation, a relation that has for him
become dominant for this specific, concrete moment in his life. When
we interrupt the action, we inevitably affect the need it represents. The
return to an interrupted act takes place on the strength of the patient’s
endeavor to continue the act he has begun.
Usually, “frontal lobe” patients do not return to an interrupted act.
Whereas in normal subjects the return to an interrupted act takes place
in 82% of cases, in patients with frontal lobe lesions it takes place in
barely 2 1% . . . . Consequently, we can say that a psychological situa-
tion that is similar to a life situation in its dynamic mechanisms does not
occur in frontal lobe patients.
Because of the absence of a personal relationship to the surroundings
and hence to the experimental situation, the task proposed to the patient
did not become part of his personal aims. This becomes more graphi-
cally evident in an experiment that is known in the psychological
literature as an experiment in the “level of demands”[or level of
aspiration-M.C.]. The patient does not lower the level of his demands
on himself after unsuccessful tries or try to increase it after successful
tries. He accepts any task close at hand. Situations of choice and
conflict do not arise in him. Individual tasks are not part of an entire
sequence of tasks for him. . .
Thus, the “active” behavior of a “frontal lobe” patient does not
derive from his inner motives; it does not stem from internal motives
related to deep-lying tendencies or needs, but is the response to an
external stimulus. The patient’s behavior is governed by the external
situation, which is the equivalent of a ‘‘psychological field. ”
. . .Clinical experience has also revealed another symptom of
 LOSS OF SPONTANEITY DUE TO COMBAT INJURY 63

“frontal” disorders, namely, the patient’s disinhibition. There are

frequent cases in which patients with lesions of the frontal cortex
(especially the basal sections) display considerable verbal and motor
liveliness. The “frontal” patient’s reacting to the doctor’s rounds is
extremely characteristic: despite the fact that such patients lie without
any movement at all, with no interest in what is going on around them,
they respond very rapidly to the doctor’s questions; moreover, despite
all their inactivity and lack of initiative, they often react when the
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doctor converses with a patient in the next bed.

This rapid reaction to an external stimulus is often a symptom of
disinhibition. The patients intrude into the conversations of others,
become tactless, loquacious, and importunate. Such behavior often
masks their aspontaneity; they may give the impression of being active,
but we see that their “activeness” is essentially not in response to
internal impulses or internal motivations.
The disinhibition of a “frontal lobe” patient is actually only another
manifestation of the same aspontaneity. It is caused by external factors;
hence, we may regard the patient’s behavior as “field” dependent. In
its rough expression, the “field” behavior of such a patient is in the
form of subordination to random factors, sometimes even to things.
There are frequent cases in which a patient who passes the entire day
in total inanition and does not comply with the doctor’s request to read a
part of a book may pass by the bookshelf and take the book out and
begin to read; a patient who is asked to bring a pencil may begin to
write with the pencil.
The “field” behavior of the “frontal lobe” patient does not always
take such gross forms. It often takes the form of a more subtle subordi-
nation to psychological factors, or of suggestibility. Clinical experience
includes cases in which patients who have always behaved normally
suddenly commit unexpected, unmotivated acts. Conversely, very often
patients who give the impression of being disinhibited are capable of
carrying out assignments appropriately if the external situation stimu-
lates them to do so. These two contradictory kinds of behavior are
equally possible since neither is a result of internal motives or the
patient’s fulfillment of a need, but only a response to stimuli coming
from without.

The deep personality disorder in patients with frontal lobe lesions, in

which their entire system of needs is affected, may be observed, as I
 64 B. K ZEIGARNIK

noted above, in any specific form of activity, e.g., intellectual activity.

A whole group of patients (about 85 cases) participated in our study;
at first glance, their behavior was not clinically defined as asponta-
neous. These patients were not indifferent to their surroundings, were
interested in their relatives, wrote letters to them, and read newspa-
pers. However, when placed in an experimental situation that required
intellectual effort, they displayed aspontaneity.
The pictures of changes in intellectual activity secondary to frontal
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lobe lesions are extremely varied. One common quality, however,

passes like a continuous thread through them all; this quality, which
distinguishes these patients from those with other types of organic
feeblemindedness, is the absence or minimalization of defects in “for-
mal” capacities and a predominance of disorders in the motivational
aspects of intellectual activity.
Disorders in activity and in the system of needs assume a special
form of intellectual aspontaneity specific to these patients; not even an
internal purpose determining intellectual activity is formed. This char-
acteristic is not manifested as an absence of fixation or a lack of
purposefulness; such a patient does not transform a task into a real
motive because he lacks a live mental relationship to that task.
I should like to demonstrate this point by analyzing various levels of
intellectual disorders. Let me begin with cases of mild abnormalities of
thought. For this type of disorder, a delay in responses is characteristic.
However, this delay differs from the usual slowness of patients with
organic brain disorders of nonfrontal localization. For the latter, a
slowing-down of the course of a mental act itself is characteristic; but
despite this slowing-down, once such a patient has received an assign-
ment, he immediately sets about carrying it out. The instructions are
continually present for him as a goal toward which he directs his
attention. This is evidenced by his replies, which indicate that the
patient has a relationship to the task.
But the slowness of a “frontal lobe” patient is of a totally different
kind: the patient responds more slowly not because the course of the
mental act itself is impeded, but because his thought is not sufficiently
directed toward the task. This disorder seems to be a slowing-down
from only a purely external perspective; in reality, it is not a usual
slowing-down of the mental act itself, but a delayed response of the
patients to a question or an instruction.

Let me give an example. Patient G., born in 1898, was wounded, on 13

July 1942, in the left frontal region by a mine fragment. He lost conscious-
 LOSS OF SPONTANEITY DUE T O COMBAT INJURY 65

ness-for how long, he does not know. He suffered vomiting and nose-
bleed. On 21 July, the patient, in serious condition, was brought to a field
hospital, where surgery was performed. Many bone fragments were re-
moved, and a bone defect with extrusion of brain matter was discovered.
Fragments were also removed from the deeper areas of the brain. The
frontal sinus was found to be destroyed; there were bone fragments in
it. . . .
Neurological condition: narrow pupils, reaction to light and conver-
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gence lively. Visual field normal; fundus oculi normal. Eyeball move-
ment normal. Tendon reflexes normal. Sensibility intact.
Upon admission, considerable akinesia and fatigue, especially in intel-
lectual work, were observed. The patient displayed quite good skills in
the hospital, where he worked in a carpenter’s workshop as part of
occupational therapy.
The patient behaved normally in the ward; there were no signs of a
slowed response, and he answered the physician’s usual questions quite
promptly; but when he was faced with any uncomplicated task, his re-
sponses became delayed.
The patient was given a simple arithmetic problem to solve: “You have
bought 3 boxes of 25 apples each; you gave one-third of the apples to your
friend. How many apples remain?” This task should not have caused any
difficulties for a person who had finished the fifth grade. However, our
patient was very slow to tackle the problem; he sat silently for a long time,
directing his gaze past the experimenter; then, after much prompting by
the latter, he began to tackle the simple problem:
“How many did you say? Oh yes, 25 apples. How many were in each
box? 25 , . . (pause) 75. There are 50 apples left. The patient solved the
”

problem correctly and made no logical or arithmetic mistake; however, he

took considerable time to solve this simple problem (10-12 minutes).

Only patients who because of diminished intelligence are unable to

cope with such a task require such a long time; for them the inability to
perform an arithmetic operation is responsible for their slowness, i.e.,
patients in whom intellectual operations themselves are impaired. In
this case, however, the patient’s intellectual operations were intact. He
was able to cope with a more complicated task, understood the meta-
phorical meaning of a proverb. If the conditions of an experiment
required it, he was able himself to apply conditions, but he was ex-
tremely slow in accomplishing these assignments.
The reason for this slowness was the patient’s inability to focus
his thought on the task. Because the patient had no “personal,”
i.e., his “own,” relationship to the situation, he did not concentrate
on the task and hence was unable to deal with it without pressure
from without. Outwardly this inability to handle an assignment
 66 B. V. ZEIGARhVK

promptly looked like “akinesia” of thought.

Often such akinesia assumes the specific character of speech disor-
ders that give an impression of aphasia.
Luria described similar disorders in a group of “dynamic aphasics”
in whom, although actual articulation of sounds and words was intact,
spontaneous and recurrent speech, writing, and reading were impeded
because of a delay in those dynamic switchovers that determine the
course of the speech p r o ~ e s s . ~
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One other characteristic of the mental activity of these patients

besides slowness was observed: their “short circuit” responses, which
outwardly looked like “ultrarapid” responses.

Here is an example. A patient was shown five pictures in succession

that depicted a boy being attacked by wolves on his way to school and his
being saved.
The patient, barely looking at the picture, responded: “The boy found
a tree and they took him from there.”
Experimenter: “Look more carefully. ”

Patient: “The boy is being saved from wolves.”

Thus, we see that the patient understood the theme of the pictures quite
well, but answered overhastily, scarcely examining the pictures.

In this case, the patient’s incorrect answers were not the result of
intellectual insufficiency; they stemmed from an excessively rapid re-
action, a hyperresponsiveness.
This produces a paradoxical phenomenon: on the one hand, a slowed
reaction and, on the other, hyperresponsiveness. This unique combina-
tion of two phenomena seemingly contradicting one another is a char-
acteristic feature of a “frontal lobe” patient whom I have described in
another ~ o n t e x tIn
. ~reality, the two phenomena have a common origin:
lack of motivation for the activity, lack of direction.
If a person focuses on a task, that task does not seem to be an
amorphous whole for him; the different aspects of the task appear in a
differentiated way. In assuming the task, the subject discriminates one
aspect of it and transforms the diversity of meaning of the task into its
specific meaning. But if a patient addresses a task directly, without an
appropriate correlation with an internal purpose or aim, or solely on the
basis of an external requirement, the task becomes some sort of diffuse
requirement devoid of meaning; in this case, any random, even very
unessential, element of the task may acquire a determining role. . . .
Despite the fact that a patient may retain all the intellectual oper-
 LOSS OF SPONTANEITY DUE TO COMBAT INJURY 67

ations necessary for understanding an assignment, an intellectual as-

signment as such does not coalesce, and instead the patient produces
those primitive responses and incorrect judgments that often impress
us.
Thus, we see that the slowing-down or rapid responsiveness that
paradoxically appears in the intellectual activity of a “frontal” patient
represents two aspects of the same disorder. The resulting impossibility
of education does not always take the form of slowness or short cir-
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cuits. In grosser cases it takes the form of more marked, specific,

intellectual impairments.
The thinking of these patients merely reflects what is accessible to it,
without processing this material. Some operations are still intact in
these patients, but they are unable to put them to use. Merely superfi-
cial acquaintance with a patient does not uncover aberrations in his
intellectual processes; the patient gives correct responses if only pas-
sive understanding of previously learned material is required of him;
his associations do not suffer from excessive concreteness, and they do
not involve excessive focusing on details. However, when active recall
is required, the patient is unable to cope with even the simplest task.
When a patient who was able to understand a metaphorical meaning
was asked to recount the theme of a story or to describe a picture of a
prisoner in a dungeon, he gave the following answer: “I don’t know.
Maybe it’s a servant of some sort. I don’t know.”
Experimenter: “Where is he?”
Patient: “In his apartment, maybe at the house of friends. How
should I know?”
The experimenter tried to direct the patient’s attention to the overall
mood of the picture: “Look here, is this an ordinary window?”
“This is probably a prisoner,” replied the patient, in a monotone.
When he involved himself in the task, he understood, but this under-
standing did not cause him any surprise because he previously had not
tried to understand.
The next picture presented, “Ice-skating,” showed a person who
had fallen into a hole; the people standing around express horror;
someone tries to help him. The patient described it thus: “People are
standing there looking; maybe they’re waiting for a tram.’’ The patient
not only did not note that the expression on the faces of the people in the
picture did not correspond to a situation of waiting but he did not even
note the fact that the man had fallen into a hole. He enumerated the
details of the picture without elaborating on them in any way. But the
 68 B. V: ZEIGARNIK

experimenter needed only to direct the subject’s attention to the task in

some way and the patient could give a correct description.
These thought disorders were especially easy to follow in experi-
ments in which the task required not simply assimilation but made sense
only if the material was actively processed. The experiment was intend-
ed not to resolve the problem of the intactness of intellectual oper-
ations, nor to determine whether synthetic thought was possible, but
whether the intellectual goal was stable enough to permit the possibility
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of screening out “field factors.”

If an intellectual goal is unstable, the patient is diverted from the
matter at hand. Indeed, this series of experiments very graphically
revealed the above-described dynamic disorders in the thought of
“frontal” patients.
Here are a few examples. The patient selects the corresponding
phrase of a riddle: “Don’t blame the mirror if your horns are curved.”
Although the patient understands the metaphorical meaning of this
proverb, he compares it with the sentence: “The quality of a mirror
depends on the glass, not on the frame.” The patient was diverted to
this sentence in this particular case because his attention was caught by
the word mirror, i.e., a word that figured in the proverb. This kind of
diversion is not the consequence of the patient’s attempt to establish
concrete associations, since this sentence does not contain a concrete
explanation in it; it signifies a diversion to a “provocative” word. A
random stimulus attracted his attention.
Though a patient may understand an abstract idea, he is unable to
incorporate that idea into his own reasoning; he cannot grasp it. This
inability to retain a hold on something that has been correctly under-
stood may be designated instability of the intellectual process itself.
The impossibility of sticking to a task or, in other words, the instabil-
ity of a goal is a special manifestation of the aspontaneity characteristic
of intellectual activity, or the mold that forms the aspontaneity of
intellectual activity. I have dealt with this form of aspontaneity in some
detail since I consider it a very sensitive indicator of the personality
disorder of a “frontal” patient. Our observations have indicated that
patients who clinically displayed no notable signs of aspontaneity none-
theless did do so when they had to solve intellectual problems. We did
not find the usual comments in the patients’ diaries to the effect that
they were not interested in the life of the ward; they wrote letters home,
were interested in the fate of others. But as soon as they were given any
 LOSS OF SPONTANEITY DUE TO COMBAT INJURY 69

kind of intellectual task, they displayed the above-described form of

aspontaneity.
This finding compels us to rethink the problem: Why was asponta-
neity more in evidence in intellectual activity than in the clinical picture
in a number of patients?
A practical task has a higher degree of reality, a greater degree of
stability and rigidity than an intellectual task. Even though the patient,
because of the absence of an inner orientation, does not develop a need
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to carry out the assignment, the practical situation gives him the possi-
bility of manipulating concrete aspects of the real situation. Even if a
patient departs from the real situation because of random factors, his
activity will still have some objective structure, and this is what gives
visibility to his action.
The situation is different with regard to intellectual activity. The
semantic “field” of intellectual activity does not have the level of stark
reality that is present in a practical situation; some “motivating”
aspects that catch the subject’s attention are in themselves extremely
dynamic; their meaning is nothing rigorously formulated, and the sub-
ject’s subordination to these aspects therefore does not, even externally,
assume the form of an action. The external and internal aspects of
intellectual activity are inseparable from one another; hence, the possi-
bility of a visible external act, such as manipulating things when there is
no internal orientation for doing so, cannot take place in intellectual
activity. Only one type of action is possible in intellectual activity, and
that corresponds precisely to this internal orientation.
In a “practical” situation, the external aspect of a goal has, as it
were, its own objective significance. This “external” significance
disappears in intellectual activity if it is not stably linked to an internal
significance.
In the case of a frontal lobe lesion, this instability of a task can reach
such a degree that we can classify it as feeblemindedness of a particular
structure.
I should like to distinguish two types of “frontal lobe” feeblemind-
edness.
The first type is when aspontaneity of intellectual activity reaches its
apogee: the absence of a goal is carried to such a degree that instead of
an intellectual act, we obtain only a response to a stimulus. For exam-
ple, the patient describes a picture portraying a traffic accident: “Here
is the car, and here is an X drawn . . . here are many people, here is a
 70 ! ZEIGARNIK
B. I

woman, here is a woman with an umbrella, here is a woman with a

basket, and near her is a child.”
Experimenter: “And what is it?”
Patient: “A children’s home or a nursery. The mothers are accompa-
nying them.”
The patient is capable only of giving a description of individual
aspects; he enumerates individual objects portrayed in the picture.
The patient’s thought is unable to produce or delimit a thought; he
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gives the first explanation that comes into his head, and that is deter-
mined only by an external factor, i.e., a “gathering of children.”
It is clear that a gathering of children could also designate a “chil-
dren’s home,” a “nursery,” or something quite different. However, in
this particular case, the gathering was not the most conspicuous for us
because the content of the picture was not determined by the depiction
of a crowd of people, but by something quite different: the red cross on
the doors of the car, and the nurse carrying the child. But in the case of
our patient, most significant was the fact that the picture itself was in
the forefront of his thought: instead of interpreting it, he just described
it.
The second type of disorder is one in which aspontaneity of thought
assumes the character of nonsensical constructions.
Patient B. explains the proverb “Forge the iron while it is hot” as
follows: A group of people who lived in the same house at the sparsely
populated edge of the city once found out one morning that the gate had
been left open all night. So one could say: “One should do what has to
be done before it’s too late, and never put things off. , .” From this
illustration it is evident that the patient did not suffer from merely a
simple disorder in intellectual activity or an insufficient capacity to
interpret events: he invented nonsensical formulations. This propensity
to “think up” foolish statements and the facile production of judgments
similar to confabulation may be explained as follows.
The aspontaneity of a “frontal lobe” patient goes so far that even
stimuli themselves operate for an extremely brief time; the patients’
responses to stimuli are fluid and fleeting. But an experimental situa-
tion is such that it requires a definite response; the patient, devoid of
spontaneity, responds with any word and any judgment in a “short
circuit’’ manner.
Thus, we see that study of different types of disorders in the intellec-
tual activity of “frontal lobe” patients, from mild symptoms of
akinesia to cases of profound feeblemindedness, disclose one and the
 LOSS OF SPONTANEITY DUE TO COMBAT INJURY 71

same disorder, namely, the impossibility of forming an internal goal or

target. This disorder assumes various forms that outwardly might seem
to contradict one another: on the one hand, akinesia, and on the other, a
‘‘subordination” to field vectors.
These disorders are essentially equivalent to what we were able to
determine in analyzing a practical situation: they are rooted in person-
ality changes, expressed in a breakdown in the structure of the system
of hierarchically arranged, differentiated, human values. These
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changes, which show up in a lack of a stable relation to the surrounding

reality and to one’s own ego, should be diagnosed as disorders of
consciousness.
However, a gross form of these changes (often occurring in the form
of an amnestic symptom cluster), which shows up in aspontaneity, the
disintegration of activity, etc., is rarely encountered in neurological
examinations (it is more often found in psychiatric examinations). For
this type of gross disintegration of activity to occur, a circumscribed
brain injury is not sufficient; the injury must be accompanied by an
inflammatory process (abscess or meningoencephalitis), which causes
dynamic general brain disorders.

Notes
1. [Experimental psychological data on frontal lobe lesions]. In [Collection of
proceedings of a meeting of the Central Institute of Psychiat~y].Moscow, 1948.
2 . This phenomenon cannot be explained by brain injury in general since, in cases
of damage to other parts of the brain (temporal, parietal), return to an interrupted act
occurs in 66%.
3. On this point, see A. R. Luria, [Traumatic aphasia]. Moscow, 1948. Chapter
IV.
4. B. V. Zeigarnik, [Experimental psychological data on frontal lobe lesions]. [See
note 1.1