Dissociation between 'theory of mind' and executive functions in a patient with early left amygdala damage

There have been recent suggestions that the amygdala may be involved in the development or mediation of 'theory of mind'. We report a patient, B.M., with early or congenital left amygdala damage who, by adulthood, had received the psychiatric diagnoses of schizophrenia and Asperger's syndrome. We conducted a series of experimental investigations to determine B.M.'s cognitive functioning. In line with his diagnoses, B.M. was found to be severely impaired in his ability to represent mental states. Following this, we conducted a second series of studies to determine B.M.'s executive functioning. In the literature, there have been frequent claims that theory of mind is mediated by general executive functioning. B.M. showed no indication of executive function impairment, passing 16 tests assessing his ability to inhibit dominant responses, create and maintain goal-related behaviours, and temporally sequence behaviour. The findings are discussed with reference to models regarding the role of the amygdala in the development of theory of mind and the degree of dissociation between theory of mind and executive functioning. We conclude that theory of mind is not simply a function of more general executive functions, and that executive functions can develop and function on-line, independently of theory of mind. Moreover, we conclude that the amygdala may play some role in the development of the circuitry mediating theory of mind.