If You Are the Big, Big Tree;
We Are the Small Axe


In 2006 I undertook a neuropsychology placement during my Clinical Psychology Doctoral training course. It was in a community brain injury service. I had the fortunate experience of undertaking not only neuropsychological assessments, but also therapeutic interventions and service projects. My eyes were opened in a very positive way. Things suddenly made sense; psychology, interactions, life, all became much clearer. I now understood that we are all unique, not only because of our experiences and views on life, but because of our neurocircuitry. I began to see how our unique cognitive profiles make us who we are.

I used to work in sportswear retail, and much of my earnings came from the commission on sales. The trick in any sales setting is to quickly find out what the customer wants, and match what you are selling, to their needs. This meant a lot of people-watching, as folk were in the store. It became easy to see who was in the shop to spend, and who was just browsing. I got good at being able to tell things, like what size shoe a person wore, and whether they were for a person who was into competitive sports, or one who just liked wearing sports clothes. Quick instinctive tips like this all made for better sales. People like a sales person who knows their needs, without having to spell them out.

As I got more into neuropsychology, I began to apply the same skills. I essentially began instinctively assessing people’s cognitive profile. For example, I’ve never been neuropsychologically tested myself, but I’d be fairly confident in saying that I have strengths in verbal/auditory memory, but pretty low processing speed and executive functioning. It’s surprising how accurately one can appraise cognitive functioning through interaction, even before conducting any formal standardised assessment.

As the style of this blog probably indicates, I’m also into narrative. By this, I don’t just mean I like a good story (which I do), but also that I am drawn to narrative therapy, narrative research, and narrative philosophies. I am particularly interested in non-structuralist writing such as Foucault, Derrida, and Deleuze. For me narrative and neuropsychology fit perfectly together. As Roberts said:

“Science and narrative, the quantitative and qualitative, are not competitors but represent a complementary duality, as intimately connected as the two sides of the cerebral cortex.” (Roberts, 2000, p.440)

Neuroscience has made huge strides in the last 20 years. We have seen great advances in neurorehabilitation, the development of useful outcome measures, and increases in knowledge about things like neuroplasticity and mirror neurons. Perhaps most influential has been the development of neuroimaging. It is remarkable to think that fMRI scanning only came into prominence in the 1990’s. Now, we are seeing neuroimaging research really hitting the mainstream.

However, therein lies the rub. I see a great problem in using such new techniques, about which we know very little, and applying them on a large scale. In recent months I have seen published research showing neuro profiles of mood disorders and schizophrenia, to name just two. This worries me. We are in danger of trying to neurofy every human experience, every response, every behaviour. I am concerned that neuropsychology may become the new psychiatry.

A little while ago, I heard a very insightful point made by a member of the public at a conference. He said that it seems as though psychiatry has spent years desperately searching for biomarkers and psychology has been desperately hoping they don’t find them! Neuropsycholgy is in severe danger of taking up the baton from psychiatry in its desperate search to neuroprofile ‘disorders’

I am a UK-based psychologist, and I used to look on with excitement when I heard about investment in neuroscience. I was recently caught by a BBC headline reporting £8,000 000 being spent on a new scanner at a leading UK neurosciences centre. That was until I read a claim further down the report that work such as this presents “the prospect of genuine breakthroughs across a range of previously intractable neurological disorders, and are promising fresh insights into psychological conditions like schizophrenia and autism”. One professor concluded that we are now in “a golden age of discovery fuelled by a combination of all the new knowledge coming from genetics, and the dramatic improvements in imaging technology”. The implication is clear; if we look at the brains of people with ‘mental disorders’, we will find out what the problem is and cure it. In fact another prominent professional was quoted in the same report as saying “Fundamentally it shows that bipolar disorder, and in fact all mental illnesses, are brain disorders of a biological nature that warrant proper investigation including scanning”.

Thankfully, the BBC held its impartial status by also reporting the other side of this coin (in brief), via a quote from another psychologist, Professor Rachel Bliss, who said “That does nothing to help the patient address the issues or problems they might be facing and come to terms with them in their life.”

My own view is a cautious one. We must be careful not to keep on digging away on this hypothesis that all mental health difficulties have a root cause in biology. I am reminded of the great Bob Marley track ‘Small Axe’ and it’s biblical lyrics “whosoever diggeth a pit shall fall in it”. I don’t want to see the profession I love self-destruct, and fall into the pit of over-simplifying complex human experience.

In future blogs, I hope to further unpick the application of neuropsychology to life, both the positive and negative elements.


BBC (2012) http://www.bbc.co.uk/news/health-19367832

Roberts, G.A. (2000). Narrative and severe mental illness: what place do stories have in an evidence-based world? Advances in Psychiatric Treatment, 6, 432-41.


  1. The Rise of Neuro B.S.

    An intellectual pestilence is upon us.

    Shop shelves groan with books purporting to explain, through snazzy brain-imaging studies, not only how thoughts and emotions function, but how politics and religion work, and what the correct answers are to age-old philosophical controversies. The dazzling real achievements of brain research are routinely pressed into service for questions they were never designed to answer. This is the plague of neuroscientism – aka neurobabble, neurobollocks, or neurotrash – and it’s everywhere.

    In my book-strewn lodgings, one literally trips over volumes promising that “the deepest mysteries of what makes us who we are are gradually being unravelled” by neuroscience and cognitive psychology. (Even practising scientists sometimes make such grandiose claims for a general audience, perhaps urged on by their editors: that quotation is from the psychologist Elaine Fox’s interesting book on “the new science of optimism”, Rainy Brain, Sunny Brain, published this summer.) In general, the “neural” explanation has become a gold standard of non-fiction exegesis, adding its own brand of computer-assisted lab-coat bling to a whole new industry of intellectual quackery that affects to elucidate even complex sociocultural phenomena. Chris Mooney’s The Republican Brain: the Science of Why They Deny Science – and Reality disavows “reductionism” yet encourages readers to treat people with whom they disagree more as pathological specimens of brain biology than as rational interlocutors.

    The New Atheist polemicist Sam Harris, in The Moral Landscape, interprets brain and other research as showing that there are objective moral truths, enthusiastically inferring – almost as though this were the point all along – that science proves “conservative Islam” is bad.

    Happily, a new branch of the neuroscienceexplains everything genre may be created at any time by the simple expedient of adding the prefix “neuro” to whatever you are talking about. Thus, “neuroeconomics” is the latest in a long line of rhetorical attempts to sell the dismal science as a hard one; “molecular gastronomy” has now been trumped in the scientised gluttony stakes by “neurogastronomy”; students of Republican and Democratic brains are doing “neuropolitics”; literature academics practise “neurocriticism”. There is “neurotheology”, “neuromagic” (according to Sleights of Mind, an amusing book about how conjurors exploit perceptual bias) and even “neuromarketing”. Hoping it’s not too late to jump on the bandwagon, I have decided to announce that I, too, am skilled in the newly minted fields of neuroprocrastination and neuroflâneurship.

    Illumination is promised on a personal as well as a political level by the junk enlightenment of the popular brain industry. How can I become more creative? How can I make better decisions? How can I be happier? Or thinner? Never fear: brain research has the answers. It is self-help armoured in hard science. Life advice is the hook for nearly all such books. (Some cram the hard sell right into the title – such as John B Arden’s Rewire Your Brain: Think Your Way to a Better Life.) Quite consistently, heir recommendations boil down to a kind of neo- Stoicism, drizzled with brain-juice. In a selfcongratulatory egalitarian age, you can no longer tell people to improve themselves morally. So self-improvement is couched in instrumental, scientifically approved terms.

    The idea that a neurological explanation could exhaust the meaning of experience was already being mocked as “medical materialism” by the psychologist William James a century ago. And today’s ubiquitous rhetorical confidence about how the brain works papers over a still-enormous scientific uncertainty. Paul Fletcher, professor of health neuroscience at the University of Cambridge, says that he gets “exasperated” by much popular coverage of neuroimaging research, which assumes that “activity in a brain region is the answer to some profound question about psychological processes. This is very hard to justify given how little we currently know about what different regions of the brain actually do.” Too often, he tells me in an email correspondence, a popular writer will “opt for some sort of neuro-flapdoodle in which a highly simplistic and questionable point is accompanied by a suitably grand-sounding neural term and thus acquires a weightiness that it really doesn’t deserve. In my view, this is no different to some mountebank selling quacksalve by talking about the physics of water molecules’ memories, or a beautician talking about action liposomes.”

    Shades of grey
    The human brain, it is said, is the most complex object in the known universe. That a part of it “lights up” on an fMRI scan does not mean the rest is inactive; nor is it obvious what any such lighting-up indicates; nor is it straightforward to infer general lessons about life from experiments conducted under highly artificial conditions. Nor do we have the faintest clue about the biggest mystery of all – how does a lump of wet grey matter produce the conscious experience you are having right now, reading this paragraph? How come the brain gives rise to the mind? No one knows.

    So, instead, here is a recipe for writing a hit popular brain book. You start each chapter with a pat anecdote about an individual’s professional or entrepreneurial success, or narrow escape from peril. You then mine the neuroscientific research for an apparently relevant specific result and narrate the experiment, perhaps interviewing the scientist involved and describing his hair. You then climax in a fit of premature extrapolation, inferring from the scientific result a calming bromide about what it is to function optimally as a modern human being. Voilà, a laboratory-sanctioned Big Idea in digestible narrative form. This is what the psychologist Christopher Chabris has named the “story-study-lesson” model, perhaps first perfected by one Malcolm Gladwell. A series of these threesomes may be packaged into a book, and then resold again and again as a stand-up act on the wonderfully lucrative corporate lecture circuit.

    Such is the rigid formula of Imagine: How Creativity Works, published in March this year by the American writer Jonah Lehrer. The book is a shatteringly glib mishmash of magazine yarn, bizarrely incompetent literary criticism, inspiring business stories about mops and dolls and zany overinterpretation of research findings in neuroscience and psychology. Lehrer responded to my hostile review of the book by claiming that I thought the science he was writing about was “useless”, but such garbage needs to be denounced precisely in defence of the achievements of science. (In a sense, as Paul Fletcher points out, such books are “anti science, given that science is supposed to be our protection against believing whatever we find most convenient, comforting or compelling”.) More recently, Lehrer admitted fabricating quotes by Bob Dylan in Imagine, which was hastily withdrawn from sale, and he resigned from his post at the New Yorker. To invent things supposedly said by the most obsessively studied popular artist of our age is a surprising gambit. Perhaps Lehrer misunderstood his own advice about creativity.

    Mastering one’s own brain is also the key to survival in a dog-eat-dog corporate world, as promised by the cognitive scientist Art Markman’s Smart Thinking: How to Think Big, Innovate and Outperform Your Rivals. Meanwhile, the field (or cult) of “neurolinguistic programming” (NLP) sells techniques not only of self-overcoming but of domination over others. (According to a recent NLP handbook, you can “create virtually any and all states” in other people by using “embedded commands”.) The employee using such arcane neurowisdom will get promoted over the heads of his colleagues; the executive will discover expert-sanctioned ways to render his underlings more docile and productive, harnessing “creativity” for profit.

    Waterstones now even has a display section labelled “Smart Thinking”, stocked with pop brain tracts. The true function of such books, of course, is to free readers from the responsibility of thinking for themselves. This is made eerily explicit in the psychologist Jonathan Haidt’s The Righteous Mind, published last March, which claims to show that “moral knowledge” is best obtained through “intuition” (arising from unconscious brain processing) rather than by explicit reasoning. “Anyone who values truth should stop worshipping reason,” Haidt enthuses, in a perverse manifesto for autolobotomy. I made an Olympian effort to take his advice seriously, and found myself rejecting the reasoning of his entire book.

    Modern neuro-self-help pictures the brain as a kind of recalcitrant Windows PC. You know there is obscure stuff going on under the hood, so you tinker delicately with what you can see to try to coax it into working the way you want. In an earlier age, thinkers pictured the brain as a marvellously subtle clockwork mechanism, that being the cutting-edge high technology of the day. Our own brain-as-computer metaphor has been around for decades: there is the “hardware”, made up of different physical parts (the brain), and the “software”, processing routines that use different neuronal “circuits”. Updating things a bit for the kids, the evolutionary psychologist Robert Kurzban, in Why Everyone (Else) Is a Hypocrite, explains that the brain is like an iPhone running a bunch of different apps.

    Such metaphors are apt to a degree, as long as you remember to get them the right way round. (Gladwell, in Blink – whose motivational selfhelp slogan is that “we can control rapid cognition” – burblingly describes the fusiform gyrus as “an incredibly sophisticated piece of brain software”, though the fusiform gyrus is a physical area of the brain, and so analogous to “hardware” not “software”.) But these writers tend to reach for just one functional story about a brain subsystem – the story that fits with their Big Idea – while ignoring other roles the same system might play. This can lead to a comical inconsistency across different books, and even within the oeuvre of a single author.

    Is dopamine “the molecule of intuition”, as Jonah Lehrer risibly suggested in The Decisive Moment (2009), or is it the basis of “the neural highway that’s responsible for generating the pleasurable emotions”, as he wrote in Imagine? (Meanwhile, Susan Cain’s Quiet: the Power of Introverts in a World That Can’t Stop Talking calls dopamine the “reward chemical” and postulates that extroverts are more responsive to it.) Other recurring stars of the pop literature are the hormone oxytocin (the “love chemical”) and mirror neurons, which allegedly explain empathy. Jonathan Haidt tells the weirdly unexplanatory micro-story that, in one experiment, “The subjects used their mirror neurons, empathised, and felt the other’s pain.” If I tell you to use your mirror neurons, do you know what to do? Alternatively, can you do as Lehrer advises and “listen to” your prefrontal cortex? Self-help can be a tricky business.

    Distortion of what and how much we know is bound to occur, Paul Fletcher points out, if the literature is cherry-picked.

    “Having outlined your theory,” he says, “you can then cite a finding from a neuroimaging study identifying, for example, activity in a brain region such as the insula . . . You then select from among the many theories of insula function, choosing the one that best fits with your overall hypothesis, but neglecting to mention that nobody really knows what the insula does or that there are many ideas about its possible function.”

    But the great movie-monster of nearly all the pop brain literature is another region: the amygdala. It is routinely described as the “ancient” or “primitive” brain, scarily atavistic. There is strong evidence for the amygdala’s role in fear, but then fear is one of the most heavily studied emotions; popularisers downplay or ignore the amygdala’s associations with the cuddlier emotions and memory. The implicit picture is of our uneasy coexistence with a beast inside the head, which needs to be controlled if we are to be happy, or at least liberal. (In The Republican Brain, Mooney suggests that “conservatives and authoritarians” might be the nasty way they are because they have a “more active amygdala”.) René Descartes located the soul in the pineal gland; the moral of modern pop neuroscience is that original sin is physical – a bestial, demonic proto-brain lurking at the heart of darkness within our own skulls. It’s an angry ghost in the machine.

    Indeed, despite their technical paraphernalia of neurotransmitters and anterior temporal gyruses, modern pop brain books are offering a spiritual topography. Such is the seductive appeal of fMRI brain scans, their splashes of red, yellow and green lighting up what looks like a black intracranial vacuum. In mass culture, the fMRI scan (usually merged from several individuals) has become a secular icon, the converse of a Hubble Space Telescope image. The latter shows us awe-inspiring vistas of distant nebulae, as though painstakingly airbrushed by a sci-fi book-jacket artist; the former peers the other way, into psychedelic inner space. And the pictures, like religious icons, inspire uncritical devotion: a 2008 study, Fletcher notes, showed that “people – even neuroscience undergrads – are more likely to believe a brain scan than a bar graph”.

    In The Invisible Gorilla, Christopher Chabris and his collaborator Daniel Simons advise readers to be wary of such “brain porn”, but popular magazines, science websites and books are frenzied consumers and hypers of these scans. “This is your brain on music”, announces a caption to a set of fMRI images, and we are invited to conclude that we now understand more about the experience of listening to music. The “This is your brain on” meme, it seems, is indefinitely extensible: Google results offer “This is your brain on poker”, “This is your brain on metaphor”, “This is your brain on diet soda”, “This is your brain on God” and so on, ad nauseam. I hereby volunteer to submit to a functional magnetic-resonance imaging scan while reading a stack of pop neuroscience volumes, for an illuminating series of pictures entitled This Is Your Brain on Stupid Books About Your Brain.

    None of the foregoing should be taken to imply that fMRI and other brain-investigation techniques are useless: there is beautiful and amazing science in how they work and what well-designed experiments can teach us. “One of my favourites,” Fletcher says, “is the observation that one can take measures of brain activity (either using fMRI or EEG) while someone is learning . . . a list of words, and that activity can actually predict whether particular words will be remembered when the person is tested later (even the next day). This to me demonstrates something important – that observing activity in the brain can tell us something about how somebody is processing stimuli in ways that the person themselves is unable to report. With measures like that, we can begin to see how valuable it is to measure brain activity – it is giving us information that would otherwise be hidden from us.”

    In this light, one might humbly venture a preliminary diagnosis of the pop brain hacks’ chronic intellectual error. It is that they misleadingly assume we always know how to interpret such “hidden” information, and that it is always more reliably meaningful than what lies in plain view. The hucksters of neuroscientism are the conspiracy theorists of the human animal, the 9/11 Truthers of the life of the mind.

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    • The question is not just, “How does the brain give rise to consciousness,” but also, “DOES the brain actually give rise to consciousness?” Or to put it another way – does the activity in the brain CREATE our thoughts and intentions, or do our thoughts and intentions create the activity in our brains?

      Ultimately, the unanswered question that neuroscience will never answer is the most fundamental of all: What is life? How and why are we alive, and what does it mean to be alive?

      Psychiatry’s biggest crime is to remove meaning from our experience. It all starts with the assumption that we’re just a product of our brains. If we’re instead the operators of our brains, the picture is completely changed.

      — Steve

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  2. What I have found after becoming just a bit too familiar with brain injury is this:

    1) Lots of people with brain injury get sent to mental health care because people have no idea how to handle brain injury

    2) Lots of psych treatments causes brain injury: ECT, benzos, antipsychotics and SSRIs among other stuff.

    3) Wow this is a self-reinforcing circle now, with psych patients getting brain injured and / or traumatized (which presents much the same way) then getting more psych “treatment.”

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  3. Stephen
    You say “My eyes were opened in a very positive way. Things suddenly made sense; psychology, interactions, life, all became much clearer. I now understood that we are all unique, not only because of our experiences and views on life, but because of our neurocircuitry. I began to see how our unique cognitive profiles make us who we are.”

    I would suggest the opposite may well be true of neuropsychology – uniqueness and ‘content’ are not parts of the explanatory model(s). The discipline does not allow us to say anything about individuals – except in the ironic sense of saying we all possess precisely the ‘same’ cognitive and largely the same neural architecture.
    Contrary to your argument, neuropsychology assumes the opposite of uniqueness – it assumes ‘sameness’ i.e. that every person on the planet is ‘the same’ (cognitively… if not neurally) – bar the odd ‘alien’ amongst us (pace Caramazza). Again ironically, this ‘sameness’ is precisely why the individual case study has been so popular in neuropsychology – e.g. we learned lots about short-term memory from HM, but we never learned much/anything about ‘HM’.
    I would be interested to hear how – apart from the trivially true sense – you see neuropsychology reveal uniqueness through neurocircuitry or cognitive profiles? I can see how you might arrive at these views, but not via neuropsychology…

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