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.