Letters
Explaining everything and nothing
OCTOBER’S article by John Read, ‘The bio-bio-bio model of madness’,
is a very necessary warning to clinical psychologists, who have
generally adopted the biospsychosocial or vulnerability-stress model
uncritically.
As I see it, the model gains its credibility from the fact that in a
weak sense, it is self-evidently true. Any human experience or
behaviour, from crossing the road to having a cup of tea, can be
described in biological, psychological and social terms, depending on
what focus you are taking. Thus, criticising the model is made to seem
nonsensical, as if one were denying the existence of bodies and brains.
But this weak sense, by explaining everything, explains nothing in
particular. It does, however, allow biomedically minded professionals
to smuggle in the ‘strong’ version of the model under the guise of
eclecticism and common sense. In the ‘strong’ version, the ‘bio’ bit –
for which of course we have no firm evidence at all in psychiatric
disorders, either from genetics or biochemistry – is assumed to be the
primary causal factor, with psychological and social factors divested
of their personal meaning and reduced to mere triggers of the
underlying ‘illness’. The result in practice is indeed the bio-bio-bio
model – or at best a kind of unhappy coalition of biological and
psychosocial perspectives, whereby people are told on the one hand that
they have a medical illness with physical causes, and on the other that
their distress is an understandable emotional response to their life
circumstances.
We do need to create integrated models that incorporate new research
into, for example, the effects of early experiences on the actual
structure of the developing brain (Gerhardt, 2004). However, this far
more sophisticated perspective implicates psychosocial factors as
primary both in aetiology and in intervention. Clinical psychologists
are better placed than most professionals to resist the superficial
plausibility of the biopsychosocial rhetoric as it is currently used.
Thank you, John, for leading the way.
Lucy Johnstone
29 Park Row
Bristol
Reference
Gerhardt, S. (2004). Why love matters: How affection shapes a baby's brain. London: Brunner-Routledge.
JOHN
Read highlighted the distorting influence of pharmaceutical companies
on popular theories of mental illness, and I was pleased to see him
championing the need to understand the role of social factors in the
development of psychopathology – something that has been woefully
under-investigated in the past.
I was less pleased to see him promote the idea that there is ‘war’
between biological and psychological approaches to understanding mental
distress. This sort of language seems both unnecessary and unhelpful.
Psychological and biological models are best considered as different
levels of explanation, with each approach describing the same
phenomenon in terms of different concepts and measurements.
Dr Read’s article reflects an attitude I have sometimes encountered,
but which never ceases to amaze me: that referring to the brain is
somehow ‘dangerous’, usually with the strong implication that it
automatically devalues the use of psychotherapy and justifies the
primacy of physical interventions.
It is clear from the literature that traditionally ‘psychological’
interventions can have detectable ‘biological’ effects (e.g. CBT can
lead to remission and detectable changes in the brain in depression:
Prasko et al., 2004) and that traditionally ‘biological’ disorders can
be managed by ‘psychological’ interventions (e.g. reducing epileptic
seizures: Goldstein, 1997).
Rather than propagating an odd form of dualism, where mind and brain
are seen as opponent processes or, worse, as sides to be taken in
ideological battles, psychologists and their clients would seem to be
better off if these approaches were integrated into holistic
explanations and therapeutic approaches.
Although I agree that we should not hesitate to point out where biology
is being inappropriately used to promote profitable or potentially
harmful treatments (something which John Read has done admirably in the
past), it is also important not to throw the baby out with the
bathwater and damn all talk of biology as if somehow we have sawdust
between our ears.
Vaughan Bell
Institute of Psychiatry
London
References
Goldstein, L.H. (1997). Psychological control of seizures. In C. Cull
& L.H. Goldstein (Eds.) The clinical psychologist’s handbook of
epilepsy. London: Routledge.
Prasko, J., Horacek, J., Zalesky, R. et al. (2004). The change of
regional brain metabolism in panic disorder during the treatment with
cognitive behavioral therapy or antidepressants. Neuro Endocrinology
Letters, 25, 340–348.
Unconscious vision - an unnecessary hypothesis
IN the 18th century the English philosopher John Locke posited a
substance he termed ‘I-know-not-what’ to explain how it was that matter
or objects remained as distinct and suspended in space. Howard Gardner
spoke about how what made for our great thinkers is not simply what
they were able to say positively, but what they were able to remain
silent on. So, for instance, Charles Darwin’s theory of natural
selection was dependent upon some mechanisms for the transmission of
biological information; however, it would be another 50 plus years
before Mendel’s work would start to become more widely known. But that
did not trouble Darwin since he anticipated that such a gap in our
knowledge would eventually be filled. In the interim we fill those
theoretical gaps with metaphors such as Locke’s ‘I-know-not-what’.
The concept of ‘unconsciousness’, I feel, is such a metaphor. It
doesn’t actually tell you anything. It is simply a handy ‘stop gap’ or
heuristic device until something more tangible comes along. Sometimes,
however the use of such ‘stop gaps’ strikes me as gratuitous.
Professors Goodale and Milner (this year’s BPS Book Award winners), for
instance, describe a patient, DF, who suffered from acquired brain
injury resulting in visual agnosia. She was unable to identify objects
but had a ‘strikingly accurate visual guidance of a hand movement when
she attempted to pick up the very objects she couldn’t identify’ (The
Psychologist, October 2005). Following this ‘discovery’ Professors
Goodale and Milner posited a conscious and unconscious visual system.
Are Professors Goodale and Milner familiar with the work of Denny-Brown
and Chambers from the 1950s? These two researchers ablated different
portions of monkeys’ brains and then subjected their animals to various
tests of visual function. Their research had been stimulated by Luria’s
report of ‘blindsight’ from Russian soldiers who had miraculously
survived shrapnel injuries to their occipital lobes. These soldiers
reported being blind; however, they were able to ambulate about a room
without bumping into furniture. Denny-Brown and Chambers’ monkeys like
Luria’s soldiers had an ablation to the occipital lobes. They could
not, as a result, make visual discriminations but could accurately
grasp a pencil being moved across their field of vision.
Schneider (1969), based on the above and his own work with hamsters,
posited that vision is made up of at least two visual systems: one
pattern recognition, located in the occipital lobes, and one based on
motion, located in the parietal lobes. He was able to detail the neural
pathways by which these two systems functioned. The medieval
philosopher Occam tells us that with two explanations with equal
explanatory weight we should choose the more parsimonious. With
Schneider’s work why do we need to posit an unconscious realm of the
mind for vision?
For instance, could it not be that what Goodale and Milner term
‘unconscious sight’, as with Luria’s soldiers, reflects simply what we
recognise the experience of vision to be? Maybe the way we process
sensory stimuli, how we label and identify it as such, is a social
construct, as with it appears everything else that governs our lives as
humans.
Stéphane Duckett
Royal Free Hospital
London
References
Denny-Brown, D. & Chambers, R. (1955). Visuo-motor responses
related to the peristriate cortex of the monkey. Archives of Neurology
and Psychiatry, 73, 566.
Schneider, G. (1969). Two visual systems. Science, 163, 895–902.
Sex and systemising
IN response to Simon-Baron Cohen’s letter (‘Sex and intelligence’,
October 2005) I would like to offer the following for contemplation.
He defines ‘systemising’ as ‘the drive to analyse a system’ and seems
to suggest that males are better at ‘systemising’ than females. As a
clinical psychologist, I, like a lot of my colleagues (it is to be
hoped), spend most of my time working with systems.
I analyse them, encourage others to do the same, tinker with them and,
dare I say it, change them a little, hopefully for the good, to create
a different system. I think it is reasonable of me to suggest that
‘systemising’ is a core component of my job. Interestingly, clinical
psychology is a profession with significantly more females than males.
Ellis Mosley
Dewsbury and District Hospital
CAMHS
Dewsbury
More please
I WOULD like to tell you how fascinating I found Professor Della Sala’s article
in the October’s issue (‘The anarchic hand’). My knowledge of cognitive neuroscience is limited.
I found his article very interesting, and his writing style very
readable, down-to-earth and refreshing to someone with my extent of
knowledge in the subject.
I thought the references to how the phenomenon is depicted in other fields, such
as the fine arts, does lots for the process of taking psychology to
society. Please can we see some more of his work – and other such
readable work – in The Psychologist?
Gesthimani Manya Merodoulaki
The Counselling Service for Staff
Rampton Hospital
Retford
Dr Sonia Gatzanis 1946–2005
IT is with great sadness that we announce the death of Sonia
Gatzanis, who had been ill with cancer for the last year.
Characteristically, she did not let this affect her departmental and
course commitments at the University of Hull until the very end. She
died peacefully in hospital in Hull on 3 June 2005.
Sonia was born on 30 December 1946 in Cape Town, South Africa, to an
Italian mother and a Greek naval officer father – the eldest of five
children. She attended the Star of the Sea Convent School, St James,
where she was taught by Dominican nuns who profoundly influenced her
life. She worked closely with the Dominican Order at Port Elizabeth,
receiving degrees in psychology and postgraduate teaching
qualifications. In 1980 she migrated to Newcastle, completing a PhD in
1985 with Professor I. Kolvin on the Thousand Families study. She
gained her MPhil in clinical psychology at the Institute of Psychiatry
in 1987. Following her appointment as a clinical psychologist and then
consultant clinical psychologist at the Royal Manchester Children’s
Hospital, she was appointed senior lecturer and subsequently deputy
director of Hull University’s ClinPsyD course in 1992.
Amongst Sonia’s many achievements during her 13 years at Hull was her
organisation of a national conference on post-traumatic stress disorder
in 1992, managing to persuade the sole living survivor of the Titanic
sinking, Eva Hart, to give a keynote speech. She organised the first
national conference on cults and counselling which attracted national
TV and newspaper interest. Sonia was a gifted administrator who planned
and organised four departmental accommodation moves with military
precision.
Sonia played a major part in the training and qualification of more
than 140 clinical psychologists. She had a particular gift and concern
for the pastoral care of students and trainees.
She was wise in the old-fashioned way; you could always rely on her for
advice that would take account of others’ feelings and likely
behaviour. She combined formidable intellectual ability with an
intuitive grasp of people, their motivation and needs. In both
university and NHS settings she could be frank and pointedly critical,
but this was always with patients’ and students’ best interests at
heart. She was meticulous in points of etiquette and procedure and
always concerned to ensure that colleagues were publicly and
appropriately thanked for their contributions in the service of the
course or the university.
Sonia was unswervingly loyal and a trusted friend to many. Even in her
final painful days she found the energy to ask after the families of
the nursing staff who were caring for her and to offer them wise
counsel concerning their children. She was a unique and irreplaceable
individual who will be much missed by all who knew her. Sonia’s
greatest legacy is the debt of gratitude owed by many of the students
and trainees she helped along their way.
She is survived by her four brothers, Dimitri, Sigfried, Gustav and Ludovic.
Mike Wang
University of Leicester
Elise Rivlin
Central Manchester & Manchester Children’s NHS Trust
Play it again
I COMMEND the article by Eugene Sadler-Smith (on The Psychologist website only, see www.bps.org.uk/tiny/ptwsk6). It looks at Tippett’s use of psychology as a context for understanding his music – focusing mainly on Jung.
However, in the preface to his opera The Mask of Time Tippett makes a
clear reference to reversal theory. One reason for this is that he was
visited by Professor Michael Apter during the writing of this music and
they spent some considerable time discussing the basic ideas of
reversal and the process of switching between opposites, which
fascinated him.
We need more of this kind of material – looking at psychology in use, especially by non-psychologists.
Stephen Murgatroyd
7608 150 Street
Edmonton
Canada
Turing test nonsense
I NOTE from a panel in the News section of the November issue that
the Turing Test nonsense is still continuing. While fun, it is surely
no longer thought to have the theoretical significance with which it
was originally loaded. Just three (of numerous) objections, might be
noted.
First, ‘passing’ the test at time t1 is no guarantee that a computer
could pass it at time t2 (consider how convincing the now transparently
faked ‘spirit photographs’ looked to the Victorians at the dawn of
photography). Secondly, what would convince me to ascribe personhood to
a computer would not be its ability to con me into thinking it was
human, but that it could tell me (preferably by spoken word rather than
text) about its life as a computer, establish a long-term social
relationship, get moody, worried, happy, and so forth, and sometimes
hail me when I came into its presence – ‘Oh, Graham, I wanted a word
with you…’. Thirdly, the role of the human ‘confederate’ is very
ambiguous – do they want to beat the computer or not? How smart are
they? What is their personality? Obviously a computer’s being able to
‘pass’ against one confederate is no guarantee it could do so against
someone else.
In short, it is quite unclear what would count as definitively
‘passing’ the test. No doubt some more formal criteria have now been
set, but the very fact that they have to be formulated at all gives the
game away – we don’t need formal criteria to decide whether someone
else is a human or not in everyday
life.
Graham Richards
1 Claremont Road
Tunbridge Wells
Controlling online tests
DAVE Bartram’s overview of the changing face of psychometric testing
(November 2005) and, in particular, the contribution of the internet to
this changing face, made fascinating reading. Having been involved in
the design of an online personality instrument, I am fully aware of the
ethical dilemmas involved.
The biggest of these, it strikes me, is in making the online
administration of ability tests trouble-free and I am not convinced
that we have solved these yet. Professor Bartram says that ability
testing can work in an unsupervised ‘controlled mode’ through
the use of usernames and passwords, but until the era
of thumb-print or retinal eye-pattern scanning technology, which is
still some way away, cheating really isn’t at all difficult – and goes
on a great deal. In fact, if applying for
a job, I think I’d be tempted to cheat: I know plenty of people better
at numerical tests than I am, to whom I could pass on any usernames or
passwords!
Furthermore, trying to control cheating by making sure ‘a different
test is created every time’ from a bank of items is all very well if
these items are exactly equivalent in terms of difficulty, but we know
that with many test formats (those of verbal tests in particular) this
simply isn’t the case. Some items are going to be harder than others,
so some candidates will get harder tests overall.
Online testing is an area in which many have clear commercial
interests, but we shouldn’t allow these to let us downplay the genuine
ethical and practical problems which currently exist.
After all, even when we start scanning thumbprints, wily candidates are bound to find new ways to cheat – it’s human nature!
George Sik
15 Danetree Close
Epsom
Surrey
Jack Wright 1915–2005
HUBERT John Wright died on 27 August at the age of 90. He was the
foremost exponent of applied professional educational psychology in
Britain in the postwar years.
After training as a teacher, Jack read psychology under Cyril Burt at
University College, London. World War II saw him rise to the rank of
captain in the Royal Artillery, taking part in the long hard slog of
the Italian campaign. He grew to love Italy and its culture, and he was
proficient in Italian; it was amusing to watch him, when shaving,
whilst on educational courses, learning 10 new Italian words to add to
his vocabulary.
In 1948 he gained his postgraduate clinical training in educational
psychology at the Tavistock Clinic. He held posts in East Ham, Southend
and Portsmouth, and became principal educational psychologist for
Hampshire in 1974, retiring in 1980. Whilst leading teams of
educational psychologists in these local education authorities, he
contributed greatly to the development of the expertise and governance
of the profession. He had been a member of the Council of the BPS
between 1955 and 1970, was elected a Fellow in 1961, and thereafter he
pressed for Fellowships to be awarded not just for academic prowess but
also for excellence in the applied fields. Jack was secretary and later
chair of the Division of Educational and Child Psychology.
Educational psychologists, as well as wanting membership of a learned
society, also needed an association with more specific emphasis on
their professional development and structure. The Association of
Educational Psychologists was born in 1962, and Jack Wright was its
first president, serving on the executive committee for over 20 years.
His name appears repeatedly in the annals of applied child psychology:
he was a member of the Council of the National Children’s Bureau, chair
of the Inter-Child Guidance Clinic Conference and BPS representative on
the National Association for Mental Health from the mid-1950s to the
mid-1970s. He was appointed OBE in 1975.
He had a most affable personality; his bonhomie was apparent to all.
The last time I saw him, he joked about himself and fellow members of
his Probus Club (for retired PROfessional and BUSiness people). When
they played table tennis, there was a hiatus because nobody could
remember what the score was or who was to serve. This was precursive of
the future; sadly his last days were blighted by Alzheimer’s disease,
over which his wife, Betty, helped him with stoic serenity.
Conrad Graham
23 Rotherwick Road
London NW11
Information
- I AM a recent psychology graduate with a first class honours
degree and am currently studying an MSc in applied psychological
research. I am seeking voluntary work experience or research experience
in clinical or counselling psychology, particularly in the North East.
Please contact me if you are able to assist with any opportunities.Paul Sharpe
E-mail: [email protected]
- I HAVE an MA in organisational psychology and am working as a family
mediator (NFM trained, UK College Member) and workplace mediator. I
have yet to encounter other psychologists working within those areas.
If any other members are working in family/ workplace mediation, and
would like to exchange ideas or develop perspectives, please contact me.
Tanja Dodd
[email protected]
- WE are interested in purchasing someone’s old original Leiter if it is intact and in reasonable condition.
Dorothy Bell
NHS Dumfries and Galloway
E-mail: [email protected]
(Please note that some pictures may have been removed for copyright reasons)
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