Why I study - The effects of brain injury
THE truth is that I’ve been doing it so long, I’m not sure I can
really remember why I started. But I’m really glad that I stumbled into
this area of research.
I do recall that the stumbling took a while, though I’ve always been interested
in the brain, and still don’t fully understand why so many of my
colleagues like to draw a sharp boundary between facts and theories
that pertain to psychology and those that are ‘mere’ neuroscience.
When I was a teenager I met someone at a party who considered himself a bit of
a psychoanalyst (his father was a real one). He told me that smoking
was an attempt to recapture the pleasures of the breast. Gobsmacked by
this remarkable insight, and with no thought of questioning its
evidence base, I started reading the works of Sigmund Freud. Mainly, I
think I was hoping to impress people at parties in the same kind of
way. For a while it worked, too. Then, gradually it began to dawn that
there were problems with the underlying theory. Why was it only the
pleasure of the sucking itself and not the taste that had to be
perpetuated? Sarcastic questions like whether cigar or cigarette smoke
is more like breast milk started to be troubling.
Noticing my interest in matters psychological, my mum brought back a
book from a jumble sale called Doctors of the Mind. It had some
terrifying stuff about the consequences of tertiary syphilis, which was
a relatively common dementing illness in the pre-antibiotic era. This
gave a glimpse of how brain disease might offer extraordinary insights
into mental abilities, but mainly got me worried about STD. Not knowing
the significance of a book’s publication date, however, I had no idea
that the information was hopelessly out of date.
These twin influences led me to want to study psychology at university,
and my schoolteachers’ antipathy to this choice confirmed that it must
be the right one. We didn’t learn much about brains, and next to
nothing about neurological diseases,
but I went on to do a PhD on Piagetian developmental psychology and in 1974 secured a lectureship at Aberdeen University.
In the end I wasn’t completely happy with my PhD work, feeling that the
gap between the kind of data I had collected and the abstract Piagetian
theory was somehow too big. When I happened to mention to Hadyn Ellis
that I was looking for something a bit different, he immediately made
use of the developmental psychology training by setting me to work on a
project investigating the development of right-hemisphere
specialisation for face recognition. This involved testing how well
children could recognise faces presented in the left and right visual
hemifields. As background reading, I gradually became acquainted with
the journals Cortex and Neuropsychologia, the split-brain studies,
Freda Newcombe’s long-term follow-up
of D-Day veterans, and the rest of the huge neuropsychological
literature on how and where our mental abilities are represented in the
brain. It was the beginning of a deep interest in such matters, and a
long period of following Hadyn’s advice. He has an infallible instinct
for an interesting question.
It seems incredible now that divided visual field studies were for so
many years one of the only methods for investigating organisation of
function in the normal brain. They were at best somewhat indirect, so
it was natural to look for something to complement them. The jump to
investigating people with brain injuries was, I think, instigated by
Andy Ellis, when we were both at Lancaster University in the late
1970s. Andy had latched on to key papers by John Marshall and Freda
Newcombe and by Tim Shallice and Elizabeth Warrington, which set the
agenda for what we now call cognitive neuropsychology.
Marshall and Newcombe (1966) described a brain-injured patient who made
numerous semantic errors in reading words (e.g. reading ‘yacht’ as
‘boat’). This was especially interesting because, in the 1960s,
theories of reading nearly always assumed that the meanings of words
were accessed by first deriving their sounds. However, ‘yacht’ does not
sound anything like ‘boat’, so someone who misreads ‘yacht’ as ‘boat’
must have accessed the meaning without knowing how the word should
sound.
Similarly, Warrington and Shallice (1969) saw that the preservation of
some types of long-term memory in a person with a severe short-term
memory impairment showed that not all long-term memories have to pass
through the short-term store. The standard model that short-term memory
forms a kind of bridge into long-term memory had to be wrong.
In both examples, a deficit caused by a brain injury was clearly
inconsistent with the dominant psychological account. This was really
exciting because most of the questions neuropsychologists were asking
at the time were to do with where different abilities reside in the
brain, not how they are achieved. Cognitive neuropsychology, which used
patterns of impairment after brain injury as tests of models of normal
function, quickly took off.
Dennis Hay, Andy Ellis and I tried to apply this approach to
understanding face recognition. We made contact with local stroke clubs
and began to put together a battery of tests of different aspects of
face perception – age, sex, identity, expression, etc. Our big break
came, though, when Freda Newcombe asked Dennis to help design tests for
a new long-term follow-up of the veterans who had suffered shrapnel
injuries on D-Day. Suddenly we were involved with a front-rank project,
despite being complete novices. Working with Freda also showed us how
much fun you can have in research, and how brain-injured participants
are always a key part of the team, not objects of cold curiosity.
People got over-enthusiastic about cognitive neuropsychology. The
explosion of interest probably peaked some years ago, and has been
replaced by huge enthusiasm for functional imaging. Like many other
universities, York has invested heavily in brain imaging, but we still
need to carry on studying brain-injured participants too.
It is a matter of what is often called ‘converging operations’. All of
the techniques we have in psychology are subject to problems of
interpretation, but these interpretative problems tend to differ
between different techniques. So a conclusion that is supported by a
number of different types of evidence is more secure than one that has
been arrived at through one technique alone. For this reason, my
colleagues and I have sought in our own research to achieve parallel
findings from a mixture of lab experiments, everyday errors,
computational modelling, effects of brain injury, and now functional
imaging. In our opinion, placing too much faith in any single approach
will always increase the chance of misinterpretation.
The other factor that has kept me working with brain-injured
participants is that it can be very rewarding. The human interest is
always present, as is clear from the popularity of neuropsychology
courses with students. Many begin by thinking they won’t like
neuropsychology because of all the technical and anatomical information
that has to be absorbed, but end up fascinated. Figuring out precisely
why someone can’t do something we usually take for granted is often a
satisfying intellectual challenge, needing a combination of careful
reasoning and willingness to follow a hunch at the right moment.
In rare instances, a person with a highly selective deficit can really
make you change the way you think about something. I already mentioned
the seminal influences of Marshall and Newcombe’s (1966) and Warrington
and Shallice’s (1969) studies. Their patients’ problems were clearly
inconsistent with contemporary psychological models of reading and
memory. In my own research, the patterns of impairment of face
perception following brain injury have led me and colleagues to
radically revise our ideas about how facial expressions are recognised
(Calder et al., 2001; Calder & Young, 2005). We are not finding the
evidence we had expected of a dedicated visual pathway for interpreting
all facial expressions. Instead, we are having to take seriously the
possibility that current models underestimate the extent to which
emotion recognition is an intrinsically multimodal process that
involves constantly monitoring the environment for specific types of
signal.
By their nature, many studies of the effects of brain injury depend on
participants giving up significant amounts of time. Sometimes what is
found out turns out to be useful to them, but just as often it doesn’t.
Instead, they take part in research for a variety of reasons – in the
hope that the knowledge will eventually help others, to gain more
insight into their own difficulties, or just because it makes for an
interesting day out.
So there is often a substantial debt of gratitude we owe to our
research participants. Some neuropsychologists have managed to repay
this debt by linking scientific findings to rehabilitation strategies.
Barbara Wilson is a shining example. But to do this successfully
usually requires a special talent, a clinical background, and a
dedication to making this your primary agenda. I don’t have any of
those. Hopefully my efforts later this month (see box) will give
something back to the kinds of people who have given so much time and
inspiration to me throughout my career.
- Andy Young is Professor of Neuropsychology at the University of York. E-mail: [email protected].
A marathon effort for stroke victims
On Friday 13 January, my wife bought a copy of The Times to read on
a train. She found it contained a competition for readers to train with
four-times Olympic gold medallist Matthew Pinsent to run in the 2006
London Marathon on 23 April, to raise funds for the Stroke Association.
The marathon is quite daunting for a person in his mid-fifties, but
many stroke victims have helped my research, and the thought of trying
to do something in return by raising funds was irresistible. Strokes
are the third biggest killer in the UK, and the biggest cause of
disability. There is an urgent need for more research on the causes and
treatment of strokes, and more funding to provide proper support for
stroke survivors. Having researched the effects of brain injury for
nearly 30 years, I know that the Stroke Association does outstanding
work.
I heard in late January that I got chosen for the Times Flora pro.activ
Marathon Challenge Team, leaving around 12 weeks to get fully prepared
to run the 26.2 miles. Now I’m keen to raise as much sponsorship as I
can, on behalf of all of us whose research has been helped by people
with brain injuries.
o For more details visit http://timesonline.typepad.com/london_marathon_weblog/andy_young/index.html, or my fundraising page at www.justgiving.com/andy_young if you wish to offer your support.
Weblinks
British Neuropsychological Society:
www.psychology.nottingham.ac.uk/bns
Neuropsychology Central:
www.neuropsychologycentral.com
References
Calder, A.J., Lawrence, A.D. & Young, A.W. (2001).
Neuropsychology of fear and loathing. Nature Reviews Neuroscience, 2,
352–363.
Calder, A.J. & Young, A.W. (2005). Understanding the recognition of
facial identity and facial expression. Nature Reviews
Neuroscience, 6, 641-651.
Marshall, J.C. & Newcombe, F. (1966). Syntactic and semantic errors in paralexia. Neuropsychologia, 4, 169–176.
Warrington, E.K. & Shallice, T. (1969). The selective impairment of auditory verbal short-term memory. Brain, 92, 885–896.
(Please note that some pictures may have been removed for copyright reasons)
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