Letters, December 2005

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