Neuropsychology as a (Psycho)Social Science: Implications for Research and Clinical Practice
Rourke, Byron P., Canadian Psychology
CPA Gold Medal Award for Distinguished Lifetime Contributions to Canadian Psychology - 2007/Prix de la médaille d'or pour contributions remarquables à la psychologie canadienne au cours de l'ensemble de la carrière - 2007
Many early investigators of brainbehaviour relationships focused their investigative efforts on the psychiatric implications of brain damage and dysfunction. Descriptions of emotional dyscontrol and other psychosocial difficulties appeared frequently in their writings. Although dimensions of perception, memory, and cognition dominate the current neuropsychological literature, the psychosocial implications of patterns of neuropsychological assets and deficits retain their importance (e.g., in the study of the dementing diseases of adulthood). Our investigations of brain-behaviour relationships and their impact on psychosocial functioning have attempted to expand upon and chart a somewhat different (subtypal) course for this area of study. One clearly evident conclusion of these efforts is that neuropsychology is a psychosocial science. Some implications of our findings for research and clinical practice are outlined.
Keywords: neuropsychology, social science, neuropsychological science, neuropsychological practice, clinical neuropsychology
Some of the most important research in the early years of neuropsychology focused on the psychosocial-almost exclusively, psychiatric-implications of brain lesions in humans. The investigations of the psychological impact of traumatically induced brain injuries in soldiers by Goldstein and his associates, for example, were principally concerned with the so-called "catastrophic reaction" that afflicted them (Goldstein, 1939, 1940). This "reaction" involved not only deficiencies in higher-order concept formation and problem solving but also the grave problems faced by these men in dealing with psychosocial relations following their brain lesions. Indeed, Goldstein noted that this reaction was especially apparent when these men faced novel problem-solving situations, thereby establishing an apparent link between their deficient novel problem solving and their most prominent psychosocial deficit. (And, of course, there is the KluverBucy syndrome, and many other brain diseases with psychosocial consequences.)
Unfortunately, these effects were deemed by most to be permanent and sufficient to render those who suffered them not amenable to any form of psychotherapy. Coincidentally, the notion of "organicity" took hold in psychiatric parlance. That said, it is one thing to be a card-carrying "organicist" (i.e., one who ascribes all mental disorders to organic lesions), and quite another to believe that one who has a mental disorder that is brain-related is doomed: that is, incapable of changing for the better with or without psychotherapeutic intervention.
Coincident with this notion arose the myth that "organic" disorders were to be treated "organically," and other mental disorders to be treated "behaviourally." Indeed, these early investigators seemed not to appreciate the illogicality of such positions. Today, we realise that many brain-related disorders are amenable to behavioural intervention. At the same time, whether behavioural disturbances (e.g., ADHD) should be treated "organically," even when the organic basis is known or unknown, is quite another matter. The notion of "organicity" became enshrined as "organic brain syndrome" in several nosologies. The absolute uselessness of the term seems to have occurred to too few of the early investigators. It became clear that a new paradigm was necessary if progress were to be made in this investigative area.
Studies in the Windsor Laboratory
We have taken on this challenge directly in several studies of adults and children. One dealt with a 40-year follow-up of soldiers who had suffered penetrating missile wounds to the brain and had, subsequently, developed a seizure disorder resulting from these (Tellier, Adams, Walker, & Rourke, 1990). …