Portrait of Sigmund Freud - by Salvador Dali

At the risk of waking up to find a horse’s head strapped to a red leather couch amongst my Christmas presents I’m going to let you into a few trade secrets.

By training I’m a psychologist.

No, that’s not a secret - although perhaps it ought to be – it just means that for my considerable and multitudinous sins my time at university was spent learning to fathom out the intricacies of the human mind. I don’t actually practice as a psychologist, never have, not because I couldn’t do the job just as well as anyone else with my background and training but because nothing I did learn left me feeling confident in taking on the responsibility for what goes on inside the head of anyone other than myself.

Let me illustrate what I mean.

Like most degree courses, psychology follows a pretty standard format. You spend the first six months covering a few introductory basics to get everyone on the course up to the same starting level (as with any number of other subjects, psychology attracts a sizable number of students for whom the degree course is their first serious entrée to the subject – A level courses in Psychology are not that widely available and, in any case, what you learn to cram at A level and what you’re expected to understand for a degree are two very different things). After that, and the mandatory lecture on professional ethics, you get to study the subject proper, spending the next year and a half covering foundation topics before finally getting to specialise in your final year.

One of the first, if not the first, foundation topic you cover is ‘theories of personality’ – note the plural, it’s important – a series of around twelve to thirteen lectures on the nature of personality and the various theories that try to explain what it is an how it works, which takes you through many of the ‘big name’ in the profession – Freud, Jung, Pavlov, Skinner, Kelly, Rogers, Maslow et al – all with the own distinct ideas of what personality is, what it does and how, as a psychologist, you might eventually learn to influence it’s development.

If that part of the course teaches you anything it’s that’s while psychology is by no means short of ideas, theories and conjectures on the subject of personality, no one really know what it is or how it works – if a psychologist says to you that they’re a ‘Freudian’ or a ‘Jungian’ or a ‘Behaviourist’ or whatever all they’re really saying is that when they sat down to consider what personality is, they simply liked a particular theory best and found it a bit more interesting than the others so that’s what they decided to go with. You could just as easily pick one at random for that it provides any semblance of a definitive view of personality.

(Personally, I always found that Kelly, Maslow and the other existentialists and iconoclasts like R D Laing suited me best, but that’s just my own view of things)

I mention all this in response to yet another brilliant commentary from Dr Crippen on the subject ADHD (Attention Deficit Hyperactivity Disorder) in which he expresses, in my opinion, what are well-founded and well-judged concerns about the growing practice of medicating children for no better reasons than their parents (and often schools) find them a bit ‘difficult’. It’s an issue in which, I must confess, I have a considerable personal interest as my own five (soon to be six) year-old daughter is one such child who falls into this category – although never once have I asked for or wanted her to be medicated because of it.

I’ll get back to my daughter and our experiences of ‘the system’ in a while, but first there are few more observations on the nature of the ‘profession’ I should make first.

I suppose I should try and give some sort of overview of what psychologists – and psychiatrists for that matter – actually know about the workings of the human mind.

Not much.

Don’t get me wrong, we know quite a bit about how the brain works.

We know what chemicals the brain produces (neurotransmitters) and have a fair idea of what happens in situations where it produces a bit too much or too little of a particular chemical and also what happens if you introduce the brain to all manner of other chemicals from the outside world – nicotine, alcohol and whole bucket load of prescription and non-prescription drug, legal and illegal.

We know all about the electrical activity that take place in the brain. We can map it to show that different patterns occur in different places when we do different things. We even know that we can make certain things happen if we go poking around in particular locations in the cranial cavity with electrodes – prod here and a finger twitches, prod there and you get the taste of strawberries.

We even know, roughly speaking, which bits of the brain control which functions; mostly as a result of studying various types of brain injury. Damage this bit a speech goes out of the window, here and you can’t remember anything for more than a few seconds, here and all aggression goes and you guarantee docility – that last one was once a big favourite, back in the days when it was thought reasonable to try to ‘cure’ criminality by liberal use of pre-frontal lobotomies.

We also know that despite it being long thought that the brain was incapable of making new brain cells and replacing damaged cells (neurons) its actually does make some new cells all the time – in the hippocampus – all of which appears linked to how the brain stores memories and, if injured, it does try to repair itself. I was actually at University and taking the module in neuropsychology at around the time this was discovered. Back then it was called simply ‘sprouting’ – cells around the area of injury respond by growing new connections to other undamaged cells in an effort to reconnect across the damaged area, often resulting in the partial recovery of functions otherwise lost to injury.

None of this, however, tells us anything in particular about the process of thought and thinking, which is what psychologist and psychiatrists, in the main, are concerned with – its what’s called the ‘mind-body’ problem, something that has occupied the thoughts of psychologists since the profession came into being in the 19th Century and philosophers certainly since the enlightenment and, perhaps, before. We can study and uncover the physiology of the brain and its pathological functioning fairly well, we just have no real idea how that all relates back to the way we think – not that that’s ever stopped people trying to link the two together, from which we’ve derived both pseudoscientific drivel (phrenology, the ‘science’ of reading ‘bumps’ on the head) through assorted forms of medical barbarity (lobotomy, electro-convulsive therapy) to today’s mood-altering drugs (lithium, Prozac, etc.).

It’s this that sets the use of drug treatments in psychiatry apart from most other fields of medicine. If we take a commonly used drug, say an analgesic like paracetamol, then we know with a considerable degree of accuracy what the drug does, the effect it has, how it does it and why it does it. In the case of Ritalin, which is increasingly prescribed to treat ADHD in children, we may still know all these things in terms of their physical effects on the body but nowhere near as much about how and especially why they affect the mind in a particular way – we can observe and record the effects, just not explain the why of them.

I need to digress here a touch, just to explain the difference between psychologists and psychiatrists.

Psychologists aren’t doctors (they don’t have a medical degree although some, working in the field of neuropsychology do go that route in order to qualify as surgeons), they don’t generally wear white lab coats (apart from some the experimental lot and the odd one or two who do it as an affectation) and they don’t – in fact they can’t – prescribe drugs.

Psychiatrist, on the other hand, are doctors, frequently wear white lab coats (it’s mandatory) and can prescribe drugs.

There is, as a result, quite a degree of professional rivalry akin to that you’ll often find between doctors and dentists (and from some strange reason at Manchester University, in particular, doctors and engineers – no I did get it either) much of which relates to this whole business of having access to the medicines cabinet. Psychologists are firmly of the belief that psychiatrists are far too inclined to reach for the pad of prescriptions rather than tackle problems properly – they’re also firmly of the belief that the majority of psychiatrists don’t enter the profession burning with a desire to cure the ills of human mind, but because they’re too crap at doctoring to become surgeons and too lazy and anti-social for General Practice. As far as psychologists are concerned, psychiatry is to doctors what philosophy and theology are to prospective university students – a means of getting on if your grades or too poor to qualify you do anything more useful.

That being said, I’m sure psychiatrists take a similar dim view of psychologists, although I’ve never encountered one with the courage to speak up and say so – I fully expect what they think of us is near enough what they think of complementary therapists, homeopathy and other assorted unproven therapies.

I point all this out really to make the point that psychology/psychiatry is a hell of a long way from being the kind of empirical discipline that the public are often les to believe it is – most of it is educated guesswork and bit of common sense and experience (hopefully) wrapped up in a whole load of made up words with enough syllable to sound impressive and the make the speaker appear to know what they’re talking about.

It’s frequently impossible to tell whether visiting a psychologist with your problems has any real effect or whether its all just one massive placebo for the mind – talking over your problems doesn’t actually solve them it just makes you feel a bit better for having talked them over with someone.

One of my all-time favourite stories about RD Laing illustrates this point perfectly.

Laing, while practicing as psychologist, was visited for a regular consultation by a patient with depression.

On this particular occasion, the patient seemed particularly down, so rather than do the whole ‘get on the couch and tell me your problems’ routine, Laing just decided to chat to them in general, talk about mundane things like the weather, the football results over the weekend. Just the normal kinds of things that people talk about socially.

About an hour later, Laing notices that the time allotted to the session is over. At no point have he and his patient talked about the patients problems or done anything which might be considered therapeutic – they’ve just talked. By now, however, the patient’s mood has picked up considerably and he and Laing have been swapping jokes and just generally enjoying a social chat.

So, Laing breaks into the conversation to point out that the sessions over, only for the patient to reply by pointing out that they hadn’t actually talked over any of his problems.

The bit of this story I particularly like is what comes next.

Laing’s reply to this was simply to point out to the patient how much he’d obviously cheered up since he’d arrived and that, because of that, he saw no real point in talking about the patient’s problems as it would only get the guy down.

How wonderful is that? You’re happy now so why spoil it?

I’m not going to say outright that psychology is complete con but I will happily argue, as someone trained in it, that its nowhere near what the public are led to think it is.

Take schizophrenia for example – what exactly is it?

Well, this is how it’s described by Wikipedia, which is as good a description as any you’ll find in textbook:

“Schizophrenia is a severe mental illness characterized by persistent defects in the perception or expression of reality. A person experiencing untreated schizophrenia typically demonstrates grossly disorganized thinking, and may also experience delusions or auditory hallucinations. Although the illness primarily affects cognition, it can also contribute to chronic problems with behaviour or emotions. Due to the many possible combinations of symptoms, it is difficult to say whether it is in fact a single psychiatric disorder; and Eugen Bleuler deliberately called the disease “the schizophrenias,” (plural) when he coined the present name.â€?

Does any of that make sense to you? Feel free to go and read the rest of the Wikipedia article if you like but before doing that I’ll let you into one of psychology’s biggest and frequently most closely guarded secrets – we’re no clearer about exactly what schizophrenia is than you are!

We may be better able to describe its symptoms than laymen.

We have no shortage of jargon and complex multi-syllabic terminology to pull out and use in order to impress the unwashed masses with our compendious knowledge of the subject.

But the reality is here that if you do someone, maybe a family member or friend, who has been diagnosed with schizophrenia then all the diagnosis really means is that the psychologist or psychiatrist who made the diagnosis thinks they’re a nutter.

That’s pretty much as good as it gets.

I mentioned my daughter a bit earlier. She’s currently five – she’ll be six just after Christmas – and she has what can only be described (in shrink terms) as a ‘developmental delay’ plus occasional marked ‘behavioural problems’.

She’s actually a very bright and lively child who, physically, has always been very forward – walked at about nine months having only crawled for about a week, tops, and never really resorted to crawling again once she’d found her feet.

The downside to this was that she was, initially, very slow in picking up speech and communication, which was spotted at a routine assessment at around 18 months and which put her, and obviously myself and my partner, onto a treadmill of assessment and, occasionally, treatments that we’re still (technically) on more than four years later without ever really having found out what the problem might be or even if there is a problem.

Initially, we spent over a year tracking backwards and forward to hearing assessments in order to ascertain whether that might be the problem – it isn’t but it took them around 15 months and four or five appointments to arrive at that conclusion, mainly because my daughter has a fairly low boredom threshold and a knack of being uncooperative which meant they found it very difficult to complete their tests.

Since then, she’s been to speech therapy, which I will say helped considerably to bring her speech along – but then so did going to nursery and interacting with other kids her age as well.

As far ‘symptoms’ go, other than the speech thing, she’s prone to periodic bouts of ‘hyperactivity’ – not that she’s particularly destructive just that she constantly on the go, running everywhere, for hours on end and can’t concentrate on anything for more than a couple of minutes when in that mood. One thing we have noticed is that certain foods – ok, well Smarties, Coca Cola and one or two other soft drinks, tend to set her off, so we avoid them (obviously).

On top of that she also ‘fixates’ every now and then on a particular behaviour which she starts to carry out obsessively – there’s one constant which is running backwards and forwards along the same ‘route’ for 15-20 minutes at a time which you might think is something all kids do at some point – she’s been doing it pretty much since she learned to walk and always on the same route (in the living room) and starting from the exact same spot every time. We moved house a couple of years ago and thought that might break the habit as the layout of our current place is very different from the house we were in before – it took her less than a week to find here ‘new route’ and start up again.

In addition we’ve had spate of obsessive hand-washing – we’ve more or less got her out of that one but it comes back very occasionally, and various other things where she just set herself on doing something over and over again, even getting very sneaky about it at times. At the height of the hand-washing phase she’d deliberate find things to do which would get her hands dirty so she could go and wash them.

We also, every now and then, get the bad days, the days when the slightest thing can set her off into tantrums and screaming fits, when her behaviour does get disruptive and sometime destructive. This rarely happens at home anymore, but at school they had a couple of weeks of her kicking off because another child ‘stood too close to her’ – a couple of times this has meant fetching her out of school as she was thought by teachers to be putting herself and others kids ‘at risk’. On another occasion, various teachers and classroom assistants ended up spending a couple of weeks sitting inside with her at lunchtime as she refused point blank to go out an play with the other kids – the school had had some new fencing put around the nursery area and she just decided she didn’t like it.

None of this is constant, she’ll go weeks, months even, without any signs of a problem then just get up one morning in the wrong kids of mood and away we go – sometimes is stuff we’ve seen before, sometimes it something new.

Oh, and as you might expect, educationally speaking she’s not coming on anything like as well as most of her classmates – she’s about a year behind with her reading and the same with writing already.

In the meantime we’ve dutifully trotted backwards and forwards to various professionals while she’s prodded and poked to see if any of them can work out what to do with her. On top of the speech therapy, we’ve had regular trips to paediatric assessments, then off to child mental health services (expect you’re only allowed five appointments while they try to make a diagnosis before you automatically get referred back off their books). We had home observations, an educational psychologist visit her at schools for a whole half and hour observation – not that that was any use as it coincided with one her better spells.

This last year, in particular, has been farcical. It was about this time last year that we finally got the referral to child mental health services and actually saw a developmental psychologist – did I forget to the mention that we’ve never even seen the educational psychologist, let alone spoken to them.

First assessment – the shrink asked questions, we answered, we talked, she observed – all took about an hour at the end of which the possibility of an autistic spectrum disorder was raised. Wonderful, eh? Still, after we got home I talked my partner down of the ceiling, we took a little comfort from having come away feeling that we might just be a little closer to finding out if there really is a problem and, if so, what it is and what, if anything, we can do to help our daughter.

Assessments two, three and four were a waste of time, really. All very hello, how are you, anything to report type stuff and no progress.

By assessment five, they’re now ruling out an autistic spectrum disorder – well actually not so much ruling it but claiming they never said anything it a possibility in the first place – mind you we’re a on a different shrink at this point. Instead they think its just a non-specific developmental delay – read around the subject of psychology for a while and you’ll soon find that there a plenty of things are non-specific as ‘non-specific’ is psychologist-speak for ‘how the hell do I know what it is?’.

Get home. Talk partner from ceiling yet again – hard as it is to hear someone talk about your daughter and use terms such as ‘autistic spectrum disorder’, its actually much harder to deal with the idea that not only do you not know what the problem is but the professionals don’t either – then off to hit the books to find out what this non-specific developmental delay business is all about.

At which point I discover that it either may or may not be part of the autistic spectrum of disorders, depending on which journal you’re reading and whether a particular researcher thinks it is or it isn’t.

So we’re still no closer to diagnosis.

Oh, but there’s more.

In the meantime, the school had asked if the shrinks had come up with anything as they were still having periodic difficulties with my daughter – so naturally we mention that an autistic spectrum disorder has been raised as a possibility.

Now how do you think the school reacts to this?

Yep, you got it – there’s goes my daughter on to the ‘special’ table with the other ‘special needs’ kids, which is fine in one respect as she’s now getting a bit of extra one-to-one tuition with her reading that most of the others kids don’t get. Unfortunately none of this goes anyway towards tackling some of the behavioural stuff, which all relates to interacting with other children, as she now spends much less time engaging in those kinds of interactions.

This goes until she gets a school visit and observation from Child Mental Health Services who points out straight away that limiting my daughters interactions with other children is no help at all.
So what did we actually get out of all this?

The promise of a ‘case conference’ with the professionals to discuss my daughter’s development.

This was around February/March this year – guess when the case conference happened?

Yep, that’s right. It didn’t.

You see the other thing I forget to mention is that where I live the diagnosis of things like ‘developmental delays’, autism and all manner of other psychological problems in children have to be done on a ‘multi-agency basis’. So getting diagnosis is not merely a case of getting seeing a child psychologist/psychiatrist and getting their opinion, you also have to get the agreement of the educational psychologist, who works for the Local Education Authority, the speech therapist (NHS but a different department and hospital in the local trust), because my daughter’s seen one, and god knows who else besides. We were told and there was something like five or six different people who would have to involved in this according to the ‘rules’, all from different departments and places – all of whom would have share information and find the time for a meeting where they could all get together to talk things over with us.

I think you should be able to see why the case conference hasn’t happened – in fact the last time this was mentioned, about three months ago, they were still waiting for written assessments from the speech therapist and education psychologist. They’d only had five or six month to get back to them.

Somewhere is all this I suspect there’s also an accountant and a couple of bureaucrats in the loop for this decision as well – after all, an actual diagnosis would mean my daughter getting some sort of therapy or support, all of which costs money as, let’s face it, the only purpose that multi-agency working appears to be serving here is to keep costs down by not allowing a diagnosis to be made.

I’ll be honest, I have left things alone for the last few months and pushed the issue anything like as hard as I could or should have.

In part that’s because for all that my daughter can be awkward and difficult and her behaviour and lack of progress at school be worrying, she’s still a bright kid with many growing talents and abilities which compensate for the other problems. One of the difficulties that myself and my partner have with helping her with a her reading is that is often difficult to be sure whether she’s actually reading the words on the page or not – there aren’t too many five year olds who manage to memorise the text of their reading book verbatim as they’re learning to read the words and often you only catch her out when she inserts a word into the text that should be there, grammatically, but has been omitted to simply the text for a child her age.

Partly it’s also because after all this time, my partner got to be pretty frazzled by the whole experience. I tend to cope with things like this a bit better, partly because I do understand the complexities of trying understand the human mind and how it works but also because I’m just the kind of person who doesn’t dwell on problems – I go looking for solutions. I’ve not said it to her, as she’s the worrier of the two of us, but I have backed off because she needs a break from this treadmill for her own good, even if she wouldn’t admit or accept it – and she’ll kill me if she finds out I’ve said this.

Still it’s difficult not to get a bit dispirited at times – and impossible not to get extremely frustrated.

I may be more that a bit disdainful of what is, strictly speaking, the profession I trained to enter while at university even if the clinical side of things wasn’t where I was heading had I decided to follow through and practice – I’m actually an organisational psychologist by speciality and do systems not people – but for all its faults, its still the best we have to work with for now…

…and right now what I wouldn’t give for a properly conducted assessment of my daughter carried out by an appropriately qualified psychologist who the system allows to actually make the kind of diagnoses they’re trained to make without a cast of thousands kibitzing over their shoulder.

But you know what really burns here?

It’s the fact that for all that I don’t practice, I know my professional well enough - and the system even better – to know that if I did really start to push the issue hard and use what I know to rack up the pressure on the professionals who, so far, have got nowhere fast, then I could easily get a diagnosis for my daughter.

What I couldn’t be sure of it that I’d get the right diagnosis and not just whatever one I jumped about demanding that she be given.

Damn me for wanting my profession to get it right for once.

This entry was posted on Thursday, December 22nd, 2005 at 3:19 pm and is filed under Health, Civil Liberties, Personal. You can follow any responses to this entry through the RSS 2.0 feed. You can leave a response, or trackback from your own site.