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Brain, Neuropsychology

One on one… with Barbara Wilson

Founder of the Oliver Zangwill Centre, Honorary Consultant Psychologist. Includes online only questions.

18 February 2012

One moment that changed the course of your career
Once qualified as a clinical psychologist, I worked for two years with children who had severe developmental learning difficulties, and then I moved to Rivermead Rehabilitation Centre in Oxford. On my first day there I knew that brain injury rehabilitation was my field and I would stay there for the rest of my career.

One patient who has changed your way of thinking
A patient I first saw in 1999 changed the way I view life and death decisions for people with prolonged periods of unconsciousness. The patient was in a vegetative state for between five and
six months. She regained consciousness (when only about 9 per cent of patients do after this period of time) and her cognitive functioning remained intact. She is severely physically impaired and communicates with a letter board and a computer. She is strongly opposed to allowing vegetative patients to die, and is adamant that this should not happen. I have been involved in assessing people referred to the courts for permission to die. I have also been involved in some of the imaging studies showing that a few vegetative patients have some, albeit limited, awareness. I used to think perhaps it was best if these patients died, but the patient I saw and her views made me change my mind and I am now far less sure that this is the right thing to do.

One book 
The Man with a Shattered World by A.R Luria. It’s about a Russian soldier who sustained a severe brain injury in World War II. The effort, hope and commitment shown by this man had a big impact on me.

One inspiration
One of my teachers, Bill Yule, said two things in his lectures that I have tried to follow ever since. First, ‘No patient is untestable. Saying such a thing says more about the psychologist than the patient.’ Second, ‘Every patient you see should be capable of being written up for a journal.’ This, is perhaps, a little too ambitious, but by trying to follow this advice, we are likely to prepare more carefully, keep data and design our therapy sessions in order to determine whether it is our treatment that is effective or whether the change would have occurred anyway.

One cultural recommendation 
I am a big fan of the music of Bob Dylan. He cut his first record the year I married (1962). I love his lyrics, his willingness to innovate, his refusal to be stereotyped and his wonderful, strange voice that gets under one’s skin.

One surprising thing about traumatic brain injury
The mixture of normality and abnormality always surprises me. However impaired brain injured people are, they retain their essential characteristics. They are unlike people with developmental learning difficulties or severe psychiatric disorders, having a combination of major problems in some areas while retaining perfectly normal characteristics in other areas.

One final thought
As someone who can remember the days before the NHS, when my mother used to worry about taking me to the doctor because of the costs, I fear that the NHS will no longer be a national health service but a patchwork of provisions. I fear for the future of brain injury rehabilitation services. Most GPs neither understand brain injury nor recognise the importance of the long-term resources required to ensure that survivors will achieve their maximum potential.

Online only answers

One thing that you would change about psychology / psychologists  
I would like to change the misconceptions among some academic neuropsychologists as to the meaning of rehabilitation. In neuropsychology there are some academics who do research, publish papers and present talks on “rehabilitation” studies when what they are really talking about is a treatment study. Neuropsychological rehabilitation is a two way interactive process whereby people who have survived an insult to the brain work together with health care staff and others to achieve their optimum levels of functioning. It is a broad process aimed at reducing cognitive, emotional, behavioural and psychosocial disorders. We need to work with families, help people return to work or school or find alternatives to work and help improve their quality of life. Studies looking at how to improve one specific cognitive function are not rehabilitation studies. Rehabilitation is not synonymous with treatment.?

One challenge you think psychology faces 
One of the main difficulties in rehabilitation is persuading  health care purchasers to fund people to attend rehabilitation programmes. Many of those needing rehabilitation are young, their lives have been saved with great expertise yet, far too often, they are then denied appropriate rehabilitation. There is evidence that rehabilitation is clinically effective and cost effective. Our challenge is to persuade purchasers of health care the value of this. The present government’s intended policy to give GPs responsibility for funding is likely to make this even more difficult as GPs are not particularly aware of the benefits of rehabilitation. It is ironic that Sir Keith Joseph, a right wing member of Thatcher’s cabinet,  said in 1973 “An improvement in rehabilitation can mean more to millions of people than almost any other medical advance” (Joseph 1973).

One regret
I regret leaving Rivermead in 1985. I was enticed away to a job I did not enjoy. I then went to another job in Southampton where I healed my wounds and from there to Cambridge. However, I wish I had stayed for a year or two longer at Rivermead and not taken the intervening job?-One best marathon time:  I have only entered (and completed) one marathon (London 2008). My time was 6 hours and 7 minutes. (I believe I could have done it in under 6 hours if I had not had to queue for the loos three times). I ran in memory of my eldest daughter Sarah, who died in a white water rafting accident in Peru in May 2000. I collected almost £8000 for The Compassionate Friends, a support group for bereaved parents.

One nugget of advice for aspiring psychologists
Clinical psychologists could be more proactive politically at local and national levels in order to bring about change. For example, I led an occupation of Rivermead Rehabilitation Centre in 1984 and saved it from closure. I also founded the Oliver Zangwill Centre for Neuropsychological Rehabilitation in 1996 after three years work persuading the local NHS and the Medical Research Council to back the proposal.?

One alternative career path you may have chosen
I would like to have been a midwife as this must have such job satisfaction. Obviously when things go wrong it would  be hard but helping to bring new life into the world successfully must be so satisfying.?

One hero / heroine from psychology past or present
Alexandr Romanov Luria who was so important in neuropsychology and rehabilitation and very much on the patients’ side. He seemed such an interesting person too. I just wish I had met him. I admire the way he combined enquiry into a patient’s problems with real care for improving those problems.?

One thing that organised psychology (e.g. the BPS / APA) could do better
Sometimes the BPS is too inflexible about statements of equivalence. I am all for generic training but sometimes very senior and experienced neuropsychologists come from overseas and are not allowed to practice here. Each case should be considered on its merits and not subject to some blanket procedure.

One great thing that psychology has achieved
Psychologists have shown that people with damaged brains can learn certain skills and gain knowledge which equips them for leading more successful lives. With even the most severely impaired people, there is always something that can be done to improve their daily  lives.?

One favourite country
Australia is one of my favourite countries and somewhere I could live. It is very beautiful, the people are laid back as well as being hard working and friendly (except when they play us at cricket!), and there are some great restaurants! I also like off the beaten track places; my best ever trip was to Mali where I trekked among the Dogon tribe and then took a river trip to Timbucktoo.?

One problem [research, professional or otherwise] that psychology should deal with
Errorless learning (avoiding trial-and-error learning) is now accepted as an important principle to follow in memory rehabilitation. While there is considerable research being conducted into errorless learning for people with language impairments, we do not as yet know whether or not errorless learning is better than trial and error learning for people with motor problems. I would like psychologists to tackle this question.?

One hope for the future of psychology
That all survivors of brain injury will receive the most appropriate rehabilitation. Again, I am worried about the government’s intended policies, which may worsen an already limited provision.?

One proud moment
In 2007 a brain injury rehabilitation centre in Quito Ecuador was named after me. It is called “Centro de Rehabilitacion Neurologico Integral: Dra Barbara Wilson”