An Unauthorised Profession

By Laurie Scarborough

Reconstructing Carey Bauer’s Tuesday

Carey Bauer makes her way through the Groote Schuur Hospital parking lot. She is a rather short brunette in her mid-twenties, dressed almost always in a top of the knitted variety which stretches over her shapely bosom. She is only a couple of weeks into her internship at the hospital, a grim-looking and colossal building made of beige concrete in the Cape Town suburb of Observatory. The hospital sits just above the constantly congested Main Road, a long stretch of tarred road that traverses almost the entire length of Cape Town from the northern to the southern tip.

Just to the right of the hospital is the original hospital building, which is considerably more cheery, with light cream walls, white window ledges and bright orange roof tiles. The greener lower slopes of Table Mountain rise behind the building like a backdrop and a garden of shrubbery and three tall palm trees are stationed in the courtyard outside the entrance of the U-shaped building. With the addition of a fountain, the building could be mistaken for a luxurious resort hotel. In 1984 the new building was constructed and most medical departments were moved to the 12-storey monstrosity. The only wards that remain in the old building are the maternity and outpatients centres. The building is now mostly home to offices of the Health Science Faculty of the University of Cape Town, which uses the space as a teaching and learning venue for practical instructions in all fields of medicine.

The original Groote Schuur building is also the location of the Heart of Cape Town museum, which memorialises the famous first human-to-human heart transplant surgery in the world, which occurred at the hospital in 1967. Christiaan Barnard and his team placed Groote Schuur on the medical map with this surgery, and the public are able to view a set-up of the operating theatre. It is a cold room with high ceilings and green-tiled walls. Mannequins dressed in turquoise scrubs assemble around an operating table, holding sharp silver instruments over a bleeding open chest.

But it is not hearts that are on Carey’s mind as she walks through the glass doors and into the hallway. It is brains.

She makes her way through the labyrinthine corridors, past dozens of olive green double doors, all the way to her home ward. Carey spends several hours each week here working as a neuropsychologist, seeing to patients with a myriad of neurological disorders. While other forms of psychology look at behaviour in a more psychosocial way, neuropsychologists look at the link between biology and the brain, and human behaviour and experience. Much of their work in practice tries to assess behaviour by linking it to damage in the brain, and thus diagnose a brain-related disorder. Brain tumours, dementia, speech problems, head injuries, paralysis, strokes, and concussions are just a few of the things she must be prepared to assess.

Today a young female sits on a bed waiting for Carey and her colleague, Leigh, to begin their assessment. The patient is about 24 and has heart problems that cause her to have strokes.

“Hi Samantha. How are we doing today?” Carey smiles warmly and crosses over to Samantha’s right hand side while her colleague stands to the left of the bed.

“We’re here to help you. We’re going to be doing some tests today to see how you’re coping. Is that all right?”

Samantha agrees.

Leigh begins the assessment. “We’re going to tell you a story and after we’re done we’ll ask you to recite the story back to us in as much detail as you can. Okay?” A pause. “Samantha is that okay?” Samantha sits upright on the edge of the bed with her hands on her knees. She is looking expectantly at Carey, as if waiting for something to happen. Leigh touches Samantha’s left arm to get her attention, but Samantha continues to look at Carey, unresponsive to Leigh’s touch. As if she weren’t there at all.

“Samantha, did you hear what Leigh just asked? We’re going to do a memory test?”

“Oh. When did she say that?”

“Just now. Didn’t you hear?”

“No, who’s Leigh?”

Leigh crosses over to the right-hand side of the bed and Carey takes a note in the patient file: Left neglect.

“Are you Leigh?”

“Yes. Hi, Samantha. I’m going to tell you story and in a short while I’ll ask you to tell me the same story. Try and remember as much of it as you can.” Leigh opens her file and begins to recite a story about severe floods in Knysna in which residents were relocated due to water damage in their houses. She looks up from her page to see Samantha looking at her intently.

“So tell me the story of the Knysna floods.”

Samantha takes a deep breath and thinks for moment before saying: “A while ago there were floods in Knysna. And it was very bad because all the animals were in danger. But the ostriches were okay because they have long necks.” She is holding up her arm with her wrist bent at a 90-degree angle to demonstrate the ostrich necks. “They didn’t drown because their necks were so long that they could swim above the floods.” She bobs her hand to show the ostriches swimming in the floods.

“That’s very interesting, Samantha. And what about the people?”

“They don’t have long necks, so they couldn’t swim like the ostriches.”

Carey takes another note in the patient file.

Tangential.

---

A man sits on a bed in the hospital waiting for the doctor. His right arm hangs limply from his shoulder while his left rests neatly in his lap.

Carey enters and greets him.

“I hear your arm is giving you some problems, Mr Davids.”

“No, my arm’s fine. Look.” He lifts his left arm and waves.

“Your other arm. Would you mind if I take a look?” The arm is perfectly ordinary in every way, unique only in the way it hangs quite lifelessly at the man’s side. “Could you lift it up for me?”

“No, I’m tired. I don’t want to.”

“You can take a rest after you’ve lifted your arm.”

“There, I just lifted it.” His arm dangles unmovingly at his side. Carey frowns.

Right arm paralysis.

“Mr Davids, your arm didn’t move. Could you try again for me please.”

“No, I already lifted it. You just weren’t looking.”

Anosagnosia.

---

Carey is halfway through an assessment of a patient. They’ve been going for an hour or so, running tests for various areas of functioning: memory, attention, language, movement. She is rounding up to a numeracy task that tests the working memory, a component of functioning that manipulates information into useful pieces. It’s been a long process and the patient is lying in her bed under the hospital linen. She’s been getting more and more frustrated as the assessment progressed, being unable to do several of the tasks and performing badly in many areas of the test. Her eyes are tired and the corners of her mouth pull downwards. She doesn’t understand what’s wrong.

Carey asks her to remember a string of numbers: 2, 7, 3, 6, 9, 1.

“No.” The woman pulls the blanket over her face and squirms down the bed until her entire head and body are covered by the blanket.

Carey looks across the bed at Leigh and then back at the mound under the hospital blanket. “Could we try remember the numbers? We’re almost done.” A hand slowly extends out from under the blanket and waves. First at Carey and then at Leigh. Goodbye.

---

A patient sits on the hospital bed waiting. First language Xhosa. She can’t speak English but Carey needs to run some tests on her to check general functioning. Carey can’t speak any Xhosa and her Afrikaans is sketchy at the best of times. She calls a nursing sister over and asks for help with translation.

“Do you feel pain anywhere?”

The sister turns to the patient. “Zikhona intlungu ozivayo?”

“Emzimbeni?”

“Ewe.”

“Ndingqubekile entloko.”

“Kubuhlungu?”

“Hayi ngoku.”

“Uye wopha na?”

“Andiqondi.”

The sister turns back to face Carey. “No.” Carey felt quite certain that the conversation had been longer than a monosyllabic answer.

“Was there anything else she said?”

“She hit her head.”

Trauma to head.

---

A team of medical interns assemble to begin their ward rounds. Carey and her colleagues are joining them today again. They’ve been only a few times previously. The doctor on duty wears his white lab coat and a stethoscope around his neck. The interns follow him through the ward from bed to bed observing the doctor with his patients.

They come to a middle-aged man lying in bed under the hospital blankets. The doctor pulls out the patient file from behind his bed and says casually, “And this is Mr Killian. He’s been injured and will never be able to work again.” By his tone you may have guessed that he had just told you that grass is green.

The man’s eyes widen and his jaw becomes quite slack. This is the first he’s heard of this news. The doctor snaps the patient’s file closed and without a backward glance leads the interns away from Mr Killian’s bedside, leaving him to ponder his misfortune alone.

---

When I meet with Carey, she is working in the EDU Hum offices at the University of Cape Town. The unit of offices is in an obscure place, tucked behind a corridor that no one ever uses. Only an A4 hand-made poster saying “EDU Hum à” guides the way. I walk right past her door and she calls after me and ushers me into her office, which she shares with one other researcher. She is dressed in a sunny knitted sweater in bright pink and purple stripes. Her face makes her look dispositionally happy, with a seemingly permanent smile and kind eyes. Her hair is tucked behind her ears.

She explains that she first got into neuropsychology by accident. She had initially wanted to be a journalist but realised after a job shadow that it wasn’t a good fit for her. So she began a BA at UCT in a variety of subjects, including psychology.

“My knowledge of psychology was what most lay people’s understanding was. You know, very Freudian, sit on a couch, help people with their problems. But then we got introduced to this biological aspect to psychology and I just thought this was fantastic.” This biological focus of psychology was her first glimpse at neuropsychology. Her second year at UCT was the first time that a neuropsychology course was offered, and she took up the opportunity gratefully, being mostly uninterested in the other fields on offer, such as Health Psychology or Critical Psychology.

“So they introduced these two new courses and I took them. And I fell in love with everything about it. I thought it was so interesting that injuries to different parts of the brain caused the development of these very odd behaviours and presentations.”

She then continued her studies with an Honours in Psychology and a Masters in Research Psychology. Until 2013, there was no official Masters in Neuropsychology, so students interested in neuropsychology were being taught neuropsychology coursework and practical instruction under the research umbrella. Most students completing a research degree would simply do research training and then complete a thesis in order to attain their degree. However, for the last decade, since the course was first offered, neuropsychology students were required to write a thesis along with neuropsychology coursework, practicals and internships. This has now changed. At UCT, the only university in South Africa that currently offers the qualification, students can now receive a Masters in Neuropsychology.

To practice as a clinical psychologist, a Masters in Psychology is required, followed by a year-long paid internship and a year of paid community service working as a psychologist. After those requirements are completed, a Board exam is necessary to register with the Health Professions Council of South Africa as a psychologist. The HPCSA is the only board in South Africa that a psychologist can register with, and is a legal requirement for all practising clinicians. Once registered, therapists are free to join the staff at clinics, hospitals, other practices or open their own private practice.

Neuropsychologists, however, face several difficulties with the HPCSA. There are currently only five categories available for registration: Clinical, Counselling, Educational, Industrial, and Research. Neuropsychologists cannot register with the board, which means that they are not legally allowed to practise or charge fees for their services.

After graduating in 2007, Carey faced a dilemma. “We couldn’t do anything with that degree. We weren’t qualified to do anything. So what I did is I started my PhD so that I could see patients.” For some time, Carey worked as an “intern” neuropsychologist, despite being fully qualified, and in some cases more qualified than the people she was interning for. She worked at Groote Schuur Hospital and at the Red Cross Childrens’ Hospital for paediatric patients. She worked a 40-hour week and was never paid for any of the assessments or treatments that she gave to patients. Contrastingly, a clinical psychologist would probably be paid around R15 000 a month for their internships. In order to earn money, Carey acquired a number of freelance jobs. She worked as a secretary, a research assistant, a guest lecturer, a tutor, a writing centre consultant, and even an Avon lady, a job for which she is fairly over-qualified. “It’s been quite stressful.” She adjusts her purple spectacles.

“We were told that at some point we would be able to be ‘grandfathered’ in as neuropsychologists.” Grandfathering, she explains, would be the acceptance of people with unofficial training (because they were trained before the programme was officially accredited) into the neuropsychology registry, provided they had enough experience. It was assumed that once the registration opened for the neuropsychologist category, all the people who studied neuropsychology under the research umbrella would be allowed to register as long as they had completed a certain number of hours of practical internships and had seen a certain number of patients. The situation has not developed as simply as Carey had hoped.

“We were told if you see 50 patients and you have training in rehab and some training in paediatrics you would be grandfatherable. But no one actually knows what the requirements are going to be, so they might turn around and say you have to have seen 200 patients. In which case none of us are going to meet the criteria.” Carey’s smile is nowhere to be seen, and it’s clear why. After studying for more than nine years in the field, she still cannot be financially compensated for any work done in the area she trained in. While usually a positive person, she seems understandably bitter. “We were made promises that haven’t been followed through on. Not because no one wanted to follow through on them, it’s just that it hasn’t happened. I mean I could’ve done a teaching degree and had a stable 12-month salary.”

The promises she speaks of have been made by people like Mark Solms, people working tirelessly to get neuropsychology recognised here in South Africa. His efforts have extended for over a decade, and the field is still not recognised.

All of the students who have studied neuropsychology are facing the same problem as Carey. Many of them earn a living by taking short contract work as research assistants and research fellows. “It’s very difficult, if you’re not being funded by your parents, to kind of make enough money. And there are a lot of people who are in this position, whose work is part time or on a very short contract. And at the end of the year, or at the end of every second year, they don’t know where they’re going to be.”

---

It’s 6 am and Carey is pulling out of her driveway in Marina de Gama, more than 20 kilometres from the UCT campus. First on her agenda today is the chemical engineering thesis waiting for her to review at the writing centre. Next is a guest lecturing slot for a psychology lecturer on sabbatical, and then some curriculum advising to students. When that’s all done she’ll go over to her office in the HUM Edu Unit to help the research team there and if there’s time she might do some work on her PhD thesis, which is about how stress affects our mental functioning.

She’s not involved in neuropsychology practice at all, because she needs to make a living. “I started a PhD to see patients. Now I’m not seeing patients any more because I can’t afford to spend that many hours a week doing something for free because I need work to earn money.”

She would love to work as a neuropsychologist in the future, but doubts she will be able to. In the absence of neuropsychology professionals entering the workplace, other medical personnel have taken over much of their work. People with damage to the area of the brain that affect speech would go to a speech pathologist, people with motor damage would go to a physiotherapist. People might see a neurosurgeon, a psychiatrist, an occupational therapist. And until now, despite the burden of brain disease in South Africa, the medical staff seem to be surviving without the neuropsychology specialists.

“That is one of the problems. Even if we get grandfathered in, there’s going to be…what? Around 100 of us? Looking for jobs and people aren’t going to…you know who’s going to hire? Because they’ve gone for however many years without neuropsychologists so why now do they suddenly pay someone to do what all these other professionals have been doing?”

But are these people qualified to give neuropsychological treatment? Carey rolls her eyes and shrugs her shoulders. “They would say yes; we would say no.”

Internationally, the neuropsychology category has been developing and in many places across the world neuropsychologists are able to register and practise. In the UK, neuropsychology has been a category since the early 1980s. Unfortunately, because South Africa doesn’t recognise neuropsychology as a category, people who train in the country are unable to register internationally either.

Carey salutes Solms in his efforts with the HPCSA, in trying to make neuropsychology a registerable category, so that people like her can practise. But she feels like the situation was handled badly, and for her at least, some of his efforts have happened too late. “For some of us there’s a tension between being very upset, disappointed, and, you know, we’ve tried to make other arrangements. But we don’t want to burn bridges because if it all does come through, we want to be able to register. But at the same time we feel like we’ve been made false promises. And you want to be very careful about who you show disappointment and dissatisfaction to.”

Even if she can’t practise as a neuropsychologist, and despite the bitterness she may feel, she does not regret her decision to study in the field. “That’s the part of psychology that I’m interested and I think that it’s a very relevant part of psychology. I think that neuropsychology is a fantastic area. It has so much to offer so many people.”

Fighting the Fuckers

Dr Mark Solms, I am told, is the face of neuropsychology South Africa. This initially intimidates me, until I see a picture of him and realise that we’ve met before. He is the Head of the Psychology Department at UCT and three years ago, upon my return from a university in Perth, engaged me in a lengthy conversation while signing my transfer forms about all the reasons why Perth is a “shit hole”. Having not enjoyed my time in Perth, I took an instant liking to him. It was therefore without much trepidation that I sent him an email to set-up an interview.

We meet in his office in the newly built Psychology Block at UCT. The department previously occupied one floor of the Humanities Building, which is near many of the other Humanities buildings and departments on UCT’s upper campus. Due to the great number of students who take psychology, and the large staff and research body, the department now populates an entire building on the other side of campus. The new building is beside the Chemistry, Zoology and Biology buildings, on the “science” side of campus. Also situated in the block is the Ascent Sleep Lab, which is famous across South Africa for its use in neuropsychological research in sleep behaviour.

The block is decorated with several large geometric art pieces. Some have strange optical illusion qualities, which I assume is linked to cognitive psychology. One piece is a series of framed illustrations of the brain. Another is a portrait of Sigmund Freud. But the feature piece is an enormous colourful mobile made of circular cogs which hangs from the ceiling on the third floor and reaches down the wall all the way to the ground floor. This, I can only assume, is either a rather concealed metaphor for the “cogs” in people heads (a common icon of psychology is a silhouette of a head with cogs inside), or it is simply there to add some colour to an otherwise cold and clinical building.

When I first walk into Solms’s office both he and his assistant are staring at the computer in the corner of the room. Neither turn around to greet me for several seconds which gives me a chance to take in the details of the office. Most things about it are normal; bookshelves, a desk with a computer, framed pictures of South African art, a small round coffee table with a protea in a vase. Quite unusual, though, is the bed against the right-hand wall. It’s dressed with crocheted blankets in bright colours. Above the bed is a framed Government Notice from 2011 that outlines the scope of practice of a neuropsychologist.

Eventually the assistant realises they’re not alone any more and offers me a seat saying, “You must be Laurie.” I’ve been told Solms’s assistant is “ever present” and this certainly seems the case. Both she and Solms pull a chair up around the coffee table in the centre of the room to begin the interview.

Solms is a well-known figure in South African psychology circles. He was head- hunted by UCT in 2001 to start the first neuropsychology training programme in South Africa. This was around the time that the Health Professions Council first began the discussion around introducing neuropsychology as a registerable category for psychologists in the country. He is also known for being at the forefront of the fight for neuropsychology to be made into a category with the HPCSA, a fight that has lasted for well over a decade.

“I’ve been engaged with a long, complicated process of initially trying to persuade them that we need a new professional category called neuropsychology. Having succeeded in persuading them of that over many years of effort, I’ve been involved in an on-going process of trying to get them to implement the category, the new professional category that they created.” He has white hair which stands centimetres from his head, giving him a definite mad scientist edge. “It’s been difficult to actually get them to put into action everything that was agreed in law.”

He leans back against his swivel computer chair with his arms crossed over his chest, which is emblazoned with the words SOLMS DELTA Ψ (the Greek letter “psi”, commonly used to represented psychology) printed on a white t-shirt. Solms Delta is the Solms family wine farm in Franschhoek, about an hour out of Cape Town. The area is well known for its vineyards, being part of the famous Cape Winelands. When Solms left South Africa in the 1980s, the farm workers ran the vineyards in his absence for almost two decades. Upon his return to the country, he gave a third of the farm’s estate to the workers. They are now shareholders in the farm’s estate, making them partial owners.

Since 2001, the HPCSA has drawn up legislation for the neuropsychologist category, which outlines their scope of practice and the category was eventually created in 2011, which is the framed government notice hanging on Solms’s right-hand wall. The UCT neuropsychology programme was accredited in 2012 by the HPCSA, which means that all UCT graduates of the Masters in Neuropsychology should be able to register. However, the registry still has not opened. With these students reaching the completion of their programme at the end of this year, the situation has become tense.

“Things have reached this point, it’s a make or break point. These students have gone through an accredited programme. The programme was accredited by them. The outcome of that, if you fulfil all the criteria, is that you should be registered. That’s understood by them and by us. Indeed they are obliged to register those of us who meet the criteria.” Solms is hopeful that his students will be registered at the end of the year. The HPCSA assures Solms that the registry will open, and that first on the register will be his students and the staff who trained those students. Emergency legislation is currently being promulgated to ensure this.

Solms explains part of the reason why the process has taken so long. “It’s never easy to get people to make legislation anywhere in the world, let alone in South Africa, but the reason why it was particularly difficult is because there was strong opposition from the clinical psychologists who saw it as a loss of territory. Very unfortunately. And more or less at the time that the new legislation was promulgated in September of 2009, a new professional board for psychology was appointed with significant attrition, in terms of the major drivers of the legislation, that got it into the government gazette, were rotated off the board. And among those new people who joined the board were people who, I think, their whole reason for putting themselves up for selection for the board was that they wanted to scapper the neuropsychology legislation. So they then made a concerted campaign from within the board to undo the legislation.”

Because of the opposition created by the clinical psychologists on the new board, Solms sought advice from the senior council who have expertise in constitutional law. The opinion of the senior council was then sent to the Minister before they were able to stop the new board from shutting down all the legislation that had taken a decade to draw-up and gain approval for.

The clinical psychologists, according to Solms, had established a trade-union-type movement to prevent the board from introducing the neuropsychology category. There seem to be several reasons for this, much of which has to do with money.

“In the absence of there being a category, the patients who need neuropsychological assessment go to clinical psychologist.” He continues: “It’s very lucrative for them. They make fortunes of money out of these patients. Not least from medico-legal cases where you’re allowed to charge double fees…it must be something like R2 000 an hour they make out of neuropsychological cases. Of which there are a great many. So if a new category is promulgated that requires you to have competencies to demonstrate your training in neuropsychology and you’re a clinical psychologist and you haven’t had such training, you’ll no longer be able to assess those patients. It’s as simple as that.”

His outrage at the clinical psychologists is evident throughout the interview. This is not the first time that they have put up a fight against the creation of a new category. Some years ago, two new categories were introduced into the HPCSA registry: Counselling Psychologist and Registered Counsellor. These two categories were each opposed by clinical psychologists because the scope of practice for a counselling psychologist encroached on the clinical psychologist’s work. The Registered Counsellor category was created for people who have an Honours in Psychology and thus less training than psychologists, but still work in the psychology field, giving short-term counselling for up to 12-weeks. Because they have less training, their fees are less, which threatened the clinical psychologists, as clients might rather see a counsellor for a reduced rate. This, however, does not exempt clinical psychologists from their opposition to health care efforts, says Solms. “I personally find it reprehensible that the clinical psychologists are looking after their own interests regardless of the needs of the population, I mean it’s really an untenable, indefensible position to say ‘We believe that we, who have no training in this field, should be the only ones allow to practise it. And we want to prevent people from getting proper training in this field so they can properly practise it.’ It’s a reprehensible position.”

These are professionals in the business of caring for people’s health, and instead they are looking after their own interests above the needs of the sick population. “The professional board is not there to look after the profession; it’s there to look after the public. So they are there to protect the public against the profession. And so the fact that they were infiltrated by members of the clinical psychology profession or allowed themselves to be lobbied in the way that they did, is…I think it’s just outrageous.

“This professional board, as part of the whole health professions counsel is constitutionally mandated to protect the public in relation to health profession matters. And they have failed dismally in their constitutional obligations. Dismally!”

Soles explains that while he had considered suing the board because of undue delays in creating the category of neuropsychologist and not opening the registry to allow people to register, he decided against it because the board has convinced him in their intention to bring about change. He says that the legislation exists and is currently being translated into all 11 official languages, before being signed by the Minister for approval.

In addition to the reasons already cited, the time for legislation to be signed is eagerly anticipated for members of the neuropsychology field for legal reasons. Since September 2011, when the Government Gazette published the scope of practice for a neuropsychologist, only people registered to practise neuropsychology with the HPCSA are legally allowed to perform those tasks. But since the registry has never been opened, there is no one who is allowed to practise, including the clinical psychologists who are currently practising as neuropsychologists. “That means the public is not allowed to receive neuropsychological treatment in law. Now, of course, the only ethical way to proceed in that case is to break the law. And that’s what we’ve all had to do.”

I think back to Carey Bauer. She is currently sitting on the other side of campus performing research into education that can bridge the gap between high school and tertiary education for under-privileged students instead of practising in the field she actually has training in. She stares at a computer screen and pounds a keyboard, her purple spectacles perched on her nose.

I ask about employment. Although it will be an enormous victory at the end of this year when the UCT graduates of the 2014 neuropsychology course are registered, all the people who were trained over the last decade will also need to register. There will then be a swarm of neuropsychologists entering into the field for the first time, looking for work. Will all of them be able to find jobs?

“Well, it depends what you mean by jobs,” is the response I receive. While there won’t be many jobs in hospitals, there will be jobs at universities who open neuropsychology training programmes for people to lecture and develop the curriculum. There will also be opportunities in private practice, since there is a huge burden of brain disease in South Africa. This brain disease, Solms explains, is due to three factors. Firstly, South Africa has an aging population, and the brain, just like any other organ, deteriorates with age. Secondly, South Africa has very high rates of head trauma, due to road accidents and violence-related injury. These traumas require neuropsychological assessment. Finally, South Africa has increased rates of cardiovascular disease which in turn leads to cerebrovascular disease. Because cerebrovascular disease affects the blood supply to the brain, this can lead to strokes and other brain injuries which require neuropsychological attention.

After many years of fighting with the HPCSA, and with the end in sight, Solms does not regret any of the late nights, stressful days, fights with lawyers and colleagues, friends lost and enemies made. He chose to fight this battle from the start for many reasons.

He wanted to make South Africa a better place by investing his skills into the country, and he was also expressly employed by UCT to fight the neuropsychology cause. But there was a third reason. “It’s an ethical reason. I think it’s just downright wrong. To see that the profession, for which there was so obviously a dire need, was not put into place mainly because of opposition who were looking after their own vested interests in a way that was really and truly to the detriment of the public. It’s a moral obligation to fight fuckers like that.”

His enthusiasm for the field is just never-ending, and you can tell that he is completely convinced of the worth of neuropsychology. “It’s the most fascinating thing. If you think about it, all that you are is your mind. You can stay alive in your brain-dead state but you wouldn’t be here. So really everything that you are, that you experience, everything that you remember, everything that you love, everything that matters to you, it’s because of your brain. What could be more important than that?”