Thinking, fast and slow

I've found a wonderful recent book by Nobel-prize winner and experimental psychologist Daniel Kahneman which summarises his work on cognitive biases, judgement, heuristics, and basically how we come to conclusions. You can see the Amazon listing here.

I ripped through the first three chapters on the plane from Melbourne to Launceston last night, and was excited to think that my nerdy interest in these things is shared by enough people to have made this book a best-seller. There's a summary of the book at this wikipedia site.

The thing that's new to me - even though I've read lots of articles on decision-making in neuropsychology and psychology by Paul Meehl, David Faust, and Howard Garb - is the division of thinking styles into System 1 and System 2. System 1 is the more automatic, intuitive, rapid, frequent, and stereotypic style of thinking that relies on our memories, knowledge, and, I imagine, procedural knowledge to form decisions about the world. System 2 is more slow and effortful, requires more mental effort, and is used for tasks that require logic and calculations. Not surprisingly, people tend to naturally use System 1 more easily than System 2, as System 2 is a whole lot more work. In my reading before this, System 1 was the area of clinical judgements and intuition, and System 2 was characterised by the much-maligned actuarial mode of analysing data.

The idea of these systems explains to me why there has been so much resistance by clinicians to research that says we will be more accurate diagnosticians if we rely on Bayesian analyses and prior probabilities than if we rely on our clinical intuitions, which are based on error-prone stereotypes, heuristics, and pattern recognition. That is, the work of Meehl, Faust, and Garb was strongly resisted by clinicians in the early days because it says we need to activate the energy-draining System 2 more often.

While the resistance has weakened, I still hear people argue that their clinical judgement is pretty darned good, and that the client is lost in focussing on the test data in a sophisticated psychometric way. I've always thought we need to use both clinical (intuitive) judgement and actuarial knowledge in making decisions - to say we should only be clinicians or psychometricians is throwing out the baby with the bathwater. Kahneman agrees that System 1 is excellent at some things, but his book demonstrates that learning about decision errors can help us to engage System 2 to overcome these errors that System 1 evokes - illustrated with examples from optical illusions, making financial choices, and probabilistic thinking. 

If you'd like to know the things you don't know, if knowing how to reduce your cognitive errors and biases so that you can be a better objective scientist-practitioner, if you want to be the best neuropsychologist you can be, then this book is definitely worth it. And its best-seller status means that it might just give us a link to people who are as mystified by the brain as I am by economics and business - see a review of the book by an economist here.

Imagining the future: Neuropsychology 3.0

I found this amazing article in my office the other day - and had the time to read it on the plane. It maps out some potential directions for neuropsychology, and give links to some resources that will probably consume many happy hours of our time.

You can see the free full-text article here.
- or paste this into your browser if the link above doesn't work: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3044645/

The net is giving us unprecedented ability to share and develop resources - this could see us develop national norms for neuropsychological data, and help us to improve our practices and knowledge more rapidly than before.

An article worth reading a few times. Thanks, Bob Bilder!

Practice resources: Neuropsychology in primary care

I'm delighted to share this article with everyone - it's a nice, clear description of how neuropsychologists can help in a primary care setting, but it's so good, I'm going to make it available on my open-access neuropsychology directory at my hospital. It has some practical suggestions about what we can do, and some nice algorithms for capacity assessments, TBI, and other conditions.
Excellent reading, and a useful resource :)

Neuroethics

The articles in the latest edition of this journal look fascinating!

I wish there was enough time to read everything I wanted to...

Follow this link to the editorial, titled The Ethics of Neuroeducation: Research, Practice and Policy  

Transcripts of Inquiry into Dementia: Early Detection and Interventions

You may be interested in reading the transcripts of the three hearings held so far in the Parliamentary Inquiry into Dementia: Early Diagnosis and Intervention.

http://www.aph.gov.au/Parliamentary_Business/Committees/House_of_Representatives_Committees?url=haa/dementia/hearings.htm

A quick search of the Adelaide hearing returned no matches for the search term "neuropsychol", the Sydney hearing mentioned it once, but we were very well-represented by David Stokes at the Melbourne hearing, with his APS colleagues Leah Collins and Li Bo making some good points (see page 17 of the Melbourne transcript). 

The final part of the transcript, with Dr Jenny Torr, an psychiatrist who specialises in intellectual disability, shows an area of need for neuropsychological services, and concerns about people with brain damage and intellectual disability falling through the cracks in the system.

It's so frustrating that we don't have more neuropsychology courses in this country, and that it's so hard to access our services for many of the people who need us. In the US, there has been a massive increase in the proportion of medicolegal work done by neuropsychologists, and in Australia, the best-paid neuropsychologists in private practice do medicolegal or insurance work. This kind of work would rarely result in the early detection of dementia. People with progressive neurological conditions often miss out on early diagnosis and intervention, unless they're lucky enough to be able to access a neuropsychologist in the public system, or afford a private assessment. 

I'm hopeful that raising awareness of the role of neuropsychology in early diagnosis of dementia will help bring about improvements in access to neuropsychologists by people in need, and in scholarships and increased support for training of neuropsychologists.

Thanks to David Stokes and the APS team for advocating for the role of neuropsychologists in early diagnosis.

happy reading!