Tuesday, 16 February 2010

The role of doctors and medicine

Well, what do you think?

Yesterday Conductive World linked to Sue Reilly's long and illmating feature in last Saturday's issue of The Australian:

I do not myself altogether agree with Sue's line of thinking. I wrote –

I'm sure that someone out there will wish to correct me on this.

Norman Perrin pitched in with a comment, which gave opportunity for me to elaborate a little further on my own position that motor disorders are psycho-social phenomena:

The issue here is that it it is not medicine that will have primacy in healing the social-psychological ills.

There is still plenty left to argue over here. Today Sue O'Reilly writes –

Yes, Andrew you’re right – someone out there will wish to correct you on this post, and it’s me.

If I could just go through, line by line, what you have written: I don’t regard the discussion to be seated legitimately with medicine either. And I totally agree that cerebral palsy is a developmental disorder. BUT:  the fact that the developmental disorder springs from a biological cause – i.e damage to the brain in infancy or early childhood - has completely opened the door to the medical profession to muscle in and claim ownership of CP and its management as primarily a medical issue. Of course it is not – but unfortunately it is doctors who first diagnose CP; not teachers, not psychologists, not even parents usually – not anyone except doctors. Medicine still has virtually nothing to offer, of course, apart from the sort of lecture my husband and I got from a paediatric neurologist in 1990, similar to that which Norman experienced: “You need to understand that there’s nothing you can do about your son’s brain damage, and that there’s no point wasting your time trying. So my advice to you would be just take him home, focus on your other two healthy children and get on with your lives”.

Complete and total pernicious, evil rubbish of course, which fortunately my husband and I completely and totally ignored, but the discussion still remains seated within medicine, however illegitimately, because - a bit like the Chinese in Tibet - the occupying medical forces rolled in a long time ago, and they ain’t about to leave any time soon.

Those of us who try to challenge the medicalisation of CP often remind me of that little guy with the plastic bags in Tiananmen Square, standing alone in front of a squad of huge tanks.

Realising that any direct frontal attack would be futile (as in no newspaper would ever publish it), I therefore decided to go for a more subtle form of subversion, by pointing out that for 400 YEARS, the medical profession has been wrong wrong wrong in asserting that brain structure is fixed and unalterable – and no one can challenge that statement, because it’s not little ol' me saying it. It’s now doctors themselves who are saying so. And, if they were so wrong for so long, well....

 If medicine can contribute to prevention or cure of CP at the biological level, then I’m all for it too. And it is now the case that medicine can prevent the development of CP, at least in a few instances. “Cure”, of course, is a pipedream, at least this side of the 22nd century, as the stem cell expert I interviewed for my article made crystal clear. But raising funds for medical research calls for marketing and PR skills – pretty much like everything else really – and “cure”, let’s face it, is an undeniably enticing word. And I was rather hoping that might have been picked up to, reading between the lines...

The sentence quoted about fundamental brain structure changing with every activity the brain performs comes from Norman Doidge’s (highly, fantastically subversive) book, The Brain That Changes Itself. All through the book, Doidge argues that it is teaching, learning and upbringing that spark the most significant, constructive changes in brain structure; he uses the word “learn” over and over. And although he does not use the word “pedagogy”, his book is at heart all about exploring the best, most effective forms of teaching and teaching methods.

Another (hopefully not too obscurely subversive) aspect of the article I wrote was this: IF doctors now universally acknowledge brain plasticity, which they do, then it follows that at some stage, it has too dawn on even the most reactionary of them that early, relatively intensive and ongoing rehab-type intervention is warranted for even the  most severely brain-damaged. In other words, it is the fact of plasticity which made those neurologist’s words to my husband and me such total and absolute garbage. And what sort of intervention is best – passive medical-model therapy, or active, educational-model learning?

 According to Doidge’s book, it is incontrovertibly the latter. Which, coming from someone from a very conventional medical background would have to be described, I think, as “progress of a kind”, as Christopher Hitchens would say.

Pedagogic nihilism, in my view, springs directly from neurological nihilism. Eliminate the latter – and who knows where things might end?


Someone else's turn now...


  1. Like the fish that got away, the Comment I post which somehow seems to have got lost was the best Comment I've ever posted.

    Believe that and you'll belief the medicos when the talk pedagogy!

    I agree with Andrew on the theoretical position - and what to see the argument pressed again and again; I agree with Sue on the pragmatics of it: work with those who will work with you, push the rocks that roll, "progress of a kind".

    However, I would want to spin a little Sue's "Pedagogic nihilism, in my view, springs directly from neurological nihilism.Eliminate the latter – and who knows where things might end?"

    "Pedagogic nihilism leans heavily upon neurological nihilism because mainstream educators will not address pedagogy. Kick away the prop and they might have to start thinking for themselves - and who knows where things might end?"

  2. See what Norman had hoped to publish at


    Yes, it was far too good to waste!